Effects of 12‐Hour Rotating Shifts on Menstrual Cycles of Photoelectronic Workers in Taiwan

12 h rotating shifts are common in high‐tech industries in Taiwan. The aim of this longitudinal study was to evaluate the effect of the disruption of circadian rhythms by the shift schedule on menstrual cycle length (MCL) and regularity of female workers at an optoelectronic company in Taiwan. We recruited females who worked rotating shifts in a clean room environment as the shift‐work group and female office workers who worked normal business hours as the comparison group. Every participant recorded their MCL for each menstruation cycle up to eight consecutive months prospectively and provided demographic characteristics, reproductive history, and menstrual characteristics. We collected data on 1,135 and 117 menstruation cycles in the shift‐work (n=280) and comparison groups (n=49). Whereas the two groups had similar group means for MCL and number of menstrual bleeding days, the prevalence of menstrual cycle irregularity (cycles<25 or>35 days) was higher in the shift‐work group (p=0.04). Univariate and multivariate logistic regression analyses demonstrated that rotating shift work was an independent predictor of menstrual cycle irregularity (odds ratio=1.71, 95% confidence interval: 1.03–2.88) after adjusting for shift‐work history, employment duration, coffee consumption, and pre‐employment menstrual cycle irregularity. Although further study is required to confirm our findings plus to explore prevention and control measures, our data indicate rotating shift work can increase the risk of MCL irregularity.     

Social jetlag and menstrual symptoms among female university students

Menstrual symptoms may have a significant impact on women’s lives. Many women experience menses-related health problems, such as menstrual pain, heavy menstrual bleeding, and premenstrual syndrome, during their reproductively fertile years. Circadian misalignment in shift workers has been reported to contribute to menstrual cycle irregularity and/or painful menstruation. However, the relationship between social jetlag (SJL) and menstrual symptoms/menstrual cycle has not been elucidated. In this study, we aimed to elucidate this relationship among female university students. One-hundred and fifty female university students (mean [SD]: 18.8 [0.71]-years old) completed self-reported questionnaires consisting of menstrual symptoms and menstrual cycle, sleep quality and sleep habits, quality of life, and demographic variables. The average menstrual cycle was 32.0 [5.4] days. The percentage of students who showed menstrual cycle irregularity, having less than 25 days or more than 39 days of menstrual cycle during the previous four menstrual cycles, was 60.6%. SJL, the difference between mid-sleep time on free days and mid-sleep time on school days, was categorized into small (absolute SJL < 1 h) or large (≥1 h). Overall, 78.0% of participants had SJL ≥ 1 h. Among the menstrual symptoms, pain, behavioral change, and water retention subscale scores were significantly higher in the SJL ≥ 1 h group than in the SJL < 1 h group. However, no significant differences were found in concentration, autonomic reaction, or negative affect subscale scores between the two groups. The menstrual cycle was 31.2 [5.5] days in the SJL < 1 h group and 32.2 [5.4] days in the SJL ≥ 1 h group, without significant difference. Logistic regression analysis showed that more than 1 h of SJL was a significant associated factor with severe menstrual symptom, independently of sleep duration and late chronotype. This study indicated that SJL was a significant factor associated with severe menstrual symptoms, suggesting the possibilities of association between circadian system and reproductive function among humans.     

The Shift-Work Accident Rate is More Related to the Shift Type than to Shift Rotation

The current study investigated the accident rates across morning, late, and night shifts in rotating shift-workers employed in two different shift rotations at the same steel work factory. A retrospective analysis has been performed of accident data (N = 578) over a 5-year period (2003 through 2007) of 730 male shift-workers employed in either a clockwise (mean age of the workers 38.1 ± SD 9.8 years) or counterclockwise rotation (mean age 38.0 ± SD 10.1 years) with comparable work conditions. The overall accident rate across the 24-h day was not significantly different between clockwise and counterclockwise shift rotation. In both shift-work rotations, morning shifts as opposed to night shifts exhibited a significantly higher accident rate. There was no significant difference between late shifts and morning or night shifts in either shift rotation. The increased accident rate in the morning shift at this steel factory could be related to the early starting time of the shift and to this shift being more labor intensive in both shift rotations. These findings suggest that work-related factors must be considered in addition to shift-work schedules when investigating accident rates in rotating shift-workers.     

