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Aims: There are concerns that lockdown measures taken during the current COVID-19 pandemic lead to a rise in loneliness, especially in vulnerable groups. We explore trends in loneliness before and during the pandemic and differences across population subgroups. Methods: Data were collected via online questionnaires in June 2020 and four to eight months prior in two Norwegian counties (N=10,740; 54% women; age 19–92 years). Baseline data come from the Norwegian Counties Public Health Survey (participation rate 46%, of which 59% took part in a COVID-19 follow-up study). Results: Overall loneliness was stable or falling during the lockdown. However, some subgroups, single individuals and older women, reported slightly increased loneliness during lockdown. Interestingly, individuals with low social support and high levels of psychological distress and loneliness before the pandemic experienced decreasing loneliness during the pandemic. Conclusions: Although data limitations preclude strong conclusions, our findings suggest that, overall, Norwegians seem to have managed the lockdown without alarming increases in loneliness. It is important to provide support and to continue investigating the psychological impact of the pandemic over time and across regions differentially affected by the pandemic.

ObjectivesThe purpose of this study was to use objective registry data to prospectively investigate the effects of quick returns (QR, <11 hours of rest between shifts) and night shifts on sick leave.MethodsA total of 1538 nurses (response rate =41.5%) answered questionnaires on demographics and personality and provided consent to link this information to registry data on shift work and sick leave from employers' records. A multilevel negative binomial model was used to investigate the predictive effect of exposure to night shifts and QR every month for 1 year, on sick leave the following month.ResultsExposure to QR the previous month increased the risk for sick leave days (incidence rate ratio (IRR)=1.066, 95% CI 1.022 to 1.108, p<0.01) and sick leave spells (IRR=1.059, 95% CI 1.025 to 1.097, p<0.001) the following month, whereas night shifts did not. 83% per cent of the nurses experienced QR within a year, and on average they were exposed to 3.0 QR per month (SD=1.6). Personality characteristics associated with shift work tolerance (low on morningness, low on languidity and high on flexibility) were not associated with sick leave, and did not moderate the relationship between QR and sick leave.ConclusionsWe found a positive linear relationship between QR and sick leave. Avoiding QR may help reduce workers' sick leave. The restricted recovery opportunity associated with QR may give little room for beneficial effects of individual characteristics usually associated with shift work tolerance.

Objective This study aimed to investigate how change in the number of quick returns [(QR) <11 hours between consecutive shifts] longitudinally is associated with risk of occupational accidents among nurses. Methods Two-year follow-up data from 1692 nurses participating in the Survey of Shiftwork, Sleep and Health among Norwegian nurses (SUSSH) (mean age 40.2, standard deviation 8.3 years, 91% female) were used. Negative binomial regression analyses were conducted to investigate the association between changes in the number of QR after two years and occupational accidents, controlling for demographics, work factors, and occupational accidents at baseline. Results An increase from having no or a moderate number of QR (1-34 per year) from baseline to the two-year follow-up assessment was associated with an increased risk of occupational accidents, compared to experiencing no change in the number of QR. Those with a moderate number of QR at baseline who experienced an increase after two years had an increased risk of causing harm to patients/others [incident rate ratio (IRR) 8.49, 95% confidence interval (CI) 2.79-25.87] and equipment at work (IRR 2.89, 95% CI 1.13-7.42). Those who had many QR (>34 per year) at baseline but experienced a reduction after two years had a reduced risk of causing harm to themselves (IRR 0.35, 95% CI 0.16-0.73) and patients/others (IRR 0.27, 95% CI 0.12-0.59). Conclusion A fairly consistent pattern was demonstrated in which changes in the number of QR over the two-year follow-up period was associated with a corresponding change in the risk of occupational accidents.

