Incidence of ambulatory care visits among female nursing staff in Taiwan: a claim data-based retrospective cohort analysis

Increased Long-Term Risks of Occupational Diseases in Homecare Nurses: A Nationwide Population-Based Retrospective Cohort Study

Background: The work of homecare nurses is different from that of general hospital nurses; therefore, it is necessary to understand the risks of occupational diseases in homecare nurses. Materials and Methods: In this retrospective cohort research conducted from 2000 to 2013, nursing staff comprised the sample obtained from the National Health Insurance Research Database. Nursing staff were subgrouped according to practice site into homecare, medical center, regional hospital, and local community hospital nurses. The control group included 4,108 subjects. Results: The risk of severe kidney disease was higher in homecare nurses than in medical center nurses (hazard ratio [HR]: 7.3, 95% confidence interval [CI]: 2.45-21.78) and regional hospital nurses (HR: 3.30, 95% CI: 1.37-7.96). The risk of severe liver disease was higher in homecare nurses than in medical center nurses (HR: 1.92, 95% CI: 1.10-3.35) and regional hospital nurses (HR: 2.06, 95% CI: 1.17-3.62). Conclusions: The prevalence of occupational diseases was higher in homecare nurses than in noncaregivers. The correlation between different practice environments and disease prevalence rates revealed that various types of nurses can be ranked in the following order based on the prevalence of the aforementioned diseases: homecare nurses > local community hospital nurses > regional hospital nurses > medical center nurses.

Upper Limb Work-Related Musculoskeletal Disorders in Operating Room Nurses: A Multicenter Cross-Sectional Study

This study aimed to evaluate the association between personal and job characteristics and the risk of upper limb work-related musculoskeletal disorders (WMSDs) among operating room nurses (ORNs). To this end, we collected data from 148 ORNs working at 8 Italian hospitals and measured any upper limb disabilities experienced in the previous year using the Italian version of the disabilities of the arm, shoulder and hand (DASH) questionnaire. The associations between personal and job characteristics and risk of upper limb WMSDs were estimated by unconditional logistic regression models. The prevalence of upper limb WMSDs was 45.9%. Multivariate analysis showed the "female gender" and "monthly hours spent working as a scrub nurse" to be directly associated with a higher DASH score (adjusted OR for gender = 5.37, 95% CI: 1.65-17.51, p < 0.01; adjusted OR for monthly hours as scrub nurse = 3.09, 95% CI: 1.33-7.19, p < 0.01). Overall, our findings indicate that a full-time job (>120 h/month) as a scrub nurse significantly increases the risk of developing upper limb WMSDs among female ORNs. Thus, to reduce such risk in this particularly sensitive population, we recommend urgent implementation of ergonomic interventions on surgical equipment alongside job rotation and medical surveillance programs.

The laparoscopic approach is more preferred among nurses for benign gynecologic conditions than among nonmedical working women: A nationwide study in Taiwan

OBJECTIVE

To compare the use of laparoscopy and laparotomy for hysterectomy in treating benign gynecological conditions in nurses and nonmedical working women.

MATERIALS AND METHODS

A nationwide population-based study was conducted using data from inpatient expenditures of Taiwan's National Health Insurance Research Datasets between 2008 and 2011. All women undergoing total hysterectomies via laparoscopy and laparotomy between the ages of 20 years and 65 years were identified. A generalized equation estimation model was used to compare the differences in laparoscopic hysterectomy (LH) and total abdominal hysterectomy (TAH) between the two groups.

RESULTS

There were 1226 nurses, and 36,624 nonmedical working women, serving as controls, in the present study. The LH rate, as compared to the TAH rate, was significantly higher among nurses than among controls (56% vs. 52%, p = 0.006). A multivariate analysis indicated that nurses were significantly more likely to undergo LH (odds ratio, 1.12; 95% confidence interval, 1.01-1.26) than TAH. Nurses were more often treated at medical centers or high-volume hospitals, and were more often treated by high-volume gynecologists.

CONCLUSION

Compared to nonmedical working women, nurses are more likely to undergo LH rather than TAH. These differences may suggest the influence of medical knowledge and physician-patient interaction on the decision to undergo laparoscopy, in addition to patients' medical conditions.

Insomnia in female nurses: a nationwide retrospective study

OBJECTIVE

This study explored the incidence of insomnia in female nursing staff and compared the incidence with that in other medical and nonmedical female workers.

METHODS

This retrospective study analyzed female nurses with insomnia using data from January 1, 2004 to December 31, 2008. The incidence of insomnia in other female medical workers and nonmedical female workers was also analyzed and compared with that of the nurses. Using the Taiwan National Health Insurance Research Database, each study patient was identified by ID number. The incidence and rate ratio of insomnia were calculated according to their outpatient claims.

