جستجوی مقالات مرتبط با کلیدواژه "risk" در نشریات گروه "پزشکی"
-
Background
Social trust in relief organizations is one of the prerequisites for community preparedness for disasters. This study aims to explore the challenges of social trust in disaster management in Iran with a focus on the COVID-19 pandemic, and provide recommendations for building social trust.
Materials and MethodsThis is a qualitative study using a conventional content analysis method. Participants were 27 lay people and managers of emergency and relief organizations in Tehran who were selected purposefully with maximum diversity. We used in-depth semi-structured interviews to explore their experiences and perceptions. Data analysis was performed using MAXQDA software, version 2018 and Graneheim and Lundman’s content analysis method.
ResultsIn this study, two main themes emerged, “challenges to building social trust” and “recommendations for building social trust.” The challenges had four categories: Managerial issues, misunderstanding of the situation, lack of transparency, and lack of coordination. The recommendations had three categories: Management improvement, efficient risk communication, and experience-based interventions.
ConclusionSocial trust during disasters in Iran can be improved by transparency in the performance and tasks of relief organizations, timely and accurate provision of information (risk communication), and emphasis on social participation and solving managerial issues.
Keywords: Trust, Disasters, COVID-19, Qualitative Research, Risk -
مقدمه
یکی از مهم ترین ارکان بهبود خدمات بهداشت و درمان، وضعیت بیمه های درمان تکمیلی است که باعث افزایش دسترسی مردم به مراقبت های بهداشتی می شود. ارزیابی دقیق و علمی ریسک صدور بیمه نامه درمان یکی از حساس ترین و مهم ترین مراحل ارزیابی ریسک است و انجام آن باعث شناسایی مشتریان پرریسک و تعیین نرخ بیمه سلامت، متناسب با ریسک مشتریان می شود؛ لذا مطالعه حاضر با هدف کلاس بندی و نرخ گذاری بیمه شدگان درمان با استفاده از رویکرد ماتریس ریسک انجام گرفت.
روش بررسیبرای ارزیابی ریسک بیمه شده ها، یک مدل دومرحله ای همراه با رویکرد ماتریس ارزیابی ریسک ارائه شده است که با استفاده از آن بتوان بیمه شده ها را در کلاس های مختلف ریسک طبقه بندی کرد. برای این منظور ابتدا در گام اول احتمال ادعای خسارت را با استفاده از رگرسیون لجستیک براساس ریسک فاکتورهای سن، جنسیت و موقعیت جغرافیایی پیش بینی کرده و در گام بعد شدت خسارت با استفاده از رگرسیون چندکی پیش بینی شد.
یافته هادر این مطالعه، مدل ارزیابی ریسک با رویکرد ماتریس ریسک ارائه شد که با به کارگیری آن می توان برای بیمه نامه ها سه کلاس ریسک بحرانی (R1 R1) متوسط (R2 R2) و قابل قبول (R3 R3) ارائه کرد.
نتیجه گیریبا استفاده از نتایج رویکرد ماتریس ریسک می توان برای بیمه نامه ها حق بیمه ای متناسب با کلاس ریسکی آنها تعیین نمود. این موضوع می تواند به افزایش سطح رضایتمندی مردم، حرکت کردن در مسیر عدالت، رسیدن به حق بیمه منصفانه، گسترش یافتن فضای امنیت و نگاه علمی کردن به صنعت بیمه کشور کمک کند.
کلید واژگان: کلاس بندی, بیمه, سلامت, ریسک, رگرسیونIntroductionOne of the most important pillars of improving healthcare services is the state of supplementary medical insurances, which increase people's access to healthcare. The accurate and scientific assessment of the risks of issuing a medical insurance policy is one of the most sensitive and important stages of risk assessment, and performing it leads to the identification of high-risk customers and the determination of the health insurance policy rate, in accordance with the customers' risk. Therefore, the present study aimed to classify and rate health insurance beneficiaries using a risk matrix approach.
MethodsIn order to assess the risk of insured persons, a two-step model has been presented along with the risk assessment matrix approach, which can be used to classify the insureds into different risk classes. For this purpose, in the first step, the probability of claiming damages using logistic regression based on age, gender and geographical location risk factors are predicted and in the next step the severity of the damage is predicted using quantile regression.
ResultsFinally a risk assessment model is presented with a risk matrix approach, which presents three risk class; critical (R_1), moderate (R_2) and acceptable (R_3) risk class.
ConclusionUsing the results of the risk matrix approach, insurance premiums have been determined for the insurance policies according to their risk class. This can help increase people's satisfaction, move towards justice, achieve fair insurance premiums, expand the security environment, and take a scientific look at the country's insurance industry.
Keywords: Classification, Insurance, Health, Risk, Regression -
مقدمه
کارکنان مراقبت های بهداشتی سربازان خط مقدم مبارزه با ویروس کرونا می باشند.
روش بررسیاین مطالعه مقطعی در یکی از بیمارستان های آموزشی شهر یزد بر روی کلیه پرسنل شاغل انجام گرفت. برای هر یک از شرکت کنندگان پرسشنامه ای حاوی اطلاعات دموگرافیک و سابقه ی تعداد دفعات و مدت زمان مواجهه روزانه با بیمار مبتلا به ویروس کرونا و مدت زمان استفاده از تجهیزات حفاظت فردی (PPE) و ضدعفونی کننده ها در زمان مواجهه مستقیم (در فاصله کمتر از 1 متر) و در زمان به کارگیری پروسیجرهای تولیدکننده ی آئروسل تکمیل گردید. میزان بروز، ضریب تکرار، احتمال، شدت پیامد و ریسک ابتلا به کرونا نیز در گروه های مختلف شغلی تعیین گردید.
