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Background: Classifying COVID-19 hospitalized patients based on multimorbidity could aid in individual evaluation and provide effective triage for better treatment and management. The aim of this study was to extract multimorbidity patterns among hospitalized COVID-19 patients and determine their associations with admission to intensive care units (ICU) and mortality. Methods: The data in this retrospective study were acquired from the registry system for all 13,960 COVID-19 patients from 42 hospitals in Mazandaran Province in northern Iran between March 20, 2020, and July 20, 2021. The multimorbidity patterns of 11 chronic diseases were extracted using latent class analysis (LCA). The association between multimorbidity patterns and mortality from COVID-19 and admission to the ICU was examined using multilevel logistic regression modeling. Results: Four classes were identified, including diabetes and cardiovascular disease (class 1, 3.7%), metabolic diseases and others (class 2, 0.6 %), diabetes and hypertension (class 3, 23.0%), and non-multimorbidity (class 4, 72.7%). Membership in class 1 (diabetes and cardiovascular disease) and class 3 (diabetes and hypertension), compared with class 4 (non-multimorbidity), was associated with higher odds of experiencing death (OR=2.66 for class 1 and 1.21 for class 3). Class 2 did not show a significant difference from class 4 regarding mortality. Conclusion: Multimorbidity classification is a key predictor of COVID-19 patient prognosis, guiding treatment decisions and prioritizing protective measures, such as vaccination. Notably, those with multimorbidity patterns of “diabetes and cardiovascular diseases” and “diabetes and hypertension” exhibit the highest risk of ICU admission and mortality.

Background: The COVID-19 pandemic created a sense of unsafety and uncertainty in various industries and occupations. The aim of this study was to explore the experiences of the employees of Golgohar Mining and Industrial Co. during the COVID-19 epidemic. Methods: This qualitative content analysis study was conducted on 20 employees of the Golgohar Mining & Industrial Co. in Sirjan, Iran, recruited through purposeful sampling from March 2021 to January 2022. After gaining informed consent, semi-structured interviews were conducted and continued until data saturation was achieved. The interviews lasted for 35-50 minutes and were recorded and transcribed. Data were analyzed by MAXQDA software, version 2020. Results: Three categories emerged from the qualitative data analysis: “Challenging work environment,” “unsafe workplace,” and “crisis management.” These categories formed the main theme, “encountering a crisis,” which refers to the very difficult situation that the workers experienced with the emergence of COVID-19. Conclusion: The workers did not fully comprehend the seriousness of the pandemic and lacked sufficient information about the disease, which contributed to the spread of infection. Teaching problem-solving strategies and behavior control, combined with training on disease prevention, can be effective in crisis management.

Abstract This study aimed to examine the impacts of single and multiple air pollutants (AP) on the severity of breast cancer (BC). Data of 1148 diagnosed BC cases (2008–2016) were obtained from the Cancer Research Center and private oncologist offices in Tehran, Iran. Ambient PM10, SO2, NO, NO2, NOX, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene, and BTEX data were obtained from previously developed land use regression models. Associations between pollutants and stage of BC were assessed by multinomial logistic regression models. An increase of 10 μg/m3 in ethylbenzene, o-xylene, m-xylene, and 10 ppb of NO corresponded to 10.41 (95% CI 1.32–82.41), 4.07 (1.46–11.33), 2.89 (1.08–7.73) and 1.08 (1.00–1.15) increase in the odds of stage I versus non-invasive BC, respectively. Benzene (OR, odds ratio = 1.16, 95% CI 1.01–1.33) and o-xylene (OR = 1.18, 1.02–1.38) were associated with increased odds of incidence of BC stages III & IV versus non-invasive stages. BC stage I and stage III&IV in women living in low SES areas was associated with significantly higher levels of benzene, ethylbenzene, o-xylene, and m-xylene. The highest multiple-air-pollutants quartile was associated with a higher odds of stage I BC (OR = 3.16) in patients under 50 years old. This study provides evidence that exposure to AP is associated with increased BC stage at diagnosis, especially under premenopause age.

Background: The large-scale spread of COVID-19 affected communities with many deaths worldwide causing significant concerns. Due to being on the front line of fighting against this disease, a great number of healthcare providers lost their lives. Accordingly, this study aimed to explore the changes in nurses’ behavior and practice while taking care of COVID-19 patients.Methods: The present study was conducted using a qualitative conventional content analysis approach in 2020-2021. The participants were 14 nurses taking care of COVID-19 patients in the infectious diseases wards of a teaching hospital affiliated with Kerman University of Medical Sciences. The data were collected through interviews with the nurses, and data collection continued until data saturation. The collected data were analyzed based on the steps proposed by Graneheim and Lundman. After recording and transcribing the interviews, the participants’ statements were categorized into semantic units. Data analysis was performed using MAXQDA-10 software.Results: The majority of nurses reported significant behavioral changes that were categorized into five main themes including intensification of protective measures and increase in concentration, emergence of mental and psychological symptoms, increase in the sense of responsibility towards the family, recourse to prayer and religious rituals, and increased empathy with patients.Conclusion: The most important behavioral changes of nurses as a result of the COVID-19 crisis were the intensification of personal protective measures, the emergence of mental and emotional symptoms, the increase in the sense of responsibility towards the family, resorting to prayer and religious rituals, and increased empathy with patients. Providing material and spiritual incentives as well as support to personnel to increase their motivation and work productivity should be taken into consideration by officials during epidemics. Moreover, actions such as providing free psychological counseling are suggested to calm the personnel.

Abstract Background The daily increase of infected individuals and mortalities related to COVID-19 in Iran increased public fear and anxiety and affected the job performance of many health workers, including the Iranian Red Crescent Society, as one of the organizations responding to COVID-19. Methods This study aimed to explore the experiences of Red Crescent rescuers, using a qualitative method with an interpretative phenomenological analysis (IPA), and by conducting semi-structured and in-depth interviews with Red Crescent relief workers from Mashhad in September 2020. Participants were selected by purposive sampling. Results Rescuers in the Red Crescent Society, had gained different experiences during the COVID-19 pandemic. The experiences were categorized into four main themes. These main themes were: (1) Psychological disorders, (2) Organizational support (3) Mis-management (both structural and human factors), and (4) Opportunities. Conclusion The COVID-19 epidemic did create unique opportunities to understand the pitfalls of the Red Crescent aid services. Red Crescent rescue workers suffered from psychological symptoms, and mismanagement was also present. Psychological support and organizational improvements should be implemented.

