A Bibliometric Analysis of Research Articles on Midwifery Based on the Web of Science

Objective

This study aimed to bibliometrically analyse the main features of the 100 top-cited articles on the midwifery index on the Web of Science.

Methods

Academic articles on midwifery' research published from 1985 to 2020 were included. VOSviewer 1.6.15, SPSS 22.0 software and a homemade applet were used to identify, analyse and visualise the citation ranking, publication year, journal, country and organisation of origin, authorship, journal impact factor and keywords along with the total link strength of countries, organisations and keywords.

Results

Among the 100 top-cited articles, the highest number of citations of the retrieved articles was 484. The median number of citations per year was 5.16 (interquartile range: 3.74-8.38). Almost two-thirds of the included articles (n = 61) centred on nursing and obstetrics/gynaecology. The top-cited articles were published in 38 different journals, the highest number of which was published by Midwifery (15%). Australia was the most productive country (24%). According to the total link strength, the sequence ran from the United States (28) to England (28) to Australia (19). The University of Technology Sydney and La Trobe University in Australia topped the list with four papers each. Hunter B was the most productive author (n = 4), and the average citations were positively related to the number of authors (r = 0.336, p < 0.05).

Conclusion

This study identified the most influential articles on midwifery and documented the core journals and the most productive countries, organisations and authors along with future research hotspots for this field; the findings may be beneficial to researchers in their publication and scientific cooperation endeavours.

Protocol for the National Nurse Health Study (NNHS): a web-based ambispective cohort study

INTRODUCTION

The physical and mental health of nurses may significantly impact the entire medical care group and directly affect the quality of medical services. Due to the intense emotional involvement and often problematic working conditions that characterise their profession, nurses appear to be especially susceptible to a complex set of stressors with repercussions to their health. Several landmark studies of nurses have provided an abundance of evidence on risk factors that influence the health status of nurses. However, few studies have investigated the health status of nurses who work in high-intensity work environments in China. The National Nurse Health Study (NNHS) objective is to build an ambispective cohort to gather web-based information on early-life events, daily habits, occupational and environmental risk factors, and health outcomes of a specific subset of healthcare professionals of Chinese nurses.

METHODS AND ANALYSIS

NNHS, which was developed at a tertiary hospital in Beijing, China, is a research initiative that enrolls registered nurses working at Peking University Third Hospital. A web-based self-administered system was designed to collect health-related data and link them with previous physical examination data. During the study period, participants with signed informed consent will be invited to annually repeat a similar procedure.

ETHICS AND DISSEMINATION

The NNHS research protocol was approved by the Institutional Ethics Committee and provides promising data that contribute to the understanding of pathophysiological links between early-life events, body composition, gut microbiota, and inflammatory and metabolic risk profiles. Moreover, the combination of a user-friendly tool with the innovative purposes of the NNHS offers a remarkable resource to test hypotheses about mechanisms of diseases, including work stress, and further plan preventive programmes in public health.

TRIAL REGISTRATION NUMBER

The study was registered on Clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04572347) and the China Cohort Consortium (http://chinacohort.bjmu.edu.cn/project/102/).

Toward a Working Definition of eCohort Studies in Health Research: Narrative Literature Review

Background

The wide availability of internet-connected devices and new sensor technologies increasingly infuse longitudinal observational study designs and cohort studies. Simultaneously, the costly and time-consuming nature of traditional cohorts has given rise to alternative, technology-driven designs such as eCohorts, which remain inadequately described in the scientific literature.

Objective

The aim of this study was to outline and discuss what may constitute an eCohort, as well as to formulate a first working definition for health researchers based on a review of the relevant literature.

Methods

A two-staged review and synthesis process was performed comparing 10 traditional cohorts and 10 eCohorts across the six core steps in the life cycle of cohort designs.

Results

eCohorts are a novel type of technology-driven cohort study that are not physically linked to a clinical setting, follow more relaxed and not necessarily random sampling procedures, are primarily based on self-reported and digitally collected data, and systematically aim to leverage the internet and digitalization to achieve flexibility, interactivity, patient-centeredness, and scalability. This approach comes with some hurdles such as data quality, generalizability, and privacy concerns.

Conclusions

eCohorts have similarities to their traditional counterparts; however, they are sufficiently distinct to be treated as a separate type of cohort design. The novelty of eCohorts is associated with a range of strengths and weaknesses that require further exploration.

Methodological considerations in establishing and maintaining longitudinal health workforce studies: Lessons learned from the WiSDOM cohort in South Africa

BACKGROUND

Health workforce cohort studies are uncommon in low-and middle-income countries (LMICs), especially those in sub-Saharan Africa.

OBJECTIVE

Describe the methodology and lessons learned from establishing and maintaining the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) health professional cohort study in South Africa.

METHODS

WiSDOM is a prospective longitudinal cohort study that commenced in 2017. The cohort focuses on the eight professional groups of clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. Annual, electronic follow-up surveys have been conducted in 2018, 2019 and 2020 with informed consent. Key steps in establishing the WiSDOM cohort include consultation, communication and marketing, stakeholder feedback, resources and infrastructure. Retention strategies consist of an electronic database, detailed cohort contact information, cohort engagement, communication and feedback, short survey tools, and appropriate incentives.

RESULTS

We obtained an overall response rate of 89.5% at baseline in 2017, 79.6% in 2018, 68.3% in 2019 and 72.8% in 2020. The largest decline in response rates is for medical doctors: 66.0% response rate in 2018, 53.2% in 2019 and 58.2% in 2020. However, for each of the three follow-up surveys, we have obtained response rates in excess of 80% for clinical associates, dentists, nurses, oral hygienists, pharmacists and physiotherapists. Since baseline, the outright refusals have remained very low at 4.7%. The multiple logistic regression analysis showed that self-identified race was the only significant socio-demographic difference between medical doctor respondents and non-respondents. Black African doctors and Indian doctors were 2.0 and 2.6 times more likely respectively to respond than White doctors (p < 0.05).

