Medical students' knowledge of indications for imaging modalities and cost analysis of incorrect requests, shiraz, iran 2011-2012.

Medical imaging has a remarkable role in the practice of clinical medicine. This study intends to evaluate the knowledge of indications of five common medical imaging modalities and estimation of the imposed cost of their non-indicated requests among medical students who attend Shiraz University of Medical Sciences, Shiraz, Iran. We conducted across-sectional survey using a self-administered questionnaire to assess the knowledge of indications of a number of medical imaging modalities among 270 medical students during their externship or internship periods. Knowledge scoring was performed according to a descriptive international grade conversion (fail to excellent) using Iranian academic grading (0 to 20). In addition, we estimated the cost for incorrect selection of those modalities according to public and private tariffs in US dollars. The participation and response rate was 200/270 (74%). The mean knowledge score was fair for all modalities. Similar scores were excellent for X-ray, acceptable for Doppler ultrasonography, and fair for ultrasonography, CT scan and MRI. The total cost for non-indicated requests of those modalities equaled $104303 (public tariff) and $205581 (private tariff). Medical students at Shiraz University of Medical Sciences lacked favorable knowledge about indications for common medical imaging modalities. The results of this study have shown a significant cost for non-indicated requests of medical imaging. Of note, the present radiology curriculum is in need of a major revision with regards to evidence-based radiology and health economy concerns.

The management of cytotoxic drug wastes in Shiraz, Iran: an overview of all government and private chemotherapy settings, and comparison with national and international guidelines.

Excessive use of cytotoxic drugs owing to a dramatic increase in malignancy incidence leads to the production of high amounts of cytotoxic wastes. In Iran, management of hazardous wastes has been neglected in recent decades. The aim of this study was to determine the amount of intravenous cytotoxic drug wastes, their collection and disposal status in chemotherapy wards, and to compare the current status with standard guidelines in Shiraz, Iran. This cross-sectional study was performed using data collected during 2 consecutive months, from 22 June to 22 August 2011, in all 13 chemotherapy wards in Shiraz. The amount of prescribed drugs, drugs waste, collection and disposal status of cytotoxic drugs were recorded. We then compared the current status of waste collection and disposal in our samples with our national guideline. The prescription of cytotoxic drugs and the amount of total drugs waste reached approximately 6 and 0.2 kilograms respectively. Total vials volume was calculated to be approximately 1000 l in order to estimate the volume of containers required for the encapsulation method. The results demonstrated that the current status of cytotoxic waste collection and disposal is inappropriate, and none of the facilities under study followed our guidelines perfectly. The adherence to all recommendations and guidelines was poorer in private wards than in government-run ones. The management of cytotoxic wastes is inappropriate and our existing national guidelines are lacking. Suggestions for the best management of cytotoxic waste are revising the existing guidelines, allocating a sufficient budget, training healthcare workers, providing multiple administration options of cytotoxic drugs and accomplishing a surveillance system.

Scientometric Analysis of Articles on Spatial Epidemiology of Cancer in Iran: A Systematic Review.

Background: Geographic information system (GIS) plays an important role in identifying areas with a high incidence of cancer. In the present study, based on a systematic review of studies by Iranian researchers, we performed a scientometric analysis of the published articles on the spatial epidemiology of cancer. In addition, the geographical distribution of certain types of cancer in Iran is presented. Methods: A literature search was conducted using electronic databases such as PubMed and NLM Gateway, Institute for Scientific Information, Scopus, Google Scholar, and Cochrane Library for relevant articles published from 2000 to 2021. The search was performed using a combination of medical subject heading terms and keywords. A narrative synthesis was performed, and descriptive data were expressed as frequency and percentage. Results: Of the 200 identified articles, 31 studies published in 15 different journals were included in this systematic review. Results showed a wide variation in high-risk breast cancer clusters. However, a similar incidence of gastrointestinal cancers has been reported, and high-risk clusters were identified in the north and the northwest of Iran. Skin cancer and acute lymphoblastic leukemia were more prevalent in the central provinces. Conclusion: The current volume of studies on the spatial epidemiology of cancer in Iran, with a CiteScore quartile of Q1, is inadequate to guide health policymakers. The geographical distribution of many prevalent types of cancer has not been assessed by Iranian researchers. Furthermore, the classification of high- and low-risk geographical clusters of cancers was not completely homogeneous.

Validation of Acromegaly Quality of Life Questionnaire (AcroQoL) for the Iranian population.

