فهرست مطالب

Health Scope - Volume:8 Issue: 1, Feb 2019

Journal of Health Scope
Volume:8 Issue: 1, Feb 2019

  • تاریخ انتشار: 1397/11/15
  • تعداد عناوین: 12
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  • Azimeh Ghorbanian , Arash Rashidian , Kamran Bagheri Lankarani , Zahra Kavosi * Page 1
    Objective
    In this systematic review, we aimed at estimating the pooled prevalence of catastrophic health expenditures (CHE) in Iran and identifying and summarizing the determinants of CHE among Iranian households.
    Methods
    We comprehensively searched the literature on November 2016 in PubMed, Scopus, Web of Science, the Cochrane Library, and 3 Persian databases. We also obtained the literature through colleague communications. Two review authors independently selected studies, extracted data, and evaluated them. We performed meta-analysis of prevalence of CHE and subgroup meta-analyses to assess the influence of data source and scope of research. Moreover, we categorized the determinants of CHE in Ian.
    Results
    In this review, 16 studies met the inclusion criteria, and of them, 2 presented the results of multiple surveys. Results of 27 cross-sectional studies were used to estimate the pooled prevalence of CHE in Iran during 1995 and 2015, which was found to be 3.91% (95% confidence interval, CI: -3.26- 11.07). Subgroup meta-analyses based on data source revealed that the highest prevalence estimate of facing CHE was associated with author-made questionnaires, and the lowest to the statistical Centre of Iran (SCI) questionnaire. Also, meta-regression showed that the difference in sample size and year of study did not have any significant effect on the prevalence of CHE. Some of the variables such as use of inpatient, outpatient, and dentistry services, education, place of residence, and household income, which were considered as determinants of CHE in Iran, increased the possibility of facing CHE.
    Conclusions
    Decrease in CHE to less than 1%, which was the objective of the 2 of Iran’s five-year development plans in 2007 and 2015, was not met. This percentage may need to be reconsidered according to the pooled estimate of CHE. Also, the factors revealed to be the determinants of an increase in the probability of facing CHE could indicate the need for health care services and socioeconomic variables that lower one’s capacity to pay for health services.
    Keywords: Catastrophic Health Expenditure, Capacity to Pay, Out-of-Pocket, Household, Iran
  • Younes Mehrifar , Sara Karimi Zeverdegani , Majid Faraji , Masoud Rismanchian * Page 2
    Background
    Exposure to the evaporated gases during the welding process has short- or long-term effects on welders’ health. Assessment of the risk by identifying and determining the chemical risk rating might be a useful tool for the experts in industrial hygiene.
    Objectives
    The present study aimed at evaluating the exposure of welders to welding gases in seven welding types in the Steel Industry.
    Methods
    The present study was conducted in one of the factories of the steel industry in 2017. Seven types of welding were studied including SMAW-E7018, SMAW-E730, MIG, MAG, PAW, SAW, and GTAW. Sampling from the NO, NO2, CO, CO2, and O3 was done via direct-reading instruments. To assess the health risk of exposure, the used approach was the one proposed by the division of occupational safety and health of the labor department of Singapore.
    Results
    Findings of the present study revealed that the average range of welders’ exposure to NO, NO2, CO, CO2, and O3 gases in various welding processes was 30 - 50, 2456 - 5000, 2 - 12, 3.5 - 6, and 0.16 - 0.5 parts per million (ppm). Maximum and minimum concentrations of exposure to each of the gases were observed in MIG and PAW welding processes, respectively. The results of risk assessment showed that ozone and nitrogen dioxide had a very high-risk rating and nitrogen monoxide had a rank of “negligible” in all types of welding. Among the different types of welding, the most and the least risks of welding types were in MIG and PAW welding, respectively.
    Conclusions
    MIG welders have a high occupational exposure to various types of welding gases. Use of control measures such as installing a local ventilation system, workplace air monitoring, implementing appropriate respiratory protection, and training the workers are recommended for safety of the welders.
    Keywords: Welding Processes, Risk Assessment, Gas, Exposure, Steel Industry
  • Iraj Mohammadfam , Ahmad Soltanzadeh*, Shahram Arsang, Jang , Heidar Mohammadi Page 3
    Background
    Due to high risks for occupational accidents, process industries are one of the most dangerous industries around the world. Accidents’ size in these industries are influenced by combination of different factors.
    Objectives
    The present study aimed at analyzing and modeling occupational accidents’ size and investigating the role of different risk management factors on accidents’ size in process industries.
    Methods
    This analytical study was carried out on accidents in ten process industries, including petrochemicals, refineries, and chemical industries during eight years (2008 to 2015). Studied data were included variables and factors of risk management systems and information about human injuring accidents. Data analysis and modeling were done based on feature selection by Pearson χ2 coefficient and structural equation modeling (SEM) approach using statistical software of IBM SPSS AMOS v22.0.
