Day Shift Research Articles

Sex difference in cardiac performance in individuals with irregular shift work

Background: sex differences existed in animal behavioral adaption and activity rhythms when exposed to chronic disruption of the circadian rhythm. Whether these differences extend to cardiac performance has not been fully investigated by cardiac imaging technology. MethodsOne hundred and thirty patients enrolled in this study. Patients were divided into the day shift (DS) group and the irregular shift (IRS) group based on whether involved in the night shift and the frequency of the night shift. Comparisons of clinical data and cardiac imaging parameters were performed to identify the sex difference in cardiac function in the participants with day shift work or irregular shifts. ResultsThe absolute value of GLS was significantly lower in male IRS group than in male DS group. In females, no significant difference was tested in left ventricular function between the two groups. In male participants, Weekly work hours (WWH) was positively correlated with HR (r = 0.51, p = 0.02) and QTc duration (r = 0.68, p < 0.00), and weakly negatively correlated with the GLS (r = -0.38, p = 0.05). Amongst patients, there was a 2.67-fold higher relative risk (RR) for impaired GLS in males than in females, with a 95 % confidence interval (CI) of 1.20–5.61. Moreover, there was an increased risk in the male IRS group compared to the female IRS group to develop impaired GLS (RR:3.14, 95 % CI 1.20–7.84). ConclusionsThe present study suggests that chronic circadian disruption brings cardiac dysfunction in people with night-shift work. Gender differences exist in the impact of circadian rhythmicity on cardiac function and may help to guide the work schedule and breaks in shift workers and bring forward prevention strategies in response to chronic circadian disruption.

Association of breakfast skipping with habitual dietary intake and BMI in female rotating shift workers.

Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers. Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants. A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20-59 years, working at 346 institutions. A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis. The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality. Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.

0025 Circadian Dysregulation of Human DNA Repair Genes and Elevated DNA Damage in Simulated Night Shift Schedule

Abstract Introduction Circadian misalignment from night shift (NS) work is associated with increased risk of cancer. In a simulated NS study, we sought to investigate the potential role of circadian disruption of cancer hallmark pathway genes. Methods N=14 healthy adults (aged 22-34) participated in a laboratory study. Seven were assigned to a simulated day shift (DS) schedule involving 3 days of daytime wakefulness (06:00-22:00); the other seven were assigned to a simulated NS schedule involving 3 days of nighttime wakefulness (18:00-10:00). Subjects then underwent a 24-hour constant routine protocol, during which blood was collected at 3-hour intervals. Leukocytes extracted from blood were subjected to transcriptomics using the NanoString nCounter PanCancer Pathways panel augmented with canonical clock genes. Statistical analysis involved mixed-effects cosinor analysis followed by functional enrichment analysis of rhythmic genes. Leukocytes were also subjected to endogenous DNA damage assessment through alkaline comet and immunofluorescence assays. Furthermore, exogenous DNA damage from exposure to ionizing radiation was investigated for blood collected at opposite times of day (07:30 and 19:30) based on DNA damage biomarkers assessed with immunofluorescence and immunoblot assays. Results Transcriptomics data showed that the simulated NS schedule, as compared to the simulated DS schedule, significantly altered the endogenous circadian rhythmicity of genes involved in cancer hallmark pathways, as measured under constant routine. A DNA repair pathway showed enrichment of rhythmic genes following the DS schedule (P&amp;lt;0.05), but not following the NS schedule. Functional assessments revealed that the NS schedule was associated with increased endogenous DNA damage, as evidenced by alkaline comet assay (P&amp;lt;0.001) and increased BRCA1 foci (P&amp;lt;0.01) and γH2AX foci by immunofluorescence assay (P&amp;lt;0.001). After exposure to ionizing radiation, there were increased BRCA1 foci (P&amp;lt;0.01) and γH2AX foci by immunofluorescence assay (P&amp;lt;0.005) and elevated DNA damage response signaling biomarkers by immunoblot assay, especially in the samples collected at 19:30. Conclusion These results suggest that a NS schedule causes circadian dysregulation of DNA repair genes and increases DNA damage – a primary hallmark of carcinogenesis – which may underlie the elevated cancer risk in NS workers. Support (If Any) WSU, CHHE P30ES025128, USAMRDC W81XWH-18-1-0100, NIH R01ES030113 and R21CA227381, CDMRP CA171123, DOE BRAVE DE-AC05-76RL01830.

