Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women

Daytime eating during simulated night work mitigates changes in cardiovascular risk factors: secondary analyses of a randomized controlled trial

Effective countermeasures against the adverse cardiovascular effects of circadian misalignment, such as effects experienced due to night work or jet lag, remain to be established in humans. Here, we aim to test whether eating only during daytime can mitigate such adverse effects vs. eating during the night and day (typical for night shift workers) under simulated night work (secondary analysis of NCT02291952). This single-blind, parallel-arm trial randomized 20 healthy participants (non-shift workers) to simulated night work with meals consumed during night and day (Nighttime Meal Control Group) or only during daytime (Daytime Meal Intervention Group). The primary outcomes were pNN50 (percentage consecutive heartbeat intervals >50 ms), RMSSD (root mean square of successive heartbeat differences), and LF/HF (low/high cardiac frequency). The secondary outcome was blood concentrations of prothrombotic factor plasminogen activator inhibitor-1 (PAI-1). These measures were assessed under Constant Routine conditions, before (baseline) and after (postmisalignment) simulated night work. The meal timing intervention significantly modified the impact of simulated night work on cardiac vagal modulation and PAI-1 (pFDR = 0.001). In the Control Group, the postmisalignment Constant Routine showed a decrease in pNN50 by 25.7% (pFDR = 0.008) and RMMSD by 14.3% (pFDR = 0.02), and an increase in LF/HF by 5.5% (pFDR = 0.04) and PAI-1 by 23.9% (pFDR = 0.04), vs. the baseline Constant Routine. In the Intervention Group, there were no significant changes in these outcomes. For exploratory outcomes, the intervention significantly modified the impact of simulated night work on blood pressure (P < 0.05), with no significant change in the Control Group, and a significant reduction by 6-8% (P < 0.01) in the Intervention Group; without significant effects for heart rate or cortisol. These findings indicate that daytime eating, despite mistimed sleep, may mitigate changes in cardiovascular risk factors and offer translational evidence for developing a behavioral strategy to help minimize the adverse changes in cardiovascular risk factors in individuals exposed to circadian misalignment, such as shift workers.

Chronotype in relation to shift work: A cohort study among 37,731 female nurses

Chronotype may affect tolerance for circadian disruption induced by shift work. This study examines the association between chronotype, self-reported sleep timing, shift type preference, and sleep problems among nurses, and studies chronotype stability over time. The study included 37,731 Dutch female nurses who completed a baseline (2011) and follow-up questionnaire (2017), with information on shift work (e.g., job history, shift type preference [collected in 2017 only]), and sleep characteristics (e.g., chronotype, preferred sleep-wake time in a work-free period [collected in 2017 only], and sleep problems between working days according to Medical Outcomes Study-Sleep Problem Index II [MOS-SPI-II]). The association between chronotype and sleep timing was examined using (age-adjusted) linear regression. Associations between chronotype and shift type preference and sleep problems (MOS-SPI-II >30) were examined using ordered logistic and Poisson regression, respectively. With later chronotype, midsleep time increased (definite evening vs. intermediate types [reference]: β = 55 min, 95% confidence interval [95% CI]: 54-55), the odds ratio (OR) for 1-point increase in preference for night (2.68; 95% CI: 2.48-2.90) and evening shifts increased (OR 2.20; 95% CI: 2.03-2.38), while the odds for day (OR 0.17; 95% CI: 0.16-0.18) and morning shifts (OR 0.22; 95% CI: 0.21-0.24) decreased. Intermediate chronotype was associated with fewer sleep problems (median MOS-SPI-II = 27.2, p < 0.01), compared with definite morning (28.9) and evening types (31.7). This study shows that chronotype is associated with sleep-wake times in a work-free period, shift type preference, and sleep problems in nurses. Future studies on the association of shift work-induced circadian disruption and health outcomes should therefore consider chronotype as effect-modifier.

The metabolic significance of peripheral tissue clocks

The circadian clock is a transcriptional-translational feedback loop which oscillates in virtually all nucleated cells of the body. In the decades since its discovery, it has become evident that the molecular clockwork is inextricably linked to energy metabolism. Given the frequency with which metabolic dysfunction and clock disruption co-occur, understanding why and how clock and metabolic processes are reciprocally coupled will have important implications for supporting human health and wellbeing. Here, we discuss the relevance of molecular clock function in metabolic tissues and explore its role not only as a driver of day-night variation in gene expression, but as a key mechanism for maintaining metabolic homeostasis in the face of fluctuating energy supply and demand.

Sexual Dimorphism in Cardiometabolic Diseases: From Development to Senescence and Therapeutic Approaches

The global incidence and prevalence of cardiometabolic disorders have risen significantly in recent years. Although lifestyle choices in adulthood play a crucial role in the development of these conditions, it is well established that events occurring early in life can have an important effect. Recent research on cardiometabolic diseases has highlighted the influence of sexual dimorphism on risk factors, underlying mechanisms, and response to therapies. In this narrative review, we summarize the current understanding of sexual dimorphism in cardiovascular and metabolic diseases in the general population and within the framework of the Developmental Origins of Health and Disease (DOHaD) concept. We explore key risk factors and mechanisms, including the influence of genetic and epigenetic factors, placental and embryonic development, maternal nutrition, sex hormones, energy metabolism, microbiota, oxidative stress, cell death, inflammation, endothelial dysfunction, circadian rhythm, and lifestyle factors. Finally, we discuss some of the main therapeutic approaches, responses to which may be influenced by sexual dimorphism, such as antihypertensive and cardiovascular treatments, oxidative stress management, nutrition, cell therapies, and hormone replacement therapy.

An innovative approach based on health surveillance for the prevention and early detection of cardiovascular diseases in a large cohort of healthcare workers

The aim of our three-year retrospective observational study on 6000 healthcare workers, all subjected to mandatory health surveillance, is to determine the risk factors and prevalence of cardiovascular diseases (CVDs) and to analyze the results of an ad hoc designated preventive health surveillance protocol. A risk assessment was performed and a preventive health surveillance protocol was implemented, including clinical-instrumental and laboratory tests aimed at the early detection of any sign of CVD. As a result, n = 442 new diagnoses of CVDs were made and the prevalence of CVDs increased from 12 to 16.1%. The higher prevalence was observed in physicians (P = 57.8%; p < 0.0001). The main risk factors for CVDs were age, male sex and family history of CVDs. The analysis of CVDs determinants highlighted an unexpected protective role of shift work (aOR = 0.64; p < 0.0001). Our preventive health surveillance protocol allowed to reveal a high prevalence of undiagnosed CVDs, laying the foundations for future primary prevention and counseling interventions as part of the health promotion and TOTAL WORKER HEALTH programs. Further studies are needed to create solid scientific evidence that can guide public health decisions regarding new prevention models and health promotion programs also in the general population.

A good night's rest: A contemporary review of sleep and cardiovascular health

Sleep is increasingly recognized as a significant contributor to the development of cardiovascular disease (CVD). Recent American Heart Association guidelines incorporate sleep duration into the "Life's Essential Eight" framework of ideal cardiovascular health. This article will review the evidence relating sleep duration, regularity, and quality with all-cause and cardiovascular mortality, cardiometabolic syndrome, and coronary artery disease in adults. Short sleep duration is strongly associated with cardiovascular mortality, cardiometabolic risk factors, and coronary artery disease. Limited studies also suggest a possible U-shaped association, with long sleep duration also associated with greater cardiovascular risk. Sleep regularity has emerged as a strong and independent risk factor for CVD-related mortality, cardiometabolic syndrome, and subclinical atherosclerosis. Less is known about the impact of sleep quality on CVD, though a number of observational studies suggest a possible association with metabolic syndrome and subclinical atherosclerosis. This review provides an update of the literature on the cardiovascular impact of sleep for the everyday clinician and highlights gaps in knowledge that warrant future research.

Development of the Quality of Life Scale for Shift-working Nurses

Background and aim

Shift work is known to have a significant impact on the health and well-being of nurses, and there is a need for practical tools to assess this impact. This study introduces the "Quality of Life Scale for Shift-Working Nurses" (QoLS-SWN), which was developed to provide a reliable and valid tool for assessing the effects of shift work on nurses' health and well-being.

Methods

This study employed a methodological research design to develop and validate a new scale for assessing the quality of life of shift-working nurses. Data were collected from two samples of nurses working in various hospitals. The first sample (n = 202) was used for exploratory factor analysis (EFA) to identify the scale's underlying factor structure. The second sample (n = 246) was used for confirmatory factor analysis (CFA) to validate the identified structure. The development process included an extensive literature review, expert consultations, and pilot testing. Factor analysis and reliability tests were conducted to ensure that the scale is highly reliable.

Results

The QoLS-SWN demonstrated excellent reliability, with a Cronbach's alpha of 0.95, and factor loadings ranging from 0.56 to 0.90. The scale comprises three dimensions: physical and mental exhaustion, health risks and job safety, and social and psychological interactions, explaining 71.89% of the total variance. CFA affirmed the structural validity of the scale, with fit indices indicating a good model fit (CMIN/df = 2.33, GFI = 0.86, IFI = 0.95, TLI = 0.94, CFI = 0.95, RMSEA = 0.07).

