دکتر قاسم یادگارفر

The quality of life of menopausal women is always an important health issue. Questionnaires available in Iran to assess the quality of life of menopausal women are short-translated questionnaires that often only measure the frequency and severity of menopausal symptoms and doesn’t include all dimensions affecting the quality of life in this time period. Therefore, the present study was conducted with aim to design and standardize a questionnaire to evaluate the quality of life of women on the threshold of menopause.

The Persian version of the questionnaire was developed by forward–backward translation process and was evaluated on 370 women aged 47 to 60 years who were randomly selected from women covered by Shahinshahr (Isfahan) health centers. The impact score index was used to evaluate the face validity, the content validity index and content validity ratio were used to evaluate the content validity, the methods of correlation of convergence validity and discriminant validity and exploratory factor analysis were used to evaluate the construct validity, and Cronbach’s alpha and intra-class-correlation (ICC) were used to evaluate the reliability of the questionnaire and reliability coefficient index.

The final questionnaire consists of 43 questions in 4 scales (psychological, sexual, physical, sychosomatic). The results show that each of the psychological, sexual, physical and psychosomatic dimensions had Cronbach's alpha coefficients of 0.862, 0.805, 0.669, 0.728 and in total 0.879, respectively and the intra-class-correlation obtained 0.875, 0.899, 0.841, 0.908 and in total 0.824. The face validity, content validity and structural validity were confirmed.

The present study provides a scientific, valid and reliable tool in Persian language to assess the quality of life of women at the threshold of menopause. Using this questionnaire to evaluate the quality of life these women can be an effective step towards its improvement.

One of the most serious human threats is the emerging disease called COVID-19. Due to its rapid spread around the world, it was raised as a global concern by the World Health Organization (WHO). This study aims to assess the role of adherence to preventive measures (wearing masks, social distancing, and washing hands) in reducing COVID-19 infection

In this case-control study, participants were 143 patients with positive polymerase chain reaction (PCR) test results (case group) and 143 patients with negative PCR test results (control group) referred to the Moein Health Center in Miandoab County, West Azerbaijan Province, Iran. Data were collected through an interview using a researcher-made questionnaire. STATA software, version 14 was used for data analysis.

In this study, the data of 298 people (143 controls and 155 cases) were examined. The odds of positive PCR test results in people who did not adhere to social distancing guidelines, wearing masks, and washing hands were 37.11, 9.042, and 14.50 compared to those who adhered to these preventive measures (P<0.001). 

According to the results, the effective method to control the COVID-19 pandemic is adherence to preventive measures (wearing masks, social distancing, and washing hands) with public participation and cooperation of government organizations.

Gastrointestinal cancers are one of the most dangerous and common cancers in Iran. This type of cancer is more common in the esophagus, stomach, colon, and rectum. The present study is aimed to determine the level of knowledge, attitude, and practice of employed health professionals about the risk factors of gastrointestinal cancers.

In the present cross-sectional study, all 175 male and female health workers in Isfahan Health Centers No. 1 and 2, Isfahan, Iran, were studied. Data were collected using a questionnaire, measuring the knowledge, attitude, and practice of health workers. Raw data of knowledge, attitude, and practice were converted to standard scores from 0 to 100 with a linear conversion and were described with mean, standard deviation (SD), 95% confidence interval (CI), median, and interquartile range. Data were analyzed by one-way analysis of variance (ANOVA) at a significance level of 5% using SPSS software.

The mean scores of knowledge for all participants were 69.3%, the mean scores of attitude were 73.9%, and the mean scores of behavior were 35.3%. The difference between the mean scores of knowledge, attitude, and behavior of health workers according to gender, marital status, family history, income, and enteritis was not statistically significant. However, the mean scores of individuals’ behavior with educational levels of diploma and sub-diploma were statistically significant (P = 0.046). Attitude score increased in terms of age (P = 0.007). Additionally, there was a significant linear positive correlation between work experience and attitude score (r = 0.218, P = 0.004). The relationship between gender and nutritional behavior was significant (P = 0.039). The average knowledge score of people who needed periodic testing was 76.6, which was also significantly different from people who did not need periodic testing (P = 0.026).

