Lars Göran KecklundProfessor, st f prefekt, föreståndare SFI
Göran arbetar som sömn- och stressforskare och hans forskningsprofil är ”arbetstider, hälsa, säkerhet och trötthet”. Han är även ackrediterad sömnspecialist sedan den 1 mars 2009. Görans forskning har varit inriktad på hur skiftarbete påverkar sömn- och vakenhetsförmåga och vad störd sömn får för konsekvenser för hälsa och säkerhet. Den tillämpade forskningen har sin teoretiska grund i sömnreglering och några nyligen publicerade lab. experiment har undersökt hur partiell sömnbrist påverkar sömnighet, prestationsförmåga och fysiologisk sömnkvalitet. Under senare år har arbetstidsforskningen varit inriktad på arbetstidsmodeller som innebär varierande grad av självvalda arbetstider. Ett annat av hans forskningsområden handlar om hur stress påverkar sömn, samt om sömn medierar sambandet mellan stress och hälsa. Han har också medverkat i flera studier av trötthet i trafiken. Göran undervisar bl.a. på psykologprogrammet vid Karolinska Institutet men har också föreläst vid olika arbetstidsseminarier riktade till exempelvis mot sjukvård och poliser. Han är associate editor för tidskriften ”Scandinavian Journal of Work, Environment & Health” och har ingått i organisationskommittén för flera stora vetenskapliga möten och kongresser. Han har också anlitats som expert av Statens Haverikommission, LO-TCO Rättsskydd, Rikspolisstyrelsen, SBU och flera fackliga organisationer. Göran är styrelseledamot för svensk trafikmedicinsk förening.
Fil.dr. i psykologi 1997,
Ackrediterad sömnspecialist 2009
I urval från Stockholms universitets publikationsdatabas
Shiftworkers’ attitude to their work hours, positive or negative, and why?
2022. Torbjörn Åkerstedt, Mikael Sallinen, Göran Kecklund. International Archives of Occupational and Environmental HealthArtikel
Objective Shift work is associated with impaired health and safety but there is a lack of systematic knowledge of shift workers attitude to their shift systems. This may be important for the ability to retain valuable personnel in the company/organization, and to attract new employees. The purpose of the present study was to investigate: the prevalence of shift characteristics (nights, long shifts, short rest, etc.) in traditional shift systems, the workers’ attitude to their shift systems, if combinations of problematic shift characteristics are associated with the workers’ attitude, and if work stress and poor sleep, fatigue, or social difficulties are associated with attitudes to shift systems.
Methods A representative sample of 3,500 individuals with non-day work in the general population of Sweden were asked to participate in the study. A total of 1965 workers remained after drop-outs. The material was analyzed by Chi2 analysis and hierarchical multiple regression.
Results The results showed that traditional shift systems included many more shift characteristics than those constituting the core of the systems. All included day work, for example. 90.2% of those with roster work had shifts > 10 h at least once a month. 66.9% of those with roster work without nights had < 11 h rest between shifts at least once a month. Less than 25% of the respondents had a rather or very negative attitude to their shift system, with the lowest level for those who work either fixed days or nights (7.6 and 5.7%, respectively) and highest for three-shift work (21.2%) and roster work without night work (24.4%). Shiftwork or roster work with nights had highest levels (> 50%) of sleep problems and fatigue. The difference across shift systems was significant at p < .001 in all cases. Combinations of the most problematic shift characteristics were associated with some increase in negative attitude to the shift schedule. Among schedule characteristics, only long weeks turned out significant in the multivariable regression. The strongest predictor of negative attitude to work hours were social difficulties due to work schedule [ß = 4.98 (95% Confidence interval (Ci) = 3.41, 7.27; p < .001], fatigue caused by schedule (ß = 3.20 Ci = 2.03, 5.05; p < .001), sleep problems caused by schedule (ß = 2.10 Ci = 1.46, 3.01; p = .01), and stressful work (ß = 1.52 Ci = 1.10, 2.11; p < .05).
Conclusion It was concluded that shift systems often included many different shift characteristics, that night shift systems had a large proportion of long shifts, and that split shifts mainly occurred in roster day work. Furthermore, it was concluded that the attitude to the worker’s present shift systems seems to be positive for the majority, with the highest level for those who work either fixed days or nights, compared to those who work alternating shifts (including night shifts). Negative attitude to shift systems was more linked to social difficulties, fatigue or sleep problems due to the shift schedule, than to schedule characteristics per se.
