Adolescent perspectives of bedtime social media use: A qualitative systematic review and thematic synthesis.

Adolescence is often characterised by changes in sleep patterns, with reports that the average adolescent does not get the recommended sleep time. Recent qualitative research has identified the use of electronics at bedtime and engagement with social media platforms as barriers to gaining sufficient time and quality of sleep during adolescence. A systematic review and thematic synthesis was undertaken following the three-step thematic synthesis framework. Four databases were searched, and full texts were screened based on pre-existing inclusion/exclusion criteria. Fourteen studies were included, encompassing 967 participants. Three analytical themes were developed: 1) social motivations; 2) habitual smartphone use and 3) recognition of a problem. Findings confirmed how bedtime social media use requires a new framework for recognising the importance of peer relations, where increased frequency and immediacy of communication lays the foundation for social accountability to meet communicative norms and fear of missing out. In the review, adolescents commonly express a lack of control in relation to their social media use which triggered discussion of the habitual aspects of bedtime social media use. The importance of intervention strategies which recognise the wider peer-to-peer social implications of bedtime social media use is discussed with some practical insights offered.

Isolated systolic hypertension in young males: a scoping review.

Isolated systolic hypertension typically occurs in young males; however, its clinical significance is unknown. Given the prevalence of the hypertension and its contribution to global morbidity and mortality, a synthesis of the most recent available evidence around isolated systolic hypertension is warranted. This review aims firstly to review the haemodynamic and physical characteristics indicative of cardiovascular risk in young males (aged 18 to 30 years) with isolated systolic hypertension, and secondly to synthesize the associated clinical management recommendations reported in the literature. Six databases were systematically searched for all relevant peer-reviewed literature examining isolated systolic hypertension in young males. Search results were screened and examined for validity, those that did not meet the inclusion criteria were removed. A total of 20 articles were appropriate for inclusion. Key factors indicative of cardiovascular risk in isolated systolic hypertension were characterized by several distinctive haemodynamic parameters and physical characteristics. After the literature was synthesized based around these key factors, two distinct cohorts (healthy and unhealthy) were highlighted. The healthy cohort of younger males with isolated systolic hypertension was associated with a decreased cardiovascular risk and therefore no medical interventions were recommended. The second (unhealthy) cohort was, however, associated with an increased cardiovascular risk and may therefore, benefit from antihypertensive therapy.

Nodding off but can't disconnect: development and validation of the iNOD index of Nighttime Offline Distress.

BACKGROUND: There is a pressing need to update sleep models, education and treatment to better reflect the realities of sleep in a 24/7 connected social world. Progress has been limited to date by available measurement tools, which have largely focused on the frequency or duration of individuals' social media use, without capturing crucial sleep-relevant aspects of this inherently social and interactive experience. METHODS: Survey data from 3008 adolescents (aged 10-18 years) was used to rigorously develop and validate a new self-report measure that quantifies difficulty disengaging from social media interactions at night: the index of Nighttime Offline Distress (iNOD). Exploratory and Confirmatory Factor analyses in a random split sample produced a ten-item two-factor solution, with subscales capturing concerns about Staying Connected and Following Etiquette (Cronbach's alphas = 0.91 and 0.92 respectively). RESULTS: Those with higher scores on these subscales tended to report using social media for longer after they felt they should be asleep (rs = 0.41 and 0.26, respectively), shorter sleep duration (rs = -0.24 and -0.17, respectively) and poorer sleep quality (rs = -0.33 and -0.31, respectively). Results also pointed towards a potentially fragmented process of sleep displacement for those who may struggle to disconnect - and to stay disconnected - from social interactions in order to allow sufficient uninterrupted sleep opportunity. CONCLUSIONS: These findings can inform current models for understanding normal and disordered sleep during adolescence, whilst highlighting specific social concerns as important potential targets for sleep education efforts.

