Efeitos do Trabalho em Turnos e Coping em Profissionais de Enfermagem Hospitalar / Effects of Shift Work and Coping in Hospital Nursing Professionals / Efectos del Trabajo por Turnos y Coping en los Profesionales de Enfermería Hospitalaria

Resumo Introdução Respostas de coping podem influenciar na adaptação dos profissionais ao trabalho em turnos, contribuindo para manutenção da saúde e qualidade de vida. Assim, objetivou-se verificar a associação entre coping e efeitos do trabalho em turnos sobre a saúde dos profissionais de enfermagem. Materiais e Métodos: Estudo transversal, realizado com 124 profissionais de enfermagem em um hospital universitário, no período de agosto a novembro de 2014. Utilizou-se o questionário Coping com o Trabalho por Turnos, instrumentos para avaliação de efeitos do trabalho em turnos na saúde e avaliação da qualidade de vida. Dados analisados estatisticamente, considerando-se significância de 0,05. Resultados Observou-se associação inversa entre efeitos do trabalho em turnos e escore total do coping (p=0,003). Domínios do coping apresentaram correlações diretas com domínios de qualidade de vida (p<0,05). Das participantes, 46 (37%) profissionais apresentavam efeitos do trabalho em turnos na saúde. Discussão O uso do coping contribui com menor ocorrência dos efeitos negativos do trabalho em turnos sobre a saúde, dentre estes, funções cognitivas, sono, hábitos alimentares e gástricos, e estresse. Ainda, podendo cooperar para manutenção do bem estar psíquico e físico, adaptação laboral, e melhor qualidade de vida. Conclusões O conhecimento da relação entre coping e efeitos do trabalho em turnos na saúde pode auxiliar na identificação de meios para promover melhores condições de trabalho, preservando o bem-estar físico e psíquico, e a saúde do profissional de enfermagem.

Abstract Introduction Coping responses can influence the adaptation of health care professionals to shift work, contributing to the maintenance of health and quality of life. Thus, this study aimed to verify the association between coping and the effects of shift work on the health of nursing professionals. Materials and Methods This was Cross-sectional study, conducted with 124 nursing professionals in a university hospital between August and November 2014. The Shift Work Coping Strategies questionnaire was used as an instrument for assessing the effects of shift work on the health and quality of life of participants. Data were statistically analyzed, considering a significance level of 0,05. Results: An inverse association was observed between the effects of shift work and the total coping score (p = 0,003). Coping domains showed direct correlations with quality-of-life domains (p <0,05). Among participants, 46 (37%) professionals reported having effects of shift work on their health. Discussion The use of coping contributes to a lower occurrence of the negative effects of shift work on health, among these, cognitive functions, sleep, eating and gastric habits, and stress. Also, being able to cooperate to maintain psychic and physical well-being, work adaptation, and better quality of life. Conclusions By understanding the relationship between coping strategies and the effects of shift work on health, several means can be identified to promote better working conditions and maintain the physical and psychological well-being and health of nursing professionals

Resumen Introducción Las respuestas de coping pueden influir en la adaptación de los profesionales al trabajo por turnos, contribuyendo al mantenimiento de la salud y la calidad de vida. Por lo tanto, el objetivo fue verificar la asociación entre coping y los efectos del trabajo por turnos en la salud de los profesionales de enfermería. Materiales y métodos Estudio transversal, realizado con 124 profesionales de enfermería en un hospital universitario, de agosto a noviembre de 2014. Se utilizó el cuestionario Coping con el trabajo por turnos, instrumentos para evaluar los efectos del trabajo por turnos en la salud, y evaluación de la calidad de vida. Datos analizados estadísticamente considerando una significancia de 0.05. Resultados Se observó asociación inversa entre los efectos del trabajo por turnos y la puntuación total del coping (p=0,003). Los dominios del coping presentaron correlaciones directas con los dominios de calidad de vida (p<0,05). De los participantes, 46 (37%) profesionales presentaban efectos del trabajo por turnos en la salud. Discusión El uso del coping contribuye a una menor ocurrencia de los efectos negativos del trabajo por turnos sobre la salud, incluidas las funciones cognitivas, el sueño, la alimentación, los hábitos gástricos y el estrés. También puede contribuir al mantenimiento del bienestar psicológico y físico, la adaptación laboral y una mejor calidad de vida. Conclusiones Conocimiento de la relación entre coping y los efectos del trabajo por turnos sobre la salud puede ayudar en la identificación de medios para promover mejores condiciones de trabajo, preservando el bienestar físico y psicológico y la salud de los profesionales de enfermería.

