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PubMed1978

Workload and fatigue--in-flight EEG changes.

Continuous recordings were made of the EEG and ECG of one pilot during a series of instrument flights in a feeder-type transport aircraft. The flights were arranged to contain epochs of distinctly differing levels of workload. In addition, some flights were made after a night of sleep deprivation and others were made as the second and third flights of the day. Subjectively, there appeared to be marked differences in performance between the two types of tired flight. The EEG analyses showed changes that correlated well with differences in workload. In the highest workload areas during fresh flights, EEG activity increased by approximately a factor of 4 over that of the preflight resting values. This large increase did not occur in the tired flights. Further experiments are planned using flights in aircraft and in simulators using several subjects.

Aerospace Medicine↗
PubMed1994

[Methodologic aspects of modern, computerized ergospirometry (CPX): ramp program, constant workload test and CO2 rebreathing method].

The cardiopulmonary exercise testing (CPX) is a non-invasive method for the evaluation of the cardiopulmonary exercise capacity. Based upon the recent technical progress in gas analysers and personal computers today it is possible to perform CPX with acceptable time consumption, high practicability and high reproducibility of the results in many clinical areas. CPX is realized on a bike or on a treadmill. In bicycle CPX a ramp program (increase of x watts per minute) or a constant workload test (p.e. with 75% of the watts at anaerobic threshold) are performed. Furthermore, an estimation of the cardiac output using CO2-rebreathing method can be realized during a ramp program or a constant workload test. In this paper, also the CPX parameters of the ramp program, the constant workload test and the CO2-rebreathing method are defined and explained. The normal values of CPX are dependent of age, sex, body weight and exercise program. This should be kept in mind in interpreting the measured CPX data. Additionally, the performance of a routine CPX will be reported. Furthermore, the accuracy of the CPX parameters and the potential influences on the data will be discussed. Finally, problems during measurements and their analysis will be clarified.

Carbon Dioxide↗
PubMed1997

[Study of workload and cervicobrachial disorder among sign language interpreters].

We conducted a nationwide questionnaire study on the workload and health conditions of professional sign language interpreters to investigate the relationship between occupational cervicobrachial disorders (OCD) and the sign language workload. The number of valid respondents was 542 (92.3%), 85.8% of them females. They were employed by the national or local governments or organizations for the disabled. The complaint rates of subjective symptoms involving the neck, shoulders, arms, fingers, eyes and ears, being equal or higher than the rates reported for cashiers, telephone operators and nursery school teachers when OCD occurred frequently. As the workload of sign language increased, the number of complaints of symptoms in the cervicobrachial region, which also includes fingers, increased as well. Occupational safety and health management for preventing OCD should be carried out immediately for sign language interpreters.

Adult↗
PubMed1998

Levels of sustainable aerobic workload in dialysis patients.

The aerobic performance of a heterogeneous group of 89 ambulatory medically stable patients on chronic hemodialysis was studied to define individual levels of the most acceptable metabolic workload. The patients performed a step test protocol (3 steps) with a cycle ergometer. Each step (25 Watt) lasted 6 min. Heart rate (HR), oxygen consumption (VO2), ventilation (VE), respiratory exchange ratio (RER), blood pressure (BP) and subjective ratings of dyspnea (CRd) and fatigue (CRf) levels were monitored throughout the test. The test was continued to exhaustion or to values of systolic arterial blood pressure (SABP) >240 mmHg, heart rate (HR) > or = 85% max, or ST changes in ECG. In eleven patients (12.5% of the whole group) the test was interrupted within the first two minutes of exercise. In the remaining 78 patients, the maximum workload sustained for at least 3 min (MSW) was 25 Watts for 43 (48.5%), 50 Watts for 27 (30%), and 75 Watts for 8 (9%) patients. Performance was affected in a statistically significant manner by the subjects' anagraphic age, but not by their dialytic age, hemoglobin (Hb) level or weight. Individual levels of tolerable workload were estimated for 60% of the group from the stability of physiological variables during 3 min, and from subjective ratings at a "moderate" level. This level corresponded to an average of 3.5+/-0.9 METs, at 60% of the HRmax, with a mean BP of 167+/-21/98+/-14 mmHg. This could become a safe starting point for a program of physical retraining.

Adult↗
PubMedDate not supplied

Differential workloads of boys and girls in rural Nepal and their association with growth.