نتایج66/40 درصد از پرسنل شاغل در بیمارستان سابقه ابتلا به ویروس کرونا داشتند. بیشترین فراوانی ابتلا به ویروس کرونا در پرستاران (60/51 درصد) مشاهده شد. بیش از 90 درصد از کارکنان مراقبت های بهداشتی که در 95 درصد از زمان کاری خود از PPE استفاده نمی کردند در سطح ریسک بالای ابتلا به ویروس کرونا قرار داشتند. پزشکان روزانه بیشترین تعداد دفعات مواجهه (بطور میانگین 94/27 بار مواجهه) و بیشترین مدت زمان مواجهه (بطور میانگین 89/243 دقیقه) را گزارش نمودند و بیشترین ریسک ابتلا به ویروس کرونا به ترتیب در پزشکان (93/60) و پرستاران (49/39) مشاهده شد. بیشترین میزان بروز (22/51) و ضریب تکرار (27/26) نیز در پرستاران مشاهده شد.
نتیجه گیریبا توجه به اینکه، درصد بالایی از کارکنان بیمارستان مبتلا به ویروس کرونا هستند و از بین گروه های شغلی بیشترین فراوانی ابتلا در بین پرستاران مشاهده شد آموزش مناسب در جهت ضرورت استفاده از PPE ضروری بنظر میرسد.
کلید واژگان: کووید-19, ریسک, بیمارستان, پرستارIntroductionHealthcare professionals are the frontline soldiers against Corona.
Materials and MethodsThis cross-sectional study was conducted on all personnel at a teaching hospital located in Yazd City. Each participant completed a questionnaire that included demographic information as well as their history regarding the frequency and length of daily contact with a patient infected with COVID-19. It also covered the duration of personal protective equipment (PPE) usage and alcohol-based hand rub application during direct exposure (with 1 meter) and throughout aerosolizing procedures performed on the patient. Incidence rate, Frequency rate, probability, severity rate, and risk of corona infection were evaluated among various occupational groups within the hospital.
Results40.66% of the staff employed in the hospital were infected with corona virus. The highest frequency of corona infection was observed among nurses (51.60%). Over 90% of healthcare personnel who did not utilize PPE for 95% of their work time faced a high-risk level for the coronavirus. Physicians reported the highest number of daily exposures (averaging 27.94 exposures) and the longest exposure time (averaging 243.89 minutes). The highest risk of infection among doctors (60.93) and nurses (39.49) was observed. The nurses exhibited the highest incidence rate (51.22) and frequency rate (26.27).
ConclusionDue to a significant percentage of hospital staff with coronavirus, and with the highest infection rates occurring among nurses, adequate training for the use of PPE is necessary.
Keywords: Covid-19, Risk, Hospital, Nurse -
Background
Investigating and identifying the causes of accidents is important in learning to prevent similar accidents. This study aimed to investigate the causes of "Struck By" in gas pipeline excavation and piping operations using Tripod Beta and Bowtie methods.
Materials and MethodsThis study is a case analysis study conducted in 2023 in Iran. It was conducted on a case basis, on "Struck By" incidents. In the first phase of the study, the data related to the accidents of gas pipeline excavation and piping were collected from all over the country. "Struck By" incidents were selected as important incidents based on the severity and repetition. In the next phase, the data related to "Struck By" incidents were analyzed using the Bowtie and Tripod Beta methods.
ResultsThis study collected 19 incidents related to excavation and piping operations of Iran gas pipelines. Out of these 19 incidents, 8 were related to the "Struck By". Analysis of accidents using the Tripod Beta method shows that basic risk factors are mainly classified into organizational factors (31.03%), work procedures (14.94 %), and tools and equipment (11.5%). The escalation factors identified by the Bowtie method were supervision, HSE systems, competence assessment, contractor management, risk management, training, work permitting, and compliance with rules and guidelines.
Conclusion"Struck By" is one of the most common accidents in gas pipeline excavation and piping operations. Based on the results obtained, to increase productivity and efficiency in practice and prevent similar accidents, there should be more focus on supervision, HSE system, competency assessment, contractor management, risk management, training, work permit system, and compliance with rules and guidelines.
Keywords: Accident, Risk Factors, Risk -
مجله علمی دانشگاه علوم پزشکی کردستان، سال بیست و نهم شماره 3 (پیاپی 132، امرداد و شهریور 1403)، صص 113 -126سابقه و هدف
با توجه به وجود تعداد بالای دانشجویان، کارکنان و اساتید و همچنین بخش های متنوع آموزشی و تحقیقاتی در محیط های دانشگاهی فراهم کردن محیطی ایمن و عاری از خطر یکی از چالش های اصلی در دانشگاه ها و مراکز آموزش عالی است. هدف این مطالعه ارزیابی جامع و دقیق خطرات در بخش های مختلف دانشگاه علوم پزشکی کردستان بود.
مواد و روش هاپژوهش توصیفی-تحلیلی حاضر بر روی ساختمان ها، آزمایشگاه ها، موتورخانه ها، کتابخانه ها و مسیرهای عبور و مرور در دانشگاه علوم پزشکی کردستان انجام گردید. ارزیابی ریسک حریق با نرم افزار FRAME (روش ارزیابی خطر آتش سوزی برای مهندسی) در سه حیطه دارایی، افراد و فعالیت ها انجام گردید. وضعیت ایمنی آزمایشگاه های آموزشی و تحقیقاتی با روش اختصاصی ACHiL (ارزیابی و طبقه بندی خطرات در آزمایشگاه ها) ارزیابی شد. نواقص ساختمان ها، تاسیسات موتورخانه و تابلو و تجهیزات برقی با روش FMEA (تحلیل حالت شکست و اثر) شناسایی و ارزشیابی گردید. سطح ایمنی مسیرهای تردد و حمل ونقل، پارکینگ، معابر و خیابان های مجموعه با روش ET&BA (تجزیه وتحلیل ردیابی انرژی و موانع) بررسی گردید.
