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Shift Work

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Detrimental effects of variable work shifts on quality of sleep, general health and work performance.
De resultaten suggereren dat ploegenarbeiders een grotere kans hebben op slaapverstoringen dan arbeiders die in een dagschema zitten. De slaapkwaliteit van de ploegenarbeiders verschilt significant dan dat van de dagarbeiders. Ze vonden ook dat ploegenarbeiders meer rookten, een hogere mate aan koffie of thee consumeerden ( zijn factoren die samenhangen met ploegenarbeid en voor gezondheidsproblemen kunnen zorgen ), meer gastro- intestinale stoornissen hadden, meer werkstress en een verminderde seksuele prestatie ervaren. Bijna de helft van de ploegenarbeiders was ook niet tevreden met hun werkprestatie. Ze vertoonden meer mentale stress, vermoeidheid en een gebrek aan concentratie. Rapporteerden meer depressieve symptomen.
Strategieën om zich aan te passen aan de werkschema’s. In een donkere en stille omgeving slapen, gecontroleerd gebruik van alcohol en cafeïne, slaap timen volgens de benodigde slaap relatief tot de ploeg, blootstellen aan fel licht en vermijden van licht om de adaptatie te verbeteren.

Eating and shift work – effects on habits, metabolism and performance
Eetgedrag moet misschien aangepast worden aan de werkshifts, vooral als er nachtwerk bij betrokken is. Vanuit een chronobiologisch gezichtspunt worden mensen als dagwezens gezien. Dit verklaart waarom nachtwerkers s’ nachts minder appetijt hebben. Het lichaam is s’nachts anders geprogrammeerd ( shift van catabolische naar anabolische processen ). Vanuit een psychosociaal gezichtspunt ervaren ploegarbeiders een mismatch tussen hun dagelijkse routines en dat van hun familie en vrienden. Dit kan verder de eetgewoontes verstoren.
Over het algemeen tonen de resultaten van de studies dat ploegenarbeid de individuele energie- inname niet dramatisch wijzigt maar dat de temporele distributie van eten beïnvloed wordt. Verminderde inname voedingsvezels worden door verschillende studies aangetoond ( minder gevarieerde voeding ). Onregelmatige eetpatronen bij ploegarbeiders en vooral nachtarbeiders. Meerdere malen eten gedurende nacht, verschillende snacks in plaats van een volledige maaltijd ( plenty of Foods but few meals ). Samenvattend kunnen we stellen dat de energie- inname niet verschilt tussen de 2 groepen doch afhankelijk van individuele verschillen. Ploegarbeid blijkt wel de hoeveelheid en de kwaliteit van het dieet te beïnvloeden.
Organisationele en sociale context waarin het eten plaats vindt is van belang om de eetgewoonten van ploegarbeiders volledig te begrijpen. Tijdstip en inhoud van de maaltijden hangen onder andere af van de taakeisen en van de eisen die gesteld worden buiten het werk. Eten is een sociale aangelegenheid en wordt dus mede bepaald door familie, vrienden en collega’s. Eten op de werkplek wordt ook beïnvloed door de eetfaciliteiten (bv. Gelimiteerd menu gedurende de nacht ) op het werk en door de attitudes t.o.v. eten op het werk.
Meer gerapporteerde gastro- intestinale klachten bij ploegarbeiders. Een verandering in de processen van vertering, absorptie en opslag van voedsel veroorzaakt door de variërende werkschema’s zou een oorzaak kunnen zijn. De klachten zouden ook kunnen gelinkt worden een frequent snoepen. Consumptie van koffie of andere drugs die ervoor zorgen dat je alert blijft. Ploegarbeid zorgt ook voor metabolische stoornissen zoals vet en glucose intolerantie. Positieve associatie tussen ploegarbeid en diabetes gevonden in andere studies. Deze metabolische verandering kunnen en belangrijke rol spelen bij het ontwikkelen van cardiovasculaire ziektes. Er werd in verschillende studies een relatie gevonden tussen obesitas en ploegarbeid ( vooral nachtarbeid ). Oorzaken hiervan nog niet helemaal duidelijk. Waarschijnlijk door beperkte slaap, effect van ploegarbeid op levensstijl en gezond gedrag ( bv sporten ). Obesitas risicofactor voor opnieuw cardiovasculaire ziekten en slaapproblemen.
Algemene richtlijnen: * Vermijd eten tussen middernacht en 6 uur. Eet bij het begin en op einde van de shift. * Vermijd grote maaltijden 1 à 2 uur voor slapengaan. * Bied een variëteit aan voedselkeuzes aan. Vermijd low- quality snacks. * Zorg voor passende eetfaciliteiten weg van de werkplek, samen met collega’s in een plezante omgeving. * Onderhoud een gezonde levensstijl met beweging, regelmatige maaltijden en goede slaap wanneer je niet werkt.
Specifieke richtlijnen voor ploegenarbeid: * Ontbijt voor de dagslaap zodat je niet wakker wordt van de honger. * Blijf zo dicht mogelijk bij een normaal dag en nachtpatroon. * Zorg in 24 uur voor 3 verzadigende maaltijd met 25- 30 % van de totale inname van die 24 u. * Kies voor groentesoep, salades, fruit, yoghurt, … in plaats van eten met hoge energiewaarden tijdens de shifts. * Vermijd suikerrijke producten * Zorg ervoor dat werkschema’s goede design hebben. O.a. vermijd snelle terugkeer, genoeg tijd tussen shift en slaap, maaltijd klaarmaken,…

