Journal of Health and Safety at Work

---

Introduction: Nursing is one of professions that employees are at risk of fatigue and work related musculoskeletal disorders, because of high physical workload and high job stress. Connecting serum set to serum solution is one of the repetitive tasks for nurses in their working times and it may cause pain and discomfort in their hand. The aim of this study was to design and ergonomic evaluation of a tool for connecting serum set to serum solution.

Material and Method: This experimental- interventional study conducted on 12 nurses (6 men and 6 women) in 3 phases. First phase was assessment of manual connecting of serum set to the bag by nurses, second phase was design and manufacturing of serum set connector and third was ergonomic assessment of the manufactured tool. In first and third phases, amount of perceived exertion by nurses was assessed using the Burg scale (CR10), and electromyography assessment for hand muscles activity was conducted during connecting serum set. Data of first and third phases compared with statistical tests.

Result: Mean score of perceived effort during manual connection of serum set was 5±1/2 (of 10) and while mechanical connection with designed tool was 2.3±0/49. There was significant difference between activity in 5 muscles (Flexor Digit Comonis, Flexor Carpi Radial, Biceps, Triceps and Deltoid) in manually and mechanically connection mode (P-value<0.05).

Conclusion: Use of serum set connector reduced the perceived effort and activity of hand and wrist muscles. This device can be used as an ergonomic tool for nurses to easing the inserting the serum set to serum solution

---

Introduction: The Surgical Safety Checklist has been introduced by the World Health Organization (WHO) as a tool for reducing medical errors. Reviewing the results of the checklist application indicates significant reduction in mortality and complications in surgery. Thus, this study aimed to customize and validate surgical safety checklist in order to complying with the surgical protocol in Iran.
 

Material and Method: In this cross-sectional and descriptive study, the WHO Safety Surgery Checklist was first translated. Next, through interviews with specialists and direct observation of activities, those tasks that were susceptible to the incident, identified, prioritized and analyzed using Hierarchical Task Analysis (HTA) and the results presented in form of HTA charts. Then, using Tabulate Task Analysis (TTA) and based on the recommendation and modification commented by expert panel, some questions added to the checklist and a customized version of the Surgical Safety Checklist was provided.  Hence, the faced validity, content validity and reliability of the checklist have been evaluated.
 

Result: In the surgery, four major tasks identified for analyzing using the HTA chart. Accordingly, 41 subtasks obtained and analyzed by TTA. The Lavashe method was used to determine the content validity ratio (CVR) and the content validity index (CVI). The question from the checklist, in which, CVI was less than 0.79, modified and replaced with appropriate question. Also, the scores for 3 questions were less than 0.49, and they were removed from the checklist due to the low CVR score. In the reliability assessment, the intra-observer method is used, and the Kappa coefficient obtained was acceptable and it was higher than 0.6, which confirmed the validity of the checklist.
 

Conclusion: In this study, the surgical safety checklist customized in terms of content validity and reliability, in a field study. Considering the compliance of the checklist items with the surgical protocol in Iran, we hope to use it to improve the quality of teamwork and reduce the complications and mortality caused by surgical errors

---

Introduction: Nowadays, working in any computer work stations, named visual display terminal (VDT), was widespread and has become popular in our lives. Due to the increasing trend of using computers in the administrative and social institutions, prevalence of eye-related signs of working with computers is still increasing and it is one of the most important health issues. Computer jobs are low-mobility and require little energy to do physical work, but require more cognitive processing and mental focus. Visual fatigue is an occupational hazard for people working with computers. Eye fatigue has symptoms such as headaches, job discomfort, and eye pain the purpose of this study was to have a systematic review on eye fatigue, dry eye and eye blink among people working with visual terminals.  
Material and Methods: Internet search databases and search engines were used to find articles with focusing on the impact of risk factors on eye indexes on computer users. In this study, related articles were obtained from websites, including: PubMed, Google Scholar, Scopus and Web of Sciences. The keywords were used to search in these websites were: computer user, eye fatigue, dry eye and eye blink. Accordingly, after finding 115 relevant articles from the related sites, 17 articles were finally selected.
Results: Findings show that using computer cause many problems in the eye. Duration of using the computer, the type of work with the computer, the mental load, the distance from the monitor, and also long-term use of the computer without break in during work can cause dry and fatigue eye in users, which is one of the most common ocular problems among computer users.
Conclusion: According to the finding and results recommended to reduce of dry and fatigue eye, distance of users from the monitors, be more than 50cm, use 20-20-20 law to rest user’s eyes, and  Positioning the monitor be 15-20 degrees below the user’s line of sight. Also, too much focus on the screen reduces blinking and resulting in dry eyes. In order to prevent dryness of the surface of the eye, it is recommended that the eyelid be optional even if possible. Increasing the contrast of the monitor can be helpful in reducing stress and strain on the eye while working with a computer and using glasses instead of lenses to correct refractive errors and one of the ways to control and improve dry eye is using artificial tears by computer users.

