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Shreedar P, Pangalangan JML, Puma JE, Farewell CV. Relationship Between Chronic Health Conditions and Occupational Burnout in the Early Care and Education Workforce. J Occup Environ Med 2024; 66:e238-e244. [PMID: 38527185 DOI: 10.1097/jom.0000000000003102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE The early care and education (ECE) workforce experiences high rates of poor mental and physical health outcomes, which impact staff well-being and burnout. This study aimed to assess the relationship between chronic health conditions and occupational burnout in ECE Head Start staff working in low-resourced locations. METHODS This study administered an 89-item cross-sectional survey to 332 ECE staff employed in 42 Head Start centers in the United States. Staff self-reported on the following 10 chronic health conditions: arthritis, asthma, cancer, depression, diabetes, heart disease, high blood pressure, insomnia, lung disease, and musculoskeletal disorders. RESULTS We found that multimorbidity of chronic conditions significantly predicted overall burnout ( B = 2.39, P < 0.01), particularly related to emotional exhaustion ( B = 2.04, P < 0.01). CONCLUSIONS Workplace interventions targeting emotional exhaustion related to chronic health conditions are recommended to effectively address occupational burnout among ECE staff.
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Affiliation(s)
- Priyanka Shreedar
- From the Rocky Mountain Prevention Research Center, Colorado School of Public Health, University of Colorado Anschutz, Aurora, Colorado
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Mongkonkansai J, Parapan P, Srinuan M, Thepnoo T, Khoklang S, Yimthiang S, Mahaboon J, Madardam U. Predicting the work ability of security guards at a university in Nakhon Si Thammarat province, Thailand. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:486-495. [PMID: 38351578 DOI: 10.1080/10803548.2024.2318952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Objectives. The number of security guards in universities has increased significantly. This study aimed to predict work ability of university security guards. Methods. A cross-sectional study of 97 university security guards in Thailand was performed. Data were collected through interviews using a questionnaire covering social demographics, behavioral health and work ability. The data were analyzed using χ2 tests and logistic regression models. Results. The average work ability index (WAI) score was 38.1 ± 3.8, with 65.0% of participants scoring 'good'. Social support significantly influenced the WAI (p = 0.004). Those with insufficient support were 4.3 times more likely to show poor work ability. Mental health also impacted the WAI (p = 0.006); those with poor mental health were 4.7 times at risk. Additionally, work experience affected the WAI (p = 0.039). Those with ≥5 years of experience showed reduced work ability compared to their less-experienced counterparts (adjusted odds ratio 0.4; 95% confidence interval [0.20, 0.96]). Conclusions. Supervisors should provide social support and offer rewards and commendations to enhance employees' abilities, health behaviors and management of underlying diseases. Additionally, organizations should prioritize health and safety in the workplace to ensure their employees are healthier and perform their tasks more effectively.
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Slowiak JM, McDonough M. Job Burnout, Work Health Management Interference, and Organizational Health Climate Among Employees with Varied Levels of Work Ability. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10198-8. [PMID: 38684640 DOI: 10.1007/s10926-024-10198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The presence of chronic health conditions (CHCs), without sufficient personal and job resources, can impede one's ability to effectively perform work tasks and manage job demands. The aim of this study was to evaluate the level of job burnout and perceptions of work health management interference (WHMI) and organizational health climate (OHC) among employees with varied levels of work ability (WA). We also examined relationships among these variables and with sociodemographic and job-related variables (e.g., age, number of physician-diagnosed conditions). METHODS A convenience sample of 878 adults living and working in the United States who responded to a recruitment message via professional listservs/email lists and social media participated in a non-experimental, cross-sectional online survey. Participants reported sociodemographic and job-related items, as well as measures to evaluate WA, burnout, WHMI, and OHC. RESULTS Statistically significant differences in burnout, WHMI, and OHC were observed across WA groups. Workers with poor WA reported the highest levels of overall burnout, WMHI, and the least supportive OHC. A more supportive OHC was associated with lower burnout. A strong inverse relationship between WA and the number of physician-diagnosed conditions was observed; weak relationships between WA and age, as well as WA and managerial status, were found. CONCLUSION Employees with lower levels of WA tended to report higher levels of burnout and WHMI and lower levels of OHC. Findings provide a foundation for future research to examine causal relationships among these variables and to inform actions to both preserve WA and support worker well-being.
