Simulated quick returns in a laboratory context and effects on sleep and pre-sleep arousal between shifts: a crossover controlled trial.

This trial presents a laboratory model investigating the effect of quick returns (QRs, <11 h time off between shifts) on sleep and pre-sleep arousal. Using a crossover design, 63 participants worked a simulated QR condition (8 h time off between consecutive evening- and day shifts) and a day-day (DD) condition (16 h time off between consecutive day shifts). Participants slept at home and sleep was measured using a sleep diary and sleep radar. Compared to the DD condition, the QR condition reduced subjective and objective total sleep time by approximately one hour (both p < .001), reduced time in light- (p < .001), deep- (p = .004), rapid eye movement (REM, p < .001), percentage of REM sleep (p = .023), and subjective sleep quality (p < .001). Remaining sleep parameters and subjective pre-sleep arousal showed no differences between conditions. Results corroborate previous field studies, validating the QR model and indicating causal effects of short rest between shifts on common sleep parameters and sleep architecture.

This trial proposes a laboratory model to investigate the consequences of quick returns (QRs, <11h time off between shifts) on subjective/objective sleep and pre-sleep arousal. QRs reduced total sleep time, light-, deep-, REM sleep, whereas pre-sleep arousal was unaffected. Results emphasise the importance of ensuring sufficient rest time between shifts.Abbreviation: QR: Quick return; DD: Day-day; NREM: Non-rapid eye movement; REM: Rapid eye movement; PSG: Polysomnography; TIB: Time in bed; SOL: Sleep onset latency; WASO: Wake after sleep onset; TST: Total sleep time; EMA: Early morning awakening; PSAS: Pre-Sleep Arousal Scale; MEQ: Morning-Evening Questionnaire; LMM: Linear mixed model; EMM: Estimated marginal mean; SD: Standard deviation; SE: Standard error; d: Cohens' d; h: hours; m: minutes.

The association between shift work disorder and turnover intention among nurses.

BACKGROUND: Shift work disorder (SWD) is highly prevalent among shift-working nurses and has multiple negative health-related effects. There is a dearth of insight into career-related decisions made by nurses suffering from SWD, for instance in terms of their intention to quit work (turnover intention). In this study, we aimed to investigate the association between SWD and turnover intention among nurses, and the individual and work-related correlates of turnover intention. METHOD: Data were derived from the ongoing longitudinal cohort study "SUrvey of Shift work, Sleep and Health (SUSSH)" among Norwegian nurses. An annual survey was initiated in 2008/2009 (N = 2965). The present study used data collected in year 2015 (wave 7) and 2016 (wave 8). Nurses were included if: 1) they were working as nurses in both 2015 and 2016, and 2) had completed a three-item scale adapted from the Michigan Organizational Assessment Questionnaire assessing turnover intention (in wave 8), and 3) did not only work day-shifts. SWD was measured in wave 7 with three questions based on the minimal criteria from the third edition of the International Classification of Sleep Disorders. Job demands, decision latitude, and social support at the workplace were measured with subscales of the Swedish Demand-Control-Support Questionnaire. RESULTS: Eight Hundred eighty-nine nurses were included. The results from the hierarchical linear regression showed that SWD predicted turnover intention one year later, i.e. from 2015 to 2016 (F1,835 = 6.00, p < 0.05; ß = 0.084, p = 0.015). The findings remained significant when controlling for age, sex, organizational tenure, number of nights worked, shift work schedule and workplace social support, job demands and decision latitude. CONCLUSION: This study showed that SWD is associated with turnover intention, even when controlling for individual and work-related variables.

Sleep and work functioning in nurses undertaking inpatient shifts in a blue-depleted light environment.