یافته هاریسک حریق برای افراد و نیز دارایی و فعالیت ها در همه دانشکده ها نامطلوب (بالاتر از یک) ارزیابی گردید. در آزمایشگاه بیشترین خطرات مربوط به سیلندرهای تحت فشار با سطح ریسک 12، مواد خورنده 6 و محلول های سمی 6 بود. در ساختمان ها بالاترین عدد اولویت ریسک مرتبط با نقص در برنامه شرایط اضطراری، ارتفاع غیراستاندارد نرده راه پله ها و عرض کم پلکان ها بود همچنین در موتورخانه ها بیشتر نقص ها مرتبط با مخزن های سوخت (نشتی شیرهای تخلیه) و دیگ های آب گرم (حرارت و فشار بیش ازحد) با سطح ریسک بالاتر از 200 بود. وضعیت ایمنی برق به دلیل نقص در سیستم های حفاظتی (اتصال به زمین و کلید محافظ جان) نامناسب ارزیابی شد. انرژی شیمیایی و پتانسیل جزء مهم ترین انرژی های آسیب رسان به مسیرها و معابر بودند.
نتیجه گیریبه طور کلی وضعیت ایمنی پردیس نامطلوب بوده و شرایط در همه بخش ها و فعالیت ها هشداردهنده است. عمده ترین ریسک موجود ریسک حریق ارزیابی شد و خطرناک ترین بخش دانشگاه نیز موتورخانه ها هستند. از این رو باید برنامه ریزی موثر جهت کنترل و مدیریت ریسک های شناسایی در مجموعه پردیس به ترتیب اولویت صورت و اجرا گردد.
کلید واژگان: ارزیابی ریسک, مدیریت ایمنی, ایمنی حریق, ایمنی مواد شیمیاییScientific Journal of Kurdistan University of Medical Sciences, Volume:29 Issue: 3, 2024, PP 113 -126Background and AimConsidering the increased number of students, staff and faculties and various educational and research departments in university environments, provision of a safe environment is one of the main challenges in the universities and higher education centers. The aim of this study was to perform a comprehensive and detailed assessment of risks in different departments of Kurdistan University of Medical Sciences.
Material and MethodIn this descriptive-analytical study we assessed buildings, laboratories, engine room heating systems, libraries and commuting routes at Kurdistan University of Medical Sciences. Fire risk assessment was performed in three areas of properties, people and activities by FRAME (Fire Risk Assessment Method for Engineering) software. The safety of laboratories was assessed by ACHiL (Assessment and Classification of Hazards in Laboratories) specific method. Failures in buildings, engine room heating systems, electrical panels and equipment were identified and evaluated by the FMEA (Failure Mode and Effect Analysis) method. The safety level of traffic and transportation routes, parking lots and streets were assessed by ET&BA (Energy Trace & Barrier Analysis) method.
ResultsThe fire risk level for individuals, properties and activities in all colleges was unfavorable (R˃1). In the laboratory, the main risks were related to chemicals such as pressurized cylinders (R=12), corrosive substances (R=6) and toxic solutions (R=6). In the buildings, the highest risks were related to a fault in the emergency condition plan, non standard height of the stairs case and low width of the stairs. Also, in the engine room heating systems, most of the risks were related to fuel tanks (leaks of valves) and boilers (excessive temperature and pressure) with R2˃00. The electrical safety status was assessed unsuitable due to failures in the protection systems (grounding system and life-saving switch). Chemical and potential energies were among the most important energies damaging the paths and passages.
ConclusionThe safety level of the campus is unfavorable and the safety conditions in all departments and activities are alarming. The main risk is the risk of fire and the most dangerous part is the engine room. Therefore, effective planning to control and manage the risks in the campus complex should be done on the basis of risk priority.e safety situation can help universities and academic institutions develop an effective risk management program.
Keywords: Risk, Risk Assessment, Safety Management, Chemical Safety -
Aims
This study aimed to fire risk assessment and prioritize the preventive measures using a FRAME‑TOPSIS method in the Isfahan School of Health Library.
MethodsThis descriptive‑analytical study was conducted in 2023. First, the FRAME method was used to calculate this risk score in three areas: individuals, buildings and their contents, and activities. Second, the Fuzzy Delphi method was used to identify the preventive measures. Finally, the TOPSIS method was applied to prioritize preventive measures. Excel 2019 was used for TOPSIS and Fuzzy Delphi, and FRAME was calculated by FRAME software.
ResultsThe results of the FRAME method showed the risk levels of fire for the Isfahan School of Health Library were unacceptable in individuals (R = 1.04) and activities (R = 1.32). The TOPSIS method revealed that the most important control measures for reducing fire risk levels in the library are installing an automatic fire alarm (0.732), improving electrical safety (0.694), and use of fireproof partitions (0.660).
ConclusionThe study library has identified a high level of risk, necessitating the thorough implementation of control measures. Moreover, the methodology presented in this study can be applied to other locations where fire safety is of paramount importance, including hospitals, buildings, and industries.
Keywords: Assessment, Delphi Methods, Fires, FRAME, Libraries, Risk, TOPSIS -
Background
Over the past decade, Iranian households have experienced a decline in dairy product consumption. This study aimed to evaluate the population-attributable risk of prevalent non-communicable diseases related to dairy product consumption.
