Recovery after shift work: Relation to coronary risk factors in women

Shift work increases the risk for developing cardiovascular disease. There is, however, little knowledge of what aspects of shift scheduling that are detrimental and what characteristics promote good health. The aim of the present study was to evaluate whether coronary risk factors deteriorate after a hard work period and whether recovery, in the form of a week off, was sufficient to improve them. A total of 19 women worked an extremely rapidly rotating and clockwise shift schedule at a paper and pulp factory. They underwent two health examinations, one at the end of the work period and one after the week off. In addition, the women were divided into a tolerant and a vulnerable group, depending on their satisfaction with their work hours. Most risk factors did not change, but total cholesterol and low-density lipoprotein (LDL)-cholesterol were lower after the working period than after the week-off. In addition, vulnerable women had higher levels of total cholesterol and a higher ratio of total cholesterol/high-density lipoprotein (HDL) than tolerant ones. In conclusion, the finding that a week-off worsens cholesterol levels was against our hypothesis and suggests further studies on how activities/responsibilities outside the workplace affect shift-working women. It was also shown that susceptible shift workers had worse lipid profiles.     

The Relation of Shift Work Tolerance to the Circadian Adjustment

The amplitude and phasing of circadian rhythms are under discussion as possible predictors of tolerance to night work. In a field study, subjective sleepiness and oral temperature of 147 female nurses were measured at 2-hour intervals during a period with one morning shift and two consecutive night shifts. The nurses also filled out a questionnaire. Two types of tolerance indices were constructed: The “health index” was based on questions referring to general fatigue, gastrointestinal symptoms, and sleep disturbances, and the “sleepiness index” on the actual subjective ratings of sleepiness. According to the health index, the group with good tolerance had a larger circadian amplitude of the oral temperature rhythm on the day of the morning shift than the group with poor tolerance. However, with regard to the sleepiness index, the corresponding difference between the groups with good or poor tolerance was not significant. The data did not confirm the hypothesis that predicts a quick adjustment of the circadian rhythm when the circadian amplitude is small before the change to night work. The contradictory results found in this and in other studies do not yet permit prediction of tolerance to night work.     

The Relation of Shift Work Tolerance to the Circadian Adjustment

The amplitude and phasing of circadian rhythms are under discussion as possible predictors of tolerance to night work. In a field study, subjective sleepiness and oral temperature of 147 female nurses were measured at 2-hour intervals during a period with one morning shift and two consecutive night shifts. The nurses also filled out a questionnaire. Two types of tolerance indices were constructed: The “health index” was based on questions referring to general fatigue, gastrointestinal symptoms, and sleep disturbances, and the “sleepiness index” on the actual subjective ratings of sleepiness. According to the health index, the group with good tolerance had a larger circadian amplitude of the oral temperature rhythm on the day of the morning shift than the group with poor tolerance. However, with regard to the sleepiness index, the corresponding difference between the groups with good or poor tolerance was not significant. The data did not confirm the hypothesis that predicts a quick adjustment of the circadian rhythm when the circadian amplitude is small before the change to night work. The contradictory results found in this and in other studies do not yet permit prediction of tolerance to night work.     

Sleep Disturbances Among Female Nurses: Comparing Shift to Day Work

Recently, attention has focused in Israel on the possible legal and health consequences of shift work. We decided to study sleep disorders among female nursing personnel working a shift schedule, in comparison with day nurses, in a large metropolitan general hospital. The study population was composed of 131 female certified nurses working shifts and 44 working days only. Inclusion criteria for the survey was at least 1 year of shift work alternating between day, evening, and night shifts, or at least 1 year of day work. All participants completed a self-report sleep questionnaire encompassing (a) demographic data, (b) sleep survey, and (c) employment details. Statistical analysis was performed using the Pearson correlation test and analysis of variance multiple range test (according to Scheffe's procedure). No significant correlation was found between sleep disorders and age of subjects. No sleep disorders were reported by 19.8% of shift workers versus 76.5% of day workers. Statistically significant findings were that the number of shifts per week >4.1 (p = 0.001) and duration of shift work >13.6 years (p = 0.007) correlated with the presence of sleep disorders. An additional significant finding (p = 0.014) was the impact of evening shifts on sleep disorders. The present small study confined to women supports the growing body of data on sleep complaints among shift workers.     

