Shift work and work injury in the New Zealand Blood Donors' Health Study

Statement by the Korean Society of Occupational and Environmental Medicine on the proposed reform of working hours in South Korea

The current 52-hour workweek in South Korea consists of 40 hours of regular work and 12 hours of overtime. Although the average working hours in South Korea is declining, it is still 199 hours longer than the Organisation for Economic Co-operation and Development average of 1,716 hours per year. In view to this, the South Korean government has now proposed to reform the workweek, mainly intending to increase the workweek to 69 hours when the workload is heavy. This reform, by increasing the labor intensity due to long working hours, goes against the global trend of reducing work hours for a safe and healthy working environment. Long working hours can lead to increased cerebrovascular and cardiovascular diseases, industrial accidents, mental health problems, and safety accidents due to lack of concentration. In conclusion, the Korean government's working hour reform plan can have a negative impact on workers' health, and therefore it should be thoroughly reviewed and modified.

Do employees' work schedules put them at-risk? The role of shift scheduling and holidays in predicting near miss and incident likelihood

INTRODUCTION

Using crew scheduling and injury incident data from a Fortune 500 manufacturing company, this study analyzed the effect of consecutive shifts and shifts near holidays on near misses and incidents.

METHODS

Logistic regressions were conducted with consecutive workdays, days near holidays, and time of shift as predictors of incident and near miss outcomes.

RESULTS

The logistic regression analysis indicated that working consecutive day shifts increases the probability of an incident occurring, with the fourth consecutive shift resulting in the most risk. The consecutive shift pattern did not replicate to employees working the night shift. However, the first and second shifts when transferring to a night schedule appear to have a greater chance of incident. Shifts near holidays did not have a significantly higher risk than other shifts.

PRACTICAL APPLICATION

The current research suggests that organizations can use similar analytic techniques to determine if shift scheduling might be related to increased risk and allocate resources to mitigate hazards during those peak probability shifts.

Cannabis use and work-related injuries: a cross-sectional analysis

BACKGROUND

Although the association of cannabis use with automobile accidents has been well-studied, the impact of cannabis on workplace safety and injuries is less clear.

AIMS

The purpose of this study was to examine the relationship between work-related injury and cannabis use in the past year.

METHODS

We performed a cross-sectional analysis of the Canadian Community Health Survey (2013-16) of working individuals. We used multiple logistic regression modelling to calculate the odds of experiencing a work-related injury (defined as non-repetitive strain injury) among workers who reported using cannabis more than once during the prior 12 months as compared to non-users. We repeated the analysis among participants working in high injury risk occupational groups only.

RESULTS

Among the 136 536 working participants, 2577 (2%) had a work-related injury in the last 12 months. Of these 2577 who had a work-related injury, 4% also reported being a cannabis user in the same period. We found no association between past-year cannabis use and work-related injury (odds ratio for work injury among users 0.81, 95% confidence interval 0.66-0.99). The association was unchanged in the subgroup analysis limited to high injury risk occupational groups.

CONCLUSIONS

We found no evidence that cannabis users experienced higher rates of work-related injuries. While awaiting prospective studies, occupational medicine practitioners should take a risk-based approach to drafting workplace cannabis policies.

Prospective Outcomes of Injury Study 10 Years on (POIS-10): An Observational Cohort Study

Injury is a leading cause of disability and is costly. This prospective cohort study extension aims to improve disability, health, and wellbeing outcomes for injured New Zealanders, including for Māori. We will identify predictors and modifiable risk factors of long-term outcomes (positive and negative), and develop an Injury Early Care Tool (INJECT) to inform the implementation of effective interventions to improve outcomes. In the Prospective Outcomes of Injury Study (POIS), 2856 people participated following an injury (occurring between 2007 and 2009) registered with New Zealand's no-fault accident compensation scheme (ACC). POIS-10 will invite 2121 people (including 358 Māori) who completed a 24-month POIS interview and agreed to follow-up, anticipating 75% participation (n = 1591). Interviews will collect sociodemographic characteristics, life events, comorbidities, and new injuries since participants' 24-month interview, as well as key disability, health, and wellbeing outcomes 12 years post-injury. Injury-related data will be collected from ACC and hospitalisation records 12 years post-injury. Regression models for the main outcomes will examine the direct effects of predictor variables after adjustment for a wide range of confounders. POIS-10 is enhanced by our partnership with ACC, and expert advisors and will benefit injured people, including Māori, through increased understanding of mechanisms and interventions to improve long-term post-injury outcomes.

