Assessing Chronotypes by Ambulatory Circadian Monitoring.

In order to develop objective indexes for chronotype identification by means of direct measurement of circadian rhythms, 159 undergraduate students were recruited as volunteers and instructed to wear ambulatory circadian monitoring (ACM) sensors that continuously gathered information on the individual's environmental light and temperature exposure, wrist temperature, body position, activity, and the integrated TAP (temperature, activity, and position) variable for 7 consecutive days under regular free-living conditions. Among all the proposed indexes, the night phase marker (NPM) of the TAP variable was the best suited to discriminate among chronotypes, due to its relationship with the Munich ChronoType Questionnaire (ß = 0.531; p < 0.001). The NPM of TAP allowed subjects to be classified as early- (E-type, 20%), neither- (N-type, 60%), and late-types (L-type, 20%), each of which had its own characteristics. In terms of light exposure, while all subjects had short exposure times to bright light (>100 lux), with a daily average of 93.84 ± 5.72 min, the earlier chronotypes were exposed to brighter days and darker nights compared to the later chronotypes. Furthermore, the earlier chronotypes were associated with higher stability and day-night contrast, along with an earlier phase, which could be the cause or consequence of the light exposure habits. Overall, these data support the use of ACM for chronotype identification and for evaluation under free living conditions, using objective markers.

Antioxidant dietary fiber isolated from spent coffee (Coffea arabica L.) grounds improves chronotype and circadian locomotor activity in young adults.

Chrononutrition, or the circadian timing of food intake, proposes that nutrients, bioactive compounds, and foods modulate the peripheral clocks with implications on health. We evaluated the effects of biscuits supplemented with the antioxidant dietary fiber isolated from spent coffee grounds as a food ingredient (SCF-B) or a combination of spent coffee grounds and fructooligosaccharides (SC-FOS-B), and a traditional recipe (TB, without added fiber) on the modulation of circadian rhythm in young adults. The repeated intake (21 days/45 g portion) of SCF-B or SC-FOS-B decreased (p < 0.05) the evening chronotypes. SCF-B and SC-FOS-B consumption enhanced the chronodisruption associated with colonic short chain fatty acid production, thus improving the quality and length of sleep. This is the first study on the positive impact of antioxidant dietary fiber obtained from spent coffee grounds on circadian activity improvement in young adults. Further clinical trials and the role of other bioactive compounds as therapeutic candidates for health disturbances related to circadian dysfunction are necessary to confirm the results.

Percepción sobre la calidad de los cuidados, entorno laboral y características del sueño de las enfermeras que trabajan en el Sistema Nacional de Salud / Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System

OBJETIVO: Describir la percepción de las enfermeras sobre la calidad de los cuidados que prestan y de su entorno laboral, así como analizar las características del sueño. Analizar si existe relación entre la unidad y el turno de trabajo con la percepción de las enfermeras de su entorno laboral y con la calidad de sueño y la somnolencia diurna. MÉTODO: Estudio multicéntrico, observacional, descriptivo realizado entre los años 2012 y 2014 en 7 hospitales españoles del Sistema Nacional de Salud que mostraron su interés por participar en este proyecto de seguimiento. Se ha medido el entorno laboral, la satisfacción laboral, la calidad del sueño y la calidad de los cuidados con herramientas validadas. RESULTADOS: Participaron en el estudio 635 enfermeras. Un 83,7% percibía la calidad de los cuidados como buena/excelente, y el 55,1% valoró el entorno laboral de su hospital como bueno/excelente. El PES-NWI clasificó al 39% de los hospitales como desfavorable y al 20% como favorable. El 15,4% de las enfermeras tenía alto nivel de burnout y el 58,3% bajo. La calidad del sueño fue de 6,38 para el turno de día, de 6,78 para el turno rotatorio y de 7,93 para el turno de noche. Se encontraron diferencias en la calidad subjetiva, en la duración, en las perturbaciones del sueño y en la disfunción durante el día. CONCLUSIONES: En la prestación de cuidados de calidad interactúan multitud de factores como el turno, la unidad, la satisfacción, la percepción de la seguridad y la calidad del sueño

OBJECTIVE: To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. METHODS: A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. RESULTS: 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. CONCLUSIONS: In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality

Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System. / Percepción sobre la calidad de los cuidados, entorno laboral y características del sueño de las enfermeras que trabajan en el Sistema Nacional de Salud.

OBJECTIVE: To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. METHODS: A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. RESULTS: 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. CONCLUSIONS: In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality.

Nurses' sleep quality, work environment and quality of care in the Spanish National Health System: observational study among different shifts.

OBJECTIVE: The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. METHODS: This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1 years, their average work experience was 16.4 years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. RESULTS: 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). CONCLUSIONS: Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers.

Protecting the melatonin rhythm through circadian healthy light exposure.

Currently, in developed countries, nights are excessively illuminated (light at night), whereas daytime is mainly spent indoors, and thus people are exposed to much lower light intensities than under natural conditions. In spite of the positive impact of artificial light, we pay a price for the easy access to light during the night: disorganization of our circadian system or chronodisruption (CD), including perturbations in melatonin rhythm. Epidemiological studies show that CD is associated with an increased incidence of diabetes, obesity, heart disease, cognitive and affective impairment, premature aging and some types of cancer. Knowledge of retinal photoreceptors and the discovery of melanopsin in some ganglion cells demonstrate that light intensity, timing and spectrum must be considered to keep the biological clock properly entrained. Importantly, not all wavelengths of light are equally chronodisrupting. Blue light, which is particularly beneficial during the daytime, seems to be more disruptive at night, and induces the strongest melatonin inhibition. Nocturnal blue light exposure is currently increasing, due to the proliferation of energy-efficient lighting (LEDs) and electronic devices. Thus, the development of lighting systems that preserve the melatonin rhythm could reduce the health risks induced by chronodisruption. This review addresses the state of the art regarding the crosstalk between light and the circadian system.