Journal of Health Sciences & Surveillance System

Abstract Nowadays, information and communications technology (ICT) has deeply influenced different aspects, especially healthcare sector.⁽¹⁾ Increasing public awareness and expectations has encouraged healthcare providers to use modern technologies to improve service quality.⁽²⁾ Health technologies provide useful information for improving planning,  implementing, monitoring, and policy making based on evidence ⁽³⁾. In fact, an electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR contains the medical and therapeutic histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.⁽⁴⁾
From the beginning of applying family physician and rural insurance program in Iran, different software packages have been developed for making EHR; however, due to technical and structural constraints and also different personal motivations, it is removed from the registration process and recording data in the early stages .⁽⁵⁾
After implementing the health transformation plan (HTP) in 2014, the Ministry of Health and Medical Education (MoHME) launched the health integrated system (SIB) in 2016 with the aim of recording the EHR of households. SIB system follows valuable goals such as applying electronic health record, creating a national health information base, and providing referral systems in the family physician plan. Now, all health workers such as supervisor, general practitioners and dentists, health care providers, midwives, dietitians, mental health and social workers at the first level of service delivery record information on the SIB system. The information that is registered by users on SIB system are as follows: demographic information, disease reporting, physicians' visit, medical history, medications, vaccinations, and radiology and laboratory results. ⁽⁶⁾
After four years of SIB implementation at the comprehensive health centers, health centers, and health houses, the significant strengths of this system are:⁽⁵⁾
• Possibility of supervision and direct and online evaluation by all managers in the health system
• Establishment of a comprehensive EHR system for individuals from birth to end of life
• Exclusion of the paper and bureaucratic system and quick extraction of health statistics
• Application of new care guidelines and instant access of users
On the other hand, constraints of the SIB systems are:
• Extensive data recording and time-consuming nature of service registration in the system
• Absence of proper internet infrastructure, especially in rural areas
 
• Increase in the possibility of unrealistic data entry by compulsion of officials in order to increase service recordings
• Incompatibility of certain system information with community needs and local preferences and specific diseases in each region of the country, and also lack of connection of SIB system information between specialized and sub-specialized centers after five years from the establishment of this system in Iran.
Therefore, for successfully implementation of the system in the health field, it is recommended that we should provide hardware infrastructure, rationalize the number of required services in the system in the first years and then add other services in the long term, hold regular training courses, encourage family physicians as primary caregivers of services at the first level to accept this system, and record the information^(7).
E-health not only could increase the wellbeing of user, but also the pressure on the health care system could be somewhat relieved. By introducing the SIB, we have expanded the toolkit of user-centered design methods for e-health development. The method facilitates easy communication with novices about a future e-health technology, the identification of factors that can hinder or support end-user acceptance of a future e-health technology, and early and cheap possibility for testing functional design decisions ^(8).
Keywords: Information, Health transformation plan, family physician Iran
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Competing interests: The authors declare that they have no competing interests.
Funding: Not applicable
Authors' contributions: All authors have contributed in all sections of the manuscript preparation.
Acknowledgements: Not applicable
Study highlights: Although Integrated Health System has limitations, by taking some measures, it can be useful for health care system of Iran.

Abstract Background: Musculoskeletal disorders (MSDs) are one of the most common causes of occupational injuries that appear in the lower back, neck and upper and lower extremities mainly. This study was conducted to assess the risk of MSDs and determine of its associated factors in workers of a dairy products company.Methods: In this cross-sectional study, 100 male employees (21-41yrs) using census sampling method participated. Data were collected using demographic questionnaire, Nordic musculoskeletal disorders questionnaire (NMQ) and QEC method for assessment of postures during the work. Data were analyzed using statistical tests including test of proportion, multiple logistic regression, and Fisher’s Exact by SPSS software (Version 16.0).Results: The results of this study showed that the lower back (37%), shoulders (36%), and hand/wrist (33%) had the highest prevalence of symptoms of disorders among workers. The results of multiple logistic regression showed a significant association between the prevalence of musculoskeletal disorders in different regions of the body and age, job experiences, shift working and BMI. The results of assessment of physical exposure to musculoskeletal risks by QEC technique showed that in 52% of the studied workers, the level of exposure to musculoskeletal risks was in Action Level (AL) 1, 9% in AL2, 30% in AL3, and 9% in AL4. Also, the finding revealed a significant relationship between the prevalence rate of MSDs and the risk level (low and high risk) achieved by QEC method.Conclusions: Prevalence of symptoms of pain in different regions of the body had an association with age, job experience, shift working and BMI. Corrective measures seemed essential in improvement of working condition in the studied workers.

