{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:01:47Z","timestamp":1785132107792,"version":"3.55.0"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the prevalence of gastrointestinal symptoms (reflux, nausea, and vomiting) among nurses in COVID-19 isolation wards and identify associated factors, with a specific focus on discomfort caused by personal protective equipment (PPE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In March 2020, 354 of 368 eligible nurses (96.2% response rate) from the COVID-19 isolation wards of a designated hospital in Wenzhou, China, completed the survey. Data were collected using a demographic questionnaire, a self-rated PPE discomfort scale, the Gastroesophageal Reflux Disease Questionnaire (GerdQ), the Pittsburgh Sleep Quality Index (PSQI), and the Symptom Checklist-90 (SCL-90). Statistical assessments included univariate, correlation, and multivariable logistic regression analyses. Firth's penalized likelihood logistic regression and sensitivity analyses were applied to address sparse data in specific subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall prevalence of gastrointestinal symptoms in the cohort was 23.2% (82\/354). Multivariable regression identified several independent factors significantly associated with these symptoms (all\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01): severe PPE-induced discomfort (\n                      <jats:italic>OR<\/jats:italic>\n                      = 3.64, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 1.95\u20136.80), elevated psychological stress (SCL-90 total score:\n                      <jats:italic>OR<\/jats:italic>\n                      = 1.14, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 1.09\u20131.20), and poor sleep quality (PSQI total score:\n                      <jats:italic>OR<\/jats:italic>\n                      = 2.10, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 1.51\u20132.92). Although univariate analyses suggested protective associations for prior intensive care unit (ICU) experience and male gender, these effects lost statistical significance following Firth correction. Temporally, 76.8% of symptomatic cases emerged within the first five days of the shift cycle.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Gastrointestinal symptoms are prevalent among nurses in COVID-19 isolation wards and are strongly associated with PPE-induced discomfort, psychological stress, and sleep disturbances. Although the cross-sectional design precludes causal inference, these findings underscore an urgent need for the ergonomic optimization of PPE to alleviate heat stress and physical burden. Furthermore, implementing rapid adaptation training programs and integrating psychological and sleep support into routine occupational health surveillance are vital to safeguarding frontline clinicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1827949","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:40:50Z","timestamp":1785130850000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Gastrointestinal symptoms associated with PPE use among nurses in COVID-19 wards: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Wenyu","family":"Li","sequence":"first","affiliation":[{"name":"Emergency Department, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xutao","family":"Wu","sequence":"additional","affiliation":[{"name":"Emergency Department, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yani","family":"Yan","sequence":"additional","affiliation":[{"name":"Emergency Department, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyang","family":"Xie","sequence":"additional","affiliation":[{"name":"Coronary Care Unit (CCU), The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Huang","sequence":"additional","affiliation":[{"name":"Emergency Department, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianlian","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaozhi","family":"Tian","sequence":"additional","affiliation":[{"name":"Emergency Department, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengjie","family":"Dai","sequence":"additional","affiliation":[{"name":"Emergency Department, Longgang Branch, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longcha","family":"Liu","sequence":"additional","affiliation":[{"name":"Coronary Care Unit (CCU), The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqun","family":"Xu","sequence":"additional","affiliation":[{"name":"Nursing Department, The First Affiliated Hospital of Wenzhou Medical University","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1111\/anae.15071","article-title":"Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review","volume":"75","author":"Cook","year":"2020","journal-title":"Anaesthesia."