Are Residents\u27 Extended Shifts Associated with Adverse Events

First paragraph: Heated debates and controversies surrounding the regulation of medical residents’ work hours have raged for over twenty years. In the wake of Libby Zion’s untimely death in 1984 and resulting recommendations by the Bell Commission, New York State enacted legislation (Code 405.4) governing residents’ working conditions and supervision [1]. Since then, there has been growing interest in regulating residents’ work hours, culminating recently (2003–2004) in national guidelines and legislation on duty-hour restrictions both in the United States and Europe [2,3]

Risk Factors for Workplace Encounters with Weapons by Hospital Employees

Objective:The specific aim of this study was to determine which risk factors were associated with frequent weapons confiscation in a healthcare facility. This study investigated the hypothesis that hospital-related factors impact the frequency of weapons confiscation. Study design:Cross-sectional. Methods:A cross-sectional survey was administered on-line to hospital security directors and assessed the associations of organizational factors with the frequency of weapons confiscation. Results:It was found that hospitals with metal detectors were more than 5 times as likely to frequently confiscate weapons, suggesting this intervention is effective. It was also found that hospitals with psychiatric units were more likely to have frequent confiscation of weapons, likely due to the standard procedure of searching patients before admission to the psychiatric unit. Conclusion:This data suggests that searching patients and using metal detectors are important tools in the prevention of weapons entering a healthcare setting

Sleep Duration, Sleep Quality, Excessive Daytime Sleepiness, and Chronotype in University Students in India: A Systematic Review

Introduction: Optimal sleep is an important aspect of academic performance and mental health. However, poor sleep health is often present among university students due to their lifestyle and academic requirements. University students in India have been shown to have poor sleep health. Though self-reported sleep issues have been evaluated among university students in India, these results have not been synthesized to date. We aimed to identify factors that may be associated with poor sleep health among university students in India from January 2010 to April 2021, inclusive. As a secondary aim, we sought to evaluate factors associated with sleep among university students in India during the COVID-19 pandemic. Methods: A systematic review was conducted using PubMed, CINAHL, and Google Scholar to identify studies conducted in India related to sleep among university students. The studies were synthesized by aspects of sleep (sleep quality, sleep duration, excessive daytime sleepiness (EDS)) and chronotype, types of university students in India (non-medical and medical) and if they examined sleep in university students during the COVID-19 pandemic. Results: 12 articles were identified that evaluated sleep duration, sleep quality, and excessive daytime sleepiness and included university students in India. Findings suggested that between 25- 72% of Indian university students reported poor sleep quality, and 17-44% experienced EDS. Similar associations were noted in both non-medical and medical undergraduate students. Students with evening chronotype vs. intermediate chronotype and morning chronotype were more likely to experience poor sleep quality. Studies conducted during the COVID-19 pandemic reported differing results of poor sleep quality and increased sleep duration. Discussion: Demographic, psychological, and socio-behavioral factors are statistically significantly related to poor sleep quality, EDS, and short sleep duration among university students in India. Take-home message: Poor sleep quality is prevalent among university students in India. To improve sleep issues among university students in India, researchers should design tailored sleep interventions that account for demographic, psychological, and socio-behavioral factors that may place students at risk for poor sleep quality, excessive daytime sleepiness, and short sleep duration

An Exploratory Study Examining the Associations between Sunlight Exposure, Sleep Behaviours and Sleep Outcomes during an Arctic Summer

Few evidence-based recommendations exist for maintaining healthy sleep during Arctic summers. Our study aimed to examine associations between sleep hygiene, sunlight exposure and sleep outcomes in workers living in and/or near the Arctic Circle during a 24-h light period. A survey was administered July 2017 to 19 workers at 3 Arctic base camps in Northeastern Alaska. Participants with poorer sleep hygiene reported increased sleepiness (r=.62, p=0.01); this correlation remained moderately strong, albeit not statistically significant (NS), after controlling for shift work (r=.46, p=0.06). No other statistically significant correlations between sleep hygiene and sleep outcomes were found. Weekly daytime (8pm) sunlight exposures, estimated from daily self-reported sunlight exposures for a typical workday and day off, were dichotomised, based on means, into: longer (\u3e45 h/week) versus shorter (/week) daytime exposures, and longer (\u3e16 h/week) versus shorter (/week) evening exposures. Participants reporting longer, versus shorter, weekly daytime sunlight exposure had statistically significantly (Mann-Whitney U=18.00, Z=-1.98, p/=.3 for longer, vis-a-vis shorter, daylight sunlight exposure suggest it could be related to poorer sleep outcomes, such as insufficient sleep and sleep quality, yet, as these correlations were NS, future work is needed to determine this. Weak or no correlations (and NS differences) were found for longer, versus shorter, weekly evening sunlight exposure and sleep outcomes. Findings support previous research suggesting self-regulation behaviours alone are not protective against poor sleep in Arctic environments. Sleep outcomes did not differ statistically significantly by evening sunlight exposure length. Longer weekly daytime sunlight exposure, versus shorter, was significantly associated with decreased sleep duration. Results from this exploratory study should be confirmed in studies using larger sample sizes

Depression: Relationships to Sleep Paralysis and Other Sleep Disturbances in a Community Sample

