Dietary and lifestyle habits and the associated health risks in shift workers

Ecological momentary assessment of physical activity and sedentary behaviour in shift workers and non-shift workers: Validation study

This study examined the criterion validity of an ecological momentary assessment (EMA)-reported physical activity and sedentary time compared with accelerometry in shift workers and non-shift workers. Australian workers (n = 102) received prompts through a mobile EMA app and wore the Actigraph accelerometer on the right hip for 7-10 days. Participants received five EMA prompts per day at 3-hour intervals on their mobile phones. EMA prompts sent to shift workers (SW-T) were tailored according to their work schedule. Non-shift workers (NSW-S) received prompts at standardised times. To assess criterion validity, the association of EMA-reported activities and the Actigraph accelerometer activity counts and number of steps were used. Participants were 36 ± 11 years and 58% were female. On occasions where participants reported physical activity, acceleration counts per minute (CPM) and steps were significantly higher (β = 1184 CPM, CI 95%: 1034, 1334; β = 20.9 steps, CI 95%: 18.2, 23.6) than each of the other EMA activities. Acceleration counts and steps were lower when sitting was reported than when no sitting was reported by EMA. Our study showed that EMA-reported physical activity and sedentary time was significantly associated with accelerometer-derived data. Therefore, EMA can be considered to assess shift workers' movement-related behaviours with accelerometers to provide rich contextual data.

A low-calorie meal replacement improves body composition and metabolic parameters in shift workers with overweight and obesity: a randomized, controlled, parallel group trial

BACKGROUND

Shift work has been identified as a risk factor for several chronic health conditions including obesity. This study evaluated the impact of a low-calorie meal replacement (MR) as a dinner substitute on body composition and metabolic parameters in shift workers with overweight and obesity.

METHODS

An 8-week parallel, randomized controlled trial was conducted on overweight and obese shift workers in a large hospital. An intervention group (IG) (n = 25) was provided with a low-calorie MR shake (∼200 kcal) as a replacement for dinner, every day for 8 weeks, while the control group (CG) (n = 25) continued their habitual diet. Anthropometric measurements, body composition, biochemical, and lifestyle data were assessed at the first and last visits. Analyses were done per protocol (PP) and by intention to treat (ITT).

RESULTS

Over the study duration, both groups displayed moderate changes in anthropometric measurements and body composition, although these were not statistically significant according to the PP analysis. In the ITT analysis, apart from the hip circumference (HC), all other anthropometric parameters demonstrated significant group and time interactions, suggesting the advantageous effects of the meal replacement over the study period (P < 0.05). HDL and VLDL cholesterol measures showed significant main effects, influenced by both group (P = 0.031) and time (P = 0.050) respectively. The most pronounced dietary shift in the IG was a reduction in carbohydrate consumption and an increase in protein intake. Throughout the study, the meal replacement was well-tolerated, with no adverse events reported.

CONCLUSIONS

The meal replacement dietary intervention appears to offer beneficial health effects over time. Extended research is crucial to understand the broader implications of meal replacements across diverse populations.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000231741. Registered on 09 February 2022. https://www.anzctr.org.au/ACTRN12622000231741.aspx .

What alleviates the harmful effect of strain on recovery from work of 4478 health and social services workers? A cross-sectional study

AIM

To analyse whether the harmful effect of job demands on recovery can be alleviated by healthy lifestyle, psychological recovery experiences and job resources. We also describe their prevalence among employees in different types of eldercare service and in the health and social services sector in general.

DESIGN

Cross-sectional study.

METHODS

The data were collected using a self-report survey in 2020 in the health and social services sector organizations (n = 4478). Employees were classified as the following service types: general health and social services (N = 3225), home care (N = 452), service housing (N = 550) and outpatient and ward care (N = 202). The data were analysed using percentages, cross-tabulations and logistic regression analysis.

RESULTS

Poor recovery, high job demands, low appreciation and low autonomy in terms of worktime and breaks were more prevalent in eldercare. Employers could alleviate the risk of high job demands by offering job resources-appreciation, autonomy in terms of worktimes and breaks-and motivating employees to maintain healthy lifestyle habits and use recovery experiences such as relaxation.

CONCLUSION

The study emphasizes the importance of appreciation in the health and social services sector context. Even with moderate levels of appreciation employers can protect employees from poor recovery from work in the demanding health and social services work environment.

IMPACT

Eldercare employees face continuous and accumulating work strain at the same time as the sector struggles against a labour shortage. One way to prevent the harmful consequences of strain is to enhance recovery from work. Employers could alleviate the risk of high job demands and poor recovery by showing appreciation and giving employees more autonomy in terms of work time and breaks during the workday. This could also motivate employees to keep up healthy lifestyle habits and use their recovery experiences. Results are important especially in the daily management of HSS work. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Managers in the health and social services sector and eldercare can use these findings to promote recovery from work.

REPORTING METHOD

STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Physiological and Pharmacological Significance of the Circadian Timing of the HPA Axis: A Mathematical Modeling Approach

As a potent endogenous regulator of homeostasis, the circadian time-keeping system synchronizes internal physiology to periodic changes in the external environment to enhance survival. Adapting endogenous rhythms to the external time is accomplished hierarchically with the central pacemaker located in the suprachiasmatic nucleus (SCN) signaling the hypothalamus-pituitary-adrenal (HPA) axis to release hormones, notably cortisol, which help maintain the body's circadian rhythm. Given the essential role of HPA-releasing hormones in regulating physiological functions, including immune response, cell cycle, and energy metabolism, their daily variation is critical for the proper function of the circadian timing system. In this review, we focus on cortisol and key fundamental properties of the HPA axis and highlight their importance in controlling circadian dynamics. We demonstrate how systems-driven, mathematical modeling of the HPA axis complements experimental findings, enhances our understanding of complex physiological systems, helps predict potential mechanisms of action, and elucidates the consequences of circadian disruption. Finally, we outline the implications of circadian regulation in the context of personalized chronotherapy. Focusing on the chrono-pharmacology of synthetic glucocorticoids, we review the challenges and opportunities associated with moving toward personalized therapies that capitalize on circadian rhythms.

The mediation of health-promoting lifestyle on self-perceived health status and quality of life among nurses: a cross-sectional study

BACKGROUND

Nurses with busy workloads lack the time to maintain health, leading to a decline in physical and mental health and quality of life. It is widely accepted that self-perception of health triggers health-promoting behaviors and impacts the quality of life; however, the relationship between these factors among nurses is unclear. The purpose of this study was to investigate the ability of a health-promoting lifestyle to mediate the relationship between self-perceived health and quality of life among nurses.

METHODS

A cross-sectional survey was conducted in four regional Taiwanese teaching hospitals with over 500 beds. The survey used stratified random sampling of 600 nurses who had worked for more than six months. The Self-Perceived Health Questionnaire, the Health-Promoting Lifestyle Profile, and the World Health Organization Quality of Life Scale were used to measure nurses' self-perceived health (SPH), health-promoting lifestyle (HPL), and quality of life (QoL). A Hayes PROCESS analysis and bootstrapping method were used for the mediation analysis.

RESULTS

A total of 518 nurses' data was included in the analysis. Nurses perceived their health status as less favorable than their colleagues, but frequently adopted health promotion behaviors. Nurses reported a moderate QoL. QoL and SPH were correlated (r = .33) and a high correlation between QoL and HPL (r = .64) was found. SPH and HPL both affect QoL (B = 0.077 and 0.070). SPH and HPL explained 42.6% of the variation in QoL. HPL played a partial mediation role.

CONCLUSIONS

The study confirmed that HPL has an important role in mediating nurses' SPH and QoL. Nurse administrators are advised to encourage nurses to monitor their health status and provide health promotion mechanisms to improve their quality of life.

