Iranian Journal of

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Background and Objectives: Iran is one of the Middle Eastern countries that implemented the HIV / AIDS control and surveillance program many years ago. The purpose of this study was to review the HIV / AIDS surveillance system in Iran.
 
Methods: This was a review research to assess the processes, structures and achievements of the HIV/AIDS surveillance system in Iran. The information sources of this study included data from the surveillance system, reports and documentation, and published guidelines, reviewing existing structures and views of managers and practitioners of the HIV/AIDS surveillance system in Iran.
 
Results: In Iran, all cases with HIV / AIDS as well as people with high risk behaviors are referred to behavioral disease counseling centers in order to receive health care services. Harm reduction in people with risky behaviors in the form of counseling centers, drug addicts' centers, and women's counseling centers in collaboration with governmental and non-governmental organizations, and attention to the second generation of HIV/AIDS surveillance, particularly conducting behavioral studies, are other components of the HIV / AIDS surveillance system in Iran
 
Conclusion: Although the HIV / AIDS surveillance system in Iran has a large structure with many achievements in reducing new HIV cases, especially in some high-risk groups such as injecting drug users, as well as reducing HIV transmission from infected mothers to their children, strengthening this surveillance system, especially for sexual high-risk groups, is essential for controlling HIV/AIDS in the country.

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Background and Objectives: Iran, like most other countries in the world, is always threatened with global epidemics and pandemics of influenza. The purpose of this study was to review the influenza surveillance system in Iran.
 
Methods: Data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, the review of records, documents, books and published articles and also interviews with process owners and experts of influenza surveillance in 2017-2019.
 
Results: Influenza surveillance in Iran Currently, a combination of surveillance methods, including caring for patients, laboratory care, hospital care and surveillance of respiratory disease epidemics and also border surveillance. Reporting of human influenza outbreaks, as well as suspected avian flu as main notifiable diseases carried out through telephone. For each suspect case, in addition to taking and sending a sample to diagnose and also detect subtypes of the virus, medical treatment is immediately initiated and tracking of possible contacts is also done.
 
Conclusion: Although there is currently good coherence in the surveillance of influenza in Iran, but based on concerns about the emergence of influenza pandemics in the future, and considering the possible genetic variation of the flu viruses, the tracking of the flu virus circulation along with updating surveillance system especially emphasizing methods and formulas for rapid identification of disease outbreaks, as well as providing better health care and treatment is essential.

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Background and Objectives: Cutaneous leishmaniasis (CL) is one of the health problems in Iran, especially in Kerman Province. The aim of this study was to determine the morbidity rate of CL in two new foci in the east and southeast of Kerman.
 
Methods: At the end of 2017, demographic data were obtained from the health centers of Kerman. Using cluster sampling, 800 households (40 clusters of 20 households) were studied in Allahabad (southeast) and Sarasiab (east), Keramn. From each subject, data were collected regarding age, sex, number and location of the ulcer(s), scarring, and time and place of infection. The collected data were analyzed using SPSS software.
 
Results: The prevalence of CL was 9.6 in Allahabad and 42.8 in Sarasiab and the incidence (new cases) was 3.2 and 3.8, respectively. The highest rate of infection was found in Allahabad in the age group under 6 years old and in the Sarasiab was over 40 years old. There was a significant difference in nationality and local transmission between the rwo regions (P <0.001).
 
Conclusion: The ratio of the prevalence to incidence in two regions showed that the focus in the east of Kerman was almost 12 years old, whilst a new focus is developing in the southeast. It is suggested that the health centers in the city of Kerman provide a regular program including active case- detection and free-of-charge treatment of patients in the aforementioned areas until complete recovery to achieve disease control.

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Background and Objectives: Low fertility reduces the workforce and causes population aging. Hence, childbearing and its determinants are important issues in demographic policies. This study was conducted to explain the causes of single child according to women’s views.
 