Sleep disturbances are important correlates of depression, with epidemiologic research heretofore focused on insomnia and sleepiness. This epidemiologic study’s aim was to investigate, in a community sample, depression’s relationships to other sleep disturbances: sleep paralysis (SP), hypnagogic/hypnopompic hallucinations (HH), cataplexy – considered rapid eye movement-related disturbances – and automatic behavior (AB). Although typical of narcolepsy, these disturbances are prevalent, albeit under-studied, in the population. Cross-sectional analyses (1998–2002), based on Wisconsin Sleep Cohort Study population-based data from 866 participants (mean age 54, 53% male), examined: depression (Zung Self-Rating Depression Scale), trait anxiety (Spielberger State-Trait Anxiety Inventory, STAI-T ≥ 75th percentile), and self-reported sleep disturbances. Descriptive sleep data were obtained by overnight polysomnography. Adjusted logistic regression models estimated depression’s associations with each (\u3efew times ever) outcome – SP, HH, AB, and cataplexy. Depression’s associations with self-reported SP and cataplexy were not explained by anxiety. After anxiety adjustment, severe depression (Zung ≥55), vis-à-vis Zung \u3c50, increased SP odds ∼500% ( P = 0.0008). Depression (Zung ≥50), after stratification by anxiety given an interaction ( P = 0.02), increased self-reported cataplexy odds in non-anxious (OR 8.9, P = 0.0008) but not anxious (OR 1.1, P = 0.82) participants. Insomnia and sleepiness seemed only partial mediators or confounders for depression’s associations with self-reported cataplexy and SP. Anxiety (OR 1.9, P = 0.04) partially explained depression’s (Zung ≥55) association with HH (OR 2.2, P = 0.08). Anxiety (OR 1.6, P = 0.02) was also more related than depression to AB. Recognizing depression’s relationships to oft-neglected sleep disturbances, most notably SP, might assist in better characterizing depression and the full range of its associated sleep problems in the population. Longitudinal studies are warranted to elucidate mediators and causality

Nocturnal Diaphoresis Secondary to Mild Obstructive Sleep Apnea in a Patient with a History of Two Malignancies

Numerous medical disorders, including obstructive sleep apnea, may cause nocturnal diaphoresis. Previous work has associated severe obstructive sleep apnea with nocturnal diaphoresis. This case report is of import as our patient with severe nocturnal diaphoresis manifested only mild sleep apnea, and, for years, his nocturnal diaphoresis was ascribed to other causes, i.e., first prostate cancer and then follicular B-cell lymphoma. Additionally, it was the nocturnal diaphoresis and not more common symptoms of obstructive sleep apnea, such as snoring, that led to the definitive diagnosis of his sleep apnea and then to treatment with a gratifying resolution of his onerous symptom

Observations of Delayed Changes in Respiratory Function Among Allergy Clinic Patients Exposed to Wildfire Smoke

Wildfires have increased in frequency and magnitude and pose a significant public health challenge. The principal objective of this study was to assess the impact of wildfire smoke on respiratory peak flow performance of patients exposed to two different wildfire events. This longitudinal study utilized an observational approach and a cohort study design with a patient-level clinical dataset from a local outpatient allergy clinic (n = 842). Meteorological data from a local weather station served as a proxy for smoke exposure because air quality measurements were not available. This study found that there were decreases in respiratory peak flow among allergy clinic patients one year after each wildfire event. For every one percent increase in wind blowing from the fire towards the community, there was, on average, a 2.21 L per minute decrease in respiratory peak flow. This study observed an effect on respiratory peak flow performance among patients at a local allergy clinic one year after suspected exposure to wildfire smoke. There are likely multiple reasons for the observation of this relationship, including the possibility that wildfire smoke may enhance allergic sensitization to other allergens or that wildfire smoke itself may elicit a delayed immune response

Adolescent Crash Rates and School Start Times in Two Central Virginia Counties, 2009-2011: A Follow-Up Study to a Southeastern Virginia Study, 2007-2008

Background and Objective: Early high school start times (EHSST) may lead to sleep loss in adolescents ( teens ), thus resulting in higher crash rates. (Vorona et al., 2011). In this study, we examined two other adjacent Virginia counties for the two years subsequent to the above-mentioned study. We again hypothesized that teens from jurisdictions with EHSST (versus later) experience higher crash rates. Methods: Virginia Department of Motor Vehicles supplied de-identified aggregate data on weekday crashes and time-of- day for 16-18 year old (teen) and adult drivers for school years 2009-2010 and 2010-2011 in Henrico and Chesterfield Counties (HC and CC, respectively). Teen crash rates for counties with early (CC) versus later (HC) school start-times were compared using two-sample Z-tests and these compared to adult crash rates using pair-wise tests. Results: Chesterfield teens manifested a statistically higher crash rate of 48.8/1,000 licensed drivers versus Henrico\u27s 37.9/1,000 (p = 0.04) for 2009-2010. For 2010-2011, CC 16-17 year old teens demonstrated a statistically significant higher crash rate (53.2/1,000 versus 42.0/1,000), while for 16-18 teens a similar trend was found, albeit nonsignificant (p = 0.09). Crash peaks occurred 1 hour earlier in the morning and 2 hours earlier in the afternoon in Chesterfield, consistent with commute times. Post hoc analyses found significantly more run-off road crashes to the right (potentially sleep-related) in Chesterfield teens. Adult crash rates and traffic congestion did not differ between counties. Conclusions: Higher teen crash rates occurred in jurisdictions with EHSST, as in our prior study. This study contributes to and extends existing data on preventable teen crashes and high school start times

Are Residents' Extended Shifts Associated With Adverse Events?

Szklo-Coxe discusses a new prospective study in PLoS Medicine that examined the relationship between residents' work patterns and adverse clinical events