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Introduction The efficacy and safety of the rapid intravenous rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice. Objective To prepare a document with evidence-based recommendations about RIR in paediatric population. Methods The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of «relevant outcomes»; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security). Results Sixteen recommendations were set up, from which we can highlight as the main ones: (1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation and moderate evidence). (2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong and high). (3) Isotonic fluids are recommended (strong and high), suggesting saline fluid as the first option (light and low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong and moderate). (4) A rhythm of 20 cc/kg/h is recommended (strong and high) during 1-4 h (strong and moderate). Conclusions This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting.

In recent years, the study of medical employees’ mental health has become an important debated topic in the literature around the world, but little information is available on the extent to which social, psychological, and organizational factors affect the degree of exhaustion, leading to behavioral changes. The pandemic period that has affected (negatively impacted) the whole world in the last year, represented even more a degree of stress for the medical staff, who imminently and directly confronted the biological enemy. Medical employees are frequently exposed to both physical and mental risks. Shocking events and the likelihood of failure encountered during the work schedule can cause mental changes and an emotional imbalance.

Objective To identify surgical resident and clinical rotation attributes which predict on-shift napping through objectively measured sleep patterns and work schedules over a 2-month period. Design In a cross-sectional study, participants provided schedules, completed the Epworth Sleepiness Scale (ESS), and wore sleep-tracking devices (Zulu watch) continuously for 8 weeks. Multiple linear regression predicted percent days with on-shift napping from resident and rotation characteristics. Setting Greater Washington, DC area hospitals. Participants Twenty-two (n = 22) surgical residents rotating in at least 1 of 5 different clinical rotation categories. Results Residents slept 6 hours within a 24-hour period (370 ± 129 minutes) with normal sleep efficiency (sleep efficiency (SE): 87.13% ± 7.55%). Resident ESS scores indicated excessive daytime sleepiness (11.64 ± 4.03). Ninety-five percent (n = 21) of residents napped on-shift. Residents napped on-shift approximately 32% of their working days and were most likely to nap when working between 23:00 and 05:00 hours. Earlier shift start times predicted less on-shift napping (B = −0.08, SE = 0.04, β = −2.40, t = −2.09, p = 0.05) while working more night shifts (B = 1.55, SE = 0.44, β = 4.12, t = 3.52, p = 0.003) and shifts over 24 hours (B = 1.45, SE = 0.55, β = 1.96, t = 2.63, p = 0.01) predicted more frequent on-shift napping. Conclusions Residents are taking advantage of opportunities to nap on-shift. Working at night seems to drive on-shift napping. However, residents still exhibit insufficient sleep and daytime sleepiness which could reduce competency and represent a safety risk to themselves and/or patients. These findings will help inform intervention strategies which are tailored to surgical residents using a biomathematical model of fatigue.

Background: Considering the importance of health anxiety (HA) and its impact on the management of a pandemic, the present study investigated HA among healthcare workers during coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: The sample of this cross-sectional study consisted of 220 healthcare staff working in health centers and hospitals in Iran. Participants were selected using convenience sampling method. The data collection tool was a two-part questionnaire. The first part contained demographic information and the second part included a health anxiety questionnaire (HAQ). This questionnaire was provided to the target community through social media and the required data was collected. Data analysis was carried out using IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). Results: In the present study, out of 220 participants 128 (58.2%) were employed in health centers and 92 (41.8%) in hospitals. The mean HA score was 17.36 ± 7.66. Moreover, the mean HA scores in health center and hospital personnel was 17.81± 8.02 and 16.52 ± 6.78, respectively, which were not significantly different (P=0.217). The results showed that exercise and chronic disease are significant predictors of HA (P=0.0001 and P=0.043, respectively). Conclusion: The HA level was very high in healthcare personnel during the COVID-19 pandemic. This study showed that physical activity and having an underlying disease are important predictors of HA. Hence, in order to reduce the level of anxiety in healthcare personnel, it is recommended to plan regular physical activity programs and make changes in the work schedule of personnel with underlying disease.

A career is the combination and sequence of roles played by a person during the course of a lifetime. Objective: To find out the barriers faced by female doctors in career development at King Edward Medical University. Methods: At Mayo Hospital, Lahore, 100 practicing female doctors including house officers, medical officers and post-graduate doctors were selected by simple random sampling. Data were collected through pre-tested questionnaire. The duration of study was 6 months. Data were compiled and analyzed using SPSS version 21.0. Results: Out of 100 doctors, more than 70% attributed early marriage, non-supportive spouse and demands of in-laws as barrier to career advancement. Preference of male doctors by patients 71% and by employers 58% was also reported to be a hurdle. More than 60% were of the view that hectic work schedule and difficult night duties were draining for them. 86% said that long working hours affect their work quality. Above 80% reported that commute problems and uncomfortable circumstances at work place act as a deterrent. However, majority were of the view that socioeconomic conditions and self-efficacy of female doctors play only a trivial role in their career development. Conclusions: This study has demonstrated that extrinsic barriers play a significant role in hindering career development of female doctors. Of these, unsupportive spouse, family pressures, professional male dominance, stressful work routine, commute problems and uncomfortable working situations are notably important. Intrinsic barriers are far less important.

Objectives The organization of night shift work affects sleep duration and quality. The aim of this study was to investigate the effects of the number of consecutive night shifts on sleep duration and quality among police officers with night shift work as part of their normal schedule. Methods This quasi-experimental, within-subject crossover study included 73 police officers. All participants performed three work schedules: two, four and seven consecutive night shifts followed by the same number of recovery days, ie, day work or days off (2+2, 4+4, and 7+7). Sleep assessed through sleep diaries and actigraphy after all night shifts and recovery days (totaling 26 days) was compared by use of repeated measures analysis. Results Participants experienced shorter sleep duration (with and without naps), more premature awakening, less difficulty falling asleep, and more non-refreshing sleep after night shifts compared with recovery days. Sleep duration and quality did not change with increasing number of consecutive night shifts. Sleep was shorter and of poorer quality after the last night shift in the 2+2 and 4+4 work schedule compared with the second and fourth night shift, respectively, in the 7+7 schedule. Conclusion Sleep duration was reduced after night shift work and did not increase with more consecutive night shifts, which leads to accumulated sleep debt. Sleep duration was shortest and sleep quality was poorest after the last night shift in a series of night shifts.

