Survey Of Workload Research Articles

Human Resources Needs for Medical Records Officers at the Mataram City Health Center

Human resources are the most important and integral part of any organization, including the health sector. Therefore, this study aimed to examine human resources needs in the medical records field, with a particular focus on the roles and responsibilities of medical records officers. The analysis was carried out to identify critical challenges faced by medical record officers in meeting health service standards and managing patient data. Secondary data were collected from a survey of workload and human resources needs for medical records in 2023. The samples were selected using the Stratified Sampling method, by dividing the population into two groups (strata) based on the accreditation levels of health centers in Mataram city. Specifically, Tanjung Karang represented the main accredited center, while Babangan was categorized as a basic accredited center. Data analysis was performed with the Workload Indicators of Staffing Need Method (WISN) to calculate labor requirements and health crew members necessary for evaluating the distribution of health worker availability. The results showed the scarcity of medical record officers, difficulties in managing patient data, as well as the need for training and skills development in line with advances in information technology within the health sector.

Impact of preferred surgical modality on surgeon wellness: a survey of workload, physical pain/discomfort, and neuromusculoskeletal disorders

BackgroundWe compared surgeons’ workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems).MethodsAn electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions including: (I) Demographics and anthropometrics; (II) The percentage of the procedural time that the surgeon spent on performing each surgical modality; (III) Physical and mental demand and physical discomfort; (IV) Neuromusculoskeletal symptoms including body part pain and NMSDs.ResultsSeventy-nine out of 245 surgeons completed the survey (32.2%) and 65 surgeons (82.2%) had a dominant surgical modality: 10 endoscopic, 15 laparoscopic, 26 open, and 14 robotic surgeons. Physical demand was the highest for open surgery and the lowest for endoscopic and robotic surgeries, (all p < 0.05). Open and robotic surgeries required the highest levels of mental workload followed by laparoscopic and endoscopic surgeries, respectively (all p < 0.05 except for the difference between robotic and laparoscopic that was not significant). Body part discomfort or pain (immediately after surgery) were lower in the shoulder for robotic surgeons compared to laparoscopic and open surgeons and in left fingers for robotic surgeons compared to endoscopic surgeons (all p < 0.05). The prevalence of NMSD was significantly lower in robotic surgeons (7%) compared to the other surgical modalities (between 60 and 67%) (all p < 0.05).ConclusionsThe distribution of NMSDs, workload, and physical discomfort varied significantly based on preferred surgical approach. Although robotic surgeons had fewer overall complaints, improvement in ergonomics of surgery are still warranted.Graphical abstract

Intuitive, Myoelectric Control of Adaptive Sports Equipment for Individuals with Tetraplegia.

This research aims to develop safe, robust, and easy-to-use adaptive technology for individuals with tetraplegia. After a debilitating spinal cord injury, clinical care focuses on improving quality of life. Participation in adaptive sports has been shown to improve several aspects of participants' well-being. The TetraSki is a power-assisted ski chair that allows individuals with tetraplegia to participate in downhill skiing by sipping and puffing air on an integrated straw to turn their skis. Here, we introduce a new intuitive and dexterous control strategy for the TetraSki using surface electromyography (sEMG) from the neck and shoulder muscles. As an initial assessment, six healthy participants completed a virtual ski racecourse using sEMG and Sip-and-Puff control. Participants also completed a detection response task of cognitive load and the NASA-TLX survey of subjective workload. No significant differences were observed between the performance of sEMG control and the performance of Sip-and-Puff control. However, sEMG control required significantly less cognitive load and subjective workload than Sip-and-Puff control. These results indicate that sEMG can effectively control the equipment and is significantly more intuitive than traditional Sip-and-Puff control. This suggests that sEMG is a promising control method for further validation with individuals with tetraplegia. Ultimately, long-term use of sEMG control may promote neuroplasticity and drive rehabilitation.

A National Survey of Job Satisfaction and Workload Among Emergency Medicine (EM) Residency Faculty.

