Iran Occupational Health

---

Background and aims

Scientific and industrial development has led to increased production,which has been associated with different complications, including occupational stress, and increased incidence of work-related musculoskeletal disorders. Musculoskeletal disorders are

frequent causes of absenteeism in developed countries. We designed this study to assess musculoskeletal disorders and occupational stress among video display terminal (VDT) workers in comparison with other office workers.

Methods

This was a cross-sectional study on 72 VDT workers (case) and 145 office workers (control). In this study we used Nordic and Osipow questionnaires in order to evaluate musculoskeletal disorders and job stress, respectively. The questionnaires were filled by direct interview. T test, chi square, Fisher test and logistic regression were used for data analysis.

Results

The frequency of musculoskeletal disorders among VDT users in the last 12 months was 46.5%, 20.3%, 5.1%, 12.4% and 57.6% in neck, shoulder, elbow, wrist and low back areas, respectively. The frequency of musculoskeletal complaints in neck, shoulder and wrist and mean score of occupational stress was significantly higher in the case group comparing with control

group, and both results were statistically significant.

Conclusion

VDT working is a high-risk job for musculoskeletal disorders. In this study the frequency of musculoskeletal disorders, especially in high-risk regions for this job, was higher in VDTworkers than other office workers. We recommend to perform other studies in order to find non-ergonomic points and postures in these persons.

---

  Background and Aims: In a healthy organization, staff's physical and mental health is as important and considerable as production and productivity. Burnout is a result of long-term tension and stress in the job environment. Its symptoms occur when employees' power and potency is not enough for the job environment demands. Emotional exhaustion, depersonalization and lack of personal accomplishment are three dimensions of burnout. In this survey we studied the nursing job environment considering nurses' participation in hospital affairs, foundation for quality of nursing care, managerial support and leadership, staffing/resource adequacy and collegial nurse-physician relation and their effects on nurses' burnout level.

  Methods:

  This survey is a cross-sectional, descriptive-analytical study to review of nursing job environment on nurses' burnout dimensions in TUMS (Tehran …) general-teaching hospitals in 1386. For this study, 214 nurses (confidence interval %95, powers %80 and attrition %30) were selected randomly. Data were gathered using Maslach Burnout Inventory (MBI) and Nursing Work Index(NWI) questionnaires filled in by studied nurses.

  The validity of these questionnaires determined using masters' instructions. To determine the reliability of NWI questionnaire, a pilot study was conducted and its reliability coefficient (Cronbach’s alpha) was 0.88. The reliability and internal validity of MBI questionnaire had been proved in previous studies. Data were analyzed by SPSS 11.5 and Logistic regression and Chi-Square test.

  Results:

  Results show that hospital type and nurses' sex have effects on lack of personal accomplishment frequency and hospital type influences lack of personal accomplishment severity. Depersonalization frequency is effected negatively by decreasing foundation for quality of nursing care (OR=2.326) and lack of managerial support and leadership (OR=4.553) and limited collegial nurse-physician relation (OR=1.339). Depersonalization severity is influenced negatively by decreasing foundation for quality of nursing care (OR=3.310). Lack of managerial support and leadership (OR=2.152) effects negatively on emotional exhaustion frequency, and finally, exhaustion severity is effected negatively by lack of foundation for quality of nursing care (OR=3.838), staffing/resource adequacy (OR=2.440) and collegial nurse-physician relation (OR=2.552). Also, logistic regression results show that all mentioned relationships (given standard errors) are positive that means increasing a variable results in increasing the other variable and vice versa.

  conclusion:

  The type and numbers of patients refer to the studied hospitals, using flexible working models, applying new working ideas, team working, participating in hospital affairs, preparing educational and preferment opportunities for employees, providing managerial support etc. have important effects on the frequency and severity of burnout dimensions.

 

---

Background and aims: Patient safety is one of the main factors in quality of services provided by a health system. Patient safety culture plays a key role in improvement of patient safety, reduction of medical errors, and prevention of adverse events in health care organizations. Thereby, the present study is aimed to survey patient safety culture in hospitals of Neyshabur University of Medical Sciences.

 Method: This research was a cross sectional study that conducted on all qualified staff of hospitals affiliated with Neyshabur University of Medical Sciences in 2013. Hospital Survey of Patient Safety Culture (HSOPSC) questionnaire was used to assess patient safety culture. The collected data were analyzed in SPSS (16), using Chi-Square test and logistic regression model.

 Results: Total score average of patient safety culture was 25.50±9.52. The results showed that among the twelve dimensions the highest and lowest scores were obtained by the supervisor/ manager expectations & actions promoting patient safety (score rate 45%) and the reporting frequency of adverse events (score rate 15%) respectively. According to logistic regression model there was also significant relationship between the patient safety culture and direct contact with the patient, employment duration in hospital, and current unit (p<0.05).

