Shift work is common worldwide and linked to deleterious cardiovascular effects that might be underlined by dyslipidemia. The aim of this systematic review and meta-analysis is to determine the ...impact of shiftwork on dyslipidemia.
Searching in PubMed, Cochrane Library, Science Direct and Embase databases without language restriction on 15 February 2020, included studies that describe blood lipids levels or a risk measure in shift workers compared with fixed-day workers (controls). Differences by study-level characteristics were estimated using stratified meta-analysis by type of shift work, and meta-regression to examine relations between dyslipidemia and demographic, lifestyle and work characteristics. Estimates were pooled using random-effect meta-analysis.
We included a total of 66 articles, representing 197,063 workers. Shift work globally increased the levels of triglycerides (overall SMD = 0.09; 95CI 0.05 to 0.13; p < 0.001), and globally decreased the levels of c-HDL (−0.08; 95CI −0.12 to −0.03; p = 0.001). Permanent night shift workers were an at-risk type of shift for dyslipidemia with significantly higher blood levels of total cholesterol (0.22; 95CI 0.01 to 0.42; p = 0.043) and triglycerides (0.18; 0.03 to 0.33; p = 0.017), and significantly lower blood levels of c-HDL (−0.16; 95CI −0.32 to 0.00; p = 0.05). Permanent night shift workers were more at-risk for total cholesterol than rotating 3 × 8 shift workers (Coefficient 0.22; 95CI 0.01 to 0.42; p = 0.038) and rotating 2 × 12 shift workers (0.24; 0.02 to 0.46; p = 0.037), and more at-risk for triglycerides than rotating day shift workers (0.21; 95CI 0.03 to 0.38; p = 0.023). Results were non-significant for c-LDL, nor depending on type of shifts.
Shift work, and particularly permanent night shift, is associated with dyslipidaemia via elevated total cholesterol and triglycerides, and reduced HDL-cholesterol. Our current study provides a practical and valuable strengthening of the evidence-base required for preventive health initiatives and workplace reform.
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•Shift work, involving 20% of the work force, is associated with deleterious cardiovascular effects that might be underlined by dyslipidemia.•Considering that 20% of the work force is subjected to shift work, the question of the best shifting rotation is of particular interest.•Analyzing a total of 66 articles and 197,063 workers, we showed that shift workers are associated with dyslipidemia.•We showed that shift work, and particularly permanent night shift work, increases the risk of dyslipidemia.•Promoting rotating shifts instead of permanent night shifts could be an effective preventive strategy to reduce cardiovascular risk of shift workers.
Objetivo: analisar as dimensões envolvidas na Síndrome de Burnout em enfermeiros de um serviço de emergência. Método: pesquisa descritiva, transversal, realizada com 37 enfermeiros de um serviço de ...emergência situado no município do Rio de Janeiro, em 2014. Utilizou-se um formulário para a caracterização dos participantes e o Maslach Burnout Inventory (MBI - Human Services Survey) para investigar a Síndrome de Burnout. Projeto aprovado em comitê de ética, com CAAE: 26913114.0.0000. Resultados: a amostra foi composta, em sua maioria, pelo sexo feminino, solteiros, com mais de um vínculo empregatício e trabalhando em regime de turnos. Identificou-se a suspeição de burnout considerando escores altos para as subescalas exaustão emocional (19; 51,3%) e despersonalização (24; 64,9%). Para a subescala realização profissional predominaram escores de médio a alto Conclusão: é relevante avaliar as dimensões da Síndrome de Burnout, pois o seu desenvolvimento implica em adoecimento, queda da produtividade e qualidade do cuidado prestado. ABSTRACT Objective: to analyze the dimensions of Burnout Syndrome in nurses of an emergency service. Methods: a descriptive cross-sectional survey was performed with 37 nurses of an emergency service in Rio de Janeiro city in 2014. The sample was characterized using a structured form, and Burnout Syndrome was investigated against the Maslach Burnout Inventory (MBI). The project was approved by the research ethics committee (CAAE: 26913114.0.0000). Results: the sample was primarily female, single, in more than one employment relationship, and working shifts. Suspected burnout was identified by high scores on the emotional exhaustion subscale (19; 51.3%) on the depersonalization subscale (24; 64.9%). On the professional achievement subscale the predominant scores were moderate to high. Conclusion: it is important to evaluate the dimensions of Burnout Syndrome, because its