Executive Performance Is Associated With Rest-Activity Rhythm in Nurses Working Rotating Shifts.

PurposeRest-activity rhythms (RAR) is one of the most fundamental biological patterns that influence basic physical and mental health, as well as working performance. Nowadays, with the utilization of actigraphy device in detecting and analyzing RAR objectively, evidence has confirmed that RAR could be interrupted by shift work. Nurses need to participate shift work in their daily routine. The aim of the present study is to identify the RAR of nurses working rotating shifts and find out the relationship between RAR and executive function.MethodsA total of 11 female nurses on day-shift (DS), 11 female nurses on rotating-shift (RS) were recruited. Demographic features, non-parametric variables of RAR as well as sleep variables according to actigraphy data, and a series of cognitive function evaluations during work time were collected.ResultsThe Student’s t-test comparison revealed that RS group nurses showed significant shorter total sleep time (TST), lower level of interdaily stability (IS) and relative amplitude (RA), as well as poorer executive performance compared with DS nurses. The linear regression analysis demonstrated that several aspects of executive performance such as choice reaction test (CRT) (reflecting attention and concentration) and trail making test (TMT) -B (reflecting cognitive flexibility) were associated with IS in RS group nurses.ConclusionThese results elucidated that RAR was disrupted for nurses working rotating shifts, and executive performance was associated with IS from day to day in nurses working rotating shifts.

Atividade física e fatores associados à ideação suicida em policiais militares de Sergipe, Brasil

This study aimed to analyse the association between anthropometric characteristics, occupational status, physical activity level, and suicidal ideation among military police in Aracaju and the Metropolitan Region, Brazil. 254 active male and female military policemen, aged between 21 and 55 years, participated in the study. 254 military police participated in the study. Data were collected through Google Forms, containing questions about sociodemographic, anthropometric, occupational characteristics, and risk behaviours. Military officers with less service were four times more likely to experience profound sadness in the past 12 months (OR = 0.22; 95% CI 0.09-0.51), and older officers three times more likely (OR = 3.12; 95% CI 1.64-7.97). Police officers who worked alternate day shifts were four times more likely to have planned suicide in the past 12 months (OR = 4.67; 95% CI 1.08-20.16), and police officers with less time on duty had seven times more chances (OR = 0.13; 95% CI 0.26-0.64). It is observed that labour characteristics are associated with suicidal ideation. It is also perceived that physical activity is a protective factor against profound sadness.

Exploring the dream pattern among the nightshift workers: A qualitative study

Nightshift workers are increasing day by day, but many times, people forget the health and sleep effects caused by the nightshift. One such impact is the altered circadian rhythm, which is very important for proper functioning of the body and a good sleep. This altered circadian rhythm can have an impact on waking and sleep life of the nightshift workers. This qualitative study is to find the dream pattern among the nightshift workers and to find the frequency in dreaming among this group. Dreams are the reflections of the waking life and dream patterns are seen among groups sharing similar wake life experiences. This study is conducted with nine nightshift and nine dayshift workers, dream journal was used to collect the dreams from the participants. The frequency of dreaming is seen more among the nightshift workers. The dream patterns among both the groups are similar but there are dreams that make the nightshift group different from the dayshift. The dreams of the nightshift group includes mainly their friends and the feelings of being stuck/in danger. Also, their dreams were more fantastic in nature and have more emotional content. The study shows that sexual dreams are seen majorly among the nightshift group. This finding can be further used to conduct researches on the impact of nightshift on the sexual health and overall well being of nightshift workers and the reflection of the same in their dreams.

