Association of sleep disturbance with shift work, occupational stress, and musculoskeletal pain in Chinese public hospital emergency workers: A multicentre cross-sectional study.

Poor sleep, which is reportedly prevalent among healthcare professionals, could lead to various detrimental consequences. This study aimed to investigate the sleep quality of individuals working in emergency departments of public hospitals in China and explore the potential factors influencing sleep disturbance. A self-administered questionnaire was completed by 7688 emergency workers from 147 public hospitals in Shandong, China. Log-binomial regression analysis was performed to explore the relationship of sleep disturbance with possible influencing factors, including individual and work characteristics, occupational stress, shift work, and musculoskeletal pain. The participants' mean Pittsburgh Sleep Quality Index score was 9.6 ± 4.8, with 5341 (69.5%, 68.2-70.7%) of them experiencing sleep disturbance. The sleep quality was poorer in doctors (10.2 ± 5.1, 71.0%, 69.0-73.0%) than in nurses (9.2 ± 4.5, 68.6%, 67.0-70.1%), and poorer in those working in secondary (9.9 ± 4.5, 70.2%, 68.0-72.3%) and tertiary (12.2 ± 4.9, 77.5%, 75.3-79.7%) hospitals than in primary hospitals (8.0 ± 4.1, 64.6%, 62.6-66.6%). High prevalence of sleep disturbance was significantly associated with shift work, occupational stress, musculoskeletal pain, fewer breaks in a work shift, and less exercise during leisure time, after adjusting for confounding variables. Sleep disturbance occurred in emergency workers in the following order: two-shift rotation > three-shift rotation > permanent night shift > permanent day shift. Emergency workers in public hospitals in China had poor sleep quality and commonly experienced musculoskeletal pain. Urgent and comprehensive measures are needed to combat these issues.

Prevalence of neck/shoulder pain among public hospital workers in China and its associated factors: a cross-sectional study.

Studies have reported that neck and/or shoulder pain (NSP) was prevalent and a non-ignorable occupational health problem in healthcare providers. Considering data deficiency on NSP, we aimed to investigate the prevalence and sick leave absence of NSP among public hospital workers in Shandong, China and to explore the associated factors for chronic NSP. A self-administered questionnaire including the Dutch Musculoskeletal Questionnaire and Modified Nordic Musculoskeletal Questionnaire was filled in by 30,520 hospital workers in 37 hospitals selected randomly from among all public hospitals of Shandong, China. The 12-month prevalence of NSP lasting for at least 3 months and sick leave absence due to NSP among 29,547 public hospital workers was 15.6% and 11.4%, respectively, most frequently reported in tertiary hospital workers (27.4% and 18.9%) and clinicians (19.1% and 15.2%). Log-binomial regression analysis revealed that chronic NSP was significantly associated with hospital level, employment position, contract/temporary employment status (vs. permanent), workload (long work hours per week), ergonomic factors (bending the neck forward for long periods of time, twisting the neck for long periods of time) and computer-related factors (prolonged computer-using time daily, the keyboard too close to the edge of the desk).

Sleep quality of nurses in the emergency department of public hospitals in China and its influencing factors: a cross-sectional study.

BACKGROUND: Studies have shown that poor sleep could result in many unpleasant consequences and is prevalent in nurses. Considering the fact of high stress, overwhelming workload and many night shifts in the emergency department in China, this study aimed to evaluate the current status of emergency nurses' sleep quality in public hospitals in Shandong, China and explored its influencing factors. METHODS: A self-administered questionnaire incorporating the Job Content Questionnaire and Pittsburgh Sleep Quality Index (PSQI) was conducted among 4856 emergency nurses in five randomly selected city emergency command systems in Shandong, China. The association of potential influencing factors, including occupational, psychosocial and individual factors, with poor sleep (PSQI> 5) was quantified by multivariate logistic regression analysis. RESULTS: The average PSQI score of 4730 emergency nurses in public hospitals was 8.2 ± 3.9, including 3114 (65.8%) subjects with PSQI > 5 and 2905 (61.4%) > 8; these figures were found highest for 337 emergency nurses in 14 tertiary hospitals with 11.8 ± 4.3, 257 (76.3%) and 232 (68.8%), followed by 1044 emergency nurses in 43 secondary hospitals with 9.5 ± 3.9, 725 (69.4%) and 675 (64.7%) and 3349 emergency nurses in 167 primary hospitals with 7.4 ± 3.5, 2132 (63.7%) and 1998 (59.7%). The following factors were associated with poor sleep: hospital level (tertiary vs. primary, secondary vs. primary), female sex, less of exercise, long work hours per week, many patients in the charge of at night, high monthly night shift frequency (4-6 vs. never, ≥7 vs. never) and high occupational stress. CONCLUSIONS: The sleep quality of emergency nurses in public hospitals in China was poor, especially in tertiary hospitals. Many factors as listed above, especially occupational stress, night shift taking and workload at night, should be considered when improving emergency nurses' sleep quality.

