Secondary traumatic stress in partners of paramedics: A scoping review.

BACKGROUND: Paramedics experience post-traumatic stress in their work, and many paramedics turn to their intimate partner for support. However, exposure to traumatic event details can leave partners vulnerable to secondary traumatic stress. Despite substantial research into reducing stress and improving support for paramedics, few studies have investigated their partners' trauma experiences and support needs. This scoping review aimed to examine evidence regarding secondary traumatic stress in paramedic partners. METHODS: The MEDLINE, PsychINFO, CINAHL, EMCare, and Sociology Source Ultimate databases were searched up to November 9, 2022. The results sections of studies published in English involving a sample of paramedic partners that examined the impact of paramedics' work-related exposure to trauma on their intimate partner were extracted for analysis. This scoping review was guided by the Joanna Briggs Institute methodology. Key themes were generated using a framework synthesis approach. RESULTS: Five qualitative studies and one quantitative study were included, indicating a paucity of literature regarding secondary traumatic stress in paramedic partners. Post-traumatic stress experienced by paramedics can crossover to paramedic partners in the form of secondary traumatic stress; furthermore, it can have widespread effects on couple functioning. While paramedic partners appear to recognise the need for effective coping strategies, they perceive that little support is available to them. Notably, effective strategies aimed at reducing secondary traumatic stress in paramedic partners are limited. CONCLUSION: Further research is required to quantify secondary traumatic stress severity in paramedic partners and explore relationships between post-traumatic stress, secondary traumatic stress, and couple functioning. Further, evaluation of partner support needs and barriers to accessing support is warranted.

A preliminary framework for managing sleep inertia in occupational settings.

Sleep inertia, the temporary period of impairment experienced upon waking, is a safety hazard that has been implicated in serious work-related incidents resulting in injuries as well as the loss of life and assets. As such, sleep inertia warrants formal management in industries where personnel are required to undertake their role soon after waking (e.g. emergency services, engineers, and health care). At present, there is a lack of practical, evidence-based guidance on how sleep inertia could be formally managed at an organizational level. We propose a preliminary framework for managing sleep inertia based on the translation of research findings into specific work procedure modifications/control mechanisms. Within the framework, work procedure modifications/control mechanisms to manage sleep inertia are organized into three levels: (1) modifications/controls that eliminate the chance of sleep inertia, (2) modifications/controls that reduce sleep inertia severity, and (3) modifications/controls that manage the risk of errors during sleep inertia. Practical considerations, limitations, and areas of further research are highlighted for each modification/control to help determine how readily each control measure could be implemented by industries at present. A guide for organizations to use this preliminary framework of sleep inertia management is put forward, as well as the next research priorities to strengthen the utility and evidence base of the framework. This paper is part of the Sleep and Circadian Rhythms: Management of Fatigue in Occupational Settings Collection.

Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis.

Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs.

"I need to be alert at night to provide care": Factors associated with problematic sleep among young Australian caregivers.

OBJECTIVES: There is increased recognition that young people (<25 years) may occupy a carer role for family or others with health conditions or disability. This is often in addition to study and social activities. This means competing demands on time, and insufficient sleep. Our aim was to determine the contribution of caring duties to problematic sleep in young carers. METHODS: A survey of Australian carers was conducted, including questions on demographics, characteristics of the carer and care recipient, and sleep quality and quantity. Participants were eligible if they reported sleep time <7 hr or dissatisfaction with their sleep, and were aged 15-24 years. RESULTS: A total of 110 participants (71.8%_female = 79, 15-17 years = 62, 18-24 years = 48) were included in analysis; 55.5% (n= 61) reporting dissatisfaction with their sleep and 62.7% (n= 69) reporting typically less than 7 hr sleep per night. Sleep duration was significantly shorter for those who reported 1-2 or ≥3 awakenings to provide care, compared with no awakenings (p_< .05). Sleep quality, as described by scores on the Pittsburgh Sleep Quality Index (PSQI) was also significantly worse for those who were frequently awoken by their care recipient (p < .05). Worrying about the care recipient, being woken by the care recipient, and listening out for the care recipient were the most frequently identified factors impacting on sleep. CONCLUSION: Young carers experience reduced sleep duration and poor sleep quality. Strategies to alleviate the burden of care work on young carer's sleep would benefit the health and safety of this group.

