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Concept: Shift work


This review summarises the literature on shift work and its relation to insufficient sleep, chronic diseases, and accidents. It is based on 38 meta-analyses and 24 systematic reviews, with additional narrative reviews and articles used for outlining possible mechanisms by which shift work may cause accidents and adverse health. Evidence shows that the effect of shift work on sleep mainly concerns acute sleep loss in connection with night shifts and early morning shifts. A link also exists between shift work and accidents, type 2 diabetes (relative risk range 1.09-1.40), weight gain, coronary heart disease (relative risk 1.23), stroke (relative risk 1.05), and cancer (relative risk range 1.01-1.32), although the original studies showed mixed results. The relations of shift work to cardiometabolic diseases and accidents mimic those with insufficient sleep. Laboratory studies indicate that cardiometabolic stress and cognitive impairments are increased by shift work, as well as by sleep loss. Given that the health and safety consequences of shift work and insufficient sleep are very similar, they are likely to share common mechanisms. However, additional research is needed to determine whether insufficient sleep is a causal pathway for the adverse health effects associated with shift work.

Concepts: Hypertension, Acute, Meta-analysis, Heart, Chronic, Shift work, Medicine, Epidemiology


Twenty-four hour nursing care involves shift work including 12-h shifts. England is unusual in deploying a mix of shift patterns. International evidence on the effects of such shifts is growing. A secondary analysis of data collected in England exploring outcomes with 12-h shifts examined the association between shift length, job satisfaction, scheduling flexibility, care quality, patient safety, and care left undone.

Concepts: Employment, The Association, Nurse uniform, Nurses, Florence Nightingale, Nurse, Shift work, Nursing


Sleep is fundamental to good health. Healthcare professionals receive little teaching on the importance of sleep, particularly with respect to their own health when working night shifts. Knowledge of basic sleep physiology, together with simple strategies to improve core sleep and the ability to cope with working nights, can result in significant improvements both for healthcare professionals and for the patients they care for. “You’re not healthy unless your sleep is healthy"Professor William Dement, Stanford University, one of the founders of modern sleep medicine.

Concepts: Public health, Sleep, Shift work, Health science, Health care provider, Health, Medicine, Health care


Shift work has been proposed to promote cognitive disturbances in humans; however, conflicting evidence is also present. By using data from 7143 middle-aged and elderly humans (45-75 years) who participated in the Swedish EpiHealth cohort study, the present analysis sought to investigate whether self-reported shift work history would be associated with performance on the trail making test (TMT). The TMT has been proposed to be a useful neuropsychological tool to evaluate humans' executive cognitive function, which is known to decrease with age. After adjustment for potential confounders (e.g., age, education, and sleep duration), it was observed that current and recent former shift workers (worked shifts during the past 5 years) performed worse on the TMT than nonshift workers. In contrast, performance on the TMT did not differ between past shift workers (off from shift work for more than 5 years) and nonshift workers. Collectively, our results indicate that shift work history is linked to poorer performance on the TMT in a cohort of middle-aged and elderly humans.

Concepts: Neurocognitive, Present, Cognition, Knowledge, Past, Psychology, Time, Shift work


We previously reported that compared with night sleep, day sleep among shift workers was associated with reduced urinary excretion of 8-hydroxydeoxyguanosine (8-OH-dG), potentially reflecting a reduced ability to repair 8-OH-dG lesions in DNA. We identified the absence of melatonin during day sleep as the likely causative factor. We now investigate whether night work is also associated with reduced urinary excretion of 8-OH-dG.