Low back pain in emergency ambulance workers in tertiary hospitals in China and its risk factors among ambulance nurses: a cross-sectional study.

OBJECTIVE: Low back pain (LBP) could cause serious consequences and has been shown to be prevalent among emergency ambulance workers. Studies on the prevalence of and risk factors for LBP among emergency ambulance workers are scarce in China. The study aimed to determine the prevalence of LBP among ambulance workers, including doctors, nurses and drivers, and to explore the risk factors for ambulance nurses' chronic LBP (lasting for at least 3 months). DESIGN: Cross-sectional study. SETTING: Emergency ambulance systems from 38 tertiary hospitals in Shandong, China were selected by random cluster sampling. PARTICIPANTS: A total of 1560 ambulance workers completed the study. OUTCOME MEASURES: A paper-based questionnaire that included the Nordic Musculoskeletal Questionnaire, which evaluated LBP, the Dutch Musculoskeletal Questionnaire, which assessed ergonomic factors, and the Job Content Questionnaire, which assessed stress, was used. Multivariate logistic regression analysis was conducted to quantify the association of potential risk factors with chronic LBP among ambulance nurses. RESULTS: The 1 year prevalence of LBP lasting for at least 24 hours, 7 days and 3 months was 86.1%, 50.6% and 21.1%, respectively, among 498 ambulance nurses; 70.5%, 36.4% and 15.8% among 519 doctors; and 57.5%, 23.8% and 12.3% among 543 drivers. The factors contributing to chronic LBP among ambulance nurses were the frequent bending of the trunk, heavy or awkward lifting, shift work, low job satisfaction, high psychological fatigue, high psychological job demand, low job control, low supervisor support, older age, female sex and obesity. CONCLUSIONS: LBP was more prevalent among ambulance nurses than among ambulance doctors and drivers. Many factors, especially psychosocial and ergonomic factors, contributed to ambulance nurses' chronic LBP. Comprehensive measures might be needed to control LBP.

Prevalence and associated factors of musculoskeletal disorders among Chinese healthcare professionals working in tertiary hospitals: a cross-sectional study.

BACKGROUND: Musculoskeletal disorders (MSDs) are prevalent in working populations and could result in a number of detrimental consequences. In China, healthcare professionals (HCP) in large hospitals may be likely to suffer from MSDs considering the facts of shortages in medical staff, the large Chinese population base, the aging of the population and patients' inclination to go to large hospitals. This study aimed to determine the prevalence and factors associated with MSDs among HCP working in tertiary hospitals. METHODS: A self-administered questionnaire incorporating the Nordic Musculoskeletal Questionnaire and the Dutch Musculoskeletal Questionnaire was conducted among 14,720 HCP in eight tertiary hospitals selected by random cluster sampling in Shandong, China. Multivariable logistic regression analysis was used to quantify the association of psychological, ergonomic, organizational and individual factors with MSDs. RESULTS: The 12-month period prevalence rate of experiencing an MSD in at least one body region for at least 24 h, experiencing an MSD for at least three months, and seeking health care for this condition were 91.2, 17.1 and 68.3%, respectively; these rates were highest for the lower back (72.8, 14.3, 60.3%) and knees (65.7, 8.1, 46.7%), followed by the shoulders (52.1, 6.2, 38.9%), neck (47.6, 4.8, 32.6%), wrists/hands (31.1, 3.2, 23.1%), ankles/feet (23.6, 1.9, 13.4%), upper back, hips/thighs and elbows. MSDs were associated with workload (work hours per week, break times during workday), psychological factors (psychological fatigue, mental stress), employment status and ergonomic factors. Regarding the ergonomic factors, lower back MSDs were associated with bending the trunk frequently, heavy or awkward lifting, and bending or twisting the neck; knee MSDs were associated with walking or standing for long periods of time; and shoulder MSDs were associated with maintaining shoulder abduction for long periods of time and bending or twisting the neck. CONCLUSIONS: MSDs among HCP in tertiary hospitals in Mainland China were highly prevalent. The many factors listed above should be considered in the prevention of MSDs in HCP.

Sleep disturbances among Chinese clinical nurses in general hospitals and its influencing factors.

