空腹血糖受损(IFG)作为糖尿病前期的重要标志,不仅与个体代谢状态密切相关,还受到多种危险因素复杂的交互影响.本综述在梳理国内外IFG相关研究的基础上,归纳了其临床定义与代谢风险意义,分析了职业暴露对IFG的影响机制,提出以"职业行为性暴露、环境物理性暴露、职业化学性暴露与心理-社会性暴露"为核心的"三重通路"致病机制框架,进一步构建了针对职业人群的IFG分级防控体系,包括健康教育、职业环境优化、高风险筛查和个体化干预等.本研究强化了职业环境中代谢相关危险因素的识别与干预,有助于将糖尿病前期防控关口前移,为实现《"健康中国2030"规划纲要》中的慢性病防控目标提供理论基础和实践路径.
Objective To assess the mental health status and associated influencing factors of occupational populations in a suburban area of Shanghai,providing scientific evidence for improving their mental health level.Methods A cross-sectional survey was conducted from March to December 2024,using a stratified cluster random sampling method across 20 enterprises located in an industrial park of the suburban area.Anxiety and depression symptoms were evaluated using the Self-Rating Anxiety Scale(SAS)and the Self-Rating Depression Scale(SDS).Binary logistic regression models were employed to analyze the prevalence and influencing factors of psychological symptoms.Results A total of 1 330 questionnaires were distributed,and 1 310 valid responses were collected,with a valid response rate of 98.5％.The detection rate of anxiety symptoms was 23.2％,and that of depression symptoms was 55.0％.Logistic regression analysis revealed the following:(1)Compared to females,individuals aged 18 to 25,those without occupational hazard exposure,working less than 8 hours per day,engaged in manual labor,and experiencing no psychological stress or stress due to health issues,the detection rate of anxiety symptoms was significantly higher among males,individuals aged 26 to 30,those exposed to occupational hazards,working more than 12 hours per day,engaged in mental labor,and experiencing occasional or frequent psychological stress or stress due to work-related issues(OR=1.43,1.69,1.48,3.05,1.43,3.02,13.36,1.75;all P＜0.05).(2)Compared to individuals aged 18 to 25,non-local residents,those with postgraduate education or above,annual income over 160 000 RMB,holding management positions,engaged in mental labor,or without psychological stress,the detection rate of depression symptoms was significantly higher among individuals aged 51 to 60,local residents,those with high school,vocational,or lower education levels,annual income below 40 000 RMB,holding non-management positions,engaged in manual labor,or experiencing frequent psychological stress(OR=1.88,1.41,3.25,5.07,2.82,2.59,1.65,2.37;all P＜0.05).Additionally,compared to individuals working less than 8 hours per day,those working 8 to 10 hours or 10 to 12 hours per day had significantly lower detection rates of depression symptoms(OR=0.64,0.63;both P＜0.05).Conclusions Anxiety and depression symptoms were more prevalent among occupational populations in suburban Shanghai compared to urban and general populations.These conditions were closely interrelated but influenced by distinct factors.Targeted interventions are necessary to mitigate associated risks.
Objective To establish a method for sampling and determining cisplatin,an antitumor drug,in workplace air,providing technical support for assessing occupational exposure to cisplatin among healthcare workers.Methods Cisplatin in simulated workplace air was collected using microporous membrane filters.Samples were pretreated by nitric acid digestion and analyzed using inductively coupled plasma mass spectrometry(ICP-MS).Results The average sampling efficiency of airborne cisplatin,using microporous membrane filters,ranged from 95.30％to 100.00％.Analysis of platinum standard solutions showed a good linear relationship between the ratio of platinum to internal standard response and platinum concentration within the range of 0 to 100.00 μg/L,with a correlation coefficient of 0.999 3.The lower limit of quantification was 0.14 μg/L.The minimum quantifiable concentrations of cisplatin in air were 2.9 × 10-5 mg/m3 for a 75 L air sample and 4.5 × 106 mg/m3 for a 480 L air sample.The average digestion efficiency of cisplatin was 95.20％to 102.49％,with intra-batch relative standard deviation(RSD)of 0.40％to 0.87％and inter-batch RSD of 1.18％to 2.40％.The average spiked recovery ranged from 100.91％to 105.20％.Samples remained stable for at least 14 days at room temperature.Conclusions This method demonstrated high sampling efficiency,good precision,high accuracy,and sample stability,making it suitable for sampling and determining cisplatin in workplace air.
