Identifying an Acceptable Number of Ambulatory Blood Pressure Measurements for Accuracy of Average Blood Pressure and Nocturnal Dipping Status.

OBJECTIVE: We aimed to identify the minimum number of ABP measures to accurately determine daytime and nighttime systolic BP averages and nocturnal dipping status (i.e., relative daytime:nighttime change). METHODS: Forty-three midlife participants wore an ABP monitor for 24 hours with measurements every 20/30 minutes during the daytime/nighttime, as identified by a sleep diary. We calculated daytime/nighttime systolic BP average and dipping status from all available measurements per participant (i.e., normative data). We then calculated daytime and nighttime BP per participant based on a random selection of 8-20 and 4-10 measurements and replicated random selections 1000 times. We calculated accuracy by checking the proportion from 1000 different randomly selected samples for a particular number of measurements that systolic BP was ±5 mmHg of normative data, and dipping status remained unchanged for each participant compared to the normative value. The best fit for the regression model estimated the minimal number of measurements for an accuracy of 95% in BP averages. RESULTS: For a 95% accuracy in estimating daytime and nighttime systolic BP, 11 daytime and 8 nighttime measurements were required. The highest accuracy for dipping status was 91.6±13.4% using 20 daytime and 10 nighttime measures, while the lowest was (83.4±15.1%) using 8 daytime and 4 nighttime measures. CONCLUSION: Eleven daytime and eight nighttime measurements are likely enough to calculate average systolic BPs accurately. However, no minimum number is suggested to accurately calculate dipping status.

Frequencies and spectra of aflatoxin B1-induced mutations in liver genomes of NEIL1-deficient mice as revealed by duplex sequencing.

Increased risk for the development of hepatocellular carcinoma (HCC) is driven by a number of etiological factors including hepatitis viral infection and dietary exposures to foods contaminated with aflatoxin-producing molds. Intracellular metabolic activation of aflatoxin B1 (AFB1) to a reactive epoxide generates highly mutagenic AFB1-Fapy-dG adducts. Previously, we demonstrated that repair of AFB1-Fapy-dG adducts can be initiated by the DNA glycosylase NEIL1 and that male Neil1-/- mice were significantly more susceptible to AFB1-induced HCC relative to wild-type mice. To investigate the mechanisms underlying this enhanced carcinogenesis, WT and Neil1-/- mice were challenged with a single, 4 mg/kg dose of AFB1 and frequencies and spectra of mutations were analyzed in liver DNAs 2.5 months post-injection using duplex sequencing. The analyses of DNAs from AFB1-challenged mice revealed highly elevated mutation frequencies in the nuclear genomes of both males and females, but not the mitochondrial genomes. In both WT and Neil1-/- mice, mutation spectra were highly similar to the AFB1-specific COSMIC signature SBS24. Relative to wild-type, the NEIL1 deficiency increased AFB1-induced mutagenesis with concomitant elevated HCCs in male Neil1-/- mice. Our data establish a critical role of NEIL1 in limiting AFB1-induced mutagenesis and ultimately carcinogenesis.

Chronological distribution of readings in ambulatory blood pressure monitoring exams affects the nighttime average and the magnitude of blood pressure dipping.

STUDY OBJECTIVES: Averaged nighttime blood pressure (BP) is superior to daytime BP for cardiovascular risk stratification, and the relative change between daytime/nighttime BP (dipping%) significantly predicts cardiovascular risk. Newer reports suggest that 4 measurements at night may be enough for cardiovascular risk stratification. Since BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. Therefore, we compared average nighttime BP and dipping% when using measurements in the first half (1st-half), second (2nd-half), and a combination of both (combined). METHODS: Forty-three (17 females and twenty-six males) midlife adults aged 50±10 years old wore an ambulatory BP monitor for 24 hours at home, programmed to measure BP every 20 minutes when scheduled for daytime and every 30 minutes during a self-selected 8-hour nighttime for time-in-bed. We compared the nighttime BP averages and dipping% when using either the first four measurements from the 1st-half or 2nd-half of the nighttime and combined. RESULTS: Nighttime Systolic BP was significantly different across 1st-half, 2nd-half, and combined (111±9 vs.107±11 vs. 109±9 mmHg, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each). Systolic BP dipping% was significantly different across 1st-half, 2nd-half, and combined (9.9±5.5 vs.13.5±6.4 vs. 11.7±5.0 %, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each. Diastolic BP and diastolic dipping% were similar across the three different bins. CONCLUSION: In midlife adults, systolic nighttime BP and dipping% may depend upon when BP measurements are taken during the night.

