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The following lecture has been approved for
University Undergraduate Students
This lecture may contain information, ideas, concepts and discursive anecdotes that may be thought provoking and challenging
It is not intended for the content or delivery to cause offence
Any issues raised in the lecture may require the viewer to engage in further thought, insight, reflection or critical evaluation
ShiftworkingShiftworking
Working HoursWorking HoursShiftworkShiftwork
Human Behaviour Human Behaviour Biopsychosocial modelBiopsychosocial model
Mental DistressMental Distress
Dr. Craig JacksonDr. Craig JacksonSenior Lecturer in Health PsychologySenior Lecturer in Health Psychology
BCUBCU
““Peoples’ health should be Peoples’ health should be no worse at the end of a no worse at the end of a working day than it was at the working day than it was at the start”start”
M.J. Harrington M.J. Harrington (1997)(1997)
““People who work sitting People who work sitting down get paid more than down get paid more than people who work standing people who work standing up”up”
Ogden Nash Ogden Nash (1902 - 1971)(1902 - 1971)
Core Occupational Diseases (EU)Core Occupational Diseases (EU)
ChemicalChemical ChemicalChemical BiologicalBiological PhysicalPhysical PhysicalPhysicalInorganicInorganic OrganicOrganic DustsDusts OthersOthers
CadmiumCadmium CSCS55 ZoonosesZoonoses AsbestosAsbestos RadiationRadiation
ChromiumChromium BenzeneBenzene HepatitisHepatitis Silica(te)Silica(te) NIHLNIHL
MercuryMercury ChlorineChlorine TBTB MesotheliomaMesothelioma
CataractCataract
ManganeseManganese AromaticsAromatics VibrationVibration
NickelNickel P.aromaticsP.aromatics
DermatitisDermatitis
LeadLead IsocyanatesIsocyanates
2121stst Century Workplaces Century Workplaces
• Global companies and operationsGlobal companies and operations
• Leaner & Meaner managersLeaner & Meaner managers
• Gender issuesGender issues
• Disability issuesDisability issues
• Migrant issuesMigrant issues
• Longer & less fixed working hoursLonger & less fixed working hours
• Shorter contractsShorter contracts
• Dirty jobs out-sourced Dirty jobs out-sourced
Regulation of working hoursRegulation of working hours
1800 – 19001800 – 190012 hour days & 6 day weeks12 hour days & 6 day weeks
Thomas Paine 1737 - 1809Thomas Paine 1737 - 1809Age of ReasonAge of ReasonRights of ManRights of Man
Annie Besant 1847 – 1933Annie Besant 1847 – 1933Reformist movementReformist movementFabian SocietyFabian SocietySecular SocietySecular Society
““Fruits of philosophy”Fruits of philosophy” “The Link”“The Link” “White slavery in London”“White slavery in London”1889 1889
Humanitarian concerns influenced changeHumanitarian concerns influenced change
48 hour week + regular rest = increased productivity48 hour week + regular rest = increased productivity
Regulation of working hoursRegulation of working hours
1900 – 19701900 – 1970progressive reduction in working hoursprogressive reduction in working hours
traditional work patternstraditional work patterns
1970 1970 working hours increaseworking hours increase
shiftwork increasesshiftwork increasesirregular hours increaseirregular hours increase
24 hour processing24 hour processingtechnologytechnology
unpaid extended hoursunpaid extended hoursflexible workingflexible working
annualised hoursannualised hours
Regulation of working hoursRegulation of working hours
Linear Assumption of workers and productivityLinear Assumption of workers and productivity
timetime
un
its
un
its
assumptionassumption realityreality
un
its
un
its
timetime
Pieter Bruegel 1563Pieter Bruegel 1563
Wembley StadiumWembley Stadium326.5 Million pounds – Multiplex 2002326.5 Million pounds – Multiplex 2002
730730 Million poundsMillion pounds
British LibraryBritish Library32 Million pounds – estimate32 Million pounds – estimate
511 Million pounds – 10 yrs late511 Million pounds – 10 yrs late
Scottish AssemblyScottish Assembly37 Million pounds – estimate37 Million pounds – estimate
431 Million Pounds – 3 yrs late431 Million Pounds – 3 yrs late
PaddyPower .comPaddyPower .com
FatigueFatigue StressStress
@#
Pilot FatiguePilot Fatigue
““NNodding off”odding off”
Uncontrolled spontaneous episodes of sleepUncontrolled spontaneous episodes of sleep
Can last seconds or minutesCan last seconds or minutes
Disengages from reality and becomes unresponsiveDisengages from reality and becomes unresponsive
Fail to respond to outside informationFail to respond to outside information
Aircraft cruising at 450 knots on glide path can travel nearly Aircraft cruising at 450 knots on glide path can travel nearly 730 feet during a one-second lapse.730 feet during a one-second lapse.
