Work as a social determinant of health in high-income countries: past, present, and future.

This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.

Age-Period-Cohort Analysis of Long-Term Trends in Ischemic Stroke Mortality in China Caused by Specific Risk Factors from 1990 to 2019.

OBJECTIVE: The objective of this study was to study the primary risk factors for the long-term trends of mortality rates in ischemic stroke (IS) in China. METHODS: Using the Global Burden of Disease Study 2019 (GBD 2019) database, research was conducted on the 11 primary risk factors for the mortality rates of IS in China from 1990 to 2019. This study employed joinpoint regression software and the age-period-cohort method to evaluate the trends of mortality rates divided by age, period, and cohort over time. RESULTS: From 1990 to 2019, the age-standardized mortality rate (ASMR) caused by a diet high in red meat and high body mass index in China showed an upward trend. ASMR increased first and then decreased due to smoking, diet high in sodium, particulate matter pollution, high fasting plasma glucose, and high systolic blood pressure. Low-density lipoprotein cholesterol (LDL-C), kidney dysfunction, low temperature, and lead exposure remained relatively stable during this period. In the 35-45 age group, the mortality rate of IS due to high LDL-C was up to about 60%, and smoking affected men more than women. Overall, high LDL-C, high systolic blood pressure, and particulate matter pollution were the most common risk factors in patients with IS. The risk of death rose with age. The period and cohort relative risks showed that metabolic risk factors had the greatest impact on the mortality of IS. CONCLUSION: Metabolic risk factors have become the primary risk factors for the ASMR of IS in China. Relevant authorities should pay attention to their long-term effects on IS. Effective public health policies and interventions should be implemented to reduce the burden of IS.

Association Between Retirement Age and Incidence of Depressive Disorders: A 19-Year Population-Based Study.

OBJECTIVE: To investigate the occurrence of depressive disorders spanning the transition to retirement, and explore the relationship between retirement age and depressive disorders. METHODS: We utilized a national population-based health insurance database encompassing 2 million Taiwanese individuals from 2000 to 2019. The study focused on individuals aged 50 years and older who were employed at the baseline, and 84,224 individuals had records of retirement during the follow-up period. Depressive disorders were identified using codes from the International Classification of Diseases. To assess the trend in the incidence of depressive disorders 7-year period before and after retirement, an interrupted time series analysis was performed. Cox-proportional hazard models were employed to investigate the association between retirement age and the occurrence of depressive disorders following retirement. RESULTS: The incidence of depression peaks at the time of retirement and shows a significant decrease after retirement. Incidence of depressive disorders was 6.4 and 7.6 per 1000 person-years among individuals who retired between the ages of 60-64 and 65-69. Comparing the two groups, those who retired between 65 and 69 exhibits a higher risk of developing depressive disorders (hazard ratio = 1.10, 95% confidence interval = 1.02-1.18). This association is particularly pronounced among women and individuals residing in areas with low urbanization levels. CONCLUSION: Retirement marks a crucial life milestone accompanied by a peak in depressive disorders. It is important to address the higher risk of depression associated with late retirement among socially disadvantaged groups.

Regulation and molecular mechanism of adiponectin on the proliferation, apoptosis, autophagy, and chemosensitivity of LN18 Glioma cell line.

