Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals

Background: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. 

Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. 

Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (p_trend<0·0001).

Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. 

Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Objective: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.
Design: Cross-sectional observational study.Setting The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.
Participants: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)—severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).
Main outcome measures: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.
Results: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.

Conclusions: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

Nuclear cataract shows significant familial aggregation in an older population after adjustment for possible shared environmental factors.

PURPOSE: To quantify the association between siblings in age-related nuclear cataract, after adjusting for known environmental and personal risk factors. METHODS: All participants (probands) in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings underwent digital slit lamp photography and were administered a questionnaire to assess risk factors for cataract including: age, gender, lifetime sun exposure, smoking and diabetes history, and use of alcohol and medications such as estrogens and steroids. In addition, blood pressure, body mass index, and serum antioxidants were measured in all participants. Lens photographs were graded by trained observers masked to the subjects' identity, using the Wilmer Cataract Grading System. The odds ratio for siblings for affectedness with nuclear cataract and the sibling correlation of nuclear cataract grade, after adjusting for covariates, were estimated with generalized estimating equations. RESULTS: Among 307 probands (mean age, 77.6 +/- 4.5 years) and 434 full siblings (mean age, 72.4 +/- 7.4 years), the average sibship size was 2.7 per family. After adjustment for covariates, the probability of development of nuclear cataract was significantly increased (odds ratio [OR] = 2.07, 95% confidence interval [CI], 1.30-3.30) among individuals with a sibling with nuclear cataract (nuclear grade > or = 3.0). The final fitted model indicated a magnitude of heritability for nuclear cataract of 35.6% (95% CI: 21.0%-50.3%) after adjustment for the covariates. CONCLUSIONS: Findings in this study are consistent with a genetic effect for age-related nuclear cataract, a common and clinically significant form of lens opacity.

Comparison of anterior ocular biometry between optical low-coherence reflectometry and anterior segment optical coherence tomography in an adult Chinese population.

PURPOSE: To evaluate the agreement between optical low-coherence reflectometry (OLCR) and anterior segment optical coherence tomography (AS-OCT) for biometry of the anterior segment. SETTING: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN: Evaluation of diagnostic technology. METHODS: A series of OLCR (Lenstar LS 900) and AS-OCT measurements of the anterior segment were taken for consecutive subjects aged 35 years and older in a population-based study. The differences and correlations between the 2 methods of ocular biometry were assessed. Agreement was calculated as the 95% limits of agreement (LoA). RESULTS: The mean age of the 776 subjects was 55.2 years ± 12.0 (SD); 54.6% were women. The mean central corneal thickness (CCT) was smaller with OLCR than with AS-OCT (537.84 ± 31.46 μm versus 559.39 ± 32.02 μm) as was anterior chamber depth (ACD) (2.60 ± 0.37 mm versus 2.72 ± 0.37 mm) and anterior chamber width (ACW) (11.76 ± 0.47 mm versus 12.04 ± 0.55 mm) (all P<.001). The 95% LoA between the 2 instruments were -44.80 to 1.71 μm for CCT, -0.17 to -0.06 mm for ACD, and -1.28 to 0.72 mm for ACW. CONCLUSION: Optical low-coherence reflectometry and AS-OCT yielded potentially interchangeable ACD measurements, while the CCT and ACW measurements acquired by the 2 devices showed clinically significant differences.

Dielectronic recombination of W 35 +

Accurate data for dielectronic recombination (DR) of the ions of tungsten are of significant interest in the modelling of tungsten impurity transport and radiative power loss in current tokamaks and in ITER. However, the complexity of the atomic structure for many of these ions makes level-resolved DR calculations untenable on currently available computers, especially for open d- and f-subshell ions. The majority of DR data presently available for ITER modelling are based on an average-atom approximation. To improve upon these baseline calculations, we investigate the use of the configuration-average distorted-wave (CADW) method to calculate DR rate coefficients for complex open d-shell systems. The aim is to produce rate coefficients that are sufficiently accurate in terms of modelling, yet greatly reduced in term of computational complexity compared to level-resolved calculations. In this paper, we consider the DR of W 35 + . Initially, we carry out several large-scale level-resolved calculations for the DR associated with the 4d → 4f and 4p → 4d excitations in this ion, using both the level-resolved distorted-wave and Dirac R -matrix methods. These calculations allow us to test the validity of the CADW approach on these same excitations by comparing cross sections and rate coefficients. These comparisons demonstrate that the CADW method is relatively accurate in relation to these level-resolved methods for the temperature range for which W 35 + should exist in a collisionally ionized plasma. We then present results for CADW rate coefficients for both Δ n = 0 and Δ n = 1 excitations for this ion. This study indicates that it is now feasible to generate a much improved comprehensive set of DR data for the entire tungsten isonuclear sequence.

Classifying cerebral palsy: are we nearly there?

