Iranian Journal of Health and Environment

Developing a performance assessment index for urban health, safety, and environmental management using a process–outcome approach: a case study of Isfahan, Iran

Reza Saeedi

Background and Objective: Performance assessment of health, safety, and environmental (HSE) management is the process of applying and estimating components and indicators through which the extent of achieving organizational objectives, as well as progress and continuous improvement in the HSE domain, can be determined. In this study, a performance assessment index for urban HSE management using a process–outcome approach was developed and applied in Isfahan.
Materials and Methods: The index design process included the following steps: (1) extracting preliminary list of principles and indicators, (2) determining the principles and indicators through expert panel consultation, (3) assigning weights to the components of the index, (4) defining integration functions, and (5) classifying the index score. The required data for evaluating HSE management in Isfahan were collected through visits to relevant organizations, existing reports and studies, and public surveys.
Results: The performance assessment index of urban HSE management, including 16 principles and 61 indicators, was validated based on expert panel opinions, and the total weights of process-oriented and outcome-based indicators were 0.16 and 0.84, respectively. The HSE performance score for Isfahan was 66.4, indicating a medium level. The most important domains identified for improvement of HSE management in Isfahan (based on high weight and low performance score) were ambient air quality, access to health-care services, solid waste management, prevention of resource degradation and loss, public education, and top management commitment.
Conclusion: The developed index demonstrated satisfactory effectiveness in assessing the performance of urban HSE management and due to comprehensiveness and flexibility can be applied to other cities.

Study of physicochemical and microbial indicators of swimming pool water in Kashan, Aran and Bidgol

Mohsen Hesami Arani

Background and Objective: Swimming pools are considered as a potential source of microbial and chemical contamination due to direct and continuous contact with different groups of people. The present study was conducted to investigate the water health indicators of swimming pools in Kashan and Aran-Bidgol and compare them with the existing standards in the country in the years 2017-2021.
Materials and Methods: In this descriptive-analytical study with a longitudinal design, 830 samples were taken from all indoor and active pools in 2017-2021. Physicochemical parameters, and microbial parameters were measured. Finally, the data were analyzed using SPSS software 16.
Results: The concentration of free residual chlorine, combined chlorine, pH, turbidity, and corrosivity were in the desired range in 53 percent, 48 percent, 67 percent, 81 percent, and 67 percent of the water samples, respectively. None of the samples were contaminated with Pseudomonas. A significant and inverse relationship was observed between the bacterial population and free residual chlorine, and a significant and direct relationship was observed between the bacterial population and turbidity (p<0.005).
Conclusion: Due to the low compliance of the water chlorine level with the standard and the observation of coliform bacteria, Staphylococcus aureus, and heterotrophs, it is necessary to continuously monitor the physicochemical and microbial parameters of the water, as well as to carry out proper health surveillance and disinfection.

Study of the concentration of particulate pollutants in the psychiatric care center of Shahid Mostafa Khomeini hospital in Ilam in 2019

Sajad Mazloomi

Background and Objective: Since the hospital is one of the important centers for treating and caring for patients, the presence of air pollutants in concentrations exceeding the standard in such places can threaten the health of patients and hospital personnel. This study aimed to investigate the concentration of particulate pollutants in the psychiatric care center of Mostafa Khomeini Hospital in Ilam in 2019.
Materials and Methods: In this descriptive-analytical study, the concentration of particulate matter in the hospital's psychiatric care center was measured. Sampling was carried out using a portable device. In each of the four studied sections (male ward, female ward, male staff, and female staff), one hour of sampling was conducted over three consecutive months (April, May, and June), resulting in a total of twelve samples. The collected data were analyzed using SPSS software (version 16).
Results: The results showed that during the sampling period, the highest average concentrations of PM₁₀, PM_2.5 and PM₁ were 50.09, 21.88, and 32.9 μg/m³, respectively, and related to the female inpatient wards, male personnel, and female inpatient wards, respectively. The highest PM₁₀ concentration was observed in the female inpatient ward, PM₂.₅ in the male staff ward, and PM₁ in the female inpatient ward.
Conclusion: According to the results of this study, the average concentrations of particulate pollutants in all sections was lower than the EPA standards. According to WHO guidelines, the PM₁₀ concentration of male and female inpatients in May, and also female staff and male and female inpatients in June, and the PM_2.5 concentration in the female inpatient wards in June were higher than the recommended limit

