Policy changes for preventing and recognizing overwork-related cardiovascular diseases in Taiwan: An overview.

OBJECTIVE: Overwork-related cardiovascular and cerebrovascular disease (CVD) has a large impact on workers' rights and labor standards across East Asian countries. This article describes the background and impact of policies regarding overwork-related CVD in the past decades in Taiwan. METHODS: We reviewed government policies, guidelines, literature, and news addressing the problems and impact of policy changes to prevent and recognize overwork-related CVD since the 1990s, and collected data on overwork-related CVD cases in Taiwan from 2006 to 2017. RESULTS: In 2017, overwork-related CVD accounted for 13% of all cases of occupational diseases, but 79% of all deaths due to occupational diseases. Guidelines for recognizing overwork-related CVD cases were established in 1991; however, under-recognition exists in Taiwan due to poor exposure data on working hours and psychological factors and because most medical expenses are covered by the national health insurance system. Amendments on the guidelines, and stricter policies on overwork prevention were enforced following calls from labor unions, nongovernmental organizations, and legislators, but health disparities were introduced when certain industries were exempted from restrictions. CONCLUSIONS: Long working hours and other work characteristics increase the risk of overwork-related CVD. By reviewing the changes in policy for preventing overwork and recognizing overwork-related disease, we identified the need for clearly defined guidance on evaluating overwork-related CVD, with specific criteria for working hours and other risk factors regarding work characteristics. National policies that lead to better working conditions and prevent overwork-related diseases must be developed.

Effects of hospital accreditation on medical students: a national qualitative study in Taiwan.

PURPOSE: Hospital accreditation has become a global trend for improving the quality of health care services. In Taiwan, nearly all hospitals are accredited. However, there is a paucity of literature on the effects of hospital accreditation on medical students and the universal applicability of hospital accreditation as developed in the West. The purpose of this study was to investigate the effects of hospital accreditation on medical students in Taiwan. METHOD: From 2010 to 2012, the authors conducted semistructured interviews with 34 senior, clinical year students at 11 different medical schools in Taiwan. Following a grounded theory approach, the authors transcribed and analyzed the transcripts concurrently with data collection in order to identify emergent themes. RESULTS: Aside from the intended positive effects of hospital accreditation, this study revealed several unintended impacts on medical students, including decreased clinical learning opportunities, increased trivial workload, and violation of professional integrity. Taiwanese students expressed doubt and frustration concerning the value of hospital accreditation and reflected on the cultural and systemic context in which accreditation takes place. Their commentary addressed the challenges associated with the globalization of hospital accreditation processes. CONCLUSIONS: This study suggests that, beyond the improvement of patient safety and quality assurance, medical educators must recognize the unintended negative effects of hospital accreditation on medical education and take into account differences in culture and health care systems amid the globalization of medicine.

Making work fit care: reconciliation strategies used by working mothers of adults with intellectual disabilities.

BACKGROUND: This study explored the experiences of working mothers with an adult child with intellectual disabilities to understand how they reconcile paid work and care responsibilities. METHODS: Fifteen working mothers in Taiwan with an adult child with intellectual disabilities were interviewed, and an interpretative phenomenological approach was adopted for data collection and analysis. RESULTS: All included mothers prioritized their caregiving role over paid work. The strategies used by these mothers to make paid work fit with caregiving included having strong social networks and informal support for their care work, use of formal services, personal religious beliefs and positive attitudes towards care, as well as having flexible working hours due to self-employment, good relations with employers, working positions and work locations. CONCLUSIONS: Formal systems, which include both welfare and labour policies, need to be responsive to and involved in supporting these working mothers, especially those who lack good personal networks.

Difficulties of care-work reconciliation: employed and nonemployed mothers of children with intellectual disability.

BACKGROUND: Whether employed and nonemployed mothers of children with intellectual disability (ID) have different experiences with reconciliation between care and work has rarely been explored. METHOD: A survey was conducted in a county in Taiwan and 487 mothers aged younger than 65 and having a child with ID were interviewed face to face at their homes to explore whether there are different factors related to the reconciliation between care and work among employed and nonemployed mothers. RESULTS: Except for the common ground of mothers' health and care demands, logistic regression revealed work flexibility and care support were important for employed mothers. In contrast, the success of reconciliation for nonemployed mothers was determined by their individual characteristics (i.e., age, marital status, family income). CONCLUSIONS: Reconciliation policies for mothers with different employment statuses need to use different strategies.

Optical constant determination of an anisotropic thin film via polarization conversion.

This study presents a simple method for determining the optical constants of an anisotropic thin film. The sensitivity of enhanced polarization conversion reflectance to optical constants is also calculated and analyzed. Based on the sensitivity calculation, the principal indices and columnar tilt angle can be derived from the polarization conversion reflectance angular spectrum.