Sleep and Sleepiness among Brazilian Shift-Working Bus Drivers

The aim of this study was to evaluate daytime and nighttime sleep, as well as daytime and nighttime sleepiness of professional shift-working bus drivers. Thirty-two licensed bus drivers were assessed by nocturnal and diurnal polysomnography (PSG) recording and multiple sleep latency testing (MSLT) sessions. Sleep length was shorter and sleep efficiency reduced during daytime sleep compared with nighttime sleep. Thirty-eight percent of the drivers had indices of obstructive apnea and hypopnea syndrome (>5/h sleep) during nighttime and daytime sleep; more drivers snored during daytime than nighttime sleep (50% vs. 35%, p < 0.05), and 38% of the drivers evidenced periodic leg movements. The MSLT revealed that 42 and 38% of the bus drivers met the criteria for sleepiness when the test was conducted during the day and night, respectively. The daytime as compared to nighttime sleep of shift-working bus drivers was shorter and more fragmented and was associated in many with evidence of excessive sleepiness. Respiratory disorder was a common finding among the professional shift-working bus drivers. All these sleep deficiencies may adversely affect on the job driving performance.     

High Risk for Obstructive Sleep Apnea in Truck Drivers Estimated by the Berlin Questionnaire: Prevalence and Associated Factors

The health issues that attract our attention when analyzing the truck driver population are the high prevalence of sedentary habits, inadequate diet, obesity, and proportion of hypertensive. All these are either considered risk factors for or a consequence of Obstructive Sleep Apnea (OSA). The objective of this study was to investigate the risk for OSA among 10,101 truck drivers and to correlate it with potentially related factors, such as serum glucose and cholesterol levels, smoking habits, alcohol and drug consumption, and self-reported physical activity. The drivers were invited to participate in the campaign “Saúde na Boléia” (Health Behind the Wheel) promoted by a Brazilian company responsible for the maintenance of approximately 360 km of roads in the country. Drivers who spontaneously stopped at the campaign booths placed along the roads were invited to answer a questionnaire covering sociodemographic data such as age, alcohol, and drug consumption. All participants completed a Berlin Questionnaire and were classified as low- or high-risk subjects for OSA based on questions about snoring, tiredness during the day, and the presence of hypertension or obesity. Blood collection was accomplished at the same site by nurses and/or nursing students collaborating with the campaign for subsequent laboratory studies. Approximately 26% of the truck drivers were found to be at high-risk group for OSA. An adjusted multiple logistic model found the independent risk factors of smoking (OR = 1.16; p = 0.014) and drug use (OR = 1.32; p < 0.0001) were associated with high risk for OSA. The presence of self-reported occasional (OR = 0.62; p < 0.0001) and regular (OR = 0.53; p < 0.0001) physical activity was found to be an independent factor protective of OSA. Educational programs, including ones aimed at improving one's health habits, such as engagement in physical exercise, should be considered in the development of initiatives to reduce the risk for OSA among the truck driver population.     

Prevalence and Correlates of Poor Sleep Quality and Daytime Sleepiness in Belgian Truck Drivers

