مجله تحقیقات نظام سلامت
سال یازدهم شماره 4 (زمستان 1394)

Hepatitis B and C and human immunodeficiency virus (HIV) infection are a serious health issue in Iran. Knowledge of the designed standard precautions can reduce occupational injuries which result in the transmission of these viruses. This study was conducted to determine the rate of occupational injuries and awareness of the standard precautions among laboratory staff and nurses of Dehaghan and Shahreza, Iran.
This cross-sectional study was conducted on 77 laboratory staff and nurses of governmental centers affiliated to Isfahan University of Medical Sciences, Iran, who were selected through census method. A researcher-made questionnaire was used to assess knowledge of standard precautions and occupational injuries. Data were analyzed using descriptive indices, and chi-square and Mann-Whitney tests in SPSS software.
Findings: None of the subjects had awareness of Standard precautions at adequate level. The findings showed that 15.6% and 84.4% of subjects had a medium and poor level of knowledge. In this study, a significant association was found between gender and immunization against hepatitis B (P Given the low level of awareness and frequent recurrence of injuries such as the needlestick injury, cutting and scratching of the skin, and etcetera in the subjects, an integrated and consistent planning for training on the standard precautions seems necessary.

The present study aimed to determine the relationship between mental disorders and burnout among employees of Shiraz University of Medical Science, Iran. In this cross-sectional study, 300 employees were selected as the study sample using random sampling method. Symptoms of mental disorder, predictor variables, and burnout were the criterion variables of this study. Data were collected using the Symptom Checklist-90-R (SCL-90-R) and Maslach Burnout Inventory (MBI). A significant positive relationship was observed between burnout and all symptoms of mental disorders. Results showed that aggression was significant predictor of emotional exhaustion (r = 0.52) (P < 0.001) and depersonalization (r = 0.410) (P < 0.010). Moreover, aggression (r = 0.57) (P = 0.030), and paranoid ideation (r = 0.45) (P < 0.001) could positively and significantly predict reduced performance. The results showed that, among the symptoms of mental disorder, aggression is considered as the most important predictor of occupational burnout. It seems that planning for educational, organizational, and psychological services based on the results of the present study can play an important role in the promotion of mental health and job satisfaction among personnel of medical universities.

Biorhythm is one of the latest issues of subjective ergonomics. It can be effective in raising the level of job satisfaction, and therefore, preventing the occurrence of accidents in the workplace through understanding the physical, emotional, and mental characteristics of individuals. Thus, the aim of this study was to examine the impact of biological cycles on occupational accidents in the metal industry.
This descriptive-analytical and cross-sectional study was conducted on 120 occupational accident cases in which individuals had caused the accident. Finally, using data obtained from the accident reports and the Easy Biorhythm Calculator, the relationship between biological cycles and occupational accidents was determined.
Findings: It was found that biological cycles affect the occurrence of occupational accidents. Critical days and the negative physical cycle had greater effect on the occurrence of occupational accidents than mental and emotional cycles.
The findings showed that when individuals were in their critical days and the negative part of their physical cycle, the frequency of occurrence of accidents was higher. This was because the work was beyond the ability of the individual which resulted in the occurrence of an accident.

Studies have shown that noise pollution has harmful effects on human health. The sound of traffic is the main source of noise pollution in cities. The purpose of this study was to determine noise pollution using a geographical information system (GIS) in the main streets of Kashan, Iran.
In this study, 180 noise samples were collected from 20 regions of the main streets in Kashan using a Cel-440 sound level meter with the ISO 1996 procedure. In each measurement, equivalent sound level, statistical sound level, and the minimum and maximum noise levels were determined in 3 periods of morning (7-10:30), noon (12-15:30), and night (18-21:30) and the traffic noise index was calculated and displayed on GIS maps.
Findings: The mean and standard deviation for the equivalent sound level in all measurements was equal to 77.2 ± 1.1 dBA and the average of the traffic noise index was 68.5 dBA. A significant difference was observed between the studied stations in terms of the traffic noise index (P Noise pollution in Kashan was higher than the Iranian Environmental Protection Organization standard. The main cause of noise pollution in this city is motor vehicles; thus, control procedures are necessary in this area.