Sleepy drivers on a slippery road
2022. Igor Radun (et al.). Journal of Sleep Research 31 (2)Artikel
Sleepy drivers have problems with keeping the vehicle within the lines, and might often need to apply a sudden or hard corrective steering wheel movement. Such movements, if they occur while driving on a slippery road, might increase the risk of ending off road due to the unforgiving nature of slippery roads. We tested this hypothesis. Twelve young men participated in a driving simulator experiment with two counterbalanced conditions; dry versus slippery road x day (alert) versus night (sleepy) driving. The participants drove 52.5 km on a monotonous two-lane highway and rated their sleepiness seven times using the Karolinska Sleepiness Scale. Blink durations were extracted from an electrooculogram. The standard deviation of lateral position and the smoothness of steering events were measures of driving performance. Each outcome variable was analysed with mixed-effect models with road condition, time-of-day and time-on-task as predictors. The Karolinska Sleepiness Scale increased with time-on-task (p < 0.001) and was higher during night drives (p < 0.001), with a three-way interaction suggesting a small increased sleepiness with driving time at night with slippery road conditions (p = 0.012). Blink durations increased with time-on-task (p < 0.01) with an interaction between time-of-day and road condition (p = 0.040) such that physiological sleepiness was lower for sleep-deprived participants in demanding road conditions. The standard deviation of lateral position increased with time-on-task (p = 0.026); however, during night driving it was lower on a slippery road (p = 0.025). The results indicate that driving in demanding road condition (i.e. slippery road) might further exhaust already sleepy drivers, although this is not clearly reflected in driving performance.
Comparing the acute effects of shiftwork on mothers and fathers
2021. Philip Tucker, Constanze Leineweber, Göran Kecklund. Occupational Medicine 71 (9), 414-421Artikel
Background: Shift work may impact women more negatively than men due to the increased burden of coping with demanding work schedules while also undertaking more of the domestic chores, including childcare.
Aims: To examine whether the combination of shift working and caring for children affects the sleep, fatigue and work–family conflict experienced by women more than it affects men.
Methods: Using data from a survey of the Swedish working population, mixed linear regression models examined work schedule (daywork, shift work with nights, shift work without nights), gender and presence of children <13 years at home as predictors of sleep insufficiency, sleep disturbance, fatigue and work–family conflict, over up to three successive measurement occasions. Adjustments were made for age, education, full/part-time working and baseline year.
Results: In fully adjusted models (N = 8938), shift work was associated with insufficient sleep (P < 0.01), disturbed sleep (P < 0.01), fatigue (P < 0.05) and work–family conflict (P < 0.001). Interactions in the analyses of sleep disturbance (P < 0.001) and work–family interference (P < 0.05) indicated that among participants with no children, females reported more disturbed sleep and more work–family conflict than their male counterparts, irrespective of schedule; while among participants with children, female dayworkers reported more disturbed sleep than their male counterparts, and females working shifts without nights reported more work–family interference.
Conclusions: Having young children did not exacerbate negative effects of shift work, in either men or women. This may reflect high levels of gender equality and childcare provision in Sweden.
Considerations on how to light the night-shift
2021. Arne Lowden, Göran Kecklund. Lighting Research and Technology 53 (5), 437-452Artikel
Electric lighting has decreased dependence on natural light to illuminate the workplace. Humans are genetically predisposed to be day-oriented (diurnal) and depend on daylight to regulate circadian rhythms. Shift work will force workers to sleep and work at non-biological times, inducing circadian disruption with implications for workers' safety and health. The scientific literature may be used in practice in shift work settings to improve safety, performance and health in the workplace by reducing circadian misalignment. Alertness profiles at work and degree of melatonin suppression may indicate degree of circadian disruption among workers. However, when considering lighting solutions at night, there are several factors that need consideration. Light measures based on biological effectiveness should be used rather than room illuminance giving better predictions of performance and long-term health among workers. Also, large individual differences in light sensitivity and preferences suggest not only to rely on common lighting alone but also to implement complementary individual lighting solutions at work. Lighting advice should consider shift scheduling characteristics such as speed of turnover and shift timing to guide decisions of preferred circadian phase influence. Lighting should also include the flexibility to be fit for morning, afternoon and evening work.
