Journal of Health Research in Community

15-26

Authors: Mahbobeh Eshaghi , Parvin Sepehr *

Introduction and purpose: One of the most effective strategies in Health, Safety, and Environment Management System (HSE-MS) is the importance of training in safety. Therefore, the present study aimed to investigate the effectiveness of safety training on reducing the rate of unsafe acts using a management system in Ekbatan profiling industry. Methods: This cross-sectional study was conducted based on a descriptive-analytical and interventional design. Safety behavior sampling was initially utilized to determine the rate of unsafe behaviors. Subsequently, the rate of individuals' unsafe behaviors was assessed using prepared checklists and random observation. The HSE-MS was used for the improvement of unsafe behaviors. The effectiveness of the intervention and the level of unsafe behaviors were analyzed before and after the intervention, after two years using Excel 2007 and SPSS software (version 16) through the paired t-test. Results: The mean rate of the individuals' unsafe behaviors was 34% before the intervention. Moreover, the highest and lowest rates of the unsafe acts were awkward posture (25.8%) and running (0.8%) at the workplace, respectively. The results obtained from the paired t-test showed the effect of the intervention and a decrease in the rate of unsafe behaviors by 20% (P=0.037). Conclusion: Training is the cornerstone of the MS leading to the improvement of the unsafe behaviors. Therefore, continuous and effective training in the safety management system will result in a reduction in the rate of accidents and the improvement of the safety status.

39-51

Authors: Zahra Rahnama , Mahshid Ahmadi * , Alireza Khalilian , Maryam Sefidgarnia Amiri

Introduction and purpose: Job burnout is a kind of psychological distress that results from various occupational factors and leads to the deterioration of job performance. This condition is usually characterized by weakness, disappointment, and nonachievement of career goals. Regarding this, the present study aimed to compare the frequency of burnout syndrome between general family and non-family physicians in Mazandaran province, Iran, in 2018. Methods: This cross-sectional study was conducted on 153 urban family physicians, 158 rural family physicians, and 295 non-family physicians (i.e., a total of 606 cases) selected using simple random sampling technique. In this study, Maslach Burnout Questionnaire was used, as the main tool for measuring the three dimensions of emotional exhaustion, depersonalization, and personal empowerment. Study participants included two groups of family general practitioners with more than two years of experience working in all shifts as a family physician, as well as non-family general practitioners working in health centers and offices affiliated to mazandaran university of medical sciences. General practitioners working in the hospital and staffing plan were excluded from the study. One-way ANOVA was used to compare the mean values and the mean differences of burnout dimensions at two levels of urban and rural family physicians and those outside the family physician plan. Results: Emotional exhaustion score in the non-family physicians was 14.6±10.31, while this score was obtained as 19.73±12.57 and 20.39±12.17 in the urban and rural family physicians, respectively, showing a statistically significant difference (P<0.0001). In this regard, family physicians (especially rural family physicians) had the highest occupational burnout in this dimension. However, regarding the other two dimensions, the difference between the family and non-family physicians was not statistically significant. Generally, emotional exhaustion had the highest prevalence (20.3 %), followed by depersonalization (29.4%) and personal accomplishment (24.1%). In addition, more than half of the subjects showed a high level of burnout at least in one of the three dimensions of this construct. Conclusion: As the findings indicated, occupational burnout was more common in family physicians, especially in rural area family physicians, which can be due to working in remote places with more duties, fewer facilities, and more difficult environmental conditions. Many demographic and environmental factors account for the incidence of burnout. Therefore, it is required to perform further studies and develop plans targeted toward reducing occupational burnout, especially in family physicians, since resolving this situation can improve the quality of patient care services.

