轮班和白班护理人员睡眠质量调查

目的评估白班和轮班护理睡眠质量状况,为改善护士的睡眠质量、健康状况提供科学依据。方法 2011年,采用匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)量表对本医院260名护士进行调查。结果白班组PSQI总分大于7分者13人,睡眠障碍的发生率为10%,轮班组130人,睡眠障碍的发生率为55.5%。两组人群PSQI各因子及总分比较,差异有统计学意义(P<0.05)。结论轮班护士比白班护士有较差的睡眠质量,需采取多种干扰措施来提高护士的睡眠质量。     

Relationship of sleep duration and annual changes in sleep duration with the incidence of gastrointestinal cancers: a prospective cohort study

Background:Prospective analyses have yet to identify a consistent relationship between sleep duration and the incidence of gastrointestinal (GI) cancers. The effect of changes in sleep duration on GI cancer incidence has scarcely been studied. Therefore, we aimed to examine the association between baseline sleep duration and annual changes in sleep duration and GI cancer risk in a large population-based cohort study.Methods:A total of 123,495 participants with baseline information and 83,511 participants with annual changes in sleep duration information were prospectively observed from 2006 to 2015 for cancer incidence. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and their confidence intervals (CIs) for GI cancers according to sleep duration and annual changes in sleep duration.Results:In baseline sleep duration analyses, short sleep duration (≤5 h) was significantly associated with a lower risk of GI cancer in females (HR: 0.31, 95% CI: 0.10–0.90), and a linear relationship between baseline sleep duration and GI cancer was observed (P = 0.010), especially in males and in the >50-year-old group. In the annual changes in sleep duration analyses, with stable category (0 to −15 min/year) as the control group, decreased sleep duration (≤−15 min/year) was significantly associated with the development of GI cancer (HR: 1.29; 95% CI: 1.04–1.61), especially in the >50-year-old group (HR: 1.32; 95% CI: 1.01–1.71), and increased sleep duration (>0 min/year) was significantly associated with GI cancer in females (HR: 2.89; 95% CI: 1.14–7.30).Conclusions:Both sleep duration and annual changes in sleep duration were associated with the incidence of GI cancer.     

手术室轮班护士睡眠质量的影响因素分析

目的:通过三因素评分模型分析手术室轮班护士睡眠质量的影响因素.方法:采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)对513名手术室轮班护士进行问卷调查.对所得数据进行三因素评分模型分析:因素1,睡眠效率;因素2,睡眠质量;因素3,日常生活功能障碍.结果:不同劳动关系、年...     

WORK SCHEDULE OF NURSING OFFICERS – A REVIEW

A survey was conducted among 345 nursing officers working in hospitals of Army, Navy and Air Force to find out their preferences on type of shift system, working hours in each shift, duration of night duties, entitlement of compensatory ''off days’ and distribution of ''off days’. Majority of them has demanded a change from the existing pattern of duty system, split shift to a ''modified shift’ system. The ''modified shift’ will have 6 hours each in first and second shifts and 12 hours in the third shift (night). Their preference for night duties is for a duration of two weeks with two compensatory ''off days’ at the end of the night duties in one instalment. But they opt for the compensatory ''off days’ of day shifts in instalments of one per week.KEYWORDS: Nurses’ work schedule, Shift system     