CONCLUSION

Other LMICs can learn from WiSDOM's lessons of establishing and maintaining a health professional cohort that aims to generate new knowledge for health system transformation.

Socio-economic characteristics and career intentions of the WiSDOM health professional cohort in South Africa

Background

The human resources for health (HRH) crisis and dearth of research on the health labour market in South Africa informed the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) cohort study. The study aims to generate new knowledge on the career choices and job location decisions of health professionals in South Africa.

Methods

WiSDOM is a prospective longitudinal cohort study. During 2017, the first cohort for each of eight professional groups was established: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. These cohorts will be followed up for 15 years. For the baseline data collection, each final year health professional student completed an electronic self-administered questionnaire (SAQ), after providing informed consent. The SAQ included information on: demographic characteristics; financing of training; reasons for choosing their profession; and their career intentions. We used STATA^® 14 to analyse the data.

Results

We obtained an 89.5% response rate and 511 final year health professional students completed the baseline survey. The mean age of all participants was 24.1 years; 13.1% were born in a rural area; 11.9% and 8.0% completed their primary and secondary schooling in a rural area respectively. The health professional students came from relatively privileged backgrounds: 45.0% had attended a private school, the majority of their fathers (77.1%) had completed tertiary education, and 69.1% of their mothers had completed tertiary education. Students with higher socio-economic status (SES Quintiles 3–5) made up a larger proportion of the occupational therapists (77.8%), physiotherapists (71.7%), doctors (66.7%), and dentists (64.7%). In contrast, individuals from SES Quintiles 1 and 2 were over-represented among the clinical associates (75.0%), oral hygienists (71.4%), nurses (61.9%), and pharmacists (56.9%). Almost one quarter (24.9%) of cohort members indicated that they had partly financed their studies through loans. Although 86.3% of all cohort members indicated that they plan to stay in their chosen profession, this ranged from 43.2% for clinical associates to 100% for dentists.

Conclusions

WiSDOM has generated new knowledge on health professional graduates of a leading South African University. The results have implications for university selection criteria and national health workforce planning.

The health of working nurses: Hypertension prevalence, awareness, treatment and control by medication

AIMS

To investigate hypertension awareness, prevalence and treatment in nurses.

BACKGROUND

Nurses are the largest health workforce group, currently facing an ageing demographic and the risk of chronic disease such as hypertension. Little is known about hypertension in nurses despite the potential impact on work productivity.

METHODS

A cross-sectional online survey was distributed to nurses and midwives via the professional association and nursing directors. Questions were taken from published longitudinal health studies for blood pressure, hypertension and key sociodemographic and health factors.

RESULTS

The participants' (n = 5,041) mean age was 47.99 (SD 11.46) years. The majority knew their blood pressure, more so if they were female, of higher body mass index and aged 45-64 years, but less so if they were smokers. Hypertension prevalence increased with age, peaking at the oldest ages and the majority were treated (anti-hypertensive medication), less so if aged <55 years. Many nurses treated for hypertension had poor blood pressure control, were most often aged 45-54 years and were smokers.

CONCLUSIONS

Hypertension prevalence is less in nurses than in the general population, however, once diagnosed treatment is not optimized.

IMPLICATIONS FOR NURSING MANAGEMENT

The potential impact of hypertension on older nurses' work productivity justifies work-based support for risk reduction behaviours.

The Korea Nurses' Health Study: A Prospective Cohort Study

BACKGROUND

The Korea Nurses' Health Study (KNHS) is a prospective cohort study of female nurses, focusing on the effects of occupational, environmental, and lifestyle risk factors on the health of Korean women.

MATERIALS AND METHODS

Female registered nurses aged 20-45 years and living in the Republic of Korea were invited to join the study, which began in July 2013. They were asked to complete a web-based baseline survey. The study protocols and questionnaires related to the KNHS are based on the Nurses' Health Study 3 (NHS3) in the United States, although they were modified to reflect the Korean lifestyle. Participants were asked about demographic, lifestyle factors, disease history, occupational exposure, reproductive factors, and dietary habits during their adolescence: Follow-up questionnaires were/will be completed at 6-8 month intervals after the baseline survey. If a participant became pregnant, she answered additional questionnaires containing pregnancy-related information.

RESULTS

Among 157,569 eligible female nurses, 20,613 (13.1%) completed the web-based baseline questionnaire. The mean age of the participants was 29.4 ± 5.9 years, and more than half of them were in their 20s. Eighty-eight percent of the participants had worked night shifts as a nurse (mean, 5.3 ± 4.3 nights per month). Approximately 80% of the participants had a body mass index below 23 kg/m². Gastrointestinal diseases were the most prevalent health issues (25.9%).

CONCLUSIONS

The findings from this prospective cohort study will help to identify the effects of lifestyle-related and occupational factors on reproductive health and development of chronic diseases in Korean women.

Lessons Learned From Methodological Validation Research in E-Epidemiology

Background

Traditional epidemiological research methods exhibit limitations leading to high logistics, human, and financial burden. The continued development of innovative digital tools has the potential to overcome many of the existing methodological issues. Nonetheless, Web-based studies remain relatively uncommon, partly due to persistent concerns about validity and generalizability.

Objective

The objective of this viewpoint is to summarize findings from methodological studies carried out in the NutriNet-Santé study, a French Web-based cohort study.

