Table of Content

15 December 2025, Volume 41 Issue 24

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Treatise

Hazard situation and risk analysis of fumes/dust in the ferroalloy smelting industry of Guangxi Zhuang Autonomous Region

HUANG Xiang, DUAN Pingning, FU Songwen, ZHOU Benjian, NIE Chuanli, MAI Lifeng

2025, 41(24):  3313-3318. 

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Objective To investigate the status and risk level of smoke/dust in the production process of ferroalloy smelting in Guangxi Zhuang Autonomous Region. Methods A cross-sectional survey was conducted on ferroalloy smelting enterprises in Guangxi Zhuang Autonomous Region from May to October 2022. The concentrations of main hazards（dust，manganese and its compounds，lead and its compounds） in the fumes/dust of major positions were collected and analyzed. The risk levels of occupational hazard factors were evaluated using the job classification method and the risk index method. Results The exceedance rates of silica dust with 10%≤free silica≤50%，silica dust with 50%<free silica≤80%，and manganese and its compounds at the major positions in the ferroalloy smelting industry in Guangxi Zhuang Autonomous Region were 24.12%，58.33% and 24.24%，respectively. The maximum exceedance multiples were 6.00，7.43，and 11.9 times，respectively. The highest concentrations all occurring at the finishing position. The exposure levels of the same hazard factors were generally similar across the main positions. The upper bounds of the 95%CI for the hazard job classification method and risk index method were 2.948 and 3.014，respectively，indicating that the overall risk level of the industry was moderate. Conclusion The fumes/dust hazards in the major positions of the ferroalloy smelting industry in Guangxi Zhuang Autonomous Region are relatively severe，with a high proportion of medium and high risks. There is still a possibility of new occupational diseases under current conditions. Strengthening comprehensive prevention and control as well as supervision is necessary to reduce the actual exposure levels and health risks for workers.

Analysis of dust and noise monitoring results of mining enterprises in Huangshi City in 2023

LI Xia, ZHENG Dengfeng, YU Yingjie, SONG Yanchao, ZHANG Jiaquan

2025, 41(24):  3319-3323. 

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Objective To analyze the monitoring results of occupational hazard factors in the workplaces of 42 mining enterprises in Huangshi City in 2023，understand the current status of occupational hazard in mining enterprises in Huangshi City，and provide reference for the prevention and control of occupational diseases in mining enterprises in Huangshi City. Methods Deriving the basic information，the investigation results and monitoring results of 42 mining enterprises in Huangshi City in 2023 from the "Monitoring System of Occupational Hazard Factors in Workplace" to analyze. Results The mining enterprises in Huangshi City were mainly distributed in Daye City（59.52%） and Yangxin County（38.10%）. The main industries were commonly used non-ferrous metal mining（30.95%），ferrous metal mining（30.95%），and sand and stone mining（26.19%），and the scale was mainly small enterprises（64.29%）.The number of people exposed to dust and noise was 3 683 and 3 407，respectively. The exceeding standard rate of noise position was higher than that of silica dust and other dust，the post exceeding standard rate of Tieshan District was higher than that of Yangxin County and Daye City，the post exceeding standard rate of medium-sized enterprises was higher than that of large，small and micro enterprises，the post exceeding standard rate of common non-ferrous metal mining industry was higher than that of precious metal mining industry，ferrous metal mining industry，asbestos and other non-metallic mining and soil，sand and stone mining industry（all P<0.05）.The exceeding standard rate of occupational hazard factors in drilling，crushing and screening positions was high，and the exceeding standard rate of occupational hazard factors in different positions was statistically significant（P<0.05）. Conclusion In 2023，the exceeding standard rate of overall dust and noise in mining enterprises in Huangshi City is high，and the exceeding standard rate of occupational hazard factors in drilling，crushing，screening and other positions is high，indicating serious occupational hazards. Enterprises should pay attention to the hazards of dust and noise，strengthen the construction of occupational disease prevention facilities and the use of personal protective equipment，and the law enforcement departments should strengthen the supervision of mining enterprises.

Effects of instant messaging software use pressure and work-family conflict on occupational stress in cardiology nurses

ZHANG Liu, ZHANG Zhenying, SUN Xiaojing, XU Zhiping, FAN Xiaoyu, HAN Wenya

2025, 41(24):  3324-3328. 

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Objective To explore the effects of stress from using instant messaging software and work-family conflict on occupational stress among nurses in the cardiology department. Methods From October to December 2024，178 nurses in the cardiology department of 11 grade-A tertiary general hospitals in Beijing were surveyed using the stress scale for using instant messaging software，the work-family conflict scale，and the occupational stress scale. The influencing factors and correlations of stress from using instant messaging software，work-family conflict，and occupational stress among nurses in the cardiology department were analyzed. Hierarchical regression was used to analyze the effects of stress from using instant messaging software and work-family conflict on occupational stress. Results The stress score of cardiology nurses using instant messaging software was （19.76±3.54）points，the work-family conflict score was （58.84±9.26）points，and the occupational stress score was （383.98±78.37）points. There were statistically significant differences in the scores of stress from using instant messaging software，work-family conflict，and occupational stress by cardiology nurses in terms of age，professional title，working time，average monthly income，and average weekly shifts（all P<0.05）. The influencing factors of stress from using instant messaging software，work-family conflict，and occupational stress of cardiology nurses were age，professional title，working time，average monthly income，and average weekly shifts（all P<0.05）. The stress of cardiology nurses using instant messaging software was positively correlated with work-family conflict and occupational stress（r=0.538，0.617，both P<0.01），and work-family conflict was positively correlated with occupational stress（r=0.584，P<0.01）. The results of hierarchical regression analysis showed that the stress of using instant messaging software and work-family conflict could jointly explain 42.80% of the variation of occupational stress of cardiology nurses. Conclusion The stress from using instant messaging software and work-family conflict are influencing factors of occupational stress in cardiology nurses. Reducing the stress from using instant messaging software and work-family conflict can significantly reduce the occupational stress of cardiology nurses.

Research on the influencing factors and management strategies of occupational burnout among psychiatric nurses based on resource conservation theory

ZHAO Jing, ZHU Jiaqi, QI Meng, WANG Leilei, HAN Xiaole

2025, 41(24):  3329-3333. 

