Shift and Night Work in Technology Intensive Environment as a Health Hazard

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Abstract

Flexible workday arrangement is a common management practice in the modern technology intensive society. The impact of shift work in night hours on human health has been a subject of a broad range of fundamental and applied studies in occupational medicine and in other fields. Epidemiological data and a body of research findings suggest that shift workers are prone to various pathologies. This paper summarizes current views on the link between shift and night work and the risk of chronic noncommunicable diseases (NCDs), which are a leading cause of morbidity and mortality among working population and are therefore a top priority. Systematic reviews and meta-analyses present strong evidence that shift workers have a higher risk of malignant tumors (breast cancer, prostate cancer, colorectal cancer), coronary heart disease, and type 2 diabetes compared to daytime-only workers. There are, however, individual differences in the risk of NCDs that may depend on the length of employment and other circumstances. Also, factors are discussed that can modify the impact of shift work on the risk of associated pathologies, such as chronotype, changing length of night shifts, proper shift rotation, sufficient rest between shifts, etc. Mechanisms of genetic regulation of individual circadian rhythms and sleep-wake cycle are a crucial element in the conceptual model of influence of night work on body. Insufficient adaptation and plasticity of the circadian system may cause desynchronization between external time and inner biorhythms in shift workers; this is accompanied with changes in circadian genes expression and may lead to pathologies. If disturbed circadian rhythms are the main factor of etiopathogenesis, the term “circadian-related disease” should be used. Deep understanding of the link between circadian desynchronosis and health problems in shift workers is important to implement ‘circadian safety’ measures, i.e. to protect workers from negative consequences of disturbed individual biorhythms that may affect their work capacities and life quality. This will require standard protocols to study circadian disturbances, standard tools and methods to diagnose circadian rhythms in workers, resolving issues of interpretation in respect of occupational capacity, research on proneness and tolerance of workers to circadian-related problems, finding pharmacological and physical approaches to reduce circadian disturbances, considering special aspects of drug therapy of desynchronosis.

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About the authors

Svetlana G. Gorokhova

Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: cafedra2004@mail.ru
ORCID iD: 0000-0001-7087-8140
SPIN-code: 1272-5072

