INTRODUCTION: Studies have demonstrated that individual and organizational factors contribute to burnout in health professionals. The COVID-19 pandemic increased demand for health care services, leading to work overload among health professionals, particularly physicians.

OBJECTIVES: To determine the prevalence of burnout and identify possible individual, organizational, and sleep - related factors associated with burnout among physicians, before and during the COVID-19 pandemic.

METHODS: We conducted a cross - sectional study on a subsample of 2,639 physicians extracted from a secondary database with health professionals from all regions of Brazil, between May and June 2020. Descriptive and inferential statistical analyses were performed. Burnout was assessed via the emotional exhaustion dimension.

RESULTS: Data for 2,374 (90.3%) physicians were analyzed. The prevalence of burnout before the pandemic was 18.9%, increasing to 31.3% during the pandemic. The factors predicting burnout during the pandemic included age 25-39 years (odds ratio = 2.76; 95%CI 1.94-3.92), female sex (odds ratio = 1.67; 95%CI 1.34-2.08), working on the front line (odds ratio = 1.62; 95%CI 1.30-2.02), poor sleep quality and quantity (odds ratio = 6.39; 95%CI 4.99-8.17), and not working from home (odds ratio = 1.31; 95%CI 1.08-1.60).

CONCLUSIONS: Compared to the work routine before the pandemic, there was a marked increase in the prevalence of burnout among physicians during the pandemic. Independent factors associated with this increase were young adult age, female sex, frontline work, poor sleep quality and quantity, and traditional on-site work.

INTRODUÇÃO: Estudos demonstram que fatores individuais e organizacionais contribuem para o desenvolvimento de burnout em profissionais de saúde. A pandemia de covid-19 acentuou a demanda de atendimento nos serviços de saúde, gerando maior sobrecarga de trabalho, especialmente entre os médicos.

OBJETIVOS: Estimar a prevalência de burnout e identificar possíveis fatores individuais, organizacionais e distúrbios do sono associados ao burnout em médicos, antes e durante a pandemia de covid-19.

MÉTODOS: Estudo transversal realizado com uma subamostra de 2.639 médicos extraída de um banco de dados secundário com profissionais de saúde de todas as regiões do Brasil, entre maio e junho de 2020. Foram realizadas análises descritivas e testes de estatística inferencial. O burnout foi estimado a partir da análise do componente de esgotamento emocional.

RESULTADOS: Foram analisados dados de 2.374 (90,3%) médicos. A prevalência de burnout antes da pandemia foi de 18,9%, aumentando para 31,3% durante a pandemia. Os fatores preditores de burnout na pandemia foram faixa etária de 25 a 39 anos (odds ratio = 2,76; IC95% 1,94-3,92), sexo feminino (odds ratio = 1,67; IC95% 1,34-2,08), atuação na linha de frente (odds ratio = 1,62; IC95% 1,30-2,02), sono de menor quantidade e pior qualidade (odds ratio = 6,39; IC95% 4,99-8,17) e não trabalhar em home office (odds ratio = 1,31; IC95% 1,08-1,60).

CONCLUSÕES: Em comparação ao período anterior à pandemia, observou-se um aumento expressivo na prevalência de burnout entre médicos durante a pandemia. Os fatores independentes associados a esse aumento foram faixa etária jovem adulto, sexo feminino, trabalho na linha de frente, sono insuficiente e de má qualidade e trabalho presencial.

Purpose Global dietary patterns are increasingly driven by ultra-processed foods–cheap, highly palatable, and ready-to-eat options. Exploring time-related eating patterns and its association with ultra-processed foods could help in intervention efforts, but knowledge on this topic is still limited. This study assessed the association of time-related eating patterns with unprocessed/minimally processed and ultra-processed food consumption across different life stages.

Methods Two 24-hour food recalls from a nationally representative sample in Brazil (Brazilian Household Budget Survey, POF, 2017–2018; n = 46,164) were used to estimate tertiles of first and last intake times, eating midpoint, caloric midpoint time, and night fasting (independent variables). All consumed foods were classified according to the Nova classification system, and the outcomes of interest were consumption of unprocessed/minimally processed and ultra-processed foods. Multiple linear regression models were performed for all individuals and stratified for each age group: adolescents (10–19 years, n = 8,469), adults (20–59 years, n = 29,332), and older individuals (≥ 60 years, n = 8,322).

Results The later tertile of first food intake time, last food intake time, caloric midpoint, and eating midpoint were positively associated with consumption of ultra-processed foods (β = 3.69, 95%CI = 3.04, 4.34; β = 1.89, 95%CI = 1.32, 2.47; β = 5.20, 95%CI = 4.60, 5.81; β = 3.10, 95%CI = 2.49, 3.71, respectively) and negatively associated with consumption of unprocessed or minimally processed foods (β=-2.79, 95%CI=-3.37; -2.22; β=-1.65, 95%CI=-2.24, -1.05; β=-3.94, 95%CI=-4.44, -3.44; β=- 2.35, 95%CI=-2.93, -1.78, respectively) compared to the first “earlier” tertile (reference). An inverse association was found for night fasting (β=-1.74, 95%CI=-2.28, -1.22 and β = 1.52, 95%CI = 0.98, 2.06 for ultra-processed and unprocessed/minimally processed foods, respectively). These associations were consistent across all age groups.

