Journal of School of Public Health and

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Background and Aim: Breastfeeding is one of the most important health determinants in infancy and childhood: physical growth and mother-child bonding in this period are two factors that program cognitive ability in later life. The main aim of this study was to examine the long-term effects of breastfeeding on subsequent cognitive performance. 

Material and Methods: A cohort of 5362 births registered over a period of one week in March, 1946 was selected by stratified sampling, based on the subjects' social class. We collected data for ages 2, 8, 11, 15, 26, and 46 years, and these data were analyzed in 2004-2005 at the school of public health, Tehran. Linear structural equation models were fitted to the data by LISREL 8.12 software in order to find path models.

Results: Descriptive findings showed that children weighing ≥3500 grams at birth acquired the ability to walk, talk, stand, and sit earlier than others. Also, subgroups within the cohort showed different patterns of change in their cognitive scores. Analysis of variance revealed that after adjustment for sex, social class, age of talking, and age of walking breastfed children still had higher means of verbal and nonverbal scores at ages 8 and 15 compared to never-breastfed children. Path analysis indicated that breastfeeding and birth weight could program later-life cognitive performance directly or indirectly through the ages of 2, 8, 11, 15, 26, and 43 years. For instance, path coefficients from breastfeeding to ages of talking and walking, to 8-15 verbal scores, to 26-year cognitive scores, and then to memory and visual scores at age 43 were estimated -for females and males, respectively- and form left o the right as follows: -0.12 (se=0.02), -0.05 (se=0.02), 0.71 (se=.05), 0.10 (se=0.04) for women    -0.01 (se=0.02), -0.07 (se=0.01), 0.75 (se=0.06), 0.13 (se=0.06) for men.

Conclusion: There are significant relationships between some early life determinants and later cognitive performance we conclude that in longitudinal studies of later life abilities, early-life nutrition and birth weight should be incorporated in the path analysis of aging.

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Background and Aim: Laboratory fume-hoods are the first-level protection for the laboratory staff against hazardous chemical pollutants. Considering the large numbers of personnel, especially in petrochemical industry laboratories, this project was carried out in order to assess the performance of laboratory hoods based on tracer gas (SF6).

Materials and Methods: In this project 22 hoods in the laboratories of a petrochemical industry were studied. Operation of the hoods was assessed based on quantitative (with SF6 as tracer gas) and qualitative (face velocity measurement, using thermal anemometer) tests, according to ASHRAE 110 stndard.

Results: In comparison with the minimum acceptable face velocity (80 fpm), the mean values of face velocities of only 9.09% of the hoods passed the test (P=0.001) and were at an acceptable level. As regards the tracer gas test, the results were even worse: only 4.5% of the hoods passed the acceptability test (p=0.001). In addition, non of the hoods having an acceptable face velocity passed the tracer gas test. Similarly, no hood with an accepatable tracer gas performance had an acceptable face velocity.

Conclusion: Since there is no consistency between face velocity and tracer gas tests, performance of laboratory hoods can necessarily be assessed on the basis of the tracer gas quantitative test. The face velocity test is a supplementary test, which, if used alone wil give false results.

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Background and Aim: Domestic violence against women is a serious public health problem and women adopt different solutions to fight against it. This study was carried out to determine the prevalence of intimate partner violence and views of women
on adopting ways to fight against it in Arak city, Iran, year 2008.

Methods and Materials: In a cross-sectional study in Arak city in 2008, a total of 1037 women were interviewed. The data collected were analysed statistically.

Results: Findings showed that the common types of abuse were emotional (64.6%), verbal (57.1%), financial (32.3%), and physical (26.8%). The women mentioned that the most efficient ways they chose to counteract the abuses were as follows: resuming talking after the settlement of quarrels (93%), keeping silent on the part of one of the partners (81%), and seeking advice from the older members of the family (81%). The considered going into a temporary sulk (51%) and reciprocation (46%) ineffective methods. Correlations were found between violence on the one hand and education, job, addiction of the spouse, income of the spouse, mental disorder of the partner, and number of children on the other hand (p<0.05).

