From Cognition to Behavior: Associations of Workplace Health Culture and Workplace Health Promotion Performance With Personal Healthy Lifestyles.

Introduction: The aim of this study was to explore associations of workplace health culture and workplace health promotion (WHP) performance with employees' healthy lifestyles and health statuses. Methods: In total, 27 enterprises and 1,732 participants were recruited for a cross-sectional designed survey. At the group level, Workplace Health Scorecard was used to measure WHP performance, and it was filled out by the WHP representative at each workplace. At the personal level, a personal questionnaire was used to measure workplace health culture, healthy lifestyles, and health statuses. A hierarchical linear model analysis was used to assess correlations between these variables. Results: Workplace health culture was significantly related to WHP performance, healthy lifestyles, and health statuses. In particular, the peer support domain was greatly related to healthy behaviors like physical activity (ß = 0.596, p < 0.001), vegetable consumption (ß = 0.291, p < 0.001) and fruit consumption (ß = 0.285, p < 0.05), and it may illustrate the importance of establishing peer support to promote healthy behaviors. Conclusions: WHP performance was significantly related to workplace health culture especially health policies, health climate, and peer and supervisor support. Hence, building a good workplace health culture should be taken seriously, and more studies exploring associations of health culture and WHP performance with employees' health are needed.

Exploring and Developing the Workplace Health Culture Scale in Taiwan.

Background: The aim of this study was to develop and validate the workplace health culture scale. Methods: This paper collected and re-organized current definitions about health culture from literature and created the domains and items to develop a new tool. Six enterprises and 2,431 participants were recruited from northern Taiwan for validity test. Results: We found the workplace health culture scale had appropriate reliability and validity, including a good model fit for the 25-item scale. Conclusions: Workplace health culture might be an important domain to the work of WHP. More validity and reliability studies about WHCS in wider industries and the correlation between WHCS and other WHP indicators are needed.

Exploring the public-private and company size differences in employees' work characteristics and burnout: data analysis of a nationwide survey in Taiwan.

Distinct differences exist between public-private sector organizations with respect to the market environment and operational objectives; furthermore, among private sector businesses, organizational structures and work conditions often vary between large- and small-sized companies. Despite these obvious structural distinctions, however, sectoral differences in employees' psychosocial risks and burnout status in national level have rarely been systematically investigated. Based on 2013 national employee survey data, 15,000 full-time employees were studied. Sector types were classified into "public," "private enterprise-large (LE)," and "private enterprise-small and medium (SME);" based on the definition of SMEs by Taiwan Ministry of Economic Affairs, and the associations of sector types with self-reported burnout status (measured by the Chinese version of Copenhagen Burnout Inventory) were examined, taking into account other work characteristics and job instability indicators. Significantly longer working hours and higher perceived job insecurity were found among private sector employees than their public sector counterparts. With further consideration of company size, greater dissatisfaction of job control and career prospect were found among SME employees than the other two sector type workers. This study explores the pattern of public-private differences in work conditions and employees' stress-related problems to have policy implications for supporting mechanism for disadvantaged workers in private sectors.

Decreased zinc and increased lead blood levels are associated with endometriosis in Asian Women.

Endometriosis is an inflammatory disease associated with multiple pathogenic factors and studies regarding roles of trace metals in endometriosis have been inconsistent and limited. The aim of this cross-sectional study was to compare the blood levels of miscellaneous trace metals measured by inductively coupled plasma mass spectrometry in infertile women with and without endometriosis. Zinc level is associated with declining odds (adjusted OR=0.39, 95% CI=0.18-0.88) of endometriosis. By contrast, lead level is associated with increasing odds (adjusted OR=2.59, 95% CI=1.11-6.06) of endometriosis. The cadmium levels were higher in women with endometriosis, but the aOR was not significant. Zinc has anti-inflammatory characteristics and regulates homeostasis of zinc-containing superoxide dismutase. High lead levels might induce reactive oxygen species and deplete antioxidant defense mechanisms. Further prospective study is needed to test for their causal associations.