BACKGROUND: Acromegaly is a chronic disease significantly affects the physical, emotional, and health-related aspects of patients' life. This study aimed to validate the Acromegaly Quality of Life Questionnaire (AcroQoL) for the Persian-speaking population. METHODS: This cross-sectional study recruited 73 Iranian patients with a confirmed diagnosis of acromegaly. The content validity of the scales was evaluated by an expert panel of eight endocrinologists applying content validity index (CVI) and content validity ratio (CVR). Construct validity was assessed by using confirmatory factor analysis. Internal consistency was assessed on the basis of Cronbach's alpha, and a goodness-of-fit (GoF) index was calculated to display whether the model fitted the data. RESULTS: CVI and CVR yielded values of 0.85 and 0.80, respectively (Acceptable CVI: > 0.78 and CVR: > 0.75). The average variances extracted (AVE) from physical and psychological dimensions were 0.520 and 0.462, respectively, exceeding the minimum criterion of 0.40. Cronbach's alpha for physical and psychological dimensions equaled 0.868 and 0.866, respectively, indicating the adequate internal consistency of multiple items for each construct. The subscales' R square and path coefficient were greater than the recommended threshold as 0.75 (physical dimension: 0.778, psychological dimension: 0.873), demonstrating the suitability of this criterion. Finally, the GoF value of 0.29 indicated the model's moderate fit. CONCLUSIONS: The findings revealed that the Persian version of AcroQoL is of adequate validity and reliability for evaluating the quality of life of Iranian people with acromegaly.

Unhealthy Lifestyle Predisposed Shiraz Healthcare Workers to Metabolic Diseases.

Background: Poor health condition may increase the risk of occupational problems and reduces an organization's productivity. Also, there is a direct, bilateral relationship between occupation and health. Objective: To evaluate the health status of health care workers (HCWs) in the largest tertiary general and teaching hospital in southern Iran. Methods: This cross-sectional study (Sep2014-Dec2016) was conducted on HCWs, who were referred to Prevention and Health Promotion Clinic of Shiraz Namazee hospital. The participants' health status was assessed and after the risk assessments and necessary physical examinations, the laboratory and para clinic tests were requested. Using descriptive and analytical tests, all data were analyzed. Results: Totally, 963 HCWs were enrolled, that 64.4% were women, with mean ± SD age of 35.51 ± 8.9 years. Eighty-eight percent and 77.4% of the participants had history of ergonomic and psychological exposures. Impaired glucose tolerance and abnormal serum cholesterol were seen in 13.6% and 29.9%, respectively. Body mass index was a predictive factor for abnormal blood pressure (OR: 1.12; 95%CI: 1.02-1.22), impaired glucose tolerance (OR: 1.08; 95%CI: 1.01-1.16), and abnormal serum cholesterol (OR: 1.17; 95%CI: 1.10-1.25), respectively. Male gender (OR: 1.83; 95%CI: 1.08-3.03) was a predictive factor for abnormal serum cholesterol. Conclusions: The health status of HCWs is not good enough in Iran. They did not have an appropriate lifestyle. They were exposed to different occupational hazards. The prevalence of chronic diseases was notable. Overweight, obesity, and inactivity were the most important causes of metabolic diseases.

Levels and predictors of happiness in the south of the Islamic Republic of Iran.

BACKGROUND: Happiness is considered an index of the development of human society and well-being in the world. AIMS: The aim of this study was to measure the level of happiness in a middle sized Iranian city (Kerman) using 2 instruments and the predictor factors. METHODS: In a cross-sectional study, 1000 adults were questioned using multi-stage cluster sampling in 2016. The LoH was assessed using the Oxford Happiness Inventory (OHI) and a self-report questionnaire. The level of physical activity and the religion index were assessed using standard questionnaires. RESULTS: The results of 2 questionnaires had a statistically significant correlation with measuring level of happiness (Pearson correlation coefficient 0.69; P-value < 0.001). Around 90% of participants stated that they had moderate to high LoH, but the mean happiness score based on the OHI was 43.2 (43.7 in men, 42.7 in women). Illiteracy, unemployment, divorce, living in deprived areas, high level of stress, weak religious beliefs and practice, lower income, and poor health significantly decreased the LoH score. CONCLUSION: Level of happiness is relatively low in Kerman. There are effective evidence-based interventions that might promote the LoH of the population, including promoting the level of community health, educating for stress management and improving access to urban facilities in deprived areas.