123 feet
Near Misses and HitsNear Misses and Hits
Regulation of working hoursRegulation of working hours
Environmental effects upon PerformanceEnvironmental effects upon Performance
Disturbed concentrationDisturbed concentration
Impaired memoryImpaired memory
Impaired decision makingImpaired decision making
Mood changesMood changes
Sleep disturbanceSleep disturbance
Increased risk takingIncreased risk taking
Paying Attention!Paying Attention!
Coping with Extreme HoursCoping with Extreme Hours
European directive on working timeEuropean directive on working time
Organisation of workOrganisation of work
Min. daily rest period of 11 consecutive hours per 24 hoursMin. daily rest period of 11 consecutive hours per 24 hours
1 rest break where working day > 6 hours1 rest break where working day > 6 hours
Min. uninterrupted rest period of 35 hours per 7 day periodMin. uninterrupted rest period of 35 hours per 7 day period
Max. of 48 work per weekMax. of 48 work per week
Min. 4 weeks paid annual leaveMin. 4 weeks paid annual leave
European directive on working timeEuropean directive on working time
Night workNight work
Mean 8 hours work in any 24 hour periodMean 8 hours work in any 24 hour period
Free health assessment before assignment and at regular intervalsFree health assessment before assignment and at regular intervals
Transfer to day work when suffering health problems connected Transfer to day work when suffering health problems connected
with night workwith night work
Night work and shiftsNight work and shifts
Protection appropriate to the nature of the night workProtection appropriate to the nature of the night work
Prevention and protection services on parity with day workersPrevention and protection services on parity with day workers
Take account of principles adapting work to the workersTake account of principles adapting work to the workers
DerogationsDerogations
Certain jobsCertain jobsjunior docsjunior docs
Certain industriesCertain industriespresspressmediamedia
utility provisionutility provision
CircumstancesCircumstanceswhere rests are not practicablewhere rests are not practicable
Does not apply to: Does not apply to: health checks health checks provision of health and safety facilitiesprovision of health and safety facilities
Nearly 900 extra consultants will be needed by 2010 Nearly 900 extra consultants will be needed by 2010 compensate for a reduction in doctors’ hours due to EWTDcompensate for a reduction in doctors’ hours due to EWTDBMJBMJ 2002;325:855 2002;325:855
ShiftworkShiftwork
Any work regularly undertaken outside “normal” working hoursAny work regularly undertaken outside “normal” working hoursNormal working hours = 07:00 – 18:00Normal working hours = 07:00 – 18:00
NightsNightsEarly amEarly amEveningEvening
FixedFixedRotatingRotating
Eight hourEight hourTwelve hourTwelve hour
EffectsEffectsCircadian disruptionCircadian disruption
Sleep lossSleep lossFatigueFatigue
Social disruptionSocial disruption
Circadian RhythmsCircadian Rhythms
Body TempBody Temp
PulsePulse
Urinary excretionUrinary excretion
Blood pressureBlood pressure
Hormonal changesHormonal changes
Mental PerformanceMental Performance
Physical PerformancePhysical Performance
Physiologically determinedPhysiologically determined
Socially modified & Externally cuedSocially modified & Externally cued
Circadian RhythmsCircadian Rhythms
Adjustment to shiftworkingAdjustment to shiftworking
Aprrox. 7 days to adjust to shiftAprrox. 7 days to adjust to shift
External cues hamper adjustmentExternal cues hamper adjustment
Nightworking sometimes never achieves adjustmentNightworking sometimes never achieves adjustment
Slow rotating shiftsSlow rotating shifts partial adjustmentpartial adjustmentcontinual adjustmentcontinual adjustmentcontinual disrhythmia statecontinual disrhythmia state