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Objective To explore the current situation of occupational burnout among psychiatric nurses and analyze the influencing factors，and propose targeted management strategies based on resource conservation theory. Methods From March to May 2023，a convenience sampling was used to select public hospitals from different regions of China，with a total of 25 hospitals from 18 provinces and cities，and psychiatric nurses were selected as research subjects based on inclusion and exclusion criteria. A cross-sectional survey was conducted using a general demographic survey，the MBI-GS（burnout inventory），the insomnia severity index（ISI），the patient health questionnaire depression scale（PHQ-9），the generalized anxiety disorder scale（GAD-7），and the nurse turnover intention scale. The influencing factors of occupational burnout among psychiatric nurses were analyzed using binary logistic regression. Results Totally 782 questionnaires were collected，with 753 valid questionnaires and a valid questionnaire rate of 96.29%. Totally 534 cases（70.92%） of occupational burnout were detected among the surveyed subjects. The scores of various dimensions of occupational burnout were emotional exhaustion（8.77±7.75）points，cynicism（5.21±5.60）points，and low sense of achievement（18.84±10.17）points，with low sense of achievement exceeding the critical value. The results of univariate analysis showed that hospital level，age，gender，years of work experience，insomnia，anxiety and depression had an impact on the degree of occupational burnout among psychiatric nurses（all P<0.05）. The results of binary logistic regression analysis showed that hospital level，gender，insomnia，anxiety，and age were the influencing factors of occupational burnout among psychiatric nurses（all P<0.05）. Conclusion The degree of occupational burnout among psychiatric nurses is relatively severe. Nurses who work in secondary and lower level hospitals，are male，senior nurses，have insomnia，anxiety，and depression have a higher degree of occupational burnout. Nursing managers should take effective measures from the perspective of resource conservation theory based on their influencing factors to reduce the incidence and degree of occupational burnout among psychiatric nurses.

Impact of personal organizational fit and workplace spirituality on occupational burnout among surgical nurses

TAN Jieying, GUO Yan, ZHANG Jigui

2025, 41(24):  3334-3338. 

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Objective To explore the impact of personal organizational fit and workplace spirituality on occupational burnout among surgical nurses in Enshi Tujia and Miao Autonomous Prefecture. Methods The convenience sampling was used to select surgical nurses from four tertiary hospitals in Enshi Tujia and Miao Autonomous Prefecture from February 1st，2024 to April 30th，2024 as survey subjects. The survey was conducted using the personal organizational fit scale，workplace spirituality scale and occupational burnout scale，and the data were analyzed. Results The personal organizational fit score of surgical nurses was （122.86±18.35）points，workplace spirituality score was （102.97±17.84）points，and occupational burnout score was （62.58±12.46）points. There were statistically significant differences in the personal organizational fit，workplace spirituality and occupational burnout among surgical nurses at different age，professional title，years of work，monthly income，weekly working hours and marital status（all P<0.05）. The personal organizational fit of surgical nurses was negatively correlated with occupational burnout（r=-0.537，P<0.01），workplace spirituality was negatively correlated with occupational burnout（r=-0.614，P<0.01），and personal organizational fit was positively correlated with workplace spirituality（r=0.548，P<0.01）. The personal organizational fit and workplace spirituality can jointly explain 39.40% of the occupational burnout in surgical nurses. Conclusion The personal organizational fit and workplace spirituality of surgical nurses in Enshi Tujia and Miao Autonomous Prefecture have a negative impact on occupational burnout，and improving the level of personal organizational fit and workplace spirituality can help reduce the level of occupational burnout among surgical nurses.

Analysis of the current status of earplugs wearing comfort and its correlation with personal attenuation ratings among noise-exposed workers in manufacturing enterprises

WEN Wei, SHU Linyan, GUO Jianyu, TANG Jia, LIN Hansheng, XIAO Bin

2025, 41(24):  3339-3343. 

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Objective To explore the current status of comfort among noise-exposed workers wearing earplugs and its relationship with personal attenuation ratings（PARs）， providing a reference for enterprises and noise-exposed workers to scientifically wear earplugs. Methods From 2022 to 2023， a convenience sampling method was used to select 441 workers exposed to noise from 3 manufacturing enterprises in Guangdong Province as the research subjects， and the comfort level of their earplug wearing was investigated. According to the types of earplugs that the research subjects usually wore， the same type of probe-style test earplugs were selected for PARs tests. Generalized linear regression was used to analyze the correlation between comfort level and PARs. Results Among 441 noise-exposed workers， 297（67.3%） wore foam earplugs， and 144（32.7%） wore pre-molded earplugs. Overall discomfort was reported by 292（66.2%） workers，with "normal communication after wearing earplugs" being the most uncomfortable indicator（67.3%）. In the pre-molded earplug group， the most uncomfortable indicator was "tightness of earplugs"[（3.0±1.2）points]， while in the foam earplug group， it was "normal communication after wearing earplugs"[（3.0±1.1）points]. The comfort score of the pre-molded earplug group was higher than that of the foam earplug group（P<0.01）， with the largest difference observed in the "softness and hardness of earplugs" indicator. Additionally， PARs testing using probe-type foam and pre-molded earplugs showed median PARs values of 15.0（4.0，20.0） and 2.0（0.0，11.8） dB， respectively. Generalized linear regression results indicated that overall earplug comfort was negatively correlated with PARs（P<0.05）. Among the comfort indicators，factors such as pain，blockage， swelling，itching，normal communication after wearing earplugs， and breathability of earplugs were all negatively correlated with PARs （all P<0.05）. Conclusion Noise-exposed workers experience significant discomfort when wearing noise reduction earplugs， primarily manifested as impaired normal communication， poor breathability，and sensations of pain，blockage，and swelling caused by wearing earplugs. Furthermore，there is a negative correlation between earplugs wearing comfort and PARs. It is recommended that enterprises and workers comprehensively consider both comfort and PARs of noise reduction earplugs，and scientifically select noise reduction earplugs.

Study on characteristics of cotton dust generation in cleaning workshop based on on-site detection and numerical simulation methods

SUI Xin, JIN Junmei, JIANG Zhongan, WANG Shusong, PAN Xingfu, NIU Dongsheng

2025, 41(24):  3344-3349. 

