Self-reported Diary Research Articles

Nurse-delivered brief behavioral treatment for insomnia in cancer survivors: a randomized controlled trial.

To determine the efficacy of nurse-delivered brief behavioral treatment for insomnia (BBTI) compared to an attention control, in a heterogeneous sample of cancer survivors to reduce insomnia symptom severity. We recruited 132 participants from cancer care clinics, who had an Insomnia Severity Index (ISI) score ≥ 8. Participants were randomized into two groups: an experimental BBTI group and a healthy eating attention control group. Demographics survey at baseline, and sleep-related questionnaires, self-reported sleep diaries, and wrist-worn actigraphy at baseline, 1, 3, and 12months were collected. Statistical analyses used analysis of covariance (ANCOVA) models with two-sided 0.05 nominal significance level for treatment effect for primary outcome of insomnia severity at 1month. Participants were cancer survivors with a mean age of 63.7years, 55% female, 88.6% white, with breast, prostate, colorectal, and lung cancer. Statistically significant group differences were observed at all time points for ISI and sleep quality (ISI effect sizes 0.56, 0.59, and 0.54 respectively). Additionally, at 1month, those in insomnia remission (ISI ≤ 8) were higher for the BBTI (55.1%) compared to the control group (43.3%). Secondary outcomes from sleep diary measures (i.e., sleep efficiency, sleep onset latency, wake after sleep onset) were significant at 1month. The BBTI group was significantly effective in reducing insomnia severity and improving sleep quality over time compared to the control among cancer survivors. Clinical trials identifier: http://ClinicalTrials.gov , NCT03810365. Implementing BBTI in survivorship settings can effectively address and manage insomnia symptoms, thus bridging a crucial gap in care for cancer survivors.

Necessary for seizure forecasting outcome metrics: Seizure frequency and benchmark model

BackgroundThis study aims to illustrate the connection between seizure frequency (SF) and performance metrics in seizure forecasting, and to compare the effectiveness of a moving average (MA) model versus the commonly used permutation benchmark. MethodsMetrics of calibration and discrimination were computed for each dataset, comparing MA and permutation performance across SF values. Three datasets were used: (1) self-reported seizure diaries from 3994 Seizure Tracker patients, (2) automatically detected and sometimes manually reported or edited generalized tonic-clonic seizures from 2350 Empatica Embrace 2 and Mate App users, and (3) simulated datasets with varying SFs. ResultsMost metrics were found to depend on SF. The MA model outperformed or matched the permutation model in all cases. These more advanced metrics show that comparison to permutation will falsely elevate poor forecasting models. ConclusionsThe findings highlight SF's role in seizure forecasting accuracy and the MA model's suitability as a benchmark. This study underscores the need for considering patient SF in forecasting studies and suggests the MA model may provide a better standard for evaluating future seizure forecasting models.

Assessing Energy Availability and Glucose Dynamics in Adolescent Cyclists: Implications for Nutritional Interventions During the Competitive Season.

The risk of developing a state of low energy availability (LEA) (<30 kcals/kg free-fat mass) in endurance athletes is known and recommendations for nutrition are available. However, information on male adolescent cyclists and the influence of hot temperatures is limited. The aim of this study was to investigate the impact on energy availability of two 4-day nutritional intervention strategies: (1) supplementary carbohydrate (CHO) intake during exercise and (2) designing and implementing individual nutritional interventions. Each intervention was preceded by a 4-day basal assessment. Eight competitive male junior road cyclists (aged 16-17 years) were investigated using a 4-day diet and activity records, alongside bioelectric impedance analysis. Their real-time power output, interstitial glucose, and temperature were recorded via sensors and a bike computer. Their energy intake (EI) was estimated from daily, self-reported food diaries. Overall, 100% and 71% of the cyclists were in a state of LEA during the baseline assessment of the supplementary CHO and nutritional interventions, respectively. LEA prevalence, not modified by supplementary CHO intake alone (from 100% to 87%, ns), was markedly reduced by the individual nutritional intervention (from 71% to 14%, p < 0.05). When considering all the data as a whole, LEA was positively influenced by the training load (OR 1.06; 95% Cl 1.03 to 1.09) and free-fat mass (OR 1.46; 1.04 to 2.04) and was negatively affected by EI (OR 0.994; 0.991 to 0.997). A hot environment (air temperature) failed to influence the LEA or glucose dynamics. the nutritional intervention, but not the supplementary CHO intake, markedly reduced the prevalence of LEA in adolescents, who often fail to match their energy expenditure with their energy intake during the competitive season. Nutritional education is essential for adolescent endurance cycling teams.

