Healthy shiftwork, healthy shiftworks

Reflecting diversifying shift systems, extensive effort is put into managing shiftwork and reducing safety and health risks. It is accepted that shiftworkers are exposed to particular risks inherent in their irregular work schedules. This raises the question of how and to what extent we can ensure healthy work life for shiftworkers. In answering the question, we need to identify effective measures to improve both shiftworking conditions and the health of shiftworkers. Based on recent experiences in managing shiftwork, we note three directions of such measures: (a) comprehensive action to avoid risk-enhancing conditions based on general guidelines, (b) risk control as to workload, worksite ergonomics and risk reduction, and (c) support for flexible and restful working life. International standards are obviously relevant to these three aspects. Our own experiences in applying a set of ergonomic checkpoints to plant maintenance shiftwork demonstrate the usefulness of focusing on flexible work schedules and on multiple job-related factors such as night workload, ergonomic environment, resting conditions and training. There is a strong need for participatory planning and implementation of multi-area improvements as well as for relying on flexible schedules and autonomic teamwork. We may conclude that healthy shiftwork and healthy shiftworkers are compatible with each other only when certain conditions are met. In achieving this end, we need to combine (a) comprehensive measures to improve work schedules and job life, (b) strict risk management and (c) locally adjusted participatory steps for continual improvement.     

Epigenetic impact of long-term shiftwork: pilot evidence from circadian genes and whole-genome methylation analysis

Epigenetic association studies have demonstrated differential promoter methylation in the core circadian genes in breast cancer cases relative to cancer-free controls. The current pilot study aims to investigate whether epigenetic changes affecting breast cancer risk could be caused by circadian disruption through exposure to light at night. Archived DNA samples extracted from whole blood of 117 female subjects from a prospective cohort conducted in Denmark were included in this study. A polymerase chain reaction (PCR)-based method was used for detection of gene-promoter methylation, whereas genome-wide methylation analysis was performed using the Illumina Infinium Methylation Chip. Long-term shiftwork resulted in the same promoter hypomethylation of CLOCK and hypermethylation of CRY2, as was previously observed in breast cancer case-control studies. Genome-wide methylation analysis further discovered widespread methylation alterations in shiftworkers, including changes in many methylation- and cancer-relevant genes. Pathway analysis of the genes with altered methylation patterns revealed several cancer-related pathways. One of the top three networks generated was designated as "DNA replication, recombination, and repair, gene expression, behavior" with ESR1 (estrogen receptor α) featured most prominently in the network, underscoring the potential breast cancer relevance of the genes differentially methylated in long-term shiftworkers. These results, although exploratory, demonstrate the first evidence of the cancer-relevant epigenetic effects of night shiftwork, which warrant further investigation. Considering there are millions of shiftworkers worldwide, understanding the effects of this exposure may lead to novel strategies for cancer prevention and new policies regulating shiftwork.     

Age and the subjective experience of shiftwork

The objective of this study was to examine age related effects of shiftwork albeit difficult to tease apart the natural effects of aging, and lifestyle or behaviour, or job done, over time and the shifts a person works. This is an issue of concern because the numbers of shiftworkers over 45 are increasing. Participants were 306 police officers who had worked a new rota for approximately 6 months. Three age groups were compared (1 = 20-32.9, 2 = 33-39.9, 3 = 40+) using a range of shiftwork-related measures and multivariate analysis of covariance (controlling for shiftwork experience and other individual differences). Younger officers tended to report significantly better attitudes towards their shiftwork, better adjustment to night-bound shifts, greater job satisfaction and organisational commitment, lower fatigue and longer sleep durations. Older shiftworkers reported significantly higher morningness and lower sleep need than the younger officers. This concurred with existing research that implicates such variables in the mechanism(s) involved in age-related tolerance to shiftwork. It was also evident that the older group tended to resort to greater caffeine intake on all shifts. The findings offer tentative support for the position that age can be linked to depleted shiftwork tolerance but the issue of establishing the relative impacts of aging, lifestyle, behaviour, work type and the rota worked remains to be a challenge.     

