نشریه سازمان نظام پزشکی مشهد (سیمرغ سپید)
سال هجدهم شماره 1 (پیاپی 65، بهار و تابستان 1393)

Physicians working in governmental institutions play an important role in providing affordable and efficient healthcare in the health system of Iran. In this study, knowledge, attitude and practice of government-related physician toward their respective organizations is evaluated. In this cross - sectional study in 2014, a categorized questionnaire containing questions in three areas of (1) "knowledge" about the rules and regulations of the organization, (2) "attitude" toward the working atmosphere of the organization, colleagues and higher rate managers and (3) level of "practice" in defined duties was given to physicians working in organizations and government related hospitals in the city of Mashhad. In this study that was performed on 120 physicians working in subsets of 3 government organizations, 74 subjects responded to the questionnaire (response rate: 61.6%) which 45 of them were men (60.8%). The mean age of respondents was 45.4 ± 6.1 years and their mean working history was 15.9 ± 5.7 years. The highest level of knowledge was found in the "five main objectives of the organization" (54.2%). The highest positive attitude of respondents was to a question about "being effective in their respective institution" (75.6%). The respondents mentioned their best practice in dealing with superiors, colleagues and clients (94.6%). Comparing the responses of men and women, more men than women were informed about the rules of promotion in the organization (P = 0.04). On the other hand, more women than men believed that the organization has responded positively to their efforts and creativity (P = 0.001). Physicians who had administrative history were significantly more aware of the details of promotion rules in their organization (P = 0.026) and know the 5 main objectives of the organization (P = 0.019) compared to those who did not have such history. It seems necessary that at the beginning of the employment of physicians in the government related organizations, their positive attitude toward the organization should also be considered and their knowledge about their duties and objectives of the organization should be increased by group brainstorming sessions and training classes.

Disasters are destructive events that necessitate a wide range of emergency resources to help and ensure the health and survival of the victim population. The types of disaster are natural disaster including earthquakes, volcanic eruptions, hurricanes, floods, and man-made disasters such as war and terrorism. Over the past 20 years, natural disasters have affected at least 800 million people and caused over 3 million deaths. Poor engineering, improper safety practices, or simple human error can cause technological disasters. Many challenges that emergency responders potentially face are identification of the nature of the hazardous materials, evacuation of people after disasters, giving appropriate medical care for victims, and protecting emergency responders against dangers. Todays, the aims of disasters prevention are disaster planning, prevention, and mitigation. The medical and public health response to a disaster can be in "micro" (the level of patient care) or "macro" (the level of public and governmental authorities). Twenty-one medical and public health practices were considered important in disaster planning at the local level: medical needs assessment, health surveillance and epidemiology, identification of medical and health resources, medical transportation, patient distribution and evacuation, pre-hospital emergency services, hospital emergency services, in-hospital care, out-of-hospital care, temporary field treatment, food safety, management of hazardous agent exposure, mental health, medical and public health information, vector control, potable water, waste management, communicable disease control, animal control, coroner and mortuary services and finally care and shelter. Adequate knowledge and experience to respond effectively to medical emergencies during a disaster are essential.

Job burnout is a syndrome consisting of emotional exhaustion, depersonalization, and reduced personal accomplishment. This study was done to assess job burnout in personnel of healthcare centers of Mashhad after the establishment of the family physician program to find out its relationship with social support and self-esteem. In this descriptive analytical study, personnel of 30 health centers in Mashhad were rendomly selected to answer to the standard questionnaires which include demographic features, Aizeng self-confidence questionnaire, Cassidy social support scale and Maslach burnout inventory. Overall, 285 health center employees completed the survey instrument. Seventy-three percent of respondents were women. Mean score of the personal accomplishment aspect of burnout was 33.8 ± 10.4, in emotional exhaustion was 17.9 ± 10.8 and in depersonalization was 4.7 ± 4.8. In most cases, low emotional exhaustion (50.2%), low depersonalization (97.2%) and a high personal accomplishment (79.3%) were found. Between social support and self-esteem of employees a significant correlation was established (r = 0.177, P = 0.03). There was no significant relationship between dimensions of burnout and self-confidence, and social support. Between emotional exhaustion, with variables such as education level, employment status and smoking habits a statistically significant relationship was found (P < 0.05). Between personal accomplishment and the variables of place of employment, education, smoking habits, a significant association was also found (P < 0.05). In this study, the emotional exhaustion was moderate, depersonalization was low and personal accomplishment was moderate in employees of health centers. It is suggested to consider coping strategies to minimize and control occupational stressors.