Conclusion

The QoLS-SWN is a reliable and valid tool for measuring the impact of shift work on nurses' quality of life. By providing insights into the multifaceted consequences of shift work, the scale may guide the development of targeted interventions to enhance nurses' quality of life. This scale can inform nursing practice and policy, ultimately improving nurse well-being and patient care outcomes.

Global, regional, and national trends in chronic kidney disease burden (1990-2021): a systematic analysis of the global burden of disease in 2021

BACKGROUND

Chronic kidney disease (CKD) is a global health challenge with diverse etiologies. However, research on the incidence trends of CKD attributable to specific causes remains limited, and the incidence and mortality rates vary across regions. This study aims to identify the patterns and temporal trends of CKD incidence, providing valuable information for the development of targeted prevention strategies and interventions.

METHODS

CKD data from the 2021 Global Burden of Disease Study (1990-2021) were analyzed by sex, region, country, cause, and Socio-demographic Index (SDI). Disease burden was assessed using age-standardized incidence (ASIR), mortality rates (ASMR), and estimated annual percentage changes (EAPC). Decomposition analysis evaluated population aging, growth, and epidemiological impacts. The autoregressive integrated moving average (ARIMA) model was used to predict the burden of CKD from 2021 to 2031, and the age-period-cohort (APC) model was employed to assess the effects of age, time, and cohort. Health inequality was analyzed using Slope Index of Inequality (SII) and Concentration Index (CI).

RESULTS

In 2021, Saudi Arabia had the highest ASIR, while Mauritius had the highest mortality. China and India contributed the most cases and deaths. ARIMA forecasts CKD cases will rise to 22.21 million and deaths to 1.81 million by 2031. Epidemiological changes drove incidence growth in medium SDI regions and mortality in high SDI regions. EAPC correlated with ASIR and ASMR. APC analysis showed incidence peaked between 70-80 years, with earlier cohorts facing higher risks. Unknown causes, type 2 diabetes, and hypertension were the leading CKD etiologies. From 1990-2021, health inequality in CKD incidence and mortality worsened, especially in high SDI regions, where the mortality CI shifted from 0.05 to - 0.09.

CONCLUSIONS

This study estimated the temporal trends of CKD incidence and mortality globally, as well as at the national and regional levels, from 1990 to 2021. It was observed that countries with higher socio-demographic index (SDI) exhibited unfavorable trends, suggesting that these countries should develop more targeted and specific strategies to address the growing burden of CKD.

Association between serum homocysteine concentration level and tooth loss: a cross-sectional study from NHANES 2003-2006

INTRODUCTION

This cross-sectional study aimed to investigate the associations between serum homocysteine levels and missing teeth, as well as to explore the threshold effect of serum homocysteine levels on the number of missing teeth.

MATERIALS AND METHODS

This study involved 4746 participants (aged ≥ 40 years) from NHANES data 2003-2006. Negative binomial regression was used to assess the association between serum homocysteine levels and tooth loss. Non-linear and dose-response relationships were analyzed using smooth curve fitting and threshold effect analysis. In addition, we supplemented the relationship between serum homocysteine levels and tooth loss and conducted subgroup analysis to determine the impact of covariates on the relationship between serum homocysteine levels and tooth loss.

RESULTS

In a fully adjusted negative binomial regression model, higher levels of serum Hcy concentration in the Q2-Q4(Q2: IRR = 1.46, 95%CI (1.67,1.79)); Q3: IRR = 1.42, 95%CI (1.36,1.48); Q4: IRR = 1.47,95%CI (1.01,1.78)) groups increased the likelihood of tooth loss compared with quartile Q1 (low level of serum homocysteine). Threshold effect analysis revealed that the log2-transformed Hcy infection point was at 2.95 μmol/L.

CONCLUSION

The likelihood of tooth loss increased by 47% for each unit increase in serum homocysteine level. There was a non-linear positive correlation between serum homocysteine and tooth loss, with a threshold effect of approximately log2(Hcy) = 2.95 μmol/L. This link emphasizes the importance of maintaining appropriate homocysteine levels to prevent oral health problems.

Acute night shift work is associated with increased blood pressure and reduced sleep duration in healthy adults

Shift workers have a 40% higher risk for cardiovascular disease (CVD) compared to people who work day shifts. However, the acute impact of shift work on CVD risk factors in free-living settings remains unclear. We therefore investigated the impact of acute night shift work on factors related to cardiovascular health including blood pressure (BP) and sleep duration. Twenty-four rotating shift workers (19F, 23 ± 4 y, BMI: 23 ± 3 kg/m2; mean ± SD) participated in a quasi-randomized crossover study. Assessments were conducted over the course of 1 day shift and one night shift in a free-living setting. BP was measured every 30 min by an ambulatory monitor. Sleep and wake times were recorded. Mixed effects models were conducted to examine changes in variables between conditions. Acute night shift work was associated with significantly higher 24 h systolic (107 ± 1 vs. 104 ± 1 mmHg; p < 0.0001) and diastolic (67 ± 1 vs. 64 ± 1 mmHg; p < 0.0001) BP, as well as blunted dipping patterns in systolic BP (8 ± 1 vs. 12 ± 1%; p = 0.032), as compared to day shift work. Sleep duration was significantly shorter during the night shift as compared to the day shift (4 h 04 ± 19 min vs. 8 h 22 ± 18 min; p < 0.0001). As little as one night of shift work in a free-living setting is sufficient to induce multiple CVD risk factors including increased BP and reduced sleep duration in healthy adults. It is critical to identify strategies to prevent or attenuate the negative impact of shift work on CVD risk in a large portion of the working population.

Investigating the impact of shift work on depression: Insights from sleep duration and physical activity

BACKGROUND

Shift work has been associated to a higher risk of depression and other health problems.

OBJECTIVE

This study aims to explore the connection between shift work and depression using NHANES data, with a focus on the roles of sleep duration and physical activity.

METHODS

NHANES data from 2007 to 2025 were examined using weighted multivariable logistic regression and stratified analysis, adjusting for demographic, chronic disease, and lifestyle factors. The impact of sleep duration and physical activity on depression among shift workers was examined using generalized additive models.

RESULTS

The study included 4965 participants. Adjusting for all covariates, shift work was significantly linked to increased depression risk (OR = 1.25, 95% CI: 1.05-1.48, p = 0.0127). For shift workers, each additional hour of sleep reduced depression risk by 19% (OR = 0.81, 95% CI: 0.72-0.91, p = 0.0007), and those with adequate sleep had a 40% lower depression risk compared to those with insufficient sleep (OR = 0.60, 95% CI: 0.42-0.87, p = 0.0072). Regular physical activity reduced depression risk by 44% (OR = 0.56, 95% CI: 0.36-0.87, p = 0.0104), whereas insufficient activity showed no significant impact (OR = 0.83, 95% CI: 0.50-1.38, p = 0.4731).

CONCLUSIONS

Shift work increases depression risk, while sufficient sleep and physical activity are protective. These findings underscore the importance of improving conditions for shift workers and developing preventive strategies.

Endothelial Dysfunction and Hemostatic System Activation in Relation to Shift Workers, Social Jetlag, and Chronotype in Female Nurses

Circadian misalignment, due to shiftwork and/or individual chronotype and/or social jetlag (SJL), quantified as the difference between internal and social timing, may contribute to cardiovascular disease. Markers of endothelial dysfunction and activation of the coagulation system may predict cardiovascular pathology. The present study aim was to investigate the effects of shift work, SJL, and chronotype on endothelial function and coagulation parameters. One hundred female nurses underwent endothelial function testing using the EndoPAT and blood sampling for coagulation markers, repeated at 06:00-9:00 and 18:00-21:00. We found that compared with day workers, endothelial function and fibrinogen levels were lower (p = 0.001, p = 0.005, respectively) and the procoagulant parameters of plasminogen activator inhibitor-1 (PAI-1) and heparanase level and activity were higher amongst shift workers (p = 0.009, p = 0.03, p = 0.029, respectively). High SJL was associated with lower endothelial function (p = 0.002) and higher PAI-1, heparanase procoagulant activity, heparanase level, and D-Dimer level (p = 0.004, p = 0.003, p = 0.021, p = 0.006, respectively). In the late chronotype, PAI-1 and heparanase procoagulant activity were higher than in the early chronotype (p = 0.009, p = 0.007, respectively). Diurnal variation was found for PAI-1, von-Willebrand factor (vWF), heparanase, and heparan-sulfate with higher levels in the mornings. The correlation between shift/day workers and SJL or chronotype was moderately strong, indicating that SJL and chronotype are independent factors. In conclusion, findings suggest endothelial impairment and increased thrombotic risk in nurses working in shifts or with high SJL or late chronotype. The thrombotic risk is increased in the morning independent of circadian misalignment cause. These findings strengthen the importance of the alliance to the biological daily rhythm in daily life. Further research is needed to evaluate inhibitors of heparanase to attenuate the thrombotic risk in individuals with circadian misalignment.