---

Background: Industrial incidents are one of the major problems of today's societies. Studies in this field show that the main and most important cause of error occurrence is human factor. Therefore, the aim of this study was to identify and evaluate the risk of human error in the activities related to the operation of electrical installations of the Tehran Province Electricity Distribution Company.
Methods: This study is a qualitative and cross-sectional research was conducted by direct observation of the activities and documents, interview. Tasks and subtasks were selected and analyzed using Hierarchical task Analysis, (HTA).The results were presented in the form of  HTA. Finally, according to the instructions of SHERPA, the relevant worksheet was completed.
Results: The analysis of SHERPA worksheets showed that a total of 3399 errors were detected for 759 tasks as 39.57% of them were action errors, 32.4% review type, 7.32% recovery type, 19.64% communication type and 1.80% were selective errors. According to the results of risk assessment, 12.47% of the errors were unacceptable risks level, 59.57% were undesirable, and 20.2% were acceptable risks but need to be revised and the rest, 7.33% acceptable with no need for revision or safe ones.
Conclusion: According to the results, the most common type of error was action errors and in order to reduce this type of errors, using necessary corrective measures such as proper selection of people for occupations, training, monitoring, using smart machines, using tag out systems and checking at the suitable time and updating the instructions would be useful and effective countermeasures.

---

Introduction: Assessing health, safety, and environment (HSE) performance based on up-to-date analytical models like resilience engineering, especially in automobile manufacturing companies, affected by the trilogy of HSE factors and functions, is of crucial importance. Therefore, this study was to review the factors effectively involved in HSE management performance assessment based on resilience engineering in automobile manufacturing industries.
Material and Methods: To collect and classify the data, many relevant articles and procedures published in journals or presented at seminars were researched and cited. In this study, reliable online databases, including Google Scholar, Web of Science, Scopus, and PubMed were searched to meet this purpose. Other databases in Farsi such as Magiran, CIVILICA, and Scientific Information Database (SID) were also employed. Accordingly, a total number of 211 articles were extracted and filtered in terms of content and topic by a team of four HSE senior experts, whereby irrelevant studies were deleted, the full text of each relevant article was more closely considered, and finally 18 studies were selected and thoroughly examined.
Results: The findings from these 18 articles revealed that the HSE would be influenced in various industries by factors such as organizational culture, learning and training, political-economic variables, workforce qualifications and skills, strategic and large-scale programs of organization plus its assets and financial resources. In automobile manufacturing industries as well, circumstances might emerge because of some extra-organizational threats and intra-organizational weaknesses, whereby the appearance of deficiencies in various processes and even the functions of the HSE as a whole would be impaired. Of the many external factors, one could mention economic sanctions, large-scale socioeconomic problems, and lack of materials and production equipment. The internal problems would also range from production reduction and cuts in budgets earmarked for different management departments to a rise in the number of accidents and diseases, soaring medical treatment costs, as well as growing expectations in employees, which together impact the HSE management performance.
Conclusion: Regarding the studies conducted on various models presented so far in the area of resilience, it was concluded that the HSE performance of organizations intended to prevent and control risk factors were by no means distinct from other management factors and strategic decision-making in an organization. Rather, the HSE indicators could be impacted by many extra- and intra-organizational factors. Based on the models surveyed, it would be essential to consider the concept of resilience in HSE management. The reason for this is that the idea of the HSE would appear to be an issue of less virtue and importance in various stages and situations in the lifecycle of an organization, which is not consistent with the HSE management system and does not keep pace with the influencing factors.