Predicting shiftwork-related outcomes: shiftwork locus of control and circadian type

This research discusses the use and viability of the shiftwork locus of control construct alongside circadian type measures as a potential predictor of shiftwork-related outcomes. The shiftwork locus of control (SHLOC) scale, measures of circadian type and shiftwork-related outcome measures were completed by 100 shiftworkers on two occasions separated by seven months. The SHLOC scale measures shiftworkers' generalised beliefs about the levels of personal control they perceive in relation to four major functional domains commonly associated with shiftwork-related disruption. These domains include: sleep, social, health and work problems. The results of multivariate regression analysis showed the SHLOC scale to be predictive of the experience of shiftwork-related sleep and social-life problems while the circadian type measures were predictive of alertness at 7 months. The results suggest that a constellation of personality factors may be an important influence on an individual's tolerance to shiftwork.     

Shiftwork and metabolic dysfunction

Many of the health problems that are more prevalent among shiftworkers are thought to be linked to their heightened susceptibility to metabolic syndrome, i.e., the association of even moderate degrees of visceral obesity, dyslipidemia, abnormal blood pressure, and serum glucose levels in the same individual. Although previous studies have identified associations between shiftwork and metabolic syndrome, there is relatively little evidence to date of how the risk of developing it varies as a function of exposure to shiftwork. The current study seeks to confirm earlier findings of an association between shiftwork exposure and metabolic dysfunction, and to examine the impact of exposure duration, while adjusting for a number of covariates in the analyses. The analyses were based on data from VISAT, a study involving the measurement of physiological, behavioral, and subjective outcomes from 1757 participants, 989 being current or former shiftworkers. The sample comprised employed and retired wage earners, male and female, who were 32, 42, 52, and 62 yrs old. The first analysis sought to confirm previous findings of an association between exposure to shiftwork and the risk of developing metabolic syndrome. It indicated that participants who were or who had previously been shiftworkers (i.e., working schedules that involved rotating shifts; not being able to go to bed before midnight; having to get up before 05:00 h; or being prevented from sleeping during the night) were more likely to exhibit symptoms of metabolic syndrome, after adjusting for age, sex, socioeconomic status, smoking, alcohol intake, perceived stress, and sleep difficulty (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.03-3.08). The results suggest the association between shiftwork and metabolic syndrome cannot be fully accounted for by either higher levels of strain or increased sleep difficulty among shiftworkers, although it remains a possibility that either one or both of these factors may have played a contributing role. The second analysis addressed the issue of duration of exposure to shiftwork. Participants with >10 yrs' experience of working rotating shifts were more likely to exhibit symptoms of metabolic syndrome than participants without exposure to shiftwork, i.e., dayworkers, even after adjusting for age and sex (OR 1.96; 95% CI 1.03-3.75). Thus, the current study confirms the association between shiftwork exposure and metabolic syndrome. It also provides new information regarding the time course of the development of the illness as function of exposure duration, although this was only examined in relation to rotating shiftwork. It is concluded that those responsible for monitoring workers' health should pay particular attention to indices of metabolic dysfunction in workers who have been exposed to shiftwork for >10 yrs.     

Shiftwork and Metabolic Dysfunction

Many of the health problems that are more prevalent among shiftworkers are thought to be linked to their heightened susceptibility to metabolic syndrome, i.e., the association of even moderate degrees of visceral obesity, dyslipidemia, abnormal blood pressure, and serum glucose levels in the same individual. Although previous studies have identified associations between shiftwork and metabolic syndrome, there is relatively little evidence to date of how the risk of developing it varies as a function of exposure to shiftwork. The current study seeks to confirm earlier findings of an association between shiftwork exposure and metabolic dysfunction, and to examine the impact of exposure duration, while adjusting for a number of covariates in the analyses. The analyses were based on data from VISAT, a study involving the measurement of physiological, behavioral, and subjective outcomes from 1757 participants, 989 being current or former shiftworkers. The sample comprised employed and retired wage earners, male and female, who were 32, 42, 52, and 62 yrs old. The first analysis sought to confirm previous findings of an association between exposure to shiftwork and the risk of developing metabolic syndrome. It indicated that participants who were or who had previously been shiftworkers (i.e., working schedules that involved rotating shifts; not being able to go to bed before midnight; having to get up before 05:00?h; or being prevented from sleeping during the night) were more likely to exhibit symptoms of metabolic syndrome, after adjusting for age, sex, socioeconomic status, smoking, alcohol intake, perceived stress, and sleep difficulty (odds ratio [OR] 1.78; 95% confidence interval [CI] 1.03–3.08). The results suggest the association between shiftwork and metabolic syndrome cannot be fully accounted for by either higher levels of strain or increased sleep difficulty among shiftworkers, although it remains a possibility that either one or both of these factors may have played a contributing role. The second analysis addressed the issue of duration of exposure to shiftwork. Participants with >10 yrs' experience of working rotating shifts were more likely to exhibit symptoms of metabolic syndrome than participants without exposure to shiftwork, i.e., dayworkers, even after adjusting for age and sex (OR 1.96; 95% CI 1.03–3.75). Thus, the current study confirms the association between shiftwork exposure and metabolic syndrome. It also provides new information regarding the time course of the development of the illness as function of exposure duration, although this was only examined in relation to rotating shiftwork. It is concluded that those responsible for monitoring workers' health should pay particular attention to indices of metabolic dysfunction in workers who have been exposed to shiftwork for >10 yrs. (Author correspondence: p.t.tucker@swansea.ac.uk)     

