Aim: This descriptive study was conducted to analyze the existing situation and nurses' perspectives on work schedules. Method: The study sample consisted of 207 nurses who worked at 23 state ...hospitals. The data were collected with a 40-item questionnaire developed by the researchers. Descriptive statistics, Kruskal-Wallis, Mann-Whitney U, chi-square, and Spearman's correlation tests were used for data analysis. Results: The mean numbers of beds, nurses, daily hospitalized patients, and patients in the unit on the last shift were 24.23 (SD=15.01), 14.79 (SD=10.48), 9.16 (SD=8.2), and 12.10 (SD=10.28), respectively. Of the nurses, 49% had a rotating shift, 54.8% were dissatisfied with the shift system, and nurse scheduling was mostly prepared on paper by the clinic's responsible nurses and then loaded onto a computer. Conclusion: Fair and objective criteria and software should be used to prepare schedules with mostly fixed shifts and convenient work hours, without wasting time on manual scheduling. These results indicate factors that need to be taken into consideration in the preparation of nurses' work schedules and workforce planning.
An increasing number of original studies suggest that exposure to shift work and long working hours during pregnancy could be associated with the risk of adverse pregnancy outcomes, but the results ...remain conflicting and inconclusive.
To examine the influences of shift work and longer working hours during pregnancy on maternal and fetal health outcomes.
Five electronic databases and 3 gray literature sources were searched up to March 15, 2019.
Studies of all designs (except case studies and reviews) were included, which contained information on the relevant population (women who engaged in paid work during pregnancy); exposure (rotating shift work shifts change according to a set schedule, fixed night shift typical working period is between 11:00 pm and 11:00 am or longer working hours >40 hours per week);comparator (fixed day shift typical working period is between 8:00 am and 6:00 pm or standard working hours ≤40 hours per week); and outcomes (preterm delivery, low birthweight birthweight <2500 g, small for gestational age, miscarriage, gestational hypertension, preeclampsia, intrauterine growth restriction, stillbirth, and gestational diabetes mellitus).
From 3305 unique citations, 62 observational studies (196,989 women) were included. “Low” to “very low” certainty evidence from these studies revealed that working rotating shifts was associated with an increased odds of preterm delivery (odds ratio, 1.13; 95% confidence interval, 1.00–1.28, I2 = 31%), an infant small for gestational age (odds ratio, 1.18, 95% confidence interval, 1.01–1.38, I2 = 0%), preeclampsia (odds ratio, 1.75, 95% confidence interval, 1.01–3.01, I2 = 75%), and gestational hypertension (odds ratio, 1.19, 95% confidence interval, 1.10–1.29, I2 = 0%), compared to those who worked a fixed day shift. Working fixed night shifts was associated with an increased odds of preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.03–1.42; I2 = 36%) and miscarriage (odds ratio, 1.23; 95% confidence interval, 1.03–1.47; I2 = 37%). Compared with standard hours, working longer hours was associated with an increased odds of miscarriage (odds ratio, 1.38; 95% confidence interval, 1.08–1.77; I2 = 73%), preterm delivery (odds ratio, 1.21; 95% confidence interval, 1.11–1.33; I2 = 30%), an infant of low birthweight (odds ratio, 1.43; 95% confidence interval, 1.11–1.84; I2 = 0%), or an infant small for gestational age (odds ratio, 1.16, 95% confidence interval, 1.00–1.36, I2 = 57%). Dose–response analysis showed that women working more than 55.5 hours (vs 40 hours) per week had a 10% increase in the odds of having a preterm delivery.
Pregnant women who work rotating shifts, fixed night shifts, or longer hours have an increased risk of adverse pregnancy outcomes.
