Negative representations of night-shift work and mental health of public hospital healthcare workers in the COVID-19 era (Aladdin survey).

BACKGROUND: Many risk factors impact the health of hospital night workers, which can lead to physical and mental health disorders. During the recent period, night hospital workers have been particularly stressed. This study therefore aims to: (i) To document the prevalence of depression, anxiety, sleep disorders, and symptoms suggestive of post-traumatic stress disorder in night shift workers (NSHW) working in Parisian public hospitals after France's first COVID-19 wave ended; (ii) To estimate the effect of negative representations and perceptions of night shift work on these mental health outcomes. METHODS: An observational cross-sectional online survey of NSHW (June to September 2020) in 39 public hospitals in Paris, France. Standard scales were used to measure mental health outcomes. Weighted multinomial logistic regression models supported the identification of predictors of depression (score > 10 on the Hospital Anxiety and Depression Scale, HADS, for depression), anxiety (score > 10 on the HADS for anxiety), severe insomnia (score > 21 on the Insomnia Severity Index, ISI) and symptoms suggestive of post-traumatic stress disorder (score > 36 on the Impact of Event Scale-Revised, IES-R). RESULTS: The weighted prevalence rates [95% confidence interval] of depression, anxiety, severe insomnia, and symptoms of post-traumatic stress disorder were, respectively, 18.9% [16.5-21.2], 7.6% [6.0-9.1], 8.6% [6.9-10.2] and 11.7% [9.7-13.6]. After multiple adjustment, organizational changes in NSHW professional lives due to the COVID-19 pandemic (such as moving to another hospital department and modified schedules) and NSHW-perceived negative representations of night work were significantly associated with all studied mental health outcomes. CONCLUSION: Our findings confirm the importance of monitoring mental health and sleep quality among NSHW in Parisian public hospitals, even more during health crises. Multilevel interventions aiming at reducing negative representations and improving work organization are urgently needed to improve overall health of this frontline healthcare providers group.

The effect of shift work on burnout and occupational fatigue among clinical faculty members during the COVID-19 pandemic.

Introduction: Shift work of clinical faculty members in the COVID-19 pandemic may cause burnout and occupational fatigue and as a result, may reduce the quality of student education and disrupt the treatment of patients, so this study was conducted to evaluate this case. Materials and methods: The statistical population of this cross-sectional research included all clinical faculty members of Ahvaz Jundishapur University of Medical Sciences in southwestern Iran, who experienced a shift work system (night shift from 8 p.m. to 8 a.m.) during the COVID-19 pandemic, and finally, 71 of them participated in it. The sampling method was also available. Two inventories were used to collect data, namely the Maslach Burnout Inventory [MBI-HSS (MP)] and the Swedish Occupational Fatigue Inventory (SOFI-20). Results: The self-reported burnout of faculty members was high (mean ± SD = 98.18 ± 17.18), which was graded into the range of emotional exhaustion (38.01 ± 10.2), range of personal accomplishment, (33.75 ± 6.75), and the range of depersonalization (26.42 ± 3.5), respectively. Perceived occupational fatigue of faculty members was also high (M ± SD = 82.25 ± 34.79), which included the dimensions of lack of motivation (18.69 ± 8.65), drowsiness (17.43 ± 8.7), lack of energy (16.33 ± 7.67), physical discomfort (15.65 ± 8.62), and physical stress (13.51 ± 6.9), respectively. In terms of demographic characteristics, occupational fatigue was significantly more common among women. Discussion and conclusion: The self-reported burnout and occupational fatigue of clinical faculty members due to shift work were reported to be high in this study. Although our knowledge of burnout has advanced in recent years, many gaps in our knowledge still remain. In order for clinical faculty members to properly fulfill their mission to treat patients, educate students, and promote public health, it is necessary to provide all the necessary conditions for their effective activity. Some interventions, such as improving organizational strategies and providing technical solutions, incentives, and occupational facilities, can help reduce or eliminate these problems.

A Cross-Sectional, Exploratory Study on the Impact of Night Shift Work on Midwives' Reproductive and Sexual Health.