Postprandial Metabolic Profiles Following Meals and Snacks Eaten during Simulated Night and Day Shift Work

Shift workers are known to have an increased risk of developing cardiovascular disease (CVD) compared with day workers. An important factor contributing to this increased risk could be the increased incidence of postprandial metabolic risk factors for CVD among shift workers, as a consequence of the maladaptation of endogenous circadian rhythms to abrupt changes in shift times. We have previously shown that both simulated and real shift workers showed relatively impaired glucose and lipid tolerance if a single test meal was consumed between 00:00–02:00 h (night shift) compared with 12:00–14:00 h (day shift). The objective of the present study was to extend these observations to compare the cumulative metabolic effect of consecutive snacks/meals, as might normally be consumed throughout a period of night or day shift work. In a randomized crossover study, eight healthy nonobese men (20–33 yrs, BMI 20–25 kg/m²) consumed a combination of two meals and a snack on two occasions following a standardized prestudy meal, simulating night and day shift working (total energy 2500 kcal: 40% fat, 50% carbohydrate, 10% protein). Meals were consumed at 01:00/13:00 h and 07:00/19:00 h, and the snack at 04:00/16:00 h. Blood was taken after an overnight fast, and for 8 h following the first meal on each occasion, for the measurement of glucose, insulin, triacylglycerol (TAG), and nonesterified fatty acids (NEFA). RM-ANOVA (factors time and shift) showed a significant effect of shift for plasma TAG, with higher levels on simulated night compared to day shift (p < 0.05). There was a trend toward an effect of shift for plasma glucose, with higher plasma glucose at night (p = 0.08), and there was a time-shift interaction for plasma insulin levels (p < 0.01). NEFA levels were unaffected by shift. Inspection of the area under the plasma response curve (AUC) following each meal and snack revealed that the differences in lipid tolerance occurred throughout the study, with greatest differences occurring following the mid-shift snack. In contrast, glucose tolerance was relatively impaired following the first night-time meal, with no differences observed following the second meal. Plasma insulin levels were significantly lower following the first meal (p < 0.05), but significantly higher following the second meal (p < 0.01) on the simulated night shift. These findings confirm our previous observations of raised postprandial TAG and glucose at night, and show that sequential meal ingestion has a more pronounced effect on subsequent lipid than carbohydrate tolerance.     

冠心病患者冠脉支架术后发生再狭窄的危险因素回归分析

目的:探讨冠心病患者冠脉支架手术后发生再狭窄的危险因素,为提高临床治疗效果和改善预后提供指导。方法:回顾性分析2014年1月至2015年12月我院收治的226例行冠脉支架手术的冠心病患者临床病历资料,采用SPSS21.0分析冠脉再狭窄的发生情况及危险因素。结果:51例冠心病患者冠脉支架术后发生冠脉再狭窄(22.57%)。单因素分析显示,不同吸烟史、糖尿病史、脂蛋白a(Lp(a))水平、空腹血糖、尿素氮(BUN)、总胆红素、术前病变狭窄程度、植入支架支数、长度以及直径组冠心病患者的冠脉再狭窄发生率比较,差异有统计学意义(P0.05)。多因素Logistic回归分析,吸烟史、糖尿病史、Lp(a)水平、术前病变狭窄程度、植入支架支数、长度是冠心病患者冠脉支架术后再狭窄发生的独立危险因素,OR分别为2.261、1.944、3.593、2.798、2.449、3.823,差异有统计学意义(P0.05),植入支架直径是冠脉再狭窄发生的保护因素,OR为0.261,差异有统计学意义(P0.05)。结论:冠脉植入支架的总长度、数量,术前病变的狭窄程度、Lp(a)水平、糖尿病以及吸烟是冠心病患者冠脉支架术后发生再狭窄的独立危险因素,临床应不断优化支架并根据再狭窄的危险因素采取针对性的防治措施。     

