مجله تحقیقات نظام سلامت
سال چهاردهم شماره 1 (بهار 1397)

According to epidemiological studies, environmental surface such as hospital equipment has role in the transmission of the microorganisms. It probably has positive influence on increase in number of ýnosocomial infections. This study aimed to assess the bacterial contamination status of elevator buttons and library ýcomputers in Dr. Mohammad Kermanshahi hospital, Kermanshah City, Iran.
In this cross-sectional study, 71 samples were taken from the elevator buttons, keyboards, mouses, and power buttons of the computers in the library of Dr. Mohammad Kermanshahi hospital. In the laboratory, using standard diagnostic methods of bacteriology, including staining, biochemical tests, and culture in differential, selective, and specific media, Gram-positive and Gram -negative bacteria were isolated.
Findings: All 71 samples were contaminated by bacteria. In the elevator buttons samples, spore-forming Gram-positive bacilli (Bacillus) with a frequency of 48.21 percent and Klebsiella pneumoniae with 3.57 percent had the highest and lowest frequencies, respectively. 66.66 percent of the computer samples contaminated to coagulase-negative staphylococcus, which 6.66 percent of them were coagulase-positive staphylococcus (aureous) and Micrococcus.
Due to the isolation of pathogenic and non-pathogenic bacteria from both groups’ samples, the need for personal hygiene practice, and principles of appropriate and regular disinfection of tools and hospital equipment surfaces are of great importance to reduce bacterial contamination and the incidence of nosocomial infections.

Ochratoxin A is one of the fungal secondary metabolites which likely transfer from food such as rice and its derivatives to the human diet. The aim of this study was to evaluate firstly the levels of ochratoxin A in samples of commonly used rice brands collected from Isfahan and Shiraz cities, Iran, and then, the effectiveness of the two methods of cooking (boiling and steaming, vs. boiling, rinsing, and steaming) in reducing the levels of ochratoxin A in the most contaminated samples.
30 samples from 6 commonly used rice brands, including 3 domestic and 3 from-abroad imported rice samples were gotten via using the simple random method. These samples cooked by two different methods (boiling and steaming, and boiling, rinsing and steaming) and then, to assess the amount of ochratoxin A, enzyme-linked immunosorbent assay (ELISA) method was used. The one-way analysis of variance (ANOVA) and Tukey's post hoc test were used to analyze the data.
Findings: 70 percent of the tested rice samples showed contamination of ochratoxin A with the range and mean of 0.94 ± 1.19 and 0-5/61 ng/g, respectively. Domestic rice contamination was 1.2 ng/g and significantly higher than the level of contamination in a variety of from-abroad imported rice (P The results of this study did not show any public health risk in case of the ochratoxin A contamination in rice samples. The cooking process was effective in reducing the fungal toxin levels, and the method with rinsing step after boiling had more efficacy in comparison with just boiling and steaming the rice.

Hypertension is one of the most important risk factors for cardiovascular disease. Recent studies showed the effect of various factors on medical adherence in hypertension. This study aimed to determine the effect of the quality of doctor-patient relationship on medical adherence in patients with hypertension.
In this cross-sectional study, conducted in Tehran Heart Center, Iran, 62 patients with essential hypertension recruited via convenience sampling method. Data were collected using Working Alliance Inventory-Short Revised (WAI-SR) and Medication Adherence Self-efficacy Scale (MASES) instruments, and analyzed in SPSS software using the multivariate linear regression model.
Findings: The effect of doctor-patient relationship quality on medical adherence was statistically significant with moderate effect size, R2 = 0.234, F(3, 58) = 5.996, P = 0.002, 95% confidence interval (CI) = 0.045-0.402. Among the components of Working Alliance Inventory, there was no evidence of a statistically significant effect on medical adherence, except for tasks, t(58) = 2.425, P = 0.023, 95% CI = 0.787-9.621.
Results of the study provided promising evidence regarding the role of the therapeutic relationship in medical adherence.

