Burnout is a syndrome that results from chronic stress at work, with several consequences to workers’ well-being and health. This systematic review aimed to summarize the evidence of the physical, psychological and occupational consequences of job burnout in prospective studies. The PubMed, Science Direct, PsycInfo, SciELO, LILACS and Web of Science databases were searched without language or date restrictions. The Transparent Reporting of Systematic Reviews and Meta-Analyses guidelines were followed. Prospective studies that analyzed burnout as the exposure condition were included. Among the 993 articles initially identified, 61 fulfilled the inclusion criteria, and 36 were analyzed because they met three criteria that must be followed in prospective studies. Burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. The psychological effects were insomnia, depressive symptoms, use of psychotropic and antidepressant medications, hospitalization for mental disorders and psychological ill-health symptoms. Job dissatisfaction, absenteeism, new disability pension, job demands, job resources and presenteeism were identified as professional outcomes. Conflicting findings were observed. In conclusion, several prospective and high-quality studies showed physical, psychological and occupational consequences of job burnout. The individual and social impacts of burnout highlight the need for preventive interventions and early identification of this health condition in the work environment.

Objective Risk factors for in-hospital mortality in confirmed COVID-19 patients have been summarized in numerous meta-analyses, but it is still unclear whether they vary according to the age, sex and health conditions of the studied populations. This study explored these variables as potential mortality predictors. Methods A systematic review was conducted by searching the MEDLINE, Scopus, and Web of Science databases of studies available through July 27, 2020. The pooled risk was estimated with the odds ratio (p-OR) or effect size (p-ES) obtained through random-effects meta-analyses. Subgroup analyses and meta-regression were applied to explore differences by age, sex and health conditions. The MOOSE guidelines were strictly followed. Results The meta-analysis included 60 studies, with a total of 51,225 patients (12,458 [24.3%] deaths) from hospitals in 13 countries. A higher in-hospital mortality risk was found for dyspnoea (p-OR = 2.5), smoking (p-OR = 1.6) and several comorbidities (p-OR range: 1.8 to 4.7) and laboratory parameters (p-ES range: 0.3 to -2.6). Age was the main source of heterogeneity, followed by sex and health condition. The following predictors were more markedly associated with mortality in studies with patients with a mean age ≤60 years: dyspnoea (p-OR = 4.3), smoking (p-OR = 2.8), kidney disease (p-OR = 3.8), hypertension (p-OR = 3.7), malignancy (p-OR = 3.7), diabetes (p-OR = 3.2), pulmonary disease (p-OR = 3.1), decreased platelet count (p-ES = -1.7), decreased haemoglobin concentration (p-ES = -0.6), increased creatinine (p-ES = 2.4), increased interleukin-6 (p-ES = 2.4) and increased cardiac troponin I (p-ES = 0.7). On the other hand, in addition to comorbidities, the most important mortality predictors in studies with older patients were albumin (p-ES = -3.1), total bilirubin (p-ES = 0.7), AST (p-ES = 1.8), ALT (p-ES = 0.4), urea nitrogen (p-ES), C-reactive protein (p-ES = 2.7), LDH (p-ES = 2.4) and ferritin (p-ES = 1.7). Obesity was associated with increased mortality only in studies with fewer chronic or critical patients (p-OR = 1.8). Conclusion The prognostic effect of clinical conditions on COVID-19 mortality vary substantially according to the mean age of patients. PROSPERO registration number CRD42020176595.

Background: The effect of coffee and caffeine on blood pressure (BP) and cardiovascular disease (CVD) in hypertensive persons is uncertain. Objective: The objective was to summarize the evidence on the acute and longer-term effects of caffeine and coffee intake on BP and on the association between habitual coffee consumption and risk of CVD in hypertensive individuals. Design: A systematic review and meta-analysis of publications identified in a PubMed and EMBASE search up to 30 April 2011 was undertaken. Data were extracted from controlled trials on the effect of caffeine or coffee intake on BP change and from cohort studies on the association between habitual coffee consumption and CVD. Results: In 5 trials, the administration of 200-300 mg caffeine produced a mean increase of 8.1 mm Hg (95% CI: 5.7, 10.6 mm Hg) in systolic BP and of 5.7 mm Hg (95% CI: 4.1, 7.4 mm Hg) in diastolic BP. The increase in BP was observed in the first hour after caffeine intake and lasted !3 h. In 3 studies of the longer-term effect (2 wk) of coffee, no increase in BP was observed after coffee was compared with a caffeine-free diet or was compared with decaffeinated coffee. Last, 7 cohort studies found no evidence of an association between habitual coffee consumption and a higher risk of CVD. Conclusions: In hypertensive individuals, caffeine intake produces an acute increase in BP for !3 h. However, current evidence does not support an association between longer-term coffee consumption and increased BP or between habitual coffee consumption and an increased risk of CVD in hypertensive subjects.Am J Clin Nutr 2011;94:1113-26.