In developing countries, heavy workloads of women adversely affect their nutritional status and that of their children. Little is known, however, about the effect of children's heavy workloads on their own well-being. In Nepal, girls are expected to help their mothers in time-consuming and energy-demanding tasks from an early age. The aim of this study was to compare work patterns and anthropometric status of boys and girls age 6-17 years in western rural Nepal. It was hypothesized that girls would work longer and harder than boys and would have poorer growth status. It was also anticipated that children's work patterns might differ between highland and lowland areas. Two study sites were therefore chosen: one in the hills and the other in the lowland terai. A time allocation study was conducted for 237 children. They were observed continuously from 7:00 AM to 7:00 PM to determine the time spent in light, moderate, and heavy activities. Body weights and heights were also measured. On average, girls worked twice as long as boys (5.8 vs. 2.8 h/day, P < 0.001) and undertook more heavy work (1.5 vs. 0.7 h/day, (P < 0.001), but they did not have poorer anthropometric status. Children in the hills worked longer hours and did heavier work than those in the terai and were more stunted in growth.

Adolescent↗
PubMed1996

General surgery with a special interest in vascular surgery: changing patterns of workload.

Prospective surveys of workload were carried out during 1989, 1990 and 1995. Analysis of outpatient referrals, inpatients and operations performed over periods of 3 months was undertaken and the changing patterns of general surgical and vascular surgical workload noted. The number of outpatient referrals rose throughout the study period because of a significant increase in the number of patients with both varicose veins and other vascular problems. There was an increase in the number of emergency admissions for vascular disease. The number of patients having general surgical operations fell; there was a corresponding increase in the number for arterial and venous disease. The general surgical component of a general surgical unit with a vascular interest is gradually declining, as increased numbers of patients with vascular problems are being referred and managed.

Ambulatory Surgical Procedures↗
PubMed2005

Implications of screening for abdominal aortic aneurysms on surgical workload.

BACKGROUND: The Multicentre Aneurysm Screening Study (MASS) provided strong evidence for both the clinical benefit and the cost-effectiveness of a screening programme for abdominal aortic aneurysms (AAAs) in men. If a national screening programme for AAA were adopted in the UK, it would be expected to increase the elective and decrease the emergency surgical workload. METHODS: The MASS trial randomized 67,800 men aged 65-74 years to be invited to attend for ultrasonographic screening for AAA or to a control group that received no invitation. Predictions of elective and emergency surgical workload were made for a 20-year interval after the introduction of a screening programme for 65-year-old men, based on surgical rates observed in the MASS trial and national mortality statistics. RESULTS: For a district general hospital serving a population of 400,000, there was an estimated reduction from nine emergency operations per year before introduction of the screening programme to three emergency operations annually in men aged 65 years and over by the end of the 20-year interval, and an increase from 24 to 43 AAA operations overall. The corresponding estimated annual costs for all AAA surgery increased by 47 per cent, from pound 209,000 to pound 308,000. These results were not affected by changes in the underlying assumptions. CONCLUSION: The results support the expectation of very few emergency operations, and principally elective operations, being performed following the introduction of a screening programme. For a typical district general hospital, a screening programme would be expected to lead to two additional elective AAA operations per month, and to save 11 AAA-related deaths per year.

Aged↗
PubMed1991

Time oriented score system (TOSS): a method for direct and quantitative assessment of nursing workload for ICU patients. Italian Multicenter Group of ICU research (GIRTI).

A method for direct quantitation of nurses' workload required by ICU patients is described. Each nursing activity has been timed in 14 different ICUs participating in the multicentre study, and the results averaged. Nursing acts were grouped in different homology lists, complied according to operative similarities. Some lists include general nursing acts, which are common to all patients admitted to ICU, others include acts peculiar to different organ system abnormalities or acts ancillary to the general group, finally one list includes emergency or occasional acts which are not encountered in every patient. The TOSS is a simple and rapid method for ICU nurses' workload assessment, can be computed both at admission and during the stay in ICU, and can provide factual information on the nurse/patient ratio necessary in a specific environment. TOSS validation was conducted with a yearly prospective study collecting 2710 patients. TOSS values varied according to diagnosis, severity of illness (SAPS) and intensity of processes (TISS), and TOSS specificity was demonstrated by the possibility of selecting a wide combination of nurse/patient ratios from 1:4 to 1:1 not possible with TISS.

Adult↗
PubMed2004

Adverse events in a paediatric intensive care unit: relationship to workload, skill mix and staff supervision.

