فهرست مطالب فرزام بیدارپور

Today, environmental pollution, including water pollution, has become a global issue, and human life is dependent on the safe drinking water. This study aimed at spatial analysis of minerals and heavy metals in drinking water distribution network in Kurdistan Province’s villages.

In this descriptive-analytical study we assessed the concentrations of nitrate, nitrite, total soluble solids, fluoride, arsenic, lead, and cadmium in drinking water of all villages connected to water distribution network (1524 villages) in Kurdistan Province from 2015 to 2017. To describe the concentrations of the studied chemicals, spatial distribution maps were plotted using Arc GIS V. 10.3 software. Other statistical analyses including the analysis of the mean difference of the concentrations of nitrate, nitrite, and total soluble solids in the studied cities were performed by one-way analysis of variance using SPSS V. 22 software.

According to the results of this study, tap water in 1485 villages of Kurdistan Province (97.44%) contained nitrate and the amount of this ion in the drinking water of 31 villages (2.03%) was above the national and WHO standards. The mean concentration of total soluble solids in Bijar City was significantly higher than that in other cities (P <0.001). The mean concentration of fluoride in the drinking water of rural areas of Kurdistan province was 0.19 ± 0.25 mg/l, which was lower than the value determined by national standard of Iran (0.5-1.5 mg/l). The concentrations of arsenic in the tap water of 47 villages of Bijar (23 villages), Qorveh (11 villages), Saqez (7 villages), Dehgolan (5 villages), and Kamyaran (1 village), respectively, were higher than the maximum permitted value.

Continuation of the current trend, especially in agricultural sector and uncontrolled use of groundwater resources in agriculture, will lead to decreased water quality. Therefore, it is necessary to monitor agricultural activities and use of fertilizers.

The Family Physician (FP) plan was implemented in rural areas and cities with a population of less than 20000 in 2005. The purpose of this study was to explain the challenges and obstacles of the Rural Family Physician Program in Kurdistan Province from the perspective of stakeholders.
  This qualitative study was conducted using 30 semi-structured interviews and 5 focused group discussions (FGD) with stakeholders of the FP plan from June 2017 to Jan 2018. The participants were selected through a purposive sampling method with maximum variation. The contents of the interviews and FGD were categorized by the content analysis method using MAXQDA10 software (V. 10).
  The challenges and obstacles of the FP plan were categorized into 16 subcategories and 5 main categories. The main categories were stewardship challenges, service delivery challenges, cultural and educational challenges, human resource challenges, and infrastructure challenges. The most important subcategories of these challenges included weaknesses in policy-making, formation of laws and regulations, weaknesses in insurance performance, weaknesses in intra-sector coordination, weaknesses in the referral system, weaknesses in communicating the plan to the community, low survival of physicians, inadequate motivational mechanisms, and weaknesses in the information system.
  The rural FP plan faces many challenges that require multi-dimensional interventions. Identifying the challenges of the FP plan from the perspective of its stakeholders can help to gradually improve the plan.

Despite the implementation of the health reform plan and the increasing number of comprehensive centers of health services in 2014 in Iran, many people still do not attend these centers for various reasons. The aim of this study was to determine the reasons why urban households do not attend comprehensive centers of health services in Sanandaj.   This study was carried out using two quantitative and qualitative approaches. In the quantitative section, data were collected through a checklist and interviews with 200 household heads who did not attend. In the qualitative section, the views of physicians, other health providers, and household heads were obtained using semi-structured interviews.   A feeling of no need for health services, paying more attention to treatment, working on morning shifts, physical problems, inappropriate location of centers, inadequate informing services to community members, inconsistency between existing services and clients’ needs, and inappropriate treatment of some health providers were the most important barriers to non-attendance of clients. Despite four years of implementation of the health reform plan in Iran, 53.5% and 60% of participants had no awareness about the presence of mental health and nutrition experts and their free services in the centers, respectively.   Although there are many reasons for people not attending comprehensive centers of health services in cities, informing and introducing services to the community and considering the clients’ needs are essential.