Factors Influencing Work-life Balance in Korean Registered Nurses / 한국직업건강간호학회지

PURPOSE: This study aimed to explore personal as well as occupational factors and health status associated with work-life balance in Korean registered nurses. METHODS: This study was a secondary data analysis using cross-sectional nationally representative data from the Korean Working Conditions Survey (KWCS) in 2014. Study participants included 450 registered nurses in South Korea. Descriptive analysis, Independent t-test, χ² test, and Logistic regression analyses were performed using the SPSS 21.0 statistical program. RESULTS: Work-life balance was reported in 70.6% individuals with 85.7% being male and 70.0% being female nurses. Logistic regression analysis revealed that being male good health state, having less than 40-hour working week, lower number of night duty, policy on flexible work arrangement were significant predictors of work-life balance. CONCLUSION: This study provided evidence that identify predictors of work-life balance in registered nurses in South Korea. Therefore, we need the actively support health care service promotion and prevention for work-life balance predictors.

The Association Between Shift Work and Health Behavior: Findings from the Korean National Health and Nutrition Examination Survey / 가정의학회지

BACKGROUND: Shift workers are increasing worldwide, and various negative health effects of shift work have been reported. This study aimed to evaluate the relationship between shift work and health behavior. METHODS: This cross-sectional study included a total of 11,680 Korean adults (6,061 men and 5,619 women) aged ≥20 years old who participated in the Fifth Korean National Health and Nutrition Examination Survey, 2010–2012. Multiple logistic regression analysis was performed to evaluate the association between shift work and health behavior after adjusting for covariates. RESULTS: In men, shift work was associated with an increased risk of inadequate sleep (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.00 to 1.40) compared to day work. In women, shift work was associated with an increased risk of smoking (OR, 1.73; 95% CI, 1.34 to 2.22) and inadequate sleep (OR, 1.24; 95% CI, 1.05 to 1.47) compared to day work. In an age-stratified subgroup analysis, female shift workers aged ≥50 years old demonstrated an increased risk of smoking (OR, 5.55; 95% CI, 3.60 to 8.55), alcohol consumption (OR, 2.22; 95% CI, 1.53 to 3.23), and inadequate sleep (OR, 1.50; 95% CI, 1.10 to 2.05) compared to female day workers. CONCLUSION: Shift work is associated with worse health behavior, and this is most evident in women aged ≥50 years. Targeted strategies to reduce the negative health effects of shift work should be implemented, with consideration of shift workers' demographic characteristics.

Does operation order has impacts on postoperative complications in gastric cancer patients? A study of surgeon fatigue

PURPOSE: There is a growing concern that accumulated fatigue due to extended working hours may contribute to poor surgical outcomes. This study aimed to compare postoperative complications of gastric cancer patients according to operation chronology in a given day as a yardstick of a surgeon's fatigue.METHODS: The clinicopathologic data of gastric cancer patients who underwent a curative gastrectomy by one surgeon in Asan Medical Center from August 2012 to August 2014 were analyzed retrospectively. The patients were divided into 3 groups according to operation chronology in a given day. Perioperative data were collected by electronic medical records. Comorbidities were assessed using the Charlson comorbidity index. Postoperative complications were categorized according to the Clavien-Dindo classification.RESULTS: A total of 517 patients were divided into three groups according to chronological order of the surgery in one day. Each group exhibited similar characteristics except for operation time (P=0.001) and the America Society of Anesthesiologists score (P=0.01). Operations conducted late in the day tended to require more time and were associated with more comorbidities. However, no significant differences were detected between the chronological order of operation in a given day and postoperative complications.CONCLUSION: The chronological order of three gastrectomies performed by one surgeon in a day was not associated with postoperative complications rate.

