Journal of School of Public Health and

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Background and Aim: Nowadays Clinical Skills Centers are important structural components of medical education systems globally. In these centers medical students are trained using a variety of methods and techniques, one method being teaching in structured stations. The objective of this study was to determine the efficacy of this method by comparing the students' self-assessment of their own basic surgical skills before and after structured stations teaching.

Materials and Methods: This quasi-experimental study was conducted in 2004-08 in Tehran University of Medical Sciences. The participants included 268 medical students at the clerkship stage there were 3 trainer groups. The pre- and post-self assessment techniques were used to assess the learning progress. ANOVA & Paired-t and non-parametric tests were used for data analysis.

Results: Irrespective of which year the students were in, self- scoring on 17 cognitive subjects and 10 procedural skills showed a significant improvement after the instruction (p<0.001). There were significant differences among the 3 trainer groups (p<0.001).
Conclusion: This study suggests that teaching basic surgical skills using structured stations is effective in improving practical skills.

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Background and Aim: Sex education of children, a complex issue in any culture, has always been a controversial subject. Schools can play a vital role in imparting sex education to children, particularly in more conservative communities. The objective of this study was to find out primary school teachers' beliefs, attitudes, values, and understandings regarding sex education of school pupils.

Materials and Methods: In this qualitative study we employed a community-based approach to design the project. Purposeful, voluntary and maximum variation sampling was used to recruit 22 teachers from selected schools in Western Tehran (21 female and 1 male teacher). Information was collected in 4 focus-group discussion sessions. Grounded theory and thematic analysis were used.

Results: Findings revealed three major themes: 1) organizational role, 2) institution construction, and 3) individual characteristics. These themes were described by subthemes as follows: 1. for organizational role: organizational culture and policies 2. for institution construction: family and educational institutions 3. for individual characteristics: biology, gender, instincts, curiosity, knowledge, and behaviors.

Conclusion: From the participants' point of views, the school and the family are two important institutions in children sex education. However, teachers are not sufficiently competent in sex behavior education. Inappropriate policies, resource limitations, and the family cultural structure are obstacles in sex education of children in schools. The participants believe the following are priorities in children's sex education: changing cultural attitudes in organizations and institutions, such as cultural diffusion sound training approaches in sex-related topics providing sufficient resources improving knowledge and skills of teachers in the area of sex education of pupils and effective interaction between families and school authorities.

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Background and Aim: Inadequate management of biomedical waste can be associated with risks to healthcare workers, patients, communities and their environment. In this study a comprehensive survey was conducted to obtain information on the management of solid wastes in Qom hospitals.

Materials and Methods: Field visits were made to 2 private and 4 governmental hospitals to collect the required information and weighing the solid wastes generated. In addition, supplementary information was collected using a modified World Health Organization questionnaire.

Results: The results showed total the average generation rate of solid waste in Qom hospitals was 3057.55 kg/day. The shares of general, infectious, sharp, and pharmaceutical and chemical solid wastes were 1523.6, 1520.6, 12.72 and 0.93 kg/day, respectively. The results on various aspects of solid waste management indicate that practices in the hospitals do not comply with the principles stated in the respective Iranian regulations. Similarly, the segregation process was inefficient. No information was available concerning the quantity and quality of solid wastes.

Conclusion: Development of suitable waste management schemes and plans are strongly recommended. In addition, establishing training programs on proper waste management for all the personnel involved (managers, physicians, nurses, workers) are essential. These actions, plus effective supervision, will result in considerable reductions in hospital solid waste disposal cost

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Background and Aim: Food insecurity implies a limited ability to secure adequate and safe food or limited or uncertain ability to acquire acceptable foods in socially acceptable ways. The nutrition transition in Iran is taking place in the context of rapid demographic change and urbanization in spite of underweight, obesity and overweight increased, especially among women. It is usually expected that food-insecure people have an inadequate food intake, less body fat, and body weight. However, several studies in developed countries have shown a higher prevalence of overweight/obesity among food-insecure household members, especially women. Under weight and overweight or obesity is the most common nutritional disorder in the developed countries and is assuming to become a serious health problem in developing countries. This study aimed to assess the association between food insecurity and socio-economic factors in households and body mass index among urban women in Dezful in 2008.