This study aimed to explore the regulatory effects and associated mechanisms of adiponectin on apoptosis and proliferation in the LN18 glioma cell line through the AMPK and Akt signaling pathways. Additionally, we sought to elucidate the impact of adiponectin on the chemosensitivity of the LN18 glioma cell line to temozolomide (TMZ). The proliferation rate of glioma cells treated with adiponectin was assessed using the cholecystokinin (CCK8) assay. The Western blot analysis was employed to assess the expression of p-Akt, p-AMPK, p-mTOR, cleaved caspase3, Bax, Cyclin D1, and Cyclin B1 following adiponectin treatment. Cell apoptosis was quantified using AnnexinV/PI flow cytometry, while changes in the cell cycle were detected using PI staining flow cytometry. The findings revealed that adiponectin upregulates p-AMPK expression and downregulates p-mTOR expression in the PTEN wild-type glioma cell line LN18, with no discernible effect on p-Akt expression. Moreover, adiponectin inhibits the proliferation rate of the PTEN wild-type glioma cell line LN18, enhances the expression of cleaved caspase3 and Bax, and significantly elevates the apoptosis rate, as evidenced by AnnexinV/PI flow cytometry. Adiponectin was observed to suppress the expression of Cyclin D1 and Cyclin B1, increase the number of cells in the G1 phase, and promote autophagy. Additionally, adiponectin augments the expression of Beclin1 and the ratio of LC3II/I in the PTEN wild-type glioma cell line LN18, while decreasing p62 expression. In conclusion, this study posits that adiponectin holds therapeutic promise for glioma treatment. Furthermore, adiponectin enhances the inhibitory effect of TMZ on the proliferation rate of LN18 cells when treated with 0.1 mM and 1 mM TMZ. These results collectively suggest that adiponectin impedes proliferation, encourages apoptosis and autophagy in the LN18 glioma cell line, and heightens its sensitivity to the chemotherapeutic drug TMZ.

Association between C-reactive protein/albumin ratio and all-cause mortality in patients with stroke: Evidence from NHANES cohort study.

BACKGROUND AND AIMS: The inflammatory nutritional status is widely associated with the long-term prognosis of non-fatal stroke. The objective of this study is to examine the correlation between the C-reactive protein to albumin ratio (CAR), a new marker indicating both inflammatory and nutritional status, and the overall mortality rate among stroke patients. METHODS AND RESULTS: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) database and corresponding public-use mortality data from the linked National Death Index (NDI). The study utilized maximally selected rank statistics to determine the optimal cutoff points for the CAR. Subsequently, participants were stratified into higher- and lower-CAR groups based on these cutoff points. The Kaplan-Meier survival method was used to study overall survival probability. Multivariable Cox proportional regression models were employed to calculate the Hazard Ratio (HR) and corresponding confidence interval (CI). Restricted cubic spline (RCS) model was applied to detect potential non-linear relationship between CAR and mortality risk. Furthermore, stratified and sensitive analyses were performed to examine the robustness and reliability of the results. The study, encompassing 1043 participants with an average age of 64.61 years, identified a cutoff value of 0.32 for CAR, with notable variances observed across gender and age cohorts. Over an average follow-up period of 116 months, 679 instances of all-cause mortality were documented. Kaplan-Meier survival analysis unveiled noteworthy disparities in survival probabilities between groups categorized by high and low CAR levels (p = 0.00081). Continuous CAR analysis consistently demonstrated a positive correlation between elevated CAR values and heightened risk (HR = 1.78 (1.36, 2.33)) of all-cause mortality among stroke patients. Similarly, individuals in the high CAR group exhibited adjusted HR of 1.34 (0.96, 1.89) for all-cause mortality compared to their low CAR counterparts. Subgroup and sensitive analysis consistently reinforced these findings. Smoothing curve fitting further validated CAR's significance as a prognostic indicator of all-cause mortality, indicating a linear relationship. CONCLUSION: Elevated CAR is associated with increased long-term risk of mortality for individuals who have experienced a stroke, suggesting that CAR could serve as a survival indicator.

Apoptotic Vesicles Regulate Bone Metabolism via the miR1324/SNX14/SMAD1/5 Signaling Axis.

Mesenchymal stem cells (MSCs) are widely used in the treatment of diseases. After their in vivo application, MSCs undergo apoptosis and release apoptotic vesicles (apoVs). This study investigates the role of apoVs derived from human bone marrow mesenchymal stem cells (hBMMSCs) in bone metabolism and the molecular mechanism of the observed effects. The results show that apoVs can promote osteogenesis and inhibit osteoclast formation in vitro and in vivo. ApoVs may therefore attenuate the bone loss caused by primary and secondary osteoporosis and stimulate bone regeneration in areas of bone defect. The mechanisms responsible for apoV-induced bone regeneration include the release of miR1324, which inhibit expression of the target gene Sorting Nexin 14 (SNX14) and thus activate the SMAD1/5 pathway in target cells. Given that MSC-derived apoVs are easily obtained and stored, with low risks of immunological rejection and neoplastic transformation, The findings suggest a novel therapeutic strategy to treat bone loss, including via cell-free approaches to bone tissue engineering.

