مجله تصویر سلامت
سال چهاردهم شماره 3 (پاییز 1402)

While light is a visible and narrow range of the electromagnetic spectrum that is responsible for vision, Light Amplification by Stimulated Emission of Radiation (laser) is a monochromatic and polarized beam with a specific frequency and minimum divergence from this spectrum (1). Since the invention of the laser in 1960, its use has become widespread in everyday life. Moreover, during the notable advances in technology in the past decades, laser devices have been used in a wide variety of applications, from educational fields to medical, military, and cosmetic purposes, and sometimes even mistakenly used by children as toys (2). Laser pointers are known as low-energy devices that emit focal non-ionizing beams that are widely used in lecture halls for educational-commercial presentations and even sometimes in passages and ceremonies for advertising and elegance purposes (1). These markers exist in different types based on the wavelength of the light beam, and consequently the color of the emitted light, which is usually red (650-670 nm) or green (532 nm) (2).Laser pointers are coded by output light power and wavelength. In the latest updates, the International Electrotechnical Commission has classified laser devices into four categories based on maximum output power, where handheld laser pointers are usually classified as 2M or sometimes 3R (Table 1) (3). According to this classification, 2M types are considered safe due to their low output power and highly divergent light beam, along with the protective effect of the blink reflex, which reduces the exposure time of the laser light with the internal structures of the eye. However, possible eye damage in class 3R is controversial, especially during accidental exposure or accompanied with the use of optical tools such as magnifying glasses, binoculars or telescopes (4), and long-term viewing and deliberate direct observation (5). So, there is the possibility of severe eye damage in both classes, which has been reported in previous studies (2, 6).The most common ocular structure involved in laser injuries is retina due to the following two reasons: 1) it is optically transparent and 2) the refractive power of the eye focuses the radiation on the retina. It should be noted that the energy of radiation rays on the retina is more than 105 times in the cornea (7), which can reach a million times in the presence of the previously mentioned optical tools (8). Eye damage by laser devices depends on the wavelength, exposure time, characteristic of eye refraction, and laser-ocular tissue interaction. In general, laser-ocular tissue interaction has three mechanisms as follows (7):1) Thermal (photothermal): the laser energy absorbed by the pigments causes an increase in the local temperature and coagulation of tissue proteins, and finally cell death and scar formation;2) Mechanical: laser energy is quickly absorbed in a very short period, and this sudden increase in temperature causes the liquid to evaporate, followed by the creation of a mechanical wave; and3) chemical (photochemical): tissue chemical reactions caused by laser energy without a substantial increase in temperature.In this context, thermal damage is considered the most important mechanism in laser damage, which mainly occurs in short-wavelength lasers (i.e., green laser). In these injuries, retinal pigments act as mediators in the laser phototoxicity (4).So far, many reports have mentioned a wide range of damaging effects of lasers on the retina, including retinal holes (9), retinal hemorrhage (2), choroidal neovascularization (CNV) (10,11), photoreceptors damage (6), etc. Nowadays, retinal damage caused by laser pointers is a matter of concern due to such factors as easy availability, cheap price, and widespread use (recreational and advertising use), as well as the lifelong visual disability that often affects children and young people, as active people in the community. In general, although there is no consensus regarding the effects of laser pointers, especially in class 2M, many countries have strict rules regarding public use, even as toys and advertising equipment. To our knowledge, no legal restrictions have been issued for the use of handheld laser devices and all advertising types in Iran. During the six years of my professional activity as an ophthalmologist (from 2014 to 2020), I encountered only two cases of eye damage following laser exposure, both of which were published as case reports (2,6). However, many cases of ocular injuries (at least one case per week) were referred to the ophthalmic center of Kermanshah, Iran between 2021 and 2023, which were usually due to the use of handheld lasers as toys and sometimes contact with colored laser beams in the public places. Previous studies warned about the eye damage caused by these pointers (5,12,13). Nonetheless, there is not enough evidence-based information on this issue in Iran. Previously, the author of this article published two case reports in international journals; one patient suffered retinal hemorrhage following contact with a green laser pointer, and the other patient suffered a macular hole following contact with advertising laser beams on the street (2,6). In conclusion, I recommend increasing public awareness about the harmful effects of using laser pointers in different ways, including the use of social media. Also, some policies should be designed to ban the use of these tools at the community level, especially in toy stores.

Effective triage is a viable solution to improve performance indicators in the emergency department. This study aimed to compare the effect of conventional triage and team triage methods on the performance indicators of emergency department.