Chronic insomnia is commonly treated with hypnotics. However, the treatment of choice is cognitive behavioral therapy for insomnia (CBTi). We investigated whether a self-help book based on CBTi is effective in reducing hypnotic use and improving sleep. Patients who had received a prescription from their GP for z-hypnotics (zopiclone or zolpidem) in the last 6 months were recruited through PraksisNett, an infrastructure within General Practice, for a randomized controlled trial comparing written materials in form of a sheet of sleep hygiene advice and a self-help book. The participants completed an online questionnaire about hypnotic use, insomnia symptoms, sleep duration, anxiety and depression before the intervention and at 4-5 months follow-up. In total, 125 patients (response rate 72.7%) completed the follow-up questionnaire. Interaction analyses indicated effects favoring the self-help book for hypnotic use and anxiety. The book reduced the proportion using hypnotics daily from 25.4% to 18.6%, while the proportion increased from 21.2% to 22.7% in the sleep hygiene group. The proportion reporting anxiety was reduced from 32.1% to 23.2% in the self-help book group, while it increased from 27.0% to 31.7% in the sleep hygiene group. Insomnia symptoms were lowered in both intervention groups, whereas depression remained unchanged. This study indicated that the self-help book was an effective low-threshold treatment option that seems to reduce hypnotic use and at the same time improve sleep and mental health. The patients who received sleep hygiene advice also reported some positive effects, but daily hypnotic use and anxiety increased.

Background Studies examining associations between injuries and outcomes like quality of life and psychological distress are important to understand a broader range of possible consequences of injuries for population health. Aims The aim of this study was to examine associations between self-reported injury and quality of life, psychological distress, sleeping problems, and global subjective health. Methods The sample was drawn from the Norwegian National Population Register. Data were collected among the general adult populations in three Norwegian counties in 2019–2020 (response rate 45.3%, n  = 74,030). Exposure variables were being injured during the last 12 months, cause of injury (if more than one, the most serious one), and functional impairment due to injuries. Outcome variables included measures of total quality of life, global quality of life, positive affect, negative affect, positive social relations, social capital (trust, belongingness, feeling safe), psychological distress, sleep problems, loneliness, and global subjective health. Data were analysed with General Linear Modelling in SPSS Complex. Results Reporting to have been injured once during the last 12 months was associated with slightly elevated levels of psychological distress, sleeping problems, and loneliness, and lower mean scores on quality-of-life indicators and global subjective health. Reporting being injured twice or more showed more pronounced contrasts to the reference group on the same outcomes, with Cohen’s d -values (absolute numbers) ranging from 0.17 to 0.54. For having been victim to violence, d -values ranged from 0.30 to 1.01. Moderate functional impairment due to injuries was associated with less favourable scores on all outcomes ( d ranging from 0.15 to 0.71). For strong functional impairment d -values ranged from 0.35 to 1.17. Conclusions Elevated levels of distress and reduced levels of quality of life are particularly associated with multiple injuries, being victim to violence, and functional impairment due to injuries. Prospective, longitudinal studies with high quality instruments and large samples, allowing adjustment for baseline values of outcome variables, and utilization of state-of-the-art statistical techniques, would bring this research closer to examining causality.

Background Nurses are in the frontline and play an important role in the battle against the COrona VIrus Disease-2019 (COVID-19) pandemic. Sleep problems among health care workers are likely to increase due to the pandemic. However, it is conceivable that negative health outcomes related to the pandemic fluctuate with the infection rate waves of the pandemic. The present study aimed to investigate sleep patterns among Norwegian nurses, after the first wave, during a period with very low rates of COVID-19. Methods Data stemmed from the cohort study “ SU rvey of S hift work, S leep and H ealth (SUSSH)” among Norwegian nurses. A total of 1532 nurses responded one time to a questionnaire between June and September in 2020 including items about demographics and work, information about COVID-19 and quarantine, sleep patterns and changes in sleep patterns due to the pandemic. Descriptive statistics for all relevant variables were calculated and McNemar tests were used to compare categorical variables. Results The majority of nurses (84.2%) reported no change in sleep duration after the first wave of the COVID-19 pandemic compared to before, 11.9% reported less sleep, and 3.9% reported more sleep. Similarly, 82.4% of the nurses reported no change in their sleep quality, whereas 16.2% of the nurses reported poorer sleep quality after the first wave of the pandemic compared to before. The majority of nurses reported no change in their sleep schedule due to the pandemic, although 9.6% of the nurses reported to go to bed later and 9.0% woke up earlier than before the pandemic. Conclusions Most existing literature exploring sleep among health care workers during the COVID-19 pandemic has been carried out during periods with high infection rates. In this study we aimed to investigate sleep patterns among Norwegian nurses following the first wave, during a period of low COVID-19 rates in Norway. Most of the nurses reported no change in neither sleep duration, sleep quality, bedtime, nor wake-up times compared to before the pandemic. Still, nearly 12% reported shorter sleep duration, and about 16% reported poorer sleep quality indicating that some nurses experienced worsening of their sleep following the pandemic.