Emerging Challenges and Opportunities in the Evolution of Teleradiology

OBJECTIVE. In recent decades, teleradiology has expanded considerably, and many radiology practices now engage in intraorganizational or extraorganizational teleradiology. In this era of patient primacy, optimizing patient care and care delivery is paramount. This article provides an update on recent changes, current challenges, and future opportunities centered around the ability of teleradiology to improve temporal and geographic imaging access. We review licensing and regulations and discuss teleradiology in providing services to rural areas and assisting with disaster response, including the response to the coronavirus disease (COVID-19) pandemic. CONCLUSION. Teleradiology can help increase imaging efficiency and mitigate both geographic and temporal discrepancies in imaging care. Technologic limitations and regulatory hurdles hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.

Systematic Review of Cannabis Use and Risk of Occupational Injury

Aim: A range of nations, including countries of the European Union, Australia, and the Americas have recently implemented or proposed reforms to how they control cannabis use, thereby departing from traditional approaches of criminal prohibition that have dominated throughout most of the twentieth century. Given these policy developments and the widespread global use of cannabis, it is critically important to understand the possible risks associated with cannabis use in relation to major societal harms. Methods: This systematic review investigates the potential link between cannabis use and occupational injury. Consequently, it appraises all available current literature from five databases, following Cochrane and PRISMA guidelines. Results: Seven of the 16 reviewed studies show evidence supporting a positive association between cannabis use and occupational injury. One study shows evidence supporting a negative association and the remaining eight studies show no evidence of a significant relation. None of the studies assessed cannabis-related impairment. Only three of the reviewed studies show clear evidence that cannabis use preceded the occupational-injury event. Conclusion: The current body of evidence does not provide sufficient evidence to support the position that cannabis users are at increased risk of occupational injury. Further, the study quality assessment suggests significant biases in the extant literature are present due to potential confounding variables, selection of participants, and measurement of exposures and outcomes. Future high-quality evidence will be needed to elucidate the relation between cannabis use and occupational injury.

Undiagnosed Obstructive Sleep Apnea and Physical Activity in Older Manual Workers

Cardiovascular disease is a negative health outcome of obstructive sleep apnea (OSA). Risk factors associated with OSA development include low physical activity (PA), high body mass index (BMI), and increasing age (>50 years), and weight loss is usually recommended as treatment. This cross-sectional study examined the association between PA, BMI, and OSA severity in manual workers. Fifty-five participants (23 females and 32 males; mean age 55.2 years), were examined for OSA and completed a PA and anthropometric assessment. On average, OSA severity was mild, PA levels were moderate, and 32% of the sample was classified as obese. PA was negatively associated with OSA severity, but BMI strongly independently predicted OSA severity, with no evidence of mediation. As both PA and BMI were significantly associated with OSA in older manual workers, increasing PA should also be a focus of treatment for OSA.

Hospital nurse shift length, patient-centered care, and the perceived quality and patient safety

BACKGROUND

There is no clear evidence that can guide decision makers regarding the appropriate shift length in the hospitals in Malaysia. Further, there is no study that explored the value of patient-centered care of nurses working longer shifts and its impact on the care outcomes.

OBJECTIVE

The study aims to investigate the effect of the hospital nurse shift length and patient-centered care on the perceived quality and safety of nurses in the medical-surgical and multidisciplinary wards in Malaysia.

METHODS

A cross-sectional survey has been conducted on 12 hospitals in Malaysia. Data have been collected via a questionnaire. A stratified sampling has been used. The Hayes macro regression analyses have been used to examine the mediating effects of patient-centered care between the effect of working long shifts on the perceived quality and patient safety.

RESULTS

There is a significant mediation effect of patient-centered care between the effect of shift length on the perceived quality (F = 42.90, P ˂ 0.001) and patient safety (F = 25.12, P ˂ 0.001).