Sleepiness and sleep complaints are common among professional drivers. Sleepiness is a considerable problem not only because it affects the drivers' well-being, but also because of the consequences for performance and safety. Assessment of the (self-reported) prevalence and research into the risk factors are thus an important health issue and are also indispensable to prevent productivity loss and work-related accidents and injuries. Therefore, the aim of this study was to describe sleeping, driving, and health characteristics of Belgian truck drivers and to determine occupational and individual factors associated with poor sleep quality and daytime sleepiness. Cross-sectional data were collected using a self-administered questionnaire that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Berlin Questionnaire (BQ). The mean (SD) age of the 476 studied truck drivers was 42.7 (10.2) yrs and the mean (SD) body mass index was 27.3 (5.1) kg/m². Approximately 47% declared that they drove >50 h/wk and found their work schedule unrealistic. The mean (SD) PSQI score was 4.45 (2.7); poor quality of sleep (PSQI >5) was found in 27.2%. The mean (SD) ESS score was 6.79 (4.17); 18% had a score >10. The BQ indicated that 21.5% had a higher risk on obstructive sleep apnea. In multiple logistic regression analysis, low educational level (odds ratio [OR] 1.86), current smoking (OR 1.75), unrealistic work schedule (OR 1.75), and risk for obstructive sleep apnea (OR 2.97) were found to be independent correlates of daytime sleepiness. Poor sleep quality was significantly associated with poor self-perceived health (OR 1.95), unrealistic work schedule (OR 2.85), low job satisfaction (OR 1.91), and less driving experience (OR 1.73). These results show that poor sleep quality and daytime sleepiness were prevalent in Belgian truck drivers. Taking into account that several significant correlates with respect to these sleep problems were identified both at the individual and the occupational level, comprehensive countermeasures to improve working conditions and organization are needed, as well as health promotion interventions, to ensure the safety and well-being of truck drivers. (Author correspondence: lutgart.braeckman@ugent.be)     

脉压、脉压指数对肥胖预测的前瞻性队列研究

目的:分析成都地区1992年时非肥胖中年居民脉压(PP)、脉压指数(PPI)对该人群15年后(2007年)肥胖发生的预测价值。方法:本研究纳入1992年时年龄处于45～60岁且BMI正常者1017人,依据PP(PP≤60mmHg及PP>60mmHg)及PP(I PPI≤0.450及PPI>0.450)分为PP/PPI正常组及增高组,分析两组人群在15年后(2007年)BMI分布特征及肥胖的患病情况。结果:①1992年PP/PPI增高人群2007年时BMI皆高于PP/PPI正常人群,t检验示BMI组间差异有统计学意义。2007年肥胖患病率亦呈类似BMI的特点,亦为PP/PPI增高组高于PP/PPI正常组,经x2检验,肥胖患病率的组间差异有统计学意义。②根据该队列人群1992年的PP增高与否计算2007年的肥胖患病率的相对危险度(RR)为4.109,P值为0.000,95%可信区间为2.874～8.847;1992年PPI与2007年肥胖患病的RR为4.998,P值为0.000,95%可信区间为2.876～8.687。③使用logistic回归模型分析1992年基线PP/PPI对2007年肥胖患病的影响,在调整了SBP、WC、BMI、HR、TG后,PP、PPI的相对危险度仍为1.040及1.044。其各自相应95%CI分别为1.017～1.065、1.025～1.063。结论:脉压、脉压指数的异常与肥胖的发生关系密切,脉压、脉压指数可以预测肥胖的发生。     

Obesity in Pima Indians: Large increases among post-World War II birth cohorts

Several studies have shown secular increases in obesity during the past 35 years, and others have reported increases in dietary fat consumption during the same period. Here we report a dramatic increase in obesity among Pima Indians born after World War II that appears to be associated with increased exposure to Western customs and diet following 1945. We examined the body mass index (BMI = weight in kilograms/height² in meters) of 1,128 male and 1,372 female Pima Indians aged 15–65 years who were born between 1901 and 1964 and were examined between 1965 and 1990. We found large increases in BMI among Pima Indian men and women in post-World War II birth cohorts (1945 and later). The parallel changes in body mass index, dietary fat, and exposure to Western culture following World War II suggest that culturally mediated changes in diet and level of physical activity associated with modern industrialized society may have led to the large increases in obesity in the Pima Indians and to smaller parallel changes observed worldwide in westernized countries. © 1993 Wiley-Liss, Inc.     

