Chronotype mediates gender differences in risk propensity and risk-taking

Adolescent circadian rhythm disruption increases reward and risk-taking

Introduction

Circadian rhythm disturbances have long been associated with the development of psychiatric disorders, including mood and substance use disorders. Adolescence is a particularly vulnerable time for the onset of psychiatric disorders and for circadian rhythm and sleep disruptions. Preclinical studies have found that circadian rhythm disruption (CRD) impacts the brain and behavior, but this research is largely focused on adult disruptions. Here, we hypothesized that adolescent CRD would have a greater effect on psychiatric-related behaviors, relative to adult disruption.

Methods

We determined the long-term behavioral and neurobiological effects of CRD during early adolescence by exposing mice to 12 h shifts in the light/dark cycle. Adult mice were exposed to the same CRD paradigm. Behavior testing began approximately 4 weeks later for both groups. To identify possible mechanisms, we also measured gene expression in brain regions relevant to circadian rhythms, mood and reward.

Results

CRD during early adolescence, but not adulthood, persistently increased exploratory drive (risk-taking behavior) and cocaine preference when tested later in life. Interestingly, we found sex differences when intravenous cocaine self-administration was tested. While female mice with a history of adolescent CRD had a greater propensity to self-administer cocaine, as well as increased motivation and cue-induced reinstatement, male adolescent CRD mice had reduced motivation and extinction responding. Importantly, we found that transcripts in the SCN were affected by adolescent CRD and these were largely distinct across sex.

Conclusion

Overall, adolescent CRD in mice caused persistent increases in risky behavior, cocaine reward and cocaine self-administration, which suggests that CRD during adolescence may predispose individuals toward substance use disorders. Future research is required to elucidate how adolescent CRD affects behaviors relevant to mood-and substance use-related disorders across the 24-h day, as well as to identify intervention strategies to alleviate disruption during adolescence and novel therapeutic approaches once symptoms have begun.

Moderating effects of PER3 gene DNA methylation on the association between problematic mobile phone use and chronotype among Chinese young adults: Focus on gender differences

Objective

To investigate the rates of problematic mobile phone use (PMPU) and chronotypes in young adults, and examine the associations of PMPU with chronotypes, as well as its gender differences. Furthermore, we explored the moderating role of PER3 gene DNA methylation on the associations.

Methods

From April to May 2019, a total of 1,179 young adults were selected from 2 universities in Anhui and Jiangxi provinces. The Self-rating Questionnaire for Adolescent Problematic Mobile Phone Use (SQAPMPU) and reduced Morningness-Eveningness Questionnaire (rMEQ) were adopted to investigate PMPU and chronotypes in young adults, respectively. Moreover, 744 blood samples were collected to measure PER3 gene DNA methylation. Multivariate logistic regression models were established to analyze the associations between PMPU and chronotypes. Moderating analysis was used to determine whether PER3 gene DNA methylation moderated the relationships between PMPU and chronotypes.

Results

The prevalence of PMPU, morning chronotypes (M-types), neutral chronotypes (N-types), and evening chronotypes (E-types) of young adults were 24.6%, 18.4%, 71.1%, and 10.5%, respectively. Multivariate logistic regression results indicated that PMPU was positively correlated with E-types (OR = 3.53, 95%CI: 2.08-6.00), and the association was observed only in females after stratified by gender (OR = 5.36, 95%CI: 2.70-10.67). Furthermore, PER3 gene DNA methylation has a negative moderating role between PMPU and chronotypes and has a sex-based difference.

Conclusions

This study can provide valuable information for the prevention and control of circadian rhythm disturbance among young adults from the perspective of epidemiology and biological etiology.

Methamphetamine increases risky choice in rats, but only when magnitude and probability of reinforcement are manipulated within a session

Risky choice is associated with maladaptive behaviors, particularly substance use disorders. Current animal models of risky choice are often confounded by other constructs like behavioral flexibility and suboptimal choice. The purpose of the current experiment was to determine if the psychostimulant methamphetamine, a drug whose popularity has increased in recent years, increases risky choice in an equivalent expected value (EEV) task. In the EEV task, rats are given a choice between two reinforcer alternatives that differ in magnitude and probability of delivery, but have equivalent expected value. Forty-eight Sprague Dawley rats were tested in three versions of the EEV task. In the first version of the EEV task, both reinforcer magnitude and probability were adjusted across blocks of trials for both alternatives. In the second and the third versions of the EEV task, reinforcer magnitude was held constant across each block of trials (either 1 vs. 2 pellets or 4 vs. 5 pellets). We found that male rats preferred the "riskier" option, except when reinforcer magnitudes were held constant at 4 and 5 pellets across each block of trials. Methamphetamine (0.5 mg/kg) increased preference for the risky option in both males and females, but only when both reinforcer magnitude and probability were manipulated across blocks of trials for each alternative. The current results demonstrate that both magnitude of reinforcement and probability of reinforcement interact to influence risky choice. Overall, this study provides additional support for using reinforcers with expected value to measure risky choice.

