Psychoneuroendocrinology (2010) 35, 13391347

a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m

j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / p s y n e u e n

Cortisol, reaction time test and health among offshore shift workers
se Marie Hansen c, Anette Harris a,b,*, Siri Waage b,d, Holger Ursin b, A Bjrn Bjorvatn d,e, Hege R. Eriksen a,b
a

Research Center for Health Promotion, Faculty of Psychology, University of Bergen, Norway Unifob Health, University Research Bergen, Norway c National Research Centre for the Working Environment, Denmark d Department of Public Health and Primary Health Care, University of Bergen, Norway e Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Norway
b

Received 29 September 2009; received in revised form 17 March 2010; accepted 18 March 2010

KEYWORDS
Cortisol; Reaction time test; Health; Shift work; Offshore workers

Summary Objective: The stress hormone cortisol shows a pronounced endogenous diurnal rhythm, which is affected by the sleep/wake cycle, meals and activity. Shift work and especially night work disrupts the sleep/wake cycle and causes a desynchronization of the natural biological rhythms. Therefore, different shift schedules may have different impact on performance at work and health. Aim: The purpose was to study if health, reaction time, and the cortisol rhythm were negatively affected when a group of shift workers changed their work schedule from ordinary daynight shift (xed shift) to swing shift. Methods and settings: 19 healthy workers on a Norwegian oil rig participated in the study. They worked 2 weeks offshore followed by 4 weeks off work. The ordinary schedule consisted of 12-h day shift and 12-h night shift every other work period (14 days or nights = xed shift). Swing shift involved 1 week of night shift, followed by 1 week of day shift during the work period. All participants worked ordinary daynight shift when baseline data were collected (questionnaires, saliva cortisol, and reaction time during work). After collection of baseline data the workers changed their work schedule to swing shift, for every working period, and 9 months later the same data were collected. Results: Swing shift did not give any negative health effects or any negative changes in reaction time during the day they shifted from night work to day work. Personnel adapted to night shift within a week regardless of schedule, but recovery from night shift took longer time. During swing shift the cortisol rhythm went back towards a normal rhythm in the second week, but it was not returned completely to normal values when they returned home for the 4 weeks off period.

* Corresponding author at: Unifob Health, University Research Bergen, Christies gate 13, 5015 Bergen, Norway. Tel.: +47 55 58 39 92; fax: +47 55 58 98 78. E-mail address: anette.harris@uib.no (A. Harris). 0306-4530/$ see front matter # 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.psyneuen.2010.03.006

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However, the cortisol rhythms were readapted to normal values after 1 week at home. For personnel returning home directly from 14 consecutive night shifts, cortisol adaptation was not complete after 1 week at home. Conclusion: We found no increase in health complaints from swing shift or reaction time in the shift from night to day work. Recovery from night shift takes longer time. # 2010 Elsevier Ltd. All rights reserved.

1. Introduction
Shift work interferes with biological functions and social rhythms. In this paper we compared three shift work schedules for effects on the rhythm of saliva cortisol, reaction time, and health, in a population of 19 healthy individuals working offshore on an oil rig in the North Sea. Ordinary work schedule is 2 weeks work, followed by 4 weeks off work. During the 2 weeks offshore period the ordinary routine was to alternate between 12-h day shift during 1 work period and 12-h night shift on the next work period (xed shift). We compared these schedules with swing shift, 12-h night shift during the rst week, then 12-h day shift for the last week. Many offshore workers prefer swing shift because they feel readapted to a normal daynight rhythm when they start their 4 weeks off work period at home (Parkes, 1997; Ross, 2009). Traditionally, this oil company does not use swing shift. However, after a request from the workers, a decision was made to evaluate the effects of swing shift. A disadvantage of swing shift is that the workers need to adapt to a new rhythm twice on every 2 weeks work period; rst at the beginning of the work period (getting adjusted to night work) and then in the middle of the work period (readjusting to day work). These changes in rhythms introduce some concerns for the health and safety of the workers (Lauridsen and Tnnesen, 1990; Parkes, 1997). The link between shift work and health is complex. In addition to disturbance in the circadian rhythms (Fujiwara et al., 1992; Costa et al., 1994) that leads to changes in the normal social rhythms (eating and sleeping habits) (Costa, 1996; Knutsson, 2003) higher risk of cardiovascular and gastrointestinal diseases, sleep problems (Costa, 1996), impaired performance (Tilley et al., 1982; Totterdell et al., 1995), and reduced alertness (Tucker et al., 1998) are reported. In general shift work also appears to require more effort and time to recover from work than day work (Jansen et al., 2003). It has been argued that swing shift is associated with greater problems of alertness and performance than a schedule were the workers alternate between day shift during one work period, and night shift on the next work period (Parkes, 1997). It is therefore also of interest to investigate whether swing shift leads to any changes in reaction time, an objective measure of sleepiness and performance (Lamond et al., 2005). The circadian rhythm is controlled by the suprachiasmatic nuclei (SCN) situated in the hypothalamus. Most humans have an endogenous circadian rhythm with a period length of between 24 and 25 h (Czeisler et al., 1999). The endogenous rhythm in humans is normally adjusted to 24 h by external factors such as light (Czeisler et al., 1989), but also by habits and behavioural factors (Bjorvatn and Pallesen, 2009). The underlying mechanisms linking shift work with health pro-