Describing Physical Activity Patterns of Truck Drivers Using Actigraphy.

Background: Truck driving is a highly sedentary occupation that places workers at risk for chronic health conditions, such as obesity and high blood pressure. The primary purpose of this study was to objectively describe truck drivers' typical physical activity (PA) patterns. Methods: We used ∼7-10-day baseline PA actigraphy data samples from drivers in the Safety & Health Involvement For Truckers (SHIFT) study (n = 394). Driver PA patterns (e.g., average number of ≥10 minute Freedson bouts per week, time in bouts, and common days/times for PA) were summarized with descriptive analyses. We also compared objective accelerometer data to self-reports. Results: Drivers' weekly PA averaged 14.4 minutes (SD = 37.0), and most PA occurred between 5-6 pm on Tuesdays and Wednesdays. Drivers overestimated self-reported weekly exercise by over 60 min/week compared to accelerometer data. Conclusion: Our results suggest that objective PA assessment may be warranted over self-report when possible, and timing may be key in future PA intervention work with truck drivers.

The Tech4Rest Randomized Controlled Trial: Applying the Hierarchy of Controls to Advance the Sleep, Health, and Well-being of Team Truck Drivers.

OBJECTIVE: The aim of the study was to evaluate the effectiveness of interventions to improve sleep, reduce fatigue, and advance the well-being of team truck drivers. METHODS: In a randomized controlled trial ( k = 24 teams; N = 49 drivers; 61.3% of planned sample), intervention teams were exposed to baseline (3-4 weeks), cab enhancements (active suspension seat, therapeutic mattress; 3-4 weeks), and cab enhancements plus a behavioral sleep-health program (1-2 months). Control teams worked as usual during the same period. RESULTS: Trends in sleep-related outcomes favored the intervention. Large and statistically significant intervention effects were observed for objectively measured physical activity (a behavioral program target). The discussion of results addresses effect sizes, statistical power, intervention exposure, and work organization. CONCLUSIONS: Trends, effect sizes, and significant findings in this rare trial provide valuable guidance for future efforts to improve working conditions and outcomes for team drivers.

Spontaneous allelic variant in deafness-blindness gene Ush1g resulting in an expanded phenotype.

Relationships between novel phenotypic behaviors and specific genetic alterations are often discovered using target-specific, directed mutagenesis or phenotypic selection following chemical mutagenesis. An alternative approach is to exploit deficiencies in DNA repair pathways that maintain genetic integrity in response to spontaneously induced damage. Mice deficient in the DNA glycosylase NEIL1 show elevated spontaneous mutations, which arise from translesion DNA synthesis past oxidatively induced base damage. Several litters of Neil1 knockout mice included animals that were distinguished by their backwards-walking behavior in open-field environments, while maintaining frantic forward movements in their home cage environment. Other phenotypic manifestations included swim test failures, head tilting and circling. Mapping of the mutation that conferred these behaviors showed the introduction of a stop codon at amino acid 4 of the Ush1g gene. Ush1gbw/bw null mice displayed auditory and vestibular defects that are commonly seen with mutations affecting inner-ear hair-cell function, including a complete lack of auditory brainstem responses and vestibular-evoked potentials. As in other Usher syndrome type I mutant mouse lines, hair cell phenotypes included disorganized and split hair bundles, as well as altered distribution of proteins for stereocilia that localize to the tips of row 1 or row 2. Disruption to the bundle and kinocilium displacement suggested that USH1G is essential for forming the hair cell's kinocilial links. Consistent with other Usher type 1 models, Ush1gbw/bw mice had no substantial retinal degeneration compared with Ush1gbw /+ controls. In contrast to previously described Ush1g alleles, this new allele provides the first knockout model for this gene.

COMMunity of Practice And Safety Support for Navigating Pain (COMPASS-NP): study protocol for a randomized controlled trial with home care workers.

