مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال هشتم شماره 1 (پیاپی 29، بهار 1389)

Monitoring and evaluation are basic components of any health program. Control charts show clearly the process performance trend longitudinally and help managers and staff to detect general and specific variations and evaluate the process performance correctly. This study was conducted to design and utilize control charts in the primary health care (PHC) system. This study was conducted in two stages. In the first stage, the average weekly, monthly and seasonal delays in receiving health services were compared retrospectively. In the second stage, appropriate control charts were introduced with due consideration of the PHC system. More than 95% of the weekly average delays were below the upper control limit, while in 100% of the cases the monthly and seasonal averages were under the upper control limit. Desirable health outcomes result from appropriate services. It is necessary to monitor health processes coverage and performance with simple and specific indicators. With regard to the health process outputs in the PHC system, it is suggested that the R-X, np and C charts be used in monitoring processes.The control charts help the service providers to determine and manage process performance by gathering simple, applicable data. Some of the advantages of using these charts are the possibility of longitudinal surveys, simplicity of the calculation methods, and their high applicability.

Weight status perception is an important factor in nutritional behavior. The aim of this study was to determine Islamshahr women's self-perception of their obesity status and perception of their husband's opinions regarding women's obesity status, as compared with the actual central obesity status of the women. This was a cross-sectional (descriptive-analytical) study carried out in 2003 on a cluster sample of Islamshahr women aged 20-65 years (n = 704). Data were collected by interviews and weight, height, and waist and hip circumferences were measured. A waist-to-hip ratio (WHR) greater than 0.849 was considered as central obesity. Based on the body mass index [BMI=weight/height2(kg/m2)], underweight, normal, overweight, and obese were defined as a BMI <18.5, 18.5-24.9, 25-29.9, and ≥30, respectively. About 35% of the women with central obesity considered themselves underweight or normal. Married women's perception of husband's opinions regarding their obesity status showed about 45% misclassification. Women with central obesity who thought their husbands would assess them as underweight or normal were more likely [OR=18.6, 95% CI: 9.1 to 38.2] to underestimate their obesity status as well. Misperception of obesity status is common among Islamshahr women. Considering the role of central obesity in metabolic diseases, menstrual disorders and increasing serum androgens, conducting nutrition education programs is essential for prevention and control of central obesity in the region studied.

Community involvement is the most important strategy in development. In health program planning, community assessment is a process in which society members get a thorough understanding of all matters, problems, resources, weaknesses, strengths, needs, and surveillance related to health by collecting, analyzing, and publishing relevant data and information. This study was conducted to identify and prioritize problems of the Chahestani region, a poor region in Bandar-Abbas city, Iran, with active participation of the people.

The study was based on a model designed in North Carolina, US. In this model, the assessment process is performed in eight steps. In the first seven steps problems are identified and prioritized, and in step 8 a plan of action is developed to deal with the problem selected.

A total of 60 problems were identified, of which the following were considered to be top priorities: lack of responsibility of the authorities, insecurity, unemployment, poverty, sewerage disposal, insufficient water, insufficient electricity, unpaved roads, lack of green space, and dirty streets and passages.

Most of the problems identified were non-health problems, including social, cultural, and economic issues.

Formaldehyde is an organic chemical with widespread applications as a raw material in many industries. Industrial effluents with high contents of formaldehyde should be treated because of their carcinogenic and mutagenic effects. The objective of this study was to determine the efficacy of the anaerobic sequence batch biofilm reactor (ASBBR) for formaldehyde biodegradation. A laboratory-scale ASBBR with a total volume of 6 liters was used. The efficacy of the reactor was determined in 9 stages with organic loading rates of 0.54 to 7.09 Kg COD/m3.d. The best removal efficiency for COD and formaldehyde were 94% and 99%, respectively, with an organic loading of 0.54 KgCOD/m3.d.The lowest efficiencies were 48% and 63.1%, respectively, with an organic loading of 7.09 KgCOD/m3.d. Based on the findings, it can be concluded that ASBBR is a viable, efficient and reliable technology for treatment of industrial wastewaters containing formaldehyde.

Today in many work environments, such as nuclear, military and chemical industries, human errors may result in disasters. Accidents in different parts of the world bear evidence to this; examples are the Chernobyl disaster (1986), the Three Mile Island accident (1974), and the Flixborough explosion (1974). Thus, identification of human error, especially in complex and intricate systems, and devising control measures are essential. This project was a case study conducted in Zagross Methanol Company in Asalouye (South Pars), Iran. The walking-talking-through method was used to collect the required data and complete the Systematic Human Error Reductive and Predictive Approach (SHERPA) worksheets. The process experts and control room operators were interviewed and technical documents of the Company examined. Analysis of the SHERPA worksheets indicated that the majority (48.62%) of the 222 errors identified were action errors, followed by checking errors (31.97%), retrieval errors (6.75%), selection errors (0.9%), and communication errors (11.7%). The results of this study show that the method can be used effectively in different industries, especially chemical industries, to identify human errors that may potentially lead to dangerous situations and accidents.

