Background Hemodynamic assessment in patients with pulmonary arterial hypertension (PAH) is essential for risk stratification and pharmacological management. However, the prognostic value of the hemodynamic changes after treatment is less well established. Objectives We investigated the prognostic impacts of the changes in hemodynamic indices, including mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), right atrial pressure (RAP), and cardiac output index (CI). We conducted this systematic review with meta-regression analysis on existing clinical trials. Methods We searched and identified all relevant randomized controlled trials from multiple databases. An analogous R2 index was used to quantify the proportion of variance explained by each predictor in the association with PAH patients’ prognosis. A total of 21 trials and 3306 individuals were enrolled. Results The changes in mPAP, PVR, RAP, and CI were all significantly associated with the change in 6MWD (∆6MWD). The change in mPAP was with the highest explanatory power for ∆6MWD (R2 analog = 0.740). Additionally, the changes in mPAP, PVR, and CI were independently predictive of adverse clinical events. The change in mPAP had the highest explanatory power for the clinical events (R2 analog = 0.911). Furthermore, the change in PVR was with the highest explanatory power for total mortality of PAH patients (R2 analog = 0.612). Conclusion Hemodynamic changes after treatment, including mPAP, PVR, CI, and RAP, were significantly associated with adverse clinical events or mortality in treated PAH patients. It is recommended that further studies be conducted to evaluate the changes in hemodynamic indices to guide drug titration. Systematic review registration PROSPERO CRD42019125157
The objective of this study is to elucidate the relationship between obstructive sleep apnea (OSA) and the risk of work‐related injuries (WRIs), synthesize the latest clinical evidence and conduct a systematic review and meta‐analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines (PRISMA 2020). Observational studies published before April 2020 in PubMed, Cochrane library, PsycINFO, Scopus, Google Scholar and Web of Science were included. Random‐effects Mantel–Haenszel meta‐analysis was performed. A total of 15 studies with 21,507 participants were included. Prespecified subgroup analyses based on study design and the characteristics of the enrollees were conducted. Overall, workers with OSA had 1.64‐fold increased odds of being involved in WRIs compared to their counterparts (OR = 1.64, 95% CI = 1.24–2.16, p = 0.0005). In addition to the professional drivers that have been studied in the past, such a trend also existed in the general working population (OR = 1.68, 95% CI = 1.14–2.49, p = 0.01). We also found that workers with excessive daytime sleepiness (Epworth Sleepiness Scale score >10) had a 1.68‐fold increased risk of WRIs compared to those with lower ESS scores (OR = 1.68, 95% CI = 1.22–2.30, p = 0.002). This study verified that OSA workers had a higher risk of WRIs, and such correlations do not show obvious differences in subgroups with different sample sizes, OSA diagnosis methods, job types or definitions of WRI. Based on the association between OSA and WRIs identified in our study, further studies investigating the protective effects of early identification and management of OSA on WRIs are warranted.
Background Stress and psychological disorders have been assigned increasing significance in the field of occupational health. Based on Japan’s psychiatric disability occupational disease recognition regulation, Taiwan’s Council of Labor Affairs announced “Evaluation Guidelines for psychiatric diseases induced by work-related stress” in 2009. This evaluation tool was designed to assess the source and intensity of work-related and non-work-related mental stress, and references existing Japanese guidelines. However, empirical data from workers in various sectors in Taiwan are still required to validate the utility of the guidelines. Methods This study recruited 2319 workers from the manufacturing, service, and public administration sectors to participate in a survey between 2010 and 2011. The survey included questions regarding participants’ demographic characteristics, job type or attributes, a life event stress intensity evaluation Table (35 work-related and 23 non-work-related items on a scale of 1–10). The Chinese version of the Copenhagen Burnout Inventory (C-CBI) and Chinese Health Questionnaire (CHQ-12) were also included to explore associations between work-related/non-work-related stress and health outcomes. Results Analyses of survey results showed events relating to employment security (e.g., “company bankruptcy” and “being fired or forced to retire” scores; mean stress intensity scores both 6.18) were the cause of the highest intensity work-related stress. Within different demographic/job type categories, women had higher stress intensity scores for most items than men (greatest difference in “sexual harassment in the workplace” score). Furthermore, executive class workers generally experienced more psychological stress than blue-collar workers (greatest difference in “serious injury or disease due to work” score). Results from regression analysis supported the observation that employees’ burnout and work-related stress was more significant than non-work-related stress. Moreover, work-related/non-work-related stress intensity levels both had significant negative predictive effects on mental health. Conclusions Regarding policy, this study provides empirical evidence and practical suggestions for establishing a psychological stress intensity database of workers under specific social contexts in a newly industrialized East Asian country. Such a database can be employed to help identify workers with work-related psychological disorders. Additionally, this study also provides a point of reference for enterprises to prioritize agendas when developing employee stress management and support protocols.
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