مجله تحقیقات نظام سلامت
سال چهاردهم شماره 3 (پاییز 1397)

Patient Satisfaction Assessment is one of the most important indicators of health services quality improvement systems. Regarding the importance of this issue, this study done with aimed The Study of Psychometric Properties of the Najmieh Outpatient Satisfaction Questionnaire Binary Response. This study was performed on 359 outpatient person referring to Najmieh subspecialty hospital in year 2016 who selected using systematic random sampling. In this study, the confirmatory factor analysis with binary response and Kuder-Richardson method used for validity and reliability respectively. Data analysis was performed using SPSS software version 20 and AMOS version 18. Findings: The sample consisted of 359 people, 297 (82.8%) women and 62 (17.2%) men. The confirmatory factor analysis with binary response showed good construct index (RMSEA = 0.024, CFI = 0.98) and reliability index (0.91). Regarding the good validity and reliability of Najmieh outpatient satisfaction questionnaire binary response, this questionnaire is recommended to assess the outpatient satisfaction in Iranian society.

Among aromatic hydrocarbons, exposure to benzene, as a known carcinogen, has the highest health risk. trans,trans-muconic acid (tt-MA) is a non-toxic product of benzene metabolism. This study aimed to select a simple, rapid, and more economical method for determination of t,t-MA. This study reviewed some reported methods for extraction of t,t-MA from urine samples in order to propose the most cost-effective one. Findings: After reviewing some related literatures, four methods solid-phase extraction (SPE), liquid-liquid extraction (LLE), molecularly imprinted solid-phase extraction (MISPE), and dispersive liquid-liquid micro-extraction (DLLME) were found for extraction of t,t-MA. After surveying the advantages and disadvantages of the mentioned methods, it was found that the PDLLME method can be considered as one of the most appropriate methods for detecting t,t-MA in the urine samples, due to its high recovery and easy application.

Thermal comfort is a mental concept that expresses the feeling of individual satisfaction from the thermal conditions of the environment. The present study aimed to determine the relationship between predicted mean vote (PMV) index and mental health comfort among boy students in Isfahan University of Medical Sciences, Isfahan, Iran. The descriptive-analytical study was done on 167 boy students in Isfahan University of Medical Sciences. Mental thermal sensation of students was determined in a 7-point scale, and their PMV was calculated as well. The collected data were analyzed using SPSS software. Findings: The mean PMV index was -1.37 °C. The most mental thermal sensations of students were the neutral and slightly warm scale, with a frequency of 29.9% and 26.3%, respectively. PMV index had no significant relationship with the mental thermal sensation of students. In this study, PMV index was not suitable for estimating people’s thermal sensation of the environment in winter. By applying appropriate changes in dormitory ventilation and heating systems, more people would be satisfied of ambient temperature conditions.

The widespread and uncontrolled use of Cyberspace has led to dependency and some problems for some users. The purpose of this study was to investigate the causes of addiction to social networks among the adolescents. This study was done using the grounded theory method. The data were collected from 39 high school students (14 boy and 25 girl students) using unstructured interviews. The method of Strauss and Corbin, which consists of open, axial, and selective coding, was used for data analysis. Findings: Research findings included 4 main categories (individual, family, social factors, and cyberspace features), and 17 primary concepts (connecting with others, loneliness, avoid from problems, reduce negative emotions, personality features, negative beliefs, psychological disorders, life-skills deficits, entertainment, authoritarian parenting, neglect, the role of peers, social damages, attractiveness, easy access, anonymity, and information transfer speed). The results revealed that along with personal factors, family and social factors affect social networks addiction in adolescents. Therefore, it is necessary for psychologists to adopt comprehensive therapeutic plans that focus on the rebuilding and rehabilitation of family relationships in addition to individual treatment.

