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Moradi T, Rezaei M, Alavi NM. Delegating care as a double-edged sword for quality of nursing care: a qualitative study. BMC Health Serv Res 2024; 24:592. [PMID: 38715066 PMCID: PMC11075185 DOI: 10.1186/s12913-024-11054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.
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Affiliation(s)
- Tayebeh Moradi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboubeh Rezaei
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | - Negin Masoudi Alavi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Moradi T, Kabir MJ, Pourasghari H, Ehsanzadeh SJ, Aryankhesal A. Challenges of Budgeting and Public Financial Management in Iran's Health System: A Qualitative Study. Med J Islam Repub Iran 2023; 37:80. [PMID: 37600636 PMCID: PMC10439693 DOI: 10.47176/mjiri.37.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background Efficient and effective management of budgets and financial resources is critical for health systems to achieve their goals; in this regard, countries may face budgetary and financial challenges owing to the weak prediction of resources and consumptions, and lack of prioritization for their budget. This study aims to identify the most critical policies and events that have affected public financial management and health budgeting and existing challenges in Iran. Methods We conducted the present study in 2022 using a 2-stage qualitative method. First, by reviewing upstream documents and laws, we identified evidence related to health budgeting. Then, we conducted 13 semi-structured interviews with informed people in the health budgeting field that led us toward the main challenges through thematic content analysis. Results After reviewing 48 upstream documents related to health budgeting, we identified 85 policies. After reviewing the articles, we achieved 11 themes and 71 subthemes. The most critical challenges of the budgeting cycle were as follows: (I) budget formulation, including inappropriate budget structure, conflicts of interest and infringement, lack of financial sustainability, and transparency; (II) budget execution, including a nonexecutable approved budget, complicated allocation process, and ineffective allocations; and (III) monitoring, reporting, and evaluation (MR&E), including fragmentation of MR&E processes, ineffective monitoring and evaluation, weak evaluation of platforms, and inadequate transparency. Conclusion Most challenges in the health budgeting system are related to the budget formulation and approval stage that have their roots in implementation, monitoring, and reporting. In addition, Iran's macroeconomic and financial issues have also damaged the budgeting of the health sector. Budget problems affect the goals and outcomes of this sector, especially the health system.
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Affiliation(s)
- Tayebeh Moradi
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Kabir
- Health Management and Social Development Research Center, Golestan University of
Medical Sciences, Gorgan, Iran
| | - Hamid Pourasghari
- Hospital Management Research Center, Health Management Research Institute, Iran
University of Medical Sciences, Tehran, Iran
| | - Seyed Jafar Ehsanzadeh
- English Language Department, School of Health Management and Information
Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Moradi T, Adib-Hajbaghery M, Dianati M, Moradi F. Rationing of nursing care: A concept analysis. Heliyon 2023; 9:e15861. [PMID: 37180901 PMCID: PMC10172910 DOI: 10.1016/j.heliyon.2023.e15861] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
Rationing of nursing care (RONC) refers to necessary nursing tasks that nurses refuse or fail to do because of limited time, staffing level, or skill mix. As an important process factor, it affects the quality of patient care. The concept of rationing of nursing care has not yet been clearly defined and analyzed and there are different views regarding this issue. Using Walker and Avant's eight-step method, this concept analysis was conducted to analyze the meaning, attributes, dimensions, antecedents, and consequences of nursing care rationing. The literature was collected by searching in electronic databases including PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar with no date limitation. Both qualitative and quantitative studies on rationing of nursing care, which were open-access and published in English, were included in this study. Thirty-three articles were investigated in the present study. The four defining attributes of RONC included the duty of performing nursing care, dealing with problems of doing nursing care, decision-making and prioritizing, and outcome. The antecedents included nurse-related, organization-related, care-related, and patient-related antecedents. A theoretical definition and a conceptual model of RONC were developed. The attributes, antecedents, and consequences of RONC identified in this study can be used in nursing education, research, and managerial and organizational planning.
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Affiliation(s)
- Tayebeh Moradi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Corresponding author.