The massive un-exploded landmines in Iran every year take many victims among the citizens of the landmine areas. The aim of this study was to investigate the health-related consequences of landmine explosions in Kurdistan province. This cross-sectional study was conducted in 2016 - 2017. An active sampling approach was carried out in urban and rural areas of Kurdistan province. Data were collected by a researcher-made questionnaire. Reliability and validity of the questionnaire were calculated. Overall, 410 cases were recruited. Data analysis was performed using SPSS V. 22 software. 32.4% of the victims were immediately killed after landmine explosions and 67.6% of the survivors were living with injuries and various disabilities. The most prevalent injury was the amputation of at least one upper or lower limb with the rate of 63.5%. The prevalence rates of complete blindness and deafness were 9.8% and 1.5%, respectively. In order to prevent and mitigate the consequences, it is recommended to detect, enclose, and clear the landmine contaminated areas and implement educational programs for people and communities at risk of landmine explosions. It is also necessary for provincial planners and policymakers to implement rehabilitation and treatment programs for landmine survivors in Kurdistan.
Keywords: Landmine; Explosion; Health Impacts; Kurdistan
Please cite this article as follows:Fathollahi S, Fatemi F, Ardalan A, Bidarpoor F, Esmaeilnasab N.Yari Arezoo Assessing health-related consequences of land mine explosions in Kurdistan province during the last 37 years: 1980-2017. Hakim Health Sys Res 2018; 21(3): 200- 210.

Drug addiction is one of the most important health problems and social harms worldwide. Based on exist evidence primary prevention is main approach for addiction control in the society and treatment could not help to deal with this issue.
Aim: The aim of this study was to determine the causes of drug addiction for the first time in drug users of Sanandaj.
This was qualitative study that conducted in Sanandaj, 2015 using respondent driven sampling (RDS), as one of the sampling methods to access the hidden population. With this method until saturation of the data 410 addicts were recruited. Focus group discussions (FGD) and in-depth interview methods were used to determine the causes of drug abuse in drug users for first time. Data analysis was performed using Open code software.
Until saturation, 410 addicts were enrolled in the study with a mean age of 36.3 years. Mean age of these patients at first onset of drug use was 17.2 years. The results showed that hedonism (pleasure), curiosity, peer pressure (recommended friends), lack of enough knowledge, having addict person in the family, emotional failures and unemployment have been recognized as major causes of drug use for the first time. Great prosperity and propensity to the mind comfort were other un-prevalent causes for beginning the drug use that reported in some participants.
Given the results, preventive interventions can be carried out for most causes of drug use identified in the study especially paying attention to the needs of these people in their teenage period besides the giving required information to them would be helpful.

From 2011 to 2013 some efforts had been made in Iran to implement urban family physician program. The aim of this study was to determine the viewpoints of managers, providers, and clients of health care services about the problems in the implementation of urban family physician program in Iran.
This study was a qualitative study. Data were collected through holding 21 sessions of focus group discussions and 37 individual interviews with managers, providers, and clients of health care services in Alborz, West Azerbaijan, and Kurdistan Provinces in 2014. Data were analyzed by means of content analysis method.
According to the results of this study, the problems on the implementation of urban family physician program in Iran can be classified into seven categories including: financial, cultural, educational, motivational, structural, administrative, and contextual problems.
We propose definition and stabilization of the financial resources and establishment of appropriate rules for payments to solve financial problems, and also training of general population and staffs and involvement of the mass media in training to solve the cultural problems. In order to solve the educational problems reforms in medical curriculum are recommended. Motivational problems can be solved via encouraging the private sector and experts to take part in the program and also through guaranteeing the continuity of the program. Establishment of appropriate organizations and provision of protocols are recommended to solve the structural problems. Finally, to overcome the contextual problems it is suggested to promote cross-sectoral and inter-sectoral coordination and also attract support from policy-makers.

