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Impaired Sleep And Bad Habits: How Shift Work Affects Our Heath

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Health authorities have long been sounding the alarm about shift work, especially night shifts. In 2019, the International Agency for Research on Cancer (IARC) categorized shift work as a class 2A “probable human carcinogen.” “That’s the same group as tobacco!” exclaims Dr. Juan Antonio Madrid, Professor of Physiology and Director of the Chronobiology Laboratory at the University of Murcia in Spain. Madrid believes that there’s sufficient experimental evidence from research on animals as well as indirect evidence from people to support that claim. Moreover, he explains, the chronic alteration of the biological rhythms involved in shift work has an enormous impact on health: “It exacerbates the release of inflammatory mediators; reduces the immune system’s activity; causes metabolic effects that can lead to prediabetes, higher triglyceride levels, hypertension, and a higher risk of myocardial infarction and stroke, etc. In short, shift work aggravates a wide variety of very significant pathologies.”

Over the long term, those effects continue, even well after shift work ends. A study performed on mice, which was recently published in the scientific journal Neurobiology of Sleep and Circadian Rhythms, found that the consequences of shift work schedules in early adulthood (the equivalent of 18-24 years old in human age) persist into middle age (55 to 60 years of age), even when the rodents had returned to normal schedules during the intervening period. “We have found that exposure to shift work schedules during early adulthood exacerbates ischemic stroke outcomes in midlife, specifically in females. And even when the study subjects returned to a normal schedule, the effects on sleep-wake rhythms from early exposure to shift work cycles persisted so that in midlife these subjects were waking earlier and becoming active at the wrong time of day and night,” explained Professor David J. Earnest, the study’s principal investigator and a researcher at the Texas A&M University Center for Biological Clocks Research.

Juan Antonio Madrid says this data is “interesting” because it disproves the idea that shift work’s effects are only temporary and disappear once a more regular/normal schedule is restored. “We know that the incidence of cardiovascular disease among the shift-working population is around 20%, as compared to 7% for daytime workers. In the case of non-shift workers, the risk percentage remains at 15%. The time spent working shifts –for a long time, not if we’re talking about one or two years – takes a toll and causes changes that are not completely reversible,” the professor says. He points out that the research was conducted on mice, so extrapolating the data to humans is risky. Nevertheless, the study does “offer clues about what happens to [body] mechanisms.” The research on rodents has the advantage of eliminating confounding factors. Shift work (especially the night shift) is also associated with unhealthy lifestyle habits (being more sedentary, having a greater tendency to use tobacco and alcohol, eating a poorer diet), “which can mask and aggravate a shift worker’s health risks that aren’t solely a function of the hours worked.”

Is it possible to adapt to working at night?

Research published in the July issue of eBioMedicine (The Lancet) debunks another myth about working the night shift: that “one gets used to everything and the body can adapt to anything.” The study monitored 63 night-shift workers (who had three or more 10-hour night shifts per week) and 77 workers who alternated between morning and evening shifts; the participants were all employees at the Paul-Brousse Hospital just outside Paris. The results were clear: night shift workers had significantly impaired sleep quality and circadian rhythms, even though they’d worked the same night shift for over five years. “One of the most surprising findings was how poorly these hospital workers’ circadian systems adapted to the night shift, despite working that shift for a long time. And the effects weren’t just for the days they worked but also their off days, which indicates that some night shift workers don’t recover normal circadian function even on their days off,” explains Francis Lévi, Director of Research in Chronotherapy, Cancers and Transplantation at the University Paris-Saclay’s School of Medicine.

“It’s nearly impossible to adapt to night shift work,” avers Juan Antonio Madrid. He believes that such adaptations are only feasible in isolated environments such as oil rigs, where night shift workers can maintain a more regular schedule. “Chaotic habits are the problem, the fact that you eat at a certain time one day and then at a different time the next day, one day you exercise your body at a given time and the next day you do it at another time, one day you go to sleep at a specific time and then the following day you go to bed at a different time. Biological clocks are designed to anticipate, to prepare the body for regular and predictable events. The body isn’t prepared when we don’t provide that predictable framework,” he argues.

Despite this extreme difficulty, Madrid says that night shift workers can use three basic strategies to try to minimize shift work’s impact on rest and circadian rhythms. The first strategy is establishing a routine: “We have to regularize our eating and sleeping schedules insofar as possible; if you have to work at night, but then on the days when you’re not working, you completely change your schedule to meet family or social obligations, you’re continually altering your schedule. That’s a bad thing. It’s much more aggressive to our bodies than just sticking to a delayed sleep schedule each day, whether we’re working [that day] or not. We must ensure that we go to sleep at the same time every day, and that we get at least four hours of good sleep. The key is to establish a routine when our work schedules promote irregularity.”

