Co-sleeping Research Articles

Increased Sleep Latency and Decreased Sleep Duration are Associated With Elevated Risk of Bed Sharing Among Mother-Infant Dyads.

Bed sharing increases risk of sleep-related infant deaths. We hypothesized that infant sleep difficulties increase bed sharing, independent of social determinants of health (SDOH). In total, 191 mother-infant dyads in a prospective, longitudinal cohort study completed the Brief Infant Sleep Questionnaire at 1, 4, 6, and 12 months. Sleep characteristics at 1 month (latency, duration, night awakenings) were compared between dyads with/without bed sharing in the first 12 months. Infants who participated in bed sharing slept fewer hours at night (7.1 ± 1.7 hours vs 8.3 ± 1.5 hours, P = .001, d = -0.79), and took longer to fall asleep (0.7 ± 0.6 hours vs 0.5 ± 0.5 hours, P = .021, d = 0.43), even when controlling for SDOH variables that influence bed sharing. Maternal perception of sleep problems did not differ between groups (P = .12). Our findings suggest that infants with quantifiable sleep difficulties at 1 month are more likely to bed share.

Trends in Supply of Nursing Home Beds, 2011-2019

Nursing homes play a vital role in providing postacute and long-term care for individuals whose needs cannot be met in the home or community. Whether the supply of nursing home beds and, specifically, the supply of high-quality beds has kept pace with the growth of the older adult population is unknown. To describe changes in the supply of population-adjusted nursing home beds from 2011 to 2019. This cross-sectional study examines changes in the population-adjusted supply of nursing home beds across all US counties from 2011 to 2019 and describes county and nursing home characteristics where the supply of nursing home beds has increased vs decreased. Number of nursing home beds adjusted per 10 000 adults aged 65 years and older. The population-adjusted supply of nursing home beds declined from 2011 to 2019 for 86.4% of US counties, by a mean (SD) of 129.9 (123.8) beds per 10 000 adults aged 65 years or older per county from a baseline mean (SD) of 552.5 (274.4) beds per 10 000 adults aged 65 years or older per county in 2011. The share of beds that were high quality (4- or 5-star ratings) also declined, which was driven by a small number of counties where nursing home bed supply increased due to a proliferation of lower-quality beds. Simultaneously, metropolitan counties with declining numbers of nursing home beds also experienced declining number of senior housing residential beds (-11.3 [54.6] beds per 10 000 adults aged 65 years or older per county from a baseline mean [SD] of 354.8 [222.3]). The findings of this cross-sectional study suggest that the supply of nursing home beds, specifically high-quality nursing home beds, and senior residential housing beds have not kept pace with the demographics of an aging population. Understanding the supply of high-quality nursing home beds and associated geographic variation can inform targeted policies to best support older adults requiring nursing home care.

