affecting factors

Numerous meta-analyses of childhood leukemia have been published, but no comprehensive study has examined the factors influencing childhood leukemia. We aimed to scrutinize the modifiable and non-modifiable factors affecting the risk of childhood leukemia.

In this overview, two independent researchers screened the articles studying the effect of modifiable and non-modifiable factors on the childhood leukemia from the related databases, including Scopus, EMBASE, Cochrane, Web of Science, and Medline, without time and language restrictions from inception up to March 10, 2020.

Eight meta-analyses were included in this overview. Breastfeeding compared with non-breastfeeding was associated with 9% reduction in the risk of childhood leukemia (OR = 0.91). The children with the birth weight of ≥4,000 g were at a higher risk of acute lymphoblastic leukemia compared with those with low birth weight (OR = 1.26, 95% CI = 1.17, 1.37). There was a significant relationship between childhood leukemia and residential pesticide exposure (SOR=1.57). There was a relationship between influenza during pregnancy and higher risk of ALL (POR=3.64; 95% CI = 1.34-9.90), and childhood leukemia (POR=1.77). The childhood AML had a statistically significant relationship with no alcohol consumption during pregnancy. The SOR of childhood ALL had an association with paternal smoking. A statistical relationship exists between magnetic field intensity of ≥0.4 μT and childhood leukemia. The exposure to NO2 and benzene exhibited the OR of 1.64 (95% CI = 0.91-2.95) and 1.21 (95% CI = 0.97-1.52), respectively.

Decreased breastfeeding, high birth weight, viral infections during pregnancy, alcohol consumption, maternal exposure to direct and indirect smoking, and exposure to electromagnetic fields and airborne pollutants are found to be significant risk factors for childhood leukemia.

The process of the patient discharge from the hospital is one of the most important processes that has been taken into consideration by managers in recent years. An efficient health system can only accomplish its duty to provide the health of the community by providing the right services and this system can be evaluated through its services. Therefore, the necessity of performing this research is to improve the quality of hospital services for patients and increasing patient satisfaction. This study has been aimed to identify the factors affecting the process of patient discharge.

This was a cross-sectional study conducted in a general hospital located in Takestan, Qazvin in 2019. The study population in the qualitative section of the study included those who were aware of the discharge process and had managerial positions in the hospital. The sampling process was continued until achieving data saturation. The required information was gathered through reviewing relevant literature, observing the discharge process, and conducting semi-structured interviews with managerial members and study experts.

In the present study, the most important factors affecting the discharge process were lack of timely physician visit and issuance of the discharge order, delay in the approval of medication used by pharmacy officer, sending discharge files to hospital discharge unit, the patients' needs, diagnostic services (discharging with doctor's opinion), delays in registering nursing records, and undue secretarial performance in reviewing and recording reports in the hospital information system.

The results of the present study, in line with other researches, have shown that the importance of the discharge process on hospital performance is undeniable and this process needs continuous investigation, monitoring, and intervention.