Belief in lunar effects on human behavior

How Cultural Behaviors and Superstitions Associate the Willingness to Undergo Cataract Surgery in Taiwan: A Nationwide Survey

Background and Objectives: Cultural beliefs influence the conceptualization, adaptation, and coping strategies for diseases. This study aimed to investigate the impact of cultural beliefs and customs on the willingness to undergo cataract surgery in Taiwan. Materials and Methods: The data were retrospectively retrieved from the national Longitudinal Health Insurance Database 2000 (LHID2000). From the national database, we enrolled patients that were diagnosed with cataracts and underwent cataract surgery from 2001 to 2010. All the patients were stratified according to their gender and living area. Gender was categorized as male or female, and the living area was classified as urban or rural. We compared the difference in the number of surgeries between stratified patient groups in each Chinese lunar month. Results: The number of cataract surgeries decreased significantly in the seventh and twelfth lunar months for both genders. There was a significant reduction in cataract surgeries in both the urban and rural groups during the seventh lunar month. Interestingly, only the seventh lunar month had an association with sex in different living areas, which meant that in the seventh month, there was a gender-specific difference in the surgical numbers. Conclusions: The Taiwanese population holds a belief that surgical procedures, including cataract surgery, during the lunar ghost month is inauspicious. Citizens tend to avoid elective surgery due to cultural practice, resulting in a decrease in surgical numbers during the period of the Chinese New Year. The authorities should consider these cultural behaviors when developing medical policies and allocating resources. Healthcare providers should be aware of these superstitions and take them into account when providing medical care and advice to patients.

Lunar cycle, seasonal variation, and prevalence of emergency urological presentations: correlation or coincidence?-A preliminary report

Objective:

The objective of this study was to conduct a pilot study to determine the prevalence and patterns of emergency urological presentations and to evaluate their relationship with the lunar cycle and seasonal variation.

Methods:

Medical records of subjects that presented with urological pathology to the Emergency Department during the 2017 calendar year were retrospectively reviewed. The data extracted included demographic details, date and day of presentation, presenting complaints, investigations, radiological findings, and final diagnosis. Associations between emergent presentations and the lunar phase and seasonal variation were determined.

Results:

A total of 199 subjects were enrolled. The median participant age was 49 (interquartile range 31–64) years with the majority (n = 136, 68.3%) being male. Cystitis (n = 55, 27.6%), prostate cancer (n = 30, 15.1%), benign prostatic hypertrophy (n = 29, 14.6%), and urolithiasis (n = 29, 14.6%) were the most common clinical diagnosis. There were 96 (48.2%) patients who presented during the waxing moon phase, whereas 85 (42.7%) presented during the waning moon phase, 11 (5.6%) presented on the day of full moon, and 7 (3.5%) patients presented on the day of the new moon. Most patients presented during the summer months (n = 61, 30.7%). There was no significant association between the lunar cycle and emergent urological presentations (p = 0.99).

Conclusion:

In this pilot study, there was no significant association between the lunar cycle and emergent urological presentations. However, during the summer months more urology-related emergency presentations to the Emergency Department were observed.

Relationship of the lunar cycle with Down's syndrome screening and its effects

The present study aimed to analyze the positive rate of Down syndrome in second-trimester pregnant women in 1 lunar cycle and calculate variation coefficients of daily person numbers and daily positive rates in this population so as to explore the relationship of the lunar cycle with Down syndrome screening and its effects.Data and laboratory results of 51,450 second-trimester pregnant women who underwent Down syndrome screening between May 2013 and June 2017 of the Chinese lunar calendar were collected. The patients were allocated into groups according to the time period of the lunar cycle based on the start date of their last menstruation. In the Chinese lunar calendar, 1 lunar cycle is divided into eight time periods. The positive rate of Down syndrome in pregnant women with the same start date of last menstruation and changes in their variation coefficients of daily person numbers and daily positive rates were analyzed.The findings displayed the lowest positive rate of Down syndrome in the group of pregnant women who had the start date of last menstruation within the full-moon time period. The greatest variation coefficients of daily person numbers and daily positive rates were also found in the same group.The study showed that the moon indeed affected pregnant women, and the effect reached the peak by the full moon. The effect interfered with the body homeostasis of pregnant women to a certain degree. Therefore, the relationship of the lunar cycle with Down syndrome screening reflected the interaction of the moon with the homeostasis of pregnant women.

