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  • 1. Brown, M.
    et al.
    Tucker, P.
    Rapport, F.
    Hutchings, H.
    Dahlgren, Anna
    Department of Shipping and Marine Technology, Chalmers University.
    Davies, G.
    Ebden, P.
    The impact of shift patterns on junior doctors' perceptions of fatigue, training, work/life balance and the role of social support2010Inngår i: Quality and Safety in Healthcare, ISSN 1475-3898, E-ISSN 1470-7934, Vol. 19, nr 6, s. e36-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The organisation of junior doctors' work hours has been radically altered following the partial implementation of the European Working Time Directive. Poorly designed shift schedules cause excessive disruption to shift workers' circadian rhythms.

    METHOD: Interviews and focus groups were used to explore perceptions among junior doctors and hospital managers regarding the impact of the European Working Time Directive on patient care and doctors' well-being.

    RESULTS: Four main themes were identified. Under "Doctors shift rotas", doctors deliberated the merits and demerits of working seven nights in row. They also discussed the impact on fatigue of long sequences of day shifts. "Education and training" focused on concerns about reduced on-the-job learning opportunities under the new working time arrangements and also about the difficulties of finding time and energy to study. "Work/life balance" reflected the conflict between the positive aspects of working on-call or at night and the impact on life outside work. "Social support structures" focused on the role of morale and team spirit. Good support structures in the work place counteracted and compensated for the effects of negative role stressors, and arduous and unsocial work schedules.

    CONCLUSIONS: The impact of junior doctors' work schedules is influenced by the nature of specific shift sequences, educational considerations, issues of work/life balance and by social support systems. Poorly designed shift rotas can have negative impacts on junior doctors' professional performance and educational training, with implications for clinical practice, patient care and the welfare of junior doctors.

  • 2.
    Dahlgren, Anna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Work stress and overtime work: effects on cortisol, sleep, sleepiness and health2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    In Sweden the National Bureau of Statistics has reported an increase in stress-related disorders and sleep problems since the mid-1990’s. They also report that the number of hours of overtime worked has increased. Previous research on work-related stress and overtime work has demonstrated associations with altered physiological arousal, increased risk for stress related diseases, shorter sleep, greater fatigue and impaired performance. However, there is a lack of knowledge on the effects within individuals. The general aim of the thesis was to investigate the effect of overtime work and increased work stress on sleep, the diurnal pattern of cortisol, sleepiness and subjective stress in a within-subject design. In addition, it examined individual differences in the diurnal cortisol response to stress.

    We used a combination of methods – questionnaires, sleep and wake diaries, objective measures of sleep, stress hormones (salivary cortisol) and ambulatory measures of heart rate and blood pressure. Studies followed office workers during two different conditions of (I) high/low work stress and (II) overtime work respectively. The individual differences in the cortisol response to stress from study I prompted study III. In this study we examined two groups that showed different cortisol responses to stress.

    In conclusion, the results (I) demonstrated that a week with higher workload and stress affects physiological stress markers such as cortisol, and is associated with increased sleepiness and problems of unwinding at bedtime, shorter sleep duration and longer work hours. Furthermore (II) overtime work, under conditions of relatively low workload, was shown to be associated with modest effects on physiological markers of arousal. More pronounced effects were found on sleep and fatigue, with greater problems during overtime work. Study III indicated that individual differences in cortisol response to stress maybe related to fatigue and exhaustion.

  • 3.
    Dahlgren, Anna
    et al.
    Human Factors, Shipping and Marine Technology, Chalmers University of Technology.
    Kecklund, Göran
    Theorell, Töres
    Akerstedt, Torbjörn
    Day-to-day variation in saliva cortisol-Relation with sleep, stress and self-rated health2009Inngår i: Biological Psychology, ISSN 0301-0511, E-ISSN 1873-6246, Vol. 82, nr 2, s. 149-155Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective was to examine the day-to-day variation in cortisol among healthy individuals and its relation to the time of saliva sampling, work, stress and fatigue. During 4 consecutive weeks, 14 office workers provided saliva samples (at awakening, 15 min after awakening and at bedtime) and made diary ratings for each day. Results showed a variation in cortisol values between participants but also within individuals. After controlling for the individual differences, results showed that low cortisol levels in the morning were associated with sleepiness at awakening and anxiety, exhaustion, and poorhealth the day before. High evening levels of cortisol were associated with symptoms ofstress and poor self-rated health. Further analysis of the cortisol awakening response (CAR) showed that all participants had a mixture of both a positive and negative responses. During mornings with a negative response participants stayed in bed for a longer time after the initial awakening, which might be a sign of snoozing, thus missing the awakening response. 