CONCLUSION

Patient-centered care mitigates the effect of the shift length on the care outcomes. The study provides an input for the policymakers that patient-centered care and restructuring duty hours are important to provide high-quality patient care.

Relationship between occupational injuries and the provision of safety and health information: data from the 4th Korean working conditions survey

Background

The aim of this study was to examine the relationship between the provision of safety and health information (PSHI) and occupational injuries.

Methods

This study was based on data from the 4th Korean Working Conditions Survey (KWCS) (2014). The sample consisted of data from 24,527 wage workers and was divided into high-risk and low-risk groups, depending on the probability of occupational injury. The high-risk group included subjects who could cause harm to themselves or others due to errors during work. We applied chi-squared tests and logistic regression analyses to examine the relationship between PSHI and occupational injuries.

Results

In the high-risk group, workers with no PSHI showed an adjusted odds ratio of 1.81 for occupational injury (95% CI 1.33–2.47). In contrast, there was no statistically significant relationship between PSHI and the incidence of occupational injury in the low-risk group.

Conclusions

To prevent occupational injuries, multi-faceted approaches that take different levels of injury risk into account are needed. Among workers with a high risk of occupational injury, more a stringent safety education program is required.

The Relationship Between Frequency of Injuries and Workplace Environment in Korea: Focus on Shift Work and Workplace Environmental Factors

Background

The purpose of this study was to investigate the effect of shift work on occupational safety in various industrial sectors. The study analyzes the effects of shift work on the health of workers by considering factors such as the workplace environment and welfare.

Methods

Focusing on the 4^th Korean Working Conditions Survey, this study used an ordinary least-square multiple regression analysis. The dependent variable was the annual frequency of injuries reported by workers. Independent variables were categorized as demographic, shift work, workplace environment, and welfare variables. The analysis was conducted on two levels: 1) Shift work and nonshift work groups were compared, and 2) Shift work was compared with fixed and rotating shifts.

Results

For the entire group, age, a low level of education, work hours, and daily and dispatch work negatively impacted the frequency of injuries. Shift work was negatively affected by workplace environment and welfare factors. In the shift group, the frequency of injuries was lower than that of regular workers, and the higher the autonomy in the choice of work hours, the lower the frequency of injuries. Furthermore, shift workers in Korea have more extended work hours (49.25 h/week) than other workers (46.34 h/week).

Conclusion

Overall, welfare factors such as workplace satisfaction and work–life balance reduced the frequency of injuries. The effect of shift work was limited, but it was confirmed that shift worker autonomy could reduce the frequency of injuries.

Associations of Shift Work and Its Duration with Work-Related Injury among Electronics Factory Workers in South Korea

This study aimed to explore the association between shift work and work-related injuries. We collected data on workers from an electronics factory. This cross-sectional study included 13,610 subjects, who were assessed based on a self-reported questionnaire about their shift work experiences, work-related injuries, and other covariates. Multiple logistic regression models were used to evaluate the associations between shift work and work-related injuries and were estimated using the odds ratio. We found that the current and past shift workers, compared to non-shift workers, were associated with a 2.7- and 1.7-fold higher risk of work-related injury. There was a dose-response relationship between shift work duration and work-related injury among current female shift workers. Shift work increased the risk of work-related injuries, and the impact could be different depending on gender.

Work related injury among Saudi Star Agro Industry workers in Gambella region, Ethiopia; a cross-sectional study

Background

Work injury is an important cause of morbidity and mortality, much of these work injuries burden can be found in industry required heavy manual work such as, agriculture and fishers. Hence; agriculture is consistently cited as one of the most hazardous industry in the world. The objective of this study isto assess the magnitude and associated factors of work related injury among Saudi Star Agro Industry workers in Gambella region, South West Ethiopia.

Methods

An institutional based cross-sectional study design was conducted on Saudi Star Agro Industry located in Gambella region, from February - June 2014 on 449 randomly selected workers who arestratifiedby working department. Anobservation checklist, factory clinical records and a structured interview questioner were used as a data collection tools.

