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The dark side of the moon: Impact of moon phases on long-term survival, mortality and morbidity of surgery for lung cancer

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Superstition is common and causes discomfiture or fear, especially in patients who have to undergo surgery for cancer. One superstition is, that moon phases influence surgical outcome. This study was performed to analyse lunar impact on the outcome following lung cancer surgery. 2411 patients underwent pulmonary resection for lung cancer in the past 30 years at our institution. Intra- and postoperative complications as well as long-term follow-up data were entered in our lung-cancer database. Factors influencing mortality, morbidity and survival were analyzed. Rate of intra-operative complications as well as rate of post-operative morbidity and mortality was not significantly affected by moon phases. Furthermore, there was no significant impact of the lunar cycle on long-term survival. In this study there was no evidence that outcome of surgery for lung cancer is affected by the moon. These results may help the physician to quiet the mind of patients who are somewhat afraid of wrong timing of surgery with respect to the moon phases. However, patients who strongly believe in the impact of moon phase should be taken seriously and correct timing of operations should be conceded to them as long as key-date scheduling doesn't constrict evidence based treatment regimens.
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EUROPEAN JOURNAL OF MEDICAL RESEARCH
Abstract
Objective: Superstition is common and causes discom-
fiture or fear, especially in patients who have to under-
go surgery for cancer. One superstition is, that moon
phases influence surgical outcome. This study was per-
formed to analyse lunar impact on the outcome fol-
lowing lung cancer surgery.
Methods: 2411 patients underwent pulmonary resec-
tion for lung cancer in the past 30 years at our institu-
tion. Intra- and postoperative complications as well as
long-term follow-up data were entered in our lung-
cancer database. Factors influencing mortality, mor-
bidity and survival were analyzed.
Results: Rate of intra-operative complications as well
as rate of post-operative morbidity and mortality was
not significantly affected by moon phases. Further-
more, there was no significant impact of the lunar cy-
cle on long-term survial.
Conclusion: In this study there was no evidence that
outcome of surgery for lung cancer is affected by the
moon. These results may help the physician to quite
the mind of patients who are somewhat afraid of
wrong timing of surgery with respect to the moon
phases. However, patients who strongly believe in the
impact of moon phase should be taken seriously and
correct timing of operations should be conceded to
them as long as key-date scheduling doesn’t constrict
evidence based treatment regimens.
Key words: Lung cancer, Superstition, Moon phases,
Survival, Surgical complications
Abbreviations: CI = Confidence interval, χ
2
= Chi-
square test, LOC = Locus of control
INTRODUCTION
Superstition is very common, especially in some rural
areas where nearly one-fifth of the population be-
lieves in the impact of moon phases on various phe-
nomena and, among other things, outcome of med-
ical treatment [1-3]. These patients may be anxious,
especially when they have to undergo surgery for can-
cer [4]. The rationale for these anticipated effects have
been credited to variations in the brightness of moon-
light, weather conditions, geomagnetic variations as
well as interstellar solar corpuscular radiation [5, 6].
“Why should the moon, which causes the tides,
doesn’t influence human beings, who consist predom-
inantly of water?” is a common believe. Consequently,
many patients are essentially afraid of wrong timing
of surgery with respect to moon phases, which might
manipulate nurses and surgeons [3, 7]. Thus, the im-
pact of lunar cycles on treatment related complica-
tions, postoperative mortality and morbidity as well as
long-term survival has been widely discussed by tele-
vision shows, lay press and newsgroups in the inter-
net. Several scientific studies have reported on the in-
fluence of moon phases on birth rates, birth compli-
cations, suicide, psychiatric crises, or outcome of
surgery for breast cancer [4]. Since some studies un-
derline significant influence of moon phases on hu-
man life [5, 8-11], other reports have failed to confirm
these results [2, 4, 12, 13]. It is well known, that physi-
ological processes of the organism, i.e. the endocrine
system, the autonomic nerve system, the liberation of
growth factors or the limbic system are influenced by
the moon cycle [4]. In addition, it is also postulated
that significant impact of lunar phases is mediated by
endogenous mechanisms [10]. In patients who have to
undergo surgery for cancer, fear of operative compli-
cations and poor outcome is very widespread. In
some cases, lunar phases are believed to be relevant
for success of treatment. Therefore, this retrospective
study was performed to analyse the influence of the
moon phases on mortality, morbidity and long-term
survival following lung cancer surgery at our institu-
tion.