| | - Mansour Dianati
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Moradi
- Department of English Language and Literature, Allameh Tabataba'i University, Tehran, Iran
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Ghiasvand H, Barnish MS, Moradi T, Nikram E, Naghdi S. Making orphan drugs and services available and accessible for people who live with rare diseases: what has been done? a systematic scoping review. Expert Opin Orphan Drugs 2022. [DOI: 10.1080/21678707.2022.2153671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Hesam Ghiasvand
- Divisional Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Maxwell S. Barnish
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, UK
| | - Tayebeh Moradi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Nikram
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, UK
| | - Seyran Naghdi
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Rezapour A, Naghdi S, Ghiasvand H, Moradi T, Kabir MJ, Yousefzadeh N. A Systematic Review on the Economic Evaluations Evidence of Enhanced External Counter-Pulsation (EECP) for Managing Chronic Stable Angina. Med J Islam Repub Iran 2022; 36:100. [PMID: 36419943 PMCID: PMC9640357 DOI: 10.47176/mjiri.36.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Chronic Stable Angina (CSA) does not respond to clinical interventions always. Therefore, enhanced external counter pulsation (EECP) has been approved by the Food and Administration Drug (FDA) as an effective technology. This study aimed to synthesize evidence on the economic evaluation of EECP in managing CSA through a systematic approach. Methods: In this systematic review study, PubMed/Medline, Cochrane Library, Web of Sciences, Scopus, National Institute for Health Research Journals Library, and the University of York Centre for Review and Dissemination (CRD) were searched. The targeted population was people who suffered from CSA, and the main therapeutic intervention was EECP. The comparators were not limited to any particular ones. Outcomes were changes in the Canadian Cardiovascular Society grading of angina pectoris, quality of life, and any other investigated relevant outcomes in the retrieved studies. The quality of studies was assessed through Philips et al and Joanna Briggs Institute Critical Appraisal tools. We synthesized data through a narrative approach. Results: We retrieved 7821 studies; among which 3 studies were included in the final phase. Two studies were systematic reviews and the Markov model economic evaluation. Another study was a partial economic evaluation. Conclusion: All studies only considered direct costs. EECP is a cost-effective technology in managing CSA, however, the sensitivity analysis of the studies showed the cost-effectiveness ratio is varied considerably and further studies are needed to extrapolate its economic value.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Seyran Naghdi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
, National Center for Health Insurance Research, Tehran, Iran
| | - Tayebeh Moradi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
, Corresponding author:Tayebeh Moradi,
| | - Mohammad Javad Kabir
- Department of Family and Community Medicine, School of Medicine Golestan University of Medical Sciences, Gorgan, Iran
| | - Negar Yousefzadeh
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Moradi T, Naghdi S, Brown H, Ghiasvand H, Mobinizadeh M. Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget? Int J Health Plann Manage 2018; 33:652-661. [PMID: 29573463 DOI: 10.1002/hpm.2517] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/20/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Lack of well-designed healthcare financing mechanisms and high level of out-of-pocket payments in Iran over the last decades led to implementing Health Transformation Plan, in 2014. This study aims to decompose inequality in financial protection of Iranian households after the implementation of the Health Transformation Plan. METHODS The data of Statistical Center of Iran (SCI) Survey on Rural and Urban Households Income-Expenditure in 2015 to 2016 were used. The headcount ratio of catastrophic health expenditures was calculated. The corrected concentration index was estimated. The role of contributors on inequality in the exposure to catastrophic health expenditures among poor and nonpoor households was calculated using Farelie's model. RESULTS The headcount ratio of the exposure to catastrophic health expenditures in urban and rural households was 2.5% (2.43% - 2.64%) and 3.6% (3.48% - 3.76%), respectively. The difference in households' income levels was the main contributor in explaining the inequality in facing catastrophic health expenditures between poor and nonpoor households. [Correction added on 02 June 2018, after first online publication: The "Results" section of the Abstract of the published article has been correctly updated on this version.] CONCLUSION: Even after implementing the HTP, the headcount ratios of catastrophic health expenditure are still considerable. The results show that income is the greatest determinant of inequality in facing catastrophic health expenditure and in urban households.
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Affiliation(s)
| | - Seyran Naghdi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Heather Brown
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Naghdi S, Moradi T, Tavangar F, Bahrami G, Shahboulaghi M, Ghiasvand H. The Barriers to Achieve Financial Protection in Iranian Health System: A Qualitative Study in a Developing Country. Ethiop J Health Sci 2017; 27:491-500. [PMID: 29217954 PMCID: PMC5615010 DOI: 10.4314/ejhs.v27i5.7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/09/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The move to universal health coverage and consequently health promotion is influenced by political, socio-economic and other contextual factors in a country. Iran, as a developing country with an upper-middle national income, has developed policies to achieve universal health coverage through financial protection. This study aims to investigate barriers to develop financial protection as a requirement to achieve universal health coverage. MATERIALS AND METHODS This qualitative study was conducted using 20 in-depth interviews with experts in social welfare, health insurance and financing. The framework analysis method was used to analyze the data. RESULTS The results have been categorized in three major themes that were extracted from ten sub-themes. The major themes included the political, social and economic context of the country, the context and structure of healthcare system and dimensions of UHC. CONCLUSION Achieving financial protection as a long-term objective should be considered as a priority among Iranian policy makers that requires an inter-sectoral collaboration with a defined in-charge body. Health policy makers in Iran should develop a more comprehensive benefits package for diseases and health conditions with catastrophic consequences. They also should develop a plan to cover the poor people.
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Affiliation(s)
- Seyran Naghdi
- Iran University of Medical Sciences, Financial Affaires Office, Department of R&D, Tehran, Iran
| | - Tayebeh Moradi
- Iran Health Insurance Organization (IHIO), Expert of Health Services Strategic Purchasing, Tehran, Iran
| | - Fateh Tavangar
- PhD. Student of Social Welfare and Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Giti Bahrami
- PhD. Student of Social Welfare and Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadi Shahboulaghi
- Associate Professor, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Assistant Professor, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Besharat Pour M, Bergström A, Bottai M, Magnusson J, Kull I, Moradi T. Age at adiposity rebound and body mass index trajectory from early childhood to adolescence; differences by breastfeeding and maternal immigration background. Pediatr Obes 2017; 12:75-84. [PMID: 26910193 DOI: 10.1111/ijpo.12111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 12/02/2015] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This paper aims to assess association between breastfeeding and maternal immigration background and body mass index development trajectories from age 2 to 16 years. METHODS A cohort of children born in Stockholm during 1994 to 1996 was followed from age 2 to 16 years with repeated measurement of height and weight at eight time points (n = 2278). Children were categorized into groups by breastfeeding status during the first 6 months of life and maternal immigration background. Body mass index (BMI) trajectories and age at adiposity rebound were estimated using mixed-effects linear models. RESULTS Body mass index trajectories were different by breastfeeding and maternal immigration status (P-value < 0.0001). Compared with exclusively breastfed counterparts, never/short breastfed children of Swedish mothers had a higher BMI trajectory, whereas never/short breastfed children of immigrant mothers followed a lower BMI trajectory. Ages at adiposity rebound were earlier for higher BMI trajectories regardless of maternal immigration background. CONCLUSION Differences in BMI trajectories between offspring of immigrant and of Swedish mothers suggest a lack of beneficial association between breastfeeding and long-term BMI development among children of immigrant mothers. Given the relation between long-term BMI development and risk of overweight/obesity, these differences challenge the notion that exclusive breastfeeding is always beneficial for children's BMI development and subsequent risk of overweight/obesity.