An investigation on the prevalence and antibiotic resistance pattern of Staphylococcus aureus in traditional sheep cheese from Chalous (Mazandaran province, Iran) in 2021-2022

Sogand Jafari

Background and Objective: One of the main causes of cheese contamination with S.aureus is the use of unpasteurized milk. Improper cheese processing methods can also lead to contamination with this bacterium. Considering the significant role of S.aureus in foodborne intoxications and the World Health Organization’s recommendation for continuous surveillance of this bacterium, this cross-sectional study aims to determine the prevalence and antibiotic resistance pattern of S.aureus in traditional sheep cheese from Chalous (Mazandaran Province, Iran).
Materials and Methods: A total of 45 samples of traditional sheep cheese were randomly collected from local dairy shops in Chalous. Initially, the samples were examined for contamination with S.aureus using culture-based methods. Finally, the antibiotic resistance pattern of the isolates against nine different antibiotics were determined using the disk diffusion method.
Results: Among 45 collected samples of traditional sheep cheese, 17 samples (37.8%) were contaminated with S. aureus. Of the 18 isolates obtained from traditional Chalus cheese samples, the highest resistance was observed against penicillin (64.7%) and tetracycline (58.8%), whereas the lowest resistance was detected against gentamicin and erythromycin (23.5%). Moreover, the 17 isolates obtained from traditional sheep cheese samples exhibited simultaneous resistance to 2 to 8 antibiotics.
Conclusion: A high level of contamination with S.aureus in traditional sheep cheeses produced in Chalous (Mazandaran, Iran), was observed. Adherence to hygienic practices in dairy farms and the implementation of public health education can help prevent secondary contamination during cheese processing and reduce the widespread dissemination of this bacterium in traditional dairy products.

Assessment and evaluation of leakage ionizing dose from radiation medicine centers of Qazvin province

Hamid Karyab

Background and Objective: Measuring leakage radiation dose in radiology centers is essential for protecting public health. This study aimed to assess the exposure levels of radiation workers (in controlled areas) and visitors (in supervised areas) to ionizing radiation in radiology centers of Qazvin Province.
Materials and Methods: This descriptive cross-sectional study was conducted as a census in 79 radiology centers across Qazvin Province. Leakage dose was measured using a FLUKE 451B ionization chamber and reported in μSv/h. Using the U.S. Radiological Protection Commission model, exposure in controlled and supervised areas was estimated in mSv/year. Finally, Monte Carlo simulation was applied to analyze the probabilistic distribution of exposure for workers and visitors.
Results: The mean leakage dose in controlled and supervised areas was 0.1–1.7 μSv/h and 0.1–2.19 μSv/h, respectively. The mean exposure dose for radiation workers and visitors was estimated at 0.1755± 0.3079 mSv/year and 6.2 ±14.9×10⁻⁵ mSv/year, respectively, which showed a statistically significant difference (p< 0.0001). Based on Monte Carlo simulation results, 93 percent of exposure for workers fell within 0.0–0.98 mSv/year, and 95% of exposure for visitors fell within 0.0–0.01 mSv/year.
Conclusion: The findings indicate that leakage doses in radiology centers of Qazvin Province are within permissible limits. However, the detection of elevated ionizing radiation leakage in CT angiography and nuclear medicine departments underscores the need for continuous monitoring and adherence to the ALARA principle. Although the study has a cross-sectional design, its results may serve as a basis for developing national radiation safety policies.