    Results
    Lost working days (LWD) as index of accident size was estimated 197.42 ± 111.06 days. Results of feature selection and SEM approach showed that LWD was affected by different factors such as safety and health (S and H) training, risk management, and risk control, and its indicator variables (P < 0.05).
    Conclusions
    The findings implied that structural equation modeling is a reliable and applicable accidents analysis method. Furthermore, the results should be considered to prevent and reduce occupational accidents’ size in process industries.
    Keywords: Occupational Accident, Risk Management, Factor Analysis
  • Yasemin Akbulut*, Bayram Goktas , Gamze Kutlu Page 4
    Refugee’s health has become an increasingly important policy concern in Turkey. The aim of this record - based study was to present the size and economic dimension of services provided to refugees in public hospitals throughout the country and explain the legal status related to health insurance. The legal regulations and data on utilization of hospitals were obtained from the Ministry of Health. The results showed that all refugees used preventive and emergency services free of charge and also registered refugees had the right to use public primary and secondary health services for free. According to utilization data, number of births was 103347, deaths 3460, operations 260212, emergency and outpatients 8.849518, and inpatients 252470 in 2014 to 2015. Total health spending for the public hospitals was approximately $ 338392896 in the same years. It can be suggested that the role and capacity of preventive health services and primary health services provided by family physicians should be increased in order to reduce the work load in public hospitals caused by the Syrian patients.
    Keywords: Health Policy, Healthcare Cost, Hospital Management
  • Asghar Mohammadpoorasl*, Mohammad Hajizadeh , Soudabeh Marin , Payam Heydari , Mehran Ghalenoei Page 5
    Background
    Noise-induced hearing loss (NIHL) is one of the most important public health problems. There is scant information about NIHL, the prevalence and using patterns of headphones and music player devices in Iran.
    Objectives
    This study aimed to assess the prevalence and using patterns of earphones and investigate the relationship between earphone use and hearing loss in a sample of students from Qazvin University of Medical Sciences (QUMS).
    Methods
    In this cross-sectional study, 890 students were randomly selected using a proportional cluster sampling method in April and May 2015. The students completed a self-administered questionnaire assessing the pattern of their earphone use and hearing loss. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off point for the questionnaire.
    Results
    The results suggested that 60.2% (95% confidence interval (CI): 56.9 - 66.4) of the students reported a history of hearing loss and hearing impairment and 86.4% (95% CI: 84.0 - 88.5) of the participants reported using an earphone in the past. Most of the participants listened to music on their cell phones (81.7%) and 89.6% of them used headphones for listening to music. The results indicated that 51.3% of those who used earphones used earbud-style earphones, 42.2% used supra-aural earphones, and 6.5% used headphones. Students who used earphones, those who used earphones more frequently during the week, and those who used earphones for more years had higher hearing loss scores compared to other students.
    Conclusions
    Students have a risky pattern of using personal listening devices. The higher hearing loss score among headphone users requires further attention in order to implement interventions to increase students’ awareness and attitude towards the use of headphones.
    Keywords: Noise-Induced Hearing Loss, Earphone, Music Player, Headphone
  • Mohammad Nourmohammadi , Farideh Golbabaei*, Ali Karimi , Mohammad Reza Pourmand , Alireza Noor Poor , Abbas Rahimi Foroushani , Esmaeil Nourmohammadi Page 6
    Background
    Volatile organic compounds are a major source of air pollution affecting human health and the environment. Different methods are used to remove these pollutants from air streams including conventional and biological methods.
    Objectives
    In this study, the absorption and biodegradation of toluene were examined in a semi-industrial bioscrubber in order to enhance the absorption rate of toluene in the aqueous phase.
    Methods
    The effect of cutting oil was examined as the organic phase. Mass transfer was measured for water only, as well as for three concentrations of cutting oil in water. The growth of microorganisms in the presence of different concentrations of cutting oil was investigated. The microbial consortium was obtained from a wastewater treatment plant in order to inoculate the bioscrubber. First, the ability of the microbial consortium was tested for the degradation of toluene in a bottle.
    Results
    The results showed 98% of toluene in the bottle was degraded by the microbial consortium. In addition, the use of cutting oil significantly decreased kla (from 3.8 to 0.37). Concerning bioscrubber performance, the use of cutting oil as the organic phase increased the efficiency and elimination capacity from 22.5 to 55 and from 34 to 69, respectively, in the case of oil in water. The elimination rate of toluene increased as 32.5% by adding the cutting oil.
