Levels Of Work Intensity Research Articles

Intensity of nursing work in a primary healthcare center: An observational study

ObjectivesIn the sphere of occupational intensity, nursing stands recognized for its inherently demanding nature, marked by a rapid succession of tasks. Our primary aim was to assess the level of job intensity within nursing by analyzing the frequency and duration of activities performed by nurses, instances of task overlap, and the distribution of break times within a primary healthcare center. MethodsThis study was conducted using a descriptive working method. Nursing activities were recorded with the observation of six nurses, each monitored for 37.5 h. We used the Maribor System for measuring Quantity in Nursing Care in Primary Health Care Settings to measure the nursing care activities about direct patient care, indirect patient care, and other unproductive aspects through direct non-participant observations. ResultsAbout 41.5% (n = 1,640) of all nursing activities involving direct contact with patients, about 38.2% (n = 1,508) was indirect patient care, where a large amount worked with paper files (n = 666, 16.9%). In addition, about 15.0% were other nursing activities (mostly computer work), and just 5.3% (n = 210) of tasks were unproductive. The observational findings indicate a pronounced level of work intensity experienced by nurses in primary health clinics. Significantly, nurses were predominantly engaged in direct patient care tasks, often managing multiple activities simultaneously. Their transitions between tasks occurred approximately every 3 min, frequently without adequate intervals for breaks. ConclusionsThis study highlights the need to shift nurses’ focus from a task-centric approach to one centered on patient care. The prevailing emphasis on tasks may contribute to enduring fatigue and professional dissatisfaction. Consequently, there is an urgent need to redefine the scope of a nurse’s role and implement a comprehensive computer information system as an integral part of this redefined approach.

Exploring the influence of the spiritual climate on psychological empowerment among nurses in China: a cross-sectional study

BackgroundPsychological empowerment notably impacts nurses’ work engagement and high-quality care. A spiritual climate is a work environment that respects individuals and encourages them to express personal views. Previous studies have shown that a spiritual climate enhances psychological empowerment, however, the relationship between them among the nursing population remains unclear. This study aimed to explore the effect of a spiritual climate on nurses’ psychological empowerment and provide a scientific basis for improving psychological empowerment among nurses.MethodsA cross-sectional survey of 837 nurses from five hospitals in Sichuan Province, Southwest China, was conducted using a convenience sampling method; this survey included nurses’ demographic characteristics, the Psychological Empowerment Scale (PES), and the Chinese version of the Spiritual Climate Scale (C-SCS). The data were analysed using one-way analysis of variance (ANOVA), correlation analysis, and multiple linear regression.ResultsThe sample of 837 nurses attained a psychological empowerment score of (45.49 ± 6.42) and a spiritual climate score of (75.25 ± 16.75). The one-way ANOVA revealed that psychological empowerment scores among nurses varied based on differences in age, department, years of work experience, professional title, level of work intensity, and children (yes/no). Pearson’s correlation analyses revealed a significant positive correlation between the spiritual climate and nurses’ psychological empowerment (r = 0.564, P < 0.001), and multiple linear regression analysis showed that working in the intensive care unit (ICU), work intensity, and the four items pertaining to spiritual climate influenced nurses’ psychological empowerment, explaining 32.6% of the total variance in psychological empowerment.ConclusionThe findings suggested that the spiritual climate perceived by nurses and psychological empowerment are moderately high. Working in the ICU, work intensity, and the four items pertaining to spiritual climate influence nurses’ psychological empowerment. Nursing managers should pay attention to the daily work intensity of nurses, especially ICU nurses, organize work tasks reasonably, promote dynamic and balanced nurse human resource deployment based on patients’ conditions and nurses’ workloads, and implement scientific scheduling plans to establish a positive spiritual climate in the workplace. Additionally, group workshops and systematic training programs can effectively enhance psychological empowerment among nurses.