Recovery from shift work

One fifth of today's workforce is engaged in shift work and exposed to various mental and physical health risks including shift work disorder. Efficiently recovering from shift work through physical and mental interventions allows us to mitigate negative effects on health, enables a better work-life balance and enhances our overall wellbeing. The aim of this review is to provide a state-of-the-art overview of the available literature. The role of sleep timing and naps, light therapy and psychotherapy, diet and exercise in recovery from shift work is presented here. We further review the impact of shift schedules and social support on post-shift unwinding.

Individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare: A cross-sectional survey

BACKGROUND

The present study aimed to understand the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings.

METHODS

A cross-sectional study was conducted using data collected from an anonymous online survey. Participant agreement was measured using five-point Likert scale (strongly disagree to strongly agree) against 38 belief statements informed by the Theoretical Domains Framework (TDF) of behaviour change.

RESULTS

From the complete responses (n = 119), 65% worked shifts without nights, 27% worked mixed shift rota including nights and 8% worked only night shifts. The statements ranked with the highest agreements were in the TDF domains: Environment Context/Resources (ECR) - mainly identified as a barrier to healthy eating, Behaviour Regulation (BR) and intention (IN) - identified as enablers to healthy eating. For the belief statement 'the available options for purchasing food are too expensive' (ECR), 80% of night workers and 75% non-night workers agreed/strongly agreed. Taking their own food to work to prevent making unhealthy food choices (BR) had agreement/strong agreement in 73% of non-night and 70% night workers; 74% non-night workers and 80% of night workers agreed/strongly agreed with the statement 'I would like to eat healthily at work' (IN). Mixed shift workers agreed that following dietary advice was easier when working a non-night compared to a night shift (p = 0.002).

CONCLUSIONS

Access and affordability of food were identified as important determinants of dietary behaviour during shifts. The findings support interventions targeting the food environment for shift workers with T2D.

Common mental disorders in Brazilian female shift workers: prevalence and associated factors

This study aimed to identify the prevalence of common mental disorders (CMD) and associated factors in female shift workers. A cross-sectional study was conducted with a sample of 450 female workers, aged 18 years or older (± 36.1 years), from an industry located in Southern Brazil. CMD was assessed using the self-reporting questionnaire (SRQ-20 ≥ 8 points), and sociodemographic, occupational, behavioral, morbidity, and self-rated health characteristics were assessed using a questionnaire survey. The prevalence of CMD was 47.3% (95% CI: 42.6-52.1). After adjusting, female workers with black/brown race/skin color had a 22% higher probability of CMD than white workers (prevalence ratio (PR) = 1.22; 95% CI: 1.01-1.49), and workers with sleep disorders or poor sleep quality were 147% more likely to have CMD compared with those with good sleep quality (PR = 2.47; 95% CI: 1.70-3.58), and workers with fair/poor self-rated health were twice as likely to have CMD (PR = 2.00; 95% CI: 1.43-2.80) compared to those with excellent/very good self-rated health. A high prevalence of CMD was observed in female shift workers, especially in workers with a black/brown race/skin color and with poor sleep quality and self-rated health.

Designing Optimal Food-Based Recommendations and Nutrient-Dense Canteen Menu for Oil and Gas Workers Using Linear Programming: A Preliminary Study in Oil and Gas Worksite in East Kalimantan, Indonesia

The objective of this study is to identify problem nutrients and to develop food-based recommendations (FBRs) and nutrient-dense menus based on the nutrient gaps. This study was conducted among male workers (n = 31) in an oil and gas worksite in East Kalimantan, Indonesia. Body weight, height, waist circumference, as well as systolic and diastolic blood pressure were measured. Weekly food consumption patterns were assessed using 1 day 24 h dietary recall (24HR), 1 day weighed food record (WFR), and 5 day food tally. Linear programming (LP) analysis using WHO Optifood software was used to identify problem nutrients and develop FBRs. The identified nutrient gaps were inserted in the nutrient-dense menu for the worksite canteen. Obesity, central obesity, and hypertension were reported in 64.5%, 48.4%, and 3.2% of the workers. Calcium, folate, total PUFA, n-6 PUFA, and dietary fiber were identified as problem nutrients. The FBRs can improve the intake of problem nutrients from 20% of recommended nutrient intake (RNI) in the nonoptimized diet to 50-70% RNI in the optimized diet, while controlling the intake of sodium and saturated fat within an acceptable range. The remaining nutrient gaps (calcium, total PUFA, n-6 PUFA, and dietary fiber) were inserted into the 14-day modified canteen snack menu. This study provides initial evidence that a combination of FBRs and a modified canteen menu can optimize the diet of the workers. Further studies assessing the effectiveness of the developed FBRs and modified menus are needed.

Association of Night Shifts and Lifestyle Risks With Incident Dementia

BACKGROUND

Little is known about the combined relationship between night shifts and lifestyle risks with incident dementia or their potential interactions. To evaluate the association of night shifts and lifestyle risks with incident dementia and further analyze their interactions.

METHODS

A total of 276 059 participants were included in this study from the UK Biobank cohort. Cox proportional hazards models were used to investigate the combined association of night shifts and lifestyle risks with incident dementia.

RESULTS

Participants with always night shifts and 3 or 4 unhealthy lifestyle factors had the highest risk of incident all-cause dementia (hazard ratio: 3.15, 95% confidence interval [CI]: 1.74-5.69). An additive interaction was found between night shifts and lifestyle risks for incident all-cause dementia (p < .001), with a relative excess risk due to the interaction of 0.14 (95% CI: 0.11-0.45). The attributable proportions of the combined effect on the incidence of all-cause dementia were 22.6% (95% CI: 20.91%-26.75%) for night shift work, 65.0% (95% CI: 63.12%-69.80%) for unhealthy lifestyle factors, and 12.1% (95% CI: 8.67%-18.04%) for their interaction.

CONCLUSIONS

Both night shifts and lifestyle risks were associated with a higher risk of incident dementia. The combined impact was higher than the increase in the risks related to each single factor. Our results indicated that most incident dementia cases might be prevented by a healthy lifestyle, and the benefits would be greater among night shift workers. Further studies are needed to confirm our results and explore the underlying mechanisms.

Incidence of cancer among Nordic police officers

Police work may expose officers to various circumstances that have potential for increasing their risk of cancer, including traffic-related air pollution, night shift work and radiation from radars. In this study, we examined the incidence of cancer among Nordic male and female police officers. We utilize data from the Nordic Occupational Cancer (NOCCA) project, which linked census data on occupations from Finland, Iceland, Norway and Sweden to national cancer registries for the period 1961 to 2005. We report standardized incidence ratios (SIR) and 95% confidence intervals (CI) of selected cancers for each country by sex, age and calendar period. The cohort included 38 523 male and 1998 female police officers. As compared with the general population, male police officers had a 7% (95% CI: 4-9%) excess cancer risk, with elevated SIRs for various cancer sites, including prostate (SIR 1.19, 1.14-1.25), breast (SIR 1.77, 1.05-2.80), colon (SIR 1.22, 1.12-1.32) and skin melanoma (SIR 1.44, 1.28-1.60). Conversely, male police officers had a lower risk of lung cancer than the general population (SIR 0.72, 0.66-0.77). In female police officers, the SIR for cancer overall was 1.15 (0.98-1.34), and there was a slight excess of cancers of the breast (SIR 1.25, 0.97-1.59) and colon (SIR 1.21, 0.55-2.30). In conclusion, cancer incidence among the police officers was slightly higher than in the general population. Notably, SIRs were elevated for cancer sites potentially related to night shift work, namely colon, breast and prostate cancer.

Meal timing variability of rotating shift workers throughout a complete shift cycle and its effect on daily energy and macronutrient intake: a field study

PURPOSE

To evaluate the meal timing variability of rotating shift workers throughout a complete shift schedule and its effect on daily energy and macronutrient intake.

