A shot in the dark: the impact of online visibility on the search for an effective sleep app.

STUDY OBJECTIVES: Dictated by consumer ratings and concealed algorithms, high levels of online visibility are granted to certain sleep apps on mainstream modes of app selection. Yet, it remains unclear to what extent these highly visible apps are evidence-based. The objectives of this review were to identify and describe the apps with the greatest online visibility when searching for a sleep app and to assess the claimed and actual research associated with them. METHODS: A keyword search was conducted in Google Play and Google search. Titles of the most visible apps were retrieved. App descriptions were examined to identify research claims made about app effectiveness on sleep and other health-related outcomes. A follow-up search on PubMed and Google Scholar was conducted to verify claims. RESULTS: The keyword search identified 53 highly visible apps. Examination of app store descriptions found that no reference to research was made for the majority of apps (n = 45, 84.9%). Published research studies were available for just three apps, with most studies evaluating app impact on non-sleep related outcomes. There was some evidence to attesting to the effectiveness of two apps in improving sleep. CONCLUSIONS: This review demonstrates how, when carrying out a typical search for a sleep app, information about the evidence base for the majority of highly visible apps is not available. Results highlight the need for the improvement of mainstream modes of app selection in terms of better consumer-app specificity and increased transparency regarding the access to information about the evidence base for apps.

Bénéfices d'un partenariat pour l'évaluation d'un programme de prévention des surdoses initié par des pairs.

In 2015, in partnership with a research team, the PROFAN program was initiated by a group of peers to counter the increasing number of overdose-related deaths in Montreal. As of 2018, they have offered, in collaboration with the Association des intervenants en dépendance du Québec (AIDQ) (Quebec Association of Addiction Workers), over 160 training sessions, and have connected with 500 Québec organizations, resulting in a total of over 2,000 participants. A participative evaluation process was undertaken with respect to the expansion of the program. The level of engagement of both partners was evaluated for each stage of the research process, as well as the benefits reported by each party. Examining the level of engagement during the evaluation process highlighted the leadership exhibited by the PROFAN team regarding funding and the dissemination of results. The research team provided leadership for the production of the protocol and analysis, and helped with dissemination among researchers and specialists in the domain. Data collection involved a collaboration between both parties. As for reported benefits, some were associated with the program’s operations (increased credibility, support for it being updated, establishing partnerships), and others involved peer empowerment (skills development). The need to urgently intervene to decrease the number of overdose deaths seems to have facilitated the funding of the program and the development of partnerships. The partnership between PROFAN and the research team has been marked by collaboration and a sharing of expertise.

Mental health legislation in Luxembourg, a small country in Western Europe.

The article provides a brief overview of the legislation governing involuntary admissions to psychiatric hospitals in Luxembourg. The legislation was completely overhauled in 2009 and several human rights principles are enshrined into it. Emphasis is placed on voluntary, community-based treatment, and where compulsory treatment is required, it uses the least restrictive treatment option. Mentally ill offenders are dealt with through separate specialist legislation. Young people under the age of 18 are often detained using family law.

Mental health services in Luxembourg: an overview.

We describe mental health services in Luxembourg and how they have evolved over the past 50 years. Health services in Luxembourg are provided through a social health insurance-based system and mental health services are no exception. Additional services are offered through mixed-funding avenues drawing on social care budgets in the main. Luxembourg is closely connected with neighbouring countries, where a large proportion of its workforce live. No run-through medical training exists and the entire medical workforce, including psychiatrists, have trained in other countries. This is reflected in a rich but often non-uniform approach to the provision of psychiatric care.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review.

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

Impact of time and phosphorus application rate on phosphorus bioavailability and efficiency of secondary fertilizers recovered from municipal wastewater.

Demand for phosphorus (P) resources other than non-renewable P rock has driven the development of several P recovery technologies from municipal wastewater treatment and directed recovery of P into valuable fertilizers (struvite, ash, iron phosphate, etc.). Although the bioavailability of novel secondary P fertilizers has been examined in previous studies, insufficient attention has been paid to defining optimal plant growth duration and monitoring conditions to assess the dynamic changes in P. Accordingly, five fertilizers recovered from municipal wastewater: two struvites (STRSL and STRLQ), two ashes (ASH1 and ASH2), and iron-phosphate pelletized sludge (FeP) using triple superphosphate (TSP) as a positive control and blank (zero P) as a negative control, were applied to P poor-sand at three P doses (equivalent to 30, 60, and 90 kg P2O5 ha-1). Fertilizer impact on perennial ryegrass (Lolium perenne) dry matter (DM) and P concentration were evaluated on a monthly basis for seven months. DM and relative agronomical efficiency (RAE) have shown the same trend between the fertilizers, but only at the lowest P dose (corresponding to 30 kg P2O5 ha-1). At higher P doses (60, and 90 kg P2O5 ha-1) the differences in DM and RAE among the fertilizers diminished. STRLQ, STRSL, ASH1 and FeP expressed a rather steady P release pattern, while ASH2 had a delay of four cuts and increase afterward. Monitoring the P uptake during four months of perennial ryegrass growth turned out to be the minimum, and seven months the optimum period for reaching the full capacity of the slow-release P fertilizers.

