Cardiovascular reaction to job stress in middle-aged train drivers

In this study, cardiovascular (CV) response to a standard laboratory challenge was compared to 24-hr noninvasive monitoring of heart rate (HR) and blood pressure (BP) in 30 healthy middle-aged train drivers. Laboratory stress test consisted of the orthostatic test, the cold pressor test, the Valsalva maneuver, the Stroop test, and the numerical square. In addition, the participants completed an extensive questionnaire on their health state and family health history, lifestyle, job stress, social and family support, personality characteristics, and health risk behaviors. In waking activities (leisure time, traveling to work, preparations for driving, and an uneventful driving) HR and systolic Wood pressure (SBP), but not diastolic Wood pressure (DBP), were normal (e.g., mean HR = 78.3, SBP = 128.6. and DBP= 92.3 during driving). In occasional stressful work situations, most participants reacted with a considerable rise in SBP and DBP (maximum values 201 for SBP and 126 for DBP). Interindividual differences in maximum BP reactions to emergency stress were predicted reliably by several psychological characteristics and by the CV reactions to the laboratory psychological challenge. The frequency, intensity, and persistence of psychological and physiological reactions to urgent situations appear to be more relevant measures of the health impact of psychological job stress than are the shift average values of physiological stress markers.     

The effect of an irregular shift system on sleepiness at work in train drivers and railway traffic controllers

Sleepiness and fatigue are frequent problems in railway transportation with occasional monotony and irregular shift schedules. This study aimed at (1) studying the prevalence of severe sleepiness in shifts and (2) examining which shift and sleep-related factors were associated with the occurrence of severe sleepiness in an irregular shift system. A total of 126 randomly selected male train drivers (Tdrs) and 104 railway traffic controllers (Tcos) were investigated using questionnaires and sleep-wake diaries. A sleep diary was used to collect information on sleepiness at work and sleeping times during the 21 consecutive days of the study. The prevalence of severe sleepiness at work (i.e. Karolinska Sleepiness Scale 7 or higher) was modelled by a logistic regression analysis for repeated measurements (GEE) using different shift schedule related factors and sleep length as explanatory variables. Severe sleepiness was reported in 49% (Tdrs) and 50% (Tcos) of the night shifts and in 20% (Tdrs) and 15% (Tcos) of the morning shifts. The odds ratios showed that the risk for severe sleepiness was 6-14 times higher in the night shift and about twice as high in the morning shift compared with the day shift. Age affected the two occupational samples differently: with Tdrs increased age was associated with an additional 8% reduction of risk for severe sleepiness for each year of age, while the Tcos did not show any age dependency. Shift length increased the risk by 15% for each hour of the shift and main sleep period decreased the risk by 15% for each hour of the main sleep. The risk of severe sleepiness was not consistently related to the time-off period before the shifts. The results indicate that adjustments for shift timing, length and off-duty time, in addition to actions aiming at extending the main sleep period, would probably decrease severe sleepiness in railway transportation.     

公交车驾驶员冲动性与心理健康的相关性研究

目的：调查公交公司驾驶员的冲动性水平及心理健康水平,并分析二者之间的关系。方法：采用自编人口学调查表、Barratt冲动性量表第11版（BIS-11）、症状自评量表（SCL-90）为研究工具,对266名公交公司驾驶员进行问卷调查。结果：公交车驾驶员的冲动性总分为（53.50±7.54）,注意冲动性（12.39±2.27）,运动冲动性（18.51±3.40）,无计划冲动性（22.62±4.29）。SCL-90中除敌对因子外,均显著高于全国常模（P<0.01）;BIS-11量表的冲动性各因子分和总分分别与SCL-90各因子得分进行相关分析,结果显示除无计划冲动性因子与SCL-90中的强迫、人际关系、偏执、精神病性及其他因子无关外,其余均呈显著正相关。逐步多元回归分析结果显示,注意力冲动性（b=7.748,P=0.000）、运动冲动性（b=2.686, P=0.022）为心理健康的影响因素,并具有正性预测作用。结论：公交车驾驶员心理健康水平低于常人,高冲动性公交公司驾驶员的心理健康水平更低,应及时进行心理干预。     

