Sleep duration and all-cause mortality among stroke survivors.

BACKGROUND: Post stroke sleep duration could increase the risk of death. This study tested the hypothesis that inadequate sleep duration is associated with increased mortality among stroke survivors. METHODS: The REasons for Geographic And Racial Differences in Stroke (REGARDS), a national population-based longitudinal study, was the data source. Sleep duration was ascertained between 2013 and 2016 among stroke survivors who were subsequently followed up until death or censored on December 31, 2022. Sleep duration was estimated as the difference between wake-up time and bedtime to which was subtracted the time spent in bed without sleep. Cox proportional hazards regression models were employed to investigate the association between sleep duration and all-cause mortality adjusting for demographic factors, socioeconomic factors, behavioral factors, and co-morbidities. RESULTS: A total of 468 non-Hispanic Black and White stroke survivors were included in this analysis. The mean age was 76.3 years, 52.6% were females and 56.0% were non-Hispanic White individuals. The distribution of short (≤6 h), adequate (7.0-8.9 h), and long sleep (≥9 h) was 30.3%, 44.7%, and 25%, respectively. Over a mean follow-up of 5.0 years, 190 (40.6%) deaths occurred. Compared to stroke survivors with adequate sleep (7.0-8.9 h), stroke survivors with long sleep (≥9 h) were at increased risk of all-cause mortality (HR=1.46, 95% CI=1.01, 2.12). However, short sleep (≤6 h) was not significantly associated with an increased risk of all-cause mortality (HR=1.31, 95% CI=0.90, 1.91). Subgroup analyses indicated higher risk in the age <75 years, females, non-Hispanic Black individuals, and those living in the Stroke Belt region, but those differences were not statistically significant. CONCLUSION: In this study of stroke survivors, 9 hours or more of sleep per day was associated with an increased risk of all-cause mortality. This finding suggests that excessive sleep duration may be a warning sign of poor life expectancy in stroke survivors.

Longitudinal and cross-sectional associations between the dietary inflammatory index and objectively and subjectively measured sleep among police officers.

Police officers experience exposures associated with increased inflammation, such as the stress associated with shiftwork and poor-quality diet, both of which have been shown to affect sleep duration and quality. This study examined the longitudinal and cross-sectional effects of the Energy-density Dietary Inflammatory Index (E-DII™) on objectively and subjectively measured sleep among police officers. Data were derived from the Buffalo Cardio-Metabolic Occupational Police Stress Cohort (n = 464 at baseline), with longitudinal data collected from 2004 to 2019. A food frequency questionnaire obtained estimated dietary intake from which E-DII scores were calculated. Dependent variables were objectively (Micro Motion Logger Sleep Watch™) and subjectively (Pittsburgh Sleep Quality Index) measured sleep quality and quantity. The analyses included a series of linear mixed-effects models used to examine cross-sectional and longitudinal associations between the E-DII and sleep quantity and quality. Cross-sectionally, more pro-inflammatory diets were associated with higher wake-after-sleep-onset but improved subjective sleep quality. In models accounting for both longitudinal and cross-sectional effects, for every 1-unit increase in the E-DII scores over time (representing a pro-inflammatory change), wake-after-sleep-onset increased by nearly 1.4 min (p = 0.07). This result was driven by officers who primarily worked day shifts (ß = 3.33, p = 0.01). Conversely, for every 1-unit increase in E-DII score, the Pittsburgh Sleep Quality Index global score improved. More pro-inflammatory diets were associated with increased wake-after-sleep-onset, an objective measure of sleep quality. Intervention studies to reduce dietary inflammatory potential may provide greater magnitude of effect for changes in sleep quality.

Symptom Management Among Cancer Survivors: Randomized Pilot Intervention Trial of Heart Rate Variability Biofeedback.