Background Cognitive impairment is a public health burden. Our objective was to investigate associations between work hours and cognitive function. Methods Multi-Ethnic Study of Atherosclerosis (MESA) participants (n = 2,497; 50.7% men; age range 44–84 years) reported hours per week worked in all jobs in Exams 1 (2000–2002), 2 (2002–2004), 3 (2004–2005), and 5 (2010–2011). Cognitive function was assessed (Exam 5) using the Cognitive Abilities Screening Instrument (version 2), a measure of global cognitive functioning; the Digit Symbol Coding, a measure of processing speed; and the Digit Span test, a measure of attention and working memory. We used a prospective approach and linear regression to assess associations for every 10 hours of work. Results Among all participants, associations of hours worked with cognitive function of any type were not statistically significant. In occupation-stratified analyses (interaction p = 0.051), longer work hours were associated with poorer global cognitive function among Sales/Office and blue-collar workers, after adjustment for age, sex, physical activity, body mass index, race/ethnicity, educational level, annual income, history of heart attack, diabetes, apolipoprotein E-epsilon 4 allele (ApoE4) status, birth-place, number of years in the United States, language spoken at MESA Exam 1, and work hours at Exam 5 (β = –0.55, 95% CI = –0.99, –0.09) and (β = –0.80, –1.51, –0.09), respectively. In occupation-stratified analyses (interaction p = 0.040), we also observed an inverse association with processing speed among blue-collar workers (adjusted β = –0.80, –1.52, –0.07). Sex, race/ethnicity, and ApoE4 did not significantly modify associations between work hours and cognitive function. Conclusion Weak inverse associations were observed between work hours and cognitive function among Sales/Office and blue-collar workers.

Firefighters are at risk for chronic sleep disruption due to their rotating 24-hour on and 48-hour off work schedule and hazardous work conditions. Forty-five firefighters were assessed to determine the impact of their shift schedule on sleep duration, sleep quality, processing speed, sustained attention, vigilance, and mental health. Assessments were conducted at the start and end of shift. Firefighters endorsed sleeping 5 hours 21 minutes at work, and the results suggest that even minimal sleep disruption affected cognitive functioning (e.g. processing speed, visual-motor coordination, and reaction time), increasing the likelihood of poor work performance or injury.

Background The emergency department is a highly demanding work environment, considered by high workload and stress. The impact of work-related factors on musculoskeletal disorders (MSDs) in emergency nurses (ENs) are not yet well understood. We investigated the association of MSDs and workload with work schedule (permanent day and night work) and job satisfaction in ENs. Method Data were collected through a questionnaire including individual and work-related factors, workload (National Aeronautics and Space Administration-Task Load Index [NASA-TLX]) and MSDs (Standardized Nordic Questionnaire) from 380 ENs in five hospitals. Results The findings revealed that work schedule and job satisfaction levels were significantly associated with the MSDs in different body regions. Work schedule was significantly related to physical demand, performance, frustration, and overall workload, whereas it was not to the mental and temporal demands and effort. Job satisfaction level was negatively associated with mental demand and frustration. A high prevalence of musculoskeletal problems, particularly in knees, upper back, lower back, neck and shoulders were found. Conclusion MSDs are highly prevalent among ENs involved in night work and with low job satisfaction levels. The results are discussed in terms of their implications for emergency hospital nurses. The findings can help to better understand the working conditions and emphasize the need for ergonomic interventions in order to reduce MSDs and workload. Also, the study findings highlight the importance of mental aspects of workload in this occupational group.

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)., Shift work (SW) encompasses 20% of the European workforce. Moreover, high blood pressure (BP) remains a leading cause of death globally. This review aimed to synthesize the magnitude of the potential impact of SW on systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension (HTN). MEDLINE, EMBASE and CENTRAL databases were searched for epidemiological studies evaluating BP and/or HTN diagnosis among shift workers, compared with day workers. Random-effects meta-analyses were performed and the results were expressed as pooled mean differences or odds ratios and 95% confidence intervals (95% CI). The Newcastle-Ottawa Scale was used to assess the risk of bias. Forty-five studies were included, involving 117,252 workers. We found a significant increase in both SBD and DBP among permanent night workers (2.52 mmHg, 95% CI 0.75-4.29 and 1.76 mmHg, 95% CI 0.41-3.12, respectively). For rotational shift workers, both with and without night work, we found a significant increase but only for SBP (0.65 mmHg, 95% CI 0.07-1.22 and 1.28 mmHg, 95% CI 0.18-2.39, respectively). No differences were found for HTN. Our findings suggest that SW is associated with an increase of BP, mainly for permanent night workers and for SBP. This is of special interest given the large number of susceptible workers exposed over time., This work was supported by the Ph.D. research Grant PDE/BDE/127787/2016 from Fundação para a Ciência e Tecnologia (FCT) /Fundo Social Europeu.

Unregulated work schedules have deleterious effects on trainees’ productivity and patients’ safety. For these reasons, duty hours have been capped in many developed countries. Such regulations, however, appear to be lacking in many parts of Africa, and the effects of unregulated work hours in this part of the world have only been scantily documented. This study evaluated the work schedule of Nigerian surgical trainees, and its impact on their wellbeing, as well as assessed the perception of trainees towards capped duty hours. A cross-sectional survey of 650 Nigerian Resident Doctors in surgical specialties was conducted in November 2020. Enquiries were made about their work schedules using a purpose-designed questionnaire, developed using Google Forms®. The data were analysed using the IBM SPSS version 23. The mean weekly work hours of surgical residents was 122.72 ± 34.17 h. Majority (228, 40.4%) of the residents had cumulative call hours of ≥ 72 h per week. One-half (283, 50.1%) of them worked continuously for up to 48–72 h during calls, with mean daily sleep hours of 3.53 ± 1.42 h during calls. The majority (558, 98.8%) of respondents had post-call clinical responsibilities. Seventy-five percent of the respondents reported hazards from prolonged work hours, and an overwhelming majority (530, 93.8%) desire official limits on work hours. Prolonged, unregulated work schedules appear to be the norm among Nigerian surgical trainees. This trend calls for urgent measures, to avoid potentially catastrophic consequences on both physicians and patients.

Background The busy and demanding work schedule of neurosurgeons suggests that they might have type A behavior patterns (TABPs). TABPs are also associated with multiple diseases; hence, their early identification could lead to behavioral changes and disease prevention. We aimed to determine the presence of TABPs among neurosurgeons and trainees in the Philippines and the association between demographic and clinical factors and TABPs. Methods An online survey was sent to neurosurgeons and neurosurgical trainees in the Philippines. Data on age, sex, comorbid conditions, smoking, alcohol use, training institution, level of residency training, and place of practice were obtained. The modified Bortner scale was used to determine TABPs. Univariate and multiple regression analyses were used for analysis. Results A total of 102 individuals (41 neurosurgeons and 61 trainees) completed the survey. Most of the respondents were men (74%), with a mean age of 36 years. The Bortner scores were normally distributed. TABPs were significantly associated with female sex (P = 0.0006) in the entire cohort. However, the trainee cohort also exhibited a significant association between TABPs and training in a public institution (P = 0.0027). Conclusion The presence of TABPs followed a normal distribution among neurosurgeons and neurosurgical trainees in the Philippines. A significant association was found between TABPs and female sex for both neurosurgeons and trainees, and training in a public institution was significantly associated with TABPs only among the trainees.

