The relationship between shift-work, sleep, and mental health among paramedics in Australia

Assessing the relationship between mental workload and work fatigue among oil and gas workers in PT X, Jambi Province, Indonesia: PLS-SEM analysis

Occupational fatigue among oil and gas workers can have perilous consequences related to safety, health, economy, and wellbeing. This makes it necessary to discover major factors related to fatigue and implement appropriate prevention programs and education. Therefore, this study aimed to investigate the relationship between mental workload, sleep quality, and occupational fatigue in oil and gas office workers in Jambi Province, Indonesia. Mental workload, sleep quality, and occupational fatigue were measured using the NASA-TLX, PSQI, and the Indonesian Questionnaire Measuring Feelings of Work Fatigue (KAUPK2), respectively. A PLS-SEM approach was used to determine the association between mental workload, sleep quality, and occupational fatigue. Out of the 116 oil and gas workers in Jambi Province who participated in this study, 58.6% were male, 54.3% had Senior High School or less, 85.3% were not smoking, and 88.8% were married, working experience from 0.17 to 34 years. The mean of body height, weight, and mass index were 165.35 cm, 64.65 kg, and 23.64 respectively. The PLS-SEM model illustrated that the direct effect of mental workload on occupational fatigue was not significant. Meanwhile, the mental workload had a significant effect on sleep quality, which significantly affected fatigue. This indicated that the effect of workload on fatigue was fully mediated by sleep quality. The impact of good sleep on an employee's ability to recover from increased mental workload was substantial. According to this study, introducing mental workload coping methods, routine measurement, and sleep hygiene programs among oil and gas workers can reduce occupational fatigue.

Effects of job demands, job resources, personal resources on night-shift alertness of ICU shift nurses: a cross‑sectional survey study based on the job demands-resources model

BACKGROUND

A positive work environment can enhance nursing safety and patient satisfaction while alleviating nurse stress. Conversely, a poor work environment can harm nurses' physical and mental health and compromise the quality of care, particularly in the high-intensity and shift-based setting of the ICU.

OBJECTIVES

Based on the Job demands-resources (JD-R) model, this study examined the effects of job demands and job resources in the work environment, as well as personal resources, on the night-shift alertness of ICU shift nurses.

METHODS

This cross-sectional correlational exploratory study, conducted from July to September 2022, recruited 291 ICU shift nurses from a hospital in Beijing, China. The Copenhagen Psychosocial Questionnaire (COPSOQ), the Self-resilience scale, the General Self-Efficacy Scale (GSES), and the Psychomotor Vigilance Task (PVT) were used to subjectively and objectively measure the job demands, job resources, personal resources, and night-shift alertness. SPSS 26.0 and Mplus 8.3 were used to analyze the data and construct the structural equation model.

RESULTS

The night-shift reaction time was 251.0 ms (Median), indicating a relatively high level of alertness. Job demands were negatively correlated with both job resources (r=-0.570, P < 0.001) and personal resources (r=-0.462, P < 0.001), while a positive correlation existed between job resources and personal resources (r = 0.554, P < 0.001). The results show that increased job demands can lead to higher levels of nurse strain (β = 0.955, P < 0.001), whereas job resources were found that it can decrease strain (β=-0.477, P = 0.047). Adequate job resources can enhance motivation directly (β = 0.874, P < 0.001), subsequently reducing reaction time (β=-0.148, P = 0.044) and improving night-shift alertness among ICU shift nurses.

CONCLUSION

Enhancing ICU shift nurses' work motivation through bolstering job resources can boost night-shift alertness. However, it is noteworthy that, in this study, neither strain nor individual resources significantly influenced nurses' night-shift alertness. This may be attributed to the complexity of the ICU environment and individual differences. Future research should explore the relationship between these factors and nurses' work alertness.

Prevalence of anxiety, depression, and post-traumatic stress disorder among paramedic students: a systematic review and meta-analysis

PURPOSE

There are elevated mental health concerns in paramedic students, but estimates vary between studies and countries, and no review has established the overall prevalence. This systematic review addressed this by estimating the global prevalence of common mental health disorders, namely anxiety, depression, and post-traumatic stress disorder (PTSD), in paramedic students internationally.

METHODS

A systematic search of six databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and medRxiv, was conducted to identify studies relating to mental health among paramedicine students. The search encompassed studies from inception until February 2023. To be considered for inclusion in the review, the studies had to report prevalence data on at least one symptom of anxiety, depression, or PTSD in paramedicine students, using quantitative validated scales. The quality of the studies was assessed using Joanna Briggs Institute (JBI) Checklist, which is a specific methodological tool for assessing prevalence studies. Subgroup analyses were not conducted due to insufficient data.

RESULTS

1638 articles were identified from the searches, and 193 full texts were screened, resulting in 13 papers for the systematic review and meta-analysis. The total number of participants was 1064 from 10 countries. The pooled prevalence of moderate PTSD was 17.9% (95% CI 14.8-21.6%), anxiety was 56.4% (95% CI 35,9-75%), and depression was at 34.7% (95% CI 23.4-48.1%).

CONCLUSION

This systematic review and meta-analysis has found that paramedicine students globally exhibit a high prevalence of moderate PTSD, anxiety, and depression. The prevalence of these mental health conditions surpasses those among paramedic providers and the general population, as indicated by previous reviews. Further research is therefore warranted to determine appropriate support and interventions for this group.

Prevalence and associated factors of insomnia symptoms among doctors and nurses under the context of high prevalence of multiple infectious diseases: a cross-sectional study

Introduction

Insomnia symptoms are prevalent among healthcare workers and represent a potential public health problem. However, there is currently insufficient evidence on insomnia symptoms among doctors and nurses under the context of high prevalence of multiple infectious diseases after the pandemic in China. The purpose of this study was to analyze the prevalence of insomnia symptoms among doctors and nurses in third-grade class-A general hospitals under the context of high prevalence of multiple infectious diseases, and to explore the influence of demographic characteristics, work-related factors, health and lifestyle-related factors on insomnia symptoms.

Methods

An institution-based cross-sectional survey was conducted among doctors and nurses in two third-grade class-A general hospitals. A structured questionnaire was used to collect information on demographic characteristics, work-related factors, health and lifestyle-related factors, and insomnia symptoms among doctors and nurses. Multivariate logistics regression analysis was applied to identify factors significantly associated with insomnia symptoms among doctors and nurses, respectively.

Results

A total of 1,004 participants were included in this study, including 503 doctors and 501 nurses. The prevalence of insomnia symptoms in doctors and nurses was 47.7 and 51.3%, respectively. Multivariate logistics regression analysis showed that workplace violence (OR: 1.631, 95% CI: 1.050-2.532), doctor-patient relationship (OR: 1.603, 95% CI: 1.049-2.450), chronic pain (OR: 4.134, 95% CI: 2.579-6.625), chronic disease (OR: 1.825, 95% CI: 1.164-2.861), and anxiety symptoms (OR: 2.273, 95% CI: 1.357-3.807) were associated factors with insomnia symptoms in doctors. Education (OR: 0.301, 95% CI: 0.106-0.851), service years (OR: 1.978, 95% CI: 1.304-3.002), weekly working hours (OR: 1.694, 95% CI: 1.061-2.705), chronic pain (OR: 5.359, 95% CI: 3.241-8.860), and anxiety symptoms (OR: 2.472, 95% CI: 1.478-4.136) were associated factors with insomnia symptoms in nurses.

Conclusion

The prevalence of insomnia symptoms among doctors and nurses was high, and affected by many factors. This information can inform tailored interventions to insomnia symptoms by doctors and nurses who play an important role in public health.

A Guided Comparative Analysis of Fatigue Frameworks in Australasian Ambulance Services

OBJECTIVE

Paramedics work in a complex, unpredictable environment, subject to many external stressors including critically unwell patients, dangerous driving conditions, and prolonged shift work. Paramedic fatigue from these and other occupational demands is well documented. Ambulance services attempt to safeguard paramedics from fatigue using internal policies or procedures - a type of Fatigue Risk Management Systems (FRMSs). This study reviews ambulance service fatigue frameworks to understand the current situation in fatigue management in paramedicine, and to identify fatigue monitoring tools, strategies, and other components of these frameworks that are designed to protect personnel.

METHODS

This study involved a qualitative document thematic content analysis. All eleven statutory ambulance services across Australia, New Zealand, and Papua New Guinea, represented by the Council of Ambulance Authorities, were contacted and invited to participate. Fatigue frameworks were collated and entered into NVivo where data extraction occurred through three a priori areas (fatigue, fatigue mitigation tools & fatigue management).

RESULTS

Nine of the eleven ambulance services provided fatigue documentation, with one declining to participate, and one did not respond to invitations. Through thematic analysis and abstraction, seven themes were identified: fatigue definition, consequences of fatigue, sources of fatigue, signs and symptoms of fatigue, fatigue-related incidents, fatigue monitoring tools, and fatigue mitigation. There was also poor alignment between provided frameworks and established FRMSs components.