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Affiliation(s)
- M Besharat Pour
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - A Bergström
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - M Bottai
- Institute of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - J Magnusson
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - I Kull
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
| | - T Moradi
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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Moradi T, Jafari M, Maleki MR, Naghdi S, Ghiasvand H. Quality Management Systems Implementation Compared With Organizational Maturity in Hospital. Glob J Health Sci 2015; 8:174-82. [PMID: 26493411 PMCID: PMC4804035 DOI: 10.5539/gjhs.v8n3p174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/13/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A quality management system can provide a framework for continuous improvement in order to increase the probability of customers and other stakeholders' satisfaction. The test maturity model helps organizations to assess the degree of maturity in implementing effective and sustained quality management systems; plan based on the current realities of the organization and prioritize their improvement programs. OBJECTIVES We aim to investigate and compare the level of organizational maturity in hospitals with the status of quality management systems implementation. MATERIALS & METHODS This analytical cross sectional study was conducted among hospital administrators and quality experts working in hospitals with over 200 beds located in Tehran. In the first step, 32 hospitals were selected and then 96 employees working in the selected hospitals were studied. The data were gathered using the implementation checklist of quality management systems and the organization maturity questionnaire derived from ISO 10014. The content validity was calculated using Lawshe method and the reliability was estimated using test - retest method and calculation of Cronbach's alpha coefficient. The descriptive and inferential statistics were used to analyze the data using SPSS 18 software. RESULTS According to the table, the mean score of organizational maturity among hospitals in the first stage of quality management systems implementation was equal to those in the third stage and hypothesis was rejected (p-value = 0.093). In general, there is no significant difference in the organizational maturity between the first and third level hospitals (in terms of implementation of quality management systems). CONCLUSIONS Overall, the findings of the study show that there is no significant difference in the organizational maturity between the hospitals in different levels of the quality management systems implementation and in fact, the maturity of the organizations cannot be attributed to the implementation of such systems. As a result, hospitals should make changes in the quantity and quality of quality management systems in an effort to increase organizational maturity, whereby they improve the hospital efficiency and productivity.
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Besharat Pour M, Bergström A, Bottai M, Magnusson J, Kull I, Wickman M, Moradi T. Body mass index development from birth to early adolescence; Effect of perinatal characteristics and maternal migration background in a Swedish cohort. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku162.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hussen HI, Moradi T, Persson M. Maternal overweight and obesity increase the risk of type 1 diabetes in offspring of parents without diabetes regardless of ethnicity. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Moradi T, Maghaminejad F, Azizi-Fini I. Quality of working life of nurses and its related factors. Nurs Midwifery Stud 2014; 3:e19450. [PMID: 25414904 PMCID: PMC4228533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Nurses as the largest group of health care providers should enjoy a satisfactory quality of working life to be able to provide quality care to their patients. Therefore, attention should be paid to the nurses' working life. OBJECTIVES This study aimed to investigate the quality of nurses' working life in Kashans' hospitals during 2012. MATERIALS AND METHODS This cross-sectional study was conducted on 200 nurses during 2012. The data-gathering instrument consisted of two parts. The first part consisted of questions on demographic information and the second part was the Walton's quality of work life questionnaire. Data were analyzed using the SPSS software. For statistical analysis T test and one way ANOVA were used. RESULTS The results of the study showed that 60% of nurses reported that they had moderate level of quality of working life while 37.1% and 2% had undesirable and good quality of working life, respectively. Nurses with associate degrees reported a better quality of working life than others. A significant relationship was found between variables such as education level, work experience, and type of hospital with quality of working life score (P < 0.05). No significant differences were observed between quality of working life score of nurses with employment status (P = 0.061), salary (P = 0.052), age, gender and marital status (P > 0.05). CONCLUSIONS Nurses' quality of work life was at the moderate level. As quality of work life has an important impact on attracting and retaining employees, it is necessary to pay more attention to the nurses' quality of work life and its affecting factors.
