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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

Performance at work Dilemmas Working Hours Shiftwork Mental Distress Dr. Craig Jackson Prof. Occupational Health Psychology Faculty of Education Law & Social Sciences BCU craig. jackson@bcu. ac. uk

“Peoples’ health should be no worse at the end of a working day than it was at the start” M. J. Harrington (1997)

“People who work sitting down get paid more than people who work standing up” Ogden Nash (1902 - 1971)

Core Occupational Diseases (EU) Chemical Physical Inorganic Others Biological Cadmium Zoonoses CS 5 Physical Dusts Asbestos Radiation Chromium Benzene Hepatitis Silica(te) NIHL Mercury Chlorine TB Mesothelioma Cataract Manganese Aromatics Nickel P. aromatics Dermatitis Vibration

21 st Century Workplaces • Global companies and operations • Leaner & Meaner managers • Gender issues • Disability issues • Migrant issues • Longer & less fixed working hours • Shorter contracts • Dirty jobs out-sourced

Regulation of working hours 1800 – 1900 12 hour days & 6 day weeks Thomas Paine 1737 - 1809 Age of Reason Rights of Man Annie Besant 1847 – 1933 Reformist movement Fabian Society Secular Society “Fruits of philosophy” “The Link” “White slavery in London” 1889 Humanitarian concerns influenced change

Regulation of working hours 1900 – 1970 progressive reduction in working hours traditional work patterns 1970 working hours increase shiftwork increases irregular hours increase 24 hour processing technology unpaid extended hours flexible working annualised hours

Regulation of working hours Linear Assumption of workers and productivity units reality units assumption time

Pieter Bruegel 1563

Wembley Stadium 326. 5 Million pounds – Multiplex 2002 730 Million pounds 731 British Library 73232 Million pounds – estimate 733511 Million pounds – 10 yrs late 734 Scottish Assembly 73537 Million pounds – estimate 736431 Million Pounds – 3 yrs late

European directive on working time Organisation of work Min. daily rest period of 11 consecutive hours per 24 hours 1 rest break where working day > 6 hours Min. uninterrupted rest period of 35 hours per 7 day period Max. of 48 work per week Min. 4 weeks paid annual leave

European directive on working time Night work Mean 8 hours work in any 24 hour period Free health assessment before assignment and at regular intervals Transfer to day work when suffering health problems connected with night work Night work and shifts Protection appropriate to the nature of the night work Prevention and protection services on parity with day workers Take account of principles adapting work to the workers

Derogations Certain jobs junior docs Certain industries press media utility provision Circumstances where rests are not practicable Does not apply to: health checks provision of health and safety facilities Nearly 900 extra consultants will be needed by 2010 compensate for a reduction in doctors’ hours due to EWTD BMJ 2002; 325: 855

Shiftwork Any work regularly undertaken outside “normal” working hours Normal working hours = 07: 00 – 18: 00 Nights Early am Evening Fixed Rotating Eight hour Twelve hour Effects Circadian disruption Sleep loss Fatigue

Circadian Rhythms Body Temp Pulse Urinary excretion Blood pressure Hormonal changes Mental Performance Physical Performance Physiologically determined Socially modified & Externally cued

Circadian Rhythms

Adjustment to shiftworking Aprrox. 7 days to adjust to shift External cues hamper adjustment Nightworking sometimes never achieves adjustment Slow rotating shifts partial adjustment continual disrhythmia state Rapid rotating shifts no adjustment

Adjustment to shiftworking stress Phase-shifting of waking and sleeping hours modifyin g factors Individual characteristics Job-related factors Environment Domestic strain organisational effects Impaired performance Impaired health Disturbed relationships > Absenteeism > Accidents > Labour turnover < Productivity Colquhoun & Rutenfranz 1980

Cardiovascular problems associated with shiftwork Increased Ischemic Heart Disease (IHD) Knutsson et al. 1986, 1988 Increased risk of IHD and Myocardial Infarction (MI) Akerstedt et al. 1986 Increased risk of Coronary V related disorders – Permanent Nightworkers Teiger 1984 Some studies show NO increased risk Bursey 1990

Cardiovascular problems of shiftwork Liu & Tanaka 2002 – Japanese working men study 260 cases 445 controls Working Hours, Sleeping Hours and Acute MI Working hours related to: increased risk in year prior to AMI increased risk in month prior to AMI x 2 increase in risk for overtime (>61 hours) x 2 -3 increase in risk for <5 hours sleep x 2 -3 increase for lack of sleep (2 or more days with <5 hours sleep) lack of sleep & few days off in recent past show > odds than those in past