CONCLUSION

Our findings provide an initial insight into existing ambulance service fatigue frameworks across Australia, New Zealand, and Papua New Guinea. The many inconsistencies in frameworks between ambulance services highlight an opportunity to develop a more consistent, collaborative approach that follows evidence-based FRMSs guidelines.

Effects of Concurrent Training on Resuscitation and Cognitive Performance in Paramedics-A Pilot Study

Paramedics work under physically and cognitively demanding conditions to provide emergency care. As physical fitness could positively impact the quality of patient care, we investigated within a pilot study whether concurrent training (CT) affects work-related performance parameters in paramedics. At baseline (T1), 16 paramedics performed cardiopulmonary resuscitation whereby resuscitation performance (RP; total resuscitation quality, compressions with correct frequency, and correct ventilation), cognitive performance (CP; reaction time, divided attention, and working memory), and heart rate variability (HRV) were assessed (pre-exertion). Then, participants climbed seven floors carrying 20 kg of gear before completing the same assessments again (post-exertion). The baseline testing was followed by a CT intervention (12 weeks, three sessions/week). After the intervention (T2), the two-stage testing was repeated. We analyzed whether the pre-exertion and post-exertion values, as well as the difference between the pre-exertion and post-exertion values, changed from T1 to T2. Nine paramedics (male: N = 7; age = 26.3 (SD = 8.17) years) took part in the study. The comparison of the pre-exertion values showed significantly better reaction times (p = 0.001) and divided attention (p = 0.02) and a trend toward greater working memory and RP parameters at T2. Regarding the post-exertion values, significant improvements in working memory (p = 0.03) and a trend toward improved reaction time, divided attention, and RP occurred at T2. The difference between the pre- and post-exertion values did not change for any parameter from T1 to T2. HRV decreased significantly from pre- to post-exertion (T1: p = 0.01, T2: p = 0.01). These results indicate that CT is a promising training concept to improve RP and CP in paramedics and should therefore be investigated further to increase patient care quality.

Association of chronotype with language and episodic memory processing in children: implications for brain structure

Introduction

Chronotype refers to individual preference in circadian cycles and is associated with psychiatric problems. It is mainly classified into early (those who prefer to be active in the morning and sleep and wake up early) and late (those who prefer to be active in the evening and sleep and wake up late) chronotypes. Although previous research has demonstrated associations between chronotype and cognitive function and brain structure in adults, little is known regarding these associations in children. Here, we aimed to investigate the relationship between chronotype and cognitive function in children. Moreover, based on the significant association between chronotype and specific cognitive functions, we extracted regions-of-interest (ROI) and examined the association between chronotype and ROI volumes.

Methods

Data from 4,493 children (mean age of 143.06 months) from the Adolescent Brain Cognitive Development Study were obtained, wherein chronotype (mid-sleep time on free days corrected for sleep debt on school days) was assessed by the Munich Chronotype Questionnaire. Subsequently, the associations between chronotype, cognitive function, and ROI volumes were evaluated using linear mixed-effects models.

Results

Behaviorally, chronotype was negatively associated with vocabulary knowledge, reading skills, and episodic memory performance. Based on these associations, the ROI analysis focused on language-related and episodic memory-related areas revealed a negative association between chronotype and left precentral gyrus and right posterior cingulate cortex volumes. Furthermore, the precentral gyrus volume was positively associated with vocabulary knowledge and reading skills, while the posterior cingulate cortex volume was positively associated with episodic memory performance.

Discussion

These results suggest that children with late chronotype have lower language comprehension and episodic memory and smaller brain volumes in the left precentral gyrus and right posterior cingulate cortex associated with these cognitive functions.

Exploring paramedics' lived experiences in confrontation with patients' death during missions: a phenomenological study

BACKGROUND

Emergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the current study aimed to clarify the lived experiences of paramedics when exposed to Patients' Deaths during their missions in 2023.

METHODS

This study was carried out using a qualitative approach and interpretative phenomenology from January 9, 2022, to September 21, 2023. The research was performed in Fars, Alborz, and Isfahan provinces in Iran. Data were gathered using semi-structured interviews with 17 male emergency personnel (both from the emergency medical service and Red Crescent). The obtained data were analyzed utilizing Smith's approach to clarify the lived experiences of emergency responders when facing deaths in various incidents in Iran.

RESULTS

Seventeen emergency personnel with the age range of 24-60 (average = 39) years and with a history of confronting patients' deaths during their services were interviewed. Their lived experiences of being exposed to patients' deaths during the emergency response in Iran were classified into three main themes: psychological and emotional status, personality, disposition, and behavior status, and mental and physical status. Sub-themes such as psychological and emotional problems, mental and physical problems, and sub-subthemes such as anxiety, stress, decreased appetite, irritability, insomnia, forgetfulness, and fatigue were also noted within the main themes.

CONCLUSION

While emergency personnel work diligently to save the lives of patients, the current study demonstrated that they were susceptible to multiple psychological, emotional, and physical problems, which potentially affect their lives outside of the workplace and make them more vulnerable to related physiological and psychological diseases. It is recommended that policymakers and clinical educators make ways to prevent these problems and provide emergency personnel with physical, psychological, and emotional support.

The Effect of Shift Work on Sleep Patterns of Paramedics in Saudi Arabia

Purpose

Shift work poses significant sleep health challenges for paramedics, affecting their ability to respond effectively in emergencies. This study aimed to evaluate the impact of shift work on sleep parameters among paramedics in Saudi Arabia, identifying key factors influencing insomnia.

Patients and Methods

A cross-sectional, online survey was conducted, gathering data on sociodemographic characteristics, work-related factors, sleep duration, and insomnia among paramedics in Saudi Arabia. The Athens Insomnia Scale was used to define insomnia. The association between shift work and sleep parameters was examined. Predictors of insomnia were identified through logistic regression models by inspecting the adjusted odds ratio (aOR).

Results

1076 Saudi paramedics were included, most of whom were 26-35 years old, males, married, had a Bachelor's degree, worked in hospital-based settings for private agencies in rural areas, and had 6-10 years of experience. Occupational stress was reported by 52.96% of paramedics. All shift work characteristics (working hours, number of shifts, work schedule, and off-work days) were significantly associated with insomnia (p=0.0001). The multivariate regression revealed that work setting (aOR=18.71, p=0.02), coffee consumption (aOR=36.83, p=0.01), work schedule (aOR=21.93, p=0.01), and time to bed (aOR=0.01, p=0.01), sleep duration (aOR=0.03, p=0.03), and occupation stress (aOR=9.31, p=0.001) were predictors for insomnia.

Conclusion

Our findings underscores the need for targeted interventions to mitigate the adverse effects of shift work on sleep health among paramedics.

The effect of cumulative night shift duties on insomnia, fatigue, and mental health in intensive care unit

Background

Night shift duties are crucial in the ICU to ensure care continuity, where critically ill patients require round-the-clock care. However, cumulative night shift duties may disturb circadian rhythm, insomnia, fatigue, and depression, and require further elucidation.

Objectives

This study aims to examine the negative consequences of various night shift patterns on insomnia, fatigue, and mental health of ICU Workers.

Methods

A cross-sectional study examined how cumulative night shift duty affects insomnia, fatigue, and mental health in critical care providers (CCPs).

Results

A total of 1006 participants completed this study between June 2022 and March 2023, including 54.5 % males. About 35 % were between 20 and 30 years of age, and Respiratory Therapists accounted for approximately 46.5 % of the entire sample. Most of our respondents (476; 47 %) reported working night shifts, with a monthly range of 8-15 nights. The prevalence rates for moderate to severe clinical insomnia, fatigue, and moderate to severe depression were 42 %, 48 %, and 32 %, respectively. CCPs working 8-15 nights had a 2-fold risk of clinical insomnia than those working fewer than eight nights with (AOR) and 95 % (CI) of 2.12 and 1.41-3.20, while those working ≥16 nights per month had a greater incidence of clinical insomnia compared to those working <8 nights per month, AOR (CI): 3.09 (1.90-5.03). Only those working ≥16-night shifts per month had a substantially higher fatigue risk compared to those working < 8-night shifts per month, with an AOR (CI) of 1.92 (1.19-3.08). Working 8-15-night shifts per month increases depression risks by 34 % compared to the <8-night shifts group, AOR (CI): 1.34 (0.87-2.08). Those working ≥16-night shifts per month showed a higher depression risk than those working <8-night shifts, AOR (CI): 2.53 (1.53-4.19).

Conclusion

A cumulative night shift above eight nights per month is linked with an increased risk of insomnia, fatigue, and depression. The risk of these conditions was significantly directly proportional to the number of night shifts performed per month.

