Anke van Mark

The impact of shift work induced chronic circadian disruption on IL-6 and TNF-α immune responses

AIMSleep disturbances induce proinflammatory immune responses, which might increase cardiovascular disease risk. So far the effects of acute sleep deprivation and chronic sleep illnesses on the immune system have been investigated. The particular impact of shift work induced chronic circadian disruption on specific immune responses has not been addressed so far.MethodsPittsburgh-Sleep-Quality-Index (PSQI) questionnaire and blood sampling was performed by 225 shift workers and 137 daytime workers. As possible markers the proinflammatory cytokines IL-6 and TNF-α and lymphocyte cell count were investigated. A medical examination was performed and biometrical data including age, gender, height, weight, waist and hip circumference and smoking habits were collected by a structured interview.ResultsShift workers had a significantly higher mean PSQI score than day workers (6.73 vs. 4.66; p < 0.001). Day workers and shift workers had similar serum levels of IL-6 (2.30 vs. 2.67 resp.; p = 0.276), TNF-α (5.58 vs. 5.68, resp.; p = 0.841) or lymphocytes count (33.68 vs. 32.99, resp.; p = 0.404). Furthermore there were no differences in cytokine levels (IL-6 p = 0.761; TNF-α p = 0.759) or lymphocyte count (p = 0.593) comparing the sleep quality within the cohorts. When this calculation of sleep quality was stratified by shift and day workers irrespective of their sleep quality day workers and shift workers had similar serum levels of IL-6, TNF-α or lymphocytes count. Multiple linear regression analysis showed a significant correlation of lymphocytes count and smoking habits.ConclusionShift work induces chronic sleep debt. Our data reveals that chronic sleep debt might not always lead to an activation of the immune system, as we did not observe differences in lymphocyte count or level of IL-6 or TNF-α serum concentration between shift workers and day workers. Therefore chronic sleep restriction might be eased by a long-term compensating immune regulation which (in healthy) protects against an overstimulation of proinflammatory immune mechanisms and moderates metabolic changes, as they are known from short-term sleep deprivation or sleep related breathing disorders.

Shift work and pathological conditions

Shift work exerts major influences on the physiological functions of the human body. These are primarily mediated by the disruption of circadian rhythms since most body functions are circadian rhythmic. Next to the disturbances caused by changes in the circadian system, shift work has also been suggested to be related to a number of other health disorders. The present study summarizes recently published data on the potential relationship between disorders and shift working.

Analysis and evaluation of environmental tobacco smoke exposure as a risk factor for chronic cough

Exposure to environmental tobacco smoke (ETS) and active tobacco smoking has been shown to increase symptoms of bronchial asthma such as bronchoconstriction but effects on other respiratory symptoms remain poorly assessed. Current levels of exposure to tobacco smoke may also be responsible for the development of chronic cough in both children and adults. The present study analyses the effects of tobacco smoke exposure as potential causes of chronic cough. A panel of PubMed-based searches was performed relating the symptom of cough to various forms of tobacco smoke exposure. It was found that especially prenatal and postnatal exposures to ETS have an important influence on childrens respiratory health including the symptom of cough. These effects may be prevented if children and pregnant women are protected from exposure to ETS. Whereas the total number of studies adressing the relationship between cough and ETS exposure is relatively small, the present study demonstrated that there is a critical amout of data pointing to a causative role of environmental ETS exposure for the respiratory symptom of cough. Since research efforts have only targeted this effect to a minor extent, future epidemiological and experimental studies are needed to further unravel the relation between ETS and cough.