Faculty workload, and its relation to job satisfaction, has not been well studied in Emergency Medicine (EM). Methods:A cross-sectional survey was conducted among EM physician faculty at 49 residency programs across the United States. We collected information on clinical and non-clinical (education, administration, and research) workload, demographics, and EM department characteristics, as well as job satisfaction measured using the Global Job Satisfaction (GJS) scale. Comparisons were made using Wilcox signed rank tests. Multivariable associations with job satisfaction were assessed in a regression model. Of 1,791 surveys sent, 265 were completed.The quantity of contracted clinical and non-clinical hours was lower than the actual clinical (difference (95% confidence interval (CI)): 2.7 (1.5-4.1)) and non-clinical hours (6.0 (3.8-8.8)) worked.Respondents preferred a distribution of 50% clinical work. However, the actual percentage was 62% (difference (95% CI): 14.4% (10.8%-17.6%)).Identifying as core faculty and required logging of non-clinical hours were associated with improved job satisfaction while increased percentage of time spent in the clinical and administrative domains were associated with significant declines. The estimated actual work performed by EM physician faculty is greater than contracted and misaligned with their preferred type of work, the latter of which is associated with decreased job satisfaction. Improved job satisfaction and faculty retention might be achieved by increasing the percentage of time devoted to education and research, by increasing the core faculty contingent and by implementing tracking of non-clinical efforts.

Personal protective equipment for COVID-19 among healthcare workers in an emergency department: An exploratory survey of workload, thermal discomfort and symptoms of heat strain.

To examine workload, thermal discomfort and heat-related symptoms among healthcare workers (HCWs) in an Australian ED during the COVID-19 pandemic. A cross-sectional study design was employed among HCWs in an ED at a metropolitan hospital in Brisbane, Australia. Respondents provided demographic information including their self-reported age, sex, height, weight, role (e.g. doctor, nurse), and whether they wore personal protective equipment (PPE) during their shift, rated as either Full PPE, Partial PPE, or usual uniform or scrubs. The workload of HCWs was assessed with the National Aeronautics and Space Administration's task load index (NASA-TLX). Thermal discomfort was evaluated using scales from the International Organisation for Standardisation. Responders rated their subjective heat illness using the Environmental Symptoms Questionnaire. Fifty-nine HCWs completed the survey (27 male, 31 female, one prefer not to answer). Overall workload from the NASA-TLX was 64.6 (interquartile range [IQR] 56.5-73.3) for doctors, 72.5 (IQR 63.3-83.3) for nurses and 66.7 (IQR 58.3-74.17) for other staff, representing moderate to high ratings. Eighty-one percent reported thermal sensation to be slightly warm, warm, or hot, and 88% reported being uncomfortable, ranging from slightly to extremely. Ninety-seven percent reported at least one heat-strain symptom. More than 50% reported light-headedness or headache and approximately 30% reported feeling dizzy, faint, or weak. ED HCWs experience thermal discomfort when wearing PPE. Combined with their workloads, HCWs experienced symptoms related to heat strain. Therefore, careful consideration should be given to managing heat strain among HCWs when wearing PPE in an ED.

Report of the 2020 British Nuclear Medicine Society survey of nuclear medicine equipment, workforce and workload.

The British Nuclear Medicine Society (BNMS) survey represents the only resource that brings together detailed information on equipment, workforce and workload from the practice of nuclear medicine in the UK. This article is a report of the most recent BNMS survey which was collected during 2019 and 2020. The survey used two methods to collect data: for equipment and workforce, participants created or updated existing online records; for workload information, respondees were asked to submit 12 months of data from local radiology information systems. Following the survey, the BNMS database contained a total of 191 sites (63% of known sites) having either equipment or workforce data or both. In total 39 centres provided workload data which included over 175 000 examinations. A combination of automated tools and visual inspection were used to clean, sort and validate submitted data into formats that allowed further analysis and extraction of useful parameters. Results are presented that the authors believe may be useful for nuclear medicine professionals and other stakeholders. Potential applications include benchmarking for service review and equipment replacement/updating. The survey represents a valuable resource that might be used by the BNMS secretariat to respond to specific queries from BNMS members.

Can mandatory monitoring in rental apartments effectively prevent legionellosis? A retrospective analysis of data from Regensburg with a review of the literature.

