Does daily energy and macronutrient intake differ between work and non-workdays in shift workers? A mixed methods study.

Shift workers are at increased risk of obesity and metabolic diseases, but their eating patterns on work and non-workdays are understudied. We aimed to examine whether energy intake and macronutrient intake of day and night shift nurses were different during work and non-workdays. We used a mixed-methods approach to study food intake of shift working nurses from two hospitals during day and night shifts. Participants completed baseline questionnaires about eating behaviour, sleep, chronotype, mood and shift work disorder. Participants then completed a 4-d food diary which included a non-workday prior to the first shift, the first and last shift (either day or night) and the following non-workday. After completion of the food diaries, we used semi-structured interviews to explore the qualitative aspects of eating behaviours. Seventy-nine shift-working nurses participated in the study. Daily energy intake was not significantly different on work and non-workdays in day or night shift workers (p > 0.05). Whilst macronutrient consumption was also not different between day and night shift workers (p > 0.05), sugar intake was higher in day compared to night shift workers (p = 0.02) on the non-workday prior to the first workday. In qualitative interviews, participants reported their eating to be different on day and night shifts as well as work and non-workdays. Eating behaviour in day and night shift workers was highly influenced by food availability, convenience, peers, and family members. Nurses qualitatively report that night and day shifts result in them eating differently despite no statistically discernible difference in energy intake.

Snacking among shiftwork nurses related to non-optimal dietary intake.

AIMS: To compare nurses' non-optimal eating behaviours across different shifts, to examine whether non-day shifts were related to deviation from optimal dietary behaviours compared with day shifts and whether such deviation was related to non-optimal macronutrient intake. DESIGN: This is a 4-day intensive longitudinal study. METHODS: A convenience sample of hospital nurses was recruited in Taiwan. From September 2018 through January 2019, 120 participants completed 4-days of 24-h dietary recalls. One-way ANOVA and Kruskal-Wallis H test were used to compare differences in energy and macronutrient intake and frequency of meals and snacking, respectively. Generalized linear regressions examined (1) the associations between shiftwork schedules and non-optimal eating behaviours and (2) associations between non-optimal eating and high energy contribution of non-optimal macronutrients. RESULTS: Nurses consumed less energy on evening and night shifts compared with day shifts. However, energy intake from snacking was higher on evening and night shifts relative to day shifts. Nurses consumed less meals but had higher snacking frequency on non-day shifts. In addition, high energy intake from snacking was positively associated with high energy intake from saturated fat. CONCLUSIONS: Nurses were more likely to have non-optimal eating behaviours on non-day shifts, which may contribute to an increased intake of saturated fat; thus, increasing their risk of chronic diseases. Strategies to improve non-day shift nurses' non-optimal eating behaviours may be beneficial to their health. IMPACT: Shiftwork is known to affect nurses' eating behaviours; however, which shift is associated with unhealthy eating remains inconclusive. Despite lower energy intakes, nurses had higher intake by snacking on evening and night shifts. High snacking intake was associated with a high intake of saturated fat. Hospitals can increase the availability of healthy foods on evening or night shifts, which may improve non-day shift nurses' non-optimal eating behaviours.

Hospital factors that predict intention of health care workers to leave their job during the COVID-19 pandemic.

PURPOSE: To identify factors responsible for hospital health care workers' intention to leave their job during the COVID-19 pandemic. DESIGN: A cross-sectional study was performed. METHODS: A self-administered questionnaire was delivered to solicit hospital health care workers' demographics, intention to leave, workplace environment, and changes related to COVID-19 from July to November 2020 in Taiwan. Principal component analysis was performed to compare group-related factors. Multiple logistic regression was used to determine the risk factors for the intention of health care workers to leave their job. FINDINGS: Among the 1209 health care workers (mean age, 36.3 years) who participated in the study, intention to leave the job was found to be related to factors relating to COVID-19, including perceived risk, affected social relationships, and increased workload and job stress, after adjustment for demographic and work factors. Supportive administration/management were protective factors against leaving the job. These results were supported by sensitivity analyses. CONCLUSIONS: Our findings suggest that the intention of health care workers to leave their job during a pandemic is related to potentially modifiable factors relating to the infection itself and work environment. CLINICAL RELEVANCE: High perceived risk of COVID-19, affected social relationaops, and increased workload and job stress were positively associated with the intention of health care workers to leave their job, whereas supportive administration and management were protective factors against leaving the job. Development of workplace strategies is important to help mitigate these above factors, improve psychological wellbeing, and promote workforce stability.