Schlafstörungen und Schichtarbeit

ZusammenfassungDie Tätigkeit in Schichtarbeit kann vielfältige Einflüsse auf die Gesundheit ausüben, denn ein Arbeitszeit-System, welches mit der circadianen und sozialen Rhythmik kollidiert, führt zwangsläufig zu verschiedenen Beschwerden, sofern nicht entsprechende Maßnahmen ergriffen werden, die sowohl die betriebliche Ebene und die Arbeitszeitorganisation als auch die individuelle Lebensweise der in Schichtarbeit Tätigen betreffen. Am häufigsten werden durch die Schichtarbeiter selbst Schlafstörungen und schlafassoziierte Befindlichkeitsstörungen, gastrointestinale und unspezifische Beschwerden beklagt. Aber auch die sozialen Folgen können gravierend sein. Wissenschaftlich liegt ein Fokus auf dem möglichen Auftreten metabolischer Veränderungen, wie sie bereits im Rahmen schlafbezogener Atemstörungen und akut bei Schlafdeprivation beobachtet wurden - dies unter der Vorstellung, dass durch schlechte Schlafhygiene und ungünstige Schichtfolgen ein chronisches Schlafdefizit entstehen kann. Im Folgenden wird der aktuelle Kenntnisstand über Schlafstörungen und einer Tätigkeit in Schichtarbeit zusammengefasst und deren mögliche Auswirkungen dargestellt.SummaryWorking in shift work system may result in varied influences on the general health. A working hour system colliding with circadian and social rhythm causes adverse effects if no actions were taken regarding the occupational level, the working hour organisation as well as the individual life-style of shift workers. Most often shift workers complain of sleep disorders and sleep-related disturbances of the general health, gastrointestinal and unspecific discomfort. But social effects may be severe, too. Most scientific attention is given to metabolic alterations due to shift work which were already observed within the scope of sleep apnea syndrome and with acute sleeping deprivation under the idea that a chronic deficit of sleep can originate from shy of sleeping hygiene and unfavourable sequence of work shifts. In the following the current state of knowledge about sleeping disturbances and working in shift work is summarised, possible effects are shown.RésuméTout travail posté peut avoir des influences multiples sur la santé car un système de travail contraire au rythme circadien et social aboutit automatiquement à des troubles divers, lorsque des mesures appropriées ne sont pas prises au niveau aussi bien de l’entreprise et de l’organisation du travail qu’à celui du style de vie individuel des personnes travaillant en équipes alternantes. Ces travailleurs se plaignent le plus fréquemment de troubles du sommeil, d’altérations de l’état général associées au sommeil ainsi que de troubles gastro-intestinaux et non spécifiques. Les conséquences sociales peuvent être également graves. D’un point de vue scientifique, on se concentre sur l’apparition possible de changements au niveau du métabolisme tels qu’ils ont déjà été observés dans le cadre de troubles respiratoires liés au sommeil ; ces changements peuvent être aussi aigus en cas de privation de sommeil — tout ceci dans l’idée qu’une mauvaise hygiène du sommeil et des conséquences défavorables du travail posté peuvent entraîner un manque de sommeil chronique. Les connaissances actuelles relatives aux troubles du sommeil et à une activité de travail posté sont résumées ci-après et complétées par une présentation des conséquences possibles.

Die neue Grippe (porzine Influenza/Schweinegrippe): Eine Zusammenfassung aktueller Informationen zu Influenza A/H1N1

ZusammenfassungDie porzine Influenza (Schweinegrippe) ist eine Viruskrankheit, die wie die aviäre Influenza (Vogelgrippe) oder SARS eine ernst zu nehmende Gefahr für die Bevölkerung darstellen kann. Die Erkrankung wird durch Infektion mit dem Influenza-A-Viruzs A/H1N1 hervorgerufen. Die Gefahr besteht durch das Reassortment von RNA-Genom-Segmenten von porzinen und humanen Influenzaviren. So kann es zur Entstehung neuer antigenetischer Varianten kommen, die für den Menschen neue pathogene Eigenschaften besitzen. Der vorliegende Artikel fasst arbeitsmedizinische relevante Informationen seitens der Behörden und anderer Institutionen zusammen.SummaryPorcine influenza is a viral disease. Along with other viral diseases such as avian influenza or SARS it may lead to serious consequences for the population. The disease occurs after infection with the influenza virus A/H1N1. Reassortment of RNA genome sequences of porcine and human influenza viruses can lead to new antigenic variants (antigen shift) with human pathogenic features. The present articles supplies recent information with relevance for occupational health.Porcine influenza is a viral disease. Along with other viral diseases such as avian influenza or SARS it may lead to serious consequences for the population. The disease occurs after infection with the influenza virus A/H1N1. Reassortment of RNA genome sequences of porcine and human influenza viruses can lead to new antigenic variants (antigen shift) with human pathogenic features. The present articles supplies recent information with relevance for occupational health.