Evaluation of occupational burnout in clinical nurses and emergency technicians in Shahroud County

. Highly challenging and unpredictable conditions in clinical setting impose excessive psychological pressure on employees who are working in these sectors. Such conditions can lead to serious consequences such as occupational burnout. This study aimed to determine the level of occupational burnout in clinical nurses and emergency technicians. This cross-sectional study was conducted on 154 clinical nurses and 114 emergency technicians in 2015. In this study we used two data collection tools including Maslach burnout Inventory and a demographic questionnaire. Data were analyzed using Pearson correlation coefficient and independent t-test.The majority of employees in both groups had a moderate level of occupational burnout (in all aspects). Emergency technicians had higher levels of occupational burnout than nurses however except for emotional exhaustion there was no statistically significant difference between the two groups in terms of other dimensions and the total score. Moreover, occupational burnout in both groups had a significant positive correlation with age and work experience. Work hours had a significant relationship with occupational burnout in nurses, but it had no significant relationship with occupational burnout in emergency technicians. Concerning occupational burnout, there was only a significant difference between the two groups in terms of emotional exhaustion. However given the prevalence of this syndrome in both groups, it is necessary to identify and modify the influencing factors so that to control the syndrome and achieve a better level of work quality

The Relationship between Spiritual Intelligence and Job Performance among Clinical Nurses

Nurses are among the most important human resources of hospitals. Nurses’ performance is affected by several factors including their spiritual intelligence. Spirituality can lead to higher commitment, productivity, and quality improvement in health services. This study aimed to determine the relationship between spiritual intelligence and job performance among nurses in southeast of Iran in 2017. In this cross-sectional study, 204 nurses working in teaching hospitals of Zabol city were assessed. The nurses were randomly selected by cluster sampling. The demographic characteristics were obtained by a checklist. The Job performance Scale and Spiritual Intelligence Scale were further used to assess the intended outcomes. The data was analyzed using Pearson correlation coefficient and multinomial regression. The multinomial regression in Enter mode demonstrated that spiritual intelligence (r=0.14), being married (r=2.17), and educational level (r=3.41) directly and significantly affected nurses’ job performance. On the other hand, higher age (r=-0.24) negatively influenced nurses’ job performance. Considering the impact of spiritual intelligence on the job performance among nurses, it is necessary to implement practical measures to upgrade spirituality in nurses

The Relationship between Spiritual Intelligence and Job Performance among Clinical Nurses

Nurses are among the most important human resources of hospitals. Nurses’ performance is affected by several factors including their spiritual intelligence. Spirituality can lead to higher commitment, productivity, and quality improvement in health services. This study aimed to determine the relationship between spiritual intelligence and job performance among nurses in southeast of Iran in 2017. In this cross-sectional study, 204 nurses working in teaching hospitals of Zabol city were assessed. The nurses were randomly selected by cluster sampling. The demographic characteristics were obtained by a checklist. The Job performance Scale and Spiritual Intelligence Scale were further used to assess the intended outcomes. The data was analyzed using Pearson correlation coefficient and multinomial regression. The multinomial regression in Enter mode demonstrated that spiritual intelligence (r=0.14), being married (r=2.17), and educational level (r=3.41) directly and significantly affected nurses’ job performance. On the other hand, higher age (r=-0.24) negatively influenced nurses’ job performance. Considering the impact of spiritual intelligence on the job performance among nurses, it is necessary to implement practical measures to upgrade spirituality in nurses

The prevalence of anxiety, stress, and depression with respect to coping strategies in caregivers of patients with head injuries

Context: Psychological problems are very common in traumatic patients' caregivers necessitating usage of appropriate coping strategies to promote their mental health. Aim: The aim of this study was to assess anxiety, stress, and depression as well as coping strategies in caregivers of patients with head injuries. Settings and Design: In this cross-sectional study, 127 caregivers of traumatic patients referred to educational hospitals of Zabol city were selected by convenience sampling method. Subjects and Methods: The data were collected using a demographic questionnaire, as well as Depression, Anxiety and Stress Scale-21 and the Jalowiec coping strategies tools. The data were analyzed using descriptive statistics, one-way ANOVA, independent samples Student's t-test, and multivariate regression model. Results: Our findings showed that more than 70 of the caregivers of patients with head injuries suffered from severe and very severe stress and anxiety. The multivariate regression model demonstrated a negative and significant relationship between either stress (B = -0.81 P = 0.001) or depression (B = -1.23 P = 0.000) and problem-based coping strategies. Furthermore, stress (B = 0.64 P = 0.006) and anxiety (B = 0.74 P = 0.002) were negatively associated with emotional-based coping strategies. Conclusion: Considering the high rates of anxiety, stress, and depression in caregivers of patients with head injuries and significant associations observed between these variables and problem-based strategies, it is necessary to identify and obviate factors leading to anxiety and to educate coping strategies to these individuals

