Biomedical subjects

E Spelten

Publications and source records attributed to E Spelten.

8 recordsLinked to original sources

PubMed2003

Return to work of cancer survivors: a prospective cohort study into the quality of rehabilitation by occupational physicians.

AIMS: To describe and assess the quality of rehabilitation of cancer survivors by occupational physicians and to relate the quality of the process of occupational rehabilitation to the outcome of return to work. METHODS: One hundred occupational physicians of a cohort of cancer survivors were interviewed about return to work management. Quality of rehabilitation was assessed by means of four indicators that related to performance in knowledge of cancer and treatment, continuity of care, patients complaints, and relations at work. The cohort of patients was prospectively followed for 12 months to assess time to return to work and rate of return to work. Patients' and physicians' satisfaction with care was also assessed. The relation between performance and these outcome measures was studied in a multivariate analysis, taking into account the influence of other work and disease related factors that could potentially predict return to work. RESULTS: For knowledge of cancer and treatment, only 3% had optimal performance because occupational physicians did not communicate with treating physicians. For continuity of care, patient complaints, and relations at work, performance was optimal for 55%, 78%, and 60% of the physicians respectively. After adjustment for other prognostic factors, overall physician's performance (hazard ratio (HR) 0.5, 95% CI 0.3 to 0.8) and continuity of care (HR 0.5, 95% CI 0.3 to 0.9) were related to the return to work of patients. Overall optimal performance was also related to a small but significant higher level of satisfaction with care, both for patients and physicians. CONCLUSION: Quality of occupational rehabilitation of cancer survivors can be improved substantially, especially with regard to communication between physicians and continuity of care. There is a need for the development of more effective rehabilitation procedures which should be evaluated in a randomised controlled trial.

Adult↗

PubMed1999

A process model of shiftwork and health.

The authors developed and tested a process model of adaptation to shiftwork, which hypothesizes that various individual and situational variables influence the development of sleep and social and domestic disturbances. Both types of disturbances trigger various types of coping behavior, leading to several proximal outcomes. The end result is the development of chronic health problems in the form of digestive and cardiovascular symptoms. The model was tested with survey data collected from 2 samples of nurses (N = 1,532) in the United Kingdom and was cross-validated against a 3rd sample of industrial workers (N = 370). Results indicate support for the model across the 3 samples, although some sample-specific and subgroup effects were found. Results have direct implications for the development of shiftwork theory and interventions.

Adaptation, Psychological↗

PubMed1995

Recovery from work shifts: how long does it take?

Although regulations on work hours usually include a minimum weekly rest period, there is little empirical evidence concerning recovery from work. Shift-working nurses (N = 61) used a handheld computer for 28 days to complete self-ratings, cognitive-performance tasks, and a sleep diary. Many measures were worse on rest days that followed a night shift rather than a day shift and tended to be worse on first rest days compared with subsequent rest days. Alertness was lowest on the 1st rest day following a night shift. Social satisfaction was better on workdays that were preceded by 2 rather than 1 rest day. Reaction time decreased over consecutive night shifts and tended to increase over rest days following night shifts. The results are interpreted as being consistent with the combined adaptive costs of fatigue and adjustment to and from a nocturnal routine. The practical implications for scheduling rest days are considered.

Adult↗

PubMed1995

The effects of nightwork on psychological changes during the menstrual cycle.

This study investigated whether the temporal stress of working at night interferes with nurses' experience of different phases of the menstrual cycle. Twenty-four, rotating-shift nurses recorded data on a hand-held computer at the start and end of each day and every 2 hours during their shifts for a period of 28 days. The measures included a sleep diary, self-ratings of mood and symptoms, and two cognitive performance tasks. Using a pooled time series analysis, it was found that some of the self-report measures showed a significant interaction between type of shift worked and menstrual cycle phase. For example, alertness was found to be lower towards the end of the night shift during the premenstrual phase compared to other phase and shift combinations. However, some of the measures showed only main effects of cycle phase or were non-significant. Retrospective measures from a larger sample showed an association between the number of nights worked per year and duration of premenstrual and menstrual problems, and severity of premenstrual problems. The results suggest that nightwork may alter some aspects of nurses' psychological experience of the menstrual cycle.