Burden of ischemic stroke in mainland China and Taiwan province from 1990 to 2019: with forecast for the next 11 years.

Ischemic stroke is featured with high incidence, mortality, and disability. The aim of this study is to use Global Burden of Disease database to describe and compare the burden of ischemic stroke in mainland China and Taiwan province and to further predict the expected changes in the next 11 years using statistical modeling methods. Information on ischemic stroke incidence and mortality in China (mainland and Taiwan province) during 1990-2019 was obtained from the Global Burden of Disease database to analyze the effects of region, gender, and age on the incidence and mortality of ischemic stroke in China. The autoregressive integrated moving average model was used to predict the age-standardized incidence rate and age-standardized mortality rate of ischemic stroke in males and females in mainland China and Taiwan province in the next 11 years. The period from 1990 to 2019 witnessed an overall upward trend in the number of incidence and deaths in mainland China and Taiwan province. In 2019, there were nearly 2.87 million ischemic incidence cases with stroke in mainland China, with more female patients than male in the age group of over 60 years. Among the nearly 1.03 million deaths, the death toll of men under the age of 85 years was higher than that of women, while in Taiwan province, the number of incidence was 28 771, with more female patients of all ages than male. Among the 6788 deaths, the death toll of men under the age of 80 years was higher than that of women. In 2019, the age group with the highest number of patients in the two regions was 65-69 years, while the highest number of deaths was found in people aged 85 years and above. As our autoregressive integrated moving average model predicted, the age-standardized incidence rate value of ischemic stroke is expected to be 163.23/100 000 persons in mainland China by 2030, which would continue to increase, while the age-standardized mortality rate value of ischemic stroke is expected to be 16.41/100 000 persons in Taiwan province by 2030, which showed a decreasing trend. Disease burden of ischemic stroke is still increasing in mainland China and Taiwan province, and health resources should be deployed to implement effective prevention and control strategies, taking into account region, gender, and age.

Repurposing of ingenol mebutate for treating human colorectal cancer by targeting S100 calcium-binding protein A4 (S100A4).

Colorectal cancer (CRC) is the world's second most common cause of cancer-related death. Novel treatments are still urgently needed. S100 calcium-binding protein A4 (S100A4) was demonstrated to be an anticancer therapeutic target. Herein, we found that higher S100A4 expression was associated with a poorer prognosis in publicly available cohorts and a Taiwanese CRC patient cohort. To identify repurposed S100A4 inhibitors, we mined the Connectivity Map (CMap) database for clinical drugs mimicking the S100A4-knockdown gene signature. Ingenol mebutate, derived from the sap of the plant Euphorbia peplus, is approved as a topical treatment for actinic keratosis. The CMap analysis predicted ingenol mebutate as a potent S100A4 inhibitor. Indeed, both messenger RNA and protein levels of S100A4 were attenuated by ingenol mebutate in human CRC cells. In addition, CRC cells with higher S100A4 expressions and/or the wild-type p53 gene were more sensitive to ingenol mebutate, and their migration and invasion were inhibited by ingenol mebutate. Therefore, our results suggest the repurposing of ingenol mebutate for treating CRC by targeting S100A4.

Influence of RBC Indices on HbA1c Measurement by Capillary Electrophoresis and HPLC Methods.

