How to schedule night shift work in order to reduce health and safety risks

Objectives This discussion paper aims to provide scientifically based recommendations on night shift schedules, including consecutive shifts, shift intervals and duration of shifts, which may reduce health and safety risks. Short-term physiological effects in terms of circadian disruption, inadequate sleep duration and quality, and fatigue were considered as possible links between night shift work and selected health and safety risks, namely, cancer, cardio-metabolic disease, injuries, and pregnancy-related outcomes. Method In early 2020, 15 experienced shift work researchers participated in a workshop where they identified relevant scientific literature within their main research area. Results Knowledge gaps and possible recommendations were discussed based on the current evidence. The consensus was that schedules which reduce circadian disruption may reduce cancer risk, particularly for breast cancer, and schedules that optimize sleep and reduce fatigue may reduce the occurrence of injuries. This is generally achieved with fewer consecutive night shifts, sufficient shift intervals, and shorter night shift duration. Conclusions Based on the limited, existing literature, we recommend that in order to reduce the risk of injuries and possibly breast cancer, night shift schedules have: (i) ≤3 consecutive night shifts; (ii) shift intervals of ≥11 hours; and (iii) ≤9 hours shift duration. In special cases - eg, oil rigs and other isolated workplaces with better possibilities to adapt to daytime sleep - additional or other recommendations may apply. Finally, to reduce risk of miscarriage, pregnant women should not work more than one night shift in a week.

Effect of continuous positive airway pressure on symptoms of anxiety and depression in patients with obstructive sleep apnea

Purpose

The objective was to assess the effect of continuous positive airway pressure (CPAP) on symptoms of anxiety and depression in patients with obstructive sleep apnea (OSA). We hypothesized a decrease in symptoms at follow-up, but that improvement relied on CPAP adherence.

Methods

The sample comprised 468 patients (mean age 55.5 years (SD = 12.0), 72% men) with OSA who received CPAP at a Norwegian hospital. OSA was diagnosed according to standard respiratory polygraphy. Mean baseline respiratory event index (REI) was 28.4 (SD = 20.6). Symptoms of anxiety and depression were assessed prior to CPAP treatment and at follow-up after a median of 20 weeks, range 6–52 weeks, with the Hospital Anxiety and Depression Scale (HADS). Patients were classified as CPAP adherent (≥ 4 h per night) or non-adherent (< 4 h per night).

Results

There was a significant decrease in anxiety scores from baseline (mean = 5.16, SD = 3.94) to follow-up (mean = 4.76, SD = 3.81), p < 0.001. Similarly, depression scores decreased from baseline (mean = 4.31, SD = 3.66) to follow-up (mean = 3.89, SD = 3.69), p < 0.001. Cohen’s d (0.19 and 0.18, respectively) indicated small effect sizes. The reduction in anxiety scores did not depend on CPAP adherence (no interaction effect F(1, 466) = 0.422, p = 0.516), whereas the reduction in depression scores were seen only in the CPAP adherent group (interaction effect F(1, 466) = 7.738, p = 0.006).

Conclusions

We found a decrease in symptoms of anxiety and depression from baseline to follow-up of CPAP treatment. The improvement in symptoms of depression was depending on CPAP adherence. This underlines the importance of adherence for optimal effect of CPAP treatment.

The effects of bright light treatment on subjective and objective sleepiness during three consecutive night shifts among hospital nurses - a counter-balanced placebo-controlled crossover study

Objectives The objective was to investigate effects of timed bright light treatment on subjective and objective measures of sleepiness during three consecutive night shifts among hospital nurses. Methods Thirty-five nurses were exposed to bright light (10,000 lux) and red dim light (100 lux) during three consecutive night shifts in a counter-balanced crossover trial lasting nine days, which included three days before and three days after the three night shifts. Light exposure for 30 minutes was scheduled between 02:00-03:00 hours on night 1, and thereafter delayed by one hour per night in order to delay the circadian rhythm. Subjective sleepiness was measured daily (heavy eyelids, reduced performance) and every second hour while awake (Karolinska Sleepiness Scale, KSS). Objective sleepiness (Psychomotor Vigilance Task, PVT) was measured at 05:00 hours during each night shift. Beyond nocturnal light exposure on the night shifts, no behavioral restrictions or recommendations were given at or off work. Results Bright light treatment significantly reduced heavy eyelids during night shifts. However, results on KSS and PVT were unaffected by bright light. There were no differences in subjective sleepiness during the three days following the night shifts. Conclusions This bright light treatment protocol did not convincingly reduce sleepiness among nurses during three consecutive night shifts. Nor did bright light impede the readaptation back to a day-oriented rhythm following the night shift period. Too few consecutive night shifts, inappropriate timing of light, and possible use of other countermeasures are among the explanations for the limited effects of bright light in the present study.

