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Objective Workplace bullying has been established as a significant correlate of sleep problems. However, little is known regarding the causal direction between bullying and sleep. The aim of this study was to examine temporal relationships between bullying and symptoms of insomnia. Methods Reciprocal and prospective associations between exposure to workplace bullying and symptoms of insomnia were investigated in a national probability sample comprising 1149 Norwegian employees. Data stemmed from a two-wave full panel survey study with a 6-month time interval between the baseline and follow-up assessments. Models with stabilities, forward-, reverse-, and reciprocal associations were tested and compared using Structural Equation Modelling. Analyses were adjusted for age, gender, and the stability in the outcome variables over time. Workplace bullying was assessed with the nine-item Short Negative Acts Questionnaire. Insomnia was assessed with a previously validated three item scale reflecting problems with sleep onset, sleep maintenance, and early morning awakening. Results The forward association model, which showed that exposure to workplace bullying prospectively increased levels of insomnia (b = 0.08; p Conclusion Workplace bullying is a risk factor for later insomnia. There is a need for further studies on moderating and mediating variables that can explain how and when bullying influence sleep.

The study investigated relationships between exposure to bullying behaviours, return to work self-efficacy (RTW-SE) and resilience, and if resilience moderates the bullying-RTW-SE relationship among patients on sick leave or at risk of sick leave due to common mental disorders (CMD). A sample of 675 patients treated in an outpatient clinic was analysed using regressions and moderation analyses by employing SPSS and the Process macro SPSS supplement. The results showed a negative relationship between exposure to bullying behaviours and RTW-SE. There was also a positive main effect for resilience, as patients with high resilience score significantly higher on RTW-SE than patients with low resilience irrespective of levels of bullying. Further, the resilience sub-dimension personal resilience moderated the bullying-RTW-SE relationship, while the sub-dimension interpersonal resilience did not. Patients high on personal resilience showed relatively lower RTW-SE scores when exposed to bullying behaviours, compared to those that were not bullied with high personal resilience levels. Hence, one should take note of the fact that even if resilience may strengthen RTW-SE, bullying is an adverse event which particularly affects individuals who present with relatively high levels of resilience resources, at least when it comes to RTW-SE.

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

ObjectivesTo investigate how a standard ceiling mounted light-emitting diode (LED)-based bright light intervention affected alertness and neurobehavioural performance during three consecutive simulated night shifts, and timing of circadian rhythm after the shifts.MethodsTwenty seven participants (20 females, 21.4±2.1 years; mean±SD) worked three consecutive night shifts (23:00–07:00) under a full-spectrum (4000 K) bright light (900 lx) and a standard light (90 lx) condition in a counterbalanced crossover design (separated by 4 weeks). Subjective alertness (Karolinska Sleepiness Scale) and neurobehavioural performance (Psychomotor Vigilance Task and Digit Symbol Substitution Test) were assessed five times during each shift. Salivary dim-light melatonin onset (DLMO) was assessed before and after the shifts. The simulated night shifts were conducted in a laboratory while the participants slept at home.ResultsSubjective alertness and neurobehavioural performance deteriorated during the night shifts in both light conditions. However, bright light significantly reduced alertness and performance decrements as compared with standard light. For a subset of the participants, DLMO was delayed by a mean of 3:17±0:23 (mean±SEM) hours after three night shifts in bright light and by 2:06±0:15 hours in standard light, indicating that bright light causes larger phase delay.ConclusionBright light improved performance and alertness during simulated night shifts and improved adaptation to night work. Bright light administered by ceiling mounted LED luminaires has the potential to improve adaptation to night work and reduce the risk of accidents and injuries among night workers.Trial registration numberNCT03203538.

