Liliane Reis Teixeira

Short Sleep Is Associated with Obesity Among Truck Drivers

Recent studies suggest that short‐sleep duration is independently associated with obesity in the general population. The population of truck drivers is of particular interest, because they frequently work irregular shifts that in turn are associated with short‐sleep duration. In addition, truck drivers have a high prevalence of sedentary habits, poor diet, and obesity. The present study aimed at verifying the association between sleep patterns and factors associated with obesity in this population. The study sample consisted in 4,878 truck drivers who participated in a campaign promoted by a highway company in the State of São Paulo, Brazil. This campaign offered highway truck drivers a medical and laboratorial evaluation. The truck drivers completed a questionnaire concerning demographic data, sleep duration, consumption of medications, and medical problems, such as diabetes, cardiopathy, and hypertension; as well as the Berlin questionnaire, which is able to discriminate low and high risk for obstructive sleep apnea. Blood samples were collected to measure glucose and cholesterol levels. Also, body weight and height were registered to calculate the body mass index (BMI). The mean age (±SD) of the truck drivers studied was 40±10 years. Out of the truck drivers analyzed, 28.3% (n=1,379) had a BMI ≥30.0 Kg/m2 (obesity). Among the 4,878 drivers included in the study, 1,199 (24.6%) were on medications and 334 (6.8%) were diabetic. Drivers (26.9%) with the greater BMI had a short sleep length. The independent factors associated with obesity were sleep duration <8 h/day (OR=1.24), age >40 years (OR=1.20), glucose levels >200 (OR=2.02), cholesterol levels >240 (OR=1.57), snoring (OR=1.74), and hypertension (OR=2.14). Smoking was not associated with obesity (OR=0.69), and diabetes was considered a control variable. In conclusion, this study supports the hypothesis that short sleep duration as well as age >40 years are independently associated with obesity. This particular combination (short‐sleep duration and obesity) is independently associated with several healthcare problems, including high levels of cholesterol, glucose, snoring, and hypertension. However, due to the cross‐sectional nature of this study, no cause–effect relationship can be drawn from these results.

WORK ABILITY OF HEALTH CARE SHIFT WORKERS: WHAT MATTERS?

This paper aims at identifying variables associated with inadequate work ability among nursing personnel at a public hospital, considering factors related to socio‐demographic, lifestyles, working conditions, and health outcomes. A cross‐sectional study was conducted in a university hospital in São Paulo, Brazil, as part of a larger research study on tolerance to 12 h night work. Nursing staff included registered nurses, nurse technicians, and nurse aides; in total, there were 996 healthcare workers (878 female; 118 male) at the time of the study. Some 696 workers (69.9%) of the population agreed to participate. Data collection (October 2004–July 2005) was based on a comprehensive questionnaire about living and working conditions (including incivility at work, work demands, work control, and support), mental and physical health symptoms (fatigue and sleep problems), and work ability. This report presents analyses of the adapted Brazilian version of the Work Ability Index (WAI) and associated variables. The study population worked one of the following shift schedules at this hospital: 12 h nights followed by 36 h off or 9 h or 6 h day (morning or afternoon) shifts. The mean age of the respondents was 34.9 (S.D.±10.4) years of age; 31.5% of the participants held two jobs. Statistical analyses using a hierarchical multiple logistic regression model were performed to evaluate the factors associated with inadequate (moderate and low scores) of the WAI. The significantly associated factors were socio‐demographic (income responsibility, sole breadwinner, raising kids, age group), working conditions (thermal discomfort, organization of the workplace, and verbal abuse), and health outcomes (high body mass index, obesity, sleep problems, and fatigue). In spite of limitations of the study design, results indicate that the nursing profession is associated with stressful working conditions, contributing to inadequate WAI. This is in addition to bad living conditions and precarious work. Intervention measures, either at the workplace or at individual levels, are necessary to prevent a decrease in work ability, even in this quite young working population.