The associations between different types of infections and circadian preference and shift work

Disturbed sleep and circadian disruption are reported to increase the risk of infections. People with an evening circadian preference and night workers typically report insufficient sleep, and the aims of the present study were to investigate possible associations between various types of infections and circadian preference and shift work status. Data were collected from an online cross-sectional survey of 1023 participants recruited from the Norwegian practice-based research network in general practice - PraksisNett. The participants completed questions about circadian preference (morning type, intermediate type, evening type), work schedule (day work, shift work without nights, shift work with night shifts), and whether they had experienced infections during the last three months (common cold, throat infection, ear infection, sinusitis, pneumonia/bronchitis, COVID-19, influenza-like illness, skin infection, gastrointestinal infection, urinary infection, venereal disease, eye infection). Data were analyzed with chi-square tests and logistic regression analyses with adjustment for relevant confounders (gender, age, marital status, country of birth, children living at home, and educational level). Results showed that evening types more often reported venereal disease compared to morning types (OR = 4.01, confidence interval (CI) = 1.08-14.84). None of the other infections were significantly associated with circadian preference. Shift work including nights was associated with higher odds of influenza-like illness (OR = 1.97, CI = 1.10-3.55), but none of the other infections. In conclusion, neither circadian preference nor shift work seemed to be strongly associated with risk of infections, except for venereal disease (more common in evening types) and influenza-like illness (more common in night workers). Longitudinal studies are needed for causal inferences.

Correlation Analysis Between Time Awareness and Morningness-Eveningness Preference

The circadian clock is adjusted by light inputs via the retinohypothalamic tract. Because environmental light is controllable for modern humans at the individual's preference although under social schedules, individual differences in time-related psychology and behavior may be associated with morningness-eveningness preference (M-E preference). To examine this hypothesis, we used the Time Management Scale and Time Anxiety Scale to quantify time-related psychology and behavior. These scales aim to evaluate "awareness of effective time management and utilization" and "anxiety about uncontrollable time schedule and unexpected time-related outcome", respectively. According to our correlation analysis using mid-sleep time as a marker for M-E preference, we obtained results supporting our hypothesis in the correlation between the M-E preference values and the Time Management Scale scores, with larger "time estimation" and "taking each moment as it comes" scores associated with more morningness and eveningness, respectively. Considering that modern humans likely become night owls under artificial light conditions, it appears plausible that lower awareness of time management leads to more eveningness.

Nocturnal selective pressures on the evolution of human musicality as a missing piece of the adaptationist puzzle

Human musicality exhibits the necessary hallmarks for biological adaptations. Evolutionary explanations focus on recurrent adaptive problems that human musicality possibly solved in ancestral environments, such as mate selection and competition, social bonding/cohesion and social grooming, perceptual and motor skill development, conflict reduction, safe time-passing, transgenerational communication, mood regulation and synchronization, and credible signaling of coalition and territorial/predator defense. Although not mutually exclusive, these different hypotheses are still not conceptually integrated nor clearly derived from independent principles. I propose The Nocturnal Evolution of Human Musicality and Performativity Theory in which the night-time is the missing piece of the adaptationist puzzle of human musicality and performing arts. The expansion of nocturnal activities throughout human evolution, which is tied to tree-to-ground sleep transition and habitual use of fire, might help (i) explain the evolution of musicality from independent principles, (ii) explain various seemingly unrelated music features and functions, and (iii) integrate many ancestral adaptive values proposed. The expansion into the nocturnal niche posed recurrent ancestral adaptive challenges/opportunities: lack of luminosity, regrouping to cook before sleep, imminent dangerousness, low temperatures, peak tiredness, and concealment of identity. These crucial night-time features might have selected evening-oriented individuals who were prone to acoustic communication, more alert and imaginative, gregarious, risk-taking and novelty-seeking, prone to anxiety modulation, hedonistic, promiscuous, and disinhibited. Those night-time selected dispositions may have converged and enhanced protomusicality into human musicality by facilitating it to assume many survival- and reproduction-enhancing roles (social cohesion and coordination, signaling of coalitions, territorial defense, antipredatorial defense, knowledge transference, safe passage of time, children lullabies, and sexual selection) that are correspondent to the co-occurring night-time adaptive challenges/opportunities. The nocturnal dynamic may help explain musical features (sound, loudness, repetitiveness, call and response, song, elaboration/virtuosity, and duetting/chorusing). Across vertebrates, acoustic communication mostly occurs in nocturnal species. The eveningness chronotype is common among musicians and composers. Adolescents, who are the most evening-oriented humans, enjoy more music. Contemporary tribal nocturnal activities around the campfire involve eating, singing/dancing, storytelling, and rituals. I discuss the nocturnal integration of musicality's many roles and conclude that musicality is probably a multifunctional mental adaptation that evolved along with the night-time adaptive landscape.