Shift Work and Metabolic Syndrome: Respective Impacts of Job Strain,Physical Activity,and Dietary Rhythms

The impact of shift work on cardiovascular disease (CVD) risk factors and metabolic syndrome are not yet completely understood. The objectives of this study were to evaluate the impact of shift work on metabolic syndrome according to two different definitions in a population of strictly rotating shift workers (3×8 h) compared to paired counterparts working only day hours, and to study whether shift work itself is a determinant of metabolic syndrome after taking into account a large panel of confusing factors. We conducted a cross‐sectional study comparing 98 strictly rotating shift workers to 100 regular day‐workers (all subjects had a long experience of their working rhythms) within the same petrochemical plant. Clinical, behavioral, occupational, and biological data were collected, and a detailed nutritional investigation was done. Shift and day workers were comparable in terms of major CVD factors, and both had a 10 yr Framingham risk scoring of 11%. Shift workers reported an increased job strain and higher total and at‐work physical activity. Alterations in metabolic parameters were evident with a rise in triglycerides, free fatty acids, and gamma glutamyl transpeptidase and lower HDL‐cholesterol. Multiple logistic regression analysis demonstrated that shift work was associated with occurrence of metabolic syndrome, as defined by the National Cholesterol Education Program‐ATPIII criteria, OR: 2.38 (1.13–4.98), but not using the more recent score from the International Diabetes Federation, which gives a major emphasis on abdominal obesity. Total energy intake and contributions of the major nutrients did not differ between the two groups, with the notable exception of saturated lipids (+10% in shift workers). Meal distribution was clearly different: energy intake was more fractionated within the day, with a lesser contribution of breakfast and lunch but with increased intakes during intermediate light meals, particularly in the afternoon and night. Multivariate analyses were performed to test for the influence of dietary rhythms on the development of an NCEP‐ATPIII metabolic syndrome. Dietary intakes at breakfast and during intermediate light meals appear to be “protective” against metabolic syndrome, while a high load at dinner favors its occurrence. A high intake at lunch is particularly deleterious to shift workers. However, in all tested models, shift work remained significantly associated with metabolic syndrome, after taking into account potential covariates like job strain, physical activity, quantitative dietary parameters, and meal distribution. A specific follow‐up of shift workers should be recommended to occupational physicians.     

Aging and Shift Work: A Complex Problem to Face

The baby boomer generation is well into the 50+ age bracket, making it one of the largest demographic age cohorts. Whereas this cohort would have previously considered retirement, the evidence suggests that it will remain in the workforce for a longer period in response to a number of social and economic drivers. Mandatory retirement has either been abolished or is under consideration. An increased and healthier life expectancy means that people may work longer for financial and/or psychological reasons. In addition, a global shortage of skilled labor will result in efforts to keep employees in the workplace for longer periods. These trends have a number of implications for working time. What are the health implications of an aging workforce? How do we sustain good work ability into the latter years? What do we know about aging and shift work? What actions are required in the workplace to assist aging workers? This paper is not a comprehensive review of the literature but serves to highlight the complexities in understanding the relationship between shift work and aging. We discuss aging and human function and, in particular, the impact of aging on the circadian system. In addition, we outline new policy directions in this area and raise several suggestions to assist the well‐being of aging workers.     

Association of Sickness Absence with Poor Sleep and Depressive Symptoms in Shift Workers