Physical and psychological health in intern paramedics commencing shift work: Protocol for an exploratory longitudinal study.

BACKGROUND: Paramedics are routinely exposed to shift work. Existing research shows that shift work exposure is associated with adverse mental and physical health outcomes. However, the current understanding of the impact of commencing shift work in a paramedic role on health is limited. This can be addressed by recruiting new paramedics before they commence shift work, and conducting regular follow-ups of potential biological, psychological and social changes. The present study aimed to examine changes in biological, psychological and social factors relative to pre-shift work baseline in a cohort of paramedics commencing intern employment with an Australian ambulance service. METHOD AND ANALYSIS: This observational, mixed-methods, longitudinal study aims to recruit 40 interns from one Australian ambulance service. Data collection will occur at baseline (standard day schedule for initial training), and subsequently at three months, six months, nine months and twelve months, to measure biological, psychological and social changes relative to baseline measurements. Changes in cardiometabolic markers (cholesterol, triglycerides, fasting glucose), microbiome (self-collected stool samples), sleep and physical activity (actigraphy) will be measured. Interns will also complete a battery of self-report questionnaires, sleep diaries and qualitative interviews to explore various psychological and social variables over time. Statistical analyses will be conducted using mixed effects regression, specifying a random effect of subject on the intercept, allowing participants to vary according to individual baseline levels, as well as tracking progress over time, appropriately accounting for serial correlation. Qualitative study components will be analysed via coding and thematic analysis procedures. DISCUSSION: The present study protocol is a comprehensive outline of the observational study planned. The study will allow for greater knowledge of any changes in biological, psychological and social factors during a 12-month transition to shift work. The findings from the proposed study will have implications for the development of strategies to support early-career shift workers.

"I Want to Be Safe and Not Still Half Asleep": Exploring Practical Countermeasures to Manage the Risk of Sleep Inertia for Emergency Service Personnel Using a Mixed Methods Approach.

Purpose: The aim of this exploratory cross-sectional mixed methods study was to determine 1) whether sleep inertia, the temporary state of impaired vigilance performance upon waking, is perceived to be a concern by emergency service personnel, 2) what strategies are currently used by emergency service workplaces to manage sleep inertia, 3) the barriers to implementing reactive sleep inertia countermeasures, and 4) what strategies personnel suggest to manage sleep inertia. Participants and Methods: A sample (n = 92) of employed and volunteer Australian emergency service personnel (fire and rescue, ambulance, police, state-based rescue and recovery personnel) completed an online survey. Data collected included demographic variables and work context, experiences of sleep inertia in the emergency role, barriers to sleep inertia countermeasures, and existing workplace sleep inertia countermeasures and recommendations. Quantitative data were analysed using descriptive statistics, and qualitative data were thematically analysed. Results: Approximately 67% of participants expressed concern about sleep inertia when responding in their emergency role. Despite this, there were few strategies to manage sleep inertia in the workplace. One major barrier identified was a lack of time in being able to implement sleep inertia countermeasures. Fatigue management strategies, such as reducing on-call periods, and operational changes, such as screening calls to reduce false alarms, were suggested by participants as potential strategies to manage sleep inertia. Conclusion: Sleep inertia is a concern for emergency service personnel and thus more research is required to determine effective sleep inertia management strategies to reduce the risks associated with sleep inertia and improve personnel safety and those in their care. In addition, future studies could investigate strategies to integrate reactive sleep inertia countermeasures into the emergency response procedure.

Sleeping together: understanding the association between relationship type, sexual activity, and sleep.

