The effect of exposure to long working hours on alcohol consumption, risky drinking and alcohol use disorder: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related burden of disease and injury

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing Joint Estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that exposure to long working hours may increase alcohol consumption and cause alcohol use disorder. In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from alcohol consumption and alcohol use disorder that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates.Objectives: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and >55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption, risky drinking (three outcomes: prevalence, incidence and mortality) and alcohol use disorder (three outcomes: prevalence, incidence and mortality).Data sources: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trials Register, Ovid MEDLINE, PubMed, Embase, and CISDOC on 30 June 2018. Searches on PubMed were updated on 18 April 2020. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand searched reference list of previous systematic reviews and included study records; and consulted additional experts.Study eligibility and criteria: We included working-age (15 years) and unpaid domestic workers. We considered for inclusion randomized controlled trials, cohort studies, case-control studies and other nonrandomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and 55 h/week), compared with exposure to standard working hours (35-40 h/week), on alcohol consumption (in g/week), risky drinking, and alcohol use disorder (prevalence, incidence or mortality). Study appraisal and synthesis methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from publications related to qualifying studies. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project.Results: Fourteen cohort studies met the inclusion criteria, comprising a total of 104,599 participants (52,107 females) in six countries of three WHO regions (Americas, South-East Asia, and Europe). The exposure and outcome were assessed with self-reported measures in most studies. Across included studies, risk of bias was generally probably high, with risk judged high or probably high for detection bias and missing data for alcohol consumption and risky drinking. Compared to working 35-40 h/week, exposure to working 41-48 h/week increased alcohol consumption by 10.4 g/week (95% confidence interval (CI) 5.59-15.20; seven studies; 25,904 participants, I2 71%, low quality evidence). Exposure to working 49-54 h/week increased alcohol consumption by 17.69 g/week (95% confidence interval (CI) 9.16-26.22; seven studies, 19,158 participants, I2 82%, low quality evidence). Exposure to working >55 h/week increased alcohol consumption by 16.29 g/week (95% confidence interval (CI) 7.93-24.65; seven studies; 19,692 participants; I2 82%, low quality evidence). We are uncertain about the effect of exposure to working 41-48 h/week, compared with working 35-40 h/week on developing risky drinking (relative risk 1.08; 95% CI 0.86-1.36; 12 studies; I2 52%, low certainty evidence). Working 49-54 h/week did not increase the risk of developing risky drinking (relative risk 1.12; 95% CI 0.90-1.39; 12 studies; 3832 participants; I2 24%, moderate certainty evidence), nor working >55 h/week (relative risk 1.11; 95% CI 0.95-1.30; 12 studies; 4525 participants; I2 0%, moderate certainty evidence). Subgroup analyses indicated that age may influence the association between long working hours and both alcohol consumption and risky drinking. We did not identify studies for which we had access to results on alcohol use disorder.Conclusions: Overall, for alcohol consumption in g/week and for risky drinking, we judged this body of evidence to be of low certainty. Exposure to long working hours may have increased alcohol consumption, but we are uncertain about the effect on risky drinking. We found no eligible studies on the effect on alcohol use disorder. Producing estimates for the burden of alcohol use disorder attributable to exposure to long working hours appears to not be evidence-based at this time. Protocol identifier: https://doi.org/10.1016/j.envint.2018.07.025. PROSPERO registration number: CRD42018084077</p

Childhood adversity as a predictor of non-adherence to statin therapy in adulthood.

PURPOSE: To investigate whether adverse experiences in childhood predict non-adherence to statin therapy in adulthood. METHODS: A cohort of 1378 women and 538 men who initiated statin therapy during 2008-2010 after responding to a survey on childhood adversities, was followed for non-adherence during the first treatment year. Log-binomial regression was used to estimate predictors of non-adherence, defined as the proportion of days covered by dispensed statin tablets <80%. In fully adjusted models including age, education, marital status, current smoking, heavy alcohol use, physical inactivity, obesity, presence of depression and cardiovascular comorbidity, the number of women ranged from 1172 to 1299 and that of men from 473 to 516, because of missing data on specific adversities and covariates. RESULTS: Two in three respondents reported at least one of the following six adversities in the family: divorce/separation of the parents, long-term financial difficulties, severe conflicts, frequent fear, severe illness, or alcohol problem of a family member. 51% of women and 44% of men were non-adherent. In men, the number of childhood adversities predicted an increased risk of non-adherence (risk ratio [RR] per adversity 1.11, 95% confidence interval [CI] 1.01-1.21], P for linear trend 0.013). Compared with those reporting no adversities, men reporting 3-6 adversities had a 1.44-fold risk of non-adherence (95% CI 1.12-1.85). Experiencing severe conflicts in the family (RR 1.27, 95% CI 1.03-1.57]) and frequent fear of a family member (RR 1.27, 95% CI 1.00-1.62]) in particular, predicted an increased risk of non-adherence. In women, neither the number of adversities nor any specific type of adversity predicted non-adherence. CONCLUSIONS: Exposure to childhood adversity may predict non-adherence to preventive cardiovascular medication in men. Usefulness of information on childhood adversities in identification of adults at high risk of non-adherence deserves further research

Implementations of the Parallel-Sampling ADC Architecture

This chapter describes circuit implementations of the parallel-sampling ADC architecture presented in Chap. 3. The parallel-sampling architecture is applied to two ADC architectures (a pipeline and a time-interleaving SAR ADC architecture), which are suitable for designing high-speed and medium-to-high resolution ADCs, to improve the ADC power efficiency for multi-carrier signals. Section 4.1 describes the architecture and operation of a 200 MS/s 12-b switched-capacitor pipeline ADC with a parallel-sampling first stage, which is suitable for broadband multi-carrier receivers for wireless standards such as LTE-advanced and the emerging generation of Wi-Fi (IEEE802.11ac). A circuit implementation of the parallel-sampling first stage of the pipeline ADC is presented and simulation results are given. Section 4.2 presents the architecture and operation of a 4 GS/s 11 b time-interleaved ADC with a parallel-sampling frontend stage, which targets wideband direct sampling receivers for DOCSIS 3.0 cable modems. Circuit implementation and simulation of the 4 GS/s parallel-sampling frontend stage are given. Due to the complexity of implementing the proposed 4 GS/s ADC on chip, a two-step design approach was adopted. In Sect. 4.3, a prototype IC of an 11 b 1 GS/s ADC with a parallel sampling architecture is presented, which serves as a first step to validate the parallel-sampling ADC concept and the performance of the high-speed parallel-sampling frontend and detection circuits. In future work, the frontend stage of the IC can be interleaved by four times to achieve the aggregate sample rate of 4 GHz of the proposed ADC discussed in Sect. 4.2. Conclusions of this chapter are drawn in Sect. 4.4