A cross-sectional study was conducted to evaluate the contribution of daily sleep habits and depressive symptoms to sickness absences of shift workers. A self-administered questionnaire that solicited answers about sleep, symptoms of depression, sickness absence, diseases/injuries, and lifestyle factors was submitted to a sample of 522 rotating shift workers between the ages of 18–59 (mean 27) yrs of an electric equipment manufacturing company. The seven features of sleep queried were daily hours of sleep, time to fall asleep, awakening during sleep, early morning awakening, sleep well at night, sufficiency of sleep, and excessive daytime sleepiness at work. The responses were assessed over the subject's previous 1-yr period. Each sleep feature, except daily sleeping hours, was dichotomized by the following responses: (1) taking more than 30 min to fall asleep (difficulty initiating sleep; DIS), (2) awakening during sleep almost every day (difficulty maintaining sleep; DMS), (3) early morning awakening almost every day (EMA), (4) sleeping very poorly or not so well at night, (5) definite or somewhat insufficient nightly sleep, and (6) excessive daytime sleepiness at work almost every day (EDS). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Sickness absence was calculated by asking subjects “How many days in total have you been absent from work due to sickness, including paid vacation, in the last 1-yr period?” The responses were divided into three groups that included no (0 days) sickness absences (reference group, n = 235 subjects), 1 to 4 days (short-term, n = 199 subjects), and 5 days or more (long-term, n = 88 subjects). Compared to the prevalence of sleep features of the reference group, workers with short-term absence showed a significantly higher prevalence of EMA with an odds ratio (OR) of 5.3, 95% confidence interval (CI) 1.3–22.0. Long-term absence was significantly associated with DMS (OR = 2.1, 95%CI 1.0–4.6), EMA (OR = 5.6, 95%CI 1.0–28.7), sleeping poorly at night (OR = 2.6, 95%CI 1.4–5.0), and high depressive symptoms (OR = 2.0, 95%CI 1.0–3.7) according to the CES-D score of ≥16, after adjusting for multiple confounding variables. These data point to an association between both the parameters of poor sleep and symptoms of deep depression when self-reported sickness absence is frequent. The association is particularly strong with long-term absence in male shift workers.     

Psychosocial Work Characteristics Predicting Daytime Sleepiness in Day and Shift Workers

Characteristics of work organization other than working time arrangements may contribute importantly to daytime sleepiness. The present study was designed to identify the psychosocial factors at work that predict daytime sleepiness in a sample of day and shift workers. Participants working at a pulp and chemical factory completed an annual questionnaire regarding psychosocial factors at work using the U.S. National Institute for Occupational Safety and Health Generic Job Stress Questionnaire (i.e., quantitative workload, variance in workload, job control, support from supervisor, coworkers, or family/friends, job satisfaction, and depressive symptoms), as well as daytime sleepiness (through the Epworth Sleepiness Scale [ESS]) and sleep disturbances for three years starting in 2002 (response rates, 94.6–99.0%). The present analysis included 55 day workers (11 women) and 57 shift workers (all men) who participated in all three years of the study, worked under the same work schedule throughout the study period, and had no missing data on any of the daytime sleep items. A repeated‐measures analysis of covariance (ANCOVA) was used to test the effects of work schedule (day vs. shift work) and psychosocial factors at work in 2002 on the ESS scores in subsequent years, with sleep duration, insomnia symptoms, chronic diseases, and sleepiness levels at baseline as covariates. Given significant and near‐significant interactions of work schedules with psychosocial factor or study year, the ANCOVA, with the factors of psychosocial work characteristics and study year, was performed by type of work schedule. The results indicated a significant main effect of psychosocial work characteristics (p=0.010, partial ?²=0.14) and an almost significant main effect of study year (p=0.067, partial ?²=0.06) and interaction between psychosocial work characteristics and study year (p=0.085, partial ?²=0.06) for variance in workload among the day work group. The day workers reporting high variance in workload in 2002 exhibited significantly higher ESS scores in 2003 and 2004 than did those reporting low variance in workload. The ANCOVA for the shift work group showed a main effect of psychosocial work characteristics for job satisfaction (p=0.026, partial ?²=0.10) and depressive symptoms (p=0.094, partial ?²=0.06) with the interaction between psychosocial work characteristics and study year for job satisfaction (p=0.172, partial ?²=0.04) and depressive symptoms (p=0.035, partial ?²=0.07). The shift workers with low job satisfaction and high symptoms of depression in 2002 showed significantly greater ESS scores in 2003 and/or 2004 than did those with opposite characteristics. These results may suggest a potential predictive value of variance in workload for day workers as well as job satisfaction and depressive symptoms for shift workers with respect to daytime sleepiness. The present findings may imply that redesigning these aspects of work environment would be of help in managing daytime sleepiness.     