This study shows a statistically and clinically significant gap between Whites and Blacks in the use of annual physical examination and preventive care services in the District of Columbia. The results of the study indicate that race (Whites versus Blacks) and work schedule conflicts are not significant factors in the noted gap. The study also found that income and education levels were not significant factors. Moreover, the study demonstrates a knowledge gap between Whites and Blacks pertaining to knowing that critical preventive care services are fully covered by health insurance plans (Section 2713 of the Affordable Care Act mandate). This is important because the study indicates that knowing that critical preventive care services are covered by health insurance companies is a (small) contributing factor in the difference in the utilization of preventive care services between Whites and Blacks in the District of Columbia.

Background Working hour regulation in Korea is being revised to allow increasing variability in number of working hours. We sought to investigate the association between variability in the number of daily or weekly working hours with or without long working hours (> 52 h/w) and mental health among South Korean workers. Methods We used data from 28,345 full-time, non-shift employed workers working more than 30 h per week participating in the Korean Working Condition Survey in 2017. We defined six groups according to variability in daily or weekly working hours (same number vs different number) and weekly working hours (31–40, 41–52, > 52 h per week). Odds ratios (ORs) and confidence intervals (CIs) for self-reported depressive symptoms and anxiety were calculated using workers with same number of working hours/31–40 h per week as the reference. Results Variability in number of work hours every day or week combined with > 52 working hours per week showed the highest risk of depressive symptoms (OR = 5.13, 95% CI 3.25–8.11) and anxiety (OR = 3.75, 95% CI 2.39–5.88) compared to the reference group, controlling for age, sex, education, occupation, industry, salary, workers’ choice of working hours and overtime payment. Workers working ≤52 h/w were adversely impacted by variable working hours as well. Conclusions Variable daily or weekly working hours were associated with poorer self-reported depressive and anxiety symptoms in Korea, among full-time and non-shift workers. Reform of the Korean Labor Standards Act warrants consideration.

Background Consumption of energy drinks has become an escalating global public health problem. The work schedule and irregular sleeping habits of commercial bus drivers make them highly susceptible to getting fatigued, hence most of them consume energy drinks as a fatigue management strategy. However, consumption of energy drinks produces numerous psychomotor side effects that if consumed among drivers puts the traveling public in danger of road accidents. This study sought to assess the prevalence of energy drink consumption and awareness of associated potential health problems among commercial long-distance bus drivers operating from the Ho municipality. Methods The study population comprised about 266 commercial bus drivers. This was a cross-sectional study involving 132 participants who completed a structured questionnaire on the participants’ socio-demographic characteristics, frequency of consumption and reasons for consumption. It also included questions to assess the knowledge of the ingredients and side effects of energy drinks. Respondents were selected using a convenience sampling technique. Descriptive analysis and Chi-square test of association were used to analyse the data. Results A majority (62.1%) of the drivers had more than 10 years of commercial driving experience. A 75% energy drink consumption prevalence was recorded with driving performance enhancement (78.8%) as the predominant reason for consumption. 7–10 bottles per week were consumed by most (32.2%) of the drivers. Also, 72.0% had poor knowledge of the side effects linked with energy drink consumption as well as the ingredients for preparation. Conclusion Energy drinks were consumed by the majority of the drivers at the Ho main bus terminal of which most of the drivers had poor knowledge of the potential health problems linked with the consumption of these drinks. The consumption of energy drinks was observed to be higher among the drivers with lower education levels, higher monthly income and those who worked long hours in a day. The Ghana National Road Safety Commission (GNRC) in collaboration with other private road transport unions in Ghana should organize regular seminars for commercial bus drivers on the potential dangers and effects associated with energy drink consumption.

Background Sleep disorders may exacerbate many physical and mental health conditions, causing difficulty function in a healthcare setting. Workers screening for the 2019 novel coronavirus (2019-nCoV) infection have a high risk of not only occupational exposure to the virus but also sleep disorders. However, the job-related factors associated with reduced sleep quality remain unclear. Methods All healthcare workers temporarily scheduled to screen the 2019-nCoV patients were asked to complete a self-administered questionnaire that included questions on demographics, job-related factors, and sleep quality as assessed using the Pittsburgh Sleep Quality Index (PSQI). Sleep quality was assessed over a 1-month follow-up period. Results A total of 116 doctors and 99 nurses were recruited for this study. The total scheduled work time was 14.78 ± 6.69 days during follow-up. Some job-related factors, such as number of work days, years of work experience, and subjective psychological stress, were associated with changes in the PSQI score. During the study, some workers tried out cognitive behavioral therapy (CBT) for sleep disorders using methods that were available online and easily accessible. Adopting online CBT was shown to be associated with scores of components of sleep quality, sleep latency, and sleep disturbance (β = -0.152, P = 0.01; β = -0.175, P = 0.008; and β = -0.158, P = 0.011, respectively). Conclusions Healthcare workers involved in screening for 2019-nCoV experienced reduced sleep quality, and a reasonable work schedule may help with maintaining sleep quality. In addition, interventions for healthcare workers should target self-help sleep assistance., Highlights • Healthcare workers involved in screening for 2019-nCoV experienced reduced sleep quality. • A reasonable work schedule and self-help interventions for sleep disorder may be considered for efficient and successful epidemic management and clinical work.

Objective: The aim of this study is to investigate the working time patterns including length, shift type, shift intensity, and special aspects of working hours for hospital nurses. Background: Working time patterns, such as long working hours and shift work with night shift, are important public health issue. However, most of the previous studies were based on the self-report data, and only a few studies have attempted to comprehensively estimate the working time pattern by considering various aspects of work. Method: The work schedule of a total of 1,254 nurses who worked at a general hospital in 2017, were analyzed using the electronic data recorded in the computerized system. We examined 15 potentially health-relevant working time factors for nurses, categorized under four main domain heading of: (1) Time of the day, (2) length of working hours, (3) shift intensity, and (4) special aspects of working hours. Results: Among a total of 1,254 nurses, most nurses (82.4%) were work with 3-shift type. 2-shfit nurses had 32.3±24.3% of the experience of more than 40 hours a week, followed by 3-shift nurses (22.5±18.7), and daytime nurses (14.7±11.6). But the experience of three consecutive night shift spells were higher among 3-shift (4.1±6.2 times) than 2-shift nurses (0.3±0.5), and the experience of working on weekend or legal holiday was higher in 3-shift nurses (42.9±23.2%) than 2-shift (36.6±17.9) and daytime (12.7±11.3) nurses, while the number of having more than three consecutive free days was lowest in 3-shift nurses (8.9±6.0 times) compared with 2-shift (21.3±12.6) and daytime nurses (10.3±5.9). Conclusion: 3-shift nurses had less long working hours, but high shift intensity and disadvantageous social working conditions than 2-shfit nurses, and 2-shift nurses worked with night shift and had long working hours, high shift intensity, but advantageous in social aspects than daytime nurses. Application: The results of this study might help to improve understanding of working time pattern in hospital nurses, and lay an important foundation for further research on health of nurses in Korea.

