Stratifying TAD boundaries pinpoints focal genomic regions of regulation, damage, and repair.

Advances in chromatin mapping have exposed the complex chromatin hierarchical organization in mammals, including topologically associating domains (TADs) and their substructures, yet the functional implications of this hierarchy in gene regulation and disease progression are not fully elucidated. Our study delves into the phenomenon of shared TAD boundaries, which are pivotal in maintaining the hierarchical chromatin structure and regulating gene activity. By integrating high-resolution Hi-C data, chromatin accessibility, and DNA double-strand breaks (DSBs) data from various cell lines, we systematically explore the complex regulatory landscape at high-level TAD boundaries. Our findings indicate that these boundaries are not only key architectural elements but also vibrant hubs, enriched with functionally crucial genes and complex transcription factor binding site-clustered regions. Moreover, they exhibit a pronounced enrichment of DSBs, suggesting a nuanced interplay between transcriptional regulation and genomic stability. Our research provides novel insights into the intricate relationship between the 3D genome structure, gene regulation, and DNA repair mechanisms, highlighting the role of shared TAD boundaries in maintaining genomic integrity and resilience against perturbations. The implications of our findings extend to understanding the complexities of genomic diseases and open new avenues for therapeutic interventions targeting the structural and functional integrity of TAD boundaries.

Work-family conflict and its related factors among emergency department physicians in China: A national cross-sectional study.

Background: Work-family conflict is common among emergency department physicians. Identifying the factors associated with work-family conflict is key to reducing its negative impact on mental health and work attitudes. However, the work-family conflict of Chinese emergency department physicians and the related factors have been scarcely studied. Objective: This study aimed to investigate the current status and related factors of work-family conflict among Chinese emergency department physicians. Methods: A national cross-sectional study was conducted among emergency department physicians in China from June 2018 to August 2018. A standard questionnaire was used to investigate the demographic characteristics, work-related factors, and work-family conflict of emergency department physicians. The generalized linear regression analysis was used to identify the related factors of work-family conflict. Results: A total of 10,457 licensed emergency department physicians participated in the study. The average score of work-family conflict among the enrolled emergency department physicians was 19.27 ± 3.94, and the prevalence of high levels of work-family conflict was 69.19%. The multivariable regression analysis showed that emergency physicians who were female (linear regression coefficient, -0.25; SE, 0.08; P = 0.002), older than 40 years (linear regression coefficient,-0.53; SE, 0.14; P < 0.001), and earning more than 4,000 CNY per month (e.g., 4,001~6,000 vs. ≤4,000 CNY: linear regression coefficient, -0.17; SE, 0.09; P = 0.04) had lower work-family conflicts. However, emergency department physicians who were married (linear regression coefficient, 0.37; SE, 0.11; P < 0.001), highly educated (linear regression coefficient, 0.46; SE, 0.10; P < 0.001), had a high technical title (e.g., intermediate vs. junior technical title: linear regression coefficient, 0.61; SE, 0.09; P < 0.001), worked in a high-grade hospital (e.g., tertiary hospital vs. emergency center: linear regression coefficient, 0.38; SE, 0.11; P < 0.001), had a higher frequency of night shifts (e.g., 6~10 night shifts per month vs. 0~5 night shifts per month: linear regression coefficient, 0.43; SE, 0.10; P < 0.001), self-perceived shortage of physicians in the department (linear regression coefficient, 2.22; SE, 0.08; P < 0.001), and experienced verbal abuse (linear regression coefficient, 1.48; SE, 0.10; P < 0.001) and physical violence (linear regression coefficient, 0.84; SE, 0.08; P < 0.001) in the workplace had higher work-family conflict scores. Conclusion: Most emergency department physicians in China experience a high-level work-family conflict. Hospital administrations are recommended to develop family-friendly workplace policies, establish a scientific shift system, and keep the number of emergency department physicians to meet the demand to reduce work-family conflict.

Factors related to turnover intention among emergency department nurses in China: A nationwide cross-sectional study.