The application of ventilation systems in industries and workplaces is with the aim of improving environmental conditions for employees. The lack of appropriate ventilation system components design and control methods result in the production of sound and vibration in most components. The purpose of this study was to determine the role of the pad isolator in controlling vibration and reducing noise in ventilation systems.
This analytical study was performed on the heating, ventilation and air-conditioning (HVAC) system that had a galvanized duct and axial fan. Vibration measurements were carried out on the body of the channel and the fan base and reduction of the amount of transmitted vibrations was assessed after installation and application of the isolator.
Findings: A 61% reduction in fan vibration velocity at 2580 rpm was observed and maximum effect of the vibration isolator was observed in 2580 rpm. Moreover, the isolator had a much greater effect on reducing the rate of vibration at high speeds. At a speed of 2200 rpm and below, vibration velocity was decreased noticeably.
Our study indicates that the performance of the rubber isolator is efficient in small machines such as fans in air conditioning systems. Based on the load, static deflection, and compression level of the materials used, isolators can be used as an effective means of reducing vibration.

Energy drink consumption has a direct relationship with high risk behaviors such as smoking and alcohol consumption. The aim of the present study was to investigate the pattern of energy drink consumption and its associated factors in college students.
A descriptive cross-sectional study was conducted on students of Isfahan University of Medical Sciences, Iran, in the academic year of 2012-2013. The study population consisted of 373 students of Isfahan University of Medical Sciences. The subjects were selected using random, stratified two-stage sampling. Data were collected using a two-part researcher-made questionnaire including the demographic information and consumption behavior regarding cold drinks, alcohol, and smoking forms.
Findings: The frequency of energy drink consumption among the participants was 7%. In Pearson correlation coefficient showed a significant correlation between energy drink consumption and consumption of fruit juices, sodas, smoking, and alcohol (P Due to the relationship between energy drinks consumption and the likelihood of engaging in high risk behaviors such as smoking and alcohol consumption, the implementation of educational interventions in this regard is necessary among college students.

In this study, the inhibitory effect of ethylene dichloride (EDC) on biodegradation was investigated using the specific methanogenic activity (SMA) Test of anaerobic biomass.
In the present study, 40 SMA tests were performed using 120-ml vials in batch mode. Substrate, biomass, and biogas occupied 66%, 17%, and 17% (v/v) of the volume of each vial, respectively. The duration of each batch was 10 days. Produced methane was measured through gas replacement with 2N KOH solution as CO2 absorbent. The chemical oxygen demand (COD) test was performed on samples before and after each test. The variation in temperature and pH were retained at 35 ± 2ºC and 7, respectively. The input COD was measured for each vial at the beginning and end of the experiment. EDC was analyzed through gas chromatography-mass spectrometry (GC-MS) at the beginning and end of the experiment.
Findings: In this study, at the concentrations of 500, 1000, 5000, and 20000 mg/l of EDC, 12.6, 9.9, 2.98, and 0.86 ml CH4/g VSS decrease in the production in methane was observed, respectively. A decline in the efficiency of COD removal was also observed in the mentioned concentrations. The efficiency of COD removal at the mentioned concentrations was 68.9, 70.5, 54.4, and 33.8%, respectively. The inhibitory effects of EDC on methanogenic activity of anaerobic biomass started at EDC concentrations of higher than 750 mg/l. The amount of cumulative methane at EDC concentrations of 750, 5000, and 20000 mg/l was 30.7, 9.86, and 1.9 ml, respectively. EDC removal efficacy at concentrations of 500, 2000, and 3000 mg/l was obtained using GC-MS and was equal to 95.2%, 94.7%, and 93.8%, respectively.
The results of this study indicated that EDC concentrations of higher than 750 mg/l caused a reduction in methane production and bacterial activity.

Although many studies have been performed on occupational and industrial musculoskeletal disorders in Iran, small scale industries have been less studied and evaluated. The purpose of this study was to perform an ergonomic assessment of handicraft workers in Isfahan, Iran, using the Assessment of Repetitive Tasks (ART) tool in 2015.
This descriptive-analytical and cross-sectional study was performed on 100 handicraft workers, who were selected using convenience sampling. The study tools consisted of demographic questionnaire (researcher-made), Body map (BM) Questionnaire, and the ART tool. Data were analyzed using t-test, one way ANOVA, and Pearson correlation coefficient in SPSS software.
Findings: Workers’ ages ranged from 18 to 80 years and their mean ± SD work experience was 12.57 ± 14.38 years. The BM Questionnaire illustrated that 74% of participants had work-related pain in at least one of their limbs. A significant relation was observed between the number of painful limbs, and age and work experience (P Handicraft workers, especially with aging, are at a high risk of upper extremity cumulative trauma disorders (ULMSDs). Therefore, the implementation of interventions to improve workstation designs, hand tools design, and work hours and work-rest regimes, and provide training on correct methods of performing activities are recommended.