Determination of prevalence of non-communicable diseases (NCD) risk factors is the key factor for designing any intervention program for the control and prevention of these diseases. The aim of this study was to determine NCD risk factors among rural areas population in Kurdistan Province, in Iran, in 2015.
In this population-based study, we investigated the prevalence of main NCD risk factors among 13710 adults above 20 years of age selected by systematic random sampling method from rural areas of Kurdistan Province, in the north-west of Iran. Data were collected by using a standard questionnaire. SPSS version 22 software was used for data analysis.
The results showed that 10.6% (9.0-12.2%) of the participants were current daily tobacco smokers and 32% (31.5-33.0%) of them had passive smoking. 54.9% (54.1-55.8%) used solid oils as the main consumed oil by the households. The prevalence rate of overweight/obesity was 17.2% (16.5-17.8%). Mean daily fruit and vegetable consumption and also mean hours of exercise or vigorous physical activity per week were 1.6±0.9 servings and 2.8±3.5 hours, respectively. The prevalence rates of hypertension and hyperlipidemia were estimated 8.2% (7.8-8.7%) and 3.3% (3.0-3.7%), respectively. The prevalence rats of stroke, various cancers, asthma, chronic obstructive pulmonary disease (COPD), depression and diabetes were 0.6% (0.5-0.8%), 0.4% (0.3-0.6%), 1.1% (0.9-1.3%), 1%(0.8-1.1%), 1.5% (1.3-1.7%) and 2.5% (2.2-2.7%), respectively. Different cities of the province showed significant differences in the prevalence rates of the most of the risk factors (P This population-based study provided the real figures of NCD risk factors among the population living in the rural areas of Kurdistan Province. We recommend use of the results of this study for designing any intervention program for control and prevention of NCD in this region.

The phenomenon of prostitution among women as one of the backgrounds for the spread of human immunodeficiency virus (HIV) and other sexual transmitted infections in recent years attracted the attention of the authorities, especially the Iranian health officials. From 2009, and accordance to the HIV surveillance, centers as centers for vulnerable women has been established by the national health system for harm reduction programs in women. In this study, experiences, risky behaviors, and causes of these behaviors in female sex workers (FSWs) came to the vulnerable women counseling center in 2015, in Sanandaj City, Iran, were studied.
In this qualitative study, semi-structured interviews and focus group discussion techniques were used to collect the data. Individual interviews with service provider personnel vulnerable women, including the director of the women counseling center, the midwife, and social worker consultant, and three focus group discussions with women referred to the center were done.
Sexual partner's unwilling to use harm reduction facilities, non-commitment of men to pay for prostitution, violence, physical and sexual harm, applying for unconventional sexual abuse, and forced use of drugs and alcohol were the main experiences and risk behaviors that prostitutes facing. Lack of adherence to religious, poverty, addiction, divorce, ethical and social distortions, and lack of healthy family relationships were the most important factors affecting the occurrence of prostitution among women.
Even the health and social consequences of the prostitution among women and their risky behaviors are associated with multiple factors (multifactorial), but to deal with this problem, attention to the social determinants of health is very important; and each of the variables identified in this study can become a target for interventional programs in the country, particularly in vulnerable women counseling centers.

Cytomegalovirus (CMV) infection is one of the most common causes of death in people with immune deficiency diseases such as: organ or tissue recipients, patients with HIV/AIDS and newborn infants. The aim of this study was to determine the prevalence of anti-CMV antibodies in patients with HIV/AIDS in the Kurdistan province.
This cross-sectional study carried out on 151 patients with HIV/AIDS covered by behavioral health counseling centers in Kurdistan province, 2015. For all patients the values of CMV antibodies, include IgG and IgM, were determined by ELISA technique and Diagnostic Kits (EIA WELL, Rome, Italy). Data analyses were done by use of t-test and multiple linear regression tests in stata software, version 13.
116 (76.8%) and 35 (23.2%) of the patients were male and female, respectively. Mean (SD) age of the patients were 39.3 (9.1) years. All studied patients were found positive for CMV-IgG (prevalence=100%), whereas only one case (0.7%) was found positive for CMV-IgM. The relationship between age and CMV-IgG levels was statistically significant.
The results showed that high prevalence of CMV in patients with HIV/AIDS, so in addition to paying more attention to the issue of HIV and CMV co-infection, about value of early antiretroviral treatment conducting further studies seems necessary.

Needle stick and sharps injuries (NSIs) have been recognized as one of the occupational hazards among health care workers. Many infections including blood-borne viruses such as Human Immunodeficieny Virus (HIV), hepatitis B and C can be transmitted by exposure to infected blood or other body fluid via accidental inoculation injury. The aim of current study was to determine prevalence of NSSIs and related factors in health care workers of Besat hospital of Sanandaj, 2014. This cross-sectional study, with sample size of 249 persons, was carried out during June and August in 2014 in Besat hospital of Sanandaj. Participants including nurses auxiliary nurse, midwives and service staff. Descriptive methods and logistic regression were used for summarie of data and assessing the associations between variables and occupational exposure, respectively. The prevalence of occupational exposure in this hospital personnel was 79.92 %. Multivariate logistic regression analysis showed that men more than women and those with experience (years of services) of 10 to 15 years were significantly more likely to needlestick. 61.36% of the participants also had correct knowledge about occupational exposures and how to deal with it. The findings showed that the occurrence of NSIs in this hospital was high. We concluded that prevention of NSI as an integral part of prevention programs in the work places is essential, and training of health care workers regarding safety practices indispensably needs to be an ongoing activity.

