The Effect of Shift Working on Dietary Patterns of Healthcare Practitioners during the COVID-19 Pandemic: A Cross-Sectional Study.

Background and Objectives: Health professionals' working schedules often do not allow them to follow a balanced way of life, and the nature of their work can affect their weight and eating habits. The aim of the present study is to shed some light on the impact of night shift working on the dietary practices of healthcare practitioners in Greece. Materials and Methods: This was a cross-sectional study. With the use of an administered questionnaire several parameters were assessed, including anthropometric characteristics, weight history, as well as nutritional habits of the same group of participants during night shifts and when at regular working hours. Moreover, nutritional beliefs of the subjects were recorded, as well as the level of adherence to the Mediterranean diet. Results: It was observed that in all food groups, including water, used to compare the nutritional patterns of the participants during night shifts and when working regular hours, statistical differences were noted (p = 0.001). Furthermore, the participants who reported a higher adherence to the Mediterranean diet and self-reported healthier nutritional habits, had a statistically lower weight compared to the participants that rarely followed the specific model or reported unhealthier eating routine (p = 0.010 and p = 0.015, respectively). Conclusions: We conclude that shift-working healthcare professionals are associated with disturbed eating behaviours leading to the high consumption of unhealthy food. The implementation of interventions that will concentrate on educating health workers on balanced nutrition and improving physical environment (i.e., food availability, healthier food choices) seems to be of great importance.

Multi-Scale Evaluation of Sleep Quality Based on Motion Signal from Unobtrusive Device.

Sleep disorders are a growing threat nowadays as they are linked to neurological, cardiovascular and metabolic diseases. The gold standard methodology for sleep study is polysomnography (PSG), an intrusive and onerous technique that can disrupt normal routines. In this perspective, m-Health technologies offer an unobtrusive and rapid solution for home monitoring. We developed a multi-scale method based on motion signal extracted from an unobtrusive device to evaluate sleep behavior. Data used in this study were collected during two different acquisition campaigns by using a Pressure Bed Sensor (PBS). The first one was carried out with 22 subjects for sleep problems, and the second one comprises 11 healthy shift workers. All underwent full PSG and PBS recordings. The algorithm consists of extracting sleep quality and fragmentation indexes correlating to clinical metrics. In particular, the method classifies sleep windows of 1-s of the motion signal into: displacement (DI), quiet sleep (QS), disrupted sleep (DS) and absence from the bed (ABS). QS proved to be positively correlated (0.72±0.014) to Sleep Efficiency (SE) and DS/DI positively correlated (0.85±0.007) to the Apnea-Hypopnea Index (AHI). The work proved to be potentially helpful in the early investigation of sleep in the home environment. The minimized intrusiveness of the device together with a low complexity and good performance might provide valuable indications for the home monitoring of sleep disorders and for subjects' awareness.

Mixed shift rotations, sleep, burnout and well-being in professions similar to radiographers: A systematic review.

INTRODUCTION: Delivering 24 h healthcare requires rotational shift work from doctors and the medical imaging team, while contributing to safe and timely care of patients. Additional service pressure and staff shortfall leads to workload pressures, adjusted shift patterns and risk of burnout. Evidence should be sought to the effects of this work on staff. METHODS: This systematic review followed PRISMA reporting guidelines, using a convergent mixed methods approach according to Guidance from Joanna Briggs International. Quantitative trends and results were qualified in order to thematically analyse in conjunction with qualitative data and discussed together in context. Following initial searching, returned articles were screened by title and abstract. A team of 3 reviewers undertook blinded critical appraisal of those suitable, with quality assurance from a 4th team member. Papers passing a threshold of 75% on JBI appraisal tools were accepted for synthesis. Data extraction of appropriate articles retrieved was undertaken in parallel. RESULTS: Following screening and critical appraisal, 13 studies were returned focusing exclusively on Non Consultant Doctors. No studies investigated diagnostic radiographers. 85% (n = 11) reported negative association between shift work and the three themes of sleep/fatigue, burnout and wellbeing: including after the introduction of shift pattern control or adjusted shift patterns. The remainder showed no change, or any improvement nullified by countermeasures to maintain service delivery. CONCLUSION: Current working practices and shift plans in the target population showed detrimental effects on the participants - this can be suggested that Diagnostic Radiographers may suffer fatigue, burnout and poor mental health from stretched shift working patterns. IMPLICATIONS FOR PRACTICE: Further study into the effects of shift work on Diagnostic Radiographers and other allied health professionals is indicated - relating to the above themes in the context of errors and patient safety. Additional research into Non Consultant Doctors, shift work effects and the context of wider service delivery required; with suitable interventions and education to maximise understanding of legal working practices, monitoring and self-management of symptoms.

