Stress Clinical Trial
Official title:
A Randomized Cross Over Trial About the Influence of Skin Temperature Gradient on the Variation of Metabolic Hormones in Climates With Different Ambient Air Temperatures
The Cyprus International Institute for Environmental and Public Health of the Cyprus
University of Technology is planning a pilot study of health indicators in relation to
spatially varying climatic conditions ranging from the city to the mountainous environment.
The purpose of the project is to understand the effect of fluctuations in external climatic
conditions on the human body temperature and metabolic biomarkers or stress hormones.
Climate change phenomena such as protracted heat waves that create areas with even higher
temperatures, especially in urban centers, may have a negative impact on human health. The
effects may be acute for an individual with the appearance of discomfort and headaches, while
chronic exposures to high air temperatures for the general population have been linked with
premature mortality and cardiovascular diseases. Due to climate change that is hitting hard
the Mediterranean, these temperature changes have been more and more common in Cyprus in
recent years.
One of the usual ways of dealing with high temperatures is the use of air conditioners. With
sudden and frequent temperature changes during the day, the human body is subject to thermal
shock for varying duration and number of times, having wear and tear consequences for the
human physiology. The investigators hypothesized that the number, duration and frequency of
human exposures to wide gradient (> 8 ° C) of air temperature changes may be related to
potential health problems. An intervention potentially reducing the health risk associated
with extended exposure to high temperatures in the summer for Cypriots may be the temporary
(for a few days or hours) stay in the villages of mountainous area. Most of the mountain
communities in Cyprus have consistently lower mean ambient air temperatures of about 10
degrees Celsius than those in the cities, so the investigators anticipate not observing the
metabolic hormone alterations induced while being in the city environment.
A randomised crossover trial study design was used to: investigate the circadian patterns of
metabolic adipokines (leptin, adiponectin and ghrelin hormones), using targeted biomarker
measurements and untargeted metabolomics in healthy adults residing in two different
climatological environments: urban and higher in latitude mountainous settings, and ii)
investigate the effect of skin temperature gradient on the variation of adipokines in the two
settings (urban and rural).
The study will take place in Cyprus. Participant recruitment will abide by the ethical
principles and the guidelines of the National Bioethics Committee of Cyprus. Participants
will be recruited after they read and complete the consent form and the whole study protocol
is explained to them. Information about the study will be disseminated through flyers and
through telephone communication via governmental and other non-profitable organizations that
will contact community leaders of the area and help us collect and create a contact list of
"Potential Participants". From there, potential participants will be informed about the study
and screened for eligibility criteria via telephone.
Upon consent, the "Potential Participants List" will have to be randomized to assign the
participants in to two different groups. A total of 50-60 subjects will be followed for a
period of one week firstly in an urban environment and later, for the same period, in a
village of the mountainous rural environment, during the summer period in Cyprus.
Once the researchers have names of potential participants, each name will be given a 2-digit
code. This will be participant's study ID that will accompany participants answered
questionnaires, diaries, urine vials and temperature measurement's files. The preparation of
each tool with filled participants ID code and Date will be made at priory.
There will be no blinding since the interventions are known to the participants and the
researchers. There will be the necessary blinding during the conduct of the all laboratory
and statistical analyses.
The field workers and participants will arrange four visits. Visit 1 and 3 will take place
one day before the sampling day which is the last day at each site(urban Vs rural), whereas
visit 2 and 4 will take place a day after the sampling day when collection of the data will
take place.
Except the preparation for the first sampling day during the first visit, participants will
be asked to sign the informed consent form and to fill in two survey questionnaires (baseline
characteristics and chronotype questionnaire). During sampling days, participants will be
handed with the diary of activities, urine vials for urine sample collection and the
instructions form (for urine collection and the use of the personal temperature sensors).
Electronic temperature sensors should be activated by the researchers on the spot and placed
on the participant during the first and third visit. The temperature data collection will be
ensured on the spot during the second and forth visit. Participants will be asked to collect
urine voids by collecting all bladder content during urination in vials provided by the Water
and Health Lab. The first urine void of each sampling day will be discarded. All urine voids
for the rest of the sampling day, of each participant, will be collected, including the first
urine void of the following day. Samples will be kept at a freezer by the participant until
collected by a member of the research team, in cool boxes. Upon arrival at the Water and
Health lab samples, aliquoting will take place and then aliquot samples will be stored in
freezers of -80◦C, until analysis.
Data collected will be digitized, anonymized and statistically evaluated. All data management
steps will be employed to ensure that a final, clean, tidy and replicable dataset will be
produced before proceeding to the statistical analysis. Descriptive statistics of the study
population will be performed that will include parameters such as the mean and standard
deviation for continuous variables and percentages for variables that indicate proportions.
The effect of temperature gradient changes and hormonal level, as well as, differences in
cortisol levels between and within subject variation will be examined. The statistical
analyses will include a range of approaches from descriptive statistics to regression
analysis and metabolomics analyses. Pre-post analyses, non-linear mixed effects models, will
be used to identify correlations of the circadian rhythms of the participants between the two
settings. Statistical evaluation and graphical presentation of results will be prepared for a
final report and presentation. All statistical analyses will be conducted at the Water and
Health laboratory.
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