Sleep disturbance as a clinical sign for severe hypogonadism: efficacy of testosterone replacement therapy on sleep disturbance among hypogonadal men without obstructive sleep apnea

Objective: The present subanalysis of the EARTH study investigates the effects of one year testosterone replacement therapy (TRT) on sleep disturbance among hypogonadal men without obstructive sleep apnea.

Methods: Sleep disturbance was defined as three or more points in question 4 of the aging males symptoms (AMS) questionnaire. All participants completed the AMS scale, International Prostatic Symptoms Score (IPSS), Sexual Health Inventory for Men (SHIM) and Short Form 36 (SF-36) health survey at baseline and after 12?months. Sexual symptoms were also evaluated based on three AMS subscores (Q15, 16 and 17).

Results: We identified 100 patients with sleep disturbance, of whom 48 (24 each in the TRT and control groups) were ultimately included for analysis. All SF-36 categories , AMS scale, IPSS and SHIM score subdomains were significantly worse in patients with sleep disturbance than in those without disturbance. Statistically significant differences in sleep disturbance, erectile symptoms, sexual desire and some domains of the SF-36 were observed between the TRT and control groups after 12?months.

Conclusion: Sleep disturbance may be one of the clinical signs for severe hypogonadism. Moreover, TRT improved sleep conditions, sexual function and quality of life among hypogonadal men with sleep disturbance.     

Effect of Increased Time Spent Outdoors on Individuals with Dementia Residing in Nursing Homes

SUMMARY

There is growing evidence that exposure to bright light may improve circadian rhythms in individuals with dementia residing in shared residential settings. The vast majority of this research uses electric bright light boxes. However, the outdoor environment not only provides exposure to bright light but to natural elements which have been shown to have a restorative effect across a broad range of situations. Previous research that sought to explore the impact of time spent outdoors on sleep and/or agitation in individuals with dementia was hampered by low time spent outdoors. This project, conducted in three nursing homes (n = 17), used actigraphy, validated proxy measures of sleep and agitation and direct observation to explore the impact of increased time outdoors on sleep and agitation. The repeated measures design assessed residents with dementia under four conditions: winter/no activity, winter/inside activity, summer/no activity and summer/outside activity. Results suggest that increased time spent outdoors resulted in a modest improvement in sleep, and mixed or immeasurable impact on agitation.     

Outdoor Environments at Three Nursing Homes

Abstract

This study investigated how the outdoor environments at nursing homes for older persons were experienced and used to gain knowledge with implications for design. Focus group methodology was used to explore staff's view of how the residents experienced and used the outdoors. Two main themes and ten sub-themes were the result when the focus group interviews were analyzed. Theme one, being comfortable in the outdoor environment, describe the residents' special needs to be able to and dare to use the outdoors. The theme suggests a precautionary design, which promotes security and safety and protects from disturbance and negative impressions. The second main theme, access to surrounding life, describes the residents' needs for change and variety in the everyday situation and suggests an inspiring design, which promotes stimulation of senses and mind and provides positive impressions.     

Effects of a sleep hygiene text message intervention on sleep in college students

Objective: To test the effectiveness of a text-message intervention to promote sleep hygiene to improve sleep in young adult college students. Participants: A convenience sample of undergraduate students from one Southwestern university (n = 96), 18–26 years old, recruited in August 2015. Methods: A 2-group pretest-posttest experimental design assigned participants to receive biweekly text messages about sleep hygiene or healthy behaviors for 6 weeks. Survey questions addressed sleep knowledge, sleep hygiene, self-efficacy for sleep hygiene, and sleep quality at baseline and posttest. Results: Though not significant, sleep quality, sleep hygiene, and sleep knowledge improved in both groups. Conclusions: Self-efficacy for sleep hygiene is a modifiable factor that may serve to improve sleep quality. Sleep quality improved in both groups. Text messaging is a feasible approach to delivering an intervention to promote healthy behaviors among young adults.     