Self-Reported Health and Sleep Complaints Among Nursing Personnel Working Under 12 h Night and Day Shifts

This cross-sectional exploratory study involved health care workers of various skill types and levels. We tested the hypothesis that the prevalence of diseases, sleep complaints, and insufficient time for nonprofessional activities (family, leisure, and rest) are higher among night than day workers. Data collection was carried out in two public hospitals using questionnaires and other forms. Night work was explored as a risk factor, considering a night worker as one who had at least one night job on the occasion of the research. Data were assessed by a univariate analysis. The association between work schedule and the dependent variables—health conditions, sleep complaints, and insufficient time for nonprofessional activities—was evaluated through the estimation of the prevalence ratio, with a confidence interval of 95%. Two hundred and fifty-eight female nursing personnel participated; 41.5% were moonlighters, and only 20 worked a shift of less than 12 h in length. Reports of migraine and need of medical care the 2 weeks before the survey were more prevalent among day than night workers (PR = 0.71; CI = 0.55–0.92 and PR = 0.71; CI = 0.52–0.95, respectively). Migraine headaches occurred less frequently among night than day workers as confirmed by comparing the reports of the night workers and day workers whose work history was always day shifts (PR = 0.74; CI = 0.57–0.96). Reports of mild emotional disorders (mild depression, tension, anxiety, or insomnia) were less frequent among night (PR = 0.76; CI = 0.59–0.98) and ex-night workers (PR = 0.68; CI = 0.50–0.91) than day workers who never had worked a night job. The healthy worker effect does not seem to explain the results of the comparisons between day and night workers. The possible role of exposure by day workers to some risk factors, such as stress, was suggested as an explanation for these results. No significant difference was observed between night and day workers as to sleep complaints, a result that may have been influenced by the nature of the shift-work schedule (no successive night shifts) and possibly nap taking during the night shift. Moreover, the long work hours and moonlighting of the healthcare workers, which is common in Brazil, may have masked other possible differences between the day and night workers. Among night workers, a significant relation was found between years working nights (more than 10 yrs) and high cholesterol values (PR = 2.58; CI = 1.07–6.27), a result that deserves additional study. Working nights more than four times per 2-week span was related to complaints about insufficient time for children (PR = 1.96; CI = 1.38–2.78) and rest/leisure (PR = 1.54; CI = 1.20–1.99). These results can be related to the “social value of time,” as evenings and nights are when families usually spend time together. The complexity of the professional life and the consequent heterogeneity of the group of workers under shift-work schemes confound the results. More in-depth study of the questions raised here demands a more sophisticated epidemiological treatment and larger sample size.     

Persistent Rotating Shift-Work Exposure Accelerates Development of Metabolic Syndrome among Middle-Aged Female Employees: A Five-Year Follow-Up

Limited follow-up studies are available as to whether special job-types, such as day-night rotating shift work, contribute to the progression of metabolic syndrome among female industrial employees. A retrospective cohort study on the development of metabolic syndrome was conducted by utilizing health examination records for a five-year interval. The records of 387 female employees without metabolic syndrome at baseline were used for the analysis. Data analyzed included age, metabolic syndrome components, insulin resistance status, lifestyle factors, and job-types. The initial mean age of subjects was 32.8 yrs. Abnormal rates at baseline, including metabolic syndrome components and insulin resistance, were all significantly higher among the 34 female workers with metabolic syndrome outcome. Also, the persistent rotating shift-work exposure rates and five-year change of metabolic syndrome component measurements were significantly unfavorable for subjects with metabolic syndrome outcome. After controlling for the potential confounders, significant raised risks were found in the female worker with persistent rotating shift-work exposure (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.3–9.0 vs. day workers) and in smokers (OR, 5.4; 95% CI, 1.1–25.8 vs. non-smokers). At the same time, the female workers initially with one or two metabolic syndrome components had a 4.6-fold (95% CI, 1.3–17.0) and 12.7-fold (95% CI, 3.2–50.1), respectively, increased risk of progressing to metabolic syndrome within five years. In conclusion, persistent day-night rotating shift work, smoking, and baseline metabolic syndrome components associate with the progression toward metabolic syndrome for middle-aged female workers. (Author correspondence: pchen@ntu.edu.tw, gphinx@gmail.com).     

