The effect of a change in sleep-wakefulness timing, bright light and physical exercise interventions on 24-hour patterns of performance, mood and body temperature.

Experiments consisting of baseline, bright light and physical exercise studies were carried out to compare the effect of a 9-hour delay in sleep-wakefulness timing, and the effects of bright light and physical exercise interventions on 24-hour patterns of performance, mood and body temperature were examined. Each study comprised a 24-hour constant routine at the beginning followed by 3 night shifts and 24-hour constant routine at the end. Performance on tasks differing in cognitive load, mood and body temperature was measured during each constant routine and the interventions were applied during the night shifts. The 24-hour pattern of alertness and performance on the tasks with low cognitive load in post-treatment conditions followed the change in sleep-wakefulness timing while more cognitively loaded tasks tended to show a reverse trend when compared to pre-treatment conditions. There was a phase delay around 4 hours in circadian rhythms of body temperature in post-treatment conditions.

Superficial contamination of bovine carcasses by Escherichia coli O157:H7 in a slaughterhouse in Normandy (France).

In 1997, analyses were carried out on 255 bovine carcasses to determine the extent of superficial contamination by E. coli O157. A 50-cm(2) meat sample taken from all carcasses was collected and tested using immunomagnetic separation method to detect E. coli O157. One strain of E. coli O157 bacterium was isolated and sent to the reference national center (Institut Pasteur, Paris). The strain was confirmed as E. coli O157:H7 and found to contain two out of the three pathogenicity genes (eae and EHEC-hlyA) necessary for enteropathogenicity. Shiga toxin genes were not detected. Superficial contamination of E. coli O157:H7 was established, but at low level (0.4%).

Bright light during nighttime: effects on the circadian regulation of alertness and performance.

The present studies evaluated to what extent duration (all-night or 4-hour exposures) and timing of nocturnal bright light (BL) (beginning or end of the night) modulate effects on vigilance. The results showed that all-night BL exposure is able to alleviate the nocturnal decrements in alertness and performance. However, under certain circumstances, this continuous BL exposure may induce adverse effects on mood and finally reveal to be counterproductive. Shorter BL exposure (4 h) during nighttime helps improve mood and performance, although the effects of short BL pulses were less efficacious than all-night BL exposure. The latter part of the night appears the best time for using the alerting effect of BL. The immediate alerting effect of BL seems to be mediated by a global activation of the central nervous system.

Anemia management: recognizing opportunities and improving outcomes through nursing interventions.

In the symposium "Anemia Management: Recognizing Opportunities and Improving Outcomes Through Nursing Interventions," Gail Wick discussed the nephrology nurse as a clinical change agent in the management of anemia of chronic renal failure. Matthew Lewis discussed the profile of sodium ferric gluconate complex, a new parenteral iron product, and Jamie Foret described his clinic's experience and research with this product. These discussions highlight how nurses, using effective and safe tools such as sodium ferric gluconate complex, can improve outcomes for hemodialysis patients.

Effects of age, working hours, and job content on sleep: a pilot study.

The effects of age, shiftwork with changing schedules, and job stress on self-reported sleep quality were studied in 2767 wage earners aged 32, 42, and 52, by means of a questionnaire. Greater age was associated with poorer sleep quality, as was shiftwork for the 32- and 42-year-olds but not for the 52-year-olds, suggesting a selection effect between the ages of 42 and 52. More than specific job demands, it was perceived job difficulty that was related to sleep dissatisfaction. No interactions between age, shiftwork, and job characteristics were found.

Sleep, age, and shiftwork experience.

The effects of age and shiftwork experience (never, past, present) on sleep were studied in a sample of 3236 wage earners and retired workers by means of a questionnaire. The sample was composed of 32-, 42-, 52-, and 62-year-old subjects, and included both sexes and various occupational statuses. Age resulted in a continuously increasing frequency of sleep disturbances and hypnotic use, except for difficulty getting back to sleep and early awakening, which peaked at 52 years and then decreased at 62 years, thus suggesting a 'retirement effect'. Current and past shiftworkers reported more problems with falling asleep and early awakening than subjects who had never worked on shifts. This is a likely explanation of why the effect of age was massive in the latter group and much less pronounced in the former groups. There were no clear effects of the length or recency of shiftwork experience. This finding does not support the hypothesized permanent effect of shiftwork experience on subsequent sleep. Females had higher complaint rates at every age. There was little interaction between age and sex, but women were affected more by shiftwork as they got older, particularly as to hypnotic consumption. Some of the results support the hypothesis that a selection process excludes workers who are no longer able to cope with the demands of shiftwork.

