Project Sandman: A Quasi-Experimental Evaluation of a Group-Based Brief Sleep Intervention in Air Force Technical Training.

OBJECTIVES: Approximately 70% of the military personnel experience chronic sleep insufficiency, which negatively impacts military readiness and health. Military sleep health does not appear to be improving despite targeted programs to optimize sleep. The present quasi-experimental study aims to evaluate a single-session sleep intervention in United States Air Force (USAF) Technical Training. METHOD: A group-based Brief Sleep Intervention (BSI) was developed for the target population. Participants included 321 technical school students (Mean age = 21; 82% male; 67% White) who were assigned to the BSI (n = 203) or a control group (n = 118). Propensity-score-weighted multivariable logistic regression was employed to compare outcomes. RESULTS: At the 2-week follow-up, students in the BSI were significantly more likely to report sleeping 6 or more hours on weekdays (OR = 1.49, p < .001) and "Good/Very Good" sleep quality (OR = 1.50, p = .032) than those in the control group. In addition, 69.2% of the students in BSI reported having engaged in the self-selected "Action Step" chosen during the intervention. CONCLUSIONS: To our knowledge, this is the first study to test a preventative sleep intervention in USAF Technical Training. Results suggest that a single-session group intervention can promote behavioral changes and improve sleep health.

A social-ecological examination of sleep among Airmen in technical training.

Inadequate sleep is an on-going risk to the health and mission readiness of U.S. Armed Forces, with estimates of sleep problems high above U.S. civilian populations. Intervening early in the career of active duty Air Force personnel (or "Airmen") with education and the establishment of healthy behaviors may prevent short and long term-detriments of sleep problems. This paper describes the results of a qualitative study seeking to understand the facilitators and barriers to achieving good sleep in a technical training school during the first year of entry into the United States Air Force. Using the social ecological framework and content analysis, three focus groups with Airmen were conducted to explore themes at the individual, social, environmental, and organizational/policy level. Overall, results indicated a cohort motivated to achieve good sleep, and also struggling with a number of barriers across each level. This paper highlights opportunities for population health interventions during technical training aimed at supporting Airmen in developing healthy sleep behaviors early in the course of their career.

The impact of childhood parental quality on mental health outcomes in older adults.

OBJECTIVE: Parental bonding is cited as a determinant of mental health outcomes in childhood, adolescence and early-mid adulthood. Examination of the long-term impact for older adults is limited. We therefore examine the long-term risk of perceived poor parental bonding on mental health across the lifespan and into early-old age. METHODS: Participants (N = 1255) were aged 60-64 years of age and drawn from the Australian Life Histories and Health study. Quality of parental bonding was assessed with the Parental Bonding Instrument (PBI). Self-reported history of doctors' mental health diagnoses and current treatment for each participant was recorded. Current depression was assessed with the Centre for Epidemiologic Studies Depression-8 (CESD-8). Due to known gender differences in mental health rates across the lifespan, analyses were stratified by sex. RESULTS: A bi-factor analysis of the PBI in a structural equation framework indicated perceived Poor Parental Quality as a risk for both ever and current depression for both sexes. For males, Over-Protective Fathers were a risk for ever and current depression, whilst overall Poor Parental Quality was a risk for reporting current depression treatment. Whilst a number of the risks associated with current depression and treatment were attenuated when controlling for current mood, parental quality remained a significant risk for having reported a lifetime diagnosis for depression and anxiety for men. CONCLUSION: Our results extend the existing literature base and demonstrate that mental health risk attributed to poor perceived parental quality continues across the life-course and into early-old age.

Examining the 16-year trajectories of mental health and wellbeing through the transition into widowhood.

