IntroductionThere is a growing interest in understanding the impact of duty hours and resting times on training outcomes and the well-being of resident physicians. Psychiatry resident’s duty hours in ...Spain comprise a regular working schedule of 37.5h per week and a minimum of 4 mandatory on-call shifts. The most recent duty hours regulations in Spain were transposed from the European Working Time Directive (EWTD). According to Spanish Law, doctors cannot work for more than 48h per week and need to have resting times per day (at least 12h), per week (at least 36h) as well as annual leave (at least a month). However, there is practically no data on this situation in psychiatry resident physicians.ObjectivesOur aim is firstly, to describe the number of shifts performed by psychiatry resident physicians in Spain. Secondly, to describe compliance with the daily and weekly rests compared to those set in national and European law. Finally, to analyse the difference by demographic variables (gender and year of residency), in both the number of on-call duty shifts and compliance with rests.MethodsA descriptive cross-sectional study was designed through an online survey adapted from the existing literature. The target population were Spanish psychiatry resident physicians undergoing PGT who started their specialist training during the years 2018–2021. The survey was disseminated through the Spanish regional medical councils to all active psychiatry resident physicians by mail as well as through informal communication channels. The study was authorised by the Spanish Medical Organization’s General Assembly which is the highest ethical and deontological body of physicians in Spain.Results55 responses were obtained, of which 61.82% identified as females. The mean number of on-call shifts in the last 3 months was 14.05. This mean was highest in women 14,32 and in the cohort of 2020 15.46 (first year of residency). Among the resident physicians surveyed, 66.07% exceeded the 48h per week limit set by the EWTD and 7% of them did not rest after a 24-h on-call shift. Furthermore, 22% of respondents did not have a day-off after a Saturday on-call shift. The mean working hours when not resting after an on-call-shift were 7 hours. The comparison by gender and year of residency of the main variables can be seen in figures 1 and 2 respectively.Image:Image 2:ConclusionsPsychiatry resident physicians in Spain greatly exceed the established 48 h/week EWTD limit. Likewise, non-compliance with labour regulations regarding mandatory rest after on-call duty and minimum weekly rest periods are observed. Differences can be seen by gender and year of residency. The situation described could potentially create a high-risk situation for the health and psychosocial well-being of resident physicians, hinder learning outcomes and could lead to suboptimal patient care.Disclosure of InterestNone Declared
Introduction Extended-duration work shifts (≥ 24 hours), the cornerstone of medical education, have been associated with reduced sleep first-year resident physicians in a single-site study. We ...compared more senior resident physician work hours and sleep habits in a multi-center clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hours) shifts or a Rapidly Cycling Work Roster (RCWR) where scheduled shift lengths were limited to no more than 16 consecutive hours. Methods Across six U.S. academic medical centers, we enrolled 302 resident physicians in their second or more senior postgraduate year. They completed 370 one-month pediatric intensive care unit rotations. Sleep was objectively estimated with wrist-worn actigraphs. Work hours and subjective sleep duration were reported in an electronic daily diary. Results Resident physicians work hours were reduced by 10% during the RCWR (61.9 ± 4.8 hours compared to 68.4 ± 7.4 hours during the EDWR; p<0.0001). During the RCWR, 73% of work hours occurred within shifts of ≤16 consecutive hours. In contrast, during the EDWR 38% of work hours occurred on shifts of ≤16 consecutive hours. Resident physicians obtained significantly more sleep per week on the RCWR (52.9 ± 6.0 hours) compared to the EDWR (49.1 ± 5.8 hours, p<0.0001). The percentage of 24-hour intervals with less than 4 hours of actigraphically measured sleep was 9% on the RCWR and 25% on the EDWR (p<0.0001). During the RCWR, 4% of work hours were preceded by two or fewer hours of sleep in the preceding 24 hours, as compared to 10% of work hours during the EDWR (p<0.0001). Conclusion: RCWRs were effective in reducing weekly work hours and the occurrence of >16 consecutive hour shifts in more senior resident physicians. Sleep duration was increased and resident physicians were more rested while caring for patients. Additional research is needed to optimize scheduling practices that ensure sufficient sleep prior to all work shifts. Support (If Any) ROSTERS supported by National Heart, Lung, and Blood Institute (U01-HL-111478, U01-HL-111691).
Abstract
Introduction
Results from previous studies are ambiguous regarding the relationship between long working hours and sick leave, and there are obvious methodological shortcomings in many of ...the previous conducted studies. The aim of this study was to investigate the effects of long working hours (≥12 hour shifts) on later sick leave using objective records of shift work exposure and of short and long term sick leave.