Job control, job demands, social support at work and health among adolescent workers

OBJETIVO: Avaliar as dimensoes fisicas e psicologicas do trabalho de adolescentes (demanda de trabalho, controle no trabalho e apoio social e ambiental), relacionando-os a relatos de: dores no corpo, acidentes de trabalho, duracao de sono e duracao diaria da jornada de trabalho. METODOS: Participaram do estudo 354 estudantes do periodo noturno de escola publica no Municipio de Sao Paulo, entre abril e maio de 2001. Esses, responderam a questionario sobre condicoes de vida, trabalho (escalas Karasek de controle no trabalho) e estado de saude. Foram feitas analises de regressao logistica multipla a fim de determinar a relacao entre variaveis. RESULTADOS: As exigencias psicologicas mostraram-se associadas aos relatos de dores no corpo (OR=3,3), maiores riscos de ocorrencia de acidentes de trabalho (OR=3,0) e reducao da duracao do sono durante os dias de semana (segunda a quinta-feira) (p<0,01). Baixa autoridade de decisao (p=0,03) e maior seguranca no emprego (p=0,02) estao relacionadas a maior duracao da jornada diaria de trabalho. CONCLUSOES: Concluiu-se que nao somente os estressores fisicos, mas tambem os psicologicos devem ser levados em consideracao quando avaliadas as condicoes de trabalho de adolescentes, ja que esses podem ser associados as mas condicoes de trabalho e efeitos negativos na saude.OBJECTIVE To evaluate physical and psychological dimensions of adolescent labor (such as job demands, job control, and social support in the work environment), and their relation to reported body pain, work injuries, sleep duration and daily working hours. METHODS A total of 354 adolescents attending evening classes at a public school in Sao Paulo, Brazil, answered questionnaires regarding their living and working conditions (Karaseks Job Content Questionnaire, 1998), and their health status. Data collection took place in April and May 2001. Multiple logistic regression analysis was used to determine relations among variables. RESULTS Psychological job demands were related to body pain (OR=3.3), higher risk of work injuries (OR=3.0) and reduced sleep duration in weekdays (Monday to Thursday) (p<0.01). Lower decision authority in the workplace (p=0.03) and higher job security (p=0.02) were related to longer daily working hours. CONCLUSIONS It was concluded that besides physical stressors, psychological factors are to be taken into account when studying adolescent working conditions, as they may be associated with negative job conditions and health effects.

Sleep and sleepiness among working and non-working high school evening students.

The aim of this study was to evaluate patterns of sleepiness, comparing working and non‐working students. The study was conducted on high school students attending evening classes (19:00–22:30 h) at a public school in São Paulo, Brazil. The study group consisted of working (n=51) and non‐working (n=41) students, aged 14–21 yrs. The students answered a questionnaire about working and living conditions and reported health symptoms and diseases. For seven consecutive days, actigraphy measurements were recorded, and the students also filled in a sleep diary. Sleepiness ratings were given six times per day, including upon waking and at bedtime, using the Karolinska Sleepiness Scale. Statistical analyses included three‐way ANOVA and t‐test. The mean sleep duration during weekdays was shorter among workers (7.2 h) than non‐workers (8.8 h) (t=4.34; p<.01). The mean duration of night awakenings was longer among workers on Tuesdays and Wednesdays (28.2 min) and shorter on Mondays (24.2 min) (t=2.57; p=.03). Among workers, mean napping duration was longer on Mondays and Tuesdays (89.9 min) (t=2.27; p=.03) but shorter on Fridays and Sundays (31.4 min) (t=3.13; p=.03). Sleep efficiency was lower on Fridays among non‐workers. Working students were moderately sleepier than non‐workers during the week and also during class on specific days: Mondays (13:00–15:00 h), Wednesdays (19:00–22:00 h), and Fridays (22:00–00:59 h). The study found that daytime sleepiness of workers is moderately higher in the evening. This might be due to a work effect, reducing the available time for sleep and shortening the sleep duration. Sleepiness and shorter sleep duration can have a negative impact on the quality of life and school development of high school students.

Explaining Sleep Duration in Adolescents: The Impact of Socio‐Demographic and Lifestyle Factors and Working Status

