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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 -
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 -
Blood Oct 2015Iron supplements acutely increase hepcidin, but the duration and magnitude of the increase, its dose dependence, and its effects on subsequent iron absorption have not... (Comparative Study)
Comparative Study Randomized Controlled Trial
Iron supplements acutely increase hepcidin, but the duration and magnitude of the increase, its dose dependence, and its effects on subsequent iron absorption have not been characterized in humans. Better understanding of these phenomena might improve oral iron dosing schedules. We investigated whether the acute iron-induced increase in hepcidin influences iron absorption of successive daily iron doses and twice-daily iron doses. We recruited 54 nonanemic young women with plasma ferritin ≤20 µg/L and conducted: (1) a dose-finding investigation with 40-, 60-, 80-, 160-, and 240-mg labeled Fe as [(57)Fe]-, [(58)Fe]-, or [(54)Fe]-FeSO4 given at 8:00 am fasting on 1 or on 2 consecutive days (study 1, n = 25; study 2, n = 16); and (2) a study giving three 60-mg Fe doses (twice-daily dosing) within 24 hours (study 3, n = 13). In studies 1 and 2, 24 hours after doses ≥60 mg, serum hepcidin was increased (P < .01) and fractional iron absorption was decreased by 35% to 45% (P < .01). With increasing dose, fractional absorption decreased (P < .001), whereas absolute absorption increased (P < .001). A sixfold increase in iron dose (40-240 mg) resulted in only a threefold increase in iron absorbed (6.7-18.1 mg). In study 3, total iron absorbed from 3 doses (2 mornings and an afternoon) was not significantly greater than that from 2 morning doses. Providing lower dosages (40-80 mg Fe) and avoiding twice-daily dosing maximize fractional absorption. The duration of the hepcidin response supports alternate day supplementation, but longer-term effects of these schedules require further investigation. These clinical trials were registered at www.ClinicalTrials.gov as #NCT01785407 and #NCT02050932.
Topics: Administration, Oral; Adolescent; Adult; Biological Availability; Biomarkers; Case-Control Studies; Cross-Over Studies; Dietary Supplements; Drug Administration Schedule; Female; Ferritins; Follow-Up Studies; Hepcidins; Humans; Intestinal Absorption; Iron; Iron, Dietary; Male; Middle Aged; Prognosis; Young Adult
PubMed: 26289639
DOI: 10.1182/blood-2015-05-642223 -
JAMA Neurology Aug 2023Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV). (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV).
OBJECTIVE
To compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.
DESIGN, SETTING, AND PARTICIPANTS
This prospective randomized clinical trial was performed at 3 national referral centers (in Munich, Germany; Siena, Italy; and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Recruitment took place from June 1, 2020, until March 10, 2022. Patients were selected randomly during routine outpatient care after being referred to 1 of the 3 centers. Two hundred fifty-three patients were assessed for eligibility. After consideration of the exclusion criteria as well as informed consent, 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. The analysis was prespecified and per-protocol.
INTERVENTIONS
After being randomized to the SM-plus or the EM group, patients received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening.
MAIN OUTCOME AND MEASURES
Patients had to document whether they could provoke positional vertigo every morning. The primary end point was the number of days until no positional vertigo could be induced on 3 consecutive mornings. The secondary end point was the effect of the single maneuver performed by the physician.
RESULTS
Of the 195 participants included in the analysis, the mean (SD) age was 62.6 (13.9) years, and 125 (64.1%) were women. The mean (SD) time until no positional vertigo attacks could be induced in the SM-plus group was 2.0 (1.6) days (median, 1 [range, 1-8] day; 95% CI, 1.64-2.28 days); in the EM group, 3.3 (3.6) days (median, 2 [range, 1-20] days; 95% CI, 2.62-4.06 days) (P = .01; α = .05, 2-tailed Mann-Whitney test). For the secondary end point (effect of a single maneuver), no significant difference was detected (67 of 98 [68.4%] vs 61 of 97 [62.9%]; P = .42; α = .05). No serious adverse event was detected with both maneuvers. Nineteen patients (19.6%) in the EM group and 24 (24.5%) in the SM-plus group experienced relevant nausea.
