Mentally Demanding Work and Strain: Effects of Study Duration on Fatigue, Vigor, and Distress in Undergraduate Medical Students.

AIMS: The impact of the extent of mentally demanding work on the next-day's strain is largely unknown, as existing studies generally investigate consequences of extended versus normal workdays. The present study sought to fill this gap by investigating how short work periods of mentally demanding academic work impact strain reactions in medical students preparing for an exam, using days of no work as reference category. METHOD: The observational design involved students repeatedly self-reporting fatigue, vigor, distress, and the preceding day's study duration. Hours of nocturnal sleep, attending paid work and compulsory classes, gender, and proximity to the exam were controls in the linear model (generalized estimating equations). Forty-nine students provided 411 self-reports (M = 8.6, SD = 7.0 self-reports/student). RESULTS: Engaging in mentally demanding work was associated with increased distress and work periods > 4 h with increased fatigue. Distress, vigor loss, and fatigue increased in proximity to the exam. CONCLUSION: Despite students' high control of their schedule, even short periods of mentally highly demanding work may impair next-day's well-being when task motivation is high. Freelancers and students might require health-promoting scheduling of work and leisure to avoid an accumulation of strain.

Nurses' rest breaks and organizational leaving intentions.

Improving nurses' staff retention is highly needed since risks of turnover are high in this profession. Prior research uncovered job demands as important driver and job resources as protective factor for the development of nurses' organizational leaving intentions. However, research on beneficial effects of rest break design as an important job resource on nurses' leaving intentions is sparse and their interactions with present job demands have been widely neglected. Therefore, we aimed to examine if different rest break characteristics (i.e. break length, break disturbances, and social breaks) predict nurses' organizational leaving intentions while also considering job demands (i.e. quantitative, cognitive, and emotional demands, and social conflicts) and other well-known person-related and work-related turnover antecedents. We conducted a cross-sectional paper-pencil survey study with 167 nurses from Germany. We found a positive relation between rest break disturbances and organizational leaving intentions even after adjusting for person-related and work-related confounders. Rest break length and the frequency of social breaks were no significant predictors when considering all rest break characteristics in combination. Moreover, high quantitative demands and high social conflicts at work related to higher leaving intentions. Fewer rest break disturbances increased the negative relation between cognitive demands and leaving intentions. In order to reduce nurses' organizational leaving intentions and to improve staff retention, nursing management should prevent disturbances of nurses' rest breaks in addition to other work design interventions such as reducing quantitative demands and social conflicts and especially when implementing cognitive challenging tasks.

The impact of rest breaks on subjective fatigue in physicians of the General Hospital of Vienna.

AIMS: Medical doctors are affected by high levels of occupational burnout. Work organization such as sufficient rest breaks can decrease stress and fatigue; however, rest breaks are often skipped under high workload and time pressure. The present study sought to investigate the effect of self-determined rest breaks on acute and daily levels of fatigue in physicians of the General Hospital of Vienna. METHODS: Rest breaks and fatigue were recorded throughout day shifts over a time span of 4 weeks with a mobile assessment device. A total of 12 physicians of a university clinic participated in the study. Data were analyzed using generalized estimating equations. RESULTS: Analyses were based on a total of 115 workdays including 93 rest breaks and 800 fatigue assessments. Physicians took an average of 0.81 rest breaks per day. Fatigue was lower in the 30 min after the break than in the hour before the break; however, the number of rest breaks did not affect the increase of fatigue during shifts. CONCLUSION: Self-determined rest breaks were effective in reducing acute fatigue in hospital physicians during work. The failure to find an effect on the increase of work-related fatigue may be due to the infrequency of rest breaks in hospital physicians.

Individual Determinants of Rest-Break Behavior in Occupational Settings.

AIMS: Work breaks improve well-being, productivity, and health. The aim of this study was to investigate the individual determinants of rest-break behavior during work using the theory of planned behavior (TPB). METHODS: The association between attitude, control, and subjective norm and rest-break intention (i.e., taking rest breaks regularly), and rest-break behavior (average number of rest breaks/workhour) was analyzed with stepwise linear regression in a cross-sectional design. The study participants included 109 clerical employees, and 215 nurses. RESULTS: Attitude and control were positively associated with rest-break intention. Intention and control were positively associated with rest-break behavior. The effect of intention was moderated by occupation, with intention being more weakly associated with rest-break behavior in nurses who had less behavioral control. CONCLUSIONS: Job control is the major predictor of rest-break behavior, with attitudes playing a minor role, and social norm playing no role. To increase rest-break behavior, a greater extent of job control is necessary.

