How to schedule night shift work in order to reduce health and safety risks

Objectives:This discussion paper aims to provide scientifically based recommendations on night shift schedules, including consecutive shifts, shift intervals and duration of shifts, which may reduce health and safety risks. Short-term physiological effects in terms of circadian disruption, inadequate sleep duration and quality, and fatigue were considered as possible links between night shift work and selected health and safety risks, namely, cancer, cardio-metabolic disease, injuries, and pregnancy-related outcomes.Method:In early 2020, 15 experienced shift work researchers participated in a workshop where they identified relevant scientific literature within their main research area.Results:Knowledge gaps and possible recommendations were discussed based on the current evidence. The consensus was that schedules which reduce circadian disruption may reduce cancer risk, particularly for breast cancer, and schedules that optimize sleep and reduce fatigue may reduce the occurrence of injuries. This is generally achieved with fewer consecutive night shifts, sufficient shift intervals, and shorter night shift duration.Conclusions:Based on the limited, existing literature, we recommend that in order to reduce the risk of injuries and possibly breast cancer, night shift schedules have: (i) ≤3 consecutive night shifts; (ii) shift intervals of ≥11 hours; and (iii) ≤9 hours shift duration. In special cases – eg, oil rigs and other isolated workplaces with better possibilities to adapt to daytime sleep – additional or other recommendations may apply. Finally, to reduce risk of miscarriage, pregnant women should not work more than one night shift in a week.     

中欧药品价格构成比较与对策建议

采用WHO/HAI药品价格构成调查方法,调查2017年版《国家基本医疗保险、工伤保险和生育保险药品目录》中所列2 535种药品的实际出厂价格和市场零售价格,分析药品价格各组成部分在零售价格中所占比例。调查结果显示,在政府取消价格管制后,中国药品价格构成仍然不合理。药品实际出厂价格在零售价格中所占比例仅为25%左右,供应链上出厂价格以外的附加费用占零售价的75%左右。本文分析认为,政府管制药品价格主要源于医药市场的信息不对称引发的药品价格扭曲。借鉴发达国家药品价格管制成功经验,建议实行全部处方药价格管制、采用参考定价以及控制流通加价等政策工具,最终将实现全面降低药价的目标。     

穴位埋线治疗单纯肥胖型阻塞性睡眠呼吸暂停低通气综合征临床研究

目的:探讨穴位埋线对单纯肥胖型阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者的治疗效果。方法:将60例单纯肥胖型OSAHS患者随机分成对照组和治疗组,均口服金嗓利咽胶囊,治疗组在此基础上,加用穴位埋线治疗,选用减肥穴:中脘、大横、曲池、天枢、上巨虚、下巨虚、丰隆、合谷、足三里、阴陵泉、三阴交。开窍醒神穴:百会、四神聪、廉泉、膻中穴。10 d埋线1次,共6次,60 d后根据体质量指数、睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)和Epworth嗜睡量表(epworth sleeping scale,ESS)评分的改善程度进行疗效评价。结果:治疗后,两组在体质量指数、AHI和ESS评分方面均有改善,但是治疗组的改善更加明显(P0.05)。结论:穴位埋线治疗单纯肥胖型OSAHS患者疗效显著,安全可靠,费用低廉。     

High bicarbonate levels in narcoleptic children

The objective of this study was to evaluate the levels of plasma bicarbonate levels in narcoleptic children. Clinical, electrophysiological data and bicarbonate levels were evaluated retrospectively in children seen in our paediatric national reference centre for hypersomnia. The cohort included 23 control subjects (11.5 ± 4 years, 43% boys) and 51 patients presenting de‐novo narcolepsy (N) (12.7 ± 3.7 years, 47% boys). In narcoleptic children, cataplexy was present in 78% and DQB1*0602 was positive in 96%. The control children were less obese (2 versus 47%, P = 0.001). Compared with control subjects, narcoleptic children had higher bicarbonate levels (P = 0.02) as well as higher PCO₂ (P < 0.01) and lower venous pH gas (P < 0.01). Bicarbonate levels higher than 27 mmol L^?1 were found in 41.2% of the narcoleptic children and 4.2% of the controls (P = 0.001). Bicarbonate levels were correlated with the Adapted Epworth Sleepiness Scale (P = 0.01). Narcoleptic patients without obesity often had bicarbonate levels higher than 27 mmol L ^?1 (55 versus 25%, P = 0.025). No differences were found between children with and without cataplexy. In conclusion, narcoleptic patients had higher bicarbonate plasma levels compared to control children. This result could be a marker of hypoventilation in this pathology, provoking an increase in PCO₂ and therefore a respiratory acidosis, compensated by an increase in plasma bicarbonates. This simple screening tool could be useful for prioritizing children for sleep laboratory evaluation in practice.     

