Demographic factors, fatigue, and driving accidents: An examination of the published literature

Sleep deprivation due to extended work hours and circadian disruptionhas long been a concern in medicine.Clinicians who have been deprived of sleepfailed to ensure that patients are safe or that the quality of care they receive is high.So it can not be ignored to solve the tense relationship between the clinicians and the patients in China.As a result,to pay attention to the fatigue among clinicians and the safety of patients in our country has its practical significance.Take an active strategy to properly resolve the problem of fatigue among clinicians to ensure medical security,the establishment of safe,high-quality health care system,not only directly related to the treatment of patients,but also to the harmonious relations between clinicians and patients to ensure the safety of health care are very important.

Fatigue among Clinicians and the Safety of Patients

The 26 December 2004 earthquake and tsunami unfairly hit the different ethnic groups of Aceh, Indonesia. About 170,000 Acehnese and Minangkabau people died in the Northern tip of Sumatra while only 44 Simeulue people passed away in the neighbouring Simeulue island located near the earthquake epicentre. Such a difference in the death toll does not lie in the nature of the hazard but in different human behaviours and ethnic contexts. The present study draws on a contextual framework of analysis where people’s behaviour in the face of natural hazards is deeply influenced by the cultural, social, economic and political context. Questionnaire-based surveys among affected communities, key informant interviews and literature reviews show that the people of Simeulue detected the tsunami very early and then escaped to the mountains. On the other hand, Acehnese and Minangkabau people, respectively in the cities of Banda Aceh and Meulaboh, did not anticipate the phenomenon and were thus caught by the waves. The different behaviours of the victims have been commanded by the existence or the absence of a disaster subculture among affected communities as well as by their capacity to protect themselves in facing the tsunami. People’s behaviours and the capacity to protect oneself can be further tracked down to a deep tangle of intricate factors which include the armed conflict that has been affecting the province since the 1970s, the historical and cultural heritage and the national political economy system. This paper finally argues that the uneven impact of the 26 December 2004 earthquake and tsunami in Aceh lies in the different daily life conditions of the ethnic groups struck by the disaster.

Ethnic groups' response to the 26 December 2004 earthquake and tsunami in Aceh, Indonesia

This article explores the relevance of historical trauma theory for Māori research. In exploring the impact of historical trauma upon Māori it has become clear that the terminology associated with ...

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Positioning historical trauma theory within Aotearoa New Zealand

Although studies have documented the associations between Intimate Partner Violence (IPV) and mental health, few have been done in developing countries. In this study, the association between IPV and mental health in women from different developing countries was established. Women, 15 to 49 years old with at least one child 18 years old or younger, were randomly selected from communities in Chile, Egypt, India, and the Philippines (N = 3974). The Self Report questionnaire (SRQ) was used to assess mental health. Women with a score on the SRQ of 8 or more, or who reported ever attempting suicide, were classified as having poor mental health. Physical IPV was defined as being slapped, hit, kicked, beaten or threatened by a male partner during the past year. Psychological violence included being insulted or belittled, threatened or abandoned. Between 22.5% (in Egypt) to 41% (in Chile) of participating women reported a score of eight or more on the SRQ. High score on the SRQ were significantly associated with current physical and psychological IPV in the samples from all participating countries except Chile. Twelve percent of women in Chile, 2.6%, in Egypt, 7.5% in India and 1.6% in the Philippines reported attempting suicide. Suicide attempts were also associated with current physical IPV in the Philippines, Egypt, and India, and with psychological violence in Egypt and India. IPV is significant risk factor for poor mental health in these developing countries. Efforts to reduce IPV should be considered as part of a mental health program.

Partner violence as a risk factor for mental health among women from communities in the Philippines, Egypt, Chile, and India.