BACKGROUND: HbA1c is the gold standard of diabetic surveys to monitor the long-term glycemic control. Anemia is cited as a major confounder to HbA1c analysis; however, the effect of RBC indices influences on HbA1c analysis is not known. The aim of this study is to compare ion-exchange high-performance liquid chromatography, and capillary electrophoresis to evaluate the influence of RBC parameters on HbA1c values in anemia patients. METHODS: Erythrocyte parameters were collected from the 307 randomly selected specimens from the Hematology division. HbA1c was measured on the same specimen using Tosoh G8 and Capillarys 2 Flex Piercing on the same day. RESULTS: There is acceptable concordance between the results of capillary electrophoresis and HPLC methods (R2 = 0.953, p < 0.001). However, significant differences in HbA1c value between the two assay methods were obtained in the patients with abnormal RBC indices (p < 0.001). CONCLUSIONS: Our results demonstrated HbA1c differences were significantly different in the patients with low Hb (≤ 8 g/dL) and high RDW-CV (≥ 13.7%). It is suggested that in the analysis of HbA1c level in anemia patients, simultaneous testing for hemoglobin level is needed. In addition, development of a new reference value of HBA1c for patients with severe anemia should be considered.

Occupation-level automation probability is associated with psychosocial work conditions and workers' health: A multilevel study.

OBJECTIVE: Work automation is increasing worldwide, and the probability of job automation has been associated with workers' adverse health outcomes. This study aimed to examine the association of occupation-level automation probability with work stress and workers' health. METHODS: We used data from a national survey of 14,948 randomly selected general workers conducted in 2016. Job control and job demand were assessed by the Job Content Questionnaire, and working hours and job insecurity were self-reported. Health outcomes were measured according to burnout and work-related injury or disease. We derived automation probabilities for 38 occupational groups and conducted multilevel analyses to examine the associations between occupation-level automation probability and workers' safety and health after adjusting for psychosocial work conditions. RESULTS: Participants working in jobs with a high probability of automation were more likely to have low job control, higher job insecurity, and work-related injury and disease prevalence; whereas workers in jobs with a low automation probability had higher psychological and physical demands and burnout prevalence. Furthermore, automation probability significantly predicted workers' health after adjustment for demographic characteristics and psychosocial work conditions. CONCLUSIONS: Workers with low automation probability jobs may experience work stress other than that captured by traditional measures of job strain. Organizational approaches to improve employment security and psychosocial conditions are essential for workers' safety and health in the context of increasing job automation.

Exploring Public Awareness of Overwork Prevention With Big Data From Google Trends: Retrospective Analysis.

BACKGROUND: To improve working conditions and prevent illness and deaths related to overwork, the Taiwanese government in 2015, 2016, and 2018 amended regulations regarding working time, overtime, shifts, and rest days. Such policy changes may lead to a rising public awareness of overwork-related issues, which may in turn reinforce policy development. OBJECTIVE: This study aimed to investigate to what extent public awareness of overwork-related issues correlated with policy changes. METHODS: Policies, laws, and regulations promulgated or amended in Taiwan between January 2004 and November 2019 were identified. We defined 3 working conditions (overwork, long working hours, and high job stress) related to overwork prevention, generated a keyword for each condition, and extracted the search volumes for each keyword on the Google search engine as proxy indicators of public awareness. We then calculated the monthly percentage change in the search volumes using the Joinpoint Regression Program. RESULTS: Apparent peaks in search volumes were observed immediately after policy changes. Especially, policy changes in 2010 were followed by a remarkable peak in search volumes for both overwork and working hours, with the search volumes for overwork increased by 29% per month from June 2010 to March 2011. This increase was preceded by the implementation of new overwork recognition guidelines and media reports of several suspected overwork-related events. The search volumes for working hours also steadily increased, by 2% per month in September 2013 and afterward, reaching a peak in January 2017. The peak was likely due to the amendment to the Labor Standards Act, which called for "1 fixed and 1 flexible day off per week," in 2016. The search volumes for job stress significantly increased (P=.026) but only by 0.4% per month since March 2013. CONCLUSIONS: Over the past 15 years, Taiwanese authorities have revised and implemented several policies to prevent overwork-related health problems. Our study suggests a relationship between the implementation of policies that clearly defined the criteria for overwork and working hours and the rising public awareness of the importance of overwork prevention and shorter working hours.