BACKGROUND: Animal bites are a major threat to human health. The present study was designed to determine the incidence and epidemiological factors and to investigate the process of referral and treatment of animal bite cases in Kerman city. MATERIALS AND METHODS: This was a cross-sectional (descriptive-analytical) study. All the cases of animal bites that were referred to rabies treatment and prevention centers under the coverage of Kerman health center during 2019 and 2021 were investigated. The data were collected from the health center of Kerman city in Excel form that was registered in the portal of the Ministry of Health. The Chi-square test and Fisher’s exact test were used in SPSS24 software to analyze the data. RESULTS: In this study, 5407 people (4076 men and 1331 women) were bitten by animals. The average incidence of animal bites was 313 per hundred thousand people. The mean ± SD age of the injured was 31.38 ± 17.72 years. 73.2% of cases of attacking animals were dogs, and half of those dogs had owners. 58.6% of cases were injured in the hand, and 94.2% referred to rabies treatment and prevention centers in the first 48 h after the bite. No cases of animal-bitten deaths were reported during this period. Between gender (P = 0.006), age (P = 0.013), place of residence (P = 0.003), occupation (P < 0.000), history of previous bites and vaccinations (P = 0.001), and injured limb (P < 0.000) and not going to receive the next round of vaccinations, there was a statistically significant correlation. CONCLUSION: Animal bites are a major health problem in Kerman, and due to creating health problems and economic losses, it is necessary to take serious action to control and prevent this health threat.

Abstract Objective Sunlight and vitamin D intake are considered as essential elements for human health. Insufficient intake of this vitamin is one of the causes of various cancers and some other diseases. The aim of this study was to investigate the relation between bladder, prostate, cervical and ovarian cancers with solar ultraviolet exposure in Iran. In this ecological study, data from 30 provinces were studied and analyzed by correlation and linear regression tests in SPSS software version 22. Physical activity, gender, human development index, lung cancer and altitude were adjusted at population level. Results The incidence of bladder cancer in both sexes was inversely related to ultraviolet radiation, but it was significant only in men. Unlike bladder cancer, the incidence of cervical cancer showed a positive relation with ultraviolet radiation. No relation was found between the incidence of prostate and ovarian cancers with ultraviolet radiation. Among the adjusting variables, the incidence of lung cancer (surrogate for smoking) in women had the highest coefficient in the linear regression model.

Some studies suggest that exposure to cement dust can cause oxidative stress, and have adverse effects on liver function, and hematological and psychological parameters. This study aimed to assess the effect of antioxidant vitamin supplementation on indices of oxidative stress, biochemical indicators, and psychological factors among cement plant workers. A total of 80 subjects (workers and non-exposed office employees) were divided into two groups. The intervention group that took vitamin E (400 IU)+ C (500 mg) and the control group that took placebo, for 60 days. The levels of malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD) and catalase (CAT) were measured in plasma, and hematological parameters were also recorded before and after the intervention. A significant decrease in the mean level of MDA, SOD and CAT, alkaline phosphatase (ALP), alanine transaminase (ALT) and aspartate transaminase (AST) were detected. On the other hand, a significant increase in the level of TAC was observed in the workers, after the intervention. Depression and anxiety also decreased significantly after the intervention. Vitamin E and C were probably effective in reducing oxidative stress and improving mental health and liver function especially among the workers.

Introduction: Neuropathy is a condition in which the Peripheral Nervous System (PNS) is disordered. Studying the effects of antioxidants on the performance improvement of this system is vital. This study aimed to investigate the effects of date extract on Nerve Conduction Velocity (NCV), Distal Motor Latency (DML), and wave height of the sciatic nerve in male rats. Methods: This laboratory study used 24 male Wistar rats weighing 250-300 g, divided into the test and control groups. The test group received 10% date extract daily, at 4 mL /kg of body weight, for three weeks. In the beginning, nerve Conduction Velocity (NCV), Distal Motor Latency (DML), and wave height of the sciatic nerve were examined in all animals and re-examined for NCV three weeks later. P-values lower than 0.05 were considered significant. Results: Sciatic NCV and wave height were significantly increased; however, compared to the control group, DML of the knee significantly declined in the test group. Conclusion: The compositions of date extract accelerate electrical signal transmission.

Background and aims: The novel coronavirus (COVID-19) epidemic has far been the biggest global health threat of the 21st century. Protective measures are still one of the most effective methods for controlling COVID-19. Practicing hygiene and control measures are largely influenced by knowledge and attitude towards COVID-19. This study aimed to investigate the knowledge, attitude, and practice of Iranians towards COVID-19 as well as the demographic factors related to it in April and May, 2020.Methods: The study population in this cross-sectional, descriptive-analytical, and web-based study included 3736 Iranian individuals who were collected via convenience sampling method. A validated Iranian knowledge, attitude, and practices (KAP) Questionnaire about COVID-19 was used for collecting the required data. Ordinal multivariate generalized estimating equations (GEEs) were applied to analyze data.Results: The majority of participants (88.1%) had considerable knowledge, the right attitude (91%), and good practices (90.3%). In the multivariate models, factors related to greater knowledge were age > 20 years (P < 0.001), living in the urban area (P = 0.030), holding a master’s or doctoral degree (P = 0.044), and a moderate financial status (P = 0.001). Females displayed mor positive attitude (P = 0.035). Variables related to more favorable practices were age > 20 years (P < 0.001), and having a good (P = 0.003) or moderate (P = 0.038) financial status.Conclusion: It was concluded that the participants had good knowledge and a positive attitude, as well as adopted sound practices regarding COVID-19. However, this conclusion might not have been generalizable to entire Iranian community; therefore, it was recommended that preventive measures against COVID-19 should receive continued monitoring and emphasis.

Plain Language Summary Scientists have found that climate change has adverse effects on human health. Because pregnant women are one of the most vulnerable groups, these negative impacts may affect their fetuses, which make up the next generation. In this study, we examined the effect of temperature on some pregnancy outcomes, including low birth weight, preterm labor, spontaneous abortion, preeclampsia and gestational hypertension in Ahvaz city, which is one of the hottest cities in the world. One way to assess temperature impact on humans is by using temperature indicators. In this study we used the Universal Thermal Climate Index (UTCI) for this purpose. The data at different time intervals were collected and evaluated with specific models. Our results showed that low values of UTCI, which is equivalent to cold weather, significantly increase the risk of preterm labor. But, high levels of UTCI, which means hot weather, significantly increase the risk of stillbirth. In conclusion; both hot and cold weather can be associated with adverse pregnancy outcomes in Ahvaz city. Therefore, pregnant women should protect themselves from exposure to hot and cold weather.

Background and aims: Knowledge, attitude, and practice (KAP) toward coronavirus disease 2019 (COVID-19) are important factors for adherence to protection strategies. The aim of this study was to construct and validate a questionnaire about the KAP of Iranians regarding COVID-19. Methods: Initially, a questionnaire about the KAP with regard to COVID-19 was constructed in this cross-sectional study. The initial questionnaire was prepared based on a review of the extensive research literature and global and national guidelines. This researcher-made questionnaire was developed using the COVID-19-KAP questionnaire, which was originally used in China in 2020, and the influenza epidemic KAP Questionnaire (2015), the MERS KAP Questionnaire (2015), the H1N1 flu KAP questionnaire (2017), and the WHO KAP questionnaire about COVID-19. The applied questionnaire consists of three parts including knowledge- (n = 26), attitude- (n = 8), and practice-related (n = 11) questions, respectively. Then, the face, content, and construct validity and the reliability of the questionnaire was determined, and analyzes were performed using SPSS v. 26 and AMOS v. 24 software. Results: In the face validity stage, 2 questions with an impact score of less than 1.5 were excluded from the questionnaire. In the content validity check, all questions had a content validity index (I-CVI) of more than 0.7. However, the content validity ratio (CVR) for 6 questions was less than 0.51, and these questions were removed accordingly. The compliance of the CVI with the chance agreement was close to one for all questions, indicating the lack of a chance agreement. In the exploratory factor analysis stage, the Kaiser-Meyer-Olkin (KMO) value of 0.90 was obtained, implying the adequacy of the sample size for factor analysis. The significance of the Bartlett test (chi-square: 5820.06, df: 630, P

