Tsutsumi Akizumi, Umehara Katsura, Ono Hiroshi, Kawakami Norito
University of Occupational and Environmental Health, Occupational Health Training Center, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
BMC Oral Health. 2007 Apr 4;7:3. doi: 10.1186/1472-6831-7-3.
A harsh work environment including psychosocial job demands might cause adverse events due to medical mismanagement, but the association has not been explored. The purpose of the study was to investigate whether some types of psychosocial job demands are associated with adverse events due to dental mismanagement experienced by general dental practitioners.
A self-administered questionnaire was mailed to members of a local branch of the Japan dental association. A total of 261 dental practitioners responded anonymously (response rate 53%). Psychosocial job demands were measured by a Japanese version of the Copenhagen Psychosocial Questionnaire, which comprises five sub-scales: quantitative demands, cognitive demands, emotional demands, demands for hiding emotions, and sensorial demands. The outcome was defined according to whether the respondent's patients experienced one of the following adverse events due to dental mismanagement at least once during the previous one year: dropping of dental instrument or broken injection needle, soft tissue or nerve injury, accidental bleeding, loss of a tooth root into the maxillary sinus, and emphysema. Associations between each demand index and experience of adverse events were examined by logistic regression analyses adjusting for potential confounders.
Emotional demands and sensorial demands were significantly associated with the experience of adverse events (odds ratio = 3.9 for each). Other than the indices, male gender, younger age, practice alone, many dental chairs (five or more), and many patients (30 or more per day) were the risks. Working hours per week and number of paramedical staff had no significant associations.
Emotional and sensorial job demands are a potential target for the reduction of adverse events due to dental mismanagement.
恶劣的工作环境,包括心理社会方面的工作要求,可能会因医疗管理不善而导致不良事件,但这种关联尚未得到探讨。本研究的目的是调查某些类型的心理社会工作要求是否与普通牙科医生因牙科管理不善而经历的不良事件有关。
向日本牙科协会当地分会的成员邮寄了一份自填式问卷。共有261名牙科医生匿名回复(回复率为53%)。心理社会工作要求通过哥本哈根心理社会问卷的日语版本进行测量,该问卷包括五个子量表:工作量要求、认知要求、情感要求、隐藏情感的要求和感官要求。结果根据受访者的患者在过去一年中是否至少经历过一次以下因牙科管理不善导致的不良事件来定义:牙科器械掉落或注射针折断、软组织或神经损伤、意外出血、牙根掉入上颌窦以及肺气肿。通过对潜在混杂因素进行调整的逻辑回归分析,检验每个需求指数与不良事件经历之间的关联。
情感要求和感官要求与不良事件的经历显著相关(每个的比值比均为3.9)。除这些指数外,男性、年龄较小、独自执业、牙科椅数量较多(五把或更多)以及患者数量较多(每天30名或更多)都是风险因素。每周工作时间和辅助医务人员数量没有显著关联。
情感和感官工作要求是减少因牙科管理不善导致的不良事件的潜在目标。