Specific diacylglycerols generated by hepatic lipogenesis stimulate the oncogenic androgen receptor activity in male hepatocytes.

BACKGROUND: Obesity-induced hepatocellular carcinoma (HCC) is more prevalent in males than in females, but the underlying mechanism remains unclear. The influence of hepatic androgen receptor (AR) pathway on the gender difference of HCC has been well documented. Here we investigated the role of hepatic lipogenesis, which is elevated in the livers of obese and nonalcoholic fatty liver disease (NAFLD) patients, in stimulating the AR pathway for the male preference of obesity induced HCC. METHODS: Male C57BL/6J mice were fed a fructose-rich high carbohydrate diet (HCD) to induce hepatic lipogenesis. The effect of hepatic lipogenesis on AR was examined by the expression of hydrodynamically injected AR reporter and the endogenous AR target gene; the mechanism was delineated in hepatoma cell lines and validated in male mice. RESULTS: The hepatic lipogenesis induced by a fructose-rich HCD enhanced the transcriptional activity of hepatic AR in male mice, which did not happen when fed a high fat diet. This AR activation was blocked by sh-RNAs or inhibitors targeting key enzymes in lipogenesis, either acetyl-CoA carboxylase subunit alpha (ACCα), or fatty acid synthase (FASN), in vivo and in vitro. Further mechanistic study identified that specific unsaturated fatty acid, the oleic acid (C18:1 n-9), incorporated DAGs produced by hepatic lipogenesis are the key molecules to enhance the AR activity, through activation of Akt kinase, and this novel mechanism is targeted by metformin. CONCLUSIONS: Our study elucidates a novel mechanism underlying the higher risk of HCC in obese/NAFLD males, through specific DAGs enriched by hepatic lipogenesis to increase the transcriptional activity of hepatic AR, a confirmed risk factor for male HCC.

Transfer of the health care burden of occupational injuries and diseases from labor insurance to national health insurance in Taiwan.

BACKGROUND: Occupational injury and diseases result in substantial national health care burden. However, medical costs are often transferred to injured workers or the health insurance system. This study aims to examine the health care service utilization patterns of injured workers under the National Health Insurance (NHI) program in Taiwan and the barriers to medical benefit claims from labor insurance workers' compensation. METHODS: The total amount spent on medical benefits and national health expenditure from 1980 to 2014 was obtained. Workers who have experienced occupational injuries or diseases were identified in four waves of national surveys, and the types of medical care use were compared. In-depth interviews were conducted with 52 workers who had experienced occupational injuries and diseases. RESULTS: Since the implementation of the NHI program in 1995, medical benefits from workers' compensation have dropped substantially. In total, 75% of the workers who experienced occupational injuries or diseases had their medical costs covered through NHI. The time and effort costs caused by barriers against claiming medical benefits from workers' compensation decreased the incentive for workers from certain socioeconomic groups to make workers' compensation claims. CONCLUSION: Medical costs attributable to occupational injuries or diseases were mainly paid through NHI instead of through labor insurance. The economic burden was partially shifted from employers to workers, taxpayers, and the government.

Differential effects of employment grade on the association between long working hours and problem drinking.

OBJECTIVE: To examine the association between working hours and problem drinking in employees from different employment grades. METHODS: We used data from a national survey of randomly sampled Taiwanese workers. A total score of 2 or more on the Cut down, Annoyed, Guilty, and Eye-Opener (CAGE) questionnaire was used to identify problem drinkers. Weekly working hours were categorized into five groups: <40, 40, 41-48, 49-59, and ≥60. Employees were classified into three employment grades: managers and professionals, skilled workers, and low-skilled workers. The associations between working hours and problem drinking in employees from different employment grades were examined by logistic regression models. RESULTS: In skilled workers, problem drinking was associated with <40 and 41-48 working hours, but not with >48 working hours. In low-skilled workers, problem drinking was most strongly associated with 49-59 working hours. CONCLUSION: The association between working hours and problem drinking was not linear and differed with employment grades.

