ORCID Profile
0000-0003-2698-4864
Current Organisations
Macquarie University
,
Woolcock Institute of Medical Research
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Publisher: Elsevier BV
Date: 10-2004
Publisher: MDPI AG
Date: 07-12-2019
Abstract: Background: High occupational stress has been associated with altered eating behaviors and obesity. Occupational stress is reported to be high in Asian countries. Furthermore, many Asian countries are increasingly consuming Western-type foods (e.g., incorporating drinks with meals) which collectively may also be contributing to obesity. Therefore, the aim of this study was to examine (a) associations between sugar-sweetened beverage (SSB) consumption as meal replacement and obesity and (b) associations between workload and substituting meals with SSB in nurses. Methods: A representative s le of 854 hospital-based nurses completed a structured questionnaire about SSB consumption, workload, and body mass index (BMI). Log binomial regression models were employed to test associations between SSBs and obesity rates and associations between workload and SSBs. Results: Most participants (57.6%) consumed SSBs as meal replacements during work. This was related to high workloads during shifts. Substituting SSBs for meals was significantly associated with increased likelihood of obesity (aPRR = 1.4, 95% CI (1.1, 1.7)). Workload was positively associated with SSB intake as meal substitutes (aPRR = 1.4, 95% CI (1.2, 1.6)). Conclusions: Our findings show that SSBs are used as meal substitutes and is due to the workload demands. Sugar-sweetened beverage consumption is also positively associated with the increased likelihood of obesity. Interventions that modify workloads and decrease SSB consumption may improve workers’ eating behaviors and health.
Publisher: Elsevier BV
Date: 04-2018
Publisher: Springer Science and Business Media LLC
Date: 03-09-2020
DOI: 10.1186/S13643-020-01458-8
Abstract: This systematic review aimed to investigate whether the administration of hypnotic medicines, z-drugs, melatonin or benzodiazepines, reduced pain intensity postoperatively. Medline, Embase, Cinahl, Psych info, Central and PubMed databases were searched, from inception to February 2020 to identify relevant trials. The search was extended, post hoc, to include meta-Register of Controlled Trials, the Web of Science and the conference booklets for the 14th, 15th, and 16th International Association for the Study of Pain conferences. Two independent reviewers screened titles and abstracts and cross-checked the extracted data. The search retrieved 5546 articles. After full-text screening, 15 trials were included, which had randomised 1252 participants. There is moderate-quality evidence that in the short-term [WMD − 1.06, CI − 1.48 to − 0.64, p ≤ .01] and low-quality evidence that in the medium-term [WMD − 0.90, CI − 1.43 to − 0.37, p ≤ .01] postoperative period oral zolpidem 5/10 mg with other analgesic medicines reduced pain intensity compared to the same analgesic medicines alone. There is low-quality evidence that melatonin was not effective on postoperative pain intensity compared to placebo. The results of benzodiazepines on pain intensity were mixed. The authors reported no significant adverse events. There is promising evidence that the hypnotic medicine zolpidem, adjuvant to other analgesics, is effective at achieving a minimally clinically important difference in pain intensity postoperatively. There is no consistent effect of melatonin or benzodiazepines on postoperative pain intensity. Readers should interpret these results with some caution due to the lack of data on safety, the small number of trials included in the pooled effects and their s le sizes. The protocol for this systematic review was registered with PROSPERO ID= CRD42015025327 .
Publisher: Springer Science and Business Media LLC
Date: 23-05-2016
Publisher: JMIR Publications Inc.
Date: 27-09-2020
Abstract: obile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. he aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. his is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation. >
Publisher: Oxford University Press (OUP)
Date: 2023
DOI: 10.1093/BRAINCOMMS/FCAD129
Abstract: Reduced heart rate variability can be an early sign of autonomic dysfunction in neurodegenerative diseases and may be related to brain dysfunction in the central autonomic network. As yet, such autonomic dysfunction has not been examined during sleep—which is an ideal physiological state to study brain–heart interaction as both the central and peripheral nervous systems behave differently compared to during wakefulness. Therefore, the primary aim of the current study was to examine whether heart rate variability during nocturnal sleep, specifically slow wave (deep) sleep, is associated with central autonomic network functional connectivity in older adults ‘at-risk’ of dementia. Older adults (n = 78 age range = 50–88 years 64% female) attending a memory clinic for cognitive concerns underwent resting-state functional magnetic resonance imaging and an overnight polysomnography. From these, central autonomic network functional connectivity strength and heart rate variability data during sleep were derived, respectively. High-frequency heart rate variability was extracted to index parasympathetic activity during distinct periods of sleep, including slow wave sleep as well as secondary outcomes of non-rapid eye movement sleep, wake after sleep onset, and rapid eye movement sleep. General linear models were used to examine associations between central autonomic network functional connectivity and high-frequency heart rate variability. Analyses revealed that increased high-frequency heart rate variability during slow wave sleep was associated with stronger functional connectivity (F = 3.98, P = 0.022) in two core brain regions within the central autonomic network, the right anterior insular and posterior midcingulate cortex, as well as stronger functional connectivity (F = 6.21, P = 0.005) between broader central autonomic network brain regions—the right amygdala with three sub-nuclei of the thalamus. There were no significant associations between high-frequency heart rate variability and central autonomic network connectivity during wake after sleep onset or rapid eye movement sleep. These findings show that in older adults ‘at-risk’ of dementia, parasympathetic regulation during slow wave sleep is uniquely linked to differential functional connectivity within both core and broader central autonomic network brain regions. It is possible that dysfunctional brain–heart interactions manifest primarily during this specific period of sleep known for its role in memory and metabolic clearance. Further studies elucidating the pathophysiology and directionality of this relationship should be conducted to determine if heart rate variability drives neurodegeneration, or if brain degeneration within the central autonomic network promotes aberrant heart rate variability.
Publisher: Wiley
Date: 03-09-2015
DOI: 10.1111/JOCN.12959
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Informa UK Limited
Date: 2015
DOI: 10.2147/JMDH.S74974
Publisher: Springer Science and Business Media LLC
Date: 08-08-2016
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.NEDT.2010.04.004
Abstract: There is a paucity of evidence regarding the efficacy in preparing medical-surgical nurses to respond to patients with acutely deteriorating conditions. The aim of this study was to evaluate registered nurses' ability to respond to the deteriorating patient in clinical practise following training using immersive simulation and use of a high fidelity simulator. This study was a follow-up survey of medical-surgical graduate nurses following immersive high fidelity simulation training. Thirty eight registered nurses practising in medical-surgical areas completed the simulation as part of university graduate study. A follow-up survey of the graduate medical-surgical registered nurses conducted three months following completion of a high fidelity simulation-based learning experience. Outcomes consisted of the number of times skills were used in practise and the usefulness of simulation in preparing for actual emergency events. Participants reported a total of 164 clinical patient emergencies in the follow-up time period including: 46% cardiac, 32% respiratory, 10% neurological, 7% cardiac arrest and 5% related to electrolyte disturbances. The ability to respond in a systematic way, handover to the emergency team and airway management were identified as the skills most improved during patient emergencies following simulation. The most useful aspects of the simulation experience identified were scenario debriefing and assertiveness training. Participants with less years of clinical experience were more likely to report practising the team leader role and debriefing as the most useful aspects of simulation. The skills practised in simulation were highly relevant to participants practise in medical-surgical areas. Non-technical skills, including assertiveness skills should be considered in future emergency training courses for nurses.
Publisher: Springer Science and Business Media LLC
Date: 24-08-2016
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.NEDT.2019.04.005
Abstract: Simulation has been used extensively to train students and health professionals in the assessment and early intervention of patients with acutely deteriorating conditions. These simulations evoke psychophysiological stress in learners which may affect performance. We examined the relationship between stress variables, confidence, and performance during repeated scenarios in clinically-based emergency simulations. Twenty-six registered nurses completed three simulation scenarios focussing on life-threatening clinical events in a single group pre-test ost-test study design. Trait anxiety was measured at baseline. Visual analogue ratings of anxiety and stress were measured before ('pre'), recalled 'during', and immediately following ('post') each simulation scenario, with a self-rating of confidence completed after each simulation scenario. Heart rate was measured continuously throughout the simulation program. Participants self-rated their clinical performance prior to and following the simulation program ('pre' and 'post'). Participants' trait anxiety was not elevated at baseline (mean: 39.6, SD 6.1). Across the three simulation scenarios, anxiety and stress was elevated 'during' simulation compared to 'pre' and 'post' time points. However, the magnitude of elevation of stress and anxiety during all time points ('pre', 'during' and 'post' simulation) decreased significantly (p < 0.05) with progressive simulations. Heart rate increased significantly during all simulations compared to 'pre'-levels but returned to similar levels following the simulation. The amount of increase in heart rate over progressive simulations was attenuated during simulation 3 compared with 1 and 2 (Sim 1: 103.6 bpm (SD 22.1), Sim 2: 101.9 bpm (SD 18.9), and Sim 3: 99.5 bpm (SD 23.4)). Confidence increased across the three simulations (p < 0.001), with most of the increase observed after the first two simulations. Performance scores increased by 19.0% 'pre-post' simulation program (p < 0.001) and were not confounded by previous ALS or simulation experience. We observed temporal-dependent changes in psychophysiological stress variables across the simulation scenarios, with decreased magnitudes of elevations of psychological (self-reported anxiety and stress) and physiological (heart rate) stress variables during successive simulation scenarios. This study has shown that simulation increased stress, especially before and during scenarios however, the learning effect decreased the magnitude of the stress response with repeated simulation scenarios. Simulation educators need to create simulations that change stress in a purposeful manner to enhance learning.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2021
DOI: 10.1038/S41598-021-03564-6
Abstract: Insomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power spectral analysis and measurement of response to acute sleep restriction may be informative in overall assessment of ID. To explore alternative classifications of ID subtypes, insomnia patients (n = 99) underwent two consecutive overnight sleep studies: (i) habitual sleep opportunity (polysomnography, PSG) and, (ii) two hours less sleep opportunity (electroencephalography, EEG), with the first night compared to healthy controls (n = 25). ID subtypes were derived from data-driven classification of PSG, EEG spectral power and interhemispheric EEG asymmetry index. Three insomnia subtypes with different sleep duration and NREM spectral power were identified. One subtype (n = 26) had shorter sleep duration and lower NREM delta power than healthy controls (short-sleep delta-deficient SSDD), the second subtype (n = 51) had normal sleep duration but lower NREM delta power than healthy controls (normal-sleep delta-deficient NSDD) and a third subtype showed (n = 22) no difference in sleep duration or delta power from healthy controls (normal neurophysiological sleep NNS). Acute sleep restriction improved multiple objective sleep measures across all insomnia subtypes including increased delta power in SSDD and NSDD, and improvements in subjective sleep quality for SSDD ( p = 0.03), with a trend observed for NSDD ( p = 0.057). These exploratory results suggest evidence of novel neurophysiological insomnia subtypes that may inform sleep state misperception in ID and with further research, may provide pathways for personalised care.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.SMRV.2016.06.004
Abstract: Heart rate variability (HRV) is an objective marker that provides insight into autonomic nervous system dynamics. There is conflicting evidence regarding the presence of HRV impairment in insomnia patients. Web-based databases were used to systematically search the literature for all studies that compared the HRV of insomnia patients to controls or reported the HRV of insomnia patients before and after an intervention. 22 relevant papers were identified. Study characteristics were summarised, HRV measures were extracted and a risk of bias assessment for each study was performed. We were limited in our ability to synthesise outcome measures and perform meta-analyses due to considerable differences in patient (and control) selection, study protocols, measurement and processing techniques and outcome reporting. Risk of bias was deemed to be high in the majority of studies. As such, we cannot confirm that HRV is reliably impaired in insomnia patients nor determine the HRV response to interventions. Whilst HRV impairment in insomnia is a widely accepted concept, it is not supported by empirical evidence. Large longitudinal studies incorporating 24-hour recordings are required to elucidate the precise nature of HRV dynamics in insomnia patients.