Green space is associated with new-onset stroke among Chinese middle-aged and older adults: data from China Health and Retirement Longitudinal Study (CHARLS)

Background and aims

The relationship between green space and new-onset stroke is inconclusive. This study aimed to investigate the association between green space and stroke risk among Chinese middle-aged and older adults.

Methods

Data were taken from participants aged ≥45 years in the China Health and Retirement Longitudinal Study (CHARLS). Baseline data were collected in 2011 and new-onset stroke data were gathered during follow-up in 2013, 2015, 2018, and 2020. Multivariate Cox regression models were constructed to investigate the association between green space and stroke risk. Subgroup analysis was also performed.

Results

A total of 13,696 participants with a mean age of 59.3 ± 9.3 years were included. After a mean follow-up duration of 6.32 years, there were 728 stroke events during a total of 86,530 person-years of follow-up. The study found a L-shaped relationship between green space and the risk of new-onset stroke in participants. By using a two-piecewise linear regression model, we calculated that the inflection point for the per capita park green area was 10.61 square meters per person (log-likelihood ratio test p = 0.041). On the left of the inflection point, we observed a negative relationship between green space and the incidence of stroke (HR: 0.89, 95% CI: 0.84-0.94, p = 0.0001). On the right side of the inflection point, however, the relationship tended to be saturated (HR: 0.97, 95% CI: 0.94-1.01, p = 0.2111).

Conclusion

Our study found that the relationship between green space and the risk of new-onset stroke follows a L-shaped curve. A lower amount of green space is associated with an increased risk of new-onset stroke. These findings require confirmation in future studies.

Working Conditions in Complementary and Integrative Healthcare Professions

OBJECTIVE

The study aimed to describe working conditions among complementary and integrative healthcare (CIH) providers, specifically acupuncturists, chiropractors, massage therapists, midwives, and naturopathic doctors.

METHODS

We used cross-sectional Occupational Information Network data (2013-2021) for five CIH occupations. We examined means and 95% confidence intervals (CIs) for 10 variables that represented positive conditions, ergonomic demands, psychosocial demands, and schedule demands. We compared CIH to conventional healthcare and non-healthcare occupations.

RESULTS

CIH occupations had relatively high degrees of positive conditions, moderate degrees of psychosocial demands, and moderate hours/scheduling. Massage therapists, chiropractors, and acupuncturists reported more ergonomic hazards (eg, 1-5 scale where 5 is the highest, mean bending/twisting frequency for chiropractors is 3.43 [95% CI, 3.80-4.05] compared to 2.17 for midwives [95% CI, 1.97-2.36] and 1.96 for managers [95% CI, 1.42-2.51]).

CONCLUSIONS

CIH occupations generally had healthy working conditions, although ergonomic hazards were prominent.

The impact of working night shifts on cardiac autonomic nervous regulation during the six-minute walk test in nurses

BACKGROUND

Clinical nurses frequently face the necessity of working night shifts, often with insufficient opportunities for timely sleep recovery, which may negatively impact autonomic nervous system regulation. The aim of this study was to evaluate changes in heart rate variability (HRV) after the six-minute walk test (6MWT) in nurses post-night shift and to explore the impact of night shift work on cardiac autonomic regulation.

METHODS

Thirty-five female nurses, with a mean age of 28.7 years (range 21.0-37.0 years), participated in this study. On the first and second mornings after a night shift, the nurses performed the 6MWT. During the test, electrocardiogram (ECG) signals, blood pressure, and walking distance were recorded simultaneously.

RESULTS

Compared with the second postshift morning, on the first postshift morning, nurses presented higher ratings of perceived exertion (RPE), higher Borg scale scores, and a slower pulse rate before and after the 6MWT but covered a shorter walking distance. Additionally, HRV indicators such as the SDNN, RMSSD, pNN50, TP, VLF, LF, and HF were all higher on the first postshift morning. Regarding the amplitude of cardiac autonomic nervous regulation, variations in the RMSSD and pNN50 were both greater during the 6MWT on the first postshift morning, although there was no significant difference in post-6MWT recovery.

CONCLUSIONS

Night shifts appear to increase the activity of the autonomic nervous system in nurses on the first postshift morning and exert a greater inhibitory effect on parasympathetic activity during the 6MWT. Therefore, it is important to ensure timely recovery sleep and improve autonomic regulation after working night shifts.

KEYWORDS

Heart rate variability; Night shift; Autonomic nervous system; Six-minute walk test; Nurses.

TRIAL REGISTRATION

This study was retrospectively registered in the Clinicaltrials.gov. Registration Date: August 1, 2024.

CLINICALTRIALS

gov ID: NCT06542510.

The Association Between Shift Work, Sleep Quality, and Health-Related Quality of Life Among Workers in the Logistics Industry

The booming online shopping industry has accelerated the growth of logistic services, often subjecting workers to irregular schedules. This study aims to examine the association between night-shift work and health-related quality of life among logistics workers, with a special focus on the mediating role of sleep characteristics. A survey was conducted among logistics workers across China, who filled out an online questionnaire. The questionnaire collected information about shift work, sleep characteristics, health-related quality of life, various sociodemographic factors, and specific job categories. The Insomnia Severity Index measured sleep quality, while the 12-Item Short Form Health Survey assessed health-related quality of life, including the physical and mental components. Linear regression analysis and structural equation modeling were used to examine the proposed associations and conduct mediation analysis, respectively. Out of the 484 respondents, 352 (72.7%) worked night shifts. These workers were predominantly males, smokers, alcohol users, less educated, and those with longer working hours involved in goods transportation and distribution. Our results showed a considerable trend of declining general health when transitioning from day to night shifts. There was a negative association between the frequency of night shift work and physical health. Specifically, those who worked more than 12 night shifts a month reported poorer health compared to those working permanent daytime, after adjustments for confounding variables. Sleep quality emerged as a significant mediator in this relationship. Our findings underscore the need to prioritize improving sleep quality to enhance the health and well-being of logistics workers.

Predictive Factors and Risk Assessment for Hospitalization in Chest Pain Patients Admitted to the Emergency Department

BACKGROUND

Chest pain is one of the most common reasons for emergency department (ED) visits. Patients presenting with inconclusive symptoms complicate the diagnostic process and add to the burden upon the ED. This study aimed to determine factors possibly influencing ED decisions on hospitalization versus discharge for patients with the diagnosis of chest pain.

METHODS

In the cohort study including 400 patients admitted to the emergency unit with a working diagnosis of chest pain, data on demographics, medical history, symptoms, lab results, and risk scores were collected from the medical records of patients admitted to the ED with a working diagnosis of chest pain. To reduce potential bias, the analysis was restricted to 330 patients who were referred to the ED by a primary care provider or clinic for chest pain.

RESULTS

Of 330 patients admitted to the ED, 58.5% were discharged, and 41.5% were hospitalized. Hospitalized patients were significantly older, with a median age of 70 versus 57 years for those discharged (p < 0.001). A higher proportion of hospitalizations occurred during the late-night shift. Significant predictors of hospitalization included hyperlipidemia (OR 3.246), diaphoresis (OR 8.525), dyspnea (OR 2.897), and hypertension (OR 1.959). Nursing home residents had a lower risk of hospitalization (OR 0.381). The area under the ROC curve for this model was 0.801 (95% CI: 0.753-0.848), indicating the predictive accuracy of the model in estimating the probability of admission. The HEART (history, ECG, age, risk factors, and troponin level) score was more effective than the TIMI (Thrombolysis in Myocardial Infarction) score in predicting the need for hospitalization, with an area under the curve (AUC) of 0.807 compared to 0.742 for TIMI.

CONCLUSIONS

The HEART score in comparison with TIMI score proved especially valuable for quick risk assessment for hospitalization. The model that included hyperlipidemia, diaphoresis, dyspnea, and hypertension was the most predictive for the risk of hospitalization. Further research with larger populations is needed to validate these findings.

Work Around the Clock: How Work Hours Induce Social Jetlag and Sleep Deficiency

A growing body of evidence has placed an increasing emphasis on how sleep affects health. Not only does insufficient sleep make one subjectively feel worse, but is associated with chronic diseases that are considered epidemics in industrialized nations. This is partly caused by the growing need for prolonged work and social schedules, exemplified by shift work, late-night weekends, and early morning work/school start times (social jetlag). Here, we consider fundamental relationships between the circadian clock and biologic processes and discuss how common practices, such as shift work and social jetlag, contribute to sleep disruption, circadian misalignment, and adverse health outcomes.

Emergency Department Patient Satisfaction Scores Are Lower for Patients Who Arrive During the Night Shift

Background

Increasingly, patient satisfaction scores are being used to assess emergency physicians. We sought to determine whether the patient satisfaction scores collected by our hospital system are lower for patients who are treated in the emergency department (ED) on night shifts as compared to those treated on day shifts.

Methods

We performed a cross-sectional analysis of patient satisfaction scores from three EDs in Florida. We obtained satisfaction data from NRC Health (the company that provides our surveys) using a random sample of 1,000 completed surveys from patients treated in 2022; we also performed manual chart review to obtain clinical data. The satisfaction surveys asked patients how likely they would be to recommend the facility (from 0-10). Patients who provided a score of 9 or 10 were considered "promoters." For our primary analysis, we compared the percentage of promoters for the day shift encounters (7 AM to 7 PM) to the night shift encounters (7 PM to 7 AM). We also performed a multivariable logistic regression analysis using several demographic and clinical variables to further assess the association between night shift arrival and satisfaction scores.