Gastrointestinal disorders and shiftwork Indigestion (Chan et al. 1987) (Poole et al. 1992) Reflux Peptic Ulceration (Waterhouse et al. 1992) Related to: irregular hours circadian dysrhythmia poor catering facilities inequality in GP access

Gastrointestinal disorders and shiftwork Irritable Bowel Syndrome (IBS) 13 -52% new referrals to GI (Walker et al. 1990) Some occupations have > G. I than others (Cucino & Sonnenburg, 2001) IBD < in manual workers and farmers IBD > in sedentary workers Assoc. with occupation difficult to prove • shift workers seen as greatest risk of IBS • especially nightworkers • night workers present in GI more than day workers Access / Availability reasons ? genuine aspects ? Research fails to answer: psychosocial aspects of workers ?

Mental health problems and shiftwork Increased stress Alcohol consumption Neuroticism Review by Cole et al. 1990 OM

Sources of performance impairment Day sleepers Endogenous factors Exogenous factors Cortisol > Daylight Temp. > Noise Societal bias Night wakers Endogenous factors Exogenous factors Melatonin > Darkness Temp. < Societal bias

Current evidence Performance impairments more likely: on nightshift vs. morning or evening on advancing shifts vs. delaying shifts on rapid rotating shifts vs. on irregular shifts vs. slower rotation at changeover periods in older shiftworkers where work is stressful Inconsistencies: 12 hour shifts Sex

Performance effects – methodological considerations Task monotony cognitive skills Measures speed accuracy efficiency Individual aspects motivation perceived importance age ability health activity Situation / context supervision morale

Subject Variables that may potentially confound STABLE FACTORS SITUATIONAL FACTORS Age Alcohol (recent use) Education Caffeine (recent use) Sex Nicotine (recent use) Socio-economic Medication (recent use) Language Paints, glues, pesticides (recent) Handedness Near visual acuity Computer experience Restricted movement (injury) Caffeine (habitual use) Cold / flu Alcohol (habitual use) Stress Nicotine (habitual use) Arousal / Fatigue Medication (habitual use) Sleep Paints, glues, pesticides (habitual use) Screen luminance Diabetes Time of day Epilepsy Time of year Other CNS / PNS disease

12 hour shifts Williamson et al. 1994 8 hr vs. 12 hr rotating psych health improved Australia computer operators reduced tiredness Duchon et al. 1994 Canada performance 8 hr vs. 12 hr rotating improved sleep miners improved Chan & Gan Singapore 8 hr vs. 12 hr rotating no health differences electronic workers some headaches

Groups prone to negative effects Over 50’s Morning types Long sleepers Personality types Heavy domestic commitments Multiple jobs Some physical conditions Psychiatric problems Employee Selection Issues ? Pre-employment counselling ?

Management Counselling Education Provide facilities Manipulate schedules carefully Increased control of work Reduce any stress Light quality Drug policy Health Surveillance

Standard Shiftwork Index (SSI) Barton et al. 1995 Questionnaires Work Context + Shift System Health Well-being Individual Differences Normative Data

Training & Education health effects Survey current work schedule performance safety quality of life Analyse data Identify problem area(s) Recommend schedule changes Shiftworker education Asses & review information & awareness coping methods education lifestyle changes info

Intervention strategies Organisation Slow / fast rotation (task considerations) Start times Rest breaks Evaluate process Expert systems Evaluate outcome Environmental Modification Bright lights Health Surveillance Mood lights Temp. compensation Do what? Workload How often? Facilities Individual Adjustment Pharmacological help Behavioural exercise, counselling sleep management, diet,

Overtime working Extension of normal workday Extension beyond 8 hours (08: 00 / 09: 00 - 16: 00 / 17: 00) Non-paid is still overtime Increasing in UK especially managerial & professional groups 1990 UK had twice as many more employees on >48 hrs than any other EU countries More common in males

Overtime working Percentage of European employees working <16 hrs per week, and > 48 hrs per week, 1990 If graph was males only?