BACKGROUND: Becoming widowed is a significant event. There is considerable evidence that surviving partners report substantial changes in their wellbeing and mental health. Changes can occur prior to partner's death as an anticipatory effect and consequently during the period after partner's death. For most, declines in wellbeing and mental health dissipate over time. However, there is a limited long-term evidence to compare age-normative trajectories in mental health and wellbeing with the trajectories of those who transition into widowhood. METHODS: Participants (n = 652) were older adults (aged 65-94 years at baseline) from the 16-year Melbourne Longitudinal Studies on Healthy Ageing project who were either married or de facto (n = 577), or recently widowed (n = 75). Generalized Estimating Equations (GEE) examined the immediate and long-term impact of widowhood. GEE piecewise regression analyses examined the trajectories of wellbeing and mental health in those who transitioned into widowed with time centered at time of partner's death. Analyses were stratified by gender. RESULTS: For both men and women, becoming widowed was strongly related to a strong decline in positive affect post partner's death. Otherwise, no long-term impact of widowhood on negative affect or depressive symptomology was reported. CONCLUSIONS: The impact of widowhood reports differential impacts on different indicators of wellbeing and mental health, which were inconsistent between men and women.

The utility of estimating population-level trajectories of terminal wellbeing decline within a growth mixture modelling framework.

PURPOSE: Mortality-related decline has been identified across multiple domains of human functioning, including mental health and wellbeing. The current study utilised a growth mixture modelling framework to establish whether a single population-level trajectory best describes mortality-related changes in both wellbeing and mental health, or whether subpopulations report quite different mortality-related changes. METHODS: Participants were older-aged (M = 69.59 years; SD = 8.08 years) deceased females (N = 1,862) from the dynamic analyses to optimise ageing (DYNOPTA) project. Growth mixture models analysed participants' responses on measures of mental health and wellbeing for up to 16 years from death. RESULTS: Multi-level models confirmed overall terminal decline and terminal drop in both mental health and wellbeing. However, modelling data from the same participants within a latent class growth mixture framework indicated that most participants reported stability in mental health (90.3 %) and wellbeing (89.0 %) in the years preceding death. CONCLUSIONS: Whilst confirming other population-level analyses which support terminal decline and drop hypotheses in both mental health and wellbeing, we subsequently identified that most of this effect is driven by a small, but significant minority of the population. Instead, most individuals report stable levels of mental health and wellbeing in the years preceding death.

Gender differences in the trajectories of late-life depressive symptomology and probable depression in the years prior to death.

BACKGROUND: Gender differences in depression are well established. Whether these differences persist into late life and in the years preceding death is less clear. There is a suggestion that there is no increased likelihood of depression in late life, but that there is an increase in depressive symptomology, particularly with proximity to death. We compared trajectories of probable depression and depressive symptomology between men and women over age and distance-to-death metrics to determine whether reports of depressive symptoms are more strongly related to age or mortality. METHODS: Participants (N = 2,852) from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project had a mean age of 75 years (SD = 5.68 years) at baseline and were observed for up to 16 years prior to death. Multi-level regression models estimated change in depressive symptomology and probable depression over two time metrics, increasing age, and distance-to-death. RESULTS: Increases in depressive symptomology were reported over increasing age and in the years approaching death. Only male participants reported increased probable depression in the years preceding death. Models that utilized distance-to-death metrics better represented changes in late-life depression, although any changes in depression appear to be accounted for by co-varying physical health status. CONCLUSIONS: As death approaches, there are increases in the levels of depressive symptomology even after controlling for socio-demographic and health covariates. In line with increases in suicide rates in late life, male participants were at greater risk of reporting increases in depressive symptomology.

The long-term mental health risk associated with non-heterosexual orientation.

AIMS: Findings that describe the mental health risk associated with non-heterosexual orientation in young and middle-aged adults are from cross-sectional designs or fail to discriminate homosexual and bisexual orientations. This study examines the mental health risk of homosexual and bisexual orientation over an 8-year period. METHODS: Participants were from the age-cohort study, the Personality and Total Health Through Life Project, were observed twice every 4 years, and aged 20-24 (n = 2353) and 40-44 (n = 2499) at baseline. RESULTS: Homosexual orientation was unrelated to long-term depression risk. Risk for anxiety and depression associated with homosexual and bisexual orientations, respectively, were attenuated in fully-adjusted models. Bisexual orientation risk associated with anxiety was partially attenuated in fully-adjusted models. CONCLUSIONS: Non-heterosexual orientation was not a major risk factor for long-term mental health outcomes. Instead, those with a non-heterosexual orientation were more likely to experience other mental health risk factors, which explain most of the risk observed amongst those with a non-heterosexual orientation.

