Full Moon and Out-of-Hospital Cardiac Arrest in Japan - Population-Based, Double-Controlled Case Series Analysis

Background: It is commonly believed that a full moon affects human behavior or the occurrence and outcome of various diseases; thus, the occurrence of out-of-hospital cardiac arrest (OHCA) might increase during full moon nights.

Methods and Results: This nationwide, population-based observational study consecutively enrolled OHCA patients in Japan with attempted resuscitation between 2005 and 2016. The primary outcome measure was the occurrence of OHCA. Based on the double-control method, assuming Poisson sampling, we evaluated the average number of OHCA events that occurred on full moon nights compared with that which occurred on control nights, which included events that occurred on the same calendar days 1 week before and after the full moon nights. A total of 29,552 OHCA that occurred on 148 full moon nights and 58,707 OHCA that occurred on 296 control nights were eligible for analysis. The occurrence of OHCA did not differ between full moon and control nights (199.7 vs. 198.3 per night; relative risk [RR], 1.007; 95% CI: 0.993–1.021). On subgroup analysis, compared with control nights, the RR of OHCA occurrence were 1.013 (95% CI: 0.994–1.032, P=0.166) and 0.998 (95% CI: 0.977–1.020, P=0.866) for cardiac and non-cardiac origins, respectively.

Conclusions: In this population, there was no significant difference in OHCA occurrence between full moon and control nights.

Lunar cycle in homicides: a population-based time series study in Finland

OBJECTIVE

To test whether homicides in Finland vary according to moon phases.

DESIGN

A time series study.

SETTING

Finland.

PARTICIPANTS

6808 homicides committed in 1961-2014.

OUTCOME

Daily numbers of homicides.

METHOD

The daily numbers of homicides were related to eight moon phases and the illuminated percentage of the moon disc using negative binomial regression. To identify lunar patterns, piecewise linear terms of lunar days were used, together with changes from one moon phase to another. Homicides were similarly regressed on quintiles of the illuminated percentage of the moon disc. A periodic term of length 29.53 days was included to detect cyclic patterns. The results were adjusted for sex, age, secular trend, distance from the moon, seasons, weekday, major holidays and temperature.

RESULTS

During the full moon, 15% less homicides were committed than during the new moon (RR 0.85; 95% CI 0.77 to 0.94) and 86% less during the lightest quintile of illumination compared with the darkest quintile (RR 0.14; 95% CI 0.04 to 0.50). Adjustments did not change the results. Piecewise linear regressions showed a significant decline in homicides at the full moon and a rise thereafter. The full moon drop in homicides was directionally similar for seasons, weekdays, sex, age and time periods, and it was particularly pronounced in the early part of period studied (1961-1974). Periodic regression showed a regular cyclic pattern of length 29.53 days (p~0.035).

CONCLUSIONS

Contrary to current scientific opinion, an association exists between moon phases and homicides, and contrary to what has been previously assumed, homicides declined during the full moon, especially in earlier decades. However, the causality of the association remains elusive.

Astrology and the Scientific Method

Despite the fact that virtually all scientists reject astrology as unfounded superstition, it continues to hold a powerful grip on the belief-systems of millions of people. With the advent of computer technology, rigorous statistical tests have been carried out to examine the validity of the oft-heard claim that astrology works. The results of these recent tests are uniformly negative. Application of the scientific method then leads us to reject the astrological hypothesis.

Impact of the moon on cerebral aneurysm rupture

BACKGROUND

Several external and internal risk factors for cerebral aneurysm rupture have been identified to date. Recently, it has been reported that moon phases correlate with the incidence of aneurysmal subarachnoid hemorrhage (SAH), however, another author found no such association. Therefore, the present study investigates the influence of the lunar cycle on the incidence of aneurysmal rupture, the initial clinical presentation, and the amount of subarachnoid blood.

METHODS

Lunar phase and the particular day of the lunar cycle were correlated to the date of aneurysm rupture, aneurysm location, initial clinical presentation, and amount of subarachnoid blood assessed from CT scans of all patients treated for basal SAH in our department from 2003 to 2010.

RESULTS

We found no correlation between incidence of aneurysmal SAH, location of the aneurysm, initial clinical presentation, or amount of subarachnoid blood and the lunar cycle.

CONCLUSIONS

The moon influences neither the incidence of aneurysmal SAH nor the grade of initial neurological deterioration or amount of subarachnoid blood.

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

Objective

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.

Methods

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.

Results

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 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.

