[Possibilities and limits of sleep recovery for night-nursing workers]

The present study had the objective of investigating the possibilities/limits of sleep recovery in women workers with medium level in nursing that develop their activities in night shifts in a first-aid clinic at a public hospital in Natal, Rio Grande do Norte, Brazil. This was an analytic study, with a qualitative approach which used the technique of thematic oral history Fifteen women workers with medium level in nursing were interviewed. The following empirical categories were defined: night shift work and night sleep and night rest at work environment Physiological and psychological sufferings are evident on their speech as well as what the lack of sleep causes in health and personal life of these women workers, making the overload of work clear and also the sociocultural imperfections of feminine gender

Atypical work hours and metabolic syndrome among police officers

This study examined whether atypical work hours are associated with metabolic syndrome among a random sample of 98 police officers. Shift work and overtime data from daily payroll records and reported sleep duration were obtained. Metabolic syndrome was defined as elevated waist circumference and triglycerides, low HDL cholesterol, hypertension, and glucose intolerance. Multivariate analysis of variance and analysis of covariance models were used for analyses. Officers working midnight shifts were on average younger and had a slightly higher mean number of metabolic syndrome components. Stratification on sleep duration and overtime revealed significant associations between midnight shifts and the mean number of metabolic syndrome components among officers with less sleep (p = .013) and more overtime (p = .007). Results suggest shorter sleep duration and more overtime combined with midnight shift work may be important contributors to the metabolic syndrome.

[Health state of civil pilots in conditions of intensified piloting load]

Studies of health state of civil pilots working in restrictedly increased piloting hours did not reveal negative influence of increased work loads (90 hours per month and 900 hours per year) on the examinees. In some parameters--medical disqualification due to internal and nervous system disease, transitory disablement morbidity, acute diseases occurrence--reliably positive results were obtained mostly because of increased attention of airline authorities and medical staffers to purposeful prophylactic and rehabilitation work with pilots exposed to intensified piloting load.

Medical and genetic differences in the adverse impact of sleep loss on performance: ethical considerations for the medical profession

The Institute of Medicine recently concluded that-on average-medical residents make more serious medical errors and have more motor vehicle crashes when they are deprived of sleep. In the interest of public safety, society has required limitations on work hours in many other safety sensitive occupations, including transportation and nuclear power generation. Those who argue in favor of traditional extended duration resident work hours often suggest that there are inter- individual differences in response to acute sleep loss or chronic sleep deprivation, implying that physicians may be more resistant than the average person to the detrimental effects of sleep deprivation on performance, although there is no evidence that physicians are particularly resistant to such effects. Indeed, recent investigations have identified genetic polymorphisms that may convey a relative resistance to the effects of prolonged wakefulness on a subset of the healthy population, although there is no evidence that physicians are over-represented in this cohort. Conversely, there are also genetic polymorphisms, sleep disorders and other inter-individual differences that appear to convey an increased vulnerability to the performance-impairing effects of 24 hours of wakefulness. Given the magnitude of inter-individual differences in the effect of sleep loss on cognitive performance, and the sizeable proportion of the population affected by sleep disorders, hospitals face a number of ethical dilemmas. How should the work hours of physicians be limited to protect patient safety optimally? For example, some have argued that, in contrast to other professions, work schedules that repeatedly induce acute and chronic sleep loss are uniquely essential to the training of physicians. If evidence were to prove this premise to be correct, how should such training be ethically accomplished in the quartile of physicians and surgeons who are most vulnerable to the effects of sleep loss on performance without unacceptably compromising patient safety? Moreover, once it is possible to identify reliably those most vulnerable to the adverse effects of sleep loss on performance, will academic medical centers have an obligation to evaluate the proficiency of both residents and staff physicians under conditions of acute and chronic sleep deprivation? Should work-hour policy limits be modified to ensure that they are not hazardous for the patients of the most vulnerable quartile of physicians, or should the limits be personalized to enable the most resistant quartile to work longer hours? Given that the prevalence of sleep disorders has increased in our society overall, and increases markedly with age, how should fitness for extended duration work hours be monitored over a physician's career? In the spirit of the dictum to do no harm, advances in understanding the medical and genetic basis of inter-individual differences in the performance vulnerability to sleep loss should be incorporated into the development of work-hour policy limits for both physicians and surgeons.

