Effects on health of a change from a delaying to an advancing shift system
Open accessAbstract
OBJECTIVES--Shift work can lead to a range of problems for some people that seem to result from the disturbance of the circadian system, and can broadly be classified as: disturbances of sleep, impaired physical and psychological health, and disturbed social and domestic life. The main attempt to try to reduce these problems has focused on the design of the shift system, and the identification of the most problematic features of the shift system. One such feature is believed to be the direction of shift rotation. Systems that advance are thought to be more problematic than those that delay. The present study examines the change in the direction of shift rotation from a delaying to an advancing system on health and wellbeing. METHODS--Self reported measures of tolerance to shift work were taken two months before and six months after the change. These included sleep difficulties, gastrointestinal problems, psychological ill health, chronic fatigue, social and domestic disruption, job satisfaction, and satisfaction with the shift system. RESULTS--The change from a delaying to an advancing system resulted in an increase in sleep difficulties between successive afternoon shifts, but a decrease in social disruption. There was little evidence of impaired health on the advancing compared with the delaying system. CONCLUSIONS--The increase in sleep difficulties was thought to result from the undesired adaptation of the circadian system to night work, as a result of the afternoon shifts now following a series of night shifts, whereas previously they followed a series of morning shifts. The decrease in social disruption was thought to result from the specific sequence of the shifts and the discontinuous nature of the shift system, in particular, the long week-end off every third week. Lack of reported health related differences are explained in terms of the relatively unharmful nature of the shift system in question, and the relatively short time span over which the study was conducted.
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In Barton 1994, selective reporting was at low risk of bias because there was no evidence of selective reporting and results were probably reported as planned.
“Selective reporting (reporting bias) Low risk No evidence of selective reporting. Results were probably reported as planned.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
The Statistical Analyses section says that only significant differences are reported, contrary to the claim that there was no evidence of selective reporting. The paper does not establish that results were reported as planned. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn Barton 1994, the intervention was at low risk of being confounded by other changes over time because no other changes were mentioned.
“Intervention independent of other changes over time Low risk No other changes mentioned in the paper.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
The Discussion reports a change over time besides the shift intervention: the first assessment was in winter and the second in summer. The authors say this seasonal difference probably contributed to reduced sleep duration across all three groups, contrary to the claim that no other changes were mentioned. The paper does not, however, identify another concurrent workplace intervention. (LLM, conf=0.84)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn Barton 1994, blinding of outcome assessment for subjective measures was at high risk of bias because blinding was not feasible and all outcomes were subjectively measured and self-reported.
“Blinding of outcome assessment (detection bias) Subjective measures High risk Blinding of participants was not feasible, considering the nature of the intervention. All outcomes were subjectively measured and self‐reported.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
The Measures and Procedure sections describe self-administered, self-reported questionnaires completed by workers, supporting the account of subjective outcomes. The paper does not itself assess detection bias or state that blinding was infeasible; the high-risk rating is the citing authors’ assessment rather than a finding reported by Barton et al. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn Barton 1994, blinding of participants and personnel for subjective measures was at high risk of bias because blinding was not feasible given the nature of the intervention.
“Blinding of participants and personnel (performance bias) Subjective measures High risk Considering the nature of the intervention itself, blinding of participants was not feasible.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
The DESIGN AND CONTEXT and MEASURES sections describe a change in workers’ shift schedules assessed with self-reported questionnaires, supporting the subjective-measures context. The paper says workers did not know at baseline which system would change, but it does not state that later blinding was infeasible or assess performance bias as high risk; that rating is the citing authors’ assessment. (LLM, conf=0.79)
Experimental — accuracy not yet measuredThe review did not include Knauth 1998 or Barton 1994 in any meta-analyses due to insufficient available data.
“We did not include Knauth 1998 or Barton 1994 in any meta‐analyses due to insufficient available data: Knauth 1998 presented no data on relevant outcomes, while Barton 1994 did not report any measures of variability, such as SDs.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
In Barton 1994, appropriateness of statistical analyses was at low risk because data were analysed using change from baseline.
“Appropriateness of statistical analyses Low risk Data analysed using change from baseline.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
In Barton 1994, the intervention was at low risk of affecting data collection because there were no changes in data collection between the measurements.
“Intervention unlikely to affect data collection Low risk No changes in data collection between the measurements.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
In Barton 1994, reliability or objectivity of measurement for sleep length and quality was at high risk because outcomes were only assessed by subjective measures, with no objective measures such as actigraphy.
“Reliable or objective measurement of outcomes Sleep length and quality High risk Outcomes were only assessed by subjective measures. No objective measures such as actigraphy.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
In Barton 1994, incomplete outcome data for sleep length off-shift was at high risk of bias because of a high attrition rate (23% of the intervention group and 30% of the control group did not complete the study).
“Incomplete outcome data (attrition bias) Sleep length off‐shift High risk High attrition rate (23% of the intervention group and 30% of the control group did not complete the study).”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
In Barton 1994, incomplete outcome data for sleep quality off-shift was at high risk of bias because of a high attrition rate (23% of the intervention group and 30% of the control group did not complete the study).
“Incomplete outcome data (attrition bias) Sleep quality off‐shift High risk High attrition rate (23% of the intervention group and 30% of the control group did not complete the study).”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
In Barton 1994, baseline differences between groups were at high risk because study groups differed at baseline in relation to time to sleep and to sleep quality.
“Baseline differences between groups High risk Study groups differed at baseline in relation to time to sleep and to sleep quality.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
In Barton 1994, other bias was at low risk because no additional sources of bias were identified.
“Other bias Low risk We identified no additional sources of bias.”
From Adapting shift work schedules for sleep quality, sleep duration, and sleepiness in shift workers (2023) · cites this paper as Barton 1994
The Design and Context section describes the study design and acknowledges a short follow-up period, but does not assess an 'other bias' category. A search for bias and additional sources of bias found no passage stating that the study was at low risk or that no additional sources were identified. The quoted assessment appears to be the citing authors’ judgment, which our copy cannot verify. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Barton, J., Folkard, S., Smith, L., & Poole, C. J.
- Affiliations
- University of Sheffield (GB)
- ORCID
- Venue
- Occupational and Environmental Medicine
- Publisher
- BMJ
- Published
- 1994-11
- Volume
- 51
- Issue
- 11
- Pages
- 749-755
- ISSN
- 0007-1072 (ISSN-L)
- 1351-0711
- 1470-7926
- PMC
- PMC1128099
- OpenAlex
- W2131294673
- Cited by
- 42
- References
- 27
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 2 · 2021: 4 · 2020: 1 · 2018: 3 · 2017: 2 · 2016: 2 · 2015: 3 · 2012: 1
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Occupational and Environmental Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- shift work, circadian rhythm disruption, sleep disorders, gastrointestinal problems, mental illness, chronic fatigue, social disruption, job satisfaction, health and well-being
- MeSH terms
- Adult, Analysis of Variance, Circadian Rhythm, Fatigue, Female, Gastrointestinal Diseases, Humans, Job Satisfaction, Longitudinal Studies, Male, Surveys and Questionnaires, Sleep Wake Disorders, Time Factors, Work Schedule Tolerance
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