Materials and Methods: A total of 400 household were randomly selected by two stage sampling from different areas in Dezful. Heights and weights of all women were measured based on standard protocols, and body mass index (BMI) was calculated. BMI status was defined based on cut-off values recommended by NIH( under weight = BMI<18.5, normal weight 18.5< BMI< 25, overweight 25≤BMI<30 and obesity BMI≥30 Women provided detailed demographic and food insecurity information via a face- to- face interview. Information on food insecurity was collected using the instrument originally developed by USDA. All analysis was conducted using the SPSS statistical package.

Results: The prevalence of household food insecurity was %37.6 and 42.8% of the women were overweight, and 12% obese, respectively. Results showed that, BMI was positively associated with food insecurity, women's age and family size and inversely associated with , race and economic status (p <0.05).

Conclusion: It is evident that household food insecurity, overweight and obesity coexist in Dezful. Women age, family size, race and economic status were recognized as associated factors with food insecurity but other factors didn't show significant relationship. There is lack of published information regarding food insecurity and some factors affecting with body weight status therefore, it is necessary to perform such studies in other regions too.

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Background and Aim: This study was undertaken to determine the effectiveness of a safe community program, as an international community-based program, for injury prevention and safety promotion, in Kashmar

Materials and Methods: In this retrospective study, the data on injured patients consulting hospital emergency wards in Kashmar and 44 other districts (as control) for a period of 3 years (March 20 2005 to March 19, 2008) were analyzed and compared.

Results: The number of injuries/100,000 population in Kashmar was 4654.6, 4570.9, and 4949.2 in March 2005-2006, 2006-2007, and 2007-2008, respectively. The corresponding figures (means) for the control districts were 822.7, 1130.0 and 1245.5. The injury- related fatality rate in the emergency ward for the 3 periods was 57.6, 52.9, and 44.2 per 100,000 in Kashmar and 12.2, 13, and 11.9 per 100,000 in the control districts. The injury rate showed an increase and the injury- related fatality rate showed a decrease in both Kashmar and the control districts over the 3 year period, but there was a statistically significant difference between the decreased injury-related fatality rate in Kashmar (p<0.0001).

Conclusion: The Kashmar International Safe Community Program resulted in no significant decrease in the rate of injuries in Kashmar. However, as compared to the control distrcts, it caused a decrease in the injury-related fatality rate over the 3-year period. Long-term studies are necessary to confirm these results.

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Background and Aim: Patients who consult hospital due to physical or mental damages have legal rights. Observation of patients' rights will result in patient satisfaction, which will help to improve hospital services. The aim of this study was to determine awareness and observation of patient's right in hospitals affiliated with medical universities in Tehran.

Materials and Methods: This was a cross-sectional study conducted in 2009 in hospitals affiliated with medical universities in Tehran. A total of 601 patients were randomly selected from 11 hospitals affiliated with three medical universities in Tehran. Data were collected using a 50-item questionnaire the validity and reliability of which had been confirmed. Chi-square and Kruskal-Wallis tests were used for statistical analysis. The software used was SPSS.17.

Results: The mean age of the patients (59% females and 41% males) was 43.3 (SD=18.5) years and the average length of hospitalization 7.1 (SD=7.4) days. Data analysis showed that the proportions of the patients with a poor, intermediate and desirable patients' rights awareness were 71.5%, 22.0% and 5.8%, respectively. Observation of patients' rights was good in 13.8% of the cases, medium in 82.9% of the cases and poor in 3.3% of the cases. There was a significant statistical relationship between observation of patients' rights on the one hand and the hospital ward and length of stay on the other hand (p=0/007). Further analysis of the data showed that the strongest and the weakest observed rights were patient awareness right and the right of making objections and lodging complaints, respectively.
Conclusion: The results of this study showed that patients are not well aware of patients' rights and that observation of patient's rights is not at a desirable level. We recommend organizing public educational programs including components on patients' rights and follow-up of patient' rights violations, as well as passing a comprehensive act to ensure observation of patients' rights and specific programs designed for monitoring and supervising it.

