Mindfulness plus physical activity reduces emotion dysregulation and insomnia severity among people with major depression.

BACKGROUND: As the disorder progresses, patients with depression suffer from decreased emotional stability, cognitive control and motivation. In the present study, we examined the effectiveness of three interventions on emotion dysregulation and insomnia severity: 1) mindfulness; 2) physical activity, and 3) mindfulness plus physical activity. METHOD: A total of 50 participants (mean age 33.21 ± 5.72 SD, 59% females) with major depression were randomly assigned to one of the three study conditions. Emotional dysregulation and insomnia severity were assessed at baseline, eight weeks later at study completion, and 4 weeks after that at follow-up. RESULTS: Emotion regulation and sleep quality improved over time from baseline to study completion and to follow-up. Compared to the mindfulness and physical activity alone conditions, the mindfulness plus physical activity condition led to higher emotion regulation and sleep quality. CONCLUSION: The combination of physical activity and mindfulness seems to have a beneficial effect on sleep quality and emotion regulation in those with major depression disorder and could be a valuable treatment strategy.

Snooze it or Lose it: Understanding Sleep Disturbance and Injuries in Soccer and Basketball Student-Athletes.

OBJECTIVES: To assess the sleep characteristics of collegiate soccer and basketball student-athletes and explore the associations between sleep and injury risk. DESIGN: Cohort study. SETTING: NCAA D1 and NAIA Tier 1. PARTICIPANTS: One hundred eighty-one collegiate soccer and basketball student-athletes (42% female; mean age: 20.0 ± 1.7 years). INDEPENDENT VARIABLES: Questionnaires were administered during the 2020/2021 and 2021/2022 preseason, collecting demographic, injury history, medical history, and sleep information, including sleep difficulty category scores of 0 to 4 (none), 5 to 7 (mild), and ≥8 (moderate/severe) and other sleep disturbance measures derived from the Athlete Sleep Screening Questionnaire (ASSQ), including insufficient sleep duration (<7 hours of sleep) and poor subjective sleep quality. MAIN OUTCOME MEASURES: All-complaint knee and ankle injuries. RESULTS: According to the ASSQ, 25.4% (95% confidence interval [CI], 17.9-34.3) of the student-athletes had mild sleep difficulty and 12.7% (95% CI, 7.3-20.1) had moderate/severe sleep difficulty. 36.1% (95% CI, 29.1-43.6) had insufficient sleep duration. 17.1% (95% CI, 11.7-23.7) were not satisfied with the quality of their sleep (poor sleep quality), and 13.8% (95% CI, 9.1-19.7) had an "eveningness" chronotype. Based on multivariable logistic regression models, student-athletes with poor sleep quality had significantly higher odds for injury (OR: 2.2, 95% CI, 1.04-4.79, P = 0.039). CONCLUSIONS: Clinically relevant dysfunctional sleep patterns are prevalent among collegiate soccer and basketball student-athletes. Poor sleep quality was significantly associated with injury risk among student-athletes. Findings suggest a substantial sleep problem in collegiate soccer and basketball student-athletes and warrant that student-athletes are regularly screened and timely interventions applied.

Exploring mental illness stigma among Asian men mobilized to become Community Mental Health Ambassadors in Toronto Canada.

BACKGROUND: Stigma of mental illness contributes to silence, denial and delayed help seeking. Existing stigma reduction strategies seldom consider gender and cultural contexts. PURPOSE: The Strengths in Unity study was a multi-site Canadian study that engaged Asian men in three stigma reduction interventions (ACT, CEE, psychoeducation) and mobilized them as Community Mental Health Ambassadors. Our participants included both men living with or affected by mental illness (LWA) as well as community leaders (CL). This paper will: (1) describe the baseline characteristics of the Toronto participants including their sociodemographic information, mental illness stigma (CAMI and ISMI), attitudes towards social change (SJS), and intervention-related process variables (AAQ-II, VLQ, FMI, Empowerment); (2) compare the differences among these variables between LWA and CL; and (3) explore factors that may correlate with socio-economic status and mental health stigma. RESULTS: A total of 609 Asian men were recruited in Toronto, Canada. Both CL and LWA had similar scores on measures of external and internalized stigma and social change attitudes, except that LWA had more positive views about the acceptance and integration of those with mental illness into the community on the CAMI, while CL had a higher level of perceived behavioral control on the SJS. Group differences were also observed between LWA and CL in some process-related variables. Exploratory analysis suggests that younger and more educated participants had lower stigma. CONCLUSION: Our findings underscore the importance of engaging both community leaders and people with lived experience as mental health advocates to address stigma.