Methods

On the basis of the previous findings from the NutriNet-Santé e-cohort (>150,000 participants are currently included), we synthesized e-epidemiological knowledge on sample representativeness, advantageous recruitment strategies, and data quality.

Results

Overall, the reported findings support the usefulness of Web-based studies in overcoming common methodological deficiencies in epidemiological research, in particular with regard to data quality (eg, the concordance for body mass index [BMI] classification was 93%), reduced social desirability bias, and access to a wide range of participant profiles, including the hard-to-reach subgroups such as young (12.30% [15,118/122,912], <25 years) and old people (6.60% [8112/122,912], ≥65 years), unemployed or homemaker (12.60% [15,487/122,912]), and low educated (38.50% [47,312/122,912]) people. However, some selection bias remained (78.00% (95,871/122,912) of the participants were women, and 61.50% (75,590/122,912) had postsecondary education), which is an inherent aspect of cohort study inclusion; other specific types of bias may also have occurred.

Conclusions

Given the rapidly growing access to the Internet across social strata, the recruitment of participants with diverse socioeconomic profiles and health risk exposures was highly feasible. Continued efforts concerning the identification of specific biases in e-cohorts and the collection of comprehensive and valid data are still needed. This summary of methodological findings from the NutriNet-Santé cohort may help researchers in the development of the next generation of high-quality Web-based epidemiological studies.

Evaluation of Selection Bias in an Internet-based Study of Pregnancy Planners

Selection bias is a potential concern in all epidemiologic studies, but it is usually difficult to assess. Recently, concerns have been raised that internet-based prospective cohort studies may be particularly prone to selection bias. Although use of the internet is efficient and facilitates recruitment of subjects that are otherwise difficult to enroll, any compromise in internal validity would be of great concern. Few studies have evaluated selection bias in internet-based prospective cohort studies. Using data from the Danish Medical Birth Registry from 2008 to 2012, we compared six well-known perinatal associations (e.g., smoking and birth weight) in an internet-based preconception cohort (Snart Gravid n = 4,801) with the total population of singleton live births in the registry (n = 239,791). We used log-binomial models to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for each association. We found that most results in both populations were very similar. For example, maternal obesity was associated with an increased risk of delivering a macrosomic infant in Snart Gravid (RR = 1.5; 95% CI: 1.2, 1.7) and the total population (RR = 1.5; 95% CI: 1.45, 1.53), and maternal smoking of >10 cigarettes per day was associated with a higher risk of low birth weight (RR = 2.7; 95% CI: 1.2, 5.9 vs. RR = 2.9; 95% CI: 2.6, 3.1) in Snart Gravid and the total population, respectively. We cannot be certain that our results would apply to other associations or different populations. Nevertheless, our results suggest that recruitment of reproductive aged women via the internet may be no more prone to selection bias than traditional methods of recruitment.

Nutritionists' Health Study cohort: a web-based approach of life events, habits and health outcomes

INTRODUCTION

Non-communicable chronic diseases (NCCDs) represent a burden for public health. Alongside the established cardiometabolic risk factors such as high blood pressure and disorders of glucose and lipid metabolism, living habits and nutritional status at different stages of life are seen as contributors to this scenario. Gut microbiota composition and subclinical inflammation have been pointed out as underlying mechanisms of NCCDs. Studies involving health professionals have brought relevant contributions to the knowledge about risk factors. Technological advances facilitate data collection and analysis for big samples. A web-based survey addressed to collect data from a cohort study, which is able to identify NCCDs risk factors, is highly desirable. The objective of the Brazilian Nutritionists' Health Study (NutriHS) is to gather online information on early life events, daily habits, emergent cardiometabolic risk factors and health outcomes of a specific subset of the Brazilian population.

METHODS AND ANALYSIS

NutriHS, developed at the School of Public Health-University of Sao Paulo, Brazil, is a research initiative that enrols undergraduates of nutrition courses from Brazilian universities and graduated volunteers. A web-based self-administered system was designed to collect health-related data. After fulfilling online questionnaires (socioeconomic, early life events and lifestyle data), participants are invited to a clinical visit for physical examination and laboratory procedures (blood sampling, faeces collection and body composition). At a 3-year interval, they will be invited to repeat similar procedures.

ETHICS AND DISSEMINATION

The NutriHS research protocol was approved by the Institutional Ethics Committee and is providing promising data which contribute to the understanding of pathophysiological links between early life events, body composition, gut microbiota, and inflammatory and metabolic risk profile. The combination of a friendly tool with the innovative purposes of NutriHS offers a remarkable resource for testing hypotheses about mechanisms of nutrition-related diseases and further planning of preventive programmes in public health.

Thai nurse cohort study: cohort profiles and key findings

BACKGROUND

Globally, the nursing profession faces shortages, high turnover, and inequitable distribution. These problems are particularly acute in South East Asia. The present paper describes the design and initial findings of the Thai Nurse Cohort Study (TNCS).

METHODS

The TNCS is a longitudinal prospective cohort study comprising multiple age cohorts, initiated in 2009 and expected to run until 2027. Cohorts comprise registered nurses (RN) holding professional licenses granted by the Thailand Nursing and Midwifery Council. Follow-up is at 3-year intervals, with new (younger) TNCS cohorts introduced and older, no-longer eligible members checked out. This maintains the cohort size as representative of the Thai RN population. The first survey round (2009) used a self-administered mailed questionnaire. The second round (2012) provided follow-up of the initial cohort and formed the baseline survey of new entries.