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.

Secular pattern of aneurismal rupture with the lunar cycle and season

Background The lunar cycle and seasons may be associated with rates of rupture of intracranial aneurysms, but the literature is mixed. Studies of the association between the lunar cycle and rates of aneurysm rupture used the eight qualitative moon phases. The purpose of this study was to assess any association of aneurysm rupture with the lunar cycle and with the season. Materials and methods We retrospectively reviewed all cases of subarachnoid haemorrhage secondary to ruptured intracranial aneurysm treated with endovascular coiling in our institution over a 10-year period. We included only cases with a known rupture date. We used the degree of illumination of the moon to quantitatively code the lunar cycle. Results A total of 212 cases were included in our analyses. The odds of aneurysm rupture were significantly greater ( p < 0.001) when the moon was least (new moon) and most (full moon) illuminated, as compared to the middle of the lunar cycle. The odds of rupture tended to be higher ( p = 0.059) in the summer, compared to autumn. Conclusions The odds of aneurysm rupture were greater when the moon was least illuminated (new moon) and most illuminated (full moon), compared to the middle of the lunar cycle.

Effect of lunar phase on frequency of psychogenic nonepileptic events in the EMU

INTRODUCTION

Studies of the effect of a full moon on seizures have yielded mixed results, despite a continuing prevailing belief regarding the association of lunar phase with human behavior. The potential effect of a full moon on psychogenic nonepileptic events has not been as well studied, despite what anecdotal accounts from most epilepsy monitoring unit (EMU) staff would suggest.

METHODS

We obtained the dates and times of all events from patients diagnosed with psychogenic nonepileptic events discharged from our EMU over a two-year period. The events were then plotted on a 29.5-day lunar calendar. Events were also broken down into lunar quarters for statistical analysis.

RESULTS

We found a statistically significant increase in psychogenic nonepileptic events during the new moon quarter in our EMU during our studied timeframe.

CONCLUSION

Our results are not concordant with the results of a similarly designed past study, raising the possibility that psychogenic nonepileptic events are not influenced by lunar phase.

Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

OBJECTIVES

Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap.

METHOD

Narrative review based on a literature search of PubMed and Google Scholar.

RESULTS

Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures.

CONCLUSIONS

The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.

Pediatric psychiatric emergency department visits during a full moon

OBJECTIVE

This study aimed to verify the hypothesis that the lunar cycle influences the number of pediatric psychiatric emergency department (ED) visits.

METHODS

Pediatric psychiatric ED visits between 2009 and 2011 were obtained retrospectively. Patients aged between 4 and 21 years presenting to Miami Children's Hospital ED with a primary psychiatric complaint were included in the study. Patients with a concomitant psychiatric problem and a secondary medical condition were excluded. The number of psychiatric visits was retrieved for the full moon dates, control dates as well as the day before and after the full moon when the moon appears full to the naked eye (full moon effect). A comparison was made using the 2-sample independent t test.

RESULTS

Between 2009 and 2011, 36 dates were considered as the true full moon dates and 108 dates as the "full moon effect." A total of 559 patients were included in the study. The 2-sample independent t tests were performed between the actual full moon date and control dates, as well as between the "full moon effect" dates and control dates. Our results failed to show a statistical significance when comparing the number of pediatric psychiatric patients presenting to a children's hospital ED during a full moon and a non-full moon date.

CONCLUSIONS

Our study's results are in agreement with those involving adult patients. The full moon does not affect psychiatric visits in a children's hospital.

Howling at the moon? The effect of lunar phases on post-surgical pain outcome

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.

Web-search trends shed light on the nature of lunacy: relationship between moon phases and epilepsy information-seeking behavior

In old and modern times and across cultures, recurrent seizures have been attributed to the lunar phase. It is unclear whether this relationship should be classified as a myth or whether a true connection exists between moon phases and seizures. We analyzed the worldwide aggregated search queries related to epilepsy health-seeking behavior between 2005 and 2012. Epilepsy-related Internet searches increased in periods with a high moon illumination. The overall association was weak (r=0.11, 95% confidence interval: 0.07 to 0.14) but seems to be higher than most control search queries not related to epilepsy. Increased sleep deprivation during periods of full moon might explain this positive association and warrants further study into epilepsy-related health-seeking behavior on the Internet, the lunar phase, and its contribution to nocturnal luminance.