Background Shift work, i.e., non-standard work hours, has been associated with both short- and long-term sickness absence. However, findings are inconsistent and inconclusive. Thus far, no comprehensive meta-analytic synthesis on the relationship between shift work and sickness absence has been published. The aims of the planned systematic review and meta-analysis are (1) to establish whether shift work is associated with sickness absence, (2) to determine if specific shift work characteristics relate to sickness absence (e.g., length and frequency of spells), and (3) to identify moderating factors affecting the relationship between shift work and sickness absence. Methods Eligible studies will be identified using a predefined search strategy in several electronic databases (MEDLINE, Web of Science, PsychInfo, EMBASE, and ProQuest) and comprise peer-reviewed papers reporting original empirical findings on the association between shift work and sickness absence. Mainly observational studies with cross-sectional, prospective, or retrospective research design and case-control studies will be included. Risk of bias will be assessed using an adapted checklist previously employed to evaluate studies on sickness absence. To carry out the meta-analytic synthesis, a random effects meta-analysis will be conducted using the Comprehensive Meta-Analysis software. The review and meta-analysis will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Heterogeneity will be evaluated by Cochran’s Q test and the I 2 statistics. Discussion The review and meta-analysis will be the first to conduct a meta-analytic synthesis of the evidence on the association between exposure to shift work and sickness absence, as well as identify relevant moderators affecting the relationship between shift work and sickness absence. Aggregation of the existing evidence will improve the knowledge on the association between shift work and sickness absence. Such knowledge can be used to guide scheduling of shift work to promote work schedules that are less detrimental to health and contribute to reduced sickness absence and higher work- and leisure-time productivity. Systematic review registration PROSPERO CRD42022301200

PurposeThe aim of this study was to investigate the effects of long working hours (≥ 12 h shifts) on sick leave using objective records of shift work exposure and of sick leave.MethodsA total of 1538 nurses (mean age 42.5, SD 12.0; response rate 42%) participated. Payroll and archival sick leave data over a 4-year period were retrieved from employers’ records and aggregated over every third calendar month. A multilevel negative binomial model was used to investigate the effects of exposure to long working hours, on subsequent sick leave rates the following 3 months. Covariates included prior sick leave, number of shifts worked, night and evening shifts, personality, and demographic characteristics.ResultsExposure to long working hours was associated with fewer sick leave days in the subsequent 3 months [adjusted model, incidence rate ratio (IRR) = 0.946, 95% CI 0.919–0.973, p < 0.001]. The interaction long working hours by a number of work days showed that sick leave days the subsequent 3 months was higher by long shifts when number of shifts was high compared to when number of shifts was low [adjusted model, IRR 1.002, 95% CI 1.000–1.004, p < 0.05].DiscussionLong working hours was associated with fewer sick leave days. The restorative effects of extra days off with long working hours are discussed as possible explanations to this relationship.

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

Background To examine whether weekday-to-weekend sleep duration (WWD) difference and specific WWD patterns are associated with mental and somatic health and academic performance in a student population. Methods This study utilized cross-sectional data from the SHoT-2018 survey which includes responses from 50,054 full-time university/college students in Norway. Participants completed online questionnaires and reported sleep duration separately for weekdays and weekends. Medium sleep duration was defined as 7 to 9 h, short sleep duration as < 7 h and long sleep duration as > 9 h. Regression analyses were used to examine whether the degree and patterns of WWD was associated with health-related outcomes and academic performance. Results The mean age of the sample was 23.2 years and comprised of 68.8% women. Most students (81.7%) slept longer on weekends compared to weekdays and 30.0% of the students reported a mean sleep duration shorter than 7 h. WWD difference was positively associated with higher odds of overweight/obesity, dissatisfaction with life, psychological distress, somatic burden and failed study exam. Concerning WWD patterns, the odds of students reporting unfavorably on the outcomes were particularly high for those who slept short on both weekdays and weekends, while those who slept short on weekdays seemed to benefit from sleeping longer (“catching up”) on weekends. Conclusions Overall, WWD was associated with adverse health outcomes for students. Short sleep duration both on weekday and weekend was associated with the most detrimental outcomes in terms of health and academic performance, while sleeping in on weekends may alleviate some of the detriments.