Are we winning the War on Sleeplessness?

Or, as the authors of this paper put it, are we seeing the “first signs of success in the fight against sleep deficiency?”

Abstract:

STUDY OBJECTIVES:

The high prevalence of chronic insufficient sleep in the population has been a concern due to the associated health and safety risks. We evaluated secular trends in sleep duration over the most recent 14-year period.

METHODS:

The American Time Use Survey, representative of US residents ≥15 years, was used to investigate trends in self-reported sleep duration and waking activities for the period 2003-2016 (N = 181335 respondents).

RESULTS:

Sleep duration increased across survey years both on weekdays (+1.40 min/year) and weekends (+0.83 min/year, both p < .0001, adjusted models). This trend was observed in students, employed respondents, and retirees, but not in those unemployed or not in the labor force. On workdays, the prevalence of short (≤7 hr), average (>7-9 hr), and long (>9 hr) sleep changed by -0.44% per year (p < .0001), -0.03% per year (p = .5515), and +0.48% per year (p < .0001), respectively. The change in sleep duration was predominantly explained by respondents retiring earlier in the evening. The percentage of respondents who watched TV or read before bed-two prominent waking activities competing with sleep-decreased over the same time period, suggesting that portions of the population are increasingly willing to trade time in leisure activities for more sleep. The results also suggest that increasing online opportunities to work, learn, bank, shop, and perform administrative tasks from home freed up time that likely contributed to increased sleep duration.

CONCLUSIONS:

The findings indicate first successes in the fight against sleep deficiency. Public health consequences of the observed increase in the prevalence of long sleep remain unclear and warrant further investigation

Here is the American Time Use Survey which the authors used for their study.

The perils of trying to do too much: data, the Life Study, and Mission Overload

One interesting moment at the CCIO Network Summer School came in a panel discussion. A speaker was talking about the vast amount of data that can be collected and how impractical this can be. He gave the example of – while acknowledging that he completely understood why this particular data might be interesting – the postcode of  the patients most frequent visitor. As someone pointed out from the audience, the person in the best position to collect this data is probably the patient themselves.

When I heard this discussion, the part of my that still harbours research ambitions thought “that is a very interesting data point.” And working in a mixed urban/rural catchment area, in a service which has experienced unit closures and admission bed centralisation, I thought of how illustrative that would be of the personal experience behind these decisions.

However, the principle that was being stated – that clinical data is that which is generated in clinical activity – seems to be one of the only ways of keeping the potential vast amount of data that could go into an EHR manageable. Recently I have been reading Helen Pearson’s “The Life Project” , a review of which will shortly enough appear. Pearson tells the story of the UK Birth Cohort Studies. Most of this story is an account of these studies surviving against the institutional odds and becoming key cornerstones of British research. Pearson explicitly tries to create a sense of civic pride about these studies, akin to that felt about the NHS and BBC. However, in late 2015 the most recent birth cohort study, the Life Study, was cancelled for sheer lack of volunteers. The reasons for this are complex, and to my mind suggest something changing in British society in general (in the 1946 study it was assumed that mothers would simply comply with the request to participate as a sort of extension of wartime duty) – but one factor was surely the amount of questions to be answered and samples to be given:

But the Life Study aims to distinguish itself, in particular by collecting detailed information on pregnancy and the first year of the children’s lives — a period that is considered crucial in shaping later development.

The scientists plan to squirrel away freezer-fulls of tissue samples, including urine, blood, faeces and pieces of placenta, as well as reams of data, ranging from parents’ income to records of their mobile-phone use and videos of the babies interacting with their parents. (from Feb 2015 article in Nature by Pearson)

All very worthy, but it seems to me that the birth cohort studies were victims of their own success. Pearson describes that, almost from the start, they were torn between a more medical outlook and a more sociological outlook. Often this tension was fruitful, but in the case of Life Study it seems to have led to a Mission Overload.

I have often felt that there is a commonality of interest between the Health IT community, the research methodology community, and the medical education community and the potential of EHRs for epidemiology research, dissemination of best evidence at point of care  and realistic “virtual patient” construction is vast. I will come back to these areas of commonality again. However, there is also a need to remember the different ways a clinician, an IT professional, an epidemiologist, an administrator, and an educationalist might look at data. The Life Study perhaps serves as a warning.