BACKGROUND: Shift work is the basis for health care system functioning. The non-standard schedules enforce abrupt changes in the timing of sleep and light-dark exposure. It can contribute to the increased risk of various medical conditions, including reproductive and sexual health issues. The purpose of the study was to assess the impact of shift work with night shifts on midwives' reproductive and sexual health. METHODS: This cross-sectional, exploratory study included 520 midwives. A descriptive questionnaire was distributed in person (414) and online (106) from July 2019 to May 2020. We used the Female Sexual Function Index (PL-FSFI) standardized questionnaire and proprietary research tools (applicable to demographic and social data and reproductive health). All statistical calculations were performed with the IBM SPSS 23 statistical package. RESULTS: Shift work affects midwives' reproductive and sexual health. Midwives working night shifts are more likely to experience reproductive problems and sexual dysfunctions. The most pronounced differences are observed in the experience of infertility and the number of miscarriages. PL-FSFI results clearly showed the adverse impact of working shifts including night shifts on functioning in various dimensions of sexual health. CONCLUSION: Shift work negatively affects reproductive and sexual health and causes work-life conflict experience. It is necessary to develop procedures that minimize shift rotation and implement work schedules that allow for recuperation or rest and ensure proper family and social life.

Health problems, turnover intention, and actual turnover among shift work female nurses: Analyzing data from a prospective longitudinal study.

AIMS: This study investigated health problems, turnover intention, and actual turnover among shift work nurses. While turnover intention is often used as a proxy variable for turnover, the relationship between these variables requires clarification. This study tested for relevant associations using prospective longitudinal data with a time lag of 12 months. We also tested for associations between health problems (sleep disturbance, fatigue, and depression) and turnover intentions/turnover, with a focus on the mediating role of turnover intention. METHODS: This study conducted a secondary analysis of data from the Shift Work Nurses' Health and Turnover project, which is a prospective longitudinal cohort study. We analyzed health problems, turnover intention, and actual turnover. The data were analyzed via descriptive statistics, the Pearson's chi-squared test, independent t-test, univariable logistic regression, multiple logistic regression, and causal mediation. RESULTS: Participants included 491 shift work female nurses. Of these, 112 (22.8%) had turnover intention, while 38 (7.7%) left their jobs within the 12-month period of investigation. Of the 112 with turnover intention, 22 left their jobs (OR 5.68. 95% CI 2.84-11.36). The logistic regression analysis showed that sleep disturbance and fatigue were associated with turnover intentions and actual turnover, while depression was only associated with turnover intention. The causal mediation analysis showed that turnover intention mediated the relationship between health problems (sleep disturbance and fatigue) and actual turnover (sleep disturbance OR 1.31, 95%CI = 1.02-1.60; fatigue OR 2.11, 95%CI = 1.50-2.68); sleep disturbance had a natural direct effect on actual turnover (OR 2.66, 95%CI,2.07-3.21). CONCLUSION: Turnover intention strongly predicted actual turnover. Sleep disturbances may result in turnover, even in cases without existing turnover intention. These findings highlight the need for early interventions aimed at preventing and alleviating sleep disturbances for shift work female nurses.

Investigating the influence of shift work rosters on stress measured as cortisol in hair during the SARS-CoV-2 pandemic.

The COVID-19 pandemic has increased the workload and has affected physical and mental health of many employees. Hair cortisol concentration (HCC) has proven useful as a marker for retrospective assessment of stress in epidemiological studies and was measured here in non-healthcare night-shift workers with standard shifts (8-h shifts) and extended shifts (12-h shifts) before and during the first wave of the COVID-19 pandemic in Germany. Results showed a twofold increase in HCC among shift workers during the first wave of the COVID-19 pandemic compared with previous measurements. Subjectively reported measures of psychosomatic stress were not found to be reliable predictors of HCC. No statistically significant HCC differences were found between rosters. Working 12-h shifts does not appear to be an additional stressor in the already demanding COVID-19 pandemic.

Night-shift work is associated with increased susceptibility to SARS-CoV-2 infection.

Night-shift workers experience disturbances of their circadian rhythm and sleep, which may make them more susceptible to infectious diseases. Therefore, we studied whether night-shift workers are at higher risk of testing positive for SARS-CoV-2 infection than day workers. In this prospective study, data were used from 20 questionnaire rounds of the Dutch Lifelines COVID-19 cohort that was initiated in March 2020. In the different questionnaire rounds, 2285 night-shift workers and 23,766 day workers reported whether they had tested positive for SARS-CoV-2. Cox proportional hazards regression models adjusted for demographic, work, and health covariates were used to compare SARS-CoV-2 incidence between night-shift and day workers. From March 2020-January 2021, 3.4% of night-shift workers and 2.2% of day workers reported to have tested positive for SARS-CoV-2 (p < .001). After adjustment for covariates, night-shift workers had a 37% higher risk of testing positive for SARS-CoV-2 (hazard ratio: 1.37, 95% confidence interval: 1.05-1.77). In this study, we show that night-shift workers were more likely to test positive for SARS-CoV-2 than day workers, which adds to the growing evidence that night-shift work may influence the complex processes involved in infection susceptibility. Further mechanistic insight is needed to understand the relation between night-shift work and (SARS-CoV-2) infection susceptibility.