Influencing Factors on the Nurse's Shiftwork Tolerance / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to identify the factors affecting shiftwork tolerance among nurses and provide basic data, ultimately, in formulating a plan for improving their shiftwork tolerance. METHODS: The participants were 317 nurses who were working at three general hospitals in Daejeon and Seoul. Data analyzed t-test, ANOVA, correlation analysis, and regression analysis using SPSS 20.0 program. RESULTS: As for the sub-areas of shiftwork tolerance for the respondents, more than a half of nurses working at shifts suffered from insomnia, felt drowsy, complained of chronic fatigue, and were at the anxious and depressed state. Shiftwork tolerance differed by the daily intake of coffee and exercise. Shiftwork tolerance was significantly positively correlated with sleep-wake habits, hardiness, and flexibility and negatively correlated with a languidity. Regression analysis revealed that shiftwork tolerance was affected by age, sleep-wake habits, languidity, flexibility, and hardiness. CONCLUSION: To put the results, nurses had shiftwork tolerance affected by sleep-wake habits, languidity, and hardiness. It is therefore necessary to make a scheme for allowing nurses to improve hardiness and flexibility and decrease the languidity with the objective of improving their shiftwork tolerance.

Influencing Factors for Sleep Quality Among Shift-working Nurses:A Cross-Sectional Study in China Using 3-factor Pittsburgh Sleep Quality Index

PURPOSE: The aim of this study was to identify influencing factors for sleep quality among shift-working nurses based on a three-factor scoring model that included sleep efficacy, sleep quality and daily dysfunction. METHODS: A cross-sectional survey of 513 nurses in a hospital in Shanghai, China, was conducted using a self-reported questionnaire. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed based on the three-factor PSQI model: Factor 1, sleep efficacy; Factor 2, sleep quality; Factor 3, daily disturbances. RESULTS: After adjusting for age, marital status, and having children, multivariate logistic regression analysis showed that participants who had previous shift work experience which was at least 6 months ago, or were currently performing shift work were significantly more likely to have poor sleep quality (PSQI > 5) than those who had never done shift work (adjusted odds ratios of 3.943 and 3.975, respectively, both p < .001). Mean scores of the three individual factors increased significantly among nurses currently performing shift work compared with those who had never done shift work (Factor 1, β = 0.61, p < .001; Factor 2, β = 1.86, p < .001; Factor 3, β = 0.45, p = .002). Mean scores of Factor 2 and Factor 3 increased significantly among nurses with previous shift work experience compared with those who had never done shift work (Factor 2, β = 1.15, p = .003; Factor 3, β = 0.52, p = .005). CONCLUSIONS: Performing current shift work and performing shift work previously were significantly associated with poor sleep quality. An appropriate arrangement and intervention strategies are needed in Chinese hospitals in order to improve sleep quality among shift-working nurses.

Metabolic syndrome in fixed-shift workers / Síndrome metabólica em trabalhadores de turnos fixos

OBJECTIVE To analyze if metabolic syndrome and its altered components are associated with demographic, socioeconomic and behavioral factors in fixed-shift workers.METHODS A cross-sectional study was conducted on a sample of 902 shift workers of both sexes in a poultry processing plant in Southern Brazil in 2010. The diagnosis of metabolic syndrome was determined according to the recommendations from Harmonizing the Metabolic Syndrome. Its frequency was evaluated according to the demographic (sex, skin color, age and marital status), socioeconomic (educational level, income and work shift), and behavioral characteristics (smoking, alcohol intake, leisure time physical activity, number of meals and sleep duration) of the sample. The multivariate analysis followed a theoretical framework for identifying metabolic syndrome in fixed-shift workers.RESULTS The prevalence of metabolic syndrome in the sample was 9.3% (95%CI 7.4;11.2). The most frequently altered component was waist circumference (PR 48.4%; 95%CI 45.5;51.2), followed by high-density lipoprotein. Work shift was not associated with metabolic syndrome and its altered components. After adjustment, the prevalence of metabolic syndrome was positively associated with women (PR 2.16; 95%CI 1.28;3.64), workers aged over 40 years (PR 3.90; 95%CI 1.78;8.93) and those who reported sleeping five hours or less per day (PR 1.70; 95%CI 1.09;2.24). On the other hand, metabolic syndrome was inversely associated with educational level and having more than three meals per day (PR 0.43; 95%CI 0.26;0.73).CONCLUSIONS Being female, older and deprived of sleep are probable risk factors for metabolic syndrome, whereas higher educational level and higher number of meals per day are protective factors for metabolic syndrome in fixed-shift workers.