Influence of night shift work on circadian heart-rate rhythm in nurses: using a holter electrocardiogram that can be continuously measured for two weeks.

The influence of night shift work on circadian heart-rate rhythm was examined in nurses engaged in shift work using a Holter electrocardiogram, continuously measured for two weeks, and cosine periodic regression analysis. We enrolled 11 nurses who were engaged in a two-shift system. The R2 value in the cosine regression curve of heart-rate rhythm (concordance rate), indicating the concordance rate between the actual heart rate over 24 h and the cosine regression curve approximated by the least-squares procedure, was significantly lower in the night shift (0.40 ± 0.15) than in the day shift (0.66 ± 0.19; p<0.001). Moreover, the amplitude was significantly lower and the acrophase was significantly delayed in the night shift. Thus, the circadian heart-rate rhythm was disrupted by the night shift work. Although the heart-rate acrophase recovered during the day and two days after the night shift, the concordance rate and amplitude did not recover, indicating that the influence of night shift work on circadian heart-rate rhythm might persist even two days after the night shift. Based on these results, adequate clinical attention should be paid to how to spend the day and two days after the night shift to correct the circadian heart-rate rhythm disruption caused by night shift work.

Shift working and cardiovascular health.

Adequate sleep is an important component of cardiovascular health. Due to circadian misalignment and irregular shifts, inadequate sleep is common in shift workers. Adverse consequences include daytime sleepiness, decreased cognitive performance, increased sympathetic tone, inflammation, impaired glucose tolerance, and altered leptin and ghrelin levels. When circadian adjustment has not occurred, daytime sleepers often experience decreased sleep duration and increased wakefulness during displaced sleep; additionally, skipping sleep is common in shift workers, further contributing to sleep deprivation. Habitual decreased sleep duration and physiological changes contribute to obesity, diabetes, hypertension, and increased cardiovascular disease risk in shift workers. Shift workers with obstructive sleep apnea (OSA), the most common sleep-related breathing disorder, can experience more frequent sleep disruptions than non-shift workers with OSA. Furthermore, shift work-induced circadian misalignment may potentiate cardiometabolic risk in OSA patients through autonomic nervous system dysfunction and other mechanisms.

Changes in intestinal parameters and their association with dietary patterns in rotational shift workers.

Circadian rhythm disturbances induced by rotating shift work contribute to development of metabolic disorders. However, their effects on intestinal parameters such as epithelial permeability and fecal short chain fatty acid (SCFA) levels have not been established yet. This study was planned to investigate the changes in intestinal integrity, fecal SCFA levels, gut microbiota and nutritional intake of rotational shift workers. The study was conducted on ten male rotational shift workers, 25-40 years old. Circadian rhythm disruption was assumed to have occurred after 14 days in the night shift. Dietary data which was obtained by using 24 h record for 7 days, physical activity data, anthropometric measurements, fecal and blood samples were collected during day and night shift. Changes in dietary consumption, anthropometric measurements, blood chemistry and intestinal epithelial permeability indicator according to day and night shifts were not significant (p > .05). Additionally, acetic, propionic and total SCFA were associated with the intestinal permeability biomarker in night shift, but not in day shift (p < .05). Consumption of dark green vegetables and beans and peas was positively associated with fecal isobutyric acid and fecal total SCFA concentration (r = 0.685, p = .029; r = 0.695, p = .026, respectively). The proportions of the genus including Blautia, Bifidobacterium, Dialister, and Ruminococcus gnavus group increased when individuals shifted to the night shift. Gut microbiota changes responding to circadian rhythm disruption became more prominent when consumed high sugar diet. So, changes have been observed in the gut microbiota of rotational shift workers, especially in individuals with certain dietary pattern. Moreover, in individuals with the circadian rhythm disruption SCFAs levels have been demonstrated to be associated with intestinal barrier integrity. A better understanding of the relation among fecal SCFAs, gut microbiota, intestinal epithelial permeability and circadian rhythm disruption is necessary for the development of new dietary strategies for gut health.

Retention of radiographers: A qualitative exploration of factors influencing decisions to leave or remain within the NHS.

