Iranian Journal of

Background and Objective: Nowadays, swimming pools as a sport and entertainment center have found more popularity. Violation of health based standards in terms of physicochemical, microbial and environmental health indices can turn pools into a potential source of disease transmission and spread. Due to the importance of maintaining swimmers’ comfort, health, and safety, the present study was aimed to consider environmental health status and physicochemical and microbial quality of swimming pools water in Tabriz.
Materials and Methods: In this descriptive cross-sectional study, the official checklists of swimming pools (consisting 10 public and 22 private swimming pools) were obtained from Tabriz Health Center. According to the inspections conducted in February 2017 and August 2017, the related information was extracted from the checklist. Data were analyzed using Excel software, SPSS version 23 and Chi-Square test.
Results: The average accordance of the physicochemical parameters with the standards for public and private pools was 67.5% and 65%, respectively. Among the physicochemical parameters, the residual free chlorine showed less accordance with the standards. On average, in the summer 49.5% and in the winter 28% of the pools showed microbial contamination.
Conclusion: The residual free chlorine values ​​in the pool, Jacuzzi and chiller indicated a weak management of pools and a high potential for pathogenicity. Therefore, continual surveillance of the environmental health status and planning for an objective inspection program by the local authorities, especially in private sector, is suggested.
 

Background and Objective: In this study, we aimed to assess Iran’s position and trends for environmental health status among the countries of “Iran’s perspective document in 1404” according to the indicators used in Environmental Performance Index (EPI) report in 2018.
Materials and Methods: The score of indicators in environmental health area; air quality (including household solid fuels, exposure to PM_2.5, and PM_2.5 exceedance), water and sanitation (including drinking water and sanitation) and heavy metals (including lead) were extracted for all studied countries as well as for the last and baseline (generally ten years prior to last report) years from EPI 2018 database. According to EPI scores, the performance of the studied countries in each indicator was ranked. The percent change in the score of each indicator from baseline to current year was calculated and compared with the mean percent change for all studied countries.
Results: Iran ranked 7^th regarding air quality in 2016. Also, it ranked 6^th, 8^th, and 9^th in terms of household solid fuels, exposure to PM_2.5, and PM_2.5 exceedance, respectively. The EPI score for Iran regarding water and sanitation was 54.4 in 2005 and 58.74 in 2016 (percent change=7.98%). Iran ranked 21^st in 2005 regarding lead exposure index. Although this index showed a growth of 100% in 2016, which is very desirable compared to the average growth of all countries (34.47%), but only leads to one step up in the ranking of Iran and was ranked 20^th in comparison with other countries.
Conclusion: Totally, according to EPI 2018, Iran ranked 6^th in the field of environmental health issues among 23 countries of “Iran’s perspective document in 1404”. However, there is uncertainty in the accuracy of the EPI raw data used for calculating index scores. Hence, caution should be exercised in their interpretation.

Background and Objective: By accurately identifying environmental issues, individuals can acquire skills to better solve environmental problems. To this end, the most appropriate method is to assess the educational needs of individuals to pave the way for the promotion of environmental knowledge. The present study aims to assess the need for training courses to empower professionals to increase their knowledge of environmental issues and educate others to take an important step in improving environmental health in society.
Materials and Methods: The present study was a descriptive needs assessment study using Delphi technique. In the first stage, the designed questionnaire was given to 150 people (faculty members, experts and students) to express their opinions in the proposed areas. In the second stage, a supplementary questionnaire entitled General needs for faculty members, specialized needs for experts and general and specialized needs for students were provided to individuals and the importance of the issues from their point of view was examined. Finally, the most important issues were prioritized by experts. Data analysis was performed using SPSS-26 software.
Results: The total number of educational needs extracted from the first stage of Delphi was 120 items, of which 31 items related to general needs (11 teaching and evaluation areas, 10 research areas and 10 communication and personal development items) and 89 items related to specialized needs. (27 cases of air pollution, 23 cases of waste management, 17 cases of wastewater treatment and reuse of wastewater, 10 cases of water treatment and pollution and 12 cases of soil pollution and its removal methods). In the second and third rounds, the importance of these items was determined by the target groups by scoring, and at the end, the first five priorities of each item were identified.
Conclusion: The results of this study, considering the comprehensive review of three target groups and determining and prioritizing the needs for each group, can increase the level of environmental awareness and empowerment of experts, which ultimately enhance the efficiency of the system and is an important step for environmental educational planning.

