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Juan de Flandes, 1514–1519. Lazarus is portrayed with a dislocated left shoulder that could be a result of a seizure (arrow). There is also an example of a Hand of Benediction (Christ), related to a nerve palsy or Dupytren's disease (dotted arrow). (B) “<span class="elsevierStyleItalic">The Descen from the</span><span class="elsevierStyleItalic">Cross</span>”. Rogier van der Weyden, 1443. In the figure with the blue dress a diffuse goiter can be seen (arrow). She also is the representation of an emotional syncope.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan J. Grau, Inés Bartolomé, Cristina Garrido, Alex Iranzo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Juan J." "apellidos" => "Grau" ] 1 => array:2 [ "nombre" => "Inés" "apellidos" => "Bartolomé" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Garrido" ] 3 => array:2 [ "nombre" => "Alex" "apellidos" => "Iranzo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622005150?idApp=UINPBA00004N" "url" => "/23870206/0000015900000010/v2_202301310819/S2387020622005150/v2_202301310819/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Improvement of sleep quality in schoolchildren after cognitive-behavioral therapy" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "505" "paginaFinal" => "506" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eduardo Josué Beltrán Ravelo, Tania Guadalupe Valdivia Morales" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Eduardo Josué" "apellidos" => "Beltrán Ravelo" "email" => array:1 [ 0 => "N00053233@upn.pe" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Tania Guadalupe" "apellidos" => "Valdivia Morales" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Universidad Privada del Norte, Trujillo, Peru" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mejora de la calidad del sueño en escolares tras la terapia cognitivo-conductual" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We understand that adolescence is a time of significant physical, hormonal and growth changes; with major emotional, psychological and social alterations, creating a series of adjustment disorders in some adolescents. Thus, at this stage we can also define sleep as a regular, recurrent and reversible state characterised by relative calm and an increased threshold or response to external stimuli in relation to the improvement of the sleep state.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Cognitive behavioural therapy (CBT) could similarly be interpreted as focusing on sleep education, on how beliefs, behaviours and external factors affect sleep; cognitive tracking, to control negative thoughts and worries that affect falling asleep and waking up; sleep restriction, to avoid skipping sleep during the day; stimulus control and sleep hygiene, to eliminate external factors that damage the brain and keep it awake; and finally, sleep hygiene, to eliminate external factors that damage the brain and keep it awake; and finally, progressive muscle self-relaxation training to calm the body and mind to allow it to relax and get enough sleep<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thus, we conducted a positivist experimental study, the objective of which was to evaluate the effectiveness of CBT in improving the quality of sleep in Peruvian schoolchildren from an educational institution in Trujillo, Peru. The hypothesis of this study is that CBT improves SQ and reduces the possible recognition of sleep disturbances (SD). The study included 79 schoolchildren (49% boys and 51% girls) aged 12-13 years, identified through the situational diagnosis of the educational institution and the results of the Pittsburgh Sleep Quality Index. After a first population screening to rule out possible serious pathologies, their participation in the study was assessed. An experimental group of 79 participants and a control group of 21 schoolchildren were set up during 90<span class="elsevierStyleHsp" style=""></span>min for each session of the total of 9 (2 times per week). To assess the efficacy of CBT, pre- and post-treatment data from the Pittsburgh Sleep Quality Index were used, which consists of seven domains: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, hypnotic drug use and daytime dysfunction. Scores above 5 would reflect the cut-off point that distinguishes people with good or poor SQ.</p><p id="par0020" class="elsevierStylePara elsevierViewall">CBT included the following elements: detailed history and description of sleep patterns, practice of stimulus control strategies to establish a consistent sleep rhythm, sleep hygiene, practice of relaxation techniques before bedtime, identification and replacement of reflexes associated with sleep disorders, identification of current sleep disorders as stressors, and relapse prevention measures.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A statistical analysis was performed comparing the scores obtained before and after CBT, for which the non-parametric Wilcoxon test was used. We found statistically significant differences in sleep quality, where the pretest scores (md<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8; rank<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12) were higher than the post-test scores (md<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4; rank<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) Z<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−7.78, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,000, g Hedges<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.29. Similarly, in descriptive statistics, the difference between the scores achieved in the questionnaire of 50% of the population was observed, indicating that the performance of sleep quality was significant with scores of p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8.00 and p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.50; representations considered in the PSQI.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Thus, published studies have shown that CBT helps in the development of new sleep habits and the avoidance of behaviours that prevent good sleep<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>, thus achieving significant improvements in sleep quality and sleep hygiene in older people<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a>; we identified similarities in the findings when taking these contributions to a school population.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The results obtained in this study show that CBT is effective in improving SQ in Peruvian schoolchildren, as well as in reducing possible SD. Furthermore, the improvement would be applicable to the context under study and would be morally lawful as it would respect the inalienable rights of individuals as outlined in the guidelines established by international associations. Therefore, CBT would also significantly improve aspects related to the domains proposed by Pittsburgh as it would teach students permissible lifestyle changes by identifying and modifying sleep-impairing thoughts through the different strategies shown in the therapy. Next, we were able to agree with the hypotheses of some authors regarding the necessary follow-up on the efficacy and safety of CBT and its impact on the quality of life in the daily activities of the participants.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trastornos del sueño en adultos mayores" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. 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Sánchez-Herrera" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Med Inst Mex Seguro Soc" "fecha" => "2014" "volumen" => "52" "paginaInicial" => "108" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24625494" "web" => "Medline" ] ] ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=47619" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015900000010/v2_202301310819/S2387020622005113/v2_202301310819/en/main.assets" "Apartado" => array:4 [ "identificador" => "43311" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015900000010/v2_202301310819/S2387020622005113/v2_202301310819/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622005113?idApp=UINPBA00004N" ]
