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BACKGROUND: Sleep disturbance including insomnia and poor sleep quality has been shown to be a major health determinant in occupational settings. Specific occupational exposures to hazards in most workplaces can lead to various health problems, especially sleep problems. OBJECTIVE: The study aimed to investigate sleep characteristics, and their relationships with work-related exposures, demographics, and other related variables in workers of a smelting factory. METHODS: This cross-sectional study was carried out on workers in a 40-year smelting factory located in the East of Tehran Province. A total of 200 male participants were included in the study. Among them, 51 workers were from the production process staff and the rest were office workers. Their shifts were from 6 AM to 5 PM. All participants were asked about demographic characteristics and exposure to respiratory pollutants. All participants answered validated Persian versions of the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The means (SD) of age and BMI were 39.1 (8.9) years and 26.8 (4.5) kg/m2, respectively. Among all participants, 51 (25.5%) experienced exposure to a respiratory pollutant. Among all workers, 96 (48%) experienced poor sleep quality and 87 (43.5%) and 10 (5%) had subthreshold and clinical insomnia, respectively. The mean (SD) night sleep duration was 6.4 (0.96) hours. Data analysis illustrated a significant positive relationship between exposure to respiratory pollutants and insomnia (p-value = 0.03). Howewer, this association between sleep quality and exposure to repiratory pollutants was not significant (p-value = 0.25). Further analysis with binominal regression showed participants with exposure to respiratory pollutants were more susceptible to clinical insomnia (p-value = 0.02, exp(B) = 0.213), and after regressing out the effect of smoking, participants with exposure to respiratory pollutants remained susceptible to clinical insomnia. A lower night sleep duration was observed among participants with exposure to inhalational material (p-value = 0.05). CONCLUSIONS: Occupational exposures to hazardous material, including inhalational exposures, could cause sleep disturbance, which warrants more attention paid by sleep specialists.

