مجله تحقیقات نظام سلامت
سال یازدهم شماره 3 (پاییز 1394)

Nowadays, computer-aided diagnosis systems are widely used in medicine. These systems could assist medical doctors in early correct diagnosis of diseases. The performance of such systems must be correctly assessed. In this paper, the performance criteria of these diagnosis systems are taken into account.
The diagnosis error of such systems was estimated based on the gold standard data using measures such as Sensitivity, Specificity, Accuracy, Precision, Area Under curve ROC (receiver operating characteristic), F-measure, Matthews correlation coefficient , etc. The advantages and disadvantages of those criteria were also discussed. Then, the performance of two Coronary Artery Disease diagnosis systems was assessed. The statistically significant superior method was identified using the McNemar’s test.
Findings: Since the analyzed dataset was balanced, the overall performance of the diagnosis methods was assessed using the accuracy measure. The accuracy of the methods was 84% and 86%, respectively. The entire systems were not reliable since Type I error (Alpha) was not less than 0.05. However, the second system had acceptable statistical power (>80%). The diagnosis performance of those systems was “very good” (0.8 The performance of the diagnosis systems must be assessed using the proper methods and criteria. Using different suitable performance measures, it is possible to assess the diagnosis performance of such systems in details.

Cancer is one of the mankind`s chronic diseases that various factors play a role in its creation. The aim of the current study was to investigate the geographic distribution of breast cancer in the Kurdistan province and identify the high risk areas andnatural geographic factors effective in its incidence.
It was a descriptive - sectional study in which the research data was analyzed using SPSS software, and charts, statistical t-tests and variance analysis was used for comparison and the distribution map of breast cancer in the province was prepared using Geographic Information System (GIS) software, version9.3 during the years 2006 to 2010. In order toinvestigate the cause ofthe highrates of breast cancer patients in some cities,Cu and Pb distribution map was prepared which affectbreastcancer.
Findings: Sanandaj, Saghez and Marivan citieshave theincidence rates of 9.59, 4.21and4.07perhundred thousand people, respectively and are considered as the common areas. Sincethe significance level of the statistical t-test obtained was 0.0001(p Urban society women are the groupat risk forbreastcancer in the Kurdistan province. Existence of Cu and Pb in the region can be one of the causes of the disease and also they can be a prognosis in order to deal with the disease. The results of this studycan provide hypotheses about the possible risk factors for breast cancer in the province; to proof this we need complementary studies done by the authorities in the future.

Medical geography is one of the sciences that geography topics related to health and disease using quantitative and qualitative methods is studied cartography, statistical analysis, one of the diseases that are prevalent today gastric cancer.
This disease worldwide, and more equal distribution in Southeast Asia can be seen, the rate of future generations of immigrants to learn the risk increases that may be due to the impact of environmental pollution on the incidence of this disease. The need for special attention to environmental causes increased prevalence of disease in the world, especially Iran confirmed.
In this study, two types of patients with gastric cancer and nitrate in drinking water is used,for Mapping information for mapping and GIS software was used to analyze the statistical software SPSS and EXCEL.
Findings: The main focus of the city in the province of Frieden, the city Semirom and Ferydonshahr. The comparison of these centers are centers of nitrate in drinking water (nitrate areas between 45 to 20 Mg/l) showed These areas are based on the correlation and regression coefficients are positive, with R =42% and P = 0.05 , respectively. The disease is more prevalent in people over 75 years and men.
According to the results obtained in this study and studies Nitrate in drinking water can cause an increased risk of gastric cancer, especially in the older people.

The purpose of the national mental health program was to provide minimum psychological services to all Iranian people by the year 2000. In 1988 the integrated mental health program in primary health care was conducted in Shahrekord and Shahreza. The aim of this project was to evaluate the effectiveness of integrating mental health program in health system. Because of the positive results of the study, mental health program was declared as the ninth element of PHC in 1990 and was gradually spread across the country. The aim of this study is to assess the patient finding indicators between 2001 and 2006 and compare them with the national expected limit.
This study was a longitudinal cross-sectional study. Sampling method was census and the sample size included the information of all patients who were under the mental health program during the years 2001 to 2006. This information was collected through evaluating standard form documentations for information of the mental health patients (No.102). At the end of each year, that year's information of mental health patients was categorized and, then, the results were analyzed by SPSS software. In this study, the patients were identified (severe and mild psychological disorders, epilepsy, mental retardation and other cases) and then compared with the national expected limit. Less than 0.05 P-value was considered as significant level.
Findings: Patient-finding indicators for severe mental disorder increased from 1.248to 2.46 per thousand, mild disorders from 9.96 to 17.5, epilepsy cases from 3.15 to 5.26, mental retardation from 3.82 to 5.86, and other psychological disorders from 2.79 to 4.28 between the years 2001 and 2006 which is more than the national expected limit.
The results of this study showed that the case finding of mild mental patients is higher than both the national expected limit and severe mental illness, epilepsy, mental retardation or other mental disorders, which requires more training of health workers, increasing the awareness of people about the symptoms of mental disorders and on time refers to medical centers.