METHODS

Thirty male shift-workers from a mining company were evaluated in a complete rotation shift cycle over 240 consecutive hours (10 days; two days of morning shifts, two days of evening shifts, 24 h free, two days of night shifts and three days off). Food intake related variables [meal timing, energy (kcal) and macronutrient intake (%)] were assessed by 24 h recall by a trained nutritionist. Mixed models were used to analyze the variation in meal timing and energy and macronutrient intake throughout the shift cycle, as well as the interaction between shift and time ranges (00:00-03:59, 04:00-07:59, 08:00-11:59, 12:00-15:59, 16:00-19:59, 20:00-23:59).

RESULTS

The first meal of the day was earlier on night shifts [D6 (3:44 ± 0:33) and D7 (5:52 ± 0:42)] compared to the other shifts (p < 0.001), except for D4 (evening shift; 5:51 ± 0:47) versus D7 (p = 0.999). Night shifts also showed a shorter night fasting (D5-D6, 9.3 h; D6-D7, 9.6 h) than most other nights (p < 0.05), except for the fasting between D1-D2 (11.3 h) and D3-D4 (11.2 h) (p > 0.05). There was no difference in 24 h energy intake throughout the shift cycle (p = 0.065). The analysis of interaction between shift and time ranges showed that night shift (D6) presented a higher intake of energy (441.5 ± 48.4 kcal), percentage of energy (D6: 17.8 ± 1.8%), fat (17.6 ± 2.0%), carbohydrate (17.0 ± 1.7%) and protein (16.4 ± 1.8%) between 00:00 and 03:59 compared with the other shift days (p < 0.05).

CONCLUSION

Night shifts seem to contribute to a longer eating window than other shifts. Moreover, there is a higher energy and macronutrients intake during night shifts, which reduces the night fast period and could have implications for metabolic dysregulation.

Eating Patterns among Emergency Medical Service Providers in the United States: A Qualitative Interview Study

Emergency medical service (EMS) providers experience demanding work conditions in addition to shift work, which increases risk for nutrition related chronic disease such as metabolic syndrome, diabetes, obesity, and cardiovascular disease. The high stress, emergent, and unpredictable nature of EMS may interfere with healthy eating patterns on and off shift, however little is known about how these conditions impact dietary patterns among EMS providers. This study aimed to understand factors impacting dietary patterns through semi-structured interviews with 40 EMS providers throughout the United States. Interviews were conducted virtually via Zoom video conference. Inductive coding was used to identify themes throughout the interviews. Salient factors mentioned in the interviews included hunger, fatigue, stress, coworker influence, ambulance posting, geographical location, agency policy, and culture. Factors were grouped into 4 domains: physiological factors, psychosocial factors, physical environment, and organizational environment, represented by an adapted version of the social ecological model of health behaviors to include factors influencing eating patterns specific to EMS, which may contribute to overall health. Various barriers to healthy eating exist within EMS, and future studies should explore interventions at each level of our proposed model to improve conditions and reduce nutrition related disease risk in this essential population.

Association between shift work and inflammatory markers in workers at an electronics manufacturing company

Background

Shift work is known to be associated with cardiovascular disease (CVD). It has been found that inflammatory reactions are involved in the onset and progression of CVD. Therefore, the purpose of this study was to investigate the association between shift work and inflammatory markers.

Methods

Among workers at an electronics manufacturing company, 2,329 workers who had a health checkup from January 2019 to December 2019 were targeted. The general and biochemical characteristics of daytime workers and shift workers were compared through the Independent-test and the χ² test. Through multiple linear regression analysis, the association with shift work and inflammatory markers was investigated. Through multiple logistic regression analysis, the association with shift work and high inflammatory markers.

Results

The mean total leukocytes, neutrophils, monocytes, lymphocytes of shift workers were significantly higher than those of daytime worker. The mean high-sensitivity C-reactive protein (hs-CRP) of shift workers was also higher than that of daytime workers but not significantly. In multiple linear regression, shift work was associated with increase of total leukocyte count (β = 0.367, p < 0.001) and hs-CRP (β = 0.140, p = 0.005) after adjusting for all variables. In multiple logistic regression analysis, shift work showed 2.27 times risk of high leukocyte count and 1.8 times risk of high hs-CRP level compared to daytime work after adjusting for all variables.

Conclusions

This study confirmed that shift work is associated with high inflammatory markers. Considering that high inflammatory markers is independent indicator of CVD, the association between shift work and high inflammatory markers may help to understand the CVD risk of shift workers.

Concurrent trajectories of self-rated health and working hour patterns in health care shift workers: A longitudinal analysis with 8-year follow-up

Background

The association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working <35 h/week and working night shifts) and the extent to which these trajectories were predicted by employees' lifestyle and mental health.

Methods

Participants of this cohort study with a 8-year follow-up were 5,947 health care shift workers. We linked self-reports of health from three repeated surveys with objective pay-roll based data on working hours. Using group-based multi-trajectory analysis we identified concurrent trajectories for self-rated health and working hour patterns. We examined their associations with baseline lifestyle-related factors (smoking, at-risk alcohol use, obesity, and physical inactivity) and mental health (sleep problems and psychological distress) using multinomial regression analysis.

Results

Three combined trajectories of self-rated health and working <35 h/week and four combined trajectories of self-rated health and night work were identified. Unhealthy lifestyle and poor mental health were associated with trajectories of moderate and declining health. Sleep problems were linked with working <35 h/week. Younger age and good mental health were associated with a combined trajectory of good health and continued night shift work.

Conclusion

Trajectories of suboptimal and declining health are associated with trajectories of reducing working hours and leaving night work, and are more common in employees with unhealthy lifestyle, sleep problems, and psychological distress.

Does Shiftwork Impact Cognitive Performance? Findings from the Canadian Longitudinal Study on Aging (CLSA)

Few large nationwide studies have investigated the relationship between shiftwork and cognitive performance, and little is known about whether and how psychological distress may impact this relationship. This study aimed to examine: (1) the cross-sectional relationship between shiftwork (yes/no) and some aspects of cognitive performance (declarative memory and executive functioning) and (2) the potential moderating effect of psychological distress among 20,610 community-dwelling adults from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). Differences by sex and retirement status were also explored. Shiftwork was significantly associated with poorer performance for executive functioning (interference condition: ß = 0.47, 95% CI: 0.31 to 0.63; MAT: ß = -0.85, 95% CI: -1.21 to -0.50) but not for declarative memory. Completely and not/partly retired males showed poorer cognitive performance on executive functioning. However, no evidence of a moderating effect by psychological distress was found. Our findings confirm the association between shiftwork and cognitive performance and highlight important health correlates of shiftwork.

Factors Associated with Gastrointestinal Symptoms among Rotating Shift Nurses in South Korea: A Cross-Sectional Study

Rotating shift work places a serious burden on nurses' physical and psychological health. Gastrointestinal (GI) symptoms are a common complaint among shift workers. This study assessed GI symptoms and identified the associations between dietary habits, psychological status, and sleep quality among rotating shift nurses. Data from 125 female nurses in rotating shifts who worked at two tertiary hospitals in South Korea were collected using a questionnaire that included the Gastrointestinal Symptoms Questionnaire; the Dietary Habit Questionnaire; the Depression, Anxiety, Stress Scale (DASS)-21; and the Pittsburgh Sleep Quality Index (PSQI). All participants experienced various GI symptoms, and 47% of them complained of at least one severe GI symptom. There were significant differences in GI symptom scores according to the status of depression, anxiety, stress, and sleep quality. In multiple linear regression analysis, the factors associated with an increase in the occurrence and severity of GI symptoms were poor sleep quality and morbid anxiety and stress. The model explained power at 43.2%. As most nurses in rotating shifts experience GI symptoms, they should receive counseling and training programs at work to alleviate psychological symptoms, improve sleep quality, and pay more attention to their health status as well as GI symptom management.

