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Determinantsofseafarersfatigue Asystematicreviewandqualityassessment
Determinantsofseafarersfatigue Asystematicreviewandqualityassessment
Determinantsofseafarersfatigue Asystematicreviewandqualityassessment
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Solveig Dohrmann
University of Southern Denmark
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REVIEW
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Int Arch Occup Environ Health
Particularly in the transport industry, fatigue as a result the present article aims at systematically describing and
of sleep deprivation, poor quality of sleep, shift work and analyzing what is known about determinants of seafarers’
long working hours is a recognized problem due to its fatigue and to assess the quality of this evidence.
evident linkage to cognitive disengagement and lack of
concentration, resulting in an increased risk of accidents
(Philip 2005; Robb et al. 2008; Caldwell 1997; Cald- Method
well et al. 2009; Dorrian et al. 2007a, b; Williamson et al.
2011). Also in seafaring, where more than 90% of global A systematic review of the scientific literature was under-
trade is carried, engaging about 1384.000 seafarers world- taken by two reviewers. The process of the review was
wide (International Maritime Organization 2012), fatigue directed by a protocol (available from sbdohrmann@health.
and its potential impact on health and safety is increas- sdu.dk), and the Preferred Reporting Items for System-
ingly being acknowledged (Allen et al. 2008; Wadsworth atic Reviews and Meta-Analysis (PRISMA) was applied
et al. 2008). Lewis and Wessely (1992) found that fatigue as guidance for reporting (Liberati et al. 2009) excluding
prevalence presented in community surveys ranged from 7 items specific for meta-analysis which were not applicable
to 45%, while rates from 38 to 76.3% have been reported for this review.
for the maritime industry (Allen et al. 2008; Sa˛lyga and
Kušleikaitė 2011; Sanquist et al. 1997). This might suggest Identification of studies
higher fatigue burden in the maritime population, but due
to a wide variety in operational definitions of fatigue, com- A two-step strategy was applied to identify relevant lit-
parisons are problematic and conclusions premature. erature in terms of articles and conference papers to be
Fatigue seems thus highly prevalent in the maritime included in the review. As a first step, articles were iden-
industry, possibly compromising vigilance on the job. tified by means of a systematic search in the sections of
According to Härmä et al. (2008), 40.6% of the seafar- title, abstract, topic and keywords in ASSIA, PsycARTI-
ers surveyed in their study reported to have fallen asleep CLES, EMBASE, MANTIS, PsycINFO, PubMed, Sco-
at work at least once during the preceding 5 years. Fatigue pus, Sociological Abstracts and Web of Science, using the
is therefore likely to be associated with the safety of the terms ‘fatigue,’ ‘determinant,’ ‘seafarer’ and their respec-
crews, the passengers, the ship and the environment (Allen tive MESH terms as search words (available from sbdohr-
et al. 2008; Maritime Accident Investigation Branch 2004; mann@health.sdu.dk). Boolean operators were used
Wadsworth et al. 2008). For instance, fatigue has been according to rules applicable for the specific databases.
assumed to have played a major role when the ferry MS In order to eliminate studies on fatigue among patients,
Herald of Free Enterprise foundered in 1987 in the Brit- especially cancer patients, the command ‘NOT patient OR
ish Channel causing 183 passengers and crew members to cancer’ was built into the search string applied in PubMed
drown (BBC 1987). Thus, to enhance health and well-being and in Scopus. The search was limited to articles includ-
of seafarers and to avoid accidents and disasters, preventing ing an abstract and published in English in scholarly jour-
fatigue is of great importance. nals from 1980 to the last day of the search, i.e., April 15,
A starting point to preventive efforts in seafaring is knowl- 2016. The search was further limited to studies on human
edge on what determines fatigue (Allen et al. 2007, 2008; adults (18 years+). As part of the first search phase con-
Smith et al. 2006). A range of factors, such as circadian ference papers were identified by means of a systematic
rhythms, sleep quality, shift schedules, watch systems, work search in Web of Science and the search engine ‘Summon’.
load, noise and environmental motion of the ship, have so far In Web of Science ‘fatigue,’ ‘determinant,’ ‘seafarer’ and
been suggested as possible determinants of fatigue among their respective MESH terms were used as search words.
seafarers, but results so far have lacked consistency, as has In a second phase a snowball search was conducted in the
been pointed out by prior seminal reviews about seafarers’ reference sections of all individual articles and papers so
fatigue (Allen et al. 2008; Oldenburg et al. 2010, 2013). As far retrieved (Horsley et al. 2011) and webpages of known
occupations and activities undertaken in the maritime indus- ongoing fatigue-related research projects were checked for
try are diverse, heterogeneity in fatigue profiles across occu- relevant publications in a third and final phase.
pational groups is probable (Allen et al. 2007). Furthermore,
it seems as if initiatives at fatigue prevention in the maritime Eligibility
domain have not had the desired effect, possibly because the
type and/or range of determinants addressed has been too Studies were considered eligible if (1) study participants
limited (Allen et al. 2007; Smith et al. 2008). were seafarers engaged in occupational sailing, (2) one
Thus, in order to obtain a systematic overview about or more research questions about factors associated with
the determinants of fatigue in different groups of seafarers seafarers’ fatigue were included, (3) fatigue was assessed
13
Int Arch Occup Environ Health
in terms of subjective ratings of fatigue, tiredness, etc., or in English or Danish. Duplicate publications and publi-
alertness and/or in terms of physiological fatigue measure- cations with a sole focus on methodological issues were
ments, while studies relying exclusively on performance excluded, as were studies with an exclusive focus on ergo-
measures as indicators for fatigue were not considered, (4) nomic factors, such as type of seats installed on vessels.
quantitative data were provided, (5) articles were published The process of article selection is outlined in Fig. 1.