Adaptations of the balloon analog risk task for neuroimaging settings: a systematic review

Introduction

The Balloon Analog Risk Task (BART), a computerized behavioral paradigm, is one of the most common tools used to assess the risk-taking propensity of an individual. Since its initial behavioral version, the BART has been adapted to neuroimaging technique to explore brain networks of risk-taking behavior. However, while there are a variety of paradigms adapted to neuroimaging to date, no consensus has been reached on the best paradigm with the appropriate parameters to study the brain during risk-taking assessed by the BART. In this review of the literature, we aimed to identify the most appropriate BART parameters to adapt the initial paradigm to neuroimaging and increase the reliability of this tool.

Methods

A systematic review focused on the BART versions adapted to neuroimaging was performed in accordance with PRISMA guidelines.

Results

A total of 105 articles with 6,879 subjects identified from the PubMed database met the inclusion criteria. The BART was adapted in four neuroimaging techniques, mostly in functional magnetic resonance imaging or electroencephalography settings.

Discussion

First, to adapt the BART to neuroimaging, a delay was included between each trial, the total number of inflations was reduced between 12 and 30 pumps, and the number of trials was increased between 80 and 100 balloons, enabling us to respect the recording constraints of neuroimaging. Second, explicit feedback about the balloon burst limited the decisions under ambiguity associated with the first trials. Third, employing an outcome index that provides more informative measures than the standard average pump score, along with a model incorporating an exponential monotonic increase in explosion probability and a maximum explosion probability between 50 and 75%, can yield a reliable estimation of risk profile. Additionally, enhancing participant motivation can be achieved by increasing the reward in line with the risk level and implementing payment based on their performance in the BART. Although there is no universal adaptation of the BART to neuroimaging, and depending on the objectives of a study, an adjustment of parameters optimizes its evaluation and clinical utility in assessing risk-taking.

Association between mobile phone addiction, chronotype and nonsuicidal self-injury among adolescents: A large-scale study in China

BACKGROUND

Nonsuicidal self-injury (NSSI) is a serious public health and clinical problem, particularly for adolescents, and may link to problematic smartphone use (PSU) and chronotype. This study examines the independent and interaction effects of PSU and chronotype on NSSI among adolescents and identified gender differences in these associations.

METHODS

A total of 21,357 students aged 11-19 were recruited using stratified cluster sampling across five representative provinces in China and completed standard questionnaires to record details of PSU, chronotype, and NSSI.

RESULTS

A total of 38.1 % of students reported having engaged in NSSI and 17.7 % had PSU. PSU and chronotype were significantly associated with NSSI among adolescents, and this relationship was stronger in females. Interaction analysis indicated that E-type and PSU were interactively associated with increased risks of NSSI.

CONCLUSION

The findings suggest that E-type and PSU can increase the risk of NSSI both independently and interactively. Therefore, they should be considered in intervention programs for NSSI, especially for females.

The Effect of Chronotype on Risk-Taking Behavior: The Chain Mediation Role of Self-Control and Emotional Stability

BACKGROUND

Although previous studies indicate that chronotype might be associated with risk-taking behavior, the specific mechanism has not been thoroughly discussed. This study aimed to fill this gap by exploring the mediating role of self-control and the chain mediating role of self-control and emotional stability between chronotype and risk-taking behavior.

