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      Efectos físicos y emocionales tras la realización de trabajo nocturno continuado en médicos internos residentes Translated title: Emotional and phisical effects after continued night shift by internal medical resident

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          Abstract

          Resumen Introducción: Los Médicos Internos Residentes (MIR) realizan guardias de 17 horas en los hospitales españoles. Dicho trabajo nocturno provoca una alteración del ritmo circadiano que puede desencadenar disfunciones en el estado físico y emocional. Objetivos: Conocer el grado de afectación física y emocional que generan las guardias en los MIR y los factores que afectan dicha relación. Material y métodos: Los participantes aleatorizados de un hospital terciario, cumplimentan un cuestionario, antes y después de la realización de la guardia, con variables sociodemográficas y test validados en su versión española: Positive and Negative Affect Schedule, Swedish Occupational Fatigue Inventory y la subescala de apoyo jerárquico de KARASEK. Resultados: Se realiza análisis estadístico de n=150 residentes. De los residentes que conducen tras la guardia, un 17,98% sufrieron un accidente in itinere. La sensación de bienestar se vio reducida tras la guardia de forma estadísticamente significativa, al contrario que la de malestar (p<0,05). Y el mayor grado de fatiga tras la guardia se centra en la somnolencia y en menor grado la falta de motivación. Conclusiones: Este estudio supone una estimación validada de los efectos del trabajo nocturno continuado de los MIR. Los resultados obtenidos podrían sugerir replantearse la organización del trabajo debido a los efectos negativos para el bienestar de los médicos del futuro.

          Translated abstract

          Abstract Introduction: Medical Internal Residents perform 17-hour shifts at Spanish hospitals. Such night work causes an alteration of the circadian rhythm that can trigger disturbances in the physical and emotional state. Objectives: To know the degree of physical and emotional affectation that the night shifts generate in Medical Residents and the factors that affect this relationship. Material and methods: Before and after their 17-hour shift, the randomized participants from a tertiary referral hospital complete a questionnaire with socio-demographic variables and tests validated in their Spanish version: Positive and Negative Affect Schedule, Swedish Occupational Fatigue Inventory and the subscale of hierarchical support of KARASEK Results: Statistical analysis of n = 150 residents of a hospital was carried out. Among the residents who drive after the 17-hour shift, 17.98% suffered a commuting accident. The pleasant experiences were reduced after shifts in a statistically significant difference (p <0.05), compared to the discomforting ones. The highest degree of fatigue after shifts is focused on drowsiness, and to a lesser degree, on a lack of motivation. Conclusions: This study supposes a validated estimate of the effects of the continuous work shift of Medical Residents. The results obtained could suggest reconsidering the organization of work given the negative effects for the well-being of future physicians.

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          One night on-call: Sleep deprivation affects cardiac autonomic control and inflammation in physicians

          Sleep loss is associated with increased cardiovascular morbidity and mortality. It is known that chronic sleep restriction affects autonomic cardiovascular control and inflammatory response. However, scanty data are available on the effects of acute sleep deprivation (ASD) due to night shifts on the cardiovascular system and its capability to respond to stressor stimuli. The aim of our study was to investigate whether a real life model of ASD, such as "one night on-call", might alter the autonomic dynamic response to orthostatic challenge and modify the immune response in young physicians.
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            Deterioration of neurobehavioral performance in resident physicians during repeated exposure to extended duration work shifts.

            Although acute sleep loss during 24- to 30-h extended duration work shifts (EDWS) has been shown to impair the performance of resident physicians, little is known about the effects of cumulative sleep deficiency on performance during residency training. Chronic sleep restriction induces a gradual degradation of neurobehavioral performance and exacerbates the effects of acute sleep loss in the laboratory, yet the extent to which this occurs under real-world conditions is unknown. In this study, the authors quantify the time course of neurobehavioral deterioration due to repeated exposure to EDWS during a 3-week residency rotation. A prospective, repeated-measures, within-subject design. Medical and cardiac intensive care units, Brigham and Women's Hospital, Boston, MA. Thirty-four postgraduate year one resident physicians (23 males; age 28.0 ± 1.83 (standard deviation) years) Residents working a 3-week Q3 schedule (24- to 30-h work shift starts every 3(rd) day), consisting of alternating 24- to 30-h (EDWS) and approximately 8-h shifts, underwent psychomotor vigilance testing before, during, and after each work shift. Mean response time, number of lapses, and slowest 10% of responses were calculated for each test. Residents also maintained daily sleep/wake/work logs. EDWS resulted in cumulative sleep deficiency over the 21-day rotation (6.3 h sleep obtained per day; average 2.3 h sleep obtained per extended shift). Response times deteriorated over a single 24- to 30-h shift (P < 0.0005), and also cumulatively with each successive EDWS: Performance on the fifth and sixth shift was significantly worse than on the first shift (P < 0.01). Controlling for time of day, there was a significant acute (time on shift) and chronic (successive EDWS) interaction on psychomotor vigilance testing response times (P < 0.05). Chronic sleep deficiency caused progressive degradation in residents' neurobehavioral performance and exacerbated the effects of acute sleep loss inherent in the 24- to 30-h EDWS that are commonly used in resident schedules.
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              Predictors of Well-Being in Resident Physicians: A Descriptive and Psychometric Study

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                Author and article information

                Journal
                mesetra
                Medicina y Seguridad del Trabajo
                Med. segur. trab.
                Escuela Nacional de Medicina del Trabajo. Instituto de Salud Carlos III (Madrid, Madrid, Spain )
                0465-546X
                1989-7790
                December 2019
                : 65
                : 257
                : 252-260
                Affiliations
                [1] León orgnameComplejo Asistencial Universitario de León orgdiv1Servicio de Prevención de Riesgos Laborales España
                [2] Majadahonda orgnameHospital Universitario Puerta de Hierro Majadahonda orgdiv1Servicio de Prevención de Riesgos Laborales Spain
                [3] Madrid Madrid orgnameUniversidad Carlos III de Madrid orgdiv1Escuela Nacional de Medicina del Trabajo Spain
                Article
                S0465-546X2019000400252 S0465-546X(19)06525700252
                4723fe76-e3cf-4b9a-8a0e-c536fc1b9f62

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 09 November 2019
                : 24 October 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 9
                Product

                SciELO Spain

                Categories
                Revisión Sistemática

                Physicians,efectos en la salud,circadian rhythm,ritmo circadiano,health impacts,trabajo nocturno,shift work,Médicos

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