Is a meditation retreat the better vacation? effect of retreats and vacations on fatigue, emotional well-being, and acting with awareness.

It is well established that leisure vacations markedly improve well-being, but that these effects are only of short duration. The present study aimed to investigate whether vacation effects would be more lasting if individuals practiced meditation during the leisure episode. Meditation is known to improve well-being durably, among others, by enhancing the mental faculty of mindfulness. In this aim, leisure vacations during which individuals practiced meditation to some extent were compared with holidays not including any formal meditation practice as well as with meditation retreats (characterized by intense meditation practice) utilizing a naturalistic observational design. Fatigue, well-being, and mindfulness were assessed ten days before, ten days after, and ten weeks after the stays in a sample of 120 individuals accustomed to meditation practices. To account for differences in the experience of these stays, recovery experiences were additionally assessed. Ten days after the stay, there were no differences except for an increase in mindfulness for those practicing meditation. Ten weeks after the stay, meditation retreats and vacations including meditation were associated with greater increases in mindfulness, lower levels of fatigue, and higher levels of well-being than an "ordinary" vacation during which meditation was not practiced. The finding suggests that the inclusion of meditation practice during vacation could help alleviate vacations' greatest pitfall, namely the rapid decline of its positive effects.

Time course of recovery after two successive night shifts: A diary study among Austrian nurses.

AIM: To explore how nurses recover from night shift work during periods off duty. BACKGROUND: Given the large number of affected individuals globally, detrimental health outcomes of night shift work are an important public health issue. Sufficient recovery opportunities are essential to prevent prolonged fatigue associated with demanding tasks and high workload as experienced in nurses working long shifts during the night. METHOD: Nurses (n = 53, 96% females) who worked in two public nursing homes in Austria completed a 5-day diary to collect data on well-being conceptualized by fatigue, distress and vigour. RESULTS: Nurses experienced worse well-being post night shift days than during rest days. Well-being improved from post night shift day 2 to the following rest day 1 and continued improvement from rest day 1 to rest day 2. CONCLUSIONS: Nurses who work at nights are at risk for experiencing prolonged fatigue. Our results suggest that after two consecutive 12-hr night shifts full recovery needs at least three days off work. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies for maintaining nurses' good health and caring attitudes as well as vigilance for patient safety should include fatigue management plans and optimised schedules for night shift work.

Comparison of rest-break interventions during a mentally demanding task.

Research is scarce on ways to enhance the effect of rest breaks during mentally demanding tasks. The present study investigated the effectiveness of two rest-break interventions on well-being during an academic lecture. Sixty-six students (53 females, mean age 22.5 years) enrolled in two different university classes of 4-hr duration participated in the study. Two measures of well-being (fatigue and vigor) were assessed immediately before, after, and 20 minutes after the break. A control condition without a break as well as an unstructured break was compared with breaks either encompassing physical activity or a relaxation exercise. Compared with the nonbreak condition, the unstructured rest break led to an increase in vigor, the exercise break as well as the relaxation break both to an increase in vigor and a decrease in fatigue at 20-min post break. Compared with the unstructured break, exercise led to an (additional) increase in vigor and relaxation to an (additional) decrease in fatigue at 20-min post break. Thus, the effects of rest breaks during mentally demanding tasks can be enhanced by engaging in physical activity or relaxation exercises, with effects lasting at least as long as 20 min into the continuation of the task.

Job-related meaningfulness moderates the association between over-commitment and emotional exhaustion in nurses.