BACKGROUND: This study aimed to determine the prevalence of sleep disturbances among clinical nurses in general hospitals in Mainland China, and identify its associate factors. METHODS: Using a cross-sectional design, a total of 5012 clinical nurses selected by random cluster sampling completed the survey on the Pittsburgh Sleep Quality Index (PSQI), measures of quality of life indexed by the Medical Outcomes Study 12-item Short-Form Health Survey, occupational stress evaluated by the Job Content Questionnaire, lifestyle and sociodemographic details. RESULTS: The average PSQI score of 4951 subjects was 7.32 ± 3.24, including 3163 subjects with PSQI ≥5, accounting for 63.9%. Multivariate Logistic regression analysis showed that the risk factors for sleep disturbances in nurses were female gender, the Emergency department and ICU, many years of service, high night shift frequency, professional status: primary and intermediate, employment status: temporary, poor quality of life: poor mental health, low perceived health, high occupational stress (high psychological demand, low job control and low workplace social support). CONCLUSIONS: Sleep disturbances are highly prevalent among clinical nurses in general hospitals in Mainland China. Many of the factors listed above were associated with the prevalence of sleep disturbances in nurses, and occupational stress plays an important role in the development of sleep disturbances in Chinese clinical nurses.

Identification of roles for H264, H306, H439, and H635 in acid-dependent lipoprotein release by the LDL receptor.

Lipoproteins internalized by the LDL receptor (LDLR) are released from this receptor in endosomes through a process that involves acid-dependent conformational changes in the receptor ectodomain. How acidic pH promotes this release process is not well understood. Here, we assessed roles for six histidine residues for which either genetic or structural data suggested a possible role in the acid-responsiveness of the LDLR. Using assays that measured conformational change, acid-dependent lipoprotein release, LDLR recycling, and net lipoprotein uptake, we show that H635 plays important roles in acid-dependent conformational change and lipoprotein release, while H264, H306, and H439 play ancillary roles in the response of the LDLR to acidic pH.

EGFR mutations and clinical outcomes of chemotherapy for advanced non-small cell lung cancer: a meta-analysis.

BACKGROUND: This meta-analysis was performed to assess whether epidermal growth factor receptor (EGFR) mutation status was associated with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) in patients with advanced non-small cell lung cancer (NSCLC) treated with chemotherapy. METHOD: We systematically identified eligible articles investigating the effects of chemotherapy in patients with NSCLC stratified by EGFR mutation status. The summary risk ratio (RR) for ORR and hazard ratios (HRs) for both PFS and OS were calculated using the inverse variance formula of meta-analysis. RESULTS: Identification for the current meta-analysis: 5 prospective studies (n=875) and 18 retrospective studies (n=1934) for ORR; 2 prospective studies (n=434) and 10 retrospective studies (n=947) for PFS; 2 prospective studies (n=438) and 7 retrospective studies (n=711) for OS. The ORR was significantly higher in patients with EGFR mutations in prospective studies (RR=1.42; 95% confidence interval [CI], 1.16-1.74; P=0.001), but not in retrospective studies (RR=1.12; 95% CI, 0.96-1.32; P=0.146). There was no obvious association between EGFR mutations and PFS both in prospective (HR=0.84; 95% CI: 0.65-1.09; P=0.197) and retrospective (HR=1.02; 95% CI: 0.87-1.18; P=0.838) studies. Association between EGFR mutations and OS was also not seen in prospective studies (HR=0.74; 95% CI: 0.27-2.05; P=0.566), but was seen in retrospective studies (HR=0.48; 95% CI: 0.33-0.72; P<0.001; I(2)=75.9%; P<0.001) with significant heterogeneity. CONCLUSION: EGFR mutations in advanced NSCLC may be associated with higher ORRs to chemotherapy, but may have nothing to do with PFS and OS. Further prospective studies are required to identify the influence of EGFR mutations on chemotherapy effects in advanced NSCLC.

Differences in regional cerebral blood flow response to a 5HT3 antagonist in early- and late-onset cocaine-dependent subjects.