Chemokines and their association with body mass index among healthy Saudis

Obesity is a chronic disorder that is associated with body mass index (BMI) of greater or equal to 30 kg/m². The prevalence of obesity in the Kingdom of Saudi Arabia (KSA) is increasing at an alarming rate and is expected to reach 41% in men and up to 78% in women by 2022. Since chemokines are associated with involuntary weight loss, the objective of this study was to elucidate their association with BMI among Saudis. A questionnaire was used to collect information about diet, health conditions, and demographics from 15 men and 16 women who participated in the study. BMI was calculated based on clinical measurements and participants were classified according to their BMI category as: normal, underweight, overweight, or obese. Serum samples were collected for a multiplex assay using the Human Chemokine Magnetic 30-plex panel. The serum concentration of either the monokine induced by gamma interferon (MIG) or the CXC-motif chemokine ligand 9 (CXCL-9) was significantly increased in obese men (P = 0.0194) and women (P = 0.043) as compared to underweight men and women, respectively. However, the serum levels of other chemokines were not significantly different among the groups. We found that MIG levels are differentially regulated in serum, based on individuals’ BMI.     

儿童阻塞性睡眠呼吸暂停低通气综合征与肥胖的相关性研究

目的:探讨儿童阻塞性睡眠呼吸暂停/低通气综合征(OSAHS)与肥胖的相关性。方法:收集单纯性肥胖儿童120例和体重正常儿童110例作为研究对象,进行统一的体格检查和专科检查,并进行多导睡眠监测记录阻塞性呼吸暂停指数(OAI)、呼吸暂停/低通气指数(AHI)、中枢性呼吸暂停指数(CAI)、最低血氧饱和度(LSa O2)和睡眠效率。结果:肥胖组OSAHS患病率为58.33%显著高于对照组的31.82%,差异有统计学意义(P0.05);OAI、AHI、CAI均显著高于对照组,而LSa O2、睡眠效率指标显著低于对照组,差异均有统计学意义(均P0.05);多因素回归分析显示,肥胖、扁桃体增生、腺样体增生是导致OSAHS的独立危险因素,差异有统计学意义(均P0.05)。结论:肥胖是儿童OSAHS发病的重要影响因素,特别是合并扁桃体肿大或腺样体肿大的患儿应注意预防OSAHS的发生。     

Obesity,physical activity and cancer risks: Results from the Cancer,Lifestyle and Evaluation of Risk Study (CLEAR)

IntroductionPhysical activity (PA) has been associated with lower risk of cardiovascular diseases, but the evidence linking PA with lower cancer risk is inconclusive. We examined the independent and interactive effects of PA and obesity using body mass index (BMI) as a proxy for obesity, on the risk of developing prostate (PC), postmenopausal breast (BC), colorectal (CRC), ovarian (OC) and uterine (UC) cancers.MethodsWe estimated odds ratios (OR) and 95% confidence intervals (CI), adjusting for cancer specific confounders, in 6831 self-reported cancer cases and 1992 self-reported cancer-free controls from the Cancer Lifestyle and Evaluation of Risk Study, using unconditional logistic regression.ResultsFor women, BMI was positively associated with UC risk; specifically, obese women (BMI ≥30 kg/m²) had nearly twice the risk of developing UC compared to women with healthy-BMI-range (<25 kg/m²) (OR = 1.99;CI:1.31–3.03). For men, BMI was also positively associated with the risk of developing any cancer type, CRC and PC. In particular, obese men had 37% (OR = 1.37;CI:1.11–1.70), 113% (OR = 2.13;CI:1.55–2.91) and 51% (OR = 1.51;CI:1.17-1.94) higher risks of developing any cancer, CRC and PC respectively, when compared to men with healthy-BMI-range (BMI<25 kg/m²).Among women, PA was inversely associated with the risks of CRC, UC and BC. In particular, the highest level of PA (versus nil activity) was associated with reduced risks of CRC (OR = 0.60;CI:0.44–0.84) and UC (OR = 0.47;CI:0.27–0.80). Reduced risks of BC were associated with low (OR = 0.66;CI:0.51–0.86) and moderate (OR = 0.72;CI:0.57–0.91) levels of PA. There was no association between PA levels and cancer risks for men.We found no evidence of an interaction between BMI and PA in the CLEAR study.ConclusionThese findings suggest that PA and obesity are independent cancer risk factors.     