The Association Between Shift Work and Immunological Biomarkers in Nurses

Objectives: Shift work is associated with several negative health effects. The underlying pathophysiological mechanisms are unclear, but low-grade inflammation has been suggested to play a role. This project aimed to determine whether levels of immunological biomarkers differ depending on work schedule, self-reported sleep duration, self-reported sleep quality, and presence of shift work disorder (study 1). Furthermore, we aimed to determine whether these biomarkers differ after a night of sleep vs. at the end of a night or a day shift (study 2).

Methods: In study 1, 390 nurses provided blood samples after a night of sleep with the dried blood spot method. In study 2, a subset of 55 nurses also provided blood samples after a day shift and after a night shift. The following biomarkers were measured: interleukin-1alpha, interleukin-1beta, interleukin-4, interleukin-6, interleukin-8, interleukin-10, interleukin-13, monocyte chemoattractant protein-1, interferon-gamma, and tumor necrosis factor-alpha. Multiple linear regressions with adjustment for age, sex and body mass index (study 1) and ANOVAs with repeated measures (study 2) were conducted.

Results: In study 1, neither work schedule, number of night shifts, number of quick returns (<11 h between consecutive shifts), sleep duration, poor sleep quality, nor shift work disorder were systematically associated with most of these biomarkers. Compared with day only work, day-evening work was associated with higher levels of IL-1alpha and IL-13, quick returns were associated with higher levels of IL-1beta and MCP-1, short sleep duration (<6 h) was associated with lower levels of IL-1beta and higher levels of TNF-alpha, and long sleep duration (8+ h) was associated with higher levels of IL-13. In study 2, IL-1beta levels were higher (large effect size) both after a day shift (14% increase) and a night shift (75% increase) compared with levels after a night of sleep. Similarly, TNF-alpha levels were higher (moderate-large effect size) after a day shift (50% increase) compared to after a night of sleep. In contrast, MCP-1 levels were lower (large effect size) both after a day shift (22% decrease) and a night shift (12% decrease) compared with after a night of sleep.

Conclusions: We found some indications that shift work influenced immunological biomarkers. The results should be interpreted with caution due to limitations, e.g., related to the sampling procedure and to low levels of biomarkers in the blood samples.

Pain complaints after consecutive nights and quick returns in Norwegian nurses working three-shift rotation: an observational study

OBJECTIVES

To determine whether nurses working consecutive night shifts, or short transitions between shifts (quick returns (QRs)), yielded higher risk for pain complaints when compared with regular morning shifts. Sleep duration was tested as a potential mediator.

DESIGN

Observational diary study.

SETTING

Random hospitals.

PARTICIPANTS

Nurses with three-shift rotation (morning, evening and night), n=679, 22-63 years old.

OUTCOMES MEASURES

Daily ratings of working hours, sleep and subjective pain complaints in six anatomical regions (head, neck/shoulder/upper back, upper extremity, low back, lower extremity and abdomen) for 28 days. In addition, we assessed demographics, habitual sleep and pain complaints, work and lifestyle factors. It was tested (1) whether the risk for pain complaints was higher after workday 3 versus after workday 2, and whether the difference was larger for consecutive night shifts versus consecutive morning shifts, and (2) whether the risk for pain complaints was higher after QRs versus after two morning shifts. Risk for pain complaints refers to combined increased risk for any pain and risk for increased intensity.

RESULTS

Adjusted analyses showed no shift type by workday interaction for pain complaints in the neck/shoulder/upper back, upper extremities, low back, lower extremities or abdomen. For headache, a strong trend indicated that the risk was higher on workday 3 compared with workday 2 for night shifts (OR 1.13, 95% CI 0.99 to 1.28). The risk was lowered if sleep duration was taken into account (OR 0.37, 95% CI 0.17 to 0.81). No conclusive support was found for the risk for pain complaints being higher after QRs, compared with after morning shifts.