Development of the Nurses' Occupational Stressor Scale.

Although nurses work in stressful environments, stressors in such environments have yet to be clearly assessed. This study aimed to develop a Nurses' Occupational Stressor Scale (NOSS) with high reliability and validity. Candidate questions for the NOSS were generated by expert consensus following focus group feedback, and were used to survey in 2013. A shorter version was then developed after examination for validity and reproducibility in 2014. The accuracy of the short version of the NOSS for predicting nurses' stress levels was evaluated based on receiver operating characteristic curves to compare existing instruments for measuring stress outcomes, namely personal burnout, client-related burnout, job dissatisfaction, and intention to leave. Examination for validity and reproducibility yielded a shorter version of NOSS with only 21 items was considered sufficient for measuring stressors in nurses' work environments. Nine subscales were included: (1) work demands, (2) work-family conflict, (3) insufficient support from coworkers or caregivers, (4) workplace violence and bullying, (5) organizational issues, (6) occupational hazards, (7) difficulty taking leave, (8) powerlessness, and (9) unmet basic physiological needs. The 21-item NOSS proved to have high concurrent and construct validity. The correlation coefficients of the subscales for test-retest reliability ranged from 0.71 to 0.83. The internal consistency (Cronbach's α) coefficients ranged from 0.35 to 0.77. The NOSS exhibited accurate prediction of personal burnout, client-related burnout, job dissatisfaction, and intention to leave.

Association Between Sugar-Sweetened Beverage Consumption as Meal Substitutes, Workload, and Obesity in Nurses: A Cross-Sectional Study.

Background: High occupational stress has been associated with altered eating behaviors and obesity. Occupational stress is reported to be high in Asian countries. Furthermore, many Asian countries are increasingly consuming Western-type foods (e.g., incorporating drinks with meals) which collectively may also be contributing to obesity. Therefore, the aim of this study was to examine (a) associations between sugar-sweetened beverage (SSB) consumption as meal replacement and obesity and (b) associations between workload and substituting meals with SSB in nurses. Methods: A representative sample of 854 hospital-based nurses completed a structured questionnaire about SSB consumption, workload, and body mass index (BMI). Log binomial regression models were employed to test associations between SSBs and obesity rates and associations between workload and SSBs. Results: Most participants (57.6%) consumed SSBs as meal replacements during work. This was related to high workloads during shifts. Substituting SSBs for meals was significantly associated with increased likelihood of obesity (aPRR = 1.4, 95% CI (1.1, 1.7)). Workload was positively associated with SSB intake as meal substitutes (aPRR = 1.4, 95% CI (1.2, 1.6)). Conclusions: Our findings show that SSBs are used as meal substitutes and is due to the workload demands. Sugar-sweetened beverage consumption is also positively associated with the increased likelihood of obesity. Interventions that modify workloads and decrease SSB consumption may improve workers' eating behaviors and health.

Patient-Nurse Ratio is Related to Nurses' Intention to Leave Their Job through Mediating Factors of Burnout and Job Dissatisfaction.

In healthcare settings, nurses' workload, burnout, and job satisfaction are associated to the patient-nurse ratio. Whether this ratio also affects their intention to leave the nursing profession, along with the underlying stress pathway, remains unclear. This study aimed to investigate the effects of the patient-nurse ratio on nurses' intention to leave and considering the mediating roles of burnout and job dissatisfaction. The study analyzed the data of two pooled cross-sectional surveys collected in 2013 and 2014. Measures were obtained by a structure questionnaire, which queried the average daily patient-nurse ratio (ADPNR), nurses' personal burnout, client-related burnout, job dissatisfaction, intention to leave, and other demographics. ADPNRs were standardized according to hospital levels. Multiple regression models examined mediation hypotheses, and a percentile bootstrap confidence interval was applied to determine the significance of indirect effects. A total of 1409 full-time registered nurses in medical and surgical wards of 24 secondary or tertiary hospitals in Taiwan completed self-administered questionnaires. Most of the participants were female (97.2%), and the mean age was 29.9 years. The association between the standardized ADPNR and intention to leave their job was significantly mediated by personal burnout, client-related burnout, and job dissatisfaction. Higher standardized ADPNRs predicted higher levels of personal burnout, client-related burnout, and job dissatisfaction, each of which resulted in higher levels of intention to leave the current job. The results highlight that appropriate patient-nurse ratio standards may be further discussed by selecting personal burnout, client-related burnout, and job dissatisfaction as indicators.