Measurement properties of the Shiftwork Survey and Standard Shiftwork Index

The Shiftwork Survey (SS) was introduced, along with the Standard Shiftwork Index (SSI), to provide a set of standardized self-report measures to be used in shiftwork research. However, beyond the initial assessment, no attempt has been made to examine the measurement properties of these scales in an independent sample of shiftworkers. Our goal, therefore, was to examine the measurement properties of these scales in an industrial sample of primarily male shiftworkers (N = 370). We found that all scales had acceptable reliabilities (alphas). The confirmatory factor analyses revealed that the chronic fatigue, coping, job satisfaction, and sleep scales are the weakest psychometrically, and the anxiety, personality (extraversion, neuroticism), general health, and physical health scales are the strongest psychometrically. Using item response theory analyses, we found that the scales overall are generally adequate measures of their underlying constructs, although many items should be altered or omitted. Our results, however, are limited by reliance on a single sample.     

Shiftwork locus of control effects in police officers

Personality and experientially-based differences are suggested to moderate the negative effects of shiftworking. This investigation was one of a series of studies aimed at examining the relationship between internal locus of control (internality) and commonly reported outcomes of exposure to shiftworking. The study concentrated on whether or not shiftwork-specific internality appeared to be associated with better experiences for two groups of shiftworkers on different shift rotas. The Shiftwork Locus of Control (SHLOC) scale was completed by each group along with a range of outcome measures (including: sleep disturbance, alertness on shift, psychological well-being, disturbance of social and family life, and fatigue). The analyses controlled for for age, shiftwork experience and years of service effects. The results showed that for the majority of outcome variables, the higher internality was associated with significantly lower levels of shiftwork problems, especially when compared to the low internality group. The findings of this study further support the use of shiftwork-specific locus of control in shiftwork research as an indicator of potentially better tolerance, and possibly as part of an occupational health monitoring process to aid the targeting of interventions.     

Mood, alertness, and performance in response to sleep deprivation and recovery sleep in experienced shiftworkers versus non-shiftworkers

Previous studies have shown increased sleepiness and mood changes in shiftworkers, which may be due to sleep deprivation or circadian disruption. Few studies, however, have compared responses of experienced shiftworkers and non-shiftworkers to sleep deprivation in an identical laboratory setting. The aim of this laboratory study, therefore, was to compare long-term shiftworkers and non-shiftworkers and to investigate the effects of one night of total sleep deprivation (30.5 h of continuous wakefulness) and recovery sleep on psychomotor vigilance, self-rated alertness, and mood. Eleven experienced male shiftworkers (shiftwork ≥5 yrs) were matched with 14 non-shiftworkers for age (mean ± SD: 35.7 ± 7.2 and 32.5 ± 6.2 yrs, respectively) and body mass index (BMI) (28.7 ± 3.8 and 26.6 ± 3.4 kg/m(2), respectively). After keeping a 7-d self-selected sleep/wake cycle (7.5/8 h nocturnal sleep), both groups entered a laboratory session consisting of a night of adaptation sleep and a baseline sleep (each 7.5/8 h), a sleep deprivation night, and recovery sleep (4-h nap plus 7.5/8 h nighttime sleep). Subjective alertness and mood were assessed with the Karolinska Sleepiness Scale (KSS) and 9-digit rating scales, and vigilance was measured by the visual psychomotor vigilance test (PVT). A mixed-model regression analysis was carried out on data collected every hour during the sleep deprivation night and on all days (except for the adaptation day), at .25, 4.25, 5.25, 11.5, 12.5, and 13.5 h after habitual wake-up time. Despite similar circadian phase (melatonin onset), demographics, food intake, body posture, and environmental light, shiftworkers felt significantly more alert, more cheerful, more elated, and calmer than non-shiftworkers throughout the laboratory study. In addition, shiftworkers showed a faster median reaction time (RT) compared to non-shiftworkers, although four other PVT parameters did not differ between the groups. As expected, both groups showed a decrease in subjective alertness and PVT performance during and following the sleep deprivation night. Subjective sleepiness and most aspects of PVT performance returned to baseline levels after a nap and recovery sleep. The mechanisms underlying the observed differences between shiftworkers and non-shiftworkers require further study, but may be related to the absence of shiftwork the week prior to and during the laboratory study as well as selection into and out of shiftwork.     