Examining Different Strategies for Stigma Reduction and Mental Health Promotion in Asian Men in Toronto.

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.

How to manage travel fatigue and jet lag in athletes? A systematic review of interventions.

OBJECTIVES: We investigated the management of travel fatigue and jet lag in athlete populations by evaluating studies that have applied non-pharmacological interventions (exercise, sleep, light and nutrition), and pharmacological interventions (melatonin, sedatives, stimulants, melatonin analogues, glucocorticoids and antihistamines) following long-haul transmeridian travel-based, or laboratory-based circadian system phase-shifts. DESIGN: Systematic review Eligibility criteria Randomised controlled trials (RCTs), and non-RCTs including experimental studies and observational studies, exploring interventions to manage travel fatigue and jet lag involving actual travel-based or laboratory-based phase-shifts. Studies included participants who were athletes, except for interventions rendering no athlete studies, then the search was expanded to include studies on healthy populations. DATA SOURCES: Electronic searches in PubMed, MEDLINE, CINAHL, Google Scholar and SPORTDiscus from inception to March 2019. We assessed included articles for risk of bias, methodological quality, level of evidence and quality of evidence. RESULTS: Twenty-two articles were included: 8 non-RCTs and 14 RCTs. No relevant travel fatigue papers were found. For jet lag, only 12 athlete-specific studies were available (six non-RCTs, six RCTs). In total (athletes and healthy populations), 11 non-pharmacological studies (participants 600; intervention group 290; four non-RCTs, seven RCTs) and 11 pharmacological studies (participants 1202; intervention group 870; four non-RCTs, seven RCTs) were included. For non-pharmacological interventions, seven studies across interventions related to actual travel and four to simulated travel. For pharmacological interventions, eight studies were based on actual travel and three on simulated travel. CONCLUSIONS: We found no literature pertaining to the management of travel fatigue. Evidence for the successful management of jet lag in athletes was of low quality. More field-based studies specifically on athlete populations are required with a multifaceted approach, better design and implementation to draw valid conclusions. PROSPERO registration number The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019126852).

Sleep and the athlete: narrative review and 2021 expert consensus recommendations.

Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (<7 hours/night) and poor sleep quality (eg, sleep fragmentation). Athletic performance is reduced by a night or more without sleep, but the influence on performance of partial sleep restriction over 1-3 nights, a more real-world scenario, remains unclear. Studies investigating sleep in athletes often suffer from inadequate experimental control, a lack of females and questions concerning the validity of the chosen sleep assessment tools. Research only scratches the surface on how sleep influences athlete health. Studies in the wider population show that habitually sleeping <7 hours/night increases susceptibility to respiratory infection. Fortunately, much is known about the salient risk factors for sleep inadequacy in athletes, enabling targeted interventions. For example, athlete sleep is influenced by sport-specific factors (relating to training, travel and competition) and non-sport factors (eg, female gender, stress and anxiety). This expert consensus culminates with a sleep toolbox for practitioners (eg, covering sleep education and screening) to mitigate these risk factors and optimise athlete sleep. A one-size-fits-all approach to athlete sleep recommendations (eg, 7-9 hours/night) is unlikely ideal for health and performance. We recommend an individualised approach that should consider the athlete's perceived sleep needs. Research is needed into the benefits of napping and sleep extension (eg, banking sleep).

Representations on adherence to the treatment of Multidrug-Resistant Tuberculosis.