---

Introduction: Designing behavioral modification interventions for the use of personal protective equipment (PPE) warrants the audiences identification and analysis. This study aimed to determine the predictive factors for using (PPE) based on Social Cognitive Theory (SCT) constructs among workers of Iran Aluminum Factory, 2018.
Material and Methods: In this descriptive analytical study with cross-sectional method, a researcher-made questionnaire including demographic information, knowledge questionnaire and designed items based on the SCT construct, was fulfilled by 188 workers employed in production line of Iran Aluminum Factory in Arak. The collected data was analyzed using descriptive statistics, Chi-square and logistic regression analysis on SPSS 24. The significance level was set at P< 0.05.
Results: Among the participants, 46.8% (n=88) and 52.2% (n=100) of workers had moderate and high level of knowledge, respectively. Demographic variables such as marital status, educational level, income, age, work experience and employment status (p <0.05), as well as all SCT constructs (p <0.05) had a significant relationship with knowledge. Logistic regression analysis revealed that the level of education and employment status with probability of 80.6% and self-control, environment and self-efficacy of perceived barriers constructs, with a 64% probability could explained workers in high-knowledge group.
Conclusion: The present study revealed that the variables such as level of education, employment status, self-control, environment and self-efficacy of perceived barriers could be effective in designing educational interventions to improve workers’ knowledge on using personal protective equipment.

---

Introduction: Workers in car manufacturing industry are at risk of a high prevalence of musculoskeletal disorders, especially low back pain. Therefore, in the present study aimed to design and fabricate a portable device to evaluate the low back kinematics and to compare these variables in workers with and without low back pain (LBP) in assembly lines of an automotive industry.
Material and Methods: In the present research workers postures were assessed using OWAS direct observational method. Moreover, simultaneously, prevalence and intensity of low back pain were evaluated by Dutch Musculoskeletal Questionnaire (DMQ) and Visual Analogue Scale (VAS). After fabricating motion analysis device, a field study was conducted using the designed device among 16 volunteers to investigate low back kinematic variables in two groups of workers: LBP and non-LBP.
Results: The results showed that 62.1 percent of all working postures were high risk with corrective action levels of 3 and 4. On average, 86.1 percent of workers experienced LBP in the previous 12 months. Regarding comparison of kinematic variable in the two groups of LBP and non-LBP, workers without LBP had higher degree and duration (in second) of movements (forward flexion, lateral bending, extension, and twisting), as compared to those with LBP. However, only movement range of forward flexion in non-LBP group (mean: 64.29 and SD: 8.41), was significantly higher than those with LBP (mean: 58.97 and SD: 11.34).  
Conclusion: The device can be used as an effective tool in the ergonomics studies in the field of back pain, due to its potential to record the kinematics of the trunk, as well as its lightweight and non-interference with the task. Device’s validity was acceptable based on the comparison of the results of this device with those obtained from inclinometer.

---

Introduction: Musculoskeletal disorders (MSDs) are prevalent in work settings and are associated with high rate of prevalence and costs. Musculoskeletal conditions have multifaceted nature, and occupational factors play an important role in their development. The aim of this study was to identify the risk factors of work-related musculoskeletal disorders in the working population in Iran during 2000 to 2015.
Material and Methods: Using the appropriate search terms, articles published in the journals, student thesis, and those presented at the conferences were searched through authentic English databases (Google Scholar, Scopus, PubMed) and Farsi ones (Magiran, SID, IranMedex, Irandoc). Following removal of duplicate citations and irrelevant studies, the full texts of the remaining publications were prepared and assessed for more detail.
Results: Perceived discomfort in low back region obtained the highest score in workers of industrial, administrative, service, and agricultural settings. However, in the handicraft and educational groups, the highest percentage of discomfort was belonged to neck (66.7%). Findings showed that the most commonly used techniques for evaluation of musculoskeletal disorders and risk factors were, respectively, Nordic questionnaire (NMQ) (76%) and REBA (13.9%). Moreover, all identified risk factors were classified into eleven groups including: biomechanical, work environment design, tools, equipment, temporal aspects of job design, job content, organizational aspects, economic and financial issues, social aspects, individual characteristics, and training.
Conclusion: Overall, a wide range of risk factors reported in the previous studies were categorized in the present review. The results are suggested to be considered by managers and decision makers as a framework to take measures for controlling musculoskeletal disorders to accomplish the goal of ergonomics, which is productivity and well-being.