PATIENTS AND METHODS
We retrospectively reviewed the files of 2411 patients
with complete long-term follow-up who received re-
sective surgery for lung cancer between January 1980
and December 2007 at the Department of Surgery at
our institution. The cohort included 1854 males and
557 females with a median age of 62.2 ± 9.9 years.
Classification of tumor stages according to UICC
2002 was 41%, 21%, 21%, 6%, and 11% for stadium I,
II, IIIa, IIIb and IV, respectively. Type of surgery con-
178
E
ur J Med Res (2009) 14: 178-181 © I. Holzapfel Publishers 2009
THE DARK SIDE OF THE MOON: IMPACT OF MOON PHASES ON
LONG-TERM SURVIVAL, MORTALITY AND MORBIDITY OF SURGERY FOR
LUNG CANCER
A. Kuehnl
1
,2
, M. Herzog
1
, M. Schmidt
3
, H.-M. Hornung
1
, K.-W. Jauch
1
, R. A. Hatz
1
, C. Graeb
1
1
Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
2
Clinic for Vascular Surgery, Klinikum rechts der Isar, Technische Universität nchen, Germany
3
Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
6. Ku?hnl##:Umbruchvorlage 28.03.2009 15:57 Uhr Seite 178
sisted pneumonectomies in 18%, lobectomies and
bilobectomies in 68%, and lesser resections in 14% of
all cases. The date of definitive surgery was allocated
to the days of lunar cycle as well as to the dates of the
four main lunar phases, that are new moon (n = 89),
waxing moon (n = 1058), full moon (n = 77) and wan-
ing moon (n = 1187). Patients were grouped according
t
o these four phases, as described by Moore and co-
w
orkers [14].
Patients long-term follow up was performed at our
institution completed by data from the Munich Cancer
Registry as well as updated by data from all GPs, com-
munity hospitals, chemoradiotherapy units and regis-
tration offices in Munich and its greater area. Median
long-term follow-up was 25 months, ranging from 1 to
326 months.
Since January 1996, detailed data of perioperative
complications occurring during the operation until pa-
tients discharge from hospital were available for all pa-
tients (n = 834) included in our lung cancer database
[15]. General complications like dysfunction of the
cardio-pulmonary system, myocardial infarction, dys-
rhythmia, pulmonary embolism, renal or liver failure,
central nervous dysfunction, sepsis, pneumonia and
postoperative bleeding requiring blood transfusion
were recorded. Empyema, bronchopleural fistula,
pneumothorax, chylothorax, wound infection, atelecta-
sis or prolonged air leak, leading to an operative revi-
sion were generally classified as specific complications.
Validity of data was assessed by comparing the four
groups according to the distributions of main prog-
nostic variables influencing long-term survival, mor-
bidity and mortality in lung cancer patients (age, gen-
der, TNM status, grading, completeness of resection
status, treatment and histopathology).
Statistical significance was evaluated using multiple
logistic regression analysis [16]. Rates and proportions
analyzes were performed using the Chi-square (χ
2
)-
test. An univariate survival analysis for each prognos-
tic variable on overall survival was estimated according
to the Kaplan-Meier method [17] including 95% confi-
dence intervals [18]. The terminal event was death at-
tributable to all causes. The statistical significance of
the differences in survival distributions among the
p
rognostic groups was evaluated by the log-rank test.
T
he statistical difference was considered to be signifi-
cant if the P value was below 0.05. Data were analyzed
using MedCalc® for Windows, Version 9.2.0.1 (Med-
Calc Software, Mariakerke, Belgium).
RESULTS
With respect to the lunar cycle, there were no signifi-
cant differences in the distribution of TNM-Status (P
= .739), grading (P = .488), completeness of resection
(P = .638), age (P = .706), gender (P = .273), treat-
ment (P = .797) and histopathology (P = .466). Rate
of intraoperative complications was 1.7%, whereas the
rate of postoperative complications needing invasive
or prolonged treatment was 16.4%. The 30-day mor-
tality rate was 3.2%. Overall median survival was 28.7
months with a survival rate of 36.0% at five years. In
contrast to age, gender, tumour stage, histopathology,
grading and completeness of resection, which have
been identified to be independent predictors affecting
long-term survival significantly (Table 1), timing of
surgery with respect to the moon phases showed no
significant impact on long-term survival (Table 2).
