Outdoor Light Exposure Research Articles

Patterns of Daily Outdoor Light Exposure in Australian and Singaporean Children.

PurposeMyopia is rising in prevalence in many locations, and there is evidence that outdoor light exposure is a major environmental factor playing a role in myopia development. This study examined the patterns of daily light exposure in similarly aged children from two geographic locations (Australia and Singapore) known to exhibit differences in myopia prevalence.MethodsWearable light sensors were used to assess daily light exposure in 69 Singaporean children aged 8 to 12 years (mean, 9.2 ± 1.1) and 43 Australian children aged 10 to 12 years (mean, 11.3 ± 0.6). The mean daily time exposed to bright outdoor light (>1000 lux) and the number and duration of daily episodes of outdoor exposure were examined.ResultsPatterns of daily outdoor light exposure differed substantially between Australia and Singapore. Australian children (105 ± 42 min/d) experienced significantly longer daily outdoor light exposure than Singaporean children (61 ± 40 min/d; P = 0.005), with the largest differences found on weekdays during school hours. Australian children (6.9 ± 1.5 episodes per day) had more frequent daily episodes of outdoor light exposure compared with Singaporean children (4.6 ± 1.5; P = 0.02); however, there was no significant difference in the mean duration of these episodes between countries (P = 0.54).ConclusionsChildren living in Singapore were exposed to significantly less daily outdoor light than Australian children, and these differences may be one of several factors contributing to the differences in myopia prevalence typically found between these populations.Translational RelevanceKnowledge of these light exposure patterns may assist in the design of outdoor interventions, including school programs, to increase outdoor time in urban Asian populations.

Sleep and Caregiving Experiences among Caregivers of Veterans in an Adult Day Health Care Program: A Pilot Study

ABSTRACTObjectives: This pilot study explored caregivers’ attitudes toward core elements of a behavioral sleep intervention for managing sleep problems of older veteran care recipients and the caregivers, as an initial step for developing a dyadic sleep intervention program.Methods: Five caregivers (all women; age range, 66–75 years) participated in a focus group discussion. Data were collected at one Veterans Affairs, adult day health care program.Results: Caregivers’ poor sleep was not necessarily explained by their caregiving responsibility. Caregivers felt that behavioral recommendations regarding sleep compression scheduling, increased indoor physical activity, and outdoor light exposure would be acceptable sleep interventions for themselves and the care recipients. Some challenges to the sleep recommendation were identified and they included limiting naptime of care recipients and change of their current sleep schedule.Conclusions: Caregivers are receptive to some key components of behavioral approaches to improving sleep. Tailored sleep recommendation strategy is needed to address potential challenges.Clinical Implications: If available within clinical care settings or delivered at the patient’s home, caregivers of older veterans are likely to engage in behavioral sleep intervention programs.

Measurement Duration and Frequency Impact Objective Light Exposure Measures.

To determine the measurement duration and frequency required to reliably quantify the typical personal light exposure patterns of children and young adults. Ambient light exposure data were obtained from 31 young adults and 30 children using a wrist-worn light sensor configured to measure ambient light exposure every 30 seconds for 14 days. To examine the influence of measurement duration upon light exposure, the daily time exposed to outdoor light levels (>1000 lux) was initially calculated based upon data from all 14 days and then recalculated from 12, 10, 8, 6, 4, and 2 randomly selected days. To examine the influence of measurement frequency, the outdoor exposure time was calculated for a 30-second sampling rate and again after resampling at 1-, 2-, 3-, 4-, 5-, and 10-minute sampling rates. Children spent significantly greater time outdoors (44 minutes higher [95% CI: 26, 62]) compared to adults (P = .001). Children spent more time outdoors during the weekdays (13 minutes higher [-7, 32]) and adults spent more time outdoors during the weekends (24 minutes higher [7, 40]) (P = .005). Calculating light exposure using a lower number of days and coarser sampling frequencies did not significantly alter the group mean light exposure (P > .05). However, a significant increase in measurement variability occurred for outdoor light exposure derived from less than 8 days and 3 minutes or coarser measurement frequencies in adults, and from less than 8 days and 4 minutes or coarser frequencies in children (all P < .05). Reducing measurement duration seemed to have a greater impact upon measurement variability than reducing the measurement frequency. These findings suggest that a measurement duration of at least 1 week and a measurement frequency of 2 minutes or finer provides the most reliable estimates of personal outdoor light exposure measures in children and young adults.

