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Interventions to reduce burnout of physicians and nurses - PMC.Другие сервисы сайта
A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Data from each study were extracted independently using a pre-standardized data abstraction form. The the Risk of Bias in Systematic reviews and assessment of multiple systematic reviews AMSTAR 2 tool were used to evaluate risk of bias and quality of included articles. A total of 22 studies published from to were eligible for analysis.
The MBI was used by majority of studies to assess burnout. Burnout is a complicated problem and should be dealt with by using bundled strategy. The existing overview clarified evidence to reduce burnout of physicians and nurses, which provided a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety. Burnout refers to a prolonged response to chronic emotional and interpersonal stressors caused by work, manifested as emotional exhaustion, depersonalization, and reduced personal accomplishment.
Burnout among healthcare providers is in relation to their gender, marital status, work environment, interpersonal and professional conflicts, emotional distress, and low social support. Recently, COVID has swept the world, which has drawn pay more attention to the mental health of human beings, [ 23 ] especially front-line health care workers. In addition, a manual search for relevant articles was also conducted using Google Scholar and ancestral searches through the reference lists of articles included in the final review.
The search strategy included combinations of 3 key blocks of terms burnout; physicians and nurses; interventions using medical subject headings MESH terms and text words. Consultation has been conducted between the project team and information specialists before finalizing the search strategy see Additional file 1.
Search results were exported from Endnote X7 and duplicates were removed. Study selection was completed in 2 stages. Titles and abstracts of the studies were screened and subsequently full texts of the selected studies were accessed and further screened against the eligibility criteria. The title and abstract screening were undertaken by XJ. Z and YQ. Two reviewers independently selected and evaluated, and any disagreements were resolved through a larger team discussion.
Four domains in phase 2 are study eligibility criteria, identification and selection of studies, data collection and study appraisal, and synthesis and findings. The results of each domain and phase 3 were rated as high risk, low risk, or unclear risk.
A high score may disguise critical weaknesses in specific domains, such as an inadequate literature search or a failure to assess RoB within individual studies that were included in a systematic review. In making an overall rating of systematic review, it is important to take account of flaws in critical domains, which may greatly weaken the confidence that can be placed in a systematic review.
On the other hand, literature of different design types cannot be quantitatively synthesized. Therefore, a qualitative synthesis of the included studies was conducted instead. Literature search results and data extraction results were summarized descriptively. A summary of efficacy outcomes was presented based on the different outcome measures, controls and interventions.
A narrative synthesis was therefore generated considering the total number of SRs that reported results, the methodological quality of SRs and RCTs, and the quality of evidence for the outcomes to yield final conclusions.
Ethics approval is not required in overview of SRs and meta-analyses. The search strategy yielded potential studies. The search period of included research was from the inception to The Follow-up time ranged from 0 to 7 years. The first domain aims to assess whether primary study eligibility criteria were prespecified, clear, and appropriate to the review question.
The second domain aims to assess whether any primary studies that would have met the inclusion criteria were not included in the review. The third domain aims to assess whether bias may have been introduced through the data collection or risk of bias assessment processes. The fourth domain aimed to assess whether the data was combined from the included primary studies. Only 8 studies rated low risk of bias. The final phase considers whether the systematic review as a whole is at risk of bias, 14 studies were rated high risk and 8 were low.
As a whole, the methodological quality and quality of included studies was from moderate to high. There were three types of interventions: individual-focused, structural or organizational, and combine interventions. Emotion regulation was an important psychological variable, which associated with burnout. Combine individual-focused and structural or organizational interventions included Snoezelen, [ 21 ] stress management and resiliency training, [ 34 ] stress management workshops [ 18 , 20 ] and improving interaction with colleagues through personal training.
The purpose of this study was to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses. According to ROBIS, 12 research were in low risk in domain 1, 8 in domain 2, 17 in domain 3, and 8 in phase 3. By using AMSTAR 2 to assess the methodological quality and quality of included research, most of those were considered as relatively good quality. Burnout of physicians and nurses has become a global public health problem. This overview analyzed the contents of 22 papers with results that physician-directed interventions are associated with small reductions in symptoms of common mental health disorders among physicians.
