-
CNS Drugs Jan 2023Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing mental disorder. Individuals with ADHD typically experience symptoms from awakening throughout... (Review)
Review
Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing mental disorder. Individuals with ADHD typically experience symptoms from awakening throughout the entire day, contributing to impaired function at home, at school, and in the workplace. Treatment is available to address the symptoms of ADHD; however, the extent to which treatments afford improved function remains less clear. Impaired function in children and adolescents, particularly in the early morning where multiple tasks must be completed, from getting out of bed, and having breakfast to leaving for school on time, is common even among stimulant-treated children, and can increase stress upon caregivers and family members. Herein, we present a narrative review on early morning functioning impairment in children and adolescents with ADHD, its impact on caregivers, the rating scales available for clinicians to identify the degree of early morning functioning impairment, and the efficacy of currently available treatments in providing functional improvements to patients with ADHD during the early morning, identifying that only treatments that are available upon awakening have been shown to statistically separate from placebo for early morning functioning improvement.
Topics: Child; Adolescent; Humans; Attention Deficit Disorder with Hyperactivity; Caregivers; Central Nervous System Stimulants
PubMed: 36520318
DOI: 10.1007/s40263-022-00978-2 -
Sports Medicine (Auckland, N.Z.) Oct 2023Some physiological responses such as circulating glucose as well as muscle performance show a circadian rhythmicity. In the present study we aimed to quantitatively... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Some physiological responses such as circulating glucose as well as muscle performance show a circadian rhythmicity. In the present study we aimed to quantitatively synthesize the data comparing the metabolic adaptations induced by morning and afternoon training.
METHODS
PubMed, SCOPUS, and Web of Science databases were systematically searched for studies comparing the metabolic adaptations (> 2 weeks) between morning and afternoon training. A meta-analysis was performed using random-effects models with DerSimonian-Laird methods for fasting blood glucose, hemoglobin A1c (HbAc1), homeostatic model assessment (HOMA), insulin, triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL).
RESULTS
We identified 9 studies with 11 different populations (n = 450 participants). We found that afternoon exercise was more effective at reducing circulating triglycerides [standardized mean difference (SMD) - 0.32; 95% confidence interval (CI) - 0.616 to - 0.025] than morning training. Moreover, afternoon tended to decrease fasting blood glucose (SMD - 0.24; 95% CI - 0.478 to 0.004) to a greater extent than morning training.
CONCLUSION
Metabolic adaptations to exercise may be dependent on the time of day. Morning training does not show superior effects to afternoon exercise in any of the analyzed outcomes. However, afternoon training is more effective at reducing circulating triglyceride levels and perhaps at reducing fasting blood glucose than morning training. The study was preregistered at PROSPERO (CRD42021287860).
Topics: Humans; Blood Glucose; Glucose; Triglycerides; Insulin; Glycated Hemoglobin
PubMed: 37458979
DOI: 10.1007/s40279-023-01879-0 -
BMJ Supportive & Palliative Care Dec 2023Purposes were to identify subgroups of patients with gastrointestinal cancers with distinct morning and evening fatigue severity profiles and evaluate for differences...
BACKGROUND
Purposes were to identify subgroups of patients with gastrointestinal cancers with distinct morning and evening fatigue severity profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, co-occurring symptoms and quality of life (QOL) outcomes.
METHODS
Patients with gastrointestinal cancers (n=405) completed questionnaires six times over two cycles of chemotherapy. Latent profile analysis was used to identify distinct morning and evening fatigue profiles. Differences in demographic and clinical characteristics, co-occurring symptoms and QOL outcomes among the subgroups were evaluated using parametric and nonparametric tests.
RESULTS
Two distinct mornings (ie, low and very high) and three distinct evenings (ie, low, moderate and very high) fatigue classes were identified. Common risk factors for both morning and evening fatigue included younger age, lower performance status, higher comorbidity burden and self-reported depression. Higher levels of morning fatigue were associated with being unmarried, living alone, being unemployed, having a lower income, lack of regular exercise and a self-reported diagnosis of anaemia. Higher levels of evening fatigue were associated with being women, white and having childcare responsibilities. Patients in the very high morning and evening fatigue classes reported higher levels of anxiety, depressive symptoms, sleep disturbance and pain and lower levels of attentional function and poorer QOL.
CONCLUSION
Findings provide new insights into risk factors for and deleterious effects of morning and evening fatigue in patients with gastrointestinal cancers. Clinicians can use this information to identify high-risk patients and develop individualised interventions for morning and evening fatigue and other co-occurring symptoms.