Conclusion: Results of this study show that a large number of women are subjected to different types of violence. It seems that increasing awareness of married women and girls concerning effective counteractive methods can be an effective step in solving this social problem.

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Background and Aim: Monitoring and evaluation are basic components of any health program. Control charts show clearly the process performance trend longitudinally and help managers and staff to detect general and specific variations and evaluate the process performance correctly. This study was conducted to design and utilize control charts in the primary health care (PHC) system.

Materials and Methods: This study was conducted in two stages. In the first stage, the average weekly, monthly and seasonal delays in receiving health services were compared retrospectively. In the second stage, appropriate control charts were introduced with due consideration of the PHC system.

Results: More than 95% of the weekly average delays were below the upper control limit, while in 100% of the cases the monthly and seasonal averages were under the upper control limit.

Conclusion:  Desirable health outcomes result from appropriate services. It is necessary to monitor health processes coverage and performance with simple and specific indicators. With regard to the health process outputs in the PHC system, it is suggested that the R-X, np and C charts be used in monitoring processes.

The control charts help the service providers to determine and manage process performance by gathering simple, applicable data. Some of the advantages of using these charts are the possibility of longitudinal surveys, simplicity of the calculation methods, and their high applicability. 

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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: Improvement of national and provincial health indices requires intersectoral collaboration and community participation So, National High Health and Food Security Council and Provincial Health and Food Security Councils (PHFSC) have been implemented since 2006. The main responsibilities of PHFSCs are, assessment of province health situation and effects of executive organizations on it's improvement, to define and approve the province health strategic plan, developing of AIDS and HIV prevention and control plan and resolving intersectoral issues of health. The goal of this study is first 3 years performance assessment of the PHFSCs.
Materials and Methods: This is a descriptive evaluation study which included all the PHFSCs. The outcome assessment indicators were determined by content analysis of "the approved tasks" and also "the essential aspects for promoting of PHFSCs" by focus group discussions. Situational analysis was provided by two researcher made questionnaires one for co Assessment of the contents of content analysis of PHFSCs all meetings minutes (from establishment year to the end of 2008) and another for gathering viewpoints of Secretaries of PHFSCs.
Results: Data analysis shows that the meeting's agendas of the PHFSCs have less followed the prioritized major health issues of provinces and national burden of diseases most issues were in the domain of ​​communicable disease control and non-communicable diseases risk factors control included scarcely. Only in two Universities of Medical Sciences (UMSc) province comprehensive health plan were proposed. None of the UMSc approved a secretariat for PHFSC in its organizational top chart. PHFSCs secretaries believed that, the main obstacles of the PHFSCs' successes, are weak financial resources, and lack of decisions executive enforcements.
Conclusion: PHFSCs performances are moderate and moderate to low due to lack of comprehensive strategic plan and no implementation model for intersectoral decisions, other organizations believe on the effectiveness of the PHFSCs less and the main burden of disease of the provinces not mostly included in the agenda of PHFSCs. Following proposals are highly recommended for PHFSCs promotion: training and empowerment of UMSc and organizations for developing comprehensive health plan in the province and defining the responsibilities of each organizations for, determining policy priorities of common health issues of the provinces by High Health and Food Security Council and publicizing them by the Ministry of Health and the other relevant ministries and approving the structure and working system of the PHFSC secretariat in UMS by the Board of Trustees of UMS.

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  Background and Aim: Quality measurement and management has changed to be one of the most important topics in health care today. This study aims to analyze service quality through Importance-performance Analysis tool in selected hospitals.

  Materials and Methods : This is an Analytical-descriptive study. Research community was all admitted patients to four hospitals during a specific period, the sample of the study consists of 284 inpatient person selected by stratified random sampling method. The main instrument was a questionnaire consists of two parts "importance" and "performance" with the same items in 8 dimensions. Assigning the scores for each of those service items in a two-dimensional diagram with four cell, each gives special guideline for hospitals. SPSS 17.0 for windows was employed for the scale measurement.

