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PubMed2007

What degree of work overload is likely to cause increased sickness absenteeism among nurses? Evidence from the RAFAELA patient classification system.

AIM: This paper reports a study examining whether nurses' work overload is associated with increased sick leave and quantifying the loss of working days from work overload. BACKGROUND: The RAFAELA patient classification system indicates nursing care intensity in relation to an optimum and is one of the few validated monitoring instruments of patient-associated workload among nurses. However, it is not clear whether work overload is a risk factor for increased sickness absenteeism, an important occupational problem in health care. METHOD: An observational cohort study was carried out with 877 nurses, 31 wards and five Finnish hospitals. Patient-associated workload scores from the RAFAELA system were based on a 6-month monitoring period in 2004. Records of 12-month self certified (1-3 days) and medically certified (>3 days) periods of sick leave in the same year were obtained from employers' registers. FINDINGS: The mean workload was 9% (sd = 8%) above the optimum. There was a linear trend between increasing workload and increasing sick leave (P < or = 0.006). Among nurses with workload > or =30% above the optimum the rate of self certified periods of sick leave was 1.44 (95% CI 1.13-1.83) times higher than among those with an optimum workload. The corresponding rate ratio for medically certified sick leave was 1.49 (1.10-2.03). These excess rates of sickness absence resulted in 12 extra sick leave days per person-year. CONCLUSION: Measuring nurses' workload may be an important part of strategic human resource management of nurses to reduce sick leave among nurses.

Absenteeism↗

PubMed1997

Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

OBJECTIVE: To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. DESIGN: Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. SETTING: Inner city group practice with a socioeconomically diverse population. SUBJECTS: 382 male and female subjects of all ages, with a total of 1296 person years of observation. MAIN OUTCOME MEASURES: Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. RESULTS: Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. CONCLUSIONS: The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

Adolescent↗

PubMed1991

[The role of physical load in the reaction of the circulatory system to professional work].

In order to evaluate the effect of particular elements of physical workload on the heart rate in a group of 148 women working at 18 work-posts whose jobs were characterized by different physical workload, 24-hour cardiograms were made using Holter's method and applying the Medilog 3000 (Oxford). It was observed that heart rate heart rate during work was higher in women who performed jobs demanding dynamic physical effort, and lower in those subjects who performed static work. Heart rate during work was positively correlated with the dynamic effort intensity and negatively--with the intensity of light dynamic work and static workload, which means that particular elements of physical workload are of different physiological importance. Therefore, the synthetic indicator of physical workload cannot be treated as a sum of the intensity of particular elements. Consequences of physical workload lasted during daytime. During sleep and leisure hours the effect of physical workload intensity upon the cardiac contraction frequency is not significant.

Adolescent↗

PubMed1999

Hard work impinges on fitness: an experimental study with zebra finches.

In experiments in which brood size is manipulated, it is impossible to disentangle the effects of changes in intensity and duration of parental care on parental fitness from those of changes in the parental energy budget. To determine whether a change in parental energy budget affects the costs of reproduction, we assessed the effects of increased levels of hopping activity, independent of parental care, on later reproductive decisions in zebra finches, Taeniopygia guttata. We imposed two levels of workload on individual, nonbreeding birds. After the workload periods, the birds were allowed to breed in ad libitum conditions. Each bird went through three alternating periods of working followed by breeding. The birds were more active, but weighed less and ate less, during the high workload than during the low workload periods. Clutch sizes and brood sizes did not vary with the previous work level. However, after a period on the high workload, reproduction, on average, was started 6 days later than after a low workload period. Females gained weight just before egg laying, but this might have been a result of egg production. If so, the delay in reproduction did not simply reflect extra time needed to restore body mass after a period of increased activity. We conclude that the level of daily activity itself, or the resulting energy budget during the workload periods, delayed reproduction. We suggest that these observations on the effects of increased activity demonstrate a causal mechanism for reduced residual fitness of parents. Copyright 1999 The Association for the Study of Animal Behaviour.