Chronic cancer-related symptoms (stress, fatigue, pain, depression, insomnia) may be linked with sympathetic nervous system over-activation and autonomic imbalance. Decreased heart rate variability (HRV) is an indicator of autonomic dysregulation that is commonly observed among cancer survivors. HRV biofeedback (HRVB) training induces HRV coherence, which maximizes HRV and facilitates autonomic and cardiorespiratory homeostasis. This randomized, wait-list-controlled, pilot intervention trial tested the hypothesis that HRVB can improve HRV coherence and alleviate cancer-related symptoms. The intervention group (n = 17) received 4-6 weekly HRVB training sessions until participants demonstrated skill acquisition. Controls (n = 17) received usual care. Outcomes assessed at baseline and follow-up included 15-min HRV recordings (HRV Coherence Ratio), and symptoms of: stress, distress, post-traumatic stress disorder (PTSD), pain, depression, fatigue, and sleep disturbance. Linear mixed models for repeated measures were used to assess Group-by-Time interactions, pre- versus post-treatment differences in mean symptom scores, and group differences at follow-up. Mean HRV Coherence Ratios (± standard error) improved in the HRVB group at follow-up (baseline: 0.37 ± 0.05, post-intervention: 0.84 ± 0.18, p = 0.01), indicating intervention validity. Statistically significant Group-by-Time interactions indicated treatment-related improvements in HRV Coherence Ratios (p = 0.03, Pre-vs. post-treatment effect size [Cohen's d]: 0.98), sleep symptoms (p = 0.001, d = 1.19), and sleep-related daytime impairment (p = 0.005, d = 0.86). Relative to controls, the intervention group experienced trends toward improvements in stress, distress, fatigue, PTSD, and depression, although no other statistically significant Group-by-Time interactions were observed. This pilot intervention found that HRVB training reduced symptoms of sleep disturbance among cancer survivors. Larger-scale interventions are warranted to further evaluate the role of HRVB for managing symptoms in this population. Registration: NCT03692624 www.clinicaltrials.gov.

Shift Work and Heart Rate Variability Coherence: Pilot Study Among Nurses.

This study used ambient heart rate monitoring among health care workers to determine whether a novel measure of heart rate variability (HRV), as well as sleep disturbances, fatigue, or cognitive performance differed among non-rotating night shift nurses relative to those working permanent day shifts. Continuous ambulatory HRV monitoring was performed among night nurses (n = 11), and a comparison group of permanent day nurses (n = 7), over a 36-h period coinciding with the last two 12-h shifts of each participant's work week. Symptoms and psychomotor vigilance were assessed at the end of the ambient HRV monitoring period, and no differences between shifts were observed. Day nurses exhibited an increase in hourly mean HRV coherence ratios during their sleep period, suggesting a circadian pattern of cardiorespiratory phase coupling, whereas night nurses had no increase in HRV coherence ratios during their sleep period. The HRV coherence patterns were similar to high frequency HRV power among nurses on the same shift. To the authors knowledge, this study was the first to quantify patterns of the HRV coherence ratio among shiftworkers in a non-experimental (work/home) setting. The results suggest a pattern of autonomic dysregulation among night workers during their sleep period relative to those working day shifts. The HRV coherence ratio may serve as a novel indicator of HRV dysregulation among shift workers.

A healthy lifestyle index is associated with reduced risk of colorectal adenomatous polyps among non-users of non-steroidal anti-inflammatory drugs.

In a Columbia, South Carolina-based case-control study, we developed a healthy lifestyle index from five modifiable lifestyle factors (smoking, alcohol intake, physical activity, diet, and body mass index), and examined the association between this lifestyle index and the risk of colorectal adenomatous polyps (adenoma). Participants were recruited from a local endoscopy center and completed questionnaires related to lifestyle behaviors prior to colonoscopy. We scored responses on each of five lifestyle factors as unhealthy (0 point) or healthy (1 point) based on current evidence and recommendations. We added the five scores to produce a combined lifestyle index for each participant ranging from 0 (least healthy) to 5 (healthiest), which was dichotomized into unhealthy (0-2) and healthy (3-5) lifestyle scores. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) for adenoma with adjustment for multiple covariates. We identified 47 adenoma cases and 91 controls. In the main analyses, there was a statistically nonsignificant inverse association between the dichotomous (OR 0.54; 95% CI 0.22, 1.29) and continuous (OR 0.75; 95% CI 0.51, 1.10) lifestyle index and adenoma. Odds of adenoma were significantly modified by the use of non-steroidal anti-inflammatory drugs (NSAIDs) (p(interaction) = 0.04). For participants who reported no use of NSAIDs, those in the healthy lifestyle category had a 72% lower odds of adenoma as compared to those in the unhealthy category (OR 0.28; 95% CI 0.08, 0.98), whereas a one-unit increase in the index significantly reduced odds of adenoma by 53% (OR 0.47; 95% CI 0.26, 0.88). Although these findings should be interpreted cautiously given our small sample size, our results suggest that higher scores from this index are associated with reduced odds of adenomas, especially in non-users of NSAIDs. Lifestyle interventions are required to test this approach as a strategy to prevent colorectal adenomatous polyps.