The Unique Impact of Menstruation on the Female Voice: Implications for the Evolution of Menstrual Cycle Cues

Research shows that hormonal changes in women across the menstrual cycle affect vocal production. Most work has documented shifts at high fertility times (i.e., ovulation) or during premenstruation. However, hormonal changes at menstruation also affect female physiology and behavior and could affect vocal production. The present studies investigated perceptual differences in voices recorded during menstruation compared with recordings taken at other times of the menstrual cycle. Results show that male raters could reliably identify voices recorded during menstruation with or without the presence of a voice recorded closest to ovulation. In addition, voices recorded at menstruation were identified as being the most unattractive. These findings indicate that voice recordings taken at times of lowest fertility may uniquely impact women’s vocal production and that perceptions of voice based on cycle phase are not specific to the time of heightened fertility. Implications for the evolution of human menstrual cycle cues are discussed.     

Menstrual cycles continue into advanced old age in the common chimpanzee (Pan troglodytes)

A long postreproductive lifespan may distinguish women from all other female primates. A long-held consensus among reproductive scientists has been that our closest living relative, the chimpanzee (Pan troglodytes), experiences menstrual cycles until death. However, a recent study of biannual assessments of gonadotropins, but lacking observations of menstruation, concluded that menopause occurs in chimpanzees between 35 and 40 yr of age. A separate report, but on wild chimpanzees, documented fertility through the 40-44 age range in all populations studied. These contradictory reports pose questions about differences between wild and captive populations and about assessments of menopause. The present study revisits this controversy by analyzing longitudinal records of anogenital swelling and menstruation in 89 female chimpanzees aged 6 to 59 yr (n = 2386 records on cycle length), monitored for most of their adult lives at the Yerkes National Primate Research Center. Twenty of these chimpanzees were observed past 39 yr of age; all 20 displayed menstrual cycles beyond this age, as confirmed by at least two observations of menses about 35 days apart. Three of these were older than 50 yr and still displayed menstrual cycles. Only the oldest female appeared menopausal, with cycles of anogenital swelling ceasing 2 yr prior to her death at age 59. Random-effects statistical modeling reveals a slight decrease in cycle length until 20 yr of age and a slight lengthening thereafter. Mean cycle length across the lifespan is 35.4 days. Our findings, based upon actual observations of menstrual cycles, suggest that menopause in the chimpanzee is rare, occurring near the end of the lifespan.     

Changes in social dynamics associated to the menstrual cycle in the vervet monkey (Cercopithecus aethiops)

Behavioral changes associated to the menstrual cycle in a social group of vervet monkeys (Cercopithecus aethiops) were studied. Three adult females were used as experimental subjects and in these, vaginal smears were taken every other day in order to detect their menstrual cycles. Only the dominant and the mid-ranking female showed regular cycles while the low-ranking female showed amenorrhea. The menstrual cycles were divided into five periods (menstrual, premenstrual, luteal, ovulatory and follicular) which were related to the behavioral data. Social behavior recordings were taken during one hour daily for five consecutive months; the data were adjusted twice in order to follow the cycles of the females with regular menstruations. By plotting in a matrix the relative frequencies of joins and displacements, the social position of each animal as well as the group's social organization and dynamics were evaluated. A clear tendency towards social rejection (emitting less joins and increasing the amount of displacements) was detected during the premenstrual periods of the dominant female which abruptly changed towards affiliation during menstruation. This observation was detected in all group members no matter their age-sex class or social position during the five months of observation. When the data were analyzed following the mid-ranking female's cycle, no consistent changes were apparent. The importance of social stimuli in the modulation and expression of hormone-related behavior is stressed, as well as the need of using social settings in the experimental analyses of premenstrual mood and behavior disorders.     