61-72

Authors: Fatemeh Rajaei , Babak Vazirianzadeh , Hossein Hamidinejat , Elham Jahanifard * , Hossein Nasiri

Introduction and purpose: Ticks as biological vectors and reservoirs of diseases, such as Crimean-Congo hemorrhagic fever (CCHF), have an important role in the transmission of pathogens to humans and animals. In this regard, this study aimed to determine the biodiversity indices, distribution, and fauna of the vectors of CCHF in Ahvaz, Iran. Methods: The tick samples were collected and identified from the head, ear, groin, under the tail, and around the rectum of cattle, sheep, and goats in spring and autumn. Biodiversity indices were calculated based on the host type. Moreover, the frequency map of the ticks was drawn using ArcGIS software (version 10.4). Results: A total of 287 livestock were examined in this descriptive cross-sectional study. Overall, five species of tick were identified from three genera. Frequency rates of Hyalomma marginatum, Hyalomma anatolicum, Rhipicephalus bursa, Rhipicephalus sanguineus, and Boophilus annulatus were calculated as 21.25%, 2.5%, 61.25%, 11.25%, and 3.75%, respectively. According to the Shannon-Weiner index, the species diversity of the goat host was less than that of the hosts of cow and sheep. In addition, based on the Simpson index, the diversity of dominant species in the goat host was less than that of the other two hosts. Furthermore, the species richness index in sheep host was the highest among the hosts. However, the evenness index of the species based on the host type was calculated to be the highest equal to 0.789 for the host of the cow. Conclusion: According to the obtained results, there was a relation between biodiversity indices and tick-borne diseases. The aforementioned relationship provides useful information in terms of preventing diseases transmitted by ticks.

83-93

Authors: Mahvash Raghibi , Haneye Sheikh * , Yaser Shamsollahzadeh , Morteza Jalmbadani

Introduction and purpose: Adolescence is associated with physical, psychological, cognitive, emotional, and social changes in a person’s life. During this time, the concepts of identity and body image are raised, both of which can lead to anxiety and ultimately social avoidance. In this regard, the present study was conducted to investigate the mediating role of identity styles in body image and social avoidance of adolescents referred to health centers in Zahedan, Iran, in 2018-2019. Methods: The present descriptive-correlational (correlational-predictive) study was performed on 128 adolescents referred to healthcare centers. The sampling was conducted using the convenience sampling method, and data collection tools were the questionnaires of body image concerns, social avoidance and distress, as well as identity styles. Data analysis performed by SPSS software (version 16) using descriptive statistics, Pearson correlation coefficient, as well as stepwise and standard regressions. Results: Results of the present study indicated that identity styles, including diffuse-avoidant, normative, and commitment, were able to predict and determine variations related to body image concerns (P<0.01). Moreover, the normative identity style could predict and determine variations associated with social avoidance and distress (P<0.01). Furthermore, the results indicated that body image concerns could predict and determine the variations related to social avoidance and distress (P<0.05). Conclusion: Identity styles and body image during adolescence can weaken communication skills, have adverse effects on the levels of adolescents’ social interactions with others, and deprive them of having the opportunity to acquire mental, physical, and social skills. Therefore, the risks associated with the aforementioned issues should be taken into consideration, and culture should be extensively developed in national and transnational levels in this regard.

11-18

Authors: Sareh Shakerian , Homeira Amini *

Introduction and purpose: Self-care and patients education is the core of diabetes care and control. Family as the most fundamental pillar of society is responsible for the provision of proper and appropriate health care. The current study aimed to investigate the family-oriented empowerment model on self-care behaviors of patients with Type 2 diabetes in Neka. Methods: This quasi-experimental study was conducted on patients with diabetes mellitus referring to comprehensive rural health centers in Naka. They were randomly assigned into two groups of intervention and control. The intervention group received training for three months. Data collection instrument included Summary of Diabetes Self Care Activities(SCSCA) questionnaire consisting of two parts, namely demographic characteristics and dimensions of self-care activities(including diet, random blood glucose, physical activity, foot care, fasting blood sugar). The obtained data were analyzed in SPSS software( version 24). Results: Based on the results of the study, there was a significant difference in the mean scores before and after the intervention in terms of blood sugar, dietary control, and self-care behaviors (P <0.05). However, the mean scores before and after intervention in foot care, insulin consumption, and Physical activity was not significantly different (P> 0.05). Conclusion: The results were indicative of the impact of family-Oriented empowerment education on most self-care behaviors of patients with type 2 diabetes.