With increasing age and the years of employment, the attitude score increased. Moreover, the average nutritional behavior of male health workers was lower than female ones. It was also found that people who needed periodic testing had higher knowledge ones. Therefore, in addition to developing appropriate training programs, adopting other health policies is needed, so that by overcoming the barriers to preventive behaviors, not only the performance of health workers can be increased but also by providing services to the covered populations, people's participation in colorectal cancer screening programs can be improved.

Every organization is created with human resources and without it, no organization will be able to survive. Due to the important role of human resources in health care systems and their satisfaction in ensuring the quality of care, the present study was conducted to determine the level of job satisfaction and its relationship with demographic variables in health workers working in Chaharmahal and Bakhtiari province.

The present study is a descriptive-analytical cross-sectional study that was conducted in 2020 on 164 health worker in Farsan and Koohrang counties of Chaharmahal and Bakhtiari province. In this study, a standardized questionnaire was used to collect data. Data were analyzed using SPSS software version 24 at 95% confidence level. For descriptive analysis, central indices and dispersion were used and for analytical analysis, independent t-test, chi-square and one-way analysis of variance were used.

The mean scores obtained from the job satisfaction scores in the present study include 1.97 for the payment system, 3.27 for the type of job, 2.69 for the opportunities for advancement, 3.08 for the health system transformation plan, 3.10 for the organizational climate, 3.03 for the leadership style, 3.09 for the physical condition. and 2.26 were obtained for the correct execution of job packages. Statistically significant relationship between the payment system and the level of education of health workers (P < 0.001), between the opportunity for advancement and gender (P = 0.002), between job satisfaction with the health care transformation plan of health workers With the amount of service records (P = 0.002), between the organizational climate with the place of service of health workers (P = 0.004), between the leadership style and the level of education (P = 0.004), between the implementation of service packages for health workers and the residence of health workers (P = 0.004) was observed.

According to the obtained results, it was found that there is the highest level of satisfaction of health workers regarding the type of job and the lowest level of satisfaction in the field of payment system. In general, the job satisfaction of health workers working in Farsan and Koohrang cities is moderate and the need for comprehensive planning to improve the quality and quantity of health care workers is essential.

Hamstrings (Hams) to Quadriceps (Quadr) strength ratio is known as a risk factor for Anterior Cruciate Ligament (ACL) injury and affects by knee and hip flexion angles. Gluteus Maximus (Gmax) muscle acts as a synergist for Hams in hip extension in a closed kinetic chain. The aim of this study was to investigate the effect of Gmax strengthening exercises on the kinetic and kinematic risk factors of ACL injury when single-leg landing from a jump. 25 volunteer women aged 18-30 years were assigned into control (n =13) and experimental (n =12) groups. Maximum isometric strength of Gmax, hip and knee joint angles and ground reaction force (GRF) was measured at landing, by dynamometer, 2D imaging and foot scan respectively,. After 8 weeks of 3 sessions of Gmax resistance training, Following the significant within-subject difference for GRF (F=5.245, P=0.032) by using Two-way mixed model ANOVA, Pre and post-test Differences were significant with 16.63% decrease (P= 0.038, t=2.354). Differences between pre and post-test peak force, time to peak, mean joint angles, impact and load rate were not significant (α = 0.05). According to a 4.55% and 3.47% increase in Gmax strength and time to peak force, and considering the fact that at the beginning of landing, the mechanical advantage of Hams is lower than that of Gmax, the risk of ACL injury could be reduced by reducing GRF following an increase in the Gmax strength.

An increased Quadriceps to Hamstrings muscle strength ratio, which leads to development of anterior shear forces on the Tibia, is known as a risk factor for Anterior Cruciate Ligament (ACL) injury. The purpose of the present study was to investigate the effect of Gluteus Maximus Muscle (GM) strengthening exercises on the intensity of Quadriceps Muscle (QFM) contraction at landing.

