group 2 plenary 4
DESCRIPTION
295TRANSCRIPT
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Factors contributing to elevated glycated hemoglobin (HbA1c)
levels among BPO shift workers in Taguig City
Group 2
Geraldine Aclan, Yang Cheng, Olivia Daluz, Rhianna Martinez, Michael Van Haute
22 March 2014
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Background of the Research Question
Chronic non-communicable diseases are on the rise, especially with high-stress jobs (e.g., employment as BPO agents) promoting tobacco use, unhealthy diet, and inadequate physical activity.
Such unhealthy behaviors may be instrumental in adding to the amount of risk for development of a variety of non-communicable diseases.
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Statement of the Problem
There are a set of psychophysiological factors inherent in a number of high-stress jobs that can lead workers to take up maladaptive lifestyles and behaviors that can lead to unhealthy anthropometric and blood chemistry profiles, which in turn can put them at substantial risk for non-communicable diseases (NCDs). Given the nature of working as a BPO agent, those in this line of employment are at particular risk for NCDs.
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Statement of the Problem
One particular NCD of interest is type 2 diabetes mellitus, as more people in younger age groups are developing this disease. Glycated hemoglobin (HbA1c) is a measurable parameter that is useful as an early indicator of risk for diabetes mellitus.
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General Objective
To determine the factors that are associated with HbA1c levels among business process outsourcing (BPO) rotating shift-workers in voice and non-voice accounts employed by major BPO companies in Taguig City.
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Specific Objectives
To determine the association of stress levels, sleep deprivation, and dietary pattern with HbA1c levels among BPO rotating shift-workers.
To determine if the type of account of BPO rotating shift-workers is associated with stress levels, sleep quality, and dietary patterns.
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Significance of the Study
Such factors contributing to elevated HbA1c levels (and thus increased risk for diabetes mellitus), once identified, can be timely addressed so that measures and programs (e.g., helping workers deal with work-related stress, promotion of healthier lifestyles at the work place) can be implemented to hopefully prevent development of type 2 diabetes mellitus among BPO shift workers.
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Glycated Hemoglobin (HbA1c)
Proportion of total hemoglobin that has undergone irreversible glycation
Levels reflect the average amount of glucose hemoglobin is exposed to over a period of 3 months (the average life span of red blood cells)
Normal levels: 3.9% to 5.6%
Better represents longer-term glycemic exposure than fasting blood sugar (FBS)
Diabetes Care 2009; 32 (7): 1327-1334 Diabetes Care 2011; 34 (2): 518-523
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Glycated Hemoglobin (HbA1c)
Diabetes Care 2011; 34 (2): 518-523
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HbA1c and risk of developing DM
Increased risk for diabetes mellitus was noted among those with HbA1c values above 5.0%, with adjusted relative risks for incident diabetes increasing for every 0.5% increment above 5.0% (2.9 for HbA1c of 5.0%5.4%, 12.1 for 5.5%5.9%, 29.3 for 6.0%6.4%, 28.2 for 6.5%6.9%, and 81.2 for 70%).
Am J Med 2007; 120 (8): 720-727
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HbA1c and risk of developing DM
N Engl J Med 2010; 362 (9): 800-811
The adjusted hazard ratios of diabetes mellitus among those with HbA1c values of
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Factors that may influence HbA1c levels
Risk factors for diabetes mellitus
Impaired fasting glucose and impaired glucose tolerance
HbA1c levels across the range of 5% to 6.5%
Family history
Obesity
Lifestyle factors: lack of exercise, smoking, sleep duration
Dietary patterns
Medical conditions: CVD, PCOS, Hyperuricemia, Metabolic
syndrome
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HbA1c Levels
BPO rotating shift-workers
Voice account
Non-voice account
Psychophysiologic and lifestyle factors of
interest
Levels of Stress
Sleep quality
Dietary Patterns
Anthropometric measures
Body-mass-index
Waist-to-hip ratio
Socio-demographic characteristics
Age
Sex
Health-related background
Family history of diabetes
Existing medical condition
Highest educational attainment
Miscellaneous lifestyle and behavioral factors
Smoking habit and status
Levels of physical activity
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Variables
INDEPENDENT CONFOUNDING INTERMEDIATE DEPENDENT
Type of BPO account
Stress levels Sleep quality Dietary
patterns
Age Sex Highest
educational attainment
Family history of diabetes mellitus
Existing medical conditions
Smoking habit Smoking status Level of
physical activity
Body mass index (BMI)
Waist-to-hip ratio (WHR)
HbA1c
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Study Design and Setting
Study Design
Prospective cohort
Observational
Follow-up period: 6 months
Study Setting
Taguig City
Fort Bonifacio (a.k.a. BGC, or The Fort) has become the preferred location of BPO firms or companies (better infrastructure development and quality of office space, lower tax rates compared to neighboring cities)
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Study Population and Study Subjects
The target population will be BPO-employed rotating shift-workers involved in customer service/relations.