MD, PhD, Professor

Russian Federation, Moscow

Oleg Yu. Atkov

Russian Medical Academy of Continuous Professional Education

Email: AtkovOYU@rmapo.ru
ORCID iD: 0000-0002-5211-2560

MD, PhD, Professor, Academician of the RAS

Russian Federation, Moscow

References

  1. Working conditions in a global perspective. Geneva (Switzerland): International Labour Organization. 2019. doi: https://doi.org/10.2806/870542
  2. Атьков О.Ю., Цфасман А.З., и др. Профессиональная биоритмология. — М.: Эксмо, 2019. —192 с. [Atkov O, Tsfasman A, i dr. Professional’naya bioritmologiya. Moscow: Eksmo; 2019. 192 s. (In Russ.)]
  3. Boivin DB, Boudreau P, Kosmadopoulos A. Disturbance of the Circadian System in Shift Work and Its Health Impact. J Biol Rhythms. 2022;37(1):3–28. doi: https://doi.org/10.1177/07487304211064218
  4. Alterman T, Luckhaupt SE, Dahlhamer JM, et al. Prevalence rates of work organization characteristics among workers in the U.S.: data from the 2010 National Health Interview Survey. Am J Ind Med. 2013;56(6):647–659. doi: https://doi.org/10.1002/ajim.22108
  5. Vetter C. Circadian disruption: What do we actually mean? Eur J Neurosci. 2020;51(1):531–550. doi: https://doi.org/10.1111/ejn.14255
  6. Okun ML. Night-Shift Workers and Health. Encyclopedia of Behavioral Medicine. Gellman MD (ed.). Geneva, Switzerland: Springer; 2017. P. 1337–1338.
  7. Трудовой кодекс РФ от 30.12.2001 № 197-ФЗ (с изм.). Гл. 16. [Trudovoj kodeks RF ot 30.12.2001 Nо. 197-FZ (s izmeneniyami). Glava 16. (In Russ.)]
  8. Конвенция Международной организации труда «О ночном труде» № 171, 1990 (ред. от 26.06.1990; действует с 04.01.1995). [Konvenciya Mezhdunarodnoj organizacii truda “O nochnom trude” No. 171, 1990 (redakciya ot 26.06.1990; dejstvuet s 04.01.1995). (In Russ.)] Available from: https://normativ.kontur.ru/document?moduleId=1&documentId=404113
  9. Национальный стандарт РФ ГОСТ Р 70675-2023 «Системы менеджмента безопасности труда и охраны здоровья. Руководство по оценке риска для здоровья работников» (дата введения 01.05.2023). [Nacional’nyj standart Rossijskoj Federacii GOST R 70675-2023 “Sistemy menedzhmenta bezopasnosti truda i ohrany zdorov’ya. Rukovodstvo po ocenke riska dlya zdorov’ya rabotnikov” (data vvedeniya 01.05.2023). (In Russ.)] Available from: https://allgosts.ru/
  10. Р 2.2.2006-2005 Руководство по гигиенической оценке факторов рабочей среды и трудового процесса. Критерии и классификация условий труда (дата введения 01.11.2005). [R 2.2.2006-2005 Rukovodstvo po gigienicheskoj ocenke faktorov rabochej sredy` i trudovogo processa. Kriterii i klassifikaciya uslovij truda (data vvedeniya 01.11.2005). (In Russ.)] Available from: https:// normativ.kontur.ru/document?moduleId=1&documentId=92758&ysclid=lu1ngeu5tr50938000
  11. Stevens RG, Hansen J, Costa G, et al. Considerations of circadian impact for defining “shift work” in cancer studies: IARC Working Group Report. Occup Environ Med. 2011;68(2):154–162. doi: https://doi.org/10.1136/oem.2009.053512
  12. Приказ Министерства здравоохранения РФ от 28.01.2021 № 29н (ред. от 01.02.2022) «Об утверждении Порядка проведения обязательных предварительных и периодических медицинских осмотров работников, предусмотренных частью четвертой статьи 213 Трудового кодекса Российской Федерации, Перечня медицинских противопоказаний к осуществлению работ с вредными и (или) опасными производственными факторами, а также работам, при выполнении которых проводятся обязательные предварительные и периодические медицинские осмотры» (зарегистрирован Министерством юстиции РФ 29.01.2021 № 62277). [Prikaz Ministerstva zdravoohraneniya Rossijskoj Federacii ot 28.01.2021 № 29n (red. ot 01.02.2022) “Ob utverzhdenii Poryadka provedeniya obyazatel’nyh predvaritel’nyh i periodicheskih medicinskih osmotrov rabotnikov, predusmotrennyh chast’yu chetvertoj stat’i 213 Trudovogo kodeksa Rossijskoj Federacii, Perechnya medicinskih protivopokazanij k osushchestvleniyu rabot s vrednymi i (ili) opasnymi proizvodstvennymi faktorami, a takzhe rabotam, pri vypolnenii kotoryh provodyatsya obyazatel’nye predvaritel’nye i periodicheskie medicinskie osmotry” (zaregistrirovan Ministerstvom yusticii Rossijskoj Federacii 29.01.2021 Nо. 62277). (In Russ.)]