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Int Arch Occup Environ Health
13
Table 1 Characteristics of reviewed studies
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
Allen et al. (2003) Passenger ferries 924 Crew members Investigation of levels of Fatigue Subscale of the Work demand factors: Multivariate analysis
High-speed passenger fatigue on different ves- Profile of Fatigue- Type of vessel (adjusting for age, gender
ferries sels at sea Related Symptoms Passenger ferries and socioeconomic fac-
Freight ships (PFRS) High-speed passenger tors):
Tankers General Fatigue Symp- ferries Fatigue at work, fatigue
Dredgers toms (7 items measuring Freight ships after work and PFRS-
Int Arch Occup Environ Health
13
Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
13
Bridger et al. (2010) 7 Royal Fleet Auxiliary T1: 322 officers and Identification of work Need for Recovery Scale Work demand factors: Officers had higher NFR
ships from UK Royal ratings demands associated (NFR) Task load than ratings at T1 and T2
Navy Age: 19–61 with need for recovery NASA Task Load Index NFR at T2 was significantly
M = 42.0 and to find out if recov- Baecke Questionnaire higher than at T1
T2: 134 officers and rat- ery needs accumulate Voyage-related factors: Age was not associated
ings who had taken part over time and fatigue is Time into tour with NFR
at T1 related to age Individual factors: Multivariate findings:
Age Ratings: NFR was
Rank positively associated with
high NASA frustration-
subscale scores and physi-
cal work demands
Officers: NFR was
positively associated with
NASA frustration-sub-
scale scores, dissatisfac-
tion with own perfor-
mance and high effort
NFR at T2 was significantly
higher than at T1 but did
not depend on age
Ratings: NFR change was
associated with T1 work
frustration and T2 tempo-
ral demands
Officers: NFR change was
associated with change in
temporal demands
Colquhoun et al. (1987) 1 Destroyer of the British 6 Watch keepers Investigation of perfor- Visual Analogue Scale for Work time factors: Alertness was lowest during
Royal Navy mance variations over Alertness Time of watch the two night watches
the first 4 days on a Time into watch Alertness was consistently
rotating watch system lower at the beginning
than at the end of watch
on the same day, inde-
pendent of prior sleep
Subsidiary analysis found
that after night watches
had disrupted sleep,
‘other than watch duty’—
alertness was lower than
after nights without night
watches
Int Arch Occup Environ Health
Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
Condon et al. (1988a) 5 Vessels: 50 Seafarers: Obtaining information on Visual Analogue Scale for Work time factors: Alertness was lowest dur-
1 Fisheries research 25 watch keepers subjective alertness in Alertness Time of watch ing night watches and
vessel 25 day workers watch keepers on the adaption of the circadian
1 Oceanographic research Age: 4-h on/8-h off system rhythm was only partial
vessel Watch keepers
2 Oil tanker M = 37.0
Int Arch Occup Environ Health
13
Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
13
Eriksen et al. (2006) 1 Bridge simulator with 3 12 Male navigators: Investigation of subjective Karolinska Sleepiness Work time factors: Time of starting watch had
bridges 6 Merchant marine sleepiness across and Scale (KKS) Time of watch start (6.00 no effect on sleepiness
officers within the four possible versus 12.00) Sleepiness increased over
6 Naval officers watches in a 6-h on/6-h Time period of watch the span of watches,
Age: 26–51 off system (morning, afternoon, except on the morning
M = 39 evening, night watch (6.00–12.00)
Time into watch Average level of sleepi-
ness was significantly
higher during the night
watch (0.00–6.00) than
during the afternoon
(12.00–18.00) and even-
ing (18.00–24.00) but
not the morning watch
(6.00–12.00)
Ferguson et al. (2008) Pilot boats operating in 17 Coastal marine pilots Examination of impact of Samn–Perelli Fatigue Voyage-related factors: Fatigue at the end (last two
the Great Barrier Reef Age: 38–74 brief, unscheduled naps Scale Time into tour hours) of pilotage was
Marine Park Area, M = 56.8 (7.8) during work periods on Sleep-related factors: significantly higher than
Australia alertness and vigilance Sleep quantity/quality: at its beginning (first two
in coastal pilots Wrist activity monitor hours)
Sleep diaries Opportunistic naps
appeared to provide
adequate recovery
Gander et al. (2008) 3 Fresher vessels involved 20 Male deckhands Monitoring of sleep and Karolinska Sleepiness Sleep-related factors: Postsleep sleepiness ratings
in Hoki fishing, New sleepiness of commer- Scale (KKS) Home periods versus were significantly higher
Zealand cial fishermen at home periods at sea working at sea than at home
and during extended in a 12-h on/6-h off
periods at sea system
How et al. (1994) 1 Naval ship, Republic of 20 Male gunners: recent Assessment of perfor- Stanford Sleepiness Scale Sleep-related factors: Sleepiness increased with
Singapore graduates from School mance patterns of naval (SSS) Hours of sleep depriva- increasing duration of
of Naval Training seamen under sleep tion sleep deprivation, with
Age: 18–20 deprivation on board first peak after 36–42 h
and second peak after
80 h
Int Arch Occup Environ Health
Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
Härmä et al. (2008) Ships with registered 92 bridge officers Examination of the Karolinska Sleepiness Work time factors: Mean onboard sleepiness
members of the Finn- Age per watch system relationship between Scale (KKS) Watch systems: (KSS) did not differ sig-
ish Maritime Officers’ (whole study): two watch systems and Skogby Excessive Day- 6-h on–6-h off nificantly between watch
Association 6/6: M = 45.1 (9.8) its impact on fatigue time Sleepiness Index 4-h on–8-h off systems
4/8: M = 36.9 (9.8) and sleepiness in bridge (SEDS) Others Highest risk of sleepiness
Others: M = 42.9 (12.3) offers Epworth Sleepiness Scale Time of day was during the early
Int Arch Occup Environ Health
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Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
13
Leung et al. (2006) 2 High-speed marine 93 Navigating officers Examination of fatigue Swedish Occupational Work time factors: Generally, night shift
crafts Hydrofoil: 72 in Chinese high-speed Fatigue Inventory Time of watch officers scored higher on
1 Hydrofoil Catamaran: 21 maritime craft officers (SOFI-Chinese version) Time into watch physical exertion (PE)
1 Catamaran operating Day shift: 35 working either a day-or Five subscales: Work demand factors: lack of energy (LE),
between Hong Kong and Night shift: 58 a night shift and to Physical exertion (PE) Perceived difficulty of physical discomfort (PD)
Macao Age: test the contribution of Physical discomfort (PD) work: Scores on PE, PD, LE and
Day shifts: 6–7 1 h-voy- M = 46.8 (6.5) other work-related and Lack of energy (LE) 9-Item-Perceived Diffi- sleepiness (S) were higher
ages over 11 h personal factors Lack of motivation (LM) culty of Tasks Checklist on day 2 than day 1
Night shifts: 3–4 1 h-voy- Sleepiness (S) (e.g., Visibility, Wind, Across all subscales, night
ages over 7 h Swell ) shift officers scored
Psychosocial work fac- higher on day 1, day shift
tors: officers on day 2
Job stress: Night shift officers showed
8-Item Psychosocial a faster rate of increase
Status Checklist (incl. in fatigue than day shift
a 4-item measure of job officers
stress) Multivariate findings:
Anxiety (State-Trait- PE and PD at the end of the
Anxiety-Inventory) 2nd day nightshift were
Individual factors: positively associated with
Age length of work experience
Length of experience and perceived voyage dif-
ficulty. PD was negatively
associated with age
S in the middle of the 2nd
day night shift was posi-
tively related to voyage
difficulty
LE during day 2 was posi-
tively related to job stress
There were no associations
with anxiety
Int Arch Occup Environ Health
Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
Lützhöft et al. (2010) 13 Swedish cargo vessels, 30 captains and nautical Examination of fatigue Karolinska Sleepiness Work time factors: Mean sleepiness levels did
among them bulk car- officers (29 males, 1 levels onboard using Scale (KKS) Watch systems: not differ significantly
riers, car carriers and female) both objective and Eye movement behavior 4-h on–8-h off versus between watch systems,
tankers Age: 27–60 subjective measures of (EOG) 6-h on–6-h off watch but there was a trend for
M = 45.8 (1.7) sleepiness: system more severe sleepiness on
Nationality: Those working on a 6-h Time of watch the 6-h on/6-h off system
Int Arch Occup Environ Health
72% Swedish on/6-h off shift system Time into watch There was no difference