During the last decade, the role of functional food in diabetes management has been increasingly getting researchers’ attention. The objective of this study was to investigate the effects of probiotic soy milk on fasting blood glucose, body weight, and fecal lactobacilli population in diabetic rats. This was an experimental study with parallel groups and a control group. The induction of diabetes in animals was done using streptozotocin-nicotinamide (STZ-NA). Three groups of thirteen diabetic rats were entered in a one-month study. All three groups received the same basic food. In addition, the first or control group, the second and third groups were fed with serum physiology, simple soymilk, and probiotic soy milk with Lactobacillus plantarum A7 (1 ml/day), respectively. Fasting blood glucose and body weight variation were analyzed at 10-day intervals, and changes in lactobacillus count were investigated (Log CFU/g) at 15-day intervals for a period of one month. Findings: The consumption of probiotic soy milk caused a significant decrease in fasting blood glucose in diabetic rats. Comparison of the percent of changes in the two groups receiving soy milk and probiotic soy milk with the control group showed a significant increase in the weight of the rats. Moreover, the fecal lactobacilli count in soy milk group significantly increased (P < 0.050). Generally, probiotic soy milk is effective in reducing blood glucose in diabetes, but its effects on weight gain require more research.

The removal of cadmium from water sources is necessary due to the inherent degradability and biocompatibility. The aim of this study was to evaluate and compare the performance of activated carbon produced from oak cap before and after modification with magnetic nanoparticles, as adsorbents for the removal of cadmium. The effect of contact time (5 to 120 minutes), adsorbent dose (1 to 15 g/l), pH (2 to 8), and cadmium concentration (5-50 mg/l) was investigated. The adsorption behavior of cadmium was evaluated using Freundlich and Langmuir models. The effect of time was described via kinetics models. Chemical composition and surface characteristics of adsorbent evaluated using X-ray diffractometry analysis (XRD) and scanning electron microscopy (SEM). Findings: The removal efficiency of conventional and modified activated carbon produced from oak caps under the constant conditions of pH of 8, contact time of 30 minutes, adsorbent dose of 5 g/l, and cadmium concentration of 30 mg/l was 81.13 and 91.32 percent, respectively. Study of isotherm results showed that conventional activated carbon produced from oak caps had a correlation coefficient of 0.98 with Langmuir model, but modified activated carbon with magnetic nanoparticles followed Freundlich model with a correlation coefficient of 0.943. The results of kinetics showed that both sorbent followed the pseudo-second order kinetics, and their equilibrium time was 30 minutes. The activated carbon prepared from oak caps pulp is able to remove cadmium from aqueous solutions, and can be used as a low-cost adsorbent material for treatment of water resources contaminated with cadmium. Moreover, modification with magnetite nanoparticles significantly increases the absorption efficiency.

The goal of this study was to determine the concentration of trihalomethanes compounds in drinking water distribution network of Isfahan City, Iran, as well as comparison of data with previously reported values. This descriptive cross-sectional study was performed during the years 2015-2016. The samples were taken at sampling periods (totally 12 periods) from eighteen sampling points in one working day, based on standard methods. Trihalomethanes were determined based on ISO-10301:1997 and ISRI 16469 standards using gas chromatography-mass spectrometric (GC-MS) method. Other parameters including temperature, pH, and residual chlorine were measured at sampling sites. Findings: Among the measured concentration of four trihahomethane species, only chloroform showed measurable values. The average concentration of chloroform in Isfahan water distribution network was 19.8, 16.2, 19.7, and 12.9 mg/l in spring, summer, autumn, and winter, respectively. The average concentration of residual free chlorine was 0.6, 0.6, 0.5, and 0.6 mg/l in same seasons, respectively. The current study reveals that the average concentration of chloroform measured in summer is approximately 20% higher than those reported values at 2013. The appeared trend in concentration of chloroform shows the importance of continuous monitoring of these compounds, and the implementation of their reduction strategies for the coming years. By the way, the quality of Isfahan drinking water respect to the mentioned species and residual chlorine currently passes credible standards as well as the United States Environmental Protection Agency (US-EPA).