Effect of bright light at night on core temperature, subjective alertness and performance as a function of exposure time.

OBJECTIVES: This simulated night shift study measured the effects of moderate bright light (a 4-hour pulse starting at 2000 or 0400) during the exposure night and subsequent night (dim light). METHODS: Eight young males remained confined with little physical activity to a laboratory in groups of 4. After a night of reference, they were active for 24 hours; then after a morning recovery sleep, they were active again for 16 hours. RESULTS: Continuously measured rectal temperature proved to be immediately sensitive to 4 hours of bright light, particularly when given at the end of the night. Self-assessed alertness and also performance on a task with a high requirement for short-term memory were improved by the exposure to bright light. During the subsequent night the subjects were exposed only to dim light. Core temperature, subjective alertness and performance continued to show a time course depending on the preceding bright light exposure. CONCLUSIONS: Probably because evening exposure to bright light and morning sleep both had a phase-delaying effect, the effects on the circadian pacemaker were more pronounced. Thus, for practical applications in long night shifts, bright light can be considered to improve mood and alertness immediately but the possibility of modifying the circadian "clock" during subsequent nights should be taken into consideration, in particular after exposure to bright light in the evening.

Unfavorable Consequences of Six-hour Shiftwork.

This study compared the effects of an uncommon 4 x 6-hour shift system used by some French customs units with the situation of customs officers working on two other shift systems (3 x 8 hours and 2 x 12 hours) and a group of day workers. Data were collected by a questionnaire on shift schedules, working hours, sleep, health, and off-the-job activities, and by time-budgets over four days and actigraphic recordings over five days. The 4 x 6-hour-shift officers reported a high proportion of sleep difficulties and digestive disturbances. Their situation was very similar to that of 3 x 8-hour shift workers and contrasted markedly with that of 2 x 12-hour workers and day workers. Three factors were critical: the irregularity of eating habits imposed by four different shifts, the greater number of working days in the week, and the frequent assignment of two shifts on the same day.

Disruption of sleep recovery after 36 hours of exposure to moderately bright light.

Eight young adults were exposed to either 36 hours of moderate bright light (BL; 1,000-2,000 lux) or a light/dark cycle (L/D < 50 lux) during constant routine. Sleep was recorded on the two subsequent recovery sleeps (R1 and R2) and compared to baseline. After the BL exposure, the rebound of stage 4 sleep and slow wave activity (SWA) were split over R1 and R2, whereas after the L/D cycle, the stage 4 sleep debt was almost completely compensated for during R1. During R1, stage 2 sleep and wakefulness accumulated faster in the BL condition than in the L/D condition. An elevation of the temperature level was also found during R1 of the BL condition. No differences between light conditions were found in urinary levels of melatonin or cortisol secreted during R1 or R2. Homeostasic process does not appear to be affected by the BL condition. A modification in the sleep-wake balance and a change in the temporal relationship between the circadian system and the sleep-wake cycle are discussed.

The effect on body temperature and melatonin of a 39-h constant routine with two different light levels at nighttime.

Eight healthy subjects were studied during 39-h spans (from 07:00 on one day until 22:00 the second) in which they remained awake. During one experiment, subjects were exposed to 100 lux of light between 18:00 and 8:00, and during a second experiment, they were exposed to 1000 lux during the same time span. Throughout the daytime period, they were exposed to normal daylight (1500 lux or more). The nighttime 1000-lux light treatment suppressed the melatonin metabolite aMT6s, while the 100 lux treatment did not. On the treatment day, the 1000 lux, in comparison to the 100 lux, light treatment resulted in both an elevated temperature minimum and a delay in its clock-time occurrence overnight. No real circadian phase shift in the temperature, urinary melatonin, or cortisol rhythms was detected after light treatment. This study confirmed that nocturnal exposure to lower light intensities is capable of modifying circadian variables more than previously estimated. The immediate effects of all-night light treatment are essentially not different from those of evening light. This may be important if bright light is used to improve alertness of night workers. Whether subsequent daytime alertness and sleep recovery are affected by the protocol used in our study remains to be determined.