blems are probably due to the desynchronization of the circadian rhythm (Regestein and Monk, 1991; Knutsson, 2003). The adrenal hormone cortisol shows a pronounced diurnal rhythm and is viewed as a robust marker of overall circadian rhythm (Born and Fehm, 2000). Several studies have monitored diurnal cortisol rhythm in relation to shift work under naturalistic conditions (Hennig et al., 1998; Kudielka et al., 2007) or laboratory conditions (Fujiwara et al., 1992; Shinkai et al., 1993). However, differences in study design and sample size make it difcult to compare and evaluate how different shift schedules really affect the cortisol rhythm. In shift workers with a slow rotation schedule, night shift has been associated with low cortisol levels after awakening from sleep (Lac and Chamoux, 2004). Under normal conditions the secretion of cortisol shows the lowest levels during the rst half of a nights sleep, a gradual elevation through the second half of the sleep, a characteristic peak the rst hour after waking, and then decreasing levels during the day (Weitzman et al., 1971; Wilhelm et al., 2007). High cortisol levels in the evening are associated with low scores on decision authority (control) (Harris et al., 2007), long term job strain (Rydstedt and Mark, 2008), and chronic pain (McBeth et al., 2007). Disturbance in the cortisol rhythm, especially a blunted response in the morning, high levels in the evening (Sluiter et al., 1998; Kristenson et al., 2004), and high morning cortisol (Gustafsson et al., 2008), may be an indication of insufcient recovery. Data from this study with three different work schedules may give important objective data on the effects of shift work on the biological rhythms, and how the rhythms are reset. Offshore work on oil rigs offers particularly good opportunities to study these effects. The most important regulatory factor in humans is the lightdark cycle (Czeisler et al., 1989), but social factors are also of importance (Honma et al., 1995). The offshore period involves long hours of work mostly indoors with little exposure to sunlight and no commitments to daily family activities. Therefore, the relatively isolated work environment on an oil rig eliminates at least some of the confounding social factors inuencing diurnal rhythms on shore. This is particularly relevant for studies of shift work effects on the rhythm of saliva cortisol, reaction time and health. It has been demonstrated already that offshore workers adapt faster to night work than night workers on shore (Barnes et al., 1998a; Bjorvatn et al., 2006). The aim of the study was to examine how different work schedules (day shift, night shift, and swing shift) affect the cortisol rhythm and the resetting of the rhythms, and how this is associated to reaction time (an objective measure of sleepiness). Furthermore, we examined if implementing the new schedule (swing shift) was associated with health complaints or changes in perceived work environment compared to xed shift.

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2. Methods
2.1. Participants and general experimental outline
A total of 19 workers, 13 men and 6 women, participated in the study. The mean age was 44 years, range from 28 to 60 years. At rst measurement they had been working on an oil rig for 12 years (sd = 8.3) and had been shift workers for 17 years (sd = 9.7). They were recruited from a sample of 32 employees working offshore in the process area on a small North Sea oil rig. All 32 employees working in the process area were invited to participate in the study, 28 workers (87.5%) agreed to participate and were screened on baseline data before shifting from xed shift schedule to swing shift. 19 participants were working swing shift 9 months later, and are included in the analyses. Of the 9 participants that did not work swing shift, 2 did not want to participate in the study, 2 worked another place in the company (onshore), and 5 worked only day shift on the same oil rig. Only one of the participants worked day shift because he did not cope with swing shift. The rest of the drop out was due to reorganization for other reasons. The baseline data were collected during Fall 2007 when the workers were working xed shift (day shift and night shift every other work period), the follow up measurements were carried out during Fall 2008 (Table 1), when the workers had about 9 months of experience with swing shift. This schedule also accounted for any seasonal changes in cortisol (Persson et al., 2008) and seasonal changes in the intensity of outdoor light. The work schedule was 2 weeks of work, followed by 4 weeks off work. The day shift started at 0700 h and ended at 1900 h and the night shift started at 1900 h and ended at 0700 h. On the rotating day of the swing shift, they ended their night shift at 0400 h or 0600 h and started the day shift 8 h later at 1200 h or 1400 h. To adjust to the same schedule as the xed shift, this shift was reduced to 7 or 5 h and ended at 1900 h. Last day at the oil rig the day shift was also reduced and started at 0400 h or 0600 h and ended at 1200 h or 1400 h. Totally there are 122 beds on the oil rig; 3 managers, 10 11 workers in the process area, 10 catering personnel and up to 98 contractor personnel included drilling. The cabins are adjusted to night work and sleeping at daytime (sound and light isolated), and the workers normally report to have good sleeping conditions. The workers stay indoors most of the time (during work and free time) with only articial light. In a

similar oil rig the average light intensity inside the oil rig was reported to be 200300 lx (range from 20 to 700) (Bjorvatn et al., 1999). Meals are served at regular times and the workers have no commitments to daily family activities. The workers were screened with questionnaires, they performed reaction time tests, and saliva was collected for cortisol analyses. They also lled out sleep diaries and used Actiwatch1, these data will not be presented here. The questionnaires were lled in twice, rst before the xed shift (day shift and night shift), then when they had worked swing shift for about 9 months. Half of the subjects started with day shift and the other half with night shift. Results from baseline data (questionnaire), therefore, came both from the day shift and night shift workers. The questionnaires were handed out by the nurse at the oil rig the rst day they arrived, and collected within 3 days. The workers collected saliva (at home and offshore) and performed a reaction time test (offshore) on three different working schedules; at baseline, when they were working day shift and night shift, and 1 year later after having worked swing shift for about 9 months. All workers gave their informed consent. The study was approved by the Regional Ethics Committee and the Norwegian Social Science Data Services National Register of Data.