BACKGROUND: Blue-depleted light environments (BDLEs) may result in beneficial health outcomes for hospital inpatients in some cases. However, less is known about the effects on hospital staff working shifts. This study aimed to explore the effects of a BDLE compared with a standard hospital light environment (STLE) in a naturalistic setting on nurses' functioning during shifts and sleep patterns between shifts. METHODS: Twenty-five nurses recruited from St. Olavs Hospital in Trondheim, Norway, completed 14 days of actigraphy recordings and self-reported assessments of sleep (e.g., total sleep time/sleep efficiency) and functioning while working shifts (e.g., mood, stress levels/caffeine use) in two different light environments. Additionally, participants were asked to complete several scales and questionnaires to assess the symptoms of medical conditions and mental health conditions and the side effects associated with each light environment. RESULTS: A multilevel fixed-effects regression model showed a within-subject increase in subjective sleepiness (by 17%) during evening shifts in the BDLE compared with the STLE (p = .034; Cohen's d = 0.49) and an 0.2 increase in number of caffeinated beverages during nightshifts in the STLE compared with the BDLE (p = .027; Cohen's d = 0.37). There were no significant differences on any sleep measures (either based on sleep diary data or actigraphy recordings) nor on self-reported levels of stress or mood across the two conditions. Exploratory between-group analyses of questionnaire data showed that there were no significant differences except that nurses working in the BDLE reported perceiving the lighting as warmer (p = .009) and more relaxing (p = .023) than nurses working in the STLE. CONCLUSIONS: Overall, there was little evidence that the change in the light environment had any negative impact on nurses' sleep and function, despite some indication of increased evening sleepiness in the BDLE. We recommend further investigations on this topic before BDLEs are implemented as standard solutions in healthcare institutions and propose specific suggestions for designing future large-scale trials and cohort studies. TRIAL REGISTRATION: The study was registered before data collection was completed on the ISRCTN website ( ISRCTN21603406 ).

Associations between exposure to workplace bullying and insomnia: a cross-lagged prospective study of causal directions.

OBJECTIVE: Workplace bullying has been established as a significant correlate of sleep problems. However, little is known regarding the causal direction between bullying and sleep. The aim of this study was to examine temporal relationships between bullying and symptoms of insomnia. METHODS: Reciprocal and prospective associations between exposure to workplace bullying and symptoms of insomnia were investigated in a national probability sample comprising 1149 Norwegian employees. Data stemmed from a two-wave full panel survey study with a 6-month time interval between the baseline and follow-up assessments. Models with stabilities, forward-, reverse-, and reciprocal associations were tested and compared using Structural Equation Modelling. Analyses were adjusted for age, gender, and the stability in the outcome variables over time. Workplace bullying was assessed with the nine-item Short Negative Acts Questionnaire. Insomnia was assessed with a previously validated three item scale reflecting problems with sleep onset, sleep maintenance, and early morning awakening. RESULTS: The forward association model, which showed that exposure to workplace bullying prospectively increased levels of insomnia (b = 0.08; p < 0.001), had best fit with the data [CFI = 0.94; TLI = 0.93; RMSEA = 0.049 (0.046-0.052)]. The reverse association model where insomnia influences risk of being subjected to bullying was not supported. CONCLUSION: Workplace bullying is a risk factor for later insomnia. There is a need for further studies on moderating and mediating variables that can explain how and when bullying influence sleep.

Sleep patterns among Norwegian nurses between the first and second wave of the COVID-19 pandemic.