Journal Article↗

PubMed1985

Evaluation of mental task strain based on occipital beta activity and subjective rating of task difficulty.

Occipital midline beta-2 (Oz beta 2) amplitudes and subjective ratings of task difficulty were measured in 24 healthy male students, aged 19-23 years, performing four kinds of mental task (transcribing, cancelling, adding, and calculating) at two grades of self-pace (maximum workload and moderate workload) for 5 min each. Significant differences in Oz beta 2 amplitudes were observed between the tasks at either workload, except between the adding task and the calculating task. However no significant difference in the subjective ratings was observed between the tasks at either workload, except between the adding task and the calculating task or the cancelling task at maximum workload. Thus the Oz beta 2 amplitude was more sensitive to differentiation of task strain between the mental tasks, than the subjective rating. In comparison with the critical levels deduced previously, it was estimated from the Oz beta 2 amplitudes that all the tasks at either workload could induce heavy task strain in the subject, except for the cancelling task at moderate workload. From the subjective ratings, however, it was estimated that no task could induce heavy task strain in the subject. It was, moreover, suggested that the Oz beta 2 amplitudes reflected the difference in the quality of cortical functions and that the subjective ratings of task difficulty were associated with time pressure rather than the quality of cortical functions.

Adult↗

PubMed2001

Physical load and psychological demand at work during pregnancy and preterm birth.

OBJECTIVES: To evaluate the effect of physical workload and psychological demand on all preterm births, and to determine whether these risk factors have the same effect on different types of preterm birth (moderate versus very preterm birth) and different modes of delivery onset (spontaneous versus indicated preterm birth). METHODS: A case-control study was carried out in two public general hospitals in the Valencia Region, Spain. All preterm births (228) which occurred between 22 and 36 completed weeks of amenorrhea and 348 controls of 37 or more completed weeks of amenorrhea were included. The information was collected by interviewing women within 2 days of their giving birth. Physical workload, psychological demand, weekly working hours and daily time spent commuting between home and work were used as explanatory variables. A polytomous logistic regression was carried out. RESULTS: Exposure to medium or high level physical workload increases the risk of preterm birth, with an adjusted odds ratio (OR) of 1.59 and 2.31, respectively. The risk of moderate preterm birth was greater in women with a medium or high level of physical workload, OR: 1.73 and 2.35, respectively. The same trend was observed for very preterm birth. Physical workload showed a different effect on spontaneous and indicated preterm birth. The exposure to medium and high level physical workload increases the risk of indicated preterm birth, with an OR of 2.74 and 3.88, respectively. The same trend was seen in the case of spontaneous preterm birth. Psychological demands were not associated with preterm birth. CONCLUSIONS: High physical exertion increases the risk of preterm birth in Spain. The magnitude of the effect of physical workload on moderate and very preterm birth is similar, but is higher on indicated preterm birth than on spontaneous preterm birth. Psychological demands show no effect on the risk of preterm birth.

Child↗

PubMed2003

The use of the [1,2-13C]acetate recovery factor in metabolic research.

To provide guidelines on the correct application of the acetate recovery factor in metabolic research, we investigated the influence of exercise intensity and infusion protocol on [1,2-(13)C]acetate label recovery during exercise. Eight cyclists were studied during [1,2-(13)C]acetate infusion for 1 h at rest followed by three 30-min stages of cycling exercise at a workload of 40, 55 and 75% maximal workload ( W(max)), respectively (protocol 1). Four cyclists were subsequently studied following [1,2-(13)C]acetate infusion in three separate trials while cycling at the same workloads but in the absence of any pre-exercise infusion period (protocol 2). Finally, we observed the cyclists during [1,2-(13)C]acetate infusion at a 40% W(max) workload after 4 h of pre-exercise infusion (protocol 3). Acetate recovery increased from 13.7 (0.4)%, after 1 h of rest, to a plateau value of 75.1 (2), 91.2 (0.7) and 101 (2)% during exercise at 40, 55 and 75% W(max) workloads, respectively. In protocol 2, without prior infusion time, fractional label recovery was substantially lower at each separate workload. In contrast, when applying an extensive pre-exercise infusion period of 4 h, acetate recovery rates were substantially increased compared to the values observed in protocols 1 and 2 during exercise at a 40% W(max) workload. In conclusion, in contrast to resting conditions, acetate recovery reaches a plateau value during exercise. Though this plateau value is repeatedly used to correct for label recovery in various exercise studies, our data clearly show that acetate label recovery during exercise not only depends on the exercise intensity but also on the applied infusion protocol. Therefore, theoretical acetate recovery factors taken from previous literature are not generally applicable.