AIM: To evaluate characteristics of job-related meaningfulness, and to assess its potential to moderate the relationship between over-commitment and emotional exhaustion in nurses. BACKGROUND: Increased demands on nurses may induce vulnerability to emotional exhaustion, decrease job satisfaction, and increase their intention to quit the job. The experience of job-related meaningfulness through meaning-centred logotherapy and counseling could be a resource to prevent emotional exhaustion. METHOD: Nurses (n = 466; 73% female) at an Austrian tertiary-care hospital participated in a cross-sectional survey for assessment of job-related meaningfulness by the newly developed CERES (Concern, Enthusiasm, Relevance, Efficacy, Satisfaction) scale. CERES was tested for its moderating interaction with over-commitment (assessed by the Effort-Reward Imbalance Questionnaire) to prevent emotional exhaustion (as measured by the Maslach Burnout Inventory) by structural equation modelling. RESULTS: The CERES scale consisting of five items has satisfactory internal consistency (Cronbach's alpha: .78). Over-commitment correlated significantly (p < .001) with emotional exhaustion. A moderating interaction of CERES with over-commitment on emotional exhaustion was found overall (p < .001), and separately for males (p = .002) and females (p < .001). CONCLUSIONS: CERES is suitable for assessing experienced job-related meaningfulness and it moderates emotionally exhausting effects of over-commitment in nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers may improve nurses' awareness of job-related meaningfulness by focusing on meaning-centred feed-back and counselling and thereby strengthening perception of concern, enthusiasm, relevance, efficacy, and satisfaction regarding their caring behaviour.

Work-related self-assessed fatigue and recovery among nurses.

PURPOSE: Adequate recovery opportunities are crucial for preventing long-term health effects of acute load reactions in response to stressful work. However, little is known about the time course of recovery from work during non-working days. Thus, the present study assessed recovery from two consecutive 12-hours day shifts during a period of three rest days among nurses. METHODS: In total, 48 nurses (89.6% females) working in three public Austrian nursing homes completed 5-day self-reporting diaries prior to a work phase consisting of two consecutive 12-hours day shifts followed by three consecutive rest days. Therefore, morning and evening fatigue, distress, vigor and sleep were self-assessed by standardized questionnaires. We analyzed the data using multivariate analysis of variance for repeated measures. RESULTS: Study participants experienced worse well-being and a greater decline in well-being on working days compared to rest days. Well-being increased from rest day 1 to rest day 2 in fatigue, vigor and distress. Rest day 2 to rest day 3 showed a further improvement in fatigue and vigor. CONCLUSIONS: Understanding the concepts of allostatic load, need for recovery and fatigue is essential to develop personalized working schedules. The results suggest that at least three rest days are necessary for full recovery after two consecutive 12-hours day shifts. Thus, adequate time for recovery enables nurses to maintain caring attitudes with patients, thus contributing to patient safety.

Effects of Rest-Break Intention on Rest-Break Frequency and Work-Related Fatigue.

OBJECTIVES: The present paper presents findings from two studies addressing the effects of the employee's intention to have rest breaks on rest-break frequency and the change of well-being during a workday. BACKGROUND: Rest breaks are effective in avoiding an accumulation of fatigue during work. However, little is known about individual differences in rest-break behavior. METHOD: In Study 1, the association between rest-break intention and the daily number of rest breaks recorded over 4 consecutive workdays was determined by generalized linear model in a sample of employees ( n = 111, 59% females). In Study 2, professional geriatric nurses ( n = 95 females) who worked over two consecutive 12-hour day shifts recorded well-being (fatigue, distress, effort motivation) at the beginning and the end of their shifts. The effect of rest-break intention on the change of well-being was determined by multilevel modeling. RESULTS: Rest-break intention was positively associated with the frequency of rest breaks (Study 1) and reduced the increase of fatigue and distress over the workday (Study 2). CONCLUSION: The results indicate that individual differences account for the number of breaks an employee takes and, as a consequence, for variations in the work-related fatigue and distress. APPLICATION: Strengthening rest-break intentions may help to increase rest-break behavior to avoid the buildup of fatigue and distress over a workday.

Fatigue and Insufficient Leisure Opportunities in Older Employees.

OBJECTIVE: The aim of this study was to investigate the impact of age on fatigue prevalence and the potential recovery effect of leisure opportunities. METHODS: The study was based on the Austrian Health Interview Survey 2006/2007. We investigated data of a subsample of working adults, which consisted of 5018 subjects (51.8% males) aged 35 to 59 years. A logistic regression analysis stratified by gender explored whether age and leisure opportunities predicted prolonged fatigue. RESULTS: Age was not associated with fatigue in females, but older male employees (55 to 59 years) were at a greater risk for fatigue than the reference group (35 to 39 years). Insufficient leisure opportunities increased the odds for fatigue in both genders and all age groups. However, this effect was especially pronounced in male employees aged 55 to 59 years. CONCLUSIONS: These results suggest that older male employees may be in need of more leisure opportunities to recover from work.