31-40

Authors: Jamshid Bahmaei * , Rozita Mostatab , Maryam Shomalinejad , Anahita Maleki , Fatemeh Mobasheri

Introduction and purpose: The learning environment affects the development and growth of a learner in an educational institution. Academic vitality and motivation are among the determining factors of success in the educational system. Consequently, the purpose of this study was to evaluate the academic vitality and motivation of students based on their perception of the learning environment in Abadan School of Medical Sciences, Iran. Methods: This descriptive-analytical study was performed on the study population of all students of Abadan School of Medical Sciences. The sample size was calculated as 283 people and the samples were selected through simple random sampling method. The data were collected by the researchers using the questionnaires of learning environment evaluation and academic vitality and motivation. All the data were statistically analyzed by Pearson’s correlation test and regression test utilizing the SPSS software version 18. Results: Our findings demonstrated that there was a positive correlation between learning vitality and the perception of students of the learning environment. Moreover, the perceptions of students of the learning environment could be predictive of their educational vitality and academic motivation. All the components of the perception of students of the learning environment were able to predict the vitality of students. It should be noted that among the components of perception of the learning environment, only the aspect of the perception of the educational environment had a significant role in predicting academic motivation. Conclusion: According to the results of the present study, a better understanding of students of the learning environment leads to higher motivation toward academic achievement in diverse educational and research fields. Furthermore, the improvement of the learning environment enhances the academic vitality of students in terms of responding to the confronted challenges and obstacles in educational environments.

52-60

Authors: Maryam Hasannezhad reskati , Seyyed hamze Hoseini , Misagh Shafizad , Farkhondeh Ahmadabadi *

Introduction and purpose: There exist several factors affecting the academic performance of students some of which improve academic performance, whereas some factors exert adverse effects on education. Therefore, the present study aimed to determine the relationship between obsessive-compulsive disorder and academic burnout among students of Mazandaran University of Medical Sciences. Methods: The statistical population of this descriptive-analytical study included general medical students out of whom 285 students were selected as the research population by simple random sampling. Data collection instruments included Nolen-Hoeksema and Morrow Mental rumination questionnaire and Breso›s academic burnout questionnaire. Subsequently, the data were analyzed using the correlation method. Results: Based on the results of the current study, a positive and significant relationship was reported between rumination and burnout in both groups of girls and boys. The correlation coefficient between rumination and burnout in girls was measured at (r=0/335; sig=0/000) and (r=0/250; sig=0/012), respectively. Furthermore, this study revealed that rumination (F=3.339) and academic years (F=3/683) were found to be influential factors affecting academic burnout. However, the effect of rumination on academic burnout in terms of the academic year was not significant. Conclusion: The results indicated a positive and significant relationship between obsessive-compulsive disorder and academic burnout. Excessive stress, as well as long working hours and years of study, predisposes medical students to obsessive-compulsive disorder and in turn to academic burnout.

73-83

Authors: Hossein Samadi-Miarkolaei , Hamzeh Samadi-Miarkolaei *

Introduction and purpose: Nowadays, healthcare and treatment networks as an operator of the executive and administrative policies of the Ministry of Health are not able to develop efficacy without the voluntary tendency of employees for cooperation. In this context, the organizational citizenship behavior (OCB) might lead to the development of organizational performance in short- and long-term by increasing the productivity and efficacy of the employees. One of the key influential factors in the occurrence of these excellent behaviors in employees is the side effects of the internet and new technologies. Therefore, the present research aimed to investigate the relationship between cyberloafing and OCB of the employees. Methods: This applied descriptive-correlational research was performed on the statistical population of all the employees of Babolsar healthcare and treatment network. A total of 165 subjects were selected through simple sampling method. In order to explore the OCB and cyberloafing, the standard scales were used. Data analysis was carried out by the SPSS and LISREL software. Results: The results of the present study showed an inverse and significant relationship between OCB and cyberloafing (P<0.001). The latter inverse significant correlation was supported by the structural equation modeling test (β=0.79). The values of goodness of fit (GFI) indices were found as χ2/df=1.91, GFI=0.97, normed fit index (NFI)=0/97, and root mean square of approximation (RMSEA)=0.076. All the findings demonstrated a desirable fitness of model. Conclusion: According to the findings of this study, the cyberloafing of the employees of healthcare and treatment network has an undesirable impact on the occurrence of their OCB. As a result, it is recommended that the authorities provide conditions and environment in a way that group norms, organizational norms, and engagement in work become more significant for employees.

