A Burden Assessment of Occupational Exposures in Iran, 1990-2010: Findings from the Global Burden of Disease Study 2010.

BACKGROUND: The present study describes the burden of occupational diseases in Iran based on the results of the Global Burden of Disease study conducted in 2010 (GBD 2010). This study aimed to determine the burden of occupational diseases in Iran based on the results of GBD 2010. It is a cross-sectional study. METHODS: Disability-adjusted life years (DALYs) of occupational diseases were calculated based on the prevalence rates obtained through model estimation, as well as GBD 2010 disability weights and mortality rates obtained from different data registry systems of Iran. Causal association criteria application to select risk outcome pairs, estimation of exposure to each risk factor in the population, estimation of etiological effect size, selection of a counterfactual exposure distribution, risk assessment, and identification of burden attributable to each risk factor were the main conducted statistical steps. RESULTS: There was an increasing trend of DALYs (710.08/100,000 people in 1990 and 833.00/100,000 people in 2005) followed by a slight decrease (833.00/100,000 in 2005-784.55/100,000 people in 2010). A total of 50.4% and 36% of total DALYs per 100,000 people were due to the adverse effects of musculoskeletal disorders and work-related injuries, respectively. CONCLUSIONS: Musculoskeletal disorders and work-related injuries are the most important adverse consequences of work-related risks that require urgent interventions to be controlled. Male workers (15-25 years and over 60) with the highest DALYs and mortality rates need more training programs, safety regulations, and higher level of protection support. In spite the decreasing trend of occupational disease related DALYs and death rates in Iran in recent years, a long-term effort is required to maintain the currently decreasing trend.

Diseases and Health Outcomes Registry Systems in I.R. Iran: Successful Initiative to Improve Public Health Programs, Quality of Care, and Biomedical Research.

Registration systems for diseases and other health outcomes provide important resource for biomedical research, as well as tools for public health surveillance and improvement of quality of care. The Ministry of Health and Medical Education (MOHME) of Iran launched a national program to establish registration systems for different diseases and health outcomes. Based on the national program, we organized several workshops and training programs and disseminated the concepts and knowledge of the registration systems. Following a call for proposals, we received 100 applications and after thorough evaluation and corrections by the principal investigators, we approved and granted about 80 registries for three years. Having strong steering committee, committed executive and scientific group, establishing national and international collaboration, stating clear objectives, applying feasible software, and considering stable financing were key components for a successful registry and were considered in the evaluation processes. We paid particulate attention to non-communicable diseases, which constitute an emerging public health problem. We prioritized establishment of regional population-based cancer registries (PBCRs) in 10 provinces in collaboration with the International Agency for Research on Cancer. This initiative was successful and registry programs became popular among researchers and research centers and created several national and international collaborations in different areas to answer important public health and clinical questions. In this paper, we report the details of the program and list of registries that were granted in the first round.

Epidemiological Profile of Hepatitis B Virus Infection in Iran in the Past 25 years; A Systematic Review and Meta-analysis of General Population Studies.

BACKGROUND Chronic hepatitis B virus (HBV) infection is one of the most important health problems worldwide with a high rate of morbidity and mortality. It is a major risk factor for cirrhosis and liver cancer. Currently, Iran is located in the intermediate HBV zone; however, recent studies have provided some evidence indicating an epidemiological change in the country. The aim of this study was to estimate the prevalence of HBV in Iran. METHODS A systematic review was conducted to evaluate the studies performed in the past 25 years that have reported the prevalence of HBV infection and its associated factors in the Iranian general population (1990-2014). Any study assessing and reporting serum Hbs Ag levels was included in this review. RESULTS After excluding all impertinent studies, 19 eligible studies were included in the analysis. The overall prevalence of HBV was 3% (95% CI 2% to 3%). Its distribution showed that the prevalence of HBV varies in different provinces from 0.87% to 8.86%. The HBV rate was highest in the Golestan (8.86%) and lowest in the Kurdistan (0.87%) provinces. CONCLUSION This study provides some evidence about the prevalence of HBV in Iran. However, the collected data was very heterogenic, even within a single province, which made it hard to estimate a single-point prevalence. High quality studies are needed to find reliable information about HBV prevalence and to decrease the heterogeneity of results in the country.

Truth-telling and hematopoietic stem cell transplantation: Iranian nurses' experiences.