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Affiliation(s)
- Tayebeh Moradi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Farzaneh Maghaminejad
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Ismail Azizi-Fini
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran,Corresponding author: Ismail Azizi-Fini, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98-9122475747, Fax: +98-2166904252, E-mail:
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Adib Hajbaghery M, Moradi T, Mohseni R. Effects of a multimodal preparation package on vital signs of patients waiting for coronary angiography. Nurs Midwifery Stud 2014; 3:e17518. [PMID: 25414893 PMCID: PMC4228516 DOI: 10.17795/nmsjournal17518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 02/01/2014] [Indexed: 11/25/2022] Open
Abstract
Background: Patients waiting for coronary angiography are often anxious and worried, experiencing considerable emotional problems before the procedure, which can result in an increase in blood pressure (BP), heart rate, respiratory rate and the myocardial oxygen demand. Such maladaptive responses may not only increase the patients need for sedative drugs, but also could increase the length of post angiography hospitalization. Therefore, it is important to implement some supportive actions to decrease the patients’ anxiety and to stabilize their vital signs before coronary angiography. Objectives: This study aimed to investigate the effects of a multimodal preparation package on vital signs of patients undergoing coronary angiography. Patients and Methods: A matched trial was conducted on 66 patients waiting for coronary angiography. Patients were assigned in intervention (n = 33) and control (n = 33) groups. A multimodal preparation package was implemented in intervention group, two hours before angiography. The data collection instrument consisted of questions on demographic characteristics and a table for recording the patients’ vital signs including systolic BP (SBP) and diastolic BP (DBP), heart rate, respiratory rate and body temperature. Vital signs were measured three times, the day before angiography, 30 minutes before and 30 minutes after the angiography, using a thermometer and a monitoring device. Data analysis was performed using the Kolmogo-Smirnov test, t test and Mann-Whitney U test. Results: From the total number of 66 patients, the 63.3% were male and married. No significant differences were observed between the mean of SBP and DBP and also the heart rate in the intervention and control groups, on the day before angiography. However, the mean SBP and DBP and heart rate of the intervention group were significantly lower compared to the control group, both 30 minutes before and 30 minutes after angiography. The intervention did not significantly change the respiration rate and temperature in the intervention group. Conclusions: The study showed that preparation package was effective in decreasing SBP and DBP, as well as heart rate. Therefore, using multimodal comprehensive preparation packages, such as the package used in the present report, is suggested.
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Affiliation(s)
- Mohsen Adib Hajbaghery
- Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Tayebeh Moradi
- Department of Medical Surgical Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Raheleh Mohseni
- Department of Medical Surgical Nursing, Kashan University of Medical Sciences, Kashan, IR Iran
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Naghdi S, Ghiasvand H, Shaarbafchi Zadeh N, Azami S, Moradi T. Association of health and food expenditures inequality with health outcomes: a case study on Iranian rural households. Iran Red Crescent Med J 2014; 16:e14335. [PMID: 24829771 PMCID: PMC4005433 DOI: 10.5812/ircmj.14335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 12/17/2013] [Accepted: 12/25/2013] [Indexed: 11/16/2022]
Abstract
Background: Inequality in households’ and individuals' consumption expenditures is one of the most important aspects of health status difference among households and individuals. Objectives: We investigated the impact of some macro-economic factors specially inequality factors on the Iranian rural health status since 1986 through 2012. Patients and Methods: We conducted a longitudinal ecological and analytical study. The average sample size was 14602 households whom Iranian Statistics Center selected by a multi-stages clustering sampling approach. All required data has been collected from Iranian Statistics Centre and Deputy for Curial Affaires of Iranian Ministry of Health. We calculated the Gini coefficients for the rural food and health expenditures, then conducted a transloge autoregressive order one (AR1) to investigate the association between the Iranian rural households' key mortality rates and the food and health expenditure Gini coefficients, time trend, GDP per capita (PPP), and GDP per capita Gini coefficients. Results: The mean of Gini coefficients were 0.137 and 0.21 for the rural food expenditures inequality based on current and constant price, respectively. In addition, the mean of Gini coefficients were 0.26 and 0.31 for the rural health expenditures inequality based on current and constant price, respectively. The time trend, transloged form of Gini coefficients for health expenditures and GDP per capita Gini coefficients presented a significant negative correlation with transloged form of neonatal mortality rate. With regard to the transloged form of under five mortality we observed a significant negative correlation with time trend and transloged form of Gini coefficients for health expenditure and GDP per capita. Finally, there was a significant negative correlation between transloged forms of maternal mortality rate. Conclusions: Iranian policy makers should consider the rural health and food expenditures inequality and try to adopt more effective policies and plans to decrease it. In addition, they should improve the macro-economic factors to improve the rural households' health status.
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Affiliation(s)
- Seyran Naghdi
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Hesam Ghiasvand
- Hospital Management Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Shaarbafchi Zadeh
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Saeidreza Azami
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Saeidreza Azami, Health Management and Economics Center, School of Health Management and Information Sciences, Yasemi St., Vali-Asr Ave, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125486014, E-mail:
| | - Tayebeh Moradi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
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Manoochehri J, Masoumi Dehshiri R, Faraji H, Mohammadi S, Dastsooz H, Moradi T, Rezaei E, Sadeghi K, Fardaei M. Family screening for a novel ATP7B gene mutation, c.2335T>G, in the South of Iran. Iran J Ped Hematol Oncol 2014; 4:26-31. [PMID: 24734161 PMCID: PMC3980019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 12/30/2013] [Indexed: 12/05/2022]
Abstract
BACKGROUND Wilson disease (WD) is a rare autosomal recessive disorder, which leads to copper metabolism, due to mutations in ATP7B gene. The gene responsible for WD consists of 21 exons that span a genomic region of about 80 kb and encodes a copper transporting P-type ATPase (ATP7B), a protein consisting of 1465 amino acids. Identifying mutation in ATP7B gene is important to find carrier individuals for proper counseling. A novel mutation in exon 8 of ATP7B gene, c.2335T>G (p.Trp779Gly), with severe neuropsychiatric condition in the South of Iran, was recently identified. The aim of this study was to screen 120 individuals from a large family using a simple amplification refractory mutation system PCR (ARMS-PCR) for carrier screening in the South of Iran. MATERIALS AND METHODS 120 individuals from family relatives of an index case in the Nasr Abad, south of Iran, were studied for screening of the c.2335T>G mutation. One patient with homozygous mutation and one homozygous normal individual were used as controls in this experiment. RESULTS Altogether, 16 out of 120 (13.3%) individuals within this region had heterozygous mutation. One individual with homozygote mutation was also identified. CONCLUSION Identification of carriers in families with affected individuals is of great importance for counseling before marriage. The results of this study can be used for further counseling programs in this population.