Fysisk aktivitet vid insomni
2021. Göran Kecklund, John Axelsson. FYSS 2021, 363-368Kapitel
How does cessation of work affect sleep? Prospective analyses of sleep duration, timing and efficiency from the Swedish Retirement Study
2021. Johnna Garefelt (et al.). Journal of Sleep Research 30 (3)Artikel
Several strands of research indicate that work competes for time with sleep, but to what extent the timing and duration of sleep is affected by work is not known. Retirement offers a quasi-experimental life transition to study this in a within-individual study design. The few existing studies report that people sleep longer and later after retirement but mainly rely on self-reported data or between-individual analyses. We recruited 100 participants aged 61–72 years who were in paid work but would soon retire and measured them in a baseline week with accelerometers, diaries and questionnaires. After 1 and 2 years, the measurements were repeated for the now retired participants. Changes in sleep duration, timing, efficiency, chronotype and social jetlag were analysed using multilevel modelling. Gender, chronotype at baseline and partner's working status were analysed as potential effect modifiers. Sleep duration increased by 21 min, whereas sleep efficiency remained similar. Time of sleep onset and final awakening were postponed by 26 and 52 min, respectively, pushing midsleep forward from 03:17 to 03:37 hours. Changes in duration and timing of sleep were driven by weekday sleep, whereas weekend sleep stayed about the same. Social jetlag decreased but still occurred after retirement. Changes at retirement in sleep duration and timing were smaller for participants with a later chronotype and who had full-time working partners. These findings indicate that paid work generates sleep loss and hinders people from sleeping in line with their biological time.
How does work impact daily sleep quality? A within-individual study using actigraphy and self-reports over the retirement transition
2021. Johanna Garefelt (et al.). Journal of Sleep ResearchArtikel
This study examined how the cessation of work at retirement affects daily measures of actigraphy-measured and self-rated sleep quality. Time in bed or asleep and stress at bedtime were examined as potential mechanisms. In total 117 employed participants who were aged 60-72 years and planned to retire soon were recruited to the Swedish Retirement Study. Sleep quality was measured in a baseline week using accelerometers, diaries, and questionnaires. Subjective sleep measures were sleep quality, restless sleep, restorative sleep, getting enough sleep, estimated wake after sleep onset, difficulties falling asleep, too early final awakening, and difficulties waking up. Actigraphy measures were sleep efficiency, wake after sleep onset, and average awakening length. After 1 and 2 years, the measurements were repeated for the now retired participants. Daily variations in sleep quality before and after retirement were analysed using multilevel modelling, with time in bed or asleep and stress at bedtime as potential mediators. We found that several self-reports of sleep improved (e.g., +0.2 standard deviations for sleep quality and +0.5 standard deviations for restorative sleep) while objective sleep quality remained unchanged or decreased slightly with retirement (e.g., -0.8% for sleep efficiency). Increased time in bed or asleep and stress at bedtime accounted partially for the improvements in self-rated sleep quality at retirement. In conclusion, actigraph-measured and self-reported sleep quality do not change in concert at retirement, highlighting the interest of studying both outcomes. The main effects of retirement from work concern subjective experiences of recovery more than sleep quality per se.
Mathematical modelling of sleep and sleepiness under various watch keeping schedules in the maritime industry
2021. Wessel M. A. van Leeuwen (et al.). Marine Policy 130Artikel
Ships typically operate on a 24/7 basis giving rise to a wide variety of working time arrangements and watch keeping schedules. Typically, these can be divided into 2-watch systems (where two watch keepers/teams share the 24-h period) and 3-watch systems (where three watch keepers/teams share the 24-h period). The current study uses the three-process model of alertness regulation to compare these systems in terms of the amount of severe sleepiness that is predicted to take place on watch and the amount of sleep that is predicted to occur while off watch. Separate predictions are calculated for individuals characterised as morning and evening chronotypes. Comparing 2-watch systems, highest levels of severe sleepiness were seen for evening types working 0000-1200 within the 12on12off system. The longest sleep per 24 h day was also found for evening types, but for those working the 1200-0000 watch within the 12on12off system. Total daily sleep duration ranged between 268 and 445 min. However, the picture is complex and the lowest risk of severe sleepiness while on watch is not necessarily correlated with the maximal time available for rest and recuperation when off watch. For 3-watch systems, the five-and-dime system (changeover times: 02-07-12-17-22) stands out having the lowest prevalence of severe sleepiness on watch and the longest amount of predicted daily sleep off watch. Considerable differences exist between morning and evening types offering the opportunity for considerable improvement in sleep amount for fixed (but not rotating) systems when individual chronotype is considered in watch scheduling. It is concluded that 3-watch systems, although economically costlier, have clear advantages over 2-watch systems, but that a perfect system that fits all does not exist due to the considerable impact of individual differences related to sleep/wake regulation.