Health concepts is influenced by complex of physical, mental, social, spiritual, cultural, and environmental factors. This study aimed to assess the psychometric properties of Persian version of mental, physical, and spiritual well-being scale and its subscales among the patients with type 2 diabetes mellitus.
After reviewing the available instruments in this field and considering cultural and social condition of Iranian community, Vella-Brodrick and Allen’s mental, physical, and spiritual standard well-being scale and its subscales was selected, translated, and back translated to Persian. This cross-sectional study conducted on 500 patients with type 2 diabetes mellitus. Sampling was performed using cluster and multistage sampling method. Construct validity was determined using explanatory factor analysis. Internal consistency was ascertained using Cronbach’s alpha. The stability was confirmed using intraclass correlation coefficients. The suitability of the data analysis was tested using the Bartlett's chi-square test of sphericity, and the sampling adequacy using Kaiser-Meyer-Olkin (KMO) test.
Findings: Total Cronbach’s alpha was 0.58. 22 question in 3 determined areas explained 42.71 of the total variance. Cumulative variances of all the different subscales were more than 0.5 which showed the credential convergence.
This study results revealed that psychometric properties of Persian version of Vella-Brodrick and Allen’s mental, physical, and spiritual well-being scale and its subscales were borderline and not at optimal level. It seems that the scale should be assessed again after making changes in demographic characteristics or target group.

The present study aimed to determine the prevalence of iron deficiency anemia in primary school students in Isfahan City, Iran, in 2014, and the effects of nutrition on its recovery.
In this interventional study, 200 students of two primary school in Isfahan, aged between 7 and 12 years were selected via multi-stage random sampling method. After measuring body mass index (BMI), blood samples were collected from these individuals. In the next stage, 35 students with serum ferritin of less than 50 μg/l, and hemoglobin (Hb) level of less than 12 g/dl were selected for new investigation under a controlled diet for 3 months. Then, blood tests were done again, and the obtained data were analyzed using SPSS software and statistical tests at the significance level of less than 0.05.
Findings: The prevalence of anemia, iron deficiency, and iron deficiency anemia was 6.0%, 8%, and 3.5%, respectively. The mean ferritin and hemoglobin levels were 27.59 ± 10.11 μg/l and 13.04 ± 0.97 g/dl, respectively; after three months, these amounts increased to 30.88 ± 10.07 μg/l and 13.35 ± 0.87 g/dl, respectively. There was a significant relationship between hemoglobin and ferritin levels with nutrition in the level of 95% of confidence.
Suitable nutrition can be used for improving the serum iron among anemic children. In addition, it is recommended to do screening programs for iron deficiency during the rapid growing age of children; so that they would be treated if necessary.

Fast food consumption has increased among teens over the past decades. Considering that many habits, including inappropriate food habits, are formed in adolescence, and in the coming years, life becomes the backbone of many chronic diseases, this study aimed to investigate the relationship between some of the underlying factors and fast food consumption among high-school students in Isfahan City, Iran.
This was a descriptive-analytic research on 400 16-year-old students from Isfahan City, in the educational year of 2015-2016. Proportional to size, samples were selected from six areas in Isfahan City, according to their gender. The data collection tool was a researcher-made questionnaire, which included two sections of demographic and nutritional information. Data analysis was performed using independent t and spearman correlation tests via SPSS software.
Findings: The participants were 400 students of the second year of high school (eleventh), 200 girls (50%) and 200 boys (50%). The mean score of fast food consumption was not significantly different among girl (0.57 ± 9.35) and boy (0.71 ± 11.16) students (P = 0.080). Spearman test showed that there was a significant and direct relationship between fast food consumption and parent's education and family income (P Interventions for adopting healthy nutrition and reducing the consumption of fast food should be done according to socioeconomic status of the students, and the education level of their parents; so, they can play a significant role in healthy lifestyle during their lives.