The Relationship between Caring Burden and Quality of Life in Caregivers of Type 2 Diabetes

Background: Taking care of patients with chronic diseases such as diabetes exerts great tiredness and stress on the caregivers. The aim of this study was to determine the extent of the caring burden and its relationship with the quality of life of caregivers of diabetic patients. Methods: In this cross-sectional study, 154 caregivers of patients with type 2 diabetes referred to Imam Hossein hospital in Shahroud city were evaluated. The data collection tools included a demographic questionnaire, SF-36 standard quality of life questionnaire, and Novak & Guest care burden questionnaire. The accessible sampling was used and the data were collected by self-reporting. The data was analyzed using descriptive and inferential statistics (Pearson correlation coefficient and regression analysis). Significant level was set at 0.05. Results: The mean age of caregivers was 41.86 ± 12.78 years old. The mean scores of care burden and quality of life of the participants were 53.21 ± 49.61 and 61.02 ± 20.71 respectively. There was a significant inverse correlation between the mean score of care burden and caregivers’ quality of life. Conclusions: According to the results of this study, providing social and informational support for caregivers is recommended to reduce the care burden and subsequently improve the quality of life. Key words: Caring pressure, Quality of life, Diabetes, Caregiver

Evaluating the Effect of Slow-Stroke Back Massage on the Anxiety of Candidates for Cataract Surgery

Background: The patients under cataract sur-gery often experience anxiety not only during the surgery, but also prior to the surgery.Purpose: We sought to determine the effects of slow-stroke back massage on anxiety in patients undergoing cataract surgery. Setting: The study was conducted in the Amiral-momenin Hospital of Zabol city, south-east of Iran.Participants: A total of 60 candidates of cataract surgery participated in the study.Research Design: The participants were ran-domly allocated to either control or intervention groups. The intervention group received slow-stroke back massages, while patients in control group received routine interventions.Intervention: The slow-stroke back massage was performed on the patients assigned to the interven-tion group. The intervention was performed in the morning of the surgery day at 30 minutes before the surgery. The researcher performed each mas-sage session in a sitting position. The duration of each massage session was 15 minutes. Main Outcome Measures: Anxiety was assessed in the both groups in the morning of the surgery, before and immediately after the intervention. In-dependent samples Student’s t test, paired samples Student’s t test, and chi-squared test were used to analyze the data.Results: Anxiety was not significantly different between the two groups before and after the mas-sage (p = .816). On the other hand, paired samples Student’s t test showed a significant difference comparing the anxiety scores before (49.7±5.43) and after (45.16±3.89) the massage in the interven-tion group (p < .001). Conclusions: Based on our results, slow-stroke back massage, which is a low-cost and safe method, reduced anxiety in patients who were candidates for cataract surgery

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed agespecific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitorin

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Epidemiology of injuries from fire, heat and hot substances : global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study

Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.Peer reviewe

Public health utility of cause of death data : applying empirical algorithms to improve data quality

Background: Accurate, comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide. Incorrectly or vaguely assigned deaths, defined as garbage-coded deaths, mask the true cause distribution. The Global Burden of Disease (GBD) study has developed methods to create comparable, timely, cause-specific mortality estimates; an impactful data processing method is the reallocation of garbage-coded deaths to a plausible underlying cause of death. We identify the pattern of garbage-coded deaths in the world and present the methods used to determine their redistribution to generate more plausible cause of death assignments. Methods: We describe the methods developed for the GBD 2019 study and subsequent iterations to redistribute garbage-coded deaths in vital registration data to plausible underlying causes. These methods include analysis of multiple cause data, negative correlation, impairment, and proportional redistribution. We classify garbage codes into classes according to the level of specificity of the reported cause of death (CoD) and capture trends in the global pattern of proportion of garbage-coded deaths, disaggregated by these classes, and the relationship between this proportion and the Socio-Demographic Index. We examine the relative importance of the top four garbage codes by age and sex and demonstrate the impact of redistribution on the annual GBD CoD rankings. Results: The proportion of least-specific (class 1 and 2) garbage-coded deaths ranged from 3.7% of all vital registration deaths to 67.3% in 2015, and the age-standardized proportion had an overall negative association with the Socio Demographic Index. When broken down by age and sex, the category for unspecified lower respiratory infections was responsible for nearly 30% of garbage-coded deaths in those under 1 year of age for both sexes, representing the largest proportion of garbage codes for that age group. We show how the cause distribution by number of deaths changes before and after redistribution for four countries: Brazil, the United States, Japan, and France, highlighting the necessity of accounting for garbage-coded deaths in the GBD