BackgroundEarthquakes cause many casualties worldwide. Taking preventive measures and improving community preparedness is critical to reducing earthquake damage. The social cognitive theory explains how individual and environmental factors cause behavior. This review was conducted to identify the social cognitive theory structures, in research on the preparedness of households against earthquakes.Materials and methodsThis systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted from January 1, 2000, to October 30, 2021 in Web of Science, Scopus, PubMed, and Google Scholar. Studies were selected based on inclusion and exclusion criteria. The initial search yielded 9,225 articles, and finally, 18 articles were selected. Articles were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.ResultsEighteen articles about disaster preparedness behaviors based on the socio-cognitive constructs were identified and reviewed. The essential constructs used in the reviewed studies included self-efficacy, collective efficacy, knowledge, outcome expectations, social support, and normative beliefs.ConclusionBy identifying the dominant structures that have been used in studies related to the preparedness of households against earthquakes, researchers can implement appropriate and more cost-effective interventions by focusing on improving suitable structures.

Abstract Aim This study aimed to investigate the effect of circadian rhythm stability and amplitude on musculoskeletal disorder prevalence and work–family conflict among nurses. Design This cross‐sectional study was conducted on 386 nurses working in three hospitals, in Shahroud, Iran. Method The data were collected using the Circadian Rhythm Inventory, Nordic Musculoskeletal Disorders, and Carlson Work‐Family Conflict questionnaires. Results The highest prevalence of musculoskeletal disorders was reported in the lower back (68.4%), upper back (65.5%) and shoulders (53.6%), respectively. No significant relation was found between circadian rhythm stability and amplitude, and musculoskeletal disorders prevalence. The nurses who could not overcome drowsiness reported more Work Interference with Family (WIF), Family Interference with Work (FIW) (time‐based) and FIW (strain‐based) compared to the nurses who overcame drowsiness. In addition, the appropriate nurses for shift work experienced less WIF, FIW (behavioural‐based) and WIF (strain‐based) compared to the nurses who could not work overtime or at night.

IntroductionEarthquakes cause a lot of damage and casualties. For various reasons, most households are not prepared for earthquakes. This study aims to identify the challenges and barriers to households' preparedness against earthquakes from the viewpoint of Kerman residents.MethodsThis qualitative-directed content analysis study was conducted from December 2021 to May 2022 in the city of Kerman in southeast Iran. Data was collected by purposive sampling through in-depth and semi-structured individual face-to-face interviews with 48 households.ResultsAfter multiple rounds of analyzing and summarizing the data based on the social-cognitive theory and taking into consideration similarities and differences, five main categories and 19 subcategories created based on the results of data analysis and including (1) Challenges related to cognitive factors (2) Challenges related to behavioral factors (3) Challenges related to the physical environment (4) Challenges related to the social environment and (5) Challenges related to financial factors.ConclusionAlthough the participants listed many challenges and barriers in different fields, in order to overcome the barriers and challenges of preparing households for an earthquake, the support of the authorities and the cooperation of the residents are necessary.

Background: Human papillomavirus virus (HPV) plays an important role in some human malignancies, including head and neck squamous cell carcinoma (SCC). However, it is necessary to evaluate the role of carcinogenic agents in local settings as well. Therefore, this study aimed to evaluate the frequency of HPV genotypes in head and neck epithelial cancers.Methods: In this case-control study, 202 patients with suspected carcinoma referred to Shafa Hospital (Kerman, Iran, 2017) for pathological evaluation were enrolled. A definitive diagnosis of carcinoma was reported for 101 patients (case group) and in the other 101 subjects, carcinoma was not diagnosed. In order to determine the presence and type of HPV in tissue samples, the PCR method was used. Data analysis was performed using Fisher’s exact test, independent t-test, and logistic regression. Results: In total, 27 head and neck SCC samples (26.7%) were positive for HPV DNA. In addition, the virus species were HPV-11 in 15 cases (14.9%), HPV-16 and HPV-18 in 12 cases (11.9%), and HPV-6 in 10 cases (9.9%). According to the results, the presence of HPV was significantly higher in patients with SCC (P < 0.001). Moreover, smoking (P = 0.03) and opioid use (P < 0.001) were also significantly associated with SCC.Conclusion: The results of the present study demonstrated the presence of HPV in tissue samples of head and neck SCC patients in Kerman, Iran. Further studies are needed to investigate the preventive role of HPV vaccination in head and neck SCC.

Abstract Background There are few epidemiological studies on the relation between temperature changes and adverse pregnancy outcomes. The purpose of this study was to determine the relation between Physiological Equivalent Temperature (PET) with adverse pregnancy outcomes including stillbirth, low birth weight (LBW), preterm labor (PTL), spontaneous abortion (SA), preeclampsia and hypertension in Ahvaz, Iran. Methods Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on adverse pregnancy outcomes. In this study the effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted. Results High PET (45.4 C°, lag = 0) caused a significant increase in risk of stillbirth. Also, high levels of PET (45.4, 43.6, 42.5 C°, lag = 0–6) and low levels of PET (9.9, 16.9 C°, lags = 0, 0–13, 0–21) significantly increased the risk of LBW. But, low levels of PET (6.4, 9.9, 16.9 C°, lags = 0–6, 0–13) reduced the risk of gestational hypertension. Conclusion The results of this study showed that hot and cold thermal stress may be associated with increased risk of stillbirth, and LBW in Ahvaz.

Background: Phenylketonuria (PKU) is a genetic autosomal recessive disorder, which, if not treated on time, can lead to mental retardation and severe developmental delay. The aim of this study was to assess the PKU neonatal screening program in Kerman County, Iran. Methods: This was a health system research study carried out on all newborns screened for PKU from 2012 to 2018 in Kerman. Data were extracted from the Comprehensive Social Genetics Program forms, genetic records, and the national form for investigation of genetic disease incidence. Results: Totally, 121,533 newborns were screened. 108,972 (89.7%) were Iranian, and 12,561 (10.3%) were non-Iranian. Screening coverage in the Iranian population was 92.1%. 80.9% of Iranian and 62.8% of non-Iranian newborns were screened from 3 to 5 days of age. Timely screening of newborns in the Iranian and non-Iranian populations in 2012 was 70.0% and 46.9%, and in 2018, it was 90.2% and 75.1%, respectively. The first visit at the PKU treatment center in 30.7% of Iranian and 33.3% of non-Iranian neonates was before 14 days of age. In the Iranian population residing in Kerman, the incidence rate of PKU was estimated to be 1.35 per 10,000 live births. 62.5% of parents of Iranian and 100% of parents of non-Iranian PKU patients were relatives. Conclusion: PKU screening coverage in Kerman is relatively acceptable, and most newborns were screened on time. Timely screening of newborns in both populations has increased since the beginning of the program until the time of this study. Interventions are required to improve early diagnosis and start treatment during the first 2 weeks of life. The incidence of PKU in Kerman County is approximately equal to the national average. Due to the fact that most parents of PKU patients are relatives, increasing awareness to prevent consanguineous marriages can be effective in decreasing the incidence of this disease.