The second strategy is to pursue contrast by getting enough physical activity (”because that makes you more resistant to shift work’s harmful effects“) and exposure to natural light during the day, because sunlight is a powerful biological regulator. Finally, we should try to synchronize mealtimes/fasts and sleep cycles/darkness, which is the most difficult thing to do: “Fasting should coincide with sleep/darkness, which is quite a challenge for people who work the night shift,” Madrid says.

Finally, Professor Francis Lévi emphasizes the need for night shift workers to have access to “specific medical evaluations throughout their professional lives” because they are exposed to greater health risks. “These days we’re able to objectively and non-invasively assess circadian rhythms and sleep health almost in real time; then, when necessary, [we can] design preventive measures for individual workers and evaluate their effectiveness,” he notes.

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Nicaragua’s Daniel Ortega Escalates Diplomatic Crisis With US And Europe

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Nicaraguan President Daniel Ortega.
Nicaraguan President Daniel Ortega.JAIRO CAJINA (AFP)

Nicaraguan President Daniel Ortega has decided to break ties with the Netherlands in what is the latest diplomatic feud to be sparked by the former guerilla. The Nicaraguan Foreign Ministry said in a statement on Friday that it had severed all diplomatic ties with the European country because it “offended and keeps offending Nicaraguan families.”

The decision to break ties was made after the Dutch ambassador for Central America, Christine Pirenne, informed the Nicaraguan government that the Netherlands would not be funding a $21.5 million hospital promised long ago. The news outraged Ortega, who accused the ambassador of treating Nicaragua as if it were “a Dutch colony.”

“Those who come to disrespect our people, our homeland, they should not appear again in Nicaragua. And we do not want relations with that interventionist government,” he said during his speech on Friday, which marked the 43rd anniversary of the founding of Nicaragua’s repressive National Police. “We [the Sandinista government] continue to open hospitals, even when we are met with human misery. The human misery of a European country, the Netherlands!” he added.

Diplomatic sources told EL PAÍS that the Netherlands had suspended the hospital project due to the “mishandling of funds, lack of transparency, and the serious human rights situation in Nicaragua.”

“The Netherlands regrets the disproportionate decision by Nicaragua to break off diplomatic relations. We take a firm stand on the worsening democratic structures and human rights violations in Nicaragua,” Dutch Foreign Minister Wopke Hoekstra said via Twitter on Saturday. “Other countries have also noticed difficulties in maintaining an open dialogue with Nicaragua. We will discuss our next steps with the EU.”

The clash with the Netherlands followed a week of heightened tensions with the European Union and the United States.

On Friday, Nicaragua’s Vice President Rosario Murillo, the wife of Ortega, also announced that the Central American country would not accept the new US-appointed ambassador Hugo Rodriguez as its representative in Managua. Ortega initially signed off on the appointment, but withdrew his support in July after Rodriguez told the US Senate Foreign Relations Committee that he would continue to advocate for an end of human rights violations in Nicaragua.

“The United States has spoken out against these abuses, and, if confirmed [as ambassador], I will continue to do so, not because we have any intention to determine Nicaragua’s internal affairs, but because it is our commitment under the Inter-American Charter, which both the United States and Nicaragua signed in 2001,” Rodriguez told the committee.

Despite Nicaragua’s objections, the Joe Biden administration appointed Rodriguez as ambassador on Thursday. Ortega railed against the decision during his speech to police forces. “The candidate for ambassador to Nicaragua appeared before the Senate, and what did he do? He insulted and disrespected us,” he said on Friday. “So we immediately said ‘get out, get out and stay out, and he can continue yelling whatever he likes out there, but here in our country, our flag is respected.’”

On Thursday, in another speech, Ortega attacked the Vatican, Chilean President Gabriel Boric and Brian Nichols, White House Assistant Secretary of State for Western Hemisphere Affairs, who he described as a “poor Black man” with a “bulldog face.” Boric and other Latin American leaders, who have called for the release of political prisoners, were branded as “lapdogs” of the United States and the European Union.

And on Wednesday, Nicaragua declared the European Union ambassador, Bettina Muscheidt, “persona non grata” and gave her three days to leave the country. The decision was made after the EU delegation demanded freedom for Nicaragua’s political prisoners at the United Nations General Assembly last week.

