Shift work is associated with an increased risk of major vascular problems, such as heart attacks and strokes, concludes a study published on www.bmj.com .
This is the largest analysis of shift work and vascular risk to date and has implications for public policy and occupational medicine, say the authors.
Shift work has long been known to disrupt the body clock (circadian rhythm) and is associated with an increased risk of high blood pressure, high cholesterol and diabetes, but its association with vascular disease is controversial.
So a team of international researchers analyzed the results of 34 studies involving over two million individuals to investigate the association between shift work and major vascular events.
Shift work was defined as evening shifts, irregular or unspecified shifts, mixed schedules, night shifts and rotating shifts. Control groups were non-shift (day) workers or the general population.
Differences in study design and quality were taken into account to minimize bias.
Among the 2,011,935 people in the studies more than 17,359 had some kind of coronary event, 6,598 had myocardial infarctions (heart attacks), and 1,854 had ischemic strokes caused by lack of blood to the brain.
These events were more common among shift workers than other people: shift work was associated with an increased risk of heart attack (23 percent), coronary events (24 percent) and stroke (5 percent).
These risks remained consistent even after adjusting for factors such as study quality, socioeconomic status and unhealthy behaviors in shift workers.
Night shifts were associated with the steepest increase in risk for coronary events (41 percent). However, shift work was not associated with increased death rates from any cause.
Although the relative risks were modest, the authors point out that the frequency of shift work in the general population mean that the overall risks are high.
For Canada – where some of the study's authors are based and where 32.8 percent of workers were on shifts during 2008-9 – 7.0 percent of myocardial infarctions, 7.3 percent of all coronary events and 1.6 percent of ischemic strokes could be attributed to shift work.
The authors say their findings have several implications.
For example, they suggest screening programs could help identify and treat risk factors, such as high blood pressure and cholesterol levels.
Shift workers could also be educated about symptoms that could indicate early heart problems.
Finally, they say more work is needed to identify the most vulnerable groups of shift workers and the effects of modifying shift patterns on overall vascular health.
SAN FRANCISCO – California Attorney General Kamala Harris announced on Friday that California joined 29 other states in a $151 million settlement with one of the nation’s largest drug wholesalers to resolve allegations the company inflated the price of prescription drugs by as much as 25 percent, causing the states’ Medicaid programs to overpay millions of dollars in pharmacy reimbursements.
California’s recovery of the settlement with San Francisco-based McKesson Corp. is $23,585,849.
“In these difficult budget times, it is crucial that California’s scarce public resources support the urgent needs of our state,” said Attorney General Harris. “We cannot allow dollars meant for patients to be diverted to inflate corporate profits.”
Friday’s settlement resolves allegations that McKesson Corp. deliberately inflated the Average Wholesale Prices (AWPs) it reported to First Data Bank, a publisher of drug prices, causing California to overpay on branded prescription drugs from Aug. 1, 2001, through Dec. 31, 2009.
Medi-Cal sets the reimbursement rates for pharmacies for many of the drugs dispensed to Medi-Cal patients based on the AWP.
The Medicaid program, which is known as Medi-Cal in California, is funded jointly by the federal government and the State of California.
The settlement is based on a 2005 qui tam case filed under the false claims statutes of the federal government, as well as California and other states.
In April, the federal government settled the federal portion of the lawsuit for more than $187 million.
A team of attorneys and investigative auditors from the California Attorney General’s Office and the New York Attorney’s General Office were appointed by the National Association of Medicaid Fraud Control Units to investigate and conduct the settlement negotiations with McKesson on behalf of the participating states.
Joining California and New York in the settlement are the District of Columbia and the following 27 states: Arkansas, Colorado, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Maine, Michigan, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Washington, West Virginia and Wyoming.
The Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse investigates and prosecutes claims of Medi-Cal civil and criminal fraud, as well as allegations of elder abuse, such as physical assaults or financial theft.
A copy of California’s settlement agreement can be found at http://oag.ca.gov/ .
SACRAMENTO – Gov. Jerry Brown has signed legislation authored by Assemblymember Wesley Chesbro (D-North Coast) that will bring more doctors to rural areas in accordance with President Obama’s Affordable Care Act.
The Affordable Care Act allows Native American health programs to bring in doctors to practice at tribal clinics when they are not licensed in the state where the clinic is located, as long as they are licensed in another state.
Chesbro’s AB 1896 changes California law so that it is aligned to the new federal law.
“Rural communities in California suffer from a chronic shortage of health care providers,” Chesbro said. “This is especially severe in communities that depend on tribal health care clinics. Tribal clinics are open to all members of the community, not just members of the tribe, and are an important part of our health-care delivery network in rural California, particularly for low-income families.”
A U.S. Civil Rights Commission report on the Native American health care delivery system found that patients who depend on tribal clinics do not receive consistent care because of high turnover of physicians. This inconsistency has led to misdiagnoses of conditions and incorrect treatment regimens.
“This is unnecessary and very dangerous to patients,” Chesbro said. “It is also expensive for the state.”
The Indian Health Service in California says the National Indian Health Service has a pool of physician applicants from other states who are eager to move to California and work in a tribal clinic for a contracted period of time.
“According to the Health Affairs Journal, President Obama’s Affordable Care Act will result in 3.4 million more Californians gaining health insurance by 2016,” Chesbro said. “Many rural California residents who previously did not have access to health care will be insured, and it is vital we have enough providers to serve them.”
SACRAMENTO – Dr. Ron Chapman, director of the California Department of Public Health (CDPH) and state health officer, today warned consumers not to eat Gold Plum candy imported from Taiwan after tests conducted by CDPH found the products contained levels of lead that exceed the state’s standards.
Consumers in possession of the candy should discard it immediately.
Recent analysis of this candy by CDPH determined that Gold Plum candy contained as much as 0.29 parts per million (ppm) of lead.
California considers candies with lead levels in excess of 0.10 ppm to be contaminated.
Gold Plum candy is sold in a 6-ounce package that has black, gold, green and orange stripes at the top and bottom. In the top right corner there is an image of a small girl with a white face and brown hair, wearing an orange outfit.
The name “Gold Plum Candy” appears in the lower left corner. The individually wrapped candy has various Asian characters on the wrapping.
Gold Plum candy is imported and distributed by Roxy Trading Inc., Pomona, Calif., which has initiated a voluntary recall after being notified of the test results by CDPH.
CDPH is currently working with the distributor to ensure that the contaminated candies are removed from the market place.
Pregnant women and parents of children who may have eaten this candy should consult their physician or health care provider to determine if medical testing is needed.
Consumers who find this candy for sale should call the CDPH Complaint Hotline at 1‑800-495-3232.
For more information about lead poisoning, contact your county childhood lead poisoning prevention program or public health department.
Additional information is available on the CDPH Childhood Lead Poisoning Prevention page, www.cdph.ca.gov/healthinfo/discond/Pages/CLPPBChildrenAtRisk.aspx , and the new Frequently Asked Questions (FAQ) about Lead and Lead-Contaminated Products Web page, www.cdph.ca.gov/programs/Pages/LeadFAQ.aspx .