Case-control study of breast cancer in India: Role of PERIOD3 clock gene length polymorphism and chronotype.

BACKGROUND: This study examined a PERIOD3 (PER3) gene variable number tandem repeat polymorphism and chronotype as potential BrCA risk factors among Indian women. METHODS: This case-control study included sporadic, histologically confirmed BrCA cases (n = 255) and controls (n = 249) from India with data collection from 2010-2012. RESULTS: Women with the 4/5 or 5/5 PER3 genotype had a nonstatistically significant 33% increased odds of BrCA. Cases were more likely to have a morning (OR = 2.43, 95% CI = 1.23-4.81) or evening (OR = 2.55, 95% CI = 1.19-5.47) chronotype. CONCLUSIONS: Findings are consistent with the possibility that extremes in chronotype may elicit circadian desynchronization, resulting in increased BrCA susceptibility.

Mercury in fish and adverse reproductive outcomes: results from South Carolina.

BACKGROUND: Mercury is a metal with widespread distribution in aquatic ecosystems and significant neurodevelopmental toxicity in humans. Fish biomonitoring for total mercury has been conducted in South Carolina (SC) since 1976, and consumption advisories have been posted for many SC waterways. However, there is limited information on the potential reproductive impacts of mercury due to recreational or subsistence fish consumption. METHODS: To address this issue, geocoded residential locations for live births from the Vital Statistics Registry (1995-2005, N = 362,625) were linked with spatially interpolated total mercury concentrations in fish to estimate potential mercury exposure from consumption of locally caught fish. Generalized estimating equations were used to test the hypothesis that risk of low birth weight (LBW, <2,500 grams) or preterm birth (PTB, < 37 weeks clinical gestation) was greater among women living in areas with elevated total mercury in fish, after adjustment for confounding. Separate analyses estimated term LBW and PTB risks using residential proximity to rivers with fish consumption advisories to characterize exposure. RESULTS: Term LBW was more likely among women residing in areas in the upper quartile of predicted total mercury in fish (odds ratio [OR] = 1.04; 95% confidence interval [CI]: 1.00-1.09) or within 8 kilometers of a river with a 'do not eat' fish advisory (1.05; 1.00-1.11) compared to the lowest quartile, or rivers without fish consumption restrictions, respectively. When stratified by race, risks for term LBW or PTB were 10-18% more likely among African-American (AA) mothers living in areas with the highest total fish mercury concentrations. CONCLUSIONS: To our knowledge, this is the first study to examine the relationship between fish total mercury concentrations and adverse reproductive outcomes in a large population-based sample that included AA women. The ecologic nature of exposure assessment in this study precludes causal inference. However, the results suggest a need for more detailed investigations to characterize patterns of local fish consumption and potential dose-response relationships between mercury exposure and adverse reproductive outcomes, particularly among AA mothers.

Cancer Prevention Among Firefighters: Examining Lifestyle, Screening Behavior, and Beliefs.

BACKGROUND: Firefighters are at increased risk of developing cancer due to occupational exposures, but they may also face increased risk due to their lifestyle, such as the quality of their diet and physical activity. Cancer beliefs and screening behavior could also influence their cancer risk. The current study aimed to identify individual differences associated with lifestyle behaviors, cancer screening, and cancer beliefs among firefighters; to describe the strategies firefighters use to adapt to their work schedule; and to describe topics firefighters believe are the most important to address in their workplace. METHODS: Career firefighters (N = 171) in a medium-sized U.S. city completed an online survey. FINDINGS: Logistic regression analyses identified age, education, racial identity, years of fire service, perceived stress, and rank as predictors of responses to items addressing cancer screening, lifestyle behaviors, and cancer beliefs. Although results varied, age, education, and racial identity were associated with most of the outcomes. Strategies related to sleep such as getting the right amount and napping, exercise, and getting family/roommate support were selected as the top adaptive strategies for work. Sleep, mental health/well-being, and work-life balance were selected most often as the most important topics to address in the fire service, with topics related to reducing occupational exposures receiving less attention. CONCLUSIONS/APPLICATION TO PRACTICE: The findings suggest individual differences, such as age, education, and racial identity, should be considered when developing occupational health interventions for firefighters. Interventions related to mental health, work-life balance, and sleep may be desired most by those in the fire service.