Virological and Clinical Outcomes of Influenza Outpatients Treated With Baloxavir, Oseltamivir, or Laninamivir in the 2023-2024 Season.

Clinical data on patients infected with influenza B Victoria (BV) after the approval of baloxavir is lacking. This observational study of the Japanese 2023-2024 influenza season analyzed data from 25 outpatients with A(H1N1)pdm09, 36 with A(H3N2), and 65 with BV. Viral samples were collected before and after administering an antiviral (70 patients received baloxavir and 56 received a neuraminidase inhibitor), on days 1, 5, and 10. Isolated viruses after culturing were amplified using RT-PCR and sequenced to detect mutations of concern, including acidic protein (PA)-amino acid (AA) E23X/I38X for influenza A and M34X/I38X for BV. Fever and symptoms were tracked via self-reporting diaries. No PA-AA-substituted virus was detected from 126 pre-treatment samples. In the baloxavir cohort, one (7.1%, 1/14) PA I38F-substituted A(H1N1)pdm09 and two (11.1%, 2/18) PA I38T-substituted A(H3N2) viruses were isolated on day 5 but not on day 10. No (0%, 0/37) PA-AA-substituted BV was detected on day 5 or after. The virus isolation rate on day 5 was higher among patients with BV than with influenza A in both baloxavir (35.1% vs. 14.3% for A(H1N1)pdm09 and 16.7% for A(H3N2)) and oseltamivir-treated patients (44.4% vs. 0% for A(H1N1)pdm09 and 33.3% for A(H3N2)). Patients with PA-AA-substituted influenza A after baloxavir administration did not have longer fever duration than those without virus isolation or with wild-type virus on day 5, for both A(H1N1)pdm09 and A(H3N2). Baloxavir-resistant variants were not detected in influenza BV before treatment, as with A. The emergence of PA-AA-substituted influenza A after baloxavir administration was temporal and did not cause prolonged symptoms. No baloxavir-resistant BV variants were observed after baloxavir administration.

Modulating the gut microbiota in Crohn's disease: a pilot study on the impact of a plant-based diet with DNA-based monitoring.

Crohn's Disease (CD) is characterized by chronic intestinal inflammation and dysbiosis. This study aimed to investigate the effects of a plant-based diet (PBD) on gut microbiota composition and inflammation in CD patients and assess the utility of trnL gene sequencing for monitoring dietary adherence. Fourteen CD patients participated in a 12-week PBD intervention. Dietary adherence was monitored through self-reported food diaries and trnL sequencing, which detects plant residues in fecal samples. Gut microbiota was analyzed using 16S rRNA sequencing, and fecal calprotectin levels were measured as an indicator of intestinal inflammation. TrnL sequencing identified 55 plant genera in fecal samples, compared to 41 reported in food diaries, highlighting its accuracy in assessing plant residue diversity. By week 4, participants demonstrated a 1.4-fold increase in plant intake, correlating with a significant increase in microbial diversity. Key genera associated with gut health, such as Faecalibacterium and Bacteroides, increased in abundance. Additionally, fecal calprotectin levels decreased from 472 mg/kg at baseline to 207 mg/kg at week 12, indicating reduced intestinal inflammation. A PBD positively influenced gut microbiota composition and decreased intestinal inflammation in CD patients. The study also demonstrated that trnL sequencing is an effective tool for assessing dietary adherence in clinical settings, offering a more objective measure than self-reported food diaries.

A pilot randomised controlled trial of a multidomain lifestyle intervention for outpatients with chronic or severe mental illness

Lifestyle-related problems are common in people with mental illness, contributing to a decreased life expectancy and high societal and personal burden. This study aimed to investigate the feasibility, acceptability, and preliminary effectiveness on recovery of a multidomain lifestyle intervention in patients with severe or chronic mental illnesses. Twenty transdiagnostic outpatients were 1:1 randomised in intervention or control. The lifestyle intervention consisted of 11 three-hour group sessions about physical activity, nutrition, relaxation, sleep, substance use, and purpose and meaning. Self-report questionnaires, physical measurements, diary questions, and accelerometers were administered at baseline, halfway and post intervention. Outcomes included attrition, retention rates, protocol deviations, quantitative evaluations and effectiveness. Both the intervention and research protocol appeared feasible and acceptable, with relaxation, purpose and meaning and nutrition as highest appreciated themes. Intervention simplification and deepening was necessary to suit the heterogeneous participants. Preliminary effects were found in all recovery domains, with biggest effects in societal recovery and smallest effects in clinical recovery. To prevent dropout and match the outpatient population, small intervention adaptations are recommended. Effects can be expected in all domains of recovery and should be measured accordingly. Research with greater sample sizes is necessary.

