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PubMed1990

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.

Adult↗
PubMedDate not supplied

Shiftwork and the older worker.

The number of workers employed on shiftwork is large, and it appears to be increasing. The impact of shiftwork on the occupational safety and health of workers is complex and involves both biological and behavioral variables. Current conceptual models propose that the impact of shiftwork, where night work is involved, increases with exposure. At some point the worker is said to reach a tolerance limit beyond which shiftwork is no longer safe. Sleep variables have proven to be sensitive markers for the effects of night shiftwork. Data from U.S. workers show a statistically significant interaction among age, gender, and shift for the workday sleep length of workers on permanent day, afternoon/evening, and night shifts. Sleep length declines with age for both male and female night workers, as well as for male workers on afternoon/evening shifts. In addition, female night workers in the 18-49 age range sleep significantly less than same-age male night workers. Nap behavior also varies with shift, but age and gender effects do not appear to account for the variance. The results support the assumption that most night shiftworkers are at risk even though they often give the appearance of being able to tolerate nocturnal work hours. However, it is not yet clear how age and gender are related to the social, circadian, and environmental factors that influence the sleep length of shiftworkers.

Adolescent↗
PubMed2005

International research needs for improving sleep and health of workers.

Research needs in identifying preventive measures dealing with working time arrangements and associated sleep problems are reviewed. These needs are based on the recognition of a range of risk factors for health involving disturbed circadian rhythms leading to various levels of sleep deficits. The review takes account of recent joint change approaches that address both working time arrangements and various relevant intervening factors. As examples of such approaches, voluntary industry-based guidelines for improving shift work are examined. Also reviewed is evidence indicating the effects of improved working time arrangements and sleep hygiene on the tolerance of workers working irregular shifts. Trends in action-oriented risk assessment are further discussed as the effects on health and sleep of these workers may be modified by complex aspects related to working situations, family and social conditions, personal characteristics and social support. Generally relevant are not only the relationships between sleep-affecting factors and health, but also advances in taking the various support measures. The effective use of participatory steps is found important in dealing with working time arrangements and associated health and sleep problems together. It is thus considered important to study (a) the efficacy of joint change approaches addressing complex sleep and health factors, (b) effective procedures for action-oriented health risk assessment in various work life situations, and (c) the relevance of innovative participatory steps to improving health and tolerance of workers. Future research topics mentioned by the participants of the international symposium on night and shift work held in Santos in 2003 are presented, and international efforts to promote research into these aspects in field conditions are discussed. Interactive research involving local people appears crucial.

Biomedical Research↗
PubMed1997

Morningness-eveningness preferences of emergency medicine residents are skewed toward eveningness.

OBJECTIVE: To determine the morningness-eveningness (ME) distribution of emergency medicine (EM) residents. METHOD: A voluntary, modified ME questionnaire was administered to all EM residents in the United States at the time of the 1995 American Board of Emergency Medicine's annual In-Training Examination. RESULTS: Seventy-eight percent (2,047/2,614) of the surveys were returned. ME scores ranged from 24 to 76, with a median score of 49 (interquartile range 44, 56). The scores were distributed differently from those of the normal population (p < 0.001), being skewed toward eveningness. There was a correlation (r = 0.13, p < 0.0001) between resident age and ME score, with older residents being more morning-oriented. Males were more morning-oriented than females (p = 0.005), and respondents with children living at home also were significantly more morning-oriented (p < 0.001). Stepwise logistic regression showed that the influence of age, gender, and children was cumulative (r = 0.19) but accounted for only 4% of the observed variability. CONCLUSION: EM residents are distributed differently from the normal population in terms of their ME preferences, tending slightly toward eveningness. The importance of this distribution in EM residents in unknown. A longitudinal follow-up of this cohort may help to determine the association of ME preference with overall practice satisfaction, tolerance of shift work, and career longevity.

Adult↗
PubMed2006

Work ability of health care shift workers: What matters?