22% Filipino are expected to experi- in mean blink duration
ence higher levels of between shift systems
fatigue than those on a Sleepiness increased with
4-h on/8-h off system time into watch in the 6-h
on/6-h off system but not
in 4-h on/8-h off system
Sleepiness, but not blink
duration, was higher at
night than during the day,
and this difference was
more pronounced in the
6-h on/6-h off system
Sa˛lyga and Kušleikaitė Sea transport, fishing and 932 Seafarers including Determination of factors 5 Questions about fatigue, Voyage-related factors: Multivariate findings:
(2011) local water transport, the following sectors: influencing fatigue among them a question Length of tour Fatigue was significantly
Lithuania Management among seafarers about frequency of Work demand factors: positively associated with
Mechanical ship service fatigue and a question Employment in different long working hours and
Deck crew about sleepiness at work ship sectors working for long hours
Auxiliary Length of work hours under harmful conditions
Age: Work environment fac- (vibrations/noise), work-
M = 40.0 (11.7) tors: ing in the auxiliary ship
Noise sector, having high work
Vibration requirements, experience
Time of work under of psychoemotional strain
harmful conditions and poor sleep quality
Psychoemotional factors: Fatigue was significantly
Psychoemotional strain inversely associated with
Sleep-related factors: age, having a non-man-
Sleep quality agement occupation and
Individual factors: duration of work at sea,
Age i.e., those working longer
Rank times at sea reported less
fatigue
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Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
13
Sanquist et al. (1997) 8 Vessels (6–7 for alert- 141 Seafarers: Quantification of work Visual Analogue Scale for Work time factors: Alertness increased during
ness data): Watch standers patterns that lead to Alertness Time of watch watch in the first half of
2 Tankers Command personnel fatigue in mariners Retrospective Alertness Sleep-related factors: the day and decreased
6 Freight ships Day workers Inventory (RAI): Sleep duration and sleep during watch in the sec-
on US West Coast runs Stewards Critical fatigue measure: quality ond half of the day
Age: Proportion of 24 h Watch standers on the
M = 43 (11.5) periods with total sleep 0.00–4.00 watch reported
≤4 h more periods with criti-
Visual Analogue Scale cally low alertness than
Alertness score ≤3 those on other watches
Sleep quality and sleep
duration were signifi-
cantly related to alertness
but sleep quantity contrib-
uted only marginally to
explained variance
Wadsworth et al. (2008) Offshore support, short 1855 seafarers: Consideration of associa- Longer-term Fatigue: Voyage-related factors: Multivariate findings:
sea and deep sea ships Deck or engineering tions between negative Fatigue Subscale of Tour length Shorter tour length, high
of the UK merchant officers: 85% occupational factors the Profile of Fatigue- Work time factors: job demands and high
shipping industry Ratings, catering and and perceived fatigue to Related Symptoms Shift schedule/Time into work stress, poor sleep
service personal: 15% establish a profile of risk (PFRS) to assess longer- shift quality were associated
96% male factors associated with term fatigue Variability of work hours with higher scores on all
Age: 17–66 fatigue among seafarers Acute Fatigue: Work demands: subtypes of acute fatigue
M = 43.5 Fatigue at work Job Demands Scale as well as longer-term
Nationality: Fatigue after work Hours worked per day fatigue
92% British Symptoms of fatigue Department Younger age, lack of sup-
at sea Job security port, physical hazards,
Work environment fac- sleep disturbance and
tors: smoking were associated
Physical hazards with longer-term fatigue
Psychosocial factors: as well as at least one of
Work stress the acute fatigue measures
Sleep-related factors: Longer time on shift, poorer
Sleep quality job security, finding
Sleep disturbance switching to port arrival
Individual factors: fatiguing, variable work
Age hours and working more
Education than 12 h per day were
Rank associated with longer-
Smoking term fatigue
A higher number of risk
factors were associated
with a higher odds ratio
for acute and longer-term
fatigue
Int Arch Occup Environ Health
Table 1 continued
References Type of ship/shipping Sample size and sample Study purpose Fatigue measurement Determinants Main outcomes
sector characteristics
Wadsworth et al. (2006) Offshore, coastal and 203 seafarers: Description of daily Visual Analogue Scale for Voyage-related factors: Fatigue on waking but not
short sea as well as deep Officers: 97% fatigue patterns among Tiredness Length of tour on retiring increased
sea sectors of the UK Age: seafarers on a tour of Port calls over the tour period,
shipping industry M = 46.1 (7.91) duty Work time factors: particularly over the first
Night work versus day week, but this tendency
work was only significant for
Int Arch Occup Environ Health
The characteristics are described exclusively in relation to those parts of the respective studies related to investigating fatigue
* Numbers refer to numbers from the ‘View Reference Checking Results’ list
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Int Arch Occup Environ Health
Work time factors Three studies, among them two cross-sectional mail sur-
veys and one of the laboratory simulator experiments,
All studies which investigated effects of time of watch investigated length of work time. Wadsworth et al. (2008)
reported significant differences between night shifts (00– found that seafarers working more than 13 h a day had
4.00/4.00–8.00) and day shifts (Colquhoun et al. 1987; higher fatigue scores than those working fewer hours, while
Condon et al. 1988a; Härmä et al. 2008; Leung et al. 2006; in the other cross-sectional survey, experience of fatigue
Lützhöft et al. 2010; Sanquist et al. 1997). Wadsworth et al. was higher for those working long hours under harm-
(2006) found in their longitudinal on-board survey with ful conditions (high levels of noise and vibration) (Sa˛lyga
203 seafarers that night work was associated with greater and Kušleikaitė 2011). van Leeuwen et al. (2013) reported
mean fatigue on waking only during the first week of overtime work (measured as disturbance of free time) to be
tour, and the highest levels were found in the group work- related to higher sleepiness on the following watch.
ing every night. The two simulator trials reported similar Task demands were focused on in five studies, three
results but with slightly less clear boundaries. Eriksen et al. cross-sectional mail surveys and two on-board longitudinal/
(2006) found the mean level of sleepiness in 12 officers to process studies, all of which showed positive associations
be higher during the night watch (00.00–06.00) than the with fatigue. Thus, Wadsworth et al. (2008) found scores
day (12.00–18.00) and the evening (18.00–24.00) watches, on a work demands scale measuring e.g., time pressure,
but not the morning watch (06.00–12.00) (see also van constant interruptions and high levels of responsibility to
Leeuwen et al. 2013). be positively related to reports of fatigue (see also Sa˛lyga
Five of the six studies which investigated time into and Kušleikaitė 2011; Allen et al. 2003). Also, in a longi-
watch/shift found significant differences in terms of higher tudinal survey it was found that temporal demands (time
sleepiness/fatigue toward the end compared to the begin- pressure) and work frustration were the main variables
ning of watch/shift, among them one of the large-scale associated with an increase in need for recovery between
cross-sectional surveys (Wadsworth et al. 2008) and one two points of measurements in both officers and ratings.
of the on-board longitudinal process studies (Leung et al. In ratings, a high need for recovery was further associated
2006) as well as both experimental simulator studies. van with high physical demands (Bridger et al. 2010). Further,
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Int Arch Occup Environ Health
the officers of high-speed crafts in the longitudinal study however, did not find a significant association between rank
by Leung et al. (2006) were more likely to report fatigue if and fatigue experience.
they perceived their trips as difficult. Only few studies have so far investigated lifestyle fac‑
tors. Wadsworth et al. (2008) found current smokers to
Physical work environment report higher fatigue, while no association was found
between BMI and excessive sleepiness in the survey by
Findings from the cross-sectional mail survey by Sa˛lyga Härmä et al. (2008).
