[How are leisure activity and shiftwork schedule associated with recovery from fatigue in shiftwork nurses?]

Listening to 15 Hz Binaural Beats Enhances the Connectivity of Functional Brain Networks in the Mental Fatigue State—An EEG Study

Introduction: It is clear that mental fatigue can have many negative impacts on individuals, such as impairing cognitive function or affecting performance. The aim of this study was to investigate the role of sound interventions in combating mental fatigue. Method: The subjects were assessed on various scales, a psychomotor vigilance task (PVT) task, and a 3 min resting-state electroencephalogram (EEG), followed by a 20 min mental fatigue–inducing task (Time Load Dual Back, TloadDback), during which subjects in different condition groups listened to either 15 Hz binaural beats, 40 Hz binaural beats, relaxing music, or a 240 Hz pure tone. After the mental fatigue–inducing task, subjects were again assessed on various scales, a PVT task, and a 3 min resting-state EEG. Results: After the fatigue-inducing task, there was no significant difference between the four groups on the scales or the PVT task performance. In TloadDback, the accuracy rate of the 40 Hz binaural beats group and the relaxing music group decreased in the middle stage of the task, while the 15 Hz binaural beats group and the 240 Hz pure tone group remained unchanged in all stages of the task. The EEG results showed that after fatigue inducement, the average path length of the 15 Hz binaural beats group decreased, and local efficiency showed an increasing tendency, indicating enhanced brain network connectivity. Meanwhile, the 240 Hz pure tone group showed enhanced functional connectivity, suggesting a state of mental fatigue in the group. Conclusions: The results of this study show that listening to 15 Hz binaural beats is a proven intervention for mental fatigue that can contribute to maintaining working memory function, enhancing brain topological structure, and alleviating the decline in brain function that occurs in a mentally fatigued state. As such, these results are of great scientific and practical value.

Psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery Scale among shift-work nurses

Objectives

Shift‐work nurses are at a higher risk of inadequate recovery from fatigue and developing maladaptive fatigue with significant health consequences. Therefore, it is necessary to monitor fatigue and recovery levels with a reliable scale. We investigated psychometric properties of the Japanese version of the Occupational Fatigue Exhaustion Recovery scale (OFER‐J) for shift‐work nurses.

Methods

Japanese shift‐work nurses responded to self‐administered questionnaires at baseline (n = 942) and one month later (n = 334). The confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to verify the structural validity and the correlation analysis and one‐way analysis of variance were conducted to test the construct and discriminative validity. Cronbach's alpha coefficient, intra‐class correlation coefficient (ICC), and smallest detectable change (SDC) were calculated to assess reliability.

Results

The CFA showed high correlations between the factors and whilst the goodness‐of‐fit of the three‐factor model was suboptimal, it was in an acceptable range. Most modifications included the error covariance of the Acute Fatigue (AF) and Intershift Recovery (IR) items. The EFA showed that Chronic Fatigue (CF) and AF were not clearly separated, indicating that the two AF items dropped out. Construct and discriminative validity were also well indicated. Cronbach's alpha coefficients were 0.75–0.85. Only CF showed sufficient reproductivity (ICC = 0.74). The SDC for CF, AF, and IR was 14.0, 17.1, and 18.7, respectively.

Conclusions

The validity and reliability of the OFER‐J were verified as acceptable for shift‐work nurses. The OFER‐J could contribute to a data‐based approach to fatigue management in nursing management practice.

[Examining the association between work-life factors and health disorders/excessive fatigue among Japanese truck drivers]

OBJECTIVES

Karoshi problems (overwork-related deaths and disorders caused by cerebrovascular and cardiovascular diseases) still occur in Japan. Truck drivers, who are in one of the riskiest occupations, are reported to show an increased prevalence of hypertension, obesity, hyperlipidemia, and diabetes, which are characteristic of Karoshi. Their health problems also include excessive fatigue. This cross-sectional study aimed to examine the association between work-life factors and health disorders/excessive fatigue among Japanese truck drivers.

METHODS

We distributed a questionnaire regarding work hours, health status, lifestyle, burden of driving, and excessive fatigue to 5,410 truck drivers and collected a total of 1,947 responses, all from males. The association between work-life factors and health outcomes was evaluated by multivariable logistic regression analysis adjusted for age, drinking, and smoking status.