Publisher: Elsevier BV
Date: 08-2017
Publisher: Public Library of Science (PLoS)
Date: 18-06-2018
Publisher: Springer Science and Business Media LLC
Date: 29-04-2020
DOI: 10.1186/S12888-020-02606-Z
Abstract: Depression is common in older people and is associated with underlying brain change increasing the risk of dementia. Sleep disturbance is frequently reported by those with lifetime depression, however whether circadian misalignment also exists is unclear. We aimed to examine circadian rhythms and sleep associations in older patients with and without lifetime depression. Thirty-four older people meeting DSM-IV criteria for lifetime major depression (mean age = 63.9 years), and 30 healthy controls (mean age = 65.7 years) were recruited. Participants underwent 2-weeks of actigraphy followed by a 3-night protocol including dim light melatonin onset (DLMO) assessment and overnight polysomnography (PSG) for sleep architecture. DLMO and phase angle of entrainment were computed. Compared to controls, participants with depression had a significantly longer phase angle of entrainment (6.82 h ± 1.45 vs. 5.87 h ± 1.60, p = 0.02, Cohens-d = 0.62). A small to moderate yet non-significant difference in DLMO times, with earlier DLMO (34 ± 27 min) observed in depression (20:36 ± 1:48 vs. 21:10 ± 1:48, p = 0.22, Cohens-d = 0.32). In iduals with depression had longer sleep latency and latency to rapid eye movement sleep than controls (all p 0.05). Circadian advancement and alterations to the timing of sleep and REM onset are evident in older people with lifetime major depression, despite having only mild residual symptoms. Further research examining the prognostic significance of these changes is warranted as well as chronotherapeutic treatment studies.
Publisher: Oxford University Press (OUP)
Date: 30-03-2021
DOI: 10.1093/TBM/IBAA019
Abstract: Insomnia is a major public health concern. Sleep restriction therapy (SRT) is an effective behavioral treatment but its delivery is impeded by a shortage of trained clinicians. We developed a mobile app delivering SRT to in iduals with insomnia. This feasibility study employed a mixed-methods design to examine the engagement, acceptability, and potential efficacy of the mobile app. Fifteen participants diagnosed with insomnia disorder used the mobile app synchronized with a wearable device for 3 weeks. Those who persisted with the study (n = 12) found the mobile app to be highly acceptable and engaging, logging on average 19 nightly sleep diary entries across the 21 day period. Significant improvements were observed for sleep measures (insomnia severity and sleep efficiency) and daytime symptoms (fatigue and sleepiness). The results suggest that a mobile app delivering SRT to in iduals with insomnia is engaging, acceptable, and potentially efficacious. Further, a full-scale effectiveness study is warranted.
Publisher: Wiley
Date: 05-10-2017
DOI: 10.1111/NHS.12310
Abstract: Nursing students have reported bioscience to be challenging and difficult to understand. This might have a negative impact upon their ability to understand patients' clinical conditions and nursing practice. We sought information about students' experiences with bioscience. A total of 126 final year nursing students completed a questionnaire. The findings showed that the majority of participants considered bioscience subjects to require more work compared to nursing subjects (65.9%), and that they would like a better understanding of bioscience (73.8%), but understood that bioscience forms the foundation of nursing practice (76.2%). Younger participants without secondary school science rated bioscience harder than nursing subjects and spent more time studying bioscience compared to older participants. Participants without any secondary school science lacked an ability to apply bioscience concepts to patient conditions. These results showed that nursing students, especially those without secondary school science, would benefit from improved bioscience integration with nursing practice. Nursing and bioscience educators should consider greater alignment of bioscience with nursing practice subjects, especially earlier in the curriculum.
Publisher: Informa UK Limited
Date: 14-09-2021
DOI: 10.1080/15402002.2021.1975718
Abstract: The first-line treatment for insomnia is cognitive-behavioral therapy. However, there is persistent use of pharmacotherapy, particularly, sedative-hypnotics. Consultant pharmacists can provide medication review services for people using multiple medications. Therefore, they are well placed to provide sleep health/insomnia care with regard to sedative-hypnotic use and behavioral treatment recommendations/sleep health education. However, this avenue is, as yet, unexplored. To explore consultant pharmacists' current sleep health-related provisions and what their perspectives are around developing/implementing a consultant pharmacist-led behavioral service for insomnia. Qualitative semi-structured interviews were conducted with a convenience-based s le of consultant pharmacists. Interviews were audio-recorded, transcribed, and inductively analyzed. Twenty-four consultant pharmacists were interviewed. Three themes were gauged: 1) Insomnia/sleep health concerns are growing. Primary health professionals need to scale up their sleep health-care provisions to accommodate for this health demand. Consultant pharmacists are interested/willing to expand their sleep-related practice and provide evidence-based insomnia therapies however, factors such as education/training, service configuration support, and patient attitudes should be addressed.
Publisher: Oxford University Press (OUP)
Date: 25-08-2017
DOI: 10.1093/SLEEP/ZSX148
Abstract: To evaluate brain metabolites in objective insomnia subtypes defined from polysomnography (PSG): insomnia with short sleep duration (I-SSD) and insomnia with normal sleep duration (I-NSD), relative to good sleeping controls (GSCs). PSG empirically grouped insomnia patients into I-SSD (n = 12: mean [SD] total sleep time [TST] = 294.7 minutes [30.5]) or I-NSD (n = 19: TST = 394.4 minutes [34.9]). 1H magnetic resonance spectroscopy (MRS) acquired in the left occipital cortex (LOCC), left prefrontal cortex, and anterior cingulate cortex was used to determine levels of creatine, aspartate, glutamate, and glutamine (referenced to water). Glutathione, glycerophosphocholine, lactate, myoinositol, and N-acetylaspartate measurements were also obtained. Sixteen GSCs were included for comparison. Multivariate analysis of variance was used to evaluate differences in creatine, aspartate, glutamate, and glutamine. Aspartate and glutamine concentrations were reduced in the LOCC in I-SSD compared with I-NSD (both p < .05, d = .80-.99). Creatine displayed a nonsignificant mean reduction in I-SSD compared with I-NSD (p = .05, d = .58). Glutamine was reduced in I-SSD compared with controls (p < .05, d = .93). There were no differences in metabolites between all (I-SSD and I-NSD) insomnia patients and controls. In patients with insomnia, LOCC glutamine concentrations were found to be positively correlated with TST (r = .43, p < .05) and negatively correlated with wake-time after sleep onset (r = -.40, p < .05). Results indicate that I-SSD is associated with reduced brain metabolites in the LOCC compared with I-NSD and control concentrations of aspartate, glutamine, and creatine. Insomnia MRS imaging sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR): www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000050853. 12612000050853.
Publisher: MDPI AG
Date: 10-2020
Abstract: Alkaline electrolyzed water (AEW) and walking are strongly recommended for ameliorating oxidative stress and inflammation. Nevertheless, there is a lack of information on the combination of both on alleviating inflammation, oxidative stress, and improving the quality of life (QoL). We investigated the synergistic effects of drinking AEW and walking on advanced glycation end products (AGEs), advanced oxidation protein products (AOPPs), malondialdehyde (MDA), white blood cells (WBCs), neutrophil-lymphocyte ratio (NLR) and QoL. In total, 81 eligible patients with type 2 diabetes (T2DM) were randomly allocated via single blind to four groups: consumed 2 L/day of AEW (n = 20), instructed to walk for 150 min/week (n = 20), received a combination of AEW and walking (n = 20), and continue their habitual diet and activity (n = 21). Data were collected and analyzed before and after 8 weeks of intervention. Our results showed a significant interaction between the group and time, with both AEW and walking independently and synergistically ameliorating AGEs, AOPPs, MDA, NLR and WBCs levels. Moreover, the AEW group had a higher physical and total QoL score. The walking group and the combined group had higher scores in physical, mental and total QoL compared to the control group. The synergistic effect of AEW and regular walking are an advisable treatment for patients with T2DM.
Publisher: Research Square Platform LLC
Date: 02-09-2021
DOI: 10.21203/RS.3.RS-849587/V1
Abstract: Insomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power spectral analysis and measurement of response to acute sleep restriction may be informative in overall assessment of ID. To explore alternative classifications of ID subtypes, insomnia patients (n = 99) underwent two consecutive overnight sleep studies: (i) habitual sleep opportunity (polysomnography, PSG) and, (ii) two hours less sleep opportunity (electroencephalography, EEG), with the first night compared to healthy controls (n = 25). ID subtypes were derived from data-driven classification of PSG, EEG spectral power and interhemispheric EEG asymmetry index. Three insomnia subtypes with different sleep duration and NREM spectral power were identified. One subtype (n = 26) had shorter sleep duration and lower NREM delta power than healthy controls (short-sleep delta-deficient SSDD), the second subtype (n = 51) had normal sleep duration but lower NREM delta power than healthy controls (normal-sleep delta-deficient NSDD) and a third subtype showed (n = 22) no difference in sleep duration or delta power from healthy controls (normal neurophysiological sleep NNS). Acute sleep restriction improved multiple objective sleep measures across all insomnia subtypes including increased delta power in SSDD and NSDD, and improvements in subjective sleep quality for SSDD ( p = 0.03), with a trend observed for NSDD ( p = 0.057). These exploratory results suggest evidence of novel neurophysiological insomnia subtypes that may inform sleep state misperception in ID and with further research, may provide pathways for personalised care.