Long-Term Effects of Psychological Symptoms after Occupational Injury on Return to Work: A 6-Year Follow-Up.

Psychological factors may compromise return to work among workers with occupational injuries, and little is known about the long-term consequences of psychological symptoms relating to return to work. The study examined the impact of psychological symptoms on return to work as well as exploring factors associated with return to work among injured workers. A total of 572 workers who experienced occupational injuries were recruited in this prospective cohort study. Surveys of the psychological symptoms using the 5-item Brief Symptom Rating Scale (BSRS-5) were conducted at 3 and 12 months after the injury. All of the workers were invited to join the study at year 6 after the injury. Sociodemographic factors, psychological symptoms, injury severity, and return-to-work status were collected. Approximately 10% of injured workers could not return to work even 6 years after the injury. Severe psychological symptoms within 1 year after the injury presented a significant risk factor for not returning to work 6 years after the injury (adjusted OR = 0.7, 95% CI: 0.5⁻0.8). Furthermore, age, education level, length of hospitalization, and injury-induced changes in appearance had significant independent influence on return to work as well. These findings highlight the importance of the effects of mental health within 1 year post injury on return to work, and support the concept of early screening, detection, and intervention in at-risk occupational injured workers with severe psychological symptoms.

Workplace justice and intention to leave the nursing profession.

BACKGROUND:: Poor psychosocial work environments are considered critical factors of nurses' intention to leave their profession. Workplace injustice has been proven to increase the incidence of psychiatric morbidity among workers. However, few studies have directly investigated the effect of workplace justice on nurses' intention to leave their profession and the population attributable risk among nurses. OBJECTIVE:: This study identified factors associated with workplace justice and nurses' intention to leave the profession. METHOD:: A cross-sectional survey was conducted using a self-administered structured questionnaire. Approximately 10% of all secondary referral centers in Taiwan were stratified and randomly sampled. Multiple logistic regression and population attributable risks were preformed to assess the effect of workplace justice on nurses' intention to leave the nursing profession. ETHICAL CONSIDERATIONS:: This study was approved by the Research and Ethical Committee of National Taiwan University Hospital. Only nurses who consented to the study participated in the survey. RESULT:: A total of 2268 nurses were recruited, of whom 1417 (62.5%) satisfactorily completed the questionnaire. The participants were classified and 342 (24.1%) of them were placed into the low workplace justice group. Nurses with low workplace justice had a higher intention of leaving the profession (adjusted odds ratio = 1.34, 95% confidence interval = 1.02-1.77). "Employees' opinions are influential in hospital's decision making" and "employees' performance is evaluated fairly" were the most influential factors of the participants' intention to quit. The adjusted population attributable risk was 3.7% for low workplace justice. CONCLUSION:: This study has identified that workplace justice is a protective factor of nurses' leaving their current profession. A fair performance appraisal system and increased autonomy at work are warranted to dissuade nurses from leaving the nursing profession.

An Integrative Index for Predicting Extubation Outcomes After Successful Completion of a Spontaneous Breathing Trial in an Adult Medical Intensive Care Unit.