INTRODUCTION: In many countries a widening imbalance exists between radiographer workforce supply and demand. Improving retention is a rapid method of workforce expansion which is gaining importance with policy makers and providers. To better understand the current leaver profile, this study aimed to identify why radiographers leave the NHS early, and what incentives are important in their decision to stay. METHODS: A qualitative framework methodology used semi-structured telephone interviews to explore the perspectives of radiography managers, radiographers who have left the NHS, and those considering leaving. Purposive sampling ensured representation across radiography professional groups, geographical and organisational diversity, and stages of career. RESULTS: Three over-arching themes were identified across all radiographer professional groups (n = 44): 1) Challenging working patterns and the impact on employee health and wellbeing; 2) Lack of flexibility in working terms and conditions; 3) Lack of timely career progression and access to CPD, and the need to feel valued. Radiographers were keen to express how they 'loved being a radiographer'; small concessions and changes to workplace culture might be the incentive to remain in radiography that some were clearly searching for. Manager participants recognised the need to offer greater flexibility in working patterns but this was challenging within financial and service delivery constraints. CONCLUSIONS: While some influencing factors varied between radiographer professional groups, the three themes were consistent across participants. Failure to address these concerns will exacerbate the loss of experienced and highly trained staff from the NHS at a time when demand for services continues to rise. IMPACT ON PRACTICE: Recommendations are presented related to three primary themes which will be a catalyst for sharing of best practice between radiology and radiotherapy centres.

The effect of rosemary essential oil inhalation on sleepiness and alertness of shift-working nurses: A randomized, controlled field trial.

BACKGROUND: Sleepiness during the night shift is a common complaint of shift workers, including the nurses. This study investigated the effects of inhaled rosemary oil on sleepiness and alertness of shift-working nurses. METHODS: Eighty shift-working nurses were selected and assigned randomly into control (n = 40) and intervention (n = 40) groups. Both groups completed the Karolinska Sleep Questionnaire and Epworth Sleepiness Survey before the intervention. The intervention group received one drop of rosemary essential oil using a mask. The control group received a drop of distilled water instead, after which the questionnaires were completed for a second time. RESULTS: The sleepiness mean score in the intervention group reduced from 12.15 to 8.3, while it increased from 11.41 to 13.76 in the control group (P < 0.001). The alertness mean scores changed from 4.45 to 3.25 and from 4.41 to 5.34 in intervention and control groups, respectively (P < 0.001). CONCLUSION: Rosemary aroma decreased sleepiness and increased alertness in shift-working nurses.

The 12-hour shift: radiographers' perspectives and its applicability during a pandemic.

INTRODUCTION: Traditionally, shift work for radiographers at our institution comprised of three shift patterns - morning (8am-2pm), afternoon (2pm-9pm) and night (9pm-8am). However, when COVID-19 was first detected in Singapore in January 2020, the 12-h shift was introduced for better team segregation and deployment to meet the service needs of the Emergency Department. The 12-h shift consisted of the day (9am-9pm) and night (9pm-9am) shifts. While the 12-h shift is common to nursing practices, it is new to the radiography profession within the study centre. This study explores the radiographers' perspectives of the new shift and the impact of shift patterns on radiographers' wellness and work performance compared to the original three shift patterns. METHODS: A mixed-methods design study was adopted for this single-centre evaluation. An anonymous online questionnaire was administered to radiographers who had experienced both shift types. Additionally, the number of radiographers who had taken sick leave, and images rejected and accepted from the X-ray consoles were retrospectively collected to measure the impact of the new shift. RESULTS: Radiographers experienced fatigue and appreciated the longer rest days associated with the 12-h shift. Additionally, the sick leave rates and image reject counts were more favourable with the 12-h shift pattern. CONCLUSION: The findings indicate that the extended shift hours are effective during a pandemic but may result in radiographer burnout during a prolonged outbreak. IMPLICATIONS FOR PRACTICE: Studying these variables will provide an effective starting point in understanding the efficacy and applicability of a 12-h shift system during pandemic periods.

Influence of sleep-wake cycle on body mass index in female shift-working nurses with sleep quality as mediating variable.

This study investigated the relationship between the sleep-wake cycle and body mass index (BMI) of female shift-working nurses and examine the mediating effect of sleep quality on this relationship. We recruited a total of 147 female nurses working monthly rotating shifts at a teaching hospital in Taiwan from the day (n=63), evening (n=50), and night (n=34) shifts. Our research instruments utilized a questionnaire to collect demographic and work-related information, the Pittsburgh Sleep Quality Index (PSQI), and actigraphs to record sleep patterns for seven consecutive days. The sleep-wake cycles were then estimated using the dichotomy index (I

Frequency of night shift and menstrual cycle characteristics in Japanese nurses working under two or three rotating shifts.

