ABSTRACT. We have compared the roles of neurologic maturity and environmental time cues in the development of the entrained circadian sleep-wake rhythm in the preterm and term human infant. The preterm infants (n = 19) spent some time after birth in a hospital nursery with no environmental time cues, whereas the term infants (n = 22) were exposed from birth to a cyclical light and dark environment with one major caregiver. The circadian sleepwake rhythm in the preterm infants entrained after a similar time of exposure to an environment with daily time cues but at an earlier postconceptional age when compared with the term group. We conclude, therefore, that it is the length of exposure to environmental time cues, rather than neurologic maturity, that determines the entrainment of the circadian rhythm of sleep and wakefulness in the human infant. (Pediarr Res 29: 381-384, 1991) The daily sleep-wake cycle in the adult is a circadian rhythm, i.e. it is a behavioral rhythm that is generated by an endogenous biologic clock and in the absence of external time cues it "freeruns" with a periodicity of approximately 25 h (1). Normally, however, the circadian sleep-wake pattern is entrained or synchronized to an exact 24-h period by external time cues that are known as zeitgebers. It has been proposed that the light-dark cycle and also social cues act as zeitgebers on the endogenous circadian pacemaker to synchronize the human sleep-wake cycle to a 24-h period ( 1 ).Although there is extensive literature that documents that sleep is consolidated toward the night by the 6th to 14th wk of life (2-6), there have been few attempts to define the factors that determine the timing of entrainment of the infant's circadian sleep-wake rhythm to the day-night cycle. It has been widely accepted that the emergence of an entrained circadian sleepwake pattern in the human infant is predominantly the result of maturation of the CNS (2-6). This is supported by the demonstration using spectral analysis that sleep-wake activity has a more prominent 24-h component in term infants when compared with preterm infants at the same postnatal age (7-13 wk),-.It may be misleading, however, to compare the development of circadian sleep-wake rhythms in pre-and full-term infants without taking into account the differences in the range of zeitgebers that these infants are exposed to after birth. A fullterm infant born at home or in hospital, where "rooming-in" with the mother is the normal practice, is exposed to a cyclical light-dark environment and the circadian behavioral and social patterns of a single caregiver. In contrast, the preterm infant will spend some time after birth in a hospital neonatal nursery where there is constant illumination and where there are several different caregivers in any 24-h period (8). Any difference between term and preterm infants in the timing of the development of an entrained circadian sleep-wake pattern may therefore not only be due to differences in maturity but also to exposure to a different range of zeitgeb...

Background: Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care facilities with respect to their effects on behavior, cognition, functional status and quality of life is lacking. Results: Our literature search resulted in 32 studies published until October 2012. Overall, patients with dementia who lived at special care units (SCUs) showed a significantly more challenging behavior, more agitation/aggression, more depression and anxiety, more cases of global cognitive impairment and a better psychosocial functioning. There was a tendency towards a better functional status in specialized care facilities, and a better quality of life was found in favor of the SCU group compared to the traditional nursing home (n-SCU) group. Longitudinal studies showed an increased number of neuropsychiatric cases, more patients displaying deteriorating behavior and resistance to care as well as less decline in activities of daily living (ADL) in the SCU group compared to the n-SCU group. Patients in small-scale, homelike SCUs showed more agitation and less ADL decline compared to SCU patients. Conclusion: This review shows that the patient characteristics in SCU and n-SCU settings and, to a minor extent, in SCU and small-scale, homelike SCU settings are different. Over time, there are differences between n-SCU, SCU and small-scale, homelike SCU facilities for some variables.

BackgroundQuality of life is a clinical highly relevant outcome for residents with dementia. The question arises whether small scaled homelike facilities are associated with better quality of life than regular larger scale nursing homes do.MethodsA sample of 145 residents living in a large scale care facility were followed over 8 months. Half of the sample (N = 77) subsequently moved to a small scaled facility. Quality of life aspects were measured with the QUALIDEM and GIP before and after relocation.ResultsWe found a significant Group x Time interaction on measures of anxiety meaning that residents who moved to small scale units became less anxious than residents who stayed on the regular care large-scale units. No significant differences were found on other aspects of quality of life.ConclusionsThis study demonstrates that residents who move from a large scale facility to a small scale environment can improve an aspect of quality of life by showing a reduction in anxiety.Trial registrationCurrent Controlled Trials ISRCTN11151241. registration date: 21–06-2017. Retrospectively registered.