Human responses to the geophysical daily, annual and lunar cycles

Collectively the daily, seasonal, lunar and tidal geophysical cycles regulate much of the temporal biology of life on Earth. The increasing isolation of human societies from these geophysical cycles, as a result of improved living conditions, high-quality nutrition and 24/7 working practices, have led many to believe that human biology functions independently of them. Yet recent studies have highlighted the dominant role that our circadian clock plays in the organisation of 24 hour patterns of behaviour and physiology. Preferred wake and sleep times are to a large extent driven by an endogenous temporal program that uses sunlight as an entraining cue. The alarm clock can drive human activity rhythms but has little direct effect on our endogenous 24 hour physiology. In many situations, our biology and our society appear to be in serious opposition, and the damaging consequences to our health under these circumstances are increasingly recognised. The seasons dominate the lives of non-equatorial species, and until recently, they also had a marked influence on much of human biology. Despite human isolation from seasonal changes in temperature, food and photoperiod in the industrialised nations, the seasons still appear to have a small, but significant, impact upon when individuals are born and many aspects of health. The seasonal changes that modulate our biology, and how these factors might interact with the social and metabolic status of the individual to drive seasonal effects, are still poorly understood. Lunar cycles had, and continue to have, an influence upon human culture, though despite a persistent belief that our mental health and other behaviours are modulated by the phase of the moon, there is no solid evidence that human biology is in any way regulated by the lunar cycle.

Are patient falls in the hospital associated with lunar cycles? A retrospective observational study

BACKGROUND

Falls and associated negative outcomes in hospitalized patients are of significant concerns. The etiology of hospital inpatient falls is multifactorial, including both intrinsic and extrinsic factors. Anecdotes from clinical practice exist in which health care professionals express the idea that the number of patient falls increases during times of full moon. The aim of this study was to examine in-hospital patient fall rates and their associations with days of the week, months, seasons and lunar cycles.

METHODS

3,842 fall incident reports of adult in-patients who fell while hospitalized in a 300-bed urban public hospital in Zurich, Switzerland were included. Adjusted fall rates per 1'000 patient days were compared with days of the week, months, and 62 complete lunar cycles from 1999 to 2003.

RESULTS

The fall rate per 1000 patient days fluctuated slightly over the entire observation time, ranging from 8.4 falls to 9.7 falls per month (P = 0.757), and from 8.3 falls on Mondays to 9.3 falls on Saturdays (P = 0.587). The fall rate per 1000 patient days within the lunar days ranged from 7.2 falls on lunar day 17 to 10.6 falls on lunar day 20 (P = 0.575).

CONCLUSION

The inpatient fall rates in this hospital were neither associated with days of the week, months, or seasons nor with lunar cycles such as full moon or new moon. Preventive strategies should be focused on patients' modifiable fall risk factors and the provision of organizational conditions which support a safe hospital environment.

Onset of spontaneous pneumothorax and the synodic lunar cycle

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.

LUNACY REVISITED

The idea that the stars and planets may influence human health and behavior can be traced to at least Roman times, and research suggests a high proportion of health professionals continue to hold this belief. Nevertheless, evidence for the supposed influence of the moon on human behavior has proved particularly elusive, and research has tended to suffer from weaknesses in methodology and data analysis. This article reports findings drawn from a re-analysis of data from a research study into the functioning of a sample of mentally ill people living in the community. The mental health and quality of life of a sample of 100 people were assessed on four occasions during a 30-month period. Data were aggregated to represent the span of one lunar month, with scores being allocated to the relevant week of the lunar cycle during which each assessment was made. Comparison of mean values across the weeks of the lunar cycle was preformed using the ANOVA, Results showed significant change at the time of the full moon only in subjects with a diagnosis of schizophrenia (n = 56), where deterioration was observed in three areas of psychopathology and one area of quality of life. Some implications for nursing practice are discussed, and it is suggested that future research into the possibility of a lunar effect on human life should focus on the direct measurement of functioning in people with schizophrenia.

The full moon and ED patient volumes: unearthing a myth

To determine if there is any effect of the full moon on emergency department (ED) patient volume, ambulance runs, admissions, or admissions to a monitored unit, a retrospective analysis of the hospital electronic records of all patients seen in an ED during a 4-year period was conducted in an ED of a suburban community hospital. A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.

Belief in lunar effects on human behavior

Questionnaires sent to 325 people indicated that 140 people (43%) held the personal belief that lunar phenomena alter individual behavior. Specifically, mental health professionals (social workers, master's clinical psychologists, nurses' aides, LPNs) held this belief more strongly than other occupational groups.

Lunar phases and psychiatric hospital admissions

To assess the lunar hypothesis as predictive of mental health emergencies and antisocial behavior, the relation of the lunar hypothesis and the occurrence of psychiatric hospital admissions of developmentally disabled adults was examined. The full moon phase of the lunar cycle did not explain a higher rate of hospital admission and accounted for only .007% of the variance. A critique of the methodology in prior research led to the suggestion that more immediate stressors and environmental factors are more plausible contributing factors to hospital admission.