Background and Objective: Outsourcing services to the private sector can be a step towards achieving the goals of community health promotion, job creation, better access to health services, and improving the quality of health services. In this regard, health service offices were established in Tehran to improve the health status of food preparation, distribution and sale centers and increase food safety based on government approval. This study aimed to evaluate the roles of health services offices on environmental health indicators. 
Materials and Methods: In this descriptive-comparative study, nine health service offices supervised by Tehran University of Medical Sciences (located in South Tehran Health Center, Eslamshahr city, and Shahr-e Rey) were surveyed. Seven environmental health indicators measured in the years before the establishment of these Health Service Offices (2015-2017) were compared with those obtained after their establishment (2018-2019). The indicators data were analyzed using Excel, SPSS software, and statistical tests.
Results: The result showed no significant difference in public places and centers for food preparation and distribution offenders, public places with health criteria, percentage of employees with a health training certificate, health care, and percentage of inspection coverage before and after establishment of health service offices (p >0.05). However, the relationship between the food preparation indicators and distribution centers with health criteria and public places and closed food preparation and distribution centers were significant (p > 0.05).
Conclusion: This study is one of the first researches conducted to evaluate the effectiveness of health services offices on health-safety indicators in Iran. Therefore, more comprehensive monitoring and studies should be done to evaluate these offices' performance quality and their related cost-benefit analysis.
 

Background and Objective: Increasing the level of health awareness of food preparation and distribution staff can have a direct impact on improving the level of public health in the community. Education can change people's knowledge, attitudes, and practices. Health education courses that provide integrated education as well as to other education systems, include educational inputs, processes, and outputs. The objective of this research is to evaluate these elements of the educational system of health education courses in Shiraz.
Materials and Methods: The current study evaluated the educational input, process, and output of 7 current health education institutions in Shiraz. Factors that influence the input of educational courses were evaluated using an inspection checklist of health education courses, the educational process was measured employing a satisfaction survey, and the educational output was assessed through a checklist of inspection of Article 13 of the Regulations. The health performance of 160 guild health certified units and 160 uncertified education units was analyzed as a criterion for effectiveness. Data were analyzed using the IBM SPSS21 software. Data related to the assessment of the input and educational process were analyzed using the Spearman correlation coefficient. Mann-Whitney and Kruskal-Wallis non-parametric statistical tests were also used for cross-group comparisons of output evaluation data.
Results: The findings of the educational input evaluation showed a strong correlation and a significant relationship between the overall evaluation score of the educational courses and the "observation" (0.96) "educational course principal" (0.94). Also, in the process evaluation, the "educational environment" and "general educational programs" with correlation coefficients of 0.99 and 0.84 had the most correlation with the overall process evaluation score. In all the health fields studied, there was a significant difference (p = 0.001) between the average score obtained for educational courses with and without certificates. There was a significant difference (p <0.0001) between the mean score obtained by public health with and without health certification. The average score obtained by the certified public and non-public places was 91.81 and 70.71, respectively.
Conclusion: Health education can have a major impact on people's health performance. Some of the elements that make up the educational output have a greater impact on achieving the desired educational output. For example, the revision and updating of the educational content and the development of the educational program according to all groups of learners can improve the performance of the learning process and the satisfaction of learners.
 

Background and Objective: Understanding the area of study stimulates the student. Therefore, students should pick their field of study with more information so that they get more engaged in it to complete the responsibilities assigned in the future as well as possible. The purpose of this study was to ascertain the attitude of Shiraz University of Medical Sciences environmental health students regarding their field of study and potential future careers.
Materials and Methods: This study was a cross-sectional, descriptive research study on medical education. In this study, 120 students studying environmental health engineering at Shiraz University of Medical Sciences had their attitudes and knowledge assessed using a questionnaire created by the University of Minnesota, America, and the results were then analyzed using chi-square and t-tests.
Results: According to the research's findings, more than 80% of students chose their field of study without having any prior knowledge of it, more than 90% did not place it among their top priorities, and 80% claimed that their field of study depended on whether or not their employment position is acceptable.
Conclusion: According to the data, the majority of students had an unfavorable perception about entering this field. As a result, it is necessary to thoroughly present this discipline to students before they begin studying it, as well as to update its subject headings to better meet societal demands.