Abstract Lung cancer is the most rapidly increasing malignancy worldwide with an estimated 2.1 million cancer cases in the latest, 2018 World Health Organization (WHO) report. The objective of this study was to investigate the association of air pollution and lung cancer, in Tehran, Iran. Residential area information of the latest registered lung cancer cases that were diagnosed between 2014 and 2016 (N = 1,850) were inquired from the population-based cancer registry of Tehran. Long-term average exposure to PM10, SO2, NO, NO2, NOX, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene (BTEX), and BTEX in 22 districts of Tehran were estimated using land use regression models. Latent profile analysis (LPA) was used to generate multi-pollutant exposure profiles. Negative binomial regression analysis was used to examine the association between air pollutants and lung cancer incidence. The districts with higher concentrations for all pollutants were mostly in downtown and around the railway station. Districts with a higher concentration for NOx (IRR = 1.05, for each 10 unit increase in air pollutant), benzene (IRR = 3.86), toluene (IRR = 1.50), ethylbenzene (IRR = 5.16), p-xylene (IRR = 9.41), o-xylene (IRR = 7.93), m-xylene (IRR = 2.63) and TBTEX (IRR = 1.21) were significantly associated with higher lung cancer incidence. Districts with a higher multiple air-pollution profile were also associated with more lung cancer incidence (IRR = 1.01). Our study shows a positive association between air pollution and lung cancer incidence. This association was stronger for, respectively, p-xylene, o-xylene, ethylbenzene, benzene, m-xylene and toluene.

Abstract Background The Crimean-Congo Hemorrhagic fever (CCHF) is endemic in Iran and has a high fatality rate. The aim of this study was to investigate the association between CCHF incidence and meteorological variables in Zahedan district, which has a high incidence of this disease. Methods Data about meteorological variables and CCHF incidence was inquired from 2010 to 2017 for Zahedan district. The analysis was performed using univariate and multivariate Seasonal Autoregressive Integrated Moving Average (SARIMA) models and Generalized Additive Models (GAM) using R software. AIC, BIC and residual tests were used to test the goodness of fit of SARIMA models, and R2 was used to select the best model in GAM/GAMM. Results During the years under study, 190 confirmed cases of CCHF were identified in Zahedan district. The fatality rate of the disease was 8.42%. The disease trend followed a seasonal pattern. The results of multivariate SARIMA showed the (0,1,1) (0,1,1)12 model with maximum monthly temperature lagged 5 months, forecasted the disease better than other models. In the GAM, monthly average temperature lagged 5 months, and the monthly minimum of relative humidity and total monthly rainfall without lag, had a nonlinear relation with the incidence of CCHF. Conclusions Meteorological variables can affect CCHF occurrence.

Introduction: Attention deficit hyperactivity disorder (ADHD) has the highest prevalence among psychiatric disorders in children. The present study investigated the effect of adenotonsillectomy on the symptoms of ADHD in a 6-month follow-up. Materials and Methods: This cross-sectional study was performed on 100 patients referred for respiratory problems during sleep due to adenotonsillar hypertrophy (ATH). The patients’ parents were asked to complete the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition checklist as a standard benchmark for ADHD before, 2 weeks, and 6 months after the surgery. The data were analyzed by SPSS software (version 20) through paired t-tests and McNemar’s test. Results: The age averages of male and female children were 7.15 and 8.4 years, respectively. The frequency of ADHD in the studied population was 30%, which is much higher than the prevalence of this disorder in the normal population. In the second week after the surgery, the mean score of ADHD decreased from 4.97±2.97 (attention deficit [AD]) and 6.77±1.61 (hyperactivity disorder [HD]) before the surgery to 3.86±2.25 (AD) and 4.28±2.02 (HD) 2 weeks after the surgery (P=0.001). After a 6-month follow-up, these figures further decreased (AD=2.34±2.32; HD=1.97±2.44; P

Background and aims: COVID-19 is one of the most dangerous pandemics of the 21st century, which has caused disease in humans and has had various consequences for humans. One of the most at-risk groups are bank employees. Therefore, this study was conducted to investigate the predictors of protective behaviors against COVID-19 in bank employees of Sirjan. Methods: This descriptive-analytical cross-sectional study was conducted in 2020 in Sirjan. The participants in this study were 280 bank employees who were selected randomly. The data collection tool was a questionnaire in three sections, including demographic information, knowledge, and questions related to the Protection Motivation Theory, which was self administered. After collecting the data, descriptive tests (frequency and percentage), Pearson correlation and linear regression were used to analyze the data in SPSS 23. Results: The mean age of participants was 41.6±2.16 years. The results of correlation coefficients showed that there was a significant correlation between perceived susceptibilityand perceived severity. However, it should be noted that there were positive correlations between protection motivation with perceived susceptibility (r = .414, P

Abstract Background In recent years, lung cancer (LC) incidence has increased in Iran. The use of opium and its derivatives (O&D) has increased as well. This study aimed to investigate the association between the use of O&D and LC incidence. Methods In this case-control study conducted in Kerman, Iran; 140 patients with lung cancer and 280 healthy controls matched by age, sex, and place of residence were included. Data, including O&D use, cigarette smoking, alcohol use, and diet, were collected using a structured questionnaire. The relation between the use of O&D and LC was evaluated using conditional logistic regression adjusted for tobacco smoking, education, daily intake of fruit, vegetables, red meat, and hydrogenated fats. Results Opium ever-use was associated with an increased risk of LC (Adjusted Odds Ratio (AOR) =5.95, 95% CI: 1.87–18.92). Participants were divided into low and high use groups based on the median of opium use in the control group. A significant dose-response relation was observed between the amount of daily O&D use and LC; and the relation was stronger in high users (AOR low users = 3.81% CI: 1.13–12.77 and OR high users = 9.36, 95% CI: 2.05–42.72). Also, LC was higher among participants starting the use of O&D at younger ages (≤ 41 years old vs never users AOR = 8.64, 95% CI: 1.90–39.18) compared to those who started at an older age (> 41 years old vs never users, AOR = 4.71, 95% CI: 1.38–16.08). The association between opium, and lung cancer among non-smokers was OR: 6.50 (95% CI: 2.89 to 14.64). Conclusion The results of this study show that opium use is probably a dose related risk factor for lung cancer.