Result

The prevalence of work related injury was 36.7%. Marital status [AOR;1.69, 95%; CI;(1.1–2.7)], service year [AOR;1.9,95%; CI;(1.17–3.1)], working more than 48 h per week [AOR;9.87, 95%; CI;(5.95–16.28)],safety training [AOR;3.38, 95%;CI;1.14–9.98)], regular health checkup [AOR; 12.29, 95%; CI (9–51.35)] and usage of personal protective equipment [AOR; 2.36, 95%; CI; (1.06–5.25)] were significant factors for the occurrence of work related injury.

Conclusion

The prevalence of work related injury was high. Working hours, safety training and regular health checkup increases the risk of work related injury.

Environmental and behavioural factors associated with school children's sleep in Aotearoa/New Zealand

AIM

To collect objective and subjective sleep data on 6- to 8-year-old children across the week and to identify factors within the family environment associated with sleep differences.

METHODS

Data were collected (n = 52) using actigraphy and diaries for 7 consecutive days and nights and a questionnaire incorporating the Children's Sleep Habits Questionnaire was completed by parents.

RESULTS

Children's actigraphic sleep periods averaged 10 h on school nights and 9.5 h on non-school nights and parents over-estimated children's sleep compared with actigraphy. One third (37%) of children had potential sleep problems. Children who shared a bedroom (31%) had shorter sleep onset latencies and those who consumed caffeinated drinks (33%) went to sleep and awoke later. Increased screen time was associated with later bedtimes on school nights and children with screens in bedrooms (12%) went to bed later and slept less on school nights, and had higher Children's Sleep Habits Questionnaire scores. Children living with a shift-working adult (27%) slept longer on non-school nights and had shorter sleep onset latencies on school nights.

CONCLUSIONS

It is important to consider children's sleep within the wider family context and to be aware that parents may over-estimate their children's sleep. Simple strategies to promote sleep health in clinical settings or education programmes include regular weekend bedtimes that align with those on school nights, removing technology from bedrooms and minimising caffeine consumption. An awareness of potential sleep differences associated with shift-working adults may ensure children are supported to have consistent sleep routines that promote adequate sleep.

Risk of Occupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-analysis

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is the single most important preventable medical cause of excessive daytime sleepiness (EDS) and driving accidents. OSA may also adversely affect work performance through a decrease in productivity, and an increase in the injury rate. Nevertheless, no systematic review and meta-analysis of the relationship between OSA and work accidents has been performed thus far.

METHODS

PubMed, PsycInfo, Scopus, Web of Science, and Cochrane Library were searched. Out of an initial list of 1,099 papers, 10 studies (12,553 participants) were eligible for our review, and 7 of them were included in the meta-analysis. The overall effects were measured by odds ratios (OR) and 95% confidence intervals (CI). An assessment was made of the methodological quality of the studies. Moderator analysis and funnel plot analysis were used to explore the sources of between-study heterogeneity.

RESULTS

Compared to controls, the odds of work accident was found to be nearly double in workers with OSA (OR = 2.18; 95% CI = 1.53-3.10). Occupational driving was associated with a higher effect size.

CONCLUSIONS

OSA is an underdiagnosed nonoccupational disease that has a strong adverse effect on work accidents. The nearly twofold increased odds of work accidents in subjects with OSA calls for workplace screening in selected safety-sensitive occupations.

COMMENTARY

A commentary on this article appears in this issue on page 1171.

Early morning awakening and nonrestorative sleep are associated with increased minor non-fatal accidents during work and leisure time

BACKGROUND

The relationship between a composite measure of insomnia and occupational or fatal accidents has been investigated previously; however, little is known regarding the effect of various insomnia symptoms on minor non-fatal accidents during work and leisure time.

OBJECTIVE

We investigated the predicting role of insomnia symptoms on minor non-fatal accidents during work and leisure time.

METHODS

Data from the 2005 Taiwan Social Development Trend Survey of 36,473 Taiwanese aged ≥18 years were analyzed in 2013. Insomnia symptoms, including difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS) were investigated. A minor non-fatal accident was defined as any mishap such as forgetting to turn off the gas or faucets, accidental falls, and abrasions or cuts occurring during work and leisure time in the past month that do not require immediate medical attention. Multivariable logistic regression was performed to assess the odds ratios (ORs) and associated 95% confidence interval (CI) of minor non-fatal accidents (as a binary variable) for each insomnia symptom compared with those of people presenting no symptoms, while controlling for possible confounders.