Objective To investigate the incidence characteristics of occupational pneumoconiosis and the status of government medical assistance in Ankang,providing a theoretical basis for local prevention and control strategies.Methods Data on newly diagnosed cases of occupational pneumoconiosis in Ankang from 2012 to 2022 were collected.Confirmed cases were used as the study population to analyze the incidence of occupational pneumoconiosis.Results A total of 1 208 cases of occupational pneumoconiosis were reported in Ankang during 2012-2022,accounting for 99.26％of all reported occupational diseases.The overall number of reported cases showed a fluctuating downward trend over time.Among these,1 196 were newly diagnosed cases(99.00％).Stage Ⅰ pneumoconiosis accounted for 574 cases(48.00％),Stage Ⅱ for 378 cases(31.60％),and Stage Ⅲ for 244 cases(20.40％).The predominant types were silicosis(728 cases),coal workers' pneumoconiosis(467 cases),and cement pneumoconiosis(1 case).The main affected industries were mining,manufacturing,and construction,with 306 cases(25.59％).All 1 196 newly diagnosed cases were male.The most common age at diagnosis was 40 to 49 years(46.91％),while the most frequent age of initial dust exposure was 20 to 29 years(41.47％).Workers with 5 to 14 years of dust exposure accounted for 47.91％.A total of 85.62％of cases were concentrated in Ziyang,Pingli,and Xunyang counties.The proportion of Stage Ⅲ silicosis cases was significantly higher than that of coal workers' pneumoconiosis(P＜0.05).Among the 1 196 newly diagnosed patients,890(74.41％)received government medical assistance.Conclusions Occupational pneumoconiosis remained a major focus of occupational disease prevention in Ankang,with silicosis and coal workers' pneumoconiosis being the most prevalent types.A high proportion of patients benefited from government medical assistance.Strengthening regulatory oversight in mining,manufacturing,and construction industries is essential for effective occupational disease control in the region.
Objective To characterize the noise intensity and spectral profiles in high-noise workplaces within the metal manufacturing industry in Foshan and to provide evidence-based insights for targeted noise control and management measures.Methods A purposive sampling method was employed to select 218 metal manufacturing enterprises in Foshan,which were included in the special monitoring program for occupational hazards in workplaces from 2022 to 2024.Noise intensity measurements were conducted,and for high-noise workplaces with noise levels ≥ 85.0 dB(A),the spectral data were recorded using Z-weighting.Cluster analysis was applied to analyze the noise spectral characteristics across different workplaces.Results Of 218 metal manufacturing enterprises,189 were micro-and small-scale enterprises(86.7％).A total of 1 182 workplaces were measured for noise intensity,with 802 workplaces(noise non-compliance rate was 67.8％)exceeding 85.0 dB(A).Cluster analysis identified three primary categories of noise sources.Category 1 included three types,namely,grinders,machine tools,and polishing machines,characterized as low-frequency narrow-band noise;Category 2 included six types,namely,packaging machines,stamping machines,punching machines,welding machines,spray guns,and cutting machines,characterized as mid-frequency narrow-band noise;Category 3 included five types,namely,lathes,shearing machines,material cutting machines,bending machines,and assembly machines,characterized as high-frequency narrow-band noise.Conclusions Noise hazards in the metal manufacturing industry in Foshan were relatively severe.It is recommended that enterprises implement effective engineering control measures and hearing protection measures tailored to the noise spectral characteristics identified at workplaces.