ОЦЕНКА ГОТОВНОСТИ СТАЦИОНАРОВ К РАБОТЕ В УСЛОВИЯХ ЧРЕЗВЫЧАЙНЫХ СИТУАЦИЙ

Significance. The COVID-19 pandemic has led to a crisis in society and seriously challenged healthcare capabilities around the world. The industry's lack of preparedness for such a large-scale and rapid spread of the virus around the world was one of the major factors in the fight against the pandemic faced by medical organizations and health services around the world. During the pandemic, the Russian Federation (hereinafter referred to as the RF) has radically restructured activities of medical organizations, re-equipped them with modern medical equipment, and intensively developed digitalization, making it possible to prevent the collapse of the industry and ultimately successfully cope with the pandemic. Analysis of the results and consequences of the restructuring the entire industry, medical organizations providing medical care of various types and in different conditions, allows us to assess emergency preparedness of hospitals and develop recommendations for the future. The purpose of the study was to assess hospital emergency preparedness in the Russian Federation based on the analysis of dynamics in bed capacity, structure of beds and utilization indicators in 2019-2022. Material and methods: comparative analysis of the number of beds, its structure and utilization indicators in the pre-COVID period, the pandemic period and the early post-COVID period based on the federal statistical observation form No. 30 “Information about medical organization” in the Russian Federation and in the constituent entities of the Russian Federation. Methods included descriptive statistics, comparative analysis and analytics. Results. A long-term trend towards reducing bed capacity and availability of beds was once interrupted in 2020, with the trend towards reducing the number of beds in rural areas remaining interrupted. In general, during the observation period, the total number beds decreased by more than 30 thousand, the population-to-bed ratio decreased by 3%, and the hospitalization rate dropped by 7%. The shortage of adult infectious disease beds at the beginning of the pandemic associated with the prior reduction of bed capacity against the background of the network restructuring was met by repurposing other beds to serve as infectious disease ones, and deploying additional infectious disease beds in and outside medical organizations to treat patients with COVID-19. The number of adult infectious disease beds increased 7.5-fold by the end of 2020. However, the number of adult infectious disease beds then started to decrease reaching a 59,4% increase by 2022 compared to 2019, but their share in rural areas decreased from 14% to 8%. The number of pediatric disease beds increased against the background of competing dynamics. Overall, during the period, the total number of pediatric and adult infectious disease beds increased by 27%. In the structure of adult infectious disease beds, the share of COVID-19 beds varied from 92% in 2020 to 34% in 2022; additionally deployed COVID-19 beds were also in operation. Over the observation period, the average bed length of stay and average bed occupancy decreased, while hospital mortality increased. Significant variability in hospital performance indicators across regions was registered. Conclusion In 2021-2022, hospital facilities in the Russian Federation were prepared to meet the increased incidence of infectious diseases. However, the renewed processes of bed capacity reduction necessitated forecasting sustainability of hospitals in emergency situations. The undertaken analysis shows that a cut in the number of round-the-clock beds should not be guided by the mere process of reduction. The decision to change the bed capacity and structure should be preceded by a thorough preliminary analysis of specialized care availability by each specialty planned to be reduced. Reducing planned hospitalizations and postponing treatment of patients with chronic non-communicable diseases turned out to be not fully justified, which was confirmed by other studies. Infectious disease beds must function in optimal numbers to cope with the increased flow of patients in early stages of an emergency. The areas where infectious disease beds are deployed must be sufficient to realize the possibility of quickly increasing the capacity of an infectious disease hospital to the required level. Planning a network of hospitals should ensure a comprehensive specialized care delivery to patients with chronic non-communicable diseases during emergencies including planned care. Scope of application: Hospital capacity and structure planning.

0010 Bed Sharing Versus Sleeping Alone Associated with Sleep Health and Mental Health

Abstract Introduction Although many adults do not sleep alone, associations between bed-sharing and sleep parameters in community samples are not well-known. The present study explored whether sharing a bed was associated with sleep duration and quality and mental health factors. Methods Data was obtained as part of the Sleep and Health Activity, Diet, Environment, and Socialization (SHADES) study of N=1,007 working-age adults from southeastern Pennsylvania. Bed Sharing was assessed with survey items assessing frequency in the past month of sharing a bed with a partner/spouse, child/children, pet(s), other family member(s), or nobody (sleeping alone). Other sleep health factors assessed included Insomnia Severity Index, Brief Index of Sleep Control, Epworth Sleepiness Scale, Fatigue Severity Scale, STOP-BANG apnea score, sleep duration, sleep latency, and wake after sleep onset. Mental health factors included PHQ9 depression score, GAD7 anxiety score, Multidimensional Scale of Perceived Social Support, Perceived Stress Scale, and global ratings for overall life satisfaction and relationship satisfaction. Covariates included age, sex, race/ethnicity, income, and education. Results Compared to those who reported “Never,” those who shared a bed with a partner “Most nights” reported less insomnia severity (B=-1.60; 95%CI[-2.55,-0.66]; p=0.001), more sleep (B=0.25; 95%CI[0.02,0.48]; p=0.035), less fatigue (B=-2.24; 95%CI[-4.10,-0.39]; p=0.018), less sleep apnea risk (B=-0.25; 95%CI[-0.42,-0.09]; p=0.003), shorter sleep latency (B=-6.32; 95%CI[-11.15,-1.50]; p=0.010) and less WASO (B=-8.69; 95%CI[-15.85,-1.52]; p=0.018). Those who slept with their child “Most nights” reported greater insomnia severity (B=2.14; 95%CI[0.65,3.62; p=0.005), less control over sleep (B=-0.37; 95%CI[-0.59,-0.15]; p=0.001), and greater sleep apnea risk (B=0.33; 95%CI[0.07,0.59]; p=0.012). Those who slept with other family members reported more apnea risk (B=0.44; 95%CI[0.07,0.82]; p=0.021). Those who slept alone reported greater insomnia severity (B=2.28; 95%CI[1.28,3.28]; p<0.0001), more sleepiness (B=0.98; 95%CI[0.22,1.74]; p=0.011), more fatigue (B=2.87; 95%CI[0.89,4.84]; p=0.005), and greater apnea risk (B=0.24; 95%CI[0.06,0.41]; p=0.007). In addition, sleeping with a partner was associated with lower depression, anxiety, and stress scores, and greater social support and satisfaction with life and relationships. Sleeping with children was associated with more stress. Sleeping alone was associated with higher depression scores, and lower social support and life and relationship satisfaction. Conclusion Sleeping with a partner/spouse is associated with better sleep quality and mental health overall. Sleeping with a child, on the other hand, was associated with worse sleep in general. Support (If Any)