Association of Night Shift Work With Chronic Spontaneous Urticaria and Effect Modification by Circadian Dysfunction Among Workers.

Purpose: Night shift work is common in the current working environment and is a risk factor for many diseases. The study aimed to explore the relationship between night shift work with chronic spontaneous urticaria (CSU), and the modification effect of circadian dysfunction on it. Methods: A cross-sectional survey was conducted among Chinese workers. Exposure was measured by night work history and duration. Circadian dysfunction was characterized by excessive daytime sleepiness (EDS). The diagnosis of CSU was made by dermatologists who were investigating on the spot. The effect size was expressed as odds ratios (ORs). Results: A total of 8,057 participants were recruited, and 7,411 (92%) with complete information were included in the final analyses. The prevalence rates of CSU for workers without night shift and those with night shift history were 0.73 and 1.28%, respectively. Compared with workers who never worked night shifts, the risk of CSU increased with the length of night shift work: OR = 1.55 (95% confidence interval [CI]: 0.78-3.06) for duration <5 years and OR = 1.91 (95% CI: 1.12-3.26) for duration ≥5 years. EDS s EDS has been shown to modify this combination. Among workers without EDS, there was no association between night shift and CSU (OR = 0.94; 95% CI: 0.49-1.79). Whereas, in participants with EDS, the correlation was significant (OR = 3.58; 95% CI: 1.14-11.20). However, the effect modification by sleep disturbance was not observed. Conclusions: Night shift work is a risk factor for CSU, and there is a dose-response relationship between night shift work hours and the risk of CSU. This connection may be modified by circadian dysfunction.

Understanding the association between sleep, shift work and COVID-19 vaccine immune response efficacy: Protocol of the S-CORE study.

This protocol describes an innovative study to investigate the relationship between sleep, shift work and the immune response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) vaccination. As the COVID-19 pandemic is a global crisis with devastating health, social and economic impacts, there is a pressing need for effective vaccination programmes. Previous influenza and hepatitis vaccination studies suggest that lack of sleep can negatively alter immune responsiveness, while circadian misalignment most likely may also play an important role in the immune response to vaccination. Our present study will be the first to address this question in actual shift workers and in relation to COVID-19 vaccination. We hypothesise that the occurrence of recent night shifts and diminished sleep will negatively alter the immune response to vaccination in shift workers compared to dayworkers. We aim to recruit 50 shift workers and 50 dayworkers. Participants will receive an mRNA-based vaccination, through the Dutch vaccination programme. To assess immune responsiveness, blood will be drawn at baseline (before first vaccination), 10 days after first vaccination, the day prior to the second vaccination; and 28 days, 6 and 12 months after the second vaccination. Actigraphy and daily sleep e-diaries will be implemented for 7 days around each vaccination to assess sleep. The Pittsburgh Sleep Quality Index will be used to monitor sleep in the long term. Optimising the efficacy of the COVID-19 vaccines is of outmost importance and results of this study could provide insights to develop sleep and circadian-based interventions to enhance vaccination immunity, and thereby improve global health.

Anxiety and COVID-19 Related Stressors Among Healthcare Workers Who Performed Shift Work at Four COVID-19 Dedicated Hospitals in Korea.

OBJECTIVE: To assess the relationship between anxiety and shift work of healthcare workers (HCWs) during COVID-19 pandemic. METHODS: From four COVID-19-dedicated hospitals in Korea, 381 HCWs were analyzed to estimate anxiety in relation to four COVID-19 job stressors and the impact of shift work on this relationship. Anxiety was measured with a generalized anxiety disorder 7-item scale. Multiple logistic regression models were utilized after stratification by sex, occupation, and shift work, after adjusting for a number of variables. RESULTS: Anxiety prevalence was 32%. Among female nurses or nursing assistants who performed shift work, anxiety risk was significantly associated with three COVID-19 related job stressors: contact with confirmed cases or patients, dealing with unpleasant patients, and discomfort from wearing protective equipment. CONCLUSIONS: Special attention is required for mental health of HCWs working shifts during the COVID-19 pandemic.