Rapid rotating shiftsRapid rotating shifts no adjustmentno adjustment
Adjustment to shiftworkingAdjustment to shiftworking
stress strain organisational effects
Phase-shifting of waking and sleeping hours
Impaired performanceImpaired healthDisturbed relationships
> Absenteeism> Accidents> Labour turnover< Productivitymodifying
factors
Individual characteristicsJob-related factorsEnvironmentDomestic
Colquhoun & Rutenfranz 1980Colquhoun & Rutenfranz 1980
Cardiovascular problems associated with shiftwork Cardiovascular problems associated with shiftwork
Increased Ischemic Heart Disease (IHD)Increased Ischemic Heart Disease (IHD)Knutsson Knutsson et al. et al. 1986, 19881986, 1988
Increased risk of IHD and Myocardial Infarction (MI)Increased risk of IHD and Myocardial Infarction (MI)Akerstedt Akerstedt et al. et al. 19861986
Increased risk of Coronary V related disorders – Permanent NightworkersIncreased risk of Coronary V related disorders – Permanent NightworkersTeiger 1984Teiger 1984
Some studies show NO increased riskSome studies show NO increased riskBursey 1990Bursey 1990Chan Chan et al. et al. 1987, 19931987, 1993KobayashiKobayashi et al. et al. 1992 1992
Cardiovascular problems of shiftwork Cardiovascular problems of shiftwork
Liu & Tanaka 2002 – Japanese working men studyLiu & Tanaka 2002 – Japanese working men study260 cases260 cases 445 controls445 controlsWorking Hours, Sleeping Hours and Acute MIWorking Hours, Sleeping Hours and Acute MI
Working hours related to:Working hours related to:
increased risk in year prior to AMIincreased risk in year prior to AMI
increased risk in month prior to AMIincreased risk in month prior to AMI
x2 increase in risk for overtime (>61 hours)x2 increase in risk for overtime (>61 hours)
x2-3 increase in risk for <5 hours sleepx2-3 increase in risk for <5 hours sleep
x2-3 increase for lack of sleep (2 or more days with <5 hours sleep)x2-3 increase for lack of sleep (2 or more days with <5 hours sleep)
lack of sleep & few days off in lack of sleep & few days off in recent pastrecent past show > odds than those in past show > odds than those in past
Overtime work and lack of sleep may be related to AMIOvertime work and lack of sleep may be related to AMI
Gastrointestinal disorders and shiftworkGastrointestinal disorders and shiftwork
IndigestionIndigestion (Chan (Chan et al.et al. 1987) 1987)(Poole (Poole et al.et al. 1992) 1992)
RefluxReflux
Peptic UlcerationPeptic Ulceration (Waterhouse (Waterhouse et al.et al. 1992) 1992)
Related to:Related to:
irregular hoursirregular hours
circadian dysrhythmiacircadian dysrhythmia
poor catering facilitiespoor catering facilities
inequality in GP accessinequality in GP access
Gastrointestinal disorders and shiftworkGastrointestinal disorders and shiftwork
Irritable Bowel Syndrome (IBS)Irritable Bowel Syndrome (IBS)13-52% new referrals to GI (Walker 13-52% new referrals to GI (Walker et al. et al. 1990)1990)
Some occupations have > G.I than others (Cucino & Sonnenburg, 2001)Some occupations have > G.I than others (Cucino & Sonnenburg, 2001)IBD < in manual workers and farmers IBD < in manual workers and farmers IBD > in sedentary workersIBD > in sedentary workers
Assoc. with occupation difficult to proveAssoc. with occupation difficult to prove• shift workers seen as greatest risk of IBSshift workers seen as greatest risk of IBS• especially nightworkersespecially nightworkers• night workers present in GI more than day workersnight workers present in GI more than day workers
Access / Availability reasons ?Access / Availability reasons ?genuine aspects ?genuine aspects ?
Research fails to answer: Research fails to answer: psychosocial aspects of workers ?psychosocial aspects of workers ?
effects of shiftwork lifestyle ?effects of shiftwork lifestyle ?