长春市公务员睡眠质量调查

目的:了解长春市公务员的睡眠状况和行为生活习惯,分析影响公务员睡眠质量的相关因素,为改善公务员睡眠质量提供建议。方法:采用方便抽样的方法,选取在吉林大学白求恩第一医院进行健康体检的440名长春市某直属机关在职公务员为调查对象,在调查人员现场指导下进行自填式问卷调查;使用中国心理卫生协会全国理事李建明编制的《睡眠状况自测量表》(SRSS),采集调查对象的睡眠状况,总分≥23分为睡眠障碍;利用自行设计的调查表调查一般人口学特征和生理健康状况等睡眠质量相关因素,并通过单因素χ2检验和Logistic回归分析研究其与睡眠质量是否存在关联。结果:长春市公务员SRSS平均22±6分,睡眠障碍率为40.4%,χ2检验结果显示:性别、年龄、值夜班情况共3个因素与睡眠质量不良的发生有关(P<0.05)。Logistic回归分析表明,性别和值夜班情况为睡眠障碍危险因素。结论:长春市公务员睡眠质量不良情况非常普遍,应重点关注女性和值夜班的人,提倡保持良好的生活习惯和心态,并减少值夜班次数。     

护士职业应激影响因素的研究

目的 探讨护士工作年限、婚姻状态、职称、年龄、地区、文化程度、工作性质以及工作科室与护士职业应激的关系.方法 应用中国护士应激源量表(CNSS)对中国东部、中部及西部的3091名护士进行调查.结果 3091名护士全部女性,年龄18～55.06岁,平均年龄(30.13±1.98)岁;工作年限最长38.00年,平均(10.23±8.05)年.不同工作年限(F=9.472,P=0.000)、不同婚姻状态(F=4.598,P=0.010)、不同职称(F=3.667,P=0.012)、不同年龄(F=7.600,P=0.000)、不同地区(F=46.971,P=0.000)、不同工作性质(F=14.888,P=0.000)以及不同工作科室(F=3.876,P=0.000)的护士职业应激水平差异有显著性,不同文化程度(F=2.052,P=0.129)的护士职业应激差异无显著性;影响护士工作应激的主要变量依次为:工作年限、工作科室、职称、工作性质、婚姻、地域.结论 我国护士的职业应激受多方面因素的影响,正确评估护士职业应激的特点,不仅对广大护士的工作,而且对护理管理者有重要意义.     

Ultrasonographic Evaluation of Femoral Cartilage Thickness in Patients with Ankylosing Spondylitis

Objective:

To evaluate femoral cartilage thickness in patients with ankylosing spondylitis (AS) by using ultrasonography.

Methods:

Eighty-four patients (55 M, 29 F) with a diagnosis of AS and 84 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients including disease duration, morning stiffness and medications were recorded. The femoral cartilage thicknesses of both knees were measured with a 7–12 MHz linear probe while subjects'' knees were held in maximum flexion. Three mid-point measurements were taken from both knees (lateral femoral condyle (LFC), intercondylar area (ICA) and medial femoral condyle (MFC)).

Results:

Concerning both ICA (p < 0.001) and left MFC (p = 0.013), cartilage measurements were significantly thicker in AS patients than control subjects. In a subgroup analysis (anti-tumour necrosis factor (TNF) users vs anti-TNF naive) cartilage thickness measurements – bilateral ICA (p = 0.000) and left MFC (p = 0.017) – were found to be greater in AS patients under anti-TNF treatment (n = 65) when compared with those of healthy controls.

Conclusion:

We imply that AS patients seem to have thicker femoral cartilage, which could be related to anti-TNF treatment.     

Interactive effects of exercise and sleep on frailty severity in community-dwelling older adults: a cross-sectional study

Objectives: This study examined the effects of the interaction between exercise and sleep on frailty severity in community-dwelling older adults.Materials and Methods: This was a cross-sectional study. Data were collected in July 2019. In total, 2021 adults participated who responded to a questionnaire. Among them, 672 participants (317 men and 355 women) with valid responses were included in the analysis. Ordinal logistic regression analysis was performed to examine the association between frailty severity and the interaction between exercise and sleep. The dependent variable represents three different levels of frailty. The independent variables included basic information and interaction between exercise and sleep.Results: The results of ordinal logistic regression analysis (odds ratio [OR]) showed that the period from the start of exercise (OR=0.96), age (OR=1.00 for participants in their 60 s, OR=1.65 for those in their 70s, and OR=3.13 for those aged >80 years), poor subjective health perception (OR=2.12), poor quality of sleep (OR=1.88), stress (OR=1.62), and exercise–sleep interaction (OR=1.00 based on good-exercise–good-sleep interaction, OR=3.09 poor-exercise–good-sleep interaction, and OR=3.50 poor-exercise–poor-sleep interaction) significantly contributed to the model. The Nagelkerke coefficient of determination adjusted for degrees-of-freedom (R²), which represents the contribution rate of the regression equation, was 0.334.Conclusions: Our results suggest that a combination of good exercise and good sleep is needed to prevent frailty progression in community-dwelling older adults.     