The effects of a pedometer-based intervention on first-year university students: A randomized control trial

ABSTRACT

Objectives: To assess the effects of a 12-week pedometer-based intervention on the physical activity behavior, health-related quality of life (HRQOL), and psychological well-being of first-year university students. Participants: First-year university students (N = 184) were recruited during September 2012 and randomly assigned to an intervention or a control group. Methods: Intervention participants were provided with a pedometer, monthly tracking logs, and follow-up e-mails. Control participants received no intervention. Physical activity, HRQOL, and psychological well-being were measured at baseline and post intervention. Data were analyzed using multivariate/univariate analysis of variance (MANOVA/ANOVA). Results: All participants experienced an increase in mild physical activity (p < .01) from baseline to follow-up. The intervention failed to produce significant differences between groups for physical activity (p = .28), HRQOL (p = .80), or psychological well-being (p = .72). Psychological well-being (p < .001), vigorous physical activity (p = .04), and mental health status (p < .001) decreased across the duration of the study. Conclusions: More intensive interventions may be required to elicit physical activity behavior change.     

The relationship between sleep and autonomic health

Abstract

Objective: To examine the relationship between sleep and resting autonomic nervous system (ANS) functioning in college students. Participants: Participants were 141 undergraduate students (52 males) recruited from a large southeastern university during September–October 2017. Methods: Participants completed self-report inventories (demographic and sleep characteristics). Resting state skin conductance (SC) and heart rate variability (HRV) were measured in a laboratory setting for ANS functioning. Results: SC was positively associated with sleep quality (p?=?0.027), sleep latency (p?=?0.040), and use of sleep medication (p?<?0.001). Analyses yielded a negative association between the standard deviation of the normal-normal interval of heart beats (SDNN) and the self-reported amount of time to fall asleep each night (p?=?0.041). Sleep efficiency was negatively correlated with low frequency HRV (p?=?0.002). Conclusions: Sleep components are associated with resting ANS activity, and targeted interventions focused on improved ANS functioning may benefit sleep quality in college students.     

Presence and Visibility of Outdoor and Indoor Physical Activity Features and Participation in Physical Activity Among Older Adults in Retirement Communities

Abstract

In this paper we examine how the presence and visibility of outdoor and indoor physical activity resources (e.g., walking path/ trail, outdoor tennis courts, gardens, etc.) influences participation in physical activity among elderly residents in non-profit continuing care retirement communities and other senior housing communities. This paper reports findings from a survey of 800 such communities. A social ecological model was used to study the relationships between the environment and physical activity behavior. A fifty-two percent response rate (n = 398) was obtained. Campuses with more attractive outdoor and indoor physical activity facilities had more residents participating in different types of physical activity.     

The Receptlveness of Health Risk Appraisals in Health Instruction

Abstract

Objectives: Data on effective strategies to enforce policies banning outdoor smoking are sparse. This study tested the effects of an enforcement package implemented on a college campus. Participants: Thirty-nine observers recorded compliance of 709 outside smokers. Methods: Smoking within 25 feet of buildings was noncompliant. The intervention included moving receptacles, marking the ground, improving signage, and distributing reinforcements and reminder cards. Results: The proportion of smokers complying with the ban was 33% during the baseline observation period, increased to 74% during the intervention week, and was at 54% during the follow-up. Differences across conditions was statistically significant (χ² (2, N = 709) = 6.299, p <.001). Compliance proportions varied by location in all conditions. Conclusions: Enforcing an outdoor smoking ban using a multiple component package increased compliance with the nonsmoking policy on a college campus.     

Effects of testosterone replacement therapy on nocturia and quality of life in men with hypogonadism: a subanalysis of a previous prospective randomized controlled study in Japan

Abstract

Objective: We investigated the effects of testosterone replacement therapy (TRT) on nocturia and general health among men with hypogonadism and nocturia.