The Occurrence of Anxiety, Depression, and Distress among Professionals Working in Emergency Care

Maintaining mental health is essential for professions with higher stress levels and challenging environments, including emergency specializations. In this study, the occurrence of distress, anxiety, and depression among a group of ambulance and hospital emergency care professionals was assessed (n = 202). A cross-sectional, quantitative, descriptive online survey was conducted, including the internationally validated Beck depression inventory (BDI), the perceived stress scale (PSS-14), and the State-Trait Anxiety Inventory (STAI). Statistical analyses involved descriptive statistics, the χ2-test, Mann-Whitney U test, Kruskal-Wallis test, Dunn-Bonferroni test, logistic regression (LR), Cramer coefficient (Cramer's V), Kolmogorov-Smirnov test, and Spearman's rank correlation coefficient (rs). Based on the results, female professionals are more likely to have depressive symptoms (OR = 2.6, 95% CI = 1.3-5.1), perceived stress (OR = 1.2, 95% CI = 1.2-4.1), and anxiety (OR = 2.1, 95% CI = 1.0-4.1) than male professionals. Perceived stress levels decreased proportionally with increasing years spent working in healthcare (OR = 7.4, 95% CI = 7.1-8.3). Extended work shifts of 12 or 24 h increase the risk of perceived stress and anxiety in emergency care workers (p = 0.02). Customized stress management interventions are needed to mitigate the amplified mental strain associated with gender, working years, and longer shifts in the emergency care sector to sustain their mental health and well-being.

The prevalence of depression among paramedical students and workers with highlights from the COVID-19 pandemic: A meta-analysis of prevalence

OBJECTIVE

To estimate the prevalence and risk factors of depression among paramedical workers/students.

METHOD

6205 paramedics (reported in 25 cross-sectional studies) were meta-analyzed after searching seven electronic databases. The main outcome was the prevalence of depression. Subgroup analyses were conducted based on year and country of investigation, pandemic status and wave, population type, and disease severity. Several risk factors were also examined (gender, marital status, and population type).

RESULTS

34% [95%CI: 26-43%] of paramedics have depression, mostly of the mild form [19%, 95%CI: 13-27%]. Depression was highest in India and Australia. Students [45%, 95%CI: 30-62%] were more vulnerable to depression than workers [29%, 95%CI: 18-40%]. No linear trend was observed for depression over the years. Depression was lower during the pandemic compared to the pre-pandemic period [25% vs. 39%] with similar rates across all pandemic waves. Male [MD = 1.40; 95%CI: 0.57: 2.23] and married paramedics [MD = -1.33, 95%CI: -2.04: -0.62] were significant predictors of depression; however, no significant difference in depression was noted between paramedics and non-paramedics [logOR = 0.08; 95%CI: -0.10: 0.25].

CONCLUSIONS

One in every three paramedics have depression, with higher rates among students and before the COVID-19 pandemic. Gender and marital status are risk factors of depression.

Role of sleep in asthenospermia induced by di (2-ethyl-hexyl) phthalate

Di (2-ethyl-hexyl) phthalate (DEHP) mainly enters the human body through the digestive tract, respiratory tract, and skin. At the same time, it has reproductive and developmental toxicity, neurotoxicity, and so on, which can cause the decrease of sperm motility. Asthenospermia is also known as low sperm motility, and the semen quality of men in some areas of China is declining year by year. Interestingly, previous studies have shown that sleep disorders can also lead to asthenospermia. However, the relationship between sleep, DEHP, and asthenospermia is still unclear. Analysis of the National Health and Nutrition Examination Survey (NHANES) population database showed that DEHP was associated with sleep disorders, and subsequent experiments in mice and Drosophila indicated that DEHP exposure had certain effects on sleep and asthenospermia. Furthermore, we analyzed the Comparative Toxicogenomics Database (CTD) to find out the common signaling pathway among the three: hypoxia-inducible factor 1(HIF-1). Then Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) was used to screen out the proteins that DEHP affected the HIF-1 pathway: glyceraldehyde-3-phosphate dehydrogenase (GAPDH), serine/threonine-protein kinase (AKT1), epidermal growth factor receptor (EGFR), and finally Western blot analysis was used to detect the expression levels of the three proteins. Compared with the control group, DEHP decreased the protein expression levels of GAPDH and AKT1 in the HIF-1 pathway, and caused sleep disorders and decreased sperm motility. This study provides preliminary evidence for exploring the mechanism among DEHP, sleep disorders, and asthenospermia.

Determinants of psychological injury among health and social care workers in community settings: A systematic review

BACKGROUND

Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings.

OBJECTIVE

To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings.

METHODS

Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist.

RESULTS

Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors.

CONCLUSION

Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.

Screening for Comorbidity of Sleep Disorders in Career Firefighters

BACKGROUND

The purpose of this study was to assess the prevalence and sequelae of insomnia, obstructive sleep apnea (OSA), and comorbid OSA and insomnia (COMISA).

METHOD

In the morning, after a shift end, Midwest career firefighters ( N = 89) in a midsized city completed an electronic battery of questionnaire to screen for OSA, daytime sleepiness, insomnia, presleep arousal, nightmares, mental and physical health symptoms, and a one-night sleep diary.

RESULTS

Prevalence of firefighters exceeding screening thresholds: OSA: 54%; insomnia: 30%; COMISA: 17%; four or more nightmares per month: 15%. Firefighters who met criteria for COMISA had shorter total sleep time, less restful and worse sleep quality, higher depression and anxiety symptoms, and presleep arousal symptoms than firefighters without self-reported sleep problems.

CONCLUSIONS

Many firefighters are at elevated risk of individual behavioral sleep disorders, COMISA, and daytime dysfunction.

Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review

Fatigue in emergency first responders (EFRs) is known to affect performance abilities and safety outcomes for both patients and EFRs. The primary aim of this review was to determine the main contributors to occupation-induced fatigue in EFRs and its subsequent impacts. Following the PRIMSA checklist, academic databases (Medline, Embase, CINAHL, and SPORTDiscus) were searched using key terms with results subjected to inclusion and exclusion criteria. Populations of interest were firefighters, paramedics, or emergency call centre personnel. Of the 5633 records identified, 43 studies, which reported on 186 unique measures from a total population of 6373 participants, informed the review. Synthesis revealed fatigue was caused by lack of sleep during the shift and consistent poor sleep quality which negatively impacted cognitive function, alertness, and physical and mental health while increasing safety-compromising behaviours and injuries. Both subjective and objective assessments of fatigue are necessary for effective risk management in EFRs. EFRs that are consistently fatigued are at a greater risk of poor physical and mental health, reduced cognitive function, and increased injuries. No studies reported on fatigue in emergency call centre personnel, highlighting a literature gap. Funding was provided by the Australian Capital Territory Emergency Services Agency. Preregistration was filed in OSF: osf.io/26f3s.

The association between chronotype, sleep quality and medication errors among critical care nurses

Medication administration errors could result in severe complications in critical care units. This study investigated an association between chronotype, sleep quality and medication errors among essential nurses of care in Qazvin teaching hospitals in Iran. In this multicenter, cross-sectional study, all registered nurses of critical care units of Qazvin teaching hospitals were recruited. Data were collected through anonymous questionnaires, including socio-demographic data, Morning-Evening Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and medication errors data. Data were analyzed with SPSS v.24 by using the Chi-square test, Mann-Whitney U test, and logistic regression analysis. P values less than 0.05 were considered significant. The mean age and work experience were 33.12 ± 6.74 and 9.11 ± 5.96, respectively. One hundred sixty-six nurses (96%) have been working in rotating shifts. Nurses with intermediate chronotypes were predominant (n = 122; 70.5%). The majority of nurses (68.2%) had poor sleep quality (n = 118). Logistic regression analysis showed eveningness chronotype was associated with 4.743 fold increased risk of medication error (P < 0.033). No association was found between medication error and sleep quality (p < 0.95). There was no significant relationship between chronotype and sleep quality (P < 0.257). Our study showed that nurses with eveningness chronotype make more medication errors; therefore, considering the individual circadian preference before deciding on their shift timing assignment will be an important issue in reducing nurses' medication errors and improving patient safety in critical care units.

Effects of shift work schedules, compensatory sleep, and work-family conflict on fatigue of shift-working nurses in Chinese intensive care units

BACKGROUND

Shift work is inevitable for nurses in intensive care units. Various studies explored nurses' fatigue in multiple hospital wards. However, few studies focused on fatigue among nurses in intensive care units.

AIMS

To determine the association between shift work schedules, compensatory sleep, work-family conflict, and fatigue of shift-working nurses in critical care units.

STUDY DESIGN

A descriptive cross-sectional multi-center study was conducted in March 2022 among intensive care nurses from five hospitals.