The study examined sleep and sleepiness among shift working Helicopter Emergency Medical Service pilots from Norway (Norwegian Air Ambulance; NAA) and Austria (Christophorus Flugrettungverein; CFV). Both pilot groups (N = 47) worked seven consecutive 24 h shifts. Sleep was assessed by diaries and actigraphy while sleepiness was assessed by the Karolinska Sleepiness Scale, all administered throughout the workweek. The results indicated that all pilots had later bedtime (p < 0.05) and wake-up time (p < 0.01) as they approached the workweek end, but no change during the workweek was evident regarding wake after sleep onset, time in bed, total sleep time, or sleep efficiency. The NAA pilots had later bedtime (p < 0.001) and wake-up time (p < 0.001), spent more time awake after sleep onset (p < 0.001), more time in bed (p < 0.001), slept longer (p < 0.01), and had lower sleep efficiency (p < 0.001) compared with the CFV pilots. The sleepiness levels of all pilots were slightly elevated on the first workday but lower on the following workdays (day 2p < 0.001, day 3p < 0.05). For both pilot groups, no major change in sleep or sleepiness parameters throughout the workweek was detected. The NAA pilots reported somewhat more disturbed sleep but obtained more sleep compared with the CFV pilots.

Night work leads to sleepiness and reduced vigilant attention during work hours, and bright light interventions may reduce such effects. It is also known that total sleep deprivation impairs cognitive flexibility as measured by reversal learning tasks. Whether night work impairs reversal learning task performance or if bright light can mitigate reversal learning deficits during night work is unclear. In this counterbalanced crossover study (ClinicaTrials.gov Identifier NCT03203538), young healthy individuals completed a reversal learning task twice during each of three consecutive simulated night shifts (23:00–07:00 h). The night shifts were performed in a laboratory under a full-spectrum (4000 K) bright light (~900 lx) and a standard light (~90 lx) condition. Reversal learning task performance was reduced towards the end of the night shifts (04:50 h), compared to the first part of the night shifts (00:20 h) in both light conditions. However, with bright light, the reversal learning task performance improved towards the end of the night shifts, compared to standard light. The study shows that bright light may mitigate performance deficits on a reversal learning task during night work and implies that bright light interventions during night work may be beneficial not only for vigilant attention but also for cognitive flexibility. acceptedVersion

Background: Victims of workplace bullying represent a group characterised by severe negative health complaints at risk of losing their foothold in working life. To date, very few studies have investigated the effect of psychological treatment of the health-related problems often facing victims of bullying. Objective: The aim was to investigate if victims of workplace bullying suffering from common mental disorders (CMD) benefit from clinical treatment for their mental health problems at an outpatient clinic treating patients using Metacognitive or Cognitive Behavioural Therapy with work-focus. Criteria were symptom reduction and change in workplace participation. Comparisons were made between the victims of workplace bullying with CMD, a wait-list control group consisting of patients who had also been exposed to bullying yet now awaiting treatment, and other patients not exposed to bullying. Methods: The sample comprised of 405 patients from an outpatient clinic in Norway. The study used a naturalistic observational design and data was collected pre-treatment and post-treatment. Results: The results showed the treatment to be effective in symptom reduction for victims of bullying to a similar degree as patients otherwise not exposed to bullying. Even more, victims receiving treatment had a larger improvement compared to the wait-list control group (p

