Impact of the COVID-19 pandemic on infection control nurses: A path analysis of job stress, burnout, and turnover intention

BACKGROUND

A infection control nurse (ICN) has played substantial roles in infection control and epidemiology programs in hospitals to protect patients and coworkers during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to explore the association between intention to leave in ICNs and job stress and burnout.

METHODS

This cross-sectional study was conducted among ICNs working in hospitals with ≥200 beds in South Korea from October 1 to 22, 2021. Variables included were related to general and job characteristics specific to COVID-19, as well as measures of job stress, burnout, and turnover intention for ICNs from previous studies. Path analysis was used to examine the relationships between job stress, burnout, turnover intention, and COVID-19-related work characteristics.

RESULTS

A total of 203 participants were included, of whom 95% were women. The results showed that work intensity in COVID-19 infection control was significantly associated with job stress (P<.001) and burnout (P = .035). Furthermore, job stress (P = .019) and burnout (P < .001) were positively correlated with turnover intention.

CONCLUSIONS

In a pandemic with emerging infectious diseases, strategies to reduce turnover among ICNs and ensure a sufficient workforce are crucial to reducing work intensity, considering the factors that affect job stress and burnout.

Risk factors for the development of postpartum depression in individuals who screened positive for antenatal depression

BACKGROUND

Women with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those previously reporting antenatal depression have been suggested, but further research is needed. This study aimed to investigate factors associated with developing subsequent postnatal depression in women who had screened positive for antenatal depression.

METHODS

This study was carried out in Hangzhou women's Hospital. 578 women who experienced antenatal depression from this cohort were enrolled in this study. The sociodemographic and clinical characteristics of the participants were collected and tabulated against the incidence of postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. The Chinese-version Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Antenatal screening for depression was conducted at 28-34 weeks during pregnancy and postpartum depressive symptoms were assessed at 6 weeks after childbirth in the women. Path Analysis of Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effects of risk factors of PPD.

RESULTS

57.6% (n = 333) of the participants subsequently developed PPD in our study. The results of the logistic analysis indicated that ages ≤ 35 years old (OR = 1.852; 95%CI: 1.002-3.423), non-one-child families (OR = 1.518; 95%CI: 1.047-2.200), and rare care from partner during pregnancy (OR = 2.801; 95%CI: 1.038-7.562), the antenatal EPDS score (OR = 1.128; 95%CI: 1.052-1.209), pyrexia during pregnancy (OR = 2.43; 95%CI: 1.358-4.345), fairly good (OR = 1.836; 95%CI: 1.009-3.340), fairly bad (OR = 3.919; 95%CI:2.072-7.414) and very bad postpartum sleep quality (OR = 9.18; 95%CI: 2.335-36.241) were associated with increased risk of PPD (compared to very good postpartum sleep quality). In path analysis model, antenatal EPDS score (standardized total β = 0.173) and pyrexia during pregnancy (standardized total β = 0.132) had both direct and indirect effects (the impact on outcome variables needs to be determined through other variables) on PPD. Sleep quality after delivery (standardized β = 0.226) and one-child family (standardized β = 0.088) had direct effects only on PPD.

CONCLUSION

The results from our study indicated that more than 50% of the women who experienced antepartum depression would subsequently develop PPD. Depressive symptoms and pyrexia during pregnancy increase PPD scores, and these effects were in part mediated via poor sleep quality during the postpartum period.

The road safety and risky behavior analysis of delivery vehicle drivers in China

The delivery industry has seen dramatic growth in demand and scale in China. Due to the stock limitations and delivery time restrictions, the couriers may commit traffic violations while delivering, resulting in a pessimistic road safety situation. This study aims to reveal critical factors that influence delivery vehicle crash risks. A cross-sectional structured questionnaire survey is conducted to collect demographic attributes, workload, work emotions, risky driving behavior, and road crash involvement data among 824 couriers in three developed regions of China. The collected data is then analyzed through an established path model to identify the contributing factors of delivery road crash risks and risky behaviors. The road crash risk level (RCRL) indicator is defined by taking into consideration both frequency and severity. While the risky behaviors are defined by both their frequency and correlations to crash risks. The results indicate that 1) Beijing-Tianjin Urban Agglomeration has the highest road crash frequency and RCRL; 2) distracted driving and wrong-lane-use are among the top three risky behaviors for both Yangtze River Delta Urban Agglomeration and Pearl River Delta Urban Agglomeration. For Beijing-Tianjin Urban Agglomeration, distracted driving, aggressive driving, and lack of protection are the top three risky behaviors; 3) time demand and personal efforts are important factors contributing to the cognitive workload of couriers; 4) objective workload can affect the cognitive workload and both workloads influence drivers' emotions (anxiety and anger); 5) the objective, cognitive workload, drivers' emotions influence the RCRL through their impacts on risky behavior but in different paths for three agglomerations. The findings highlight the importance of developing targeted countermeasures to reduce the delivery workers' workload, improve their performance on roads, and mitigate severe crash risks.

Distribution of soil available nutrients and their response to environmental factors based on path analysis model in arid and semi-arid area of northwest China

The study on the distribution of soil available nutrients and their response to the natural environment can provide valuable data and theoretical guidance for supporting human agricultural activities, especially in arid and semi-arid area where the ecological environment is extremely fragile. Based on the soil sampling and survey data set, this study established the path analysis model of SANs (soil available nutrients, including ammonium nitrogen (AN), available phosphorus (AP) and available potassium (AK)) with topography, climate and vegetation in order to explore how environmental factors interact to affect the content of SANs. Then, we combined Pearson correlation analysis and statistical analysis to explore the distribution of SANs under different environmental conditions and the response of vegetation growth to climate changes, in order to further reveal the availability of soil nutrients. The results showed that vegetation was the most important direct factor affecting AN and AP, and AK was the most sensitive to climate changes. The indirect effects of topography and climate on SANs were much greater than their direct effects. Elevation largely predicted the change of climate environment, and the regional climate directly controlled the growth of vegetation. These indirect effects strengthened the connection between topography as well as climate factors and SANs. It is worth noting that the response of vegetation to temperature and precipitation had time lag, which would have a certain impact on the content of SANs response to the environmental changes. This study is of great significance for improved understanding of soil nutrients supply and how ecosystems respond to soil nutrients availability in arid and semi-arid area.