Sleep disorders and cancer incidence: examining duration and severity of diagnosis among veterans.

Introduction: Sleep disruption affects biological processes that facilitate carcinogenesis. This retrospective cohort study used de-identified data from the Veterans Administration (VA) electronic medical record system to test the hypothesis that patients with diagnosed sleep disorders had an increased risk of prostate, breast, colorectal, or other cancers (1999-2010, N=663,869). This study builds upon existing evidence by examining whether patients with more severe or longer-duration diagnoses were at a greater risk of these cancers relative to those with a less severe or shorter duration sleep disorder. Methods: Incident cancer cases were identified in the VA Tumor Registry and sleep disorders were defined by International Classification of Sleep Disorder codes. Analyses were performed using extended Cox regression with sleep disorder diagnosis as a time-varying covariate. Results: Sleep disorders were present among 56,055 eligible patients (8% of the study population); sleep apnea (46%) and insomnia (40%) were the most common diagnoses. There were 18,181 cancer diagnoses (41% prostate, 12% colorectal, 1% female breast, 46% other). The hazard ratio (HR) for a cancer diagnosis was 1.45 (95% confidence interval [CI]: 1.37, 1.54) among those with any sleep disorder, after adjustment for age, sex, state of residence, and marital status. Risks increased with increasing sleep disorder duration (short [<1-2 years] HR: 1.04 [CI: 1.03-1.06], medium [>2-5 years] 1.23 [1.16-1.32]; long [>5-12 years] 1.52 [1.34-1.73]). Risks also increased with increasing sleep disorder severity using cumulative sleep disorder treatments as a surrogate exposure; African Americans with more severe disorders had greater risks relative to those with fewer treatments and other race groups. Results among patients with only sleep apnea, insomnia, or another sleep disorder were similar to those for all sleep disorders combined. Discussion: The findings are consistent with other studies indicating that sleep disruption is a cancer risk factor. Optimal sleep and appropriate sleep disorder management are modifiable risk factors that may facilitate cancer prevention.

Association Between Insomnia Symptoms and Trajectory With the Risk of Stroke in the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: Insomnia is a common condition affecting more than a third of the US population. However, the link between insomnia symptoms and stroke is understudied and the underlying mechanism remains unclear. This study aimed to investigate the relationship between insomnia symptoms and the incidence of stroke. METHODS: The Health and Retirement Study, a survey of Americans older than 50 years and their spouses, from 2002 to 2020 was used as the data source. Only those who were stroke-free at baseline were included in this study. The exposure variable was insomnia symptoms and was derived from self-reported sleep-related factors including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated-measures latent class analysis was used to identify insomnia trajectories over time. To investigate the relationship between insomnia symptoms and stroke events reported during the follow-up period, Cox proportional hazards regression models were used. Mediation analyses of comorbidities were performed using causal mediation within a counterfactual framework. RESULTS: A total of 31,126 participants were included with a mean follow-up of 9 years. The mean age was 61 years (SD = 11.1) and 57% were females. Insomnia symptom trajectories remained constant over time. Compared with those with no insomnia symptoms, an increased risk of stroke was observed for those with insomnia symptom scores ranging from 1 to 4 and 5 to 8 (hazard ratio (HR) = 1.16, 95% confidence interval (CI) 1.02-1.33) and (HR = 1.51, 95% CI 1.29-1.77), respectively, indicating a dose-response relationship. The association was stronger in participants younger than 50 years (HR = 3.84, 95% CI 1.50-9.85) than in those aged 50 years and older (HR = 1.38, 95% CI 1.18-1.62), comparing those with insomnia symptoms ranging from 5 to 8 with those with no insomnia symptoms. This association was mediated by diabetes, hypertension, heart disease, and depression. DISCUSSION: Insomnia symptoms were associated with an increased risk of stroke, especially in adults younger than 50 years, and the risk was mediated by certain comorbidities. Increased awareness and management of insomnia symptoms may contribute to the prevention of stroke occurrence.

The role of sleep and heart rate variability in metabolic syndrome: evidence from the Midlife in the United States study.