Adaptive staffing can mitigate essential worker disease and absenteeism in an emerging epidemic.

Essential worker absenteeism has been a pressing problem in the COVID-19 pandemic. Nearly 20% of US hospitals experienced staff shortages, exhausting replacement pools and at times requiring COVID-positive healthcare workers to remain at work. To our knowledge there are no data-informed models examining how different staffing strategies affect epidemic dynamics on a network in the context of rising worker absenteeism. Here we develop a susceptible-infected-quarantined-recovered adaptive network model using pair approximations to gauge the effects of worker replacement versus redistribution of work among remaining healthy workers in the early epidemic phase. Parameterized with hospital data, the model exhibits a time-varying trade-off: Worker replacement minimizes peak prevalence in the early phase, while redistribution minimizes final outbreak size. Any "ideal" strategy requires balancing the need to maintain a baseline number of workers against the desire to decrease total number infected. We show that one adaptive strategy-switching from replacement to redistribution at epidemic peak-decreases disease burden by 9.7% and nearly doubles the final fraction of healthy workers compared to pure replacement.

Constructing high-quality rest facilities to maximise performance and ensure patient safety.

INTRODUCTION: Junior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds to create high-quality rest facilities and improve junior doctor well-being. METHODS: An audit and survey in KGH identified the structural and functional improvements needed. From November 2019 to June 2020, £47 841.24 was spent on creating new rest facilities. On completion, a postaction review assessed how the changes impacted morale, well-being and quality of patient care. RESULTS: The majority of doctors were happy with the new rest areas (60%), a majority felt that they would use the on-call room area (63%) and the renovation improved morale and well-being. There was an increased ability to take breaks. However, the majority of doctors are not exception-reporting missing breaks: 79% (2019), 74% (2020). CONCLUSIONS AND IMPLICATIONS: This report recommends the maintenance of increased staffing levels and rest facilities during the recovery phase of COVID-19. The remaining £12 958.76 should be directed at sustaining the quality of KGH rest facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities ensures workforce well-being and translates into patient safety.

Protocol for a randomised controlled trial on the feasibility and effects of 10-hour time-restricted eating on cardiometabolic disease risk among career firefighters doing 24-hour shift work: the Healthy Heroes Study.

INTRODUCTION: Career firefighters experience chronic circadian rhythm disruption, increasing their risk of cardiometabolic disease. The recent discovery that eating patterns regulate circadian rhythmicity in metabolic organs has raised the hypothesis that maintaining a consistent daily cycle of eating and fasting can support circadian rhythms and reduce disease risks. Preclinical animal studies and preliminary clinical trials have shown promising effects of time-restricted eating (TRE) to reduce disease risk without compromising physical performance. However, there is a lack of research on TRE in shift workers including firefighters. This study aims to investigate the feasibility and efficacy of 10-hour TRE on health parameters that contribute to cardiometabolic disease risks among career firefighters who work on a 24-hour shift schedule. METHODS AND ANALYSES: The Healthy Heroes Study is a randomised controlled parallel open-label clinical trial with 150 firefighters over 1 year. Firefighters are randomised with a 1:1 ratio to either the control or intervention group. The control group receives Mediterranean diet nutritional counselling (standard of care, 'SOC'). The intervention group receives the same SOC and a self-selected 10-hour TRE window. After the 2-week baseline, participants enter a 3-month monitored intervention, followed by a 9-month self-guided period with follow-up assessments. The impact of TRE on blood glucose, body weight, body composition, biomarkers (neuroendocrine, inflammatory and metabolic), sleep and mood is evaluated. These assessments occur at baseline, at the end of intervention and at 6, 9 and 12-month follow-ups. Temporal calorie intake is monitored with the smartphone application myCircadianClock throughout the study. Continuous glucose monitors, wrist-worn actigraphy device and questionnaires are used to monitor glucose levels, activity, sleep and light exposure. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Boards of the University of California San Diego and the Salk Institute for Biological Studies. Results will be disseminated through peer-reviewed manuscripts, reports and presentations. TRIAL REGISTRATION NUMBER: NCT03533023; Pre result.

Shift work is associated with positive COVID-19 status in hospitalised patients.

