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Hong HC, Kim YM. Multimorbidity and its Associated Factors in Korean Shift Workers: Population-Based Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e55014. [PMID: 38857074 PMCID: PMC11196912 DOI: 10.2196/55014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/11/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Multimorbidity is a crucial factor that influences premature death rates, poor health, depression, quality of life, and use of health care. Approximately one-fifth of the global workforce is involved in shift work, which is associated with increased risk for several chronic diseases and multimorbidity. About 12% to 14% of wage workers in Korea are shift workers. However, the prevalence of multimorbidity and its associated factors in Korean shift workers are rarely reported. OBJECTIVE This study aimed to assess multimorbidity prevalence, examine the factors associated with multimorbidity, and identify multimorbidity patterns among shift workers in Korea. METHODS This study is a population-based cross-sectional study using Korea National Health and Nutrition Examination Survey data from 2016 to 2020. The study included 1704 (weighted n=2,697,228) Korean shift workers aged 19 years and older. Multimorbidity was defined as participants having 2 or more chronic diseases. Demographic and job-related variables, including regular work status, average working hours per week, and shift work type, as well as health behaviors, including BMI, smoking status, alcohol use, physical activity, and sleep duration, were included in the analysis. A survey-corrected logistic regression analysis was performed to identify factors influencing multimorbidity among the workers, and multimorbidity patterns were identified with a network analysis. RESULTS The overall prevalence of multimorbidity was 13.7% (302/1704). Logistic regression indicated that age, income, regular work, and obesity were significant factors influencing multimorbidity. Network analysis results revealed that chronic diseases clustered into three groups: (1) cardiometabolic multimorbidity (hypertension, dyslipidemia, diabetes, coronary heart disease, and stroke), (2) musculoskeletal multimorbidity (arthritis and osteoporosis), and (3) unclassified diseases (depression, chronic liver disease, thyroid disease, asthma, cancer, and chronic kidney disease). CONCLUSIONS The findings revealed that several socioeconomic and behavioral factors were associated with multimorbidity among shift workers, indicating the need for policy development related to work schedule modification. Further organization-level screening and intervention programs are needed to prevent and manage multimorbidity among shift workers. We also recommend longitudinal studies to confirm the effects of job-related factors and health behaviors on multimorbidity among shift workers in the future.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Young Man Kim
- College of Nursing, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Varma P, Postnova S, Knock S, Howard ME, Aidman E, Rajaratnam SWM, Sletten TL. SleepSync: Early Testing of a Personalised Sleep-Wake Management Smartphone Application for Improving Sleep and Cognitive Fitness in Defence Shift Workers. Clocks Sleep 2024; 6:267-280. [PMID: 38920420 PMCID: PMC11203003 DOI: 10.3390/clockssleep6020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Shift work, long work hours, and operational tasks contribute to sleep and circadian disruption in defence personnel, with profound impacts on cognition. To address this, a digital technology, the SleepSync app, was designed for use in defence. A pre-post design study was undertaken to examine whether four weeks app use improved sleep and cognitive fitness (high performance neurocognition) in a cohort of shift workers from the Royal Australian Air Force. In total, 13 of approximately 20 shift-working personnel from one base volunteered for the study. Sleep outcomes were assessed using the Insomnia Severity Index (ISI), the Patient-Reported Outcomes Measurement Information System (PROMIS), Sleep Disturbance and Sleep-Related Impairment Scales, the Glasgow Sleep Effort Scale, the Sleep Hygiene Index, and mental health was assessed using the Depression, Anxiety, and Stress Scale-21. Sustained attention was measured using the 3-min Psychomotor Vigilance Task (PVT) and controlled response using the NBack. Results showed significant improvements in insomnia (ISI scores 10.31 at baseline and 7.50 after app use), sleep-related impairments (SRI T-scores 53.03 at baseline to 46.75 post-app use), and healthy sleep practices (SHI scores 21.61 at baseline to 18.83 post-app use; all p < 0.001). Trends for improvement were recorded for depression. NBack incorrect responses reduced significantly (9.36 at baseline; reduced by -3.87 at last week of app use, p < 0.001), but no other objective measures improved. These findings suggest that SleepSync may improve sleep and positively enhance cognitive fitness but warrants further investigation in large samples. Randomised control trials with other cohorts of defence personnel are needed to confirm the utility of this intervention in defence settings.
