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Does Work after Retirement Matter? Sleep Features among Workers in the Brazilian Longitudinal Study of Adult Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084117. [PMID: 33924687 PMCID: PMC8069779 DOI: 10.3390/ijerph18084117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/28/2022]
Abstract
A growing number of people keep working after retirement, a phenomenon known as bridge employment. Sleep features, which are related to morbidity and mortality outcomes, are expected to be influenced by bridge employment or permanent retirement. The objective of this study was to analyze sleep duration and quality of bridge employees and permanent retirees compared to nonretired, i.e., active workers, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants (second wave of ELSA-Brasil, 2012–2014) comprised permanently retired (n = 2348), career bridge workers (n = 694), bridge workers in a different place (n = 760), and active workers (n = 6271). The associations of all studied retirement schemes and self-reported sleep quality and duration were estimated through logistic and linear regression analysis. Workers from all studied retirement schemes showed better sleep patterns than active workers. In comparison to active workers, bridge workers who had changed workplace also showed a reduced chance of difficulty falling asleep and too-early awakenings, which were not found among career bridge workers. Bridge employment and permanent retirement were associated with a reduced chance of reporting sleep deficit. Bridge work at a different place rather than staying at the same workplace seems to be favorable for sleep. Further study is needed to explain mechanisms.
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Toyoshima A, Moriyama M, Yamashita H, Rahman MM, Huq KE, Jahan Y, Kazawa K. Understanding the process for developing sleep disorders among Japanese workers: a qualitative study. Health Promot Perspect 2021; 11:87-96. [PMID: 33758760 PMCID: PMC7967132 DOI: 10.34172/hpp.2021.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Sleep disorders have an enormous impact on occupational health and are counterproductive from an economic perspective. However, the processes of causing sleep disorders from psychosocial aspects have not yet been known. The purpose of this study was to describe how sleep disorders develop among workers with respect to different psychosocial conditions. Methods: A conventional qualitative content analysis was conducted with a semi-structured interview among twenty-seven workers (14 males and 13 females) who were diagnosed with sleep disorders or had a self-reported history of sleep difficulties. Study participants were recruited from a specialized clinic and communities using snowball sampling. This paper adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Results: The results showed that there were four steps involved in the sleep disorders development process. Firstly, participants with sleep disorders developed ‘early warning signs’ with 11 categories of triggers; secondly, ‘aggravating factors’ on top of these early warning signs; thirdly, workers tried to ‘cope with’ their sleep disorders in the ways they thought would be effective. Finally, when coping failed to improve the quality of sleep, it led to the onset of sleep disorders. Conclusion: The development of sleep disorders and triggers of psychosocial factors were revealed. An occupational health nurse can bring these findings in practice for preventing worker’s sleep disorders.
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Affiliation(s)
- Ayako Toyoshima
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hidehisa Yamashita
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Katm Ehsanul Huq
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasmin Jahan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kana Kazawa
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Takahashi M. Sociomedical problems of overwork-related deaths and disorders in Japan. J Occup Health 2019; 61:269-277. [PMID: 30977205 PMCID: PMC6620752 DOI: 10.1002/1348-9585.12016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives Cerebrovascular and cardiovascular diseases (CCVDs) and mental disorders, including suicide, are prevalent among overworked individuals in Japan. The 2014 legislation regarding the prevention of overwork‐related deaths and disorders has accelerated the research in this field and ultimately the implementation of preventive actions. Methods To understand the current problematic situations, the Research Center for Overwork‐Related Disorders of the National Institute of Occupational Safety and Health, Japan, conducted analyses of compensated claims for overwork‐related CCVDs and mental disorders that were recognized from January 2010 to March 2015. Results The majority of CCVD cases were the men in their 50s. Transport and postal activities was the highest risk industry. Cerebrovascular cases were higher than cardiovascular ones. Long working hours was the principal factor for CCVDs. The mental disorder cases comprised approximately 70% men and affected younger age groups (peak in the third decade) with various industries at risk. In men, there was an almost equal number of F3 (Mood [affective] disorders) and F4 (Neurotic, stress‐related, and somatoform disorders) diagnoses according to the 10th revision of the International Classification of Diseases and Related Health Problems. A larger number of women were diagnosed to have F4. The mental disorder cases were associated not only with long working hours, but also with injuries and disasters as well as interpersonal conflict at work. Conclusions Multiple, simultaneous actions need to be made by employees, employers, researchers, and the authorities to achieve the goal of reducing the number of workers suffering from the overwork‐related CCVDs and mental disorders.
