Reproductive outcomes among female health care workers.

OBJECTIVE: Occupational exposures may be associated with reproductive health and pregnancy outcomes. This study investigated the association between occupational exposures and reproductive health, pregnancy outcomes, and the lactation period among hospital staff. MATERIALS AND METHODS: Seven hundred thirty-three female healthcare workers from hospitals affiliated with the Tehran University of Medical Sciences were invited to participate in this cross-sectional study. The measurement method for fertility consequences was self-report. Demographic characteristics, occupational data, medical history, and reproductive history were collected via data collection form. Finally, reproductive outcomes were evaluated in different occupational hazard categories. RESULT: Chemical exposures (solvents) were a risk factor for stillbirth. Prolonged working hours were associated with spontaneous abortion and breastfeeding periods. Shift workers did not have a higher frequency of reproductive and pregnancy outcomes, but the breastfeeding period was significantly decreased in shift workers. Psychiatric disorders were associated with preterm labour, low birth weight, and stillbirth in sequence with nervousness, depression, and mood disturbance. Furthermore, depression affects the breastfeeding period. Moreover, we found a link between job titles and infertility. In addition, socioeconomic status was related to stillbirth and infertility. CONCLUSION: The study revealed that chemical and ergonomic exposures have associations with some reproductive outcomes. We also conclude that shift work could adversely affect the breastfeeding period. So, implementing some organizational strategies to control adverse health effects of occupational hazards and modifying shift work and working hours for nursing mothers is recommended.

Characterization of Long COVID and Its Contributing Factors among a Population of Health Care Workers in a 6-Month Follow-up.

Background: Health care workers (HCWs) are at the frontline of the fight against the coronavirus disease 2019 (COVID-19). Long COVID is defined as "the persistence of some symptoms of COVID-19, more than 4 weeks after the initial infection." The aim of the present study was to investigate the prevalence of long COVID status among HCWs in the largest hospital complex of Iran. Methods: In this cross-sectional study, all patients with COVID-19 who had taken sick leave were included in the study (n = 445). Data regarding sick leave characteristics were collected from the records of the nursing management department of the hospital. Study variables included demographic and occupational information, variables related to mental health assessment, organ systems involved in COVID-19, and duration of symptoms. Frequencies, percentage distributions, means, standard deviation, and range (minimum, maximum) were used as descriptive analysis methods. Associations between symptoms' persistency and clinical characteristics were assessed by logistic and linear regressions. Results: Age, N95 mask use, and respiratory protection significantly contributed to the persistence of COVID-19 symptoms (P < 0.05). The prevalence of long COVID among HCWs was 9.44% among 445 participants. The loss of taste persisted longer than the other symptoms before returning to normal. Among the postrecovery complications asked, anxiety was the most common persistent mental symptom (58.5%), followed by gloomy mood (46.3%) and low interest (46.2%), respectively. Conclusion: HCWs with COVID-19 symptoms had prolonged symptoms of COVID-19 that can affect their work performance, thus, we recommend evaluating COVID-19 symptoms in HCWs with infection history.

Prevalence of premenstrual syndrome and related factors among nurses.

Objective: Premenstrual syndrome (PMS) is a common condition among women during their menstrual cycle. PMS can negatively affect a woman's daily life and function. Nurses, as an important and substantial segment of healthcare staff, are affected by the demanding environment of work place. Since PMS, as a prevalent counterproductive condition, has not been studied in this population in Iran, we assessed the prevalence of PMS and its associated factors among nurses aged 23 to 49 in teaching hospitals of the Tehran province of Iran. Material and Methods: In this cross-sectional study from April 2021 to January 2022, 280 participants from teaching hospitals were enrolled. Simple random sampling was used to determine the sample size of the study. Two validated questionnaires and a data gathering sheet were used to collect information. The premenstrual symptoms screening tool was used to determine PMS severity and the Copenhagen Psychosocial Questionnaire to evaluate the associated job demands. Demographic data and work-related data included: night shift, shift type, monthly COVID-19 care and gynecologic and past medical history were gathered. Then data were analyzed using logistic regression analysis, chi-square and t-test. Results: The severity of PMS was: mild (42.5%); moderate (30%); and severe (27.5%). Regular menstruation and dysmenorrhea were reported by 84.6% and 72.3%, respectively. Moderate to severe PMS was associated with: monthly COVID shift (p=0.02); emotional (p<0.01) and quantitative (p<0.01) demands; regular caffeine intake (p=0.01); education level (p=0.005); regular exercise (p=0.003); regular fiber intake (p=0.08); and irregular menstrual cycles (p=0.007). In logistic regression only quantitative (p=0.003) and emotional (p=0.018) job demands were significant. Conclusion: Results showed that the prevalence of PMS was high among Iranian nurses and was associated with quantitative and emotional job demands. We suggest further studies focusing on preventative and effective interventions to diminish the consequences of PMS in this population. We also suggest investigating the practical application of the findings of this study for healthcare professionals and policymakers.