---

Introduction: Nowadays, excessive computer use in the workplace has raised concerns about the health status of VDT workers, particularly complaints about eye discomforts. Due to the importance of the eyelids and eye closure parameters on eye health during computer works and the direct effect of monitor height on these parameters, this study was aimed to examine the effect of different monitor heights adjustment on the eye indicators and eye discomfort among participants.
Material and Methods: In this study, any changes in the eye indicators including blink rate, the eye blink opening and closing time, the blink opening rate in three different monitor heights (standard, low, and high) were examined among 11 participants. The blink rate and the eye blink opening and closing time were measured and evaluated using videotaping and analyzing by an image processing software, developed in this study. Participants were also asked to complete a questionnaire for eye fatigue assessment due to daily computer uses.
Results: Results showed that the highest rate of eye blink was at the standard height of the monitor, and this rate was significantly different at three different heights of monitors (high, standard, and low) (p<0.05). The lowest blink rate was observed at low and high heights with an average of 7.3 and 7.8 and the highest blink rate at standard height with an average of 8.9 blink per minute, respectively. Meanwhile, image processing and analyzing of eye surface showed, in average, 16% decrease in the opening rate of the eye surface by decreasing the height of the monitor, and 15% increase by increasing it, relative to the standard mode of monitor.
Conclusion: To protect users from computer-related eye strain, it is recommended to correct monitors height to the standard height along with typing and data entry training for keyboarding skill development and minimizing working times as a result. What is more, a proper work-rest schedule when working with computer can be considered as an effective countermeasure to prevent from eye strain.

---

Introduction: The noise could affect some aspects of human health, including the cognitive performance. In addition to sound pressure level and exposure time, the psychoacoustic features of noise may cause destructive effects on humans. A few recent studies have been conducted on effect of sound quality on cognitive performance. This study aims to find the noise loudness and sharpness levels as the most destructive effects on human cognitive performance.
Material and Methods: This was a cross-sectional study on 10 male students of Tehran University of Medical Sciences. The Noises were generated in two channels that the left channel produced the pink noise as a background noise. The pink noise loudness and sharpness were 19.7 sone and 2.49 acum, respectively. The right channel generated noises with different loudness and sharpness levels the noise loudness ranged from 8.87 to 67.9 sone and the noise sharpness ranged from 1.07 to 6.4 acum. Finally, ten noises with different loudness and sharpness were applied. The students were exposed to ten different types of noise and a silent condition. The Mathematical Problem Solving Task (MPST) test was performed to assess cognitive performance. The reaction time and the accuracy rate were measured after 5 minutes of noise exposure. Data were analyzed by SPSS (ver. 22). P< 0.05 was considered as significant level.
Results: The mean reaction time and the mean accuracy rate increased with the sharpness level.  However, alteration in the loudness and sharpness levels had no significant effect on the speed and accuracy of students. Performance speed increased in noise 3 with the highest loudness (L=67.9, SH=1.07) in comparison with the silent condition (p-value=0.05). The mean accuracy rate in exposure to the noise 9 reduced in comparison with silence (p-value=0.04)
Conclusion: Different levels of psychoacoustic features had no significant effect on the cognitive performance parameters. Although, the accuracy rate and the reaction time decreased in noises 9, the sharpest noise, and 3, the loudest noise, in comparison to the silence, respectively.

---

---

Introduction: Complex sociotechnical systems, such as automotive industry, require a proper macro-ergonomic approach to design and implement the work system at micro-ergonomic level. The purpose of this study was to develop and validate effective macroeconomic factors to improve productivity, health and safety of employees in the automotive industry based on Holden & Karsh model.
Material and Methods: At the first step, relevant documents were reviewed, and then experts were interviewed to identify macro-ergonomic factors. The identified factors were categorized into four groups based on Holden & Karsh’s model. In the follow-up phase of the study, then, the content validity of the factors was calculated using Delphi technique in the form of an expert panel. Finally, validity acceptance was assessed using mean content validity index, and agreement between experts was evaluated using modified kappa coefficient
Results: 28 main factors were identified and categorized into four subgroups, including personnel, unit /department, organization and environment factors. 19 main factors were selected as the effective macro-ergonomic factors to improve employee’s productivity, health, and safety. The content validity index and the modified kappa coefficient were calculated as 0.901 and 0.90, respectively.
Conclusion: Macro-ergonomic factors identified in this study can be considered to improve employee’s productivity, health, and safety in the automotive industry. These factors can be used as specific context-based criteria for an ergonomic evaluation in the automotive industry, or even be generalized to other industries, organizations and companies.