Topics: Female; Humans; Male; Antineoplastic Agents; Fatigue; Gastrointestinal Neoplasms; Quality of Life
PubMed: 34049967
DOI: 10.1136/bmjspcare-2021-002914 -
Frontiers in Nutrition 2022Light is an important environmental factor that regulates the activity of metabolism-related biochemical pathways during tomato maturation. Using LED to improve lighting...
Light is an important environmental factor that regulates the activity of metabolism-related biochemical pathways during tomato maturation. Using LED to improve lighting conditions during the process of tomato growth and development is a feasible and efficient method to improve the quality of tomato fruit. In this study, red and blue LEDs were used to supplement light on "MicroTom" tomato plants for different periods of time in the morning and evening, and the differences between the primary and secondary metabolites and other nutrient metabolites in the tomato fruit were analyzed using liquid chromatography and liquid chromatography mass spectrometry and other methods. Supplementing light in the morning promoted the accumulation of vitamin C, organic acids, amino acids, carotenoids, phenolic acids, and other health-promoting substances in the tomato fruits. Supplementing light in the evening significantly increased the content of sugars, flavonoids, and aromatic substances in tomato fruits, whereas the promoting effect of LED on the accumulation of amino acids and carotenoids was lower in the evening than in the morning. Both morning and evening light supplementation reduced the mineral content of fruit. In conclusion, morning light supplementation improved the nutritional quality of tomato fruits, while evening light supplementation improved their flavor.
PubMed: 35174200
DOI: 10.3389/fnut.2022.833723 -
Frontiers in Pharmacology 2023Ondansetron is a selective antagonist of the serotonin 5-HT3 receptor that is commonly used to treat morning sickness. It is estimated that 70%-80% of pregnant women...
Ondansetron is a selective antagonist of the serotonin 5-HT3 receptor that is commonly used to treat morning sickness. It is estimated that 70%-80% of pregnant women suffer from morning sickness, a condition characterized by nausea and vomiting. However, it is still controversial regarding its safety during pregnancy, and continued research will be necessary to fully understand the risks and benefits associated with its use. Therefore, we aimed to identify and provide details of the efficacy and safety of ondansetron in clinical trials. A search was conducted of the ClinicalTrials.gov database on 13 April 2023, using the search term "ondansetron and pregnancy." Inclusion and exclusion criteria were defined to identify relevant clinical trials. The inclusion criteria encompassed clinical trials related to pregnancy that utilized ondansetron as a treatment, while other clinical trials were excluded from consideration. All data extractions such as study title, study status, study type, intervention details, and outcome were collected. A total of 18 clinical trials were identified, of which only 6 focused on studying the effects of ondansetron. Their respective study titles, statuses, conditions, interventions, outcome measures, and enrollment sizes have been written in detail. The information collected from these trials will contribute to our understanding of the potential benefits and risks of ondansetron in the context of pregnancy and its complications. Ondansetron has been shown to be an effective treatment for nausea and vomiting, including pregnancy-related morning sickness. Further research is needed to better understand the potential risks and benefits associated with its use in pregnant women. ClinicalTrials.gov, identifier.
PubMed: 37936910
DOI: 10.3389/fphar.2023.1291235 -
Journal of the Endocrine Society Dec 2022Blood pressure and plasma catecholamines normally decline during sleep and rapidly increase in early morning. This is blunted in adults with type 2 diabetes (T2D).
CONTEXT
Blood pressure and plasma catecholamines normally decline during sleep and rapidly increase in early morning. This is blunted in adults with type 2 diabetes (T2D).
OBJECTIVE
We hypothesize that increased sympatho-adrenal activity during sleep differentiates youth with T2D from nondiabetic obese youth and lean youth.
METHODS
Fasting spot morning and 24-hour urines were collected in obese adolescents with and without T2D, and normal-weight controls. Fractionated free urine catecholamines (epinephrine, norepinephrine, and dopamine) were measured, and the ratio of fasting spot morning to 24-hour catecholamines was calculated.
RESULTS
Urinary 24-hour catecholamine levels were comparable across the 3 groups. Fasting morning epinephrine and the ratio of fasting morning/24-hour epinephrine were higher in youth with T2D ( = 0.004 and = 0.035, respectively). In males, the ratio of fasting morning/24-hour epinephrine was also higher in youth with T2D ( = 0.005). In females, fasting morning norepinephrine and the ratio of fasting morning/24-hour dopamine were lower in obese youth with and without T2D ( = 0.013 and = 0.005, respectively) compared with lean youth. Systolic blood pressure was higher in diabetic participants than other groups; males trended higher than females.
