Extended work duration and the risk of self-reported percutaneous injuries in interns

Harvard University, Cambridge, Massachusetts, United States
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 10/2006; 296(9):1055-62. DOI: 10.1001/jama.296.9.1055
Source: PubMed

ABSTRACT In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries.
To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States.
National prospective cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed.
Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm).
From a total of 17,003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11).
Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.

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    • "Many studies have been carried out regarding the relationship between sleep disturbance and injury in adults. for example, a number of studies have examined the relationship between insomnia and occupational [12] [13] [14] and driving accidents [15] [16] in adults. However, similar empirical evidence remains sparse for children [17] [18] [19] [20]. "
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    ABSTRACT: Background. A good night's sleep plays a key role in diseases resistance, injury prevention, and mood stability. The objective of this study was to examine relationship between sleep problems and accidental injury occurrences in school-aged children. Method. A retrospective study was conducted for comparing two groups of children. Children who have experienced injuries for at least two times during an academic year are the participants in the injury group (IG) and those who have not experienced any kind of injuries are placed in the noninjury group (NIG). Data was collected through parent-reported sleep patterns and problems using Children's Sleep Habits Questionnaire (CSHQ). Findings. The findings showed that global sleep problems were more in the IG than in the NIG. Multivariate logistic regression analysis showed that the daytime sleepiness and sleep duration are the two major reasons for accidental injury. In addition, significant difference was seen between the sleep patterns of the two groups. Sleep duration was also shorter in the IG, and this group had a greater percentage (63% versus 41.1%) of "short sleepers" (<9 h). Conclusion. There is a significant relationship between injury occurrence and sleep problems and sleep duration in Iranian school-aged children.
    09/2013; 2013:891090. DOI:10.1155/2013/891090
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    • "It is clear that fatigue can affect professional performance of residents. Lapse in concentration and fatigue were the two most common factors contributing to the increase in percutaneous injuries during extended work shifts [8]. Papp et al. found that only 16% of 149 residents from 5 US academic health centers scored within the " normal " range on the Epworth Sleepiness Scale while 84% scored in the range for which clinical intervention is indicated. "
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    ABSTRACT: The main objective of this study was to detect fatigue-induced clinical symptoms of immune suppression in medical residents. Samples were collected from the subjects at rest, following the first night (low-stress), and the last night (high-stress) of night float. Computerized reaction tests, Epworth Sleepiness Scale, and Wellness Profile questionnaires were used to quantify fatigue level. DNA of human herpes viruses HSV-1, VZV, EBV, as well as cortisol and melatonin concentrations, were measured in saliva. Residents at the high-stress interval reported being sleepier compared to the rest interval. EBV DNA level increased significantly at both stress intervals, while VZV DNA level increased only at low-stress. DNA levels of HSV-1 decreased at low-stress but increased at high-stress. Combined assessment of the viral DNA showed significant effect of stress on herpes virus reactivation at both stress intervals. Cortisol concentrations at both stress intervals were significantly higher than those at rest.
    Interdisciplinary Perspectives on Infectious Diseases 12/2011; 2011:571340. DOI:10.1155/2011/571340
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    • "Since the vast majority of 24‐hour shifts begin in the morning (see Figure 1), it is specifically defined for incidents occurring between midnight and 7 AM. This definition captures the intuition that fatigue may manifest itself after long durations on call and especially at night (Veasey et al., 2002; Lockley et al., 2004; Arendt et al., 2005; Ayas et al., 2006). "
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    ABSTRACT: The effect of shift structure on worker performance and productivity is of increasing interest to firms and regulatory bodies. Using approximately 743,000 emergency medical incidents attended by 2,381 paramedics in Mississippi, we evaluate the extent that paramedics' performance toward the end of shifts is impacted by shift length. We find evidence that performance deteriorates toward the end of long shifts, and argue that fatigue is the mediating factor. Our calculations imply that such deterioration may result in a 0.76 percent increase in 30-day mortality. These findings have implications for workforce organization, calling attention to regulation designed to limit extended work hours. (JEL J22, J24, J28, J45, M12)
    American Economic Journal Applied Economics 01/2011; 4(2):219-46. DOI:10.1257/app.4.2.219 · 2.76 Impact Factor
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