مجله تحقیقات نظام سلامت
سال دوازدهم شماره 2 (تابستان 1395)

Today, infertility is a major medical problem and its prevalence is increasing worldwide. Infertility affects men and women of reproductive ages. In addition, infertile couples encounter many emotional and mental problems. The Theory of Planned Behavior is a theory that explains the process of adopting appropriate behaviors. The aim of this study was to determine the predictive power of the Theory of Planned Behavior on the intention of infertile couples to solve the problem of infertility.
This descriptive-analytical study was conducted on 64 infertile couples referred to obstetrics and gynecologist clinics of Birjand, Iran, in 2015. The study participants were selected through convenience sampling. The data gathering tool was a researcher-made questionnaire in accordance with constructs of the Theory of Planned Behavior. The validity and reliability of the questionnaire were approved using the opinions of 10 experts and Cronbach’s alpha (α = 0.91), respectively. Data were analyzed in SPSS software. The Pearson correlation coefficient was used to determine the relationship between the constructs and regression analysis was used to determine the predictive power of each construct. All P values of less than 0.05 were considered significant.
Findings: The mean age of the subject was 30.68 ± 5.24 years. Significant positive correlations were observed between all variables of the Theory of Planned Behavior and intention (P The Theory of Planned Behavior can predict the intention to solve the infertility problem.

Knowledge, risk perception, and preparedness of individuals regarding earthquake have a vital role in the reduction of its consequences. This study was conducted to evaluate the level preparedness, knowledge, and risk perception regarding earthquake among the personnel of Shiraz University of Medical Sciences, Shiraz, Iran.
This cross-sectional study was conducted on 215 personnel of Shiraz University of Medical Sciences. The subjects were randomly selected. Data were gathered using a researcher-made questionnaire including demographic data, and risk perception, knowledge, and preparedness regarding earthquake. The collected data were analyzed in SPSS software. All P values of less than 0.05 were considered significant.
Findings: Most of the studied individuals were women (54%), had diploma and higher levels of education (85%), had 30-40 years of age (50%), and were married (75.3%). Most of them had an intermediate level of preparedness and risk perception and a high level of knowledge in regards to earthquake.
The subjects in this study had a high educational level, and due to their job and education, had received some training regarding earthquake preparedness. However, their level of earthquake preparedness was at an intermediate level. Since the earthquake preparedness level of the public is at a lower level, similar studies with greater sample size among the public are required in order to plan for the promotion of the present situation.

Considering health and public health risks, particulate matters are the main pollutants of air and are associated with high rates of mortality and morbidity in long and short term exposures. Hence, the present study was performed with the aim of estimating the health impacts attributable to PM10 in the 7 cities of Mashhad, Tabriz, Isfahan, Shiraz, Arak, Ahwaz, and Urmia (Iran) during 2011-2012 using the AirQ model.
In this cross-sectional study, to achieve the purposes of the study, initially, data on PM10 pollutant were obtained from the Department of Environment of the studied cities. After data validation, the required statistical parameters were calculated in order to quantify the health effects. The processed data were imported to the AirQ model, and the results of the model for each city were presented in the form of mortality and morbidity cases.
Findings: The highest annual average concentrations of PM10 were observed in Ahwaz and Isfahan and were 193 and 127 μg/m3, respectively, which were almost 9.65 and 6.35 times the Iranian and World Health Organization (WHO) standards (20 µg/m3). Cumulative number of total mortality cases attributed to PM10 in Mashhad, Tabriz, Isfahan, Shiraz, Arak, Ahwaz, and Urmia were estimated at 634, 302, 542, 362, 123, 549, and 169 cases, respectively. From the total 122282 cases of hospital admission due to respiratory disease in the 7 cities, 8144 cases were attributed to PM10.
The current study emphasized the adverse effects of particulate matter on human health. Therefore, it revealed the necessity of appropriate planning and implementation of effective measures to decrease the health consequences of air pollutants, such as particulate matter, on public health and control their detrimental effects.

