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系統識別號 U0026-0501201615435300
論文名稱(中文) 工作壓力源、職業倦怠與動脈硬化之相關性研究- 以醫療人員為例
論文名稱(英文) The Relationship between Job Stressors, Burnout and Arteriosclerosis among Medical Professionals
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 104
學期 2
出版年 104
研究生(中文) 周立平
研究生(英文) Li-Ping Chou
學號 T88991038
學位類別 博士
語文別 英文
論文頁數 85頁
口試委員 指導教授-胡淑貞
口試委員-呂宗學
口試委員-李中一
口試委員-鄭雅文
召集委員-鍾國屏
中文關鍵字 工作壓力源  工作張力  職業倦怠  醫療專業  脈波速度  動脈硬化  心血管健康狀態 
英文關鍵字 Job stressors  Job strain  Burnout  Medical profession  Pulse wave velocity  Arteriosclerosis  Cardiovascular health status 
學科別分類
中文摘要 研究背景
許多的研究結果顯示,長期的處於工作壓力之下會導致職業倦怠。另外從流行病學的研究證據亦顯示心血管疾病與危險因子及不健康的生活習慣有相關。然而到目前為止,有關工作壓力源與心血管疾病的相關性研究,仍呈現不一致結果。

研究目的
本研究欲達到三個目的:(一)探究醫療專業人員工作壓力源與職業倦怠的相關性;(二)闡明工作壓力源與動脈硬化(代表心血管疾病的臨床前期)之相關性;(三)研究醫療專業人員工作壓力源與心血管健康狀態的相關性。

研究方法
這是一個橫斷性研究設計,參與者的資料取自於西元2012年新樓醫院員工健康促進調查報告。總共收集1329位參與者,包括101位醫師、510位護理師、68位醫師助理(現在名稱是專科護理師)與374位行政人員。問卷內容包含社會人口學資料、工作狀態、職業倦怠、心理健康程度及生活型態。使用的問卷量表包含中文版的工作內容問卷(C-JCQ)、中文版的哥本哈根疲勞量表(C-CBI)及台灣人憂鬱症量表,部份資料如動脈硬化程度(baPWV)是取自於員工健康資料庫。七項合併的理想心血管健康因子包括4項健康行為(不抽菸、正常身體質量指數、健康飲食及足夠的身體活動時間)及3項健康因子(血壓 < 120/80 mmHg, 飯前血糖 < 100 mg/dL, 總膽固醇< 200 mg/dL)。統計方法包含描述性、雙變項、及多變項分析。

研究結果
階層迴歸分析的結果顯示工作張力、工作過度投入及低社會支持度三因子與職業倦怠最有相關,可解釋32.6%的變異性。醫師助理是新出現的過勞族群(佔61.8%),僅次於護理師(66%),但是遠高於醫師的38.6%,行政人員的36.1%及醫技人員的31.9%。
動脈硬化(baPWV)程度與性別、年齡、醫療專業別、工作時數、工作班別、心理健康、身體質量指數、收縮壓、舒張壓、空腹血糖及膽固醇均有相關,但是經過因子調整只有每晚睡眠不足6小時及每週工作超過60小時呈現有意義的增加動脈硬化風險。但是其他相關因子如工作負荷、工作控制、工作張力、社會支持、輪班及心理不健康都沒有顯著相關。
本研究族群心血管健康的盛行率是理想者佔0.2%,普通佔20%,不佳者佔79.2%,有統計學上較高的心血管健康狀態不佳族群包括高張力工作者佔85.1%,護理師佔85.3%及專科護理師佔83.1%。多變項分析結果顯示,唯有身體活動不足這項因子與工作張力有顯著相關。經過校正,高張力與主動張力的工作者比低張力工作者有較高的身體活動不足盛行率(勝算比1.9, 95%信賴區間1.38~2.81及勝算比1.4, 95%信賴區間1.00~2.03)。


結論
工作壓力源與職業倦怠、心理健康及不佳的心血管健康有相關。另外動脈硬化與工時較長及睡眠不足有相關,但是與其他身心社會的危害無關。員工屬於高張力工作特質及護理人員和專科護理師都是不佳心血管健康狀態的危險族群,以上這些研究發現將有助於擬定健康促進活動。然而,進一步的前瞻性追蹤資料將更能釐清工作壓力源與動脈硬化的相關性。
英文摘要 Background:
A great deal of research has indicated that long-term exposure to job stressors can lead to burnout. Research and epidemiologic evidence indicate cardiovascular disease (CVD) is associated with risk factors and unhealthy behaviors. However, the evidence of relationship between job stressors and CVD is still inconsistence.

Purposes:
The aims of this study were to achieve three goals: (1) to explore the relationships between job stressors and burnout among medical professional; (2) to elucidate the associations of job stressors with arteriosclerosis, which represents a pre-clinical CVD; (3) to investigate the relationship between job stressors and cardiovascular health status among medical professional.