Impact of seasonal and lunar cycles on psychological symptoms in the ED: an empirical investigation of widely spread beliefs

OBJECTIVES

This study evaluates the impacts of seasonal and lunar cycles on anxiety and mood disorders, panic and suicidal ideation in patients consulting the emergency department (ED) with a complaint of unexplained chest pain (UCP).

METHODS

Patients with UCP were recruited from two EDs. Psychiatric diagnoses were evaluated with the Anxiety Disorders Interview Schedule for DSM-IV.

RESULTS

Significant seasonal effects were observed on panic and anxiety disorders, with panic more frequently encountered during spring [odds ratio (OR)=1.378, 95% confidence interval (CI)=1.002-1.896] and anxiety disorders during summer (OR=1.586, 95% CI=1.037-2.425). Except for one significant finding, no significant effects of lunar cycles were observed. These findings encourage ED professionals and physicians to abandon their beliefs about the influence of lunar cycles on the mental health of their patients. Such unfounded beliefs are likely to be maintained by self-fulfilling prophecies.

The influence of lunar phases on the occurrence of myocardial infarction: fact or myth? The MONICA/KORA Myocardial Infarction Registry

AIMS

The potential influence of lunar phases on the occurrence of myocardial infarction is still controversial. The purpose of the present study was to investigate the association of the lunar cycle on the occurrence of fatal and non-fatal myocardial infarction based on a myocardial infarction registry.

METHODS AND RESULTS

We studied 15,985 patients consecutively hospitalised with an acute myocardial infarction (AMI) between 1 January 1985 and 31 December 2007 with a known date of symptom onset who were recruited from a population-based myocardial infarction registry. The exact hour of AMI onset was known for 9813 events. Poisson regression analysis was performed to examine the relation between the lunar cycle and the occurrence of AMI. There was no association between new moon, full moon, waning moon and waxing moon and the occurrence of AMI. However, we observed that the three days after a new moon may be significantly protective for the occurrence of AMI, rate ratio (RR) 0.94 (95% CI 0.91-0.98), and the day before a new moon had a slightly negative effect (RR 1.06, 95% CI 1.00-1.12). Stratified analysis did not reveal any susceptible subgroups.

CONCLUSION

The moon phases did not show any apparent association with AMI occurrence. However, there might be a 'cardioprotective' time three days after a new moon.

Popular belief meets surgical reality: impact of lunar phases, Friday the 13th and zodiac signs on emergency operations and intraoperative blood loss

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Relationship between lunar phases and serious crimes of battery: a population-based study

OBJECTIVE

The hypothesis of a lunar influence on human abnormal behavior is still widespread, although research has led to conflicting findings. Therefore, a population-based study to assess the influence of lunar phases on violent crimes was conducted.

METHODS

The study included all serious crimes of battery (aggravated assaults) committed in Middle Franconia (Bavaria, Germany) between 1999 and 2005 (n = 23 142). Data were analyzed regarding lunar phase, sex, and place of crime scene (outdoor vs indoor).

RESULTS

No significant associations between full, absent, and the moon's interphases and serious crimes of battery could be detected. Furthermore, a Fourier analysis was conducted that failed to produce an association between violence and the moon's phases.

DISCUSSION

Several possible explanations for the presented results are discussed including biological and social mechanisms.

CONCLUSIONS

The present study fails to find a significant association between lunar phases and crimes of battery.

Influence of Lunar Phases on Suicide: The End of a Myth? A Population‐Based Study

The hypothesis of lunar influence on suicide remains widespread, despite the fact that little scientific evidence to substantiate it. We conducted a population-based study to assess the influence of the lunar phases on suicides according to age, sex, and chosen method. The study included all suicides in Middle Franconia between 1998 and 2003. From a population-based sample of 3351 events, the files of 3054 suicides (1949 males and 1105 females) were complete for the study variables. Data were categorized by lunar phase, sex, age, and chosen method-"violent" vs. "non-violent" acts. No significant relationship was detected between the full, absent, and moon's interphases and suicide incidence. Nevertheless, there was a weak association between the absent moon and choice of a non-violent suicide method in men aged less than the median of 40.2 yrs. There was no evidence of a relationship between suicide and lunar phase. Some explanations for this phenomenon are discussed.