  Results: The results of the study indicate that the most important dimensions in patients attribute with 3.55 mean were for "accountability" and the best performance in patients point of view was for "responsiveness" and "reliability". The key dissatisfier with least importance and performance score was for "service organization" with the mean of 3.11.

  In analyzing service quality, reliability, empathy, assurance and accountability dimensions were located in Cell I, service process was located in Cell II, service organization was located in Cell III and finally tangibles and responsiveness dimensions were located in Cell IV.

  Conclusion: Application of IPA to these data showed that developing service process management system in order to improve process of service delivering is important directions for hospitals to work on.

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  Background and Aim: One of the most important problems in intensive care unit is high nursing workload. High workload may lead to increased human errors, compromised quality and safety of care, and reducing quality of working life. The purpose of this study provides valid and reliable tools to assess the mental workload of the ICU nurses and also identify inducing factors that will create workload.

  Materials and Methods: This study had two phases. 1- Determine the face validity and reliability of the NASA-TLX (to assess the workload) by Backward Translation method and Cronbach's alpha method. 2–Designing the performance obstacles and facilitators questionnaire by interview and pilot study.

  Results: Face validity and reliability of NASA-TLX method was confirmed (α=0.897). The performance obstacles and facilitators questionnaire for ICU nurses provides in 53 questions and 10 subscales. Relevancy is 97% and Clarity is 96%. Overall, 90% of nurses assessment comprehensiveness of the questionnaire was very comprehensive and comprehensive.

  Conclusion : According to the results, can be used NASA-TLX method and the performance obstacles and facilitators questionnaire to assess workload of ICU nurses.

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Background and Aim: The Pars Energy-Economic Special Zone, as the energy capital of Iran, needs a healthy productive workforce. In order to be able to promote equitable health indicators of the Zone, it is essential to first obtain information about the situation of the health system in the region.

Material and Methods: This was a cross-sectional qualitative study. Data were collected using an essential public health services (EPHS) performance assessment questionnaire and a researcher-developed questionnaire for strengths, weaknesses, opportunities and threats (SWOT) analysis of the Zone health system. In the next phase, stakeholder analysis was done:  the major stakeholders were invited and asked, after explaining the methodology to them, to complete, individually, the EPHS performance assessment and the SWOT analysis questionnaires, followed by grouping and summarizing the results. Finally, content analysis of results of the group discussions was done and the main domainsا extracted.

Results: The EPHS overall average score was 37.8 (out of 100, the standard score). The greatest weakness was allocated to information functioning. Delivering public health services by the district health networks was the most important strength. Further analysis of the data showed that the far external environment in all the subdomains was the major threat to the public health in the zone.

Conclusion: Based on the findings, it can be said that the organizational status of the Zone is in a weak and threat position. One of the root causes is poor functioning of the public health system. It is essential that the Ministry of Petroleum and the Ministry of Health and Medical Education find effective ways for integrated leadership of the public health services in the Zone.                 

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Background and Aim: A New Health Reform Plan consisting of seven programs was initiated in Iran in mid-May 2015 aiming to reduce the out-of-pocket payments, improve the public’s health, and promote the public health indicators. This study was conducted to determine the effect of the Plan on the performance indicators of Hamedan university hospitals.

Materials and Methods: In this longitudinal descriptive-analytical study, based on the interrupted time series design, data related to hospital performance indicators were collected from all (15) Hamedan University hospitals for a period of 15 months (7 months before, and 7 months after, the implementation of the Plan, with a one-month interval in between). The SPSS software was used for data analysis.

Results: The data indicated changes in all the performance indicators after the implementation of the Plan. The largest changes were in the number of emergency and selective surgeries and the smallest in the ratio of active to total beds. Further analysis of the data showed that, as compared to the same months in the previous year, only a small number of these changes (number of emergency surgical operations and the ratio of active to total beds) were statistically significant.