BACKGROUND: Nurses are in the frontline and play an important role in the battle against the COrona VIrus Disease-2019 (COVID-19) pandemic. Sleep problems among health care workers are likely to increase due to the pandemic. However, it is conceivable that negative health outcomes related to the pandemic fluctuate with the infection rate waves of the pandemic. The present study aimed to investigate sleep patterns among Norwegian nurses, after the first wave, during a period with very low rates of COVID-19. METHODS: Data stemmed from the cohort study "SUrvey of Shift work, Sleep and Health (SUSSH)" among Norwegian nurses. A total of 1532 nurses responded one time to a questionnaire between June and September in 2020 including items about demographics and work, information about COVID-19 and quarantine, sleep patterns and changes in sleep patterns due to the pandemic. Descriptive statistics for all relevant variables were calculated and McNemar tests were used to compare categorical variables. RESULTS: The majority of nurses (84.2%) reported no change in sleep duration after the first wave of the COVID-19 pandemic compared to before, 11.9% reported less sleep, and 3.9% reported more sleep. Similarly, 82.4% of the nurses reported no change in their sleep quality, whereas 16.2% of the nurses reported poorer sleep quality after the first wave of the pandemic compared to before. The majority of nurses reported no change in their sleep schedule due to the pandemic, although 9.6% of the nurses reported to go to bed later and 9.0% woke up earlier than before the pandemic. CONCLUSIONS: Most existing literature exploring sleep among health care workers during the COVID-19 pandemic has been carried out during periods with high infection rates. In this study we aimed to investigate sleep patterns among Norwegian nurses following the first wave, during a period of low COVID-19 rates in Norway. Most of the nurses reported no change in neither sleep duration, sleep quality, bedtime, nor wake-up times compared to before the pandemic. Still, nearly 12% reported shorter sleep duration, and about 16% reported poorer sleep quality indicating that some nurses experienced worsening of their sleep following the pandemic.

Role of nocturnal light intensity on adaptation to three consecutive night shifts: a counterbalanced crossover study.

OBJECTIVES: To investigate how a standard ceiling mounted light-emitting diode (LED)-based bright light intervention affected alertness and neurobehavioural performance during three consecutive simulated night shifts, and timing of circadian rhythm after the shifts. METHODS: Twenty seven participants (20 females, 21.4±2.1 years; mean±SD) worked three consecutive night shifts (23:00-07:00) under a full-spectrum (4000 K) bright light (900 lx) and a standard light (90 lx) condition in a counterbalanced crossover design (separated by 4 weeks). Subjective alertness (Karolinska Sleepiness Scale) and neurobehavioural performance (Psychomotor Vigilance Task and Digit Symbol Substitution Test) were assessed five times during each shift. Salivary dim-light melatonin onset (DLMO) was assessed before and after the shifts. The simulated night shifts were conducted in a laboratory while the participants slept at home. RESULTS: Subjective alertness and neurobehavioural performance deteriorated during the night shifts in both light conditions. However, bright light significantly reduced alertness and performance decrements as compared with standard light. For a subset of the participants, DLMO was delayed by a mean of 3:17±0:23 (mean±SEM) hours after three night shifts in bright light and by 2:06±0:15 hours in standard light, indicating that bright light causes larger phase delay. CONCLUSION: Bright light improved performance and alertness during simulated night shifts and improved adaptation to night work. Bright light administered by ceiling mounted LED luminaires has the potential to improve adaptation to night work and reduce the risk of accidents and injuries among night workers. TRIAL REGISTRATION NUMBER: NCT03203538.

Workplace inclusion of employees with back pain and mental health problems: A focus group study about employees' experiences.

AIM: To explore how employees experience workplace inclusion of their colleagues or themselves when having back pain or mental health problems. METHODS: Three focus group interviews with a sample of 16 kindergarten employees were conducted. Systematic Text Condensation was used for analysis. RESULTS: The participants emphasized that it was easier to include colleagues whose health problems were specific, especially when they were open about having problems and expressed their needs for accommodation clearly. Discussions revealed difficulties of acceptance and accommodating colleagues with longstanding health problems, when the burden on the other staff members was heavy, and if it had negative consequences for the kindergarten children. Some of the participants had experienced health problems themselves, which was also described as challenging. Having health problems at work often induced feelings of guilt, being a burden to their colleagues, and experiencing a disparity between the ideals and the realities of inclusion practices. CONCLUSIONS: Workplace inclusion of employees is difficult when their health problems are unspecific, longstanding, and lead to negative consequences for children or colleagues. System level efforts are necessary to reduce negative stereotypes about employees with health problems and facilitate inclusion practices.

Sleepiness among personnel in the Norwegian Air Ambulance Service.

