Journal of Health Research in Community

10-19

Authors: Mohamad Taghi Badeleh shamooshaki * , Nargesbeigom Mirbehbahani , Maedeh Ariakhah , Mahsa Latifizadeh , Negar Jahanshi

Introduction and purpose: The diagnosis of cancer in children is considered a crisis for the family causing some disturbances in the quality of life of parents. One of the best strategies to improve the quality of life is resilience. Resilience refers to adaptation to diseases and stressors in life. Religious beliefs also play an important role in social and psychological life and resilience. The present study was conducted to demonstrate the relationship between religious beliefs with the quality of life and resilience of mothers of children suffering from cancer. Methods: This descriptive correlational study was carried out on 123 mothers of children with cancer referring to the Cancer Ward of Taleghani hospital in Gorgan, Iran, in 2019. The data were assessed using demographic information questionnaires, Connor-Davidson Resilience Scale questionnaire, Khodayariʼs religiosity questionnaire, and Weitzner’s Caregiver Quality of Life Cancer Scale questionnaire. The data were analyzed using SPSS software (version 17), Pearson correlation coefficient, and linear regression. A p-value of less than 0.05 was considered statistically significant. Results: The results of Pearson correlation coefficient indicated that religious beliefs had a significant positive relationship with resilience; however, there was no significant difference between religious beliefs and quality of life. Conclusion: According to the obtained findings, religious beliefs are effective factors in the resilience of mothers of children suffering from cancer; therefore, it is necessary to find a way for the development of useful clinical services and appropriate counseling programs to improve the quality of life of these mothers and their children.

33-42

Authors: Zeinab Nezamodini , Behnoush Jafari * , Hanan Sari , Seyd Amin Jazayeri

Introduction and purpose: Industries face different risks and dangers depending on the type of their activity. To reduce the level of risks in the workplace, the application of standard methods of risk identification and assessment is highly beneficial. This study aimed to identify hazards and assess risks using the hazard analysis (HAZAN) method in one of the steel industries in Khuzestan Province, Iran. Methods: This descriptive study was conducted with a cross-sectional qualitative design in the facilities zone of one of the steel companies in the south of Iran within 4 months in 2018. The hazard analysis risk assessment technique was used to assess the risk of occupations in units. In this study, direct observation of jobs, workerschr('39') experiences, and interviews with officials and supervisors were used to collect the required data. Risk levels were classified as unacceptable, undesirable, acceptable if controlled, and acceptable represented by ranks of 1, 2, 3, and 4, respectively. Results: According to the results of this study, 1,763 hazards were identified in the whole facilities zone with water treatment plant 1, Makeup, and water treatment plant 2 areas as the most dangerous facilities areas with 644, 410, and 395 hazards, respectively. Moreover, out of the total identified risks in the 7 investigated units in the facilities zone, 4.6, 6.5, 28.9, and 60% areas were identified in the ranks of 1, 2, 3, and 4, respectively. Conclusion: The implementation of the HAZAN method in the studied industry determined systematically what dangers existed in the steel facilities zone and which areas were involved in more risks. Furthermore, it was possible for the relevant officials and supervisors to properly prioritize the implementation of control strategies. Therefore, the HAZAN method can be well applied to increase staff awareness of existing risks and assess the available risks of the steel industry.

55-64

Authors: Gholamreza Darvishi , Daryush Yousefi Kebria , Majid Ehteshami , Mahdi Asadi-Ghalhari , Farshad Golbabaei Kootenaei *