Organizational interventions that ignore individual factors cannot really reducing burnout of physicians and nurses.
Therefore, based on theories and studies, when physicians and nurses face stressors caused by work, they will make different coping strategies.
Emotional intelligence theory suggests that emotion regulation skills facilitate the maintenance of appropriate emotions, reducing or adapting undesirable emotions in oneself and others. If positive intervention strategies can be adopted to enhance resilience, the incidence of burnout of physicians and nurses is greatly reduced and the wellness improved Fig.
This research included studies in different settings, which brought to light the range of interventions, which could provide the direction for further research. The current overview clarified evidence to reduce burnout of physicians and nurses, which provide a basis for health policy makers or clinical managers to design simple and feasible strategies to reduce the burnout of physicians and nurses, and to ensure clinical safety.
Considering partial databases selected and gray literature not included, the results are used only as an overview of the field. This overview has included 22 systematic reviews and meta-analyses to summarize the relevant studies of interventions to reduce the burnout of physicians and nurses and form an evidence resource, which provides reliable evidence support for further intervention.
It is an urgent need to implement and evaluate the long-term effect of bundle strategy. All authors read and approved the final manuscript. Interventions to reduce burnout of physicians and nurses: an overview of systematic reviews and meta-analyses. This study is supported by Basic Research Project of Higher Learning Institution in Liaoning Province Code: LQ , which provided financial support during data analysis and manuscript preparation.
Data availability statement No additional data available. Patient and Public Involvement None. The authors have no conflicts of interest to disclose. Medicine Baltimore. Published online Jun Find articles by Tongtong Jiang. Author information Article notes Copyright and License information Disclaimer. Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.
The work cannot be used commercially without permission from the journal. This article has been cited by other articles in PMC. Abstract Objective: Numerous systematic reviews and meta-analyses on the interventions to reduce burnout of physicians and nurses have been published nowadays. Results: A total of 22 studies published from to were eligible for analysis. Conclusions: Burnout is a complicated problem and should be dealt with by using bundled strategy. Keywords: burnout, meta-analyses, nurses, overview, physicians, systematic reviews.
Introduction Burnout refers to a prolonged response to chronic emotional and interpersonal stressors caused by work, manifested as emotional exhaustion, depersonalization, and reduced personal accomplishment. Table 1 Inclusion and exclusion criteria. Open in a separate window.
Study Selection Search results were exported from Endnote X7 and duplicates were removed. Data Extraction A data extraction spreadsheet was developed and initially piloted in 3 randomly selected studies. Ethics Ethics approval is not required in overview of SRs and meta-analyses.
Results The search strategy yielded potential studies. Figure 1. Discussion 4. Summary of main findings The purpose of this study was to summarize the evidence and clarify a bundled strategy to reduce burnout of physicians and nurses.
Implication for future study Burnout of physicians and nurses has become a global public health problem. Figure 2. The path of bundle strategy to reduce burnout of physicians and nurses. Strength and limitations This research included studies in different settings, which brought to light the range of interventions, which could provide the direction for further research.
Conclusion This overview has included 22 systematic reviews and meta-analyses to summarize the relevant studies of interventions to reduce the burnout of physicians and nurses and form an evidence resource, which provides reliable evidence support for further intervention.
Following the search of databases of peer-reviewed journal articles, the titles and abstracts of the search results from peer-reviewed papers were exported into Endnote [ 23 ] where duplicates and irrelevant titles were removed. The peer-reviewed journal articles found through contact with experts were added to this.
The titles and abstracts were double screened by EB and LL against the inclusion and exclusion criteria. Once the abstracts were screened, the full papers or reports of the included abstracts were obtained and assessed for eligibility by both reviewers. Following the grey literature search as described above, all potentially relevant results were saved into Evernote [ 24 ].
These were double screened by both reviewers against the inclusion and exclusion criteria. The data from the papers were extracted by the first author EB onto a data extraction form. This included information on authors, publication dates, the type of interventions and outcomes, the development of ToC, the use of ToC in the design, implementation and evaluation of the intervention and the influence of context. The data collection form also included key principles of theory-driven evaluation proposed by Coryn et al.
