Study On The Status And Intervention Of Occupational Hygiene And Occupational Health Of Medical Radiation Workers In Xinjiang

Objective: In order to obtain the distribution and utilization of medical radiation resource in Xinjiang and provide reference for the researches about occupational hygiene of radiation diagnosis and treatment,this study forced on the investigation of medical institutions,radiation equipments,radiation protective supplies,quality control equipments and the management of occupational hygiene of medical radiation workers.The effects of occupational exposures on occupational stress,job burnout,depression and work ability of medical staff among different radiation work types werer assessed for the analysis of the occupational factors affecting occupational mental health.The intervention measures were conducted and evaluated,aiming to provide a theoretical basis and promote the occupational health management of medical radiation workers.Methods: 1)Using the census method,the distribution of medical radiation resource was investigated from 768 medical radiation institutions in 14 prefectures in Xinjiang,which participated in the "medical radiation protection testing of medical and health institutions in Xinjiang" in2018,Lorenz curve and Gini coefficient were used to evaluate the allocation fairness of medical radiation resource.2)Using the cluster sampling method,3372 participants from75 medical radiation institutions in Xinjiang were initially selected and 3089 questionnaires were collected.Those with the answers less than 90%or with continuous answers more than 10 items were excluded.Finally,2992 valid questionnaires were enrolled with an effective rate of 88.73%.3)Using Effort-Reward Imbalance questionnaire(ERI),Chinese Maslach Burnout Inventory(CMBI),Self-Rating Depression Scale(SDS)and Work Ability Index questionnaire(WAI),the influences of demographic characteristics(gender,age,professional title,education background,marital status,hypertension,diabetes)and behavior characteristic(smoking,drinking)on occupational stress,job burnout,depression and work ability of medical radiation workers were discussed.Propensity score matching(PSM)was used to acquire the subjects with the same baseline of demographic and behavior characteristics,and thereby investigated the influencing factors of occupational characteristics(job position,radiation work type,radiation seniority,thyroid diseases,visual damage)on occupational stress,job burnout,depression and work ability of medical radiation workers.4)Using the cluster sampling method,625 medical radiation workers from three tertiary hospitals were selected as intervention objects and divided into four groups of non-intervention group(140 people),health education intervention group(126 people),workplace intervention group(161people),and health education and workplace intervention group(198 people).The intervention was implemented for 8 months,and the intervention effect was evaluated by ERI,CMBI,SDS and WAI questionnaires.Results: 1)768 medical radiation institutions carried out diagnostic radiology of 768,interventional radiology of 42,radiotherapy of 12 and nuclear medicine of 8.In 2018,a total of 6.87 million times in general X-ray diagnosis,2.49 million times in CT diagnosis,218.9 thousand times in other X-ray diagnosis,72.2 thousand times in interventional therapy,90.5 thousand cases in radiotherapy,106.8 thousand times in nuclear medicine diagnosis and 4560 cases in nuclear medicine treatment were carried out,respectively.2)The number of medical radiation institutions per 10000 square kilometers and per million people in the survey area were 4.63 and 35.28,and the Gini coefficients based on area and population were0.47 and 0.43,respectively.The number of medical radiation equipments per 10000 people was 0.87,and most of them were DR and dental radiograph equipments.The Gini coefficients of diagnostic radiology equipments and CT were less than 0.30,that of interventional radiology equipments and DSA were between 0.30 and 0.40,and that of nuclear medicine equipments and radiotherapy equipments were more than 0.50.3)The number of radiation protective supplies per diagnostic radiology equipment,interventional radiology equipment and nuclear medicine equipment were 3.82,23.89 and 13.97,respectively.However,the number of quality control equipments per medical radiation institution was much less than one,except Aksu area.4)This survey included 5038 medical radiation workers.The number of medical radiation workers per 10000 people was 2.31 and the Gini coefficients based on area and population were 0.29 and 0.22,respectively.In 2018,the occupational health examination rate was 92.28%,the personal dose monitoring rate was 97.41%,and the radiation protection training rate was 94.27%.5)The incidence of occupational stress of medical radiation workers in Xinjiang was 44.20%.There were significant statistics differences of occupational stress level among age,gender,professional title,education background,marital status,diabetes,drinking,job position,radiation work type,radiation seniority,thyroid diseases and visual damage(P<0.05).Those aged 30 and above,male,middle professional title and above,bachelor degree and above,divorced or widowed,diabetes,nurse,interventional radiology,radiation seniority?5 years,thyroid diseases and visual damage were at a higher level of occupational stress(P<0.05).The risks of occupational stress of nurse,radiographer and other radiation work type were 1.623 times,1.421 times and 1.643 times that of doctor,respectively.The risks of occupational stress of interventional radiology,dental radiology,nuclear medicine and radiotherapy were 1.444 times,0.193 times,0.484 times and 0.716 times that of diagnostic radiology,respectively.The risks of occupational stress of radiation seniority with 5?9 years and 10?20 years were 1.560 times and 2.226 times that