STUDY OBJECTIVES: Poor sleep and autonomic dysregulation can both disrupt metabolic processes. This study examined the individual and combined effects of poor sleep and reduced heart rate variability (HRV) on metabolic syndrome among 966 participants in the Midlife in the United States II (MIDUS II) study. METHODS: Self-reported sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). HRV was acquired from 11-minute resting heart rate recordings. Spearman correlations, general linear regression, and logistic regression models were used to examine the study hypotheses. RESULTS: Poor sleep quality was associated with metabolic syndrome when global PSQI scores were evaluated as a continuous (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.03 to 1.11) or categorical measure (cutoff > 5, OR: 1.58, 95% CI: 1.19 to 2.10), after adjustment for confounding. There also was an association between reduced HRV and metabolic syndrome (ln [HF-HRV] OR: 0.89, 95% CI: 0.80 to 0.99; ln [LF-HRV] OR: 0.82, 95% CI: 0.72 to 0.92; ln [SDRR] OR: 0.59, 95% CI: 0.43 to 0.79; ln [RMSSD] OR: 0.75, 95% CI: 0.60 to 0.94). When the combined effects of poor sleep and low HRV were examined, the association with metabolic syndrome was further strengthened relative to those with normal sleep and HRV. CONCLUSIONS: To the best of the author's knowledge, this is the first study to suggest a combined effect of poor sleep and low HRV on the odds of metabolic syndrome.

Bright Light Treatment of Combat-related PTSD: A Randomized Controlled Trial.

INTRODUCTION: Post-traumatic stress disorder (PTSD) is a prevalent consequence of combat with significant associated morbidity. Available treatments for PTSD have had limitations, suggesting a need to explore alternative or adjuvant treatments. Numerous rationales for bright light treatment of PTSD include its benefits for common PTSD comorbidities of depression, anxiety, and circadian misalignment and its relative ease of use with few side effects. The primary aims of this research were to examine the effects of bright light treatment for combat-related PTSD and associated morbidity. MATERIALS AND METHODS: A randomized controlled trial was performed in N = 69 veterans with PTSD attributable to combat in Afghanistan and/or Iraq. Following a 1-week baseline, participants were randomized to 4 weeks of daily morning bright light treatment (10,000 lux for 30 min/day) or a control treatment (inactivated negative ion generator). At baseline and at the end of treatment, participants were rated blindly on the Clinician Assessed PTSD Scale (CAPS), the Clinical Global Impressions Scale (CGI), and the Hamilton Depression Scale and rated themselves on the PTSD Checklist-Military (PCL-M). Following baseline and each treatment week, participants completed self-reported scales of state anxiety, depression, and sleep, and sleep and the circadian rhythm of wrist activity were also assessed with wrist actigraphy. RESULTS: Compared with the control treatment, bright light elicited significantly greater improvements in the CAPS and CGI-Improvement. The bright light also elicited a significantly greater rate of treatment response (reduction ≥33%) for the CAPS (44.1% vs. 8.6%) and PCL-M (33% vs. 6%), but no participant had remission from PTSD. Changes in depression, anxiety, and sleep did not differ between treatments. Improvement in CAPS was significantly correlated with a phase advance of the circadian rhythm of wrist activity. CONCLUSIONS: The most comprehensive study on the topic to date indicated significant short-term efficacy of bright light treatment on the primary variables (CAPS and CGI) with clinical relevance (i.e., treatment response) in veterans with chronic PTSD who did not report extremely high habitual light exposure. No significant effects were found for anxiety, depression, or sleep disturbance. Further research is warranted, particularly exploration of circadian phase-shifting mechanisms of bright light for PTSD.

Colonoscopy screening rates among patients of colonoscopy-trained African American primary care physicians.

BACKGROUND: When performed competently, colonoscopy screening can reduce colorectal cancer rates, especially in high-risk groups such as African Americans. Training primary care physicians (PCPs) to perform colonoscopy may improve screening rates among underserved high-risk populations. METHODS: The authors compared colonoscopy screening rates and computed adjusted odds ratios for colonoscopy-eligible patients of trained African American PCPs (study group) versus untrained PCPs (comparison group), before and after initiating colonoscopy training. All colonoscopies were performed at a licensed ambulatory surgery center with specialist standby support. Retrospective chart review was conducted on 200 consecutive, established outpatients aged ≥50 years at each of 12 PCP offices (7 trained African American PCPs and 5 untrained PCPs, practicing in the same geographic region). There were a total of 1244 study group and 923 comparison group patients. RESULTS: Post-training colonoscopy rates in both groups were higher than pretraining rates: 48.3% versus 9.3% in the study group, 29.6% versus 9.8% in the comparison group (both P < .001). African American patients in the study group showed a >5-fold increase (8.9% pretraining vs 52.8% post-training), with no change among whites (18.2% vs 25.0%). Corresponding pretraining and post-training rates among comparison patients were 10.4%% and 38.7%, respectively, among African Americans (P < .001), and 13.3% versus 13.2%, respectively, among whites. After adjusting for demographics, duration since becoming the PCP's patient, and health insurance, the study group had a 66% higher likelihood of colonoscopy in the post-training period (odds ratio, 1.66; 95% confidence interval, 1.30-2.13), and African Americans had a 5-fold increased likelihood of colonoscopy relative to whites. CONCLUSIONS: Colonoscopy-trained PCPs may help reduce colorectal cancer disparities.