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Objective To analyze the characteristics of cotton dust generation in the cleaning workshop of a cotton spinning enterprise and provide a reference for the design of engineering protective facilities for cotton dust in the workshop. Methods In July2024，following relevant national standards，the cotton dust samples were collected from the workplace of the cleaning workshop in a cotton-spinning enterprise in Northwest China，and the test results were analyzed. Combined with Fluent software simulation results，the characteristics of cotton dust generation in the cleaning workshop of a cotton-spinning enterprise in Northwest China were studied. Results In the cleaning workshop of a cotton spinning enterprise in Northwest China，the CPE concentration of cotton dust near the foreign fiber collection bag of the foreign fiber machine was 2.60 mg/m³，and that near the cotton bale of the cotton grabbing machine was 0.77 mg/m³. Under different work shifts，the occupational health risk level of cotton dust in the workshop was moderate or higher. The cotton dust concentration at 1 m from the foreign fiber collection bag showed a statistically significant difference compared to the concentrations at other measurement points（P<0.05）. The physicochemical analysis of cotton dust indicated that 90% of the cotton dust particles in the workshop had a diameter smaller than 1 μm. Fluent simulation results revealed that the three foreign fiber collection bags in the workshop were the primary sources of cotton dust pollution. The simulation results were highly consistent with the measured concentrations on-site. Conclusion The cotton dust in the cleaning workshop of the cotton spinning enterprise in Northwest China is primarily composed of organic substances with particle sizes smaller than 1 μm，mainly originating from the foreign fiber collection bags，which leads to increased cotton dust concentrations along the inspection routes，adversely affecting the working environment for employees.

Exploring the mechanism of occupational cadmium exposure inducing malignant biological behavior of colorectal cancer cells based on the circ-0072309/miR-26a-5p pathway

XIN Qingwang, ZHANG Peijun

2025, 41(24):  3350-3356. 

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Objective To explore the mechanism of occupational cadmium exposure-induced malignant biological behavior of colorectal cancer cells based on the circular RNA-0072309（circ-0072309）/microRNA-26a-5p（miR-26a-5p） pathway. Methods From February to May 2024，experiments were conducted at Baoding First Central Hospital. Colorectal cancer cells were divided into SW480 group，50 nmol/L CdCl₂ group，100 nmol/L CdCl₂ group，and 200 nmol/L CdCl₂ group. The cells were cultured for 72 hours. After the experiment，cell proliferation，monoclonal number，and apoptosis level，invasion and migration level，epithelial mesenchymal transition（EMT） level were measured. Circ-0072309，miR-26a-5p，and phosphatase and tensin homolog deleted on chromosome 10（PTEN） levels were detected by RT-PCR and West-blot. Results Compared with the colorectal cancer cell SW480 group，Vimentin levels，number of single cell clones，migration distance，miR-26a-5p mRNA levels（0.97±0.16 vs 1.63±0.27，2.48±0.41，3.35±0.59），the survival rate，and number of membrane penetration of the 50，100，and 200 nmol/L CdCl₂ groups increased，while PTEN mRNA protein levels（3.24±0.54 vs 2.63±0.43，1.89±0.32，1.01±0.16；1.28±0.21 vs 0.95±0.16，0.60±0.10，0.23±0.05），epithelial cadherin（E-cadherin），circ-0072309 mRNA（3.59±0.61 vs 2.89±0.48，2.12±0.35，1.35±0.23），and apoptosis rate decreased，and the differences were statistically significant（all P<0.05）. Moreover，with the increase of CdCl₂ exposure dose，Vimentin levels，number of single cell clones，migration distance，miR-26a-5p mRNA level，survival rate，and number of membrane penetration of the 50，100，and 200 nmol/L CdCl₂ groups showed an upward trend，while PTEN mRNA protein levels，E-cadherin level，circ-0072309 mRNA，and apoptosis rate showed a downward trend，and the differences were statistically significant（all P<0.05）. Conclusion Occupational Cd exposure inhibits the expression of circ-0072309 and releases its adsorption to miR-26a-5p，leading to overexpression of miR-26a-5p and targeted down regulation of PTEN gene，activating PI3K/AKT pathway，thereby promoting the proliferation，invasion and migration of colorectal cancer cells and EMT process（Vimentin↑/E-cadherin↓） in a dose-dependent manner（50-200 nmol/L），and inhibiting apoptosis. This study is the first to clarify the ceRNA regulatory mechanism of circ-0072309/miR-26a-5p/PTEN axis in cadmium carcinogenesis，providing a theoretical basis for molecular intervention of occupational cadmium exposure-related colorectal cancer and the development of circRNA biomarkers.

Effects of three blood collection methods on hematological parameters in Wistar rats

LI Shufei, ZHOU Qinghong, ZHAO Miao, LIU Yinghua, QIAN Zhiyong

2025, 41(24):  3357-3361. 

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Objective To analyze the effects of different blood collection methods on hematological indexes in Wistar rats. Methods Hematological test results of specific pathogen free（SPF） Wistar rats aged 8 weeks in Tianjin Centers for Disease Control and Prevention were collected. A total of 280 test results were collected，among which 80 blood samples were collected from inner canthal veins，80 blood samples were collected from inner canthal veins after anesthesia，120 blood samples were collected from abdominal aorta after anesthesia，with half male and half female. Results There were statistically significant differences in white blood cell（WBC），red blood cell（RBC），hemoglobin（HGB），platelet（PLT），hematocrit（HCT），and leukocyte count among Wistar rats inner canthal venous blood collection group，anaesthesia inner canthal venous blood collection group and abdominal aorta blood collection group（all P<0.05）.The WBC[（9.56±1.97）×10⁹/L]，RBC[（8.16±0.41）×10¹²/L]，and HGB[（157.07±6.53）g/L] detection values obtained by inner canthal veins after anesthesia were higher than the WBC[（8.12±1.72）×10⁹/L]，RBC[（7.46±0.45）×10¹²/L]，and HGB[（143.38±9.08）g/L] detection values obtained by inner canthal veins，and were also higher than the WBC [（4.21±2.22）×10⁹/L]，RBC[（6.68±0.49）×10¹²/L]，and HGB[（136.18±8.81）g/L] detection values obtained by abdominal aorta puncture after anesthesia. The PLT values in the inner canthal veins[（996.08±171.58）×10⁹/L] were lower than those measured by the inner canthal veins after anesthesia[（1233.89±272.38）×10⁹/L] and the abdominal aorta blood sampling method after anesthesia [（1 172.61±151.16）×10⁹/L]. There was no statistically significant difference（all P>0.05） between the PLT values measured by the conjunctival vein method after anesthesia and the abdominal aorta blood sampling method after anesthesia. Conclusion The WBC，RBC and HGB venous blood values of Wistar rats are higher than arterial blood values，and peritoneal injection of 50 mg/（kg·BW） pentobarbital sodium has a certain effect on the hematological detection.