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.

Admission to intensive care for parasuicide by self-poisoning: variation by time cycles, climate and the lunar cycle

The aim of this study was to characterize patients after self-poisoning with suicidal intent regarding age, sex and type of substances ingested, as well as to identify temporal variations of attempted suicides and associations with climate variables and the lunar cycle. During the years 2002-2004, a total of 691 patients were admitted for self-poisoning parasuicides. The male to female ratio was 1:1.65 with mean ages of 39 and 37 years, respectively. Benzodiazepines and antidepressants were the most frequently taken substances. A significant variation with the time of the day with a peak before midnight was observed for both sexes. Variation with the day of the week was less clear and showed a peak incidence for parasuicides on Mondays. There was no significant variation with the monthly or annual cycle. The frequency of parasuicides was associated with "bad weather" (precipitation). No association of parasuicide incidences to the lunar cycle was observed.

Moonstruck? The effect of the lunar cycle on seizures

Recent reports on the effects of the lunar cycle on seizure occurrence have yielded mixed results. If the moon phase is influential, we hypothesized that this would be due to the moon's contribution to nocturnal illumination, rather than its waxing or waning state, and that significant correlations would not be apparent if local cloud cover were controlled for. We found a significant negative correlation between the mean number of seizures and the fraction of the moon illuminated by the sun (rho=-0.09, P<0.05) in 1571 seizures recorded in a dedicated epilepsy inpatient unit over 341 days. This correlation disappeared when we controlled for the local clarity of the night sky, suggesting that it is the brightness of the night and the contribution the moon phase makes to nocturnal luminance, rather than the moon phase per se, that may influence the occurrence of epileptic seizures.

Association of environmental factors with the onset of status epilepticus

OBJECTIVE

The goal of the work described here was to investigate the influence of environmental factors on admissions of patients with status epilepticus (SE) to the intensive care unit (ICU).

METHODS

This retrospective cohort study analyzed all admissions to a university hospital ICU because of SE. Poisson regression and likelihood ratio tests were employed to determine associations between environmental factors and the incidence of SE.

RESULTS

Data on 184 patients (mean age: 57, range: 18-89) indicated a significant (P<0.0001) diurnal pattern, with admissions peaking between 4 and 5 PM and reaching a minimum in the early morning. No significant weekly, monthly, or seasonal pattern was observed. Admissions varied significantly across the lunar cycle (P=0.003), peaking at Day 3 after new moon and being minimal 3 days before new moon. The incidence of SE increased on bright days (P=0.04) and with the duration of daily sunshine (P=0.03). High relative humidity (P<0.01), high temperature (P<0.05), and dark days (P=0.02) were significantly protective factors. The incidence of SE on weekends was significantly lower in the subgroup of patients with known epilepsy (P=0.004), and the risk of nonconvulsive SE was significantly higher in summer (P=0.04).

CONCLUSIONS

Admissions of patients with SE to the ICU are significantly associated with several environmental protective and precipitating factors, such as diurnal, weekly, and lunar cycles and weather variables.

The influence of the full moon on the number of accessions to an animal emergency centre

OBJECTIVE

To test the hypothesis that the number of animal emergency centre accessions is associated with the time of the full moon.

DESIGN AND PROCEDURE

Retrospective study. A comparison was made of the number of accessions to the University of Melbourne Animal Emergency Centre in the period February 2003 to January 2006 on full moon and non-full moon days, adjusted for day of the week and public holiday. A three day period with the day of the full moon as the middle day was taken to be a full moon period.

RESULTS

A total of 12,102 animals were presented to the Centre in this time. An adjusted count ratio of 1.048 (95% CI 0.97 to 1.14; P = 0.26) for accessions on full moon days compared with those on non-full moon days indicated that there was no significant association between the full moon and the number of accessions per day.

CONCLUSION

There was no significant difference between the number of animals presented to the University of Melbourne Animal Emergency Centre on full moon days and non-full moon days.