Adult↗

PubMed1995

The use of survey measures to assess circadian variations in alertness.

Current models of sleep regulation postulate both a homeostatic and circadian component and promise an understanding of disturbed and displaced sleep. Estimates of these components have traditionally required relatively cumbersome and costly measures, including sleep electroencephalograms and continuously recorded rectal temperature, but it has recently been demonstrated that they may successfully be based on frequent (e.g. 2-hourly) concurrent ratings of alertness. This paper examines whether similar results might be obtained using retrospective survey measures of alertness obtained from shiftworking nurses at a single sitting. These retrospective measures are shown to be sensitive to both time of day and shift, to have a high level of reliability even for relatively small sample sizes (e.g. 10) and to be valid predictors of more traditional concurrent measures of alertness. It is concluded that retrospective alertness ratings may prove to be an extremely cost-effective method for examining the trends in alertness in various groups, including those suffering from specific types of sleep disorder.

Adult↗

PubMedDate not supplied

The relationship between coping strategies and GHQ-scores in nurses.

This paper discusses the development of a situation specific questionnaire for measuring coping with shiftwork. Previously, no standardized measure appears to have been developed, even though coping behaviour is considered to be an important factor in determining tolerance to shiftwork. The results from this study indicated that the present questionnaire may have some potential. Its psychometric qualities were relatively good. Coping scores were related to psychological health, measured by GHQ-12. Analysis of variance showed a main effect of only one of the subscales (disengagement strategies) on GHQ and also a reliable interaction between disengagement and engagement on GHQ-scores. Further research into the effect of coping strategies on shiftwork tolerance is suggested.

Adaptation, Psychological↗

PubMedDate not supplied

Have we underestimated shiftworkers' problems? Evidence from a 'reminiscence' study.

This paper argues that shiftworkers may have gradually habituated to their problems and hence that they underestimate them. Some support for this view was obtained in a 'reminiscence' questionnaire study of retired UK Police Officers who had all subsequently taken on another (mainly day-time) job. They completed a specially constructed questionnaire, which included several measures of health and well being, and in which they were asked to reminisce about how they had felt while still a shiftworker. These reminiscence scores were compared to their current perception of how they were. The results clearly indicated that individuals in retrospect perceive their situation as being worse than they realised at the time. This effect was most marked for scores on the General Health Questionnaire and Chronic Fatigue scale. The results of this study draw attention to a potential confounding in much of the shiftwork literature which demands further, more detailed, investigation.

Adult↗

PubMedDate not supplied

Is there an optimum number of night shifts? Relationship between sleep, health and well-being.

By concentrating on the impact of a specific shift-system feature on the well-being of those concerned, rather than on the impact of the shift system as a whole, one might be able to offer more meaningful suggestions as to what constitutes a better form of shift system. The present study focused on the impact of the number of consecutive night shifts worked on the health and well-being of two groups of nurses (permanent night and rotating shift). All nurses completed a copy of the Standard Shiftwork Index, which is a set of questionnaires designed for comparing the effects of different types of shift system on large groups of workers. It includes measurements of psychological ill-health, physical ill-health, chronic fatigue, social and domestic disruption, attitudes towards shiftwork, sleep quality and sleep habits. Results showed clearly the impact of the number of consecutive nights worked on health and well-being, not directly, but indirectly through the impact on sleep duration and sleep quality. Sleep duration was shown to increase with more consecutive nights worked. This in turn was found to predict sleep quality, which in turn was found to be the stronger direct predictor of psychological and physical ill-health i.e. better health was associated with longer and better quality sleeps. Explanations in terms of circadian adaptation are discussed.

Adaptation, Physiological↗