Polysomnography shows sleep fragmentation in patients with inactive inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD), classified as Crohn's disease or ulcerative colitis, is a chronic inflammatory condition that affects the gastrointestinal tract. Fatigue is a common symptom of IBD, even in periods of inactive disease; however, the cause of this fatigue is unknown. Studies have suggested that altered sleep patterns may be associated with the fatigue experienced by IBD patients. The aim of our study was to assess the sleep quality of patients with inactive IBD who report fatigue. METHODS: We conducted a prospective observational pilot study that examined IBD outpatients with inactive disease who had complaints of fatigue. Upon enrolment, patients underwent Level 1 diagnostic polysomnography for one night to measure objective sleep parameters. Patients were also asked to complete 3 validated questionnaires to assess fatigue, depression levels, and subjective sleep quality. RESULTS: Fifteen patients (7 with CD, 8 with UC) were enrolled in the study; their mean age was 38.6±11.6 years. IBD patients had a mean spontaneous arousal index of 20.0±9.7 arousals /h. Patients spent an average of 6.6%, 60.4%, 15.2%, and 17.9% of their total sleep time in stages N1, N2, N3 and rapid-eye-movement sleep, respectively. Four (26.7%) patients had obstructive sleep apnea, and 7 (46.7%) patients experienced periodic limb movements of sleep. CONCLUSIONS: Patients with IBD experienced altered sleep patterns and high rates of sleep fragmentation. Further research is needed to determine how poor sleep quality can be treated in patients with IBD.

Developmental assessments during the first 5 years of life in infants fed breast milk, cow's milk formula, or soy formula.

OBJECTIVE: To investigate the effects of infant feeding mode on childhood cognition and language as the differential effects of infant feeding on development remain understudied. METHODS: Breastfed [BF, 174], cow's milk-based formula-fed [MF, 169], or soy protein-based formula-fed [SF, 161] children were longitudinally tested from age 3 to 60 months for neurodevelopment. Data were analyzed using mixed models while adjusting for multiple covariates. Sex differences were also assessed. RESULTS: Standard scores were within established norms for all groups. There were no differences in mental development to age 24 months, yet BF children had significantly higher motor development scores at age 3 months than SF children (99.1 versus. 97.2). BF children had significantly higher composite intelligence scores at 48 months than MF and SF children (113.4 versus. 109.6 and 108.4, respectively) and higher verbal intelligence scores than SF children at 48 (105.6 versus. 100.7) and 60 months (109.8 versus. 105.9). Greater total language scores at ages 36 and 48 months were found in BF children compared with children fed MF or SF (p < .001), with differences between sexes for auditory comprehension. Higher total language scores at age 60 months were found between BF and SF (105.0 versus. 100.1). CONCLUSION: Breastfeeding was associated with small, statistically significant, differences between children ages 3 and 5 years in verbal intelligence, expressive communication, and auditory comprehension with the latter having potential sexual dimorphic effects. Yet, these differences remain small and may not be of clinical relevance. Overall, MF and SF did not significantly differ.

Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study.

OBJECTIVES: This study examines associations between social media use and multiple sleep parameters in a large representative adolescent sample, controlling for a wide range of covariates. DESIGN: The authors used cross-sectional data from the Millennium Cohort Study, a large nationally representative UK birth cohort study. PARTICIPANTS: Data from 11 872 adolescents (aged 13-15 years) were used in analyses. METHODS: Six self-reported sleep parameters captured sleep timing and quality: sleep onset and wake times (on school days and free days), sleep onset latency (time taken to fall asleep) and trouble falling back asleep after nighttime awakening. Binomial logistic regressions investigated associations between daily social media use and each sleep parameter, controlling for a range of relevant covariates. RESULTS: Average social media use was 1 to <3 hours per day (31.6%, n=3720). 33.7% were classed as low users (<1 hour; n=3986); 13.9% were high users (3 to <5 hours; n=1602) and 20.8% were very high users (5+ hours; n=2203). Girls reported spending more time on social media than boys. Overall, heavier social media use was associated with poorer sleep patterns, controlling for covariates. For example, very high social media users were more likely than comparable average users to report late sleep onset (OR 2.14, 95% CI 1.83 to 2.50) and wake times (OR 1.97, 95% CI 1.32 to 2.93) on school days and trouble falling back asleep after nighttime awakening (OR 1.36, 95% CI 1.10 to 1.66). CONCLUSIONS: This study provides a normative profile of UK adolescent social media use and sleep. Results indicate statistically and practically significant associations between social media use and sleep patterns, particularly late sleep onset. Sleep education and interventions can focus on supporting young people to balance online interactions with an appropriate sleep schedule that allows sufficient sleep on school nights.

