Age, burnout and physical and psychological work ability among nurses

Background

The ageing of the US labour force highlights the need to examine older adults' physical and psychological ability to work, under varying levels of occupational burnout.

Aims

To examine how age and burnout interact in predicting physical and psychological work ability.

Methods

Using a cohort of actively working nurses, we assessed factors on the Work Ability Index at 12-month follow-up and determined how these were related to age and exhaustion-related burnout at baseline.

Results

The study group consisted of 402 nurses aged 25-67 (mean = 41.7). Results indicated age by burnout interactions in which decrements in physical work ability with greater age were observed at all but the lowest level of burnout (1.5 SD below mean: β = -0.14, 95% CI -0.36, 0.07; 1 SD below: β = -0.23, 95% CI -0.39, -0.06; mean: β = -0.39, 95% CI -0.50, -0.29; 1 SD above: β = -0.56, 95% CI -0.70, -0.42; 1.5 SD above: β = -0.64, 95% CI -0.83, -0.46). In contrast, we observed decrements in psychological work ability with age at higher levels of burnout only (1 SD above: β = -0.20, 95% CI -0.35, -0.05; 1.5 SD above: β = -0.30, 95% CI -0.49, -0.11); at lower levels of burnout, older age was associated with improvements in this (1 SD below: β = 0.19, 95% CI 0.03, 0.35; 1.5 SD below: β = 0.29, 95% CI 0.08, 0.50).

Conclusions

Findings indicated physical and psychological dimensions of work ability that differed by age and occupational burnout. This emphasizes the need for interventions to reduce burnout and to address age-related strengths and vulnerabilities relating to physical and psychological work ability.

[An unusual cranial vault tumor: the chondromyxoid fibroma]

Chondromyxoid fibroma is an uncommon benign bone tumor of cartilaginous origin. It is often located in long bone metaphysis. We report a case involving the left frontotemporal cranial vault in a 44-year-old woman. Fifteen cranial vault cases have been reported in the international literature. Surgical resection of the lesion with tumor-free margins is the key factor to cure it and avoid local recurrence.

A comparative analysis of the Work Ability Index

BACKGROUND

The Work Ability Index (WAI) is a well-established instrument to measure work ability. However, the dimensionality of the WAI remains controversial.

AIMS

To identify the dimensionality of the WAI and to investigate dependencies of factors and subscales.

METHODS

The sample analysed in this study consisted of 371 subjects of different occupational groups (teachers, office workers, nursery school teachers and managers). The WAI was measured for all subgroups. Psychometric characteristics of the WAI were investigated using factor analyses with different numbers and different patterns of dependency among the factors. Chi-square analysis and the Comparative Fit Index were used to statistically assess fit quality.

RESULTS

The group of managers had to be excluded from the analysis as their results were probably overoptimistic due to reporting bias; thus, 324 subjects entered. The one-factor model and an orthogonal two-factor model did not fit the observed correlational structures. A satisfactory fit was obtained using a two-dimensional model with correlated factors. These factors could be interpreted as subjectively estimated work ability and objective health status. Only five of seven items of the WAI could be related unambiguously to one of both factors.

CONCLUSIONS

From our study, we conclude that using only the total score of the WAI is not adequate for population analysis of and assessment of work ability to individuals. Instead, the two-dimensional structure of the instrument must be taken into account.

Auditory probe sensitivity to mental workload changes - an event-related potential study

The goal of this study was to explore the utility of parameters of ERPs for assessment of mental workload during performance of complex tasks. In addition to a baseline auditory oddball task, 15 healthy adult volunteers performed gauge monitoring (Gauge) and mental arithmetic (Math) separately and together. Throughout the task performance three types of auditory stimuli were presented as probes, i.e. 80% 1000 Hz tones, 10% 2000 Hz tones and 10% novel sounds. The ERP components N1 and P3 were analysed, which are assumed to reflect perceptive and central processing resources. The results interpreted in the framework of capacity theory indicate high demand on processing resources already during separate performance of both tasks Gauge or Math. During simultaneous performance the workload on average exceeded the limits of processing capacity: the performance data impaired significantly. The ERP measures N1 and P3 were confirmed in their sensitivity and diagnosticity. By using novel sounds as probes with involuntary attention-capturing properties, one might overcome a problem of the irrelevant probe technique, i.e. whether the operator spends his spare capacity for processing of the irrelevant probes.