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Background and Aim: Multiple sclerosis (MS) is considered as a common inflammatory disease of the human central nervous system (CNS). 4 amino pyridine (4-AP), a potassium channel blocker, is used widely in MS treatment to reduce fatigue and cachexia often experienced by the patients. The objective of this study was to get a better understanding of the mechanism of action of this drug, using the cell culture model. More specifically, we attempted to determine the effects of the drug on 1. The profileration of, and its cytotoxicity on, the neurons, and 2. The activity of MMP-9 in the neurons.

Materials and Methods: Considering the available reports on the wide range of 4-AP effects, we designed this study to investigate its possible role in proliferation or cytotoxicity of the MS cellular model, i.e. astrocytoma U373-MG, using the MTT assay technique. We also analyzed the effect of 4-AP on cell functionality as assessed by matrix metalloproteinase-9 (MMP-9) zymography.

Results: The results showed that while 4-AP at a concentration of 0.1 and 1 mM has no significant cytotoxic effects on the treated cells, it has remarkable MMP-9 inhibitory effects (p<0.01). The proliferation analyses confirmed the stability of 4-AP effects on cell functionality.

Conclusion: On the whole, the results of the present study show the desirable effect of 4-AP on MMP-9 activity at non-cytotoxic doses, promising its further therapeutic applications.

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Background and Aim: Length of stay (LOS) in a hospital is one of the best hospital indicators that can be used for various purposes. In this survey, we studied the hospital LOS and its associated factors in Tehran University of Medical Sciences Women's Hospital (a teaching hospital) in Tehran using the Cox proportional hazards semi parametric model and compared the results with the results obtained using the multiple linear regression.

Materials and Methods: This was a descriptive-analytical study in which we reviewed 3421 files of inpatients hospitalized in, and those discharged from, the oncology, surgery and obstetrics units in 2008. The required data were collected using a data collection sheet and inpatient interviews. A P<0.05 was considered statistically significant.

Results: The median of patients' LOS in the hospital was 50.8 hours, that in the obstetrics, surgical and oncology units being 48.5, 54.4 and 94.2 hours, respectively. Of all the patients, 2632 (76.9%) had been discharged with a recovery status and the rest (23.1%) with a no-recovery status. Results of the Cox proportional hazards model showed that the following variables had increased LOS: a distance longer than 200 km between a patent's residence and the hospital, hospitalization in the surgery and oncology units, admission on a Thursday, admission by an internist, hospitalization for neoplastic, endocrine, nutritional, or genitourinary system diseases (P<0.005), as well as a high number of diagnostic laboratory tests, radiographies or sonographies (P<0.001). Patients admitted and hospitalized as an emergency case had a shorter LOS (P<0.001) than others. On the other hand, based on the multiple linear regression model results, some occupations (being a worker, a farmer, a stockbreeder, or a retired spouse) admission on a Thursday, (The first day of the weekend in Iran), suffering from a neoplastic disease, and a high number of diagnostic tests or radiographies or sonographies increased, and admission by a resident decreased, patients' LOS (P<0.05).

Conclusion: Considering having censored data, the Cox proportional hazards model is a more suitable model than the multiple linear regression models for identifying factors influencing patients' LOS in a hospital. From among the LOS Cox model's associated factors as identified in this study, policy-makers and managers can only change admission days and the number of diagnostic tests. That is to say, they should try to prevent admission on a Thursday (unless emergency cases) and also perform the required primary diagnostic tests before admitting a patient into the hospital, which would lead to a more effective utilization of hospital beds and other resources.

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Background and Aim: Inequality in the distribution of hospital recourses is a great obstacle in planning and provision of health care. This inequality in mainly observed in the government hospitals in a country. The objective of the present study was to determine the distribution of specialized physicians and active beds in the Iranian government hospitals between 2001 and 2006

Materials and Methods: The method used in the study was retrospective, descriptive- analytical. The data were analyzed (Lorenz Curve and Gini index estimation), using the Excel Software.