Groundwater uranium and cancer incidence in South Carolina.

OBJECTIVE: This ecologic study tested the hypothesis that census tracts with elevated groundwater uranium and more frequent groundwater use have increased cancer incidence. METHODS: Data sources included: incident total, leukemia, prostate, breast, colorectal, lung, kidney, and bladder cancers (1996-2005, SC Central Cancer Registry); demographic and groundwater use (1990 US Census); and groundwater uranium concentrations (n = 4,600, from existing federal and state databases). Kriging was used to predict average uranium concentrations within tracts. The relationship between uranium and standardized cancer incidence ratios was modeled among tracts with substantial groundwater use via linear or semiparametric regression, with and without stratification by the proportion of African Americans in each area. RESULTS: A total of 134,685 cancer cases were evaluated. Tracts with ≥50% groundwater use and uranium concentrations in the upper quartile had increased risks for colorectal, breast, kidney, prostate, and total cancer compared to referent tracts. Some of these relationships were more likely to be observed among tracts populated primarily by African Americans. CONCLUSION: SC regions with elevated groundwater uranium and more groundwater use may have an increased incidence of certain cancers, although additional research is needed since the design precluded adjustment for race or other predictive factors at the individual level.

Shift Work Adaptation Among Police Officers: The BCOPS Study.

Few studies have examined shiftwork adaptation among police officers or potential differences in disease biomarkers among adapted and maladapted shiftworkers. This study characterized shiftwork adaptation among 430 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Police officers working fixed night shifts with symptoms characteristic of adaptation and maladaptation were identified using latent class analysis (n = 242). Two approaches were applied, one with police-specific symptoms and another using more general symptoms as shiftwork adaptation indicators. Biomarkers of inflammation, heart rate variability, and cardiometabolic risk were then compared between shiftwork adaptation groups, and with officers working day shifts, after adjusting for confounding. When analyses included police-specific symptoms, maladapted shiftworkers (n = 73) had more self-reported stress, sleep disturbances, fatigue, and less social support than adapted shiftworkers (n = 169). Using more general symptoms, maladapted officers (n = 56) reported more stress and depression, and less social support than adapted officers (n = 186). In police-specific models, adjusted (least-squares) means (± standard error) of circulating interleukin-6 (IL-6) concentrations in maladapted officers (0.8 ± 0.1 ln[pg/ml]) were modestly elevated relative to adapted shiftworkers (0.7 ± 0.1 ln[pg/ml], p = .09) and relative to permanent day workers (0.5 ± 0.1 ln[pg/ml], p ≤ 0.01), and leptin levels in maladapted officers (9.6 ± 0.1 ln[pg/ml]) exceeded those in the adapted (9.4 ± 0.1 ln[pg/ml], p ≤ 0.01) and day shift groups (9.4 ± 0.1 ln[pg/ml], p = .03). In the general model, adjusted mean tumor necrosis factor-alpha (TNF-α) concentrations among maladapted officers (5.6 ± 0.23 pg/ml) exceeded the adapted (4.8 ± 0.2 pg/ml, p ≤ 0.01) and day workers (5.0 ± 0.2 pg/ml, p = .04), and insulin among maladapted officers was higher (2.4 ± 0.1 ln[uu/ml]) than the adapted group (1.8 ± 0.1 ln[uu/ml], p = .03). No differences were observed for the other biomarkers. The results suggest that maladaptation among police officers working fixed night shifts may lead to increases in leptin, insulin, IL-6, and TNF-α; however, the cross-sectional design and possible residual confounding preclude interpretation of cause and effect. Prospective studies are planned to further characterize the relationship between shiftwork maladaptation and biomarkers of chronic disease risk in this police officer cohort.

An analysis of shiftwork and self-reported depressive symptoms in a police cohort from Buffalo, New York.