Background: Legionella pneumophila can cause severe, often fatal, pneumonia in humans. Mandatory water sampling in commercially used buildings (mainly rental apartments) as regulated in the Drinking Water Ordinance (Trinkwasserverordnung) aim to protect the population against infection with Legionella. However, no data exist to date that could prove the effectiveness of the measures. At the same time, having the Public Health Department’s Infection Control Division deal with Legionalla is very time consuming.Methods: A retrospective analysis of data from the city and district of Regensburg, a selective literature search, a prospective survey of workload using an anonymous questionnaire were performed.Results: The evaluated data from the city/district of Regensburg suggest underreporting to a similar extent as shown by the RKI’s data in the compared period. Neither is the actual incidence known, nor can exposures be clearly determined in most cases. The exposure categories “travel” and “private/occupational” seem to be the most pertinent. The potential public hazard of Legionella posed by domestic plumbing systems is unclear. A connection between exceeding the technical measurement limit (Technischer Maßnahmenwert, TMW) in routine tests in rental apartments and disease cases cannot be shown. A survey among non-medical personnel in the field of infection control and hygiene on the time spent on the topic of Legionella yielded a mean number of 39% of daily working hours for the observed 2-month period.Conclusion: The data on incidence, exposure, and causality are incomplete. Evidence of effective protection by the current practice of sampling in apartment buildings could not be found. For many aspects, there are no unambiguous data in the literature. Restricting mandatory monitoring to certain public/commercial institutions should be discussed, given the high workload for the Public Health Department and the unproven protective effect. Further research on this topic is necessary.

Medical oncology workload in Canada: infrastructure, supports, and delivery of clinical care.

In 2000, a Canadian task force recommended that medical oncologists (mos) meet a target of 160-175 new patient consultations per year. Here, we report the Canadian results of a global survey of mo workload compared with mo workload in other high-income countries (hics). Using a snowball method, an online survey was distributed by national oncology societies to chemotherapy-prescribing physicians in 22 hics (World Bank criteria). The survey was distributed within Canada to all members of the Canadian Association of Medical Oncologists. Workload was measured as the annual number of new cancer patient consults per oncologist. The survey was completed by 782 oncologists from hics, including 58 from Canada. Median annual consults per mo were 175 in Canada compared with 125 in other hics. The proportions of mos having 100 or fewer consults or more than 300 consults per year were 3% (2/58) and 5% (3/58) in Canada compared with 31% (222/724) and 16% (116/724) in other hics (p < 0.001 and p = 0.023 respectively). The median number of patients seen in a full-day clinic was 15 in Canada and 25 in other hics (p = 0.220). Canadian mos reported spending a median of 55 minutes per new consultation; new consultations of 35 minutes were reported in other hics (p < 0.001). Median hours worked per week was 55 in Canada and 45 in other hics (p = 0.200). Although the median annual clinical volume for Canadian mos aligns with recommended targets, half the respondents exceeded that level of activity. Health policymakers and educators have to consider mo workforce supply and alternative models of care in preparation for the anticipated surge in cancer incidence in the coming decade.

Anaesthesia, surgery, and life-threatening allergic reactions: protocol and methods of the 6th National Audit Project (NAP6) of the Royal College of Anaesthetists

BackgroundAnaphylaxis during anaesthesia is a serious complication for patients and anaesthetists. MethodsThe Sixth National Audit Project (NAP6) of the Royal College of Anaesthetists examined the incidence, predisposing factors, management, and impact of life-threatening perioperative anaphylaxis in the UK. NAP6 included: a national survey of anaesthetists' experiences and perceptions; a national survey of allergy clinics; a registry collecting detailed reports of all Grade 3–5 perioperative anaphylaxis cases for 1 yr; and a national survey of anaesthetic workload and perioperative allergen exposure. NHS and independent sector (IS) hospitals were approached to participate. Cases were reviewed by a multi-disciplinary expert panel (anaesthetists, intensivists, allergists, immunologists, patient representatives, and stakeholders) using a structured process designed to minimise bias. Clinical management and investigation were compared with published guidelines. This paper describes detailed study methods and reports on project engagement by NHS and IS hospitals. The methodology includes a new classification of perioperative anaphylaxis and a new structured method for classifying suspected anaphylactic events including the degree of certainty with which a causal trigger agent can be attributed. ResultsNHS engagement was complete (100% of hospitals). Independent sector engagement was limited (13% of approached hospitals). We received >500 reports of Grade 3–5 perioperative anaphylaxis, with 266 suitable for analysis. We identified 199 definite or probable culprit agents in 192 cases. ConclusionsThe methods of NAP6 were robust in identifying causative agents of anaphylaxis, and support the accompanying analytical papers.