The relationship between periodontal disease and adverse pregnancy outcomes according to the status of oral health in pregnant women is evident. The theory of planned behavior is one of the few theories that social factors on behavior indicates that special attention.
The main theory of the cause of behavior, knows the intention to perform that behavior. Intention is affected by attitude toward the behavior, subjective feeling of control over one's behavior on the behavior (in terms of ease or difficulty of the work ) is.The present study aimed to determine the predictive value of oral health care for pregnant women Ashkhaneh city was based on the theory of planned behavior.
In this cross-sectional study, 150 pregnant mothers in Ashkhaneh city a sampling of urban health center Ashkhaneh selected. Scale of the theory of planned behavior regarding oral health care were collected through questionnaires. The data were analyzed using the software spss 18.
Findings: The results showed that the average age of mothers in the study 24/4 ± 4/9 and the average maternal DMF index was 5.16± 2.2.
In this study, the correlation between behavioral intention were studied by structural theory of planned behavior. Between behavioral intention and awareness (r = 0/403), and attitude (r = 0 / 369), subjective norms(r = 0/415), and perceived behavioral control, (r = 0/488) and the behavior of the (r= 0/399 ) found a positive correlation.
This theory of planned behavior in the prediction of performance measures of oral health care to pregnant women showed. Thus, this theory can be used as a framework for designing and implementing educational interventions for reducing dental caries should be used during pregnancy to help maintain the health of mother and child.

The purpose of the present study was to determine the dominant schemas and comparison of early maladaptive schemas in borderline personality disorders patients and normal individuals.
In this cross sectional study, 90 borderline personality disorders patients & normal individuals have been chosen (45 in each group). Collecting information tool was the short form of the Young Schema Questionnaire and Millon Clinical Multiaxial Inventory. After collecting information, data were analyzed using chi-square and independent T-test.
Findings: Our findings indicated that there is a significant difference between early maladaptive schemas in borderline personality disorders patients and normal individuals. Also, The borderline personality disorders group had significantly higher scores on most maladaptive schemas with the Disconnection and Rejection, Impaired Autonomy, Impaired Limits (P This study showed that the early maladaptive schemas are inefficient on the borderline personality disorders patients. With the identification early maladaptive schemas before getting a borderline personality disorder and Measurement of the schemas, can be done an appropriate intervention strategies to reduce the scheme.

This cross-sectional study was undertaken to assess the association between spicy foods consumption and functional dyspepsia (FD) in a large population of Iranian adults.
In this cross-sectional study, we assessed spicy foods consumption of 4763 Iranian adults by the use of a dietary habit questionnaire. A modified validated version of the Rome III questionnaire for assessment of gastrointestinal health was applied.
Findings: Frequent consumption of spicy foods was associated with greater odds (OR: 1.64; 95% CI: 1.09-2.49) of having FD. This relationship was significant even after adjustment of diet-related practices and BMI (OR: 1.66; 95% CI: 1.00-2.78). There was a significant positive association between spicy foods consumption with postprandial fullness (OR: 1.76; 95% CI: 1.29-2.40) and epigastric pain (OR: 1.78; 95% CI: 1.30-2.44). However, no significant relationship was observed between frequent spicy food consumption and early satiation.
High consumption of spicy foods was associated with greater odds of FD, frequent postprandial fullness and epigastric pain.

Importance of identifying wellness with diabetes, this study aimed at determining wellness and its dimensions with type 2 diabetic patients.
This descriptive –analytical study performed among 621 patients with type 2 diabetes and using simple sampling method. The instrument was a two part questionnaire. In the first part were questions about sociodemoghraphic characteristics followed by second part which was standard questionnaire related to wellness and diabetes. This questionnaire translated and back translated and achieved validity and reliability. With the intention of data analysis, descriptive statistics were conducted. Significant level assumed at 0.05.
Findings: Mean score of total wellness was 137.6± 11. There were significant associations between gender and spiritual dimension, between family history and total wellness score, between educational level and physical and mental dimensions, between type of treatment and total wellness score and intellectual dimension with family income with mental, social and intellectual dimensions.
Gender, family history, education level, income level, type of treatment factors is affecting emotional well-being in patients with type 2 diabetes.