Assessment of peripheral neuropathy in male hospitalized patients with lead toxicity in Iran.

BACKGROUND: This study assessed the effect of lead exposure on the peripheral nervous system in 40 hospitalized patients with lead toxicity [blood lead level (BLL) >70 µg/dl] and compared their electrodiagnostic indices with the results of the control group. MATERIALS AND METHODS: We assessed signs and symptoms of neuropathy in patients and conducted nerve conduction velocity (NCV) in patients and control groups, then compared the results between the two groups. RESULTS: Average duration of exposure to lead was 10.85 years. The mean BLL of patients was 100.32 µg/dl (SD = 18.42). The most common symptoms in patients were mood and sleep disturbance (64.1%) and paresthesia (47.5%). Among the patients, all of the NCV indices in median, ulnar, and radial nerves were normal. On comparing the average indices of NCV in lead-exposed men with controls, significant reductions were noted in most of the indices and with prolonged distal motor latency and peak latency. Significant but weak correlations were found between BLL and some of the indices (P value < 0.05, r = 0.33-0.52). CONCLUSION: Comparing electrophysiological study indicators between case vs controls and considering the symptoms of patients, our study showed that patient may progress to sensory neuropathy.

Occupational stress and job performance among Iranian hospital nurses: A cross-sectional survey.

BACKGROUND: Occupational stress is one of the most important factors affecting nurse performance. However, there is a lack of data about the association between occupational stress and performance. OBJECTIVE: The aim of this study was to determine the occupational stress level and its association with job performance in hospital staff. METHODS: This cross-sectional study was conducted among 400 hospital staff of Tehran University of medical sciences in 2018. Subjects completed the World Health Organization Health and Work Performance questionnaire (WHO HPQ) for demographic and occupational characteristics, and the Short Form of Copenhagen questionnaire. RESULTS: The demand and individual interface domain received the highest and the lowest score of occupational stress respectively. We found that the median for absenteeism distribution was 16 hours and, in our study, less than 10 % of the nurses had low performance. Working in intensive care units, fewer night shifts, higher income, higher levels of vitality, and social support could decrease absenteeism. In addition, staff who felt more supported and reported lower emotional demands had higher performance. CONCLUSION: Since higher levels of social support could have positive influences on reducing absenteeism and improving performance, it is recommended that hospital managers should be encouraged to use educational programs, coping behaviors, and effective interventions to improve social support. Financial incentives are a factor that could also be used to reduce absenteeism.

Needlestick Injury and Psychomotor Performance as Measured by Pursuit-Aiming Test in Health-Care Professionals.

Background: Several factors play a role in Needlestick Injury (NSI). We aimed to determine the association of NSI with psychomotor performance in health-care workers. Materials and Methods: In this cross-sectional study, demographic, occupational characteristics, and needlestick history were completed for 357 health personnel of a university hospital of Tehran in 2019 through a checklist. Psychomotor performance was measured using a pursuit-aiming test. Results: Most of the NSI occurred in nurses. The mean age of the workers with a positive history of NSI was significantly lower compared to their peers with a negative history, and similarly, they had lower work experience. After adjustment for the confounding variables, the correct pursuit-aiming test had a borderline association with the occurrence of the NSI. Conclusions: Psychomotor performance had a borderline association with the history of NSI.