RESULTS

The sampling frame for the first round was 142,699 licensed RN; 50,200 age-stratified participants were randomly selected and mailed the questionnaire, and 18,198 questionnaires were returned owing to incorrect addresses. Of the remaining 32,002 participants, 18,756 (58.6 %) responded (average age 43.7 ± 9.8 years). About 15.4 % (equivalent to 20,000 of the current RN population), reported an intention to leave their nursing career. The second round achieved a follow-up rate of 60.2 %. This round included 3020 participants randomly selected from 6402 new RN (response rate, 38.3 %; mean age 23.1 ± 3.5 years). In this round, 11.2 % reported they intended to leave nursing in the next 2 years.

CONCLUSIONS

These two survey rounds have highlighted that Thailand is facing critical nurse shortages. A high rate of nurses expressed an intention to leave the profession; the capacity to replace these potential losses is much lower.

Comparison of web versus interview participants in a case-control study

PURPOSE

To evaluate whether selection bias might be introduced because of differential self-selection into an internet-based case-control study.

METHODS

We compared sociodemographic factors and behavioral factors for cases and controls who opted for their first entrée into the study be via the internet (Web group) versus the telephone (Phone group), using data from a study on clubfoot.

RESULTS

Overall, 200 of 1,825 mothers were in the Web group and were more likely to be non-Hispanic White, nonsmokers, more educated, wealthier, and took ≥7 medications/vitamins in pregnancy. These differences were greater for case mothers, introducing the potential for selection bias. Maternal smoking is an established risk factor for clubfoot and was confirmed in the Phone group (OR = 1.61) but was not observed in the Web group (OR = 1.15).

CONCLUSION

Our results suggest there is potential for selection bias if enrollment is solely internet based for a case-control study.

Design and Conduct of an Internet-Based Preconception Cohort Study in North America: Pregnancy Study Online

BACKGROUND

We launched the Boston University Pregnancy Study Online (PRESTO) to assess the feasibility of carrying out an Internet-based preconception cohort study in the US and Canada.

METHODS

We recruited female participants age 21-45 and their male partners through Internet advertisements, word of mouth, and flyers. Female participants were randomised with 50% probability to receive a subscription to FertilityFriend.com (FF), a web-based programme that collects real-time data on menstrual characteristics. We compared recruitment methods within PRESTO, assessed the cost-efficiency of PRESTO relative to its Danish counterpart (Snart-Gravid), and validated retrospectively reported date of last menstrual period (LMP) against the FF data.

RESULTS

After 99 weeks of recruitment (2013-15), 2421 women enrolled; 1384 (57%) invited their male partners to participate, of whom 693 (50%) enrolled. Baseline characteristics were balanced across randomisation groups. Cohort retention was similar among those randomised vs. not randomised to FF (84% vs. 81%). At study enrollment, 56%, 22%, and 22% couples had been trying to conceive for < 3, 3-5, and ≥ 6 months, respectively. The cost per subject enrolled was $146 (2013 US$), which was similar to our companion Danish study and half that of a traditional cohort study. Among FF users who conceived, > 97% reported their LMP on the PRESTO questionnaire within 1 day of the LMP recorded via FF.

CONCLUSIONS

Use of the Internet as a method of recruitment and follow-up in a North American preconception cohort study was feasible and cost-effective.

How computer literacy and socioeconomic status affect attitudes toward a Web-based cohort: results from the NutriNet-Santé study

BACKGROUND

In spite of the growing literature in the field of e-epidemiology, clear evidence about computer literacy or attitudes toward respondent burden among e-cohort participants is largely lacking.

OBJECTIVE

We assessed the computer and Internet skills of participants in the NutriNet-Santé Web-based cohort. We then explored attitudes toward the study demands/respondent burden according to levels of computer literacy and sociodemographic status.

METHODS

Self-reported data from 43,028 e-cohort participants were collected in 2013 via a Web-based questionnaire. We employed unconditional logistic and linear regression analyses.

RESULTS

Approximately one-quarter of participants (23.79%, 10,235/43,028) reported being inexperienced in terms of computer use. Regarding attitudes toward participant burden, women tended to be more favorable (eg, "The overall website use is easy") than were men (OR 0.65, 95% CI 0.59-0.71, P<.001), whereas better educated participants (>12 years of schooling) were less likely to accept the demands associated with participation (eg, "I receive questionnaires too often") compared to their less educated counterparts (OR 1.62, 95% CI 1.48-1.76, P<.001).

CONCLUSIONS

A substantial proportion of participants had low computer/Internet skills, suggesting that this does not represent a barrier to participation in Web-based cohorts. Our study also suggests that several subgroups of participants with lower computer skills (eg, women or those with lower educational level) might more readily accept the demands associated with participation in the Web cohort. These findings can help guide future Web-based research strategies.

A Comparative Study of Australian and New Zealand Male and Female Nurses' Health: A Sex Comparison and Gender Analysis

The aim of this research was to compare the health and lifestyle behaviors between male and female nursing professionals. Biological, workplace, and lifestyle factors as well as health behaviors and outcomes are reported as different between male and female nurses. Although male nurses show distinct health-related patterns and experience health disparities at work, few studies have investigated health differences by sex in a large cohort group of nursing professionals. This observation study of Australian and New Zealand nurses and midwives drew data from an eCohort survey. A cohort of 342 females was generated by SPSS randomization (total N=3625), to compare against 342 participating males. Measures for comparison include health markers and behaviors, cognitive well-being, workplace and leisure-time vitality, and functional capacity. Findings suggest that male nurses had a higher BMI, sat for longer, slept for less time, and were more likely to be a smoker than their female nurse counterparts. Men were more likely to report restrictions in bending, bathing, and dressing. In relation to disease, male nurses reported greater rates of respiratory disease and cardiovascular disease, including a three times greater incidence of myocardial infarction, and were more likely to have metabolic problems. In contrast, however, male nurses were more likely to report feeling calm and peaceful with less worries about their health. Important for nurse workforce administrators concerned about the well-being of their staff, the current study reveals significant sex differences and supports the need for gender-sensitive approaches to aid the well-being of male nurses.