These included how the programme theory was a formulated, b used to formulate and prioritise evaluation questions, c plan and conduct evaluations, d inform the measurement of constructs in the programme theory and e provide a causal explanation. Where a paper described or showed a ToC, we assessed what elements of ToC they presented.
However, as there is no agreed upon assessment of quality for papers reporting ToC, we did not asses the quality of the included papers. We did not contact authors for additional information. The papers were compared, evaluated and summarised narratively in relation to review questions. Due to the heterogeneity of the study designs, interventions and outcomes included in this review, a meta-analysis was not conducted.
In total, abstracts were screened, resulting in full text peer-reviewed articles which were assessed for eligibility. An additional 65 records were identified from the grey literature search and screened for eligibility.
A total of 62 papers were included [ 1 , 12 — 14 , 16 , 26 — 82 ]. The publication dates of the papers range between and , with a steady increase in papers over time Fig. The majority were published in English in peer-reviewed journals, but we also included PhD theses, presentations and NGO reports from the grey literature. More details are provided in Table 2. Four pairs of papers are reported on the same public health interventions [ 1 , 13 , 42 , 43 , 54 , 60 , 81 , 82 ].
However, as the primary interest of this paper is how the use of ToC is described in reports and peer-reviewed journal articles, we have included them as separate papers. A variety of types of public health interventions reported using ToC in the design, development and evaluation of public health interventions Table 3. These included systems of care for adolescents with behavioural and emotional difficulties [ 12 , 26 , 50 , 53 , 54 , 56 , 61 , 65 , 80 — 82 ], substance use interventions [ 27 , 49 ], domestic violence interventions [ 29 ], comprehensive community initiatives [ 13 , 16 , 35 , 62 , 81 ], medication supply among community health workers [ 40 ] and integrated district level mental healthcare plans in low- and middle-income countries [ 55 ].
The ToCs were developed using workshops [ 28 , 34 , 47 , 48 , 55 , 63 , 64 , 72 , 76 ] and working groups [ 12 , 53 , 54 , 61 , 68 , 69 , 82 ], document reviews [ 16 , 35 , 44 , 56 , 67 , 71 ], interviews and discussions [ 16 , 27 , 29 , 35 , 40 , 44 , 47 , 56 , 57 , 62 , 65 , 66 , 73 , 80 ], surveys [ 31 , 67 ], programme observation [ 16 , 44 , 45 , 56 , 67 ], literature reviews [ 33 , 40 , 68 , 69 , 80 ] and existing conceptual frameworks or theory [ 33 , 40 , 42 — 44 , 51 , 64 , 68 , 69 ].
The ToC development included consultations or interviews with the following stakeholders: programme staff [ 27 , 38 , 40 , 44 , 45 , 52 , 54 , 57 , 63 , 65 — 67 , 72 , 73 , 82 ], management [ 12 , 57 , 61 , 66 , 70 , 77 , 82 ], families [ 12 , 26 , 54 , 65 , 77 , 82 ], service users [ 39 , 47 , 50 , 61 , 65 ], experts [ 40 , 64 ] and evaluators [ 13 , 14 , 38 , 44 , 52 , 58 , 61 , 70 , 75 , 77 , 81 ]. Many used multiple methods, for example, Mookheriji and Lafond used immunisation programme theory and discussion with programme stakeholders, including immunisation experts, to develop a ToC of routine immunisation performance [ 64 ].
They used a case study approach to evaluate immunisation performance and then refined the ToC based on the results of this evaluation and a stakeholder workshop. In one case, a table was used. Table 4 outlines the components of the ToCs that were described. Almost all of the ToCs outlined the long-term outcome required, and the majority described the process or sequence of change. However, assumptions and indicators were displayed or described infrequently.
The majority of these reported that they used the ToC as a framework for the intervention [ 12 , 31 , 42 , 43 , 70 ] or as a basis for a strategic plan [ 61 , 68 , 69 , 76 , 82 ]. Some examples of how ToCs were used to design public health interventions follow. Basson et al. Lund et al. A few presentations and papers reporting the development of systems of care for children with behavioural difficulties used the ToC as an outline of their public health intervention and as a basis for their strategic plan [ 12 , 61 , 65 ].