Unravelling the relationship between employment, social transfers and income poverty: Policy and measurement

Despite the rise in employment, consistently high EU-average poverty rates continue to generate debates about the factors that explain the level and changes in the relative poverty rate, both within and across countries. Assuming a strong negative correlation between poverty and employment, the article investigates the role of four mechanisms responsible for this blurred relationship. Using decomposition analysis and macro-level regression analysis, we investigate the extent to which (i) the distribution of employment across households with different levels of work intensity, (ii) the expansion of non-standard work, (iii) the change in the effectiveness of social welfare systems, and (iv) the change in median income and the corresponding shift in the poverty threshold have contributed to changes in relative income poverty in the last decades. We found that employment growth benefits poverty reduction, but this positive effect was partially offset by the precarious characteristics of some newly created jobs. If the distribution of jobs had favoured the jobless more in the pre-crisis period, the relative income poverty rate would have been lower. Although the share of persons in jobless households decreased during the recovery years, their risk of poverty increased due to the retrenchment of social transfers during and after the Great Recession. Furthermore, the use of a floating threshold, which is linked to changes in median income, underestimates the strength of the relationships between poverty, employment and social transfers: when the poverty threshold is kept fixed, not only do the dynamics of poverty look different, but the estimated coefficients are considerably larger.

Risk factors of musculoskeletal disorders in loading and unloading tasks of couriers.

The use of home delivery services has expanded due to coronavirus disease - 2019, and couriers' high level of work intensity has become a severe social issue in various nations. This study investigates the risk factors of musculoskeletal disorders (MSDs) caused by frequent loading and unloading actions, known to be the most demanding tasks for couriers. A self-report survey and post-hoc interview were employed to collect personal information, task frequency, and the incidence of MSDs. Frequent actions during loading and unloading packages were identified, and the Rapid Entry Body Assessment (REBA) and National Institute for Occupational Safety and Health (NIOSH) lifting equations were assessed. Approximately 29.5% of the 44 subjects suffered from MSDs, and identify the types of actions that frequently occur during loading and unloading packages. According to the REBA survey, 60% of the responses for both loading and unloading are distributed within the risk range of 8-13 points, suggesting a high risk (mean REBA score: 8.8 (loading), 8.5 (unloading)). In every case, NIOSH determined that the lifting index (LI) was harmful (mean LI: 1.62). Thereby, the bending or twisting posture of the hands and neck, long horizontal distance between the packages and the body, and high lifting frequency were identified as major problems. The study identified a very high level of musculoskeletal risk for couriers, and the detailed working methods and body parts vulnerable to MSDs.

The effect of work area on work alienation among China’s grassroots judicial administrators

Work alienation refers to mental self-separation from work, and it is an integral reflection of workers and their work. Few studies have explored the association between work area and work alienation among grassroots judicial administrators. A stratified sampling method was used to collect data from 288 grassroots judicial administrators in Guangzhou to measure the overall status quo and work alienation in this group. This study found that the current grassroots judicial administrative team has a reasonable structure, high professional quality, and rich grassroots work experience, but a high level of work intensity (Mean = .667) and a lack of autonomy (Mean = .757) are prominent. Work area (unstandardized regression coefficient, B = .917) is significantly related to work alienation when controlling for sociodemographic and work characteristic variables: the closer the work area is to the city centre areas, the higher the level of work alienation. In addition, education level also has a significant effect on work alienation: the lower the individual education level is, the stronger the work alienation. The discussion focuses on the knowledge needs in grassroots judicial administrative work and the importance of the external working environment, and further research implications are proposed.

In search of the ‘buffering’ effect in the job demands–control model: The role of teamwork HRM practices and occupations

The job demands–control/support (JDC/JDCS) models are highly influential in the HRM and employee well-being literature. Despite the high face validity, however, research has failed to find convincing empirical support for the ‘buffer’ hypothesis suggested by the JDC/JDCS models. In this article the authors explore this issue from three perspectives. First, they test the controversial ‘buffer’ hypothesis using a large nationally representative matched employer–employee sample from Britain. Second, they examine the role of teamwork HRM practices as a moderator of the buffering effect of job control against job demands on employee well-being. Finally, incorporating occupational level data into the analysis, the authors further explore the moderating effects of teamwork under different occupation-specific work intensity. The analysis suggests that there is strong evidence supporting the ‘buffering’ hypothesis. Also, it was found that teamwork moderates the buffering effect for employee intrinsic job satisfaction. Finally, the moderating effect of teamwork differs between occupations with different levels of work intensity.

