Prevalence of Burnout among Primary Health Care Staff and Its Predictors: A Study in Iran.

: Burnout, which is an emerging challenge in health systems, is very common among primary health care (PHC) workers. The aim of this study was to investigate the level of burnout among PHC workers, and its predictive factors, in a region in the west of Iran.In this cross-sectional study, all the health network staff (n = 539) were enrolled. The data collection instrument was the Maslach Burnout Inventory (MBI), which consists of 22 items and the three subscales of emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). High scores in EE and DP and low scores in PA are indicative of high burnout. Logistic regression was used to determine the predictors of high burnout. The data were analyzed using SPSS version 16. The findings showed that 90.5% of the staff had high DP, 55.3% had high EE, and 98.9% had low PA scores. Also, 52.9% (277 people) of the staff suffered from high burnout. Single people (OR = 3.33), less experienced employees (OR = 9.09), people aged over 35 years (OR = 2.35), physicians (OR = 1.72), and staff with permanent employment (OR = 5.0) were more likely to suffer high levels of burnout. We conclude that burnout is a common problem in PHC workers. Less experienced, younger, single employees and physicians were more at risk of suffering from high burnout. Preventive measures, such as strengthening social skills, communication competencies, and coping strategies, and reduction of risk factors such as job stress, are suggested for reducing employees' risk of burnout.

Prescribing patterns of rural family physicians: a study in Kermanshah Province, Iran.

BACKGROUND: The inappropriate use of drugs due to irrational prescriptions is a common problem in Iran, but there is little evidence of prescription patterns in rural family physicians. This study aimed to explore the prescribing pattern and rational drug use indicators for family physicians using Index of Rational Drug Prescribing (IRDP) in Kermanshah Province, Iran. METHODS: In this retrospective study, 352,399 prescriptions from 184 family physicians in 103 primary health care (PHC) centers were examined. As stated, an analysis was done for rational use indicators suggested by World Health Organization (WHO): e.g., the percentage of prescriptions containing antibiotics, injections, and those prescribed by a generic name and from a national essential medicine list, plus the average number of drugs per prescription; these factors were all taken into account. Rational drug use was studied with the IRDP. RESULTS: The average number of drugs per prescription was 3.14 (± 1.2) and the average cost per prescription was 116,740 IRR (USD 3.6). Around 19% of prescriptions had more than four drugs, while the percentage of prescriptions involving antibiotics and injections was 52.1% and 24.4%, respectively. There was 95.1% drugs prescribed by their generic name and 95.9% were retrieved from the essential drugs list. The value of the IRDP was 3.70 out of 5. CONCLUSION: The findings of this study showed that some degree of irrational drug prescribing exists among family physicians, especially in terms of injections, antibiotics, and polypharmacy. It is recommended that there be continuing education programs for physicians regarding rational prescribing for different kinds of medical indications. Clinical practice guidelines should also assist with the rational use of medicine.

Modulatory function of NMDA glutamate receptor on MC3/MC4 receptors agonist-induced hypophagia in neonatal meat-type chicken.

Melanocortin 3 and 4 receptors (MC3R and MC4R) are known as the main receptors for melanocortin-induced hypophagia in mammalian and poultry. Also, central glutamatergic system has mediatory role on function of the melanocortin system in some brain areas. So, the aim of the current study was to determine the role of MC3/MC4 receptors agonist on food intake and its interaction with glutamatergic in 3-h food-deprived (FD3) neonatal broilers. In experiment 1, chickens were intracerebroventricular (ICV) injected with control solution, MTII (MC3/MC4 receptors agonist; 2.45, 4.8 and 9.8 pmol). In experiment 2, control solution, SHU9119 (MC3/MC4 receptors antagonist; 0.5, 1 and 2 nmol) were ICV injected. In experiment 3, birds ICV injected with control solution, SHU9119 (0.5 nmol), MTII (9.8 pmol) and co-injection of the SHU9119 + MTII. Experiments 4-8 were similar to experiment 3, except birds injected with MK-801 (NMDA glutamate receptors antagonist, 15 nmol), CNQX (AMPA glutamate receptors antagonist; 390 nmol), AIDA (mGLUR1 glutamate receptors antagonist; 2 nmol), LY341495 (mGLUR2 glutamate receptors antagonist; 150 nmol) and UBP1112 (mGLUR3 glutamate receptors antagonist; 2 nmol) instead of SHU9119. Then, cumulative food intake was recorded until 120 min after injection. According to the results, dose dependent hypophagia observed after ICV injection of the MTII (p < 0.05). ICV injection of SHU9119 significantly increased food intake in birds (p < 0.05). Co-injection of SHU9119 + MTII significantly inhibited MTII- induced hypophagia in neonatal chicks (p < 0.05). In addition, hypophagia- induced by MTII was significantly attenuated with co-injection of MTII + MK-801(p < 0.05). These results suggested MC3 and MC4 receptors have inhibitory role on food intake and this effect is probably mediated by NMDA glutamate receptors in neonatal chickens.

Circulating basic fibroblast growth factor in serum of gastric ulcers patient as a biomarker of wound severity.

UNLABELLED: Background : Basic fibroblast growth factor (bFGF) is a glycoprotein with stimulating ability of angiogenesis. In addition, bFGF plays an important role in wound healing process in some tissues for example gastrointestinal tract, but its ability for discrimination of various stages of wound severity in these diseases was not reported. Therefore, we aimed to determine the bFGF levels in gastric ulcer patients compared with healthy controls as a biomarker for staging the severity of wound. METHODS: The study group consisted of 33 patients with gastric ulcer and 27 healthy controls. The diagnosis of patients was based on standard clinical, endoscopic, and histological criteria. Serum levels of bFGF were analyzed by an Elisa kit. Results : According to the histological findings, 19 (57.6%) patients were in moderate stage of ulcer and 14 (42.4%) were in the severe stage of gastric ulcer. The mean bFGF serum levels in patients group (7.8±1.3pg/ml) were lower than the healthy group (8.2±1.4pg/ml) in crude data, but in statistical analysis the differences were not significant (p=0.082). The mean bFGF serum levels in patients with severe stage of gastric ulcer were greater than the patients with moderate gastric ulcer (8.4±1.3 vs. 7.4±1.2 pg) and the differences were statistically significant (p<0.05). CONCLUSION: The differences in serum bFGF levels in patients with severe stage of gastric ulcer vs. moderate gastric ulcer was significant. Therefore, serum bFGF level measurements can be used as a useful clinical tool for discrimination of patients with severe stage of gastric ulcer vs. moderate gastric ulcer, when endoscopic and histological examination are not possible to perform.