Journal of Arak University of Medical Sciences

The Loud Silence of Nurses: Is Our Voice Being Heard?

Amir Mohammad Dorosti

In global healthcare systems, nurses are recognized as the main pillars of care, but their voices, despite their vital role, are often lost amidst a cacophony of loud silences. This silence does not signify tranquility, but rather reflects hidden pressures, unexpressed fears, and an imposed passivity in the face of structures that limit the freedom of expression.
"Organizational silence," a concept recognized for years in the fields of management and organizational psychology, has become a global crisis in nursing. According to a qualitative meta-synthesis, over 91% of nurses have experienced organizational silence at least once in their professional careers [1].
The causes of silence among nurses are multifaceted. Part of it stems from defensive silence, meaning a nurse refrains from speaking up before superiors or in hierarchical structures for fear of negative consequences. At other times, we encounter acquiescent silence, where the nurse believes that speaking out is futile and will not bring about any change. Previous experiences of having concerns ignored or autocratic leadership styles reinforce this feeling [1,2]. Furthermore, in some cultures, such as Japan or Egypt, prioritizing group harmony over individual expression leads to the normalization of silence [3].
Silence is not just an individual reaction but a response to an inefficient work environment. Nurses who feel their voices are not heard eventually experience job burnout, decreased motivation, and ultimately, leave the profession [2,3,4]. In a study from Spain, half of the nurses surveyed had considered leaving the profession [3,5]. Job burnout not only harms the nurse's mental health but also reduces the quality of patient care. Fatigue, reduced concentration, and impaired communication with patients increase the risk of clinical errors [1,6].
This vicious cycle of silence and its consequences creates a downward spiral in healthcare organizations:
Silence on staff or resource shortages → Increased stress and workload → Job burnout → Decreased quality of care → Intensified dissatisfaction → More silence.
If nurses feel that their concerns are ignored even when expressed, silence becomes an adaptive strategy [4].
Meanwhile, the financial impact of nurse turnover is also significant. According to estimates, the turnover cost for a single nurse in the United States is over $44,000, and hospitals lose an average of $3.6 to $6.1 million annually due to nurse turnover [7]. This substantial figure provides an economic incentive for systemic interventions to reduce silence and retain human resources.
Solving this problem is not possible through individual training or psychological resilience alone. Although strengthening skills like professional assertiveness can be effective, it will not be sustainable without structural and cultural support [4]. Creating psychological safety in the workplace—where nurses can freely express their concerns without fear of punishment—is a vital starting point for change [6].
Leaders of healthcare organizations play a key role in shaping or dismantling a culture of silence. When managers interact with nurses with empathy, a listening ear, and responsiveness, trust is built, and the space for expression becomes safer. A transformational leadership style, participation in decision-making, and the creation of professional growth paths are among the most important factors in retaining nurses and reducing silence [8].
There is also a need for macro-level policymaking at national and international levels. Programs like the "Global Nursing Workforce," which focuses on supporting the sustainability of the profession, can be effective in addressing the root causes of the problem [7]. Moreover, new guidelines from bodies such as The Joint Commission on preventing workplace violence (effective July 2024), which define requirements for reporting and accountability, can serve as models for combating silence on other issues as well [8].
Ultimately, organizational silence in nursing is not just a communication issue; it is an alarming indicator of the ethical, psychological, and systemic health of healthcare institutions. This phenomenon should be considered an "organizational vital sign." The healthcare system has a duty not only to listen but to act. The voices of nurses must lead to decisions, policies, and structural reforms, so that their silence is no longer loud, but is transformed into an effective cry on the path to improvement.

The Relationship between Sensory Processing Sensitivity and Substance Craving with the Mediating Role of Resilience in Addicted Prisoners

Hassan Shafiei

Introduction: High sensory processing sensitivity in the face of psychological pressures predisposes individuals to substance craving, while resilience, as a protective factor, plays a role in reducing this vulnerability. The present study aimed to examine the structural relationship between sensory processing sensitivity and substance craving with the mediating role of resilience among substance-addicted prisoners.
Methods: The study population included all substance-dependent clients in the Delijan Prison in 2022. A convenience sample of 200 participants was selected based on the research constructs. Data collection tools included the Aron and Aron Sensory Processing Sensitivity Questionnaire (1997), the Connor-Davidson Resilience Scale (2003), and the Salehi Fardhadi, Berefan, and Ziaei Substance Use Cravings Questionnaire (2008). Structural equation modeling (SEM) using SmartPLS version 2 and SPSS version 19 was employed to test the hypotheses.
Results: The results of the study indicated that the proposed model exhibited a good fit to the data, and high sensory processing sensitivity was directly and indirectly (through resilience) associated with an increased risk of substance craving in addicted individuals (P < 0.05).
Conclusions: The findings of this study indicate that sensory processing sensitivity and resilience play a significant role in substance craving in addicted individuals. Overall, the results of this study emphasize the importance of considering cognitive-emotional factors in the design and implementation of treatment and prevention programs for addiction, as well as in reducing the risk of substance craving.