Decline in semen quality in men in northern Taiwan between 2001 and 2010.

Semen quality is a key indicator of the male reproductive ability. The decline in semen quality has been debated for several decades. However, data on decline in semen quality might be inconsistent given factors such as geographical area, ethnicity, environmental exposure and lifestyle changes. This study aimed to provide information on the semen quality of men in Northern Taiwanese. We recruited 7,187 male participants between 2001 and 2010 from a reproductive medical center. The age of the participants ranged from 26 to 57 years, with a mean age of 36.9 ± 4.77 years. Semen analysis was performed through standardized methods outlined in the World Health Organization laboratory manual. Increasing age (per year) was significantly and negatively associated with semen volume (1.006 ml), progressive sperm motility, rapid progressive sperm motility and sperm with normal morphology (reduction by 1.010%, 1.013% and 1.002% per year, respectively). In addition, sperm concentration, semen volume, number of sperms, progressive sperm motility, rapid progressive sperm motility, and sperm with normal morphology were significantly reduced annually by 1.013 × 106/ml, 1.015 ml, 1.028 × 106, 1.021 %, 1.017% and 1.016%, respectively). Age-period-cohort (APC) analyses revealed that age and cohort had effects on reduction of the progressive and rapid progressive sperm motility. Moreover, all the sperm parameter values were significantly reduced annually. Our findings provide useful information for clinical practice and public health investigations of male reproductive health.

Biomonitoring of blood heavy metals and reproductive hormone level related to low semen quality.

Reproductive hormones and exposure to environmental metals are correlated with low-quality semen. The aim of this study was to evaluate the levels of heavy metals and reproductive hormones in the blood in addition to other relevant factors to clarify the relationship between these factors and semen quality. We recruited 154 male participants from a reproductive medical center. All participants were provided with a questionnaire on lifestyle implementation. The levels of metals in the blood were determined using inductively coupled plasma-mass spectrometry. The levels of hormones in the blood were determined using an automatic gamma counter. Multiple logistic regression analyses were conducted to predict the effects of statistically significant risk factors on semen quality by adjusting for relevant confounders and modifiers. After adjusting for the age, education level, and related factors in the multiple logistic regression analyses, we observed that the increased blood Pb levels were significantly and positively associated with low semen quality. High blood Pb levels (>50 µg/L) had an 11-fold risk of low semen quality. Our results suggest that progressive motility sperm may be a sensitive indicator of the semen quality among all the semen parameters in Taiwan.

Association Between Organization Culture, Health Status, and Presenteeism.

OBJECTIVE: The aim of this study was to examine relationships of organizational culture and health behaviors with presenteeism. METHOD: Data of a self-reported questionnaire were collected from 816 employees, who joined the study on a voluntary basis, in seven enterprises in northern Taiwan. RESULTS: Organizational culture and health behaviors were found to be significantly associated with presenteeism. After adjusting for confounding factors, the number of health complaints seemed to be more suitable than chronic diseases in predicting presenteeism. CONCLUSIONS: This study result implied that advantage could be taken of organizational culture and employees' health behaviors to reduce presenteeism in the workplace.

Combined effects of noise, vibration, and low temperature on the physiological parameters of labor employees.

Noise, vibration, and low temperature render specific occupational hazards to labor employees. The purpose of this research was to investigate the combined effects of these three physical hazards on employees' physiological parameters. The Taguchi experimental method was used to simulate different exposure conditions caused by noise, vibration, and low temperature, and their effects on the physiological parameters of the test takers were measured. The data were then analyzed using statistical methods to evaluate the combined effects of these three factors on human health. Results showed that the factor that influenced the finger skin temperature, manual dexterity, and mean artery pressure (MAP) most was air temperature, and exposure time was the second most influential factor. Noise was found to be the major factor responsible for hearing loss; in this case, hand-arm vibration and temperature had no effect at all. During the study, the temperature was confined in the 5-25°C range (which was not sufficient to study the effects at extremely high- and low-temperature working conditions) because the combined effects of even two factors were very complicated. For example, the combined effects of hand-arm vibration and low temperature might lead to occupational hazards such as vibration-induced white finger syndrome in working labors. Further studies concerning the occupational damage caused by the combined effects of hazardous factors need to be conducted in the future.

