All night long: an assessment of the cognitive effects of night shift work in anaesthesiology trainees

Background: Excessive working hours and fatigue in medical training are a source of concern. Practitioner fatigue manifests itself in both risks to the patient and the medical trainee. This study aimed to quantify the effect of shift work on multiple cognitive function domains in anaesthesiology trainees at Tygerberg Academic Hospital. Secondary outcomes were to identify strategies to ameliorate shift work-related fatigue. Methods: An analytical observational study was conducted using mixed methods. The participants, anaesthesiology registrars and medical officers, completed an electronic cognitive test battery consisting of four tests, and a paper-based questionnaire prior to and following a 14-hour night shift. Results: Twenty-nine participants engaged in the study; including 14 males and 15 females with an age range 29–58 years. The study demonstrated a statistically significant impairment in reaction time in two of the four cognitive domains tested, ranging from 13.4–17.8%. No statistically significant change in accuracy was seen in any of the cognitive tests. A subjective increase in fatigue was also demonstrated using the Karolinska Sleepiness Scale. Further, no statistically significant correlation was found between the decline in reaction time and the individual and work-related factors which were assessed in the paper-based questionnaires. Conclusion: Fatigue in anaesthesiology trainees after a 14-hour night shift results in a decline in reaction time in the cognitive domains of psychomotor function and attention. Accuracy, however, remained unchanged. The study was unable to identify strategies which ameliorated these effects with statistical significance. Nevertheless, the recommendations and guidelines of various anaesthesiology bodies, including the South African Society of Anaesthesiologists, are supported. Further studies using a larger and more diverse study population are suggested.

Download Full-text

Effects of sleepiness on clinical decision making among paramedic students: a simulated night shift study

Emergency Medicine Journal ◽

10.1136/emermed-2019-209211 ◽

2021 ◽

pp. emermed-2019-209211

Author(s):

Danielle Bartlett ◽

Sara Hansen ◽

Travis Cruickshank ◽

Timothy Rankin ◽

Pauline Zaenker ◽

...

Keyword(s):

Decision Making ◽

Reaction Time ◽

Shift Work ◽

Clinical Decision Making ◽

Clinical Performance ◽

Night Shift ◽

Clinical Decision ◽

Night Shift Work ◽

Clinical Scenarios ◽

Perceived Workload

ObjectiveParamedics are at the forefront of emergency healthcare. Quick and careful decision making is required to effectively care for their patients; however, excessive sleepiness has the potential to impact on clinical decision making. Studies investigating the effects of night shift work on sleepiness, cognitive function and clinical performance in the prehospital setting are limited. Here, we aimed to determine the extent to which sleepiness is experienced over the course of a simulation-based 13-hour night shift and how this impacts on clinical performance and reaction time.MethodsTwenty-four second year paramedic students undertook a 13-hour night shift simulation study in August 2017. The study consisted of 10 real-to-life clinical scenarios. Sleepiness, perceived workload and motivation were self-reported, and clinical performance graded for each scenario. Reaction time, visual attention and task switching were also evaluated following each block of two scenarios.ResultsThe accuracy of participants’ clinical decision making declined significantly over the 13-hour night shift simulation. This was accompanied by an increase in sleepiness and a steady decline in motivation. Participants performed significantly better on the cognitive flexibility task across the duration of the simulated night shift and no changes were observed on the reaction time task. Perceived workload varied across the course of the night.ConclusionOverall, increased sleepiness and decreased clinical decision making were noted towards the end of the 13-hour simulated night shift. It is unclear the extent to which these results are reflective of practising paramedics who have endured several years of night shift work, however, this could have serious implications for patient outcomes and warrants further investigation.