Metronidazole, as one of the most widely used antibiotics in the world, in addition to various benefits, has significant adverse effects on the environment and animals. The catalytic ozonation process is one of the most successful methods for antibiotics removal. However, it should be noted that this process, like other oxidation processes, has some byproducts that can be toxic in the process effluent.
Under optimum conditions for catalytic ozonation in the presence of MgO nanoparticles, 1 sample was obtained from a reactor after 10 minutes of ozonation. The sample was analyzed by gas chromatography–mass spectrometry (GS-MS) and the intermediates were identified. The mineralization rate was determined using TOC analysis and the toxicity changes were calculated through bioassay with Daphnia magna.
Findings: In the present study, 4 compositions were identified as oxidation intermediates. The mineralization rate was about 93.5% and the 48-hour toxicity unit decreased from 1.24 in the influent to 0.32 in the effluent.
A high mineralization rate was obtained in the process. Nevertheless, it was not complete, and thus, the influent solution was converted from toxic to slightly toxic. In conclusion, we can say that catalytic ozonation process in the presence of MgO nanoparticles can be acceptable for metronidazole removal.

The entrance of toxic compounds into wastewater treatment plants (WWTPs) can induce disorder in their biological units. Therefore, it is necessary to determine the sources of toxic wastewaters. In this study, the toxicity of the wastewater of 3 metal plating industries was assessed using sequencing batch reactor (SBR) bacteria.
To obtain the 1-1000 ml/l concentrations, the 3 metal plating wastewater solutions were diluted using distilled water. To determine the growth inhibition in each concentration, the 0.5 cc cultured SBR bacteria on nutrient broth media was used and cultured on nutrient agar media. Data were analyzed using the Probit analysis in SPSS software and the 50% effective concentration (EC50) was calculated.
Findings: According to the Probit analysis, there was no effect on the tested bacteria at the concentrations of 1 ml/l, less than 50 ml/l, and less than 100 ml/l of metal plating wastewater in samples 1, 2, and 3, respectively. However, all studied bacterial species were eliminated in the concentration of 1000 ml/l of each metal plating wastewater. Maximum and minimum EC50 were recorded for the metal plating wastewater sample number 3 (960 ml/l) and number 1 (6.5 ml/l), respectively.
Results of this study showed that some metal plating wastewaters, even in very low concentrations, can induce adverse effects on the bacterial community structures of biological units of WWTPs. Thus, it is recommended that effluent standards and in situ treatment rules be applied according to the performed process type in such industries.

To the best of the authors’ knowledge, to date, no systematic study has been carried out in Tabriz city to investigate the extent, frequency, causes, and major outcome(s) of falling accidents in the houses of rural and urban areas of this city. The current study was, therefore, undertaken to address some of these issues.
In this cross-sectional retrospective study, 43170 individuals who referred to emergency units of hospitals as a result of falling accidents during 2006-2010 were studied. The data were collected from national registration program of incidents in a safe community. Gender, age, year, seasonal distribution, and place and outcome of injuries were considered in data analysis. The data were analyzed using descriptive statistics and independent t-test and chi-square test.
Findings: A total of 43170 falling accidents had been registered during the study period. Of the total registered patients, 56.6% were injured in the houses. Accidents, in general, were more common (52.9%) in women, than in men (47.1%). Accidents were more prevalent in children under 10 years of age (27.3%) followed by people of 20-29 years of age (16.6%). Seasonal distribution of the accidents revealed that they were more common in summer and less in winter in all age groups, except in people older than 70 years of age (more common in winter).
According to the results of this study, over 50% of falling accidents occurred in the house. Therefore, in order to reduce the rate and prevalence of this accident and its outcomes, designing appropriate educational programs and house environments according to ergonomic principles is recommended.