5-hydroxytryptamine 3 (5HT3) receptors are important modulators of mesostriatal dopaminergic transmission and have been implicated in the pathophysiology of cocaine reward, withdrawal and self-administration. In addition, the 5HT3 antagonist ondansetron is effective in treating early-onset, but not late-onset, alcohol-dependent subjects. To explore the role of 5HT3 receptor systems in cocaine addiction using functioning imaging, we administered ondansetron to 23 abstinent, treatment-seeking cocaine-addicted and 22 sex-, age- and race-matched healthy control participants. Differences between early- (first use before 20 years, n = 10) and late-onset (first use after 20 years, n = 10) cocaine-addicted subjects were also assessed. On two separate days, subjects were administered ondansetron (0.15 mg/kg intravenously over 15 minutes) or saline. Regional cerebral blood flow (rCBF) was measured following each infusion with single photon emission computed tomography. No significant rCBF differences between the cocaine-addicted and control participants were observed following ondansetron relative to saline. Early-onset subjects, however, showed increased (P < 0.001) right posterior parahippocampal rCBF following ondansetron. In contrast, late-onset subjects showed decreased rCBF following ondansetron in an overlapping region of the right parahippocampal/hippocampal gyrus. Early-onset subjects also displayed increased rCBF in the left anterior insula and subthalamic nucleus following ondansetron; late-onset subjects showed decreased rCBF in the right anterior insula. These findings suggest that the age of drug use onset is associated with serotonergic biosignatures in cocaine-addicted subjects. Further clarification of these alterations may guide targeted treatment with serotonergic medications similar to those successfully used in alcohol-dependent patients.

[Structural equation model analysis of risk factors for low back pain among greenhouse vegetable-planting farmers].

OBJECTIVE: To explore the risk factors of low back pain (LBP) among greenhouse vegetable planting farmers and estimate the level of the effects. METHODS: A self-made questionnaire based on the Dutch Musculoskeletal Questionnaire and the Nordic Questionnaire was conducted to 639 greenhouse vegetable planting farmers and then structural equation model was used to analyze the risk factors of LBP in SmartPLS software. RESULTS: The coefficient of determination of the model was 0.827, and the structural coefficients of dynamic loads, static loads, force exertion, ergonomic environment and repetitive loads on LBP were 0.21, 0.43,0.27, 0.045 and 0.034 respectively, and the total effects of the above latent variables on LBP were 0.21, 0.43,0.27, 0.33 and 0.034 respectively. CONCLUSION: The main risk factors of LBP among greenhouse vegetable planting farmers were static loads, ergonomic environment, force exertion and dynamic loads.

Cavin-3 dictates the balance between ERK and Akt signaling.

Cavin-3 is a tumor suppressor protein of unknown function. Using both in vivo and in vitro approaches, we show that cavin-3 dictates the balance between ERK and Akt signaling. Loss of cavin-3 increases Akt signaling at the expense of ERK, while gain of cavin-3 increases ERK signaling at the expense Akt. Cavin-3 facilitates signal transduction to ERK by anchoring caveolae to the membrane skeleton of the plasma membrane via myosin-1c. Caveolae are lipid raft specializations that contain an ERK activation module and loss of the cavin-3 linkage reduces the abundance of caveolae, thereby separating this ERK activation module from signaling receptors. Loss of cavin-3 promotes Akt signaling through suppression of EGR1 and PTEN. The in vitro consequences of the loss of cavin-3 include induction of Warburg metabolism (aerobic glycolysis), accelerated cell proliferation, and resistance to apoptosis. The in vivo consequences of cavin-3 knockout are increased lactate production and cachexia. DOI:http://dx.doi.org/10.7554/eLife.00905.001.

S-nitrosylation of ARH is required for LDL uptake by the LDL receptor.

The LDL receptor (LDLR) relies upon endocytic adaptor proteins for internalization of lipoproteins. The results of this study show that the LDLR adaptor autosomal recessive hypercholesterolemia protein (ARH) requires nitric oxide to support LDL uptake. Nitric oxide nitrosylates ARH at C199 and C286, and these posttranslational modifications are necessary for association of ARH with the adaptor protein 2 (AP-2) component of clathrin-coated pits. In the absence of nitrosylation, ARH is unable to target LDL-LDLR complexes to coated pits, resulting in poor LDL uptake. The role of nitric oxide on LDLR function is specific for ARH because inhibition of nitric oxide synthase activity impairs ARH-supported LDL uptake but has no effect on other LDLR-dependent lipoprotein uptake processes, including VLDL remnant uptake and dab2-supported LDL uptake. These findings suggest that cells that depend upon ARH for LDL uptake can control which lipoproteins are internalized by their LDLRs through changes in nitric oxide.

[Analyzing the factors of influencing the musculoskeletal disorders of greenhouse vegetable farmers].

OBJECTIVE: To study the prevalence of musculoskeletal disorders (MSDs) among greenhouse vegetable farmers and to explore the risk factors of MSDs. METHODS: A household questionnaire survey was conducted to investigate 203 greenhouse vegetable farmers and 127 non-greenhouse vegetable farmers in February, 2011. RESULTS: The one-year prevalence rates of MSDs were 70.0% and 33.9% among greenhouse vegetable farmers and non-greenhouse vegetable farmers, respectively. The three main positions of MSDs in greenhouse farmers were low back, knee (s) and shoulder (s). Age, working years, body weight and usage of rolling machine were statistically associated with MSDs of greenhouse farmers, ORadj values were 1.17, 1.82, 1.08 and 0.07, respectively. CONCLUSIONS: The prevalence of MSDs is high in greenhouse workers. Low back pain, knee (s), and shoulder (s) disorders are the main disorders. Age, working years, body weight and usage of rolling machine are main risk factors for the development of MSDs in greenhouse farmers.