Objective: Insufficient sleep, and particularly difficulties initiating sleep, are prevalent in the community. Treatment for poor sleep typically consists of pharmacological intervention, or cognitive behavioural therapies - which can be both costly and time-consuming. Evidence suggests that sexual activities may positively impact sleep. However, little is known about relationship types, sexual activities, and perceived sleep outcomes. The aim of this study was to explore the association between relationship type (e.g., having a regular, occasional, or casual partner), sexual activity and satisfaction, and perceived sleep outcomes, to identify potential strategies to improve sleep. Methods: Seven-hundred and seventy-eight participants aged 18 years and over (442 females, 336 males; mean age 34.5 ± 11.4 years) responded to a cross-sectional online anonymous survey at their convenience. Participants were asked about their sleep, sexual activity and satisfaction, and relationship type. Results: Results from multiple regression analyses with age and gender covariates revealed that shorter sleep latencies were associated with regular relationships (p = 0.030), greater emotional satisfaction with sexual activity (p = 0.029), and increased frequency of orgasm (p < 0.001). Men reported a greater frequency of orgasm than women (p < 0.001). Discussion: Findings indicate that relationship type may be associated with improved sleep outcomes, including sleep latency. Relationship type should therefore be taken into consideration by clinicians when developing treatment plans for individuals with poor sleep.

Informal management of health and safety risks associated with alarm response by Australian firefighters.

Fire-fighters use informal strategies to manage risks to health and safety during operations. It is not known whether such strategies are used during the high-risk alarm response period. The aim of this study was to determine if informal risk management strategies are employed by Australian firefighters during the alarm response procedure, and if these strategies differ between salaried and retained personnel. Forty-six metropolitan firefighters (all male; mean age 38 years ± 10 years; 22 salaried; 24 retained) participated in semi-structured group interviews. A general inductive data analysis approach revealed that firefighters use multiple informal risk management strategies. Some similar themes were reported by both salaried and retained personnel, for example leveraging team dynamics, communication about sleep and fatigue, stress adaptation, informal debriefs, and enhancing physical preparedness. These findings could be used by fire services to tailor risk management approaches during the alarm response period. Practitioner summary: Identifying informal risk management strategies firefighters use during alarm response will allow their development, refinement and dissemination, and may help other firefighters and emergency service workers to manage these risks. This qualitative study reveals multiple informal strategies that firefighters employ during alarm response to keep themselves and their team-mates safe.

The Tern Programme Study protocol for an implementation trial of a flexible, long-term psychosocial intervention for complex posttraumatic stress in young people.

Background: Complex Trauma (CT) is a term used to refer to multiple or prolonged traumatic experiences. Such experiences are often first encountered during childhood and may impact key developmental periods. CT is a risk for a broad range of deleterious physical, psychological, social, and occupational outcomes. The diagnosis of Complex Posttraumatic Stress Disorder (C-PTSD) has been proposed to capture the symptomatology resulting from CT exposure.In Australia, there are few publicly funded services that target, and are purposely designed to support, the mental health needs of young people with symptoms of complex post-traumatic stress (C-PTSD). The Tern Programme has been designed as a purpose-built model of care for providing mental health support to young people with C-PTSD. Methods: This implementation trial will involve a longitudinal examination of Tern participants for a fixed 24-month period. Participants will be recruited from the young people referred to Tern at headspace centres in regional Australia where Tern operates. Eligible participants will have reported a history of complex trauma, and present with symptoms of C-PTSD. All participants will be invited to complete a series of surveys during their participation in the programme. Survey items will assess C-PTSD symptom change, quality of life and occupational functioning.The Tern model of care is delivered in a semi-structured format to accommodate a person-centred flexible approach. Fidelity will be monitored through the completion of a clinician post-session checklist and through group supervision. Discussion: This study will provide the first quantitative data on the new Tern model of care and evaluate mental health and functional outcomes of its participants. If effective, Tern may be suitable for replication in other Australian or international youth mental health services where complex post-traumatic stress is prevalent. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Prospectively registered on 29 January 2021. Abbreviations: CT = Complex Trauma; C-PTSD = Complex Posttraumatic Stress Disorder.