Geophysical variables and behavior: LXXII. Barometric pressure, lunar cycle, and traffic accidents

This study assessed relationships between traffic accidents and variables of the physical environment. Daily data on traffic accidents over a 4-year period were compared with daily records of barometric pressure and synodic lunar cycle. No significant variations in the number of accidents were found related to barometric height but a significant lunar periodicity was observed for one of the years considered. The number of accidents occurring during the full moon day was lowest; the highest occurred two days before the full moon. Accidents occurred more frequently during crescent moon than during waning moon, but no significant differences were noted when the lunar month was divided into four intervals of new moon, first quarter, full moon, and second quarter.

Snow fall and heart attacks

Total numbers of daily hospital admissions for cardiac emergencies were obtained from 3 hospitals within the Sudbury Basin in Canada for November through March for each of 4 consecutive years (1983-1986). Major diagnostic categories were also differentiated. No statistically significant correlations were found between the amount of snowfall during the day of or the days before or after admissions for the major categories of cardiac emergency. Specific analyses, conducted to reveal possible recondite associations between extreme or cumulative snowfalls and the most extreme days of cardiac emergencies, indicated a chance association. We conclude that the occurrence of heart attacks is independent of snowfall but that, when they occur, they are attributed to shoveling if there has been a recent major snow storm.

Suicide and lunar cycles: a critical review over 28 years

20 studies which have examined the relations between completed suicide or attempted suicide and suicide threats with the synodic lunar cycle are reviewed. Most studies indicated no relation between lunar phase and the measures of suicide. The positive findings conflicted, have not been replicated, or were confounded with variables such as season, weekday, weather, or holidays. It is concluded that there is insufficient evidence for assuming a relationship between the synodic lunar cycle and completed or attempted suicide.

Geophysical variables and behavior: LXVIII. Distal and lunar variables and traffic accidents in Saskatchewan 1984-1989

The daily total number of traffic accidents and traffic accident severity for the years 1984 to 1989 in Saskatchewan were analyzed to estimate relationships with day of the week, season of the year, and various lunar variables (lunar phase, distance of the moon from the earth, and moon-sun tidal index). A regression model with both a linear term and a trigonometric term was fitted to the data. No relationship between lunar cycles and total accidents or severity of accident was found. A larger number of total accidents was found during the winter months and weekends; however, more severe accidents tended to occur during the summer months. A slight linear trend was uncovered for total accidents over the time period under consideration.

Critical comment on Hicks-Caskey and Potter, "Effect of the full moon on a sample of developmentally delayed, institutionalized women"

Hicks-Caskey and Potter (1991) claim to have found a "full moon effect" on women in a developmental center. Further, they suggest the discrepancies in findings on lunar effects can be accounted for by (i) a lack of equivalent operational definitions and (ii) a person selection factor. It is argued that the Hicks-Caskey and Potter findings are undermined by weekday, holiday, season, weather, particular staff-subject interactions, and expectancy effects. In addition, the proposed explanations for differing outcomes in lunar studies do not explain both the negative findings and conflicting positive findings.

Effects of moon phase and other temporal variables on absenteeism

Previous research on the effects of lunar phase on deviant behavior has produced weak and inconsistent results and has been criticized for failing to use appropriate statistical controls. This study examined the effects of the full moon on daily absenteeism rates in a large organization while correcting for autocorrelation and controlling for the effects of the day of the week, month, and proximity to a holiday. Contrary to expectations, the full moon was associated with a significant (but very slight) decrease in absenteeism. Reasons for persistent beliefs in the effects of the full moon are discussed.

Attempted suicide and the lunar cycle

An analysis of 383 cases of attempted suicide presented to the Accident and Emergency Department during 12 complete lunar cycles (one year) gave no support for an association between attempted suicide and the lunar cycle, especially the full moon. No control for weekends or holidays was made.

Effect of the full moon on a sample of developmentally delayed, institutionalized women

Over 19 lunar months reports of all aggressive acting-out misbehaviors as recorded by direct-care staff were evaluated and recorded on a day-by-day basis for a randomly selected sample of 20 developmentally delayed women, CA 18 to 50; MA, 9 to 18 months. All had been in continuous residence in a residential treatment center for a minimum of 31 months. A grid representing the 24-hr. period of the full moon (a), the three days prior to the day of the full moon (b), the three days after the full moon (c), and the balance of the lunar period (d) was placed over the record. Comparisons using the Duncan multiple-range test indicated that the mean number of misbehaviors on the day of the full moon was significantly higher than the mean number on any other day of the lunar period (the next highest was for the three days prior to the day of the full moon).

Lunar phase and birthrate: a 50-year critical review

This review examines 21 studies for which data relating to lunar periodicities and birth have been analyzed. There is insufficient evidence to support such a relationship. Most studies have reported negative results, and the positive studies contradict each other.