Association Between Infant Sleep Location and Breastfeeding.

Objective: Studies have shown that mothers sleeping with their babies have longer breastfeeding duration. Bedsharing (BS) is thought to be a risk factor for Sudden Infant Death Syndrome. The aim was to investigate the frequency of BS and roomsharing (RS) and the effect of those on breastfeeding during the first 2 years of life. Also to evaluate risk-bearing situations regarding sleep environment. Methods and Study Design: This is a cross-sectional study, with retrospective cohort features for the evaluation of some data. The setting was a Well-Child Clinic at Bakırköy Research and Training Hospital. The children were followed from the first month until survey. Feeding history was collected retrospectively from child health records. Parents were surveyed concerning sleeping location and sleeping arrangements with a questionnaire. The study encompassed 351 children and their families. Results: The rate of exclusive breastfeeding was found to be 50.2% for the first 6 months of life and BS increased in exclusively breastfed infants. When breastfeeding continued after 6 months, the trend of increased BS through months was observed. RS, BS, and breastsleeping rates were 80.6%, 22.8%, 56.1%, respectively, in the whole cohort. Working mothers and mothers >35 years of age were significantly more likely to bedshare. Cigarette smoking in BS parents was identified as a child health risk. Unsafe sleep environment was found in 72.4% of the group. Conclusions: BS increases breastfeeding for the first 6 months. Families need guidance on safe sleeping practices and should be advised regarding avoidable risks and unsafe situations in BS. Parents should be counseled to make informed decisions.

Costs of polish county hospitals-A behavioral panel function.

In the paper the costs of Polish county hospitals in 2015–2018 are studied using behavioral cost function. The set of variables combines hospitals’ characteristics which may determine their level of costs, such as the form of ownership, bed turnover rate, number of patient-days and share of beds in emergency department with environment characteristics which may influence both outsourcing costs and patients’ health. In 2017 the system of basic hospital service provision (hospital network) was introduced in Poland. Dummy variables included in the model represent the category of hospital in the system. The results show that the costs may be described using fixed effect panel model. Positive impact of percentage of emergency department patients transferred to other departments and of wages is found. Higher ratio of residents and interns to doctors is found to decrease costs. Dummy variable for the period after the introduction of hospital network assumed a negative sign with costs, but the parameter remained insignificant.