RESULTS

The prevalence rates of obesity, hypertension, hyperlipidemia, diabetes, cardiovascular disease, cerebrovascular disease, and excessive fatigue were 22.2%, 19.3%, 8.5%, 5.6%, 2.5%, 0.7%, and 6.0%, respectively. Significant associations were observed for long-haul trips (two days or more) with obesity (adjusted odds ratio 1.5 [95% Confidence Interval 1.1-2.1]), local and night trips with hypertension (1.5 [1.0-2.2]), early morning awakening on workdays with obesity (1.5 [1.1-2.1]), being indoor-oriented on weekends with hypertension (1.5 [1.1-2.0]); and heavy burden of driving at night with hyperlipidemia (2.0 [1.3-3.0]). The adjusted odds ratios were significant for waking after sleep onset (2.6 [1.2-5.3]) and lack of sleep satisfaction (2.7 [1.4-5.1]) on workdays, less than six hours of sleep (2.8 [1.0-7.8]) and lack of sleep satisfaction (2.8 [1.5-5.2]) on weekends, 0-3 days off per month (3.6 [1.3-10.2]), and heavy burden of driving at night (2.2 [1.0-4.8]) with excessive fatigue.

CONCLUSIONS

The present findings highlight that night and early morning work, heavy burden of night driving, and the resultant decreases in the quality and quantity of sleep may represent shared risk factors for health disorders and excessive fatigue among truck drivers. Adequate measures should be taken to limit the amount of night and early morning work, reduce the burden of night driving, and ensure days off for sleep opportunities and leisure activities, with the goal of preventing Karoshi.

Association analysis of Suboptimal health Status: a cross-sectional study in China

Background

Suboptimal health status (SHS) among urban residents is commonplace in China. However, factors influencing SHS have not been thoroughly explored, especially with regard to the effects of internal factors (e.g., personality and health awareness) on SHS.

Methods

A cross-sectional study was conducted with a nationally representative sample of 5460 Chinese urban residents..SHS was measured using the Suboptimal Health Mesurement Scale Version 1.0. Demographic information, and information pertaining to lifestyle behaviors, environmental factors, and internal factors were abtained through a questionnaire. The associations between demographic information, lifestyle behaviors, environmental factors, internal factors and SHS were assessed using logistic regression.

Results

Of the 5460 participants (with a mean age of 41.56 ±  16.14 years), 2640 (48.4 %) were men. Out of 36 variables, 23 were significantly associated with SHS: age (odds ratio [OR]: 1.014), an education level of high school/junior college (OR: 1.443) , marital status (OR: 1.899), area of registered permanent residence (OR: 0.767), monthly household income (p < 0.001) , exposure to second-hand smoke (p = 0.001), alcohol drinking (OR: 1.284), bad eating habits (OR: 1.717), not sleeping before 11 p.m. every day (p = 0.002), spending time online more than five hours a day (OR: 1.526), having a good relationship with parents during one’s growth period (OR: 0.602), living with good quality air (OR:0.817), living in not crowded conditions (OR:0.636), having a harmonious neighborhood (OR:0.775), having adequate fitness facilities (OR:0.783), one’s health being affected by two-child policy (OR: 1.468) and medical policies (OR: 1.265) , high adverse quotient (OR: 0.488), many (≥3 kinds) interests and hobbies (OR: 0.617), mature and steady personality traits (OR: 0.469) , a high attention to one’s health (OR: 0.833), and effective health promotion induced by leading a leisurely lifestyle (OR: 0.466) were significantly associated with SHS.

Conclusions

All these variables were included demographic information, lifestyle behaviors, environmental factors and internal factors. Our study supports the benefits of controlling both internal and external factors in preventing suboptimal health.

Restorative yoga for occupational stress among Japanese female nurses working night shift: Randomized crossover trial

OBJECTIVES

To determine whether restorative yoga is an effective method for relieving occupational stress among female nurses working the night shift in Japan.

METHODS

From July 2017 to May 2018, 20 female nurses aged in their 20s to 30s who were working the night shift at a university hospital participated in a randomized crossover trial, consisting of a 1-hour guided group yoga session followed by 4 weeks of at-home practice and 4 weeks of usual stress relief methods. The level of stress was assessed by the Brief Job Stress Questionnaire of the Ministry of Health, Labour and Welfare before and after performing restorative yoga. Descriptive statistics were calculated and data were analyzed by Student's t test, one-way analysis of variance (with repeated measures), or Bonferroni's multiple comparison test.

RESULTS

Vital signs showed no significant differences from before to after the group yoga session, and there was no change of weight after 4 weeks of at-home practice. The mean questionnaire score for "psychological and physical stress reactions" was significantly reduced after the group yoga session. In addition, the mean score was significantly lower after 4 weeks of at-home practice than before or after group yoga, or after 4 weeks of the usual stress relief methods.

CONCLUSIONS

These findings suggest that restorative yoga may be effective for alleviating occupational stress among female nurses working the night shift.

The effects of a 120-minute nap on sleepiness, fatigue, and performance during 16-hour night shifts: A pilot study

Objective

To investigate sleepiness, fatigue, and performance following a 120‐minute nap during simulated 16‐hour night shifts based on subjective and objective assessments.