RESULTS

Compared with other medical and nonmedical female workers, female nurses had higher incidences of adjustment insomnia and psychophysiological insomnia. However, female nurses had a lower incidence of nonorganic insomnia than did other female medical personnel. Older participants and those with the comorbidities of depressive and respiratory disorders had a higher risk of insomnia than did younger participants and those with other comorbidities.

CONCLUSION

We suggest that nurses should be encouraged to relax in order to facilitate stress relief and improve their quality of sleep.

A nationwide population analysis of antenatal and perinatal complications among nurses and nonmedical working women

OBJECTIVE

Limited information is available on health issues during pregnancy and after childbirth among nurses, especially on a nationwide level. This study thus aimed to compare antenatal and perinatal complications between nurses and nonmedical working women in Taiwan.

MATERIALS AND METHODS

This nationwide population-based study was conducted using data from the Taiwan National Health Insurance Research Database. A total of 44,166 nurses and 442,107 nonmedical working women with full-time employment, aged 20-50 years, who gave birth to singletons were identified between 2007 and 2011. Logistic regression analyses (generalized estimating equation method) were used to compare risks between the two groups.

RESULTS

Multivariable analyses showed that nurses had a significantly higher risk of anemia [adjusted odds ratio (AOR) 1.37; 95% confidence intervals (CI), 1.31-1.44], placenta previa, and abruptio placentae (AOR, 1.13; 95% CI, 1.07-1.20), and pregnancy-associated hypertensive diseases and preeclampsia (AOR, 1.10; 95% CI, 1.03-1.18) during the antenatal period than nonmedical working women. Moreover, they also experienced an increased risk of malpresentation (AOR, 1.30; 95% CI, 1.26-1.34), dystocia (AOR, 1.09; 95%, CI 1.06-1.13), preterm delivery (AOR, 1.08; 95% CI, 1.03-1.13), premature rupture of membranes (AOR, 1.09; 95% CI, 1.05-1.14), and post-term delivery (AOR, 1.11; 95% CI, 1.07-1.16) during the perinatal period.

CONCLUSION

Our nationwide population-based study revealed increased risks of antenatal and perinatal complications among nurses compared with those among nonmedical working women. The large-scale observation of the increased antenatal and perinatal complications draws attention to the health issues faced by nursing personnel who represent one of the most important workforces in the healthcare system.

Seasonal variations in sleep disorders of nurses

AIMS AND OBJECTIVES

To investigate the difference between nurses and the general population regarding seasonal variations in sleep disorders during 2004-2008. The effects of season and group interaction on sleep disorders with regard to different comorbidities were also examined.

BACKGROUND

Studies on seasonal variations in sleep disorders were mainly conducted in Norway for the general population. Furthermore, whether different comorbidities cause seasonal variations in sleep disorders in nurses remains unknown.

DESIGN

A retrospective study.

METHODS

Data from the Taiwan National Health Insurance Research Database were used in generalised estimating equation Poisson distribution models to investigate the differences in sleep disorders between nurses and the general population diagnosed with sleep disorders (each n = 7643) as well as the interaction effects of sleep disorders between the groups with respect to different seasons. Furthermore, the interaction effects between groups and seasons on sleep disorders in the subgroups of comorbid anxiety disorders and depressive disorders were studied.

RESULTS

Both the nurses and the general population had fewer outpatient visits for sleep disorders in winter than in other seasons. The nurses had fewer outpatient visits for sleep disorders than the general population did in each season. The nurses had more outpatient visits for sleep disorders in winter than in summer compared with the general population in the comorbid depressive disorder subgroup but not in the comorbid anxiety disorder subgroup.

CONCLUSIONS

Nurses and the general population exhibited similar seasonal patterns of sleep disorders, but nurses had fewer outpatient visits for sleep disorders than the general population did in each season. For nurses with comorbid depressive disorders, outpatient visits for sleep disorders were more numerous in winter than in summer, potentially because nurses with comorbid depressive disorders are affected by shorter daylight exposure during winter.

RELEVANCE TO CLINICAL PRACTICE

Depression and daylight exposure may be considered in mitigating sleep disorders in nurses.

Lower extremity musculoskeletal disorders in nurses: A narrative literature review

AIMS

The aim of the narrative review was to describe and analyze lower extremity musculoskeletal disorders (MSDs) in nurses and to identify factors associated with these disorders. The ultimate goal was to promote lower extremity health in nurses by recognizing factors that could improve their well-being at work.