Real-Time Adaptation of Driving Time and Rest Periods in Automated Long-Haul Trucking
2021. Christer Ahlström (et al.). IEEE transactions on intelligent transportation systems (Print)Artikel
Hours of service regulations govern the working hours of commercial motor vehicle drivers, but these regulations may become more flexible as highly automated vehicles have the potential to afford periods of in-cab rest or even sleep while the vehicle is moving. A prerequisite is robust continuous monitoring of when the driver is resting (to account for reduced time on task) or sleeping (to account for the reduced physiological drive to sleep). The overall aims of this paper are to raise a discussion of whether it is possible to obtain successful rest during automated driving, and to present initial work on a hypothetical data driven algorithm aimed to estimate if it is possible to gain driving time after resting under fully automated driving. The presented algorithm consists of four central components, a heart rate-based relaxation detection algorithm, a camera-based sleep detection algorithm, a fatigue modelling component taking time awake, time of day and time on task into account, and a component that estimates gained driving time. Real-time assessment of driver fitness is complicated, especially when it comes to the recuperative value of in-cab sleep and rest, as it depends on sleep quality, time of day, homeostatic sleep pressure and on the activities that are carried out while resting. The monotony that characterizes for long-haul truck driving is clearly interrupted for a while, but the long-term consequences of extended driving times, including user acceptance of the key stakeholders, requires further research.
Workplace violence and health in human service industries
2021. Anna Nyberg (et al.). Occupational and Environmental Medicine 78 (2), 69-81Artikel
Objectives To provide systematically evaluated evidence of prospective associations between exposure to physical, psychological and gender-based violence and health among healthcare, social care and education workers.
Methods The guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Medline, Cinahl, Web of Science and PsycInfo were searched for population: human service workers; exposure: workplace violence; and study type:prospective or longitudinal in articles published 1990–August 2019. Quality assessment was performed based on a modified version of the Cochrane’s ‘Tool to Assess Risk of Bias in Cohort Studies’.
Results After deduplication, 3566 studies remained, of which 132 articles were selected for full-text screening and 28 were included in the systematic review. A majority of the studies focused on healthcare personnel, were from the Nordic countries and were assessed to have medium quality. Nine of 11 associations between physical violence and poor mental health were statistically significant, and 3 of 4 associations between physical violence and sickness absence. Ten of 13 associations between psychological violence and poor mental health were statistically significant and 6 of 6 associations between psychological violence and sickness absence. The only study on gender-based violence and health reported a statistically non-significant association.
Conclusion There is consistent evidence mainly in medium quality studies of prospective associations between psychological violence and poor mental health and sickness absence, and between physical violence and poor mental health in human service workers. More research using objective outcomes, improved exposure assessment and that focus on gender-based violence is needed.
A combined fMRI and EMG study of emotional contagion following partial sleep deprivation in young and older humans
2020. Sandra Tamm (et al.). Scientific Reports 10 (1)Artikel
Sleep deprivation is proposed to inhibit top-down-control in emotion processing, but it is unclear whether sleep deprivation affects emotional mimicry and contagion. Here, we aimed to investigate effects of partial sleep deprivation on emotional contagion and mimicry in young and older humans. Participants underwent partial sleep deprivation (3 h sleep opportunity at the end of night), crossed-over with a full sleep condition in a balanced order, followed by a functional magnetic resonance imaging and electromyography (EMG) experiment with viewing of emotional and neutral faces and ratings of emotional responses. The final sample for main analyses was n = 69 (n = 36 aged 20–30 years, n = 33 aged 65–75 years). Partial sleep deprivation caused decreased activation in fusiform gyri for angry faces and decreased ratings of happiness for all stimuli, but no significant effect on the amygdala. Older participants reported more anger compared to younger participants, but no age differences were seen in brain responses to emotional faces or sensitivity to partial sleep deprivation. No effect of the sleep manipulation was seen on EMG. In conclusion, emotional contagion, but not mimicry, was affected by sleep deprivation. Our results are consistent with the previously reported increased negativity bias after insufficient sleep.