Physical activity is a key factor in maintaining health and preventing non-communicable diseases. The present study was conducted in 2016-2017 academic year to investigate level of self-efficacy and physical activity among boy high school students (junior) in the city of Flavarjan, Iran. The present descriptive-analytical study was conducted on 254 boy junior high school students selected according to a multistage cluster sampling method. Data were collected using the International Physical Activity Questionnaire (IPAQ) and Physical Activity Self-Efficacy Questionnaire. Data were analyzed using Pearson, independent t, one-way ANOVA, and linear regression tests at the significance level of P < 0.050. Findings: Students' mean physical activity score was 2630.36 met/cal/week, and physical activity was intense in 10.2%, moderate in 52.3%, and poor in 37.5% of students. Mean self-efficacy score was 57.26 ± 18.14. A significant relationship was observed between self-efficacy and physical activity (r = 0.24, P < 0.001). Mother education and self-efficacy predicted physical activity by 0.36. Self-Efficacy in physical activity among high school students was moderate. As regards, self-efficacy affects physical activity as an intrinsic factor; so, it is recommended to use strategies of self-efficacy to enhance physical activity among the students.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disrupters, with an outbreak of 4-25 percent, depending on the definition. This syndrome has several different outcomes that affect various aspects of life. The purpose of this study was to compare mental health and personality dimensions among the women with and without polycystic ovary syndrome. This was a causal-comparative study, and the statistical sample consisted of 126 women with and without polycystic ovarian syndrome selected via available sampling from clinics and private clinics of women in Isfahan City, Iran. Data were collected using Neuroticism-Extraversion-Openness Five-Factors Inventory-60 (NEO-FFI-60) and General Health Questionnaire-28 (GHQ-28). Data were analyzed using MANOVA test via SPSS software at a significant level of less than 0.010. Findings: There was a significant difference between the two groups in mental health dimensions, and it was lower in the group of women with polycystic ovary syndrome (P < 0.010). The variance of the differences in general health was 10%. Moreover, the results of personality dimensions showed that the group of women with polycystic ovary syndrome had significantly higher levels of neuroticism and lower openness as well (P < 0.010). Women with polycystic ovary syndrome have a lower mental health than normal women, are more anxious, and have less openness to the experiences. Therefore, it is necessary to consider some psychological interventions for the diagnosis and treatment of psychiatric syndromes in women with polycystic ovary syndrome.

Due to the high prevalence of breast cancer among women and its effects on personal and social life, it is important to detect effective factors on survival of these patients. This study was conducted to determine the factors affecting the survival of patients with breast cancer. This was a retrospective cohort study on 1077 patients with breast cancer referred to Seyed-al-Shohada hospital, Isfahan, Iran, between the years 1999 and 2010 and followed until 2014. Cox regression model were used to test the effects of various factors on the survival, log-rank test was carried out in the different categories of involved lymph nodes, and survival curves of these categories were plotted using Kaplan-Meier method. Analysis was done using SPSS software at the significance level of less than 0.05. Findings: The median of follow-up time was 5.5 years, and mean age of patient was 47.9 ± 11.3 years. 164 patients (15.2%) died during the follow-up period. The effect of the number of involved lymph nodes (P = 0.047) and cathepsin D (P = 0.009) was significant on the survival time of the patients. In patients with lymph node involvement between 3 and 10 (P = 0.031) and in patients with lymph node involvement of more than 10 (P = 0.030), risk of death was 3.02 and 3.08 times compared with patients without lymph node involvement, respectively. The log-rank test indicated a significant difference in survival between the different categories of involved nodes (P < 0.001). This study showed that the number of involved axillary lymph nodes and cathepsin D level associated with poor prognosis in survival of patients with breast cancer.