Background and Aims: Shift work can lead to adverse health effects including gastrointestinal and cardiovascular disorders. The recent study aimed to compare the prevalence of gastrointestinal disorders among day work nurses, shift work nurses and office employees of Kerman University of Medical Sciences, Kerman, Iran. Methods: This was a cross-sectional study conducted in 2011. In this study, 159 nurses working at hospitals affiliated to Kerman University of Medical Sciences and 167 office employees of the same university participated. Data was obtained using a researcher-made questionnaire and was analyzed by SPSS 18., Chi-square test and ANOVA was used for analysis. Results: Results showed anorexia (P=0.0001), dyspepsia (P=0.002), nausea (P=0.001), hiccups (P=0.003) and heath burn (P=0.002) were more prevalent among shift workers than day workers. The results also showed that the prevalence of anorexia (P=0.02), gastric ulcers (P=0.04) and heartburn (P= 0.02) was more prevalent among nurses with irregular shift work than those with regular shiftwork. Among the demographic characteristics, gender was related to the nausea (P=0.004), and nausea was more prevalent in women (4.3, 95% CI: 1.7-6.3). Also, increased age was related to heartburn (P= 0.02) Conclusion: Gastrointestinal disorders are more common in shift workers. Nurses with more ability to cope with these adverse effects should be chosen for shift work. More ways to reduce the negative health effects of shift work should be investigated.

Abstract Background and aims: Noise is an important source of physical and psychological stress that is considered as the most important physical detrimental factor in developed and developing countries. In the United States, more than 30 million workers are exposed to dangerous noise, and 7.4 to 10.2 million industrial workers are at risk of hearing loss due to exposure to industry noise, but what is certain is that the noisy environment causes carelessness in activities. The brain becomes inconsistent in intellectual work and so on. Noise is an environmental stressors and in combination with other stressors can cause or exacerbate mental disorders and even under certain conditions can affect performance to the extent that WHO considers accidents as one of the indicators of performance decline. Recognizes noise-induced and recognizes ambient noise as a direct cause of mental disorders.Noise is the most common occupational hazard in various industries, especially petrochemicals and related companies. Noise exposure causes a wide range of the discomforts, disorders and occupational diseases and effects including focus loss, long-term memory loss, anger, increasing stress and etc. Cognitive performance such as consistent attention, comprehension, speed of reaction as well as correct information processing and correct decision making play a key role in performing many tasks .In some occupations, in order to react appropriately and in a timely manner, the person needs to process the information completely and without defects. Therefore, even temporary defects in cognitive and mental performance can lead to serious consequences in individuals, especially when an accurate and immediate response is needed. The results of various studies conducted in the oil and gas industry and related companies indicate that sometimes noise contact is outside the permissible range (85 dBA) .Basically, in the oil and petrochemical industries, a lot of noise is produced, which can be said that the main noise produced is related to the movement of fluids and related piping on the one hand, and on the other hand, the era of engines and compressors in refining operations. It is essential to maintain human health and safety of the work system at the highest possible level, and any error on the part of operators can lead to unintended and harmful consequences or accidents, or reduce the quantity and quality of products and irreparable economic losses and considering that the accuracy, speed of action and ability to perform skills by individuals; are the most important factors affecting the efficiency and increasing the productivity of human resources in improving the level of production and its quality, so evaluate the effects of different sound pressure level cognitive performance has been performed on petrochemical industry workers. Methods: This descriptive-analytical cross-sectional study was conducted in 1398 in Kavian Petrochemical Company located in South Pars region (Assaluyeh). In this study, before collecting information, the purpose of the study was explained to the participants. Demographic data collected included: age, work experience, body mass index and metabolism. Exclusion criteria included: less than one year of work experience, use of hypnotic and caffeinated substances, having any mental disorders, sleep disorders, major systemic diseases, etc. Subjects were divided into three groups (one control group and two case groups). There were 30 people in each group. In the study of the effects of sound pressure levels below the allowable limit, control room operators were selected and participants in 2 case groups were selected from site operators who were exposed to more than the allowable noise level. Metabolism of participants in three groups was determined according to ISO 8996 standard. Participants in the study had a work schedule of one week working day and one week working night. In this study, day workers who were active from 7 am to 7 pm were selected. To investigate the effect of noise on workers' cognitive performance, first the average equivalent sound level during the shift (beginning, middle and end of the shift) was measured .Since the sound pressure level is different in different parts of the workplace and the company workers normally commute in different parts of the environment, so to determine the average sound level equivalent to their exposure, the dosimeter is the most reliable method for measuring and evaluating. It is an individual encounter. The dosimetry was performed by TES-1345 dosimeter made in Taiwan, in accordance with ISO 9612 standard. Before using, the device was calibrated by a CEL110.2 calibrator made by Casella Company. In the studied units, measurements were performed using a regular grid pattern and then the cognitive performance of individuals at the beginning, middle and end of the shift was measured using CPT and N-back tests.The Continuous Performance Test (CPT) is used to measure people's attentive attention and alertness. It is a valid test that is used to find sustained attention deficit impaired performance.In the continuous performance test (CPT), 150 numbers appear at regular intervals and a stimulus is determined as the target stimulus, and the participant must press the relevant key on the computer screen as soon as possible by observing the desired numbers. The variables measured in the CPT test were commission error, omission error, and response time (milliseconds), and working memory test (N-back) is used to measure working memory of individuals, since this task includes both cognitive information retention and manipulation, it is known to be very suitable for measuring working memory performance. And repeatedly used for this purpose, in the working memory performance test (N-back), a sequence of numbers, step by step, appears randomly on the screen as a visual stimulus. . The subject should then examine whether the current stimulus presented is consistent with the N-stimulus preceded by it. The variables measured in the working memory performance test (N-back) were reaction time (milliseconds) and mean correct response. The collected data were analyzed with SPSS V.20 .Then descriptive methods (mean, standard deviation and frequency) were used to summarize the data. The normality assumption for the data was performed using the Kolmogorov-Smirnov test. The main basis of data analysis was based on analysis of variance (ANOVA). Significance level in data analysis was considered less than 0.05. Results: Comparison of the results in the Continuous Performance Test (CPT) showed that the average equivalent sound level has no effect on the commission error, but at the end of the shift the commission error is significantly affected (P=0.040).However, the average equivalent sound level has no effect on the omission error and only the omission error in the middle and end of the shift is statistically significant (P0.05) and only the correct response in the middle and end of the shift was statistically significant. The highest reaction time and the lowest mean correct response belonged to the third group who were faced with a sound pressure level of 91.83± 1.78 dBA .Accordingly, the number of correct responses of the groups that were exposed to more than the allowable noise was significantly less than the group that was exposed to less than the allowable noise .Also, the number of errors in these groups was more than that group. According to the Continuous Performance Test (CPT) and also according to the Memory Performance Test (N-Back), the sound pressure level increases the reaction time of the subjects (P