Little is known about the role of occupational-related physical activity and risk factors for cardiovascular disease.This study aimed to assess the association between different types of physical activity (work-related, transport-related, home-time and leisure-time) and risk factors for cardiovascular disease in a sample of Iranian workers.This cross-sectional study was conducted from February to November 2018 among 415 workers of a rubber factory in Tehran province. Physical activity levels of the participants were measured using the International Physical Activity Questionnaire. Blood sample were analysed for cardiovascular disease risk factors (fasting blood sugar ≥ 100 mg/ dL, triglycerides ≥ 150 mg/dL, total cholesterol ≥ 200 mg/dL, systolic blood pressure ≥ 130 mmHg, diastolic blood pressure ≥ 85 mmHg and waist circumference ≥ 102 cm). Alanine aminotransferase and aspartate aminotransferase were also measured, as was body mass index (BMI).Risk factors for cardiovascular disease differed significantly according to type of physical activity. Fasting blood sugar ≥ 100 mg/dL and BMI ≥ 25 kg/m2 had a significant negative association with overall physical activity level (P0.001). In a logistic regression analysis, leisure-time physical activity had a significant negative correlation with all risk factors for cardiovascular disease after adjusting for age and smoking.Leisure-time physical activity has a more important role in reducing cardiovascular disease risk factors than other types of activity, including work-related physical activity.الارتباط بين نوع النشاط البدني وعوامل خطر أمراض القلب والأوعية الدموية، جمهورية إيران الإسلامية.أوميد أمينيان، مريم ساراي، سعيد نجيب بور، سحر افتخاري.لا يُعرف سوى القليل عن دور النشاط البدني المرتبط بممارسة المهنة وعوامل خطر الإصابة بأمراض القلب والأوعية الدموية.هدفت هذه الدراسة إلى تقييم الارتباط بين مختلف أنواع النشاط البدني (المتصل بالعمل، والمتصل بالنقل، وفي المنزل، وفي وقت الفراغ) وبين عوامل خطر الإصابة بأمراض القلب والأوعية الدموية لدى عينة من العاملين الإيرانيين.أُجريت هذه الدراسة المقطعية في الفترة من فبراير / شباط وحتى نوفمبر / تشرين الثاني 2018 على 415 عاملاً في مصنع للمطاط في محافظة طهران. وقيست مستويات النشاط البدني للمشاركين باستخدام الاستبيان الدولي للنشاط البدني. وحُلِّلت عينة من الدم لمعرفة عوامل خطر الإصابة بأمراض القلب والأوعية الدموية (سكر الدم أثناء الصيام يساوي أو يزيد عن 100 مجم/ دل (ميليجرام بالديسي لتر)، والدهون الثلاثية تساوي أو تزيد عن 150 مجم/ دل، والكولسترول الإجمالي يساوي أو يزيد عن 200 مجم/ دل، وضغط الدم الانقباضي يساوي أو يزيد عن 130 مليمتر زئبق، وضغط الدم الانبساطي يساوي أو يزيد عن 85 مليمتر زئبق، ومحيط الخصر يساوي أو يزيد عن 102 سم. كما قيس إنزيم ناقلة أمينو ألانين وإنزيم ناقلة أمينو أسبارتيت، وكذلك مَنْسَب كتلة الجسم.تتفاوت عوامل خطر الإصابة بأمراض القلب والأوعية الدموية بشكل كبير حسب نوع النشاط البدني. وتب يَّ وجود ارتباط سلبي ملحوظ بين سكر الدم أثناء الصيام الذي يساوي أو يزيد عن 100 مجم/ دل ومنسب كتلة الجسم الذي يساوي أو يزيد عن 25 كجم/م 2 ومستوى النشاط البدني الإجمالي (قيمة احتمالية0.001). وفي تحليل الانحدار اللوجستي، ارتبط النشاط البدني أثناء وقت الفراغ ارتباطًا سلبيًّا ملحوظًا بجميع عوامل خطر أمراض القلب والأوعية الدموية بعد التصحيح مع العمر والتدخين.يؤدي النشاط البدني في وقت الفراغ دورًا أكثر أهمية في الحد من عوامل خطر الإصابة بأمراض القلب والأوعية الدموية من سائر أنواع النشاط الأخرى، لا سيّما النشاط البدني المتصل بالعمل.Lien entre le type d'activité physique et les facteurs de risque des maladies cardiovasculaires, République islamique d'Iran.Peu d'informations sont disponibles sur le rôle de l'activité physique liée au travail par rapport aux facteurs de risque des maladies cardiovasculaires.La présente étude visait à évaluer, dans un échantillon de travailleurs iraniens, le lien entre différents types d'activité physique (liée au travail, au transport, au temps libre à domicile ou aux loisirs) et facteurs de risque de maladies cardiovasculaires.Cette étude transversale a été menée de février à novembre 2018 auprès de 415 travailleurs d'une usine de caoutchouc de la province de Téhéran. Les niveaux d'activité physique des participants ont été mesurés à l'aide du questionnaire international sur l'activité physique (International Physical Activity Questionnaire, IPAQ). Les facteurs de risque de maladies cardiovasculaires ont été recherchés au moyen d’une analyse des échantillons sanguins (glycémie à jeun ≥ 100 mg/dl, triglycérides ≥ 150 mg/dl, cholestérol total ≥ 200 mg/ dl, tension artérielle systolique ≥ 130 mm Hg, tension artérielle diastolique ≥ 85 mm Hg et tour de taille ≥ 102 cm). L'alanine aminotransférase et l'aspartate aminotransférase ont également été mesurées, ainsi que l'indice de masse corporelle (IMC).Les facteurs de risque des maladies cardiovasculaires différaient considérablement selon le type d'activité physique. Une glycémie à jeun supérieure ou égale à 100 mg/dl et un IMC supérieur ou égal à 25 kg/m2 étaient liés de façon négative et significative au niveau global d'activité physique (p0,001). Dans une analyse de régression logistique, l'activité physique de loisir était corrélée de façon négative et significative avec tous les facteurs de risque des maladies cardiovasculaires après ajustement en fonction de l'âge et du tabagisme.L'activité physique de loisir joue un rôle plus important dans la réduction des facteurs de risque des maladies cardiovasculaires que les autres types d'activité, y compris l'activité physique liée au travail.