Methods
A total of 1,538 nurses (mean age: 42.5, SD: 12.0; response rate 42.5%) participated. Payroll and archival sick leave data over a four-year period were retrieved from employers’ records and aggregated over every third calendar month. A multilevel negative binomial model was used to investigate the effects of exposure to long working hours, on subsequent sick leave rates the following three months. Covariates included prior sick leave, number of shifts worked, night and evening shifts, personality (morningness, flexibility, and languidity), and demographic characteristics.
Results
Exposure to long working hours reduced the risk of sick leave the subsequent three months adjusted model, incidence rate ratio (IRR)=0.946, 95%CI=0.919–0.973, p<0.001. Night shifts were unrelated to sick leave, whereas evening shifts significantly increased the risk of sick leave in the subsequent three months adjusted model, IRR=1.009, 95%CI=1.002–1.016, p=0.012.
Conclusion
Long working hours emerged as a protective factor against future sick leave. The restorative effects of extra days off with long working hours, ‘the healthy shift worker effect’, and a higher degree of presenteeism may be possible explanations to these findings.
Support (If Any)
The study was partly funded from Nordforsk, Nordic Program on Health and Welfare (74809).
Working few hours a week, known as marginal part-time work, may increase both job and income insecurity, which have been linked to the risk of depression. This study examines the association between ...marginal part-time work and depression and the mediating role of job and income insecurity.
We included 30 523 respondents of the Danish Labor Force Survey (DLFS) between 2010 and 2017 and linked them to register-based information on weekly working hours, which was used to identify full-time workers and model group-based trajectories of marginal part-time. These data were linked with survey information on job and income insecurity, and register-based information on hospital-diagnosed depression or redeemed anti-depressant drugs in the following two years. We estimated hazard ratios (HR) by Cox proportional hazards models and conducted mediation analyses to estimate the natural direct and indirect effects using job and income insecurity as mediators.
We identified three distinct trajectories of marginal part-time work: constant marginal part-time work, mobile towards marginal part-time work, and fluctuating in and out of marginal part-time work. Compared with full-time workers, the constant HR 2.42, 95% confidence interval (CI) 1.83-3.20, mobile (HR 2.84, 95% CI 2.16-3.75), and fluctuating (HR 3.51, 95% CI 2.07-5.97) trajectories all had higher risks of depression. There was no evidence of mediation by either job (HR 1.02, 95% CI 0.92-1.12) or income (HR 0.98, 95% CI 0.89-1.08) insecurity.
We found a higher risk of depression following marginal part-time work. The higher risk was not mediated by job or income insecurity.
•We present the first WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.•Globally in 2016, 488 million people were exposed to long working hours (≥55 hours/week).•This exposure ...had 745,194 attributable deaths and 23.3 million DALYs from ischemic heart disease and stroke.•These are 4.9% of all deaths and 6.9% of all DALYs from these causes.•The Western Pacific, South-East Asia, men, and older people carried higher burdens.
World Health Organization (WHO) and International Labour Organization (ILO) systematic reviews reported sufficient evidence for higher risks of ischemic heart disease and stroke amongst people working long hours (≥55 hours/week), compared with people working standard hours (35–40 hours/week). This article presents WHO/ILO Joint Estimates of global, regional, and national exposure to long working hours, for 194 countries, and the attributable burdens of ischemic heart disease and stroke, for 183 countries, by sex and age, for 2000, 2010, and 2016.
We calculated population-attributable fractions from estimates of the population exposed to long working hours and relative risks of exposure on the diseases from the systematic reviews. The exposed population was modelled using data from 2324 cross-sectional surveys and 1742 quarterly survey datasets. Attributable disease burdens were estimated by applying the population-attributable fractions to WHO’s Global Health Estimates of total disease burdens.
In 2016, 488 million people (95% uncertainty range: 472–503 million), or 8.9% (8.6–9.1) of the global population, were exposed to working long hours (≥55 hours/week). An estimated 745,194 deaths (705,786–784,601) and 23.3 million disability-adjusted life years (22.2–24.4) from ischemic heart disease and stroke combined were attributable to this exposure. The population-attributable fractions for deaths were 3.7% (3.4–4.0) for ischemic heart disease and 6.9% for stroke (6.4–7.5); for disability-adjusted life years they were 5.3% (4.9–5.6) for ischemic heart disease and 9.3% (8.7–9.9) for stroke.