Shift work and insulin resistance (HOMA-IR) among professional drivers.

BACKGROUND: Shift work may be associated with insulin resistance. OBJECTIVE: This study aimed to investigate the potential association between shift work and the homeostatic model assessment of insulin resistance (HOMA-IR) index in professional drivers. METHOD: A total of four hundred fifty-three professional drivers were invited to participate in the study within a periodic medical examination in the occupational setting. One hundred seventy-seven daytime workers were compared with 175 night shifts and 101 early morning shift drivers. Demographic, occupational, and medical examination including blood pressure, anthropometric data was assessed. Measurement of serum insulin, fasting blood glucose and lipid profile were done for all drivers. RESULTS: Compared with day workers, night shift and early morning shift drivers displayed higher levels of HOMA-IR. Metabolic syndrome was found to be significantly increased in night workers. In linear regression analysis, insulin resistance was correlated with shift work independently of demographic and occupational characteristics. CONCLUSION: The study revealed that shift work could be a risk factor in developing the risk of metabolic syndrome and insulin resistance. Suggestively, health strategies such as structured lifestyle counseling in occupational health settings are warranted to improve and modify cardiometabolic risk factors.

The Combined Effect of Noise and Solvent Exposure on Hearing Loss in the Tire Factory Workers.

Noise and organic solvents are common in many industries and both of them affect hearing. In this study, we estimated the concurrent effect of them on hearing by evaluating the existence of notch in audiograms of workers. The number of 540 persons were enrolled in this study after eliminating workers who had the exclusion criteria. We divided them into 4 groups based on their exposure status; no exposure, exposure to noise, exposure to solvent, exposure to both of them. The presence of notch in left, right, or both ears were assessed through Coles model. The rates of notch presence in both ears in the groups of noise and organic solvents exposure, noise exposure only, solvents exposure only were 11.72, 4.49, 1.86 times higher than the control group and sole solvent exposure didn't affect hearing significantly. The same pattern was seen for notch presence in left or right ear and the solvent-noise exposure group had the highest rate of notch presence. This study aims to show the synergic effect of noise and organic solvents exposure on hearing loss. Hence, we recommend implementing a hearing protection program and a higher frequency of audiological assessments in the industries involved with concurrent exposure to noise and organic solvents.

Association of sleep characteristics and respiratory symptoms at a smelting factory.

BACKGROUND: Sleep disturbance including insomnia and poor sleep quality has been shown to be a major health determinant in occupational settings. Specific occupational exposures to hazards in most workplaces can lead to various health problems, especially sleep problems. OBJECTIVE: The study aimed to investigate sleep characteristics, and their relationships with work-related exposures, demographics, and other related variables in workers of a smelting factory. METHODS: This cross-sectional study was carried out on workers in a 40-year smelting factory located in the East of Tehran Province. A total of 200 male participants were included in the study. Among them, 51 workers were from the production process staff and the rest were office workers. Their shifts were from 6 AM to 5 PM. All participants were asked about demographic characteristics and exposure to respiratory pollutants. All participants answered validated Persian versions of the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The means (SD) of age and BMI were 39.1 (8.9) years and 26.8 (4.5) kg/m2, respectively. Among all participants, 51 (25.5%) experienced exposure to a respiratory pollutant. Among all workers, 96 (48%) experienced poor sleep quality and 87 (43.5%) and 10 (5%) had subthreshold and clinical insomnia, respectively. The mean (SD) night sleep duration was 6.4 (0.96) hours. Data analysis illustrated a significant positive relationship between exposure to respiratory pollutants and insomnia (p-value = 0.03). Howewer, this association between sleep quality and exposure to repiratory pollutants was not significant (p-value = 0.25). Further analysis with binominal regression showed participants with exposure to respiratory pollutants were more susceptible to clinical insomnia (p-value = 0.02, exp(B) = 0.213), and after regressing out the effect of smoking, participants with exposure to respiratory pollutants remained susceptible to clinical insomnia. A lower night sleep duration was observed among participants with exposure to inhalational material (p-value = 0.05). CONCLUSIONS: Occupational exposures to hazardous material, including inhalational exposures, could cause sleep disturbance, which warrants more attention paid by sleep specialists.

