Shiraz E-Medical Journal
Year:2023 | Volume:24 | Issue:1|Papers Count:8

Background: Shift work disrupts the sleep rhythm and leads to daily sleepiness and physical and mental complications. Objectives: This study aimed to investigate the predictive role of shift work in poor sleep quality and daytime sleepiness in railway personnel. Methods: This descriptive-analytical and cross-sectional study was conducted on the employees of the Khorasan railway in Iran in 2021, 450 individuals of whom were selected as a sample using the census sampling method. The data collection method was through a checklist containing demographic information and related factors (e. g., employment history) and through a physician to evaluate underlying diseases, body mass index (BMI), smoking and use of substances (past medical history), and completion of standard questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Karolinska Sleepiness Scale (KSS), and STOP-BANG questionnaire. The data were analyzed using the t-test and simultaneous multivariate regression analysis by SPSS software (version 24). Results: Out of 450 employees, 144 (32%) and 306 (68%) subjects were day workers and shift workers, respectively. The average age of the participants was 40 ±,5. 97 years. A signifi, cant diff, erence was observed between the BMI with PSQI, KSS, and STOP-BANG scores (P = 0. 001). Additionally, binary logistic regression analysis showed that shift work had a signifi, cant eff, ect as a risk factor on both PSQI scores (CR = 1. 25, 95% CI: 1. 16-1. 32, P = 0. 001) and KSS scores (CR = 1. 43, 95% CI: 1. 29-1. 59, P = 0. 001). Conclusions: Shift work could increase the amount of sleepiness during work in personnel as the main cause, along with other eff, ective factors, such as personal and occupational characteristics.

Context: Iranian community health workers (known as behvarzes) have played an undeniable role in improving the health status of the rural community in recent decades. Therefore, this study aimed to identify the performance challenges faced by behvarzes using a literature review. Methods: This systematic review searched the Web of Science, Scopus, Science Direct, Springer, PubMed, ProQuest, SID, and Magiran databases/search engines in January 2020. There were 2 inclusion criteria, namely articles published in English or Persian languages and those published in or after 2000. The search strategy resulted in the retrieval of 1, 472 primary articles, 16 of which were fi, nally included in the study, and their related contents were entered into extraction tables. Then, the identifi, ed challenges were categorized based on the context, input, process, and product (CIPP) model. Results: The study results recognized the major challenges in 5 dimensions, including context (i. e., changes in societal, cultural, demographical, and epidemiological characteristics of rural communities), input (i. e., inadequate number of behvarzes, their insuffi, cient competencies, and limited resources), process (i. e., increase in healthcare process complexity and the number of bahvarzes’,tasks and managerial problems), output (i. e., decrease in the quality, effi, ciency, accessibility, continuity, utilization, and eff, ectiveness of services provided by behvarzes, poor health literacy of rural population and their weak involvement in health aff, airs, and emerging mental health problems in behvarzes), and outcome (i. e., low equity, urban-rural disparity in the diagnosis and treatment of diseases, and dissatisfaction of behvarzes and caregivers). Conclusions: This study revealed numerous important challenges faced by behvarzes, which need eff, ective intervention by policymakers.

Background: Infectious hospital waste, including needles and sharp instruments, is one of the most important causes of needle sticks. Objectives: The study aimed to investigate the factors aff, ecting the disposal of special medical waste with needle sticks among healthcare workers in hospitals at the Iran University of Medical Sciences. Methods: This descriptive-analytical, retrospective, and cross-sectional study were done regarding the data in the autumn of 2019. Among 6119 medical-service staff, , 180 subjects have been exposed to the needle stick at least once. Data were collected in two parts. The data were analyzed using correlation tests by SPSS software version 25. Results: The most devices leading to injury were needles (58%), angiocatheter (21%), ampoules (17%), suture needles (12%), scalpels (9%), other tools (8%), and razor blades (7%). The fi, ve wards with the highest needle sticks were the operating room (24. 44%), surgery (22. 22%), emergency (15%), internal wards (10%), and paraclinical (8. 33%). Also, several factors, such as work shifts and the amount of work experience of individuals, can play an essential role in the rate of needle stitching of medical personnel. Importantly, we found a signifi, cant relationship between the volume of medical waste and employee needlestick rates. Conclusions: According to the results, we found a signifi, cant positive relationship between the volume of medical waste and employees’,needle sticking rate. The observance of standard guidelines and the development and increase of occupational safety protection training courses have the most signifi, cant role in reducing needle sticks.