Conclusion Chrononutrition patterns characterized by late intake timing and shortened overnight fasting were associated with higher consumption of ultra-processed foods and lower intake of unprocessed/minimally processed foods across all age groups.

Purpose Time-related eating patterns have been associated with metabolic and nutritional diseases such as obesity. However, there is a lack of representative studies on this subject. This study's aim was to assess the association between the timing of eating and obesity in a large and representative sample of the Brazilian adult population (POF 2008–2009 survey).

Methods Two days of adults’ food diary (n = 21,020) were used to estimate tertiles of first and last meal intake times, eating midpoint, caloric midpoint time, and calories consumed from 18:00 h onwards. BMI was estimated and its values, as well as excess weight (BMI ≥ 25 kg/m²) and obesity (BMI ≥ 30 kg/m²) were used as outcomes. Multiple linear and logistic regressions were performed.

Results The first (β = 0.65, 95% CI 0.37–0.93) and last food intake time (β = 0.40, 95% CI 0.14–0.66), eating midpoint (β = 0.61, 95% CI 0.34–0.88) and calories consumed after 21:00 h (β = 0.74, 95% CI 0.32–1.16) and 22:00 h (β = 0.75, 95% CI 0.18–1.32) were positively associated with BMI. The likelihood of having excess weight or obesity was significantly higher in the third tertile of the first food intake time (OR = 1.28, 95% CI 1.13–1.45 and OR = 1.34, 95% CI 1.13–1.58, respectively), last food intake time (OR = 1.16, 95% CI 1.03–1.32; and OR = 1.18, 95% CI 1.00–1.41, respectively), eating midpoint (OR = 1.28, 95% CI 1.13–1.45; and OR = 1.35, 95% CI 1.14–1.59, respectively) and energy consumption after 21:00 h (OR = 1.33, 95% CI 1.10–1.59).

Conclusion Chrononutrition meal patterns indicative of late meal intake were significantly associated with high BMI, excess weight and obesity in the Brazilian population.

Introduction: The relationship between sleep quality and rest location is rarely explored in the literature. In this context, ergonomic analysis instruments can contribute with information for a satisfactory rest environment throughout the work schedule. Objectives: To analyze the performance of an instrument based on Ergonomic Workplace Analysis for assessing rest locations. Methods: This study adapted an ergonomic instrument to a new purpose. To analyze its performance, we assessed the rest locations of truck drivers working for a large transportation company located in the state of São Paulo. Results: The variables adapted from the original Ergonomic Workplace Analysis were rest location, sequence of tasks, lighting, noise, indoor comfort, and thermal comfort. Photos and flowcharts were used to better describe the data. Conclusion: The new instrument was shown to be adequate for assessing rest locations. The drivers evaluated the accommodations more positively than the analyst, and truck sleepers and company accommodations were considered different both by the drivers and the analyst.

Many factors are involved in the development of fatigue in transportation, as discussed previously in other chapters. This chapter proposes to present lifestyle as a mediator of fatigue among professionals working in this sector. First, we distinguish between fatigue and sleepiness and present their definitions. Then, we show examples of lifestyle factors that can contribute to fatigue. Finally, we discuss how society is driven to determine lifestyle. At the end of the chapter, some final remarks put together the factors presented and how they can act together.

Human food intake and its timing are a complex behavior that can be influenced by a variety of factors, some of which may vary from season to season or from region to region. In this study, our aim was to investigate the seasonal variation in food intake times, with a particular focus on how these may vary across different regions of a country. We conducted an analysis of data from 20,622 adults from the National Household Budget Survey (POF-IBGE), encompassing complete food diaries collected from individuals residing in Brazil, and thereby ensuring representation across different latitudes. Each participant’s daily food intake was reported for two non-consecutive days at different times in the same week using food diaries. An ANOVA revealed a later food intake time in the evening in high-latitude regions compared to low-latitude regions. The Sidak post-hoc test showed a significant interaction effect between region and season, demonstrating a pattern of early First Intake Time and Eating Midpoint in the Northeast region during spring/summer. Additionally, we observed an independent effect of the region, as early food intake times were found in low-latitude regions. These findings offer a basis for discussing food intake times among individuals living in different regions located on distinct latitudes.

Circadian hygiene, a concept not to be confused with the notion of public or social hygiene, should be discussed among experts and society. Light–dark cycles and other possible synchronizers of the human circadian timing system affect ways of life, including sleeping, eating, working and physical activity. Some of these behaviors have also been investigated individually as synchronizers (e.g., eating times). Therefore, the knowledge held today about circadian rhythms, and their implications for health, allows future perspectives in this field to be mapped. The present article summarizes the latest knowledge on factors influencing circadian rhythms to discuss a perspective for the future of health promotion based on circadian hygiene. However, it is important to highlight that circadian hygiene is the product of an imbrication of individual and societal involvement. First, it is important to adopt practices and devise public health policies in line with circadian hygiene. Second, individual healthy habits require internal rhythms to be examined. Last, the research agenda on circadian hygiene can be developed on a public as well as individual level, raising the question as to how much society is willing to embrace this change.