轮值夜班对女性护士排尿的影响

目的：比较轮值夜班的护士与非轮值夜班的护士排尿日记的差异。方法： 选择2014年1月至6月期间一直在北京大学人民医院住院病房工作的女性护士共58名,入选的护士年龄为20~43岁,其中28名护士在这半年内轮值夜班,作为夜班组,平均年龄为（26.75±4.11）岁,另外30名护士在这半年内无需轮值夜班,作为白班组,平均年龄为（27.80±5.60）岁。在这半年的最后1周记录其排尿日记,并要求在记录期间保证每日摄水量控制在1 500~2 000 mL。比较两组护士正常睡眠时的夜尿情况,并比较相应的8 h时间段内排尿情况的差异。结果： 值夜班的护士与值白班的护士相比,正常睡眠时夜间排尿量［125 mL (0~660 mL) vs. 0 mL (0~340 mL)］及夜间排尿次数［0.5次 (0~2.4次) vs. 0次 (0~2次)］明显增加（P<0.05）,而且在连续1周的记录中,夜班护士在值完夜班后的2天内夜间排尿量比值夜班前明显增加（P<0.01）。夜班组护士与白班组护士相比,在下午的8 h时间段（2 pm-10 pm）内,排尿量［(542.35±204.66) mL vs. (675.62±256.09) mL］和排尿次数［(2.24±0.69) 次 vs. (2.91±0.73) 次］明显减少（P<0.05）。在夜间的8 h时间段（10 pm-6 am）内,夜班组护士与白班组护士相比,排尿量［(309.74±162.74) mL vs. (199.38±153.98) mL, P=0.01］和排尿次数［(1.31±0.52) 次 vs. (0.82±0.55) 次,P<0.01）］均明显增加。结论： 轮值夜班明显影响护士的排尿,增加夜尿量及夜尿次数。     

Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

Background:

For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM), the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM.

Methods:

Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data.

Results:

After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P = 0.03, respectively). The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P = 0.002, respectively) compared to pretreatment levels. During the night, MAGE also significantly decreased (P = 0.049). The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P = 0.024, respectively). The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05, respectively) after the treatment. In addition, HbA1c levels were also lower than those before treatment (P < 0.05), and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P = 0.034).

Conclusions:

CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.     

外来劳务工睡眠质量的研究

目的了解外来劳务工睡眠质量及影响睡眠的因素。方法通过测量外来劳务工的生理指标来了解其身体情况，采用匹兹堡睡眠质量指数量表作为评定睡眠质量的工具，来了解外来劳务工的睡眠现状及其影响因素。结果PSQI总分为3．49±2．23，有29．8％的人存在睡眠问题（PSQI〉5）。影响外来劳务工睡眠质量的因素分别是年龄、性别、是否上晚班、是否有规律运动及血压、工作压力等。结论需要重点关注年轻、不爱运动的女性员工，特别是需上晚夜班者，以不断增进国人健康。     

The impact of time spent on the electronic health record after work and of clerical work on burnout among clinical faculty

ObjectiveTo identify specific thresholds of daily electronic health record (EHR) time after work and daily clerical time burden associated with burnout in clinical faculty.Materials and MethodsWe administered an institution-wide survey to faculty in all departments at Mount Sinai Health System from November 2018 to February 2019. The Maslach Burnout Inventory and Mayo Well-Being Index assessed burnout. Demographics, possible confounding variables, and time spent on EHR work/clerical burden were assessed.ResultsOf 4156 eligible faculty members, 1781(42.9%) participated in the survey. After adjustment for background factors, EHR frustration (odds ratio [OR]=1.64–1.66), spending >90 minutes on EHR-outside the workday by self-report (OR = 1.41–1.90) and >1 hour of self-reported clerical work/day (OR = 1.39) were associated with burnout. Reporting that one’s practice unloads clerical burden (OR = 0.50–0.66) and higher resilience scores (OR = 0.77–0.84) were negatively associated with burnout.Spending >90 minutes/day on EHR-outside work (OR = 0.66–0.67) and >60 minutes/day on clerical work (OR = 0.54–0.58) was associated with decreased likelihood of satisfactory work–life integration (WLI) and professional satisfaction (PS). Greater meaning in work was associated with an increasedlikelihoodof achieving WLI (OR = 2.51) and PS (OR = 21.67).ConclusionResults suggest there are thresholds of excessive time on the EHR-outside the workday (>90 minutes) and overall clerical tasks (>60 minutes), above which clinical faculty may be at increased risk for burnout, as well as reduced WLI and PS, independent of demographic characteristics and clinical work hours. These thresholds of EHR and clerical burden may inform interventions aimed at mitigating this burden to reduce physician burnout.     

大型综合医院一线护士的睡眠状况调查

目的 调查北京某大型综合医院一线护士的睡眠状况及相关因素.方法 选择北京某大型综合医院一线护士300名,由专人对其进行匹斯堡睡眠质量指数量表(PSQI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)以及一些睡眠卫生习惯的问卷调查.结果 实际收回问卷256份,有效问卷209份.对于怀疑失眠的问卷采取面对面的回访,根据CCMD-2-R中失眠症以及最新的失眠定义,最终确定护士实际失眠症患病率为27.3%,SAS评分达到焦虑状态者23.0%,SDS评分达到抑郁状态者31.1%.相关性分析显示,每周值夜班次数、做梦严重与否、SAS评分、SDS评分与匹斯堡总分存在正相关性.部分护士的睡眠卫生知识欠缺或习惯不正确.结论 北京某大型综合医院约1/3的一线护士患有不同程度的失眠症、焦虑和抑郁状态,需要引起关注.     

Negative affect moderates the link between body image dissatisfaction and disordered eating among psychiatric outpatients in a multi-ethnic Asian setting

INTRODUCTIONFew studies have investigated the factors that affect the relationship between body image dissatisfaction and disordered eating locally. Our study aimed to investigate the moderating effects of depression and anxiety levels on the body dissatisfaction-disordered eating link in Singapore.METHODSA total of 329 participants completed a set of questionnaires that included various scales pertaining to eating behaviours, body image, psychological distress and quality of life.RESULTSParticipants were diagnosed with schizophrenia (47.4%), depression (46.8%) and substance use disorders (5.8%). Moderation analyses revealed that depression (F [9, 251] = 18.50, p < 0.001, R² change = 0.021) and anxiety levels (F [9, 268] = 19.54, p < 0.001, R² change = 0.014) were significant moderators of the relationship between body dissatisfaction and disordered eating scores. Subsequent multivariate linear logistic regression analyses showed that high disordered eating scores were significantly associated with lower physical (F [8, 273] = 9.59, R² = 0.22, p < 0.001, β = −0.27, p < 0.001), psychological (F [8, 273] = 10.51, R² = 0.49, p < 0.001, β = −0.27, p < 0.001), social (F [8, 256] = 6.78, R² = 0.18, p < 0.001, β = −0.18, p = 0.004) and environment (F [8, 273] = 5.29, R² = 0.13, p < 0.001, β = −0.19, p = 0.001) quality of life scores after controlling for sociodemographic covariates.CONCLUSIONGreater effort should be dedicated to the screening of disordered eating behaviours in psychiatric outpatients presenting with greater psychological distress.     

