Shift work disorder and its related factors among health-care workers in a Tertiary Care Hospital in Bangalore, India.

BACKGROUND & OBJECTIVE: Shift work disorder is the presence of excessive day time sleepiness and insomnia affecting people whose work hours overlap with the typical sleep period. Shift work has pronounced effect on physical and mental health of an individual. Our objective was to estimate the prevalence of symptoms of shift work disorder and the factors associated with it among hospital staff in a tertiary care hospital in Bangalore, India. METHODS: This cross-sectional study was conducted at a private teaching tertiary hospital among 318 hospital workers in Bangalore during September to December 2015. Stratified random sampling method was used and the study population was divided into five strata based upon their parent department. Socioeconomic details, work profile and standard tools- Insomnia severity index, The Epworth sleepiness scale and the FACIT fatigue scale were used. RESULTS: Of the 318 workers, 290 (91.2%) were females, between 21-25 years of age. Most had work experience of ≤4 years (77.6%). Insomnia was reported among 39.9%, and fatigue among 4.7% of hospital staff. Around 19.8% staff had excessive daytime sleepiness out of which 2.8% warranted medical attention. CONCLUSION: Periodic screening during annual medical check-ups and health education on practicing good sleep hygiene will help address this important issue of shift work disorders among workers.

Iron Deficiency Anemia Coexists with Cancer Related Anemia and Adversely Impacts Quality of Life.

Cancer related anemia (CRA) adversely affects patient Quality of Life (QoL) and overall survival. We prospectively studied the prevalence, etiology and the impact of anemia on QoL in 218 Indian cancer patients attending a tertiary referral hospital. The study used the sTfR/log Ferritin index to detect iron deficiency anemia and assessed patient QoL using the Functional Assessment of Cancer Therapy-Anemia (FACT-An) tool, standardized for language. Mean patient age was 51±13 years and 60% were female. The prevalence of cancer related anemia in this setting was 64% (n = 139). As expected, plasma ferritin did not differ significantly between anemic (n = 121) and non-anemic cancer patients (n = 73). In contrast, plasma sTfR levels were significantly higher in anemic cancer patients compared to non-anemic cancer patients (31 nmol/L vs. 24 nmol/L, p = 0.002). Among anemic cancer patients, using the sTfR/log Ferritin index, we found that 60% (n = 83) had iron deficiency anemia (IDA). Interestingly, plasma sTfR levels were significantly higher in cancer patients with CRA+IDA (n = 83) compared with patients having CRA (n = 38) alone (39 nmol/L vs. 20 nmol/L, p<0.001). There was a significant linear correlation between Hb and QoL (Spearman ρ = 0.21; p = 0.001) and multivariate regression analysis revealed that every gram rise in Hb was accompanied by a 3.1 unit increase in the QoL score (95% CI = 0.19-5.33; p = 0.003). The high prevalence of anemia in cancer patients, a major portion of which is due to iron deficiency anemia, the availability of sensitive and specific biomarkers of iron status to detect IDA superimposed on anemia of inflammation, suggests an urgent need to diagnose and treat such patients. Despite the potential negative consequences of increasing metabolically available plasma iron in cancer, our clinical data suggest that detecting and treating IDA in anemic cancer patients will have important consequences to their QoL and overall survival. Clinical trials of iron therapy in these patients will be able to demonstrate the potential for benefit or harm.