RESULTS

EMA and NRS increased the odds of minor non-fatal accidents occurring during work and leisure time (adjusted OR=1.19, 95% CI=1.08-1.32 and adjusted OR=1.27, 95% CI=1.17-1.37, respectively).

CONCLUSION

EMA and NRS are two symptoms that are significantly associated with an increased likelihood of minor non-fatal accidents during work and leisure time after adjusting for of a range of covariates.

Sleep disordered breathing and polysomnography in Australia: trends in provision from 2005 to 2012 and the impact of home-based diagnosis

STUDY OBJECTIVES

To describe the growth of publicly funded polysomnography (PSG) in Australia since 2004 and to compare this with earlier growth.

METHODS

Longitudinal census-level data stratified by jurisdiction were retrieved from the Medicare Australia online database.

RESULTS

There has been a near doubling in provision of PSG since the introduction of publicly funded in-home PSG under the Australian national Medicare program available to all Australian citizens in 2008. Overall annual PSG rates have risen from 339 in 2005 to 608 in 2012 per 100,000. This growth has exceeded that of comparable diagnostic procedures and all Medicare services overall. Queensland remains the leading jurisdiction per 100,000 Medicare enrollees for accessing Medicare-funded PSG.

CONCLUSION

The continued growth in publicly funded PSG provision in Australia is unlikely to abate. The disparity in Australia between the estimated prevalence of sleep disorders, particularly obstructive sleep apnea, and the number of people having PSGs would suggest there remain a large number of undiagnosed cases. Support for the development of appropriate diagnostic and screening algorithms will be key in ensuring sustainable, effective, efficient, and accessible PSG services.

What roles do team climate, roster control, and work life conflict play in shiftworkers' fatigue longitudinally?

The study aimed to examine shiftworkers fatigue and the longitudinal relationships that impact on fatigue such as team climate, work life conflict, control of shifts and shift type in shift working nurses. We used a quantitative survey methodology and analysed data with a moderated hierarchical multiple regression. After matching across two time periods 18 months apart, the sample consisted of 166 nurses from one Australian hospital. Of these nurses, 61 worked two rotating day shifts (morning & afternoon/evening) and 105 were rotating shiftworkers who worked three shifts (morning afternoon/evening and nights). The findings suggest that control over shift scheduling can have significant effects on fatigue for both two-shift and three-shift workers. A significant negative relationship between positive team climate and fatigue was moderated by shift type. At both Time 1 and Time 2, work life conflict was the strongest predictor of concurrent fatigue, but over time it was not.

The impact of various work schedules on sleep complaints and minor accidents during work or leisure time: evidence from a national survey

OBJECTIVE

To explore the prevalence of insomnia symptoms and excessive daytime sleepiness (EDS) in different work schedules and the impact of shift schedules on the risk of minor accidents during work or leisure time.

METHODS

Using the data from Taiwan Social Development Trend Survey in 2005 (n = 18,794), insomnia symptoms, EDS, and minor accidents were analyzed using descriptive statistics and multivariable logistic regression model.

RESULTS

The evening-to-night group had significantly higher prevalence rates of insomnia symptoms. Higher prevalence rate of EDS was presented in both day-to-evening and evening-to-night groups. Adjusting for confounders, the day-to-evening shift had a higher odds ratio of minor accidents as compared with the fixed daytime workers.

CONCLUSIONS

Extended-shift workers tend to experience insomnia symptoms and EDS and have an increased likelihood of minor accidents.

Descriptive Study of Occupational Accidents and their Causes among Electricity Distribution Company Workers at an Eight-year Period in Iran

Background

Occupational accidents are unplanned events that cause damage. The socio-economic impacts and human costs of accidents are tremendous around the world. Many fatalities happen every year in workplaces such as electricity distribution companies. Some electrical injuries are electrocution, electric shock, and burns. This study was conducted in an electricity distribution company (with rotational 12-hour shift work) in Iran during an 8-year period to survey descriptive factors of injuries.