[Influence of working shift on nervous system functional state in operators of control unit in nuclear power station]

Operators of control unit in nuclear power station, if after the working shift, were diagnosed as having changes of cerebral functions and vegetative regulation, with sometimes increased blood pressure up to the level of cerebrovascular disease risk, and with higher spectral density of main EEG rhythms intensity.

Comparison of alertness levels in ship crew. An experiment on rotating versus fixed watch schedules

A short pilot study was conducted during a shipboard training deployment to compare alertness levels in the same crew members while working a fixed watch schedule, and then a rotating watch schedule. Alertness levels were assessed before and after each duty watch using measurements of oculomotor function (Fitness Impairment Tester). Saccadic velocity was shown to have the greatest correlation with duration of sleep deprivation and was significantly slower (indicating decreased alertness) in the crew working the rotating watch schedule than the crew working the fixed watch schedule. This pilot study corroborates previous studies' recommendations that fixed watch schedules allow better acclimatization of sleep patterns, thus minimizing fatigue and increasing operational alertness.

Sleeping and working hours of residents at a national university hospital in Japan

This study aimed to examine the status of time spent working and sleeping by resident doctors before the introduction of the New Training System for Residents in Japan. A time-budget survey was conducted over a 4-wk period on 102 residents at the Shiga University of Medical Science Hospital, and the response rate among residents was 76% of a total of 2,722 person-days. The average number of hours spent sleeping was the lowest and spent in the hospital including commuting time was the highest in residents of the surgery department, at 4.4 h and 18.9 h, respectively. Forty percent of residents reported dozing off at work, with the incidence rate being highest in residents of the surgery department (0.7 times/person-day). Dozing appeared to occur in response to the lack of sleep and fatigue, since the same residents slept longer on nights before days they reported not dozing off than on nights before days when they did doze off. Strong correlations were observed between the number of sleeping and working hours and between working hours and the number of patients in a resident's care. In order to maintain high standards of training and to get sufficient sleep it is therefore necessary for residents to manage their work and the number of patients in their care.

Factors associated with intern fatigue

BACKGROUND

Prior data suggest that fatigue adversely affects patient safety and resident well-being. ACGME duty hour limitations were intended, in part, to reduce resident fatigue, but the factors that affect intern fatigue are unknown.

OBJECTIVE

To identify factors associated with intern fatigue following implementation of duty hour limitations.

DESIGN

Cross-sectional confidential survey of validated questions related to fatigue, sleep, and stress, as well as author-developed teamwork questions.

SUBJECTS

Interns in cognitive specialties at the University of California, San Francisco.

MEASUREMENTS

Univariate statistics characterized the distribution of responses. Pearson correlations elucidated bivariate relationships between fatigue and other variables. Multivariate linear regression models identified factors independently associated with fatigue, sleep, and stress.

RESULTS

Of 111 eligible interns, 66 responded (59%). In a regression analysis including gender, hours worked in the previous week, sleep quality, perceived stress, and teamwork, only poorer quality of sleep and greater perceived stress were significantly associated with fatigue (p < 0.001 and p = 0.02, respectively). To identify factors that may affect sleep, specifically duty hours and stress, a secondary model was constructed. Only greater perceived stress was significantly associated with diminished sleep quality (p = 0.04), and only poorer teamwork was significantly associated with perceived stress (p < 0.001). Working >80 h was not significantly associated with perceived stress, quality of sleep, or fatigue.