Survey of faculty workload and operational characteristics for academic drug information centers

IntroductionA survey of drug information specialists from academic drug information centers in the United States was conducted to identify faculty workload, operational characteristics of the center, and contribution of those faculty and centers to pharmacy education. MethodsA 32-item survey was administered to drug information specialists and pharmacy college/school deans. Faculty workload items included age, credentials, training, and responsibilities. Center operational items identified clients, number of requests, staffing structure, and funding source. Pharmacy education items included number and type of students training at the center as well as drug information's role in the curriculum. Participants were also asked to identify recent and anticipated changes as well as predict future challenges for academic drug information centers. ResultsThe survey achieved a response rate of 81% from eligible institutions. The typical drug information specialist is between 31 and 50 years old, in a clinical track faculty position, and has an average of 13 years of drug information experience. Academic drug information centers are generally funded by the institution, open five days a week, and serve a variety of clients including the lay public. The average drug information specialist teaches one didactic course and is a preceptor for 17 advanced practice experience students, and 15 introductory practice experience students. ConclusionsDrug information specialists and centers play an important role in pharmacy education. Results of this survey could assist in the creation of benchmarks for academic drug information faculty and centers in terms of workload, resource allocation, and promotion.

Results of a 10-year survey of workload for 10 treatment vaults at a high-throughput comprehensive cancer center.

The workload for shielding purposes of modern linear accelerators (linacs) consists of primary and scatter radiation which depends on the dose delivered to isocenter (cGy) and leakage radiation which depends on the monitor units (MUs). In this study, we report on the workload for 10 treatment vaults in terms of dose to isocenter (cGy), monitor units delivered (MUs), number of treatment sessions (Txs), as well as, use factors (U) and modulation factors (CI) for different treatment techniques. The survey was performed for the years between 2006 and 2015 and included 16 treatment machines which represent different generations of Varian linear accelerators (6EX, 600C, 2100C, 2100EX, and TrueBeam) operating at different electron and x‐ray energies (6, 9, 12, 16 and 20 MeV electrons and, 6 and 15 MV x‐rays). An institutional review board (IRB) approval was acquired to perform this study. Data regarding patient workload, dose to isocenter, number of monitor units delivered, beam energies, gantry angles, and treatment techniques were exported from an ARIA treatment management system (Varian Medical Systems, Palo Alto, Ca.) into Excel spreadsheets and data analysis was performed in Matlab. The average (± std‐dev) number of treatment sessions, dose to isocenter, and number of monitor units delivered per week per machine in 2006 was 119 ± 39 Txs, (300 ± 116) × 102 cGys, and (78 ± 28) × 103 MUs respectively. In contrast, the workload in 2015 was 112 ± 40 Txs, (337 ± 124) × 102 cGys, and (111 ± 46) × 103 MUs. 60% of the workload (cGy) was delivered using 6 MV and 30% using 15 MV while the remaining 10% was delivered using electron beams. The modulation factors (MU/cGy) for IMRT and VMAT were 5.0 (± 3.4) and 4.6 (± 1.6) respectively. Use factors using 90° gantry angle intervals were equally distributed (~0.25) but varied considerably among different treatment techniques. The workload, in terms of dose to isocenter (cGy) and subsequently monitor units (MUs), has been steadily increasing over the past decade. This increase can be attributed to increased use of high dose hypo‐fractionated regimens (SBRT, SRS) and the increase in use of IMRT and VMAT, which require higher MUs per cGy as compared to more conventional treatment (3DCRT). Meanwhile, the patient workload in terms of treatment sessions per week remained relatively constant. The findings of this report show that variables used for shielding purposes still fall within the recommendation of NCRP Report 151.