Effects of microwaves emitted by cellular phones on human slow brain potentials

The influence of electromagnetic fields (EMF) emitted by cellular phones on preparatory slow brain potentials (SP) was studied in two different experimental tasks: In the first, healthy male human subjects had to perform simple self-paced finger movements to elicit a Bereitschaftspotential; in the second, they performed a complex and cognitive demanding visual monitoring task (VMT). Both tasks were performed with and without EMF exposure in counterbalanced order. Whereas subjects' performance did not differ between the EMF exposure conditions, SP parameters were influenced by EMF in the VMT: EMF exposure effected a significant decrease of SPs at central and temporo-parieto-occipital brain regions, but not at the frontal one. In the simple finger movement task, EMF did not affect the Bereitschaftspotential.

Microwaves emitted by cellular telephones affect human slow brain potentials

The influence of electromagnetic fields (EMF) emitted by cellular telephones on preparatory slow brain potentials (SP) was studied in two experiments, about 6 months apart. In the first experiment, a significant decrease of SP was found during exposure to EMF in a complex visual monitoring task (VMT). This effect was replicated in the second experiment. In addition to the VMT, EMF effects on SP were analysed in two further, less demanding tasks: in a simple finger movement task to elicit a Bereitschaftspotential (BP) and in a two-stimulus task to elicit a contingent negative variation (CNV). In comparison to the VMT, no significant main EMF effects were found in BP and CNV tasks. The results accounted for a selective EMF effect on particular aspects of human information processing, but did not indicate any influence on human performance, well-being and health.

Slow brain potentials in a visual monitoring task

The purpose of this study was to analyse slow brain potentials (SPs) during visual monitoring, needed to perform the clock-monitoring task (CMT). This task was successfully applied in behavioural studies, in which attention capabilities were investigated in dependence on individual factors. Clearly pronounced preparatory SPs were observed during the CMT reflecting a high level of preparation and attention, necessary for achieving high performance accuracy. The well-known influence of task repetition on SPs and the relation between SP and behaviour were confirmed. The practicability of the CMT, the clear and easily detectable SP components and the sensitivity of the present approach makes it recommendable for further applications, e.g. for the evaluation of the effects of occupational/environmental exposures on processes of information processing.

Mobile phones modulate response patterns of human brain activity

Mobile phones emit a pulsed high-frequency electromagnetic field (PEMF) which may penetrate the scalp and the skull. Increasingly, there is an interest in the interaction of this pulsed microwave radiation with the human brain. Our investigations show that these electromagnetic fields alter distinct aspects of the brain's electrical response to acoustic stimuli. More precisely, our results demonstrate that aspects of the induced but not the evoked brain activity during PEMF exposure can be different from those not influenced by PEMF radiation. This effect appears in higher frequency bands when subjects process task-relevant target stimuli but was not present for irrelevant standard stimuli. As the induced brain activity in higher frequency bands has been proposed to be a correlate of coherent high-frequency neuronal activity, PEMF exposure may provide means to systematically alter the pattern fluctuations in neural mass activity.

The differential effects of extremity and movement side on the scalp distribution of the readiness potential (RP) and the stimulus-preceding negativity (SPN)

In a time estimation task subjects had to press a button 3 s after the presentation of a warning stimulus. Two seconds after the movement they were informed about their performance by a knowledge of results (KR) stimulus. Preceding the movement a readiness potential (RP) and prior to the presentation of the KR stimulus a stimulus-preceding negativity (SPN) was recorded. Movement side (left/right) and extremity (hand/foot) were varied within subjects to demonstrate that the RP but not the SPN is affected by such manipulations. The scalp distribution of the late part of the RP was affected by movement side and extremity. Yet it exhibited the expected lateral asymmetry only preceding a movement of the left hand or of the right foot. The scalp distribution of the SPN was not affected by extremity. The size of the right hemisphere preponderance of the SPN depended on movement side following a finger flexion, but not following a plantar flexion of the foot. The experimental design was intended to avoid the temporal overlap between movement-related and stimulus-related activity. Yet it is argued that both results of this experiment can best be explained by such an overlap.