Analysis of the current status and influencing factors of nutritional literacy among school-age children in Chaoyang District of Beijing City

YU Jiangfan, WANG Yinhui, RUAN Mingjie, BA Lei

2025, 41(24):  3362-3367. 

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Objective To investigate the nutritional literacy level and influencing factors of school-age children in Chaoyang District of Beijing City，and provide reference for improving their nutritional health level. Methods From April to June 2023，school-age children in Chaoyang District of Beijing City were selected as the survey subjects by multi-stage stratified cluster sampling. The health and nutrition status of students and their parents were investigated by questionnaire survey，and the information of students' routine physical examination was collected. SPSS 29.0 statistical software was used for data processing and analysis，and the binary logistics regression model was used to analyze the influencing factors of nutritional literacy. Results Finally，605 groups of valid questionnaires of students and their corresponding parents were obtained. The mean comprehensive score of students' nutritional literacy was（69.02±9.58）points，and the qualification rate was 23.80%. Grade，family food environment，daily outdoor activity time，BMI，and screen entertainment time were all influencing factors of nutritional literacy（all P<0.05 ）. Senior grade（grades 7-9：OR=2.743， 95%CI：1.687-4.460； grade 10-12：OR=2.942， 95%CI：1.748-4.953 ） ， healthier family food environment（ OR=1.735， 95%CI：1.146-2.626 ） and daily outdoor activity time ≥1 hour（ OR=1.738， 95%CI：1.187-2.679） were protective factors for the nutritional literacy of school-age children in Chaoyang District. Overweight and obesity（OR=0.524，95%CI：0.322-0.855） and daily screen entertainment time ≥2 h（OR=0.325，95%CI：0.151-0.696） were risk factors for the nutritional literacy of school-age children. Conclusion The nutritional literacy rate of school-age children in Chaoyang District is relatively high，especially in the dimensions of knowledge and concepts，but the literacy levels in each dimension are uneven. We should focus on cultivating students' transformation from nutritional knowledge concepts to the ability to choose，make and consume food.Strengthen education and practice，explore the establishment of a "five-in-one" collaborative model involving the government，professional institutions，schools，families and communities to improve students' nutritional literacy and ensure nutritional health.

Epidemiological analysis and trend prediction of hemorrhagic fever with renal syndrome in Tianjin from 2000 to 2024

ZHAO Jian, LIU Yifang, HAN Yixia, LYU Jie

2025, 41(24):  3368-3372. 

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Objective To understand the epidemiological characteristics of hemorrhagic fever with renal syndrome（HFRS） in Tianjin from 2000 to 2024 and predict the epidemic trend for the next three years，thereby providing a basis for future prevention and control efforts. Methods The descriptive epidemiological method was conducted on the surveillance data of HFRS in Tianjin from 2000 to 2024，and the auto-regressive moving average model（ARIMA） model was used to predict the incidence trend for the next two years. Results From 2000 to 2024，a total of 1 944 HFRS cases were reported in Tianjin，with 26 deaths，the average annual incidence rate was 0.57/100 000. A significant peak in cases occurred between 2000 and 2002，with the number of cases reported during these three years accounting for 49.9% of the total cases. Subsequently，the epidemic declined rapidly，entering a period of low-level fluctuations since 2007. The annual incidence rate of HFRS in Tianjin had remained consistently below 0.1/100 000 since 2019，with no death. Joinpoint regression analysis showed that the overall incidence of HFRS in Tianjin showed a downward trend（APC=-15.3%，95%CI：-18.3%- -12.1%，P<0.01），the decline rate changed in 2004 and 2007，and the decline trend was faster during 2004-2007. The decline trend during 2007-2024 was slower than that in 2000-2004. The incidence showed a bimodal pattern of small winter peak and big spring peak. The seasonal index from January to June was >1，the disease became a winter single peak（November to January of the following year） since 2019，and the number of months with seasonal index >1 also decreased to 3 months. Areas with high incidence of diseases had gradually shifted from urban areas to rural areas. The number of cases in men was significantly higher than that of women，and the sex ratio was 3.6 ∶ 1. The cases aged 30-<50 years old accounted for 50.3% of the total cases，and the occupational distribution was dominated by farmers（33.1%）. The index of rat density and rat toxicity showed a downward trend，and the carry virus index of rat was positively correlated with the incidence of epidemic hemorrhagic fever（r=0.732，P<0.01）. The ARIMA model predicted that the incidence of HFRS in Tianjin would remain steadily low in the next 3 years. Conclusion The HFRS epidemic in Tianjin will continue to maintain a steadily low state，but due to the characteristics of natural epidemic diseases，the relevant monitoring work still needs to be carried out for a long time to grasp the changes in the disease. At the same time，new technologies and new methods should be actively explored to improve the monitoring efficiency.

Impact of workplace communication stress and psychological detachment on work-family conflict among internal medicine nurses

LU Huiqing, HU Ruijuan, YE Ruiying, ZHU Jieyi, TAN Fenghui, YANG Qunmei

2025, 41(24):  3373-3377. 

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Objective To understand the workplace communication stress，psychological detachment，and work-family conflict among internal medicine nurses，and to explore the impact of workplace communication stress and psychological detachment on work-family conflict. Methods From June to July 2024，a convenient sampling was used to select 196 nurses from internal medicine department of 9 tertiary comprehensive hospitals in Guangdong Province as the survey subjects.The workplace communication stress scale，psychological separation scale，and work-family conflict scale were used for investigation and analysis. Results The scores for workplace communication stress，psychological detachment，and work-family conflict among internal medicine nurses were （20.34±4.72），（10.37±2.28） and （61.13±12.47）points，respectively. There were statistically significant differences in the scores of workplace communication stress among internal medicine nurses of different genders，ages，professional titles，years of work experience，monthly income，marital status，and weekly overtime hours（all P<0.05）. There were statistically significant differences in the scores of occupational burnout among internal medicine nurses of different ages，professional titles，years of work experience，monthly income，and weekly overtime hours（all P<0.05）. There was a positive correlation between workplace communication stress and work-family conflict among internal medicine nurses（r=0.614，P<0.01），and a negative correlation between psychological detachment and work-family conflict（r=-0.572，P<0.01）.Workplace communication stress and psychological detachment were negatively correlated（r=-0.552，P<0.01）. Psychological detachment played a partial mediating role between workplace communication stress and work-family conflict among internal medicine nurses，with a mediating effect of 0.285，accounting for 48.14% of the total effect. Conclusion Psychological detachment plays a partial mediating role between workplace communication stress and work-family stress.Improving psychological resilience plays an important role in reducing occupational burnout among internal medicine nurses，while reducing communication stress in the workplace.