The Stockholm sleepy brain study: effects of sleep deprivation on cognitive and emotional processing in young and old. https://clinicaltrials.gov/ct2/show/NCT02000076.
Association of work-time control with sickness absence due to musculoskeletal and mental disorders
2020. Sophie Charlotte Albrecht (et al.). Journal of Occupational Health 62 (1)Artikel
Objectives: Work-time control is associated with lower sickness absence rates, but it remains unclear whether this association differs by type of diagnosis and sub-dimension of work-time control (control over daily hours and control over time off) and whether certain vulnerable groups benefit more from higher levels of work-time control.
Methods: Survey data from the Finnish 10-town study in 2004 were used to examine if baseline levels of work-time control were associated with register data on diagnose-specific sickness absence for 7 consecutive years (n = 22 599). Cox proportional hazard models were conducted, adjusted for age, sex, education, occupational status, shift work including nights, and physical/mental workload.
Results: During follow-up, 2,818 individuals were on sick leave (>= 10 days) due to musculoskeletal disorders and 1724 due to mental disorders. Employees with high (HR = 0.80, 95% CI 0.74-0.87; HR = 0.76, 95% CI 0.70-0.82, respectively) and moderate (HR = 0.83, 95% CI 0.77-0.90; HR = 0.85, 95% CI 0.79-0.91, respectively) levels of control over daily hours/control over time off had a decreased risk of sickness absence due to musculoskeletal disorders. Sub-group analyses revealed that especially workers who were older benefitted the most from higher levels of work-time control. Neither sub-dimension of work-time control was related to sickness absence due to mental disorders.
Conclusions: Over a 7-year period of follow-up, high and moderate levels of work-time control were related to lower rates of sickness absence due to musculoskeletal disorders, but not due to mental disorders.
Can psychosocial working conditions help to explain the impact of shiftwork on health in male- and female-dominated occupations?
2020. Philip Tucker (et al.). Chronobiology International 37 (9-10), 1348-1356Artikel
Occupational factors are sometimes invoked to explain gender differences in the associations between shiftwork and health. We examined prospective associations between shiftwork and health, and between shiftwork and sick leave, separately for workers in female-dominated (FD) and male-dominated (MD) occupations; and whether the associations remained after controlling for psychosocial working conditions. Data from six waves of the Swedish Longitudinal Occupational Survey of Health were used to examine prospective associations with a four-year time lag between work schedule (daywork versus shiftwork involving nightwork; and daywork versus shiftwork not involving nightwork) and self-reports of depressive symptoms; incidents of short- and long-term sick leave; self-rated health; and sleep disturbance. Dynamic panel models with fixed effects were applied, using structural equation modeling. The analyses included adjustments for personal circumstances and employment conditions; and additional adjustments for psychosocial working conditions (psychological and emotional job demands; job control; worktime control; social support at work; persecution at work; and threats or violence at work). Within FD occupations, shiftwork that included night work (as compared to daytime work) predicted higher incidence of short-term sick leave (<1 week); within MD occupations, shiftwork that included nightwork predicted greater symptoms of mild depression. Despite notable differences in psychosocial working conditions between dayworkers and shiftworkers, both associations remained significant after adjustments. Thus, it was not confirmed that the associations between shiftwork and health reflected poorer working conditions of shiftworkers in either FD or MD occupations, although the possibility remains that the associations were due to other unmeasured aspects of the working environment.
Gray Matter Volume Correlates of Sleepiness
2020. Torbjörn Åkerstedt (et al.). Nature and Science of Sleep 12, 289-298Artikel
Background: Subjectively experienced sleepiness is a problem in society, possibly linked with gray matter (GM) volume. Given a different sleep pattern, aging may affect such associations, possibly due to shrinking brain volume.
Purpose: The purpose of the present study was to investigate the association between subjectively rated sleepiness and GM volume in thalamus, insula, hippocampus, and orbitofrontal cortex of young and older adults, after a normal night’s sleep.