Moving beyond moderate-to-vigorous physical activity: A longitudinal study on adherence to 24-hour Movement Guidelines in adolescents

ObjectivesLow adherence to 24-hour Movement Guidelines for moderate-to-vigorous physical activity, screen time and sleep during adolescence is well documented, yet recommendations regarding light physical activity, vigorous physical activity and muscle and bone strengthening activities have received less attention. This study comprehensively examined adherence to seven components of the movement guidelines in adolescents and analysed disparities by age and gender. DesignLongitudinal study with two assessment time points, separated by one year. MethodsData were collected in 216 New Zealand adolescents aged 12–17 years, and at 1-year follow-up in 167 participants (77 %), using thigh-worn accelerometers and a self-reported diary. ResultsAdherence rates were 3.7 % for moderate-to-vigorous physical activity, 13.0 % for screen time, 44.0 % for sleep, 14.4 % for light physical activity, 36.1 % for vigorous physical activity, 30.6 % for bone and muscle strengthening activities, and 4.6 % for consistent bedtimes. Less than 1 % of participants met all seven recommendations. Adherence was disproportionately low amongst older adolescents for light physical activity, screen time and consistent bedtimes, and amongst girls for vigorous physical activity and muscle and bone strengthening activities. Over one year, adherence declined for light physical activity (15.0 %–7.2 %) and screen time (15.6 %–6.0 %). ConclusionsNew Zealand adolescents are not adhering to recommendations for a healthy balance of time use outlined in the 24-h Movement Guidelines. These findings highlight the need for adolescents to increase their daily movement, with a particular focus on light physical activity amongst older adolescents and muscle and bone strengthening activities amongst girls.

Personalised Health Behaviour Support Programme in Adults With Post-COVID Syndrome: A Randomised, Controlled Pilot Feasibility Trial.

We investigated whether a novel 8-week personalised health behaviour support programme, focusing on the stability of symptoms and strategies to improve activities of daily living, was feasible and acceptable in adults with post-COVID syndrome. In this randomised, controlled, pilot feasibility trial, 32 adults with post-COVID syndrome (continued symptoms for ≥ 12 weeks) were randomised 1:1 to receive personalised health behaviour support (self-reported physical activity and symptom diaries, plus seven one-to-one remotely delivered personalised self-management support sessions), once weekly for 8-weeks, or usual care (referral to online 'your COVID-19 recovery' programme). The primary outcome was the feasibility of recruiting and randomising adults with post-COVID syndrome. The secondary outcomes were to assess the acceptability and safety of the intervention and various outcome measures. Of the 48 adults who expressed interest in the study, 32 (67%) were eligible and completed the baseline assessment. All 32 adults were willing to be randomised to either the personalised health behaviour support programme (n = 17) or usual care (n = 15) and 27 (age: 45 ± 12 years) adults completed follow-up at 9 weeks. The intervention was deemed feasible, with high adherence (92% and 94% completion rates for the physical activity and symptom diaries, respectively) and excellent acceptability rates (94% 'liked the intervention a lot'). The intervention was deemed safe, with no symptom exacerbations reported. An 8-week personalised health behaviour support programme was feasible for adults with post-COVID syndrome, with good adherence and acceptability rates. Early pilot data from this small sample also suggests meaningful improvements in physical activity, fatigue and respiratory symptoms. People living with post-COVID syndrome were involved from the outset with the study design, review of study documentation and interpretation of the data following completion. Furthermore, several participants have supported the local dissemination of findings following the completion of the study.

Statistical characteristics of large-scale objective tonic-clonic seizure records from medical smartwatches used in daily life.

