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JMIR Formative Research Sep 2022Early morning behaviors between waking up and beginning daily work can develop into productive habits. However, sleep inertia limits the level of human ability...
BACKGROUND
Early morning behaviors between waking up and beginning daily work can develop into productive habits. However, sleep inertia limits the level of human ability immediately after waking, lowering a person's motivation and available time for productive morning behavior.
OBJECTIVE
This study explores a design for morning behavior change using a wake-up task, a simple assignment the user needs to finish before alarm dismissal. Specifically, we set two research objectives: (1) exploring key factors that relate to morning behavior performance, including the use of wake-up tasks in an alarm app and (2) understanding the general practice of affecting morning behavior change by implementing wake-up tasks.
METHODS
We designed and implemented an apparatus that provides wake-up task alarms and facilities for squat exercises. We recruited 36 participants to perform squat exercises in the early morning using the wake-up tasks for 2 weeks. First, we conducted a generalized estimating equation (GEE) analysis for the first research objective. Next, we conducted a thematic analysis of the postsurvey answers to identify key themes about morning behavior change with the wake-up tasks for the second objective.
RESULTS
The use of wake-up tasks was significantly associated with both the completion of the target behavior (math task: P=.005; picture task: P<.001) and the elapsed time (picture task: P=.08); the time to alarm dismissal was significantly related to the elapsed time to completion (P<.001). Moreover, the theory of planned behavior (TPB) variables, common factors for behavior change, were significant, but their magnitudes and directions differed slightly from the other domains. Furthermore, the survey results reveal how the participants used the wake-up tasks and why they were effective for morning behavior performance.
CONCLUSIONS
The results reveal the effectiveness of wake-up tasks in accomplishing the target morning behavior and address key factors for morning behavior change, such as (1) waking up on time, (2) escaping from sleep inertia, and (3) quickly starting the desired target behavior.
PubMed: 36129742
DOI: 10.2196/39497 -
Obstetrics and Gynecology Feb 2015
Topics: Doxylamine; Female; Humans; Morning Sickness; Ondansetron; Pregnancy; Pyridoxine
PubMed: 25611628
DOI: 10.1097/AOG.0000000000000651 -
Infant Behavior & Development Nov 2021In infancy, sleep occurs in multiple nap and overnight bouts that change developmentally in quantity and distribution. Though studies suggest that infant memory benefits...
In infancy, sleep occurs in multiple nap and overnight bouts that change developmentally in quantity and distribution. Though studies suggest that infant memory benefits from a single nap, no work has assessed the relative benefits of different naps (morning vs. afternoon), nor how multiple naps support memory across the day. We investigated the memory benefit of a morning nap, relative to morning wake, and the effect of these intervals on afternoon nap function in 9-month-olds (n = 15). Infants participated in two within-subjects conditions (separated by 1-2 weeks). In the Nap-Nap condition, infants took their morning and afternoon naps; in the Wake-Nap condition, infants were kept awake during morning naptime, but napped unrestricted in the afternoon. Before each nap/wake interval, infants completed an imitation memory task, with memory assessed again shortly after the nap/wake interval. In the Nap-Nap condition, infants showed memory retention across morning and afternoon naps. In contrast, infants tended to forget items learned across morning wake in the Wake-Nap condition. Moreover, morning wake was associated with a significant decline in post-nap retention of items learned in the afternoon. Furthermore, relations between nap slow-wave activity (SWA) and memory varied across naps, with SWA either not predicting (morning naps) or positively predicting (afternoon naps) memory change in the Nap-Nap condition, but negatively predicting afternoon memory change in the Wake-Nap condition. We conclude that two naps per day (rather than one) aids memory at 9 months, and that skipping the morning nap may moderate relations between afternoon nap physiology and memory.
Topics: Humans; Infant; Learning; Memory; Pilot Projects; Sleep; Wakefulness
PubMed: 34530287
DOI: 10.1016/j.infbeh.2021.101647 -
Clinical Transplantation May 2023Recently, the impact of circadian rhythm and daytime variation on surgical outcomes has attracted interest. Although studies for coronary artery and aortic valve surgery...
INTRO
Recently, the impact of circadian rhythm and daytime variation on surgical outcomes has attracted interest. Although studies for coronary artery and aortic valve surgery report contrary results, effects on heart transplantation have not been studied.