Investigating the concentration of Patulin in various juices samples sold in Tehran market in 2024

Parisa Shavali-Gilani

Background and Objective: Patulin is one of the most important mycotoxins produced by a wide range of molds. The main source of this mycotoxin is rotten fruits, especially apple juice. Patulin may damage the liver, spleen, and kidneys and cause seizures, edema, intestinal inflammation, and vomiting. Patulin may also have genotoxic and neurotoxic properties and disrupt the functioning of the immune and nervous systems.
Materials and Methods: In this study, the concentration of patulin in 34 random samples of fruit juice, including 26 apple juice samples, 4 apple and banana mixed juice samples, 2 apple and kiwi mixed juice samples, and 2 pomegranate juice samples sold in stores in Tehran in May 2024, was measured and reported using the HPLC-UV method.
Results: The LOD and LOQ levels were 1.21 and 3.49 µg/kg, respectively, and the recovery percentage was between 91 and 97 percent. The mean and standard deviation of patulin concentration in a total of 34 samples was 13.425 ± 21.348 µg/kg, which was below the permissible limit of the Iranian standard and Codex (50 µg/kg), and only the findings related to one of the samples were higher than the standard limit (14.88 µg/kg).
Conclusion: The results of this study show that the levels of patulin in the samples examined are mostly within the limits of Iranian and Codex standards. However, more comprehensive studies with a larger number of samples are recommended for a more accurate assessment of potential risks.

Investigating the knowledge, attitude, and behavior of microplastic pollution prevention among students of Khoy university of medical sciences

MoradAli Zareipour

Background and Objective: Microplastic pollution is recognized as a major environmental threat, and individuals’ Knowledge, attitudes, and behaviors play a crucial role in its prevention. This study aimed to assess the levels of Knowledge, attitudes, and preventive behaviors of students at Khoy University of Medical Sciences toward microplastic pollution.
Materials and Methods: This cross-sectional study was conducted among students of Khoy University of Medical Sciences. All enrolled students (n = 550) were invited to participate using a voluntary census-based approach, of whom 400 completed the questionnaire. After excluding incomplete responses, data from 372 participants were included in the final analysis. Data were collected using a two-part questionnaire comprising demographic characteristics and a researcher-developed instrument assessing knowledge, attitude, and practice (KAP) regarding the prevention of microplastic pollution. Content validity was confirmed using the content validity ratio (CVR) and content validity index (CVI), and reliability was established through test–retest analysis (ICC = 0.78) and internal consistency (Cronbach’s alpha = 0.83–0.95). Data were analyzed using Pearson correlation and ordinal logistic regression in STATA version 15.
Results: The findings indicated that students’ levels of knowledge and preventive behaviors were predominantly moderate, while their attitudes toward preventing microplastic pollution were mostly positive. Ordinal logistic regression analysis showed that higher levels of knowledge (OR = 3.98, 95% CI = 1.91–8.28)and positive attitudes (OR = 14.96, 95% CI = 7.26–30.83) significantly increased the likelihood of engaging in preventive behaviors. In addition, younger age (OR = 9.41, 95% CI = 1.26–7.29), being married (OR = 3.03, 95% CI = 3.33–26.52), higher maternal educational level (OR = 2.99, 95% CI = 1.24–7.17), and father's employment status (OR = 1.67, 95% CI = 1.02–2.73) were identified as demographic factors effective in promoting preventive behaviors.
Conclusion: The results suggest that enhancing Knowledge and fostering positive attitudes considerably improve preventive behaviors against microplastic pollution among students. Therefore, implementing targeted educational programs focusing on increasing knowledge and strengthening positive attitudes is essential for promoting preventive practices and mitigating the environmental impacts of microplastics.