Results: Based on the Gini coefficient, the distribution of specialized physicians during the 5-year period (2001-2006) was 0.0876, 0.0874, 0.0909, 0.0329, 0.0951, and 0.0520, respectively. The corresponding figures for active beds were 0.024, 0.0171, 0.0208, 0.0251, 0.0212, and 0.084.

Conclusion: The findings of the study indicate that, in spite of differences in the proportions of specialized physicians and active beds among the provinces with regard to their populations, the distributions in the government hospitals have been equitable. The results of this study can provide useful insights for the country's Health Ministry policy-makers.

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Background and Aim: Today cardiovascular diseases are the main cause of disability and mortality in many countries. This study was performed to determine the effect of health education based on the Health Belief Model on the knowledge, attitude and practice of housewives in Isfahan, Iran regarding improving their nutritional behavior for preventing heart disease.

Materials and Methods: This was a quasi-experimental intervention, including 68 Isfahani housewives randomly divided into an experimental (n=34) and a control (n=34) group. Data were collected using a standard health belief model (HBM) and a food-frequency (FFQ) questionnaire. The experimental group attended, after a pre-test, 6 weekly education sessions. The HBM questionnaire was completed 3 times (before and immediately, and 2 months, after education), while the FFQ questionnaire was completed twice (before and 2 months after education) by the housewives. The data were analyzed using SPSS16 software, the statistical tests being t-test, and repeated measure ANOVA.

Results: The two groups were not significantly different with regard to demographic variables. Similarly, before the intervention they were statistically similar with respect to the scores of the HBM components (P>0.05). After the intervention, significant differences appeared between the experimental and the control groups with regard to all the components (knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived efficacy, and performance in all cases, P<0.001)

Conclusion: Based on the findings, it can be concluded that the intervention had a positive impact on the feeding pattern of the women and was effective in increasing or improving their knowledge, attitude and practice.

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Background and Aim: Rabies, a viral and zoonotic disease, causes acute and fetal encephalitis in humans and other mammals and is a cause of death in developing countries. It is usually transmitted by animal bite, but other routes of transmission are mucus membranes, breathing, placenta, contaminated instruments, and organ implanting. This study shows the mapping of geographical distribution of animal bite cases, rabies, and death due rabies in 3 Caspian Sea littoral provinces, namely, Golestan, Mazandaran, and Gilan.

Materials and Methods: Data on human and animal rabies cases and animal bites were collected from the Reference Rabies Center of the Pasteur Institute in Tehran and the Rabies Diagnosis Section of the Amol Research Center during 2002-2007.The data was analyzed by the SPSS (11.5) software and mapping was done by Arc GIS 9.2.

Results: During the 6-year period, of the 670,743 animal bite cases reported in Iran 63890 (9.5%) had occurred in Golestan, 25,767 (3.8%) in Mazandaran, and 22,874 (3.4%) in Gilan. The distribution of animal bite cases in the 3 provinces was as follows: Agh ghala, Bandar Torkaman, Azad shahr and Kolaleh in Golestan Galugah, Behshahr, Ramsar and Neka in Mazandaran and Shaft, Masal, Siahkal and Fuman in Gilan. The data also showed that of the total 2,312 animal rabies cases, in Iran, 9.22% had been reported from Golestan, 4% from Mazandaran, and 2.6% from Gilan. Furthermore, animal rabies cases had occurred mostly in Gonbadekavoos, Bandar Torkaman, Gorgan and Kolaleh in the Golestan Province Behshahr, Neka and Chalus in the Mazandaran Province and Masal, Fuman and Rezvanshahr in the Gilan Province. The most important disease vector (91.3%) for both human and animal rabies was the dog. A total of 41 human deaths due to rabies had been reported during the period, 2 being from Mazandaran.

Conclusion: The results show that a more effective disease control and surveillance system is essential and can help improve planning for service provision in the health care centers.