Lunar phases showed neither influence on intraop-
erative complications rate, nor on overall morbidity or
mortality. However, as shown in Table 2, also alloca-
tion of patients to single days of lunar cycle as well as
allocation to waning and waxing phases revealed no
significant impact on surgical outcome.
EUROPEAN JOURNAL OF MEDICAL RESEARCH 179
Table 1. Impact of several oncological factors on long-term survival in our cohort.
outcome parameter test used independent factor P value
Survival log-rank T status < 0.001
log-rank N status < 0.001
log-rank M status < 0.001
log-rank tumour grading 0.015
log-rank completeness of resection < 0.001
log-rank pathohistology 0.003
Table 2. Impact of lunar cycle on intra- and postoperative morbidity, mortality and long-term survival. Outcome parameters are
not significantly affected by moon phase.
outcome parameter test used independent factor
day of lunar cycle 4 moon phases waxing full moon
vs. each other vs. each other vs. waning moon vs. remaining phases
Survival log-rank P = .459 P = .646 P = .631 P = .110
operative complications χ
2
P = .963 P = .430 P = .579 P = .941
post-OP mortality χ
2
P = .885 P = .952 P = .756 P = .920
post-OP morbidity χ
2
P = .846 P = .910 P = .967 P = .970
6. Ku?hnl##:Umbruchvorlage 28.03.2009 15:57 Uhr Seite 179
DISCUSSION
This study revealed that moon phases had generally no
measurable impact on outcome after surgery for lung
cancer.
In accordance to our results, Peters-Engl and col-
leagues [4], reporting their results on outcome of 3757
women operated for breast cancer, revealed no effect
of moon phases on surgical or patient outcome. Arliss
et al. [2] examined the influence of the lunar cycle on
the frequency of deliveries and delivery related com-
plications, but also failed to demonstrate predictable
influence of moon phases on patients included in the
study. In addition, Kumar et al. [13] report about miss-
ing evidence that full moon have significant influence
on post-tonsillectomy haemorrhage. Postoperative
mortality with respect to moon phases was analyzed
by Smolle and coworkers [3], but they also failed to
demonstrate an impact of lunar phases on outcome.
According to these and other studies [1], there was no
evidence in our series, that long-term survival was dif-
ferent in any of the four primary moon phases. The
overall median survival in this study was 29 months
with a 5-year survival of 36%, which is comparable to
international reported survival rates after pulmonary
resection for cancer [19,20].
Román and associates [10] described that hospital
admission for gastrointestinal bleeding was significant-
ly increased during full moon. In our series postopera-
tive bleeding events were not significantly more fre-
quent during the full moon. To our opinion, this is due
to the circumstance, that in the series described by
Román et al. the bleeding event was definitively during
full moon, in contrast to our study, where bleeding
events were always linked to the moon phase at the
time of surgery.
IMPLICATIONS FOR GENERAL AND CLINICAL PRACTICE
In this study there was no evidence that outcome of sur-
gery for lung cancer is affected by the moon. These re-
sults may help the physician to quite the mind of patients
who are somewhat afraid of wrong timing of surgery
with respect to the moon phases. On the other hand, lo-
cus of control is a well known individual factor within
the coping strategies of many patients being in such
desperate situations. In whatever these patients trust
(internal LOC, powerful others LOC or chance exter-
nal LOC), it may supports them handling their disease.
Therefore, patients who strongly believe in the im-
pact of moon phase should be taken seriously and
correct timing of operations should be conceded to
them as long as key-date scheduling doesn’t constrict
evidence based treatment regimens.
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Fig. 1. Rate of postoperative complications in % on each day of the lunar cycle when initial surgery took place. Rhombi indicate
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Received: July 25, 2008 / Accepted: September 26, 2008
Address for correspondence:
PD Dr. med. Christian Graeb
Chirurgische Klinik und Poliklinik Großhadern
Ludwig-Maximilians Universität nchen
Marchioninistraße 15
81377 München
Germany
Tel.: +49 89/7095 3510
Fax: +49 89/7095 3508
E-mail: christian.graeb@med.uni-muenchen.de
6. Ku?hnl##:Umbruchvorlage 28.03.2009 15:57 Uhr Seite 181
... However, profound evidence that the LP potentially affects human health is lacking [4]. In the literature, the influence of the LP on total hip arthroplasty [2,3,5], radical cystectomy [11], surgery for breast [14] or lung cancer [9], general, visceral or vascular surgery (excluding neurosurgery) [14], and miscellaneous ambulatory surgery [7] was found to be nil. The same held true for postoperative survival in oncology [9,11,14]. ...
