Consecutive Shifts Research Articles

The association of schedule characteristics of heavy vehicle drivers with continuous eye-blink parameters of drowsiness

Study objectivesWhile drowsiness contributes to 20% of heavy vehicle crashes, the impact of work schedules on heavy vehicle driver (HVD) drowsiness is unclear. This study explored the impact of work schedules on drowsiness (measured by infrared oculography) in HVDs. MethodWork and drowsiness monitoring (Optalert, Australia) of ten HVDs, aged 37–62 years collected nearly 2430 h of work and 1068 h of oculography data during four weeks of naturalistic drives. Drowsiness events were defined as a John's Drowsiness Scores ≥ 2.6. Nine HVDs slept for 5.82 ± 1.37 h during five weeks of actigraphy. Association of driving schedule characteristics and drivers’ continuous eye-blink parameters were observed using logistic and mixed linear regression analyses. ResultsCombination of time of day (10 pm- 2 am), shift start time (2 pm-3 pm), hours into the shift (16–21 h), break duration (7–9 h), and sleep time (<6 h) increased the likelihood of drowsiness events when controlling for other covariates. A combination of night times (6 pm to 2 am), 18 to 21 h into the shift, shift start times (6 am to 7 am), shifts lengths (8 to15 h) and break times (<7 to 9 h) increased the hourly rate of drowsiness significantly when adjusting for other covariates. ConclusionsThe combination of prolonged work hours, night-time drives, early-morning shift starts and short breaks increase drowsiness rates in HVDs. Large datasets are needed to examine the interplay between sleep time, consecutive shifts and shift order and type with this combination.

Skin and respiratory exposure to soluble lead, cobalt, nickel, copper, arsenic and silver at two South African precious metals refineries.

Precious metals refinery workers are exposed to soluble platinum group metals (PGMs) during PGM-refining but may also be exposed to hazardous non-PGMs (Pb, Co, Ni, Cu, As and Ag) still present in the matte following base metals refining. The aim of this article was to report the skin and respiratory exposure of workers to soluble non-PGMs during PGM-refining. Skin and respiratory exposure (of 40 workers at two precious metals refineries) were measured simultaneously over two consecutive shifts. Skin exposure was measured on the palm, wrist, neck and forehead using Ghostwipes™ and respiratory exposure was measured using the MDHS method 46/2 during which soluble metals were extracted using 0.07M HCl and mechanical agitation, followed by ICP-MS analysis. The geometric means (GM) of average skin exposure to individual soluble metals on all anatomical areas was found in the order Cu (0.018µg/cm2) > Ni (0.016µg/cm2) > Pb (0.008µg/cm2) > Ag (0.006µg/cm2) > As (0.004µg/cm2) > Co (0.0008µg/cm2) with the palm being the highest exposed anatomical area. The order of the GM respiratory exposure was Pb (0.224µg/m3) > Ag (0.201µg/m3) > Cu (0.159µg/m3) > As (0.079µg/m3) > Ni (0.034µg/m3) > Co (0.016µg/m3) with exposure to As exceeding the South African occupational exposure limit (20µg/m3) during concentrate handling (max 66.174µg/m3). Workers were exposed to a mixture of toxic PGM and non-PGMs via the skin and inhalation. Exposure to these metals could lead to the development of diseases, such as contact dermatitis, occupational allergy, or occupational cancer. Non-PGMs must be included in hazardous chemical risk assessments and control strategies implemented at precious metals refineries.

Do employees’ work schedules put them at-risk? The role of shift scheduling and holidays in predicting near miss and incident likelihood

Introduction: Using crew scheduling and injury incident data from a Fortune 500 manufacturing company, this study analyzed the effect of consecutive shifts and shifts near holidays on near misses and incidents. Methods: Logistic regressions were conducted with consecutive workdays, days near holidays, and time of shift as predictors of incident and near miss outcomes. Results: The logistic regression analysis indicated that working consecutive day shifts increases the probability of an incident occurring, with the fourth consecutive shift resulting in the most risk. The consecutive shift pattern did not replicate to employees working the night shift. However, the first and second shifts when transferring to a night schedule appear to have a greater chance of incident. Shifts near holidays did not have a significantly higher risk than other shifts. Practical application: The current research suggests that organizations can use similar analytic techniques to determine if shift scheduling might be related to increased risk and allocate resources to mitigate hazards during those peak probability shifts.