Off-the-job embeddedness moderates work intensity on employee stress

PurposeWork intensity causes employee stress. This paper demonstrates that off-the-job embeddedness (OffJE), a potential source of social support resources, buffers the negative effect of work intensity on employee stress.Design/methodology/approachGuided by conservation of resources (COR) and job embeddedness theory (JET), this paper reports on the moderated regression analysis of the survey responses of 385 adult employees from a variety of industries in Queensland, Australia, using a student-recruited sampling strategy.FindingsHigher levels of work intensity were found to be associated with higher levels of employee stress. However, this effect was weaker for employees who had higher OffJE. In this sample, work intensity has no relationship with stress for employees who report OffJE beyond the 70th percentile.Originality/valueThis paper demonstrates the positive role of outside workplace relationships embodied in OffJE on workplace employee experience, justifies employer work-life balance initiatives and community involvement, demonstrates the potential positive return for employer involvement in helping employees manage the experience of work intensity and contributes to the social support, COR and job embeddedness literature studies.

Inequality at work and employees' perceptions of organisational fairness

AbstractThe need to promote fairness at work, as a way of both enhancing employee well‐being and raising productivity, has become increasingly central to political discourse. There has been little research, however, on perceptions of fairness across the diverse spectrum of employees in the workforce—the extent to which they regard their organisations as fair and the work experiences that most strongly inform their judgements about fairness. The paper draws on a representative national sample of British employees to examine the distribution and potential determinants of their views about the overall fairness of their organisations and how these differ by occupational class and sex. As well as pointing to the central importance of employee voice and the quality of supervisory treatment, it shows that the level of work intensity and job security are strongly associated with evaluations of fairness. In contrast, the effects of pay policies are relatively modest.

The content of acoustic signals and biological effects of noise in conditions of high level of work intensity.

SummaryBackgroundThe biological effects of noise depend on its physical parameters, combination with other hazards, the content of acoustic signals. This article aimed to analyze the difference in biological effects caused by the selection of nonverbal and verbal signals in conditions of a high level of work intensity.MethodsWork conditions, physical characteristics of noise, levels of work intensity were studied among 75 telephone operators and 96 geophone operators. Levels of permanent hearing thresholds, evaluated by pure-tone audiometry, and results of self-estimation of operators’ health were compared. The contribution of the content of acoustic signals in the shifting of hearing thresholds was evaluated by the one-way analysis of variance.ResultsSelection of acoustic signals in the noise background (< 65 dB), in conditions of high work intensity, causes a significant increase of permanent hearing thresholds in both studied groups comparing to the non-noise exposed population. A combination of the high level of work intensity and distinguishing of nonverbal acoustic messages leads to significant deterioration of health resulting in decreasing of hearing sensitivity and a number of complaints on the state of health (p < 0.05). The content of acoustic signals significantly contributes to the biological effects of the nose.ConclusionObtained results testify necessity to revise safe criteria of noise levels for workers, engaged in selection, recognition and distinguishing of acoustic messages in the noise background combined with a high level of work intensity. In case when the energy of the acoustic field cannot be reduced, occupational safety measures should focus on decreasing of work intensity.

A Study on Work Intensity, Work-Life Balance, and Burnout among Korean Neurosurgeons after the Enactment of the Special Act on Korean Medical Residents.