Acetates↗

PubMed2006

Performance predicting factors in prolonged exhausting exercise of varying intensity.

Several endurance sports, e.g. road cycling, have a varying intensity profile during competition. At present, few laboratory tests take this intensity profile into consideration. Thus, the purpose of this study was to examine the prognostic value of heart rate (HR), lactate (La(-1)), potassium (K(+)), and respiratory exchange ratio (RER) performance at an exhausting cycling exercise with varying intensity. Eight national level cyclists performed two cycle tests each on a cycle ergometer: (1) a incremental test to establish VO(2max), maximum power (W (max)), and lactate threshold (VO(2LT)), and (2) a variable intensity protocol (VIP). Exercise intensity for the VIP was based upon the VO(2max) obtained during the incremental test. The VIP consisted of six high intense (HI) workloads at 90% of VO(2max) for 3 min each, interspersed by five middle intense (MI) workloads at 70% of VO(2max )for 6 min each. VO(2 )and HR were continuously measured throughout the tests. Venous blood samples were taken before, during, and after the test. Increases in HR, La(-), K(+), and RER were observed when workload changed from MI to HI workload (P < 0.05). Potassium and RER decreased after transition from HI to MI workloads (P < 0.05). There was a negative correlation between time to exhaustion and decrease in La(-) concentration during the first MI (r = -0.714; P = 0.047). Furthermore, time to exhaustion correlated with VO(2LT )calculated from the ramp test (r = 0.738; P = 0.037). Our results suggest that the magnitude of decrease of La(-1) between the first HI workload and the consecutive MI workload could predict performance during prolonged exercise with variable intensity.

Adult↗

PubMed1980

Entrainment of breathing rate to movement frequency during work at two intensities.

Ten males and six females exercised on an electrically braked cycle ergometer. Three conditions were tested: preferred pedal frequency with no cues; preferred frequency established by listening to a metronome and preferred frequency maintained by watching a digital display. Each condition was performed at a low workload and a high workload, and this set of tests was repeated once. During each test, computer sampling of pedal and breath information occurred, and the relationship of breath signal occurrences to pedal signals was plotted by a post stimulus histogram program. Fourier analysis of psh data (Time Series Spectrum Estimation) decomposed each histogram into it's frequency components. The magnitude of the frequency at the fundamental of the pedal period (F1), and it's first harmonic (F2), were assessed using F ratios. For retest results, preferred condition, 100% of subjects were entrained for both low and high workloads. With the metronome, 87% were entrained at the low workload and 94% at the high workload. For both workloads, 94% were entrained when watching a digital printout of pedal frequency. For preferred pedal rate, at the two workloads tested, the results of this study strongly support the existence of entrainment, and provide evidence for neurogenic input to ventilatory control during steady state work.

Adult↗

PubMed2000

Effects of simulated altitude-induced hypoxia on exercise capacity in patients with chronic heart failure.