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Affiliation(s)
- Prerna Varma
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Svetlana Postnova
- School of Physics, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Stuart Knock
- School of Physics, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Mark E. Howard
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC 3084, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Eugene Aidman
- Defence, Science and Technology Group, Department of Defence, Edinburgh, SA 5111, Australia;
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Shantha W. M. Rajaratnam
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Tracey L. Sletten
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
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Crowther ME, Ferguson SA, Gupta CC, Reynolds AC. The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale. Behav Sleep Med 2024; 22:353-377. [PMID: 37807653 DOI: 10.1080/15402002.2023.2265520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Shift work is associated with circadian misalignment, sleep loss, and suboptimal health behaviors, which may contribute to longer term negative health outcomes. To inform future interventions for shift workers, the present study aimed to develop and evaluate the Health Belief Model for Shift Workers (HBM-SW) scale. METHODS The HBM-SW development involved a seven-step process, including a literature review, expert panel analysis, cognitive interviews with shift workers, and a trial with a pilot sample of shift workers (n = 153). Utilizing exploratory factor analysis for factor identification and item reduction, the developed scale loaded on seven factors in line with the theoretical framework of the Health Belief Model: Perceived Threat, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy, and Health Motivation. Validation of the scale was conducted utilizing Pittsburgh Sleep Quality Index, International Physical Activity Questionnaire, and Food Frequency Questionnaire. RESULTS The pilot sample had an average age of 34.0 (18.0) years, was majority female (54.2%), with an average of 8.0 (11.0) years shift work experience. The HBM-SW showed good - excellent (α = 0.74-0.93) internal consistency and moderate - good (ICC = 0.64-0.89) test re-test reliability. Using health behavior outcome measures, the HBM-SW scale showed meaningful correlations with sleep quality, sleep duration, diet quality and leisure time physical activity, and acceptable validity and reliability. Further testing should be conducted in a larger sample to facilitate confirmatory factor analysis. CONCLUSIONS The developed Health Belief Model for Shift Workers scale is likely beneficial for use in future studies of interventions for shift workers.
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Affiliation(s)
- Meagan E Crowther
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Sally A Ferguson
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Charlotte C Gupta
- Appleton Institute, CQUniversity Australia, Adelaide, South Australia, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, South Australia, Australia
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Easton DF, Gupta CC, Vincent GE, Ferguson SA. Move the night way: how can physical activity facilitate adaptation to shift work? Commun Biol 2024; 7:259. [PMID: 38431743 PMCID: PMC10908783 DOI: 10.1038/s42003-024-05962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
Shift work, involving night work, leads to impaired sleep, cognition, health and wellbeing, and an increased risk of occupational incidents. Current countermeasures include circadian adaptation to phase shift circadian biomarkers. However, evidence of real-world circadian adaptation is found primarily in occupations where light exposure is readily controlled. Despite this, non-photic adaptation to shift work remains under researched. Other markers of shift work adaptation exist (e.g., improvements in cognition and wellbeing outcomes) but are relatively unexplored. Timeframes for shift work adaptation involve changes which occur over a block of shifts, or over a shift working career. We propose an additional shift work adaptation timeframe exists which encompasses acute within shift changes in markers of adaptation. We also propose that physical activity might be an accessible and cost-effective countermeasure that could influence multiple markers of adaptation across three timeframes (Within Shift, Within Block, Within Work-span). Finally, practical considerations for shift workers, shift work industries and future research are identified.