Health literacy refers to individuals’ ability to acquire, analyze, and understand basic health information and services, required to make decisions on health and health-related issues. The current study was conducted to investigate the level of health literacy among the women in Bardaskan City, Iran, and the factors affecting it.
This was a cross-sectional descriptive-analytic study conducted on 431 women aged 18 to 65 years in Bardaskan city, who were selected using cluster sampling method in year 2016. The data were collected using Health Literacy for Iranian Adults Questionnaire (HELIA). Data analysis was performed using Kolmogorov-Smirnov, chi-square and Mann-Whitney tests via SPSS software.
Findings: The mean age of participants was 29.90 ± 8.74 years. Health literacy had a significant relationship with age, marriage, education, history of illness, and occupation. The health literacy score among the participants was 67.6 ± 16.1 out of 100, which showed an average level. The most important sources of health information from the participant’ points of views included physicians and health staff, the internet, and radio and television, respectively. 57% of participants with a history of disease had inadequate health literacy.
In general, the health literacy of most women participating in this study was modest. Given the important role of women in family and community education, and the impression of health literacy on this important role, it is necessary to design and implement educational programs aimed at promoting the level of health literacy among the women and, consequently, self-care skills.

Self-care has a vital role in control and prediction of complications in patients with type 2 diabetes mellitus. Two important parts of self-care behaviors are medication adherence and physical activity. This study was conducted to investigate the effect of educational intervention, based on theory of planned behavior, on medication adherence and physical activity in patients with type 2 diabetes mellitus.
This quasi-experimental study was performed on 160 men and women referred to urban healthcare centers in Yasuj City, Iran, in year 2016. Participant were selected using random cluster sampling. Data gathered from questionnaires were analyzed using SPSS software.
Findings: After the educational intervention, a statistically significant difference was observed in all constructs, except subjective norms of medication adherence. Significant differences were observed in physical activity and medication adherence after the educational intervention.
Educational interventions, based on the theory of planned behavior, have a positive and significant effect on the level of physical activity and drug compliance in patients with type 2 diabetes mellitus.

This survey was performed to determine the status of medical solid waste and its management in hospitals in Bushehr Province, Iran, during the years 2015-2016.
This descriptive and cross-sectional study was carried out using questionnaire, interview, observation, survey, weighing, and laboratory tests during the 24 months in ten hospitals in the Bushehr Province. The researcher-made questionnaire contained 103 questions, based on the guidelines of the WHO, medical waste management programs, and expert guidance of work and environment health center.
Findings: In 10 evaluated hospitals in Bushehr Province, the solid waste generation rate was 5718.34 kg/day, including general wastes (59.61%) and dangerous wastes (40.39%). Infectious waste recycling was not done in any of the hospitals. In two hospitals, safe and updated methods were not carried out; but the waste separation programs were performed in all hospitals. All service personnel in the process of waste handling, used personal protective equipment. Every hospital had a disposal special place. Only six hospitals had hazardous waste disposal special place; and in five hospitals, the transportation of wastes to final disposal place was done acceptably.
Despite the great efforts in the management of medical wastes, there are many problems in the management process, particularly in segregation, transportation, temporary storage, and making safe. To solve these problems, updated methods for solids, which require continuing education for staff, and strict supervision to make systems safe in destruction and final disposal in the field, along with consideration of environmental factors, should be performed.