Medical education and informal teaching by nurses and midwives

OBJECTIVE

The aim of this study was to examine the contribution of nurses and midwives to the education of medical colleagues in the clinical context.

METHODS

The research design was a cross-sectional survey using an online questionnaire. A subsample of 2906 respondents, from a total of 4763 nurses and midwives participating in a web-based study, had taught doctors in the 12 months prior to the survey. The questionnaire generated mainly categorical data analysed with descriptive statistics.

RESULTS

In the group of respondents who taught doctors (n =2906), most provided informal teaching (92.9%, n=2677). Nearly a quarter (23.9%, n=695) self-rated the amount of time spent teaching as at least moderate in duration. The most common named teaching topics were documentation (74.8%, n=2005) and implementing unit procedures (74.3, n=1987), followed by medication charting (61.9%, n=1657) and choosing correct medications (55.8%, n=1493). Respondents felt their contributions were unrecognised by the doctors and students they taught (43.9%, n=1256).

CONCLUSIONS

Educational contributions while unrecognised could be considered positively by the respondents. However, discussion of teaching responsibilities is necessary to support the development of teaching protocols and supervision responsibilities as respondents reported teaching clinical medical tasks related to medications, consent and other skills within the medical domain. Study limitations include the nature of self-reported responses which cannot be validated and data drawn from a survey concluded in 2009.

Motives for participating in a web-based nutrition cohort according to sociodemographic, lifestyle, and health characteristics: the NutriNet-Santé cohort study

BACKGROUND

In traditional epidemiological studies, participants are likely motivated by perceived benefits, feelings of accomplishment, and belonging. No study has explored motives for participation in a Web-based cohort and the associated participant characteristics, although such information is useful for enhancing recruitment and improving cohort retention.

OBJECTIVE

We aimed to evaluate the relationships between motives for participation and sociodemographic, health, and lifestyle characteristics of participants in the NutriNet-Santé Web-based cohort, designed to identify nutritional risk or protective factors for chronic diseases.

METHODS

The motives for participation were assessed using a specifically developed questionnaire administered approximately 2 years after baseline. A total of 6352 completed the motives questionnaire (43.34%, 6352/15,000 randomly invited cohort participants). We studied the associations between motives (dependent variables) and individual characteristics with multivariate multinomial logistic regression models providing odds ratios and 95% confidence intervals.

RESULTS

In total, 46.45% (2951/6352) of participants reported that they would not have enrolled if the study had not been conducted on the Internet, whereas 28.75% (1826/6352) were not sure. Men (OR 1.21, 95% CI 1.04-1.42), individuals aged 26-35 years (OR 1.51, 95% CI 1.20-1.91), and obese participants (OR 1.30, 95% CI 1.02-1.65) were more inclined to be motivated by the Internet aspect. Compared with younger adults and managerial staff, individuals >55 years (OR 0.60, 95% CI 0.48-0.45) and employees/manual workers were less likely motivated by the Internet aspect (OR 0.77, 95% CI 0.63-0.92). Regarding reasons for participation, 61.37% (3898/6352) reported participating to help advance public health research on chronic disease prevention; 22.24% (1413/6352) to help advance nutrition-focused research; 6.89% (438/6352) in response to the call from the media, after being encouraged by a close friend/associate, or a medical provider. Individuals >45 years (vs younger participants) were more likely (OR 1.62, 95% CI 1.07-2.47), whereas overweight and obese participants (vs nonobese participants) were less likely to participate in the study for reasons related to helping public health research on chronic disease prevention (OR 0.72, 95% CI 0.58-0.89; OR 0.62, 95% CI 0.46-0.84; respectively). Exclusive public funding of the study was important for 67.02% (4257/6352) of the participants. Men (OR 1.37, 95% CI 1.17-1.61) and persons >55 years (OR 1.97, 95% CI 1.57-2.47) were more likely to consider the exclusive public funding as very important.

CONCLUSIONS

The use of the Internet, the willingness to help advance public health research, and the study being publicly funded were key motives for participating in the Web-based NutriNet-Santé cohort. These motives differed by sociodemographic profile and obesity, yet were not associated with lifestyle or health status. These findings can help improve the retention strategies in Web-based cohorts, particularly during decisive study periods when principal exposure information is collected.

Determinants of follow-up participation in the Internet-based European influenza surveillance platform Influenzanet

BACKGROUND

"Influenzanet" is a network of Internet-based platforms aimed at collecting real-time data for influenza surveillance in several European countries. More than 30,000 European volunteers participate every year in the study, representing one of the largest existing Internet-based multicenter cohorts. Each week during the influenza season, participants are asked to report their symptoms (if any) along with a set of additional questions.

OBJECTIVE

Focusing on the first influenza season of 2011-12, when the Influenzanet system was completely harmonized within a common framework in Sweden, the United Kingdom, the Netherlands, Belgium, France, Italy, and Portugal, we investigated the propensity of users to regularly come back to the platform to provide information about their health status. Our purpose was to investigate demographic and behavioral factors associated with participation in follow-up.

METHODS

By means of a multilevel analysis, we evaluated the association between regular participation during the season and sociodemographic and behavioral characteristics as measured by a background questionnaire completed by participants on registration.

RESULTS

We found that lower participation in follow-up was associated with lower educational status (odds ratio [OR] 0.80, 95% CI 0.75-0.85), smoking (OR 0.64, 95% CI 0.59-0.70), younger age (OR ranging from 0.30, 95% CI 0.26-0.33 to 0.70, 95% CI 0.64-0.77), not being vaccinated against seasonal influenza (OR 0.77, 95% CI 0.72-0.84), and living in a household with children (OR 0.69, 95% CI 0.65-0.74). Most of these results hold when single countries are analyzed separately.