目的 分析尘肺病死亡病例的基本特征及死因分布,为改善患者生活质量、延长生存时间以及优化康复干预策略提供科学依据.方法 运用横断面调查方法,选择截至2023年12月31日的南京市尘肺病随访与调查数据库中有完整数据的652名尘肺病死亡病例作为研究对象,描述不同维度下死因分布的特征,对死亡病例的生存时间进行多元线性回归分析,对死因可能的影响因素进行无序多分类logistic回归分析.结果 所有病例中,男性586例,女性66例.矽肺462例,占70.9％;病例平均初诊年龄为(55.62±9.97)岁,平均接害工龄为(23.41±8.91)年,平均死亡年龄为(80.45±8.08)岁.多元线性回归分析结果显示:男性病例的生存时间相比女性平均缩短4.949年(P＜0.01);相比其余病种,水泥尘肺病例的生存时间平均缩短4.812年(P＜0.01);初诊年龄每增加1岁,生存时间平均缩短0.632年(P＜0.01).尘肺病病例死因顺位第一位为循环系统疾病,共230例(占35.3％);第二位为呼吸系统疾病,共178例(占27.3％);第三位为肿瘤,共163例(占25.0％).无序多分类logistic回归分析结果显示:(1)与其他死因相比,随着初诊年龄的增加,因循环系统疾病、呼吸系统疾病死亡的风险增加(O R=1.035、1.028,均P＜0.05);(2)与其他死因相比,随着尘肺病期别的增加,因呼吸系统疾病死亡的风险增加(OR=2.686,P＜0.05).结论 南京市尘肺病患者的生存状况较好.死因谱呈现出高龄驱动循环系统死亡、疾病进展驱动呼吸系统死亡的双重特征.应重点对现存的尘肺病合并心血管疾病患者群进行防控,积极治疗合并症、并发症,通过多系统协同干预,切实延长患者生存期与健康寿命.
Objective To investigate the protective effect of exogenous metallothionein-1(MT-1)against liver injury induced by mercuric chloride poisoning in Brown-Norway rats.Methods Male Brown-Norway rats(n=42)were randomly divided into six groups(n=7 per group),including normal control,model control,positive control,and low-,medium-,and high-dose MT-1 groups.Except for the rats in the normal control group,the rats in all other groups received subcutaneous injections of 1 mg/mL mercuric chloride solution(1.0 mg/kg)every other day for 14 days(7 injections total).The positive control group rats were intramuscularly injected with 2.5 mg/mL sodium 2,3-dimercapto-1-propanesulfonate(DMPS)at 5 mL/kg every 2 days.Rats in the low-,medium-,and high-dose MT-1 groups received MT-1 via oral gavage at concentrations of 0.032,0.080,and 0.160 mg/mL(5 mL/kg body weight),respectively,once daily.The normal control and model control groups received equivalent volumes of 9 g/L sodium chloride solution(mass-volume concentration).After the experiment,rat body weight and liver wet weight were measured,and the liver index was calculated.Gross pathological changes of the liver were observed,and serum alanine aminotransferase(ALT),γ-glutamyl transferase(GGT),bilirubin,total protein,globulin,and albumin-to-globulin ratio were determined as indicators of liver function.Results Compared with the normal control group,the mercuric chloride-treated groups of rats showed varying degrees of poisoning symptoms,including reduced body weight,increased liver index,significant elevation in serum ALT,GGT,and total bilirubin levels,and significantly reduced total protein and albumin/globulin ratio.Compared with the model control group,the medium and high dose MT-1 groups and the DMPS group showed a significant lower serum ALT and GGT levels(P＜0.05).All MT-1 dose groups demonstrated significantly higher total protein levels(P＜0.05),and the high-dose MT-1 group also showed a significant recovery in albumin/globulin ratio and total bilirubin level(both P＜0.05).Conclusions Exogenous high-dose MT-1 could alleviate some mercuric chloride-induced liver function abnormalities,with comparable efficacy to DMPS,while also improving total protein level in the model rats.