METHODS
Between 2010 and February 2022, 235 patients underwent HTx in our department. The recipients were reviewed and categorized according to the start of the HTx procedure - between 04:00 am and 11:59 am (morning, n = 79), 12:00 pm and 07:59 pm (afternoon, n = 68) or 08:00 pm and 03:59 am (night, n = 88).
RESULTS
The incidence of high urgency status was slightly but not significantly increased (p = .08) in the morning (55.7%), compared to the afternoon (41.2%) or night (39.8%). The most important donor and recipient characteristics were comparable among the three groups. The incidence of severe primary graft dysfunction (PGD) requiring extracorporeal life support (morning: 36.7%, afternoon: 27.3%, night: 23.0%, p = .15) was also similarly distributed. In addition, there were no significant differences for kidney failure, infections, and acute graft rejection. However, the incidence of bleeding that required rethoracotomy showed an increased trend in the afternoon (morning: 29.1%, afternoon: 40.9%, night: 23.0%, p = .06). 30-day survival (morning: 88.6%, afternoon: 90.8%, night: 92.0%, p = .82) and 1-year survival (morning: 77.5%, afternoon: 76.0%, night: 84.4%, p = .41) were comparable between all groups.
CONCLUSION
Circadian rhythm and daytime variation did not affect the outcome after HTx. Postoperative adverse events as well as survival were comparable throughout day- and night-time. As the timing of the HTx procedure is rarely possible and depends on the timing of organ recovery, these results are encouraging, as they allow for the continuation of the prevalent practice.
Topics: Humans; Circadian Rhythm; Graft Rejection; Heart Transplantation
PubMed: 36812498
DOI: 10.1111/ctr.14939 -
Journal of Physical Activity & Health Jun 2023Early morning is characterized by an increased risk of cardiovascular events, a sudden rise in blood pressure, impaired endothelial function, and exacerbated hemodynamic...
INTRODUCTION
Early morning is characterized by an increased risk of cardiovascular events, a sudden rise in blood pressure, impaired endothelial function, and exacerbated hemodynamic changes during physical activity. The study aims to examine whether the time of day of physical activity is associated with incident cardiovascular disease (CVD).
METHODS
We prospectively analyzed 83,053 participants in the UK Biobank with objectively measured physical activity and initially free of CVD. Based on the diurnal patterns of physical activity, participants were categorized into 4 groups: early morning (n = 15,908), late morning (n = 22,371), midday (n = 24,764), and evening (n = 20,010). Incident CVD was defined as the first diagnosis of coronary heart disease or stroke.
RESULTS
During 197.4 million person-years of follow-up, we identified 3454 CVD cases. After adjusting for the overall acceleration average, the hazard ratios and 95% confidence intervals were 0.95 (0.86-1.07) for late morning, 1.15 (1.03-1.27) for midday, and 1.03 (0.92-1.15) for evening, as compared with the early morning group. In the joint analyses, higher levels of physical activity were associated with a lower risk of incident CVD in a similar manner across the early morning, late morning, and evening groups. However, the beneficial association was attenuated in the midday group.
CONCLUSION
In conclusion, early morning, late morning, and evening are all favorable times of day to engage in physical activity for the primary prevention of CVD, while midday physical activity is associated with an increased risk of CVD compared with early morning physical activity after controlling for the levels of physical activity.
Topics: Humans; Cardiovascular Diseases; Exercise; Risk Factors; Biological Specimen Banks; Prospective Studies; United Kingdom
PubMed: 37076242
DOI: 10.1123/jpah.2022-0505 -
Chronobiology International Dec 2022Morningness is associated with well-being, better sleep quality, and more conscientiousness, while eveningness is associated with negative emotionality, poorer sleep...