  • 4. Dahlgren, Anna
    et al.
    Kecklund, Göran
    Åkerstedt, Torbjörn
    Different levels of work-related stress and the effects on sleep, fatigue and cortisol2005Inngår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 31, nr 4, s. 277-285Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives The aim of the study was to relate different levels of work stress to measures of sleep and the diurnal pattern of salivary cortisol and subjective sleepiness.

    Methods Thirty-four white-collar workers participated under two different conditions. One workweek with a relatively high stress level (H) and one with a lower stress level (L) as measured through self-rated stress during workdays. The workers wore activity monitors, filled out a sleep diary, gave saliva samples (for cortisol), and rated their sleepiness and stress during one workday and one free day.

    Results During the week with stress the number of workhours increased and total sleep time decreased. Sleepiness showed a significant interaction between weeks and time of day, with particularly high levels towards the evenings of the stress week. Cortisol also showed a significant interaction, with a more flattened pattern, probably due to increased evening levels during the stress week. Stress (restlessness) at bedtime was significantly increased during the stress week.

    Conclusion The results demonstrate that a workweek with a high workload and much stress increases sleepiness and workhours, impairs sleep, and affects the pattern of diurnal cortisol secretion.

  • 5. Dahlgren, Anna
    et al.
    Kecklund, Göran
    Åkerstedt, Torbjörn
    Overtime work and its effects on sleep, sleepiness, cortisol and blood pressure in an experimental field study2006Inngår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 32, nr 4, s. 318-327Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives Previous studies of long workhours and their effects on stress, sleep, and health show inconclusive results. This inconclusiveness may be partly due to methodological problems such as the use of between-group designs or comparisons before and after reorganizations. In addition, stress is usually a confounder. A within-person design was used to examine the effects of working 8- or 12-hour shifts in the absence of additional stress.

    Methods In an experimental field study, 16 white-collar workers [9 women, mean age 45.9 (SD 15) years] undertook one workweek with normal workhours (8 hours) and 1 week of overtime with 4 extra hours of regular worktasks (12 hours). The participants wore actigraphs, rated sleepiness (Karolinska Sleepiness Scale) and stress throughout the day, and rated workload and how exhausted they felt. Saliva samples were collected on Mondays and Thursdays for cortisol analysis. On these days, ambulatory heart rate and blood pressure were also measured for 24 hours.

    Results Overtime was associated with higher levels of exhaustion. Sleepiness showed a significant interaction between conditions, with higher levels at the end of the workweek featuring overtime. Total sleep time was shorter in the overtime week. There were no significant differences between ratings of stress and workload. Cortisol showed a circadian variation but no main effect of condition.

    Conclusions One week of overtime work with a moderate workload produced no main effects on physiological stress markers. Nevertheless, sleep was negatively affected, with shorter sleeps during overtime work and greater problems with fatigue and sleepiness.

  • 6.
    Dahlgren, Anna
    et al.
    KTH, Skolan för teknik och hälsa (STH), Patientsäkerhet.
    Van Leeuwen, W.
    Kircher, A.
    Lutzhoft, M.
    Barnett, M.
    Kecklund, G.
    Akerstedt, T.
    Sleep and fatigue in bridge officers working 6 h on and 6 h off - a simulator study2012Inngår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, s. 331-331Artikkel i tidsskrift (Annet vitenskapelig)
  • 7. Dahlgren, Anna
    et al.
    Åkerstedt, Torbjörn
    Kecklund, Göran
    Individual differences in the diurnal cortisol response to stress2004Inngår i: Chronobiology International, ISSN 0742-0528, E-ISSN 1525-6073, Vol. 21, nr 6, s. 913-922Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objectives of this study were to explore individual differences associated with diverse reactions in cortisol secretion under different stress levels. This study was part of a larger project concerning working hours and health. Thirty-four whitecollar workers participated under two different conditions; one work week with a high stress level (H) and one with a lower stress level (L) as measured through self-rated stress during workdays. Based on the morning cortisol concentration during a workday subjects were divided into two groups. One group consisted of subjects whose morning level of cortisol increased in response to the high-stress week, compared to their morning levels in the low-stress condition (Group 1). The other group consisted of subjects whose morning cortisol response was the opposite, with a lower level under the high stress condition (Group 2). Subjects wore actiwatches, completed a sleep diary, and rated their sleepiness and stress for one work week in each condition, i.e., high and low stress. Saliva samples for measures of cortisol were collected on a Wednesday. Group 2 reported higher workload, fatigue, and exhaustion during both weeks. Since there were no differences in perceived stress, neither within nor between groups, the data indicate that there are other factors influencing morning cortisol. The results suggest that one component modulating the cortisol response might be the level of exhaustion, probably related to work overload. Higher levels of stress in exhausted individuals might suppress morning cortisol levels.