目的 探讨心血管专科护士一般自我效能感、结构授权、感知压力与生涯适应力的相互关系,为管理者实施干预策略,提升心血管专科护士生涯适应力提供理论依据.方法 采用便利抽样法,于2024年5-6月选取700名心血管专科护士作为研究对象,采用一般资料调查表、《感知压力量表》《一般自我效能感量表》《结构授权量表》和《生涯适应力量表》对其进行问卷调查,采用AMOS 28.0软件构建结构方程模型,分析一般自我效能感与结构授权在感知压力与生涯适应力间的中介效应,并通过bootstrap法进一步对中介效应的显著性进行验证.结果 回收有效问卷659份,有效回收率为94.14％.心血管专科护士感知压力总分为(29.31±4.20)分,一般自我效能感总分为(24.25±6.30)分,结构授权总分为(54.41±13.02)分,生涯适应力总分为(41.94±8.27)分.中介效应分析结果显示:感知压力可以负向预测一般生涯适应力,直接效应值为47.38％;存在3条中介效应链:感知压力通过一般自我效能感预测生涯适应力,间接效应为27.49％;感知压力通过结构授权预测生涯适应力,间接效应为14.14％;感知压力还通过一般自我效能感和结构授权的链式中介效应预测生涯适应力,间接效应为10.99％.结论 心血管专科护士生涯适应力处于中等偏上水平,感知压力可以分别通过一般自我效能感与结构授权的中介作用和链式中介作用影响心血管专科护士的生涯适应力.建议提升护士的一般自我效能感,帮助其更积极地应对感知压力,促进对结构授权资源的有效利用,最终增强其生涯适应力水平.
Objective To assess the current status of disaster preparedness among emergency nurses in secondary class A and above general hospitals in Jiangxi Province and identify influencing factors,providing evidence for improving disaster management capacity.Methods Using the Disaster Preparedness Evaluation Scale,a disaster preparedness survey was conducted among emergency nurses from 70 secondary class A and above general hospitals in Jiangxi Province.A multiple linear regression model was applied to analyze factors associated with disaster preparedness.Results A total of 987 questionnaires were distributed,and 943 responses were collected,with a valid response rate of 95.54％.The overall disaster preparedness score of emergency nurses was(216.05±45.15)points,indicating an upper-middle level.Among the three dimensions,scores ranked from high to low as follows:disaster knowledge(4.91±0.98)points,post-disaster management(4.80±1.03)points and disaster skills(4.68±1.16)points.Multiple linear regression analysis showed that nurses aged≤30 years had higher preparedness levels than those aged ≥ 40 years(β=15.121,P＜0.05).Nurses with work experience ≤ 5 years or 6 to 10 years had lower preparedness levels than those with ≥ 11 years of experience(β=-49.607 and-28.786,P＜0.001).Nurses working in top tertiary hospitals had lower preparedness levels than those in tertiary class B hospitals(β=-10.523,P＜0.05).Nurses with disaster rescue experience had higher preparedness levels than those without such experience(β=19.406,P＜0.001).Nurses participating in disaster training scored higher than those not participating(β=18.042,P＜0.001).Conclusions Emergency nurses in secondary class A and above general hospitals in Jiangxi Province demonstrated a moderate level of disaster preparedness.Standardized training focusing on basic disaster knowledge and practical skills should be strengthened for junior and less-educated nurses,while senior or highly educated nurses should receive advanced training in areas such as emergency decision-making,organizational coordination,and post-disaster management.Additionally,high-fidelity simulation drills and tabletop exercises should be widely implemented to enhance the practical response capabilities of emergency nurses.