Measurement of the maximum aerobic capacity (VO2-max) is important in creating physiological compatibility between the job and worker. This compatibility, in addition to maintaining health and physical capacity, may cause to increase production and productivity. The purposes of this study were to estimate aerobic capacity and determine factors affecting it. Since the estimation of VO2-max ýhas not been previously performed in Iran, these data can be recorded in the National Data Bank.
In this cross-sectional study, 85 workers of an underground mine in the province of Isfahan, Iran, participated. Their demographic data were recorded, and parameters of height, weight, BMI, and heart rate were measured. VO2-max was estimated using an ergometer bicycle and Astrand nomogram. Finally, the relationships between VO2-max and the measured parameters were analyzed using t-test and regression analysis in SPSS software.
Findings: The mean aerobic capacity in workers was 4.22 ± 0.86 liters per minute. Results showed that there was no significant relationship between aerobic capacity and BMI, age, and work experience. However, t-test showed significant relationships between VO2-max and smoking (P = 0.036), and exercise (P This study showed that BMI is not an appropriate index for predicting VO2-max, and thus, physical work capacity. Results showed that regular exercise and lack of smoking has a great effect on maximum oxygen consumption.

In many jobs, individuals are exposed to thermal stress, and thus, evaluation of heat stress is necessary. This study was conducted with the purpose of investigating the relationship of perceptual strain index (PeSI) with other heat indexes under hot laboratory conditions.
This empirical-experimental and cross-sectional study was performed in 5 different temperatures (21 ºC, 24 ºC, 27 ºC, 30 ºC, and 35 ºC). It was carried out on 15 male students in the climate chamber and on the treadmill with the three levels of light (2.4 km/hour), medium (4.8 km/hour), and heavy (6.3 km/hour) activity. The thermal sensation scale and perceived exertion rate were recorded to calculate PeSI and the Heat Strain Score Index (HSSI) was completed. Moreover, wet-bulb globe temperature (WBGT) and air temperature were recorded. Data were analyzed using Pearson correlation test and regression analysis.
Findings: Pearson correlation test showed a high correlation (r = 0.84) between PeSI and HSSI (P = 0.001). Furthermore, Pearson correlation test showed, respectively, a good correlation (r = 0.74) and a high correlation (r = 0.81) between PeSI and WBGT, and air temperature (P = 0.001).
The results of this study showed that PeSI can be used for the evaluation of heat strain since it has an acceptable correlation with other heat strain indices, can be easily and rapidly applied, and its cost is much less than other heat strain evaluation indices.

The sequencing batch reactor (SBR) is one of the most widely used systems in sewage treatment because of the simplicity of the process, flexibility of operation in the removal of nutrients, and the ability to be used in different scales. The aim of this study was to evaluate the efficiency of the SBR in the removal of organic matter (nitrogen and phosphorus) from synthetic wastewater at laboratory scale.
In this study, a SBR with a capacity of 24 liters and 24-hour working cycle was used. The sequences of phases consisted of 30 minutes filling, 180 minutes aerobic, 120 minutes anaerobic, 900 minutes aerobic, 180 minutes anaerobic, 20 minutes settle, 5 minute decant, and 5 minutes idle. The initial concentration of nitrogen and phosphorus were 40 and 20 mg/l, respectively. The initial organic load was 0.41 to 0.83 kg chemical oxygen demand (COD)/m3/day. Sampling was carried out in the first aerobic phase and after the third hour anaerobic phase.
Findings: In this system, the average COD removal efficiency in the effluent during these six steps were 65.35%, 92.9%, 95.2%, 93.33%, 96%, and 96.5%, respectively. The results showed that the highest average removal efficiency of organic matter and phosphate phosphorus were 96.5% and 33.05%, respectively, in the sixth stage, and for nitrogen was 34.6% in the first stage.
The results showed the acceptable performance of the SBR in the removal of organic matter and nutrients (P, N).