My struggle against EMBASE Screening addiction

Ok, the headline is a little glib, and I don’t want to make fun of any actual addiction – but since discovering EMBASE screening at a HRB TMRN event on systematic reviews on Thursday last, I’ve been hooked.
EMBASE screening is very simple – as the Cochrane Collaboration Community Page on the project states “The project’s purpose is to identify reports of randomised controlled trials (RCTs) and quasi-RCTs from EMBASE for publication in the Cochrane Central Register of Controlled Trials (CENTRAL)” Put simply , “The EMBASE project provides an opportunity for new and potential contributors to get involved with Cochrane work by diving into a task that needs doing. No prior experience is necessary as the task supports a ‘learn as you do’ approach. ”

 

Basically the screener is presented with a title and abstract (occasionally just a title) and has to decide if this is an RCT/quasi-RCT, definitely not an RCT/quasi-RCT, or impossible to tell. There are lots of checks and balances so one shouldn’t worry about making a mistake. The interface is very simple and a good, clear training module is provided before you get stuck it.

This is a much better way of passing a few minutes with a smart phone than checking news sites again or again, or whatever your poison is…. and along the way I have come across some intriguing abstracts such as this and this (neither of which is a RCT)

 

 

#TRIALSYM15

The original purpose of this blog was as an entirely personal, reflective project. In the last few weeks (not that the blog has a history before this) it has become a forum for my reflections on events I have attended of a general medical innovation bent -the AMEE Hackathon and a CCIO meeting.  And now it is the turn of the inaugural Clinical Trials Methodology Symposium of the HRB’s brand new Trials Methodology Research Network. I only attended day 1 of this event which is a pity. The hashtag #trialsym15 is being used on Twitter so proceedings can be followed there. I won’t try and summarise proceedings here as it would be a little too much “he said… she said…” but give some reflective thoughts, especially following on from my prior posts.

As a full time clinician with an aspirational interest in research (ie a desire to take part in it that is often foiled) I find the concept of a network very appealing, and having an interest in conceptual issues in mental health and illness the methodology element is also fascinating.   It is rather invidious to select highlights; one was Sir Iain Chalmers , a founder of the Cochrane Collaboration (the logo of which incorporates a metaanalysis performed by an Irish doctor, Patricia Crowley ) who in a fascinating talk showed how, contrary to what is often taught, the randomised controlled trial did not emerge in 1948 from statistical theory but from a much longer history of clinical researchers engaging in fair trials of treatment.

Another was NUI Galway’s John Newell who gave the most engaging talk by a statistician I have ever heard

(his NUIG bio photo is also pleasingly Action Man-y)  

Newell gave a really honest and inspirational talk on translational statistics, and conveying statistical concepts to non-statistician audiences. I also learned about an egregious misuse of statistics by no less a moral authority than Fintan O’Toole … in a rather self-righteous article decrying the misuse of statistics. “The most entertaining talk I ever heard by a statistician” probably sounds like a set-up for a joke, but actually statisticians in my experience tend to be a wry lot. Newell’s talk really was the most entertaining talk I ever heard by a statistician.

I also enjoyed the total absence of the words “transform” or “revolutionise.” This was a particularly evident absence in Prof Craig Ramsay’s  witty, optimistic-yet-realistic presentation on  implementation science or knowledge transfer or (insert current description of this field here) . I had to pop out for a call towards the end (see the passing comment on not having time to do research above!) and, lurking at the door afterwards, was interested to hear him discuss developing research teams integrated into clinical settings. This chimed with some of my thoughts on the technology-health interface discussed towards the end of my Glasgow Hackathon post

The dynamic between technology and healthcare (and technology and education) is becoming one of the themes of these blog posts. My Glasgow experience made me wonder if the dynamic is, almost irretrievably, biased towards the tech being in the driving seat. I was more reassured by the CCIO meeting and even more impressed today by the amount of thought going into methodology by the likes of Prof Ramsay and the COMET Initiative .

Another highlight was Prof Peter Sandercock’s at times harrowing account of the travails of the International Stroke Trial and an illustration of the downside of social media and healthcare’s interaction. A questioner asked him about his current thoughts on pharma and drug trials. To paraphrase his reply, he said that he worried less about pharma influence, which is now highly scrutinised and regulated, than the medical device industry, which is not to anything like the same degree.

This got me thinking again about the deification of tech, or rather a certain kind of tech. Big Pharma is now a regular movie villain, whereas medical devices are Good Tech and therefore only criticised by fogeys. As it happened, during the day I came across a blog post by my  friend Phil Lawton  which, in dealing with the recent move of the Web Summit from Dublin, captured many of my own thoughts not only about the uncritical adoration of tech, but also about Dublin itself – especially as a Dublin native now happily domiciled a long long way away in Tipperary.