Hypoxia-activated cytotoxic agent tirapazamine enhances hepatic artery ligation-induced killing of liver tumor in HBx transgenic mice.

Transarterial chemoembolization (TACE) is the main treatment for intermediate stage hepatocellular carcinoma (HCC) with Barcelona Clinic Liver Cancer classification because of its exclusive arterial blood supply. Although TACE achieves substantial necrosis of the tumor, complete tumor necrosis is uncommon, and the residual tumor generally rapidly recurs. We combined tirapazamine (TPZ), a hypoxia-activated cytotoxic agent, with hepatic artery ligation (HAL), which recapitulates transarterial embolization in mouse models, to enhance the efficacy of TACE. The effectiveness of this combination treatment was examined in HCC that spontaneously developed in hepatitis B virus X protein (HBx) transgenic mice. We proved that the tumor blood flow in this model was exclusively supplied by the hepatic artery, in contrast to conventional orthotopic HCC xenografts that receive both arterial and venous blood supplies. At levels below the threshold oxygen levels created by HAL, TPZ was activated and killed the hypoxic cells, but spared the normoxic cells. This combination treatment clearly limited the toxicity of TPZ to HCC, which caused the rapid and near-complete necrosis of HCC. In conclusion, the combination of TPZ and HAL showed a synergistic tumor killing activity that was specific for HCC in HBx transgenic mice. This preclinical study forms the basis for the ongoing clinical program for the TPZ-TACE regimen in HCC treatment.

Internal workplace violence from colleagues is more strongly associated with poor health outcomes in nurses than violence from patients and families.

AIMS: To examine the associations between different workplace violence sources and health outcome in nurses. BACKGROUND: Workplace violence is a major threat to nurses' physical and mental health. Other workers in the health sector, patients and visitors can cause workplace violence. To effectively prevent workplace violence-related health problems, the differential impact of internal and external violence needs to be explored. DESIGNS: A cross-sectional survey of 1,690 fully employed female nurses. METHODS: A self-administered questionnaire was used to record the nurses' experiences of workplace violence, including types (physical, psychological, verbal and sexual) and sources (internal and external) of violence. Data on psychosocial work conditions including work shift, psychological job demands, job control and workplace justice, were also collected. The nurses' health condition was measured using the 5-item Brief Symptom Rating Scale and Self-Rated Health Scale and multivariable logistic regression was used to examine the associations between workplace violence and health. The study was carried out in 2015-2016. RESULTS: Sixty percent of the internal workplace violence was psychological and verbal and adverse psychosocial work conditions were associated with workplace violence. After adjustment for demographic characteristics and psychosocial work conditions, internal workplace violence resulted in higher risks of poor self-rated health and mental health than did external workplace violence, particularly in nurses who had experienced psychological and verbal violence. CONCLUSION: Internal workplace violence in the form of psychological and verbal violence had a stronger effect on nurses' health than did external workplace violence. Organization-level measures should be implemented to prevent internal violence.

The Expression Profile and Prognostic Significance of Metallothionein Genes in Colorectal Cancer.

Colorectal cancer (CRC) is a heterogeneous disease resulting from the combined influence of many genetic factors. This complexity has caused the molecular characterization of CRC to remain uncharacterized, with a lack of clear gene markers associated with CRC and the prognosis of this disease. Thus, highly sensitive tumor markers for the detection of CRC are the most essential determinants of survival. In this study, we examined the simultaneous downregulation of the mRNA levels of six metallothionein (MT) genes in CRC cell lines and public CRC datasets for the first time. In addition, we detected downregulation of these six MT mRNAs' levels in 30 pairs of tumor (T) and adjacent non-tumor (N) CRC specimens. In order to understand the potential prognostic relevance of these six MT genes and CRC, we presented a four-gene signature to evaluate the prognosis of CRC patients. Further discovery suggested that the four-gene signature (MT1F, MT1G, MT1L, and MT1X) predicted survival better than any combination of two-, three-, four-, five-, or six-gene models. In conclusion, this study is the first to report that simultaneous downregulation of six MT mRNAs' levels in CRC patients, and their aberrant expression together, accurately predicted CRC patients' outcomes.