Background Drug abuse is one of the world's most serious and rapidly rising problems, causing a wide variety of health issues with significant morbidity and mortality. This study aimed to explore the association between part-time work and substance abuse among vocational students. Design and methods We conducted a cross-sectional analytical study that included all part-time working male students from five vocational male schools, and we used a standardized pretested questionnaire after obtaining written informed consent. A One- Step Multi-Drug Screen Test was used to assess the substances that were abused Results A total of 316 out of the 400 invited students participated in our study. Of the total screened subjects, 26.6 % were abusing substances. Twenty-five (36.2%) day working adolescents, nine (14.0%) night working adolescents, and forty (36.0%) day and night working adolescents were abusers. Tobacco was the most widely abused drug (68%) in the form of smoking, followed by cannabis (24%), marijuana (16.4%), alcohol (10%), and opioid (6.3%). Night workers had significantly lower rates of smoking, cannabis, Marijuana, alcohol, or opioids abuse, and Logistic regression was performed to ascertain the effects of the work schedule on the likelihood that participants have substance abuse; Night workers were 7.14 times less likely to have substance abuse than day workers, while day and night work did not differ from day work. Conclusions The prevalence of drug abuse in vocational students is considered high and a serious problem that damages the youth and the community.

Background: HIV among pregnant women poses particular risks to their family, offspring and health workers at the time of delivery. Aims: To determine the level of adherence to antiretroviral therapy among HIV-positive pregnant women in an HIV/AIDS treatment centre in Ibadan, Nigeria and, to identify factors influencing adherence. Methods: A descriptive cross-sectional study was employed among 66 HIV-positive pregnant women attending an HIV clinic at Adeoyo Maternity Health Centre, Ibadan, Nigeria. Findings: Results showed that 47% of the HIV-positive pregnant women adhered to their drug regimen, while 53% did not. Among the non-adherent women, forgetfulness (16.4%), unfavourable work schedule (15.2%) and side effects (12.1%) were the common factors reported for missing drugs. Conclusions: The study concluded that the level of adherence to antiretroviral medications among HIV-positive pregnant women was considerably low.

Objective This study aimed to evaluate the knowledge, perceived challenges and attitude of primary health care (PHC) workers in Lagos to depression and its management in the PHC. Methods Health workers ( n =607) from 49 "flagship" PHCs in Lagos were evaluated for their level of knowledge, experience, competence, attitude and perceived challenges to managing depression in the primary care using a case vignette. Results More than half (56.2%) of the health workers correctly diagnosed depression. The most endorsed causative factors were "Psycho-social" (77.3%), but "spiritual factors" were endorsed by 36.2%. While only 39.4% agreed that the depressed patient is best managed in a PHC, 86.2% would support treating the patient in their PHC if their capacity is enhanced. Top identified challenges were "heavy work schedule" (68.5%) and "lack of competence of the PHC staff" (67.5%). Over 42% had poor attitude towards depressed patient. Having a mental health training was the major factor that predicted good knowledge (OR 4.52, 95%CI 2.96–7.00) and good attitude (OR 2.17, 95% CI 1.48–3.17). Conclusions For successful scale up of mental health services in LMICs, the design of mental health training curriculum for PHC workers should consider their knowledge, experience, competence level, perception and attitudes.

Zusammenfassung Hintergrund Systematische und vergleichende Analysen der Tätigkeiten des ärztlichen und pflegerischen Personals in der Notaufnahme fehlen für den deutschsprachigen Bereich. Ziel der Arbeit Analyse der Aktivitäten des pflegerischen und ärztlichen Personals einer Notaufnahme sowie der Anteile direkten Patientenkontakts und stündlicher Tätigkeitswechsel. Material und Methoden Tätigkeitsanalysen auf Basis teilnehmender Beobachtungen (je 90 min) bei Pflegekräften und Ärzt*innen einer interdisziplinären Notaufnahme eines süddeutschen Krankenhauses der Maximalversorgung. Beobachtete Tätigkeiten wurden anhand eines Klassifikationssystems mitsamt Zeitdauern kodiert. Insgesamt wurden 160 Einzelbeobachtungen (mit einer Gesamtzeit von ca. 240 h) durchgeführt; 99 bei Pflegekräften sowie 61 bei Ärzt*innen. Ergebnisse Notaufnahmeärzt*innen arbeiten 30 % ihrer Zeit in direktem Patientenkontakt, Pflegekräfte hingegen 44 %. Für die Einzeltätigkeiten entfielen die größten Zeitanteile ärztlicher Tätigkeit auf Dokumentation und Schriftarbeit (29,3 %), interne Kommunikation mit Personal (16,9 %) sowie mit Patient*innen (13,6 %). Pflegekräfte verwenden die meiste Zeit auf therapeutische und Behandlungsaktivitäten (27,6 %) sowie interne Kommunikation (17,9 %). Diese Tätigkeiten waren stark fragmentiert: Im Durchschnitt erfassten wir 41,3 Einzeltätigkeiten pro Stunde mit einer durchschnittlichen Dauer von 1,5 min. Pflegekräfte hatten signifikant kürzere Tätigkeitsdauern als Ärzt*innen (F[df = 1] = 4,5; p = 0,04). Tätigkeitsspezifische Analysen ergaben weitere Professionsunterschiede. Diskussion Unsere Ergebnisse liefern erstmalig fundierte Einsichten in die Verteilung und Dauer von ärztlichen sowie pflegerischen Tätigkeiten in der akutmedizinischen Versorgung in der Notaufnahme. Zukünftige Arbeiten sollten sich insbesondere einhergehenden Auswirkungen auf die Leistungsfähigkeit und Beanspruchung des Personals wie auch der Sicherheit und Qualität der Versorgung widmen.

OBJECTIVE: The purpose of this study was to determine which lifestyle factors influence medical students who choose a career in emergency medicine (EM). METHODS: Final‐year medical students from 10 medical schools were surveyed after the National Residency Match Program match but prior to graduation regarding preferred medical specialty and lifestyle preferences. Responses from students pursuing EM regarding importance of lifestyle factors were compared to students interested in other specialties. RESULTS: A total of 453 of 1,575 invited medical students completed an electronic survey. EM was the third most preferred specialty. Students selecting EM were less likely to endorse “having control of work schedule” as being important (p

Objective. This study aimed to recommend an appropriate sit–stand schedule among office workers. Methods. The participants were randomly allocated into Time Regime 1 (TR1), Time Regime 2 (TR2) and ...

Introduction Patients with hypothyroidism are managed with life-long levothyroxine (LT4) therapy. However, as with other chronic illnesses, drug adherence (DA) is a prominent issue in these patients. The aim of this study is to identify the extent of DA to LT4 in hypothyroidism patients and study the clinical factors contributing to DA in these patients. Methods This cross-sectional study assessed patient adherence to LT4 therapy by Modified Morisky Adherence Scale (MMAS). Factors predicting the pattern of medication adherence were also assessed in all patients. Data were entered and analyzed using SPSS v. 22.0. Results On MMAS, 79 (27.3%) participants indicated low adherence, 117 (40.48%) indicated medium adherence, and 93 (32.2%) participants indicated high adherence. Regular endocrinologist visits and knowledge about medication were highest in high adherent patients (p < 0.05). Need for assistance in taking medication, avoidance of medication with symptomatic relief and busy work schedule was highest in low adherent patients (p < 0.05). Conclusion Patients with hypothyroidism showed moderate adherence to their treatment.

