Sleep duration and quality in permanent night work: an observational field study.

PURPOSE: Permanent night workers conceivably show better adaptation of circadian rhythms to night work than shift workers and therefore better possibilities of obtaining sufficient sleep of good quality after night shifts. We investigated the effect of night shifts including number of consecutive shifts on sleep among self-selected permanent night workers, and studied if the effect of night shifts differed between morning and evening types and compared with 3-shift workers. METHODS: The study population included 90 permanent night workers followed for 14 days (warehouse workers, 1228 observation days, 80% males). For comparison, we included 70 3-shift workers followed for 26 days (police officers, 1774 observation days, 100% men). Total sleep time (TST), primary sleep duration (PSD), and sleep efficiency were assessed by actigraphy. Measures of sleep quality and diurnal type were self-reported. RESULTS: Among permanent night workers, TST, PSD, difficulties falling asleep, disturbed sleep, and the number of awakenings decreased after night shifts compared with days without night work. Sleep efficiency, difficulties awakening, and non-refreshing sleep increased. More consecutive night shifts were associated with shorter TST and PSD. Sleep outcomes did not differ by diurnal type. Permanent night workers had fewer awakenings after night shifts than 3-shift workers, but no other differences were observed. CONCLUSION: This study does not provide evidence that supports recommendation of permanent night work to reduce adverse effects of night shifts on sleep. A limited number of consecutive night shifts is recommended to reduce accumulation of sleep debt.

Disentangling concepts of inappropriate polypharmacy in old age: a scoping review.

INTRODUCTION: Polypharmacy is a common concern, especially in the older population. In some countries more that 50% of all individuals over 60 receive five or more drugs, most often due to multimorbidity and increased longevity. However, polypharmacy is associated with multiple adverse events, and more medication may not always be the answer. The terms "appropriate" and "inappropriate" are often used to distinguish between "much" and "too much" medications in relation to polypharmacy in research and practice, but no explicit definition exists to describe what these terms encompass. The aim of this review is to unfold the different understandings of and perspectives on (in)appropriate polypharmacy and suggest a framework for further research and practice. METHOD: A scoping review was conducted using the framework of Arksey and O'Malley and Levac et al. Pubmed, Embase, PsycINFO, CINAHL, Cochrane database, Scopus and Web of Science were searched for references in English, Danish, Norwegian and Swedish using the search string "Polypharmacy" AND "Appropriate" OR "Inappropriate". Data was extracted on author information, aims and objectives, methodology, study population and setting, country of origin, main findings and implications, and all text including the words "appropriate," "inappropriate," and "polypharmacy." Qualitative meaning condensation analysis was used and data charted using descriptive and thematic analysis. RESULTS: Of 3982 references, a total of 92 references were included in the review. Most references were from 2016-2021, from fields related to medicine or pharmacy, and occurred within primary and secondary healthcare settings. Based on the qualitative analysis, a framework were assembled consisting of Context, three domains (Standardization, Practices and Values & Concerns) and Patient Perspective. CONCLUSION: Inappropriate polypharmacy is a concept loaded by its heterogeneity and the usefulness of a single definition is doubtful. Instead, the framework suggested in this article representing different dimensions of inappropriate polypharmacy may serve as an initial strategy for focusing research and practice on polypharmacy in old age.

Acute effects of night work and meals on blood glucose levels.

Employees working at night are at increased risk of diabetes. A possible mechanism is related to differences in glucose regulation at night. Laboratory simulated night work studies show regulation of blood glucose is impaired at night. Regular exposure to high glucose levels at night may explain the observed relationship between night work and diabetes. We performed a field study of 19 nonsmoking women from the health-care sector to investigate how night work and the composition of meals affect post-prandial blood glucose levels. Blood glucose levels were self-assessed by finger-prick blood sampling using the Beurer blood glucose monitoring system. Measurements were done before and 15, 30, 60, and 120 min after different test meals: a nighttime high sugar meal during a night shift and during a day shift, and a reference (low sugar) meal under these same two conditions. There was a statistically significant difference in blood glucose concentration between the four test meal conditions (P = .0086). Post-meal blood glucose levels following the night-shift meals, compared to following daytime meals, rose faster and remained elevated for longer a duration of time. At the 15 min time point following the high sugar test meal, the blood glucose concentration was 8.3 mmol/L when consumed at night vs. 7.3 mmol/L when consumed during the day. We found no difference in area under the blood glucose concentration-time curve (AUC) after consumption of the high or low sugar test meals during the night shift compared with consumption of them during the day. Our findings indicate the glucose levels in response to food intake by female night working healthcare assistants are higher following the nighttime compared with daytime consumption of a high sugar content meal. However, we did not find a difference in total glucose exposure across time (assessed as AUC) after eating a high vs. low sugar meal during the night shift.