Work-related fatigue among medical personnel in Taiwan.

BACKGROUND/PURPOSE: Work-related fatigue among medical personnel is a major concern for patient safety, however heavy on-call duty is common in many hospitals. The purpose of this study was to investigate the prevalence of self-reported work-related fatigue and its associated factors. METHODS: A cross-sectional survey of 1833 participants was conducted in two hospitals in Taipei City, Taiwan, using a self-administered questionnaire. Participants reported their demographic characteristics, health-related behavior, health status and symptoms, and work-related fatigue during the past 3 months. RESULTS: The prevalence of work-related fatigue among the 1833 participants was 30.9%. Younger participants (20-29 years old) were more likely to report work-related fatigue than older participants (40-65 years old) [adjusted odds ratio (aOR) = 1.55, 95% confidence interval (CI) = 1.18-2.01]. Physicians, nurses, and medical technicians were more likely to report work-related fatigue symptoms than administrative personnel (aOR = 2.30, 95% CI = 1.57-2.79; aOR = 2.83, 95% CI = 1.87-3.99; and aOR = 2.01, 95% CI = 1.12-3.06, respectively). Those who drank coffee more than five times a week were more likely to report work-related fatigue than those who did not drink coffee at all (aOR = 2.53, 95% CI = 1.25-1.93). Participants with poor and very poor self-reported health were more likely to report work-related fatigue (aOR = 1.80, 95% CI = 1.26-2.38) than those who reported that their health was fair, good, or very good. CONCLUSION: We identified factors associated with work-related fatigue among hospital workers in Taipei City. These findings can be applied toward on-the-job training and the development of preventive measures for occupational safety in general hospitals.

The effects of exercise program on burnout and metabolic syndrome components in banking and insurance workers.

To explore the effectiveness of exercise program for banking and insurance workers and clarify the association between exercise, burnout, and metabolic syndrome components. In the process of the study, a practicable worksite exercise program was developed for bank and insurance enterprises. A three-month (12-wk) exercise course was conducted, and its benefits evaluated. Levels of burnout and metabolic syndrome components were analyzed after exercise intervention. After intervention, the indicators of burnout and metabolic syndrome components were significantly improved in both low and high intensity groups, and the improvement were expressed in reduction of waist circumference, systolic blood pressure, person burnout and work-related burnout. A dose-response of burnouts and metabolic syndrome components with exercise intensity are shown (p<0.05). Metabolic syndrome components were independently associated with burnout and exercise intensity in the crude model. After adjustment for potential confounders, waist circumference and systolic blood pressure differences showed significant associations with exercise intensity (p<0.05). This study demonstrated an effective approach to worksite exercise intervention and exercise intensity played an important role to alleviate damage between burnouts and metabolic syndrome components.

Intratympanic dexamethasone on cochlear blood flow in Guinea pigs.

UNLABELLED: To determine the effect of intratympanically delivered dexamethasone on cochlear blood flow. 29 white Hartly guinea pigs were divided into 2 groups. By laser Doppler flowmeter, baseline data were recorded in the first 15-20 min, followed by 20 min' recording after applying dexamethasone or normal saline, with a record of flow every 5 min in 2 groups. Friedman Test was used to test the change of blood flow in these four timing. There were no significant changes of blood flow after injecting dexamethasone (p = .18 > .05) and normal saline (p = .93 > .05). The effects of dexamethasone on cochlear blood flow were variable and not significant. The following research would be designed under pathological conditions, such as cochlear ischemia, to show the possible mechanism of dexamethasone for specific inner ear disease. LEVEL OF EVIDENCE: 3a (SR of case-control studies).

Effect of low frequency noise on the echocardiographic parameter E/A ratio.