CONCLUSIONS

Given the opportunistic enrollment of self-selected volunteers in the Influenzanet study, we have investigated how sociodemographic and behavioral characteristics may be associated with follow-up participation in the Influenzanet cohort. The study described in this paper shows that, overall, the most important determinants of participation are related to education and lifestyle: smoking, lower education level, younger age, people living with children, and people who have not been vaccinated against seasonal influenza tend to have a lower participation in follow-up. Despite the cross-country variation, the main findings are similar in the different national cohorts, and indeed the results are found to be valid also when performing a single-country analysis. Differences between countries do not seem to play a crucial role in determining the factors associated with participation in follow-up.

'Why nurses are leaving the profession … lack of support from managers': What nurses from an e-cohort study said

The shortage of nurses is known. We explored nurses' reasons for leaving the profession based on responses from an e-newsletter of the Nurses and Midwives e-cohort Study. Qualitative content analysis of data from email responses (n = 66) showed 'Lack of support' as a social work value describing their manager's lack of support, unsupportive relationships within their work group, and a health-care system putting business principles before care resulting in job dissatisfaction and nurse turnover. These findings are examples of a 'complex'/'wicked' problem and as such will resist simple solutions to the presenting issues. The dialogic process such as Open Space Technology and Talking Circles should be considered as potentially suitable to the needs of nurses.

Pain-related psychological cognitions and behaviours associated with sick leave due to neck pain: findings from the Nurses and Midwives e-Cohort Study

BACKGROUND

Sick leave due to neck pain (NP-SL) is costly and negatively impacts the productivity of the nursing and midwifery workforce. Identification of modifiable risk indicators is necessary to inform preventive efforts. This study aimed to investigate the role of pain-related psychological features (pain catastrophizing, fear of movement, and pain coping) in NP-SL alongside other potential risk indicators.

METHODS

A cross-sectional analysis of a large cohort study of Australian and New Zealand nurses and midwives, established between 1st April 2006 to 30th March 2008, was undertaken. Recruitment procedures adopted within each Nursing Council jurisdiction were governed by the individual regulatory authorities and their willingness to engage with the study. Invitations directed potential participants to a purpose-built internet-based survey, where study information was provided and consent requested. Once consent was obtained, a range of standardized tools combined into one comprehensive electronic questionnaire was elicited. Exposure variables assessed included pain characteristics and a broad range of psychological, psychosocial, occupational, general health and demographic factors. Two-way interactions between age and gender and candidate exposures were also assessed. Binary logistic regression was performed using manual backward stepwise elimination of non-significant terms.

RESULTS

The cohort included 4,903 currently working nurses or midwives aged 18-65 years. Of these, 2,481 (50.6%) reported neck pain in the preceding 12 months. Our sample comprised of 1,854 working nurses and midwives with neck pain in the preceding year who supplied sick leave data. Of these, 343 (18.5%) reported taking sick leave in the preceding year due to their neck pain. The final most parsimonious multivariable model demonstrated neck pain severity (adjusted odds ratio, [aOR] = 1.59), passive pain coping (aOR = 1.08) and fear of movement (aOR = 1.06) increased the likelihood of NP-SL in the previous year. Interactions between demographic and general health factors exhibited both protective and risk relationships with NP-SL, and there was no association between pain catastrophizing and NP-SL.

CONCLUSIONS

Findings demonstrate that sick leave due to neck pain was associated with pain severity, fear of movement and passive pain coping. In addition, there were complex interactions found between demographic and general health factors. These features represent potentially modifiable targets for preventive programs.

Models for predicting turnover of residential aged care nurses: a structural equation modelling analysis of secondary data

BACKGROUND

Nurse turnover in the residential aged care industry is a pressing issue. Researchers have shown ongoing interest in exploring how the factors that are amendable to change in aged care policy, regulation and funding and in organizational procedures (e.g. job demands, coping resources and psychological health of nurses) impact on turnover. However, the findings are mixed.

OBJECTIVE

This study tested two theoretical models of turnover to examine the structural relationships among job demands, coping resources, psychological health and turnover of residential aged care nurses. Although many previous studies operationalized turnover as intention to leave, the present study investigated actual turnover by following up with the same individuals over time, and thus provided more accurate predictive models of turnover behaviour.

DESIGN AND METHODS

The sample, 239 Australian residential aged care nurses, came from the Nurses and Midwives e-cohort Study. Job demands, coping resources, and psychological health were measured using standardized instruments. Structural equation modelling was used to test the measurement and structural models.

RESULTS

Controlling for a number of workforce and individual characteristics, coping resources (measured by job control, supervisor support, and co-worker support) were negatively and directly associated with turnover. Additionally, the findings supported the Job Demand-Control-Support model in that higher coping resources and lower job demands (indicated by psychological demands, physical demands, and effort) were related to better psychological health (measured by vitality, social functioning, role emotional, and mental health), and higher job demands were related to lower coping resources.

CONCLUSIONS

Findings suggest that aged care policy makers and service providers might consider increasing coping resources available to nurses and minimizing job demands of care work to reduce turnover and improve nurses' psychological health. Moreover, findings from this Australian study may provide valuable practical and policy implications for other developed countries.

Internet and telephonic IVR mixed-mode survey for longitudinal studies: choice, retention, and data equivalency

PURPOSE

This study examined data equivalency and loss to follow-up rates from Internet and interactive voice response (IVR) system surveys in a prospective-cohort study.

METHODS

475 limited-service restaurant workers participating in the 12-week study were given a choice to report their weekly slipping experience by either IVR or Internet. Demographic differences, loss to follow-up, self-reported rates of slipping, and selection of first and last choices were compared.

