Iranian Journal of Health Sciences
Volume:1 Issue: 2, Summer 2013

Background and To determine an appropriate financial model for the health system of Iran, several studies have been conducted. But it seems that these studies were not comprehensive and further investigation is required. So to design a valid and enforceable mechanism, the study of policy interventions will be considered through consensus of all stakeholders. This investigation was done to determine the necessary policies and internal interventions for health care system financial improvement in Iran. The present work was carried out through investigating all key stakeholders in the medical system and the related sectors in Iran, along with the analysis of internal and external communication by using SWOT and STEEP.V methods. Strategic management of health-care costs, the development of a new financial system, clarity of costs, benefiting from health national accounts, the regulation of budget based on operations, preparing the credit of per capita from prepayment and risk accumulation, the development of referral systems and mechanisms, the establishment of public fund for services purchase, preventing the involvement of insurances in non-insurance cases, competing services with the private sector and increasing resources for the promotion of equality level have been determined as the key proposed interventions. It seems that the interventions based to the development of improving health financial system including the deployment of full accrual basis instead of cash basis, preparing and using services cost and operational budgeting and finally, cost management and productivity are the prerequisites of reforming health financial system.

Background and Disposing sludge from industrial wastewater treatment plants (IWWTPs) is a serious issue because it can affect human and animals health, and also environmental quality. In this study, sludge from an IWWTP was analyzed regarding its physicochemical characteristics and disposal options. Grab sampling was used to collect 12 sludge samples biweekly (May-October 2012). One sample T-test was applied to analyze the obtained data. Canadian Soil Quality Guidelines (CSQG) and New Jersey Department of Environmental Protection Soil Cleanup Criteria (NJDEPSCC) were used to discuss the generated sludge disposal fate. The results show that the order of the studied metals in the sludge was as: Fe>Al>Zn>Cr>Pb>Ni>Cd>Co>Cu>Mn>As>Hg. It was found that the generated sludge compared with CSQG is not suitable for residential/parkland, agricultural, commercial and industrial applications. But compared with NJDEPSCC, the studied sludge was suitable for residential and non-residential applications. According to NJDEPSCC, the studied sludge has the potential to be used for residential and non-residential purposes.

Background and Fluoride is one of the fundamental and required components in human body. The current study intends to survey the status of fluoride in drinking water supplies (underground water source and drinking water) in Qaemshahr city from 2006 (march/21) to 2012(march/19) and comparison with universal standards, national and climatic conditions. This is a descriptive and sectional study. Samples were experimented in Qaemshahr water and wastewater department laboratory. Fluoride concentration in samples has been measured by DR 2800 and SPADNS Fluoride Reagent Solution. Results were analyzed with Excel software. The medium of maximum temperature in different seasons has been obtained from meteorology department. Then fluoride levels in several years have been compared to each other and to universal, national and climatic standards. Comparing to standards National standards of IRAN and according to climatic conditions, proper levels of fluoride were in underground water sources respectively (9 % - 0.9 %) in spring, (17 % - 6.5 %) in summer and, (13 % - 0.00 %) in autumn and in winter. Also in Urban water distribution network were respectively (3.2 % - 3.2 %) in spring, (12.5 % - 5 %) in summer, (8.3 % - 0.00 %) in autumn and, (0.00 % - 0.00 %) in winter. The Fluoride levels in 100% of samples were lower than standards (MCLG and MCL= 4 mg/l). No significant relation was observed between fluoride concentrations obtained in different seasons and in different years.In most cases the Fluoride levels in studied city were lower than universal standards, national and climatic conditions. It is recommended that adding fluoride to food chain of the studied citizens should be noticed by the relevant authorities.

Background & Since 2005, a reform known as Rural Insurance and Family Medicine Scheme has introduced to primary health care network in Iran in rural areas and small towns. The content of the reform implies a substantial change in those aspects of health centers that mainly could be categorized as structural quality. Although, this is the requirement of all health care providers, they are not identical in those items. In this article, we have tried to report the relation between structural quality of health centers and utilization of curative care in Mazandran province. This was a cross-sectional study conducted in 2013. Secondary and routinely collected data was used to answer the research questions. The source of original data was provincial health authority’s data set. A check list containing pre-identified variables was used to extract the data. Using SPSS software package, regression analysis was run to measure the role of different independent variable on dependent variable. There were 215 rural health centers affiliated to 16 cities or small towns that the reform has taken place. The outreach area population of these health centers was 1ˏ330ˏ212 of which 834ˏ189 (62.71%) were covered by rural insurance solely. Health centers are not identical in terms of the characteristics of health centers and their utilization. Among the variables with significant impact on the utilization of outpatient care, except for number of physician in each health centre and existence of state owned pharmacy that were found in some health centers, the rest of variables had significant positive impact on the demand for physician visit. Structural quality has significant impact on the utilization of curative care of primary healthcare units at rural area in Iran. The reform seems well targeted the quality improvement and utilization of effective primary health care.