OBJETIVO Analisar se síndrome metabólica e seus componentes alterados estão associados a fatores demográficos, socioeconômicos e comportamentais em trabalhadores de turnos fixos.MÉTODOS Estudo transversal com amostra de 902 trabalhadores de turnos, de ambos os sexos, de um frigorífico de frango do sul do Brasil, em 2010. O diagnóstico da síndrome metabólica foi determinado pelas recomendações doHarmonizing the Metabolic Syndrome; e sua frequência foi avaliada segundo características demográficas (sexo, cor de pele, idade e estado civil), socioeconômicas (escolaridade, renda e turno de trabalho) e comportamentais (tabagismo, consumo de álcool, atividade física de lazer, número de refeições/dia e duração do sono). A análise multivariada seguiu um modelo conceitual de determinação da síndrome metabólica em trabalhadores de turnos fixos.RESULTADOS A prevalência de síndrome metabólica foi 9,3% (IC95% 7,4;11,2). O componente mais frequentemente alterado foi a circunferência da cintura (RP 48,4%; IC95% 45,5;51,2), seguido pela lipoproteína de alta densidade. O turno de trabalho não esteve associado à síndrome metabólica e aos seus componentes alterados. Após ajustes, a prevalência da síndrome metabólica foi positivamente associada ao sexo feminino (RP 2,16; IC95% 1,28;3,64), a trabalhadores com 40 anos ou mais (RP 3,90; IC95% 1,78;8.93) e àqueles que reportaram dormir cinco horas ou menos por dia (RP 1,70; IC95% 1,09;2,24). Por outro lado, a síndrome metabólica esteve negativamente relacionada à escolaridade e a fazer mais do que três refeições por dia (RP 0,43 IC95% 0,26;0,73).CONCLUSÕES Ser mulher, possuir idade mais avançada e ter privação de sono mostraram-se potenciais fatores de risco para síndrome metabólica, enquanto ter maior escolaridade e realizar maior número de refeições/dia foram fatores de proteção para síndrome metabólica em trabalhadores de turnos fixos.

The Association between Shift Work and Bone Mineral Density : analysis of 2008-2009 Korean National Health and Nutrition Examination Survey / 대한산업의학회지

OBJECTIVES: The objectives of this study were to explore the association between shift work and the bone mineral density in a representative sample of Korean workers. METHODS: He data from the Fourth Korean National Health and Nutrition Examination Survey (2008-2009) was used. The participants were Korean workers aged 16 to 60 years. Logistic regression analysis was applied to determine the association between shift work and the bone mineral density after controlling for covariates using the SAS version 9.3 package program. RESULTS: The blood vitamin D level in shift workers was significantly lower than that of day workers in both males and females. In male shift workers, shift work was significantly associated with a decreased bone mineral density in the femoral neck (odds ratio(OR) 1.42, 95% confidence interval(CI)=1.05~1.92) and lumbar spine (OR 1.53, 95% CI=1.09~2.15) compared to day workers. After controlling for covariates, this association was still significant. In the case of female shift workers, shift work was significantly related to a decreased bone mineral density in the total femur (OR 2.84, 95% CI=1.69~4.79) and lumbar spine (OR 1.58, 95% CI=1.12~2.24). After controlling for covariates, this risk was not statistically significant. CONCLUSIONS: The blood vitamin D level of shift workers was significantly lower than that of day workers. In male shift workers, shift work can decrease the bone mineral density in the femoral neck and lumbar spine. Prospective studies with information on the shift work intensity and duration and exposuredata to explain mechanisms will be needed.