Alzheimer's disease is the most common form of dementia causing a disruption to memory and thinking, and for its treatment, many costs are imposed on the health system and society. The purpose of this study was to estimate the economic burden of Alzheimer's disease in the elderly in Tehran City, Iran. In this cross-sectional study, we used the prevalence-based approach, bottom-up method, and social perspective to estimate the direct and indirect costs of Alzheimer in Tehran City during the years in 2016-2017. The research sample (211 patints) was selected from the Alzheimer's Association of Iran. The required information was completed through interviews with family members of the patients, and their medical files. Findings: The yearly economic burden of Alzheimer's disease was 810,391,868 United States dollar (US$). Most of the cost (52.5%) related to direct medical costs [such as outpatient expenses (3.0%), hospitalization costs (3.0%), tests and diagnostic measures (0.5%), drugs, supplies, and equipment (7%), and nursing and patient care services (39.5%)], 0.5% related to non-medical direct costs, and 47.0% to indirect costs. Alzheimer's disease is one of the most important causes of functional dependence and special care in the elderly, with many direct and indirect costs for the treatment and care of people with this condition imposed on the health system and society. To reduce the economic burden of disease on society and health systems, we recommend that disease prevention programs should be developed, and effective care should be provided in health system be the top priority, and government support should increase for poor families.

The main goal of controlling urban wastewater treatment plants is to adopt an algorithm in which the process works in optimal operating conditions. For this purpose, we need to use the process mathematical model. In this study, the steps of building the enchmark Simulation Model No. 1 (BSM1) were presented step by step. Appropriate numerical methods were proposed for solving the simulation model, and the most effective parameter of the process was determined to provide control strategies. Finally, behavior of the process was examined against different weather conditions. The initial values inside the reactors and the clarifier layers were calculated by solving the state equations of each reactor. Using the Euler and Range Kutta hybrid numerical approach, the BSM1 simulating model was created in MATLAB environment. By applying different weather conditions, the behavior of the treatment process was investigated. Findings: Applying more than one numerical solution to solve the simulation model reduced significantly the amount of additional calculus and time, as a very important item in predictive controlling systems. Make use of different control strategies, necessarily do not improve the quality of all process parameters. Nitrogen-containing parameters, especially ammonia nitrogen, are the most effective control parameters in activated sludge process. This process complies effluents standard limits of chemical oxygen demand (COD), 5- day biological oxygen demand (BOD5), and total suspended solids (TSS) with significant difference. Only in nitrogen parameter, we see some violations of the standard. The model that is created for the first time in the country can be used for different purposes in the fields of process recognition and operation.

Research has indicated the potential for dissociation amongst individuals with obsessive-compulsive disorder (OCD). The Inference-Based Approach (IBA) offers one provoking line of enquiry in this context. This study aimed to determine the mediating role of the inferential confusion in the relationship between dissociative experiences and obsessive-compulsive symptoms. In this cross-sectional study, 212 students from Shahed University, Tehran, Iran, participated. The participants were selected using cluster random sampling method. Data were collected using the Obsessive- Compulsive Inventory-Revised (OCI-R), Dissociative Experiences Scale (DES-II), and Inferential Confusion Questionnaire (ICQ-EV). Data were analyzed using Pearson correlation, hierarchical regression based on Baron and Kenny’s method, and Sobel test via SPSS software. Findings: There were significant relationships between dissociative experiences and obsessive-compulsive symptoms and inferential confusion (P < 0.010). Regression analysis demonstrated that inferential confusion mediated the relationship between dissociative experiences and obsessive-compulsive symptoms (β = 0.356, P < 0.001). Results of this study indicate the role of the inferential confusion in explaining the relationship between dissociative experiences and obsessive-compulsive symptoms. This finding can provide evidence to support the usefulness of IBA in treating those with OCD who have dissociative experiences.

The continuous introduce of antibiotics, including amoxicillin into the environment, has created potential health risks, especially resistance to pathogenic microorganisms. In recent years, several efforts have been made by researchers to develop methods that lead to the destruction of antibiotics, including photocatalytic processes based on TiO2. The aim of this study was to evaluate the efficiency of catalyst Bi2O3-TiO2 in the removal of amoxicillin from aqueous environment. In this fundamental-applied study, the catalyst Bi2O3-TiO2 was first synthesized by hydrothermal method. The SEM, EDX and DRS analysis were used to determine the characteristics of the nanocomposite. Then, the effect of factors such as the content of bismuth in the Bi2O3-TiO2, the initial concentration of amoxicillin (10, 15, and 20 mg L-1), pH (3 to 11), and mineralization rate were investigated. Findings: Based on the results of this study, catalyst BT-5%, show more photocatalytic degradation efficiency of amoxicillin under visible light irradiation. The optimum pH and amoxicillin concentration in this process were determined 11 and 10 mg L-1 reapectively. Maximum efficiency thise process at optimal conditions after 120 minutes was 85%. The results of this study showed that the photocatalytic process based on Bi2O3-TiO2 compared to pure TiO2 is an effective method for removing amoxicillin from the aqueous environment(p > 0.05), and the use of Bi2O3 will effectively increase the photocatalytic activity of TiO2 in visible light.