Functional communication training is an effective treatment for decreasing socially reinforced destructive behavior (Carr & Durand, 1985). Clinicians frequently use multiple schedules to thin the ...reinforcement schedule (Hanley et al., 2001). Individuals are often taught to wait for functional reinforcers without alternative programmed stimuli. However, concurrently available items and activities are often accessible in the natural environment. In this study, we taught 4 participants a functional communication response to access functional reinforcers. We implemented a multiple schedule during schedule thinning, comparing a control condition (nothing available during S
intervals) to separate conditions with items/activities (moderately preferred tangible items, attention, demands) noncontingently available during S
intervals. After reaching the terminal schedule in one condition, therapists assessed participant preference across S
conditions. For all participants, the terminal schedule was reached with alternative items and activities, and participant preference corresponded with the most efficient schedule thinning condition. Therapists also indicated preference for alternative items/activities.
AbstractObjectivesTo characterize the clinical severity of covid-19 associated with the alpha, delta, and omicron SARS-CoV-2 variants among adults admitted to hospital and to compare the ...effectiveness of mRNA vaccines to prevent hospital admissions related to each variant.DesignCase-control study.Setting21 hospitals across the United States.Participants11 690 adults (≥18 years) admitted to hospital: 5728 with covid-19 (cases) and 5962 without covid-19 (controls). Patients were classified into SARS-CoV-2 variant groups based on viral whole genome sequencing, and, if sequencing did not reveal a lineage, by the predominant circulating variant at the time of hospital admission: alpha (11 March to 3 July 2021), delta (4 July to 25 December 2021), and omicron (26 December 2021 to 14 January 2022).Main outcome measuresVaccine effectiveness calculated using a test negative design for mRNA vaccines to prevent covid-19 related hospital admissions by each variant (alpha, delta, omicron). Among patients admitted to hospital with covid-19, disease severity on the World Health Organization’s clinical progression scale was compared among variants using proportional odds regression.ResultsEffectiveness of the mRNA vaccines to prevent covid-19 associated hospital admissions was 85% (95% confidence interval 82% to 88%) for two vaccine doses against the alpha variant, 85% (83% to 87%) for two doses against the delta variant, 94% (92% to 95%) for three doses against the delta variant, 65% (51% to 75%) for two doses against the omicron variant; and 86% (77% to 91%) for three doses against the omicron variant. In-hospital mortality was 7.6% (81/1060) for alpha, 12.2% (461/3788) for delta, and 7.1% (40/565) for omicron. Among unvaccinated patients with covid-19 admitted to hospital, severity on the WHO clinical progression scale was higher for the delta versus alpha variant (adjusted proportional odds ratio 1.28, 95% confidence interval 1.11 to 1.46), and lower for the omicron versus delta variant (0.61, 0.49 to 0.77). Compared with unvaccinated patients, severity was lower for vaccinated patients for each variant, including alpha (adjusted proportional odds ratio 0.33, 0.23 to 0.49), delta (0.44, 0.37 to 0.51), and omicron (0.61, 0.44 to 0.85).ConclusionsmRNA vaccines were found to be highly effective in preventing covid-19 associated hospital admissions related to the alpha, delta, and omicron variants, but three vaccine doses were required to achieve protection against omicron similar to the protection that two doses provided against the delta and alpha variants. Among adults admitted to hospital with covid-19, the omicron variant was associated with less severe disease than the delta variant but still resulted in substantial morbidity and mortality. Vaccinated patients admitted to hospital with covid-19 had significantly lower disease severity than unvaccinated patients for all the variants.
We compared psychomotor vigilance in female shift workers of the Bergmannsheil University Hospital in Bochum, Germany (N = 74, 94% nurses) after day and night shifts.
Participants performed a ...3-minute Psychomotor Vigilance Task (PVT) test bout at the end of two consecutive day and three consecutive night shifts, respectively. Psychomotor vigilance was analyzed with respect to mean reaction time, percentage of lapses and false starts, and throughput as an overall performance score, combining reaction time and error frequencies. We also determined the reaction time coefficient of variation (RTCV) to assess relative reaction time variability after day and night shifts. Further, we examined the influence of shift type (night vs. day) by mixed linear models with associated 95% confidence intervals (CI), adjusted for age, chronotype, study day, season, and the presence of obstructive sleep apnea (OSA).