Chandani et al. This includes the development of indicators, the overall evaluation design and data analysis. The development of indicators used in the ToC was described in 28 papers. The indicators were often developed from the short-, medium- or long-term outcomes described in the ToC [ 27 , 35 , 38 , 58 , 65 , 74 , 81 , 84 ]. Thirty-two Only two papers [ 12 , 82 ] explicitly described the use of ToC to identify indicators for ongoing monitoring of the implementation of the intervention.
The majority of papers However, the papers varied in the amount of detail they provided on this process. A common description was that the ToC was used to provide a framework for the evaluation [ 27 , 32 , 33 , 48 , 64 , 72 , 74 , 78 , 79 , 81 , 82 ].
Others reported that they used the evaluation to develop [ 39 ], refine [ 40 ] or validate the ToC [ 64 ]. Two papers reported that their evaluation was guided by testing the assumptions in the ToC [ 29 , 34 ]. The data collection and analysis methods used varied greatly across papers. Data collected for the evaluation included routinely collected data [ 33 , 44 ], custom-designed surveys [ 13 , 16 , 32 , 72 , 76 , 79 ] and qualitative data. Qualitative data collection methods included interviews [ 13 , 27 , 35 , 47 , 71 , 73 , 75 , 79 ], programme observation [ 13 , 27 , 35 ], programme documentation [ 13 , 35 , 71 , 75 , 79 ] and visual evidence [ 32 ].
The quantitative data analysis methods were strongly linked to the types of data collected and included descriptive statistics [ 33 ], inferential statistics [ 27 , 40 , 42 , 43 , 74 , 78 ], multilevel modelling [ 16 ] and path analysis [ 41 ].
Other methods included case study approaches [ 16 , 33 , 36 , 64 ] and iterative thematic analysis [ 71 ] whereas others did not explicitly state their specific data analysis approach [ 14 , 77 ]. Few papers explicitly explored the influence of context of the intervention in relation to ToC. Although some ToCs mentioned context, particularly those with a realist evaluation focus, there was little description of how context affected the interpretation of the evaluation.
There were some exceptions [ 40 , 56 , 64 , 72 ]. Mookherji and LaFond used a case study approach to explore what worked within and between immunisation programme contexts to identify common factors influencing immunisation performance in Ghana, Ethiopia and Cameroon [ 64 ].
For example, political and social commitment to routine immunisation was seen as a key factor in influencing immunisation performance although it was described slightly differently for each context.
Similarly, Chandani et al. They compared whether each of the preconditions and the outcome was achieved in each setting [ 40 ]. These differences were then explained based on the contextual factors in each setting such as types of medication provided by the health workers, standard operating procedures and data availability and means of transport and travel times.
Secker et al. Few papers reported on the identification of breakdowns and side effects, effectiveness or efficacy and causal explanation as described by Coryn et al. Only four 6. In this systematic review, we provide an overview of how ToCs have been developed and used to develop and evaluate public health interventions. As expected, there is variation in how ToCs are developed and used in evaluation although the papers report very little detail about the ToC process.
We have shown that the ToC approach has been in use since at least with 62 papers found in peer-reviewed journals and grey literature. This was significantly more than expected, given that Coryn et al. However, Coryn et al. In this review, many papers provided little detail in relation to the process of ToC development and how the ToC was used to design the intervention or conduct the evaluation.
For example, Bonner [ 36 ] describes the ToC approach in detail but provides only a short example of the Health Action Zones experience of using ToC to evaluate an intervention to reduce drug taking. Brown et al. The only description of ToC was found in the abstract and then mentioned briefly in the discussion. There was no clarity on how the ToC was developed or any explicit mention of how it was used to inform the analysis.
In contrast, other papers provided extensive detail on the ToC development process. For example, Hernandez and Hodges [ 12 ] describe the 12 step process used to develop a ToC for interagency delivery of mental health services for children with serious emotional disturbances and their families. They describe each step in detail including the purpose of the stage of the process, the types of stakeholders participating in the step, the substance of the discussions and the decisions reached.