OBJECTIVE: To identify representations regarding adherence to the treatment of multidrug-resistant tuberculosis from the perspective of patients who were discharged upon being cured. METHOD: A qualitative study with patients who completed the drug treatment for multidrug-resistant tuberculosis in São Paulo. Social Determination was used to interpret the health-disease process, and the testimonies were analyzed according to dialectical hermeneutics and the discourse analysis technique. RESULTS: Twenty-one patients were interviewed. The majority (80.9%) were men, in the productive age group (90.4%) and on sick leave or unemployed (57.2%) during the treatment. Based on the testimonies, three categories associated with adherence to treatment emerged: the desire to live, support for the development of treatment and care provided by the health services. CONCLUSION: For the study sample, adherence to the treatment of multidrug-resistant tuberculosis was related to having a life project and support from the family and health professionals. Free treatment is fundamental for adherence, given the fragilities arising from the social insertion of people affected by the disease. Therefore, special attention is required from the health services to understand patient needs.

Waking Up to the Issue! Research Inattention and Sex-Related Differences Warrant More Sleep Studies in Female Athletes.

Understanding sleep patterns and behaviors of athletes is essential for developing targeted sleep-based interventions for implementation in practice. However, more than double the number of sleep studies have examined male athletes compared with female athletes, making the current understanding of sleep patterns, behaviors, and interventions among athletes disproportionately indicative of men. Consequently, this review demonstrates the need for more female-specific sleep data among athlete populations due to research inattention and sex-related differences. Specifically, this review identifies variations in sleep patterns and behaviors between male and female athletes, as well as physiological and lifestyle factors that potentially affect sleep patterns and behaviors across the lifespan, specifically in female athletes. In this regard, evidence suggests some female athletes experience longer sleep durations and better objective sleep quality, but similar or worse subjective sleep quality compared with male athletes. Additionally, scheduling training in the morning or throughout the day may benefit sleep in some female athletes. Considering sleep disorders, women may be at greater risk for insomnia and restless legs syndrome compared with men, which may be attributed to pregnancy, as well as a higher prevalence of anxiety and depressive symptoms, iron deficiency without anemia, and use of psychotropic medication among women. Finally, the menstrual cycle, menstrual disorders, oral contraceptive use, and the postpartum period have been shown to exert detrimental effects on sleep patterns and behaviors and should theoretically be considered when monitoring and managing sleep in female athletes.

The obligation of debriefing in global health education.

BACKGROUND: An outcome of globalization and internationalization in higher education in the health professions has been increasing global health placements. There is, however, a lack of literature on debriefing and support following these placements. The authors undertook a participatory project to develop peer support and debriefing in a global health nursing elective, during which this gap in literature was addressed. AIMS: The purpose of the project was to develop a peer support component of the course and revise the debriefing component based on results of a previous course evaluation. METHODS: The methods were guided by a participatory approach involving course alumni and included a scoping review and focus groups. RESULTS: The project resulted in development of: (1) a peer support statement and (2) a debriefing framework. CONCLUSIONS: Key lessons about the obligation of appropriate debriefing for students returning from global health placements include importance of affective learning, a pedagogy of discomfort, and global health ethics.

Pyjamas, Polysomnography and Professional Athletes: The Role of Sleep Tracking Technology in Sport.

Technological advances in sleep monitoring have seen an explosion of devices used to gather important sleep metrics. These devices range from instrumented 'smart pyjamas' through to at-home polysomnography devices. Alongside these developments in sleep technologies, there have been concomitant increases in sleep monitoring in athletic populations, both in the research and in practical settings. The increase in sleep monitoring in sport is likely due to the increased knowledge of the importance of sleep in the recovery process and performance of an athlete, as well as the well-reported challenges that athletes can face with their sleep. This narrative review will discuss: (1) the importance of sleep to athletes; (2) the various wearable tools and technologies being used to monitor sleep in the sport setting; (3) the role that sleep tracking devices may play in gathering information about sleep; (4) the reliability and validity of sleep tracking devices; (5) the limitations and cautions associated with sleep trackers; and, (6) the use of sleep trackers to guide behaviour change in athletes. We also provide some practical recommendations for practitioners working with athletes to ensure that the selection of such devices and technology will meet the goals and requirements of the athlete.

