- Volume:9 Issue: 2, 2017
- تاریخ انتشار: 1396/06/15
- تعداد عناوین: 7
Page 73Workplace Violence (WPV) is defined as exerting intentional physical and psychological force and pressure on individuals to harm, threaten, or insult them in the workplace (1). Currently, WPV in the healthcare systems has become a major problem for the health and productivity of employees (2). The highest rates of WPV in healthcare systems have been reported in Emergency and Psychiatry wards (3). Studies have shown that one out of every five patients admitted to acute psychiatric wards acts violently towards the staff (4, 5). Moreover, most physical forms of WPV occur by patients in psychiatry wards; while in other medical wards verbal violence by those accompanying the patients is more prevalent (6).
Recently, one of the faculty members of Tabriz University of Medical Sciences was severely attacked in the hospitals clinic by a patient with psychotic symptoms (Figure 1). Apart from the terrible and dramatic dimensions of the incident, this violent behavior can be carefully considered in several aspects as a WPV. First of all, this patient was a man with psychotic characteristics diagnosed to have schizoaffective disorder and had included some of the staff in his delusional system. Second, the aim of this serious attack was a psychiatrist older than 40 with nearly 15 years of clinical and academic experience. This professor has specific experience in working and communicating with patients with various disorders. Therefore, although the patient had several patient-related risk factors for WPV, the psychiatrist who was attacked did not have any of the staff-related risk factors. Thus, this incident should be considered as a serious warning for the policy makers of psychiatry in the country and causes to arise several important questions.
Various risk factors have been introduced to create WPV. Some of these factors such as male sex, schizophrenia, substance abuse, and history of violence, are related to the patients (7). Other factors are mostly related to the personnel and include weak relationship with patients, being less than 40 years old, little clinical experience, female sex, low educational status, less work experience, and high anxiety (8). Some risk factors can also be related to the safety climate dominating the workplace. It has been emphasized that the safety climate of the workplace is a very important factor and its improvement could maintain the wellbeing and safety of the personnel (9). Although various risk factors have been determined, some studies have shown that almost 70% of healthcare personnel cannot predict the occurrence of WPV (10).
The main question is whether relying solely on the professional and personal skills of staff in mental healthcare personnel can have a preventive effect on WPV. Moreover, the unpredictability of such incidents makes the WPV far more out of control for the staff. The second question is whether measures have been taken to provide a safe work environment based on national standards; and whether the countrys healthcare system is equipped with comprehensive and effective guidelines for preventing WPV in critical situations. On the other hand, the social effects of these incidents on the general public and the reactions of the victim are yet among the issues requiring further investigation. Finally, does the destigmatization of mental diseases in modern psychiatry cause to neglect the potential threats imposed by these patients?
In conclusion, it could be stated that approaches towards destigmatization of psychiatric patients should not distant us from searching for methods of controlling violence-related risk factors in the workplace. It seems that healthcare and educational centers in Iran need to implement security measures, and create safe environments, as well as compile comprehensive guidelines and protocols for protecting the wellbeing of the personnel.
