Competitive Tendering In The Netherlands: Central Planning Or Functional Specifications?

Institute of Transport and Logistics Studies. Faculty of Economics and Business. The University of Sydne

Sleep Duration From Infancy to Adolescence: Reference Values and Generational Trends

OBJECTIVE: The main purpose of the present study was to calculate percentile curves for total sleep duration per 24 hours, for nighttime and for daytime sleep duration from early infancy to late adolescence to illustrate the developmental course and age-specific variability of these variables among subjects. METHODS: A total of 493 subjects from the Zurich Longitudinal Studies were followed using structured sleep-related questionnaires at 1, 3, 6, 9, 12, 18, and 24 months after birth and then at annual intervals until 16 years of age. Gaussian percentiles for ages 3 months to 16 years were calculated for total sleep duration (time in bed) and nighttime and daytime sleep duration. The mean sleep duration for ages 1 to 16 years was estimated by generalized additive models based on the loess smoother; a cohort effect also had to be included. The standard deviation (SD) was estimated from the loess smoothed absolute residuals from the mean curve. For ages 3, 6, and 9 months, an alternative approach with a simple model linear in age was used. For age 1 month, empirical percentiles were calculated. RESULTS: Total sleep duration decreased from an average of 14.2 hours (SD: 1.9 hours) at 6 months of age to an average of 8.1 hours (SD: 0.8 hours) at 16 years of age. The variance showed the same declining trend: the interquartile range at 6 months after birth was 2.5 hours, whereas at 16 years of age, it was only 1.0 hours. Total sleep duration decreased across the studied cohorts (1974-1993) because of increasingly later bedtime but unchanged wake time across decades. Consolidation of nocturnal sleep occurred during the first 12 months after birth with a decreasing trend of daytime sleep. This resulted in a small increase of nighttime sleep duration by 1 year of age (mean 11.0 +/- 1.1 hours at 1 month to 11.7 +/- 1.0 hours at 1 year of age). The most prominent decline in napping habits occurred between 1.5 years of age (96.4% of all children) and 4 years of age (35.4%). CONCLUSIONS: Percentile curves provide valuable information on developmental course and age-specific variability of sleep duration for the health care professional who deals with sleep problems in pediatric practice

A Longitudinal Study of Bed Sharing and Sleep Problems Among Swiss Children in the First 10 Years of Life

OBJECTIVE: To study age trends, long-term course and secular changes of bed-sharing practices, and sleep problems among Swiss families. METHODS: A total of 493 children were longitudinally followed between 1974 and 2001 by using structured sleep-related interviews at 1, 3, 6, 9, 12, 18, and 24 months after birth and at annual intervals thereafter until 10 years of age. Parents were queried about bed sharing, night wakings, bedtime resistance, and sleep-onset difficulties during the 3 months before each follow-up interview. RESULTS: Although in the first year of life relatively few children slept with their parents ( or =1 times per week: 38%). Bed sharing of at least once per week was noted in 44% of the children between 2 and 7 years old. Nocturnal wakings also increased from 6 months old to a maximum at 4 years, when more than half of all children woke up at least once per week (22% every night at 3 years). Less than 10% of all children demonstrated frequent bedtime resistance and sleep-onset difficulties. Bed sharing and night wakings during early infancy were not predictive for bed sharing or night wakings during childhood, whereas both bed sharing and night wakings during childhood tended to persist over time. In contrast, bedtime resistance and sleep-onset difficulties seemed to be rather transient phenomena across all ages. No consistent cohort trends were found except for bedtime resistance, which decreased significantly between 1974 and 2001. CONCLUSIONS: Bed sharing and nocturnal wakings are common during early childhood. Developmental changes in separation-attachment processes, cognitive capabilities to develop self-recognition and nighttime fears, and motor locomotion may contribute to the particular age trend of night wakings and bed sharing during early childhood

Paediatric community-acquired septic shock: Results from the REPEM network study

PubMedID: 23354787Introduction and purpose of the study With this study we aimed to describe a "true world" picture of severe pae-diatric 'community-acquired' septic shock and establish the feasibility of a future prospective trial on early goal-directed therapy in children. During a 6-month to 1-year retrospective screening period in 16 emergency departments (ED) in 12 different countries, all children with severe sepsis and signs of decreased perfusion were included. Results A 270,461 paediatric ED consultations were screened, and 176 cases were identified. Significant comorbidity was present in 35.8 % of these cases. Intensive care admission was deemed necessary in 65.7 %, mechanical ventilation in 25.9 % and vasoactive medications in 42.9 %. The median amount of fluid given in the first 6 h was 30 ml/kg. The overall mortality in this sample was 4.5 %. Only 1.2 % of the survivors showed a substantial decrease in Paediatric Overall Performance Category (POPC). 'Severe' outcome (death or a decrease ?2 in POPC) was significantly related (p0.01) to: any desaturation below 90 %, the amount of fluid given in the first 6 h, the need for and length of mechanical ventilation or vasoactive support, the use of dobutamine and a higher lactate or lower base excess but not to any variables of predisposition, infection or host response (as in the PIRO (Predisposition, Infection, Response, Organ dysfunction) concept). Conclusion The outcome in our samplewas very good.Many children received treatment early in their disease course, so avoiding subsequent intensive care. While certain variables predispose children to become septic and shocked, in our sample, only measures of organ dysfunction and concomitant treatment proved to be significantly related with outcome. We argue why future studies should rather be large multinational prospective observational trials and not necessarily randomised controlled trials.©2013 Springer-Verlag Berlin Heidelberg.Pfizer Merck Meso Scale DiagnosticsConflict of interest and funding The SEPEM network was supported by educational grants from Fresenius Kabi, Merck MSD and Pfizer. There has been no further involvement from the funding sources in the study design, conduct and interpretation or in the manuscript writing, approval or submission. For none of the authors there is any conflict of interest