Shift work research: Where do we stand, where should we go?
Ploegenarbeid interfereert met de gezondheid en welzijn van werknemers, zowel acuut als chronisch. Acuut: slaap en spijsverteringsproblemen, sociale problemen. Chronisch: intestinale, metabolische en cardiovasculaire pathologiëen, verhoogd risico op kanker. Sociaal: geen stabiel sociaal leven, sociale marginalisatie, verhoogde scheidingscijfers.
Epidemiologische studies tonen aan dat ploegarbeiders een verhoogd prevalentie hebben voor slaap, metabolische, cardiovasculaire aandoeningen en kanker. Morningness personen hebben minder problemen met slaap bij ochtendshifts dan eveningness types. Het omgekeerde geldt voor nachtshifts. Slapen na nachtshift hangt onder meer af van de thuisomgeving zoals licht en lawaai. Gevolgen van slaapproblemen zijn slaperigheid gedurende de activiteitsperiodes wat resulteert in meer werkgerelateerde ongevallen.
Verhogen van de lichtintensiteit ’s nachts en afschermen van licht door donkere zonnebrillen of donkere slaapkamers. Exogene melatonine verbeterde de slaapkwaliteit overdag maar kon er niet voor zorgen dat alertheid verbeterde gedurende de nacht. Andere farmacologische interventies werden ook al gebruikt ( mannetjes slaan door ). Een dutje voor de nachtshift verbeterde reactietijd en subjectieve alertheid gedurende de nacht. Geprogrammeerde fysieke beweging kunnen de lichaamstemperaturen beïnvloeden ongeacht morningness/ eveningness type. Veel effectiviteit bij gesimuleerde experimenten maar enkel korte termijn en moeilijk in te voeren in real life. Focus vooral op nachtshifts.
Interindividuele verschillen in de mate waarin men ploegenarbeid kan tolereren en verschillende copingstrategieën met deze onnatuurlijke levensstijl. Interindividuele verschillen onder andere afhankelijk van chronotype. Eveningness betere tolerantie t.o.v. ploegenarbeid bij nachtshifts maar meer moeilijkheden met ochtendshifts. Kan van belang zijn bij selectie van ploegarbeiders.
Gebruik van licht om biologische klok aan te passen. Bv opstaan voor 4 uur -- > blootstellen aan fel licht. Maar effectiviteit van licht als tijdgever afhankelijk van verschillende aspecten. Gebruik van licht enkel zinvol bij ploegarbeiders met permanente schema’s. Maar dan nog gebruiken met voorzichtigheid.
Extending a model of shift work tolerance
Sleep, sleepiness and health complaints in police officers: the effects of a flexible shift system
Work schedule differences in sleep problems of nursing home caregivers

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