Methods:
This is a cross-sectional study design. The participants’ profiles were obtained from the database of a health promotion survey at Sin-Lau Hospital in 2012. A total of 1,329 participants were recruited, including 101 physicians, 570 nurses, 68 physician assistants, 216 medical technicians, and 374 administrators. The survey achieved an 89% response rate. The questionnaire used in the study included socio-demographic information, working conditions, level of burnout, job stress, mental health, and lifestyle behaviors. Validated tools included the Chinese version of the Job Content Questionnaire, the Chinese version of the Copenhagen Burnout Inventory, and the Taiwan Depression Questionnaire. Some of the data were matched with the employees’ health profiles, including the measurement of arteriosclerosis by brachial-ankle pulse wave velocity (baPWV). Seven aggregated ideal cardiovascular health factors included 4 health behaviors (non-smoker, ideal body mass index, healthy diet, and physical activity achieved to goal) and 3 health factors (blood pressure < 120/80 mmHg, fasting sugar < 100 mg/dL, and total cholesterol < 200 mg/dL). Statistical methods included descriptive, bivariate, and multivariate analysis.

Results:
Hierarchical regression analysis indicated that job strain, over-commitment, and low social support explained the most variance (32.6%) of burnout. Physician assistant (61.8%) is an emerging high-burnout group; its severity is similar to nurse (66%) and far more than physician (38.6%), administrative staff (36.1%), and medical technician (31.9%).
The baPWV was associated with gender, age, medical profession, work hours, work type, mental health, body mass index, systolic and diastolic blood pressures, fasting glucose, and cholesterol. However, after being fully adjusted by these factors, only sleep duration of less than 6 hours and weekly work hours longer than 60 hours were significantly associated with an increased risk of arteriosclerosis. The conditions of job demands, job control, job strain, social support, shift work, and mental ill-health all showed no significant association with baPWV.
The prevalence of cardiovascular health among studying sample who were characterized as ideal was only 0.2%, intermediate 20.6% and poor 79.2%. There were significantly higher percentages of poor health in workers with high strain (85.1%), and the professions of nurse (85.3%) and physician assistant (83.1%). By multivariate analysis, the only significant factor correlated with job strain was physical inactivity. After being adjusted, workers with high strain and active strain possessed a higher prevalence of physical inactivity compared to those with low strain (odds ratio 1.9, 95% CI 1.38-2.81; odds ratio 1.4, 95% CI 1.00-2.03).

Conclusions:
Job stressors are associated with burnout, mental ill-health, and poor cardiovascular health. Additionally, arteriosclerosis is related to longer work hours and shorter sleep duration, but not relating to other psychosocial hazards. Employees with high job strain, being nurse, and physician assistant are high risk groups for poor cardiovascular health. These findings may help facilitate the development of health promotion programs in the future. However, further prospective follow up is warranted to elucidate the relationship between job stressors and arteriosclerosis.
論文目次 Content
Abstract I
Chinese abstract IV
Aknowledgement VI
Content VII
List of Tables IX
List of Figures X
Abbreviations XI
Chapter 1 Introduction 1
Chapter 2 Literature Review 4
2.1 Job stress and burnout (in medical professional) 4
2.2 Job stressors and arteriosclerosis 5
2.3 Job strain and cardiovascular health status 7
Chapter 3 Conceptual Framework & Study Questions/ Hypotheses 9
Chapter 4 Body of Studies 11
4.1 Job stressors and burnout 11
Abstract 11
Introduction 12
Methods 13
Results 16
Discussion 18
4.2 Job stressors and atherosclerosis 27
Abstract 27
Introduction 28
Methods 30
Results 33
Discussion 35
Conclusion 39
4.3 Job strain and cardiovascular health status 46
Abstract 46
Introduction 47
Methods 49
Results 52
Discussion 54
Conclusion 57
Chapter 5 Summary and future work 68
5.1 Summary 68
5.2 Future work 69
References 70
Publication List 85

List of Tables
Table 4-1-1 Characteristics of participants 21
Table 4-1-2 Analysis of burnout score according to socio-demographic, profession, and job stressors 22
Table 4-1-3 Multiple regression analysis of factors associated with work-related burnout 24
Table 4-1-4 Distribution of age, gender, job stressors and burnout among medical professions 26
Table 4-2-1 Characteristic of study participants 41
Table 4-2-2 Correlation coefficients between baPWV and covariates 43
Table 4-2-3 Multiple linear regression analysis of job related factors in association with baPWV 44
Table 4-3-1 Comparisons of socio-demographic characteristics between study participants with various types of job strain 59
Table 4-3-2 Health metric-specific definitions and prevalence of poor, Intermediate and ideal cardiovascular health 61
Table 4-3-3 Comparisons of cardiovascular health between study participants with various types of job strain 62
Table 4-3-4 Comparisons of cardiovascular health factors between medical professional 63
Table 4-3-5 Regression coefficients (standard errors) indicating the associations of job demand and, job control, and job strain, respectively with cardiovascular risk factors 64
Table 4-3-6 Odds ratio of physical inactivity in association with types of job strain 65

List of Figures
Figure 3-1 Conceptual Framework 9
Figure 4-3-1 Prevalence of cardiovascular health status by job strain 66
Figure 4-3-2 Prevalence of cardiovascular health status by medical profession 67

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