Equity and working time: a challenge to achieve

Introductory Overview--19th International Symposium on Shiftwork and Working Time: Health and Well-being in the 24-h Society

This dedicated issue of Chronobiology International comprises the partial proceedings of the "19th International Symposium on Shiftwork and Working Time" held August 2009 in Venice, Italy. The key theme of the symposium was "Health and Well-being in the 24-h Society." The topics covered by the 19 peer-reviewed original research papers address the direct and indirect effects of working time arrangement on the circadian system, sleep, performance, safety, and well-being, i.e., work-family conflict, work-ability, and depression--topics that are consistent with the scope of the Journal. The laboratory-based studies utilize well-designed protocols, and the survey studies constitute representative and large sample sizes. This issue builds upon the tradition established by the Journal commencing with the publication in 2004 of the proceedings of the "16th International Symposium on Shiftwork and Working Time" and the three symposia on shiftwork and working hours published thereafter by the Journal.

Vital Working Hour Schemes: The Dynamic Balance between Various Interests

"Balancing Interests", the theme of the 17th International Symposium on Shift Work and Working Time held in Hoofddorp, The Netherlands (September 2005), refers to the ambition to reach an optimal balance between the various aspects of shift work. Economic, ergonomic, physical, and psychosocial factors all interact in determining the impact of shift work at the individual, organizational, and societal level. It is the challenge of this multidisciplinary field of research to model all relevant factors in such a way that it will allow us to optimize the dynamic trade-off between the yield and the risk of shift work. The organizers of the 17th International Symposium and the co-editors of these proceedings are convinced that the high quality of the contributions will bring us closer to this ultimate goal.

Fatigue and Mood Correlates of Sleep Length in Three Age‐Social Groups: School Children, Students, and Employees

The aim of the study was to trace the consequences of insufficient sleep, in terms of chronic sleep reduction rather than acute sleep deprivation, on fatigue, mood, cognitive performance self-estimations, and daytime sleepiness in different age-social groups. The age group of the subjects reflects their social situation and their working time organization: adolescents (n = 191) obeyed the strict school schedules with starting times often before 08:00 h; university students (n = 115) had more flexible timetables; young employees (n = 126) were engaged in regular morning schedules or irregular daytime hours or day and night shifts. A questionnaire study determined the declared need of sleep, self-reported sleep length, chronic fatigue (using a scale comprised of eight fatigue symptoms and four mood and three cognitive items), and daytime sleepiness (Epworth Sleepiness Scale). The declared need for sleep decreased in subsequent age groups from 9 h 23 min in school children to 8 h 22 min in university students and to 7 h 37 min in young employees. Consequently, the discrepancy between preferred and real sleep length (sleep deficit) was the largest in adolescents: 106 min. Females showed a greater need of sleep than males (p = .025) and significantly more fatigue, mood, and cognitive problems; they also exhibited higher level of daytime sleepiness (p < .000). The sleep index (reported sleep length related to requirements) correlated significantly with all health issues in women (p < .000), while only with fatigue symptoms in men (p = .013). Actual sleep length was unrelated to mood and fatigue issues; the declared individual need of sleep and sleep index showed significant associations, especially in the group of adolescents. The most frequent complaints of adolescents included tiredness on awakening (46%), nervousness, and general weakness; university students reported excessive drowsiness (50%), tension, and nervousness; employees suffered mostly from negative moods, such as tension (49%), nervousness, and irritability. The findings of the study indicate that chronic sleep loss seems to affect females more severely than males. The associations of fatigue and mood with sleep need and sleep index were more pronounced in younger subjects. Surprisingly, fatigue symptoms in school children and university students were as frequent as in hard-working adults. Because the problem of insufficient sleep is already present in youngsters, their work time organization needs more attention.

A Psychometric Evaluation and Validation of the Preferences Scale

The Preferences Scale (PS) is a new measure of morningness and therefore requires intensive investigation to establish its measurement properties and validity. A confirmatory factor analysis (CFA) of Smith and colleagues (2002) posited model structure was not optimal in both a student (n = 731) and working sample (n = 218). However, significant differences (p < 0.01) were found for times to sleep and wake between morning and evening types. Principal components and reliability analyses were used to develop a 6-item model comprising 2 factors using a student sample (n = 368). Cronbach's alpha for the PS was 0.73 and the factors explained 61% of the variance. The revised model was replicated via CFA in a separate student sample (n = 363). A subsequent CFA confirmed the model structure in the working sample. Cronbach's alpha was 0.74 and the factors explained 64% of the variance. Significant differences (p < 0.01) in self-reported alertness ratings between morning and evening types were obtained by time-of-day. These results provide preliminary support for the PS. The predictive efficacy of the PS requires further validation against a number of health and work-related variables.