CONCLUSIONS

Simply decreasing the number of duty hours may be insufficient to reduce intern fatigue. Residency programs may need to incorporate programmatic changes to reduce stress, improve sleep quality, and foster teamwork in order to decrease intern fatigue and its deleterious consequences.

Doppler ultrasound surveillance in deep tunneling compressed-air work with Trimix breathing: bounce dive technique compared to saturation-excursion technique

The Western Scheldt Tunneling Project in The Netherlands provided a unique opportunity to evaluate two deep-diving techniques with Doppler ultrasound surveillance. Divers used the bounce diving techniques for repair and maintenance of the TBM. The tunnel boring machine jammed at its deepest depth. As a result the work time was not sufficient. The saturation diving technique was developed and permitted longer work time at great depth. Thirty-one divers were involved in this project. Twenty-three divers were examined using Doppler ultrasound. Data analysis addressed 52 exposures to Trimix at 4.6-4.8 bar gauge using the bounce technique and 354 exposures to Trimix at 4.0-6.9 bar gauge on saturation excursions. No decompression incidents occurred with either technique during the described phase of the project. Doppler ultrasound revealed that the bubble loads assessed in both techniques were generally low. We find out, that despite longer working hours, shorter decompression times and larger physical workloads, the saturation-excursion technique was associated with significant lower bubble grades than in the bounce technique using Doppler Ultrasound. We conclude that the saturation-excursion technique with Trimix is a good option for deep and long exposures in caisson work. The Doppler technique proved valuable, and it should be incorporated in future compressed-air work.

A longitudinal study on the effect of shift work on weight gain in male Japanese workers

OBJECTIVE

This study compared the effect of alternating shift work and day work on weight gain in Japanese male workers.

METHODS AND PROCEDURES

A longitudinal cohort study was conducted in day workers (n = 4,328) and alternating shift workers (n = 2,926) of a steel company who received annual health checkups over a 14-year period between 1991 and 2005. The association between the type of job schedule and weight gain was investigated using multivariate pooled logistic regression analyses. The endpoints in the study were either a 5, 7.5, or 10% increase in BMI during the period of observation, compared to the BMI at entry.

RESULTS

The type of job schedule was significantly associated with all three BMI endpoints (5% increase in BMI; odds ratio (OR) for comparison between alternating shift workers and regular day workers, 1.14; 95% confidence interval (CI), 1.06-1.23): (7.5% increase in BMI; OR, 1.13; 95%CI, 1.03-1.24: 10% increase in BMI; OR, 1.13; 95%CI, 1.00-1.28). BMI at study entry was also positively associated with the 5, 7.5, and 10% increases in BMI during the study. On the other hand, age and drinking habits were negatively associated with 5, 7.5, and 10% increases in BMI.

DISCUSSION

Our study revealed that alternating shift work was an independent risk factor for weight gain in male Japanese workers. Efficient health screening and regular checkups, combined with support to control unhealthy lifestyle factors, would be of considerable benefit for maintaining the health of Japanese shift workers.

Shift work in nursing: is it really a risk factor for nurses' health and patients' safety?

There is evidence in the scientific literature of the adverse physiological and psychological effects of shift work, including disruption to biological rhythm, sleep disorders, health problems, diminished performance at work, job dissatisfaction, and social isolation. In this study, the results of health problems and sleep disorders between female and male nurses, between daytime and shift nurses, and between sleep-adjusted and non-sleep-adjusted shift nurses were compared. Also the relationship between adjustment to shift work and organizational outcomes (errors and incidents and absenteeism from work) was analyzed. Gender, age, and weight were more significant factors than shift work in determining the well-being of nurses. Shift work by itself was not found to be a risk factor for nurses' health and organizational outcomes in this study. Moreover, nurses who were identified as being "non-adaptive" to shift work were found to work as effectively and safely as their adaptive colleagues in terms of absenteeism from work and involvement in professional errors and accidents. This research adds two additional findings to the field of shift work studies. The first finding is that female shift workers complain significantly more about sleep disorders than male shift workers. Second, although high rates of nurses whose sleep was not adapted to shift work were found, this did not have a more adverse impact on their health, absenteeism rates, or performance (reported errors and incidents), compared to their "adaptive" and "daytime" colleagues.

