Shift work and risk of chronic kidney disease: A systematic review and meta-analysis.

What is the nature of sleep and circadian rhythm health on gastrointestinal microbiota? A systematic review of studies in humans.

This cross-sectional study assesses cardiovascular disease (CVD) risk factors in industrial rotating night shift and day workers. We examined 27 day workers; 40 night shift workers with high and 34 with low night loads. We assessed sleep, blood pressure (BP), pulse wave velocity (PWV), carotid intima-media thickness (cIMT), maximal oxygen uptake (V̇O2max), glycosylated haemoglobin (HbA1c), lipids, focusing on inflammatory markers, and adipokines. High load night shift workers had higher inflammation and lower adiponectin level compared to other shift workers and day workers. Night shifts of 8 and 12 hours shortened sleep. Number of night shifts was positively associated with inflammatory markers and negatively associated with adiponectin. Night shift work is associated with CVD risk factors. Shift schedules with fewer night shifts and longer recovery periods could mitigate it.

Shift work and the risk of incident hospital-treated infections: quantifying the role of lifestyle factors.

Paramedics face unique occupational hazards, including high operational demands, trauma exposure, and shift work, all of which impact mental well-being. Suboptimal sleep is also common in this workforce and closely linked to adverse mental health outcomes. This scoping review synthesizes evidence to date on interventions to support paramedic mental well-being including sleep-based interventions. This review was pre-registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/7VSD9). Systematic database searches were conducted in October 2024 for original research published after 2004. Data were narratively synthesised, and findings reported following established guidelines. Nineteen sources were included, involving 1,067 participants across seven countries. Seventeen interventions were examined, predominantly via randomized controlled trials (58%), utilizing a total of 43 different measurement scales to evaluate mental health and sleep outcomes. Interventions included psychological (37%), sleep, fatigue and/or shift work (32%), and complementary and alternative medicine (32%) approaches which primarily focussed on the individual-level (94%). Studies were limited by sample sizes, design and quality, limited long term follow-up, and low baseline symptoms. This review highlights a critical gap in robust, evidence-based, system-level interventions to address poor sleep and mental well-being in paramedics. Future research should prioritise co-designed, context-sensitive approaches, ideally integrated within organisational structures to ensure relevance and accessibility.

Author reply to comments on "association between health literacy and behaviors among shift workers: an observational cross-sectional study with mediation analysis."

Association of shift work with body weight, stress, sleep, and dietary intake in prison officers and firefighters.

Background: Hyperuricemia is increasingly recognized as a cardiometabolic risk factor, yet data among Indonesian healthcare workers remain limited. Healthcare workers, particularly those engaged in shift work, are prone to obesity and metabolic disorders that may predispose them to hyperuricemia. Objective: To examine the association between body mass index (BMI) and hyperuricemia among hospital employees. Methods: This analytical observational study, with a cross-sectional design, utilized general check-up data from University of Muhammadiyah Malang Hospital (UMM) (2023–2024). Of 467 employees screened, 67 met the inclusion criteria of complete BMI and serum uric acid data. Hyperuricemia was defined as >7 mg/dL in men and >6 mg/dL in women. Associations between BMI and hyperuricemia were assessed using the chi-square or Fisher’s exact test as an alternative. Results: Among 67 employees (34 males and 33 females), the prevalence of hyperuricemia was 16.4%. It was more common in males (23.5% vs. 9.1% in females) and in employees aged 40–49 years (18.7%). Hyperuricemia prevalence was higher in obese employees (27.8%) compared with non-obese (12.2%), although this association was not statistically significant (p = 0.127). Conclusion: No significant association was found between BMI-defined obesity and hyperuricemia among hospital employees, although a higher prevalence was observed in males, middle-aged groups, and obese individuals. Future occupational health screenings should consider integrating central adiposity indices, such as waist circumference or waist-to-height ratio, to improve the identification of hyperuricemia risk.

Objective: This study investigated the association between self-reported shift work and change in kidney function in women and men in a multi-ethnic cohort. Method: Data from the prospective HELIUS cohort (n=3812 women, 3488 men) including adults from six ethnic backgrounds based in the Netherlands, was used to assess associations between self-reported shift work and change in eGFR and ACR using sex-stratified linear regressions and mediation analyses. Results: Shift work was associated with a significant decline in eGFR but not ACR among men versus non-shift workers. No significant associations were found for change in eGFR or ACR in women overall. No evidence was found for a mediating role of traditional and lifestyle-related CKD risk factors. Conclusion: Shift work may be detrimental to kidney health. Employers and policymakers should consider addressing the potential kidney health risks of shift work, particularly in men.