Unhealthy lifestyle are the factors influencing glycemic control. The present study aimed to determine the effectiveness of training programs on improving the lifestyle of diabetics was based on Pender's health promotion model. This quasi-experimental study was performed on 90 patients with type 2 diabetes admitted to hospital in Darab, 2015. The Data was collected by standard lifestyle questionnaire consisting of 52 questions in two main sections including health promotion and mental health behaviors by the control and control group before and 3 months after the intervention. Educational program in 5 sessions for experimental group was conducted by group discussion with educational booklet. The data were analyzed by SPSS and P < 0.05 was considered as statistically significant. Findings: The average age of patients in the experimental and control group 52.09 ± 12.60 and 51.51 ± 13.40 respectively. Most of the subjects in the test and control group were married, employed and had a diploma. There was no significant difference between the two groups (P > 0.05). The mean scores of in all areas of lifestyle increased in the experimental group than the control group after the intervention, this increase was statistically significant (P < 0.05). The results of the study emphasize the effectiveness of education in improving the lifestyle of diabetic patients. Therefore, is recommended designing educational programs using health promotion model in health centers to promote health.

Hazard and operability studies (HAZOP) are necessary for risk management and safety enhancement at municipal gas depressurization stations. The present study was performed to identify operational hazards at gas depressurization station and propose technical and management solutions for attenuating them. This study was performed in two gas depressurization stations in Isfahan Province, Iran. For this purpose, firstly, HAZOP team was built, and based on the team members’ opinions, five principal nodes were identified across the gas depressurization process: gas inlet, filter inlet, filter, heater, regulator, and odorizer. Operational parameters, design limit, and possible deviations were investigated. Required information for HAZOP worksheets were gathered by referring to textbooks, operational procedures, daily report book, and interviews with engineers and operators working at the stations. Findings: Deviations in pressure, flow intensity, temperature and corrosion at the gas and filter inlet nodes, and also those in gas flow, gas temperature, heater temperature, gas pressure, and corrosion at the heater node were determined. At the regulator node, deviations in gas pressure at upstream and downstream of the regulator, corrosion, regulator pilot, and insensitivity of the pilot to the pressure at downstream were evaluated. Finally, deviations in injection rate of odorant, gas flow, pressure, and velocity, and odor intensity were considered at the odorizer node. In this HAZOP study, causes and effects of deviations in operational parameters at five nodes in gas depressurization station were identified, and preventive and corrective actions were emphasized, such as preventive and timely maintenance, consistent inspection of pipelines, preparing a well-scheduled plan for inspecting the equipment in terms of corrosion, inspection, and design revision.

The high consumption of nitrogen-containing fertilizers in the agricultural lands of Freidan is resulted to increasing of the nitrate concentration in drinking water in some of the underground water wells even higher than allowed amount. Therefore, the aim of this study is survey and zoning of nitrate concentration in groundwater resources in Freidan using Geographic Information System (GIS). This study is analytical-cross sectional. In this research, nitrate concentration determination carried out by spectrophotometry according to standard method and compared with WHO guideline (50 mg/l). Then zoning of nitrate concentration in groundwater resources in Freidan was investigated using Arc GIS 10.1 by IDW and Kriging methods. Findings: The results of this study showed that in half of the wells in Freidan, nitrate concentration was higher than the WHO guideline. Also, nitrate concentration zoning using GIS in groundwater resources was showed that the wells including high nitrate were located in central and southern regions of Freidan. Improper irrigation methods and excessive use of nitrogen fertilizers by untrained farmers can increase nitrate in groundwater resources. So should consider arrangements for farmers Training related to reduction of these fertilizers consumption.