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Affiliation(s)
- Masaya Takahashi
- National Institute of Occupational Safety and Health, Tama-ku, Kawasaki, Japan
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Takahashi M, Koda S. From "shift work that involves circadian disruption" to "night shift work". INDUSTRIAL HEALTH 2019; 57:555-556. [PMID: 31554758 PMCID: PMC6783283 DOI: 10.2486/indhealth.57_500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Koritala BSC, Çakmaklı S. The human circadian clock from health to economics. Psych J 2018; 7:176-196. [DOI: 10.1002/pchj.252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Bala S. C. Koritala
- Department of Biology; Rutgers, The State University of New Jersey; Camden New Jersey USA
- Center for Computational and Integrative Biology; Rutgers, The State University of New Jersey; Camden New Jersey USA
| | - Selim Çakmaklı
- Department of Economics; Rutgers, The State University of New Jersey; Camden New Jersey USA
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Elfering A, Kottwitz MU, Tamcan Ö, Müller U, Mannion AF. Impaired sleep predicts onset of low back pain and burnout symptoms: evidence from a three-wave study. PSYCHOL HEALTH MED 2018; 23:1196-1210. [PMID: 29792065 DOI: 10.1080/13548506.2018.1479038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In a three-wave questionnaire study of 405 working participants, who were initially free of low back pain (LBP) and emotional exhaustion, sleep problems were evaluated as a potential risk factor for the development of LBP and burnout up to three years later. Prospective risk paths were compared between the sexes and between two age-groups (18 to 45 years and older than 45 years). A longitudinal structural equation model showed a good fit with empirical data (RMSEA = .04, SRMR = .06, CFI = .97). Prospective risk paths between the latent constructs showed sleep problems to significantly predict self-reported LBP (β = .15, p = .011) and burnout (β = .24, p < .001) two years later. Sleep problems also predicted the occurrence of burnout three years later (β = .18, p = .002). Sleep-related risk of burnout after two years was greater in older than younger participants (βolder = .42 vs. βyounger = .13, p < .001). Sleep problems seem to precede LBP and burnout in working individuals. Health promotion initiatives should use sleep quality as an important early risk indicator, and interventions should focus on promoting better quality sleep, in an attempt to reduce the incidence of LBP and burnout.
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Affiliation(s)
- Achim Elfering
- a Institute of Psychology , University of Bern , Bern , Switzerland.,b National Centre of Competence in Research, Affective Sciences , University of Geneva, CISA , Geneva , Switzerland
| | | | - Özgür Tamcan
- d Institute for Evaluative Research in Orthopaedic Surgery , University of Bern , Bern , Switzerland
| | - Urs Müller
- d Institute for Evaluative Research in Orthopaedic Surgery , University of Bern , Bern , Switzerland
| | - Anne F Mannion
- e Spine Center , Schulthess Klinik , Zurich , Switzerland
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Kottwitz MU, Rolli Salathé C, Buser C, Elfering A. Emotion Work and Musculoskeletal Pain in Supermarket Cashiers: A Test of a Sleep-Mediation Model. SCANDINAVIAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2017. [DOI: 10.16993/sjwop.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Siengsukon CF, Al-Dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Phys Ther 2017; 97:826-836. [PMID: 28789471 DOI: 10.1093/ptj/pzx057] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/17/2017] [Indexed: 11/14/2022]
Abstract
Sleep disturbances occur in one third of the US population, and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control has deemed insufficient sleep to be a public health problem. Knowledge about sleep and skills to screen sleep disorders and to promote sleep health have been recommended for physical therapists. Furthermore, in survey studies, physical therapists overwhelmingly agree that sleep is important for health and poor sleep impairs function. Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory. Sleep disruptions occur across the life span and in individuals with various conditions that are typically treated by physical therapists. Therefore, the purpose of this perspective paper is to (1) discuss the relevance of sleep to physical therapist practice, (2) recommend tools to screen for the 3 most common sleep disorders, and (3) provide suggestions for how therapists can integrate sleep health in prevention, health promotion, and wellness interventions.
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Affiliation(s)
- Catherine F Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Mail Stop 2002, Kansas City, KS 66160 (USA)
| | - Mayis Al-Dughmi
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center
| | - Suzanne Stevens
- Department of Neurology, University of Kansas Medical Center
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The psycho-sensory wake drive-a power source for power naps and other common sleep-wake phenomena: a hypothesis. Sleep Breath 2017; 22:41-48. [PMID: 28456884 PMCID: PMC5835054 DOI: 10.1007/s11325-017-1505-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 11/17/2022]
Abstract
Power naps are extensively practiced worldwide and there exists ample documentation of their efficacy in reversing daytime sleepiness. The source of their efficacy, however, as well as the cause and manifestation of many other common sleep-wake phenomena, cannot be entirely explained by the most commonly accepted model of sleep-wake regulation, the two-process model of Borbély, which considers the drives of the circadian and homeostatic sleep processes only. When considering the causes and manifestations of these unexplained phenomena, there appears to be evidence of a wake-promoting drive that is independent of the circadian oscillator indicated in the two-process model of sleep-wake regulation. Although this posited secondary wake drive, herein referred to as the psycho-sensory wake drive, is always active during the awake state, its strength unpredictably varies during a normal day and, therefore, cannot be incorporated into the prevalent two-process model by any current mathematical formula. However, a supplemental graphic model superimposing it on the drives of Process S and Process C can provides plausible and parsimonious explanations for many otherwise unexplainable sleep-wake phenomena and enables rational guidelines for their effective practical management.
