Background: The aim of this study was to estimate the incidence, main causes, and risk factors of iatrogenic disease occurring in a department of internal medicine. Methods: Over a 1-year period, physicians systematically filled out a 2-page questionnaire for all patients admitted to the ward. A database was created and the data were statistically analyzed. Patients undergoing immunosuppressive, chemo-, or radiation therapy were excluded. Missing data were completed by reviewing the patients' charts. The patients were then divided into two groups: those with and those without iatrogenic disease. The groups were compared using several parameters including gender, age, social features, days of hospitalization, associated illness, functional status, medical impression, prognosis, associated renal or liver function impairment, drugs taken daily, and outcome. In the group with iatrogenic disease, the type, severity, and predictability were also analyzed. Results: Of the 879 patients admitted to the ward, 445 completed questionnaires and were included in the study. A total of 102 patients (22.9%) developed 121 iatrogenic events. Forty-four patients (43.1%) were admitted for iatrogenic illness, 10 (9.8%) developed lifethreatening events, and in 3 (6.8%) it was the cause of death. Fifty-eight patients (56.8%) registered 77 episodes of iatrogenic disease during their hospital stay, 20 (19.6%) developed life-threatening events, and 9 (11.7%) died, 4 (5.2%) of an iatrogenic cause (nosocomial infections). Significant differences were found in 20 out of 26 parameters studied ( p b 0.005 for all cases; 95% confidence interval). Eighteen percent of all iatrogenic disease was severe, 61.9% predictable, 54.5% avoidable, and 59% drug-related, 80% of which was due to side effects or adverse reactions. Infection and metabolic and electrolyte disorders were the most frequent effects. Conclusions: It is possible to identify risk factors for iatrogenic events. Chronically ill elderly inpatients are the main target of iatrogenic events.
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Fundação para a Ciência e Tecnologia (FCT) and Fundo Social Europeu (FSE) Introduction Modern societies function 24h/day which accounts for shift work (SW) encompassing already more than 20% of the European workforce. While the relationship between blood pressure (BP) and cardiovascular events is a continuous, hypertension (HTN) remains the major preventable cause of cardiovascular disease (CVD) in our continent. SW has been associated with sleep disturbances, circadian misalignment and unhealthy behaviours, possibly conducting to several chronic diseases. Therefore, we aimed to determine if shift workers have higher BP values and/or HTN risk. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed on MEDLINE, EMBASE and Cochrane electronic databases. Included studies reported HTN diagnosis using current thresholds and/or BP values, in both shift workers and in a control group of day workers. SW was categorized in 4 subgroups, focused mostly on night work. Pooled mean difference and 95% Confidence Intervals (95%IC) were estimated for continuous outcomes, Systolic BP (SBP) and diastolic BP (DBP), and pooled Odds Ratio and 95%IC were determined for HTN risk. The Newcastle-Ottawa Quality Assessment Scale was used for quality evaluation of included studies. Results Forty-five independent studies were included engaging 117252 workers. Of these, 41 studies were included in the meta-analysis for SBP, 39 for DBP and 14 for HTN. Most studies provided cross-sectional data (n = 42), were developed in Asia (n = 21), in an industrial setting (n = 25) and included only men (n = 26). Most studies were rated as satisfactory quality (n = 23) with confounder adjustment being the weakest parameter. We found a statically significant increase for both systolic and diastolic BP among permanent night workers, 2.52mmHg [0.75–4.29] and 1.77mmHg [0.39–3.15] respectively. Amongst rotational shift workers, both with and without night work, we found a significant increase only for SBP, namely 1.28 mmHg [0.18–2.39] and 0.65 mmHg [0.07–1.22]. For HTN risk, none of SW types showed significant differences. Conclusions Certain groups of shift workers may be at special risk for increased BP. This is the first review assessing the impact of SW specifically on BP values. Although the increases were generally modest, these may play an important role among already susceptible individuals exposed overtime. The effect of SW was more consistent for SBP, which has a major impact on CVD risk. Hence, occupational health services should embrace a holistic CVD preventive approach including atypical risk factors such as SW, with active monitoring across the lifespan of more vulnerable workers.
Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Fundação para a Ciência e Tecnologia (FCT) and Fundo Social Europeu (FSE) Introduction Atypical work schedules encompass more than 20% of the European workforce. The link between shift work and cardiovascular disease (CVD) has been extensively studied being lifestyle behaviours, sleep disruption and circadian misalignment the key mechanisms involved. Social Jetlag (SJL) has been proposed as a proxy for circadian misalignment in epidemiological studies, once it takes into account individual’s chronotype and working schedules. Therefore we hypothesize that, among workers under fixed atypical work schedules, those with a greater SJL have a higher CVD risk. Methods A cross-sectional observational study was conducted among blue-collar workers of one retail company. Fixed working schedules were early morning, late evening, and night work. Sociodemographic, occupational, lifestyle and sleep data were collected through questionnaire. SJL was quantified by the difference for mid-sleep points on work- and free-days. Even though SJL is a continuous variable, 3 categories have been used (≤2h; 2-4h; ≥4h). Blood pressure (BP) and the total cholesterol (TC) were assessed. The CVD risk was estimated according to the relative risk SCORE chart. A relative risk≥3 was considered "high CVD risk". Descriptive statistics and bivariate analysis according to the CVD risk (high vs other) was performed. The relationship between SJL and high CVD risk was analysed through logistic binary regression using generalized linear models adjusted for age, sex, education, Body Mass Index, consumptions, sleep duration and quality plus work schedule and seniority. Results Of the 301 workers, 56.1% were male with a mean age of 33.0 ± 9.4years. Average SJL was 1:57 ± 1:38hours with the majority of workers experiencing ≤2h (59.4%) and 8% (n = 24) more than 4h. Less than a half had hypercholesterolemia (48.8%), overweight (37.9%)or hypertensive values (10.6%), however 50.5% were currently smokers. We found a significant trend for hypertension (p = 0.006) and smoking prevalence (p = 0.043) among ordinal SJL categories. A relative "high CVD risk" was found in 20.3% of the sample (n = 61). These workers were significantly older (p < 0.001), less educated (p = 0.003) and slept less hours on workdays (p = 0.021). In the multiple regression analysis, SJL was an independent risk factor for a "high CVD risk" (p = 0.029).The odds of having a "high CVD risk" increased almost thirty per cent per each additional hour of SJL (OR = 1.29; 95% CI:1.03-1.63), even after adjusting for sociodemographic, lifestyle, sleep and working features. Conclusions We found compelling evidence that a greater SJL was associated with a bigger chance of high CVD risk. From this innovative perspective, the focus is not just on the working schedule itself but also on the worker’s chronotype. These findings suggest that interventions aimed to reduce Social Jetlag, especially in extreme chronotypes and working schedules, poses a great opportunity to minimize the cardiovascular health impact of shift work.
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