The Spectral Sensitivity of Human Circadian Phase Resetting and Melatonin Suppression to Light Changes Dynamically with Light Duration

Human circadian, neuroendocrine, and neurobehavioral responses to light are mediated primarily by melanopsin-containing intrinsically-photosensitive retinal ganglion cells (ipRGCs) but they also receive input from visual photoreceptors. Relative photoreceptor contributions are irradiance- and duration-dependent but results for long-duration light exposures are limited. We constructed irradiance-response curves and action spectra for melatonin suppression and circadian resetting responses in participants exposed to 6.5-h monochromatic 420, 460, 480, 507, 555, or 620 nm light exposures initiated near the onset of nocturnal melatonin secretion. Melatonin suppression and phase resetting action spectra were best fit by a single-opsin template with lambdamax at 481 and 483 nm, respectively. Linear combinations of melanopsin (ipRGC), short-wavelength (S) cone, and combined long- and medium-wavelength (L+M) cone functions were also fit and compared. For melatonin suppression, lambdamax was 441 nm in the first quarter of the 6.5-h exposure with a second peak at 550 nm, suggesting strong initial S and L+M cone contribution. This contribution decayed over time; lambdamax was 485 nm in the final quarter of light exposure, consistent with a predominant melanopsin contribution. Similarly, for circadian resetting, lambdamax ranged from 445 nm (all three functions) to 487 nm (L+M-cone and melanopsin functions only), suggesting significant S-cone contribution, consistent with recent model findings that the first few minutes of a light exposure drive the majority of the phase resetting response. These findings suggest a possible initial strong cone contribution in driving melatonin suppression and phase resetting, followed by a dominant melanopsin contribution over longer duration light exposures

Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study

BackgroundIncreasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. ObjectiveWe aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. MethodsWe conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. ResultsIn total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96%) were still logging their steps, with 19 (68%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89%) were likely to recommend the program, 23 (82%) said the program helped them deal with the disease, and 24 (86%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. ConclusionsThe high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention

Engagement, Retention and Acceptability in a Digital Health Program for Atopic Dermatitis: Prospective Interventional Study

BACKGROUND: Patients with Atopic Dermatitis (AD) can experience chronic eczema with pruritus, skin pain, sleep problems, anxiety, and other problems that reduce their quality of life (QoL). Current treatments aim to improve these symptoms and reduce inflammation, but poor treatment adherence and disease understanding are key concerns in the long-term management of AD. Digital therapeutics can help with these, and support patients towards a healthier lifestyle to improve their overall QoL. OBJECTIVE: To test the feasibility of a digital health program tailored for AD through program engagement, retention and acceptability. METHODS: Adults with AD were recruited in Iceland for a six-week digital health program delivered through a smartphone app. Key components of the digital program were disease and trigger education, medication reminders, patient-reported outcomes (PROs) on energy levels, stress levels, and quality of sleep (referred to as QoL PROs), AD symptom PROs, guided meditation, and healthy lifestyle coaching. The primary outcome was program feasibility, as assessed by in-app retention and engagement. User satisfaction was assessed by the mHealth App Usability Questionnaire (MAUQ). RESULTS: Twenty-one patients were recruited (17 female, mean age: 31 years); 20 (95%) completed the program. On average, users were active in the app 6.5 days per week and completed 8.2 missions per day. The education content, medication reminders, and PROs had high user engagement and retention; all users who were exposed to the QoL PROs (n=17) interacted with these, and 20/21 (95%) users continuously engaged with the education missions, medication missions, and symptom PROs. Continued engagement with the step counter and mind missions among exposed users was lower (17/21 and 13/20 participants respectively). Medication reminder and education task completion remained high over time (at least 18/20, 90%), but weekly interactions declined. All assigned users completed AD symptom PROs on weeks 1-5 and only one did not do so on week 6; the reported number and total severity of AD symptoms reduced during the program. Regarding the QoL PROs, 16/17 (94%) and 14/17 (82%) users interacted with these at least 3 times in the first and last week of the program respectively, and all reported improvements over time. User satisfaction was high, with a total score of 6.2/7. CONCLUSIONS: We found high overall engagement and retention in a targeted digital health program among patients with AD, as well as high compliance with missions relating to medication reminders, patient education, and PROs. Symptom number and severity was reduced and QoL PROs improved over time. We conclude that a digital health program is feasible and may provide added benefits for patients with AD, including the tracking and improvement of AD symptoms