Methods: Eighty-four healthy individuals participated (46 aged 20– 30 years, and 38 aged 65– 75 years). Morphological brain data were collected in a 3T magnetic resonance imaging (MRI) scanner. Sleepiness was rated multiple times during the imaging sessions.
Results: In older, relative to younger, adults, clusters within bilateral mid-anterior insular cortex and right thalamus were negatively associated with sleepiness. Adjustment for the immediately preceding total sleep time eliminated the significant associations.
Conclusion: Self-rated momentary sleepiness in a monotonous situation appears to be negatively associated with GM volume in clusters within both thalamus and insula in older individuals, and total sleep time seems to play a role in this association. Possibly, this suggests that larger GM volume in these clusters may be protective against sleepiness in older individuals. This notion needs confirmation in further studies.
How to schedule night shift work in order to reduce health and safety risks
2020. Anne Helene Garde (et al.). Scandinavian Journal of Work, Environment and Health 46 (6), 557-569Artikel
Objectives This discussion paper aims to provide scientifically based recommendations on night shift schedules, including consecutive shifts, shift intervals and duration of shifts, which may reduce health and safety risks. Short-term physiological effects in terms of circadian disruption, inadequate sleep duration and quality, and fatigue were considered as possible links between night shift work and selected health and safety risks, namely, cancer, cardio-metabolic disease, injuries, and pregnancy-related outcomes.
Method In early 2020, 15 experienced shift work researchers participated in a workshop where they identified relevant scientific literature within their main research area.
Results Knowledge gaps and possible recommendations were discussed based on the current evidence. The consensus was that schedules which reduce circadian disruption may reduce cancer risk, particularly for breast cancer, and schedules that optimize sleep and reduce fatigue may reduce the occurrence of injuries. This is generally achieved with fewer consecutive night shifts, sufficient shift intervals, and shorter night shift duration.
Conclusions Based on the limited, existing literature, we recommend that in order to reduce the risk of injuries and possibly breast cancer, night shift schedules have: (i) ≤3 consecutive night shifts; (ii) shift intervals of ≥11 hours; and (iii) ≤9 hours shift duration. In special cases – eg, oil rigs and other isolated workplaces with better possibilities to adapt to daytime sleep – additional or other recommendations may apply. Finally, to reduce risk of miscarriage, pregnant women should not work more than one night shift in a week.
Inflammatory cytokines in patients with common mental disorders treated with cognitive behavior therapy
2020. Fredrik Santoft (et al.). Brain, Behavior, & Immunity - Health 3Artikel
Peripheral inflammation has been found associated with psychiatric disorders. However, results are inconclusive as to its role in common mental disorders (CMDs), i.e., depression, anxiety, insomnia and stress-related disorders. Further, some research suggests that cognitive behavior therapy (CBT) could reduce inflammatory markers in CMDs. In the present study, we measured pro-inflammatory cytokines (tumor necrosis factor alpha [TNF-α], interleukin-6 [IL-6] and IL-8) pre- and post-treatment in two clinical trials (N = 367) investigating CBT for patients with CMDs in primary care. We hypothesized that higher levels of these cytokines would be associated with more severe psychiatric symptoms (i.e., symptoms of depression, stress and anxiety). We also hypothesized that level of cytokines would decrease after CBT and that the reduced levels would correlate with a reduction in symptoms. Results showed that in men, higher levels of TNF-α were associated with more severe psychiatric symptoms. Further, age moderated the association between TNF-α, as well as IL-6, and stress, and exploratory stratified analyses revealed significant associations in subgroups. No other significant associations between cytokines and psychiatric symptoms were found. None of the cytokines were reduced following CBT, and the marked improvements in psychiatric symptoms after treatment were not associated with changes in cytokines. In conclusion, although inflammation might be of relevance in subgroups, it seems to be of limited importance for clinical improvements across mild to moderate CMDs.