Methods: From our previous EARTH study population, 64 patients with a clinical diagnosis of nocturia (two or more times per one night) and hypogonadism, comprising the TRT group (n?=?31) and controls (n?=?33), were included in this analysis. The TRT group was administered 250?mg of testosterone enanthate as an intramuscular injection every 4 weeks for 6 months. All patients responded to the following questionnaires: International Prostatic Symptoms Score (IPSS), Aging Male Symptoms (AMS) score and Short Form-36 health survey at baseline and 6-month visit. These categories were compared based on changes from baseline to the 6-month visit between TRT and control groups.

Results: At the 6-month visit, the TRT group had a significant decrease in IPSS question no. 7 and AMS question no. 4, whereas no significant changes were observed in the control group. Additionally, role limitation because of health program, vitality and mental health domains were significantly improved in the TRT group.

Conclusions: Six-month TRT may improve nocturia, sleep conditions and quality of life among men with hypogonadism and nocturia.     

Designing Successful Gardens and Outdoor Spaces for Individuals with Alzheimer's Disease

SUMMARY

There are many benefits derived from exposure to the outdoors for older adults with Alzheimer's disease, which include exposure to fresh air, sunlight and opportunities for walking and other forms of exercise. There are also opportunities for socialization that can minimize feelings of isolation and vulnerability, improve depression, enhance self-esteem, and simply experience the joys and surprises of nature.

While there seems to be universal agreement of the health and quality of life benefits in getting institutionalized persons into appropriate outdoor settings, in many ways gardens and outside spaces have failed. Time after time visitors stroll through the gardens admiring the landscaped grounds, the abundance of beautiful and fragrant flowers and other features, while noting the absence of residents.

Creditable research studies support the health benefits of exposure to the outdoors and nature. This discussion of design issues, barriers to use, the role of activity, the necessity of staff involvement, and design recommendations supports the urgent need for empirical research to inform the development of effective gardens and outdoor spaces to benefit older adults with Alzheimer's disease.     

My Student Body: Effects of an Internet-Based Prevention Program to Decrease Obesity Among College Students

Abstract

Objective: To determine the impact of My Student Body (MSB)–Nutrition, an Internet-based obesity prevention program for college students. Participants: Three hundred and twenty ethnically diverse undergraduate students were randomly assigned to 1 of 3 conditions: MSB-Nutrition program, an on-campus weight management course, and a comparison group. Methods: Students completed baseline and follow-up surveys regarding their nutrition and physical activity behaviors, self-efficacy, stress, attitudes, and body weight. Results: Compared with the on-campus course and a comparison group, the MSB-Nutrition program increased fruit and vegetable consumption, reduced stress, and increased fruit and vegetable self-efficacy but had no significant effect on students’ exercise self-efficacy, exercise behavior, or weight loss. Conclusions: The MSB-Nutrition program was effective in changing students’ nutrition behaviors but had no effect on physical activity behaviors or weight loss. Suggestions for improving Internet-based interventions aimed at decreasing obesity rates among college students are offered.     

The State of Sleep Among College Students at a Large Public University

Abstract

Objective: Data about college student sleep were collected and used to develop an education campaign to improve sleep. Participants: On-campus residents at a large state university were surveyed on 4 occasions, October 2005 to April 2007. Sample size was 675 to 1,823 students. Fall 2005 mean age = 18.5 years, SD = 1.03 (range 18–30) years. Initial survey included 935 males and 1,859 females (2005–2006). Matched pairs data (2006–2007) included 91 males and 107 females. Twenty-six males and 22 females participated in interviews. Methods: A survey administered online included the Pittsburgh Sleep Quality Index, along with an 8-question in-person interview. Results: Poor sleep interacted with academics and mental health, and an education campaign positively affected student sleep. Conclusions: Teaching students how to effectively manage sleep can improve their well-being. Sleep may also be a gateway topic for health care professionals to address sensitive health issues such as depression.     