Epigenetic Impact of Long-Term Shiftwork: Pilot Evidence From Circadian Genes and Whole-Genome Methylation Analysis

Epigenetic association studies have demonstrated differential promoter methylation in the core circadian genes in breast cancer cases relative to cancer-free controls. The current pilot study aims to investigate whether epigenetic changes affecting breast cancer risk could be caused by circadian disruption through exposure to light at night. Archived DNA samples extracted from whole blood of 117 female subjects from a prospective cohort conducted in Denmark were included in this study. A polymerase chain reaction (PCR)-based method was used for detection of gene-promoter methylation, whereas genome-wide methylation analysis was performed using the Illumina Infinium Methylation Chip. Long-term shiftwork resulted in the same promoter hypomethylation of CLOCK and hypermethylation of CRY2, as was previously observed in breast cancer case-control studies. Genome-wide methylation analysis further discovered widespread methylation alterations in shiftworkers, including changes in many methylation- and cancer-relevant genes. Pathway analysis of the genes with altered methylation patterns revealed several cancer-related pathways. One of the top three networks generated was designated as “DNA replication, recombination, and repair, gene expression, behavior” with ESR1 (estrogen receptor α) featured most prominently in the network, underscoring the potential breast cancer relevance of the genes differentially methylated in long-term shiftworkers. These results, although exploratory, demonstrate the first evidence of the cancer-relevant epigenetic effects of night shiftwork, which warrant further investigation. Considering there are millions of shiftworkers worldwide, understanding the effects of this exposure may lead to novel strategies for cancer prevention and new policies regulating shiftwork. (Author correspondence: yong.zhu@yale.edu)     

EPIGENETIC EFFECTS OF SHIFTWORK ON BLOOD DNA METHYLATION

In the present study, the authors investigated the effects of shiftwork exposure on DNA methylation using peripheral blood DNA from subjects working in two chemical plants in Northern Italy. The investigation was designed to evaluate (a) DNA methylation changes in Alu and long interspersed nuclear element-1 (LINE-1) repetitive elements as a surrogate of global methylation and (b) promoter methylation of glucocorticoid receptor (GCR), tumor necrosis factor alpha (TNF-α), and interferon-gamma (IFN-γ). One hundred and fifty white male workers (mean?±?SD: 41.0?±?9 yrs of age) were examined: 100 3?×?8 rotating shiftworkers (40.4?±?8.7 yrs of age) and 50 day workers (42.2?±?9.4 yrs of age). The authors used bisulfite-pyrosequencing to estimate repetitive elements and gene-specific methylation. Multiple regression analysis, adjusted for age, body mass index (BMI), and job seniority, did not show any significant association between the five DNA methylation markers and shiftwork. However, job seniority, in all subjects, was significantly associated with Alu (β?=??0.019, p?=?.033) and IFN-γ (β?=??0.224, p?<?.001) methylation, whereas TNF-α methylation was inversely correlated with age (β?=??0.093, p?<?.001). Considering only shiftworkers, multiple regression analysis, adjusted for age, BMI, and job seniority, showed a significant difference between morning and evening types in TNF-α methylation (mean morning type [MT] 11.425 %5mC versus evening type [ET] 12.975 %5mC; β?=?1.33, p?=?.022). No difference was observed between good and poor tolerance to shiftwork. Increasing job seniority (<5, 5–15, >15 yrs) was associated with significantly lower Alu (β?=??0.86, p?=?.006) and IFN-γ methylation (β?=??6.50, p?=?.007) after adjustment for age, BMI, and morningness/eveningness. In addition, GCR significantly increased with length of shiftwork (β?=?3.33, p?=?.05). The data showed alterations in blood DNA methylation in a group of shiftworkers, including changes in Alu repetitive elements methylation and gene-specific methylation of IFN-γ and TNF-α promoters. Further studies are required to determine the role of such alterations in mediating the effects of shiftwork on human health. (Author correspondence: giovanni.costa@unimi.it)     