Purpose To examine the effects of shift work and extended working hours on sleepiness among pilots and Helicopter Emergency Medical Service (HEMS) crew members in the Norwegian Air Ambulance. METHODS: This field study investigated sleepiness during 3 consecutive weeks: the week before work, the work week, and the week after work. The pilots and HEMS crew members (N = 50) kept a wake diary during all 3 weeks and completed reaction time tests during the work week. RESULTS: The overall sleepiness scores were low during all 3 weeks. When comparing the 3 weeks, the lowest sleepiness levels were found for the work week. There was a small difference across work days, in which subjective sleepiness scores were highest the first duty day. No change in the reaction time tests was evident during the work week. The crew members reported being most sleepy at midnight, compared to all the other timepoints over the course of a duty day. Regarding workload and total work time, having larger workload was associated with lower sleepiness scores, while having higher total work time was associated with higher sleepiness score, both compared to the medium category. CONCLUSIONS: The findings indicate that the work schedules and setting for this distinct occupational group do not seem to negatively affect the sleepiness levels.

Short rest between shifts (quick returns) and night work is associated with work-related accidents.

PURPOSE: The aim of this study was to examine whether less than 11 h between shifts (i.e., quick returns, QRs) and night shifts is associated with self-reported work-related accidents, near accidents or dozing off at work in a sample of nurses. METHODS: The study was based on cross-sectional data from 1784 nurses (response rate = 60%; mean age = 40.1 years, SD = 8.4; 91% female). Negative binomial regression analyses were conducted to investigate the association between the shift exposures, and eight different self-reported work-related items on accidents, near accidents and dozing off at work, controlling for demographics and work factors. RESULTS: The number of QRs during a year was positively associated with seven of the eight items on work-related accidents, near-accidents and dozing off at work, and number of night shifts was positively associated with five items. Some of the key findings were that QRs were associated with nurses causing harm to themselves (incidence rate ratio [IRR] = 1.009; 95% CI = 1.005-1.013), causing harm to patients/others (IRR = 1.006; 95% CI = 1.002-1.010) and causing harm to equipment (IRR = 1.004; 95% CI = 1.001-1.007); while night shifts were associated with nurses involuntarily dozing off at work (IRR = 1.015; 95% CI = 1.013-1.018), dozing off while driving to/from work (IRR = 1.009; 95% CI = 1.006-1.011), and harming patients/others (IRR = 1.005; 95% CI = 1.001-1.009). CONCLUSION: QRs and night shifts were both associated with the self-reported work-related accidents, near-accidents and dozing off at work. Studies that can establish the causal relationship between QRs and accidents are called for.

Long working hours are inversely related to sick leave in the following 3 months: a 4-year registry study.

PURPOSE: The aim of this study was to investigate the effects of long working hours (≥ 12 h shifts) on sick leave using objective records of shift work exposure and of sick leave. METHODS: A total of 1538 nurses (mean age 42.5, SD 12.0; response rate 42%) participated. Payroll and archival sick leave data over a 4-year period were retrieved from employers' records and aggregated over every third calendar month. A multilevel negative binomial model was used to investigate the effects of exposure to long working hours, on subsequent sick leave rates the following 3 months. Covariates included prior sick leave, number of shifts worked, night and evening shifts, personality, and demographic characteristics. RESULTS: Exposure to long working hours was associated with fewer sick leave days in the subsequent 3 months [adjusted model, incidence rate ratio (IRR) = 0.946, 95% CI 0.919-0.973, p < 0.001]. The interaction long working hours by a number of work days showed that sick leave days the subsequent 3 months was higher by long shifts when number of shifts was high compared to when number of shifts was low [adjusted model, IRR 1.002, 95% CI 1.000-1.004, p < 0.05]. DISCUSSION: Long working hours was associated with fewer sick leave days. The restorative effects of extra days off with long working hours are discussed as possible explanations to this relationship.

Working hour characteristics and schedules among nurses in three Nordic countries - a comparative study using payroll data.