Selected Neurophysiological,Psychological, and Behavioral Influences on Subjective Sleep Quality in Nurses: A Structure Equation Model

Few studies have examined relationships among neurophysiological, psychological, and behavioral factors with regard to their effects on sleep quality. We used a structure equation model to investigate behavioral and psychological factors that influence neurophysiological regulation of sleep in shift workers. Using a cross-sectional study design, we tested the model with a sample of 338 female nurses working rotating shifts at an urban regional hospital. The Morningness-Eveningness Questionnaire (MEQ) and short-form Menstrual Distress Questionnaire (MDQ) were used to measure neurophysiological factors involved in morningness-eveningness and menstrual distress. The Sleep Hygiene Awareness and Practice Scale (SHAPS) and Profile of Mood States Short Form (POMS-SF) were completed to measure behavioral factors of sleep hygiene practices and psychological factors of mood states. In addition, the Pittsburgh Sleep Quality Index (PSQI) measured participant''s self-reported sleep quality. The results revealed that sleep hygiene practices and mood states mediated the effects of morningness-eveningness and menstrual distress on sleep quality. Our findings provide support for developing interventions to enhance sleep hygiene and maintain positive mood states to reduce the influence of neurophysiological factors on sleep quality among shift workers.     

Self-reported health and sleep complaints among nursing personnel working under 12 h night and day shifts

This cross-sectional exploratory study involved health care workers of various skill types and levels. We tested the hypothesis that the prevalence of diseases, sleep complaints, and insufficient time for nonprofessional activities (family, leisure, and rest) are higher among night than day workers. Data collection was carried out in two public hospitals using questionnaires and other forms. Night work was explored as a risk factor, considering a night worker as one who had at least one night job on the occasion of the research. Data were assessed by a univariate analysis. The association between work schedule and the dependent variables—health conditions, sleep complaints, and insufficient time for nonprofessional activities—was evaluated through the estimation of the prevalence ratio, with a confidence interval of 95%. Two hundred and fifty-eight female nursing personnel participated; 41.5% were moonlighters, and only 20 worked a shift of less than 12 h in length. Reports of migraine and need of medical care the 2 weeks before the survey were more prevalent among day than night workers (PR = 0.71; CI = 0.55-0.92 and PR = 0.71; CI = 0.52-0.95, respectively). Migraine headaches occurred less frequently among night than day workers as confirmed by comparing the reports of the night workers and day workers whose work history was always day shifts (PR = 0.74; CI = 0.57-0.96). Reports of mild emotional disorders (mild depression, tension, anxiety, or insomnia) were less frequent among night (PR = 0.76; CI = 0.59-0.98) and ex-night workers (PR = 0.68; CI = 0.50-0.91) than day workers who never had worked a night job. The healthy worker effect does not seem to explain the results of the comparisons between day and night workers. The possible role of exposure by day workers to some risk factors, such as stress, was suggested as an explanation for these results. No significant difference was observed between night and day workers as to sleep complaints, a result that may have been influenced by the nature of the shift-work schedule (no successive night shifts) and possibly nap taking during the night shift. Moreover, the long work hours and moonlighting of the healthcare workers, which is common in Brazil, may have masked other possible differences between the day and night workers. Among night workers, a significant relation was found between years working nights (more than 10 yrs) and high cholesterol values (PR = 2.58; CI = 1.07-6.27), a result that deserves additional study. Working nights more than four times per 2-week span was related to complaints about insufficient time for children (PR = 1.96; CI = 1.38-2.78) and rest/leisure (PR = 1.54; CI = 1.20-1.99). These results can be related to the “social value of time,” as evenings and nights are when families usually spend time together. The complexity of the professional life and the consequent heterogeneity of the group of workers under shift-work schemes confound the results. More in-depth study of the questions raised here demands a more sophisticated epidemiological treatment and larger sample size.     