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Affiliation(s)
- J Manoochehri
- Department of Medical Genetics, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran,Comprehensive Medical Genetics Centre, Shiraz, Iran
| | - R Masoumi Dehshiri
- Health Policy Research Center, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - H Faraji
- Comprehensive Medical Genetics Centre, Shiraz, Iran
| | - S Mohammadi
- Comprehensive Medical Genetics Centre, Shiraz, Iran
| | - H Dastsooz
- Department of Medical Genetics, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran,Department of Molecular Medicine, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - T Moradi
- Comprehensive Medical Genetics Centre, Shiraz, Iran
| | - E Rezaei
- Comprehensive Medical Genetics Centre, Shiraz, Iran
| | - Kh Sadeghi
- Comprehensive Medical Genetics Centre, Shiraz, Iran
| | - M Fardaei
- Department of Medical Genetics, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran,Comprehensive Medical Genetics Centre, Shiraz, Iran,Department of Molecular Medicine, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
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Adib Hajbaghery M, Moradi T. Quality of care for patients with traction in shahid beheshti hospital in 2012. Arch Trauma Res 2013; 2:85-90. [PMID: 24396800 PMCID: PMC3876554 DOI: 10.5812/atr.9127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/18/2013] [Accepted: 04/20/2013] [Indexed: 11/16/2022]
Abstract
Background With increasing incidence of traumatic fractures, the use of orthopedic intervention
such as traction has increased. Inappropriate traction care may cause substantial
morbidity and delay the patient rehabilitation. Objectives This study was conducted to evaluate the quality of care for patients with traction in
the orthopedic unit of Kashan's Shahid Beheshti Hospital, Kashan, Iran. Patients and Methods This observational study was conducted on 100 patients with traumatic fractures of hip
and femur bones who were admitted to Kashan Shahid-Beheshti Hospital during the first 6
months of 2012, and for whom skeletal or skin traction was performed. Data were
collected using a checklist including questions about the personal characteristics and
23 items related to care for patients with tractions. These items were in three domains
including caring while establishing traction, recording care and patient’s education.
Descriptive statistics were calculated and data were analyzed using the independent
sample t-test and Pearson correlation coefficient. Results The mean age of patients was 51.16 ± 23.28 years and 66% of them were male. In
total, 47% of the patients were treated by skin traction and 53% by skeletal traction.
The overall mean score of quality of care was 10.20 ± 2.64. Quality of establishing
traction was good in 55% of patients, but the quality of care was poor in the domains of
recording care (88%) and patient education (96%). Total mean of quality of care was
significantly different between male and female patients (P < 0.02). Conclusions The quality of care of patients with traction was not optimal. Therefore it is
necessary to improve measures in this area.
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Affiliation(s)
- Mohsen Adib Hajbaghery
- Trauma Nursing Research Center, Kashan University of
Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohsen Adib Hajbaghery, Trauma
Nursing Research Center, Kashan University of Medical Sciences. Kashan, IR Iran. Tel.:
+98-3615550021, Fax: +98-3615556633, E-mail:
| | - Tayebeh Moradi
- Student Research Committee, Faculty of Nursing and
Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
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Abstract
Cryptosporidium is a ubiquitous enteropathogen protozoan infection affecting livestock worldwide. The present study was carried out to determine the prevalence of Cryptosporidium infection in different age groups of dromedary camels in northwestern Iran from November 2009 to July 2010. A total number of 170 fecal samples were collected and examined using modified Ziehl-Neelsen (MZN) staining under light microscope. Examination of stained fecal smears revealed that 17 camels (10%) were positive for Cryptosporidium-like. The prevalence of Cryptosporidium-like was significantly higher in camel calves (< 1 years old) (20%) than other age groups, in which the diarrhoeic calves had the prevalence of 16%. In adult camels the prevalence was 6.5%. There was no significant difference in the prevalence of Cryptosporidium-like between male and female camels. It is concluded that Cryptosporidium infection is a problem in camel husbandry and could be of public health concern in the region.
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Affiliation(s)
- M Yakhchali
- Department of Pathobiology, Parasitology Division, Nazlu campus, Urmia University, Urmia city, West Azerbaijan province, Iran.