Fatigue risk associated with work schedules of hospital doctors is coming under increasing scrutiny, with much of the research and regulatory focus on trainees. However, provision of 24 h services involves both trainees and specialists, who have different but interdependent work patterns. This study examined work patterns, sleep (actigraphy, diaries) and performance (psychomotor vigilance task pre- and post-duty) of 28 anaesthesia trainees and 20 specialists across a two-week work cycle in two urban public hospitals. Trainees at one hospital worked back-to-back 12 h shifts, while the others usually worked 9 h day shifts but periodically worked a 14 h day (08:00-22:00 h) to maintain cover until arrival of the night shift (10 h). On 11% of day shifts and 23% of night shifts, trainees were working with> or =2 h of acute sleep loss. However, average sleep loss was not greater on night shifts, possibly because workload at night in one hospital often permitted some sleep. Post-night shift performance was worse than post-day shift performance for the median (t((131))=3.57, p or =2 h of acute sleep loss. They averaged 0.6 h less sleep when working day shifts (t((23.5))=2.66, p=0.014) and 0.8 h less sleep when working day shifts+call schedules (t((26.3))=2.65, p=0.013) than on days off. Post-duty reaction times slowed linearly across consecutive duty days (median reaction time, t((131))=-3.38, p<0.001; slowest 10%, t((160))=-3.33, p<0.01; fastest 10%, t((138))=-2.67, p<0.01). Poorer post-duty performance was associated with greater acute sleep loss and longer time since waking, but better performance was associated with longer day shifts, consistent with circadian improvement in psychomotor performance across the waking day. This appears to be the first study to document sleep loss among specialist anaesthetists. Consistent with observations from experimental studies, the sleep loss of specialists across 12 consecutive working days was associated with a progressive decline in post-duty PVT performance. However, this decline occurred with much less sleep restriction (< 1 h per day) than in laboratory studies, suggesting an exacerbating effect of extended wakefulness and/or cumulative fatigue associated with work demands. For both trainees and specialists, robust circadian variation in PVT performance was evident in this complex work setting, despite the potential confounds of variable shift durations and workloads. The relationship between PVT performance of an individual and the safe administration of anaesthesia in the operating theater is unknown. Nevertheless, the findings reinforce that any schedule changes to reduce work-related fatigue need to consider circadian performance variation and the potential transfer of workload and fatigue risk between trainees and specialists.

Sleep loss and performance of anaesthesia trainees and specialists.

One thousand five hundred community residing New Zealand adults were assessed regarding their experience of traumatic events. Sixty-one per cent of those surveyed reported exposure to a traumatic event during their lifetime. Unexpected death of a close friend or relative was the most prevalent traumatic experience for the present sample, whereas combat and natural disasters were the least prevalent traumatic events. Consistent with prior research demonstrating gender differences in exposure to traumatic events, child and adult sexual assault was more common among women, and motor vehicle accidents and combat were more common among men. The present study also found that Maori individuals (indigenous people) had experienced a number of traumatic events to a greater extent than their European counterparts. These results are discussed within the New Zealand social context. Copyright © 2004 John Wiley & Sons, Ltd.

Gender and ethnicity differences in the prevalence of traumatic events: evidence from a New Zealand community sample

This study aimed to measure the prevalence of psychological distress and physical illness among women in New Zealand, and to identify the risk factors for psychological distress and health, with specific reference to domestic violence. A survey was carried out among a community sample of 961 women aged 19-90 years. Among all women surveyed, 25% were classified as experiencing psychological distress at the time of interview, 22% were classified as experiencing severe symptoms of physical illness, and 17% reported domestic violence by a family member at some point in their lives. Among those women who had experienced domestic violence, the perception that their life was in serious danger and the impact of the violence on their life each contributed significantly to variability in psychological distress (22% variance accounted). An estimated 12% of all cases of psychological distress and 7% of all cases of serious physical illness were attributable to domestic violence. The study underscores the need to improve policy for mental and physical health screening and care for abused women within health services in New Zealand. Domestic violence is increasingly becoming recognized as a worldwide public health problem that presents serious implications for the psychological and physical health of women and children. Despite the fact that population-based research is lacking, the available data suggests that between 20% and 50% of women in most countries have been abused at some point in their lives (Heise, Raikes, Watts, & Zwi, 1994). Domestic violence has been indicated as a significant risk factor for a diverse range of health conditions, including but not limited to, low birth weight (Bullock & McFarlane, 1989), gynecological disorders (Schei & Bakketeig, 1989; Stewart & Stotland, 1993), injuries and mortality (Grisso, Schwarz, Miles, & Holmes, 1996), and sexually transmitted diseases (Handwerker, 1993). Indeed, preliminary research suggests a host of medical conditions may be associated with domestic abuse (see Fischbach & Herbert, 1997; Gerlock, 1999). The impact of domestic violence on women's mental health has also been well documented (Koss, 1990). Battering may be the single most important factor in predicting suicidality in women (Stark & Flitcraft, 1996), and women exposed to domestic violence within an intimate relationship typically exhibit a wide variety of symptoms of psychological distress, including depression and anxiety, high avoidance or arousal, and substance abuse or addiction (Hill, 1995). In combination with the concomitant cognitive disturbances (Gondolf, 1998; Roberts, Williams, Lawrence, & Raphael, 1998), these psychological symptoms often meet criteria for diagnosis of posttraumatic stress disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994). A limitation of existing data on the risk of mental and physical illness following domestic violence is that the majority of studies have been conducted on convenience samples of women seeking help for mental health problems related to their abuse (Sorenson & Saftlas, 1994). Given that prior data is drawn from samples of women who have sought help, it is possible that that the findings are not representative of those who do not seek help, either for domestic violence, or general physical and mental health problems. The existing studies that have surveyed population-based samples have focused exclusively on specific populations, such as Nicaraguan (Ellsberg, 1997) and American Indian (Norton & Manson, 1995) women. Thus, data on the impact of domestic violence among women in the general population is lacking. Further rationale for sampling a broader cross-section of the population may be drawn from the fact that gender differences are consistently found in epidemiological studies of psychiatric disorders. A primary example is depression. …