Methods: This qualitative study was the second part of a sequential explanatory study carried out using a conventional content analysis approach and inductive reasoning. The research population comprised married women aged 15-49 years old living in Babol who had one child and did not intend to have any pregnancies in the future. The subjects were selected via a target-based sampling method. After receiving written consent, semi-structured interviews were conducted. Data saturation was achieved after 13 interviews.
 
Results: The findings showed that single child was affected by the media and social patterns associated with their own priorities. Uncertainty about the future and marital conflicts boosted having only one child. In fact, there were issues that forced women to accept "single child” in spite of "single child complaints" and try to a find a meaning for life with only one child.
 
Conclusion: Apart from economic issues, there are many social issues involved in child-rearing, and demographic policy-makers should consider these issues in order to achieve their desired demographic goals.

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Background and Objectives: Burns are tragic events with considerable mortality rates. This study was conducted to analyze the spatial pattern of burns and identify the factors associated with the burn injuries in Mashhad, Iran.
 
Methods: This retrospective cross-sectional study was conducted in patients hospitalized in Imam Reza Hospital Burn Center, Mashhad, which is the only referral burn center in the northeast of Iran. Spatial generalized linear models (Poisson and negative binomial) were used to model the association between socio-economic characteristics and the incidence of burn injury.
 
Results: A total of 1044 acute burn patients (69.9% male, 30.1% female) were reviewed. Most of the burned patients were in the age group 20-29 years (41.4%). The most common cause of burn injury was flame (64.6%). The local test of spatial autocorrelation confirmed that the burns had cluster pattern in the central areas of the city and the worn-out urban texture was at higher risk of burns. The results of model showed that the percentage of worn-out urban texture (IRR =1.007; 95%CI 1.005-1.008), literacy (IRR =0.98; 95% CI 0.95-0.99), percentage of employed women (IRR =0.96; 95%CI 0.92-0.99), unemployment rate (IRR =0.92; 95%CI 0.85-0.99) and percentage of margination (IRR =1.006; 95%CI 1.005-1.008) were associated with burns.
 
Conclusion: Based on the findings, socio-economic and environmental characteristics are associated with the incidence of burn injuries in different areas. The results of this study could be used to design burn prevention strategies, especially in the high-risk areas and groups.

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Background and Objectives: Lifestyle is a way that a person chooses throughout life and is an indicator that can affect physical and mental health. This study was conducted to determine the lifestyle of people in Rasht and its predictive factors.
 
Methods: This analytical, cross-sectional study was conducted in 1000 residents of 5 districts of Rasht. Data were collected using a demographic questionnaire and the Behavioral Health Questionnaire. SPSS software version 20 was used to analyze the data. Pearson correlation coefficient, independent t-test and linear regression were applied.
 
Results: The result showed that 50.3% of the participants were male and 49.7% were female. According to lifestyle, the rate of using alcohol, physical activity, breakfast, red meat, fruits, salt, and ready meal was 13.4%, 54.3%, 95.6%, 87.7%, 98.4%, 59.6%, and 45.9%, respectively. The majority of the research units (70.1%) never smoked. The mean sleep time was 7.45 ± 63/1 hours.
 
Conclusion: Based on the results, promotion of nutritional knowledge, increased awareness of the disadvantages of smoking, availability of healthy food at a reasonable price, and physical activity are important factors for lifestyle improvement.

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Background and Objectives: Anthropometric indices, especially weight, provide useful information for the care and treatment of newborn infants and can be used to identify infants at risk. Therefore, this study was conducted to examine the mean weight, height and head circumference measurements of infants and some related factors.
 
Methods: This cross-sectional study was performed to investigate the anthropometric indices (weight, height and head circumference), demographic characteristics, and delivery data of 1484 newborns in 2016 using multi-stage sampling. Moreover, the predictors of these indices were analyzed using a linear regression model.
 
Results: The mean weight, height and head circumference of the newborn infants was 3185 ± 465 g, 49.92 ± 2.92 cm, and 34.58 ± 2.29 cm respectively, and 7% of newborns were low birth weight. The male newborns weighed 57.29 g more than females on average at birth (p <0.05). Besides, the height and head circumference of the male newborns were 0.15 and 0.10 cm larger than the female newborns respectively but the difference was not statistically significant. In addition to gender, gestational age at birth (week) and type of delivery correlated with all three anthropometric indices in multivariate analysis.
 