Obesity and the incidence of chronic diseases in Spain: A seemingly unrelated probit approach

Western societies can reduce avoidable mortality and morbidity by better understanding the relationship between obesity and chronic disease. This paper examines the empirical association between obesity and the incidence of heart disease, diabetes, hypertension, and elevated cholesterol. We analyze a broadly representative Spanish dataset, the 1999 Survey on Disabilities, Impairments and Health Status, using a health production theoretical framework together with a seemingly unrelated probit model approach that controls for unobserved heterogeneity and endogeneity. Its findings provide evidence of a positive and significant, although specification-dependent, association between obesity and the prevalence of all chronic illness examined.     

Work‐Related Physical Activity Is Not Associated with Body Mass Index and Obesity

Objective: To analyze the association of work‐related physical activity (WRPA) and leisure‐time physical activity (LTPA) with body mass index (BMI) and obesity in the Spanish adult population aged 20 to 60 years. Research Methods and Procedures: The data were taken from the 1993 Spanish National Health Survey. We analyzed a sample of 12,044 men and women representative of the Spanish population aged 20 to 60 years. BMI and frequency of obesity (BMI ≥ 30 kg/m²) were obtained from self‐reported weight and height. Multiple linear regression and logistic regression models were constructed, adjusting for the main confounding factors. WRPA and LTPA were measured by two questions to classify subjects into four categories of physical activity. Results: Neither mean BMI nor percentage of obesity varied significantly (p > 0.05) by WRPA. Mean BMI was significantly higher (p < 0.01) in those who were inactive in their leisure time (25.90 kg/m² in men and 24.43 kg/m² in women) than in those who reported vigorous activity (24.42 kg/m² and 22.97 kg/m² in men and women, respectively). The odds ration (OR) for obesity decreased with increasing level of LTPA in both men (OR of 0.64 for vigorous activity) and women (OR = 0.68), showing a statistically significant dose‐response relation in both men (for linear trend, p = 0.0021) and women (p = 0.0245). Discussion: These results raise questions about the association between WRPA and obesity and suggest the need to reexamine models of the obesity epidemic that point to automation of the workplace as one of the major explanatory factors.     

The long-run effect of education on obesity in the US

The proportion of obese population has been gradually increasing in the US over the past few decades. In this study I investigate how education is associated with Body Mass Index (BMI) in later stages of life. BMI, weight(kg)/height(m)², is the principle measure used for classifying people as obese. Using sibling data and methods that take account of unobserved endowments and environment shared by siblings, I find that there is large variation in BMI between siblings and that education is negatively associated with BMI. One more year of schooling is associated with an estimated reduction of 0.15 in BMI. When considering different education levels, completing college education is associated with 0.7 reduction in BMI relative to high school graduation only. The significant effect of education on obesity that remains in the long-run has policy implications.     

Associations of body mass index with cancer incidence among populations,genders, and menopausal status: A systematic review and meta-analysis

In order to further reveal the differences of association between body mass index (BMI) and cancer incidence across populations, genders, and menopausal status, we performed comprehensive meta-analysis with eligible citations. The risk ratio (RR) of incidence at 10 different cancer sites (per 5 kg/m² increase in BMI) were quantified separately by employing generalized least-squares to estimate trends, and combined by meta-analyses. We observed significantly stronger association between increased BMI and breast cancer incidence in the Asia⿿Pacific group (RR 1.18:1.11⿿1.26) than in European⿿Australian (1.05:1.00⿿1.09) and North-American group (1.06:1.03⿿1.08) (meta-regression p < 0.05). No association between increased BMI and pancreatic cancer incidence (0.94:0.71⿿1.24) was shown in the Asia⿿Pacific group (meta-regression p < 0.05), whereas positive associations were found in other two groups. A significantly higher RR in men was found for colorectal cancer in comparison with women (meta-regression p < 0.05). Compared with postmenopausal women, premenopausal women displayed significantly higher RR for ovarian cancer (pre- vs. post- = 1.10 vs. 1.01, meta-regression p < 0.05), but lower RR for breast cancer (pre- vs. post- = 0.99 vs. 1.11, meta-regression p < 0.0001). Our results indicate that overweight or obesity is a strong risk factor of cancer incidence at several cancer sites. Genders, populations, and menopausal status are important factors effecting the association between obesity and cancer incidence for certain cancer types.     