Previous studies found students who both work and attend school undergo a partial sleep deprivation that accumulates across the week. The aim of the present study was to obtain information using a questionnaire on a number of variables (e.g., socio‐demographics, lifestyle, work timing, and sleep‐wake habits) considered to impact on sleep duration of working (n=51) and non‐working (n=41) high‐school students aged 14–21 yrs old attending evening classes (19:00–22:30 h) at a public school in the city of São Paulo, Brazil. Data were collected for working days and days off. Multiple linear regression analyses were performed to assess the factors associated with sleep duration on weekdays and weekends. Work, sex, age, smoking, consumption of alcohol and caffeine, and physical activity were considered control variables. Significant predictors of sleep duration were: work (p < 0.01), daily work duration (8–10 h/day; p < 0.01), sex (p=0.04), age 18–21 yrs (0.01), smoking (p=0.02) and drinking habits (p=0.03), irregular physical exercise (p < 0.01), ease of falling asleep (p=0.04), and the sleep‐wake cycle variables of napping (p < 0.01), nocturnal awakenings (p < 0.01), and mid‐sleep regularity (p < 0.01). The results confirm the hypotheses that young students who work and attend school showed a reduction in night‐time sleep duration. Sleep deprivation across the week, particularly in students working 8–10 h/day, is manifested through a sleep rebound (i.e., extended sleep duration) on Saturdays. However, the different roles played by socio‐demographic and lifestyle variables have proven to be factors that intervene with nocturnal sleep duration. The variables related to the sleep‐wake cycle—naps and night awakenings—proved to be associated with a slight reduction in night‐time sleep, while regularity in sleep and wake‐up schedules was shown to be associated with more extended sleep duration, with a distinct expression along the week and the weekend. Having to attend school and work, coupled with other socio‐demographic and lifestyle factors, creates an unfavorable scenario for satisfactory sleep duration.

Efeitos do trabalho sobre a saúde de adolescentes

O estudo analisa consequencias do trabalho para as condicoes de vida, saude e desenvolvimento psicossocial de adolescentes. Participaram do estudo 354 estudantes de 14 a 18 anos, do ensino medio, periodo noturno. A analise das representacoes foi realizada a partir da coleta de evocacoes livres. Os dados sobre sono foram obtidos por meio de questionarios, sobre auto-percepcoes acerca das condicoes de vida e trabalho, sintomas de saude e doencas. A analise de dados foi realizada com o software EVOC 2000 e SPSS. Constataram-se diferencas significativas na duracao media de sono entre os adolescentes: os trabalhadores relataram menores medias de duracao de sono. Entre os trabalhadores, referiram dormir menos os que sentem sono no trabalho e nas aulas, tem maiores exigencias psicologicas no trabalho, ganham acima de 1 salario minimo mensal, jornadas acima de 6 horas diarias ou acima de 20 horas semanais, trabalham em local barulhento e com presenca de gases e vapores. As representacoes do trabalho entre os jovens apontam contradicao entre o seu reconhecimento como valor moral positivo para o desenvolvimento psicossocial e a construcao da identidade, e as consequencias negativas decorrentes da exposicao a cargas fisicas e psicologicas precocemente.

Occupational accidents among middle and high school students of the state of São Paulo, Brazil

OBJECTIVES To estimate the prevalence of occupational injuries and identify their risk factors among students in two municipalities. METHODS A cross-sectional survey was conducted in public schools of the municipalities of Santo Antonio do Pinhal and Monteiro Lobato, Brazil. A stratified probabilistic sample was drawn from public middle and high schools of the study municipalities. A total of 781 students aged 11 to 19 years participated in the study. Students attending middle and high school answered a comprehensive questionnaire on living and working conditions, as well as aspects of work injuries, and health conditions. Multiple logistic regression models were fitted to estimate risk factors of previous and present occupational injuries. RESULTS Of 781 students, 604 previously had or currently have jobs and 47% reported previous injuries. Among current workers (n=555), 38% reported injuries on their current job. Risk factors for work injuries with statistically significant odds ratio >2.0 included attending evening school, working as a housekeeper, waiter or brickmaker, and with potentially dangerous machines. CONCLUSIONS The study results reinforce the need of restricting adolescent work and support communities to implement social promotion programs.

Sleep Patterns of Day-Working, Evening High-Schooled Adolescents of São Paulo, Brazil