OBJECTIVES: In Japan, the prevalence of irregular menstrual cycles and its association with the frequency of night shifts have scarcely assessed. The present study aimed to evaluate the relationship between irregular menstrual cycles and the frequency of night shifts in Japanese female nurses. METHODS: We conducted a cross-sectional web-based self-administered questionnaire survey in 2019. An irregular menstrual cycle was defined as a cycle length of ≤21 days or ≥39 days at least a few times over the past year or amenorrhea for at least 3 months. We used Poison regression analysis with a robust error variance to calculate the prevalence ratios adjusted for age, body mass index, hospital size, and the department in which they worked. RESULTS: A total of 1249 women were included, and 679 (54.4%) and 195 (15.6%) of them worked under two and three rotating shifts. The prevalence of irregular menstrual cycles was 24.8%, 37.4%, and 35.9% in the no night, two rotating, and three rotating shifts groups, respectively. While the frequency of night shifts had a dose-responsive relationship with irregular menstrual cycles in the two rotating shifts group, it was not observed in the three rotating shifts group. However, the risk of work getting affected by dysmenorrhea or premenstrual symptoms increased in the three rotating shifts group. CONCLUSIONS: Over 30% of Japanese female nurses working under night shifts had irregular menstrual cycles. The high frequency of night shifts increased the risk of irregular menstrual cycles and secondary amenorrhea in the two rotating shifts group.

Relationship between job satisfaction and sleep quality of female shift-working nurses: using shift type as moderator variable.

This study was to investigate the impact of job satisfaction as the independent variable and the type of shift as the moderator variable on the sleep quality of female shift-working nurses. The Minnesota Satisfaction Questionnaire (MSQ) short form and the Pittsburgh Sleep Quality Index (PSQI) were used as evaluation tools. The subjects in the study were female shift-working nurses from teaching hospitals in northern Taiwan. A total of 178 valid questionnaires were recovered. A hierarchical multiple regression (HMR) was used to test for the moderating effect of shift type. The results demonstrated that there was a negative correlation between the total score for general job satisfaction and the Global PSQI scores. The Global PSQI scores were higher for nurses working night shifts than for those working day and evening shifts. HMR showed significant variances in the interaction between general job satisfaction of female shift-working nurses and the day/night shift as well as the evening/night shift. The type of shift had a moderating effect on the ways in which general job satisfaction impacts sleep quality. Furthermore, the moderating effect of night shift on the impact of job satisfaction on sleep quality was weaker in nurses working the night shift.

The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms.

Modern lifestyle has profoundly modified human sleep habits. Sleep duration has shortened over recent decades from 8 to 6.5 hours resulting in chronic sleep deprivation. Additionally, irregular sleep, shift work and travelling across time zones lead to disruption of circadian rhythms and asynchrony between the master hypothalamic clock and pacemakers in peripheral tissues. Furthermore, obstructive sleep apnea syndrome (OSA), which affects 4 - 15% of the population, is not only characterized by impaired sleep architecture but also by repetitive hemoglobin desaturations during sleep. Epidemiological studies have identified impaired sleep as an independent risk factor for all cause of-, as well as for cardiovascular, mortality/morbidity. More recently, sleep abnormalities were causally linked to impairments in glucose homeostasis, metabolic syndrome and Type 2 Diabetes Mellitus (T2DM). This review summarized current knowledge on the metabolic alterations associated with the most prevalent sleep disturbances, i.e. short sleep duration, shift work and OSA. We have focused on various endocrine and molecular mechanisms underlying the associations between inadequate sleep quality, quantity and timing with impaired glucose tolerance, insulin resistance and pancreatic ß-cell dysfunction. Of these mechanisms, the role of the hypothalamic-pituitary-adrenal axis, circadian pacemakers in peripheral tissues, adipose tissue metabolism, sympathetic nervous system activation, oxidative stress and whole-body inflammation are discussed. Additionally, the impact of intermittent hypoxia and sleep fragmentation (key components of OSA) on intracellular signaling and metabolism in muscle, liver, fat and pancreas are also examined. In summary, this review provides endocrine and molecular explanations for the associations between common sleep disturbances and the pathogenesis of T2DM.

Sleep quality of professional firefighters.