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Affiliation(s)
- Dayna F Easton
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, SA, Australia.
| | - Charlotte C Gupta
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, SA, Australia
| | - Grace E Vincent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, SA, Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Wayville, SA, Australia
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Davis C, Huggins CE, Kleve S, Leung GKW, Bonham MP. Conceptualizing weight management for night shift workers: A mixed-methods systematic review. Obes Rev 2024; 25:e13659. [PMID: 37985937 DOI: 10.1111/obr.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/24/2023] [Accepted: 10/01/2023] [Indexed: 11/22/2023]
Abstract
Shift workers have an increased risk of obesity and metabolic conditions. This mixed-methods systematic literature review on night shift workers aimed to: (1) identify barriers/enablers of weight management; (2) examine effectiveness of weight management interventions; and (3) determine whether interventions addressed enablers/barriers. Six databases were searched, articles screened by title/abstract, followed by full-text review, and quality assessment. Eligible qualitative studies documented experiences of behaviors related to weight change. Eligible quantitative studies were behavior change interventions with weight/body mass index outcomes. A thematic synthesis was undertaken for qualitative studies using the social-ecological model (SEM). Interventions were synthesized narratively including: weight/body composition change; components mapped by behavior change taxonomy; and SEM. A synthesis was undertaken to identify if interventions addressed perceived enablers/barriers. Eight qualitative (n = 169 participants) and 12 quantitative studies (n = 1142 participants) were included. Barriers predominated discussions: intrapersonal (time, fatigue, stress); interpersonal (work routines/cultural norms); organizational (fatigue, lack of: routine, healthy food options, breaks/predictable work); community (lack of healthy food options). The primary outcome for interventions was not weight loss and most did not address many identified enablers/barriers. One intervention reported a clinically significant weight loss result. Weight loss interventions that address barriers/enablers at multiple SEM levels are needed.
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Affiliation(s)
- Corinne Davis
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Australia
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Australia
| | - Gloria K W Leung
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Australia
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Varma P, Postnova S, Phillips AJK, Knock S, Howard ME, Rajaratnam SMW, Sletten TL. Pilot feasibility testing of biomathematical model recommendations for personalising sleep timing in shift workers. J Sleep Res 2023:e14026. [PMID: 37632717 DOI: 10.1111/jsr.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
Sleep disturbances and circadian disruption play a central role in adverse health, safety, and performance outcomes in shift workers. While biomathematical models of sleep and alertness can be used to personalise interventions for shift workers, their practical implementation is undertested. This study tested the feasibility of implementing two biomathematical models-the Phillips-Robinson Model and the Model for Arousal Dynamics-in 28 shift-working nurses, 14 in each group. The study examined the overlap and adherence between model recommendations and sleep behaviours, and changes in sleep following the implementation of recommendations. For both groups combined, the mean (SD) percentage overlap between when a model recommended an individual to sleep and when sleep was obtained was 73.62% (10.24%). Adherence between model recommendations and sleep onset and offset times was significantly higher with the Model of Arousal Dynamics compared to the Phillips-Robinson Model. For the Phillips-Robinson model, 27% of sleep onset and 35% of sleep offset times were within ± 30 min of model recommendations. For the Model of Arousal Dynamics, 49% of sleep onset, and 35% of sleep offset times were within ± 30 min of model recommendations. Compared to pre-study, significant improvements were observed post-study for sleep disturbance (Phillips-Robinson Model), and insomnia severity and sleep-related impairments (Model of Arousal Dynamics). Participants reported that using a digital, automated format for the delivery of sleep recommendations would enable greater uptake. These findings provide a positive proof-of-concept for using biomathematical models to recommend sleep in operational contexts.
