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Dolu İ, Açıkgöz S, Rıza Demirbaş A, Karabulut E. Circadian Rhythms Characteristics of Nurses Providing Direct Patient Care: An Observational Study. Saf Health Work 2024; 15:102-109. [PMID: 38496283 PMCID: PMC10944160 DOI: 10.1016/j.shaw.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 03/19/2024] Open
Abstract
Background In today's modern world, longer working hours, shift work, and working at night have become major causes of the disruption of our natural circadian rhythms. This study aimed to investigate the effects of the type of shift work (rotating vs. fixed day), duty period (on-duty vs. off-duty), and working period within each shift (nighttime vs. daytime) on the circadian rhythm characteristics of nurses who provide direct patient care. Methods This cross-sectional study used a purposive sampling method. Cosinor analysis was applied to analyze the actigraphy data of nurses providing direct patient care for seven consecutive days. The linear mixed effects model was then used to determine any variances between shift type, duty period, and working period within each shift for the nurses. Results The mesor value did not differ according to nurses' shift type, duty period, and working period within each shift. The amplitude was statistically higher in on-duty nurses and in daytime working hours. The acrophase was significantly delayed in nighttime working hours. As well as nurses in rotating shift had experience. Conclusion Our findings revealed that the peak activity of nurses occurs significantly later at night while working and nurses working during nighttime hours may have a weaker or less distinct circadian rhythm. Thus, this study suggests that limits be placed on the number of rotating nighttime shifts for nurses.
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Affiliation(s)
- İlknur Dolu
- Department of Nursing, Faculty of Health Science, 74100 Bartın University, Bartın, Turkey
| | - Serap Açıkgöz
- Department of Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey
| | - Ali Rıza Demirbaş
- Governors State University, Department of Health Administration and Informatics, United States
| | - Erdem Karabulut
- Hacettepe University, Faculty of Medicine, Basic Medical Sciences, Department of Biostatistics, Turkey
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2
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Booker LA, Fitzgerald J, Mills J, Bish M, Spong J, Deacon‐Crouch M, Skinner TC. Sleep and fatigue management strategies: How nurses, midwives and paramedics cope with their shift work schedules-a qualitative study. Nurs Open 2024; 11:e2099. [PMID: 38268269 PMCID: PMC10803889 DOI: 10.1002/nop2.2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024] Open
Abstract
AIMS To understand the benefits and challenges of shift work, and the coping strategies used by nurses, midwives and paramedics to manage the impact of shift work on sleep and fatigue from shift work. DESIGN A single case study with embedded units. METHODS Twenty-seven participants were interviewed exploring their shift work experiences, coping strategies used to improve sleep, and what their recommendations are for improving shift work management. Interviews were completed between November and December 2022. RESULTS Participants enjoyed the lifestyle, flexibility and financial rewards offered by working shift work. However, fatigue and sleep deprivation undermined these benefits, as it impacted their ability to enjoy social and family events. There were also concerns of long-term health consequences of shift work and delivery of care. Changes to rostering practices and sleep and shift work education were common recommendations. CONCLUSION This study provides insights on how healthcare professionals manage sleep and fatigue due to shift work and the inadequate support. There is absence of adequate policies, processes and training at an organizational, academic and personal level on how to best manage sleep and fatigue when working shift work. Future research is needed to explore how to equip healthcare shift workers with the skills to successfully manage their schedules to mitigate the negative impact that poor sleep and fatigue has on the health and safety of themselves and their patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Understanding the specific challenges of shift work and how workers manage their shift work schedules is critical for improving the health and safety of themselves and their patients. This study identified that there is insufficient training regarding sleep and shift work management strategies, potentially leading to occupational health and safety concerns. Further education and training to equip staff with the necessary information, training and guidance to staff on how to reduce fatigue risk is required. PATIENT OR PUBLIC CONTRIBUTION This study involved healthcare shift workers in semi-structured interviews. Data gathered from a previous survey that participants were involved in helped shape the interview topics and the study design.