Abstract Background: Nowadays, self-medication of therapeutic agents is of global concern particularly in developing and underdeveloped countries. Some studies conducted in Iran showed that the frequency of self-medication was significant. Objective: This research was conducted to estimate the prevalence of arbitrary use of antibiotics in Shiraz community with special interest in its determinant factors. Methods: This cross-sectional study was conducted in Shiraz, in 2009. Approximately 710 out of all patients referred to all health care centers in Shiraz were selected to fill out a questionnaire containing 23 questions divided into two parts. The frequency of self-medication according to demographic factors was described and the association between independent variables and selfmedication was analyzed. Results: The frequency of self-medication in this study was 44.5% and the request to prescribe antibiotics by the patients was 53.5%. Amoxicillin was the most widely used drug by the participants. There was a significant association between age and gender with self-medication. The frequent cause for self-medication was common cold. Approximately, 74.4% of the participants reported their previous experience as the main reason for self-medication. Conclusion: The results of this survey demonstrated the high frequency of self-medication in Shiraz. Socio-cultural determinants are the etiologic factors for self-medication. Policy makers are recommended to provide community-wide educational programs to make people aware about the adverse effects of self-medication. There was a significant association between age, gender and education with self-medication and governments could pay more attention to these factors for designing the interventional programs.

Abstract Background/Objective: Musculoskeletal disorders (MSDs) are one of the most common causes of occupational injuries. This study was conducted with the objectives of determination of prevalence rate of MSDs and ergonomics assessment of the risk of MSDs among workers of a petrochemical company. Methods: In this study, 261randomly selected workers in a petrochemical company with at least one year of job tenure participated. Office and operational personnel were studied separately. In office jobs, data were collected using Nordic musculoskeletal disorders questionnaire (NMQ) and ergonomics checklist for assessment of work conditions. In operational jobs, NMQ and QEC (Quick Exposure Check) methods were applied to gather the required data. Data analysis was performed using SPSS software. Results: The most prevalent MSDs symptoms were reported in the lower back (36.2%), upper back (31%), neck (31%) and knees (30.3%). The results showed that the prevalence of MSDs indifferent body regions of the office staff was higher than those of operational workers. Also, in 40.9% of the observed cases, total ergonomics index was in action category 1 (inappropriate working conditions) and 59.9% of the subjects taken in action category 2 (appropriate working conditions). The results of assessment by QEC technique among operational workers showed that in 82.8% of the workers studied, the level of exposure to musculoskeletal risks was high or very high. Conclusions: The prevalence of musculoskeletal disorders in the office staff was higher than that of operational subjects. To improve the working conditions, taking risk factors of the lower back, upper back, neck and knees into consideration seems to be essential.

Abstract Background: Physicians are one of the most important groups directly associated with public health and their health related lifestyle has a significant impact on their patient’s behaviors. Several studies showed that the majority of medical students did not have appropriate and healthy behaviors. The aim of this study was to determine the prevalence of risky lifestyle knowledge and behaviors among Shiraz medical students.Methods: This cross-sectional survey was conducted in 2011. Using a stratified random sampling method, 400 medical students were selected to fill in the questionnaires. The questionnaire contained 33 questions including demographic data, healthy lifestyle knowledge and behavior (including physical activity, fruit and vegetable consumption, water drinking, etc), perception of stress and student’s health information resource. The association between demographic factors and participants’ knowledge, practice and stress score was determined. The correlation between the participants’ knowledge and behavior scores was calculated.Results: The mean knowledge and attitude scores were 2.8 and 3.6, respectively. In 40% of knowledge and 80% of practice questions, the percentage of the correct answer was below 50%. There was a significant correlation between the participants’ knowledge and behavior scores (P<0.05).Conclusion: This study raises the voice of concern with medical students’ knowledge and behavior on healthy lifestyle measures. There is a need for re-thinking, planning and reviewing these concepts of pure reason which is essential in their future professional career. Health considerations, health surveillance and care systems which are based on evidence, reasonability and rationality still have to be paramount.

Abstract Background: Manual load lifting is the most common and stressful activity that imposes high biomechanical pressures on the body, particularly on the back. Diverse studies have shown that load lifting can cause work-related musculoskeletal disorders among workers. This study was conducted to assess manual lifting activity using NIOSH equation and WISHA index and compare the results of the two methods in workers with manual lifting activities.Methods: This cross- sectional study was carried out among 120 workers with manual lifting activity in 7 industrial settings of Shiraz city. Nordic Musculoskeletal disorders Questionnaire (NMQ) and demographic questionnaire, as well as NIOSH lifting equation and WISHA index were used to gather the required data. Statistical analyses were performed using SPSS, 19.Results: The results showed that back problems were the most frequent musculoskeletal disorders among the workers studied (68.3%). The results of lifting evaluation indicated that 79.2% of the individuals in the NIOSH method and 39.2% in WISHA index were at risk of back injuries. The kappa value was equal to 0.29, indicating a fair agreement between the results of assessment by the two methods.Conclusion: The results of this study confirmed a fair correlation between these two assessment methods, so they might be used interchangeably.