Conclusion: Identifying and controlling largely adjustable risk factors can make it possible to prevent low anthropometric parameters, particularly low birth weight.

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Background and Objectives: Nowadays, despite several global initiatives, the use of doping agents has become a problem in athletic societies. Therefore, the aim of the current study was to investigate the prevalence, attitude and tendency toward the use of performance-enhancing supplements among athletes in North Khorasan Province.
 
Methods: The statistical population of this cross-sectional, descriptive-analytical study was all athletes of North Khorasan Province. Demographic characteristics and data related to doping agents were collected using a researcher-made questionnaire. The validity of the questionnaire was approved by doping experts and its reliability was calculated by Cronbach's alpha. The questionnaires were then distributed using stratified random sampling and 436 questionnaires were collected. Data were analyzed using SPSS software at P<0.05.
 
Results: The findings showed that 39.2% of the subjects used at least one of the agents for doping. The most common agents were vitamin and protein supplements (36%), minerals (28.7%) and drugs (21.3%). Also, there was a significant negative correlation between the prevalence of using doping agents and age, sport background, and educational level. In addition, attitude and tendency toward the use of doping agents were higher in weightlifters, body builders, and footballers compared to other athletes. Furthermore, knowledge of athletes, awareness about side effects, and the overall awareness of athletes toward performance-enhancing supplements was low.
 
Conclusion: It is necessary to develop comprehensive educational programs to raise the knowledge and awareness of athletes and coaches toward the use of performance-enhancing supplements in North Khorasan Province.

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Background and Objectives: To provide an overview of the national program of Crimean-Congo hemorrhagic fever surveillance in Iran, its current achievements, and challenges.
 
Methods: In this mixed method study, the relevant reports, documents, and guidelines, as well as published literature and surveillance data were gathered and critically reviewed. The opinions of the key informants at local and governmental levels were assessed through structured interviews.
 
Results: The program was integrated into Iran’s primary healthcare (PHC) network in 1999. The involved organizations include CDC, medical universities, Pasteur Institute of Iran (PII), and Veterinary Organization. Case finding is based on standard definitions of suspected, probable, and confirmed cases. Laboratory confirmation is necessary for diagnosis and is provided within 48 hours after receipt of the specimen by the National Reference Laboratory of PII. CCHF treatment is primarily supportive. Antiviral therapy with ribavirin is also considered. Both therapeutic services are free. Education mainly focuses on high-risk groups and healthcare workers. Major achievements of the program include rapid diagnosis and treatment of cases, prevention of nosocomial transmission, identification of high-risk provinces and major transmission routes, improved outbreak preparedness, development of laboratory tests for detection of other arboviruses, and reduction of CCHF case fatality rate.
 
Conclusion: Program implementation has had a positive impact on early detection and proper control of annual outbreaks. However, some aspects of the program still need improvement, including promotion of the general and high-risk populations’ awareness and regional collaborations (especially among neighboring countries) for infection control in humans, livestock, and vectors.

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Background and Objectives: Alcohol consumption among various occupations' staff leads to many problems. Therefore, due to the importance of the issue, this comprehensive study was conducted to determine the prevalence of alcohol consumption among industrial workers.
 
Methods: In this descriptive cross-sectional study, the data were collected using a structured questionnaire through interview based on the workers’ self-reports. The participants included 13,128 workers across the country selected by multi-stage cluster sampling according to the population of labor workers and industrial centers in each province. The data were reported according to the consumption prevalence in the 10 spatial planning zones.
 
Results: In the optimistic situation, wokers in Ardebil (10.7%), Kermanshah (10.6%) and Guilan (7.1%) reported the highest frequency of alcohol consumption. The country’s mean prevalence of current consumption was 3.2% and the prevalence of alcohol consumption in life was up to 12.4% in the workers.
 