CONCLUSIONS

For five of six pain complaints, the hypotheses were not supported by the current data. For headache, we found potential support for a sleep-relieving effect on headache after working several nights in a row. Pain complaints were not instigated or exacerbated by an evening-to-morning transition between shifts.

Longitudinal Relationships between Perceived Social Support and Symptom Outcomes: Findings from a sample of Adult Survivors of Childhood Sexual Abuse

INTRODUCTION

Cross-sectional studies have consistently reported an inverse association between perceived social support and the severity of mental health symptoms among adult survivors of childhood sexual abuse (CSA). However, there is a lack of longitudinal studies investigating the bidirectional association between social support and the severity of symptoms among adult CSA-survivors, as well as the role of relational problems in predicting perceived social support and symptom levels over time. The present study addressed these questions in a sample of primarily female CSA-survivors.

METHODS

In a three-wave, four-year longitudinal study of 506 CSA-survivors (94.9% women, 5.1% men) recruited from support centers for sexual abuse survivors in Norway, we used cross-lagged panel structural equation modeling to examine the directionality of the longitudinal associations between perceived social support and symptoms of posttraumatic stress, anxiety, depression and insomnia.

RESULTS

Cross-lagged panel analyses revealed significant weak reciprocal associations between perceived social support and depression, posttraumatic stress symptoms and anxiety symptoms, but not with insomnia symptoms. The observed effects were partly overlapping and partly inconsistent across the different symptom domains. Relational problems predicted social support cross-sectionally and longitudinally, whereas only cross-sectional associations were found between the relational problems variable and mental health symptoms. Theoretical and clinical implications of the findings are discussed, alongside methodological limitations of the study.

Subjective and objective sleep among air ambulance personnel

The present study aimed to investigate the effects of shift work on sleep among pilots and Helicopter Emergency Medical Service crew members (HCM) in the Norwegian Air Ambulance. Sleep was assessed by diaries and actigraphy during a workweek (24 h duty for 7 consecutive days) in the winter season and a workweek during the summer season in pilots and HCM (N = 50). Additionally, differences in sleep were studied between the week before work, the workweek, and the week after work in both seasons. Results indicated that bedtime was later (p <.001) and time spent in bed (p <.05) was shorter during the summer, compared to the winter, season. The workers delayed the sleep period in the workweek, compared to the week before (winter: p <.001, summer: p <.001) and the week after (winter: p <.05-.001, summer: p <.001). They spent more time in bed during the workweek, compared to the week before (winter: p <.001, summer: p <.01) and after (winter: p <.001, summer: p =.37). Further, the workers had longer wake after sleep onset during the workweek, compared to the week before (winter: p <.001, summer: p <.01) and the week after (winter: p <.01, summer: p <.01). Finally, the workers had lower sleep efficiency during the workweek recorded by actigraphy compared to the week before (winter: p <.01, summer: p <.001) and the week after (winter: p <.01, summer: p <.001). According to the sleep diaries the total sleep time was 7:17 h in the winter and 7:03 h in the summer season. Overall, the sleep was somewhat affected during the workweek, with delayed sleep period, longer wake after sleep onset, and lower sleep efficiency compared to when off work. However, the workers spent more time in bed during the workweek compared to the weeks off, and they obtained over 7 h of sleep in both workweeks. Our findings suggest that the pilots and the HCM sleep well during the workweek, although it affected their sleep to some extent.

Blue-Enriched White Light Improves Performance but Not Subjective Alertness and Circadian Adaptation During Three Consecutive Simulated Night Shifts