... In the literature, the influence of the LP on total hip arthroplasty [2,3,5], radical cystectomy [11], surgery for breast [14] or lung cancer [9], general, visceral or vascular surgery (excluding neurosurgery) [14], and miscellaneous ambulatory surgery [7] was found to be nil. The same held true for postoperative survival in oncology [9,11,14]. Regardless of this lack of evidence, we frequently face patients in our neurosurgery clinics who request elective spine surgery for degenerative disc disease (DDD) on dates that fall into what they consider a 'favorable' LP. In our tri-country region of Switzerland, Austria and Germany, popular moon calendar-related activities of daily life and surgery date preferences are based on regional moon calendars [15,18,19,23]. ...
... The likelihood of intraoperative complications was similar on days with a full moon or 'unfavorable' zodiac sign. Figure 2 is a graphical display of the likelihood of intraoperative complications in relation to each day of the lunar cycle as described by Kuehnl et al. [9]. As becomes evident, there is no phase of However, the trend to higher odds at a waxing moon and lower odds at a waning moon is deducible. ...
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Background: Many people believe that the moon has an influence on daily life, and some even request elective surgery dates depending on the moon calendar. The aim of this study was to assess the influence of 'unfavorable' lunar or zodiac constellations on perioperative complications and outcome in elective surgery for degenerative disc disease. Methods: Retrospective database analysis including 924 patients. Using uni- and multivariate logistic regression, the likelihood for intraoperative complications and re-do surgeries as well as the clinical outcomes at 4 weeks was analyzed for surgeries performed during the waxing moon, full moon, and dates when the moon passed through the zodiac sign 'Leo.' Results: In multivariate analysis, patients operated on during the waxing moon were 1.54 times as likely as patients who were operated on during the waning moon to suffer from an intraoperative complication (OR 1.54, 95 % CI 1.07-2.21, p = 0.019). In contrast, there was a trend toward fewer re-do surgeries for surgery during the waxing moon (OR 0.51, 95 % CI 0.23-1.16, p = 0.109), while the 4-week responder status was similar (OR 0.73, 95 % CI 0.47-1.14, p = 0.169). A full moon and the zodiac sign Leo did not increase the likelihood for complications, re-do surgeries or unfavorable outcomes. Conclusions: We found no influence of 'unfavorable' lunar or zodiac constellations on the 4-week responder status or the revision rate that would justify a moon calendar-based selection approach to elective spine surgery dates. However, the fact that patients undergoing surgery during the waxing moon were more likely to suffer from an intraoperative complication is a surprising curiosity and defies our ability to find a rational explanation.
... The fear of Friday the 13th is called Paraskavedekatriaphobia and was first mentioned by Coriat in 1911 [16]. A number of publications supporting the hypothesis of a lunar influence [17], Friday 13th [11,18,19], and zodiac signs alternate with a larger number of publications rejecting any such correlation [3,8,10,[20][21][22]. When analyzing mentally ill people, only the World J Surg (2011) 35:1945-1949 1947 mental health of patients with schizophrenia has been shown to be affected by moon phases [8]. ...
... In his original publication, only a pseudo-coincidence of postoperative bleeding complications after tonsillectomy was found [23]. The myth that moon phases influence long term follow-up in oncological surgery was broken by May et al. [22], as well as by Kuehnl et al. [21]. As there are no studies evaluating moon effects, zodiac signs, or Friday the 13th on intraoperative blood loss and emergency frequency, we have evaluated almost 28,000 patient records in 111 lunar cycles representing the biggest cohort dealing with this question to our knowledge. ...
... To our knowledge, however, no study dealing with the problem of superstition in medicine to date has provided a detailed power and sample size calculation. Third, recent studies dealing with the influence of the full moon on medical emergency cases may face a large degree of beta error because of small patient cohorts and rare events [3,17,21,24,27]. To overcome the problem of analyzing rare events in a cyclical context within a limited number of patients, some of the recent studies have not clearly defined the event of ''full moon'' or allocated this event to a time period of several days [22,27]. ...