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Background and Aim: Non-communicable diseases (NCD), also referred to as chronic or lifestyle-related diseases, are a serious health problem in most countries today. The World Health Organization (WHO) has discussed this issue and presented solutions for it in its annual meetings. This paper reviews and reports on the action taken by the Medical University of Isfahan (MUI) through its Non-communicable Disease Control Program based on the WHO "Prevention and control of non-communicable diseases: implementation of the global strategy", which is a comprehensive program for controlling non-communicable diseases.

Materials and Methods: In this descriptive-analytical study, the activities of 21 Non-communicable Disease Units in Isfahan Province affiliated to MUI in its Non-communicable Disease Surveillance System aiming at combating non-communicable diseases were assessed using a self-assessment technique and the relevant documents reviewed. All the NCD officers (n=30) were enrolled in the study. A validated researcher-designed questionnaire containing items related to six areas based on the WHO "Prevention and control of non communicable diseases: implementation of the global strategy", the reliability of which had been confirmed, was used. The data were analyzed using the SPSS software, the statistical tests being the t-test.

Results: The general self-assessment score of MUI in the activities related to non-communicable disease surveillance and control program was 1.44 0.59 (out of 4). From among the six strategies studied, the "increasing public awareness about non-communicable diseases" strategy and the "improving collaboration and participation in prevention and control of non-communicable diseases" strategy achieved the highest and the lowest score, respectively. Documentation was weak (less than 50%), and there was no significant difference between the scores of actions documented and those not documented (P = 0.1).

Conclusion: Isfahan Medical University is one of the leading universities in Iran. It has taken important valuable measures in the area of non-communicable disease control and surveillance programs. However, our findings show that there are several weaknesses in these programs. Not paying sufficient attention to documentation, for example, is a serious weakness, since documentation plays an important role in the performance and excellence of an organization, guaranteeing its success.

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Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.

Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.

Results: Pressure ulcer occurred more frequently in the elderly women patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.

Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.

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Background and Aim: Lead is a toxic metal used in different industries and occupational and environmental exposure to it is quite likely to occur. Because of its high potential toxicity, serious damages to those exposed to it are common. Since the ceramic industry, in which lead is used, is considered a domestic industry in Iran, in this study occupational exposure of glaze workers to lead was assessed in a ceramic industry.

Materials and Methods: A total of 55 glaze workers (39 tillers and 16 potters) were selected as the case group. Association of lead concentration with several variables, including work shift, work type, ventilation system, and the number of extra work hours during the previous month, was determined. A sampling pump (SKC Co.) and ester cellulose filters with a pore size of 0.8 µm, 37 mm in diameter, were used for sampling. The flow-rate was adjusted at 2 l/min based on the NIOSH 7300 method. After sampling, filters were transferred to the laboratory and digested in a mixture of nitric acid and per chlorate solution (4:1) and analyzed by ICP-AES. To minimize probable errors and pollution during sampling and sample handling, samples were also taken from employees in the administration department to serve as control. Spiro metric tests were performed on both the case and the control groups.

Results: The lead concentrations were higher than the threshold limit value (TLV) (0.17 mg/m). Independent t-test showed that there was a significant relation between concentration of the lead present in the breathing zone air and 2 independent variables, including shifts work (morning and afternoon) and the ventilation system among tillers. Also, based on the one-way ANOVA, there was a significant relation between concentration of the lead present in the breathing zone and the number of extra working hours over the shift.

Conclusion: The mean lead concentration in the breathing zone was higher than the respective TLV. Considering the hazardous nature of lead, protective measures─ personal, occupational and environmental─ should be taken. Moreover, clinical examination of job applicants at the time of employment, as well as periodic examinations and Spiro metric tests on the workers, are also strongly recommended.

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Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.

Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.

Results: Pressure ulcer occurred more frequently in the elderly women patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.

Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.