Noise and organic solvents are common in many industries and both of them affect hearing. In this study, we estimated the concurrent effect of them on hearing by evaluating the existence of notch in audiograms of workers. The number of 540 persons were enrolled in this study after eliminating workers who had the exclusion criteria. We divided them into 4 groups based on their exposure status; no exposure, exposure to noise, exposure to solvent, exposure to both of them. The presence of notch in left, right, or both ears were assessed through Coles model. The rates of notch presence in both ears in the groups of noise and organic solvents exposure, noise exposure only, solvents exposure only were 11.72, 4.49, 1.86 times higher than the control group and sole solvent exposure didn't affect hearing significantly. The same pattern was seen for notch presence in left or right ear and the solvent-noise exposure group had the highest rate of notch presence. This study aims to show the synergic effect of noise and organic solvents exposure on hearing loss. Hence, we recommend implementing a hearing protection program and a higher frequency of audiological assessments in the industries involved with concurrent exposure to noise and organic solvents.

Chemical-related disorders put a great burden on the economy and the health care system. This study aimed to determine the prevalence of depressive symptoms based on the Beck depression inventory (BDI) in the workers of an industrial factory and find its association with solvent exposure. In this cross-sectional study, all workers at an industrial factory were enrolled. Demographic and clinical data of the participants were collected by a trained interviewer and entered in the study form. All the participants completed the Beck depression inventory questionnaire. Based on the score of the BDI, the study population was dichotomized around the score 11 and the study variables, particularly exposure to solvents, were compared between the two groups. The association of solvent exposure and BDI score > 11 was then assessed in an adjusted multivariable model. A total of 396 workers were enrolled in this study (mean age = 33.4 ± 7.2 years); 156 (39.4%) workers had BDI ≥ 11. Participants with BDI score ≥ 11 were significantly older than their peers with BDI

Background and Objective: Workplace exposes workers to different hazardous chemicals. In this study, we aimed to assess the changes of pulmonary function test (PFT) parameters as the objective indicator of lung impairment and its association with demographic data and sleep characteristics. Materials and Methods: This cross-sectional study was carried out on 200 male workers of a smelting factory located in Tehran Province, Iran. The respiratory symptoms questionnaire, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and demographic characteristics were recorded for the participants. Participants also underwent spirometry and the related parameters were recorded. Results: A total of 200 iron foundry workers were assessed. All participants were men, and mean ± standard deviation (SD) of age was 39.1 ± 8.9 years ranging from 20 to 65 years. Of 200 workers, 153 (76.5%) were married and 72 (36.0%) were smokers. Among all participants, 131 (65.5%) reported at least one respiratory symptom, and these workers had significantly poorer sleep quality (P = 0.02) and insomnia (P = 0.01). Across-shift change in forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR) of spirometry parameters was significant among participants with clinical insomnia (P = 0.02 and P = 0.04, respectively) and poor sleep quality (P < 0.0001 and P = 0.04, respectively). Conclusion: Results showed a significant cross-shift reduction in PFT values among workers with clinical insomnia or poor sleep quality. Accordingly, evaluation of sleep characteristics along with respiratory symptoms in workers with inhalational occupational exposure is recommended.

Background In recent decades, metabolic syndrome is one of the most important public health risk factors. Having this in mind, the present study was conducted to evaluate the frequency of metabolic syndrome and its associated risk factors in healthcare workers. Method This study is a cross-sectional study conducted on 410 healthcare workers in a teaching hospital in Iran. Demographic, occupational, and psychosocial characteristics were assessed using questionnaire. Assessment of metabolic syndrome of hospital staff was performed at workplace during their medical examination. Results The frequency of metabolic syndrome was found to be 22.4%. This relationship was found among blood pressure and occupational stress, despite the fact that there was no significant relationship between metabolic syndrome and occupational stress. Higher age, having shift work, and inactivity were associated with metabolic syndrome. Conclusion Considering the high frequency of metabolic syndrome among Iranian healthcare workers, it is advised that effective management should be employed to correct the occupational and psychosocial factors associated with this syndrome.

