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BACKGROUND: Shift work affects the mental and physical health of nurses, yet the effect of working irregular shifts on sleep and its association with the need for recovery is under-explored. OBJECTIVE: The purpose of this study was to investigate the sleep quality of nurses working irregular shifts, including night shifts, and to determine whether sleep quality is associated with the need for recovery. METHODS: This cross-sectional study included 405 nurses working irregular shifts. Data were collected using an online questionnaire that included sociodemographic characteristics, the Sleep-Wake Experience List, sleep problems, sleep duration, and the Need for Recovery scale. Data analyses included descriptive statistics, chi-square tests, t-tests, logistic and multiple linear regressions. RESULTS: Nurses who worked irregular shifts had poor sleep quality. Those who also worked night shifts, had significantly poorer sleep quality and experienced more difficulties in daily functioning than those who did not work night shifts. Sleep quality was significantly associated with the need for recovery and this remained so after controlling for confounding variables (ß= .554, p = .001). CONCLUSION: The findings indicate that in nurses who work irregular shifts, the sleep quality is low. In this group, the sleep quality in nurses who work night shifts is lower than in nurses who do not work night shifts. Furthermore, better sleep quality was associated with lower need for recovery. These findings suggest that improving sleep quality in nurses working irregular shifts may lower their need for recovery, which may improve health, and reduce burnout and sickness absence.

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Given the obligatory nature of physical fitness training in the military and in order to guide intervention development, our study assessed possible motivational determinants as suggested by self-determination theory in addition to other possible determinants. A cross-sectional study was conducted among 218 military recruits during their basic training in Jordan. Physical activity and lifestyle behaviors were measured using the Arab Teens Lifestyle Study (ATLS). Psychosocial variables were assessed using the Exercise Self-Efficacy Scale (ESE), Behavioral Regulation Exercise Scale (BREQ-2) and Exercise Benefits/Barriers Scale (EBBS). Bivariate correlation analysis revealed that identified self-regulation, introjected regulation and exercise self-efficacy scores were positively associated with higher Metabolic Equivalent of Task (METs) and minutes per week of physical activity among male recruits and the overall sample respectively. Among females, only external regulation was positively associated with the total METs/week. Being a male was significantly associated with higher minutes of physical activity among the overall sample. Multivariate regression analyses showed that identified regulation was significantly and positively associated with higher minutes of physical activity among the overall sample and male recruits in addition to higher METs per week among the male recruits. Also, the amotivation score was significantly and positively associated with higher minutes of physical activity among the overall sample and male recruits. A multivariate regression analysis for female recruits showed no significant associations. Intervention developers are advised to increase autonomous forms of motivation through structured enjoyable physical fitness programs in order to enhance intrinsic motivation in the long term.

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AIMS: To assess the sleep strategies that nurses working irregular night shifts use to improve their sleep quality, and to compare the strategies of good and poor sleepers to determine whether the differences between the two groups could provide insights into possible effective strategies. DESIGN: A qualitative descriptive study. METHODS: The study was conducted from September 2019 to January 2020. Thirty-four nurses working irregular night shifts participated; 17 were classified as good sleepers and 17 as poor sleepers based on the Sleep-Wake Experience List, a validated self-report instrument that measures one's sleep quality. Interviews were conducted using open questions to explore strategies around the night-shift set. The interviews were analysed using thematic analysis. FINDINGS: Both groups described similar and different strategies that help them work and sleep well during and after night shifts. However, good sleepers mentioned a greater number of strategies and seemed to have thought about them more than poor sleepers. The most common strategies were having a clear structure, being organized-especially regarding sleeping time-maintaining a daily routine and adjusting their sleep environment. CONCLUSION: Healthcare institutions should consider offering education and training programs aimed at empowering nurses who work irregular night shifts. These programs should provide nurses with various sleep strategies to enhance their sleep quality and overall well-being. IMPLICATIONS FOR THE PROFESSION: Nurses working irregular night shifts can possibly enhance their sleep quality by making personalized plans, for example, including a clear day structure, or an optimized sleep environment. IMPACT: The study focused on how nurses working night shifts could possibly enhance their sleep quality. The findings highlight the importance of providing nurses with diverse sleep strategies to improve sleep quality, helping them to identify what works best for them and consistently apply these strategies. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: Nurses working irregular night shifts at Maastricht University Medical Center in Maastricht, the Netherlands, who agreed to participate in the study, engaged in a discussion to assess the relevance of sleep quality to their work. They were also encouraged to share their perspectives during the interviews.