An overview on deficit and requirements of the Irish national soil phosphorus balance.

Phosphorus (P) is an essential life-supporting nutrient for which there is no substitute. Modern farming practice and food production are supported by the application of mineral P fertiliser derived from finite mined phosphate rock. The European Union does not have indigenous mineral phosphate reserves, which poses a significant issue to food security. This research paper assesses the potential of indigenous recycled P sources to replace imported P fertiliser within the Republic of Ireland. The research is undertaken at NUTS 3 (Nomenclature of Territorial Units) regional level, the nutrient soil P requirement is established, and the extent to which the regional production of indigenous recycled P sources can offset this requirement is determined. The soil P requirement was derived from analyzing the regional soil P indexes, stocking rate and land-use. It was established that to optimise Irish agricultural production, approximately 95,500 t of P fertiliser is required by Irish agriculture per annum. Indigenous P sources were reviewed to determine their contribution to the Irish P balance; the sources included sewage sludge, dairy processing waste, and animal manures. Regional indigenous P quantities vary greatly with the South-West Region producing the largest quantity of indigenous recycled P at 42.4% of required P than the Mid-West Region only producing 22.0% of its P requirement indigenously. Sources of indigenous P also vary greatly from region to region depending on population and industry, with the highest quantity of sewage sludge being produced in the Dublin plus Mid-East Region while the greatest contributor of dairy waste is the South-West Region. In total, over 28,500 t of P is recovered from indigenous sources per annum. This indicates that approximately 30% of the national P requirement could be met by indigenous P recycling.

Associations between cognitive function, metabolic factors and depression: A prospective study in Quebec, Canada.

BACKGROUND: Metabolic risk factors, low cognitive function and history of depression are known risk factors for future depressive episodes. This paper aims to evaluate the potential interactions between these factors on the risk of a major depressive episodes in middle-age. METHODS: Baseline and follow-up data from a population-based study of Quebec, Canada were used. The sample consisted of 1788 adults between 40 and 69 years of age without diabetes. Cognitive function and metabolic risk factors were assessed at baseline. Three cognitive domains were assessed: processing speed, episodic memory and executive function. History of depression was assessed five years later by a clinical interview. Logistic regression analysis was conducted to evaluate interactions between individual metabolic factors, low cognitive function, and depression history. RESULTS: Participants with a comorbidity of at least one metabolic factor, history of depression and low cognitive function had the highest risk of experiencing a depressive episode in middle age. The highest risk was observed in individuals with abdominal obesity, low cognitive function, and a history of depression (OR= 8.66, 95% CI 3.83-19.59). The risks for those with abdominal obesity only, depression history only, and low cognitive function were 1.20 (95%CI 0.71-2.02), 3.10 (95%CI 1.81-5.24), and 1.39 (95%CI 0.72-2.67), respectively. LIMITATIONS: Depression was only assessed at follow-up. CONCLUSION: Metabolic risk factors comorbid with low cognitive function in middle-aged individuals with a history of depression were associated with an increased risk of a future depressive episode. This study highlights the importance of screening for metabolic and cognitive comorbidities in patients with a history of depression.

Association between depressive symptoms, metabolic risk factors, and cognitive function: cross-sectional results from a community study in Quebec, Canada.