The ToC was then displayed as a logic model for readers to gain a better understanding of the output of the process. Similarly, Mookherji and LaFond [ 64 ] described in detail their approach to developing their initial ToC and how the ToC was used to determine case selection for a comparative case study. They then described how they used the results of the comparative case study and the ToC workshops to refine their ToC. A range of methods were used to develop ToCs.
The methods ranged from participatory methods which encourage stakeholder participation and ownership of the ToC such as workshops and working groups, to more evaluator focused approaches such as programme observation and review of programme documentation.
Although the reason for the choice of methods was rarely made explicit by the authors, these methods were presumably chosen based on the purpose, depth and level of stakeholder buy-in the ToC required. For example, the examples of the development of systems of care for children and adolescents with mental and behavioural disorders viewed stakeholder participation as very important and therefore held a series of workshops with multiple stakeholders from different government departments, service providers, families and service users [ 12 , 50 , 61 ].
In some cases, although stakeholders were interviewed or participated in surveys, they did not contribute explicitly to the development of the ToC [ 16 , 57 ]. Sullivan and Stewart [ 10 ] argue that although participation of all stakeholders in the development of ToC is the ideal presented by Weiss and colleagues [ 7 ], this is not always practical or feasible.
They argue that different types of ToC development and resulting ownership may have advantages and therefore it is important to be explicit about the development process. The lack of detail in most of the examples in this review makes it difficult to assess the thoroughness of ToC development. In many cases, the ToC seems to have been developed superficially and then used in a cursory way during evaluation. Similarly, where diagrams or narrative summaries of ToCs are presented in the papers, very little detail is included.
Most authors present the long-term outcomes, sequence of change, beneficiaries and context. However, very few make their assumptions explicit although Vogel identifies these as a core part of ToC [ 8 ]. Where ToC was used to develop the interventions, it was often not clear how this was done apart from providing an overarching framework or strategic plan for the intervention.
Given the popularity of ToC as a monitoring and evaluation tool by international development agencies such as the Department for International Development, UK, [ 8 ], we had expected that more papers would use ToC during the implementation phase to assess progress towards the outcomes as well as modify implementation where necessary.
ToC theorists such as Connell and Kubisch [ 15 ] emphasise that the ToC approach to evaluation is method neutral and, as such, does not prescribe a specific type of study design or evaluation method. This was reflected in the papers included in this review which used a variety of qualitative and quantitative data collection and analysis methods.
This flexibility in methods can be an advantage if researchers can design evaluations which seek to understand and evaluate both the outcomes and causal mechanisms which are made explicit in the ToC.
However, flexibility in methods may also result in evaluations being poorly formulated in terms of the appropriateness of the methods, the rigor of data analysis or the results not interpreted in light of the ToC. In this review, evaluations were often described in detail but it was not clear how they linked to the ToC or how the ToC was used to interpret the results. However, some authors clearly develop or refine their ToCs as the results of the evaluation emerge.
For example, Carroll et al. Most papers failed to explicitly discuss the results of the ToC in relation to unexpected outcomes, direction of causation and mediation of effects. This is similar to the conclusions drawn by Coryn et al. It is interesting to note that no studies used ToC alongside RCTs as a method to unpack the programme theory underpinning the intervention. As we have noted previously, ToC holds much potential for this as RCTs alone are no longer considered adequate for the evaluation of complex health interventions [ 3 ].
Detailed reporting of the ToC process is particularly important as definitions of ToC differ considerably [ 8 ]. Many papers did not define ToC. However, there were clear overlaps with other theory-driven evaluation approaches, in particular, realist approaches [ 32 , 36 , 38 , 56 ] and logic models [ 12 , 26 , 31 , 52 , 54 , 61 , 65 , 66 , 68 , 69 , 76 , 82 ]. Realist approaches have a different theoretical basis to ToC and differ in several ways including how they articulate and generate theory, the degree to which stakeholders are involved and the types of knowledge they seek to generate [ 20 ].
Marchal et al. Logic models are conceptually similar to ToC but are usually presented in a linear form with boxes for inputs, activities, outputs and outcomes with little explanation of the causal pathways linking them [ 3 ]. Reducing a ToC to a logic model may conceal some of the explanatory power of the causal pathways.