Changes in the Work Schedule of Nurses Related to the COVID-19 Pandemic and Its Relationship with Sleep and Turnover Intention.

Background: This study aimed to investigate whether different types of changes in the work schedule of nurses working rotating shifts during the COVID-19 pandemic were associated with sleep duration, sleep quality, and turnover intention. Methods: Cross-sectional questionnaire data from 694 nurses participating in the SUrvey of Shift work, Sleep and Health (SUSSH) were collected between the first and the second wave of the COVID-19 pandemic in Norway. A total of 89.9% were female, and mean age was 44.6 years (SD = 8.6 years). Changes in the shift work schedule related to the pandemic comprised reports of more long workdays (>8 h), less days off between work periods, more night shifts, more quick returns (i.e., 11 h or less between two consecutive shifts), more day shifts, and more evening shifts compared to no change in the respective shift characteristics. Change in sleep duration, sleep quality, and turnover intention as well as demographics were also assessed. Logistic regression analyses were performed to investigate whether changes in the specific work schedules were associated with sleep duration, sleep quality, and turnover intention, controlling for sex, age, cohabitation, children living in household, percentage of full time equivalent and other changes in the work schedule. Results: A total of 17% reported experiencing one or more changes in their work schedule during the pandemic. Experiencing any change in the work schedule predicted worse sleep quality (OR = 2.68, p < 0.001), reduced sleep duration (OR = 4.56, p < 0.001), and higher turnover intention (OR = 1.96, p = 0.006) compared to experiencing no change in work schedule. Among the specific changes in work schedules, experiencing an increase in quick returns had the highest odds ratio for worse sleep quality (OR = 10.34, p = 0.007) and higher turnover intention (OR = 8.49, p = 0.014) compared to those who reported no change in quick returns. Nurses experiencing an increase in long workdays were more likely to report higher turnover intention (OR = 4.37, p = 0.003) compared to those experiencing no change in long workdays. Conclusions: Change in work schedule related to the pandemic was associated with worse sleep quality, reduced sleep duration, and higher turnover intention. Increase in quick returns emerged as especially problematic in terms of sleep quality and turnover intention, along with long workdays, which were associated with higher turnover intention.

The 12-Hour Nursing Shift: Preferred by Staff, but Good for Patients?

A new study finds reduced communication skills after consecutive shifts but no clinical deficits.

Extended Work Shifts Increase Subjective Pain Complaints Among Cabin Crewmembers, but Not Among Airline Pilots or Healthcare Workers: A Repeated-Measures Study.

To determine whether four consecutive extended work shifts are associated with an increased risk of subjective pain complaints, sleep duration, and sleep disturbances. Forty-three healthcare workers, 41 cabin crewmembers, and 18 airline pilots working 4 consecutive extended workdays reported subjective pain complaints and sleep after the 1st and 4th workday. The risk of headache (odds ratio [OR] 21.4, 95% confidence interval [CI] 1.85 to 246.5) and pain in the hands, arms, or wrists (OR 3.78, 95% CI 1.84 to 7.76) increased after workday 4 versus workday 1 in cabin crewmembers. Sleep duration was longer (0.6 to 1.1 hours), and sleep disturbances fewer, the night before the fourth extended workday, compared with before the first workday, in all occupations. We found no general support for an association between extended work shifts and subjective pain, whereas sleep duration was improved, and sleep disturbances reduced after 4 consecutive extended workdays.

Night work, chronotype and cortisol at awakening in female hospital employees

To examine the effect of night shift on salivary cortisol at awakening (C1), 30 min later (C2), and on the cortisol awakening response (CAR, the difference between C2 and C1). We compared shift and non-shift workers with a focus on the impact of worker chronotype. Our study included 66 shift-working females (mean age = 37.3 years, SD = 10.2) and 21 non-shift working females (mean age = 47.0 years, SD = 8.9). The shift workers collected their saliva samples at C1 and C2 on each two consecutive day shifts and night shifts. Non-shift workers collected their samples on two consecutive day shifts. We applied linear mixed-effects models (LMM) to determine the effect of night shift on CAR and log-transformed C1 and C2 levels. LMMs were stratified by chronotype group. Compared to non-shift workers, shift workers before day shifts (i.e. after night sleep) showed lower cortisol at C1 (exp (widehat{beta })=0.58, 95% CI 0.42, 0.81) but not at C2. In shift workers, the CARs after night shifts (i.e. after day sleep) were lower compared to CARs before day shifts (widehat{beta }= − 11.07, 95% CI − 15.64, − 6.50). This effect was most pronounced in early chronotypes (early: widehat{beta }= − 16.61, 95% CI − 27.87, − 5.35; intermediate: widehat{beta }= − 11.82, 95% CI − 18.35, − 5.29; late: widehat{beta }= − 6.27, 95% CI − 14.28, 1.74). Chronotype did not modify the association between night shift and CAR. In our population of shift workers, there was a mismatch between time of waking up and their natural cortisol peak at waking up (CAR) both during day and night shift duties.