METHODS

Data were collected by online survey, including self-designed demographic questions, the Fatigue Scale-14, the Chinese adult daytime sleepiness scale, and the work-family scale. Pearson correlation was conducted for bivariate analysis. Independent-sample t-test, one-way ANOVA, and multiple linear regression analysis were performed to examine fatigue-related variables.

RESULTS

A total of 326 nurses responded to the survey with an effective response rate of 74.9%. The mean scores of physical fatigue and mental fatigue were 6.80 and 3.72, respectively. The bivariate analyses showed that work-family conflict was positively correlated with physical (r = 0.483, p < .001) and mental fatigue (r = 0.406, p < .001). Multiple linear regression results showed that work-family conflict, daytime sleepiness, and shift system were statistically significant factors influencing physical fatigue (F = 41.793, p < .001). Work-family conflict, sleep duration after the night shift, and daytime sleepiness were the main influencing factors of mental fatigue (F = 25.105, p < .001).

CONCLUSIONS

Nurses with higher work-family conflict, daytime sleepiness, and working 12-h shifts have higher levels of physical fatigue. Higher work-family conflict, shorter sleep duration after night shifts, and daytime sleepiness are associated with higher mental fatigue among intensive care nurses.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers and nurses should consider work-family factors and compensatory sleep in their efforts to reduce fatigue. It is necessary to strengthen work-supporting strategies and compensatory sleep guidance for nurses to promote fatigue recovery.

Effect of Work-Related Behavior and Experience Patterns on Sleep Quality in Emergency Medical Service Personnel

OBJECTIVE

The aim of this study was to examine the influence of work-related behavior and experience patterns on sleep quality in emergency medical service personnel.

METHODS

From the total sample of 508 emergency medical service workers who took part in the Germany-wide online survey, 368 respondents completed the questionnaires on sleep characteristics (Pittsburgh Sleep Quality Index [PSQI]) and work-related behavior and experience pattern. Three hundred sixty-seven of the 368 participants also finished the Regensburg Insomnia Scale.

RESULTS

Based on their work-related behavior and experience pattern results, individuals were categorized into one of the four following patterns: two risk patterns (A, B) and two healthy behavior and experience patterns (G, S). Participants that were classified into risk-pattern A and B (33.85%) scored significantly higher in both PSQI and Regensburg Insomnia Scale overall score and all PSQI components implicating a poorer sleep quality. A total of 78.5% of the individuals with pattern A and B were considered bad sleepers whereas only 43.4% of individuals with pattern G and S were scored as bad sleepers.

CONCLUSIONS

Work-related behavior and experience patterns showed a strong association to sleep characteristics and may therefore be used to identify appropriate preventative measures.

Fatigue and somatization in shift-workers: Effects of depression and sleep

OBJECTIVE

We investigated the differences in fatigue and somatization between shift and non-shift workers and explored the effects of sleep and depression on fatigue and somatization in shift workers.

METHODS

In total, 4543 shift workers and 2089 non-shift workers completed self-reported questionnaires. The Center for Epidemiologic Studies Depression Scale (CESD), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Somatization subscale of the Symptom Checklist 90-item version (SCL-SOM) were used to measure depression, sleep quality, fatigue, and somatization, respectively. Fatigue and somatization were compared between shift and non-shift workers after controlling for different sets of covariates.

RESULTS

Compared to non-shift workers, shift workers reported higher FSS (mean difference: 2.19 ± 0.30, p < 0.01) and SCL-SOM (mean difference: 1.77 ± 0.21, p < 0.01) scores after controlling for age, gender, presence of medical illness, occupational category, monthly income, length of service, and weekly working hours. The between-group difference in FSS score was no longer significant after additionally controlling for CES-D (p = 0.15) or PSQI (p = 0.18). The between-group difference in SCL-SOM score showed only non-significant trends after additionally controlling for CES-D (p = 0.09) or PSQI (p = 0.07). The group difference in SCL-SOM scores disappeared after controlling for both CES-D and PSQI scores (p = 0.99).

CONCLUSIONS

Shift workers had higher fatigue and somatization levels than non-shift workers and the group difference was associated with disturbed sleep and depressed mood in shift workers.

Workplace Health Promotion Programs Available to Emergency Medical Services Clinicians in North Carolina

BACKGROUND

Emergency medical services (EMS) clinicians demonstrate a high prevalence of chronic medical conditions that place them at risk for early mortality. Workplace health promotion programs improve health outcomes, but the availably of such programs for EMS clinicians has not been described. We investigate the availability, scope, and participation of workplace health promotion programs available to EMS clinicians in North Carolina (NC).

METHODS

We administered an electronic survey based on the Centers for Disease Control and Prevention Worksite Health ScoreCard to key representatives of EMS agencies within NC that provide primarily transport-capable 9-1-1 response with ground ambulances. We collected information on agency size, rurality, elements of health promotion programs offered, incentives for participation, and participation rate. We calculated descriptive statistics using frequency and percentage for worksite and health promotion program characteristics. We compared the participation rate for agencies who did and did not incentivize participation using Fisher's exact test.

RESULTS

Complete responses were received from 69 of 92 agencies (response = 75%) that collectively employ 6679 EMS clinicians [median employees per agency 71 (IQR 50-131)]. Most agencies (88.4%, 61/69) offered at least one element of a worksite health program, but only 13.0% (9/69) offered all elements of a worksite health program. In descending order, the availability of program elements were employee assistance programs (73.9%, 51/69), supportive physical and social environment (66.7%, 46/69), health education (62.3%, 43/69), health risk assessments (52.2%, 36/69), and organization culture of health promotion (20.3%, 14/69). Of agencies with programs, few (11.5%, 7/61) required participation, but most (59.0%, 36/61) offered incentives to participate. Participation rates were <25% among nearly all of the agencies that did not offer incentives, but >50% among most agencies that did offer incentives (p < 0.001).

CONCLUSION

While most agencies offer at least one element of a worksite health promotion program, few agencies offer all elements and participation rates are low.

Exploring factors associated with paramedic work-related psychological injury through data linkage

INTRODUCTION

In comparison to the general population and other emergency services workers, paramedics experience high rates of work-related psychological injury. However, there is limited understanding of the case and practitioner-related factors that increase the risk of psychological injury among these workers. This paper aims to identify case and practitioner-related factors associated with paramedic work-related psychological injury in Victoria, Australia, through data linkage.

METHODS

Data linkage of 7,223 paramedic injury reports with electronic patient care records, and paramedic demographic data from the single state-wide ambulance service in Victoria, Australia - Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Factors associated with paramedic psychological injury were assessed using multivariable logistic regression analysis.

RESULTS

A total of 4,641 (64%) injury reports were successfully linked, of which, 244 (5%) were psychological injuries. Shift hours between 0401 and 0800 (AOR 1.83; 95%CI: 1.12-2.97), cardiac arrest or deceased patient attendances (AOR 2.15; 95%CI: 1.06-4.34), hospital or medical center case locations (AOR 2.44; 95%CI: 1.22-4.91), and Priority 0 (AOR 2.27; 95%CI: 1.26-4.09), Priority 2 (AOR 1.56; 95%CI: 1.04-2.33), and Priority 3 (AOR 1.95; 95%CI: 1.15-3.32) dispatch codes were associated with increased odds of psychological injury. Increasing patient age (AOR 0.98; 95%CI: 0.97-0.99), and the absence of other emergency services on scene (AOR 0.50; 95%CI: 0.34-0.72) were associated with decreased odds of paramedic psychological injury.

CONCLUSIONS

This is the first study to collectively examine and identify EMS case and practitioner-related characteristics associated with paramedic psychological injury through data linkage of EMS agency-level data sources.

PRACTICAL APPLICATION

The findings of this study highlight the dispatch case characteristics that may increase the risk of a paramedic sustaining a work-related psychological injury, and consequently facilitate the early identification, intervention, and support of the individuals most at risk.

Sleep and mental health in recruit paramedics: a 6-month longitudinal study

STUDY OBJECTIVES

To explore potential relationships and longitudinal changes in sleep and mental health in recruit paramedics over the first 6 months of work, and whether sleep disturbances pre-emergency work predict future mental health outcomes.

METHODS

Participants (N = 101, 52% female, Mage = 26 years) completed questionnaires prior to (baseline), and after 6 months of emergency work to assess for symptoms of insomnia, obstructive sleep apnea, post-traumatic stress disorder (PTSD), depression, anxiety, and trauma exposure. At each timepoint, participants also completed a sleep diary and wore an actigraph for 14 days to assess sleep patterns. Correlations between baseline sleep and mental health were conducted and changes in these variables across timepoints were examined using linear mixed models. Hierarchical regressions assessed whether sleep at baseline predicted mental health at follow-up.