15-26

Authors: Ahmad Jonidi , Niloufar Bahari * , Ali akbar Nowroozi

Introduction and purpose: The efficient hospital waste management requires a detailed knowledge of the quantity and type of medical centers generated waste. The most important factor in planning and management of hospital waste is the estimation of the generated waste. It is worth mentioning here that modern methods of waste disposal are necessary, due to the harmful potential of medical waste. Methods: A total of 62 hospital under the supervision of Iran University of Medical Science were studied. The data were obtained from waste self-reporting form, the results of biological and chemical tests, and calibration result of medical waste sterilization equipment. It should be noted that the hospitals were divided into three groups of state (H1), private(H2), and the other hospitals (H3) to facilitate the process of study. Thereafter, the obtained data were analyzed in Excel 2013. Results: waste generation rate (kg/bed. Day) is 4.09, 4.12, and 4.9, in state, private, and the other hospitals, respectively. Based on the results, all hospitals except the four psychiatry hospitals were equipped with the medical waste sterilization equipment (e.g., autoclave, hydroclave, chemiclave, and dry heat). In addition, all H1, H3, and 98% of H2 used biological indicators. Furthermore , all H2, H3 and 91.6% of H1, used chemical indicators. Biological supervision of the hospitals showed the positive and desired results with indicating no microbial growth in 76.4%, 86.4%, and 56.2% of H1, H2, and H3, respectively. Conclusion: According to the results of the research and other similar studies, the process of waste generation and separation, as well as the performance of the waste sterilization equipment need further optimization.

38-48

Authors: Zohreh Asadi , Shahin Ahmadi *

Introduction and purpose: Antibiotics are a large group of pharmaceutical compounds which are stable in the environment. When they are not being removed during refinery wastewater treatment, they enter receiving water bodies which lead to environmental pollution. This study aimed to investigate the efficiency of alum and poly aluminum chloride coagulants in the removal of ciprofloxacin antibiotic from aqueous solutions. Methods: The batch experiments were conducted in this laboratory study. Optimum conditions of pH parameters, slow mixing time, initial concentration of ciprofloxacin, alum concentration, poly aluminum chloride concentration, and turbidity were determined during the process of coagulation on synthetic wastewater using the jar test. Results: Maximum removal efficiency of ciprofloxacin for both coagulants with pH=6 were determined at coagulant concentration of 20 mg/l and ciprofloxacin concentration of 25 mg/L. Moreover, it was estimated at 65% and 64% for poly aluminum chloride and alum, respectively. Conclusion: As the findings indicated, poly aluminum chloride was more efficient than alum for ciprofloxacin removal. Therefore, the coagulation process can be used as an efficient method to remove antibiotics from aqueous solutions.

60-70

Authors: Fariba Etezadi , Alireza Ghaemi , Zahra Jalili

Introduction and purpose: Proper nutrition during pregnancy is of utmost importance in the maintenance of maternal and fetal health. This study aimed to determine the effect of educational intervention based on the theory of planned behavior in the promotion and nutritional behaviors of pregnant women referring to comprehensive health centers in Amol, Iran in 1397. Methods: This semi-experimental interventional research was performed on 72 pregnant women in the first trimester of pregnancy who were randomly assigned to intervention and control groups. The instrument utilized in this study was a questionnaire developed by the researcher and used after the validity and reliability confirmation. The P-value <0.05 was considered statistically significant. Results: The results showed that there was a significant difference between the mean scores of knowledge, attitude, abstract norm, perceived behavior control, behavioral intention, and the behavior of the experimental group after the intervention in educational intervention group (P <0.001). Conclusion: Based on the results of this study, educational intervention based on planned behavioral theory was effective in the promotion of nutritional behaviors of pregnant women. Educational intervention of this theory could be a appropriate theoretical framework for the design and implementation of interventions to promote nutritional behavior of pregnant women.

