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A cross-sectional study of breast cancer biomarkers among shift working nurses.

ABSTRACT: Objectives In 2007, the International Agency for Research on Cancer classified long-term shift work as a probable carcinogen, with the strongest evidence for breast cancer. One proposed mechanism involves night-time light exposure and decreases in melatonin, a circadian rhythmic hormone. It is hypothesised that melatonin influences patterns of sex hormone production that in turn influence breast cancer risk. This study sought to investigate the relationships of shift work history, 6-sulfatoxymelatonin (aMTs-6, the primary melatonin metabolite) and sex hormone levels among shift working nurses. Design This is a cross-sectional biomarker study. Setting 94 premenopausal nurses who work a full-time rotating shift schedule at one Ontario hospital were recruited for this study; 82 completed follow-up. Primary and secondary outcome measures Study participants provided morning void urine and fasting blood samples for the assessment of aMTs-6 and sex hormone (oestradiol, oestrone, progesterone, prolactin) levels, respectively. These data were collected at two time points (summer and winter) such that relationships between melatonin and sex hormones could be assessed with respect to two time frames of interest (acute and cross-seasonal). Results An inverse relationship between aMTs-6 and oestradiol was suggested in the winter (?=-0.18, p=0.04), but this result was not statistically significant in multivariate modelling that adjusted for age, body mass index and menstrual cycle. Likewise, while oestradiol, oestrone and progesterone levels increased with greater years of shift work history (all p<0.05), these associations were attenuated after confounder adjustment. Conclusions These results do not support the proposed relationship between melatonin and sex hormone levels as biomarkers on the pathway of shift work and breast cancer but emphasise the importance of adjusting for confounders in modelling.

SUBMITTER: Langley AR

PROVIDER: S-EPMC3269052 | biostudies-literature | 2012

REPOSITORIES: biostudies-literature

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A cross-sectional study of breast cancer biomarkers among shift working nurses.

Langley Annie R AR Graham Charles H CH Grundy Anne L AL Tranmer Joan E JE Richardson Harriet H Aronson Kristan J KJ

BMJ open 20120121 1

Objectives In 2007, the International Agency for Research on Cancer classified long-term shift work as a probable carcinogen, with the strongest evidence for breast cancer. One proposed mechanism involves night-time light exposure and decreases in melatonin, a circadian rhythmic hormone. It is hypothesised that melatonin influences patterns of sex hormone production that in turn influence breast cancer risk. This study sought to investigate the relationships of shift work history, 6-sulfatoxymel ...[more]

PMID: 22267710

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Project description:ObjectivesTo investigate associations between different types of headaches and shift work.Design, participants and outcome measuresNurses with different work schedules (day work, two-shift rotation, night work, three-shift rotation) participated in a cohort study with annual surveys that started in 2008/2009. In 2014 (wave 6), a comprehensive headache instrument was included in the survey, in which 1585 nurses participated. Headaches were assessed according to the International Classification of Headache Disorders IIIb. Frequent headache (≥1 day per month), migraine, tension-type headache, chronic headache (headache >14 days per month) and medication-overuse headache (chronic headache + acute headache medication ≥10 days last month) comprised the dependent variables. Adjusted (for sex, age, percentage of full-time equivalent, marital status, children living at home) logistic regression analyses were conducted with work schedule, number of night shifts worked last year, number of quick returns (<11 hours in-between shifts) last year, shift work disorder and insomnia disorder as predictors.ResultsFrequent headache, migraine and chronic headache were associated with shift work disorder (OR 2.04, 95% CI 1.62 to 2.59; 1.60, 1.21 to 2.12; 2.45, 1.25 to 4.80, respectively) and insomnia disorder (OR 1.79, 95% CI 1.43 to 2.23; 1.55, 1.18 to 2.02; 3.03, 1.54 to 5.95, respectively), but not with work schedule, number of night shifts or number of quick returns. Tension-type headache was only associated with >20 night shifts last year (OR 1.41, 95% CI 1.07 to 1.86). Medication-overuse headache was only associated with insomnia disorder (OR 7.62, 95% CI 2.48 to 23.41).ConclusionsWe did not find any association between different types of headaches and work schedule. However, tension-type headache was associated with high number of night shifts. Nurses with sleep disorders (insomnia disorder and shift work disorder) reported higher prevalence of frequent headaches, migraine, chronic headache and medication-overuse headache (only insomnia) compared with nurses not having insomnia disorder and shift work disorder, respectively.