Conclusion: The data are based on the self-report of the participants. Therefore, the estimated prevalence rate is considered optimistic and below the actual prevalence. In the work environments of the country, especially in provinces with the highest frequency, special policies and interventions are needed to reduce the prevalence of alcohol consumption and minimize the harms caused by it.

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Background and Objectives: In survival analysis, using the Cox model to determine the effective factors requires the assumptions whose failure of leads to biased results. The aim of this paper was to determine the factors affecting the survival of metastatic gastric cancer patients using the non-parametric method of Randomized Survival Forest (RSF) model and to compare its result with the Cox model.
 
Methods: In this retrospective cohort study, 201 patients with metastatic gastric cancer were evaluated in Hamadan Province. Patient survival was calculated from diagnosis to death or end of study. Demographic characteristics (such as gender and age) and clinical variables (including stage, tumor size, etc.) were extracted from the patient records. Factors affecting survival were determined using the Cox model and RSF. Data analysis was performed using the R3.4.3 software and RandomForestSRC and survival packages.
 
Results: The mean (SD) age of patients was 61.5 (12.9) years old. The Cox model showed that chemotherapy (p=0.033) was effective in survival, and the results of fitting the RSF model showed that the most important variables affecting survival were type of surgery, location of metastasis, chemotherapy, age, tumor grade, surgery, number of involved lymph nodes, sex and radiotherapy. Based on the model appropriateness, the RSF model with log-rank split rule had a better performance compared to the Cox model.
 
Conclusion: If the number of variables is high and there is a relationship between the variables, the RSF method identifies the important and effective variables on survival with high accuracy without requiring restrictive assumptions compared to the Cox model.

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Background and Objectives: The aim of this study was to determine the predictability of the PLS-SEM model for injuries resulting in hospitalization in motorcyclists using a mediator variable in a case-control study.
 
Methods: In this case-control study, 300 cases and 156 controls were randomly selected from 150 clusters using random cluster sampling. The data were collected using the motorcycle riding behavior (MRB) questionnaire, adult attention deficit hyperactivity disorder (ADHD) questionnaire (subscales) and a checklist containing motorcycle related variables.
 
Results: The motorcycle riding behavior, adult ADHD, motorcycling related variables and some demographic variables were found to be the predictors of injury. There were significant positive relationships between injury and motorcycling related variables (B=0.20, P=0.001) and ADHD (B=0.33, P=0.001), between MRB and motorcycling related variables (B=0.51, P=0.001) and ADHD (B=0.52, P=0.001), and between ADHD and motorcycling related variables (B=0.39, P=0.001).
 
Conclusion: Considering the more accurate results of PLS-SEM, the intervention programs should especially address those who have hyperactive children, those who use the cellphone while riding, and those who ride in dark hours of the night.

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Background and Objectives: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder in pregnancy. In case of early detection, some of its complications can be prevented. The aim of this study was to investigate early prediction of GDM by logistic regression (LR), discriminant analysis (DA), decision tree (DT) and perceptron artificial neural network (ANN) and to compare these models.
 
Methods: The medical files of 420 pregnant women (2010-12) in Kermanshah health centers were evaluated using convenience sampling. Demographic data, pregnancy-related variables, lab tests results, and a diagnosis of GDM according to a fasting blood sugar level of 92 or more were collected from their files. After fitting the four models, the performance of the models was compared and according to the criteria of accuracy, sensitivity and specificity (based on the ROC curve), the superior model was introduced.
 
Results: Following the fitting of LR, DA, DT and perceptron ANN models, the following results were obtained. The accuracy of the above models was 0.81, 0.83, 0.78 and 0.83, respectively, the sensitivity of the models was 0.50, 0.63, 0.58 and 0.58, the specificity of the models was 0.96, 0.93, 0.87 and 0.94, and the area under the ROC curve was 0.86, 0.78, 0.73 and 0.87, respectively.
 
Conclusion: In predicting and categorizing the presence of GDM, the ANN model had a lower error rate and a higher area under the ROC curve compared to other models. It can be concluded that this model offers better predictions and is closer to reality than other models.