Circulating Exosomal miRNAs Signal Circadian Misalignment to Peripheral Metabolic Tissues

Night shift work increases risk of metabolic disorders, particularly obesity and insulin resistance. While the underlying mechanisms are unknown, evidence points to misalignment of peripheral oscillators causing metabolic disturbances. A pathway conveying such misalignment may involve exosome-based intercellular communication. Fourteen volunteers were assigned to a simulated day shift (DS) or night shift (NS) condition. After 3 days on the simulated shift schedule, blood samples were collected during a 24-h constant routine protocol. Exosomes were isolated from the plasma samples from each of the blood draws. Exosomes were added to naïve differentiated adipocytes, and insulin-induced pAkt/Akt expression changes were assessed. ChIP-Seq analyses for BMAL1 protein, mRNA microarrays and exosomal miRNA arrays combined with bioinformatics and functional effects of agomirs and antagomirs targeting miRNAs in NS and DS exosomal cargo were examined. Human adipocytes treated with exosomes from the NS condition showed altered Akt phosphorylation responses to insulin in comparison to those treated with exosomes from the DS condition. BMAL1 ChIP-Seq of exosome-treated adipocytes showed 42,037 binding sites in the DS condition and 5538 sites in the NS condition, with a large proportion of BMAL1 targets including genes encoding for metabolic regulators. A significant and restricted miRNA exosomal signature emerged after exposure to the NS condition. Among the exosomal miRNAs regulated differentially after 3 days of simulated NS versus DS, proof-of-concept validation of circadian misalignment signaling was demonstrated with hsa-mir-3614-5p. Exosomes from the NS condition markedly altered expression of key genes related to circadian rhythm in several cultured cell types, including adipocytes, myocytes, and hepatocytes, along with significant changes in 29 genes and downstream gene network interactions. Our results indicate that a simulated NS schedule leads to changes in exosomal cargo in the circulation. These changes promote reduction of insulin sensitivity of adipocytes in vitro and alter the expression of core clock genes in peripheral tissues. Circulating exosomal miRNAs may play an important role in metabolic dysfunction in NS workers by serving as messengers of circadian misalignment to peripheral tissues.

Study on the influence and intervention strategy of nursing staff rushing to plateau on sleep quality

Objective To understand the changing characteristics of sleep quality of acute plateau nursing staff during the period of assistance to Tibet, formulate comprehensive intervention measures, improve the support ability of nursing staff, and provide the basis for effectively completing the work of plateau assistance to Tibet. Methods From November to December 2017, 12 nurses who participated in the assistance work for Tibet in Lhasa region with an altitude of 3,650 m were selected as the emergency group, and 12 nurses from a hospital in Tibet were selected as the plateau group. Pittsburgh sleep quality index (PSQI) was used to investigate the sleep quality of the acute group before and after Tibet entry and the plateau group respectively. A sleep quality survey scale was designed to investigate the sleep quality of nursing staff in the emergency group and the plateau group at 5 different shifts on the same night after admission to Tibet. Results The scores of total sleep score, sleep quality, sleep time, sleep time, sleep efficiency and daytime dysfunction in the acute group were 3.77±1.79, 0.89±0.47, 0.78±0.36, 0.76±0.41, 0.19±0.05, 0.54±0.07, and 5.37±1.23, 1.57±0.36, 1.53±0.43, 1.21±0.38, 0.72±0.10, 0.99±0.91 respectively. The differences before and after Tibet were statistically significant (t=2.327-4.399, P <0.05).The scores of sleep time, sleep time, sleep efficiency and sleep disorder in the acute group were 1.53±0.43, 1.21±0.38, 0.72±0.19, 1.16±0.21, and 1.04±0.21, 0.86±0.32, 0.39±0.31 and 0.76±0.33 respectively. The differences between the two groups were statistically significant (t=2.441-3.547, P<0.05 or 0.01).Radical groups after Tibet plateau and nursing staff sleep quality scale scores compare, radical group day shift, middle shift, night after night under three different shifts the total score of sleep quality, respectively 11.76±0.12, 11.98±0.23, 12.43±0.52, higher than that of plateau group 11.18±0.04 11.23±0.57, 11.98±0.54, the difference between two groups was statistically significant (t=15.554, 4.227, 2.07, P<0.01 or 0.05). The sleep quality score (11.38±0.36) in the night of the rest class was lower than that of the plateau group (11.92±0.38), and the difference was statistically significant (t=-3.574, P=0.002). The score of sleep quality and sleep delay of the acute group were 1.87±0.57, 1.93±0.61, and 1.39±0.39, 1.25±0.42 respectively. The difference between the two groups was statistically significant (t=2.408, 3.181, P< 0.05 or 0.01). Conclusions It is a common sleep problem for medical and nursing personnel in Tibet who rush into the plateau. Comprehensive intervention measures should be taken in advance, scientific popularization, education and health technical guidance should be carried out in the early stage, mental health conditions should be improved, and drug prevention should be taken when necessary to help medical and nursing personnel in Tibet sleep quality. Key words: Into the plateau; Nursing staff; Quality of sleep; Intervention strategy