Warding off sleepiness

This article focused on the sleep effects of three schedule attributes. Ideally, business requirements and employee preferences also will be taken into account when selecting the "best" shift schedule for your site.

The association of shift work and hypertension among male factory workers in Kota Bharu, Kelantan, Malaysia

Shift work associated with various health problems and there is concern that shift workers are at higher risk to develop hypertension. A cross-sectional study was conducted from December 2003 to May 2004 to compare the prevalence of hypertension and to examine the relationship between shift work and hypertension among 148 randomly selected male workers from one of the factories in Kota Bharu, Kelantan. Information on psychosocial and life-style factors, anthropometric and blood pressure measurements, and fasting blood sugar and lipid profiles analyses were obtained. The prevalence of hypertension was significantly higher among shift workers (22.4%) compared to day workers (4.2%), with p-value of 0.001. Shift work was significantly associated with hypertension (adjusted odds ratio 9.1; 95% CI 1.4-56.7).

Linking learning and health: a pilot study of medical students' perceptions of the academic impact of various health issues

OBJECTIVE

To assess medical students' experience with a wide variety of health concerns and their perceptions of the impact of these health concerns on their academic performance.

METHODS

The National College Health Assessment (NCHA) was administered to all students enrolled at a single medical school during the spring term of 2005.

RESULTS

Students reported the greatest perceived negative academic impact related to experiencing interpersonal concerns (concerns about troubled friends or family members, death of a friend or family member, and relationship difficulty) and mental health concerns (depression/anxiety/seasonal affective disorder and stress). A total of 315 students participated (48% response rate).

CONCLUSION

Medical students perceive their experiences with social and psychological concerns as negatively influential to their academic well-being. Strategies that assist students in coping with these issues support the learning mission of the academic medical center.

[Left ventricular diastolic function in subjects with arterial hypertension living in the Far North depending on the work schedule]

Left ventricular diastolic function (LVDF) was studied in subjects with arterial hypertension (AH) living in the Far North in relation to their working regime. A total of 95 patients with grade I-II AH were divided into two groups, one including 53 dayworkers the other comprising 42 patients working in shifts. The control group included 25 practically healthy subjects. All the patients were examined by Doppler echocardiography. Analysis of the results demonstrated that patients with AH working night shifts more frequently experienced LVDF disturbances than subjects of other groups. These disturbances included increased contribution of the left atrial systole to left ventricle filling. Patients with AH exhibited the well-apparent dependence of left ventricle diastolic filling on the degree of its hypertrophy. LVDF was related to the elevation of nocturnal arterial pressure due to a rise in systolic AP.