Sleep Health, Individual Characteristics, Lifestyle Factors, and Marathon Completion Time in Marathon Runners: A Retrospective Investigation of the 2016 London Marathon.

Despite sleep health being critically important for athlete performance and well-being, sleep health in marathoners is understudied. This foundational study explored relations between sleep health, individual characteristics, lifestyle factors, and marathon completion time. Data were obtained from the 2016 London Marathon participants. Participants completed the Athlete Sleep Screening Questionnaire (ASSQ) along with a brief survey capturing individual characteristics and lifestyle factors. Sleep health focused on the ASSQ sleep difficulty score (SDS) and its components. Linear regression computed relations among sleep, individual, lifestyle, and marathon variables. The analytic sample (N = 943) was mostly male (64.5%) and young adults (66.5%). A total of 23.5% of the sample reported sleep difficulties (SDS ≥ 8) at a severity warranting follow-up with a trained sleep provider. Middle-aged adults generally reported significantly worse sleep health characteristics, relative to young adults, except young adults reported significantly longer sleep onset latency (SOL). Sleep tracker users reported worse sleep satisfaction. Pre-bedtime electronic device use was associated with longer SOL and longer marathon completion time, while increasing SOL was also associated with longer marathon completion. Our results suggest a deleterious influence of pre-bedtime electronic device use and sleep tracker use on sleep health in marathoners. Orthosomnia may be a relevant factor in the relationship between sleep tracking and sleep health for marathoners.

Tuberculosis and common mental disorders: international lessons for Canadian immigrant health.

Tuberculosis is a pressing global health issue. Its association with other infections, illnesses, and social factors, including immigration, is well known, yet comparatively little research has examined the connections between tuberculosis and mental disorder, particularly among immigrants in Canada. The authors report on a scoping review conducted to better understand the synergies of tuberculosis, mental disorders, and underlying social conditions as they affect immigrants' health. They highlight the articles that focused on the co-occurrence of tuberculosis and depression/anxiety. After describing their approach and strategy, the authors present key thematic categories: prevalence, clinical presentation, and effects of stigma and poverty. Examining the research within the global context, they argue that migration contributes to these synergistic conditions. The review shows that Canadians stand to gain much by learning from low- and middle-income countries about what constitutes best evidence in approaching complex global health issues.

Associations of circadian change, travel distance, and their interaction with basketball performance: a retrospective analysis of 2014-2018 National Basketball Association data.

This investigation aimed to clarify the influence of circadian change and travel distance on National Basketball Association (NBA) team performance using a dataset from the 2014-2018 seasons. Data from 9,840 games were acquired from an open-access source. Game point differential and team free-throw percentage served as outcome variables. Time zone change (TZΔ) captured raw circadian delay/advance based on travel for a game and adjusted TZΔ (AdjTZΔ) evolved TZΔ by allowing acclimation to a novel TZ. We also further categorized AdjTZΔ into AdjTZΔ_A, which assumed travel the day before each game and AdjTZΔ_B, which assumed teams spent as many days in their home city as possible. Travel distance for each game was calculated. Linear mixed-effects modeling estimated associations, with games nested within team and year. Adjusted associations accounted for differences in team ability, whether the game was home or away, and whether the game occurred on the second half of a back-to-back game sequence. Greater circadian misalignment, regardless of delay or advance, and increasing travel distance negatively influenced NBA game performance. Yet, results suggest that performance outcomes may be more influenced by travel distance than circadian misalignment. Moreover, circadian misalignment and travel distance interacted to significantly influence game point differential. Furthermore, differences in results across analyses were observed between AdjTZΔ_A and AdjTZΔ_B, which suggests that subtle differences in constructed travel schedules can have notable impact on NBA performance outcomes. Lastly, playing on the second half of a back-to-back sequence emerged as a robust predictor of performance disadvantage, which corroborates the existing literature and provides further support for NBA schedule changes purposed to enhance competitive equity by reducing the number of back-to-back games across a season. These findings can help guide NBA teams on key strategies for reducing travel-related disadvantages and inform schedule makers on critical factors to prioritize across future schedules to attenuate competitive inequity from travel. Furthermore, they can help direct teams towards scenarios that are best to target for load management purposes due to the cumulative disadvantage arising from travel-related factors, opponent quality, game location, and game sequence.