Introduction and purpose: Nowadays, traffic-induced air pollution factors are classified as destructive to the environment. Regarding an increase in urbanization and the number of cars, transportation, and movement of passengers and citizens between cities, transportation systems should utilize mathematics scientifically and intelligent systems practically to move towards sustainable development and benefit from healthy air and transportation. This study aimed to investigate the effect of traffic parameters on air pollution of the suburban route of Sari-Qaemshahr road in Mazandaran province, Iran, regarding the atmospheric variables and ozone pollutants. Methods: This study analyzed and modeled the ozone pollutant concentrations in the suburban route of Sari-Qaemshahr road. Moreover, the factors affecting the concentration of pollutants based on traffic and climate statistics were determined in this study. Additionally, it was attempted to investigate the relationship of air pollution with traffic variables, average speed, rainfall, temperature, humidity, and wind speed. Subsequently, SPSS software (version 16) and regression method were used to present a model that will be able to estimate the concentration of ozone pollutants on suburban roads with appropriate accuracy for the coming years. Results: According to the proposed model for ozone pollutants, among the available variables, temperature, traffic volume, and wind speed had the greatest impact on ozone pollutants. Moreover, the results obtained from the validation showed the success rate of the proposed model in estimating pollution. In this study, the level of regression significance was above 95%. In addition, the 90% data contribution rate for ozone pollutants in the model has been satisfying. Conclusion: According to the results, the modeling by a regression method and SPSS software is a suitable method for estimating ozone pollutants. The proposed model can control and manage pollution emissions in road design and construction.

73-82

Authors: Yahya Ehteshaminia , Hamid Mohammadi , Behzad Javadian *

Introduction and purpose: Legionella is a Gram-negative bacterium that is present worldwide in natural and man-made water sources, such as hospital water distribution networks. This bacterium causes two types of Legionnaires and Pontiac fever. This study aimed to review the effect of biological and environmental factors on legionella growth in the water distribution networks of hospitals. Methods: The databases of PubMed, Scopus, SID, Magiran, Web of Science, IranDoc, and google scholar were searched in this study, and the related articles were reviewed from 2001 to 2020. Results: The symbiosis of Legionella with other bacteria in the biofilm and the presence of amoebae increase the Legionella growth in the water distribution networks of hospitals. For each increase in iron and manganese concentration, the chance of Legionella presence increases 1.22 and 3.3 times, respectively. Moreover, an increase in the concentration of zinc by 1 mg/L increases the density of Legionella by 17%. Furthermore, the concentrations of zinc greater than 200 g/L and less than 100 g/L are considered inhibitory. Following that, an increase in the concentration of copper by 1 mg/L reduces the density of Legionella by 7%. The temperature for growing Legionella is from 29°C to 40°C with an optimum temperature of 35°C. Conclusion: Amoebae, biofilm structure, metal ions, temperature, and pH affect the persistence and growth of Legionella. Sufficient knowledge of these factors can be useful in future studies to better design and construct hospital water distribution networks to provide a suitable solution to control this beneficial bacterium.

11-26

Authors: Isa Mohammadi Zeidi * , Tahereh Seifpour , Hadi Morshedi , Hamid Alizadeh

Introduction and purpose: It has been proven that coping strategies and cognitive-behavioral techniques exert a positive impact on the improvement of negative emotions and the promotion of physical and mental health of patients with chronic headaches. The present study aimed to determine the effect of pain coping skills training interventions on knowledge, pain-specific self-efficacy, and the indices related to migraine headaches. Methods: This randomized controlled trial was conducted on 60 patients with migraine headaches referring to specialized clinics in Anzali. They were assigned to experimental and control groups using randomized sampling. Data were collected using a demographic and personal questionnaire, Coping Strategies Questionnaire, Pain specific Self-efficacy Questionnaire (PSEQ), and Knowledge Scale before and two months after the intervention. The educational intervention for the experimental group consisted of five 60-minute sessions, which was conducted in groups of 8-10 people. Chi-square test, independent and paired t-test, as well as one way ANOVA, were used for data analysis. Results: The obtained results were indicative of a significant increase in the mean score of knowledge and self-efficacy in the experimental group after the intervention (P<0.001). Moreover, the mean of frequency, severity, and duration of migraine headaches in the experimental group significantly decreased after the intervention (P<0.05). In addition, except for positive re-evaluation strategy, the mean frequency of using coping strategies significantly increased in the experimental group after the training (P<0.05). Conclusion: It is recommended that specialized physicians and therapists provide intervention based on chronic pain strategies along with treatment protocols to control chronic headaches and improve the quality of life of patients with migraine headaches.