Background: A major problem in surgical procedures is postoperative pain. The effectiveness of prescribing preoperative tizanidine in reducing postoperative pain is not clear. The aim of this study was to determine the efficacy of tizanidine as a premedication in reducing pain after septoplasty. Methods: This double blind clinical trial study was performed in 71 patients aged from 18 to 50 years, undergoing septoplastic surgery for the first time, who were classified in ASA (American Society of Anesthesiologists) classes 1 and 2 in the Ear, Nose, and Throat (ENT) Department of Shafa Hospital, in Kerman, Iran from April 2014 to March 2015. Patients were randomly assigned into two groups using numbers from a randomization table. A dosage of 4 mg of tizanidine was administered orally to the patients two hours before the surgery (septoplasty) in the intervention group. In the control group, placebo pills which were 100 mg vitamin B1 were prescribed. The severity of pain was measured and recorded after 4 and 8 hours, and the morning after the surgery. Results: 62 patients (87.32%) were male and 9 (12.68%) were female. The mean age of the subjects was 24.6±7.5 years. The two groups were similar in regard to age (P=0.54), but the duration of surgery was different in the two groups (P=0.038) and was longer in the group that received tizanidine. The mean of pain was different between the two groups, after 4 hours and was significantly higher in the group that received tizanidine (P=0.043). The mean of pain was not significantly different between the two groups after 8 hours (P=0.95) or one day after surgery (P=0.79). Conclusion: Although some researchers have reported that taking tizanidine before some surgeries may reduce postoperative pain, in this study the administration of tizanidine before surgery was not effective in reducing pain after septoplasty.

Background: The lack of a comprehensive instrument to measure school climate with good psychometric properties in Iran is strongly felt. This study aimed to examine the construct validity of the multidimensional structure of the Maryland Safe and Supportive Schools Climate Survey (MDS3) among Iranian pupils. Methods: This validation study was peformed on a sample of 1540 pupils from 42 schools in Mazandran province in 2017. Confirmatory factor analyses (CFA) and exploratory structural equation modeling (ESEM) were employed to evaluate the construct validity of each of the three scales of the questionnaire (Safety, Engagement, and Environment). The current study tested measurement invariance across gender, school type, and grade levels. Results: Our findings confirmed the factor structures and measurement invariance across gender, school types, and grade levels regarding Safety, Engagement, and Environment scales of the Persian version of the MDS3 Climate Survey. This study revealed a conceptual overlap between the dimensions of school climate which can be well shown by ESEM (CFI=0.975, TLI=0.945, RMSEA=0.053, SRMR=0.029 for Safety scale; CFI=0.987, TLI=0.961, RMSEA=0.027, SRMR=0.018 regarding Engagement scale; CFI=0.960, TLI=0.926, RMSEA=0.036, SRMR=0.025 concerning Environment scale). Furthermore, the Pearson correlations of all school climate sub-scales were significant (P Conclusion: The Persian version of MDS3 Climate Survey can be used to measure the three key domains of school climate (Safety, Engagement, and Environment) in Iranian context and the epidemiological studies associated with student health and behaviors.

Introduction: Noise is one of the most common and harmful physical factors in the working environment and has physical and psychological effects on individuals. In this study, the audiometry results of industrial workers were modeled and the effect of noise and other factors on hearing loss was examined. Materials and Methods: This was a longitudinal study based on the records of workers who had worked over 10 years in the industry and had recorded audiometries since their employment. Data was analyzed through linear mixed models. Results: During each year of noise exposure, hearing loss was 1.9 db at 4000 Hz; 0.059 in low frequencies and 0.62 db in high frequencies. At 8000 Hz the effect of the age at employment on hearing loss was significant (P=0.014). At low frequencies the interaction of smoking and age at employment was significantly related to hearing loss (P˂0.001). Conclusion: This study showed that despite acquaintance with safety measures, workers still face hearing loss in industry and employers should put workers under more surveillance for using protective gear. Smoking might be another risk factor for hearing loss.

Background: There are few studies on the association between bullying types and psychosomatic issues in pupils. The current study aimed to examine the association of verbal, relational, physical, and cyber bullying with psychosomatic problems among students. Methods: This was a cross-sectional study conducted in northern Iran on 834 participants, which were in 8th and 9th grades in 2014. Bullying and psychosomatic problems were measured by the Iranian-version of the Olweus Bullying and the Health and Illness Questionnaires. Descriptive statistics and multilevel logistic regression analysis were used for data analysis. Results: Findings revealed that bad temper was the most prevalent psychosomatic problem and the prevalence of headache (P=0.021), feeling low (P=0.009), bad temperedness (P=0.004), nervousness (P Conclusions: The results showed the different psychological and somatic burdens associated with various types of bullying. Therefore, it is necessary to implement preventive and interventional programs so as to reduce bullying behaviors in Iran. Implications of these findings for health care professionals, educational systems, and parents were further discussed.

Introduction: Heat stress disrupts blood hormones and reduces workers' cognitive performance. To further shed light on the dysfunction of heat stress, the present study aimed to evaluate its effect on cognitive performance of petrochemical workers. Materials and methods: This descriptive-analytical cross-sectional study was conducted in 2020 in one of the Iranian petrochemical companies. Participants were divided into 2 case groups and 1 control group. They worked 12 h and their shift entialed one week working day and one week working night. According to the ISO 7243 standard, the heat stress index of employees was measured at the beginning, in the middle and at the end of the shift separately. Continuous Performance Test (CPT) and N-back cognitive performance tests were performed at the beginning, in the middle and at the end of the shift to determine the level of cognitive performance. The data were analyzed using SPSS software version 20 and the significance level was set at 0.05. Results: Comparison of the results in the continuous performance test showed significant differences between the three groups with regard to the omission error and response time at the end of the shift. Moreover, according to the working memory test, participants reaction time during the shift significantly increased. Besides, average correct responses significantly reduced during the shift. Finally, the heat stress throughout the shift had a significant effect on the commission error and the response time of individuals. Conclusion: Heat stress affects people's cognitive performance in such a way that it can decrease their cognitive performance by increasing the commission error and response time and reducing the average correct response of site operators, generally reducing the cognitive performance of people at the end of the shift.

Introduction: This study was conducted to determine the relation between exposure to particulate matter less than 10 microns (PM10) caused by dust storms and the risk of cardiovascular, respiratory and traffic accident missions carried out by Emergency Medical Services (EMS). Methods: This was a time-series study conducted in Dezful city, Iran. Daily information on the number of missions by the EMS due to cardiovascular, respiratory and crash problems and data on PM10 were inquired from March 2013 until March 2016. A generalized linear model (GLM) with distributed lag models (DLMs) was used to evaluate the relation between the number of EMS missions and the average daily PM10. The latent effects of PM10 were estimated in single and cumulative lags, up to 14 days. Results: In the adjusted model, for each IQR increase in the average daily PM10 concentration, the risk of EMS missions in the total population in single lags of 2 to 7 days, and the cumulative lags of 0-7 and 0-14 days after exposure had a 0.8, 0.8, 0.8, 0.8, 0.7, 0.6, 6.7 and 1.4% significant increase. Also, for each IQR increase in the daily mean concentration of PM10 in single 1 to 7, and cumulative lags of 0-2, 0-7, and 0-14 days after exposure, respectively, a 2.4, 2.7, 2.8, 2.9, 2.9, 2.7, 2.5, 7.4, 23.5 and 33. 3 % increase was observed in the risk of EMS cardiovascular missions. Conclusion: Increase in daily PM10 concentrations in Dezful is associated with an increase in the risk of EMS missions in lags up to two weeks after exposure.