PURPOSE: Patients with stable heart failure often wish to spend time at altitudes above those of their residence. However, it is not known whether they can safely tolerate ascent to high altitudes or what its effects on work capacity may be. SUBJECTS AND METHODS: We studied 14 normal subjects and 38 patients with clinically stable heart failure, 12 of whom had normal workload [peak exercise oxygen consumption (VO(2)) greater than 20 mL/min/kg], 14 of whom had slightly diminished workload (peak VO(2) 20 to 15 mL/min/kg), and 12 of whom had markedly diminished workload (peak VO(2) less than 15 mL/min/kg) at baseline. All performed cardiopulmonary exercise tests with inspired oxygen fractions equal to those at 92, 1,000, 1,500, 2,000, and 3,000 m, and maximum achieved work rates (mean +/- SD) were measured. RESULTS: All subjects completed the trial; no test was interrupted because of arrhythmia, angina, or ischemia. Maximum work rate decreased in parallel with increasing simulated altitude. The percentage decrease was greater for patients with heart failure and was most marked among those with the lowest workload at baseline. Maximum achieved work rate declined by 3% +/- 4% per 1,000 m in normal subjects, by 5% +/- 3% (P <0.01) in patients with heart failure with normal workload, by 5% +/- 4% (P <0.01) in patients with slightly diminished workload, and by 11% +/- 5% (P <0.01 vs normal subjects and vs the other patients with heart failure) in patients with markedly reduced workload. CONCLUSION: Patients with stable heart failure who ascend to higher altitudes should expect to have a reduction in maximum physical activity in proportion to their exercise capacity at sea level.

Aged↗

PubMed1987

Voluntary isocapnic hyperventilation and breathlessness during exercise in normal subjects.

1. Nine normal subjects performed 6 min, constant-workload, exercise tests on a bicycle ergometer at either a 'high workload' or at a 'low workload'. During the first 'high workload' test their spontaneous breathing pattern was recorded on to magnetic tape. During one subsequent 'high workload' test and one 'low workload' test they voluntarily copied their recorded breathing pattern. During a second 'low workload' test they breathed spontaneously. Isocapnia was maintained by the operator throughout both the copying tests. During the exercise tests ventilation was recorded and subjects indicated the level of their sensation of breathlessness every 30 s. 2. Subjects felt markedly less breathless when a proportion of their ventilation was produced by voluntary effort than when the same total level of ventilation was produced entirely by the stimulus of exercise. Furthermore, voluntary isocapnic hyperventilation during exercise did not increase breathlessness above that normally associated with that level of exercise. 3. These results suggest that it is reflexly driven ventilation, and not simply the level of ventilation itself, which relates to the level of breathlessness during exercise.

Adult↗

PubMed2004

Management of acute renal colic in the UK: a questionnaire survey.

BACKGROUND: There is great variation in the Accident and Emergency workload and location of Urology services in UK hospitals. This study investigated the relationship of the initial management of acute renal colic with the department workload plus local facilities including location of X-ray and urology services in UK Accident and Emergency (A&E) departments. METHODS: A&E departments in each of the 11 UK Deanery regions were stratified based on departmental workload, namely <30,000 (small); 30,000 to 50,000 (medium); 50,000 to 80,000 (large) and >80,000 (very large) patients per year. One third of departments were selected in each group leading to a sample size of 106. A questionnaire was administered. Associations between categorical variables were investigated using the chi-squared test and when not valid, Fisher's Exact test was employed. Differences between groups in ordinal variables were investigated using the Mann-Whitney test. RESULTS: All questionnaires were returned. Twenty-nine units (27.4%) did not perform any radiological investigation on renal colic patients. The number of radiological investigations that were available to departments was associated with workload (P = 0.003); with 57.1% of the small departments performing none and at least 82.8% of units in the other categories performing at least one. Of those departments with X-ray facilities in or adjacent to the department, 63% performed an intravenous urography (IVU) compared to 25% of those departments without (P = 0.026). Of those departments with on-site urology services, 86% performed at least one radiological investigation compared to 52% of units without such services (P = 0.001). Department workload was associated with the first choice analgesia (NSAIDs or parenteral opiates) (P = 0.011). Of the small departments, 64.3% used NSAIDs, 21.4% used parenteral opiates and 14.3% used neither. In comparison, NSAIDS were used by at least 87%, and opiates by at most 12.5% of units in each of the other three categories of department workload. CONCLUSIONS: Over a quarter of UK A&E departments did not perform any radiological investigations and some departments do not even offer renal colic patients any analgesia. Patient management was associated with departmental workload, location of X-ray and Urology services. National guidelines are needed to ensure optimum care for all patients.

