مجله تحقیقات نظام سلامت
سال چهاردهم شماره 2 (تابستان 1397)

Maintaining cleanliness in the environment of hospitals and medical spaces is of special importance, as it can reduce hospital infection and maintain and improve the health of patients and staff. Given the paucity of studies about the relationship of environmental features and physical spaces with the control of infections in medical settings, the present research aimed to study the cleanliness of operating rooms using physical features of the space and develop solutions for defining the operating room features considering the effects of these features on their cleanliness.

The present research was a systematic review which was conducted in 2017 through searching the keywords such as operating room, clean room, features of the physical environment, infection control, and hospital infection in ISI, PubMed, ScienceDirect, SID, CIVILICA, Irandoc, and Magiran scientific databases and the website of organizations such as World Health Organization (WHO), Center for Disease Control and Prevention (CDC), American Institute of Architects (AIA), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), and International Health Facility Guidelines (IHFG). Domestic and foreign articles published in the period of 2000-2016 in both Persian and English languages were considered. Findings: Factors such as the facilities for washing and hand sanitation, identification of the process and workflow, determination and separation of functional areas, air conditioning, and final materials used at different surfaces play a vital role in the cleanliness of operating rooms.

Environmental factors which affect the cleanliness of medical spaces are necessary to be taken into account from the beginning of the design process in order to reduce hospital infections.

Health system financing is one of the main challenges especially in low and middle income countries. Various financing frameworks presented in this field have been applied to evaluate financing system and develop strategies for policy reforms. This study aimed to explore, analyze, and adjust different health financing frameworks. This comparative descriptive study was based on explanation and comparative analysis of different health financing frameworks. Data were collected from foreign databases and published reports in international websites including World Health Organization (WHO) and World Bank. Four main steps of comparative study were followed for combination, description, and analysis of data. Findings: Sixteen health financing frameworks, developed during 2001-2014 were extracted. Of the frameworks developed in international level, we can name the framework of Organizational Assessment for Improving and Strengthening Health Financing (OASIS) (Hsiao and Kutzin) with the aim of evaluating financing systems of different countries of the world. Some frameworks such as health financing strategy for countries of the Western Pacific and South-East Asia Regions and African Bank Development model have been developed to evaluate financing functions in regional area. Financing frameworks have been developed and modified during the years according to health sector needs and requirements. Appropriate use of these frameworks can improve responsibility of health systems regarding the financing functions. Considering the dimensions of each framework, the financing method and policy of health systems can be evaluated.

Increase in amount and variety of healthcare wastes is one of the most important problems affecting human health and environment. Due to the infectious effects of these wastes, accurate management of them in the healthcare centers is essential. The aim of this study was to determine the quantity and quality of the wastes generated in the healthcare centers of Kohgiluyeh and Boyerahmad province, Iran, in 2015. This descriptive cross-sectional study was conducted in Kohgiluyeh and Boyerahmad province. Samples were taken from 432 healthcare centers in the province through census method. Three samples were taken from the affiliated units of Yasuj (capital city of Kohgiluyeh and Boyerahmad province) University of Medical Science in one year, and the average weight of them was considered as final weight. Data were analyzed using SPSS and Excel software. Findings: Total wastes generated in the affiliated units of Yasuj University of Medical Science were 1186.26 kg/day. Ordinary waste, sharp waste, infectious waste, chemical waste, radiological waste, and pathological waste were 80.86%, 1.50%, 16.09%, 0.71%, 0.36%, and 0.44%, respectively. Healthcare centers in Boyerahmad and Choram counties had the highest and the lowest amount of infectious and sharp wastes, respectively. Due to the relatively high volume of infectious wastes in the provincial centers (more than 16%), it is essential to equip the centers with devices which treat the infectious and sharp wastes

A person can perform heavy activities easier when he has high aerobic capacity. Measuring hand grip is a cheap and easy way to measure muscle strength. This study aims at evaluating the effect of physical work capacity (PWC) and gender on hand grip strength in the youth. This cross-sectional study was performed on 120 young people (19-29 years old) by means of simple random sampling. To assess the PWC, grip and pinch strength and endurance, the step test (McArdle method), dynamometer, and pinch gauge were used, respectively. Data analysis was carried out using independent-samples t-test and paired-samples t-test via SPSS software. P-value < 0.050 was considered significant. Findings: PWC, grip and pinch strength and endurance in men were higher than women (P < 0.050). Meanwhile, PWC in men and women affected only the pinch strength and grip endurance, respectively (P < 0.050). In jobs that require high pinch strength and grip endurance, it is necessary to employ those with high PWC, so that the irreparable damages caused by incongruity between the job and the worker could be prevented or reduced. In general, gender should be considered as an important factor in employing workers in different jobs