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OBJECTIVES: This study examined the cross-sectional association between sleep duration, prediabetes, and type 2 diabetes, and its independence from the traditional lifestyle risk factors diet, physical activity, smoking behavior, and alcohol consumption. METHODS: Cross-sectional data from 5561 people aged 40-75 years recruited into The Maastricht Study between 2010 and 2018 were used (1:1 female:male and mean age: 60.1 years [standard deviation: 8.6]). Sleep duration was operationalized as in-bed time, algorithmically derived from activPAL3 accelerometer data (median 7 nights, IQR 1). Glucose metabolism status was determined with an oral glucose tolerance test. Multinomial logistic regression was used to assess the association of sleep duration as restricted cubic spline with prediabetes and type 2 diabetes. We adjusted for sex, age, educational level, the use of sleep medication or antidepressants, and the following lifestyle risk factors: diet quality, physical activity, smoking behavior, and alcohol consumption. RESULTS: A U-shaped association between sleep duration and type 2 diabetes was found. Compared to those with a sleep duration of 8 hours, participants with a sleep duration of 5 and 12 hours had higher odds of type 2 diabetes (OR: 2.9 [95% CI 1.9 to 4.4] and OR 3.2 [2.0 to 5.2], respectively). This association remained after further adjustment for the lifestyle risk factors (OR: 2.6 [1.7 to 4.1] and OR 1.8 [1.1 to 3.1]). No such association was observed between sleep duration and prediabetes. CONCLUSIONS: Both short and long sleep durations are associated positively and independently of lifestyle and cardiovascular risk factors with type 2 diabetes, but not with prediabetes.

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INTRODUCTION: It is important to understand the correlates of different dietary behaviors in a military context in the United Arab Emirates (UAE) to guide intervention development to prevent and treat obesity as it has a significant impact at the country and regional level. This study aimed to assess different dietary behaviors and their association with potential correlates including age, marital status, educational level, smoking status, screen time, dietary knowledge, eating self-efficacy, and general self-efficacy. MATERIALS AND METHODS: The study used a cross-sectional design and included 153 (M = 25.9 years, SD = ± 3.2) military recruits completing their basic training at a single military camp in the UAE. Dietary behaviors of these recruits were measured using the Arab Teens Lifestyle Study. Other potential correlates included dietary knowledge, general self-efficacy, and eating efficacy. The ethical approval was obtained from the research ethics committee in the UAE university. RESULTS: Daily intake of fruits, vegetables, and breakfast was reported by 14.4%, 25.5%, and 22.9% of the military recruits, respectively. Almost half of the recruits (46.4%) consumed sugar-sweetened drinks more than 3 times a week, 39.2% consumed fast food more than 3 times a week, and 37.3% consumed sweets/chocolates more than 3 times a week. Bivariate regression analyses revealed that eating self-efficacy was positively associated with breakfast and dairy food consumption, although it was inversely associated with sugar, fast-food, and French fries intake. Age was significantly and inversely associated with sugar, fast-food, and energy drink intake. Moreover, nutrition knowledge was significantly and positively correlated with vegetable intake and negatively correlated with energy drink consumption. Multiple regressions showed that lower age and lower eating self-efficacy were found to be the main predictors for sugar-sweetened drinks (adjusted R2 = 0.112) and fast-food intake (adjusted R2 = 0.084). Also, a higher dietary knowledge score was a predictor of vegetable intake (adjusted R2 = 0.093), although age and smoking predict energy drink intake (adjusted R2 = 0.225). CONCLUSIONS: The results show that unhealthy eating patterns are common among new recruits in the UAE military. The study suggests that age, eating self-efficacy, and nutrition knowledge are the main correlates of selected dietary behaviors. Interventions are advised to target these correlates to achieve healthier dietary habits inside the military.