Acute and chronic exposure to cadmium can cause numerous health effects including poisoning, as well as, bone, liver, and kidney diseases. Cadmium competes with iron absorption in blood and can induce anemia. Cadmium body burden can be measured through urine and blood samples. Urine reflects chronic and blood indicates recent and cumulative exposures to cadmium. Dietary is considered as the main source of exposure to cadmium in non-smoking general population. The study was conducted to determine cadmium level in blood, urine, and in diet of 120 non-smoking adults in Tehran. Dietary components and consumption pattern of participants estimated by a food frequency questionnaire. Next, the correlation investigated between them. Moreover, serum ferritin measured as a marker of iron storage in blood to determine its association with cadmium. The prediction of cadmium fate in the body is determined by toxicokinetic models. This study tried to evaluate one of these models’ validity which is developed to predict urinary cadmium from dietary. Afterwards, the predicted urinary compared with the measured urinary cadmium. The correlation coefficient between dietary and blood cadmium equaled 0.66 which was statically significant, but the correlation between dietary and urinary cadmium was minimal and not statically significant (p > 0.05). An inverse and negative correlation was found between serum ferritin and blood cadmium. The mean predicted urinary cadmium calculated by the model was 2.5-fold higher than the measured value in the total population. Results of the present study revealed that blood cadmium reflected mainly acute exposure. There was no correlation between chronic and acute exposures to cadmium. The low serum ferritin level increased cadmium amount in blood. Moreover, the mean predicted urinary cadmium by the model was greater than the measured value. It can because of characteristics of populations and type of dietary exposure. Thus, it is suggested that the model coefficients are determined in each society based on their characteristics.

BACKGROUND: Drivers are one of the trade unions that are most exposed to various health-related risks, especially metabolic diseases. The present study aimed to systematically assess the overall prevalence of metabolic syndrome and its determinants among drivers in the world. METHODS: All retrospective, cross-sectional, or prospective studies evaluating the prevalence and risk for metabolic syndrome and its main components among male professional drivers were eligible for the initial assessment. PRISMA guideline was used. Two blinded reviewers independently screened the titles and abstracts of the manuscripts followed by a deep assessment of the full texts for determining the inclusion appropriateness. RESULTS: In the final, 12 articles were eligible for the final analysis. Overall, 19,350 professional male drivers with a total average age of 43.06 years (ranged from 35.5 to 51.1 years) were included in the study. The prevalence of metabolic syndrome was estimated to be 32.8% (95%CI: 32.1% to 33.5%), and the major determinants of appearing this syndrome among professional drivers were advanced age, years of driving experience, higher body mass index, smoking, high cholesterol dietary regimen, high Framingham risk score, low regular exercising, history of diabetes mellitus, history of gout, and shift work pattern. CONCLUSION: According to the 32.8% prevalence rate of metabolic syndrome among drivers, managerial measures are needed to prevent and control metabolic disturbances among professional drivers are recommended.

BACKGROUND: The relationship between job stress and each component of metabolic syndrome has been previously suggested; however, this association is not consistent. The present study was conducted to assess the association between job stress and metabolic syndrome and its components in a group of Iranian workers affiliated with Tehran University of Medical Sciences. METHODOLOGY: This cross-sectional study was performed on 3,537 randomly selected staff in Tehran University of Medical Sciences including the staff of clinical, administrative, and service departments with at least one year of working experience. The overall frequency of metabolic syndrome was assessed based on the international diabetes federation (IDF) criteria. The Persian version of the Copenhagen Psychosocial Questionnaire (COPSOQ) was used to measure major domains of psychosocial factors in the workplace. RESULTS: The overall frequency of metabolic syndrome in the assessed personnel was estimated to be 22.1 % and there was a significantly higher rate of metabolic syndrome in office workers and service personnel compared to clinical staff (OR: 1.51, CI 95 %: 1.25–1.82 and OR: 1.74, CI 95 %: 1.41–2.14, respectively). Health and well-being as a major domain of COPSOQ was found to be significantly impaired by the presence of metabolic syndrome. According to the results of multiple logistic regression modeling, the relationship between metabolic syndrome and impaired health and well-being domain remained significant after adjusting for age, gender, marital status, educational level, and employment category. CONCLUSIONS: Our findings revealed a close association between job-related stress and the impaired well-being in the presence of metabolic syndrome among the medical university staff.