Download Full-text

Relationship of work-related stress with obesity among Brazilian female shift workers

Public Health Nutrition ◽

10.1017/s1368980020004243 ◽

2020 ◽

pp. 1-7

Author(s):

Janaína Cristina da Silva ◽

Anderson Garcez ◽

Gabriela Herrmann Cibeira ◽

Heloísa Theodoro ◽

Maria Teresa Anselmo Olinto

Keyword(s):

Shift Work ◽

Night Shift ◽

Cross Sectional Study ◽

Cross Sectional ◽

Work Related Stress ◽

Shift Workers ◽

Night Shift Work ◽

Work Related ◽

Prevalence Of Obesity ◽

Related Stress

Abstract Objectives: To explore the relationship between work-related stress and obesity among female shift workers. Additionally, we also aimed to test the interaction between shift work and work-related stress in this association. Design: A cross-sectional study was conducted among Brazilian female shift workers. Work-related stress was assessed through a demand–control questionnaire (Job Stress Scale). Work-related stress was defined by the presence of high psychological demands and low control at work. The obesity cases were defined as those with a BMI of 30 kg/m2 or more. Multivariate Poisson regression with robust variance was used to obtain the prevalence ratios (PR) and their respective 95 % CI. Setting: A group of industries located in southern Brazil in 2017. Participants: Four hundred and twenty female workers aged 18–59 years. Results: The overall prevalence of obesity was 30 % (95 % CI: 25·6, 34·4), and the presence of work-related stress was identified in 24 % (95 % CI: 19·9, 28·1) of the sample. We found an indication of interaction between work-related stress and night shift work on obesity (P = 0·026). After adjusting for confounding factors, work-related stress was associated with a 71 % greater probability of obesity (PR = 1·71; 95 % CI: 1·02, 2·87; P = 0·042) among female night shift workers. Conclusions: In this study, we revealed that exposure to work-related stress and night shift work were associated with obesity among female shift workers. Furthermore, the prevalence of obesity was high among female shift workers.

Download Full-text

Shift Work-Related Problems in 16-h Night Shift Nurses (2): Effects on Subjective Symptoms, Physical Activity, Heart Rate, and Sleep.

Industrial Health ◽

10.2486/indhealth.37.228 ◽

1999 ◽

Vol 37 (2) ◽

pp. 228-236 ◽

Cited By ~ 24

Author(s):

Masaya TAKAHASHI ◽

Hideki FUKUDA ◽

Keiichi MIKI ◽

Takashi HARATANI ◽

Lumie KURABAYASHI ◽

...

Keyword(s):

Physical Activity ◽

Heart Rate ◽

Shift Work ◽

Night Shift ◽

Subjective Symptoms ◽

Work Related

Download Full-text

Two step cluster analysis of burnout among preschool teachers

European Journal of Public Health ◽

10.1093/eurpub/ckz186.328 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

P Piperac ◽

Z Terzic-Supic ◽

J Todorovic ◽

A Maksimovic ◽

S Karic ◽

...

Keyword(s):

Cluster Analysis ◽

Shift Work ◽

Representative Sample ◽

Preschool Teachers ◽

Demographic Characteristics ◽

Related Factors ◽

Workplace Environment ◽

Work Related ◽

Personal Domain ◽

National Representative Sample

Abstract Background The burnout is influenced by a variety of personal, work-related and client-related factors, which are included in different domains of Copenhagen burnout inventory (CBI). The aim of this study was to examine if there are different groups of preschool teachers which differ in scores on different domains of CBI. Methods This was the analysis of the data from the survey on burnout on a National representative sample of 456 preschool teachers in Serbia. The study was conducted between October of 2018 and January 2019. The study instrument contained questions on socio-demographic characteristics, workplace environment characteristics, and Copenhagen burnout inventory. We used two-step cluster analysis in SPSS to segment the participants based on age and average scores on personal, work-related and client related domains of CBI. Results Our participants clustered in three distinguished groups: participants aged 35.31 years, who worked in shifts, with personal burnout average of 29.46, work-related burnout average of 24.06 and client related burnout average of 19.46; participants aged 44.09 years, who worked in shifts, personal domain scores of 55.24, work-related burnout scores of 51.72, and client-related burnout scores of 51.13; and participants aged 43.01 years, who did not work in shifts, with personal burnout scores of 36.47, work-related burnout scores of 31.95, and client-related burnout scores of 32.08. Conclusions Participants clustered in three different groups, and the group with the highest average age and with the shift work had higher scores on all three domains compared to other groups. Key messages Preschool teachers clustered in three groups with different scores on domains on burnout. The group with the highest average age had the highest scores on all three domains of burnout.

