مجله تحقیقات سلامت در جامعه
سال چهارم شماره 4 (زمستان 1397)

Patient involvement in paying the out-of-pocket medical expenses is common in most countries. According to the instructions of the Urban Family Physician Program in Iran (Version 02), all care services should be provided free of charge. This study aimed to investigate the viewpoints of administrators and executives in Fars and Mazandaran provinces regarding the free provision of services.  This cross-sectional study was conducted in winter 2016. The study population included administrators and experts monitoring the Urban Family Physician Program, as well as representatives of Family Physicians who were selected by the census. The data were collected using a researcher-made questionnaire containing two parts with 20 items. In addition, The reliability and validity of this questionnaire were confirmed using alpha Cronbach at 0.87%. The data were collected from 29 expert panels in cities of Fars and Mazandaran. The obtained data were analyzed in SPSS software (version. 23). P-value less than 0.05 was considered statistically significant.  Out of 635 participants, 49 cases (7.7%) agreed that all services provided by family physicians and health care providers should be free. According to the results, free of charge services include care for chronic diseases (63.7%), basic visits and periodic examinations (48.1%), injections (40.4%), serum therapy (36.6%), bandaging (35.2%), therapeutic visits (22.8%), prescriptions of family physicians (22.6%), laboratory services (17.3%), and radiography and ultrasound services (15.7%).  This study showed that the majority of people disagreed with free of charge services provided by urban family physicians. Therefore, it is suggested to revise franchise systems regarding the provision of some services.

Lack of a safety culture in organizations is the main reason for the occurrence of accidents. This phenomenon is formed in an improper safety management system and an inappropriate safety culture. One of the ways to improve the culture of safety is education. Therefore, this study aimed at investigating the promotion of safety culture and the impact of education on this culture.  The present study was conducted on all employers working at Ekbatan Metal Industry to evaluate the safety culture using a questionnaire with the aim of promoting safety. The obtained data were analyzed in Excel and SPSS software (version. 19) through statistical tests. The training sessions were held and the safety culture was then    evaluated after the intervention. Ultimately, a comparison was made between the scores of safety culture and its ten dimensions before and after the  intervention.  The mean value of safety culture before the intervention was obtained at 287 and ten dimensions of the safety culture were  investigated individually. The mean scores of safety culture obtained from the employers and workers were 290.67±26.17 and 283±47.25, respectively, before the intervention. However, the mean score of safety culture was 318±31.11 after the intervention.  The results showed that education is one of the effective ways to promote safety culture. Education on safety can have a significant effect on the promotion of safety culture. Therefore, it is necessary to develop and implement educational programs based on the needs analysis. It is recommended to monitor these programs continuously and implement them in high-risk contexts.

Nowadays, the effects of air pollution, especially its detrimental effects om health, have made air quality control a matter of national concern. The present study aimed to compare air quality in Urmia based on the Air Quality Index in a five-year period of 2012-2017.  The samples in the present study included hourly data of five air quality criteria, including PM10, PM2.5, SO2, NO2, and CO collected and validated by the
Environmental Protection Agencyof Iran during a five-year period. Afterwards, the highest daily index value for the pollutants was determined using a standard method. The highest value among the calculated indices was considered as the final index, and pollutant that represents the highest index was introduced as the main pollutant of the day.  The results showed that air quality in Urmia was more than the expected standard of the   Environmental Protection Agency of Iran during 297, 265, 245, 267, 290, and 292 days in 2012-2017, respectively. On the basis of the results, the major pollutant in 2011 was SO2. Regarding other investigated years, PM2.5 played a significant role as a pollutant.  The evaluation of the air quality of Urmia during 5 years revealed that the current condition is far from the ideal.

Obesity is one of the most important causes of mortality in developing countries. Omentin-1 and chemerin, as cytokines secreted by adipose tissue, are associated with obesity. Chemerin is considered a bridge between obesity and the exacerbation of diabetes type II. On the other hand, omentin-1 plays a role in regulating energy metabolism and body fat distribution in the body. The aim of the present study was to determine the effect of 8-week aerobic training on the serum levels of chemerin and omentin-1 in overweight women.  This semi-experimental study was conducted on 21 overweight women with a pretest-posttest design and a control group. The study population was randomly divided into two groups of exercise (n=11) and control (n=10). The training program consisted of moderate aerobic training, including 30 min of running within 50-70% of maximum heart rate that was controlled with a Polar watch. This intervention was performed 3 sessions a week for 8 weeks. Blood samples were collected 48 h before the first session and 48 h after the last training session to measure the levels of serum omentin-1, chemerin, lipid profile, and insulin. Analysis of covariance was used to assess the differences between the groups.  The serum chemerin levels showed a significant reduction in the exercise group as compared to that in the control group (P=0.023). In addition, the serum levels of omentin-1 significantly increased in the exercise group, compared to that in the control group (P≤0.001).  Aerobic exercises can improve the body composition and regulate the serum levels of insulin and glucose, thereby regulating the serum levels of chemerin and omentin-1 as adipokines. It seems that 8 weeks of aerobic exercise training accompanied by the elevation of omentin-1 level and reduction of chemerin level and factors related to obesity have an important role in the  improvement of cardiovascular health and metabolic disorders associated with obesity in overweight women.