Concepts: Adenosine triphosphate, Circadian rhythms, Working time, Shift work


Background: Obesity is a multifactorial condition influenced by genetics, lifestyle, and environment.Objective: We investigated whether the association of a validated genetic profile risk score for obesity (GPRS-obesity) with body mass index (BMI) and waist circumference (WC) was modified by sleep characteristics.Design: This study included cross-sectional data from 119,859 white European adults, aged 37-73 y, participating in the UK Biobank. Interactions of GPRS-obesity and sleep characteristics (sleep duration, chronotype, day napping, and shift work) with their effects on BMI and WC were investigated. Results: β Values are expressed as the change in BMI (in kg/m(2)) or WC per 1-SD increase in GPRS-obesity. The GPRS-obesity was associated with BMI (β: 0.57; 95% CI: 0.55, 0.60; P = 6.3 × 10(-207)) and WC (1.21 cm; 95% CI: 1.15, 1.28 cm; P = 4.2 × 10(-289)). There were significant interactions of GPRS-obesity and a variety of sleep characteristics with their relation with BMI (P-interaction < 0.05). In participants who slept <7 or >9 h daily, the effect of GPRS-obesity on BMI was stronger (β: 0.60; 95% CI: 0.54, 0.65 and β: 0.73; 95% CI: 0.49, 0.97, respectively) than in normal-length sleepers (7-9 h; β: 0.52; 95% CI: 0.49, 0.55). A similar pattern was observed for shift workers (β: 0.68; 95% CI: 0.59, 0.77 compared with β: 0.54; 95% CI: 0.51, 0.58 for non-shift workers) and for night-shift workers (β: 0.69; 95% CI: 0.56, 0.82 compared with β: 0.55; 95% CI: 0.51, 0.58 for non-night-shift workers), for those taking naps during the day (β: 0.65; 95% CI: 0.52, 0.78 compared with β: 0.51; 95% CI: 0.48, 0.55 for those who never or rarely had naps), and for those with a self-reported evening chronotype (β: 0.72; 95% CI: 0.61, 0.82 compared with β: 0.52; 95% CI: 0.47, 0.57 for morning chronotype). Similar findings were obtained by using WC as the outcome.Conclusion: This study shows that the association between genetic risk for obesity and phenotypic adiposity measures is exacerbated by adverse sleeping characteristics.

Concepts: Waist-hip ratio, Obesity, Circadian rhythm, Night owl, Lark, Shift work, Body mass index, Sleep


PURPOSE: Healthcare organizations often have to provide patient care around the clock. Shift work (any shift outside of 7 a.m. to 6 p.m) and long work hours increase the risk for short sleep duration and sleep disturbances. Thirty-two percent of healthcare workers report they do not get enough sleep. The purpose of the article is to give an overview of the wide range of risks to nurses, patients, and employers that are linked to shift work, long work hours, and poor sleep from other sources. FINDINGS: Shift work and long work hours increase the risk for reduced performance on the job, obesity, injuries, and a wide range of chronic diseases. In addition, fatigue-related errors could harm patients. Fatigued nurses also endanger others during their commute to and from work. CONCLUSION AND CLINICAL RELEVANCE: The key strategy to reduce these risks is making sleep a priority in the employer’s systems for organizing work and in the nurse’s personal life.

Concepts: Working time, Shift work, Illness, Medicine, Health care, Patient, Employment, Health care provider


Surprisingly little research investigates employee breaks at work, and even less research provides prescriptive suggestions for better workday breaks in terms of when, where, and how break activities are most beneficial. Based on the effort-recovery model and using experience sampling methodology, we examined the characteristics of employee workday breaks with 95 employees across 5 workdays. In addition, we examined resources as a mediator between break characteristics and well-being. Multilevel analysis results indicated that activities that were preferred and earlier in the work shift related to more resource recovery following the break. We also found that resources mediated the influence of preferred break activities and time of break on health symptoms and that resource recovery benefited person-level outcomes of emotional exhaustion, job satisfaction, and organizational citizenship behavior. Finally, break length interacted with the number of breaks per day such that longer breaks and frequent short breaks were associated with more resources than infrequent short breaks. (PsycINFO Database Record

Concepts: Sampling, Resources, Shift work, Organizational citizenship behavior, The Work, Resource, Break, Employment


OBJECTIVE: To investigate whether or not use of sit-stand desks and awareness of the importance of postural variation and breaks are associated with the pattern of sedentary behavior in office workers. METHOD: The data came from a cross-sectional observation study of Swedish call centre workers. Inclinometers recorded ‘seated’ or ‘standing/walking’ episodes of 131 operators over a full work shift. Differences in sedentary behavior based on desk type and awareness of the importance of posture variation and breaks were assessed by non-parametric analyses. RESULTS: 90 (68.7%) operators worked at a sit-stand desk. Working at a sit-stand desk, as opposed to a sit desk, was associated with less time seated (78.5 vs 83.8%, p = 0.010), and less time taken to accumulate 5 min of standing/walking (36.2 vs 46.3 min, p = 0.022), but no significant difference to sitting episode length or the number of switches between sitting and standing/walking per hour. Ergonomics awareness was not associated with any sedentary pattern variable among those using a sit-stand desk. CONCLUSION: Use of sit-stand desks was associated with better sedentary behavior in call centre workers, however ergonomics awareness did not enhance the effect.

Concepts: Shift work, Sitting, Kneeling chair, Desk, Statistical significance, Office, Call centre


The impact of long working hours on diabetes is controversial; however, shift work is known to increase the risk of diabetes. This study aimed to investigate the association between long working hours and diabetes among civil servants in Japan separately by shift work schedules.

Concepts: Working time, Shift work