Hemo-Lymphopoietic Malignancies Surround the Women of the Family: A Case Report and Literature Review.

The co-occurrence of different types of hemo-lymphopoietic malignancies within a family provides clues about the pattern of inheritance and common environmental risk factors. A family presented with developing hemo-lymphopoietic cancers in three female first-degree relatives: a mother and her daughters. Case 1 was diagnosed with Walden Strom's macroglobulinemia at age 57. Case 2 and 3 presented with chronic myelogenous leukemia at age 32 and diffuse large B-cell lymphoma at age 28, respectively. There were not any significant common environmental risk factors in this family, but all three cases suffered from skin dermatitis and one of them, who suffered from chronic myelogenous leukemia, was diagnosed with morphea. This family had a sedentary and stressful lifestyle. Genetic is the foundation of some familial aggregation of cancers. Common lifestyle habits and environmental etiologies are important. Morphea as an autoimmune disease could have the essential role in developing hematolymphoid malignancies.

Social Determinants of Health and Attempt to Change Unhealthy Lifestyle: A Population-based Study.

BACKGROUND: A healthy lifestyle is important because of its long-term benefits; however, there is a paucity of information concerning health choices among Iranians. We evaluated personal health behaviors, attempts to change unhealthy behaviors, and factors affecting attempts at change. METHODS: The design of this cross-sectional study was to assemble a representative cadre of >18-year-old adults in Shiraz, Iran, using a multistage cluster sampling technique. Validated questionnaires collected participant's demographic information, such as weight, height, cigarette smoking history, physical activity, and attempts at lifestyle changes during the previous year. To determine predictors of attempts to change unhealthy lifestyle and to identify confounders, we applied single and multivariable logistic regression methods, respectively. A confidence interval of 95% was calculated for each odds ratio. RESULTS: The prevalence of attempts to change unhealthy lifestyle was 42%, 64.8%, and 27.8%, respectively, for losing weight, being more physically active, and smoking cessation. Unemployment, low levels of education, and decreased socioeconomic status have important roles in attempts to change lifestyle conditions. Low socioeconomic status was a risk factor for quitting smoking. Occupation (unemployed/homemaker) and low level of education were two significant factors for being more physically active. CONCLUSIONS: The prevalence of inadequate physical activity and being overweight or obese was considerable in Shiraz, Iran. Attempts to change unhealthy lifestyle were less than ideal. Social determinants of health factors including unemployment and low levels of education and socioeconomic status play important roles in attempts to change current lifestyles.

Waterpipe Tobacco Smoking Prevalence and Associated Factors in the Southeast of Iran.

BACKGROUND: Waterpipe smoking is a growing public health threat worldwide. The aim of this study was to assess waterpipe smoking prevalence and its associated factors among Iranian adults. METHODS: This cross-sectional study was conducted in Kerman, Iran, recruiting 1090 adult participants using multistage sampling in 2016. A self-reported researcher-designed questionnaire was used. The socio-demographic characteristics and waterpipe smoking behaviors such as pattern, duration, and the most common place of waterpipe use, the type of tobacco, and the concurrent use of alcohol and substances were assessed. Data analyses were performed using chi-square, independent t-test, and multiple logistic regression. FINDINGS: The prevalence of ever, current and daily waterpipe smoking were 43.8%, 28.8%, and 7.2%, respectively. Men initiated to use waterpipe in more early ages than women (P < 0.001). Café or restaurant (34.4%) and friends' house (36.8%) were the most frequent places for waterpipe using by men and women, respectively. Men used waterpipe 2.8 times more frequently than women. Waterpipe smoking was 4.9 times more likely in the 18-24 years age range compared to the 45 years or older. Waterpipe use was 2.4 times greater in the unemployed than in housewives. People with a university education were 1.4 and 1.7 times more likely to use waterpipe compared to people with high school diploma and illiterates, respectively. CONCLUSION: The present study revealed that men, high level of education, younger age and unemployment were associated with waterpipe smoking. Therefore, we need to design and implement more effective interventions, especially for vulnerable target groups.

Prevalence and Risk Factors of Low Birth Weight in the Southeast of Iran.