Background: Low back pain is one of the most common causes of clinic referrals. In most patients, radicular pain results from the compression or injury of the proximal nerve root or dorsal root ganglion. Objectives: This study aimed to investigate the electrodiagnostic involvement of lumbar nerve roots in patients with lumbar radicular pain undergoing electromyography (EMG) and nerve conduction study. Methods: The sample population was selected from 18-70-year-old patients who had fi, les in the clinic, complaining of lumbar pain radiating to the lower extremities for at least 2 months. Patient data were extracted from the available data and recorded in a separate anonymous information sheet. Results: This study was carried out on 352 patients with lumbar radicular pain. In addition to radicular pain, paresthesia was present in 86 patients (24. 4%). Out of 352 patients with radicular pain, 294 cases (83. 52%) showed unilateral or bilateral involvement in EMG. Among those who had paresthesia, 74 patients (86%) showed nerve root involvement in EMG. Conclusions: This study indicated the compatibility between lumbar radicular pain symptoms and the features observed in EMG, particularly in areas of paresthesia or the side of pain. Therefore, the patient’, s symptoms can help predict nerve root involvement in the electrodiagnostic study before conducting this test.

Background: Health insurance is one of the important parts of fi, nancing in the health system to reduce inequality in household health expenditures. Objectives: This study aimed to investigate the role of health insurance in facing health expenditures among urban female-headed households in Iran. Methods: This descriptive-analytical applied study was performed cross-sectionally using the double-sample selection econometrics method in Stata software (version 16) in 2021. The sample included 2645 female-headed households, and the data were prepared by the Statistics Center of Iran using a questionnaire. Results: The results showed that social security insurance, private insurance, and insurance of special organizations led to an increase in the health expenditures of female-headed households by 159896, 334137, and 18332 Rials, respectively. Increasing household size, having children, having an elderly person, increasing per capita income, and per capita tobacco expenditures led to an increase in the health expenditures of female-headed households by 875260, 1545153, 2441094, 0. 32, and 1. 65 Rials, respectively. Conclusions: Private insurance, social security insurance, and insurance of special organizations had the greatest impact on increasing the health expenditures of female-headed households, respectively. Therefore, it is necessary to create an integrated health insurance system that reduces insurance organizations and funds and provides the same level of coverage for health goods and services. It is also suggested to adopt policies to increase the educational level of female-headed households to reduce health expenditures.

Dear Editor, Today a movement toward competency-based medical education (CBME), as an outcome-based method compared to the traditional time-based medical training method (1), is required. Worldwide adoption of competency-based assessment to guarantee the achievement and maintenance of competence will require evaluations, both during training and in unsupervised practice. The CBME needs many alterations and adaptations in academic health sciences systems. Although a series of medical high-stakes examinations are administered by the diff, erent national boards of medical examiners worldwide during medical education and even after completion for various reasons such as promotion to a higher year, graduation, obtaining a certifi, cate, etc., it could be challenging to sustain a single and consistent approach for the decision-making process in such high volumes and repeatability. Therefore, achieving high consistency, low delays, resolving bottlenecks, and competency-based assessment in this process must be considered. . .

Dear Editor, We read the paper of Samimagham et al. (1), which was recently published in Shiraz E-Medical Journal and attracted wide interest and attention. In that article, the authors reported two cases with possible recurrent COVID-19 infection. However, there are some points that can be addressed. COVID-19 re-infection and its viral reactivation are two controversial issues. According to a recently published population-level observational study, protection against re-infection with SARS-CoV-2 can be more than 80% among people aged less than 65 years,however, it is about 47% in older cases (2). Although it is not precisely known, previous studies suggest that the reduced risk of re-infection with SARS-CoV-2 lasts for about 5 to 6 months after the primary infection (2-4). It has been suggested that viral re-infection is rare and aff, ects less than 1% of all patients with COVID-19 (2). . .

Background: Coronary artery bypass graft (CABG) is a common surgical procedure in patients with heart disease associated with pain and problems with great saphenous veins (GSVs) wound healing. Objectives: We aimed to determine the eff, ect of aloe vera gel on pain intensity, and GSVs wound healing in non-diabetic patients undergoing CABG. Methods: In this clinical trial, 35 CABG candidate patients fulfi, lling admission criteria were selected by convenience sampling, and their lower limbs were randomly assigned to the intervention or control group. The wound care for both groups was the same except for using aloe vera gel for the intervention group from the fi, rst to the fourth days after surgery. Pain intensity and GSVs wound healing data were collected by Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) scale and Visual Analog Scale (VAS) questionnaires on the fi, rst, fourth, seventh, and fourteenth days and analyzed by SPSS software. Results: On the seventh day, the mean pain intensity in the intervention group was signifi, cantly lower (P = 0. 01). The mean scores of wound healing in the intervention limb decreased faster,however, the wound healing score was not signifi, cantly diff, erent between the two groups at any time (P > 0. 05). Using aloe vera gel reduced ecchymosis on the seventh and fourteenth days and reduced pain on the seventh day compared to the control limb (P < 0. 001). Conclusions: Aloe vera gel can eff, ectively reduce GSVs’,pain intensity and ecchymosis from the seventh day. The topical application of this herb can have various degrees of eff, ectiveness in decreasing pain and speeding up the healing of surgical wounds.