appearance means illness, and declining productivity and quality of care provided. RESUMEN Objetivo: analizar las dimensiones involucradas en el Síndrome de Burnout en enfermeros de un servicio de urgencias. Método: investigación descriptiva, transversal, realizada junto a 37 enfermeros de un servicio de urgencias situado en el municipio de Río de Janeiro, en 2014. Se utilizó un cuestionario para la caracterización de los participantes y el Maslach Burnout Inventory (MBI - Human Services Survey) para investigar el Síndrome de Burnout. Proyecto aprobado por comité de ética (CAAE: 26913114.0.0000). Resultados: la muestra estaba compuesta, en su mayoría, por el sexo femenino, solteras, con más de un vínculo laboral y trabajando en régimen de turnos. Se identificó la sospecha de burnout en la muestra, considerando puntajes altos para las subescalas: agotamiento emocional (19; 51,3%) y despersonalización (24; 64,9%). Para la subescala realización profesional predominaron puntajes de moderado a alto. Conclusión: es relevante evaluar las dimensiones del Síndrome de Burnout, pues su desarrollo implica en enfermedad, baja de la productividad y calidad del cuidado prestado. DOI: http://dx.doi.org/10.12957/reuerj.2017.28842
Purpose
The objective of this study was to determine the glycemic index (GI) and glycemic load (GL) of three products from the Brazilian market used as a supplement and food formula for oral and/or ...enteral nutrition.
Methods
The volunteers (
n
= 16) attended Food Research Center weekly for six weeks after a 10–12-h overnight fasting. Blood was sampled in the fasting state (
t
= 0) and at 15 min, 30 min, 45 min, 60 min, 90 min, and 120 min after starting to eat each evaluated meal: glucose solution (reference food, three times) and three products: Cubitan® vanilla (specific for wounds healing), Diasip® chocolate, and Diasip® vanilla (diabetic supplements). GI was determined by calculating the area under the glycemic response curve using the trapezoidal rule and ignoring the areas below the fasting line and considering the GI of glucose to be 100. To determine GL, it was considered the amount of carbohydrates available in a standard serving of the product and GI.
Results
The three products studied showed low GI and low GL (Cubitan® GI = 35, GL = 6; Diasip® chocolate GI = 49, GL = 7; Diasip® vanilla GI = 47, GL = 7), with significant differences from those and the reference food, but no significant difference between them. Similar results were also observed for the blood glucose peak, which occurred 30 min after the consumption of all products.
Conclusions
GI and GL of the products were considerably lower than those of the reference food. The products evaluated presented a low glycemic response, shown by a glycemic response curve with a slightly accentuated shape and no high peaks.
Objective: to analyze the dimensions of Burnout Syndrome in nurses of an emergency service. Methods: a descriptive cross-sectional survey was performed with 37 nurses of an emergency service in Rio ...de Janeiro city in 2014. The sample was characterized using a structured form, and Burnout Syndrome was investigated against the Maslach Burnout Inventory (MBI). The project was approved by the research ethics committee (CAAE: 26913114.0.0000). Results: the sample was primarily female, single, in more than one employment relationship, and working shifts. Suspected burnout was identified by high scores on the emotional exhaustion subscale (19; 51.3%) on the depersonalization subscale (24; 64.9%). On the professional achievement subscale the predominant scores were moderate to high. Conclusion: it is important to evaluate the dimensions of Burnout Syndrome, because its appearance means illness, and declining productivity and quality of care provided. Keywords: Professional exhaustion; nursing team; worker's health; emergency service. Objetivo: analisar as dimensoes envolvidas na Sindrome de Burnout em enfermeiros de um servico de emergencia. Metodo: pesquisa descritiva, transversal, realizada com 37 enfermeiros de um servico de emergencia situado no municipio do Rio de Janeiro, em 2014. Utilizou-se um formulario para a caracterizacao dos participantes e o Maslach Burnout Inventory (MBI--Human Services Survey) para investigar a Sindrome de Burnout. Projeto aprovado em comite de etica, com CAAE: 26913114.0.0000. Resultados: a amostra foi composta, em sua maioria, pelo sexo feminino, solteiros, com mais de um vinculo empregaticio e trabalhando em regime de turnos. Identificou-se a suspeicao de burnout considerando escores altos para as subescalas exaustao emocional (19; 51,3%) e despersonalizacao (24; 64,9%). Para a subescala