Results

Of the 1,000 surveys analyzed, 66.3% of patients arrived during the day shift, and 33.7% arrived during the night shift. Of those who arrived during the day shift, 525 (79.2%) were promoters compared to 228 (67.7%) of those who arrived during the night shift, a difference of 11.5% (95% confidence interval [CI] 5.7-17.4%), P < 0.001. On multivariable analysis, night shift arrival was associated with a lower chance of a patient being a promoter, with adjusted odds ratio 0.60 (95% CI 0.43-0.84), P = 0.003.

Conclusion

Patients who presented to the ED during the night shift were less likely to be promoters than patients who arrived during the day shift. Assessments of patient satisfaction data should account for time of visit and other facility-related and operational characteristics.

Influence of sleep on physiological systems in atherosclerosis

Sleep is a fundamental requirement of life and is integral to health. Deviation from optimal sleep associates with numerous diseases including those of the cardiovascular system. Studies, spanning animal models to humans, show that insufficient, disrupted or inconsistent sleep contribute to poor cardiovascular health by disrupting body systems. Fundamental experiments have begun to uncover the molecular and cellular links between sleep and heart health while large-scale human studies have associated sleep with cardiovascular outcomes in diverse populations. Here, we review preclinical and clinical findings that demonstrate how sleep influences the autonomic nervous, metabolic and immune systems to affect atherosclerotic cardiovascular disease.

Night shift-induced circadian disruption: links to initiation of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis and risk of hepatic cancer

The circadian system plays a crucial role in regulating metabolic homeostasis at both systemic and tissue levels by synchronizing the central and peripheral clocks with exogenous time cues, known as zeitgebers (such as the light/dark cycle). Our body's behavioral rhythms, including sleep-wake cycles and feeding-fasting patterns, align with these extrinsic time cues. The body cannot effectively rest and repair itself when circadian rhythms are frequently disrupted. In many shift workers, the internal rhythms fail to fully synchronize with the end and start times of their shifts. Additionally, exposure to artificial light at night (LAN), irregular eating patterns, and sleep deprivation contribute to circadian disruption and misalignment. Shift work and jet lag disrupt the normal circadian rhythm of liver activity, resulting in a condition known as "circadian disruption". This disturbance adversely affects the metabolism and homeostasis of the liver, contributing to excessive fat accumulation and abnormal liver function. Additionally, extended working hours, such as prolonged night shifts, may worsen the progression of non-alcoholic fatty liver disease (NAFLD) toward non-alcoholic steatohepatitis (NASH) and increase disease severity. Studies have demonstrated a positive correlation between night shift work (NSW) and elevated liver enzymes, indicative of hepatic metabolic dysfunction, potentially increasing the risk of hepatocellular carcinoma (HCC) related to NAFLD. This review consolidates research findings on circadian disruption caused by NSW, late chronotype, jet lag, and social jet lag, drawing insights from studies involving both humans and animal models that investigate the effects of these factors on circadian rhythms in liver metabolism.

Association Between Pericoronary Fat Attenuation Index as Evaluated by Coronary Artery CT Angiography and Clinical Interventions in Lipid Management Among Patients with Coronary Artery Disease

Objective

This study aims to evaluate the relationship between the pericoronary fat attenuation index (FAI), derived from coronary artery computed tomography angiography, and post-lipid management levels of low-density lipoprotein cholesterol in patients with coronary artery disease (CAD). Additionally, the study investigates coronary inflammation across different lipid management strategies.

Methods

We selected a cohort comprising 521 CAD patients who met the inclusion criteria. Patients were categorized into well-managed (LDL-C<2.6 mmol/L) and poorly managed (LDL-C≥2.6 mmol/L) groups based on lipid management efficacy. We collected anthropometric measures (height, weight, body mass index, and body surface area) and clinical indicators, including Gensini score, and FAI-related parameters for coronary atherosclerotic lesions. We analyzed the interrelations along these parameters and lipid management using statistical methods and assessed diagnostic value via receiver operating characteristic (ROC) curve analysis of these parameters was assessed through.

Results

The poorly managed group exhibited significantly higher levels of total cholesterol, triglycerides, and lower levels of high-density lipoprotein compared to the well-managed group (P < 0.05). Significant differences were observed between the groups in terms of lesion length in the proximal segment of the left anterior descending artery, FAI value in the proximal segment of lesions in the right coronary artery (RCA), volume thickness in the middle segment of RCA lesions, and lesion length in the distal segment of RCA (P < 0.05). ROC curve analysis revealed areas under the curve ranging from 0.484 to 0.660 for the parameters, indicating limited diagnostic efficacy.

Conclusion

The FAI in the RCA varies with lipid management strategies, suggesting it as a valuable metric for monitoring both perivascular inflammation and lipid status in CAD patients. However, its current diagnostic efficacy is limited, indicating the need for further research to improve its clinical utility.

The British Sleep Society position statement on Daylight Saving Time in the UK

There is an ongoing debate in the United Kingdom and in other countries about whether twice-yearly changes into and out of Daylight Saving Time should be abolished. Opinions are divided about whether any abolition of Daylight Saving Time should result in permanent Standard Time, or year-long Daylight Saving Time. The British Sleep Society concludes from the available scientific evidence that circadian and sleep health are affected negatively by enforced changes of clock time (especially in a forward direction) and positively by the availability of natural daylight during the morning. Thus, our recommendation is that the United Kingdom should abolish the twice-yearly clock change and reinstate Standard Time throughout the year.

Shifting Rhythms: A Systematic Review Exploring the Multifaceted Effects of Shift Work and Circadian Disruption on Employee Cardiovascular Health

Shift work has long been studied as a contributing risk factor for cardiovascular disease. This study aims to provide a comprehensive summary of data regarding shiftwork and its impact on the cardiovascular system from the last decade. It explores the association of shift schedules with multiple aspects of cardiovascular disease and the physiological processes that lead up to it. It also identifies gaps in current knowledge regarding the topic. Two hundred and sixty-eight articles were gathered from PubMed, Google Scholar, and Science Direct using relevant medical subject headings (MeSH) strategy and advanced search using keywords including 'Shift work,' 'Night shift,' 'Occupational health,' 'Circadian rhythm,' 'Cardiovascular disease,' 'Cardiovascular health.' The search was conducted in April and completed in May 2023. Systemic reviews, meta-analysis, cohort and cross-sectional studies from the last 10 years were included, and assessment of multiple systematic reviews (AMSTAR), Newcastle Ottawa, and Joanna Briggs Institute (JBI) tools were used, respectively, for quality assessment. A total of 14 articles were included in our review, including five systematic reviews and meta-analyses, six prospective cohort studies, and three cross-sectional studies. Each study reported a significant association between shift work with some aspect of cardiovascular disease. An increase in the risk of myocardial infarction, coronary heart disease, hypertension, atherosclerosis, and metabolic syndrome is reported. Circadian disruption, unhealthy diet, and emotional and physiological stress contribute to these effects. Oxidative damage and inflammatory biomarkers appear to play a role in this process, but more research is warranted for a deeper understanding of these changes. Despite an abundance of evidence pointing towards the short-term and long-term harm to shift workers' cardiovascular health, there is limited research regarding the policies that are needed to better monitor cardiovascular damage in employees. The focus needs to shift toward prevention-based policies and their efficacy in workplace settings.

Circadian misalignment disrupts biomarkers of cardiovascular disease risk and promotes a hypercoagulable state

The circadian system regulates 24-h time-of-day patterns of cardiovascular physiology, with circadian misalignment resulting in adverse cardiovascular risk. Although many proteins in the coagulation-fibrinolysis axis show 24-h time-of-day patterns, it is not understood if these temporal patterns are regulated by circadian or behavioral (e.g., sleep and food intake) cycles, or how circadian misalignment influences these patterns. Thus, we utilized a night shiftwork protocol to analyze circadian versus behavioral cycle regulation of 238 plasma proteins linked to cardiovascular physiology. Six healthy men aged 26.2 ± 5.6 years (mean ± SD) completed the protocol involving two baseline days with 8-h nighttime sleep opportunities (circadian alignment), a transition to shiftwork day, followed by 2 days of simulated night shiftwork with 8-h daytime sleep opportunities (circadian misalignment). Plasma was collected for proteomics every 4 h across 24 h during baseline and during daytime sleep and the second night shift. Cosinor analyses identified proteins with circadian or behavioral cycle-regulated 24-h time-of-day patterns. Five proteins were circadian regulated (plasminogen activator inhibitor-1, angiopoietin-2, insulin-like growth factor binding protein-4, follistatin-related protein-3, and endoplasmic reticulum resident protein-29). No cardiovascular-related proteins showed regulation by behavioral cycles. Within the coagulation pathway, circadian misalignment decreased tissue factor pathway inhibitor, increased tissue factor, and induced a 24-h time-of-day pattern in coagulation factor VII (all FDR < 0.10). Such changes in protein abundance are consistent with changes observed in hypercoagulable states. Our analyses identify circadian regulation of proteins involved in cardiovascular physiology and indicate that acute circadian misalignment could promote a hypercoagulable state, possibly contributing to elevated cardiovascular disease risk among shift workers.