Mental health problems and shiftwork Mental health problems and shiftwork
Increased stressIncreased stress
Alcohol consumptionAlcohol consumption
NeuroticismNeuroticism
Review by Cole Review by Cole et al.et al. 1990 OM 1990 OM
Sources of performance impairment
Day sleepersDay sleepers
Endogenous factorsEndogenous factors Exogenous factorsExogenous factorsCortisol >Cortisol > DaylightDaylightTemp. >Temp. > Noise Noise
Societal biasSocietal bias
Night wakersNight wakers
Endogenous factorsEndogenous factors Exogenous factorsExogenous factorsMelatonin >Melatonin > DarknessDarknessTemp. <Temp. < Societal biasSocietal bias
Current evidenceCurrent evidence
Performance impairments more likely:Performance impairments more likely:
on nightshift on nightshift vs.vs. morning or eveningmorning or evening
on advancing shiftson advancing shifts vs.vs. delaying shiftsdelaying shifts
on rapid rotating shiftson rapid rotating shifts vs.vs. slower rotationslower rotation
on irregular shiftson irregular shifts vs. vs. regular shiftsregular shifts
at changeover periodsat changeover periods
in older shiftworkersin older shiftworkers
where work is stressfulwhere work is stressful
Inconsistencies:Inconsistencies:
12 hour shifts12 hour shifts
SexSex
Performance effects – methodological considerationsPerformance effects – methodological considerations
TaskTask monotonymonotonycognitive skillscognitive skills
MeasuresMeasures speedspeedaccuracyaccuracyefficiencyefficiency
Individual aspectsIndividual aspects motivationmotivationperceived importanceperceived importanceageageabilityabilityhealthhealthactivityactivity
Situation / contextSituation / context supervisionsupervisionmoralemoraledistractionsdistractions
12 hour shifts12 hour shifts
Williamson et al. 1994Williamson et al. 1994 8hr vs. 12hr rotating8hr vs. 12hr rotating psych health improvedpsych health improvedAustraliaAustralia computer operators computer operators reduced tirednessreduced tiredness
Duchon et al. 1994Duchon et al. 1994 8hr vs. 12hr rotating8hr vs. 12hr rotating improved sleepimproved sleepCanadaCanada minersminers improved performanceimproved performance
Chan & GanChan & Gan 8hr vs. 12hr rotating8hr vs. 12hr rotating no health differencesno health differencesSingaporeSingapore electronic workerselectronic workers some headachessome headaches
Groups prone to negative effectsGroups prone to negative effects
Over 50’sOver 50’s
Morning typesMorning types
Long sleepersLong sleepers
Personality typesPersonality types
Heavy domestic commitmentsHeavy domestic commitments
Multiple jobsMultiple jobs
Some physical conditionsSome physical conditions
Psychiatric problemsPsychiatric problems
Employee Selection Issues ? Employee Selection Issues ?
Pre-employment counselling ?Pre-employment counselling ?
Standard Shiftwork Index (SSI) Barton et al. 1995Standard Shiftwork Index (SSI) Barton et al. 1995
QuestionnairesQuestionnaires
Work Context + Shift SystemWork Context + Shift System
Health Health
Well-beingWell-being
Individual DifferencesIndividual Differences
Normative DataNormative Data
Training & EducationTraining & Education
health effectshealth effects
performanceperformance
safetysafety
quality of lifequality of life
information & awarenessinformation & awareness
coping methods educationcoping methods education
lifestyle changes infolifestyle changes info
Survey current work scheduleSurvey current work schedule
Analyse dataAnalyse data
Identify problem area(s)Identify problem area(s)
Recommend schedule changesRecommend schedule changes
Shiftworker educationShiftworker education
Asses & reviewAsses & review
Intervention strategiesIntervention strategies
OrganisationOrganisationSlow / fast rotation (task considerations)Slow / fast rotation (task considerations)Start timesStart timesRest breaksRest breaksExpert systemsExpert systems
Environmental ModificationEnvironmental ModificationBright lightsBright lightsMood lightsMood lightsTemp. compensationTemp. compensationWorkloadWorkloadFacilitiesFacilities
Individual AdjustmentIndividual AdjustmentPharmacological helpPharmacological helpBehaviouralBehavioural sleep management, diet,sleep management, diet, exercise, counselling exercise, counselling
Evaluate processEvaluate processEvaluate outcomeEvaluate outcome
Health SurveillanceHealth Surveillance
Do what?Do what?How often?How often?
Overtime workingOvertime working
Extension of normal workdayExtension of normal workday
Extension beyond 8 hours (08:00 / 09:00 - 16:00 / 17:00)Extension beyond 8 hours (08:00 / 09:00 - 16:00 / 17:00)
Non-paid is still overtimeNon-paid is still overtime
Increasing in UKIncreasing in UKespecially managerial & professional groupsespecially managerial & professional groups
1990 UK had twice as many more employees on >48 hrs than any other EU 1990 UK had twice as many more employees on >48 hrs than any other EU countriescountries
More common in malesMore common in males
Overtime working Overtime working
Percentage of European employees working <16 hrs per week, and > 48 hrs Percentage of European employees working <16 hrs per week, and > 48 hrs per week, 1990per week, 1990
If graph was males only?If graph was males only?