This study aimed to assess whether population-level patterns in seizure occurrence previously observed in self-reported diaries, medical records, and electroencephalographic recordings were also present in tonic-clonic seizure (TCS) diaries produced via the combined input of a US Food and Drug Administration-cleared wristband with an artificial intelligence detection algorithm and patient self-reports. We also investigated the characteristics of patient interactions with wearable seizure alerts. We analyzed wristband data from patients with TCSs who had at least three reported TCSs over a minimum of 90 days. We quantified TCS frequency and cycles, and the relationship between the mean and variability of monthly TCS counts. We also assessed interaction metrics such as false alarm dismissal and seizure confirmation rates. Applying strict criteria for usable data, we reviewed 137 490 TCSs from 3012 patients, with a median length of TCS alert records of 445 days (range = 90-1806). Analyses showed consistency between prior diary studies and the present data concerning (1) the distribution of monthly TCS frequency (median = 3.1, range = .08-26); (2) the linear relationship (slope = .79, R2 = .83) between the logarithm of the mean and the logarithm of the SD of monthly TCS frequency (L-relationship); and (iii) the prevalence of multiple coexisting seizure cycles, including circadian (84.0%), weekly (24.6%), and long-term cycles (31.1%). Key population-level patterns in seizure occurrence are recapitulated in wrist-worn device recordings, supporting their validity for tracking TCS burden. Compared to other approaches, wearables can provide noninvasive, objective, long-term data, revealing cycles in seizure risk. However, improved patient engagement with wristband alerts and further validation of detection accuracy in ambulatory settings are needed. Together, these findings suggest that data from smart wristbands may be used to derive features of TCS records and, ultimately, facilitate remote monitoring and the development of personalized forecasting tools for TCS management. Our findings may not generalize to other types of seizures.

Device-based 24-hour movement behaviours in adult phase III cardiac rehabilitation service-users during the COVID-19 pandemic: a mixed-methods prospective observational study

Purpose To examine changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR). Materials and methods This prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 ± 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis. Results At start, service-users were sedentary for 12.6 ± 0.7 h · day−1 and accumulated most PA at a light-intensity (133.52 ± 28.57 min · day−1) – neither changed significantly during RDCR. Sleep efficiency significantly reduced from start (88.80 ± 4.2%) to the end (86.1 ± 4.76%) of CR, with values meeting health-based recommendations (≥85%). Barriers to RDCR exercise included exertional discomfort and cardiac symptoms, and reduced confidence when exercising alone. Setting meaningful PA goals, self-monitoring health targets, and having social support, facilitated PA and exercise during RDCR. Conclusions Our RDCR programme failed to elicit significant changes in MB or sleep. To increase the likelihood of successful RDCR, it is important to promote a variety of exercise and PA options, target sedentary time, and apply theory to RDCR design, delivery, and support strategies.

Changes in Sleep of Families After the Arrival of an Autism Service Dog.

This study aimed to investigate the changes in sleep quality and quantity among families following the arrival of an autism service dog. We hypothesized that the sleep of the child or adolescent with autism spectrum disorder (assessed objectively with actigraphy and subjectively with a parent-reported sleep diary), and of both parents (assessed by self-reported diaries) would improve after the dog's arrival. The sleep of 18 youths (15 boys) aged from 5 to 16 years (M = 8.86), and of their parents (14 mothers, 11 fathers) was assessed for a 5- to 7-day period before (pretest) and eight to ten weeks after the dog's arrival (posttest). A designated parent (the same at the pretest and posttest) completed the sleep diary of the child, who wore an actiwatch in the meantime. Significant improvement in most sleep parameters was observed from pretest to posttest for the child and the mother, as reported in the sleep diaries. However, there was no improvement in the child's sleep when assessed objectively. Fathers' sleep duration increased after the dog's arrival, when adjusting for the child's age. All significant effects had medium to large sizes. This study provides the first quantitative evidence of the positive effect of autism service dogs on the sleep of families. These findings suggest that the dog's presence may increase the sense of safety for the child, who would resume sleeping faster or stay in the bedroom after nocturnal awakenings, leading to improved parents' sleep.

Systematic review of adherence to technology-based falls prevention programs for community-dwelling older adults: Reimagining future interventions.