Pattern of shiftwork and health status among nurses in a university hospital in northeastern Thailand

This study was aimed to explore shiftwork patterns and health status among nurses at a university hospital in northeastern Thailand. A descriptive study was conducted. The study population was 1,221. The data were collected via self-reported questionnaire including personal information and the last month shift schedule. Descriptive statistics were applied using STATA v 10. The response rate was 68.1 % (831/1,221) and completion rate was 59.1% (721/1,221). There were 82.2% (593/721) participants had performed shiftwork. The shiftwork patterns were (a) day shift plus over time, (b) day and evening shift, (c) day and night shift, and (d) rotational shift. All of rotational shift were fast rotation with irregular shift pattern (n=531; 89.5%). Even though there was no pure forward or backward rotations, the researcher divided the participants into three groups (namely, primarily forward, primarily backward, and evenly split between backward and forward). Most shift workers performed primarily backward rotational pattern (n=479; 90.2%). A minority (n=143; 24.1%) did extended shifts: median extended shift was once a month (IQR 1-3). The majority (n=523; 88%) of participants did quick return shifts (88%) (median=11 times/month, IQR7-13) Nearly one-third (28.0%) of participants had underlying diseases such as allergic rhinitis (7.9%), asthma (1.9%), and/or dyslipidemia (1.8%). Based on a BMI > 25 kg/m2, 17.5 % of the participants were obese. Over one-tenth (12.2%) of the participants had a sleep disorder and 14.9% used sleepiness- or drowsiness-inducing medication. Most of the participants had no depression (86.4%) and were at low risk of obstructive sleep apnea (76.0%). Comparing characteristics of shift and non-shift personnel, median age, proportion of married nurses and caffeine needed were lower for shift workers than the non-shift workers. Working experiences were shorter in shift workers than the non-shift workers and there was a statistically significant difference among job position, task, work unit, and salary. Likewise, shift workers had fewer underlying diseases, using sleepiness or drowsiness drug and depression. In conclusion, there was a high proportion of shift workers represented in the study, and most nurses did rotational shift with primarily backward rotation, quick return and extended shifts which are associated with a higher health risk. The health effect from shiftwork on the current study could not be concluded however, nearly one-third revealed some kinds of underlying diseases. The association of effect from shiftwork will be presented elsewhere.

Abstract 4159: Circadian clock protects against radiation-induced dermatitis and cardiomyopathy in mice