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Affiliation(s)
- Lauren A. Booker
- School of Psychology & Public HealthLa Trobe UniversityBendigoVictoriaAustralia
- Institute for Breathing and Sleep, Austin HealthMelbourneAustralia
| | - Jarrah Fitzgerald
- Department of Rural Health Sciences, La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
| | - Jane Mills
- Department of Rural Health Sciences, La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
| | - Melanie Bish
- Department of Rural Health Sciences, La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
| | - Jo Spong
- Institute for Breathing and Sleep, Austin HealthMelbourneAustralia
- Department of Rural Health Sciences, La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
| | - Melissa Deacon‐Crouch
- Department of Rural Health Sciences, La Trobe Rural Health SchoolLa Trobe UniversityBendigoVictoriaAustralia
| | - Timothy C. Skinner
- School of Psychology & Public HealthLa Trobe UniversityBendigoVictoriaAustralia
- Department of Psychology, Centre for Health and SocietyUniversity of CopenhagenCopenhagenDenmark
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3
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Zhao Y, Lu X, Wang Y, Cheng Y, He Q, Qin R, Li W, Liu H, Liu Y. Peripheral blood lipid and liver and kidney function test results in long-term night shift nurses: a cross-sectional study in South China. Front Endocrinol (Lausanne) 2023; 14:1237467. [PMID: 37904784 PMCID: PMC10613520 DOI: 10.3389/fendo.2023.1237467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/14/2023] [Indexed: 11/01/2023] Open
Abstract
Purpose This study aimed to elucidate the effects of long-term day and night shifts on liver function and lipid metabolism in a group of nurses. Methods This cross-sectional study in December 2019 was based on a group of nurses. A total of 1,253 physically healthy caregivers were included, including 1231 women and 22 men. A total of 886 nurses had long-term shift work (working in a rotating system for >1 year). The receiver operating characteristic (ROC) curve and logistic regression analyses were used to evaluate factors related to long-term shift work. Results We observed differences in liver and kidney indicators between the non-night and night shift groups. The ROC curve revealed that CHO (AUC: 62.4%), LDLC (AUC: 62%), and GLUO (AUC: 61.5%) were more related to the night shift. Logistic regression analysis showed that night shift work was associated significantly with CREA (log (OR) = -0.02, 95% CI: -0.04 to -0.01), CHO (log (OR) = -0.38, 95% CI: -0.67 to -0.09), and GLUO (log (OR) = -0.35, 95% CI: -0.56 to -0.17). This correlation was observed only for CHO and LDHC (CHO: log (OR) = -0.55, 95% CI: -0.98 to -0.12; LDLC: log (OR) = 0.83, 95% CI: 0.32, 1.4) after age standardization. After using propensity score matching, we did not find evidence to support that the indicators differed between night and non-night shift groups. Conclusion Our study observed an association of long-term night work with abnormal liver and kidney function and dyslipidemia, but the difference was not significant after strict age matching. Although these findings may support interventions for long-term night shift nurses, more detailed studies are needed to confirm.
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Affiliation(s)
- Yang Zhao
- Department of Radiology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xunhao Lu
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yanghua Wang
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yiyi Cheng
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Qiao He
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Rongqi Qin
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Wenrui Li
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Haizhou Liu
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
- Department of Research, Guangxi Cancer Molecular Medicine Engineering Research Center, Nanning, China
| | - Yuanfang Liu
- Department of Traditional Chinese Medicine, Guangxi Medical University Cancer Hospital, Nanning, China
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4
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Hittle BM, Hils J, Fendinger SL, Wong IS. A scoping review of sleep education and training for nurses. Int J Nurs Stud 2023; 142:104468. [PMID: 37080122 PMCID: PMC10180237 DOI: 10.1016/j.ijnurstu.2023.104468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Shift work and resulting sleep impairment among nurses can increase their risk for poor health outcomes, occupational injuries, and errors due to sleep deficiencies. While sleep education and training for nurses has been recommended as part of a larger fatigue risk management system, little is known about training programs designed specifically for nurses. OBJECTIVE Investigate the literature for current sleep education or training programs specifically for shift working nurses, with intent to assess training content, delivery characteristics, and outcome measures. DESIGN A scoping review conducted October 2020 through September 2021. METHODS The bibliographic databases Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, PubMed, and NIOSHTIC-2 were searched using words such as "nurse," "sleep hygiene," "shift work," and "education". Studies were included if they: 1) were original research; 2) discussed sleep education, training, or sleep hygiene interventions; 3) included a study population of nurses engaging in shift work; 4) focused on sleep as a primary study measure; 5) were written in English language; and 6) were published in 2000 or later. RESULTS Search results included 17,237 articles. After duplicates were removed, 14,620 articles were screened. Nine articles were found to meet established criteria. All studies included sleep hygiene content in the training programs, with five studies adding psychological and/or behavior change motivation training to support change in nurse sleep habits. Three studies added specific training for nurses and for managers. Delivery modes included in-person training of various lengths and frequency, mobile phone application with daily engagement, an online self-guided presentation, and daily reading material coupled with audio training. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were the outcome measures most frequently used. Although studies demonstrated improved sleep measures, most were pilot studies testing feasibility. CONCLUSION Although there is a paucity of studies focused on sleep education and training for shift working nurses, we found the inclusion of sleep hygiene content was the only common characteristic of all nine studies. The variability in training content, delivery methods, and outcome measures suggests further research is needed on what constitutes effective sleep education and training for nurses.