Psychosocial safety climate, workplace violence and self-rated health: A multi-level study among hospital nurses.

AIMS: To validate the Chinese version Psychosocial Safety Climate scale (PSC-12), and examine the associations between PSC, workplace violence and self-rated health (SRH). BACKGROUND: Psychosocial safety climate moderates the negative effect of workplace violence on health. To address workplace violence experienced by nurses across the Asia-Pacific region, it is important to develop and apply a Chinese language version of the tool. METHODS: We conducted a two-part study. In the first part, the Chinese version PSC-12 was developed and tested for its validity in 405 nurses. In the second part, a total of 1690 nurses from 73 hospitals filled a questionnaire concerning their work and health conditions. Multi-level modelling was used to examine the association between PSC, workplace violence and SRH. RESULTS: A comparable validity and reliability of the Chinese version PSC-12 with the original PSC was found. PSC scores were negatively associated with workplace violence. In the hierarchical linear model, participants from hospitals with the lowest PSC score had twofold risks of having poor SRH. CONCLUSIONS: The Chinese version PSC-12 is a valid tool. Hospital-level PSC was associated with poor health status in female nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Psychosocial safety climate should be evaluated and promoted to prevent workplace violence in nurses.

Night shift and rotating shift in association with sleep problems, burnout and minor mental disorder in male and female employees.

OBJECTIVES: Shift work is associated with adverse physical and psychological health outcomes. However, the independent health effects of night work and rotating shift on workers' sleep and mental health risks and the potential gender differences have not been fully evaluated. METHODS: We used data from a nationwide survey of representative employees of Taiwan in 2013, consisting of 16 440 employees. Participants reported their work shift patterns 1 week prior to the survey, which were classified into the four following shift types: fixed day, rotating day, fixed night and rotating night shifts. Also obtained were self-reported sleep duration, presence of insomnia, burnout and mental disorder assessed by the Brief Symptom Rating Scale. RESULTS: Among all shift types, workers with fixed night shifts were found to have the shortest duration of sleep, highest level of burnout score, and highest prevalence of insomnia and minor mental disorders. Gender-stratified regression analyses with adjustment of age, education and psychosocial work conditions showed that both in male and female workers, fixed night shifts were associated with greater risks for short sleep duration (<7 hours per day) and insomnia. In female workers, fixed night shifts were also associated with increased risks for burnout and mental disorders, but after adjusting for insomnia, the associations between fixed night shifts and poor mental health were no longer significant. CONCLUSIONS: The findings of this study suggested that a fixed night shift was associated with greater risks for sleep and mental health problems, and the associations might be mediated by sleep disturbance.

Effects of caffeinated alcoholic beverages with low alcohol and high caffeine content on cognitive and motor functions.

OBJECTIVE: In Taiwan, caffeinated alcoholic beverages (CABs), with high caffeine but low alcohol concentrations compared to those sold in Western countries, are commonly consumed at work and have been associated with work-related injuries. However, the effects on cognitive and motor functions and self-perception have not been examined. METHODS: Twenty-eight healthy male volunteers (mean age: 32.6 ± 2.7) participated in the study. Each participant visited our laboratory 4 times at intervals of at least 1 week and was assigned to one of 4 trials in a counterbalanced order at each visit: placebo, alcohol, caffeinated energy drink, and CAB. They completed the subjective perception ratings, go/no-go tasks, Stroop color-word tests, Purdue pegboard tests, and the standardized field sobriety test. We used analysis of variance to examine the intraindividual differences in the performance. RESULTS: Consuming alcohol of 0.23 g/kg typically consumed by Taiwanese CAB drinkers caused significant impairments in fine and crude motor functions; caffeine (1.5 mg/kg) did not antagonize these effects but led to an improvement in response speed in the go/no-go task. The subjective perceptions produced by alcohol were not masked by caffeine. CONCLUSIONS: CABs that contains a higher ratio of caffeine to alcohol did not counteract the motor function impairments induced by alcohol.