Shiftwork has been associated with elevated depressive symptoms; police officers frequently work shifts and may experience depressive symptoms. This study assessed the association between depressive symptoms and shiftwork in a police cohort from Buffalo, New York, USA using a repeated cross-sectional design with data collected in 2004-2009 (n = 428) and 2010-2014 (n = 261). Electronic payroll records were used to quantitatively classify officers on the day, evening, or night shift based on the shift they spent most of their working hours. Two self-reported depressive symptomology measures were used as outcomes - the Center for Epidemiological Studies - Depression (CES-D) scale and the Beck Depression Inventory (BDI). Repeated measures linear and logistic regression analyses were used to estimate least squares means or odds, respectively, of depressive symptom questionnaire scores by shiftwork category. Those working the evening/night shift had higher odds for depressive symptoms according to the BDI (based on a cut-point score of 14) than those working the day shift (OR = 4.60, 95% CI = 1.15-18.39). Similar results were observed for the evening shift group. No differences in mean CES-D or BDI scores were observed between groups for short-term shiftwork, long-term shiftwork, or shift changes. After stratifying by stress, as measured by the Perceived Stress Scale (PSS), total Impact of Events (IES), and the Spielberger Police Stress Survey (SPSS), mean values for depressive symptoms were higher in the high-stress categories regardless of shiftwork status. Further research should include biomarkers for depression, a longitudinal study design with a larger cohort, and joint effects of shiftwork and stress on depressive symptoms.

Actigraphic assessment of daily sleep-activity pattern abnormalities reflects self-assessed depression and anxiety in outpatients with advanced non-small cell lung cancer.

OBJECTIVES: We measured subjectively evaluated depression and anxiety, and objectively measured daily sleep-activity patterns in inpatients and outpatients with advanced non-small cell lung cancer (NSCLC) and determined whether cancer-associated depression and anxiety are accompanied by characteristic circadian rhythm abnormalities. METHODS: Equal numbers of inpatients (n=42) and outpatients (n=42) with advanced NSCLC were studied. Baseline depression and anxiety, assessed by the Hospital Anxiety and Depression Scale (HADS), and actigraphy were recorded before chemotherapy initiation. The effects of the presence and severity of chronic obstructive pulmonary disease (COPD) on depression, anxiety, and actigraphy were assessed only among the 42 outpatients. RESULTS: Anxiety occurred in 40% and depression in 25% of these lung cancer patients, equally among inpatients and outpatients. All patients suffer extremely disturbed daily sleep-activity cycles but each patient also maintains some degree of circadian organization. Outpatients maintain more robust daily activity patterns and longer, more consolidated nighttime sleep compared with inpatients. The more disrupted the daily sleep-activity rhythm, the worse the depression and/or anxiety scores for outpatients. These relationships are obscured among inpatients. COPD has no independent measurable effects on the daily organization of sleep-activity, depression, or anxiety. CONCLUSIONS: Lung cancer patients whose diurnal activity is disturbed by prolonged and frequent sedentary episodes and whose sleep is disturbed by frequent and prolonged waking are most anxious and depressed. These findings and relationships are masked by hospitalization. Since diurnal exercise improves both sleep and mood, it is reasonable to test whether enhancing daytime activity and nighttime sleep can diminish cancer-associated depression.

Indoor air pollution, cookstove quality, and housing characteristics in two Honduran communities.

Elevated indoor air pollution exposures associated with the burning of biomass fuels in developing countries are well established. Improved cookstoves have the potential to substantially reduce these exposures. However, few studies have quantitatively evaluated exposure reductions associated with the introduction of improved stoves, likely due to the cost and time-intensive nature of such evaluations. Several studies have demonstrated the value of estimating indoor air pollution exposures by evaluating personal cooking practices and household parameters in addition to stove type. We assessed carbon monoxide (n=54) and fine particulate matter (PM(2.5)) (n=58) levels among non-smoking Honduran women cooking with traditional or improved wood-burning cookstoves in two communities, one semi-urban and one rural. Exposure concentrations were assessed via 8-h indoor monitoring, as well as 8-h personal PM(2.5) monitoring. Housing characteristics were determined to indicate ventilation that may affect carbon monoxide and PM(2.5). Stove quality was assessed using a four-level subjective scale representing the potential for indoor emissions, ranging from poorly functioning traditional stoves to well-functioning improved stoves. Univariately, the stove scale as compared to stove type (traditional versus improved) accounted for a higher percent of the variation in pollutant concentrations; for example, the stove scale predicted 79% of the variation and the stove type predicted 54% of the variation in indoor carbon monoxide concentrations. In multivariable models, the stove scale, age of the stove, and ventilation factors predicted more than 50% of the variation in personal and indoor PM(2.5) and 85% of the variation in indoor carbon monoxide. Results indicate that using type of stove alone as a proxy for exposure may lead to exposure misclassification and potentially biased exposure and health effects relationships. Utilizing stove quality and housing characteristics that influence ventilation may provide a viable alternative to the more time- and cost-intensive pollutant assessments for larger-scale studies. Designing kitchens with proper ventilation structures could lead to improved indoor environments, especially important in areas where biomass will continue to be the preferred and necessary cooking fuel for some time.