Methods

Variables collected included accident time, age of injured worker, employment type, work experience, injury cause, educational background, and other information about accidents.

Results

Results indicated that most of the accidents occurred in summer, and 51.3% were during shift work. Worker negligence (malpractice) was the cause of 75% of deaths. Type of employment had a significant relationship with type of injuries (p < 0.05). Most injuries were electrical burns.

Conclusion

High rate of accidents in summer may be due to the warm weather or insufficient professional skills in seasonal workers. Shift workers are at risk of sleep complaints leading to a high rate of work injuries. Acquiring knowledge about safety was related to job experiences. Temporary workers have no chance to work all year like permanent workers, therefore impressive experiences may be less in them. Because the lack of protective equipment and negligence are main causes of accidents, periodical inspections in workshops are necessary.

Sleep problems and work injuries: a systematic review and meta-analysis

OBJECTIVES

Sleep problems are a potential risk factor for work injuries but the extent of the risk is unclear. We conducted a systematic review and meta-analysis to quantify the effect of sleep problems on work injuries.

METHODS

A systematic literature search using several databases was performed. Sleep problems of any duration or frequency as well as work injuries of any severity were of interest. The effect estimates of the individual studies were pooled and relative risks (RR) and 95% confidence intervals (CI) were calculated through random effects models. Additionally, the population attributable risk was estimated.

RESULTS

In total, 27 observational studies (n = 268,332 participants) that provided 54 relative risk estimates were included. The findings of the meta-analysis suggested that workers with sleep problems had a 1.62 times higher risk of being injured than workers without sleep problems (RR: 1.62, 95% CI: 1.43-1.84). Approximately 13% of work injuries could be attributed to sleep problems.

CONCLUSION

This systematic review confirmed the association between sleep problems and work injuries and, for the first time, quantified its magnitude. As sleep problems are of growing concern in the population, these findings are of interest for both sleep researchers and occupational physicians.

Photic resetting in night-shift work: impact on nurses' sleep

The objective of this study was to quantify daytime sleep in night-shift workers with and without an intervention designed to recover the normal relationship between the endogenous circadian pacemaker and the sleep/wake cycle. Workers of the treatment group received intermittent exposure to full-spectrum bright light during night shifts and wore dark goggles during the morning commute home. All workers maintained stable 8-h daytime sleep/darkness schedules. The authors found that workers of the treatment group had daytime sleep episodes that lasted 7.1 ± .1 h (mean ± SEM) versus 6.6 ± .2 h for workers in the control group (p = .04). The increase in total sleep time co-occurred with a larger proportion of the melatonin secretory episode during daytime sleep in workers of the treatment group. The results of this study showed reestablishment of a phase angle that is comparable to that observed on a day-oriented schedule favors longer daytime sleep episodes in night-shift workers. (Author correspondence: diane.boivin@douglas.mcgill.ca ).

The long-term tolerability and efficacy of armodafinil in patients with excessive sleepiness associated with treated obstructive sleep apnea, shift work disorder, or narcolepsy: an open-label extension study

STUDY OBJECTIVES

Armodafinil is a wakefulness-promoting medication. Its efficacy and tolerability have been established in 12-week studies of patients with excessive sleepiness (ES) associated with treated obstructive sleep apnea (OSA), shift work disorder (SWD), or narcolepsy. This study evaluated the tolerability and efficacy of armodafinil for > or = 12 months.

METHODS

Patients with ES associated with treated OSA, SWD, or narcolepsy who completed one of four 12-week, double-blind studies were eligible for this multicenter, open-label study of > or = 12 months' duration of treatment with armodafinil (50 to 250 mg/day). Adverse events and other criteria of tolerability were monitored throughout the study. Efficacy assessments included the Clinical Global Impression of Change (CGI-C), Brief Fatigue Inventory (BFI), and Epworth Sleepiness Scale (ESS).