Estimating hourly work schedule risk in railway traffic controllers

Around-the-clock staffing in safety-critical environments calls for an accurate risk assessment of work schedules. In this paper we introduce and evaluate an hourly version of the “Risk Index”, an established risk model in the UK rail industry. This “Hourly Risk Index” is the first risk-based model that allows the prediction of risk at the hourly level, and is founded on the most recent scientific insights in fatigue-related accident risk. It considers the build-up of risk over consecutive shifts, recovery during days off, quick returns, and time-of-day and time-on-duty effects. Improved understanding of hourly risk is highly relevant for both ex-ante (staff rostering) and ex-post (accident and incident analysis) evaluations. We evaluated the performance of the Hourly Risk Index by analyzing a purpose-built real-world dataset from Belgium’s railway traffic control centers (containing close to 8 million round-the-clock working hours in the period 2013–2018). Results not only show that the occurrence of safety-critical errors is significantly associated with higher Hourly Risk Index values, but also that error severity is significantly related to a further increase in risk. In addition, the Hourly Risk Index outperformed the original Risk Index. Our empirical results also emphasize the importance of job demands, by indicating a higher performance of the Hourly Risk Index under conditions of low or high workload. Given these outcomes, it is currently being deployed and tested at Belgian national railways. This should allow the further refinement of the Hourly Risk Index in an iterative manner.

Physiological Demands of Common Occupational Tasks among Australian Police Officers: A Descriptive Analysis

ObjectivesThe aim of this study was to investigate the physiological demands placed on Australian police officers carrying out common operational tasks.MethodsForty participants (n = 40) from an Australian police force (mean age = 33.58 ± 7.78 years, mean height = 177.70 ± 7.28 cm, mean weight = 85.68 ± 14.52 kg, mean years of service: 6.74 ± 6.29 years) were recruited through preidentified local area commands. Spanning nine police stations from the same Australian state, volunteers wore monitoring devices to collect physiological measures (heart rate, respiratory rate, and skin temperature) throughout the course of four consecutive shifts (two day shifts and two night shifts). Descriptive data were recorded and analyzed by task and changes in physiological measures.ResultsOf the 345 duty calls attended by participants, the four most commonly reported tasks were as follows: ‘check bona fides’ (n = 76; 22%), ‘driving urgently’ (n = 45; 13%), ‘attending a domestic incident’ (n = 37; 10%), and ‘attending a concern for welfare’ (n = 30; 8%). Mean percentages of maximum heart rates (%HRmax) were considered of very light exercise intensity and ranged from 47.11 (± 7.18) to 50.15 (± 9.35) % for checking bona fides through to driving urgently respectively. Fifteen percent of tasks attended had officers exceed 100 %HRmax (near maximal to maximal exercise intensity). Mean skin temperatures varied little (36.02–36.27°C) between tasks, while mean respiratory rates were lowest when attending a domestic incident and highest when driving urgently (22.56 ± 3.83 and 24.72 ± 6.12 breaths/min, respectively).ConclusionPolice officers experienced numerous physiological challenges ranging from an intensity of very light exercise through to near maximal and maximal exercise throughout their working day with occasions where their heart rates exceeded 100 %HRmax. These findings highlight the physiological stress associated with common occupational policing tasks, highlighting the importance of cardiovascular health in police officers and the need for cardiovascular monitoring and conditioning.