Hypertension and hematologic parameters in a community near a uranium processing facility.

BACKGROUND: Environmental uranium exposure originating as a byproduct of uranium processing can impact human health. The Fernald Feed Materials Production Center functioned as a uranium processing facility from 1951 to 1989, and potential health effects among residents living near this plant were investigated via the Fernald Medical Monitoring Program (FMMP). METHODS: Data from 8216 adult FMMP participants were used to test the hypothesis that elevated uranium exposure was associated with indicators of hypertension or changes in hematologic parameters at entry into the program. A cumulative uranium exposure estimate, developed by FMMP investigators, was used to classify exposure. Systolic and diastolic blood pressure and physician diagnoses were used to assess hypertension; and red blood cells, platelets, and white blood cell differential counts were used to characterize hematology. The relationship between uranium exposure and hypertension or hematologic parameters was evaluated using generalized linear models and quantile regression for continuous outcomes, and logistic regression or ordinal logistic regression for categorical outcomes, after adjustment for potential confounding factors. RESULTS: Of 8216 adult FMMP participants 4187 (51%) had low cumulative uranium exposure, 1273 (15%) had moderate exposure, and 2756 (34%) were in the high (>0.50 Sievert) cumulative lifetime uranium exposure category. Participants with elevated uranium exposure had decreased white blood cell and lymphocyte counts and increased eosinophil counts. Female participants with higher uranium exposures had elevated systolic blood pressure compared to women with lower exposures. However, no exposure-related changes were observed in diastolic blood pressure or hypertension diagnoses among female or male participants. CONCLUSIONS: Results from this investigation suggest that residents in the vicinity of the Fernald plant with elevated exposure to uranium primarily via inhalation exhibited decreases in white blood cell counts, and small, though statistically significant, gender-specific alterations in systolic blood pressure at entry into the FMMP.

Endotoxin exposure and inflammation markers among agricultural workers in Colorado and Nebraska.

The adverse respiratory effects of agricultural dust inhalation are mediated in part by endotoxin, a constituent of gram-negative bacterial cell walls. This study quantified personal work-shift exposures to inhalable dust, endotoxin, and its reactive 3-hydroxy fatty acid (3-OHFA) constituents among workers in grain elevators, cattle feedlots, dairies, and on corn farms. Exposures were compared with post-work-shift nasal lavage fluid inflammation markers and respiratory symptoms. Breathing-zone personal air monitoring was performed over one work shift to quantify inhalable dust (Institute of Medicine samplers), endotoxin (recombinant factor C [rFC] assay), and 3-OHFA (gas chromatography/mass spectrometry). Post-shift nasal lavage fluids were assayed for polymorphonuclear neutrophils (PMN), myeloperoxidase (MPO), interleukin 8 (IL-8), albumin, and eosinophilic cation protein (ECP) concentrations. The geometric mean (GSD) of endotoxin exposure (rFC assay) among the 125 male participants was 888 +/- (6.5) EU/m(3), and 93% exceeded the proposed exposure limit (50 EU/m(3)). Mean PMN, MPO, albumin, and ECP levels were two- to threefold higher among workers in the upper quartile of 3-OHFA exposure compared to the lowest exposure quartile. Even numbered 3-OHFA were most strongly associated with nasal inflammation. Symptom prevalence was not elevated among exposed workers, possibly due to endotoxin tolerance or a healthy worker effect in this population. This is the first study to evaluate the relationship between endotoxin's 3-OHFA constituents in agricultural dust and nasal airway inflammation. More research is needed to characterize the extent to which these agents contribute to respiratory disease among agricultural workers.