1,720,963 research outputs found
Social patterns of pay systems and their associations with psychosocial job characteristics and burnout among paid employees in Taiwan
No full textNon-steroidal anti-inflammatory drugs and the risk of first occurrence of heart failure
No full text背景：目前研究指出，在曾經因為心衰竭住院的病人身上使用非類固醇消炎止痛藥(Non-steroidal anti-inflammatory drugs, NSAID)，會增加病人再次因心衰竭住院的風險，也增加病人的死亡率。但在還未發生心衰竭的病人身上使用非類固醇消炎止痛藥，是否也增加病人發生心衰竭的風險，過去的文獻沒有一致的結論。
研究目的: 探討一般族群使用非類固醇消炎止痛藥(包括 non-selective NSAID與COX-2 inhibitor)是否增加新發生心衰竭的風險。
研究方法：以台灣健保資料庫2005年國衛院百萬人抽樣歸人檔為資料來源，選取2004-2007年間第一次因心衰竭住院，或第一次在門診診斷心衰竭的個案，以病例交叉研究設計方式分析。定義第一次因心衰竭住院的就診日期，或是第一次在門診診斷心衰竭的就診日期，為心衰竭發生日(index date)。選取心衰竭發生日(index date)前30天為病例期(case period)，心衰竭發生日(index date)前90-120天為對照期(control period)，比較病例期與對照期非選擇性非類固醇消炎止痛藥(non-selective NSAID)與選擇性非類固醇消炎止痛藥(COX- 2 inhibitor ,celecoxib)的暴露是否有差異。使用conditional logistic regression做分析，估算NSAID藥物使用與心衰竭風險之勝算比(OR)和95%信賴區間。並在multivariable analysis中控制病例期與對照期間不一致的干擾藥物使用( discordant pair of potential confounding drugs)。
結果：總共有5053位病人納入分析，女性比例約53%，年齡分布以60歲以上族群為多(80%)。在研究藥物使用與心衰竭風險的勝算比估算方面，發現使用non-selective NSAID會顯著增加心衰竭的風險，風險約為1.4倍(95% CI 1.25-1.57)，其中高劑量使用時期(>1DDD/day)較中低劑量使用時期(1DDD/day) 較中低劑量使用時期(<1DDD/day)有風險增高趨勢，但未達統計顯著性。 年齡別、性別不影響使用non-selective NSAID/celecoxib對心衰竭風險的勝算比。但新使用者(new user)或長期使用者(prevalent user)會影響使用non-selective NSAID/celecoxib對心衰竭風險的勝算比，達統計顯著性，其中新使用者(new user)有較高風險: non-selective NSAID的新使用者，心衰竭風險為4.64倍(95%CI 3.00-7.17)；celecoxib的新使用者，心衰竭風險為3.53倍(95%CI 1.19-10.50)。在個別藥物分析部分，使用口服etodolac, nimesulide, meloxicam, diclofenac之心衰竭風險顯著增加，分別為1.98至1.33倍不等。使用口服ketorolac, piroxicam, flurbiprofen, mefenamic acid, ibuprofen有增加心衰竭風險的趨勢，但未達統計顯著性，其風險分別為1.61至1.22不等。使用口服Indometacin, sulindac, acemetacin, naproxen, ketoprofen則未明顯增加心衰竭風險。在注射藥物分析部分，ketorolac增加心衰竭風險，達統計顯著性。Diclofenac有增加心衰竭風險趨勢，但未達統計顯著性。Ketoprofen未明顯增加心衰竭風險。比較三種藥物口服劑型與注射劑型之效果，皆呈現一致的方向，且注射劑型似乎較口服劑型風險更高。敏感性分析部分，改變定義心衰竭發生日期(提前1或2周)，改變對照期選取(index date前60-90天)，改變時間窗長度為14天，結果均呈穩定狀態(robust) 。
結論： 本篇研究發現使用non-selective NSAID會顯著增加心衰竭風險，且有劑量效應。高劑量使用時期與新使用者(new user)有更高風險。不同種類non-selective NSAID有不同危險性，其中口服藥etodolac, nimesulide, meloxicam, diclofenac與注射藥ketorolac的使用顯著增加心衰竭風險。Celecoxib的使用在本研究中有增加心衰竭風險的趨勢，但未達統計顯著性，因celecoxib使用個案數少，需要後續研究探討。
根據本研究結果，建議醫師在開立non-selective NSAID之前，應做心衰竭之風險評估，並且在使用過程中密集監控病人是否出現早期心衰竭症狀，尤其是高劑量使用時期或新使用者。在做藥物選擇時，也可參考不同藥物的相對風險，選擇相對安全的藥物
Little Women in Big Hospitals: Work Conditions and Occupational Health and Safety among Female Personal Aides in Hospitals of Taiwan