Domestic violence, psychological distress, and physical illness among New Zealand women: Results from a community-based study

We examined the lifetime prevalence of 12 traumatic experiences (combat, child sex abuse, sexual abuse as an adult, family violence, other physical assault, theft by force, vehicle accident, other accident, natural disaster, disaster precautions, traumatic death (secondary trauma) and the links between these experiences and physical and mental health, via a cross sectional survey of 502 community dwelling New Zealand Maori adults. We found that the overall frequency with which such events occur in this group to be relatively high. Males were significantly more likely than females to report experience of combat, physical assault, theft by force, vehicle accident and other forms of accident. Females were significantly more likely to report sexual abuse as a child or adult, violence at the hands of a family member, and a traumatic death of a loved one. Younger respondents and those living in urban areas also reported more traumatic experiences of various sorts. There were some significant linkages between traumatic experiences and mental health (specifically PTSD, and the well-being scale of the MHI) but the size of the effects were small. We argue, that despite methodological limitations, these data are instructive about the frequency and impact of traumatic events among this group. ********** Over the past twenty years an extensive literature has emerged relating to the psychological impact on the individual from exposure to traumatic events--events which are outside the realm of everyday human experience such as violence, combat, and criminal victimization. This research has more recently been via community-based survey studies. Exposure to traumatic events may be more widespread than once thought with estimates ranging from 39% to 84% of individuals being exposed to at least one traumatic event in their lifetime (Breslau, Davis, Andreski & Petersen, 1991; Fairbank, Schlenger, Saigh & Davidson, 1995; Norris, 1992; Vrana & Lauterbach, 1994). Traumatic experiences are relatively common and are associated with negative health outcomes in a range of ethnically diverse populations (e.g. Holman, Silver & Waitzkin, 2000; Peltzer 1999). The present study documents prevalence of a range of traumatic experiences in a community sample of New Zealand Maori. The DSM-IV (1994) defines an extreme traumatic stressor as involving direct personal experience of an event that involves actual or threatened death or serious injury, or witnessing of an actual or threatened death or serious injury (p. 424). Green (1990) suggested that there are certain generic experiences which make any event traumatic. These experiences, or dimensions, are: threat to one's life or bodily integrity; severe physical harm or injury; receipt of intentional injury or harm; exposure to the grotesque; violent and sudden loss of a loved one; witnessing or learning of violence to a loved one; learning of exposure to a noxious agent, and; causing death or severe harm to another. The present study will consider traumatic events defined by Green's criteria. The first large scale community study to consider exposure rates to traumatic events in a general population found that 39% had been exposed to at least one traumatic event in their lives, and of those, 24% had PTSD as defined by DSM-II-R (Breslau et al., 1991). Norris (1992) examined the frequency and impact of various traumatic events amongst a diverse group of North American respondents Jiving in the community. Participants lived in one of 12 neighbourhoods across four mid-sized south-eastern US cities and were sampled such that there was equal racial (50% African American, 50% European American), gender (50% male, 50% female) and age (33% young--18-39 years, 33% middle-aged--40-59 years, and 33% older--60+ years) representation. Nine different types of traumatic events were investigated; robbery, physical assault, sexual assault, tragic death, motor vehicle crash, combat, fire, other disaster (including injury or property damage because of a natural or man-made disaster) and other hazard (e. …

Michelle Millar

Papers

Sleep loss and performance of anaesthesia trainees and specialists.

Gender and ethnicity differences in the prevalence of traumatic events: evidence from a New Zealand community sample

Domestic violence, psychological distress, and physical illness among New Zealand women: Results from a community-based study

Frequency of traumatic events, physical and psychological health among Maori

Health care needs for older Maori: A study of Kaumatua and Kuia