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Association of circadian expression of cortisol in nurses accordingly to shiftwork, occupational stress and fatigue

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Dnieber Chagas de Assis
Total Authors: 1
Document type: Doctoral Thesis
Press: Ribeirão Preto.
Institution: Universidade de São Paulo (USP). Escola de Enfermagem de Ribeirão Preto (PCARP/BC)
Defense date:
Examining board members:
Maria Helena Palucci Marziale; Samara dos Santos Rodrigues Gomes; Daiane Dal Pai; Maria Lucia do Carmo Cruz Robazzi; Fernanda Ludmilla Rossi Rocha
Advisor: Maria Helena Palucci Marziale

Night-work and shiftwork are identified as maximizing negative effects on worker health, such as stress and fatigue, by making it difficult to adapt the circadian rhythm of cortisol to work. Objective: to investigate the effect of the fixed and alternating and nocturnal shifts of nurses on the occupational stress index, fatigue and circadian expression of salivary cortisol. Method: observational, cross-sectional and quantitative study based on Cooper\'s theoretical framework. Performed with 104 nurses from the emergency units and surgical center of a public teaching hospital in the State of São Paulo and another from Minas Gerais, from January to March, 2017. Stress and fatigue indexes were measured using two instruments, the Nurses\' Stress Inventory and the Fatigue Assessment Scale, both of which were validated and salivary cortisol quantification was performed by ELISA assay. The project was approved by the Research Ethics Committee under protocol. 55695416.7.0000.5393. Results: 66.67% of the nurses worked on alternating shifts and 39.39% were fixed on the morning shift. It was found that 50.8% of the nurses had a high stress index and 46.03% presented fatigue. There were no statistically significant associations between salivary cortisol index, shiftwork, fixed or alternating shift scheme, stress and fatigue. However, nursing professionals from critical units who worked in an alternating and morning shift schedule showed a trend towards higher levels of stress and fatigue and lower cortisol secretion throughout the workday than fixed and night shift workers. Fatigue was significantly and positively correlated to overall morning cortisol. Conclusions: The findings of the present study provide evidence of a hypothalamic-pituitary-adrenal axis desynchronization in nurses of the alternating and morning shift and, consequently, a greater susceptibility of these to the development of cardiac, metabolic and immunological diseases (AU)