and Kušleikaitė (2011) showed that both, noise and vibra-
tion, were positively associated with fatigue. Wadsworth Risk of bias
et al. (2008) similarly reported background noise and bad
weather to be related to acute fatigue in their cross-sec- As can be seen from Table 2 only two experimental stud-
tional survey. Additionally, they found physical hazards, ies were categorized as being at low risk of bias/confound-
like fumes and other harmful substances, to be associated ing (11%). Five further studies (26%), four of which were
with longer-term fatigue. Ellis et al. (2003) found in an on- based on an on-board longitudinal/process design and one
board study over a one-week period that increase of fatigue study with a one-group crossover design, were classified as
levels during the work day depended on vessel motion and having a low to moderate risk of bias, while the majority of
that cabin noise was predictive of changes in alertness over 11 studies (58%) were evaluated as having a moderate to
the one-week period with high noise exposure leading to high risk of bias—and one study (5%) as having a high risk
reduced alertness. of bias. Among the ‘moderate to high risk’ and ‘high risk’
groups were all three cross-sectional studies, on-board lon-
Psychosocial work‑related factors gitudinal studies with a strong possibility for confounding
and one case process study. Beyond the problem of possi-
Only three studies investigated psychosocial reactions, and ble differential initial selection into the groups that were to
all three of them found significant results for stress. Two be compared, which affected all studies with higher risk of
large-scale cross-sectional surveys (Sa˛lyga and Kušleikaitė bias, many of the longitudinal studies with a moderate to
2011; Wadsworth et al. 2008) showed that those with higher high risk of bias reported substantial dropout rates and over
experience of psychoemotional strain and job stress were 40% did not report any controlling for confounding, while
also more likely to feel fatigued. Further, in a longitudinal among those who did control for confounders often only
study with high-speed maritime craft officers, job stress few potential influence factors were taken into account.
was related to sleepiness scores among night shift officers Studies with lesser risk of bias were focusing mainly
and lack of energy for day shift officers (Leung et al. 2006). on work time factors (time into tour, time of watch, watch
Beyond stress, the only other psychosocial factors investi- systems), sleep-related factors (length of sleep) or work
gated were anxiety, for which Leung et al. (2006) did not demands in terms of work length, while all of the studies
find an effect, while lack of support and poorer job security investigating more complex work demands, work environ-
showed significant positive associations with fatigue in the ments, psychosocial or individual factors were character-
cross-sectional survey by Wadsworth et al. (2008). ized by a moderate to high risk of bias.
A further prevalent methodological problem was con-
Individual factors venience sampling and self-selection of ships and/or seafar-
ers in combination with often only moderate participation
Five studies included individual determinants, with a focus rates. The reported range of initial participation (data for
mostly on age and/or rank. As for age, Wadsworth et al. 11 studies) varied between 15 and 100% with a median of
(2008) as well as Leung et al. (2006) showed that younger 47%. Over 50% of studies were based on samples with less
age was associated with higher fatigue. Vice versa, how- than 50 participants and thus had a risk of being underpow-
ever, Härmä et al. (2008) in their longitudinal study indi- ered and providing estimates with limited precision.
cated that older officers had higher sleepiness scores than
younger ones in the afternoon and at night in the 4-h on/8-h
off system, but not the 6-h on/6-h off system. No effect for Discussion
age was reported for need for recovery in the longitudinal
survey by Bridger et al. (2010). This review shows that the present literature supports the
Sa˛lyga and Kušleikaitė (2011) showed that those work- existence of a range of determinants for fatigue. At the
ing in the management sector were more likely to expe- same time it also clearly indicates that there is a distinct
rience fatigue compared to others. Similar results were lack of research on certain types of determinants such
reported by Bridger et al. (2010). Wadsworth et al. (2008), as work demands and work environments, especially
13
13
<15% confounders
Allen et al. (2003) Cross-sectional mail survey Mail shot targeted at mari- 15–31.8% in different No Yes 2−
time union members and subsamples; no significant
crews of four purposively differences in response
sampled shipping compa- between subsamples
nies from different sectors
plus onboard distribution
of self-report question-
naires on ships of the four
companies
Arulanandam and Tsing On-board field pilot study; Crew members volunteered No information No information No information 2+
(2009) One-group intervention for participation
trial with a crossover
design including pre- and
postwatch measurements
from three watch groups
working first in a fixed 4-h
on–8-h off watch system
and then in an anticlock-
wise rotating 4-h on–8-h
off system (4 working
days—6 days for wash-
out—4 working days)
Bridger et al. (2010) On-board field study; Personnel from 7 Royal Response rate T1: 58% No Yes 2−
Longitudinal design Fleet Auxiliary ships were Ratings: 53%
with two measurement asked to sign up for par- Officers: 72%
points 1–2 months apart ticipation in the study Response rate T2: 42% of
T1 sample
Responders and non-
responders did not differ
in T1 characteristics
Colquhoun et al. (1987) On-board field study; Crew of one British Royal No information Yes (for main analysis) No 3
Case process design with Navy destroyer was
2-h-measurements (excl. targeted and 6 volunteers
sleep times) over a full recruited
watch cycle of 4 days
Int Arch Occup Environ Health
Table 2 continued
References Study design Sampling Response/participation rate Loss of data in analysis Multivariate analysis and Risk of bias
compared to initial sample adjustment for potential
<15% confounders
Condon et al. (1988a) On-board field study; Purposive selection of 5 Fishery vessel: 30% No No 2−
Longitudinal/process design ships based on voyage Research vessel: 27%
over 6–13 consecutive characteristics; all watch Oil tankers: 50–73%
days, with 6 four-hourly keeping and day work Container ship: 71%
points of measurement crew were targeted for
Int Arch Occup Environ Health
13
Table 2 continued
References Study design Sampling Response/participation rate Loss of data in analysis Multivariate analysis and Risk of bias
compared to initial sample adjustment for potential
13
<15% confounders
Gander et al. (2008) On-board/at-home field Skippers from regional Hoki No information No No 2+
study fishery industry were con-
Longitudinal design with tacted, all of who agreed
sleepiness ratings before to participate;
and after each sleep for 3 ships from the overall
up to 3 sleep periods over population were selected
24 h on 4–13 days at home based on convenience and
and 5–9 days at sea crew members contacted
for participation
How et al. (1994) On-board field study No information No information Yes No 2−
Intervention trial with a
one-group pretest–posttest
design and measurement
points every 6 h
Härmä et al. (2008) On-board field study A representative sample of 31.6% for whole study, 92% Yes Yes 2−
Longitudinal/process design navigator members of the of who also participated
over 7 consecutive days at Finnish Officers Asso- in the sleep diary part
sea with sleepiness assess- ciation were mailed the (fatigue data)
ment every 2 h while on questionnaire
watch
van Leeuwen et al. (2013) Laboratory simulator study Paid volunteers were n/a Yes No/N/a 1
Experimental design recruited via a maritime
comparing sleepiness in recruitment agency and
three watch teams within website advertisements
a simulated 4-h on/8-h
off watch system over
a period of 7 days with
1-hourly recordings for
KSS and PSG during 6
selected watches from day
2 to day 6
Leung et al. (2006) On-board field study Purposive sampling of two No information Yes Yes 2−
Longitudinal survey with local companies operating
three measurement points, a certain type of vessel
at beginning, in the middle (high-speed ferries) and
and at the end of shift subsequent recruitment of
volunteers from group of
navigators
Int Arch Occup Environ Health
Table 2 continued
References Study design Sampling Response/participation rate Loss of data in analysis Multivariate analysis and Risk of bias
compared to initial sample adjustment for potential
<15% confounders
Lützhöft et al. (2010) On-board field study Purposive sampling of 13 100% Yes No 2+
Longitudinal/process design ships representing differ-
with 7 sleepiness ratings ent types of cargo vessels
during each watch within (e.g., bulk carriers, car
6-h on/6-h off system and carriers, tankers)
Int Arch Occup Environ Health
13
Int Arch Occup Environ Health
increases over the watch period. While this does not nec-
essarily imply that it is always critically high levels of
fatigue which are reached, the finding warrants attention
since effects of time into watch can be expected to interact
Longitudinal survey design
atic than fixed ones, and the 6-h on–6-h off scheme is more
fatiguing than other watch routines—especially the 4-h
on–8-h off system (see also Allen et al. 2008; Jepsen et al.