Objective: Prior reports using the validated Barriers to Physical Activity in Diabetes (type 1) [BAPAD1] scale showed fear of hypoglycemia was the strongest barrier to regular physical activity (PA) in people with type 1 diabetes (T1D). This was before the higher prevalence of continuous glucose monitoring (CGM) use today. Methods: Twenty adults with T1D enrolling in an exercise tracking study completed the BAPAD1, reporting perceived barriers to regular PA on a scale of 1 (extremely unlikely) to 7 (extremely likely). All used insulin pumps. Fifteen of the 20 were current CGM users. Results: Baseline characteristics were age 44.9±15.0 years, F/M 12/8, HbA1c 6.8±0.7%, and diabetes duration 22.9±15.9 years. Mean BAPAD1 score was 2.55±1.05. The highest scores were for risk of hypoglycemia (4.00±1.78) and work schedule (3.70±2.00), with current CGM users reporting higher overall scores than non-CGM users (2.71±1.04 vs. 2.10±1.07, p=0.28). Significantly higher scores were reported by CGM users for “The fear of being tired” (p=0.01), “The fact that you have diabetes” (p=0.03), and “The location of a gym” (p=0.04) (Table 1). Greater barrier scores for work schedule were associated with lower age (r=-0.5, p=0.02). Conclusions: CGM use was not associated with lower perceived barriers to regular PA, suggesting additional interventions beyond providing ways to measure glucose are needed to reduce these barriers in people with T1D. Disclosure C.C. Andre: None. Y.C. Kudva: Advisory Panel; Self; Novo Nordisk Inc. Other Relationship; Self; Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. V. Dadlani: None. M. Cescon: None. S.K. McCrady-Spitzer: None. M. Church: None. C. Reid: None. K. Kumari: None. D. Choudhary: None. F.J. Doyle: Consultant; Self; ModeAGC. Other Relationship; Self; Insulet Corporation. E. Dassau: Consultant; Self; Eli Lilly and Company, Insulet Corporation. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Ltd., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; Roche Diabetes Care. Other Relationship; Self; ModAGC. J.E. Pinsker: Research Support; Self; Ascensia Diabetes Care, Dexcom, Inc., Insulet Corporation, LifeScan, Inc., Roche Diabetes Care, Tandem Diabetes Care. Speaker's Bureau; Self; Tandem Diabetes Care. Funding JDRF; The Leona M. and Harry B. Helmsley Charitable Trust (2-SRA-2017-503-M-B); Dexcom, Inc. (IIS-2017-043)

Background Burnout among physicians has been a topic of growing interest in both the scientific and the lay press. It has been well established that burnout and perceived inequity in work-life balance can contribute to poor physician work satisfaction and poorer patient outcomes. To better understand burnout among neurosurgery residents at our institution, we systematically surveyed residents for symptoms of burnout and enacted responsive protocols to try to combat its deleterious effects. Methods Before and after the institution of a series of initiatives aimed at combating burnout, residents were surveyed to assess for symptoms of burnout, strength of relationships, and status of physical and mental health. Initiatives included gym access and group gym visits, a mentoring program, and a lecture series targeting multiple facets of health and well-being. Results Nearly two thirds of neurosurgery residents demonstrated ≥1 signs of burnout at a moderate to severe level before and after the first year of our wellness initiative. Residents reported that work schedule and time availability were obstacles in focusing on their own personal health and wellness (utilization preventive health care visits, participation in group gym activities). Less than half of residents were content with their work-life balance. Conclusions Making a significant change in burnout rates in neurosurgery will require a number of key factors, including targeted initiatives that focus on specific local needs, honest buy-in by departmental leaders, and recognition by the physicians themselves that a problem exists.

Background: This study investigated the workload and its effects on the prevalence of needlestick injuries (NSIs) among the nurses in the hospitals affiliated with Ahvaz University of Medical Sciences (AUMS). Methods: In this cross-sectional study, 416 registered nurses working in different wards of the hospitals affiliated with Ahvaz University of Medical Sciences (AUMS) were randomly selected. Data collection instruments were a demographic questionnaire and NASA-TLX workload questionnaire. Results: The prevalence of NSIs in the total work experience and the last year were 72% and 50%, respectively. The mean total score of NASA-TLX calculated to the extent of 78.27 ± 12.2. The regression modeling demonstrated that NSIs significantly correlated with patients treated/d (OR: 1.136, CI: 1.02 - 1.27, P value: 0.002), Timing of injury (OR: 2.13, CI: 1.20 - 3.79, P value: 0.010), and the third dimensions of NASA-TLX index (time pressure) (OR: 1.031, CI: 1.02- 1.05, P value: < 0.001). Conclusions: The study showed a high prevalence of NSIs among nurses. Corrective measures such as planning training programs targeting at using personal protective equipment (PPE), modification of work schedule by limiting working hours and the number of shifts per month, and providing sufficient human resources are essential for the effective prevention of NSI incidents among the studied nurses.

This study aimed to assess fatigue among onshore oil rig shift workers in a petroleum company working in swing shifts. The work schedule consisted of 12 h of night shifts for one week followed by 12 h of day shifts for one week. Fatigue was assessed using both subjective and objective measurements which were visual analogue fatigue scale (VAFS) and simple reaction time (SRT) test, respectively. A total of 38 male onshore oil rig shift workers participated in this study. Fatigue assessment was conducted at the start and at the end of workdays on nights 1, 4 and 7, and days 1, 4 and 7. The results showed that there were significant differences of VAFS and SRT at the end of workdays, compared with at the start of workdays (p

Although a necessity in a modern society, irregular work schedule can lead to sleep problems. We investigated the effect of work schedule irregularity on sleep disturbance of 17,846 Korean service workers using the fifth Korean Working Conditions Survey. The odds ratio (OR) and 95% confidence interval (CI) for sleep disturbance occurrence were calculated through a multiple logistic regression model. The adjusted ORs for moderate and severe sleep disturbances for those with irregular work hours were 2.11 (95% CI 1.90–2.33) and 3.10 (95% CI 2.62–3.66), respectively. Work schedule irregularity and emotion suppression at work showed synergistic effect on both moderate and severe sleep disturbances. Sleep disturbances can lead to brain function deterioration and work-related injuries, therefore, appropriate measures should be addressed for the vulnerable population.

This paper outlines the findings from a qualitative study exploring what motivates Trust Grade doctors to undertake postgraduate study alongside an already busy work schedule. They are surgical specialists who have completed a Master of Surgery Programme (MCh) at Edge Hill University.