RESULTS

Insomnia and depression symptoms, and total sleep time increased while sleep onset latency decreased across the first 6 months of emergency work. Participants experienced an average of 1 potentially traumatic event during the 6-month period. Baseline insomnia predicted increased depression symptoms at the 6-month follow-up, while baseline wake after sleep onset predicted follow-up PTSD symptoms.

CONCLUSION

Results highlight an increase in insomnia and depression across the initial months of emergency work, while sleep disturbances before emergency work were identified as potential risk factors for the development of depression and PTSD among paramedics in their early career. Screening and early interventions targeting poor sleep at the beginning of emergency employment may assist in reducing the risk of future mental health outcomes in this high-risk occupation.

Evaluation of the psychological distress and mental well-being of pre-hospital care providers in Saudi Arabia during COVID-19

Background

Pre-hospital care providers are the first line of contact when emergencies occur. They are at high risk of mental health disorders associated with trauma and stress. The magnitude of their stress could increase during difficult times such as the COVID-19 pandemic.

Objectives

This study reports on the state of mental well-being and the degree of psychological distress among pre-hospital care workers (paramedics, emergency medical technicians, doctors, paramedic interns and other healthcare practitioners) during the COVID-19 pandemic in Saudi Arabia.

Methods

The study was a cross-sectional survey study in Saudi Arabia. A questionnaire was distributed among pre-hospital care workers in Saudi Arabia during the first wave of the COVID-19 pandemic. The questionnaire was based on the Kessler Psychological Distress Scale (K10) and the World Health Organization Well-Being Index (WHO-5).

Results

In total, 427 pre-hospital care providers completed the questionnaire; 60% of the respondents had scores of more than 30 in the K10 and were likely to have a severe disorder. The WHO-5 showed a similar percentage of respondents with a score of more than 50 and coded as having poor well-being.

Conclusions

The findings of this study provide evidence around mental health and well-being for pre-hospital care workers. They also highlight the need to better understand the quality of mental health and well-being for this population and to provide appropriate interventions to improve their quality of life.

Association between matched chronotype and poor mental health among shift workers: a systematic review and meta-analysis

BACKGROUND

Nearly 0.7 billion workers are involved in the shift work system, leading to concerns about its potential impacts on the large-scale population mental health. This study aimed to synthesise evidence of the associations between matched chronotype and the risk of poor mental health among shift workers.

METHODS

Six computerised databases were searched from inception to September 2022. Observational studies were selected if they reported any association between common mental health parameters and chronotype scores/types of shift workers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed. We extracted adjusted risk estimates to calculate pooled effect sizes and explore sources of heterogeneity. The study was registered in PROSPERO: CRD42022357437.

RESULTS

Fourteen studies including 49 909 workers were identified. Ever shift workers had a higher risk of poor mental health than the day workers (pooled OR 1.15, 95% CI 1.03 to 1.28; I²=14%, p=0.29), with the evening chronotype ever shift workers having a 1.47 times higher risk than those who worked during the day (pooled OR 1.47, 95% CI 1.13 to 1.91; I²=42%, p=0.16). Sensitivity analysis excluding studies with the highest risk of bias of each group demonstrated consistent findings.

CONCLUSIONS

Evening chronotype ever shift workers have poorer mental health than shift workers with other chronotypes. Chronotype remains unrecognised in the contemporary rostering system, making it a hidden contributor to occupational mental health. Work-related physical and mental stresses may be prevented/mitigated with further investigation on optimising shift work schedule combined with individual chronotype preference.

Use of accelerometers and inertial measurement units to quantify movement of tactical athletes: A systematic review

The dynamic work environments of tactical athletes are difficult to replicate in a laboratory. Accelerometers and inertial measurement units provide a way to characterize movement in the field. This systematic review identified how accelerometers and inertial measurement units are currently being used to quantify movement patterns of tactical athletes. Seven research and military databases were searched, producing 26,228 potential articles with 78 articles included in this review. The articles studied military personnel (73.1%), firefighters (19.2%), paramedics (3.8%), and law enforcement officers (3.8%). Accelerometers were the most used type of sensor, and physical activity was the primarily reported outcome variable. Seventy of the studies had fair or poor quality. Research on firefighters, emergency medical services, and law enforcement officers was limited. Future research should strive to make quantified movement data more accessible and user-friendly for non-research personnel, thereby prompting increased use in tactical athlete groups, especially first responder agencies.

Psychosocial Work Stress and Occupational Stressors in Emergency Medical Services

Emergency medical service (EMS) professionals often experience work stress, which escalated during COVID-19. High job demand in the EMS profession may lead to progressive decline in physical and mental health. We investigated the prevalence of psychosocial job stress in the three levels of EMS: basic, advanced, and paramedic, before and during the COVID-19 pandemic. EMS professionals (n = 36) were recruited from EMS agencies following the Institutional Review Board approval. Participants took surveys on demographics, personal characteristics, chronic diseases, and work schedules. Job stress indicators, namely the effort–reward ratio (ERR) and overcommitment (OC), were evaluated from survey questionnaires using the effort–reward imbalance model. Associations of job stress indicators with age, sex, body mass index, and working conditions were measured by logistic regression. Psychosocial work stress was prevalent with effort reward ratio > 1 in 83% of participants and overcommitment scores > 13 in 89% of participants. Age, body mass index, and work hours showed strong associations with ERR and OC scores. The investigation findings suggested that a psychosocial work environment is prevalent among EMS, as revealed by high ERR, OC, and their correlation with sleep apnea in rotating shift employees. Appropriate interventions may be helpful in reducing psychosocial work stress in EMS professionals.

Sleep disturbances and depressive symptoms of shift workers: Effects of shift schedules

This study explored sleep disturbances and depression among various types of shift workers (SWs) and non-SWs, focusing on work schedule diversity. We enrolled 6,654 adults (4,561 SWs, 2,093 non-SWs). Based on self-report questionnaires on work schedules, the participants were classified according to shift work type: non-shift work; and fixed evening, fixed night, regularly rotating, irregularly rotating, casual, and flexible shift work. All completed the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and short-term Center for Epidemiologic Studies-Depression scale (CES-D). SWs reported higher PSQI, ESS, ISI, and CES-D than non-SWs. Fixed SWs (fixed evenings and fixed nights) and true SWs (regularly and irregularly rotating SWs) scored higher on the PSQI, ISI, and CES-D than non-SWs. True SWs scored higher on the ESS than fixed SWs and non-SWs. Among fixed SWs, fixed night SWs scored higher on the PSQI and ISI than fixed evening SWs. Among true SWs, irregular SWs (irregularly rotating and casual SWs) scored higher on the PSQI, ISI, and CES-D compared to regularly rotating SWs. The PSQI, ESS, and ISI independently were associated with the CES-D of all SWs. We found an interaction between the ESS and the work schedule on the one hand, and the CES-D on the other, which was stronger in SWs than non-SWs. Fixed night and irregular shifts were linked with sleep disturbances. The depressive symptoms of SWs are associated with sleep problems. The effects of sleepiness on depression were more prominent in SWs than non-SWs.

No Two Systems Are the Same: Paramedic Perceptions of Contemporary System Performance Using Prehospital Quality Indicators

Introduction In recent years, researchers have identified two new models of paramedicine within the Anglo-American paramedic system known as the Directive and Professionally Autonomous paramedic systems. The research team now seek to compare paramedic perception of system performance between the two systems using prehospital quality indicators. Methods Paramedics employed within Anglo-American paramedic systems undertook a survey evaluating their experience and perception of system performance against a set of modified prehospital quality indicators. Data were collected using a survey combining single-choice questions with matrix multiple-choice questions. Key results were cross-tabulated with demographic (informant) and system factors to compare performance between the two new paramedic systems. Results The survey indicated a substantial difference in perceived clinical and operational performance between the Professionally Autonomous and Directive paramedic systems, with the Professionally Autonomous paramedic system performing consistently better in all 11 prehospital quality indicator domains. Conclusion The results of this survey are a vital step in helping paramedics, health leaders, and academics understand the complex relationship between paramedic system design and system performance, and, for the first time, provides empirical evidence upon which to make a conscious decision to adopt one system or the other.

Factors Associated with Lost Time Injury among Paramedics in Victoria, Australia

BACKGROUND

The dynamic and uncontrolled nature of paramedic work frequently exposes these workers to physical and psychological injury. Often paramedic injury rates are estimated based on national injury surveillance data or compensation databases. These data sources tend to only capture cases of a more serious nature and overlook the broader factors that contribute to injury. This limits our understanding of the true burden of paramedic injury and the characteristics associated with increased injury severity.

OBJECTIVES

To describe the incidence and proportions of paramedic occupational injury in Victoria, Australia, and to determine the injury-related characteristics associated with lost time from work.

METHODS

A retrospective analysis of paramedic injury report data from the single state-wide ambulance service in Victoria, Australia - Ambulance Victoria. Injuries reported between 1 January 2015 and 30 June 2020 were included. Chi-square tests of independence were used to explore shift and injury characteristic variables that may be associated with time lost from work.

