Improving working conditions in an Iranian hospital: a participatory ergonomics approach

Objectives. The future workshop (FW), as a participatory ergonomics approach, is used to change the actual situation of a system into a preferable one. This study was conducted at a major hospital to identify ergonomic problems and provide appropriate solutions for improving working conditions using the FW technique. Methods. Twenty-five mid-level managers of the hospital participated in a 2-day FW. In the critique phase, the ergonomic problems were thoroughly discussed. After brainstorming followed by structuring and grouping of ideas, 75 ergonomic problems were identified and classified into four groups. Solutions and action plans were proposed to improve working conditions. Results. There were nine problems in the personnel-managerial group. Eighteen action plans were proposed to fix them. Stressful occupational factors were the worst problem in this group. Five problems were characterized in the physical space group and 10 action plans were presented. Seven problems were detected in the equipment group, for which 13 action plans were presented. In the welfare group, six problems and 12 action plans were presented. Conclusion. The results revealed that the FW was an appropriate method to find ergonomic bottlenecks in the hospital and a good basis for devising ergonomic interventions.

Is screening of Staghorn Stones cost-effective?

BACKGROUND

Staghorn stones can cause damage to the kidneys and are considered as the one of the main cause of renal failure. If they are identified during the initial stages of diagnosis, kidney damage can be prevented. Screening can lead to a better diagnosis. Before the screening, it is necessary to calculate the cost-effectiveness of screening.

METHODS

Using the possibility calculations of staghorn stones in the society and different age groups as well as a decision tree model, the screening costs and effectiveness were calculated against no screening. Effectiveness was determined based on the number of prevented cases of renal failure. Ultimately, the incremental cost-effectiveness ration (ICER) was calculated and compared with the World Health Organization (WHO) method based on the gross domestic product (GDP) per capita and subgroup analysis was done for different age groups. In addition, the robustness of results was examined by sensitivity analysis.

RESULTS

The results of decision tree showed that in the screening group, the expected cost was 8815997 USD and the expected effectiveness was 358 and in the no-screening group, the expected cost was 3954214 USD and the expected effectiveness was 258. Based on the results of the study, screening compared with no screening would increase the cost by 4861783 USD and effectiveness would increase by 100 people. The incremental cost-effectiveness ratio (ICER) showed that for each unit of increase in effectiveness of screening compared with no screening, would lead to an increase the cost by 48618 USD. The results also indicated that screening 30-70-year-old people compared with other age groups (20-70 and 25-70) if done every two years, could reduce the mean costs per preventing each case of renal failure.     Conclusion: If screening staghorn stones are done every two years for 30-70-year-old individuals, it would be cost effective considering WHO method and 3026 USD could be saved in the health care system per each person.

Osteoporosis guideline awareness among Iranian family physicians: results of a knowledge, attitudes, and practices survey

AimThis study investigates the knowledge, attitudes, and practices (KAP) of family physicians in Iran, regarding osteoporosis and their experience with national osteoporosis guideline.

BACKGROUND

Osteoporosis is a relatively preventable, chronic and progressive disease. Family physicians play a crucial role in relieving the burden of care.

METHODS

This cross-sectional study was addressed at all qualified family physicians who registered at urban family physicians and referral system program. Data collection included demographics, professional experience, and knowledge of guidelines based on a standardized KAP questionnaire. Student's t-test was used to measure the associations between KAP scores and demographic, professional experience variables.FindingsThe response rate was 72% (540/750). Based on Bloom's cut off scale, family physicians knowledge and practice scores were in moderate level, and only 14 and 38.5% of them had good knowledge and practice, respectively. Attitude score was in good level, and 64.1% of participants had positive attitude. Mean score of knowledge and practice were higher significantly among family physicians that practice in public settings. Family physicians, who completed osteoporosis training courses, had higher attitude score (P=0.03). Only 23.5% of family physicians were aware of the existence of national osteoporosis guideline.

CONCLUSION

Although most family physicians believed in the importance of preventive measures, however, limited number of them had good knowledge and practice regarding osteoporosis and less than a quarter were aware of national guideline. This is a clear need to disseminate the guideline more effectively, make greater use of efficient training methods.

Self-reported Factors Associated with Engagement in Moderate to Vigorous Physical Activity among Elderly People: A Population-based Study

Background:

Physical activity (PA) typically decreases with aging, especially of moderate to vigorous level, and this change affects health outcomes of older adults. Age-related decline is not evenly distributed across elderly population and is attributed to psychosocial, physical, and environmental determinants.

Methods:

We selected a sample of 1000 elderly people from urban parts of Shiraz in Southern Iran with a two-stage random sampling procedure. Self-reported PA data and correlates of moderate to vigorous activity were collected by interview with the respondents from selected households. Bivariate associations were examined using Chi-square test. Log-binomial regression was used to weigh variables associated with more than light PA.