BACKGROUND: The purpose of this study was to determine the prevalence and related factors of low birth weight (LBW) in the Southeast of Iran. METHODS: This cross-sectional study was carried out in Kerman province. Data were collected from Iranian Maternal and Neonatal Network at public and private hospitals. All live births from March 2014 to March 2015 considered as the source population. The risk factors including maternal age, gravida, parity, abortion, pregnancy risk factors, maternal nationality, maternal education, maternity insurance, place of living, consanguinity, neonate sex, preterm labor, place of birth, delivery manager, and delivery type were compared between LBW and normal birth weight groups. RESULTS: The prevalence of LBW was 9.4% in the present study. Preterm labor (odds ratio [OR]: 22.06; P < 0.001), neonate female sex (OR: 1.41; P < 0.001), low parity (OR: 0.85; P < 0.001), pregnancy age <18 years (OR: 1.26; P = 0.012), pregnancy age >35 years (OR: 1.21; P = 0.001), delivery by cesarean section (OR: 1.17; P = 0.002), pregnancy risk factors (OR: 1.67; P < 0.001), maternal illiteracy (OR: 1.91; P < 0.001), living in the rural area (OR: 1.19; P < 0.001), consanguineous (OR: 1.08; P = 0.025), and delivery by obstetrician (OR: 1.12; P = 0.029) were identified as significant factors associated with LBW in this study. CONCLUSIONS: Prevention of preterm labor, consanguineous marriage, pregnancy age <18 and >35 years old, and maternal medical risk factors are some critical interventions to reduce its burden. Increasing the access to high-quality health-care services in rural and deprived areas is another effective strategy for the prevention of LBW.

Using Queuing Theory and Simulation Modelling to Reduce Waiting Times in An Iranian Emergency Department.

BACKGROUND: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department (ED) is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time. METHODS: This is a cross-sectional study in which simulation software (Arena, version 14) was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them. RESULTS: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run (actually these patients received services out of their defined capacity). The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients. CONCLUSION: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution.

Shiraz medical students' perceptions of their colleagues' professional behavior.

INTRODUCTION: Today, development of professionalism is a critical aim of medical schools. Studies have demonstrated that medical students' perceived level of professionalism is inadequate worldwide. This study aimed to investigate the medical students' perceptions of their colleagues' professional behavior. METHODS: This study is a cross-sectional study with 280 medical students at Shiraz University of Medical Sciences in their fifth to seventh year of study as the sample. The study was performed during one month in 2013, using stratified random sampling method. The instrument of the study was the Persian version of the questionnaire of the American Board of Internal Medicine (ABIM).The questionnaire includes demographic information, questions about the meaning of the professionalism, history of medical ethics education programs and 12 behavioral questions. The data were analyzed using student t-test and Pearson correlation test. The significance level was set as 0.05. RESULTS: Forty percent of respondents did not know the meaning of professionalism. The mean±SD score of behavioral questions was 5.91±1.2 on a scale from 0 to 10. The mean±SD score of excellence questions was 4.94±1.7. It was 7.05±1.9 for 'honor/integrity', and 6.07±2.1 for 'altruism/respect' questions. There was a significant association between gender and excellence score (p=0.007). CONCLUSION: Medical students assessed their colleagues' professional behavior as poor. They did not have proper information about professionalism. Medical students are future general practitioners and respecting medical ethics by them is very important in a perfect health system. Universities should emphasize the importance of teaching professionalism to medical students and faculty members, using innovative education methods.

A qualitative study of the causes of improper segregation of infectious waste at Nemazee Hospital, Shiraz, Iran.

BACKGROUND AND OBJECTIVES: Medical waste management is a major concern for healthcare facilities. One important element is the segregation of infectious waste from domestic, non-infectious waste. The aim of this qualitative study was to identify factors that negatively affect proper segregation at Nemazee Hospital, which is affiliated with Shiraz University of Medical Sciences. METHODS: Study data came from focus groups involving hospital workers. Participants expressed their opinions regarding barriers to proper segregation of medical wastes. The participants gave their permission to have their comments recorded. Data analyses were based on a grounded theory approach. RESULTS: The results indicated that managerial weakness was an important factor in suboptimal disposal of medical waste. It appears that hospital authorities should pay better attention to educational planning, organizational resources and supervision. Together, these considerations should help reduce waste-management errors. The results also suggest that healthcare worker training needs improvement. In general, patients and their companions, as well as the local population, did not appear to have sufficient knowledge concerning disposal of infectious medical waste. CONCLUSIONS: Hospital authorities should conduct a broad review of medical waste management, including improved employee training. This step should have a positive effect on local health, as well as the environment. Improvement is also needed in the infection prevention performance of hospital healthcare workers. This approach should reduce additional production of infectious waste and costs associated with healthcare.