Effect of phytate removal on zinc absorption from soy formula.

Low zinc bioavailability from soy formula may be the result of the formula's phytate content. We assessed the effect of phytate removal from soy formula on Zn absorption using infant rhesus monkeys and suckling rat pups as animal models. Zn absorption in monkeys, as determined by whole-body counting, was 65% from human milk, 54% from monkey milk, 60% from whey-predominant formula, 46% from casein-predominant formula, and only 27% from conventional soy formula (0.621 mmol phytate/L). In contrast, Zn absorption from dephytinized soy formula (0.067 mmol phytate/L) was 45%. In suckling rats, Zn absorption from conventional soy formula was only 16% vs 47% from dephytinized soy formula. Phytate concentration in a variety of experimental soy formulas was inversely correlated to Zn absorption. These results suggest that the low bioavailability of Zn from soy formula is a function of its phytate concentration and can be overcome by the removal of phytate.

Hemiplegic migraine associated with an aseptic meningeal reaction.

A 21-year-old man had typical symptoms of hemiplegic migraine. A lumbar puncture demonstrated a significant lymphocytic response and an elevated CSF protein level on the day of and 24 days after the headache despite the absence of any other clinical symptoms. Other reported cases of CSF leukorrhaghia associated with hemiplegic migraine are briefly reviewed.

Secretory mutants in the cellular slime mold Dictyostelium discoideum.

Our initial studies have shown that the cellular slime mold Dictyostelium discoideum is a particularly suitable organism for the study of lysosomal enzyme secretion. During appropriate stages in the life cycle, secretion is prominent for a number of lysosomal enzymes. The methods described here have been developed to investigate various aspects of the secretion process. Moreover, our evidence that regulation of the secretory system is influenced by environmental changes and by cell differentiation indicates that this organism may be useful for studying the functional regulation of this organellar system. To a large degree these types of studies have been limited in the past due to the lack of an appropriate experimental system. The ability to isolate secretory mutants affecting the secretion of lysosomal enzymes adds another dimension to investigations using D. discoideum. In our initial attempts we have been successful in isolating a variety of different types of mutants that alter the secretion of one or more lysosomal enzymes. While the results are in agreement with the results of our physiological investigations, they also indicate much more heterogeneity in the lysosomal system than we had previously suspected. The indications that many of our secretory mutants may also affect modification of the enzymes is also intriguing. This observation may also help to explain the fact that many of these strains are defective in normal development. Together with the immunological methods available in this organism for studying posttranslational modification, the mutants may be valuable in deciphering the relationship between modification of lysosomal enzymes and their proper localization and secretion from the cell. Thus, Dictyostelium discoideum may become as useful for the study of some questions of cell biology as it has been for development.

Platelet 5-HT uptake sites, labelled with [3H] paroxetine, in controls and depressed patients before and after treatment with fluoxetine or lofepramine.

Platelet [3H] paroxetine binding was measured in 73 depressed patients and in 64 healthy volunteers. No differences were found in Bmax or Kd either overall, or when the 61 depressed subjects who had never received psychotropic drugs were analysed separately. Within the depressed group, no differences in Bmax or Kd were found between subgroups divided on the basis of endogenicity, suicidal thoughts or severity of depression. None of the subgroups differed significantly from controls. Forty of the depressed subjects were retested after 6 weeks' treatment with fluoxetine (n = 22) or lofepramine (n = 18). Treatment was not associated with any change in Bmax but a similar and significant increase in Kd was noted following treatment with either antidepressant. Neither pre- nor post-treatment platelet binding parameters appeared to relate to clinical response to treatment.

Predictors of response to amine-specific antidepressants.

