title: European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  The total number of participants was 14 338.
  
  
  METHODS
  Health effects classified under the International Classification of Diseases (ICD-10).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Catalan and Spanish Societies of Occupational Medicine, Barcelona, Spain Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain.
authors.forename: Maria Cruz
authors.initials: MC
authors.lastname: Rodriguez-Jareño
authors.affiliation: 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.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Demou
authors.affiliation: CiSAL-Centre for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Vargas-Prada
authors.affiliation: Healthy 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.
authors.forename: Kaveh A
authors.initials: KA
authors.lastname: Sanati
authors.affiliation: Clinical Institute of Occupational, Traffic and Sports Medicine, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Alenka
authors.initials: A
authors.lastname: Skerjanc
authors.affiliation: College of Occupational Medicine, Portuguese Medical Association, Lisbon, Portugal.
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Reis
authors.affiliation: Helsinki City Occupational Health Centre, Helsinki, Finland.
authors.forename: Ritva
authors.initials: R
authors.lastname: Helimäki-Aro
authors.affiliation: Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Ewan B
authors.initials: EB
authors.lastname: Macdonald
authors.affiliation: Catalan 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.
authors.forename: Consol
authors.initials: C
authors.lastname: Serra
mesh_terms: D005060:Europe; D006801:Humans; D016272:Occupational Health; D010820:Physicians; D013997:Time Factors; D014937:Work / Q000706:statistics & numerical data*