Identifying drivers for bedtime social media use despite sleep costs: The adolescent perspective.

OBJECTIVES: Bedtime social media use is associated with poor sleep during adolescence, which in turn contributes to poor mental health, impaired daytime functioning and lower academic achievement. However, the underlying drivers for these bedtime social media habits remain understudied. This study adds an adolescent perspective on motivations for bedtime social media use and perceived impact on sleep. METHODS: Adolescents aged 11-17 years (n = 24) participated in focus group discussions exploring their experiences of using social media, particularly at night. Inductive reflexive thematic analysis produced themes that captured underlying drivers for social media use and associated impact on sleep. RESULTS: Our analyses produced two overarching themes: Missing Out and Norms & Expectations. Adolescents' nighttime social media use was driven by concerns over negative consequences for real-world relationships if they disconnected (often reporting delayed bedtimes, insufficient sleep and daytime tiredness). These concerns included the risk of offline peer exclusion from missing out on online interactions, and the fear of social disapproval from violating norms around online availability and prompt responses. CONCLUSIONS: These findings offer novel insight into why adolescents may choose to prioritize social media over sleep. Researchers and practitioners can respond to the evolving needs of today's adolescents by approaching social media use not as a technology-based activity, but as an embedded social experience underpinned by the same concerns as offline interactions.

Fear of missing out and sleep: Cognitive behavioural factors in adolescents' nighttime social media use.

INTRODUCTION: Social media use has been linked to poor adolescent sleep outcomes, but the mechanisms behind this association are not yet well understood. This study examines links between adolescents' social media habits, fear of missing out and sleep outcomes, using path analysis to evaluate a model of proposed underlying mechanisms. METHODS: Adolescents aged 12-18 years (N = 101) completed questionnaire measures. RESULTS: Nighttime social media use was associated with later bedtimes, increased pre-sleep cognitive arousal, longer sleep onset latency and shorter sleep duration. Path analysis supported a model whereby fear of missing out predicted shorter sleep duration via two distinct mechanisms: (1) at a behavioural level, by driving late night social media use, which delays bedtimes; (2) at a cognitive level, by increasing pre-sleep cognitive arousal, thus further delaying sleep onset. CONCLUSIONS: Efforts to develop and evaluate intervention strategies should therefore consider not only social media behaviours but also underlying cognitive factors, such as fear of missing out.

#Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem.

This study examined how social media use related to sleep quality, self-esteem, anxiety and depression in 467 Scottish adolescents. We measured overall social media use, nighttime-specific social media use, emotional investment in social media, sleep quality, self-esteem and levels of anxiety and depression. Adolescents who used social media more - both overall and at night - and those who were more emotionally invested in social media experienced poorer sleep quality, lower self-esteem and higher levels of anxiety and depression. Nighttime-specific social media use predicted poorer sleep quality after controlling for anxiety, depression and self-esteem. These findings contribute to the growing body of evidence that social media use is related to various aspects of wellbeing in adolescents. In addition, our results indicate that nighttime-specific social media use and emotional investment in social media are two important factors that merit further investigation in relation to adolescent sleep and wellbeing.

Engaging parents and schools improves uptake of the human papillomavirus (HPV) vaccine: examining the role of the public health nurse.