Publisher: MDPI AG
Date: 10-08-2020
DOI: 10.3390/HEALTHCARE8030260
Abstract: Cervical cancer is one of the most prevalent malignant neoplasms worldwide. We investigated whether leisure-time physical activity is sufficient to decrease the cervical neoplasia risk and provide suggested guidance of metabolic equivalents of task–hours per week (MET-h/week) spent on leisure-time physical activity to prevent cervical neoplasia. Ultimately, 433 participants, including 126 participants with cervical intraepithelial neoplasia I or higher disease (≥CIN 1) and 307 healthy controls, were recruited. All participants completed a standardized questionnaire about leisure-time physical activity engagement (MET-h/week) and a general health questionnaire and had cervical specimens taken to detect human papillomavirus (HPV) infection. CIN 1 staging was identified from the specimens. Participants with physical activity of ≥3.75 MET-h/week had a significantly lower CIN risk compared to those with physical activity of .75 MET-h/week (p = 0.01). However, among participants with HPV infection or smokers, the minimal requirement of leisure-time physical actively to lessen the CIN risk was ≥7.5 MET-h/week. Lifetime leisure-time physical activity of ≥0.12 MET-h/week–year also significantly decreased the CIN risk, but women with HPV infection needed ≥13.2 MET-h/week–year to protect them from a CIN risk. We concluded that regular leisure-time physical activity of ≥7.5 MET-h/week and sustained lifetime leisure-time physical activity ≥13.2 MET-h/week–year are vital factors for protecting women against cervical neoplasia risk.
Publisher: Informa UK Limited
Date: 18-04-2019
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.NEPR.2017.10.006
Abstract: With the increasing risk of mass casualty incidents from extreme climate events, global terrorism, pandemics and nuclear incidents, it's important to prepare nurses with skills and knowledge necessary to manage such incidents. There are very few documented accounts of the inclusion of mass casualty education within undergraduate nursing programs. This paper is the first to describe undergraduate mass casualty nursing education in Australia. A final year Bachelor of Nursing undergraduate subject was developed. The subject focused on initial treatment and stabilisation of casualties predominantly within pre-hospital environments, and included a capstone inter-professional mass casualty simulation. Students experience of the subject was evaluated using the Satisfaction with Simulation Experience Scale (Levett-Jones et al., 2011) and a subject evaluation survey. Student satisfaction and evaluations were extremely positive. As a tool for developing clinical skills, 93% (n = 43) agreed that the simulation developed their clinical reasoning and decision making skills. In particular, the simulation enabled students to apply what they had learned (77%, n = 35, strongly agree). Due to the frequency of mass casualty events worldwide, there is a need for educational exposure in undergraduate nursing curricula. We believe that this mass casualty education could be used as a template for development in nursing curricula.
Publisher: Public Library of Science (PLoS)
Date: 18-12-2015
Publisher: Informa UK Limited
Date: 11-07-2018
DOI: 10.1080/07420528.2018.1493597
Abstract: Travel across time zones disrupts circadian rhythms causing increased daytime sleepiness, impaired alertness and sleep disturbance. However, the effect of repeated consecutive transmeridian travel on sleep-wake cycles and circadian dynamics is unknown. The aim of this study was to investigate changes in alertness, sleep-wake schedule and sleepiness and predict circadian and sleep dynamics of an in idual undergoing demanding transmeridian travel. A 47-year-old healthy male flew 16 international flights over 12 consecutive days. He maintained a sleep-wake schedule based on Sydney, Australia time (GMT + 10 h). The participant completed a sleep diary and wore an Actiwatch before, during and after the flights. Subjective alertness, fatigue and sleepiness were rated 4 hourly (08:00-00:00), if awake during the flights. A validated physiologically based mathematical model of arousal dynamics was used to further explore the dynamics and compare sleep time predictions with observational data and to estimate circadian phase changes. The participant completed 191 h and 159 736 km of flying and traversed a total of 144 time-zones. Total sleep time during the flights decreased (357.5 min actigraphy 292.4 min diary) compared to baseline (430.8 min actigraphy 472.1 min diary), predominately due to restricted sleep opportunities. The daily range of alertness, sleepiness and fatigue increased compared to baseline, with heightened fatigue towards the end of the flight schedule. The arousal dynamics model predicted sleep/wake states during and post travel with 88% and 95% agreement with sleep diary data. The circadian phase predicted a delay of only 34 min over the 16 transmeridian flights. Despite repeated changes in transmeridian travel direction and flight duration, the participant was able to maintain a stable sleep schedule aligned with the Sydney night. Modelling revealed only minor circadian misalignment during the flying period. This was likely due to the transitory time spent in the overseas airports that did not allow for resynchronisation to the new time zone. The robustness of the arousal model in the real-world was demonstrated for the first time using unique transmeridian travel.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.SLEH.2015.02.007
Abstract: Self-reported habitual sleep duration has been used widely in epidemiologic research, yet this measure remains to be validated. We evaluated whether simple sleep duration questions concord with sleep diaries in an online s le. Australian adults aged 18+ years completed an internet survey examining measures of sleep, sociodemographic risk factors, and a 7-day sleep diary. We examined single-question (how many hours of sleep would you normally get?) and 2-question assessments (difference between sleep and wake times) to a 7-day sleep diary estimation of sleep duration. Using Bland-Altman plots and associated statistics, we tested systematic differences, precision, and systematic bias. We also evaluated whether the differences were consistent along the entire range of the measurement and whether they were associated with any sociodemographic risk factors (Spearman rho). Data were analyzed from 1662 participants (67.3% female). Bland-Altman plots displayed visual discrepancies between both 1-question and 2-question reports of sleep duration compared with sleep diaries. Both the single- (-17 minutes) and double-question (8 minutes) sleep duration estimates differed significantly (both P < .001). These simple estimates only agreed to within ±2.5-3 hours compared with diary estimates. The measure was also weakly systematically biased (rho = +0.204 and +0.309, P < .001) through the measurement range. There were significant differences and associations between differences in sleep duration estimation and determinants of health. Simple questions estimating habitual sleep duration are imprecise and systematically biased in a large online survey. The amount of difference is correlated with well-known sociodemographic risk factors.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.SMRV.2021.101567
Abstract: The comparative efficacy of various approaches of digital cognitive behavioral therapy for insomnia (CBTi) is still unclear. This network meta-analysis explored the comparative efficacy of digital CBTi approaches in adults with insomnia. Four electronic databases were searched from inception to June 27, 2020. Primary outcomes were self-reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and insomnia symptoms these were measured using sleep diaries or valid questionnaires. A random-effects network meta-analysis in a frequentist framework was used. Fifty-four randomized controlled trials comprising 11,815 participants were included. Compared with usual care, web-based CBTi with a therapist demonstrated significantly longer TST (mean difference [MD]: 23.19 min, 95% confidence interval [CI]: 18.98-27.39 min), shorter SOL (MD: -18.76 min, 95% CI -24.20 to -13.31 min), lower WASO (MD: -31.40 min, 95% CI: -36.26 to -26.55 min), and greater SE (MD: 10.37%, 95% CI: 8.08%-12.65%). The surface under the cumulative ranking curve indicates that web-based CBTi with therapists is most likely to be ranked the highest among all treatments, and thus, this network meta-analysis suggests that such a treatment is the optimal intervention for improving sleep duration and SE as well as the reductions in SOL and WASO. PROSPERO REGISTRATION NUMBER: CRD42020171134.
Publisher: Elsevier BV
Date: 10-2021
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15078
Abstract: Practice managers are often involved in the employment of practice nurses and are likely to have a significant role in future transition programs in general practice. Therefore, the aim of the study was to explore practice managers’ expectations of new graduate registered nurses working in general practice. A nation-wide web-based electronic survey distributed by the Australian Association of Practice Management was used to collect demographic data and practice managers’ expectations of new graduate nurses directly transitioning into general practice in their first year of practice. The s le was broadly representative of the Australian state and territory population numbers. Respondents were predominantly female with postgraduate qualifications. The findings of this study highlight that practice managers who currently work with practice nurses would be supportive of graduate registered nurses in general practice in their first year with preceptor support. The results of this study have important implications for nursing workforce development and it is recommended that such initiatives are widely introduced with appropriate financial support.
Publisher: Informa UK Limited
Date: 21-11-2023
DOI: 10.1080/07420528.2022.2144744
Abstract: Circadian rhythms alter with ageing and may be aetiologically linked to neurodegeneration. This study explored the association between clinical markers and 1) dim light melatonin onset (DLMO) time and 2) phase angle derived from sleep midpoint, in older adults with varying dementia risks. Participants completed 14 days of actigraphy followed by in-lab measurement of salivary melatonin, from which DLMO time and phase angle were computed. Eighty participants (age = 65.5, SD = 9.6), 44 males (55%), MMSE (28.6, SD = 1.5) were included in the analysis. Sex (t = 2.15, p = .04), sleep onset (r = 0.49, p < .001) and midpoint (r = 0.44, p < .001) also correlated with DLMO time. Multiple linear regression showed chronotype, average actigraphy-derived light exposure during the DLMO window (window 2 h prior to DLMO to 2 h post), early biological day (6-10 h post DLMO time) and late biological day (10-14 h post DLMO time) were predictive of DLMO time (adjusted R
Publisher: Wiley
Date: 30-12-2022
DOI: 10.1111/JPI.12782
Abstract: Melatonin is commonly used for sleep and jetlag at low doses. However, there is less documentation on the safety of higher doses, which are being increasingly used for a wide variety of conditions, including more recently COVID‐19 prevention and treatment. The aim of this review was to investigate the safety of higher doses of melatonin in adults. Medline, Scopus, Embase and PsycINFO databases from inception until December 2019 with convenience searches until October 2020. Randomised controlled trials investigating high‐dose melatonin (≥10 mg) in human adults over 30 years of age were included. Two investigators independently abstracted articles using PRISMA guidelines. Risk of bias was assessed by a committee of three investigators. 79 studies were identified with a total of 3861 participants. Studies included a large range of medical conditions. The meta‐analysis was pooled data using a random effects model. The outcomes examined were the number of adverse events (AEs), serious adverse events (SAEs) and withdrawals due to AEs. A total of 29 studies (37%) made no mention of the presence or absence of AEs. Overall, only four studies met the pre‐specified low risk of bias criteria for meta‐analysis. In that small subset, melatonin did not cause a detectable increase in SAEs (Rate Ratio = 0.88 [0.52, 1.50], p = .64) or withdrawals due to AEs (0.93 [0.24, 3.56], p = .92), but did appear to increase the risk of AEs such as drowsiness, headache and dizziness (1.40 [1.15, 1.69], p .001). Overall, there has been limited AE reporting from high‐dose melatonin studies. Based on this limited evidence, melatonin appears to have a good safety profile. Better safety reporting in future long‐term trials is needed to confirm this as our confidence limits were very wide due to the paucity of suitable data.