MethodsThis cross-sectional analytical study involved 628 adults over 18 years old in Hamadan City in 2021. Clusters were selected based on comprehensive urban health centers. The standardized Iranian version of the food frequency questionnaire was used. Participants were categorized into 3 levels of dairy product consumption: >1 serving per day, 1–2 servings per day, and ≥3 servings per day.
ResultsThe mean age of the 628 participants was 38.05 (SD: 12.5), with 42.36% being male. Cheese (54.5%), yogurt (39.7%), and milk (30.4%) were consumed most frequently. The prevalence of insufficient dairy product consumption was 48.6%, higher than that reported in previous studies. Insufficient dairy product consumption was associated with hypertension (9.3%), cardiovascular disease (5.6%), and osteoporosis (5.1%).
ConclusionIndividuals with lower education levels, female gender, lowest quartile of socioeconomic status, and those diagnosed with cardiovascular disease were more likely to have insufficient dairy product consumption. Insufficient dairy product consumption was associated with hypertension, cardiovascular disease, and osteoporosis.
Keywords: Food-Processing Industry, Dairy Products, Biomedical Research, Methods, Humans, Population, Risk, Hypertension, Epidemiology, Etiology, Cross-Sectional Study, Iran -
Background
Ecological conditions can change infection routes and increase the risks of outbreaks. The aim of this study is risk assessment of foodborne disease outbreaks based on dispersed regional climatic and demographic variables in Yazd Province, Iran.
MethodsIn this cross-sectional study, data of temporal climatic parameters and regional demographic factors linked to bacterial foodborne diseases were addressed. A multi-level regression analysis model was used to detect associations between the risk of outbreaks and ecological risk factors; the relationships were verified using (P<0.05).
ResultsSignificant associations were observed between the outbreaks and age )P<0.001(, community type (P<0.001), temperature (P=0.04), rainfall (P=0.03) and dust pollution (P<0.001) in scattered parts of the province. The maximum rate of outbreaks was seen in spring, while the frequency of the outbreaks increased during April and October, compared to other months of the year (2012–2016).
ConclusionConsequences have revealed interventions of the environmental exposures in transmissions of microbial agents by complex ecological processes that caused the outbreaks.
Keywords: Climate, Environment, Disease outbreaks, Risk, Iran -
Environmental Risk Assessment of a Hydrocracker Unit in Abadan Oil Refinery Using the EFMEA AnalysisBackgroundThe aim of risk assessment is to use a rational method to analyze risks and to identify the possible hazards and outcomes for people, equipment, materials, and the environment.MethodsThe criteria and indices for assessing the environmental, health, and safety risks of the hydrocracker unit were determined by a Delphi questionnaire in this study. Then, an Environmental Failure Mode and Effects Analysis was applied to evaluate, score, and rank the risks based on their probability of occurrence, severity, probability of detection, extent of pollution, and potential of recycling.ResultsAccording to the results of the Delphi process, 19 out of the 22 items were identified as the main criteria in the environmental, health, and safety risk evaluation of the hydrocracker unit at the Abadan Oil Refinery. However, the results indicated that 67% of the risks associated with the life cycle operation were low while 33% of them were high in terms of intensity. In contrast, 75% of the risks associated with control room operators were low and 25% were high in terms of intensity. On the other hand, 64, 7, and 29% of the risks associated with the activities of site employees were low, moderate, and high in terms of intensity, respectively, while the corresponding figures were 14, 29, and 57% in the case of risks associated with repairs.ConclusionBased on the results of techniques of environmental failure modes and effects analysis (EFMEA) and Delphi, appropriate methods can be used to identify and reduce risks in similar industries.Keywords: Environmental health Risks, Pollution, EFMEA Method, risk, Hydrocracker Unit
-
Background
The COVID-19 pandemic is significant due to its global impact on public health and life situations. It has led to widespread infections and strained healthcare systems, causing significant loss of life. The pandemic has underscored the urgent need for effective measures to control its spread and protect communities worldwide.
ObjectivesThe main goal of this research was to evaluate the clinical symptoms, risk factors, and manifestations linked to COVID-19 among the vaccinated healthcare worker (HCW) population under study.
Materials and MethodsThe study population comprised HCWs with respiratory symptoms who received three doses of vaccination homogeneously. Real-time polymerase chain reaction (RT-PCR) testing was conducted on nasopharyngeal and nasal swab samples using a one-step RT-PCR. The enzyme-linked immunosorbent assay also evaluated immunoglobulin G antibody levels.
ResultsAmong the most commonly reported symptoms, general fatigue, fever, and cough were the most prevalent, divided by vaccine type. Furthermore, among the associated risk factors, concerns about transmission to other family members, anxiety, and depression were found to be prominent.
ConclusionThe study findings highlight that the vaccine type is associated with clinical manifestations. Additionally, the result reveals the significant contribution of occupational roles to the experiences of HCWs during the COVID-19 pandemic. The findings emphasize the need for tailored support systems to address the diverse challenges faced by HCWs, such as concerns about transmission, anxiety, and occupational stress.
Keywords: COVID-19, SARS-CoV-2, Vaccination, Clinical manifestation, Risk -
Background
Among non-communicable diseases, myocardial infarction (MI) and stroke are the most common cause of death in the world. The current study aimed to investigate the relationship between risk level and preventive behaviors of heart in people aged 30 to 60 years of Jiroft city in 2022.
MethodsThis research was a cross-sectional study. The population under study is 383 middle-aged individuals (30-60 year) of Jiroft city with the combined sampling method. The data collection tools was reseacher made, included demographic questions, risk perception questionnaires, and preventive behavior questions for MI and stroke. Information was analyzed by SPSSv21 software and further analyzed with descriptive statistics tests, chi-square test, independent t-test, one-way ANOVA, and Pearson correlation test at level 0.05.