  13. Wang Y, Yu L, Gao Y, et al. Association between shift work or long working hours with metabolic syndrome: a systematic review and dose-response meta-analysis of observational studies. Chronobiol Int. 2021;38(3):318–333. doi: https://doi.org/10.1080/07420528.2020.1797763
  14. Gao Y, Gan T, Jiang L, et al. Association between shift work and risk of type 2 diabetes mellitus: a systematic review and dose-response meta-analysis of observational studies. Chronobiol Int. 2020;37(1):29–46. doi: https://doi.org/10.1080/07420528.2019.1683570
  15. Manohar S, Thongprayoon C, Cheungpasitporn W, et al. Associations of rotational shift work and night shift status with hypertension: a systematic review and meta-analysis. J Hypertens. 2017;35(10):1929–1937. doi: https://doi.org/10.1097/HJH.0000000000001442
  16. Torquati L, Mielke GI, Brown WJ, et al. Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose-response relationship. Scand J Work Environ Health. 2018;44(3):229–238. doi: https://doi.org/10.5271/sjweh.3700
  17. Manouchehri E, Taghipour A, Ghavami V, et al. Night-shift work duration and breast cancer risk: an updated systematic review and meta-analysis. BMC Womens Health. 2021;21(1):89. doi: https://doi.org/10.1186/s12905-021-01233-4
  18. Dun A, Zhao X, Jin X, et al. Association between night-shift work and cancer risk: updated systematic review and meta-analysis. Front Oncol. 2020;10:1006. doi: https://doi.org/10.3389/fonc.2020.01006
  19. Wei F, Chen W, Lin X. Night-shift work, breast cancer incidence, and all-cause mortality: an updated meta-analysis of prospective cohort studies. Sleep Breath. 2022;26(4):1509–1526. doi: https://doi.org/10.1007/s11325-021-02523-9
  20. Cai C, Vandermeer B, Khurana R, et al. The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol. 2019;221(6):563–576. doi: https://doi.org/10.1016/j.ajog.2019.06.051
  21. Stenger S, Grasshoff H, Hundt J, et al. Potential effects of shift work on skin autoimmune diseases. Front Immunol. 2023;13:1000951. doi: https://doi.org/10.3389/fimmu.2022.1000951
  22. Night shift work. IARC Working Group on the identification of carcinogenic hazards to humans. Lyon (FR): International Agency for Research on Cancer; 2020.
  23. Niedhammer I, Coutrot T, Geoffroy-Perez B, et al. Shift and Night Work and All-Cause and Cause-Specific Mortality: Prospective Results From the STRESSJEM Study. J Biol Rhythms. 2022;37(3): 249–259. doi: https://doi.org/10.1177/07487304221092103
  24. Szkiela M, Kusideł E, Makowiec-Dąbrowska T, et al. How the Intensity of Night Shift Work Affects Breast Cancer Risk. Int J Environ Res Public Health. 2021;18(9):4570. doi: https://doi.org/10.3390/ijerph18094570
  25. Hong J, He Y, Fu R, et al. The relationship between night shift work and breast cancer incidence: A systematic review and meta-analysis of observational studies. Open Med (Wars). 2022;17(1):712–731. doi: https://doi.org/10.1515/med-2022-0470
  26. Ijaz S, Verbeek J, Seidler A, et al. Night-shift work and breast cancer — A systematic review and meta-analysis. Scand J Work Environ Health. 2013;39(5):431–447. doi: https://doi.org/10.5271/sjweh.3371
  27. Cordina-Duverger E, Menegaux F, Popa A, et al. Night shift work and breast cancer: a pooled analysis of population-based case-control studies with complete work history. Eur J Epidemiol. 2018;33(4):369–379. doi: https://doi.org/10.1007/s10654-018-0368-x
  28. Su F, Huang D, Wang H, et al. Associations of shift work and night work with risk of all-cause, cardiovascular and cancer mortality: a meta-analysis of cohort studies. Sleep Med. 2021;86:90–98. doi: https://doi.org/10.1016/j.sleep.2021.08.017
  29. Li M, Huang JT, Tan Y, et al. Shift work and risk of stroke: A meta-analysis. Int J Cardiol. 2016;214:370–373. doi: https://doi.org/10.1016/j.ijcard.2016.03.052
  30. Jørgensen JT, Karlsen S, Stayner L, et al. Shift work and overall and cause-specific mortality in the Danish nurse cohort. Scand J Work Environ Health 2017;43(2):117–26. doi: https://doi.org/10.5271/sjweh.3612