At the end of a night shift, reaction times were increased (β = 7.64; 95% CI 0.94; 14.35) and the number of lapses higher compared to day shifts (exp(β) = 1.55; 95% CI 1.16-2.08). By contrast, we did not observe differences in the number of false starts between day and night shifts. Throughput was reduced after night shifts (β = -15.52; 95% CI -27.49; -3.46). Reaction times improved across consecutive day and night shifts, whereas the frequency of lapses decreased after the third night. RTCV remained unaffected by both, night shifts and consecutive shift blocks.
Our results add to the growing body of literature demonstrating that night-shift work is associated with decreased psychomotor vigilance. As the analysis of RTCV suggests, performance deficits may selectively be driven by few slow reactions at the lower end of the reaction time distribution function. Comparing intra-individual PVT-performances over three consecutive night and two consecutive day shifts, we observed performance improvements after the third night shift. Although a training effect cannot be ruled out, this finding may suggest better adaptation to the night schedule if avoiding fast-changing shift schedules.
Background
Flexible working conditions are increasingly popular in developed countries but the effects on employee health and wellbeing are largely unknown.
Objectives
To evaluate the effects ...(benefits and harms) of flexible working interventions on the physical, mental and general health and wellbeing of employees and their families.
Search methods
Our searches (July 2009) covered 12 databases including the Cochrane Public Health Group Specialised Register, CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Social Science Citation Index; ASSIA; IBSS; Sociological s; and ABI/Inform. We also searched relevant websites, handsearched key journals, searched bibliographies and contacted study authors and key experts.
Selection criteria
Randomised controlled trials (RCT), interrupted time series and controlled before and after studies (CBA), which examined the effects of flexible working interventions on employee health and wellbeing. We excluded studies assessing outcomes for less than six months and extracted outcomes relating to physical, mental and general health/ill health measured using a validated instrument. We also extracted secondary outcomes (including sickness absence, health service usage, behavioural changes, accidents, work‐life balance, quality of life, health and wellbeing of children, family members and co‐workers) if reported alongside at least one primary outcome.
Data collection and analysis
Two experienced review authors conducted data extraction and quality appraisal. We undertook a narrative synthesis as there was substantial heterogeneity between studies.
Main results
Ten studies fulfilled the inclusion criteria. Six CBA studies reported on interventions relating to temporal flexibility: self‐scheduling of shift work (n = 4), flexitime (n = 1) and overtime (n = 1). The remaining four CBA studies evaluated a form of contractual flexibility: partial/gradual retirement (n = 2), involuntary part‐time work (n = 1) and fixed‐term contract (n = 1). The studies retrieved had a number of methodological limitations including short follow‐up periods, risk of selection bias and reliance on largely self‐reported outcome data.
Four CBA studies on self‐scheduling of shifts and one CBA study on gradual/partial retirement reported statistically significant improvements in either primary outcomes (including systolic blood pressure and heart rate; tiredness; mental health, sleep duration, sleep quality and alertness; self‐rated health status) or secondary health outcomes (co‐workers social support and sense of community) and no ill health effects were reported. Flexitime was shown not to have significant effects on self‐reported physiological and psychological health outcomes. Similarly, when comparing individuals working overtime with those who did not the odds of ill health effects were not significantly higher in the intervention group at follow up. The effects of contractual flexibility on self‐reported health (with the exception of gradual/partial retirement, which when controlled by employees improved health outcomes) were either equivocal or negative. No studies differentiated results by socio‐economic status, although one study did compare findings by gender but found no differential effect on self‐reported health outcomes.
Authors' conclusions
The findings of this review tentatively suggest that flexible working interventions that increase worker control and choice (such as self‐scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes. In contrast, interventions that were motivated or dictated by organisational interests, such as fixed‐term contract and involuntary part‐time employment, found equivocal or negative health effects. Given the partial and methodologically limited evidence base these findings should be interpreted with caution. Moreover, there is a clear need for well‐designed intervention studies to delineate the impact of flexible working conditions on health, wellbeing and health inequalities.