    Keywords: Toluene, Bioscrubber, Cutting Oil
  • Sajad Zare , Naser Hasheminejad , Saeid Ahmadi , Mokhles Bateni , Mohammad Reza Baneshi , Rasoul Hemmatjo * Page 7
    Background
    Heat is one of the harmful physical factors in the workplace. Occupational heat stress refers to the net load that the workers should put up with as a result of the combined impact of metabolic heat, environmental factors, and clothing causing heat storage in the body.
    Objectives
    This study aimed to compare the correlation between environmental stress index (ESI) and other thermal indices including wet-bulb globe temperature (WBGT), wet-bulb dry temperature (WBDT), thermal work limit (TWL), heat index (HI), standard effective temperature (SET), and physiological equivalent temperature (PET).
    Methods
    Data were collected from 30 workers in one pelletizing factory located in southeastern Iran. The measurement of environmental variables and workers’ physiological responses at the workplace was implemented in 10 conditions. Pearson product-moment correlation coefficient and linear regression were utilized to determine the relationship between ESI and environmental/physiological variables.
    Results
    The results showed that the strongest correlation was recorded between ESI and dry temperature (r = 0.96), natural wet temperature (r = 0.96), and heart rate in the working condition (r = 0.94). ESI was strongly correlated with WBDT (r = 0.99) and WBGT (r = 0.98).
    Conclusions
    It is concluded that ESI is strongly related to heat indices (WBGT, WBDT, TWL, HI, SET, PET, PSI, and PSIHR) and heat stress was higher than the legitimate range in some of the working stations. The highest coefficient was recorded for the relationship between ESI and WBDT.
    Keywords: Dry Temperature, Heat, Heat Stress, Physiological Strain, Environmental Stress Index
  • Ali Mohammad Aslani , Ehsanollah Habibi * Page 8
    Background and Objectives
    Beyond being very valuable assets, hospitals are symbols of health and societal well-being. Destruction of a hospital or damage due to fire may result in a loss of trust by local authorities as well as injuries for patients and staff and will not allow provision of health care services. This study aimed at assessing fire quantify risk assessment and the effect of crisis management team on fire risk.
    Methods
    This study was a descriptive analytically study. At first, according to fire risk assessment method for engineering (FRAME), fire risk was calculated for 15 hospital wards and then, the crisis management team was formed and trained, and the effects of fire risk were calculated. Data were analyzed by SPSS 20 software at a significant level of P < 0.05 with the Wilcoxon test.
    Results
    Overall, 13.33% of the risk was for buildings (mean = 0.57 and SD = 0.51), 100% of the risk was for individuals (mean = 4.60 and SD = 2.37), and 53.33% of the risk was for activities (mean = 1.81 and SD = 1.56), which were greater than one (unfavorable). An effective crisis management team reduces fire risk by an average of 31.4%.
    Conclusions
    Due to the poor state of fire safety in all hospitals studied in the research, organizing a crisis management team in each hospital can reduce fire risk by a relatively large amount.
    Keywords: Fire, Risk, Risk Assessment, Hospitals, FRAME
  • Mohammad Hassan Safarian , Fatemeh Rahmati, Najarkolaei*, Alireza Mortezapour Page 9
    Background
    One of the most important and the most common health problems among office workers and computer users is the risk of developing musculoskeletal disorders (MSDs).
    Objectives
    This study aimed at evaluating risk factors of MSDs and determining the effectiveness of the ergonomic, organization, education interventions on reducing MSDs in the office workers of university offices of Tehran, Iran.
    Methods
    This quasi-experimental study was conducted on 221 employees during spring 2015 to summer 2016. Participants were categorized to four groups by simple random sampling: control group (n = 55), recipients of education interventions (n = 57), recipients of organization interventions including job enrichment, job enlargement and job rotation (n = 54), and recipients of ergonomics interventions (n = 55). Rapid office strain assessment (ROSA) and Cornell musculoskeletal discomfort questionnaires (CMDQ) were used for data gathering. Data were analyzed by one-way analysis of variance (ANOVA) and paired-samples t-test using the SPSS version 16 software.
    Results
    After the intervention, a significant difference was revealed in the final mean score for ROSA in the two groups of recipients of education and ergonomic interventions (P < 0.05). Also, data revealed a significant difference in MSDs, including neck, shoulders, and hand/wrist, among ergonomics and education groups.
    Conclusions
    Educational and ergonomic interventions may reduce ergonomics risk factors of MSDs and prevalence of discomfort. However, according to the results, organizational interventions alone may not be more effective in reducing risk factors of MSDs and their discomforts. The effectiveness of multilayered interventions should be investigated in the future.
    Keywords: Ergonomics, Health Education, Human Engineering, Musculoskeletal Diseases, Workplace
  • Maryam Hormozi, Ramazan Mirzaei *, Alireza Nakhaee, Abolfazl Payandeh, Shahrokh Izadi, Javid Dehghan Haghighi, Razzagh Rahimpoor Page 10
    Background