METHODS

A systematic search on the Medline, CINAHL, and PsychInfo databases was conducted, producing altogether 945 citations, of which 35 were selected for this review. The studies were analyzed by content analysis.

RESULTS

Nurses have different MSDs in their lower extremities, with which the knee, foot, and ankle being most commonly affected. These problems are often correlated, and problems in the ankle can first appear as knee problems.

CONCLUSIONS

Musculoskeletal disorders in lower extremities and their resulting disability are common within the nursing workforce worldwide, representing a major cause of sick leave absence and often leading to long-term absence.

Ambulatory medical services utilization for menstrual disorders among female personnel of different medical professions in Taiwan: a nationwide retrospective cohort study

Background

Menstrual disorders and their adverse symptoms can have a deleterious effect on both the private and working lives of women. Previous studies indicated that female nurses have elevated risk of menstrual disorders. Moreover, female nurses showed a higher incidence of ambulatory care visit for genitourinary diseases compared with other female medical personnel. However, little is known whether the medical services utilization for menstrual disorders were different among personnel from various medical professions. Therefore, the present study compared the ambulatory medical services utilization for menstrual disorders among personnel of six different medical professions in Taiwan using a nationwide, population-based health claim research database.

Methods

The National Health Insurance Research Database (NHIRD) was used to identify female medical professionals, aged 18 to 45 years, who obtained their licenses during January 1, 2000 to December 31, 2012. Personnel from six different medical professions were examined and they included (1) medical technologists and therapists, (2) registered nurses, (3) physicians, (4) doctors of Chinese medicine, (5) dentists, and (6) pharmacists. Diagnoses of menstrual disorders, based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, were obtained from the ambulatory medical services utilization that occurred after their license date. Cox proportional hazards model was used to assess the hazards of medical services utilization for menstrual disorders using medical technologists and therapists as the reference category.

Results

A total of 7653 medical personnel were included in the analysis. Using the group containing medical technologists and therapists as the reference category, registered nurses (adjusted hazards ratio [AHR] = 1.13, p = 0.018) and doctors of Chinese medicine (AHR = 2.52, p < 0.001) showed a significant increased risk of medical services utilization for menstrual disorders. Conversely, physicians showed a significant decreased risk of medical services utilization for menstrual disorders (AHR = 0.58, p < 0.001). Regarding the nine specific menstrual disorders observed in this study, registered nurses and doctors of Chinese medicine showed an increased risk in six and four of them, respectively. Pharmacists showed an increased risk only in menorrhagia (AHR = 1.64, p = 0.020) and dentists showed no significant differences in any of the nine specific menstrual disorders compared with medical technologists and therapists. Physicians showed a significant decreased risk all specific menstrual disorders except menorrhagia and dysfunctional uterine bleeding.

Conclusions

Findings from this population-based cohort study revealed that, compared with medical technologists and therapists, registered nurses and doctors of Chinese medicine exhibited significant increased risks in medical services utilization for menstrual disorders whereas physicians showed a significant decreased risk in menstrual disorders. Further studies should be conducted to delineate whether the differences in the medical services utilization is an indicator of risk of menstrual disorders or the results of varying patterns of health care seeking behavior among women of different medical professions.

Risk of musculoskeletal disorder among Taiwanese nurses cohort: a nationwide population-based study

BACKGROUND

Musculoskeletal disorders (MSDs) represent the leading causes of occupational injuries among nursing staff. This population-based study was designed to assess the incidence and age-specific incidence of MSDs among a Taiwanese nurse cohort compared with non-nurses.

DESCRIPTION

Data from the Taiwan National Health Insurance Research Database were used to identify MSDs in the study population. A total of 3914 nurses with a diagnosis of MSD were included, together with 11,744 non-nurses as a comparison group. The comparison subjects were randomly selected at a ratio of 3:1 relative to the nurse population and were matched by gender and age. The incidence of MSDs was calculated for the study group, with nurse-to-reference risk ratios presented as odds ratios with 95% confidence intervals (CIs). During the period 2004-2010, 3004 MSDs occurred among the nurses (76.24%) and 7779 (65.79%) in the non-nurses. The annual incidence of MSDs for the nurses increased from 28.35% in 2006 to 33.65% in 2010. The nurse-to-reference risk ratio was 1.27 (95% CI 1.19-1.35) in 2004 and 1.46 (1.37-1.55) in 2010. Herniation of intervertebral disc, lumbago, rotator cuff syndrome, medial epicondylitis, trigger finger and carpal tunnel syndrome were the most common problems.

CONCLUSIONS

Nurses are at higher risk of MSDs and the trend is increasing. Incorrect work-related posture/movement, psychological issues and the rolling shift system may be the major causes of MSDs among nurses in Taiwan.