In recent years, extreme usage of tetracycline antibiotic in aviculture has been evidenced repeatedly in some countries. In some cases, the residue levels exceeded the maximum permitted level. However, the presence of tetracycline in eggs has not been scientifically investigated in Iran thus far. The present study was conducted in order to assess the level of tetracycline residue in egg samples distributed in Isfahan market, Iran.
The present cross-sectional study was designed and conducted during autumn 2014 on 40 samples of commercially produced eggs from different brands and 6 samples of locally produced eggs. The samples were randomly collected from retail markets in Isfahan. Samples were examined using Enzyme-linked immunosorbent assay (ELISA) commercial test kit for tetracycline residue measurement. Data were analyzed using one-way ANOVA in SPSS software.
Findings: The levels of tetracycline residue in egg samples ranged from 0.56 ppb to 9.7 ppb, with an average value of 3.1 ppb. These results suggest the compliance of the detected residue levels with the permitted maximum levels established by the European committee (200 ppb). In addition, egg yolk samples showed significantly higher amounts of tetracycline than the albumen samples.
As a major finding of this study, the eggs distributed in Isfahan maintain wide margin of safety regarding tetracycline contamination.

Road runoff is a linear diffuse source of pollution, with very specific pollutant characteristics and ability to discharge into the environment. Heavy metal pollution in road runoff has caused widespread concern since the last century. Therefore, the purpose of this study was to assess Fe, Pb, and Cd concentrations in surface runoff from regions with high traffic intensity in the city of Hamadan, Iran, in 2014.
Runoff samples were collected from 8 selected stations. After the laboratory preparation stage, the concentration of the elements was determined using inductively-coupled plasma-atomic emission spectroscopy
(ICP-OES). All statistical analyses were performed using the SPSS statistical package.
Findings: The results showed that the mean concentrations of Fe, Pb, and Cd in runoff samples were 0.42 ± 0.38, 4.23 ± 3.0, and 6.48 ± 4.46 µg/l, respectively. The comparison of the mean concentrations of the assessed metals with the World Health Organization’s (WHO) permissible limits revealed a significant difference (P The results indicated that surface runoff from regions with high traffic intensity in Hamadan were polluted with Fe, Pb, and Cd, which threatens surface water resources, and thus, the health of citizens

The restriction in resources of health services renders the prioritization of the distribution of these resources necessary. The health care need index is used to investigate equality in distribution of health services. The main aim of the current study was to estimate this index for skin cancer in Iran by involving the effect of adjacent regions.
The present study was a correlational research. The study population consisted of all patients with and deceased due to skin cancer registered by the Iranian Ministry of Health from 2008 to 2010. Data were analyzed using winBUGS software and through geographical mapping using ArcGIS software.
Findings: The results suggested that Markazi, Isfahan, and Kohgiluyeh and Boyer-Ahmad Provinces, respectively, had the highest health care need indices for skin cancer.
The results of this study displayed that the central provinces, which have longer sunshine duration, require more health services. Therefore, policymakers should pay additional attention to these regions because longer duration of exposure to sunshine is a risk factor for skin cancer.

Skin cancer is the most common malignancy in the world. Thus, the aim of this study was to determine the incidence trend of skin cancer in Isfahan Province, Iran.
The present cross-sectional study was conducted using data registered during 2004-2008 in the Disease Management Center and Cancer Registry System of the Ministry of Health and Medical Education. The trend of skin cancer incidence in both sexes was analyzed using the Cochran–Mantel–Haenszel test.
Findings: Age-standardized incidence among men and women was 28.4 and 18.3 per 100,000 in 2004 and 30.8 and 18.9 per 100,000 in 2008, respectively. Relative incidence of skin cancer was 1.08 and 1.03 in the year 2008 compared to 2004 in men and women, respectively. During the study period, the highest specific incidence rate was observed in the age group of 84-80 years in both men and women. Results of the Cochran–Mantel–Haenszel test revealed that the incidence trend during 2004-2008 among men (P = 0.065) and women (P = 0.49) was not statistically significant.
Although the trend of skin cancer incidence in Isfahan Province was not significant, the rate increased over the years and it was nearly two fold in men compared with women. As a result, it seems necessary to train at risk individuals to use protective equipment against the sun's ultra violet rays and further research is needed on its risk factors.

