Philip arbetar som gästforskare vid Stressforskningsinstitutet, efter att ha lånats ut från sin position som universitetslektor vid Institutionen för psykologi vid Swansea University i Storbritannien. Hans utstationering ska löpa från 2011 till 2014. Philips forskning avser arbetstidens påverkan på hälsa och säkerhet för den anställde. Ett av hans huvudområden är betydelsen av dygnsrytmen i förhållande till effekterna av skiftarbete. Han har publicerat flera artiklar som berör vad olika aspekter av skiftarbetes-system har för inverkan på sömn, vakenhet och välbefinnande. Han undersöker även andra aspekter av arbetets schemaläggning, såsom tidpunkt för och fördelning av raster, långa arbetstider, innovativa arbetsscheman och effekterna av fritidssysselsättning på återhämtning från arbetet. Philips forskning handlar om olika metodologiska angreppssätt, såsom storskaliga enkäter, epidemiologisk analys av olycksdata, fältstudier med både objektiva och subjektiva mått av sömn, stress och kognitiv förmåga. Nu senast har hans forskning fokuserat på skiftarbete i relation till ett antal ämnen, inklusive åldrande, kost och påverkan på ämnesomsättningssystemet, samt läkares arbetstid. Vid sin tid på Stressforskningsinstitutet kommer Philip att arbeta på ett antal projekt, inklusive den svenska longitudinella arbetsmiljöundersökningen SLOSH, samt LANE-studien (Longitudinal Analysis of Nursing Education). Den senare kommer att göras i samarbete med kollegor vid Karolinska institutet och Kungliga Tekniska Högskolan (KTH). Philip samarbetar även med kollegor i Frankrike, då han analyserar data från VISAT-studien (åldrande, hälsa och arbete). Han är redaktör för tidskrifterna Work & Stress samt Scandinavian Journal of Work, Environment and Health. Han har vid två tillfällen, på uppdrag av International Labour Organization, skrivit sammanställningar om arbetstidens förläggning. Han har även arbetat som konsult och gett råd på arbetets schemaläggning för kunder inom fritidsindustrin, livsmedelsindustrin och hälsosektorn.
Fil.dr. i psykologi, 1994
I urval från Stockholms universitets publikationsdatabas
Associations between shift work and use of prescribed medications for the treatment of hypertension, diabetes, and dyslipidemia
2019. Philip Tucker (et al.). Scandinavian Journal of Work, Environment and Health 45 (5), 465-474Artikel
Objective This study examined the associations between shift work and use of antihypertensive, lipid-lowering, and antidiabetic medications. Methods Survey data from two cohorts of Finnish men (N=11998) and women (N=49 944) working in multiple occupations where shift work was used were linked to national Drug Prescription Register data, with up to 11 years of follow-up. In each cohort, age-stratified Cox proportional hazard regression models were computed to examine any incident use of prescription medication for each of the three medical conditions, separately comparing each of two groups of rotating shift workers (those whose schedules included night shifts. and those whose schedules did not include night shifts) with day workers who worked in a similar range of occupations. Results In the larger cohort, among participants aged 40-49 at baseline, shift work without night shifts was associated with increased use of type-2 diabetes medication after adjustments for sex, occupational status, marital status, alcohol consumption, smoking, and physical activity [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.01-1.62], while shift work with night shifts was associated with increased use of dyslipidemia medication after adjustments (HR 1.33, 95% CI 1.12-1.57). There were no such associations among younger and older shift workers. Also in the larger cohort, among those aged <50 years at baseline, both types of shift work were associated with increased use of hypertension medication after adjustments [up to HR 1.20 (95% CI 1.05-1.37)]. There were no positive associations in the smaller cohort. Conclusions There was mixed evidence regarding the use of medications for cardiovascular risk factors by shift workers. Selection effects may have affected the associations.