Antecedentes: El trauma complejo (TC) es un término que se utiliza para referirse a experiencias traumáticas múltiples o prolongadas. A menudo, estas experiencias se encuentran por primera vez durante la infancia y pueden afectar períodos clave del desarrollo. El TC es un riesgo para una amplia gama de secuelas perjudiciales físicas, psicológicas, sociales y ocupacionales. Se ha propuesto el diagnóstico de trastorno de estrés postraumático complejo (TEPT-C) para capturar la sintomatología resultante de la exposición al TC. En Australia existen pocos servicios financiados con fondos públicos dirigidos a las necesidades de salud mental de los jóvenes con síntomas de estrés postraumático complejo (TEPT-C) y que estén específicamente diseñados para respaldarlos. El Programa Tern ha sido diseñado como un modelo de atención especialmente orientado para brindar apoyo de salud mental a los jóvenes con TEPT-C.Métodos: Esta implementación implicará un examen longitudinal de los participantes del programa Tern durante un período fijo de 24 meses. Los participantes serán reclutados entre los jóvenes derivados al programa Tern en los centros de referencia en la región de Australia donde opera Tern. Los participantes elegibles informarán un historial de trauma complejo y presentarán síntomas de TEPT-C. Se invitará a todos los participantes a completar una serie de encuestas durante su participación en el programa. Los ítemes de la encuesta evaluarán el cambio en los síntomas de TEPT-C, la calidad de vida y el funcionamiento ocupacional. El modelo de atención Tern se ofrece en un formato semiestructurado para adaptarse a un enfoque flexible centrado en la persona. La fidelidad se controlará mediante la realización de una lista de verificación posterior a la sesión por parte del clínico y mediante supervisión grupal.Discusión: Este estudio proporcionará los primeros datos cuantitativos sobre el nuevo modelo de atención Tern, y evaluará la salud mental y resultados funcionales de sus participantes. Si es eficaz, el programa Tern puede ser adecuado para su reproducción en otros servicios de salud mental para jóvenes australianos o internacionales donde prevalece el estrés postraumático complejo.Registro de Ensayo Clínico: Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Registrado prospectivamente el 29 de enero del 2021.

Who is 'on-call' in Australia? A new classification approach for on-call employment in future population-level studies.

BACKGROUND: On-call research and guidance materials typically focus on 'traditional' on-call work (e.g., emergency services, healthcare). However, given the increasing prevalence of non-standard employment arrangements (e.g., gig work and casualisation), it is likely that a proportion of individuals who describe themselves as being on-call are not included in current on-call literature. This study therefore aimed to describe the current sociodemographic and work characteristics of Australian on-call workers. METHODS: A survey of 2044 adults assessed sociodemographic and work arrangements. Of this population, 1057 individuals were workforce participants, who were asked to provide information regarding any on-call work they performed over the last three months, occupation type, weekly work hours, and the presence or absence of non-standard work conditions. RESULTS: Of respondents who were working, 45.5% reported working at least one day on-call in the previous month. There was a high prevalence of on-call work in younger respondents (63.1% of participants aged 18-24 years), and those who worked multiple jobs and more weekly work hours. Additionally, high prevalence rates of on-call work were reported by machinery operators, drivers, community and personal service workers, sales workers, and high-level managers. CONCLUSIONS: These data suggest that on-call work is more prevalent than previously recorded and is likely to refer to a broad set of employment arrangements. Current classification systems may therefore be inadequate for population-level research. A taxonomy for the classification of on-call work is proposed, incorporating traditional on-call work, gig economy work, relief, or unscheduled work, and out of hours work.

The impact of a short burst of exercise on sleep inertia.