Use of blue-enriched light has received increasing interest regarding its activating and performance sustaining effects. However, studies assessing effects of such light during night work are few, and novel strategies for lighting using light emitting diode (LED) technology need to be researched. In a counterbalanced crossover design, we investigated the effects of a standard polychromatic blue-enriched white light (7000 K; ∼200 lx) compared to a warm white light (2500 K), of similar photon density (∼1.6 × 1014 photons/cm2/s), during three consecutive simulated night shifts. A total of 30 healthy participants [10 males, mean age 23.3 (SD = 2.9) years] were included in the study. Dependent variables comprised subjective alertness using the Karolinska Sleepiness Scale, a psychomotor vigilance task (PVT) and a digit symbol substitution test (DSST), all administered at five time points throughout each night shift. We also assessed dim-light melatonin onset (DLMO) before and after the night shifts, as well as participants' opinion of the light conditions. Subjective alertness and performance on the PVT and DSST deteriorated during the night shifts, but 7000 K light was more beneficial for performance, mainly in terms of fewer errors on the PVT, at the end of the first- and second- night shift, compared to 2500 K light. Blue-enriched light only had a minor impact on PVT response times (RTs), as only the fastest 10% of the RTs were significantly improved in 7000 K compared to 2500 K light. In both 7000 and 2500 K light, the DLMO was delayed in those participants with valid assessment of this parameter [n = 20 (69.0%) in 7000 K light, n = 22 (78.6%) in 2500 K light], with a mean of 2:34 (SE = 0:14) and 2:12 (SE = 0:14) hours, respectively, which was not significantly different between the light conditions. Both light conditions were positively rated, although participants found 7000 K to be more suitable for work yet evaluated 2500 K light as more pleasant. The data indicate minor, but beneficial, effects of 7000 K light compared to 2500 K light on performance during night work. Circadian adaptation did not differ significantly between light conditions, though caution should be taken when interpreting these findings due to missing data. Field studies are needed to investigate similar light interventions in real-life settings, to develop recommendations regarding illumination for night workers. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03203538.

A longitudinal study on the association between quick returns and occupational accidents

Objective This study aimed to investigate how change in the number of quick returns [(QR) <11 hours between consecutive shifts] longitudinally is associated with risk of occupational accidents among nurses. Methods Two-year follow-up data from 1692 nurses participating in the Survey of Shiftwork, Sleep and Health among Norwegian nurses (SUSSH) (mean age 40.2, standard deviation 8.3 years, 91% female) were used. Negative binomial regression analyses were conducted to investigate the association between changes in the number of QR after two years and occupational accidents, controlling for demographics, work factors, and occupational accidents at baseline. Results An increase from having no or a moderate number of QR (1-34 per year) from baseline to the two-year follow-up assessment was associated with an increased risk of occupational accidents, compared to experiencing no change in the number of QR. Those with a moderate number of QR at baseline who experienced an increase after two years had an increased risk of causing harm to patients/others [incident rate ratio (IRR) 8.49, 95% confidence interval (CI) 2.79-25.87] and equipment at work (IRR 2.89, 95% CI 1.13-7.42). Those who had many QR (>34 per year) at baseline but experienced a reduction after two years had a reduced risk of causing harm to themselves (IRR 0.35, 95% CI 0.16-0.73) and patients/others (IRR 0.27, 95% CI 0.12-0.59). Conclusion A fairly consistent pattern was demonstrated in which changes in the number of QR over the two-year follow-up period was associated with a corresponding change in the risk of occupational accidents.

Doxazosin for the treatment of nightmare disorder: A diary-based case study

The α₁-adrenergic antagonist prazosin has showed good effect against posttraumatic stress disorder–related nightmares in several randomized controlled trials. The α₁-adrenergic antagonist doxazosin, which has a longer half-live than prazosin, has received far less attention in the treatment of such nightmares. Here, we report a case of a patient suffering from severe nightmares following an erroneous medical administration of adrenaline (causing severe physiological hyper-activation) who was treated with doxazosin. Over a period of 280 days, the patient kept a nightmare diary and took 0, 4, or 8 mg doxazosin. The analyses showed that 8 mg doxazosin (55.2% nightmare-free nights) worked better (odds ratio = 28.2; 95% confidence interval = 3.7–213.9) compared to nights without doxazosin (4.3% nightmare-free nights). Except dizziness, which was not regarded as particularly bothersome by the patient, doxazosin was well tolerated. It is concluded that doxazosin may be indicated as a pharmacological treatment for patients suffering from posttraumatic stress disorder–related nightmares.

