The following lecture has been approved for University Undergraduate Students

1. The following lecture has been approved for University Undergraduate Students This lecture may contain information, ideas, concepts and discursive anecdotes that may be thought provoking and challenging It is not intended for the content or delivery to cause offence Any issues raised in the lecture may require the viewer to engage in further thought, insight, reflection or critical evaluation

2. Shiftworking Working Hours Shiftwork Human Behaviour Biopsychosocial model Mental Distress Dr. Craig Jackson Senior Lecturer in Health PsychologyBCU

3. “Peoples’ health should be no worse at the end of a working day than it was at the start” M.J. Harrington (1997)

4. “People who work sitting down get paid more than people who work standing up” Ogden Nash (1902 - 1971)

5. Core Occupational Diseases (EU) Chemical Chemical Biological Physical Physical Inorganic Organic Dusts Others Cadmium CS5 Zoonoses Asbestos Radiation Chromium Benzene Hepatitis Silica(te) NIHL Mercury Chlorine TB Mesothelioma Cataract Manganese Aromatics Vibration Nickel P.aromatics Dermatitis Lead Isocyanates

6. 21st Century Workplaces • Global companies and operations • Leaner & Meaner managers • Gender issues • Disability issues • Migrant issues • Longer & less fixed working hours • Shorter contracts • Dirty jobs out-sourced

7. Regulation of working hours • 1800 – 1900 • 12 hour days & 6 day weeks • Thomas Paine 1737 - 1809 • Age of Reason • Rights of Man • Annie Besant 1847 – 1933 • Reformist movement • Fabian Society • Secular Society • “Fruits of philosophy” “The Link” “White slavery in London” • 1889 • Humanitarian concerns influenced change • 48 hour week + regular rest = increased productivity

8. Regulation of working hours 1900 – 1970 progressive reduction in working hours traditional work patterns 1970  working hours increase shiftwork increases irregular hours increase 24 hour processing technology unpaid extended hours flexible working annualised hours

9. assumption reality units units time time Regulation of working hours Linear Assumption of workers and productivity

10. Pieter Bruegel 1563

11. Wembley Stadium • 326.5 Million pounds – Multiplex 2002 • Million pounds • British Library • 32 Million pounds – estimate • 511 Million pounds – 10 yrs late • Scottish Assembly • 37 Million pounds – estimate • 431 Million Pounds – 3 yrs late

12. PaddyPower .com

13. Stress @ # Fatigue

14. Pilot Fatigue “Nodding off” Uncontrolled spontaneous episodes of sleep Can last seconds or minutes Disengages from reality and becomes unresponsive Fail to respond to outside information Aircraft cruising at 450 knots on glide path can travel nearly 730 feet during a one-second lapse. 123 feet

15. Near Misses and Hits

16. Regulation of working hours

17. Environmental effects upon Performance Disturbed concentration Impaired memory Impaired decision making Mood changes Sleep disturbance Increased risk taking

18. Paying Attention!

19. Coping with Extreme Hours

20. European directive on working time Organisation of work Min. daily rest period of 11 consecutive hours per 24 hours 1 rest break where working day > 6 hours Min. uninterrupted rest period of 35 hours per 7 day period Max. of 48 work per week Min. 4 weeks paid annual leave

21. European directive on working time Night work Mean 8 hours work in any 24 hour period Free health assessment before assignment and at regular intervals Transfer to day work when suffering health problems connected with night work Night work and shifts Protection appropriate to the nature of the night work Prevention and protection services on parity with day workers Take account of principles adapting work to the workers

22. Derogations Certain jobs junior docs Certain industries press media utility provision Circumstances where rests are not practicable Does not apply to: health checks provision of health and safety facilities Nearly 900 extra consultants will be needed by 2010 compensate for a reduction in doctors’ hours due to EWTD BMJ 2002;325:855

23. Shiftwork Any work regularly undertaken outside “normal” working hours Normal working hours = 07:00 – 18:00 Nights Early am Evening Fixed Rotating Eight hour Twelve hour Effects Circadian disruption Sleep loss Fatigue Social disruption