Factores determinantes del índice de masa corporal en escolares españoles a partir de las Encuestas Nacionales de Salud

IntroductionSpanish National Health Surveys do not establish synergistic relations between variables. The purpose of this study was to perform a deeper historical analysis of body mass index (BMI) and its relation to other parameters included in the questionnaire for children.Material and methodsData from interviews conducted (between 1987 and 2006) to parents and guardians of schoolchildren aged 9-15 years were analyzed. Height and weight reported by parents were selected and used to calculate BMI. Subjects were stratified by age, gender, time spent sleeping and watching television and, finally, frequency of physical activity. The historical trend of BMI and its dependence on the above factors were analyzed using ANOVA tests.Results and conclusionsSignificant weight and height increases were seen, which were more marked in boys aged 12 to 15 years. Influence of physical activity on BMI was shown, but decreased (P < .001) as exercise time increased. By contrast, BMI increased (P < .001) as time spent watching television increased. On the other hand, the role of sleep as modulator of body size was confirmed, since schoolchildren aged 9-11 years who slept over 9 h had lower BMIs (P < .001). In subjects aged 12 to 15, BMI decreased (P < .001) from 6 h of sleep.     

Adjusting body mass for measurement error with invalid validation data

We propose a new method for using validation data to correct self-reported weight and height in surveys that do not measure respondents. The standard correction in prior research regresses actual measures on reported values using an external validation dataset, and then uses the estimated coefficients to predict actual measures in the primary dataset. This approach requires the strong assumption that the expectations of measured weight and height conditional on the reported values are the same in both datasets. In contrast, we use percentile ranks rather than levels of reported weight and height. Our approach requires the weaker assumption that the conditional expectations of actual measures are increasing in reported values in both samples. This makes our correction more robust to differences in measurement error across surveys as long as both surveys represent the same population. We examine three nationally representative datasets and find that misreporting appears to be sensitive to differences in survey context. When we compare predicted BMI distributions using the two validation approaches, we find that the standard correction is affected by differences in misreporting while our correction is not. Finally, we present several examples that demonstrate the potential importance of our correction for future econometric analyses and estimates of obesity rates.     

Major gender difference in association of FTO gene variant among severely obese children with obesity and obesity related phenotypes

Recent studies have shown that SNPs in the FTO gene predispose to childhood and adult obesity. In this study, we examined the association between variants in FTO and KIAA1005, a gene that maps closely to FTO, and obesity, as well as obesity related traits among 450 well characterised severely obese children and 512 normal weight controls. FTO showed significant association with several obesity related traits while SNPs in KIAA1005 did not. When stratified by gender, the FTO variant rs9939609 showed association with obesity and BMI among girls (P = 0.006 and 0.004, respectively) but not among boys. Gender differences were also found in the associations of the FTO rs9939609 with obesity related traits such as insulin sensitivity and plasma glucose. This study suggests that FTO may have an important role for gender specific development of severe obesity and insulin resistance in children.     