Measurement of acrylamide in traditional breads sold in Tehran: a health risk assessment study

Gholamali Sharifiarab

Background and Objective: Bread is one of the most important foods in the world that may contain harmful compounds such as acrylamide (AA). The aim of the present study was to measure the levels of AA in three types of widely consumed Iranian bread (Sangak, Lavas, and Taftoon).
Materials and Methods: A total of 36 bread samples were randomly collected from 4 districts of Tehran. A derivatization method was used to prepare the samples, and gas chromatography-mass spectrometry (GC-MS) was used to measure the amount of (AA). Carcinogenic risk assessment for the different types of flatbreads was performed using Monte Carlo simulation technique.
Results: The average (µg/kg) AA (maximum-minimum) in all bread samples was 170.4±80.8 (62.4-301.4). Also, the average AA in Lavash, Taftoon and Sangak bread samples was 98.6±24.5, 142.6±52.1 and 270.0±21.14 µg/kg, respectively. The chronic daily intake (CDI) of AA (50th) from flatbread was at 4.78×10^-4mg/kg/day for adults and 1.02×10^-3 mg/kg/day for children. On the other hand, the non-cancer hazard index (THQ) (50th) values were 2.36×10^-1 and 5.13×10^-1, respectively. While the incremental lifetime cancer risk (ILCR) (50th) were 2.31×10^-4 for adults and 5.10×10^-4 for children.
Conclusion: The average AA in the samples was higher than the EU standard (50-80 µg/kg) level. Considering the average AA concentration values in bread types and the estimated ILCR values, there is a possibility of carcinogenic risk and further monitoring is needed at all stages of bread production.

Risk assessment and disease burden of colorectal cancer attributable to dietary nitrate exposure from fruits and vegetables in Shahre-Rey market of fruits and vegetables

Mehrnoosh Abtahi

Background and Objective: Despite their high nutritional value, fruits and vegetables may pose a risk to public health due to nitrate accumulation. This study aimed to assess the health risks associated with dietary exposure to nitrates present in fruits and vegetables sold in produce markets of Shahre-Rey.
Materials and Methods: In this cross-sectional study, samples of apples, oranges, potatoes, onions, and both greenhouse- and field-grown tomatoes and cucumbers (n = 13, 12, 22, 18, 24, and 32, respectively) were collected during autumn and winter 2023 and spring and summer 2024. Nitrate concentrations were measured using a spectrophotometric method. The non-carcinogenic hazard quotient (HQ) was calculated based on the measured nitrate levels. In addition, using GBD data, the contribution of nitrate to the disease burden of colorectal cancer was estimated through YLL (Years of Life Lost), YLD (Years Lived with Disability), and DALY (Disability-Adjusted Life Years) indices.
Results: The mean nitrate concentration varied significantly across the products, with the highest level found in field cucumbers (294.06 mg/kg) and the lowest in apples (51.99 mg/kg). In some products, nitrate levels exceeded the permissible limits set by the Iranian national standard. The highest non-carcinogenic risk was observed in potatoes, with a mean HQ of 0.231. Potatoes also had the highest incidence rate of colorectal cancer (2.02 per 100,000 population), the greatest DALY (23.15), and the highest nitrate-related mortality. The mean DALY attributed to nitrate exposure was estimated at 107.38 for potatoes, 94.87 for onions, and 12.10 for greenhouse cucumbers.
Conclusion: Certain agricultural products, particularly potatoes and onions, are significant sources of dietary nitrate exposure and may contribute to an increased risk of colorectal cancer. Continuous monitoring and management of nitrate levels in these products are essential.

Assessing pollution and associated health risks of street dust contaminated with potentially toxic elements, the case of city of Kermanshah