24. Circadian Rhythms Body Temp Pulse Urinary excretion Blood pressure Hormonal changes Mental Performance Physical Performance Physiologically determined Socially modified & Externally cued

25. Circadian Rhythms

26. Adjustment to shiftworking Aprrox. 7 days to adjust to shift External cues hamper adjustment Nightworking sometimes never achieves adjustment Slow rotating shifts partial adjustment continual adjustment continual disrhythmia state Rapid rotating shifts no adjustment

27. Adjustment to shiftworking stress strain organisational effects Phase-shifting of waking and sleeping hours Impaired performance Impaired health Disturbed relationships > Absenteeism > Accidents > Labour turnover < Productivity modifying factors Individual characteristics Job-related factors Environment Domestic Colquhoun & Rutenfranz 1980

28. Cardiovascular problems associated with shiftwork Increased Ischemic Heart Disease (IHD) Knutsson et al. 1986, 1988 Increased risk of IHD and Myocardial Infarction (MI) Akerstedt et al. 1986 Increased risk of Coronary V related disorders – Permanent Nightworkers Teiger 1984 Some studies show NO increased risk Bursey 1990 Chan et al. 1987, 1993 Kobayashi et al. 1992

29. Cardiovascular problems of shiftwork Liu & Tanaka 2002 – Japanese working men study 260 cases 445 controls Working Hours, Sleeping Hours and Acute MI Working hours related to: increased risk in year prior to AMI increased risk in month prior to AMI x2 increase in risk for overtime (>61 hours) x2-3 increase in risk for <5 hours sleep x2-3 increase for lack of sleep (2 or more days with <5 hours sleep) lack of sleep & few days off in recent past show > odds than those in past Overtime work and lack of sleep may be related to AMI

30. Gastrointestinal disorders and shiftwork Indigestion (Chan et al. 1987) (Poole et al. 1992) Reflux Peptic Ulceration (Waterhouse et al. 1992) Related to: irregular hours circadian dysrhythmia poor catering facilities inequality in GP access

31. Gastrointestinal disorders and shiftwork • Irritable Bowel Syndrome (IBS) • 13-52% new referrals to GI (Walker et al. 1990) • Some occupations have > G.I than others (Cucino & Sonnenburg, 2001) • IBD < in manual workers and farmers IBD > in sedentary workers • Assoc. with occupation difficult to prove • shift workers seen as greatest risk of IBS • especially nightworkers • night workers present in GI more than day workers • Access / Availability reasons ? • genuine aspects ? • Research fails to answer: psychosocial aspects of workers ? • effects of shiftwork lifestyle ?

32. Mental health problems and shiftwork Increased stress Alcohol consumption Neuroticism Review by Cole et al. 1990 OM

33. Sources of performance impairment Day sleepers Endogenous factors Exogenous factors Cortisol > Daylight Temp. > Noise Societal bias Night wakers Endogenous factors Exogenous factors Melatonin > Darkness Temp. < Societal bias

34. Current evidence Performance impairments more likely: on nightshift vs. morning or evening on advancing shifts vs. delaying shifts on rapid rotating shifts vs. slower rotation on irregular shifts vs. regular shifts at changeover periods in older shiftworkers where work is stressful Inconsistencies: 12 hour shifts Sex

35. Performance effects – methodological considerations Task monotony cognitive skills Measures speed accuracy efficiency Individual aspects motivation perceived importance age ability health activity Situation / context supervision morale distractions

36. 12 hour shifts Williamson et al. 1994 8hr vs. 12hr rotating psych health improved Australia computer operators reduced tiredness Duchon et al. 1994 8hr vs. 12hr rotating improved sleep Canada miners improved performance Chan & Gan 8hr vs. 12hr rotating no health differences Singapore electronic workers some headaches

37. Groups prone to negative effects Over 50’s Morning types Long sleepers Personality types Heavy domestic commitments Multiple jobs Some physical conditions Psychiatric problems Employee Selection Issues ? Pre-employment counselling ?