---

Introduction: Universities play a key role in creating a knowledge-based society and its sustainable development. Strategic planning by strategically analyses internal and external environments of the organization, forecast its future, identifying its strategic direction, and strengthening organizational structures, processes, and outcomes, creates and sustains competitive advantages. This study aimed to formulate a strategic plan for the Occupational Health Engineering (OHE) department of School of Public Health (SPH) at Tehran University of Medical Sciences (TUMS).
Material and Methods: In this participatory action research, a strategic planning committee was formed. The strategic planning committee used the strength, weakness, opportunity and threat (SWOT) matrix to evaluate the internal and external environments of the OHE department. Then, the mission, vision, values, goals and objectives of the OHE department were defined. Finally, the operational plan including actions to achieve the goals and objectives were formulated.
Results: Experienced professors and staff, specialized laboratories, professional journals, and high ranked postgraduate students were the most important strengths; and theoretical and non-practical courses, lack of educational protocols, poor communication with industries, lack of resources, and low motivation of employees were some of the weaknesses of the OHE department.  The support of senior managers of TUMS, industry liaison council at school and university, facilities of the university faculties, comprehensive research laboratories of the university, capacities of the private sector and increasing the demand for research in the industry were the opportunities. High inflation, political sanctions, the absence of consulting engineering companies and the uncertainty of research priorities of industries were important threats to the OHE department. Therefore, the OHE department is in a conservative strategic position. The strategic direction of the department, including the mission, vision, values and goals, until 2025 was determined. Improving the structures, working processes and performance of the occupational health department were determined as objectives and 81 actions were formulated to achieve these objectives.
Conclusion: The educational departments, schools and universities must have a strategic plan for progress. The strategic plan of the occupational health department of TUMS was formulated in line with the four-year plan of the university and coordinated with the operational plans of the educational, health and research deputies of TUMS and school of public Health. Proper implementation of this comprehensive and evidence-based strategic plan will improve the performance of the occupational health department.

---

Introduction: Human factor analysis has been identified as the most common cause of accidents in natural gas transportation and distribution facilities. The occurrence of accidents at these systems, especially gas reduction stations located in residential and industrial areas, has had catastrophic consequences. Therefore, this study aimed at analyzing critical tasks and human error assessment using the system for predictive error analysis and reduction (SPEAR) method and providing the appropriate framework for error management in the operation and maintenance of city gate stations.
Material and Methods: This descriptive cross-sectional study was conducted using the SPEAR framework and safety critical task analysis guideline to evaluate errors in gas pressure reduction stations. First, critical tasks were screened and evaluated, followed by performing task analysis by the hierarchical task analysis and detecting performance-influencing factors (PIF). Then, human errors were predicted and assessed based on the predictive human error analysis. Finally, error management was developed at three process, equipment, and training improvement levels.
Results: In general, out of 23 operations and 164 sub-tasks, 12 critical tasks were identified based on the results. Criticality level percentages were about 67% high risk, 25% moderate, and 8% low risk. In addition, 134 errors were identified which were mostly related to action (42.53%) and checking (39.55%) errors, respectively. Eventually, communication, retrieval, and selection errors were 8.96, 5.22, and 3.74%, respectively.
Conclusion: The results revealed that action and checking errors had the highest percentages. This method can be applied to appropriate the systems approach to error reduction using the PIF assessment output. The privilege affecting factors include preparing standard operation procedures, implementing a comprehensive training program, and controlling environmental hazards.