Improving infection prevention methods in hemodialysis units: a multicenter survey.

The aim of this cross-sectional study was to investigate the implementation of and compliance with international infection control standards by patients and staff in dialysis centers in Shiraz, Iran. The results indicate negligence in various aspects of infection control. Providing staff education and training programs, establishing effective surveillance systems, and enforcing regulations in the hospitals should help improve infection prevention.

Knowledge, Attitudes, and Practices Regarding Pandemic H1N1 Influenza Among Medical and Dental Residents and Fellowships in Shiraz, Iran.

BACKGROUND: Influenza disease is one of the oldest medical problems that can cause severe illness and high mortality rates, worldwide. In flu pandemics, medical and dental students' knowledge, attitudes, and practices (KAP) is critical to save patients life. The aim of this study was to determine the score of KAP toward the Pandemic H1N1 and their predictor factors among the medical and dental residents and fellowships of Shiraz University of Medical Sciences, Iran. METHODS: In 2009, 125 participants were recruited in a convenient sampling cross-sectional survey. Self-reported questionnaire were used and results were analyzed applying appropriate statistical tests. RESULTS: The mean score of participants' knowledge, attitude and practice were 22.6, 21.1 and 26.5 respectively. Participants practice had significant linear positive correlation with knowledge and attitude. Also, their age was significantly and directly correlated to knowledge and practice. The educational major, age, and sex were significant predictors of responder's knowledge score and age was the only significant predictor of both attitude and practice scores. CONCLUSIONS: High knowledge is not sufficient lonely for improve attitude and practices. It seems that traditional educational models are not efficient and governments should emphasize to advanced and motivational education methods including health belief model and motivational interview at postgraduate levels. Perhaps younger students, dentists and males have less motivation to change their attitude and behavior, so we can focuses our interventions in these groups.

Are The Predictors of Hookah Smoking Differ From Those of Cigarette Smoking? Report of a population-based study in Shiraz, Iran, 2010.

BACKGROUND: The aim of this study was to determine the prevalence of tobacco use and effect of lifestyle factors on cigarette and hookah use among adult residents of Shiraz, Iran. METHODS: In 2010, 1,000 participants were recruited in a multistage, random sampling cross-sectional population-based survey. RESULTS: Response rate was 98%. Prevalence of cigarette smoking was 9.7%. Among cigarette users, 12.6% reported smoking <1 year; 13.4% smoked 1-2 years and 73.9% smoked>2 years. Almost half of those surveyed (48.9%) smoked <10 cigarettes per day (cpd); 28.4% smoked 10-15 cpd; 14.8% smoked 16-19 cpd, and 8%>20 cpd. Almost a quarter (20.4%) of the cigarette smokers tried to quit in the past year. Being male, married, aged 37-54, having higher perceived levels of stress, a non-manual occupation, and sedentary lifestyle were positively associated with cigarette smoking. Manual labor occupations, housewife/jobless status, and going frequently to restaurants were positive predictors of hookah smoking. CONCLUSIONS: Compared to cigarettes, hookah smoking was more prevalent among Iranian adults. Approximately, the prevalence of hookah smoking in women is the same as men, whereas cigarette use was 31 times more common in men. Cigarette and hookah smoking were associated with less healthy lifestyle habits in both men and women.

Transportation behaviors in Shiraz, Iran.

OBJECTIVE: Motor vehicle accidents can occur as a result of improper driver behavior. There needs to be a comprehensive collection of information concerning driver behavior and its predisposing factors. METHODS: Study participants (500 males and 500 females ≥18 years old) living in Shiraz, Iran, were selected using a multistage sampling methodology. Data came from questionnaires completed using a face-to-face interview process. Independent variables such as age, gender, marital status, occupation, educational level, socioeconomic status (SES), and history of smoking and stress levels were compared to the dependent variables using a private automobile, public transportation, or motorcycle, wearing a seat belts, wearing safety helmets, and obeying the speed limit. Statistical significance was set at a P value of .05 or less. RESULTS: In general, female, better educated persons, and those with higher SES reported better driving behaviors. Better drivers also did not use tobacco or hookah. Compliance with driving safety factors was disappointing 49.8 percent always wore a seat belt, 22.4 percent always wore a safety helmet (29.4% never wore a helmet), and 49.4 percent always observed the speed limit. CONCLUSIONS: There is a need to improve driver safety compliance in Shiraz, Iran. One factor that can be addressed concerns regulation of male drivers, especially among lower SES groups.