The aim of this study was the determination of formaldehyde dispersion pattern in Zarghan, Iran, through passive sampling and using geographic information system (GIS) software.
In this cross-sectional study, passive sampling method was used to measure the concentration of formaldehyde at 10 stations. Sampling was conducted in one season for the duration of 14 days. Formaldehyde concentration in other areas of the city was interpolated in ArcGIS software using nearest neighbor (NN), inverse distance weighting (IDW), and Kriging methods.
Findings: The results showed that formaldehyde concentration near Fars Chemical Industries Co. (FCICo.) and Sina Chemical Industries Co. (SCIC) was 38.1 μgm-3. Interpolation using GIS showed that the concentration of this pollutant, based on the direction of the wind, at a distance of 1400 m from the source was at the standard limit of 10 μgm-3.
NN interpolation was the most suitable method for determination of formaldehyde concentration. During morning inversion and when the weather is in stable conditions, the concentration of formaldehyde around the chemical industry was several times higher than the average limit. In spite of the mountains surrounding the city, formaldehyde concentration in residential areas of Zarghan and Dudag, Iran, was at the standard limit.

In recent years, due to its distinct geographical circumstances and position in a gorge, and accumulation of pollutants in surface air, Isfahan, Iran has become one of the most polluted cities in the Iran in terms of air pollution. The purpose of this study was to estimate cardiovascular and respiratory diseases attributed to particulate matter of less than 10 microns (PM10) in Isfahan in 2013.
This descriptive study was conducted in Isfahan in 2013. In the first phase, the concentration of PM10 was measured using GRIMM portable device 15-channel (Model 108, made in Germany). Temperature and pressure were obtained hourly using devices of the meteorological organization and recorded. Then, the data were processed using Excel software and health effects attributed to PM10 were evaluated through statistical analysis and using the World Health Organization Air Q model.
Findings: The results showed that the concentration of PM10 was higher in the spring and summer than in the autumn and winter. The maximum concentration of PM10 was recorded in Ahmadabad station (1000/83 micrograms per cubic meter). In addition, the results show that the cumulative number of cases of cardiovascular and respiratory disease estimated in the middle relative risk were 585 and 1517 individuals in 2013, respectively.
The high number of cases of PM10-related respiratory and cardiovascular diseases can be the result of high PM10 concentration in Isfahan for consecutive days.

Depression is a mood disorder in which the individual experiences feelings of sadness, lack of pleasure, and discouragement. In light of the increasing rate of depression, especially among tertiary-educated individuals, this paper aims to investigate the effect of resistance exercises on occupational performance areas and depression score in individuals with academic education in Isfahan, Iran.
Convenience nonprobability sampling was performed in this study. The Beck Depression Inventory-Second Edition (BDI-II) and Canadian Occupational Performance Measure (COPM) were completed before and after the intervention by the experimental group (n = 40) and control group (n = 40). Based on the designed protocols, resistance exercises were performed for 8 weeks, 3 days per week for 1:30 hours. During the first week after the intervention, the BDI-II and COPM were completed once more. Data were analyzed using SPSS software. All P-values of equal to or less than 0.001 were considered significant.
Findings: The paired t-test results showed significant differences in performance (P The results showed that 8 weeks of resistance exercises can effectively reduce depression severity and improve performance and satisfaction among adults with academic education in Isfahan.

The aim of this study was to identify factors affecting self-medication and its pattern among the students of Tabriz University of Medical Sciences, Tabriz, Iran.
This descriptive cross-sectional study was conducted on 385 students of Tabriz University of Medical Sciences in 2012. The data collection tool was a researcher-made questionnaire. The validity of the questionnaire was reviewed and confirmed by 10 experts and its reliability was confirmed based on Cronbach's alpha index (α = 0.83). To investigate the relationship between qualitative variables, chi-square and Fisher’s exact tests were used. The significance level was set at 0.05 and data were analyzed using SPSS software.
Findings: In the present study, 154 (48%) students reported having self-medicated. Moreover, the rate of self-medication was higher among women than men (P = 0.024). A significant relationship was observed between field of study and self-medication (P = 0.035). The main reasons for self-medication were fever and headache (70.4%), previous experience of the disease (41.6%), and purchasing drugs from pharmacies during consumption (55.6%). Furthermore, the majority of self-medicated drugs were antibiotics (60%) and cold medicines (42%).
The study findings indicate a high prevalence of self-medication among students of Tabriz University of Medical Sciences. Therefore, it is necessary to reduce self-medication through provision of education and correct information.

