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.

Traffic accidents and the resulting injury and trauma constitute an important social and public health problem. The objective of this study was to analyze the characteristics of such accidents and the victims treated by the only pre-hospital service -- the Integrated Trauma and Emergency Aid Service (SIATE) -- in the city of Londrina, Paraná State, southern Brazil, from 1997 to 2000. All victims (14,474) registered in the SIATE database were studied. The majority (> 70.0%) were male and aged 10 to 39 years. Motorcyclists were the most frequent victims (> 40.0%), and accidents occurred most frequently in December, on weekends (especially Saturdays), and at night. These results are consistent with those of other studies showing the need to implement preventive measures targeting young males, especially motorcyclists.

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OBJETIVO: Avaliar a magnitude da morbimortalidade por acidentes de transporte terrestre e as características das vítimas. MÉTODOS: Foram estudadas 3.643 vítimas de acidentes de transporte terrestre ocorridos em Londrina, Paraná, no primeiro semestre de 1996, abrangendo as registradas pela Polícia Militar, as que morreram no local do evento ou no trajeto para o hospital, além das atendidas em serviços de pronto-socorro ou internadas pelo Sistema Único de Saúde. Foi observado um prazo de 180 dias para verificar ocorrência de óbito. RESULTADOS: Os coeficientes de incidência de agravos e de mortalidade médios por acidentes de transporte terrestre foram de 1582,2 e 29,0 por 100.000 habitantes, respectivamente. Esses coeficientes, entretanto, mostraram grande variabilidade em relação a diversas características (local de residência, sexo, idade e categoria da vítima). Motociclistas representaram o principal tipo de vítima, seguidos por ciclistas e pedestres, perfazendo, juntos, 76,9% do total de vítimas e 81,5% das que morreram. CONCLUSÕES: Os resultados revelam que os acidentes de transporte terrestre constituem-se importante causa de morbimortalidade e sugerem a necessidade de estratégias específicas de prevenção com vistas a reduzir esses eventos, principalmente os que envolvem os usuários mais vulneráveis da via pública.

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.

Adesão ao tratamento farmacológico e não farmacológico e fatores associados na atenção primária da hipertensão arterialAdherence to pharmacological and non pharmacological treatment for arterial hypertension and associated factors in primary care

Tests are described showing the results obtained for the determination of REE and the trace elements Rb, Y, Zr, Nb, Cs, Ba, Hf, Ta, Pb, Th and U with ICP‐MS methodology for nine basaltic reference materials, and thirteen basalts and amphibolites from the mafic‐ultramafic Niquelândia Complex, central Brazil. Sample decomposition for the reference materials was performed by microwave oven digestion (HF and HNO3, 100 mg of sample), and that for the Niquelândia samples also by Parr bomb treatment (5 days at 200°C, 40 mg of sample). Results for the reference materials were similar to published values, thus showing that the microwave technique can be used with confidence for basaltic rocks. No fluoride precipitates were observed in the microwave‐digested solutions. Total recovery of elements, including Zr and Hf, was obtained for the Niquelândia samples, with the exception of an amphibolite. For this latter sample, the Parr method achieved a total digestion, but not so the microwave decomposition; losses, however, were observed only for Zr and Hf, indicating difficulty in dissolving Zr‐bearing minerals by microwave acid attack.