38-51

Authors: Seyyedtaghi Mirmohammadi , Seyyedaliiakbar Mahmoudi - , Mortaza Nojabaei * , Maryam Salmaniseraji , Musa Farmanbar

Introduction and purpose: Low mobility and muscle weakness are increasing musculoskeletal disorders (MSD) in many individuals. Therefore, the present study aimed to investigate the effect of 8-week resistance exercises on reducing the prevalence of the symptoms of MSD in the neck, shoulders, wrists, and back among the teachers of Bardaskan, Iran. Methods: Firstly, a total of 384 subjects were randomly selected from the school teachers of Bardaskan, and demographic and Nordic questionnaires were completed for all of them. Then, the prevalence of the aforementioned symptoms in each of the studied organs was evaluated. Accordingly, 80 eligible individuals were identified for this study according to the inclusion criteria and allocated to two intervention (n=40) and control (n=40) groups. In addition, forms of A (i.e., intervention) and B (i.e., control) were used for the random assignment of the groups. The Nordic questionnaire was completed for both groups 24 h before the intervention. After the termination of the 2-month intervention period and 24 h after the last exercise session, the Nordic questionnaire was again completed for both groups. For the result comparison, the GEE statistycal test was used. Results: The results of the examined hypotheses showed that that resistance exercises had no significant effects on reducing the prevalence of the symptoms of MSD in the neck, shoulders, wrists, hands, buttocks, and back of school teachers, compared to that reported for the last year and 2 months (P>0.05); however, these exercises significantly decreased the severity of the pain in the intervention group over the last 7 days (P<0.05). Conclusion: Due to the low impact of resistance training, it is recommended to carry out further studies on redesigning the exercise plan, changing the type and the duration of exercises, or increasing the sample size in order to relieve the pain in the studied regions.

61-68

Authors: Mostafa Delavar , Atefeh Navabi * , Ahmad Abdollahi , Hasan Mahmodi , Ali Jamshidi

Introduction and purpose: Due to the increasing consumption of fried foods, it is important to check the quality of the oil used for frying to maintain the health of consumers. Therefore, this study aimed to determine the amount of peroxide, acidity, and thermal stability of the oils used in Falafel stores in Arak, Iran. Methods: This cross-sectional study was performed on 25 traditional units and 2 industrial units producing Falafel in Arak, Iran, during 2018. In total, 50 and 3 samples were obtained from traditional (two samples from each unit) and industrial units, respectively, to determine the peroxide and acidity based on the standardized methods No. 4178 and 4179. Moreover, thermal stability was measured using the Rancimat device. The data were analyzed using SPSS software (version 22) through with Wilcoxon tests and correlated t-test. Results: The results showed that the peroxide and acidity of the used oils were higher than the allowable limit, and the thermal stability was lower than the allowable limit. According to the obtained data, the samples were rejected in terms of peroxide content of 72%, acidity of 68%, and thermal stability of 98%. Conclusion: These findings show the inefficiency of the oils used in Falafel stores in Arak, Iran. In addition, the shelf-life of half-cooked Falafel should be reduced.

80-86

Authors: Aghaali Ghasemnian * , Fariba Sojasi Gheydari , Akram Karimiasl , Hamidreza Norouzi

Introduction and purpose: free radicals cause more than 60 diseases; however, antioxidants can stop the harmful processes induced by free radicals in the body. In this regard, the present study aimed to investigate the effect of 8 weeks of strenuous endurance training (ET) and high-intensity interval training (HT) on thioredoxin reductase-1 (TRX1) and malondialdehyde (MDA) in hippocampal tissue in male Wistar rats. Methods: In this experimental study, 24 male Wistar rats were randomly divided into three groups of control, ET, and HT. The training protocols consisted of ET and HT on a treadmill for 8 weeks (5 days a week) and the hippocampal tissue samples were collected 48 h after the last session of training. Tissue concentration of TRX1 was measured by ELISA method and MDA concentration was measured by Thiobarbituric acid. Finally, the collected data were analyzed using the one-way analysis of variance. Results: Based on the results, after 8 weeks, there were no significant differences in the TRX1 level in hippocampal tissue in ET and HT groups compared to the control group (P=0.62). Moreover, after 8 weeks, there were no significant differences in the TRX1 level in hippocampal tissue in ET and HT groups in comparison to the control group (P=0.83). Conclusion: In conclusion, 8 weeks of ET and HT did not affect the TRX1 and TRX1 level in hippocampal tissue in male Wistar rats.