Results:

Some demographic variables (older age, female sex, lower education level, retirement, and single or widowed status), health problems (lower extremity pain and hypertension), and psychosocial factors (lack of motivation, fear of injury, unsafe roads, and daily life problems) were potential correlates of inadequate PA with bivariate analysis. In log-binomial regression model, lack of motivation (adjusted prevalence ratio [APR] = 2.11, 95% confidence interval [CI]: 1.25–3.56), daily life problems (APR = 1.82, 95% CI: 1.26–2.62), lower educational level (APR = 1.64, 95% CI: 1.08–2.49), unsafe roads (APR = 1.59, 95% CI: 1.02–2.49), and knee pain (APR = 1.68, 95% CI: 1.09–2.58) were associated with lower engagement in moderate to vigorous PA among Iranian older adults.

Conclusions:

Psychosocial attributes considerably influence PA behaviors in older adults. Lower extremity joint pain is a key medical concern. Interventions to promote PA among older adults should be multilevel and particularly targeting personal psychosocial factors.

The financial cost of preventive and curative programs for breast cancer: a case study of women in Shiraz-Iran

BACKGROUND

This cross-sectional study was conducted to compare the average costs of breast cancer screening and treatment among women with the age of 25 and over in Shiraz-Iran.

METHODS

Three majors hospitals affiliated with Shiraz University of Medical Sciences (SUMS) were selected for data collection. Financial documents and interviews with the hospitals' financial officers were used for data collection.

RESULTS

Finding shows that the total cost of screening would be 5,847,544.96 US dollars for age groups of 25-34 and 35 and above, demonstrating the huge expense of screening programs. On the other hand, the average cost of breast cancer treatment for each patient would be 3608.47, 996.89, and 311.47 US dollars for mastectomy, radiotherapy, and chemotherapy, respectively. In addition, the total average cost for treatment of 2217 patients would be 1,466,988.9 US dollars, which is much less than screening programs expenses.

CONCLUSION

It is concluded that although screening can be effective for improving quality of life and treatment effectiveness, considering the high costs of screening, it is not economical in Iran. Screening methods within suitable intervals, and also considering patients' medical history have been recommended by the present study.

Assessment of injection practice in primary health care facilities of Shiraz, Iran

BACKGROUND

Occupational risk for several bloodborne viruses is attributable to unsafe injection practices. To understand injection frequency and safety, we surveyed injection rates and factors influencing injection prescription in primary health care facilities and associated health clinics in Shiraz, Iran.

METHODS

We used both quantitative and qualitative approaches to study the frequency and safety of injections delivered in 27 primary health care facilities. We used observations and 3 data collecting tools. Patterns of 600 general practice physicians' (GPs) prescriptions were also reviewed. In-depth interviews to elicit the factors contributing to injection prescriptions were conducted.

RESULTS

The annual per capita injection rate was 3.12. Corticosteroids were prescribed more frequently than antibiotics (P < .001). Knowledge of participants concerning transmission risks for 3 of the most common bloodborne infections (BBIs) was less than 75%. Factors affecting use of injections by GPs included strong patient preference for injections over oral medications and financial benefit for GPs, especially those in private practice settings.

CONCLUSION

Frequency of therapeutic injections in the participating facilities in Shiraz was high. Sociocultural factors in the patient community and their beliefs in the effectiveness of injections exerted influence on GP prescribing practices. Programs for appropriate and safe injection practices should target GP and injection providers, as well as patients, informing them about alternative treatments and possible complications of unnecessary and unsafe injections.

To assess the effects of nutritional intervention based on advocacy approach on malnutrition status among school-aged children in Shiraz

BACKGROUND

The present study was carried out to assess the effects of community nutrition intervention based on advocacy approach on malnutrition status among school-aged children in Shiraz, Iran.

MATERIALS AND METHODS

This case-control nutritional intervention has been done between 2008 and 2009 on 2897 primary and secondary school boys and girls (7-13 years old) based on advocacy approach in Shiraz, Iran. The project provided nutritious snacks in public schools over a 2-year period along with advocacy oriented actions in order to implement and promote nutritional intervention. For evaluation of effectiveness of the intervention growth monitoring indices of pre- and post-intervention were statistically compared.

RESULTS

The frequency of subjects with body mass index lower than 5% decreased significantly after intervention among girls (P = 0.02). However, there were no significant changes among boys or total population. The mean of all anthropometric indices changed significantly after intervention both among girls and boys as well as in total population. The pre- and post-test education assessment in both groups showed that the student's average knowledge score has been significantly increased from 12.5 ± 3.2 to 16.8 ± 4.3 (P < 0.0001).

CONCLUSION

This study demonstrates the potential success and scalability of school feeding programs in Iran. Community nutrition intervention based on the advocacy process model is effective on reducing the prevalence of underweight specifically among female school aged children.