    In the printing industry, workers are occupationally exposed to an extensive variety of chemical solvents, including toluene and xylene. Biological monitoring is an essential tool for assessing occupational health risk.

    Objectives

    The aim of the present study was to evaluate occupational exposure to toluene and xylene, as well as the biomarkers of exposure, in workers of the printing industry.

    Methods

    The hippuric acid (HA) and o-, m- and p-methyl hippuric acids (o-, m-, p- MHAs) as the biomarkers of occupational exposure to toluene and each of the three xylene isomers, respectively, were determined in the urine samples of 84 subjects, including 44 printing workers and 40 non-exposed subjects.

    Results

    The mean concentrations of toluene (37.64 ± 24.09 ppm) in the breathing zone of workers were higher, and the mean level of each of the three isomers of xylene (o-, m-, and p-xylene) was less than the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit values (TLVs). In addition, the levels of urinary HA, o-MHA, and m- and p-MHA in the exposed group were 0.15 ± 0.04, 0.11 ± 0.01, and 0.19 ± 0.07 g g-1 creatinine, respectively. Printing workers showed a significant increase in the levels of urinary HA compared to the non-exposed subjects (P < 0.001). The correlation analysis demonstrated significant correlations between the intensity of the occupational exposure to toluene and xylene and the level of exposure biomarkers in the urine.

    Conclusions

    The results indicated that although all the urinary biomarkers of exposure were below the Biological Exposure Indices (BEIs) recommended by ACGIH, the levels of the urinary metabolites of toluene and xylene were increased in printing workers. Therefore, monitoring of occupational exposure to toluene and xylene is helpful in the following-up of affected workers in the printing industry.

    Keywords: Biological Monitoring, Hippuric Acid, Methylhippuric Acid, Printing Workers, Toluene, Xylene
  • Seyed Nosratolah Taghavi, Hossein Kamani, Mohammad Hadi Dehghani, Ramin Nabizadeh, Nasim Afshari, Amir Hossein Mahvi* Page 11
    Street dust contains small matters coming from motor combustion and other anthropogenic sources. These elements are known as indicators of heavy metals, which have an important role in environmental pollution. The purpose of this study is to evaluate the degrees of arsenic, cadmium, copper, lead, and zinc pollution in street dust by using of the geo-accumulation index and enrichment factor.
    For sampling, 35 points are randomly defined by using the geographic information system. The metals were detected using acid digestion inductively coupled plasma optical emission spectrometry. The order of geo-accumulation index of analyzed heavy metals were: arsenic < lead < cadmium < zinc < copper. The copper levels can be considered as “moderately to heavily polluted” status. The assessment results of enrichment factor and geo-accumulation index showed that Arsenic did not have any noticeable concern, while enrichment factor of lead and zinc had moderate enrichment, and cadmium and copper had moderately severe enrichment. The average levels of studied metals were higher than the mentioned background level. There are variant elements causing high levels of heavy metals in street dust of Tehran. For instance, the extensive traffic following by the vehicles speed and braking, power plants, and industrial emissions are the main factors. Therefore, considering this information as an alarming sign for the safety of our environment is needed.
    Keywords: Heavy Metals, Street Dust, Geo-Accumulation Index, Enrichment Factor
  • Mehdi Karimi Aval, Ali Reza Ansari, Moghadam, Gholamreza Masoudy* Page 12
    Background
    Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral bleeding disease.
    Objectives
    This study conducted in 2016 and its aim was to determine the effect of education on promoting preventive behaviors in ranchers against the disease based on the health belief model (HBM).
    Methods
    In a quasi-experimental study, 183 subjects were selected and divided into intervention (n = 92) and control group (n = 91) using a multistage random sampling method. The data collection tool was a questionnaire, including specific and demographic questions that its validity and reliability was confirmed. At first, the data were collected in both groups and analyzed. An educational program based on the HBM, including educational content, media, and method was designed and two educational sessions were accomplished for experimental group. The data were analyzed by descriptive and analytic statistics with respect to the statistical significance level (P ≤ 0.05).
    Results
    After the intervention, the mean scores of behavior (1.55 ± 2.2), perceived susceptibility (2.06 ± 3.69), severity (0.92 ± 1.96), perceived benefits (2.06 ± 5.26), self-efficacy (2.85 ± 4.69), and cues to action (0.57 ± 3.14) significantly were increased in the intervention group compared to the control group and a positive correlation was found among them and preventive behaviors (P < 0.05). Moreover, perceived barriers in the intervention group significantly were decreased and self-efficacy was the most important predictor for preventive behaviors (P < 0.05).
    Conclusions
    HBM and particularly cues to action is an appropriate framework for educational interventions for promoting the preventive behaviors of Crimean-Congo fever among ranchers.
    Keywords: Educational, Health Belief Model, Crimean-Congo Fever, Ranchers