BACKGROUND: Nova Scotia has the highest rate of cervical cancer in Canada, and most of these cases are attributed to the Human Papillomavirus (HPV). In 2007, Gardasil(®) was approved and implemented in a successful school-based HPV immunization program. Little is known, however, which strategies (if any) used within a school-based program help to improve vaccine uptake. METHODS: A retrospective, exploratory correlation study was conducted to examine the relationship between school-based strategies and uptake of HPV vaccine. Data was analyzed through Logistic regression, using PASW Statistics 17 (formerly SPSS 17). RESULTS: HPV vaccine initiation was significantly associated with Public Health Nurses providing reminder calls for: consent return (p=0.017) and missed school clinic (p=0.004); HPV education to teachers (p<0.001), and a thank-you note to teachers (p<0.001). Completion of the HPV series was associated with vaccine consents being returned to the students' teacher (p=0.003), and a Public Health Nurse being assigned to a school (p=0.025). CONCLUSIONS: These findings can be used to help guide school-based immunization programs for optimal uptake of the HPV vaccine among the student population.

Breakfast Cereal Consumption Moderates the Association Between Body Composition and Body Esteem in Young Women but not in Young Men.

PURPOSE: To explore the role of breakfast cereal consumption on the relationships among BMI, percent fat mass (%FM), and body esteem in young adults. METHODS: Weight, height, and %FM (by air displacement plethysmography) were measured in 29 males (aged 25.1 ± 4.0 years) and 28 females (aged 24.6 ± 4.0 years). Body esteem was measured using the Body Esteem Scale for Adolescents and Adults (BESAA). Three-day food records classified participants as breakfast cereal consumers (n = 27, any amount of ready-to-eat or cooked cereal consumed at breakfast) versus nonconsumers (n = 30, no cereal consumed at breakfast). RESULTS: The %FM was significantly (P ≤ 0.05) inversely correlated with weight esteem (r = -0.769), appearance esteem (r = -0.723), and external attribution (r = -0.620) in female noncereal consumers. BMI was similarly correlated with BESAA scores. These relationships were not significant in female cereal consumers (all r < 0.426), despite no difference in confounding variables between female cereal consumers and nonconsumers. Neither BMI nor %FM were correlated with measures of body esteem (all r < 0.466, NS) in either male cereal consumers or nonconsumers. CONCLUSIONS: Breakfast cereal consumption may moderate the relationship among BMI, %FM, and body esteem in young adult women and may be useful for improving body esteem without focusing on weight loss.

Mycobacterium tuberculosis in chemokine receptor 2-deficient mice: influence of dose on disease progression.

Within a Mycobacterium tuberculosis-induced granuloma, lymphocytes and macrophages work together to control bacterial growth and limit the spread of infection. Chemokines and chemokine receptors are involved in cell migration and are logical candidates for a role in granuloma formation. In the present study we addressed the role of CC chemokine receptor 2 (CCR2) in M. tuberculosis infection. In previous studies (W. Peters et al., Proc. Natl. Acad. Sci. USA 98:7958-7963, 2001), CCR2(-/-) mice were found to be highly susceptible to a moderate or high dose of H37Rv administered intravenously (i.v.). We have expanded those studies to demonstrate that the susceptibility of CCR2(-/-) mice is dose dependent. After low-dose aerosol or i.v. infection of CCR2(-/-) mice with M. tuberculosis, there was a substantial delay in cell migration to the lungs and delayed expression of gamma interferon and inducible nitric oxide synthase. The CCR2(-/-) mice had a severe and prolonged deficiency in the number of macrophages in the lungs and an early increase in the number of neutrophils. Despite these deficiencies in cell migration, the CCR2(-/-) mice did not have increased bacterial loads in the lungs compared to wild-type (C57BL/6) mice and successfully formed granulomas. This finding is in contrast to CCR2(-/-) mice infected with a high dose of M. tuberculosis administered i.v. These results indicate that with low-dose infection, a delay in immune response in the lungs does not necessarily have detrimental long-term effects on the progression of the disease. The fact that CCR2(-/-) mice survive with substantially fewer macrophages in the low-dose models implies that the immune response to low-dose M. tuberculosis infection in mice is more robust than necessary to control the infection. Finally, these data demonstrate that, in cases of infectious disease in knockout models, clear phenotypes may not be evident when one is solely evaluating bacterial numbers and survival. Functional assays may be necessary to reveal roles for components of the multifactorial immune system.