This study focused on the role of exogenous factors and other macroeconomic factors in the business environment of small and medium financial institutions working in pharmaceutical sector in Isfahan Province, Iran.
The current study had an applied goal, and used descriptive survey method. Data gathering was carried out in the field, using a researcher-made questionnaire based on PESTEL (Political, Economic, Social, Technological, Environmental, Legal) model. Statistical population consisted of financial 238 agents in pharmaceutical sector in Isfahan Province. From this number, 142 people were selected based on Krejcie and Morgan table, using convenient sampling method. Face and conceptual validity of the questionnaire were evaluated and confirmed; while its reliability was measured using Cronbach’s alpha coefficient, which was equal to 0.95. In order to investigate the role of six PESTEL factors, single variable t and Friedman ranking tests were used.
Findings: All six factors of PESTEL model played important roles in business environment for small and medium sized businesses in pharmaceutical sector in Isfahan Province. Among these, political factors played the most important role, while technological factors were the least important factor.
Factors such as political changes, government policies in pharmaceutical market, stability of currency exchange rate, stability of laws and regulations, heath development plan, environmental factors, drug use pattern and medication culture, medicine manufacturing and distribution regulations, and other similar factors can cause changes in business environment for small and medium players in pharmaceutical sector.

To prevent heat stress in hot environments, it is essential to reduce the level heat stress among the workers. This study aimed to compare the effect of two kinds of cooling vests [Iranian cooling vest (Spadana ice gel) and phase change material cooling vest (paraffin)] on physiological strain indices (PSI) among the workers in hot-wet conditions of Asaluyeh region, Iran.
This cross-sectional and interventional study was conducted on 90 workers in Asaluyeh region in the summer in 2016 with the temperature of 47 °C and (RH) of 95%. Heart rate, oral temperature, perspiration, and the wet-bulb globe temperature (WBGT) index were measured for 120 minutes, in experiment groups, when using the 2 kinds of cooling vests, and in control group.
Findings: The mean WBGT was calculated as 37.65 °C for the three group. The mean heart rate was 91.76, 89.53, and 97.07 beats per minute in Iranian cooling vests group, phase change material cooling vest, and control groups, respectively; moreover, the mean oral temperature was 36.7, 36.63, and 36.78° C, and the mean physiological strain index was 3.18, 2.29, and 6.12, in the three groups, respectively. Physiological strain index was significantly difference between the experiment groups compared with the control group (P The study showed that Iranian Spadana cooling vest and phase change material cooling vest can reduce heat stress level for 90 minutes, in hot and humid conditions in the summer.

Organophosphate compounds are a class of pesticides with well-known uses in agriculture. Poisoning with this group of toxins, has created major problems around the world, especially in developing countries. This study aimed to investigate the effect of organophosphate pesticides on plasma cholinesterase activity among the farmers.
This cross-sectional study was done on 17 male spraying farmers, who were exposed to organophosphate pesticides, and 17 non-farmer people as controls. Before and after spraying operations, a blood sample was collected from each of the participants in both groups. Plasma cholinesterase activity was investigated using transparent-substrate (TS) technology model photometric device.
Findings: The mean level of cholinesterase enzyme activity in the case group (farmers exposed to organophosphate pesticides) was 12086.2 mg/l before the spraying; which decreased to 8516.3 mg/l after spraying. The mean level of the activity of this enzyme in the control group was 13655.8 mg/l.
Considering the importance of the evaluation of organophosphate contact among the farmers, and its effect on cholinesterase enzyme activity, it can be said that training farmers to produce organic products, to use less pesticide, and to prevent poisoning caused by spraying, seems to be necessary.

Particulate matters are very harmful for human health. Long term exposure to particulate matter is important factor in deaths due to lung cancer and heart diseases. The aim of this study was to evaluate the health effects attributable to air pollutants PM10 in Gachsaran city.
In this descriptive study, required data were collected from the Environmental Protection Office of Kohgiluye-Boyerahmad Province, and they were analyzed in Excel software. Then, in order to estimate relative risk (RR) and attributable component, the information was entered the AirQ2.2.3 software.
Findings: According to the results, the average annual concentration of PM10 in Gachsaran city was about 121 µg/m3. Of the total of 58 deaths attributable to the PM10, 27 deaths were due to cardiovascular disease and 13 deaths were due to respiratory diseases. Also, the cumulative number of hospital admissions due to cardiovascular and respiratory diseases were 39 and 147 patients respectively.
This study showed that air pollution due to PM10 in Gachsaran city has been caused many deaths and hospitalizations in 1394. Therefore, it is expected that the authorities use short-term, medium-term and long-term programs to control these types of pollutants.

