ABSTRACT

Shiftwork is a significant risk factor for a host of negative health and safety outcomes, which have been at least partly attributed to disturbances of the circadian timing system. As a result, an entire sub-field of chronobiology has been devoted to developing and evaluating countermeasures for circadian misalignment, sleep disruption, fatigue, and other issues associated with shiftwork. Much of this research takes place under highly controlled laboratory conditions due to the necessity of accurately characterizing individual rhythms, both for intervention design and assessment of efficacy. Applied studies of interventions for shiftworkers are, by their nature, more complicated, often demonstrating less consistent findings. While this, in part, reflects execution under less rigorously controlled conditions, it may also stem from variability in implementation approaches. A systematic review of published studies (through May 2017) of interventions designed to enhance circadian health in shiftworkers was conducted to determine the frequency and quality of the assessment of implementation as well as barriers and enablers to implementation. A search of PubMed, PsychINFO, Web of Science, and CINAHL databases yielded a total of 5368 unique references. After a title and abstract screen, 323 proceeded to full-text review; 68 of those met final criteria for data extraction. Implementation was assessed to some degree in 60.3% of those 68 articles. Where it was assessed, the mean quality score on a scale from 1 to 5 (1 = very little, 3 = moderate, 5 = very in-depth) was 2.56. One or more enablers were identified in just 17 of the 68 studies (25.0%), and barriers in just 18 (26.5%). Implementation of these interventions is a critical but seldom-acknowledged component of their uptake and effectiveness, and we highly recommend that future shiftworker intervention research make an effort to incorporate formalized assessments of implementation and/or hybrid effectiveness-implementation approaches.

摘要

轮班工作是造成许多负面健康和安全后果的重要风险因素，这些后果至少部分归因于昼夜节律系统的干扰。结果，整个时间生物学领域致力于研究和评估昼夜节律紊乱，睡眠中断，疲劳以及与轮班相关的其他问题的对策。由于需要对干预措施设计和疗效评估中的各个节律进行准确表征，因此许多研究是在严格控制的实验室条件下进行的。就轮班工作人员的干预措施而进行的应用研究，从本质上讲更为复杂，通常显示出不一致的发现。虽然这部分反映了在不太严格控制的条件下的执行，它也可能源于实施方法的可变性。对旨在增强轮班工作人员昼夜健康状况的干预措施的已发表研究（至2017年5月）进行了系统的审查，以确定实施评估的频率和质量以及实施的障碍和推动因素。对PubMed，PsychINFO，Web of Science和CINAHL数据库的搜索总共产生了5368个唯一引用。在标题和摘要屏幕之后，323进行了全文阅读；其中68个符合数据提取的最终标准。在这68篇文章中，有60.3％对执行情况进行了评估。在进行评估的地方，从1到5（1 =非常少，3 =中等，5 =非常深入）的平均质量得分为2.56。在68项研究中，只有17项（25.0％）确定了一个或多个促成因素，和障碍只有18个（26.5％）。这些干预措施的实施是其采用和有效性的关键但很少被认可的组成部分，我们强烈建议未来的轮班工作人员干预研究应努力纳入对实施和/或混合有效性实施方法的正式评估。