Dose finding of melatonin for chronic idiopathic childhood sleep onset insomnia: an RCT

Contains fulltext : 86695.pdf (publisher's version ) (Open Access)Rationale Pharmacokinetics of melatonin in children might differ from that in adults. Objectives This study aims to establish a dose–response relationship for melatonin in advancing dim light melatonin onset (DLMO), sleep onset (SO), and reducing sleep onset latency (SOL) in children between 6 and 12 years with chronic sleep onset insomnia (CSOI). Methods The method used for this study is the randomized, placebo-controlled double-blind trial. Children with CSOI (n=72) received either melatonin 0.05, 0.1, and 0.15 mg/kg or placebo during 1 week. Sleep was assessed with log and actigraphy during this week and the week before. Outcomes were the shifts in DLMO, SO, and SOL. Results Treatment with melatonin significantly advanced SO and DLMO by approximately 1 h and decreased SOL by 35 min. Within the three melatonin groups, effect size was not different, but the circadian time of administration (TOA) correlated significantly with treatment effect on DLMO (rs=-0.33, p=0.022) and SO (rs=-0.38, p=0.004), whereas clock TOA was correlated with SO shift (r=-0.35, p=0.006) and not with DLMO shift. Conclusions No dose–response relationship of melatonin with SO, SOL, and DLMO is found within a dosage range of 0.05–0.15 mg/kg. The effect of exogenous melatonin on SO, SOL, and DLMO increases with an earlier circadian TOA. The soporific effects of melatonin enhance the SO shift. This study demonstrates that melatonin for treatment of CSOI in children is effective in a dosage of 0.05 mg/kg given at least 1 to 2 h before DLMO and before desired bedtime.13 p

Percepções de gestantes sobre atenção odontológica durante a gravidez The beliefs of pregnant women about dental care during gestation

O presente artigo tem como proposta discutir a percepção de gestantes usuárias do Sistema Único de Saúde e também as assistidas em serviço privado conveniado sobre saúde bucal no período gestacional, por meio de entrevistas semi-estruturadas, cujos dados foram objeto de análise de conteúdo. Foram realizadas entrevistas até obter-se saturação em relação à compreensão dos objetivos dessa pesquisa, totalizando vinte. A análise e interpretação dos dados mostraram a existência de mitos, medos e restrições relacionados à atenção odontológica no pré-natal. A busca pela atenção odontológica entre as usuárias do SUS é mais rotineira e sistemática durante o pré-natal devido à oferta programática realizada neste período pelas Unidades Básicas de Saúde (UBS), sendo uma oportunidade de resolver problemas odontológicos pré-existentes. Identificou-se entre as gestantes assistidas por convênio a existência de atenção odontológica programada em outras épocas e evitadas durante o pré-natal.<br>The objective of this study was identifying beliefs of pregnant women, both users of the Unified Health System (the Brazilian Healthcare System) and women assisted by the private sector, with respect to oral health and dental care during their pregnancy. The approach used in this survey was theme-based qualitative content analysis. The subjects' comprehension of the objectives of this study was checked in semi-structured interviews, a total of 20. Analysis and interpretation of the collected data revealed the existence of myths, fears and restrictions with regard to prenatal dental care. According to our findings the users of the Unified Health System seem to have dental visits on a more systematic and regular basis than the users of the private health sector, probably because the dental services offered by the prenatal program of the Primary Care Units is providing them with an opportunity to solve pre-existing dental problems. On the other hand, the users of the private health system seem to avoid scheduling dental visits during pregnancy