ObjectiveSince the enactment of the Special Act on Korean Medical Residents, neurosurgeons working at training hospitals have been performing the duties of residents, in addition to their existing patient care responsibilities, which include surgery, education, and research. This study explores the relationships between work intensity, work-life balance, and burnout experienced by Korean neurosurgeons. MethodsThe participants (n=451) were neurosurgeons working at training hospitals throughout Republic of Korea. Data on socio-demographic characteristics (including objective and subjective work environment), work intensity, work-life balance, and burnout were gathered using self-report questionnaires completed between March 1 and December 20, 2019. The data were analyzed using descriptive statistics, independent samples t-tests, one-way analysis of variance, Pearson’s correlations, and multiple regression analysis. IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, NY, USA) was used for the analyses. ResultsThe work intensity, work-life balance, and burnout levels of neurosurgeons were 3.95, 3.57 (on a scale from 1 to 5) and 4.60 (on a scale from 1 to 7); and 280 (62.1%) of 451 neurosurgeons were found to be experiencing burnout. By controlling for the socio-demographic characteristics, the effects of work intensity and work-life balance on burnout were analyzed. Work intensity (B=0.314), work-life balance-family and leisure (B=0.216), work-life balance-growth (B=0.147), job stress (B=0.133), and satisfaction with human relationships (B=-0.069) were shown to be significant (all p<0.05), and they were found to affect burnout in the abovementioned order. The overall explanatory power was 58.3% (p<0.05), and the explanatory power with the addition of independent variables such as work intensity and work-life balance was 14.5% (p<0.05). ConclusionThis study showed that Korean neurosurgeons working at training hospitals experienced a high level of work intensity and job stress, and low work-life balance. Additionally, nearly half of the neurosurgeons were found to experience burnout related to factors such as work intensity, work-life balance, job stress, and satisfaction with human relationships. In particular, these factors seem to have deteriorated further after the implementation of the Special Act on Korean Medical Residents. These very high levels of burnout among Korean neurosurgeons who care for patients with both brain and spinal diseases may have a very important impact on patients’ health. Therefore, it is recommended that the Korean Neurosurgical Society and the Korean government make efforts to improve the factors that affect burnout among Korean neurosurgeons.

Energy and macronutrient intakes of employees at different levels of work intensity in China from 2010 to 2012

To analyze the intake of energy and macronutrients of employees at different levels of work intensity in China. Based on the data of National Nutrition and Health Survey in 2010-2012, this paper analyzed the energy and macro nutrients intakes of employees at three levels of working strength. The energy intake of employees in China was 1952. 7 kcal/d, the intakes of protein, fat and carbohydrate were 62. 7 g/d, 76. 6 g/d and 254. 0 g/d, respectively, the energy supply ratios were 13. 1%, 34. 9% and 52. 4%, respectively. From food sources of energy, the percentage of total energy provided by cereals and animal foods was 47. 7% and 18. 2%, respectively. The percentage of protein from cereal, legumes and Animal food was 39. 8%, 6. 7% and 37. 5%, respectively. The percentage of fat from animal food was 34. 8%. From the age and work intensity groups, the energy intake was lower in the low age group and the light work intensity of employees. There was the lowest intake of protein and fats in high age groups with heavy work intensity. Energy levels form protein and fat were highest in the light intensity group. Energy supply from cereal food was the highest in the group with heavy work intensity and energy supply from animal food was the highest in the group with low age group and light work intensity. The intake of high quality protein and animal food fat decreased with the increase of age and work intensity. The energy intake of employees in China is lower than the recommended energy intake for Chinese residents, and fat provides a higher proportion of energy. Employees with high age and heavy work intensity have insufficient protein intake, and the unreasonable dietary structure was particularly prominent with them, and their nutritional status needs to be paid more attention.

Work related ICT use and work intensity: The role of mobile devices

In this paper, we examine whether ICT use at work is related to different facets of work intensity, including time pressure, multitasking, and interruptions, as well as the number of hours worked overtime as an indicator of work extension. For ICT use, we distinguish different devices by their associated flexibility options for employees considering using a desktop PC, a laptop, and a smartphone/tablet. Moreover, we explore whether further technology-related variables at the intersection of technology, the organization, and the individual are related to work intensity or might even partly explain why ICT use is related to work intensity. The analyses are based on the 2019 survey “Digitization and Change in Employment (DiWaBe).” OLS results indicate that the work-related use of a smartphone or tablet is related to significantly higher levels of work intensity and work extension, regardless of the indicator considered. In contrast, we find no evidence that working with a laptop is associated with increased work intensity. This suggests that the flexibility options associated with a given mobile device are crucial. Further analyses reveal that technology-induced interruptions and information overload in particular are strongly related to work intensity.