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The influence of superstition, moon calendars, and popular belief on evidence-based medicine is stunning. More than 40% of medical staff is convinced that lunar phases can affect human behavior. The idea that Friday the 13th is associated with adverse events and bad luck is deep-rooted in the population of Western industrial countries. The aim of the present study was to test the hypothesis that these myths are transferable to real-life surgery. We analyzed the extent to which moon phases, zodiac signs, and Friday the 13th influence blood loss, emergency frequency, and intestinal perforations by evaluating the operation records of all 27,914 consecutive patients of our institution undergoing general, visceral, or vascular surgery between August 2001 and August 2010. Dates of surgery were allocated to lunar phases and to zodiac signs, as well as to Friday the 13th. A total of 111 lunar cycles and 15 Fridays the 13th occurred within the 3,281-day observation period. Patients' characteristics did not differ in lunar phases, zodiac signs, or Fridays the 13th. Full moon phases, the presence of Friday the 13th, and zodiac signs influenced neither intraoperative blood loss nor emergency frequency. No statistical peaks regarding perforated aortic aneurysms and gastrointestinal perforations were found on full moon or Friday the 13th. Scientific analysis of our data does not support the belief that moon phases, zodiac signs, or Friday 13th influence surgical blood loss and emergency frequency. Our data indicate that such beliefs are myths far beyond reality.
... Studies have been performed to analyze the effect of the lunar cycle on birth rates [4], emergency department presentations [5], cardiopulmonary resuscitations [6,7] and psychiatric disorders [8]. Surgery specific studies looked into the incidence of postoperative hemorrhage [9,10], intraoperative blood loss [11], morbidity and mortality after lung and breast cancer surgery [12,13] and quality of radical cystectomy for bladder cancer [14] in relation to the lunar cycle. These studies could not show any effect of the moon. ...
... Quality of radical cystectomy with respect to progression free survival was studied in a smaller sample size of patients with bladder cancer with respect to lunar influences, as well as long-term survival and morbidity and mortality after lung surgery in cancer patients [12,14]. A study on lunar constellations on minor surgical procedures such as herniotomy, hemorrhoidectomy and crossectomy yielded only 3.7% complications without any major complications [24]. ...
... The moon phase hypothesis, almost completely abandoned by the medical field since 1700 [23], had a renaissance in the second half of the 20th century after a report by Andrews in 1960 who observed an increased incidence of bleeding complications after tonsillectomies carried out during the full moon [8]. Studies in terms of an influence of the moon phases on human life thereafter were inconclusive [9,10,[24][25][26][27][28][29][30][31][32][33][34], or failed to confirm it [35][36][37][38]. Nevertheless, several studies demonstrated significant differences in social life, for example in alcohol consumption, nutritional intake, birth rates, and the frequency of incidents such as crime, self-poisoning, suicide and traffic accidents, during the four moon phases [25,[31][32][33][34]. ...
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... The possible relationship between surgical complications and lunar phases has aroused the interest of many authors [33][34][35][36][37][38][39]. Several human and animal biological phenomena have been attributed to circatrigintan (monthly) rhythms related to the effects of the moon around the earth [19,40]. ...
... [45] found no correlation between the incidence of postoperative nausea and vomiting and the phase of the moon. In recent years, publications [33][34][35][36][37][38][39] evaluating postsurgical progress associated with lunar phases have been scarce. No significant differences in overall survival of breast cancer patients were observed when timing of breast cancer surgery [31] during the lunar cycle was considered. ...
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Citing a related article published within this issue of the Journal of Patient-Centered Research and Reviews, the author opines on why traditional ideas regarding human health can persist over decades, and even centuries, despite a lack of scientifically accumulated evidence. It is important to keep in mind that some commonly accepted truths are supported by little to no factual data, and that occasionally patients may benefit from clarification on what is (or, often, is not) actually known about longstanding “rules of thumb” (eg, certain home remedies, disease-prevention measures or behavioral concerns). On the flip side, traditions that are shown to be not harmful, like drinking chicken soup to relieve cold symptoms, may be safely indulged regardless of effectiveness.
... Studies investigating the influence of the moon and its passage through the zodiac are controversial. The majority of them have reported no influence of the lunar phase on survival or complications: Kühnl et al. concluded, from their study in patients with lung cancer, that the moon had no significant effect on intra-and postoperative complications or morbidity and mortality [12]. Wolbank et al. performed a 6-year retrospective investigation of frequency distribution in 11,134 patients presenting for emergency treatment. ...