---

Introduction: Given the high prevalence of low back pain in manual handling activities, its known relationship with spinal loads, and the role of muscular fatigue and the body’s adaptive mechanisms to counteract fatigue, this study investigated the effect of repetitive lifting tasks on trunk muscular fatigue and the kinematics of the spine and load-in-hand.
Material and Methods: Eighteen male volunteers lifted a box from the floor to their waist height at a pace of ten lifts per minute until they could no longer continue the task and reported the highest level of exhaustion. Kinematic data and muscle electromyographic activity were simultaneously recorded using a motion capture system and an electromyography device. In this study, average trunk flexion angle and trunk angular velocity were calculated as trunk kinematic variables, while average box vertical travel distance, average box horizontal displacement from L5-S1, and average box vertical displacement velocity were considered as box kinematic variables. The median frequency of electromyographic signals from selected muscles was quantified as a muscle fatigue indicator. Since subjects performed different lifting cycles, the total number of cycles was divided into five distinct blocks for data analysis.
Results: The results showed significant effects of lifting trial blocks on trunk angle (p=0.004) and vertical box displacement (p<0.001). Median frequency was significantly affected by lifting blocks for right (p=0.016) and left erector spinae (p=0.014), right (p=0.021) and left multifidus (p<0.001), right latissimus dorsi (p=0.001), and left rectus abdominis (p=0.039).
Conclusion: Overall, the results highlight variations in most kinematic parameters and a reduction in the frequency content of EMG signal spectra. These changes serve as indices of the central nervous system’s control over lifting behavior under dynamic conditions. A better understanding of these central nervous system adaptations could have practical applications in interventions such as workstation design, exoskeleton development, and worker training to manage musculoskeletal disorders.

---

Introduction: Strategic management involves determining the organization’s direction, preparing a strategic vision and mission statement, and providing the basis for growth, profitability, and production. It also includes the inclusion of employee safety and health programs throughout the organization. The existence of a strategic plan for the scientific and practical strengthening of occupational health and safety is one of the country’s academic and industrial priorities. The purpose of this study is to present a strategic plan for developing the specialized field of occupational health and safety engineering in Iran.
Material and Methods: The current study is a collaborative action research study that was conducted in 2021. The strategic planning committee consisted of 20 professors, experts, and doctoral students. Over the course of 14 weeks, they held regular weekly meetings, collected information from inside and outside the organization, analyzed the organization’s internal and external environment, and identified its strengths, weaknesses, opportunities, and threats. Based on this analysis, the committee determined the organization’s mission, perspective, values, and general and specific goals for 2021-2024. They also identified the necessary measures to achieve these goals and developed an operational plan to improve the performance of the specialized field of occupational health and safety.
Results: Conducting this applied research led to the strategy of internal and external analysis of the specialized OHS field, determining the direction of the basic strategy, mission, perspective, values, and general goals. Finally, seven specific goals and 286 actions were determined to improve the performance of OHS. The SWOT analysis of OHS’s internal and external environment identified 27 strengths, seven weaknesses, 26 opportunities, and 12 threats. According to the results of the SWOT matrix, the strategic position of the OHS field is to implement preventive strategies and maintain existing conditions.
Conclusion: This plan aligns with the 4-year OHS plan. In developing the program, attention has been paid to the documents and policies of upstream organizations. The strategic position of occupational health and safety engineering is a prudent strategy. In this situation, strategies for maintaining existing conditions can be applied. Therefore, it is suggested to reduce the weaknesses of OHS as much as possible and increase its strategic capabilities by focusing on prudent strategies. From the second year of implementing the strategic plan, the OHS field can gradually focus on developing activities.

---

Introduction: Air traffic control is a very complex process, including multiple human-machine interactions. Human mental workload plays an important role in this process. Nowadays, electroencephalography indexes are considered as new indicators in the field of assessment of mental workload. The purpose of the present study was to investigate the relationship between EEG theta power and mental workload in air traffic control simulation.
Material and Methods: Fourteen air traffic controllers participated in this study. Controllers carried out two scenarios, including low and high workload, based on task load factors in an air traffic control simulator. Mental workload was assessed in these two scenarios by the NASA-TLX questionnaire. EEG signals were continuously recorded during air traffic control tasks. Afterward, absolute theta power was extracted from participants’ EEG using Fast Fourier Transform (FFT) by the MATLAB software and was compared with each other in terms of high and low workload.
Results: The results showed a significant relationship in absolute theta power during low and high workload scenarios in all regions of the brain (p < 0.05). Absolute theta power increased primarily in the frontal region during the high workload scenario. Also, there was a significant increase in the relationship between work experience and absolute theta power at the F3 region during the high workload scenario (P=0.021, r=0.607).
Conclusion: Absolute theta power provides a good parameter to assess mental workload at different levels of air traffic control tasks. Therefore, it can be used as a tool for the design of human-machine complex systems.

