Health Scope
Year:2018 | Volume:7 | Issue:2|Papers Count:15

In the framework convention on tobacco control (FCTC), world health organization (WHO) adopted a range of tobacco control policies including labelling tobacco packages with health warnings. Now, 180 countries are parties of this treaty and committed to implement it (1). Through years of implementation of this treaty, text and graphic messages, which are applied on the packages, are getting repetitive. Thus, states have been searching for more powerful ones to intensify the health threats of smoking. This is probably due to the fact that they believe that the more fear, the more effect...

Background: The world’ s chemical industries are confronted with formidable environmental regulatory challenges in treating their wastewaters. Aerobic granulation is increasingly drawing interest of researchers engaging work in the area of biological wastewater treatment. Objectives: The objective is to develop a new cost-effective technique for treatment of chemical industry effluents. The possibility and effectiveness of this new enhanced biological treatment system were determined through mean diameter, relative hydrophobicity, sphericity, and sludge volume index (SVI5) of aerobic microbial aggregates. Scanning electron microscopy (SEM) analysis was also used to characterize the granules. Methods: The granules were cultivated in a single sequencing batch reactor (SBR) system fed with synthetic ethylene glycol (MEG) wastewater. The characteristics of the aerobic granular sludge were monitored during the study period. Results: Aerobic granules with dense and strong microbial structure as well as excellent settling ability were cultivated. Developed granules had an average size of 8. 21 2mm. The process of granulation resulted in an increased biomass concentration from about 2500 to 4750 mg/L. The microbial granular sludge was able to remove 97% of the influent COD at organic loading rate (OLR) of 2. 0 kg COD/m3. day, at the end of the study. Conclusions: The findings of the present study revealed that aerobic granular sludge could be successfully developed in a SBR and is capable in treating the simulated chemical industries wastewater.

Background: Balanced Score card is a performance evaluation tool that in combination with the AHP approach, creates a framework for transforming vision and mission to a set of targets and indicators, on the basis of importance in terms of the customer, financial and internal processes, and growth and learning perspectives. Objectives: The aim of this study was to evaluate the performance of Montaserieh hospital in 2015 using the balanced score card approach. Methods: This study combined quantitative and qualitative methods, and was conducted in Montaserieh Hospital in Mashhad, Iran, during year 2015. First, through group discussion sessions among the members of score card, a list of performance assessment indices were prepared using the BSC approach, and then the list was finalized using the Delphi method. After that, the hospital strategic map was illustrated based on its objectives, and with the completion of analytic hierarchy process (AHP) standard questionnaires, the priority of visions and indices with adjustment rate lower than 0. 1 was obtained from 14 experts. At the end, the realization of each of the visions and indices and the hospital performance during 2015 was evaluated. Results: Thirty-four indices were selected regarding the four visions of the model, as seven indices were placed in each of the visions of customer, financial, growth and learning, and 13 indices for the processes vision. Among the visions of BSC, customer vision with 58. 26% was more powerful than the other ones. Among the indices, the index of percentage of respondents (0. 39) had the highest factor of importance among the hospital indices. The final score for hospital performance in 2015 was obtained as 89. 27%. Based on the analysis obtained from the AHP questionnaire pair wise comparison, the importance coefficient was calculated as 65. 7%, 19. 7%, 9% and 5. 6% for customer, financial, processes, and growth and learning, respectively. Conclusions: Given the gap between expected objectives and current status of the hospital and resource constraints and conditions, the hospital should consider the priority and weight of each of the visions and indices for its future planning to identify the appropriate goals and define improvement projects more efficiently, and take effective steps for better performance.