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Purpose Popular beliefs exert an impact of lunar phases on elective surgery. The aim of our study was to evaluate potential correlations between complications in cataract surgery and the phases of the moon during its passage through the zodiac and Fridays that fall on the 13th. Methods Patients with complications during cataract surgery were extracted retrospectively from the clinical database from 2010 to 2014. The dates of surgeries were viewed in relation to the phase and the position of the moon (sign of the zodiac). Results Of 16,965 cataract surgeries, 132 eyes developed complications. 0.70% developed complications with a waxing moon, and 0.87% with a waning moon (p = 0.745). After Bonferroni correction, there were no statistically significant differences between the numbers of complications under the different signs of the zodiac and no complications on Fridays that fell on the 13th. Conclusions The analysis of “non-moon-fitting days” for surgery showed quantitative differences, without statistically significant findings. Our results revealed more complications when the moon was waning, which is in contrast to esoteric belief. Patients may be informed that phases of the moon, signs of the zodiac, or a particular date will have no impact on their surgeries.
... frequency of births 4 and spontaneous abortions 5 ) and on medical effects in general (e.g. myocardial infarctions 6 and surgical mortality 7 ). Although nearly all relevant studies show that no effects can be attributed to the different lunar phases, public interest in literature on the moon's impact is persistently high and many people still believe in correlations or even causality between the moon and their personal lives. ...
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Objective: Many people are convinced that lunar phases influence their lives - despite the fact that a lot of studies have shown that this belief is wrong. In this article, we investigate the effect of lunar phases on acute post-surgical pain and on treatment-related side effects. We hypothesize that there is no influence. Methods: The data for the study were collected in 2010 and 2011 in 10 international hospitals participating in the research project PAIN OUT. Hospitalized patients were asked for their pain after surgery and pain treatment side effects using numerical ratings scales from 0 to 10. We applied Kurskal-Wallis H-tests to find out if the four moon phases show significant differences in 14 outcome variables. Afterwards, we adjusted for age, gender and three tracer surgeries. Results: A total of 12,224 patient data sets were assessed. For most variables and sub-groups, there is no lunar effect on the observed outcome variables. The only items that show statistically significant differences are pain interference with sleep (p = 0.01) and drowsiness (p = 0.01). The only sub-groups that show statistically significant connections to lunar phases in some variables are men (7 out of 14 variables significant) and elderly people (4 out of 14 variables significant). Discussion: Even in the statistically significant sub-groups, the differences are small and only show up in some variables. We conclude that lunar phases have no effect on post-surgical pain or its side effects. The hypothesis holds. Thus, there is no reason for patients to postpone surgeries or to fear surgeries on any given date.
... 18 Although, some of the studies found associations of events with lunar cycle, 11,12,17,18 most of the studies either could not find enough evidence to support the association or exclude the possibility of any association in conclusion. [8][9][10][13][14][15][16] Similarly, relationship of obstetric delivery with lunar cycle is not out of controversies. Although, some studies state in favor of positive association between them, 1,2 most of the studies gave a dissent. ...
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For ancient period moon has been held responsible for many biological activities. That way, lunar cycle, by activity of moon, has been held responsible for increase in number of child birth. In this retrospective, observational study, we examined a total of 9890 full-term spontaneous deliveries as well as non-elective cesarean sections that occurred throughout 12 lunar months (February 7 th , 2008-January 25 th , 2009) in a rural medical college to evaluate the influence of the lunar position on the distribution of deliveries among Indian population. Student's 't' test and ANOVA were used for statistical analysis where each delivery was considered as a single measure. We found no significant differences in the frequency of births during various phase of lunar cycle regardless of route of delivery. Our observations do not support the hypothesis of a relationship between lunar cycle and the frequency of obstetric deliveries.
... Common causes of tissue defects include trauma, surgical tissue removal or inflammation [24-27]. Defects are closed applying mobilization of the surrounding soft tissue (suture, local flap repair), tissue transplants (free flap transfer, skin transplant), or by stimulation of the body's own healing processes (granulation tissue formation, spontaneous epithelization). ...
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Today, the biomechanical fundamentals of skin expansion are based on viscoelastic models of the skin. Although many studies have been conducted in vitro, analyses performed in vivo are rare. Here, we present in vivo measurements of the expansion at the skin surface as well as measurement of the corresponding intracutaneous oxygen partial pressure. In our study the average skin stretching was 24%, with a standard deviation of 11%, excluding age or gender dependency. The measurement of intracutaneous oxygen partial pressure produced strong inter-individual fluctuations, including initial values at the beginning of the measurement, as well as varying individual patient reactions to expansion of the skin. Taken together, we propose that even large defect wounds can be closed successfully using the mass displacement caused by expansion especially in areas where soft, voluminous tissue layers are present.