Accumulated Long-Term Exposure to Workplace Bullying Impairs Psychological Hardiness: A Five-Year Longitudinal Study among Nurses

Personality has been hypothesized to act as antecedent as well as an outcome of workplace bullying. Still, investigations on the longitudinal relationship between bullying and personality are scarce. We investigated the relationship between accumulated exposure to bullying at work and subsequent changes in psychological hardiness. Additionally, we examined whether hardiness predicted subsequent exposure to bullying. The data were based on the Survey of Shiftwork, Sleep, and Health (SUSSH), a cohort study with annual surveys among Norwegian nurses. The participants who completed standardized instruments measuring exposure to bullying behavior at T1 (2008/09) to T4 (2012) and psychological hardiness at T1 (2008/09) and T5 (2012) were included (n = 938). The results showed that accumulated exposure to bullying (sum of exposure from T1-T4) was associated with reduced psychological hardiness at T5, adjusted for age, sex, and hardiness at baseline (β = -0.16, t = -5.70, p < 0.001). Accumulated exposure to bullying behaviors explained 2.3% of the change in hardiness. Less hardy individuals experienced higher levels of subsequent exposure to bullying behaviors, adjusted for age, sex, and bullying at baseline (β = -0.04, t = -2.21 p < 0.05). Long-term accumulated exposure to bullying behaviors seemed to be a stronger predictor for changes in hardiness as compared to hardiness in predicting exposure to bullying.

The Prevalence of Insomnia Subtypes in Relation to Demographic Characteristics, Anxiety, Depression, Alcohol Consumption and Use of Hypnotics

Objective

The aim of the present study was to examine the prevalence of insomnia subtypes in relation to several demographic characteristics, as well as to investigate the prevalence of possible anxiety and depression, alcohol consumption and use of hypnotics within the different insomnia subtypes.

Methods

The present study was based on an extensive web-based survey made publicly available in 2012. The data was downloaded in January 2019, after 113 887 people had responded to parts of, or the entire questionnaire. The 64 503 participants who met the criteria for chronic insomnia disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) comprised the study population. The present study divided insomnia into seven subtypes based on type of sleep difficulty reported; sleep onset insomnia (SOL-insomnia), sleep maintenance insomnia (WASO-insomnia), early morning awakening insomnia (EMA-insomnia) and combinations of these. Data were analyzed with chi-square tests and logistic regression analyses adjusted for sex, age, level of education and marital status.

Results

More than 60% of the study population met the criteria of either SOL-insomnia or a mixed insomnia subtype consisting of SOL-, WASO- and EMA-insomnia (SOL + WASO + EMA-insomnia). The percentage distribution of insomnia subtypes within the demographic characteristics showed that participants with female sex, high age, low level of education and who were divorced, separated or a widow/widower had a higher prevalence of SOL + WASO + EMA-insomnia compared to their respective demographic counterparts. The prevalence of possible anxiety, possible depression and use of hypnotics were higher among participants with SOL + WASO + EMA-insomnia compared to the other insomnia subtypes. The combination of WASO- and EMA-insomnia (WASO + EMA-insomnia) was associated with the most frequent alcohol consumption.

Conclusion

Our findings suggest that there are major differences between the insomnia subtypes, both regarding demographics, but also in terms of how the complaints may affect daily life. Participants with combinations of SOL, WASO and EMA were more likely than participants with the other subtypes to have possible anxiety and possible depression, high alcohol consumption and to use hypnotics.

Role of nocturnal light intensity on adaptation to three consecutive night shifts: a counterbalanced crossover study

OBJECTIVES

To investigate how a standard ceiling mounted light-emitting diode (LED)-based bright light intervention affected alertness and neurobehavioural performance during three consecutive simulated night shifts, and timing of circadian rhythm after the shifts.

METHODS

Twenty seven participants (20 females, 21.4±2.1 years; mean±SD) worked three consecutive night shifts (23:00-07:00) under a full-spectrum (4000 K) bright light (900 lx) and a standard light (90 lx) condition in a counterbalanced crossover design (separated by 4 weeks). Subjective alertness (Karolinska Sleepiness Scale) and neurobehavioural performance (Psychomotor Vigilance Task and Digit Symbol Substitution Test) were assessed five times during each shift. Salivary dim-light melatonin onset (DLMO) was assessed before and after the shifts. The simulated night shifts were conducted in a laboratory while the participants slept at home.