ResultsThe participants' average age was 41.26 ± 8.32 years. The highest percentage (51.4%) of middle-aged individuals had a risk level between 10 and 20% for cardiovascular diseases. The study investigated a significant correlation (p < 0.01) between risk level, risk perception, and preventive behaviors for MI and stroke. Smoking and physical activity failed to reveal a significant correlation (p > 0.05), but other dimensions of preventive behaviors correlated positively and significantly with the total score of preventive behaviors (p < 0.01).
ConclusionAccording to study findings, risk perception plays a significant role in influencing preventive behaviors for MI and stroke. It is recommended to conduct educational interventions to enhance understanding of the actual risk of MI and stroke, particularly among individuals with a high-risk assessment level. This would encourage the adoption of preventive behaviors in this population.
Keywords: Risk, Perception, Preventive, Behavior, Myocardial infarction, Stroke -
زمینه و هدف
هدف بررسی حاضر پاسخ به سوال PICO زیر است: "خطر خونریزی در بیمارانی که داروهای ضد انعقاد خوراکی مصرف می کنند و تحت عمل جراحی دهان با یا بدون قطع درمان آنتی ترومبوتیک قرار می گیرند، چیست؟" بر این اساس، با انجام این مطالعه متاآنالیز، هدف ما تعیین خطر خونریزی در حین و بعد از جراحی دندان در بیماران تحت درمان ضد انعقاد، و همچنین ارایه راهنمایی هایی است که به متخصصان دندانپزشکی در تصمیم گیری آگاهانه بالینی کمک می کند، می باشد.
مواد و روش هادر این مطالعه متاآنالیز، ما جستجوهایی را برای مطالعات کارآزمایی بالینی واجد شرایط در مرکز کتابخانه کاکرین (واحد مرکزی کارآزمایی های کنترل شده کاکرین) و Medline (Ovid وEMBASE) از پایگاه های داده ای ذکر شده با کلید واژه-های جراحی دهان، اگزودنتیا و نصب ایمپلنت دندان، خطر حوادث خونریزی دهنده و مترادف آنها و ضد انعقاد خوراکی (آنتاگونیست های ویتامینK) انجام دادیم. تجزیه و تحلیل برای هر ضد انعقاد و نتیجه مورد انتظار انجام شد. برای مطالعاتی که پیامدهای دوگانه را گزارش کردند، خطر نسبی (RR) همراه با فاصله اطمینان 95% محاسبه شد. اثرات تصادفی مرتبط با متاآنالیز با استفاده از نرم افزار STATA (نسخه 1/10) تعیین شد.
یافته هانتایج یک تا سه برابر بیشتر خطر خونریزی را در بیمارانی که وارفارین مصرف می کنند در مقایسه با بیمارانی که استفاده از داروهای ضد انعقاد را در حین عمل قطع کرده بودند (67/1=RR و 89/2-97/0:CI) و بعد از عمل (44/1=RR و 92/2-71/0:CI) نشان داده اند.
نتیجه گیریخطر خونریزی حین و پس از جراحی در بیمارانی که داروی ضد انعقاد خود را قطع نکنند، نسبت به بیمارانی که داروی خود را قطع نمایند، در حین اعمال جراحی مینور دهان و دندان وجود دارد؛ با این حال، یافته ها باید با احتیاط تفسیر شوند و مطالعات جدید در مورد این موضوع باید آغاز شود.
Introduction & ObjectiveThe purpose of this study is to answer the following PICO question: "What is the risk of bleeding in patients who take oral anticoagulants and undergo oral surgery with or without discontinuation of antithrombotic therapy?" Accordingly, by conducting this systematic review, we aim to determine the risk of bleeding during and after dental surgery in patients receiving anticoagulation therapy, as well as provide guidance that will assist dental professionals in making informed clinical decisions.
Materials & MethodsIn this meta-analysis study, we performed searches for eligible clinical trial studies in the Cochrane Library (Cochrane Central Unit for Controlled Trials) and Medline (Ovid and EMBASE) from the databases listed with the keywords oral surgery, extradontia and implants. We performed dental implants, the risk of bleeding events and their synonyms, and oral anticoagulants (vitamin K antagonists). Analyzes were performed for each anticoagulant and expected outcome. For studies that reported dichotomous outcomes, relative risk (RR) with 95% confidence interval was calculated. Random effects associated with meta-analysis were determined using STATA software (version 10/1).
ResultsOne to three times higher risk of bleeding in patients taking warfarin compared to patients who stopped using anticoagulants during the operation (RR=1.67 and CI: 0.97-2-2.89) and after surgery (RR=1.44 and CI: 0.71-0.2-92) have shown.
ConclusionsThere is a risk of bleeding during and after surgery in patients who do not discontinue their anticoagulant medication compared to patients who discontinue their medication during minor oral and dental surgery; however, the findings should be interpreted with caution and new studies on this topic should be initiated.
Keywords: Bleeding, Risk, Oral, Dental Surgery, Meta-Analysis -
Objective
Multiple sclerosis is an autoimmune disease of central nervous system (CNS). There are a few articles studying the risk factors of developing MS in men. Male infertility can stem from a range of etiological factors such as genetics or environment. In the context of MS, research suggests a potential link, possibly due to shared immunological and inflammatory mechanisms. Therefore, we designed this study to evaluate the relationship between male infertility and MS development.