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Summary.-In this paper the explanations put forward by lunar advocates to account for a "lunar effect" on human behavior are critically appraised. The hypotheses considered are ozone, moonlight, gravity, tidal force, geo- magnetism, electromagnetism, weather, ions, and ELF waves. It is concluded that none of these are sufficient to explain the alleged effects of the moon on human behavior. In view of (a) the lack of a satisfactory mechanism, (b) the lack of a reliable connection between lunar periodicities and human behavior, and (c) the generally negative results obtained in studies, it is suggested that the scientific community exercise great caution with regard to further studies claiming lunar effects on human behavior. Interest
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Objective To assess whether dog bites requiring hospital admission occur more at the full moon. Design Review of dates of admission for dog bites to accident and emergency departments,June 1997 to June 1998, compared with dates of the full moon. Setting All public hospitals in Australia. Main outcome measures Admissions for dog bites. Results 12 peak clusters of admissions were unrelated to the time of the full moon. Conclusion Dog bites are no more frequent on full moons than at any other time of the month. Sceptics rejoice.
Article
The analysis of censored failure times is considered. It is assumed that on each individual are available values of one or more explanatory variables. The hazard function (age-specific failure rate) is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time. A conditional likelihood is obtained, leading to inferences about the unknown regression coefficients. Some generalizations are outlined. LIFEtables are one of the oldest statistical techniques and are extensively used by medical statisticians and by actuaries. Yet relatively little has been written about their more formal statistical theory. Kaplan and Meier (1958) gave a comprehensive review of earlier work and many new results. Chiang in a series of papers has, in particular, explored the connection with birth-death processes; see, for example, Chiang (1968). The present paper is largely concerned with the extension of the results of Kaplan and Meier to the comparison of life tables and more generally to the incorporation of regression-like arguments into life-table analysis. The arguments are asymptotic but are relevant to situations where the sampling fluctuations are large enough to be of practical importance. In other words, the applications are more likely to be in industrial reliability studies and in medical statistics than in actuarial science. The procedures proposed are, especially for the two-sample problem, closely related to procedures for combining contingency tables; see Mantel and Haenzel (1959), Mantel (1963) and, especially for the application to life tables, Mantel (1966). There is also a strong connection with a paper read recently to the Society by R. and J. Peto (1972). We consider a population of individuals; for each individual we observe either the time to "failure" or the time to ccloss" or censoring. That is, for the censored individuals we know only that the time to failure is greater than the censoring time. Denote by T a random variable representing failure time; it may be discrete or continuous. Let F(t) be the survivor function, %(t) = pr (T2 t)
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The potential influence of lunar phases on human life has been widely discussed by the lay press. The purpose of this study was to find out whether the timing of surgery during particular lunar phases influences the survival of breast cancer patients. It has been postulated that breast cancer surgery performed during the waxing moon, or particularly at full moon, is associated with a poorer outcome. We tested this hypothesis by evaluating the overall survival for 3,757 consecutive patients with invasive breast cancer. All patients underwent either modified radical mastectomy or breast conserving surgery plus radiotherapy, followed by adjuvant cytotoxic or hormonal therapy. The date of definitive surgery was allocated to the lunar phases. 1,904 (50.7%) patients were operated on during the waxing moon and 1,853 (47.3%) during the waning moon. The median follow-up was 74 months (range 1–372 months). The mean age at primary surgery did not differ significantly in the two groups 58.39 (SD 13.14) versus 58.34 (12.75) (p>0.05, t-test). Breast cancer stages at initial diagnosis were evenly distributed according to the lunar phases (p=0.325; chi-square). Survival curves were plotted according to the method of Kaplan–Meier. No significant differences were observed when timing of surgery was allocated to the lunar phases (p=0.4841, log-rank). Subgroup analysis of premenopausal patients revealed similar results (p=0.2950, log-rank; n=1072). Using multivariate Cox modelling, we found a significant association between the patient's age, stage of disease and survival, whereas no association with survival was observed for the timing of surgery (RR=1.062; 95% CI, 0.970–1.163; p=0.1937). No significant differences in overall survival of breast cancer patients were observed when timing of breast cancer surgery during the lunar cycle was considered. Although this was not a prospective randomized trial, the statistical magnitude of the results do not support any recommendations for scheduling patients for surgery at any particular day of the lunar phase.