CONCLUSION
Circadian rhythm in catecholamines is disrupted in youth-onset T2D, with a blunted overnight fall in urinary epinephrine in males. Conversely, fasting morning norepinephrine and dopamine levels were lower in obese females with or without T2D. Higher nocturnal catecholamines in males with T2D might associate with, or predispose to, hypertension and cardiovascular complications. Lower catecholamine excretion in females with obesity might serve an adaptive, protective role.
PubMed: 36632209
DOI: 10.1210/jendso/bvac190 -
Chronobiology International Dec 2021Circadian clocks regulate multiple physiological domains from molecular to behavioral levels and adjust bodily physiology to seasonal changes in day length. Circadian...
Circadian clocks regulate multiple physiological domains from molecular to behavioral levels and adjust bodily physiology to seasonal changes in day length. Circadian regulation of cellular bioenergy and immunity in the cardiovascular and muscle systems may underpin the individual diurnal differences in performance capacity during exercise. Several studies have shown diurnal differences in cardiopulmonary parameters at maximal and submaximal workloads in morning and evening circadian human phenotypes. However, the effect of seasons on these changes was not elucidated. In this study, we recruited subjects with Morningness-Eveningness Questionnaire scores corresponding to morning and evening types. Subjects underwent morning (7:00-9:00) and evening (20:00-22:00) maximal workload spiroergometry in both winter and summer seasons. We analyzed their performance time, anaerobic threshold, heart rate, and respiratory parameters. Our results suggest that evening types manifest diurnal variations in physical performance, particularly in winter. They also have slower heart rate recovery than morning types, irrespective of the time of day or season. Compared to winter, the chronotype effect on the magnitude of morning-evening differences in performance time, maximal heart rate, and anaerobic threshold onset was more significant in summer. Our data are in concordance with previous observations and confirm the difference between morning and evening types in the timing of maximum performance capacity.
Topics: Circadian Clocks; Circadian Rhythm; Exercise; Humans; Seasons; Surveys and Questionnaires
PubMed: 34128445
DOI: 10.1080/07420528.2021.1938598 -
Journal of Hospital Medicine Jun 2021Many initiatives seek to increase the number of morning hospital discharges to improve patient flow, but little evidence supports this practice.
BACKGROUND
Many initiatives seek to increase the number of morning hospital discharges to improve patient flow, but little evidence supports this practice.
OBJECTIVE
To determine the association between the number of morning discharges and emergency department (ED) length of stay (LOS) and hospital LOS in general internal medicine (GIM).
DESIGN, SETTING, AND PARTICIPANTS
Multicenter retrospective cohort study involving all GIM patients discharged between April 1, 2010, and October 31, 2017, at seven hospitals in Ontario, Canada.
MAIN MEASURES
The primary outcomes were ED LOS and hospital LOS, and secondary outcomes were 30-day readmission and in-hospital mortality. The number of morning GIM discharges (defined as the number of patients discharged alive between 8:00 AM and 12:00 PM) on the day of each hospital admission was the primary exposure. Multivariable regression models were fit to control for patient characteristics and situational factors, including GIM census.
RESULTS
The sample included 189,781 patient admissions. In total, 36,043 (19.0%) discharges occurred between 8:00 AM and 12:00 PM. The average daily number of morning discharges and total discharges per hospital was 1.7 (SD, 1.4) and 8.4 (SD, 4.6), respectively. The median ED LOS was 14.5 hours (interquartile range [IQR], 10.0- 23.1), and the median hospital LOS was 4.6 days (IQR, 2.4-9.0). After multivariable adjustment, there was not a significant association between morning discharge and hospital LOS (adjusted rate ratio [aRR], 1.000; 95% CI, 0.996-1.000; P = .997), ED LOS (aRR, 0.999; 95% CI, 0.997-1.000; P = .307), 30-day readmission (aRR, 1.010; 95% CI, 0.991-1.020; P = .471), or in-hospital mortality (aRR, 0.967; 95% CI, 0.920-1.020; P = .183). The lack of association between morning discharge and LOS was generally consistent across all seven hospitals. At one hospital, morning discharge was associated with a 1.9% shorter ED LOS after multivariable adjustment (aRR, 0.981; 95% CI, 0.966-0.996; P = .013).
CONCLUSIONS
The number of morning discharges was not significantly associated with shorter ED LOS or hospital LOS in GIM. Our findings suggest that increasing the number of morning discharges alone is unlikely to substantially improve patient throughput in GIM, but further research is needed to determine the effectiveness of specific interventions.