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Affiliation(s)
- Prerna Varma
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
| | | | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
| | - Stuart Knock
- School of Physics, The University of Sydney, Camperdown, Australia
| | - Mark E Howard
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracey L Sletten
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
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Jeon BM, Kim SH, Shin SH. Effectiveness of sleep interventions for rotating night shift workers: a systematic review and meta-analysis. Front Public Health 2023; 11:1187382. [PMID: 37427284 PMCID: PMC10323438 DOI: 10.3389/fpubh.2023.1187382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Sleep disturbance is a common issue among rotating night shift workers and is closely related to health risks. The present study aimed to determine the effectiveness of pharmacological and non-pharmacological sleep interventions for the management of sleep disturbance among rotating night shift workers. Methods For this systematic review and meta-analysis, we searched six electronic databases-EMBASE, CINAHL, Cochrane Library, PubMed, Scopus, and Web of Science-for randomized controlled trials and clinical trials published from January 1990 to June 2022. The quality of eligible studies was independently assessed by three authors using the Joanna Briggs Institute Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies. The meta-analysis was performed based on the random effects model using the Comprehensive Meta-Analysis software. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of the 1019 studies retrieved, 30 met the inclusion criteria for the systematic review; 25 were selected for the meta-analysis. Sleep interventions were categorized as follows: pharmacological approach (n = 7), light therapy (n = 9), cognitive behavioral approach (n = 7), aroma or alternative therapy (n = 4), and shift schedule modification (n = 3). The overall mean effect size of the interventions was moderate (Hedges' g = 0.59; 95% confidence interval = 0.33-0.84, z = 4.50, p < 0.001). Conclusion Sleep interventions were effective in promoting sleep or reducing sleep disturbance among rotating night shift workers. These findings provide evidence of the effectiveness of various pharmacological and non-pharmacological sleep interventions for managing sleep health in the work environment of rotating night shift workers.
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Affiliation(s)
- Bo Min Jeon
- College of Nursing, Kyungpook National University, Daegu, Republic of Korea
| | - Su Hyun Kim
- College of Nursing, The Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Hwa Shin
- Department of Nursing, Andong Science College, Andong, Republic of Korea
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Conway-Jones R, Dunlop E, Kyle S, Ray D, Roberts N, Farmer A. A scoping review of the evidence for the impact of pharmacological and non-pharmacological interventions on shift work related sleep disturbance in an occupational setting. Wellcome Open Res 2023; 6:198. [PMID: 37346814 PMCID: PMC10280030 DOI: 10.12688/wellcomeopenres.17002.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 08/17/2023] Open
Abstract
Background: Shift work is essential in society but can be detrimental to health and quality of life and is associated with decreased productivity and increased risk of accidents. Interventions to reduce these consequences are needed, but the extent and range of trial evidence for interventions for those most affected by their shift-work schedules is unclear. We therefore carried out a scoping review to assess the availability of evidence to inform the development and evaluation of future interventions. Methods: We aimed to identify clinical trials of any intervention for shift work-related sleep disturbance that included a comparator group, where the intervention was delivered in an occupational setting. We searched Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Medline and Science Citation Index from inception to 30 th March 2020 for relevant citations. Citations were screened by two independent reviewers, a third reviewer resolved disagreements. Data were extracted by two independent reviewers. Results: From 1250 unique citations, 14 studies met inclusion criteria for comparative trials of treatment in an occupational setting. There were five trials of hypnotics, five trials of stimulants, and four trials of non-pharmacological therapies (cognitive behavioural therapy, light therapy, aromatherapy and herbal medicine). Outcomes included sleep parameters, day-time sleepiness, and quality of life. There were no consistently reported outcomes across trials. Conclusions: Interventions fell into three distinct groups investigated in distinct time periods without progression from efficacy trials to wider-scale interventions. The lack of consistent patient-reported outcome measures limits synthesising findings. Some trials focussed on optimising sleep, others on reducing wake-time sleepiness. Adequately powered trials of existing interventions are needed, with the development and testing of novel combination treatments in patients with well-defined shift work sleep disorder. A core set of clinically relevant outcomes will develop and standardise the evidence-base for shift work sleep disorder.