Prevention programs, and specifically exercise, can reduce falls among community-dwelling older adults, but low adherence limits the benefits of effective interventions. Technology may overcome some barriers to improve uptake and engagement in prevention programs, although less is known on adherence for providing them via this delivery mode. We aimed to synthesize evidence for adherence to technology-based falls prevention programs in community-dwelling older adults 60 years and older. We conducted a systematic review following standard guidelines to identify randomized controlled trials for remote delivered (i.e., no or limited in-person sessions) technology-based falls prevention programs for community-dwelling older adults. We searched nine sources using Medical Subject Headings (MeSH) terms and keywords (2007-present). The initial search was conducted in June 2023 and updated in December 2023. We also conducted a forward and backward citation search of included studies. Two reviewers independently conducted screening and study assessment; one author extracted data and a second author confirmed findings. We conducted a random effects meta-analysis for adherence, operationalized as participants' completion of program components, and aimed to conduct meta-regressions to examine factors related to program adherence and the association between adherence and functional mobility. We included 11 studies with 569 intervention participants (average mean age 74.5 years). Studies used a variety of technology, such as apps, exergames, or virtual synchronous classes. Risk of bias was low for eight studies. Five interventions automatically collected data for monitoring and completion of exercise sessions, two studies collected participants' online attendance, and four studies used self-reported diaries or attendance sheets. Studies included some behavior change techniques or strategies alongside the technology. There was substantial variability in the way adherence data were reported. The mean (range) percent of participants who did not complete planned sessions (i.e., dropped out or lost to follow-up) was 14% (0-32%). The pooled estimate of the proportion of participants who were adherent to a technology-based falls prevention program was 0.82 (95% CI 0.68, 0.93) for studies that reported the mean number of completed exercise sessions. Many studies needed to provide access to the internet, training, and/or resources (e.g., tablets) to support participants to take part in the intervention. We were unable to conduct the meta-regression for adherence and functional mobility due to an insufficient number of studies. There were no serious adverse events for studies reporting this information (n = 8). The use of technology may confer some benefits for program delivery and data collection. But better reporting of adherence data is needed, as well as routine integration and measurement of training and skill development to use technology, and behavior change strategies within interventions. There may be an opportunity to rethink or reimagine how technology can be used to support people's adoption and integration of physical activity into daily life routines.

Comparing sleep measures in cancer survivors: self-reported sleep diary versus objective wearable sleep tracker.

Cancer survivors are increasingly using wearable fitness trackers, but it is unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB), and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon signed rank test, Spearman's rank correlation coefficients, and the Mann-Whitney test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but there were no differences measured byFitbit. TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.

COST ANALYSIS OF DIRECT ANTERIOR VERSUS DIRECT LATERAL APPROACH FOR OUTPATIENT TOTAL HIP ARTHROPLASTY

The increased demand for total hip arthroplasty (THA) is having a significant impact on healthcare resources, resulting in increased interest in outpatient care pathways to reduce resource consumption. This study compared costs between patients who underwent outpatient THA using a Direct Anterior (DA) approach compared to a Direct Lateral (DL) approach to understand the effect of surgical approach on resource use.We conducted a prospective randomized controlled trial for DA patients undergoing primary THA. We compared patients in the outpatient arm of the trial to a prospective cohort of outpatient DL approach THAs. We recorded all costs including: equipment, length of stay in hospital, and laboratory or other medical tests. Following discharge, participants also completed a self-reported cost diary recording resource utilization such as emergency department visits or subsequent hospitalizations, tests and procedures, consultations or follow-up, healthcare professional services, rehabilitation, use of pain medications, informal care, productivity losses and out of pocket expenditures.We report costs from both Canadian public health care payer (HCP) and a societal perspective. The HCP perspective includes any direct health costs covered by the publicly funded system. In addition to the health care system costs, the societal perspective also includes additional costs to the patient (e.g. physiotherapy, medication, or assistive devices), as well as any indirect costs such as time off paid employment for patients or caregivers.We included 127 patients in the DA group (66.6 years old) and 51 patients in the DL group (59.4 years old) (p&lt;0.01).There were no statistically significant differences in costs between groups from both the healthcare payer (DA= 7910.19, DL= 7847.17, p=0.80) and societal perspectives (DA= 14657.21, DL= 14581.21, p=0.96)In patients undergoing a successful outpatient hip replacement, surgical approach does not have an effect on cost from in hospital or societal perspectives.

Utilizing self-report diaries to explore task time distribution of school nurses in UAE.