  • 8. Donofrio, P.
    et al.
    Dahlgren, Anna
    KTH, Skolan för teknik och hälsa (STH), Patientsäkerhet.
    Barnett, M.
    Lutzhoft, M.
    Kircher, A.
    Gillberg, M.
    Kecklund, G.
    Akerstedt, T.
    The effects of a 6 h on/6 h off maritime watch system on sleep2012Inngår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, s. 268-269Artikkel i tidsskrift (Annet vitenskapelig)
  • 9.
    Ekstedt, Mirjam
    et al.
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Systemsäkerhet och organisation.
    Dahlgren, Anna
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Systemsäkerhet och organisation. Karolinska institutet, Sweden.
    Säker vård även i hemmet en framtida utmaning2015Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, nr 22, s. 1-2Artikkel i tidsskrift (Fagfellevurdert)
  • 10. Lützhöft, Margareta
    et al.
    Dahlgren, Anna
    Chalmers University of Technology.
    Kircher, Albert
    Thorslund, Birgitta
    Gillberg, Mats
    Fatigue at sea in Swedish shipping-a field study2010Inngår i: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 53, nr 7, s. 733-740Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Today many merchant ships sail with only two nautical officers, working a shift schedule of 6 hr on and 6 hr off. There are concerns that such a shift schedule is related to fatigue. However, little data exist from onboard studies of seafarers.

    METHODS: Data were collected on board 13 ships. Fifteen participants worked on a 6-on, 6-off watch system and another 15 on a 4-on, 8-off watch system. Electrooculography, actigraphy, diaries, and reaction time tests were used to measure the effects of shift system on fatigue and sleep.

    RESULTS AND CONCLUSIONS: Sleepiness was higher during the night shift in the 6-on, 6-off system. Moreover, sleepiness increased more during the watch in the 6-on, 6-off system compared to the 4-on, 8-off system. There was a trend toward shorter sleep episodes in the 6-on, 6-off system and sleep was more often split into two episodes.

  • 11. Taris, T.
    et al.
    Beckers, D.
    Dahlgren, Anna
    Stockholm University.
    Geurts, S.
    Tucker, P.
    Overtime work and well-being: Prevalence, conceptualization and effects of working overtime2007Inngår i: Occupational Health Psychology: European Perspectives on Research, Education and Practice / [ed] J. Houdmont, ISMAI Publishers , 2007, s. 21-41Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 12. Tucker, P.
    et al.
    Dahlgren, Anna
    Seafarers International Research Centre, Cardiff University, Cardiff, United Kingdom.
    Akerstedt, T.
    Waterhouse, J.
    The impact of free-time activities on sleep, recovery and well-being2008Inngår i: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 39, nr 5, s. 653-662Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We compared the effects of different types of free-time activity on subjective and objective indices of sleep, recovery and well-being in an experimental field study. Twelve participants spent four consecutive evenings after work in each of three conditions: pursuing quiet leisure activities at home; undertaking active leisure pursuits; doing additional work. Ratings of rest and recuperation, and of satisfaction, were lowest in the additional work condition. There were few other differences between conditions. However, being satisfied with one's evening activities (regardless of which experimental condition was being undertaken) was associated with improved subsequent sleep (self-reported). Evening activities involving lower mental effort were also associated with better-rated sleep, as well as improved recuperation and fatigue the next day. It is concluded that the nature of activity per se may be less important than (1) whether the activity accords with individual preference and (2) the cumulative demands of daytime and evening activities.