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Affiliation(s)
- Beverly M Hittle
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers, for Disease Control and Prevention, 1090 Tusculum Ave, Cincinnati, OH 45226, USA; University of Cincinnati, College of Nursing, 3110 Vine St, Cincinnati, OH 45219, USA.
| | - Janie Hils
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers, for Disease Control and Prevention, 1090 Tusculum Ave, Cincinnati, OH 45226, USA; Oak Ridge Institute for Science and Education, P.O. Box 117, Oak Ridge, TN 37830, USA; Division of Environmental Health Science and Practice, National Center for Environmental, Health, Centers for Disease Control and Prevention. Mailstop S106-5, 4770 Buford Highway, Atlanta, GA 30341, USA.
| | - Sherry L Fendinger
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers, for Disease Control and Prevention, 1090 Tusculum Ave, Cincinnati, OH 45226, USA.
| | - Imelda S Wong
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers, for Disease Control and Prevention, 1090 Tusculum Ave, Cincinnati, OH 45226, USA.
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5
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Cheng H, Liu G, Yang J, Wang Q, Yang H. Shift work disorder, mental health and burnout among nurses: A cross-sectional study. Nurs Open 2023; 10:2611-2620. [PMID: 36539975 PMCID: PMC10006599 DOI: 10.1002/nop2.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/12/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022] Open
Abstract
AIM The aim of the study was to examine the relationships among nurses' shift work disorder, mental health and burnout to inform efforts to alleviate shift work disorder. DESIGN This cross-sectional study was conducted in China using a web-based platform for questionnaire. METHODS The study was comprised of a convenience sample of 1,268 Registered Nurses from 21 public hospitals in mainland China from June 2019-July 2019. Participants completed a web-based survey designed to collect demographic and other self-reported data. An independent sample t test and Pearson correlation were performed to analyse the relationship between shift work disorder, mental health and burnout. RESULTS The vast majority (98.2%) of the participants were women between the ages of 20-59 years. The participants exhibited a higher incidence of mental health problems (58.1%) and burnout (65.5%) and those with shift work disorder exhibited a higher risk of mental health problems and burnout than those who did not have shift work disorder. Our research demonstrated that shift work disorder, combined with other variables, accounted for 40.5% of the variance in mental health (R2 = .405, adjusted R2 = .401, F = 107.214, p < .001) and 36.5% in burnout (R2 = .365, adjusted R2 = .361, F = 90.323, p < .001). Moreover, burnout negatively regulated the relationship between shift work disorder and mental health. CONCLUSION High-risk nurses with shift work disorder were at a much higher risk of mental health problems and burnout.