Clinical Efficacy of a Digital Intervention for Patients with Atopic Dermatitis: a Prospective Single-Center Study

INTRODUCTION: Improving disease awareness and treatment adherence is key for the long-term management of atopic dermatitis (AD). Digital interventions can support patients in disease self-management and adopting a healthier lifestyle through behavioral modifications. We aimed to test the clinical efficacy of a digital program in patients with AD. METHODS: Adults with mild-to-severe AD were recruited for a 6-week feasibility study. The intervention was delivered through a mobile app and consisted of symptom and trigger education, treatment reminders, lifestyle coaching, and healthy lifestyle support. Here we report the secondary outcomes of intervention efficacy on clinical symptoms, as assessed by Scoring Atopic Dermatitis (SCORAD) and Patient-Oriented Eczema Measure (POEM), on health-related quality of life (HR QoL) as assessed by Dermatology Life Quality Index (DLQI), and changes in behaviors related to disease management as assessed by a six-item questionnaire. RESULTS: Twenty of 21 patients (95.2%) completed the program (81% female, mean age 31.4 years, mean time from diagnosis 26.8 years). Clinical symptoms and patient-reported global severity improved by 44% and 46%, respectively, while HR QoL improved by 41% (p \u3c 0.001 for all measures). Adherence to treatments and preventive measures improved from pre- to post-intervention, including skincare, avoidance of triggers, and disease-related knowledge. A significant interaction was observed between increased treatment adherence and clinical improvement, such that larger clinical improvements were observed in patients with higher treatment adherence. CONCLUSION: Patients with AD are open to and can benefit from a digitally delivered targeted intervention, as demonstrated by significant improvements in treatment adherence and related clinical outcomes

Clinical Efficacy of a Digital Intervention for Patients with Atopic Dermatitis: a Prospective Single-Center Study

INTRODUCTION: Improving disease awareness and treatment adherence is key for the long-term management of atopic dermatitis (AD). Digital interventions can support patients in disease self-management and adopting a healthier lifestyle through behavioral modifications. We aimed to test the clinical efficacy of a digital program in patients with AD. METHODS: Adults with mild-to-severe AD were recruited for a 6-week feasibility study. The intervention was delivered through a mobile app and consisted of symptom and trigger education, treatment reminders, lifestyle coaching, and healthy lifestyle support. Here we report the secondary outcomes of intervention efficacy on clinical symptoms, as assessed by Scoring Atopic Dermatitis (SCORAD) and Patient-Oriented Eczema Measure (POEM), on health-related quality of life (HR QoL) as assessed by Dermatology Life Quality Index (DLQI), and changes in behaviors related to disease management as assessed by a six-item questionnaire. RESULTS: Twenty of 21 patients (95.2%) completed the program (81% female, mean age 31.4 years, mean time from diagnosis 26.8 years). Clinical symptoms and patient-reported global severity improved by 44% and 46%, respectively, while HR QoL improved by 41% (p \u3c 0.001 for all measures). Adherence to treatments and preventive measures improved from pre- to post-intervention, including skincare, avoidance of triggers, and disease-related knowledge. A significant interaction was observed between increased treatment adherence and clinical improvement, such that larger clinical improvements were observed in patients with higher treatment adherence. CONCLUSION: Patients with AD are open to and can benefit from a digitally delivered targeted intervention, as demonstrated by significant improvements in treatment adherence and related clinical outcomes