METHODS

A total of 547 Chinese college students between 18 and 24 years old were selected to complete the Morningness-Eveningness Questionnaire (MEQ), Self-Control Scale (SCS), Eysenck's Personality Questionnaire-neuroticism (EPQ-N), and Adolescent Risk-Taking Questionnaire: Risk Behavior Scale (ARQ-RB) to assess chronotype, risk-taking behavior, self-control, and emotional stability, respectively. Hayes' PROCESS macro for SPSS was used to test the relationships among these variables.

RESULTS

Our result showed significant positive correlations among chronotype, self-control, emotional stability, and significant negative correlations between self-control, emotional stability, and risk-taking behavior. We also found that chronotype had a significant predictive effect on risk-taking behavior in the chain mediation model. Specifically, chronotype affected risk-taking behavior through two pathways: the separate mediating role of self-control and the serial mediation pathway of self-control → emotional stability.

CONCLUSIONS

Our study provides direct evidence that chronotype is associated with risk-taking behavior. The results showed that the predictive function of chronotype was mediated by self-control and emotional stability. This study provides a new perspective on preventing and reducing risk-taking behavior.

When the clock ticks wrong with COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the coronavirus family that causes the novel coronavirus disease first diagnosed in 2019 (COVID-19). Although many studies have been carried out in recent months to determine why the disease clinical presentations and outcomes can vary significantly from asymptomatic to severe or lethal, the underlying mechanisms are not fully understood. It is likely that unique individual characteristics can strongly influence the broad disease variability; thus, tailored diagnostic and therapeutic approaches are needed to improve clinical outcomes. The circadian clock is a critical regulatory mechanism orchestrating major physiological and pathological processes. It is generally accepted that more than half of the cell-specific genes in any given organ are under circadian control. Although it is known that a specific role of the circadian clock is to coordinate the immune system's steady-state function and response to infectious threats, the links between the circadian clock and SARS-CoV-2 infection are only now emerging. How inter-individual variability of the circadian profile and its dysregulation may play a role in the differences noted in the COVID-19-related disease presentations, and outcome remains largely underinvestigated. This review summarizes the current evidence on the potential links between circadian clock dysregulation and SARS-CoV-2 infection susceptibility, disease presentation and progression, and clinical outcomes. Further research in this area may contribute towards novel circadian-centred prognostic, diagnostic and therapeutic approaches for COVID-19 in the era of precision health.

The Effect of Chronotype on Oppositional Behaviour and Psychomotor Agitation of School-Age Children: A Cross-Sectional Study

The aim of this study is to examine the relationship between chronotype, classroom behaviour and school performance in 140 healthy school-age children attending various levels of education during the 1st cycle during 2021 in Portugal. In this cross-sectional and quantitative study, the Chronotype Questionnaire for Children (to assess the chronotype) and the Conners Scale-a reduced version was presented to the teachers (to assess behaviours such as excessive movement, inattention and oppositional behaviours)-were used. The methodology of this study followed a comparative method since the independent variables were not controlled, and therefore, it was still possible to compare the differences between the morning and evening groups. Statistical methods were used such as multivariate analyses, inter-item correlations and reliability tests, and descriptive tests were used for the percentile analysis. The sample was divided into three groups based on the identification of the chronotype-morning, intermediate and evening types-to further study the relationship between these chronotypes, their academic performance and classroom behaviour were studied. A multivariate analysis of variance revealed that there was a higher rate of oppositional behaviour in the morning type and no differences in the school performance during the two semesters (covering all of the school periods) regarding the chronotype effect, even with the analysis of regression parameters and covariates. On the other hand, the morning-type children showed a greater amount of motor agitation and impulsivity after controlling for the gender covariate. Age had an effect on the chronotype, after controlling for the covariate parental education. This study highlights the need for further research on the chronotype of the morning children in order to regulate their behaviour. The data that were obtained raise questions that have not been yet considered in the literature in the area of education and infant development.