79-94

Authors: Mohammad Reza Khani , Yousef Dadban Shahamat , Zeynab Shahidi * , Narges Sadeghi moghaddam , Yousef Kor

Introduction and purpose: Previous epidemiological studies suggested a close correlation between suspended particles and the prevalence of respiratory diseases, cardiovascular problems, cancer, and mortality. Moreover, it was reported that the city space contains pollutions of motionless and moving sources. Therefore, the aim of this study was to determine the concentration and release status of PM10 and PM2.5 particles in the air of Gorgan, Iran in 2016-2017 and to provide effective solutions. Methods: In this descriptive cross-sectional study, the concentration of air pollutants in Gorgan was measured at eight stations in different parts of the city for one year during July 2016-June 2017. Afterwards, the results of monthly PM2.5 and PM10 measurements by the portable device were modeled following the calculation of the quality index and estimation of their effect on health in the Geographic Information System using the Air Quality Index (AQI) Calculator software. In addition, the measurements were compared with national and international standard values. Furthermore, solutions were provided for reducing pollution. Results: Our findings demonstrated that the highest amount of PM2.5 and PM10 were recorded in December (116 and 76 μg/m3) and the lowest was in April (40 and 34 μg/m3). The results of one-way analysis of variance revealed a significant difference in the mean concentrations of the two particles between months. According to the results of this study, air inversion in cold seasons was effective in the concentration of these pollutants. The annual mean of PM10 and PM2.5 was reported as 41 and 30 μg/m3, respectively. The latter means were lower and higher than the EPA standards of 50 and 12 μg/m3, respectively. Conclusion: The results of the current investigation showed that the highest AQI was related to PM2.5 in the central regions of the city, Municipality Square, and Mazandaran Square. In addition, the highest PM10 pollution was measured in the central and southern parts of the city. This could be attributed to the high density of cars, which is the most important factor in the production of particles in cities

13-21

Authors: Parvin Sepehr * , Nayera Naimi Ghasabiyan

Introduction and purpose: Lack of a safety culture in organizations is the main reason for the occurrence of accidents. This phenomenon is formed in an improper safety management system and an inappropriate safety culture. One of the ways to improve the culture of safety is education. Therefore, this study aimed at investigating the promotion of safety culture and the impact of education on this culture. Methods: The present study was conducted on all employers working at Ekbatan Metal Industry to evaluate the safety culture using a questionnaire with the aim of promoting safety. The obtained data were analyzed in Excel and SPSS software (version. 19) through statistical tests. The training sessions were held and the safety culture was then evaluated after the intervention. Ultimately, a comparison was made between the scores of safety culture and its ten dimensions before and after the intervention. Results: The mean value of safety culture before the intervention was obtained at 287 and ten dimensions of the safety culture were investigated individually. The mean scores of safety culture obtained from the employers and workers were 290.67±26.17 and 283±47.25, respectively, before the intervention. However, the mean score of safety culture was 318±31.11 after the intervention. Conclusion: The results showed that education is one of the effective ways to promote safety culture. Education on safety can have a significant effect on the promotion of safety culture. Therefore, it is necessary to develop and implement educational programs based on the needs analysis. It is recommended to monitor these programs continuously and implement them in high-risk contexts.

32-40

Authors: Abdolreza Kazemi * , Khatereh Naderi pour

Introduction and purpose: Obesity is one of the most important causes of mortality in developing countries. Omentin-1 and chemerin, as cytokines secreted by adipose tissue, are associated with obesity. Chemerin is considered a bridge between obesity and the exacerbation of diabetes type II. On the other hand, omentin-1 plays a role in regulating energy metabolism and body fat distribution in the body. The aim of the present study was to determine the effect of 8-week aerobic training on the serum levels of chemerin and omentin-1 in overweight women. Methods: This semi-experimental study was conducted on 21 overweight women with a pretest-posttest design and a control group. The study population was randomly divided into two groups of exercise (n=11) and control (n=10). The training program consisted of moderate aerobic training, including 30 min of running within 50-70% of maximum heart rate that was controlled with a Polar watch. This intervention was performed 3 sessions a week for 8 weeks. Blood samples were collected 48 h before the first session and 48 h after the last training session to measure the levels of serum omentin-1, chemerin, lipid profile, and insulin. Analysis of covariance was used to assess the differences between the groups. Results: The serum chemerin levels showed a significant reduction in the exercise group as compared to that in the control group (P=0.023). In addition, the serum levels of omentin-1 significantly increased in the exercise group, compared to that in the control group (P≤0.001). Conclusion: Aerobic exercises can improve the body composition and regulate the serum levels of insulin and glucose, thereby regulating the serum levels of chemerin and omentin-1 as adipokines. It seems that 8 weeks of aerobic exercise training accompanied by the elevation of omentin-1 level and reduction of chemerin level and factors related to obesity have an important role in the improvement of cardiovascular health and metabolic disorders associated with obesity in overweight women.