Analysis on current status of career success and related factors among oncology nurses

MENG Juan, MA Xueling

2025, 41(24):  3378-3382. 

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Objective To investigate the current status of career success perception among oncology nurses and explore its related factors. Methods From January to April 2025，a cluster sampling survey was conducted to select 185 oncology nurses working in a grade-A tertiary specialized hospital in Tianjin and some grade-A tertiary hospitals across the country as survey subjects. Cross-sectional surveys were conducted using self-designed questionnaires on basic information，perceived management carescale and role stress scale. Results The score for the career success scale among oncology nurses was （38.54±6.43）points，the score for the caring assessment tool was （137.40±30.37）points，and the score for the role stressor scale was （32.53±14.63）points. Correlation analysis showed that the scores of the career success scale were negatively correlated with those of the role stressor scale（r=-0.253，P<0.05），and positively correlated with those of the caring assessment tool scores（r=0.588，P<0.01）. Multiple linear regression analysis indicated that factors such as income，specialized nursing training status，career planning，research/paper publication status，and interpersonal relationships among nursing staff were the influencing factors on the career success perception of oncology nurses（all P<0.05）. Conclusion The overall career success perception of oncology nurses is at a moderate level. Nursing managers can promote the development of high-level career success perception among oncology nurses by enhancing their perception of management care and reducing role stress.

Network analysis of dimensions of risk perception and mental health among nursing staff

SHAO Xiaoqin, MA Xiaojing, SONG Xiangrui, YANG Qiong, SHI Xiaoying, DONG Wei

2025, 41(24):  3383-3388. 

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Objective To understand the relationship between nursing staff's risk perception and psychological health dimensions，analyze the core dimensions that affect mental health，and provide potential intervention targets for maintaining nursing staff's mental health. Methods From April 1，2022 to October 31，2023，a total of 2 546 nursing staff from 20 hospitals from east，west，south，north，and central regions were conveniently selected for investigation. Using a self-compiled general data questionnaire，a revised risk perception questionnaire for nurses and the 21-item depression anxiety and stress scale（DASS-21） as tools. The R software was used for statistical analysis and visualization，the network model was used to analyze the relations between the five dimensions of risk perception and the three dimensions of DASS-21，and to analyze the intensity and bridge-intensity centrality of each dimension in the network. Results In the network analysis of risk perception and mental health network，the association between "time risk" and "stress" "social mental risk" and "stress" were strong，their non-regularized partial correlation coefficients were 0.07 and 0.04，respectively. Analysis of strength and bridge-strength centrality showed that "stress" had the strongest strength centrality，with an expected influence（EI） of 0.13，and the two dimensions with the highest bridge-strength centrality were "stress" [bridge expected influence（BEI）=0.13] and "time risk"（BEI=0.11）. Conclusion There are different correlation paths between various dimensions of risk perception and mental health. "Time risk" may be the core dimension affecting the mental health of nursing staff，and "stress" in mental health dimension may be the core symptom.

Chain mediation effect of financial practitioners' self-efficacy and mental toughness on perceived stress and mental health status

ZHANG Jing, FAN Chunlei, TAO Ting, WANG Ligang, GAO Wenbin

2025, 41(24):  3389-3394. 

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Objective To understanding the perceived stress and mental health status of financial professionals，including their situation in depression，anxiety，somatization，and sleep and diet，and to explore the influence mechanisms of self-efficacy and mental toughness on the relationship between perceived stress and mental health status among financial practitioners，providing decision-making basis for stress coping and improving mental health level of employees in financial institutions. Methods From September to October 2024，344 in-service employees in the domestic financial industry were recruited to conduct a questionnaire survey using the stress perception scale（PSS），general self-efficacy scale（GSES），Connor-Davidson resilience scale（CD-RISC），symptom check-list scale（SCL-90） and self-designed basic information table of respondents. SPSS AU was used to conduct statistical and mediating effect test. Results The total perceived stress score of 344 financial practitioners was （1.725±0.649）points，including loss of control factor（1.564±0.803）points and tension factor（1.887±0.885）points. In SCL-90 symptom self-report scale，depression was （1.970±0.848）points，anxiety was （1.759±0.798）points，somatization was （1.589±0.662）points，other（sleep，diet） was （1.836±0.765）points，and the total scores of the above dimensions was （1.788±0.716）points. The self-efficacy score was （2.550±0.809）points. Mental toughness score was （2.445±1.185）points，including toughness factor（2.437±1.176）points，strength factor（2.437±1.176）points，optimism factor（2.365±1.314）pints.The mental health status，including depression，anxiety，somatization and other dimensions（sleep，diet），were positively correlated with stress perception（all P<0.01），and negatively correlated with self-efficacy and mental toughness（all P<0.01）. The results of mediation effect analysis using Bootstrap method showed that self-efficacy and mental toughness had a chain mediation effect path between stress perception and mental health status（95%CI：0.089-0.170）. Conclusion The perceived stress of financial practitioners is at a high level，and the perceived stress and mental health status are different due to gender，region，working years，institution type，position，income and other factors. Perceived stress has a significant positive predictive effect on the mental health status of financial practitioners，and self-efficacy and mental toughness play a chain intermediary role between the perceived stress and mental health status.

Study on cardiovascular health effects of extreme temperature event warning levels

ZHANG Jingwei, TIAN Yingze, WANG Jingya, WANG Mengmeng, DU Yuxin, LI Tiantian

2025, 41(24):  3395-3400. 