Salt taste after bariatric surgery and weight loss in obese persons.

Background. Little is known about the perception of salty taste in obese patients, especially after bariatric surgery. Therefore, the aim of this study was to analyse possible differences in salt detection thresholds and preferences for foods differing in salt content in obese persons before and after bariatric surgery with weight loss compared to non-obese individuals. Methods. Sodium chloride detection thresholds and liking for cream soups with different salt concentrations were studied with established tests. Moreover, a brief salt food questionnaire was assessed to identify the usage and awareness of salt in food. Results. The results showed similar mean sodium chloride detection thresholds between non-obese and obese participants. After bariatric surgery a non-significant increase in the salt detection threshold was observed in the obese patients (mean ± SD: 0.44 ± 0.24 g NaCl/L before OP vs. 0.64 ± 0.47 g NaCl/L after OP, p = 0.069). Cream soup liking between controls and obese patients were not significantly different. However, significant sex specific differences were detected with the tested women not liking the soups (p < 0.001). Results from the food questionnaire were similar between the groups. Conclusion. No differences between non-obese persons and obese patients were shown regarding the salt detection threshold. However, due to highly significant differences in soup liking, sex should be taken into consideration when conducting similar sensory studies.

Task-related increases in fatigue predict recovery time after academic stress.

OBJECTIVE: The aim of this study was to investigate the time course of recovery after an academic exam as a model of high workload and its association with stress-related fatigue. METHODS: Thirty-six medical students (17 females, 19 males) filled out diaries during an exam phase, starting 2 days prior to the exam, and a control phase 4 weeks after the exam for 14 days, respectively. Fatigue, distress, quality of sleep, and health complaints were assessed. Recovery time was determined for each individual and variable by comparing the 3-day average with the confidence interval of the control phase. Recovery time was predicted by Cox regression analyses. RESULTS: Recovery times of all variables except health complaints were predicted by stress-related fatigue. Half of the individuals had recovered after 6 days, and 80% of the individuals had recovered after 8 days. CONCLUSION: The time necessary for recovery from work demands is determined by fatigue as a measure of resource depletion.

Is There an Association Between the Body Mass Index and Interpersonal Violent Behavior?

An inverse relationship between the body mass index (BMI) and the risk of completed suicide was shown in several studies. Furthermore, it is suggested that obesity might be associated with a lower risk for violent criminality. Therefore, the aim of this study was to analyze whether a higher BMI is associated with a lower risk for being arrested due to violent behavior in a sample of 43,992 male offenders. Multinomial logistic regression analysis was applied to assess the relationship between different BMI categories and categories of committed crime as outcome variable by including various covariates. Our results indicated that compared to a normal BMI a higher BMI was associated with a significantly lower risk for being arrested in different crime categories associated with interpersonal violence, such as crimes against life and limb (for example: odds ratio=0.60, CI 95%: 0.52-0.69 for 30-34.9 kg/m2).

Health care utilisation in subjects with osteoarthritis, chronic back pain and osteoporosis aged 65 years and more: mediating effects of limitations in activities of daily living, pain intensity and mental diseases.

Musculoskeletal diseases (MDs) have major consequences for the individual, and also for society and may thus lead to increased use of health care. It was the aim of this study to explore health care utilisation in patients with self-reported osteoarthritis, chronic back pain or osteoporosis compared with people of the same age without those diseases, based on data of the Austrian health interview survey including 3,097 subjects aged ≥ 65 years. Patients with MDs in our study visited a general practitioner (GP) and were hospitalised significantly more often compared with persons without the respective diseases. Problems in the activities of daily living (ADLs), pain intensity and anxiety/depression influenced GP consultations. Complex factors explain the higher health care utilisation in subjects with MDs in our study. Our results indicate that integrated strategies are needed to manage those patients, which should focus on management of ADL problems, pain and mental health.

The treatment experience questionnaire: development and validation of a questionnaire assessing the individual's emotional, perceptual, and cognitive reactions to alternative, physical, and dental treatments.