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Affiliation(s)
| | - Ella Dunlop
- Medical Science Division, University of Oxford, Oxford, UK
| | - Simon Kyle
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Nia Roberts
- The Bodleian Libraries, University of Oxford, Oxford, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kim S, Lee H, Koo J. Impact of reduced night work on shift workers' sleep using difference-in-difference estimation. J Occup Health 2023; 65:e12400. [PMID: 37098821 PMCID: PMC10132182 DOI: 10.1002/1348-9585.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/27/2023] Open
Abstract
OBJECTIVES We used a quasi-experimental design to investigate the impact of a change in the shift work system by reducing overnight work on the sleep health of workers. METHODS A difference-in-difference (DID) analysis was used to investigate changes in sleep time and sleep quality between the experimental group (shift workers, N = 116 in 2007 and N = 118 in 2013) and the control group (regular day workers, N = 256 in 2007 and N = 185 in 2013) before and after a change in the shift system that eliminated overnight work. The sleep outcomes were measured using a questionnaire that inquired about sleep duration, mid-sleep awakenings, and subjective sleep quality. We used a generalized estimating equation model to investigate differences in the prevalence of sleep-related outcomes between baseline and post-intervention. RESULTS In the DID models, the sleep time per day (+0.5 h), the prevalence of awakening during sleep (-13.9%), and self-reported poor sleep quality (-34.9%) were improved with statistical significance during evening shifts in the experimental group, but there was no significant change during day shifts in the experimental group compared to the control group after the implementation of the new shift system without overnight shift. CONCLUSIONS Quitting overnight work improved sleep health of shift workers.
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Affiliation(s)
- Se‐Eun Kim
- Department of Occupational and Environmental MedicineEwha Womans University Seoul HospitalSeoulRepublic of Korea
| | - Hye‐Eun Lee
- Department of Social and Preventive MedicineHallym University College of MedicineChuncheonRepublic of Korea
- Institute of Social Medicine, Hallym University College of MedicineChuncheonRepublic of Korea
| | - Jung‐Wan Koo
- Department of Occupational and Environmental MedicineCollege of Medicine, The Catholic University of KoreaSeoulRepublic of Korea
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Zhang Z, Hu Y, Liu S, Zhang Y, Zhou J, Li J, Zhu W, Qi Z, Wu VX. Trend Analysis of the Mortality Rates of the Top Three Causes of Death Among Chinese Residents from 2003 to 2019. Int J Public Health 2022; 67:1604988. [PMID: 36147882 PMCID: PMC9485456 DOI: 10.3389/ijph.2022.1604988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To delineate the mortality trends of malignant tumors, heart disease and cerebrovascular disease in China.Methods: The crude mortality from 2003 to 2019 was derived from the China Health Statistical Yearbook, and the mortality rates were analyzed through joinpoint regression supplemented by descriptive statistics and χ2 tests.Results: The fitting model of age-standardized mortality due to malignant tumors showed three joinpoints. The APCs from 2003 to 2005, 2005–2008, 2008–2012 and 2012–2019 were −11.00%, 9.63%, −4.67% and −1.40%, respectively, and the AAPC was −1.54%. The mortality rate of cerebrovascular disease consistently decreased (APC = AAPC = −0.98%). In the subgroup analyses, significant differences were observed between sexes and regions. The mortality rate of heart disease among rural females exhibited an upward trend (APC = AAPC = 2.33%). Older adults aged over 75 years had the highest mortality rates and the most drastic change.Conclusion: The three diseases had variable change trends. The government should focus more on policies that promote the equalization of basic public health services. Continuous education on heart disease, which includes not only beneficial behaviors but also knowledge of first aid, should be strengthened for rural females.