realizacao profissional predominaram escores de medio a alto Conclusao: e relevante avaliar as dimensoes da Sindrome de Burnout, pois o seu desenvolvimento implica em adoecimento, queda da produtividade e qualidade do cuidado prestado. Palavras-chave: Esgotamento profissional; equipe de enfermagem; saude do trabalhador; servico de emergencia. Objetivo: analizar las dimensiones involucradas en el Sindrome de Burnout en enfermeros de un servicio de urgencias. Metodo: investigacion descriptiva, transversal, realizada junto a 37 enfermeros de un servicio de urgencias situado en el municipio de Rio de Janeiro, en 2014. Se utilizo un cuestionario para la caracterizacion de los participantes y el Maslach Burnout Inventory (MBI--Human Services Survey) para investigar el Sindrome de Burnout. Proyecto aprobado por comite de etica (CAAE: 26913114.0.0000). Resultados: la muestra estaba compuesta, en su mayoria, por el sexo femenino, solteras, con mas de un vinculo laboral y trabajando en regimen de turnos. Se identifico la sospecha de burnout en la muestra, considerando puntajes altos para las subescalas: agotamiento emocional (19; 51,3%) y despersonalizacion (24; 64,9%). Para la subescala realizacion profesional predominaron puntajes de moderado a alto. Conclusion: es relevante evaluar las dimensiones del Sindrome de Burnout, pues su desarrollo implica en enfermedad, baja de la productividad y calidad del cuidado prestado. Palabras clave: Agotamiento; personal de enfermeria; salud ocupacional; servicio de emergencia.
Purpose of Review
To discuss evidence supporting the use of glucagon-like peptide 1 receptor agonists (GLP-1RA) to treat obesity and their role as a cardioprotective drug. Obesity is not just a ...hypertrophy of the adipose tissue because it may become dysfunctional and inflamed resulting in increased insulin resistance. Being overweight is associated with increased incidence of cardiovascular events and weight loss achieved through lifestyle changes lowers risk factors, but has no clear effect on cardiovascular outcomes. In contrast, treating obesity with GLP-1RA decreases cardiovascular risk and the possible mechanisms of cardioprotection achieved by this class of drugs are discussed. GLP-1RA were initially developed to treat type 2 diabetes patients, in whom the effects upon glycemia and, moreover, weight loss, especially with long-acting GLP-1RA, were evident. However, cardiovascular safety trials in type 2 diabetes patients, the majority presenting cardiovascular disease and excess weight, showed that GLP-1 receptor agonists were indeed capable of decreasing cardiovascular risk.
Recent Findings
Type 2 diabetes treatment with GLP-1RA liraglutide and semaglutide paved way to a ground-breaking therapy specific for obesity, as shown with the SCALE 3 mg/day liraglutide program and the STEP 2.4 mg/week semaglutide program. A novel molecule with superior performance is tirzepatide, a GLP-1 and GIP (Gastric Inhibitory Peptide) receptor agonist and recent results from the SURPASS and SURMOUNT programs are briefly described. Liraglutide was approved without a CVOT (Cardiovascular Outcome Trial) because authorities accepted the results from the LEADER study, designed for superiority. The SELECT study with semaglutide will report results only in 2023 and tirzepatide is being tested in patients with diabetes in the SURPASS-CVOT.
Summary
Clinical studies highlight that GLP-1RA to treat obesity, alongside their concomitant cardioprotective effects, have become a hallmark in clinical science.
Exogenous attention, the process that makes external salient stimuli pop-out of a visual scene, is essential for survival. How attention-capturing events modulate human brain processing remains ...unclear. Here we show how the psychological construct of exogenous attention gradually emerges over large-scale gradients in the human cortex, by analyzing activity from 1,403 intracortical contacts implanted in 28 individuals, while they performed an exogenous attention task. The timing, location and task-relevance of attentional events defined a spatiotemporal gradient of three neural clusters, which mapped onto cortical gradients and presented a hierarchy of timescales. Visual attributes modulated neural activity at one end of the gradient, while at the other end it reflected the upcoming response timing, with attentional effects occurring at the intersection of visual and response signals. These findings challenge multi-step models of attention, and suggest that frontoparietal networks, which process sequential stimuli as separate events sharing the same location, drive exogenous attention phenomena such as inhibition of return.