This study delved into the complex effects of work schedules on the well-being of healthcare professionals, spotlighting Nigeria's medical landscape. A diverse cohort of 387 participants, spanning ...doctors, nurses, pharmacists, and laboratory technicians or scientists, formed the research base, with the majority being women (67.7%), with a mean age of 34.67 years. Professionals self-reported their predominant schedules to gauge work patterns, classifying them as day or night shifts. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) tool assessed the quality of life across the physical, psychological, social relationship, and environmental domains. Psychological distress was measured using the Depression, Anxiety, and Stress Scales (DASS), and perceived social support was evaluated via the Multidimensional Scale of Perceived Social Support (MSPSS). A cross-sectional design was adopted, and the study employed moderated mediation analysis using SmartPLS 4.0. The results underscored the significant ramifications of night shifts on environmental and physical well-being. Psychological health and social relationships were better among day shift than night shift workers. There was a pronounced correlation between night shifts and heightened levels of anxiety, stress, and depression. The mediating role of psychological distress and the moderating influence of social support in these relationships were evident. This study offers invaluable insights into the role of work schedules in shaping the well-being of healthcare professionals, emphasising the protective role of social support and the unique challenges faced by migrant health workers.
Extended-duration work rosters (EDWRs) with shifts of 24+ hours impair performance compared with rapid cycling work rosters (RCWRs) that limit shifts to 16 hours in postgraduate year (PGY) 1 ...resident-physicians. We examined the impact of a RCWR on PGY 2 and PGY 3 resident-physicians.
Data from 294 resident-physicians were analyzed from a multicenter clinical trial of 6 US PICUs. Resident-physicians worked 4-week EDWRs with shifts of 24+ hours every third or fourth shift, or an RCWR in which most shifts were ≤16 consecutive hours. Participants completed a daily sleep and work log and the 10-minute Psychomotor Vigilance Task and Karolinska Sleepiness Scale 2 to 5 times per shift approximately once per week as operational demands allowed.
Overall, the mean (± SE) number of attentional failures was significantly higher (
=.01) on the EDWR (6.8 ± 1.0) compared with RCWR (2.9 ± 0.7). Reaction time and subjective alertness were also significantly higher, by ∼18% and ∼9%, respectively (both
<.0001). These differences were sustained across the 4-week rotation. Moreover, attentional failures were associated with resident-physician-related serious medical errors (SMEs) (
=.04). Although a higher rate of SMEs was observed under the RCWR, after adjusting for workload, RCWR had a protective effect on the rate of SMEs (rate ratio 0.48 95% confidence interval: 0.30-0.77).
Performance impairment due to EDWR is improved by limiting shift duration. These data and their correlation with SME rates highlight the impairment of neurobehavioral performance due to extended-duration shifts and have important implications for patient safety.
Interventions for multiply maintained problem behavior often involve developing separate treatment conditions to address each function. Although isolating treatment conditions lead to positive ...outcomes, developing individual treatments for each identified function may be time‐consuming. Alternatively, synthesizing treatment procedures may allow for more efficient treatment effects. We extended previous research by evaluating functional communication training (FCT) and chained schedules of reinforcement to treat multiply maintained problem behavior in children diagnosed with autism spectrum disorder. First, we conducted a functional analysis that concluded problem behavior was multiply maintained. Next, we taught functional communication responses (FCRs) and implemented a chained schedule of reinforcement. During the initial link, FCRs for a break resulted in the presentation of a choice menu with the other putative reinforcers in the terminal link. The relevant reinforcer was delivered contingent on the emission of subsequent FCRs. Finally, we systematically schedule thinned to caregiver‐informed terminal schedules for each participant. The results of our study demonstrated that FCT, in combination with a sequential compound schedule of reinforcement, effectively decreased multiply maintained problem behavior and increased appropriate alternative responses (FCRs and compliance) even at terminal schedules of reinforcement.
PDF
