Table 4

Available scientific evidence on the health problems associated with long working hours in physicians: levels of evidence synthesis

Health outcomeDegree of evidence*Magnitude of the association†Studies ID
Percutaneous injuries++++Ayas et al,40 Fisman et al43
Motor vehicle accidents++++Barger et al,41 Kirkcaldy et al45
Mood disorders+±Varma et al,49 Hayasaka et al,44 Firth-Cozens,42 Zahrai et al,50 Stamp et al,47 Sundquist and Johansson48
General health+±Zahrai et al,50 Stamp et al,47 Sundquist and Johansson,48 Rosta and Aasland46
  • *Strong evidence (+++): consistent results in more than two studies of high quality; moderate evidence (++): consistent results in two studies of high quality, or one high-quality study and one intermediate, or between some studies of intermediate quality; insufficient evidence (+): identification of only one study or inconsistent results across studies; evidence of no association (−): consistent results of a non-association in two or more studies.

  • †Magnitude of the association: it refers to the magnitude of the association point estimate (RR=relative risk, rate ratio or OR): high (+++) if RR >3; intermediate (++) if RR=1.5–3; low (+) if RR <1.5; no association (−); unclear (±).