RESULTS

Subjective alertness and neurobehavioural performance deteriorated during the night shifts in both light conditions. However, bright light significantly reduced alertness and performance decrements as compared with standard light. For a subset of the participants, DLMO was delayed by a mean of 3:17±0:23 (mean±SEM) hours after three night shifts in bright light and by 2:06±0:15 hours in standard light, indicating that bright light causes larger phase delay.

CONCLUSION

Bright light improved performance and alertness during simulated night shifts and improved adaptation to night work. Bright light administered by ceiling mounted LED luminaires has the potential to improve adaptation to night work and reduce the risk of accidents and injuries among night workers.

TRIAL REGISTRATION NUMBER

NCT03203538.

New diagnostic criteria for insomnia and the association between insomnia, anxiety and depression

BACKGROUND

The diagnostic criteria for insomnia in the Diagnostic Statistical Manual of Mental Disorders, version 5 (DSM-5), have been changed. The same changes are expected to be made in the International Classification of Diseases, version 11 (ICD-11). In this study, we examine the impact of the changes in the diagnostic criteria for insomnia on the association between insomnia, anxiety and depression.

MATERIAL AND METHOD

The study is based on a questionnaire survey with 68 questions that can be found on the website of the Norwegian Competence Centre for Sleep Disorders. The survey began in 2012, and our data were retrieved in 2016. The survey included validated questionnaires for insomnia, anxiety and depression: the Bergen Insomnia Scale and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

A total of 48 932 participants met the DSM-IV diagnostic criteria for insomnia. Of these, 42 873 (87.6 %) also met the DSM-5 diagnostic criteria for insomnia, while the remaining 6059 (12.4 %) did not satisfy the new criteria. Of those who met the DSM-IV diagnostic criteria for insomnia, 46 704 also responded to the questions on anxiety and depression. The prevalence of possible anxiety (HADS-A ≥ 8) among those who met the new criteria was 25 708 (62.9 %), while the prevalence of possible depression (HADS-D ≥ 8) was 15 591 (38.1 %). Among the participants who did not satisfy the new criteria, the prevalence was significantly lower: possible anxiety 2791 (48.1 %) and possible depression 1763 (30.4 %) (both p < 0.001).

INTERPRETATION

The study indicates that the new diagnostic criteria for insomnia strengthened the association between insomnia, anxiety and depression. This may mean that with the new diagnostic criteria, more patients with insomnia will have comorbid mental disorders.

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.

Habitual Sleep, Social Jetlag, and Reaction Time in Youths With Delayed Sleep-Wake Phase Disorder. A Case-Control Study

The aim of this study was to explore habitual sleep, social jetlag, and day-to-day variations in sleep (measured as intra-individual standard deviation, ISD) in youths with delayed sleep-wake phase disorder (DSWPD), compared to healthy controls. We also aimed to investigate time of day effects in performance. The sample comprised 40 youths with DSWPD (70.0% female, mean age 20.7 ± 3.1 years) and 21 healthy controls (71.4% female, mean age 21.2 ± 2.2 years). Subjective and objective sleep were measured over 7 days on a habitual sleep schedule by sleep diary and actigraphy recordings. Performance was tested twice with a 12-h interval (22:00 in the evening and 10:00 the following morning) using a simple, 10-min sustained reaction time test (RTT). The results showed later sleep timing in the DSWPD group compared to the controls, but sleep duration, social jetlag, and ISD in sleep timing did not differ between the groups. Still, participants with DSWPD reported longer sleep onset latency (SOL) and poorer sleep efficiency (SE), sleep quality, and daytime functioning, as well as larger ISD in SOL, sleep duration, and SE. The groups had similar evening performances on the RTT, but the DSWPD group performed poorer (slower with more lapses) than the controls in the morning. The poor morning performance in the DSWPD group likely reflects the combined impact of sleep curtailment and circadian variations in performance (synchrony effect), and importantly illustrates the challenges individuals with DSWPD face when trying to adhere to early morning obligations.

Patient-reported depression treatment and future treatment preferences: an observational study in general practice

BACKGROUND

Depression is prevalent in general practice, but few studies have explored patient-reported depression care.

AIM

To investigate patient-reported treatment received for depression and future treatment preferences among adult patients visiting their GP, and to evaluate the associations with sex, age and educational level.