BACKGROUND: The aim of this study was to develop and validate a questionnaire designed to assess the patient's affective, cognitive, and perceptual state during treatment administration. METHODS: 362 individuals (214 females, 148 males, mean age 54.6 years) with predominantly musculoskeletal or dental problems participated in the study. Patients responded to the questionnaire immediately following a treatment. The questionnaire included items of 9 proposed scales devised to assess mood, psychological tension, sleepiness, mental absorption, treatment appraisal, perceived cooperation during treatment administration, perceived somatosensory intensity of treatment as well as negative and positive bodily sensations during treatment. Treatments were administered in 2 spa centers, a clinic for physical medicine and rehabilitation and a clinic for dentistry. Treatments investigated were among others dental treatment, massage, packs, baths, relaxation training, exercise, and acupuncture. RESULTS: The proposed scales were confirmed. Scales had adequate to good reliability and validity. All scales significantly distinguished between treatments. CONCLUSION: The devised questionnaire has adequate properties to assess patients' experiences during treatment administration.

Work-site health promotion of frequent computer users: comparing selected interventions.

OBJECTIVE: Frequent computer use is associated with an increase in musculoskeletal complaints. The present study aims at comparing the relative efficacy of three novel interventions for the preventions of musculoskeletal complaints in frequent computer users. PARTICIPANTS: 93 employees (56 woman, 37 men, mean age 40.1 ± 8.8 years) with frequent computer use. METHODS: Participants were assigned on the basis of preference to one of the following interventions of 8 week duration: Nordic Walking (NW), biofeedback assisted relaxation and stretching (BFB), balance exercises on a wobble board (BAL) or a waiting list control group. Outcome measures were musculoskeletal complaints, emotional well-being, fatigue, job dissatisfaction as well as neuromuscular activity in the neck/shoulder region at rest and during computer work assessed before and after the intervention and at 3 months follow-up. RESULTS: The average number of training-units per week was 2.2 ± 0.8, 5.5 ± 3.5 and 4.1 ± 2.9 for NW, BFB and BAL, respectively. NW led to short and medium term improvement of musculoskeletal complaints, BFB to a short term improvement of musculoskeletal complaints. Effects on the well-being related variables or on neuromuscular activity were not found. BAL had no effect on the studied variables. CONCLUSION: NW and to a limited extent BFB are interventions potentially useful for reducing musculoskeletal complaints in frequent computer users.

Too much salt and how we can get rid of it.

Humans evolved on potassium-rich diets containing only small amounts of sodium. Nowadays, sodium intake considerably exceeds potassium intake. However, from the evolutionary point of view we are not accustomed to such high salt (sodium chloride) ingestion. The consequences of a high dietary salt intake are primarily elevated blood pressure with a higher risk for cardiovascular diseases, but also a higher probability of developing kidney diseases and stomach cancer. High sodium consumption is favored by an extremely 'salty' environment, where palatable salty food is frequently available promoting a dietary salt overload of the human body. To efficiently achieve a consistent reduction in dietary salt intake, sodium content of food should be reduced and eating behavior modified. This review covers both of these aspects, including the reasons why we are not 'programmed' to cope with high salt loads, the clinical consequences of a high salt consumption and the possibilities of reducing dietary salt intake and getting rid of the 'salty' environment.

Short-term effect of macronutrient composition and glycemic index of a yoghurt breakfast on satiety and mood in healthy young men.

BACKGROUND: Promoting satiety and repressing appetite is one major goal in the dietetic therapy of obesity. In the past, several studies investigated the effect of different macronutrients, especially protein and carbohydrates, on short- and long-term satiety in humans. This paper aims to directly compare the effect of protein, rolled oats (low glycemic index), sugar or cornflakes (high glycemic index), and walnuts (high amount of omega-3 fatty acids) as ingredients of a yoghurt breakfast on short-term hunger and satiety in one setting. A second objective was to study the effect of these yoghurt breakfasts on mental state. METHODS: 14 healthy male volunteers participated in this randomized, controlled, cross-over design study. After consuming the different test meals, volunteers repeatedly completed 2 questionnaires over a total of 3 h. RESULTS: The protein meal showed the highest satiety scores and the controls (low-calorie yoghurt) the lowest. The other test meals were not different among each other. Regarding mental state (mood, fatigue, and calmness), no significant difference between the test meals and the low-calorie control was observed. CONCLUSION: The glycemic index does not seem to modify satiety in this short-term setting. The similar mental state between low- and high-calorie breakfasts deserves further investigations.