Objective . We aimed to assess the impact of the adaptation index in relation to dosed physical activity and average daily blood pressure (BP) variability on the risk of heart failure with preserved ejection fraction (HFpEF) in Arctic shift-workers (both men (M) and women (W)), based on the study of 24-hour ambulatory BP monitoring (ABPM), treadmill ergometry, calculation of the adaptation potential (AP) index and echocardiography indicators in groups with low and intermediate probability according to the H2FPEF algorithm. Design and methods . In the Arctic settlement of Yamburg (68° 21' 40" N), 99 M and 81 W with stage 1–2 arterial hypertension (HTN) and normotensive individuals were examined in the medical unit of Gazprom Dobycha Yamburg. They were comparable by age (p = 0,450), shift work experience (p = 0,824), office systolic BP (SBP) (p = 0,251) and diastolic BP (DBP) (p = 0,579). We performed ABPM (BPLab v.3.2, Russia), echocardiography (Phillips CX 50, Netherlands), and a treadmill test (Schiller Cardiovit CS-200, Switzerland) with AP index calculation. Patients were divided into subgroups with low and intermediate probability of HFpEF based on the H2FPEF algorithm (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure) with scoring. Results . Group 1 included 95 patients (52 M and 43 W) with H 2 FPEF score of 0–1, group 2 consisted of 85 patients (47 M and 38 W) with a score of 2–5. In group 2, M and W were more likely to experience tension or poor adaptation to dosed physical activity, and a hypertensive response to exercise was more common. Significantly increased average daily variability in SBP (SBP24) and DBP (DBP24) was observed due to both average daytime and nighttime values. W in group 2 had significantly reduced left ventricular ejection fraction and increased right atrial volume. M of group 2 showed significantly reduced movement velocities of the mitral valve fibrous ring. According to the logistic regression analysis, M in group 2 with a poor adaptation to physical activity and AP index value ≥ 3,1 had a 7,5-fold increased risk of developing HFpEF, and each 1 mmHg increase in DBP24 variability increased the risk by 76 %. In W with an AP index value ≥ 3,1, the probability of developing HFpEF increased by 3,9 times. An increase of 1 mmHg in the SBP24 variability increased the risk of HFpEF by 44,4 %. An increase in nighttime DBP variability also increased the risk by 37,2 %. The model correctly identified distinctive features that increased the likelihood of HFpEF development in M with sensitivity of 76,6 % and specificity of 75,0 %. In W, the model had a sensitivity of 84,2 % and specificity of 81,4 %. Conclusion . In Arctic shifts-workers with HTN, poor adaptation to physical activity and increased average daily BP variability are important factors that increase the risk of HFpEF according to the H 2 FPEF algorithm. These findings suggest a significant role for the autonomic nervous system dysfunction in the development of the disease and warrant further investigation. Our data indicate the need for regular monitoring of high-risk groups in a medical facility and the implementation of preventive and therapeutic measures.

We critically examined the proposal to establish occupational exposure limits (OEL) for psychosocial hazards, evaluating its scientific feasibility, methodological challenges, and implications for occupational health practice. We reviewed the conceptual framework and recommendations by Pauli et al and compared them with established approaches for chemical and physical hazards. Key obstacles were analyzed, including the reliance on latent constructs, terminological ambiguity, and the absence of objective exposure metrics, while considering the advent of the exposome in epidemiology, emerging technologies and political economy factors. Our analysis shows that analogies with physical and chemical OEL offer useful insights but cannot be directly applied to psychosocial hazards. Unlike traditional hazards, psychosocial hazards are context-dependent, socially constructed, and often measured through self-reported surveys, limiting the derivation of adverse effect levels. Current psychosocial models of occupational stress aggregate diverse stressors under broad constructs, impeding actionable risk assessment. While organizational hazards such as shift work and long working hours can be objectively quantified using human resource data and sensors, social and moral dimensions remain elusive. Individual biomarkers might not offer adequate diagnostic value, while using multiple biomarkers in combination introduces challenges related to cost and feasibility. Furthermore, regulatory decisions are shaped by economic interests and stakeholder conflicts, complicating consensus and OEL adoption. A paradigm shift is required: moving from generic theoretical models to specific, measurable indicators, integrating multi-source data, and harmonizing methodologies. Without this transformation, OEL risk over-simplifying complex psychosocial phenomena and failing to achieve meaningful preventive outcomes. For occupational safety and health practice, work organizations should prioritize the more specific identification and measurement of psychosocial hazards, using context-specific data and harmonized methods, to enable more effective risk management and prevention, pending the establishment of formal occupational exposure limits for psychosocial hazards.