  Physical activity may help relieve some symptoms of mental disorders such as depression. The purpose of this study was to investigate the effect of eight weeks of combined training of running and swimming on N-Methyl-D-Aspartate (NMDA), Brain-Derived Neurotrophic Factor (BDNF), and serotonin in young girls. This quasi-experimental study was conducted with pre-test and post-test design with a control group. 20 young women (mean age: 24.20 ± 3.27 years, mean height: 1.61 ± 0.05 m, and mean weight: 56.24 ± 11.69 kg) were randomly assigned to 2 groups of experimental and control. Exercise schedule of subjects included a combination of running and swimming for eight weeks (three sessions per week). Running exercise included a 10-minute warm-up and 25 minutes of continuous running in the range of 60% to 75% maximum heart rate and 25 minutes of swimming. Before and after the training period, plasma levels of NMDA, BDNF, and serotonin were measured. To evaluate the normal distribution of data, Kolmogorov-Smirnov test (K-S test) and for between-groups comparison repeated measures analysis of variance (ANOVA) were used. Findings: In the experimental group, a significant increase in serotonin, BDNF, and NMDA levels was observed. The trend of change in body fat percentage in the experimental group showed a significant decrease compared with the control group. The trend of weight change had a significant decrease in the experimental group, but compared with the control group, no significant difference was observed. Endurance training increases the levels of serotonin, NMDA, and BDNF, and decreases the weight and body fat percentage, which will reduce the risk of depression, eventually. Moreover, it is possible that BDNF upregulates the expression of NMDA receptors

Remediation of soils polluted to heavy metals especially in industrial cities is very important in environmental pollution studies. This research was performed to investigate the effect of rubber ash enriched urban waste vermi-compost on decreasing Cadmium (Cd) availability in lettuce plant in Cd-polluted soil. Treatments consisted of applying urban waste vermi-compost (0, 20, and 40 t/ha) enriched with 0 and 200 kg/ha rubber ash in a polluted soil with 0, 20, 30, and 40 mg Cd per kg, and plant in this experiment was lettuce. Soil and plant Cd concentration was measured by atomic absorption spectroscopy (AAS). Findings: Increasing the use of urban waste vermi-compost from 0 to 20 and 40 t/ha in a Cd-polluted soil (20 mg Cd per kg soil) caused a significant decrease in soil Cd availability by 1.3 and 2.4 times, respectively. Cd concentration in plant aerial organ was also decreased by 1.1 and 1.8 times, respectively. Applying 20 and 40 t/ha rubber ash enriched urban waste vermi-compost in a Cd-polluted soil (30 mg Cd/kg soil) caused a significant decrease in Cd concentration of plant aerial organ by 1.2 and 1.9 times, respectively. Applying urban waste vermi-compost causes a decrease in Cd availability in soil and plants and meanwhile, enrichment of this organic compound with rubber ash also decreases Cd sorption by plant

Occupational stress is a condition in which a person is faced with a demand that is more than his ability to perform it. The aim of this study was to investigate the relationship between three dimensions of occupational stress (effort, reward, and commitment) and mental health among the employees of Isfahan steel company, Iran. 3063 employees of Isfahan steel company were surveyed in a cross sectional study in 2014. The questionnaire of Effort-Reward Imbalance (ERI) and General Health Questionnaire (GHQ-12) were used to collect data. The relationship between variables was analyzed using quantile regression method by Stata software. Findings: 91.5% (2800 people) of the participants were men and their mean age was 36.47 ± 7.31 years. All three dimensions of occupational stress (effort, reward, and commitment) were significantly related to mental health (P < 0.05). High levels of effort and commitment and low levels of reward occurred at low levels of mental health. People at different levels of mental health are differently affected by occupational stress. Hence, industry managers must take steps to reduce its effects.

Sexual addiction is a growing concern which is known as a serious disorder. The present study was conducted to predict sexual addiction of couples based on meta-cognitive belief (MCB) and cognitive fusion. The study was based on a descriptive correlational method. Statistical population consisted of all couples in Ardabil city, Iran, in 2017. 112 people (56 couples) were selected as the statistical sample using the convenience sampling method. For data collection, the MCB Scale, Cognitive Fusion Questionnaire (CFQ), and Sexual Addiction Scale (SAS) were used. Research data were analyzed using Pearson correlation coefficient and multiple regression. Findings: There was a significant relationship between the MCB and cognitive fusion with sexual addiction in couples (P < 0.05). In addition, the results of multiple regressions showed that MCB and cognitive fusion could predict the sexual addiction of couples by 0.59 (P < 0.05). MCB and cognitive fusion are considered as the predictor variables related to sexual addiction. Therefore, sexual addiction can be reduced in couples by decreasing MCB and cognitive fusion.