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Fatigue and Sleep Among Employees With Prospective Increase in Work Time Control: A 1-Year Observational Study With Objective Assessment. J Occup Environ Med 2016; 58:1066-1072. [PMID: 27608280 DOI: 10.1097/jom.0000000000000858] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This observational study aimed to determine how 1-year changes in work time control (WTC) have an impact upon objectively measured fatigue and sleep among employees. METHODS Thirty-nine employees were divided into two groups according to whether or not their WTC increased from baseline to 1 year later. Psychomotor vigilance task (PVT) and wrist actigraphy were used to objectively measure fatigue and sleep, respectively. Self-reported outcomes were also measured. RESULTS The increased WTC group showed gradual improvements in PVT performance and sleep quality over the course of the follow-up period compared with the not-increased WTC group. Between-group differences were statistically significant for PVT lapses and tended to be significant for PVT speed after 1 year. CONCLUSIONS A progressive increase in WTC could play a crucial role in reducing fatigue and promoting sleep among employees.
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Takahashi M, Matsudaira K, Shimazu A. Disabling low back pain associated with night shift duration: sleep problems as a potentiator. Am J Ind Med 2015; 58:1300-10. [PMID: 26122920 DOI: 10.1002/ajim.22493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND We investigated how night shift duration and sleep problems were jointly associated with disabling low back pain (LBP) among workers in different occupations. METHODS An online-survey was conducted regarding work schedules, disabling LBP, sleep problems, and other relevant factors in 5,008 workers who were randomly selected from a market research panel. Multiple logistic regression analyses determined the joint associations of night shift duration (0 [permanent day shift], <8, 8-9.9, 10-15.9, ≥16 hr) and sleep problems (no, yes) with disabling LBP adjusted for potential confounders. RESULTS A night shift ≥16 hr was associated with a significant increase in the likelihood of disabling LBP. The magnitude of this association was elevated when participants perceived sleep problems including both sleep duration and quality. CONCLUSION Associations between extended night shifts and disabling LBP became stronger in the presence of short or poor quality sleep.
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Affiliation(s)
- Masaya Takahashi
- National Institute of Occupational Safety and Health, Tama-ku, Kawasaki, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Clinical Research Center for Occupational Musculoskeletal Disorders, Kanto Rosai Hospital, Nakahara-ku, Kawasaki, Japan
| | - Akihito Shimazu
- Department of Mental Health, The University of Tokyo, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Olson R, Crain TL, Bodner TE, King R, Hammer LB, Klein LC, Erickson L, Moen P, Berkman LF, Buxton OM. A workplace intervention improves sleep: results from the randomized controlled Work, Family, and Health Study. Sleep Health 2015; 1:55-65. [PMID: 29073416 PMCID: PMC9019820 DOI: 10.1016/j.sleh.2014.11.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/25/2014] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES The Work, Family, and Health Network Study tested the hypothesis that a workplace intervention designed to increase family-supportive supervision and employee control over work time improves actigraphic measures of sleep quantity and quality. DESIGN Cluster-randomized trial. SETTING A global information technology firm. PARTICIPANTS US employees at an information technology firm. INTERVENTIONS Randomly selected clusters of managers and employees participated in a 3-month, social, and organizational change process intended to reduce work-family conflict. The intervention included interactive sessions with facilitated discussions, role playing, and games. Managers completed training in family-supportive supervision. MEASUREMENTS AND RESULTS Primary outcomes of total sleep time (sleep duration) and wake after sleep onset (sleep quality) were collected from week-long actigraphy recordings at baseline and 12 months. Secondary outcomes included self-reported sleep insufficiency and insomnia symptoms. Twelve-month interviews were completed by 701 (93% retention), of whom 595 (85%) completed actigraphy. Restricting analyses to participants with e3 valid days of actigraphy yielded a sample of 473-474 for intervention effectiveness analyses. Actigraphy-measured sleep duration was 8 min/d greater among intervention employees relative to controls (P < .05). Sleep insufficiency was reduced among intervention employees (P = .002). Wake after sleep onset and insomnia symptoms were not different between groups. Path models indicated that increased control over work hours and subsequent reductions in work-family conflict mediated the improvement in sleep sufficiency. CONCLUSIONS The workplace intervention did not overtly address sleep, yet intervention employees slept 8 min/d more and reported greater sleep sufficiency. Interventions should address environmental and psychosocial causes of sleep deficiency, including workplace factors.