Morningness is associated with well-being, better sleep quality, and more conscientiousness, while eveningness is associated with negative emotionality, poorer sleep quality, and less conscientiousness. The current study aimed to further understanding of associations with conscientiousness by assessing specific behavioural indicators of conscientiousness, morningness-eveningness, and also the Morning Affect and Distinctness (amplitude of diurnal variation) aspects of circadian functioning. A survey of Chinese university students ( = 369, aged 18-30, mean = 19.48, = 1.922; 108 males, 261 females), included the Morningness-Eveningness-Stability-Scale, measures of conscientiousness, mindfulness, life satisfaction, aspects of sleep, and the Behavioural Indicators of Conscientiousness (BIC) scale. Morningness and Morning Affect were positively correlated with life satisfaction, mindfulness, better sleep quality, more conscientiousness, and with BIC including Hardworking, Self-control, and Punctuality. Distinctness showed negative correlations with these variables. Negative correlations between Eveningness and conscientiousness, and the BIC subscales of Hardworking and Cleanliness were no longer significant after controlling for Morning Affect. Mediation analysis showed that the associations between Eveningness and conscientiousness/BIC were mediated by Morning Affect. These results extend previous research by showing associations between circadian functioning and specific behavioural indicators of conscientiousness, and suggest that low Morning Affect may provide a mechanism for the relationship between Eveningness and conscientiousness.
Topics: Male; Female; Humans; Circadian Rhythm; Sleep; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires
PubMed: 36278268
DOI: 10.1080/07420528.2022.2134787 -
Journal of Clinical Medicine Jan 2022Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder...
BACKGROUND
Naloxegol antagonizes peripheral opioid-related side effects without preventing opioid-related analgesia. However, the effect of naloxegol on opioid-induced bladder dysfunction remains unknown.
HYPOTHESIS
patients given naloxegol have lower residual bladder urine volume than those given placebo.
METHODS
136 patients scheduled for elective hip and knee surgery were randomized to oral naloxegol or placebo given the morning of surgery, and on the first two postoperative mornings. Residual urine volume was measured ultrasonographically within 30 min after voiding once in the morning and once in the afternoon for two postoperative days. Opioid-related Symptom Distress Scale (ORSDS), the need for indwelling urinary catheterization, and quality of recovery (QoR) score were secondary outcomes.
RESULTS
67 were randomized to naloxegol and 64 to placebo. We did not identify a significant effect on urine residual volume, with an estimated ratio of geometric means of 0.9 (0.3, 2.6), = 0.84. There were no significant differences in ORSDS or QoR. There were 19 (29%) patients assigned to naloxegol who needed indwelling urination catheterization versus 7 (11%) patients in the placebo group, = 0.012.
CONCLUSIONS
Our results do not support use of naloxegol for postoperative urinary retention after hip and knee surgery.
PubMed: 35054148
DOI: 10.3390/jcm11020454 -
Israel Journal of Health Policy Research Oct 2021Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and...
BACKGROUND AND AIM
Since 2014, the annual number of patients entering our emergency department (ED) has increased significantly. These were primarily Internal Medicine (IM) patients, and of these, 25-30% were admitted. The present governmental policy presents a deterrent to adding IM beds for these patients, and Emergency and IM departments cope with ever-increasing number of IM patients. We describe a quality improvement intervention to increase outflow of IM patients from the ED to the IM departments.
METHODS
We conducted a quality improvement intervention at the Shaare Zedek Medical Center from 2014 to 2018. The first stage consisted of an effort to increase morning discharges from the IM departments. The second stage consisted of establishing a process to increase the number of admissions to the IM departments from the ED.
RESULTS
Implementation of the first stage led to an increased morning discharge rate from a baseline of 2-4 to 18%. The second stage led to an immediate mean (± SD) morning transfer of 35 ± 7 patients to the medical departments (8-12 per department), providing significant relief for the ED. However, the additional workload for the IM departments' medical and nursing staff led to a rapid decrease in morning discharges, returning to pre-intervention rates. Throughout the period of the new throughput intervention, morning admissions increased from 30 to > 70%, and were sustained. The number of patients in each department increased from 36 to 38 to a new steady state of 42-44, included constant hallway housing, and often midday peaks of 48-50 patients. Mean length of stay did not change. IM physician and nurse dissatisfaction led to increased number of patients being admitted during the evening and night hours and fewer during the morning.
CONCLUSION
We describe a quality improvement intervention to improve outflow of medical patients from the ED in the morning hours. The new ED practices had mixed effects. They led to less ED crowding in the morning hours but increased dissatisfaction among the IM department medical and nursing staff due to an increased number of admissions in a limited number of hours. The present governmental reimbursement policy needs to address hospital overcrowding as it relates to limited community healthcare beds and an aging population.