BACKGROUND: Turnover intention among nurses is high, especially in the emergency department. However, factors that are associated with Chinese emergency department nurses' turnover intention have been scarcely studied. AIMS: The present study examined relationships between turnover intention and demographic characteristics, job-related factors, depressive symptoms, and organizational commitment among emergency department nurses. STUDY DESIGN: A cross-sectional study of emergency department nurses was conducted in China between July and August 2018. The questionnaire included demographic characteristics (age, gender, level of education, and self-rated health status), job-related factors (qualification title, job seniority, night shifts, and workplace violence), depressive symptoms, organizational commitment, and turnover intention. A hierarchical linear regression model was used to identify factors that are associated with turnover intention among emergency department nurses. RESULTS: A total of 17 582 emergency department nurses participated in the study. The response rate was 68.9%. The findings indicated that poor self-rated health status (ß = 0.25, p < .001), working more than 11 night shifts per month (ß = 0.14, p < .01), experiencing workplace violence in the past year (ß = 0.08, p < .05), and higher depressive symptom scores (ß = 0.07, p < .001) positively correlated with turnover intention. More years of service (ß = -0.38, p < .001) and higher organizational commitment scores (ß = -0.45, p < .001) negatively correlated with turnover intention. CONCLUSIONS: Health status, job seniority, night shift frequency per month, workplace violence, depressive symptoms, and organizational commitment were significantly associated with emergency department nurses' turnover intention. RELEVANCE TO CLINICAL PRACTICE: To reduce turnover intention in the emergency department nurses, hospital administrators and managers should implement measures to improve their physical and mental health, increase organizational commitment, develop staff acceptable shift schedules, and reduce incidences of workplace violence.

The Relationship Between Occupational Stress and Turnover Intention Among Emergency Physicians: A Mediation Analysis.

Background: There is evidence that occupational stress is a risk factor for turnover intentions. However, the structural relationship between occupational stress and turnover intention among emergency physicians has rarely been studied. This study aimed to examine the pathways of occupational stress on turnover intention through job satisfaction and depressive symptoms among emergency physicians in China. Methods: A cross-sectional study was conducted in China from July 2018 to August 2018. Data were collected using a structured questionnaire that included demographic characteristics, occupational stress, job satisfaction, depressive symptoms, and turnover intention. Hierarchical linear regression was performed to explore the related factors of turnover intention. Structural equation modeling was used to examine the pathways from occupational stress to turnover intention. Results: A total of 10,457 emergency physicians completed the questionnaire. The score of turnover intention was 11.34 (SD = 3.25), and the average item score of turnover intention was 2.84 (SD = 0.81). In structural equation modeling, the occupational stress not only had a direct effect on turnover intention (standardized direct effect = 0.311, bias-corrected 95% confidence interval [0.261, 0.361], P < 0.001), but also had an indirect effect through job satisfaction and depressive symptoms (standardized indirect effect = 0.448, bias-corrected 95% confidence interval [0.412, 0.484], P < 0.001). However, the effect of depressive symptoms on turnover intention was weak (standardized coefficient [ß] = 0.08, P < 0.001). Conclusions: Job satisfaction partially mediated the relationship between occupational stress and turnover intention. However, due to the weak effect of depressive symptoms on turnover intention, the mediating role of depressive symptoms between occupational and turnover intention had little practical value. It is recommended that hospital administrators prioritize increasing job satisfaction of emergency physicians to reduce the impact of occupational stress on their turnover intention.

Prevalence of depressive symptoms in nurses compared to the general population based on Propensity Score Matching: A nationwide cross-sectional study in China.

BACKGROUND: Depressive symptoms have a series of negative effects and are considered especially severe among nurses, whereas there is a lack of quantitative studies comparing the risk of depressive symptoms between nurses and the general population. METHODS: We respectively conducted a nationwide cross-sectional online survey among 17,582 Chinese nurses from July to August 2018, and 101,120 Chinese community residents from January to February 2019. The questionnaire covered social-demographic characteristics and depressive symptoms for both, work-related factors and life-related factors for nurses. Propensity Score Matching was performed to match nurses and residents by gender, age, educational level, marital status, and habitual residence. RESULTS: Before Propensity Score Matching, the risk of depressive symptoms in nurses was higher than residents (OR, 2.16; 95% CI, 2.07-2.26). After matching, there were 15,256 nurses and residents respectively, and the risk in nurses was higher (OR, 2.14; 95% CI, 2.02-2.27). Logistic regression showed that longer years of service (OR, 1.54; 95% CI, 1.30-1.83), higher night shift frequency (OR, 1.48; 95% CI, 1.35-1.64), perceived shortage of nurses (OR, 1.98; 95% CI, 1.84-2.13), suffered verbal violence (OR, 2.43; 95% CI, 2.21-2.66) and physical violence (OR, 1.80; 95% CI, 1.64-1.98) were risk factors for depressive symptoms in nurses. LIMITATIONS: Convenience sampling and online survey were adopted in this cross-sectional study, which may diminish the representativeness of samples. CONCLUSIONS: Compared with the general population, nurses have a higher risk of depressive symptoms in China. Reasonable work allocation, adequate staffing, scientific shift system and violence emergency system should be implemented.