Exercise, energy balance and the shift worker

Shift work is now common in society and is not restricted to heavy industry or emergency services, but is increasingly found amongst 'white collar' occupations and the growing number of service industries. Participation in shift work is associated with increased body mass index, prevalence of obesity and other health problems. We review the behavioural and biological disturbances that occur during shift work and discuss their impact on leisure-time physical activity and energy balance. Shift work generally decreases opportunities for physical activity and participation in sports. For those shift workers who are able to exercise, subjective and biological responses can be altered if the exercise is taken at unusual times of day and/or if the shift worker is sleep deprived. These altered responses may in turn impact on the longer-term adherence to an exercise programme. The favourable effects of exercise on body mass control and sleep quality in shift workers have not been confirmed. Similarly, recent reports of relationships between sleep duration and obesity have not been examined in a shift work context. There is no evidence that exercise can mediate certain circadian rhythm characteristics (e.g. amplitude or timing) for improved tolerance to shift work. Total energy intake and meal composition do not seem to be affected by participation in shift work. Meal frequency is generally reduced but snacking is increased on the night shift. Unavailability of preferred foods in the workplace, a lack of time, and a reduced desire to eat at night explain these findings. 'Normal' eating habits with the family are also disrupted. The metabolic responses to food are also altered by shift work-mediated disruptions to sleep and circadian rhythms. Whether any interactions on human metabolism exist between timing or content of food intake and physical activity during shift work is not known at present. There are very few randomized controlled studies on the efficacy of physical activity or dietary interventions during shift work. Some favourable effects of such interventions on fatigue levels at work have been reported, but biological and behavioural outcomes relevant to long-term health and energy balance have not been studied adequately. In addition, recruitment and retention of research participants for randomized controlled trials of physical activity or dietary interventions have been very difficult. We present a model of the various behavioural and biological factors relevant to exercise and energy balance during shift work as a framework for future research.

The sleep of commercial vehicle drivers under the 2003 hours-of-service regulations

Previous research has found that commercial drivers get an average of 5.18 h of sleep per night. The revised hours-of-service (HOS) regulations (in the United States) are in place to provide drivers with more opportunities to get sleep. However, are drivers really getting more sleep under these new regulations? Also, is there a relationship between sleep quantity and involvement in critical incident (crashes, near-crashes, or crash-relevant conflicts)? Data from 73 truck drivers, collected during a naturalistic driving study after the implementation of the 2003 HOS regulations, were analyzed to determine overall sleep quantity (using actigraphy), along with sleep quantity prior to being involved in a critical incident. Sixty-two drivers had at least seven consecutive days (Monday through Sunday) of reliable actigraphy data; mean sleep quantity per 24-h period (midnight centered using the Cole-Kripke algorithm) for these drivers was 6.28 h (S.D.=1.42 h). Fifty-eight critical incidents were recorded in the 10th and 11th driving hours. Analysis results indicated that drivers received significantly less sleep in the period prior to a critical incident as compared to their mean overall sleep quantity. The results of this study indicate drivers may be getting more sleep under the revised 2003 HOS regulations as compared to the old regulations. In addition, significantly less sleep in the 24-h period prior to involvement in a critical incident suggests driver fatigue may have been a potential contributing factor in these critical incidents.

Function-centered rehabilitation increases work days in patients with nonacute nonspecific low back pain: 1-year results from a randomized controlled trial

OBJECTIVE

To compare the effect of function-centered treatment (FCT) and pain-centered treatment (PCT) on the number of work days, permanent disability, and the unemployment rate.

DESIGN

Randomized controlled trial.

SETTING

Inpatient rehabilitation center.

PARTICIPANTS

Patients (N=174; 79% male; mean age, 42 y) with previous sick leave of 6 weeks or more.

INTERVENTIONS

FCT (4 h/d for 3 wk) emphasized activity despite pain by using work simulation, strength, endurance, and cardiovascular training. PCT (2.5h/d for 3 wk) emphasized pain reduction and included passive and active mobilization, stretching, strength training, and a 4-hour mini back school with education and exercise. Analysis was by intention to treat.

MAIN OUTCOME MEASURES

Work days, return to work, rate of patients receiving financial compensation for permanent disability, and unemployment rate. Effect sizes (Cohen d) were defined as small (0.2-0.5), moderate (0.5-0.8), and large (>0.8).

RESULTS

After 1 year, the FCT group had significantly more work days (mean, 118; median, 39.5; interquartile range [IQR], 0-198) than the PCT group (mean, 74; median, 0; IQR, 0-160; Mann-Whitney U test, P=.011). The odds ratio of returning to work in the FCT group relative to the PCT group was 2.1 (95% confidence interval, 1.1-3.9). The differences in unemployment rates and in the numbers of patients receiving compensation for permanent disability were not significant.