Genomic alterations and molecular subtypes of gastric cancers in Asians

Gastric cancer (GC) is a highly heterogenic disease, and it is the second leading cause of cancer death in the world. Common chemotherapies are not very effective for GC, which often presents as an advanced or metastatic disease at diagnosis. Treatment options are limited, and the prognosis for advanced GCs is poor. The landscape of genomic alterations in GCs has recently been characterized by several international cancer genome programs, including stud-ies that focused exclusively on GCs in Asians. These studies identiifed major recurrent driver mutations and provided new insights into the mutational heterogeneity and genetic proifles of GCs. An analysis of gene expression data by the Asian Cancer Research Group (ACRG) further uncovered four distinct molecular subtypes with well-deifned clini-cal features and their intersections with actionable genetic alterations to which targeted therapeutic agents are either already available or under clinical development. In this article, we review the ACRG GC project. We also discuss the implications of the genetic and molecular ifndings from various GC genomic studies with respect to developing more precise diagnoses and treatment approaches for GCs.     

Declines in violence and police arrest among female sex workers in Karnataka state,south India,following a comprehensive HIV prevention programme

Introduction

Female sex workers (FSWs) frequently experience violence, harassment and arrest by the police or their clients, but there is little evidence as to the impact that such factors may have on HIV risk or whether community interventions could mitigate this impact.

Methods

As part of the evaluation of the Avahan programme in Karnataka, serial integrated behavioural and biological assessment (IBBA) surveys (four districts) (2005 to 2011) and anonymous polling booth surveys (PBS) (16 districts) (2007 to 2011) were conducted with random samples of FSWs. Logistic regression analysis was used to assess 1) changes in reported violence and arrests over time and 2) associations between violence by non-partners and police arrest and HIV/STI risk and prevalence. Mediation analysis was used to identify mediating factors.

Results

5,792 FSWs participated in the IBBAs and 15,813 participated in the PBS. Over time, there were significant reductions in the percentages of FSWs reporting being raped in the past year (PBS) (30.0% in 2007, 10.0% in 2011, p<0.001), being arrested in the past year [adjusted odds ratio (AOR) 0.57 (0.35, 0.93), p=0.025] and being beaten in the past six months by a non-partner (clients, police, pimps, strangers, rowdies) [AOR 0.69 (0.49, 0.95), p=0.024)] (IBBA). The proportion drinking alcohol (during the past week) also fell significantly (32.5% in 2005, 24.9% in 2008, 16.8% in 2011; p<0.001). Violence by non-partners (being raped in the past year and/or beaten in the past six months) and being arrested in the past year were both strongly associated with HIV infection [AOR 1.59 (1.18, 2.15), p=0.002; AOR 1.91 (1.17, 3.12), p=0.01, respectively]. They were also associated with drinking alcohol (during the past week) [AOR 1.98 (1.54, 2.53), p<0.001; AOR 2.79 (1.93, 4.04), p<0.001, respectively], reduced condom self-efficacy with clients [AOR 0.36 (0.27, 0.47), p<0.001; AOR 0.62 (0.39, 0.98), p=0.039, respectively], symptomatic STI (during the past year) [AOR 2.62 (2.07, 3.30), p<0.001; AOR 2.17 (1.51, 3.13), p<0.001, respectively], gonorrhoea infection [AOR 2.79 (1.51, 5.15), p=0.001; AOR 2.69 (0.96, 7.56), p=0.060, respectively] and syphilis infection [AOR 1.86 (1.04, 3.31), p=0.036; AOR 3.35 (1.78, 6.28), p<0.001, respectively], but not with exposure to peer education, community mobilization or HIV testing uptake. Mediation analysis suggests that alcohol use and STIs may partially mediate the association between violence or arrests and HIV prevalence.