Background Nurses are in the frontline and play an important role in the battle against the COrona VIrus Disease-2019 (COVID-19) pandemic. Sleep problems among health care workers are likely to increase due to the pandemic. However, it is conceivable that negative health outcomes related to the pandemic fluctuate with the infection rate waves of the pandemic. The present study aimed to investigate sleep patterns among Norwegian nurses, after the first wave, during a period with very low rates of COVID-19. Methods Data stemmed from the cohort study “SUrvey of Shift work, Sleep and Health (SUSSH)” among Norwegian nurses. A total of 1532 nurses responded one time to a questionnaire between June and September in 2020 including items about demographics and work, information about COVID-19 and quarantine, sleep patterns and changes in sleep patterns due to the pandemic. Descriptive statistics for all relevant variables were calculated and McNemar tests were used to compare categorical variables. Results The majority of nurses (84.2%) reported no change in sleep duration after the first wave of the COVID-19 pandemic compared to before, 11.9% reported less sleep, and 3.9% reported more sleep. Similarly, 82.4% of the nurses reported no change in their sleep quality, whereas 16.2% of the nurses reported poorer sleep quality after the first wave of the pandemic compared to before. The majority of nurses reported no change in their sleep schedule due to the pandemic, although 9.6% of the nurses reported to go to bed later and 9.0% woke up earlier than before the pandemic. Conclusions Most existing literature exploring sleep among health care workers during the COVID-19 pandemic has been carried out during periods with high infection rates. In this study we aimed to investigate sleep patterns among Norwegian nurses following the first wave, during a period of low COVID-19 rates in Norway. Most of the nurses reported no change in neither sleep duration, sleep quality, bedtime, nor wake-up times compared to before the pandemic. Still, nearly 12% reported shorter sleep duration, and about 16% reported poorer sleep quality indicating that some nurses experienced worsening of their sleep following the pandemic.

This study aimed to explore how changes in the work schedule would affect the prevalence of Shift Work Disorder (SWD) over time. Two-year follow-up data from 1076 nurses participating in the longitudinal SUrvey of Shift work, Sleep and Health among Norwegian nurses (SUSSH) were included in the study. The questionnaires included measures of work-related factors, i.e., work schedule and numbers of night shifts and quick returns (QRs) worked the last year, as well as questions related to SWD according to the ICSD-3 diagnostic criteria at both baseline and at 2-year follow-up. Data were analyzed with paired samples t-tests, chi-square tests, and logistic regression analyses adjusting for sex and age. Terminating night work was the strongest predictor for recovering from SWD from baseline to follow-up (OR 10.91, 95% CI 6.11–19.46). Additionally, changing the work schedule from day work to night work from baseline to follow-up was the strongest predictor for developing SWD in the same period (OR 4.75, 95% CI 2.39–9.47). Reductions in number of nights (more than 10) and QRs (more than 10) worked the last year were associated with recovering from SWD between baseline and follow-up. Nurses who recovered from SWD had significantly reduced the mean number of night shifts worked the last year from 32.3 at baseline to 20.4 at follow-up (p = .001). Furthermore, an increase of more than 10 nights or more than 10 QRs worked the last year between baseline and follow-up predicted developing SWD. Nurses developing SWD between baseline and follow-up had significantly increased the mean number of nights worked the last year from 25.8 at baseline to 31.0 at follow-up (p =-.043). Changes in night work exposure were the strongest predictors for both recovering from or developing SWD from baseline to follow-up. Reducing exposure to night work and QRs were associated with recovering from SWD and increasing exposure to night work and QRs were associated with developing SWD. The results imply that unfavorable work schedules play a role in the development of sleep problems among nurses. These results may be useful when designing healthy working schedules.

IntroductionIn shift work, quick returns refer to transitions between two shifts with less than 11 hours available rest time. Twenty-three per cent of employees in European countries reported having quick returns. Quick returns are related to short sleep duration, fatigue, sleepiness, work-related accidents and sickness absence. The present study is the first randomised controlled trial (RCT) to investigate the effect of a work schedule without quick returns for 6 months, compared with a work schedule that maintains quick returns during the same time frame.Methods and analysisA parallel-group cluster RCT in a target sample of more than 4000 healthcare workers at Haukeland University Hospital in Norway will be conducted. More than 70 hospital units will be assessed for eligibility and randomised to a work schedule without quick returns for 6 months or continue with a schedule that maintains quick returns. The primary outcome is objective records of sickness absence; secondary outcomes are questionnaire data (n≈4000 invited) on sleep and functioning, physical and psychological health, work-related accidents and turnover intention. For a subsample, sleep diaries and objective sleep registrations with radar technology (n≈ 50) will be collected.Ethics and disseminationThe study protocol was approved by the Regional Committee for Medical and Health Research Ethics in Western Norway (2020/200386). Findings from the trial will be disseminated in peer-reviewed journals and presented at national and international conferences. Exploratory analyses of potential mediators and moderators will be reported. User-friendly outputs will be disseminated to relevant stakeholders, unions and other relevant societal groups.Trial registration numberNCT04693182.

