Puttonen S, Härmä M, Hublin C. Shift work and cardiovascular disease -pathways from circadian stress to morbidity. Scand J Work Environ Health. 2010;36(2):96-108.In order to establish a causal relation between shift work and cardiovascular disease (CVD), we need to verify the pathways from the former to the latter. This paper aims to review the current knowledge of the mechanisms between shift work and CVD. Shift work can increase the risk of CVD by several interrelated psychosocial, behavioral, and physiological mechanisms. The psychosocial mechanisms relate to difficulties in controlling working hours, decreased work-life balance, and poor recovery following work. The most probable behavioral changes are weight gain and smoking. The plausible physiological and biological mechanisms are related to the activation of the autonomic nervous system, inflammation, changed lipid and glucose metabolism, and related changes in the risk for atherosclerosis, metabolic syndrome, and type II diabetes. The data provide evidence for possible disease mechanisms between shift work and CVD, but compelling evidence on any specific mechanism is missing.

The authors examined emotional valence- and arousal-related phasic psychophysiological responses to different violent events in the first-person shooter video game "James Bond 007: NightFire" among 36 young adults. Event-related changes in zygomaticus major, corrugator supercilii, and orbicularis oculi electromyographic (EMG) activity and skin conductance level (SCL) were recorded, and the participants rated their emotions and the trait psychoticism based on the Psychoticism dimension of the Eysenck Personality Questionnaire--Revised, Short Form. Wounding and killing the opponent elicited an increase in SCL and a decrease in zygomatic and orbicularis oculi EMG activity. The decrease in zygomatic and orbicularis oculi activity was less pronounced among high Psychoticism scorers compared with low Psychoticism scorers. The wounding and death of the player's own character (James Bond) elicited an increase in SCL and zygomatic and orbicularis oculi EMG activity and a decrease in corrugator activity. Instead of joy resulting from victory and success, wounding and killing the opponent may elicit high-arousal negative affect (anxiety), with high Psychoticism scorers experiencing less anxiety than low Psychoticism scorers. Although counterintuitive, the wounding and death of the player's own character may increase some aspect of positive emotion.

The developed method and algorithms allow a detailed characterization of four main dimensions of working time patterns potentially relevant for health. We recommend this method for future large-scale epidemiological studies.

Background Electronic health records (EHRs) are an elementary part of the work of registered nurses (RNs) in healthcare. RNs are the largest group of healthcare workers, and their experiences with EHRs and their informatics competence play a crucial role in a fluent workflow. The present study examined EHR usability factors and nurses’ informatics competence factors related to self-reported time pressure and psychological distress. Methods A nationwide survey was conducted for working-age registered nurses in 2017. The study sample included 3607 nurses (5% men) in Finland. The association of age, sex, employment sector, EHR usability factors, and nurses’ informatics competence factors with time pressure and psychological distress were examined with analyses of covariance. Results The EHR usability factors that were associated with high time pressure were low EHR reliability and poor user-friendliness. Regarding the nurses’ informatics competence factors, only low e-Care competence was associated with time pressure. Of the EHR usability factors, low EHR reliability and low support for cooperation were associated with high psychological distress. Of the nurses’ informatics competence factors, low e-Care competence was associated with high psychological distress. Conclusions Unreliability and poor user-friendliness of EHRs seem to be prominent sources of time pressure and psychological distress among registered nurses. User-friendly EHR systems and digital tools in healthcare are needed. Nurses’ competence to use eHealth tools to tailor patient care should be strengthened through organizational and regional actions. For example, house rules about how to use eHealth tools and instructions on common practices in cooperation with other organizations could be useful.

Shiftwork is associated with an increased risk of cardiovascular diseases, but the possible role of inflammation in this relationship is not well known. We tested the hypothesis that shiftwork would be associated with higher levels of C-reactive protein (CRP) and increased leukocyte count. We analyzed the cross-sectional associations between work arrangements and low-grade inflammation in 1877 airline-company employees separately for men (n = 1037) and women (n = 840). The participants were classified into five categories according to their work schedule: day workers who have not worked in shifts (referent group), former shiftworkers, 2-shift workers, 3-shift workers, and in-flight workers. In models adjusted for age and recent infectious diseases, CRP levels were higher among male 3-shift workers (p = .002) and marginally higher in male 2-shift workers (p = .076). In addition, leukocyte count was higher in 2-shift (p = .005) and 3-shift (p = .021) working men. In women, CRP level was higher in 2-shift workers (p = .028), whereas leukocyte count was lower in flight workers (p = .005). Any separate adjustment additionally for smoking, education, alcohol consumption, physical activity, and obesity did not substantially affect the results of 2- and 3-shift work. In the fully adjusted model, only the association between 3-shift work and CRP in men (p = .021) and 2-shift work and leukocyte count in men (p = .020) and leukocyte count in 3-shift-working women (p = .044) were significant. Our results suggest that 2- and 3-shift work is associated with increased systemic inflammation and the relationship is relatively independent of the considered risk factors of cardiovascular disease.