STUDY OBJECTIVES: Determine whether 30 s (s) of exercise performed upon waking can reduce sleep inertia and accelerate an increase in the cortisol awakening response (CAR) and core body temperature (CBT), compared to when sedentary. METHODS: Fifteen participants (mean age ± SD, 25.9 ± 5.9 years; six females) completed a counterbalanced, repeated measures, in-laboratory study involving three single experimental nights, each separated by a four-night recovery period. Participants were woken following a 2-h nap (2400-0200) and completed a cycling bout of high-intensity (30-s sprint), low-intensity (30 s at 60% maximum heart rate), or no exercise (sedentary). Sleep inertia testing (eight batteries, 15-min intervals) began immediately following and included measures of subjective sleepiness (Karolinska Sleepiness Scale) and cognitive performance tasks (psychomotor vigilance, serial addition and subtraction, and spatial configuration). CBT was measured continuously via an ingestible telemetric capsule. The CAR was determined using salivary cortisol samples collected at 0, 30 and 45 min post-waking. Data were analysed using mixed effects analysis of variance. RESULTS: There was no difference in cognitive performance or CBT between conditions. Participants felt less sleepy in the high-intensity condition, followed by the low-intensity and sedentary conditions (p = .003). The CAR was greatest in the high-intensity condition, followed by the sedentary condition, and low-intensity condition (p < 0.001), with no differences between the low-intensity and sedentary conditions. CONCLUSIONS: Those who exercise upon waking should be aware that while they may feel more alert, they may not be performing better than if they had not exercised. Future research should investigate whether exercise of different duration or timing may impact sleep inertia.

Protecting the health and safety of the paramedic workforce in Australia: The role of cohort studies with new recruits.

Research related to the paramedic workforce is increasing, particularly given the associations with physical and mental health outcomes. However, it is clear that the evidence base to support future paramedic workforce initiatives lacks longitudinal data in cohorts of paramedics. We identify gaps in the epidemiological evidence base for this workforce, and provide insight into the role that prospective cohorts can, and should, play in future research in the paramedic workforce in order to identify health and safety changes over time, and the associations with job requirements, particularly shift work.

What Factors Influence the Sleep of On-call Workers?

Objective: On-call work is becoming increasingly common in response to service demands. This study had two aims; 1) describe the demographic profile of on-call workers in Australia, and 2) establish the impacts of on-call work on workers' sleep. Methods: A cross-sectional study was conducted using an online questionnaire completed by Australian on-call workers (n = 228) from various professions. The questionnaire included items on i) demographic and work characteristics, ii) rumination about on-call factors, iii) sleep quantity and quality. Analyses were conducted using mixed effects ordinal regression and multivariable logistic regression. Results: Workers slept <7 hours per night when on-call (80%), and reported sleep was impacted on-call even when no-calls were received (56%). On-call workers rated interruptions to family/leisure time (70%), missing a call (69%), preplanning in case of a call (69%), and not able to make plans (67%) as the main factors they ruminated about. Female on-call workers were more likely to think about the likelihood of being called, report frequent thoughts about what they would need to do if called, and think about interruptions to family/leisure time as a result of a call. Younger workers were more likely to think about the likelihood of being called compared to older adults, however middle-aged workers were less likely to plan for a call compared to younger workers. Conclusions: This study is the first to describe Australia's on-call population, including factors that specifically impact sleep. Future studies should implement tailored education and support strategies to address the unique challenges facing on-call workers.

Impacts of Australian Firefighters' On-Call Work Arrangements on the Sleep of Partners.