Effort-Reward Imbalance in Emergency Department Physicians: Prevalence and Associated Factors.

OBJECTIVES: To examine the prevalence of effort-reward imbalance and explore its associated factors among emergency department physicians in China. METHODS: A cross-sectional survey was conducted in the Chinese emergency department in 2018. A total of 10,457 emergency department physicians completed a structured questionnaire containing demographic characteristics, work-related data, and effort-reward imbalance scale. All the data were analyzed using descriptive analysis and stepwise logistic regression. RESULTS: The prevalence of effort-reward imbalance was 78.39% among emergency department physicians in China. The results showed that the male emergency department physicians with a bachelor's degree, an intermediate title, long years of service, a high frequency of night shift, and who suffered workplace violence were at a higher risk of effort-reward imbalance. In contrast, physicians with higher monthly income and perceived adequate staff were associated with a lower risk of effort-reward imbalance. CONCLUSIONS: The situation of effort-reward imbalance was serious among emergency department physicians in China. Administrators should pay more attention to key groups and take measures from the perspectives of effort and reward to improve the effort-reward imbalance in emergency department physicians.

Effectiveness of Systemic Corticosteroids Therapy for Nonsevere Patients With COVID-19: A Multicenter, Retrospective, Longitudinal Cohort Study.

OBJECTIVES: Corticosteroids were clinically used in the treatment of nonsevere patients with COVID-19, but the efficacy of such treatment lacked sufficient clinical evidence, and the impact of dose had never been studied. This study aimed to evaluate the effect of systemic corticosteroid use (SCU) in nonsevere patients with COVID-19. METHODS: We conducted a multicenter retrospective cohort study in Hubei Province. A total of 1726 patients admitted with nonsevere type COVID-19 were included. Mixed-effect Cox model, mixed-effect Cox model with time-varying exposure, multiple linear regression, and propensity score analysis (inverse probability of treatment weight and propensity score matching) were used to explore the association between SCU and progression into severe type, all-cause mortality, and length of stay. RESULTS: During the follow-up of 30 days, 29.8% of nonsevere patients with COVID-19 received treatment with systemic corticosteroids. The use of systemic corticosteroids was associated with higher probability of developing severe type (adjusted hazard ratio 1.81; 95% confidence interval 1.47-2.21), all-cause mortality (adjusted hazard ratio 2.92; 95% confidence interval 1.39-6.15) in time-varying Cox analysis, and prolonged hospitalization (ß 4.14; P < .001) in multiple linear regression. Analysis with 2 propensity score cohorts displayed similar results. Besides, increased corticosteroid dose was significantly associated with elevated probability of developing severe type (P < .001) and prolonged hospitalization (P < .001). CONCLUSIONS: Corticosteroid treatment against nonsevere patients with COVID-19 was significantly associated with worse clinical outcomes. The higher dose was significantly associated with elevated risk of poor disease progression. We recommend that SCU should be avoided unless necessary among nonsevere patients with COVID-19.

Work-Family Conflict of Emergency Nurses and Its Related Factors: A National Cross-Sectional Survey in China.

The prevalence of work-family conflict (WFC) among nurses was high, especially in the emergency department. WFC has a series of negative influences on emergency nurses, but factors associated with WFC require elucidation. Thus, we conducted a national cross-sectional survey among emergency nurses in China. In this study, we described the current situation of WFC and explored its related factors among emergency nurses in China. We found that the WFC of emergency nurses was severe, and emergency nurses aged 25 to 34, male, married, highly educated, with high professional title and long years of service, perceiving the shortage of nurses, experiencing a high frequency of night shift, tended to have higher WFC. Targeted interventions, such as reasonable work allocation, adequate staffing, and a scientific night shift system should be implemented to alleviate the WFC of emergency nurses.