Discriminant function analysis of data from a double-blind comparative trial of lofepramine (a noradrenaline-specific reuptake inhibitor) and fluoxetine (a serotonin-specific reuptake inhibitor), involving 183 patients was used to identify predictors of response. Psychic anxiety significantly predicted a positive response to antidepressant medication, whereas psychomotor retardation, observed sadness, subjective lassitude and somatic complaints were significant predictors of nonresponse. Age, gender, endogenicity, duration of illness and number of previous episodes were not predictive of response. Significant differences were found between predictors of response to fluoxetine and lofepramine (P < 0.001 all groups). Predictors of response to lofepramine were similar to overall predictors, i.e., psychic anxiety predicted responders whilst observed sadness, psychomotor retardation, lassitude, inability to feel and somatic complaints predicted nonresponders. In contrast, baseline weight loss predicted response to fluoxetine, whereas anxiety, reduced insight and a tendency to blame others significantly predicted nonresponse. Such findings have practical implications for the management of depressive illness.

Important drug-nutrient interactions in the elderly.

Several drug-nutrient interactions can occur, but their prevalence may be accentuated in the elderly. Geriatric patients may experience age-related changes in the pharmacokinetics of a drug-absorption, distribution, metabolism and excretion. When drug-nutrient interactions occur, they usually affect absorptive processes more frequently. Specific transporter systems facilitate the absorption of many drugs. Little is known about how these transporter systems are affected by aging. Co-existing disease states in the elderly may exaggerate the action of a drug and represent a confounding factor in drug-nutrient interactions. While several different drug-nutrient interactions are important in the elderly, those affecting the cardiovascular system warrant special attention.

A double-blind controlled comparison of fluoxetine and lofepramine in major depressive illness.

One hundred and eighty three patients with DSM-III-R major depressive illness were allocated randomly to treatment with one of two new generation antidepressants, fluoxetine and lofepramine. Both patient groups had significantly lower mean scores on the Hamilton Depression Rating Scale (HDRS) 6 weeks after entry to the trial (p < 0.001), but there were no differences between the groups, either at baseline or after 6 weeks, in total HRDS score or in subscores for anxiety or suicidality. Anticholinergic side effects were commoner with lofepramine; adverse effects were on the whole mild and few patients dropped out because of them. This study does not support previous claims of specific adverse effects of fluoxetine on anxiety and suicidality.

Evaluation of single-cell sources of docosahexaenoic acid and arachidonic acid: 3-month rat oral safety study with an in utero phase.

Owing to the presence of the polyunsaturated fatty acids (PUFA) docosahexaenoic acid (DHA) and arachidonic acid (ARA) in human milk and their important biological function, several authorities recommend that they be added to infant formulas. This study assessed the safety of an algal oil rich in DHA and a fungal oil rich in ARA, blended to provide a DHA to ARA ratio similar to human milk. The oil blend was incorporated into diets and fed to rats such that they received 3, 11 and 22 times the anticipated infant exposure to DHA and ARA. Low-fat and high-fat control groups received canola oil. Rats received experimental diets over a premating interval and throughout mating, gestation and lactation. Pups born during this period (F1) consumed treatment diets from weaning for 3 months. Physical observations, ophthalmoscopic examinations, body weight, food intake, clinical chemistry, neurobehavioural evaluations and postmortem histopathology of selected tissues were performed. No statistically significant, dose-dependent adverse effects were seen in reproductive performance or fertility, nor in the neonates from birth to weaning. Mid- and high-dose treated F1 animals exhibited increased white cell count, neutrophil count and blood urea nitrogen; increased liver and spleen weights (absolute and relative to body weight) also were observed. There were no corresponding microscopic findings. The clinical pathology and organ weight differences at these treatment levels represent physiological or metabolic responses to the test substance rather than adverse responses. These single-cell oils produced no adverse effects in rats when administered in utero and for 90 days at dietary levels resulting in exposures up to 22 or 66 times higher than those expected in infant formulas when extrapolated on the basis of diet composition (g/100 Cal) or intake (g/kg body weight), respectively.

Evaluation of single cell sources of docosahexaenoic acid and arachidonic acid: a 4-week oral safety study in rats.