Publisher: Informa UK Limited
Date: 03-08-2023
Publisher: Wiley
Date: 31-07-2018
DOI: 10.1111/JSR.12738
Publisher: Informa UK Limited
Date: 20-08-2021
DOI: 10.1080/15402002.2021.1967157
Abstract: This pilot trial aimed to provide evidence for whether the integration of a wearable device with digital behavioral therapy for insomnia (dBTi) improves treatment outcomes and engagement. One hundred and twenty-eight participants with insomnia symptoms were randomized to a 3-week dBTi program (SleepFix®) with a wearable device enabling sleep data synchronization (dBTi+wearable group n = 62) or dBTi alone (n = 66). Participants completed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI) parameters: wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST) at baseline and weeks 1, 2, 3, and primary endpoint of week 6 and follow-up at 12 weeks. Engagement was measured by the number of daily sleep diaries logged in the app. There was no difference in ISI change scores between the groups from pre- to post-treatment (Cohen's This pilot trial found that integration of wearable device with a digital insomnia therapy enhanced user engagement and led to improvements in sleep parameters compared to dBTi alone. These findings suggest that adjunctive wearable technologies may improve digital insomnia therapy effectiveness.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2016
Publisher: Springer Science and Business Media LLC
Date: 06-2003
DOI: 10.1007/S00421-003-0823-5
Abstract: Plasma volume (PV), determined indirectly from changes in haematocrit (Hct) and haemoglobin concentration ([Hb]), underestimates the absolute PV change (Evans blue dye) during thermoneutral immersion. Since PV changes during cold-water immersion have only been determined indirectly, we hypothesised that a similar underestimation may occur. Therefore, we compared the indirectly-measured PV with a direct-tracer dilution method (Evans blue dye column elution) in seven healthy males, during three, 60-min exposures: air (control 21.2 degrees C), thermoneutral immersion (34.5 degrees C) and cold-water immersion (18.6 degrees C). During thermoneutral immersion, the directly-measured PV increased by 16.2 (1.4)% (P<0.05) and the indirectly-measured by 8.5 (0.8)% (P<0.05), with the latter underestimating the former by 43 (9.1)% (P<0.05). During cold immersion, the direct PV decreased by 17.9 (3.0)% (P<0.05) and the indirect by 8.0 (1.2)% (P<0.05), with the latter representing a 52 (6.8)% (P<0.05) underestimation of the direct PV change. Directionally-equivalent underestimations of PV change occur when using the indirect method during both thermoneutral and cold-water immersion. The assumptions inherent in the indirect method (constant F-cell ratio) appear to be violated during water immersion.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.NEDT.2012.10.020
Abstract: It is known that bioscience is perceived to be difficult and causes anxiety within undergraduate nursing students yet, commencing students' perceptions of bioscience is not known. Therefore, the aim of this study was to ascertain incoming students' perceptions, knowledge and approaches to learning bioscience. Incoming students to the Bachelor of Nursing completed a questionnaire prior to undertaking bioscience. Two hundred and seventy three students completed the questionnaire that explored their expectations, preconceptions of bioscience content, approaches to learning bioscience, and relationship to clinical practice in the context of biosciences. Participant ages ranged from 17 to 53 (mean 23 years), and 78% of students had completed at least one secondary school science subject, of which 60% had studied biology. Overall, students' preconceptions included anxiety about studying bioscience, bioscience being difficult and harder than nursing subjects, and that more content will be required for bioscience than nursing subjects. Analysis using ANOVA revealed the relationships for secondary school science and age on student responses. A significant effect of secondary school science was found for science in school being advantageous for bioscience (p=0.010), understanding what bioscience entails (p=0.002), needing to study science prior to the start of the semester (p=0.009), and that bioscience is considered difficult (p=0.029). A significant effect of age was found for exams being more difficult than other assessments (p=0.000) and for being able to see the relevance of nursing when reaching the workplace (p=0.011). The findings also indicated that perceptions and associated anxieties related to bioscience were present in commencing students, similar to those which have been reported previously in established student groups. This strongly suggests that the faculty should attempt to dispel preconceptions about bioscience and target improved supports to facilitate the transition of students into the commencement of bioscience for nursing students.
Publisher: Wiley
Date: 09-02-2023
DOI: 10.1111/JAN.15577
Abstract: To explore community nurses sleep health practices and their perspectives on improving sleep health care provision. An exploratory study utilizing the qualitative description methodology. Semi‐structured interviews were conducted with community nurses from May 2019 – October 2021. Interviews were audio‐recorded, transcribed, and subjected to an inductive thematic analysis using a constructivist–interpretive paradigm. Twenty‐three Australian community nurses were interviewed. Participants frequently encountered sleep disturbances/disorders in their patients. Data analysis yielded three main themes: (1) Sleep health in the community serviced, (2) sleep health awareness and management, and (3) community nurses' A to Z of improving sleep health. The most common sleep disorder presentations were insomnia and sleep apnea. Although most community sleep apnea cases were appropriately managed, insomnia was often mismanaged. Participants described their sleep health knowledge as deficient, with the majority advocating for increased sleep‐related education tailored to their profession. Other important factors needed for improving sleep health provision were standardized patient treatment/referral pathways, increased interprofessional collaboration, and sufficient time for patient consults. Community nurses service a patient population that requires increased sleep health care. However, they are currently underequipped to do so, leading to suboptimal treatment provision. Providing community nurses with the appropriate resources, such as increased sleep‐related education and standardized treatment frameworks, could enable them to better manage sleep disturbance/disorder presentations, such as insomnia. Little is known about how community nurses care for patients with sleep disturbance/sleep disorders. This study found that contemporary sleep health care was lacking due to knowledge deficits, competing challenges, and a need for standardized care pathways. These findings can inform the development of targeted education/training and standardized guidelines for community nurses providing sleep health care to patients as well as the design of future practice models of care provision. Previous research by authors has involved extensive engagement with patients and health professionals, such as community pharmacists, general practitioners, and naturopaths who play a role in sleep health in the primary health care sector. These previous research projects built a significant understanding of the patient and health practitioner experience and have provided the background to the concept and design of this study.
Publisher: Elsevier BV
Date: 10-2021
Publisher: Wiley
Date: 12-09-2023
DOI: 10.1111/JOCN.16522
Abstract: This integrative review aimed to draw conclusions from evidence on how registered nurses are measuring respiratory rates for acute care patients. Despite the growing research supporting respiratory rate as an early indicator for clinical deterioration, respiratory rate has consistently been the least frequently measured and accurately documented vital sign. An integrative review. A systematic literature search was conducted in June 2022 in four databases: CINAHL, PubMed, Medline and Scopus. Quality appraisal was undertaken using the Joanna Briggs Institute's Checklist. PRISMA guidelines were followed to ensure explicit reporting and reported in the PRISMA checklist. Overall, 9915 records were identified, and 19 met the inclusion criteria. Of these 19 articles, seven themes emerged: estimation and digit preference, lack of understanding and knowledge, not valuing the clinical significance of respiratory rate, oxygen saturation substitute, interobserver agreement, subjective concern and count duration. A high prevalence of bias, estimation and incorrect technique was evident. A total of 15 articles reported specifically on how registered nurses are measuring respiratory rates on general medical and surgical wards. Despite its importance, this integrative review has determined that respiratory rates are not being assessed correctly by nursing staff in the acute care environment. Evidence of using estimation, value bias or quick count and multiply techniques are emerging themes which urgently require further research. No patient or public contribution.
Publisher: American Medical Association (AMA)
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 13-05-2020
DOI: 10.1007/S10597-020-00631-6
Abstract: Social prescribing, also known as “community referral”, is a means of referring in iduals living in the community to existing local non-clinical health, welfare, and social support services. International evidence demonstrates that social prescribing improves biopsychosocial quality of life, and burden on health services. Australia’s first social prescribing pilot program for in iduals with mental illness (mood and psychotic spectrum disorders) was implemented in Sydney in 2016/2017 this study evaluates that program. Participants included 13 adults who were assessed at baseline and six-month follow-up. Outcomes included self-perceived quality of life, welfare needs, health status, loneliness, social participation, and economic participation. Results indicate significant improvements in quality of life and health status. This pilot program demonstrates that social prescribing may improve participant outcomes. It fits well within Australian health policy and funding models which focus on bolstering community care, and may be scalable, particularly in geographically isolated communities.
Publisher: JMIR Publications Inc.
Date: 24-05-2019
DOI: 10.2196/13895
Abstract: Mobile health (mHealth) apps demonstrate promise for improving sleep at scale. End-user engagement is a prerequisite for sustained use and effectiveness. We assessed the needs and preferences of those with poor sleep and insomnia to inform the development of an engaging sleep app. We triangulated results from qualitative (focus groups and app reviews) and quantitative (online survey) approaches. A total of 2 focus groups were conducted (N=9). An online survey tested themes identified from the focus groups against a larger population (N=167). In addition, we analyzed 434 user reviews of 6 mobile apps available on app stores. Common focus group themes included the need to account for erse sleep phenotypes with an adaptive and tailored program, key app features (alarms and sleep diaries), the complex yet condescending nature of existing resources, providing rationale for information requested, and cost as a motivator. Most survey participants (156/167, 93%) would try an evidence-based sleep app. The most important app features reported were sleep diaries (148/167, 88%), sharing sleep data with a doctor (116/167, 70%), and lifestyle tracking (107/167, 64%). App reviews highlighted the alarm as the most salient app feature (43/122, 35%) and data synchronization with a wearable device (WD) as the most commonly mentioned functionality (40/135, 30%). This co-design process involving end users through 3 methods consistently highlighted sleep tracking (through a diary and WD), alarms, and personalization as vital for engagement, although their implementation was commonly criticized in review. Engagement is negatively affected by poorly designed features, bugs, and didactic information which must be addressed. Other needs depend upon the type of user, for ex le, those with severe insomnia.