The purpose of this study was to investigate the difference between influence of health locus of control on medication adherence among outpatients undergoing directly observed treatment-short course (DOTS) and those receiving antiretroviral therapy (ART). Resurgence of tuberculosis (TB) infection following the spread of HIV epidemic has made treatment of TB and HIV co-infection a public healthcare priority in Nigeria. However, strict adherence to medications is critical for the treatment to be effective and to prevent death due to TB and rapid progression of HIV to full-blown AIDS. Locus of control perceptions of outpatients with TB and HIV infections should be assessed and determined for effective package of treatment that requires strict medication adherence. The participants were 100 outpatients receiving tuberculosis (n = 30) and HIV/AIDS (n = 70) services in seven selected treatment facilities across Edo State, Nigeria. The respondents were selected using a purposive sampling technique. All participants were individually administered with multidimensional health locus of control (MHLC) scale and Morisky (8-Item) medication adherence questionnaire (MMAQ). Percentage and inferential statistics (ANOVA) were used to analyse the data collected and were tested at p < 0.05. Heath locus of control presents similar influence on medication adherence among outpatients. There was an association between non-adherence (27%) and reported health complications (27%) by outpatients. The reasons cited for missing medications were travelling (48%), work schedule (14.8%), religion activities (14.8%), side effects of drug (11.1%), financial constraints (7.4%) and bereavement (3.7%). It was also observed that Internal-LOC [F = (23, 76) = 0.469, P

Thyroid hormones are regulated by the pituitary thyroid stimulating hormone (TSH), whose secretion presents a circadian rhythmicity. Indeed, it is conceivable that shift- and night shift-work, affecting sleep-wake rhythms, may impact thyroid functionality. Therefore, the aim of the present review was to provide an overview on the association between shift- and night shift-work and thyroid hormonal changes and disease development. A systematic review of studies available in PubMed, Scopus, and ISI Web of Science databases was performed. A positive association between night shift-work and increased TSH concentrations was reported by most of the reviewed investigations. Inconclusive evidence was available on thyroid diseases. However, the limited number of studies, the noticeable heterogeneity in the shift-work scheduling, in terms of amount, duration, type of shift- or night shift-work, prevents easily integrating findings and extrapolating definite conclusions. Further investigation seems necessary to better define the relationship between shift schedules and different thyroid outcomes, and possible long-term implications of early functional changes. Overall, this may support the adoption of advanced risk assessment and management strategies aimed to achieve a safer workplace organization and a timely, responsible realization of all the benefits of a 24-h economy.

STUDY OBJECTIVES Recent experimental research indicates a substantial impact of shift work related fatigue on police officers' encounters with the public. In recent years, biomathematical models of fatigue have provided a new way to identify potential relationships between working time arrangements and job performance. This study focused on public complaints against police officers and determined whether the odds of a public complaint were associated with work schedules and/or a biomathematical model's predictions of fatigue and sleepiness. METHODS N = 144 police officers from two municipal police departments in the United States reported shift start times, shift hours, court hours, and public complaints each duty day during study participation. A biomathematical model of fatigue (FAID Quantum) predicted sleep duration and sleep timing and inferred fatigue and sleepiness for 15 744 shifts. Fatigue, sleepiness, 24 hr sleep estimates, and work schedule were tested as predictors of public complaints. RESULTS Greater fatigue, greater sleepiness, and less sleep in the 24 hr prior to a shift increased the odds of a public complaint (F ≥ 9.14, p < 0.01). Working back-to-back night shifts increased the odds of a public complaint (OR = 4.27, p < 0.01), particularly when off-duty court hours were worked between the night shifts (OR = 4.73, p < 0.01). CONCLUSIONS On-duty fatigue and sleepiness, sleep obtained prior to a shift, and working night shifts were strongly associated with public complaints. Off-duty court appearances reduced sleep between night shifts and further increased the odds of a public complaint. The results suggest that off-duty court hours should be limited between night shifts and duty schedules should be considered when scheduling court appearances.

Introduction: A two-shift work schedule with different rotations is common among firefighters in Iranian petrochemical companies. This study compared salivary melatonin and sleepiness on the last night before turning to day shift at 19:00, 23:00, 3:00, and 7:00 among petrochemical firefighters (PFFs) working seven and four consecutive night shifts. Methods: Sixty four PFFs working in the petrochemical industry were selected. To measure melatonin, saliva samples were taken, whereas the KSS index was used to assess sleepiness. Chi-square and independent samples t-test were carried out to analyze the data, and generalized linear model (GLM) was employed to determine the effect of confounding factors such as lighting and caffeine. Results: The levels of melatonin at 3:00 and 7:00, and the overall changes during the shift in the two shift patterns under the study were different (P < 0.05). Sleepiness was significantly different only at 3:00 in the two studied shift patterns, while the effects of lighting and caffeine on melatonin changes were not significant (P > 0.05). Conclusion: It seems that a slow shift rotation is better because it reduces the secretion of melatonin (hence reducing sleepiness during the night) and changes the peak of melatonin secretion to the daytime, which is a sign of adaptation.

Background: Breast cancer is the most common type of cancer in women. Disruption of the body's circadian rhythm has been linked to increased risk of breast cancer. This study aimed to examine the effects of circadian rhythm and environment factor on the risk of breast cancer, using path analysis model. Subjects and Method: A case control study was conducted in Kediri, East Java, from April to May 2018. A sample of 200 women was selected by fixed disease sampling. The dependent variable was breast cancer. The independent variables were work schedule, sleep duration, room light, room temperature, chemical exposure, and air pollution. The data were collected by questionnaire and analyzed by path analysis run on Stata 13. Results: The risk of breast cancer increased with irregular work shift (b=1.76; 95% CI= 0.82 to 2.70; p

Background: Decreases in subjective sleep quality are prevalent among nurses and midwives engaged in rotating shift work. Objectives: The present study aimed to examine the relationship between differences in work schedules and subjective sleep quality among female nursing staff. Design: A cross-sectional survey design was used for descriptive and logistic regression analyses. Data collection was conducted from December 2016 to September 2017. Settings: Participants were recruited from five regional core hospitals in Japan. Participants: A total of 1253 nurses and midwives were included in the final analysis. Methods: Subjective sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index. Chronotype and social jet lag were calculated for both work day and work-free day. Symptoms related to restless legs syndrome/Willis-Ekbom disease were assessed using the Japanese version of the Cambridge-Hopkins questionnaire short form 13. Participants with the urge to move their legs, though not fulfilling the restless legs syndrome/Willis-Ekbom disease criteria, were classified as having leg motor restlessness. Logistic regression analyses for poor sleep were adjusted for age, body mass index, smoking, drinking, menstruation status, the presence of premenstrual syndrome, and the presence of a spouse. Results: Rates of poor sleep (Pittsburgh Sleep Quality Index score ?6) among those working, day shifts, rotating 12.5 hour night shifts, rotating 16 hour night shifts, and three-shift rotations were 41.2%, 51.1%, 44.5%, and 60.4%, respectively. Approximately 40% of three-shift rotation workers experienced difficulty initiating sleep. Shift workers tended to exhibit evening chronotype, delayed sleep phase, and high social jet lag. The prevalence of restless legs syndrome/Willis-Ekbom disease was 2.5%. Leg motor restlessness was observed in. 15.5% of participants. The adjusted odds ratios (95% confidence interval) of three-shift work (vs. day shift), evening chronotype (vs. morning chronotype), and the presence of leg motor restlessness (vs. no leg motor restlessness) for those with poor sleep were 2.20 (1.47?3.30), 1.95 (1.29?2.94),and 1.66 (1.15?2.39), respectively. Conclusions: Regardless of the working schedules, rates of poor sleep were high among female hospital nurses and midwives. Our findings suggest that poor sleep quality is influenced by three-shift rotation, the evening chronotype, and leg motor restlessness., International Journal of Nursing Studies, 95, pp.103-112; 2019