Abstract Radiation therapy (RT) is commonly used in cancer treatment. Despite technological advances to improve precision external-beam RT in treating breast, lung, and esophageal tumors, a substantial number of patients receive radiation to their hearts and the external skin region. This radiation insult results in acute and chronic toxicities including dermatitis and cardiomyopathy, affecting the patient's quality of life and survival. Hence, reducing toxicities associated with RT are desirable outcomes. With the knowledge that the natural circadian clock, present in almost every cells of the body including the skin and heart, regulates DNA repair, cell death and proliferation, and cardiac function processes, we hypothesize that molecular defensive mechanisms of the circadian system play regulatory roles to minimizing RT-induced skin and heart toxicity in cancer patients. To investigate acute toxicity of RT, studies were performed using SKH-1 hairless mice with healthy clock (wild-type day shift (DS)) and environmentally disrupted clock (wild-type rotating shift (RS) and genetically disrupted clock (Per1/2 knockout (Per1/2-/-)) conditions. We treated all groups (n=9 mice per group) with a single dose RT (6 grays of ionizing radiation) to the whole body. We used body weight as an indicator of overall toxicity, red spots as a measure of dermatitis, and left ventricular ejection fraction (LVEF) by ultrasound echocardiography as a readout for cardiomyopathy, relative to the measurements pre-RT as controls. After sacrifice, genotoxicity was detected using alkaline comet assay in PBMCs. Worse toxicities were observed until 2 weeks post-RT in mice with circadian clock disruption compared to mice with healthy clocks. Body weights of the disrupted clock groups were significantly reduced by up to 10% on day 2, unlike the DS group which reduced by only 2%. However, there was body weight loss recovery from day 6 in clock disrupted mice but this recovery was not sustained in Per1/2-/- mice. Dermatitis was counted where visible and there was 2.4- and 1.7- fold increases in RS and Per1/2-/- mice compared to DS mice. In the heart, LVEF was significantly decreased in RS and Per1/2-/- mice by days 1 and 4, and began to recover by day 8 in RS. Comparatively, the LVEF in DS mice was not significantly reduced. On a cellular level, genotoxicity in blood cells were significantly increased in RS and Per1/2-/- mice relative to DS mice. Taken together, these findings strongly suggest that the healthy circadian clock protects the whole body, skin, and heart from RT-induced toxicity. Future work includes mechanistic understanding of how the natural circadian clock system can be harnessed to minimize toxicity against RT. The successful completion of this project will provide a novel mechanistic understanding into the protective role of the circadian clock against acute and chronic skin and heart toxicities for cancer patients undergoing RT. Citation Format: Panshak P. Dakup, Kenneth I. Porter, Zhaokang Cheng, Shobhan Gaddameedhi. Circadian clock protects against radiation-induced dermatitis and cardiomyopathy in mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4159.

Clinical female nurses' five-tone distribution and analysis of traditional Chinese medicine constitution

Objective To explore the five-tone distribution of clinical female nurses and the constitution of Traditional Chinese Medicine (TCM) . Methods Totally 300 clinical female nurses from a Class Ⅲ Grade A hospital were selected. Zhiji Wenyin identification evaluator (KY3H) was used to identify their five tones, and the TCM Constitution Classification and Identification Scale developed by China Association of Chinese Medicine was used to identify their TCM constitution. The five-tone distribution and TCM constitution were compared between the nurses with different ages, job categories and shifts. Results The tones of Jue, Zhi and Yu accounted for 39%, 34% and 21.4% respectively of the five-tone distribution in the 300 clinical female nurses. Divided by age, the tone of Yu was more often found in the younger group, while the tone of Jue had a larger share in the older group (χ2=13.014, 4.719; P<0.05) . The tones of Yu and Jue were more often found in the night shift group than in the day shift group (χ2=5.902, 3.985; P<0.05) . As for the TCM constitution, the mildly, yang-insufficiency, qi-stagnation and damp-heat constitutions accounted for 31.33%, 21.67%, 11.67% and 11.00%, respectively. The nurses in the internal medicine group showed a higher proportion of qi-stagnation and blood-stasis constitutions than the nurses in the surgery group (χ2=6.478, 5.902; P<0.05) . The nurses in the day shift group showed a higher proportion of mildly constitution than the nurses in the night shift group, while the nurses in the night shift group showed a higher proportion of qi-insufficiency constitution than the nurses in the day shift group (χ2=6.210, 5.270; P<0.05) . The tone of Zhi had the largest share in the nurses with the qi-insufficiency constitution (P=0.002) , while the nurses with the qi-stagnation constitution had the least share among the nurses with the tone of Yu (P=0.045) . Conclusions The characteristics of five-tone distribution and TCM constitution of clinical female nurses may be affected by their age and job category. Key words: Nurses; Five tones correlated with five zang viscera; Constitution identification; The Canon of Internal Medicine

A Comparative Study of Shift Work Effects and Injuries among Nurses Working in Rotating Night and Day Shifts in a Tertiary Care Hospital of North India.