早发冠心病患者的危险因素及冠脉病变特点研究

目的:探讨早发冠心病(PCAD)患者的危险因素及冠脉病变特点。方法:收集2014年8月至2015年2月北京安贞医院急诊科行冠状动脉造影的1000例患者为研究对象,根据冠状动脉造影结果和临床资料分为早发冠心病(PCAD)组(男55岁,女65岁,n=340)、晚发冠心病组(n=300)和对照组(非冠心病者,n=360)。对三组患者的临床资料进行统计学分析,采用logistic回归分析PCAD患者的危险因素,并比较PCAD组与晚发冠心病组的冠状动脉病变特点。结果:Logistic回归分析结果提示:吸烟、早发冠心病家族史、高血压病及2型糖尿病是PCAD的独立危险因素(P0.001)。PCAD组单支病变比例显著高于晚发冠心病组(P0.05);回旋支、右冠状动脉病变比例低于晚发冠心病组(P0.05)。结论:吸烟、早发冠心病家族史、高血压病及2型糖尿病是PCAD的独立危险因素。早发冠心病患者冠脉病变主要累及前降支,单支病变多于晚发冠心病患者。     

Sleep Parameters among Offshore Workers: An Initial Assessment in the Campos Basin,Rio De Janeiro,Brazil

Shift work has potentially adverse effects on health, particularly on sleep. The purpose of the present study was to assess sleep parameters among personnel working in oil and gas offshore installations in the Campos Basin, Rio de Janeiro, Brazil. One hundred and seventy-nine subjects were asked to complete a sleep questionnaire with multiple-choice answers. Offshore workers were divided into two groups according to their work schedule: (1) fixed daytime workers (n = 86; age: 35.8 ± 9.6 yrs) and (2) shift (n = 87) or night (n = 6) workers (total n = 93; age: 37.7 ± 9.7 yrs). Shift/night workers reported poor sleep more frequently than the daytime workers (20.4% vs. 1.2%, p < 0.01), as well as habitual difficulty in falling asleep (15.1% vs. 4.7%, p < 0.01), long latency of sleep onset (28% vs. 7%, p < 0.01), fragmented sleep (45.2% vs. 16.3%, p < 0.01), short sleep episodes (44.1% vs. 16.3%, p < 0.01), irregular bedtimes (29.0% vs. 12.8%, p < 0.01), and feeling tired upon awakening (15.1% vs. 3.5%, p < 0.01). Habitual napping and loud snoring were reported twice as often in shift/night than in day workers (p < 0.01). Nightmares, somnambulism, and unpleasant feeling in the legs were equality reported by both groups (p > 0.05). Few offshore workers had sought medical help for their sleep problems. A higher number of shift/night workers reported feelings of sadness compared with day workers (26.9% vs. 9.3%, p < 0.01). The findings of this study show that subjective reports of sleep-related problems are quite common among Brazilian offshore shift workers. Reliance on self-reported sleep problems and a cross-sectional design are the main limitations of our study.     

