Dealing With a Stressful Extra Duty: The Intrapersonal Conflict Experiences of Nurses Caring for Survivors of Suicide Attempts on Medical-Surgical Wards.

Nurses are the frontline professionals caring for patients who have attempted suicide. When clinical nurses learn from medical records or nursing handover, or are proactively informed by patients or family members, that the patients they are caring for have suicidal tendencies, they often experience pressure and face challenges. However, little attention has been given to the experiences of the nurses caring for patients with suicidal intent on medical and surgical wards. We aimed to address this knowledge gap. The purpose of this study was to explore medical and surgical nurses' experiences, especially the internal conflicts they might experience while caring for patients who have a history of attempted suicide. A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-three nurses were recruited and interviewed individually. Data were analysed by qualitative content analysis. The focus of this paper is to examine the emergent theme of intrapersonal conflict experienced by the participants. Nurses' experiences can be clustered into two themes: (1) Pity and annoyance and (2) Hard work does not necessarily pay off. Intrapersonal conflict was identified by participants as considerable fear and anxiety about the possibility of a patient's suicide, as well as a mixture of pity for and annoyance with the patients. Nurses feel sorry for such patients, but they are also annoyed by the extra work required to prevent suicide attempts in the ward. Additionally, having limited time and ability, they see that their hard work does not necessarily pay off and may sometimes lead to punishment. Our findings raise serious concerns about the adequacy of the knowledge of the nurses, their competence and their difficulties in caring for such patients. In addition, there is a need to provide them with appropriate on-the-job education and immediate emotional support relevant to caring for survivors of suicide attempts.

Experience of Patients With Heroin Addiction Receiving Methadone Maintenance Treatment in Community Settings in Taiwan.

BACKGROUND: The World Health Organization has identified methadone maintenance therapy (MMT) as the most effective treatment for reducing patient dependence on heroin. In Taiwan, MMT has been used as a heroin harm reduction strategy since 2006. Although the effectiveness of MMT in reducing heroin addiction has been examined quantitatively in prison samples, little attention has been paid to the experiences and perspectives of patients with heroin addiction receiving MMT. This study was designed to address this gap in scientific knowledge. PURPOSE: The aim of this study was to investigate the experiences of individuals struggling with heroin addiction who are receiving MMT in the community. METHODS: A qualitative descriptive research approach and semistructured interviews were used in this study. We interviewed 14 participants who had received MMT in a medical center in central Taiwan. All of the interview data were recorded, transcribed, and analyzed using qualitative content analysis. RESULTS: Four themes emerged: (a) a chance to change one's life, (b) the helpfulness of MMT, (c) a sense of being restricted and controlled, and (d) need for support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This article fills a gap in current scholarly understanding of patient experiences and their perspectives on the helpfulness of MMT. Understanding patient experiences and perspectives is critical to informing and developing concrete strategies for clinical practice and MMT policy. Clinical professionals should assess patient needs and concerns to determine whether they are met by current treatment programs. Policymakers should design more flexible policies to facilitate easier access by patients to methadone to reduce the risk of relapse.

"To do or not to do", male nurses' experiences of providing intimate care to female patients in China, a constructivist grounded theory study.

BACKGROUND: Some studies suggest that female patients have more concerns about receiving intimate care from male than female nurses. Thus, providing intimate care to female patients is a challenging experience for male nurses. The purpose of this study was to explore Chinese male nurses' experiences and process of providing intimate clinical care to female patients. METHODS: A constructivist grounded theory approach was used to develop a theoretical understanding of male nurses' experiences. This study included participants from 3 hospitals in different locations in China. Twenty-five male nurses were recruited using purposive and theoretical sampling. Semi-structured interviews were conducted. Data analysis was completed using initial coding, focused coding, theoretical coding and memo writing to produce core concepts and categories, and theory development. RESULTS: Chinese male nurses' experiences of providing intimate care to female patients can be constructed as a three-stage process: (1) anticipation of the level of embarrassment, (2) deciding on the process: do it or not do it and (3) protecting both parties and dealing with embarrassment. Additionally, seven themes and associated categories were identified to represent the important factors in the process of male nurses providing intimate care to female patients in China. CONCLUSIONS: Chinese traditional culture may affect the embarrassment in Chinese male nurses providing intimate care to female patients. The embarrassing situation can be divided into three different stages, and male nurses have different main concerns in each stage. Hospital nursing administrators should consider the experiences and needs of male nurses in providing intimate care and provide them with psychological support, education and training.