---

Introduction: Compared to other hospital departments, emergency department (ED) nurses experience higher levels of occupational fatigue. However, despite the importance of fatigue in EDs, limited studies have investigated the issue. Therefore, the present study aimed to identify factors affecting ED nurses’ fatigue with a systemic approach and provide a comprehensive model of fatigue.
Material and Methods: The present study was the first phase of a mixed-methods study with an exploratory sequential design that was conducted qualitatively. Data was collected using a semi-structured interview technique among ED nurses in TUMS hospitals in Tehran. The data was analyzed with a systematic approach and qualitative content analysis method. To check the credibility and trustworthiness of the study results, Goba and Lincoln criteria, including transferability, peer review, and member check, were used.
Results: Extensive factors were identified in the four levels of nurses’ work system, including individual factors, work unit, organization, and extra-hospital factors that could facilitate or prevent nurse fatigue. Specifically, the categories that were mentioned the most by the nurses were aggression and conflict with visitors, ED workload, understaffing, crowding and noise, obligatory overtime, acknowledgement, visitor’s expectations, reporting (paperwork), and clients’ distrust of nurses. Finally, based on the qualitative results, a conceptual model of factors affecting occupational fatigue of ED nurses in Tehran was presented.
Conclusion: Traditionally, fatigue management programs in hospitals only consider issues related to work shifts and sleep hygiene. However, the results of the present study revealed other fatiguing factors in the work system of ED nurses. These findings can help health system decision makers and HFE experts in designing effective fatigue risk management systems in Iranian hospitals, especially in emergency departments.

---

Introduction: The purpose of occupational health is to maintain and improve the health of employees and improve their physical, mental and social well-being through the prevention, control and elimination of occupational hazards. It is necessary to integrate educational, research and health service activities to prevent and control potential occupational health hazards in the community. This study aimed to develop a Joint Comprehensive Plan Of Action (JCPOA) for occupational health at Tehran University of Medical Sciences (TUMS).
Material and Methods: In this participatory action research, a strategic planning committee was established, whose members were professors of the occupational health department in the school of public health and managers of the occupational health department in the health deputy of TUMS. The strategic planning committee carried out a strategic evaluation of the internal and external environments of both occupational health deprtments of TUMS and identified the strengths, weaknesses, opportunities and threats. Then, the strategic direction of JCPOA including the vision, mission, values, goals and objectives was determined. Also, the strategies and actions to achieve the goals and objectives were identified. Finally, the action plan to achieve these objectives was developed.
Results: This applied research led to the strategic evaluation of the internal and external environments of the occupational health depratment of the School of Public Health and the occupational health depratment of the Health deputy of TUMS, determining the strategic direction, and finally, developing an action plan to achieve the goals and objectives.
Conclusion: The JCPOA for occupational health was developed using a collaborative and systemic approach. The proper implementation of this plan can lead to the improvement of occupational health indicators in the community. Cooperation between university and industry is necessary for the sustainable development of society.

---

Introduction: Despite advancements in road safety and vehicle design, road accidents remain prevalent, a quarter of which are caused by driver distraction. This issue is particularly critical in the public transport sector, especially among urban bus drivers, as distraction can lead to serious injuries and fatalities. Accordingly, this study explored the factors influencing distraction among urban bus drivers through a qualitative approach and a macroergonomics perspective.
Material and Methods: In this study conducted in 2024 in Tehran, 18 urban bus drivers were selected through cluster sampling. The participants included 10 drivers from bus rapid transit (BRT) system and 8 drivers from non-BRT services. Data were collected through semi-structured interviews with the drivers as well as on-site observations. Subsequently, a directed qualitative content analysis approach, based on the balance theory model, was used to analyze the collected data.
Results: The findings revealed that the primary sources of distraction belonged to six levels of the work system, the most cited of which were environment, tasks, and organization. Specifically, inappropriate behavior of other street users as an environmental factor and the driver’s interactions with passengers as task-related factors were identified as key sources. Additionally, organizational factors such as interactions with supervisors and colleagues, as well as salary issues, were significantly important. The participants very limitedly expressed using mobile phone while driving as a main distractor to their driving.
Conclusion: The current study identified various influential factors, spanning different levels of the work system, affecting bus drivers’ distraction, including generic factors that impact all urban drivers and specific factors that uniquely affect bus drivers. Addressing these factors through providing appropriate education for both passengers and street users along with implementing management strategies in the organization to enhance intra-organizational relationships and organizational support can lead to the safety of the bus drivers.