Regarding the possibility of existence of crystalline silica in production process or usage of refractory materials, the workers of this industry are exposed to the risk of silicosis. Silicosis is a type of pneumoconiosis that is a risk factor for lung cancer and also one of the causes of temporary or permanent occupational disabilities. This study aimed to examine the toxicity of refractory materials during destruction in metal melting furnaces. The study was done in the refractory process of one of the metal melting industries in refractory destruction job. For the evaluation of total and respirable dust in workplace air, gravimetric method was used according to the National Institute for Occupational Safety and Health (NIOSH) 0500 and NIOSH 0600, respectively. For evaluation of crystalline silica in total and respirable dust in workplace air, the samples were analyzed by NIOSH 7601 spectrophotometry. Findings: Average total dust concentration in the furnaces during the destruction of refractory materials was obtained 153.6 mg/m3 that was 15.3 times more than the permissible limit of Iran's occupational standards. The average concentration of respirable dust during destruction of refractory materials in furnaces was reported 27.98 mg/m3 that was 9.3 times more than the permissible limit of Iran's occupational standards. The average concentration of crystalline silica dust in the total air in furnaces during the destruction of refractory materials was obtained 0.2235 mg/m3 that was 8.9 times more than the permissible limit of Iran's occupational standards. The average concentration of crystalline silica dust in the respirable air in furnaces during destruction of refractory materials was 0.1008 mg/m3 that was 4 times more than the permissible limit of Iran’s occupational standards. The average concentration of total and respirable dust and also crystalline silica produced during destruction of refractory materials in the furnaces is higher than the permissible level of Iran’s occupational standards

In addition to providing nutritional needs of the body for the purpose of physical and cognitive development, proper nutrition during adolescence is effective in protecting the person’s future health and preventing obesity in adulthood. The present study was conducted for the first time in Iran with the aim of determining the adequacy of diet using the Healthy Eating Index (HEI)-2005 in 13-17-year-old students in Isfahan, Iran, in 2014.

This descriptive-analytical study was conducted on a cross-sectional basis. Data related to nutritional status of participants was collected using a three-day food record. A valid standard questionnaire was used to measure physical activity. Dietary intake, daily energy, and nutrients were recorded using Nutritionist software. Data were analyzed using analysis of variance (ANOVA) and multiple linear regression via SPSS software. Findings: The mean score of HEI in adolescents was obtained 72.67 which was not favorable. There was a significant association between the two variables of mother's job and calorie intake with the score of HEI (P < 0.05).

The diet quality of the most adolescents needs change and modification. Therefore, in order to improve the quality of their diet, some methods are needed to modify the nutritional habits of adolescents, including educational programs and advertisements

Investigating the hazardous factors and points in process industries through risk management and evaluation for preventing accidents is particularly important. Oil and gas refineries have several risks such as fire, explosion, or the release of toxic substances, which might have catastrophic and irremediable consequences. Conducting safety integrity level (SIL) studies in the process industries for assessing safety status and reliability of complex engineering systems is of particular importance. This study aimed to investigate the effectiveness of safety instrumented systems (SIS) in the isomerization unit of the gasoline production complex of Isfahan oil refinery, Iran. In the first part of the study, the semi-quantitative method of layer of protection analysis (LOPA) was used to analyze the layers of protection and determine the required SIL of the system (target SIL). In the second part, using the fault tree analysis (FTA), the existing SIL of the system was verified. Findings: In all selected scenarios, the existing SIL of system is consistent with the required SIL (target SIL). The frequency of final reduced event corresponded to the acceptable risk standard of the refinery as well, which indicated the adequacy of the existing independent protection layers (IPLs). Accurate designing and using the state-of-the-art equipment lead to an acceptable level of safety in this process, and the system is working with a proper reliability

