News in brief

A META-analysis published in The Lancet has found that employees who work long hours each week have a higher risk of stroke than those working standard hours, with less persuasive evidence that it also increases the risk of coronary heart disease (CHD). The analysis included more than 600 000 men and women from Europe, the US and Australia who took part in 25 studies. The participants were free of CHD and stroke at baseline. The researchers conducted a cumulative meta-analysis adjusted for age, sex and socioeconomic status that compared standard working hours (35–40 hours per week) with long hours of 55 hours or more. The longer hours were associated with an increase in risk of incident CHD (relative risk [RR], 1·13) and incident stroke (RR, 1·33). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment. The researchers wrote that their meta-analysis included high-quality cohort studies and confirmed a stronger association for fatal and non-fatal incident CHD in people working in low-paying jobs than in those in higher-paying occupations. “Sudden death from overwork is often caused by stroke and is believed to result from a repetitive triggering of the stress response”, the authors wrote. “Behavioural mechanisms, such as physical inactivity, might also link long working hours and stroke; a hypothesis supported by evidence of an increased risk of incident stroke in individuals who sit for long periods at work.” They wrote that more attention should be paid to the management of vascular risks in people who work long hours. An accompanying commentary said that although some countries had legislation for working hours, it was not always implemented. The author wrote that the research finding that the length of a working day was a determinant mainly for stroke and possibly also for CHD was important.

 

RESEARCHERS have found an independent association between being hospitalised with infection during childhood and adverse adult metabolic variables. The Finnish study, published in Pediatrics, included 1376 participants aged 3‒9 years at baseline in 1980 whose lifetime hospitalisation data were available from a national health database. At least one adult assessment of participants was performed in 2001, 2007 and/or 2011. Early childhood (< 5 years), childhood and adolescence (5–18 years), adult (> 18 years) and total lifetime infection-related hospitalisation (IRH) were related to adiposity, body mass index (BMI) and metabolic syndrome in adulthood. The authors found that childhood IRH was significantly associated with increased BMI and metabolic syndrome in adulthood. This association was independent of age, sex, socioeconomic status, childhood BMI and other traditional cardiometabolic risk factors. The relationship between IRH and adult adiposity-related risk factors was largely driven by IRH in preschool-aged children. The authors said the mechanism underlying this association might be due to unwell children being given antibiotics, which could lead to obesity later in life. Infection with a variety of pathogens might also have had a non-specific effect on cardiometabolic outcomes. The authors said their findings indicated that children hospitalised with infection might represent an at-risk group for later non-communicable disease. “Prospective studies are required to identify causal and mechanistic pathways necessary for the development of therapeutic interventions”, they wrote.

 

THE spouses of stroke survivors experienced impaired health-related quality of life (HRQoL) not only in the first years after stroke onset, but also in the longer term, according to a study published in Stroke. The researchers used a Swedish database that includes 600 consecutively recruited patients diagnosed with ischaemic stroke before 70 years of age between 1998 and 2003 and 600 age- and sex-matched controls. A 7-year follow-up included 299 cohabitant stroke survivors and 344 controls. The researchers found that the spouses of stroke survivors compared with spouses of controls experienced highly reduced HRQoL 7 years after the stroke episode, particularly in vitality, mental and general health scores, social functioning, and physical and social roles. “However, the main predictor of the spouses’ HRQoL at this point in time was the global disability of the stroke survivors”, they wrote. The main predictors of physical HRQoL of the spouses of stroke survivors were their own age and the global disability of stroke survivors, while predictors of the mental domains were depressive symptoms, cognitive impairment and global disability of the stroke survivor, as well as lack of social support for the spouses. The authors wrote that the challenge for society was to develop long-lasting support of the family of stroke survivors.

 

ANTIBIOTIC-impregnated cemented total hip replacements (THR) have the best short-term prognosis , while metal-on-metal (MoM) have the worst, according to French research published in JAMA Surgery. The large population study included 100 191 patients aged 40 years or older who were covered by the French national health insurance system and underwent a THR for arthritis in 2010‒2011. The mean age of the cohort at baseline was 69.5 years and 56.6% were women. Antibiotic-free cemented THRs and antibiotic-impregnated cemented THRs were compared with uncemented THRs, while ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP) and MoM THRs were compared with metal-on-polyethylene (MoP) THRs. The study outcomes and measures were revisions, including any surgical interventions in which the implant or any of it components was changed or removed. During the median 33-month follow-up period, 3142 patients underwent prosthetic revision. Antibiotic-impregnated cemented THRs had a better prognosis than uncemented THRs, with cumulative revision rates of 2.4% and 3.3% respectively. This association was particularly significant in women. The CoP and CoC THRs were no different from the MoP THR; however, the MoM THR had slightly shorter survivorship compared with the MoP THR. Overall, short-term THR outcomes were poorer in younger patients. The author said their findings would be useful “for helping surgeons choose the appropriate THR fixation technique for their patients”. An accompanying commentary said that given the well established long-term success of THR, the results of this study “should not be overextended to affect use of THR fixation techniques with proven long-term clinical success”.

 

UNSAFE termination of pregnancy (TOP) continues to be a major problem in the developing world with new findings that an estimated 7 million women were treated for complications in 2012. The research, published in the BJOG, showed that unsafe TOP remains a significant global source of morbidity for women. The research was based on national estimates of facility-based treatment for TOP complications in 26 countries in 2012. Estimated annual treatment rates ranged from a relative low of 2.4 per 1000 women in Brazil to a high of 14.6 in women aged 15–44 years in Pakistan. In Africa, Kenya had the highest rate at 13.4. In Latin America, the Dominican Republic had the highest rate at 10.3 and Brazil the lowest. In Asia, Pakistan had the highest rate and Myanmar the lowest at 2.9. The authors wrote that that the morbidity burden from unsafe TOP might be much greater than indicated by the data based on treatment alone. “Based on estimates made by health professionals (averaged across several surveys conducted between 2000 and 2008), about 60% of women with TOP complications were expected to obtain care in health facilities and 40% would not get such care”, they wrote. “In addition to the morbidity burden for women, treatment of complications from unsafe TOP also results in substantial costs to health systems and to women and their families.” The authors said reducing unsafe TOP would benefit women and their families and would also yield net economic gains by improving women’s productivity and by reducing the costs of postabortion care.