Does Bed Sharing with an Infant Influence Parents’ Sexual Life? A Scoping Review in Western Countries

Bed sharing—the sharing of a sleeping surface by parents and children—is a common, yet controversial, practice. While most research has focused on the public health aspect of this practice, much less is known regarding its effect on the marital relationship. The aim of the present study was to conduct a scoping review on the impact of parent–infant bed sharing sleeping practices on the sexual and marital relationship of couples. The qualitative synthesis of six studies on this topic suggests that overall, bed sharing does not exert a significant negative impact on family functioning; when it does, it appears to be related to incongruent parental beliefs and expectations, especially when bed sharing is not an intentional choice of sleep arrangement, and there are other confounding factors such as fatigue and psychological distress. Suggestions for future studies and clinical implications are discussed.

Pēpē-infant sleep practices and sudden unexpected death in infancy in Aotearoa New Zealand.

To explore pēpē [infant] sleep practices and the key motivators among selected Māori and non-Māori māmā [mothers] in Auckland, New Zealand, in relation to the risk of sudden unexpected death in infancy (SUDI). Qualitative research underpinned by a kaupapa Māori cultural framework was undertaken. In-depth face-to-face interviews occurred in the homes of māmā with young pēpē born in Counties Manukau, Auckland. Interview transcripts were analyzed using general purpose thematic analysis. Thirty māmā participated, including 17 Māori. Two-thirds of māmā reported previous or current bed sharing. The fundamental human need for adequate sleep motivated half the māmā in the present study, and especially Māori māmā, to bed share. The second most common reason given was closeness and convenience. This was followed by breastfeeding, which was cited as a reason by Māori māmā only. These findings were interpreted in terms of intrinsic fear, culture, and māmā deployment of knowledge. Service providers are encouraged to respond to the lived experiences and cultural realities, values, and beliefs of māmā when designing and delivering effective SUDI prevention interventions. Innovative approaches for providing structured and opportunistic, culturally appropriate education and support around safe sleep are likely to be well-received by māmā and their whānau [family/ies].

The increasing impact of length of stay \u201coutliers\u201d on length of stay at an urban academic hospital

BackgroundAs healthcare systems strive for efficiency, hospital “length of stay outliers” have the potential to significantly impact a hospital’s overall utilization. There is a tendency to exclude such “outlier” stays in local quality improvement and data reporting due to their assumed rare occurrence and disproportionate ability to skew mean and other summary data. This study sought to assess the influence of length of stay (LOS) outliers on inpatient length of stay and hospital capacity over a 5-year period at a large urban academic medical center.MethodsFrom January 2014 through December 2019, 169,645 consecutive inpatient cases were analyzed and assigned an expected LOS based on national academic center benchmarks. Cases in the top 1% of national sample LOS by diagnosis were flagged as length of stay outliers.ResultsFrom 2014 to 2019, mean outlier LOS increased (40.98 to 45.11 days), as did inpatient LOS with outliers excluded (5.63 to 6.19 days). Outlier cases increased both in number (from 297 to 412) and as a percent of total discharges (0.98 to 1.56%), and outlier patient days increased from 6.7 to 9.8% of total inpatient plus observation days over the study period.ConclusionsOutlier cases utilize a disproportionate and increasing share of hospital resources and available beds. The current tendency to exclude such outlier stays in data reporting due to assumed rare occurrence may need to be revisited. Outlier stays require distinct and targeted interventions to appropriately reduce length of stay to both improve patient care and maintain hospital capacity.

Bed sharing versus no bed sharing for healthy term neonates.

There isgreat global variation in the sleeping arrangements for healthy newborn infants. Bed sharingis a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharingwithin 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such asbreastfeeding status and risk of SIDS. They should alsoinclude neonates fromhigh-income countries and low- and middle-income countries, especially those countries wherebed sharing is more prevalent because of cultural practices (e.g. Asian countries).

