Work patterns and fatigue-related risk among junior doctors

Background

To reduce fatigue‐related risk among junior doctors, recent initiatives in Europe and the USA have introduced limits on work hours. However, research in other industries has highlighted that other aspects of work patterns are important in generating fatigue, in addition to total work hours. The Australian Medical Association (AMA) has proposed a more comprehensive fatigue risk management approach.

Objectives

To evaluate the work patterns of New Zealand junior doctors based on the AMA approach, examining relationships between different aspects of work and fatigue‐related outcomes.

Methods

An anonymous questionnaire mailed to all house officers and registrars dealt with demographics, work patterns, sleepiness, fatigue‐related clinical errors, and support for coping with work demands. Each participant was assigned a total fatigue risk score combining 10 aspects of work patterns and sleep in the preceding week.

Results

The response rate was 63% (1366 questionnaires from doctors working ⩾40 hours a week). On fatigue measures, 30% of participants scored as excessively sleepy (Epworth Sleepiness Score >10), 24% reported falling asleep driving home since becoming a doctor, 66% had felt close to falling asleep at the wheel in the past 12 months, and 42% recalled a fatigue‐related clinical error in the past 6 months. Night work and schedule instability were independently associated with more fatigue measures than was total hours worked, after controlling for demographic factors, The total risk score was a significant independent risk factor for all fatigue measures, in a dose‐dependent manner (all p<0.01). Regular access to adequate supervision at work reduced the risk of fatigue on all measures.

Conclusions

To reduce fatigue‐related risk among junior doctors, account must be taken of factors in addition to total hours of work and duration of rest breaks. The AMA fatigue risk assessment model offers a useful example of a more comprehensive approach.     

Quercetin protects against acute immobilization stress-induced behaviors and biochemical alterations in mice

Oxidative stress is a major contributor to the alterations of various pathological conditions, including neurodegenerative and neuropsychiatric problems. Antioxidative flavonoids, ubiquitously included in vegetables, fruits, and teas, are expected to prevent degenerative diseases. Recently, flavonoids have been characterized as neuroprotectants in the treatment of various neurological disorders. The present study was designed to investigate protective effects of quercetin, a bioflavonoid, against acute immobilization-induced behavioral and biochemical alterations in mice. Mice were immobilized for a period of 6 hours. Quercetin (20 and 40 mg/kg, i.p.) was administered 30 minutes before subjecting the animals to acute stress. Behavioral tests (mirror chamber, actophotometer, and tail flick test) and biochemical analysis (malondialdehyde, reduced glutathione, catalase, nitrite, and protein levels) were subsequently performed. Acute immobilization stress for a period of 6 hours caused severe anxiety, analgesia, and impaired motor activity in mice. Biochemical analyses revealed an increase in malondialdehyde and nitrite levels as well as partial depletion of reduced glutathione and catalase activity in immobilization-stressed brain. Behavioral and biochemical parameters were significantly altered as compared to naive mice. Pretreatment with quercetin (20 and 40 mg/kg, i.p.) significantly reversed immobilized stress-induced anxiety and analgesia and reduced locomotor activity. Biochemically, quercetin treatment attenuated malondialdehyde accumulation and nitrite activity and restored the depleted reduced glutathione and catalase activity. Neuroprotective effects of quercetin were significantly improved as compared to control (immobilized stressed) animals. Results suggest that neuroprotective properties of quercetin can be used in the treatment and management of stress and related disorders.     

Mental disorders among physical disability determination patients.

Persons claiming physical disability who were evaluated at a primary care health center in a small southern city were administered the Diagnostic Interview Schedule. Fifty-six per cent of the 43 patients were found to have one or more psychiatric disorders. The relationship between physical disability and psychiatric disorders needs to be recognized in the disability evaluation system.     

Mental and physical health status among chronic hepatitis B patients

Quality of Life Research - Little is known about health-related quality of life (HRQoL) in patients with chronic hepatitis B virus (CHB) infection in the United States. Our goal is to understand...     

Nutritional assessment of senior rural Utahns by biochemical and physical measurements

Biochemical composition of blood and urine was used to evaluate the nutritional status of 187 ambulatory, older residents of five rural Utah communities. Measurements were also taken of height, weight, and blood pressure. The sample included 58 men and 129 women, with a mean age of 69 years. No deficiencies were observed for hemoglobin, hematocrit, and serum iron levels, although approximately 15% of the men had low levels for the first two indices. Serum mineral status for zinc, copper, sodium, potassium, magnesium, and calcium was adequate for most of the participants. Of the women 40% and of the men 21% had low serum total protein levels. No low serum levels of vitamin A and carotene were observed. Urinary excretion of riboflavin and thiamine was high for approximately 90% of the participants. Of the women 46% and of the men 37% had serum cholesterol values above 249 mg/100 ml of serum. One half of the women and 30% of the men were determined to be obese. Approximately one-fourth of both sexes had systolic pressures above 160 mm Hg.     