This paper aims at identifying variables associated with inadequate work ability among nursing personnel at a public hospital, considering factors related to socio-demographic, lifestyles, working conditions, and health outcomes. A cross-sectional study was conducted in a university hospital in São Paulo, Brazil, as part of a larger research study on tolerance to 12 h night work. Nursing staff included registered nurses, nurse technicians, and nurse aides; in total, there were 996 healthcare workers (878 female; 118 male) at the time of the study. Some 696 workers (69.9%) of the population agreed to participate. Data collection (October 2004-July 2005) was based on a comprehensive questionnaire about living and working conditions (including incivility at work, work demands, work control, and support), mental and physical health symptoms (fatigue and sleep problems), and work ability. This report presents analyses of the adapted Brazilian version of the Work Ability Index (WAI) and associated variables. The study population worked one of the following shift schedules at this hospital: 12 h nights followed by 36 h off or 9 h or 6 h day (morning or afternoon) shifts. The mean age of the respondents was 34.9 (S.D.+/-10.4) years of age; 31.5% of the participants held two jobs. Statistical analyses using a hierarchical multiple logistic regression model were performed to evaluate the factors associated with inadequate (moderate and low scores) of the WAI. The significantly associated factors were socio-demographic (income responsibility, sole breadwinner, raising kids, age group), working conditions (thermal discomfort, organization of the workplace, and verbal abuse), and health outcomes (high body mass index, obesity, sleep problems, and fatigue). In spite of limitations of the study design, results indicate that the nursing profession is associated with stressful working conditions, contributing to inadequate WAI. This is in addition to bad living conditions and precarious work. Intervention measures, either at the workplace or at individual levels, are necessary to prevent a decrease in work ability, even in this quite young working population.

Adult↗
PubMed1996

The relationship between night duty tolerance and personality.

This study sought to investigate whether the differences that exist between individuals in the degree they tolerate shiftwork are related to personality factors. Forty six nurses, all of whom worked some night duty in their shift pattern, were divided into two groups, those who would (S = 24) or would not (S = 22) choose some nightwork given a free choice. The 'no nightwork' group scored significantly higher on both the physical and psychological symptom scales taken as a measure of shiftwork tolerance. There were also significant differences between the two groups on a number of the personality variables measured. The largest difference was on the rigidity/flexibility of sleeping habits variable (p < 0.001). This study supported the premise that any decision whether or not to work nightshifts should be left to the individual.

Adult↗
PubMed1999

Managing chronic fatigue syndrome: overview and case study.

1. The basic principles of envelope theory are explained. By not overexerting themselves, people with CFS can avoid the setbacks and relapses that commonly occur in response to overexertion while increasing their tolerance to activity. 2. By collecting time series data on fluctuations in energy levels, important clinical observations can be made in respect to a client's unique condition and experience with CFS.

Fatigue Syndrome, Chronic↗
PubMedDate not supplied

Internal desynchronization of circadian rhythms and tolerance of shift work.

Fifteen male subjects including 12 shift workers (oil refinery operators) volunteered to document circadian rhythms in sleep-wake, grip strength of both hands, peak expiratory flow, heart rate, self-rated drowsiness, fatigue and attention. Each of these variables was measured 4 to 6 times/day for 2 to 3 weeks. In addition, both axillary temperature (with a shielded probe) and wrist activity were almost continuously recorded at 15 min intervals during the same time span. Individual time series were analyzed according to several statistical methods (power spectrum, cosinor, chi 2, etc.), in order to estimate the prominent circadian period tau and to evaluate both individual and subgroup differences with regard to tolerance of shift work, age, duration of shift work. The present study confirms for continuously recorded temperature and wrist activity, grip strength of both hands, heart rate and peak expiratory flow that intolerance of shift work is frequently associated with an internal desynchronization. However, this conclusion cannot be extended to circadian rhythms in self-rated drowsiness, fatigue and attention. The internal desynchronization among several circadian rhythms supports the hypothesis that these latter are driven by several oscillators, with presumable differences between right and left hemispheres as suggested by unequal values of tau in rhythms of both hand grip strength. Since an internal desynchronization can be observed in tolerant shift workers having no complaint, it is likely that symptoms of intolerance are related to the subject's sensitivity to internal desynchronization rather than to the desynchronization itself.

Adult↗
PubMed2003

Staying in hospital social work.

Hospitals have traditionally been large employers of social workers. As workplaces they are often identified as being challenging and ambiguous environments for social work practice. In this study the experience of hospital work is explored. Social workers' 'tolerance' of the hospital environment is identified as a way of explaining 'staying.' Staying has both positive and negative features which arise from the interaction between workers' tolerance of the environment and their qualities of 'self-actualisation.' The identification of this relationship informs and challenges existing theories of retention and turnover of workers.

Adult↗
PubMed2005

Aging human circadian rhythms: conventional wisdom may not always be right.

This review discusses the ways in which the circadian rhythms of older people are different from those of younger adults. After a brief discussion of clinical issues, the review describes the conventional wisdom regarding age-related changes in circadian rhythms. These can be summarized as four assertions regarding what happens to people as they get older: 1) the amplitude of their circadian rhythms reduces, 2) the phase of their circadian rhythms becomes earlier, 3) their natural free-running period (tau) shortens, and 4) their ability to tolerate abrupt phase shifts (e.g., from jet travel or night work) worsens. The review then discusses the empirical evidence for and against these assertions and discusses some alternative explanations. The conclusions are that although older people undoubtedly have earlier circadian phases than younger adults, and have more trouble coping with shift work and jet lag, evidence for the assertions about rhythm amplitude and tau are, at best, mixed.