Sleeping on the Job during Night Shifts May Be Associated with Extended Night Shifts and/or Variable Night Shift Onset Times

Continuous rotating shiftworkers temporarily working overtime slept at least once during the working hours of their night shifts. They worked at an electric power distribution plant in São Paulo (Brazil). In order to detect factors that could be associated with sleeping on the job, we compared those who slept (sleep group – S) with those who did not sleep (non-sleep group – NS) as to the number of night shifts, the average length of night shifts, the variability in night shift onset and offset times and the length of sleep episodes at home between consecutive night shifts. Data collection was based on dairies filled in by the workers for 30 consecutive days. For both S and NS groups, the number of night shifts for each worker varied from 5 to 9, no difference being found between groups. Individual means of night shifts length varied from 9.4 ± 0.3 hr to 14.2 ± 0.6 hr; they were significantly longer in the S than in the NS group. Night shift onset times were shown to be significantly more variable in the S than in the NS group, whereas offset times did not differ significantly between groups. Length of sleep episodes at home was not significantly different between groups. Workers who slept on the job were those who had longer working bouts and / or more variable night shift onset times. Differences among workers may be due to individual strategies to cope with a situation in which the work schedule included night shifts that were much longer than the established 8 hours, and with many changes in onset times from one night shift to the next.     

Smoking among shift workers: More than a confounding factor

In studies on the cardiovascular disease risk among shift workers, smoking is considered to be a confounding factor. In a study of 239 shift and 157 daytime workers, it was found that shift work was prospectively related to increased cigarette consumption, indicating that smoking might be in the causative pathway; however, the number of study subjects was too low to warrant sound conclusions. Therefore, data from the Maastricht Cohort study were used to investigate the longitudinal relation between smoking and shift work in a much larger population. In this study, a total of 12,140 employees were followed for two years by means of self-administered questionnaires. The authors compared workers who normally worked during daytime hours only (74%) with those who worked other than day shifts (26%). Logistic regression analyses were performed, adjusting for demographic factors of age, gender, and educational level to evaluate the risk of starting to smoke (n=25) in the group of non-smoking workers and the risk of quitting (n=318) in the group of smoking workers. Logistic regression analysis showed a significant association between shift work and taking up smoking during the two-year follow-up (odds ratio: 1.46, p=0.03). The risk to stop smoking was somewhat lower in shift workers (odds ratio: 0.91) but not statistically significant (p=0.5). To conclude, this study showed that, independent of educational level, shift workers are more prone to start smoking. This finding might have important implications for studies on the health effects of shift workers and for possible interventions aimed at the reduction of the excess health risk among shift workers.     

C-reactive protein across the menstrual cycle

C-reactive protein (CRP) is a widely used, sensitive biomarker of inflammation. Studies conducted among users of exogenous hormones suggest that estrogen increases CRP, whereas progesterone decreases CRP. Examinations of CRP in normally cycling women suggest the opposite: CRP is negatively associated with endogenous estrogen and positively associated with endogenous progesterone. This work evaluates the association between menstrual cycle-related hormone changes and events (menstruation and ovulation) and CRP. Eight female subjects gave urine and blood samples from twelve days across the menstrual cycle, for a total of eleven cycles. Blood samples were assayed for CRP; urine samples for beta-follicle stimulating hormone (betaFSH), pregnanediol 3-glucuronide (PDG), and estrone glucuronide (E1G). Ovulation day was estimated using hormone levels. Presence or absence of menses was reported by subjects. Analyses were conducted with random-effects linear regression. All cycles were ovulatory; day of ovulation was identified for nine cycles. A ten-fold increase in progesterone was associated with a 23% increase in CRP (P = 0.01), a ten-fold increase in estrogen was associated with a 29% decrease in CRP (P = 0.05), and menses was associated with a 17% increase in CRP (P = 0.18); no association between ovulation or FSH and CRP was found. Hormone changes across the menstrual cycle should be controlled for in future studies of inflammation in reproductive-age women.     