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJOPEN-2019-034421
Abstract: Insomnia is a highly prevalent and costly condition that is associated with increased health risks and healthcare utilisation. Anecdotally, cannabis use is frequently reported by consumers to promote sleep. However, there is limited research on the effects of cannabis on sleep and daytime function in people with insomnia disorder using objective measures. This proof-of-concept study will evaluate the effects of a single dose of an oral cannabis-based medicine on sleep and daytime function in participants with chronic insomnia disorder. A randomised, crossover, placebo-controlled, single-dose study design will be used to test the safety and efficacy of an oral oil solution (‘ETC120’) containing 10 mg Δ 9 -tetrahydrocannabinol (THC) and 200 mg cannabidiol (CBD) in 20 participants diagnosed with chronic insomnia disorder. Participants aged 35–60 years will be recruited over an 18-month period commencing August 2019. Each participant will receive both the active drug and matched placebo, in a counterbalanced order, during two overnight study assessment visits, with at least a 1-week washout period between each visit. The primary outcomes are total sleep time and wake after sleep onset assessed via polysomnography. In addition, 256-channel high-density electroencephalography and source modelling using structural brain MRI will be used to comprehensively examine brain activation during sleep and wake periods on ETC120 versus placebo. Next-day cognitive function, alertness and simulated driving performance will also be investigated. Ethics approval was received from Bellberry Human Research Ethics Committee (2018-04-284). The findings will be disseminated in a peer-reviewed open-access journal and at academic conferences. ANZCTRN12619000714189.
Publisher: Informa UK Limited
Date: 02-2016
DOI: 10.2147/JMDH.S92695
Publisher: Informa UK Limited
Date: 15-08-2004
Publisher: Informa UK Limited
Date: 10-2019
Publisher: SAGE Publications
Date: 22-04-0022
Abstract: Chronic insomnia is associated with subjective daytime cognitive dysfunction, but objective corroborative data are often lacking. In this study, we use Perceptual Load Theory to objectively assess distractibility in participants with insomnia ( N = 23) compared with age- and sex-matched controls ( N = 23). Following overnight supervised sleep observation, all participants completed a selective attention task which varied in the level of perceptual load and distractor congruency. The insomnia group was found to be more distracted than controls, whereas their selective attention mechanism appeared to be intact, with reduced distractor processing under high load for both groups. Insomnia symptom severity was positively correlated with participant distractibility. These findings suggest that there are insomnia-related daytime cognitive impairments that are likely to arise from compromised cognitive control rather than an ineffective selective attention mechanism. This task may be clinically useful in assessing daytime impairments, and potentially treatment response, in those with insomnia.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.COLEGN.2015.02.001
Abstract: This paper reports findings from the first phase of a national study conducted to identify the intention of nursing students' to work in a Primary Health Care setting following registration. An online survey of final year nursing students enrolled at Australian universities offering education leading to eligibility for registration as a nurse with the Australian Health Practitioner Regulation Agency was undertaken during July-August 2014. Data were collected about students' intention to enter Primary Health Care as a career option, as well as their exposure to primary health care during their nursing education and whether they had undertaken practice placements in a primary health care setting. Analysis was conducted on 456 completed surveys. The findings demonstrated that, despite the majority (98.2% n = 447) of students being exposed to Primary Health Care during their studies, less than a quarter (22.8% n = 104) of the students who responded identified this as an area in which they intended to work following registration. No association was found between students' clinical experiences and their identification of primary health care as a career preference. Given the ageing population in Australia, the increased prevalence of chronic health issues and the predicted ongoing primary health care workforce shortages, educational and workplace strategies aimed at attracting new graduate nurse into Primary Health Care settings are imperative.
Publisher: Oxford University Press (OUP)
Date: 18-11-2020
Abstract: Cardiovascular autonomic dysfunction, as measured by short-term diurnal heart rate variability (HRV), has been reported in older adults with mild cognitive impairment (MCI). However, it is unclear whether this impairment also exists during sleep in this group. We, therefore, compared overnight HRV during sleep in older adults with MCI and those with subjective cognitive impairment (SCI). Older adults (n = 210) underwent overnight polysomnography. Eligible participants were characterized as multi-domain MCI or SCI. The multi-domain MCI group was comprised of amnestic and non-amnestic subtypes. Power spectral analysis of HRV was conducted on the overnight electrocardiogram during non-rapid eye movement (NREM), rapid eye movement (REM), N1, N2, N3 sleep stages, and wake periods. High-frequency HRV (HF-HRV) was employed as the primary measure to estimate parasympathetic function. The MCI group showed reduced HF-HRV during NREM sleep (p = 0.018), but not during wake or REM sleep (p & 0.05) compared to the SCI group. Participants with aMCI compared to SCI had the most pronounced reduction in HF-HRV across all NREM sleep stages—N1, N2, and N3, but not during wake or REM sleep. The naMCI sub-group did not show any significant differences in HF-HRV during any sleep stage compared to SCI. Our study showed that amnestic MCI participants had greater reductions in HF-HRV during NREM sleep, relative to those with SCI, suggesting potential vulnerability to sleep-related parasympathetic dysfunction. HF-HRV, especially during NREM sleep, may be an early biomarker for dementia detection.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Wiley
Date: 16-09-2020
DOI: 10.1111/JPI.12684
Publisher: MDPI AG
Date: 04-04-2023
Abstract: Insomnia is a highly prevalent sleep disorder with strong bidirectional associations with depressive symptoms. The circadian preference for eveningness has been shown to be associated with depressive symptoms in insomnia and other mental health conditions. However, there is a lack of studies in insomnia investigating whether objective measures, such as dim light melatonin onset (DLMO) or polysomnographic (PSG) sleep, are associated with depressive symptoms. Therefore, we investigated the associations between subjective measures (questionnaires assessing anxiety, sleep quality and circadian preference, and sleep diary) and depressive symptoms and whether the addition of objective measures (DLMO, PSG parameters) would strengthen the associations with depressive symptoms. In 115 insomnia disorder patients we found that anxiety was strongly associated with depressive symptoms in a model including circadian preference, dysfunctional beliefs of sleep, and self-reported previous depressive symptoms (R2 = 0.496, p 0.001). The addition of sleep diary measures did not strengthen the model. We also found that the addition of objective measures (DLMO, PSG parameters) did not improve the subjective associations with depressive symptoms. Our data suggest that objective circadian markers are less important in the prediction of depressive symptoms in insomnia compared to subjective measures.
Publisher: Wiley
Date: 06-03-2017
DOI: 10.1111/JOCN.13569
Abstract: To explore new graduate registered nurses’ reflections of bioscience courses during their nursing programme and the relationship between bioscience content and their clinical practice. Undergraduate nursing students internationally find bioscience courses challenging, which may be due to the volume of content and level of difficulty of these courses. Such challenges may be exacerbated by insufficient integration between bioscience theory and nursing clinical practice. A descriptive, cross‐sectional mixed methods study was conducted. A 30‐item questionnaire with five written response questions which explored recently registered nurses’ reflections on bioscience courses during their nursing degree was employed. Descriptive analyses were reported for in idual items. Thematic analysis of qualitative responses was grouped to reveal emerging themes. Registered nurses’ ( n = 22) reflections revealed that bioscience courses were a significant challenge during their undergraduate programme, and they lacked confidence explaining the biological basis of nursing. Participants would like improved knowledge of the relevant bioscience for nursing and agreed that bioscience courses should be extended into the undergraduate final year. The importance of relating bioscience content to nursing practice was elaborated extensively throughout written responses. Although registered nurses reflected that bioscience courses were difficult with large volumes of content, having more bioscience with greater relevance to nursing applications was considered important in their current clinical practice. It is suggested that bioscience academics develop greater contextual links between bioscience content and clinical practice relevant to nursing. After working as a registered nurse, there was appreciation of bioscience relevance for clinical practice, and the nurses believed they would have benefitted from more nursing‐related bioscience during their undergraduate programme. Focussed integration of bioscience with clinical nursing courses should be driven by academics, nurse educators and clinical nurses to provide a biological basis for patient care to nursing students.
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.COMPBIOMED.2021.104989
Abstract: Insomnia is one of the most common sleep disorders which can dramatically impair life quality and negatively affect an in idual's physical and mental health. Recently, various deep learning based methods have been proposed for automatic and objective insomnia detection, owing to the great success of deep learning techniques. However, due to the scarcity of public insomnia data, a deep learning model trained on a dataset with a small number of insomnia subjects may compromise the generalization capacity of the model and eventually limit the performance of insomnia detection. Meanwhile, there have been a number of public EEG datasets collected from a large number of healthy subjects for various sleep research tasks such as sleep staging. Therefore, to utilize such abundant EEG datasets for addressing the data scarcity issue in insomnia detection, in this paper we propose a domain adaptation based model to better extract insomnia related features of the target domain by leveraging stage annotations from the source domain. For each domain, two pairs of common encoder and private encoder are firstly trained to extract sleep related features and sleep irrelevant features, respectively. In order to further discriminate source domain and target domain, a domain classifier is introduced. Then, the common encoder of the target domain will be used together with the Long Short Term Memory (LSTM) network for insomnia detection. To the best of our knowledge, this is the first deep learning based domain adaptation model using single channel raw EEG signals to detect insomnia at subject level. We use the Montreal Archive of Sleep Studies (MASS) dataset which contains only healthy subjects as source domain and two datasets which contain both healthy and insomnia subjects as target domain to validate our model's generalizability. Experimental results on the two target domain datasets (a public one and an in-house one) demonstrate that our model generalizes well on two target domain datasets with different s ling rates. In particular, our proposed method is able to improve insomnia detection performance from 50.0% to 90.9% and 66.7%-79.2% in terms of accuracy on the two target domain datasets, respectively.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2017
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 07-03-2018
Publisher: BMJ
Date: 08-2023
DOI: 10.1136/BMJOPEN-2022-071148
Abstract: Insomnia is the most prevalent sleep disorder, with few effective pharmacotherapies. Anecdotal reports and recent preclinical research suggest that cannabinol (CBN), a constituent of Cannabis sativa derived from delta-9-tetrahydrocannabinol, could be an effective treatment. Despite this, the isolated effects of CBN on sleep have yet to be systematically studied in humans. The present protocol paper describes a randomised, double-blind, placebo-controlled, single-dose, three-arm, cross-over, proof-of-concept study which investigates the effects of CBN on sleep and next-day function in 20 participants with clinician-diagnosed insomnia disorder and an Insomnia Severity Index Score ≥15. Participants receive a single fixed oral liquid dose of 30 mg CBN, 300 mg CBN and matched placebo, in random order on three treatment nights each separated by a 2-week wash-out period. Participants undergo overnight sleep assessment using in-laboratory polysomnography and next-day neurobehavioural function tests. The primary outcome is wake after sleep onset minutes. Secondary outcomes include changes to traditional sleep staging, sleep-onset latency and absolute spectral power during non-rapid eye movement (NREM) sleep. Tertiary outcomes include changes to sleep spindles during NREM sleep, arousal indices, absolute spectral power during REM sleep and subjective sleep quality. Safety-related and exploratory outcomes include changes to next-day simulated driving performance, subjective mood and drug effects, postural sway, alertness and reaction time, overnight memory consolidation, pre and post-sleep subjective and objective sleepiness and plasma, urinary, and salivary cannabinoid concentrations. The study will provide novel preliminary data on CBN efficacy and safety in insomnia disorder, which will inform larger clinical trials. Human Research Ethics Committee approval has been granted by Bellberry (2021-08-907). Study findings will be disseminated in a peer-reviewed journal and at academic conferences. NCT05344170 .