Arctic populations live in an environment characterized by extreme cold and the absence of plant foods for much of the year and are likely to have undergone genetic adaptations to these environmental ...conditions in the time they have been living there. Genome-wide selection scans based on genotype data from native Siberians have previously highlighted a 3 Mb chromosome 11 region containing 79 protein-coding genes as the strongest candidates for positive selection in Northeast Siberians. However, it was not possible to determine which of the genes might be driving the selection signal. Here, using whole-genome high-coverage sequence data, we identified the most likely causative variant as a nonsynonymous G>A transition (rs80356779; c.1436C>T p.Pro479Leu on the reverse strand) in CPT1A, a key regulator of mitochondrial long-chain fatty-acid oxidation. Remarkably, the derived allele is associated with hypoketotic hypoglycemia and high infant mortality yet occurs at high frequency in Canadian and Greenland Inuits and was also found at 68% frequency in our Northeast Siberian sample. We provide evidence of one of the strongest selective sweeps reported in humans; this sweep has driven this variant to high frequency in circum-Arctic populations within the last 6–23 ka despite associated deleterious consequences, possibly as a result of the selective advantage it originally provided to either a high-fat diet or a cold environment.
Enterobacter hormaechei, one of the species within the Enterobacter cloacae complex, is a relevant agent of healthcare-associated infections. In addition, it has gained relevance because isolates ...have shown the capacity to resist several antibiotics, particularly carbapenems. However, knowledge regarding colonization and virulence mechanisms of E. hormaechei has not progressed to the same extent as other Enterobacteriaceae species as Escherichia coli or Klebsiella pneumoniae. Here, we describe the presence and role of the type 3 fimbria, a chaperone-usher assembled fimbria, which was first described in Klebsiella spp., and which has been detected in other representatives of the Enterobacteriaceae family. Eight Chilean E. cloacae isolates were examined, and among them, four E. hormaechei isolates were found to produce the type 3 fimbria. These isolates were identified as E. hormaechei subsp. hoffmannii, one of the five subspecies known. A mutant E. hormaechei subsp. hoffmannii strain lacking the mrkA gene, encoding the major structural subunit, displayed a significantly reduced adherence capacity to a plastic surface and to Caco-2 cells, compared to the wild-type strain. This phenotype of reduced adherence capacity was not observed in the mutant strains complemented with the mrkA gene under the control of an inducible promoter. Therefore, these data suggest a role of the type 3 fimbria in the adherence capacity of E. hormaechei subsp. hoffmannii. A screening in E. hormaechei genomes contained in the NCBI RefSeq Assembly database indicated that the overall presence of the type 3 fimbria is uncommon (5.94–7.37%), although genes encoding the structure were detected in representatives of the five E. hormaechei subspecies. Exploration of complete genomes indicates that, in most of the cases, the mrkABCDF locus, encoding the type 3 fimbria, is located in plasmids. Furthermore, sequence types currently found in healthcare-associated infections were found to harbor genes encoding the type 3 fimbria, mainly ST145, ST78, ST118, ST168, ST66, ST93, and ST171. Thus, although the type 3 fimbria is not widespread among the species, it might be a determinant of fitness for a subset of E. hormaechei representatives.
Pigeon peas (
Cajanus cajan) seeds were germinated for 4 days at 20
°C in darkness in order to improve the nutritional quality of seeds. Germination brought about a sharp reduction of α-galactosides, ...phytic acid and trypsin inhibitor activity (83%, 61% and 36%, respectively) and an increment of vitamin B
2 (145%), vitamin C (from negligible amounts to 14
mg/100
g d.m.), vitamin E (108%) and total antioxidant capacity (28%). These flours were used as ingredients to produce pasta products in a proportion of 5%, 8% and 10%. The supplemented pasta products had shorter cooking time and higher water absorption, cooking and protein losses in water than had control pasta (100% semolina). From sensory evaluation, fortified pasta generally had acceptability similar to control pasta. Cooked pasta with the highest level of substitution (semolina:germinated pigeon pea flour at 10%) was chemically and biologically evaluated and results showed that protein, fat, dietary fibre and mineral contents were improved. Fortified pasta provided more vitamin B
1, B
2, E and antioxidant capacity than did control pasta. Biological assessment of fortified, cooked pasta indicated that true TD and PER value increased by 12% and 64%, respectively, in comparison with control. The germinated pigeon pea flour can be an excellent ingredient to increase the nutritional value of semolina pasta without affecting the sensory properties.
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