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Affiliation(s)
- Hui Cheng
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Guangbi Liu
- Department of Nursing, The People's Hospital of Bishan District, Chongqing, China
| | - Junyi Yang
- Department of Nursing, The People's Hospital of Bishan District, Chongqing, China
| | - Qiaohong Wang
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Hui Yang
- Nursing College of Shanxi Medical University, Taiyuan, China
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6
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Sooriyaarachchi P, Jayawardena R, Pavey T, King NA. Shift work and the risk for metabolic syndrome among healthcare workers: A systematic review and meta-analysis. Obes Rev 2022; 23:e13489. [PMID: 35734805 PMCID: PMC9539605 DOI: 10.1111/obr.13489] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Abstract
Shift work, defined as work occurring outside typical daytime working hours, is associated with an increased risk for metabolic syndrome (MetS) due to several biological and environmental changes. The MetS refers to the clustering of several known cardiovascular risk factors, including insulin resistance, obesity, dyslipidemia, and hypertension. This systematic review aims to evaluate the literature on the association between shift work and the risk of MetS in employees of the health sector. A systematic search was conducted in PubMed, Web of Science, and Scopus databases using appropriate keywords for studies published before September 1, 2021. Eligible studies were those that compared the prevalence of MetS between day and shift healthcare workers; had a cross-sectional, case-control, or cohort study design; provided sufficient data for calculating odds ratios or relative risks with 95% confidence intervals; and articles in English. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality analysis. Risk for MetS and related measures of effect size were retrieved from studies for meta-analysis. Twelve studies met the criteria for inclusion in the review and meta-analysis. Sample sizes ranged from 42 to 738, and the age range of subjects was between 18 and 65 years. Ten studies demonstrated high methodological quality, while two studies were of average quality. Ten out of 12 studies in the review demonstrated a higher risk in shift workers for developing MetS than day workers. The pooled OR of MetS in shift workers based on 12 studies was 2.17 (95% CI = 1.31-3.60, P = 0.003; I2 = 82%, P < 0.001). Shift workers exhibited more than a twofold increase in the chance of developing MetS in comparison with day workers.
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Affiliation(s)
- Piumika Sooriyaarachchi
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Health and Wellness Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ranil Jayawardena
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Toby Pavey
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Neil A King
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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7
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Adane A, Getnet M, Belete M, Yeshaw Y, Dagnew B. Shift-work sleep disorder among health care workers at public hospitals, the case of Sidama national regional state, Ethiopia: A multicenter cross-sectional study. PLoS One 2022; 17:e0270480. [PMID: 35802698 PMCID: PMC9269933 DOI: 10.1371/journal.pone.0270480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/12/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Shift-work disrupts circadian rhythm, resulting in disturbed sleep time and excessive sleepiness during the work shift. Little is known about shift-work sleep disorder among health care workers in Ethiopia. This study examined the magnitude and associated factors of shift-work sleep disorder among health care workers in Public Hospitals in Sidama National Regional State, Southern Ethiopia. Methods An institution-based cross-sectional study was carried out on 398 health care workers selected using a systematic random sampling technique. A self-administered structured questionnaire consisting of insomnia, sleepiness scales and international classification of sleep disorder criteria items was employed. Epi data version 4.6 and Stata 14 were used for data entry and statistical analysis respectively. Binary logistic regression was fitted to determine associated factors and decision for the statistical significance was made at p<0.05 in the multivariable binary logistic regression. Results Three hundred and ninety-eight health care workers (female = 53%) were included in the analysis with a response rate of 94.8%. The prevalence of shift-work sleep disorder was 33.67% (95% CI: 29.17%-38.45%). Being married (AOR = 1.88 (1.01–3.28)), three-shift (AOR = 1.078 (1.00–3.16)), ≥11 night shifts per month (AOR = 2.44 (1.36–4.38)), missing nap (AOR = 1.85 (1.04–3.30)), daily sleep time < 7hours (AOR = 1.88 (1.05–3.38)), khat chewing (AOR = 2.98 (1.27–8.09)), alcohol drinking (AOR = 2.6(1.45–4.92)), and cigarette smoking (AOR = 3.32 (1.35–8.14)) were significantly associated with shift-work sleep disorder. Conclusion This study showed a high prevalence of shift-work sleep disorder. Two shift schedule, napping, and reduction of substance use might reduce shift-work sleep disorder.