Background:Shift work can have an impact on the physical and psychological well-being of the healthcare worker, affecting patients as well as their own safety at the workplace. This study was conducted to compare the health outcomes and injuries, along with associated risk factors between the nurses working in rotating night shift (RNS) as compared to day shift (DS) only.Materials and Methods:It was a cross-sectional study conducted from June to November 2016 in a tertiary care hospital of Delhi. It involved 275 nurses working in RNS and 275 nurses from DS of various departments, selected through simple random sampling. Standard Shift Work Index Questionnaire (SSI) was used as the study instrument, with selected variables (according to objectives of the study). Data were analyzed using descriptive statistics, Chi-square, t-test, and multivariate regression.Results:Female nurses had more sleep disturbance, fatigue, and poor psychological health. Working on a contractual basis, RNS, and living outside the hospital campus were associated with higher odds of having needle stick injury (NSI). The nurses working in RNSs were found to have significantly lower mean scores in job satisfaction (p = 0.04), sleep (p < 0.001), and psychological well-being (p = 0.047) as compared to DS workers.Conclusions:Health outcomes among nurses working in RNSs call for the interventions, focused on various factors which can be modified to provide supportive and safer working environment.

The correlation of serum concentration of copper and prevalence of depressive mood in psychiatric night shift nurses

Objective The aim of this study was to investigate the correlation of serum copper levels and mental health in psychiatric shift nurses. Methods The participants were divided into day shift nurses (control group,n=60) and night shift nurses (n=60) . The concentrations of trace mineral, serum biochemical levels, inflammatory and oxidative markers in blood samples of 120 shift nurses were measured. The depressive mood was measured with second edition of Chinese version of the Beck Depression Inventory,(BDI-Ⅱ) . Results The night shift nurses showed moderate-to-severe depression levels, which were significantly higher than those of the day shift nurses, 23.3% (14/60) and 11.7% (7/60) vs. 6.7% (4/60) and 1.7% (1/60) ,χ2=6.536, 4.82,P < 0.05. Night-shift nurses also had higher levels of serum copper, hs-CRP, IL-6, T-SOD and Cu-Zn SOD than the control group, (19.57±4.14) μmol/L vs. (18.03±3.20) μmol/L, 1.32 (0.78-1.89) mg/L vs.0.89(0.45-1.44) mg/L, 68.54 (51.43-96.78) ng/L vs. 56.39 (35.56-78.71) ng/L, (66.78± 14.72) kU/L vs. (47.32±17.84) kU/L, (54.22±14.91) kU/L vs. (48.17±17.23) kU/L,t=-3.133~-2.057,P < 0.01 or 0.05. BDI-Ⅱscores correlated positively with serum copper, hs-CRP, IL-6, T-SOD and Cu-Zn SOD,r=0.248-0.457, all P <0.01. In night shift group, multivariate regression analysis showed that serum copper, hs-CRP, IL-6 and T-SOD (β=0.097-5.340,P<0.01 or 0.05) were independently related factors influencing BDI-Ⅱ scores (R2 = 0.609,P = 0.000) . Conclusions Serum copper may serve as an evaluation index for depressive mood in psychiatric shift nurses, and serum copper concentrations in night shift nurses should be monitored regularly. Clinical Trial Registry Chinese Clinical Trial Registry, ChiCTR-OOC-14005540. Key words: Psychiatric; Night shift; Nurse; Depressive mood; Copper

