مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال هفتم شماره 4 (پیاپی 28، زمستان 1388)

Despite the fact that the proportion of youth population is very high in Iran, there is no well designed, comprehensive reproductive health program for the youth. This prompted the health planners to evaluate all the existing centers that deliver reproductive health services to the youth in the country in order to identify the weaknesses and strengths of the services and the centers. A descriptive analytic study was conducted from March 2006 to March 2007, in coordination with the Vice-chancellor for Health of Universities of Medical Sciences, through Offices for Health of the Youth and Schools (OHYS). Five health centers, namely, Tehran, Semnan, Bam, Chabahar, and Fassa Health Centers (the only centers delivering reproductive health services to the youth) were included in the study. They were assessed for structure and physical facilities, job satisfaction of the personnel, satisfaction of the youth consulting them, and the services (including consultative services) delivered. The data were gathered through questionnaires using a checklist and analyzed by the SPSS-13 software. The health center personnel thought that the quality of services delivered at the centers was low. They also believed that the physical facilities, including equipment in the clinical examination room, furniture, cleanliness of the premises, and entertainment facilities, were not of an acceptable standard. About 64% of the personnel of the health centers personnel expressed job satisfaction. On the other hand, 39% of the young people consulting the centers expressed full, and 54% relative, satisfaction with the services they were receiving; the remaining 7% were not content at all. The highest rate of satisfaction was with the psychologist, physician, and midwife, so that 95% of the clients recommended the centers to other young people seeking reproductive health services. Finally, the clients said that in most of the centers paramedical personnel, including nutrition officers (50%) and midwives with a Master's degree (17.5%), were insufficient. It is suggested that a comprehensive service package be developed to be used in all the health centers, rather than each center deliver services based on the existing facilities and individual preferences. Such a package should be based on the national reproductive health programs (according to the medical education curricula). Intersectoral collaboration (particularly from the Ministry of Education and cultural organizations) is also very essential.

Anemia is an important public health problem in Iran. The most prevalent type (50%) is iron-deficiency anemia. Flour fortification with iron and folic acid is one of the main strategies usually adopted to combat anemia. Two pilot projects were conducted in 2 Iranian provinces: the first one in Bushehr in 2001 and the second one in Golestan in 2007. The present study was conducted in January 2009 to evaluate the process and determine the effectiveness of the flour fortification pilot project in the 2 provinces. To evaluate the effectiveness of the project, blood hemoglobin and ferritin levels were measured in a sample population of child-bearing women aged 15-49 years in Bushehr Province (n=600) and Golestan Province (n=625), selected by multi-stage sampling before and after the intervention. For process evaluation, the iron content in samples of flour and bread made from the flour were measured in a descriptive study. We found similar trends in the indicators of anemia/iron deficiency among the women in Bushehr and Golestan provinces. The flour fortification project appears to have had beneficial effects on the serum ferritin levels (low levels indicate iron deficiency) in both provinces. The prevalence of iron deficiency decreased from 22.2% to 15.7% (p<0.002) and from 26.7% to 14.6% (p<0.001), in Bushehr and Golestan, respectively. However, the prevalence of anemia was significantly higher after intervention in Golestan (p<0.001). Further analysis of the data also revealed that the intervention did not have any statistically significant effect on the prevalence of iron-deficiency anemia in either province. The coverages of fortified flour and bread were 90% and 98.7% in Bushehr and 94.1% and 95% in Golestan, respectively. The flour fortification pilot project in Iran resulted in reducing prevalence of iron deficiency and improving body iron reserves in women, but it had no effect on anemia prevalence. It can be concluded that in circumstances where iron deficiency is not a major cause of anemia, interventions such as flour fortification with iron alone will not produce any significant effect.

Previous studies show that disability and mortality due to cardiovascular diseases are closely related to socioeconomic status in a community. The objective of this study was to determine the relationships between socioeconomic factors and coronary artery disease (CAD) among people under 45 years old at Shahid Rajaei Hospital, Tehran, Iran. This case-control study was conducted in Shahid Rajaei Hospital, Tehran, Iran in summer 2008. The participants were 100 CAD cases (<45 years old, mean age = 41.2 years; 85% men) and 100 controls from among accompanying persons matched for age and gender. In order to assess the risk of factors related to such variables as educational level, occupation, income, social exclusion, social support, stress, exercise, nutritional status, smoking, etc, odds ratio (95% CI) was used. Multinomial logistic regression was used to assess the synchronic effect of the risk factors, and the t-test was used to find differences between means. The odds ratio (95% CI) for smoking vs nonsmoking was 3.9 (1.9-7.9) for CAD. Individuals with a low educational level showed an odds ratio of 2.7 (1.9-7-9), compared to those with a high educational level. Eating fruits and vegetables at least seven servings a week has an odds ratio of 2.7 (1.01-7.4) vs eating fewer servings. Occupation, job grade and physical activity had statistically significant relationships with CAD. Mean BMI was different between cases and controls. The disease had no significant association with stress, social support, social exclusion or income. Smoking, a low educational level and eating small amounts of fruits and vegetables were the most important socioeconomic factors contributing to coronary artery disease. Policymaking and planning aiming at improving the socioeconomic situation of the people, particularly those under 45 years old, seem essential