In this descriptive cross-sectional research, all 749 patients referred to the emergency department of Tabriz Sina Hospital were triaged using conventional and team methods for two consecutive weeks in July 2020. A researcher-made checklist was used to collect emergency performance indicators. The data were extracted from patient records and recorded in the checklist. Data analysis was performed using descriptive statistics, Chi-square and Mann-Whitney tests in the SPSS.19 software.

Among the patients, 86.9% in the triage group using the conventional method (52.7% female) and 86.7% in the group using the team method (52% female) were older than 40 years. The results showed that in the team triage group, the number of temporarily hospitalized patients was significantly higher and the frequency of self-responsible exit was lower compared to the conventional method (P < 0.05). In addition, the waiting time for patients triaged with the team method was shorter, and the difference in values was significant for all three triage levels (P < 0.05).

According to our results, team triage had a more positive effect on improving emergency performance indicators compared to the conventional method. Therefore, it is recommended to consider this method in hospital emergency departments to provide better services and increase patient satisfaction.

Smoking at a younger age puts people at greater risk for health damage. This study aimed to investigate the relationship between the age of smoking onset and high-risk behaviors such as smoking, alcohol consumption, substance abuse, and high-risk sexual behavior among university students in Tabriz, Iran.

This web-based, cross-sectional study was conducted in Tabriz, Iran, in 2019. A total of 3,649 students were included in the study according to the proportion of students in each university. The required information was collected through an online questionnaire. Logistic regression analysis was used to assess the relationship between the age of smoking onset and high-risk behaviors.

The mean (standard deviation) age of the participants in the study was 22.85 (3.66) years old, and 55.7% were boys. The findings of the study indicate that students who initiated smoking at the age of 16 or younger exhibited higher likelihoods of alcohol consumption over the previous 30 days (OR= 1.77, CI 95%: 1.20 - 2.62) and participation in unsafe sexual practices (OR= 1.54, CI 95%: 1.06 - 2.26) compared to their non-smoking counterparts.

  Early smoking onset is associated with high-risk behaviors. The age of onset of smoking should be considered as one of the factors associated with high-risk behaviors, and smoking prevention programs should be started from adolescence.

 Due to the progress and expansion of medical science, innovation and promotion of community-oriented medical education has a significant impact on the quality of medical services. The existence of creativity and innovation in every field of medical education among faculty members and their innovative performance can provide a suitable platform for improving the quality of medical education. Meanwhile, self-management skills and professional development play a constructive role in improving the knowledge and skills of faculty members to achieve these goals. The research aimed to investigate the potential correlation between self-leadership and innovative job performance among the faculty members at Tabriz University of Medical Sciences, Iran.

The current study employed a quantitative approach with a practical purpose. The research method was descriptive and correlational, utilizing structural equation modeling. We focused on the faculty members of Tabriz University of Medical Sciences during the academic year 2021-2022. According to the statistical resources, there were 793 faculty members at the university in the mentioned period. As per Morgan's table, the sample size consisted of 260 individuals. The methods utilized to collect the required data were the standard questionnaire of occupational innovation developed by Etlai and Akif (1982), the professional development questionnaire of faculty members developed by Davarpanah (2018), and the self-leadership questionnaire developed by Rahimi, et al. (2019). To statistically analyze the research data, the SPSS 23 software was used to verify the normality of the studied variables. To calculate the correlation coefficients between them, AMOS Ver. 23 was utilized.

According to the correlation matrix table, there was a direct and significant relationship between professional development, self-leadership, and inventive performance. The measurement models fit well based on the results of confirmatory factor analysis and assessment indices. The Cronbach's alpha value was 0.82. The self-leadership coefficient of influence on work innovation was 0.37, self-leadership had a 0.38 coefficient of influence on professional progress, and professional development had a 0.31 impact factor on job innovation.

  This study revealed that faculty members' self-leadership and professional development had a positive and statistically significant effect on their innovative career performance. The results also confirmed the mediating function of professional development in the relationship between self-leadership and innovative career performance.

 Health systems are responsible for providing healthcare services for all people in a community with reasonable costs. The primary objective was to evaluate and minimize the various expenses the patients incur consistently. The current study aimed to examine the direct non-medical and indirect expenses incurred to hospitalized patients infected with the Omicron variant of COVID-19.

This cross-sectional study was conducted in February 2022 at Kosar Hospital in Semnan, Iran to investigate 400 hospitalized patients infected with the COVID-19 Omicron variant. The data were collected using a standardized instrument and conducting interviews with the patient. The descriptive findings were presented as frequencies (percentages) for qualitative variables and as means (standard deviations) for quantitative variables. The statistical relationship between demographic and background variables and the types of costs imposed on patients was examined performing T-test, ANOVA, and Tukey's post hoc test.

