Because poor sleep quality can reduce quality of life and increase prevalence of illness in workers, interventions are becoming increasingly important for businesses. To evaluate how sleep quality is affected by one-on-one behavioral modification when combined with group education, we conducted a randomized, controlled trial among day-shift white-collar employees working for an information-technology service company in Japan. Participants were randomly allocated to groups receiving either sleep hygiene group education (control group), or education combined with individual sleep modification training (one-on-one group). Occupational health professionals carried out both procedures, and sleep quality was assessed using the Pittsburgh Sleep Quality index (PSQi). PSQi scores were obtained before and after the intervention period, and changes in scores were compared across groups after adjustments for age, gender, job title, smoking and drinking habits, body-mass index, and mental health as assessed using k6 scores. The average PSQi score for the control group decreased by 0.8, whereas that of the one-on-one group decreased by 1.8 (difference of 1), resulting in a significantly greater decrease in score for the one-on-one group (95% confidence interval: 0.02 to 2.0). These results show that, compared to sleep hygiene group education alone, the addition of individual behavioral training significantly improved the sleep quality of workers after only three months.
To evaluate the effects of a combined sleep hygiene education and behavioral approach program on sleep quality in workers with insomnia, we conducted a randomized controlled trial at a design engineering unit in Japan. Employees evaluated for insomnia by the Athens Insomnia Scale (≥6 points) were divided into an intervention and control group. The intervention group received a short-term intervention (30 min) program that included sleep hygiene education and behavioral approaches (relaxation training, stimulus control, and sleep restriction) performed by occupational health professionals. We calculated differences in change in Pittsburgh Sleep Quality Index (PSQI) scores between the two groups from baseline to three months after the start of intervention after adjusting for gender, age, job title, job category, average number of hours of overtime during the study period, marital status, smoking habit, average number of days of alcohol consumption per week, exercise habits, K6 score, and baseline PSQI score. Results showed that the average PSQI score decreased by 1.0 in the intervention group but increased by 0.9 in the control group. Additionally, the difference in variation between the two groups was 1.9 (95% confidence interval: 0.6 to 3.4), which was significant. Taken together, these results indicate that the intervention program significantly improved the sleep quality of workers with insomnia.
Methods:We conducted a randomized crossover study involving registered nurses at a teaching hospital working a two-shift system including the night shift. Participants were instructed to expose themselves to BL for 10 min on workday mornings. Results: A total of 61 participants were enrolled in the present study. Thirty-one participants received BL exposure in the first month, and the other 30 received it in the second month. Significant improvements were noted in the BL periods compared with the non-BL periods for self-assessed sleepiness at 10:00 on day-shift days evaluated using the Karolinska Sleepiness Scale, self-assessment of night sleep for day-shift days using the Visual Analogue Scale and for fatigue assessed using the Checklist Individual Strength Questionnaire. The estimated mean difference for each scale (95% confidence interval) was -0.55 (-0.91, -0.20), 0.37 (0.04, 0.70) and -2.13 (-3.78, -0.48), respectively. Mean response time evaluated using the psychomotor vigilance task test (PVT) showed significant improvement in the BL periods compared with the non-BL periods. No statistically significant differences were observed for sleepiness at 14:00, depression, number of PVT lapses or frequency of perceived adverse events and near misses. Conclusion: Our findings suggest that brief BL exposure on mornings preceding a day shift is effective in improving sleepiness and performance during day-shift work, subjective nighttime sleep on day-shift days, and perceived fatigue for the preceding two weeks in rapidly rotating shift nurses. (J Occup Health 2011; 53: 258-266)
Near miss-based analysis has been recently suggested to be more important in the medical field than focusing on adverse events, as in the industrial field. To validate the utility of near miss-based analysis in the medical fields, we investigated whether or not predictors of near misses and adverse events were similar among nurses at teaching hospitals. Of the 1,860 nurses approached, 1,737 (93.4%) were included in the final analysis. Potential predictors provided for analysis included gender, age, years of nursing experience, frequency of alcohol consumption, work place, ward rotation, frequency of night shifts, sleepiness during work, frequency of feeling unskilled, nurses' job stressors, working conditions, and depression. Variables for multivariate analysis were determined by bivariable analysis. Ordinal logistic analysis showed that predictors of near misses and adverse events were markedly similar. Parameters that were significantly related to both near misses and adverse events were years of experience, frequency of night shifts, internal ward, and time pressure (p<0.05 for all). The present study suggested that there was a negligible difference between choosing near miss-or adverse eventbased analysis when identifying possible causes of adverse events in the medical field.
There have been few studies focusing on the creatine phosphokinase (CPK) elevations in chronic psychiatric patients. The survey was conducted prospectively to investigate the incidence and risk factors of CPK elevations in chronic psychiatric patients during a 2-year follow-up period. Sixteen of 32 (50%) patients had maximums of more than 230 U/l (upper limit of our normal range) and 7 (22%) patients had maximums of more than 500 U/l. Surprisingly, 4 (13%) patients had maximums of more than 1,000 U/l after exercises such as swimming and walking. Nonetheless, none of the 16 patients with the CPK elevations developed severe conditions such as rhabdomyolysis despite an absence of therapeutic intervention, and their CPK elevations were proven to be benign. According to the path analysis, usual physical activity and neuroleptic doses seemed to underlie CPK elevations directly. The present findings suggest that not a few chronic psychiatric inpatients may have at least one CPK elevation per 2 years. Patients engaging in more physical activity or receiving higher neuroleptic doses are at greater risk of developing such CPK elevations. However, most of these increases are benign, and it is not considered necessary to treat them.
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