Night shift work and myocardial infarction in the UK Biobank

BACKGROUND

Shift work has become popular along with adverse effects such as disrupted biological rhythms, metabolic changes, sleep disorders and myocardial infarction. Studies have shown a link between myocardial infarction and shift work, but evidence is still lacking.

AIMS

We aim to explore the association between present and past shift work and risk of myocardial infarction in a large population of European workers.

METHODS

We analysed data from the UK Biobank with >500 000 participants and an average 12-year follow-up duration. Cox proportional hazard models were employed to analyse the relationship between present shift work (n = 265 064), lifetime duration or frequency of shift work (n = 71 428) and the risk of myocardial infarction, as well as the association between rest day during shift work and myocardial infarction incidents in night shift workers (n = 14 588).

RESULTS

Night shift workers had a higher risk of myocardial infarction compared to day workers, including 'shift but never/rarely night shifts' (hazard ratio [HR] = 1.09, 95% confidence interval [CI] 1.00-1.20), 'some night shifts' (HR = 1.13, 95% CI 1.01-1.27) and 'usual/permanent night shifts' (HR = 1.21, 95% CI 1.07-1.37), respectively. Similarly, higher frequency and longer duration of night shift work were associated with the increased risk of myocardial infarction (<10 years: HR = 1.20, 95% CI 1.01-1.42; ≥10 years: HR = 1.51, 95% CI 1.28-1.77; or an average of more than eight nights per month: HR = 1.45, 95% CI 1.23-1.71). However, longer rest days couldn't decrease myocardial infarction risk compared to those who rest 1 day.

CONCLUSIONS

Present and lifetime exposure to night shifts were associated with a risk of myocardial infarction and did not benefit from longer rest days.

Long-term night shift work, genetic predisposition and risk of incident asthma: a prospective cohort study

BACKGROUND

Evidence about a potential link between current and lifetime night shift work and risk of incident asthma is insufficient.

AIM

To investigate the association of current and lifetime night shift work with risk of incident asthma, and the modified effect of genetic susceptibility on this association.

DESIGN AND METHODS

We included 253 773 individuals with complete night shift work information in the UK biobank. We calculated the standard polygenetic risk score (PRS) for asthma. The Cox proportional hazard models were conducted to estimate hazard ratios and 95% CIs.

RESULTS

After multivariable adjustments, we found that current night shift work was associated with an increased risk of incident asthma in a dose-response fashion (P for trend < 0.001). Compared with day workers, those working usual/permanent night shifts had a 17% (95% CI: 1.04-1.33) higher risk of asthma incidence. In addition, we observed significant dose-dependent relationships of longer lifetime duration or frequency of night shift work with elevated risk of asthma incidence (all P for trend < 0.05). Compared with never night shift workers, those with a duration (≥5 years) or frequency (≥8 nights/month) of night shift work exhibited a 20% (95% CI: 1.03-1.39) or 22% (95% CI: 1.03-1.44) higher risk of incident asthma, respectively. Moreover, the elevated risk of incident asthma related to current and lifetime night shift work exposure was strengthened by high PRS, although no significant shift work-PRS interactions were detected.

CONCLUSION

Both current and lifetime night shift work may increase the risk of incident asthma, regardless of genetic predisposition to asthma.

Association of adverse childhood experiences with poor health condition among middle-aged and elderly adults in the United States: A nationally retrospective cohort study

BACKGROUND

The specific effects of adverse childhood experiences (ACEs) in adulthood and senectitude were less known. We aim to examine the relationship between early ACEs and overall health condition as well as specific dimensions in the middle-aged and elderly population.

METHODS

In the 2019-2021 Behavioral Risk Factor Surveillance System Study, robust Poisson regression models were used to estimate the relationship between ACE exposure and current health status among adults aged 45 ≥ years.

RESULTS

Of the 195,472 participants, 53.8 % were female and the mean age was 65.0 years. Compared to populations without ACE, ACE exposures were more significantly associated with depression (PR: 2.03, 95 %CI: 1.94-2.21), frequent mental health (PR: 1.85, 95 %CI: 1.74-1.97) and subject cognitive decline (PR: 1.99, 95 %CI:1.85-2.14) than with physical health (PR: 1.37, 95 %CI: 1.32-1.44), with dose-response patterns. The association with mental disorder was especially significant among the elderly population.

CONCLUSION

Early ACEs are associated with adverse health outcomes that persist into later life, particularly mental disorders and cognitive decline. Poor mental health may indirectly influence associations with ACEs and cognitive decline as well as physical health. Our findings emphasize the importance of lifelong psychological screening and support for the ACE-exposed middle-aged and elderly population.

Differences in impact of current and former shift work on cardiovascular risk factors, carotid atherosclerosis, and white matter integrity

Study Objectives

The association of shift work (SW) and disrupted circadian rhythm with markers of large artery atherosclerosis and cerebral small vessel disease is uncertain. We aimed to study the separate association of current and former SW with these markers.

Methods

We included participants from the population-based Hamburg City Health Study. SW was defined by monthly working hours between 06:00 pm and 07:00 am containing night shifts for at least 12 months. Cross-sectional data were obtained from structured questionnaires, laboratory analyses, physical examinations, brain magnetic resonance imaging, and carotid ultrasound. We performed multivariable regression analysis with carotid intima-media thickness (CIMT), and peak-width skeletonized mean diffusivity (PSMD) as dependent variables.

Results

Three hundred and forty-four current, 238 former, and 7162 never-shift workers were included. The median age was 60 years for both current and former shift workers, and total duration of SW was comparable for the two groups. Current shift workers were less frequently female (27.3% vs. 44.5%; p < .001), had more frequent hyperlipidemia (31.5% vs. 22.3%; p = .024), and diabetes (16.2% vs. 3.2%; p < .001). After adjustment for age and sex, reduced quality of sleep (β = 1.61, p = .001) and low education (β = 2.63, p < .001) were associated with current but not former SW. Adjusted for age and sex, the current SW was associated with higher CIMT (β = 0.02, p = .001) and PSMD (β = 9.06e-06, p = .006), whereas former SW was not. Adjusted for risk factors, current SW remained associated with PSMD (β = 9.91e-06, p = .006) but not with CIMT.

Conclusions

Current SW was associated with CIMT and with PSMD, with the latter association remaining after adjustment for risk factors. Former SW showed no associations with CIMT or PSMD. This may indicate that current SW is linked with increased neurovascular risk through disrupted circadian rhythms.

Trial Registration Information

The trial was submitted at http://www.clinicaltrials.gov, under NCT03934957 on January 4, 2019. The first participant was enrolled in February 2016.

Assessment of Diet Quality Based on Selected Dietary Quality Indices and Consumption of Specific Food Items of Midwives Working on a Shift Schedule in Wroclaw, Poland

The aim of this study was to assess the quality of diets among midwives working in a shift system and to analyze variations in their dietary habits according to their working hours. In a group of fifty midwives employed in four public hospitals in Wrocław, the HDI-2015, HEI-2015, AHEI-2010, and Mellen's DASH diet index were calculated. The significance of differences in terms of the prevalence of selected dietary habits, meal frequency, average content of selected food items, and the percentage of energy obtained from them was assessed. Over half of the diets of the participants exhibited low adherence to the selected dietary indices. Only the scores on Mellen's DASH diet index were significantly associated with other components of the diet. Diets scoring ≥ 4.5 points were characterized by significantly lower processed meat content, meal frequency, and energy value, as well as lower sugar content and lower dietary energy value, compared to diets scoring < 4.5 points. Regardless of their working hours, the diets of midwives are characterized by low quality. Therefore, it appears essential to introduce targeted educational programs and provide guidance on appropriate dietary models, such as the DASH diet.

Genetic variants affect diurnal glucose levels throughout the day

Circadian rhythms not only coordinate the timing of wake and sleep but also regulate homeostasis within the body, including glucose metabolism. However, the genetic variants that contribute to temporal control of glucose levels have not been previously examined. Using data from 420,000 individuals from the UK Biobank and replicating our findings in 100,000 individuals from the Estonian Biobank, we show that diurnal serum glucose is under genetic control. We discover a robust temporal association of glucose levels at the Melatonin receptor 1B ( MTNR1B) (rs10830963, P = 1e-22) and a canonical circadian pacemaker gene Cryptochrome 2 ( CRY2) loci (rs12419690, P = 1e-16). Furthermore, we show that sleep modulates serum glucose levels and the genetic variants have a separate mechanism of diurnal control. Finally, we show that these variants independently modulate risk of type 2 diabetes. Our findings, together with earlier genetic and epidemiological evidence, show a clear connection between sleep and metabolism and highlight variation at MTNR1B and CRY2 as temporal regulators for glucose levels.