  31. Bigert C, Kader M, Andersson T, et al. Night and shift work and incidence of cerebrovascular disease — a prospective cohort study of healthcare employees in Stockholm. Scand J Work Environ Health. 2022;48(1):31–34. doi: https://doi.org/10.5271/sjweh.3986
  32. Kader M, Selander J, Andersson T, et al. Night and shift work characteristics and incident ischemic heart disease and atrial fibrillation among healthcare employees — a prospective cohort study. Scand J Work Environ Health. 2022;48(7):520–529. doi: https://doi.org/10.5271/sjweh.4045
  33. Åkerstedt T, Narusyte J, Svedberg P. Night work, mortality, and the link to occupational group and sex. Scand J Work. Environ Health. 2020;46(5):508–515. doi: https://doi.org/10.5271/sjweh.3892
  34. Eriksson HP, Söderberg M, Neitzel RL, et al. Cardiovascular mortality in a Swedish cohort of female industrial workers exposed to noise and shift work. Int Arch Occup Environ Health. 2021;94(2):285–293. doi: https://doi.org/10.1007/s00420-020-01574-x
  35. Cheng M, He H, Wang D, et al. Shift work and ischaemic heart disease: meta-analysis and dose-response relationship. Occup Med. 2019;69(3):182–188. doi: https://doi.org/10.1093/occmed/kqz020
  36. Wang N, Sun Y, Zhang H, et al. Long-term night shift work is associated with the risk of atrial fibrillation and coronary heart disease. Eur Heart J. 2021;42(40):4180–4188. doi: https://doi.org/10.1093/eurheartj/ehab505
  37. Hermansson J, Bøggild H, Hallqvist J, et al. Interaction between Shift Work and Established Coronary Risk Factors. Int J Occup Environ Med. 2019;10(2):57–65. doi: https://doi.org/10.15171/ijoem.2019.1466
  38. Havakuk O, Zukerman N, Flint N, et al. Shift Work and the Risk of Coronary Artery Disease: A Cardiac Computed Tomography Angiography Study. Cardiology. 2018;139(1):11–16. doi: https://doi.org/10.1159/000481088
  39. Rivera AS, Akanbi M, O’Dwyer LC, McHugh M. Shift work and long work hours and their association with chronic health conditions: A systematic review of systematic reviews with meta-analyses. PLoS One. 2020;15(4):e0231037. doi: https://doi.org/10.1371/journal.pone.0231037
  40. Wang D, Ruan W, Chen Z, et al. Shift work and risk of cardiovascular disease morbidity and mortality: A dose-response meta-analysis of cohort studies. Eur J Prev Cardiol. 2018;25(12):1293–1302. doi: https://doi.org/10.1177/2047487318783892
  41. Vetter C, Devore EE, Wegrzyn LR, et al. Association between rotating night shift work and risk of coronary heart disease among women. JAMA. 2016;315(16):1726–1734. doi: https://doi.org/10.1001/jama.2016.4454
  42. Li Q, Li R, Zhang S, et al. Occupational physical activity and new-onset hypertension: a nationwide cohort study in China. Hypertension 2021;78(1):220–229. doi: https://doi.org/10.1161/HYPERTENSIONAHA.121.17281
  43. Zhu JL, Liu MY, Qin QR, et al. Association between Night Shift and Hypertension: A Cross-Sectional Study in Chinese Adults. J Occup Environ Med. 2023;65(2):e36–e42. doi: https://doi.org/10.1097/JOM.0000000000002749
  44. Dicom AR, Huang X, Hilal S. Association between Shift Work Schedules and Cardiovascular Events in a Multi-Ethnic Cohort. Int J Environ Res Public Health. 2023;20(3):2047. doi: https://doi.org/10.3390/ijerph20032047
  45. Gamboa Madeira S, Fernandes C, Paiva T, et al. The Impact of Different Types of Shift Work on Blood Pressure and Hypertension: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021;18(13):6738. doi: https://doi.org/10.3390/ijerph18136738
  46. Boini S, Bourgkard E, Ferrières J, et al. What do we know about the effect of night-shift work on cardiovascular risk factors? An umbrella review. Front Public Health. 2022;10:1034195. doi: https://doi.org/10.3389/fpubh.2022.1034195
  47. Цфасман А.З., Алпаев Д.В. Циркадная ритмика артериального давления при измененном суточном ритме жизни (работе в ночное время). — 2-е изд., испр. и доп. — М.: Репроцентр М, 2011. — 143 с. [Tsfasman AZ, Alpaev DV. Cirkadnaya ritmika arterial’nogo davleniya pri izmenennom sutochnom ritme zhizni (rabote v nochnoe vremya). 2 izd., ispr. i dop. M.: Reprocentr M; 2011. 143 s. (In Russ.)]