Topics: Emergency Service, Hospital; Humans; Inpatients; Length of Stay; Ontario; Patient Admission; Patient Discharge; Patient Readmission; Retrospective Studies
PubMed: 34129483
DOI: 10.12788/jhm.3605 -
European Journal of Clinical Nutrition Oct 2022Although regular breakfast consumption is associated with various health benefits, many adolescents skip this meal, particularly those with shorter sleep durations. In...
BACKGROUND/OBJECTIVES
Although regular breakfast consumption is associated with various health benefits, many adolescents skip this meal, particularly those with shorter sleep durations. In order to better understand the association between sleep duration and breakfast consumption among youth, we analyzed the association between weekday morning tiredness and daily breakfast consumption in adolescents, and explored the mediating role of morning tiredness in the association between sleep duration and daily breakfast consumption on weekdays.
SUBJECTS/METHODS
The "Health Behaviour in School-aged Children" survey conducted in 2018 in French-speaking Belgian schools provided data (n = 8444 11-20-year-old adolescents) on bed- and wake-up times, and on the frequency of breakfast consumption and morning tiredness on weekdays. Multivariable logistic regressions and mediation analyses assessed the association, on weekdays, of morning tiredness (≥4 school mornings a week vs. less) and sleep duration (hours), with daily breakfast consumption, and the mediating role of morning tiredness.
RESULTS
Feeling tired ≥4 school mornings a week was associated with lower odds of daily breakfast consumption on weekdays (aOR = 0.77 (95% CI 0.69-0.86)). In turn, on weekdays, sleep duration was positively associated with daily breakfast consumption (aOR = 1.29 (95% CI 1.23-1.36)), even after adjustment for morning tiredness (aOR = 1.28 (95% CI 1.21-1.35)). Morning tiredness only explained 4.9% of the association between sleep duration and daily breakfast consumption.
CONCLUSION
Our findings suggest that in adolescents, sleep duration and morning tiredness are independent correlates of daily breakfast consumption on weekdays.
Topics: Adolescent; Breakfast; Caffeine; Child; Feeding Behavior; Humans; Schools; Sleep; Surveys and Questionnaires
PubMed: 35332297
DOI: 10.1038/s41430-022-01117-2 -
Neurology Feb 2023In medical school, students learn to view the world through a biomedical lens. While necessary clinically, this lens can be impersonal. For example, the mental status...
In medical school, students learn to view the world through a biomedical lens. While necessary clinically, this lens can be impersonal. For example, the mental status examination (MSE) evaluates cognitive function through a brief assessment of alertness and orientation to person, place, time, and situation. While clinically useful, the MSE often neglects to capture a person's individuality. Visiting my grandmother who has Alzheimer disease highlighted this tension. I juxtaposed the impersonality of our MSE orientation scale with my grandmother's lived experiences. My grandmother is identified using a pseudonym. Informed consent was obtained from her health care power of attorney and family.Birds twitter and chirp as they flit into the shade,the covered patio a respite from the morning's heat.I sit with Joanna and show her a painting:an apple, red peppers, a garlic clove, and a grapefruitrest on a white napkin.Produce so vibrant the napkin is stainedwith their vivid reflections.The wrinkles around her eyes deepen as she squints at the picture.She always liked to see my artwork.Bright colors illuminate the lines of confusion on her face.Where did you get all this food?We're rationing for the war to stop Hitler.I have evaluated dementia:limited treatment options, behavioral interventions.Cognitive changes alterorientation to self,place, time, situation.Joanna and I sit on the memory care patio.The birdfeeder dances in the humid summer air.I've shared my artwork with Grandma Jofrom crayons' waxy scrawlto crisp acrylic colors.Today a t-shirt replaces my white coat.The war is over, grandma.The produce is from a grocery store.I redirect with another painting.This is a bridge in a park-She smiles: it's New York City, I miss going there.In the middle of Central Park,a cement bridge in a grassy parkspans a wide, still pond.Today, the colors of the bridge,reflected on the water,spark a glimmer of my grandmother.This time she knows the memory is in the past,as she tells me about New York in the Forties.With the beating of sparrow wings,the moment of clarity endsas past and present are blended again.When the sun sinks, my visit will fade.I clutch what happenedoutside, away from the clinical setting.What we cannot quantifywith A&O x1: oriented to self.
Topics: Humans; Female; Alzheimer Disease; Emotions; Brain; New York City
PubMed: 36443014
DOI: 10.1212/WNL.0000000000201602