 Conclusion: Total average of patient safety culture and scores of all twelve dimensions were lower than the acceptable criteria. Patient safety culture in the studied hospitals urgently needs enhancement and improvement. So, creating policies to institutionalize and enhance patient safety culture among the staffs are recommended.

---

Background and aims: Musculoskeletal disorders are the most prevalent occupational injuries and disability in the world. One of the most important risk factors of these disorders is awkward posture. Previous studies reported high prevalence of musculoskeletal disorders in medical laboratory personnel. This study was carried out to determine Prevalence and postural risk factors associated with musculoskeletal disorders among medical laboratory personnel in Kashan in 2012. Material and Methods: This cross-sectional study was carried on 168 clinical laboratories staff in Kashan. Standard Cornell questionnaire was used to determine the prevalence of work-related musculoskeletal disorders and quick exposure check (QEC) method was used for analyzing posture. Data were analyzed using descriptive statistical methods and logistic regression analysis.

Results: 155 of these personnel (92.3 percent) suffer from pain and have disorder at least 1-2 times per week. The incidence of neck disorders is more than other limbs. There is no significant deference between musculoskeletal disorders with age and sex. Only 47 percent of the participants in the overall level of risk have acceptable posture. There is significant relationship between prevalence of musculoskeletal disorders and awkward posture.

Conclusion: Prevalence of musculoskeletal disorders in clinical laboratories staff is high. Awkward posture is one of the main causes of the disorders and ergonomics interventions for improvement of work station in medical laboratory is essential.

---

Background and aims: The operating room is a critical place for accident. One of the events that is likely to occur at this location is fire accident during the surgery. Despite of this truth that such accident rarely happen, but they can lead to serious injury or death of patients. Therefore the purpose of this study is the assessment of awareness and practice of operating room personnel about prevention of fire and effective factors in operating room in Khuzestan hospitals.

  Methods: This Cross-sectional study was conducted among operating room in Khuzestan hospitals in 2013. In this study, all operating rooms personnel were investigated, in random sampling. Questionnaires were used to collect information and knowledge and practice of operating room personnel about preventing of fire, the relationship between these two factors with the age, work experience and the effect of training, education, sex and job title was considered. To examine the relationship between variants, the SPSS16 was used and compare the groups the Mann–Whitney was used.

Results: The Result show that in aware, 15% were high aware, 25% were medium aware, 48/4% were poor aware and 11/1% were unaware, also in operation, 87/2% were high operating, 14/2% were medium operating, 6/7% were poor operating and 8% were very poor. There was no relation between the age and work experience with awareness and operation in Kendal's correlation test (P>0.05). the comparison test in this study show that training is effective on operation and awareness (p<0.05), but there isn’t any significant different between awareness and operation of man and women. Also there was a significant difference in comparison of average scores of awareness between education levels (technician and bachelor) (P<0/05), but there isn’t any significant differences between the kind of jobs (P>0/05). This study show that the level of operation of operation room personnel is more than anesthesia personnel and the differences is significant (p<0.05).

 Conclusion: the results from this study and previous ones indicate that awareness about fire prevention ways between operating room personnel is low and their safety in not satisfied. To increase the awareness about fire prevention ways is operating room, It is suggested to execute safety courses for different levels, aware the personnel about the potential dangers and create a suitable and effective reporting system for happenings.

---

Abstract
Background and aims: The previous studies has shown high incidence of accidents and occupational injuries in metal smelting industry because of the nature of the processes. It was also found that more than 70 percent of the accidents occur due to workers' unsafe behaviors. The aim of this study was to investigate and analysis of workers' unsafe acts in metal smelting industry in Kashan in 2016.
Methods: This cross-sectional study was conducted on 178 Metal smelting Industry Workers. Workers' unsafe behaviors were determined by observation method using Tarannt checklist. Demographic data were collected by Self-made questionnaire. Data were analyzed using chi-square-test, t-test, ANOVA and linear regression by SPSS16 software.
Results: 43.23 percent out of Workers' behaviors was unsafe. The most of the unsafe behaviors was Non-use of personal protective equipment and the least of them was indiscretion. The significant differences were observed between unsafe behaviors and age, education level, smoking, work stations and safety and health training (p<0.05).
Conclusion: The study showed high prevalence of unsafe acts in metal smelting industry. The most of workers 'unsafe acts was related to lack of use of personal protective equipment. Producing and distributing high-quality personal protective equipment, encouraging the use of these devices and specialized training courses in the field, can reduce workers' unsafe acts and occupational accidents effectively.
 