Public attention has been growingly given to healthy food products. Development of organic farming and enhancement of consuming such products in society require attending to consumers’ orientations and tendencies. Regarding this, the aim of the present study was to evaluate the viewpoints of experts and consumers about organic livestock products in Sistan and Baluchistan province, Iran.  For the purpose of the study, first, an open-ended question regarding the barriers to the expansion of organic livestock products was sent to the experts (n=33) through Delphi technique. After extracting the main indices from the experts’ responses, a questionnaire, consisting of 13 items, was designed to evaluate the consumers’ viewpoints (n=516) about the barriers to developing organic livestock products in Sistan and Baluchistan province.  From the experts’ points of view, the main factors accounting for the restriction of the extension and promotion of animal organic products consumption included the lack of consumer s’ confidence about organic products, consumers’ unawareness of the benefits of organic animal products, and inability to purchase the organic livestock products due to economic weakness. Moreover, the consumers reported the inefficient organic animal production technology, lack of appropriate conditions for organic animal production, and shortage and limitation of supplying organic livestock products in the market as the most important barriers to developing and promoting the organic animal products.  Enhancement of people’s acceptance of the novel products and approximation of the experts and consumers’ viewpoints could have a key role in the expansion of organic animal product consumption in Sistan and Baluchistan province.

The most prevalent accidents and injuries occur in industries. Risk assessment and risk management are the basis for planning to provide solutions and control hazards. Therefore, the present study aimed to identify and assess the workplace hazards using the failure mode and effects analysis (FMEA) approach in a carpet manufacturing company located in Mazandaran.  The current study utilized FMEA approach to evaluate the potential risk factors. Some units of carpet manufacturing company including 8 different workstations were assessed with 60 employees. Furthermore, failure modes and effects, as well as the causes of the failure of each component, were evaluated in this study. Subsequently, the Risk Priority Number of each workstation was separately calculated and the crisis level of each risk was prioritized.  According to the results of the study, out of 55 risk factors identified in 8 different workstations at the factory, 18.2 %, 67.3%, and 14.5% of these risk factors were within acceptable, unacceptable, and emergency level, respectively. Moreover, the units, including painting, dipping, extrusion, and assembly obtained the highest risk frequency in terms of explosion and electric shock.  According to the results of this study, workers are highly susceptible to occupational accidents and injuries due to the presence of high risks factors in the above-mentioned unit. Although FMEA approach is applicable to identify the potential failures in work-related accidents, it is recommended using Preliminary Risk Assessment Method in order to conduct a more exact and comprehensive assessment.

Scorpion stings can threaten human health. The investigation of the epidemiologic factors affecting scorpion stings plays an important role in the prevention of this public health issue. Therefore, this study was conducted to investigate the epidemiology of scorpionism in Qaenat  city, South Khorasan Province, Iran.  This retrospective cross-sectional study was conducted on all the stung people residing in Qaenat city of South Khorasan Province during 2011- 2016. The epidemiology of patients and demographic data were collected in a checklist and data were analyzed in SPSS (version 20).  A total of 164 cases stung by scorpion were enrolled in the present study, including 75 males (45.7%) and 89 females (54.3%). The most and least frequent cases of stung were observed among individuals within the age range of 25-34 and 55-64 years, respectively. Hands, head, and face were the  most prevalent sting sites with the occur-rence rates of 56.7, 37.8, and 5.5%, respectively. Scorpion stings occurred mostly during spring and summer with the highest rate of 30% in July. Out of total cases, 46.3% were residing in urban areas and 53.7% in rural areas.  Considering the fact that the highest occurrence rate of scorpion sting was observed in rural areas, educa-tional programs for all health and medical personnel as well as physicians of centers, promotion of public aware-ness in the city and village, improvement of places and rural roads can play an important role in the prevention of scorpionism and mortality.

Maternal death during pregnancy or delivery and 42 days after the termination of pregnancy for any reason other than an accident is called maternal mortality. Maternal mortality due to the complications of pregnancy and childbirth is a sensitive indicator of women status in society, access to care, efficiency and quality of healthcare, capacity of the service system to meet the needs of women and demonstrates the economic and social conditions of each society. In addition, mortality due to pregnancy and delivery complications is one of the most important indicators that shows the condition of developing countries. In this regard, this study was conducted to investigate the causes of maternal mortality and related risk factors in pregnant women in Ardebil, Iran, from 2006 to 2016.  In this cross-sectional study, registered information were extracted regarding   the mortality of pregnant women, including demographic characteristics, indicators related to pregnancy, childbirth, and causes of death from 2006 to 2016 from the Family Health Unit of Provincial Health Deputy. Finally, the collected data were analyzed.  According to the obtained results, there were 39 cases of maternal mortality from 2006 to 2016. However; there was no maternal mortality in 2008 and 2015. The mean age of dead mothers was 30±1.8 years (age range: 15-44 years). Considering the mortality stage, 10 patients died during pregnancy (25.6%), one patient died during labor (2.5%), 12 patients died 24 h after delivery (30.7%), and 16 patients died after 24 h. On the other hand, 11 (28.2%) mothers had normal vaginal birth (NVD) and 28 cases (71.8%) had a cesarean section. Moreover, 31 women (79.48%) were at risk. There was a positive relationship between the type of delivery (cesarean section or NVD), parity (the first and second pregnancy), and risk factors during pregnancy with maternal mortality. Hemorrhage was the most common cause of maternal mortality. It is worth mentioning that there was no significant relationship between the causes of maternal mortality.  According to the obtained results, there was a significant relationship between the number of pregnancies and type of delivery with maternal mortality. Moreover, hemorrhage was the most common cause of maternal mortality. Regarding the high levels of cesarean section effects on maternal mortality, it is recommended to carry out vaginal delivery. In this regard, it is necessary to take measures to conduct vaginal delivery without pain to reduce cesarean section rates. In addition, due to the high mortality rate in middle-aged mothers with a high number of pregnancies, it is suggested to use contraceptive methods, such as oral contraceptives, condoms, and birth control.