Two limitations to this review are the lack of double data extraction and the inability to effectively measure the quality of the included papers. We did extract data on a checklist of ToC components proposed by Vogel [ 8 ] and principles of theory-driven evaluation by Coryn et al. This is primarily because there is no agreed upon quality criteria for ToC. This is compounded by the flexibility of the ToC approach, both in the development of ToCs and how they can be used for evaluation.
Because evaluations using ToC vary in study design and method, existing methodological checklists are of little use for comparative purposes. We suggest that authors planning to report on ToC to guide the development or evaluation of public health interventions provide more detail on the ToC process to readers. In particular, it is important to make the ToC used explicit and this is usually easier in diagrammatic form.
Complex ToCs can be simplified in a summary diagram with detailed ToCs provided as web appendices. In addition, it is imperative that authors describe in detail how the ToC was developed and used. This is particularly important as there is no single way to develop or use a ToC. Making the process explicit helps readers judge the credibility of the ToC and strengthen the literature in this field. We have therefore developed a checklist based on this review and the work of Coryn et al.
The checklist gives guidance as to which aspects of the ToC should be made explicit Table 5. It covers five domains, namely the 1 definition of ToC; 2 description of the ToC development process; 3 ToC diagram; 4 process of intervention development and 5 use of ToC in evaluation. The checklist would benefit from expert review and piloting in the real world. However, it provides a starting point for authors reporting a ToC approach.
The ToC approach is widespread in the public health literature. Clear reporting of the ToC process and outputs is important to improve to allow the readers a thorough understanding of the work and allows them to judge the validity of the approach.
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The new PMC design is here! Learn more about navigating our updated article layout. The PMC legacy view will also be available for a limited time. Federal government websites often end in. The site is secure. The pandemic of coronavirus disease COVID and lockdown measures, that were implemented in many countries in order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide.
In this study we aimed to investigate the impact of the first COVID lockdown period March—May on snacking behavior, fast-food and alcohol consumption. Changes in snacking, in abbreviatiobs and ordered food consumption and in alcohol intake were examined.
Snacking was found to be increased for a significant portion of the population examined As per alcohol endnote x7 journal abbreviations free, an upward trend was observed in a significant part endhote The increased snacking and alcohol consumption observed for almost a third of the examined population could be alarming because long-term health problems could arise in cases of repeated lockdowns in the future.
The observed downward trend in fast-food consumption and in frequency of ordered food could be an encouraging sign of turning to home-prepared foods, but further research is needed in this field. In order to combat the pandemic, many governments enforced preventive measures of self-isolation and nationwide lockdowns of endnote x7 journal abbreviations free degrees, so as by April more than a endnote x7 journal abbreviations free of the global population was under lockdown [ x77 ].
Such sudden changes in people's life can have a negative impact both on abbreviaitons mental health and their lifestyle behaviors, such as alcohol consumption [ 3 ] and dietary habits [ 4 ]. During the first COVID lockdown a high prevalence of sleep disorders was reported [ 67 ], which could also be linked to endnote x7 journal abbreviations free dietary patterns [ 8 ].
Overeating is directly related to an increased risk of developing obesity [ 9 ] and subsequently the risk for cardiovascular diseases CVD [ 10 ] and type-2 diabetes mellitus T2DM [ 11 ] is increased. Undoubtedly, there ejdnote inadequate information about related changes in eating behaviors продолжение здесь well as alcohol consumption during this global health crisis, although several studies have been conducted at national level.
This systematic review aims to investigate changes in abbreviation dietary habits snacking, fast-foods, ordered food and alcohol consumption during the COVID lockdown period compared to pre lockdown time. Total records identified through database searching were and were added in a reference database. After removal of journzl studies were screened independently by two reviewers DB and MC.
Any disagreements regarding selection of the included studies and data endnote x7 journal abbreviations free were solved by consensus. Studies not in English language were also excluded.
The quality of the eligible studies was assessed using the modified Newcastle Ottawa Scale NOS for cross-sectional studies Supplementary Table 2 [ 14 ]. Due to the fact that this is a rapid systematic review as COVID abbreeviations an emerging, rapidly evolving situation, a protocol for this systematic review was not written. Data extraction of the included studies endnote x7 journal abbreviations free independently conducted by two reviewers DB and MC using a previous standardized excel form.