The present study aimed to investigate the effects of shift work on sleep among pilots and Helicopter Emergency Medical Service crew members (HCM) in the Norwegian Air Ambulance. Sleep was assessed by diaries and actigraphy during a workweek (24 h duty for 7 consecutive days) in the winter season and a workweek during the summer season in pilots and HCM (N = 50). Additionally, differences in sleep were studied between the week before work, the workweek, and the week after work in both seasons. Results indicated that bedtime was later (p

Objective: To assess the predictive effect of a multidisciplinary intervention programme, pain, work-related factors and health, including anxiety/depression and beliefs, on return-to-work for patients sick-listed due to musculoskeletal pain. Design: A randomized clinical study. Methods: A total of 284 patients were randomized to either a multidisciplinary intervention programme (n = 141) or to a less resource-demanding brief intervention (n = 143). Work participation was estimated monthly from register data for 12 months. Return-to-work was defined as increased work participation in 3 consecutive months. Results: In the adjusted model, return-to-work by 3 months was associated with a multidisciplinary intervention programme (odds ratio (OR) = 2.7, 95% confidence interval (95% CI) = 1.1–6.9), the factor “belief that work was cause of the pain” (OR = 2.2, 95% CI = 1.1–4.3), anxiety and depression (OR = 0.5, 95% CI = 0.2–0.98), and by an interaction between the multidisciplinary intervention and perceived support at work (OR = 0.3, 95% CI = 0.1–0.9). At 12 months, only duration of sick leave was associated with return-to-work (OR = 0.6, 95% CI = 0.5–0.8). Conclusion: Multidisciplinary intervention may hasten return-to-work and benefit those who perceive low support at work, but at 12 months only duration of sick leave at baseline was associated with return-to-work.

Background:Sleep and mood have seldom been compared between elite athletes and nonelite athletes, although potential differences suggest that physical activity may affect these parameters. This study aims to explore whether adolescent elite athletes differ from controls in terms of sleep, positive affect (PA) and negative affect (NA).Methods:Forty-eight elite athletes and 26 controls participating in organized and nonorganized sport completed a questionnaire, and a 7-day sleep diary.Results:On school days, the athletes and the controls who participated in organized and nonorganized sport differed in bedtime (22:46, 23:14, 23:42, P < .01), sleep onset (23:03, 23:27, 00:12, P < .01), and total sleep time (7:52, 8:00, 6:50, P < 01). During weekend, the athletes, the controls who participated in organized and nonorganized sport differed in bedtime (23:30, 00:04, 00:49, P < .01), sleep onset (23.42, 00:18, 01:13, P < .01), rise time (9:15, 9:47, 10:55, P < .01), sleep efficiency (95.0%, 94.2%, 90.0%, P < 05), and sleep onset latency (11.8, 18.0, 28.0 minutes, P < .01). Furthermore, the athletes reported less social jetlag (0:53) and higher score for PA (34.3) compared with the controls who participated in nonorganized sport (jetlag: 1:25, P < .05, PA: 29.8, P < .05).Conclusions:An almost dose-response association was found between weekly training hours, sleep, social jetlag and mood in adolescents.