Background: Automobile spray painting is considered a high-risk occupation for respiratory diseases. The present survey aimed to assess the effects of automobile paint vapors on spirometric parameters among workers of a painting workshop in a large automobile manufacturing plant in Iran. Materials and Methods: This cross-sectional study was conducted on 820 workers of an automobile manufacturing plant, including 431 spray painters (case group) and 389 assembly line workers (control group). Spirometry was conducted for all participants under standard conditions, according to the American Thoracic Society (ATS) Clinical Practice Guidelines. The forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow at 25% and 75% of the pulmonary volume (FEF25-75) were reported. Results: Painters with more than ten years of work experience had significantly lower predicted values of FEV1/FVC (P= 0.005), FEV1 (P=0.008), and FEF25-75 (P=0.003), compared to the control group. Also, painters who were exposed to solvent-based paints were not significantly different from those exposed to water-based paints in terms of spirometric parameters (P>0.05). Conclusion: The results indicated the impact of automobile spray painting on the spirometric parameters. A slight decrease in the mean values of these parameters calls for attention to occupational safety, regular medical examinations, and effective measures.

Introduction: Screening of risk factors for metabolic syndrome among commercial and train drivers that are considered safety sensitive jobs, is an important issue in safety of transportation system. Metabolic syndrome is consisted of disturbed lipid profile, high blood pressure, and high waist circumference. It can lead to decrease the quality of life and higher health associated costs for these patients. This study aimed to assess risk factors for metabolic syndrome among train drivers. Methods: This cross-sectional study was conducted on 281 train drivers referred to their annual health examinations to Occupational Medicine Clinic of Baharloo Hospital, Tehran University of Medical Sciences. Demographic characteristics of participants were recorded. Blood pressure, body mass index and waist circumference of drivers were measured. Participants’ blood sample for fasting blood sugar, triglyceride, high and low density lipoproteins were collected. Metabolic syndrome was defined according to the NCEP ATP III criteria. Results: All of the participants were males. Their mean age and BMI was 43±10 year and 26.60±3.67 Kg/m2, respectively. Fifty three (21%) of the participants were diagnosed with metabolic syndrome. The more frequent risk factor for metabolic syndrome was triglyceride more than 150mg/dl. Conclusion: Findings of the present study revealed high prevalence of metabolic syndrome among train drivers. Further studies are needed for screening the metabolic syndrome in this occupational group as it is a sensitive occupation.

Chronic Kidney Disease (CKD) is of high clinical importance due to cost of outcomes such as kidney transplantation. However, CKD is an overlooked disorder among commercial drivers. The present study aimed to evaluate hypertension and Glomerular Filtration Rate (GFR) among commercial drivers.In this cross-sectional study, a total of 903 commercial drivers referred for obtaining their health license were recruited. After obtaining informed consent, a questionnaire consisted of demographic characteristics was completed. Blood pressure, level of lipid profile, blood sugar, blood urea nitrogen, and plasma creatinine were measured. Chi-square and independent T-test were used for data analysis.All participants were male. The mean ( ± SD) age and Body mass index were 42 ± (10) years and 27 ± (4) kg/m2, respectively. Of 903 studied cases 40 (4%) had GFR60. Increased age and high blood pressure had a significant association with reduced GFR (P.0001). The ones with sleep apnea were more likely to have GFR60, however, the association was not statistically significant after adjusting for related risk factors.Older age and hypertension are considered as risk factors for CKD among commercial drivers. Obstructive sleep apnea also should be kept in mind as a possible risk factor that requires further elucidation and management.