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.SMRV.2022.101672
Abstract: Chronic low back pain (LBP) shares a bidirectional relationship with sleep disturbance. Analgesics are often used for chronic LBP management however, the effects on sleep have not been thoroughly reviewed. This systematic review and meta-analysis assessed the effect of opioid and non-opioid medications on sleep in people with chronic LBP. Electronic databases were searched for randomized controlled trials which resulted in 16 eligible articles (14 studies). Sleep measures were secondary outcomes, with one study assessing sleep objectively and all other studies reporting subjective sleep. Twelve studies assessed opioid therapies whilst two studies examined non-opioid therapies. Eight studies (all opioid) were included in meta-analyses of sleep quality and sleep disturbance comparing opioid therapies with placebo-controls. Opioid therapies significantly improved sleep quality (SMD = 0.27, 95% CI: 0.17-0.36) and reduced sleep disturbance (SMD = 0.32, 95% CI: 0.25-0.40) compared to placebo-control. These findings show a clear improvement in subjective sleep associated with opioid therapies however, future studies should examine objective sleep outcomes which remain largely unexplored in chronic LBP. Addressing both pain and sleep together is important for effective management of comorbid conditions of chronic LBP and sleep disturbance due to their bidirectional relationship.
Publisher: Oxford University Press (OUP)
Date: 25-01-2017
DOI: 10.1093/SLEEP/ZSW002
Abstract: To examine the prevalence of circadian misalignment in clinically diagnosed delayed sleep phase disorder (DSPD) and to compare mood and daytime functioning in those with and without a circadian basis for the disorder. One hundred and eighty-two DSPD patients aged 16-64 years, engaged in regular employment or school, underwent sleep-wake monitoring in the home, followed by a sleep laboratory visit for assessment of salivary dim light melatonin onset (DLMO). Based on the DLMO assessments, patients were classified into two groups: circadian DSPD, defined as DLMO occurring at or after desired bedtime (DBT), or non-circadian DSPD, defined as DLMO occurring before DBT. One hundred and three patients (57%) were classified as circadian DSPD and 79 (43%) as non-circadian DSPD. DLMO occurred 1.66 hours later in circadian DSPD compared to non-circadian DSPD (p < .001). Moderate-severe depressive symptoms (Beck Depression Inventory-II) were more prevalent in circadian DSPD (14.0%) than in non-circadian DSPD (3.8% p < .05). Relative to non-circadian DSPD patients, circadian DSPD patients had 4.31 times increased odds of at least mild depressive symptoms (95% CI 1.75 to 10.64 p < .01). No group differences were found for daytime sleepiness or function, but DSPD symptoms were rated by clinicians to be more severe in those with circadian DSPD. Almost half of patients clinically diagnosed with DSPD did not show misalignment between the circadian pacemaker and the DBT, suggesting that the reported difficulties initiating sleep at the DBT are unlikely to be explained by the (mis)timing of the circadian rhythm of sleep propensity. Circadian misalignment in DSPD is associated with increased depressive symptoms and DSPD symptom severity.
Publisher: JMIR Publications Inc.
Date: 17-02-2021
DOI: 10.2196/24607
Abstract: Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation.
Publisher: MDPI AG
Date: 06-08-2020
Abstract: Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM–associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil–lymphocyte ratio (NLR) and white blood cells (WBCs). A case–control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.NEPR.2018.03.005
Abstract: Australia has an increasing demand for a sustainable primary health care registered nursing workforce. Targeting graduate registered nurses who typically begin their nursing career in acute-care hospital settings is a potential workforce development strategy. We evaluated a graduate registered nurse Community Transition to Professional Practice Program which was designed specifically to develop and foster skills required for primary health care. The aims of this study were to evaluate graduates' intention to remain in the primary health care nursing workforce, and graduate competency, confidence and experiences of program support these were compared with graduates undertaking the conventional acute-care transition program. Preceptor ratings of graduate competence were also measured. All of the 25 graduates (n = 12 community, n = 13 acute-care) who completed the questionnaire at 6 and 12 months intended to remain in nursing, and 55% (n = 6) of graduates in the Community Transition Program intended to remain in the primary health care nursing workforce. There were no differences in graduate experiences, including level of competence, or preceptors' perceptions of graduate competence, between acute-care and Community Transition Programs. The Community Transition to Professional Practice program represents a substantial step towards developing the primary health care health workforce by facilitating graduate nurse employment in this area.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2021
DOI: 10.1161/STROKEAHA.120.029847
Abstract: The exact prevalence of sleep disorders following stroke or transient ischemic attack (TIA) remains unclear. We aimed to determine the prevalence of sleep-disordered breathing, insomnia, periodic leg movement during sleep, and restless leg syndrome following stroke or TIA in acute, subacute, and chronic phases and examine the moderating effects of patient characteristics (eg, age) and methodological features (eg, study quality) on the prevalence. We performed a systematic review and meta-analysis. Embase and PubMed were searched from inception to December 18, 2019. We included 64 047 adults in 169 studies (prospective, retrospective, case-control, and cross-sectional study designs) reporting the prevalence of sleep disorders following stroke or TIA. In the acute phase, the overall prevalence of mild, moderate, and severe sleep-disordered breathing was 66.8%, 50.3%, and 31.6% (95% CIs, 63.8–69.7, 41.9–58.7, and 24.9–39.1). In the subacute phase, the prevalence of mild, moderate, and severe sleep-disordered breathing was 65.5%, 44.3%, and 36.1% (95% CIs, 58.9–71.5, 36.1–52.8, and 22.2–52.8). In the chronic phase, the summary prevalence of mild, moderate, and severe sleep-disordered breathing was 66.2%, 33.1%, and 25.1% (95% CIs, 58.6–73.1, 24.8–42.6, and 10.9–47.6). The prevalence rates of insomnia in the acute, subacute, and chronic phases were 40.7%, 42.6%, and 35.9% (95% CIs, 31.8–50.3, 31.7–54.1, and 28.6–44.0). The pooled prevalence of periodic leg movement during sleep in the acute, subacute, and chronic phases was 32.0%, 27.3%, and 48.2% (95% CIs, 7.4–73.5, 11.6–51.7, and 33.1–63.5). The summary prevalence of restless leg syndrome in the acute and chronic phases was 10.4% and 13.7% (95 CIs, 6.4–16.4 and 2.3–51.8). Age, sex, comorbidities, smoking history, and study region had significant moderating effects on the prevalence of sleep disorders. Sleep disorders following stroke or TIA are highly prevalent over time. Our findings indicate the importance of early screening and treating sleep disorders following stroke or TIA.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2021
DOI: 10.1038/S41598-021-89924-8
Abstract: Methods for predicting circadian phase have been developed for healthy in iduals. It is unknown whether these methods generalize to clinical populations, such as delayed sleep–wake phase disorder (DSWPD), where circadian timing is associated with functional outcomes. This study evaluated two methods for predicting dim light melatonin onset (DLMO) in 154 DSWPD patients using ~ 7 days of sleep–wake and light data: a dynamic model and a statistical model. The dynamic model has been validated in healthy in iduals under both laboratory and field conditions. The statistical model was developed for this dataset and used a multiple linear regression of light exposure during phase delay/advance portions of the phase response curve, as well as sleep timing and demographic variables. Both models performed comparably well in predicting DLMO. The dynamic model predicted DLMO with root mean square error of 68 min, with predictions accurate to within ± 1 h in 58% of participants and ± 2 h in 95%. The statistical model predicted DLMO with root mean square error of 57 min, with predictions accurate to within ± 1 h in 75% of participants and ± 2 h in 96%. We conclude that circadian phase prediction from light data is a viable technique for improving screening, diagnosis, and treatment of DSWPD.
Publisher: Informa UK Limited
Date: 02-04-2016
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 12-2016
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.IJNURSTU.2022.104220
Abstract: Disrupted sleep is a critical and highly prevalent concern among critically ill patients requiring intensive care. However, the question of which nonpharmacological intervention represents the best strategy for improving sleep quality remains unanswered. To compare the efficacy of nonpharmacological interventions in improving sleep quality in people who are critically ill. Databases, namely PubMed, Embase, CINAHL, and ProQuest Dissertations and Theses A&I, were searched from their inception up until January 15, 2021, for relevant randomised controlled trials. No language or time period restrictions were applied. Only randomised controlled trials examining the effects of nonpharmacological interventions on sleep among adults (aged ≥18 years) admitted to an intensive care unit were included. A random-effects model was used for data analyses. The study protocol was registered at PROSPERO (CRD42021232004). Twenty randomised controlled trials involving 1,207 participants were included. Music combined with earplugs and eye masks (standardised mean difference =1.64), eye masks alone (0.98), aromatherapy (0.87), and earplugs combined with eye masks (0.61) significantly improved sleep quality compared with routine care (all p <0.05). Music combined with earplugs and eye masks significantly enhanced sleep quality in comparison with music (1.34), earplugs combined with eye masks (1.03), and nursing intervention (1.76, all p <0.05). Earplugs alone was less likely to have effects on sleep quality improvement compared with routine care. Eye masks alone and music combined with earplugs and eye masks appear to be the most effective interventions for improving sleep quality in people who are critically ill. Critical care nurses should incorporate the use of eye masks alone or music combined with eye masks into sleep care.