Circadian Variation in Stroke Onset: Identical Temporal Pattern in Ischemic and Hemorrhagic Events

Stroke is the culmination of a heterogeneous group of cerebrovascular diseases that is manifested as ischemia or hemorrhage of one or more blood vessels of the brain. The occurrence of many acute cardiovascular events--such as myocardial infarction, sudden cardiac death, pulmonary embolism, critical limb ischemia, and aortic aneurysm rupture--exhibits prominent 24 h patterning, with a major morning peak and secondary early evening peak. The incidence of stroke exhibits the same 24 h pattern. Although ischemic and hemorrhagic strokes are different entities and are characterized by different pathophysiological mechanisms, they share an identical double-peak 24 h pattern. A constellation of endogenous circadian rhythms and exogenous cyclic factors are involved. The staging of the circadian rhythms in vascular tone, coagulative balance, and blood pressure plus temporal patterns in posture, physical activity, emotional stress, and medication effects play central and/or triggering roles. Features of the circadian rhythm of blood pressure, in terms of their chronic and acute effects on cerebral vessels, and of coagulation are especially important. Clinical medicine has been most concerned with the prevention of stroke in the morning, when population-based studies show it is of greatest risk during the 24 h; however, improved protection of at-risk patients against stroke in the early evening, the second most vulnerable time of cerebrovascular accidents, has received relatively little attention thus far.

Introduction: aging and the multifaceted influences on adaptation to working time

This special issue of Chronobiology International presents a selection of papers originally delivered at the 18th International Symposium on Shift Work and Working Time, held at Yeppoon, Australia, in August 2007. The key theme of the symposium was "Aging and Working Time: Creating Safe Environments." Older workers are widely believed to experience greater difficulty than younger workers adapting to shift work and irregular work schedules. However, while the three reviews of age effects published here (Costa & Di Milia, 2008; Folkard, 2008b; Gander & Signal, 2008) identify evidence that older workers do indeed adapt less well, they also demonstrate that much more research is urgently required. The remaining papers address various aspects of the impact of work schedules on health, safety, sleep, and performance. They can be divided into three broad categories: circadian and other periodic factors; sleep, sleepiness, and fatigue; and other aspects of health and adjustment. This collection of papers showcases the best of contemporary research on the safety and health effects of working hours, continuing the tradition established by the two previous issues of the journal devoted to earlier symposia on shift work and working time.

Chronobiology and chronotherapy of allergic rhinitis and bronchial asthma

Study of the chronobiology of allergic rhinitis (AR) and bronchial asthma (BA) and the chronopharmacology and chronotherapy of the medications used in their treatment began five decades ago. AR is an inflammatory disease of the upper airway tissue with hypersensitivity to specific environmental antigens, resulting in further local inflammation, vasomotor changes, and mucus hypersecretion. Symptoms include sneezing, nasal congestion, and runny and itchy nose. Approximately 25% of children and 40% of adults in USA are affected by AR during one or more seasons of the year. The manifestation and severity of AR symptoms exhibit prominent 24-h variation; in most persons they are worse overnight or early in the morning and often comprise nighttime sleep, resulting in poor daytime quality of life, compromised school and work performance, and irritability and moodiness. BA is also an inflammatory medical condition of the lower airways characterized by hypersensitivity to specific environmental antigens, resulting in greater local inflammation as well as bronchoconstriction, vasomotor change, and mucus hypersecretion. In USA an estimated 6.5 million children and 15.7 million adults have BA. The onset and worsening of BA are signaled by chest wheeze and/or croupy cough and difficult and labored breathing. Like AR, BA is primarily a nighttime medical condition. AR is treated with H1-antagonist, decongestant, and anti-inflammatory (glucocorticoid and leukotriene receptor antagonist and modifier) medications. Only H1-antagonist AR medications have been studied for their chronopharmacology and potential chronotherapy. BA is treated with some of the same medications and also theophylline and beta2-agonists. The chronopharmacology and chronotherapy of many classes of BA medications have been explored. This article reviews the rather extensive knowledge of the chronobiology of AR and BA and the chronopharmacology and chronotherapy of the various medications used in their treatment.

Biological clocks and shift work: circadian dysregulation and potential long-term effects

Long-term epidemiologic studies on large numbers of night and rotating shift workers have suggested an increase in the incidence of breast and colon cancer in these populations. These studies suffer from poor definition and quantification of the work schedules of the exposed subjects. Against this background, the pathophysiology of phase shift and phase adaptation is reviewed. A phase shift as experienced in night and rotating shift work involves desynchronization at the molecular level in the circadian oscillators in the central nervous tissue and in most peripheral tissues of the body. There is a change in the coordination between oscillators with transient loss of control by the master-oscillator (the Suprachiasmatic Nucleus, SCN) in the hypothalamus. The implications of the pathophysiology of phase shift are discussed for long-term health effects and for the design of ergonomic work schedules minimizing the adverse health effects upon the worker.