Internal Desynchronization of Circadian Rhythms and Tolerance to Shift Work

Intolerance to shift work may result from individual susceptibility to an internal desynchronization. Some shift workers (SW) who show desynchronization of their circadian rhythms (e.g., sleep‐wake, body temperature, and grip strength of both hands) exhibit symptoms of SW intolerance, such as sleep alteration, persistent fatigue, sleep medication dependence, and mood disturbances, including depression. Existing time series data previously collected from 48 male Caucasian French SW were reanalyzed specifically to test the hypothesis that internal synchronization of circadian rhythms is associated with SW intolerance and symptoms. The entry of the subjects into the study was randomized. Three groups were formed thereafter: SW with good tolerance (n=14); SW with poor tolerance, as evident by medical complaints for at least one year (n=19); and former SW (n=15) with very poor tolerance and who had been discharged from night work for at 1.5 yr span but who were symptom‐free at the time of the study. Individual and longitudinal time series of selected variables (self‐recorded sleep‐wake data using a sleep log, self‐measured grip strength of both hands using a Colin Gentile dynamometer, and oral temperature using a clinical thermometer) were gathered for at least 15 days, including during one or two night shifts. Measurements were performed 4–5 times/24 h. Power spectra that quantify the prominent period (τ) and t‐test, chi square, and correlation coefficient were used as statistical tools. The mean (±SEM) age of SW with good tolerance was greater than that of SW with poor tolerance (44.9±2.1 yrs vs. 40.1±2.6 yrs, p<.001) and of former SW discharged from night work (very poor tolerance; 33.4±1.7, p<.001). The shift-work duration (yrs) was longer in SW with good than poor tolerance (19.9±2.2 yrs vs. 15.7±2.2; p<0.002) and former SW (10.7±1.2; p<.0001). The correlation between subject age and shift-work duration was stronger in tolerant SW (r=0.97, p<.0001) than in non‐tolerant SW (r=0.80, p<0.001) and greater than that of former SW (r=0.72, p<.01). The mean sleep‐wake rhythm τ was 24 h for all 48 subjects. The number of desynchronized circadian rhythms (τ differing from 24 h) was greater in non‐tolerant than in tolerant SW (chi square=38.9, p<.0001). In Former SW (i.e., 15 individuals assessed in follow‐up studies done 1.5 to 20 yrs after return to day work), both symptoms of intolerance and internal desynchronization were reduced or absent. The results suggest that non‐tolerant SW are particularly sensitive to the internal desynchronization of their circadian time organization.     

女性冠心病患者的危险因素分析及与冠脉病变严重程度的关系

目的:了解女性冠心病患者的危险因素及与冠脉病变严重程度的关系。方法:随机选取本院2012年至2014年心血管科住院治疗的疑似冠心病女性患者150例,经冠脉造影确诊冠心病患者105例,非冠心病患者45例。对患者的临床资料和冠脉病变严重程度进行单因素和多因素分析。结果:冠心病患者高血压与糖尿病百分比、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)及纤维蛋白原水平均高于非冠心病患者,而高密度脂蛋白(HDL-C)和血红蛋白水平均低于非冠心病患者(P0.05);年龄、高血压与糖尿病百分比、血脂上升百分比(高TC、高TG、低HDL-C、高LDL-C)、高尿酸百分比和纤维蛋白原水平均随冠状动脉病变支数及Gensini积分的增加而增加(P0.05);多因素分析发现女性冠心病的影响因素分别为高LDL-C、糖尿病、低HDL-C、TG和高血压,其中高LDL-C的影响最为显著(P0.05)。结论:高血压、糖尿病史、血脂水平为女性冠心病的影响因素,其中高LDL-C的影响最显著,各影响因素均与冠脉病变程度紧密相关。     

Predicting the Timing and Duration of Sleep in an Operational Setting Using Social Factors

In recent years, there has been increasing interest in the use of bio‐mathematical models to predict alertness, performance, and/or fatigue in operational settings. Current models use only biological factors to make their estimations, which can be limited in operational settings where social and geo‐physical factors also dictate when sleep occurs. The interaction between social and biological factors that help determine the timing and duration of sleep during layover periods have been investigated in order to create and initially validate a mathematical model that may better predict sleep in the field. Participants were 32 male transmeridian airline pilots (17 captains, 10 first officers, and 5 second officers) flying the Sydney‐Bangkok‐London‐Singapore‐Sydney (SYD‐LHR) pattern. Participants continued their regular schedule while wearing activity monitors and completing sleep and work diaries. The theoretical sleep timing model underpinning this analysis consists of separate formulations for short (<32 h) and long (>32 h) break periods. Longer break periods are split into three distinct phases—recovery (break start until first local night), personal (first local night until last local night), and preparation phases (last local night until break end)—in order to exploit potential differences specific to each. Furthermore, an iterative procedure combining prediction and retrodiction (i.e., using future duty timing information to predict current sleep timing) was developed to optimize predictive ability. Analysis found an interaction between the social and circadian sleep pressures that changed over the break period. Correlation analysis indicated a strong relationship between the actual sleep and new model's predictions (r=0.7–0.9), a significant improvement when compared to existing models (r=0.1–0.4). Social and circadian pressures play important roles in regulating sleep for international flight crews. An initial model has been developed in order to regulate sleep in these crews. The initial results have shown promise when applied to small sets of data; however, more rigorous validation must be carried out.     