Effect of shift work on the night-time secretory patterns of melatonin, prolactin, cortisol and testosterone

In a study of the internal desynchronization of circadian rhythms in 12 shift workers, 4 of them, aged 25-34 years, agreed to be sampled every 2 h during their night shift (0000 hours to 0800 hours). They were oil refinery operators with a fast rotating shift system (every 3-4 days). We found marked changes in the secretory profiles of melatonin, prolactin and testosterone. Melatonin had higher peak-values resulting in a four-times higher amplitude than in controls. With respect to prolactin and testosterone, peak and trough times were erratic and the serum concentrations were significantly decreased in shift workers. Serum cortisol presented a decreased rhythm amplitude together with higher concentrations at 0000 hours in shift workers. This study clearly shows that fast rotating shift-work modifies peak or trough values and rhythm amplitudes of melatonin, prolactin, testosterone and cortisol without any apparent phase shift of these hormones. Whether the large rhythm amplitude of melatonin may be considered as a marker of tolerance to shift work, as reported for body temperature and hand grip strength, since it would help the subjects to maintain their internal synchronization, needs further investigation.     

Prolactin levels in Western Lowland gorillas

Hyperprolactinemia is known to cause menstrual irregularity and infertility in humans. However, little is known about the role of prolactin in menstruation and fertility in Western Lowland gorillas. To create a database of prolactin values in gorillas, we have performed immunoassays on serum specimens dating back to 1983 from nine female gorillas at the Brookfield Zoo. We matched these samples with documented behavioral data to correlate menstrual timing. In addition, we ran other reproductive hormones both to aid in determining the phase of the menstrual cycle and to evaluate the effect of the prolactin on suppression of these hormones during the premenarchal and postpartum phases. We found that values for luteinizing hormone, follicle-stimulating hormone, estradiol and progesterone cycle in very similar patterns to humans. Based on the 59 available samples, prolactin was found to be higher in gorillas than in humans in nearly every phase of the menstrual cycle (range 49.9-93.7 ng/mL) and such levels do not appear to alter the reproductive axis as it does in humans. Thus, prolactin may have a different impact on fertility in gorillas than it does in humans.     

Ovulatory cycle effects on tip earnings by lap dancers: economic evidence for human estrus?☆

To see whether estrus was really “lost” during human evolution (as researchers often claim), we examined ovulatory cycle effects on tip earnings by professional lap dancers working in gentlemen's clubs. Eighteen dancers recorded their menstrual periods, work shifts, and tip earnings for 60 days on a study web site. A mixed-model analysis of 296 work shifts (representing about 5300 lap dances) showed an interaction between cycle phase and hormonal contraception use. Normally cycling participants earned about US$335 per 5-h shift during estrus, US$260 per shift during the luteal phase, and US$185 per shift during menstruation. By contrast, participants using contraceptive pills showed no estrous earnings peak. These results constitute the first direct economic evidence for the existence and importance of estrus in contemporary human females, in a real-world work setting. These results have clear implications for human evolution, sexuality, and economics.     

Shift-specific associations between age,chronotype and sleep duration

The objective of this study was to examine the association of age with chronotype and sleep duration in day workers and rotating shift workers, including night shift work. Between October 2012 and February 2015, a cross-sectional study was conducted in a German chemical company. Using the “Munich ChronoType Questionnaire” (MCTQ), data about sleep onset and sleep offset during workdays and work-free days were retrieved and the chronotype was computed during regular voluntary occupational health check-ups. Associations between age and chronotype, as well as sleep duration, were assessed using linear regression analyses. Potential effect modification by the working time system was examined. Within the study period, 4,040 employees (82.3% and 17.7% were engaged in day work and rotating shift work, respectively) completed the questionnaire. Study participants were on average 41.8 years old (Min = 18.0, Max = 65.0, SD = 10.2) and predominantly male (75.4%). Mean chronotype and overall sleep duration was 03:22 (SD = 54 min) and 7.2 h (SD = 1.0 h) respectively. Older age was associated with earlier chronotype and reduced overall sleep duration in both day workers and rotating shift workers (p < 0.001 for all models). Compared to day workers, employees whom engaged in rotating shift work were later chronotypes and had overall a longer sleep duration. With older age, the difference between day and rotating shift workers regarding chronotype increased, while the difference regarding overall sleep duration decreased (p_interaction<0.005 for both models). This finding could indicate that both changes in circadian physiology and exposure to certain work schedules contribute to the age-related changes. Older rotating shift workers, with early chronotypes may have issues with night shifts, while day work and morning shifts may be best compatible to earlier chronotypes. Differences in sleep timing across age groups, might indicate that the same work hours will affect shift workers differently, dependent on their age, suggesting that more flexible and chronotype-adapted work hours could provide useful; especially for older employees. Sleep education in the form of courses and health campaigns could be a way to raise awareness of the importance of a healthy sleep pattern. This could be achieved by learning strategies to better adjust individual sleep patterns to work hours.     