14-24

Authors: Yahya Esfandyari , Keivan Saeb * , Ahmad Tavana , Aptin Rahnavard , Farid Ghlamrezafahimi

Introduction and purpose: One of the problems of hospital effluents is the presence of drug residues, including antibiotics, which if not completely eliminated, will be diverted to water resources and lead to health and environmental problems. Therefore, the present study aimed to investigate the efficacy of the electrocoagulation process with iron and aluminum electrodes in the removal of cefazolin antibiotics from the hospital wastewater. Methods: To determine the quality of the sewage, 12 samples were taken from the hospital for one year. The trials were repeated 3 times with different pH values, voltages, and at different contact times. Finally, the concentration of cefazolin was determined using an HPLC device. Other related qualitative parameters were tested based on the Standard Methods for the Examination of Water and Wastewater. Results: Based on the results, the removal efficiency of total solids, chemical oxygen demand, and cefazolin, at optimal conditions (pH=7, voltage=30V and contact time=30 min) were 69.49%, 79.49%, and 86.67%, respectively. The three-way ANOVA indicated that variations in pH, voltage, and contact time have a significant relationship with the process efficiency (P˂0.05). Conclusion: According to the findings, it can be concluded that the simultaneous electrocoagulation process with iron and aluminum electrodes is able to satisfactorily filtrate hospital wastewater.

36-47

Authors: Aghaali Ghasemnian * , Zahra Ghorbanlou , Akram karimiasl Asl , Jabar Seifpanahi Shabani

Background and Objectives: Oxidative stress from exercise, either injured muscles and reduces performance in athletes, or stimulates the production of cytokines from many cells. body respond to oxidative stress by activating antioxidant defenses and other protective devices to counteract these body pressures. Therefore, the purpose of this study is to investigate the effect of 8 weeks of strenuous endurance training on HO-1 and TNF-α in gastrocnemius and soleus muscle tissue of male wistar rats. Material and Methods: 16 adult male Wistar rats, were randomly divided in 2 groups (control and endurance training). The strenuous endurance training protocol included running on the treadmill for 8 weeks (5 sessions per week). Standard meal and water were freely provided for the subjects. 24 hours after the last session of training and 4 hours of overnight fasting, tissue samples were collected and HO-1 and TNF-α levels were measured by ELISA method. Independent t-test was used for data analysis. Results: The results showed that 8 weeks of strenuous endurance training did not have a significant effect on the amount of HO-1 enzyme in gastrocnemius and soleus muscle (P˃0/05). Also, 8 weeks of strenuous endurance training had no significant effect on TNF-α in soleus and gastrocnemius muscle (P˃0/05). Discussion and conclusion: Due to the lack of effect of exercise on the levels of HO-1 and TNF-α, it can be said with caution that regular exercise has created a useful adaptation.

58-66

Authors: Gholamabbas Shiali , Emel Saki , Atefeh Siahi Ahangar

Introduction and purpose: Occupational hazards in the workplace cause serious injuries to workers and create many problems for them. The assessment of workerschr('39') safety attitudes and implementation of codified safety training can reduce accidents, unsafe practices, human errors, and costs. Therefore, the present study aimed to investigate the correlation between the demographic characteristics of individuals and the safety attitude towards work in the workers of a dairy company. Methods: This descriptive study was conducted on all 168 employees working in a dairy companychr('39')s production line. The data collection tool was a two-part questionnaire, and the obtained data were analyzed in SPSS software (version 21). Results: As evidenced by the obtained results, most workers had a positive attitude toward safety (6.7±80.18). There was a significant relationship between the number of occupational accidents and the level of workerschr('39') safety attitude (P=0.01). Moreover, the results pointed to the significant relationship between the number of occupational accidents and the work experience of workers (P=0.004) and the number of occupational accidents and job satisfaction (P=0.044). Conclusion: The assessment of safety attitudes and its dimensions can be of great help to identify those areas of training that require more attention and better design. Prioritizing safety and improving workerschr('39') safety attitudes can reduce occupational accidents in the industry.