Effects of 24-Hour Shift Work with Nighttin Napping on Circadian Rhythm Characteristi in Ambulance Personnel

Forty-two ambulance personnel engaged in a 24-h shift system participated in a chronobiological field study to study the effects of 24-h shift work on circadian rhythm characteristics. Autorhythmometry of circadian rhythms of oral temperature, right and left grip strengths, and heart rate plus subjective assessment of drowsiness, fatigue, and attention was performed every ～ 4 h except during sleep for 7 days. Cosinor and power spectral analyses were applied to the longitudinal data of each individual. Changes in circadian period different from 24 h of oral temperature, grip strengths, and heart rate plus subjective drowsiness, fatigue, and attention were observed in ambulance personnel. The incidence of circadian periodicity different from 24 h in oral temperature and right and left grip strength was 28.6%, 35.7%, and 47.6%, respectively. The incidence was relatively lower than that of shift workers engaged in a discontinuous 8-h shift system we reported on previously. Working conditions allowing ambulance personnel to nap when not called for emergency (for > 4 h) might contribute to a stabilization of circadian rhythms. Furthermore, long nighttime ambulance service amounting to >100 min was significantly associated with a high incidence of at least one prominent circadian period among oral temperature and right and left grip strength rhythms different from 24 h. In conclusion, 24-h shift work altered the characteristics of circadian rhythms of ambulance personnel; nighttime naps seemed to have a favorable effect on averting changes in circadian rhythms.     

冠心病患者经皮冠状动脉介入治疗术后支架内再狭窄的相关危险因素分析

目的:探究冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的相关危险因素。方法:选取2014年6月～2017年6月期间我院收治的行PCI的CHD患者200例为研究对象,术后随访一年再行冠脉造影检测,根据患者是否发生ISR分为观察组(38例,发生ISR)和对照组(162例,未发生ISR),收集并比较两组患者基线资料及生化指标,采用多因素logistic回归分析CHD患者PCI术后发生ISR的危险因素。结果:观察组吸烟、饮酒、高血压、糖尿病的人数占比、病程及支架直径均高于对照组,差异有统计学意义(P0.05)。观察组脂蛋白(a)[LP(a)]、纤维蛋白原(FIB)及尿酸(UA)水平显著高于对照组,总胆红素(TBIL)水平显著低于对照组,差异有统计学意义(P0.05)。多因素logistic回归分析显示,吸烟、糖尿病、支架直径(小)以及高水平LP(a)、低水平UA为CHD患者行PCI术后发生ISR的危险因素。结论:CHD患者行PCI术后发生ISR的危险因素有吸烟、糖尿病、支架直径以及高水平LP(a)、低水平UA,因此在PCI术中应尽可能选用较大的支架,同时戒烟、控制血糖有利于预防ISR的发生,定期检测血清LP(a)、UA水平变化,并采取有效的医疗与保健措施能够减少ISR的发生风险。     

油田作业人员职业紧张状况调查及心理障碍的影响因素分析

目的:调查油田作业人员职业紧张状况,并分析心理障碍的影响因素。方法:通过分层整群抽样法纳入600例油田作业人员作为研究对象,采用职业紧张量表(OSI-R)以及症状自评量表(SCL-90)对油田作业人员的职业紧张程度以及心理障碍状况进行评估,并按照SCL-90评分将其分为研究组(SCL-90评分160分)214例与对照组(SCL-90评分≤160分)386例,采用多因素Logistic回归分析油田作业人员心理障碍的影响因素。结果:研究组年龄45岁、受教育程度为本科及以上、工龄20年人数占比均高于对照组(均P0.05)。研究组职业任务问卷(ORQ)、个体紧张反应(PSQ)评分均高于对照组(均P0.05)。研究组重度职业紧张程度人数占比高于对照组(P0.05)。经多因素Logistic回归分析发现:年龄45岁、受教育程度本科及以上、工龄20年、重度职业紧张均是油田作业人员心理障碍的独立危险因素(均P0.05)。结论:油田作业人员职业紧张状况不容乐观,重度职业紧张、年龄较小、工龄较短及受教育程度较高的油田工作人员发生心理障碍的风险往往较大。临床工作中可通过降低油田作业人员的职业紧张程度,继而达到降低心理障碍发生几率的目的。     