OBJECTIVE: To investigate the cross-sectional association between depressive symptoms and metabolic risk factors with cognitive function in a middle-aged population. METHODS: A stratified subsample of the CARTaGENE (CaG) cohort (n = 1991) was used to compare cognitive function outcomes between groups. The stratification was based on the presence of depressive symptoms and metabolic dysregulation (MetD): the presence of a) neither condition (reference group); b) MetD only; c) depressive symptoms only; and d) both depressive symptoms and MetD. Individuals with type 2 diabetes were excluded. Three cognitive domains were assessed: processing speed, episodic memory, and executive function. An overall cognitive function score, standardized for age and education, was computed. Poor cognitive function was defined as the lower quartile of the overall cognitive function distribution. Linear and logistic regression analyses were conducted. RESULTS: The poorest cognitive performance was observed in the group with both depressive symptoms and MetD, followed by the group with depressive symptoms only, then the group with MetD only and the reference group. Mean (SD) overall cognition scores for the four groups were -0.25 (1.13), -0.13 (1.05), 0.11 (0.90), and 0.15 (0.93), respectively. Linear regression analyses suggested a linear increase in cognitive function across groups.In the logistic regression analyses, the highest risk of poor cognitive function was observed in the comorbid (depressive symptoms and MetD) group (adjusted OR = 1.99, 95% CI 1.46, 2.71). CONCLUSION: Comorbidity of depressive symptoms and MetD was associated with reduced cognitive performance in middle-aged adults without diabetes.KEY POINTSPoor cognitive function is a major public health concern and can be potentially prevented by targeting its modifiable risk factors.Metabolic dysregulation and depression have both been independently associated with poor cognitive function.Comorbidity of metabolic dysregulation and depressive symptoms is associated with an increased risk of poor cognitive function in middle-aged individuals.Future health interventions might benefit by screening for comorbidity in patients with poor cognitive function and by targeting depression and metabolic dysregulation together.

Job strain and the incidence of heart diseases: A prospective community study in Quebec, Canada.

OBJECTIVE: Job strain (high psychological demands and low decision control) is associated with cardiovascular diseases, however it remains unclear if the associations are explained by depressive symptoms, and whether there are sex differences. The objective of the present study was to evaluate the association between job strain and heart diseases in a middle-aged population-based cohort. METHODS: Baseline data were from CARTaGENE, a community survey of adults aged 40-60 years in Quebec, Canada. Incidence of heart diseases was examined in 8073 individuals by linking survey data with administrative data. Cox regression models were used to examine the association between job strain and heart disease, adjusting for sociodemographic characteristics, behavioral and clinical factors, and depressive symptoms. RESULTS: In total, 557 (6.9%) participants developed heart diseases over an average follow-up of 6.6 years. Job strain was associated with an increased risk of heart diseases in women (adjusted HR = 1.63, 95% CI 1.02-2.64) after controlling for depressive symptoms, behavioral and clinical factors. There was no overall association between job strain and heart diseases in men (adjusted HR = 0.96, 95% CI 0.62-1.49); an association was observed only in men aged 50 years and older. Incidence of heart diseases and high job strain was highest in those with labour jobs, and lowest in those with professional jobs. CONCLUSION: Job strain was associated with an increased risk of heart diseases in middle-aged women and in men aged 50 years and older. This association was not accounted for by depressive symptoms or sociodemographic, clinical, and behavioral factors.

The association between job strain, depressive symptoms, and cardiovascular disease risk: results from a cross-sectional population-based study in Québec, Canada.

PURPOSE: Job strain (high psychological demands and low decision control) has been associated with cardiovascular disease (CVD). It is unclear if job strain is associated with CVD risk score independently of depression, an established risk factor for CVD. This study investigated whether there is an association between job strain and CVD risk score, when depressive symptoms are controlled for. Sex differences were examined. METHODS: Data came from the CARTaGENE study, a community health survey of adults in Québec, Canada (n = 7848). Participants were working adults aged 40-69 years. CVD risk was estimated using the Framingham risk score. Job strain was measured as the ratio of job demands to control using the Job Content Questionnaire. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Regression analyses were conducted to examine the association between job strain and CVD risk score controlling for depressive symptoms. There was no interaction effect between job strain and depressive symptoms in the association with CVD risk score. RESULTS: High job strain was reported in approximately 21% of participants, high Framingham risk score was observed in approximately 9%. Job strain was associated with the Framingham risk score (B = 0.73, p < 0.001, adjusted for age, sex, and education) and controlling for depressive symptoms did not significantly change the association (B = 0.59, p < 0.001). CONCLUSION: The results suggest that the job strain is associated with CVD risk score and that this association is not explained by depressive symptoms. Similar associations were observed for males and females.

Transitional Employment and Psychological Distress: a Longitudinal Study.