Objective To assess the current status of hearing protector effectiveness among noise-exposed workers in automobile manufacturing enterprises and to identify factors influencing personal attenuation performance.Methods From July to September 2022,three automobile manufacturing enterprises in Guangdong Province were selected as study sites.A questionnaire was administered to collect information on workers' demographic characteristics,noise exposure,and hearing protector use.Workplace noise exposure levels were measured for workers in noise-exposed positions.The baseline personal attenuation ratings(PARs)for workers wearing earplugs were tested using the 3M E-A-Rfit Dual-Ear Validation System.A multivariable logistic regression model was applied to analyze factors associated with hearing protector performance.Results A total of 900 questionnaires were distributed,and 873 valid responses were obtained(effective response rate of 97.0％).Individual noise exposure levels ranged from 80 to 100 dB(A).The overall baseline PAR pass rate was 77.1％.Multivariable logistic regression analysis showed that enterprise type,sex,and subjective perception of correct hearing-protector use were associated with baseline PAR pass rates.Male workers had higher PAR pass rates than female workers(OR=1.906;95％CI:1.348 to 2.694).Compared with workers who believed they did not use hearing protectors correctly,those who self-identified correct use had higher PAR pass rates(OR=1.530;95％CI:1.052 to 2.226).Conclusions The protective effectiveness of hearing protectors among automobile manufacturing workers needs improvement.Automobile manufacturing enterprises should strengthen occupational health governance systems,promote the development of suitable products by manufacturers,provide customized hearing protection and fit-testing guidance,implement effective training and competency assessments,and adopt comprehensive noise-control measures at the source to better safeguard the health of noise-exposed workers.
基于一起食物中毒事件,利用气相色谱-串联质谱(GC-MS/MS)的多种工作模式对采集的汤液、汤渣、药材干品以及患者的洗胃液、血液、尿液进行定性检测.所有采集的样品均检出了钩吻素甲和钩吻素子,确证本起食物中毒事件系误食钩吻所致.实验室通过GC-MS/MS的多种模式协同分析,建立了一套从多类型检材中逐步鉴定毒物的应急检测流程和跨介质、多模式联用的应急检测策略,可推广应用于缺乏标准品情况下的食源性中毒分析,为患者救治和类似中毒事件的快速响应提供可复制的技术方案.
目的 探究临床一线护士心理安全感、逆商对工作适应障碍的影响机制,为促进一线护士的心理与行为健康提供依据.方法 2024年6-7月,采用方便抽样法,在四川省5家三甲医院对500名在职护士开展调查,采用《医务人员安全感量表》《工作适应障碍量表》和《护士逆商自我评价量表》调查护士的心理健康状况.用SPSS 23.0软件分析3个量表得分的相关性,并验证逆商在心理安全感和工作适应障碍间的中介效应.结果 回收有效问卷422份,问卷有效回收率为84.4％.不同年龄、工龄、科室护士的工作适应障碍得分差异有统计学意义(P＜0.05),表现为31～40岁、工龄长、急危重症科护士的工作适应障碍得分较高.心理安全感水平越低,工作适应障碍水平就越高(r=0.547,P＜0.01);逆商水平越低,工作适应障碍水平越高(r=0.581,P＜0.01);心理安全感越低,逆商水平也越低(r=0.854,P＜0.01)o逆商在护士心理安全感与工作适应障碍中起部分中介效应,中介效应占比为64.34％.结论 心理安全感对工作适应障碍具有直接影响作用,也可以通过逆商对工作适应障碍起到部分影响作用.医院管理人员应重视营造良好的工作氛围,多开展逆商的培训项目,通过增加工作中的积极心理资源,提高一线护士工作适应水平.