No full text近年來由於人口老化與社會經濟型態變遷等因素的影響，家庭能提供的照顧能力逐漸減少，當病患住院而其家屬難以獨力照顧時，家庭選擇僱用「看護」 來協助家屬陪伴與照顧病患，是普遍存在的現象。在台灣許多醫院護理人力相當吃緊的情況下，看護成為醫療照護體系中相當重要的補充性照顧人力。隨著社會中照顧需求的增加，像看護這樣的照顧工作，吸引許多勞動市場弱勢群體的投入，其中以已婚、中高齡、就業競爭能力較低的女性為主要的人力來源。目前醫院看護就業的方式多是先加入如看護中心、勞動合作社等人力仲介組織，醫院透過勞務採購招標，將病患照顧人力管理委外經營，承攬醫院業務的人力仲介單位再將旗下人力引介為家屬雇用。看護在醫院病房中工作，卻不屬於院內員工，其工作狀況攸關病患照顧服務的品質，但其工作與職業安全健康問題，卻很少受到社會的關注。
本研究透過多元質性方法，包括對本國籍女性醫院看護（19位）與管理人員（護理人員5位、看護中心負責人5位、職業工會人員2位）的訪談、文獻資料的蒐集與分析，以及研究者在看護工作與訓練單位的參與觀察，從多方角度檢視女性醫院看護所面臨的工作處境與職業安全健康問題，並將這些問題置於其所處的醫院組織管理制度與職場社會結構來理解。
研究發現分為四個部分。第一部份探討女性醫院看護的從業背景，其從業經驗，是在女性照顧者的傳統性別角色、女性在勞動市場二度就業的困境、照顧工作的低度勞動條件等多重社會脈絡下交織而成，而醫院病患照顧工作則是在其有限的就業空間中較有利的選擇。第二部分分析女性醫院看護所處的複雜職場權力結構，發現她們所面臨共通的工作處境是在職場權力關係中處於弱勢，她們同時受到醫院、仲介與病患（雇主）的多重指揮監控，以及非法外勞、外籍配偶等外來人口的比價競爭，她們對於工作內容與工作權益經驗強烈的無力感。第三部分則以造成女性醫院看護工作權益的結構性限制為基礎，探討看護普遍的身心健康問題，包括工作時間極長、休息時間不固定、工作不穩定的心理經濟壓力、家庭社交生活隔離、肌肉骨骼傷害，以及潛在的職業風險，包括疾病感染與高風險照護行為。這些職場安全健康風險，是與她們在職場權力結構中的弱勢、勞動市場彈性化趨勢下的就業不安定、以及社會勞動保障制度未將家事勞動者納入等因素息息相關，這些風險所導致的後果，必須由工作者獨力承擔。第四部分則探討政府在照顧政策中扮演的角色。照顧政策目的具有同時促進「產業發展」以及「弱勢就業」的雙重意涵，但實際在照顧產業工作者工作與健康權益的考量，卻相當有限。此部分並從勞工工作與健康權益的角度，批判評論目前政府對於醫院看護工作狀況的少數介入措施—包括年度健康檢查的規定、流感疫苗的免費施打、以及證照制度的加強；最後歸結到政府對於照顧產業的整體規劃，醫院急性期照護體系的人力問題長久以來受到漠視，看護在醫院中不明確的定位一直未獲得衛政部門的澄清，反而藉由看護在醫院中角色模糊但又具備多種功能的特性，放任醫療院所在運用這些委外照顧人力的過程中獲得經營利益。
在人口老化與少子化的社會趨勢之下，家屬能承擔的照顧能力越來越低，照顧人力市場必然更加擴張，探討醫療機構照顧工作者的工作狀況，對於整體健康照護體系的運作，具有相當重要的意義。研究者認為，女性醫院看護的工作與健康問題需要被重視，在照顧政策的規劃中，除了片面要求看護提升專業服務品質，也應考量造成這群工作者身心健康問題的社會結構因素，將照顧工作者的職業安全健康納入照顧人力發展的重要環節。In recent years, caring capacity provided by family members has been weekened due to the demographic and social changes such as aging of the population and the growing predominance of nuclear families. In Taiwan, it is a custom that hospitalized patients have to be accompanied by their family members during their stay in hospital. In the situation that the family cannot provide accompany and care to their sick member during his or her stay in hospital, a personal aide (PA) temporarily hired by the family become an important substitute to carry out care work in hospital. Under pressure of cost control of nursing staff costs in many hospitals of Taiwan, PAs－as an important group of outsourced workers, mostly women－are also considered by hospital management as complements of the manpower and a means to reduce nursing cost of the organization. Most PAs work in hospitals, where they often expose to various health risks. However, because most PAs are outsourced workers and work without fixed employers, hospitals’ occupational health and safety provisions for their staff are often not equally applied. PAs’ work conditions and safety and health status might impact greatly on quality of care, but the society has paid little attention to these issues.