Sentido del trabajo para enfermeros nocturnos de un hospital universitario: estudio descriptivo / Sentido do trabalho para enfermeiros noturnos de um Hospital Universitário: estudo descritivo / Meaning of work for night nurses of a university hospital: descriptive study

Type of study: descriptive study with qualitative approach. Objective: To identify the meaning of work assigned by nurses working at night, connecting it to the professional satisfaction or dissatisfaction. Methodology: The sample consisted of 42 nurses at a teaching hospital of high complexity located in Rio Grande do Sul / Brazil. The of data collection technique used was semi-structured interview. The thematic analysis which allowed the construction of categories called work is: a central element of life, satisfaction and pleasure; economic performance, and work means dissatisfaction. Results: One can say that by the prevalence of positive expressions toward work, the majority of nurses assign positive meaning to the accomplished task, it being understood that these nurses are professionally satisfied. Conclusion: Understanding the meaning of work enables managers to create and implement strategies to expand activities related to workers' health from the perspective of improving services and professional satisfaction.

Tipo de Estudio: Pesquisa descriptiva con abordaje cualitativa. Objetivo: Identificar el sentido del trabajo atribuido por los enfermeros que actúan en el período nocturno, relacionándolo a la satisfacción o insatisfacción profesional. Metodología: La muestra fue compuesta por 42 enfermeros de un hospital de enseñanza de alta complejidad localizado en Rio Grande do Sul/Brasil. La técnica de colecta de datos utilizada fue la entrevista semi-estructurada. El análisis temático posibilitó la construcción de las categorías denominadas trabajo que son: elemento central de la vida; satisfacción y placer; rendimiento económico; y trabajo es insatisfacción. Resultados: Se puede afirmar que por la prevalencia de expresiones positivas con relación al trabajo, la mayoría de los enfermeros atribuye significado positivo a la labor realizada, comprendiéndose que esos enfermeros están satisfechos profesionalmente. Conclusión: Comprender el sentido del trabajo posibilita a los gestores crear e implementar estrategias que permitan ampliar acciones referentes a la salud del trabajador con la perspectiva de mejorías en los servicios y de la satisfacción profesional.

Tipo do Estudo: Pesquisa descritiva com abordagem qualitativa. Objetivo: Identificar o sentido do trabalho atribuído pelos enfermeiros que atuam no período noturno, relacionando-o à satisfação ou insatisfação profissional. Metodologia: A amostra foi composta por 42 enfermeiros de um hospital de ensino de alta complexidade localizado no Rio Grande do Sul/Brasil. A técnica de coleta dos dados utilizada foi a entrevista semi-estruturada. A análise temática possibilitou a construção das categorias denominadas trabalho é: elemento central da vida; satisfação e prazer; rendimento econômico; e, trabalho é insatisfação. Resultados: Pode-se afirmar que pela prevalência de expressões positivas com relação ao trabalho, a maioria dos enfermeiros atribui significado positivo a tarefa realizada, compreendendo-se que esses enfermeiros estejam satisfeitos profissionalmente. Conclusão: Compreender o sentido do trabalho possibilite aos gestores criar e implementar estratégias que permitam ampliar ações referentes à saúde do trabalhador na perspectiva da melhoria dos serviços e da satisfação profissional.

Risk Factors for Breast Cancer, Including Occupational Exposures

The knowledge on the etiology of breast cancer has advanced substantially in recent years, and several etiological factors are now firmly established. However, very few new discoveries have been made in relation to occupational risk factors. The International Agency for Research on Cancer has evaluated over 900 different exposures or agents to-date to determine whether they are carcinogenic to humans. These evaluations are published as a series of Monographs (www.iarc.fr). For breast cancer the following substances have been classified as "carcinogenic to humans" (Group 1): alcoholic beverages, exposure to diethylstilbestrol, estrogen-progestogen contraceptives, estrogen-progestogen hormone replacement therapy and exposure to X-radiation and gamma-radiation (in special populations such as atomic bomb survivors, medical patients, and in-utero exposure). Ethylene oxide is also classified as a Group 1 carcinogen, although the evidence for carcinogenicity in epidemiologic studies, and specifically for the human breast, is limited. The classification "probably carcinogenic to humans" (Group 2A) includes estrogen hormone replacement therapy, tobacco smoking, and shift work involving circadian disruption, including work as a flight attendant. If the association between shift work and breast cancer, the most common female cancer, is confirmed, shift work could become the leading cause of occupational cancer in women.