BACKGROUND: Organisation of working hour schedules in the Northern European countries are rather similar. EU countries are obliged to adopt national legislation regarding duration of weekly working hours and rest periods. Yet, working hour characteristics and schedules are likely to differ with respect to starting times and duration depending e.g. on culture and tradition. Yet, very little is known about potential differences between shifts and schedules across countries among nursing personel. This knowledge is relevant, since the potential differences in working hour characteristics may influence and possibly explain some of the differences observed in studies of health and safety.The aim of the study was to compare characteristics of working hours and work schedules among nursing personel in three Nordic countries: Denmark, Finland and Norway. METHODS: The study populations included nursing personnel holding a ≥ 50% position at public hospitals in Denmark (n = 63,678), Finland (n = 18,257) or Norway (n = 1538) in 2013. Objective payroll based registry data with information on daily starting and ending times were used to compare working hour characteristics e.g. starting time, duration of shift, and quick returns (< 11 h between two shifts), as well as work schedules e.g. permanent or 3-shift work between the three countries. RESULTS: Night shifts generally started earlier and lasted longer in Finland (10-11 h starting at 20:00-22:59) than in Norway (10 h starting at 21:00-21:59) and in Denmark (8 h starting at 23:00-23:59). Very long shifts (≥12 h) were more common in Denmark (12%) compared to Finland (8%) and Norway (3%). More employees had many (> 13/year) quick returns in Norway (64%) and Finland (47%) compared to Denmark (16%). The frequency of 3-shift rotation workers was highest in Norway (41%) and lower in Denmark (22%) and Finland (22%). There were few differences across the countries in terms of early morning shifts and (very) long weekly working hours. CONCLUSION: Despite similar distribution of operational hours among nurses in the three countries, there were differences in working hour characteristics and the use of different types of work schedules. The observed differences may affect health and safety.

Causes and Management of Sleepiness Among Pilots in a Norwegian and an Austrian Air Ambulance Service-A Comparative Study.

OBJECTIVE: We compared subjectively reported sleepiness and fatigue as well as causes and management strategies for combating sleepiness among pilots working in 2 different helicopter emergency medical services operating with different shift systems. METHODS: Pilots from the Norwegian Air Ambulance (NAA) and Christophorus Flugrettungsverein (CFV) in Austria participated. NAA performs flight missions 24/7, whereas at the time of the study the participating CFV bases did not fly after sunset. The pilots are on duty for 1 week in both services. NAA and CFV used an identical research protocol, including questionnaires about sleep, sleepiness (Epworth Sleepiness Scale and Karolinska Sleepiness Scale), coping strategies, and work-related causes of fatigue. RESULTS: CFV pilots kept busy, whereas NAA pilots slept and did physical exercise as strategies to prevent sleepiness. The majority in both groups used napping and coffee consumption as strategies. CFV pilots reported more frequently than NAA pilots that administrative duties and environmental factors were reasons preventing napping. CONCLUSION: Some differences existed between the 2 pilot groups regarding strategies for managing sleepiness and causes that prevented pilots from napping. Pilots in both groups were healthy, physically active, and had normal Epworth Sleepiness Scale and Karolinska Sleepiness Scale scores.

Short rest between shift intervals increases the risk of sick leave: a prospective registry study.

OBJECTIVES: The purpose of this study was to use objective registry data to prospectively investigate the effects of quick returns (QR, <11 hours of rest between shifts) and night shifts on sick leave. METHODS: A total of 1538 nurses (response rate =41.5%) answered questionnaires on demographics and personality and provided consent to link this information to registry data on shift work and sick leave from employers' records. A multilevel negative binomial model was used to investigate the predictive effect of exposure to night shifts and QR every month for 1 year, on sick leave the following month. RESULTS: Exposure to QR the previous month increased the risk for sick leave days (incidence rate ratio (IRR)=1.066, 95% CI 1.022 to 1.108, p<0.01) and sick leave spells (IRR=1.059, 95% CI 1.025 to 1.097, p<0.001) the following month, whereas night shifts did not. 83% per cent of the nurses experienced QR within a year, and on average they were exposed to 3.0 QR per month (SD=1.6). Personality characteristics associated with shift work tolerance (low on morningness, low on languidity and high on flexibility) were not associated with sick leave, and did not moderate the relationship between QR and sick leave. CONCLUSIONS: We found a positive linear relationship between QR and sick leave. Avoiding QR may help reduce workers' sick leave. The restricted recovery opportunity associated with QR may give little room for beneficial effects of individual characteristics usually associated with shift work tolerance.