Psychological burnout syndrome based organization consisting of emotional exhaustion, depersonalization, and reduced personal accomplishment. Health workers as frontline troops (Primary Health Care- PHC) with the mission of promoting public health are exposed to a variety of physical and psychological problems. This research aims to "determine the status of burnout in health care personnel working in the homes of a number of health center in 2013" was conducted to provide an appropriate.
This study is a descriptive - cross-sectional analysis of 120 health workers employed - Esfahan 1health center was conducted. Data were collected with a questionnaire including personal information, professional information, questionnaire, Maslach (Maslach), respectively. Data were analyzed for statistical software SPSS version 20, SPSS Pearson, T-independent, analysis of variance and Spearman correlation were used.
Findings: The resulting score was moderate in all dimensions of burnout (mean= 42.1 and Standard deviation =14.7). Depersonalization dimensions of burnout in the emotional domain scores (P This study showed that the prevalence and severity of burnout among health workers Health Center, a number of medium but Burnout in women than in men, the reason can be simultaneously performed tasks and home tasks, jobs, health workers and children which increases the level of anxiety and stress as well as distance and lack of access to transportation facilities for commuting to work on.

One of the harmful factors in the field of occupational health is exposure to noise and vibration. Better control of hazardous agent requires robust and efficient software that prevents the increased risk with real-time control. Therefore, this study was conducted with the aim of setting a system using labview software to monitor the sound momently.
The research is an experimental study that was doing by using Labview software, microphones and sound analyzer card. Environmental information collected as sound pressure level via microphones and then processed by the sound analyzes card. The information showed by software as a graph or plot in the next step.
Findings: This software is including the front panel, back panel and connector panel that with these panels can be determined information such as various frequency weighting and time weighing. After entering the information, can be specified the sound pressure level, sound amplitude, power spectrum, power spectral density and other sound characteristics.
Labview programming capabilities in the field of sound can be referred to the measurement of sound, frequency analysis and sound control that actually the software acts like a sound level meter and sound analyzer. According to the mentioned features, you can use this software to analyze and process sound and vibration as a monitoring system.

One of the important consequences of the Industrial Revolution, increasing the intensity level of workplace noise. Aim of this paper to explain the role and importance of the noise level in the dental workplace, to has been Evaluate of dentistry noise exposure, dental unit hand piece noise level and the different part equipment of the great centers of Dentistry, Tehran.
In this cross - sectional study, Sound pressure level(SPL) were measured using B&K noisemeter models 2237 in the hearing zone of dentists at restoration parts, diagnostics, pediatrics, periodontics, oral surgery, endodontics and the CSR parts. The average sound pressure level means were measurement using the ISO 3744 standard.
Findings: The results show that the highest levels of sound pressure level (dB) among all studied parts were pediatric Ángel hand piece that was obtained 86 dB. Comparison of sound pressure level (LPT) showed the Maximum amount belonging to ultrasonic devices that was obtained 96.8dB.
The results of this study showed that the average noise level is high and as an important risk factor for hearing loss in exposed personals. In order to avoid problems caused by noise, such as hearing loss and use of suitable PPE is required accurate performance of hearing conservation program.

Inadequate consumption of fruits in students is as a risk factor for some diseases such as cancers and cardiovascular in adulthood. The purpose of this study was to survey associated with the fruit daily consumption in elementary student based on the theory of planned behavior (TPB) in Chalderan.
In this study were selected randomly 184 students from elementary school boys and completed questionnaires related to demographic data, structures the theory of planned behavior and daily consumption of the fruits of the data gathering were analyzed with SPSS version 20 and statistical analysis of correlation and Linear Regression.
Findings: The results showed that mean 1.32 of the students 1 time, 2.58 of 2 time, 2.9 percent 3 times and only 0.5 percent 4 times daily consumption of fruits. The results showed that 32.1 percent of the students 1 time, 58.2 percent 2 times, 9.2 percent 3 times and only 0.5 percent, consumed 4 times in day fruits. According to Linear Regression analysis, attitude and subjective norms were greater predictive power for intention of fruit consumption (=0.19, F=36, P Fruit consumption in students is less than the amount recommended by the World Health Organization. According to the findings of this study should be attention in design educational interventions for elementary student on subjective norms and behavioral intention variables.