Virtual reality during work breaks to reduce fatigue of intensive unit caregivers: A crossover, pilot, randomised trial

PurposeIntensive care unit (ICU) caregivers are exposed to high levels of stress. Work-related stress can impact quality of life and may lead to burnout. Virtual reality (VR) simulates a person's presence in a pleasant and enjoyable artificial environment. Thus, VR may be used to improve breaktime efficacy during the work shift of ICU caregivers. ObjectiveThe study objectives were to evaluate the feasibility and efficacy of VR to decrease stress, anxiety, and fatigue, as well as to increase work disconnection during the breaktime. MethodsWe conducted a prospective, monocentric, open-label, crossover, randomised study comparing a half an hour breaktime including an 8-min-long VR session and a usual breaktime among ICU caregivers, on two consecutive work shifts. Participants were evaluated before and after the breaktime as well as at the end of the work shift for stress, anxiety, fatigue, and work disconnection using visual analog scales. ResultsFor the 88 participants, VR was easy to use. VR induced a significantly higher reduction in the fatigue score after the breaktime. Individual changes in the fatigue score were +0.17 (1.87) vs. −0.33 (1.87). A significantly higher feeling of disconnection from the work environment at the end of the breaktime was also observed with VR: 5.98 (3.04) vs. 4.20 (2.64). No significant difference was observed for other parameters, in particular at the end of the shift. ConclusionVR sessions could improve the efficacy of breaktimes among ICU caregivers and contribute to a better quality of work life; repeated or longer sessions may be required to induce sustained effects.

Relationship Between Coping Styles and Blood Pressure in the Staff of Covid-19 Wards of Hospitals of Kermanshah University of Medical Sciences During 2020 - 2021

Background: With the global outbreak of Covid-19 at the beginning of 2020, the staff of hospitals involved in the care for the Covid-19 patients underwent great physical and psychological pressure. Objectives: This study was conducted to determine the correlation between coping styles and blood pressure in the staff of Covid-19 centers during 2020 - 2021. Methods: A total of 278 medical staff of Kermanshah University of Medical Sciences who were serving in the Covid-19 wards during 2020 - 2021 were recruited in this cross-sectional correlational study. The ways of coping questionnaire (Lazarus and Folkman, 1985) was used to assess the coping strategies. The blood pressure of the personnel was measured after three consecutive shifts. Data were analyzed by SPSS-20 software using descriptive and inferential statistics. Results: Among the coping styles used by the staff, the highest score (17.9 ± 4.4) was reported for planful problem-solving. The results showed a significant and positive correlation between emotion-oriented coping styles and blood pressure, while problem-oriented coping styles had a negative correlation with blood pressure. Conclusions: Emotion-oriented coping styles have a positive and significant correlation and problem-oriented coping styles have a negative and significant correlation with the increased blood pressure of employees. The relationship between coping styles in medical staff in different wards and the application of coping styles in medical assistants in different educational levels and specialties are suggested to be evaluated.

An Evaluation of Sleepiness, Performance, and Workload Among Operators During a Real-Time Reactive Telerobotic Lunar Mission Simulation.

We assessed operator performance during a real-time reactive telerobotic lunar mission simulation to understand how daytime versus nighttime operations might affect sleepiness, performance, and workload. Control center operations present factors that can influence sleepiness, neurobehavioral performance, and workload. Each spaceflight mission poses unique challenges that make it difficult to predict how long operators can safely and accurately conduct operations. We aimed to evaluate the performance impact of time-on-task and time-of-day using a simulated telerobotic lunar rover to better inform staffing and scheduling needs for the upcoming Volatiles Investigating Polar Exploration Rover (VIPER) mission. We studied seven trained operators in a simulated mission control environment. Operators completed two five-hour simulations in a randomized order, beginning at noon and midnight. Performance was evaluated every 25 minutes using the Karolinska Sleepiness Scale, Psychomotor Vigilance Task, and NASA Task Load Index. Participants rated themselves as sleepier (5.06 ± 2.28) on the midnight compared to the noon simulation (3.12 ± 1.44; p < .001). Reaction time worsened over time during the midnight simulation but did not vary between simulations. Workload was rated higher during the noon (37.93 ± 20.09) compared to the midnight simulation (32.09 ± 21.74; p = .007). Our findings suggest that work shifts during future operations should be limited in duration to minimize sleepiness. Our findings also suggest that working during the day, when distractions are present, increases perceived workload. Further research is needed to understand how working consecutive shifts and taking breaks within a shift influence performance.

The influence of shift work on the psychomotor capabilities of emergency medicine residents.