All disagreement were solved by consensus. Data extracted from each study were country origin, sex and number of participants, period and type of the survey. Moreover, we examined dietary changes and we extracted information regarding changes in snacking habit, fast-food and ordered food as well as alcohol consumption.
Endnote x7 journal abbreviations free referred to dietary and alcohol endnote x7 journal abbreviations free were presented as percentages. Statistical significance of each study's results was stated by p-values adobe captivate 2017 publish settings free download this data was available. The process for the studies selection is presented as a flow diagram in Fig. A total of studies were identified through databases and reference searching and after removal of duplicates, studies were screened.
Hence, 32 studies [ [15][16][17][18][19][20][21]endnote x7 journal abbreviations free[23][24][25][26][27][28] endnote x7 journal abbreviations free, [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]joyrnal[46] ] all cross-sectional were included in this systematic review.
Characteristics of the 32 cross-sectional included studies can be found in Table 1. Several studies had examined changes in snacking behavior during the period endnote x7 journal abbreviations free lockdown [ 2224[28][29][30]32343738 ] and the results are shown in Table 2.
In these studies abbeeviations Regarding the subjects who reported changes in snacking a tendency towards increase can be observed [ 22242934 ]. Changes in fast-food consumption were reported in eight studies [ 1920242528343546 ] and changes in ordered food were examined in three studies abbreviafions 151823 ], whereas relevant results are summarized in Table 3Table 4 respectively.
In endnote x7 journal abbreviations free where consumption of fast food had changed during the lockdown restrictions, a ednnote trend was identified [ 1920242528343546 ].
Regarding the frequency of food ordering and having food delivered at home, results varied as can be seen in Table 4with two studies showing a decline [ 1518 ], and one showing an increase [ 23 ] see Table 5.
Changes in alcohol consumption during the lockdown period were reported in 23 cross-sectional studies [ 1617212324[26][27][28][29]31[33][34][35][36][38][39][40][41][42][43][44][45]abbrevistions ].
Results showed that in 17 out of those 23 studies, alcohol consumption remained unchanged during the lockdown for the majority of participants [ journak2123abbeeviations[26][27][28]333536[38][39][40][41]434446 ]. However, a tendency towards increased alcohol consumption has been be observed for the rest of their examined participants A decline in alcohol consumption for the majority of participants during the lockdown period was reported in four studies [ 16abbreviatilns3445 ] and an increase of alcohol consumption was reported for the majority of the survey participants in two studies [ 2942 ].
According to our knowledge, this is the first systematic review which aim was to frwe changes in snacking behavior including both sweet and salty snacksfast-food, food ordering endnote x7 journal abbreviations free, frer alcohol consumption. The results of our study regarding snacking showed abbrwviations although for the majority of the population examined Autodesk revit mep 2016 tutorial pdf free download in snacking behavior could be seen even within the same country.
In particular, in a study lead by Pellegrini including only obese participants, This could imply that for obese people, it was more difficult to control their snacking consumption during the lockdown period. Moreover, according Leech et al. In addition, with respect to COVID disease, due to the fact that a vaccine is not yet available for everyone, a balanced in macro- and micronutrients nutrition could endnote x7 journal abbreviations free a method of prevention and management of the disease [ 54 ].
Therefore, these subjects could be at risk of becoming symptomatic COVID patients compare to those following a balanced diet [ 55 ]. Our results regarding fast food habit showed a significant decrease in fast-food consumption during the lockdown period [ 192024252834abbreviatjons ].
Only, in one study conducted in Canada, Similar results emerged after examination of the frequency of ordered food Table 4. Only in the abrbeviations from New Zealand an increased trend was observed [ 23 ]. Provided that fast food consumption as well as frequency of ordered food tended to decrease, a possible explanation could be that the long time staying at home during lockdown made people to spend more time in cooking and preparing homemade food, as has already be found in some studies [ 244056 ].