WHO and ILO estimate exposure to long working hours (≥55 hours/week) is common and causes large attributable burdens of ischemic heart disease and stroke. Protecting and promoting occupational and workers’ safety and health requires interventions to reduce hazardous long working hours.
Abstract
Introduction:
Adverse safety outcomes are associated with extended-duration (≥ 24 hour) shifts worked by resident physicians. In 2011 the Accreditation Council for Graduate Medical Education ...(ACGME) implemented an 80-hour work week (averaged over 4 weeks) and a 16-hour limit on the number of consecutive hours that resident physicians may be scheduled to work in their first postgraduate year (PGY1). We sought to determine if long work weeks and shifts of 16 hours or greater was associated with adverse safety outcomes in PGY1 resident physicians.
Methods:
Graduating medical students who registered for the National Residency Matching Program were invited to participate in a nationwide survey. From July 2014 to May 2016, residents completed online monthly surveys reporting their work hours, shift lengths, near-crashes and percutaneous injuries. We used linear and generalized linear regression models to estimate the risk of adverse safety outcomes associated with work hours (≤80 and >80 hours/week) and number of shifts that were at least 16 hours (16h; none, 1–4, >4). Age, gender, and BMI were controlled as covariates.
Results:
7,345 PGY1 residents completed 46,871 monthly surveys. Compared to those PGY1 residents working ≤80 hours per week with no 16-hour shifts, PGY1 residents working ≤ 80 hours with 1–4 16h shifts had an increased risk of near-crashes (adjusted odds ratio 1.45, 95% CI 1.29–1.61). Residents working ≤ 80 hours with >4 16h shifts had an increased risk of near crashes (1.72, 1.42–2.08). Residents working > 80 hours with 1–4 and > 4 16h shifts had an increased risk of near-crashes (1.89, 1.47–2.42; 2.50, 1.91–3.27) and percutaneous injuries (2.71, 1.79–4.10; 2.49, 1.61–3.86), respectively.
Conclusion:
PGY1 resident safety is negatively affected by shifts of 16 or more hours, as well as by working >80 hours per week. The ACGME’s current proposal to eliminate the 16-hour consecutive work limit for PGY1 residents could significantly increase the occurrence of adverse safety outcomes in this vulnerable population, and is inconsistent with the ACGME’s stated commitment to the well-being of residents.
Support (If Any):
National Institute for Occupational Safety and Health R01OH010300.
Abstract
Introduction:
The prevalence of short sleep durations (≤6 hours/night) has been linked to industry sector, with the highest levels found in transportation and manufacturing. Typically such ...findings are based on single sleep items in national surveys (e.g. the US National Health Interview Survey) which offer few insights into cross-national trends, or workplace-related sleep health. We examined sleep duration in relation to working hours, industry sector and insomnia symptoms in 5 countries.
Methods:
Demographic and sleep profiles were obtained from an online survey of 7068 working people (18-74y; 25% male) in the UK, South Africa, China, South Korea and Australia, conducted June-September, 2016. Industry sector was based on the World Bank classification. Sleep parameters were subjectively reported. ‘Insomnia symptoms’ included those reporting sleep onset or maintenance problems, or unrestorative sleep (all with daytime consequences) on ≥3 nights/week for the previous ≥3 months. Analyses included chi-square and multiple regression models adjusted for age, sex and country.
Results:
Proportions working 40–60 hrs/week were significantly greater in emerging (South Africa = 57%; China = 56%; South Korea = 70%) compared with the more developed economies (UK = 24%; Australia = 35%). A similar dichotomy emerged in proportions stating they often felt they could function better at work if they slept better (South Africa = 61%; China = 75%; South Korea = 72% v UK = 44%; Australia = 47%). Across sectors, the shortest sleep times were found in agriculture, transportation and manufacturing; the longest sleep times were in retail, public administration and banking. Working hours negatively correlated with sleep time (p<0.001); proportions sleeping <6 hour/night ranged from 10% (Australia) to 31% (South Korea). Insomnia symptom prevalence was similar across the UK (21.2%), South Africa (20.7%), China (21.0%) and Australia (19.5%), but highest in South Korea (28.7%).
Conclusion:
The findings are consistent with a 2-way relationship between work and sleep, with longer working hours associated with both lower sleep times, and a greater conviction that better sleep would improve work performance. This relationship is strongly influenced by industry sector and economic development
Support (If Any):
The Sleep Census was supported by Sealy (UK) Ltd.
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