Association of the ins/del polymorphisms of uncoupling protein 2 (UCP2) with BMI in a Korean population

To elucidate the potential impact of the variants of the UCP2 gene on obesity phenotypes, we have genotyped four polymorphisms in UCP2 among 988 Korean subjects using TaqMan^® methods, and three common haplotypes with frequency greater than 0.1 were constructed in the Korean population. No significant associations were detected with the risk of metabolic syndrome by logistic regression analyses. However, the 45 base-pair ins/del polymorphism (+3474 ins/del) in the 3′ untranslated region (3′ UTR) showed significant association with body mass index (P = 0.007, P^corr = 0.02) and waist circumference (P = 0.005). Further subgroup analysis revealed that the genetic effects were more apparent among female subjects. In addition, a summary of the controversial genetic effects on obesity mediated by UCP2 polymorphisms from previous studies is also given. Our results suggest that subjects with a 45 bp insertion allele of UCP2+3474 ins/del might have a higher risk of developing obesity, although the biological effects of this variant are not completely known.     

汶川地震救援官兵睡眠质量与睡眠自适应的关系研究*

目的:考察汶川地震救援官兵在连续作业状态下睡眠质量及其与睡眠自适应的关系。方法:采用匹兹堡睡眠质量问卷,在地震爆发后约65天左右,对122名救援官兵进行调查;采用匹兹堡睡眠质量问卷和军人睡眠自适应量表,在地震爆发后约102天,对2000名救援官兵进行调查。结果:地震救援官兵在执行任务中睡眠质量差者占72%,结束任务后睡眠质量差者占30%。两组睡眠质量各分量表得分除"催眠药物"因素外均有显著差异;救援官兵的睡眠自适应水平偏低,平均分为2.74,低于理论中点分3分;睡眠质量与睡眠自适应水平之间的关系较为密切,除了与对睡眠的影响因素相关不显著外(相关系数为-.027),与睡眠自适应总体水平及其5个因子的相关在.16-.533之间(P<0.001);睡眠的积极暗示、睡眠的抗干扰力和睡眠的积极态度等3个因子是影响军人睡眠质量总体水平的主要因素。结论:使官兵形成和睡眠有关的积极、正确的信念与态度能够有效改善人们的睡眠质量。     

生化指标与2 型糖尿病患者实验诊断及预后相关性研究

目的：研究BMI、HbA1c、病程、相关代谢指标与2 型糖尿病（T2DM）诊断及预后的关系。方法：收集379 例T2DM 患者与 383 例健康体检者,采用生化分析仪分析二组人群的生化指标,采用高效液相色谱法检测T2DM 组HbA1c 水平,胰岛素及C 肽 采用电化学发光法检测。计量资料采用t 检验、单因素方差及相关性分析,计数资料采用卡方检验分析。结果：对各组结果进行比 较显示（1）T2DM 患者的BMI、FBG、TG、LDL-C、BUN、UA、HbA1c 水平明显高于正常对照组（P均<0.01),HDL-C、CREA 水平明 显低于对照组（P均<0.01);（2 ）TC、LDL-C、BUN、CREA及2hINS 与年龄相关。（3）肥胖组的TG、CREA、UA、FCP、2hCP 高于非肥 胖组（P 均<0.05);（4 ）初诊T2DM 患者的FBG、TG、HbAlc、LDL-C 水平明显高于5 年以上患者（P均<0.05),而HDL-C 低于5 年 以上患者（P<0.05);（5 ）HbA1c≥ 11%组的FBG水平明显高于HbA1c≤ 8%及HbA1c＝8～11%组（P<0.01）,而UA、FINS、FCP、 2hINS、2hCP 水平明显低于HbA1c<8%组（P 均<0.01);FBG、TG 与HbA1c 水平呈正相关（P<0.05）;FINS、FCP、2hINS、2hCP、UA 与HbA1c 水平呈负相关（P<0.01);结论：BMI、FBG、TG、LDL-C、BUN、UA、HDL-C、CREA均可作为T2DM诊断的参考指标。其中 LDL-C、BUN、CREA、2hINS 指受年龄影响。TG、CREA、UA、FCP(空腹C-肽）、2hCP与肥胖相关。FBG、TG、HbAlc、LDL-C、HDL-C 与病程相关;FBG、TG、HbA1c、FINS、FCP、2hINS、2hCP、UA与HbA1c 相关。