Effect of work schedule on prospective antidepressant prescriptions in Sweden
2019. Amy L. Hall (et al.). BMJ Open 9 (1)Artikel
Introduction Depression-related mood disorders affect millions of people worldwide and contribute to substantial morbidity and disability, yet little is known about the effects of work scheduling on depression. This study used a large Swedish survey to prospectively examine the effects of work schedule on registry-based antidepressant prescriptions in females and males over a 2-year period. Methods The study was based on an approximately representative sample (n= 3980 males, 4663 females) of gainfully employed participants in the Swedish Longitudinal Occupational Survey of Health. Sex-stratified analyses were conducted using logistic regression. For exposure, eight categories described work schedule in 2008: ` regular days' (three categories of night work history: none, <= 3 years, 4+ years), 'night shift work', 'regular shift work (no nights)', 'rostered work (no nights)', 'flexible/non-regulated hours' and 'other'. For the primary outcome measure, all prescriptions coded N06A according to the Anatomical Therapeutic Chemical System were obtained from the Swedish National Prescribed Drug Register and dichotomised into 'any' or 'no' prescriptions between 2008 and 2010. Estimates were adjusted for potential sociodemographic, health and work confounders, and for prior depressive symptoms. Results In 2008, 22% of females versus 19% of males worked outside of regular daytime schedule. Registered antidepressant prescription rates in the postsurvey period were 11.4% for females versus 5.8% for males. In fully adjusted models, females in 'flexible/non-regulated' schedules showed an increased OR for prospective antidepressant prescriptions (OR= 2.01, 95% CI= 1.08 to 3.76). In males, odds ratios were most increased in those working 'other' schedules (OR= 1.72, 95% CI= 0.75 to 3.94) and 'Regular days with four or more years' history of night work' (OR= 1.54, 95% CI= 0.93 to 2.56). Conclusions This study's findings support a relationship between work schedule and prospective antidepressant prescriptions in the Swedish workforce. Future research should continue to assess sex-stratified relationships, using detailed shift work exposure categories and objective registry data where possible.
Sleep and fatigue in newly graduated nurses-Experiences and strategies for handling shiftwork
2019. Majken Epstein (et al.). Journal of Clinical NursingArtikel
Aims and objectives To explore newly graduated nurses' strategies for, and experiences of, sleep problems and fatigue when starting shiftwork. A more comprehensive insight into nurses' strategies, sleep problems, fatigue experiences and contributing factors is needed to understand what support should be provided. Background For graduate nurses, the first years of practice are often stressful, with many reporting high levels of burnout symptoms. Usually, starting working as a nurse also means an introduction to shiftwork, which is related to sleep problems. Sleep problems may impair stress management and, at the same time, stress may cause sleep problems. Previously, sleep problems and fatigue have been associated with burnout, poor health and increased accident risk. Design and Methods Semi-structured interviews were conducted with nurses (N = 11) from four different Swedish hospitals, and qualitative inductive content analysis was used. The study was approved by the Regional Ethical Review Board in Stockholm. The COREQ checklist was followed. Results Many nurses lacked effective strategies for managing sleep and fatigue in relation to shiftwork. Various strategies were used, of which some might interfere with factors regulating and promoting sleep such as the homeostatic drive. Sleep problems were common during quick returns, often due to difficulties unwinding before sleep, and high workloads exacerbated the problems. The described consequences of fatigue in a clinical work context indicated impaired executive and nonexecutive cognitive function. Conclusion The findings indicate that supporting strategies and behaviours for sleep and fatigue in an intervention for newly graduated nurses starting shiftwork may be of importance to improve well-being among nurses and increase patient safety. Relevance to clinical practice This study highlights the importance of addressing sleep and fatigue issues in nursing education and work introduction programmes to increase patient safety and improve well-being among nurses.
Working Time Society consensus statements
2019. Claudia R. C. Moreno (et al.). Industrial Health 57 (2), 139-157Artikel
Potential effects of shift work on health are probably related to the misalignment between the light-dark cycle and the human activity-rest cycle. Light exposure at night mediates these ef- fects, including social misalignment and leads to an inversion of activity and rest, which, in turn, is linked to changes in behaviours. This article reviews the epidemiological evidence on the association between shift work and health, and possible mechanisms underlying this association. First, evidence from findings of the meta-analyses and systematic reviews published in the last 10 yr is presented. In addition, it reports the larger single-occupation studies and recent large population- based studies of the general workforce. Koch’s postulates were used to evaluate the evidence related to the development of disease as a result of exposure to shift work. Finally, we discussed limitations of the multiple pathways that link shift work with specific disorders and the methodological challenges facing shift work research. We concluded that the clearest indications of shift work being the cause of a disease are given when there is a substantial body of evidence from high quality field studies showing an association and there is good evidence from laboratory studies supporting a causal explanation of the link.
Work schedule and prospective antidepressant prescriptions in the swedish workforce
2018. A. L. Hall (et al.).Artikel
Introduction Mood disorders affect millions of individuals worldwide and contribute to substantial morbidity and disability. A better understanding of modifiable work-related risk factors for depression could inform and advance prevention efforts in this area. This study used a large Swedish longitudinal occupational survey to prospectively examine the effect of self-reported work schedule on registry-based antidepressant prescriptions over a two-year period.