The study findings revealed that the patients and their families spent 20,260,000 IRR on direct non-medical treatment and 28,300,000 IRR on indirect treatment. A comprehensive statistical analysis was conducted to examine the correlation between demographic and background variables and the types of the costs incurred by patients and their families. The results indicated that a previous lung disease, asthma, diabetes, an admission to the intensive care unit (ICU), a coma in the patient, and COVID-19-induced heart complications were statistically and significantly associated with the direct non-medical costs. Furthermore, it was found that variables such as age, gender, educational status, employment status, engagement in occupational and physical activities, as well as the occurrence of a coma imposed additional indirect costs on the patients and their families (P<0.05).

In sum, an infection with the Omicron variant of COVID-19 placed a substantial financial burden on the individuals and their households. Various factors may have influenced the magnitude of these expenses; therefore, it was recommended that these factors should be considered when implementing the promotional initiatives.

The reduced level of physical activity is a current global concern. To address this concern, encouraging physical activity should be highlighted by public health policymakers of the countries. This study aimed to identify the factors affecting the policies on physical activity in Iran.

In this qualitative study, the analytical framework was adopted to interview 23 key informants selected by the targeted sampling with maximum variation from October 2020 to February 2021. The semi-structured interviews were performed and analyzed until the data saturation was achieved. MAXQDA-10 software was used for data management.

Different factors including managerial-structural, socio-cultural, political (i.e., policymaking, legal, and international), and situational factors (i.e., perceived environmental factors, changes in people's lifestyle, and restrictions caused by COVID-19) were the main contextual factors affecting the policymaking process.

It was concluded that several relevant factors affected the policymaking in Iran regarding the physical activity. Therefore, it was recommended that these contributory factors should be considered by policymakers when making policies on physical activities.

Economic evaluation evidence can improve policies and decision-making processes in medicine and health system, prevent wastage of resources caused by trial and error, and facilitate the patients' access to medications. Therefore, the present study aimed to explore the feasibility of using economic evaluation evidence in the Iranian pharmaceutical sector.

In this qualitative study, 29 stakeholders selected by purposeful sampling were interviewed using semi-structured interviews. The statistical population consisted of 29 experts in the fields of pharmacology, management, policymaking, and health economics. The inclusion criteria for participants included being employed in decision-making fields, having a minimum of a master's degree, as well as possessing sufficient and comprehensive knowledge of the subject matter. The interviews were analyzed adopting content analysis method, and the data were coded using the MAXQDA 11 software.

  In order to identify the obstacles and facilitators of the application of economic evaluation evidence in medicine and health system, the study findings were extracted from three main sections (i.e., characteristics of production and extraction of evidence and information, mechanisms and requirements of using evidence, opportunities and benefits of using evidence) and 11 sub-sections of the identification.

  In sum, implementing all identified facilitators and mechanisms needed to establish a robust foundation was found extremely important for correcting an economic evaluation and evidence-based management. Removing the obstacles to an evidence-based management was also found crucial for creating an enabling environment required to implement the evidence-based practices effectively and for facilitating the production and utilization of evidence sources.

Evidence-based policymaking is a type of policy based on valid, timely, and appropriate evidence. This study aimed to explain the evidence-based policy in education and health promotion to students.The method of the present research was a narrative review. The statistical population included 114 Persian and English articles published between 2010 and 2022 which were indexed in ERIC, ScienceDirect, Sage, SID, Irandoc, Magiran, and Medline databases. The search was done using evidence-based policy, health education evidence, health promotion, health education policy, educational policy and health key words. The search was conducted using the SPIDER framework due to the speciality of the subject being studied. Using Downs and Black checklist for quality assessment, the final research sample included 20 references selected through screening. Thematic analysis was used to codify the texts using the Sternberg method. We extracted 59 concepts and six themes based on coding of the findings. Evidence-based policymaking in educating and promoting student health can be categorized into six themes: the necessity for evidence-based policymaking, the characteristics of evidence-based policymaking, the prerequisites of evidence-based policymaking, the impetus for evidence-based policymaking, the barriers to evidence-based policymaking, and the consequences of evidence-based policymaking. Application of evidence-based policymaking in educating and promoting students’ health, based on global trends, technologies and strategies can lead to efficient education and health promotion policies. This study provided useful, practical guidelines such as filling the theoretical gap, ensuring clarity and motivation, influencing political decisions, and building trust among researchers, the scientific community, and other policy stakeholders to use evidence-based policymaking effectively in students’ health promotion