Soheil Sobhanardakani

Background and Objective: Street dust, as a significant non-point source of PTEs contamination, is one of the primary pathways through which human can be exposed to environmental pollutants. Therefore, this study was performed to assess the pollution and health risk of As, Cd, Co, Pb, and V in street dust in Kermanshah in 2023.
Materials and Methods: A total of 48 dust samples were collected from 16 sites. After sample digestion, the contents of the elements were determined using ICP-OES. Additionally, the enrichment factor (EF), integrated pollution index (IPI), and Nemerow integrated pollution index (NIPI) were calculated. The carcinogenic and non-carcinogenic risks from exposure to contaminated dust were estimated.
Results: The highest mean contents of As, Cd, and Co, and V with 7.28, 0.729, 9.02, and 8.78 mg/kg, respectively, were belonged to the industrial regions and for Pb with 101 mg/kg was recorded for the commercial areas, reflecting the impact of human inputs, especially from industrial and traffic sources. The EF values indicated that "no" to "severe" enrichment level in the study area. Also, the average values of IPI, indicating the "low" to "high" pollution conditions entire the sampling sites. The mean NIPI values ranged from 1.17 to 1.68, indicating "low" pollution conditions in the study area. The mean average values of HI for children and adults were categorized as "severe risk" and "low risk", respectively. However, the mean TCR values for citizens indicated high carcinogenic risk.
Conclusion: The results indicated that As and Pb had the highest contribution to cumulative health risks for both age groups; therefore, the control of emission sources of these elements, including fossil fuel combustion and traffic and also regular monitoring of street dusts especially in the regions with heavy pollution level are recommended.

Prevalence of enterobius vermicularis (Pinworm) infection in Iranian kindergartens: a systematic review

Hossein Azarpira

Background and Objective: Parasitic infections are major public health challenges in children, particularly in group settings such as kindergartens, where conditions for transmission are more favorable. Enterobius vermicularis (pinworm) is one of the most common causes of intestinal infections in this age group. This study was conducted to investigate the prevalence of Enterobius infection and associated factors in kindergartens across Iran.
Materials and Methods: In this systematic review, articles published up to the end of January 2025 were retrieved from the following databases: Google Scholar, SID, Magiran, Irandoc, Web of Science, PubMed, and Scopus using the keywords: “Enterobiasis,” “Enterobius vermicularis,” “Oxyuriasis,” “Oxyur,” “Intestinal infection,” “Intestinal parasite,” “Prevalence,” “Children,” “Elementary schools,” “Preschool centers,” “Kindergarten,” and “Iran.” Out of a total of 1116 identified articles, 707 were excluded after reviewing the title and abstract, and 333 were removed due to duplication. Ultimately, 76 articles were selected for full-text evaluation, from which 24 studies related to the prevalence of Enterobius in Iranian kindergartens were included in the final analysis.
Results: Of the 24 studies reviewed, 23 were conducted using questionnaires, and one study utilized interviews. The total sample size across these studies was 13.567 children, and the average prevalence of Enterobius infection was estimated at 14.90 percentage.
Conclusion: Despite relative improvements in hygiene conditions, the prevalence of Enterobius infection in some kindergartens remains concerning. The role of active transmission pathways and their association with children's demographic factors highlights the importance of timely identification and intervention. Implementing targeted educational programs for parents and kindergarten staff, along with coordinated preventive measures, is essential to control the spread of this parasite.

Public participation in municipal waste management: a structured review study in developing countries and Iran

Samaneh Khademikia

Background and Objective: Public participation is fundamental to sustainable municipal solid waste management (MSWM). This structured review analyzed participation levels, determinants, and barriers in developing countries, focusing on Iran.
Materials and Methods: Following PRISMA 2020, a systematic search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and SID using terms: Municipal Solid Waste Management, Public Participation, Developing Countries, Iran. Qualitative, quantitative, and mixed-method studies (2019–2025) were included. Data were synthesized via narrative synthesis and thematic analysis (Clarke & Braun, 2006).
Results: Of 2,310 records, 30 studies (20 Iran, 10 others) were included. Most were moderate to high quality. Participation was moderate in 73.3% of studies. Iran’s average was 43.5%. Key determinants: awareness (individual), municipal trust (social), infrastructure/transparency (managerial). Main barriers: institutional distrust (23 studies), lack of source-separation infrastructure (20), recycling opacity (18). A conceptual model with three domains (determinants, barriers, strategies) was developed.
Conclusion: Despite high willingness (up to 70%), actual participation remains moderate to low (43.5%). The core issue is institutional distrust and recycling opacity, not merely awareness deficits. Without trust-building via feedback, infrastructure upgrades, and shifting education from segregation to waste reduction, single-strategy approaches fail. The model offers policymakers a framework to shift from top-down to participatory, trust-based governance.