RESUMO
Shift workers have been reported to have an increased bone resorption. However, no existing evidence indicates lower bone mineral density (BMD) in this group. The objective of this study was to test the hypothesis that a rotating-shift work schedule is associated with low BMD and osteoporosis. We evaluated 70 postmenopausal nurses from the Naval Hospital in Concepcion, Chile. The participants were categorized according to the type of work schedule: 39 had a rotating shift and 31 were daytime workers. Medical history, a health examination, a questionnaire on health-related behaviors and biochemical determinations, and BMD examination were obtained for all participants. When comparing the 2 groups, the rotating-shift workers had lower BMD in the lumbar spine (L1-L4: 0.957 ± 0.15 vs 1.104 ± 0.13; p<0.05) and lower bone density in both femoral neck bones (right: 0.936 ± 0.17 vs 1.06 ± 0.12; p<0.05 and left: 0.956 ± 0.19 vs 1.05 ± 0.12; p<0.05). Additionally, the T-scores for 10 (25.6%) of the rotating-shift workers indicated osteoporosis at lumbar spine (T-score>-2.5). No evidence of osteoporosis was found for daytime workers. When comparing the 2 groups, the rotating-shift workers had a higher prevalence of osteopenia (T-score=-1.0 to -2.5) than the daytime workers: 46.2% vs 35.5%, respectively. We found significant evidence that rotating-shift workers have lower BMD in the trabecular and cortical bones, thus suggesting that this type of work may be a risk factor for osteoporosis. Because this is the first time that this osteoporosis risk factor has been reported, the association needs to be replicated and confirmed in other settings.
Assuntos
Densidade Óssea , Osteoporose Pós-Menopausa/epidemiologia , Tolerância ao Trabalho Programado , Absorciometria de Fóton , Biomarcadores/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
El dolor por cáncer es un problema frecuente en nuestro medio, se presenta en 80 a 90 % de los pacientes y en aproximadamente 90 % de ellos se resuelve con medidas relativamente sencillas. No obstante, aproximadamente 40 % de los pacientes se encuentra insatisfecho con el médico o la enfermera respecto al manejo de su dolor. Por tal motivo, se convocó a un grupo de consenso con la finalidad de generar parámetros de práctica clínica fundamentados en la evidencia publicada y en la opinión de los expertos. Este grupo estuvo integrado por 31 médicos líderes de opinión es este campo, quienes con base en 599 documentos emitieron esta serie de recomendaciones, identificadas cada una según su nivel de evidencia.
Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.