The aim of this study was to investigate the trend of mortality of children under five years old in Kurdistan Province during 2007 to 2011.

The data of this descriptive-analytical study on deaths and births was collected from provincial deaths registry system and Civil Registration System during 2007 to 2011. The main indicators including under-five mortality, infant mortality, and neonatal mortality rate during the given period were studied. The relationship between variables was calculated using chi-square test.

The neonatal mortality rate changed from 13.5 per thousand live births in 2007 to 12.2 per thousand live births in 2011. During the same period of time, the infant mortality rate and under-five mortality rate declined from 17.1 and 20.2 to 14.9 and 17.4 per thousand live births, respectively. A significant relationship was found between gender and infant mortality. Among the major causes of mortality, prenatal diseases, especially infant diseases, were the most common cause of death in the neonatal period.

According to the results of this study, although there was a reduction in the under-five mortality rate during these years, the observed decline, especially the decline in infant mortality rate, was very slow. There are still some preventable causes of death in children which require more attention by the health system and researchers.

Brucellosis is one of the most important zoonotic diseases that can be transmitted with contact with Blood, Placenta, other animal genital production, milk and other productions. The most important control way is prevention. In this survey that is a cross - sectional study, exactly 1059 brucellosis patients were studied in1385. The Index for patient was Right agglutination test 1/80 and more. All patients with this Index were investigated and all data from them were gathered. The date was analyzed with t-test & qi-2 in SPSSwin13. 1059 patients were investigated in this Survey which 538 (% 50/8) of them were male and 521 (49/2%) were female. 106 (%10) were from urban areas and 935 (%90) were lived in rural areas. The incidence rats were 73/5 per 100000 in, and the highest incidence rat in KurdistanProvince was reported in Bijar with 329 per 100000 The lowest incidence rat was in Baneh with 28 per 100000. Most of the patients were from house keeper wives (%44/2). There wasn't any relationship between sex and place of living, but there was a relationship between average of the age in urban and rural areas. The results of this study show clear difference between epidemiologic status in 1385 compared with 1383&1382, and it shows that incidence of brucellosis in rural and urban areas in Kurdistan has decreased. It's seemed that proceedings of veterinarian system special vaccination of animal and health education by health system of the medical university are effective in decreasing the brucellosis in Kurdistan.

With respect to the geographic variation of diabetes prevalence, recognition type 2 diabetes risk factors in each area are important. Expert diabetic committee suggest men and women should be screened for type 2 diabetes if they are over age 45, have BMI over 27 kg/m2, a family history of diabetes, a blood pressure over 140/90, a history of gestation diabetes, delivered a baby over 4.1 Kg, Hypertriglyceridemia and previous evidence of impaired glucose homeostasis. In this survey the relation between type 2 diabetes and family history of diabetes, obesity, hypertension, gestational diabetes, 2 or more spontaneous abortion and stillbirths was studied. This study was case-control and the population under study included 240 patients from Kurdistan diabetes center and 240 none diabetic controls. Data were analyzed by x2, Mantel Hansel and t-test. There was a significant correlation between family history of diabetes OR=8.17, CI 95%(4.65-14.47); obesity OR=1.92, CI 95% (1.31-2.81); age over 40 OR= 8.65, CI 95% (4.36-16.81); female sex OR=0.58, CI 95% (0.38-0.88); hypertension OR=2.53, CI 95% (1.66-3.88); stillbirth OR=2.3, CI 95% (1.3-4.20) and type 2 diabetes. There was no significant correlation between gestation diabetes, spontaneous abortion and type 2 diabetes mellitus. With respect to the result of this survey screening program for those people who are 45 or more, are obese, hypertensive, have a family history of diabetes and stillbirth prerecord is suggested.