Discussion

Violence by non-partners and arrest are both strongly associated with HIV infection among FSWs. Large-scale, comprehensive HIV prevention programming can reduce violence, arrests and HIV/STI infection among FSWs.     

Outsourcing and stress: physiological effects on bus drivers

The aim of this study was to evaluate the physiological effects of changes in work organization due to the outsourcing of bus routes. Twenty bus drivers served as the study group. They were voluntarily transferred to work for another bus company after this company had won a tender from their former employer. Twenty drivers from the former employer served as the control group. At baseline, one month before the transfer, all were monitored for 2 days: blood pressure was measured every 2 hours while awake. On the first day, urine samples were collected in order to detect adrenaline, noradrenaline and cortisol, and blood samples were taken for the detection of lipids, glycated haemoglobine (HbA_1c), fibrinogen, dehydroepiandrosteronsulfat (DHEA‐S) and prolactin. In addition, all participants filled out a questionnaire on health and work related items. Eight and 12 months later, a similar data collection took place in the study group. During the follow‐up period, seven drivers in the study group left their job due to dissatisfaction with the working conditions and the remaining 13 drivers changed their attitude to the work place. In accordance with this, the drivers scored worse on questions regarding job satisfaction. After 12 months the following changes in physiological measures were detected: increase in HbA_1c (4.4–4.7 per cent; p<0.001), urinary cortisol (7.3–12.1 nmol/mmol cretatinine; p=0.04) and systolic blood pressure at work (129.4–134.1; p=0.04). In addition, a decrease in DHEA‐S (8.8–7.6 nmol/l; p=0.06) was observed. The changes in systolic blood pressure and DHEA‐S were even higher after 8 months. The physiological changes were, as expected, in agreement with the assumption that metabolism turns to a catabolic direction during a period of perceived stress. The implications of the findings, which should be noted with caution due to the small size of the study and the selection during the follow‐up first suggest that outsourcing and other radical changes in the psychosocial work environment may lead to prolonged stress among employees. Second, that urinary cortisol, HbA_1c, DEAH‐S and ambulatory measurements of blood pressure are useful measures of chronic stress. Copyright © 2000 John Wiley & Sons, Ltd.     

Stress among package truck drivers

In 1992, a cross-sectional questionnaire study of package truck drivers in one company was conducted at four widely scattered sites throughout the US; 317 drivers participated, representing 82% of those eligible. The package truck drivers scored significantly above the US working population comparison norm on all summary and individual scales derived from the SCL 90-R, indicating a substantial increase in psychologic distress for this group. The Global Severity Index, the best single summary measure of psychological distress in the SCL 90-R, revealed a mean T score for the drivers of 64.20, 91st percentile of the normative population. The group perceived significantly more daily stressful events than the average working adult, and their sensitivity to these events was also increased. Role overload, a component of the Occupational Stress Inventory, was the most consistent factor associated with symptoms of psychological distress on multiple regression analysis. This study suggests that job stress is a psychological health hazard for these drivers. Am. J. Ind. Med. 31:202–210, 1997. © Wiley-Liss, Inc.     

Young drivers who continue to drive while sleepy: What are the associated sleep‐ and driving‐related factors?

Crashes due to sleepiness account for a substantial proportion of road crash incidents. The purpose of the current study was to examine several sleep‐related factors and driving‐related factors for their association with self‐reports of continuing to drive while sleepy. In total 257 young drivers aged 18–25 years completed an online survey that assessed factors such as sleep quality, sleep duration and consistency, excessive daytime sleepiness, experiences with sleepiness and their driving‐related behaviours. The results demonstrate that being older, having a perceived ability to overcome sleepiness, committing more highway code violations and having experienced a sleep‐related close call were positively associated with an increased likelihood of continuing to drive while sleepy. The obtained results highlight the acceptance of risky driving behaviours among some younger drivers. Younger drivers’ risky driving behaviour is certainly a road safety concern given the impairment associated with sleepiness and their over‐representation in road crash incidents.