ObjectiveShift work affects health status of healthcare providers and patients. We assessed the effect of shift work on psychomotor activities of emergency medicine residents of 3 university hospitals.MethodsThe participants were enrolled to perform selected psychomotor tests via the Vienna test system (VTS) after written consent. They passed 4 episodes of test performance before and after 2 consecutive day and night clinical shifts of 12 hours. The status of general health, circadian rhythm, sleepiness, smoking habits, and the scores of the cognition test (COG), the determination test (DT), and the visual pursuit test of emergency medicine residents were compared before and after morning and night shifts.ResultsOverall, 23 residents (34.8% were male) performed tests. The mean (SD) age was 35.7 + 8.5 years. The mean general health and circadian scores before and after day/night shifts were not different. The Stanford sleepiness scale showed higher scores after night shifts. In the cognition test, the sum of correct rejections was higher after day shifts. Moreover, in the DT results, correct responses were more prevalent, the omitted responses were fewer accompanied by better median reaction time after day shifts. The sum of correct rejections of the COG test showed difference in terms of improved results in night tests compared to day‐shift tests. The mean reaction time of the DT showed significant difference with shorter reaction time in night‐shift tests. The visual pursuit test results were not different between day and night shifts.ConclusionsSleepiness was higher after night shifts. The results of selected psychomotor tests showed that the psychomotor function of the residents was not delayed or worse after night shifts in comparison to the day shifts.

A comparison of occupational physical activity and sedentary behavior patterns of nurses working 12-h day and night shifts.

Past studies have reported nurses working day shifts engage in high amounts of light and moderate-intensity occupational physical activity. However, little is known regarding how occupational physical activity and sedentary behavior is accumulated within shifts and/or over consecutive shifts. This study compared occupational physical activity and sedentary behavior patterns of nurses working 12-h. day vs. 12 -h. night shifts. We hypothesized nurses working day shifts would be more active and less sedentary while at work compared to nurses working night shifts and that within shift and between shift differences would emerge. Prospective-cohort study design. Midwestern trauma one academic medical center medical units (medical surgical, critical care, pediatrics, mother and baby, and other). A total of 56 registered nurses working 12-h. day and night shifts participated in this study. Occupational physical activity and sedentary behaviors (e.g., step count, time spent sitting, standing, and walking) were measured for 14 continuous days using the ActivPAL 3 micro activity monitor. Repeated measures mixed-effects regression models were used to examine the effects of shift type, consecutive shifts, and time within a shift on occupational physical activity and sedentary behaviors. Nurses spent more time standing and walking, and less time sitting overall during day shifts compared to night shifts. Nurses walked less during the third consecutive night shift and stood less and sat more during the second and third consecutive night shifts, compared to day shifts. Nurses tended to walk less and sit more during the middle portion of each night shift compared to day shifts. Our findings suggest nurses spend more than half of each shift either standing or walking and that differential patterns of occupational physical activity and sedentary behavior exist between day and night shifts. These findings should be used to inform future interventions designed to advance the health and work performance of nurses.

P133 Backward Rotating Shifts are Associated with Real-Time Drowsiness During Daytime Drives in Heavy Vehicle Drivers

Abstract Purpose While 10–20% of heavy vehicle crashes (HVDs) are drowsiness-related, the contributions of subsequent shifts to chronic drowsiness in HVDs is largely unknown. Eye-blink parameters indicate driver drowsiness reliably. This study examined the association of consecutive shifts and real-time drowsiness in HVDs. Methods Habitual sleep-wake of HVDs (all males, aged 49.5 ± 8 years) was monitored objectively (Philips Actiwatch, N=15) for 5 weeks (5.75± 1.4 hours). Johns Drowsiness Score (JDS, a composite eye-blink parameter in one-min intervals) was monitored for 4 weeks in HVDs (N=14) using an infrared oculography (Optalert, Melbourne, Australia) device. We assessed the association of drowsiness events (JDS equal or larger than 2.6) with consecutive shift types via mixed linear regression models. Results Eigth consecutive shifts increased drowsiness by 1.06 times compared to 2 shifts (8.37 events/h vs 6.77 events/h, P= 0.03). Consecutive shift sequences included afternoons (9%), mornings (29%), nights (5%), mixed rotating shifts (28%), forward-rotating shifts (11%) and backward-rotating shifts (12%). Drowsiness event rates were 1.23 times greater during night consecutive shifts relative to afternoon shifts (8.37 events/h vs 6.67 events/h, P= 0.03). Backward-rotating shifts (morning-night-evening- afternoon) elevated daytime drowsiness between 10 am and 3 pm by 1.55 times (10.01 events/h vs 6.47 events/h, P= 0.016). Conclusions Regardless of the number of consecutive shifts, sequential night shifts increase real-time drowsiness in HVDs, with backward rotating shifts resulting in higher rates of drowsiness events during daytime. The interaction of schedule features should inform the work scheduling of HVDs to reduce the risk of drowsiness.