Sleepiness in a population of Italian shiftwork policemen

The aim of this study was to evaluate the effects of shiftwork on sleepiness, sleep disorders and sleep related accidents in a population of policemen. Data concerning age and physical characteristics, working conditions, sleep problems and accidents were collected by a questionnaire. Sleepiness was evaluated by the Epworth Sleepiness Scale (ESS) while the presence of sleep disorders was evaluated by a score (SD-score) drawn from indicators of insomnia, breathing disorders, periodic limb movements-restless leg syndrome and hypersomnia. The effects of age, gender, body mass index, working condition and seniority on ESS, SD-score and accidents were analysed by linear and logistic regression. Participants were 1280 policemen: 611 shiftworkers and 669 non-shiftworkers. The ESS scores were not higher in shiftworkers than in non-shiftworkers, but the SD-score was found to be significantly influenced by shiftwork condition and seniority. The occurrence of sleep-related accidents was found to have been significantly increased for shiftworkers and related to the presence of indicators of sleep disorders. The sleepiness could be underestimated or even overcome by the influence of stressing conditions. However our data should alert occupational health physicians for the diagnosis and prevention of possible lurking intrinsic sleep disorders likely to influence health problems and risk of accidents in shiftworkers.     

Mood,Alertness, and Performance in Response to Sleep Deprivation and Recovery Sleep in Experienced Shiftworkers Versus Non-Shiftworkers

Previous studies have shown increased sleepiness and mood changes in shiftworkers, which may be due to sleep deprivation or circadian disruption. Few studies, however, have compared responses of experienced shiftworkers and non-shiftworkers to sleep deprivation in an identical laboratory setting. The aim of this laboratory study, therefore, was to compare long-term shiftworkers and non-shiftworkers and to investigate the effects of one night of total sleep deprivation (30.5?h of continuous wakefulness) and recovery sleep on psychomotor vigilance, self-rated alertness, and mood. Eleven experienced male shiftworkers (shiftwork ≥5 yrs) were matched with 14 non-shiftworkers for age (mean?±?SD: 35.7?±?7.2 and 32.5?±?6.2 yrs, respectively) and body mass index (BMI) (28.7?±?3.8 and 26.6?±?3.4?kg/m², respectively). After keeping a 7-d self-selected sleep/wake cycle (7.5/8?h nocturnal sleep), both groups entered a laboratory session consisting of a night of adaptation sleep and a baseline sleep (each 7.5/8?h), a sleep deprivation night, and recovery sleep (4-h nap plus 7.5/8?h nighttime sleep). Subjective alertness and mood were assessed with the Karolinska Sleepiness Scale (KSS) and 9-digit rating scales, and vigilance was measured by the visual psychomotor vigilance test (PVT). A mixed-model regression analysis was carried out on data collected every hour during the sleep deprivation night and on all days (except for the adaptation day), at .25, 4.25, 5.25, 11.5, 12.5, and 13.5?h after habitual wake-up time. Despite similar circadian phase (melatonin onset), demographics, food intake, body posture, and environmental light, shiftworkers felt significantly more alert, more cheerful, more elated, and calmer than non-shiftworkers throughout the laboratory study. In addition, shiftworkers showed a faster median reaction time (RT) compared to non-shiftworkers, although four other PVT parameters did not differ between the groups. As expected, both groups showed a decrease in subjective alertness and PVT performance during and following the sleep deprivation night. Subjective sleepiness and most aspects of PVT performance returned to baseline levels after a nap and recovery sleep. The mechanisms underlying the observed differences between shiftworkers and non-shiftworkers require further study, but may be related to the absence of shiftwork the week prior to and during the laboratory study as well as selection into and out of shiftwork. (Author correspondence: sophie.wehrens@surrey.ac.uk)     

Focus Group Evaluation of Night Nurse Shiftwork Difficulties and Coping Strategies