  Surgery is the best treatment for colorectal cancer, but recurrence occurs at a steady rate according to the stage of disease. The aim of this study was to investigate the factors influencing the survival of patients with colon cancer who referred to cancer research center affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, during 2001 to 2011. In this historical cohort study, 146 patients with colon cancer were enrolled. The required information was collected from patients’ medical records. To investigate the factors influencing survival, flexible healing model was used. Data were analyzed by Stata software. Findings: Of 146 patients enrolled in the study, recurrence was observed in 29 cases (19.9%). Median of survival without recurrence was 19.87 months and healing rate was 71%. The carcinoembryonic antigen (CEA) variable had a significant effect on the survival of uncured patients (P < 0.05). Regarding the obtained regression coefficients, all variables, except for right hemicolectomy, had an increasing effect on healing fraction. The presence of cured people in the data contributes to the flattening of the Kaplan-Meier chart. In such a situation, the use of healing models is appropriate to examine the effect of factors on healing fraction and survival of uncured individuals separately

%VO2max index is the gold standard of physical workload classification. Because of difficulty of this index measurement, it is not a practical method in the real work places. Recently, a new method was proposed for estimating %VO2max through three parameters of resting heart rate, working heart rate, and weight based on a neuro-fuzzy network in MATLAB software. The goal of this study was designing and fabricating a laboratory model of physical workload classification tool based on the mentioned method. The programming of the device was performed with the Arduino software and in C++ language in the AVR microcontroller; then, it was entered into integrated circuit (IC) by the programmer. The output of heart rate sensor was entered into the microcontroller through I2c protocol. The usability score of the device was evaluated by 20 occupational health experts employed in the industry and was compared with manual physical workload classification. Findings: The mean usability score of this system was 84.6 ± 7.3 and was ranked in B category. It means that the usability of the system is very good. The required time for physical workload classification using this tool was approximately half of the required time for this work without the tool. The adaptive neuro-fuzzy inference system (ANFIS) was presented for estimating physical workload in the form of a practical tool in order to be used in the industry. Regarding the lack of sufficient accuracy of current indexes for estimating physical workload such as heart rate, this fabricated tool is a proper substitute for the former methods. High usability and low required time are two main advantages of the proposed tool

Educating health to patients is a patient-centered process based on needs expressed by both the physician and the patient in order to make a collaborative and conscious decision over the disease. Surveying and analyzing the research fields in this area and discovering the relationships between the expressions used in this paper can provide researchers and scholars with useful information. Therefore, this paper aims at analyzing the article contents related to the area of health education for the patients through thematic mapping and hierarchical clustering methods. The current research is of descriptive-analytical type and has dealt with analyzing texts’ contents with a hierarchical clustering approach. Searching the phrase “Health Education” and filtering the search with “Patient Education” as well as the “Major Topics” helped us extract the entire data on PubMed database (1964 to 2014). Analysis and clustering of data were done using software such as SPSS20 and Ravar PreMap. Findings: Producing scientific articles on health education for the patients has showed an increasing trend. Regarding the hierarchical clustering, noted thematic areas included health education, drug consumption pathology, nurses, communication skills, health promotional behaviors, adaptability and mental health, health literacy, and preventive behaviors. The thematic clusters formed have structural relationships as they exploit similarity measurement method and the distance between descriptors. The majority of researchers noticed psychological and therapeutic aspects in health education area.

Among the volatile organic compounds, benzene, toluene, ethylbenzene and xylene compounds (BTEX) are important as air pollutants that have harmful effect for health even at very low concentrations. The main source of these compounds is the exhaust gases from vehicles exhaust. The purpose of this study was to measure BTEX compounds in outdoor and indoor environment of 4 high schools located in two districts of Isfahan and Chadegan city. Samples of air from inside and outside the schools were collected by individual sampling pumps using active carbon tubes. Then BTEX compounds were extracted by solvent CS2 and measured by mass spectrometric gas chromatography (GC-MS). Findings: The average concentration of BTEX compounds in Isfahan city was higher than Chadegan. Also, the concentration of BTEX compounds in Isfahan region 2 (Imam Hossein Square) was higher than Zone 1 (Chahar Bagh Khaju) and the highest and lowest concentrations among the BTEX components were respectively in relation to toluene and ethylbenzene. There was not significant difference between Indoor/Outdoor ratio in two regions. There was no significant relationship between the indoor and outdoor concentrations of BTEX compounds in two cities and two regions, which shows that the indoor environment is contaminated by internal resources. Based on the results, the city of Isfahan was more polluted then Chadegan. Also, region 2 in Isfahan was more polluted than region 1. So that the pollution is more related to external sources such as traffic. Keywords