ABSTRACT Shift work has been increasingly associated with alterations in immune regulation and stress responses. Circadian alteration, sleep disruption, and occupational stressors collectively impair immune status. However, the specific association between shift work, psychological stress, and the immune function of monocytes, neutrophils and lymphocytes among female nurses is still not clear. The aim of our study is to evaluate the association between shift work, psychological stress, and immune cell functions in female nurses using a within-subject design. A cross-sectional, repeated-measures observational study with a within-subject design was conducted at a tertiary care hospital from March to July 2025 among eight female nurses aged 22–32 y. Blood sampling and psychological stress assessments (Perceived Stress Scale and Copenhagen Psychosocial Questionnaire) were conducted within 2 h after completion of each shift. Monocytes, neutrophils, lymphocytes, and plasma were isolated from the blood of the same participants after each shift for immune marker assessment. Stress scores were significantly higher after night shifts. Night shift samples showed increased oxidative stress and stress-related markers, reduced nitric oxide levels, decreased phagocytic activity, leads towards the pro-inflammatory state along with altered chemokine receptor expression. This study highlights the association between shift work, psychological stress, and altered immune function in female nurses. Lack of sleep data is a limitation, as sleep variability may influence stress and immune responses. Future studies with larger, more diverse cohorts and detailed sleep assessments are needed to confirm these findings across different healthcare settings.

Shift work is associated with various leading causes of premature death, which has been linked with individuals with specific chronotypes. This study synthesized evidence on chronotype's role in associations between ever shift work and health outcomes. Six databases were searched (inception-September 2025) for cohort/case-control studies assessing chronotype-specific shift work impacts on breast/prostate cancer, diabetes mellitus, and mental health. PRISMA guidelines were used for reporting. Fourteen studies were included in the review, comprising 2247 breast cancer cases, 3045 prostate cancer cases, 336 218 participants in diabetes studies, and 2128 poor mental health cases. Compared to daytime workers, both night shift workers with morning or evening chronotypes were more susceptible to breast cancer [morning type: pooled odds ratio (OR) 1.54, 95% confidence interval (CI) 1.01-2.37; evening type: pooled OR 1.41, 95% CI 1.04-1.90) and poor mental health (morning type: pooled OR 1.19, 95% CI 1.12-1.27; evening type: pooled OR 1.11, 95% CI 1.05-1.17]. Notably, night shift workers with evening chronotype were 84% more likely to develop prostate cancer than daytime workers. A positive dose-response relationship was identified between cumulative years of night shifts and prostate cancer among night shift workers with evening chronotype, indicating a 2.1% increase in risk for each additional year (P=0.012). Chronotype-matched scheduling does not effectively mitigate night shift risks. Nevertheless, evening chronotype night shift workers are particularly susceptible to various chronic non-communicable diseases, with a notable positive dose-response relationship observed between prostate cancer and evening chronotype night shift workers.

Association between occupational stress exposure and altered white matter integrity in firefighters.

Sleepiness is a specific aspect of fatigue and considered a key factor linking working time to health and safety outcomes, such as occupational injuries. Therefore, this meta-analysis synthesizes evidence on how specific work schedule characteristics relate to sleepiness. Specifically, we examine how sleepiness varies with: (a) shift type (eg, day versus night), (b) shift length, and (c) the number of consecutive shifts. We conducted a systematic literature search across multiple platforms and databases. Only studies that measured sleepiness using the Karolinska Sleepiness Scale were included. Mean effect sizes (Hedges` g) were calculated using random-effects models. The analysis included 48 studies (28 on shift type, 30 on shift length, and 13 on shift number). Compared to day shifts, sleepiness was significantly higher during night shifts and lower during afternoon shifts. Sleepiness increased with shift length during night shifts but showed no consistent pattern during day shifts. Furthermore, sleepiness was highest on the first night shift and decreased over subsequent nights, whereas it remained relatively stable across consecutive day shifts. Due to the low number of studies, results on shift length and shift number were limited or unavailable for afternoon shifts. Overall, this meta-analysis shows that sleepiness is most pronounced during night shifts, particularly the first in a block. These findings emphasize the importance of circadian and homeostatic factors in shift work. Therefore, shift schedules should be designed to mitigate these heightened risks, for example by allowing sufficient recovery time before and during the first night shift.

