Study of the incidence of weight gain in night-shift workers and its relationship with the sleeping

Orientador: Milva Maria Figueiredo De MartinoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Os objetivos deste estudo foram: avaliar as características individuais do ciclo vigília-sono; comparar a diferença de peso, no intervalo de dois anos, entre indivíduos do turno diurno e noturno; identificar se existe associação entre tempo de trabalho no turno noturno e alteração de peso e IMC; verificar se existem associação entre alterações de peso e IMC e as variáveis do ciclo vigília-sono consideradas neste estudo como latência, qualidade de sono noturno, duração de sono e cochilos e verificar a influência da atividade física no peso. Participaram da pesquisa um total de (n=76) sujeitos, (n=50 turno noturno e n=26 turno diurno), distribuídos nas seguintes categorias: enfermeiros, auxiliares de enfermagem e técnicos de enfermagem, que trabalhavam no Hospital das Clinicas da Universidade Estadual de Campinas. A idade média foi de 42 anos. O horário de trabalho do turno noturno era das 19h00min até às 07h00min do dia seguinte e do turno diurno, das 07h00min às 13h00min ou das 13h00min até às 19h00min. Os instrumentos utilizados para a coleta de dados foram: o diário de sono (coletado durante 30 dias); questionário de informações pessoais; uma balança para pesagem e mensuração da altura para o cálculo do índice de massa corporal (IMC), e para classificar o IMC utilizou-se a tabela de BRAY (1998). Os dados do peso foram coletados em dois momentos caracterizados por peso 1, altura 1 e IMC 1 do registro da Divisão de Segurança e Saúde Ocupacional da UNICAMP, correspondendo ao controle de saúde do trabalho no período de 2003. O segundo momento em 2005, correspondendo ao peso 2, altura 2 e IMC 2. Os resultados da análise dos padrões do sono dos grupos diurno e noturno mostraram dados estatisticamente significantes (Teste de Mann-Whitney) para a latência do sono (p=<0,001), horário de acordar (p=<0,001), duração do sono noturno (p=0,002), qualidade do sono noturno (p=0,009) e presença de cochilos (p=0,001). Constatou-se pelo teste de correlação de Spearman que houve diferença significativa estatisticamente. (r=-0,296; p=0,0366) dado que, conforme aumenta a freqüenta da prática de atividade física, diminui a diferença de peso e IMC. Comparando os resultados do aumento de peso associados com o tempo de trabalho em turno noturno observou-se que não houve diferença significativa pelo teste Mann-Whitney (p=0,302), no entanto, os valores das médias do tempo de trabalho dos grupos de redução e aumento de peso mostraram diferenças (11,18 anos e 13,87 anos respectivamente). Verifcou-se que os sujeitos do grupo do turno noturno apresentaram média de IMC maior em comparação ao grupo diurno com diferenças estatisticamente significantes (teste Mann- Whitney). Entretanto,não se pode afirmar que as alterações de sono estiveram presentes influenciando o ganho de peso no grupo do noturnoAbstract: The main goals of this work were: evaluate the individuals? characteristics of the sleep-wake cycle compare the variation in weight, in the period of two years, among individuals working in the day-shift and in the night-shift; investigate the existence of any relationship between the working time in the night-shift and change in weight and BMI as well as investigate any relationship between change in weight and BMI and the variables of the sleep-wake cycle which in this study are taken as latency, quality of sleep in the night, sleep duration and napping. This research counted on a number of participants of (n=76) people, (n=50 of the night-shift and n=26 of the day-shift), from several distinct professions: nurses, nursing technician and nurses aides that worked in the Hospital das Clínicas da Universidade Estadual de Campinas. The average age of the group was 42 years. The working time of the night-shift was from 19h00min to 07h00min of the following day, and the working time of the day-shift was from 07h00min to 13h00min or from 13h00min to 19h00min. The instrumentation used to collect the date was: the diary of sleep (which was filled in with data for 30 consecutive days); questionnaire on personal information related to life style; a balance to measure weight and height to get data for BMI calculation, and the BRAY (1998) table to classify the BMI. The data related to weight were collected in two distinct points in time; the first instant is represented by weight-1, height-1 and BMI-1 of the records from Occupational Health and Safety Division at UNICAMP, respective to the Labor Health control of the period of 2003. The second instant, in 2005, is represented by weight-2, height-2 and BMI-2. The results of the analysis of the night- shift group and day-shift group sleep patterns lead to data statistically significative (Mann-Whitney test) for the latency of sleep (p=<0,001), wake up time (p=<0,001), night sleep duration (p=0,002), night sleep quality (p=0,009), and occurrence of napping (p=0,001). It was found through the test of correlation of Spearman that there was a statistically significant difference (r=-0,296; p=0,0366), given that the difference in weight and the IMC decrease as it increases the frequency of physical activity. From the comparison among the results of the weight increase associated with time of work in the night-shift, it was noticed that there was not significant difference by means of the test of Mann-Whitney (p=0,302), however, the average time of work of the groups with weight reduction and with weight increase showed differences: (11,18 years and 13,87 years respectively). It was noticed that the individuals from the group of night-shift lead to average IMC higher than the ones from the group of day-shift with statistically significant differences (test of Mann-Whitney). However, it was not identified any reason to support the statement that the altered sleep was present and that influenced the weight increase in the group of night-shiftDoutoradoEnfermagem e TrabalhoDoutor em Enfermage