We aimed to compared sleep characteristics associated with quick returns (QRs,11 hours between shift intervals) with those associated with other common shift transitions.Sixty-seven nurses completed a 2-week work and sleep diary (94.0% female, mean age 47.7 years). A multilevel fixed effects model was used to examine the sleep in QRs compared with two consecutive night shifts, two consecutive evening shifts, and two consecutive day shifts, respectively.None of the other shift transitions studied encumbered as many detriments as QRs, which included short sleep duration (5.6 hours), slightly prolonged sleep onset latency, more abrupt ending of main sleep period, increased sleepiness, and higher level of perceived stress on the following shift.The study emphasizes the need for sufficient time for rest and recuperation between shifts.

Background Workplace bullying has consistently been found to predict mental health problems among those affected. However, less attention has been given to personal dispositions as possible moderators in this relationship. Aims To investigate the moderating role of individual hardiness in the relationship between exposure to bullying behaviours and symptoms of anxiety and depression, respectively, assuming that high hardiness, being an individual stress resilience factor, acts as a buffer in these relationships. Methods Survey data were gathered in 2016-17, among land-based employees in a Norwegian oil and gas company. Participants completed a questionnaire electronically via a link sent to their work e-mail. The PROCESS macro SPSS supplement was used to analyse the proposed relationships, with mean-centred variables. Results Altogether, 275 participated in the study (46% response rate). High hardiness acted as a buffer in the bullying-anxiety relationship, in that hardy individuals did not experience increased levels of anxiety when facing bullying behaviours. Low levels of hardiness, on the other hand, acted as an enhancement factor, in that the bullying-anxiety relationship was strengthened for this group. Contrary to expectations, hardiness did not act as a buffer in the bullying-depression relationship. Conclusions Hardy individuals were less likely to report anxiety in response to bullying than non-hardy workers, a finding with important practical implications. Yet, regardless of who is affected, managers should focus on good strategies to intervene when bullying is detected, and stress resilience training should be considered as part of these strategies.

Purpose: To examine the effects of shift work and extended working hours on sleepiness among pilots and Helicopter Emergency Medical Service (HEMS) crew members in the Norwegian Air Ambulance. Methods: This field study investigated sleepiness during 3 consecutive weeks: the week before work, the work week, and the week after work. The pilots and HEMS crew members (N = 50) kept a wake diary during all 3 weeks and completed reaction time tests during the work week. Results: The overall sleepiness scores were low during all 3 weeks. When comparing the 3 weeks, the lowest sleepiness levels were found for the work week. There was a small difference across work days, in which subjective sleepiness scores were highest the first duty day. No change in the reaction time tests was evident during the work week. The crew members reported being most sleepy at midnight, compared to all the other timepoints over the course of a duty day. Regarding workload and total work time, having larger workload was associated with lower sleepiness scores, while having higher total work time was associated with higher sleepiness score, both compared to the medium category. Conclusions: The findings indicate that the work schedules and setting for this distinct occupational group do not seem to negatively affect the sleepiness levels. publishedVersion

Objective We compared subjectively reported sleepiness and fatigue as well as causes and management strategies for combating sleepiness among pilots working in 2 different helicopter emergency medical services operating with different shift systems. Methods Pilots from the Norwegian Air Ambulance (NAA) and Christophorus Flugrettungsverein (CFV) in Austria participated. NAA performs flight missions 24/7, whereas at the time of the study the participating CFV bases did not fly after sunset. The pilots are on duty for 1 week in both services. NAA and CFV used an identical research protocol, including questionnaires about sleep, sleepiness (Epworth Sleepiness Scale and Karolinska Sleepiness Scale), coping strategies, and work-related causes of fatigue. Results CFV pilots kept busy, whereas NAA pilots slept and did physical exercise as strategies to prevent sleepiness. The majority in both groups used napping and coffee consumption as strategies. CFV pilots reported more frequently than NAA pilots that administrative duties and environmental factors were reasons preventing napping. Conclusion Some differences existed between the 2 pilot groups regarding strategies for managing sleepiness and causes that prevented pilots from napping. Pilots in both groups were healthy, physically active, and had normal Epworth Sleepiness Scale and Karolinska Sleepiness Scale scores.