A Mixed-Methods, Multimedia Pilot Study to Investigate Sleep Irregularity Determinants Among Undergraduate Students

PURPOSE

To pilot a novel approach investigating the interplay of social and institutional determinants influencing university undergraduate student sleep patterns.

DESIGN

A two-part, three-phase mixed-methods approach.

SETTING

A mid-size US university conducted in spring and fall 2020.

PARTICIPANTS

191 undergraduate students (69 first-years, 43 second-years, 48 third-years, 31 fourth-years).

METHOD

For Part A, participants texted their activities and emotions in real time, producing a data-rich, weeklong diary of comprehensive activity logs, emoticons, multimedia submissions, and juxtapositions of ideal vs real schedules. Semi-structured contextual interviews were also conducted. For Part B, a one-time survey examined Part A insights across all class years. These diverse datasets were triangulated using thematic, comparative, and content analyses through MAXQDA software and visual mapping methods.

RESULTS

Three preliminary themes were identified as encouraging an irregular sleep schedule: a prevailing academic ethos emphasizing busyness, time management challenges, and the rhythm of institutional schedules and deadlines. An overarching theme suggests that perceptions of peer sleep habits and academic prioritization above all else could be influential across factors.

CONCLUSION

This pilot study indicates that sleep regularity among undergraduates is potentially shaped by individual choices combined with broader institutional paradigms. While it is limited by its exploratory nature, timing, and small sample size, the results highlight the promise of this methodology for more extensive studies and suggest that future interventions should emphasize systemic changes that prioritize sleep.

Relationship between long-term shift work; night work; sleep deficiency and stroke: A systematic review and meta-analysis

BACKGROUND

The association between shift/night work and the risk of stroke is not supported by strong evidence.

OBJECTIVE

This study aimed to obtain evidence of a potential relationship between shift/night shift work and the risk of stroke.

METHODS

We searched PubMed, Embase, the Cochrane Library and Web of science databases for eligible studies from inception to January 19, 2024. We followed the statement in the Preferred Reporting Items for Systematic Evaluations and Meta-Analysis (PRISMA). STATA 14.0 software was used for meta-analysis.

RESULTS

A total of five studies involving 700,742 subjects were included in this meta-analysis. We found that shift/night workers had a 1.08 times higher risk of stroke than non-shift/night workers (RR: 1.08; 95 % CI: 1.05-1.10; P < 0.001).

CONCLUSION

Shift/night work may be a risk factor for stroke. More objective prospective studies are needed to further support this result.

Longitudinal Assessment of Seasonal Impacts and Depression Associations on Circadian Rhythm Using Multimodal Wearable Sensing: Retrospective Analysis

BACKGROUND

Previous mobile health (mHealth) studies have revealed significant links between depression and circadian rhythm features measured via wearables. However, the comprehensive impact of seasonal variations was not fully considered in these studies, potentially biasing interpretations in real-world settings.

OBJECTIVE

This study aims to explore the associations between depression severity and wearable-measured circadian rhythms while accounting for seasonal impacts.

METHODS

Data were sourced from a large longitudinal mHealth study, wherein participants' depression severity was assessed biweekly using the 8-item Patient Health Questionnaire (PHQ-8), and participants' behaviors, including sleep, step count, and heart rate (HR), were tracked via Fitbit devices for up to 2 years. We extracted 12 circadian rhythm features from the 14-day Fitbit data preceding each PHQ-8 assessment, including cosinor variables, such as HR peak timing (HR acrophase), and nonparametric features, such as the onset of the most active continuous 10-hour period (M10 onset). To investigate the association between depression severity and circadian rhythms while also assessing the seasonal impacts, we used three nested linear mixed-effects models for each circadian rhythm feature: (1) incorporating the PHQ-8 score as an independent variable, (2) adding seasonality, and (3) adding an interaction term between season and the PHQ-8 score.

RESULTS

Analyzing 10,018 PHQ-8 records alongside Fitbit data from 543 participants (n=414, 76.2% female; median age 48, IQR 32-58 years), we found that after adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced daily steps (β=-93.61, P<.001), increased sleep variability (β=0.96, P<.001), and delayed circadian rhythms (ie, sleep onset: β=0.55, P=.001; sleep offset: β=1.12, P<.001; M10 onset: β=0.73, P=.003; HR acrophase: β=0.71, P=.001). Notably, the negative association with daily steps was more pronounced in spring (β of PHQ-8 × spring = -31.51, P=.002) and summer (β of PHQ-8 × summer = -42.61, P<.001) compared with winter. Additionally, the significant correlation with delayed M10 onset was observed solely in summer (β of PHQ-8 × summer = 1.06, P=.008). Moreover, compared with winter, participants experienced a shorter sleep duration by 16.6 minutes, an increase in daily steps by 394.5, a delay in M10 onset by 20.5 minutes, and a delay in HR peak time by 67.9 minutes during summer.

CONCLUSIONS

Our findings highlight significant seasonal influences on human circadian rhythms and their associations with depression, underscoring the importance of considering seasonal variations in mHealth research for real-world applications. This study also indicates the potential of wearable-measured circadian rhythms as digital biomarkers for depression.

Associations of RBC counts and incidence of DVT in patients with spinal cord injury: a five year observational retrospective study

BACKGROUND

The role of red blood cell (RBC) counts as potential independent risk factors for deep vein thrombosis (DVT) in patients with spinal cord injury (SCI) remains uncertain. This study aims to clarify the associations between RBC counts and DVT incidence among this population.

METHODS

A retrospective analysis was performed on 576 patients with SCI admitted to the rehabilitation medicine department from January 1, 2017 to December 31, 2021. After exclusions, 319 patients were analyzed, among which 94 cases of DVT were identified.

RESULTS

Mode of injury, D-dimer and anticoagulant therapy were significant covariates (P < 0.05). Age, fibrinogen, D-dimer, anticoagulant therapy and American Spinal Cord Injury Association impairment scale (AIS) grades were associated with RBC counts and DVT incidence (P < 0.05). Adjusting for these factors, a 1.00 × 10^12/L increase in RBC counts correlated with a 45% decrease in DVT incidence (P = 0.042), revealing a "U" shaped relationship with a pivot at 4.56 × 10^12/L (P < 0.05).

CONCLUSION

RBC counts below 4.56 × 10^12/L serve as a protective factor against DVT, while counts above this threshold pose a risk. These findings could inform the development of DVT prevention strategies for patients with SCI, emphasizing the need for targeted monitoring and management of RBC counts.

Multimorbidity and its Associated Factors in Korean Shift Workers: Population-Based Cross-Sectional Study

BACKGROUND

Multimorbidity is a crucial factor that influences premature death rates, poor health, depression, quality of life, and use of health care. Approximately one-fifth of the global workforce is involved in shift work, which is associated with increased risk for several chronic diseases and multimorbidity. About 12% to 14% of wage workers in Korea are shift workers. However, the prevalence of multimorbidity and its associated factors in Korean shift workers are rarely reported.

OBJECTIVE

This study aimed to assess multimorbidity prevalence, examine the factors associated with multimorbidity, and identify multimorbidity patterns among shift workers in Korea.

METHODS

This study is a population-based cross-sectional study using Korea National Health and Nutrition Examination Survey data from 2016 to 2020. The study included 1704 (weighted n=2,697,228) Korean shift workers aged 19 years and older. Multimorbidity was defined as participants having 2 or more chronic diseases. Demographic and job-related variables, including regular work status, average working hours per week, and shift work type, as well as health behaviors, including BMI, smoking status, alcohol use, physical activity, and sleep duration, were included in the analysis. A survey-corrected logistic regression analysis was performed to identify factors influencing multimorbidity among the workers, and multimorbidity patterns were identified with a network analysis.

RESULTS

The overall prevalence of multimorbidity was 13.7% (302/1704). Logistic regression indicated that age, income, regular work, and obesity were significant factors influencing multimorbidity. Network analysis results revealed that chronic diseases clustered into three groups: (1) cardiometabolic multimorbidity (hypertension, dyslipidemia, diabetes, coronary heart disease, and stroke), (2) musculoskeletal multimorbidity (arthritis and osteoporosis), and (3) unclassified diseases (depression, chronic liver disease, thyroid disease, asthma, cancer, and chronic kidney disease).

CONCLUSIONS

The findings revealed that several socioeconomic and behavioral factors were associated with multimorbidity among shift workers, indicating the need for policy development related to work schedule modification. Further organization-level screening and intervention programs are needed to prevent and manage multimorbidity among shift workers. We also recommend longitudinal studies to confirm the effects of job-related factors and health behaviors on multimorbidity among shift workers in the future.

A Cross Talking between the Gut Microbiota and Metabolites of Participants in a Confined Environment

Certain workplaces, like deep-sea voyages, subject workers to chronic psychological stress and circadian rhythm disorders due to confined environments and frequent shifts. In this study, participants lived in a strictly controlled confined environment, and we analyzed the effects of a confined environment on gut microbiota and metabolites. The results showed that living in confined environments can significantly alter both the gut microbiota and the gut metabolome, particularly affecting lipid metabolism pathways like glycerophospholipid metabolism. There was a significant reduction in the abundance of Faecalibacterium and Bacteroides, while Blautia, Bifidobacterium, and Collinsella showed significant increases. An association analysis revealed a strong correlation between changes in the gut microbiota and the metabolome. Four upregulated lipid metabolites may serve as biomarkers for damage induced by confined environments, and certain gut microbiota alterations, such as those involving Faecalibacterium and Bacteroides, could be potential psychobiotics or therapeutic targets for enhancing mental health in a confined environment.