Research and applications: Impact of an electronic medication management system on hospital doctors’ and nurses’ work: a controlled pre–post,time and motion study

Objective

To quantify and compare the time doctors and nurses spent on direct patient care, medication-related tasks, and interactions before and after electronic medication management system (eMMS) introduction.

Methods

Controlled pre–post, time and motion study of 129 doctors and nurses for 633.2 h on four wards in a 400-bed hospital in Sydney, Australia. We measured changes in proportions of time on tasks and interactions by period, intervention/control group, and profession.

Results

eMMS was associated with no significant change in proportions of time spent on direct care or medication-related tasks relative to control wards. In the post-period control ward, doctors spent 19.7% (2 h/10 h shift) of their time on direct care and 7.4% (44.4 min/10 h shift) on medication tasks, compared to intervention ward doctors (25.7% (2.6 h/shift; p=0.08) and 8.5% (51 min/shift; p=0.40), respectively). Control ward nurses in the post-period spent 22.1% (1.9 h/8.5 h shift) of their time on direct care and 23.7% on medication tasks compared to intervention ward nurses (26.1% (2.2 h/shift; p=0.23) and 22.6% (1.9 h/shift; p=0.28), respectively). We found intervention ward doctors spent less time alone (p=0.0003) and more time with other doctors (p=0.003) and patients (p=0.009). Nurses on the intervention wards spent less time with doctors following eMMS introduction (p=0.0001).

Conclusions

eMMS introduction did not result in redistribution of time away from direct care or towards medication tasks. Work patterns observed on these intervention wards were associated with previously reported significant reductions in prescribing error rates relative to the control wards.     

Prevalence of obesity and its associated risk factors among Chinese adults in a Malaysian suburban village

INTRODUCTION

Obesity is a major modifiable risk factor associated with most chronic diseases. The aim of this study was to determine the prevalence of obesity, and its associated risk factors, among apparently healthy Chinese adults in a Malaysian suburban village.

METHODS

This was a cross-sectional study conducted among the Chinese residents in Seri Kembangan New Village, Klang Valley, Selangor, Malaysia. Convenience sampling was used for the selection of participants. Body weight, height, waist and hip circumferences, and blood pressure were measured. Fasting venous plasma was drawn for the measurement of fasting glucose level and lipid profile. Data on sociodemographic factors, dietary habits, physical activity, perceived stress level and sleep duration were collected using interviewer-administered, pretested and validated questionnaires.

RESULTS

Among the 258 Chinese residents (mean age 41.4 ± 10.0 years) recruited, the prevalence of obesity was 40%. The obese participants had significantly higher mean blood pressure, and triglyceride and fasting plasma glucose levels than the non-obese participants (p < 0.05). The obese participants also had a significantly lower high-density lipoprotein cholesterol level than the non-obese participants. Logistic regression analysis showed that drinking soy milk (adjusted odds ratio [OR] 0.447; 95% confidence interval [CI] 0.253–0.787; p < 0.05) and the perception that a balanced diet consists mainly of vegetables (adjusted OR 0.440; 95% CI 0.215–0.900; p < 0.05) were associated with a reduced risk of obesity. The risk of obesity was higher in younger participants (adjusted OR 2.714; 95% CI 1.225–6.011; p < 0.05).

CONCLUSION

The prevalence of obesity was high among the apparently healthy suburban Chinese. Our findings suggest that soy milk consumption and the perception that a balanced diet consists mainly of vegetables are associated with a lower risk of developing obesity in this population.     

