Evidence map›Paper›PMID 25001394›Full record

SynthesisBMJ open2014

European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence.

Maria Cruz Rodriguez-Jareño, Evangelia Demou, Sergio Vargas-Prada, Kaveh A Sanati, Alenka Skerjanc, Pedro G Reis, Ritva Helimäki-Aro, Ewan B Macdonald, Consol Serra

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
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  8. Review
  9. Observational
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  19. Comparing family medicine residency training in Canada and the United Kingdom.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Maria Cruz Rodriguez-JareñoCatalan and Spanish Societies of Occupational Medicine, Barcelona, Spain Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain.
Evangelia DemouMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Sergio Vargas-PradaCiSAL-Centre for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain.
Kaveh A SanatiHealthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK Occupational Health Department, Epsom & St Helier University Hospitals NHS Trust, Surrey, UK.
Alenka SkerjancClinical Institute of Occupational, Traffic and Sports Medicine, University Medical Centre, Ljubljana, Slovenia.
Pedro G ReisCollege of Occupational Medicine, Portuguese Medical Association, Lisbon, Portugal.
Ritva Helimäki-AroHelsinki City Occupational Health Centre, Helsinki, Finland.
Ewan B MacdonaldHealthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Consol SerraCatalan and Spanish Societies of Occupational Medicine, Barcelona, Spain CiSAL-Centre for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain Occupational Health Service, Parc de Salut MAR, Barcelona, Spain CIBER of Epidemiology and Public Health, Spain.

Funding

Medical Research Council MC_PC_13027
6 · The paper itself

Abstract

objectiveTo summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians.

designA systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria.

settingPhysicians of any medical, surgical or community specialty, working in any possible setting (hospitals, primary healthcare, etc), as well as trainees, residents, junior house officers or postgraduate interns, were included.

participantsThe total number of participants was 14 338. PRIMARY AND SECONDARY OUTCOME MEASURES: Health effects classified under the International Classification of Diseases (ICD-10).

resultsOver 3000 citations and 110 full articles were reviewed. From these, 11 studies of high or intermediate quality carried out in North America, Europe and Japan met the inclusion criteria. Six studies included medical residents, junior doctors or house officers and the five others included medical specialists or consultants, medical, dental, and general practitioners and hospital physicians. Evidence of an association was found between percutaneous injuries and road traffic accidents with extended long working hours (LWH)/days or very LWH/weeks. The evidence was insufficient for mood disorders and general health. No studies on other health outcomes were identified.

conclusionsLWH could increase the risk of percutaneous injuries and road traffic accidents, and possibly other incidents at work through the same pathway. While associations are clear, the existing evidence does not allow for an established causal or 'dose-response' relationship between LWH and incidents at work, or for a threshold number of extended hours above which there is a significantly higher risk and the hours physicians could work and remain safe and healthy. Policymakers should consider safety issues when working on relaxing EWTD for doctors.

Indexed as

Occupational HealthPhysiciansEuropeHumansTime FactorsWork

Identifiers

PMID25001394
PMCPMC4091509

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.