Focus group interviews were performed on 45 intensive care nurses who worked 12-h shifts in a large metropolitan hospital. The purpose of this study was to identify nurses' perceptions of difficulties associated with shiftwork and coping strategies used to combat them. Overall, the findings were not different than those currently discussed in the literature. For example, nurses frequently utilized white noise, telephone answering machines, and light-darkening shades to improve the quality and quantity of day sleep. They also used exercise and increased early shift caffeine consumption to improve night work performance. However, the major incentive for performing night work for these nurses was a high shift differential that equaled approximately 20% of their hourly salary. Most nurses also felt that group educational interventions regarding shiftwork difficulties and coping strategies would be preferred to individual counseling. The most significant finding of this study was the discovery of an extremely high incidence (95%) of automobile-related injuries and near-accidents that occurred while driving to and from the workplace, potentially posing a significant public health risk. (Chronobiology International, 13(6), 457-463, 1996)     

Shiftwork and Sickness Absence Among Police Officers: The BCOPS Study

Shiftwork, regarded as a significant occupational stressor, has become increasingly prevalent across a wide range of occupations. The adverse health outcomes associated with shiftwork are well documented. Shiftwork is an integral part of law enforcement, a high-stress occupation with elevated risks of chronic disease and mortality. Sickness absence is an important source of productivity loss and may also serve as an indirect measure of workers’ morbidity. Prior studies of shiftwork and sickness absenteeism have yielded varying results and the association has not been examined specifically among police officers. The objective of this study was to compare the incidence rate of sick leave (any, ≥3 consecutive days) among day-, afternoon-, and night-shift workers in a cohort of police officers and also examine the role of lifestyle factors as potential moderators of the association. Participants (N?=?464) from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study examined between 2004 and 2009 were used. Daily work history records that included the shift schedule, number of hours worked, and occurrence of sick leave were available for up to 15 yrs starting in 1994 to the date of the BCOPS study examination for each officer. Poisson regression analysis for ungrouped data was used to estimate incidence rates (IRs) of sick leave by shift, and comparison of IRs across shifts were made by computing incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). Sick leave occurred at a higher rate on the night shift (4.37 per 10?000 person-hours) compared with either day (1.55 per 10?000 person-hours) or afternoon (1.96 per 10?000 person-hours) shifts. The association between shiftwork and sickness absence depended on body mass index (BMI). For overweight individuals (BMI?≥?25?kg/m²), the covariate-adjusted incidence rate of sick leave (≥1 day) was twice as large for night-shift officers compared with those working on the day (IRR?=?2.29, 95% CI: 1.69–3.10) or afternoon (IRR?=?1.74, 95% CI: 1.29–2.34) shift. The IR of three or more consecutive days of sick leave was 1.7 times larger for those working on night shift (IRR?=?1.65, 95% CI: 1.17–2.31) and 1.5 times larger for those working on afternoon shift (IRR?=?1.50, 95% CI: 1.08–2.08) compared with day shiftworkers. For subjects with normal BMI (<25?kg/m²), the incidence rates of sick leave did not differ significantly across shifts. In conclusion, shiftwork is independently associated with sickness absence, with officers who work the night shift having elevated incidence of sick leave. In addition, overweight officers who work the night shift may be at additional risk for sickness absence.     

SLEEP AND SLEEPINESS: IMPACT OF ENTERING OR LEAVING SHIFTWORK—A PROSPECTIVE STUDY

Very little is known about the effects on sleep and sleepiness of entering or exiting shiftwork. The present study used a longitudinal database (n?=?3637). Participants completed a questionnaire on work hours, sleep, and work environment at the start and end of a 5-yr period. Changes in shift/day work status were related to change in a number of subjective sleep variables using logistic regression analysis. The analyses were adjusted for age, sex, and differences in socioeconomic status, work demands, work control, physical workload, marriage status, and number of children. In comparison with constant day work, entering shiftwork (with or without night shifts) from day work increased the risk of difficulties in falling asleep, and leaving shiftwork reduced this risk (odds ratio [OR]?=?2.8 [confidence interval, CI?=?1.8–4.5]). Also falling asleep at work showed a consistent pattern; an increased risk of falling asleep for those with shiftwork on both occasions, and for those with night work on both occasions. Also entering night work was associated with a strongly increased risk of falling asleep at work (OR?=?2.9 [CI?=?1.3–6.7]). These results suggest that entering and leaving shiftwork has a considerable impact on sleep and alertness. However, there is a need for large and more extended longitudinal studies to support our findings. (Author correspondence: Torbjorn.akerstedt@ki.se)     