BACKGROUND: Cerebral palsy (CP) is the most common cause of physical disability in childhood in developed countries and encompasses a wide range of clinical phenotypes. Classification of CP according to movement disorder or topographical distribution is widely used. However, these classifications are not reliable nor do they accurately predict musculoskeletal pathology. More recently, the Gross Motor Function Classification System (GMFCS) has been introduced and its validity, reliability, and clinical utility have been confirmed. In 2005 it was suggested that children should be described and classified according to the GMFCS in all outcome studies involving children with CP, in the Journal of Pediatric Orthopaedics (JPO). This study aimed to describe utilization of the GMFCS in 3 journals: Journal of Bone and Joint Surgery (JBJS Am), JPO, and Developmental Medicine and Child Neurology (DMCN), over a 7-year period (2005 to 2011), and any relationship to the journal's impact factor. A secondary aim was to establish if differences in methodological quality existed between those studies utilizing GMFCS and those that did not.

METHODS: A targeted literature search of the 3 selected journals using the term "cerebral palsy" was conducted using the Medline database. Utilization of the GMFCS was assessed using report of these data in the methods or results section of the retrieved papers. The Methodological Index for Non-Randomized Studies (MINORS) was employed to evaluate the quality of papers published in JPO.

RESULTS: One hundred and fifty-four studies met the inclusion criteria and in 85 (68%) the GMFCS was used. Of these, 112 were published in JPO, of which 51 (46%) utilized the GMFCS, compared with 72% for JBJS Am, and 88% for DMCN. In the JPO, utilization of the GMFCS improved from 13% to 80%, over the 7-year study period.

CONCLUSIONS: Utilization of the GMFCS has increased rapidly over the past 7 years in the JPO but there is room for further improvement.

LEVEL OF EVIDENCE: Not applicable.

Engagement no trabalho: a perspetiva do modelo demandas-recursos laborais

Cada vez mais as organizações encetam a dar valor ao funcionamento ótimo do indivíduo, uma vez que acarreta vantagens, tanto para o indivíduo, como para a própria organização. Partindo deste pressuposto, surge o engagement como o conceito em estudo na presente investigação. O objetivo desta investigação, a partir do modelo demandas-recursos laborais (Job Demand-Resources), é analisar as relações entre o empowerment psicológico e o engagement no trabalho, bem como o seu impacto sobre a satisfação no trabalho e no bem-estar dos trabalhadores. Participaram 306 sujeitos empregados de ambos os géneros, com idades compreendidas entre os 18 e 72 anos (M = 35.59, DP = 10.66), através de um questionário online. Os resultados indicam que o empowerment psicológico prediz significativamente o engagement, e o engagement prediz positivamente a satisfação profissional e o bemestar positivo no trabalho. Os resultados demonstram ainda, através da realização de uma path analysis que o engagement medeia a relação entre o empowerment psicológico e a satisfação profissional e o bem-estar positivo no trabalho. Constata-se assim a importância do engagement para a melhoria de qualidade de vida no trabalho. Futuras investigações deverão analisar profundamente as relações entre estas variáveis, com diferentes amostras e instituições.

Antioxidant and phenolic compounds in sweet potato peels and leaves: food applications and health benefits

Tese de doutoramento, Ciências Biotecnológicas (Biotecnologia Alimentar), Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2014

Desenvolvimento de filmes à base de quitosano com microencapsulação de agentes naturais: cinéticas de libertação

Dissertação de mestrado, Tecnologia de Alimentos, Instituto Superior de Engenharia, Universidade do Algarve, 2013

O piloto aviador militar : traços disposicionais, características adaptativas e história de vida

Tese de doutoramento, Psicologia (Psicologia da Social), Universidade de Lisboa, Faculdade de Psicologia, 2015

Enhanced bio-decolourisation of acid orange 7 by Shewanella oneidensis through co-metabolism in a microbial fuel cell

The decolourisation of acid orange 7 (AO7) (C.I.15510) through co-metabolism in a microbial fuel cell by Shewanella oneidensis strain 14063 was investigated with respect to the kinetics of decolourisation, extent of degradation and toxicity of biotransformation products. Rapid decolourisation of AO7 (>98% within 30 h) was achieved at all tested dye concentrations with concomitant power production. The aromatic amine degradation products were recalcitrant under tested conditions. The first-order kinetic constant of decolourisation (k) decreased from 0.709 ± 0.05 h−1 to 0.05 ± 0.01 h−1 (co-substrate – pyruvate) when the dye concentration was raised from 35 mg l−1 to 350 mg l−1. The use of unrefined co-substrates such as rapeseed cake, corn-steep liquor and molasses also indicated comparable or better AO7 decolourisation kinetic constant values. The fully decolourised solutions indicated increased toxicity as the initial AO7 concentration was increased. This work highlights the possibility of using microbial fuel cells to achieve high kinetic rates of AO7 decolourisation through co-metabolism with concomitant electricity production and could potentially be utilised as the initial step of a two stage anaerobic/aerobic process for azo dye biotreatment.

Influência da espessura do substrato dental sobre a eficácia clareadora e citotoxicidade de diferentes protocolos de clareamento

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeitos do treinamento aeróbio intervalado periodizado sobre os parâmetros antropométricos, bioquímicos e clínicos em portadores de síndrome metabólica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)