In this study, we aimed to investigate work conditions and occupational health problems among female hospital PAs, and to understand the factors underlying the social production of PA’s work conditions as well as safety and health problems, including the government’s health care policies, labor legislations, power relationships at worksite, and hospitals’ management policies.
In this study, multiple qualitative methods were adopted, including policy analysis, participant observation in health worker training places, and in-depth interviews with 19 PAs and 12 managing staffs, including 5 head nurses, 5 managers from brokering companys, and 2 union leaders.
Study results are divided into four parts. In part one, I discussed how these women’s job choices were restricted by traditional social roles of women as care provides, and by discrimination against middle-aged and eldly women from labor market. Due to their relatively disadvantaged socioeconomic status, PA becomes one of their limited job choices in labor market. In part two, I revealed how PAs’ work was closely supervised by multiple players, including the patients, their families, nurses, and managers from brokering companies. Besides, they had to compete for work with undocumented foreign workers. Most of the female PAs were disadvantaged in power structure of worksite and often felt deeply powerless at work. In part three, I explored how PAs’ marginal status was reinforced by organizational policies, government policies on health care, and labor-related policies. The work of PA was regulated by policies from multiple sectors, but their role in hospital remained ambiguous. Many hospitals took advantage of such an ambiguous labor force and treated PAs as as a means to share nurses’ workloads and reduce personnel cost. In part four, I explained how PAs’ work and health conditions were formed in a social milieu. Because PAs were not covered by the Labor Standard Act, they lacked basic labor protections, such as long working hours, no regular times of rest, and separation from family and social life were commonly cited. Being flexibly employed and lacking in collective power, these PAs had difficulties in resisting unsafe work conditions and were highly individualized and burdened with high risks of musculoskeletal discomforts, infectious diseases, and psychological distress from interpersonal conflicts.
Findings of this research highlight the disadvantageous work and health conditions among this group of workers. Structural controlling mechanisms restrict their collective power to fight for their rights to work. Health policies and regulations should not unilaterally request these health care workers to provide high quality of care without any support; policy makers should address occupational health issues of PAs, not only to protect their work and health rights, but also to safeguard the quality of health care.第一章 緒論 1
一、研究緣起 1
二、研究對象與範圍 5
三、研究問題與目的 8
四、研究定位與基本立場 8
第二章 現況與文獻回顧 10
一、國內看護相關研究回顧 10
二、醫院看護的工作現況 16
三、勞動市場彈性化 21
四、照顧工作的特殊性 23
五、工作、社會與健康不平等 27
六、女性的職場發展與邊際勞動 29
第三章 研究方法 34
一、研究設計 34
二、訪談過程 36
三、資料分析 39
第四章 進入看護生涯：她們的從業歷程 45
一、醫院看護的工作時間與工作待遇 45
二、女性醫院看護的就業條件與職業選擇 45
三、小結 53
第五章 夾縫中求生存：醫院看護所處的管理制度與市場競爭 54
一、醫院看護的就業管道與牽涉部門 54
二、醫院看護的職場關係 57
三、小結 71
第六章 照顧產業發展與看護工作權益：政府的角色 72
一、醫院看護角色轉變過程與政策介入之動機 72
二、政府對看護工作的介入措施分析 77
三、照顧政策中「看護」的政治定位與勞動權益之檢視 81
四、小結 85
第七章 社會結構下的健康問題與職業風險 86
一、照顧工作型態下普遍的身心健康問題 87
二、照顧工作過程中潛在的職業風險 93
三、職業傷病補償體系的困境 96
四、看護對於職業安全健康處境的認知 98
五、小結 100
第八章 結論與未來方向 101
一、研究發現 101
二、未來政策與研究方向 102
參考文獻 106
附錄一 台灣照顧服務相關制度發展大事記* 112