CONCLUSIONS AND RELEVANCE
The SM-plus self-maneuver is superior to the EM self-maneuver in terms of the number of days until recovery in pcBPPV.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05853328.
Topics: Humans; Female; Middle Aged; Male; Benign Paroxysmal Positional Vertigo; Prospective Studies; Physical Therapy Modalities; Treatment Outcome; Ambulatory Care
PubMed: 37358870
DOI: 10.1001/jamaneurol.2023.1408 -
Hypertension Research : Official... Sep 2023Although social jetlag (SJL) is generally considered a chronic condition, even acute SJL may have unfavorable effects on the cardiovascular system. We focused on the... (Randomized Controlled Trial)
Randomized Controlled Trial
Although social jetlag (SJL) is generally considered a chronic condition, even acute SJL may have unfavorable effects on the cardiovascular system. We focused on the acute effects of SJL on morning blood pressure (BP) surge. This randomized crossover trial recruited 20 healthy men. In the SJL trial, participants delayed their bedtime by three hours on Friday and Saturday nights. Participants in the control (CON) trial implemented the same sleep-wake timing as on weekdays. Pre- and post-intervention measurements were performed to evaluate resting cardiovascular variables on Friday and Monday mornings, respectively. The ambulatory BP was automatically measured during the sleep and awake periods for 2 h after the participant woke up at night before pre- and post-intervention measurements. SJL (average mid-sleep time on weekends - average mid-sleep time on weekdays) occurred only in the SJL trial (SJL: 181 ± 24 min vs. CON: 8 ± 47 min). Carotid-femoral pulse wave velocity (cfPWV) and morning BP surge on Monday in the SJL trial were significantly higher than those on Friday in the SJL trial (cfPWV: P = 0.001, morning BP surge: P < 0.001), and those on Monday in the CON trial (cfPWV: P = 0.007; morning BP surge: P < 0.001). Furthermore, a significant positive correlation was found between ΔcfPWV and Δmorning BP surge (R = 0.587, P = 0.004). These results suggest that even acute SJL augments morning BP surge. This phenomenon may correspond to increased central arterial stiffness.State the details of Clinical Trials: Name: Effect of acute social jetlag on risk factors of lifestyle-related diseases. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053204 . Unique identifier: UMIN000046639. Registration date: 17/01/2022.
Topics: Male; Humans; Blood Pressure; Circadian Rhythm; Pulse Wave Analysis; Cross-Over Studies; Sleep; Blood Pressure Monitoring, Ambulatory
PubMed: 37452155
DOI: 10.1038/s41440-023-01360-5 -
Psychology of Addictive Behaviors :... May 2024Affective experiences are associated with smoking urges and behavior. Few studies have examined the temporal nature of these associations within a day, such as whether... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Affective experiences are associated with smoking urges and behavior. Few studies have examined the temporal nature of these associations within a day, such as whether positive and negative affect in the morning are associated with smoking urges and behavior later in the day.
METHOD
Participants ( = 63; = 50 years, 48% female; 60% White) were randomized into one of three smoking cessation interventions and answered up to five daily ecological momentary assessments for 28 days during a quit attempt ( = 21.0 days, = 7.1). Before analysis, scores for morning positive and negative affect and later-day smoking urges and behavior were calculated.
RESULTS
On days when individuals' morning positive affect was higher than usual, later-day smoking urges tended to be lower than usual. In contrast, on days when individuals' morning negative affect was higher than usual, later-day smoking urges tended to be higher than usual, and smoking was more likely. Further, individuals who had higher characteristic morning positive affect tended to have less intense later-day smoking urges, whereas those who tended to have higher characteristic morning negative affect tended to have more intense later-day smoking urges.