Article
To use scientific methods to evaluate 2 claims made by practitioners of alternative medicine. A placebo-controlled, double-blind study of homeopathy in children with warts, and a cohort study of the influence of lunar phases on postoperative outcome in surgical patients. Outpatients of a dermatology department (homeopathy study) and inpatients evaluated at an anesthesiology department (lunar phases). Sixty volunteers for the homeopathy study and 14,970 consecutive patients undergoing surgery under general anesthesia for the lunar phase study. Treatment of children with warts with individually selected homeopathic preparations (homeopathic study); surgical procedures including abdominal, vascular, cardiac, thoracic, plastic, and orthopedic operations and assessment of the lunar phase at the time of operation (lunar phase study). Reduction of area occupied by warts by at least 50% within 8 weeks; death from any cause within 30 days after surgery. Nine of 30 subjects in the homeopathy group and 7 of 30 subjects in the placebo group experienced at least 50% reduction in area occupied by warts (chi 2 = 0.34; P = .56); the mortality rate was 1.20% in patients operated on during waxing moon and 1.33% in patients operated on during waning moon (chi 2 = 0.49; P = .50). Statements and methods of alternative medicine--as far as they concern observable clinical phenomena--can be tested by scientific methods. When such tests yield negative results, as in the studies presented herein the particular method or statement should be abandoned. Otherwise one would run the risk of supporting superstition and quackery.
Article
The effect of the full moon on human behaviour, the so-called 'Transylvania hypothesis', has fascinated the public and occupied the mind of researchers for centuries. The aim of the present study was to determine whether or not there was any change in general practice consultation patterns around the time of the full moon. We analysed data from the fourth national morbidity study of general practice. The data set was split into two groups and analysed separately: consultations on ordinary weekdays and consultations on weekends and bank holidays. The data were split randomly into two equal sets, one for model building and one for model validation. The lunar cycle effect was assumed to be sinusoidal, on the grounds that any effect would be maximal at the time of the full moon and decline to the new moon, following a cosine curve (with a period of 29.54 days, the mean length of a lunar cycle). There was a statistically significant, but small, effect associated with the lunar cycle of 1.8% of the mean value [95% confidence interval (CI) 0.9-2.7%]. This equates to an average difference between the two extremes during the cycle of 3.6%. For this data set, this accounts for 190 (95% CI 95-285) more consultations on days at the peak of the cycle compared with those at the bottom of the cycle, or, put another way, about three consultations per practice. We can speculate neither as to what the nature of these moon-related problems may be, nor as to the mechanisms underpinning such behaviour. However, we have confirmed that it does not seem to be related to anxiety and depression.
Article
The relation between spontaneous pneumothorax events and synodic lunar cycle was studied in a retrospective analysis of patients with a first or recurrent spontaneous pneumothorax. The study included a total of 244 patients, 203 males and 41 females. The data were arranged along the first (new moon) to 28th day (one day before another new moon) of the synodic lunar cycle. Periodogram analysis revealed a 14-day rhythm, significant for the male and pooled sample. Cosinor analysis found the whole synodic lunar cycle and its 2nd, 4th and 5th harmonics as significant. Maximal accumulation of cases happened 1 week before and 1 week after the new moon. Mechanisms of a putative moon influence are not clear.
Article
Mass media deliver pertinacious rumours that lunar phases influence the progress and long-term results in several medical procedures. Peer reviewed studies support this, e.g. in myocardial infarction, others do not. We looked retrospectively at the dates of cardiac arrests (CA; n=368) of cardiac origin and of acute myocardial infarctions (AMI) with consecutive thrombolytic therapy or acute PTCA (n=872) and at the lunar phases at the corresponding dates. Medical data had been collected prospectively on the patient's admission. The lunar phases were defined as full moon+/-1 day, new moon+/-1 day and the days in between as waning and waxing moon. The incidence of these cardiac events at each phase was calculated as days with a case divided by the total number of days of the specific moon phase in the observation period (1992-1998). Wilcoxon Rank Test was used for statistical analysis. AMI and CA occurred on equal percentages of days within each lunar phase: AMI on 35% of all days with new moon, on 38% of full moon days, on 39% waning, and on 41% of the waxing moon days; CA on 19, 17, 16 and 16% of all days of the respective lunar phase. This difference was not significant. Lunar phases do not appear to correlate with acute coronary events leading to myocardial infarction or sudden cardiac death.