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Yang D, Dzayee D, Beiki O, Alfredsson L, de Faire U, Moradi T. P1-377 Trends and incidence of and mortality after first myocardial infarction in a national-wide cohort of men and women with diverse socioeconomic position and country of birth, 1987-2007. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976f.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dzayee D, Beiki O, Ljung R, Moradi T. P1-141 Myocardial re-infarction: country of birth, gender, socio-economic position (SEP), and age to be considered. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976d.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Beiki O, Granath F, Allebeck P, Akre O, Moradi T. 64 Subtype-specific risk of testicular germ-cell tumours among immigrants and their descendants in Sweden, 1960–2007. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Norman A, Moradi T, Gridley G, Dosemeci M, Rydh B, Nyrén O, Wolk A. Occupational physical activity and risk for prostate cancer in a nationwide cohort study in Sweden. Br J Cancer 2002; 86:70-5. [PMID: 11857014 PMCID: PMC2746533 DOI: 10.1038/sj.bjc.6600023] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2001] [Revised: 10/25/2001] [Accepted: 10/25/2001] [Indexed: 11/11/2022] Open
Abstract
We investigated effects of occupational physical activity on relative risk for prostate cancer. From Swedish nationwide censuses in 1960 and 1970, we defined two cohorts of men whose occupational titles allowed classification of physical activity levels at work in 1960 (n=1,348,971) and in 1970 (n=1,377,629). A third cohort included only men whose jobs required a similar level of physical activity in both 1960 and 1970 (n=673,443). The incidence of prostate cancer between 1971 and 1989 was ascertained through record linkage to the Swedish Cancer Register. A total of 43,836, 28,702, and 19,670 prostate cancers, respectively, occurred in the three cohorts. In all three cohorts, the relative risk for prostate cancer increased with decreasing level of occupational physical activity (P<0.001), using Poisson regression. Among men with the same physical activity levels in 1960 and 1970, the rate ratio was 1.11 for men with sedentary jobs as compared with those whose jobs had very high/high activity levels after adjustment for age at follow-up, calendar year of follow-up and place of residence (95% CI 1.05-1.17; P for trend <0.001). There was no association between occupational activity and prostate cancer mortality. Since we had no data on other potential risk factors the observed associations for both incidence and mortality might have been confounded. Further studies are needed to better understand the potential role of physical activity for prostate cancer.
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Affiliation(s)
- A Norman
- Department of Medical Epidemiology, Karolinska Institutet, P.O.B. 281, SE-171 77 Stockholm, Sweden.
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Boffetta P, Dosemeci M, Gridley G, Bath H, Moradi T, Silverman D. Occupational exposure to diesel engine emissions and risk of cancer in Swedish men and women. Cancer Causes Control 2001; 12:365-74. [PMID: 11456233 DOI: 10.1023/a:1011262105972] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the risk of cancer among workers exposed to diesel emissions in a large record-linkage study from Sweden. METHODS The Swedish Cancer Environment Register III contains nationwide data on cancer incidence during 1971-1989, by occupation and industry of employment as reported in the 1960 and 1970 censuses. After excluding farmers, we classified job and industry titles according to estimated probability and intensity of exposure to diesel emissions. Exposed men in the 1960 census contributed over 7,400,000 person-years, and exposed women contributed over 240,000. We compared them to the remainder of the employed population, using indirect standardization and multivariate Poisson regression analysis. RESULTS Men exposed in the 1960 census experienced an increased risk of lung cancer: the relative risks (RRs) were 0.95 (95% confidence interval [CI] 0.9-1.0), 1.1 (1.1-1.2) and 1.3 (1.3-1.4) for low, medium, and high intensity of exposure. Corresponding results for probability of exposure were 1.1 (1.0-1.1), 0.9 (0.86-0.94) and 1.2 (1.1-1.2). The risk was higher for squamous cell carcinoma of the lung than for other histological types. Results in women were not suggestive of an effect (RR in the category of medium or high intensity of exposure 1.1, 95% CI 0.6-1.8). A small but significant increase in risk of cancers of the stomach (SIR 1.06), pancreas (SIR 1.05), larynx (SIR 1.09), and the kidney (SIR 1.06) was present among men exposed to diesel emissions, without a clear trend according to either probability or intensity of exposure. The SIR among women was non-significantly increased for stomach, pancreatic, and laryngeal cancers, but not for kidney cancer. Furthermore, a significantly increased risk of oral/pharyngeal (SIR 1.64) and cervical (SIR 1.48) cancers was present among women, with a suggestion of a dose-response relationship. There was no increased risk of bladder cancer in either gender. CONCLUSIONS The results of this study provide evidence of a positive exposure-response relationship between exposure to diesel emissions and lung cancer risk among men. The positive results for other neoplasms, such as stomach, pancreatic, oral/pharyngeal, and cervical cancers, cannot be attributed to diesel exposure, but they deserve attention in future investigations.
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Affiliation(s)
- P Boffetta
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
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Abstract
OBJECTIVES To examine the hypothesis that sedentary women have an increased risk of endometrial cancer compared to physically active women. METHODS This is a population-based case-control study in the entire Swedish female population aged 50-74 years in 1994-1995. We obtained self-reported information on leisure-time physical activity during childhood, at ages 18-30, and recently from 709 incident case women with endometrial cancer and 3368 population controls. Occupational physical activity was estimated through record linkage to the Swedish census data from 1960, 1970, 1980, and 1990. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for different activity levels by multivariate logistic regression, taking into account potential confounders. RESULTS Comparing lowest to highest (reference) levels of physical exercise, we observed statistically significant associations with risk of endometrial cancer for leisure-time activity at age 18-30 years (multivariate OR = 1.4; 95% CI = 1.0-1.8; p for trend 0.01) and in recent years (multivariate OR = 1.3; 95% CI = 1.0-1.7; p for trend 0.01). We found similar associations comparing lowest to highest (reference) levels of occupational activity assessed at the censuses in 1980 (multivariate OR = 1.4; 95% CI = 1.0-1.9; p for trend 0.03) and 1990 (multivariate OR = 1.3; 95% CI = 0.9-1.9, p for trend 0.05), but a less consistent association with censuses in 1960 and 1970. The increased risk associated with low level of occupational physical activity was confined to women who were not obese and to women who were smokers. CONCLUSION Our data, in conjunction with past epidemiological studies, indicate that both occupational and leisure-time physical activity may reduce the risk for postmenopausal endometrial cancer.