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Objective To explore the impact of extreme temperatures（heatwaves and cold spells） on cardiovascular mortality in Tianjin and assess the risk variations of specific cardiovascular diseases under different levels of temperature fluctuations. Methods Based on daily mortality data from seven districts in Tianjin from 2019 to 2022，a time-series analysis using generalized linear models was employed to assess the impact of extreme temperature events of different intensities（severe heatwaves，mild heatwaves，severe cold spells，and mild cold spells） on daily cardiovascular mortality，controlling for lag effects and other confounding factors. Results Both heatwaves and cold spells significantly increased the risk of cardiovascular mortality. Exposure to severe heatwaves raised the risk of ischemic heart disease（IHD） mortality by 2.15 times. During cold spells，the risk of stroke mortality increased significantly，with severe cold spells raising the risk by 1.41 times. Mortality risk for other types of cardiovascular diseases also increased. Conclusion Extreme temperature events have a significant impact on cardiovascular mortality，with particularly pronounced effects of high and low temperatures on ischemic heart disease and stroke mortality. Relevant departments should develop public health interventions for extreme climate conditions to reduce the adverse effects of climate change on cardiovascular health.

Analysis of atmospheric NO₂ pollution characteristics in 31 key cities in China from 2003 to 2019

LIAO Yan, WANG Li, ZHANG Wenli

2025, 41(24):  3401-3407. 

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Objective To collect and organize the atmospheric nitrogen dioxide（NO₂） pollution data in 31 key cities in China from 2003 to 2019，and analyze their changing trend. Methods Collect annual average mass concentration data of atmospheric NO₂ in 31 key cities from 2003 to 2019 from the official website of the National Bureau of Statistics，and evaluate the annual average mass concentration of NO₂ based on the limit standards in GB 3095-2012 "the Ambient Air Quality Standards". The Daniel trend test method was used to evaluate the annual trend of atmospheric NO₂ mass concentration，and the Kruskal-Wallis H test was used to compare the differences of NO₂ mass concentrations in different groups. Results The annual average mass concentration of atmospheric NO₂ in 31 key cities from 2003 to 2019 was （41±12）μg/m³，with an annual average decline rate of 0.79%. There was no statistically significant difference in the annual average mass concentration of NO₂ between different years（χ²=16.24，P>0.05）. NO₂ pollution was relatively mild in Southwest and South China，and more severe in North and Central China. The annual average mass concentration of NO₂ in the Northwest China showed an upward trend（r_s=0.710，P<0.01），while in the East China and South China，it showed a downward trend（r_s=-0.757，-0.815，both P<0.01）. Compared with 2003，the annual average mass concentration of NO₂ in 18 cities in 2019 showed varying degrees of decline，with a decrease of 2% to 51%（an average annual decrease rate of 0.1% to 4.3%），the annual average mass concentration of NO₂ in 8 cities（including Hefei，Taiyuan，Changchun，Xi'an，Zhengzhou，Xining，Guiyang，and Shijiazhuang） increased by 5% to 68%（an average annual growth rate of 0.3% to 3.3%），and the annual average mass concentration of NO₂ remained the same in 5 cities（Shenyang，Nanchang，Haikou，Lanzhou，and Yinchuan）. The trend test results showed that the annual average mass concentration of NO₂ in 9 cities（Shijiazhuang，Taiyuan，Hefei，Jinan，Zhengzhou，Guiyang，Xi'an，Xining，and Yinchuan） showed an upward trend（all r_s>0，all P<0.05），while in 10 cities（Beijing，Harbin，Shanghai，Nanjing，Hangzhou，Fuzhou，Guangzhou，Kunming，Lhasa，Urumqi），the annual average mass concentration of NO₂ showed a downward trend（all r_s<0，all P<0.01）. From 2003 to 2019，the annual average mass concentration of NO₂ in seven cities（Shanghai，Nanjing，Hangzhou，Wuhan，Guangzhou，Chengdu，and Urumqi） exceeded the standard limit every year，while three cities（Haikou，Guiyang，and Lhasa） had good quality and were within the standard limit every year. Conclusion There are regional and urban differences in atmospheric NO₂ pollution in 31 key cities in China，with heavy pollution in North China，Central China，and Northwest China. The situation of NO₂ prevention and control in Beijing-Tianjin-Hebei and its surrounding areas，the Yangtze River Delta，the Pearl River Delta，and western cities remains severe. In the future，comprehensive treatment measures，"tailored measures"，and regional coordinated prevention and control should continue to be taken for NO₂ pollution.

Impact of social exclusion on cooperation tendency among college freshmen and the mediating role of sense of control and self-esteem

TIAN Luyao, HUANG Lieyu, LI Jinlu, LIN Feng'e, SONG Haoyang, HUANG Jiani

2025, 41(24):  3408-3412. 

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Objective To explore the relationship among social exclusion，sense of control，self-esteem and cooperative tendency of freshmen in universities，and to test the mediating role of sense of control and self-esteem between social exclusion and cooperative tendency. Methods In December 2023，a convenience sampling method was adopted to survey 750 freshmen at a university in Guizhou Province using the college students' social exclusion questionnaire，the cooperative tendency rating scale，the Chinese version of the sense of control questionnaire，and the Rosenberg self-esteem scale. The collected data were analyzed through correlation analysis and chain mediation analysis. Results The social exclusion score of freshmen was（32.23±8.90） points，the sense of control score was （53.70±7.88）points，the self-esteem score was （28.36±3.72）points，and the cooperative tendency score was （47.76±6.83）points. There were statistically significant differences in social exclusion scores among freshmen of different genders and left-behind experience（both P<0.05），and there were statistically significant differences in sense of control scores and self-esteem scores among freshmen of different places and left-behind experience（all P<0.05）. Social exclusion was negatively correlated with self-esteem，sense of control，and cooperative tendency（r=-0.39，-0.44，-0.24，all P<0.01），sense of control was positively correlated with self-esteem and cooperative tendency（r=0.60，0.19，both P<0.01），and self-esteem was positively correlated with cooperative tendency（r=0.32，P<0.01）. Social exclusion could not only directly predict the college freshmen's cooperative tendencies（β=-0.62，t=-13.35，P<0.01），but also indirectly predict it through sense of control and self-esteem. Conclusion Social exclusion negatively predicts college freshmen's cooperative tendencies，while sense of control and self-esteem play a chain mediating role in this process. For the reduction of cooperation tendency caused by social exclusion of college freshmen，the influence of social exclusion can be weakened by improving individual sense of control and cultivating their high self-esteem，and at the same time，the cooperation tendency of college freshmen can be improved.

Meta-analysis of the prevalence of dental caries among primary and secondary school students in China

HAO Zhengyang, CHEN Xiangjun, WU Ruipeng, PENG Qing, WANG Shaokang

2025, 41(24):  3413-3418. 