Background: There has been a major focus on hospital waste management and challenges of infectious waste removal in different researches. The aim of this study was to analyze medical wastes and examine the current situation of hospital waste management in Tehran, Iran. Methods: Five hospitals were selected, and a questionnaire was developed, based on theWorld Health Organization (WHO) guidelines for the assessment of hospital waste management. Moreover, hospital waste managers, hospital authorities, and other involved personnel were interviewed to gather further information. Results: The average rate of waste production was 4. 72 Kg/bed/day (infectious waste, 2. 3 Kg/bed/day). General and medical wastes were routinely segregated, and disinfection was accomplished in nearly 43% of hospital waste containers. The sanitary status of storage systems was strong in 20%, moderate in 60%, and poor in 20% of hospitals. Conclusions: Observations indicated the unsuitable conditions of waste storage systems. Implementation of management activities can improve health and environmental aspects of hospital waste management.

Introduction: Western Uttar Prdesh (UP), in India, is reaching the category of the unhealthiest region, due to emerging risk of a cancer river. Here, soil and water have high concentration of multi-metals, especially, contaminant like Lead (Pb), Mercury (Hg), and (As), which is a major risk to the individuals; therefore, numerous health problems in many villages along the banks of the river have been observed. Individuals are using contaminated water for daily life purposes as well as for crop irrigation, thus, the metal deposited successively to different tropic level. Therefore, this area immediately required an exhaustive study by a governmental and non-governmental institute to undertake with this difficult position and find marvel solutions that can remove the metal from the soil and water. Here, people suffer on a daily basis due to the above reason. Case Presentation: In this region, industry releasing its waste directly to the river without executing the proper treatment and disposal of the waste, results in water obtaining many hazardous compounds; therefore, river water becomes seriously polluted and turns to a cancer river. Major rivers running in this area are Yamuna, Kali Nadi (Krishna), Hindon, and Ganga, these rivers turn to a cancer river due to different industries that reside in this area, which are sugar industries, pulp and paper mills, as well as slaughter houses. The industrial wastewaters contain hazardous inorganic pollutants, mainly heavy metals like Mercury (Hg), Lead (Pb), and (As). Various types of cancer, bone deformities, and neurological disorders are few of them, which can be seen frequently in individuals in this region. Conclusions: This area emerged as a hotspot of contaminant from river water, especially with metal contaminant, and turned to a cancer river. The number of affected individuals is increasing day by day in the recent year; therefore, cancer and death become a common phenomena in this particular area. Thus, this area needs great attention of governmental and non-governmental organizations to need systematic studies and find a miracle solution to help the villagers.

Background and Objectives: Several studies have been shown the beneficial effect of exercise on markers of health. This study was designed to evaluate the effect of two aerobic and anaerobic exercise protocols on triglyceride, cholesterol, anthropometric indices, chemerin, and adiponectin levels in non-athletic men. Methods: A total of 39 non-athletic men were recruited to the present study. According to protocol, participants in three categories including; aerobic, anaerobic, and control groups, which had endurance, speedy exercise, and without activity, respectively. The duration of interventional program was two months. Body weight, height, and waist circumference (WC) were determined. Body fat percent, waist-to-hip ratio (WHpR) and body mass index (BMI) were calculated. Dietary intake was recorded by 48-hours recall method. Briefly, Total cholesterol and triglyceride levels were determined by an automated analyzer. Serum levels chemerin and adiponectin were measured by enzyme-linked immune-sorbent assay (ELISA) by commercial kits. Data was analyzed using the SPSS statistical software version 16. P < 0. 05 was considered as the level of significant. Results: No significant difference among groups was observed according to BMI, WC, andWHR. Significant difference was observed based on percent of body fat in the aerobic group. There was no significant difference in the cholesterol and triglyceride levels and daily calorie intake between groups. There was a significant difference in adiponectin level in three steps between two groups (P < 0. 001). There was a significant difference on chemerin level between baseline training and detraining steps in aerobic groups as compared to control (P = 0. 01). There was an increase in chemerin level between baseline, training, and detraining steps in anerobic groups (P = 0. 01). A significant increase in adiponectin level was observed after training. Whilst, after detraining, it was decreased significantly (P < 0. 001). Conclusions: Aerobic exercise caused chemerin levels to decrease significantly after training and detraining. Whereas it increased in anaerobic groups. Besides, adiponectin level significantly increased in aerobic and anaerobic groups. It seems that the difference in the type of activity between the two groups led to the changes in the above indicators that require more extensive studies.