Aim: To explore how employees experience workplace inclusion of their colleagues or themselves when having back pain or mental health problems. Methods: Three focus group interviews with a sample of 16 kindergarten employees were conducted. Systematic Text Condensation was used for analysis. Results: The participants emphasized that it was easier to include colleagues whose health problems were specific, especially when they were open about having problems and expressed their needs for accommodation clearly. Discussions revealed difficulties of acceptance and accommodating colleagues with longstanding health problems, when the burden on the other staff members was heavy, and if it had negative consequences for the kindergarten children. Some of the participants had experienced health problems themselves, which was also described as challenging. Having health problems at work often induced feelings of guilt, being a burden to their colleagues, and experiencing a disparity between the ideals and the realities of inclusion practices. Conclusions: Workplace inclusion of employees is difficult when their health problems are unspecific, longstanding, and lead to negative consequences for children or colleagues. System level efforts are necessary to reduce negative stereotypes about employees with health problems and facilitate inclusion practices.

Purpose: The aim of this study was to examine whether less than 11 h between shifts (i.e., quick returns, QRs) and night shifts is associated with self-reported work-related accidents, near accidents or dozing off at work in a sample of nurses. Methods: The study was based on cross-sectional data from 1784 nurses (response rate = 60%; mean age = 40.1 years, SD = 8.4; 91% female). Negative binomial regression analyses were conducted to investigate the association between the shift exposures, and eight different self-reported work-related items on accidents, near accidents and dozing off at work, controlling for demographics and work factors. Results: The number of QRs during a year was positively associated with seven of the eight items on work-related accidents, near-accidents and dozing off at work, and number of night shifts was positively associated with five items. Some of the key findings were that QRs were associated with nurses causing harm to themselves (incidence rate ratio [IRR] = 1.009; 95% CI = 1.005–1.013), causing harm to patients/others (IRR = 1.006; 95% CI = 1.002–1.010) and causing harm to equipment (IRR = 1.004; 95% CI = 1.001–1.007); while night shifts were associated with nurses involuntarily dozing off at work (IRR = 1.015; 95% CI = 1.013–1.018), dozing off while driving to/from work (IRR = 1.009; 95% CI = 1.006–1.011), and harming patients/others (IRR = 1.005; 95% CI = 1.001–1.009). Conclusion: QRs and night shifts were both associated with the self-reported work-related accidents, near-accidents and dozing off at work. Studies that can establish the causal relationship between QRs and accidents are called for. acceptedVersion

Background: Organisation of working hour schedules in the Northern European countries are rather similar. EU countries are obliged to adopt national legislation regarding duration of weekly working hours and rest periods. Yet, working hour characteristics and schedules are likely to differ with respect to starting times and duration depending e.g. on culture and tradition. Yet, very little is known about potential differences between shifts and schedules across countries among nursing personel. This knowledge is relevant, since the potential differences in working hour characteristics may influence and possibly explain some of the differences observed in studies of health and safety. The aim of the study was to compare characteristics of working hours and work schedules among nursing personel in three Nordic countries: Denmark, Finland and Norway. Methods: The study populations included nursing personnel holding a ≥ 50% position at public hospitals in Denmark (n = 63,678), Finland (n = 18,257) or Norway (n = 1538) in 2013. Objective payroll based registry data with information on daily starting and ending times were used to compare working hour characteristics e.g. starting time, duration of shift, and quick returns ( 13/year) quick returns in Norway (64%) and Finland (47%) compared to Denmark (16%). The frequency of 3-shift rotation workers was highest in Norway (41%) and lower in Denmark (22%) and Finland (22%). There were few differences across the countries in terms of early morning shifts and (very) long weekly working hours. Conclusion: Despite similar distribution of operational hours among nurses in the three countries, there were differences in working hour characteristics and the use of different types of work schedules. The observed differences may affect health and safety. publishedVersion