Circadian preference is associated with multiple domains of trait and state level impulsivity

Impulsivity is a multidimensional construct with well-documented risk for substance use problems at both the trait- and state levels. A circadian preference towards eveningness has been linked to trait-level, global impulsivity, but whether this association holds true across multiple dimensions of impulsivity and whether actual sleep timing shows parallel associations with impulsivity remain unclear. Here, we extend existing literature by investigating whether eveningness is associated with multiple facets of both trait- and state-level impulsivity. We also examined these associations utilizing daily measures of sleep timing and duration and explored whether they differed by sex and/or race. All participants were moderate-to-heavy social drinkers aged 21-35. Primary analyses included 78 participants (100% White male participants: Sample 1) with circadian preference data (Composite Scale of Morningness: CSM) and sleep timing (midsleep) and duration assessed via daily self-report over 10 days. Five facets of impulsivity were assessed via the UPPS-P, both at baseline (full scale; trait-level) and up to 6 times per day over 10 days (reduced scale; state-level). Linear regression and mixed-effects models were used to examine between- and within-person associations of impulsivity with measures of circadian preference, timing, and duration, accounting for covariates. Exploratory analyses combined Sample 1 with an additional more diverse sample (Sample 2), resulting in a total of 182 participants (29.1% self-identified as Black, 29.7% as female) with daily self-report sleep timing and duration only (no circadian preference). Primary between-person models found that eveningness was associated with multiple facets of impulsivity, at trait (lack of perseverance) and state levels (negative and positive urgency, lack of perseverance, and lack of premeditation), while average midsleep and duration were generally unrelated to impulsivity. Primary within-person models largely paralleled the between-person findings. Exploratory analyses in the larger combined Samples 1 and 2 (without circadian preference) found that later midsleep timing was associated with greater mean state-level impulsivity across multiple facets, associations that may differ by race and sex. In a sample of White male participants, circadian preference for eveningness was strongly associated with multiple facets of impulsivity, at both trait- and state-levels, which may contribute to risk for substance use. Preliminary findings suggest sex and race differences in sleep-impulsivity associations, but future research with objective sleep/circadian measures in larger, more diverse samples will be important to clarify implications for sleep-focused prevention and/or treatment of substance use.

COVID ‐19 exposure, pandemic‐related appraisals, coping strategies, and psychological symptoms among the frontline medical staff and gender differences in coping processes

This study sought to explore the effects of COVID‐19 exposure, pandemic‐related appraisals and coping strategies on psychological symptoms among the front‐line healthcare workers based on the transactional theory of stress and coping. A cross‐sectional study was conducted in a Wuhan hospital designated for inpatients with COVID‐19, assessing COVID‐19 exposure (whether or not exposed to confirmed patients at workplace), psychological symptoms, appraisals, and coping strategies in 311 participants. Results revealed that the pandemic markedly affected healthcare workers' mental well‐being through appraisal and coping, with 38.9% reporting high levels of psychological symptoms. Primary appraisal related closely with COVID‐19 exposure, especially in female, while secondary appraisal was associated with problem‐focused coping. Both problem‐focused and emotion‐focused coping had a protective effect against psychological symptoms, but also showed gender differences in its relations with other variables. These findings could potentially benefit to enrich relevant theories, and to develop psychological programs for future epidemics.

COVID-19 Pandemic on Fire: Evolved Propensities for Nocturnal Activities as a Liability Against Epidemiological Control

Humans have been using fire for hundreds of millennia, creating an ancestral expansion toward the nocturnal niche. The new adaptive challenges faced at night were recurrent enough to amplify existing psychological variation in our species. Night-time is dangerous and mysterious, so it selects for individuals with higher tendencies for paranoia, risk-taking, and sociability (because of security in numbers). During night-time, individuals are generally tired and show decreased self-control and increased impulsive behaviors. The lower visibility during night-time favors the partial concealment of identity and opens more opportunities for disinhibition of self-interested behaviors. Indeed, individuals with an evening-oriented chronotype are more paranoid, risk-taking, extraverted, impulsive, promiscuous, and have higher antisocial personality traits. However, under some circumstances, such as respiratory pandemics, the psychobehavioral traits favored by the nocturnal niche might be counter-productive, increasing contagion rates of a disease that can evade the behavioral immune system because its disease cues are often nonexistent or mild. The eveningness epidemiological liability hypothesis presented here suggests that during the COVID-19 pandemic, the evening-oriented psychobehavioral profile can have collectively harmful consequences: there is a clash of core tendencies between the nocturnal chronotype and the recent viral transmission-mitigating safety guidelines and rules. The pandemic safety protocols disrupt much normal social activity, particularly at night when making new social contacts is desired. The SARS-CoV-2 virus is contagious even in presymptomatic and asymptomatic individuals, which enables it to mostly evade our evolved contagious disease avoidance mechanisms. A growing body of research has indirectly shown that individual traits interfering with social distancing and anti-contagion measures are related to those of the nocturnal chronotype. Indeed, some of the social contexts that have been identified as superspreading events occur at night, such as in restaurants, bars, and nightclubs. Furthermore, nocturnal environmental conditions favor the survival of the SARS-CoV-2 virus much longer than daytime conditions. We compare the eveningness epidemiological liability hypothesis with other factors related to non-compliance with pandemic safety protocols, namely sex, age, and life history. Although there is not yet a direct link between the nocturnal chronotype and non-compliance with pandemic safety protocols, security measures and future empirical research should take this crucial evolutionary mismatch and adaptive metaproblem into account, and focus on how to avoid nocturnal individuals becoming superspreaders, offering secure alternatives for nocturnal social activities.