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Background and Objectives: Progressive muscle relaxation (PMR) training as part of an educational program for patients involved in pathologic and physiological events (PPE) can have important physiological and psychological benefits for the patients, and can affect various dimensions of their lives including the quality of life. This systematic review and meta-analysis was conducted to determine the effect of PMR on the quality of life of patients involved in PPE.
 
Methods: Through searching the words “PMR” and “quality of life (QOL)” in Persian databases including SID, MagIran, IranMedex, and IranDoc and international databases including Google Scholar, Scopus, PubMed, Web of Science, ProQuest, and ScienceDirect, all studies published on the effect of PMR on the QOL were extracted. The methodological quality of the papers was examined using Cochrane risk of bias. Data analysis was carried out using a random-effects model and heterogeneity was assessed by I2. The data were analyzed using the STATA software version 14.0.
 
Results: Of 495 studies, only 10 explored the effect of PMR on the QOL of patients. The pooled mean of the QOL and all dimensions were statistically significant, including physical functioning (0.339), physical role limitation (0.378), bodily pain (0.341), general health (0.598), social functioning (0.873), mental health (0.736), emotional role limitation (0.791), vitality (0.706), total physical dimensions (0.652), total mental dimensions (1.316), and total QOF score (0.480). Only one study had a low risk of bias.
 
Conclusion: Implementation of PMR has a significant effect on the quality of life of patients involved in PPE. PMR is recommended to improve the QOL of the patients.

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Background and Objectives: Over the past decades, the Iran’s anti-tuberculosis campaign has become highly structured and many achievements have been made. The purpose of this study was to describe the characteristics of the TB surveillance system and its components in the Islamic Republic of Iran.
 
Methods: The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, a review of the records, documents, books and published articles, and also interviews with process owners and experts of TB surveillance during 2017-2019.
 
Results: Case finding and treatment and follow-up of TB patients and their household contacts are done In the TB surveillance system. The implementation of the DOTS, (DIRECTLY OBSERVED TREATMENT SHORT-Course) is a major component of the TB surveillance system. Patient registration is done in an online application, which allows extracting and reporting the important indicators of the program. In this surveillance system, there is a special sensitivity to the treatment of patients, so the incidence of multi drug-resistant TB in the country is lower than that of the neighbors. The presence of regional laboratories that cover the entire region of the country is one of the strengths of the TB surveillance program in Iran.
 
Conclusion: Despite budget problems, the anti-TB program in Iran has many achievements. However, new strategies need to be considered to reduce the incidence of TB.

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Background and Objectives: The study aimed to analysis the psychometric properties of the health system resilience scale, assessing it and to introduce a conceptual model for qualitative analysis of Iran health system in the face of the civid-19 crisis.
 
Methods: In this Mixed-method study, the determination of face and content validity was performed using 8 experts. The structure validity was investigated in a cross-sectional study through an electronic survey of 178 actors in the Iran health system. Resilience has been assessed in five dimensions using 5point Likert scale.
 
Results: The percentage mean score of the Iranian health system resilience in the face of the Covid19 crisis was 41/08 and in the moderate level. The percentage mean score (standard deviation) for 5 dimension include awareness 39/2 (21), diversity 38/7 (21), self-regulation 36 (20/6), integration 39/9 (21/5) and adaptation 41/2 (21/8). Confirmatory factor analysis indicated the appropriate fit of the information with the five-component structure.
 
Conclusion: The maximum score of resilience dimension belongs to adaptation and the lowest to the self-regulation indicating that it requires interventions to involve the private sector, and to design a new delivery system for crisis situations. The questionnaire can be used as a standard instrument for assessing the health system resilience.
 

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Background and Objectives: Rheumatoid arthritis is a chronic, progressive disease of the joints that presents with articular and systemic symptoms. The purpose of this study was to determine the quality of life in patients with rheumatoid arthritis and its relationship with body mass index.
 
Methods: This descriptive-analytical study was performed in 195 patients with rheumatoid arthritis in Tohid Hospital, Sanandaj, Iran. The data collection tool was a questionnaire including demographic and clinical characteristics. The SF-36 instrument was used to evaluate the quality of life.
 