Conclusion: Based on the findings it can be concluded that changes have occurred in all the selected indicators as a result of implementation of the New Reform Plan, indicating that the Plan has affected favorably performance of the hospitals. However, the effects observed should be judged cautiously, considering the possible negative consequences such as induced demand and hospital workload increase in the long run.

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Background and Aim: Human resources in any organization are its main capital. They are the only unique asset that are not liable to depreciation over time, but they even create more added value. The Social Security Organization (SCO) as a social insurer organization needs urgent assessment of its human resource management. In this regard, it appears that such an essential assessment can be done using the European Foundation for Quality Management (EFQM) model.

Materials and Methods: This project was an applied descriptive study conducted at the Social Security General Department in Tehran, Iran. The data collection tool was a standard questionnaire for performance assessment based on the EFQM model, the reliability of which (0.989) was determined by using the Cronbach's alpha coefficient. A total of 388 questionnaires were distributed, of which 311 were completed and returned to the researcher; the response rate was 81%. Analysis of the data was done using the SPSS-16 software.

Results: The human resource managers in the SCO achieved a score of 495.72. The empowerment and results dimensions rated 261.34 and 198.38, respectively. In the empowerment dimension, policy and strategy criteria had the highest score (56.12) and process the lowest (51.28), while in the results dimension, community criteria had the highest (50.27) and the customers criteria the lowest (51.18) score.

Conclusion: Based on the findings it can be concluded that the European Foundation for Quality Management (EFQM) model is suitable for assessing both the performance, strengths and weaknesses of the Tehran Security General Department human resources and improving its performance. Certainly better implementation of programs and achieving excellence will be possible through sustainable collaboration.

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Background and Aim: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. This study aimed to examine the relationship between accreditation and hospital performance. In addition, the most important accreditation constructs affecting hospital performance were identified and ranked.
Materials and Methods: This descriptive, correlational and cross-sectional study was conducted using the data related to accreditation scores and nine performance indicators of 121 hospitals in 2014 and 123 hospitals in 2015 in Tehran province, Iran. Shannon entropy method was used for calculating the weights of the hospital indicators. Then, Feature Selection method in data mining was used to explore the relationship between accreditation scores and hospital indicators. Data were analyzed using IBM SPSS Modeler software. Analyses were carried out at the 0.05 significance level
Results: The mean of hospitals’ accreditation scores were 61.98% and 69.56% in 2014 and 2015 respectively. All performance indicators except the number of outpatients were increased in 2015 compared to 2014. There was no significant difference in the scores between 2014 and 2015 data. Hospitals’ accreditation scores were not associated with their performances. However, accreditation scores of leadership and management; accident and emergency; and procurement departments had the most effect on hospitals’ performance.
Conclusion: Accreditation was not correlated with hospital performance. Thus, improving accreditation system including standards, methods and surveyors and using quality management strategies in hospitals are necessary for improving hospital’ performance.
 

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Background and Aim: All hospitals need to be monitored and continuously evaluated. Pabon Lasso graphical model assesses the efficiency of hospitals using a combination of their input data and performance indicators. The aim of this study was to determine the effects of Iran Health System Evolution Plan on Tehran University of Medical Sciences (TUMS) hospitals’ performance indicators using the Pabon Lasso model in 2016.
Materials and Methods: This was a descriptive-analytical and cross-sectional study including 8 general and specialized hospitals. The hospital input data and performance indicators were collected by permission of TUMS Vice-chancellor’s Office for Therapeutic Services. Chi-square and the two-sample T2 tests were used for data analysis, and hospital performance was assessed using the Pabon Lasso Model.
Results: The results showed that the number of TUMS hospitals located in zones 3 and 4 had increased after implementation of the Iran Health System Evolution Plan, which indicates improved efficiency of these hospitals, as confirmed by the chi-square test.
Conclusion: Based on the Pabon Lasso graphical model, it can be concluded that the performance indicators of the hospitals show improvements in performance after implementation of the Iran Health System Evolution Plan. The successful experience in the management of the hospitals in this study can act as a practical guide for managers of other hospitals throughout the country for better management. 