Spanish Women Making Risky Decisions in the Social Domain: The Mediating Role of Femininity and Fear of Negative Evaluation

Authors have empirically evidenced that cultural stereotypes influence gender-typed behavior. With the present work, we have added to this literature by demonstrating that gender roles can explain sex differences in risk-taking, a stereotypically masculine domain. Our aim was to replicate previous findings and to analyze what variables affect women making risky decisions in the social domain. A sample composed of 417 Spanish participants (281 women and 136 men), between 17 and 30 years old (M = 22.34, SD = 3.01), answered a set of self-report measures referring to femininity, fear of negative evaluation, and social risk-taking. According to the main results, sex indirectly linked to risk-taking in the social domain, through femininity and fear of negative evaluation. Specifically, women (vs. men) self-reported higher feminine traits, which were associated with increased fear of negative evaluation, which in turn was associated with less risky decisions in the social domain. Thus, we have showed the relationship between gender roles and women's behaviors in a stereotypically masculine domain (risk-taking). Our findings highlight the necessity of considering a gender-based perspective in the field of risk-taking, showing that not all women make more risky decisions in the social domain.

Associations between diurnal preference, impulsivity and substance use in a young-adult student sample

A diurnal preference for eveningness is common in young adulthood and previous research has associated eveningness with anxiety symptoms as well as increased smoking and alcohol use behaviors. There is some evidence that impulsivity might be an important explanatory variable in these associations, but this has not been comprehensively researched. Here we used both subjective and objective measures of impulsivity to characterize impulsive tendencies in young adults and investigated whether trait impulsivity or trait anxiety could mediate the link between eveningness and substance use. A total of 191 university students (169 females), age range 18-25 y, completed the study. Diurnal preference, sleep quality, anxiety, impulsivity, and substance use were assessed by questionnaire. Impulsivity was also measured using a delay discounting task. Eveningness correlated with trait anxiety and trait impulsivity, and these associations were still significant after controlling for sleep quality. On the delayed discounting task, eveningness correlated with a tendency to prefer smaller immediate rewards over delayed, larger ones. Evening types also reported higher levels of alcohol and cigarette use even after controlling for sleep quality. These associations were found to be completely mediated by self-reported impulsivity; anxiety did not contribute. The current results could help inform interventions aiming to reduce substance use in young adult populations.

Individual Circadian Preference, Shift Work, and Risk of Medication Errors: A Cross-Sectional Web Survey among Italian Midwives

BACKGROUND

In order to explore the possible association between chronotype and risk of medication errors and chronotype in Italian midwives, we conducted a web-based survey. The questionnaire comprised three main components: (1) demographic information, previous working experience, actual working schedule; (2) individual chronotype, either calculated by Morningness-Eveningness Questionnaire (MEQ); (3) self-perception of risk of medication error.

RESULTS

Midwives (n = 401) responded "yes, at least once" to the question dealing with self-perception of risk of medication error in 48.1% of cases. Cluster analysis showed that perception of risk of medication errors was associated with class of age 31-35 years, shift work schedule, working experience 6-10 years, and Intermediate-type MEQ score.

CONCLUSIONS

Perception of the risk of medication errors is present in near one out of two midwives in Italy. In particular, younger midwives with lower working experience, engaged in shift work, and belonging to an Intermediate chronotype, seem to be at higher risk of potential medication error. Since early morning hours seem to represent highest risk frame for female healthcare workers, shift work is not always aligned with individual circadian preference. Assessment of chronotype could represent a method to identify healthcare personnel at higher risk of circadian disruption.