Shift work: health, performance and safety problems, traditional countermeasures, and innovative management strategies to reduce circadian misalignment.

There are three mechanisms that may contribute to the health, performance, and safety problems associated with night-shift work: (1) circadian misalignment between the internal circadian clock and activities such as work, sleep, and eating, (2) chronic, partial sleep deprivation, and (3) melatonin suppression by light at night. The typical countermeasures, such as caffeine, naps, and melatonin (for its sleep-promoting effect), along with education about sleep and circadian rhythms, are the components of most fatigue risk-management plans. We contend that these, while better than nothing, are not enough because they do not address the underlying cause of the problems, which is circadian misalignment. We explain how to reset (phase-shift) the circadian clock to partially align with the night-work, day-sleep schedule, and thus reduce circadian misalignment while preserving sleep and functioning on days off. This involves controlling light and dark using outdoor light exposure, sunglasses, sleep in the dark, and a little bright light during night work. We present a diagram of a sleep-and-light schedule to reduce circadian misalignment in permanent night work, or a rotation between evenings and nights, and give practical advice on how to implement this type of plan.

The Association between Time Spent Outdoors and Myopia Using a Novel Biomarker of Outdoor Light Exposure

We sought to determine whether conjunctival ultraviolet autofluorescence (UVAF), a biomarker of outdoor light exposure, is associated with myopia. We performed a cross-sectional study on Norfolk Island and recruited individuals aged ≥ 15 years. Participants completed a sun-exposure questionnaire and underwent non-cycloplegic autorefraction. Conjunctival UVAF used a specially adapted electronic flash system fitted with UV-transmission filters (transmittance range 300-400 nm, peak 365 nm) as the excitation source. Temporal and nasal conjunctival UVAF was measured in both eyes using computerized photographic analysis with the sum referred to as "total UVAF." In 636 participants, prevalence of myopia decreased with an increasing quartile of total UVAF (P(trend) = 0.002). Median total UVAF was lower in subjects with myopia (spherical equivalent [SE] ≤ -1.0 diopter [D]) than participants without myopia: 16.6 mm(2) versus 28.6 mm(2), P = 0.001. In the multivariable model that adjusted for age, sex, smoking, cataract, height and weight, UVAF was independently associated with myopia (SE ≤ -1.0 D): odds ratio (OR) for total UVAF (per 10 mm(2)) was 0.81, 95% confidence interval (CI) 0.69 to 0.94, P = 0.007. UVAF was also significantly associated with myopia when analysis was restricted to subjects <50 years, and in moderate-severe myopia (SE ≤ -3.0 D). Prevalence of myopia decreased with increasing time outdoors (P(trend) = 0.03), but time outdoors was not associated with myopia on multivariable analysis. Study authors identified a protective association between increasing UVAF and myopia. The protective association of higher UVAF against myopia was stronger than that of increased levels of time spent outdoors as measured by this study's questionnaire. Future studies should investigate the association between UVAF and incident myopia, and its relationship to myopic progression.

Cutaneous T-Cell Lymphoma

Cutaneous T-Cell Lymphoma

Practical Interventions to Promote Circadian Adaptation to Permanent Night Shift Work: Study 4

Scheduled bright light and darkness can phase shift the circadian clocks of night workers for complete adaptation to a night work, day sleep schedule, but few night workers would want this because it would leave them out of phase with the diurnal world on days off. This is the final study in a series designed to produce a compromise circadian phase position for permanent night shift work in which the sleepiest circadian time is delayed out of the night work period and into the first half of the day sleep episode. The target compromise phase position was a dim light melatonin onset (DLMO) of 3:00, which puts the sleepiest circadian time at approximately 10:00. This was predicted to improve night shift alertness and performance while permitting sufficient daytime sleep after work as well as late-night sleep on days off. In a between-subjects design, 19 healthy subjects underwent 3 simulated night shifts (23:00-7:00), 2 days off, 4 more night shifts, and 2 more days off. Subjects "worked" in the lab and slept at home. Experimental subjects received four 15-min bright light pulses during each night shift, wore dark sunglasses when outside, slept in dark bedrooms at scheduled times, and received outdoor afternoon light exposure ("light brake") to keep their rhythms from delaying too far. Control subjects remained in normal room light during night shifts, wore lighter sunglasses, and had unrestricted sleep and outdoor light exposure. The final DLMO of the experimental group was 3:22 +/- 2.0 h, close to the target of 3:00, and later than the control group at 23:24 +/- 3.8 h. Experimental subjects slept for nearly all the permitted time in bed. Some control subjects who slept late on weekends also reached the compromise phase position and obtained more daytime sleep. Subjects who phase delayed (whether in the experimental or control group) close to the target phase performed better during night shifts. A compromise circadian phase position improved performance during night shifts, allowed sufficient sleep during the daytime after night shifts and during the late nighttime on days off, and can be produced by inexpensive and feasible interventions.