2.2. Questionnaires
Background variables include gender, age, years working on an oil rig, experience with shift work, health, physical form and preferred working schedule. Health complaints were measured with the Subjective Health Complaints inventory (SHC) (Eriksen et al., 1999). The instrument consists of 29 items and measures subjective somatic and psychological complaints experienced the last 30 days. In addition to a sum score, the inventory yields ve subscales; musculoskeletal complaints, gastrointestinal complaints, pseudoneurology (tiredness, mood changes), allergy, and u complaints. The questionnaire picks up any unspecic (or specic) health complaint arising during the free period at home, which may occur as an effect of the work period. The SHC inventory has been tested in different populations and has satisfactory validity and reliability (Eriksen et al., 1999; Ihlebaek et al., 2007; Wilhelmsen et al., 2007). Perceived work environment was measured with the short Swedish version of the Demand-Control and Social Support Inventory (Theorell, 1993). The instrument consists of 5

Table 1 Study outline. The questionnaires were lled in twice, at baseline (day shift or night shift) and follow up (swing shift), cortisol (C) were collected in the workers leisure time (home) and when they were working offshore, and reaction time tests (R) were performed only when they were working offshore.

1342 items that measure work demands, 6 items that measure control and 6 items that measure social support. Total workload is the sum of demands divided with the sum of control.

A. Harris et al. rotation when they were on swing shift), and day/night 14. The workers were instructed to sit down in a quiet room without any distractions from TV, radio, etc., when they take the test, either in the room where they normally have the coffee break or in the medic room at the oil rig. Each day the test was performed at the start (within the two rst hours) and the end of the shift (within the two last hours). The mean scores from the different days are used in the statistical analysis and in the gure.

2.3. Saliva sampling

Salivettes1 with cotton rolls (Sarstedt, Ski, Norway), were used to measure cortisol in saliva at home and at work, saliva cortisol is a reliable marker of unbound cortisol in plasma (Kirschbaum and Hellhammer, 1989). The workers collected saliva at days off work for 2 consecutive days (between Tuesday and Friday), 1 week before the work period, and 1 week after the work period (between Tuesday and Friday). When they were on day shift they collected saliva three times; the second day offshore, in the middle of the offshore tour and the last whole working day. When they were on night shift they collected saliva the second night offshore, in the middle of the offshore tour and the last night offshore. When they were on swing shift, they collected saliva four times; the second night offshore, the last night before rotating, the rst day after rotating, and the last day offshore. The workers collected saliva samples ve times: 1: on awakening, 2: 30 min after awakening (0 + 30 min), 3: 6 h after awakening (0 + 6 h), 4: 12 h after awakening (0 + 12 h), 5: just before bedtime. Oral and written instructions on the sampling procedure were given when the salivettes were distributed. The workers were instructed to avoid food, drink, tobacco, and brushing their teeth the last 30 min prior to the tests, and note the exact time of awakening and saliva collection. Based on the subjective reports, morning samples with a delay of more than 15 min (21 of 171 samples) were excluded from the analysis (Dockray et al., 2008). All ve samples were used as a marker of cortisol rhythm. Samples 1 and 2 were used to calculate the cortisol awakening response (CAR). Samples 2, 3, 4, and 5 were used to calculate the level for cortisol decrease during the shift. Sample 5 (before bedtime) was used as a measure of recovery after a working day (Sluiter et al., 1998). The mean recovery period between the end of dayshift and bedtime was 3.36 h (sd = 41 min) and the mean recovery period between end of night shift and bedtime was 42 min (sd = 46 min). The saliva samples were kept in freezer either at home or at the oil rig (20 8C) until they were transported to the laboratory for analysis.

2.5. Hormonal analysis

Determination of cortisol in saliva was carried out with a competitive radioimmunoassay (RIA) designed for quantitative in vitro measurement of cortisol in serum, plasma, urine, and saliva, the Spectria Cortisol Coated Tube RIA, purchased from Orion Diagnostica, Espoo, Finland, according to the manufacturers specications. The sample volume was 150 ml, the range of the standard solutions prepared was 1.0100.0 nmol/l, and the incubation time was 30 min at 37 8C. The specications given by the manufacturer were a sensitivity of twice the standard deviation of the zero binding value in saliva (0.8 nmol/l), a bias of 110% (103115%), an intra-assay variation of 5.4%, and an inter-assay variation of 7.3%. The cross-reactivity of the antiserum used was tested by the manufacturer to be 84.3% for 5a-dihydrocortisol, 78.8% for 21-desoxycortisol, 45.3% for prednisolone, 11.9% for 5b-dihydrocortisol, and 11.0% for 6a-methylprednisolone (these components are not relevant in healthy individuals). Cross-reactivity to cortisone was <0.2%. A 1470 Wizard gamma counter (Wallac, Turku, Finland) was used for measurement of radioactivity. A method evaluation of certied reference material in water showed no bias of the method, with recovery being 97% [95% CI: 94.0100.9]. Limit of detection (LOD) was 1.59 nmol/l. Between-run coefcients of variation (CVs) were 19% at 11.5 nmol/l and 16% at 49.2 nmol/l (Hansen et al., 2003). To show equivalence between different runs, natural saliva samples (5.9 and 18.5 nmol/l) were used as control materials and analyzed together with the samples. Westgard control charts were used to document that the analytical method remained under analytical and statistical controlin other words, that the trueness and the precision of the analytical methods remained stable (Westgard et al., 1981). The performance of the methods has been further validated by participation in interlaboratory comparison schemes (Garde et al., 2003; Hansen et al., 2003).

2.4. Reaction time test

Reaction time was measured with a 10 min simple serial reaction time test on a handheld computer (Palm Inc, Santa Clara, CA, USA)1. The software measures reaction time in milliseconds (ms). When a black square was displayed on the screen, workers were asked to respond to the stimulus by pressing a key to turn off the square. If no response was given within 1750 ms a new interval was started. If they pressed the key in advance or within 120 ms the response would be discarded and a warning signal would be displayed. Mean reaction time was calculated. The test has been validated as a measure of sleepiness and performance (Lamond et al., 2005). When the workers were offshore they performed the reaction time test at day/night 1, day/night 7 (day 8, after

2.6. Statistical analyses

SPSS (version 15.0) was used for all the statistical analyses. The mixed model routine was used to model xed effect for day, time of day and shift for the cortisol measures. The interaction of shift, day, and time were set as repeated measure and subjects were included as a random factor. Shift differences in cortisol rhythm were tested by contrasting cortisol levels during the day shift with those during the night shift and swing shift. The cortisol data were not normally distributed; therefore the analyses were done on log transformed data. Geometric means were used in the gures. Cortisol levels at day shift were set as the reference category.

Cortisol, reaction time test and health among offshore shift workers In the analysis of the reaction time we also used mixed models. For the reaction time measures xed effect for day and shift were modelled and the interaction of shift and day were set as the repeated measure. Reaction time at day shift was set as the reference category. A number of different covariance structures were applied to the data in both models. An autoregressive covariance structure gave the best t (lowest Aikaikes value) and was therefore applied in both models (cortisol and reaction time). Gender and age were adjusted in both models. Paired sample t-tests were used in all analyses for continuous variables from the questionnaire (subjective health complaints and demand/con-

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trol). p-Values less than .05 were considered as statistical signicant.

3. Results
3.1. Descriptive statistics
Fourteen workers (73.7%) reported to have very good or good health, 5 workers (26.3%) reported to have average health. Only one worker described his physical tness as bad, the rest (18 workers (94.7%)) were in very good or good shape. Swing shift was the preferred schedule at baseline (15 workers

Figure 1 Cortisol rhythm (mean and 95% CI) at different time point in connection to the different working schedule; xed shift (14D/ 14N) and swing shift (7N + 7D): (a) home 1 week before offshore tour*; (b) the rst whole day/night offshore; (c) in the middle of the offshore tour (before rotating day); (d) in the middle of the offshore tour (after rotating day); (e) the last whole day/night offshore; (f) home 1 week after offshore tour*. *Mean of 2 consecutive days.

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Table 2 Mean score and standard deviation in subjective health complaints (SHC) and perceived work environment (demand, control and social support) at baseline (xed shift) and 1 year later (swing shift). Fixed shift (14D/14N) (n = 19) Mean (sd) SHC sum score SHC-musculoskeletal SHC-gastrointestinal SHC-pseudoneurology SHC-allergy SHC-u Demand/control Demand Control Social support 6.82 3.68 1.00 1.33 0.32 0.58 0.72 12.58 17.57 20.05 (6.40) (3.51) (1.60) (2.23) (0.58) (1.02) (0.12) (1.57) (1.77) (2.34) Swing shift (7N + 7D) (n = 19) Mean (sd) 5.97 2.99 1.26 1.00 0.16 0.53 0.75 12.88 17.31 20.63 (4.36) (2.43) (1.73) (1.33) (0.37) (0.96) (0.09) (1.75) (1.70) (2.52) p-Value .494 .272 .588 .479 .187 .889 .371 .373 .556 .172

(78.9%)) and also after working the new schedule for 9 months (16 workers (84.1%)).

3.2. Health and perceived work environment

There were no differences in the mean scores for Subjective Health Complaints, Perceived Work Environment or social support between baseline and follow up (Table 2).

3.3. Cortisol rhythm at home and work

There were no signicant differences between xed shift (day shift and night shift) and swing shift (7 nights + 7 days) in cortisol rhythm at home before the offshore period (Fig. 1a, Table 3). The cortisol rhythm showed the characteristic peak levels after awakening followed by a decrease during the shift. When the workers were on night shift and woke up after the rst night offshore, the cortisol response at awakening (CAR) was signicantly lower ( p < .001) and the cortisol levels before bedtime were signicantly higher ( p < .001), compared to the levels measured when they were working day shift (Fig. 2b). There were no differences in the level for

cortisol decrease between night shift and day shift ( p = .368) on this shift. When the workers woke up after the rst night offshore after having worked swing shift, there were no differences in CAR ( p = .884), or in the level for cortisol decrease ( p = .101). However, the bedtime values were higher ( p < .001). When they were working day shift, the mean wake up time was approximately 0600 h and when they were on night shift they woke up approximately 1530 h. With one exception, there were no signicant differences in the cortisol rhythm between the different shift schedules in the middle of the offshore tour (before rotating) (Fig. 2c). The cortisol rhythm showed the characteristic peak levels after awakening on all shifts and there were no differences in CAR ( p = .930) or the level for cortisol decrease ( p = .431) between the shifts. However, the bedtime values were higher when they were on swing shift compared to day shift ( p = .035). As expected, the cortisol rhythm from the rst day after rotating from night shift to day shift showed a at cortisol rhythm with lower CAR ( p < .001), and corresponding higher bedtime values ( p < .001) and lower level of cortisol decrease ( p = .024) compared to day shift (Fig. 2d). Last day offshore working swing shift the CAR ( p < .001) was low compared to the CAR when working day shift. There were no differences in the level for cortisol decrease

Table 3 Multilevel estimates for the cortisol response after awakening (CAR), level for cortisol decrease and cortisol just before bedtime on different days, at 2 weeks night shift and swing shift (7N + 7D) when cortisol levels at 2 weeks day shift where considered as reference category. Signicant differences are bold. Week Day CAR Night shift estimate Swing shift estimate 1 (Home) D1 .1031 .1980 D2 .0152 .1282 .1369 .0854 .1538 .1353 2 (Offshore) D2 S.5738 ** .0236 .1163 .2061 1.2620 ** 1.4666 ** D7 .0265 .0115 .1006 .0854 .2014 .6184 * 3 (Offshore) D1 D6 .0758 S.6330 ** S.2986 ** .1294 .3625 .2981 4 (Home) D6 S.4145 ** .0120 .0191 .0605 .3011 .2078 D7 S.3460 * .2206 .2056 .1086 .6407 * .0226

S.8903

**

Level for cortisol decrease Night shift estimate .0194 Swing shift estimate .1045 Cortisol bedtime Night shift estimate Swing shift estimate
* **

.2879 *

.0358 .2752

1.0172

**

p < .05. p < .01.

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Figure 2 Mean reaction times (95% CI) were measured three separate days/nights (day 1, day 78, and day 14 off shore) in relation to xed shift (14D/14N) and swing shift (7N + 7D). During swing shift the reaction time test in the middle of the work period were measured rst day after rotation. The different shift schedules are separated by dotted lines. Signicant differences ( p < .05) between night shift (D1) and day shift (D1).

( p = .211) or cortisol level before bedtime ( p = .134) between swing shift and day shift. Last night offshore working night shift there were no differences in CAR ( p = .590) or cortisol at bedtime ( p = .069), but the level for cortisol decrease was low ( p = .005) compared to day shift (14 days) (Fig. 2e). When cortisol levels were tested 1 week after return from the swing shift offshore period, the rhythms were readapted to normal rhythms. However, 1 week was not enough when returning from ordinary night shift (Fig. 2f). The CAR was signicantly lower on both days (day 1: p = .011 and day 2: p = .015), on the second day the cortisol levels before bedtime were also higher ( p = .041) compared to cortisol levels at home when they had been on day shift.

3.4. Reaction time test

With one exception, there were no signicant differences in reaction time between the different shift schedules (Fig. 2). The workers had a small, but signicantly higher mean score on reaction time the rst night offshore when they were on night shift compared to day shift.

4. Discussion
The majority of the personnel (84%) preferred the new schedule with night shift during the rst week and day shift for the last week. This is in accordance with previous studies (Parkes, 1997). As expected the results showed that during the second night on the oil rig, the circadian rhythm of cortisol was disturbed. However, the cortisol rhythm was more disturbed after awakening when they were on their second night on a 2-week night shift than it was the second night on a swing shift tour. This result may be related to random factors, but we may speculate that this result is related to expectation factors. The majority of the group preferred swing shift and it may be that the prospect of only 1

week with night shifts is easier to cope with than prospect of night work for the next 2 weeks (Ursin and Eriksen, 2004). The adaptation to night work, assessed by the cortisol rhythm was complete within a week. Other studies from oil rigs have also found a complete adaptation within a week, as assessed by the aMT6S (melatonin) rhythm (Barnes et al., 1998a; Gibbs et al., 2002) and by sleep and sleepiness assessment (Bjorvatn et al., 1998, 2006). The fast adaptation to night work the rst week on the oil rigs could probably be explained by a combination of environmental and social factors (Barnes et al., 1998b) or lack of light exposure in the morning (Bjorvatn et al., 2006). When they were on swing shift the cortisol rhythm the rst day after rotation was totally at. One week later, they were almost readapted to a normal day rhythm. The adaptation from night work (at the oil rig when working swing shift and at home when working only night shift) took longer time than adaptation to night work. The result indicates that direction and leisure time between the shifts are of importance. One explanation may be the fact that most people have a biological clock that is longer than 24 h. It is therefore easier to phase delay than phase advance the diurnal rhythm (Czeisler et al., 1999; Bjorvatn and Pallesen, 2009). The results are in accordance with a study from the industrial and service organizations showing that backward rotating shift (from night shift to day shift) was related to health and wellbeing problems when the shift system involved quick returns with less than 8 h between the shifts (Barton and Folkard, 1993). Another study from offshore workers on a swing shift schedule have found that measured with melatonin (aMT6S) the readaptation from night shift to day shift in the second week was more difcult than the adaptation from day rhythm into night shift the rst week (Gibbs et al., 2002). The low cortisol response after awakening (CAR) and high evening values after night shift (14 nights) indicate that the workers were not recovered 1 week after the offshore tour. This result is in accordance with a previous study showing that the resetting of the rhythm after returning home from 2 weeks night shift was more difcult than the adaptation to night shift when they arrived on the installation (Bjorvatn et al., 1998). However, when returning home from swing shift, the cortisol rhythm was readapted after 1 week. This is a better situation for leisure time activities, and is the reason given for the preference for this schedule. Cortisol is not only a robust marker of overall circadian rhythm (Born and Fehm, 2000). It is also used a measurement of stress, since it is a sensitive indicator of phasic shifts in arousal (Ursin and Eriksen, 2004). Variance in the cortisol rhythm, therefore, may be related to psychological factors as, for instance, expectancies and attributions connected to the work situation. In the recent cognitive activation theory of stress (CATS), expectancies associated with stimulus and response outcome are held to be decisive for the arousal (or stress) levels of the organism. A blunted response in the morning and high levels in the evening may be an indication of insufcient recovery, which may be an important element in the potential ill effects of stress and shift work (Kristenson et al., 2004; Sluiter et al., 1998). The rapid readaptation in the onshore period agrees with the reason given for the preference for this schedule. However, our data do not tell us whether swing shift has any long term health benet compared with other shift schedules.

1346 A legitimate concern is the potential security and performance risk of changing from night shift to day shift in the middle of an offshore period. We did not nd any evidence for this in the reaction time test, our only objective measurement relevant for this type of performance risk. Reaction time appeared stable through the whole working period on the different schedules. The rst night on the oil rig when they were on night shift, the mean reaction time was higher compared to rst day on day shift. However, for the rest of the work period there were no differences between the different schedules. Our results are in accordance with another study of shift workers from the oil industry, where reaction time during 1 week on night shift was the same as the next week on day shift (Bjorvatn et al., 2006). These ndings are in contrast to earlier studies from offshore personnel working swing shift. Parkes (1997) found that personnel working swing shift (7 nights + 7 days) showed moderate increases (10.7%) in reaction time compared to day shift. The increases were especially marked during the rst 2 days after rotation from night to day shift. The opposite nding has also been reported. Reaction time decreased in nurses following a period with night shift only, but increased again after 1 day off (Totterdell et al., 1995). Introduction of the new swing shift schedule was not associated with more subjective health problems or changes in perceived work environment. Previous survey studies have concluded that rotating shift systems may cause more subjective sleep problems, lower alertness and performance than xed shift rotation (Lauridsen and Tnnesen, 1990; Parkes, 1997). Our study is a within-subjects design, the same individual was assessed under different shift work conditions. This design is less likely to be vulnerable to selection bias, except for the fact that our workers wanted this particular shift system. Also the workers in our study are highly selected. In average they have been shift workers for 17 years. It seems reasonable to assume a healthy worker effect (Costa, 2003), only the healthiest and ttest, those who cope with shift work, are the ones who continue to work shift for several years. Another potential problem from generalising from our ndings is a possible order effect, all workers were tested with xed shift followed by swing shift. However, this order is the whole point with the swing shift, to go home from dayshift instead of from night shift to have better quality in their leisure time. Finally, our workers worked in the processing division of the oil rig. There are also differences in rules and regulations between different countries (e.g. the Norwegian sector versus the UK sector) (Ross, 2009). The overall ndings from this study indicate that there was no increase in health complaints from swing shift. There were no effects on reaction time on the day they shifted from night work to day work. The cortisol curve was a good indicator for changes in diurnal rhythm. Personnel adapt to night shift within a week regardless of schedule, but recovery from night shift takes longer time. The cortisol rhythm was closer to the normal day values in the second week, but it was not fully returned to normal values when they started on their home period. However, the rhythm was totally reset 1 week after returning home from swing shift. It might therefore be less apprehension of potential problems for the swing shift schedule in the home period.

A. Harris et al. Personnel returning home from 14 consecutive night shifts need more than 1 week at home to recover their cortisol rhythm.

Role of funding source

The study was supported by a grant from The Norwegian oil company StatoilHydro and by grants from the University of Bergen and Unifob Health. StatoilHydro (administration, trade unions, and the health service) accepted the design and offered logistic support and advice for the data collection. Results were presented, explained, and discussed with participants and representatives of the company. The interpretations and conclusions of the paper are solely the responsibility of the authors.

Conict of interest
None declared.

Acknowledgments
The authors would like to acknowledge funding from the oil company StatoilHydro. We thank all the volunteers for their patience and compliance and the medical personnel on the oil rig for their help. Thanks also to Stein Atle Lie for statistical support and advice and to Nina Konglevold and Anne Abildtrup for technical assistance.

References
Barnes, R.G., Deacon, S.J., Forbes, M.J., Arendt, J., 1998a. Adaptation of the 6-sulphatoxymelatonin rhythm in shiftworkers on offshore oil installations during a 2-week [12-h] night shift. Neurosci. Lett. 241, 912. Barnes, R.G., Forbes, M.J., Arendt, J., 1998b. Shift type and season affect adaptation of the 6-sulphatoxymelatonin rhythm in offshore oil rig workers. Neurosci. Lett. 252, 179182. Barton, J., Folkard, S., 1993. Advancing versus delaying shift systems. Ergonomics 36, 5964. Bjorvatn, B., Kecklund, G., Akerstedt, T., 1998. Rapid adaptation to night work at an oil platform, but slow readaptation after returning home. J. Occup. Environ. Med. 40, 601608. Bjorvatn, B., Kecklund, G., Akerstedt, T., 1999. Bright light treatment used for adaptation to night work and re-adaptation back to day life. A eld study at an oil platform in the North Sea. J. Sleep Res. 8, 105112. Bjorvatn, B., Pallesen, S., 2009. A practical apporach to circadian rhythm sleep disorders. Sleep Med. Rev. 13, 4760. Bjorvatn, B., Stangenes, K., Oyane, N., Forberg, K., Lowden, A., Holsten, F., Akerstedt, T., 2006. Subjective and objective measures of adaptation and readaptation to night work on an oil rig in the North Sea. Sleep 29, 821829. Born, J., Fehm, H.L., 2000. The neuroendocrine recovery function of sleep. Noise Health 2, 2538. Costa, G., 1996. The impact of shift and night work on health. Appl. Ergon. 27, 916. Costa, G., 2003. Shift work and occupational medicine: an overview. Occup. Med. (Lond.) 53, 8388. Costa, G., Ghirlanda, G., Tarondi, G., Minors, D., Waterhouse, J., 1994. Evaluation of a rapidly rotating shift system for tolerance of nurses to nightwork. Int. Arch. Occup. Environ. Health 65, 305 311.

Cortisol, reaction time test and health among offshore shift workers
Czeisler, C.A., Duffy, J.F., Shanahan, T.L., Brown, E.N., Mitchell, J.F., Rimmer, D.W., Ronda, J.M., Silva, E.J., Allan, J.S., Emens, J.S., Dijk, D.J., Kronauer, R.E., 1999. Stability, precision, and near-24hour period of the human circadian pacemaker. Science 284, 21772181. Czeisler, C.A., Kronauer, R.E., Allan, J.S., Duffy, J.F., Jewett, M.E., Brown, E.N., Ronda, J.M., 1989. Bright light induction of strong (type 0) resetting of the human circadian pacemaker. Science 244, 13281333. Dockray, S., Bhattacharyya, M.R., Molloy, G.J., Steptoe, A., 2008. The cortisol awakening response in relation to objective and subjective measures of waking in the morning. Psychoneuroendocrinology 33, 7782. Eriksen, H.R., Ihlebaek, C., Ursin, H., 1999. A scoring system for subjective health complaints (SHC). Scand. J. Public Health 27, 6372. Fujiwara, S., Shinkai, S., Kurokawa, Y., Watanabe, T., 1992. The acute effects of experimental short-term evening and night shifts on human circadian rhythm: the oral temperature, heart rate, serum cortisol and urinary catecholamines levels. Int. Arch. Occup. Environ. Health 63, 409418. .M., Nikolajsen, T.B., 2003. An inter-laboraGarde, A.H., Hansen, A tory comparison for determination of cortisol in saliva. Accredit. Qual. Assur. 8, 1620. Gibbs, M., Hampton, S., Morgan, L., Arendt, J., 2002. Adaptation of the circadian rhythm of 6-sulphatoxymelatonin to a shift schedule of seven nights followed by seven days in offshore oil installation workers. Neurosci. Lett. 325, 9194. Gustafsson, K., Lindfors, P., Aronsson, G., Lundberg, U., 2008. Relationships between self-rating of recovery from work and morning salivary cortisol. J. Occup. Health 50, 2430. Hansen, A.M., Garde, A.H., Christensen, J.M., Eller, N.H., Netterstrom, B., 2003. Evaluation of a radioimmunoassay and establishment of a reference interval for salivary cortisol in healthy subjects in Denmark. Scand. J. Clin. Lab. Invest. 63, 303310. Harris, A., Ursin, H., Murison, R., Eriksen, H.R., 2007. Coffee, stress and cortisol in nursing staff. Psychoneuroendocrinology 32, 322 330. Hennig, J., Kieferdorf, P., Moritz, C., Huwe, S., Netter, P., 1998. Changes in cortisol secretion during shiftwork: implications for tolerance to shiftwork? Ergonomics 41, 610621. Honma, K., Honma, S., Nakamura, K., Sasaki, M., Endo, T., Takahashi, T., 1995. Differential effects of bright light and social cues on reentrainment of human circadian rhythms. Am. J. Physiol. 268, R528R535. Ihlebaek, C., Brage, S., Eriksen, H.R., 2007. Health complaints and sickness absence in Norway, 19962003. Occup. Med. (Lond.) 57, 4349. Jansen, N., Kant, I., van Amelsvoort, L., Nijhuis, F., van den Brandt, P., 2003. Need for recovery from work: evaluating short-term effects of working hours, patterns and schedules. Ergonomics 46, 664680. Kirschbaum, C., Hellhammer, D.H., 1989. Salivary cortisol in psychobiological research: an overview. Neuropsychobiology 22, 150169. Knutsson, A., 2003. Health disorders of shift workers. Occup. Med. (Lond.) 53, 103108. Kristenson, M., Eriksen, H.R., Sluiter, J.K., Starke, D., Ursin, H., 2004. Psychobiological mechanisms of socioeconomic differences in health. Soc. Sci. Med. 58, 15111522. Kudielka, B.M., Buchtal, J., Uhde, A., Wust, S., 2007. Circadian cortisol proles and psychological self-reports in shift workers with and without recent change in the shift rotation system. Biol. Psychol. 74, 92103.

1347

Lac, G., Chamoux, A., 2004. Biological and psychological responses to two rapid shiftwork schedules. Ergonomics 47, 13391349. Lamond, N., Dawson, D., Roach, G.D., 2005. Fatigue assessment in the eld: validation of a hand-held electronic psychomotor vigilance task. Aviat. Space Environ. Med. 76, 486489. Lauridsen, ., Tnnesen, T., 1990. Injuuries related to the aspect of shift working. A comparison of different offshore shift arrangements. J. Occup. Accidents 12, 167176. McBeth, J., Silman, A.J., Gupta, A., Chiu, Y.H., Ray, D., Morriss, R., Dickens, C., King, Y., Macfarlane, G.J., 2007. Moderation of psychosocial risk factors through dysfunction of the hypothalamicpituitaryadrenal stress axis in the onset of chronic widespread musculoskeletal pain: ndings of a population-based prospective cohort study. Arthritis Rheum. 56, 360371. Parkes, K.R., 1997. Psychosocial aspects of work and health in the North Sea oil and gas industry. Part III. Sleep, mood and performance in relation to offshore shift rotation schedules. In: Executive, H.a.S. (Ed.), HSE Report 96, London, p. 530. Persson, R., Garde, A.H., Hansen, A.M., Osterberg, K., Larsson, B., Orbaek, P., Karlson, B., 2008. Seasonal variation in human salivary cortisol concentration. Chronobiol. Int. 25, 923937. Regestein, Q.R., Monk, T.H., 1991. Is the poor sleep of shift workers a disorder. Am. J. Psychol. 148, 14871493. Ross, J.K., 2009. Offshore industry shift work health and social considerations. Occup. Med. (Lond.) 59, 310315. Rydstedt, L.W., Mark, C., 2008. The relationship between long-term job strain and morning and evening saliva cortisol secretion among white-collar workers. J. Occup. Health Psychol. 13, 105113. Shinkai, S., Watanabe, S., Kurokawa, Y., Torii, J., 1993. Salivary cortisol for monitoring circadian rhythm variation in adrenal activity during shiftwork. Int. Arch. Occup. Environ. Health 64, 499502. Sluiter, J.K., van der Beek, A.J., Frings-Dresen, M.H., 1998. Work stress and recovery measured by urinary catecholamines and cortisol excretion in long distance coach drivers. Occup. Environ. Med. 55, 407413. Theorell, T., 1993. Demands-control-support. A new model for research of occupational environment. Lakartidningen 90, 36833686. Tilley, A.J., Wilkinson, R.T., Warren, P.S., Watson, B., Drud, M., 1982. The sleep and performance of shift workers. Hum. Factors 24, 629641. Totterdell, P., Spelten, E., Smith, L., Barton, J., Folkard, S., 1995. Recovery from work shifts: how long does it take? J. Appl. Psychol. 80, 4357. Tucker, P., Smith, L., Macdonald, I., Folkard, S., 1998. Shift length as a determinant of retrospective on-shift alertness. Scand. J. Work Environ. Health 24 (Suppl. 3), 4954. Ursin, H., Eriksen, H.R., 2004. The cognitive activation theory of stress. Psychoneuroendocrinology 29, 567592. Weitzman, E.D., Fukushima, D., Nogeire, C., Roffwarg, H., Gallagher, T.F., Hellman, L., 1971. Twenty-four hour pattern of the episodic secretion of cortisol in normal subjects. J. Clin. Endocrinol. Metab. 33, 1422. Westgard, J.O., Barry, P.L., Hunt, M.R., Groth, T., 1981. A multi-rule Shewhart chart for quality control in clinical chemistry. Clin. Chem. 27, 493501. Wilhelm, I., Born, J., Kudielka, B.M., Schlotz, W., Wust, S., 2007. Is the cortisol awakening rise a response to awakening? Psychoneuroendocrinology 32, 358366. Wilhelmsen, I., Mulindi, S., Sankok, D., Wilhelmsen, A.B., Eriksen, H.R., Ursin, H., 2007. Subjective health complaints are more prevalent in Maasais than in Norwegians. Nord. J. Psychiatr. 61, 304309.