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Affiliation(s)
- Zemiao Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinhuan Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Yinhuan Hu,
| | - Sha Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yeyan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghan Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weilin Zhu
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Zhen Qi
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Rampling CM, Gupta CC, Shriane AE, Ferguson SA, Rigney G, Vincent GE. Does knowledge of sleep hygiene recommendations match behaviour in Australian shift workers? A cross-sectional study. BMJ Open 2022; 12:e059677. [PMID: 35793914 PMCID: PMC9260798 DOI: 10.1136/bmjopen-2021-059677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Shiftworkers routinely obtain inadequate sleep, which has major health consequences. Sleep hygiene describes a range of behaviours, lifestyle and environmental factors that can improve sleep. To date, limited research has examined sleep hygiene in shiftworkers. This study aimed to assess the sociodemographic and behavioural correlates of sleep hygiene knowledge and engagement with sleep hygiene practices in Australian shiftworkers. STUDY DESIGN An online, cross-sectional survey. SETTING AND PARTICIPANTS Australian adults from across multiple industries (n=588) who work shift work. MEASURES The online survey included questions regarding sleep hygiene knowledge and questions from modified versions of the Pittsburgh Sleep Quality Index and Sleep Hygiene Index. RESULTS Of the 588 participants, 52.9% reported having heard of 'sleep hygiene'. Of these participants, 77.5% reported understanding the term moderately, extremely or very well. Engagement with each sleep hygiene practice was varied. Common sleep hygiene practices were controlling the bedroom environment (eg, a cool, dark and quiet bedroom). Less common practices were avoiding light as bedtime approaches. Logistic regressions revealed that shiftworkers who had heard of sleep hygiene were more likely to engage in sleep hygiene practices and had better sleep quality compared with those who had not heard of sleep hygiene. Increased engagement in sleep hygiene practices did not predict the likelihood of individuals reporting better sleep quality. CONCLUSIONS Shiftworkers demonstrated varied knowledge, understanding and engagement with individual sleep hygiene practices. Future research should focus on the development of sleep hygiene interventions that accommodate the unique challenges of shift work to optimise sleep.
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Affiliation(s)
- Caroline M Rampling
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
| | | | - Alexandra E Shriane
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
| | - Gabrielle Rigney
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
| | - Grace E Vincent
- Appleton Institute, Central Queensland University, Adelaide, South Australia, Australia
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Abstract
The modern way of life has dramatically affected our biological rhythms. Circadian rhythms, which are generated by an endogenous circadian clock, are observed in a large number of physiological functions including metabolism. Proper peripheral clock synchronization by different signals including appropriate feeding/fasting cycles is essential to coordinate and temporally gate metabolic processes. In this chapter, we emphasize the importance of nutrient sensing by peripheral clocks and highlight the major role of peripheral and central clock communication to locally regulate metabolic processes and ensure optimal energy storage and expenditure. As a consequence, changes in eating behavior and/or bedtime, as occurs upon shift work and jet lag, have direct consequences on metabolism and participate in the increasing prevalence of obesity and associated metabolic diseases such as type 2 diabetes and non-alcoholic fatty liver disease. In this setting, time-restricted feeding has been suggested as an efficient approach to ameliorate metabolic parameters and control body weight.
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Affiliation(s)
- Yasmine Sebti
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - Aurore Hebras
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - Benoit Pourcet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
| | - Bart Staels
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France.