Materials and methodsWe systematically searched PubMed, Embase, Scopus, web of science, Google scholar and gray literature including references of the references as well as conference papers which were published up to June 2021. The search strategy in PubMed was ("Infertility, Male"[Mesh] OR [Male Infertility] OR [Sterility, Male] OR [Male Sterility] OR [Subfertility, Male] OR [Male Subfertility] OR [Sub-Fertility, Male] OR [Male Sub-Fertility] OR [Sub Fertility, Male]) AND ("Multiple Sclerosis"[Mesh] OR [Sclerosis, Multiple] OR [Sclerosis, disseminated] OR [Disseminated Sclerosis] OR [MS] OR [Multiple Sclerosis, Acute Fulminating]) AND ("Testicular Diseases"[Mesh] OR [Disease, Testicular] OR [Diseases, Testicular] OR [Testicular Disease]) AND ("Multiple Sclerosis"[Mesh] OR [Sclerosis, Multiple] OR [Sclerosis, disseminated] OR [Disseminated Sclerosis] OR [Multiple Sclerosis, Acute Fulminating] OR [MS]).
ResultsThe literature search revealed 197 articles, after deleting duplicates 109 remained. For the meta-analysis, 3 studies were included. Totally, 2090 MS cases as well as 3895562 healthy subjects were enrolled. One hundred and fourteen infertile men were in MS group and 139716 infertile men were in controls. The pooled OR for male factor infertility and odds of developing MS was1.87 (95% CI: 0.89-3.94) (I2=86.1%, P=0.001).
ConclusionThe results of this systematic review and meta-analysis show that there is no relationship between male factor infertility and risk of MS.
Keywords: Multiple Sclerosis, Infertility, Risk -
Background & Objective
The safety of women during childbirth and personnel working in maternity care amidst the COVID-19 pandemic is a priority for the health system. Hence, good risk management practices need to be implemented to reduce the spread of infection between healthcare workers and pregnant women who have contracted COVID-19. Therefore, this study aimed to establish a risk map for managing dyspneic parturients suffering from COVID-19-related pneumopathy during delivery.
Materials & MethodsThis study focuses on examining potential risks beforehand in the context of the management of a dyspneic parturient suffering from COVID-19-related pneumopathy during delivery, executed using the method FMECA (Failure Mode, Effects and Criticality Analysis); this was conducted from September to December 2021 in the maternity service of the Hospital Center ElJadida, Morocco.
ResultsThe risk analysis of a dyspneic parturient suffering from COVID-19-related pneumopathy during delivery revealed thirteen failure modes. Proposed are corrective measures aimed at addressing the failure modes of criticality class C3 whose vital risks are linked to the care of the dyspneic parturient suffering from COVID-19-related pneumopathy at the level of the reanimation service and the level of the neonatal intensive care unit.
ConclusionEmploying risk mapping is a fundamental instrument for the ongoing enhancement of quality to maximize the safety of the parturient care process by changing the organizational culture from a reactive to a preventive approach.
Keywords: COVID-19, delivery, Dyspneic, Mapping, Parturient, Pneumopathy, Risk -
Background
Major adverse cardiovascular events (MACEs) are frequently encountered in patients undergoing noncardiac surgeries. This study evaluated the utility of cardiac troponin I (cTnI) and brain natriuretic peptide (BNP) to predict MACE in elderly patients (aged ≥60 years) undergoing noncardiac surgeries.
MethodsThis comparative cross-sectional study was carried out at a tertiary care center in India between November 2016 and August 2018. A total of 136 consecutive patients (aged ≥60 years) presenting for noncardiac surgeries under general/spinal/regional anesthesia in the departments of surgery, orthopedics, or gynecology were included in the study. Patients with chronic kidney disease stages 4 and 5 and those receiving hemodialysis or peritoneal dialysis for renal failure were excluded from the study. Peripheral blood samples for BNP and cTnI were obtained within 24 h preoperatively. The primary endpoint was the occurrence of MACE, defined as the composite of cardiac death, nonfatal myocardial infarction, heart failure, arrhythmias, and cardiac arrest at 6 days postsurgery.
ResultsThe mean age of patients was 69.41 ± 7.56 years. Females comprised 54.1% of the study population. During the perioperative period and follow-up of 6 days, 12 MACE were recorded. Preoperative cTnI levels alone or both cTnI and BNP together (cTnI levels >0.07 ng/mL and BNP levels >40 pg/mL) increased significantly in the patients who experienced MACE (P < 0.05). The area under receiver operating characteristics curve for cTnI and BNP for predicting perioperative cardiac events was 0.817 (95% confidence interval [CI] 0.646–0.988; P < 0.001) and 0.520 (95% CI 0.337–0.704; P = 0.817), respectively.
ConclusionsIn elderly patients undergoing noncardiac surgeries, a preoperative assessment of BNP and cTnI may help in the assessment of MACE.
Keywords: Heart failure, mortality, natriuretic peptide, risk -
مقدمه
سرطان کولورکتال یک مشکل سلامت جهانی است. اکثر بیماران با تشخیص زودهنگام قابل درمان هستند. مطالعه حاضر با هدف تعیین عوامل موثر بر غربالگری سرطان کولورکتال براساس مدل پیشگیرانه سلامت در شهر قم انجام گرفت.
مواد و روش کاراین مطالعه به روش توصیفی - مقطعی روی 300 نفراز افراد بالای 50 سال، مراجعه کننده به درمانگاه بیمارستانهای آموزشی شهر قم در سال 1400 انجام شد. روش نمونه گیری به صورت در دسترس و ابزار گردآوری اطلاعات، پرسشنامه سازه های مدل سلامت پیشگیرانه و مشخصات جمعیت شناختی و پزشکی بود. داده ها با استفاده از آمار توصیفی و رگرسیون لجستیگ چندگانه تجزیه و تحلیل شدند.