The hearing condition of the Taiwanese aerospace maintenance workers affected by the low frequency noise had not been reported. The purpose of this research is to clarify the maintenance workers' health effect when exposed to low frequency and/or general noises and to understand the relationship between the variations of the worker's echocardiographic E/A ratio and the low frequency noise. The low frequency noise monitoring and echocardiographic E/A ratio results obtained for 213 aerospace maintenance workers indicated that the workers' hearing loss was more serious at high frequency 4k and 6k when exposed to the low frequency noise and could be more than 40 dB. The abnormality of echocardiographic E/A ratio was also higher than that of control group.

Hypoadiponectinemia: a useful marker of dyslipidemia in women with polycystic ovary syndrome.

OBJECTIVE: Adiponectin plays a role in obesity, lipid metabolism, and anti-inflammation. Women with polycystic ovary syndrome (PCOS) are also at risk for dyslipidemia. Therefore, we investigated the association between adiponectin levels and the lipid profile including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TGs) in women with PCOS and contemplated what role adiponectin might play in dyslipidemia with PCOS. MATERIALS AND METHODS: We recruited 118 young Taiwanese women with PCOS. The women enrolled were not taking any medication and those with other systemic diseases of nonovarian origin, which could have affected the hypothalamic-pituitary-ovarian axis, were excluded. The serum lipid profile, metabolic and hormonal parameters, and adiponectin were measured. The lipid profile and adiponectin were analyzed and adjusted for age, body mass index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR), and sex hormone-binding globulin (SHBG). RESULTS: In a simple linear regression, adiponectin was significantly inversely related to LDL-C and TGs, but positively related to HDL-C (all p < 0.001) after logarithmic transformation. In the multiple linear regression, adiponectin was significantly related to HDL-C (p < 0.001) independent of age, BMI, HOMA-IR, and SHBG after logarithmic transformation. Using a logistic regression, the odds ratio was 0.088 between the association of increased adiponectin and abnormal HDL-C (≤ 50 mg/dL). CONCLUSIONS: We demonstrated that adiponectin is an independent biomarker that is positively and evidently related to HDL-C and TGs in women with PCOS. Hypoadiponectinemia may be a useful marker of dyslipidemia in women with PCOS.

A case-control study of HIV infection among incarcerated female drug users: impact of sharing needles and having drug-using sexual partners.

BACKGROUND/PURPOSE: Taiwan experienced a rapid surge in human immunodeficiency virus (HIV) among injection drug users (IDUs) from 2003 to 2005. The male-to-female ratio of HIV cases decreased from 20:1 in 2003 to 6:1 in 2006. This change is primarily due to increasing numbers of female injection drug users in Taiwan. Our primary objective was to identify the risk factors associated with HIV infection among incarcerated female drug users. METHODS: A case-control design involved recruitment of all eligible HIV-infected female inmates from all 24 prisons in Taiwan from November to December, 2007. Eligible HIV seronegative controls were chosen within the same prison and matched to the cases by age (within 3 years) and by history of illicit drug use. A subsample of these matches was randomly selected since there were many more eligible controls than HIV-infected cases. An anonymous self-administered questionnaire was completed with assistance from trained research assistants. RESULTS: A total of 114 cases and 149 control participants were recruited, with a response rate of 82% and 54%. Injectable heroin use was significantly greater (p = 0.02) among HIV-infected cases (93.0%) than un-infected controls (84.6%). Compared to seronegative controls, HIV-infected cases were more likely to share drug paraphernalia and have drug-using sexual partners. Multiple logistic regression analysis revealed that the number of imprisonments (between 2-5 times; OR = 5.23), sharing mainly dilutes (OR= 63.47), and sharing dilutes concurrently with needles (OR= 127.33) significantly predicted HIV seroconversion, after controlling for age and years of education. CONCLUSION: Sharing needles/dilutes and practicing unsafe intercourse with drug-using sexual partners places female drug users at considerable risk.

An effective physical fitness program for small and medium-sized enterprises.