| | - Hélène Duez
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France
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13
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Desmet L, Thijs T, Segers A, Verbeke K, Depoortere I. Chronodisruption by chronic jetlag impacts metabolic and gastrointestinal homeostasis in male mice. Acta Physiol (Oxf) 2021; 233:e13703. [PMID: 34107165 DOI: 10.1111/apha.13703] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 01/20/2023]
Abstract
AIM Chronodisruption desynchronizes peripheral clocks and leads to metabolic diseases. Feeding cues are important synchronizers of peripheral clocks and influence rhythmic oscillations in intestinal microbiota and their metabolites. We investigated whether chronic jetlag, mimicking frequent time zone travelling, affected the diurnal fluctuations in faecal short-chain fatty acid (SCFA) levels, that feed back to the gut clock to regulate rhythmicity in gut function. METHODS Rhythms in faecal SCFAs levels and in the expression of clock genes and epithelial markers were measured in the colonic mucosa of control and jetlagged mice. The entraining effect of SCFAs on the rhythm in clock gene mRNA expression was studied in primary colonic crypts. The role of the circadian clock in epithelial marker expression was studied in Arntl-/- mice. RESULTS Chronic jetlag increased body weight gain and abolished the day/night food intake pattern which resulted in a phase-delay in the rhythm of faecal SCFAs that paralleled the shift in the expression of mucosal clock genes. This effect was mimicked by stimulation of primary colonic crypts from control mice with SCFAs. Jetlag abolished the rhythm in Tnfα, proglucagon and ghrelin expression but not in the expression of tight junction markers. Only a dampening in plasma glucagon-like peptide-1 but not in ghrelin levels was observed. Rhythms in ghrelin but not proglucagon mRNA expression were abolished in Arntl-/- mice. CONCLUSION The altered food intake pattern during chronodisruption corresponds with the changes in rhythmicity of SCFA levels that entrain clock genes to affect rhythms in mRNA expression of gut epithelial markers.
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Affiliation(s)
- Louis Desmet
- Translational Research Center for Gastrointestinal Disorders KU Leuven Leuven Belgium
| | - Theo Thijs
- Translational Research Center for Gastrointestinal Disorders KU Leuven Leuven Belgium
| | - Anneleen Segers
- Translational Research Center for Gastrointestinal Disorders KU Leuven Leuven Belgium
| | - Kristin Verbeke
- Translational Research Center for Gastrointestinal Disorders KU Leuven Leuven Belgium
| | - Inge Depoortere
- Translational Research Center for Gastrointestinal Disorders KU Leuven Leuven Belgium
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14
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Cable J, Schernhammer E, Hanlon EC, Vetter C, Cedernaes J, Makarem N, Dashti HS, Shechter A, Depner C, Ingiosi A, Blume C, Tan X, Gottlieb E, Benedict C, Van Cauter E, St-Onge MP. Sleep and circadian rhythms: pillars of health-a Keystone Symposia report. Ann N Y Acad Sci 2021; 1506:18-34. [PMID: 34341993 PMCID: PMC8688158 DOI: 10.1111/nyas.14661] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022]
Abstract
The human circadian system consists of the master clock in the suprachiasmatic nuclei of the hypothalamus as well as in peripheral molecular clocks located in organs throughout the body. This system plays a major role in the temporal organization of biological and physiological processes, such as body temperature, blood pressure, hormone secretion, gene expression, and immune functions, which all manifest consistent diurnal patterns. Many facets of modern life, such as work schedules, travel, and social activities, can lead to sleep/wake and eating schedules that are misaligned relative to the biological clock. This misalignment can disrupt and impair physiological and psychological parameters that may ultimately put people at higher risk for chronic diseases like cancer, cardiovascular disease, and other metabolic disorders. Understanding the mechanisms that regulate sleep circadian rhythms may ultimately lead to insights on behavioral interventions that can lower the risk of these diseases. On February 25, 2021, experts in sleep, circadian rhythms, and chronobiology met virtually for the Keystone eSymposium "Sleep & Circadian Rhythms: Pillars of Health" to discuss the latest research for understanding the bidirectional relationships between sleep, circadian rhythms, and health and disease.