Evaluating effort-reward imbalance among nurses in emergency departments: a cross-sectional study in China.

BACKGROUND: Effort-reward imbalance is an adverse psychological response to working conditions that has several negative effects on nurses. However, there is little research on effort-reward imbalance and its influencing factors among nurses in emergency departments. This study aimed to understand the current situation of effort-reward imbalance and explore its influencing factors among emergency department nurses in China. METHODS: From July to August 2018, a structured online questionnaire survey was conducted among emergency department nurses in China. Data were collected from emergency department nurses employed in hospitals providing pre-hospital care in China. The questionnaire consisted of sociodemographic characteristics, work-related factors and effort-reward imbalance. A descriptive analysis and a binary logistic regression were conducted to explore the effort-reward imbalance and its influencing factors among emergency department nurses. RESULTS: The study involved 17,582 emergency department nurses; notably, the prevalence of effort-reward imbalance was 59.66%. The participating nurses who were males, aged 25 to 34 years, whose educational level was a bachelor degree or above, who had a junior or above title, who had longer years of service, and who had suffered verbal or physical violence in the past year had a higher risk of effort-reward imbalance. Furthermore, the nurses with a high monthly income, who believed that the number of nurses met the department's demand had a lower risk of effort-reward imbalance. CONCLUSIONS: Effort-reward imbalance was prevalent among emergency department nurses in China. Measures such as adjusting the night shift frequency, increasing the number of nurses, raising salaries and reducing workplace violence should be considered to reduce the level of effort-reward imbalance.

Prevalence and Associated Factors of Depressive Symptoms Among Patients With Chronic Low Back Pain: A Cross-Sectional Study.

Background: Few studies have focused on depressive symptoms among patients with chronic low back pain in China. The aim of this cross-sectional study was to assess the prevalence and associated factors of depressive symptoms in patients with chronic low back pain. Methods: From May to August 2021, 1,172 patients with chronic low back pain were recruited in China. Depressive symptoms were assessed through the Patient Health Questionnaire. Associations of demographic characteristics, clinical characters and social-psychological factors with depressive symptoms were investigated among patients with chronic low back pain. Results: The prevalence of depressive symptoms was 25.00%. Logistic regression analysis found that duration of pain in 1-5 years (1-3 years: OR = 2.91, 95%CI: 1.65-5.14, 3-5 years: OR = 3.09, 95%CI: 1.55-6.15) and more severe pain (OR = 1.13, 95%CI: 1.10-1.17) were associated with higher risks of depressive symptoms. Better family function (good family function: OR = 0.25, 95%CI: 0.15-0.41, moderate family dysfunction: OR = 0.47, 95%CI: 0.29-0.77) and higher pain self-efficacy (OR = 0.94, 95%CI: 0.93-0.95) were associated with lower risks of depressive symptoms. Conclusion: Patients with chronic low back pain have a high prevalence of depressive symptoms in China. Duration of pain, pain severity, family function and pain self-efficacy were predictors of depressive symptoms among chronic low back pain patients in China. Early identification of the associated factors may be helpful for the timely management of depressive symptoms.

Association of metformin with mortality or ARDS in patients with COVID-19 and type 2 diabetes: A retrospective cohort study.

AIMS: To determine the association between metformin use and mortality and ARDS incidence in patients with COVID-19 and type 2 diabetes. METHODS: This study was a multi-center retrospective analysis of COVID-19 patients with type 2 diabetes and admitted to four hospitals in Hubei province, China from December 31st, 2019 to March 31st, 2020. Patients were divided into two groups according to their exposure to metformin during hospitalization. The outcomes of interest were 30-day all-cause mortality and incidence of ARDS. We used mixed-effect Cox model and random effect logistic regression to evaluate the associations of metformin use with outcomes, adjusted for baseline characteristics. RESULTS: Of 328 patients with COVID-19 and type 2 diabetes included in the study cohort, 30.5% (100/328) were in the metformin group. In the mixed-effected model, metformin use was associated with the lower incidence of ARDS. There was no significant association between metformin use and 30-day all-cause mortality. Propensity score-matched analysis confirmed the results. In the subgroup analysis, metformin use was associated with the lower incidence of ARDS in females. CONCLUSIONS: Metformin may have potential benefits in reducing the incidence of ARDS in patients with COVID-19 and type 2 diabetes. However, this benefit differs significantly by gender.