Journal Article↗

PubMed2004

Prediction of peak oxygen uptake in patients fulfilling the 1994 CDC criteria for chronic fatigue syndrome.

PURPOSE: To establish an inexpensive, simple method of predicting peak oxygen uptake (VO2peak) in patients fulfilling the 1994 Centers for Disease Control and Prevention (CDC) criteria for chronic fatigue syndrome (CFS). DESIGN: A retrospective observational study. SETTING: An outpatient tertiary care chronic fatigue clinic. SUBJECTS: Two hundred and forty consecutive patients fulfilling the 1994 CDC criteria for CFS. INTERVENTIONS: Heart rate, metabolic and ventilatory parameters were measured continuously during a maximal exercise stress test on a bicycle ergometer. Using the equation peak oxygen uptake = 13.1 x peak workload +284 (used by Mullis et al., Br J Sports Med 1999; 33: 352-56), VO2peak was predicted from the peak workload of a maximal exercise capacity test. Pearson correlation coefficient and linear regression analysis were used to establish the most accurate way to predict VO2peak. RESULTS: Percentage error encountered when comparing actual measured VO2peak with predicted value was 17.3% (+/-10.0). A strong correlation between VO2peak and peak workload was observed (r= 0.89, p < 0.001). A regression analysis established the relation as VO2peak = 10.47 x peak workload +284.1, where VO2peak is given in ml/min and peak workload in W (error in prediction = 11.0+/-9.5%). CONCLUSIONS: Monitoring of the peak workload during a maximal, graded bicycle ergometric test suffices to predict the VO2peak. When predicting VO2peak the used operational definition for the diagnosis of CFS could be taken into account. Compared with the equation used by Mullis et al., peak workload is multiplied by 10.47 in order to predict peak oxygen uptake in CDC-defined CFS patients.

Adult↗

PubMed2005

Reduced heterogeneity of muscle deoxygenation during heavy bicycle exercise.

PURPOSE: This study evaluated heterogeneity of muscle O2 dynamics in a single muscle during bicycle exercise using an eight-channel near-infrared continuous wave spectroscopy (NIRcws) mapping system. METHODS: Nine healthy subjects performed bicycle exercise at fixed workloads of 20, 40, 60, 80, and 100% maximal workload for 5 min at each level. Muscle oxygenation in the vastus lateralis (VL) during and after each exercise was monitored using the NIRcws mapping system. Pulmonary O2 uptake and heart rate were monitored continuously during the experiment. Blood samples were taken to measure blood lactate concentration at 30 s after each exercise stage. RESULTS: Half time reoxygenation, the time taken to reach a value of half-maximal recovery, was significantly delayed in distal sites compared with proximal sites of VL. Conversely, muscle deoxygenation for all measurement sites increased incrementally with higher exercise workloads, and no significant difference of deoxygenation level showed within each channel. However, relative dispersion of muscle deoxygenation during exercise significantly decreased when the workload increased. Moreover, relative dispersion of muscle deoxygenation between the subjects also decreased with an increase in the workload. CONCLUSION: Muscle deoxygenation in a single muscle was more heterogeneous at lower exercise workloads, and variations of the muscle deoxygenation heterogeneity between subjects were greater at lower exercise workloads.

Adult↗

PubMed1993

Hyperoxic training increases work capacity after maximal training at moderate altitude.

High-intensity training may be difficult to sustain due to limitations in systemic oxygen transport, particularly at high altitudes. The purpose of this study was to examine the effects of a high-intensity training protocol using hyperoxic gas breathing in athletes "maximally trained" at an altitude of 1,600 m. Five subjects underwent progressive cycle training until they reached a plateau of aerobic capacity, maximal workload, and endurance time at 85 percent maximal workload. Significant decreases (2 to 6 percent) in arterial oxygen saturation were found after the 85 percent maximal workload tests. Training intensity was then increased to 95 percent maximal workload while the subjects breathed a gas mixture containing at least 70 percent oxygen. After 6 weeks of hyperoxic training, exercise parameters were compared with the plateau values obtained during the baseline training period. Total time during maximal cycle testing increased from 19.1 to 19.6 min (p = 0.015), heart rate at 85 percent maximal workload decreased from 168 to 163 bpm (p = 0.047), and endurance time at 85 percent maximal workload increased from 6.2 to 8.2 min (p = 0.012). There was a trend toward improvement of maximal workload. We conclude that hyperoxic training increases work capacity after attainment of "maximal training" at moderate altitude.