One of the criteria of health equity is having health insurance coverage. Construction workers and their families are one of the most vulnerable populations regarding diseases and accidents. Thus, this study was conducted with the aim to determine the utilization rate of health services among construction workers ýand their families.
In this descriptive-analytical study, the rate of health services utilization by the families of construction workersý and factors associated with them were evaluated in the city of Isfahan, Iran, in 2013 using a standard questionnaire. Therefore, 400 married construction workers who were waiting for daily work on the walkways of the main squares of Isfahan were selected randomly. Data were gathered through interviews.
Findings: The findings showed that 39.5% of construction workers were not covered by any health insurance. Moreover, 19.25% of the construction workers’ families had required outpatient health services within the past 2 weeks, but only 71.43% of them had used these services. Approximately 17.25% of the construction workers’ families had required hospitalization within the past year. The average number of hospitalizations among the construction workersý’s families was 1.54 times per year. In addition, 4.75% of the families had suffered from catastrophic health expenditures due to hospitalization.
The rate of health insurance coverage among construction workers ýis lower than the average of the Iranian population. Construction workers’ ýfamilies who suffered from catastrophic health expenditures due to hospitalization were 2.5 times more than the average of the general population.

Providing fairly accessible and economical services for rural communities is one of the main challenges of health systems in many countries. Geographical information system (GIS) can be used as useful tool for analyzing and modeling the accessibility of rural communities to health services. This study aimed to perform geographical analysis on the accessibility of rural communities of Khozestan Province, Iran, to rural health houses.
This was an applied and descriptive-analytical study. The study population consisted of all villages of Khozestan Province. After gathering spatial data, and defining descriptive indexes and reforming them, this data was entered into ArcGIS software. Then, major levels were defined and the operational area of the health houses was determined.
Findings: The results of this study showed that 3315 of the total 4547 villages (72.9%) had permanent inhabitants, 146 (3.2%) had seasonal inhabitants, and 985 (23.9%) had no inhabitants. Only 2223 (48.9%) villages had asphalt roads. Moreover, 358 villages which had permanent inhabitants were located outside the health house accessibility boundary.
In Khuzestan Province, geographical accessibility to rural health houses has some challenges. Some of these challenges are due to the inappropriate condition of rural roads, geographical isolation and scattered villages, and unbalanced development of villages. GIS can be used to improve the efficiency of the rural network extension plan.

The aim of this study was to compare the difficulty in emotional regulation and traits of borderline personality disorder among addicts undergoing methadone treatment, self-referred addicts, and healthy subjects.
The current study was a causal-comparative research. The statistical population of this research included all men referring to substance abuse addiction treatment centers in Khoy, Iran, in 2013. The sample consisted of 40 addicts underdoing methadone treatment, 40 self-referred drug addicts, and 40 non-addicted individuals. The subjects were selected through convenience sampling method. For data collection, subjects completed the Difficulties in Emotional Regulation Scale (DERS) and Schizotypal Trait Questionnaire-B Form (STB). Data analysis was performed using multivariate analysis of variance (MANOVA) and Tukey’s test in SPSS software.
Findings: The results indicated that self-referred patients (receiving no treatment) had significantly higher scores in STB [f = 15.05, P = 0.0001] and DERS [f = 47.33, P = 0.0001] than individuals treated with methadone and healthy individuals. However, Tukey’s test results showed no significant difference between patients treated with methadone and healthy subjects in this component.
Due to the role of difficulty in emotional regulation and borderline personality traits in substance use disorders (SUDs), further studies on the role of these variables in the initiation and maintenance of substance use are necessary. Moreover, holding workshops related to emotional regulation and impulse control skills for substance users seems necessary.