Cross-sectional survey of workload and burnout among Japanese physicians working in stroke care: the nationwide survey of acute stroke care capacity for proper designation of comprehensive stroke center in Japan (J-ASPECT) study.

Burnout is common among physicians and affects the quality of care. We aimed to determine the prevalence of burnout among Japanese physicians working in stroke care and evaluate personal and professional characteristics associated with burnout. A cross-sectional design was used to develop and distribute a survey to 11 211 physicians. Physician burnout was assessed using the Maslach Burnout Inventory General Survey. The predictors of burnout and the relationships among them were identified by multivariable logistic regression analysis. A total of 2724 (25.3%) physicians returned the surveys. After excluding those who were not working in stroke care or did not complete the survey appropriately, 2564 surveys were analyzed. Analysis of the participants' scores revealed that 41.1% were burned out. Multivariable analysis indicated that number of hours worked per week is positively associated with burnout. Hours slept per night, day-offs per week, years of experience, as well as income, are inversely associated with burnout. Short Form 36 mental health subscale was also inversely associated with burnout. The primary risk factors for burnout are heavy workload, short sleep duration, relatively little experience, and low mental quality of life. Prospective research is required to confirm these findings and develop programs for preventing burnout.

SU-E-T-290: Results of a 12 Year Survey of Workload for 10 Linear Accelerators at a High-Throughput Comprehensive Cancer Center

Purpose: To report on the workload for 10 different treatment machines in terms of number of patients (pts), monitor units delivered (MUs), dose at isocenter (Gys), use factors (U) and modulation factors (C). Methods: The survey was performed for 10 treatment machines in the years from 2001 to 2012. The machines represented different generations of Varian linear accelerators (6EX, 600C, 2100C, 2100EX, and True Beam) operating at different electron and photon energies (6, 9, 12, 16 and 20 MeV electrons and, 6 and 15MV photons). An IRB approval was acquired to perform this study. Data regarding patient workload, number of monitor units delivered, dose at isocenter, beam energies, gantry angles, and techniques were exported from ARIA treatment management system (Varian Medical Systems) into excel spreadsheets. Data analysis was performed in Matlab (R2011a). Results: The number of patients, dose at isocenter, and number of monitor units delivered per week in 2002 was on average 92±32 pts, 267±34 Gys, and (49.2±10) × 103 MUs respectively. Meanwhile, the average workload in 2012 was 106±38 pts, 326±69 Gys, and (110.7±34) × 103 MUs. The photon beam energies predominantly used were the 6 and 15 MV. The modulation factors for SBRT (CS) and IMRT (CI) were 4.1 and 3.4. Use factor (30° bin angles) varied considerably among different techniques and ranged between 0.06 and 0.35. Conclusion: The workload, in terms of monitor units (MUs), has been steadily increasing over the past decade. However, the patient workload and consequently the dose at isocenter remained relatively constant. This increase can be attributed to the emergence of treatment techniques (SBRT, IMRT) which require more MUs per Gy as compared to more conventional treatment (3DCRT). The findings of this report show that variables are still within the recommendation of NCRP Report 151. youtube to mp3

Measuring radiologist workload: how to do it, and why it matters

This article discusses the results and implications of a nationwide survey of radiologist workload. Although the results are specific to one country, the method used, the underlying issues and the discussion engendered should be of interest to all radiologists worldwide. The balance between quality and quantity is highlighted, and the growing impact of activities outside of traditional reporting is considered. Variations in health care funding and staffing amongst countries clearly influence patterns of workload. It is hoped that this discussion will lead other radiologists to consider the method used, and to analyse workload in other countries, with a view to creating more robust workload data and stimulating debate.