BACKGROUND: Among respiratory predictors, rapid shallow breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remains inconsistent. Regarding nonrespiratory predictors, serum albumin, hemoglobin, bicarbonate, and patients' alertness have been reported to be associated with successful weaning or extubation. We aimed to develop an integrative index combining commonly used predictors in the adult medical intensive care units (MICUs) and to compare the predictability of the index with RSBI. METHODS: This prospective observational study with retrospective data collection of planned extubations was conducted in a 14-bed adult MICU. We enrolled patients who received mechanical ventilation via an endotracheal tube in the adult MICU for >24 hours and passed a 2-hour spontaneous breathing trial and underwent extubation. Extubation failure was defined as reinstitution of invasive mechanical ventilation within 48 hours of extubation. Respiratory parameters and Glasgow Coma Scale (GCS) scores of patients were recorded prospectively. Nonrespiratory parameters were recorded retrospectively. Logistic regression was used to determine significant predictors of extubation outcomes. RESULTS: Fifty-nine patients comprising 70 extubations were enrolled. Extubation failure was significantly and positively associated with lower serum albumin (albumin < 2.6 g/dL, odds ratio [OR] = 5.1; 95% confidence interval [CI], 1.04-24.66), lower hemoglobin (hemoglobin < 10.0 g/dL, OR = 10.8; 95% CI, 2.00-58.04), and lower GCS scores (GCS score ≤ 8, OR = 6.1; 95% CI = 1.15-32.34). By using an integrative index combining the 3 parameters together, the sensitivity and specificity to predict extubation outcomes were 78.6% and 75.9%, respectively. The area under the receiver operating characteristic curve of the index was significantly higher than RSBI (0.84 vs 0.61, P = .026). CONCLUSION: The integrative index combining serum albumin, hemoglobin, and GCS scores could predict extubation outcomes better than RSBI in an adult MICU.

Quality of life at 6 years after occupational injury.

PURPOSE: Occupational injuries have considerable impact on workers' lives. However, data regarding workers' health-related quality of life (HRQOL) at several years after the injury are lacking. This study assessed workers' HRQOL at 6 years after occupational injury and determined related factors in each HRQOL domain. METHODS: Workers who sustained an occupational injury in 2009 and who responded to a previous survey at 3 or 12 months after their injury were followed up in 2015. A total of 1715 participants were candidates for this study. The Taiwanese version of the World Health Organization Quality of Life scale-abbreviated version (WHOQOL-BREF) was used to assess their HRQOL. Multiple linear regression analysis identified predictive factors for HRQOL at 6 years after occupational injury. RESULTS: A total of 563 workers completed the questionnaire (response rate, 32.8%). Adverse life events and additional severe occupational injuries that occurred within the follow-up period, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF. In addition, unmarried participants had low scores in the social relationship domain. Workers with family members requiring care scored low in the physical and environment domains. Workers whose injuries had major effects on their physical appearance had low scores in the physical and psychological domains. Workers with unstable employment had low scores in physical, psychological, and environment domains. CONCLUSION: At 6 years after occupational injury, workers' HRQOL was poor among those whose salaries decreased after the injury, after adjustment for other factors.

Depressive, anxiety and post-traumatic stress disorders at six years after occupational injuries.

The aim of this study is to determine the prevalence rates of depressive, anxiety and PTSDs, and the risk factors for psychological symptoms at 6 years after occupational injury. This longitudinal study followed workers who were occupationally injured in 2009. Psychological symptoms and return to work were assessed at 3 and 12 months after injury. Injured workers who had completed the initial questionnaire survey at 3 or 12 months after injury were recruited. A self-administered questionnaire was mailed to the participants. For workers with high Brief Symptom Rating Scale and Post-traumatic Symptom Checklist scores, an in-depth psychiatric evaluation was performed using the Mini-international Neuropsychiatric Interview. A total of 570 workers completed the questionnaire (response rate, 28.7%). Among them, 243 (42.6%) had high psychological symptom scores and were invited for a phone interview; 135 (55.6%) completed the interview. The estimated rates of major depression and post-traumatic stress disorder (PTSD)/partial PTSD were 9.2 and 7.2%, respectively, and both these rates were higher at 6 years after injury than at 12 months after injury (2.0 and 5.1%). After adjustment for family and social factors, the risk factors for high psychological scores were length of hospitalization immediately after injury, affected physical appearance, repeated occupational injuries, unemployment, and number of quit jobs after the injury. At 6 years after occupational injury, the re-emergence of psychiatric disorders was observed. Relevant factors for poor psychological health were severity of injury and instability of work. Periodic monitoring of psychological and physical health and economic stability are warranted.