Children who grow up in developing countries of the world must work to help financially support their families, and they must also attend school. We investigated the impact of work on the sleep of working vs. nonworking high school students. Twenty-seven São Paulo, Brazil, public high school students (eight male and eight female working students plus six nonworking female and five nonworking male students) 14–18 yrs of age who attended school Monday–Friday between 19:00 to 22:30 h participated. A comprehensive questionnaire about work and living conditions, health status, and diseases and their symptoms was also answered. The activity level and rest pattern (sleep at night and napping during the day) were continuously assessed by wrist actigraphy (Ambulatory Monitoring, USA). The main variables were analyzed by a two-factor ANOVA with application of the Tukey HSD test for multiple comparisons, and the length of sleep during weekdays vs. weekends was compared by Student t-test. Working students went to sleep earlier weekends [F(1,23) = 6.1; p = 0.02] and woke up earlier work days than nonworking students [F(1,23) = 17.3; p = 0.001]. The length of nighttime sleep during weekdays was shorter among all the working [F(1,23) = 16.7; p < 0.001] than all the nonworking students. The sleep duration of boys was shorter than of girls during weekends [F(1,23) = 10.8; p < 0.001]. During weekdays, the duration of napping by working and nonworking male students was shorter than nonworking female students. During weekdays, working girls took the shortest naps [F(1,23) = 5.6; p = 0.03]. The most commonly reported sleep complaint during weekdays was difficulty waking up in the morning [F(1,23) = 6.5; p = 0.02]. During weekdays, the self-perceived sleep quality of working students was worse than nonworking students [F(1,23) = 6.2; p = 0.02]. The findings of this study show that work has negative effects on the sleep of adolescents, with the possible build-up of a chronic sleep debt with potential consequent impact on quality of life and school learning.

Percepção de sono: duração, qualidade e alerta em profissionais da área de enfermagem

This study was conducted among health care personnel (registered nurses and nurse aides) in a public hospital in São Paulo, Brazil. Work was organized in 12-hour daytime or nighttime shifts, followed by 36 hours off. The study aimed to evaluate how the nursing staff perceived the duration and quality of sleep both during and off work days, as well as their perception of alertness during working hours. There were significant differences between night and day in the duration of sleep (Student t test = 10.82; p < 0.000). Quality of daytime sleep after working night shifts was perceived as worse than nighttime sleep (Wilcoxon test, Z = 2.67; p < 0.007). Significant differences were detected in self-evaluation of alertness after the 2nd, 6th, and 10th hour of night shifts (Friedman = 63.0; p < 0.00). Alertness was perceived as worse during dawn hours. This is an indication of sleepiness at work and can have serious consequences for both health care workers and patients.

Teen at Work: The Burden of a Double Shift on Daily Activities

The purpose of this study was to the evaluate time spent by working and nonworking adolescents on daily activities (work, home duties, school, transportation, other activities, leisure, sleep, and naps). Twenty-seven students, 8 male workers, 8 female workers, 5 male nonworkers, and 6 female nonworkers, ages 14–18 yrs participated in the study. They attended evening classes Monday–Friday (19:00–22:30 h) in a public school in the city of São Paulo, Brazil. The students answered a comprehensive questionnaire on the characterization of their life, work, and health conditions. Simultaneously, they wore actigraphs (Ambulatory Monitoring, Inc.) and completed a diary of their daily activities (time spent at work, on home duties, commuting, leisure, other activities) for a minimum of 10 to a maximum of 17 consecutive days. The means of the variables were tested for differences by a two-factor (work and sex) ANOVA and Student-t test applied to pair-wise samples (weekdays and weekends). The average duration during weekdays of working time was 7 h 09 min and home duties 0 h 48 min. As for commuting time, there was a work effect [F(1,23) = 4.9; p = 0.04]; mean commuting time was 2 h 22 min for workers (males and females) and 1 h 25 min for nonworkers. There was a significant difference between workers and nonworkers [F(1,23) = 4.6; p = 0.04] regarding extra-cirricular class activities; workers spent a mean of 3 min/day on them as opposed to 1 h 14 min by nonworkers. The average daily time spent on leisure activities by workers was 6 h 31 min; whereas, for nonworkers it was 7 h 38 min. Time spent in school amounted to 2 h 47 min for workers in comparison to 3 h 22 min by nonworkers. There was a significant work effect upon sleep [F(1,23) = 10.0; p < 0.01]. The work effect upon nighttime sleep duration was significant [F(1,23) = 16.7; p < 0.01]. Male workers showed a mean night sleep of 6 h 57 min and female workers 07 h 15 min. The average nighttime sleep duration for nonworkers was 9 h 06 min. There was a significant interactive effect between work and sex [F(1,23) = 5.6; p = 0.03] for naps. Female workers showed took shortest nap on average (36 min; SD = 26 min), and female nonworkers the longest naps (1 h 45 min; SD = 35 min). Study and employment exert significant impact on the life and activities of high school students. Work affects sleep and nap duration plus the amount of time spent in school and other extra-curricular activities.