“The EU profoundly regrets and rejects this unjustified and unilateral decision,” the European External Action Service (EEAS) said in a statement released on Sunday, a day after Muscheidt left Nicaragua. “The EU also profoundly regrets the disproportional and unjustified unilateral decision taken on Friday by the Nicaraguan government to cut diplomatic ties with the kingdom of the Netherlands and expresses its unwavering support to the Dutch government,” it added, warning that it would respond in a “firm and proportional manner.”

In recent months, Nicaragua has also rejected all proposals for dialogue, including those put forward by Pope Francis, Colombian President Gustavo Petro and the US government.

“Ortega’s strategy is to escalate the crisis to a point where only the use of force will solve it, but he knows very well that the use of force is not an option the international community is going to consider,” Eliseo Núñez, a former opposition deputy in Nicaragua, told EL PAÍS. “Everyone believed that they could push Ortega to the brink of the abyss, but he has taken the international community to that brink and is forcing it to choose between two options: a global economic blockade, which would collapse Nicaragua, or to sit back and wait to see what happens.”

Some analysts believe that Washington is seeking to exhaust all diplomatic routes with Nicaragua via Ambassador Rodriguez in order to justify future action against the country, such as expelling it from the DR-CAFTA free trade agreement.

“Ortega has been using vulgar, racist and blasphemous rhetoric,” Arturo McFields, Nicaragua’s former ambassador to the Organization of American States (OAS), told EL PAÍS. “It is a narrative that is aligned with Russia’s foreign policy. Right now, Russia is facing NATO, the United States and the European Union. Ortega is sticking in a parasitic to the foreign policy of Moscow and China.”

McFields recalled that Nicaragua was one of the seven countries that did not want the president of Ukraine, Volodymyr Zelenskiy, to appear remotely at the United Nations General Assembly. “I believe that in the next few days, Ortega is going to break diplomatic relations with other countries in the European Union,” said McFields.

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Six Takeaways From Brazil’s Election

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Brazilians waiting to vote in Rio de Janeiro.
Brazilians waiting to vote in Rio de Janeiro.RICARDO MORAES (Reuters)

Luiz Inácio Lula da Silva, Jair Bolsonaro and six other candidates faced each other this past Sunday, October 2, in the first round of Brazil’s presidential election.

These were the key takeaways of the day:

Run-off. None of the candidates obtained enough votes to clinch the election in the first round. Luiz Inácio Lula da Silva received more than 57 million votes (48.38%), two points short of the figure required to win a third term outright. That means that in four weeks he will again face off against the president, Jair Bolsonaro. On October 30, Brazilians will choose between two antagonistic models for running the country.

Bolsonaro’s strength. The incumbent’s performance has been much better than any of the polls had predicted. He is only five points behind Lula when the polls had placed him between 10 and 15 points behind his leftist rival.

Failure of polls. For months, Bolsonaro and his followers had been insisting that polls underestimated his strength, just like in 2018. And they were right. Although several surveys have been published each week in recent months, none of the most reliable ones foresaw such a close presidential race.

-Victory in São Paulo. Nobody was expecting it: Bolsonaro won comfortably in the wealthiest state in Brazil. His candidate in the race for governor, Tarcísio Gomes Freitas, a former minister who is from the rival city of Rio de Janeiro, obtained a seven-point lead over Fernando Haddad, a former Workers’ Party (PT) candidate and former mayor. Both will fight it out in the second round of voting.

-A right-leaning Congress. The next president of Brazil, whoever he may be, will have to govern with a clearly conservative National Congress. Bolsonaro’s Liberal Party (PL) will have the biggest presence in the Chamber of Deputies, with 99 seats. The lower house has 513 seats, but it will be nearly impossible for Lula’s Workers’ Party (PT) to build a majority.

– A five-hour vote count. Although Brazil is twice the size of Europe and its electorate exceeds 156 million voters, electronic ballot boxes reach every corner of the country, including the remote villages of the Amazon. This facilitates a speedy vote count: in just five hours, 99% of the votes had already been counted.

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‘Time Is Brain: The Longer You Take To Go To The Hospital After A Stroke, The Worse The Damage’

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To find out if the brain development of a newborn baby is normal, doctors usually look at – among other things – a small reflex action, triggered by exerting a tiny amount of pressure on the palm of the hand or the sole of the foot. This little movement in the first months of life provides invaluable information.

Lluís Barraquer Roviralta – considered the father of neurology in Spain – first utilized this technique over a century ago at Sant Pau Hospital in Barcelona. A full 140 years of scientific advances (and three generations of Barraquers) have now passed in the neurology clinics of Sant Pau. Today, specialized services in this area of medicine have taken giant leaps, thanks to the development of imaging technology.