Assessment of sleep disturbances with the athlete sleep screening questionnaire in Chinese athletes.

This study investigated the factors that are associated with sleep disturbances among Chinese athletes. Sleep quality and associated factors were assessed by the Athlete Sleep Screening Questionnaire (ASSQ, n â€‹= â€‹394, aged 18-32 years, 47.6% female). Sleep difficulty score (SDS) and level of sleep problem (none, mild, moderate, or severe) were used to classify participants' sleep quality. Categorical variables were analyzed by Chi-square or fisher's exact tests. An ordinal logistic regression analysis was used to explore factors with poor sleep (SDS ≥8). Approximately 14.2% of participants had moderate to severe sleep problem (SDS ≥8). Fifty-nine percent of the athletes reported sleep disturbance during travel, while 43.3% experienced daytime dysfunction when travelling for competition. No significant difference was found in the SDS category between gender, sports level and events. Athletes with evening chronotype were more likely to report worse sleep than athletes with morning and intermediate chronotype (OR, 2.25; 95%CI, 1.44-3.52; p â€‹< â€‹0.001). For each additional year of age, there was an increase of odds ratio for poor sleep quality (OR, 1.15; 95%CI, 1.04-1.26; p â€‹= â€‹0.004), while each additional year of training reduced the odds ratio (OR, 0.95; 95%CI, 0.91-0.99; p â€‹= â€‹0.044). To improve sleep health in athletes, chronotype, travel-related issues, age and years of training should be taken into consideration.

Associations between time zone changes, travel distance and performance: A retrospective analysis of 2013-2020 National Hockey League Data.

OBJECTIVES: Many studies have investigated the role that travel plays in athletic performance. However, these studies lacked a holistic representation of travel. For instance, they do not consider travel distance and uniquely focuses on travel direction. DESIGN: An open source (www.evolving-hockey.com) provided NHL (2013-2020) game data. In total, this resulted in 17,088 regular season games. METHODS: Linear and quadratic versions of time zone change (TZΔ) and adjusted jet lag (AJL) were formulated. TZΔ captured circadian delay/advance based on travel for a game, with each TZ going eastward and westward reflected by -1 and +1, respectively. AJL advances TZΔ by allowing TZ acclimation, with each day resulting in a 1-unit change towards circadian neutral. AJL is a season-long rolling summation, which was computed using two different travel approaches: Approach A (AJL_A) assumes travel the day before each game, whereas Approach B (AJL_B) was designed to prioritize being home. A standardized flight tracker determined travel distance for each game. Team ability differences, characterized as difference in total season points, served as an analytic covariate. Outcome variables included goal differential, difference between actual and expected Fenwick save percentage (dFSv%), and goals saved above average (GSAA). RESULTS: GameDistance (ß = -0.14, p = 0.0007), AJL_B2 (ß = -0.15, p = 0.0006), and their interaction (p = 0.0004) associated with GoalDifferential. GameDistance (ß = -0.18, p = 0.02) and AJL_B2 (ß = 0.12, p = 0.03) associated with dFSv%, whereas only AJL_B2 (ß = 0.03, p = 0.05) associated with GSAA. CONCLUSIONS: Results suggest that circadian change, in both direction, and greater traveled distance can negatively impact NHL athletes.

International research collaboration as social relation: an Ethiopian-Canadian example.

International collaboration in nursing and other health disciplines is vital for addressing global health issues. While the results and processes of such collaborations have been reported, few publications have addressed their philosophical or theoretical underpinnings, particularly with respect to collaboration between those in low- and high-income countries. Piaget's notion of social relations of cooperation and constraint and Habermas's notion of "lifeworld" provide a theoretical lens through which to examine international collaboration as a construction of knowledge. This article is an exploration of these ideas as seen in the collective experience of Canadians and Ethiopians organizing an interdisciplinary forum on intimate partner violence in Ethiopia. The project is presented as a case study for reflecting on international collaboration as a manifestation of social relations. Such re-visioning of international collaboration may be useful for improving collaborative processes and their outcomes.