Detrimental influence of bright light exposure on alertness, performance, and mood in the early morning.

The aim of this study was to assess the effects of exposure for one night to moderate bright light (BL) on subjective and objective measures of alertness, performance, and mood. Eight subjects were exposed to either BL or dim light (DL) during one night. During the previous day, they were exposed to bright light in both experimental conditions. Nocturnal BL suppressed melatonin secretion and increased body temperature. The ability to stay awake during the night, as measured by the power density in the alpha band, was significantly improved by BL exposure. BL also improved subjective alertness and performance during the first part of the night. However, improvements in the last two variables were followed by marked disruption in early morning patterns, with deterioration of mood and motivation.

Irregularity of working hours in railway workers and types of complaints.

Seventy-three permanent morning workers, 33 three-shift workers and 43 workers with irregular working schedules (roster) filled out a questionnaire on sleep, well-being and health complaints. The frequency of sick leave tended to be smaller in workers in the roster group. However, in this group health was rated "poor" more often; digestive, respiratory, osteoarticular and nervous symptoms as well as sleep difficulties were more frequently reported. In the day work and shift group, ratings of sleep quality were higher on days of rest than on working days but not in the roster group. This suggests that a worker does not at present get enough non-work days for a complete short-term recovery. In contrast, the length of sleep reported did not differ among groups. The gap between the subjective assessment of health and the actual frequency of sick leave corresponded with the irregularity of the working schedule.

Temperature drop and sleep: testing the contribution of SWS in keeping cool.

Sleep and body temperature characteristics were studied in man in baseline (B), 24 h-constant routine (CR) and recovery (R) after the CR. The sleep advanced and deepened the trough of the minimum temperature when compared with CR. No relevant difference in minimum body temperature, or in the slope of temperature decrease was found, however, between B and R sleeping nights. No correlation was found between the amount of slow wave sleep and body cooling. The results do not support a homeostatic role of slow wave sleep in brain and/or body cooling.

Effect of morning bright light on body temperature, plasma cortisol and wrist motility measured during 24 hour of constant conditions.

Using 24 h constant conditions, time course of body temperature, plasma cortisol and wrist motility was measured in response to a 3 day morning 2 h bright light pulse. This protocol demonstrated that a 2000 lux illumination was sufficient to elicit a shift of about 2 h of temperature minimum and cortisol peak. In reference session, actimetric recordings showed a circadian time course, closely in relation with core temperature. Bright light pulse resulted in a decrease of amplitude and a disappearance of circadian pattern of actimetry.

Bright light affects alertness and performance rhythms during a 24-h constant routine.

The aim of the present study was to assess the stimulating effects of bright light (BL) on subjective and objective alertness. Eight subjects were exposed to either bright light or dim light (DL) during a 24-h constant routine (0900-0900). Bright light failed to modify either the 24-h course or the level of body temperature. Compared to DL, BL delayed the circadian trough of motor activity by 2 h. During the night, relative to the dim-light condition, BL significantly increased subjective and objective (EEG test) alertness and improved performances. Thus, BL exposure partly counteracted the effects of sleep deprivation and/or the circadian trough on alertness and performances. During the day, BL only improved the mood and motivation levels. However, the time course of mood and motivation was not affected by the BL exposure, a nocturnal circadian trough occurring at 0630 in both light conditions.

Effects of a two-hour early awakening and of bright light exposure on plasma patterns of cortisol, melatonin, prolactin and testosterone in man.

Bright light is a synchronizing agent that entrains human circadian rhythms and modifies various endocrine and neuroendocrine functions. The aim of the present study was to determine whether and how the exposure to a bright light stimulus during the 2 h following a 2 h earlier awakening could modify the disturbance induced by the the sleep deprivation on the plasma patterns of hormones whose secretion is sensitive to light and/or sleep, namely melatonin, prolactin, cortisol and testosterone. Six healthy and synchronized (lights on: 07.00-23.00) male students (22.5 +/- 1.1 years) with normal psychological profiles volunteered for the study in winter. The protocol consisted of a baseline control night (customary sleep schedule) followed by three shortened nights with a rising at 05.00 and a 2 h exposure to either dim light (50 lux; one week) or bright light (2000 lux; other week). Our study showed a phase advance of the circadian rhythm of plasma cortisol without significant modifications of the hormone mean or peak concentration. Plasma melatonin concentration decreased following bright light exposure, whereas no obvious modifications of plasma testosterone or prolactin patterns could be observed in this protocol.