Objective: This study aimed firstly to describe sleep-related and mental health symptoms before and during the COVID-19 pandemic in a national-wide sample and, secondly, to verify attitudes towards help-seeking to treat these symptoms. Material and Methods: Data were collected through an online questionnaire sent through the Brazilian Sleep Association's social media. The questionnaire included sociodemographic and sleep aspects questions currently and before the pandemic period. In addition, the survey addressed current and previous anxiety, depression, and burnout symptoms. The outcome help-seeking was addressed in the questionnaire as well by a single question asked when the participant reported mental or sleep problems. Results: The study covered 6,360 participants, mean age 43.5 years (SD=14.3), 76.7% female and 63.7% with undergraduate or higher degree filled out the survey. Seventy percent of participants reported sleep disturbances and 80% reported symptoms of anxiety during the pandemic. Help-seeking behavior was found only in one third of them. Hours of sleep reduced from 7.12 to 6.2h, which can be related with the increase in 28.2% of dissatisfaction with sleep duration during the pandemic. The highest frequency of complaints related to sleep was difficulty to fall asleep three or more times a week (going from 27.6% before the pandemic to 58.9% during the pandemic; p<0.001). Moreover, it was observed that help-seeking was more prevalent in men than women, and more in younger participants than in older ones. Conclusion: There was an increase of sleep and mental self-reported problems during the pandemic, which was not followed by help-seeking.

OBJECTIVES: Truck drivers’ work organization requires that rest and sleep be taken in various locations, where sleep quality might be affected by the discomfort of these environments. The purpose of this study was to evaluate truck drivers’ rest locations and their association with sleep quality utilizing an ergonomic approach. MATERIAL AND METHODS: The sleep quality of 81 truck drivers was assessed using the Pittsburgh sleep quality index (PSQI). An adapted version of the ergonomics workplace analysis (EWA) instrument was used to evaluate 44 rest locations. RESULTS: Half of the workers preferred sleeper berths (51.2%) as a rest place. Sleep was classified as poor by 71.6% of the drivers. Dorms were rated more positively (p<0.001) by truck drivers (2.0±1.1) than by the analyst (2.6±0.6). Sleeper berths and dorms were rated statistically different by truck drivers (p=0.002), as well as by the analyst (p=0.003). No correlation was found between EWA evaluations and total score for sleep quality. Separate analyses of dorms and truck berths showed very few correlations. The higher the noise of roommates in dorms, the worse the sleep quality. Conversely, noise in corridors or outside the room positively impacted sleep quality. CONCLUSION: Noise in the rest place may affect sleep in both directions, negatively or positively. Sleep was classified as poor regardless of resting place. The quality of resting places seemed to have little effect on sleep quality of truck drivers. Factors other than rest place, such as work scheduling, are probably more important for promoting good sleep quality.

Study Objectives: To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on insomnia and other sleep disturbances in health care professionals.

Methods: A survey was distributed using social media and organizational emails to Brazilian active health care professionals during the COVID-19 outbreak. We explored potential associated factors including age, sex, occupation, workplace, work hours, income, previous infection with COVID-19, recent/current contact with COVID-19 patients, regional number of incident deaths, anxiety, and burnout. We evaluated new-onset/previous insomnia worsening episodes (primary outcome), new pharmacological treatments, sleep quality, duration, nightmares, and snoring (secondary outcomes).

Results: A total of 4,384 health professionals from all regions of the country were included in the analysis (44 ± 12 years, 76% females, 53.8% physicians). Overall, 55.7% were assisting patients with COVID-19, and 9.2% had a previous COVID-19 infection. The primary outcome occurred in 32.9% of respondents inparallel to 13% new pharmacological treatments for insomnia. The sleep quality worsened for 61.4%, while 43.5% and 22.8% reported≥1-hour sleep duration reduction and worsening or new-onset nightmares, respectively. Multivariate analyses showed that age (odds ratio [OR]: 1.008; 95% confidence interval [CI] 1.001–1.015), females (OR: 1.590; 95% CI 1.335–1.900), weight change (decrease: OR: 1.772; 95% CI 1.453–2.161; increase: OR: 1.468; 95% CI 1.249–1.728), prevalent anxiety (OR: 3.414; 95% CI 2.954–3.948), new-onset burnout (OR: 1.761; 95% CI 1.489–2.083), family income reduction > 30% (OR: 1.288; 95% CI 1.069–1.553), and assisting patients with COVID-19 (OR: 1.275; 95% CI 1.081–1.506) were independently associated with new-onset or worsening of previous insomnia episodes.

Conclusions: We observed a huge burden of insomnia episodes and other sleep disturbances in health care professionals during the COVID-19 pandemic.