RESUMO
BACKGROUND: The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. METHODS: This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. RESULTS: Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. CONCLUSIONS: Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.
Assuntos
Sono , Tolerância ao Trabalho Programado , Humanos , Tolerância ao Trabalho Programado/psicologia , Estudos Transversais , Análise Multivariada , Erros MédicosRESUMO
INTRODUCTION: Melatonin is a safe medication with multiple uses in sleep medicine for the treatment of circadian rhythm disorders, insomnia, and REM sleep behavior disorder. In view that melatonin has been recommended as an adjuvant treatment in COVID-19 pandemic mainly due to its anti-inflammatory properties, the objective of the present study was to evaluate the history of COVID-19 infection and the requirement of hospitalization in a group of adult patients previously treated with melatonin for various sleep disorders. MATERIAL AND METHODS: This is a retrospective cross-sectional study of data from a closed population of 110 adult patients at a University Hospital treated with melatonin for various sleep disorders, analyzed until the onset of COVID-19 pandemic. Demographic and melatonin-related variables (dose, treatment time) were analyzed and were reevaluated during the pandemic period, by scheduled tele-consultation regarding diagnosis, hospitalization requirements, variables related to COVID-19 infection prior to specific vaccination. Categorical variables were described as relative and absolute frequencies. RESULTS: N = 110 patients. Age range = 40- 96 years (mean = 71 years ± 9.9), older adults > 65 years: N =87 (79,1%). COVID-19 infection was recorded in 15 patients (13.5%) requiring hospitalization in 5 of those infected, only one of them with severe pneumonia. There were no deaths due to COVID-19. There were no differences between infected vs. uninfected in age (p = 0.74), body mass index (p = 0.65) or melatonin dose (p = 0.10).The melatonin dose range was 3-150 mg / day (mean = 46.33 ± 34.1), older adults receiving a mean dose of 50,3 ± 35,6.The 75.5% of the patients were treated for at least 12 months with melatonin. CONCLUSION: We found that 13.5% of patients previously treated with melatonin for various sleep disorders were infected by COVID-19, requiring hospitalization with subsequent medical discharge one third of them. According to national records the lethality rate in older adults in August 2020 was 10.5%. No patient treated with melatonin died for this cause in this sample. We did not find statistically significant differences in terms of indicated melatonin dose, age or body mass index, when comparing those infected with those not infected. The patients in general were mostly older adults, treated with a mean dose greater than 40 mg / day of melatonin for various sleep disorders, mainly for complaints of insomnia, for more than 12 months. The results are consistent with a possible preventive effect of melatonin in the COVID-19 pandemic.