Adult↗
PubMed1988

Social fate and long-term survival of patients with a recent myocardial infarction, after cardiac rehabilitation.

The aim of this study was to assess the social fate (work resumption) and long-term (four years) survival in 141 patients who completed a cardiac rehabilitation programme after a recent myocardial infarction. Out of the 100 patients who had been working up to recently before the myocardial infarction, 58 resumed their work. Of the predischarge evaluation (clinical data, resting radionuclide ventriculography, bicycle ergometry and 24-h ambulatory ECG monitoring) and bicycle ergometry after the rehabilitation, the only significant predictor of work resumption was a better exercise tolerance at discharge (P less than 0.02). Work was resumed by 68% of white-collar workers and by 52% of blue-collar workers. The four-year cardiac mortality in patients who completed the rehabilitation was 8.5% (N = 12). Four patients died during the first year. Clinical, ventriculographic and ergometric variables collected at hospital discharge, which were related to left ventricular dysfunction, were predictive of survival, while ventricular arrhythmias and markers of myocardial ischaemia were less predictive. The exercise testing performed after the rehabilitation programme was not useful for risk assessment. It is concluded that markers of left-ventricular dysfunction are predictive of a poor outcome; however, due to the low risk of patients who were referred to our rehabilitation unit and completed the rehabilitation programme, it seems reasonable for return to work to be based primarily on clinical information, exercise tolerance, and on psychological and social grounds. An additional extensive cardiological evaluation should be individually tailored for patients with specific symptoms.

Adult↗
PubMed1990

Spinal rehabilitation by work tolerance based on objective physical capacity assessment of dysfunction. A prospective study with control subjects and twelve-month review.

A work tolerance program was used for rehabilitation treatment of 45 patients with spinal dysfunction. Patients entering the treatment group were prospectively evaluated by objective physical capacity assessment (PCA). Treatment patients averaged 4 weeks of three, one half day sessions per week. These patients were compared with a control group of 33 patients who did not participate in the rehabilitation program but were evaluated by PCA. A telephone review of all patients in each group was carried out at 6- and 12-month follow-up. Results demonstrated that 78% of the rehabilitation treatment group were discharged with an improved functional work capacity. Most importantly, at 6-month follow-up, 73.0% of patients in the treatment group were productively working while only 38% of control group patients were actively employed. In addition, 84.4% showed an improvement in spinal range of motion. The subjective pain scale ratings of these treatment patients demonstrated only 44.4% decreased pain, while 51.1% stayed the same, and two patients increased discomfort. Further medical diagnostics or intervention was required in 24.4% of treatment patients. These findings definitely show that a spinal rehabilitation work-tolerance program based on objective measurement will enhance an increased rate of return to productive employment activity. There is poor correlation of subjective pain assessment when compared to objective PCAs. Therefore, recommendations of patients for return-to-productive work should be based pain ratings. When adjusted for nonselection patients, the authors community-based hospital program showed similar results to other programs. The work tolerance and rehabilitation program in Concord, New Hampshire, demonstrated a significant cost-effective approach; being less expensive, less time-consuming, and less psychologically oriented.

Adult↗
PubMed1997

Development of fatigue symptoms during simulated driving.

Why do people sometimes allow themselves to be overcome by fatigue? Ancient human survival may have depended on ignoring fatigue. Its modern occurrence in the absence of strain may further render us insensitive to its warning value. To test whether deliberate monitoring of certain symptoms may help drivers and other workers realize when they need to rest to avoid hazard, the development of fatigue while driving a simulator was objectively measured in terms of how many persons quit driving as a function of time. Some subjects asked to stop after 90 minutes; others lasted 240 minutes. Grouping data from an adapted Pearson [(1957) Journal of Applied Psychology, 44, 186-191] fatigue checklist revealed a curious phenomenon. No matter how long subjects drove before wanting to quit, they still developed much the same subjective level of fatigue at the end. This suggests that people do not differ greatly in how much fatigue they can tolerate but rather how quickly they reach a certain critical level of fatigue. Averaging fatigue scores backwards from the time subjects quit produced a function similar to the quitting function. Similar treatment of the other data revealed certain clusters of symptoms whose development also paralleled the development of fatigue.

Adolescent↗
PubMedDate not supplied

Increased pain tolerance as an indicator of return to work in low-back injuries after work hardening.