Background: The respiratory effects of fume exposure during spot welding may aggravate some environmental risk factors such as tobacco smoking. Fume exposure and smoking have negative effects on pulmonary function tests (PFTs). This study assessed the simultaneous effects of smoking and welding fume on spirometry tests in spot welders. Materials and Methods: This cross-sectional study was conducted on 667 spot welders and 1000 assemblers in an automotive manufacturing plant. Spirometry was carried out on all the participants under standard conditions and according to the American Thoracic Society Clinical Practice Guidelines and indices including FEV1, FVC, FEV1/FVC, FEF 25–75, and PEF were measured and compared between two groups of the study population including workers of spot welding and assembling. Results: It was found that the effect of simultaneous exposure to smoking and welding fume was aggravated on the PFT indices including the FEV1 percent, FEV1/FVC, the FEV1/FVC percent, the PEF percent, FEF25–75, and the FEF25–75 percent, but not on indices such as FVC, the FVC percent, and PEF. Conclusion: Simultaneous exposure to smoking and welding fume resulted in a reduction in some spirometry indices, causing respiratory airway obstruction in the spot welders. Occupational safety and regular medical examinations with shorter intervals in smoking spot welders can prevent acute respiratory effects of exposure to smoking and welding fume.

Gestational hypertension or pregnancy-induced hypertension is the emergence of hypertension in a pregnant women after 20 weeks of gestation. This study aimed to evaluate the job-related factors associated with pregnancy-induced hypertension. This cross-sectional study was conducted on 560 pregnant women who referred to the Nursing Clinic of Imam Khomeini Hospital in 2017; of all studied cases, 210 pregnant women with pregnancy-induced hypertension were selected as cases and 350 women without pregnancy-induced hypertension were selected as controls. The data on demographic characteristics, occupational characteristics, and ergonomic dangers were collected by the researchers. Finally, the relationship between job variables and the probability of developing hypertension in pregnant women was measured. The results of the logistic regression analysis showed that the variables of body mass index, fertility, shift work, and service works had a significant relationship with pregnancy-induced hypertension. Women with service work were 2.32 times more likely to develop hypertension than women with other types of jobs (P=0.013). The people who had a shift work were 2.28 times more likely to develop pregnancy-induced hypertension than those who did not have shift work. Based on the results of this study, there was no relationship between ergonomic risks and pregnancy-induced hypertension. It seems that due to the higher frequency of pregnancy-induced hypertension in highly demanding jobs, it is necessary to pay more attention to the assessment of related risk factors, such as psychological variables. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):430-434.

BACKGROUND The screening of risk factors for sleep apnea among drivers with safety-sensitive jobs is considered as an issue of utmost importance in a safe transportation system. OBJECTIVE This study was conducted to assess the risk factors of sleep apnea among locomotive drivers. METHODS The present research is a cross-sectional study conducted in Baharloo Hospital, Tehran University of Medical Sciences, Iran. The study population included 281 locomotive drivers referred for their annual physical examination. Demographic characteristics, Epworth Sleepiness Scale (ESS), blood pressure, body mass index (BMI), neck circumference, and laboratory measurements including fasting blood sugar (FBS), cholesterol, high density lipoprotein, and low-density lipoprotein were recorded for each participant. Blood pressure ≥140/90 mmHg, history of drug use, BMI > 35 kg/m2, age >50 years, and neck circumference >40 cm were defined as risk factors for obstructive sleep apnea (OSA-RFs). RESULTS All participants were male with a mean age of 43±10 years. The mean BMI was 26.9±3.9 kg/m2. Also, the mean FBS and Total cholesterol of participants was 96.9±24.9 and 181.7±41.8, respectively. Among participants, 166 (59.9%) drivers had two or more risk factors of obstructive sleep apnea (OSA-RFs)CONCLUSIONS:The findings of this study indicated a high prevalence of obstructive sleep apnea among locomotive drivers. Therefore, further research is warranted to re-evaluate the current screening regulations of diagnosing sleep apnea among locomotive drivers.