Short sleep duration is dose-dependently related to job strain and burnout in nurses: a cross sectional survey.

OBJECTIVES: Lack of sleep is a common problem amongst nurses. Short sleep duration has been related to stress and burnout. However, in nurses, the effects of short sleep duration on job strain and burnout are controversial and a clear relationship has been lacking. This study aims to assess whether short sleep duration is related to job strain and burnout statue, and whether such relationship is in a dose-dependent manner. METHODS: A cross-sectional survey among female nurses in secondary referral health centers in Taiwan, using a self-administered structured questionnaire. Stratified sampling by region and patient bed number category was done to select representative centers for this survey. Approximately 10% of all secondary referral centers were randomly selected from each stratum. Non-linear dose-response relationship between sleep duration and job strain and burnout scores was assessed by general additive models (GAM), adjusting for personal characteristics, work condition, and family situation. RESULTS: Among the 2268 full-time nurses in 39 hospitals invited to participate in this study, 1384 (61%) satisfactorily completed the questionnaire. There were 169 nurses (12.2%) who slept less than 6 h per working day. Among the participants, 37% (n=512) were classified into high strain group. The mean scores of personal, work-related, and client-related burnout were 59.4 (SD=22.0), 54.6 (SD=21.7), and 42.3 (SD=18.6). Compared to those slept longer than 7 h, nurse who slept less than 6 h per working day had higher risk for job strain (adjusted odds ratio, AOR=1.8, 95% confidence interval, CI=1.2-2.7), personal burnout (AOR=3.0, CI=1.7-5.2), work-related burnout (AOR=3.4, CI=2.0-6.0), and client-related burnout (AOR=2.0, CI=1.2-3.6). GAM analysis found a linear relationship between sleep duration and job strain, and client-related burnout. For personal and work-related burnout, a linear increase in burnout score between 7 h and 5 h of sleep was observed, followed by a leveling off for durations of less than 5 h. CONCLUSION: Our study found sleep duration at working days was inversely associated with female nurses' job strain and burnout in a dose-dependent manner. Further studies on work factors which affecting sleep duration are warranted.

Long-term psychological outcome of workers after occupational injury: prevalence and risk factors.

INTRODUCTION: This study aimed to examine the prevalence rates of both post-traumatic stress disorder (PTSD) and major depression at 12 months in workers experiencing different types of occupational injury in Taiwan. Demographic and injury-related risk factors for psychological symptoms were also evaluated. METHODS: Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale and Post-traumatic Symptom Checklist was sent to workers at 12 months after injury. Those who met the criteria were recruited for the second-stage phone interview with a psychiatrist using the Mini-international Neuropsychiatric Interview (MINI). RESULTS: A total of 1,233 workers completed the questionnaire (response rate 28.0 %). Among them, 167 (13.5 %) fulfilled the criteria for the MINI interview and were invited. A total of 106 (63.5 %) completed the phone interview. The estimated rate of either PTSD/PPTSD or major depression was 5.2 %. The risk factors for psychological symptoms were female gender, lower education level, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family. CONCLUSIONS: These results showed that occupational injury can cause long-term psychological impact in workers. Key demographic and injury characteristics may enhance the identification of at-risk occupational injured workers who would benefit from targeted screening and early intervention efforts.

A qualitative study of psychosocial factors affecting expecting mothers who choose to continue a cleft lip and/or palate pregnancy to term.