Association between Medicare\u2019s Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share

BackgroundMedicare’s Hospital Readmissions Reduction Program (HRRP), implemented beginning in 2013, seeks to incentivize Inpatient Prospective Payment System (IPPS) hospitals to reduce 30-day readmissions for selected inpatient cohorts including acute myocardial infarction, heart failure, and pneumonia. Performance-based penalties, which take the form of a percentage reduction in Medicare reimbursement for all inpatient care services, have a risk of unintended financial burden on hospitals that care for a larger proportion of Medicare patients. To examine the role of this unintended risk on 30-day readmissions, we estimated the association between the extent of their Medicare share of total hospital bed days and changes in 30-day readmissions.MethodsWe used publicly available nationwide hospital level data for 2009–2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. Using a quasi-experimental difference-in-differences approach, we compared pre- vs. post-HRRP changes in 30-day readmission rate in hospitals with high and moderate Medicare share of total hospital bed days (“Medicare bed share”) vs. low Medicare bed share hospitals.ResultsWe grouped the 1904 study hospitals into tertiles (low, moderate and high) by Medicare bed share; the average bed share in the three tertile groups was 31.2, 47.8 and 59.9%, respectively. Compared to low Medicare bed share hospitals, high bed share hospitals were more likely to be non-profit, have smaller bed size and less likely to be a teaching hospital. High bed share hospitals were more likely to be in rural and non-large-urban areas, have fewer lower income patients and have a less complex patient case-mix profile. At baseline, the average readmissions rate in the low Medicare bed share (control) hospitals was 20.0% (AMI), 24.7% (HF) and 18.4% (pneumonia). The observed pre- to post-program change in the control hospitals was − 1.35% (AMI), − 1.02% (HF) and − 0.35% (pneumonia). Difference in differences model estimates indicated no differential change in readmissions among moderate and high Medicare bed share hospitals.ConclusionsHRRP penalties were not associated with any change in readmissions rate. The CMS should consider alternative options – including working collaboratively with hospitals – to reduce readmissions.

Experimental manipulation of maternal proximity during short sequences of sleep and infant calming response

This study aimed to understand how different mother-infant sleeping arrangements impact infants’ self-regulation, particularly their calming response. Thus this study investigated the effect of three prevalent mother-infant sleeping arrangements, co-sleeping (CS), sleeping beyond arm’s length from their mother (BAL), and solitary sleeping (SS), on infants’ physiological calming through self-regulation during a nap session in 24 infants (50% female, M = 1.85 months SD = 0.93 months), who were identified as either regular co-sleepers with their mothers, infants who slept in the BAL sleeping arrangement from their mother, and infants who are solitary sleepers (SS). The effect of all three sleeping conditions amongst all the three types of infants with different habitual sleeping arrangements was assessed. All infants spent 10 min (2 × 5 min sessions) in each sleeping condition (CS, BAL, SS) during which electrocardiographic recordings were collected to obtain interbeat intervals (IBI) and rMSSD, a measure of heart rate variability (HRV) an index of physiological calming, maintained by the parasympathetic pathway involved in self-regulation. Infants who regularly co-slept with their mothers had the highest IBI, indicating greater physiological calming and self-regulation across all sleeping arrangement conditions (CS, BAL, SS), followed by infants who regularly slept in the BAL sleeping arrangement from their mothers. IBI was lowest amongst regular solitary sleepers, potentially indicating physiological stress due to mother-infant separation. However, HRV indices during the sleeping arrangements (especially across regular solitary sleepers) were inconclusive as to whether the lack of change in HRV across all sleeping conditions was due to physiological stress responses or greater physiological regulation. This study is the first to investigate the effect of manipulated and habitual mother-infant sleeping arrangements on infant physiological calming.

Association between degree of exposure to the Hospital Value Based Purchasing Program and 30-day mortality: experience from the first four years of Medicare\u2019s pay-for-performance program