Keywords: Unsafe behavior, Occupational accidents, Metal smelting industry.

---

Background and Objective: Inappropriate atmospheric conditions are harmful factors that cause particular problems in certain seasons (summer or winter). The occupation of confectionery in the regions like Ilam causes severe problems due to the heat generated by the nature of the work (synthetic heat-generating processes) and the heat resulting from the climatic conditions in the region. Exposure to excessive heat, in addition to disrupting the physiology and health of the individuals that may cause many diseases and complications, also affects their efficiency and safety. One of the indices of heat stress is the WBGT index, confirmed by various national and international organizations and institutions as the standard method for measuring heat stress. WBGT index engages important environmental factors directly or indirectly in its computational structure. The Discomfort Index (DI) has been recommended for more than four decades along with the WBGT index for the evaluation of warm environments. Today, the oral temperature is used to determine the heat stress and strain. In addition, oral temperature is one of the important parameters for the validation of indices. Therefore, in order to prevent the occurrence of heat stress complications in occupational environments, a study was conducted to determine the amount of heat stress in the employees of confectionery workshops in Ilam city, so as to identify the factors affecting the heat stress of workers and to provide recommendations for the reduction of these risk factors and to create a healthy working environment.
Methods: This descriptive-analytical study was carried out on 104 workers in 35 confectionary workshops in summer of 2017. The sample size was selected based on census method. Prior to the study, the workers were monitored through medical records and interviews, and, two of them did not qualify for inclusion in the study. Measurement of the study variables was performed at the hottest work hours (10 to 14), once for each worker, in the worst workstation (nearest to the heat source). In the present study, four groups of occupations, i.e. workers of oven, mixer, flattener, cleaning and packaging, three types of ovens, i.e. layered, winch and furnace, and three productions of wet and dry pastry, cake and French bread, Baghlava and Ka’ak. Assessment of heat stress was performed by the WBGT (based on ISO7243 standard) and the DI indices. Metabolism and activity of workers were calculated according to the ACGIH standard. Also, the working pattern was 75% of the work-25% of the rest, and according to ISO 9920, the clothing insulation coefficient in WBGT calculations was 0.6 clo. Along with the environmental parameters such as dry bulb temperature, natural wet bulb temperature, globe bulb temperature, relative humidity and dew point temperature, the oral temperature of the workers was measured by a digital medical thermometer. Finally, data analysis was performed using SPSS v.22 and statistical tests of Kolmogorov-Smirnov, Mann-Whitney, Kruskal-Wallis, one-way ANOVA and Pearson correlation were performed.
Results: Findings of this study showed that the mean of WBGT index in the workers of oven, mixer, flattener, cleaning and packaging was 33.66±3.96, 29.58±3.05, 31.73±3.61 and 29.87±2.4. Also, this index was 30.94±3.86, 34.14±3.89, and 32.2±2.91 for the winch (wet and dry pastry), layered (cake and French bread), and furnace (Baghlava and Ka’ak) ovens (products). These results show that the amount of heat stress in working with the oven and the cake and French bread product (layered oven) was more than others. Kruskal Wallis tests and one way ANOVA showed a significant difference between the mean of WBGT and DI indices with job variables, type of oven and products (p <0.05). A 95% confidence interval was observed in terms of the WBGT index between the subgroups of the oven and flattener, oven and cleaning and packing, layered oven and winch oven, and French bread and the wet and dry pastry. However, in terms of the DI index, this difference was found between the sub-groups of the oven and cleaning and packing, oven and mixer with flattener, layered oven and winch oven, and French bread and the wet and dry pastry. Pearson correlation test showed that there was no significant correlation between oral temperature and indices and variables (p<0.05). Based on the results of this study, the mean of WBGT index at the heights of head, waist and ankle was 32.54±5.01, 31.54±3.86 and 30.49±3.12, respectively. Also, according to Kruskal Wallis statistical tests and one way ANOVA, there was a significant difference in WBGT index and dry bulb temperature, natural wet bulb temperature, globe bulb temperature and relative humidity at the heights of head, waist and ankle (P <0.05). The results of the Mann-Whitney test indicated that there was a significant difference between the gender variable and the oral temperature (p <0.05), with the mean of this variable was higher in women (36.7±0.27) than men (36.42±0.84). The results of this study showed that 85.6% of the subjects had a “severe” discomfort index (DI), and regarding the WBGT index, 14.4% and 85.6% were lower and higher than the threshold, respectively.
Conclusion: According to the results, almost all of the workers in the confectionary workshops are exposed to heat stress, but subgroups of oven, mixer, layered oven (cake and French bread), furnace oven (Baghlava and Ka’ak) and the females were exposed to higher stress. So, these subjects have a priority when adopting control measures. It is recommended that measures such as pre-employment examinations, preparation of proper drinks, training the workers, reduction of working time, using thermal shields, using air conditioning system, and paying particular attention to reducing the wet temperature and relative humidity of the workplace are taken to minimize the exposure to heat and the resulting diseases. 