The relationship between obesity and the intake of macronutrients and specific foods is uncertain. Thus, there is growing interest in some eating behaviours because they may reflect the joint effect of several foods and nutrients and, thus, increase the likelihood of finding a link to obesity. This study examined the association between selected eating behaviours and excess weight in the general population throughout a systematic review of publications written in English, Spanish or Portuguese identified in a PubMed search up to 31 December 2010. We included 153 articles, 73 of which have been published since 2008. Only 30 studies had a prospective design; of these, 15 adjusted for sociodemographic variables, physical activity and energy or food intake. Moreover, definitions of eating behaviours varied substantially across studies. We found only small or inconsistent evidence of a relationship between excess weight and skipping breakfast, daily eating frequency, snacking, irregular meals, eating away from home, consumption of fast food, takeaway food intake, consumption of large food portions, eating until full and eating quickly. In conclusion, this review highlights the difficulty in measuring human behaviour, and suggests that a more systematic approach is needed for capturing the effects of eating behaviours on body weight.

This work examined the Spanish population's degree of accordance with the Mediterranean diet (MD). This was a cross-sectional study conducted in 2008-2010 among 11,742 individuals representative of the Spanish population aged ≥ 18 y. Habitual food consumption was assessed with a computerized diet history. Accordance of food consumption with the MD was assessed with the MD Adherence Screener (MEDAS) score using the cutoffs ≥ 9 to define strict accordance and ≥ 7 (mid-range value) for modest accordance. Accordance of nutrient intake with the MD was defined as ≥ 4.5 points (mid-range value) on the high-unsaturated fat OmniHeart diet score. The diet of 12% (95% CI: 11.3-12.7%) of the Spanish population reached MEDAS-based strict accordance with the MD and 46% (95% CI: 44.7-47.7) attained modest accordance. Moreover, 39.0% (95%: 37.8-40.1%) of the population achieved OnmiHeart-based MD accordance. Factor analysis identified 2 main dietary patterns. The first one was called "Westernized" and was rich in red and processed meat, French fries, refined cereals, and sweetened beverages and poor in fresh fruit; the second pattern was named "Mediterranean" and was rich in olive oil and plant-based foods. Regardless of how it was defined, MD accordance was less frequent and the Westernized pattern was more frequent among the younger, the less educated, current smokers, and those less physically active and more sedentary. In conclusion, the Spanish population is drifting away from the MD to adopt a less healthy diet, typical of Western countries. The departure from the MD mostly affects the socially disadvantaged and clusters with other unhealthy lifestyles, which may have synergistic undesirable effects on health.

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The aim of this study was to summarise the scientific evidence on the prevalence of psychoactive substance use and on the factors associated with their intake among truck drivers. A systematic review was performed in the databases PubMed, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences, and Cochrane and 36 cross-sectional studies were identified with quantitative results about the use of psychoactive substances by truck drivers. Out of these, 28 were carried out in countries with large land areas and 23 obtained their information through self-reporting. The most frequently studied substances were alcohol (n=25), amphetamines (n=17), marijuana (n=16) and cocaine (n=13). The prevalence of the use of these substances greatly varied: alcohol (0.1–91.0%); amphetamines (0.2–82.5%), marijuana (0.2–29.9%), cocaine (0.1–8.3%). The frequency of substance use was lower in studies that investigated the presence of these substances in biological samples than in those based on self-reported use. In 12 studies that evaluated factors associated with the intake of psychoactive substances, the following stood out: younger age, higher income, longer trips, alcohol consumption, driving in the night shift, travelling interstate routes, long or short sleep, fewer hours of rest, little experience of the driver, connection with small and medium sized companies, income below levels determined by labour agreements, productivity-based earnings and prior involvement in accidents. The frequency of psychoactive substance use by truck drivers seems to be high, although that greatly varies according to the type of substance and the method of collecting the information. The use of these substances was mainly associated with indicators of poor working conditions.

Self-reported sleep duration was associated with 7-year mortality in this cohort of older adults, even when adjusted for health status. Further research is needed to determine the mechanisms and clinical implications of these findings.