Background and The movement of spiritual leadership is a special kind of service-centered leadership which looks forward to progress and staff control. Job involvement also emphasizes timely attendance of staff, feeling successful at work, and sense of optimism and success about the future of the organization. Therefore, this study investigated the relation between spiritual leadership and job involvement of employees in the selected hospitals located in Isfahan. This study was descriptive–analytical and was conducted in 7 hospitals of Isfahan in 2010. The instrument used was a valid and reliable questionnaire consisting of three parts of demographic data, spiritual leadership questionnaire, and job involvement. Data was analyzed by SPSS. 18 and analytical and descriptive statistics (t-test, ANOVA and Pearson correlation) were performed. Results showed that the average score of spiritual leadership and job involvement in entire hospital cases were more than 3. There was a direct correlation between spiritual leadership and job involvement. Also there was a significant relation between the staff work experience and the two studied components. According to the results, it is recommended that organizations authorities involved in health issue provide conditions in addition to focusing on various aspects of spiritual leadership so that the health community rights and especially the staff of this sector be respected and have a sense of job security so that more improvement of job commitment and job involvement be provided for people by enjoying social supports.

Background and The 2-chlorophenol (2-CP) and 4-chlorophenol (4-CP) are phenolic compounds which may have adverse effects on human and environment. Therefore, removing these compounds from water and wastewater is necessary. This study aims to analyze 2-CP and 4-CP removal by using Azolla filiculoides biomass. Azolla biomass was sun dried, crushed and sieved to particle sizes ranging 1-2 mm. Then it was treated with 0.1M HCl for 5h followed by washing with distilled water and it was used as adsorbent. The residues concentration of 2-CP and 4-CP was measured by spectrophotometer in λmax of 274 and 280 nm, respectively. The solute removed increases as contact time rises. The equilibrium time for 2-CP and 4-CP is 90 and 75, respectively. The removal efficiency of 4-CP is more than 2-CP. An increase in initial concentration of both compounds can lead to decrease of their removal efficiency. The optimum pH to remove both compounds is 5. The equilibrium data matched best on Freundlich isotherm and the adsorption kinetic model follows pseudo-second model. The results indicated that Azolla is an effective adsorbent for removing 2-CP and 4-CP from water and wastewater.

Background and Sample size and its determination is one of the most important problems in health researches. Calculating sample size for prevalence studies is one of the common questions of sample size topics. Minimum sample size with least complexity is desirable in order to achieve the basic goal of these studies. This study aims to compare two formulas of sample size calculation for prevalence researches and finally, to use the simplest formula to get the most appropriate sample size. Sample size for proportions: 0.9, 0.95, 0.99, 0.999 candidates of p close to 1 proportions; 10-5, 10-4, 10-3, 10-2, 0.05, 0.1 candidates of p close to 0, and proportions 0.3, 0.4, 0.5, 0.6, 0.7 candidates of p close to 0.5 were calculated. For comparing n1, n2; φ =n_1⁄n_2, it was computed by R package (2.10.1). Computed sample size by (f2) is lightly greater than sample size computed by (f1) and maximum value of φ index for comparing the two formulas equals 1. Results show that the calculated sample size by (f1) is similar to what was obtained by (f2), though, according to its interpretation and easy computation, it is suggested for all values of p.

Background & In the health sector, in addition to the important consequence of treatment, health system should meet the expectations regarding the desirability of services. Expectations and perceptions of patients about the desirability of services play an important role in selecting hospitals, their loyalty to the organization & replanning to purchase. Thus the present study has been done with the aim to determine the relationship between services desirability and patients’ tendency to public or private hospitals in Sari. This study is a descriptive and analytical type done in 2012 in four private and public hospitals located in Sari. The study population consists of hospitalized patients that have been subjected to inquiry by using 361stratified random samples. The survey tool was questionnaire that its validity was judged and approved by the teachers and its reliability was obtained by alpha Cronbach as 0.972. The collected data was analyzed by SPSS software, independent t-test, t-sample test and descriptive statistics. Findings show that in services cost indexes, there are not any significant differences between public and private hospitals while in the other services desirability indexes such as accessibility, availability, speed, quality, and complete package of services and …, there is a significant difference between public and private hospitals. In patients’ tendency to hospitals, utility service indicators satisfy a significant impact. So, codified planning to improve these indexes in order to absorb more patients by authorities is required.

Background & Air pollution has been known as one of the most effective factors on cardiovascular, pulmonary and infectious diseases. This study aims to determine the relation between mortality rate and air pollution in Mashhad during 2007-2009. Data of air pollution, mortality rate and geographic factors were collected during 2007-2009 and analyzed. Mortality rate, the average PSI of individual pollutants, temperature and moisture were weekly measured and the diagrams were then drawn according to the methods of statistical correlation and regression analysis of air pollution and mortality rate. According to the findings, there was no significant relation between CO and mortality rate, but the other pollutants played a significant role in this regard. The maximum correlation was obtained for SO2 and O3 in the concentrations of 0.936 and 0.154 ppm, respectively, but in the final model for all pollutants and weather variables, only PSI for O3, season and humidity showed significant change. O3 has increased during three years of research and has been the leading cause of death among the pollutants. Most deaths occurred in cold seasons. Among all pollutants, the maximum concentration of SO2 was in winter and the maximum concentration of O3 was in spring and summer 2009.