RESULTS

Loss to follow-up rates were slightly higher for those choosing the IVR mode. Rates of slipping and selection of first and last choices were not significantly different between survey modes. Propensity to choose an Internet survey decreased with increasing age, and was the lowest among Spanish speakers (5%) and those with less than a high school education (14%).

CONCLUSIONS

Studies relying solely on Internet-based data collection may lead to selective exclusion of certain populations. Findings suggest that Internet and IVR may be combined as survey modalities within longitudinal studies.

Participant profiles according to recruitment source in a large Web-based prospective study: experience from the Nutrinet-Santé study

Background

Interest in Internet-based epidemiologic research is growing given the logistic and cost advantages. Cohort recruitment to maximally diversify the sociodemographic profiles of participants, however, remains a contentious issue.

Objective

The aim of the study was to characterize the sociodemographic profiles according to the recruitment mode of adult volunteers enrolled in a Web-based cohort.

Methods

The French NutriNet-Santé Web-based cohort was launched in 2009. Recruitment is ongoing and largely relies on recurrent multimedia campaigns. One month after enrollment, participants are asked how they learned about the study (eg, general newscast or a health program on television, radio newscast, newspaper articles, Internet, personal advice, leaflet/flyers) The sociodemographic profiles of participants recruited through operative communication channels (radio, print media, Internet, advice) were compared with the profiles of those informed through television by using polytomous logistic regression.

Results

Among the 88,238 participants enrolled through the end of 2011, 30,401 (34.45%), 16,751 (18.98%), and 14,309 (16.22%) learned about the study from television, Internet, and radio newscasts, respectively. Sociodemographic profiles were various, with 14,541 (16.5%) aged ≥60 years, 20,166 (22.9%) aged <30 years, 27,766 (32.1%) without postsecondary education, 15,397 (19.7%) with household income <€1200/month, and 8258 (10.6%) with household income €3700/month. Compared to employed individuals, unemployed and retired participants were less likely to be informed about the study through other sources than through television (adjusted ORs 0.56-0.83, P<.001). Participants reporting up to secondary education were also less likely to have learned about the study through radio newscasts, newspaper articles, Internet, and advice than through television (adjusted ORs 0.60-0.77, P<.001).

Conclusions

Television broadcasts appear to permit the recruitment of e-cohort participants with diverse sociodemographic backgrounds, including socioeconomically disadvantaged individuals who are usually difficult to reach and retain in long-term epidemiologic studies. These findings could inform future Web-based studies regarding the development of promising targeted or general population recruitment strategies.

A pilot project in distance education: nurse practitioner students' experience of personal video capture technology as an assessment method of clinical skills

This paper reports on a pilot project aimed at exploring postgraduate distance students' experiences using personal video capture technology to complete competency assessments in physical examination. A pre-intervention survey gathered demographic data from nurse practitioner students (n=31) and measured their information communication technology fluency. Subsequently, thirteen (13) students were allocated a hand held video camera to use in their clinical setting. Those participating in the trial completed a post-intervention survey and further data were gathered using semi-structured interviews. Data were analysed by descriptive statistics and deductive content analysis, and the Unified Theory of Acceptance and Use of Technology (Venkatesh et al., 2003) were used to guide the project. Uptake of the intervention was high (93%) as students recognised the potential benefit. Students were video recorded while performing physical examinations. They described high level of stress and some anxiety, which decreased rapidly while assessment was underway. Barriers experienced were in the areas of facilitating conditions (technical character e.g. upload of files) and social influence (e.g. local ethical approval). Students valued the opportunity to reflect on their recorded performance with their clinical mentors and by themselves. This project highlights the demands and difficulties of introducing technology to support work-based learning.

Midwives’ Experiences of Work-Related Shoulder Musculoskeletal Problems

INTRODUCTION: Little is known about musculoskeletal disorders in midwives as distinct from nurses. The study objective was to gain an understanding of midwives’ experiences with work-related shoulder problems.

METHODS: We carried out semistructured interviews with 11 qualified Australian midwives with a history of shoulder problems, recruited through purposive sampling. Interviews were recorded, transcribed verbatim, and manually coded. An inductive approach was used to generate themes.

RESULTS: Five major themes emerged in the analysis: attribution, universality of the experience, short-term coping, long-term coping, and support. Most participants held the view that musculoskeletal problems were normal occurrences and to be expected. Participants felt vulnerable and described the ways they protect themselves from further injury. Those who had left midwifery practice had generally done so for reasons other than the shoulder problem. Family members and coworkers were the main sources of support, whereas most supervisors were perceived as neutral at best.

CONCLUSIONS: Coping strategies that enhance well-being may be most effective. The workplace culture must encourage injury reporting to monitor safety issues and decrease costs at all levels. The study findings suggest several areas for future research in midwives to provide an evidence base for prevention/intervention strategies.

A cross-sectional analysis of the association between night-only or rotating shift work and overweight/obesity among female nurses and midwives

OBJECTIVE

To examine the associations between shift work types and overweight/obesity among female nurses and midwives.

METHODS

A cross-sectional study. Measurement included exposure variables: rotating shift work and night-only shift work; outcome variables: overweight and obesity; and potential confounding and associated variables: modifiable lifestyle factors, general health status, menopausal status, and work pattern.

RESULTS

Among the 2086 participants, almost 60% were overweight/obese (31.7% overweight; 27.1% obese). After we adjusted the selected confounders, we found that rotating shift workers were 1.02 times more likely to be overweight/obese than day workers (P = 0.007; 95% confidence interval [95% CI], 1.004 to 1.03; and P = 0.02; 95% CI: 1.004 to 1.04, respectively). Night-only shift work was found to be significantly associated with obesity only (P = 0.031; relative risk, 1.02; 95% CI, 1.002 to 1.04).