Social Determinants of Health in Maternity Care: A Quality Improvement Project for Food Insecurity Screening and Health Care Provider Referral.

Purpose: This quality improvement project evaluated implementation of social determinants of health screening and referral for food insecurity.Methods: Four obstetric providers used study-developed resources to screen and refer English-speaking patients (n=14) during clinic visits. Providers and patients completed post-visit questionnaires. Provider feedback informed improvements to the intervention approach for consecutive study shifts.Results: Providers and patients reported high satisfaction with encounters. Referrals were made for four patients. Challenges to implementation included resource organization, time constraints, and integration into clinic workflow.Conclusion: Processes for universal screening and tailored information provision are areas to continue to strengthen for establishing equitable health care.

Ultrafine PdRu Nanoparticles Immobilized in Metal–Organic Frameworks for Efficient Fluorophenol Hydrodefluorination under Mild Aqueous Conditions

Ultrafine PdRu Nanoparticles Immobilized in Metal–Organic Frameworks for Efficient Fluorophenol Hydrodefluorination under Mild Aqueous Conditions

Optimization of shift cycles in the South African mining sector

Increased depths of conventional gold and platinum mines, longer travelling times as working places move further from the shaft, and ancillary activities taking place in the mining cycle reduce the useable time spent at the workface. Current shift lengths of 8 hours 20 minutes may no longer be adequate to complete required mining activities.The impact of mineworker commuting times on shift work is also not well understood. The aim of this research was to draft a framework to optimize shift cycles in order to maximize productivity, health, safety, and wellness in the South African mining sector. The framework was informed by a review of the literature, case studies at a local gold mine and platinum mine, and a workshop with industry experts. The findings indicate potential advantages of extended shift lengths and continuous operations, such as improved productivity, asset utilization, and employee morale. However, concerns included fatigue and the associated safety hazards, particularly when working longer shifts, night shifts, and numerous consecutive shifts. Job demands, personal factors, and commuting times are further considerations when scheduling shifts. The ideal shift system for the mining sector should holistically consider and balance operational requirements, health and safety, and employees' and their families' requirements, and suit the unique needs of each operation. Changes in shift cycles will require a structured change management process, which involves all stakeholders, and could help to enhance the viability of the South African mining sector.

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study

BackgroundHealthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied. ObjectiveTo determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures. DesignA quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested). SettingParticipants were tested in a northwestern US university's nursing simulation laboratory. ParticipantsA volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals. MethodsSimulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness. ResultsIn our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors. Conclusions and RelevanceNurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts—if any—on patient care.Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

Sugarcane Workweek Study: Risk Factors for Daily Changes in Creatinine

IntroductionAgricultural workers laboring in thermally stressful environments are at increased risk for kidney injury and chronic kidney disease of unknown origin (CKDu), and their environmental and occupational exposures have been considered to be important risk factors. This study examined the effects of repeated kidney stress from the simultaneous strain of work and other factors experienced by workers in Guatemala during a typical workweek.MethodsWe collected data from 107 sugarcane workers across 7 consecutive work shifts. Data included information on daily occupational, meteorological, environmental, and lifestyle factors. We used multivariable linear mixed models to evaluate associations of these factors with percent change in creatinine.ResultsWe observed that increasing wet bulb globe temperature (β = 2.5%, 95% confidence interval [CI] = 0.3%, 4.7%) and increasing diastolic blood pressure (β = 6.2%, 95% CI = 0.9%, 11.6%) were associated with increases in creatinine across the shift, whereas consumption of water from chlorinated dormitory tanks as compared to artesian well water (β = −17.5%, 95% CI = −29.6%, −5.4%) and increasing number of rest breaks (β = −5.8%, 95% CI = −9.0%, −2.6%) were found to be protective against increases in creatinine. Workers reporting drinking tank water had lower concentrations of urine creatinine−corrected arsenic, lead, uranium, and glyphosate compared to workers reporting the use of well water or municipal water.ConclusionThese results reinforce the need to focus on preventive actions that reduce kidney injury among this worker population, including strategies to reduce heat stress, managing blood pressure, and examining water sources of workers for nephrotoxic contaminants.