Project description:Night shifts are part of clinical care. It is unclear whether poor sleep quality of nurses working both consecutive night shifts and day shifts after quitting night shifts is common. In this cross-sectional study, Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality as study outcome. Univariable and multivariable linear and logistic regressions were performed to compare PSQI score and prevalence of poor sleep quality between 512 nurses currently working consecutive night shifts and 174 nurses having worked night shifts in the past. The prevalence of poor sleep quality was 62.11% in nurses working consecutive night shifts and 55.75% in nurses having worked night shifts before. In multivariable regressions with adjustment for potential confounders, compared with nurses working consecutive night shifts, nurses having worked past night shifts reported decreased PSQI score [mean difference: -0.82 (95% CI: -1.27 to -0.38, p < 0.001)] and lower poor sleep quality [odds ratio (OR): 0.49 (95% CI: 0.29 to 0.80, p = 0.005)]. In nurses working consecutive night shifts, a rising curve that plateaued at the end was observed between years of consecutive night shifts and PSQI score, p = 0.004. To explore the change in PSQI score after quitting night shift, we constructed a hypothetical prospective cohort from the cross-sectional data. Here, 98 pairs of nurses with consecutive and past night shifts were matched for the number of night shift years, religion, marital status, living condition, hypertension, and hyperlipidemia. In each pair, a hypothetical change in PSQI score was calculated between the two types of nurses and hypothetical years after quitting night shifts was obtained from the matched nurse with past night shifts. A U-shaped curve between change in PSQI and years after quitting night shifts was observed, p = 0.007. The rising curve and U-shaped curve together formed an S-shaped curve, which mapped the change in sleep quality. These results based on the hypothetical cohort constructed from cross-sectional data suggested the presence of persistent poor sleep quality in night shift nurses. Also, we support early and continuous sleep hygiene education and reflection for an optimal strategy for when to cease working night shifts with regard to sleep-related problems.

Project description:IntroductionRetaining nurses in the workforce is an urgent concern in healthcare. Emergency nurses report high levels of stress and burnout, however, there is no gold standard of how to measure these responses. This study aims to measure stress, burnout, and fatigue in emergency nurses using biomarkers and psychometric instruments. Biomarkers will be used to better understand nurses' levels of stress and burnout and to assess the feasibility of using biomarkers as a viable stress measurement tool in a real-world setting.Methods and analysisA two stage cross-sectional design to measure stress, burnout and fatigue in emergency nurses while they work is proposed. All registered and enrolled nurses working in the emergency department from four hospitals in Australia will be invited to participate. Validated psychometric tools will be used in stage 1 to measure depression, anxiety, acute stress, chronic stress, burnout and fatigue. Biomarkers comprising hair cortisol, saliva alpha amylase and heart rate variability will be collected as an objective measure of stress and burnout in stage 2 over one working shift per participant. Written consent will be sought for stage 2 where nurses will provide one hair sample, wear a heart rate sensor and be asked to collect their saliva at three different time points of one shift. Data analysis will measure the domains of acute stress, chronic stress and burnout and explore relationships and correlation between psychometric measures and biomarkers.Ethics and disseminationEthics approval obtained from the Human Research Ethics Committee of the Hunter New England Local Health District (approval number: HREC/2020/ETH01684) and University of Newcastle HREC (H-2022-0169). Results will be reported in peer-reviewed publications using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Public dissemination will occur by presenting at conferences and to the participating local health district.

Dataset Information

A cross-sectional study of breast cancer biomarkers among shift working nurses.

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A cross-sectional study of breast cancer biomarkers among shift working nurses.

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