Publisher: MDPI AG
Date: 09-08-2022
DOI: 10.3390/CLOCKSSLEEP4030030
Abstract: Light therapy is used to treat sleep and circadian rhythm disorders, yet there are limited studies on whether light therapy impacts electroencephalographic (EEG) activity during sleep. Therefore, we aimed to provide an overview of research studies that examined the effects of light therapy on sleep macro- and micro-architecture in populations with sleep and circadian rhythm disorders. We searched for randomized controlled trials that used light therapy and included EEG sleep measures using MEDLINE, PubMed, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials databases. Five articles met the inclusion criteria of patients with either insomnia or delayed sleep–wake phase disorder (DSWPD). These trials reported sleep macro-architecture outcomes using EEG or polysomnography. Three insomnia trials showed no effect of the timing or intensity of light therapy on total sleep time, wake after sleep onset, sleep efficiency and sleep stage duration compared to controls. Only one insomnia trial reported significantly higher sleep efficiency after evening light therapy ( lx between 21:00–23:00 h) compared with afternoon light therapy ( lx between 15:00–17:00 h). In the only DSWPD trial, six multiple sleep latency tests were conducted across the day (09:00 and 19:00 h) and bright light (2500 lx) significantly lengthened sleep latency in the morning (09:00 and 11:00 h) compared to control light (300 lx). None of the five trials reported any sleep micro-architecture measures. Overall, there was limited research about the effect of light therapy on EEG sleep measures, and studies were confined to patients with insomnia and DSWPD only. More research is needed to better understand whether lighting interventions in clinical populations affect sleep macro- and micro-architecture and objective sleep timing and quality.
Publisher: Oxford University Press (OUP)
Date: 18-05-2023
Publisher: JMIR Publications Inc.
Date: 04-03-2019
Abstract: obile health (mHealth) apps demonstrate promise for improving sleep at scale. End-user engagement is a prerequisite for sustained use and effectiveness. e assessed the needs and preferences of those with poor sleep and insomnia to inform the development of an engaging sleep app. e triangulated results from qualitative (focus groups and app reviews) and quantitative (online survey) approaches. A total of 2 focus groups were conducted (N=9). An online survey tested themes identified from the focus groups against a larger population (N=167). In addition, we analyzed 434 user reviews of 6 mobile apps available on app stores. ommon focus group themes included the need to account for erse sleep phenotypes with an adaptive and tailored program, key app features (alarms and sleep diaries), the complex yet condescending nature of existing resources, providing rationale for information requested, and cost as a motivator. Most survey participants (156/167, 93%) would try an evidence-based sleep app. The most important app features reported were sleep diaries (148/167, 88%), sharing sleep data with a doctor (116/167, 70%), and lifestyle tracking (107/167, 64%). App reviews highlighted the alarm as the most salient app feature (43/122, 35%) and data synchronization with a wearable device (WD) as the most commonly mentioned functionality (40/135, 30%). his co-design process involving end users through 3 methods consistently highlighted sleep tracking (through a diary and WD), alarms, and personalization as vital for engagement, although their implementation was commonly criticized in review. Engagement is negatively affected by poorly designed features, bugs, and didactic information which must be addressed. Other needs depend upon the type of user, for ex le, those with severe insomnia.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Springer Science and Business Media LLC
Date: 27-04-2018
DOI: 10.1038/S41598-018-25033-3
Abstract: In this retrospective cohort study, we describe acceptability, tolerability and potential efficacy of cognitive behavioural therapy (CBT) in Insomnia Disorder subtypes, derived from polysomnography (PSG): insomnia with normal-sleep duration (I-NSD) and insomnia with short-sleep duration (I-SSD). All research volunteers were offered access to digital CBT, single component sleep restriction therapy and face-to-face group CBT. Follow-up occurred at three months post-treatment using the insomnia severity index (ISI). 96 participants (61 females, mean age of 41 years) were grouped into either normal-sleep (n = 53) or short-sleep (n = 43). CBT was acceptable to 63% of participants (normal-sleep = 31, short-sleep = 29), with 28 completing therapy (tolerability: normal-sleep = 11, short-sleep = 17). For potential efficacy, 39 (normal-sleep = 20, short-sleep = 19) out of 96 participants (41%) completed a follow-up ISI assessment. In this reduced s le, mean (SD) ISI scores decreased across both groups (normal-sleep: 18.0 (4.0) to 10.7 (4.6) short-sleep: 16.5 (5.5) to 11.0 (6.3) both P 0.01). Those with normal-sleep were more likely to respond (≥6-point ISI reduction) to CBT compared to short-sleep (70%, n = 14/20 vs. 37%, n = 7/19 respectively, P = 0.038). In this cohort, 60 (63%) of participants attempted CBT and of those 28 (47%) completed therapy. Results may be comparable to clinical participants with implications for the successful translation of CBT for insomnia.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.SLEEP.2019.03.009
Abstract: In healthy populations, irregular sleep patterns are associated with delayed sleep and poor functional/mood outcomes. Currently, it is unknown whether irregular sleep contributes to poor functional/mood outcomes in in iduals with Delayed Sleep-Wake Phase Disorder (DSWPD). In 170 patients with DSWPD, we collected sleep-wake patterns, dim light melatonin onset (DLMO), and functional/mood outcomes. The Sleep Regularity Index (SRI) and other sleep timing metrics were computed. Correlations of SRI were computed with phase angle (difference between DLMO and desired bedtime), sleep timing and quality variables, daytime function, sleep-related daytime impairment, mood, and insomnia symptom severity. Path analyses assessed whether SRI or total sleep time mediated the associations between sleep onset time and phase angle with daytime functioning, sleep-related impairment, and mood outcomes. Higher SRI was associated with earlier sleep and longer total sleep time, but did not relate to sleep quality, daytime function, or mood outcomes. Path analysis showed that phase angle was directly associated with all outcome variables, whereas sleep onset time was not directly associated with any. SRI mediated the effects of sleep onset time and phase angle on daytime function. Total sleep time mediated the effects of sleep onset time and phase angle on sleep-related impairment. In iduals with DSWPD who have more delayed sleep and a greater phase angle also have more irregular sleep. This suggests that it is not delayed sleep timing per se that drives poor functional outcomes in DSWPD, but rather the timing of sleep relative to circadian phase and resultant irregular sleep patterns.
Publisher: Wiley
Date: 07-2014
DOI: 10.1111/APHA.12327
Abstract: Few investigators have considered the possibility that skeletal muscles might contain thermosensitive elements capable of modifying thermoeffector responses. In this experiment, the temporal relationships between dynamic changes in deep-body and intramuscular temperatures and eccrine sweat secretion were explored during rhythmical and reproducible variations in heat production. Eight subjects performed semi-recumbent cycling (25 °C) at a constant load to first establish whole-body thermal and sudomotor steady states (35 min), followed by a 24-min block of sinusoidal workload variations (three, 8-min periods) and then returning to steady-state cycling (20 min). In idual oesophageal, mean skin and intramuscular (vastus lateralis) temperatures were independently cross-correlated with simultaneously measured forehead sweat rates to evaluate the possible thermal modulation of sudomotor activity. Both intramuscular and oesophageal temperatures showed strong correlations with sinusoidal variations in sweating with respective maximal cross-correlation coefficients of 0.807 (±0.044) and 0.845 (±0.035), but these were not different (P = 0.40). However, the phase delay between intramuscular temperature changes and sweat secretion was significantly shorter than the delay between oesophageal temperature and sweating [25.6 s (±12.6) vs. 46.9 s (±11.3) P = 0.03]. The temporal coupling of eccrine sweating to intramuscular temperature, combined with a shorter phase delay, was consistent with the presence of thermosensitive elements within skeletal muscles that appear to participate in the modulation of thermal sweating.
Publisher: Informa UK Limited
Date: 09-02-2018
Publisher: Elsevier BV
Date: 04-2021
Publisher: Springer International Publishing
Date: 2022
Publisher: Elsevier BV
Date: 08-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
DOI: 10.1097/SIH.0000000000000155
Abstract: Simulation-based clinical education often aims to replicate varying aspects of real clinical practice. It is unknown whether learners’ stress levels in simulation are comparable with those in clinical practice. The current study compared acute stress markers during simulation-based clinical education with that experienced in situ in a hospital-based environment. Undergraduate physiotherapy students’ (n = 33) acute stress responses [visual analog scales of stress and anxiety, continuous heart rate (HR), and saliva cortisol] were assessed during matched patient encounters in simulation-based laboratories using standardized patients and during hospital clinical placements with real patients. Group differences in stress variables were compared using repeated measures analysis of variance for 3 time points (before, during the patient encounter, and after) at 2 settings (simulation and hospital). Visual analog scale stress and anxiety as well as HR increased significantly from baseline levels before the encounter in both settings (all P 0.05). Stress and anxiety were significantly higher in simulation [mean (SD), 45 (22) and 44 (25) mm P = 0.003] compared with hospital [mean (SD), 31 (21) and 26 (20) mm P = 0.002]. The mean (SD) HR during the simulation patient encounter was 90 (16) beats per minute and was not different compared with hospital [mean (SD), 87 (15) beats per minute P = 0.89]. Changes in salivary cortisol before and after patient encounters were not statistically different between settings [mean (SD) simulation, 1.5 (2.4) nmol/L hospital, 2.5 (2.9) nmol/L P = 0.70]. Participants’ experienced stress on clinical placements, irrespective of the clinical education setting (simulation vs. hospital). This study revealed that psychological stress and anxiety were greater during simulation compared with hospital settings however, physiological stress responses (HR and cortisol) were comparable. These results indicate that psychological stress may be heightened in simulation, and health professional educators need to consider the impact of this on learners in simulation-based clinical education. New learners in their clinical education program may benefit from a less stressful simulation environment, before a gradual increase in stress demands as they approach clinical practice.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.JPSYCHIRES.2017.07.007
Abstract: While disturbances of the sleep-wake cycle are common in people with affective disorders, the characteristics of these disturbances differ greatly between in iduals. This heterogeneity is likely to reflect multiple underlying pathophysiologies, with different perturbations in circadian systems contributing to the variation in sleep-wake cycle disturbances. Such disturbances may be particularly relevant in adolescents and young adults with affective disorders as circadian rhythms undergo considerable change during this key developmental period. This study aimed to identify profiles of sleep-wake disturbance in young people with affective disorders and investigate associations with biological circadian rhythms. Fifty young people with affective disorders and 19 control participants (aged 16-31 years) underwent actigraphy monitoring for approximately two weeks to derive sleep-wake cycle parameters, and completed an in-laboratory assessment including evening dim-light saliva collection for melatonin assay and overnight continuous core body temperature measurement. Cluster analysis based on sleep-wake cycle parameters identified three distinct patient groups, characterised by 'delayed sleep-wake', 'disrupted sleep', and 'long sleep' respectively. The 'delayed sleep-wake' group had both delayed melatonin onset and core temperature nadir whereas the other two cluster groups did not differ from controls on these circadian markers. The three groups did not differ on clinical characteristics. These results provide evidence that only some types of sleep-wake disturbance in young people with affective disorders are associated with fundamental circadian perturbations. Consequently, interventions targeting endogenous circadian rhythms to promote a phase shift may be particularly relevant in youth with affective disorders presenting with delayed sleep-wake cycles.