Czech Rep. Turkey S. Korea Iceland Swiss Mexico Hungary USE Canada Japan Ireland UK Australia Portugal Greece Italy Spain Denmark France Germany Norway Sweden Austria Belgium Finland Netherlands Employers >40 hrs per week as % of labour force, 1996

Potential effects cardiovascular mental health Stress immune system gastrointestinal musculoskeletal social effects Fatigue Exposu re performance impairment safety problems over-exposure

Cardiovascular disorders and overtime Increased Risk > 60 hrs > 48 hrs Night school students 50 – 60 hrs Overtime (females only) No increased Risk >10 hrs overtime / week “Overtime” 60 hrs / wk Karoshi BP & Serum Chol. Range of CVIs 65%> if

1980 Mental Health 1985 SITES WITH MASS PSYCHOGENIC ILLNESS (USA) KIBBUTZIM (ISRAEL) ? No. of symptoms >8 hrs/ day < 50 Smoking Burnout X Psychiatric Status (Crown Crisp) Stimulant use/ Sleep disturbance Exhaustion/ Insomnia 1987 MUSIC THERAPISTS (USA) 1990 BUS DRIVERS (UK) ? 1991 COACH DRIVERS (AUSTRALIA) 30 -70 1992 FEMALE HOSPITAL STAFF (USA) 32 -19 1994 FACTORY WORKERS (JAPAN) ? Psychiatric State (GHQ) 1995 ACCOUNTANT (UK) ? Psychiatric Status (GHQ) 1991 1995 MANAGERIAL STAFF (USA/JAPAN) ? 50 55 Stress (OSI) 1991 1995 CLERICAL STAFF (USA/JAPAN) ACADEMICS ? Stress (OSI) 50 Stress (SACL) X 1996

Health & Well-being: Methodological Issues Mostly Cross-sectional studies Direction of any association ? Lag Healthy worker / Survivor Effects Response Rates Control Groups Exposure Assessment Outcome Measures

Performance Effects: Optimal Productivity Mather 1894 Engineering Weekly hours of 48 - 53 Abbia 1901 Optical Instrument Makers Daily hours of 8/9 max. Vernon 1918 Munitions workers Weekly hours of 50 - 60 Accounts for > degree of munitions errors in W W I ?

Performance Effects: Accidents General Data Analyses suggests: Rise in accident rates after 9 hrs work Cognitive (simulation) studies suggests errors increase after 8 hrs work HOWEVER Shift change from 8 to 12 hrs Safety record stays same Attitudes ? Safety culture increased ? Schedule org ?

Existing Gaps in Research Irregular Hours Increased concomitant exposure to other hazards Reproductive effects Family / Social influences Behavioural Effects Effect Modifiers Intervention procedures

Further Reading Cooper, C. L. , and Sutherland, V. J: Job Stress, Mental Health and Accidents among Offshore Workers in Oil and Gas extraction Industries. Journal of Occupational Medicine (1987) 29. Gann, M. , Corpe, U. , and Wilson, I. (1990) The Application of a Short Anxiety and Depression Questionnaire to Oil Industry Staff. Journal of the Society of Occupational Medicine 40: Glazner, L. K. Shift Work and its effects on fire fighters and nurses. Occupational Health & Safety, July 1992 Hanecke, K. , Tiedemann, S. , Nachreiner, F. , and Grzech-Sukalo, H: 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. Scandinavian Journal of Work,

Further Reading Harrington, J. M. , Shiftwork and health: a critical review of the literature. London, The Stationary Office, 1978. Harrington, JM. (2001) Health effects of shift work and extended hours of work. Occup Environ Med 58: 68 -72. Jackson, C. A. (2002) Working hours and shifts in the petrochemical and gas industries: a review. Croner’s Occupational Hygiene 34: 13 -17. Jackson, C. A. , Spurgeon, A. and De. Jong. G Mental Health of expatriate oil workers on extended twelve hour shifts in a desert -based oil field. Society of Petroleum Engineers. SPE 61016. Lees, R. , and Laundry, B. R. Comparison of reported workplace

Further Reading Lodden, T. , The Effect on the Health and Safety of Older Offshore Personnel - Long Shifts and Working Night Shift. Society of Petroleum Engineers. SPE 60996. Parkes, K. R. : Sleep patterns, Shift work, and Individual Differences: A Comparison of Onshore and Offshore Control. Room Operators. Ergonomics (1994) 37(5). Rosa, R. R: Performance, alertness, and sleep after 3. 5 years of 12 hour shifts: a follow-up study. Work and Stress (1991) 5(2). Spurgeon A, Harrington JM, Cooper CL. (1997) Health and safety problems associated with long working hours: a review of the current position. Occup Environ Med; 54: 367 -375.