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Affiliation(s)
- Julie M Slowiak
- Department of Psychology, University of Minnesota Duluth, 1207 Ordean Ct., 320 Bohannon Hall, Duluth, MN, 55812-3011, USA.
| | - Mariah McDonough
- Department of Psychology, University of Minnesota Duluth, 1207 Ordean Ct., 320 Bohannon Hall, Duluth, MN, 55812-3011, USA
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Teborg S, Hünefeld L, Gerdes TS. Exploring the working conditions of disabled employees: a scoping review. J Occup Med Toxicol 2024; 19:2. [PMID: 38291467 PMCID: PMC10826256 DOI: 10.1186/s12995-023-00397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Disabled people are often overlooked in considerations about work design, which contributes to their exclusion from the labor market. This issue also reflects within research, as the body of knowledge on the working conditions of disabled employees remains relatively limited. METHODS A scoping review was conducted to assess the research landscape concerning the working conditions of disabled employees. Five databases have been searched, focusing on relevant studies published between 2017 and 2022. RESULTS One hundred fourteen studies were included in the review. It was found that social aspects of work appeared within a substantial portion of the examined studies. Furthermore, it became evident that the interplay of accessibility and flexibility provides an important dynamic to make work design both inclusive and feasible. CONCLUSION The recurrent prominence of social aspects, accessibility, and flexibility across the studies shows common challenges and potentials within the work situation of disabled employees. This suggests avenues for future research and inclusive work design.
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Affiliation(s)
- Sophie Teborg
- Federal Institute for Occupational Safety and Health, Unit 1.2 Monitoring Working Conditions, Dortmund, Germany.
| | - Lena Hünefeld
- Federal Institute for Occupational Safety and Health, Unit 1.2 Monitoring Working Conditions, Dortmund, Germany
| | - Tomke S Gerdes
- Department of Rehabilitation Sciences, TU Dortmund University, Dortmund, Germany
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Shaw WS, McLellan RK, Besen E, Namazi S, Nicholas MK, Dugan AG, Tveito TH. A Worksite Self-management Program for Workers with Chronic Health Conditions Improves Worker Engagement and Retention, but not Workplace Function. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:77-86. [PMID: 33983524 PMCID: PMC8858918 DOI: 10.1007/s10926-021-09983-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 05/26/2023]
Abstract
Purpose An increasing number of workers in the US have chronic health conditions that limit their ability to work, and few worksite interventions have been tested to improve worker coping and problem solving at work. The purpose of this study was to evaluate a worksite-based health self-management program designed to improve workplace function among workers with chronic health conditions. Methods We conducted a randomized, controlled trial of a worksite self-management program ("Manage at Work") (clinicaltrials.gov #NCT01978392) for workers with chronic health conditions (N = 119; 82% female, ages 20-69). Most workers were recruited from the health care or light manufacturing industry sectors. Workers attended a 5-session, facilitated psychoeducational program using concepts of health self-management, self-efficacy, ergonomics, and communication. Changes on outcomes of work engagement, work limitation, job satisfaction, work fatigue, work self-efficacy, days absent, and turnover intention at 6-month follow-up were compared to wait-list controls. Results The most prevalent chronic health conditions were musculoskeletal pain, headaches, vision problems, gastrointestinal disorders, respiratory disorders, and mental health disorders. The self-management program showed greater improvement in work engagement and turnover intent at 6-month follow-up, but there was no evidence of a parallel reduction in perceived work limitation. Trends for improved outcomes of work self-efficacy, job satisfaction, and work fatigue in the intervention group did not reach statistical significance in a group x time interaction test. Conclusions Offering a worksite self-management program to workers with chronic health conditions may be a feasible and beneficial strategy to engage and retain skilled workers who are risking disability.Clinical trial registration: Clinicaltrials.gov #NCT01978392.