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Background and Aim: Accreditation is one of the important measures in the evaluation of health services. Today, the issue of accreditation has been established with the aim of creating and promoting a safety culture and quality of patient care. The purpose of this study was to determine the effect of accreditation on key and performance indicators of public hospitals in Zahedan before and after its implementation.
Materials and Methods: This descriptive-analytic cross-sectional study was conducted in 1396 in governmental hospitals of Zahedan University of Medical Sciences (Khatam-ol-Anbia and Ali ibn Abi Talib, AS). All of the key indicators of hospital performance were evaluated two years before the implementation of the accreditation (years 1391-1392) and two years after the implementation of the accreditation (1394-1395) in these hospitals. Data was collected using a form designed for study purposes. Descriptive statistics, tables and descriptive charts were used to draw information.
 Results: Based on the results of the study, the duration of stay of patients after the implementation of the accreditation scheme in hospitals has improved somewhat and decreased by 0.5 days to 4 days in 1395. The rate of cesarean delivery has risen from 49.2% in 1391 to 56.8 in 1395. The percentage of flat occupancy has risen to over 90 percent in 1395. The bed rotation distance was reduced by 31.1%, and releasing by personal desire in 1395 was 9% lower than in 1394. The personal satisfaction score of the emergency releasing by personal desire also dropped by 7%. It should be noted that there was no change in the net mortality index before and after the validation.
Conclusion: Accreditation has had a favorable impact on hospital performance indicators of course, the implementation of the healthcare reform plan may also have an impact on this. In general, the implementation of accreditation in the hospitals of the country can reduce the problems in this sector and provide more quality services to clients. Also, for better implementation of this program, emphasis on mortality and cesarean section rates can lead to improved hospital performance.

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Background and Aim: Human resources are of paramount importance in the success of any organization. In the health care system, nurses play a great role in the delivery of high-quality care. In this regard, in the process of providing high-quality and efficient healthcare delivery, justice perception of performance appraisal system and organizational citizenship behavior (JPPAS & OCB) are strong tools for performance management. The aim of this study was to determine the association between JPPAS & OCB among nurses in Tehran University of Medical Sciences hospitals in Tehran, Iran.
Materials and Methods: This was a cross-sectional study with a sample size of 346 nurses working in Tehran University of Medical Sciences hospitals. Data were collected using two questionnaires, namely, the JPPAS & OCB and a general demographic questionnaire. SPSS 24.0 for windows was used for statistical analysis of the data.
Results: Analysis of the data showed that justice perception of performance appraisal system (2.70) and organizational citizenship behavior (2.66) are at a moderate level. Based on the correlation analysis, a significant positive association was found between performance appraisal and organizational citizenship behavior. In the final analysis it was shown that performance appraisal could predict organizational citizenship behavior (30.9% of the variance).
Conclusion: Justice perception of performance appraisal system can positively influence loyalty, job satisfaction and employees’ commitment, as well as create organizational confidence, enhance productivity and improve participation.