  48. Горохова С.Г., Атьков О.Ю. Основы профессиональной кардиологии. Сердечно-сосудистые заболевания при трудовой деятельности. — М.: ГЭОТАР-Медиа, 2022. — 344 с. [Gorokhova SG, Atkov OYu. Osnovy professional’noj kardiologii. Serdechno-sosudistye zabolevaniya pri trudovoj deyatel’nosti. M.: GEOTAR-Media; 2022. 344 s. (In Russ.)]
  49. Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances. Eur J Neurosci. 2020;51(1):396–412. doi: https://doi.org/10.1111/ejn.14216
  50. Vetter C, Dashti HS, Lane JM, et al. Night Shift Work, Genetic Risk, and Type 2 Diabetes in the UK Biobank. Diabetes Care. 2018;41(4):762–769. doi: https://doi.org/10.2337/dc17-1933
  51. Docimo A, Verde L, Barrea L, et al. Type 2 Diabetes: Also a “Clock Matter”? Nutrients. 2023;15(6):1427. doi: https://doi.org/10.3390/nu15061427
  52. Suwazono Y, Sakata K, Okubo Y, et al. Long-term longitudinal study on the relationship between alternating shift work and the onset of diabetes mellitus in male Japanese workers. J Occup Environ Med. 2006;48(5):455–461. doi: https://doi.org/10.1097/01.jom.0000214355.69182.fa
  53. Évaluation des risques sanitaires liés au travail de nuit. Avis de l’Anses, Rapport d’expertise collective. Agency for Food, Environmental and Occupational Health & Safety; Administración Nacional de la Seguridad Social. Available from: https://www.anses.fr/fr/system/files/AP2011SA0088Ra.pdf
  54. Roenneberg T, Merrow M. The Circadian Clock and Human Health. Curr Biol. 2016;26(10):R432–443. doi: https://doi.org/10.1016/j.cub.2016.04.011
  55. Gibson M. A systematic review of the relationship between night shift work and oxidative stress. Chronobiol Int. 2022;39(2):285–298. doi: https://doi.org/10.1080/07420528.2021.1989446
  56. Hung AY, Chien LC, Lin RT. Association between shift rotation and 30-year Framingham risk of cardiovascular disease among male workers in a medium-sized manufacturing factory. Ind Health. 2023;61(1):14–23. doi: https://doi.org/10.2486/indhealth.2021-0278
  57. Luckhaupt SE, Tak S, Calvert GM. The prevalence of short sleep duration by industry and occupation in the National Health Interview Survey. Sleep. 2010;33(2):149-59. doi: 10.1093/sleep/33.2.149
  58. Bosler O, Girardet C, Franc JL, et al. Structural plasticity of the circadian timing system. An overview from flies to mammals. Front Neuroendocrinol. 2015;38:50–64. doi: https://doi.org/10.1016/j.yfrne.2015.02.001
  59. Muraro NI, Pírez N, Ceriani MF. The circadian system: plasticity at many levels. Neuroscience. 2013;247:280–293. doi: https://doi.org/10.1016/j.neuroscience.2013.05.036
  60. Oostra V, Saastamoinen M, Zwaan BJ, et al. Strong phenotypic plasticity limits potential for evolutionary responses to climate change. Nat Commun. 2018;9(1):1005. doi: https://doi.org/10.1038/s41467-018-03384-9
  61. Kervezee L, Cuesta M, Cermakian N, Boivin DB. Simulated night shift work induces circadian misalignment of the human peripheral blood mononuclear cell transcriptome. Proc Natl Acad Sci USA. 2018;115(21):5540–5545. doi: https://doi.org/10.1073/pnas.1720719115
  62. Holmer BJ, Lapierre SS, Jake-Schoffman DE, et al. Effects of sleep deprivation on endothelial function in adult humans: a systematic review. Geroscience. 2021;43(1):137–158. doi: https://doi.org/10.1007/s11357-020-00312-y
  63. Burns AC, Saxena R, Vetter C, et al. Time spent in outdoor light is associated with mood, sleep, and circadian rhythm-related outcomes: A cross-sectional and longitudinal study in over 400,000 UK Biobank participants. J Affect Disord. 2021;295:347–352. doi: https://doi.org/10.1016/j.jad.2021.08.056
  64. Sumova A, Sladek M, Polidarova L, et al. Circadian system from conception till adulthood. Prog Brain Res. 2012;199:83–103. doi: https://doi.org/10.1016/B978-0-444-59427-3.00005-8
  65. Xie Y, Tang Q, Chen G, et al. New Insights into the Circadian Rhythm and Its Related Diseases. Front Physiol. 2019;10:682. doi: https://doi.org/10.3389/fphys.2019.00682