The study population will be in rotating shift-workers employed in major BPO companies/firms in Taguig City; the study groups will be the voice and non-voice account groups.
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Sampling Technique
Probability sampling method cluster sampling
BPO companies (the clusters) will be randomly selected, and the voice and non-voice shift-workers will be selected.
Sampling frame list of BPO companies/firms in Taguig City
Sampling units individual BPO companies in the list
Elementary units BPO voice and non-voice employees.
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Inclusion Criteria
1. Individuals employed in the client relations department, with either a voice or a non-voice-account, in major BPO companies located in Taguig City.
2. Having an employment duration no longer than 1 month at time of inclusion.
3. Having a baseline HbA1c level below 6.5%.
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Exclusion Criteria
1. BPO employees having a fixed working schedule.
2. Having on-going, or have a prior history of, anemia (includes iron-deficiency)
3. A history of recent (i.e., within 3 months) clinically significant blood loss (described as having had signs and symptoms of hemodynamic instability, pallor, cyanosis, irritability, and fatigue, requiring hospitalization and blood transfusion).
4. Had blood transfusion(s) within 3 months of the start of the study.
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Exclusion Criteria
5. Presence of chronic kidney disease or chronic liver
disease.
6. Carrying a diagnosis of any hemoglobinopathy.
7. A history of chronic Vitamin C, Vitamin E, or Aspirin
intake.
8. A history of chronic alcohol intake.
9. Having a baseline HbA1c level of 6.5% or greater.
10. Carrying a diagnosis of diabetes mellitus, or currently
being treated medically for diabetes mellitus.
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Figure 1. Summary of the process of identifying and defining study groups
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Figure 2. Flowchart summarizing the sampling procedure
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Figure 3. Summary of the general flow of the research process.
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Calculations for the minimum sample size requirement
Data used as basis for sample size derived from a Japanese 14-year (1991 to 2005) prospective cohort study (Suwazono Y, et al. Chronobiology International 2009; 26(5): 926-941), which compared % increases in HbA1c levels from baseline between day workers (n = 4219) and alternating shift-workers (n = 2885) employed in a Japanese steel company. In this study, the OR for having an HbA1c level increase of at least 10% from baseline is 1.35.
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Calculations for the minimum sample size requirement
Calculation of sample size was carried out using OpenEpi. A sample size calculator for cohort/RCT was employed.
Using the settings of 90% CI and 1 of 80%, the OR for having an HbA1c level increase of at least 10% from baseline which is 1.35 was entered.
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Data Collection
Data collection tool: questionnaire
GPAQ (Global Physical Activity Questionnaire) levels of
physical activity
PSS-10 (Perceived Stress Scale) stress levels
FFQ (Food Frequency Questionnaire) dietary patterns
PSQI (Pittsburgh Sleep Quality Index) sleep quality
Direct measurement
Height and weight for BMI
Waist and hip circumferences for WHR
HbA1c (laboratory)
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Data Processing and Analysis
Multivariate ordinal logistic regression
Outcome variable (HbA1c) is ordinal
10%, 15%, 20% increase from baseline level
Residual analysis test for linearity, homoscedasticity
Test for normality and randomness
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Ethical Considerations
Confidentiality agreement
Participant comprehension of research objectives
Informed consent
Contact information (tracking participants with
elevated HbA1c level)
Control numbers to access electronic questionnaire
Protection of participant information
Risks and benefits
Proper disposal of whole blood samples
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Study Limitations
Intensity and pace of employee training may vary from one company to another
Possibility of dropouts
Is a 6-month follow-up period long enough?
Self report questionnaire shortcomings
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Time Table
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Time Table
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Budget
ACTIVITY COST (PhP)
Staffs salary (15 persons) 450,000
Training research assistants (10 persons) 20,000
First HbA1c determination (5,316 participants) 2,658,000
Second HbA1c determination (5,316 participants) 2,658,000
Field work allowances (15 persons) 10,000
Materials (measuring tools, FFQ for each participant, token for participants)
120,000
Transportation expenses 50,000
TOTAL 5,966,000
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References
Gillett MJ. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes. Diabetes Care 2009; 32(7): 1327-1334.
Sacks DB. A1C versus glucose testing: a comparison. Diabetes Care 2011; 34 (2): 518-523.
Pradhan AD, et al. Hemoglobin A1c predicts diabetes but not cardiovascular disease in nondiabetic women. Am J Med 2007; 120 (8): 720-727.
Selvin E, et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 2010; 362 (9): 800-811.
Suwazono Y, et al. ShiftWork and Impaired Glucose Metabolism: A 14-Year Cohort Study on 7104 Male Workers. Chronobiology International 2009; 26(5): 926-941.
Why Bonifacio Global City is still top choice for BPOs (by JC Rodriguez). Accessed from http://www.abs-cbnnews.com/business/12/11/13/why-bonifacio- global-city-still-top-choice-bpos on 18 March 2014.
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THANK YOU 22 March 2014