Molecular cloning and characterization of a trehalose-6-phosphate synthase/phosphatase from Dunaliella viridis.

Dunaliella is a group of green algae with exceptional stress tolerance capability, and is considered as an important model organism for stress tolerance study. Here we cloned a TPS (trehalose-6-phosphate synthase) gene from Dunaliella viridis and designated it as DvTPS (D. viridis trehalose-6-phosphate synthase/phosphatase).The DvTPS cDNA contained an ORF of 2793 bp encoding 930 aa. DvTPS had both TPS and TPP domain and belonged to the Group II TPS/TPP fusion gene family. Southern blots showed it has a single copy in the genome. Genome sequence analysis revealed that it has 18 exons and 17 introns. DvTPS had a constitutive high expression level under various NaCl culture conditions, however, could be induced by salt shock. Promoter analysis indicated there were ten STREs (stress response element) in its promoter region, giving a possible explanation of its inducible expression pattern upon salt shock. Yeast functional complementation analysis showed that DvTPS had neither TPS nor TPP activity. However, DvTPS could improve the salt tolerance of yeast salt sensitive mutant G19. Our results indicated that despite DvTPS showed significant similarity with TPS/TPP, its real biological function is still remained to be revealed.

A JAK2 interdomain linker relays Epo receptor engagement signals to kinase activation.

JAK2 (Janus kinase 2) is essential for cytokine receptor signaling, and several lines of evidence support a causal role of an activating JAK2 mutation in myeloproliferative disorders. JAK2 activity is autoinhibited by its pseudokinase domain in the basal state, and the inhibition is released by cytokine stimulation; how engagement of the cognate receptor triggers this release is unknown. From a functional screen for gain-of-function JAK2 mutations, we discovered 13 missense mutations, nine in the pseudokinase domain and four in the Src homology 2 (SH2)-pseudokinase domain linker. These mutations identified determinants for autoinhibition and inducible activation in JAK2. Two of the mutants, K539I and N622I, resulted in erythrocytosis in mice. Scanning mutagenesis of the SH2-pseudokinase domain linker indicated that its N-terminal part was essential for interaction of JAK2 with the Epo receptor, whereas certain mutations in the C-terminal region conferred constitutive activation. We further showed that substitutions for Glu(543)-Asp(544) in this linker or Leu(611), Arg(683), or Phe(694) in the hinge proximal region of the pseudokinase domain resulted in activated JAK2 mutants that could not be further stimulated by Epo. These results suggest that the SH2-pseudokinase domain linker acts as a switch that relays cytokine engagement to JAK2 activation by flexing the pseudokinase domain hinge.

In vitro refolding/unfolding pathways of amphioxus insulin-like peptide: implications for folding behavior of insulin family proteins.

Amphioxus insulin-like peptide (AILP) belongs to the insulin superfamily and is proposed as the common ancestor of insulin and insulin-like growth factor 1. Herein, the studies on oxidative refolding and reductive unfolding of AILP are reported. During the refolding process, four major intermediates, P1, P2, P3, and P4, were captured, which were almost identical to those intermediates, U1, U2, U3, and U4, captured during the AILP unfolding process. P4 (U4) has the native disulfide A20-B19; P1 (U1), P2 (U2), and P3 (U3) have two disulfide bonds, which include A20-B19. Based on the analysis of the time course distribution and properties of the intermediates, we proposed that fully reduced AILP refolded through 1SS, 2SS, and 3SS intermediate stages to the native form; native AILP unfolded through 2SS and 1SS intermediate stages to the full reduced form. A schematic flow chart of major oxidative refolding and reductive unfolding pathways of AILP was proposed. Implication for the folding behavior of insulin family proteins was discussed. There may be seen three common folding features in the insulin superfamily: 1) A20-B19 disulfide is most important and formed during the initial stage of folding process; 2) the second disulfide is nonspecifically formed, which then rearranged to native disulfide; 3) in vitro refolding and unfolding pathways may share some common folding intermediates but flow in opposite directions. Furthermore, although swap AILP is a thermodynamically stable final product, a refolding study of swap AILP demonstrated that it is also a productive intermediate of native AILP during refolding.