Systematic review of shift work and nurses’ health

Background Nursing is characterized by a working articulation in shifts to ensure continuity of care throughout the 24 h. However, shift work and the resulting desynchronization of circadian rhythms may have adverse effects on nurses’ health. Aims To describe the effects of shift work and desynchronization of circadian rhythms on nurse’s health. Methods Databases: PubMed, Cinahl, Scopus, Embase and Ilisi. Search terms (free terms, MeSH): ‘nurses’, ‘shiftwork’, ‘nightwork’, ‘sleep disorder, circadian rhythm’, ‘work schedule tolerance’, ‘breast neoplasm’, ‘metabolic syndrome X’, ‘metabolic cardiovascular syndrome’, ‘Cardiovascular disease’, ‘stress’, ‘diabetes’. We included all randomized controlled trials, observational studies, reviews and papers studying nurses’ shift work. Quality assessment of the retrieved papers was verified according to Dixon-Woods checklist. Results Twenty-four articles were analyzed. Literature review has shown that shift work involves an alteration in psychophysical homeostasis, with a decrease in performance. It is an obstacle for social and family relationships, as well as a risk factor for stress, sleep disorders, metabolic disorders, diabetes, cardiovascular disorders and breast cancer. Conclusions An organized ergonomic turnaround can be less detrimental to the health of nurses and more beneficial for the healthcare providers. Therefore, we suggest organizing studies to assess whether improving nurses’ health would lead to a reduction in miscarriages, absenteeism and work-related stress.

FROM LANG TO REAVEN History of the First Department of Internal Medicine at Pavlov St Petersburg State Medical University

The review provides evidence that in the early twentieth century the research on the mechanisms of «metabolic cardiovascular syndrome» was started at the Department of Faculty Therapy in Pavlov St Petersburg State Medical University (that was called St Petersburg Women’s Medical University at that time). The investigations were initiated by G.F. Lang, and extended by A.L. Myasnikov, D.M. Grotel, B.V. Ilyinskiy, V.M. Dilman, V.A. Almazov and others, and based on the results they proposed the concept of a cascade of metabolic syndrome and its main components — obesity, insulin resistance and hyperinsulinemia. Nowadays, as the continuation of those studies, the first epidemiological Russian study NICA (National Investigation of Cardiovascular Complications in mеtАbolic syndrome) is conducted by the employees of the Department of Faculty Therapy and Almazov Federal Heart, Blood and Endocrinology Centre.

Adiposopathy as a key factor in the development of insulin resistance

The metabolic cardiovascular syndrome (MS) is a common cluster of metabolic abnormalities (abdominal obesity, hypertension, dyslipidemia and carbohydrate metabolism disorders) that are related to insulin resistance and hyperinsulinemia and are associated with accelerated atherogenesis. Insulin excess is known to promote the development of the whole metabolic cascade. Recently it has been shown that the inflammatory and hemostatic abnormalities, immunological disorders, endothelial dysfunction, hyperhomocysteinemia and hyperuricemia are also important features of MS. Despite the numerous studies of MS its underlying cause is still not established. The dysfunction of visceral adipocytes (adiposopathy) might be genetically determined, and is considered nowadays as the main factor contributing to the development of the MS. Understanding the underlying mechanisms is of particular interest for prevention and target therapy of all the components of MS.

Mechanisms of arterial hypertension in metabolic syndrome

Arterial hypertension in patients with metabolic cardiovascular syndrome (MS) has a number of features which are of great theoretical and practical significance. It has been shown that hypertension is the most frequent component of MS and chronologically follows abdominal obesity while clinical manifestations of atherosclerosis and carbohydrate metabolism disturbances develop much later. In addition, the disorders of hypothalamic-pituitary-adrenal axis contribute to the development of arterial hypertension in patients with abdominal obesity. Besides the abnormalities of central regulatory mechanisms, increased sympathetic tone, insulin resistance and hyperinsulinemia, functional state of adipose tissue is an established important factor for the development of systemic hypertension in patients with abdominal obesity, and in some cases the dysfunction of adipocytes, which can be genetically determined or acquired, may cause the whole cascade of MS. Search for the causes and mechanisms of arterial hypertension in patients with MS can help to find the possible targeted treatment and prevention of the disease.

Evidence for an Association between Metabolic Cardiovascular Syndrome and Coronary and Aortic Calcification among Women with Polycystic Ovary Syndrome

Women with polycystic ovary syndrome (PCOS) exhibit an adverse cardiovascular risk profile, characteristic of the metabolic cardiovascular syndrome (MCS). The aim of this study was to determine the prevalence of coronary artery (CAC) and aortic (AC) calcification among middle-aged PCOS cases and controls and to explore the relationship among calcification, MCS, and other cardiovascular risk factors assessed 9 yr earlier. This was a prospective study of 61 PCOS cases and 85 similarly aged controls screened in 1993–1994 for risk factors and reevaluated in 2001–2002. The main outcome measures were CAC and AC, measured by electron beam tomography. Women with PCOS had a higher prevalence of CAC (45.9% vs. 30.6%) and AC (68.9% vs. 55.3%) than controls. After adjustment for age and body mass index, PCOS was a significant predictor of CAC (odds ratio = 2.31; P = 0.049). PCOS subjects were also 4.4 times more likely to meet the criteria for MCS than controls. High-density lipoprotein cholesterol and insulin appeared to mediate the PCOS influence on CAC. Interestingly, total testosterone was an independent risk factor for AC in all subjects after controlling for PCOS, age, and body mass index (P = 0.034). We conclude that women with PCOS are at increased risk of MCS and demonstrate increased CAC and AC compared with controls. Components of MCS mediate the association between PCOS and CAC, independently of obesity.