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Affiliation(s)
- William S. Shaw
- University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030 USA
| | - Robert K. McLellan
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Drive, Hanover, NH 03755 USA
| | - Elyssa Besen
- Liberty Mutual Insurance, 175 Berkeley Street, Boston, MA 02116 USA
| | - Sara Namazi
- University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030 USA
| | - Michael K. Nicholas
- University of Sydney at North Shore Hospital, St. Leonards, NSW 2065 Australia
| | - Alicia G. Dugan
- University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT 06030 USA
| | - Torill H. Tveito
- University of South-Eastern Norway, Raveien 215, 3184 Borre, Norway
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Boelhouwer IG, Vermeer W, van Vuuren T. Late Effects of Cancer Treatment, Job Resources, and Burnout Complaints Among Employees With a Breast Cancer Diagnosis 2–10 Years Ago: A Longitudinal Study. Front Psychol 2022; 12:793138. [PMID: 35153917 PMCID: PMC8832114 DOI: 10.3389/fpsyg.2021.793138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to investigate the effect of possible late effects of cancer treatment (physical complaints, fatigue, and cognitive complaints) and of two job resources (autonomy and supportive leadership style) on future burnout complaints, among employees living 2–10 years beyond breast cancer diagnosis. Methods Data at T1 (baseline questionnaire) and at T2 (9 months later) were collected in 2018 and 2019 (N = 287). These data were part of a longitudinal study among Dutch speaking workers with a cancer diagnosis 2–10 years ago. All complaints and job resources were self-reported. Longitudinal multivariate regression analyses were executed, controlling for years since diagnosis, living with cancer (recurrence or metastasis), and other chronic or severe diseases. Mediation by baseline burnout complaints was considered. Results A higher level of fatigue and cognitive complaints at baseline (T1) resulted in higher future burnout complaints (at T2), with partial mediation by baseline burnout complaints. No effect of physical complaints at T1 was observed. Higher levels of autonomy or a supportive leadership style resulted in lower burnout complaints, with full mediation by baseline burnout complaints. Buffering was observed by autonomy in the relationship of cognitive complaints with future burnout complaints. No moderation was observed by supportive leadership. Conclusion The level of burnout complaints among employees 2–10 years beyond breast cancer diagnosis may be an effect of fatigue or cognitive complaints, and awareness of this effect is necessary. Interventions to stimulate supportive leadership and autonomy are advisable, the latter especially in the case of cognitive complaints.
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Affiliation(s)
- Ingrid G. Boelhouwer
- Department of Organisation, Faculty of Management, Open Universiteit, Heerlen, Netherlands
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- *Correspondence: Ingrid G. Boelhouwer,
| | - Willemijn Vermeer
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Tinka van Vuuren
- Department of Organisation, Faculty of Management, Open Universiteit, Heerlen, Netherlands
- Loyalis Knowledge & Consult, Heerlen, Netherlands
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Richter A, Roczniewska M, Loeb C, Stempel CR, Rigotti T. The Cross-Level Moderation Effect of Resource-Providing Leadership on the Demands-Work Ability Relationship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179084. [PMID: 34501678 PMCID: PMC8431616 DOI: 10.3390/ijerph18179084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 01/01/2023]
Abstract
Employees in female-dominated sectors are exposed to high workloads, emotional job demands, and role ambiguity, and often have insufficient resources to deal with these demands. This imbalance causes strain, threatening employees’ work ability. The aim of this study was to examine whether resource-providing leadership at the workplace level buffers against the negative repercussions of these job demands on work ability. Employees (N = 2383) from 290 work groups across three countries (Germany, Finland, and Sweden) in female-dominated sectors were asked to complete questionnaires in this study. Employees rated their immediate supervisor’s resource-providing leadership and also self-reported their work ability, role ambiguity, workload, and emotional demands. Multilevel modeling was performed to predict individual work ability with job demands as employee-level predictors, and leadership as a group-level predictor. Work ability was poor when employees reported high workloads, high role ambiguity, and high emotional demands. Resource-providing leadership at the group level had a positive impact on employees’ work ability. We observed a cross-level interaction between emotional demands and resource-providing leadership. We conclude that resource-providing leadership buffers against the repercussions of emotional demands for the work ability of employees in female-dominated sectors; however, it is not influential in dealing with workload or role ambiguity.