Topics: Aged; Crowding; Emergency Service, Hospital; Hospitalization; Humans; Israel; Patient Discharge
PubMed: 34706781
DOI: 10.1186/s13584-021-00491-9 -
High Blood Pressure & Cardiovascular... Jun 2019Automated office blood pressure (AOBP) has been recently shown to predict equally well to ambulatory blood pressure (ABP), conventional office blood pressure (OBP) and... (Comparative Study)
Comparative Study
INTRODUCTION
Automated office blood pressure (AOBP) has been recently shown to predict equally well to ambulatory blood pressure (ABP), conventional office blood pressure (OBP) and home blood pressure (HBP), cardiovascular (CV) events among hypertensives.
AIM
To compare AOBP recording and ABP monitoring in order to evaluate morning blood pressure (BP) peak in predicting CV events and deaths in hypertensives.
METHODS
We assessed 236 initially untreated hypertensives, examined between 2009 and 2013. The end points were CV and non-CV death and any CV event including myocardial infarction, evidence of coronary heart disease, heart failure hospitalization, severe arrhythmia, stroke, and symptomatic peripheral artery disease. We fitted proportional hazards models using the different modalities as predictors and evaluated their predictive performance using two metrics: the Akaike's Information Criterion, and Harrell's C-index.
RESULTS
After a mean follow-up of 7 years, 23 subjects (39% women) had at least one CV event. In Cox regression models, systolic conventional OBP, AOBP and peak morning BP were predictive of CV events (p < 0.05). The Akaike Information Criterion showed smaller values for AOBP than peak morning BP, indicating a better performance in predicting CV events (227.2736 and 238.7413, respectively). The C-index was 0.6563 for systolic AOBP and 0.6243 for peak morning BP indicating a better predicting ability for AOBP.
CONCLUSION
In initially untreated hypertensives, AOBP appears to be at least equally reliable to 24-h monitoring in the evaluation of morning BP peak in order to detect CV disease whereas the sleep-trough and preawakening morning BP surge did not indicate such an effect.
Topics: Adult; Aged; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Circadian Rhythm; Female; Humans; Hypertension; Male; Middle Aged; Office Visits; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Time Factors
PubMed: 30989620
DOI: 10.1007/s40292-019-00315-7 -
Cancer Nursing 2019Morning fatigue is a distinct symptom experienced during chemotherapy that demonstrates significant interindividual variability.
BACKGROUND
Morning fatigue is a distinct symptom experienced during chemotherapy that demonstrates significant interindividual variability.
OBJECTIVES
The aims of this study were to identify subgroups with distinct morning fatigue profiles and evaluate how these subgroups differed by demographic, clinical, and symptom characteristics.
METHODS
Outpatients (N = 1332) with breast, gastrointestinal, gynecological, or lung cancer completed questionnaires 6 times over 2 cycles of chemotherapy. Morning fatigue was assessed with the Lee Fatigue Scale. Latent profile analysis was used to identify distinct morning fatigue profiles.
RESULTS
Four morning fatigue profiles (ie, very low, low, high, and very high) were identified. In the high and very high classes, all 6 morning fatigue scores were higher than the clinical cutoff score. Compared with those in the very low and low classes, patients in the very high class were younger and not married/partnered; lived alone; had higher incomes, higher comorbidity, and higher body mass index; and did not exercise regularly. Across the 4 classes, functional status and attentional function scores decreased and anxiety, depression, sleep disturbance, morning fatigue, and evening fatigue scores increased across the 2 cycles.
CONCLUSION
Results provide insights into modifiable risk factors for morning fatigue. These risk factors can be used to develop more targeted interventions.
IMPLICATIONS FOR PRACTICE
Patients in the high and very high morning fatigue classes experienced high symptom and comorbidity burdens and significant decrements in functional status. Using this information, clinicians can identify patients who are at an increased risk for higher levels of morning fatigue and prescribe interventions to improve this devastating symptom.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Fatigue; Female; Humans; Male; Middle Aged; Neoplasms; Outpatients; Risk Factors; Severity of Illness Index; Sleep Wake Disorders; Surveys and Questionnaires
PubMed: 30024437
DOI: 10.1097/NCC.0000000000000626