Perceived sleep quality: a comparison between hospital nurses and student nurses

BACKGROUND

The prevalence of poor sleep quality is high among nurses, and affects them physically and psychologically as well as organisational functioning. However, evidence on equipping student nurses with good sleep practices that could mitigate poor sleep as they transition into the nursing workforce is lacking.

AIM

This study compared the prevalence and quality of good sleep among hospital nurses and student nurses.

METHODS

A descriptive cross-sectional study of 130 hospital nurses and 130 student nurses in Brunei was carried out. Sleep quality was assessed using the Pittsburgh Sleep Quality index. Multiple logistic regression was applied.

RESULTS

Hospital nurses were 4.29 times more likely to experience poor sleep than student nurses. Those who were overweight were 2.35 times more likely to have poor sleep quality than those with a healthy weight. Although students had significantly good sleep latency, needing less time to fall asleep, they experienced significantly more sleep disturbances, shorter sleep duration and less sleep efficiency.

CONCLUSION

The prevalence of poor sleep quality among nurses in Brunei is higher than global estimates. Stakeholders such as nursing leaders, nursing educators and healthcare policymakers should prepare student nurses and help existing nurses by formulating strategies to promote working schedules and rosters that minimise circadian disruption.

Impact of Rotating Shifts on Lifestyle Patterns and Perceived Stress among Nurses: A Cross-Sectional Study

Although rotating shifts have a negative health impact, their association with hospital nurses’ health risks remains controversial due to incomplete adjustment in lifestyle patterns and heterogeneity of work schedules. However, whether work schedule characteristics are associated with lifestyle patterns and perceived stress remains undetermined. We assessed the correlations of work schedule characteristics, lifestyle patterns, and perceived stress among hospital nurses. This cross-sectional study included 340 nurses from two hospitals. Final data from 329 nurses regarding work schedule characteristics, lifestyle patterns (physical activity, dietary behavior, and sleep pattern), and perceived stress were analyzed via linear regression models. Fixed-day-shift nurses had reduced perceived stress (β = 0.15, p = 0.007) compared with rotating-shift nurses. Additionally, among rotating-shift nurses, fixed-evening- and fixed-night-shift nurses had longer sleep duration (β = 0.27, p < 0.001; β = 0.25, p < 0.001) compared to non-fixed-rotating-shift nurses. Longer rotating-shift work was associated with healthier dietary behaviors (β = 0.15, p = 0.008), better sleep quality (β = −0.17, p = 0.003), lower perceived stress (β = −0.24, p < 0.001), and shorter sleep duration (β = −0.17, p = 0.003). Hospital nurses’ work schedule characteristics were associated with lifestyle patterns, dietary behavior, sleep pattern, and perceived stress. Fixed-shifts were beneficial for lifestyle and lower perceived stress. Longer rotating shifts could help nurses adjust their lifestyles accordingly.

Dietary Intake in Law Enforcement Personnel: Occupation Is an Additional Challenge for Changing Behavior

Background: Law enforcement is a dangerous, stressful, and health-threatening occupation. This study investigated the association between demographic factors including sex, age, and types of law enforcement occupation and described self-reported barriers to healthy and enjoyable diets within a cohort of law enforcement personnel. Methods: This mixed-methods study explored cross-sectional data from the Perceived Barriers to Healthy Eating validated survey. The survey included eight questions obtaining quantitative data and two open ended question obtaining qualitative data. A framework thematic analysis using the theory of planned behavior was undertaken to describe self-reported barriers to a healthy and enjoyable dietary intake. Results: 159 participants (median age = 27 (range 19–60) years; 74% males) were surveyed. In general, demographic factors are not associated with the dietary beliefs and behavior of law enforcement personnel. Self-reported barriers (generated themes) to a healthy and enjoyable diet included individual preferences, social influences, internal drive, capacity to change and occupational influences, which broadly aligned with the theory of planned behavior. Conclusions: Dietary intake in law enforcement personnel is impacted by occupational considerations, including busy schedules, long working hours, inconsistent meal breaks, tiredness, and shift work. The study provides useful information to support dietary interventions.

Towards targeted dietary support for shift workers with type 2 diabetes (Shift-Diabetes study): A mixed-methods case study protocol

BACKGROUND

Blood glucose is higher in people working night shifts compared to day workers. Changes to eating behaviour, activity and sleep patterns in addition to circadian disruption are likely to impact glucose management in night-shift workers with type 2 diabetes.

AIM

To investigate current dietary intake and glucose variability during night work, including barriers and facilitators to dietary behaviour in this context.

METHODS

A mixed-methods case study will be conducted. Shift workers with type 2 diabetes working in a hospital setting will be recruited to this two-part study. Part 1: 70 participants will complete a 10-day observational study collecting data on continuous glucose, diet (self-report diary), sleep and physical activity during a period covering night work, rest days and non-night workdays. Mean glucose concentration and variability, and the mean healthy diet index score, will be compared between days of night work, non-night work and rest, after adjusting for other individual factors (sleep/physical activity/demographics). Part 2: A sample (n~13) will complete semi-structured interviews based on behavioural science frameworks to explore barriers/enablers to dietary behaviour when working night shifts. This will inform a quantitative survey to explore the generalisability of interview findings.

DISCUSSION

Findings from Part 1 and 2 will be triangulated to identify potential intervention strategies to address key barriers and enablers to healthier eating, and in turn improved glucose control, in shift workers with type 2 diabetes. This will be facilitated through stakeholder consultation and application of behavioural science frameworks. Shift-Diabetes study registration: ISRCTN11764942.

Shiftwork Is Associated with Higher Food Insecurity in U.S. Workers: Findings from a Cross-Sectional Study (NHANES)

The number of shift workers has increased substantially within the last decades to keep pace with the increasingly complex societal need for 24 h services. Shift work has been associated with unhealthy lifestyles and a lower overall diet quality. Little is known, however, with regard to food security and consumer behavior in shift workers. The present study sought to address this gap in the literature, exploring a sample of n = 4418 day workers and n = 1065 shift workers in the United States. Using cross-sectional data from the National Health and Nutrition Examination Surveys (NHANES, 2007−2010), we found that shiftwork was associated with a lower amount of money spent on eating out and higher food insecurity issues. Compared to day workers, a higher proportion of shift workers reported receipt of food stamps (12.5% vs. 23.4%, p < 0.001) and worried about running out of food (3.95% vs. 8.05%, p < 0.001). These associations remained significant after adjustment for confounders when using multivariate logistic regression. The number of not-home-prepared meals did not differ between both groups. In light of the population health disparities and adverse health outcomes associated with food insecurity, novel strategies are urgently warranted to improve the situation of shift workers.

A Simulated Shift Work Schedule Does Not Increase DNA Double-Strand Break Repair by NHEJ in the Drosophila Rr3 System

Long-term shift work is widely believed to increase the risk of certain cancers, but conflicting findings between studies render this association unclear. Evidence of interplay between the circadian clock, cell cycle regulation, and DNA damage detection machinery suggests the possibility that circadian rhythm disruption consequent to shift work could alter the DNA double-strand break (DSB) repair pathway usage to favor mutagenic non-homologous end-joining (NHEJ) repair. To test this hypothesis, we compared relative usage of NHEJ and single-strand annealing (SSA) repair of a complementary ended chromosomal double-stranded break using the Repair Reporter 3 (Rr3) system in Drosophila between flies reared on 12:12 and 8:8 (simulated shift work) light:dark schedules. Actimetric analysis showed that the 8:8 light:dark schedule effectively disrupted the rhythms in locomotor output. Inaccurate NHEJ repair was not a frequent outcome in this system overall, and no significant difference was seen in the usage of NHEJ or SSA repair between the control and simulated shift work schedules. We conclude that this circadian disruption regimen does not alter the usage of mutagenic NHEJ DSB repair in the Drosophila male pre-meiotic germline, in the context of the Rr3 system.