2015; Oldenburg et al. 2013; Smith et al. 2003), which is
plausible, since the 6-h on–6-h off system allows for only
six hours of consecutive sleep, which is below the recom-
Wadsworth et al. (2006)
time into watch was relevant for the 6-h on–6-h off but
not other watch systems (Lützhöft et al. 2010). In view
of these findings it can be considered problematic that the
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Int Arch Occup Environ Health
6-h on–6-h off system is still commonly used as only two Tasks for future studies
watch teams are needed, which is why it is considered as
more cost-effective than, for instance, the 4-h on–8-h off First, beyond the underrepresentation of work environ-
system, which requires three watch teams. Other research ment and word demand factors in past and current research
has emphasized that shift work, including night shifts, has on seafarer’s fatigue, a specific problem was a common
a negative impact on work efficiency, vigilance, safety and neglect of more complex relationships between differ-
health (Boivin and Boudreau 2014; Knutsson 2003; Moser ent types of factors, such as additive effects or interac-
et al. 2006; Niu et al. 2011; Szosland 2010; Touitou et al. tions. Lützhöft et al. (2010) investigated interaction effects
2014) and part of these effects may well be mediated by between watch systems and time of watch, and Wadsworth
buildup of fatigue. et al. (2008), from a cross-sectional mail survey, reported
Fourth, while fatigue tended to increase over the period that a higher number of risk factors also meant a higher
of a tour, comparisons between groups of seafarers on dif- level of fatigue experience, indicating a cumulative effect,
ferent vessels/tours indicated that a short time spent at sea but these were exceptions. Second, a widening of the focus
was experienced as more fatiguing than longer times. At toward aspects of work environment, specific types of work
first glance this may seem counterintuitive as longer time demands and psychosocial issues as well as additive effects
spent at sea implies longer exposure to fatigue-related risk and interactions between these factors and work time issues
factors. However, length of time at sea may be associ- or watch systems should thus be major issues for future
ated with different types of vessels and work tasks. Allen studies. Related to this is, third, the need to apply well-
et al. (2003) reported that fatigue levels were notably established theoretical models about psychosocial work
higher among those working on passenger vessels than, for environments and demands, such as Karasek’s Demand-
instance, tankers or dredgers. Ferry but also freight ship- Control Model (Karasek 1979; Karasek and Theorell 1990;
ping often involves short-term trips and tighter time sched- Bultmann et al. 2002), Siegrist’s Effort-Reward Imbalance
ules as well as more port calls. Compared to routine activi- Model (Siegrist 1996; Siegrist and Li 2016) or the use of
ties and leisure time during sea passage, port calls usually approaches focusing on interactions between professional
involve a higher task load and more time pressure, such as groups (Gittell 2005, 2009; Gittell et al. 2000, 2013). As
frequent loading/unloading of goods or embarking/disem- has been shown for onshore worksites, a systemic approach
barking of passengers as well as documentation, adminis- to fatigue management and prevention which is needed to
tration and controlling duties for officers. In comprehensive design and implement successful programs requires knowl-
field studies it is therefore necessary to distinguish between edge about a wide range of possible determinants (Dawson
occupational groups, type of vessel, voyage episodes and and Mcculloch 2005; Dawson et al. 2012; Horrey et al.
shipping route as a precondition to develop specific inter- 2011).
vention strategies against fatigue. Finally, it should be noted that the most important infor-
mation about fatigue comes from on-board field studies.
Work demand factors as determinants of fatigue While time-consuming and personnel intensive, it is these
studies which best allow for a realistic assessment of the
Studies on the influence from the working environment working and living conditions likely to produce high lev-
were surprisingly few—especially those explicitly deal- els of fatigue and which therefore are needed in greater
ing with specific work demands and stress. Specific work numbers.
demands, e.g., experience of time pressure, physical
demands or work frustration, and stress were all reported to Risk of bias
be related to fatigue. It should be noticed though that all of
the respective studies were considered to be at higher risk In view of the fact that more than half of the included stud-
of bias due to, for instance, cross-sectional study designs, ies had to be considered as being at substantial risk for
and conclusions are therefore tentative at best. In particu- biased findings due to potential confounding, more stud-
lar work-related stress is considered an important factor ies are needed which try to exclude extraneous influences
in other occupational areas (Sharpe and Wilks 2002) and by using more compelling designs or at least make more
has been well researched in other occupational branches. systematic attempts at assessing and statistically control-
Therefore, the dearth of such studies in seafaring is aston- ling such influences. It needs to be acknowledged though
ishing—not at least because in general seafaring is consid- that seafaring is inherently a challenging field for research,
ered to be a potentially stressful occupation (Carotenuto since the range of work place influences is potentially larger
et al. 2012; Oldenburg et al. 2009; Rengamani and Muru- than on land, crews on individual ships are often small and
gan 2012). targets are moving and thus often difficult to recruit.
13
Int Arch Occup Environ Health
Another shortcoming relates to definition and measure- argued that even a systematic review like the present one is
ment of fatigue and the extent to which findings based on limited in its conclusions by the simultaneous variation of
different measures can be compared. There were no obvi- types of study, study samples and fatigue measurement. In
ous differences in terms of detection of significant associa- the same vein, a more systematic and comprehensive link-
tions using different measures, but for a valid judgment on age of evidence quality with specific types of outcomes was
these issue larger subgroups of studies being similar in all not possible since variations over different parameters made
other respects but measurement would be needed than were subgrouping problematic. Further, the inclusion/exclusion
actually available. This also links to the general question of of studies based on a restricted fatigue definition/measure-
how fatigue was defined. Substantial differences and a lack ment might be debated. As discussed above, concepts and
of coherence in definition have been noted in the more gen- operationalizations varied widely and using narrower or
eral fatigue literature (Soames-Job and Dalziel 2008), and it wider criteria (for instance by including performance crite-
surely has implications whether the term fatigue is treated as ria) could be argued for or against. Finally, there is a pos-
a synonym for (short-term) acute sleepiness, or if it reflects sibility of publication bias in that it cannot be excluded that
a longer-term accumulated functional capacity reduction. the review overlooked studies which have not found their
This, however, was rarely dealt with in the reviewed studies, way into the established documented publication outlets.