Effects of workload on human cognitive performance of exposure to extremely cold environment

Many jobs like outdoor work and emergency rescue have to be exposed to extremely cold environments. The combined effects of the cold exposure and work intensity on human cognitive performance remain unclear. In this paper, the experiments of six Chinese young men exposed to an extremely cold environment (-10 °C) were conducted in a climatic chamber. The work intensity level was graded according to the metabolic rate corresponding to three walking speeds. Nine cognitive functions and one perceived were recorded to evaluate the subjects’ cognitive performance, including NCTB (seven items), Stroop, and RPE were measured. The increase of workload from moderate to high could lead to the acceleration of fatigue speed and the aggravation of fatigue degree 5 min earlier. Moderate work intensity is a noteworthy work level in extremely cold environment, which is an inflection point in the impact of fatigue and cognitive levels. The manual dexterity significantly increases by the workload intensity, and the high work intensity makes the hands more dexterous (29% increase). Extremely cold environment has a significant effect on short-term memory (decreased 33%). The selective attention was reduced by 16% in the extremely cold environment. With the moderate work intensity in extremely cold environment, the perceived judgment response speed would decrease. The combined effects of the extremely cold environment and the workload on the cognitive functions of psychomotor ability and attention or sensorimotor speed should be paid more attention to.

Cardiorespiratory fitness, occupational aerobic workload and age: workplace measurements among blue-collar workers

BackgroundThe knowledge, from laboratory studies dating back to the 1950s on the importance of the association between cardiorespiratory fitness and aerobic workload for workers health, is fundamental for promoting sustainable healthy employability among ageing blue-collar workers today. However, the association between cardiorespiratory fitness and aerobic workload has not yet been documented during daily work, and we do not know if it applies to the normal work of blue-collar workers in different age groups. We aim to investigate the association between cardiorespiratory fitness and aerobic workload among blue-collar workers using measurements of 24-h heart rate collected over consecutive working days.MethodsWe analyzed baseline cardiorespiratory fitness, assessed using a sub-maximal cycle ergometer test, and 1–4 days of 24-h heart rate measurement from 497 blue-collar workers participating in the DPHACTO study. We investigated the association between cardiorespiratory fitness and aerobic workload defined as the average percentage of heart rate reserve (%HRR), maximum %HRR and the duration time spent at a high HRR (> 30%) during working hours. The association was assessed using multivariate linear regression models adjusted for age, sex, self-rated health, shift-work, prescription medication and occupation, as well as for different age strata.ResultsHigher cardiorespiratory fitness was significantly associated with decreased mean %HRR −0.32 [95% CI −0.39 to −0.25], maximum %HRR −0.35 [95% CI −0.45 to −0.25] and time spent at ≥ 30% HRR; −1.8% [95% CI −2.2 to −1.5%]. These associations were evident across age groups, with slightly stronger associations for workers aged 46–51 (total range 18–68).ConclusionsHigher cardiorespiratory fitness was associated with the decreased aerobic workload during normal work across all age groups and levels of work intensity. Our findings highlight the importance of cardiorespiratory fitness when considering the workload and its relevance in the promotion of healthy sustainable employment.

Hospital doctors and the struggle for work-life balance: the case of Ireland

Abstract Background Ireland has a high rate of doctor emigration. Difficult working conditions, particularly in the hospital sector, are often cited as a driver of doctor emigration. In October 2019, a random sample of Ireland's hospital doctors were invited to participate in an anonymous online survey about their working conditions. Methods The survey was distributed via the national Medical Register (with the assistance of the Medical Council of Ireland). Invitations were sent to 5356 hospital doctors, stratified by registration status (including interns, trainees, those not in training and consultants). An overall response rate of 20% was achieved (N = 1070). This paper focusses on responses to two free-text survey questions: (1) Do you have any other comments about your work-life balance? (N = 314). (2) Do you have any other comments on your working conditions as a hospital doctor? (N = 469). Results Respondent hospital doctors, at all levels of seniority, were struggling to achieve a balance between work and life. Of the free-text responses received, 8/10 were negative, with work-life balance/imbalance and work-overload being the issues arising most frequently. Respondents discussed how long and unpredictable working hours, combined with a high level of work intensity, meant that they often spent their personal time recovering from work. Conclusions Poor work-life balance has become normalised within Irish hospital medicine. The findings call to action to critically reflect on the sustainability of this way of working for the individual doctors, the wider workforce and the Irish health system.