Download Full-text

Prevalence of Vitamin D Deficiency and Its Associated Work-Related Factors among Indoor Workers in a Multi-Ethnic Southeast Asian Country

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010164 ◽

2019 ◽

Vol 17 (1) ◽

pp. 164

Author(s):

Ushashree Divakar ◽

Thirunavukkarasu Sathish ◽

Michael Soljak ◽

Ram Bajpai ◽

Gerard Dunleavy ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Night Shift ◽

Prevalence Ratio ◽

Asian Country ◽

Control Room ◽

Related Factors ◽

Hydroxyvitamin D ◽

Work Related ◽

Vitamin D Levels

Little is known about the effect of working conditions on vitamin D status in Southeast Asia, where vitamin D deficiency is common despite the presence of sunlight all year round in most places. We examined the prevalence of vitamin D deficiency and its associated work-related factors among indoor workers using the data of 213 participants (aged ≥21 years) from a workplace cohort study in Singapore. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/L. Data on work-related factors, socio-demographic characteristics, and lifestyle habits were collected using standardized questionnaires. Clinical and biochemical measurements were performed using standard tools and protocols. Multivariate Poisson regression was used to examine the independent association of work-related factors with vitamin D deficiency. Mean serum 25(OH)D concentration was 59.6 nmol/L. The prevalence of vitamin D deficiency was 32.9% (95% confidence interval (CI): 26.6–39.6%). In the multivariate analysis, office workers (prevalence ratio (PR): 2.16, 95% CI: 1.12–4.16 versus control room workers), workshop workers (PR: 2.25, 95% CI: 1.05–4.81 versus control room workers), and night shift workers (PR: 1.31, 95% CI: 1.03–1.67) were at a greater risk for vitamin D deficiency. Workplace policies and wellness programs should encourage workers to take regular breaks to go outdoors for sunlight exposure and to consume adequate amounts of vitamin D-rich foods to maintain optimal vitamin D levels.

Download Full-text

Night‐Shift Work Related Problems in Young Female Nurses in Japan

Journal of Occupational Health ◽

10.1539/joh.43.150 ◽

2001 ◽

Vol 43 (3) ◽

pp. 150-156 ◽

Cited By ~ 29

Author(s):

Takashi Ohida ◽

AMM Kamal ◽

Tomofumi Sone ◽

Toshihiro Ishii ◽

Makoto Uchiyama ◽

...

Keyword(s):

Shift Work ◽

Night Shift ◽

Young Female ◽

Night Shift Work ◽

Work Related ◽

Female Nurses

Download Full-text

306 Circadian activity rhythms and alertness among rapid-shift work female nurses

SLEEP ◽

10.1093/sleep/zsab072.305 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A122-A122

Author(s):

Xin Zhang ◽

Shih-Yu Lee

Keyword(s):