Background: Absence from work for health reasons is known as “sickness absenteeism”. Frequent sick leave is a major concern to any organization, especially hospitals. Objective: This study analyzed the extent and causes of sickness absenteeism in a teaching hospital and evaluated its corelation with demographic and occupational factors. Methods: In a cross-sectional study, data was extracted from computerized records regarding sickness absenteeism of healthcare workers (HCWs) in the Occupational Health Department of a teaching hospital in Tehran. Studied variables included demographic characteristics, occupational factors, and causes of sickness absenteeism. The sickness absence rate (SAR) and absence frequency rate (AFR) in the study period were calculated. Chi-square and Mann-Whitney tests were used for the comparison of categorical and quantitative variables, respectively. Results: In the current study, SAR and AFR were 0.011 and 0.68, respectively. Job type was the only factor that had a significant correlation with sickness absenteeism. The major disease-causing sicknesses were flu (21%) and musculoskeletal disorders (18.9%). Conclusion: A significant relationship was found between the nursing group and sickness absence episodes. Flu, musculoskeletal disorders, and infectious diseases were the most frequent causes of sickness absence. Based on these findings, it can be concluded that factors such as availability of the flu vaccine and providing principles of personal protection and infection control can reduce sickness absence due to infectious disease.

Background and Objective: Obstructive sleep apnea (OSA) is a common sleep-disordered breathing (SDB) characterized by intermittent hypoxemia (IH). OSA and IH are considered risk factors for increased hearing thresholds as well. Furthermore, thresholds of speech frequency affect personal fitness for driving. Thus, main purpose of this study was to assess the association between speech frequency thresholds and OSA among commercial drivers. Materials and Methods: This cross-sectional study was conducted on 1000 commercial drivers who were referred to obtain a health license at the Occupational Medicine Clinic of Baharloo Hospital, Tehran, Iran. Blood pressure, neck size, weight, and height were recorded. Validated Persian version of Epworth Sleepiness Scale (ESS) and STOP-BANG questionnaire were completed by the participants. STOP-BANG score ≥ 3 was defined as high risk for OSA. Fast blood sugar (FBS), triglyceride (TG), and total cholesterol (TC) were measured for all drivers. Hearing threshold levels of all subjects were recorded by pure tone audiometry (PTA) in frequencies of 500, 1000, 2000, and 3000 Hz for each ear in decibels (dB). Results: The mean age of the participants was 43.0 ± 9.9 years. The mean ESS and STOP-BANG scores of the participants were 3.1 ± 2.8 and 1.8 ± 0.8, respectively. 237 (23.7%) drivers were high-risk for OSA. Participants with OSA had significantly higher thresholds of speech frequencies compared to the low-risk ones (P < 0.0001). Conclusion: OSA may be also considered as a risk factor for increased thresholds of speech frequency among commercial drivers. During drivers’ periodic medical examination, evaluation of OSA as a strong risk factor for increasing hearing thresholds is recommended.

Study design Descriptive cross-sectional study. Purpose To validate the Persian version of the Million Visual Analogue Scale Questionnaire (MVAS), a self-administered low back pain (LBP) questionnaire. Overview of literature The majority of LBP questionnaires translated into Persian evaluate the impact of LBP on daily living. The MVAS is one of the most commonly used self-administered LBP questionnaires, and was developed to assess a different direction and effect of activities of daily living on LBP intensity. Methods The questionnaire was translated into Persian with the forward-backward method and was administered to 150 patients randomly sampled from an occupational medicine clinic in Tehran in 2017. Results Cronbach's alpha for all subscales ranged between 0.670 and 0.799. Confirmatory factor analysis showed adequate construct validity of the Persian version of the MVAS, with root mean square error of approximation 0.046, goodness of fit index 0.902, and comparative fit index 0.969. Other indexes were satisfactory. Conclusions The Persian MVAS is a valid and reliable instrument that can assess the effect of various daily activities on the intensity of LBP.