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Affiliation(s)
- Anne Richter
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Correspondence:
| | - Marta Roczniewska
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Center of Research on Cognition and Behaviour, Institute of Psychology, Faculty in Sopot, SWPS University of Social Sciences and Humanities, 81 745 Sopot, Poland
| | - Carina Loeb
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23 Vasteras, Sweden;
| | - Christiane R. Stempel
- Department of Work & Organizational Psychology, FernUniversität Hagen, 58097 Hagen, Germany;
| | - Thomas Rigotti
- Department of Work and Organizational Psychology, Johannes Gutenberg University Mainz, 55128 Mainz, Germany;
- Leibniz Institute for Resilience Research, 55122 Mainz, Germany
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Wang Y, Gao Y, Xun Y. Work engagement and associated factors among dental nurses in China. BMC Oral Health 2021; 21:402. [PMID: 34399752 PMCID: PMC8369711 DOI: 10.1186/s12903-021-01766-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Work engagement is affected by many factors. The level of work engagement among dental nurses is unknown. METHODS A cross-sectional questionnaire survey was conducted among 215 dental nurses. The Utrecht Work Engagement Scale, Chinese Nurse Stressors Scale, Work-related Acceptance and Action Questionnaire, Multi-dimensional Scale of Perceived Social Support, and General Well-Being Schedule were applied to measure Chinese nurses' work engagement, job stress, psychological flexibility, perceived social support and subjective well-being, respectively. Univariate analysis was used to identify the relationships of work engagement with demographic and psychological characteristics. Hierarchical linear regression analysis was applied to test the variance in work engagement accounted for by factors related to work engagement in the univariate analysis. RESULTS The level of work engagement among Chinese dental nurses was moderate or above. Work engagement was positively associated with perceived social support, psychological flexibility and subjective well-being but negatively correlated with job stress. The hierarchical regression analysis showed that age, job stress, psychological flexibility and subjective well-being were significantly correlated with work engagement, though perceived social support was not, all of those psychological variables together explained 34.7% of the variance in work engagement. CONCLUSIONS Dental nurses in China had an acceptable level of work engagement in terms of vigour, dedication and absorption. Increased job stress resulted in lower work engagement. Nurses who had higher levels of perceived social support, psychological flexibility and subjective well-being also had higher work engagement. It is necessary to understand the job stress of nurses, strengthen nurses' social support, relieve nurses' job stress, improve nurses' psychological flexibility and subjective well-being, which will improve nurses' work engagement levels.
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Affiliation(s)
- Yujing Wang
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002, People's Republic of China.
| | - Yuqin Gao
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002, People's Republic of China
| | - Yang Xun
- Department of Nursing, School and Hospital of Stomatology, China Medical University, Liaoning Provincial Key Laboratory of Oral Diseases, Shenyang, 110002, People's Republic of China
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Boelhouwer IG, Vermeer W, van Vuuren T. Late effects of cancer (treatment) and work ability: guidance by managers and professionals. BMC Public Health 2021; 21:1255. [PMID: 34187437 PMCID: PMC8240423 DOI: 10.1186/s12889-021-11261-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/10/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The prevalence of the group of workers that had a cancer diagnosis in the past is growing. These workers may still be confronted with late effects of cancer (treatment) possibly affecting their work ability. As little is known about the guidance of this group, the aim of this study was to explore the experiences and ideas of managers and professionals about the guidance of these workers in the case of late effects of cancer (treatment). Given the positive associations with work ability of the job resources autonomy, social support by colleagues and an open organisational culture found in several quantitative studies, these job resources were also discussed. Further ideas about the influences of other factors and points of attention in the guidance of this group of workers were explored. METHODS Semi-structured interviews were conducted with managers (n = 11) and professionals (n = 47). Data-collection was from November 2019 to June 2020. The data were coded and analysed using directed content analyses. RESULTS The late effects of cancer or cancer treatment discussed were physical problems, fatigue, cognitive problems, anxiety for cancer recurrence, and a different view of life. The self-employed have less options for guidance but may struggle with late effects affecting work ability in the same way as the salaried. Late effects may affect work ability and various approaches have been described. Autonomy, social support of colleagues and an open organisational culture were regarded as beneficial. It was indicated that interventions need to be tailor-made and created in dialogue with the worker. CONCLUSIONS Especially with respect to cognitive problems and fatigue, guidance sometimes turned out to be complicated. In general, the importance of psychological safety to be open about late effects that affect work ability was emphasized. Moreover, it is important to take the perspective of the worker as the starting point and explore the possibilities together with the worker. Autonomy is an important factor in general, and a factor that must always be monitored when adjustments in work are considered. There is a lot of experience, but there are still gaps in knowledge and opportunities for more knowledge sharing.