Reaction Time ◽

Shift Work ◽

Night Shift ◽

Circadian Activity ◽

Activity Rhythms ◽

Saliva Cortisol ◽

Before And After ◽

Shift Rotation ◽

Fatigue Severity ◽

Rapid Shift

Abstract Introduction Circadian rhythms play an important role in regulating sleep. Sleep disturbances are prevalent in shift-work nurses, particularly for those work in rapid-shift rotation, including night shifts and day shifts. This study aimed to: 1) describe the characters of sleep-wake index (total sleep time [TST], wake after sleep onset [WASO], circadian activity rhythms [CAR]), psychomotor vigilance test (PVT), salivary cortisol, fatigue, and activity level during 8- and 12-hour rapid-shift work nurses; and 2) compare the parameters between two different shifts. Methods This exploratory study used registered nurses (RNs) from nine intensive care units in Beijing area. 7-days consecutive wrist actigraphy data, including TST and WASO were collected. Cosiner analysis was used for computing the CAR, including amplitude and mesor. PVT and saliva cortisol were used to assess alertness level, which measured before and after shift. Self-reported fatigue severity was measured by Lee Fatigue Scale-Short Form and assessed before and after shift. Results A total of 152 RNs (12-hour, n=82; 8-hour, n=70) participated this study, with a mean age of 31.81 (SD= 6.09). Compared with the 8-hour shift nurses, the 12-hour shift nurses were significantly higher in TST (456 vs. 364 minutes), median saliva cortisol level (before day shift, 0.54 vs. 0.31), and median PVT reaction time (before night shift). However, CAR were 0.53 (SD=0.13) and 0.50 (SD=0.18) for 12-hour and 8-hour shift RNs, respectively, and indicates desynchronized CAR in both groups. Regardless shift rotation, almost three-quarters of the RNs had a 500 ms PVT reaction time. For the 12-hour and 8-hour nurses, the level of activity during day shift was similar. However, during night shift work it was significantly lower in 12-hour nurses compared to the 8-hour nurses. All RNs experienced clinical significant fatigue severity (ranged 3.78 to 8.14) regardless before or after shift work; however, the 12-hour group reported lower fatigue severity than 8-hour group. Conclusion In this study, findings revealed shift-work RNs experienced fatigue and desynchronized CAR. The TST was low and reaction time was prolonged before and after shift work. Sleep intervention should be mandatorily included in clinical continue education. Support (if any) This project was supported by Chinese National Natural Science Foundation (71603279).

Download Full-text

Women’s psychological health, family function, and social support during their third trimester of pregnancy within the COVID-19 epidemic: A cross-sectional survey

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.244 ◽

2021 ◽

pp. 1-13

Author(s):

Dongning He ◽

Jianhua Ren ◽

Biru Luo ◽

Jie Xiang ◽

Guoyu Wang ◽

...

Keyword(s):

Social Support ◽

Fetal Growth ◽

Psychological Health ◽

Statistical Significance ◽

Depression Scale ◽

Third Trimester ◽

Related Factors ◽

Family Function ◽

Work Related ◽

Prenatal Examination

Abstract Objective: The study aims to investigate women’s psychological health, family function, and social support during the third trimester within the COVID-19 epidemic. Method: From January 30, 2020 to February 26, 2020, 177 pregnant women during their third trimester (mean gestation time was 37.05±4.06 weeks) in a maternal and children’s hospital were investigated using the Self-Rating Anxiety Scale (SAS), the Edinburgh Postnatal Depression Scale, the Family APGAR Index, and the Perceived Social Support Scale. Non-parametric tests were conducted in the study. The statistical significance was set as p < 0.05. Result: The incidence rate of the participants’ anxiety and depression during the COVID-19 epidemic was 19.21% and 24.29%, respectively. The participants’ greatest concerns in the previous week were the risk of virus transmission (79.66%), and the prenatal examination and fetal growth (70.62%). The SAS ranks were higher in the participants who were concerned about the prenatal examination and fetal growth and work-related affairs. Conclusion: The participants’ psychological health was indirectly affected by the epidemic through the supply of medical resources and work-related factors. The medical staff should employ family support and social resources to guarantee the accessibility of medical services and living materials to decrease the pregnant women’s stress and further improve their psychological health.

Download Full-text

Individuell variasjon i utskillelse av 6-sulfatoksymelatonin og døgnrytmetype analysert hos skiftarbeidere

Norsk Epidemiologi ◽

10.5324/nje.v9i1.440 ◽

2009 ◽

Vol 9 (1) ◽

Author(s):

Tore Tynes ◽

Bjarte Haugsdal ◽

Magnar Kleiven ◽

Arnfinn Tønnessen

Keyword(s):