74-82

Authors: Atena Ramezani * , Mahsa Amirpour

Introduction and purpose: A new species of the new beta-coronavirus family has recently been found in Wuhan, China (nCoV-2019). This virus can cause a variety of serious respiratory illnesses, such as severe acute respiratory syndrome. Therefore, due to the relationship of nutrition with the immune and respiratory systems, the present review study was designed with the aim of collecting evidence on the role of nutritional care in the prevention and treatment of COVID-19. Methods: The Persian and English articles that were related to the subject of interest and published up to 2020 were searched in such databases as PubMed and Google Scholar. The search was performed using the following keywords: “Coronavirus”, “Nutrition”, “Supplement”, and “Influenza”. Results: According to the reviewed studies, the main transmission route of coronavirus is the person-to-person transmission. Therefore, frequent hand washing, maintaining social distance, and observing personal hygiene play an important role in preventing the disease. Due to the role of nutrition in the prevention of infections and the relationship of vitamin and salt deficiency with the exacerbation of respiratory diseases, all patients are recommended to consume a variety of fruits and vegetables. The use of lukewarm liquids to dilute respiratory secretions and a healthy balanced diet, including all major food groups, are measures of significant importance in these patients. People with nutritional deficiencies are recommended to use supplements. However, there are contradictory findings in this regard for all patients. Conclusion: To improve the immune system, it is recommended to cook the protein foods thoroughly and avoid using unpackaged foods. With regard to the fruits and vegetables, it is better to use the fruits and vegetables that can be peeled. Considering the relationship between malnutrition and the spread of infectious diseases, it is suggested to receive sufficient macronutrients, proteins, useful fats, and omega-3 sources, as well as fruits and vegetables as the main sources of vitamins.

11-22

Authors: Ayat Rahmani; Taleb Askaripoor; Hamed Aghaei; Mohammad Ebrahim Ghaffari; Mahdi Mohammadian Mastanabad; Mohammad Ali Jalilvand; Hasan Irvani; Elahe Kazemi;Amir Abedin Darkoush

Introduction and purpose: Students’ perceptions of the learning environment play a vital role in the process of education, buoyancy, and academic performance. This study aimed to investigate the capability of explaining the academic buoyancy and academic performance of health students of Semnan University of Medical Sciences, Semnan, Iran, based on their perception of learning environment. Methods: The statistical population of this descriptive-correlational study consisted of all health students who were studying at Semnan University of Medical Sciences, Semnan, Iran, in the academic year 2018-19. A total number of 138 students were selected through systematic random sampling. The data were collected using a Dundee Ready Educational Environment Measure (DREEM), academic buoyancy questionnaires, and grade point average. Moreover, simple and multiple regressions were used for data analysis. Results: The results showed that 16.1% (R=0.408, R2=0.167, Adjusted R2=0.161, F=27.212, P<0.01) of the variance of academic buoyancy can be explained by the overall score of students’ perception of the learning environment. Furthermore, according to the regression coefficients, the subscale of students’ perception of educational climate had a significant role in explaining academic buoyancy. According to the findings of the study, 13.3% (R=0.373, R2=0.139, Adjusted R2=0.133, F=21.971, P<0.01) of the variance in academic performance could be explained by the overall score of students’ perception of the learning environment. In addition, the subscales of students’ perceptions of learning and social conditions of education had a significant role in explaining academic performance. Conclusion: Given the positive role of perception of the learning environment in explaining academic buoyancy and academic performance based on the study findings, it is very important to conduct comprehensive assessments, identify strengths and weaknesses, and perform educational interventions to enhance students’ perception of the learning environment.