RESULTS

Over the study period, 7,591 paramedic injuries were reported that met the inclusion criteria, of which 2,124 (28%) resulted in lost time from work. The cumulative incidence of paramedic injury was 333.8 injuries per 1,000 FTE workers per year, and the rate of lost time injury was 93.0 per 1,000 FTE workers per year. Musculoskeletal injuries were the most frequently reported injury type irrespective of lost time status. Manual handling followed by psychological stressors were the two leading mechanisms of injury based on incidence. Psychological injury was associated with lost time from work (X2= 384.2, p < 0.001). Conversely, injury to the head and neck (X2= 7.5, p = 0.006), and upper limb injuries (X2= 104.5, p < 0.001), were more strongly associated with no lost time from work.

CONCLUSIONS

Paramedics working in Victoria have a higher rate of work-related injury than other Australian workers. Injury-related factors that are often overlooked, such as time, shift type, location, and injury characteristics, all contribute to an increased risk of lost time injury. An understanding of the factors that contribute to an increase in injury severity may facilitate the development and targeting of appropriate interventions.

Relationship satisfaction moderates links between poor sleep quality and psychological distress among couples coping with type 1 diabetes

OBJECTIVES

We examined links between sleep quality and psychological distress among couples dealing with type 1 diabetes (T1D) across cross-sectional and daily diary methods and investigated whether relationship satisfaction moderated these associations.

METHODS

199 persons with T1D and their spouses completed survey questionnaires reporting their own sleep quality, depressive symptoms, and relationship satisfaction. They also completed 14-day diaries reporting their own sleep quality and negative affect. Multi-level actor-partner interdependence models examined associations between sleep quality and psychological distress.

RESULTS

Cross-sectional and daily diary data revealed an association between poorer sleep quality and higher psychological distress for both persons with T1D and their spouses (ie, actor effects). Some partner effects were found. For example, poorer sleep quality of persons with T1D was associated with greater negative affect for spouses (within persons). Relationship satisfaction moderated the effects of sleep quality on psychological distress. For example, participants' poorer overall daily sleep quality was associated with greater negative affect for those with lower relationship satisfaction but not for those with higher relationship satisfaction (ie, actor effects). In contrast, partners' poorer overall daily sleep quality was associated with participants' greater negative affect for those with higher relationship satisfaction but not for those with lower relationship satisfaction (ie, partner-effects).

CONCLUSION

Links between sleep quality and psychological distress occur both within and between persons. Relationship satisfaction moderates the effect of poorer sleep quality on psychological distress in a nuanced way.

Physical and psychological health in intern paramedics commencing shift work: Protocol for an exploratory longitudinal study

BACKGROUND

Paramedics are routinely exposed to shift work. Existing research shows that shift work exposure is associated with adverse mental and physical health outcomes. However, the current understanding of the impact of commencing shift work in a paramedic role on health is limited. This can be addressed by recruiting new paramedics before they commence shift work, and conducting regular follow-ups of potential biological, psychological and social changes. The present study aimed to examine changes in biological, psychological and social factors relative to pre-shift work baseline in a cohort of paramedics commencing intern employment with an Australian ambulance service.

METHOD AND ANALYSIS

This observational, mixed-methods, longitudinal study aims to recruit 40 interns from one Australian ambulance service. Data collection will occur at baseline (standard day schedule for initial training), and subsequently at three months, six months, nine months and twelve months, to measure biological, psychological and social changes relative to baseline measurements. Changes in cardiometabolic markers (cholesterol, triglycerides, fasting glucose), microbiome (self-collected stool samples), sleep and physical activity (actigraphy) will be measured. Interns will also complete a battery of self-report questionnaires, sleep diaries and qualitative interviews to explore various psychological and social variables over time. Statistical analyses will be conducted using mixed effects regression, specifying a random effect of subject on the intercept, allowing participants to vary according to individual baseline levels, as well as tracking progress over time, appropriately accounting for serial correlation. Qualitative study components will be analysed via coding and thematic analysis procedures.

DISCUSSION

The present study protocol is a comprehensive outline of the observational study planned. The study will allow for greater knowledge of any changes in biological, psychological and social factors during a 12-month transition to shift work. The findings from the proposed study will have implications for the development of strategies to support early-career shift workers.

The Molecular Relationship between Stress and Insomnia

The bi-directional relationship between sleep and stress has been actively researched as sleep disturbances and stress have become increasingly common in society. Interestingly, the brain and underlying neural circuits important for sleep regulation may respond uniquely to stress that leads to post-traumatic stress disorder (PTSD) and stress that does not. In stress that does not lead to PTSD, the hypothalamic-pituitary-adrenal axis (HPA) pathway is activated normally that results in sympathetic nervous system activation that allows the brain and body to return to baseline functioning. However, exposure to stress that leads to PTSD, causes enhanced negative feedback of this same pathway and results in long-term physiological and psychological changes. In this review, how stress regulates glucocorticoid signaling pathways in brain glial cells called astrocytes, and then mediates stress-induced insomnia are examined. Astrocytes are critical sleep regulatory cells and their connections to sleep and stress due to disturbed glucocorticoid signaling provide a novel mechanism to explain how stress leads to insomnia. This review will examine the interactions of stress neurobiology, astrocytes, sleep, and glucocorticoid signaling pathways and will examine the how stress that leads to PTSD and stress that does not impacts sleep-regulatory processes.

Prevalence of sleep disorders among first responders for medical emergencies: A meta-analysis

Background

Shift work and irregular work schedules among first responders have been associated with physical and psychological problems such as sleep disorders. We conducted the first meta-analysis to explore and estimate the prevalence of sleep disorders among first responders for medical emergencies.

Methods

We searched four databases: Web of Science, Psych Info, CINAHL, and PubMed. The Generalized Linear Mixed model (GLMM) was used to estimate the prevalence estimates of sleep disorders in R software and the DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis was used to explore associated comorbidities for OSA and insomnia, presented as odds ratios (ORs) and confidence intervals (CIs). The Cochran's Q, τ², and the statistics were used to assess heterogeneity and the moderator analysis was conducted to identify moderator variables.

Results

Twenty-eight studies with 100 080 first responders were included from the total of 1119 studies retrieved from the databases. The prevalence rates for sleep disorders were 31% (95% CI = 15%-53%) for shift work disorder (SWD), 30% (95% CI = 18%-46%) for obstructive sleep apnea (OSA), 28% (95% CI = 19%-39%) for insomnia, 28% (95% CI = 24%-33%) for excessive daytime sleepiness (EDS), 2% (95% CI = 1%-4%) for restless leg syndrome, and 1% (95% CI = 0%-5%) for narcolepsy. Anxiety (OR = 2.46; 95% CI = 1.99%-3.03%), cardiovascular disease (CVD) (OR = 2.03; 95% CI = 1.43-2.88), diabetes mellitus (DM) (OR = 1.93; 95% CI = 1.41-2.65), depression (OR = 1.89; 95% CI = 1.01-3.56), gastroesophageal reflux disease (GERD) (OR = 1.83; 95% CI = 150-2.22), and post-traumatic stress disorder (PTSD) (OR = 1.78; 95% CI = 1.33-2.39) were associated with OSA. Depression (OR = 9.74; 95% CI = 4.67-20.3), anxiety (OR = 9.22; 95% CI = 3.81-22.3), and PTSD (OR = 7.13; 95% CI = 6.27-8.10) were associated with insomnia. Age, gender, first responders, continent, study quality, study design, and assessment tool were significant moderator variables for OSA, insomnia, and EDS.

Conclusions

This meta-analysis found a substantially high prevalence of sleep disorders including SWD, OSA, insomnia, and EDS among first responders for medical emergencies. Early assessment and management of sleep disorders among first responders is necessary to promote good, quality sleep to help prevent anxiety, depression, CVD, DM, GERD, and PTSD.

Neural activation underlying emotional interference of cognitive control in rotating shift workers: moderating effects of the prefrontal cortex response on the association between sleep disturbance and depressive symptoms

Study Objectives

This study investigated the altered neural function involved in emotional interference and its role in linking sleep disturbance and depressive/anxiety symptoms in rotating shift workers.

Methods

Sixty rotating shift workers and 61 controls performed the emotional Stroop task in three blocks (emotional-related, sleep-related, and neutral words) during functional magnetic resonance imaging (fMRI) assessments. Sleep disturbance and depressive/anxiety symptoms were assessed using self-report measures and sleep diaries. Actigraphy was used to assess the sleep and circadian variables. fMRI scans were performed to compare brain activation during the emotional Stroop task. The proposed moderating models were tested using the PROCESS macro in SPSS software.