Wer ist von hoher Arbeitsintensität betroffen? Gefährdungspotenziale erkennen und reduzieren

Who is affected by high work intensity? Identifying and reducing potential hazards Objectives: The health of employees is under threat from excessively high work intensity. Despite numerous studies emphasising the growing significance of work intensity, still not enough is known about the workplaces where increased work intensity is occurring or what form of work is affected. In order to evaluate levels of work intensity amongst employees in a more differentiated way, this article describes various dimensions of high work intensity according to occupational segments and requirement levels. We also discuss what the findings mean for operational practice. Methods: The data basis for the analyses was the BiBB/BAUA Employment Survey 2018 (the Federal Institute for Vocational Education and Training, in cooperation with the Federal Institute for Occupational Safety and Health), a representative cross-sectional survey of some 20,000 employed persons in Germany. Results: The results of the analysis show that the demands of high work intensity affect all the occupational groups observed here. It also becomes clear that the observed dimensions of high work intensity – multitasking, pressure to perform or meet deadlines, frequent interruptions, working very quickly and at the limits of individual capabilities – occur in all occupational segments and at all levels of requirement. These dimensions occur to varying degrees and in varying combinations, however, and are often displayed as a “bundle of work-related stress”. This means on the one hand that specific work intensity profiles can be identified for the occupational groups observed. On the other hand it is also possible to detect overarching patterns: multitasking is particularly common in the service sector, for example, where customer contact plays a greater role. Conclusions: The fact that high work intensity is noticeable in different ways in the groups of employees considered on the one hand, and that commonalities are also apparent across occupations on the other, indicates that both the level of work intensity and its structure are related to overarching job characteristics, work organisation processes and other workplace-related organisational frameworks. For workplace design these multiple causes mean that the focus should not only be on individual working activities or stressors but that a more holistic approach is also needed, e.g. working time organisation, work organisation processes or business models and their effects on employees. The results emphasise the need to establish throughout the company an awareness of health risks caused by high work intensity. The established instruments of occupational health and safety should serve as a basis for shaping developments. Keywords: work intensity – work organisation – occupational health and safety – recommendation for action

Standards of Good Work in the Organisation of Working Time: Fragmentation and the Intensification of Work Across Sectors and OccupationsDate submitted: September 9, 2018Revised version accepted after double-blind review: August 13, 2019.

This article addresses the issue of good work in terms of working time organisation by exploring the link between diverse working time practices and work intensity. Existing studies have demonstrated that non-standard working hours expose workers to the pressures of work intensification, which can be defined as the compression of work activities into a unit of time. This article expands existing knowledge by investigating how the outcomes of non-standard working hours differ by sector and occupation, as well as by incorporating detailed and comprehensive measures of working time organisation in the empirical analysis. Based on EWCS data from 2010 and 2015 for 28 EU countries, the empirical analysis uses multilevel regression models with workers nested within countries. The results show that non-standard working hours and employer-driven scheduling are, on average, linked to more intense work than regular daytime hours scheduled from Monday to Friday or under worker-led flexibility arrangements. Consistent with expectations, the study points to significant differences in this relationship between sectors and occupations. Among others, in low-skilled and routine occupations, and service sectors such as transport, commerce, hospitality and health, short hours of work and employer-led flexibility are associated with relatively more intense work. Even where workers have some control over their schedules, jobs in these areas are not linked to lower levels of work intensity. The findings also support the expectation of overwork in high-skilled jobs, where long hours of work and high levels of worker-led flexibility are linked to relatively more intense work.