Fact-finding Survey of Work Load in Vine Growing Operation

ブドウ果房管理作業における頸肩部の負担は上肢系筋骨格系症状の発症要因となっている。負担軽減策の立案に資するために，現状のブドウ果房管理における作業負担の程度と要因を明らかにすることを目的として，滋賀県湖南地域でブドウを栽培している作業者を対象に，観察，聞き取り，ビデオ撮影による姿勢計測から作業分析を行ない，合わせて全身や局所の疲労状況を把握するための質問紙調査を，2009年の5月から6月にかけて実施した。 作業者12人についての作業分析と47人日分の質問紙調査の結果から，作業位置の高さに起因する長時間で高頻度に繰り返された頸部後屈 (作業時間の82%) と上肢挙上保持 (左肘頭が肩より上方に位置した時間率56%) が大きな負荷となり，全身的な疲労や頸肩部の筋疲労を生じさせていたことが判明した。特に，頸部後屈や上肢挙上保持作業に慣れていない状況で行なう最も高い作業位置の「新梢の水平誘引」，「ジベレリン処理」における上肢へのジベレリン水溶液重量負荷，「第2回ジベレリン処理」による疲労が蓄積した状態で行なう最も困難度が高く長い時間を要する「摘粒」での負担が大きな問題であった。負担軽減策として，作業位置の低下 (樹木の仕立て方，足台の使用)，頭部や上肢を支持する用具，「ジベレリン処理」における上肢への荷重負荷軽減，身体の使い方の工夫 (左右上肢の役割交替等) が考えられた。

British Association of Retinal Screeners (BARS): survey of workload in UK diabetic retinopathy screening programmes

AbstractThe aim of this survey was to determine the number of patients being screened per session in UK diabetic retinal screening programmes and the number of patients images being graded in stand alone grading sessions.A questionnaire was sent to all members of the British Association of Retinal Screeners asking for information about diabetic retinal screening schemes in which they were involved.Sixty‐eight (31%) replied and suggested that an average of 14.4 patients were being screened per session on a fixed site programme, and an average of 15.7 per session with a mobile service. A standard morning session was, on average, 3 hours and 23 minutes long on a fixed site and 3 hours and 14 minutes on a mobile site. A standard afternoon session was, on average, 3 hours and 5 minutes long on a fixed site and 2 hours and 44 minutes long on a mobile site. Those undertaking grading as a stand alone activity screened an average of 39.3 patients per session (ranging from 20–75 patients per session).While the lengths of morning and afternoon screening sessions were relatively consistent there was more variability in the number of patients whom a stand alone grader would typically grade per session. We believe this range of activity reinforces the importance of a good quality assurance programme to maintain the consistency of the service offered. Copyright © 2010 John Wiley &amp; Sons.

PTH-021 A survey of endoscopy workload in northern England: lower gastrointestinal endoscopy workload exceeds British Society of Gastroenterology projections

Introduction The BSG working party report on the Provision of Endoscopy Related Services in District General Hospitals (2001) made clear projections of the estimated endoscopic workload in an average district general hospital.1 The Northern Region Endoscopy Group (NREG) is a network connecting all endoscopy units in the North East of England with the aim of promoting collaboration and endoscopy based research. The aim of this study was to measure current endoscopic workload in the Northern Region Endoscopy Goup and compare it to the BSG recommendations. Methods Questionnaires were sent to each of the 16 endoscopy units within the Northern Region of England. Completed questionnaires were received from all 16 endoscopy units in nine trusts. Results The total population served by endoscopy units within NREG is 3.5 million people. Ninety-five thousand endoscopic procedures were performed across the region last year, 45 194 (47%) were upper GI, 27 541 (29%) colonoscopies, 17 912 (19%) flexible sigmoidoscopies and 2688 (3%) were ERCPs. Across the region 13 gastroscopies per 1000 population, 7.9 colonoscopies, 5.1 flexible sigmoidoscopies and 0.77 ERCPs were performed per 1000 population per annum. Conclusion Current endoscopic workload figures for upper GI endoscopy and ERCP are in line with the BSG working party9s estimations of 2001. The burden of lower GI work within the Northern Region is greater than the BSG predictions with nearly twice as many procedures as predicted being performed. Contributing factors include changing referral practices, the Bowel Cancer Screening Programme, and more widespread open access services. Current lower GI endoscopy workload figures are considerably higher than those quoted in the NICE document “Improving Outcomes on Colorectal Cancers” (2004)2 and the Royal College of Physicians publication “Consultant Physicians Working with Patients” (2004).3 Current workload is in line with Healthcare commission9s 2006 survey.4 The implications of these data include: Financial and manpower planning needs to take into account the increased burden on endoscopy services. The BSG estimates for lower GI endoscopy workload should be revised. A similar evaluation of changes in endoscopy workload should be performed at a national level. Abstract submitted on behalf on the Northern Region Endoscopy Group (NREG).