The Multiple Sleep Latency Test: individual variability and time of day effect in normal young adults.

The influence of individual characteristics on diurnal physiological sleep tendency was investigated in young good sleepers. Fifty-five subjects underwent a Multiple Sleep Latency Test (MSLT) procedure. Among them 11 also participated in Repeated Test Sustained Wakefulness (RTSW) procedure. The MSLT results were analyzed as a function of both the number of sleep onsets per day and the time of day. Diurnal sleepiness seemed to be better appreciated by sleep onset (SO) frequency than by the traditional criteria of sleep latency. SO frequency, unlike latency, was influenced by factors such as usual sleep duration, morning/evening score, and RTSW procedure. Time of day effect was characterized by a decrease in sleep tendency at the beginning and at the end of the day (decrease in SO frequency and increase in SO latencies); between these two points a peak of sleepiness around 1400 was observed. The morning and evening periods of high alertness could represent important anchor points for the coupling of the sleep/wake and temperature rhythms.

Daytime wakefulness following a bedtime oral dose of zolpidem 20 mg, flunitrazepam 2 mg and placebo.

1. The effects of zolpidem 20 mg, flunitrazepam 2 mg and placebo, administered at bed time, were studied in 12 healthy young male volunteers. 2. The assessments included, at awakening, subjective ratings of overnight sleep, cognitive function, psychomotor performance (digit symbol substitution, choice reaction time, flicker fusion threshold), subjective ratings of alertness, and plasma assay of residual drug concentration. Daytime sleep propensity during the day after dosing was evaluated with the multiple sleep latency test. 3. Compared with placebo, both active drugs improved subjective assessment of the ease of getting to sleep. At awakening, under flunitrazepam treatment, the reduction of performance, on memory and psychomotor tests, paralleled an increased subjective rating of sleepiness, but zolpidem treatment left subjects unimpaired compared with placebo. Similarly, daytime sleep propensity was enhanced throughout the following day under flunitrazepam treatment, but not under zolpidem treatment. Plasma assay for residual drug concentration at awakening found significant amounts of flunitrazepam and marginal amounts of zolpidem. 4. Results indicate that zolpidem 20 mg is devoid of residual effects in a range of tasks that were sensitive enough to demonstrate a prolonged wakefulness impairment following flunitrzepam 2 mg in healthy volunteers.

Analysis and management of chronic testicular pain.

A total of 45 patients was seen in consultation between May 1980 and April 1989 for chronic unilateral or bilateral orchialgia, defined as intermittent or constant testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient so as to prompt him to seek medical attention. We analyzed 34 patients available for followup in terms of socioeconomic parameters, etiology and duration of pain, associated urological symptomatology, specific treatment and results of therapy. Of the patients 31 underwent surgical treatment after failing medical management (24 orchiectomies, 10 epididymectomies, 5 orchiopexies and 1 hydrocelectomy). Of 10 patients who underwent epididymectomy 9 underwent subsequent orchiectomy as definitive treatment. Of 15 patients who underwent inguinal orchiectomy 11 (73%) reported complete relief of pain, while 4 had partial relief. Of the 9 patients who underwent scrotal orchiectomy 5 (55%) reported complete relief of pain, 3 had partial relief and 1 denied improvement. On the basis of these results we recommend inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when conservative measures are unsuccessful.

Modifications of sleep structure by brief forced awakenings at different times of the night.

Four subjects were awakened once a night for 10 min at either 01.30, 03.30 or 05.30 h. During the waking intervals, they performed a mental task while remaining in bed. The awakenings did not significantly modify the amount of different stages during subsequent sleep with no effect of time of occurrence in the night. In contrast, the timing of the awakening within the cycle had a significant influence on REM cycle structure. If awakening occurred during a REM episode or shortly thereafter, the following inter-REM interval was shortened; if it occurred late in the cycle, that is shortly before a REM episode, it increased the inter-REM interval beyond the reference length of the corresponding uninterrupted cycle. An explanation based on a model of sleep which implies the simultaneous activity of REM-on and REM-off neurones is proposed.