  66. Manoogian ENC, Zadourian A, Lo HC, et al. Feasibility of time-restricted eating and impacts on cardiometabolic health in 24-h shift workers: The Healthy Heroes randomized control trial. Cell Metab. 2022;34(10):1442–1456.e7. doi: https://doi.org/10.1016/j.cmet.2022.08.018
  67. Senesi P, Ferrulli A, Luzi L, et al. Chrono-communication and cardiometabolic health: The intrinsic relationship and therapeutic nutritional promises. Front Endocrinol (Lausanne). 2022;13:975509. doi: https://doi.org/10.3389/fendo.2022.975509
  68. Costa G, Tommasi E, Giovannini L, et al. Shiftwork Organization. 2020. In: Donaldson L, Ricciardi W, Sheridan S, Tartaglia R (eds). Textbook of Patient Safety and Clinical Risk Management [Internet]. Cham (CH): Springer; 2021. Ch. 29.
  69. Storemark SS, Fossum IN, Bjorvatn B, et al. Рersonality factors predict sleep-related shift work tolerance in different shifts at 2-year follow-up: a prospective study. BMJ Open. 2013;3(11):e003696. doi: https://doi.org/10.1136/bmjopen-2013-003696
  70. Degenfellner J, Schernhammer E. Shift work tolerance. Occup Med (Lond). 2021;71(9):404–413. doi: https://doi.org/10.1093/occmed/kqab138
  71. Bhar D, Bagepally BS, Balachandar R. Association between chronotype and cardio-vascular disease risk factors: A systematic review and meta-analysis. Clinical Epidemiology and Global Health. 2022;5:101–108. doi: https://doi.org/10.1016/j.cegh.2022.101108
  72. Sládek M, Klusáček J, Hamplová D, et al. Population-representative study reveals cardiovascular and metabolic disease biomarkers associated with misaligned sleep schedules. Sleep. 2023;46(6):zsad037. doi: https://doi.org/10.1093/sleep/zsad037
  73. Papantoniou K, Castaño-Vinyals G, Espinosa A, et al. Breast cancer risk and night shift work in a case-control study in a Spanish population. Eur J Epidemiol. 2016;31(9):867–878. doi: https://doi.org/10.1007/s10654-015-0073-y
  74. Papantoniou K, Castaño-Vinyals G, Espinosa A, et al. Night shift work, chronotype and prostate cancer risk in the MCC-Spain case-control study. Int J Cancer. 2015;137(5):1147–1157. doi: https://doi.org/10.1002/ijc.29400
  75. Dickerman BA, Markt SC, Koskenvuo M, et al. Sleep disruption, chronotype, shift work, and prostate cancer risk and mortality: a 30-year prospective cohort study of Finnish twins. Cancer Causes Control. 2016;27(11):1361–1370. doi: https://doi.org/10.1007/s10552-016-0815-5
  76. Cao XM, Kang WD, Xia TH, et al. High expression of the circadian clock gene NPAS2 is associated with progression and poor prognosis of gastric cancer: A single-center study. World J Gastroenterol. 2023;29(23):3645–3657. doi: https://doi.org/10.3748/wjg.v29.i23.3645
  77. Tan X, Ciuculete DM, Schiöth HB, et al. Associations between chronotype, MTNR1B genotype and risk of type 2 diabetes in UK Biobank. Intern Med. 2020;287(2):189–196. doi: https://doi.org/10.1111/joim.12994
  78. Dashti HS, Vetter C, Lane JM, et al. Assessment of MTNR1B Type 2 Diabetes Genetic Risk Modification by Shift Work and Morningness-Eveningness Preference in the UK Biobank. Diabetes. 2020;69(2):259–266. doi: https://doi.org/10.2337/db19-0606
  79. Иванов В.П., Иванова Н.В., Полоников А.В. Медицинская экология: учебник для медицинских вузов / под общ. ред. В.П. Иванова. — СПб.: СпецЛит, 2012. — 320 с. [Ivanov VP, Ivanova NV, Polonikov AV. Medicinskaya ekologiya: uchebnik dlya medicinskih vuzov / pod obshch. red. V.P. Ivanova. Saint Petersburg: SpecLit; 2012. 320 s. (In Russ.)]
  80. Beres LK, Simbeza S, Holmes CB, et al. Human-centered design lessons for implementation science: improving the implementation of a patient-centered care intervention. J Acquir Immune Defic Syndr. 2019;82(Suppl 3(3)):S230–S243. doi: https://doi.org/10.1097/qai.0000000000002216
  81. Wu QJ, Sun H, Wen ZY, et al. Shift work and health outcomes: an umbrella review of systematic reviews and meta-analyses of epidemiological studies. J Clin Sleep Med. 2022;18(2):653–662. doi: https://doi.org/10.5664/jcsm.9642

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