  • 13. Tucker, Philip
    et al.
    Brown, Menna
    Dahlgren, Anna
    Department of Shipping and Marine Technology, Chalmers University, Gothenburg, Sweden.
    Davies, Gwyneth
    Ebden, Philip
    Folkard, Simon
    Hutchings, Hayley
    Åkerstedt, Torbjörn
    The impact of junior doctors’ worktime arrangements on their fatigue and well-being2010Inngår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 36, nr 6, s. 458-465Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective Many doctors report working excessively demanding schedules that comply with the European Working Time Directive (EWTD). We compared groups of junior doctors working on different schedules in order to identify which features of schedule design most negatively affected their fatigue and well-being in recent weeks. Methods Completed by 336 doctors, the questionnaires focused on the respondents' personal circumstances, work situation, work schedules, sleep, and perceptions of fatigue, work-life balance and psychological strain. Results Working 7 consecutive nights was associated with greater accumulated fatigue and greater work life interference, compared with working just 3 or 4 nights. Having only I rest day after working nights was associated with increased fatigue. Working a weekend on-call between 2 consecutive working weeks was associated with increased work-life interference. Working frequent on-calls (either on weekends or during the week) was associated with increased work-life interference and psychological strain. Inter-shift intervals of <10 hours were associated with shorter periods of sleep and increased fatigue. The number of hours worked per week was positively associated with work-life interference and fatigue on night shifts. Conclusion The current findings identify parameters, in addition to those specified in the EWTD, for designing schedules that limit their impact on doctors' fatigue and well-being.

  • 14. van Leeuwen, W.
    et al.
    Kecklund, G.
    Dahlgren, Anna
    KTH, Skolan för teknik och hälsa (STH), Patientsäkerhet.
    Kircher, A.
    Lutzhoft, M.
    Barnett, M.
    Åkerstedt, T.
    Fatigue, Sleepiness And Sleep In Maritime Watch Systems: A Series Of Simulator Studies2012Inngår i: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 35, s. A203-A203Artikkel i tidsskrift (Annet vitenskapelig)
  • 15. Van Leeuwen, W. M. A.
    et al.
    Kircher, A.
    Dahlgren, Anna
    KTH, Skolan för teknik och hälsa (STH), Patientsäkerhet.
    Lutzhoft, M.
    Barnett, M.
    Kecklund, G.
    Akerstedt, T.
    Sleep and sleepiness while on watch in a simulated '4 h on/8 h off' maritime watch system2012Inngår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, s. 331-331Artikkel i tidsskrift (Annet vitenskapelig)
  • 16. van Leeuwen, Wessel M. A.
    et al.
    Kircher, Albert
    Dahlgren, Anna
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Systemsäkerhet och organisation.
    Lützhöft, Margareta
    Barnett, Mike
    Kecklund, Göran
    Åkerstedt, Torbjörn
    Sleep, Sleepiness, and Neurobehavioral Performance While on Watch in a Simulated 4 Hours on/8 Hours off Maritime Watch System2013Inngår i: Chronobiology International, ISSN 0742-0528, E-ISSN 1525-6073, Vol. 30, nr 9, s. 1108-1115Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Seafarer sleepiness jeopardizes safety at sea and has been documented as a direct or contributing factor in many maritime accidents. This study investigates sleep, sleepiness, and neurobehavioral performance in a simulated 4 h on/8 h off watch system as well as the effects of a single free watch disturbance, simulating a condition of overtime work, resulting in 16 h of work in a row and a missed sleep opportunity. Thirty bridge officers (age 30 +/- 6 yrs; 29 men) participated in bridge simulator trials on an identical 1-wk voyage in the North Sea and English Channel. The three watch teams started respectively with the 00-04, the 04-08, and the 08-12 watches. Participants rated their sleepiness every hour (Karolinska Sleepiness Scale [KSS]) and carried out a 5-min psychomotor vigilance test (PVT) test at the start and end of every watch. Polysomnography (PSG) was recorded during 6 watches in the first and the second half of the week. KSS was higher during the first (mean +/- SD: 4.0 +/- 0.2) compared with the second (3.3 +/- 0.2) watch of the day (p < 0.001). In addition, it increased with hours on watch (p < 0.001), peaking at the end of watch (4.1 +/- 0.2). The free watch disturbance increased KSS profoundly (p < 0.001): from 4.2 +/- 0.2 to 6.5 +/- 0.3. PVT reaction times were slower during the first (290 +/- 6 ms) compared with the second (280 +/- 6 ms) watch of the day (p < 0.001) as well as at the end of the watch (289 +/- 6 ms) compared with the start (281 +/- 6 ms; p = 0.001). The free watch disturbance increased reaction times (p < 0.001) from 283 +/- 5 to 306 +/- 7 ms. Similar effects were observed for PVT lapses. One third of all participants slept during at least one of the PSG watches. Sleep on watch was most abundant in the team working 00-04 and it increased following the free watch disturbance. This study reveals that-within a 4 h on/8 h off shift system-subjective and objective sleepiness peak during the night and early morning watches, coinciding with a time frame in which relatively many maritime accidents occur. In addition, we showed that overtime work strongly increases sleepiness. Finally, a striking amount of participants fell asleep while on duty.

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