Although it has been established that employed status is generally associated with better mental health than unemployed status, the psychological mechanisms that underlie the longitudinal association between employment status and psychological distress remain to be understood. Initial mental health, lower coping skills and social support, and more stressful events could potentially preselect certain vulnerable individuals to be at higher risk for unemployment or employment instability. The aim of this study was to examine the longitudinal association between employment status (including transitional employment status) and psychological distress, controlling for the effect of initial psychological distress, coping skills, social support, and stressful events. In 2009, residents from the epidemiological catchment area of south-west Montréal responded to a randomized household survey for adults. Follow-up surveys were conducted in 2011 and 2013 (n = 1168). Psychological distress was measured using the K-10 scale. Employment status was not significantly associated with psychological distress over time, however there were significant differences between the groups with the continually employed reporting the lowest average levels of psychological distress over time. Controlling for coping skills, social support, stressful events and initial psychological distress changed the strengths of the association between transitional employment status and psychological distress at follow-up. A significant longitudinal association between continual unemployment and psychological distress was observed. Initial psychological distress was significantly associated with becoming unemployed. Results suggest initial psychological distress as a risk factor for becoming unemployed and that the negative psychological implications of employment transitions can be significantly reduced when conditions for coping are optimized.

The association between sleep and diabetes outcomes - A systematic review.

AIM: This study aimed to systematically review the prevalence of diagnosed sleep disorders in people with diabetes and to determine the association between sleep disorders and blood glucose levels and diabetes outcomes. METHODS: We conducted a literature search in the following databases: MEDLINE (Pubmed), EMBASE, CINAHL, PsychInfo and Web of Science Citation Index. Meta-analysis (random-effects models) was conducted to estimate the prevalence of sleep disorders in people with diabetes. RESULTS: Forty-one articles measured the prevalence of sleep disorders in adults with diabetes. The estimated pooled prevalence of sleep disorders in diabetes was estimated to be 52% (95% CI 42-63%). The highest pooled prevalence was observed for unspecified sleep apnea (69%; 95% CI: 59-78%), followed by obstructive sleep apnea (60%; 95% CI 39-80%), and restless leg syndrome (27%; 95% CI 20-34%). Eleven studies examined the association between sleep disorders and diabetes control and complications. The presence of comorbid sleep disorders was associated with increased diabetes outcomes. CONCLUSIONS: Diagnosed sleep disorders are highly prevalent in people with diabetes. Sleep disorders are associated with diabetes outcomes, though there was considerable heterogeneity across studies.

What is the effect of mandatory pasteurisation on the biogas transformation of solid slaughterhouse wastes?

The effect of mandatory pasteurisation on Category 3 offals, according to the Animal By-Products Regulation (ABPR 1069/2009/EC), was determined using Biochemical Methane Potential (BMP) assays as well as kinetic and statistical analysis. Pasteurised and unpasteurised offals sampled from cattle, pig and chicken slaughterhouses were characterised and their specific methane yields (SMYs) and their bioavailability was assessed. The resultant SMYs were high (465-650mLCH4gVS(-1)) with no statistically significant increase in methane production identified due to pasteurisation. However, the kinetics of the biogas transformation processes highlighted increased bioavailability of the organics due to pasteurisation. This was brought to light by the change in maximum daily SMY from day 22 to day 1 for the cattle offal (p=0.001), day 17 to day 1 for chicken offal (p=0.025) and an increase of 18.8% in the maximum daily SMY of the pig offal on day 1 (p=0.003). The increased bioavailability of the offals manifested itself in two ways with the determining factor being identified as the physical characteristics of the fats i.e. particle size. Firstly reducing the hydrolytic lag phase for the cattle offal, λ=7.46-1.52days (p=0.013). Secondly, causing increased accumulation of Long Chain Fatty Acids to acute inhibitory levels in the chicken and pig offal indicated by increased lag phases λ=5.05-21.91days (p=0.012), λ=15.54-23.04days (p=0.007) respectively.

A technical, economic and environmental comparison of composting and anaerobic digestion of biodegradable municipal waste.

Ireland produces two million tonnes per annum of biodegradable municipal solid waste. The implementation of the Landfill Directive (1999/31/EC) will lead to the construction of centralised biological facilities; these facilities may be either composting facilities or anaerobic digestion facilities. A technical, economic and environmental analysis of composting and anaerobic digestion is undertaken in this paper. The results of the analysis suggest that composting is economically preferable to anaerobic digestion at scales at or below 50 kt/a of biowaste treated. However when CH4-enriched biogas is produced for use as a transport fuel and excise duty is reduced, as allowed by the Biofuels Directive (2003/30/EC), then the economics of anaerobic digestion improve greatly. If 100% of excise duty is removed then anaerobic digestion is economically preferable to composting above 20 kt/a of biowaste treated. From an environment perspective anaerobic digestion saves more greenhouse gas due to displacement of fossil fuel powered energy. Anaerobic digestion with CH4-enriched biogas has the potential to save 1,451 kgCO2/t of biowaste treated as opposed to composting, which has the potential to save 1,190 kgCO2/t.