},{"key":"B2","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1093\/cid\/cix956","article-title":"Assessing viral transfer during doffing of Ebola-level personal protective equipment in a biocontainment unit","volume":"66","author":"Casanova","year":"2018","journal-title":"Clin Infect Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1093\/occmed\/kqac114","article-title":"Heat stress associated with aerosol PPE and its impact","volume":"73","author":"Chaudhari","year":"2023","journal-title":"Occup Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jhin.2020.11.027","article-title":"Heat stress and PPE during COVID-19: impact on healthcare workers' performance, safety and well-being in NHS settings","volume":"108","author":"Davey","year":"2021","journal-title":"J Hosp Infect."},{"key":"B5","doi-asserted-by":"publisher","first-page":"3444","DOI":"10.1111\/jocn.17695","article-title":"Skin problems in the facial area due to the use of personal protective equipment in healthcare workers: a systematic review","volume":"34","author":"\u00c7akar","year":"2025","journal-title":"J Clin Nurs."},{"key":"B6","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1111\/head.13811","article-title":"Headaches associated with personal protective equipment - a cross-sectional study among frontline healthcare workers during COVID-19","volume":"60","author":"Ong","year":"2020","journal-title":"Headache."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e13477","DOI":"10.1111\/dth.13477","article-title":"Itch in the era of COVID-19 pandemic: an unfolding scenario","volume":"33","author":"Stefaniak","year":"2020","journal-title":"Dermatol Ther."},{"key":"B8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin Nutr."},{"key":"B9","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: an international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"CD011621","DOI":"10.1002\/14651858.CD011621.pub4","article-title":"Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff","volume":"4","author":"Verbeek","year":"2020","journal-title":"Cochrane Database Syst Rev."},{"key":"B11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3760\/j.issn:0254-1432.2003.11.004","article-title":"The value of the reflux disease questionnaire in the diagnosis of gastroesophageal reflux disease [in Chinese]","volume":"11","year":"2003","journal-title":"Chin J Dig"},{"key":"B12","doi-asserted-by":"publisher","first-page":"260","DOI":"10.3969\/j.issn.1671-8348.2014.03.002","article-title":"Analysis on reliability and validity of the Pittsburgh Sleep Quality Index [in Chinese]","volume":"43","author":"Lu","year":"2014","journal-title":"Chongqing Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3969\/j.issn.1009-6574.2006.02.030","article-title":"Evaluation of the SCL-90 scale [in Chinese]","volume":"2","author":"Xie","year":"2006","journal-title":"J Neurosci Ment Health."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3451","DOI":"10.3892\/etm.2020.8646","article-title":"COVID-19 pandemic and its impact on mental health of healthcare professionals","volume":"19","author":"Tsamakis","year":"2020","journal-title":"Exp Ther Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"706","DOI":"10.14188\/j.1671-8852.2020.0154","article-title":"Mental health status of medical staff during the outbreak of coronavirus disease 2019 [in Chinese]","volume":"41","author":"Wang","year":"2020","journal-title":"Med J Wuhan Univ."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.1053\/j.gastro.2006.10.026","article-title":"Neuroimaging of the brain-gut axis: from basic understanding to treatment of functional GI disorders","volume":"131","author":"Mayer","year":"2006","journal-title":"Gastroenterology."},{"key":"B17","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1007\/s10620-012-2377-z","article-title":"The association between reflux esophagitis and psychosocial stress","volume":"58","author":"Song","year":"2013","journal-title":"Dig Dis Sci."},{"key":"B18","doi-asserted-by":"publisher","first-page":"G32","DOI":"10.1152\/ajpgi.00067.2016","article-title":"Enhanced sympathetic nerve activity induced by neonatal colon inflammation induces gastric hypersensitivity and anxiety-like behavior in adult rats","volume":"311","author":"Winston","year":"2016","journal-title":"Am J Physiol Gastrointest Liver Physiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"319","DOI":"10.2466\/pms.1968.27.1.319","article-title":"Responses to confinement: an investigation of sensory deprivation, social isolation, restriction of movement and set factors","volume":"27","author":"Zuckerman","year":"1968","journal-title":"Percept Mot Skills."},{"key":"B20","doi-asserted-by":"publisher","first-page":"G519","DOI":"10.1152\/ajpgi.2001.280.4.G519","article-title":"Stress and irritable bowel syndrome","volume":"280","author":"Mayer","year":"2001","journal-title":"Am J Physiol Gastrointest Liver Physiol."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1827949\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:40:55Z","timestamp":1785130855000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1827949\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":20,"alternative-id":["10.3389\/fpubh.2026.1827949"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1827949","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"article-number":"1827949"}}