Sleepless night, the moon is bright: longitudinal study of lunar phase and sleep

Popular belief holds that the lunar cycle affects human physiology, behaviour and health. We examined the influence of moon phase on sleep duration in a secondary analysis of a feasibility study of mobile telephone base stations and sleep quality. We studied 31 volunteers (18 women and 13 men, mean age 50 years) from a suburban area of Switzerland longitudinally over 6 weeks, including two full moons. Subjective sleep duration was calculated from sleep diary data. Data were analysed using multiple linear regression models with random effects. Mean sleep duration was 6 h 49 min. Subjective sleep duration varied with the lunar cycle, from 6 h 41 min at full moon to 7 h 00 min at new moon (P < 0.001). Average sleep duration was shortened by 68 min during the week compared with weekends (P < 0.001). Men slept 17 min longer than women (P < 0.001) and sleep duration decreased with age (P < 0.001). There was also evidence that rating of fatigue in the morning was associated with moon phase, with more tiredness (P = 0.027) at full moon. The study was designed for other purposes and the association between lunar cycle and sleep duration will need to be confirmed in further studies.

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.

Appointments at a thyroid outpatient clinic and the lunar cycle

INTRODUCTION

Several variables of health-related human behaviour have been analysed with regard to a possible association with lunar phases. The aim of this study was to evaluate a possible relation between the lunar cycle and the number of requests for appointments at an outpatient clinic. This variable has not been studied hitherto.

METHODS

We analysed a total number of 11,413 requests for appointments at our thyroid outpatient clinic during one year. Access to this clinic is not restricted, and all patients with known or suspected thyroid disease living in the area of Vienna may ask for an appointment. During the study period, 8,852 patients requested a follow-up appointment, and 2561 patients asked for a new appointment. We analysed a possible cyclic pattern in these requests using a nonlinear regression model based on both groups of patients.

RESULTS

A cosinus curve with a period of 29.531 days (the mean length of a lunar cycle) was significantly associated with the number of requests for both follow-up appointments (p = 0.007) and new appointments (p = 0.001). Requests for follow-up appointments had their highest peaks three days after the full moon, whereas requests for new appointments were most frequent five days afterwards.

CONCLUSION

Our findings suggest that lunar phases may affect patients' requests for appointments at a thyroid outpatient clinic. To the best of our knowledge, this is the first study reporting a possible association between health-related behaviour and lunar phases using requests for appointments as a relevant variable. There is a need for more research into the mechanism underpinning this behaviour.

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 moon and madness reconsidered

Belief that the full moon is associated with psychiatric disturbance persists despite 50 years research showing no association. This article traces the historical roots of belief in the power of the moon to cause disorders the mind, especially insanity and epilepsy. Putative mechanisms of lunar action are critiqued. It is proposed that modern findings showing lack of lunar effect can be reconciled with pre-modern beliefs in the moon's power through a mechanism of sleep deprivation. Prior to the advent of modern lighting the moon was a significant source of nocturnal illumination that affected sleep-wake cycle, tending to cause sleep deprivation around the time of full moon. This partial sleep deprivation would have been sufficient to induce mania/hypomania in susceptible bipolar patients and seizures in patients with seizure disorders. The advent of modern lighting attenuated this lunar effect, especially in modern urban areas, where most 20th century studies of lunar effects on the mind have been conducted. The hypothesis presented in this article is open to empirical validation or falsification. Potential tests for the sleep-deprivation hypothesis of lunar action are discussed.

Lunar cycles and violent behaviour

OBJECTIVE

It is commonly believed that the full moon exerts an influence on violence and aggression in psychiatric settings. The literature to date is contentious. This study used a robust methodology to examine the hypothesis that there was an increased frequency of violent and aggressive behaviour among hospitalised psychiatric clients at the time of the full moon.

METHOD

Prospective data were collected in five inpatient psychiatric settings across the Northern Sydney Area Health Service. Morrison's hierarchy of violence and aggression was used to rate behaviour. Lunar phases were clearly defined and Poisson regression used to examine relationships between lunar phase and violence. Extraneous temporal variation was considered.

RESULTS

No significant relationship was found between total violence and aggression or level of violence and aggression and any phase of the moon.

CONCLUSION

Future research could profitably examine the implications of a belief in the lunar effect among health workers in the face of evidence that no relationship exists between violence, aggression and the lunar cycle.