38. Standard Shiftwork Index (SSI) Barton et al. 1995 • Questionnaires • Work Context + Shift System • Health • Well-being • Individual Differences • Normative Data

39. Training & Education health effects performance safety quality of life information & awareness coping methods education lifestyle changes info Survey current work schedule Analyse data Identify problem area(s) Recommend schedule changes Shiftworker education Asses & review

40. Intervention strategies • Organisation • Slow / fast rotation (task considerations) • Start times • Rest breaks • Expert systems • Environmental Modification • Bright lights • Mood lights • Temp. compensation • Workload • Facilities • Individual Adjustment • Pharmacological help • Behavioural sleep management, diet, exercise, counselling Evaluate process Evaluate outcome Health Surveillance Do what? How often?

41. Overtime working Extension of normal workday Extension beyond 8 hours (08:00 / 09:00 - 16:00 / 17:00) Non-paid is still overtime Increasing in UK especially managerial & professional groups 1990 UK had twice as many more employees on >48 hrs than any other EU countries More common in males

42. Overtime working Percentage of European employees working <16 hrs per week, and > 48 hrs per week, 1990 If graph was males only?

43. Employers >40hrs per week as % of labour force, 1996 ILO Czech Rep. Turkey S. Korea Iceland Swiss Mexico Hungary USE Canada Japan Ireland UK Australia Portugal Greece Italy Spain Denmark France Germany Norway Sweden Austria Belgium Finland Netherlands

44. Potential effects cardiovascular mental health immune system Stress gastrointestinal musculoskeletal social effects performance impairment Fatigue safety problems Exposure over-exposure

45. Cardiovascular disorders and overtime • Increased Risk > 60hrs > 48hrs Night school students 50 – 60 hrs Overtime (females only) No increased Risk >10 hrs overtime / week “Overtime” BP & Serum Chol. Karoshi Range of CVIs 65%> if 60hrs / wk

46. 1980 SITES WITH MASS PSYCHOGENIC ILLNESS (USA) ? No. of symptoms  1985 KIBBUTZIM (ISRAEL) > 8 hrs/ day Smoking  1987 MUSIC THERAPISTS (USA) < 50 Burnout X 1990 BUS DRIVERS (UK) ? Psychiatric Status (Crown Crisp)  1991 COACH DRIVERS (AUSTRALIA) 30-70 Stimulant use/ Sleep disturbance  1992 FEMALE HOSPITAL STAFF (USA) 32-19 Exhaustion/ Insomnia  1994 FACTORY WORKERS (JAPAN) ? Psychiatric State (GHQ)  1995 ACCOUNTANT (UK) ? Psychiatric Status (GHQ)  1991 - 1995 MANAGERIAL STAFF (USA/JAPAN) ? 50 - 55 Stress (OSI)  1991 - 1995 CLERICAL STAFF (USA/JAPAN) ? Stress (OSI)  1996 ACADEMICS 50 Stress (SACL) X Mental Health

47. Health & Well-being: Methodological Issues Mostly Cross-sectional studies Direction of any association ? Lag Healthy worker / Survivor Effects Response Rates Control Groups Exposure Assessment Outcome Measures

48. Performance Effects: Accidents General Data Analyses suggests: Rise in accident rates after 9hrs work Cognitive (simulation) studies suggests errors increase after 8 hrs work HOWEVER Shift change from 8 to 12 hrs Safety record stays same Attitudes ? Safety culture increased ? Schedule org ? Nature of work ?

49. Existing Gaps in Research Irregular Hours Increased concomitant exposure to other hazards Reproductive effects Family / Social influences Behavioural Effects Effect Modifiers Intervention procedures

50. Further Reading Cooper, C.L., and Sutherland, V.J: Job Stress, Mental Health and Accidents among Offshore Workers in Oil and Gas extraction Industries. Journal of Occupational Medicine (1987) 29. Gann, M., Corpe, U., and Wilson, I. (1990) The Application of a Short Anxiety and Depression Questionnaire to Oil Industry Staff. Journal of the Society of Occupational Medicine 40: Glazner, L.K. Shift Work and its effects on fire fighters and nurses. Occupational Health & Safety, July 1992 Hanecke, K., Tiedemann, S., Nachreiner, F., and Grzech-Sukalo, H: Accident risk as a function of hour at work and time of day as determined from accident data and exposure models for the German working population. Scandinavian Journal of Work, Environment and Health (1998) 24(3).