A survey of workload, facilities and awareness of uncertainty of measurement among Italian laboratories performing analyses in occupational and environmental medicine

Biological monitoring is essential for risk assessment in the presence of exposure of workers or the general population to harmful chemical agents. Besides the choice of analytical methods which are fit for purpose and the skills of the analysts, the performance of laboratories, including those working in the field of environmental and occupational medicine, also depends on other technical factors such as frequency of testing, the use of well maintained and properly functioning equipment and the implementation of quality control procedures including the participation in External Quality Assessment Schemes (EQAS). Surveys of laboratory workload have been organized periodically since 1997 within the MeTos Project, an Italian national EQAS for biomarkers of environmental and occupational exposure to chemical agents. In 2001, a more extensive survey, including specific technical issues, was organized as part of the activities of the Thematic Network of European Organizers of External Quality Assessment/Proficiency Testing Schemes Related to Occupational and Environmental Medicine (Network survey). In addition, information on the awareness and implementation of the new requirement for laboratories to estimate the uncertainty of their measurements was collected since 2000. The results of these surveys are reported and compared here. In all surveys, Pb in blood was the biomarker most frequently determined. As for biomarkers of exposure to organic compounds, the data collected in the Network survey indicate that methylhippuric acid, hippuric acid and mandelic acid in urine were the assays most commonly performed. About a third of the participants stated that they estimate the uncertainty of at least some of their measurements. Preliminary analysis of data, limited to Pb in blood, showed that analytical performance improved with continuous participation in EQAS and was positively influenced by a high workload.

Helping patterns and reproductive success in Aymara communities.

"Helpers at the nest," young adults remaining in their parents home to take care of younger siblings, are known in many species of birds and mammals. Similar behaviors are occasionally observed in human societies but their frequency and significance for parental reproductive success are still not fully appraised. This study was designed to document this issue in a traditional Aymara peasant society of the Bolivian Altiplano, It is based on 359 reproductive life histories of women 45 years of age or older and on a survey of children's workload in 1998 and 1999. The presence of "potential helpers" in the household is significantly associated with higher fertility and with improved survival of siblings to sexual maturity. Caretaking is not particularly assigned to older daughters. The positive relationship between the availability of offspring help and reproductive success does not demonstrate a causal role for child caretaking because, in contrast with nonhuman helpers, workloads of children range from housekeeping to agricultural tasks, instead of being focused on feeding or protecting younger siblings. Correlation and multiple regression analyses, however, suggest that the total amount of care given by the older offspring and the amount of care received by each recipient are, along with offspring contribution to household economy, among the determinants of parental reproductive success.

A National Survey of Autopsy Cost and Workload

We mailed survey questionnaires to a random sample of medicolegal offices throughout the USA. The survey asked how many forensic pathologists were used, their American Board of Pathology forensic examination (Board) status, how many autopsies they performed, and, if payment were fee-for-service, what fees were paid for medicolegal autopsies. Response rate was 61%, with 188 offices returning questionnaires. The average fee, was $518 with a standard error of $27. The number of fee-for-service autopsies was split evenly between Board qualified and Board ineligible pathologists, accounting for about one-third of medicolegal autopsies nationwide. Although smaller offices used more pathologists ineligible for forensic Boards, they paid a premium for such qualification. Larger offices used more forensic Board qualified pathologists, but paid them less than those ineligible to take the examination! Overall there was no significant premium paid for Board qualification. The average fee paid is far less than the published estimates of the cost of an autopsy. The low fees paid may reflect: (1) the value of the teaching experience supplied to medical students and/or residents; (2) pathologists performing medico-legal examinations as community service; and (3) the lower marginal cost of additional autopsies.