CONCLUSIONS

FCT is more effective than PCT for increasing work days.

Strategies for coping with shift work

Shift work is a requirement of nursing and essential to provide patients with optimum levels of continuous care. However, working shift patterns can have deleterious effects on the health of nursing staff and patient safety. Adverse effects can be physical and/or psychological. This article focuses on some of the consequences of a disrupted circadian rhythm, provides advice on coping with shift work, in particular night-time shifts, and offers some practical recommendations for practice.

Rapid counterclockwise shift rotation in air traffic control: effects on sleep and night work

INTRODUCTION

In Air Traffic Control, counterclockwise rapidly rotating shift schedules are often employed but may result in significant sleep loss. This has potential consequences for performance, particularly if a night shift is worked. As part of a large-scale field study, the pattern of sleep across a 4-d counterclockwise, rapidly rotating schedule (afternoon, day, morning, night shift) was documented and relationships between prior sleep and performance during the night shift were investigated.

METHODS

There were 28 controllers who completed 4 periods of data collection which included 2 d before and 2 d after a 4-d shift cycle. Sleep was recorded using an actigraph and sleep diary, and performance on each night shift was measured three times using the Psychomotor Vigilance Task.

RESULTS

Across the work week, sleep duration decreased largely due to earlier rise times associated with shift start times moving backward. In the short turn-around between the morning and night shift, 90% of controllers slept for an average of 2.2 h. Improved performance on the night shift was related only to longer periods of sleep the night prior.

DISCUSSION

This study demonstrates that a 4-d counterclockwise, rapidly rotating schedule results in a progressive reduction in sleep and consequently the rapid accumulation of a sleep debt. To help maintain their performance on the night shift, it is recommended that controllers attempt to obtain at least 6 h sleep the night before a night shift. It is also recommended that ATC providers educate their workforce about this issue.

Tolerance of shift work

This study aimed to explore criteria for shift work tolerance and to investigate the relationships between personality traits and states and shift work tolerance. Eighty-nine policemen and police women completed a questionnaire, once during consecutive night shifts and again during rotating shifts, and their responses were used to assess anxiety, emotional control, positive and negative affect, health complaints, sleep quality, difficulties in social and domestic life, and perceptions about shift work. Both the criteria for tolerance and the relationship between tolerance and personality varied according to shift type. Night shift tolerance involved four factors--somatic health, flexibility, sleep and sleep need--while rotating shift tolerance involved three factors--somatic health, flexibility and fatigue. Tolerance of shift work was associated with anxiety, repressive emotional style and mood. During night shifts, anxiety was the most influential personality factor for the somatic health and sleep dimensions of shift tolerance. During rotating shifts, positive and negative moods, rather than trait personality factors, were important predictors of the somatic health and fatigue shift tolerance dimensions. These results suggest a mechanism for more effective matching of workers to suitable shift schedules.

Impact of nap length, nap timing and sleep quality on sustaining early morning performance

The study examined how nap length, nap timing and sleep quality affect early morning performance (6:00 to 8:00). Twelve students participated in a simulated nightshift schedule (22:00 to 8:00) where the length and timing of nocturnal naps were manipulated (0:00-1:00, 0:00-2:00, 4:00-5:00 and 4:00-6:00). A performance test battery was administered consisting of a psychomotor vigilance test, a logical reasoning test, and a visual analogue scale for subjective fatigue and sleepiness. The results showed that a 120-min nap sustained early morning performance better than a 60-min nap. Taking a nap earlier or later did not affect the neurobehavioral performance tests, although participants slept more efficiently during naps later in the night shift. A negative effect of a nocturnal nap during the night shift on subsequent daytime and nocturnal sleep was not observed in the sleep architecture. It still remains unclear whether slow wave sleep plays an important role in sustaining early morning performance. In terms of work safety and sleep health, the results suggest that a longer and later nap is beneficial during night shifts.