Background: Bullying among adolescences is known as a public health abnormality and studying the prevalence of bullying behaviors using different methods of data gathering can help researchers in surveillance and planning preventions. Objectives: The objective of this study was to compare the prevalence of perpetration and victimization of bullying reported by self-report, peer-report, and principle-report. Methods: In this cross-sectional study that was conducted in 2017 - 2018, a total of 1,540 students from 42 schools throughout Mazandaran province completed self- and peer-report questionnaires and 42 principals of 42 schools completed a principal-report questionnaire. The chi-square test was used to compare the prevalence of victimization and perpetration of bullying with self-report, peer-report, and principal-report methods across gender, school types and grade levels. Results: The prevalence of bullies and victims in self-, peer-, and principal-report methods were different (20.2% as victim and 7.8% as a bully for self-report, 9.4% as victim and 8.9% as a bully for peer-report, and 4.3% as victim and 3.1% as a bully for principal-report). Conclusions: This study showed the discrepancy in the prevalence of perpetration and victimization of bullying reported in three measurement methods (self-, peer-, and principal-report) in Iranian schools and suggests the use of multiple assessment methods for bullying behaviors.

Background and aims: Many workers face significant hazardous workplace exposures, especially in developing countries. The objective of this study was to investigate the prevalence of occupational risk factors and common occupational diseases in Kerman. Methods: This study was based on data from occupational risk factor and disease monitoring systems available at Kerman Province Health Center during 2011-2015. These data are gathered semiannually by occupational hygienists based on standard checklists provided by the Ministry of Health and Medical Education and these checklists include exposures and diseases related to the workplace. Results: Based on the results, 292 (3.7%), 281 (3.58%), 261 (3.32%), and 115 (1.47%) cases were found regarding occupational hearing loss, respiratory conditions, work-related back pain, and musculoskeletal disorders, respectively, which were related to different occupational exposures diagnosed in Kerman during 2011-2015. Moreover, dust, work tools, wrong body position during work, and noise were the most common risk factors in this respect. Conclusion: Overall, occupational hazards are considered as an important health issue in Kerman. Therefore, it is necessary to control exposure to these risk factors in order to prevent occupational diseases.

There are limited studies on the relation between short-term exposure to air pollutants and the risk of deep venous thrombosis (DVT). The aim of this study was to determine the relation between the concentration of these pollutants and the risk of hospital admissions due to DVT in Ahvaz, which is one of the world's highly polluted cities. Daily data on pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5and DVT hospital admissions were collected from2008until 2018. Quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays, and holidays were used to assess the relation between the daily average of air pollutants and hospital admission for DVT. The results showed that there was a significant increase in hospital admissions due to DVT in the total, men, women, and elderly populations in relation to NO and NO2. There was also a significant increase in DVT hospital admissions in the male and ≤60 years populations related to PM10; and among the female and ≤60 years old populations, related to PM2.5. Finally, the results showed that there were significant positive associations between SO2 and CO exposure and the incidence of DVT hospital admissions among men and women, respectively. The results of this study show the possible effect of short-term exposure to air pollution on the risk of DVT. Further studies are required to investigate whether direct interventions through industry and government policy may alter the impact of specific pollutants in order to alter the incidence of DVT and other identified health complications.

Purpose: The aim of this study was to determine the prevalence of amblyopia in the population of Iran. Methods: This article is a systematic review. A comprehensive search was conducted in PubMed, Scopus, Science Direct, Ovid, Web of Science, SID, Magiran, with appropriate terms. Information related to the sample size and the prevalence of amblyopia was extracted and summarized in tables. Analysis was performed using STATA software. Results: From 551 articles that were originally extracted from the databases, 31 articles met the criteria for entering the review. These studies were conducted in different regions of Iran. The prevalence of amblyopia in different regions varied between 0.19 and 3.69%. Study results were heterogeneous (I2 = 99.7%), and therefore, a meta-analysis was not done. Conclusions: The prevalence of amblyopia in Iran is very different. In addition to conducting national screenings, it is necessary to report the incidence of amblyopia and its related factors in different parts of the country. Keywords: Amblyopia, Systematic review, Iran, Prevalence

Background & Aim: Depression is common among cardiac patients, especially patients with heart failure and leads to a poor prognosis. This study aimed to assess the effect of exercise on depressive symptoms in patients with heart failure, attending the Cardiac Rehabilitation Center. Methods & Materials: In this clinical trial, 60 patients with NYHA class II and III heart failure who referred to the Cardiac Rehabilitation Center of Shafa Hospital affiliated to Kerman University of Medical Sciences in 2015 were randomly assigned into two groups of 30 patients. Subjects in the intervention group participated in a supervised 8-week exercise program, 3 days per week, while those in the control group only received standard routine care. Data were collected before and after the intervention by the demographic form and the Personal Health Questionnaire Depression Scale (PHQ-8). Data analysis was done by Chi-Square, Wilcoxon, Mann-Whitney U and Nonparametric ANCOVA tests using the SPSS version 21 and R software. Results: The two groups were homogeneous in terms of depression score before the intervention. The median and interquartile range of the score of depression were 10 (5.25) in the control group and 8.5 (9.25) in the intervention group which showed a significant difference (P=0.042). By adjusting the variables of the duration of the disease and the pre-test scores of depression symptoms by non-parametric covariance test, the difference between the two groups was also significant. Conclusion: Exercise can reduce depressive symptoms in patients with heart failure. Clinical trial registry: IRCT201605107844N10

Objectives There are few studies about the association between breathing polluted air and increased risk of cardiovascular diseases and cardiac death in the Middle East. This study aimed to investigate the relation between air pollutants and cardiovascular mortality (based on ICD-10) in Ahvaz. Material and methods In this ecological study, the data about cardiovascular disease mortality and air pollutants from March 2008 until March 2015 was inquired from the Ahvaz City Authority and the Khuzestan Province Environmental Protection Agency. The quasi-Poisson, second degree polynomial constrained, distributed lag model; using single and cumulative lag structures, adjusted by trend, seasonality, temperature, relative humidity, weekdays and holidays was used for the data analysis purposes. Results Findings indicated a direct significant relation between an interquartile range (IQR) increase in ozone and cardiovascular deaths among men after 3 days’ lag. There was also a significant relation between an IQR increase in particulate matter below 10 μm and cardiovascular deaths for all people, over 60 years old and under 18 years old after 3 and 13 days’ lags. There was a significant relation between an IQR increase in nitrogen dioxide and carbon monoxide, and cardiovascular deaths in the case of under 18-year-olds (in the lag 11) and over 60-year-olds (in the lag 9), respectively. We finally found a significant association between an IQR increase in sulfur dioxide and cardiovascular deaths in the case of men, under 18-year-olds and from 18- to 60-year-olds in the lag 9, 0, and 11, respectively (p-values < 0.05). Conclusions It appears that air pollution is significantly associated with cardiovascular deaths in Ahvaz City. Int J Occup Med Environ Health 2018;31(4):459–473