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Fatigue is a distressing complaint with high detriment to quality of life that persists in one-third of colorectal cancer survivors after cancer treatment. Previous studies in mixed groups of cancer patients have suggested sleep quality is associated with fatigue. We aimed to investigate this association in colorectal cancer survivors up until two years post-treatment. Data on n = 388 stage I-III colorectal cancer patients were utilized from the EnCoRe study. Sleep quality and fatigue were measured at 6 weeks and 6, 12, and 24 months post-treatment. Sleep quality was measured using the Pittsburgh Sleep Quality Index (cross-sectional analysis only) and the single-item insomnia scale from the EORTC QLQ-C30. Fatigue was measured by the Checklist Individual Strength. Linear and mixed-model regression analyses analysed associations between sleep quality and fatigue cross-sectionally and longitudinally. Longitudinal analysis revealed worsening sleep quality over time was significantly associated with increased levels of fatigue over time (ß per 0.5 SD increase in the EORTC-insomnia score = 2.56, 95% Cl: 1.91, 3.22). Significant cross-sectional associations were observed between worse sleep quality and higher levels of fatigue at all time points. Worse sleep quality in colorectal cancer patients was associated with higher levels of fatigue during the first two years post-treatment.

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Sleep is receiving increasing attention in public health. The aim of this umbrella review is to determine what non-pharmacological sleep health interventions have been evaluated among healthy populations, by examining target groups, settings, and effectiveness in improving sleep quality and duration. Comprehensive searches were conducted in five electronic databases (January 1975-February 2019), yielding 6505 records. Thirty-five articles were selected meeting the following eligibility criteria: (1) systematic reviews or meta-analyses of (2) sleep health interventions in (3) primarily healthy populations. Two reviewers independently screened for inclusion, extracted the data, and assessed the review quality. This umbrella review was registered with PROSPERO (CRD42019126291). Eleven intervention types were defined, and their effectiveness discussed. Substantial evidence demonstrated the effectiveness of later school start times, behavior change methods, and mind-body exercise. Other intervention types, including sleep education or relaxation techniques, demonstrated some promising impacts on sleep, but with less consistent evidence. Results were limited by high heterogeneity between studies, mixed results, and variable review quality. Nevertheless, this umbrella review is a first step towards understanding the current state of sleep health promotion and gives an overview of interventions across the lifespan.

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Obesity is a serious public health concern in the Gulf States. Students are exposed to many unhealthy weight-related behaviors due to college life. However, research that gives insight into regional and culture-specific aspects and determinants of weight-related behaviors in students is lacking. The purpose of this study was to explore the potential determinants of weight change, eating behaviors, physical activity, sedentary behaviors, and sleep behaviors in Saudi university students. Five semi-structured focus group discussions guided by Social Cognitive Theory were conducted, consisting of 33 male university students 20 to 22 years old. The data were transcribed, coded, and organized according to themes. The students reported weight gain due to personal, social, and environmental factors related to university lifestyle, such as unhealthy eating behaviors, low physical activity, high sedentary behaviors, and inadequate sleep. Both eating behaviors and physical activity shared similar personal aspects found in other studies, such as knowledge, stress, lack of time, and lack of motivation. However, there were some unique social and environmental factors in the region, such as the social norms, cultural aspects, weather conditions, passive transport dependency, and khat consumption, compared with studies worldwide. Such differences are key factors to developing effective interventions in the future.