Results

A significant condition effect on reaction time was detected. Regardless of the group, reaction times were longer in the negative emotional word and sleep-related conditions than in the neutral word condition. Whole-brain analysis revealed that rotating shift workers show greater neural activation in the left dorsolateral prefrontal cortex (DLPFC) compared with controls while performing the emotional Stroop task with negative emotional words. Sleep disturbance was more strongly associated with depressive symptoms when activation of the left DLPFC was higher during the emotional Stroop task with negative words.

Conclusions

The left DLPFC may play important roles in increased sensitivity to emotional information, possibly due to circadian misalignment, and has moderating effects on the association between sleep disturbance and depressive symptoms in rotating shift workers. These findings will help to identify possible brain regions where interventions can be performed to correct sleep and mood problems in rotating shift workers.

Chronotype, circadian rhythm, and psychiatric disorders: Recent evidence and potential mechanisms

The circadian rhythm is crucial for physiological and behavioral functions. Chronotype, which represents individual preferences for activity and performance, is associated with human health issues, particularly psychiatric disorders. This narrative review, which focuses on the relationship between chronotype and mental disorders, provides an insight into the potential mechanism. Recent evidence indicates that (1) the evening chronotype is a risk factor for depressive disorders and substance use disorders, whereas the morning chronotype is a protective factor. (2) Evening chronotype individuals with bipolar disorder tend to have more severe symptoms and comorbidities. (3) The evening chronotype is only related to anxiety symptoms. (4) The relationship between chronotype and schizophrenia remains unclear, despite increasing evidence on their link. (5) The evening chronotype is significantly associated with eating disorders, with the majority of studies have focused on binge eating disorders. Furthermore, the underlying mechanisms or influence factors are described in detail, including clock genes, brain characteristics, neuroendocrinology, the light/dark cycle, social factors, psychological factors, and sleep disorders. These findings provide the latest evidence on chronotypes and psychiatric disorders and serve as a valuable reference for researchers.

Transition to shift work: Sleep patterns, activity levels, and physiological health of early-career paramedics

The physiological impact of transitioning from full-time study to work in occupations that involve high-stress environments and shift work may plausibly impact sleep patterns and quality. There are limited studies focusing on the transition to shift work in graduate paramedics. This study aimed to assess early metabolic markers of health, activity, and sleep quality during the first 5 months of rostered shift work in a cohort of 28 graduate paramedics. Participants were tested for 4-week blocks before starting shift work (baseline), and during their first and fifth month of shift work. In each block, sleep and activity levels were monitored 24 h/day (workdays and nonworking days) using a wrist-worn actigraph. During shift work, the number of sleep episodes increased by 16.7% (p = .02) and self-reporting of poor sleep quality increased by 35.4% (p = .05); however, overall sleep quantity and sleep efficiency did not differ. Sleep metrics recorded during nonwork days were not different to baseline with exception of reduced sleep duration recorded the night before returning to work (5.99 ± 1.66 hours Month 1; 5.72 ± 1.06 hours Month 5). Sedentary behavior increased by 4.8% across the study, attributable to a significant decline in light exercise (p = .05). No changes were recorded in vigorous physical activity, average steps recorded per day, fasting blood glucose levels, systolic and diastolic blood pressure, weight, or waist circumference. These results warrant further large-scale and longitudinal studies to gauge any physiological implications for ongoing paramedic health.

Effects of Factors Related to Shift Work on Depression and Anxiety in Nurses

Background

Although shift work is the foundation of the provision of 24-h continuous care in hospitals, it can negatively impact mental health in hospital workers such as nurses. Despite the connection between mental health and overall health, little is known about the effect of shift work-related factors on mental health in this population.

Objectives

We investigated the effect of scheduling practices, physical and psychological characteristics related to shift work, and personal habits during shift work on depression and anxiety among nurses.

Methods

In this multi-center cross-sectional study, 11,061 nurses from 20 hospitals in the Shandong Province of China completed an online survey between December 2020 and February 2022. Multivariate ordered logistic regression analysis was performed to examine shift-related factors associated with depression and anxiety in the study population.

Results

The completion rate of all nurses' questionnaires was 83.00% (n = 9,181). Among the 9,181 respondents, 66.20% (n = 6,078) were shift nurses. Depression and anxiety were found in 58.82 and 62.08% of shift nurses, respectively, and these rates were influenced by fatigue during shift work, psychological stress before/during/after night shifts, feeling of being refreshed after resting before/after night shifts, using sleep medication before/after night shifts, physical discomfort during night shifts, busyness during night shifts, food intake during shift work, working > 40 h/week during shift work, and sleep quality before/after night shifts.

Conclusions

Depression and anxiety in shift nurses may be addressed by reducing their workload, sources of stress during night shifts, and facilitating rest and relaxation.

Saudi female paramedics' perceptions of challenges in the workplace: A qualitative study

BACKGROUND

It is immensely important that Saudi women become involved in the field of paramedicine in larger numbers; however, anecdotally they continue to experience significant challenges that limit their opportunities for recruitment and deployment in the field. This study set out to explore working female paramedics' perceptions of challenges in their workplace in the Kingdom of Saudi Arabia (KSA).

METHODS

This study utilised a descriptive qualitative approach. Fifteen Saudi female paramedics were recruited to attend one of four focus groups in Riyadh, Saudi Arabia. Data were assessed using thematic analysis.

RESULTS

Three themes emerged from the focus groups that described the perceptions of Saudi female paramedics: personal factors, social factors and employment-related factors. They faced several challenges that could affect their family responsibilities, workplace duties and capacity to work in the field of paramedicine. Saudi society also challenged female paramedics, as the culture and traditions of the KSA limited their participation in the paramedicine workforce. Furthermore, they reported experiencing many employment issues related to recruitment to pre-hospital settings, resulting from organisational policies and procedures.

CONCLUSION

This study investigated the perceptions held by a cohort of female Saudi paramedics of the personal and professional challenges they faced in the workplace in the KSA. The study findings and their implications for female paramedics suggest further research is required to understand the unique challenges they face and to develop various strategies to manage them.

Mental Health Outcomes in Australian Healthcare and Aged-Care Workers during the Second Year of the COVID-19 Pandemic

Objective: the COVID-19 pandemic has incurred psychological risks for healthcare workers (HCWs). We established a Victorian HCW cohort (the Coronavirus in Victorian Healthcare and Aged-Care Workers (COVIC-HA) cohort study) to examine COVID-19 impacts on HCWs and assess organisational responses over time. Methods: mixed-methods cohort study, with baseline data collected via an online survey (7 May–18 July 2021) across four healthcare settings: ambulance, hospitals, primary care, and residential aged-care. Outcomes included self-reported symptoms of depression, anxiety, post-traumatic stress (PTS), wellbeing, burnout, and resilience, measured using validated tools. Work and home-related COVID-19 impacts and perceptions of workplace responses were also captured. Results: among 984 HCWs, symptoms of clinically significant depression, anxiety, and PTS were reported by 22.5%, 14.0%, and 20.4%, respectively, highest among paramedics and nurses. Emotional exhaustion reflecting moderate–severe burnout was reported by 65.1%. Concerns about contracting COVID-19 at work and transmitting COVID-19 were common, but 91.2% felt well-informed on workplace changes and 78.3% reported that support services were available. Conclusions: Australian HCWs employed during 2021 experienced adverse mental health outcomes, with prevalence differences observed according to occupation. Longitudinal evidence is needed to inform workplace strategies that support the physical and mental wellbeing of HCWs at organisational and state policy levels.

A systematic review of incidence, prevalence, and trends in health outcomes for Australian and New Zealand paramedics

Introduction: The paramedic role carries inherent risk to practitioner health, due to a combination of work characteristics and the employment practices of different organisations. Emerging evidence suggests that paramedics worldwide may face a range of negative health outcomes. The purpose of this paper was to systematically review the literature of paramedic health outcomes in the Australian and New Zealand context.Methods: A systematic search of key databases and grey literature was conducted to identify all available studies reporting on quantitative health outcomes for paramedics working in Australia or New Zealand. The review was conducted using the JBI methodology for prevalence studies, and uses a narrative synthesis approach to reporting.Results: There were k = 20 studies that met inclusion criteria, and most used Australian samples. Results indicated between 57.3-66.5% of paramedics studied were classified as overweight or obese, while up to 80% reported poor sleep, and 55.6% reported fatigue. Incidence rates per 100,000 FTE included 26.62 for completed suicide, 5.46 for drug-caused death, and 9.3 for workplace fatalities. The most recent incidence per 1,000 FTE for injury compensation claims was 141.4.Conclusions: Australian and New Zealand paramedics demonstrate poor health according to several metrics. Our sample demonstrated considerably worse health than the general population or similar occupations. There is little trend data available, so it was difficult to ascertain if rates are changing. The range of health outcomes studied was limited, and correlations between different health outcomes were rarely considered by authors. Data relating to specific rates for gender and sexuality, location of work, and First Nations status or ethnicity was often not available.Systematic review registration number (PROSPERO): CRD42021232196.