“This is the decade of neurology,” proclaims Albert Lleó, the current director of the department that Barraquer created. The 50-year-old neurologist recently received a lot of media attention after his team successfully treated the 92-year-old former premier of Catalonia, Jordi Pujol, after he suffered a stroke. Pujol was released from hospital last weekend.

This interview has been translated and edited for clarity and brevity.

Question. How has the field of neurology changed in 140 years?

Answer. Neurological disorders are becoming more frequent. Many of these are age-related diseases – this is to be expected, given that people are living longer. It’s projected that the prevalence of degenerative diseases could triple within the next 30 years.

Q. How has the prognosis of these diseases evolved?

A. Thirty years ago, there were very few diseases that had effective treatment. In most cases, the causes and mechanisms were not well understood. For strokes, there were only antiaggregants, such as aspirin. Practically nothing was known about degenerative diseases. As for neuromuscular diseases, only cortisone or very broad-acting immunosuppressants were available. What has happened in recent years is that more knowledge about the causes has resulted in more effective treatments.

Q. It used to be said that neurologists know all about the diseases, but they can’t cure any of them…

A. This belief is totally obsolete. There are effective treatments for cerebral vascular diseases, for stopping blood clots from growing or causing problems… there are very effective treatments for migraines, there’s gene therapy treatment being carried out for spinal muscular atrophy. Perhaps the most difficult diseases to treat are Alzheimer’s and Parkinson’s.

Q. These are good times for neurology, then?

A. We are in a fantastic era, because of the therapeutic tools we have access to. But the rise of neurological diseases is also, in turn, a time bomb, because it can squeeze health services. We have aging populations, a greater prevalence of chronic diseases… all of this comes at a very high cost, the treatments aren’t cheap. This is why it’s very important to have adequate plans for Alzheimer’s, for example, or for other neurodegenerative diseases, to prioritize where we’re going to put the money – do we put it into long-term care homes or do we put it in research?

Q. Last week, former Catalan premier Jordi Pujol was proof that strokes can be reversible, even at an advanced age.

A. Today, more and more work is being done on biological age rather than on chronological age. That is, you can be 60 years old, but have the brain of an 80-year-old, because you’ve had an unhealthy lifestyle.

The rise of neurological diseases is a time bomb, because it can squeeze health services

Q. Mar Castellanos, the head of neurology at A Coruña Hospital, said in an interview with EL PAÍS that strokes don’t just take place among the elderly – more and more often, they are affecting the working age population. Why is this happening?

A. A stroke is highly influenced by lifestyle: smoking, diabetes, high cholesterol, a sedentary lifestyle, high stress levels… age is not the only factor.

Q. Speaking of lifestyle… even though we’re living longer, are we living worse? Are we harming our brain with our habits?

A. I think there is still a lack of awareness regarding the prevention and early detection of neurological diseases. In the case of a stroke, for example, there are people who still think that it’s not necessary to go to the emergency room, that you can wait and see if it goes away. We see this every day. And why is this happening? Because cardiovascular or cancer prevention campaigns began in the 1970s, but in neurology, they started much later – we’ve been repeating this message for less time. In the case of a stroke, time is brain: the longer it takes to get to the hospital, the more brain damage there will be. Neurological diseases have been largely neglected from the point of view of awareness campaigns and funding.

Q. There’s a kind of knowledge black hole when it comes to neurodegenerative diseases, which still have no treatment. Why?

A. Alzheimer’s, Parkinson’s… these are very difficult diseases to study and treat. Sometimes, many years may pass before a person notices the first symptoms. By the time they begin to notice and seek help, there is already significant brain damage. When someone has a tumor, oncologists do a biopsy of the tissue, analyze it and look for viable treatment options. But you can’t do a biopsy in the brain: we depend on imaging techniques, which don’t have microscopic resolution. We aren’t able to examine these diseases in detail in the early stages – not knowing what’s happening during these critical years makes it difficult to find treatments.

In Alzheimer’s, there are more than 50 genes involved – it’s very difficult to know what the sequence of events is. Even so, I would say that much progress has been made. And it’s also very clear that the greatest advances have been made in the degenerative diseases that have received the most funding, like Alzheimer’s and MS. The common thread of all chronic diseases – except for strokes – is to understand the immune system in our brain, about which very little is known. This will be essential research over the coming decades.

Q. How can the healthcare system remain sustainable?

A. It’s necessary to carry out a cost-effectiveness analysis. If we manage to reduce or postpone the onset of Alzheimer’s for five years with effective treatments, we can reduce the number of total cases and, most importantly, improve people’s quality of life. This has a very high cost, but maybe it will buy patients a few extra years of life outside of long-term care.

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