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Objective To understand the prevalence of dental caries among primary and secondary school students over the past five years，and provide scientific basis for the prevention and treatment of dental caries among primary and secondary school students. Methods A systematic literature search was conducted in the CNKI，Pubmed，VIP，Wanfang，Web of Science，Embase，and Medline databases for studies on the epidemiology of dental caries among primary and secondary school students in China from January 2020 to September 2024. A meta-analysis was performed on the selected studies that met the predefined criteria，and subgroup analysis were carried out based on gender，educational level，regional distribution，and place of residence. Results A total of 47 articles were included，including 1 961 694 primary and secondary school students and 557 186 cases of dental caries. Meta-analysis results indicated that the composite detection rate of dental caries among primary and secondary school-aged children in China was 41.5%（95%CI：38.0%-45.0%）. Subgroup analysis results revealed a combined prevalence of dental caries of 50.6%（95%CI：46.3%-45.8%） among primary school students and 31.6%（95%CI：26.9%-36.4%） among secondary school students，with statistically significant differences between different grades（P<0.05）. The difference in different geographical regions were statistically significant（P<0.05），with the highest prevalence of dental caries among primary and secondary school students in Northeast China，at 68.9%（95%CI：66.8%-71.0%），while the lowest prevalence among primary and secondary school students in Central China，at 32.0%（95%CI：21.8%-43.2%）. In addition，there were no statistically significant difference in the prevalence of dental caries among primary and secondary school students of different genders and place of residence（both P>0.05）. Conclusion Attention should be paid to the prevalence of dental caries among primary and secondary school students in China. It is necessary to strengthen the prevention and treatment of dental caries and oral health among primary and secondary school students，and carry out targeted publicity and education.

Investigation and Research

Surveillance and analysis of adverse events following immunization in Tianjin from 2023 to 2024

ZHU Di, LUO Xiaoyan, LI Yongcheng, GUO Baihui

2025, 41(24):  3419-3422. 

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Objective To analyze the surveillance data of adverse events following immunization（AEFI） in Tianjin from 2023 to 2024，and to provide scientific guidance for improving the precision and effectiveness of regional AEFI monitoring and management. Methods Based on the Tianjin Immunization Planning Information Management System and the AEFI monitoring system of the Chinese Immunization Information Management System，data on vaccination and AEFI reports in Tianjin from 2023 to 2024 were collected. Descriptive epidemiological methods were used to analyze the AEFI monitoring data. Results The reported incidence rate of AEFI in Tianjin from 2023 to 2024 was 29.07 per 100 000 doses. The reported incidence rates of general reactions and abnormal reactions were 26.95 per 100 000 doses and 1.11 per 100 000 doses，respectively. The majority of reported cases occurred in individuals aged ≤1 year（63.76%），with a higher proportion in males（51.78%）. The highest AEFI reported incidence rate was observed in the second quarter（34.04 per 100 000 doses）. Japanese encephalitis inactivated vaccine（JE-I），recombinant zoster vaccine（RZV），and group A，C，Y and W135 meningococcal polysaccharide conjugate vaccine（MPCV-ACYW） had the top three highest total AEFI reported incidence rates. The most common general reactions were fever，local redness/swelling，and local induration，with reported incidence rates of 15.38 per 100 000 doses，9.00 per 100 000 doses，and 3.50 per 100 000 doses，respectively. The predominant abnormal reaction was allergic rash，with a reported incidence rate of 0.54 per 100 000 doses. Most adverse reactions occurred within 0-1 day after vaccination. Conclusion In Tianjin，AEFI cases reported were primarily general reactions，with abnormal reactions remaining at a low level. Standardized AEFI surveillance and reporting should be continued to improve monitoring sensitivity.

Analysis of AEFI monitoring results following stand-alone and simultaneous vaccination with oral pentavalent rotavirus attenuated live vaccine and 13-valent pneumococcal polysaccharide conjugate vaccine in Tianjin City

GUO Baihui, LUO Xiaoyan, LI Yongcheng, ZHU Di

2025, 41(24):  3423-3426. 

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Objective To compare and analyze the reported incidence of adverse events following immunization（AEFI） following simultaneous vaccination with oral pentavalent rotavirus attenuated live vaccine（RV5） and 13-valent pneumococcal polysaccharide conjugate vaccine（PCV13） in Tianjin City，thereby improving the safety surveillance of multi-vaccine co-administration and providing a scientific basis for optimizing co-administration policies. Methods AEFI case data were exported from the AEFI monitoring module of the Immunization Program Subsystem of the China Disease Prevention and Control Information System according to the vaccination date. Concurrent relevant vaccination data were exported from the Tianjin Immunization Program Information Management System for analysis and comparison of reported incidence rates. Results From 2020 to 2024，the reported incidence rates of AEFIs in Tianjin were 18.23/100 000 doses for RV5 vaccination alone，104.51/100 000 doses for PCV13 vaccination alone，and 46.39/100 000 doses for simultaneous vaccination of RV5 and PCV13. The reported incidence rate of AEFI for simultaneous vaccination was lower than that for PCV13 vaccination alone（χ²=8.289，P<0.01），and higher than that for RV5 vaccination alone（χ²=7.530，P<0.01）. Conclusion The general reactions for single vaccination with PCV13，RV5，and simultaneous vaccination mainly diagnosed as symptoms of general reactions（fever/redness and swelling/hardening），while the abnormal reactions were mainly allergic reactions. Severe abnormal reactions were rare. The risk of simultaneous vaccination with PCV13 and RV5 did not increase，and the overall safety was good.

Health Management and Research

Investigation of the current situation of hospital acquired infection in inpatients of a grade-A tertiary traditional Chinese medicine hospital in Tianjin and management countermeasures

ZHANG Jing, XU Guoying

2025, 41(24):  3427-3431. 