This study aimed to investigate the effects of 8 weeks corrective selected exercises on angle of kyphos boy students affected by kyphosis.. Kyphosis abnormally high levels of arch thoracic back associated with being the Stretching of extensors Spinal and weaken traps middle and lower and brief abduction , short pectoral muscle and intercostal muscles are large and small. Therefore, the necessity and importance of such research, especially among the young is quite noticeable, because the flexible bones and growth of the body at this age can be used with corrective exercise proper removal of anomalies of the action provide them with appropriate solutions.
24 boy students in gym of Esfahan city¡15-18years old participated in this study.angle of khyphos were measured by Flexible ruler. stretching¡resistance and self-mobility exercises were performed for 8 weeks.covariation test was used to analysis the data.
Findings: The measure angle of kyphos in boy students affected by kyphosis before the test: (f = 0.275) (p = 0.604), after the using corrective selected excercises differences were significant (p = 0.001, f = 1680.068).
In this study¡the types of exercises will includ: stretching ¡ resistance and self-mobility movements. The findings of this study showed that corrective exercise alone and for three days a week for eight consecutive weeks, the subjects had a positive impact on improving the kyphosis.

Perinatal mortality indicator is a major indicator of health and health assessment that has a direct impact on infant mortality indicator. This study was aimed to determine the rate and causes of perinatal mortality in district of Kermanshah.
In this cross-sectional study, records of perinatal mortality in district of Kermanshah were extracted during 2011-14. Information, including the neonate, data about the mother and indicators of pregnancy and childbirth and the leading cause of death based on ICD-10 was collected. Data were analyzed using mean and standard deviation for quantitative variables and count and percent for qualitative variables by Stata ver.11 software.
Findings: 56.1% of 1236 perinatal death was boy. Most mortality was in low and very low weight and most common underlying disease mother was hypertension. The highest perinatal mortality rate was in 2012 year (12.3 per thousand births) and the lowest in 2014 year (5.7 per thousand births). The most common cause of perinatal death by 87.6% was related to specific disorders originated around the time of birth.
According to the results, emphasizing adequate care during pregnancy and perinatal, more accurately identify and track high-risk women with underlying disease and the prevention of preterm birth and low birth weight babies can be effective in reduction of perinatal mortalities.

Previously, wastewater treatment process designing was used to be based on experimental parameters. But because of various quality and quantity of inflow, effluent wasn’t being applicable to meet expected quality when standard parameters were used in design process only. Nowadays, logical parameters which are based on biological kinetic equation are used as experimental parameters in WWTP designing. The aim of this study is determination of bio kinetic coefficients KB and Umax in Sepahanshahr WWTP to use in similar conditions.
In wastewater treatment plant, efficiency of BOD, COD and TSS removal at a 3-years-period is investigated and the kinetic coefficients are determined.
Findings: The efficiency of BOD, COD and TSS removal in aeration lagoon were above 72±4%, 70±6%, 62±6% respectively. Bio kinetic coefficients are obtained by Kincannon- Stover model. KB and Umax for aeration lagoon were 136.5 g COD/l.d and 55.8 gCOD/l.d, respectively.
¡he effluent quality of Sepahanshahr WWTP met the environmental organization of Iran to reuse in irrigation. Bio kinetic coefficients calculation shows that Kincannon-Stover model is adapted for COD removal in aeration lagoon (R2>0.88).