Background and Breast cancer is the most prevalent cancer among all widespread cancers worldwide. After lung cancer, breast cancer is the main cause of death among women. One of the best ways to detect this disease early is to do screening. This study has been done to analyze the knowledge, attitude, and behavior of women regarding the breast cancer screening methods. The study is of cross-sectional descriptive type. The participants were 500 Behshahr dwelling women above 20 years old selected based on cluster sampling. The instrument used was a 34-item questionnaire to investigate the knowledge, attitude, and behavior of the women. The data has been analyzed through inferential statistical methods. The participants'' age mean was 35.16. The average knowledge score of the disease and screening methods was 1.3 and 54.6. The average attitude score of was 82.5. Regarding behavior, 13.1 percent do regular self-examination, and 15.2 percent do regular clinical examination. 16.7 percent of women have one experience of doing mammography. In the present study, there was a significant relation among knowledge, attitude and behavior. Since the knowledge of women was at average level and the behavior of using the screening methods was weak, planning to enable and motivate women to use the screening methods is highly emphasized.

Background and Hydatidosis is one of the most important zoonoses in the world that have public health and economic perspectives. The aim of this study was to investigate the prevalence of hydatid cysts in slaughtered animals in the industrial slaughterhouse of Khomein, Markazi province (2007-2011(. In this study was invistigated 28760 head of animals, including; 12860 sheep, 3840 cows and 12060 goats. Their carcasses were inspected using macroscopic method for hydatid cyst in livers and lungs. Data analysis was performed by Chi-square test and SPSS software (Version 16.0). Resuts: The prevalence frequency of hydatidosis in slaughtered cattle was 523 head with the most infected animals of 113(2.94%) cow, 223(1.73%) sheep and 187 (1.55%) goats respectively. Moreover, 1126(3.9%) infected lungs and 1076(3074%) infected livers were found. On the seasonal bases, the surveys showed that maximum spread of the disease was in summer. The prevalence of hydatid cysts of parasites is relatively high which in addition to imposing high economic losses due to the deleting of infested organs of animals and decrease in livestock products, indicates the existence of conditions for health risks for residents which requires more inclusive and comprehensive sanitary and control measures due to this parasite''s life cycle and transmission.

Background and Work-related Musculoskeletal Disorders are the most prevalent work- related disorders and the main cause of disability among workers. Also these disorders are the main cause of absence from work and losing work hours and lead to reduction of productivity. This cross–sectional analytical study was done on 100 workers of Sorak tobacco factory selected randomly. Posture analysis was evaluated by OWAS method and the prevalence of MSDs by Nordic questionnaire. The data was analyzed using EXCEL and SPSS software version 18. The workers age mean was (43+-3.97) years OLD and work experience was 12 years. The prevalence of MSDs was 75% in the last year. The limb part (55%), knee (45%) and shoulders (37%) were the most parts of workers’ complaints. WAS posture analysis showed that most postures are critical or need the modification intervention. The prevalence of MSDs in Sorak tobacco factory workers is high and the postures are inappropriate. Ergonomic interventional programs as well as educating workers are recommended.

Background & There are occupational hazards related to Nitrous Oxide (N2O) in hospitals operating and recovery rooms. These hazards include the decrease of mental performance and audio-visual ability, and reduced fertility, spontaneous abortion and neurological, renal and liver diseases. In this survey, the concentration of Nitrous Oxide in indoor air of hospitals operating and recovery rooms in Babol University of medical sciences was determined. This descriptive study was performed in 23 operating rooms and 3 recovery rooms in 3 educational hospitals of Babol medical sciences university. The rooms with continuous usage of N2O with 2-3 lit/min of flow of general anesthesia were studied. For sampling and detecting N2O concentration as part per million (ppm), a portable IR spectrophotometer (3015 model of Bacharach Inc.) was used. The sampling was performed in 5 different zones of the operating rooms and 1zone of recovery room in 3 different hours of work time (8:30-9AM, 10:30-11AM and 12:30-1:00PM). One-way ANOVA, SPSS 18 was used to analyze data and comparing the means. N2O concentration mean in 5 different zones of the operating rooms was 318± 22.6, 325.5± 24.1, 299± 21.8, and 301± 22, 314± 23.7 ppm and in recovery room, it was 51± 15 ppm. There was no significant difference between the means of N2O concentration in different zones of the operating rooms, but the means of N2O concentration in different zones of the operating rooms and recovery room were significant (p<0.05). Considering high average concentration of Nitrous Oxide in different operating and recovery rooms with maximum contamination levels of N2O, this situation subjects the health personnel to risk. Therefore, further research and applying protection utilities are recommended.