Methods The analytic sample (n=8643) was obtained from the Swedish Longitudinal Occupational Survey of Health. Sex-stratified and unstratified analyses were conducted using logistic regression. For exposure, 8 categories were used to describe work schedule in 2008: ‘regular days’ (3 categories: night work history=none,≤3 years, or 4+years) ‘night work (regular, rostered, or rotating)’, ‘regular shift work (no nights)’, ‘rostered work (no nights)’, ‘flexible/non-regulated hours’, and ‘other’. For the outcome, all prescriptions coded N06A according to the Anatomical Therapeutic Chemical System were obtained from the Swedish National Prescribed Drug Register and dichotomized into ‘any’ or ‘no’ prescriptions between 2008 and 2010. Estimates were adjusted for potential sociodemographic, health, and work confounders, and for prior depressive symptoms.
Results In unadjusted analyses, an increased odds ratio for depression was observed for ‘Other’ work hours in unstratified (OR=1.75, 95% CI: 1.21 to 2.51) and female (OR=1.62, 95% CI: 1.05 to 2.51) models; in adjusted models effects persisted but confidence intervals widened to non-significance at the p=0.05 level. In models adjusted for previous depressive symptoms, females in ‘flexible/non-regulated’ schedules showed an increased odds ratio for depression (OR=2.01, 95% CI: 1.08 to 3.76), while a decreased odds ratio was observed for the unstratified model ‘regular shift work (no nights)’ category (OR=0.61; 95% CI: 0.38 to 0.97).
Discussion This study’s findings support prospective relationships between work schedule and antidepressant prescriptions in the Swedish workforce. Future research should continue to assess sex-stratified relationships, using detailed shift work exposure categories and objective registry data where possible.
Nurses' strategies for managing sleep when starting shift work – implications for interventions targeting sleep behaviours in a shift work population
2017. A. Dahlgren (et al.). Sleep Medicine 40 (Suppl. 1)Artikel
Introduction: Shift work is related to short and disturbed sleep. Various aspects of a shift schedule will produce different opportunities and conditions for sleep depending on how they interact with circadian rhythms and the homeostatic drive for sleep. A third factor influencing sleep between shifts is the activation of the stress system. The aim of the current study was to examine sleep behaviours and strategies that nurses used when starting shift work and determine which sleep behaviours should be promoted when developing a programme for sleep interventions for newly graduated nurses.
Material and methods: 11 (mean age 29.1±8) newly graduated nurses (3–12 months work experience) from different hospitals in Sweden were recruited for a semi-structured interview (approx. 45 min). Deductive content analysis was used to examine sleep strategies related to the homeostatic and circadian regulation of sleep, and to managing stress.
Results: In relation to morning shifts (starting 6:45 h) most nurses perceived sleep as somewhat disturbed. Some had a strategy of undertaking activities that helped them unwind before bedtime, such as having a shower, watching TV, surfing the Internet or using relaxation techniques. One nurse had a strategy of getting up early in the morning before a morning shift in order to facilitate sleep in the evening, thereby enhancing the homeostatic drive for sleep. One nurse tried to keep her bed times constant despite irregular work hours in order to maintain a stable circadian rhythm.
In relation to evening shifts, few experienced problems with sleep. Most had a lie-in before starting an evening shift and were being quite inactive before the shift started.
Most nurses reported sleep problems when an evening shift was followed by a morning shift, i.e. a quick return, with many having problems unwinding and stopping thinking about work before bedtime. A few nurses described experiencing stress from knowing that their sleep would be short. Many had a strategy of undertaking other activities to unwind (see examples from morning shifts) before going to bed. A few went to bed straight away but described experiencing difficulties falling asleep. A few who reported no problems with sleep during quick returns said that they undertook activities that made them detach from work, with one regularly using a relaxation technique. The five nurses who worked night shifts had strategies of either sleeping in the evening before the nightshift, or staying up as long as possible the night before, thereby reducing the homeostatic drive for sleep during the shift.
Conclusions: Newly graduated nurses would probably benefit from a sleep programme based on cognitive behavioural therapy techniques that are modified to fit shift workers. Behaviours and strategies that should be targeted are: routines and techniques for unwinding before bed time; sleep behaviours that promote building up enough homeostatic pressure for initiating sleep (e.g. not having long lie-ins before evening shifts that are followed by morning shifts); and sleep behaviours that promote a stable circadian rhythm.