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BACKGROUND: Samoa is suffering from alarming rates of noncommunicable diseases (NCDs). To address this epidemic, tackling health literacy is important. A qualitative study was conducted with the aim to explore health literacy in Samoa in relation to NCDs. METHODS: Six focus groups were conducted, with a total sample size of 73 participants aged over 18 years. The semi-structured interview guide was based on the conceptual model of the European Health Literacy project (HLS-EU). Data was translated, transcribed, coded, and categorized as part of the qualitative analysis. RESULTS: The analysis resulted in one overarching category and seven sub-categories based on 19 themes. It revealed that health literacy in Samoa is strongly influenced by the culture. Personal responsibility is lacking. The family circle is central to health in a community where support is provided through the church and local groupings. Basic knowledge of NCDs was present in the population, but a deeper understanding of chronic disease implications was lacking. Difficulties with regards to medication adherence for chronic diseases arose as a topic, and traditional healers are still strongly embedded in the local society. Finally, the health system's performance, especially primary care services at the local level, is suffering from the high burden of NCDs and has been challenged to respond to the needs of the community it serves. CONCLUSION: The findings of this study show how health literacy in Samoa is influenced by culture and suggest employing participatory, culture-sensitive, public health interventions which address the family as a whole, building on health literacy to address major public health problems like NCDs and remove barriers in the health system.

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Obesity has increased to an epidemic level in the Gulf States. This systematic review is the first to explore the scientific evidence on correlates and interventions for overweight (body mass index [BMI] ≥ 25) or weight-related behaviours in the region. A systematic search of peer-reviewed articles was conducted using PubMed and PsycINFO. Ninety-one studies were eligible for this review including 84 correlate studies and seven intervention studies. Correlate studies of overweight focused on sociodemographic factors, physical activity, and dietary habits. Low physical activity, sedentary behaviour, and unhealthy dietary habits were associated with overweight. The most-reported sociodemographic correlates of overweight were increased age, being married, low education, urban residence, and unemployment. Correlate studies of physical activity and dietary behaviours mostly focused on sociodemographic variables. Being female and increased age (the latter less consistently) were associated with low physical activity. Interventions were very heterogeneous with respect to the target group, intensity, and behavioural strategies used. The effectiveness of interventions was difficult to evaluate because of the chosen study design or outcome measure, the small sample size, or high attrition rate. Few studies have investigated sociocognitive and environmental determinants of weight-related behaviours. Such information is crucial to developing health promotion initiatives that target those weight-related behaviours.

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BACKGROUND: Research has been conducted to assess the effectiveness of weight management, dietary and physical activity interventions in military settings. However, a recent and comprehensive overview is lacking. The aim of this systematic review is to examine the evidence and describe key components of effective interventions in terms of improving body composition, dietary behaviors, and physical activity among active-duty military personnel. METHODS: PubMed, PsycInfo, and CINAHL were searched on the 17th of November 2017 to identify interventions that promoted diet and/or physical activity among active-duty military personnel. Studies were included if they assessed outcomes related to anthropometric measurements, dietary behaviors, or fitness/physical activity levels. There were no restrictions regarding publication date, follow-up duration, and sex. After screening, a total of 136 studies were eligible. Of these studies, 38 included an educational and/or behavioral change component, and 98 had only physical or fitness training as part of basic military training. Only studies that included an educational and/or behavioral change component were assessed for quality using the Effective Public Health Practice Project tool and included in the qualitative synthesis of the results. RESULTS: Based on consistent evidence from studies that were rated as moderate or strong, there is good evidence that military weight management interventions are effective in improving body composition for durations of up to 12 months. Effective interventions are more likely to be high intensity (have a greater number of sessions), are more often delivered by specialists, and use theoretical base/behavioral change techniques and a standardized guideline. Dietary interventions can potentially reduce total fat and saturated fat intake. Dietary interventions that target the kitchen staff and/or increase the availability of healthy food are more likely to be effective in the short term. The results regarding military physical fitness interventions were inconclusive. CONCLUSION: Despite limitations such as the diversity and heterogeneity of the included interventions, outcome measurements, and follow-up duration, this systematic review found good evidence that weight management interventions are effective, especially in terms of weight loss. More studies are needed to acquire solid evidence for effectiveness for durations longer than 12 months and to identify key components of the effective dietary and physical activity educational and/or behavioral change interventions, especially in countries outside Europe and the US.