Effect of night work on the hormonal control of hunger and satiety

Orientador: Bruno Geloneze NetoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Devido ao aumento considerável de trabalhadores noturnos é importante o estudo dos efeitos deste tipo de trabalho na saúde do trabalhador. Estudos atuais demonstram que trabalhos em turno e noturno favorecem transtornos digestivos relacionados a diferenças no hábito alimentar, tanto no valor calórico total, como no horário e número de refeições. Além disso, há aumento dos fatores de risco cardiovasculares, tais como: altos níveis de triglicérides e colesterol séricos, obesidade abdominal, resistência à insulina e outros marcadores da síndrome metabólica. Estes fenômenos estão relacionados a um ganho e redistribuição do peso corporal, em parte atribuível a diferenças no padrão de fome e saciedade. Trabalhadores do turno noturno podem apresentar perturbação no ritmo biológico endógeno em função do conflito temporal entre o relógio biológico endógeno e a estrutura de funcionamento das atividades sociais. Esta dessincronização pode produzir transtornos intensos e persistentes na fisiologia do sono. Foram selecionados 12 trabalhadoras de turno noturno e 12 do diurno do HC-UNICAMP, com IMC entre 25 e 29.9 (sobrepeso). O objetivo deste trabalho foi comparar uma população trabalhadora de turno noturno com uma população trabalhadora diurna, em relação a componentes bioquímicos e antropométricos da síndrome metabólica. Além disso, a caracterização das respostas de hormônios reguladores da fome e saciedade foi acessada a partir de um teste de refeição padrão, com dosagens de grelina, (hormônio orexigênico), oxintomodulina, xenina, glucagon-like peptide 1 (GLP-1) e PYY3-36 (hormônios anorexigênicos). A resistência à insulina foi avaliada por índices que relacionam a produção de insulina com a curva glicêmica durante o teste de refeição (Metabolic Clearance Rate, ou índice de Stumvoll). Estes mesmos voluntários foram avaliados quanto à qualidade de sono, ao cronótipo e ao estado inflamatório sub-clínico (avaliado pelos níveis circulantes de interleucina 6, TNF-?, adiponectina e proteína C-reativa). Na avaliação quanto ao cronótipo, a maior proporção de indivíduos indiferentes foram encontrados no grupo do turno noturno. A qualidade de sono avaliada pelo score de Pittsburgh não demonstrou diferença significante entre os grupos estudados. Os trabalhadores de turno noturno demonstraram valores maiores para disfunção diurna, demonstrando sonolência excessiva diurna. O principal achado foi a caracterização de uma resposta de produção do hormônio orexigênico - grelina - aumentada no período pós-prandial das voluntárias de trabalho noturno e uma resposta reduzida de xenina (um hormônio anorexígeno e de fonte estomacal). Assim este fato pode ser responsável pela mudança do comportamento alimentar e consequente ganho de peso destas trabalhadoras de turno noturno.Abstract: Due to the considerable increase of night shift workers it is important the study of its effects on worker health. Recent studies reveal that work in shifts and night shift work propitiate digestive disorders related to differences in dietary habits, in the total caloric content, as well as in the timing and number of meals. Moreover, it is noticed an increase in cardiovascular risk factors such as high levels of triglycerides and cholesterol, and abdominal obesity, insulin resistance and markers of metabolic syndrome. These phenomena are related to gain and redistribution of body weight, in part attributable to changes in the pattern of hunger and satiety. Night shift workers may have endogenous biological rhythm disturbance as a result of the temporal conflict between the endogenous biological clock and the functioning structure of social activities. This asynchronization may produce intense and persistent disorders in sleep physiology. We selected 12 night shift workers and 12 day workers of the HC-UNICAMP, with BMI between 25 and 29.9 (overweight). The objective of this study was to compare a population of night shift workers with a daytime working population in relation to anthropometric and biochemical components of the metabolic syndrome. Besides that, the characterization of the responses of hormones regulating hunger and satiety was accessed by means of a standard meal test , with dosages of ghrelin, oxyntomodulin, xenin, glucagon-like peptide 1 (GLP-1) and PYY3-36. Insulin resistance was evaluated by indexes relating the production of insulin during the glycemic test meal (Stumvol index). These same volunteers were evaluated for the quality of sleep, the chronotype and sub-clinical inflammatory state (assessed by circulating levels of interleukin-6, TNF-?, adiponectin and protein C-reactive). In the assessment for the chronotype, the highest proportion of indifferent individuals were found in the group of night shift. The quality of sleep assessed by pittsburgh score showed no significant difference between groups. The night shift workers showed higher values for daytime dysfunction, demonstrating excessive daytime sleepiness. The main finding was the characterization of a increased response in production of hormone - ghrelin - in the postprandial period of night shift workers and reduced response of xenina (an anorectic hormone source and stomach). As a conclusion, this fact may be responsible for the weight gain observed for those night shift workers.DoutoradoClinica MedicaDoutora em Clínica Médic

Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences and Countermeasures.

Circadian (∼ 24 hour) timing systems pervade all kingdoms of life, and temporally optimize behaviour and physiology in humans. Relatively recent changes to our environments, such as the introduction of artificial lighting, can disorganize the circadian system, from the level of the molecular clocks that regulate the timing of cellular activities to the level of synchronization between our daily cycles of behaviour and the solar day. Sleep/wake cycles are intertwined with the circadian system, and global trends indicate that these too are increasingly subject to disruption. A large proportion of the world's population is at increased risk of environmentally-driven circadian rhythm and sleep disruption, and a minority of individuals are also genetically predisposed to circadian misalignment and sleep disorders. The consequences of disruption to the circadian system and sleep are profound and include myriad metabolic ramifications, some of which may be compounded by adverse effects on dietary choices. If not addressed, the deleterious effects of such disruption will continue to cause widespread health problems; therefore, implementation of the numerous behavioural and pharmaceutical interventions that can help restore circadian system alignment and enhance sleep will be important

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Appetite-regulating hormones from the upper gut: disrupted control of xenin and ghrelin in night workers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)ObjectiveShift work is associated with circadian rhythm disorder, impaired sleep and behavioural changes, including eating habits, predisposing to obesity and metabolic dysfunctions. It involves a neuro-hormonal dysregulation of appetite towards positive energy balance, including increased ghrelin and decreased leptin, but little is known about other hormones, such as xenin, derived from the upper gut (like ghrelin), and lower gut hormones. Our objective was to compare night workers with day workers in relation to appetite-regulating hormones and other metabolic parameters. DesignCross-sectional, observational study. ParticipantsTwenty-four overweight women, divided into night shift workers (n=12) and day shift workers (n=12). MeasurementsBMI, waist circumference, fat mass percentage; diet composition; Pittsburgh Sleep Quality Index; lipids; adipokines; meal tolerance test curves of glucose, insulin, ghrelin, PYY3-36, oxyntomodulin, xenin, GLP-1; insulin sensitivity (Stumvoll index). ResultsNight workers, as compared with day workers, had greater body fat mass percentage and tendency to greater waist circumference despite similar BMI; greater energy intake; impaired sleep; lower insulin sensitivity; increased triglycerides and tendency to increased C-reactive protein; similar levels of leptin and other adipokines. Night workers had a blunted post-meal suppression of ghrelin (AUCi(0-60min) 19<bold>41399</bold> vs -141<bold>9</bold>+/- 9<bold>0</bold>ng/ml<bold>60</bold>min, P<0<bold>01</bold>); blunted rise of xenin (AUC(0-180min) 8690<bold>9</bold>+/- 2988<bold>2</bold> vs 28504<bold>4</bold>+/- 20308<bold>3</bold>pg/ml<bold>180</bold>min, P<0<bold>01</bold>) and similar curves of PYY3-36, oxyntomodulin and GPL-1. ConclusionCompared with day workers within the same BMI range, night workers presented a disrupted control of ghrelin and xenin, associated with behavioural changes in diet and sleep and increased adiposity and related metabolic alterations.796807811Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP