Shift work and health--a critical review of the literature on working hours.

Working outside normal hours either by extended days or shift work is a fact of industrial society. Its economic advantages must be weighed against detrimental effects on the individual worker in the form of circadian rhythm disturbance, poorer quality and quantity of sleep and increased fatigue. The link between shift work and increased cardiovascular morbidity and mortality has strengthened in recent years. The case for an association with gastrointestinal disease remains quite good. Evidence of poorer work performance and increased accidents, particularly on the night shift, is persuasive, although individual factors may be as important as workplace factors. Correct shift work scheduling is important and for rotating shifts, rapid forward rotation is the least disruptive option. The compressed working week of 10 to 12-hour shifts is gaining popularity but evidence is too scant at present to suggest there are many long-term health and safety risks provided the rest day block is preserved. Optimal hours for the working week cannot be formulated on present scientific evidence, though working more than 48-56 hours a week probably carries serious health and safety implications. The inherent conflict between the interest of the worker and the enterprise over unsocial hours can be mitigated by improvements in working conditions especially at night and by advice to the worker on coping strategies. Further research is needed on the effects of the compressed working week, as well as the influence of culture, task and gender on any health effects. Studies to define individual characteristics which may cause shift work intolerance would be of great practical use.