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PROBLEM: Samoa has been struggling to address the burden of noncommunicable diseases at the health system, community and individual levels. APPROACH: The World Health Organization (WHO) package of essential noncommunicable disease interventions for primary health care in low-resource settings was adopted in seven villages throughout Samoa in 2015. The National Steering Committee Members designed and implemented a screening process, and local facilitators and health-care workers collected health and lifestyle data. The WHO/International Society of Hypertension risk assessment was used on villagers older than 40 years to identify people at high risk of noncommunicable disease. LOCAL SETTING: Samoa is a small island developing state with increasing morbidity and mortality due to noncommunicable diseases. A national representative survey indicated that 50.1% (595/1188) of the Samoan adult population is at high risk of such diseases. High numbers of noncommunicable diseases are undiagnosed or untreated, because of shortage of health-care staff and lack of awareness of risk factors. RELEVANT CHANGES: The teams collected data from 2234 adults. For people older than 40 years, 6.7% (54/804) were identified as being at high-risk and were encouraged to seek treatment or manage risk factors. Community members developed an awareness programme to improve understanding of lifestyle risk factors. LESSONS LEARNT: Engaging community members was crucial in conducting a successful screening campaign. By identifying those villagers at high risk of developing noncommunicable diseases, early intervention was possible. Education improved awareness of the symptom-free nature of early-stage noncommunicable diseases.

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Implementation of health education programs is often inadequately considered or not considered at all in planning, developing and evaluating interventions. With the focus being predominantly on the adoption stage, little is known about the factors influencing the implementation and continuation stages of the diffusion process. This study contributes to the understanding of factors that promote or impede each stage of the diffusion process in the school setting using the sex education program Long Live Love (LLL) as an example. A survey integrating different diffusion-related concepts was completed by 130 teachers. Results showed that teacher curriculum-related beliefs were associated with all stages in the diffusion process. Although adoption of LLL was predominantly related to teacher curriculum-related beliefs, implementation completeness and fidelity and continued use of LLL were also enhanced by contextual factors, namely teacher training and interactive context variables (school policy, governing body support and student response), respectively. The results of this study can be used to optimize the adoption, implementation and continuation of school-based (sexual) health promotion programs.

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BACKGROUND: 'An ounce of prevention is worth a pound of cure' is a common saying, and indeed, most health economic studies conclude that people are more willing to pay for preventive measures than for treatment activities. This may be because most health economic studies ask respondents to compare preventive measures with treatment, and thus prompt respondents to consider other uses of resources. However, psychological theorizing suggests that, when methods do not challenge subjects to consider other uses of resources, curative treatment is favored over prevention. Could it be that while prevention is praised, cure is preferred? METHODS: In two experimental studies, we investigated, from a psychological perspective and using a between-subjects design, whether prevention or treatment is preferred and why. In both studies, participants first read a lung cancer prevention or treatment intervention scenario that varied on the prevention-treatment dimension, but that were the same on factors like 'costs per saved life' and kind of disease. Then participants completed a survey measuring appreciation (general and monetary) as well as a number of potential mediating variables. RESULTS: Both studies clearly demonstrated that, when the design was between-subjects, participants had greater (general and monetary) appreciation for treatment interventions than for preventive interventions with perceived urgency of the intervention quite consistently mediating this effect. Differences in appreciation of treatment over preventive treatment were shown to be .59 (Study 1) and .45 (Study 2) on a 5-point scale. Furthermore, participants thought that health insurance should compensate more for the treatment than for preventive measures, differences of 16% (Study 1), and 22% (Study 2). When participants were asked to directly compare both interventions on the basis of a short description, they preferred the preventive intervention. CONCLUSION: It appears that people claim to prefer prevention when they are asked to consider other use of resources, but otherwise they prefer treatment. This preference is related to perceived urgency. The preference for treatment may be related to the prevention-treatment dimension itself, but also to variations on other dimensions that are inherently linked to prevention and treatment (like different efficacy rates and costs per treatment).