OBJECTIVES: A systems approach proposes that hospital adverse events (AE) represent a failure of the organization rather than the individual, and are more likely when sub-optimal working conditions occur. We analysed AE using a systems approach to (a) investigate the association between AE occurrence and "latent" risk factors, which included temporal, workload, skill mix and supervision issues, and (b) document interactions between clinically related risk factors. DESIGN: Prospective observational study. SETTING: Regional paediatric intensive care unit. MEASUREMENTS AND RESULTS: Data from 730 consecutive nursing shifts over 12 months (816 patient episodes, crude mortality 7.2%) were analysed using logistic regression modelling. Two hundred eighty-four AE occurred during 220 of 730 (30%) shifts. There were 103 unit- and 181 patient-related AE; the latter occurred at a rate of 6.0 per 100 patient days. Factors associated with increased AE included day shift, average patient dependency, number of occupied beds and the presence of multiple, simultaneous management-related issues that compromised the supervisory ability of the nurse in charge. Factors associated with decreased AE included the presence of a senior nurse in charge, a high proportion of the shift filled by rostered permanent staff, and/or senior nurses, the number of admissions and discharges and, surprisingly, the presence of new junior doctors. Interaction effects were demonstrated between patient workload factors (bed occupancy and patient acuity) and also between nursing supervision factors (seniority of the nurse in charge and factors compromising the nurse's supervisory ability). CONCLUSIONS: These findings may provide a framework for strategies to reduce AE occurrence.

Child, Preschool↗
PubMed2004

Winter excess mortality in intensive care in the UK: an analysis of outcome adjusted for patient case mix and unit workload.

OBJECTIVE: To investigate whether mortality in UK intensive care units is higher in winter than in non-winter and to explore the importance of variations in case mix and increased pressure on ICUs. DESIGN AND SETTING: Cohort study in 115 adult, general ICUs in England, Wales and Northern Ireland. PATIENTS AND PARTICIPANTS: 113,389 admissions from 1995 to 2000. MEASUREMENTS AND RESULTS: Hospital mortality following admission to ICU was compared between winter (December-February) and non-winter (March-November). The causes of any observed differences were explored by adjusting for the case mix of admissions and the workload of the ICUs. Crude hospital mortality was higher in winter. After adjusting for case mix using the APACHE II mortality probability this effect was reduced but still significant. When additional factors reflecting case mix and workload were introduced into the model, the overall effect of winter admission was no longer significant. Factors reflecting both the case mix of the individual patient and of the patients in surrounding beds were found to be significantly associated with outcome. After adjustment for other factors, the occupancy of the unit (proportion of beds occupied) was not significantly associated with mortality. CONCLUSIONS: The excess winter mortality observed in UK ICUs can be explained by variation in the case mix of admissions. Unit occupancy was not associated with mortality.

APACHE↗
PubMed2001

Relationships between perceived workload, stress and oxidative DNA damage.

OBJECTIVES: The present study was performed to investigate the relationship between work-related factors, including psychological stress, and the formation of a type of oxidative DNA damage, 8-hydroxydeoxyguanosine (8-OH-dG), in order to examine their possible risk factor for occupational carcinogenesis. METHODS: A total of 54 healthy workers (27 male and 27 female, aged 41.2 +/- 12.5 years) in a company were investigated for 8-OH-dG levels in the peripheral blood leukocytes at the time of a questionnaire survey regarding several factors, such as working hours, workload, fatigue, sleep, psychological stress and the prospect of alleviating it. Subjects were limited to non-smoking and non-drinking workers to exclude the influence of cigarette smoking and alcohol drinking, which have been reported to have associations with the formation of 8-OH-dG. RESULTS: The levels of 8-OH-dG in female subjects were significantly related to the perceived workload (F = 5.56, P = 0.010), the perceived psychological stress (F = 6.15, P = 0.007), and the impossibility of alleviating stress (F = 3.82, P = 0.048). No associations were observed in male subjects. CONCLUSIONS: Psychological stress and perceived over-work appear to be related to the pathogenesis of cancer via the formation of 8-OH-dG, particularly in female workers.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed2004

Estimating relative physical workload using heart rate monitoring: a validation by whole-body indirect calorimetry.

Measuring physical workload in occupational medicine is fundamental for risk prevention. An indirect measurement of total and relative energy expenditure (EE) from heart rate (HR) is widely used but it has never been validated. The aim of this study was to validate this HR-estimated energy expenditure (HREEE) method against whole-body indirect calorimetry. Twenty-four-hour HR and EE values were recorded continuously in a calorimetric chambers for 52 adult males and females (19-65 years). An 8-h working period was retained, comprising several exercise sessions on a cycloergometer at intensities up to 65% of the peak rate of oxygen uptake. HREEE was calculated with reference to cardiac reserve. A corrected HREEE (CHREEE) was also calculated with a modification to the lowest value of cardiac reserve. Both values were further compared to established methods: the flex-HR method, and the use of a 3rd order polynomial relationship to estimate total and relative EE. No significant difference was found in total EE when measured in a calorimetric chamber or estimated from CHREEE for the working period. A perfect linear and identity relationship was found between CHREEE and energy reserve values for intensities ranging from 15% to 65%. Relative physical workload can be accurately assessed from HR recordings when expressed in CHREEE between 15% to 65%, and EE can be accurately estimated using the CHREEE method.