Background and Objective: Due to the presence of infectious diseases and parasitic contamination in kindergartens, it is very important to observe the health points in these centers. This cross-sectional analytical study was conducted to investigate the environmental health status of Saveh kindergartens in 2020.
Materials and Methods: A checklist with 133 questions was designed, including 57 questions specific to the conditions of the coronavirus, taken from the instructions for the second step of the fight against the coronavirus and 76 questions from regulation 150/920318. All active kindergartens (9 cases) in the study were included, and the answers to the questions as yes, no, and not applicable were recorded and using SPSS software, independent T, chi-square, and one-way ANOVA was analyzed.
Results: The results obtained from the analysis of the checklist showed that the compliance of the health status of all kinds of kindergartens with the regulations of 150/920318 has a percentage of total desirability that includes personal hygiene (81/4%), food hygiene (63%), tools and equipment hygiene (66/5%), building hygiene (78%), health education (90%), considerations regarding disinfectants and disinfectants based on alcohol (92%) and considerations regarding bleaches (94%). There was no significant relationship between the per capita of each child and the different items on the checklist (p>0/05).
Conclusion: This study showed that the general environmental health status of kindergartens in Saveh was favorable and only two variables of hygiene of tools and equipment (66/5%) and food hygiene (63%) were the least desirable among the studied factors that should be considered.

Background and Objective: The trend of developments in the health system and medical education and other related sciences, including environmental health, is a global challenge. In this research educational content of environmental health and its revision were studied from the point of view of students and graduates.
Materials and Methods: The present study was a cross-sectional descriptive study. In this research, through two checklists, the opinions of environmental health students and graduates regarding the necessity of revising the educational content of the field according to the requirements of the time and considering the future situation were investigated with the participation of 441 people. Data analysis was performed using SPSS-22 software.
Results: According to the results, 73.7 percent of participants believed that the educational content of environmental health in Iran has fundamental differences from developed countries. 81.7 percent believed that the educational content provided to environmental health students is not proportional to their duties. Meantime, 91.4 percent of the graduates of environmental health believe that the expected capabilities included in the educational curricula of different degrees of environmental health should be revised. 88.4 percent believed that it is necessary to revise the educational content of this field considering the "change in executive and practical functions of environmental health during the past years".
Conclusion: The overwhelming majority of graduates of the field emphasized the need to revise the educational content of the environmental health field, taking into account the requirements of the time. It is necessary to redefine the field of environmental health in the country according to the changing situation and the emergence of new indicators.
 

Background and Objective: Occurrence of the pharmaceutical active residues (particularly antibiotics) threatens the health of the environment and human society. Therefore, this research aimed to investigate the impacts of the Amoxicillin (AMX) residues on resistance to environmental stress and biochemical compositions of the body in Penaeus vannamei.
Materials and Methods: Six-hundred specimens with a mean (±SD) weight and total length of 9.23±1.77 g and 9.28±0.73 cm were randomly experimented in four triplicate treatments, namely T₁(control): without AMX residues in a rearing environment, T₂: 100 μg/L AMX residues concentration in water, T₃: 300 μg/L and T₄: 500 μg/L for 60 days. At the end of the experimental trial, five specimens for biochemical body composition analyses were separately sampled. Ten shrimps from each treatment were also randomly selected and exposed to 50 ppt salinity stress for 48 hours, and then survival rates were computed.
Results: Body composition analyses showed that moisture and protein not differed among the treatments (p>0.05), while fat in T₂ (28.29±5.50) was significantly more than in others (p<0.05). The lowest values of ash were obtained in T₁ and T₄, and they differed with T₂ and T₃ (p<0.05). The highest survival rate of shrimps exposed to salinity stress (50 ppt in 48 h) was observed in T₂ and T₃, in contrast, the lowest value was recorded for T₄ (p<0.01).
Conclusion: Findings of the present research indicate that the occurrence of high doses of AMX residues pollution in the rearing water affects the stress resistance of P. vannamei which can be due to disruption of protein and fat metabolisms in the shrimp body.
 

