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Praca w nocy a zdrowie pielęgniarek i położnych – przegląd literatury

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Burdelak W., Pepłońska B.
Medycyna Pracy
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2013
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vol. 64
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issue 3
397-418
EN
Night shift work has been thought to play a role in the etiology of chronic diseases through a disruption of the circadian rhythm, decreased synthesis of melatonin and sleep deprivation. Our aim was to review the epidemiological studies on the association between night shift work and some pathologies in nurses and midwives. We reviewed publications available in the MEDLINE database and published before June 2012, describing the cross-sectional (almost two thirds of all papers) and cohort studies. In total, we identified 26 original papers, including 5 epidemiological studies addressing diseases or disorders of the digestive system, 3 - metabolic syndrome, 2 - diabetes type 2, 9 - cardiovascular diseases and CVD risk factors, 5 - obesity/overweight, 2 - menstrual disorders and 3 - poor pregnancy outcomes. The analysis of the literature indicates that night shift work of nurses and midwives is most strongly associated with a higher risk of obesity/overweight. In each of the five studies, which we identified this association was observed (confirmed by the statistical significance of the results), also after adjustment for confounders. The results for diabetes type 2 and disorders of the menstrual cycle are also suggestive. Epidemiological data on the other disorders or pathologies discussed in this article seem to be less certain - their results are inconsistent or their number is too small to draw definite conclusions. Further epidemiological studies of nurses and midwives working on night shifts and prospective observations in particular are recommended to find out whether potential association between the night work and discussed health issues is causal. Med Pr 2013;64(3):397–418
PL
Praca w nocy prawdopodobnie odgrywa rolę w etiologii chorób przewlekłych poprzez zaburzenie rytmu okołodobowego, obniżenie syntezy melatoniny i niedobory snu. Celem naszej pracy był przegląd badań epidemiologicznych dotyczących związku między pracą w nocy a występowaniem wybranych patologii u pielęgniarek i położnych. Przeglądu dokonano na podstawie publikacji zawartych w bazie Medline, opublikowanych do czerwca 2012 r. Podstawę przeglądu stanowiły artykuły naukowe opisujące wyniki badań przekrojowych (prawie 2/3 wszystkich prac) oraz badań kohortowych (prospektywnych). Zidentyfikowałyśmy ogółem 26 prac oryginalnych, w tym 5 badań epidemiologicznych dotyczących chorób/zaburzeń czynnościowych układu pokarmowego, 3 - zespołu metabolicznego, 2 - cukrzycy typu 2, 9 - chorób układu krążenia i czynników ryzyka chorób układu krążenia, 5 - otyłości/nadwagi, 2 - zaburzeń miesiączkowania i 3 - zaburzeń przebiegu ciąży. Z przeprowadzonej analizy piśmiennictwa wynika, że praca pielęgniarek i położnych na zmianach nocnych, w systemie rotacyjnym, najsilniej łączy się ze wzrostem ryzyka otyłości i nadwagi. W każdym z przeanalizowanych przez nas 5 badań dotyczących tego zagadnienia obserwowano omawianą zależność (potwierdzoną istotnością statystyczną wyników), także po uwzględnieniu czynników zakłócających. Sugestywne są także wyniki dotyczące cukrzycy typu 2 i zaburzeń cyklu menstruacyjnego. Dane epidemiologiczne dotyczące pozostałych, omawianych w pracy zaburzeń lub patologii wydają się mniej pewne - podawane wyniki są niespójne lub liczba danych jest zbyt mała, aby można było formułować zdecydowane wnioski. Wskazane jest prowadzenie dalszych badań epidemiologicznych pielęgniarek i położnych pracujących w nocy, w szczególności obserwacji prospektywnych, które pozwolą ustalić, czy potencjalny związek pracy w nocy z omówionymi problemami zdrowotnymi ma charakter przyczynowo-skutkowy. Med. Pr. 2013;64(3):397–418
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Night shift work characteristics and occupational co-exposures in industrial plants in Łódź, Poland

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Pepłońska B., Burdelak W., Bukowska A., Krysicka J., Konieczko K.
International Journal of Occupational Medicine and Environmental Health
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2013
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vol. 26
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issue 4
522-534
EN
Objectives: Night shift work involving circadian rhythm disruption has been classified by IARC as a probably carcinogenic to humans (Group 2A). Little is known about co-exposures of the night shift work in occupational settings. The aim of our study was to characterize night shift work systems and industrial exposures occurring in the manufacturing plants in Łódź, Poland, where night shift work system operates, with particular focus on potential carcinogens. Material and Methods: Data on the night shift work systems and hazardous agents were collected through survey performed in 44 enterprises. The identified hazardous agents were checked using the IARC carcinogen list, and the harmonized EU classification of chemical substances. We also examined databases of the Central Register of Data on exposure to substances, preparations, agents and technological processes showing carcinogenic or mutagenic properties in Poland. Results: The most common system of work among studied enterprises employed 3 (8-hour) shifts within a 5-day cycle. We identified as many as 153 hazards occurring in the environment of the plants, with noise, carbon monoxide and formaldehyde recorded as the most common ones. Out of these hazards, 11 agents have been classified by IARC to group 1 - carcinogenic to humans, whereas 10 agents have been classified as carcino - gens by the regulation of European Classification of carcinogens. Analysis of the data from the Central Register revealed that 6 plants reported presence of carcinogens in the environment of work. Conclusions: In our study we observed that in none of the workplaces the night shift work was a single exposure. Further epidemiological studies focusing on investigation of health effects of the night shift work should identify occupational co -exposures and examine them as potential confounders.
3
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Night shift work and modifiable lifestyle factors

51%
Pepłońska B., Burdelak W., Krysicka J., Bukowska A., Marcinkiewicz A., Sobala W., Klimecka-Muszyńska D., Rybacki M.
International Journal of Occupational Medicine and Environmental Health
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2014
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vol. 27
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issue 5
693-706
EN
Objectives: Night shift work has been linked to some chronic diseases. Modification of lifestyle by night work may partially contribute to the development of these diseases, nevertheless, so far epidemiological evidence is limited. The aim of the study was to explore association between night shift work and lifestyle factors using data from a cross-sectional study among blue-collar workers employed in industrial plants in Łódź, Poland. Material and Methods: The anonymous questionnaire was self-administered among 605 employees (236 women and 369 men, aged 35 or more) - 434 individuals currently working night shifts. Distribution of the selected lifestyle related factors such as smoking, alcohol drinking, physical activity, body mass index (BMI), number of main meals and the hour of the last meal was compared between current, former, and never night shift workers. Adjusted ORs or predicted means were calculated, as a measure of the associations between night shift work and lifestyle factors, with age, marital status and education included in the models as covariates. Results: Recreational inactivity (defined here as less than one hour per week of recreational physical activity) was associated with current night shift work when compared to never night shift workers (OR = 2.43, 95% CI: 1.13-5.22) among men. Alcohol abstinence and later time of the last meal was associated with night shift work among women. Statistically significant positive relationship between night shift work duration and BMI was observed among men (p = 0.029). Conclusions: This study confirms previous studies reporting lower exercising among night shift workers and tendency to increase body weight. This finding provides important public health implication for the prevention of chronic diseases among night shift workers. Initiatives promoting physical activity addressed in particular to the night shift workers are recommended.
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