Objective To explore the practical application of digital supervision technology in occupational health supervision and provide a scientific basis for improving regional occupational health supervision efficiency.Methods The informatization data resources related to occupational health management in the Pudong New Area of Shanghai were collected and analyzed.An intelligent supervision system for occupational health was established in Pudong,and its application was evaluated with optimization suggestions proposed.Results A total of 201 279 pieces of informatization data were obtained from five information systems at the national,Shanghai municipal,and Pudong New Area levels,as well as from monitoring reports.Among these,the application quality of occupational health-related professional data was higher than that in other fields.The intelligent occupational health supervision system included a basic database of occupational health management entities,a basic task database for occupational health supervision,and a comprehensive supervision and response module.After implementing the system,the problem discovery rate during occupational health inspections was higher than before(P＜0.05).Conclusions The application of digital supervision technology contributed to improving the efficiency of occupational health supervision.However,challenges remain,such as data silos,varying quality of multi-source data,insufficient reliability of model algorithms,and low acceptance of digital supervision by employers.It is recommended that government departments optimize data management policies and further promote data openness and sharing.Data standardization should be implemented alongside system construction,and management models should be continuously refined.Additionally,efforts should be made to increase awareness and application of digital supervision technologies and systems to boost employers' engagement in self-compliance management.
氰化物中毒因其剧毒性和多途径暴露对公共卫生构成严峻的挑战.氰化物通过抑制线粒体细胞色素c氧化酶,阻断有氧呼吸链,导致细胞内低氧和三磷酸腺苷(ATP)严重耗竭,中毒者临床表现为头痛、呼吸困难、代谢性酸中毒、肺水肿,严重者可迅速死亡.氰化物中毒诊断主要基于暴露史、典型症状及间接生化指标;尽管血氰浓度测定为直接诊断标准,但因检测耗时长、技术要求高,临床实用性有限.标准治疗方案包括:立即脱离暴露源、高浓度氧疗、静脉注射特异性解毒剂(羟钴胺或亚硝酸钠联合硫代硫酸钠),以及针对循环与呼吸衰竭的支持治疗.然而,现有解毒剂均为静脉制剂,缺乏可用于院前急救的口服或肌内注射剂型.近年来,多种新型救治策略展现出应用前景:硫辛酸衍生物可修复线粒体功能;纳米材料解毒剂能高效吸附并催化降解CN-;基于CRISPR技术上调内源性硫氰酸酶(TST)表达水平以增强解毒能力;高压氧治疗(HBO)和体外膜肺氧合(ECMO)等可作为危重病例的生命支持手段.鉴于氰化物中毒可能引发重大公共卫生事件,亟需加快研发快速床旁检测技术、便携式解毒剂及靶向治疗药物,以提高应急响应能力和救治成功率.
Objective To develop a regional coordination capability index system for emergency medical responders to biosafety incidents,thereby providing a reference for formulating cross-regional emergency coordination strategies,optimizing resource allocation,and strengthening biosafety risk response capacity.Methods An index system was developed through literature review,qualitative interviews,and the Delphi method.Results The effective questionnaire response rate for both rounds of Delphi consultation was 100％(22/22).The experts' judgment coefficient was 0.945,familiarity coefficient was 0.873,and authority coefficient was 0.909.The Kendall's concordance coefficients for the first-round of consultation across indicator level were 0.203,0.262,and 0.256,and for the second round were 0.230,0.327,and 0.278(all P＜0.01).The constructed regional coordination capability index system comprised five first-level indicators:organizational structure and coordination mechanisms,resource support capacity,information-sharing and communication technology capability,training and collaborative response efficiency,with corresponding weights of 0.196,0.194,0.194,0.206,and 0.211,respectively.These were further divided into 13 second-level indicators and 38 third-level indicators.Conclusions The proposed index system can provide a valuable reference for optimizing emergency response processes,improving cross-regional collaboration frameworks,and enhancing overall capacity for managing biosafety incidents,demonstrating strong practical value.