CONCLUSIONS

Rotating shift work was associated with both overweight and obesity; and night-only shift work was associated with obesity, not overweight.

Bullying in the Australian medical workforce: cross-sectional data from an Australian e-Cohort study

OBJECTIVE

This study aimed to describe the prevalence of perceived workplace bullying in the Australian medical workforce, and investigate the relationship between workplace bullying and job satisfaction, health status, and current and planned medical workforce participation.

METHODS

An electronic cross-sectional survey of doctors currently in the paid workforce, conducted between April 2008 and October 2009, was nested within a longitudinal cohort study investigating factors affecting the recruitment and retention of the Australian medical workforce. To address the specific aims of this study, a subset of questions in the survey investigated the prevalence of self-reported bullying; physical and mental health; workforce participation patterns; job satisfaction; and job stressors.

RESULTS

Seven hundred and forty-seven participants responded to the bullying question and were included in this analysis. Twenty-five percent of participants reported being bullied in the last 12 months. There were no differences in the reported rates of bullying across age groups, sex and country of medical qualification. Bullied doctors were least satisfied with their jobs (P<0.001), had taken more sick leave in the last 12 months (P<0.001), and were more likely to be planning to decrease the number of hours worked in medicine in the next 12 months (P=0.01) or ceasing direct patient care in the next 5 years (independent of their age or the number of hours currently worked in patient care) (P=0.006).

CONCLUSIONS

Our findings suggest that Australian doctors, independent of age or sex, have experienced workplace bullying, and although no conclusions can be made about causal pathways, there were strong associations between this exposure and poorer health and wellbeing, and on remaining in the medical workforce.

What makes a healthier nurse, workplace or leisure physical activity? Informed by the Australian and New Zealand e-Cohort Study

AIM AND OBJECTIVE

To investigate health differences between nurses who report meeting the daily physical activity recommendations in or away from the workplace.

BACKGROUND

Adhering to the national physical activity recommendations has known health benefits. Whilst often considered a workplace active profession, data are emerging of poor health amongst nurses. However, health differences between workplace or leisure-time physically active nurses are understudied.

DESIGN

The investigation is an observation study of Australian and New Zealand nurses. Data were generated from the longitudinal, population-based, observational e-Cohort nursing survey.

METHODS

Data were informed and groups defined by the self-reported minutes per day of moderate physical activity collected from a large international survey of practicing nurses (n = 2264). Groups were: Group (G) 1--high workplace (≥30 minutes/day)/high leisure (≥30 minutes/day), G2--high workplace/low leisure (<30 minutes/day), G3--low workplace/low leisure (<30 minutes/day) and G4--low workplace/high leisure.

RESULTS

G2 had a high BMI and were younger than G4. G4 were significantly more active away from work and more likely to report cycling to work than G2. In contrast, G2 were most likely to have taken sick days because of their health (χ(2) = 19·101), have difficulty sleeping most of the time and have a medical history of diagnosed anxiety and depression.

CONCLUSIONS

This study shows that improved well-being can be achieved in nursing cohort through leisure-time physical activity.

RELEVANCE TO CLINICAL PRACTICE

This research shows that nurse should consider leisure-time physical activity necessary to maintain and prolong health and that workplace activity is not a sufficient stimulus. This has important implications for workforce planners and administrators.

Helping women but hurting ourselves? Neck and upper back musculoskeletal symptoms in a cohort of Australian Midwives

OBJECTIVE

To determine the prevalence of neck and upper back musculoskeletal symptoms in a group of Australian midwives and explore individual characteristics and workplace exposures associated with these symptoms.

DESIGN

cross-sectional, using data from the Nurses and Midwives e-Cohort Study, a longitudinal, electronic survey of midwives and nurses in Australia, New Zealand and the United Kingdom.

SETTING

data were collected via an online survey in 2006-2008.

PARTICIPANTS

qualified Australian midwives aged 23-70 years.

MEASUREMENTS AND FINDINGS

We undertook descriptive analysis of the sample, calculated prevalence and examined associations between individual and workplace variables and neck and upper back musculoskeletal symptoms. Variables achieving p<0.1 in bivariate analysis were entered simultaneously into logistic regression models. Overall prevalence rates were 48.8% for neck and 28.2% for upper back musculoskeletal symptoms; work-related prevalence was 40.8% (neck) and 24.5% (upper back), comparable to reported rates among nurses and physicians. Presence of symptoms in the adjacent area was associated with greater than a fourfold increased risk for neck and upper back symptoms. Participants with care responsibility for an adult dependent were 36% more likely to report neck symptoms. Current shift work and total physical activity were associated with decreased likelihood of neck and upper back symptoms, respectively. Psychological job demands were only weakly associated with upper back symptoms, possibly because the survey tool could not capture a sufficiently broad range of psychosocial exposures to present a complete picture. A striking finding was that work in awkward postures conferred an increased risk of 35% for neck and nearly 50% for upper back symptoms.

KEY CONCLUSIONS

neck and upper back musculoskeletal symptoms were prevalent in this sample. Both individual and workplace factors were significantly associated with neck and/or upper back symptoms. Psychological job demands and work in awkward postures are potentially modifiable exposures that deserve further examination.

IMPLICATIONS FOR PRACTICE

midwives who are or may become carers for adult dependents should be aware of a possible increased risk for neck symptoms. It may be prudent for midwives and those who employ/supervise them to monitor and, where possible, jointly develop strategies to mitigate psychological job demands. The potential hazard posed by work in awkward postures warrants consideration of how midwives may minimize time spent working in these postures.