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Various authors (e.g. Kahnemann, D., & Tversky, A. (1982). The simulation heuristic. In D. Kahnemann, P. Slovic, & A. Tversky (Eds.), Judgment under uncertainty: Heuristics and biases (pp. 201-208). New York, NY: Cambridge University Press) have suggested that imagining an event and its consequences influences the perceived likelihood that it might happen in reality (simulation heuristic). A scenario--a description of how a certain activity can lead to a certain outcome--may stimulate one to imagine the outcomes and may influence one's likelihood judgement. The present research studied the effect of risk scenarios on perceptions of susceptibility to sexually transmitted infections and the role of imaginability therein. In a randomised experimental study, we examined the effects of a prefabricated risk scenario and a self-constructed risk scenario against a non-message condition on perceived susceptibility to get infected with Chlamydia. Participants considered themselves more susceptible to Chlamydia after writing their own risk scenario but not after reading the prefabricated risk scenario. The imaginability of the event seemed to mediate the effect of self-constructed scenario information on perceived susceptibility. Recommendations for health education practices are discussed.

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The efficacy of a tailored, web-based intervention communicating the risks of sexually transmitted infections (STI) for heterosexual young adults was examined in a randomised, controlled trial. The main aims of the relationship-oriented intervention were to influence risk perceptions and to promote (maintenance of) condom use and STI-testing among young adults who reported being recently engaged in a heterosexual relationship. The intervention addressed risk perceptions, attitudes, normative beliefs, self-efficacy and skills related to condom use and STI-testing. Outcomes were compared immediately after the intervention (N = 171) and 3 months later (N = 115) to a non-tailored intervention group and to a control group. Cognitive and behavioural outcomes showed that the tailored intervention was efficacious in influencing perceived susceptibility to STI and STI-testing intentions immediately after the intervention, and in reducing rates of unprotected sex at 3 months.

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When people underestimate a risk, often probability information is communicated because of the implicit assumption that it will raise people's risk estimates as a result of these objective facts. Also, scientific literature suggested that stressing the cumulative aspects of a risk might lead to higher susceptibility perceptions than only emphasizing the single incident probability. Empirical evidence that supports the effectiveness of these strategies, however, is lacking. In two studies, we examined whether cumulative and single incident probability information on sexually transmitted infections leads to higher perceived susceptibility for Chlamydia and HIV. Contrary to assumptions and recommendations, results showed that both types of probability information may result in people feeling less susceptible toward Chlamydia and having less intention to reduce the risk. For HIV, no effects were found. These results contradict implicit assumptions and explicit recommendations concerning the effects of probability information on risk perceptions.

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BACKGROUND: Little is known regarding which behavioural responses can be expected if an influenza pandemic were to occur. METHODS: A survey comprising questions based on risk perception theories, in particular PMT, was conducted with a Dutch sample. RESULTS: Although fear that an influenza pandemic may occur was high, participants do not feel well informed. General practitioners and local health authorities were considered trustworthy sources of information and the information considered most urgent pertained to which protective measures should be taken. Participants reported an intention to comply with recommendations regarding protective measures. However, response and self efficacy were low. Maladaptive behaviours can be expected. Increasing numbers of ill individuals and school closures are also expected to lead to a decreased work force. Participants indicated wanting antiviral drugs even if the supply were to be insufficient. CONCLUSIONS: Messages regarding health protective behaviours from local health authorities should anticipate the balance between overreacting and underreacting. Also, when protective recommendations from health professionals conflict with company policies, it is unclear how employees will react.

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The simulation heuristic of Kahnemann and Tversky (1982) suggests that the subjective ease by which a risky situation can be mentally construed, positively influences the person's perceived susceptibility to the presented threat. Assuming that a detailed outline of how a risky event can end up negatively increases the ease of imagination, we tested the hypothesis that scenario-based risk information enhances perceived susceptibility towards contracting a sexually transmitted infection (STI). In an experimental design, undergraduate students were exposed to one or two risk scenario messages or no scenario message (control). The results confirmed the hypothesis, but only when more than one risk scenario message was provided. This adds to the evidence that presenting scenario-based messages could be a feasible method to influence risk perceptions.

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