Nfs Shift 2 Patch 1.02 Download ##BEST##
Ralf Roth
Conclusions A short shift interval is an important risk factor for short SA. Improving intervals between shifts and shortening long weekly working hours could reduce the risk of short SA among retail workers.
The bigger shift I believe is necessary is not just from frequentist to Bayesian, but that the glamor journals need to change their perspective on RCTs. There is zero doubt that RCTs are the best way of gathering medical evidence of therapeutic efficacy. However, they must be designed and implemented well if a result worthy of generalization to clinical practice is desired. An RCT that is so under powered that a quite large reduction in death (8.5% absolute difference in death at 28 days!) is not statistically significant is a major design flaw.
According to the last annual report by the Skin Cancer Foundation, skin cancer is the most commonly diagnosed cancer in the USA7. It can be classified into melanoma skin cancer, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The last two subtypes are grouped together as non-melanoma skin cancer which is the most frequently diagnosed cancer in white populations8. Both BCC and SCC have a good prognosis when detected in their early stages. While most non-melanoma skin cancer are rarely fatal, they can result in considerable morbidity which presents an increasing burden on the healthcare services9. On the other hand, while invasive melanoma accounts for only a small percentage (4%) of all skin cancer cases, it is responsible for the vast majority of deaths due to skin cancer8. The main risk factor for all types of skin cancer is exposure to ultraviolet light. However, many other risk factors have been reported to predispose patients to skin cancer, such as family history of the disease, fair skin and shift work10,11.
Previous studies that examined the relationship between shift work and skin cancer risk have provided inconclusive results. Some studies have demonstrated a significant association between shift work and skin cancer12,13,14,15, while others have failed to reveal any significant correlation16,17. In this context, identification of the associations between shift work and the risks of different types of skin cancer would be of the utmost interest. In the present study, we conducted a meta-analysis to summarize the results of published case-control and cohort studies exploring the association between shift work and the risk of skin cancer. More specifically, we sought to assess the effect of increased duration of shift work on the risk of skin cancer.
Forest plots depicting the risk estimates from included studies on the associations between shift work and risks of different types of skin cancer (a) Melanoma, (b) BCC, (c) SCC, RR: relative risk, CI: confidence interval. I2 is an indicator that used to determine the degree of heterogeneity in the meta-analysis. The horizontal lines and squares correspond to the 95% CI and to the study-specific RR. The area of the square represents the weight of each study. The dotted red-line and the diamond represents the 95% CI and the pooled RR.
Our dose-response analysis demonstrated that every extra year of shift work is causing a significant increase of 2% of melanoma. Similar results were demonstrated in several studies that showed higher risks of colorectal, breast, lung and prostate cancers with an increased duration of shift work26,27,28,29,30,31,32. The results presented herein, together with the findings of the previously mentioned studies, suggest that longer exposure to shift work increases the risks of different types of cancers. Moreover, one might assume that shift work is not a real problem in short-term, but its effect accumulates with time. One possible justification is that long-term circadian disruption associated with prolonged duration of shift work may play a role in development of melanoma.
The relationship between shift work and the risk of all types of skin cancer has some biological plausibility. One of the possible explanations is that shift workers are mostly exposed to light at night (LAN) that could trigger the inhibition of melatonin secretion with serious perturbations of the circadian rhythm33. Melatonin, which is considered a marker of the circadian rhythm, is a natural antioxidant with immunoenhancing properties8,34. Several in vitro studies speculated that melatonin derivatives exhibited antitumourigenic effects through their ability to inhibit melanoma and breast cancer cell proliferation35,36. There is now growing evidence that circadian disruption can interfere with cell proliferation, apoptosis, DNA damage repair, and immune functions8,37. It has been recognized that disrupting the expression of circadian genes, which oscillates according to the circadian rhythm, increases the risks of different types of cancer38. Indeed, both exposure to LAN and melatonin suppression are associated with an imbalance in the regulation of melanocyte function and the inhibition of melanin secretion in the skin with a subsequent loss of the protective effects against carcinogenic agents, such as exposure to UV radiation39. This type of radiation is known to have multiple effects on skin tissue, including inflammation, DNA damage and immunosuppression40,41. According to the Skin Cancer Foundation, approximately 86% of melanomas and 90% of non-melanoma skin cancers are associated with exposure to solar UV radiation7. Therefore, the increased risk of melanoma with longer duration of shift work detected in our results can be explained by intense intermittent exposure to UV radiation, which could be related to shift work. In addition, the association of lower risk of BCC with shift work demonstrated in our results can possibly be explained by shorter duration of exposure to UV radiation. Another important point that should be highlighted is the association of certain occupations, which include shift work in their schedules, such as nurses and pilots, with the risk of skin cancer. One might surmise that there are other potential factors related to these occupations that increase the risk of skin cancer, such as exposure to cosmic radiation that can cause genetic and cytogenetic damage24,42. Therefore, it is difficult to determine whether shift work alone or in association with other occupational factors is responsible for the increased risk of certain type of skin cancer in this population. Taken together, these factors could contribute to the progression and development of many cancers, including all types of skin cancer. Notably, the differences in the risks of BCC, SCC, and melanoma as related to shift work history suggest a variable role played by this type of work in the carcinogenesis of different types of skin cancers.
In conclusion, this meta-analysis demonstrated that shift work was potentially associated with increased risk of melanoma and decreased risks of BCC. No association between shift work and the risk of SCC was detected. Our results indicated that the risk of melanoma increases cumulatively by 2% for every year of shift work. Taken together, our findings suggest that more efforts are needed to protect the health of shift workers, such as regular follow-up in this population. Clearly, experimental studies and large cohort studies with long-term follow-up are needed to confirm our results and to elucidate the potential biological mechanisms that are related to shift work.
The included articles were identified according to the following inclusion and exclusion criteria. The inclusion criteria were as follows: 1) studies with a cohort or case-control study design; 2) studies evaluating the possible relationships between shift work and the risks of different types of skin cancer; 3) studies with defined and quantified shift work, 4) studies with results that included the risk estimates, such as RRs, Odds rations (ORs), hazard ratios (HRs), and standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) or that provided sufficient data to calculate them. The exclusion criteria were as follows: 1) studies written in language other than English; 2) studies including recurrent skin cancer; 3) studies with the same population included in more than one study; however, in the latter case, the study with the largest number of patients was selected. Investigators were divided into two groups that worked independently to evaluate articles for inclusion. In cases of doubt, full-text articles were discussed between the two groups to solve any discrepancies.
Exposure to shift work has been associated with negative health consequences, although the association between shift work and sickness absence remains unclear. The aim of this study is to investigate associations between cumulative exposure to shift work and sickness absence among ground staff employees of an airline company.
This study used data from the MORE (Monitoring Occupational Health Risks in Employees) cohort, which is a 5-year historic cohort. The population of the present study consisted of 7562 ground staff employees. For each employee, work schedules and sickness absence days between 2005 and 2009 were obtained from company records. For the exposure to different shift schedule types and to the cumulative number of night shifts, the association with long-term sickness absence (>7 consecutive sickness absence days) and the number of sickness absence episodes during 2009, was calculated using logistic and Poisson regression analyses. Socio-demographic variables, work-related variables, job classification variables, and previous sickness absence days were regarded as confounders.
Cumulative exposure to shift work proved to be negatively associated with more sickness absence episodes, and was not associated with more long-term sickness absence, although selection bias could not be ruled out. Future research should explore the influence of household composition, and take into account both previous sickness absence and psychosocial and physical work factors to obtain a better estimation of the association between shift work and sickness absence.
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