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Affiliation(s)
- Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, L606, Portland, OR 97239; Department of Public Health & Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code CB 669, Portland, OR 97239; Department of Psychology, Portland State University, 1721 SW Broadway, Rm 317, Portland, OR 97201
| | - Tori L Crain
- Department of Psychology, Portland State University, 1721 SW Broadway, Rm 317, Portland, OR 97201
| | - Todd E Bodner
- Department of Psychology, Portland State University, 1721 SW Broadway, Rm 317, Portland, OR 97201
| | - Rosalind King
- Population Dynamics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Bethesda, MD 20892-7510
| | - Leslie B Hammer
- Department of Psychology, Portland State University, 1721 SW Broadway, Rm 317, Portland, OR 97201
| | - Laura Cousino Klein
- Department of Biobehavioral Health and Penn State Institute of the Neurosciences, Pennsylvania State University, 221 Biobehavioral Health Bldg, University Park, PA 16802
| | - Leslie Erickson
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709
| | - Phyllis Moen
- Department of Sociology and Minnesota Population Center, University of Minnesota, 50 Willey Hall, 225-19th Ave South, Minneapolis, MN 55455
| | - Lisa F Berkman
- Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge MA 02138; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Kresge Building, Boston, MA 02115
| | - Orfeu M Buxton
- Department of Biobehavioral Health and Penn State Institute of the Neurosciences, Pennsylvania State University, 221 Biobehavioral Health Bldg, University Park, PA 16802; Harvard Center for Population and Development Studies, Harvard University, 9 Bow Street, Cambridge MA 02138; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Kresge Building, Boston, MA 02115; Department of Medicine, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115; Division of Sleep Medicine, Harvard Medical School, 221 Longwood Ave, Boston, MA 02115.
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Affiliation(s)
- Masaya Takahashi
- National Institute of Occupational Safety and Health; Kawasaki Japan
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Kubo T, Takahashi M, Sallinen M, Kubo Y, Suzumura H. [How are leisure activity and shiftwork schedule associated with recovery from fatigue in shiftwork nurses?]. SANGYŌ EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2013; 55:90-102. [PMID: 23448717 DOI: 10.1539/sangyoeisei.b12004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The period of leisure is an appropriate time to recover from work-induced fatigue, though some recovery takes place during rest breaks at work. Recently, much attention has been paid to the critical role of leisure activity in recovery. However, the findings relevant to shiftwork nurses who cannot take a day-off regularly are limited. This study explored how leisure activity during days off and shift work schedule are associated with recovery from fatigue in nurses working rotating shifts. METHODS A total of 426 nurses working rotating shifts at a university hospital returned a questionnaire regarding leisure activity and fatigue (response rate: 81.5%). Nurses were eligible for this study if they were female, worked 2 or 3 shifts, and had no missing data. A total of 390 respondents satisfied the inclusion criteria. A factor analysis classified their responses on how to spend an assumed period of two consecutive days off into three activity types: outdoor-, sleep-, and indoor-oriented. Fatigue (recovery from fatigue, accumulated fatigue, burnout), work conditions (working time, overtime, nightshift napping), sleep (sleep duration before day shift or day off, sleepiness) were measured. These data were analyzed using a two-way mixed model analysis of covariance (type [outdoor, sleep, indoor], shift schedule [two or three-shift system]). Covariates included age, length of career, partner, children, and hospital ward. Multiple regression analyses were performed to examine the factors determining the level of fatigue. RESULTS Outdoor-oriented nurses showed significantly faster fatigue recovery, lower accumulated fatigue and less burnout symptoms than others, regardless of the shiftwork schedule. In contrast, sleep-oriented nurses showed significantly slower recovery from fatigue. Besides, their level of fatigue deteriorated more when they worked under a 3-shift system (counter-clockwise) compared with under 2-shift system (with mainly 16-hour nightshift). Multiple regression analysis indicated that sleep-oriented type of leisure activity, workload perception of working time, work-induced insomnia and length of nightshift naps were significantly related to fatigue-related outcomes. CONCLUSIONS The primary finding of this study suggests that the level of fatigue is associated with the type of leisure activity, especially sleep-oriented activity, during shiftwork nurses' days off. Also, ensuring sufficient nightshift nap time may be one of the most important nightshift-related factors for recovery from fatigue. The present findings may have implications for appropriate activities during days off as factors facilitating recovery from work, though further investigations are needed to examine the causal links.
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Affiliation(s)
- Tomohide Kubo
- National Institute of Occupational Safety and Health, 6-21-1 Nagao, Tama-ku, Kawasaki, Kanagawa 214-8585, Japan.
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