Night shift pros and cons in nursing: qualitative study / Facilidades e dificuldades enfrentadas por enfermeiros no trabalho noturno: estudo qualitativo / Las facilidades y las dificultades enfrentadas por los enfermeros en el trabajo nocturno: un estudio cualitativo

Working at the night shift interferes with the worker personally, socially, and with family matters. The objective of the following qualitative research, conducted in a university hospital in the state of Rio Grande do Sul (Brazil), was to identify the pros and cons faced by 42 nurses in performing nocturnal work. The data collection was made from March to April 2008 through semi-structured interview. The transcription and theme analysis on the data originated pros such as interaction among nursing team and more time availability for personal life; as well as categories for cons, like lack of supporting services and social/work isolation, among others. It is suggested that managers promote collective activities for reflection, stimulating workers to identify benefits and difficulties in the working process, favoring work satisfaction.

O trabalho no período noturno interfere na esfera pessoal, social e familiar do trabalhador. O objetivo desta pesquisa qualitativa, que foi realizada em um hospital universitário do Estado do Rio Grande do Sul (Brasil), foi identificar as facilidades e dificuldades enfrentadas por 42 enfermeiros na realização do trabalho noturno. A coleta dos dados foi realizada no período de março a abril de 2008 por meio de uma entrevista semi-estruturada. A transcrição e análise temática dos dados originaram categorias para facilidades, como a interação entre a equipe de enfermagem e a maior disponibilidade de tempo para a vida particular; e categorias para dificuldades, como a carência dos serviços de apoio e o isolamento social e no trabalho dentre outras. Sugere-se que os gestores promovam momentos coletivos de reflexão, para estimular os trabalhadores a identificar benefícios e dificuldades do processo de trabalho, o que poderá favorecer a satisfação no trabalho.

El trabajo en el período nocturno interfiere en la esfera personal, social y familiar del trabajador. El objetivo de esta investigación cualitativa, que se llevó a cabo en un hospital universitario de la provincia del Rio Grande do Sul (Brasil), fue identificar las facilidades y dificultades enfrentadas por 42 enfermeros en la realización del trabajo nocturno. La recolección de los datos fue realizada en el periodo de marzo a abril del 2008 por medio de una entrevista semiestructurada. La transcripción y el análisis temático de los datos originaron categorías para facilidades, como la interacción entre el equipo de enfermería y mayor disponibilidad de tiempo para la vida privada; y categorías para dificultades, como la carencia de los servicios de apoyo y el aislamiento social y en el trabajo, entre otras. Se sugiere que los gestores promuevan momentos colectivos de reflexión, para estimular a los trabajadores a identificar beneficios y dificultades del proceso laboral, lo que podrá favorecer la satisfacción en el trabajo.

Maternal Working Conditions on Adverse Pregnancy Outcomes: A Prospective Cohort Study / 예방의학회지

OBJECTIVES: To evaluate the association between working conditions and adverse pregnancy outcomes in Korea. METHODS: We obtained data on health history, lifestyle, housework and working conditions, such as shift work, hours standing, working time, job demand, lifting at work and at home, between August and September 2000, from self-reported questionnaires. A group of 344, occupationally active, pregnant women from 51 industries were studied. Of the women studied, 328 women were further interviewed by telephone between November 2000 and September 2001. Result : Compared with daytime work, shift work increased the risk for preterm birth (an adjusted risk ratio of 2.74, 95% CI=1.02-2.62) and low birth weight (an adjusted risk ratio of 2.74, 95% CI=1.02-2.62). A significantly increased risk was found for prolonged standing, with an adjusted risk ratio of preterm births of 6.80 (95% CI=2.01-23.0). There were no significant differences in the incidence of spontaneous abortion between the occupational working conditions, with the exception of a previous history of spontaneous abortion. CONCLUSION: These findings suggest that maternal working conditions, such as shift work and prolonged standing, contribute significantly to preterm birth and low birth weight.