Results: In the study, 40% of men and 58% of women had a disease severity higher than 2.6 according to the Disease Activity Score 28. There was a significant difference in all dimensions of quality of life including physical function, energy / fatigue and general health between men and women (P <0.05). All dimensions of quality of life were inversely correlated with BMI. There was a significant relationship between the disease severity and each of the dimensions of pain, general health and general changes (P <0.05).
 
Conclusion: Quality of life in patients with rheumatoid arthritis is correlated with body mass index and severity of rheumatoid arthritis; therefore, it seems that health policy makers or clinical practitioners need to pay more attention to these two factors to increase the patients’ quality of life.
 

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Background and Objectives: The purpose of this study was to present a summary of the rabies surveillance program in humans in the country, its achievements and its strengths and weaknesses.
 
Methods: This study was a review of the country's plan for surveillance and control of rabies in humans. The sources of information included the data, reports, documents, and published guidelines. The viewpoints of stakeholders and experts were also reviewed in this study.
 
Results: Since rabies is a zoonotic disease, its effective management requires a good collaboration between several organizations. Moreover, because Iran is located in an endemic region, there is a need for the development of regional and international cooperation for the success of disease prevention, control and management. Animal services for biting and rabies control are provided free of charge in more than 700 centers in the country. Major achievements of the program include timely preventive treatment for animal bite cases, knowledge of the geographical distribution of the disease, identification of high-risk provinces, and decreasing the percentage of human deaths.
 
Conclusion: The program has performed well for rabies secondary prevention. Some aspects of the program, however, still need to be improved, including improvement of educational programs targeting general population and high-risk groups, animal bite prevention, vaccination of domestic dogs, controlling the population of stray dogs, rabies control in wild animals, and proper waste collection and disposal.
 

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Background and Objectives: : According to the global strategy for polio eradication, targeted surveillance of the disease is one of the main tasks of the health system. The purpose of this study was to review the status and surveillance of poliomyelitis/acute flaccid paralysis (AFP) in Iran.
 
Methods: The present study was a review on the processes, structures and achievements of the poliomyelitis/AFP surveillance system in Iran during 2017-2019. The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control; a review of the records, documents, books and published articles; and interviews with process owners and experts of poliomyelitis/AFP surveillance.
 
Results: The polio eradication program in Iran is based on the action plan of the World Health Organization that was introduced initially in 1988. Currently, the surveillance system of AFP is active at three levels: country, university, and city. The number of poliomyelitis cases in the country decreased from 50 cases per year in 1985 to zero in 2001, and Iran has been a polio-free country since 2001. The final report on polio eradication in Iran was approved by the regional commission on polio detection in April 2006.
 
Conclusion: The surveillance system of AFP has had a proper effectiveness throughout the country. Maintaining this situation in the country requires an increase in the sensitivity of the surveillance system of the disease, regular monitoring of vaccine coverage, strict implementation of international health regulations, especially on the eastern borders of the country, and providing technical assistance to neighboring countries.

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Background and Objectives: The purpose of this study was to investigate the status of HSE indices in a number of organizations affiliated with Tehran Municipality.
 
Methods: In this cross-sectional study, the study population included all organizations affiliated with Tehran Municipality HSE performance was assessed through an 18-item checklist. The content validity of this checklist was examined by obtaining the opinions of experts in the field. The data of this study were analyzed using the SPSS software version 22.
 
Results: The results of this study showed that three organizations, namely Suburbs Bus Company, Urban Planning Organization, and Terminals and Parks Organization had the best HSE performance with indexes of 63.6%, 57.485 and 52.59%, respectively. Among the 18 items of HSE performance, the HSE policy had the highest score (68.6%).
 
Conclusion: Based on the findings of this study, the value of the HSE index was not complete in any of the fields. The results of this study showed that although the foundation of the HSE system was implemented in many units of Tehran Municipality, it is still a long way before the desired point is reached. Therefore, it is necessary to formulate and implement appropriate action plans and to evaluate the effectiveness of control measures to improve the HSE indicators.