A total of 25 healthy volunteer females, aged 18-30 years, were assigned into two groups of control (n = 13) and experimental (n = 12) in a randomized control trial. Maximum isometric strength was measured using hand-held dynamometer and the intensity of contraction on the moment of landing to the maximum intensity of voluntary isometric contraction (%MVIC) for GM, QFM, and Hams were measured using surface EMG, respectively. After eight weeks (3 sessions per week) of resistance training on the experimental group, measurements were repeated. Two-factor mixed model ANOVA was used as a significance test and paired samples T-test as the post hoc.

There was a 4.55% non-significant increase in the mean GM strengths in the experimental group. In term of the intensity of contraction, there were a 16.36% increase, a 8.26% decrease, and a 9.21% increase all of which were significant in the experimental group (P≤0.05), and a 2.93% increase, a 4.73% decrease, and a 4.3% increase, all non-significant, in control group, for GM, QFM and HAMS, respectively.

These results suggest that GM strengthening exercises along with HAMS could be effective in decreasing the intensity of QFM contraction, preventing anterior translation of Tibia, and decreasing ACL injury, as a consequence.

Pre-hospital emergency care technicians are faced with a high level of physical and mental stress because they must quickly attend emergency situations, and this high level of stress can lead to occupational stress in them. Occupational stress is the result of an interaction between job conditions and personal factors, when the demands of the workplace and the related pressures are higher than the degree tolerated by the individual. Research shows that prolonged and continuous stress in the workplace can result in reduced productivity, decreased job satisfaction, poorer quality of service provision to patients, fewer accurate and timely decisions, a sense of job-related incompetence, occupational fatigue, a higher degree of absenteeism, and finally the occupational burnout syndrome. If occupational burnout is not identified and an effective solution is not proposed to reduce or prevent it, the physical and mental health of the employees will be threatened, and their performance efficiency and quality will suffer. Having a skillful and efficient human force is an important factor contributing to the efficiency of organizations; therefore, it is necessary to implement personal interventions to enhance the capacity of the employees in the face of stress, and maintain and promote their mental health. One such intervention which may help mitigate occupational stress is the use of positive psychology. In positive psychology, one’s higher focus on the positive aspects of events and less focus on negative aspects create a positive feeling, promote effective relationships with others, contribute to rational decisions, improve one’s resilience in the face of problems, and help one resolve life challenges and better manage problems. A gratitude program is a positive psychology skill which serves as a mental health indicator and complements psychotherapy and cognitive therapy interventions. Gratitude is not compatible with negative feelings and emotions such as stress, and even protects one from the impact of mental distress. It empowers people in fighting stress and promotes their general positive attitude by improving mental, spiritual, and physical well-being. It is evident that emergency care technicians experience high levels of stress and occupational burnout as a result of the stressful nature of their job. Thus, it is highly important to study the mental health of these technicians. The present study examined the effect of a gratitude program on the stress and occupational burnout of pre-hospital emergency care technicians.