Oncology nurses' experiences of providing emotional support for cancer patients: a qualitative study.

BACKGROUND: A high percentage of cancer patients may experience emotional distress. Oncology nurses are expected to play an important role in recognizing emotional distress and planning and delivering care that meets the individual needs of each patient. However, few studies have focused on the experiences of clinical nurses in such cases. This study adopted a qualitative research method to gain an in-depth understanding of the experience of nursing staff in caring for cancer patients with emotional distress. METHODS: A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-one oncology nurses were interviewed, and the qualitative content analysis suggested by Graneheim & Lundman (2004) was used to interpret the data. RESULTS: Six themes were identified, as follows: (1) dictating the abnormality of emotion, (2) soothing and comforting patients, (3) a lack of psychology knowledge and communication skills, (4) negative impacts of a lack of time, (5) managing emotional labor, and (6) reflecting on the experiences. CONCLUSION: Hospital administrators should arrange pre-employment education and training as well as on-the-job education to help nurses in caring for cancer patients with emotional distress. They should also focus attention on the personal emotional states of nursing staff in a timely manner and provide psychological support and emotional counseling as necessary.

Exploring return to work for patients with head and neck cancer.

BACKGROUND: The number of survivors of head and neck cancer (HNC) has steadily increased due to major advances in cancer care. However, cancer survivors who experience job loss face different challenges regarding return to work (RTW). Relatively few studies have integrated the experience encountered by patients. OBJECTIVE: This mixed-methods study aimed to explore the experience and challenges of RTW in patients with HNC. METHODS: Data were collected with structured questionnaires (n = 120) and semi-structured face-to-face interviews (n = 12). RESULTS: Relationships were found between patient's physical status, perceived stress, and social support. Patients who continued work, or not, had significant differences in reported physical function and stress. Four themes emerged from the qualitative data, including the perceived meaning of work, challenges for RTW, preparing for RTW, and social support. After diagnosis and treatment, patients perceived the meaning of work, such as personal value, responsibility, and financial need. They faced many challenges to RTW, including declining physical strength, workload, schedule rearrangement, speech difficulty, and changed appearance. In order to RTW, they prepared extensively and needed support from family and friends. CONCLUSION: This study revealed the experiences and challenges of RTW patients with HNC. The results allowed us to identify patients' concerns and ways that healthcare providers could improve the RTW process. Future studies may develop tailored approaches for RTW in healthcare and government policies.

[The Health-Seeking Experience of Patients With Sjögren's Syndrome].

BACKGROUND: The multiple symptoms of Sjögren's syndrome lead patients affected by this disease to seek medical advice from different medical disciplines and specialists. Diagnoses are often made many years after initial onset, resulting in mental and physical exhaustion and misunderstandings. PURPOSE: This study was designed to explore the health-seeking experiences of patients with Sjögren's syndrome. METHODS: Qualitative research methods and purposive sampling were used. Fourteen patients with Sjögren's syndrome were interviewed by the first author, and the collected data were analyzed using content analysis. RESULTS: Four themes were revealed from the data, including: (1) distressing symptoms; (2) difficulty in diagnosis; (3) concerns about drug side effects; and (4) facing the disease. The participants initially sought medical attention when they began experiencing early onset symptoms that caused discomfort or annoyance. Their doctors' failure to provide proper diagnoses during the long health-seeking process caused a great deal of suffering to the participants. Although related medications should be taken for life, the participants reported taking lower-than-prescribed dosages out of fear of side-effects. The participants explored their process of coping with the disease, which began with denial and ended with acceptance. By learning from their health-seeking process, participants realized that they needed to take proper care of themselves, adapt to life with their disease, and control related symptoms. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: To facilitate the early diagnosis of Sjögren's syndrome, healthcare professionals should improve their awareness of this condition and refer patients with related symptoms to rheumatologists and immunologists. Effective early diagnosis and treatment can help these patients reduce the time and effort involved in unproductive doctor's visits, allowing them to better continue as productive members of society and to maintain a good quality of life.