where only about half explicitly outlined a definition, and
where a clear rationale for the choice of measurement scale
was mostly lacking. Whether, however, alertness and fatigue Conclusion
represent opposite ends of the same dimension or stand
for different dimensions altogether remains an open ques- What was most striking in general, was the limited range of
tion just as whether, for instance, the often-used Karolinska factors that has so far been investigated and that the focus has
Sleepiness Scale and the Patient-Specific Functional Scale predominantly been on more ‘obvious’ issues such as sleep
(PSFS) are functionally equivalent, since the latter has origi- and work time aspects, establishing in particular the relevance
nally been developed to identify individuals with chronic of night shift work, length of shifts and watch system arrange-
fatigue syndrome (Ray et al. 1992). ments. As the maritime business is a 24-h industry, night and
Regarding external validity, it needs to be noted that a evening shifts are unavoidable. This means, however, that
substantial group of studies focused on officers and/or realistic countermeasures ought to be established, e.g., in
watch-keeping personnel from the merchant marine. Even terms of shared or split night shifts, longer or more frequent
where other groups were included, systematic comparisons breaks as well as an increased reliance on the 4-h on–8-h
in terms of age or rank were rarely conducted. Also, differ- off system, and also aiming at less than nine working hours
ent cultural backgrounds, which are common in seafaring, a day. Clearly this will raise demands for manning, which
seem not to have found much attention yet (see also Olden- puts a strain on budgets, thus jeopardizing the competitive-
burg et al., 2013). Further, many studies used self-selection ness of shipping companies which are operating under highly
or convenience sampling to recruit ships and/or/individual competitive market conditions (Allen et al. 2007). However,
participants and reported participation rates often were in fatigue endangers the safety of the crews, the passengers, the
the low to moderate range only, all of which raises ques- ship and the environment (Allen et al. 2008; Maritime Acci-
tions with regard to external validity. Thus, it appears dent Investigation Branch 2004; Wadsworth et al. 2008), and
questionable if examined samples are representative for therefore realistic preventive programs must be initiated—
the general seafaring population. While on the one hand, preferably supported by international regulations based on a
ships with lesser fatigue problems on board might be over- ‘shared responsibility’ approach in order to promote fair con-
represented, it might vice versa be individuals with higher ditions across the industry (Allen et al. 2007).
fatigue problems who might have been more motivated to Most importantly, to support development of effective
participate in such studies. work-site prevention interventions which go beyond work
time regulations, further knowledge needs to be provided
from studies of high methodological quality including
Limitations of the review larger samples which, in particular, broaden the scope by
including factors from a much wider range of influences on
While it would have been desirable to estimate average fatigue than has so far been the case. This includes investi-
effect sizes by meta-analytic techniques, the diversity of gations of the role of specific work demands, work climate,
study designs, samples, etc., and resulting small numbers psychosocial factors as well as collaborative processes,
for comparable subgroups of findings as well as a presum- which not at least also start focusing on the interplay
able bias in many studies made pooling of effect estimates between these different types of fatigue determinants. To
non-feasible (Higgins and Altman 2008). In fact, it might be support future research the development of a set of research
13
Int Arch Occup Environ Health
guidelines is strongly recommended and should be prior- Caldwell JA, Mallis MM, Caldwell JL, Paul MA, Miller JC, Neri DF
itized by the Maritime Research Society. Such guidelines (2009) Fatigue countermeasures in aviation. Aviat Space Environ
Med 80:29–59
should, for instance, outline recommended study designs, Carotenuto A, Molino I, Fasanaro AM, Amenta F (2012) Psychologi-
sampling methods and measurements instruments and cal stress in seafarers: a review. Int Marit Health 63:188–194
thereby not only help reduce risk of bias in future studies *Colquhoun WP, Watson KJ, Gordon DS (1987) A shipboard study
but also enable comparability between study findings. of a four-crew rotating watchkeeping system. Ergonomics
30:1341–1352. doi:10.1080/00140138708966028
*Condon R, Colquhoun P, Plett R, De Vol D, Fletcher N (1988a)
Acknowledgements The funding was provided by Faculty of Health Work at sea: a study of sleep, and of circadian rhythms in physi-
Sciences, University of Southern Denmark. ological and psychological functions, in watchkeepers on mer-
chant vessels. IV. Rhythms in performance and alertness. Int
Compliance with ethical standards Arch Occup Environ Health 60:405–411
*Condon R, Colquhoun WP, Knauth P, Plett R, Neidhart B, Devol D,
Conflict of interest The authors declare that they have no conflict of Eickhoff S, Rutenfranz J (1988b) Work at sea: a study of sleep,
interest. and of circadian rhythms in physiological and psychological
functions, in watchkeepers on merchant vessels. Int Arch Occup
Environ Health 61:39–49. doi:10.1007/BF00381606
Dawson D, McCulloch K (2005) Managing fatigue: it’s about sleep.
Sleep Med Rev 9:365–380. doi:10.1016/j.smrv.2005.03.002
References Dawson D, Chapman J, Thomas MJ (2012) Fatigue-proofing: a new
approach to reducing fatigue-related risk using the principles of
Abrams RM (2015) Sleep deprivation. Obstet Gynecol Clin North Am error management. Sleep Med Rev 16:167–175. doi:10.1016/j.
42:493–506. doi:10.1016/j.ogc.2015.05.013 smrv.2011.05.004
Akerstedt T (1995) Work hours and sleepiness. Neurophysiol Clin Dorrian J, Hussey F, Dawson D (2007a) Train driving efficiency
25:367–375. doi:10.1016/0987-7053(96)84910-0 and safety: examining the cost of fatigue. J Sleep Res 16:1–11.
Akerstedt T (2003) Shift work and disturbed sleep/wakefulness. doi:10.1111/j.1365-2869.2007.00563.x
Occup Med 53:89–94. doi:10.1093/occmed/kqg046 Dorrian J, Roach GD, Fletcher A, Dawson D (2007b) Simulated train
Akerstedt T, Knutsson A, Westerholm P, Theorell T, Alfredsson L, driving: fatigue, self-awareness and cognitive disengagement.
Kecklund G (2004) Mental fatigue, work and sleep. J Psychosom Appl Ergon 38:155–166. doi:10.1016/j.apergo.2006.03.006
Res 57:427–433. doi:10.1016/j.jpsychores.2003.12.001 Dorrian J, Baulk SD, Dawson D (2011) Work hours, workload, sleep
*Allen P, Burke A, Ellis N (2003) A cross-vessel survey of seafar- and fatigue in Australian Rail Industry employees. Appl Ergon
ers examining factors associated with fatigue. In: Mcabe PT 42:202–209. doi:10.1016/j.apergo.2010.06.009
(ed) Contemporary ergonomics. Taylor & Francis, London, pp *Ellis N, Allen P, Burke A (2003) The influence of noise and motion on
125–130 sleep, mood and performance of seafarers. In: Mcabe P (ed) Con-
Allen P, Wadsworth E, Smith A (2007) The prevention and manage- temporary ergonomics. Taylor & Francis, London, pp 131–136
ment of seafarers’ fatigue: a review. Int Marit Health 58:167–177 *Eriksen CA, Gillberg M, Vestergren P (2006) Sleepiness and sleep
Allen P, Wadsworth E, Smith A (2008) Seafarers’ fatigue: a review of in a simulated “six hours on/six hours off” sea watch system.