Objective Utilize the unique capabilities of a longitudinal design to 1) examine whether burnout is increasing over time among 2 cohorts of pediatricians, and 2) identify factors associated with decreased burnout. Methods Data from a national longitudinal study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine self-reported burnout over a 5-year period (2012 to 2016) among 2002 to 2004 and 2009 to 2011 residency graduates (N = 1804). Study participation rates ranged from 94% in 2012 to 85% in 2016. Mixed-effects logistic regression for longitudinal analysis was used to examine burnout over time. Results In any given year, between 20% and 35% of study pediatricians reported that they were currently experiencing burnout. Significant increases in burnout over time were found for all participants combined and for each subgroup examined. Several factors were associated with reduced burnout. The largest associations with reduced burnout were found for increased flexibility in work schedule (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.22–0.35), decreased work busyness (aOR, 0.28; 95% CI, 0.22–0.36), or a job change (aOR, 0.48; 95% CI, 0.36–0.65). Conclusions Following 5 years of participation in a longitudinal study, more than 1 in 3 early- to mid-career pediatricians reported experiencing burnout. This represents a 75% relative increase in burnout from the start of the study. Specific characteristics of pediatricians’ jobs, such as flexible work schedules and busyness of work settings, were most strongly associated with reduced burnout.

(1) Evaluate radiology resident perception of emergency radiology (ER). (2) Identify potential barriers to pursuing fellowship training or a career in ER among radiology residents. A 9-question digital survey was designed using Qualtrics Experience Management software (Qualtrics Inc., Provo, UT) and distributed to all US radiology residents via a multi-pronged distribution approach. Four hundred fifty-one residents responded out of an estimated national total of 4432 residents (10.2%). Gender proportion was nationally representative (female = 24.5%; p = 0.57), with a slight R1 predominance (p = 0.034). Of the residents, 88.8% were aware that an ER subspecialty exists, 82.0% were aware that ER fellowships exist, but only 51.7% were aware that the American Society of Emergency Radiology (ASER) exists. Nearly a quarter reported no ER division or ER resident rotation. Residents in a program without an ER division or rotation were nearly twice as likely to be unaware of the existence of ER subspecialty, ER fellowships, and ASER compared to others (p = 0.017). The presence of an ER division and rotation significantly increases the knowledge of ASER (65.5% vs. 40.7%, p

Exercise in microgravity is a necessary activity for astronauts to preserve skeletal muscles’ form and function. Due to the challenging work schedule on space flight as well as the environmental limitations, astronauts have limited time and limited equipment to perform specific physical activities able to stimulate the cardiovascular and neuromuscular systems. While studies have focused on the effects of spaceflight, little is known about the day to day changes in skeletal muscle form and function as well as the optimal ‘dose’ of exercise necessary to retain it. A wearable solution integrating electromyography (EMG) and near-infrared spectroscopy (NIRS) was commissioned by the European Space Agency to be able to monitor the effects of dedicated exercise programs in-flight and be able to modify them according to individual astronauts’ needs and progressions. The aim of this study was to present the feasibility of a textile-wearable solution integrating EMG/NIRS and its applicability for assessing the effectiveness of the exercises typically performed by space crews. The results indicate that the proposed solution is feasible and it could be applied as a reliable tool on space flight for evaluating exercise-induced effects in skeletal muscles.

Aims This project aims to explore the experiences of Yorkshire-based paediatrics trainees of all grades following the recent transition of some trainees to the new (2016) terms and conditions of service (TCS) 1 for junior doctors in England. The authors intend to identify areas which can be addressed to improve the experience of paediatrics trainees in Yorkshire. Methods An electronic survey was designed and circulated to paediatric trainees of all grades in the Yorkshire School of Paediatrics between 17th–31 st July 2017. Results Ninety (25%) out of 361 trainees responded (including those on maternity leave, excluding those out of programme). Sixty-six respondents (73%) were full time trainees. The respondents were equally split between those on the 2016 TCS and those on the old (2002) TCS. Thirteen (30%) of those on the new TCS had exception reported, with five of the 13 trainees (38%) having experienced exception reports being actioned within two weeks, and two respondents (5%) having experienced a work schedule review. Nineteen (44%) of respondents were either dissatisfied or very dissatisfied with the new contractual limits on working hours. The main positive experiences identified were: rest rostering, pay, exception reporting, awareness of rest entitlements. The main negative experiences identified were: swapping shifts more difficult due to safe working hours limits, rota gaps, pay disparity, lower morale. Conclusion Work is ongoing to begin to address some of these issues in Yorkshire. The results highlighted both contractual and extra-contractual issues. More work is needed to address concerns identified by paediatrics trainees, particularly around morale and rota gaps. Trainees should be encouraged to exception report and exception reports should be actioned within the appropriate timeline. Further work can be pursued to explore if these results are comparable across England, and across other specialty training programmes. Reference . Junior Doctors Termsand Conditions of Service. NHS Employers . http://www.nhsemployers.org/case-studies-and-resources/2016/05/junior-doctors-terms-and-conditions-of-service [Accessed: 14/10/17].

Introduction: Evaluating a patients' risk is an essential primary step in the prevention of dental caries. Based on its results, different preventive strategies catering to patients' specific needs should be advised. Aim: To assess and compare the knowledge, attitude, and practice among dentists who are either attached with an institute or running a private practice or both in Delhi-National Capital Region regarding caries risk assessment (CRA) and management. Materials and Methods: Knowledge, attitude, and practices of dentists' regarding CRA and management were assessed through a 30-item questionnaire. Data were analyzed using SPSS software 21.5. Frequencies were used to assess the demographic information, knowledge, attitude, and risk assessment practices. Results: Dental professionals with institutional attachment were better aware of the importance of CRA and practised it more frequently as compared to the dentists who were solely attached with a private practice. This attitude could be due to lack of time and inclination to treat more number of patients in a working day. Pedodontists were more aware than other specialists. Conclusions: There is a need to update knowledge regarding CRA and incorporate preventive practices in daily work schedule among dentists of all specialties.