Night Shift ◽

Potential Effect ◽

English Summary ◽

Font Size ◽

Related Factors ◽

Shift Workers ◽

Future Studies ◽

Work Related ◽

Hormone Balance ◽

Individual Variations

SAMMENDRAGI denne studien har vi undersøkt om det finnes noen sammenheng mellom målte verdier av urinmetabolitten6-sulfatoxymelatonin (aMT6s) tatt ut i porsjoner gjennom døgnet og selvrapportert døgnrytme hos engruppe norske skiftarbeidere. Studien omfatter 19 arbeidstakere ved to produksjonsenheter ved HydroPorsgrunn, magnesiumfabrikken og fullgjødselfabrikk 3. Etter å ha deltatt i en studie der urinprøver blesamlet inn, svarte de involverte senere på et spørreskjema om søvn og døgnrytme. Resultatene indikerer ategenrapporterte B-type mennesker har en tendens til høyere midlere timeutskillelse av aMT6s analysert pådøgnbasis første døgn med nattskift, og en signifikant høyere nattutskillelse (8 timer) i et kontrolldøgnhjemme. I fremtidige studier av melatoninsekresjon og utskillelse av metabolitt i urin, kan det være avinteresse samtidig å samle inn spørreskjemabaserte opplysninger om døgnrytmetype og utfyllende opplysningerom søvn og søvnmønster i relasjon til eksponeringer som skiftarbeid og andre arbeidsmiljøfaktorersom kan ha effekt på hormonbalansen.Tynes T, Haugsdal B, Tønnessen A, Kleiven M. Individual variations in excretion of6-sulfatoxymelatonin in morning and evening type Norwegian shift workers.Nor J Epidemiol ENGLISH SUMMARYThe aim of this study was to evaluate whether there is an association between measured values of the urinemetabolite 6-sulfatoxymelatonin (aMT6s) in samples collected at selected intervals and self-reported diurnalrhythm in a group of Norwegian shift workers. The study included 19 workers at two production unitsat Hydro Porsgrunn, the magnesium factory and fertiliser factory 3. After submitting the urine samplesused for the study, subjects filled in a questionnaire on sleep and diurnal rhythm at a later date. The resultsindicate that self-reported evening type subjects have a tendency towards a higher mean hourly aMT6ssecretionfirst day on night shift, and a significantly higher night secretion (8 hours) analysed for a controlday at home. In future studies on secretion of melatonin and its metabolite in urine, the collection ofquestionnaire-based information on diurnal type, sleep and sleep pattern in relation to exposures like shiftwork, and other work-related factors with potential effect on hormone balance might be of interest.1999; 9 (1): 33-38.

Download Full-text

Salivary Biomarkers and Work-Related Stress in Night Shift Workers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063184 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3184

Author(s):

Giusi Briguglio ◽

Michele Teodoro ◽

Sebastiano Italia ◽

Francesca Verduci ◽

Manuela Pollicino ◽

...

Keyword(s):

Shift Work ◽

Negative Impact ◽

Night Shift ◽

Significant Negative Correlation ◽

Work Related Stress ◽

Night Shift Work ◽

Work Related ◽

Salivary Biomarkers ◽

Related Stress ◽

Dock Workers

Work organization, such as shifts and night work, can interfere with the perception of work-related stress and therefore on the development of pathological conditions. Night shift work, particularly, can have a negative impact on workers’ wellbeing by interfering with the biological sphere. The aim of this study is to evaluate the associations between work activities, shift work effects and stress-related responses in 106 dock workers enrolled in southeast Italy. Dock workers’ tasks consist of complex activities that seemed to affect more sleep quality than work-related stress. An analysis of salivary biomarkers such as cortisol, α-amylase, melatonin and lysozyme was performed along with validated psycho-diagnostic questionnaires. Alpha-amylase showed a significant negative correlation with the effort/reward imbalance score; thus, the measurement of salivary α-amylase is proposed as a sensitive and non-invasive biomarker of work-related stress. This study may provide new insights into developing strategies for the management of night shift work. Salivary biomarkers should be further investigated in the future in order to develop simple and effective tools for the early diagnosis of work-related stress or its outcomes.

Download Full-text