Due to the recognized benefits of breastfeeding, health policies have been based on the promotion of breastfeeding and it seems that one suitable way to promote breastfeeding is electronic learning. In this survey, the impact of a breastfeeding electronic education package on mothers’ knowledge of breastfeeding was evaluated.
This quasi-experimental and single blind study was performed on 300 primiparous women in the Women’s Hospital of Saveh, Iran, in 2010. The participants were selected through simple random sampling and assigned to three groups. Mothers received the intervention after delivery. The first group received the electronic education package and face-to-face training and the second group only received the education package. The control group only received standard postpartum care. The data gathering tool was a questionnaire including demographic information and a 20-item, researcher-made breastfeeding questionnaire. The questionnaires were completed immediately and 3 months after delivery. Data analysis was performed using SPSS software.
Findings: The results of one-way ANOVA indicated that the breastfeeding knowledge scores of the three groups were not significantly different before the intervention (P = 0.127). However, 3 months after the intervention, their scores differed significantly (P Electronic education in addition to face-to-face training was associated with an increase in breastfeeding knowledge in the third month after birth.

Diabetes mellitus is a metabolic disorder and is considered as the sixth most common cause of mortality. Hospital readmission in patients with diabetes is important and can impose great costs on the health system. Therefore, this study investigated factors affecting the readmission of patients with type II diabetes to selected hospitals in Kermanshah, Iran, in 2012.
This was a descriptive-analytical and cross-sectional study on 140 patients with diabetes. The participants were selected through convenient sampling from Imam Khomeini, Taleghani, and Imam Reza Hospitals. The validity of the questionnaire used was confirmed through content validity method and its reliability through Cronbach's alpha (86%). Data were analyzed using chi-square test in SPSS software.
Findings: The results of chi-square test showed that hospital readmission had a significant relationship with the variables of sex, educational level, and occupation, number of children, present smoking status, smoking history, substance abuse, and history of disease.
This study provides a clear picture of the causes of hospital readmission for patients with diabetes. Previous studies have evaluated this phenomenon in general. However, this study presents a specific approach to patients with diabetes, thus allowing policy-makers to better plan for this group of patients in order to prevent much of the costs resulting from readmission.

A detailed study of hidden and hard to reach populations in order to identify their characteristics is essential because they endanger the health of the society by their dangerous behaviors. However, sampling in these populations through conventional sampling methods is impossible due to reasons such as being hidden and lacking a precise frame.
In this article, applicable concepts and key points in the implementation of respondent driven sampling were defined by focusing on designs that aimed to study dangerous and hidden behaviors such as dangerous sexual behavior, injecting drug abuse, and HIV infection.
Findings: The merits of the respondent driven sampling are the production of unbiased and effective estimations of necessary parameters in populations at risk of rare and hidden diseases in comparison to other chain referral and conventional sampling methods, and the innovations of this sampling method during its implementation.
The application of the respondent driven sampling method in order to achieve unbiased and precise estimates of the prevalence rate of rare and hidden diseases is recommended in health programs of the society.

Agaricus blazei mushrooms are one of the most important edible and therapeutic mushrooms, and they contain minerals, vitamins, and amino acids essential for the human body. This mushroom is used raw, dried, and in the form of pharmaceutical products. One of the most important processes after harvesting is drying in order to enhance the quality and the length of maintenance of the products. The aim of this study was to determine the most effective drying method in terms of the better maintenance of the nutritional and medicinal properties of this mushroom.
In this study, the impact of return composting and vermicomposting in addition to the oven drying, microwave drying, and freeze-drying methods were evaluated on the antioxidant capacity, water absorption, and dietary fiber of the mushrooms. The present study was performed using a factorial and completely randomized design.
Findings: According to the results, the maximum antioxidant capacity and dietary fiber amount were observed in the microwave method. However, the minimum antioxidant capacity was observed in the oven and return composting methods. The maximum water absorption was reached in the freeze-drying method with both composting methods, and the minimum water absorption was observed in the combination of the oven method and vermicomposting.
These drying methods had different effects on the quality of Agaricus blazei mushroom. Therefore, based on the objective, nutritional properties, appearance, and economic efficiency, each of the mentioned methods can be used to increase the quality of Agaricus blazei mushrooms.