This study aims to evaluate the roles and tasks of school nurses in the UAE, quantify the time spent on each, and identify areas for improvement in school health services. This aligns with the UAE government's initiative to enhance primary healthcare, focusing on illness prevention and health promotion for children and adolescents. The research adopts an observational study design, utilizing self-observation through diary recordings by school nurses to collect data on their daily tasks and time allocation. A sample of total of 2024 school nurse activities were recorded and analyzed over 126days and 1084h of observation by eight school nurses using self-report diaries. This method allowed for the collection of detailed information on how nursing time is allocated between core and noncore tasks. In this study a total of 2024 tasks were observed over 1084h. The findings reveal that core nursing tasks accounted for 78% of activities but only 53% of the total 1084h observed, while non-nursing tasks, making up 22% of activities, disproportionately consumed 47% of the hours. This discrepancy highlights the inefficiency of time allocation, with non-nursing tasks such as administrative duties taking significantly longer than core patient care tasks. The study highlights a significant opportunity to enhance school health services in the UAE by optimizing the allocation of nursing time towards more illness prevention and health promotion interventions. By addressing the identified challenges, including the gaps in nurse competencies and the lack of structured practice frameworks, school health services can be improved.

Can weekend catch-up sleep decrease the risk of cognitive dysfunction in older adults?

This study investigated whether weekend catch-up sleep was related to a decreased risk of cognitive dysfunction in older Taiwanese adults by using self-reported diaries and objective accelerometer measurements. This cross-sectional study enrolled participants who were aged ≥ 65 years and had the capability to walk independently from a medical center in Taipei City, Taiwan, between September 2020 and December 2022. Self-reported sleep diaries and tri-axial accelerometers were used to record and measure sleep-related data for 7 consecutive nights. Weekend catch-up sleep was defined as the mean of weekend sleep time minus the mean of weekdays sleep time. Mini-Mental State Examination (MMSE) was evaluated the risk of cognitive dysfunction. The association between weekend catch-up sleep and the MMSE score was examined using a binary logistic regression model. A total of 215 older adults (53.0% female; 80.5 ± 7.1 years old; 11.6% at risk of cognitive dysfunction) were included. In the adjusted model (adjusted for sex, education level, moderate-to-vigorous physical activity and total accelerometer wear time), both the self-reported sleep diaries (odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.09-0.69, P = 0.007) and the accelerometer data (OR = 0.27, 95% CI = 0.10-0.70, P = 0.007) indicated that weekend catch-up sleep could decrease the risk of cognitive dysfunction by 73-74%. The study findings suggest that there is an association between weekend catch-up sleep and lower risk for cognitive decline. The causal relationship between weekend catch-up sleep and cognitive function in older adults should be further investigated in a study with longitudinal design.

How accurate do self-reported seizures need to be for effective medication management in epilepsy?

Studies suggest that self-reported seizure diaries suffer from 50% under-reporting on average. It is unknown to what extent this impacts medication management. This study used simulation to predict the seizure outcomes of a large heterogeneous clinic population treated with a standardized algorithm based on self-reported seizures. Using CHOCOLATES, a state-of-the-art realistic seizure diary simulator, 100 000 patients were simulated over 10 years. A standard algorithm for medication management was employed at 3 month intervals for all patients. The impact on true seizure rates, expected seizure rates, and time-to-steady-dose were computed for self-reporting sensitivities 0%-100%. Time-to-steady-dose and medication use mostly did not depend on sensitivity. True seizure rate decreased minimally with increasing self-reporting in a non-linear fashion, with the largest decreases at low sensitivity rates (0%-10%). This study suggests that an extremely wide range of sensitivity will have similar seizure outcomes when patients are clinically treated using an algorithm similar to the one presented. Conversely, patients with sensitivity ≤10% would be expected to benefit (via lower seizure rates) from objective devices that provide even small improvements in seizure sensitivity.

Do Iranian Female Dancers Face a Risk of Chronic Negative Energy Balance? A Study on Energy Intake and Expenditure Among Non-professional Female Dancers

Background: Female dancers are at risk of negative energy balance and its adverse effects. However, there is no evidence regarding the energy balance of Iranian female dancers in the literature. Methods: In a cross-sectional study of 25 female nonprofessional dancers, dietary intake was assessed using self-reported food diaries and recall interviews on three different days: One dance day, one workday without dance, and one weekend day without dance. Nutrient intake was analyzed and converted into protein, carbohydrate, and fat components, and subsequently into energy equivalents. Total energy expenditure was calculated based on physical activity measurements taken on dance, work, and rest days. The average daily energy intake and expenditure over a 7-day period were then compared. Results: Significant daily energy deficiency was observed based on the average over 7 days (- 772.7 kcal +/- 450 kcal, P-value &lt; 0.05). Dancers consumed less protein and carbohydrates and more fat than the recommended daily values (P-value &lt; 0.05). Conclusions: It appears that Iranian female dancers suffer from negative energy balance and nutritional malpractice. This may be related to underlying eating disorders or perceptions of body image, as well as inadequate nutritional knowledge. Consulting experienced sports nutritionists and other necessary specialists is recommended.