Adult↗

PubMed2002

Competition between internal and external sources of information during exercise: influence on RPE and the impact of the exercise load.

BACKGROUND: The purpose of this study was to investigate the influence of the exercise setting on perceived exertion during sustained low and high intensity cycling exercise. METHODS: Thirteen untrained males completed 4 15-min cycling sessions at 50% VO(2peak) and at 80% VO(2peak) under each of the following conditions: control, sensory deprived, video, and music. Ratings of perceived exertion (RPE) from Borg's 6-20 scale and heart rate (HR) were recorded at 5 min intervals during all sessions. RESULTS: RPE increased with exercise duration at both intensities and, as expected, was substantially higher at the harder workload. Exercising to music resulted in significantly lower RPE when compared to all other conditions at both the low and high workloads, while RPE was higher in the sensory deprived condition when compared to the other 3 conditions. However, RPE was similar for the control and video conditions at both workloads. A significant ordinal interaction existed between conditions and exercise duration during the low but not the high workload. While HR was higher for the harder workload and increased during each workload as a function of exercise duration, it was not different among the 4 conditions at either workload. CONCLUSIONS: Varying the type of sensory information available to the exercising individual did influence perceptual responses to the exercise with the degree of influence dependent on the intensity and duration of the exercise. These results are consistent with information processing models that suggest a limited capacity to attend to the information available. The type of information available, the work intensity, and the work duration were important elements influencing perceptual responses to exercise.

Adult↗

PubMed1989

[Perception of work load among female workers as an indicator of work stress and chronic fatigue].

The aim of the present paper was to determine the trends and extent of the effect of primary parameters of female workers' workload on the feeling of fatigue caused by a day's work and on chronic fatigue. The study comprised female workers 138 of whom performed fynamic-static work and 117 were busy with static work only. Methods used for measuring both the workload and fatigue were subjective. The experiments demonstrated that the extent of different types of workload was, according to workers, not always related to an increased fatigue caused by day's work and chronic fatigue. The effect of workload parameters is modified by the type of work performed and characteristics of workers groups. Time pressure turned out to be a negative factor affecting an increased fatigue caused by a work's day. Physical workload is an important indicator of an intensified fatigue resulting from a day's work as well as of chronic fatigue of female workers performing dynamic work. Physical workload has not the same effect on the other group of workers. Negative influence of workload parameters revealed itself mainly in relation to day's work fatigue, and to a lesser degree, in relation to chronic fatigue.

Chronic Disease↗

PubMed1986

Left ventricular potentiation at a reduced exercise level: a cause of false-negative radionuclide ventriculograms.

During exercise radionuclide ventriculography (RVG), many patients cannot maintain peak workload for acquisition of more than a left anterior oblique view. To acquire further views, the workload may have to be reduced. In this study of 16 normals and 20 patients with coronary disease, the workload at peak exercise was reduced by approximately 40%. By paired t-test analysis, there was a rise in the left ventricular ejection fraction (LVEF) in patients with coronary disease from the peak exercise workload to the reduced workload level (postpeak) (52.4 +/- 15.3 to 59.3 +/- 13.7, P = .0001). There was also improvement in LVEF in the normals at the postpeak workload (71.3 +/- 11.7 to 75.1 +/- 13.7, P = .05). Of five coronary disease patients with exercise-induced wall motion abnormalities, four returned to baseline motion at the reduced exercise levels. Partial workload reduction can lead to an increase in LVEF and improvement in wall motion and thus, may result in false-negative studies.

Adult↗