Night shift work, genetic risk, and the risk of depression: A prospective cohort study

BACKGROUND

Genetic factors and night shift work both contribute to the risk of depression, but whether the association of night shift work with depression varies by genetic predisposition remains unclear.

OBJECTIVES

To assess whether night shift work is associated with a higher risk of depression regardless of genetic predisposition.

METHODS

We used data from the UK biobank of 247,828 adults aged 38-71 free of depression at baseline from March 13, 2006, to October 1, 2010. Genetic predisposition to depression was assessed using polygenic risk scores (PRS) weighted sums of genetic variant indicator variables and classified as low (lowest tertile), intermediate (tertile 2), and high (highest tertile). Night shift work exposures were collected using a touchscreen questionnaire and were divided into four categories.

RESULTS

After a median follow-up of 12.7 years, 7315 participants developed depression. Compared with day workers, HRs (95 % CIs) of depression were 1.28 (1.19-1.38) for shift work, but never or rarely night shifts, 1.32 (1.20-1.45) for irregular night shifts, and 1.20 (1.07-1.34) for permanent night shifts. Considering lifetime employment and compared with never shift workers, >8 nights/month (HR: 1.40; 95 % CI: 1.19-1.66) and <10 years (HR: 1.30; 95 % CI: 1.09-1.54) of night shift work were associated with a higher risk of depression. In joint effect analyses, compared to participants with low genetic predisposition and day workers, the HRs (95 % CIs) of depression were 1.49 (1.32-1.69) in those with high genetic predisposition and shift work, but never or rarely night shifts, and 1.36 (1.20-1.55) for those with high genetic predisposition and irregular/permanent night shifts. In addition, there was neither multiplicative nor additive interaction between genetic predisposition and night shift work on the risk of depression.

CONCLUSIONS

Night shift work was associated with an increased risk of depression regardless of genetic risk.

Use of melatonin supplements and risk of type 2 diabetes and cardiovascular diseases in the USA: insights from three prospective cohort studies

BACKGROUND

Use of melatonin supplements has been increasing substantially in both children and adults in the USA; however, their long-term cardiometabolic effects remain unclear. We aimed to assess the associations between regular use of melatonin supplements and the risk of developing type 2 diabetes or cardiovascular disease in adults.

METHODS

In this study, we included individuals from three US cohorts: the Nurses' Health Study (women only), the Health Professionals Follow-up Study (men only), and the Nurses' Health Study II (women only). Women aged 25-55 years and men aged 45-75 years at baseline, who had no diagnosis of cancer at baseline, and who responded to the question about melatonin supplement use (yes or no) were included. We excluded baseline prevalent cardiovascular disease and baseline prevalent type 2 diabetes for the main analyses. The main outcomes were cardiovascular disease and type 2 diabetes incidence. In secondary analyses, we stratified by duration of rotating night shift work in the Nurses' Health Study and Nurses' Health Study II to examine whether the associations with melatonin supplement use differed by rotating night shift work.

FINDINGS

For the cardiovascular disease analysis, we included 67 202 women from the Nurses' Health Study (follow-up 1998-2019, mean age at baseline: 63·6 years [SD 7·1]), 26 629 men from the Health Professionals Follow-up Study (1998-2020, 62·9 years [8·8], and 65 241 women from the Nurses' Health Study II (2003-19, 48·2 years [4·7]). Follow-up for incident type 2 diabetes was from 1998 to June 30, 2021, for the Nurses' Health Study; 2003 to Jan 31, 2023, for the Nurses' Health Study II; and from 1998 to Jan 31, 2020, for the Health Professionals' Follow-up Study. Melatonin supplement use in the study cohorts doubled over recent decades from less than 2% in 1998-2007 to 4% or higher in 2014-15 (4·0% in men and 5·3% in women). We documented 16 917 incident cardiovascular disease events during 2 609 068 person-years of follow-up and 12 730 incident cases of type 2 diabetes during 2 701 830 person-years of follow-up. In a pooled analysis of the three cohorts, comparing users with non-users of melatonin supplements, the pooled multivariable-adjusted hazard ratios were 0·94 (95% CI 0·83-1·06, p=0·32) for cardiovascular disease and 0·98 (0·86-1·12, p=0·80) for type 2 diabetes. In secondary analyses, melatonin supplement use appeared to attenuate the positive association between long-term shift work (>5 years) and risk of cardiovascular disease (pinteraction=0·013) among the female nurses.

INTERPRETATION

With up to 23 years of follow-up of three large prospective cohorts of middle-aged and older men and women, self-reported melatonin supplement use was not associated with risk of type 2 diabetes or cardiovascular disease. Further research is warranted to assess if melatonin supplement use could mitigate the potential risks of type 2 diabetes and cardiovascular disease associated with rotating night shift work.

FUNDING

US National Institutes of Health.

Tackling Shift Work: Cardiovascular Health in the Auto Industry

Shift work, particularly in the auto industry, presents significant health challenges, notably in how it impacts cardiovascular health due to irregular work schedules and associated sleep disruptions. This prospective study evaluated 4683 workers from a single Romanian automotive enterprise to investigate the relationship between fixed shift work schedules and cardiovascular health outcomes. Our analysis focused on fixed-shift workers, excluding those on rotating shifts to reduce variability and enhance the clarity of the findings. The findings reveal that night shift workers are at a heightened risk of cardiovascular diseases (CVDs) compared to their day shift counterparts. Night shift workers demonstrated a higher CVD incidence (4.3%) compared to day shift workers (2.6%), with an odds ratio (OR) of 1.68 (95% CI: 1.08 to 2.62, p = 0.021). This association remained significant after adjusting for potential confounders, with an adjusted OR of 1.74 (95% CI: 1.09 to 2.75, p = 0.019). Male night shift workers exhibited a significantly higher CVD incidence (4.5%) compared to male day shift workers (3.0%), with an OR of 1.75 (95% CI: 1.07 to 2.89, p = 0.026). Female night shift workers also showed a higher CVD incidence (3.4%) compared to female day shift workers (1.3%), although this was not statistically significant. These findings underscore the urgent need for targeted interventions and effective strategies to mitigate these risks and promote the cardiovascular health and overall well-being of shift workers in the auto industry. This research contributes to a deeper understanding of how non-traditional work schedules affect health and provides a basis for implementing protective measures in occupational settings.

Chronic circadian rhythm disorder induces heart failure with preserved ejection fraction-like phenotype through the Clock-sGC-cGMP-PKG1 signaling pathway

Emerging evidence has documented that circadian rhythm disorders could be related to cardiovascular diseases. However, there is limited knowledge on the direct adverse effects of circadian misalignment on the heart. This study aimed to investigate the effect of chronic circadian rhythm disorder on heart homeostasis in a mouse model of consistent jetlag. The jetlag model was induced in mice by a serial 8-h phase advance of the light cycle using a light-controlled isolation box every 4 days for up to 3 months. Herein, we demonstrated for the first time that chronic circadian rhythm disorder established in the mouse jetlag model could lead to HFpEF-like phenotype such as cardiac hypertrophy, cardiac fibrosis, and cardiac diastolic dysfunction, following the attenuation of the Clock-sGC-cGMP-PKG1 signaling. In addition, clock gene knock down in cardiomyocytes induced hypertrophy via decreased sGC-cGMP-PKG signaling pathway. Furthermore, treatment with an sGC-activator riociguat directly attenuated the adverse effects of jetlag model-induced cardiac hypertrophy, cardiac fibrosis, and cardiac diastolic dysfunction. Our data suggest that circadian rhythm disruption could induce HFpEF-like phenotype through downregulation of the clock-sGC-cGMP-PKG1 signaling pathway. sGC could be one of the molecular targets against circadian rhythm disorder-related heart disease.

Occupational Risk for Coronary Artery Disease in Shift Workers - A Systematic Review

BACKGROUND

Coronary artery disease (CAD) prevention in shift workers (SWs) poses a significant challenge worldwide, as CAD remains a major cause of mortality and disability. In the past, SWs were found at higher risk of CAD than non-s SWs. Nevertheless, the pathogenic mechanism between shift work and CAD to date is unclear. This systematic review aims to enhance understanding of the risk of CAD occurrence in SWs.

METHODS

A systematic literature review was conducted from January 2013 to December 2023. MEDLINE/Pubmed databases were used initially, and additional relevant studies were searched from references. Shift work was defined as any schedule outside traditional shifts, including the night shift.

RESULTS

Fifteen pertinent papers were categorized into risk assessment or risk management. Findings demonstrated an increased risk of CAD among SWs compared to non-SWs, with an increased CAD risk observed for both shift work and night shift work.