BACKGROUND: Chronic pain is a prevalent and costly problem that often has occupational origins. Home care workers (HCWs) are at high risk for work-related injuries, pain, and disability. Current treatments for chronic pain emphasize medications, which are an inadequate stand-alone treatment and can produce significant adverse effects. METHODS: In this translational study, we will adapt an established work-based injury prevention and health promotion program (COMmunity of Practice And Safety Support: COMPASS) to address the needs of HCWs experiencing chronic pain. COMPASS employs peer-led, scripted group meetings that include educational content, activities, goal setting, and structured social support. The translated intervention, named COMPASS for Navigating Pain (COMPASS-NP), will be delivered in an online group format. Safety protections will be strengthened through an ergonomic self-assessment and vouchers for purchasing ergonomic tools. Educational content will integrate a self-management approach to chronic pain using proven cognitive-behavioral therapy (CBT) principles. We will use a mixed-methods hybrid type 2 evaluation approach to assess effectiveness and implementation. A cluster-randomized waitlist control design will involve 14 groups of 10 HCWs (n = 140) recruited from Washington, Oregon, and Idaho. Half of the groups will be randomly selected to complete the intervention during the first 10 weeks, while the waitlist groups serve as controls. During weeks 10-20, the waitlist groups will complete the intervention while the original intervention groups complete a follow-up period without further intervention. Our primary hypothesis is that COMPASS-NP will reduce pain interference with work and life. Secondary outcomes include injury and pain prevention behaviors, pain severity, changes in medication use, risk for opioid misuse, well-being, physical activity, and sleep. Qualitative data, including phone interviews with group facilitators and organizational partners, will evaluate the implementation and guide dissemination. DISCUSSION: The results will advance the use and knowledge of secondary prevention interventions such as ergonomic tools and cognitive behavior therapy, to reduce injury, pain, and disability and to encourage appropriate uses of analgesic medications among HCWs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05492903. Registered on 08 August 2022.

Resting coronary flow drives the daily pattern in coronary flow reserve in patients with chest pain without obstructive epicardial stenosis.

Objectives: Ischemia with no obstructive coronary artery disease (INOCA) is a risk factor for major adverse cardiovascular events and is characterized by abnormal coronary microvascular tone. In patients with INOCA, adverse cardiovascular events most commonly occur in the morning compared to other times of the day and night. Materials and methods: We tested whether coronary microvascular function varies diurnally with attenuation in the morning in patients with symptomatic coronary artery disease without significant (>50%) epicardial stenosis. We evaluated data from 17 patients studied in the AM (700-1159 h) and 11 patients in the PM (1200-1800 h). Coronary microvascular function was measured using perfusion contrast imaging at rest and after infusion of intravenous regadenoson. We calculated microvascular flow reserve as the ratio of hyperemic to resting flow. Along with independent sample t-tests, we performed bootstrapping procedures to test mean differences between AM and PM groups, using the bias-corrected and accelerated method with 5,000 bootstrapped samples. Results and conclusion: The AM and PM groups were matched for demographic and existing risk factors. Coronary microvascular flow reserve was ∼33% higher in the AM compared to the PM (P = 0.025, BCa 95% CI [0.25, 1.64]; Hedge's g = 0.89, 95% CI [0.11, 1.66]) as a result of significantly lower resting flow (∼50%) in the AM compared to the PM (P = 0.03, M Diff = -56.65, BCa 95% CI [-118.59, -2.12]; Hedge's g = -0.86, 95% CI [-1.60, -0.06]). Our observations are of clinical value and can influence diagnosis and treatment in the clinic based on the time of day of measurements.

Primary Prevention of Weight Gain Among New Bus Operators: Results of the "Success & Health Impacts For Transit operators during Onboarding" (SHIFT Onboard) Pilot Study.

OBJECTIVE: This study aimed to test the feasibility and efficacy of an enhanced onboarding intervention to prevent weight gain and support the early job success of new bus operators. METHODS: Control participants ( n = 9) completed usual practice new employee training and onboarding. Intervention participants ( n = 14) completed five supplemental trainings and four online challenges during their first year. Primary outcomes were body weight, dietary behaviors, physical activity, and sleep duration/quality. Early job success was evaluated with measures of newcomer adjustment. RESULTS: The difference between intervention and control participants in body weight change at 12-month was -6.71 lb (Cohen's d = -1.35). Differences in health behavior changes were mixed, but newcomer adjustment changes favored the intervention group. CONCLUSIONS: Results support the feasibility of enhanced onboarding for bus operators to prevent worsening health while simultaneously advancing their success as new employees.

The circadian system modulates the cortisol awakening response in humans.