This was a randomized two-group ad three-phase field trial with a pretest-posttest (immediately after intervention) design and one-month follow-up. Eighty pre-hospital emergency care technicians in the south of Isfahan Province, Iran, were randomly selected. After explaining the study to the participants and receiving their written informed consent for participation, they were randomly allocated to the experimental and control groups based on the inclusion criteria. The demographic information form, the Occupational Stress in Emergency Technicians Questionnaire, and the Maslach Burnout Inventory were completed by both groups in the introductory session and before implementing the intervention. The demographic information form examined the participants’ age, marital status, job experience, working hours, level of education, type of employment, and type of the emergency base. The occupational stress questionnaire was developed and standardized by Danesh. It comprised 46 items examining stress in four dimensions of physical, occupational, group-related, and organizational. The reliability of this questionnaire was examined in the present study by checking its internal consistency, and the Cronbachchr('39')s alpha of 0.86 was obtained. The Maslach Burnout Inventory consisted of 22 items which assessed the three dimensions of occupational burnout: emotional exhaustion, lack of personal accomplishment, and depersonalization. Maslach and Jackson reported the internal consistency coefficient of 9.0, 0.79, and 0.71 for emotional exhaustion, depersonalization, and personal accomplishment, respectively. The reliability and validity of this questionnaire were confirmed by numerous studies in Iran, and Cronbach’s alpha of 0.75-0.87 was reported for it, indicating its reliability. The intervention comprised six sessions of in-person gratitude program as a positive coping technique in stressful and difficult situations, developed based on the models of verbal gratitude (Emmons & McCullough, 2003), behavioral gratitude (Tsang, 2002), and practical gratitude (Seligman, 2005), and approved by the Department of Psychiatric Nursing,  School of Nursing and Midwifery, Isfahan University of Medical Sciences. The educational content consisted of writing a letter of gratitude to significant people in onechr('39')s life, consciously searching for gratitude in daily life, recalling memories of gratitude by people and the organization during onechr('39')s work life, increasing attention to the smallest positive events during missions despite a high level of stress and recording them. Next, the program was followed for four weeks online by using the Telegram app. For the experimental group, five in-person sessions of gratitude were held at the Accidents and Emergencies Educational Center in the south of Isfahan Province. At the end of the fifth session, the participants joined a Telegram channel and were requested to record the positive aspects which merited gratitude encountered in their missions for four weeks (twice a week). The person in charge of education at the center reminded the participants of sending their messages to the Telegram group once before the shift was started and once at the time of shift change. After four weeks of online program, the sixth session was held at the center, in which the content provided throughout the program was summarized, and the messages sent to the Telegram group were examined in terms of their positive and negative load. The participants were then asked to fill in the same questionnaires once more. To eliminate the cohort effect of the intervention group, the control group also received two sessions in which general topics related to the missions and the importance of implementing mental health interventions for the personnel were discussed. The control group joined another Telegram group and their requested to record the events related to their missions for four weeks (twice a week). At the end of this program, the control group also filled in the questionnaires, and their messages were examined in terms of negative and positive loads. One month later, all the participants in the experimental and control groups completed the questionnaires for a third time without receiving any additional intervention. The questionnaires were distributed and collected in all three phases by the person in charge of education at the center. The data were inputted in SPSS 18 and analyzed by using t-test and ANOVA.

The highest frequency in both groups belonged to married people who worked in urban bases on a 24-hour basis. In terms of level of education and type of employment, the highest frequency belonged to those with a bachelorchr('39')s degree and full employment (experimental group), and an associate degree and contractual employment (control group). Results of the t-test indicated that the mean scores of the dimensions of occupational stress and burnout did not significantly differ before the intervention between the two groups (p>0.05). However, this difference was significant immediately after and one month after the intervention (p<0.001), demonstrating the effect of the gratitude program on the dimensions of occupational stress and burnout in the experimental group.  One-way ANOVA showed that, in the experimental group, the mean difference in the scores of the dimensions of occupational stress and burnout before, immediately after, and one month after the intervention was significant in all the dimensions of occupational stress, except for the group-related dimensions (p<0.05).  In other words, the intervention affected the physical, occupational, and organizational dimensions of occupational stress. Findings also showed that gratitude was effective only on the emotional exhaustion dimension of occupational burnout (p<0.05).

Based on the findings, implementation of the gratitude program reduces occupational stress and also affects emotional exhaustion which is a dimension of occupational burnout. Based on the nature of the emergency care technicians’ job and the inadequate time they have to spend on mental health programs, the implementation of such programs over messaging services such as Telegram is cost-effective and practical in a short period. It can also help these technicians overcome occupational stress in the first stages, preventing it from progressing to more advanced levels which lead to occupational stress. The effect of interventions is stronger in the first stages of a problem than the final and progressed stages. This must be kept in mind when trying to prevent occupational burnout which has negative effects on organizational productivity and personal relations. It is recommended that such programs be implemented to maintain and promote the mental health of pre-hospital emergency care technicians.