with<5 years.The risk of occupational stress with visual damage was 2.233 times of that without damage.6)The incidence of job burnout of medical radiation workers in Xinjiang was 57.2%,of which the percentages of mild,moderate and severe were 29.6%,22.6%and5.0%.There were significant statistics differences of job burnout levels among age,education background,diabetes,job position,radiation work type,thyroid diseases and visual damage(P<0.05).Those aged 30?39 years old,bachelor degree,diabetes,nurse,diagnostic radiology,thyroid diseases and visual damage were at a higher level of job burnout(P<0.05).The risks of job burnout of dental radiology,nuclear medicine and radiotherapy were 0.532 times,0.578 times and 0.655 times that of diagnostic radiology,respectively.The risk of job burnout of radiation seniority with 5?9 years was 1.278 times that with<5 years.The risks of job burnout with thyroid diseases and visual damage were1.553 times and 2.233 times that without diseases and damage,respectively.7)Depression was common in medical radiation workers,which the percentages of mild,moderate and severe were 51.70%,10.23% and 1.24%,respectively.There were significant statistics differences of depression levels among diabetes,smoking and thyroid diseases(P<0.05).Those with diabetes,smoking occasionally and visual damage were at a higher level of depression(P<0.05).The risk of depression with thyroid diseases was 1.429 times that without diseases.8)42.08%of medical radiation workers had poor or moderate work ability,and 57.92% of medical radiation workers had good or excellent work ability.There were significant statistics differences of work ability among age,gender,professional title,education background,marital status,diabetes,radiation work type,radiation seniority,thyroid diseases and visual damage(P<0.05).Better work ability of medical radiation workers was observed among those under 30 years old,male,junior and below professional title,graduate degree,unmarried,dental radiology,radiation seniority<5 years and without thyroid diseases and visual damage(P<0.05).The risks of work ability at poor or moderate of dental radiology,nuclear medicine,radiotherapy and other radiation work type were 0.449 times,0.603 times,0.611 times and 0.697 times that of diagnostic radiology,respectively.The risks of work ability at poor or moderate of radiation seniority with 10?20 years and>20 years were 1.373 times and 0.676 times that with<5 years.9)There were significant statistics differences of work ability among different levels of occupational stress,job burnout and depression(P<0.05).The risk of work ability at poor or moderate of medical radiation workers with occupational stress was 1.855 times that without occupational stress.The risks of work ability at poor or moderate of medical radiation workers with mild,moderate and severe job burnout were2.225 times,3.734 times and 13.355 times that without job burnout.10)There were significant statistics differences of occupational stress,job burnout,depression and work ability among different intervention groups(P<0.05),the intervention effects of medical radiation workers among different education background,work position,radiation work type and radiation seniority were statistically different(P < 0.05).Workplace improvement and health education were effective in alleviating occupational stress,job burnout,depression and improving the work ability of medical radiation workers.A combination of workplace improvement and health education showed the best effect on reducing occupational stress,depression and promoting work ability.Conclusion: 1)The medical radiation resource in Xinjiang were unfair in service area and population,and presented the advantages in quantity and structure at the North of Xinjiang.The radiation medical resource in Urumqi was much better than other regions.The allocation of radiation diagnosis equipments in different regions was fair,but the nuclear medicine and radiation therapy equipments were not due to the high cost and operation requirements of corresponding radiation equipments.The configuration of radiation protective supplies matched the basic requirements of national laws and regulations,but that of radiation quality control equipments were much insufficient.The occupational health monitoring indexes of medical radiation workers met the relevant national standards.2)Occupational stress,job burnout and depression of medical radiation workers were high.Job position,radiation work type,radiation seniority,organs sensitive to occupational exposure had impacts on occupational mental health of medical radiation workers.Nurse,diagnostic radiology and interventional radiology,radiation seniority?5 years,suffering from thyroid disease and visual damage increased the risk of occupational mental health.The aggravation of occupational stress and job burnout seriously affected the work ability of occupational groups.It was suggested that employers should pay more attention to occupational health monitoring,as well as mental health management.Optimizing the management process,strengthening occupational health education,and improving the awareness of radiation protection can alleviate the adverse occupational psychological emotions,and thereby promote the occupational physical and mental health of medical radiation workers.3)Workplace improvement should focus on the radiation protection performance,personal protective supplies and ionizing radiation warning signs;and occupational health education should include the basic knowledge of radiation protection and mental health,laws and regulations of radiation health supervision,strategies of radiation utilization according to different radiation work types.Reasonable intervention program in workplace improvement and occupational health education was conducive to the promotion of occupational mental health of medical radiation workers.