The linkage "Body Mass Index-Insomnia Levels-Eating Disorder Flexibility" in Italian nurses during the Covid-19 outbreak: a psychoendocrinological employment disease

AIM

To evaluate differences between insomnia condition and flexibility attitude to eating in Italian nurses directly involved in the care of patients affected by Covid-19 according to sex, Body Mass Index, shift working condition and incidence of new Covid-19 cases in the region of participants. Moreover, any correlations between the insomnia condition and the flexible attitude to eat have been investigated.

METHODS

An online questionnaire was administered in October 2020, including the socio-demographic section, the insomnia condition assessment, and the behavioral flexibility evaluation to develop an eating disorder.

RESULTS

341 Italian nurses answered the questionnaire. Regarding the insomnia condition levels, nurses belonging to regions with a higher incidence rate of the Covid-19 pandemic recorded higher levels of insomnia than others (p=.004). Females and nurses belonging to areas with lower Covid-19 incidence rate recorded a significantly higher total eating flexibility attitude (p=.003; p<.001), also, in the Food and Exercise flexibility (p=.007; p<.001). As regards the flexible attitude for weight and shape, significant differences were recorded among nurses according to their BMI values (p<.001) and to their incidence rate of the belonging region (p<.001). The insomnia condition levels significantly correlated with the eat flexibility attitude both in its total score (p=.010), in the general score (p=.010), and the weight and shape score (p<.001). All correlations between the insomnia conditions and the flexibility to eat were significantly inverse except for the food and exercise dimension. All the eat flexibility sub-dimensions significantly correlated among them (p<.001).

CONCLUSION

There was a direct correlation among socio-demographic factors, BMI values, insomnia, and behavioral flexibility scores in Italian nurses. So, it could be assumed that the nursing profession is at risk of developing a metabolic syndrome condition. Therefore, it could be considered a psychoendocrinological employment disease during the Covid-19 outbreak.

The mediating role of unhealthy behavior in the relationship between shift work and perceived health

Background

Little is known about the relationship between shift work and perceived health, including potential underlying mechanisms such as unhealthy behaviors. The aim of this study was to investigate whether unhealthy behaviors mediate the relationship between shift work and perceived mental and physical health, taking into account potential differences by level of education.

Methods

Data from 1633 workers participating in the Doetinchem Cohort Study during 1995–2016 were used. Being engaged in shift work was determined at 1 year preceding the assessment of health behaviors. Mental and physical health were assessed after 5 years of follow-up by the 5-item Mental Health Inventory and the physical functioning scale of the 36-item Short Form Health Survey. Smoking, physical inactivity, alcohol consumption, and overweight were considered as potential mediators and education was treated as moderator. Moderated mediation analyses using generalized estimated equations were performed.

Results

Shift work was not statistically significantly related to either mental or physical health. Despite this, statistically significant mediation effects of smoking (Beta − 0.09; 95% Confidence Interval − 0.20 - -0.01, respectively B -0.09; 95%CI -0.21 - -0.01) and physical inactivity (B 0.11; 95%CI 0.03–0.23, respectively B 0.08; 95%CI 0.01–0.18) were found in the relationship between shift work and mental or physical health. Direct and indirect effects outweighed each other in the relationship between shift work and mental health, since the direction of these effects was opposite. The relationship between shift work, unhealthy behavior, and health was not different by educational level.

Conclusion

Shift workers did not report lower mental or physical health than non-shift workers. Though mediation effects of unhealthy behavior were observed in the relationship between shift work and perceived health, these small effects had minor public health relevance.

Overweight and obesity in shift workers: associated dietary and lifestyle factors

BACKGROUND

Approximately 17% of the European Union workforce is engaged in shift work. Shift work has been associated with a number of chronic conditions, including obesity and obesity-related metabolic diseases. The aim of this study was to explore the dietary and lifestyle behaviours of shift workers with a healthy vs. overweight/obese body mass index (BMI).

METHODS

A cross-sectional study was conducted on 1080 shift workers using a 15-min, telephone-administered questionnaire developed from qualitative research on Irish shift workers and national dietary intake data. Demographic and work-related factors, as well as dietary and lifestyle behaviours were recorded. BMI was calculated using self-reported height and weight. Univariate and multivariate logistic regression methods were used to analyze data according to BMI category.

RESULTS

Over 40% of shift workers were classified as overweight or obese. Multivariate analysis indicated that being male [P < 0.001, aOR = 2.102, 95% CI (1.62-2.73)] and middle- or older-aged were independently associated with overweight and obesity [P < 0.001, aOR = 2.44 95% CI (1.84-3.24) and P < 0.001, aOR = 2.9 95% CI (1.94-4.35), respectively]. Having a medium-high consumption of fried foods was independently associated with overweight and obesity [aOR = 1.38, 95% CI (1.06-1.8)].

CONCLUSIONS

Similar to the general population, overweight and obesity were strongly associated with male sex and middle- or older-age. Male shift workers may benefit from targeted dietary and lifestyle advice specifically focused on limiting fried foods to help protect against overweight and obesity.

Health and wellness in the Australian coal mining industry: A cross sectional analysis of baseline findings from the RESHAPE workplace wellness program

Overweight and obesity has reach pandemic levels, with two-thirds (67%) of adult Australians classified as overweight or obese. As two of the most significant behavioral risk factors for obesity are modifiable (diet and exercise), there exists an opportunity for treatment through workplace health promotion initiatives. As one of Australia’s largest industries with its own unique workplace factors, the mining industry has previously reported higher than population levels of overweight and obesity. This represented an opportune setting to test the RESHAPE workplace wellness program. RESHAPE is an eight-step framework (based on the WHO ‘Health Workplace Framework and Model’) which aims to provide a sustained approach to wellness in the workplace. This paper presents baseline findings from a pilot study that aimed to implement RESHAPE at three mine sites in NSW, Australia, and investigates the issue of overweight and obesity in the coal mining industry. Across three mine sites, 949 coal miners were examined cross-sectionally on a range of workplace, wellness, health, diet, and exercise factors using a paper-based survey. This was a predominantly male sample (90.4%) with the majority (59.2%) of participants aged 25–44 years. Self-reported height and weight measures indicated that less than 20 percent (18.9%) of participants were in a healthy BMI range, while there were effectively equal numbers of overweight (40.9%) and obese (39.1%) participants. Only 3.5% of participants met the daily recommendation for vegetables (5 serves) and shift-workers had greater association with elevated BMI compared to non-shift workers (B = 1.21, 95% CI: 0.23, 2.20, p = 0.016). Poor nutrition is likely to be a key component in elevated levels of overweight and obesity within this industry, with workplace factors compounding challenges workers face in implementing health behavior change. Future studies would benefit from assessing diet and physical activity knowledge in relation to recommendations and serving sizes.

Chronic disruption of circadian rhythm with mistimed sleep and appetite - an exploratory research

This research aimed to explore the relation of social jetlag (SJL) with perceived appetite, and hormones involved in hunger regulation in healthy subjects in free-living conditions (study registration number: ACTRN12618001182280). Eighty normally diurnally active men and women were enrolled in 4 study groups according to the presence of SJL and sleep deprivation (2 groups with SJL with or without sleep deprivations and 2 groups without SJL with or without sleep deprivation) matched 1:1:1:1 for age, gender, and body mass index. Appetite was assessed in fasting state, by measuring acylated ghrelin level and using 100 mm visual analog scales. Persons with SJL had a higher perceived appetite for pork, poultry, fish, eggs, milk, and dairy products and higher acylated ghrelin levels than those without SJL. When considering the presence of sleep deprivation, subjects with SJL, with and without sleep deprivation, reported a higher perceived appetite than group with sleep deprivation alone. They also reported later meal times for lunch and dinner, had more frequently a snack before sleep and reported eating more frequently while watching TV or playing on computer, suggesting poorer eating habits in these subjects. In conclusion, independent of sleep duration, SJL is associated with an increased appetite for caloric dense food, suggesting an increased incentive value of food in these subjects and an anticipated pleasure of ingesting these foods.