Return to Work in Patients with Chronic Musculoskeletal Pain: Multidisciplinary Intervention Versus Brief Intervention: A Randomized Clinical Trial.

OBJECTIVE: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. METHODS: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patient-therapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. RESULTS: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7  months of the follow-up compared to the BI-group. CONCLUSIONS: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. TRIAL REGISTRATION: http://www.clinicaltrials.gov with the registration number NCT01346423.

Reduction in sick leave by a workplace educational low back pain intervention: A cluster randomized controlled trial.

AIMS: The aim of this study was to investigate whether a workplace educational low back pain intervention had an effect on sick leave at the individual level and to identify possible predictors of the effect of intervention. METHODS: Work units in two municipalities were cluster randomized to (a) educational meetings and peer support (45 units), (b) educational meetings, peer support and access to an outpatient clinic if needed (48 units) or (c) a control group (42 units). Both intervention groups attended educational meetings with information about back pain based on a non-injury model. A peer adviser was selected from among their colleagues. The outcome was days of sick leave at the individual level at 3, 6, 9 and 12 months, adjusting for previous sick leave at the unit level. As a result of similar effects on sick leave, the two intervention groups were merged (n=646) and compared with the control group (n=211). The predictors were different levels of belief in back pain myths, pain-related fear, helplessness/hopelessness and low back pain. RESULTS: The intervention group had significantly less days of sick leave at the three month (4.9 days, p=0.001) and six month (4.4 days, p=0.016) follow ups compared with the control group. At three months, a low level of pain-related fear was the only predictor for the intervention effect (8.0 less days of sick leave, p<0.001). CONCLUSIONS A WORKPLACE EDUCATIONAL BACK PAIN INTERVENTION HAD AN EFFECT ON SICK LEAVE FOR UP TO SIX MONTHS A LOW SCORE ON PAIN-RELATED FEAR WAS A PREDICTOR OF THE INTERVENTION EFFECT.

Multidisciplinary Intervention in Patients with Musculoskeletal Pain: a Randomized Clinical Trial.

BACKGROUND: Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. PURPOSE: The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. METHOD: Two hundred eighty-four adults aged 18-60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months. RESULTS: Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p < 0.05), depression (p < 0.01), somatization (p < 0.01)) and functioning ability (p < 0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p < 0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p < 0.001) and they took better care of their own health (p < 0.001), compared to the BI group. CONCLUSION: The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.

Psychometric properties of the Nursing Home Survey on Patient Safety Culture in Norwegian nursing homes.

BACKGROUND: Developing a culture where staff are actively aware of how to prevent adverse events is a challenge. The use of survey tools to assess the status of patient safety culture seems to be acceptable as an early step in improving patient safety. The Nursing Home Survey on Patient Safety Culture (NHSOPSC) includes 12 dimensions and is specifically developed for nursing homes. In this study, we describe a Norwegian version of the NHSOPSC and assess its psychometric properties when tested on a sample of healthcare staff in nursing homes. METHODS: The NHSOPSC was translated into Norwegian and pilot tested before being distributed to 12 nursing homes in Norway. Of the 671 healthcare staff invited, 466 (69 %) answered the questionnaire. SPSS 23.0 was used for descriptive data analysis and estimating internal consistency (Cronbach's alpha). The dimensional structure of the questionnaire was tested by confirmatory factor analysis (CFA) using Mplus (version 7.2). RESULTS: The CFA testing of the original 12-factor solution suggested that some modifications were needed because of the high correlations between three of the latent factors. A subsequent analysis resulted in a final ten-factor solution. The final model showed acceptable fit to the data (root mean square error of approximation = 0.060, 90 % confidence interval: 0.057-0.063, comparative fit index = 0.934, Tucker-Lewis index = 0.926, χ (2) = 2058.33, df = 765, p < 0.001) and acceptable factor loadings ranging from 0.402 to 0.891. Moreover, moderate-to-strong correlations ranging from 0.455 to 0.812 were found between the ten latent factors. Finally, moderate-to-high correlations were found between the ten latent factors and an overall rating of patient safety in the nursing home. CONCLUSIONS: Factor analysis indicated that a modified ten-factor model fitted the data set in a Norwegian community healthcare context with acceptable goodness-of-fit values and could be recommended as a useful tool to assess staff perceptions of patient safety issues in Norwegian nursing homes.