یافته هامیانگین و انحراف معیار سن شرکت کنندگان 10/68±57/67 بود و 48/8 درصد از ایشان را مردان تشکیل می دادند. اکثریت شرکت کنندگان در مورد تشخیص زودرس سرطان کولورکتال آگاهی نداشتند و تنها 11 درصد آزمایش های تشخیص زودرس سرطان کولورکتال انجام داده بودند. رابطه مثبت معنی دار بین سن، سابقه خانوادگی مثبت ابتلا به سرطان، آگاهی و تاثیر اجتماعی با تشخیص زودرس سرطان کولورکتال وجود داشت.
نتیجه گیرییافته ها نشان داد که آگاهی، سن، سابقه خانوادگی مثبت ابتلا به سرطان و تاثیر اجتماعی از عوامل موثر بر تشخیص زودرس سرطان کولورکتال بودند. از نتایج مطالعه حاضر میتوان در تدوین برنامه های سیاستی و آموزشی به منظور افزایش انجام رفتارهای تشخیص زودرس استفاده نمود.
کلید واژگان: غربالگری, سرطان کولورکتال, مدل پیشگیرانه سلامت, در معرض خطرPayesh, Volume:22 Issue: 6, 2023, PP 709 -718Objective (s)Colorectal cancer is a significant global health issue, but early diagnosis can greatly increase the chances of successful treatment. The purpose of this study was to identify factors that influence early diagnosis of colorectal cancer, using a preventive health model.
MethodsThis cross-sectional study involved 300 individuals over the age of 50 who were referred to the clinics of teaching hospitals in Qom, Iran in 2022. The convenience sampling method was utilized, and data was collected using the Preventive Health Model (PHM) Scale. Descriptive statistics and multiple logistic regression were employed for data analysis.
ResultsThe mean age of the participants was 57.67±10.68 years, with 48.8% being male. A majority (76.2%) of the participants had no knowledge about early diagnosis of colorectal cancer, and only 11% had attended for early diagnosis. The study revealed a significant positive correlation between age (OR: 1.01; 95% CI: 1.00, 1.10), positive family history of cancer (OR: 1.05; 95% CI: 1.01, 1.10), knowledge (OR: 3.15; 95% CI: 1.41, 7.06), and social influence (OR: 1.32; 95% CI: 1.01, 1.77) with early diagnosis of colorectal cancer.
ConclusionThe findings suggest that knowledge, age, positive family history of cancer, and social influence are important factors in the early diagnosis of colorectal cancer. The findings can be utilized to develop policies and educational programs aimed at promoting early diagnosis behaviors.
Keywords: Screening, Colorectal Cancer, Health Preventive Model, Risk -
زمینه و هدف
خط مشی ها پس از تدوین و تصویب، برای اجرا به مدیران ابلاغ می گردند. عوامل متعددی منجر به شکست اجرای خط مشی های نظام سلامت می شود. در این پژوهش به شناسایی و اولویت بندی این عوامل پرداخته شده است.
روش پژوهش:
این پژوهش کاربردی و از حیث راهبرد، پیمایشی است. جامعه تحقیق را 21 نفر از صاحب نظران حوزه ی سلامت در وزارت بهداشت و دانشگاه های علوم پزشکی تشکیل داده اند که از طریق نمونه گیری غیر تصادفی و هدفمند انتخاب شدند. ابزار گردآوری داده، مصاحبه و پرسشنامه بوده و جهت تحلیل داده ها از تکنیک واکاوی حالات نقص و اثرات آن و روش تحلیل سلسله مراتبی استفاده شده است.
یافته هادر این تحقیق تعداد 4 بعد از عوامل شکست اجرای خط مشی نظام سلامت شامل ابعاد حاکمیتی، مدیریتی، محیطی و تامین منابع مالی و 23 مولفه از ابعاد مذکور شناسایی شد. همچنین مهم ترین عوامل شکست شناسایی شده با روش تحلیل سلسله مراتبی و تکنیک واکاوی حالات نقص و اثرات آن اولویت بندی و ارزیابی شد.
نتیجه گیریآنچه در این تحقیق به عنوان عوامل شکست در اجرای این خط مشی ها بیان شد، با توجه به شناخت آن ها می توان به ارتقاء ظرفیت اجرای خط مشی های نظام سلامت کمک کرد.
کلید واژگان: خط مشی گذاری, نظام سلامت, تحلیل سلسله مراتبی, ریسکBackgroundAfter the policies are formulated and approved, they are communicated to the managers for implementation. Several factors lead to the failure of health system policies. In this research, these factors have been identified and ranked.
MethodsThis was an applied research, and in terms of strategy, it was a survey. The research community consisted of 21 experts in the field of health in the Ministry of Health and universities of medical sciences, who were selected through random and targeted sampling. The tools of data collection were interviews and questionnaires, and to analyze data, Failure Modes and Effects Analysis (FMEA) and Analytical Hierarchy Process (AHP) were used.
ResultsIn this research, 4 dimensions of failure factors regarding the implementation of the health system policy were identified, including governance, management, environmental and financial resources, and 23 components of the mentioned dimensions were identified. Moreover, the most important identified failure factors through AHP and FMEA were prioritized and evaluated.
ConclusionKnowledge of failure factors can help to improve the capacity of the implementation of health system policies.