Sleep, health, and well-being in elite athletes from different sports, before, during, and after international competition.

Objectives: Limited research has been conducted on sleep problems in elite athletes at international competition, and how this relates to their general health and well-being. Methods: Sixty-five elite international athletes (37 males, 28 females, 21.8 ± 2.1 years) from different sports completed validated sleep (Athlete Sleep Screening Questionnaire), health (Subjective Health Complaints Inventory) and well-being (Sports Profile of Mood States) questionnaires; 1 month pre-competition, at the end of international competition, and 1 month post-competition. Results: Twenty-three percent of the elite athletes were identified as having a moderate or severe clinically significant sleep problem during competition, with 82% reporting less than 8 h of sleep per night. Athletes with a moderate or severe clinically significant sleep problem during competition had significantly greater general health complaints (p = 0.002), mood disturbance (p = 0.001) and poorer sleep hygiene (p = 0.002). Swimmers had more sleep difficulty pre and during competition compared to athletics and soccer (p = 0.009). Conclusion: Sleep disturbance during international competition is common and associated with poorer health and lower mood. Swimmers may be more at risk of sleep difficulty pre and during competition compared to those competing in athletics and soccer. Sleep services may be required to support elite athletes at international competition.

Managing Travel Fatigue and Jet Lag in Athletes: A Review and Consensus Statement.

Athletes are increasingly required to travel domestically and internationally, often resulting in travel fatigue and jet lag. Despite considerable agreement that travel fatigue and jet lag can be a real and impactful issue for athletes regarding performance and risk of illness and injury, evidence on optimal assessment and management is lacking. Therefore 26 researchers and/or clinicians with knowledge in travel fatigue, jet lag and sleep in the sports setting, formed an expert panel to formalise a review and consensus document. This manuscript includes definitions of terminology commonly used in the field of circadian physiology, outlines basic information on the human circadian system and how it is affected by time-givers, discusses the causes and consequences of travel fatigue and jet lag, and provides consensus on recommendations for managing travel fatigue and jet lag in athletes. The lack of evidence restricts the strength of recommendations that are possible but the consensus group identified the fundamental principles and interventions to consider for both the assessment and management of travel fatigue and jet lag. These are summarised in travel toolboxes including strategies for pre-flight, during flight and post-flight. The consensus group also outlined specific steps to advance theory and practice in these areas.

Becoming a global citizen through nursing education: lessons learned in developing evaluation tools.

While global health practica are being increasingly described in nursing education literature, course evaluation of same receives comparatively less attention. In this article, authors report on an evaluation project, undertaken to rigorously examine the existing evaluation methods for an elective global health practicum with placements in India and northern Canada. Sixteen students were interviewed and course evaluation tools were reviewed. Resulting themes include students' sense of preparedness, the centrality of the student-preceptor relationship, the importance of supported self-reflection, and the usefulness of evaluation methods. Participants viewed existing course evaluation methods as generally useful, therefore requiring only minor adjustments. There were also structural revisions to the preparation, placement, and post-placement phases of the course and broader lessons learned. Lessons include the importance of critical social perspectives and the value of past students revisiting their experiences in such a way as make conscious connections between placement experiences and their current professional practice.

Considering place in community health nursing.

When a geographic location is assigned meaning, it becomes a place. The authors argue that place matters as both geographical location and lived experience.They extend the current conceptualization of nursing geography to encompass community health nursing and address intricacies of community nursing practice and research that often go unnoticed. They do so by exploring the notion of place in home and community, including the structural/spatial dimensions of the nurse-client relationship. The authors review the health geography literatures, then discuss the implications for practice and research in community health. They invite community health nurses to critically examine their practice and research with reference to such issues as the power of the nurse, marginalized places as determinants of health, and how best to care for clients living in diverse community settings.