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Affiliation(s)
- Adugnaw Adane
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Belete
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yigizie Yeshaw
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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d’Ettorre G, Pellicani V, Hasa A, Lo Cicero E, Perrucci M, Perez MC, La Torre G. Assessing and managing the rotating shiftwork risk in 24-hours hospital wards: An empirical multicenter study. Work 2022; 71:615-624. [DOI: 10.3233/wor-205169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: A growing body of literature has showed the need to minimize the impact of rotating shiftwork (RS) on health of shift-healthcare workers (HCWs). OBJECTIVE: The aims of the study were: 1) assessing the occupational risk associated with RS program in HCWs employed in 24 hours hospital wards 2) testing the feasibility of the questionnaire used. METHODS: The Rotating Shiftwork Questionnaire (RSQ) was implemented to assess the RS risk (RSR); the analysis was addressed to: 1) Sentinel events (SE) and 2) Risk factors (RF). The RSQ was administered to the specialist nursing coordinators in eighteen hospitals in Italy with the aim to evaluate the RSR index among nurses in 24 hours hospital wards. RESULTS: Eighteen structures participated in the multicenter study, of which 12 (66.7%) were public. Concerning the Rotating Shiftwork Risk index, there are the 78.8% of observations in the intermediate zone, with RSR scores ranging from 14.1 and 16 and in the high score area (RSR > 26) in which there are 4 observations equal to the 21.2% of the total. The multivariate analysis showed that the only significant variable associated with RF score was the macro-area (for Northern regionsbeta = –0.651; p = 0.008). CONCLUSIONS: RSQ has been shown a feasible and applicable tool to analyze the RSR in healthcare sector through the detection of quantitative data involving indicators of the risk. The questionnaire allowed to identify improvement actions targeted at minimizing specific critical issues through strategic interventions focused on organizational environment.
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Affiliation(s)
- Gabriele d’Ettorre
- Department of Occupational Medicine, Local Health Authority of Lecce, Lecce, Italy
| | - Vincenza Pellicani
- Department of Mental Health, Local Health Authority of Lecce, Lecce, Italy
| | - Ardi Hasa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Edoardo Lo Cicero
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Martina Perrucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Camila Perez
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Stenger S, Grasshoff H, Hundt JE, Lange T. Potential effects of shift work on skin autoimmune diseases. Front Immunol 2022; 13:1000951. [PMID: 36865523 PMCID: PMC9972893 DOI: 10.3389/fimmu.2022.1000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 02/16/2023] Open
Abstract
Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.
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Affiliation(s)
- Sarah Stenger
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
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10
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Feng HL, Qi XX, Xia CL, Xiao SQ, Fan L. Association between night shift and sleep quality and health among Chinese nurses: A cross-sectional study. J Nurs Manag 2021; 29:2123-2131. [PMID: 33908108 DOI: 10.1111/jonm.13351] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022]
Abstract
AIM To explore the sleep quality among Chinese nurses and identify the association between night shift and sleep quality and health. BACKGROUND Chinese nurses have many night shifts; the effect of it regarding nurses' sleep quality and health is still not being explored. METHODS This was a cross-sectional study. There were 3,206 nurse participants. The participants self-completed a sociodemographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) and the Cornell Medical Index (CMI). RESULTS Night shift nurses demonstrated relatively worse sleep quality (55.1%) and more health problems (20.7%). Night shift work was significantly associated with poor sleep quality (β = 0.96, confidence interval [CI] = 0.67-1.26) and poor health (β = 2.01, CI = 0.15-3.88). Except for sleep medication (β = 0.02, CI = -0.01, 0.05) and psychological health (β = 0.38, CI = -0.27, 1.03), night shift work was significantly associated with other PSQI domains and physical health. CONCLUSION Night shift work was a risk factor for nurses' sleep quality and health. Night shift nurses have more sleep disorders and physical health problems. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers should pay attention to the impact of shift work on nurses' sleep quality and health and reform the rotating shift work system to improve nurses' occupational health.
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Affiliation(s)
- Hui-Ling Feng
- School of Nursing, China Medical University, Shenyang, China.,School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Xiang-Xiu Qi
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chun-Ling Xia
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shi-Qi Xiao
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Fan
- School of Nursing, China Medical University, Shenyang, China.,Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
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