Keywords: Policy making, health system, Analytical hierarchy process (AHP), risk -
The utilisation of surface water has increased in the Niger Delta area of Nigeria due to high ground water abstraction rates. This study aims to assess the pollution status of heavy metals in water from Chanomi Creek, Nigeria, and conduct an ecological risk assessment to evaluate potential environmental impacts and implications for marine life and local communities. Ten stations adjoining the creek were sampled and analysed for Cr, Cd, Cu, Pb, Ni, Fe, Zn, As, and Mn, using atomic absorption spectrophotometry. Indices such as the heavy metal pollution index (HPIs), Nemerow pollution index (PN), and potential ecological risk indices (PERI) were used to assess the degree of water contamination and its suitability for marine life and agricultural purposes. Monthly data were aggregated and analysed as dry and wet seasons to evaluate seasonal influences on these parameters. During the dry season, Cd, Cu, Pb, Ni, and Zn increased significantly (p < 0.05). The HPIs for both seasons clearly exceeded the threshold of 100, making the water grossly inadequate for drinking. Across seasons, PN for agricultural purposes ranged from 0.4 to 2.3 indicating slightly to moderate pollution status but was heavily polluted for aquatic life (PN: 98 – 240). High ecological risks (PERI > 400) were observed for human consumption and aquatic life. Chanomi Creek is moderately contaminated for animal watering and irrigation but extensively polluted for marine life.The study posits possible impacts on ecosystem health, biodiversity, and communities relying on the creek. Urgent action is required with effective pollution control and sustainable water management practices for environmental and health safety.
Keywords: Risk, Pollution, Heavy Metal, Chanomi, Creek, Marine -
مقدمه
ارزیابی ریسک از موضوعات مهم در صنعت بیمه است که می تواند به عملکرد بهتر شرکت های بیمه ای منجر شود. پژوهش حاضر با هدف ارایه الگوی ارزیابی ریسک پوشش ناهنجاری های جنین بیمه های تکمیلی در صنعت بیمه ایران به منظور شناسایی عوامل موثر و میزان تاثیر هر کدام با رویکرد آمیخته انجام شده است.
روش بررسیاین پژوهش، براساس نحوه گردآوری و ماهیت داده ها، اکتشافی-توصیفی و از نظر هدف، توسعه ای-کاربردی است. بخش کیفی، با مصاحبه عمیق با 14 نفر از خبرگان صنعت بیمه و پزشکان متخصص و به روش داده بنیاد در سه مرحله کدگذاری باز، کدگذاری محوری و کدگذاری انتخابی الگوی کیفی در نرم افزار MAXQDA صورت گرفت. در بخش کمی، داده هایی که با استفاده از پرسشنامه از 67 کارشناس صنعت بیمه گردآوری شد، با روش مدل معادلات ساختاری و به کمک نرم افزار SMART-PLS مورد سنجش قرار گرفت. پایایی و روایی روش کمی به ترتیب با استفاده از ضریب آلفای کرونباخ و تحلیل عاملی محاسبه و تایید شد.
یافته هادر بخش کیفی، شش عامل اصلی شامل ویژگی های والدین، ویژگی های گروه بیمه شده، عوامل محیطی، عوامل علمی و فناوری، عوامل فرهنگی و اجتماعی و عوامل مربوط به صنعت بیمه شناسایی شد و 36 شاخص نیز به عنوان عوامل موثر بر ریسک پوشش بیمه ناهنجاری های جنین تعیین گردید. یافته ها نشان داد 32 شاخص از 36 شاخص، از نظر آماری مورد تایید است و هر شش عامل شناسایی شده نیز تاثیر مثبت و معناداری بر ناهنجاری جنین دارد.
نتیجه گیرینتایج مطالعه موید این است که ویژگی های گروه بیمه شده بیش ترین تاثیر را بر ریسک پوشش بیمه ناهنجاری های جنین دارا هستند. لذا شرکت های بیمه جهت پوشش ریسک مذکور باید به شاخص های تحصیلات، وضعیت جغرافیایی، ترکیب جمعیت شناختی و ترکیب جنسیتی افراد گروه بیمه توجه ویژه ای داشته باشند.
کلید واژگان: ناهنجاری جنین, نرخ حق بیمه, پوشش ناهنجاری جنین, ریسکIntroductionRisk assessment is one of the important issues in insurance industry that can lead to better performance of insurance companies. The aim of this study is to provide a risk assessment model for the coverage of fetal malformations of supplementary insurance in the Iranian insurance industry in order to identify the effective factors and the extent of the impact of each with a mixed approach.
MethodsThis research is exploratory-descriptive based on the way of data collection and is developmental-applied in terms of purpose. The qualitative section was conducted with in-depth interviews with 14 insurance industry experts and specialized physicians using the data method of the foundation in three stages of open coding, axial coding, and selective coding in MAXQDA software. In the quantitative section, the data collected using a questionnaire from 67 insurance industry experts were measured by the structural equation modeling method using SMART-PLS software. The reliability and validity of the quantitative method were calculated and confirmed using Cronbach's alpha coefficient and confirmatory factor analysis, respectively.
ResultsIn the qualitative section, six main factors including parental characteristics, insured group characteristics, environmental factors, scientific and technological factors, cultural and social factors, and factors related to the insurance industry were identified, and 36 indicators as factors affecting risk of coverage fetal malformations insurance. Findings showed that 32 indicators out of 36 indicators are statistically confirmed and all six identified factors have a positive and significant effect on fetal malformations.
ConclusionThe results confirm that the insured group characteristics have the greatest impact on the risk of insurance coverage for fetal malformations. Therefore, in order to cover the mentioned risk, insurance companies should pay special attention to the indicators of education, geographical status, demographic composition, and gender composition of the members of the insurance group.
Keywords: Fetal Malformation, Premium Rate, Fetal Malformation Coverage, Risk
- نتایج بر اساس تاریخ انتشار مرتب شدهاند.
- کلیدواژه مورد نظر شما تنها در فیلد کلیدواژگان مقالات جستجو شدهاست. به منظور حذف نتایج غیر مرتبط، جستجو تنها در مقالات مجلاتی انجام شده که با مجله ماخذ هم موضوع هستند.
- در صورتی که میخواهید جستجو را در همه موضوعات و با شرایط دیگر تکرار کنید به صفحه جستجوی پیشرفته مجلات مراجعه کنید.