Background: Selecting the appropriate method for analysis of accidents is an important phase in accident investigation, due to the varieties of factors affecting the selection process, varieties of accident analysis methods, and their specific strengths and weaknesses. Objectives: This study was carried out with aim of determining the important criteria that accident analysis methods should have and selecting the optimal method for analysis of accidents in the Iranian oil industry. Methods: The fuzzy analytical network process (FANP) technique was used to address the relative importance of the evaluation criteria and sub-criteria (pair-wise comparisons of criteria was carried out by oil industry safety expert) for selecting accident analysis methods. Fuzzy TOPSIS (technique for order preference by similarity to ideal solution) were used for accident analysis methods prioritizing and ranking (methods was scored by occupational health post-graduate students). Results: Results indicated that the multiple levels cause identification capability and provides solution are the most and least important criteria in comparison with the other criteria for selecting accident analysis method, respectively. Based on the studied criteria, it was concluded that tripod beta (CCi = 0. 303) can be used as an optimal method for accident analysis in oil industry. Conclusions: The present study found that Tripod beta has a greater ability to analyze oil industry accidents compared with the other methods under consideration. However, it has limitations, which can be addressed by other methods.

Background: The north-easterlymonsoonsoriginatingfromSiberia-Mongolia predominantly determine the weather patterns during the cold and dry seasons in Taiwan. Laoshan Winds (LWs), which have been recorded since 1894, can influence agricultural activities and cause an increase in the amount of dust during the dry period in the Hengchun Peninsula. Methods: This study investigated the associations among weather changes, Particulate Matter (PM), LW, and public health impact in Hengchun Peninsula during January to April and October to December 2006 to 2010. The data regarding weather conditions, PM with aerodynamic diameters smaller than or equal to 2. 5  m (PM2. 5), PM with aerodynamic diameters smaller than or equal to 10  m(PM10), and hospital and clinic admissions for respiratory and cardiovascular diseases were obtained from several governmental sources in Taiwan. Disease admissions data were categorised to four age groups: zero to four: Infants, five to fourteen: Children, 15 to 64: Adults; and > 65: Elderly. The Australian apparent temperature, poisson regression model, and parametric test (z statistic for a one-tailed test) were used to analyse the data. Results: The resultsshowedthat LWs cause a significant reduction in relative humidityandsurface air temperatureanda significant increase in air pressure and wind speed, which induces a significant decrease in the apparent temperature. Significant increases were noted in the mean number of admissions in the adults group for respiratory diseases; there was a 13. 4% [95% CI, 2. 13% to 25. 8%] increase on the LWdays (P < 0. 05). Conclusions: These results imply that the LWs along with the cold weather and strong local winds caused an increase in the incidence of respiratory diseases, which was also associated with winter monsoon and topographical characteristics.

Background: Oxytetracycline (OTC) is commonly used in aquaculture industry and has high potency against bacterial diseases. Objectives: The present study aimed at examining the rate of oxytetracycline (OTC) antibiotic residue in the tissues of cultured rainbow trout (Oncorhynchus mykiss). Methods: Samples were taken randomly from the livers and fillets of 45 rainbow trout from 15 large aquaculture ponds inHamadan province, West of Iran. The OTC residue was measured using high performance liquid chromatography (HPLC). Data analysis was performed with SPSS (V. 18) (mean and standard deviation), and Man-Whitney test was employed for statistical analysis. Results: The results revealed that OTC residue were 389 to 641 ppb in the livers and 175 to 295 ppb in the fillets, respectively. However, in 86. 66% of the samples (liver and fillet) the amounts of OTC residue was found to be higher than the maximum residue limits (MRLs) in codex alimentarius commission, and 13. 33% of the samples (liver and fillet) were within the standard range. Analysis of input and output data using Man-Whitney test showed significant differences in liver and fillet (P < 0. 05). Conclusions: This research determined that the use of OTC must be reduced to an acceptable level in aquaculture industry. Also, antibiotic residue in rainbow trout must be controlled before their delivery to the market.