Background and Objective: The high risk of Sars-CoV-2 infection in dental centers is a serious problem for doctors and patients. The main purpose of this study was to investigate the environmental health measures related to corona disease in the dental offices of Sari city during the COVID-19 epidemic in 2021.
Materials and Methods: The present study is descriptive and cross-sectional, and the tool used in it is a researcher-made questionnaire collected with the cooperation of the personnel working in 100 active dental service centers in Sari. to determine content validity, two qualitative and quantitative -qualitative methods were used. The qualitative content validity of this questionnaire was confirmed by 8 environmental health experts. Cronbach's alpha was used to determine the reliability of the questionnaire. Data analysis was done using SPSS software V. 25.
Results: Based on the results of this study, personal protective equipment was used continuously in 100% of the centers. In 93% of the centers, sodium hypochlorite and formaldehyde were used to disinfect the equipment, and in 94% of the cases, the frequency of disinfection of the equipment was after each patient. Disinfection of toilets was done daily in 62% of the centers and every two days in the rest. In 72% of the examined dental centers, had no local hood installed or turned on above the units, but in 92% of the offices, there was proper ventilation of public spaces. In addition, according to the results, in 99% of clinics, waste management was carried out in accordance with national laws and regulations and based on the rules and methods of the executive management of medical waste and related waste and related instructions, and also in 100% of clinics, water consumption was healthy and desirable.
Conclusion: Overall, environmental health measures in dental offices were at an optimal level in most cases and in accordance with the instructions of the Ministry of Health. Not installing a hood or not turning it on above the units and improper ventilation of the dentist's office were the most critical problems of the centers, which need to be given more attention and corrective measures should be taken according to the instructions of the Ministry of Health.
 

Background and Objective: Compliance with the principles of environmental health is of particular importance in any gathering ceremony. This issue needs more attention in the Muharram and Safar mourning ceremonies due to the position of health in Islam and the presence of different populations in this ceremony. Based on this, the present study was conducted with the aim of environmental health management during Muharram and Safar days using the Analytic Hierarchy Process.
Materials and Methods: According to the main purpose of the study, a literature review was done. Then, a team of experts was formed and criteria, sub-criteria and programs related to the purpose of the study were determined by brainstorming, and the relevant questionnaire was prepared and after completion by 25 experts, the relevant criteria were prioritized using the Analytic Hierarchy Process.
Results: Based on the weighting with the Analytic Hierarchy Process method, the highest score (0.441) was awarded to the health inspection criteria, and then the administrative coordination criteria(0.186), education (0.182), reporting (0.169) and finally the support and services criterion (0.022) were prioritized.
Conclusion: The results of the study indicate the emphasis on environmental health management during the Muharram and Safar mourning ceremonies from the point of view of experts, that compliance with the three principles of health inspection, administrative coordination and continuous training has the particular importance.
 

Background and Objective: Scientometrics is used to identify existing study gaps, discover the future research directions, investigate fundamental trends and implement the necessary policies in a specific field of knowledge. Considering the key role of environmental factors in the health trends and the varyingburden of diseases in the country, this study was conducted with the aim of performing scientometric analysis of the role of environmental health in the prevention and control of diseases related to environmental factors in Iran.
Materials and Methods: Bibliographic information related to scientific documents indexed in the Web of Science database until September 12, 2022, was analyzed and visualized using Citespace and Biblioshiny software.
Results: A total of 1,212 documents were retrieved. These documents were published in 629 sources with the participation of 8,461 authors. The average publication year of the documents was 2010. The top three ranks of organizational affiliations were as follows: Tehran University of Medical Sciences (747 documents), Isfahan University of Medical Sciences (436 documents), and Shahid Beheshti University of Medical Sciences (393 documents). Iran's cooperation network with other countries indicates substantial joint researchbetween Iran and the main countries in this network. Over time, the co-occurrence network of keywords has evolved from outcomes (such as cardiovascular diseases, cancers, etc.) to environmental exposure factors, especially air pollutants, heavy metals, and food-borne pathogens factors. Risk assessment has also been a category of interest in recent years.
Conclusion: Scientometric analysis showed that environmental health studies in prevention and control of diseases related to environmental factors in Iran are young and still progressing. In the early years, studies were mainly focused on diseases as an outcome, while in recent years, they have focused more on exposure factors or environmental pathogens. It is suggested that the future studies based on the retrieved keywords should be more mission-oriented and the priority of solving the problems of environmental pollutants affecting people's health in the country based on the extent and scope of the problems of each province should be considered by policy makers and researchers.