In today's competitive environment, organizations focus on issues that affect cost and productivity, such as absenteeism due to illness (sick leave). According to the importance of this subject, this study done with the aim of study of effective factors on the number of sick leave days. This longitudinal study was conducted on workers of Esfahan’s Mobarakeh Steel Company during 2011- 2015. In this study, was used model multilevel path analysis with Poisson's response and MPLUS software was used to analyze such data. Findings: This study includes 7020 participants with the average age of 38.89 years. The results of the study showed that in within-group level variables of age, education and disease (cardiovascular disease, arthritis and osteopathy disease, indigestion, endocrine and cancer) have direct effect and variables of work experience and Framingham score have indirect effect on the number of sick leave days. In addition in between-group level the possibility of shift work and being a smoker has a direct effect on the number of the sick leave days. The results from the study shows that shift work workers are more exposed to disease that eventually results in an increase in the number of their sick leave days than day workers

Through the widespread use of antibiotics including metronidazole, they are continuously released to the environment, while traditional treatment processes unable to remove them. Therefore, they are accumulated in the environment and led to unpredictable risks to human health and ecosystem. In recent years, advanced oxidation processes have been introduced as effective technology for the destruction of pollutants from the aquatic environment. The aim of this study was to evaluate the efficiency of catalyst g-C3N4-TiO2 in the removal of metronidazole from aqueous environment. In this fundamental-applied study, the catalyst g-C3N4-TiO2 was first synthesized. The SEM, EDX and DRS analysis were used to determine the characteristics of the nanocomposite. Then, the effect of factors such as the content of g-C3N4 in the structure g-C3N4-TiO2 catalyst, the initial concentration of metronidazole (10, 15, and 20 mg/l), pH (4, 7, and 10) were investigated. Finally, the mechanism of function of synthesis photocatalyst was investigated by conducting in the presence of radical scavenger agents experiments. Findings: Based on the results of this study, catalyst TC3 shows more photocatalytic degradation efficiency mineralization. Maximum efficiency of this process at optimal conditions (pH=10, C0=10 mg l-1) after 360 minutes was 83%. The results of this study showed that the photocatalytic process based on catalyst g-C3N4-TiO2 is an effective method for removing metronidazole from the aqueous environment, and the use of g-C3N4 effectively enhances the photocatalytic activity of TiO2.

Removal of reactive azo dyes has been recognized as one of the major problems in textile wastewater treatment process. In recent years, the use of nanoparticles has been very considered for the removal and reduction of contaminants in aquatic environments. In this survey, after synthesis of magnetic nanoparticles with a functional group of ester, their efficiency was investigated to remove the Reactive Black 5 (RB 5) dye from aqueous solutions. The synthesis of magnetic silica-ester nanoparticles was carried out with co-precipitation method in alkaline conditions. TEM analysis was used to identify the nanoparticles size. The effect of independent variables of pH, initial concentration of dye and amount of nanoparticles on dye removal efficiency were evaluated. Kinetic, isotherm and thermodynamic analysis were implemented for determining the mechanism and rate of absorption. Finally the efficiency of recycled nanoparticles to remove the RB 5 dye was investigated. Findings: The results showed that 100% of the dye was removed at pH = 2 , dye concentration 20 mg/l and 0.3 g/l of silica-ester nanoabsorbent during 80 min. Kinetic studies of RB 5 removal in the optimal conditions demonstrated that the Pseudo-second-order equation kinetic model correspond to the adsorption process, and also represent the chemical absorption procedure. The absorption equilibrium data were in good agreement with the Langmuir isotherm model. Thermodynamic studies showed that the process of dye absorption was feasible, spontaneous and endothermic. The synthesized nano-adsorbents had five-fold suitable recycle efficiency. According to the results, the silica-ester nanoparticles have been shown to be effective in removing RB 5 dye from aqueous solutionand these nanoparticles due to proper recycling capability and chemical stretcher can be noticed as an active absorbent for other anionic dyes.