![]() Furthermore, studies included in recent systematic reviews were checked for relevant information. After the workshop, a supplementary literature search was performed in PubMed. Prior to the workshop, the participants identified the most relevant scientific literature on the associations and possible mechanisms between night shift work and health and safety within their main research area. Working within different fields of night shift work and health and safety research and performing epidemiological, observational or experimental studies, 15 experience shift work researchers participated in a 3-day workshop held in January 2020 in Denmark. Furthermore, short term physiological effects related to circadian disruption, inadequate sleep duration and quality, fatigue and sleepiness were considered as possible mechanisms linking night shift work to health and safety risks and considered for further evidence in the formulation of the given recommendations. These outcomes were selected because of severity of the disease/event and prior knowledge of studies expected to be informative. The a priori selected health and safety outcomes were cancer, cardio-metabolic disease, injuries and pregnancy-related outcomes, such as miscarriage and pregnancy-related hypertension and pre-eclampsia. As outlined in figure 1, night shift schedules included night shift intensity (number of night shifts per unit time), consecutive night shifts (number of night shifts in a row), permanent night shift work (primarily or only night shifts), shift intervals (time between shifts), direction of rotation (typically forward, eg, D → E → N, or backward rotation, eg, N → E → D) and shift duration (number of hours in a shift). This paper aims to provide scientifically based recommendations on night shift schedules that reduce health and safety risks. The increasing amount of studies on shift work, health and safety has prompted requests from policy-makers, employers and employees for scientifically based recommendations on specific ways to schedule night shift work in order to reduce health and safety risks, which extend previous recommendations on breast cancer to other outcomes. Furthermore, the risk of other adverse health outcomes, such as cardiovascular disease, diabetes, injuries and pregnancy-related outcomes, have also been associated with night shift work. Since then, numerous epidemiological and experimental studies on different types of cancer have been published. ![]() The 2007 IARC evaluation prompted a workshop in Denmark resulting in recommendations for the prevention of the effects of night shift work on risk of breast cancer based upon the available epidemiological, experimental and mechanistic evidence at that time ( 4). Night shift work was defined as work of ≥3 hours between 23:00–06:00 hours and may be organized in many ways including 2- or 3-shift work, irregular schedules, and permanent night shift work ( 2, 3). In 2007 and again in 2019, the International Agency for Research on Cancer (IARC) classified night shift work as probably carcinogenic to humans (group 2A) based on limited evidence of cancer in humans, sufficient evidence of cancer in experimental animals, and strong mechanistic evidence in experimental animals ( 1).
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