Aims: The aim of this study was to investigate whether a workplace educational low back pain intervention had an effect on sick leave at the individual level and to identify possible predictors of the effect of intervention. Methods: Work units in two municipalities were cluster randomized to (a) educational meetings and peer support (45 units), (b) educational meetings, peer support and access to an outpatient clinic if needed (48 units) or (c) a control group (42 units). Both intervention groups attended educational meetings with information about back pain based on a non-injury model. A peer adviser was selected from among their colleagues. The outcome was days of sick leave at the individual level at 3, 6, 9 and 12 months, adjusting for previous sick leave at the unit level. As a result of similar effects on sick leave, the two intervention groups were merged ( n=646) and compared with the control group ( n=211). The predictors were different levels of belief in back pain myths, pain-related fear, helplessness/hopelessness and low back pain. Results: The intervention group had significantly less days of sick leave at the three month (4.9 days, p=0.001) and six month (4.4 days, p=0.016) follow ups compared with the control group. At three months, a low level of pain-related fear was the only predictor for the intervention effect (8.0 less days of sick leave, p

Objective: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. Methods: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patienttherapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. Results: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7 months of the follow-up compared to the BI-group. Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. Trial Registration: http://www.clinicaltrials.gov with the registration number NCT01346423. Return to work in patients with chronic musculoskeletal pain: multidisciplinary intervention versus brief intervention: a randomized clinical trial Innlandet Hospital Trust, Norway funded the study.

This systematic review and meta-analysis 1) clarifies and quantifies existing results on the association between exposure to workplace bullying and sleep, 2) evaluates the methodological quality of existing studies, 3) identifies theoretical frameworks used in research, 4) determines moderating and mediating variables, and 5) provides guidelines for future research. Searches for primary studies were conducted in Pubmed, Medline, Embase, PsycINFO and Web of Science. Of the 406 studies identified, 26 fulfilled the inclusion criteria for the qualitative synthesis whereas sixteen studies were included in the meta-analysis (cross sectional effect sizes: 15; N=69,199/prospective effect sizes: 6; N=26,164). Workplace bullying was significantly related to sleep problems in all studies. Across cross-sectional studies, targets of bullying had 2.31 higher odds of reporting sleep problems compared to non-bullied workers. The odds across the prospective studies was 1.62. The quality of evidence for the association between workplace bullying and sleep problems was low to moderate. Only eight studies had a predefined theoretical rationale for the association, and few studies examined mediating and moderating variables or bidirectional associations. The methodological quality of the studies was moderate. Further research is needed to establish the nature, directionality, mechanisms, and conditions of the association between bullying and sleep. publishedVersion

Personality has been hypothesized to act as antecedent as well as an outcome of workplace bullying. Still, investigations on the longitudinal relationship between bullying and personality are scarce. We investigated the relationship between accumulated exposure to bullying at work and subsequent changes in psychological hardiness. Additionally, we examined whether hardiness predicted subsequent exposure to bullying. The data were based on the Survey of Shiftwork, Sleep, and Health (SUSSH), a cohort study with annual surveys among Norwegian nurses. The participants who completed standardized instruments measuring exposure to bullying behavior at T1 (2008/09) to T4 (2012) and psychological hardiness at T1 (2008/09) and T5 (2012) were included (n = 938). The results showed that accumulated exposure to bullying (sum of exposure from T1&ndash, T4) was associated with reduced psychological hardiness at T5, adjusted for age, sex, and hardiness at baseline (&beta, = &ndash, 0.16, t = &ndash, 5.70, p &lt, 0.001). Accumulated exposure to bullying behaviors explained 2.3% of the change in hardiness. Less hardy individuals experienced higher levels of subsequent exposure to bullying behaviors, adjusted for age, sex, and bullying at baseline (&beta, 0.04, t = &ndash, 2.21 p &lt, 0.05). Long-term accumulated exposure to bullying behaviors seemed to be a stronger predictor for changes in hardiness as compared to hardiness in predicting exposure to bullying.