BACKGROUND: Firefighting is a unique job with contradictious demands that expose firefighters to many well documented causal factors of sleep debt, but no studies in Iran and only a few worldwide studies have investigated their sleep quality while sleep problems may lead to catastrophes especially in critical service workers. The aim of this study is to evaluate sleep quality and its related factors among a sample of professional Iranian firefighters. METHODS: Using simple random sampling method in a cross-sectional study, 427 personnel of fire and rescue service were invited. They completed the Persian version of Pittsburgh Sleep Quality Index (PSQI) and a data collection sheet about their demographic and occupational features during an individual face to face interview in central office and firehouses throughout Tehran. Response rate was 88.7%. RESULTS: The mean ± SD global PSQI score was 7.97 ± 3.77. Sleep latency was the component of PSQI with the greatest degree of abnormality. 69.9% of participants were poor sleepers. Interestingly, we found no significant differences between sleep quality of shift workers and non shift workers. Using multiple logistic regression analysis, only having another job, smoking and years of job experience were predictors of poor sleep. CONCLUSIONS: In comparison with adult population of Tehran, sleep quality deterioration is notably more common in Tehran firefighters which require health promotion interventions to prevent its serious adverse outcomes.

Outline of changes in cortisol and melatonin circadian rhythms in the security guards of shiraz university of medical sciences.

BACKGROUND: According to the literature, a large number of people working in industries and service providing personnel, such as firefighters, physicians, and nurses are shift workers. The spread of shift working in industrial societies and the incidence of the problems resulting from shift working have caused the researchers to conduct studies on this issue. The present study also aimed to investigate melatonin and cortisol circadian rhythms in the security guards of Shiraz University of Medical Sciences, Shiraz, Iran. METHODS: The present study was conducted on 20 security guards of Shiraz University of Medical Sciences. In order to collect the study data, blood samples were taken from the study subjects in different times of the day (1, 4, 7, 10, 13, 16, 19, and 22) and cortisol and melatonin levels were determined using the radioimmunoassay and enzyme immunoassay techniques, respectively. RESULTS: The results showed that as the intensity of light increased at night, the plasma cortisol level increased, as well. Besides, no statistically significant difference was found between the plasma cortisol levels in natural light and 4500-lux light. On the other hand, a significant difference was observed between the plasma cortisol levels in natural light and 9000-lux light as well as 4500- and 9000-lux lights. The study findings also showed that as the intensity of light increased at night, the plasma melatonin level decreased. In addition, a statistically significant difference was found between the plasma melatonin levels in natural light and 4500-lux light. Nevertheless, no significant difference was observed between the plasma melatonin levels in the natural light and 9000-lux light as well as 4500- and 9000-lux lights. CONCLUSIONS: The present study aimed to investigate the subsequences of shift working in the security guards of Shiraz University of Medical Sciences and showed that occupational exposure to bright light could affect some biological markers, such as melatonin and cortisol secretion.

Comparisons of Subjective and Actigraphic Measurements of Sleep between Shift-working and Daytime Psychiatric Nurses / 정신신체의학

OBJECTIVES: Shiftwork is known to be one of the common causes of sleep and health problems and finally causes the decreased quality of life. The purpose of this study was to investigate the sleep patterns of shiftworking and daytime psychiatric nurses using actigraphy and compare it with subjective assessment for sleep. METHODS: Twenty-three shift-working and 25 daytime nurses were enrolled. They rated their sleep quality using Pittsburgh Sleep Quality Index(PSQI) and other self-rating scales were measured for psychosocial aspects. Actigraphy was applied to the subjects for a total of 7 days to measure the sleep parameters. They also wrote sleep diaries during the period of wearing actigraphy. Sleep-related parameters of actigraphy, global score and components of PSQI, and the results of other self-rating scales were compared between shift-working and daytime nurses. RESULTS: Although the global score of PSQI did not show significant difference, the PSQI components showed significant differences between two groups: the shift-working nurses showed lower sleep quality, more sleep disturbance and hypnotic medication use, and worsened daytime dysfunction than daytime nurses. The shift-working nurses showed significantly shorter total time in bed and total sleep time, lower sleep efficiency, and longer average awakening time than those of daytime nurses in actigraphy. CONCLUSIONS: The results showed that shift-working nurses experienced more sleep disturbances in both subjective and objective aspects of sleep than daytime nurses. This study also suggests that actigraphy may be useful to measure the objective aspects of sleep that are difficult to assess with subjective questionnaires alone.