BACKGROUND: Prenatal detection of cleft lip and/or palate (CL/P) leads to high rates of induced termination of pregnancy. There has been little research in Taiwan done on the psychosocial factors affecting those who decide to continue their CL/P pregnancy. PURPOSE: This study identified the principal psychosocial factors that affect expecting mothers who chose to continue their CL/P pregnancy to term. METHODS: Purposive sampling recruited expecting mothers with CL/P-diagnosed fetuses. Recruiting took place between May 2000 and March 2002 at a tertiary referral hospital in Taipei, Taiwan. Those who had decided to continue their pregnancy to term were asked to participate. Researchers obtained oral informed consent to be interviewed during the week following CL/P diagnosis. Interviews for each participant were completed within a 2-week period. All information was given to the interviewees in written and verbal forms before providing their written informed consent to participate. RESULTS: The five major themes central to participant experiences included (1) loss of self-value as a mother, (2) blaming the mother, (3) indecision about whether to continue the pregnancy, (4) anxiety triggered by insufficient information, and (5) burden of care and concerns about potential disadvantaged status. CONCLUSIONS: Significant psychological distress was identified among participants following their fetus' CL/P diagnosis. It was encouraging to learn that all participants told researchers in postpartum interviews that they did not regret the decision to take their child to term.

A novel Doppler spectral index for differentiating benign from malignant lung tumors.

PURPOSE: It has been reported that the resistance index (RI) and pulsatility index (PI) are of limited value in differentiating lung cancers from benign lesions. We hypothesized that a vascular work index (VWI), derived from Doppler spectral waveforms, would yield better results. METHODS: Forty-one patients were enrolled, 20 of them having malignancies and 21 having benign lesions. The VWI was defined as the square of peak systolic velocity times the time-velocity integral. Maximal VWI, minimal RI, and minimal PI of each tumor were used for analysis. RESULTS: Significantly higher VWI values were found in malignant tumors compared with benign lesions (p < 0.0001). VWI was shown by analysis of the receiver operating characteristic curve to be a best predictor of lung malignancies than PI and RI (p < 0.05), with a 0.89 (95% confidence interval, 0.80-0.98) area under the receiver operating characteristic curve. CONCLUSIONS: VWI may be a useful index to help differentiate malignant from benign lung tumors.

Assaults against nurses of general and psychiatric hospitals in Taiwan.

PURPOSE: Nurses are at risk of occupational assaults. However, the incidence and effects have not been documented among nurses in Taiwan. We aimed to study the incidence of assaults and their effects, including quality of life and job-related stress among nurses. METHODS: A cross-sectional study was conducted to understand the incidence of work-related assaults in nurses. Job content questionnaire was used to determine the job control, psychological demands at work, and workplace support in these nurses. Quality of life was assessed by short form-36 (SF-36). RESULTS: A total of 842 nurses satisfactorily completed the questionnaire, including 375 from general hospitals and 467 from psychiatric hospitals. A total of 237 (28.1%) reported to have experienced physical and/or verbal assaults in past 6 months. Experiences of sexual assault or verbal abuse were risk factors for feeling threatened by potential attacks. Nurses who felt threatened by potential attacked scored lower in general health, mental health, and vitality by SF-36, and had higher psychological demands at work, lower job control, and lower workplace support. CONCLUSION: We conclude that nurses in general and psychiatric hospitals had high risk of assaults. Worksite assaults caused nurses to feel threatened, and such an effect was likely to cause increased job stress and decreased quality of life.

Chinese EPINet and recall rates for percutaneous injuries: an epidemic proportion of underreporting in the Taiwan healthcare system.

OBJECTIVES: As an occupational injury, percutaneous injury (PI) can result in chronic morbidity and death for healthcare workers (HCWs). A pilot surveillance system for PIs using the Chinese version of Exposure Prevention Information Network (EPINet) was introduced in Taiwan in 2003. We compared data from EPINet and recall of PIs using a cross-sectional survey for rates to establish the reliability of the new system. METHODS: HCWs from hospitals that had implemented EPINet for > or =12 months completed a survey for recall of contaminated PIs sustained between October 2004 and September 2005, type of item involved, and reasons for reporting or not reporting the PI. Comparative data from EPINet for the same period were analyzed. RESULTS: The EPINet rate, 36.1/1,000 HCW (95%CI 31.8-41.1) was almost 5 times lower (p<0.0001) than the PI recall rate for 2,464 HCWs of 170/1,000 HCWs (95%CI 155.4-185.5). Approximately 2.5 PIs were recalled for every 1,000 bed-days of care. The recall rate by physicians was 268.3/1,000, 188.5/1,000 for nurses, 88.9/1,000 for medical technologists and 81.3/1,000 for support staff. Hollow-bore needle items most commonly recorded on EPINet includ, disposable needles and syringes were underreported by 81%, vacuum tube holder/needles by 67%, and arterial blood gas needles by 75%. Nearly 63% of the reasons for underreporting were related to the complexity of the reporting process, while 37% were associated with incorrect knowledge about the risks associated with PIs. CONCLUSIONS: EPINet data underestimates a commonplace occupational injury with nearly four in five PIs not reported. Addressing the real barriers to reporting must begin with hospital administrators impressing on HCWs that reporting is essential for designing appropriate safety interventions.