The mediating role of lifestyle in the relationship between shift work, obesity and diabetes

PURPOSE

Shift work has been related to obesity and diabetes, but the potential mediating role of lifestyle is yet unknown. Our aim was to investigate this mediating role of physical activity, diet, smoking, and sleep quality in the relationships between shift work, and obesity and diabetes.

METHODS

In this cross-sectional study, 3188 shift workers and 6395 non-shift workers participated between 2013 and 2018 in periodical occupational health checks. Weight and height were objectively measured to calculate obesity (BMI ≥ 30 kg/m²). Diabetes status, physical activity, diet, smoking, and sleep quality were assessed using standardized questionnaires. Structural equation models adjusted for relevant confounders were used to analyze the mediating role of lifestyle in the relationships between shift work, and obesity and diabetes.

RESULTS

Shift workers were more often obese (OR: 1.37, 95% CI 1.16-1.61) and reported more often to have diabetes (OR:1.35, 95% CI 1.003-1.11) than non-shift workers. Shift workers had lower physical activity levels, ate fruit and vegetables less often, smoked more often, and had poorer sleep quality (p < 0.05). Mediation analysis revealed that shift workers had a higher odds of obesity (OR: 1.07, 95% CI 1.01-1.15) and diabetes (OR: 1.13, 95% CI 1.02-1.27) mediated by poorer sleep quality. Lower physical activity levels (OR: 1.11, 95% CI 1.05-1.19) and lower intake of fruit and vegetables (OR: 1.04, 95% CI 1.01-1.15) were also mediators in the relationship between shift work and obesity, but not in the relationship between shift work and diabetes (p ≥ 0.05).

CONCLUSION

These results imply that interventions targeting diet, physical activity and in particular sleep problems specifically developed for shift workers could potentially reduce the adverse health effects of shift work.

The Health of Health Care Professionals

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Shiftwork and Alcohol Consumption: A Systematic Review of the Literature

INTRODUCTION

Shiftwork can be a risk factor for a number of different somatic and psychological health conditions, especially sleep disorders. Shiftworkers sleep less than dayworkers, and 20-40% of them suffer from difficulties initiating and maintaining sleep, which result in reduced capacity for work and social life. A common coping strategy might be the use of alcohol, which presents a health and safety hazard as it further impairs sleep quality and exacerbates sleepiness in the workplace. This review aimed to assess the extent of such possible connections.

METHODS

We performed a systematic search of the scientific literature on shiftwork and alcohol consumption in PubMed, PsycInfo, and Cochrane Library. Only original studies comparing shiftworkers with non-shiftworkers were included. The recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-Analyses were followed.

RESULTS

Fourteen articles are included in this review. Six studies report some kind of connection between shift- or nightwork and alcohol consumption, especially as a sleep aid. Conflicting or negative results are reported by 3 studies.

DISCUSSION

Shiftwork, especially working at night and in rotation shifts, is associated with binge drinking disorder in different professions. The reasons for pathological consumption of alcohol can be self-medication of sleep problems or coping with stress and psychosocial problems typical for shiftwork. Nurses aged over 50 years represent one important risk group. These results can be important for preventive programs against sleep disorders, including measures other than drinking alcohol as a sleep aid in the workplace of shiftworkers.

Relationship of work-related stress with obesity among Brazilian female shift workers

OBJECTIVES

To explore the relationship between work-related stress and obesity among female shift workers. Additionally, we also aimed to test the interaction between shift work and work-related stress in this association.

DESIGN

A cross-sectional study was conducted among Brazilian female shift workers. Work-related stress was assessed through a demand-control questionnaire (Job Stress Scale). Work-related stress was defined by the presence of high psychological demands and low control at work. The obesity cases were defined as those with a BMI of 30 kg/m2 or more. Multivariate Poisson regression with robust variance was used to obtain the prevalence ratios (PR) and their respective 95 % CI.

SETTING

A group of industries located in southern Brazil in 2017.

PARTICIPANTS

Four hundred and twenty female workers aged 18-59 years.

RESULTS

The overall prevalence of obesity was 30 % (95 % CI: 25·6, 34·4), and the presence of work-related stress was identified in 24 % (95 % CI: 19·9, 28·1) of the sample. We found an indication of interaction between work-related stress and night shift work on obesity (P = 0·026). After adjusting for confounding factors, work-related stress was associated with a 71 % greater probability of obesity (PR = 1·71; 95 % CI: 1·02, 2·87; P = 0·042) among female night shift workers.

CONCLUSIONS

In this study, we revealed that exposure to work-related stress and night shift work were associated with obesity among female shift workers. Furthermore, the prevalence of obesity was high among female shift workers.

Adherence to dietary and physical activity guidelines among shift workers: associations with individual and work-related factors

Objectives

Shift work is associated with adverse effects on the health and lifestyle behaviours of employees. This study aimed to examine factors associated with adherence among shift workers to selected indicators of dietary and physical activity guidelines.

Methods

A cross-sectional study was conducted on 1300 shift workers. Data were collected using a 15 minute telephone-administered questionnaire. Logistic regression methods were used for data analysis.

Results

Male shift workers (p<0.001, OR=0.55, 95% CI 0.40 to 0.74) and those of lower socioeconomic status (p=0.046, OR=0.75, 95% CI 0.57 to 0.99) were significantly less likely to consume five or more daily servings of fruits and vegetables. Shift workers with access to workplace vending machines were significantly more likely to consume soft drinks at least weekly (p=0.003, OR=1.64, 95% CI 1.18 to 2.27). Middle-aged shift workers (p=0.012, OR=0.65, 95% CI 0.46 to 0.91) and those reporting insufficient break times at work (p=0.026, OR=0.69, 95% CI 0.49 to 0.96) were significantly less likely to be sufficiently active.

Conclusions

Individual, work schedule and workplace environment related factors were independently associated with selected indicators of adherence to dietary and physical activity guidelines in this cohort of shift workers.

Effect of consuming a late-night high-protein/moderate-carbohydrate vs. low-protein/high-carbohydrate meal by night workers on their food perceptions later during the day: a randomized crossover study

It is typical of night workers to consume a large dinner meal before their work shift, even though this practice may increase the risk for metabolic disorders. Night workers usually eat at night to socialize with colleagues as well as to stay alert and to avoid upset stomach during the night shift. However, little is known if and how the composition of the nighttime meal by night shift workers influences their food perceptions and eating behavior later during the day. The aim of this study was to analyze the effect of a high-protein/moderate-carbohydrate (HP/MCHO) meal vs. low-protein/high-carbohydrate (LP/HCHO) meal eaten at night by night-shift workers on their food consumption and perceptions later during the day. Fourteen male night shift workers were followed-up for 7 days for their eating and sleep habits. Then, participants underwent two isocaloric dietary events - one event a HP/MCHO meal containing 45% carbohydrate, 35% protein, and 20% fat and the other event a LP/HCHO meal containing 65% carbohydrate, 15% protein, and 20% fat, with a 6-day washout period between them - at 01:00 h during their night shift. Thereafter throughout the day, participants filled a food register of all the food consumed and perceptions, including hunger before meals, enjoyment of meals, and satiety. Generalized estimating equation analyses were used to examine the effect of both conditions on food consumption and food perceptions. Appetite for salty food snacks was greater after the HP/MCHO condition than after the LP/HCHO condition (p = .041). During the day following consumption of the nighttime HP/MCHO vs. LP/HCHO meal, there was higher percentage of carbohydrate consumption during lunch and a lower percentage of fat consumption during dinner (48.14% vs. 36.98% and 27.34% vs. 40.39%, respectively). These findings suggest the composition in terms of carbohydrates, protein, and fats of the meal consumed for the night shift by night workers may affect later during the day both food consumption and perceptions.