Background: Humic acid is a trihalomethane component in water supplies, causing various health disorders in humans. Objectives: This study was performed to examine humic acid adsorption on saturated activated carbon and to evaluate adsorbent regeneration through ultrasonic processes. Methods: In the present study, effects of various parameters, including initial concentration of humic acid, pH, contact time, adsorbent dose, and temperature, on the adsorption stage were investigated. Also, effects of different parameters, such as regeneration time, pH, and number of saturation-regeneration cycles, were studied in the regeneration stage. Results: The highest percentage of humic acid removal was reported atpHof three and initial humic acid concentration of 10 mg/L. The highest adsorption capacity of activated carbon was 29. 7 mg/g at adsorbent dosage of 0. 1 g/L and contact time of 10 minutes. The results of thermodynamic experiments showed that removal of humic acid by saturated activated carbon was endothermic. Also, maximum regeneration occurred at pH of 11 and contact time of 60 minutes. Finally, the adsorption capacity of saturated activated carbon changed from 42. 94 to 42. 14 mg/g after five cycles of saturation and regeneration. Conclusions: The results of this study showed that activated carbon is an effective adsorbent in the removal of humic acid from water. Also, the ultrasonic process is effective in regeneration of activated carbon, saturated with humic acid.

Background: Fatigue, as a destructive phenomenon, can have adverse effects on various aspects of workers’ lives. Job burnout is one of the important consequences of fatigue among employees including nurses in different workplaces, especially healthcare centers. Objectives: The present study aimed to assess the relationship between fatigue and job burnout. Methods: This cross sectional study was conducted on 522 nurses, who were randomly selected from teaching hospitals of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran. Fatigue dimensions and job burnout were measured by Multidimensional Fatigue Inventory (MFI-20) and Maslach Burnout Inventory (MBI), respectively. Results: The results revealed that among burnout dimensions, depersonalization and diminished personal accomplishment had the highest mean scores, while emotional exhaustion had the lowest mean score. Among different fatigue dimensions, the highest mean score was related to general fatigue. Moreover, the results of Pearson’ s correlation test showed a significant positive relationship between emotional exhaustion and fatigue dimensions. Also, a significant direct correlation was found between depersonalization and general, physical, and mental fatigue. On the other hand, a significant negative correlation was observed between diminished personal accomplishment and all fatigue dimensions, except mental fatigue. Conclusions: Considering the adverse effects of fatigue on various aspects of nurses’ job burnout, more attention should be paid to fatigue in healthcare facilities, especially hospitals. In addition, a suitable managerial program should be developed to decrease nurses’ job burnout and other fatigue consequences and to improve working conditions.

Background: Climate change and air pollution are linked. Both of themare expected to impacthumanhealth. Climate can increase health risks from poor air quality and lead to emergencies. Forecasting health consequences of air pollution episodes is a matter of great concern. Objectives: The current study mainly aimed at simulating the climate change impact on emergency medical services (EMS) clients caused by air pollution to estimate the future trend of EMS clients with cardiovascular and respiratory symptoms by 2050. Methods: Future climate pattern was projected using general circulation model outputs under the scenario of two representative concentration pathways (RCP2. 6 and RCP8. 5). Statistical downscaling was performed by LARS weather generator to produce highresolution synthetic time series weather dataset. Simulation was performed using an artificial neural network (ANN). Observed climate and air pollutant variables were tagged as predictors inANN, and EMS clients were considered as the target. Projected future (2020-2050) climate and air pollution were applied to estimate the future trend of EMS clients. Results: The climate pattern was predicted to become warmer and wetter in the study area (Tehran, Iran). Annual trend of EMS clients with cardiovascular and respiratory symptoms increases under both RCP scenarios. Further increase is under RCP8. 5 for EMS clients with cardiovascular symptoms, and the least increase is under RCP2. 6 for those with respiratory symptoms. Annual and monthly trends of EMS clients with cardiovascular and respiratory problems are more sensitive to different groups of climate and air pollution variables. Conclusions: ANN is an executive tool to simulate the impact of climate change and air pollution on public health to estimate the future trend of related morbidity and forecast short-term cases across the world.