The relatively long hours of work (most of the adults are at work for half of waking hours) and much time spent travelling from home to work and vice versa practically do not leave time for regular physical exercise for employees. The purpose of this study was to investigate the performance of regular physical activity and effective factors on it among Borkhar and Shahinshahr Health Network Employees according to social cognitive theory (SCT). In this descriptive-analytical study, 170 employees were enrolled by census. A standard questionnaire consisting of three sections, i.e., demographic information, international physical activity questionnaire and an SCT construct measure were used to collect information. Data were analyzed using SPSS 21. Descriptive statistics and multiple hierarchical regression were used to determine the predictive value of regular physical activity among employees by using SCT constructs. Findings: The mean age of participants was 38.42 years. The constructs of SCT (self-efficacy, outcome expectations, outcome value, family support and friends support) were analyzed in the first step, and were found to explain 13% of the variance in physical activity behavior. Results showed that, among the constructs of SCT, selfefficacy, and among demographic variables, age had a significant association with regular physical activity. According to the results of this study, self-efficacy is an important factor in predicting the regular physical activity of employees. Therefore, it is suggested that strategies for self-efficacy promotion in physical activity in employees be addressed in future studies.

Regards to the occurrence heat strain when using acid-resistant protective work clothing clothing in the workplace, this study aimed to determine performance of two types of cooling vests on heat strain indices in hot conditions when wearing acid-resistant protective clothing.

This experimental study was conducted on ten healthy male students in hot conditions (Ta = 40°C, RH= 25%) when they were wearied acid-resistant protective clothing. Each participant was contributed in three trials including without cooling vest (A) with ice gel cooling vest, (B) and phase change material paraffin (C). In each trials, participant was walked on tread mill for 90 min. The heart rate, oral temperature, skin temperatureswere measured in regular time. Findings: Data analysis in the A, B and C trials showed that the mean of heart rate, were 104. 0, 97. 2 and 97. 7 beat/min respectively, skin temperature were 37. 1 °C, 31. 1 °C and 33. 2 °C, respectively and oral temperature 36. 3 °C, 33. 0 °C and 34. 0 °C respectively. There were significant difference physiological اheat strain indices in B and C trials compared to A trial.

When using the acid-resistant work clothing, wearing the ice gel cooling vest (Spadana Model) and phase change material paraffin (Techkewl-7026 Model) can be used to reduce physiological heat strain indices.

Mycotoxins in milk are a public health concern, then there is a need for monitoring its level regularly. In this study the levels of aflatoxin M1 in milk were evaluated. During late march and early April 2015, 19 raw milk and 89 pasteurized milk samples distributed in Isfahan (Isfahan province, Iran) were collected in supermarkets and checked for aflatoxin M1 (AFM1). Samples were analyzed for aflatoxin M1 (AFM1) with a validated high performance liquid chromatography (HPLC) method. Findings: The mean concentration of aflatoxin M1 in pasteurized milk was 0.03 ± 0.019 µg/kg that was lower than Codex Alimentarius, FDA standards (0.5 µg/L), Iranian national standard (0.1 µg /L) and EU standard (0.05 µg/kg) (p < 0.05). The mean concentration of aflatoxin M1 in raw milk was 0.008 ± 0.011µg/L that were significantly not only below the FDA, Codex Alimentarius, Iranian national and EU standards, but also lower than mean concentration of aflatoxin M1 in pasteurized milk .The mean aflatoxin M1 concentration in pasteurized milk produced in Isfahan was 0.02 ± 0.011µg/L that was lower than aflatoxin M1 concentration (0.040 ± 0.020 µg/L) that import from other province to Isfahan (p < 0.05). It is concluded that during winter of 2015, aflatoxin M1 levels in raw and pasteurized milks marketed in Isfahan were not a serious human health hazard, but strict regular control by official organization is emphasized.

In the field of water treatment with potassium ferrate, (FeO4)2- ion is known as a long-lasting and having high oxidation potential. In this regard, the removal efficiency of humic acids from the aqueous solutions was investigated by a synthetized potassium ferrate. This study was an experimental that was conducted on a laboratory scale. The potassium ferrate was synthetized in lab as an oxidizer to remove humic acid. The effect of various parameters pH (in the range of 6-12), initial concentration of humic acid (in the range of 5-20 mg/l), potassium ferrate dosage (in the range of 3-12 mg/l), and contact time (in the range of 20-80 min) on the removal of humic acid were studied. Findings: Optimum conditions for humic acid removal by potassium ferrate oxidation were obtained for the humic acid concentration, the dose of potassium ferrate, pH and contact time of 5 mg/l, 12 mg/l, 8 and 80 minutes, respectively. Maximum humic acid removal in the optimal conditions was 72%. The potassium ferrate as a potent oxidizer agent and also the coagulant property can be effective in removing humic acid from aqueous solutions.