Individual physical performance capacity with physiological and biochemical indicators of stress

22 health male subjects were exposed by a combination of physical exercises and heat. Strain related physiological and biochemical parameters were measured. Different individual reactions were obtained under controlled conditions. In dependence on the individual performance an increased mobilisation of lactat, free fatty acids and catecholamines were found. The determination of aerob physical performance can be applied for the evaluation of working capacity.     

Mental wellbeing and physical activity levels: A prospective cohort study

BackgroundAlthough much research has been devoted to examining the relationship between negative mental health states (e.g., depression) and physical activity, the literature is scarce in terms of associations between positive mental health states (e.g., mental wellbeing) and physical activity. The objective of this study was to examine the association between mental wellbeing measured in 2019 and physical activity measured in 2020 (including bi-directionality).MethodsData stem from a Danish nationally-representative panel of 5000 adults (aged 15+ years) conducted in 2019 and 2020, which was linked to register data. The SWEMWBS scale was used to assess mental wellbeing. The outcome was ≥150 min of physical activity per week (self-reported). Logistic regression models were performed, adjusting for covariates and physical activity at baseline.ResultsEach point increase in mental wellbeing in 2019 positively predicted ≥150 min of physical activity per week in 2020 (OR = 1.03, 95%CI 1.01–1.05). Compared to low mental wellbeing, moderate wellbeing was associated with higher odds (OR = 1.51, 95%CI 1.10–2.08) of engaging in ≥150 min of physical activity, while the odds among those with high mental wellbeing were even higher (OR = 1.93, 95%CI 1.37–2.72). The results reflected a dose-response pattern. Finally, the reverse pathway was noted as well, i.e., physical activity in 2019 positively predicted mental wellbeing in 2020.ConclusionsThe results show that favorable mental health status – beyond the absence of mental illness – positively predicts adherence to recommended physical activity levels in the following year. Initiatives to promote mental wellbeing may be instrumental as a means to protect and enhance general health by positively influencing engagement in physical activity. Conversely, increasing physical activity levels may protect against mental illness and further enhance population mental wellbeing.     

Exposure to mixtures of solvents among paint workers and biochemical alterations of liver function

The objective of this study was to determine biochemical alterations of liver function among paint manufacturers and sprayers associated with exposure to organic solvents. Two paint manufacturing factories and 22 various kinds of spray painting factories (16 car painting, two aircraft painting, three video terminal painting; and one trailer painting) were included. Air concentrations of organic solvents were collected by personal samplers and analysed by gas chromatography. A total of 180 workers were given a comprehensive physical examination, a questionnaire, a liver function test, and a test for hepatitis B surface antigen. The questionnaire contained questions regarding detailed personal medical history, intake of alcohol, and use of medicine. Mixtures of solvents were used throughout the factories, and xylene and toluene were the major components found in almost all air samples with average contents of 46% and 29% on a weight basis of 67 air samples. No strong hepatotoxic solvents were detected. Workers were classified according to the different exposure patterns and different air concentrations of breathing zones as: high (eight hour time weighted average (8 h TWA) hygienic effects of solvents 0.25-9.83, median 1.66), short term high (8 h TWA hygienic effects of solvents 0-3.38, median 0.12), and low (8 h TWA hygienic effects of solvents all below 0.38). After applying a multivariate model to control the non-occupational factors (alcohol, medication, age, and hepatitis B viral infection), increase in gamma-glutamyl transferase (GGT) activity was found to be associated with severity of exposure to the mixture of solvents. Because the possible effects on GGT activity of non-occupational factors were controlled for, it is concluded that increased GGT activity among exposed workers may be due to a higher exposure to the mixture of solvents.     

Early biochemical alterations in manganese toxicity: ameliorating effects of magnesium nitrate and vitamins

Manganese-induced early biochemical changes and effects of supplementation of magnesium nitrate (Mg(NO3)2) and antioxidant vitamins (A, C, D and E) were studied in rats intoxicated with manganese. Significant elevation in the level of chlorides in plasma, erythrocytes, liver and cerebellum, and a decrease in plasma inorganic phosphate (pi) with an increase in liver pi were observed in animals exposed to manganese as compared to controls. The level of erythrocyte-acid labile phosphate (ALP), nicotinamide adeninedinucleotide (NAD+) and plasma sialic acid (N-acetylneuraminic acid, NANA) also increased significantly. Elevated levels of chlorides in plasma, erythrocytes and cerebellum reversed to normal control values whereas liver chlorides restored partially by the supplementation of Mg(NO3)2. Vitamins supplementation was effective to reverse chlorides level in erythrocytes, liver and cerebellum. Decreased level of pi in plasma and the highly elevated level of erythrocyte ALP were also recovered in animals received Mg(NO3)2 in addition to MnSO4. However, such effect of Mg(NO3)2 was not seen in lowering the elevated level of NANA that restored by the administration of vitamins. Thus, the early alterations in plasma levels of chlorides, pi, and NANA and erythrocyte-ALP seem to be an indicative of early manganese toxicity while Mg(NO3)2 and vitamins supplementation appear to provide, at least in part, protection against manganese toxicity.