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Background and Aim: Many researchers have studied survival (time to death) of gastric cancer patients. Although gastric cancer diagnosed in early stages can be cured by surgery, chance of relapse still exists after operation. Hence, we should consider both events, that is, relapse of the disease and death, in order to be able to make a more precise estimation for survival of the patients. The purpose of this study was to use the competing risks method to estimate the cumulative incidence functions (CIF) of the relapse of disease and death and consequently to estimate the postoperative disease-free survival.
Materials and Methods: A total of 330 patients admitted to Iran Cancer Institute and operated between March 1995 and March 1999 were enrolled in the study. They were followed up for at least 5 years to estimate their 5-year disease-free survival. Information on their demographic, clinical, and therapeutic characteristics, as well as on the type and time of occurrence of the first event (relapse of disease or death) after surgery was collected from their medical records. The direct parametric method was applied to estimate CIFs of relapse of the disease and death, while to adjust the effects of some covariates the parametric regression model was used. Data analysis was done using the R software and a p-value <0.05 was considered statistically significant. The findings were compared with the results obtained on the basis of data analysis in which the competing events were not considered.
Results: The median follow-up time was 37.9 months. Of all the patients 13% experienced relapse and 60.9% death as the first event after surgery. The CIFs of relapse of disease and death 5 years after operation, with due consideration of covariates, were estimated at 11.0% and 68.6%, respectively. Age, stage of disease, and complementary treatment were statistically associated with the CIF of death, while only complementary treatment was related to the CIF of relapse. Older patients and those in more advanced stages of disease were more likely to die after operation. Moreover, while complementary treatment after operation decreased the CIF of relapse of disease, it increased the CIF of death. The disease-free survival of patients 5 years after surgery was 20.(consideringtheeffectsofsomecovariates).
Conclusion: The competing risks method is recommended for analyzing survival data because of its capability in considering different events and, therefore, making it possible to make more precise estimations. By using this method, considering smaller variance estimates for model parameters and also narrow confidence intervals for the cumulative incidence functions of competing events, it is expected to obtain more precise results. Unfortunately, the results have revealed that the disease-free survival of gastric cancer patients is low in Iran.

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Background and Aim: Presently not sufficient attention is paid to adolescent health promotion in many countries, because of the widespread belief that adolescents are generally healthy. The purpose of this study was to evaluate predictors of adolescent girls' quality of life using path analysis based on Pender's health promotion model.

Materials and Methods: The Pender's health promotion model served as the framework of this cross-sectional study, which included a total of 500 adolescent girls (grades 9-11) selected by stratified random sampling from 20 high schools for girls in 4 districts of Kashan province, Iran. Inclusion criteria were being in grades 9-11 and a written informed consent (from teachers, parents and the girls themselves). Data were collected through interviewing the girls, the interviewers being trained persons, using several standard questionnaires (for perceived self-efficacy, perceived affect, perceived barriers, perceived social support health promoting lifestyle, and health-related quality of life). Data analysis was done using SPSS18 and LISREL 8.8, the statistical test being path analysis.

Results: All constructs of the health promotion model and health promoting lifestyle were significantly related to adolescent girls' quality of life. Perceived self-efficacy (β=0.70, p<0/01) and perceived affect (β=0.21, p<0/01) had the highest correlation with the quality of life. The model and the health-promoting lifestyle as a mediator accounted for 73% and 39% of variance in adolescent girls' quality of life, respectively.

Conclusion: The findings of this study indicate that the health promotion model can be used to explain and predict the quality of life of adolescent girls. Thus, the Pender's health promotion model is recommended to health planners for promoting the quality of life in this population.