Factors predicting nurses' consideration of leaving their job during the SARS outbreak.

Taiwan was affected by an outbreak of severe acute respiratory syndrome (SARS) in early 2003. A questionnaire survey was conducted to determine (1) the perceptions of risk of SARS infection in nurses; (2) the proportion of nurses considering leaving their job; and (3) work as well as non-work factors related to nurses' consideration of leaving their job because of the SARS outbreak. Nearly three quarters (71.9%) of the participants believed they were 'at great risk of exposure to SARS', 49.9% felt 'an increase in workload', and 32.4% thought that people avoided them because of their job; 7.6% of the nurses not only considered that they should not care for SARS patients but were looking for another job or considering resignation. The main predictors of nurses' consideration of leaving their job were shorter tenure, increased work stress, perceived risk of fatality from SARS, and affected social relationships. The findings are important in view of potential impending threats of pandemics such as avian influenza.

Risk factors for musculoskeletal discomfort in nurses.

Although musculoskeletal problems are commonly reported among the working population, including nurses, the prevalence and risk factors for musculoskeletal discomfort in nurses have not been extensively studied in Taiwan. To understand the risk factors and prevalence of musculoskeletal discomfort in different body parts among nurses in Taiwan, we performed a cross-sectional study using a self-administered questionnaire to collect data. A total of 5,269 (93%) nurses completed the questionnaire survey. Musculoskeletal discomfort was found to be prevalent in this group. In terms of location, the lower back was the most commonly reported site of discomfort, followed by lower legs, shoulders and neck. Considering limitation of motion as an indicator of musculoskeletal discomfort severity, the highest levels of prevalence were reported, respectively, in the lower back, shoulder, lower leg, and wrist. Numbness was most commonly reported in lower legs, hands, thighs, and lower back. Risk factors for pain in shoulders/neck included waist-bending and waist-twisting, while those for lower back pain included duration of standing, waist-bending, and weight-lifting. Risk factors for lower leg pain included duration of standing and weight-lifting. Musculoskeletal discomfort was prevalent among nurses (91.6%). Pain in different body parts was related to different ergonomic risk factors while at work, namely, bending and twisting of the waist, and standing for extended periods of time. The development and testing of interventions to minimize these risk factors is warranted in future studies.

Prevalence and risk factors of occupational hand dermatoses in electronics workers.

The electronics industry is becoming an important mainstream in the workforce in some developed countries and in Taiwan. Among patients with occupational hand dermatitis in northern Taiwan, workers from electronics industries were one of the most important groups. We conducted a field investigation to determine the prevalence, patterns and risk factors of occupational hand dermatoses among electronics workers. The survey was conducted in five electronics plants using a self-administered questionnaire on skin symptoms and risk factors. Skin examination and patch testing were followed for those with symptoms compatible with hand dermatitis. A total of 3070 workers completed the questionnaire. Among them, 302 (9.8%) reported to have symptoms (itching and with either redness/scaling) compatible with contact dermatitis on hands. Hand dermatitis was associated with working in the fabrication unit and personal history of atopy and metal allergy, as well as the following job titles: wafer bonding, cutting, printing/photomasking, softening/degluing, impregnation and tin plating. Among those with reported hand dermatitis, 183 completed skin examination and patch testing, 65/183 (35.5%) were diagnosed as having irritant contact dermatitis (ICD) and 7/183 (3.8%) allergic contact dermatitis. The most important allergens were nickel, cobalt and phenylenediamine. In conclusion, Taiwanese electronics workers have a high risk of having hand dermatitis, especially ICD. Preventive efforts should be focused on the workers with risk factors or at certain worksites.