Not only a problem of fatigue and sleepiness: Changes in psychomotor performance in Italian nurses across 8-h rapidly rotating shifts

Although many studies have detailed the consequences of shift work in nurses concerning health, fatigue, sleepiness, or medical errors, no study has been carried out trying to disentangle the contribution of sleepiness and fatigue associated to shift work from the attentional performance. The aim of this pilot study is (A) to investigate the effects of an 8-h rapidly rotating shift on fatigue and sleepiness among staff nurses and (B) how these factors affect their psychomotor performance. Fourteen nurses were selected for a within-subject cross-sectional study according to this sequence of shifts: morning–afternoon–night, which were compared as function of tiredness, sleepiness, and performance at the Psychomotor Vigilance Task (PVT). Subsequently, a within-subject Analysis of Covariance (ANCOVA) evaluated if the observed differences between shifts persist when the contribution of sleepiness is controlled. Our results clearly indicate that night shifts are associated with significant greater sleepiness and tiredness, and worsened performance at the PVT. As hypothesized, ANCOVA showed that these differences disappear when the contribution of sleepiness is controlled. Results point to a lower psychomotor performance in night compared to day shifts that depends on sleepiness. Hence, interventions to minimize the consequences of the night shift should consider a reduction of sleepiness

Nurses and Night Shifts. Poor Sleep Quality Exacerbates Psychomotor Performance

In Europe, 40% of health-care employees are involved in shift work. The altered sleep/wake rhythm of night-shift nurses is also associated with deteriorated cognitive efficiency. In this study, we examine the effects of the night shift on psychomotor performance, sleepiness, and tiredness in a large sample of shift-working nurses and evaluated if poor sleep quality, sex, age, or years on the job could impact on a better adaptation to shift work. Eighty-six nurses with 8-h-rapidly-rotating-shifts were evaluated at the end of three shifts (morning/afternoon/night) for sleepiness and tiredness. Sleepiness, as measured by the Karolinska Sleepiness Scale, and tiredness, as measured by the Tiredness Symptoms Scale, were more pronounced after the night shift. These increases were paralleled by lower attentional performance on the psychomotor vigilance task (PVT) after the night shift. While sex, age, and years on the job did not affect PVT performance after the night shift, lower sleep quality (Pittsburgh Sleep Quality, PSQI > 5) was associated with decreased performance. The high prevalence of altered sleep quality showed that nurses, and shift workers in general, are at risk for a poor sleep quality. The evaluation of sleep quality through PSQI could represent a rapid, inexpensive tool to assess health-care workers assigned to rotating night shifts or to evaluate nurses who coped poorly with night-shift work

Comparison of sleep and attention metrics among nurses working shifts on a forward- vs backward-rotating schedule

IMPORTANCE The association of fast backward-rotating shift work (ie, anticlockwise sequence of afternoon, morning, and night shifts) with subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of health care workers has not yet been established. OBJECTIVE To investigate the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward- and backward-rotating shifts. DESIGN, SETTING, AND PARTICIPANTS Data of this cohort study were collected from nurses working at 5 midsized Italian hospitals. The nurses had either a forward-rotating schedule (ie, morning to afternoon to night) and or a backward-rotating schedule (ie, afternoon to morning to night). The data were collected from July 2017 to February 2020. Data analysis was performed from May to October 2020. EXPOSURES Participants were working either forward- or backward-rotating schedules, in which the sequence of 3 shifts (morning, afternoon, and night) changed in a clockwise or anticlockwise direction. MAIN OUTCOMES AND MEASURES Sleep data were collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Sustained attention was measured using the Psychomotor Vigilance Task. Tiredness was evaluated using the Tiredness Symptom Scale. RESULTS A total of 144 nurses (mean [SE] age, 41.3 [0.8] years; 92 women [63.9%]) participated in the study; 80 nurses had forward-rotating schedules, and 64 had backward-rotating schedules. Nurses with irregular sleep-wake patterns due to night shift work had poor sleep quality (46 [57.5%] in forward-rotating schedule group; 37 [57.8%] in backward-rotating schedule group). Nurses working backward-rotating shifts exhibited significantly greater sleepiness (F1,139 = 41.23; P < .001) and cognitive slowing (ie, longer median reaction times; F1,139 = 42.12; P < .001) than those working forward rotations. Importantly, these differences were not affected by age, years of employment, and quality of sleep. Of nurses working on a backward-rotating schedule, 60 (93.8%) reported elevated sleepiness (Karolinska Sleepiness Scale score7) after the night shift. The median reaction time (F1,139 = 42.12; P < .001), 10% fastest reaction time (F1,139 = 97.07; P < .001), minor lapses (F1,139 = 46.29; P < .001), and reaction time distribution (F1,139 = 60.13; P < .001) of nurses on backward-rotating schedules indicated a lower level of vigilance, which is negatively associated with neurobehavioral performance. CONCLUSIONS AND RELEVANCE In this study, both shift rotation models were negatively associated with health and cognitive performance. These findings suggest that forward shift rotation may be more beneficial than backward rotation for several measured performance attentiona

Guinea Worm Disease: A Neglected Diseases on the Verge of Eradication

Background: Dracunculiasis, also known as Guinea worm disease (GWD), is a neglected tropical disease (NTD) caused by a parasite (Dracunculus medinensis). In the past, dracunculiasis was known as “the disease of the empty granary” because of the difficulties patients had in going to work in fields or to school when affected by this disease. In tropical areas, the condition has been widespread in economically disadvantaged communities, and has been associated with reduced economic status and low levels of education. Methods: we searched PubMed, Scopus, Google Scholar, EMBASE, Cochrane Library, and WHO websites for literature addressing dracunculiasis published in the last 50 years. Results: by development and optimization of multi-layered control measures, transmission by the vector has been interrupted, but there are foci in several African countries with a high risk of compromising the results obtained in the control of this neglected disease. Conclusion: this review features state-of-the-art data on the infection prevalence, geographical distribution, diagnostics, parasite–host interactions, and the pathology of dracunculiasis. Also described are the current state and future perspectives for vector control and elimination strategies