BackgroundThe Hospital Value Based Purchasing Program (HVBP) in the United States, announced in 2010 and implemented since 2013 by the Centers for Medicare and Medicaid Services (CMS), introduced payment penalties and bonuses based on hospital performance on patient 30-day mortality and other indicators. Evidence on the impact of this program is limited and reliant on the choice of program-exempt hospitals as controls. As program-exempt hospitals may have systematic differences with program-participating hospitals, in this study we used an alternative approach wherein program-participating hospitals are stratified by their financial exposure to penalty, and examined changes in hospital performance on 30-day mortality between hospitals with high vs. low financial exposure to penalty.MethodsOur study examined all hospitals reimbursed through the Medicare Inpatient Prospective Payment System (IPPS) – which include most community and tertiary acute care hospitals – from 2009 to 2016. A hospital’s financial exposure to HVBP penalties was measured by the share of its annual aggregate inpatient days provided to Medicare patients (“Medicare bed share”). The main outcome measures were annual hospital-level 30-day risk-adjusted mortality rates for acute myocardial infarction (AMI), heart failure (HF) and pneumonia patients. Using difference-in-differences models we estimated the change in the outcomes in high vs. low Medicare bed share hospitals following HVBP.ResultsIn the study cohort of 1902 US hospitals, average Medicare bed share was 61 and 41% in high (n = 540) and low (n = 1362) Medicare bed share hospitals, respectively. High Medicare bed share hospitals were more likely to have smaller bed size and less likely to be teaching hospitals, but ownership type was similar among both Medicare bed share groups.. Among low Medicare bed share (control) hospitals, baseline (pre-HVBP) 30-day mortality was 16.0% (AMI), 10.9% (HF) and 11.4% (pneumonia). In both high and low Medicare bed share hospitals 30-day mortality experienced a secular decrease for AMI, increase for HF and pneumonia; differences in the pre-post change between the two hospital groups were small (< 0.12%) and not significant across all three conditions.ConclusionsHVBP was not associated with a meaningful change in 30-day mortality across hospitals with differential exposure to the program penalty.

Sleep and wake are shared and transmitted between partners of bed-sharing couples

Sleep and wake are shared and transmitted between partners of bed-sharing couples

What has driven the spatial spillover of China\u2019s out-of-pocket payments?

BackgroundEven though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China’s OPP.MethodsGlobal and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors.ResultsOPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China’s OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents’ OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs.ConclusionThis paper finds that China’s OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects.

19-Month-Old Male Presenting with Near Strangulation by Human Hair

Introduction: Hair tourniquet syndrome is a well-documented phenomenon in which hair can become tightly wrapped around an appendage resulting in ischemic injury and necrosis. When a hair tourniquet involves the neck as the appendage, fatality can result due to asphyxia, specifically strangulation. Strangulation can be fatal, and death can result within minutes. In the pediatric population, suffocation is a concern when assessing the sleep of newborns and infants. There are inherent dangers of co-sleeping that are routinely discussed during pediatric office visits, particularly about newborns. Parents are alerted to the …

Sleep and wake are shared and transmitted between members of bed‐sharing couples

Sleep and wake are shared and transmitted between members of bed‐sharing couples

Co-Sleeping: Parents, Children, and Musical Beds

Co-Sleeping: Parents, Children, and Musical Beds

The Impact of Dementia Special Care Units on Quality of Care: An Instrumental Variables Analysis

To compare the quality of care following admission to a nursing home (NH) with and without a dementia special care unit (SCU) for residents with dementia. National resident-level minimum dataset assessments (MDS) 2005-2010 merged with Medicare claims and provider-level data from the Online Survey, Certification, and Reporting database. We employ an instrumental variable approach to address the endogeneity of selection into an SCU facility controlling for a range of individual-level covariates. We use "differential distance" to a nursing home with and without an SCU as our instrument. Minimum dataset assessments performed at NH admission and every quarter thereafter. Admission to a facility with an SCU led to a reduction in inappropriate antipsychotics (-9.7 percent), physical restraints (-9.6 percent), pressure ulcers (-3.3 percent), feeding tubes (-8.3 percent), and hospitalizations (-14.7 percent). We found no impact on the use of indwelling urinary catheters. Results held in sensitivity analyses that accounted for the share of SCU beds and the facilities' overall quality. Facilities with an SCU provide better quality of care as measured by several validated quality indicators. Given the aging population, policies to promote the expansion and use of dementia SCUs may be warranted.

0826 Poverty Mediates the Relation Between Bed Sharing and Decreased Toddler Nighttime Sleep Over Six Months

0826 Poverty Mediates the Relation Between Bed Sharing and Decreased Toddler Nighttime Sleep Over Six Months