Abstract In December 2019, in Wuhan, China, a group of acute respiratory illnesses was diagnosed with unknown etiology, which today is known as Coronavirus disease 2019 (COVID 19) [1]. Coronavirus is a single-stranded RNA virus that affects both humans and animals. The disease spread rapidly throughout China and other countries [2, 3]. In January 2020, the World Health Organization (WHO) announced the outbreak of the new coronavirus as the sixth public health emergency of international concern [4].
In general, the first step in preventing the spread of infectious diseases is quarantine and isolation; in public health, quarantine means separating and keeping people at risk of contracting an infectious disease, including travel bans, daily commutes, and public gatherings. Isolation also means isolating the infected people [5]. For the first time, China's National Health Commission has implemented quarantine and isolation of people at risk and patients with COVID 19, and other countries have taken action following the outbreak [6]. Usually, people who experience quarantine have unpleasant feeling about it. Cases such as separation from loved ones, loss of freedom, insecurity about illness, and boredom can have many negative psychological burdens, for example disorders such as anxiety, depression, dysfunction, or unwillingness to work [7].
In addition to the fear and anxiety caused by the virus, other factors can negatively affect a person's mental health. One of these factors is Internet addiction [8]. The Internet is an essential and integral part of the new lifestyle. The term Internet addiction refers to the psychological dependence on the use of the Internet, which is a problematic behavior in human interaction with technology that can have significant effects on increasing stress, depression and social communication disorders [9]. In general, it can be said that three personal, social and internet factors play a role in Internet addiction. Personal factors are related to individual characteristics such as introversion, inability to communicate sufficiently, and low self-efficacy. Internet factors also include more time to use the Internet, easier access to the Internet, and superior Internet skills. Social factors also include low family support and sociological problems of the individuals. The important point is that the combination of social and personal factors can have a significant impact on Internet addiction [10].
Due to the prevalence of COVID 19 and home quarantine and lifestyle changes, Internet addiction is one of the disorders that can increase dramatically. On the other hand, Internet addiction can increase the chances of developing other mental disorders such as anxiety and depression. Internet addiction can also endanger a person's physical health and reduce social, occupational, and recreational activities. Applying educational and counseling programs (virtually via the Internet and the media) to help reduce the psychological problems of Internet addiction and provide solutions in this course can be helpful.

Abstract AbstractBackground: Gifted individuals have exclusive personalitytraits and need various experiences to achieve more informationabout themselves and their ability into developmental process fromgiftedness to talent. Also, they can increase mental experiencesand obtain greater self- actualization with recognition of thelevel of challenges, values and their personality traits. The aimof this study was to assess the relationship between personalitytraits, self-awareness and self-actualization dimensions.Methods: This descriptive study was conducted in Shiraz cityamong 239 gifted students from high schools during 2013. TheBig Five Personality Questionnaire (BFPQ), Self-ConsciousnessScale (SCS) and Measure of Actualization of Potential (MAP)were used to gather the data. Validity and reliability of thesetools were acceptable. Data were analyzed by regression testusing SPSS v19 statistic software.Results: The finding showed that agreeableness (r=0.34)and conscientiousness (r=0.41) factors (from five factors ofpersonality) had a positive relationship and neuroticism (r=-0.21)had a correlation with self-actualization negatively. Moreover,the privative self-awareness (r=0.41) and public self-awareness(r=0.15) showed a positive correlation and social anxiety revealeda significant negative relationship (r=-0.27) with general selfactualization.On the other hand, privative self-awarenessand agreeableness predicted that 23% of the scores belong toopenness to experience dimension (self–actualization) positively.In addition, conscientiousness and privative self-awarenesspredicted self-reference dimension positively, and neuroticismpredicted it negatively. These variables determine 40% of thescores of self reference dimension. Also, conscientiousness,agreeableness and privative self-awareness predicted that 36%of the scores belong to general self-actualization.Conclusion: Based on our study results, conscientiousnessand agreeableness factors (personality traits) had a significantrelationship with self-actualization and predicted the scores ofself-actualization. It was noted that privative self-awareness (selfawarenessdimension) had a significantly positive correlationwith self-actualization and predicted its scores.