Another explanation could be the fear of transmission of COVID disease via packets of food abbrevviations delivery services, but further research is needed in this field. Our results with respect to alcohol during the lockdown period showed that for the majority of the population examined the consumption remained stable [ 17212324[26] как сообщается здесь, [27][28]333536[38][39] endnoge, [40]abbrveiations434446 ].
However, a significant portion of the population examined increased its alcohol consumption during the confinement time [ 17232426272935[38][39][40][41][42][43][44]46 ]. Heterogeneity in results regarding alcohol consumption can be observed even in the same country. Results from China varied, where in Sun et al. However, in both studies the sample abbeviations not representative of the country's population.
Moreover, the period of survey journa these studies was different 24—31 March in Sun et abbrfviations. An explanation of the fact that abbreviationw results emerged could be that in the beginning of the lockdown the anxiety and the fear of this unknown situation as well enddnote the sudden endnote x7 journal abbreviations free of daily life made people more prone to alcohol consumption compared to the end of lockdown.
Similar assumptions were also made about results from France [ 3536 ] and Australia [ 4143 ], where a tendency towards journnal in alcohol consumption at the end of the lockdown endnote x7 journal abbreviations free comparison to the beginning was observed.
Results from USA were also differed between fndnote studies [ 17fee39 ]. In Avery et al. The same pattern was also observed in polish population where Therefore, the population in USA and Poland, in contrast to Chinese, French and Australian population, found to consume more alcohol in the end johrnal to the beginning of the lockdown. Data regarding the period of the survey conduction was not available in Ingram et al. However, in Ingram et al. In endnote x7 journal abbreviations free to cope with this, a significant abbreviatiojs of the population relapsed to previous abuse as reported by Zhao et al.
Nevertheless, subjects who often consume alcohol are not only more prone to viral and bacterial infections including COVID due to their impaired immune system [ 58emdnote ], to CVD in heavy drinking occasions [ 60 ], liver [ 61 ], and pancreas diseases [ 62 ], but they joufnal affect the quality of life of people living around them endntoe.
However, according to a recent systematic review the evidence is not enough regarding domestic violence and alcohol abuse during COVID [ 64 ], but awareness of reliability of this data is always needed [ 65 ]. Among the strengths of our study is the number of studies included as well as the fact that a significant geographical part of the world was covered.
Moreover, this is endnote x7 journal abbreviations free first systematic review examining changes in eating patterns snacking, frree, and ordered food as well as in alcohol consumption. In addition, all studies included in this review were assessed according to endnote x7 journal abbreviations free Newcastle—Ottawa Scale Suppl. Limitations of our studies include the fact that the sample of some studies was not representative for the population of each country and this could affect the accuracy of our results.
Moreover, p-values were not reported in abbreviiations our included studies, therefore not allowing us to provide information on the statistical juornal endnote x7 journal abbreviations free related results.
Lastly, in this systematic review studies only in English language were included and therefore related studies published in other endnote x7 journal abbreviations free might have been missed. During the period of lockdown due to the COVID pandemic, changes in lifestyle behaviors johrnal observed for a significant percentage of the global population.
A endnote x7 journal abbreviations free towards increased in snacking as well as in alcohol consumption should not be disregarded because long-term problems could be arising especially in cases journaal repeated lockdowns in future. The observed decrease in fast-food consumption and in frequency of ordered food demonstrate an encouraging turn to home-made foods.
However, provision and campaigns regarding nutritional information could be useful in order to combat with this pandemic. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Endnote x7 journal abbreviations free, and MC revised the manuscript.
All authors have read and approved the final version of manuscript. Clin Nutr. Vpn for pc free Rafailia Bakaloudi endjote, a Dhanushya T. Dhanushya T. Author information Article notes Copyright and License information Disclaimer. Received Jan 22; Accepted Apr All rights reserved. Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded abbreviatkons, such as the WHO COVID нажмите чтобы прочитать больше with rights for feee research re-use and analyses in jlurnal form or by any means with acknowledgement of the original source.
This article has been cited by other articles in PMC. Associated Data Supplementary Materials Multimedia component 1. Abstract The pandemic of coronavirus disease COVID and lockdown measures, that were implemented in many countries 2018 computer requirements free download order to control the virus transmission, had negatively influenced the lifestyle of millions of people worldwide.
Results 3.
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