附錄二 國內本國籍照顧服務員相關研究（期刊論文+學位論文）（至2007年6月） 116
附錄三 照顧服務員訓練實施計畫 (2003.2.13行政院內政部暨衛生署會銜公告) 119
附錄四 照顧服務員訓練課程表 (2003.2.13行政院內政部暨衛生署會銜公告) 121
圖目錄
圖 1- 1 國內照護型態概要圖 4
圖 5- 1 醫院中病患透過人力管理單位僱用照顧服務員之作業流程 55
圖 5- 2 醫院看護的工作生態圖 57
表目錄
表 1- 1 台灣有關醫院看護的研究 11
表 3- 1 台北與嘉義地區人口結構與婦女勞動參與率（和全國資料比較） 37
表 3- 2 本研究訪談之相關機構 40
表 3- 3 參與本研究正式訪談者的代號、化名與背景資料（醫院看護） 41
表 3- 4 參與本研究正式訪談者的代號、化名與背景資料（看護相關管理人員） 42
表 3- 5 質性訪談大綱（醫院看護） 43
表 3- 6 質性訪談大綱（看護相關管理人員） 4
Psychometric properties of the Chinese version of Copenhagen Burnout Inventory among employees in two companies in Taiwan
No full textThe effect of BisGMA on cyclooxygenase-2 expression, PGE2 production and cytotoxicity via reactive oxygen species- and MEK/ERK-dependent and -independent pathways
No full textCopyright © 2009 Elsevier Ltd All rights reserved.Mei-Chi Chang, Li-Deh Lin, Chiu-Po Chan, Hsiao-Hua Chang, Lin-I. Chen, Hsueh-Jen Lin, Hung-Wei Yeh, Wan-Yu Tseng, Po-Shuen Lin, Chiu-Chun Lin and Jiiang-Huei Jenghttp://www.elsevier.com/wps/find/journaldescription.cws_home/30392/description#descriptio
Social Patterns of Pay Systems and Their Associations with Psychosocial Job Characteristics and Burnout among Paid Employees in Taiwan
No full textToday, performance-based pay systems, also known as variable pay systems, are commonly implemented in workplaces as a business strategy to improve workers' performance and reduce labor costs. However, their impact on workers' job stress and stress-related health outcomes has rarely been investigated. By utilizing data from a nationally representative sample of paid employees in Taiwan, we examined the distribution of variable pay systems across socio-demographic categories and employment sectors. We also examined the associations of pay systems with psychosocial job characteristics (assessed by Karasek's Demand-Control model) and self- reported burnout status (measured by the Chinese version of the Copenhagen Burnout Inventory). A total of 8906 men and 6382 women aged 25-65 years were studied, and pay systems were classified into three categories, i.e., fixed salary, performance-based pay (with a basic salary), and piece- rated or time-based pay (without a basic salary). Results indicated that in men, 57% of employees were given a fixed salary, 24% were given a performance-based pay, and 19% were remunerated through a piece-rated or time-based pay. In women, the distributions of the 3 pay systems were 64%, 20% and 15%, respectively. Among the three pay systems, employees earning through a performance-based pay were found to have the longest working hours, highest level of job control, and highest percentage of workers who perceived high stress at work. Those remunerated through a piece-rated/ time-based pay were found to have the lowest job control, shortest working hours, highest job insecurity, lowest potential for career growth, and lowest job satisfaction. The results of multivariate regression analyses showed that employees earning through performance-based and piece-rated pay systems showed higher scores for personal burnout and work-related burnout, as compared to those who were given fixed salaries, after adjusting for age, education, marital status, employment grade, job characteristics, and family care workloads. As variable pay systems have gained in popularity, findings from this study call for more attention on the tradeoff between the widely discussed management advantages of such pay systems and the health burden they place on employees
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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