The age standardized incidence rates of esophageal cancer in women and men in Iran have the fifth and eighth ranks, respectively. Due to the high incidence rate of esophageal cancer and the necessity of knowledge of its geographical distribution, the incidence of this cancer was mapped at province and county levels in the present study.
The study population of this empirical and ecological study included all cases of esophageal cancer from 2005 to 2008 in Iran. The Bayesian Multilevel Space-Time Model was used to measure the relative risk of esophageal cancer. The data consisted of three geographically nested levels in which the countries were nested in the provinces and provinces in time (year). Data analysis was conducted using the Integrated Nested Laplace Approximations (INLA) Bayesian approach in R software.
Findings: The total number of registered esophageal cancer cases in Iran was 7160 from 2005 to 2008. Based on the results of the three-level model, with the adjustment of all risk factors, the annual variation trend was significant and cumulative.
Considering the better fit of the three-level model with the adjustment of all risk factors (physical activity, smoking, fruit and vegetable intake, and overweight), the use of multi-level models with the adjustment of more effective risk factors is recommended in future studies. This investigation showed that Northeast, Northwest, and some areas in Central Iran had the highest risk of esophageal cancer incidence.

Application of strategic management processes at the local level can lead to modeling and development of efficient systems of energy, wastewater, and environmental protection through air pollution prevention. This process is only possible through attention to the strengths, weaknesses, opportunities, and threats of hospitals. This study was conducted with the aim of the presentation of optimal green management strategies in relation to the abovementioned systems using the Strengths, Weaknesses, Opportunities, and Threats (SWOT) model in educational hospitals of Yazd, Iran.
This was an applied and descriptive-analytic study. The research was performed using a checklist, and through interviews with health professionals and university and educational hospitals administrators during October to March 2013. Internal and external matrices were used for data analysis and the SWOT model was used for formulation of strategies.
Findings: The results of this research showed that the suggested strategies for green management of systems are SO, WO, ST, and WT, respectively. The SO green hospital strategic management plans emphasize the presentation of applicable plans to reduce the use of energy and water carriers, acquisition of new technologies in order to optimize the water and energy consumption technique. They also accentuate attention to observing all points on reusing wastewater or sewage sludge, developing the content of air pollution prevention laws, and compiling an annual report of the actions taken to achieve green management in different wards of educational hospitals.
The results showed that focus on SO strategy in respect to maximizing the use of available internal assets and external opportunities should be the priority for managers of educational hospitals of the province for the implementation of green management and improvement of the quality of health services.

The prevalence of overweight and obesity among children and adolescents has increased to a considerable level internationally. One of the most important causes of childhood obesity is the lack of meal frequency. Self-efficacy has been considered as one of the most important psychological factors which can affect nutritional behaviors of adolescents in previous studies. Thus, the aim of this study was to assess the relationship between self-efficacy and meal frequency in obese adolescents of Shahinshahr, Iran.
This cross-sectional study was conducted on 172 overweight and obese female students who studied in schools in Shahinshahr in 2013-2014. After simple random sampling and assessment of anthropometric indicators, the self-efficacy and meal frequency questionnaire was completed by the students. Data were analyzed using SPSS software.
Findings: The mean of age and BMI were 13.4 ± 0.6 and 28.2 ± 3.6, respectively. BMI had a significant inversely relationship with eating breakfast, and morning and afternoon snacks (P Eating breakfast was effectively predicted by self-efficacy in obese students. It seems that to better understand the relationship between psychological constructs and eating breakfast, further studies, especially interventional studies, are required.

Due to the crucial role of dental solid waste in the spreading of pathogens and threats to human health and the environment, its optimal management is very important.
This was a descriptive cross-sectional study. The study population consisted of 40 dental centers, from among which 11 dental centers were selected through random sampling. From each center, 3 samples were collected during 3 successive days (Monday, Tuesday, and Wednesday). These materials were divided into 5 categories of pathologic, chemical-pharmaceutical, infectious, semi-domestic, and sharp material, then, they were weighted using a laboratory scale. In order to assess the dental waste material management method, a 25-item checklist was used.
Findings: The maximum and minimum average weights were that of infectious waste (1920 g) and pathological waste (32 g), respectively. The maximum averaged weight per capital was related to infectious waste (43 g) and chemical-pharmaceutical waste (23.15 g), respectively. The maximum seasonal rate of waste per capita was that of infectious waste (60%) and chemical-pharmaceutical waste (21%), respectively.
The present study showed that in most of the studied centers, no plan existed for the reduction of waste production. Regarding the optimal management of solid waste, it is suggested that, in addition to teaching dentists to reduce, separate, and recycle the waste within their offices, the collection, transportation, and disposal of each component of the wastes should be performed separately and in accordance with the guidelines.