In the raw furniture preparation workshops, in which the workers usually have an undesirable postures when at work, ergonomic assessment and the work environment improvement seem essential. Developing checklists and calculating ergonomic indices would be useful in this assessment. This study was conducted with the objectives of assessing musculoskeletal disorders (MSDs) risk factors and determining types of corrective measures in raw furniture preparation workshops.

After conducting task analysis, 268 workers were assessed using an ergonomic checklist developed for the purpose and ergonomic indices were calculated. The Nordic musculoskeletal disorders questionnaire was used to determine the prevalence rate of MSDs among the workers. Data were analyzed using the t-test and the test of proportions.

The highest prevalence was in the lower back (38.4%) and the knees 36.2%). Statistical analysis revealed that there were significant associations between MSDs and calculated ergonomic indices (p<0.001). In addition, calculation of OR revealed that ergonomic conditions were associated with MSDs in different body parts (OR=2.90-9.49, p<0.001). On the whole, the working conditions of 32.46% of the workers studied were poor from an ergonomic point of view.

The checklist developed was found to be an appropriate and low-cost tool for ergonomic assessment. The most important problems in the workshops were due to inappropriate general working conditions, inappropriate organization, and unsuitable work stations.

Agricultural and industrial activities, as well as population growth, have resulted in increases in the amounts of pollutants in the environment, the human body, and other organisms. Cadmium is one of the common heavy metals entering the biological cycles through different paths causing disease in humans, animals and plants. This study aimed at determining cadmium levels and physicochemical and biological factors in water and sediment samples, as well as determining relationships between culturable bacterial counts and cadmium toxicity and assessing bacterial resistance/tolerance spectrum through MIC and MBC. Surface water and sediment samples were taken from five stations in areas believed to be polluted along the Kor River. The stations included 1. Dorudzan Dam outflow, 2. Petrochemistry Bridge, 3. Khan Bridge, 4. Doshakh Bridge, and 5. the mouth of the Kor River to the Bakhtegan Lake. Two sets of samples were taken. Set 1was used for measuring cadmium level, physicochemical and biological factors, while Set 2 was used for the isolation and identification of cadmium resistant/tolerant bacteria and determination of their resistance spectrum. Pure cultures of each bacterial species were prepared and the more resistant bacteria were identified by exposure to media with different cadmium concentrations. Stations 2 and 3 were found to be significantly more polluted with cadmium than the other 3 stations (p<0.001). The cadmium level in sediments of all the stations was higher than in water (p<0.001) and quite high as compared with the existing standards. The data also showed a lower BOD/COD ratio in the last 2 stations and higher phosphate levels in the last 4 stations. As compared to control, the bacterial count decreased in the presence of 1 mM cadmium chloride solution (p<0.001). Cadmium-resistant bacterial counts were higher in stations 3 and 5 than in the others (p<0.001). The most cadmium-resistant/tolerant bacteria were P. aeruginosa ETs and Bacillus ABs with MIC 6 and 4 and MBC 7 and 5 mM, respectively. The most resistant bacteria were gram-negative, isolated from the sediments. Cadmium pollution, especially in stations 2 and 3, are due to man's activities. Although many bacterial types were found to be sensitive to cadmium in this study, some of them showed resistance/tolerance to it to different extents. Our findings also show that unlike water, which is an unstable environment, sediments are stable and provide a suitable environment for bacteria to form biofilms as a way to reduce cadmium accumulation. The most resistant bacteria were found in the stations with the highest cadmium concentrations. This may be a result of cadmium-resistant gene expression in the presence of this heavy metal. The use of these resistant strains in biofilters and wastewater bioremediation can potentially help to reduce cadmium pollution, a problem in some rivers.

Rapid growth of Iran's population attracted attention of the authorities after the 1986 national census. This led to population control and family planning programs to be considered as a priority. Appropriate strategies of the family planning program led to a very fast decrease in population growth and fertility indices:; and use of contraceptive techniquies rate increased from 49% in 1989 to 73.8% in 2007. This study aimed at reviewing family planning program in Iran (FPPI) during the last four decades and discussing the reasons for its success, as it can be a guide for future efforts aimed at improving other aspects of reproductive health. The method used was systematic reviewing of articles indexed in Medline and University Jihad Scientific Database, reports of the Demographic and Health Project, the Iranian Statistical Center National Censuses, and the Ministry of Health and Medical Education reports on knowledge, attitude and practice. FPPI initiated officially in 1966 faced with limited success. Following the 1986 national census, population control was announced as a public policy, supported by the leaders. A supportive environment was created by mass media. Establishment of the Departments of Population and FP in the Ministry of Health made possible reorganizing family planning services: expanding coverage of PHC services, including FP services; training skilled personnel; providing free contraceptives; and vasectomy and tubectomy services. Involvement of volunteers and NGOs helped in strengthening community actions. In order to develop personal skills, in addition to face-to-face FP counseling in the health centers, FP education in schools, colleges, workplaces, army and pre-marriage classes was also imparted. Promotion of men's participation in FPPI, by providing male methods of contraception, such as vasectomy or condom use, was also considered. There was also cooperation and support on the part of nongovernmental and international organizations. Based on the findings, it may be concluded that the principles of health promotion can explain the FPP achievements in Iran. This model can be used in expanding other reproductive health programs in Iran.