Factors influencing the effects of the mindfulness-based interventions of patients with substance abuse: A qualitative systematic review and meta-synthesis.

Objective: This article aims to provide the experiences of mindfulness treatments from the perspectives of patients with a history of substance abuse. Data source: Peer-reviewed articles on 5 databases, namely, PubMed, PsychINFO, Medline, CINAHL and the Cochrane Library, between the year of 2000 and 2023. Study Inclusion and Exclusion Criteria: Studies were included if they were published in the English language and reported on qualitative studies that directly engaged patients with experiences of substance abuse and mindfulness treatments. Data extraction: After our initial search, 5355 studies were reviewed by title and abstract, consequently, 10 studies were included. Data synthesis: Meta-ethnography were used in this study. Data were obtained from the quotations from participants and text under the heading "results" or "findings" from the included 10 studies. Results: Effective mindfulness-based interventions (MBI) influence recovery from substance abuse. Four themes were identified as factors influencing the MBI treatment effect. They were (1) engaging in mindfulness: entry and retention, (2) perceived benefits of MBIs, (3) implementation of treatment group and (4) maintenance of treatment effect. Conclusion: This article examines the scientific literature to date and presents the evidence on the factors that influentially impact the effect of MBIs in patients with substance abuse. The findings of this study should be helpful in guiding clinical practice, policy, and future research focused on the treatment effect of MBIs for person with substance use.

Experiences of Participating in an Academic-Hospital Partnership Nursing Program: A Qualitative Study.

BACKGROUND: Although 5-year colleges account for 41.7% of all nursing graduates in Taiwan, most of these graduates go on to university and earn a bachelor's degree. In 2015, four universities received approval from the Ministry of Education of Taiwan and started to enroll students in the academic-hospital partnership nursing program to guide nursing graduates from 5-year colleges into the nursing workplace. The effects of this program have never been examined, especially from the perspective of the students. PURPOSE: The aim of this study was to explore the experiences of students currently participating in the academic-hospital partnership nursing program. METHODS: A qualitative approach was used in this study. Twelve students were invited to participate in a focus group that met for five sessions over 3 years to understand the motivations for and experiences of participating in the academic-hospital partnership nursing program. Data were analyzed using thematic analysis. RESULTS: Six themes were identified: (a) incentives for participating in the academic-hospital partnership nursing program, (b) worries about making the wrong decision, (c) worries about future adaptation, (d) facing the real workplace, (e) confusion about role perception and benefits, and (f) administrator support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study enhance the general understanding of nursing student experiences and the changes over time in the academic-hospital partnership nursing programs. Moreover, the findings may be used to help teachers and nursing administrators at healthcare institutes better support the needs of students at each program stage. In addition, the findings may serve as a reference for the government in refining the design of these programs in the future.

Healthcare workers' experiences of caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders.

WHAT IS KNOWN ON THE SUBJECT?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning. People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living. Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co-occurrent with psychiatric disorders (IDPD). In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management. Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. ABSTRACT: Introduction When intellectual disability co-occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods A qualitative descriptive research approach and semi-structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in-service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions.

Service Quality and Customer Satisfaction in Pharmaceutical Logistics: An Analysis Based on Kano Model and Importance-Satisfaction Model.

The implementation of National Health Insurance in Taiwan has affected the medical industry by significantly depleting the supply chain's profits. Service providers in the medical industry must meet the dual-service expectation of serving as medical manufacturers with upper reaches and as suppliers in the downstream marketing channel. As a result, service providers must anticipate customer requirements, offer new service items that align with customer demands and improve the quality of existing services. This study aims to examine consumer perspectives about service satisfaction in the domestic medical industry using Kano's two-dimensional model. In addition, it employs the importance-satisfaction model to determine service items that need improvement. The empirical findings show that consumer perceptions about service quality attributes vary and thus, service items may be categorized differently in Kano's model. Further, the reliability of service quality significantly affects customer satisfaction. Thus, service providers can gain a competitive edge and maintain their market position by offering high value added and critical quality attributes. Finally, analyzing customer attitudes toward new service items for indifference quality will help service providers determine effective tactics in a competitive market. In general, service providers should assign higher priority to items that customers consider in need of improvement.