Adult↗
PubMed1980

Bioinstrumentation for evaluation of workload in payload specialists: results of ASSESS II.

ASSESS II (Airborne Science/Spacelab Experiments System Simulation) was a cooperative NASA-ESA project which consisted of a detailed simulation of Spacelab operations using the NASA Ames Research Center CV-990 aircraft laboratory. The Medical Experiment reported on in this paper was part of the complex payload consisting of 11 different experiments. Its general purpose was to develop a technology, possibly flown on board of Spacelab, and enabling the assessment of workload through evaluating changes of circadian rhythmicity, sleep disturbances and episodical or cumulative stress. As parameters the following variables were measured: Rectal temperature, ECG, sleep-EEG and -EOG, the urinary excretion of hormones and electrolytes. The results revealed evidence that a Spacelab environment, as simulated in ASSESS II, will lead to internal dissociation of circadian rhythms, to sleep disturbances and to highly stressful working conditions. Altogether these effects will impose considerable workload upon Payload Specialists. It is suggested that an intensive pre-mission system simulation will reduce these impairments to a reasonable degree. The bioinstrumentation applied in this experiment proved to be a practical and reliable tool in assessing the objectives of the study.

Adrenal Cortex Hormones↗
PubMed1994

Nursing summary and experienced workload.

Nursing summary and experienced workload form a new approach to patient documentation. The data used for this documentation are provided by nurses without being subjected to a formal nomenclature. It is important to highlight patient complexity, nursing difficulty and to evaluate workload. The emphasis on these concepts provides data which allow qualitative and quantitative assessment of the patient's entire stay. After a discussion of the philosophical and economic aspects that are the basis of the methodology, this paper focuses on the design and the development of a nursing database.

Forms and Records Control↗
PubMed2004

Heavier workload, less personal control: Impact of delivery on obstetrician/gynecologists' career satisfaction.

OBJECTIVE: Obstetrician/gynecologists' career satisfaction with certain work-related activities was examined among clinicians who perform deliveries and clinicians who do not. STUDY DESIGN: A questionnaire was sent to 1500 member-fellows of the American College of Obstetricians and Gynecologists; 842 members (56%) responded. The questionnaire was designed to distinguish between obstetrician/gynecologists who perform deliveries and clinicians who do not in the areas of satisfaction with specific aspects of career and work-related activities. Data were examined initially by multivariate analysis of variance and subsequently by univariate analysis of variance if the multivariate test was found to be significant. RESULTS: Workload and personal control were the primary factors for which there was a significant difference in satisfaction between clinicians who perform deliveries and clinicians who do not (P<.001). Obstetrician/gynecologists who do not perform deliveries reported working significantly fewer hours per week (P<.001) and had more satisfaction with their work activities than the delivery group overall. Despite lowered satisfaction with certain career aspects among the delivery Group, the highest positive disposition ratings that was given by respondents were for surgery, vaginal delivery, and planned cesarean delivery, with gender differences observed in the level of disposition for these particular activities. The most negative rating was reported for on-call/in-hospital time. CONCLUSION: Although positive disposition is associated with the activity of vaginal and cesarean delivery overall, 2 primary contributing factors of dissatisfaction that were identified among obstetrician/gynecologists who perform deliveries were increased workload and decreased personal control.

Delivery, Obstetric↗
PubMed2005

[Regionalization of obstetric services and anaesthetic workload in a tertiary level perinatal unit].

OBJECTIVE: Evaluation of anaesthetic workload associated with care of high-risk pregnant women (i.e. patients transferred to a referral perinatal center). STUDY DESIGN: A case-control prospective study. METHODS: During a three-month period, 63 women with in-utero transfer and their control counterparts (63 normal pregnancies) were prospectively followed until discharge. RESULTS: At inclusion, high-risk patients (n = 63) were more frequently scored ASA 2 or more (21 vs 0%, p < 0.05). ASA score had increased at delivery in 8% of high-risk women and in none of controls. ICU admission (4 vs none), Caesarean delivery (57 vs 11%), preanaesthetic visit at night (41 vs 0%) and general anaesthesia (27 % versus none) were all more frequent in high-risk parturients (p < 0.05). CONCLUSION: Comparison of the workload associated with high-risk patients and normal pregnant women confirms the need for increased anaesthetic staffing in referral perinatal centers and provides a basis for better understanding the distribution of anaesthetic requirements in each perinatal network.

Adult↗