Insomnia Partially Mediates the Relationship of Occupational Stress with Mental Health Among Shift Working Nurses and Midwives in Polish Hospitals

PURPOSE

Insufficient sleep increases sensitivity to chronic stress and may be a precursor to the deterioration of mental health and the development of burnout. The aim of our study was to verify whether symptoms of insomnia mediate the relationship of occupational stress with mental health among nurses who work shifts.

MATERIALS AND METHODS

The analyses included 117 female nurses and midwives who work shifts. They filled in the 16-item Effort-Reward Imbalance Questionnaire (ERIQ) assessing occupational stress, the Insomnia Severity Index (ISI), the Patient Health Questionnaire (PHQ-9, the question about sleep was excluded from the analyses), the Generalized Anxiety Disorder Assessment (GAD-7), and the 16-item Oldenburg Burnout Inventory (OLBI) consisting of two scales - Disengagement and Exhaustion (OLBI-D and OLBI-E).

RESULTS

Insomnia partially mediated the association of the effort-reward imbalance ratio with depression, anxiety and the exhaustion dimension of burnout. We found no association of insomnia symptoms with the depersonalization dimension of burnout, but the effort-reward imbalance ratio was associated with the depersonalization scale.

CONCLUSION

The results showed that occupational stress has varying degrees of influence on mental health, partly depending on the severity of insomnia symptoms among nurses and midwives who work shifts.

Firefighter sleep: a pilot study of the agreement between actigraphy and self-reported sleep measures

STUDY OBJECTIVES

The aim of this study is to determine the extent of agreement between self-reported measurements of total sleep time (TST) and actigraphy in the fire and emergency services occupation.

METHODS

Twenty-four firefighters participated in an 18-day study. Four measurements were used to assess TST: Pittsburgh Sleep Quality Index, a newly developed habitual Extended Sleep Survey, a newly developed daily Emergency Services Sleep Diary (ESSD), and actigraphy. The Extended Sleep Survey and ESSD were constructed to address the specific job-related characteristics of fire and emergency services that other measurements cannot achieve (eg, multiple sleep episode in a single night).

RESULTS

The Pittsburgh Sleep Quality Index TST is least accurate compared to actigraphy. The Extended Sleep Survey TST shows improvement over Pittsburgh Sleep Quality Index TST, but was statistically different from actigraphy TST. No difference in mean TST was found between ESSD TST and actigraphy TST. Furthermore, ESSD TST and actigraphy TST correlated strongly together.

CONCLUSIONS

Without modification, traditional self-reported measures may not be appropriate in the fire and emergency service occupation. This study suggests that the ESSD may serve as a useful alternative to actigraphy to measure TST.

CITATION

Billings JM. Firefighter sleep: a pilot study of the agreement between actigraphy and self-reported sleep measures. J Clin Sleep Med. 2022;18(1):109-117.

The interaction of occupational stress, mental health, and cytokine levels on sleep in Xinjiang oil workers: A cross-sectional study

BACKGROUND

Sleep occupies one third of a person's life, and good sleep quality is an important factor to ensure good health.

PURPOSE

This study investigated and analyzed the occupational stress, mental health and sleep quality of oil workers, analyzed the effects of occupational stress and mental health on sleep, and explored the effects of the interaction between occupational stress, mental health and cytokines on sleep.

MATERIALS AND METHODS

In this study, stratified cluster random sampling was used to conduct a cross-sectional survey on the occupational stress, mental health and sleep quality of 1,141 oil workers in the Occupational Health Examination Department of Karamay Central Hospital, from June 2019 to January 2020, and 30% of the participants were randomly selected for measurement of their cytokine levels: interleukin 2 (IL-2), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor α (TNF-α). The objectives were to analyze the effects of occupational stress and mental health on sleep quality, and to explore the effects of occupational stress, mental disorders and cytokine interactions on sleep.

RESULTS

There were 646 individuals (56.6%) who suffered from sleep disorders; the incidence of sleep disorders differed according to sex, age, professional title, working years, type of work and shift (P < 0.05). The scores for occupational stress, mental health, and sleep quality were positively correlated (P < 0.05). Multivariate logistic regression analysis showed that age (30-45 years) (OR = 1.753, 95% CI: 1.067-2.881), junior college and above (OR = 1.473, 95% CI: 1.025-2.118), borehole operation (OR = 2.689, 95% CI: 1.508-4.792), extraction of oil (OR = 2.405, 95% CI: 1.229-4.705), drilling (OR = 1.791, 95% CI: 1.017-3.155), shift work (OR = 2.144, 95% CI: 1.615-2.846), occupational stress (OR = 1.007, 95% CI: 1.002-1.013), and mental disorders (OR = 1.020, 95% CI: 1.009-1.032) are risk factors for sleep disorders. In the high occupational stress group and the mental disorders group as the control group, the results showed that the interaction between IL-2 and moderate occupational stress (OR = 0.778, 95% CI: 0.778-0.942), IL-2 and non-mental disorders (OR = 0.398, 95% CI: 0.398-0.468) were protective factors for the occurrence of sleep disorders. The results of structural equation modeling analysis showed that occupational stress and mental health had positive predictive effects on IL-2 level and sleep quality [normalized path coefficients (β) were 0.10\0.06\0.05\0.71, respectively]. Occupational stress had a direct positive predictive effect on mental disorder (β = 0.25), and sleep disorder had a direct negative predictive effect on IL-2 concentration (β = -0.21).

CONCLUSION

Oil workers have serious sleep problems, so effective measures should be taken to reduce occupational stress and relieve mental health problems, and cytokine levels can be used as a predictor of sleep disorders.

The impact of sleep, physical activity and sedentary behaviour on symptoms of depression and anxiety before and during the COVID-19 pandemic in a sample of South African participants

During lockdowns associated with the COVID-19 pandemic, individuals have experienced poor sleep quality and sleep regularity, changes in lifestyle behaviours, and heightened depression and anxiety. However, the inter-relationship and relative strength of those behaviours on mental health outcomes is still unknown. We collected data between 12 May and 15 June 2020 from 1048 South African adults (age: 32.76 ± 14.43 years; n = 767 female; n = 473 students) using an online questionnaire. Using structural equation modelling, we investigated how insomnia symptoms, sleep regularity, exercise intensity/frequency and sitting/screen-use (sedentary screen-use) interacted to predict depressive and anxiety-related symptoms before and during lockdown. We also controlled for the effects of sex and student status. Irrespective of lockdown, (a) more severe symptoms of insomnia and greater sedentary screen-use predicted greater symptoms of depression and anxiety and (b) the effects of sedentary screen-use on mental health outcomes were mediated by insomnia. The effects of physical activity on mental health outcomes, however, were only significant during lockdown. Low physical activity predicted greater insomnia symptom severity, which in turn predicted increased depressive and anxiety-related symptoms. Overall, relationships between the study variables and mental health outcomes were amplified during lockdown. The findings highlight the importance of maintaining physical activity and reducing sedentary screen-use to promote better sleep and mental health.

Association between sleep characteristics, ideal cardiovascular health, and systemic inflammation, NHANES 2017-2018

There is conflicting evidence regarding the associations between sleep deprivation and inflammatory biomarkers indicative of cardiovascular disease risk, such as high-sensitivity C-reactive protein (hsCRP). The association between sleep habits and hsCRP was quantified in a nationally representative sample of adults in the United States and mediation by ideal cardiovascular health metrics was explored. A cross-sectional analysis of cardiovascular disease-free participants aged 20-79 years from the 2017-2018 National Health and Nutrition Examination Survey was conducted. The primary exposures were self-reported sleep duration, sleep debt (difference between the average weekday and weekend sleep duration), and ideal cardiovascular health (11-14 points). The primary outcome was hsCRP (high-risk ≥ 3.0 mg/L). Multivariable robust Poisson models were used to estimate prevalence ratios after multiple imputation. A subgroup analysis of shift workers was also conducted. Of 4027 participants included (mean age 46 years; 52% female; 41% shift workers), the prevalence of sleeping <6 h on weekdays was 9%, with 40% sleeping ≥9 h on weekends. One-quarter had a high (≥2 h) sleep debt, 82% had poor cardiovascular health, and 34% had high-risk hsCRP. There were no significant associations between weekday sleep duration or sleep debt with high-risk hsCRP, even among shift workers. Mediation analysis was not conducted. Ideal cardiovascular health was associated with a lower prevalence of high-risk hsCRP (prevalence ratios, 0.60, 95% CI, 0.48-0.75). The lack of significant associations suggests a complex interrelationship of hsCRP with factors beyond sleep duration. Examination of populations at highest risk of chronic sleep deprivation could help to elucidate the association with systemic inflammation-related outcomes.