Background: Despite being frequently described, Restless Leg Syndrome (RLS) in patients, who are on hemodialysis, is a common disease which, has not been well documented in Iran. Objectives: The current study aimed to investigate the prevalence of RLS and its sleep disorders in Iranian patients on hemodialysis. Patients and Methods: In this multicenter cross sectional study, 397 consecutive patients on hemodialysis were evaluated by face-to-face interviews. RLS was diagnosed using the International RLS Study Group (IRLSS) criteria. In addition, three validated sleep disorder questionnaires (Insomnia Severity Index, Epworth sleepiness scale and Pittsburgh sleep quality index) were completed by the patients. Results: One hundred-twenty-six patients with RLS (31.7%; mean age 57.6 ± 15.4 years) participated in the current study. RLS mostly occurs in females (P < 0.001). RLS cases showed poorer quality of sleep (Pittsburgh Sleep Quality Index > 5, P = 0.001), higher scores of Epworth Sleepiness Scale (P < 0.001) and insomnia severity index (P = 0.001). Except thyroid gland dysfunction (P < 0.03, OR ≈ 2.50) and anti-hypertensive medications (P < 0.01, OR ≈ 1.7), there were no significant differences between age, duration of dialysis, etiology of renal insufficiency, intake of nicotine, alcohol or caffeine, and other associated comorbidities between the patients with and without RLS. Conclusions: In the current study, prevalence of RLS was near the weighted-mean prevalence of other studies (mean 30%, range 8%t-52%). This is not just racial variability and may attribute to narrow or wide definition of the disease, plus variations of the prevalence recording time, and sometimes not using the standard criteria or standard interview.

The main purpose of this study was to assess the reliability and validity of the Iranian version of the Epworth Sleepiness Scale (ESS-IR). This was a cross-sectional study of 507 suspicious patients either to obstructive sleep apnea (n = 466) or narcolepsy (n = 41) in order to carry out a psychometric evaluation of the ESS-IR by performing reliability, validity, and responsiveness analyses. Reliability of the ESS-IR was assessed by internal consistency and test–retest reliability. Validity of the instrument was assessed using several statistical approaches including construct validity (exploratory factor analysis), discriminant validity, and criterion validity. Responsiveness of the ESS-IR was assessed by comparing the ESS-IR total score before and after 6–9 months of continues positive airway pressure (CPAP) treatment in 16 patients with obstructive sleep apnea (OSA). The ESS-IR had an acceptable internal consistency and test–retest reliability. Factor analysis in both groups showed a two-factor solution for the ESS-IR, but the first factor showed statistically significant loads in all items. In addition, the ESS-IR discriminated well between patients with and without OSA. There is a fair correlation between the ESS-IR total score and multiple sleep latency test results that is not significant at all. Finally, the ESS-IR was found to be responsive to change where the total score was significantly decreased after CPAP treatment (P

Background Road transport drivers are one of the professional groups whose activities have a strong impact of public safety. In view of the natural professional activity, the drivers are at a higher risk of obesity, hypertension and hyperlipidemia, and carbohydrate metabolism disorders such as diabetes mellitus. Materials and methods Medical documentation was the source of data for the reported study. It derived from medical examinations of 1903 drivers applying for driving license. Results Hyperglycemia was found in 52.1% of the drivers, 9.1% of them were in diabetic stage, and with HbA1C criteria 77.6% of these drivers were in this stage. Excessive body weight was recorded in 65.6% of the study population, 44.8% were diagnosed with overweight and 20.8% with obesity. High blood pressure was recorded in 16.4% of drivers. Conclusion High prevalence of excessive body weight and high blood pressure and hyperlipidemia are risk factors for diabetes mellitus in professional drivers that indicates a need to undertake multidimensional actions target on this particular profession and involving various health care sectors. Prophylactic and detailed pre-placement examinations should be considered, depending on the rate and the intensity of disorders. These should be coupled with an introduction of primary and secondary prophylactic activities and monitoring of relevant treatment.