On-call work arrangements are commonly utilised in the emergency services sector and are consistency associated with inadequate sleep. Despite sleep being a common shared behaviour, studies are yet to assess the impact of on-call work on the sleep of co-sleeping partners. This study aimed to investigate whether frequent 24/7 on-call work impacted the sleep and relationship happiness of firefighters' partners. Two key research questions were investigated: (1) Does the frequency of calls impact sleep and relationship happiness? and, (2) Does the (a) sleep quantity and (b) sleep quality of partners impact perceived relationship happiness? A cross-sectional study was conducted using an online questionnaire completed by partners of on-call workers (n = 66; 93% female). The questionnaire included items on (i) sleep quantity and quality, (ii) on-call sleep disturbances and, (iii) relationship happiness. Responses were analysed using logistic regression models. Higher overnight call frequency was associated with greater self-reported levels of inadequate sleep (<7 h per night; p = 0.024). Support for continuance of a firefighter's role was less likely if the partner reported they regularly had trouble falling asleep within 30 min (p < 0.001). There were no other significant relationships between the frequency of calls or other sleep quantity or quality variables and relationship happiness. This study provides important first insights into how firefighters' on-call work arrangements impact partners' sleep. Future research is needed across periods of high and low call demand, using objective measures of sleep to further define the impacts of on-call work on partners' sleep.

Can an increase in noradrenaline induced by brief exercise counteract sleep inertia?

Emergency responders often credit 'adrenaline' (i.e. sympathetic activity) as the reason they respond quickly upon waking, unimpaired by sleep inertia. Movement upon waking may promote sympathetic activity in this population. This pilot study (n = 4 healthy males) tested the effects of a 30 s exercise bout (maximal sprint) upon waking during the night (02:00 h) on sympathetic activity and sleep inertia. When compared to sedentary conditions, exercise reduced subjective sleepiness levels and elicited a temporary increase in sympathetic activity, measured by plasma noradrenaline levels. These findings provide preliminary support for exercise as a potential sleep inertia countermeasure.

Exercising Caution Upon Waking-Can Exercise Reduce Sleep Inertia?

Sleep inertia, the transitional state of reduced alertness and impaired cognitive performance upon waking, is a safety risk for on-call personnel who can be required to perform critical tasks soon after waking. Sleep inertia countermeasures have previously been investigated; however, none have successfully dissipated sleep inertia within the first 15 min following waking. During this time, on-call personnel could already be driving, providing advice, or performing other safety-critical tasks. Exercise has not yet been investigated as a sleep inertia countermeasure but has the potential to stimulate the key physiological mechanisms that occur upon waking, including changes in cerebral blood flow, the cortisol awakening response, and increases in core body temperature. Here, we examine these physiological processes and hypothesize how exercise can stimulate them, positioning exercise as an effective sleep inertia countermeasure. We then propose key considerations for research investigating the efficacy of exercise as a sleep inertia countermeasure, including the need to determine the intensity and duration of exercise required to reduce sleep inertia, as well as testing the effectiveness of exercise across a range of conditions in which the severity of sleep inertia may vary. Finally, practical considerations are identified, including the recommendation that qualitative field-based research be conducted with on-call personnel to determine the potential constraints in utilizing exercise as a sleep inertia countermeasure in real-world scenarios.

Sex and Sleep: Perceptions of Sex as a Sleep Promoting Behavior in the General Adult Population.

Objective: The main aim of this study was to explore the perceived relationship between sexual activities, sleep quality, and sleep latency in the general adult population and identify whether any gender differences exist. Participants/methods: We used a cross-sectional survey to examine the perceived relationship between sexual activity and subsequent sleep in the general adult population. Seven-hundred and seventy-eight participants (442 females, 336 males; mean age 34.5 ± 11.4 years) volunteered to complete an online anonymous survey at their convenience. Statistical Analyses: Chi square analyses were conducted to examine if there were any gender differences between sexual activities [i.e., masturbation (self-stimulation), sex with a partner without orgasm, and sex with a partner with orgasm] and self-reported sleep. Results: There were no gender differences in sleep (quality and onset) between males and females when reporting sex with a partner [ χ ( 2 ) 2 = 2.20, p = 0.332; χ ( 2 ) 2 = 5.73, p = 0.057] or masturbation (self-stimulation) [ χ ( 2 ) 2 = 1.34, p = 0.513; χ ( 2 ) 2 = 0.89, p = 0.640] involved an orgasm. Conclusions: Orgasms with a partner were associated with the perception of favorable sleep outcomes, however, orgasms achieved through masturbation (self-stimulation) were associated with the perception of better sleep quality and latency. These findings indicate that the public perceive sexual activity with orgasm precedes improved sleep outcomes. Promoting safe sexual activity before bed may offer a novel behavioral strategy for promoting sleep.