The aim of this study is to develop a practicable worksite physical fitness program for small and medium-sized enterprises (SMEs). Community-based intervention consisting of a three-month exercise course was conducted, and its benefits evaluated. A self-administrated structured questionnaire and physical fitness examination were designed to compare the difference between pre and post intervention. A total of 133 SME workers completed the lifestyle/exercise course and filled out the questionnaire, but 16 were excluded from the exercise group due to health reasons. After the intervention, health indicators such as weight, blood pressure, resting heart rate, waistline, BMI, front and back trunk flexibility, abdominal muscle durability and back muscle strength were significantly improved, and improvements in musculoskeletal disorders were seen in reduced neck pain (18.8%), wrist pain (17.4%), and upper/lower back pain (8.7% and 21.7%, respectively). Cardiovascular risk factors (BMI and resting heart rate) showed a significant improvement related to frequent participation in the program (p=0.02), and the exercise group reported a significant difference in overall health (p=0.02). This study has demonstrated an effective approach to community-based fitness intervention through SMEs.

Acceptability of rapid oral fluid HIV testing among male injection drug users in Taiwan, 1997 and 2007.

Rapid oral fluid HIV testing (rapid oral testing) is in the process of being adapted in Taiwan and elsewhere given its advantages over prior HIV testing methods. To guide this process, we examined the acceptability of rapid oral testing at two time points (i.e., 1997 and 2007) among one of the highest risk populations, male injection drug users (IDUs). For this purpose, an anonymous self-administered survey was completed by HIV-negative IDUs involved in the criminal justice system in 1997 (N (1)=137 parolees) and 2007 (N (2)=106 prisoners). A social marketing model helped guide the design of our questionnaire to assess the acceptability of rapid oral testing. This included assessing a new product, across four marketing dimensions: product, price, promotion, and place. Results revealed that in both 1997 and 2007, over 90% indicated that rapid oral testing would be highly acceptable, particularly if the cost was under US$6, and that a pharmacy would be the most appropriate and accessible venue for selling the rapid oral testing kits. The vast majority of survey respondents believed that the cost of rapid oral testing should be federally subsidized and that television and newspaper advertisements would be the most effective media to advertise for rapid oral testing. Both the 1997 and 2007 surveys suggested that rapid oral HIV testing would be particularly accepted in Taiwan by IDUs after release from the criminal justice system.

Prevalence and correlates of lifetime suicidal ideation among HIV-infected male inmates in Taiwan.

The purpose of this study was to explore the prevalence and correlates of lifetime suicidal ideation (SI) among HIV-infected male inmates. All participants in seven prisons, comprising roughly 20% of all HIV-infected male inmates in Taiwan, were stratified by geographic location and surveyed using a self-administered, anonymous questionnaire. The five-item Brief Symptom Rating Scale (BSRS-5) was used on 535 participants to measure various dimensions of psychological distress. Seven questions regarding lifetime psychiatric symptoms were also added to the questionnaire. Questionnaire results in this sample revealed that 23.7% had suffered depressive symptoms for at least two weeks, 20.6% experienced serious anxiety or tension symptoms, 12.5% had serious thoughts of suicide symptoms, and 4.1% had made a suicide attempt. Results of multiple logistic regression analysis indicated that SI was significantly related to (1) recent psychological distress, and (2) lifetime experience of depression for two weeks or more, serious anxiety or tension, or hallucinations. Since nearly 70% of the respondents reported at least one psychiatric symptom in their lifetime, it would seem important to target HIV-infected male inmates with mental health interventions and suicide prevention.

Psychiatric morbidity in HIV-infected male prisoners.