Dairies and livestock industries generate wastewater which is high in nutrients and can impressed water resources. Constructed wetlands are one of alternatives for livestock wastewater treatments because of its pollution removal efficiency and low cost in construction and operation. The goal of this study is determination of constructed wetland efficiency at organic matter and nutrient removal at different Hydraulic Loading Rate (HLR) and Hydraulic Retention Time (HRT).
The removal efficiency of BOD5, COD, TSS, NO3-N and PO4(orthophosphate) from livestock wastewater in constructed wetlands at different HLR and HRT at a 6-months period are investigated.
Findings: The highest efficiency of BOD, COD, TSS, NO3 and PO4 removal at lowest HLR and highest HRT in temperature above 15 °C were 74%, 62%, 69%, 61% and 23% respectively.
Constructed wetlands can improve effluent quality from secondary wastewater treatment plant of livestock industry to meet the environmental organization of Iran to reuse in irrigation.

Dust is one of the harmful factors in some working environments. One of the way to reduce exposure to dust in these environments is to use air purifying masks. Therefore, the purpose of this study was Performance evaluation of respiratory masks used by refractory workers in controlling exposure against particulate pollutants in a steel factory.
The performance of three types of masks against particle contamination was evaluated in this study. To evaluate performance, during the work and simultaneously the concentration of particles in inside and outside of the mask was measured then the percentage of efficiency and percentage of penetration rate was calculated.
Findings: The average of penetration rate percentage in the FFP3 mask was higher than FFP2 and elastomeric halfmask with a P100 filter. Performance evaluation of FFP2 and FFP3 masks based on of consumption time showed that during the first few hours of consumption efficiency decreased and then increased.
Resistance surface of filter and air penetration from free space between face and around the mask is the main factor of poor performance masks.

Policyclic aromatic hydrocarbons (PAHs) mainly release to the air from incomplete combustion of fossil fuels like oil, coal, wood, etc. Because of their bioaccumulation, carcinogenicity and mutagenicity effects, they are one of the major concerns of the scientific community. In this study, the concentrations of PAHs in the ambient air of heavily trafficed areas in Isfahan during summer and autumn seasons of 2016 were measured.
Air sampling was conducted passively using SPME fibres (PDMS).. The SPME samplers were installed in 7 points of selected high traffic areas for 24 hours. After sampling, PAHs adsorbed on the fibres were directly analysed with a GC / TQ-MS device without the need for extraction according to standard methods.
Findings: In the studied samples, maximum ΣPAHs was related to Azadi Square with a concentration of 53.83 ± 4.06 ng/m3 in autumn, and minimum concentration of ΣPAHs was measured at Vahid bridge with an average of 21.82 ± 1.28 ng/m3 in summer. Acenaphthylene over the other PAH concentration was the highest. Based on the results, the average concentration of PAHs in autumn was more than summer.
The results showed that exposures to these compounds via ambient air at all stations, especially in high-traffic areas were higher than those suggested by OSHA, NIOSH and AGCCIH. High level of these compounds in different parts of the city can be attributed to the excessive vehicle traffic as well as the topography of the city. Therefore, traffic management and control of emissions from vehicles can be very effective in reducing PAHs emissions.

The necessity of introducing an effective interventional package in helping couples who have suffered from and adversely influenced by cyberspace is evident from its expansive nature in married life communications and interactions as well as its significant role in the quality of conjugal relationships. Accordingly, the present study aimed to examine the efficacy of cyberspace-induced damage interventions on marital quality.
The subjects of this quasi-experimental study were selected from among cyberspace-damaged couples who visited various cultural centers, completed a cyberspace-induced damage questionnaire, and received significantly higher scores than the mean damage score. They were randomly assigned to an experimental and a control group. Intervention in the experimental group was made in the form of 11 educational sessions. Research instruments included a cyberspace-induced damage to conjugal relationship questionnaire and the Assessment of Marital Quality Scale. SPSS 23 software and multivariate analysis of covariance analysis were used to analyze the data.
Findings: Cyberspace-induced damage treatment/education was effective in improving the marital quality of the experimental group, meaning that post-test mean values for marital quality was significantly higher for the experimental group compared with the control group )Sig ≤ 0.05(.
Based on the results, the developed pair counseling program can serve as an effective method of enhancing the quality of cyberspace-damaged married lives.