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Background and Aim: Previous research has shown that many factors can affect sportspersons’ quality of life. Sleep deprivation is one of these factors. Based on laboratory evidence, a number of possible mechanisms for the relationship between sleep deprivation and quality of life of sportspersons have been suggested. The aim of this study was to investigate the effect of sleep deprivation on the quality of life of sport science students.
Materials and Methods: This was an experimental research study. The sample was 20 volunteer male sport science students selected by simple random sampling using a counterbalanced intra-group design. Data on the volunteer students were collected at two time points under controlled conditions in the university dormitory: 1. after twelve hours of fasting and eight hours of sufficient sleep, and 2. after twelve hours of fasting and thirty hours of full lack of sleep. The initial and final quality of life of the subjects were assessed and compared using the World Health Organization Quality of Life Questionnaire (WHOQOL_BREF). Changes in the dependent variable resulting from intervention were analyzed using the dependent t-test at p<0.05 with the SPSS software ver.22.
Results: Analysis of the data showed that 30 hours of sleep deprivation significantly reduced the quality of life scale, perception of physical health, mental health, social relationships, environmental health and the general health of the students (p=0.012).
Conclusion: According to the results of this study, it is concluded that 30 hours of sleep deprivation can bring about a significant change in the quality of life of active male sport science students. Athletes need more sleep than inactive people because of exercise needs that affect the quality and quantity of sleep. Therefore, coaches and athletes are advised to identify the factors that cause sleep deprivation and, based on this, try to prevent athletes from falling asleep during training and competitions, and consequently reduce the negative effect of sleep deprivation on sports performance.

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Background and Aim: Performance evaluation is a useful way to obtain information for decision-making and management of healthcare organizations. The purpose of this study was to assess the performance of health houses in rural areas in Kerman City, Iran during the outbreak of Covid-19.
Materials and Methods: This cross-sectional study was conducted in 2021-22 using descriptive and analytical methods. The research population included all the health houses in Kerman City (n=57), Iran. The tool for data collection was the Health House Performance Evaluation Checklist of the Ministry of Health and Medical Education developed to supervise the performance of health houses during the outbreak of Covid-19. Data analysis was done using SPSS 26 software, the statistical tests being descriptive statistics (mean and standard deviation) and analytical statistics including independent t-test, one-way analysis of variance and Pearson and Spearman correlations.
Results: The average performance score of the health houses (n =55) in managing Covid-19 was 96.37 out of 136. Installation of the village map on the wall of the health house  (92.3%), screening and following up the positive-test individuals and informing the health care team to track and isolate individuals in close contact (84.6%) were found to have the highest, and injecting the third dose (78.8%) and the second dose (75%) of the Covid vaccine the lowest,  scores. From among the characteristics investigated the variable of native Behvarzes (the personnel of health houses) had a statistically significant positive relationship with the performance score (p=0.01). In addition, the health houses with more than one Behvarz were found to perform better than those with only one Behvarz (p=0.05).
Conclusion: Assessing the performance of health care units at times of crisis, including communicable diseases epidemics, will make it possible to identify the bottlenecks that need improvement for better preparedness in the future. Based on the findings of this  research, the expansion of the coverage of the covid-19 vaccination, updating the disease incidence, the performance of health care teams at home visits, and the progress of the operational plan were the variables that needed improvement most.
 

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Background and Aim: The objective of this study was to gain a deep understanding of the importance (expected services) and performance (services provided) of mental health services to determine the priority indicators of mental health to help design higher quality and more effective community mental health interventions.
Materials and Methods: This was a mixed-method study including all the mental health executives and practitioners (n=998) in Iran. In the quantitative part, the Importance-Performance Analysis (IPA) model was used to determine the importance and performance of the current mental health programs in the primary health care (PHC) system, and in the qualitative part complementary explanations were analyzed using the thematic analysis method.
Results: The findings show that there were gaps between the expected services and the services provided in the mental health program. Thus, the following points should be taken into account to be able to improve the mental health services: 1. Strengthening the domestic violence prevention program as regards spouse misbehavior and misbehavior towards children; 2. Continuation of lifestyle skills and parenting programs, 3. Self-care in mental health and drug use programs; 4. psychiatric disorders diagnosis and care and a healthy adolescents program is desirable and necessary, but revising and modifying the suicide prevention program (as regards costs and treatment) are essential. 5. In addition, the psycho-social intervention programs in disasters, addiction harm reduction program, strengthening family foundation and the Competent Family Program are of low importance in formulating a strategy.
Conclusion: Corrective actions based on the prioritizations determined can be included in the working agenda of the managers of mental health care systems at the primary levels to improve the quality of mental health services.