Employers >40hrs per week as % of labour force, 1996 Employers >40hrs per week as % of labour force, 1996
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Potential effectsPotential effects
StressStress
FatigueFatigue
ExposureExposure
cardiovascularcardiovascular
mental healthmental health
immune systemimmune system
gastrointestinalgastrointestinal
musculoskeletalmusculoskeletal
social effectssocial effects
performance impairmentperformance impairment
safety problemssafety problems
over-exposureover-exposure
Cardiovascular disorders and overtimeCardiovascular disorders and overtime
Increased RiskIncreased Risk
> 60hrs> 60hrs
> 48hrs> 48hrs
Night school studentsNight school students
50 – 60 hrs50 – 60 hrs
Overtime (females only)Overtime (females only)
No increased RiskNo increased Risk
>10 hrs overtime / week>10 hrs overtime / week
““Overtime”Overtime” BP & Serum Chol.BP & Serum Chol.
KaroshiKaroshi Range of CVIs 65%> if 60hrs / wkRange of CVIs 65%> if 60hrs / wk
XXStress (SACL)Stress (SACL)5050ACADEMICSACADEMICS19961996
Stress (OSI)Stress (OSI)??CLERICAL STAFFCLERICAL STAFF
(USA/JAPAN)(USA/JAPAN)1991 - 1991 - 19951995
Stress (OSI)Stress (OSI)? 50 - ? 50 - 5555
MANAGERIAL STAFF MANAGERIAL STAFF (USA/JAPAN)(USA/JAPAN)
1991 - 1991 - 19951995
Psychiatric Psychiatric Status (GHQ)Status (GHQ)
??ACCOUNTANT (UK)ACCOUNTANT (UK)19951995
Psychiatric Psychiatric State (GHQ)State (GHQ)
??FACTORY WORKERS FACTORY WORKERS (JAPAN)(JAPAN)
19941994
Exhaustion/ Exhaustion/ InsomniaInsomnia
32-1932-19FEMALE HOSPITAL FEMALE HOSPITAL STAFF (USA)STAFF (USA)
19921992
Stimulant Stimulant
use/ Sleep use/ Sleep disturbancedisturbance
30-7030-70COACH DRIVERSCOACH DRIVERS
(AUSTRALIA)(AUSTRALIA)
19911991
Psychiatric Psychiatric Status (Crown Status (Crown Crisp)Crisp)
??BUS DRIVERS (UK)BUS DRIVERS (UK)19901990
XXBurnoutBurnout< 50< 50MUSIC THERAPISTS MUSIC THERAPISTS (USA)(USA)
19871987
SmokingSmoking> 8 > 8 hrs/ hrs/ dayday
KIBBUTZIMKIBBUTZIM
(ISRAEL)(ISRAEL)
19851985
No. of No. of symptomssymptoms
??SITES WITH MASS SITES WITH MASS PSYCHOGENIC PSYCHOGENIC ILLNESS (USA)ILLNESS (USA)
19801980
Mental HealthMental Health
Health & Well-being:Health & Well-being:Methodological IssuesMethodological Issues
Mostly Cross-sectional studiesMostly Cross-sectional studies
Direction of any association ?Direction of any association ?LagLagHealthy worker / Survivor EffectsHealthy worker / Survivor Effects
Response RatesResponse Rates
Control GroupsControl Groups
Exposure AssessmentExposure Assessment
Outcome MeasuresOutcome Measures
Performance Effects:Performance Effects:AccidentsAccidents
General Data Analyses suggests:General Data Analyses suggests:
Rise in accident rates after 9hrs workRise in accident rates after 9hrs work
Cognitive (simulation) studies suggests errors increase after 8 hrs workCognitive (simulation) studies suggests errors increase after 8 hrs work
HOWEVERHOWEVER
Shift change from 8 to 12 hrsShift change from 8 to 12 hrsSafety record stays sameSafety record stays same
Attitudes ?Attitudes ?Safety culture increased ?Safety culture increased ?Schedule org ?Schedule org ?Nature of work ?Nature of work ?