Barriers and Enablers to Modifying Sleep Behavior in Adolescents and Young Adults: A Qualitative Investigation.

OBJECTIVE: Many young adults obtain less than the recommended sleep duration for healthy and safe functioning. Behavior change interventions have had only moderate success in increasing sleep duration for this cohort. This may be because the way young adults think about sleep, including their willingness and ability to change sleep behavior, is unknown. The purpose of the present study was to determine what changes, if any, young adults are willing to make to their sleep behavior, and to identify factors that may enable or prevent these changes. PARTICIPANTS: Fifty-seven young adults (16-25 years; 57% female) took part in focus groups addressing (a) willingness to change, (b) desired outcomes of change, and (c) barriers to change in regards to sleep behavior. METHODS: An inductive approach to data analysis was employed, involving data immersion, coding, categorization, and theme generation. RESULTS: Participants were willing to change sleep behavior, and had previously employed strategies including advancing bedtime and minimizing phone use, with limited success. Desired changes were improved waking function, advanced sleep onset, optimized sleep periods, and improved sleep habits. Barriers to making these changes included time demands, technology use, difficulty switching off, and unpredictable habits. Young adults want to improve sleep behavior and waking function; this is an important first step in modifying behavior. Notably, participants wanted more efficient and better quality sleep, rather than increasing sleep duration. CONCLUSION: The reported barriers to sleep, particularly using technology for social purposes, will require innovative and specialized strategies if they are to be overcome.

A Test of How Australian Adults Allocate Time for Physical Activity.

The most common reported barrier to physical activity is a lack of sufficient time. Just like most resources in economics are finite, so too is time within a day. We utilized a time-utility model to better understand how people are allocating time for physical activity. Additionally, we tested whether the allocation of physical activity time impacts people's perception of "lack of time" as a barrier for physical activity or their likelihood of being sufficiently physical active. Australian adults (N = 725 participants, 54% men) reported their time use throughout their day, perceived lack of time as a barrier to activity, and physical activity. Cluster analysis and χ2-tests were used to test the study research questions. People tended to either be entirely inactive (29%) or active while doing either leisure (18%), occupation (18%), transport (14%), or household (22%) activities. Those who were active during their leisure or transport time were most likely to be sufficiently active. There were no significant differences among clusters in how much people perceived that lack of time was a physical activity barrier. The commonly reported barrier of not having enough time to be active might be a fallacy. Although a lack of time is a commonly reported barrier of physical activity, these findings bring to light that increasing physical activity behavior is not as simple as adding more time to the day.

More than hours of work: fatigue management during high-intensity maritime operations.

OBJECTIVES: This study examines the impacts of peak summer demand on operator workload and fatigue in a maritime environment. METHODS: Participants (n = 12) were senior shipboard personnel who were working during the summer "double sailing" period for a roll-on roll-off ferry service. Wrist actigraphy was used to determine sleep opportunity and sleep duration, as well as prior sleep, total wake time, performance and alertness at the beginning and end of work periods. RESULTS: Contrary to expectations, sleep was significantly greater, and both subjective estimates of fatigue and objective neurobehavioral performance were not impacted negatively by periods of increased work intensity. CONCLUSIONS: This study highlights a number of features of a fatigue-risk management system that appear to have been instrumental in ensuring adequate sleep and performance was maintained throughout periods of increased operational intensity. As a simple colloquial description of the fatigue-risk management system at play in this operation, it was fine to "work hard" if you were able to "sleep hard" as well.