Background: In humans, circulating cortisol usually peaks 30-60 min after awakening from nocturnal sleep, this is commonly referred to as the cortisol awakening response (CAR). We examined the extent to which the CAR is influenced by the circadian system, independent of behaviors including sleep. Materials and methods: We examined the CAR in 34 adults (20 female) using two complementary multiday in-laboratory circadian protocols performed in dim light, throughout which behavioral factors were uniformly distributed across the 24-hour circadian cycle. Protocol 1 consisted of 10 identical consecutive 5-hour 20-minute sleep/wake cycles, and protocol 2 consisted of 5 identical consecutive 18-hour sleep/wake cycles. Salivary melatonin was used as the circadian phase marker (0° = dim light melatonin onset). During each sleep/wake cycle, salivary cortisol was measured upon scheduled awakening and 50-minutes later, with the change in cortisol defined as the CAR. Cosinor analyses were used to detect any significant circadian rhythmicity in the CAR. In secondary analyses, we adjusted the models for time awake before lights on, total sleep time, percent of rapid eye movement (REM) sleep, and percent of non-rapid eye movement (NREM) sleep. Results: Both protocols revealed a similar circadian rhythm in the CAR, with peaks occurring at a circadian phase corresponding to 3:40-3:45 a.m., with no detectable CAR during the circadian phases corresponding to the afternoon. In addition to the sinusoidal component of the circadian rhythm, total sleep time was also associated with the CAR for protocol 1. The percent of sleep spent in REM or NREM sleep were not associated with the CAR in either protocol. Conclusion: Our results show that the CAR exhibits a robust circadian rhythm that persists even after adjusting for prior sleep. Presuming that the CAR optimizes physiological responses to the anticipated stressors related to awakening, these findings may have implications for shift workers who wake up at unusual circadian phases. A blunted CAR in shift workers upon awakening in the evening may result in diminished responses to stressors.

Cross-Cultural Measurement of Positive and Negative Emotions in Adolescence: Evidence from Three Countries.

Cross-cultural assessment of affective well-being among adolescents has received scarce attention in positive psychological research. The present study investigated cross-cultural measurement invariance of the Scale of Positive and Negative Experience (SPANE) among adolescents from three countries (India, Poland, and Serbia). The sample included a total of 1080 adolescents (53.6% female; M age = 16.75, range = 15-19 years). Surveys were administered online in each country. Measurement invariance testing provided evidence for partial scalar invariance of the SPANE across cultures, with item "afraid" showing nonivariance across the three countries. Latent factor correlations between positive and negative emotions were stronger in Serbia compared to Poland and India. Positive emotions and life satisfaction had strong positive associations in all three countries (ranging from 0.68 to 0.75). The inverse correlations between negative emotions and life satisfaction were - 0.27, - 0.54, - 0.69 in India, Poland, and Serbia, respectively. Polish adolescents demonstrated the lowest levels of affective well-being, whereas Indian and Serbian adolescents did not differ substantially in levels of positive and negative emotions. The present study demonstrated that the SPANE is a reliable and useful tool for the assessment of positive and negative emotions among adolescents from different cultural settings. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-022-00521-6.

The Impact of COVID-19 on Transit Workers: Perceptions of Employer Responses and Associations with Health Factors.

COVID-19 has had a substantial impact on transit workers' lives, especially among public-facing vehicle operators. The current project examined relationships between workers' knowledge and perceptions of their employer's COVID-19 safety responses, job attitudes, and health. We surveyed transit workers (N = 174) between July and August 2020 and followed up 3 months later. Fifty-seven workers responded to the follow-up survey. Surveys addressed workers' knowledge and perceptions of their employer implementing Centers for Disease Control and Prevention (CDC)-recommended COVID-19 safety responses, COVID-19 risk perceptions, job attitudes, and health factors. Employees reported knowledge of their employer implementing ~8 of 12 CDC-recommended responses. The most reported response was informational poster placements; the least reported was designating a point-person for COVID-19 concerns. Significant associations were found between knowledge of employer safety responses and lower COVID-19 risk perceptions, better job attitudes, and greater mental and global health. Operators (i.e. public-facing workers) reported worse perceptions of employer responses, and higher COVID-19 risk perceptions, work stress, and turnover intentions, compared with non-operators. A time-lagged panel model found that COVID-19 risk perceptions significantly mediated the relationship between public-facing work status and follow-up depression, anxiety, stress, and global health. Results reveal opportunities for transit authorities to broaden and better communicate their responses to emergent occupational safety and health crises.

Measurement Invariance of the Scale of Positive and Negative Experience Across 13 Countries.