Background: Health services provided to disabled veterans and families of martyrs play a key role in the health status of this group. Objectives: The current study aimed at investigating the insurance problems faced by veterans and their families. Methods: In 2015, the study was started as a Delphi method with a stratified random sampling of 30 participants among experts and managers of Foundation of Martyr and Veterans Affairs of Tehran, Iran. After data collection, encoding and classification, health insurance problems encountered by veterans were identified. Results: The major medical problems faced by veterans were issues related to insurance company policies, financial partnership, insurance coverage, decision-makers, service systems, and the evaluation and monitoring of insurance claims. Conclusions: It is necessary to design and introduce an intra-organisational and independent insurance system under the category of ‘ health insurance for veterans and their dependents’ to provide preventive and remedial health services for the targeted group.

Background: Formulation of cost efficiency of health insurance benefit package requires an evidence-based policy making, with efficient management of stakeholders, therefore, identifying the stakeholders and considering their characteristics and interests and also the position and power of the main actors involved in policies seems to be necessary. For this purpose, this study aimed at analyzing the stakeholders of health insurance benefit package in Iran to specify their position in the assessed policy. Methods: This was done on a qualitative basis during years 2015 and 2016. Data was collected from semi-structured interviews, document analysis, and participation in decision-making meetings of the Supreme Council of Health Insurance, to identify the stakeholders, and their power, situation, interests, opportunities, and challenges. The data was analyzed with the content analysis approach using the MAXQDA software. Results: Overall, 23 stakeholders were identified and categorized in 6 groups, including policy makers, service providers, payers, suppliers of medicines and equipment, service recipients, and others. Sixteen stakeholders were at the national level, 3 stakeholders of regional, and 4 stakeholders of local level, however most stakeholders were owned by the public sector. Furthermore, 78% of stakeholders supported the policies of health insurance benefit package, and 48% had moderate power. Stakeholders had different interests and various opportunities and challenges to health insurance benefit package. Conclusions: The findings show that multiple stakeholders directly and indirectly affect the formulation and implementation of HIBP policies. Meanwhile, themembersof supremecouncil of health insurance, legally being authorized to apply for entry of service and drug into the HIBP, have the most important role in decision making related to HIBP. Establishment of a systematic approach, considering the role of all stakeholders and alignment of their interests leads to a positive outcome of the stakeholders’ power and finally effective formulation and implementation of policies, and facilitates the ultimate goal of this policy, which promotes public health.

Background: Excessive vibration is one of the harmful agents in the work environment, and many drivers are inevitably exposed to that during driving. Objectives: Using ISO 2631-1&5 standards in the present study, the evaluation of the whole-body vibration (WBV) exposure was carried among Tehran metro drivers. Methods: In this descriptive cross-sectional study, 23 trains were investigated and the level of exposure to vibration during daily working shift and vibration indicators were evaluated. According to ISO 2631-1, the following 5 factors were measured: the rate of frequency-weight acceleration r. m. s for each axis, the combination of axes, crest factor, peak acceleration, vibration dose value (VDV), and recent equivalent static compressive stress (Sed) and risk (R) factors-estimation criteria for damage to lumbar spine. Results: The results indicated that based on the basic method, the levels of drivers exposure to the vibration are less than the lower limit set by health guidance caution zone (HGCZ), and according to theVDVmethods, 4 cases were found to be above the upper limit, 8 cases were within the HGCZ, and the rest were less than the mentioned limit. Moreover, according to the Sed method, 4 drivers had exposures below the lower limit, 7 had exposures within the range of HGCZ, and 12 of the mover the limit. On the other hand, on the basis of R factor, the levels of exposure of the 3 drivers were within the range of HGCZ, while the rest of them experienced the levels lower than that. Conclusions: The results showed that there are several differences among the calculated criteria confirming that some of these indicators may not show a safe limit.