DISCUSSION

Duration-response associations indicate that greater shift exposure is linked to higher CAD risk. SWs incur an increased risk of CAD through the atherosclerotic process. As shift work duration increases as the risk of atherosclerosis is higher, workers demonstrate a higher prevalence and severity of coronary artery plaques.

CONCLUSIONS

The evidence-based results underscore the increased risk of CAD in SWs and are sufficient for proposing guidelines aimed at reducing the risk of CAD in SWs and at managing people with CAD in return to work characterized by disrupted circadian rhythms.

Association of rotating night shift work with tooth loss and severe periodontitis among permanent employees in Japan: a cross-sectional study

Background

The modern 24/7 society demands night shift work, which is a possible risk factor for chronic diseases. This study aimed to examine the associations of rotating night shift work duration with tooth loss and severe periodontitis.

Methods

This cross-sectional study used data from a self-administered questionnaire survey conducted among 3,044 permanent employees aged 20-64 years through a Japanese web research company in 2023. The duration of rotating night shift work was assessed using a question from the Nurses' Health Study. Tooth loss was assessed based on self-reported remaining natural teeth count. Severe periodontitis was assessed using a validated screening questionnaire comprising four questions related to gum disease, loose tooth, bone loss, and bleeding gums. We employed linear regression models for tooth loss and Poisson regression models for severe periodontitis, adjusting for demographic, health and work-related variables and socioeconomic status.

Results

Among participants included, 10.9% worked in rotating night shifts for 1-5 years, while 11.0% worked in such shifts for ≥6 years. In fully adjusted models, rotating night shift work duration of 1-5 years was associated with tooth loss (beta -0.74, 95% confidence interval (CI) [-1.55 to 0.08]) and severe periodontitis (prevalence ratio 1.80, 95% CI [1.33-2.43]); however, the association with tooth loss was not statistically significant.

Conclusions

This study supports that employees who work short-term rotating night shifts may experience poor oral conditions. Further research is needed to determine whether long-term rotating night shift work is associated with deteriorated oral health.

Night shift work and cardiovascular diseases among employees in Germany: five-year follow-up of the Gutenberg Health Study

OBJECTIVE

This study aimed to determine if there is an increased risk of incident cardiovascular diseases (CVD) resulting from cumulative night shift work in the German population-based Gutenberg Health Study (GHS).

METHODS

We examined working participants of the GHS at baseline and after five years. Cumulative night shift work in the 10 years before baseline was assessed and categorized as low (1-220 nights ≙ up to 1 year), middle (221-660 nights ≙ 1-3 years), and high (>660 nights ≙ more than 3 years) night shift exposure. Hazard ratios (HR) were estimated for incident "quality-assured CVD events" using Cox proportional hazard models.

RESULTS

At baseline, 1092 of 8167 working participants performed night shift work. During the follow-up, 202 incident cardiovascular events occurred. The crude incidence rates for CVD per 1000 person-years were 6.88 [95% confidence interval (CI) 4.80-9.55] for night shift workers and 5.19 (95% CI 4.44-6.04) for day workers. Cumulative incidence curves showed a higher cumulative incidence in workers exposed to night shift work compared to day workers after five years. The adjusted HR for incident CVD events were 1.26 (95% CI 0.68-2.33), 1.37 (95% CI 0.74-2.53) and 1.19 (95% CI 0.67-2.12) for employees in the low, middle and high night shift categories compared to employees without night shift work, respectively.

CONCLUSIONS

The observed tendencies indicate that night shift work might be negatively associated with cardiovascular health. We expect the continued follow-up will clarify the long-term impact of night shift work.

Managing Circadian Disruption due to Hospitalization: A Pilot Randomized Controlled Trial of the CircadianCare Inpatient Management System

The objective of the present study was to test the effects of an inpatient management system (CircadianCare) aimed at limiting the negative impact of hospitalization on sleep by enhancing circadian rhythmicity. Fifty inpatients were randomized to either CircadianCare (n = 25; 18 males, 62.4 ± 1.9 years) or standard of care (n = 25; 14 males, 64.5 ± 2.3 years). On admission, all underwent a full sleep-wake evaluation; they then completed daily sleep diaries and wore an actigraph for the whole length of hospitalization. On days 1 (T0), 7 (T1), and 14 (T2, if still hospitalized), salivary melatonin for dim light melatonin onset (DLMO) and 24-h skin temperature were recorded. In addition, environmental noise, temperature, and illuminance were monitored. Patients in the CircadianCare arm followed 1 of 3 schedules for light/dark, meal, and physical activity timings, based on their diurnal preference/habits. They wore short-wavelength-enriched light-emitting glasses for 45 min after awakening and short-wavelength light filter shades from 18:00 h until sleep onset. While the first, primary registered outcome (reduced sleep-onset latency on actigraphy or diary) was not met, based on sleep diaries, there was a trend (0.05 < p < 0.1) toward an advance in bedtime for CircadianCare compared to standard of care patients between T0 and T1. Similarly, DLMO time significantly advanced in the small group of patients for whom it could be computed on both occasions, with untreated ones starting from earlier baseline values. Patients sleeping near the window had significantly higher sleep efficiency, regardless of treatment arm. As noise fluctuation increased, so did the number of night awakenings, regardless of treatment arm. In conclusion, the CircadianCare management system showed positive results in terms of advancing sleep timing and the circadian rhythm of melatonin. Furthermore, our study identified a combination of environmental noise and lighting indices, which could be easily modulated to prevent hospitalization-related insomnia.

Meal timing and its role in obesity and associated diseases

Meal timing emerges as a crucial factor influencing metabolic health that can be explained by the tight interaction between the endogenous circadian clock and metabolic homeostasis. Mistimed food intake, such as delayed or nighttime consumption, leads to desynchronization of the internal circadian clock and is associated with an increased risk for obesity and associated metabolic disturbances such as type 2 diabetes and cardiovascular diseases. Conversely, meal timing aligned with cellular rhythms can optimize the performance of tissues and organs. In this review, we provide an overview of the metabolic effects of meal timing and discuss the underlying mechanisms. Additionally, we explore factors influencing meal timing, including internal determinants such as chronotype and genetics, as well as external influences like social factors, cultural aspects, and work schedules. This review could contribute to defining meal-timing-based recommendations for public health initiatives and developing guidelines for effective lifestyle modifications targeting the prevention and treatment of obesity and associated metabolic diseases. Furthermore, it sheds light on crucial factors that must be considered in the design of future food timing intervention trials.

Work environment and hypertension in industrial settings in Benin in 2019: a cross-sectional study

OBJECTIVE

To determine the association between occupational factors, particularly psychosocial factors, and hypertension.

DESIGN

Descriptive and analytical cross-sectional study using logistic multivariate regression.

SETTING

Fifteen cotton ginning plants in Benin.

PARTICIPANTS

Permanent and occasional workers in the cotton ginning industry.

DATA COLLECTION

Data on sociodemographic, occupational, behavioural and clinical history characteristics were collected using a number of standardised, interviewer-administered questionnaires. These questionnaires were based on the WHO's non-communicable disease questionnaire, Karasek questionnaire and Siegrist questionnaire. Weight, height and blood pressure were measured. Any worker with systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg according to the WHO criteria was considered hypertensive, as was any subject on antihypertensive treatment even if blood pressure was normal.

RESULTS

A total of 1883 workers were included, with a male to female ratio of 9.08. Of these, 510 suffered from hypertension (27.1%, 95% CI 25.1 to 29.2). In the multivariate analysis, the risk factors identified were occupational stress (adjusted OR (aOR)=3.96, 95% CI 1.28 to 12.2), age ≥25 years (aOR=2.77, 95% CI 1.55 to 4.96), body mass index of 25-30 kg/m2 (aOR=1.71, 95% CI 1.32 to 2.2), body mass index >30 kg/m2 (aOR=2.74, 95% CI 1.84 to 4.09), permanent worker status (aOR=1.66, 95% CI 1.44 to 2.41) and seniority in the textile sector >5 years (aOR=2.18, 95% CI 1.7 to 2.8). Recognition at work emerged as an effect-modifying factor subject to stratification.

CONCLUSIONS

Occupational factors, particularly job strain and recognition at work, are modifiable factors associated with hypertension in the ginning plants sector and deserve to be corrected through occupational health promotion and prevention.

Circadian Influences on Myocardial Ischemia-Reperfusion Injury and Heart Failure

The impact of circadian rhythms on cardiovascular function and disease development is well established, with numerous studies in genetically modified animals emphasizing the circadian molecular clock's significance in the pathogenesis and pathophysiology of myocardial ischemia and heart failure progression. However, translational preclinical studies targeting the heart's circadian biology are just now emerging and are leading to the development of a novel field of medicine termed circadian medicine. In this review, we explore circadian molecular mechanisms and novel therapies, including (1) intense light, (2) small molecules modulating the circadian mechanism, and (3) chronotherapies such as cardiovascular drugs and meal timings. These promise significant clinical translation in circadian medicine for cardiovascular disease. (4) Additionally, we address the differential functioning of the circadian mechanism in males versus females, emphasizing the consideration of biological sex, gender, and aging in circadian therapies for cardiovascular disease.