This paper summarizes the associations between long workhours and health, with special attention for the physiological recovery and behavioral life-style mechanisms that may explain the relationship. The evidence for these mechanisms has not been systematically reviewed earlier. A total of 27 recent empirical studies met the selection criteria. They showed that long workhours are associated with adverse health as measured by several indicators (cardiovascular disease, diabetes, disability retirement, subjectively reported physical health, subjective fatigue). Furthermore, some evidence exists for an association between long workhours and physiological changes (cardiovascular and immunologic parameters) and changes in health-related behavior (reduced sleep hours). Support for the physiological recovery mechanism seems stronger than support for the behavioral life-style mechanism. However, the evidence is inconclusive because many studies did not control for potential confounders. Due to the gaps in the current evidence and the methodological shortcomings of the studies in the review, further research is needed.

Long workhours and health.

Clinical burnout is not reflected in the cortisol awakening response, the day-curve or the response to a low-dose dexamethasone suppression test

STUDY OBJECTIVES: To evaluate the next-morning residual effects of ramelteon (8 mg), zopiclone (7.5 mg), and placebo on driving performance, memory functioning, psychomotor performance, and mood in healthy adult subjects following bedtime dosing and a middle of the night awakening. DESIGN: Single-center, randomized, double-blind, double-dummy, placebo-controlled, crossover study. SETTING: Utrecht University, The Netherlands. PARTICIPANTS: 30 healthy volunteers (15 males and 15 females). INTERVENTIONS: a single dose of ramelteon (8 mg), zopiclone (7.5 mg), and placebo, administered at bedtime. MEASUREMENTS: A balance test was performed at night. Other tests were performed the following morning, 8.5 h after administration. Subjects performed a 100-km highway driving test in normal traffic. Primary outcome measure was the standard deviation of the lateral position (SDLP), i.e., the weaving of the car. After driving, cognitive, memory, and psychomotor tests were performed and mood was assessed. RESULTS: SDLP was significantly increased after the intake of ramelteon (+2.2 cm) and zopiclone (+2.9 cm). Ramelteon and zopiclone produced significant impairment on reaction time (P Language: en

Next-day effects of ramelteon (8 mg), zopiclone (7.5 mg), and placebo on highway driving performance, memory functioning, psychomotor performance, and mood in healthy adult subjects.

The effects of explanatory variables derived from a work stress model (the effort-reward imbalance model) on salivary cortisol were assessed. A multilevel analysis was used to distinguish the effects of single occasion and multiple occasion measurements of work stress and effect on cortisol. The single (or cross-sectional) factors include Effort-Reward Imbalance (ERI), need for control, negative affect, and other enduring factors (type of occupation, gender, and smoking). The multiple occasion measurements include momentary negative mood, Momentary Demand-Satisfaction Ratio (MD-SR), sleep quality, work load (workday versus day off), at work (versus not being at the workplace), and lunch. The effect of time of day on cortisol was controlled for before the effects of these variables were determined. Momentary negative mood but not trait negative affect was positively associated with ambulatory measured cortisol. The variables from the work stress model—effort, reward, need for control, and the multiple occasion measurements of demand and satisfaction—did not affect cortisol. As could be expected, time of day had an effect on cortisol, but a hypothesised interaction with momentary negative mood was not found. Additionally, the results show that the time course of cortisol differs between individuals and that the effect of sleep quality on cortisol can vary from person to person. This points to the necessity of continued efforts to single out sources of individual variability. The finding that variables derived from the effort-reward imbalance model are not related with cortisol does not support the hypothesis that ERI leads to short-term changes in cortisol, indicating no relation with hypothalamic-pituitary-adrenal (HPA) axis activity. On the other hand, the present results invite further qualification of negative affect as a potential determinant of HPA activity, at least, as far as can be deduced from cortisol measurements.

Cortisol secretion throughout the day, perceptions of the work environment, and negative affect.

Objective Burnout is a stress-induced work-related syndrome. It is associated with a higher incidence of infections possibly pointing to a compromised immune system. In the present study, endocrine and ex vivo immune function of severe cases of burnout were investigated. Methods Endocrine and immune variables were compared in 56 persons with burnout and 38 healthy control subjects. Cortisol after awakening, after a low-dose dexamethasone, and dehydroepiandrosterone-sulphate (DHEAS) were analyzed from saliva. Peripheral blood was analyzed for T, B, and NK cell number and in vitro mitogen-induced pro- and antiinflammatory cytokine release. The capacity of dexamethasone to regulate cytokine release was compared between the groups. Results The burnout group showed an increased production of the antiinflammatory cytokine interleukin-10 (IL-10) by monocytes after lipopolysaccharide stimulation. No differences were observed in IL-10 release induced by the T-cell mitogen PHA nor in the proinflammatory cytokines gamma interferon and tumor necrosis factor alpha. The capacity of dexamethasone to regulate cytokine release did not differ between the groups. The number of peripheral blood T cells, B cells, or NK cells was not different either. The burnout group showed higher DHEAS levels but no difference in cortisol levels after awakening or after dexamethasone intake in comparison to controls. Conclusion Production of the antiinflammatory cytokine IL-10 by monocytes was increased in individuals with burnout syndrome. It seems unlikely that glucocorticoids or changes in glucocorticoid receptor function play a role in this higher IL-10 production.

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Immune and Endocrine Function in Burnout Syndrome

The effects of day-sleep on the quality ofsleep are not restricted to the night-work period itself. Effects can be measured during night-sleep in the period following night-work. A study on these after-effects, using a self-report instrument to measure sleep quality, is described. A total of N=7O operators wcrc observed over five consecutive undisturbed nights after a working period of seven morning shifts (N= 35) and after a working period of seven night-shifts (N= 35). The quality of sleep during the third night after the night-shift period was still significantly worse than the third night after the rnorning-shift period. No differential (after-)effects were observed with respect to differences in sleep duration.

Tf Meijman

Papers

The after-effects of a prolonged period of day-sleep on subjective sleep quality