An analysis of child deaths by suicide in Queensland Australia, 2004-2012. What are we missing from a preventative health services perspective?Page 75BackgroundThis article analyses case descriptions of child suicides from 2004 to 2012 toinform future policy and practice.MethodsQuantitative data and case descriptions for 159 child suicides (under 18 years) in Queensland, Australia, were analysed quantitatively using SPSS and qualitatively using automated content analyzis (Leximancer).ResultsMore than three quarters of child suicides involved hanging and 81% of suicides occurred in the family home. Less than 20% of the deceased left a note, however there was evidence of planning in 54% of cases. Most common triggering events were family conflicts.ConclusionsEffective suicide prevention interventions require a comprehensive understanding of risk factors. Quality of case descriptions varied widely, which can hamper injury prevention efforts through an incomplete understanding of characteristics of, and important factors in child suicide. Additional attention and resources dedicated to this public health issue could enhance the development and implementation of effective intervention strategies targeting child and adolescent suicide.Keywords: Suicide, Children, Adolescents, Risk factors, Prevention
Page 83BackgroundThe aims were to assess the frequency of falls among the diabetic adult population of the Italian Northeastern region Friuli Venezia Giulia and to identify risk factors.MethodsThis was a population-based retrospective cohort study using administrative data of the regional health information system as the source of information. In a cohort of diabetics 18 years of age or more, living in the region on December 31, 2014, the occurrence of falls requiring a visit to the regional Emergency Rooms was assessed. Multivariate logistic regression was used to identify factors associated with increased risk of falling.ResultsOf 80,162 cohort subjects, 2967 (3.7%) had at least one fall requiring a visit to ER. Factors associated with increased risk of falling were female sex, older age, prescription of a thiazolidinedione as the last antidiabetic medication in 2014, increasing number of active principles prescribed in 2014, longer diabetes duration, and prescription of certain classes of medications other than antidiabetics in 2014.ConclusionsIn Friuli Venezia Giulia, injurious falls are a complication of diabetes relevant from the public health viewpoint. Efforts are needed to screen diabetic patients, review their prescriptions, provide appropriate care, and implement targeted interventions to minimize the individual risk of falls.Keywords: diabetes mellitus, accidental falls, Italy, emergency department
Page 91BackgroundUnintentional drowning is the leading cause of death for children younger than 5 years old. A bucket is one of the most common water container in which children can drown. The objective of this work was to evaluate the base diameter of a bucket and the necessary force to shed it.MethodsThis was an experimental study. We used six galvanized buckets of different diameters. Each selected bucket was pulled using a pulley with other buckets full of water until the water spilled out. The statistical analysis was done by linear regression with pResultsThis research shows a direct relation between the wide base diameter (in a bucket 23 cm high, 25 cm rim, with a 20 cm water depth) and the strength required to spill the liquid contents (β = 1.21; x = diameter of the base in centimeters; α = ‑14.59; r = 0.99 and pConclusionsWe conclude that the bucket structure could determine the risk of child drowning. The risk could increase directly as its base width increases.Keywords: drowning, water storage, infant, child preschool, accident prevention
Attention deficit/hyperactivity disorder and risk of injuries: a systematic review and meta-analysisPage 95BackgroundThis study systematically reviewed the literature in order to determine the effect of ADHD on injuries and assessed the magnitude of the potential association.MethodsA systematic review of the studies examining the association of ADHD and injuries was carried out across multiple databases. Odds ratios and standardized mean differences were pooled.ResultsA total of 35 studies were selected for quantitative analysis. The association of ADHD and injuries was confirmed over the meta-analysis of eligible studies. The odds ratio pooled over all comparative studies was 1.96(95% CI: 1.6-2.4) using random effects model. Pooled odds ratio of 2.1 and 2.17 were calculated respectively when cohort and case-control studies or just cohort studies were included. The pooled odds ratio reduced to 1.8(CI:1.45-2.3) when studies on specific injuries were removed. For studies comparing scores of rating scales, the pooled standardized mean difference was 0.61(95% CI: 0.03-1.2).ConclusionsThose with ADHD are nearly two times more likely to be injured.Keywords: Attention deficit hyperactivity disorder, Injuries, Accidents, Systematic review
Page 107BackgroundPresence of a trauma team leader (TTL) in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS) guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients.MethodsIn accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data.ResultsThree retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR): 0.82, 95% confidence interval (CI) 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03).ConclusionsDespite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare the effectiveness of surgeon and non-surgeon trauma team leaders in order to resolve the controversy about who should lead the trauma team. Clinically significant missed injuries should be considered as important outcome in future studies.Keywords: Wounds, injuries, Leadership, Emergency care
Page 117This article outlines the goals and targets of Sustainable Development Goals (SDGs) related to elimination of violence against women and girls (VAWG) and to explain the framework to target these goals. Prevention of VAWG has been identified as one of the key agents for sustainable development. SDGs gave enough importance and called for the elimination of all forms of violence against all women and girls everywhere. It identified different social and political enablers of reducing violence which are targeted under different SDGs. This acknowledges tacitly that VAWG is preventable and it is set to prevent and eliminate it. Evidences show that preventing VAWG is possible through multi-sectorial programs. The United Nations committed to revitalized global partnership to mobilize resources for implementing the agenda. Hence, designing and implementing interventions and subsequently scaling-up and intensifying these interventions are required to end VAWG.Keywords: Sustainable Development Goals, gender, violence, women's health