54-62

Authors: Solale Ramzani * , Mirtaghi Mirmohammadi

Introduction and purpose: The most prevalent accidents and injuries occur in industries. Risk assessment and risk management are the basis for planning to provide solutions and control hazards. Therefore, the present study aimed to identify and assess the workplace hazards using the failure mode and effects analysis (FMEA) approach in a carpet manufacturing company located in Mazandaran. Methods: The current study utilized FMEA approach to evaluate the potential risk factors. Some units of carpet manufacturing company including 8 different workstations were assessed with 60 employees. Furthermore, failure modes and effects, as well as the causes of the failure of each component, were evaluated in this study. Subsequently, the Risk Priority Number of each workstation was separately calculated and the crisis level of each risk was prioritized. Results: According to the results of the study, out of 55 risk factors identified in 8 different workstations at the factory, 18.2 %, 67.3%, and 14.5% of these risk factors were within acceptable, unacceptable, and emergency level, respectively. Moreover, the units, including painting, dipping, extrusion, and assembly obtained the highest risk frequency in terms of explosion and electric shock. Conclusion: According to the results of this study, workers are highly susceptible to occupational accidents and injuries due to the presence of high risks factors in the above-mentioned unit. Although FMEA approach is applicable to identify the potential failures in work-related accidents, it is recommended using Preliminary Risk Assessment Method in order to conduct a more exact and comprehensive assessment.

73-83

Authors: Giti Rahimi , Shahram; Habibzadeh , Afshin Fathi, Shima Ghasemzadeh , Samira Shahbazzadegan *

Introduction and purpose: Maternal death during pregnancy or delivery and 42 days after the termination of pregnancy for any reason other than an accident is called maternal mortality. Maternal mortality due to the complications of pregnancy and childbirth is a sensitive indicator of women status in society, access to care, efficiency and quality of healthcare, capacity of the service system to meet the needs of women and demonstrates the economic and social conditions of each society. In addition, mortality due to pregnancy and delivery complications is one of the most important indicators that shows the condition of developing countries. In this regard, this study was conducted to investigate the causes of maternal mortality and related risk factors in pregnant women in Ardebil, Iran, from 2006 to 2016. Methods: In this cross-sectional study, registered information were extracted regarding the mortality of pregnant women, including demographic characteristics, indicators related to pregnancy, childbirth, and causes of death from 2006 to 2016 from the Family Health Unit of Provincial Health Deputy. Finally, the collected data were analyzed. Results: According to the obtained results, there were 39 cases of maternal mortality from 2006 to 2016. However; there was no maternal mortality in 2008 and 2015. The mean age of dead mothers was 30±1.8 years (age range: 15-44 years). Considering the mortality stage, 10 patients died during pregnancy (25.6%), one patient died during labor (2.5%), 12 patients died 24 h after delivery (30.7%), and 16 patients died after 24 h. On the other hand, 11 (28.2%) mothers had normal vaginal birth (NVD) and 28 cases (71.8%) had a cesarean section. Moreover, 31 women (79.48%) were at risk. There was a positive relationship between the type of delivery (cesarean section or NVD), parity (the first and second pregnancy), and risk factors during pregnancy with maternal mortality. Hemorrhage was the most common cause of maternal mortality. It is worth mentioning that there was no significant relationship between the causes of maternal mortality. Conclusion: According to the obtained results, there was a significant relationship between the number of pregnancies and type of delivery with maternal mortality. Moreover, hemorrhage was the most common cause of maternal mortality. Regarding the high levels of cesarean section effects on maternal mortality, it is recommended to carry out vaginal delivery. In this regard, it is necessary to take measures to conduct vaginal delivery without pain to reduce cesarean section rates. In addition, due to the high mortality rate in middle-aged mothers with a high number of pregnancies, it is suggested to use contraceptive methods, such as oral contraceptives, condoms, and birth control.