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Affiliation(s)
- T Moradi
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
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Moradi T, Nyrén O, Zack M, Magnusson C, Persson I, Adami HO. Breast cancer risk and lifetime leisure-time and occupational physical activity (Sweden). Cancer Causes Control 2000; 11:523-31. [PMID: 10880034 DOI: 10.1023/a:1008900512471] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To clarify whether type and timing of physical activity affect postmenopausal breast cancer risk. METHODS In a population-based case-control study within the Swedish female population 50-74 years of age, 3347 women with invasive, postmenopausal breast cancer (84% of all eligible) and 3455 controls (82% of all selected) reported on past leisure-time physical activity. Record linkage to decennial census data (1960-1990) provided estimates of their occupational physical activity. Odds ratios with 95% confidence intervals were estimated by multivariate logistic regression. RESULTS After adjustment for potential confounders, women in sedentary occupations during their reproductive years (25-44 years of age) had a 50% higher risk for postmenopausal breast cancer, compared to those with the physically most demanding jobs. Only the most recent leisure-time physical activity was associated with a significant risk reduction. Women with the combination of sedentary jobs and lack of leisure-time exercise had a three-fold higher risk of breast cancer, compared to the physically most active both inside and outside the workplace. CONCLUSION Effects of occupational and leisure-time physical activity on breast cancer risk appear to have different latency times, and/or to be effect-modified by age or reproductive status. Although chance might explain our findings, it is advisable to consider type and timing of physical activity in future studies.
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Affiliation(s)
- T Moradi
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
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Farahmand BY, Persson PG, Michaëlsson K, Baron JA, Alberts A, Moradi T, Ljunghall S. Physical activity and hip fracture: a population-based case-control study. Swedish Hip Fracture Study Group. Int J Epidemiol 2000; 29:308-14. [PMID: 10817130 DOI: 10.1093/ije/29.2.308] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A growing body of literature suggests that physical activity may be a protective factor against hip fracture. METHODS To study the association between hip fracture risk and recreational physical activity at various ages, changes in activity during adult life, occupational physical activity and how risks vary by adult weight change, we performed a population-based case-control study among postmenopausal women aged 50-81 years residing in six counties in Sweden in 1993-1995. The analysis consisted of 1327 women with hip fracture and 3262 randomly selected controls. Information on leisure physical activity before age 18, at 18-30 years and during recent years was based on a questionnaire. Data on occupational physical activity were collected through an independent classification of job titles obtained from record linkage with census data from 1960, 1970 and 1980. RESULTS There was a protective effect of recent leisure physical activity. Compared to women who reported no leisure activity, the odds ratios (OR) were 0.79 (95% CI: 0.62-1.00), 0.67 (95% CI: 0.54-0.84) and 0.48 (95% CI: 0.39-0.60) for women who exercised <1 h per week, 1-2 h per week, and 3+ h per week, respectively. These decreased OR were more pronounced in women who had lost weight after 18 years of age than in those who had gained weight. Women with high physical activity at both 18-30 years and during recent years did not have a stronger protection than those with isolated high activity late in life, after accounting for recent activity. Occupational physical activity was not associated with hip fracture risk in this study. CONCLUSIONS Recent physical activity is protective against hip fracture. The protective effect is most pronounced in women who had lost weight after age 18.
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Affiliation(s)
- B Y Farahmand
- Division of Epidemiology, Karolinska Hospital, Stockholm County Council, Karolinska Institutet, Sweden.
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Abstract
The causes of renal cell cancer remain incompletely understood. In one previous retrospective case-control study, high occupational physical activity has been associated with a decreased risk among men, but not among women. Our aim was to investigate the association between occupational physical activity and renal cell cancer in a large cohort in Sweden. A cohort of Swedish men and women was identified in the nationwide censuses in 1960 and 1970, and the reported occupations were classified into 4 levels of physical demands. Follow-up from 1971 through 1989 was accomplished through record linkages to the Swedish Cancer Registry. Multivariate Poisson regression models were used to estimate relative risk (RR) and 95% confidence intervals (CI). We found a monotonic increase in risk of renal cell cancer with decreasing level of occupational physical activity among men (p for trend <0.001). After adjustment for socio-economic status, place of residence, and calendar year of follow-up, men with long-term sedentary jobs had a 25% (RR = 1.25, 95% CI 1.02-1.53) increased risk compared to men with physically demanding occupations. Among women there was no association, the dose-risk trend was not significant (p for trend >0.50). Occupational physical activity was inversely associated with renal cell cancer among men. The absence of association among women might be due to smaller range of exposure, confounding by household work or reproductive factors, or to a difference in biological response to physical activity in men and women.