Må bra i skiftarbete
2020. Göran Kecklund (et al.).Rapport
Projektet ”Må bra i skiftarbete” handlar om sambandet mellan skiftschemats utformning och förekomst av sömn och hälsobesvär. Projektet består av fyra delstudier:
1) en enkätstudie med syfte att undersöka samband mellan objektiva arbetstider och sömn, trötthet, hälsa och välbefinnande bland sjukvårdspersonal, exklusive läkare
2) i samma population undersöka skillnader i hälsa och välbefinnande mellan tre olika arbetstidsmodeller – fast schema, reducerad arbetstid (med bibehållen lön) samt individuell schemaplanering (ISP)
3) en klusterrandomiserad interventionsstudie där personalen vid tre avdelningar erbjöds utbildning om skiftarbete, sömn och hälsa. Dessa avdelningar jämfördes med tre avdelningar där personalen förutom utbildning även fick individuell schemaåterkoppling. Samtliga avdelningar hade ISP.
4) en pilotstudie på läkare som använder ISP. Pilotstudien omfattade en enkät samt objektiva arbetstidsdata bland ett litet urval läkare.
Undersökningen är baserad på enkäter och objektiva arbetstider. De viktigaste resultaten var:
(1) De besvärligaste arbetstidskomponenterna var kort dygnsvila, roterande treskift, och helgarbete. Kort dygnsvila innebar otillräcklig sömn och ungefär 2,5 timmes sömnbrist.
(2) Det fanns inga samband mellan förekomst av kort dygnsvila respektive nattarbete (baserade på objektiva arbetstidsdata) och psykisk ohälsa, otillräcklig återhämtning, att arbetet stör privatlivet och uppfattning om att inte orka arbeta fram till pension.
(3) Däremot fanns det tydliga samband mellan att uppleva stora besvär med kort dygnsvila och nattarbete, och psykisk ohälsa, otillräcklig återhämtning, att arbetet stör privatlivet och att inte orka arbeta fram till pension (under rådande arbetsförhållanden).
(4) Även hög arbetsbelastning, att uppleva att arbetet är emotionellt krävande, samt att inte få tillräckliga raster, visade samband med psykisk ohälsa och att inte orka arbeta fram till pension.
(5) Jämförelsen av arbetstidsmodellerna – fast schema, reducerad arbetstid och ISP – visade marginella skillnader när det gäller hälsa, återhämtning och arbetsrelaterade störningar av privatlivet.
(6) Interventionen, särskilt utbildning, var uppskattad av deltagarna men hade ingen effekt på hälsa, återhämtning och störningar i privatlivet. Interventionen innebar en ökning av mindre personalkonflikter relaterade till de valda arbetstiderna.
(7) Pilotstudien om ISP för läkare visade att många uppskattade att kunna påverka sitt arbetstidsschema och rekommenderade andra avdelningar att pröva ISP. Däremot påverkade inte ISP förekomsten av hälso- och sömnbesvär.
Sleepiness as motivation
2020. John Axelsson (et al.). Sleep 43 (6)Artikel
STUDY OBJECTIVES: To determine how sleepiness and sleep deprivation drive the motivation to engage in different behaviors.
METHODS: We studied the sleepiness of 123 participants who had been randomized to sleep deprivation or normal sleep, and their willingness to engage in a range of everyday behaviors.
RESULTS: Self-reported sleepiness was a strong predictor of the motivation to engage in sleep-preparatory behaviors such as shutting one's eyes (OR=2.78, 95%CI: 2.19-3.52 for each step up on the Karolinska Sleepiness Scale) and resting (OR=3.20, CI: 2.46-4.16). Sleepiness was also related to the desire to be cared for by a loved one (OR=1.49, CI: 1.22-1.82), and preparedness to utilize monetary and energy resources to get to sleep. Conversely, increased sleepiness was associated with a decreased motivation for social and physical activities (e.g., be with friends OR=0.71, CI: 0.61-0.82; exercise OR=0.65, CI: 0.56-0.76). Sleep deprivation had similar effects as sleepiness on these behaviors. Neither sleepiness nor sleep deprivation had strong associations with hunger, thirst, or food preferences.
CONCLUSIONS: Our findings indicate that sleepiness is a dynamic motivational drive that promotes sleep-preparatory behaviors and competes with other drives and desired outcomes. Consequently, sleepiness may be a central mechanism by which impaired alertness, e.g., due to insufficient sleep, contributes to poor quality of life and adverse health. We propose that sleepiness helps organize behaviors toward the specific goal of assuring sufficient sleep, in competition with other needs and incentives. A theoretical framework on sleepiness and its behavioral consequences are likely to improve our understanding of several disease mechanisms.