CONCLUSIONS
Morning positive and negative affect were associated with later-day smoking urges, and morning negative affect was related to later-day smoking behavior. Future research should examine whether interventions that boost positive affect on mornings when it is lower than usual and attenuate negative affect on mornings when it is higher than usual, may reduce the intensity of smoking urges and the likelihood of smoking later in the day. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Topics: Humans; Female; Male; Middle Aged; Smoking Cessation; Affect; Ecological Momentary Assessment; Adult; Smoking; Time Factors; Craving
PubMed: 38095939
DOI: 10.1037/adb0000970 -
European Journal of Nutrition Sep 2021We previously observed increased energy intake (EI) at the meal before planned afternoon exercise, but the proximity of the meal to exercise might have reduced the scale...
PURPOSE
We previously observed increased energy intake (EI) at the meal before planned afternoon exercise, but the proximity of the meal to exercise might have reduced the scale of the pre-exercise anticipatory eating. Therefore, this study examined EI in the 24 h before fasted morning exercise.
METHODS
Fourteen males, experienced with gym-based aerobic exercise (age 25 ± 5 years, BMI 23.8 ± 2.5 kg/m), completed counterbalanced exercise (EX) and resting (REST) trials. On day 1, subjects were told the following morning's activity (EX/REST), before eating ad-libitum laboratory-based breakfast and lunch meals and a home-based afternoon/evening food pack. The following morning, subjects completed 30-min cycling and 30-min running (EX; 3274 ± 278 kJ) or 60-min supine rest (REST; 311 ± 34 kJ) fasted. Appetite was measured periodically, and EI quantified.
RESULTS
Afternoon/evening EI (EX 7371 ± 2176 kJ; REST 6437 ± 2070 kJ; P = 0.017) and total 24-h EI (EX 14,055 ± 3672 kJ; REST 12,718 ± 3379 kJ; P = 0.011) were greater during EX, with no difference between trials at breakfast (P = 0.761) or lunch (P = 0.071). Relative EI (EI minus energy expended through EX/REST) was lower in EX (EX 10,781 ± 3539 kJ; REST 12,407 ± 3385 kJ; P = 0.004).
CONCLUSION
This study suggests planned fasted aerobic exercise increases EI during the preceding afternoon/evening, precipitating a ~ 10% increase in EI in the preceding 24-h. However, this increase did not fully compensate for energy expended during exercise; meaning exercise induced an acute negative energy balance.
Topics: Adult; Appetite; Energy Intake; Energy Metabolism; Exercise; Fasting; Feeding Behavior; Humans; Male; Young Adult
PubMed: 33620552
DOI: 10.1007/s00394-021-02501-7 -
Brain and Cognition Mar 2024Adolescents may be less ready to learn in the mornings due to a propensity for waking up later. High-intensity interval exercise (HIIE) has been shown to acutely improve...
PURPOSE
Adolescents may be less ready to learn in the mornings due to a propensity for waking up later. High-intensity interval exercise (HIIE) has been shown to acutely improve cognitive functioning in teenagers. This within-measures study explored whether the benefit of HIIE differs when delivered in the morning or afternoon.
METHODS
37 teenagers (19 boys, 13.7 ± 0.4 years) each completed 3 trials in school; morning HIIE (MORN), afternoon HIIE (AFTER) and a no-exercise control trial (CON). The HIIE involved 10x10 second sprints, interspersed by 50 s of walking. Cognitive function was assessed using a battery of computerised tasks four times over the course of the day.
RESULTS
Z scores for reaction time, but not proportion of correct responses, were improved 45 min post exercise in the MORN trial (P < 0.01, d = 0.47), and this improvement persisted until the third (P = 0.04, d = 0.34), but not final (P = 0.93, d = 0.01), time point. Global reaction time was not improved 45 min post exercise in the AFTER trial (P = 0.17, d = 0.20). Global reaction time was quicker 45 min post morning exercise compared to the same time point in CON (P = 0.02, d = 0.56) and AFTER (P = 0.01, d = 0.72).
CONCLUSION
HIIE may be more effectual in improving cognitive functioning when delivered in the morning.
Topics: Adolescent; Humans; Male; Cognition; Exercise; Learning; Time; Walking; Female
PubMed: 38306762
DOI: 10.1016/j.bandc.2024.106135 -
Scandinavian Journal of Work,... Jul 2019Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated...
Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated both with shift work and diet, such as sleep and mood, that may further influence food intake among shift workers. The aim of this study was to explore the relationship between shift work, sleep, mood, and diet. Methods Shift working nurses [N=52; 46 female; age: mean 39.8 (SD 12.4) years] participated in a 14-day, repeated measures, within- and between-subjects design study. Analyses included data from 40 nurses over 181 shifts. Food diaries were completed for a minimum of three days per shift type (morning, afternoon, night). Foodworks nutrition software was used to determine energy intake in kilojoules and macronutrient intake (as a percentage of total energy intake). Mood (happiness, anxiety, depressive mood, stress, and tiredness) was measured using visual analog scales. Sleep was estimated using actigraphy. Demographic and work-related variables (covariates) were measured using a modified version of the Standard Shiftwork Index. A path analysis was conducted using generalized structural equation modelling with a random effect of participant ID. Predictors were selected using purposive selection of covariates (an alternative to stepwise modelling) and final models included important predictors only. Results Compared to night and morning shifts, results showed that working an afternoon shift was associated with a lower energy intake (β= -1659.4, P<0.01) and lower levels of stress (β= -5.6, P<0.01). Higher levels of stress were associated with a higher energy intake (β=35.3, P<0.01) and a higher percentage of fat (ß=0.1, P=0.05) and saturated fat (β=0.1, P<0.01). Compared to the other shift types, morning shift was associated with lower carbohydrates (β= -4.3, P<0.01) and night shift was associated with lower protein (β= -2.7, P=0.03). Lower sleep efficiency was associated with a higher carbohydrate intake (β= -0.4, P<0.01) and a lower protein intake (β=0.25, P<0.01) Conclusions Results suggest that compared to nights and mornings, afternoon shifts were associated with reduced energy consumption. Negative mood (stress, depression, and anxiety) mediated the association between shift type and energy intake. Negative mood was also associated with higher fat intake. Dietary interventions for shift workers should consider the role of mood as well as shift type.
Topics: Adult; Affect; Circadian Rhythm; Diet; Energy Intake; Fatigue; Female; Humans; Male; Middle Aged; Occupational Health; Occupational Stress; Shift Work Schedule; Sleep; Socioeconomic Factors
PubMed: 30806474
DOI: 10.5271/sjweh.3803 -
Sleep Advances : a Journal of the Sleep... 2022During adolescence, an interplay between biological and environmental factors leads to constrained sleep duration and timing. The high prevalence of sleep deprivation...
STUDY OBJECTIVES
During adolescence, an interplay between biological and environmental factors leads to constrained sleep duration and timing. The high prevalence of sleep deprivation during this developmental period is a public health concern, given the value of restorative sleep for mental, emotional, and physical health. One of the primary contributing factors is the normative delay of the circadian rhythm. Therefore, the present study aimed to evaluate the effect of a gradually advanced morning exercise schedule (30 min shift each day) completed for 45 min on 5 consecutive mornings, on the circadian phase and daytime functioning of adolescents with a late chronotype, compared with a sedentary control group.
METHODS
A total of 18 physically inactive male adolescents aged 15-18 years spent 6 nights at the sleep laboratory. The morning procedure included either 45 min walking on a treadmill or sedentary activities in dim light. Saliva dim light melatonin onset, evening sleepiness, and daytime functioning were assessed during the first and last night of laboratory attendance.
RESULTS
The morning exercise group had a significantly advanced (earlier) circadian phase (27.5 min ± 32.0), while sedentary activity resulted in a phase delay (-34.3 min ± 53.2). Morning exercise also led to higher evening sleepiness in the earlier hours of the night, but not at bedtime. Mood measures improved slightly in both study conditions.
CONCLUSIONS
These findings highlight the phase-advancing effect of low-intensity morning exercise among this population. Future studies are needed to test the transference of these laboratory findings to adolescents' real life.
PubMed: 37193396
DOI: 10.1093/sleepadvances/zpac021