Background Existing evidence on the association between exposure to bullying and sleep is limited and inconclusive. The aims of this planned systematic review and meta-analysis are therefore (1) to determine whether exposure to workplace bullying is related to changes in sleep function and (2) to establish mediating and moderating factors that govern the relationship between bullying and sleep. Methods A systematic review and meta-analysis will be conducted. Electronic databases will be searched using predefined search terms to identify relevant studies. Eligible studies should report empirical findings on the association between exposure to workplace bullying and at least one indicator of sleep. Primary observational studies with cross-sectional or prospective research design, case-control studies, and studies with experimental designs will be included. Qualitative interviews and case studies will be excluded. The methodological quality of the included studies will be assessed with a previously established checklist for studies on workplace bullying. The quality of evidence for an association between bullying and sleep problems will evaluated in accordance with the GRADE system. A random effects meta-analysis will be conducted with the Comprehensive Meta-Analysis software, version 3. Discussion This review and meta-analysis will be among the first to systematically explore and integrate the evidence available on the association between exposure to bullying and sleep, as well as on the mediating and moderating factors that can govern this associations. By gathering and summarizing information about potential factors that can explain when and how bullying is related to sleep, the findings from this study will provide directions for future research and provide practitioners and clinicians with an understanding about the nature and consequences of workplace bullying and point to directions for relevant interventions. Systematic review registration The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018082192). Electronic supplementary material The online version of this article (10.1186/s13643-018-0898-z) contains supplementary material, which is available to authorized users.

Purpose: The aim of this study was to investigate the effects of long working hours (≥ 12h shifts) on sick leave using objective records of shift work exposure and of sick leave. Methods: A total of 1538 nurses (mean age 42.5, SD 12.0; response rate 42%) participated. Payroll and archival sick leave data over a 4-year period were retrieved from employers’ records and aggregated over every third calendar month. A multilevel negative binomial model was used to investigate the effects of exposure to long working hours, on subsequent sick leave rates the following 3months. Covariates included prior sick leave, number of shifts worked, night and evening shifts, personality, and demographic characteristics. Results: Exposure to long working hours was associated with fewer sick leave days in the subsequent 3months [adjusted model, incidence rate ratio (IRR) = 0.946, 95% CI 0.919–0.973,p&thinsp

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Background Patients in nursing homes are at risk of adverse events, representing a highly vulnerable group that is chronically weak and cognitively or physically reduced. To prevent adverse events, knowledge of patient safety culture can act as a basis for nursing homes’ own organizational improvement initiatives. There is scarcity of longitudinal studies exploring the sustainability or variability of safety culture in nursing homes. This study therefore describes the variability in staff perceptions of patient safety culture over time in a cross-sectional sample of Norwegian nursing homes, and tests the influence of nursing homes’ own organizational initiatives. Methods The study applied a cross-sectional and prospective longitudinal design collecting data on staff perceptions of patient safety culture in nine Norwegian nursing homes based on the Norwegian version of the Nursing Home Survey on Patient Safety Culture (NHSOPSC) instrument. Data collection took place through a baseline survey (June–September 2013) and through a follow-up survey (March–April 2015). Data were analyzed by descriptive statistics, t-test, and hierarchical regression analysis. Results The response rate was 70% at baseline and 69% at follow-up. Variability, measured by changes in the average percentage of positive responses per safety culture dimension, showed a high degree of stability for the nine nursing homes in total with more variability across each single nursing home. When comparing mean scores for the total patient safety culture score, only one of the nursing homes improved significantly from the baseline to the follow-up. After adjusting for the facility level (single nursing home), nursing homes’ own organizational initiatives explained 29.5% of the variance in the total patient safety culture score (F [4, 263] = 27.53, p