Rodriguez-Jareño Maria Cruz, Demou Evangelia, Vargas-Prada Sergio, Sanati Kaveh A, Skerjanc Alenka, Reis Pedro G, Helimäki-Aro Ritva, Macdonald Ewan B, Serra Consol
Catalan and Spanish Societies of Occupational Medicine, Barcelona, Spain Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain.
MRC/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.
BMJ Open. 2014 Jul 7;4(7):e004916. doi: 10.1136/bmjopen-2014-004916.
To 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.
A 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.
Physicians 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.
The total number of participants was 14 338.
Health effects classified under the International Classification of Diseases (ICD-10).
Over 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.
LWH 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.
总结关于医生暴露于超出欧洲工作时间指令（EWTD）规定的最长工作时长对健康影响的现有科学证据。
在PubMed和EMBASE中进行了系统的文献检索。由独立的研究人员对根据既定标准进行研究选择、质量评估和数据提取。
纳入了从事任何医学、外科或社区专科工作的医生，工作环境不限（医院、基层医疗等），以及实习生、住院医师、初级住院医生或研究生实习生。
参与者总数为14338人。
根据国际疾病分类（ICD - 10）分类的健康影响。
共检索到3000多篇引文和110篇全文。其中，在北美、欧洲和日本进行的11项高质量或中等质量的研究符合纳入标准。6项研究纳入了住院医师、初级医生或住院医生，另外5项研究纳入了医学专家或顾问、医学、牙科和全科医生以及医院医生。发现长时间工作（LWH）/天数延长或每周LWH时间过长与经皮损伤和道路交通事故之间存在关联证据。关于情绪障碍和总体健康的证据不足。未发现关于其他健康结局的研究。
长时间工作可能会增加经皮损伤和道路交通事故的风险，并可能通过相同途径导致其他工作事故。虽然关联明确，但现有证据无法确定长时间工作与工作事故之间存在既定的因果关系或“剂量 - 反应”关系，也无法确定延长工作时长的阈值，超过该阈值风险会显著增加，以及医生能够安全健康工作的时长。政策制定者在考虑放宽医生的EWTD规定时应考虑安全问题。