Existing Gaps in ResearchExisting Gaps in Research
Irregular HoursIrregular Hours
Increased concomitant exposure to other hazardsIncreased concomitant exposure to other hazards
Reproductive effectsReproductive effects
Family / Social influencesFamily / Social influences
Behavioural EffectsBehavioural Effects
Effect ModifiersEffect Modifiers
Intervention proceduresIntervention procedures
Further ReadingFurther Reading
Cooper, C.L., and Sutherland, V.J: Cooper, C.L., and Sutherland, V.J: Job Stress, Mental Health and Accidents Job Stress, Mental Health and Accidents among Offshore Workers in Oil and Gas extraction Industries.among Offshore Workers in Oil and Gas extraction Industries. Journal of Journal of Occupational Medicine (1987) 29.Occupational Medicine (1987) 29.
Gann, M., Corpe, U., and Wilson, I. (1990) Gann, M., Corpe, U., and Wilson, I. (1990) The Application of a Short Anxiety The Application of a Short Anxiety and Depression Questionnaire to Oil Industry Staff.and Depression Questionnaire to Oil Industry Staff. Journal of the Society of Journal of the Society of Occupational Medicine 40:Occupational Medicine 40:
Glazner, L.K. Glazner, L.K. Shift Work and its effects on fire fighters and nurses.Shift Work and its effects on fire fighters and nurses. Occupational Health & Safety, July 1992Occupational Health & Safety, July 1992
Hanecke, K., Tiedemann, S., Nachreiner, F., and Grzech-Sukalo, H: Hanecke, K., Tiedemann, S., Nachreiner, F., and Grzech-Sukalo, H: Accident Accident risk as a function of hour at work and time of day as determined from accident risk as a function of hour at work and time of day as determined from accident data and exposure models for the German working population.data and exposure models for the German working population. Scandinavian Scandinavian Journal of Work, Environment and Health (1998) 24(3).Journal of Work, Environment and Health (1998) 24(3).
Further ReadingFurther Reading
Harrington, J.M., Harrington, J.M., Shiftwork and health: a critical review of the literature.Shiftwork and health: a critical review of the literature. London, The Stationary Office, 1978.London, The Stationary Office, 1978.
Harrington, JM. (2001) Harrington, JM. (2001) Health effects of shift work and extended hours of work.Health effects of shift work and extended hours of work.Occup Environ Med 58: 68-72.Occup Environ Med 58: 68-72.
Jackson,C.A. (2002) Jackson,C.A. (2002) Working hours Working hours and shifts and shifts in the petrochemical and gas in the petrochemical and gas industries: a review.industries: a review. Croner’s Occupational Hygiene 34: 13-17. Croner’s Occupational Hygiene 34: 13-17.
Jackson,C.A., Spurgeon,A. and DeJong.G Jackson,C.A., Spurgeon,A. and DeJong.G Mental Health of expatriate oil Mental Health of expatriate oil workers on extended twelve hour shifts in a desert-based oil field.workers on extended twelve hour shifts in a desert-based oil field. Society of Society of Petroleum Engineers. SPE 61016.Petroleum Engineers. SPE 61016.
Lees, R., and Laundry, B.R. Lees, R., and Laundry, B.R. Comparison of reported workplace morbidity in 8-Comparison of reported workplace morbidity in 8-hour and 12-hour shifts in one plant.hour and 12-hour shifts in one plant. Journal of the Society of Occupational Journal of the Society of Occupational Medicine (1989) 39.Medicine (1989) 39.
Further ReadingFurther Reading
Lodden, T., Lodden, T., The Effect on the Health and Safety of Older Offshore Personnel - The Effect on the Health and Safety of Older Offshore Personnel - Long Shifts and Working Night Shift.Long Shifts and Working Night Shift. Society of Petroleum Engineers. SPE Society of Petroleum Engineers. SPE 60996.60996.
Parkes, K.R.: Parkes, K.R.: Sleep patterns, Shift work, and Individual Differences: A Sleep patterns, Shift work, and Individual Differences: A Comparison of Onshore and Offshore Control-Room OperatorsComparison of Onshore and Offshore Control-Room Operators. Ergonomics . Ergonomics (1994) 37(5).(1994) 37(5).
Rosa, R.R: Rosa, R.R: Performance, alertness, and sleep after 3.5 years of 12 hour shifts: Performance, alertness, and sleep after 3.5 years of 12 hour shifts: a follow-up studya follow-up study. Work and Stress (1991) 5(2).. Work and Stress (1991) 5(2).
Spurgeon A, Harrington JM, Cooper CL. (1997) Spurgeon A, Harrington JM, Cooper CL. (1997) Health and safety problems Health and safety problems associated with long working hours: a review of the current position.associated with long working hours: a review of the current position. Occup Occup Environ MedEnviron Med; 54:367-375.; 54:367-375.