Relationship between social support, coping strategy against COVID-19, and anxiety among home-quarantined Chinese university students: A path analysis modeling approach

With the continued spread of the COVID-19 pandemic and the strict implementation of quarantine policy, the levels of anxiety among university students surged in the lockdown period. Previous studies confirmed the effectiveness of social support in mitigating anxiety, so offering social support should be of high priority in COVID-19, especially in quarantine. However, various coping strategies against the pandemic may explain the link between social support and anxiety. The purpose of this study was to investigate the associations of social support, coping strategy against COVID-19, and anxiety, identifying the potential mediating effect of coping strategy between social support and anxiety during the COVID-19 quarantine. Home-quarantined Chinese university students (N = 2640; 68.79% female) completed online ratings of social support, coping, and anxiety from February 21st to 24th, 2020, when they had been confined to their homes in the peak of the pandemic. Sex and academic attainment being covariates, path analysis with parallel mediation were conducted using "lavaan" package in R environment. Anxiety was significantly negatively related to subjective support and counselor support, while family support did not demonstrate substantive associations with anxiety. The mediating role of cognitive coping was found between all the three social support sources and anxiety. Emotional coping and behavioral coping were found to partially mediate the relationship between subjective support and anxiety, fully mediate the associations of family support and anxiety. However, the impact of counselor support on anxiety was not found to be mediated by emotional coping and behavioral coping. This large-scale online study provides initial evidence that various coping strategies may mediate the relationship between three sources of social support and anxiety in quarantine to some extent. Given that coping against COVID-19 is a valuable reasearch goal upon the global ongoing challenge, the findings will shed more light on the mechanism in the link between coping, social support, and anxiety.

Risk factors associated with endometritis in zero-grazed dairy cows on smallholder farms in Rwanda

Clinical endometritis (CLE) and subclinical endometritis (SCLE) manifesting at the cow- and herd-levels has been associated with multiple risk factors (RFs), but hardly are RFs with direct influences separated from those with mediated indirect influences. This study identified and quantified the direct and indirect associations of cow- and herd-levels RFs with CLE and SCLE cases observed among 466 zero-grazed dairy cows that were in their 21-60 days postpartum (dpp). The cases were observed in a cross-sectional survey of smallholder farms (n = 370) in Rwanda. The direct and indirect associations were constructed with odds ratio (OR) derived from multiple logistic regression modelling. The cow-level RFs that had direct positive association with CLE and SCLE were the season of calving (OR: 5.0, 2.1), dystocia (OR: 1.9, 2.2), poor body condition score (OR: 4.1, 2.2), stillbirth (OR: 3.5, 3.3), and retained placenta (OR: 1.4, 1.8) while mastitis (OR: 2.5) and parity (OR: 1.5) had a direct positive association with SCLE. Breed and parity of cow, sex of calf, and twin births had indirect positive association with both CLE and SCLE cases. At the herd-level, unhygienic cowshed (OR: 25.1, 8.9) had direct positive association with both CLE and SCLE cases. In contrast, earthen floor cowshed (OR: 6.6) and large herd size (OR: 3.1) had direct positive association with CLE and not using bedding materials (OR: 1.5) had direct positive association with SCLE. Herd-level RFs that showed indirect positive association with both CLE and SCLE cases were farm size (OR: 2.9) and farmer's experience in dairying (OR: 1.7) while housing cows within the first 30 dpp (OR: 0.1) showed indirect negative association. These results show which RFs have strong direct and indirect influences on CLE and SCLE cases at the cow- and herd-levels. Effective management of those RFs should be a priority in extension education and services to enable smallholder farmers effectively manage them to prevent and control endometritis among their zero-grazed dairy cows.

Biochar increases plant growth and alters microbial communities via regulating the moisture and temperature of green roof substrates

Green roofs have increasingly been designed and applied to relieve environmental problems, such as water loss, air pollution as well as heat island effect. Substrate and vegetation are important components of green roofs providing ecosystem services and benefiting the urban development. Biochar made from sewage sludge could be potentially used as the substrate amendment for green roofs, however, the effects of biochar on substrate quality and plant performance in green roofs are still unclear. We evaluated the effects of adding sludge biochar (0, 5, 10, 15 and 20%, v/v) to natural soil planted with three types of plant species (ryegrass, Sedum lineare and cucumber) on soil properties, plant growth and microbial communities in both green roof and ground ecosystems. Our results showed that sludge biochar addition significantly increased substrate moisture, adjusted substrate temperature, altered microbial community structure and increased plant growth. The application rate of 10-15% sludge biochar on the green roof exerted the most significant effects on both microbial and plant biomass by 63.9-89.6% and 54.0-54.2% respectively. Path analysis showed that biochar addition had a strong effect on microbial biomass via changing the soil air-filled porosity, soil moisture and temperature, and promoted plant growth through the positive effects on microbial biomass. These results suggest that the applications of biochar at an appropriate rate can significantly alter plant growth and microbial community structure, and increase the ecological benefits of green roofs via exerting effects on the moisture, temperature and nutrients of roof substrates.