Nowadays, synthetic azo compounds as environmental pollutants are widely used in different application. In this research the treatability of effluent polluted with reactive black 5 azo dye using electrocoagulation (EC) and electrocoagulation/ flotation (ECF) processes with aluminum electrodes investigated in a lab scale batch experimental reactor.
In present study an electrocoagulation flotation reactor in a lab scale to an approximate volume of 1 liter which is equipped with four Al0Al electrodes with dimensions of 200*20*2 mm was proposed. The effects of operational parameters such as initial pH, current density, contact time, initial dye concentrations and flotation were evaluated.
Findings: The results indicated that the highest dye removal rates in the EC process were observed in natural pH of solutions, 12.71 mA/Cm2 current density and 100 mg/l initial dye concentration at 30 min contact time. In these conditions up to 81% of dye was removed in the EC process. Based on the result obtained in this study, it was found that much higher dyes removal could be achieved by ECF (86%) process than that by EC process in the same conditions.
EC and ECF processes using aluminum electrodes for dye removal could be a promising process.

Despite of strategic planning for routine operation, many organizations fail to plan for emergency and crisis. Any organization should have a clear mission, pre-defined objectives and strategies for crisis period. Having a well established objectives and strategies can resolve many ambiguities at emergency scenes. Also, roles, direction and leadership will be implemented successfully.
A group of top managers identified the weakness, strengths, threats and opportunities within the organization. Then, this list refined using the Delphi technique and proper strategies were established by SWOT analysis. In the last step, AHP method was utilized for selecting the best choice among three options.
Findings: The main idea in the adaoptive strategy is utilizing the external opportunities for resolving internal weaknesses. External opportunities may includes external emergency teams and neighbors.
For any organization, as the normal situations it is necessary to havethe emergency documented plan and objectives. Such plans should be selecte sistematiclly and updated continuously

Various reports in the country concerning the adulteration of using Tartrazine instead of saffron in traditional candies (Poolaki and Nabat) highlights the urgent need to conduct a risk assessment study to evaluate the risk of Tartrazine intake through using these two candies .As a result, the current study aimed at assessing the risk associated of tartarazin intake through a descriptive study to determine the degree of Tartrazine by considering the role of these two sweets in Isfahan province and the presence and concentration of pollution in prepared samples.
Atotal of 500 questioners consist of demographic questions and questions related to patterns of nabat andpoulaki consumption were distributed among the households. Acquired data was analyzed using SPSS20 software. Also, 60 samples (35 Nabat, 25poulaki) were collected from the retail market and examined by TLC test.
Findings: This study showed that no sign of nabat contamination with tartarazin but 3 poulaki samples (12%) were detected to be contaminated at maximum 1µg/kg. Since the weight average of participant was 67 kg, the maximum intake of tartrazine is .07 microgram that very low thanADI (7.5 mg/BW)
Low occurrence of deception in using Tartrazine in whole tested samples is probably due to permanent control of such a deception by supervising organizations particularly vice chancellor of Food and Drug in Isfahan. The results showed low probability of Tartrazine human health risk through these two traditional candies and proposed that no new legal action to manage the risk at the current situation is required. However, higher prevalence of pollution in poulaki samples in addition to its greater daily consumption than nabat shows that poulaki seems to have a greater role in transferring this synthetic color in Iranian diet.

Breast cancer is the leading cancer among women in Iran with standardized incidence rate of 28.25. With regard to the aging and increasing cancer trends in Iranian population, the importance and geographical variations of cancer,it is necessary to identify those regions with high breast cancer incidence and get information on geographical its patterns and prominent risk factors using advanced statistical methods.
The used population in the present ecological study is all those breast cancer patients in Iran 2005-2008. We assessed the impact of cigarette, fruit and vegetable consumption, physical activity, overweight, and socioeconomic status on breast cancer using gamma-poisson, log-normal and BYM models.
Findings: Total number of registered breast cancer patients was 25152. From models used to analyze the data, unadjusted BYM had the best performance. In unadjusted models, Isfahan, Yazd, and Tehran had the highest and Sistan-and Baluchestan and Chaharmahal-and-Bakhtiyari incidence had the lowest incidence rate. After adjustment, the incidence was estimated to be the highest in Khorasan-Razavi, Khoramabad, and Hamadan and the lowest in Ardebil and Kohgiluyeh-and –Boyerahmad. Direct association between human development index (HDI) and breast cancer incidence was found to be statistically significant.
BYM model had the best fit and may cast so in future applications. Due to significant relationsip between HDI breast cancer, it is recommended to take it into account as a risk factor in future researches in this field. The incidence is generally high in central provinces.