The Effect of Endurance Training on Oxidative Stress Markers in the Brain Tissue of Rats Under Cisplatin

Zahra Yousefvand

Introduction: Cisplatin, a widely used chemotherapy agent, offers therapeutic benefits for cancer treatment but often leads to adverse effects on neurogenesis and oxidative stress. On the other hand, physical activity has been proposed as a potential strategy to counteract these side effects. Therefore, the aim of the present study was to investigate the effect of an endurance training period on oxidative stress markers in the brain tissue of rats induced with cisplatin.
Methods: In this study, 32 male rats with an average weight of 220 grams were divided into four groups: healthy control, cisplatin-injected control, endurance training, and cisplatin + endurance training. After 8 weeks of endurance training, the rats were dissected, and blood serum was separated to measure oxidant and antioxidant factors. Additionally, the brain was removed under sterile conditions for the examination of the desired markers. Data were analyzed using one-way ANOVA.
Results: The results showed that cisplatin significantly decreased MDA and significantly increased TAC and CAT in the cisplatin-receiving control group. On the other hand, 8 weeks of endurance training significantly decreased MDA and significantly increased TAC and CAT. Moreover, no significant change was observed in serum SOD levels. In brain tissue, MDA levels significantly increased, and TAC, CAT, and SOD levels significantly decreased in the cisplatin-receiving group. Conversely, 8 weeks of endurance training reduced MDA levels and increased TAC, CAT, and SOD levels.
Conclusions: Based on the findings of the present study, it appears that physical exercise has protective effects against cisplatin-induced oxidative stress in the brain, which may be attributed to its antioxidant capabilities

Examining the Prevalence of Hypothyroidism in Pregnant Women with Fetal Echogenic Foci Referred to Amir Al-Momenin Hospital in Semnan from September 2022 to September 2023

Soodeh Hooshmandi

Introduction: An echogenic intracardiac focus (EIF) is one of the most common non-structural findings on fetal ultrasound, typically detected between 18 and 20 weeks of gestation. EIF is often considered a soft marker in prenatal screening. However, its association with maternal risk factors—particularly endocrine disorders such as hypothyroidism—remains unclear. This study aimed to evaluate the prevalence of hypothyroidism in pregnant women carrying fetuses with EIF and to investigate its correlation with other clinical variables.
Methods: In this cross-sectional study conducted from September 2022 to September 2023 at Amir-al-Momenin Hospital in Semnan, Iran, 100 pregnant women with fetuses diagnosed with EIF confirmed by fetal echocardiography were evaluated. Maternal demographic data, medical history, and fetal sex were collected and statistically analyzed.
Results: The mean maternal age was 41.55 ± 4.0 years, and the mean gestational age was 21.4 ± 3.65 weeks. Hypothyroidism was observed in 7% of the mothers and showed a statistically significant association with the presence of fetal EIF (P = 0.00). Furthermore, hypothyroidism was also significantly associated with underlying maternal diseases and fetal sex. However, no significant association was found between hypothyroidism and maternal age or gestational age.
Conclusions: The findings indicate a noteworthy prevalence of hypothyroidism among pregnant women carrying fetuses with EIF. These results highlight the importance of evaluating maternal thyroid function during pregnancy, particularly in cases where EIF is detected. Further research is recommended to clarify the underlying mechanisms and potential outcomes of this association.

The Effect of Mancozeb on Histomorphometric Changes in the Ovaries of Small White Laboratory Mice

Ghodrat Ebadimanas

Introduction: Mancozeb a widely used fungicide, is extensively applied to protect fruits, vegetables, and crops. It has various toxic effects on humans. The aim of the present study was to investigate the effects of mancozeb exposure on the ovaries of small laboratory mice.
Methods: Twenty-four immature small white laboratory mice were randomly divided into a control and a mancozeb group, each comprising 12 mice. Each group was divided into three subgroups of days 17, 24, and 31. Mice in the mancozeb group received 100 mg/kg/day mancozeb via gavage for 14 days, and the control group received an equivalent volume of distilled water daily. On day 28, mice were anesthetized for ovary collection, and microscopic sections were prepared and stained from the ovaries. Histomorphometric examination was performed by counting and measuring follicles.
Results: Findings showed that mancozeb exposure resulted in a decrease in the number of mature follicles, an increase in immature follicles, and a reduction in follicle diameter in the experimental group compared to the control group.
Conclusions: Mancozeb disrupts follicle development, potentially leading to reduced fertility in female mice.