Influencing factors for needlestick injuries in student nurses

To investigate the needlestick injuries in student nurses during nine months of in-ternship in our hospital, and reveal the high-risk periods, risk procedures, and influencing factors for needlestick injuries, and explore the prevention approaches. Three hundred and fifty student nurses who interned at our hospital from April to December 2014 and from July 2014 to March 2015 were surveyed using self-de-signed questionnaires. Three hundred and forty questionnaires were recovered and 334 out of them were valid. Data were collected and questionnaires were analyzed. The incidence of needlestick injuries was 60.8%; the incidence of needlestick injuries was substantially higher at the early stage than at the late stage of the internship, and higher in the day shift than in the night shift. Moreover, the incidence of needlestick injuries was the highest during the removal of a syringe or infusion needle, accounting for 24.3% of the total incidence. Some other significant factors for needlestick injuries in student nurses included education level, reports on oc-cupational exposure, constant update of nursing knowledge, regular hematological examination, and relevant training experiences. According to 61.7% of student nurses, clinical operations were affected due to underlying concern about needlestick injuries. More attention should be paid to high incidence of needlestick injuries in student nurses, especially at the early stage of their internship. To reduce the incidence of needlestick injuries, education on occupational protection should be given to student nurses in advance, and the pre-job training should be enhanced.

Analysis of the status quo of pediatric nursing post setting of 7 hospitals

Objective We tried to investigate the current status of pediatric nursing post setting and analyze the practical application effect in the clinical working practice for the foundation of readjusting and setting up the pediatric nursing positions. Methods By convenient sampling method, the general condi-tion and current post setting situation in the pediatric wards of 7 hospitals with self-designed questionnaires were investigated. The results underwent analysis Results The nursing post setting in pediatric wards of 7 hospitals were not all the same, nursing posts in the pediatric ward included three categories: management positions, teaching positions and clinical positions. Management positions included the head nurse, deputy head nurse and head nurse assistant; teaching positions included the teaching secretary and clinical total teaching nurse; the seven kinds of clinical nursing positions were office job, day shift, night shift, evening shift, midnight shift, late-morning shift, auxiliary job. Though some nursing jobs differed in the position names and working hours, their job contents were nearly identical. Conclusions Pediatric nursing post setting management in our country is still in the exploratory stage at present, it has not form a unified per-fect job management system. Pediatric nursing positions should be set from the perspective of evidence-based theory, satisfying the demands of patients as the guidance, coming from clinical needs as the first principle, in the full implementation of the accountability for nursing and based on comprehensive consid-eration of various factors, so that the post setting can be scientific and reasonable. Key words: Pediatrics; Nursing management; Post setting; Status quo

Status of nurse staffing and nursing care delivery in Pudong, Shanghai.

Abstract Aim To evaluate nurse staffing levels and nursing care delivery in adult general medical or surgical wards of hospitals in the Pudong district of Shanghai, China. Background Rapid economic development and improved Chinese living standards have spurred increased demands for high quality health care. Thus, the quality of nursing services has become a focus of attention. Design A cross-sectional, descriptive design was used for the study. Methods We used an anonymous survey to collect data from 1614 nurses from 98 wards in seven general hospitals in Pudong, Shanghai. Results During day shifts, the nurse-to-patient ratios were >1:10. However, these ratios were much higher during evening and night shifts. The clinical front-line nursing workforce primarily consisted of nurses with junior college degrees that had limited working experience. Junior nurses with different educational backgrounds, professional levels, and work experiences were assigned almost similar nursing care work as senior nurses. Conclusions In the surveyed hospitals in the Pudong district, nurse staffing levels and skill mix may be inadequate to meet the increasing demands of patient care. The clinical nursing workforce needs to be strengthened and used effectively to enhance the quality and safety of patient care. Relevance to clinical practice We should focus on the quantity and quality of the nursing workforce, as well as nursing skill utilization.