Cortisol, Health, and Coping in Patients with Nonspecific Low Back Pain.

Subjective health complaints (SHC), including nonspecific low back pain (LBP) as the most common single complaint, are the main reasons for long-term sick leave in many western countries. These complaints are often attributed to "stress". Cortisol has frequently been considered a biomarker reflecting sustained physiological HPA-axis activity, and is characterized by a high cortisol awakening response (CAR) and low evening values. The aim of the study was to investigate whether LBP patients had a normal characteristic cortisol profile, and whether possible deviations were related to coping and health. 305 patients on long-term sick leave for LBP participated in the study, and saliva cortisol profiles were compared to a reference population consisting of Danish workers. Cortisol was measured upon awakening, after 30 min, and in the evening. Additionally, patients answered questionnaires about SHC, fatigue, pain, coping, and social support. The patients showed a seemingly normal cortisol profile. However, CAR was larger among patients compared to the reference population. Patients with low cortisol reactivity had more SHC, pain, and fatigue, and those with higher evening cortisol reported higher scores on coping. The results are discussed in terms of theory, practical considerations, and possible mechanisms for the association between cortisol, health, and coping.

Systematic review of the relationship between quick returns in rotating shift work and health-related outcomes.

A systematic literature search was carried out to investigate the relationship between quick returns (i.e., 11.0 hours or less between two consecutive shifts) and outcome measures of health, sleep, functional ability and work-life balance. A total of 22 studies published in 21 articles were included. Three types of quick returns were differentiated (from evening to morning/day, night to evening, morning/day to night shifts) where sleep duration and sleepiness appeared to be differently affected depending on which shifts the quick returns occurred between. There were some indications of detrimental effects of quick returns on proximate problems (e.g., sleep, sleepiness and fatigue), although the evidence of associations with more chronic outcome measures (physical and mental health and work-life balance) was inconclusive. PRACTITIONER SUMMARY: Modern societies are dependent on people working shifts. This study systematically reviews literature on the consequences of quick returns (11.0 hours or less between two shifts). Quick returns have detrimental effects on acute health problems. However, the evidence regarding effects on chronic health is inconclusive.

Noise exposure and cognitive performance: A study on personnel on board Royal Norwegian Navy vessels.

Prior research shows that work on board vessels of the Royal Norwegian Navy (RNoN) is associated with noise exposure levels above recommended standards. Further, noise exposure has been found to impair cognitive performance in environmental, occupational, and experimental settings, although prior research in naval and maritime settings is sparse. The aim of this study was to evaluate cognitive performance after exposure to noise among personnel working on board vessels in the RNoN. Altogether 87 Navy personnel (80 men, 7 women; 31 ± 9 years) from 24 RNoN vessels were included. Noise exposure was recorded by personal noise dosimeters at a minimum of 4 h prior to testing, and categorized into 4 groups for the analysis: <72.6 dB(A), 72.6-77.0 dB(A), 77.1-85.2 dB(A), and >85.2 dB(A). The participants performed a visual attention test based on the Posner cue-target paradigm. Multivariable general linear model (GLM) analyses were performed to analyze whether noise exposure was associated with response time (RT) when adjusting for the covariates age, alertness, workload, noise exposure in test location, sleep the night before testing, use of hearing protection device (HPD), and percentage of errors. When adjusting for covariates, RT was significantly increased among personnel exposed to >85.2 dB(A) and 77.1-85.2 dB(A) compared to personnel exposed to <72.6 dB(A).