A Population-Wide Screening and Tailored Intervention Platform for Eating Disorders on College Campuses: The Healthy Body Image Program

Abstract

Objectives: This article presents a new approach to intervention for eating disorders and body image concerns on college campuses, using a model of integrated eating disorder screening and intervention. Formative data on implementation feasibility are presented. Participants: College students enrolled at 2 universities between 2011 and 2012. Methods: The Healthy Body Image program is an evidence-based screening and intervention platform, enacted via community and online resources. An online screen was used to identify students at varying levels of risk or eating disorder symptom status; responses were used to direct students to universal or targeted online interventions or further evaluation. Universal prevention programs to improve healthy weight regulation and body image culture were offered to all students. Results: Formative data from 1,551 students illustrates the application of this model. Conclusions: The Healthy Body Image program is feasible to deliver and provides a comprehensive system of screening, evidence-based intervention, and community culture change.     

Prevalence of Insomnia and Its Psychosocial Correlates Among College Students in Hong Kong

Abstract

Objective: This study examined the prevalence of insomnia and its psychosocial correlates among college students in Hong Kong. Participants: A total of 529 Hong Kong college students participated in the study. Methods: Participants completed a self-reported questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), the Revised Life Orientation Test, the Perceived Stress Scale, and the Beck Depression Inventory, and questions about sociodemographic and lifestyle factors. A PSQI global score equal to or greater than 5 indicated insomnia. Results: Results indicated that 68.6% of the participants were insomniacs. Adjusted regression analyses revealed that optimism, stress, and depression significantly predicted insomnia (p < .01). Conclusions: These results suggest that insomnia is very common among Hong Kong college students and associated with other psychosocial factors. This study provides preliminary data on sleep quality and risk factors for insomnia, which may be used to guide sleep hygiene promotion and intervention among college students.     

Improving body image and sexual health behaviors among college women

ABSTRACT

Objective: To conduct a pilot test to determine if the Body Project, an eating disorder prevention program, was able to reduce risky sexual behaviors. Participants: Twenty college-age women ages 18–21 (in March, 2015) who endorsed both body image dissatisfaction and previous or current sexual activity. Methods: Participants were randomized to the Body Project or psychoeducational control group, and completed baseline, post-test, and 6-month follow-up measures assessing body image concerns, eating behaviors, and sexual behaviors and attitudes. Results: An intervention manipulation check demonstrated that body image variables were in expected directions, though were not significant by group. There was a significant interaction across group and time for “unanticipated sexual encounters,” which decreased in the Body Project group. Conclusions: This pilot study supports the feasibility of using an eating disorder prevention program to reduce other risky behaviors, specifically risky sexual behaviors.     

Measures of Restoration in Geriatric Care Residences

Abstract

In this paper, we have studied how elderly people's frame of mind influences their response to experiencing nature, measured in terms of blood pressure, pulse rate, concentration and results from protocols. Two theories concerning the importance of psychological balance have been put forward earlier by Lawton and Kiiller, both of whom maintain that the surrounding everyday environment is one of the keys to a harmonious existence. We present findings supporting the theory that the positive experience of natural surroundings per se has a balancing and healing effect.

We have found that the people most affected by their surroundings are those with the greatest psycho-physiological imbalance. When the balance tilts, the balancing effect of the green experience can restore the individual to a state of better harmony. Time spent in the outdoors is, thus, especially important for individuals who easily lose their equilibrium or find it difficult to make compensatory changes to restore harmony on their own.

The research project is an intervention study in which fifteen elderly individuals living at a home for very old people participated. Their power of concentration, blood pressure and heart rate were measured before and after an hour of rest in a garden and in an indoor setting, respectively. Seven elderly people were randomly chosen to have their first series of tests in a garden, while eight elderly people had their first series of tests indoors. The results indicate that power of concentration increases for very old people after a visit in a garden outside the geriatric home in which they live, as compared to resting indoors in their favorite room.