Being Working Poor or Feeling Working Poor? The Role of Work Intensity and Job Stability for Subjective Poverty

Low work intensity and high job instability are crucial micro-determinants of in-work poverty. Importantly, they might also affect subjective poverty in households that are above the poverty threshold. We contribute to the literature by studying the relationship between subjective and objective in-work poverty and how this relationship is affected by household members’ job characteristics. We use data from the 2014 wave of the Italian module of the EU-SILC survey. Italy is an interesting case as—similarly to other Southern European countries—the share of individuals and households reporting subjective hardship is strikingly high compared to the levels reported in other EU areas. We find no statistically significant differences in the association between subjective poverty and different degrees of objective poverty by different levels of work intensity. Conversely, subjective poverty is positively associated with the instability of household members’ job contracts. We argue that policies aimed at increasing work intensity rather than work stability might not help to reduce subjective poverty as well as its (negative) spillover effects on other life domains—such as well-being, adequate levels of consumption, and social integration.

Clinical Work Intensity Among Medical Oncologists Practicing in National Community Oncology Research Program Community Sites.

This study (1) assesses the level of clinical work intensity medical oncologists and oncologic nurse practitioners experience providing care and (2) identifies patient, provider, and practice factors mediating intensity. Seventeen medical oncologists (12 physicians and five nurse practitioners) from five national sites national reported on the level of work intensity associated with 339 patient visits. Data collection at each site occurred over a 2- to 6 week period; for each provider, five visits were randomly selected from each of 4 randomly selected clinic days, yielding 20 visits per provider. Intensity was measured by the NASA-Task Load Index. Patient and visit characteristics were abstracted from the medical record; provider characteristics were self-reported by questionnaire. Clinical work intensity increased monotonically with level of service and was greatest when the visit involved discussion of either chemotherapy or terminal prognosis. Provider characteristics (including age, sex, and years of experience) were unrelated to intensity. Dimensions of work intensity that correlated directly with level of service included mental, physical, and temporal demand; effort; frustration; and stress. Perceptions of performance and of satisfaction with the visit were unrelated to level of service. Visits related to chemotherapy had greater mental, physical, and temporal demand, and effort, but worse perception of performance. When the visit involved a discussion of a terminal prognosis, greater intensity was reflected in all dimensions; stress was also greater, whereas visit satisfaction was significantly lower. Clinical work intensity increases with level of service provided and is greater for visits involving discussion of either terminal prognosis or chemotherapy.

THE CHARACTERISTICS OF FUNCTIONAL CONDITION OF CENTRAL NERVOUS SYSTEM IN INDIVIDUALS WITH CHRONIC INSOMNIA AND PROGNOSIS OF DEVELOPMENT OF SLEEP DISORDERS

The higher prevalence and variety of clinical manifestation of disorders of falling asleep and sleep maintenance (insomnia) in persons of able-bodied age condition necessity of development of personified prevention programs subject to main pathophysiologic mechanisms conditioning risks of development of sleep disorders and related to them somatic diseases. Purpose of study. To analyze functional state of brain and cerebral blood flow in brain workers with higher level of professional stress and sleep disorders and to determine risk factors of development of established disorders for scientific substantiation of preventive activities. Material and methods. The examination was applied to two groups of brain workers with higher level of work intensity (class 3.3) and professional stress. The main group included 77 individuals stated availability of insomnia (index of insomnia severity 20.4±3.1 points). The control group included 88 individuals without significant sleep disorders. The clinical instrumental examination was implemented including questionnaire survey, night polysome graphic analysis, electroencephalography (EEG) and rheography analysis. Results. The high level of professional stress in workers with sleep disorders was statistically related to decreasing of efficiency of total time of sleep, decreasing of slow-wave sleep шт its structure, increased sleep fragmentation due to increasing of reactions of EEG-activation (r=0.35). The study of cerebral blood flow established that in 50% of individuals with sleep disorders and 32% of individuals without sleep disorders the instability of vascular tone was registered. According data of prospective observation, the signs of sleep disorders continued in 92% of patients with non-specific alterations of EEG with predominance of low-amplitude high-frequency activity and in 65% of patients with absence of similar alterations. The detected alterations can be considered as markers of condition of increased reactivity of central and vegetative nervous system being predisposing factor of changing from acute or transitory insomnia to chronic form.