Divergent effects of high-frequency rTMS on cognitive performance in sleep-deprived nurses: An EEG brain network study.

Alterations in cardiovascular biomarkers and gut microbiome associated with night shift work: Insights from the Chinese platform workers study.

Background: This study examined how type of work and working conditions (such as shift work and long working hours) are associated with subjective health components including health-maintenance behaviors, health-related quality of life (HRQOL), and self-management strategies for maintaining health among Korean workers.Methods: A nationwide cross-sectional online survey was conducted in November 2021 among adults aged 20-64 years from 17 regions of the Republic of Korea (N = 3,900). Participants were categorized into unpaid family workers, irregular workers, self-employed workers, and permanent employee workers (n = 3,275). Paid workers were subcategorized into shift work (n = 574) and weekly working hours over 41 hours (n = 932). Among the subjective health components, HRQOL and self-management strategies for maintaining health were assessed using tools with proven validity and reliability. Descriptive and multivariate logistic regression analyses were performed.Results: Adequate rest, as a health maintenance behavior, was determined to have a statistically significant association with type of work, shift work, and working hours. Shift work and working over 41 hours per week were positively associated with the use of preparation strategies, with adjusted odds ratios of 1.052 [95% confidence interval (CI): 1.015-1.090] and 1.035 (95% CI: 1.005-1.067), respectively. Furthermore, shift work negatively correlated with HRQOL (aOR = 0.026, 95% CI: 0.009-0.070).Conclusion: Subjective health components were influenced by differences in type of work, and working conditions. Utilizing this information to develop indicators for worker health management within Korean medicine and integrative medicine may contribute to efficient health management of workers.

The research was conducted to determine nurses' attitudes toward evidence-based practices and the affecting factors. This research was planned as descriptive and cross-sectional. The sample of the research consisted of 275 nurses actively working in a university hospital. A "Personal Information Form" and "Attitude Toward Evidence-Based Nursing Questionnaire" were used to collect the data. Frequency, percentage, kurtosis, skewness, t-test, ANOVA, Tukey, LSD tests, (The Least Significant Difference) and multiple regression analysis were used to evaluate the data. It was found that mean scores of the nurses were 67.856 Å} 7.754 for "total attitude toward evidence-based nursing," 32.530 Å} 3.617 for "beliefs and expectations toward evidence-based nursing,"17.383 Å} 2.711 for "evidence-based practice intention," and 17.944 Å} 3.039 for "feelings about evidencebased nursing." The total score of those who worked on shifts was 66.159 Å} 8.003. The total score of those who followed professional publications on the attitude toward evidence-based nursing questionnaire was 69.141 Å} 7.489. It was determined that nurses' attitudes toward evidence-based practices were positive, shift work reduced the attitude level, and following professional publications increased the attitude level. Cite this article as: Bodu., N., Karadede, .., & Budak, B. (2026). Determination of nurses' attitudes towards evidence-based practice and affecting factors. Florence Nightingale Journal of Nursing. 34, 0250, doi:10.5152/FNJN.2026.24250.

A production company usually has two types of working time systems, namely daily and shift systems. Shift workers divide work hours into different time periods. In one day, a work shift can consist of 2 – 3 shifts, depending on company conditions. Some of the reasons companies implement work shifts are maintaining production quantities, maximizing service for customers, and monitoring security. Professions that have a shift work system include operators, laboratory analysts, firefighters, security officers and medics. The shift work system is considered not quite common because you have to work in the morning, afternoon and evening periods. On the other hand, the negative stigma regarding shift workers is very strong, so workers must be able to adapt to changing lifestyle patterns.This research focuses on the values ​​that motivate workers to choose a shift work system. Based on the results of research on 17 shift workers with different types of work, age, gender and length of work in a company, it was found that the shared values ​​that motivate workers to want to work shifts are family oriented and welfare (financial) values.