Metabolic syndrome and its determinants among professional drivers: a systematic review and meta-analysis.

BACKGROUND: Drivers are one of the trade unions that are most exposed to various health-related risks, especially metabolic diseases. The present study aimed to systematically assess the overall prevalence of metabolic syndrome and its determinants among drivers in the world. METHODS: All retrospective, cross-sectional, or prospective studies evaluating the prevalence and risk for metabolic syndrome and its main components among male professional drivers were eligible for the initial assessment. PRISMA guideline was used. Two blinded reviewers independently screened the titles and abstracts of the manuscripts followed by a deep assessment of the full texts for determining the inclusion appropriateness. RESULTS: In the final, 12 articles were eligible for the final analysis. Overall, 19,350 professional male drivers with a total average age of 43.06 years (ranged from 35.5 to 51.1 years) were included in the study. The prevalence of metabolic syndrome was estimated to be 32.8% (95%CI: 32.1% to 33.5%), and the major determinants of appearing this syndrome among professional drivers were advanced age, years of driving experience, higher body mass index, smoking, high cholesterol dietary regimen, high Framingham risk score, low regular exercising, history of diabetes mellitus, history of gout, and shift work pattern. CONCLUSION: According to the 32.8% prevalence rate of metabolic syndrome among drivers, managerial measures are needed to prevent and control metabolic disturbances among professional drivers are recommended.

Predictive factors for return to work after lumbar discectomy.

Background. Lower back pain (LBP) is one of the most common complaints leading to disability and work absence. This study was performed to determine the rate and contributing factors of return to work in the postoperative phase after lumbar discectomy. Methods. This cohort study was performed among 142 patients attending the orthopedics spine clinic of a teaching hospital during 2016. Initially, the demographic and occupational characteristics and Oswestry disability index (ODI) were fulfilled, and patients were followed with regard to time off, work return and type of job after surgery. Results. 113 participants (79.5%) returned to work in 3 months. Male gender, higher literacy, non-manual job, less physical activity, non-smoking, formal work agreement, lower working hours and higher income were associated with return to previous work. Also, shorter preoperative duration of LBP, longer hospital stay, lower severity of LBP, lower ODI score and poor perceived prognosis of return to work were associated with return to previous work. Conclusions. Return to work after discectomy is seen in more than two-thirds of patients and is related to factors such as pain intensity and body mass index. However, return to previous versus modified job is a multifactorial issue.

Osteopathic Manipulative Treatment of Herpes Zoster Ophthalmicus/Postherpetic Neuralgia.

Herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) are the result of reactivation of varicella-zoster virus (VZV) from a dormant condition. Although HZ symptoms typically subside after a few weeks, HZO and postherpetic neuralgia (PHN) can persist at least 90 days after the appearance of the HZ rash. Presently, there is no gold standard for a disease-modifying therapy for postherpetic neuralgia and the current treatment is focused on early intervention and management of symptoms and dermatological complications. In the present case, a 74-year-old Caucasian male initially developed severe right-sided eye pain and headache. He was diagnosed with HZO and treated with acyclovir, but later developed swelling over the right eye and skin rash over the right side of the forehead and face. He presented to the office after the acute manifestation of the infection disappeared, but the headache and scalp hypersensitivity persisted and increased. Osteopathic manipulative treatment (OMT) included correction of cranial strains, inhibition, myofascial release, balanced ligamentous tension, and facilitated positional release. In one week, the patient reported a reduction in pain from 10/10 to 2/10. Two weeks later, he reported complete resolution of his initial symptoms. There are a limited number of cases that illustrate the benefit of OMT in diminishing pain and associated symptoms in different types of neuralgias. OMT ensures the restoration of normal anatomical structure and associated function through correcting somatic dysfunction, normalization of blood supply, muscle tone, and lymphatic drainage, therefore, providing pain relief. Better documentation of case reports and more research in this area would greatly benefit the medical community. The present case demonstrates the successful treatment of PHN with OMT. OMT can be successfully used as an adjunct therapy in cases of HZ and PHN.