持续气道正压通气对冠心病合并阻塞性睡眠呼吸暂停患者血压和昼间嗜睡的干预效果

目的 探讨持续气道正压通气(continuous positive airway pressure,CPAP)对于冠心病合并阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的血压以及白天嗜睡情况的干预效果.方法 选取我院收治的160例冠心病合并OSA患者作为研究对象,随机分为观察组(在药物治疗的同时应用CPAP治疗)和对照组(仅药物治疗),各80例,监测治疗前后各组患者的血压、Epworth嗜睡评分量表(即ESS评分),以及多次小睡潜伏时间试验(multiplesleep latency test,MSLT)的变化.结果 治疗前,两组的血压水平、ESS评分及MSLT试验结果差异无统计学意义.治疗后两组的血压水平均有明显降低,两组24 h平均收缩压(24 h-MDBP)、24h平均舒张压(24 h-MSBP)、白天平均收缩压(dMSBP)、白天平均舒张压(dMDBP)、夜间平均收缩压(nMSBP)及夜间平均舒张压(nMDBP)比较,观察组治疗后的分别为(130.8±11.9) mmHg,(85.5±2.9) mmHg,(131.9±10.2)mmHg,(86.1 ±3.5)mmHg,(128.4±18.66) mmHg,(83.7±4.1) mmHg,均显著优于对照组(P＜0.05);两组ESS评分、MSLT、AMI,以及呼吸暂停时间比较,观察组治疗1个月,3个月的效果明显优于对照组,差异有统计学意义(P＜0.05).结论 CPAP能够促进冠心病合并OSA患者的血压趋于正常,改善昼间嗜睡情况.     

社区老年人多重用药率及其相关因素的系统综述

背景　随着人群的老化和寿命的延长,需要药物治疗的老年人多病共存率明显增加,多重用药已经成为全球重要的公共卫生问题。目的　评价社区老年人多重用药率及其相关因素,为减少多重用药及危害、制定公共卫生政策提供依据。方法　检索Medline、Embase、Cochrane Library、中国知网和万方数据知识服务平台2000-01-01至2021-01-01发表的社区老年人多重用药现患率的相关中英文文献,并对纳入的研究进行质量评价与数据提取,使用RevMan 5.4软件进行Meta分析。结果　共纳入合格文献49篇。Meta分析结果显示,社区老年人多重用药率为37%〔95%CI（34%,39%）〕,过度多重用药率为14%〔95%CI（12%,16%）〕。有13篇文献进行了多重用药相关因素多变量分析,结果显示较多慢性病数量/多病共存（7篇）,较年老者（6篇）,超重/肥胖（5篇）,自述健康不佳（4篇）,日常生活能力受限（4篇）,较低教育水平（4篇）,自述患糖尿病（3篇）,自述患高血压（2篇）,自述患心脏病（2篇）等与多重用药呈正相关。结论　社区老年人多重用药高度流行,过度多重用药较为普遍。明确多重用药的相关因素对发现和监测老年人多重用药至关重要。在制定社区多重用药干预措施时,必须要考虑各种各样的多重用药相关因素,尤其是慢性病的预防和管理。医生和药师应基于循证处方,合理使用药物,从公共卫生角度而言,健康生活方式可能有助于减少慢性病和多重用药的发生。     

阻塞性睡眠呼吸暂停低通气综合征患者Epworth嗜睡评分与甲状腺激素的相关性

目的分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者甲状腺激素水平与患者Epworth嗜睡评分(ESS)的关系。方法选取2018年1月—2019年12月新疆医科大学第一附属医院呼吸与呼吸危重症中心收治OSAHS患者83例为研究对象,入院时参照ESS评分评估患者嗜睡程度,分为轻度嗜睡组(n=51)和中重度嗜睡组(n=32);采集患者基线资料,比较各组血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT₃)、游离甲状腺素(FT₄)、瘦素水平,并分析甲状腺激素水平与ESS评分的相关性。结果中重度嗜睡组TSH、FT₄水平低于轻度嗜睡组,瘦素水平高于轻度嗜睡组(t=3.942、5.252、8.661,P均<0.001);TSH、FT₄水平与OSAHS患者ESS评分呈负相关(r=-0.526、-0.500,P均<0.001);TSH、FT₄低表达,瘦素过表达是患者嗜睡程度加重的危险因素(OR=18.401、12.096、54.493,P均<0.05)。TSH、FT₄预测OSAHS患者嗜睡程度加重风险的AUC分别为0.896、0.873,两者联合检测的AUC为0.901。结论OSAHS患者的甲状腺激素(TSH、FT₄)水平与ESS评分呈负相关,TSH、FT₄低表达可能提示OSAHS患者嗜睡程度加重。