---

ABSTRACT
Introduction: Nowadays, due to the increase in violence against emergency medical technicians and the adverse effects of these behaviors on physical and mental health, as well as employee productivity, it seems necessary to investigate occupational violence and try to reduce it. Therefore, the present study was conducted to investigate the level of violence in the workplace against emergency medical technicians of Mashhad University of Medical Sciences and related factors.
Methods and Materials: This was a cross-sectional study performed on 204 emergency medical technicians of Mashhad University of Medical Sciences. The sampling method was census. The data collection tool was a researcher-made questionnaire. Data were analyzed using descriptive statistics and statistical tests including chi-square, t-test and analysis of variance using Stata software.
Results: The response rate was 19.2%. Findings showed that 78.92% of the subjects in the past year have experienced at least one type of violence. The most common type of violence was verbal violence. 70.10% of the violence occurred at the scene of accident and the patient's family was the main group of perpetrators of violence (59.31%). There was a significant relationship between the rate of physical violence with the rate of verbal and cultural violence (P-value≤0.05).
Conclusion: Emergency medical technicians are always exposed to different types of occupational violence, so training in violence management and communication skills, as well as follow-up of violence by the relevant authorities, is recommended to reduce the violence.
KEYWORDS: occupational violence; emergency medical staff; paramedics

---

Background and Aim: Teachers experience more mental health problems due to teaching-learning activities compared to other employees. Optimum use of talents can reduce job stress and prevent teachers from psychological damage. Therefore, the current research was conducted with the aim of designing a model of using talents and its role in the mental health of teachers of primary schools in Ardabil city.
Materials and methods: The present research was conducted with a qualitative-quantitative mixed method. In the quantitative stage, among the 1632 elementary school teachers in Ardabil, 320 people were selected using Morgan's table by multi-stage and stratified sampling method, and the questionnaire was distributed among them. The statistical population of the research in the qualitative phase was an elite group consisting of principals and teachers sampled in the last three years, experts in elementary education, and 20 of them were interviewed with the purposeful sampling method and in terms of theoretical saturation. After analyzing the qualitative data, a researcher-made questionnaire of 46 questions was compiled, which was confirmed by the supervisors and advisors, and the combined reliability, Cronbach's alpha and AVE were obtained as 0.78, 0.84 and 0.58, respectively, which shows that It has good reliability (values ​​above 0.7, 0.7 and 0.5 respectively are considered strong for these indicators). Quantitative data were analyzed using structural equation method in Smart PLS2.
Results: The findings of the research showed that the components of talent utilization include provision of talented human resources (Beta=0.371, T.valu=2.842), intelligence of goals (Beta=0.418, T.valu=5.702) and training facilities (Beta=0.348), T.valu=3.440) have a positive and significant effect on the deployment strategy of talent management, and the talent management deployment strategy (T.valu=36.624, Beta=0.862) has a significant effect on teachers' mental health.
Conclusion: According to the results of the research, the use of talents by attracting talented and interested people and by applying the necessary strategies and contexts can have a very important effect on improving the mental health of primary school teachers. Therefore, the authorities can protect the mental health of teachers by paying attention to the effective components in using talents and removing obstacles and facilitating things.

---

Intriduction: Nurses play an important and direct role in the diagnosis, treatment and care for patients during the COVID-19 pandemic, and working in emergencies puts a lot of pressure on them. Therefore, this study was carried out aimed to determine the level of stress, anxiety and depressive symptoms among nurses caring for hospitalized COVID-19 patients.
Methods: This descriptive-analytical study was carried out on 104 nurses caring for hospitalized COVID-19 patients in Imam Jafar Sadegh Meybod Hospital 1n 1399 with convenience Sampling method was done  and DASS-21 questionnaire were used to collect data and after completion, data was analyzed in Spss statistical software version 21 using descriptive statistics and independent t-test and binary logistic regression and the significance level of p <0.05 was considered.
Results: The mean anxiety was 9.2 + 4.42, stress level was 10.45+ 5.2 and depression was 6.9+5.3. In terms of severity, nurses experienced 15.37% moderate to severe depression, 22.11% moderate to severe stress level, 36.53% moderate to severe anxiety.Statistically significant differences were observed in the mean of anxiety, stress and depression by sex and type of shift and the mean of anxiety, stress by working ward (p <0.05).
Conclusion: Most nurses caring for Covid-19 patients experience mild degrees of stress, anxiety and depression.