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Affiliation(s)
| | - Eva Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erin C Hanlon
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado at Boulder, Boulder, Colorado
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Jonathan Cedernaes
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nour Makarem
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Hassan S Dashti
- Department of Integrative Physiology, University of Colorado at Boulder, Boulder, Colorado
- Center for Genomic Medicine, Massachusetts General Hospital, and Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ari Shechter
- Department of Medicine and Sleep Center of Excellence, Columbia University Irving Medical Center, New York, New York
| | - Christopher Depner
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah
| | - Ashley Ingiosi
- Department of Biomedical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Christine Blume
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, and Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Xiao Tan
- Department of Neuroscience (Sleep Science, BMC), Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, and University of Melbourne, Melbourne, Victoria, Australia
| | - Christian Benedict
- Department of Neuroscience (Sleep Science, BMC), Uppsala University, Uppsala, Sweden
| | - Eve Van Cauter
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago, Illinois
| | - Marie-Pierre St-Onge
- Sleep Center of Excellence, Columbia University Irving Medical Center, New York, New York
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15
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Time-Restricted Feeding in Mice Prevents the Disruption of the Peripheral Circadian Clocks and Its Metabolic Impact during Chronic Jetlag. Nutrients 2021; 13:nu13113846. [PMID: 34836101 PMCID: PMC8622682 DOI: 10.3390/nu13113846] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 01/17/2023] Open
Abstract
We used time-restricted feeding (TRF) to investigate whether microbial metabolites and the hunger hormone ghrelin can become the dominant entraining factor during chronic jetlag to prevent disruption of the master and peripheral clocks, in order to promote health. Therefore, hypothalamic clock gene and Agrp/Npy mRNA expression were measured in mice that were either chronically jetlagged and fed ad libitum, jetlagged and fed a TRF diet, or not jetlagged and fed a TRF diet. Fecal short-chain fatty acid (SCFA) concentrations, plasma ghrelin and corticosterone levels, and colonic clock gene mRNA expression were measured. Preventing the disruption of the food intake pattern during chronic jetlag using TRF restored the rhythmicity in hypothalamic clock gene mRNA expression of Reverbα but not of Arntl. TRF countered the changes in plasma ghrelin levels and in hypothalamic Npy mRNA expression induced by chronic jetlag, thereby reestablishing the food intake pattern. Increase in body mass induced by chronic jetlag was prevented. Alterations in diurnal fluctuations in fecal SCFAs during chronic jetlag were prevented thereby re-entraining the rhythmic expression of peripheral clock genes. In conclusion, TRF during chronodisruption re-entrains the rhythms in clock gene expression and signals from the gut that regulate food intake to normalize body homeostasis.
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16
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Conway-Jones R, Dunlop E, Kyle S, Ray D, Roberts N, Farmer A. A scoping review of the evidence for the impact of pharmacological and non-pharmacological interventions on shift work related sleep disturbance in an occupational setting. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17002.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Shift work is essential in society but can be detrimental to health and quality of life and is associated with decreased productivity and increased risk of accidents. Interventions to reduce these consequences are needed, but the extent and range of trial evidence for interventions for those most affected by their shift-work schedules is unclear. We therefore carried out a scoping review to assess the availability of evidence to inform the development and evaluation of future interventions. Methods: We aimed to identify clinical trials of any intervention for shift work-related sleep disturbance that included a comparator group, where the intervention was delivered in an occupational setting. We searched Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Medline and Science Citation Index from inception to 30th March 2020 for relevant citations. Citations were screened by two independent reviewers, a third reviewer resolved disagreements. Data were extracted by two independent reviewers. Results: From 1250 unique citations, 14 studies met inclusion criteria for comparative trials of treatment in an occupational setting. There were five trials of hypnotics, five trials of stimulants, and four trials of non-pharmacological therapies (cognitive behavioural therapy, light therapy, aromatherapy and herbal medicine). Outcomes included sleep parameters, day-time sleepiness, and quality of life. There were no consistently reported outcomes across trials. Conclusions: Interventions fell into three distinct groups investigated in distinct time periods without progression from efficacy trials to wider-scale interventions. The lack of consistent patient-reported outcome measures limits synthesising findings. Some trials focussed on optimising sleep, others on reducing wake-time sleepiness. Adequately powered trials of existing interventions are needed, with the development and testing of novel combination treatments in patients with well-defined shift work sleep disorder. A core set of clinically relevant outcomes will develop and standardise the evidence-base for shift work sleep disorder.
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