RESULTS

Of 743 enrolled patients (474 with treated OSA, 113 with SWD, and 156 with narcolepsy), 57% of patients (420/743) completed 12 months or more of treatment. Discontinuations due to adverse events occurred in 13% of patients (95/743) during the initial 12-month period. Throughout the > or = 12-month study, adverse events were generally of mild-to-moderate intensity; headache (25% [180/731]), nasopharyngitis (17% [123/731]), and insomnia (14% [99/731]) were the most common. Modest increases were observed in vital sign measurements (blood pressure [3.6/2.3 mm Hg], heart rate [6.7 beats per minute]) across all patient groups; most of the changes occurred by month 3. Improvements from baseline in efficacy assessments started at month 1 and were maintained throughout the study.

CONCLUSIONS

Armodafinil remained effective and was generally well tolerated. Increased monitoring of blood pressure may be appropriate in patients on armodafinil. Armodafinil represents an option for long-term treatment of patients with ES associated with treated OSA, SWD, or narcolepsy.

The New Zealand workforce survey I: self-reported occupational exposures

INTRODUCTION

This study examines the prevalence of a range of occupational risk factors reported by a random sample of the New Zealand working population.

METHODS

Men and women aged 20-64 were selected from the New Zealand Electoral Roll and invited to take part in a telephone interview, which collected information on lifetime work history, current workplace exposures and organizational factors, and various health conditions. The prevalences of occupational risk factors in each occupational and industry group are reported.

RESULTS

Three thousand and three interviews were completed (37% of the eligible sample and 55% of those that could be contacted). Trades workers reported the highest prevalences of exposure to dust (75%) and oils and solvents (59%). Agriculture and fishery workers reported the highest prevalences of exposure to pesticides (63%) and acids or alkalis (25%). Plant and machine operators and assemblers reported the highest prevalences of exposure to smoke/fume/gas (43%), working night shift in the previous 4 weeks (18%), and working irregular hours (33%). In the high exposure occupational and industry groups, males reported a higher prevalence of exposure than females. Lifting, exposure to loud noise, and the use of personal protective equipment were reported by >50% of the manual occupational groups.

CONCLUSIONS

This study indicates that occupational exposure to risk factors for work-related disease and injury remains common in the New Zealand working population. While these occupational exposures are disproportionately experienced by workers in certain industries, they also occur in occupational groups not traditionally associated with hazardous exposures or occupational disease.

Methamphetamine self-administration by humans subjected to abrupt shift and sleep schedule changes

RATIONALE

Methamphetamine attenuates disruptions that occur after changes in work shifts. The reinforcing effects of the drug during shift work have yet to be characterized.

OBJECTIVES

This study examined methamphetamine-related mood, performance, and reinforcing effects during simulated shift work.

MATERIALS AND METHODS

Ten volunteers (four women and six men) completed this 19-day study. Participants were given an opportunity to self-administer oral methamphetamine (10 mg) or receive a $1 voucher before and after an 8-h work period for four consecutive days under two shift conditions: (1) "day shift" in which they went to bed at 2400 hours and woke up at 0800 hours and (2) "night shift" when they went to bed at 1600 hours and woke up at 2400 hours. Thus, participants completed task batteries either from 0815 to 1715 hours or from 0015 to 0915 hours. Shift conditions alternated three times during the study and were separated by an "off" day.

RESULTS

Night-shift work disrupted psychomotor task performance and some ratings of mood, especially on the first night. Consistent with this, participants chose to take methamphetamine significantly more often on the first night-shift night compared with the first day-shift day. Regardless of shift condition, however, participants selected markedly more methamphetamine doses before the work period than after it (73% versus 34%).

CONCLUSIONS

These data show that methamphetamine self-administration occurred more often before work rather than after work, suggesting that the use of stimulants by shift workers may be one strategy employed to meet behavioral demands especially under conditions engendering poor performance, fatigue, and/or sleep disruptions.

