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).
Résumé Malgré les retombées économiques, sociales et environnementales de l'évolution du temps de travail, les études sur les préférences en la matière sont dispersées entre diverses disciplines et ...disséminées dans de multiples revues. Dans cette revue systématique de la littérature fondée sur 173 articles, il est démontré que les études existantes concernent un petit nombre de pays de l'OCDE, portent surtout sur les professions médicales et font essentiellement appel à des données d'enquête et à des méthodes statistiques. Les résultats les plus clairs et les plus homogènes ont trait à l'influence du genre, des obligations en matière de garde des enfants et du temps de travail actuel, tandis que les normes et la formation des préférences demeurent mal comprises. Davantage de travaux qualitatifs sont indispensables pour déterminer comment faire progresser la réduction du temps de travail.
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).
•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.
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.
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.
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.
Before the European Union Working Time Directive3 placed restrictions on junior doctors’ working hours some brutal on-call rotas were commonplace (1 in 2, 1 in 3, or 1 in 4), including continuous 80 ...hour weekend and 36 hour weekday blocks, with no sleep guaranteed.4 Tired doctors put patients’ and their own health at risk.5 On the other hand, the exhaustion came with free (if basic) onsite accommodation, camaraderie, peer support, and the continuity of a firm structure, and we quickly gained vast amounts of hands-on experience. Care was arguably far more regimented, institutional, and paternalistic—and patients more deferential The historical switch, in Modernising Medical Careers,8 to run through higher specialty medical training from previously more meandering routes has also attracted much adverse comment, as has the botched introduction of the Medical Training Application Service9 in 2007 or more recent findings that junior doctors often feel rushed or pressurised to decide on a specialty stem too early in their career.1011 On the other hand, back in the day many senior registrars, long qualified to become consultants, waited endlessly for consultant posts to become vacant. ...not for nothing did the Department of Health report that led to Modernising Medical Careers call senior house officers “the lost tribe,”12 as so many doctors were stuck or drifting at that grade and sometimes trying to enter a specialty they weren’t suited to or, realistically, able to enter.13 Nor did we have today’s transparency and scrutiny around preferential selection based on sex, race, or patronage. Yet patient case mix and healthcare were far less acute and complex; pressure and throughput on beds was lower; and a far more limited range of interventions was available for nurses to carry out, let alone as independent advanced practitioners or prescribers.
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