Objective To investigate the exposure levels and occupational health risks of workers exposed to hexavalent chromium compounds in the chromate production and chrome plating industries in China under currently accessible economic and technological conditions.Methods A chromate production enterprise and a chrome plating enterprise with domestic advanced technologies and processes were selected as study subjects.Relevant data were collected through occupational health investigations,and airborne hexavalent chromium concentration in workplaces was measured.The models specified in Technical Guidelines for Occupational Health Risk Assessment of Chemical Hazards in the Workplace(GBZ/T 298-2017)were applied to evaluate the non-carcinogenic and carcinogenic risks associated with inhalation exposure to hexavalent chromium.Results The time-weighted average concentrations(CTWA)of hexavalent chromium exposure across different job positions in the two enterprises ranged from 0.071 to 29.484 μg/m3.Among the 33 job positions exposed to hexavalent chromium in two enterprises,the worker's non-carcinogenic risk from inhalation exposure to hexavalent chromium was unacceptable in 100％of the positions,and the carcinogenic risk was unacceptable in 81.8％(27 job positions).Specifically,in the chromium salt production enterprise,the proportion of workers exposed to hexavalent chromium with unacceptable non-carcinogenic risk was 100％(24/24 job positions),and the proportion with unacceptable carcinogenic risk was 75％(18/24 job positions).In the chrome plating enterprise,both the non-carcinogenic and carcinogenic risks from inhalation exposure to hexavalent chromium among workers were unacceptable(100％,9/9 job positions).No statistically significant differences were observed in the proportions of unacceptable non-carcinogenic and carcinogenic risks between these two industries(both P＞0.05).Conclusions Occupational health risks in the chromate production and chrome plating industries remain high.Enterprises are advised to implement measures such as upgrading processes,renewing equipment,and substituting materials to effectively reduce the concentration of hexavalent chromium in workplace air and thereby lower the health risks to workers caused by inhalation exposure.
目的 探讨护士应急救援能力的潜在类别特征,分析护士应急救援能力不同类别的特征差异及影响因素,为护理管理者制订个性化的应急救援能力培训方案提供依据.方法 2024年10-12月,采用方便抽样法,选取内蒙古自治区某三级甲等医院的908名护士进行问卷调查,采用《护士应急救援能力量表》《一般自我效能感量表》《组织支持感量表》对研究对象进行问卷调查,使用潜在剖面分析模型识别护士应急救援能力的潜在类别,并采用多元logistic回归分析其影响因素.结果 回收有效问卷855份,有效回收率94.16％.临床护士应急救援能力可以分为低应急救援水平组(194人,占25.85％)、中等应急救援水平组(440人,51.46％)、高应急救援水平-综合发展组(221人,22.69％)3个潜在类别.多因素logistic回归分析结果显示:自我效能感得分每增加1分,低应急救援水平组护士转变为中等应急救援水平组护士的可能性增加1.318倍(P＜0.001);自我效能感、组织支持感得分每增加1分,低应急救援水平组护士转变为高应急救援水平-综合发展组护士的可能性分别增加1.823、1.070倍(均P＜0.001);有应急救援相关经验使低应急救援水平组护士转变为中等应急救援水平组护士和高应急救援水平-综合发展组护士的可能性分别增加4.300、7.339倍(均P＜0.001).结论 护士应急救援能力总体处于中等偏上水平.一般自我效能感是影响临床护士应急救援能力的重要内部因素,组织支持是影响临床护士应急救援能力的重要情境因素.建议护理管理者基于人-情境交互模型,制定护士应急救援能力分层干预计划,提升护士应急救援能力.