OBJECTIVE: This study examined retrospective data from a multidisciplinary work-hardening program that compared patients who did and did not return to work after low-back injury. The objective of this study was to identify differences between these groups to better guide work-hardening programs and return-to-work decisions. METHOD: Retrospective data from patients with low-back injuries (n = 115) who participated in a northern California work-hardening program were analyzed. Using two-way analysis of variance, male and female patients who did and did not return to work were compared. RESULTS: No significant differences were found between men and women for any of the variables studied. Patients who did and did not return to work were not significantly different in age, length of injury, and subjective pain at the beginning or end of the work-hardening program or in activity tolerance (p = .08). Patients who returned to work perceived a significantly (p < or = . 05) greater improvement in pain tolerance by the end of the work-hardening program than those who did not return to work. CONCLUSION: The results of this study suggest that rehabilitation emphasis should not be placed on the reduction of subjective pain but, rather, on strategies to cope with existing pain while improving functional ability.

Adult↗
PubMed2006

A prospective study of night shift work, sleep duration, and risk of Parkinson's disease.

The authors prospectively investigated whether working rotating night shifts was associated with the risk of Parkinson's disease among 84,794 female nurses who reported years of night shift work in 1988 (the US Nurses' Health Study). After 975,912 person-years of follow-up (1988-2000), 181 incident Parkinson's disease cases were documented. Compared with nurses who never worked rotating night shifts, those with 15 years or more of night shift work had a 50% lower risk of Parkinson's disease after adjustment for age and smoking (95% confidence interval: 0.26, 0.97; p(trend) = 0.01). Sleep duration was positively associated with Parkinson's disease risk: The relative risk was 1.84 (95% confidence interval: 0.99, 3.42) when comparing nurses who reported 9 or more hours of sleep per day with those who slept 6 hours or less (p(trend) = 0.005). These data suggest that working night shifts may be protective against Parkinson's disease or that low tolerance for night shift work is an early marker of Parkinson's disease. Conversely, habitual longer sleep duration may be an earlier marker of Parkinson's disease. Because of the novelty and the exploratory nature of these findings, confirmation is needed.

Alcohol Drinking↗
PubMed1992

[Recommendations in relation to shift work].

The purpose of the recommendations is to decrease as much as possible physiological, psychological and social problems connected with shift work. To achieve this goal working hours should be organized to take account of shift workers' tolerance to shift work. When recruiting new shift workers certain personal characteristics that make work in any shift work system inadvisable should be checked. As shift work can be considered to be an additional load, shift workers' health requires regular checking-up. If there are signs of health impairment, the workers should be removed from night shift work permanently or at least temporarily. The shift workers' free time should be arranged so as to facilitate recovery from shift work, especially after night shift. To decrease the workload during the night shift, if possible, workers should be given opportunity to take naps during work.

Humans↗
PubMedDate not supplied

Perspectives on the improvement of quality of life with epoetin alfa therapy.

Epoetin alfa (recombinant human erythropoietin) effectively diminishes the anemia associated with end-stage renal disease (ESRD). Although many clinical manifestations of ESRD have been attributed to uremic toxins, the ability of epoetin alfa therapy to improve several of these conditions, such as diminished energy levels, appetite, cold tolerance, sexual function, and cognitive abilities, suggests that anemia may be an important factor in uremia-associated symptoms. Correction of this anemia results in improvements in the patient's quality of life. These improvements can be measured by objective criteria such as exercise tolerance tests, or by subjective standards such as patient response to questionnaires. In studies to date, both subjective and objective data show that epoetin alfa therapy significantly improves the quality of life of patients with ESRD.

Activities of Daily Living↗
PubMed2004

Multidimensional aspects related to shiftworkers' health and well-being.

The impact of shift and night work on health shows a high inter- and intra-individual variability, both in terms of kind of troubles and temporal occurrence, related to various intervening factors dealing with individual characteristics, lifestyles, work demands, company organisation, family relations and social conditions. The way we define "health" and "well-being" can significantly influence appraisals, outcomes and interventions. As the goal is the optimisation of shiftworkers' health, it is necessary to go beyond the health protection and to act for health promotion. In this perspective, not only people related to medical sciences, but many other actors (ergonomists, psychologists, sociologists, educators, legislators), as well as shiftworkers themselves. Many models have been proposed aimed at describing the intervening variables mediating and/or moderating the effects; they try to define the interactions and the pathways connecting risk factors and outcomes through several human dimensions, which refer to physiology, psychology, pathology, sociology, ergonomics, economics, politics, and ethics. So, different criteria can be used to evaluate shiftworkers' health and well-being, starting from biological rhythms and ending in severe health disorders, passing through psychological strain, job dissatisfaction, family perturbation and social dis-adaptation, both in the short- and long-term. Consequently, it appears rather arbitrary to focus the problem of shiftworkers' health and tolerance only on specific aspects (e.g. individual characteristics), but a systemic approach appears more appropriate, able to match as many variables as possible, and aimed at defining which factors are the most relevant for those specific work and social conditions. This can support a more effective and profitable (for individuals, companies, and society) adoption of preventive and compensative measures, that must refer more to "countervalues" rather than to "counterweights".

Age Factors↗