护士睡眠自适应能力与睡眠质量的关系

目的考察护士睡眠自适应能力与睡眠质量的关系。方法采用中国军人睡眠自适应量表和中国军人睡眠质量量表对223名军队护士进行了测量。结果护士睡眠自适应水平中等偏低,平均分为2.81,低于理论中点分3分;睡眠质量除了与对睡眠的重视因子相关不显著外（相关系数为-0.027）,与睡眠自适应总体水平及其5个因子的相关在0.18~0.56之间（P〈0.05）;睡眠的积极暗示、睡眠的抗干扰力、睡眠的影响因素和对睡眠的重视4个因子能够显著预测军队护士的睡眠质量。结论通过认知模式干预,使护士形成与睡眠有关的积极、正确的信念和态度能够有效地改善睡眠质量。     

八段锦功法锻炼改善轮班睡眠障碍女性护理人员疲劳状态的临床观察

目的 观测八段锦功法锻炼在改善轮班睡眠障碍女性护理人员疲劳状态的临床疗效及安全性。方法 选择2015 年1 月至2019 年12 月在我市多家医院招募的55 例患者，随机分为治疗组与对照组，对照组给予睡眠健康宣教及平秘脏腑推拿；治疗组在对照组的基础上，指导患者睡前进行低强度的八段锦“辨证习功”自我功法锻炼。治疗前后，采用Flinders 疲劳量表评估两组患者日间疲劳状态；VAS 疲劳评分对患者治疗周期内的疲劳情况进行动态观察；同时使用Pittsburgh 睡眠量表观测睡眠质量情况。运用睡眠质量和日间疲劳VAS 评分在治疗结束后进行随访。结果 疗程结束后，治疗组Flinders 疲劳评分高于对照组，差异有统计学意义（P<0.05）；但VAS疲劳评分多个观测节点组间比较，治疗组均无优势，差异无统计学意义（P>0.05），仅在VAS 评分均值下降趋势上，治疗组变化差异较对照组相对明显。两组患者Pittsburgh 睡眠量表评分组间比较，差异无统计学意义（P>0.05）。随访时睡眠质量和日间疲劳状态VAS 评分比较，差异无统计学意义（P>0.05）。结论 八段锦联合平秘脏腑推拿的主要优势在于能更有效地改善轮班睡眠障碍患者的日间疲劳症状，虽然远期疗效不佳，但功法锻炼重在“简便易学”，适合长期规律性运用，继而维持医护人员对夜班工作的适应能力，具备一定的临床推广价值。     

Fatigue correlates with sleep disturbances in Parkinson disease

Background:Many Parkinson disease (PD) patients complain about chronic fatigue and sleep disturbances during the night. The objective of this study is to determine the relationship between fatigue and sleep disturbances by using polysomnography (PSG) in PD patients.Methods:Two hundred and thirty-two PD patients (152 with mild fatigue and 80 with severe fatigue) were recruited in this study. Demographic information and clinical symptoms were collected. Fatigue severity scale (FSS) was applied to evaluate the severity of fatigue, and PSG was conducted in all PD patients. FSS ≥4 was defined as severe fatigue, and FSS <4 was defined as mild fatigue. Multivariate logistic regression and linear regression models were used to investigate the associations between fatigue and sleep disturbances.Results:Patients with severe fatigue tended to have a longer duration of disease, higher Unified Parkinson Disease Rating Scale score, more advanced Hoehn and Yahr stage, higher daily levodopa equivalent dose, worse depression, anxiety, and higher daytime sleepiness score. In addition, they had lower percentage of rapid eye movement (REM) sleep (P = 0.009) and were more likely to have REM sleep behavior disorder (RBD) (P = 0.018). Multivariate logistic regression analyses found that the presence of RBD and proportion of REM sleep were the independent predictors for fatigue. After the adjustment of age, sex, duration, body mass index, severity of disease, scores of Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and other sleep disorders, proportion of REM sleep and degree of REM sleep without atonia in patients with PD were still associated with FSS score.Conclusion:Considering the association between fatigue, RBD, and the altered sleep architecture, fatigue is a special subtype in PD and more studies should be focused on this debilitating symptom.