Fertility is one of the important subjects in demographic studies which affects the population growth. Fertility variations can be explained by economical, political and cultural conditions and demographers have studied many of them. The purpose of this article, is modeling Children Ever Born (CEB), as one of the fertility determinant indicator, by Poisson regression to find affecting factors on it.
405, 15-49 year-old married women in Semnan, was collected by random stratified sampling and structured questionnaire in 2012. Birth local, educational level, job status and type of marriage were considered as affecting factors on CEB which modeled by Poisson regression.
Findings: Among the factors of birth local, educational level, job status and type of marriage, only birth local and educational level had statistically significant effects (p For modeling CEB, Poisson regression is more effective than linear regression model, because it is a discrete countable variable.

The aim of this study was to evaluate the nitrate removal using modified and unmodified natural zeolite, Clinoptilolite, from aqueous solutions.
In this study, due to low removal efficiency of unmodified zeolite, the zinc chloride and ferrous sulfate were used for adsorbent modification. The studied parameters were pH (1-12), contact times (2-186 min), nitrate concentration of the solutions (50-100 mg/l) and the adsorbent dose (5-20 g/l).
Findings: The nitrate removal efficiency by unmodified zeolite was about 40%, so, in the next series of experiments, the modified zeolites were used as adsorbent. The optimum conditions of nitrate removal for modified zeolite with zinc chloride and ferrous sulfate samples were pH=5 and 3, the contact times 66 and 66 min, the adsorbent doses 15 and 20 g/l and the initial nitrate concentrations 100 and 50 mg/l, respectively. The maximum obtained nitrate removals were 78.8% and 90.8%, respectively. The adsorption process by modified zeolite with zinc chloride and ferrous sulfate follows the Freundlich and Langmuir isotherm equations, respectively.
The results showed that the modified zeolite due to several adsorbent sites, simplicity, and high efficiency removal was more efficient than unmodified zeolite for nitrate removal. Therefore, at high nitrate concentrations the appropriate adsorbent was the zeolites that modified with zinc chloride, however, at low nitrate concentrations, the modified zeolites by ferrous sulfate showed high nitrate removal efficiency.

The need to improve the quality of lagoon effluent is one of the environmental priorities for wastewater projects. Thus, the study objective was to investigate horizontal roughing filter (HRF) performance to improvement total suspended solides (TSS), chemical oxygen demand (COD), turbidity and fecal coliform in the effluent from polishing pond following aerated lagoons in order to provide national standards.
The pilot-scale experimental study was carried out on-site wastewater treatment plant of Boukan, Iran. Design, manufacture and installation of horizontal roughing filter pilot was performed according to Wegelin guidelines. HRF Performance for removal of TSS, COD, turbidity and fecal Coliform was studied in three filtration rates 0.5, 1 and 1.5 m3/m2.hr. The results were analyzed by analysis of covariance (ANCOVA) using SPSS 16.
Findings: The mean of TSS, COD, turbidity and fecal coliform in the horizontal roughing filter effluent had the significant difference within various hydroulic loading rates (P The HRF can be used as appropriate option, due to high efficiency and easy operation, to improve the quality of effluent from the polishing pond following aerated lagoons in order to provide national standards.

Dye is considered as one of the most important environmental pollutants in industrial wastewater due to its harmful effects on both human and environment. This study was aimed to determine the the photocatalytic activity of titanium dioxide (TiO2), combined with the zeolite in removing red safranin dye in the aqueous phase.
TiO2 nanoparticles were produced using sol – gel method and 2.5 ml sol-gel was coated on zeolite. Red safranin dye was chosen as the model pollutant. X-ray diffraction (XRD) and scanning electron microscopy (SEM) were applied to specify the structure and morphology of TiO2 nanoparticles. The effect of TiO2 coating on zeolite, UV radiation intensity, initial concentration of dye and type of photocatalyst substrate in photocatalytic removal efficiency was investigated.
Findings: XRD results, the TiO2 nanoparticles had two phases including anatase (80.5%) and rutile (19.5%).The uniformity of nanoparticles was evidents in the SEM images. The removal efficiency of TiO2 coated on zeolite was more than that of only the TiO2 coating. With increasing UV radiation intensity from 2.4 w/m2 to 3.9 w/m2, the photocatalytic efficiency was also enhanced but the removal efficiency decreased from 91.61% to 77.91% when the red safranin dye concentration increased from 10 mg/L to 50 mg/L. The moving TiO2/zeolite photocatalyst bed had a higher efficiency than the fixed bed.
The TiO2/zeolite photocatalyst was much more effective than TiO2 photocatalyst in removing the red safranin dye in the aqueous phase. In other words, TiO2 coating on the zeolite, The removal efficiency of dyes increases from aqueous environment. TiO2/zeolite photocatalyst with fixed bed is recommended to be used in water treatment where the most important problem of using moving-bed TiO2/zeolite photocatalyst is opacity in the water treatment.