The results did not show any effects on blood pressure or heart rate.

However, when we compared these results with the background variables, we found interesting correlations. Background variables included how often they took part in social activities, showed helpfulness toward other residents in group activities and tolerance/critique of other residents. After a factor analysis, the background variables formed three distinct factors, one of which showed significant correlation with blood pressure and heart rate: the factor psycho-physiological balance, with the variables “degree of tolerance,” “degree of helpfulness” and “frequency of hospital visits.” Elderly people with low psycho-physiological balance, that is, who had low tolerance of other residents, were not helpful in group activities and had a high frequency of hospital visits, were most affected by a stay in a garden, as could be measured in changes in heart rate and blood pressure. The results may be interpreted as showing that a garden can restore an elderly person with low psycho-physiological balance to a state of better harmony.

The present study show, first, that an outdoor visit is important for recovery from stress and fatigue and, second, that the improvement is especially significant for the most susceptible. Thus, it is of particular importance that weak groups, such as elderly in great need of care, have access to an outdoor space. Such groups are likely to include many people who are in psycho-physiological imbalance.     

Sleep Quality and Alcohol Risk in College Students: Examining the Moderating Effects of Drinking Motives

Abstract

Objective: Sleep problems and alcohol misuse are common issues experienced by college students that can have detrimental effects on overall health. Previous work indicates a strong relationship between poor sleep quality and alcohol risk in this population. This study explored the moderating effect of drinking motives in the relationship between global sleep quality and experience of alcohol-related negative consequences. Participants: College students (N = 1,878) who reported past-month drinking. Methods: Participants completed online surveys assessing sleep and alcohol-related behaviors. Results: Poorer sleep quality and higher drinking motives (coping, conformity, and enhancement) predicted greater alcohol-related consequences, controlling for drinking. Further, coping motives moderated the relationship between sleep quality and consequences such that participants reporting poor sleep and high coping motives experienced heightened levels of consequences. Conclusions: These findings advance the understanding of the relationship between sleep problems and alcohol-related risk and provide implications for targeted campus-based health promotion interventions.     

Maternal Mental Health,Neighborhood Characteristics,and Time Investments in Children

We use data from the Fragile Families and Child Wellbeing Study (N = 3,572) to examine relationships between maternal depression and mothers' time investments with their 5‐year‐old children in outings, trips to playgrounds or parks, time spent reading with the child, and time spent playing indoors with the child. We also examine whether mothers' self‐assessments of neighborhoods are associated with time investments in children. Findings indicate that persistent maternal depression is associated with fewer time investments in all four activities with 5‐year‐old children. Mothers' fear of children playing outdoors and self‐assessments of neighborhood collective efficacy are associated with indoor and outdoor activities with children, but do not mediate the relationships between maternal depression and maternal time investments. In sum, maternal depression and neighborhood context play significant but largely independent roles in regulating mothers' time spent in primary child‐care activities.     

Collaborative Family Work in Youth Justice

ABSTRACT

A number of studies have found that working with family groups can be successful in improving outcomes for young people and their families. This article reports on a study in New South Wales in which juvenile justice staff offered collaborative family work interventions to young people as part of the routine offerings of a juvenile justice service. The primary objective of this study was to examine the extent to which young people who completed the family work had lower recidivism rates compared to three control groups. The methods included a comparison of recidivism rates between young people who completed the intervention, those who failed to complete, those who declined, and a matched sample of young people who were not offered the intervention. The results of the study indicated that many young people and their families were agreeable to be involved in the intervention and the completion rates were high, particularly if the work was undertaken in the family home. The young people who completed the intervention also had lower recidivism rates than young people in each of the control groups.

IMPLICATIONS

• Collaborative family work can be offered successfully by juvenile justice services to young offenders and their families.

• Collaborative family work can reduce recidivism rates for those who complete the intervention.

• It is preferable to conduct the work in the family home where completion rates are likely to be higher.