Students' Experiences of Studying in an Accelerated BSN Program in Taiwan.

INTRODUCTION: Today's global nursing shortage is having an adverse impact on health systems around the world and in Taiwan. Many universities in the United States have implemented accelerated BSN (ABSN) programs to create a shortcut for students who have bachelor's degrees in other fields to become nurses. Previous studies have revealed that students feel stress during the programs, especially in their first year. Students' first-year experiences in an ABSN program in the Taiwanese context are worthy of study. STUDY AIM: The purpose of the study was to understand nursing students' first-year experiences in an ABSN program in Taiwan. DESIGN: A qualitative research design was used in this study. SETTING AND PARTICIPATIONS: A total of 25 students from a university in central Taiwan participated in this study to share their first-year experiences of studying in an ABSN program. METHODS: Data were collected from 3 focus group interviews and students' written reflections and were analyzed by qualitative content analysis with the help of ATLAS.ti 7.0. FINDINGS: Five themes were identified: (1) pursuing a brighter future, (2) positively facing doubts (3) challenges of surviving, (4) changing their learning attitudes and methods, and (5) seeking support. CONCLUSIONS: The findings of this study may help nursing schools to provide the support students need and serve school administrators as a reference for refining such programs in the future.

Infection preventionists' challenges in psychiatric clinical settings.

BACKGROUND: Infection preventionists (IPs) play an important role in preventing health care-associated infections in a health care system. However, the limitations of the clinical setting and the unique characteristics of psychiatric patients could be barriers to effective infection prevention. The purpose of this study was to understand how IPs perceived their challenges and how these challenges negatively affect their infection prevention work in psychiatric clinical settings. METHODS: A descriptive, qualitative research approach was used in this study. Thirteen Taiwanese psychiatric IPs were interviewed in semistructured interviews. Data were transcribed and then analyzed by thematic analysis. RESULTS: This analysis identified 6 themes: (1) lack of preservice training in psychiatric infection control, (2) insufficient staffing in practice, (3) working within environmental limits, (4) patient noncompliance, (5) undervaluation of the importance of infection control by professionals, and (6) involvement of hospital administrators. CONCLUSIONS: The implementation of effective infection prevention in psychiatric clinical settings may be strongly related to the factors of sufficient training and IP staffing while relying on collaboration among patients and clinical professionals and on the full support of administrators.

[Using the Cognitive Behavioral Therapy to Improve the Mental Health of Women With Breast Cancer].

Previous studies have shown that patients with breast cancer may suffer from symptoms of psychological distress, such as: depression, anxiety, insomnia, and chronic fatigue. Nurses are expected to offer physical and mental support to these patients. Cognitive behavior therapy (CBT) is commonly used in psychiatry as well as in the treatment of patients with breast cancer. CBT is believed to reduce mental distress in patients by changing their negative cognitive schema. The present article discusses the mental problems of patients with breast cancer and introduces the effects of using CBT on patients with breast cancer. Successful examples of training clinical nurses to apply CBT to the patients are introduced in order to facilitate the design of effective CBT training programs for nurses that improve professional knowledge and skills in dealing with the mental health problems of these patients and further enhance the quality of nursing care.

There is nothing wrong with being a nurse: The experiences of male nursing students in Taiwan.

AIM: Male nurses are reported to experience role strain. Fear of gender stereotyping can be stressful and frustrating for male nursing students, which could make them feel isolated and excluded. The aim of this qualitative study was to investigate how male nursing students in Taiwan perceive the barriers to their experience as nursing students and how they manage these barriers in their study environment and social life. METHODS: A qualitative research approach was used in this study. Data were collected during 2014 from 24 male nursing students from three nursing educational institutes in Taiwan who participated in order to share their experiences by using a semistructured interview. All the interviews were recorded, transcribed verbatim, and analyzed by thematic analysis. RESULTS: The main theme that described the experiences of the male nursing students in Taiwan was: "There is nothing wrong with being a male nurse." Contrary to other studies, role strain for the participants was minimal. The students experienced some barriers because of being a male nursing student, both at school and in their social life. Most of these students tended to manage the barriers by developing positive thinking and coping strategies. CONCLUSION: Nursing educators are encouraged to use the findings from this study to provide appropriate support for male nursing students.