33-44

Authors: Maryam Haghighi;Ehteramsadat Ilali; Jamshid Yazdani; Zohreh Taraghi

Introduction and purpose: Poor medication adherence may result in adverse outcomes, such as a higher rate of hospitalization and increased costs of healthcare. In this regard, the present study was designed to determine the relationship between cognitive status and medication adherence among elderly patients with hypertension. Methods: In this cross-sectional study, 180 elderly patients with hypertension were selected from Imam Reza Hospital in Amol, Iran, (2018) using convenience sampling. Cognitive impairment and medication adherence were assessed using the Cognitive State Test and Morisky Medication Adherence Scale, respectively. The data were analyzed by SPSS software (version 16) using the independent t-test, Chi-square test, and logistic regression. Results: Out of 180 participants, 66.1% (n=119) of them were female. The mean age of the patients was 72.877.63± years. The mean values of medication adherence and cognition score were reported as 5.212.29± and 26.033.21±, respectively. There was no significant relationship between medication adherence and total cognition score (P=0.322). Medication adherence was two times higher among those who were reported with no anxiety, compared to those who suffered from anxiety (β=-0.67; odds=0.51; P=0.008). The obtained results also showed medication adherence increased twelve times with one unit increase of verbal fluency. Moreover, medication adherence enhanced eight times with one unit increase of abstract thinking and judgment. Conclusion: The subdomains of cognition, such as verbal fluency, as well as abstract thinking and judgment, had a significant relationship with medication adherence in elderly patients with hypertension. In this regard, it is suggested to assess cognitive status among elderly patients with hypertension and design appropriate interventions.

57-67

Authors: Hamid Jani Darmian; Tayebeh Khazaei;GholamhoseinYaghoubi;Gholamreza Sharifzadeh; Ayoub Akbari

Introduction and purpose: Diabetic retinopathy is the most common cause of blindness in adult diabetic patients. Therefore, it is necessary to provide patients with appropriate training programs, such as multimedia education as a new and effective method to enhance their understanding of self-care. This study aimed to evaluate the effect of multimedia education on disease perception and eye care performance in type 2 diabetic patients referring to Birjand Diabetes Clinic in 2019. Methods: This controlled clinical trial included 70 patients who were divided into two groups according to the inclusion criteria.The intervention group received 4 multimedia educational sessions (one session per week). The relevant parameters were measured before and after the intervention . Moreover, the data were analyzed in SPSS software (vesrion18). Results: The results of this study showed a significant difference before and after the intervention in the case group in terms of the mean score of eye care performance (P=0.005). Moreover, a significant difference was observed before and after the study regarding the mean diastolic pressure in the case group (P=0.05). However, there was no significant difference between the two groups before and after the intervention in terms of the mean score of perception of disease (P=0.35), blood glucose changes (P=0.13), hemoglobin A1c (P=0.86), and systolic blood pressure (P=0.89). Conclusion: In this study, the implementation of multimedia method improved the performance of eye care in diabetic patients. Therefore, it is recommended to use this educational method to improve self-care in type 2 diabetic patients.

82-98

Authors: Jamshid Bahmaei; Peivand Bastani; Ali Keshtkaran;Mohammadtaghi Mohammadpour; Yaser Sarikhani

Introduction and purpose: Accreditation is a method used for the improvement of the quality of hospital services. It refers to the systematic evaluation of the health centers based on specific standards. The present study aimed to critically review the implementation of accreditation standards in hospitals. Methods: This critical review investigated all the articles that were published during 1993-2019. In order to find the sources, the authors referred to various databases, namely ISC, DOAJ, PubMed, ProQuest, Embase, Science Direct, Scopus, and Web of Science. The keywords used for the search included Mesh terms and common keywords related to the subject of the study, including challenges, barriers, hospital management, accreditation, hospital, or accreditation hospital. Finally, the full texts of 16 articles were reviewed for the purposes of the study. Results: According to the results, various issues, such as the accreditation organization independence, staff and physician participation, number, structure, and content of standards, structural and contextual problems, importance of human resources, financial and capital resources, organizational and management issues, other plans, role of evaluators and their evaluation methods, role of stakeholders, and impact of accreditation on the patients and teaching atmosphere of the hospital were executive challenges of hospital accreditation. Conclusion: In order to increase the impact of accredition and significantly address its challenges, there should be emphasis on performance indicators, preparation by training and raising awareness of the personnel, budget allocation, and development of plans on accreditation

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.