INTRODUCTION: Shift work is associated with lung disease and infections. We therefore investigated the impact of shift work on significant COVID-19 illness. METHODS: 501 000 UK Biobank participants were linked to secondary care SARS-CoV-2 PCR results from Public Health England. Healthcare worker occupational testing and those without an occupational history were excluded from analysis. RESULTS: Multivariate logistic regression (age, sex, ethnicity and deprivation index) revealed that irregular shift work (OR 2.42, 95% CI 1.92 to 3.05), permanent shift work (OR 2.5, 95% CI 1.95 to 3.19), day shift work (OR 2.01, 95% CI 1.55 to 2.6), irregular night shift work (OR 3.04, 95% CI 2.37 to 3.9) and permanent night shift work (OR 2.49, 95% CI 1.67 to 3.7) were all associated with positive COVID-19 tests compared with participants that did not perform shift work. This relationship persisted after adding sleep duration, chronotype, premorbid disease, body mass index, alcohol and smoking to the model. The effects of workplace were controlled for in three ways: (1) by adding in work factors (proximity to a colleague combined with estimated disease exposure) to the multivariate model or (2) comparing participants within each job sector (non-essential, essential and healthcare) and (3) comparing shift work and non-shift working colleagues. In all cases, shift work was significantly associated with COVID-19. In 2017, 120 307 UK Biobank participants had their occupational history reprofiled. Using this updated occupational data shift work remained associated with COVID-19 (OR 4.48 (95% CI 1.8 to 11.18). CONCLUSIONS: Shift work is associated with a higher likelihood of in-hospital COVID-19 positivity. This risk could potentially be mitigated via additional workplace precautions or vaccination.

Pediatric Residents' Perception of Medical Education, General Wellness and Patient Care Following the Shortening of Shifts during the COVID-19 Pandemic.

BACKGROUND: The effect of extended shift length on pediatric residency is controversial. Israeli residents perform shifts extending up to 26 hours, a practice leading to general dissatisfaction. In early 2020, during the coronavirus disease-2019 (COVID-19) pandemic, many Israeli hospitals transitioned from 26-hour shifts to 13-hour shifts in fixed teams (capsules) followed by a 24-hour rest period at home. The regulation changes enacted by the Israeli government during the COVID-19 pandemic provided a rare opportunity to assess perception by residents regarding length of shifts before and after the change. OBJECTIVES: To assess perception of pediatric residency in three aspects: resident wellness, ability to deliver quality healthcare, and acquisition of medical education following the change to the shorter shifts model. METHODS: We performed a prospective observational study among pediatric residents. Residents completed an online self-assessment questionnaire before and after the COVID-19 emergency regulations changed toward shorter shifts. RESULTS: Sixty-seven residents answered the questionnaires before (37) and after (30) the shift changes. The average score was significantly better for the 13-hour shifts versus the 26-hour shifts, except for questions regarding available time for research. There was a positive perception regarding the shorter night shifts model among pediatric residents, with an increase in general satisfaction and improvement in perception of general wellness, ability to deliver quality healthcare, and medical education acquisition. CONCLUSIONS: Following the change to shorter shift length, perception of pediatric residents included improvement in wellness, ability to deliver quality healthcare, and availability of medical education.

Shift work is associated with increased risk of COVID-19: Findings from the UK Biobank cohort.

Despite the strong evidence on circadian rhythm disruption in shift workers and consequent increased vulnerability for infection, longitudinal association between shift work and COVID-19 infection is unexplored. In this study, data from UK Biobank participants who were tested for COVID-19 infection (16 March to 7 September 2020) were used to explore the link between shift work and COVID-19 infection. Using the baseline occupational information, participants were categorised as non-shift workers, day shift workers, mixed shift workers and night shift workers. Multivariable regression models were used to assess the association between shift work and COVID-19 infection. Among the 18,221 participants (9.4% positive cases), 11.2% were health workers, and 16.4% were involved in shift-work-based jobs. Ethnic minorities (18%) and people in night-shift-based jobs (18.1%) had a significantly higher prevalence of COVID-19 infection than others. Adjusted logistics regression model suggest that, compared with their counterparts, people employed in a night-shift-based job were 1.85-fold (95% CI: 1.42-2.41) more likely to have COVID-19 infection. Sensitivity analysis focusing on people working in a non-healthcare setting suggests that people in shift-work-based jobs had 1.81-fold (95% CI: 1.04%-3.18%) higher odds of COVID-19 infection than their counterparts. Shift workers, particularly night shift workers, irrespective of their occupational group, seem to be at high risk of COVID-19 infection. If similar results are obtained from other studies, then it would mandate to revisit the criteria for defining high-risk groups for COVID-19 and implementing appropriate interventions to protect people in shift-based jobs.

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.