The relation between shift work, sleepiness, fatigue and accidents in Iranian Industrial Mining Group workers

The aim of this study was to examine the rate of fatigue and sleepiness around the shift and non-shift workers and its relation to occupational accidents. This was a cross-sectional study on the workers of Iranian Industrial Mining Group. They included 137 shift workers as the case and 130 non-shift workers as the control. A multi-part questionnaire including demographic characteristics, Piper Fatigue Scale and Epworth Sleepiness Scale were applied. The chi(2) test and t-test were used to measure differences between variables. The mean of PFS scores in the two groups was significantly different (p=0.045), but the difference in the mean of ESS scores was not significant. Shift workers with the reported accident had a higher score on fatigue than shift workers with no accident (p<0.001) whereas the difference in the number of accidents in the two groups was not related significantly to the rate of sleepiness. The rate of fatigue and the number of the work accidents was more in the shift workers. Also, fatigue had a stronger relationship with the occupational accidents as compared to sleepiness. It seems that evaluation of fatigue as compared to sleepiness is a more accurate factor for preventing work accidents.

A 15-year prospective study of shift work and disability pension

Objective:

To estimate the hazard ratio for disability pension associated with shift work.

Methods:

Cohorts of shift and day workers were identified in three waves of the Danish Work Environment Cohort Study and followed up for incidence of disability pension in a national register of social transfer payment. A total of 3980 female and 4025 male employees were included in the cohorts. Information about shift work status, age, smoking habits, body mass index and ergonomic work environment were updated according to responses in subsequent waves of the survey when possible. Respondents reporting shift work were classified as shift workers in the following waves as well. Respondents were followed in the register from the time of first interview and were censored at the time of their 60th birthday, emigration, death or end of follow-up (18 June 2006). The authors used the Cox proportional hazards model to estimate hazard ratios for incidence of disability pension and 95% confidence intervals.

Results:

The authors observed 253 new disability pensions among women and 173 among men during 56 903 and 57 886 person-years at risk respectively, Among women, shift work predicted disability after adjustment for age, general health and socioeconomic status HR 1.39 (95% CI 1.07 to 1.82). After further adjustment for body mass index, smoking habits, socioeconomic status and ergonomic exposures the association remained statistically significant HR 1.34 (95% CI 1.02 to 1.75). Shift work was not associated with disability among men.

Conclusion:

Shift work might be moderately associated with disability pension among women; however, more powerful studies are needed to establish the possible association.

Fatigue and sleep quality in nurses

Fatigue is a critical issue for nurses that may lead to medical errors, degradation in performance, decreased mental acuity, and social problems. Poor sleep quality is also a contributing factor in fatigue that nurses experience. Therefore, the purpose of this study was to examine the differences in perceptions of fatigue between night-shift and day-shift nurses, as measured by scores on the Brief Fatigue Inventory (BFI) and to examine differences in sleep quality between the two groups, as measured by responses on the Pittsburgh Sleep Quality Index (PSQI). Univariate analysis of variance showed significant differences between the two groups on the BFI, with the night-shift cohort reporting higher mean scores on the BFI. Significant differences were also found between the two groups on PSQI mean scores, with the night-shift cohort reporting higher mean scores. Findings from this study suggest that night-shift nurses, compared with day-shift nurses, perceived a much higher level of fatigue and had poorer sleep quality. Further research is needed to evaluate interventions that might decrease fatigue in nurses and improve their sleep quality.

A systematic review of the neurobehavioural and physiological effects of shiftwork systems

Shiftwork is a common experience for many workers. There are a wide range of shift systems in use, with a number of general approaches and myriad variations of each one. Many aspects of shift systems have been studied, but attempts to reach definitive conclusions about appropriate designs have been hampered by a number of methodological issues. The aim of this systematic review was to provide evidence-based recommendations on the effect of various shift systems on neurobehavioural and physiological functioning and to identify areas which are lacking in appropriate evidence. Two main aspects of shift design were able to be considered-the direction of shift rotation and extended shift length (mainly 12-h shifts). Other areas for which there was at least one relevant paper of adequate methodology were the use of naps during night shifts, the starting time of shifts, and several other specific shift issues. Overall, the review found there is insufficient evidence to support definitive conclusions regarding any of these factors. However, the analysis provides support for the use of forward rotating shift systems in preference to backward rotating shift systems, at last as far as 8-h shifts are concerned. There are many unanswered questions in shift design. For these questions to be answered, it is important that the methodological shortcomings present in most of the studies published to date be overcome.