目的 了解肿瘤陪护人员角色压力、护患沟通能力和共情疲劳现状及三者之间的关系,为提高肿瘤陪护人员心理健康水平提供理论依据.方法 2025年1-4月,选择某大型医院肿瘤陪护人员为研究对象,采用一般资料调查表、《角色压力量表》《护患语言与社会交往问卷》《中文版共情疲劳简短量表》进行问卷调查,通过SPSS 26.0和AMOS 26.0软件进行数据分析,采用偏差校正的bootstrap法检验护患沟通能力在角色压力与共情疲劳间的中介效应.结果 发放300份调查问卷,回收有效问卷285份,有效回收率为95.00％.285名肿瘤陪护人员的角色压力总得分为(44.56±7.08)分,护患沟通能力总得分为(80.80±14.66)分,共情疲劳总得分为(59.27±8.14)分;其中离异/丧偶、无医学背景以及患者为特级护理的肿瘤陪护人员的角色压力更高,大学专科及以上、有医学背景的陪护人员护患沟通能力更强,无医学背景、工龄＜1年以及患者为特级护理的陪护人员共情疲劳症状更严重,以上差异均有统计学意义(P＜0.05).肿瘤陪护人员的角色压力总得分与护患沟通能力总得分呈负相关(r=-0.540,P＜0.01),与共情疲劳总得分呈正相关(r=0.379,P＜0.01),护患沟通能力总得分与共情疲劳总得分呈负相关(r=-0.426,P＜0.01).护患沟通能力在角色压力与共情疲劳间具有部分中介效应,中介效应值占总效应的44.53％.结论 肿瘤陪护人员的角色压力既可以直接影响共情疲劳,也可以通过护患沟通能力间接影响共情疲劳.医院及机构管理者可通过采取有效干预措施,降低肿瘤陪护人员的角色压力水平、提高护患沟通能力,进而缓解其共情疲劳现象.
Objective To reveal the current status of competency development needs among primary health care(PHC)managers in China and to analyze the impact pathways of their character strengths on these needs,providing evidence-based recommendations for improving the quality of primary health care services.Methods Using a stratified sampling method,369 PHC managers from 11 cities in Zhejiang Province were studied from June to September 2023.Their Character strengths and competency development needs were surveyed by the Chinese Virtues Questionnaire(CVQ-96)and the Competency Development Needs Scale.Hierarchical linear regression analysis was employed to explore the impact of character strengths on competency development needs.Results The mean scores of character strengths and competency development needs of 369 PHC managers were(4.03±0.60)and(4.43±0.60),respectively.Hierarchical linear regression indicated that the Interpersonal dimension of character strengths positively predicted all four dimensions of competency development needs(β=0.285 to 0.422,P＜0.001).The Prudence dimension had a significant positive effect on the needs for professional knowledge and basic management skills(β=0.269 and 0.226,respectively;P＜0.05).Conversely,the Vitality dimension did not show statistically significant predictive effects across any dimension of competency development needs in the multifactorial model(P＞0.05).Conclusions Primary health care managers demonstrated a strong demand for professional competency development,and character strengths served as a critical influencing factor of these needs.It is recommended that primary health care institutions implement comprehensive training needs assessments,prioritize the enhancement of PHC managers' interpersonal communication skills,and precisely stimulate individual internal drivers for competency development.
Objective To explore the mechanisms and configurational paths of factors influencing job bumout of medical staff in order to propose preventing and alleviating measures against such conditions.Methods A total of 64 medical staff from public hospitals of various levels in a district of Tianjin were surveyed with questionnaires of the Occupational Risk Perception Scale and the Maslach Bumout Inventory(MBI).Fuzzy set qualitative comparative analysis(fsQCA)was utilized to identify the core influencing factors and configurational paths leading to job burnout.Results The mean of the total score of job burnout among 64 medical staff was(33.06±13.41)points,with an average item score of(2.2±0.89)points.The prevalence of job burnout was 60.94％(n=39).Five configurational paths leading to job burnout were identified.The consistency of these five paths exceeded the threshold of 0.8(range:0.849 to 0.974),with an overall solution consistency of 0.896 and an overall coverage of 0.582.Configurations 1 to 4 formed the"physical sensation-induced"bumout paths,identifying"workload"and"occupational injury risk"as core conditions and risk factors such as personal development,social relations,or organizational management as supplementary factors.Configuration 5 formed the"psychological incentive-induced"path,which demonstrated that burnout was triggered by 3 core conditions of high personal development risk,high economic risk,and high occupational injury risk,even when workload,organizational management,and social relation risk were relatively low.Conclusions Job burnout of medical staff emerged from the specific interplay of multiple risks across various contexts.Interventions should target both physical sensation factors and psychological incentive factors by reducing workload,preventing occupational injuries,and addressing personal development and economic income issues in order to lower the risk of job burnout among medical staff.