DESIGN AND SETTING

A cross-sectional survey was conducted in general practices in Norway from 2016 to 2017.

METHODS

Altogether, 2335 consecutive patients (response rate, 89.2%) in the GPs' waiting rooms answered a questionnaire about their received depression treatment and treatment preferences in case of future depression.

RESULTS

The study population (N = 2239) had a mean age of 48.6 ± 17.7 years (range 18-91), 60.1% were women. Of the 770 patients reporting to have received depression treatment, 39.1% were treated exclusively by their GP while 52.5% also were referred to a psychologist/psychiatrist. Older age was positively associated with medication and negatively associated with referrals to psychologist/psychiatrist. People with high education had lower odds for receiving medication (odds ratios [OR], 0.49; 95% confidence intervals [CI]: 0.30-0.80) compared to those with low education. If future depression, 81.6% of the respondents would discuss this with their GP, 60.9% would prefer talking therapy with their GP, 22.5% medication, and 52.9% referral to psychologist or psychiatrist.

CONCLUSION

One-third of the patients attending their GPs had consulted with them at some time concerning depression the case of future depression, most patients preferred talking therapy with the GP. This finding warrants increased research focus on the GP's role in depression care.

Pain complaints are associated with quick returns and insomnia among Norwegian nurses, but do not differ between shift workers and day only workers

PURPOSE

To determine whether common work schedule characteristics among Norwegian nurses were associated with subjective pain complaints.

METHODS

A cross-sectional study in a sample of 1585 nurses, part of the longitudinal questionnaire-based cohort project 'Survey of Shift work, Sleep and Health' (SUSSH). Pain from six regions were assessed: 'headache', 'neck/shoulder/upper back', 'upper extremities', 'lower back', 'lower extremities', and 'abdomen'. Logistic and negative binomial regression (adjusted for age, sex, percentage of full-time equivalent, marital status and children living at home) were conducted where work schedule, number of night shifts last year, number of quick returns (QR) last year (< 11 h between shifts) and insomnia were predictors of localized pain, widespread pain and number of pain sites.

RESULTS

Localized pain, widespread pain and number of pain sites were associated with insomnia (OR 2.06, 95% CI 1.66-2.55, OR 2.14, 95% CI 1.47-3.09, IRR 1.70, 95% CI 1.51-1.91, respectively). Work schedule and number of night shifts worked last year were not associated with any of the three pain measures. Number of QRs worked last year tended to be associated with number of pain sites.

CONCLUSION

The study did not support the hypothesis that non-daytime work schedules are associated with pain complaints. Neither was there support for the hypothesis linking number of night shifts, or the number of QRs, to pain complaints. Future studies should aim to determine the association between QRs and pain in more detail. Pain complaints were associated with insomnia.

Shift Work and Lifestyle Factors: A 6-Year Follow-Up Study Among Nurses

Objectives: To evaluate different work schedules, short rest time between shifts (quick returns), and night shift exposure for their possible adverse effects on different lifestyle factors in a 6-year follow-up study.

Methods: Data stemmed from “The Survey of Shiftwork, Sleep and Health,” a cohort study of Norwegian nurses started in 2008/9. The data analyzed in this sub-cohort of SUSSH were from 2008/9 to 2015 and consisted of 1,371 nurses. The lifestyle factors were: Exercise (≥1 h/week, <1 h/week), caffeine consumption (units/day), smoking (prevalence and cigarettes/day), and alcohol consumption (AUDIT-C score). We divided the nurses into four groups: (1) day workers, (2) night workers, (3) nurses who changed toward, and (4) nurses who changed away from a schedule containing night shifts. Furthermore, average number of yearly night shifts (NN), and average number of quick returns (QR) were calculated. Paired t-tests, McNemar tests, and logistic regression analyses were used in the analyses.

Results: We found a significant increase in caffeine consumption across all work schedule groups and a decline in smoking prevalence for day workers and night workers at follow-up. Analyses did not show any significant differences between groups when analyzing (1) different work schedules, (2) different exposures to QR, (3) different exposures to NN on the respective lifestyle factor trajectories.

Conclusion: We found no significant differences between the different work schedule groups or concerning different exposures to QR or NN when evaluating these lifestyle factor trajectories. This challenges the notion that shift work has an adverse impact on lifestyle factors.