Evidence for Simultaneous Muscle Atrophy and Hypertrophy in Response to Resistance Training in Humans.

Human skeletal muscle has the profound ability to hypertrophy in response to resistance training (RT). However, this has a high energy and protein cost and is presumably mainly restricted to recruited muscles. It remains largely unknown what happens with nonrecruited muscles during RT. This study investigated the volume changes of 17 recruited and 13 nonrecruited muscles during a 10-wk single-joint RT program targeting upper arm and upper leg musculature. Muscle volume changes were measured by manual or automatic 3D segmentation in 21 RT novices. Subjects ate ad libitum during the study and energy and protein intake were assessed by self-reported diaries. Posttraining, all recruited muscles increased in volume (range: +2.2% to +17.7%, P < 0.05), whereas the nonrecruited adductor magnus (mean: -1.5% ± 3.1%, P = 0.038) and soleus (-2.4% ± 2.3%, P = 0.0004) decreased in volume. Net muscle growth ( r = 0.453, P = 0.045) and changes in adductor magnus volume ( r = 0.450, P = 0.047) were positively associated with protein intake. Changes in total nonrecruited muscle volume ( r = 0.469, P = 0.037), adductor magnus ( r = 0.640, P = 0.002), adductor longus ( r = 0.465, P = 0.039), and soleus muscle volume ( r = 0.481, P = 0.032) were positively related to energy intake. When subjects were divided into a HIGH or LOW energy intake group, overall nonrecruited muscle volume (-1.7% ± 2.0%), adductor longus (-5.6% ± 3.7%), adductor magnus (-2.8% ± 2.4%), and soleus volume (-3.7% ± 1.8%) decreased significantly ( P < 0.05) in the LOW but not the HIGH group. To our knowledge, this is the first study documenting that some nonrecruited muscles significantly atrophy during a period of RT. Our data therefore suggest muscle mass reallocation, that is, that hypertrophy in recruited muscles takes place at the expense of atrophy in nonrecruited muscles, especially when energy and protein availability are limited.

Electronic Real-Time Monitoring Reveals Limited Adherence to Long-Term Opioid Prescriptions in Pain Patients.

Pain management physicians are increasingly focused on limiting prescription opioid abuse, yet existing tools for monitoring adherence have limited accuracy. Medication event monitoring system (MEMS) is an emerging technology for tracking medication usage in real-time but has not been tested in chronic pain patients on long-term opioid regimens. We conducted a pilot clinical trial to investigate the utility of MEMS for monitoring opioid adherence and compared to traditional methods including self-report diaries, urine drug screen (UDS), and physicians' opinions. Opioid-maintained chronic pain patients were recruited from a pain management clinic. Participants (n=28) were randomly assigned to either receive MEMS bottles containing their opioid medication for a 90-day period or to continue using standard medication bottles. MEMS bottles were configured to record and timestamp all bottle openings and the number of pills that were removed from the bottle (via measurement of weight change). Participants who received MEMS demonstrated highly heterogenous dosing patterns, with a substantial number of patients rapidly removing excessive amounts of medication and/or "stockpiling" medication. By comparison, physicians rated all participants as either "totally compliant" or "mostly compliant". UDS results did not reveal any illicit drug use, but 25% of participants (n=7) tested negative for their prescribed opioid metabolite. MEMS data did not correlate with physician-rated adherence (P=0.24) and UDS results (P=0.77). MEMS data consistently revealed greater non-adherence than self-report data (P<0.001). These results highlight the limits in our understanding of naturalistic patterns of daily opioid use in chronic pain patients as well as support the use of MEMS for detecting potential misuse as compared to routine adherence monitoring methods. Future research directions include the need to determine how MEMS could be used to improve patient outcomes, minimize harm, and aid in clinical decision-making. This study was preregistered on ClinicalTrials.gov (NCT03752411).