the recent literature. Int Marit Health 59:81–92 Chronobiol Int 23:1193–1202. doi:10.1080/07420520601057981
Arendt J (2010) Shift work: coping with the biological clock. Occup *Ferguson SA, Lamond N, Kandelaars K, Jay SM, Dawson D (2008)
Med 60:10–20. doi:10.1093/occmed/kqp162 The impact of short, irregular sleep opportunities at sea on the
*Arulanandam S, Tsing GC (2009) Comparison of alertness levels in alertness of marine pilots working extended hours. Chronobiol
ship crew. An experiment on rotating versus fixed watch sched- Int 25:399–411. doi:10.1080/07420520802106819
ules. Int Marit Health 60:6–9 *Gander P, Van Den Berg M, Signal L (2008) Sleep and sleepiness
Balkin TJ, Rupp T, Picchioni D, Wesensten NJ (2008) Sleep loss and of fishermen on rotating schedules. Chronobiol Int 25:389–398.
sleepiness: current issues. Chest 134:653–660. doi:10.1378/ doi:10.1080/07420520802106728
chest.08-1064 Gittell JH (2005) The southwest airlines way. Using the power of rela-
BBC (1987) Hundreds trapped as car ferry capsizes. BBC NEWS tionships to achieve high performance. Mc-Graw Hill, New York
on this day. http://news.bbc.co.uk/onthisday/hi/dates/stories/ Gittell JH (2009) High performance healthcare. Using the power of
march/6/newsid_2515000/2515923.stm. Accessed 10 May 2016 relationships to achieve quality, efficiency and resilience. Mc-
Boivin DB, Boudreau P (2014) Impacts of shift work on sleep and Graw Hill, New York
circadian rhythms. Pathol Biol 62:292–301. doi:10.1016/j. Gittell JH, Fairfield KM, Bierbaum B, Head W, Jackson R, Kelly M,
patbio.2014.08.001 Laskin R, Lipson S, Siliski J, Thornhill T, Zuckerman J (2000)
*Bridger RS, Brasher K, Dew A (2010) Work demands and need for Impact of relational coordination on quality of care, postop-
recovery from work in ageing seafarers. Ergonomics 53:1006– erative pain and functioning, and length of stay: a nine-hospital
1015. doi:10.1080/00140139.2010.493958 study of surgical patients. Med Care 38:807–819
Bultmann U, Kant IJ, Schroer CA, Kasl SV (2002) The relationship Gittell JH, Godfrey M, Thistlethwaite J (2013) Interprofessional
between psychosocial work characteristics and fatigue and psy- collaborative practice and relational coordination: improving
chological distress. Int Arch Occup Environ Health 75:259–266. healthcare through relationships. J Interprof Care 27:210–213.
doi:10.1007/s00420-001-0294-0 doi:10.3109/13561820.2012.730564
Cajochen C, Chellappa S, Schmidt C (2010) What keeps us awake? Härmä M, Sallinen M, Ranta R, Mutanen P, Muller K (2002) The
The role of clocks and hourglasses, light, and melatonin. Int Rev effect of an irregular shift system on sleepiness at work in train
Neurobiol 93:57–90. doi:10.1016/S0074-7742(10)93003-1 drivers and railway traffic controllers. J Sleep Res 11:141–151
Caldwell JA Jr (1997) Fatigue in the aviation environment: an over- *Härmä M, Partinen M, Repo R, Sorsa M, Siivonen P (2008) Effects
view of the causes and effects as well as recommended counter- of 6/6 and 4/8 watch systems on sleepiness among bridge officers.
measures. Aviat Space Environ Med 68:932–938 Chronobiol Int 25:413–423. doi:10.1080/07420520802106769
13
Int Arch Occup Environ Health
Hartzler BM (2014) Fatigue on the flight deck: the consequences of National Heart, Lung, and Blood Institute (2014) Quality assess-
sleep loss and the benefits of napping. Accid Anal Prev 62:309– ment tool for observational cohort and cross-sectional studies.
318. doi:10.1016/j.aap.2013.10.010 National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.
Higgins JPT, Altman DG (2008) Assessing the risk of bias in included gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduc-
studies. In: Higgins JPT, Green S (eds) Cochrane handbook for tion/tools/cohort. Accessed 10 May 2016
systematic reviews of interventions, 1st edn. Wiley, West Sussex, Niu SF, Chung MH, Chen CH, Hegney D, O’Brien A, Chou KR
pp 187–235 (2011) The effect of shift rotation on employee cortisol profile,
Horrey WJ, Noy YI, Folkard S, Popkin SM, Howarth HD, Courtney sleep quality, fatigue, and attention level: a systematic review. J
TK (2011) Research needs and opportunities for reducing the Nurs Res 19:68–81. doi:10.1097/JNR.0b013e31820c1879
adverse safety consequences of fatigue. Accid Anal Prev 43:591– Oldenburg M, Jensen HJ, Latza U, Baur X (2009) Seafaring stressors
594. doi:10.1016/j.aap.2010.01.014 aboard merchant and passenger ships. Int J Public Health 54:96–105
Horsley T, Dingwall O, Sampson M (2011) Checking reference lists Oldenburg M, Baur X, Schlaich C (2010) Occupational risks and
to find additional studies for systematic reviews. Cochrane challenges of seafaring. J Occup Health 52:249–256
Database Syst Rev. doi:10.1002/14651858.MR000026.pub2. Oldenburg M, Hogan B, Jensen HJ (2013) Systematic review of mari-
Accessed 20 Oct 2016 time field studies about stress and strain in seafaring. Int Arch
*How JM, Foo SC, Low E, Wong TM, Vijayan A, Siew MG, Kanapa- Occup Environ Health 86:1–15. doi:10.1007/s00420-012-0801-5
thy R (1994) Effects of sleep deprivation on performance of Philip P (2005) Sleepiness of occupational drivers. Ind Health
Naval seamen: I. Total sleep deprivation on performance. Ann 43:30–33
Acad Med Singapore 23:669–675 Pylkkonen M, Sihvola M, Hyvarinen HK, Puttonen S, Hublin C, Sal-
International Maritime Organization (2012) International ship- linen M (2015) Sleepiness, sleep, and use of sleepiness counter-
ping facts and figures—information resources on trade, safety, measures in shift-working long-haul truck drivers. Accid Anal
security, environment. Maritime Knowledge Centre: Maritime Prev 80:201–210. doi:10.1016/j.aap.2015.03.031
Knowledge Centre. http://www.imo.org/en/KnowledgeCentre/ Ray C, Weir WRC, Phillips S, Cullen S (1992) Development of a
ShipsAndShippingFactsAndFigures/TheRoleandImportan- measure of symptoms in chronic fatigue syndrome: the profile
ceofInternationalShipping/Documents/International%20Ship- of fatigue-related symptoms (PFRS). Psychol Health 7:27–43.
ping%20-%20Facts%20and%20Figures.pdf. Accessed 10 May doi:10.1080/08870449208404293
2016 Rengamani J, Murugan MS (2012) A study in the factors influencing
Jepsen JR, Zhao Z, Van Leeuwen WM (2015) Seafarer fatigue: a the seafarers’ stress. AIJM July–Dec. http://www.ametjournal.
