Nearly one-fourth of Americans—especially minorities and the poor—must travel farther to trauma centers than they did a decade ago due to hospital closures, according to a new study led by University of California, San Francisco, researchers.
The researchers analyzed ZIP codes covering nearly the entire U.S. population and found that 24 percent of residents—69 million people—were farther from the nearest trauma center in 2007 than they were in 2001. Nearly 16 million people had to travel 30 minutes farther than they once did.
Communities with high numbers of African Americans, uninsured and people living in poverty were most likely to be affected, as were people in rural areas. Yet even with the closures, nearly three-quarters of U.S. residents live within 10 miles of a trauma center, while 14 percent live more than 30 miles away. The study is in the October issue of Health Affairs.
In a related study in the May 18 issue of the Journal of the American Medical Association, also by UCSF researchers, during the past 20 or so years, the number of hospital emergency departments in nonrural areas of the U.S. has declined by 27 percent.
From 1990 to 2009, the number of hospitals with EDs in nonrural areas of the U.S. fell from 2,446 to 1,779, with an average of 89 closing per year. EDs that closed tended to be located in counties with high shares of minority populations (36 percent vs. 31 percent), high shares of populations in poverty (37 percent vs. 31 percent), and with more than 15 percent of residents without insurance (42 percent vs. 36 percent).
“As the only place in the U.S. health care system that serves all patients, emergency departments (EDs) are the ‘safety net of the safety net.’ Federal law requires hospital EDs to evaluate and treat all patients in need of emergency care regardless of ability to pay,” background information in the article reads. “Between 1998 and 2008, the number of hospital-based EDs in the United States declined, while the number of ED visits increased, particularly visits by patients who were publicly insured and uninsured. Little is known about the hospital, community, and market factors associated with ED closures.”
Shiftwork Takes Toll on Young Workers
Working the night shift is associated with higher levels of the stress hormone cortisol over the long term, a finding that may help to explain why shift workers face increased risk of abdominal obesity, hypertension, diabetes and cardiovascular disease.
Researchers from the Netherlands measured cortisol levels in hair samples collected from 33 nightshift workers and 89 day workers. They found that long-term cortisol levels were significantly increased in nightshift workers under age 40, although not older workers. Younger nightshift workers also had a higher body mass index (BMI) compared to day workers. Higher levels of cortisol in the hair was also associated with a higher BMI.
Cortisol is released into the bloodstream during stress and can seep into the blood vessels in the scalp and get trapped in the hair shaft. Cortisol levels in the hair are a way of measuring the hormone over time, compared to measuring cortisol in the blood or urine, which measures more short-term levels. Prior research has found an association between cortisol levels in the hair and heart attacks.
The study was published online Aug. 31 in the Journal of Clinical Endocrinology & Metabolism.
Teamwork Can Offset Effects of Fatigue
Fatigue can lead to mistakes and a decline in good decision-making, but teamwork seems to help overcome that. Researchers in England had 171 army officer cadets aged 18 to 24 do a series of problem-solving exercises when they were well rested, before the start of a weekend training camp, and after the camp, when they were tired from drills, night watch duty and lack of sleep.
The fatigued soldiers performed significantly worse on the tests than the well-rested soldiers. However, when cadets were organized into teams and asked to solve the problems, they performed just as well when they were tired as when they were alert, according to the findings, published online Aug. 15 in the Journal of Experimental Psychology: Applied. “Teams appear to be more highly motivated to perform well, and team members can compare solutions to reach the best decision when they are fatigued. This appears to allow teams to avoid the inflexible thinking experienced by fatigued individuals,” said Daniel Frings, Ph.D., a senior lecturer in social psychology at London South Bank University, in a journal news release.
The tests measured the “Einstellung effect,” or the tendency toward rigidity of thought, such as relying on past or familiar solutions rather than being flexible and adapting to new situations that may require a different approach.
“Flexible thinking during problem solving is vital in many fields,” Frings said. “Failing to adapt quickly to new situations can be very dangerous in constantly changing environments, such as hospitals and battlefields. A doctor may misdiagnose a patient if he always connects one group of symptoms with a certain condition rather than considering other possibilities.”
