Abstract:

This year I coordinated an elective for medical students in which they developed an understanding on chronomedicine. Chronomedicine deals with prevention, cause, diagnosis, and treatment of diseases with a particular focus on the role played by time in metabolism, physiology, and behavior. Thus, it examines the connection of daily biological rhythms with health. Alterations of our rhythms and activity, e.g. by sleep disorders due to shift work or jet lag, increase the risk of disease. Students therefore became aware of the medical concern of circadian rhythm disruption.

Students actively participated in a workshop intended to analyze two anonymous questionnaires filled out by night-shift nurses. One was the classical Horne & Östberg Morningness-Eveningness questionnaire (MEQ, Int. J. Chronobiol. 1976), which measures degree of activity and alertness in the morning compared to evening/night. The other one was elaborated in-house to assess nurses’ healthy habits (NHHQ), as well as other parameters, and therefore their degree of adaptation to the night-shift schedule.

Gathered in groups of 2-3 in the computer lab, students first plotted frequencies of MEQ scores. To our surprise, the curve did not fit a normal distribution. On the contrary, about 20 % of participants represented an obvious subpopulation of moderate evening types; as reported, this subpopulation might reflect workers with a chronotype truly adapted to nighttime activity. The NHHQ provided on the other hand an excellent study material on shift workers’ habits and circadian rhythm. This experimental set up allowed students to elaborate score tables to quantify if the dynamics of night-shift personnel is adequately healthy. Here, students grouped questions of the NHHQ related to adequate rest & sleep; eating patterns; interactions with employees and patients; etc. More or fewer points were awarded depending on how appropriate each answer was considered; for instance, an affirmative answer to sufficient amount of sleep produced a point, whereas a negative answer produced none. They carefully analyzed multiple answers, no answer, invalid answers, a different answer provided, and even answers with an explanatory note. Potential correlations between answers within the NHHQ were observed in some cases, and even between the two questionnaires. Moreover, students revised the NHHQ, addressing if there were any inappropriate questions, if some required to be rephrased, or if additional ones could be included. Finally, factors that might have influenced answers were also enumerated, pointing out potential limitations of the study.

Finally, and based on the participants’ answers, students considered chrono-medical methods that could be applied to realign (fix) potential circadian rhythm alterations. These included medical/pharmacological, technological/architectural, and sociopolitical strategies. In summary, this scenario allowed students to identify aspects potentially associated to predisposition and vulnerability to pathologies, such as type-2 diabetes or other diseases. The data obtained in this students’ workshop, if analyzed in-depth, may contribute to debating both on night-shift staff performance in the workplace and on care for their own health.

Keywords:

Medical education research, Chronomedicine, Nurse’s health.