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Objective To investigate the occurrence of hospital acquired infection in inpatients in a grade-A tertiary traditional Chinese medicine hospital in Tianjin in 2023，analyze the epidemiological characteristics and risk factors，and put forward targeted management countermeasures. Methods Inpatients diagnosed with hospital acquired infection in 2023 were selected as the research objects，using descriptive statistical analysis method to collect and analyze the data of gender，age，site of infection and pathogen distribution，and calculate the subinfection rate of hospital acquired infection and the infection rate of each department. Results In 2023，the subinfection rate of hospitalized patients was 0.63%（95%CI：0.53%-0.73%），and the mean age of infected patients was （72.92±11.31）years.The departments with the highest infection rate were traditional Chinese medicine（1.85%），nephrology（1.57%），and cardiology（1.60%）. There was a statistically significant difference in hospital acquired infection rates between different departments（χ²=188.387，P<0.01）.The respiratory tract below the infection site was predominant（69.57%），followed by the urinary tract（13.04%） and the upper respiratory tract（9.94%）.The main pathogens were Gram-negative bacteria（60.58%），with the highest detection rate of K.pneumoniae（20.43%）. Conclusion The hospital infection in this hospital is mainly elderly patients，the department of traditional Chinese medicine is the high incidence department，the lower respiratory tract is the high incidence site，and Gram-negative bacteria are the main pathogens.Based on this，it is suggested to build a comprehensive hospital acquired infection prevention and control system，rationally apply the appropriate technology of traditional Chinese medicine，strengthen the cognitive education of patients，and improve the comprehensive management ability of medical staff，so as to reduce the risk of hospital infection.

Survey on competence and research ability of master's degree graduates in clinical medicine for standardized training in Xinjiang

Jiayina Lazibieke, WEN Baofeng, LI Baojun, CAO Mingqin

2025, 41(24):  3432-3436. 

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Objective To investigate the influencing factors and interactions between standardized training competence and research ability of master's degree students in clinical medicine in Xinjiang，and provide a basis for promoting the development of postgraduate education. Methods A questionnaire survey was conducted from March to June 2023 on 1 011 master's degree students of clinical medicine in Xinjiang，and linear regression was used to analyze the influencing factors of competence in standardized training，and logistic regression was used to analyze the influencing factors of scientific research ability. Results The total score of competence in standardized training for master's degree students in clinical medicine was（164.86±33.01）points. The results of the multiple linear regression showed that whether they had scientific competence，whether they had received patient complaints，whether they could apply theory to practice，and satisfaction with training were the influencing factors of competence in standardized training（R²=0.194，F=34.547，all P<0.05）. The results of the multifactorial logistic regression showed that gender，grade，frequency of communicating with supervisors，academic conference presentations or poster exchanges，filing of projects and competency level were the influencing factors of research ability of master's degree graduates（all P<0.05）. Conclusion The standardized training competence and scientific research ability of master's degree students of clinical medicine in Xinjiang region still need to be further improved.Universities and training base managers should comprehensively consider the influencing factors，optimize the training programme，strengthen the cultivation of scientific research and practical ability，and promote the comprehensive development of master's degree training in clinical medicine.

Overview

Research progress on vocational rehabilitation for patients with occupational hand injuries

JIA Huimei, XU Yanwen

2025, 41(24):  3437-3441. 

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There may be many dangerous factors in work，such as workers being easily injured due to errors or machine failures during the operation of equipment，and hand injuries are often more common in the construction industry，machinery manufacturing industry，catering industry，and agriculture. Most hand injuries are caused by external forces，and these injuries including various types such as soft tissue contusions，tendon ruptures，and damage to blood vessels and nerves. In severe cases，these injuries may cause varying degrees of impairment in the patient's motor and sensory functions. The rehabilitation period for hand trauma is usually long and leads to different degrees of persistent disability.These injuries may prevent the patients from returning to their original jobs，resulting in job changes or unemployment，etc.，which has a serious impact on the patients' career development and quality of life. This paper reviews the concept of vocational rehabilitation，assessment tools，current situation，influencing factors，etc.，to provide reference and guidance for vocational rehabilitation intervention programs for patients with traumatic hand injuries，to facilitate their return to work.

Research progress on professional identity and turnover intention of clinical nurses

CHEN Zhenyi, HUANG Yuxiao, LI Luohong

2025, 41(24):  3442-3446. 

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The level of medical technology in China has steadily improved，and the aging population is growing at an ascending rate，the demand for medical resources is constantly rising. However，there is still a significant gap in the number of clinical nurses，and the issue of turnover intention remains severe. The professional identity of clinical nurses is closely related to their turnover intention. This paper reviews the concepts，current status，assessment tools，and influencing factors of nurses' professional identity and turnover intention. Based on this，the paper further explores measures to enhance nurses' professional identity and reduce turnover intention，aiming to alleviate the shortage of clinical nurses，stabilize the nursing workforce，improve job satisfaction，and meet clinical demands，and provide a reference for research on nurses' professional identity and turnover intention in China.

Application prospects of large language model in occupational disease prevention and treatment

JIN Jiachun, WANG Qiting, XIA Bing, WANG Shu, YANG Aichu, CHENG Weibin

2025, 41(24):  3447-3451. 

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With the acceleration of industrialization，occupational diseases have become increasingly prominent，posing a serious threat to the health of workers. Traditional methods for the prevention and treatment of occupational diseases face challenges such as insufficient data integration，low diagnostic efficiency，and lack of targeted preventive measures. Large language model（LLM），which is artificial intelligence model based on deep learning technology，can understand natural language and generate logical content through the deep analysis and training of massive amounts of data. Faced with the heavy task of occupational disease prevention and treatment，LLM offers new possibilities for optimizing traditional occupational disease prevention and treatment. By integrating vast amounts of data，LLM can facilitate intelligent diagnosis and early warning of occupational diseases and provide personalized occupational health education and training for workers，potentially bringing revolutionary changes to the field of occupational disease prevention and treatment. This paper aims to explore the application advantages of LLM in occupational disease prevention and treatment，its anticipated application scenarios，the challenges it may face，and propose future prospects.

Research progress on perceived stress in nurses

YANG Yanxia, YANG Yanhui, LIU Jing, LYU Liming

2025, 41(24):  3452-3456. 

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Perceived stress is a state of tension and anxiety that arises from an individual's perception of external environmental threats. Appropriate perceived stress can stimulate individual potential and ensure good coping skills，while excessive perceived stress can lead to physical and mental distress and poor coping skills. Nurses，as an indispensable and important part of the healthcare system，experience various levels of perceived stress in the face of high-pressure work environments，tense doctor-patient relationships，and low social recognition，which can easily affect their own development，patient safety，and overall nursing quality. Therefore，how to establish a sound support system and reduce the perceived stress on nursing staff is currently a key concern for nursing managers.This article reviews the concept，evaluation tools，current status，influencing factors，and adverse effects of perceived stress among nurses.Strategies for coping with nurse stress are proposed from the perspectives of individuals，departments，and organizations，providing reference for maintaining the physical and mental health of nurses，stabilizing the nursing team，and improving the quality of clinical work.