review of risk factors, consequences for seafarers’ health and com/attachment/ametjournal-4/Dev-Article-6-Rengamani.pdf.
safety and options for mitigation. Int Marit Health 66:106–117. Accessed 10 May 2016
doi:10.5603/imh.2015.0024 Roach GD, Darwent D, Sletten TL, Dawson D (2011) Long-haul
Kaltsas G, Vgontzas A, Chrousos G (2010) Fatigue, Endocrinopa- pilots use in-flight napping as a countermeasure to fatigue. Appl
thies, and Metabolic Disorders. PM R 2:393–398. doi:10.1016/j. Ergon 42:214–218. doi:10.1016/j.apergo.2010.06.016
pmrj.2010.04.011 Robb G, Sultana S, Ameratunga S, Jackson R (2008) A systematic
Karasek RA Jr (1979) Job demands, job decision latitude, and men- review of epidemiological studies investigating risk factors for
tal strain: implications for job redesign. Adm Sci Q 24:285–308. work-related road traffic crashes and injuries. Inj Prev 14:51–58.
doi:10.2307/2392498 doi:10.1136/ip.2007.016766
Karasek RA, Theorell T (1990) Healthy work. Basic Books Inc, New Sallinen M, Härmä M, Mutanen P, Ranta R, Virkkala J, Muller K
York (2003) Sleep-wake rhythm in an irregular shift system. J Sleep
Knutson KL (2010) Sleep duration and cardiometabolic risk: a review Res 12:103–112
of the epidemiologic evidence. Best Pract Res Clin Endocrinol *Sa˛lyga J, Kušleikaitė M (2011) Factors influencing psychoemotional
Metab 24:731–743. doi:10.1016/j.beem.2010.07.001 strain and fatigue, and relationship of these factors with health com-
Knutsson A (2003) Health disorders of shift workers. Occup Med plaints at sea among lithuanian seafarers. Medicina 47:675–681
53:103–108 *Sanquist TF, Raby M, Forsythe A, Carvalhais AB (1997) Work hours,
*Leung AWS, Chan CCH, Ng JJM, Wong PCC (2006) Factors contrib- sleep patterns and fatigue among merchant marine personnel. J
uting to officers’ fatigue in high-speed maritime craft operations. Sleep Res 6:245–251. doi:10.1111/j.1365-2869.1997.00245.x
Appl Ergon 37:565–576. doi:10.1016/j.apergo.2005.11.003 Sharpe M, Wilks D (2002) Fatigue. BMJ 325:480–483
Lewis G, Wessely S (1992) The epidemiology of fatigue: more ques- Short MA, Banks S (2014) The functional impact of sleep depriva-
tions than answers. J Epidemiol Community Health 46:92–97 tion, sleep restriction, and sleep fragmentation. In: Bianchi MT
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis (ed) Sleep deprivation and disease: effects on the body, brain and
JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The behavior, 1st edn. Springer, New York, pp 13–26
PRISMA statement for reporting systematic reviews and meta- Siegrist J (1996) Adverse health effects of high-effort/low-reward
analyses of studies that evaluate healthcare interventions: expla- conditions. J Occup Health Psychol 1:27–41
nation and elaboration. BMJ. doi:10.1136/bmj.b2700 Siegrist J, Li J (2016) Associations of extrinsic and intrinsic compo-
*Lützhöft M, Dahlgren A, Kircher A, Thorslund B, Gillberg M (2010) nents of work stress with health: a systematic review of evidence
Fatigue at sea in Swedish shipping—a field study. Am J Ind Med on the effort-reward imbalance model. Int J Environ Res Public
53:733–740. doi:10.1002/ajim.20814 Health. doi:10.3390/ijerph13040432
Maritime Accident Investigation Branch (2004) Bridge watchkeeping Smith A, Lane T, Bloor M (2003) An overview of research on fatigue
safety study. Marine Accident investigation Branch. https://www. in support shipping in the offshore oil industry. In: Mccabe PT
gov.uk/government/uploads/system/uploads/attachment_data/ (ed) Contemporary ergonomics. Taylor & Francis, London, pp
file/377400/Bridge_watchkeeping_safety_study.pdf. Accessed 119–124
10 May 2016 Smith A, Allen P, Wadsworth E (2006) Seafarer fatigue: the cardiff
Moser M, Penter R, Fruehwirth M, Kenner T (2006) Why life oscil- research programme. Centre for Occupational and Health Psy-
lates—biological rhythms and health. Conf Proc IEEE Eng Med chology, Cardiff University. http://www.vdks.org/pdf/seafarer_
Biol Soc 1:424–428. doi:10.1109/iembs.2006.259562 fatigue.pdf. Accessed 10 May 2016
13
Int Arch Occup Environ Health
Smith A, Allen P, Wadsworth E (2008) Seafarers’ fatigue: conclusion neurobehavioral performance while on watch in a simulated
and the way forward. In: Bust PD (ed) Contemporary ergonom- 4 hours on/8 hours off maritime watch system. Chronobiol Int
ics. Taylor & Francis, London, pp 607–612 30:1108–1115. doi:10.3109/07420528.2013.800874
Soames-Job RF, Dalziel J (2008) Defining fatigue as a condition of Vincent GE, Aisbett B, Hall SJ, Ferguson SA (2015) Fighting fire and
the organism and distinguishing it from habituation, adaption, fatigue: sleep quantity and quality during multi-day wildfire sup-
and boredom. In: Handcock PA, Desmond PA (eds) Stress, work- pression. Ergonomics. doi:10.1080/00140139.2015.1105389
load and fatigue, 1st edn. CRC Press, Taylor & Francis Group, *Wadsworth E, Allen P, Wellens BT, McNamara RL, Smith AP
Boca Raton, pp 466–475 (2006) Patterns of fatigue among seafarers during a tour of duty.
Szosland D (2010) Shift work and metabolic syndrome, diabetes Am J Ind Med 49:836–844. doi:10.1002/aijn.20381
mellitus and ischaemic heart disease. Int J Occup Med Environ *Wadsworth E, Allen P, McNamara RL, Smith AP (2008) Fatigue
Health 23:287–291. doi:10.2478/v10001-010-0032-5 and health in a seafaring population. Occup Med 58:198–204.
Touitou Y, Reinberg A, Smolensky MH, Riedel M, Mauvieux B, doi:10.1093/occmed/kqn008
Brousse E, Marlot M, Berrez S (2014) Twenty-four-hour pattern Williamson A, Lombardi DA, Folkard S, Stutts J, Courtney TK, Con-
in French firemen of lag time response to out-of-hospital cardiac nor JL (2011) The link between fatigue and safety. Accid Anal
arrest and work-related injury. Indian J Exp Biol 52:420–424 Prev 43:498–515. doi:10.1016/j.aap.2009.11.011
Van Dongen HP (2006) Shift work and inter-individual differ- Zaharna M, Guilleminault C (2010) Sleep, noise and health: review.
ences in sleep and sleepiness. Chronobiol Int 23:1139–1147. Noise Health 12:64–69. doi:10.4103/1463-1741.63205
doi:10.1080/07420520601100971
van Leeuwen WMA, Kircher A, Dahlgren A, Lützhöft M, Bar-
nett M, Kecklund G, Akerstedt T (2013) Sleep, sleepiness, and
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