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Aim: To evaluate operating room nurses' perception of teamwork performance and their level of mental stress and to identify related factors. Background:Little is known about the factors affecting teamwork and the mental stress of surgical nurses, although the performance of the surgical team is essential for patient safety. Methods:The questionnaire survey for operation room nurses consisted of simple questions about teamwork performance and mental stress. Multivariate analyses were used to identify factors causing a sense of teamwork performance or mental stress.Results: A large number of surgical nurses had a sense of teamwork performance, but 30-40% of operation room nurses were mentally stressed during surgery. Neither the patient nor the operation factors were related to the sense of teamwork performance in both types of nurses. Among scrub nurses, endoscopic and abdominal surgery, body mass index, blood loss and the American Society of Anesthesiologists physical status class were related to their mental stress. Conversely, circulating nurses were stressed about teamwork performance. Conclusions:The factors related to teamwork performance and mental stress during surgery differed between scrub and circulating nurses. Implications for nursing management:Increased support for operation room nurses is necessary. The increased support leads to safer surgical procedures and better patient outcomes. K E Y W O R D Smental stress, operation room, teamwork performance

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Background: Although multiple combinations of weather factors may contribute to an increased incidence of Mycoplasma pneumoniae pneumonia, few studies have investigated the association between weather factors and cases of M pneumoniae pneumonia. Methods: Data on cases of M pneumoniae pneumonia and weather factors in Fukuoka, Japan from 1999 to 2007 were obtained and time-series analysis was used to assess the effects of weather variables on M pneumoniae pneumonia cases, adjusting for confounding factors. A total of 13 056 M pneumoniae pneumonia cases were reported during the 9-year study period, of which 12 234 (93.7%) were under 15 years of age. Results: The weekly number of M pneumoniae pneumonia cases increased by 16.9% (95% CI 11.3% to 22.8%) for every 1uC increase in the average temperature and by 4.1% (95% CI 2.7% to 5.5%) for every 1% increase in relative humidity. Conclusions: From 1999 to 2007, cases of M pneumoniae pneumonia increased significantly with increased average temperature and relative humidity in Fukuoka, Japan.Mycoplasma pneumoniae (M pneumoniae) is a common respiratory pathogen that affects both upper and lower respiratory tract infections in all age groups.1 2 This agent is estimated to be responsible for 15-20% of all cases of community-acquired pneumonia (CAP) and as many as 40% of cases among children.2 3 An estimated 30% or more of M pneumoniae infections in children aged 5-15 years result in pneumonia, and as many as 18% of these cases require hospitalisation. 5M pneumoniae infections can occur worldwide, with outbreaks occurring cyclically every 3-7 years. 6 7 A study has shown that M pneumoniae infection did not show seasonal variations; 8 in contrast, however, recent studies have shown that M pneumoniae infection peaks in winter 9 or spring, 10 and this aetiology should be considered first when it occurs in the summer and autumn months. 11 The clear cyclical and seasonal occurrence suggests that climatic factors could play a role. Moreover, another study has shown that the most important factor explaining the variance in CAP is the direct and indirect effects of meteorological variables. 12However, few quantitative studies have investigated the impact of weather factors and variability on the incidence of M pneumoniae pneumonia, allowing for the mutual confounding between weather factors and potential confounding by other seasonally varying factors. The objective of this study was to investigate the relationship between weather variations and the weekly incidence of M pneumoniae pneumonia between 1999 and 2007 in Fukuoka, Japan using time-series methodology.

The increasing international interest in the potential health effects of climate change has emphasized the importance of investigations into the relationship between weather variability and infectious diseases. However, few studies have examined the impact of weather variability on mumps in children, despite the fact that children are considered particularly vulnerable to climate change. We acquired data about cases of mumps in children aged <15 years and weather variability in Fukuoka, Japan from 2000 to 2008, and then used time-series analyses to assess how weather variability affected mumps cases, adjusting for seasonal variations, inter-annual variations, and temporal variations of two large epidemics in 2001 and 2004-2005. The weekly number of mumps cases increased by 7·5% (95% CI 4·0-11·1) for every 1°C increase in average temperature and by 1·4% (95% CI 0·5-2·4) for every 1% increase in relative humidity. The percentage increase was greatest in the 0-4 years age group and tended to decrease with increasing age. The number of mumps cases in children increased significantly with increased average temperature and relative humidity.