Letter to the Editor on "Leveraging Biomedical Engineering Engineers to Improve Obstructive Sleep Apnea (OSA) Care for Our Stroke Patients".

Obstructive sleep apnea (OSA), a condition of recurring, episodic complete or upper airway collapse, is a common disorder, affecting an estimated 17.4% of women and 33.9% of men in the United States [1].

Sleep Disturbances in Neurological Disease: A Target for Intervention.

Sleep is a biological function required for neurological and general health, but a significant and under-recognized proportion of the population has disturbed sleep. Here, we briefly overview the biology of sleep, sleep requirements over the lifespan, and common sleep disorders. We then turn our attention to five neurological diseases that significantly contribute to global disease burden and neurology practice makeup: epilepsy, headache, ischemic stroke, Parkinson's disease, and Alzheimer's disease.

Sleep in Patients With Neurologic Disease.

Purpose Of Review: This article provides a discussion of the current evidence and contemporary views on the relationship between sleep disorders and neurologic disease.

Recent Findings: Disrupted or disordered sleep can be associated with increased morbidity and mortality, the risk of cardiovascular events, increased seizure frequency, and altered immune responses. Studies have implicated disrupted sleep and circadian rhythm dysfunction with both amyloid-β (Aβ) deposition and tau deposition.

A review of state regulations to promote physical activity and safety on playgrounds in child care centers and family child care homes.

Background: As interventions increasingly emphasize early child care settings, it is necessary to understand the state regulatory context that provides guidelines for outdoor physical activity and safety and sets standards for child care environments.

Methods: Researchers reviewed regulations for child care facilities for 50 states, the District of Columbia and the Virgin Islands. We compared state regulations with national standards for 17 physical activity- and safety-related items for outdoor playground settings outlined in Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs (CFOC).

Best-practice guidelines for physical activity at child care.

Research has indicated that the child care center is a very strong predictor of preschool-aged children's physical activity levels, making this an important setting to help young children obtain physical activity that is appropriate for their health and development. However, some evidence suggests that organized child care may not adequately support children's physical activity needs. Although many organizations provide recommendations, guidelines, or standards for motor skill development and physical activity opportunities, no set of guidelines exist that directly target the overall physical activity environment at child care.

Early child care and adiposity at ages 1 and 3 years.

Background: The majority of infants in the United States are in nonparental child care, yet little is known about the effect of child care on development of obesity.

Objective: To examine the relationship between child care attendance from birth to 6 months and adiposity at 1 and 3 years of age.

Methods: We studied 1138 children from a prospective cohort of pregnant women and their offspring.

State and regional variation in regulations related to feeding infants in child care.

Objective: The purpose of this study was to compare state and regional variation in infant feeding regulations for child care facilities and to compare these regulations to national standards.

Methods: We reviewed regulations for child care for all US states and Washington, DC, and examined patterns according to type of facility and geographic region. We compared state regulations with national standards for feeding infants in child care.

Menus in child care: a comparison of state regulations with national standards.

The purpose of this project was to compare individual state regulations regarding menus for child-care centers and family child-care homes with national menu standards. For all 50 states and the District of Columbia, state regulations were compared with menu standards found in Caring for Our Children--National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs. Specifically, these guidelines suggest that (a) menus must be posted or made available to parents, (b) menus must be dated, (c) menus must reflect food served, (d) menus must be planned in advance, and (e) menus must be kept on file.

Improving nutrition and physical activity in child care: what parents recommend.

A large percentage of children in the United States spend part of their day in out-of-home child care. As rates of obesity continue to rise, especially among young children, child care has become a focus for nutrition and physical activity intervention. Parental involvement is an important component of these efforts.

Nutrition and physical activity in child care: results from an environmental intervention.

Background: With evidence of increased levels of obesity in younger children, the child-care setting is an important intervention target. Few environmental interventions exist, and none target both diet and physical activity. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this research and practice gap.

Obesity prevention in child care: a review of U.S. state regulations.

Objective: To describe and contrast individual state nutrition and physical activity regulations related to childhood obesity for child care centers and family child care homes in the United States.

Methods: We conducted a review of regulations for child care facilities for all 50 states and the District of Columbia. We examined state regulations and recorded key nutrition and physical activity items that may contribute to childhood obesity.

Dietary intakes in North Carolina child-care centers: are children meeting current recommendations?

The purpose of this study was to determine whether food consumed by children while in center-based child care meets the new MyPyramid food group recommendations for children 2 to 5 years of age. Dietary observation of 117 children from 20 child-care centers throughout North Carolina was conducted. The type and amount of food served to and consumed by children was observed and assessed using Nutrition Data System for Research (NDS-R) software (version 2005, Nutrition Coordinating Center, University of Minnesota, Minneapolis).

The childcare environment and children's physical activity.

Background: With increased numbers of children attending child care, this setting presents an ideal opportunity to promote physical activity and the early development of healthy behaviors. The purpose of this study was to examine the relationships between the childcare environment and physical activity behavior of preschool children.

Methods: Aspects of the environment hypothesized to influence children's physical activity were assessed in 20 childcare centers using the Environment and Policy Assessment and Observation (EPAO) instrument.

Preparing Child Care Health Consultants to address childhood overweight: a randomized controlled trial comparing web to in-person training.

Objectives: Child care centers have recently become targets for overweight prevention efforts directed at young children. Child Care Health Consultants (CCHCs), who provide consultation to these centers, receive little training on the basic nutrition and physical activity principles important for the promotion of child healthy weight. Traditional approaches, such as in-person training, are limited in their ability to disseminate health information to a geographically diverse population of health professionals.

Reliability and validity of a nutrition and physical activity environmental self-assessment for child care.

Background: Few assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed.

Methods: To measure inter-rater reliability, 59 child care center directors and 109 staff completed the self-assessment concurrently, but independently.

An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design.

Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention.

Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention.

Objective: To determine the feasibility, acceptability, and reported impact of a nutrition and physical activity environmental intervention in child care.

Design: Self-assessment instrument completed pre- and post-intervention by randomly assigned intervention and comparison child care centers.

Setting: Child care centers in 8 counties across North Carolina.

Development and reliability of an observation method to assess food intake of young children in child care.

To our knowledge, a direct observation protocol for assessing dietary intake among young children in child care has not been published. This article reviews the development and testing of a diet observation system for child care facilities that occurred during a larger intervention trial. Development of this system was divided into five phases, done in conjunction with a larger intervention study; (a) protocol development, (b) training of field staff, (c) certification of field staff in a laboratory setting, (d) implementation in a child-care setting, and (e) certification of field staff in a child-care setting.