Evaluation of Excess Deaths During the COVID-19 Pandemic from 2020 to 2022 in Maragheh, Iran

Ali Abdi Tazeh

Introduction: The present study was conducted with the aim of analyzing excess deaths during the COVID-19 pandemic in the population covered by Maragheh university of Medical Sciences.
Methods: This descriptive-analytical study extracted the number of recorded deaths and their information, including age, sex, and date of death, by year from march 2020 to march 2021 and march 2021 to march 2022, from the cause-specific registration and classification system of mortality in Maragheh County. The number of expected deaths for 2020 and 2021 was calculated based on the number of deaths recorded from march 2018 to march 2020 in this system. Specifically, the number of deaths stratified by age, gender, and date of death from march 2018 to march 2020 was extracted, and after standardization, mortality rates were calculated. These rates were then adjusted to the population of 2020 and 2021 to estimate the expected number of deaths for these two years.
Results: from march 2020 to March 2022, 3821 deaths were recorded in the causal system. Given the expected number of 2958 deaths, 863 (29.17%) excess deaths occurred. The excess death rate among men was 24.59% and among women was 35.41%. The 60-69 year age group had the highest excess death rate. Overall, 96.06% (829 cases) of the excess deaths during these two years were attributed to COVID-19, with rates of 97.85% among men and 94.36% among women. The highest number of excess deaths occurred in the third quarter of 2020, which was 72.17% higher than the expected deaths for that period.
Conclusions: The excess death rate was higher among older age groups and in the female group. Furthermore,the occurrence of excess deaths increased during the COVID-19 infection waves. Therefore, adopting appropriate policies to prevent disease waves and implementing care and treatment strategies for older age groups will prevent many excess deaths.

Characteristics of the Maxillary Sinuosus and Accessory Canals in the Arak Population: Age and Gender Correlation

Yusef Abbasi

Introduction: The sinuosus canal and its branching accessory canals have crucial importance across different races for minimizing neurovascular problems in dental implantation.
Methods: This study was performed as a retrospective analysis, employing Cone beam computed tomography(CBCT) images of 174 patients who attended a private oral and maxillofacial radiology center in Arak from 2018 to 2020. The CBCT images were examined with Romexis software. Quantitative variables were reported as mean ± standard deviation, whereas qualitative variables were presented as frequency percentages. The data were analyzed using the independent T-test. The correlation between quantitative data was examined using Pearsons correlation coefficient and logistic regression analysis. One-way ANOVA was performed to analyze variables including age groups and the location of accessory canals.
Results: 65.5% of the participants had a canalis sinuosus, demonstrating a considerable prevalence of canalis sinuosus in the studied population. Age and gender did not significantly correlate with the prevalence of accessory and sinuosus canals (P > 0.05). However, a significant difference was observed in the mean diameter of the canalis sinuosus between males and females (P = 0.01). The most common location for the termination of accessory canals on the left side in females was posterior to the lateral incisor (48.3%), whereas in males, it was posterior to the central incisor (45.8%). On the right side, the most common place in females (45.5%) and males (36.4%) was also posterior to the central incisor.
Conclusions: The prevalence of sinuosus and accessory canals in different populations and races is more closely related to sample size and race and requires investigation across different races to reduce neurovascular complications.

An Investigation into the Histological Impacts of Thiamine on Renal Architecture in the Presence of Copper Oxide Nanoparticles

Rahmatallah Fatahian

Introduction: The study discusses the impact of thiamine on the kidney tissue of rats that have been exposed to copper oxide nanoparticles. The research examined how thiamine correlates with the level of kidney damage caused by the intrusion of nanoparticles.
Methods: In this experimental study, forty male Wistar rats were randomly divided into four groups (10 rats per group). Two groups of rats were used as the control group (I) and the thiamine group (II). Rats of group III were administered an intraperitoneal injection of 25 mg/kg body weight of copper oxide nanoparticles for 14 days. Rats in group IV received the same dose of copper oxide nanoparticles along with thiamine (30 mg/kg body weight).
Results: The histopathological findings showed disruption of the arrangement of convoluted tubules and their disintegration and widening of the tubular lumen, cell separation and tubular necrosis in the majority of the renal tubules in-group III. In the group treated with copper oxide nanoparticles along with thiamine (IV), the pathological changes were slight and the majority of the tubules had retained normal structure. Statistically significant differences in the levels of some serum biochemical parameters (catalase, superoxide dismutase, TBARS, and TAC) were observed in groups III and IV on day 14 when compared to the control group.
Conclusions: This study demonstrated that thiamine can be utilized as an effective compound to reduce the damage caused by nanoparticles to kidney tissue and may lead to significant improvement in the health of kidney tissue in individuals suffering from damage caused by these nanoparticles.

A Review of the Effect of Rehabilitation Exercises and Supportive Devices in Individuals with Kyphosis and Forward Head Posture

AmirAli Jafarnezhadgero

Introduction: One of the common undesirable postural abnormalities that poor mobility has brought to humans due to the significant growth of technology and widespread use of tools and communication devices is the excessive increase of the back arch (hyperkyphosis) and forward head deformity. Therefore, the aim of this research is to review the effects of rehabilitation exercises on people with kyphosis and forward head posture.
Methods: The current study was a systematic review, searching for articles in Persian and Latin from the beginning of December 2005 to the beginning of April 2023, using the Wos, SID, Magiran, Scopus, ISC, PubMed and Google Scholar databases.
Results: A number of seven articles in the field of rehabilitation exercises reported that corrective exercises improve forward head and kyphosis, as well as posture. One article indicated that the use of braces reduced trapezius muscle electrical activity in patients with kyphosis, which may delay fatigue onset.
Conclusions: : The current review study showed that exercise protocols improve kyphosis and forward head complications, as well as improve pain and maintain proper posture in affected individuals.