The Scale of Positive and Negative Experience (SPANE) is widely used to measure emotional experiences, but not much is known about its cross-cultural utility. The present study evaluated the measurement invariance of the SPANE across adult samples (N = 12,635; age range = 18-85 years; 58.2% female) from 13 countries (China, Colombia, Germany, Greece, India, Italy, Japan, Poland, Portugal, Serbia, Spain, Turkey, and the United States). Configural and partial scalar invariance of the SPANE were supported. Three items capturing specific negative emotions (sad, afraid, and angry) were found to be culturally noninvariant. Our findings suggest that the SPANE's positive emotion terms and general negative emotion terms (e.g., negative and unpleasant) might be more suitable for cross-cultural studies on emotions and well-being, whereas caution is needed when comparing countries using the SPANE's specific negative emotion items.

Bus Operators' Body Weight Changes During Their First 2 Years of Work: A Retrospective Survey.

OBJECTIVE: To empirically assess retrospective reports of weight changes during bus operators' first years on the job, and to investigate experienced and desired training topics for new operators. METHODS: Bus operators (n = 261) completed an online survey on topics of early weight changes and training experiences. RESULTS: Operators reported gaining an average of 7.64 lb (SD = 16.36) during their first year. Further weight gain was not reported during the second year. Most operators reported that health-related topics were not addressed during their initial training. Stress management and healthy eating were the operators' two most desired topics to be included in their initial training. CONCLUSION: Bus operators reported medically meaningful weight gain during their first year of work and a desire for more health-related training. Objective research to document the magnitude of this hazard, and contributing working conditions, is needed.

Exploring biopsychosocial correlates of pain, pain management strategies, and risk for opioid misuse among home care workers in Washington State.

Home care workers (HCWs) are at high risk for musculoskeletal pain and injury, and they are an important population for pain management research and intervention. The purpose of this study was to gather novel data on HCWs' work characteristics, pain experiences, pain management strategies, and risk for opioid misuse. A survey invitation was e-mailed to a random sub-sample of HCWs in Washington State, and 421 responded. Over half (54.2%) reported chronic or currently elevated pain. Pharmacological pain management strategies were used by 67.3% of all respondents with 4.8% reporting prescription opioid use. Biopsychosocial factors like injuries, interpersonal conflict, financial strain, and anxiety were associated with increased opioid misuse risk. Multimodal primary and secondary interventions are recommended to improve HCWs' pain management.

Advancing the Safety, Health, and Well-Being of Commercial Driving Teams Who Sleep in Moving Semi-Trucks: The Tech4Rest Pilot Study.

OBJECTIVE: To test the feasibility, acceptability, and potential effectiveness of engineering and behavioral interventions to improve the sleep, health, and well-being of team truck drivers (dyads) who sleep in moving semi-trucks. METHODS: Drivers (n = 16) were exposed to Condition A: a new innerspring mattress, and Condition B: a novel therapeutic mattress. A subsample of drivers (n = 8) were also exposed to Condition C: use of their preferred mattress (all chose to keep B), switching to an active suspension driver's seat, and completing a behavioral sleep-health program. Primary outcomes were sleep duration, sleep quality, and fatigue. Behavioral program targets included physical activity and sleep hygiene. RESULTS: Self-reported sleep and fatigue improved with mattress A, and improved further with mattress B which altered vibration exposures and was universally preferred and kept by all drivers. Condition C improved additional targets and produced larger effect sizes for most outcomes. CONCLUSIONS: Results support these interventions as promising for advancing team truck drivers' sleep, health, and well-being.

Challenging Aggressive Behaviors Experienced by Personal Support Workers in Comparison to Home Care Workers: Relationships between Caregiver Experiences and Psychological Health.

Personal support workers (PSW) are caregivers for children and adults with intellectual and developmental disabilities (IDDs) or adults experiencing mental illness or other behavioral health conditions. The work can be very meaningful, but many PSWs must prepare for, monitor, and manage challenging behaviors, including aggression. This study was designed to estimate the prevalence of aggression experienced by PSWs in Oregon, and compare it to a previous sample of Oregon home care workers (HCWs). This comparison included an analysis of relationships between exposures to aggression and psychological health factors. PSWs in Oregon (N = 240) were surveyed electronically at a single time point. PSWs generally reported higher rates of exposure to aggression compared to HCWs. Experiences with aggression were positively associated with fatigue and weakly associated with depression, but not stress. PSWs' self-reported lost work time injury rate was elevated compared to the US average, but it was comparable to previous self-reported injury rates from HCWs. Physical demands of work were the most prevalent reported primary safety concern, followed by challenging behaviors (including aggression). Developing tailored training to help PSWs understand, plan for, minimize, and manage challenging behaviors is a social priority.