Shiftwork and the use of prescription medication for sleep, anxiety and depression
2017. Philip Tucker (et al.). Sleep Medicine 40 (Suppl. 1)Artikel
Introduction: There is only limited evidence to date linking shiftwork with clinical levels of sleep disturbance and mental health problems. Few studies have examined redeemed drug prescriptions using register data, which is the focus of this study.
Materials and methods: Data were obtained from three waves of the Finnish Public Sector Study (2000, 2004, 2008. 66-68% response rate). Participants were from two cohorts; local government employees in 10 towns–a mixture of healthcare workers and employees from other occupational sectors ('10 Towns Cohort'); and employees of 21 hospitals ('Hospitals Cohort'). The overall sample was N=53,275 (mean age 43.6 (SD=9.8), range 18-69), with approximately 73% coming from the 10 Towns Cohort. Women made up 82% of the entire sample. Responses to surveys were linked to records on redeemed prescriptions (until December 2011).
Data from the two cohorts were analysed separately to examine the associations between work schedule and drug purchase. Cox regressions were used to predict time to first incident use of:
1. Hypnotics & Sedatives; and
2. Anxiolytics & Antidepressants. We separately compared 2- and 3-shift workers (i.e. rotating shifts either without, or with, nights) with dayworkers, matched for occupational group.
Each analysis was stratified by age (< = 39 years, 40-49 years and >= 50 years). HRs were calculated with adjustments for age, sex, socioeconomic status and marital status (Model 1); and with additional adjustments for alcohol consumption (Model 2). Participants were excluded if they had any recorded purchase of the drug in question prior to follow-up, or if they reported previous diagnosis of depression or other mental disease.
Results: There were fewer significant associations in the Hospitals Cohort than in the 10 Towns Cohort. The 10 Towns Cohort showed significant positive associations between 3-shift work and the use of both categories of medication; with the exception of Anxiolytic & Antidepressant use among the middle-age group. Among the 2-shift workers, the only significant associations were with the use of Anxiolytics & Antidepressants in the lower- and upper-age groups. In the Hospitals Cohort, the majority of associations were either non-significant or negative (i.e. indicative of a protective effect). The main exception was positive associations between 3-shift work and use of Hypnotics & Sedatives among the upper-age group.
Conclusions: The finding of greater use of hypnotics and sedatives by rotating nightshift workers adds to the limited evidence to date linking night with clinical levels of sleep disturbance. The finding of greater use of anxiolytics and antidepressants by some groups of shiftworkers provides limited evidence of a link between shiftwork and mental health problems.
Sensitivity analyses indicated that the disparity between cohorts was neither due to the presence of non-healthcare workers in the 10 Towns Cohort, nor to the presence of former shiftworkers in the control sample of the Hospital Cohort. Other possible explanations are that: the cohorts differ with respect to type of shift schedule e.g. the intensity of nightwork; shiftworkers in the Hospital Cohort may be more selected as it may be easier for them to transfer to daywork.
Investigating the factorial structure and availability of work time control in a representative sample of the Swedish working population
2016. Sophie Albrecht (et al.). Scandinavian Journal of Public Health 44 (3), 320-328Artikel
Aims: Past research has often neglected the sub-dimensions of work time control (WTC). Moreover, differences in levels of WTC with respect to work and demographic characteristics have not yet been examined in a representative sample. We investigated these matters in a recent sample of the Swedish working population. Methods: The study was based on the 2014 data collection of the Swedish Longitudinal Occupational Survey of Health. We assessed the structure of the WTC measure using exploratory and confirmatory factor analysis. Differences in WTC by work and demographic characteristics were examined with independent sample t-tests, one-way ANOVAs and gender-stratified logistic regressions. Results: Best model fit was found for a two-factor structure that distinguished between control over daily hours and control over time off (root mean square error of approximation = 0.06; 95% CI 0.04 to 0.09; Comparative Fit Index (CFI) = 0.99). Women, shift and public-sector workers reported lower control in relation to both factors. Age showed small associations with WTC, while a stronger link was suggested for civil status and family situation. Night, roster and rotating shift work seemed to be the most influential factors on reporting low control over daily hours and time off. Conclusions: Our data confirm the two-dimensional structure underlying WTC, namely the components 'control over daily hours' and 'control over time off'. Women, public-sector and shift workers reported lower levels of control. Future research should examine the public health implications of WTC, in particular whether increased control over daily hours and time off can reduce health problems associated with difficult working-time arrangements.