Methods

Fourteen females participated in this crossover comparative study. Three experimental nap conditions were used: naps from 22:00 to 00:00 (22‐NAP), 00:00 to 02:00 (00‐NAP), and 02:00 to 04:00 (02‐NAP), respectively. Measurement items were sleep parameters, sublingual temperature, a Visual Analog Scale for sleepiness and fatigue, a single‐digit mental arithmetic task (for 10 minutes), and heart rate variability. Participants wore an ActiGraph to estimate their sleep state.

Results

There was no difference in the sleep parameters at the time of naps among the three conditions. Immediately following a 120‐minute nap, sleepiness and fatigue increased, and the number of calculations performed in the single‐digit mental arithmetic task decreased in any of the conditions. In particular, immediately after the 02‐NAP, fatigue and high‐frequency power (HF) were higher than after the 22‐NAP. In the early morning (from 05:00 to 09:00), in the 22‐NAP, sleepiness and fatigue increased, and performance and sublingual temperature decreased more than in the 00‐NAP and 02‐NAP. Furthermore, the ratio of errors was significantly lower in the 00‐NAP than in the 22‐NAP in the early morning.

Conclusions

A 120‐minute nap taken from 22:00 to 02:00 may cause temporary sleepiness after waking, increase fatigue and reduce performance. Greater attention should be given to naps taken at a later time (ie, 02‐NAP). In addition, taking a nap starting at 00:00 might decrease the risks of errors in the morning.

Insufficiently studied factors related to burnout in nursing: Results from an e-Delphi study

OBJECTIVE

This study aimed to identify potentially important factors in explaining burnout in nursing that have been insufficiently studied or ignored.

METHODS

A three-round Delphi study via e-mail correspondence was conducted, with a group of 40 European experts. The e-Delphi questionnaire consisted of 52 factors identified from a literature review. Experts rated and scored the importance of factors in the occurrence of burnout and the degree of attention given by researchers to each of the variables listed, on a six-point Likert scale. We used the agreement percentage (>80%) to measure the level of consensus between experts. Furthermore, to confirm the level of consensus, we also calculated mean scores and modes. Regardless of the degree of consensus reached by the experts, we have calculated the mean of the stability of the answers for each expert (individual's qualitative stability) and the mean of the stability percentages of the experts (qualitative group stability).

RESULTS

The response rate in the three rounds was 93.02% (n = 40). Eight new factors were suggested in the first round. After modified, the e-Delphi questionnaire in the second and third rounds had 60 factors. All the factors reached the third round with a consensus level above 80% in terms of the attention that researchers gave them in their studies. Moreover, the data show a total mean qualitative group stability of 96.21%. In the third round 9 factors were classified by experts as 'studied very little', 17 as 'studied little' and 34 as 'well studied'.

CONCLUSION

Findings show that not all the factors that may influence nursing burnout have received the same attention from researchers. The panel of experts has identified factors that, although important in explaining burnout, have been poorly studied or even forgotten. Our results suggest that further study into factors such as a lack of recognition of part of the tasks that nurses perform, feminine stereotype or excessive bureaucracy is needed for a better understanding of this syndrome and improve the quality of life in nurses.

Nonstandard working schedules and health: the systematic search for a comprehensive model

BACKGROUND

Theoretical models on shift work fall short of describing relevant health-related pathways associated with the broader concept of nonstandard working schedules. Shift work models neither combine relevant working time characteristics applicable to nonstandard schedules nor include the role of rest periods and recovery in the development of health complaints. Therefore, this paper aimed to develop a comprehensive model on nonstandard working schedules to address these shortcomings.

METHODS

A literature review was conducted using a systematic search and selection process. Two searches were performed: one associating the working time characteristics time-of-day and working time duration with health and one associating recovery after work with health. Data extracted from the models were used to develop a comprehensive model on nonstandard working schedules and health.

RESULTS

For models on the working time characteristics, the search strategy yielded 3044 references, of which 26 met the inclusion criteria that contained 22 distinctive models. For models on recovery after work, the search strategy yielded 896 references, of which seven met the inclusion criteria containing seven distinctive models. Of the models on the working time characteristics, three combined time-of-day with working time duration, 18 were on time-of-day (i.e. shift work), and one was on working time duration. The model developed in the paper has a comprehensive approach to working hours and other work-related risk factors and proposes that they should be balanced by positive non-work factors to maintain health. Physiological processes leading to health complaints are circadian disruption, sleep deprivation, and activation that should be counterbalanced by (re-)entrainment, restorative sleep, and recovery, respectively, to maintain health.

CONCLUSIONS

A comprehensive model on nonstandard working schedules and health was developed. The model proposes that work and non-work as well as their associated physiological processes need to be balanced to maintain good health. The model gives researchers a useful overview over the various risk factors and pathways associated with health that should be considered when studying any form of nonstandard working schedule.