BackgroundEvidence shows that living in small scale homelike Special Care Units (SCU) has positive effects on behavioural and psychological symptoms of patients with dementia. Effects on cognitive functioning in relation to care facilities, however, are scarcely investigated. The purpose of this study is to gain more insight into the effects of living in small scale homelike Special Care Units, compared to regular SCU’s, on the course of cognitive functioning in dementia.MethodsA group of 67 patients with dementia who moved from a regular SCU to a small scale homelike SCU and a group of 48 patients with dementia who stayed in a regular SCU participated in the study. Cognitive and behavioural functioning was assessed by means of a neuropsychological test battery and observation scales one month before (baseline), as well as 3 (post) and 6 months (follow-up) after relocation.ResultsComparing the post and follow-up measurement with the baseline measurement, no significant differences on separate measures of cognitive functioning between both groups were found. Additional analyses, however, on ‘domain clusters’ revealed that global cognitive functioning of the small scale homelike SCU group showed significantly less cognitive decline three months after the transfer (p < 0.05).Effect sizes (95 % CI) show a tendency for better aspects of cognition in favour of the homelike small scaled SCU group, i.e., visual memory, picture recognition, cognitive decline as observed by representatives and the clustered domains episodic memory and global cognitive functioning.ConclusionsWhile there is no significant longitudinal effect on the progression of cognitive decline comparing small scaled homelike SCU’s with regular SCU’s for patients with dementia, analyses on the domain clusters and effect sizes cautiously suggest differences in favour of the small scaled homelike SCU for different aspects of cognition.

BackgroundAn enriched environment for residents with dementia may have a positive effect on the rest-activity rhythm. A small scaled homelike special care unit might be such an enriched environment. The present study shows whether the rest-activity rhythm of residents with moderate to severe dementia responds positively to a transfer from a regular Special Care Unit (SCU) to a small scaled homelike SCU.MethodsInitially, a group of 145 residents living in a regular SCU participated. Out of this group, 77 residents moved to a small scaled homelike SCU. This group was compared to the group of 68 residents that remained at the regular SCU. Rest-activity rhythm was assessed by means of actigraphy and observation scales before and after relocation.ResultsNo significant main effects nor significant interaction effects in intradaily and interdaily activity were found for the data of 38 residents in the small scaled homelike SCU and 20 residents of the regular SCU. The effect sizes, however, ranged from small to large.ConclusionsConsidering the effect sizes, a new study with a larger number of participants is necessary before firm conclusions can be drawn.Trial registrationCurrent Controlled Trials ISRCTN11151241. registration date: 21–06-2017. Retrospectively registered.

No abstract

Objectives: Over the past decade, a trend has been noticed in the Netherlands to replace largescaled special care units (SCUs) caring for 20-30 residents with dementia by small-scaled SCUs caring for up to 8 residents. Systematic evaluations, however, have yielded a differentiated picture of the effects. As the impact on psychotropic drug use has hardly been addressed thus far, we examined the (potential) impact of psychotropic drug use when moving residents with dementia from large-scaled to small-scaled SCUs. Methods: We conducted a non-randomized, controlled study with a six-month follow-up. Among 145 residents with dementia living a large-scaled SCUs for dementia caring for 20-30 residents per unit, a total of 77 residents were moved to small-scaled SCUs caring for up to 8 residents per unit. Psychotropic drug use, classified according to the Anatomical Therapeutic Chemical Classification (ATC) system was monitored at 2 months before replacement, as well as at 3 and 6 months thereafter. Repeated measures ANOVAs were conducted for the mean Defined Daily Doses (DDDs) of both groups. Results: No significant differences between both groups in psychotropic medication use were found over a period of 8 months. Conclusion: Prescription of psychotropic drugs does not change after a transfer from a largescaled SCU to a small-scaled SCU of patients with moderate to severe dementia. Current Controlled Trials: ISRCTN11151241.

Geen samenvatting