Retrospective analysis of monitoring of death patients and the time of death and nursing countermeasures in ICU

Objective To analyze the ICU death patient monitoring time,to explore the impact factors of time monitoring and put forward nursing countermeasures ; To analyze the distribution of death time of the patients and make preventive measures.Methods The medical history and the data of 52 death patients from July 2011 to July 2012 were retrospectively analyzed.Results The incidence and mortality of nosocomial infection in the three groups patients including intensive care time ≤ 1 day,from 2 to 7 days and ≥7 days were different,and the difference was statistically significant (x2 =6.741,P ＜ 0.05).The longer intensive care time,the higher incidence and mortality of nosocomial infection.The death cases were similar in the day shift and night shift,and the difference was not statistically significant (P ＞ 0.05).The time of death focus on each class after hand-over 2 hours.Conclusions Managers should take effective measures to prevent the occurrence of nosocomial infection.To standardize access and exit in ICU and to control the residence time of ICU patients,so as to reduce the infection and mortality.In this study,the time of death was concentrated in the shift time,managers should take corresponding nursing countermeasures,increase the force of nursing,timely detect changes in condition,so as to reduce the patients' death. Key words: ICU; Intensive care time; Impact factors; Time of death

Effects of shift changes on female workers at a dish factory.

This study investigated the effects of working night shifts on social and family life by examining changes in workers' daily life before and after a change in their shifts. Subjects were 40 women aged 27-59 years, working at a dish factory. During the health examination of night workers in autumn of 2000, the subjects were directly interviewed about changes in their lives induced by the shift change. Question parameters consisted of 8 items including 30 sub-items related to social and family life, such as sleep, rest, meals, sports, family time, hobbies, neighborhood association and social activities. The subjects selected one of four response categories: "becoming worse", "no change", "becoming better" and "difficult to determine." With regard to the percentage of "becoming worse", meal-related items ranked high in all of the shift types. "Family time" and "hobbies" showed high percentages in the subjects transferring from day shifts to night shifts, and in those transferring from early-morning shifts to night shifts. "Rest", "sports" and "hobbies" showed high percentages in the subjects transferring from night shifts to midnight shifts. Decreased sleeping hours were confirmed in all of the shift types, while the subjects tended to sleep more soundly. As the workers transfer to shifts at earlier hours, they were obliged to make sacrifices in various aspects of their social and family life. Therefore, much assistance in this regard should be given to them.

Study and practice on nursing skills training methods under 24 hours shift system

Objective To explore a new training method of nursing skills under 24 hours shift system in the practical training base in the college. Methods The practical training base in the college was rebuilt into a simulated hospital. 120 three-year-course nursing students in grade 2007 were divided into the control class and the experimental class with 60 students in each class. The control class adopted routine teaching method, including teacher demonstration, single project training, concentrated training before clinical practice. The experimental class participated in the tutoring mode of nursing skills under 24 hours shift system in simulated hospital. The cases were pre-designed and students acted as patients by tums. One teacher led 4 students into nursing skill training by day shift, evening shift and mid-night shift. The teaching effect was compared between two classes. Results There was significant difference between the two groups in comprehensive technique test and graduation theoretical test score. Clinical nursing teachers thought the skill training in simulated hospital under 24 hours shift system can help students prepare for the nursing work in hospital ahead of time and improve their comprehensive capability. Conclusions Training mode of nursing skills in simulated hospital under 24 hours shift system is feasible for enhancing nursing skills. Key words: Nursing skill; Practical training base; 24 h shift system

The intervention on hand hygiene to improve the compliance of hands disinfection in a neonatal intensive care unit

Objective To evaluate the effectiveness of hand hygiene management in the neonatal intensive care unit and find the right way to increase hand hygiene compliance. Methods The intervention measures of hand hygiene were established and video monitor was used to observe different contact ways during 13 months. Results The hand hygiene compliance increased after hand hygiene intervention (from 25.15%pre-intervention to 88.20% post-intervention). The hand hygiene compliance of nursing workers was relatively lower than that of doctors and nurses after intervention (65.94% , 74.72% and 77.02% respectively). In addition, the hand hygiene compliance of nurses and nursing workers on the night shift was lower than that in the day shift. Conclusions The hand hygiene intervention can effectively improve hand hygiene compliance. Key words: Hand hygiene; Neonatal intensive care unit; Compliance