The most important principles in an organization are continuous development and survival. Nowadays, creativity and innovation are vital for survival in a competitive world. The thinking style of a manager in an organization is an important factor in his/her creativity. The purpose of this study was to investigate the relationship between thinking style and organizational innovation in 84 senior and junior managers of Shiraz educational hospitals in 2008. In this descriptive-analytical study 84 top and mid-level managers of Shiraz teaching hospitals were selected by the census method. Data were collected using two standard questionnaires, one for thinking style and one for innovation, the content validity and reliability of which had been confirmed. A preliminary test showed the Cronbach's alpha for the thinking style and organizational questionnaires to be 0.83 and 0.72, respectively. Data analysis was performed using Spearman correlation test. The Spearman correlation analysis showed a statistically significant, although weak, relationship between thinking style of senior and junior managers of Shiraz teaching hospitals and their organizational innovation. A pragmatic thinking style had the strongest association with organizational innovation. The thinking style of a teaching hospital manager plays a vital role in his/her creativity. No thinking style is particularly preferred; any thinking style may give desirable results as regards creativity of a manger, depending on the circumstances and conditions.

Human error often plays an important role in accident causation either through direct action or poor design. The focus of this work was on prediction of human error probabilities during the process of emergency musters in gas compressor stations.This paper aims to present a brief description of Human Error Probability Index (HEPI) for the gas compressor station musters process.

Due to a lack of human error databases, and in particular human error data on gas compressor station musters, an expert judgment technique, the Success Likelihood Index Methodology (SLIM), was adopted as a means to predict human error probabilities Two muster scenarios of varying severity (gas release, fire and explosion) were studied in detail. A total of 34 reference graphs provided data for both the weighting and rating of six performance shaping factors and the data were subsequently processed by means of SLIM to calculate the probability of success for 16 muster actions ranging from point of muster initiator to the final actions in the temporary safe refuge (TSR). The actions were categorized into 4 phases, namely, awareness, evaluation, egress, and recovery phases. The six performance shaping factors considered in this work were stress, complexity, training, experience, event factors, and atmospheric factors.

Human error probabilities in the egress phase were highest, followed by those in the evaluation phase; the lowest were in the awareness phase.

The HEPI can be applied to limit the chances of human error occurrence and mitigate the consequences of such errors through changes in training, design, safety systems, and procedures, resulting in a more error-tolerant design and operation.

The aims of this study was to explore the feasibility of improving efficiency of the wastewater treatment system of the Fars Pegah Dairy Industries (FPDI) and propose ways to upgrade it in 2006-2007. The FPDI wastewater treatment system was of a successive anaerobic-aerobic type using anaerobic stabilization ponds and conventional and extended aeration activated sludge. Due to improper design and operation, it did not meet the required standards with regard to disposal to the surrounding cultivated land. To overcome the problem and eliminate the bad smell, modifications were made, such as changing the entries and exits of the ponds, adjustment of the activated sludge process, and converting the conventional activated sludge F/M to a step-feed activated sludge shift. The efficiency of the system was assessed before and after these modifications The efficiency of the system to eliminate biochemical oxygen demand (BOD5), chemical oxygen demand (COD), total dissolved solids (TDS), total suspended solids (TSS), total coliform, and fecal coliform increased from 82.42%, 86.87%, 64.18%, 20.23%, 54.56% and 50.87% to 97.34%, 98.61%, 90.4%, 28.44%, 90.09% and 89.95%, respectively. The findings show improvements in the efficiency of the wastewater treatment system due to the changes made in it. It was also observed that efficiencies of the feed-step aeration and the extended aeration are similar. This means that application of the extended aeration in the treatment system of the plant would result in waste of money and energy.

The hospital is considered as the biggest and the most costly unit of a health care system. Therefore, paying full attention to its cost efficiency is very important. The objective of this study was to assess the technical efficiency of hospitals affiliated with Tehran University of Medical Science by data envelopment analysis method. Technical efficiency in hospitals affiliated with Tehran University of Medical Sciences was assessed by Data Envelopment Analysis (DEA) from 1996 to 2006. The input-oriented form of variable return-to-scale (VRS) was used to collect the data using 4 inputs (number of beds, nursing staff, medical personnel, and other personnel) and 4 outputs (outpatient admissions, hospitalized-patient days, bed occupations, and the number of surgical operations performed). The software used for data analysis was Deap 2.1. The DEA results indicate that: 1.There is a potential to improve the hospital technical efficiency by 3 % (the mean technical efficiency of the hospitals was 0.972); 2. Constant return-to-scale (CRS) exists in the production process, meaning that production in the hospitals is at its optimum level; 3. Hospital services have suffered from extra production factors, especially human resources (specifically the nursing staff). With proper planning, limiting the number of personnel can reduce greatly health care costs and hospital expenditures. It is suggested to conduct studies to determine the effects of the quality of services delivered in hospitals and patient satisfaction on hospital technical efficiency.