Docosahexaenoic acid (DHA) and arachidonic acid (ARA) are secreted in human milk and consumed by the nursing neonate but are not present in infant formulas currently available in the US. Supplementation of formulas with DHA and ARA may be particularly important for premature infants, who have less accretion of these fatty acids in utero than term infants. Some experts suggest that DHA and ARA should be added to infant formulas. Common sources of these fatty acids (e.g. fish oils, egg yolk lipids) are not optimal for infants in that they contain disproportionate amounts of other fatty acids. This 4-wk study examined the safety of a high-DHA algal oil and a high-ARA fungal oil, blended so that the DHA:ARA ratio approximates that in human milk. Rats were fed the blend at levels representing three, 11 and 22 times the anticipated infant exposure. Control animals were fed either a high-fat diet (13.1%, w/w; equivalent to the fat content of the treated groups) or a low-fat diet (5%, w/w). There were no treatment-related differences in body weight, food intake, organ weights, haematology or clinical chemistry. Thus, this study indicates that a blend of algal and fungal oils is a safe source of DHA and ARA as it produced no adverse effects in rats when administered for 4 wk at levels up to 22 times the expected infant exposure.

The metabolism of [3',5',9(n)-3H] pteroylglutamic acid by chicken liver in vivo. Effects of folate deficiency and vitamin B12 supplementation.

1. Control, folate-deficient and vitamin B12-supplemented chickens were given [3', 5', 9 (n)-3H] pteroylglutamic acid by intraperitoneal injection. After various time intervals (1.5 h-8d) the incorporation of radioactivity into hepatic folate derivatives was measured. 2. The results confirm that avian species have a faster assimilation of folate than most mammalian species. 3. Folate deficiency increased the incorporation and retention of [3H] pteroylglutamic acid. The degree of folate conjugation was unaffected by folate deficiency but the formyl to methyl folate ratio was decreased. 4. Vitamin B12 supplementation had no effect on the uptake or conjugation of [3H] pteroylglutamic acid, but increased the formyl to methyl folate ratio.

Ordinal position learning and remote anticipation.

Rats were runway trained on each of two 3-trial series of reward outcomes. The series are labeled XNY and ZNN, for which X represents a trial that was rewarded with Noyes pellets and N represents a trial that ended with no reward. Units of distinctively flavored breakfast cereals served as reward on trials labeled Y and Z. One group (Floor) had each series occur with a correlated runway floor, either smooth and black or rough and white. For a second group (Memory), the floor cue was uncorrelated with series. Animals in both groups learned to approach the goal rapidly on the 1st trials of the 2 series and slowly on the 2nd trials, but only Group Floor learned to differentiate the 3rd trials of the series. These results recommend a view of serial learning that emphasizes the role played by information about the ordinal position of series items.

A test for order relevance in a three-element serial learning task.

Rats were trained in a straight runway on a simple three-element series of differing reward quantities. The first trial of the series ended with a two-pellet reward, and the second and third trials ended with a 12-pellet reward and a nonreward, respectively (2-12-0). All animals developed accurate anticipation of the terminal nonreward in the 2-12-0 series before it was rearranged for two test days during which the elements appeared in the order 12-2-0. The rats' anticipation of the terminal nonreward did not transfer to the reordered series, a result taken to mean that anticipation had been based upon interitem associations among memorial representations of the differing reward quantities. A second transfer test to 0-0-0, given after anticipation was reestablished to the 2-12-0 series, gave evidence that the ordinal position of the series elements was also a source of anticipation; the animals continued to run relatively slowly on the third trial in extinction. In neither transfer test was there evidence that the rats employed the strategy of enumerating rewarded trials, because counting is an order-irrelevant process.

Conditional discrimination of series containing either two or three rewarded trials.

Series of trials differing only in the number of rewarded trials (2R or 3R series) were used to test rats' ability to learn conditional numerical discriminations. Although the series were conditionally related to initially non-numerical situations, the rats successfully learned the discrimination. It is concluded that these discriminations can plausibly be conceptualized as conditional counting. A pair of transfer tests given after the discriminations were well established suggested that, under these conditions, numerical information will overshadow other non-numerical sources of discrimination made relevant by the transfer shifts.