[Intravaginal culture--simplification of IVF]

Initial results with intravaginal cultures (IVC) of human oocytes are reported. Up to 5 oocytes are harvested by follicular puncture guided by transvaginal sonography. Together with washed spermatocytes (final concentration 0.1 to 0.15 x 10(6)/tube) these are transferred to a plastic capsule filled with Menezzo B2 medium. After air-tight closure the capsule is placed into the patient's vagina and left in situ for 48 to 52 hours. Capsule loss is prevented by plugging the vagina with a tampon of appropriate size. In the first 15 females undergoing IVC fertilization was obtained in 56% of cases. Three intact pregnancies were recorded after embryo transfer. Of these, 2 occurred in the group of patients with tubal infertility and one in the group with tubal infertility and an additional andrologic abnormality. Our results and the reports by others suggest that IVC may well facilitate the technique of IVF. Potentially detrimental effects of light exposure and temperature variations on the gametes during conventional IVF are minimized. The more active involvement of the patients is an added psychological benefit.

The Bereitschaftspotential in preparation to mental activities

Earlier studies had investigated the Bereitschaftspotential (Bp) under different aspects of muscular activities. The present experiments were designed to test whether the Bp will be affected by the degree of mental load while motor activity is kept constant. Fourteen healthy male subjects had to solve arithmetical tasks under a graduated time pressure (3 categories of tasks). The subjects had to indicate by pressing one of three keys (trigger), which category of task they wanted to solve next. As soon as a key had been pressed, a task appeared on the computer display and disappeared after the time interval corresponding to the selected category. The results had to be entered into a computer via a keyboard. The EEG signals (5 s time constant, 15 Hz upper frequency cut-off) were averaged time-locked to the movement onset, starting 1.5 s before the pressing of the key. Trials with artefacts were rejected from averaging. The Bp was found to be significantly higher when the tasks were to be solved under higher time pressure. We assume that this might be rather an expression of an appropriate self-activation for the expected mental task than due to a different motor preparation.

[The readiness potential--movement-correlated changes in bioelectric brain activity]

The Bereitschaftspotential which belongs to the group of slow potentials can be recorded in the period of preparation to a voluntary motor act and is connected with changes of the level of central nervous activation. This paper is concerned with general questions of classification of Bp in the complex of movement-related brain potentials, with the topographic distribution over the scalp, and with the relation of Bp to some motor functions of the cortex. The relationship to psychological factors affecting the Bp is discussed.

Changes in Bereitschaftspotential during fatiguing and non-fatiguing hand movements

This study investigates the electroencephalographic Bereitschaftspotential (Bp) during muscular-fatiguing and non-fatiguing rhythmical hand contractions at 20%, 50%, and 80% maximum voluntary contraction (MVC). A feedback arrangement was provided so that subjects were able to adjust the force as required. The results confirm that Bp depends on force level. An increase in force results in a Bp increase. Further, they show that muscular-fatiguing contractions at 80% MVC are accompanied by an increased Bp. This could be the result of an increase in the central nervous activation required when preparing for motor activity with fatigued muscles. A decrease in Bp was observed during non-fatiguing repetitive hand contractions at 50% MVC. Possibly, the decrease reflects a decrease in subjects intentional involvement due to the monotony of the exercise. Repetitive movements at 20% MVC, which require a high degree of concentration and attention to adjust exactly to this very small force level, also result in an increased Bp, perhaps due to the higher intentional involvement. It may be concluded that the influence of muscular fatigue on Bp should be investigated with consideration of the psychological aspects of repetitive movements.

[Theory and practice in the care of diabetic pregnancy--a timely concept]

Perinatal mortality in diabetic pregnancy has decreased markedly over the past 25 years; this reduction in fetal loss can be attributed to a variety of advances. These include technologic advances in obstetrics and pediatrics, as well as greater understanding of the metabolic aberrations occurring in pregnancy complicated by diabetes. Basically it seems convenient to consider the various disorders in cases of diabetes in pregnancy from several points of view: 1. the effect of pregnancy on the maternal diabetes and 2. the effect of maternal diabetes on the pregnancy and especially on the fetus, and from the above results we can consider 3. an actual procedure in the care of diabetic pregnancy. Regarding the necessary criteria in the care of pregnant diabetics neither pregnancy nor delivery will cause any serious problems.