臺灣博碩士論文加值系統

據文獻報告約有10-15%的夫婦曾遭遇不孕的問題；而與生殖系統有關之問題，包括早產、畸胎、死產、低體重兒等均可能與工作中之某些特定暴露有關。醫療工作人員之輪班、自覺工作壓力過大、接觸抗癌藥物、放射物質、化學物質等都是可能導致其生殖功能障礙的重要因素；其中，人數最多的護理人員則因大多數均正值生育年齡，其與職業相關的生殖功能障礙問題更應受到重視。本研究以5家精神專科醫院護理人員（n=460）與4家綜合醫院護理人員（n=447）為調查對象，主要目的為評估台灣地區精神專科醫院護理人員與綜合醫院護理人員之自覺工作相關壓力與其生殖健康的情形。
本研究在工作相關之自我感受除了參考Karasek 的工作特質問卷（Job Content Questionnaire, JCQ）外，並進行焦點團體，以確定問卷內容之合宜性與適用性。分析方法則將精神專科醫院護理人員和綜合醫院護理人員個別分析，並以羅吉式複迴歸（multiple logistic regression）來觀察其相對危險性（odds ratio）。
結果顯示精神專科醫院護理人員「自我感受高工作壓力」(同意或很同意)的盛行率為63.9％，且其與月經週期不規則（±7天）與月經來潮天數延長（ 7天）的相關具有統計上的意義；月經週期不規則（±7天）之AOR為5.04 (95% CI=2.90-8.75)，月經來潮天數延長（ 7天）之AOR則為2.08 (95% CI=1.24-3.51)。綜合醫院護理人員之「自我感受高工作壓力」的盛行率為79.6％，發現其與月經週期不規則（±7天）及月經來潮天數延長（ 7天）均具有統計上的相關；月經週期不規則（±7天）之AOR為5.11（95% CI=2.69-9.71），而月經來潮天數延長（ 7天）之AOR為3.18（95% CI=1.67-6.07）。
以受孕所需時間（TTP）作為生育力的指標時，精神專科醫院護理人員(n=173)與綜合醫院護理人員(n=122)之分析結果有不同的發現。精神專科醫院護理人員懷孕前自我感受(工作、生活) 壓力高者較低者之受孕比在統計上有顯著下降（fecundability ratio=0.63, 95% CI=0.53-0.76）；綜合醫院護理人員之懷孕前自我感受(工作、生活) 壓力高與低者之受孕比，並無統計上之顯著差異。
本研究的結論是:不論是精神專科或綜合醫院之護理人員，自覺工作壓力高是月經狀態紊亂的因素之一；至於壓力對生育功能方面之影響，則以精神專科醫院之護理人員較顯著。然而，上述二種情況之生理作用機轉仍需再進一步確認，例如未來可以實驗室之理學檢查來觀察其因壓力程度所產生的生理變化。

Approximately 10-15% of all couples have experienced infertility problems. Some of them are related to abnormalities of the reproductive system, including prematurity, abnormal fetus, stillbirth, low-birth weight newborns, which may be caused by specific occupational exposures. Shift work, high level of self-perceived job stress, contact with anti-neoplastic agents, radiation and chemical exposures have been reported to be responsible for the dysfunctional reproductive systems of health care workers. As most of the nursing staff are in their reproductive age, thus the potential reproductive hazardous in this group should be highlighted. The aim of this study was to assess the association between self-reported stress and reproductive health of the nurses. A total of 907 nurses, including 460 from psychiatric hospitals and 447 from general hospitals, were enrolled in this study.
To ensure the suitability and validity of the questionnaire, the self-report of the job stress was evaluated according to Karasek's Job Content Questionnaire (JCQ) and a focus group was also conducted. Data analysis included the personal analysis of all of cases and odds ratios were analyzed using multiple logistic regression.
The results have demonstrated that 63.9% of the psychiatric nurses reported to have high level of job stress, which was associated with irregular menstrual cycles (AOR=5.04, 95% CI: 2.90-8.75), and longer menstruation period (more than 7 days) (AOR=2.08, 95% CI: 1.24-3.51). Of the general hospitals, 79.6% of the nurses reported to have high level of self-perceived job stress, which was associated with irregular menstrual cycles (AOR=5.11, 95% CI: 2.69-9.71), and longer menstruation period (more than 7 days) (AOR=3.18, 95% CI: 1.67-6.07).
'Time-to-pregnancy' (TTP) was used to evaluate subfertility in this study, and data were obtained from 195 psychiatric nurses and 147 nurses of general hospitals. The TTP of the psychiatric nurses with high–stress level was longer than that of those with low-stress, and a decreased fecundibility ratio was found (fecundibility ratio=0.63, 95% CI: 0.53-0.76). The TTP differences between the general-hospital nurses with the high-stress level and those with low-stress level was not statistically significant, nor was there an increase risk in fecundibility in this group.
Furthermore, this study identified that nurses of either psychiatric or general hospitals with self-reported high level of job stress would be at risk for menstrual dysfunction. In addition, high level of self-perceived job stress might be an indicating factor for the reduced fertility of the nurses in both types of hospitals. Nevertheless, the impact of high level of job stress on fertility was more prominent in psychiatric nurses, while being compared to those of the general hospitals. The underlying pathophysiologic mechanism regarding the infertility induced by high level of job stress in nurses requires further clarification. Further laboratory examinations are recommended to determine the association between job stress and any physical alteration of the reproductive system.

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