Shaping the light/dark pattern for circadian adaptation to night shift work

This is the second in a series of simulated night shift studies designed to achieve and subsequently maintain a compromise circadian phase position between complete entrainment to the daytime sleep period and no phase shift at all. We predict that this compromise will yield improved night shift alertness and daytime sleep, while still permitting adequate late night sleep and daytime wakefulness on days off. Our goal is to delay the dim light melatonin onset (DLMO) from its baseline phase of ∼ 21:00 to our target of ∼ 3:00. Healthy young subjects ( n = 31) underwent three night shifts followed by two days off. Two experimental groups received intermittent bright light pulses during night shifts (total durations of 75 and 120 min per night shift), wore dark sunglasses when outside, slept in dark bedrooms at scheduled times after night shifts and on days off, and received outdoor light exposure upon awakening from sleep. A control group remained in dim room light during night shifts, wore lighter sunglasses, and had unrestricted sleep and outdoor light exposure. After the days off, the DLMO of the experimental groups was ∼ 00:00–1:00, not quite at the target of 3:00, but in a good position to reach the target after subsequent night shifts with bright light. The DLMO of the control group changed little from baseline. Experimental subjects performed better than control subjects during night shifts on a reaction time task. Subsequent studies will reveal whether the target phase is achieved and maintained through more alternations of night shifts and days off.

Influence of Timed Nutrient Diet on Depression and Light Sensitivity in Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) patients crave and eat more carbohydrates (CHO) in fall‐winter when depressed, especially in the evenings, and feel energetic thereafter. Evening CHO‐rich meals can phase delay circadian rhythms, and glucose increases retinal response to light. We studied timed CHO‐ or protein‐rich (PROT) diet as a putative therapy for SAD. Unmedicated, DSM‐IV‐diagnosed depressed women with SAD (n=22, 19–63 yrs) in the follicular phase of the menstrual cycle (present in 19) were randomized to nine days of eating ∼1600 kcal of either CHO before 12:00 h (n=9), CHO after 18:00 h (n=6), or PROT after 18:00 h (n=7); only water was allowed for the rest of the day. Measurements included the depression questionnaire SIGH‐SAD (with 21‐item Hamilton depression subscale), Eating Behavior Questionnaire (DEBQ), percentage fat (by bioimpedancemetry), clinical biochemistry (glucose, cholesterol, triglycerides, TSH, T4, cortisol), and electroretinogram (ERG). No differential effects of diet were found on any of the studied parameters (except DEBQ). Clinically, participants improved slightly; the 21‐HDRS score (mean±SD) decreased from 19.6±6.4 to 14.4±7.4 (p=.004). Percent change correlated significantly with menstrual day at diet onset (mood improved the first week after menstruation onset), change in available sunshine (more sunlight, better mood), and initial percentage fat (fatter patients improved more). Scotopic ERG amplitude was diminished after treatment (p=.025, three groups combined), probably due to greater exposure to sunshine in 14/22 subjects (partial correlation analysis significant). Keeping in mind the limitations of this ambulatory study (i.e., inability to control outdoor light exposure, small number of participants, and briefness of intervention), it is suggested that the 25% clinical improvement (of the order of magnitude of placebo) is not related to nutrient diet or its timing, but rather to natural changes during the menstrual cycle, available sunshine, and ease of dieting for fatter patients.

Coping with jet-lag: A Position Statement for the European College of Sport Science

Elite athletes and their coaches are accustomed to international travel for purposes of training or sports competition. Recreational participants are similarly, if less frequently, exposed to travel stress. Transient negative effects that constitute travel fatigue are quickly overcome, whereas longer-lasting difficulties are associated with crossing multiple time-zones. Jet-lag is linked with desynchronization of circadian rhythms, and its impact depends on the duration and direction of flight, flight schedule, and individual differences. Athletes’ performances are likely to be affected for some days until the body clock is readjusted in harmony with local time. Knowledge of the physiological characteristics of the body clock can be used to develop behavioural strategies that accelerate readjustment, in particular the timing of outdoor or bright light exposure, perhaps melatonin ingestion, meals, and exercise. Attempts to promote sleep by use of drugs that adjust the body clock, induce sleepiness or promote wakefulness are relevant but discouraged in travelling athletes. Support staff should develop appropriate education programmes for their athletes who can then make informed choices about their behaviour and minimize the transient effects of jet-lag on their well-being and performance.