Sleepiness, sleep duration, and human social activity
2020. Benjamin C. Holding (et al.). Proceedings of the National Academy of Sciences of the United States of America 117 (35), 21209-21217Artikel
Daytime sleepiness impairs cognitive ability, but recent evidence suggests it is also an important driver of human motivation and behavior. We aimed to investigate the relationship between sleepiness and a behavior strongly associated with better health: social activity. We additionally aimed to investigate whether a key driver of sleepiness, sleep duration, had a similar relationship with social activity. For these questions, we considered bidirectionality, time of day, and differences between workdays and days off. Over 3 wk, 641 working adults logged their behavior every 30 min, completed a sleepiness scale every 3 h, and filled a sleep diary every morning (rendering >292,000 activity and >70,000 sleepiness datapoints). Using generalized additive mixed-effect models, we analyzed potential nonlinear relationships between sleepiness/sleep duration and social activity. Greater sleepiness predicted a substantial decrease in the probability of social activity (odds ratio 95% CI = 0.34 to 0.35 for days off), as well as a decreased duration of such activity when it did occur. These associations appear especially robust on days off and in the evenings. Social duration moderated the typical time-of-day pattern of sleepiness, with, for example, extended evening socializing associated with lower sleepiness. Sleep duration did not robustly predict next-day social activity. However, extensive social activity (>5 h) predicted up to 30 min shorter subsequent sleep duration. These results indicate that sleepiness is a strong predictor of voluntary decreases in social contact. It is possible that bouts of sleepiness lead to social withdrawal and loneliness, both risk factors for mental and physical ill health.
Suicide by crashing into a heavy vehicle
2020. Igor Radun (et al.). Transportation Research Part F 73, 318-324Artikel
Train and heavy vehicle drivers can experience a traumatic event caused by people attempting suicide by crashing into their vehicles or jumping in front of them. While there are a number of studies on train drivers showing the negative consequences these events can have on their well-being, there are no studies on heavy vehicle drivers involved in these types of crashes. In the current study, we surveyed Finnish heavy vehicle drivers (N = 15) involved in a suicide crash in the year 2017 regarding their experiences and coping approximately one month (T1) and one year (T2) after the crash. Ten of these drivers reported one or various combinations of measurable consequences such as minor physical injuries, shorter or longer sickness absences, significant posttraumatic stress symptoms (measured using the Impact of Events Scale-Revised) and requiring psychological help. Posttraumatic stress symptoms decreased over time; however, three out of the four drivers who had a high IES-R score at T1 were still around the IES-R cut-off score at T2. This research raises questions whether and what kind of support heavy vehicle drivers who have been involved in a suicide crash should be given.
The mediating effect of work-life interference on the relationship between work-time control and depressive and musculoskeletal symptoms
2020. Sophie C. Albrecht, Göran Kecklund, Constanze Leineweber. Scandinavian Journal of Work, Environment and Health 46 (5), 469-479Artikel
Objectives Evidence shows that work-time control (WTC) affects health but underlying mechanisms are still unclear. Work-life interference (WLI) might be a step on the causal pathway. The present study examined whether WLI mediates effects on mental and physical health and contrasted these to other causal pathways.
Methods Four biennial waves from the Swedish Longitudinal Occupational Survey of Health (SLOSH, N=26 804) were used. Cross-lagged analyses were conducted to estimate if WLI mediated effects from WTC (differentiating between control over daily hours and time off) to subsequent depressive and musculoskeletal symptoms. Other causal directions (reversed mediation, direct and reversed direct effects) and robustness of mediation (by including covariates) were examined.
Results WLI partially mediated the relationship of WTC (control over daily hours/time off) with both health outcomes. Indirect effect estimates were small for depressive symptoms (-0.053 for control over time off and -0.018 for control over daily hours) and very small for musculoskeletal symptoms (-0.007 and -0.003, respectively). While other causal directions were generally weaker than causal mediational pathways, they played a larger role for musculoskeletal compared to depressive symptoms. Estimates relating to control over time off were in general larger than for control over daily hours.
Conclusions Our results suggest that WLI mediates part of the effect from WTC to mental/musculoskeletal symptoms, but small estimates suggest that (i) WTC plays a small but consistent role in effects on health and (ii) particularly regarding musculoskeletal disorders, other causal directions and mediators need to be further examined.