BACKGROUND/PURPOSE: The seroincidence of human immunodeficiency virus (HIV) in Taiwan has drastically increased since 2004, particularly among injection drug users and prisoners. The major purpose of this study was to explore the prevalence and correlates of psychiatric morbidity among HIV-infected male prisoners. METHODS: In 2006, data were collected from all of HIV-infected male prisoners (n = 535) in seven prisons in Taiwan. This collection was performed using a self-administered, anonymous questionnaire in group settings directed by our interviewers. Psychiatric morbidity was measured using the five-item Brief Symptom Rating Scale in 535 participants, which represented an 85% response rate. After excluding incomplete data, 479 participants were included in the analysis. RESULTS: Psychiatric morbidity was present in 46% of participants. Multivariate logistic regression revealed that correlates of the five-item Brief Symptom Rating Scale defined cases included the following: being a recidivist, having poor self-rated health status, and having experienced psychiatric symptoms in one's lifetime (e.g. significant physical pain or discomfort, depression for 2 weeks or longer, serious anxiety or tension, trouble understanding, concentrating, or remembering, and serious thoughts of suicide), with a Nagelkerke R(2) equal to 0.365. CONCLUSION: Psychiatric morbidity is prevalent among HIV-infected male prisoners. Tailored HIV/AIDS education related to mental health is therefore suggested for inclusion as part of a comprehensive HIV/AIDS training program among incarcerated populations.

Mercury concentration in meconium and risk assessment of fish consumption among pregnant women in Taiwan.

Meconium is a matrix that can be obtained easily and noninvasively and is useful for detecting antenatal fetal exposure to environmental toxins. Taiwan is an island with high fish consumption, and many pregnant women would like to enjoy the benefits of fish without jeopardizing their health or that of their child. The aim of this study is to assess the mercury concentration in meconium in relation to the health risk of mercury exposure. A total of 198 mother-infant pairs residing in the city of HsinChu were recruited for the study between January 2007 and June 2007. The average mean concentration of mercury in meconium was 79.2+/-7.3 ng g(-1) dry wt We use the Monte Carlo technique to assess the uncertainty in risk assessment and the impact of these uncertainties on the estimation of expected risk of mercury intake from fish in mothers. Based on the FAO/WHO's tolerable daily intake of methylmercury (0.23 microg kg(-1)d(-1)), we found that 17.3% and 14.0% of the daily mercury exposure estimated exceeded the reference dose for foreign-born and Taiwan-born mothers, respectively. We found that the mercury concentration in meconium was much higher than in other studies, except for one study done in Tagum in the Philippines where mercury is used in gold mining. This may be because Asia is the largest emitter of anthropogenic mercury, accounting for 53% of worldwide emissions. Sensitivity analysis suggests that mercury concentration in fish and the rate of ingesting fish may be the key parameters for governments offering risk management guidance to protect the health of mothers and unborn babies.

Significant effects of implementation of health-promoting schools on schoolteachers' nutrition knowledge and dietary intake in Taiwan.

OBJECTIVE: Although teachers are the key participants in health-promoting schools (HPS) programme delivery, it is still unknown whether teachers are appropriate health information resources and role models for students with respect to healthy diets. The present study aimed to investigate the effects of implementing HPS programmes on teachers' nutrition knowledge and diets. DESIGN: One HPS programme aiming at dietary intervention (HP-D) and one HPS not aiming at dietary intervention (HP-ND) were selected, along with two non-health-promoting (NHP) schools matched for school size and urbanization level with the two HPS. All 361 teachers in the four schools were invited to participate, yielding a 78.4 % overall valid response rate. A structured, self-reported questionnaire was administered, with regression models used for statistical analysis. RESULTS: Teachers in the HP-D group had a mean score of 21.1 on a range of 0-30 for nutrition knowledge, which was significantly higher than the mean scores of 18.5 in the HP-ND group and 19.1 in the NHP group (P < 0.001). Better dietary behaviours were also observed among HP-D teachers. Further, being a 'health education' course instructor was associated with significantly higher scores on nutrition knowledge (beta = 2.6, P < 0.001) and vegetable and fruit consumption (beta = 1.4, P = 0.02) in the HP-D group than in the NHP group. The HP-ND and NHP groups exhibited similar patterns of non-significant differences compared with the HP-D group. CONCLUSIONS: Implementation of a coordinated HPS framework on nutrition and diet was positively correlated with schoolteachers' nutrition knowledge and dietary intake.