BACKGROUND: Hematopoietic stem cell transplantation is a potential cure for a range of life-threatening diseases, but is also associated with a high mortality rate. Nurses encounter a variety of situations wherein they are faced with discussing bad news with hematopoietic stem cell transplantation patients. RESEARCH OBJECTIVE: The aim of this study was to explore the experiences and strategies used by Iranian nurses related to truth-telling and communicating bad news to hematopoietic stem cell transplantation patients. RESEARCH DESIGN: A qualitative approach using content analysis of interview data was conducted. PARTICIPANTS AND RESEARCH CONTEXT: A total of 18 nurses from the main hematopoietic stem cell transplantation center in Iran participated in semi-structured interviews. ETHICAL CONSIDERATIONS: The Institutional Review Board of the Tabriz University of Medical Sciences and the Hematology-Oncology and Stem Cell Transplantation Research Center affiliated with the Tehran University of Medical Sciences approved the study. FINDINGS: In the first main category, not talking about the disease and potential negative outcomes, the nurses described the strategies of not naming the disease, talking about the truth in indirect ways and telling gradually. In the second main category, not disclosing the sad truth, the nurses described the strategies of protecting patients from upsetting information, secrecy, denying the truth and minimizing the importance of the problem. The nurses used these strategies to minimize psychological harm, avoid patient demoralization, and improve the patient's likelihood of a fast and full recovery. DISCUSSION: The priority for Iranian hematopoietic stem cell transplantation nurses is to first do no harm and to help patients maintain hope. This reflects the Iranian healthcare environment wherein communicating the truth to hematopoietic stem cell transplantation patients is commonly considered inappropriate and avoided. CONCLUSION: Iranian nurses require education and support to engage in therapeutic, culturally appropriate communication that emphasizes effective techniques for telling the truth and breaking bad news, thereby potentially improving patient outcomes and protecting patient rights.

Views of patients undergo hematopoietic stem cell transplantation on their basic needs.

BACKGROUND: Today, hematopoietic stem cells transplantation (HSCT) has been accepted as a therapeutic approach and is widely applied in many patients with disorders of hematopoietic systems or patients with malignancies. Concomitant use of this therapeutic approach with long term chemotherapeutic procedures and hospitalization requires special care. This study was conducted to examine basic needs of patients after HSCT. METHODS: In this study, 171 hospitalized patients were selected after transplantation, using convenience sampling method. They completed a questionnaire formulated on the basis of Yura and Walsh Theory of Basic Needs. RESULTS: Most of the needs reported in the areas of vital functions, functional health status, and reaction to functional health status were chills (76.8%), insomnia (68.5%), and dissatisfaction with changes of lifestyle/habits (53.6%), respectively. Furthermore, 94.1% of the patients were aware of their disease. CONCLUSION: This study identified a broad spectrum of the needs in HSCT patients. Given the importance of determining needs to reach thorough nursing care, paying attention to the provided list can facilitate the achievement of the goals of the care program for these patients.

Life in limbo: experiences of Iranian hematopoietic stem cell transplantation recipient patients and nurses in a qualitative study.

BACKGROUND: This study explored the state of hematopoietic stem cell transplantation (HSCT) recipient patients and problems experienced by them and nurse about these state and problems, in Iran. METHODS: Qualitative content analysis was used for analyzing semi-structured interviews with 12 HSCT recipient patients and 18 nurses. RESULTS: THREE MAIN CATEGORIES DESCRIBED THE HSCT STATE AND PROBLEMS: shadow of death, living with uncertainty, and immersion in problems. Patients treated with risk variety in continuity with probability of death. The patients lived with uncertainty. Consequently these resulted immersion in problems with four sub-categories including: (a) Physical problems, (b) money worries, (c) life disturbances, and (d) emotional strain. CONCLUSION: HSCT patients live in a state of limbo between life and death with multidimensional problems. Establish centers for supporting and educating of patients and their families, education of health care providers, enhancement of public knowledge about HSCT along with allocating more budgets to take care of these patients can help patients for passing from this limbo.

Emotional labour of caring for hematopoietic stem cell transplantation patients: Iranian nurses' experiences.

PURPOSE: The purpose of this study was to describe the emotional labour experienced by nurses who care for hematopoietic stem cell transplantation (HSCT) patients in Iran. METHODS: Eighteen nurses participated in semi-structured interviews. The interviews were analyzed using qualitative content analysis methods. RESULTS: Three main categories described the emotional labour involved, namely, emotional intimacy, feeling overwhelmed with the sadness and suffering, and changing self. Nurses had compassion for their patients, contributing to a close nurse-patient relationship. The nurses' emotional labour resulted in their feeling overwhelmed with sadness and suffering. Five subcategories described this emotional toll: (a) witnessing suffering, (b) struggling mentally, (c) hurting emotionally, (d) feeling drained of energy, and (e) escaping grief. Dealing with death and dying on an ongoing basis promoted the nurses' changing self. CONCLUSION: Iranian nurses who care for HSCT patients experience a range of positive and negative emotions. Establishing appropriate support systems for nurses might help mediate the negative aspects of emotional labour. thereby improving nursing work life and ultimately the quality of patient care.