Immunological and hematological changes in patients with hyperthyroidism or hypothyroidism.

AIMS: Thyroid hormones have been shown to influence the immune system and haematopoiesis. The aim of this study was to evaluate some immunological and hematological parameters in peripheral blood of hypo- or hyperthyroid women. MATERIALS AND METHODS: Blood samples were collected from 50 women with hypothyroid disease, 50 women with hyperthyroid disease and a control group consisting of 50 sex - and age - matched euthyroid subjects. Thyroid function assesed according to measurent of T3, T4 and TSH levels. The complete blood count (CBC), total and differential counts of white blood cells (WBC), serum levels of immunoglobulins (IgG, IgA, IgM and IgE) and C3 and C4 complement components determined in three groups by using standard immunological and hematological methods. RESULTS: In hyperthyroid women the mean serum concentrations of IgG (2312.4±584 mg/dl), IgA (296± 87 mg/dl) and IgE ( 301± 264 IU/ml) were significantly higher than those found in the control group (1539± 974 mg/dl, P < 0.0003; 234± 116 mg/dl, P < 0.01; 109.8±115 IU/ml, P < 0.0001, respectively) and the mean MCV was significantly lower in comparison with the euthyroid group (P < 0.05). Hypothyroid patients had higher serum IgE concentrations in comparison with the euthyroid group (179.8± 218 IU/ml vs. 109.8± 115 IU/ml; P < 0.047). The mean serum C3 concentration in hypothyroid patients was also significantly higher in comparison with the euthyroid group (138.7± 36.6 mg/ml vs. 117.8± 32.1 mg/dl; P < 0.01). In the hypothyroid group the mean eosinophil count was markedly higher in comparison with the hyperthyroid group (P < 0.06) and the mean count of RBC and the levels of some RBC-related indices, such as hematocrit and hemoglobin, were significantly lower in comparison with the euthyroid group (P < 0.05). CONCLUSION: These results indicate hypergammablobulinemia and lower MVC in hyperythyroid patients, and higher IgE levels, C3 levels and eosinophil count as well as anemia in hypothyroid patients.

Occupational Accidents in Iran: Risk Factors and Long Term Trend (2007-2016).

BACKGROUND: Although much is known about the distribution of occupational accidents in the world, less is known about occupational injuries in developing countries. Therefore, the aim of this study was to investigate the trend of occupational accidents during 10 years (2007-2016) and to find factors affecting the accident outcome. STUDY DESIGN: A cross-sectional study. METHODS: This study was done based on the data gathered by the Iranian Social Security Organization (ISSO), including demographic data (age, sex, marital status) and occupational accident characteristics (accident sector, cause, type, body part, location, time, month, and incident outcome). RESULTS: A decreasing pattern of occupational accidents was found from 2.95 per 1000 workers in 2007 to 1.46 per 1000 workers in 2016. The mean age of injured workers was 32.97 years. The most common cause and type of accidents were incaution and lack of attention and collision, and trapping, respectively. Limbs were the most affected body parts, and less than 1% of occupational accidents resulted in death. The highest incident was seen in the industrial sector during all years. More severe accident outcomes were seen at older ages and in the male gender, married subjects, winter season, agriculture sector, and outside of work place. CONCLUSION: These results provide a basis for further investigations regarding data collection and accident causes. Modification of some associated factors and implementation of safety prevention programs would be useful in reducing occupational accidents in Iran.

Frequency of metabolic syndrome and its associated factors in health care workers.