Experiences of caring for a sibling with schizophrenia in a Chinese context: A neglected issue.

Adult clients with schizophrenia are primarily cared for by their ageing parents. When the parents become ill or die, siblings are considered to be responsible for taking over the caregiving role. However, little is known about caregiving for a sibling with schizophrenia, and no studies have explored this phenomenon in an Asian context. The aim of the present descriptive, qualitative study was to understand the experiences of being the primary caregiver of a sibling with schizophrenia. Data were collected from 10 siblings of currently-hospitalized patients diagnosed with schizophrenia using semistructured, in-depth interviews. Recorded interviews were transcribed and analysed by qualitative content analysis. This analysis identified four themes: (i) stepping forward to become caregiver; (ii) challenges of caregiving; (iii) need for support; and (iv) worries about future care. Our findings suggest that mental health-care professionals should involve all family members, including siblings, in the care plan for the person with schizophrenia, and provide appropriate psychoeducation for all family members to reduce not only the tension and stress of current caregiving, but also anxieties about future care.

Assault experiences: Lessons learned from mental health nurses in Taiwan.

Mental health nurse are frequently subjected to patients' violent and aggressive behaviour. These assault experiences have given rise to mental health nurses' physical and psychological trauma, and negatively impact the quality of patient care. The purpose of the present qualitative study was to understand mental health nurses' experiences of being assaulted, the influences on their patient care, and their perspectives of the effectiveness of in-service, violence-prevention education. Ten mental health nurses from two different inpatient mental health facilities were interviewed using a semistructured interview guide. Thematic analysis of interview data found six themes: (i) violence is unpredictable; (ii) violence is normal; (iii) lasting psychological trauma; (iv) limited support from peers and the administrator; (v) violence prevention requires team cooperation; and (vi) doubting the effectiveness of in-service education on violence prevention. Psychiatric ward administrators should assess nurses' learning and skill needs to determine whether these needs are met by existing in-service training programmes. A culture of safety should also be promoted by building a warm and supportive ward climate for both staff and patients, which would include team cooperation and support for colleagues who suffer a violent incident.

Working in a danger zone: A qualitative study of Taiwanese nurses' work experiences in a negative pressure isolation ward.

BACKGROUND: Hospital nurses are frontline health care workers in controlling the spread of infectious diseases. It is not known if nurses working in negative pressure isolation wards (NPIWs) are better prepared than before to safely care for patients with common infectious diseases. METHODS: For this qualitative descriptive study, 10 nurses were interviewed in depth about their experiences caring for patients in an NPIW. Tape recordings were transcribed verbatim and analyzed by qualitative content analysis. RESULTS: The following 5 themes were identified: (1) complexity of patient care, (2) dissatisfaction with the quantity and quality of protective equipment, (3) shortage of nursing staff, (4) continued worries about being infected, and (5) sensitivity to self-protection. Our participants' anxiety and uncertainty about being infected in the NPIW were increased by the complexity of patients' health problems and organizational factors. To protect themselves against infection before and during patient care, participants also developed sensitivity to, concepts about, and strategies to improve self-protection. CONCLUSIONS: NPIW administrators should pay more attention to nurses' concerns about improving the NPIW working environment, supply good quality protective equipment, and provide appropriate psychologic support and ongoing education to ensure that nurses feel safe while working. This ongoing education should refresh and update nurses' knowledge about disease transmission, therefore decreasing unnecessary anxiety based on misunderstandings about becoming infected.

[The relationship between qualitative research and positivism].

Historically, positivism has been the dominant approach in the philosophy of science. In nursing, most quantitative researchers tend to employ positivism as their epistemological underpinning, which could be why positivism has long been identified as the epistemology of quantitative research. It can be argued, however, that some of the procedures of qualitative research reflect the perspectives on which positivists insist. This article takes grounded theory and phenomenology as examples, in order to observe how positivism influences their methodologies, evidence obtained is then used to support the aruthors' arguments. The article, furthermore encourages beginning researchers to familiarize themselves with background knowledge of philosophy of social sciences, especially epistemologies and methodologies, in order to make clear the philosophical context in which their research is conducted.