Focus Group Evaluation of Night Nurse Shiftwork Difficulties and Coping Strategies

Focus group interviews were performed on 45 intensive care nurses who worked 12-h shifts in a large metropolitan hospital. The purpose of this study was to identify nurses' perceptions of difficulties associated with shiftwork and coping strategies used to combat them. Overall, the findings were not different than those currently discussed in the literature. For example, nurses frequently utilized white noise, telephone answering machines, and light-darkening shades to improve the quality and quantity of day sleep. They also used exercise and increased early shift caffeine consumption to improve night work performance. However, the major incentive for performing night work for these nurses was a high shift differential that equaled approximately 20% of their hourly salary. Most nurses also felt that group educational interventions regarding shiftwork difficulties and coping strategies would be preferred to individual counseling. The most significant finding of this study was the discovery of an extremely high incidence (95%) of automobile-related injuries and near-accidents that occurred while driving to and from the workplace, potentially posing a significant public health risk. (Chronobiology International, 13(6), 457–463, 1996)     

Effects of lifetime exposure to shiftwork on fitness for duty in police officers

Aging and demographic changes in Europe and other global economies have led to a discussion about postponing the legal retirement age; however, health and safety consequences for the workforce have not yet been examined. Thus, the aim of this study was to investigate the effects of lifetime exposure to shiftwork on health impairments and fitness for duty. Two samples of the police force from one of the states of the Federal Republic of Germany were used. One sample was collected in 2008-2009 with a self-administered Internet questionnaire (n = 705); the other sample was derived from employment records provided by the police force of the same federal state for the years 2002-2009 (n = 2460). Both samples contained information about the number of years worked in shiftwork across the entire working life and impairments to fitness for duty assessed by occupational physicians. Thus, the number of years of shiftwork until the diagnosis of the first reduction in fitness for duty could be calculated. Survival analyses were performed to estimate the risk (hazard rate) for experiencing a reduction in fitness for duty across lifetime exposure to shiftwork in years, controlling for age, sex, work type, and police district. Hazard estimates were compared across both samples to cross-validate the results. The findings indicated an increase in the risk of reduced fitness for duty with increasing number of years in shiftwork during the working life in both samples. The hazard rates followed an exponential trend, indicating a rapid increase in health impairments in particular beyond 20 yrs of shiftwork. These findings were consistent in both samples, collected with different methods and over different time periods, thus indicating high validity. Therefore, occupational stress factors, such as exposure to shiftwork, need to be taken into account when discussing the postponement of the legal retirement age.     

Effects of Lifetime Exposure to Shiftwork on Fitness for Duty in Police Officers

Aging and demographic changes in Europe and other global economies have led to a discussion about postponing the legal retirement age; however, health and safety consequences for the workforce have not yet been examined. Thus, the aim of this study was to investigate the effects of lifetime exposure to shiftwork on health impairments and fitness for duty. Two samples of the police force from one of the states of the Federal Republic of Germany were used. One sample was collected in 2008–2009 with a self-administered Internet questionnaire (n?=?705); the other sample was derived from employment records provided by the police force of the same federal state for the years 2002–2009 (n?=?2460). Both samples contained information about the number of years worked in shiftwork across the entire working life and impairments to fitness for duty assessed by occupational physicians. Thus, the number of years of shiftwork until the diagnosis of the first reduction in fitness for duty could be calculated. Survival analyses were performed to estimate the risk (hazard rate) for experiencing a reduction in fitness for duty across lifetime exposure to shiftwork in years, controlling for age, sex, work type, and police district. Hazard estimates were compared across both samples to cross-validate the results. The findings indicated an increase in the risk of reduced fitness for duty with increasing number of years in shiftwork during the working life in both samples. The hazard rates followed an exponential trend, indicating a rapid increase in health impairments in particular beyond 20 yrs of shiftwork. These findings were consistent in both samples, collected with different methods and over different time periods, thus indicating high validity. Therefore, occupational stress factors, such as exposure to shiftwork, need to be taken into account when discussing the postponement of the legal retirement age. (Author correspondence: anna.wirtz@gawo-ev.de)