Background. Shiftwork is considered as one of risk factors of arterial hypertension (HT) and metabolic disorders. Aim. To study effects of different types of shift plan on HT and the metabolic disorders development. Material and Methods. 1091 men were included in the study. Patients were split into subgroups according to age (20–29, 30–39, 40–49, 50–59 years old) and shift plan (steady or shiftable work schedule). HT (blood pressure >130/85 mm Hg), abdominal obesity (waist circumference >94 cm), disorders of glucose metabolism were revealed. Results. HT prevalence in patients with shiftwork was significantly higher than that in employees with steady work schedule (34.4 vs 27.4%, respectively; р

Individuals seeking treatment for addiction often experience barriers due to cost, lack of local treatment resources, or either school or work schedule conflicts. Text-messaging-based addiction treatment is inexpensive and has the potential to be widely accessible in real time. We conducted a comprehensive literature review identifying 11 published, randomized controlled trials (RCTs) evaluating text-messaging-based interventions for tobacco smoking, four studies for reducing alcohol consumption, one pilot study in former methamphetamine (MA) users, and one study based on qualitative interviews with cannabis users. Abstinence outcome results in RCTs of smokers willing to make a quit attempt have been positive overall in the short term and as far out as at six and 12 months. Studies aimed at reducing alcohol consumption have been promising. More data are needed to evaluate the feasibility, acceptability, and efficacy of this approach for other substance use problems.

Introduction Cancer diagnosis affects employment status. Our health network offers supportive services to cancer patients. We hypothesized patients who used these services were more likely to continue to work during and after treatment. Methods A mailed survey was used to assess employment before, during, and after treatment, and support services used. Chi-square analysis was performed. Results The response rate was 34% (273/782). 87% of patients worked full or part time before cancer diagnosis, 68.8% continued to work during treatment, and 73.9% returned to work after treatment. 61% of patients used at least one type of support service. Patients who had no change in work status during treatment and who returned to work less than one month after treatment were more likely to use services. Conclusions Most patients used support services, continued to work during treatment, and returned to pre-cancer employment status. Physicians should encourage patients to pursue supportive therapies.

Background Shiftwork and long work hours have been reported as significant risk factors for nurses’ burnout. In addition, whether nurses have ability to control their own schedule , such as having options and decision over swapping shifts or taking unpaid leave, remain lacking. Objective To examine the associations between nurses’ work schedule control (WSC) and their effect on burnout. Method A total of 3431 fulltime registered nurses working in the hospital were systematically sampled in 2013. A structured self-administered questionnaire was performed to assess nurses’ WSC, work schedule demands (WSDs) and their effect on burnout. The WSC was assessed by asking nurses’ experiences of requesting leave. Personal and client burnout status were measured using the Chinese version of the Copenhagen Burnout Inventory. Multivariable logistic regression was used to analyse the associations between nurses’ WSC and their effect on burnout. The WSDs, including shiftwork patterns and average weekly working hours, were controlled. Results A total of 2631 questionnaires were eligible for final analysis. Only 5% of participants experienced unrestricted leave. After adjusting for demographic data, both average weekly working hours and unrestricted leave were significantly associated with nurses’ personal and client burnout. Nurses exposed to rotating shift work were more likely to experience client burnout. Conclusion This study identified that work schedule control (WSC) was related to personal and client burnout among hospital nurses. Hospitals wishing to proactively reduce nurses’ burnout may permit more unrestricted leaves when requested by the staff nurse.

Fast rotation three-shift working schedules are common in the medical field in Taiwan. This study investigated whether 24 h off is sufficient for re-adaptation to a daytime routine after working two night shifts (NSs) by comparing changes in cognitive function, anxiety state and objectively measured sleep propensity between those working two NSs followed by 24 h off (n = 21, 2NS-off) and an off-duty group (n = 21, OD). The results showed that nurses in the 2NS-off group were less alert and had decreased visual attention performance and executive function ability than the OD group during the daytime. One day off appeared to be insufficient to adapt back to a daytime shift after two NSs. Further studies are warranted to investigate whether a longer sequence of consecutive NSs (e.g. four NSs) followed by two days off is suitable for a fast rotation three-shift work schedule to allow for optimal performance throughout the next daytime shift. Practitioner Summary: The medical field in Taiwan mandates at least 24 h off between night and day shifts, but this appears to be insufficient for re-adapting to a daytime shift after two night shifts. A longer sequence of consecutive night shifts followed by two days off may be more suitable.

The option of daily hemodialysis (HD) was discussed in November 1998 with a group of 35 HD patients on home or self-care/limited-care HD in a single, freestanding unit. After the meeting, 3 patients on home HD chose to switch to daily HD. The clinical success of the first patient and the immediate followers was one of the main reasons for further extension of this experience. At the time of this writing (February 2000), 10 patients were on a daily HD program (8 at home and 2 in a self-care/limited-care center) and one was in training for home daily HD. One further patient who tried 1 month of daily HD dropped out for logistic reasons. On daily HD, patients are dialyzed 2 - 3 hours/day, 6 days/ week, with blood flow of 270 - 300 mL/min, on bicarbonate dialysate with individually determined levels of Na and K. The schedule is flexible and a switch to 3 - 4 dialyses/week is occasionally allowed for working needs or for vacation. In addition to the well-known clinical advantages (better well-being, blood pressure control, nutrition, etc.), some patients preferred daily HD because of easier organization of daily activities, including work schedule. Patients initially feared frequent needle punctures and excessive burden on partners, but those concerns proved to be less a problem than anticipated. All current patients are willing to continue daily HD; only a nursing shortage limits further extension of the program in the self-care/limited-care center.

This study sought to obtain a better understanding of how clergy view their health and to investigate their self-reported health status. Additionally, this study sought to explore personal and professional barriers among clergy to living a healthier life. An electronic 32-item survey was sent to all practicing clergy in Kansas East and West conferences of United Methodist church by the Kansas Area Office of the United Methodist Church. Survey items included participants' demographic information and health conditions (e.g., diabetes, heart disease, high blood pressure, high cholesterol). The self-reported general health, mental health, and physical health data were also collected to compare to the general population in Kansas. Clergy were also asked to identify perceived barriers to health. A total of 150 clergy participated in the survey. The majority (93.7 %) self-reported their health as good, very good, or excellent. Participating clergy self-reported a higher prevalence of chronic diseases (diabetes, heart disease, high blood pressure, and high cholesterol) than the Kansas general population, but those differences were not statistically significant. More than three-fourths (77.4 %) of the participating clergy reported weights and heights that classified them as either overweight or obese. Lack of family time was the most frequently reported personal barrier to achieving a healthier lifestyle. An unpredictable work schedule was reported as the most frequent professional barrier to achieving a healthier lifestyle. This study suggests that Kansas clergy generally view their overall health status favorably despite being overweight or obese. Clergy also self-reported higher prevalence of chronic diseases than the general Kansas population, though the prevalence was not statistically different. This study provides additional insight into clergy health and offers suggestions to address the barriers preventing clergy from working toward better health.

This study examined the effects of work schedule flexibility and the spillover of work stress to family life on the health of parents of adult children with serious mental illness (SMI). We compared 100 parents of adult children with SMI to 500 parents with nondisabled adult children using data from the Wisconsin Longitudinal Study. The detrimental impact on health of a lack of work flexibility and of higher levels of negative work-to-family spillover were more pronounced among parents of adult children with SMI than parents with non-disabled adult children. The results have significant implications for developing interventions to help midlife families of persons with SMI cope with work-related stress and for policies that provide for greater work schedule flexibility.