Publisher: Elsevier BV
Date: 10-2004
Publisher: SLACK, Inc.
Date: 11-2009
DOI: 10.3928/00220124-20091023-06
Abstract: Recognition of and early intervention for patients with acutely deteriorating conditions is often the responsibility of medical-surgical nurses. This study examined the effect of simulation on medical-surgical graduate nurses' perceived ability and confidence in responding to patient clinical emergencies. Fifty medical-surgical graduate students participated in high-fidelity immersive simulations. Questionnaires completed before and after simulation asked participants to rate their perceived ability and confidence. After simulation, participants reported increased confidence in their ability to perform both technical and nontechnical aspects of responding to patient clinical emergencies. Ninety-four percent of participants identified formal debriefing as the most useful aspect of the simulation experience. Medical-surgical graduate nurses' confidence and perceived technical and nontechnical skills during patient clinical emergencies are enhanced following simulation. The ability of graduates to transfer the increased confidence and perceived advanced resuscitation skills following simulation to the clinical environment needs to be investigated. J Contin Educ Nurs 2009 (11):491–498.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.NEDT.2017.10.001
Abstract: Registered nurses are under-represented in the primary health care setting both internationally and in Australia, and this shortage is predicted to worsen. To address the increasingly complex healthcare needs of an ageing population, it is vital to develop and sustain a primary health care nursing workforce, yet attracting nurses is challenging. In Australia, registered nurses graduating from university typically commence their careers in hospital-based transition to professional practice programs. Similar programs in primary health care settings may be a valuable strategy for developing the primary health care nursing workforce, yet little is known about nursing students desire to work in this setting, factors that influence this, or their expectations of primary health care-focused transition to professional practice programs. This study sought to identify factors associated with final year nursing students' desire to work in primary health care setting including demographic factors, expectations of future employment conditions, and job content. It also explored expectations of graduate transition programs based in primary health care. A cross-sectional survey design comprising a quantitative online survey. 14 Australian universities from all states/territories, both rural and urban. 530 final-year nursing students. Binary logistic regression identifying factors contributing to desire to work in primary health care. The desire of nursing students to work in primary health care is associated with older age, greater perceived value of employment conditions including flexibility, and less perceived importance of workplace support. Collaborative efforts from primary health care nurses, health professionals, academics and policy makers are needed to attract new graduate nurses to primary health care.
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/20552076231180970
Abstract: While digital health interventions (DHIs) can potentially address the unmet needs for sleep health services, little is known about their implementation in practice. The current study aimed to explore primary care health providers’ attitudes and beliefs towards DHIs for sleep and implementation into practice. A cross-sectional online survey was administered to Australian primary care health professionals: general practitioners (GPs), community nurses, and community pharmacists. Semi-structured interviews were conducted within a sub-s le of participants exploring their experiences with DHIs and perceived barriers/facilitators for embedding DHIs into primary care. Semi-structured interviews were thematically analysed using the framework approach to contextualise survey findings. Ninety-six surveys were returned (GPs = 36, nurses = 30, and pharmacists = 30) and 45 interviews conducted (GPs = 17, nurses = 14, and pharmacists = 14). From the survey, GPs were more likely to endorse familiarity ( p = 0.009) and use ( p 0.001) of sleep DHIs in clinical practice than pharmacists and nurses. GPs were more interested in utilising the diagnostic features within a sleep DHI ( p = 0.009) compared to other professionals. Thematic analysis of the interviews revealed three major themes, contextualised by profession: (1) Scope for DHIs in Current Practice, (2) Practice Gaps and Training Needs, and (3) Envisioning a Model of Care Using Sleep DHIs. While DHIs can potentially improve care, greater clarity of care pathways and reimbursement structures are needed for integration into practice. Primary care health professionals highlighted the training, care pathway and financial models required to realise the potential for translating findings from efficacy studies for DHIs into primary care to optimise sleep health.
Publisher: Wiley
Date: 15-04-2022
DOI: 10.1111/JAN.15253
Abstract: To compare nurses’ non‐optimal eating behaviours across different shifts, to examine whether non‐day shifts were related to deviation from optimal dietary behaviours compared with day shifts and whether such deviation was related to non‐optimal macronutrient intake. This is a 4‐day intensive longitudinal study. A convenience s le of hospital nurses was recruited in Taiwan. From September 2018 through January 2019, 120 participants completed 4‐days of 24‐h dietary recalls. One‐way ANOVA and Kruskal–Wallis H test were used to compare differences in energy and macronutrient intake and frequency of meals and snacking, respectively. Generalized linear regressions examined (1) the associations between shiftwork schedules and non‐optimal eating behaviours and (2) associations between non‐optimal eating and high energy contribution of non‐optimal macronutrients. Nurses consumed less energy on evening and night shifts compared with day shifts. However, energy intake from snacking was higher on evening and night shifts relative to day shifts. Nurses consumed less meals but had higher snacking frequency on non‐day shifts. In addition, high energy intake from snacking was positively associated with high energy intake from saturated fat. Nurses were more likely to have non‐optimal eating behaviours on non‐day shifts, which may contribute to an increased intake of saturated fat thus, increasing their risk of chronic diseases. Strategies to improve non‐day shift nurses' non‐optimal eating behaviours may be beneficial to their health. Shiftwork is known to affect nurses' eating behaviours however, which shift is associated with unhealthy eating remains inconclusive. Despite lower energy intakes, nurses had higher intake by snacking on evening and night shifts. High snacking intake was associated with a high intake of saturated fat. Hospitals can increase the availability of healthy foods on evening or night shifts, which may improve non‐day shift nurses' non‐optimal eating behaviours.
Publisher: Frontiers Media SA
Date: 16-07-2018
Publisher: Oxford University Press (OUP)
Date: 11-2016
DOI: 10.5665/SLEEP.6230
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.SLEEP.2018.12.011
Abstract: The popularity of biofeedback as a non-pharmacological treatment option for insomnia has increased in recent times despite inconsistent empirical evidence for its therapeutic efficacy. The purpose of the current review was to systematically assess the efficacy of using biofeedback to treat insomnia. A search of electronic databases (PubMED, MEDLINE, OvidSP, Ovid EMBASE, PsychInfo, The Cochrane Library including Cochrane Reviews), clinical trials databases and registries (Clinical Trials Database [US], Australian New Zealand Clinical Trials Registry [ANZCTR]) and online journal (eg, SLEEP, Sleep Medicine) identified 92 studies. Of these, 50 publications were descriptive or review papers about use of biofeedback for the treatment of insomnia, while an additional 37 did not meet the detailed inclusion criteria (ie not original research, participants do not meet the diagnostic criteria for insomnia). Six full-text articles met inclusion criteria and were included in this review. Methodological flaws including poor study design (small s le size, lack of control group) limit the validity of the body of work in this field to date and fail adequately to account for other unspecified factors likely to drive the observed changes, such as care and attention of those administering the treatment, as well as the expectations and motivations of the patient. There is an urgent need for future studies to clarify the role of unspecific placebo effects when reporting biofeedback effects for the treatment of insomnia.
Publisher: Elsevier
Date: 2005
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-041500
Abstract: Melatonin has multiple proposed therapeutic benefits including antioxidant properties, synchronisation of the circadian system and lowering of blood pressure. In this protocol, we outline a randomised controlled trial to assess the feasibility, acceptability and tolerability of higher dose (25 mg) melatonin to target brain oxidative stress and sleep disturbance in older adults with mild cognitive impairment (MCI). The study design is a randomised double-blind, placebo-controlled, parallel group trial. Forty in iduals with MCI will be recruited from the Healthy Brain Ageing Clinic, University of Sydney and from the community, and randomised to receive either 25 mg oral melatonin or placebo nightly for 12 weeks. The primary outcomes are feasibility of recruitment, acceptability of intervention and adherence to trial medication at 12 weeks. Secondary outcomes will include the effect of melatonin on brain oxidative stress as measured by magnetic resonance spectroscopy, blood pressure, blood biomarkers, mood, cognition and sleep. Outcomes will be collected at 6 and 12 weeks. The results of this feasibility trial will inform a future conclusive randomised controlled trial to specifically test the efficacy of melatonin on modifiable risk factors of dementia, as well as cognition and brain function. This will be the first trial to investigate the effect of melatonin in the population with MCI in this way, with the future aim of using this approach to reduce progression to dementia. This protocol has been approved by the Sydney Local Health District Ethics Committee (X18-0077). This randomised controlled trial will be conducted in compliance with the protocol published in the registry, the International Conference for Harmonisation on Good Clinical Practice and all other applicable regulatory requirements. The findings of the trial will be disseminated via conferences, publications and media, as applicable. Participants will be informed of results of the study at the conclusion of the trial. Eligible authors will include investigators who are involved in the conception and design of the study, the conduct of the trial, the analysis of the results, and reporting and presentation of study findings. Australian and New Zealand Clinical Trials Registry (ANZCTRN 12619000876190). V.8 15 October 2020.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2013
Location: Australia
No related grants have been discovered for Christopher James Gordon.