Smoking among Shift Workers: More Than a Confounding Factor

In studies on the cardiovascular disease risk among shift workers, smoking is considered to be a confounding factor. In a study of 239 shift and 157 daytime workers, it was found that shift work was prospectively related to increased cigarette consumption, indicating that smoking might be in the causative pathway; however, the number of study subjects was too low to warrant sound conclusions. Therefore, data from the Maastricht Cohort study were used to investigate the longitudinal relation between smoking and shift work in a much larger population. In this study, a total of 12,140 employees were followed for two years by means of self‐administered questionnaires. The authors compared workers who normally worked during daytime hours only (74%) with those who worked other than day shifts (26%). Logistic regression analyses were performed, adjusting for demographic factors of age, gender, and educational level to evaluate the risk of starting to smoke (n=25) in the group of non‐smoking workers and the risk of quitting (n=318) in the group of smoking workers. Logistic regression analysis showed a significant association between shift work and taking up smoking during the two‐year follow‐up (odds ratio: 1.46, p=0.03). The risk to stop smoking was somewhat lower in shift workers (odds ratio: 0.91) but not statistically significant (p=0.5). To conclude, this study showed that, independent of educational level, shift workers are more prone to start smoking. This finding might have important implications for studies on the health effects of shift workers and for possible interventions aimed at the reduction of the excess health risk among shift workers.     

Effects of shift work on attention deficit,hyperactivity, and impulsivity,and their relationship with chronotype

There is growing evidence that shift-work schedules cause severe disturbances to circadian rhythms and the sleep–wakefulness cycle, and that these changes in turn lead to cognitive and behavioral problems. The objective of this study is to explore the relationships between biological rhythm differences (chronotype) and impulsive behaviors and attention-deficit hyperactivity symptoms in shift workers. Seventy-nine nurses working in the daytime and 127 nurses working on night shifts were evaluated with the Barratt Impulsiveness Scale, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS), and Morningness–Eveningness questionnaire for identifying circadian preference. It was found that shift workers had more attention deficit (p < .05) and impulsivity (p < .01) when compared with daytime workers. Morning-type workers reported lower hyperactivity and ASRS total scores than evening- and intermediate-type workers. The mean impulsivity score of evening-type workers was higher than both the other groups (p < .05). It has been shown that attention deficit, hyperactivity, and impulsivity levels that appear as a result of working shifts might change in accordance with the individual’s chronotype. It might, therefore, be desirable to evaluate an individual’s chronotype to establish suitability for working shifts.     

Sleep Disturbances Among Female Nurses: Comparing Shift to Day Work

Recently, attention has focused in Israel on the possible legal and health consequences of shift work. We decided to study sleep disorders among female nursing personnel working a shift schedule, in comparison with day nurses, in a large metropolitan general hospital. The study population was composed of 131 female certified nurses working shifts and 44 working days only. Inclusion criteria for the survey was at least 1 year of shift work alternating between day, evening, and night shifts, or at least 1 year of day work. All participants completed a self-report sleep questionnaire encompassing (a) demographic data, (b) sleep survey, and (c) employment details. Statistical analysis was performed using the Pearson correlation test and analysis of variance multiple range test (according to Scheffe's procedure). No significant correlation was found between sleep disorders and age of subjects. No sleep disorders were reported by 19.8% of shift workers versus 76.5% of day workers. Statistically significant findings were that the number of shifts per week >4.1 (p = 0.001) and duration of shift work >13.6 years (p = 0.007) correlated with the presence of sleep disorders. An additional significant finding (p = 0.014) was the impact of evening shifts on sleep disorders. The present small study confined to women supports the growing body of data on sleep complaints among shift workers.