A High-Protein Meal during a Night Shift Does Not Improve Postprandial Metabolic Response the Following Breakfast: A Randomized Crossover Study with Night Workers

The aim of this study was to compare the acute effect of a high-protein/moderate carbohydrate (HP-MCHO) versus low-protein/high-carbohydrate (LP-HCHO) meal served at night on the postprandial metabolic response of male night workers the following breakfast. A randomized crossover study was performed with 14 male night workers (40.9 ± 8.9 years old; 29.1 ± 5.3 kg/m²). Participants underwent two different isocaloric dietary conditions at 1:00 h of the night shift: HP-MCHO (45 en% carbohydrate, 35 en% protein and 20 en% fat) and LP-HCHO (65 en% carbohydrate, 15 en% protein and 20 en% fat). Postprandial capillary glucose levels were determined immediately before the intake of the test meal and 30, 60, 90 and 120 min after the end of the meal. At the end of the work shift (6:30 h), participants received a standard breakfast and postprandial levels of glucose, insulin and triglycerides were determined immediately before and then every 30 min for 2 h (30, 60, 90 and 120 min). Higher values of capillary glucose were found after the LP-HCHO condition compared to the HP-MCHO condition (area under the curve (AUC) = 119.46 ± 1.49 mg/dL × min and 102.95 ± 1.28 mg/dL × min, respectively; p < 0.001). For the metabolic response to standard breakfast as the following meal, no significant differences in glucose, insulin, triglyceride, and HOMA-IR levels were found between interventions. A night meal with a higher percentage of protein and a lower percentage of carbohydrate led to minor postprandial glucose levels during the night shift but exerted no effect on the metabolic response of the following meal. This trial was registered at ClinicalTrials.gov as NCT03456219.

A longitudinal study of multiple lifestyle health risk behaviours among nursing students and non-nursing peers

AIM

The aim of this paper is to compare the evolution of health risk behaviours between undergraduate nursing and social work students.

BACKGROUND

Nursing includes the promotion of health and the shaping of healthy behaviours. An important determinant for providing lifestyle advice is the lifestyle of nurses themselves.

DESIGN

Longitudinal comparative study.

MEASUREMENTS

We compared lifestyle risk behaviours (binge drinking, cannabis/hashish/marijuana use, smoking, oral hygiene/toothbrushing, breakfast/fruit/vegetable consumption, physical activity and screen time/sedentary behaviours) using a self-administered standardized questionnaire in nursing (n = 121) and social work (n = 140) students at the beginning (2012) and the end of their studies (2015). Adjusted multivariable logistic/Poisson regression models were performed.

RESULTS

There were no statistically significant differences between the departments in most risk factors in both assessments. However, in relation to their first year, both nursing and social work students displayed higher relative risk of engaging in more behavioural risk factors at the end of their studies (in delivery/junk food consumption, sunburns, hashish/marijuana use and multiple sexual partners). Social work students displayed better behaviours in physical activity and breakfast intake.

CONCLUSION

Nursing students share the patterns of their nonnursing peers in behavioural risk factors compromising their future health and health-promoting role. We need strategies to safeguard the professional nursing practice.

A feasibility study of a WhatsApp-delivered Transtheoretical Model-based intervention to promote healthy eating habits for firefighters in Hong Kong: a cluster randomized controlled trial

BACKGROUND

Firefighters' health is often affected by a high prevalence of obesity and cardiovascular diseases, which are common risk factors for sudden cardiac death. The aim of this study is to investigate the feasibility of enhancing healthy eating habits in firefighters through an education programme.

METHODS

This will be a cluster randomized control trial study. The participants will be assigned randomly into either control (health promotion pamphlet) or intervention (health promotion pamphlet and education materials through WhatsApp) groups. Changes in healthy eating habits will be assessed by a self-administered questionnaire and anthropometric measurements at three different time points.

DISCUSSION

More education is required in order to improve firefighters' eating habits.

TRIAL REGISTRATION

ISRCTN registry identifier: Registered on 8 April 2019 ISRCTN95472464.

Shift work and sickness absence at a Norwegian hospital: a longitudinal multilevel study

OBJECTIVE

Shift work is known to be related to several negative health consequences and sickness absence. Research results regarding the relationship between types of shift schedules and sickness absence and whether and how individual factors moderate this relationship, are mixed though. The present paper aims to provide more insight in these relationships.

METHODS

We used registry data from a large Norwegian hospital gathered for the years 2012-2016, for >14 000 employees. With random effects at the individual and unit levels, we analysed the relationship between shift schedule worked and sickness absence in the same year.

RESULTS

The results showed increased risk of short-term sickness absence for two-shift and three-shift rotations, as well as fixed night shifts compared with fixed-day shifts. We also found an increased number of absence periods for two-shift rotations without nights and three-shift rotations. Results for long-term sickness absence were mixed, with increased odds for two-shift rotations without nights, but reduced odds for three-shift rotations. We found partial support for a moderating influence of age, gender and parental status.

CONCLUSIONS

There is a clear relationship between working shifts and increased risk of short-term sickness absence. The relationship persists across gender, age group and parental status. The relationship between shift work and long-term sickness absence appears to be schedule and population specific. These findings may have implications for HR policies and the organisation of shift work in healthcare organisations.

Energy, Nutrient and Food Intakes of Male Shift Workers Vary According to the Schedule Type but Not the Number of Nights Worked

Shift work is associated with increased risk of chronic diseases due to circadian rhythm disruptions and behavioral changes such as in eating habits. Impact of type of shifts and number of night shifts on energy, nutrient and food intake is as yet unknown. Our goal was to analyze shift workers’ dietary intake, eating behavior and eating structure, with respect to frequency of nights worked in a given week and seven schedule types. Eating habits and dietary intakes of 65 male shift workers were analyzed in three steps based on 365 24-h food records: (1) according to the number of nights, (2) in a pooled analysis according to schedule type, and (3) in search of an interaction of the schedule and the timing of intake. Mean nutrient and food group intake during the study period did not depend on the number of nights worked. Amount and distribution of energy intake as well as quality of food, in terms of nutrient and food groups, differed depending on the type of schedule, split night shifts and recovery day (day after night shift) being the most impacted. Shift workers’ qualitative and quantitative dietary intakes varied between different schedules, indicating the need for tailored preventive interventions.

Salivary Cortisol, Subjective Stress and Quality of Sleep Among Female Healthcare Professionals

Background

Stress is globally recognised as a risk factor impacting workers’ health and workplace safety. Women healthcare professionals are at risk for considerable stress given the demanding nature of their jobs and current working conditions. This study assessed levels of stress among women healthcare professionals using measures of their cortisol levels, subjective stress and quality of sleep.

Participants and Methods

This study used a cross-sectional design. Data were collected from 335 apparently healthy adult women healthcare professionals working in the United Arab Emirates. Participants provided morning and bedtime saliva samples for analysis of their cortisol levels. The Perceived Stress Scale, Stress Symptoms Scale, Brief Coping Scale and Pittsburgh Sleep Quality Index were used to assess perceived stress level, symptoms of stress, stress-coping strategies and sleep quality, respectively.

Results

In total, 121 (36.15%) women had impaired morning cortisol levels (below the normal range of 0.094–1.551 µg/dL) and 48 (14.3%) had impaired bedtime cortisol levels (above 0.359 µg/dL). Around 57% of women reported moderate levels of perceived stress, with the most frequently reported stress symptoms being heart rate and back/neck pain. Poor sleep quality was reported by around 60% of participating women. No significant association was found between cortisol and psychosocial measurements of stress or sleep quality. However, night shift and longer shift duration (more than 8 hrs) were significantly associated with impaired morning and bedtime cortisol levels (P ≥ 0.05). Impaired cortisol levels were strongly dependent on using adaptive coping strategies such as active coping, acceptance and seeking emotional support (P ≥ 0.05).

Conclusion

Evaluating cortisol levels and subjective stress could help to identify groups with impaired response to stress and elevated cortisol levels. Our findings support the need to examine shift work patterns and stress coping strategies in women healthcare professionals to promote their health and productivity and maintain workplace safety.