Environmental exposure to cooking oil fumes and cervical intraepithelial neoplasm.

The fumes from cooking oil, similar to cigarette smoke, contain numerous carcinogens such as polycyclic aromatic hydrocarbons, aromatic amines, nitro-polycyclic aromatic hydrocarbons, etc. In this study, we examined the association between exposure to cooking oil fumes and the risk of cervical intraepithelial neoplasm. The study population in this nested case-control study consisted of women above the age of 19 years living in Chia-Yi County, located in the southwestern Taiwan, who had received pap smear screening between October, 1999, and December, 2000 (n=32,466). The potential cases were women having lesions greater than cervical intraepithelium neoplasm II (> or =CIN2) reconfirmed by cervical biopsy (n=116). The potential controls (case: control=1:2) were age-matched (+/-2 years) and residence-matched women who had normal pap smears within 6 months of the cases. In total, 100 cases and 197 controls were completely interviewed by public health nurses about cooking methods, ventilation, and other potential risk factors. Women who cooked at home in a kitchen (n=269) without the presence of a fume extractor at least once a week between the ages of 20 and 40 had a 2.29 times higher risk [95% confidence interval (CI)=1.08-4.87] of developing cervical intraepithelial neoplasm than those who did not cook once a week in such a kitchen during the same age span, after adjusting for other potential confounders. This finding was further strengthened by the finding that women who did not use the fume extractors had a 2.47 times higher risk (95% CI=1.15-5.32) of developing cervical intraepithelial neoplasm than women who cooked in kitchens with fume extractors that were always switched on while cooking. We also found a joint protective effect of fume extractor use among women older than 40 years (n=202) if they used the extractors during both age spans of their lives, ages 20-40 and >40 years. Comparing our findings on women more than 40 years old who used fume extractors during both periods, we found a 2.05-fold greater risk (95% CI=0.86-4.86) for those who used exhaust fans during only one of the two age spans and a 3.46-fold greater risk in those who had not used an exhaust fan for either period (95% CI=1.08-11.10) (trend test, P=0.02). While exposure to cooking oil fumes may cause cervical intraepithelial neoplasm, women can be protected from this risk by always cooking in kitchens equipped with fume extractors and by keeping them on while cooking.

No association between polymorphisms of the DNA repair geneXRCC1 and cervical neoplasm risk.

OBJECTIVES: To investigate the association between genetic polymorphisms ofX-ray repair crosscomplementing group 1 (XRCC1) codons 194, 280, and 399 and cervical neoplasm susceptibility. METHODS: A community-based nested case-control study was conducted. The study population consisted of women living in Chiayi City, located in southwestern Taiwan, who had received pap smear screening between October, 1999, and December, 2000 (n=32,466). The potential cases were women having lesions greater than cervical intraepithelium neoplasm II (C1N2) reconfirmed by cervical biopsy. The potential controls (case: control=1∶2) were age matched (±2 yrs) and residency matched women who had had normal pap smears. In total, 100 cases (39 C1N2, 12 C1N3, 46 carcinoma in situ (CIS), and 3 invasive cancer) and 196 controls had the information on both questionnaire and data ofXRCC1 polymorphisms. RESULTS: The frequency ofArg/Arg, Arg/Gln, andGln/Gln in codon 399 among cases and controls was 54% (54/100), 38% (38/100), and 8% (8/100) and 58% (114/196), 37% (73/196), and 5% (9/196), respectively, which were not significantly different. No associations were also observed betweenXRCC1 codon 194 and 280 genotypes and cervical neoplasm. While dichotomized by age (<40 vs. ≥40 yrs), smoking status (active and passive smokers vs. non-smokers), and disease status (C1N2 and C1N3 vs. CIS and invasive cancer), the results remained insignificant. CONCLUSIONS: The present findings suggest thatXRRC1 codon 194, 280 and 399 genotypes may not influence cervical neoplasm risk in the Taiwanese population.