BACKGROUND: In recent decades, metabolic syndrome is one of the most important public health risk factors. Having this in mind, the present study was conducted to evaluate the frequency of metabolic syndrome and its associated risk factors in healthcare workers. METHOD: This study is a cross-sectional study conducted on 410 healthcare workers in a teaching hospital in Iran. Demographic, occupational, and psychosocial characteristics were assessed using questionnaire. Assessment of metabolic syndrome of hospital staff was performed at workplace during their medical examination. RESULTS: The frequency of metabolic syndrome was found to be 22.4%. This relationship was found among blood pressure and occupational stress, despite the fact that there was no significant relationship between metabolic syndrome and occupational stress. Higher age, having shift work, and inactivity were associated with metabolic syndrome. CONCLUSION: Considering the high frequency of metabolic syndrome among Iranian healthcare workers, it is advised that effective management should be employed to correct the occupational and psychosocial factors associated with this syndrome.

Pulmonary Function Testing in Cement Transport Workers at Incheh Borun Border, Northeast of Iran.

BACKGROUND: The aim of this study was to evaluate respiratory problems via pulmonary function testing in cement transport workers at Incheh Borun border in northeast of Iran in 2016. METHODS: The study was conducted on 358 male workers. All subjects were evaluated for respiratory symptoms via pulmonary function testing and completion of the American Thoracic Society questionnaire. RESULTS: Mean age of workers was 34.8±12.87 yr (age range 16-79 yr). Mean duration of employment was 6.1±4.36 yr. Most workers (75.4%) were illiterate or had elementary education. In addition, 56 (15.6%) subjects were smokers. Only three individuals (0.3%) had obstructive pattern. There was a significant relationship between age of workers and frequency of respiratory problems (P<0.05). CONCLUSION: It is necessary to educate the workers about the health and safety regulations and use of personal protective equipment in workplace. In addition, periodic evaluation of respiratory function could help protect workers from developing occupational diseases.

Respiratory Health and Cross-Shift Changes of Foundry Workers in Iran.

BACKGROUND: Respirable dust exposure is associated with increased respiratory impairment. As there are various airborne contaminants in the foundry industry, our aim was to thoroughly examine the acute effects of ambient respiratory dust on the respiratory system. MATERIALS AND METHODS: A cross-shift study was conducted in a cast iron foundry in Iran. A total of 200 participants, including 110 workers from production department and 90 office workers were enrolled in this study. Workers were evaluated with regard to respiratory symptoms using the American Thoracic Society (ATS) questionnaire and examination of their lung function by spirometry. RESULTS: The mean exposure of all studied substances was higher than occupational exposure limits. The most common respiratory symptom in exposed workers was cough (24.5%). A statistically significant post shift reduction in FEV1 and FEF25-75 was seen in exposed group. After adjusting for age, working history, smoking and Body Mass Index (BMI), there was a significant decrease based on exposure in FEV1 and FVC. CONCLUSION: Dust exposure was a significant predictor of lung function. Implementing the health promotion program, periodic medical surveillance and efficient use of respiratory protection equipment could help to protect foundry workers from respiratory impairment.

Respiratory problems among cotton textile workers.

BACKGROUND: Long term occupational exposure to cotton dust is associated with respiratory symptoms and loss of pulmonary function. AIM: This study was conducted to explore respiratory symptoms, pulmonary function tests and chest radiography of workers, and to evaluate the findings of high resolution computed tomographyand its correlation with pulmonary function tests (PFT). MATERIAL AND METHODS: The study was conducted on 100 cotton workers as exposed group and 100 unexposed subjects. Smokers were excluded from the study. All workers were interviewed and examined by the pulmonologist. PFT and chest radiography were conducted for all subjects. HRCT was performed for those with abnormal PFT or chest radiography. RESULTS: A total of 51% and 31% of the cotton textile workers had one or more respiratory symptoms and respiratory signs respectively. 28% of subjects in the exposed group and 5% of subjects in unexposed group had obstructive pattern. Bronchia wall thickening and air trapping were the most frequent chest radiography and HRCT abnormalities respectively. There was a significant correlation between HRCT and the results of PFT. CONCLUSION: We conclude that long term exposure to cotton dust is associated with obstructive disease that increase with duration of exposure (history of working years), also use of HRCT as a sensitive tool in the assessment of pathologic changes and it's correlation with PFT, confirms the expected pathophysiology of airway obstruction in cotton workers.