Lifestyle and Shiftwork: Designing and Testing a Model for Health Promotion of Iranian Nurses

BACKGROUND: Lifestyle is one factor that forms the nurses' health, particularly those who work in shiftwork schedules. AIMS: The aim of this study was to design and test a model for health promotion of Iranian nurses. In this model, nurses' lifestyle was considered as the precedent, physical and mental health as the outcomes, and sleep disturbance and chronic fatigue as the mediators. METHODS: A cross-sectional study using structural equation modeling was conducted among 240 shiftworker nurses in Iran. The data collection was performed using the Persian versions of the Survey of Shiftworkers Questionnaire and Life Style Questionnaire. Bootstrap in Preacher and Hayes' Macro program was used for testing mediation. RESULTS: Lifestyle had a weak significant direct effect on physical (β = 0.13, p < .04) and mental health (β = 0.12, p < .02), and it had a significant indirect effect on physical health via chronic fatigue (β = -0.11, p < .001) and sleep disturbance (β = -0.05, p < .01). This variable only had a significant indirect effect on mental health via chronic fatigue (β = -0.19, p < .001). The final model proposed a new significant path between sleep disturbances and chronic fatigue (β = 0.22, p < .001). CONCLUSIONS: Therefore, the hospital officials can enhance the nurses' physical and mental well-being by providing interventions and training courses on aspects of healthy lifestyles, such as physical activity, avoidance of smoking, and maintenance of body weight.

Healthy Diet and Reduction of Chronic Disease Risks of Night Shift Workers

BACKGROUND

The large increase in epidemiological studies on night shift work is due to the important effects of night shift work on workers' health and psychophysical wellbeing. The short-term effects-insomnia, difficulties in managing work and private life, lower work performance, and more work and extra-work accidents-are easily studied. However, there are several long-term effects that are difficult to study because of the need for detailed exposure assessment and the long latency periods of these diseases.

OBJECTIVE

The aim was to collect epidemiologic evidence of diseases in night shift workers, describing their biological pathways and a set of dietary guidelines.

METHODS

This is a review on diet and health effects in night shift workers.

RESULTS

Significant increases in the rate ratios and hazard ratios of different diseases were associated with modified eating behaviours and poor eating habits among night shift workers. Night shift work is a risk factor for disruption of the circadian rhythms and for some genetic deregulation because it produces the inversion of the sleep/wake cycle and modifies the alternation between activity and rest.

CONCLUSION

A healthy diet and improved dietary practices, together with other factors, can reduce shift workers' chronic disease risk. The literature showed the importance of eating behaviour in order to prevent diseases in these workers; therefore, educational programmes are necessary to encourage several important lifestyle changes. The target of our future research will be the role of food components in some dietetic habits for the prevention of disease in night shift workers.

Feasibility and Preliminary Efficacy of an m-Health Intervention Targeting Physical Activity, Diet, and Sleep Quality in Shift-Workers

Poor health behaviors are prevalent in shift-workers, but few multiple health-behavior interventions consider their unique needs. This study aimed to (1) evaluate the feasibility and acceptability of an existing app-based intervention to improve physical activity, diet, and sleep quality in a shift-worker population, (2) estimate intervention effect in a four-week pilot randomized controlled trial (RCT) (ACTRN12618001785291). Shift-workers (18–65 years old) were randomized to intervention (n = 20) or wait-list (n = 20) groups. Outcomes included recruitment, engagement, attrition, usefulness ratings, System Usability Scale (SUS), qualitative interviews, and estimation of treatment effect (minutes of physical activity, diet quality, and sleep quality) using mixed model analysis. Recruitment took one week. App-use at week four was 55% (11/20), 85% (34/40) completed the four-week follow-up questionnaire, and 20% (4/20) of the intervention group completed the qualitative interview. The intervention was rated as slightly to moderately useful by 76.9% (10/13) of participants on a five-point scale. The SUS score was 62.7 (12.7) out of 100. Diet quality improved for the intervention (4.5 points; 95% confidence interval (CI) = 0.1, 8.9; p = 0.047) vs. the wait-list group, but not physical activity or sleep quality. Qualitative interviews found that a more tailored intervention, more accessible information, and interactive features were desired. The intervention was feasible in terms of recruitment, but modifications to increase engagement are needed.

Working against the biological clock: a review for the Occupational Physician

The master clock of the biological rhythm, located in the suprachiasmatic nucleus of the anterior hypothalamus, synchronizes the molecular biological clock found in every cell of most peripheral tissues. The human circadian rhythm is largely based on the light-dark cycle. In night shift workers, alteration of the cycle and inversion of the sleep-wake rhythm can result in disruption of the biological clock and induce adverse health effects. This paper offers an overview of the main physiological mechanisms that regulate the circadian rhythm and of the health risks that are associated with its perturbation in shift and night workers. The Occupational Physician should screen shift and night workers for clinical symptoms related to the perturbation of the biological clock and consider preventive strategies to reduce the associated health risks.

Impact of shift work schedules on actigraphy-based measures of sleep in Hispanic workers: results from the Hispanic Community Health Study/Study of Latinos ancillary Sueño study

Study Objectives

To describe sleep characteristics of shift workers compared with day workers from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sueño ancillary study and test the hypothesis that shift work is associated with shorter sleep duration, worse sleep quality, greater sleep variability, and other sleep/health-related factors.

Methods

Employed adults (N = 1253, mean age 46.3 years, 36.3% male) from the Sueño study were included. Measures of sleep duration, timing, regularity, and continuity were calculated from 7 days of wrist-activity monitoring. Participants provided information on demographics, employment, work schedule (day, afternoon, night, split, irregular, and rotating), sleepiness, depressive symptoms, medications, caffeine, and alcohol use. Survey linear regression adjusting for age, sex, background, site, number of jobs, and work hours was used.

Results

In age and sex-adjusted models, all shift work schedules were associated with delayed sleep timing. Night and irregular schedules were associated with shorter sleep duration, greater napping, and greater variability of sleep. Afternoon and rotating shifts were associated with lower sleep regularity. In fully adjusted models, night and irregular schedules remained associated with shorter sleep duration, later sleep midpoint, and greater variability in sleep measures compared with day schedules. Split schedules were associated with, less time in bed, less sleep fragmentation, and less wake during the sleep period than day schedules.

Conclusions

Work schedule significantly affects sleep-wake with substantial differences between day work and other types of schedule. Detailed assessment of work schedule type not just night shift should be considered as an important covariate when examining the association between sleep and health outcomes.

Temporal pattern of eating in night shift workers

Understanding shift workers dietary intake patterns may inform interventions targeted at lowering chronic disease risk. This study examined the temporal distribution of food intake as shift workers rotate between night shifts, day shift and/or days off to identify differences in energy intake, eating frequency, and adherence to dietary guidelines by shift type (night shift vs. day). Night shift (NS) workers completed a four-day food diary that included a minimum of two night shifts and one-day shift (DS)/day off (DO), recording all food, beverages and time of consumption. Comparisons were between shift types, using ANOVA for continuous data and generalized estimating equations for count data, data reported as mean (SE). When comparing NS and DSDO, there were no differences in energy intake (24 h) (8853 (702) vs. 9041 (605) kJ, n = 22) or adherence to dietary guidelines. There was no difference between the number of eating occasions on NS and DSDO (5.6(0.3) vs 5.1(0.6) occasions) but less energy per eating occasion at night (1661(125) vs 1933(159) kJ). When working NS compared with DSDO there was higher total sugar (%E, 19.1(2.0) vs 15.0(2.4)) and lower saturated fat (%E, 13.8(1.2) vs 15.7(1.3)). Further, DSDO were characterized by a pattern of three main meals and a prolonged fasting period. It is important to determine if reducing eating occasions and providing opportunities for fasting improves metabolic health.