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Affiliation(s)
- A Bergström
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
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Moradi T, Adami HO, Bergström R, Gridley G, Wolk A, Gerhardsson M, Dosemeci M, Nyrén O. Occupational physical activity and risk for breast cancer in a nationwide cohort study in Sweden. Cancer Causes Control 1999; 10:423-30. [PMID: 10530613 DOI: 10.1023/a:1008922205665] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Our purpose was to investigate effects of physical activity on risk for breast cancer. METHODS From the Swedish nationwide censuses in 1960 and 1970 we defined three partly overlapping cohorts of women whose occupational titles allowed reproducible classification of physical demands at work in 1960 (n = 704,904), in 1970 (n = 982,270), or with the same demands in both 1960 and 1970 (n = 253,336). The incidence of breast cancer during 1971-89 was ascertained through record linkage to the Swedish Cancer Register. We used Poisson regression to estimate relative risks (RR). RESULTS A total of 20,419, 22,840, and 8261 breast cancers, respectively, were detected in the three cohorts. In all three cohorts the risk for breast cancer increased monotonically with decreasing level of occupational physical activity and with increasing socioeconomic status. Among women with the same estimated physical activity level in 1960 and 1970 the RR was 1.3 for sedentary as compared with high/very high activity level (95% CI 1.2-1.4; p for trend < 0.001). Adjustment for socioeconomic status virtually eliminated this association (RR 1.1; 95% CI 0.9-1.2; p for trend 0.12) leaving a statistically significant 30% gradient only among women aged 50-59 years at follow-up. The association between socioeconomic status and breast cancer risk was largely unchanged after adjustment for occupational physical activity. CONCLUSION The protective effect of occupational physical activity on breast cancer risk, if any, appears to be confined to certain age groups.
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Affiliation(s)
- T Moradi
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
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Abstract
BACKGROUND Our aim was to evaluate whether there is a healthy worker effect (HWE) for cancer incidence among women. HWE is a bias found in occupational studies that compare rates of disease among employed people to disease rates for the general population, which includes unemployed people (who may be less healthy than those who are employed). METHODS Data from the 1960 and 1970 Swedish censuses were used to identify all 1,659,940 Swedish women who were employed in either year. They were followed during 1971-1989 through linkages to the national cancer and death registers. Standardized incidence ratios (SIRs) were computed comparing employed women to the 1,627,873 women who were not employed in either 1960 or 1970. RESULTS For the 545,857 women employed in both 1960 and 1970, the SIR for all cancers combined was 1.05 (1.04-1.06). When specific cancer sites were analyzed separately, the highest cancer risks were for cancers of the lung and bladder (SIR = 1.2) and reproductive organs (breast, ovary, endometrium, and cervix SIR = 1.1). Overall cancer risks were highest among full-time workers, younger workers, urban workers, and workers with the highest socioeconomic status (based on the woman's job title). CONCLUSIONS These results show no general HWE for cancer incidence among employed Swedish women.
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Affiliation(s)
- G Gridley
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20892-7244, USA.
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Moradi T, Nyrén O, Bergström R, Gridley G, Linet M, Wolk A, Dosemeci M, Adami HO. Risk for endometrial cancer in relation to occupational physical activity: a nationwide cohort study in Sweden. Int J Cancer 1998; 76:665-70. [PMID: 9610723 DOI: 10.1002/(sici)1097-0215(19980529)76:5<665::aid-ijc9>3.0.co;2-o] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Notwithstanding its biologic plausibility, the association between physical activity and endometrial cancer has been analyzed in only a few epidemiological studies. Retrospective assessment of exposure and small sample size often hampers interpretation of published data. We studied risk for endometrial cancer in relation to physical activity at work in a large cohort of Swedish women identified in the nationwide censuses in 1960 and 1970, with jobs that could be consistently classified into one of 4 levels of physical demands. Follow-up from 1971 through 1989 was accomplished through record linkages. Multivariate Poisson regression models were used to estimate relative risk. The risk for endometrial cancer increased regularly with decreasing level of occupational physical activity (p for trend < 0.001), and was associated more strongly with activity in 1970 than in 1960. In multivariate analyses, adjusted for age at follow-up, place of residence, calendar year of follow-up, and social class, the relative risk among women with the same physical activity level in 1960 and in 1970 was 30% higher for sedentary as compared with high/very high activity level; (p for trend=0.04). The protective effect of physical activity appeared to be confined to women aged 50 to 69, among whom sedentary work was associated with a 60% higher risk than that observed among women estimated to be physically most active. The excess seemed to disappear within 10 years after a change in physical activity level. Although confounding cannot be ruled out in our data, occupational physical activity appears to reduce the risk for endometrial cancer.
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Affiliation(s)
- T Moradi
- Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
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Moradi T, Delfino RJ, Bergström SR, Yu ES, Adami HO, Yuen J. Cancer risk among Scandinavian immigrants in the US and Scandinavian residents compared with US whites, 1973-89. Eur J Cancer Prev 1998; 7:117-25. [PMID: 9818773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Studies of migrants can generate hypotheses on the aetiology of cancer. Such studies are most informative when cancer incidence data are available both in the source and host country. We compared the incidence rate ratio of cancers (stomach, lung, female breast, colorectal and prostate) in Scandinavian immigrants to the US to US-born whites, using data from the SEER registry, 1973-89. Odds ratios (OR) for cancer sites in relation to birthplace were estimated using logistic regression. We also compared rate ratios (RR) for Scandinavian and US residents, using Poisson regression. Compared with US whites, most Scandinavian migrant groups had elevated OR for stomach cancer (1.58 to 3.92), and lower OR for lung cancer (0.38 to 0.88). Similarly, compared with US whites, residents of most Scandinavian countries had elevated RR for stomach cancer (1.47 to 3.33) and lower RR for lung cancer (0.27 to 0.97). Therefore, risk factors for lung and stomach cancers, such as smoking habits and Helicobacter pylori infection, respectively, may have been retained upon migration. Risks for breast, colorectal and prostate cancer among immigrants approached risks in the US (contrasting Scandinavian risks) suggesting assimilation of environmental and/or lifestyle factors.
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Affiliation(s)
- T Moradi
- Department of Medical Epidemiology, Karolinska Institution, Stockholm, Sweden
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