Working long hours ‘increases stroke risk’

NHS Choices

“People working long hours are more likely to have a stroke, according to analysis of more than half a million people,” BBC News reports.

Researchers pooled the data from 25 previous studies that included more than 600,000 individuals who were free from heart disease or other types of cardiovascular disease at enrolment.

They found the risk of developing strokeincreased by a third in individuals who worked long hours (above 55 hours a week) compared with individuals with traditional 9-5 working hours. The association of long working hours with heart disease was less – only a 13% increase.

This study has several strengths, including its large size and the inclusion of published and unpublished studies, which removes the risk ofpublication bias. But the study does have limitations.

The idea that overwork can lead to serious illness and even death is not a new one. The Japanese even have a word for it – “Karōshi”. But it is very difficult to prove direct cause and effect.

Read the full article via Working long hours ‘increases stroke risk’ – Health News – NHS Choices.

Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology

Cancer Services News

JCO August 20, 2015 vol. 33 no. 24 2705-2711

Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape.

The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors.

In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice.

The National Cancer Institute recently…

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Health and Social Care – Internet delivers mixed messages for older people

by Geoff Ellis for LSE health and Social Care Blog

How will the internet impact on older people’s ability to maintain social networks in coming decades? A new report argues there will always be a generational divide in capabilities and preferences about information and communication technology (ICT), and this could materially and socially disadvantage some older people.

Jacqueline Damant and Martin Knapp of the Personal Social Services Research Unit at LSE looked at the likely changes in society and technology which could affect the ability of older people to maintain social networks of support. Their study is part of the Government Office for Science’s Foresight project on the Future of an Ageing Population.

The report finds that ICT has the potential both to help and to harm social networking. It can help alleviate feelings of loneliness by bridging geographical distance from family members and friends, but it could also lead to the breakdown of traditional forms of social interaction.

While internet connectivity plays a central role in the daily lives of young people, older people commonly express ambivalence about ICT and tend to use it more peripherally. But if they do not take advantage of ICT, they could be doubly penalised. Not only would they miss out on convenience of lower-cost e-commerce, but older people could also lose important opportunities for social engagement.

Read the full article via Health and Social Care – Internet delivers mixed messages for older people.

Primary care in the NHS: Busting the myths – NHS Confederation


The NHS Confederation is publishing a series of myth busters, which challenge common misconceptions and enrich debate on topical, sometimes controversial, issues regarding our health and care.

The third in the series dispels myths about primary care in the NHS.

Check out the rest in the myth buster series:

via Primary care in the NHS: Busting the myths – NHS Confederation.

individuals who work 55 h or more per week have a 1·3-times higher risk of incident stroke

The Lancet: Published Online: 19 August 2015

Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.

We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.

We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35–40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02–1·26; p=0·02) and incident stroke (1·33, 1·11–1·61; p=0·002). 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 (range of RR estimates 1·30–1·42). We recorded a dose–response association for stroke, with RR estimates of 1·10 (95% CI 0·94–1·28; p=0·24) for 41–48 working hours, 1·27 (1·03–1·56; p=0·03) for 49–54 working hours, and 1·33 (1·11–1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).

Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.

via Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals – The Lancet.

‘Better Knowledge, Better Care’ videos

To build an understanding of what it means to have ‘better knowledge’ in health and care, this short animation series takes viewers on a journey explaining key concepts

No matter where you work in the system, whether your role is a provider or commissioner of health or care services for example, the animations demonstrate that by making small changes to how you capture, store, share and apply knowledge, it can lead to improved quality of care, outcomes and patient experience.

It is hoped the animations inspire audiences to share the passion of the team that better knowledge leads to better care, to recognise the importance of this activity in their day-to-day working and to increase access of the practical resources so far developed by the Knowledge and Intelligence team.

The four animations are:

If you enjoy watching the animations, please help us to spread the word about ‘Better Knowledge, Better Care’ by sharing them with your networks using #BKBC.

via NHS IQ.

E-cigarettes around 95% less harmful than tobacco estimates landmark review

Expert independent review concludes that e-cigarettes have potential to help smokers quit.

An expert independent evidence review published today by Public Health England (PHE) concludes that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.

Key findings of the review include:

  • the current best estimate is that e-cigarettes are around 95% less harmful than smoking
  • nearly half the population (44.8%) don’t realise e-cigarettes are much less harmful than smoking
  • there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers

The review, commissioned by PHE and led by Professor Ann McNeill (King’s College London) and Professor Peter Hajek (Queen Mary University of London), suggests that e-cigarettes may be contributing to falling smoking rates among adults and young people. Following the review PHE has published a paper on the implications of the evidence for policy and practice.

The comprehensive review of the evidence finds that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers, most of whom are using the devices to help them quit smoking or to prevent them going back to cigarettes. It also provides reassurance that very few adults and young people who have never smoked are becoming regular e-cigarette users (less than 1% in each group).

Full review E-cigarettes: an evidence update – A report commissioned by Public Health England

Related articles:

BBC News: E-cigarettes could be prescribed by the NHS to help smokers quit, report says

Guardian: Vaping: e-cigarettes safer than smoking, says Public Health England

Video: E-cigs ‘a game changer’ for smokers says report

The debate over digital technology and young people | The BMJ

BMJ 2015; 351

teens on laptopsSusan Greenfield, a senior research fellow at Lincoln College, Oxford, has promoted the idea that internet use and computer games can have harmful effects on the brain, emotions, and behaviour, and she draws a parallel between the effects of digital technology and climate change. Despite repeated calls for her to publish these claims in the peer reviewed scientific literature, where clinical researchers can check how well they are supported by evidence, this has not happened, and the claims have largely been aired in the media. As scientists working in mental health, developmental neuropsychology, and the psychological impact of digital technology, we are concerned that Greenfield’s claims are not based on a fair scientific appraisal of the evidence, often confuse correlation for causation, give undue weight to anecdote and poor quality studies, and are misleading to parents and the public at large.

Greenfield claims that social networking sites could negatively affect social interaction, interpersonal empathy, and personal identity. However, the bulk of research does not support this characterisation. With regard to social interaction and empathy, adolescents’ use of social networking sites has been found to enhance existing friendships and the quality of relationships, although some individuals benefit more than others. The general finding is that those who use social networks to avoid social difficulties have reduced wellbeing, while use of social networks to deal with social challenges improves outcomes.  In terms of affecting personal identity, Facebook is the most widely used social network and the best studied, and evidence suggests that people generally portray their identity accurately.

Read the full article via The debate over digital technology and young people | The BMJ.

Music in hospital

The Lancet: Published Online, 12 August 2015

Many of us would agree with Martin Luther’s claim that “My heart…has often been solaced and refreshed by music when sick and weary.” If that solace can happen in our private lives, why not in hospitals? Companies have profited from the mood-altering effects of music, but medicine has been much slower to reap the benefits.

Hopefully, the accumulating evidence base might change that: inThe Lancet, a meta-analysis1 of 72 randomised trials of perioperative music, reported by Jenny Hole and colleagues, shows that music was associated with modest reductions in patient-reported postoperative pain and anxiety (standardised mean differences −0·77 [95% CI −0·99 to −0·56] and −0·68 [–0·95 to −0·41], respectively), reduced analgesia use (−0·37, −0·54 to −0·20), and with increased patient satisfaction (1·09, 0·51–1·68).

via Music in hospital – The Lancet.