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Background and Aim: Today in most of the work environments, such as nuclear, military and chemical industries, human error may result in catastrophic events. A common characteristic of large technological systems is that massive amounts of potentially dangerous materials are kept in one single unit controlled by control room operators. A control room is indeed the heart of a system of this type and any error in task performance by the operators may have undesirable consequences which could never be compensated. In this study we aimed to identify and assess human errors in the control room of the Aromatic Unit of Bouali-Sina Petrochemical Company, Iran using the CREAM method.
Materials and Methods: This was a cross-sectional and analytical-descriptive study carried out in the control room of the Aromatic Unit of Bouali-Sina Petrochemical Company, Iran with 39 operators. After a job analysis by the hierarchical task analysis (HTA), probable control modes and cognitive failure probability were determined for occupational tasks using the basic and the extended CREAM methodologies.
Results: Based on the results of the basic CREAM method, control modes for the tasks of action, Boardman and shift control supervisor were determined as Opportunistic Control mode, while for the task of control room head it was obtained as Tactical control mode. With regard to the error types, the following results were obtained on the basis of the extended method of CREAM: execution failure (51.70%), interpretation failure (19.55%), planning failure (14.94%), and observation failure (13.81%).
Conclusion: The basic CREAM method showed the common performance factors (CPCs) leading to reduced performance reliability to be the number of simultaneous tasks, time of day (circadian rhythm), and adequacy and quality of training and experience. These factors caused the operators to choose an opportunistic control mode. In addition, based on the extended CREAM method results, the most noticeable cognitive failure was execution failure. In addition, the most important cognitive activities related to the control process in the control room were communication, execution, diagnosis, monitoring, and planning. Based on these findings, providing instructions and guidelines for work procedures, holding training courses, shift work scheduling, optimization of the communication systems and modifications in the control software are essential to minimize human errors in the Bouali Sina Petrochemical Company control room.

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Background and Aim: Cardiovascular diseases are the main cause of death in the world. Several factors such as lifestyle can alter incidence of these diseases. Cardiovascular diseases originate from childhood therefore, early prevention must begin from childhood and adolescence in order to be able to modify risk factors. The aim of this study was to identify modifiable (tobacco smoke exposure, physical inactivity, hypertension, obesity, incorrect dietary habits and high blood pressure) and non-modifiable (family history) cardiovascular risk factors in Hamedani adolescents.
Materials and Methods: This was a descriptive- analytic Cross- Sectional study, including 1000 students selected by stratified cluster sampling, from 8 high schools in Hamden, Iran. The subjects’ height, weight and blood pressure were measured and their body mass index (BMI) was calculated. A questionnaire was used to obtain information on life style.
Results: On the whole, 23% of the participants had a family history of hypertension and hyperlipidemia. The data also showed that 10.7% of the participants had a BMI more than 25kg/m², 59% had no physical activity, more than 50% had a high intake of salt, and 67% were exposed to passive tobacco smoke. The average length of time spent daily on watching T.V. or playing video games was 6 hours. Proportions of the subjects consuming saturated oils, high-fat dairy products, ready-to-eat foods, and junk foods (potato chips and puffed cereals) were 50.8%, 33.1%, 48.6%, and 75.4%, respectively. The most common method of cooking was frying (used by 35.9% of the families). Finally, 3.4% of the adolescents were smokers themselves and 25% of them said that their friends smoked, while 67.7% were exposed to cigarette smoke from their smoker-relatives.
Conclusion: Most of the Hamedani adolescents are at risk of cardiovascular diseases risk factors. Primary intervention programs should be designed and implemented aiming at promoting the health and nutritional awareness and, ultimately, practice, of the general population with particular emphasis on adolescents.

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Background and Aim: Thalassemia, a heterogeneous disease, is one of the most common single-gene diseases worldwide. The aim of this study was to find associations between hematological indices and severity of beta-globin gene mutations in beta-thalassemia carriers.
Materials and Methods: In this cross-sectional study, 30 beta-goblin gene mutations (b+ and b○) in 1206 unrelated beta-thalassemia carriers were investigated. In addition, their hematological indices, including CBC and electrophoresis results, were determined. The association between genetic findings and hematological parameters (mean corpuscular volume (MCV) and mean hematocrit corpuscular hematocrit (MCH)) were determined using the SPSS software, the statistical test being the t-test.
Results: The results indicated that b+-thalassemia carriers had higher MCV and MCH means than b○-thalassemia carriers. These findings would certainly have practical implications in public health.
Conclusion: The results show a significant correlation between two hematological indices and certain types of mutations in beta-thalassemia carriers.