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Affiliation(s)
- Ingrid G Boelhouwer
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Wibauthuis/Wibautstraat 3b, 1091 GH, Amsterdam, The Netherlands.
| | - Willemijn Vermeer
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Wibauthuis/Wibautstraat 3b, 1091 GH, Amsterdam, The Netherlands
| | - Tinka van Vuuren
- Faculty of Management, Open University of The Netherlands, Heerlen, The Netherlands / Loyalis Knowledge & Consult, Heerlen, The Netherlands
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Zhang SE, Wang J, Liu L, Meng DX, Wang HN, Zhao X, Wang XH, Liu B, Cao DP, Sun T. Does abusive supervision lead nurses to suffer from workplace violence? A cross-sectional study. J Nurs Manag 2021; 30:1396-1406. [PMID: 33794045 DOI: 10.1111/jonm.13326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/12/2021] [Accepted: 03/27/2021] [Indexed: 02/03/2023]
Abstract
AIM This study aimed to (1) assess the current status of Chinese nurses' exposure to workplace violence; (2) identify the cluster of interrelationships between abusive supervision, anxiety and depression symptoms, work ability, and workplace violence in nursing settings; and (3) clarify the functional mechanism among these variables. METHODS A cross-sectional survey was conducted online from September to October 2020 in China. A total of 1,221 valid questionnaires were collected across 100 cities in 31 provinces. RESULTS Approximately 67.57% of participants experienced workplace violence in the past one year, in the types of verbal violence (59.71%), made difficulties (43.16%), mobbing behaviour (26.70%), smear reputation (22.52%), physical violence (11.30%), intimidating behaviour (10.16%) and sexual harassment (4.10%), respectively. Moreover, nurses' exposure to workplace violence was significantly and positively influenced by the perceptions of abusive supervision (β = 0.209, p < .01) and the symptoms of anxiety and depression (β = 0.328, p < .01). Anxious and depressive symptoms partly mediated the association between abusive supervision and workplace violence, which were significantly moderated by work ability (β = -0.021, p < .05). CONCLUSIONS Our study assesses the prevalence of the seven types of workplace violence against Chinese nurses. Majority of nurses have experienced different types of workplace violence. Nurses who are abused by their supervisor are more likely to develop poor psychological health than those who are not. Moreover, nurses' positive association of abusive supervision with workplace violence is more notable among nurses with lower work ability. IMPLICATIONS OF NURSING MANAGEMENT: 'No abusive supervision, no workplace violence'. A harmonious nursing environment needs to be provided to minimize exposure to workplace violence and mental health threats towards nursing staff, which is a key point for hospital administrators and health policymakers. Essential work ability should be developed to reduce the damage of the abusive supervision and workplace violence against nurses.
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Affiliation(s)
- Shu-E Zhang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Juan Wang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Li Liu
- Department of Social Medicine, School of Public Health, China Medical University, ShengYang, China
| | - De-Xin Meng
- Department of Administration, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong-Ni Wang
- Department of Health Management, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Xin Zhao
- Department of Health Management, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Xiao-He Wang
- Department of Health Management, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Bei Liu
- Department of Inspection, School of Public Health, Peking University, Beijing, China
| | - De-Pin Cao
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Tao Sun
- Department of Health Management, School of Medicine, Hangzhou Normal University, Hangzhou, China
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