Association of sickness absence with poor sleep and depressive symptoms in shift workers

A cross-sectional study was conducted to evaluate the contribution of daily sleep habits and depressive symptoms to sickness absences of shift workers. A self-administered questionnaire that solicited answers about sleep, symptoms of depression, sickness absence, diseases/injuries, and lifestyle factors was submitted to a sample of 522 rotating shift workers between the ages of 18-59 (mean 27) yrs of an electric equipment manufacturing company. The seven features of sleep queried were daily hours of sleep, time to fall asleep, awakening during sleep, early morning awakening, sleep well at night, sufficiency of sleep, and excessive daytime sleepiness at work. The responses were assessed over the subject's previous 1-yr period. Each sleep feature, except daily sleeping hours, was dichotomized by the following responses: (1) taking more than 30min to fall asleep (difficulty initiating sleep; DIS), (2) awakening during sleep almost every day (difficulty maintaining sleep; DMS), (3) early morning awakening almost every day (EMA), (4) sleeping very poorly or not so well at night, (5) definite or somewhat insufficient nightly sleep, and (6) excessive daytime sleepiness at work almost every day (EDS). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Sickness absence was calculated by asking subjects "How many days in total have you been absent from work due to sickness, including paid vacation, in the last 1-yr period?" The responses were divided into three groups that included no (0 days) sickness absences (reference group, n=235 subjects), 1 to 4 days (short-term, n=199 subjects), and 5 days or more (long-term, n = 88 subjects). Compared to the prevalence of sleep features of the reference group, workers with short-term absence showed a significantly higher prevalence of EMA with an odds ratio (OR) of 5.3, 95% confidence interval (CI) 1.3-22.0. Long-term absence was significantly associated with DMS (OR = 2.1, 95%CI 1.0-4.6), EMA (OR = 5.6, 95%CI 1.0-28.7), sleeping poorly at night (OR= 2.6, 95%CI 1.4-5.0), and high depressive symptoms (OR = 2.0, 95%CI 1.0-3.7) according to the CES-D score of >16, after adjusting for multiple confounding variables. These data point to an association between both the parameters of poor sleep and symptoms of deep depression when self-reported sickness absence is frequent. The association is particularly strong with long-term absence in male shift workers.     

冠状动脉旁路移植术后老年患者早期肺部并发症危险因素分析

目的:探讨老年冠心病(CHD)患者冠状动脉旁路移植术(CABG)后早期肺部并发症危险因素。方法:收集296例在我院接受CABG的老年冠心病患者(≥60岁)的临床资料,按照术后早期是否出现肺部并发症将患者分为肺部并发症组和非肺并发症组,比较两组一般临床资料及相关围术期指标的差异,利用Logistic回归分析探讨影响早期术后肺部并发症的危险因素。结果:296例CABG手术患者中有52例出现肺部并发症(发生率17.6%);两组在年龄、吸烟、体质量指数(BMI)、术前心功能分级、术前左室射血分数(LEVF)、三支病变、左主干病变、体外循环、体外循环时间、主动脉阻断时间、手术时间、术后24 h输红细胞(RBC)量、术后24 h胸腔引流量、术后24 h平均血糖存在统计学差异(P0.05);年龄(OR=1.137)、BMI(OR=1.636)、术前LEVF(OR=1.733)、左主干病变(OR=1.532)、体外循环(OR=2.134)、术后24 h输RBC量(OR=1.243)、术后24 h平均血糖水平(OR=1.335)是影响术后肺部并发症发生的危险因素(P0.05)。结论:老年冠心病患者CABG术后早期肺部并发症受到多种因素影响,临床中应当重视此类高危因素,以制定相关干预措施降低肺部并发症的发生率。