Winter and summer outdoor light exposure in women with and without seasonal affective disorder

Background: The annual decrease of daylight duration initiates a depressive phase in patients with seasonal affective disorder (SAD), and light therapy treats it. How much bright light exposure in winter and summer these patients actually receive may help understand the pathogenetic factors initiating SAD. Methods: During a week in winter and summer, women with and without SAD kept daily logs of the time spent outdoors, subjective sleep, and self-ratings of mood and alertness. Results: Compared with the winter depressive state, mood, alertness, and sleep of SAD patients improved in summer to control values, but did not correlate with the amount of light exposure. In summer, patients with SAD spent more time outdoors than controls. Limitation: Light logs – in comparison with light monitor measurements – may overestimate light exposure outdoors. Conclusion: Women with SAD do not spend less time outdoors in winter than controls, but spend more time outdoors in summer. Clinical Relevance: Patients with SAD show a high amplitude seasonal difference in outdoor light exposure. The susceptibility to winter depression may arise not from behaviourally-related lack of sufficient light exposure, but an increased vulnerability to the amount of light received. They may require more light than controls to remain euthymic (higher light exposure in summer, light therapy in winter).

Wavelength-dependent photoresponse of biological and aqueous model systems using the photodynamic plant pigment hypericin

Photodynamic eradication of tumour cells in vivo depends on the presence of a photosensitizer, light delivery to the cells, and an oxygen supply. Hypericin, a polycyclic quinone with absorption maxima in the ultraviolet and visible ranges, was prepared for clinical use as a photosensitizer. Due to antitumoral and antineoplastic activities as well as the generation of singlet oxygen after photoexcitation, hypericin was applied in clinical oncology and photodynamic therapy. Hypericin was administered subcutaneously (20 μg hypericin in 200 μl Nacl/pyridine solution) into the ante brachium (forearm) of two volunteers. After the diffusion and equilibration of 120 min phototesting was carried out using outdoor light exposure, halogen lamp, laser 514 nm (argon), laser 632 nm (argon dye) and laser 670 nm (diode laser), from 60 to 120 J cm −2. Positive phototests to outdoor light exposure, halogen lamp and laser 514 nm were characterized by rubescence, oozing, vesiculation and darting pain. Phototests with laser 632 nm and 670 nm showed no effects after irradiation. When hypericin was administered topically on skin, erythema and flaring could not be induced by any irradiation. These results suggest that hypericin is a potent photosensitizer only within the UV and green light ranges. This characteristic photoresponse could also be obtained in guinea pig papillary muscle (GPPM) bioassay, which may be established as a model for photosensitizer testing. Irradiation of hypericin-incubated GPPM with 514 nm (20 J cm −2) led to a decrease of the contractile force of about 31%. However, excitation with 632 nm and 670 nm did not cause inotropic effects on GPPM. In addition, hypericin and Photosan 3 were shown to be capable of sensitizing the photo-oxidation of sodium linoleate. This assay should be established for testing interactions between photosensitizers and light sources in vitro.

‘Natural’ light treatment of seasonal affective disorder

Patients with seasonal affective disorder (SAD) were treated for 1 week either with a daily 1-h morning walk outdoors (natural light) or low-dose artificial light (0.5 h @ 2800 lux). The latter treatment (given under double-blind conditions) can be considered mainly placebo and did not improve any of the depression self-ratings, whereas natural light exposure improved all self-ratings. According to the Hamilton depression score, 25% remitted after low-dose artificial light and 50% after the walk. Sleep duration or timing were not crucial for the therapeutic response. The morning walk phase-advanced the onset and/or offset of salivary melatonin secretion, but individual clinical improvement could not be correlated with specific phase-shifts. Morning cortisol was decreased. Low-dose artificial light did not modify melatonin or cortisol patterns. This is the first study to provide evidence for the use of outdoor light exposure as a potential alternative or adjuvant to conventional artificial light therapy in SAD.