BACKGROUND: Several studies have suggested that temperature may have an effect on the number of cardiovascular deaths in societies. Global warming is a concern, and cardiovascular diseases are the top cause of death worldwide. This study investigated the relation between temperature and cardiovascular mortality in Shiraz City, Iran.METHODS: In this ecological study, data about temperature and cardiovascular deaths (in age and gender groups) in Shiraz City were inquired from 2006 to 2012. The simultaneous and delayed relation between monthly temperature and cardiovascular deaths was examined using Spearman and Pearson correlation tests, and crude and adjusted negative binomial regression analysis with adjustment for confounding factors such as humidity, rainfall, wind direction, wind speed, and air pollutants. Analysis was done using MINITAB and STATA software.RESULTS: During this period 17,167 deaths were reported in Shiraz. The lowest number of cardiovascular deaths was reported in 20 °C. No significant relation was observed between mean monthly temperature and cardiovascular deaths in the same month after adjusting for confounding factors. Although, cardiovascular death in 18- to 60-year-old people showed an inverse significant relation with minimum [Incidence rate ratio (IRR) = 0.98989, P = 0.020], maximum (IRR = 0.99046, P = 0.011), and mean temperature (IRR = 0.98913, P = 0.006) of the same month in the crude model, it was not significant in the adjusted model (IRR = 0.99848, P = 0.848, IRR = 0.99587, P = 0.584, and IRR = 0.99512, P = 0.506, respectively).CONCLUSIONS: It seems that there is no significant relation between temperature and cardiovascular deaths in Shiraz, which is probably due to its moderate climate, and the fact that no major heat or cold wave occurred during this time.

Background: This study was designed to investigate job satisfaction and its relation to perceived job stress among hospital nurses in Babol County, Iran.Methods: This cross-sectional study was conducted on 406 female nurses in 6 Babol hospitals.Respondents completed the Minnesota Satisfaction Questionnaire (MSQ), the health and safety executive (HSE) indicator tool and a demographic questionnaire. Descriptive, analytical and structural equation modeling (SEM) analyses were carried out applying SPSS v. 22 and AMOS v. 22.Results: The Normed Fit Index (NFI), Non-normed Fit Index (NNFI), Incremental Fit Index (IFI)and Comparative Fit Index (CFI) were greater than 0.9. Also, goodness of fit index (GFI=0.99)and adjusted goodness of fit index (AGFI) were greater than 0.8, and root mean square error of approximation (RMSEA) were 0.04, The model was found to be with an appropriate fit. The R-squared was 0.42 for job satisfaction, and all its dimensions were related to job stress. The dimensions of job stress explained 42% of changes in the variance of job satisfaction. There was a significant relationship between the dimensions of job stress such as demand (β =0.173,CI =0.095 - 0.365, P≤0.001), control (β =0.135, CI =0.062 - 0.404, P =0.008), relationships(β =-0.208, CI =-0.637– -0.209; P≤0.001) and changes (β =0.247, CI =0.360 - 1.026, P≤0.001)with job satisfaction.Conclusion: One of the important interventions to increase job satisfaction among nurses maybe improvement in the workplace. Reducing the level of workload in order to improve job demand and minimizing role conflict through reducing conflicting demands are recommended.

Abstract Background Some epidemiological evidence has shown a relation between ambient air pollution and adverse health outcomes. The aim of this study was to investigate the effect of air pollution on mortality from respiratory diseases in Tehran, Iran. Methods In this ecological study, air pollution data was inquired from the Tehran Province Environmental Protection Agency and the Tehran Air Quality Control Company. Meteorological data was collected from the Tehran Meteorology Organization and mortality data from the Tehran Cemetery Mortality Registration. Generalized Additive Models (GAM) was used for data analysis with different lags, up to 15 days. A 10-unit increase in all pollutants except CO (1-unit) was used to compute the Relative Risk of deaths. Results During 2005 until 2014, 37,967 respiratory deaths occurred in Tehran in which 21,913 (57.7%) were male. The strongest relationship between NO2 and PM10and respiratory death was seen on the same day (lag 0), and was respectively (RR = 1.04, 95% CI: 1.02–1.07) and (RR = 1.03, 95% CI: 1.02–1.04). O3 and PM2.5 had the strongest relationship with respiratory deaths on lag 2 and 1 respectively, and the RR was equal to 1.03, 95% CI: 1.01–1.05 and 1.06, 95% CI: 1.02–1.10 respectively. NO2, O3, PM10 and PM2.5 also showed significant relations with respiratory deaths in the older age groups. Conclusions The findings of this study showed that O3, NO2, PM10 and PM2.5 air pollutants were related to respiratory deaths in Tehran. Reducing ambient air pollution can save lives in Tehran.

Background and aim: Work-related injuries are among the most important health problems in developing countries, such as Iran. The purpose of this study was to determine the epidemiology of work-related injuries among construction workers who had been insured by the Iranian Social Security Organization (ISSO). Methods: This is a cross-sectional study. The population included all construction workers who had a workrelated accident during 2012 in Iran, which were recorded in the ISSO database after inspection. The effects of independent variables on injuries were estimated by logistic regression. SPSS software version 18 was used for analyzing the data. Results: Overall, 5352 work-related injuries were investigated. The incidence rate of fatal and nonfatal injuries was 0.07 in 1000 and 11.18 in 1000 workers, respectively. More than half of these accidents were due to careless activities. A younger age at the time of the accident (OR=0.98, CI: 0.97-0.99, p=0.001), being married (OR=1.37, CI: 1.04-1.79, p=0.02), place of accident (OR=1.86, CI: 1.18-2.92, p=0.007), lack of information (OR=5.28, CI: 1.57-17.75, p=0.007), disrespect of safety regulations (OR=3.11, CI: 1.87–5.17, p=0.001), non-use of protective equipment (OR=2.98, CI: 1.62-5.50, p=0.001), and defective equipment (OR=2.22, CI: 1.18-4.20, p=0.01) had a significant effect on the incidence of work-related injury. Conclusions: The pattern of work-related injury in Iran was almost similar in regard to age, gender, cause and type of the accident, with other parts of the world.

Introduction Addiction is one of the major crises in the world which has many victims and imposes serious damage on the family and society, especially among children who are the most vulnerable social stratum. The aim of this study was to determine the probable causes of drug addiction among children in Kerman. Methods This case-control study was conducted after a qualitative study. Ninety children aged from 6 to 16 years were enrolled. The case group included 30 addicted children supported by the Welfare Organization. The control group included two groups of 30 children, one selected from the Welfare Organization and the other from across the city. All participants were male and groups were matched for age. Then, the probable causes of addiction were compared between these two groups. Data were analyzed using the SPSS22 and by chi-square tests and logistic regression. Results The mean age of children was 10.8 ± 2.4 in the case group, 11.4 ± 1.8 in the park control and 12.8±1.5 in the welfare center control group. All participants were male.The results indicated that there were significant statistical differences between the addicted and non-addicted children in regard to parent’s religious beliefs, parent imprisonment, history of addiction in families, visiting the park alone and parental employment. Conclusion Strengthening religious beliefs of parents, teaching life skills to children and their parents, parental control on children, tracking and monitoring the peers; and promoting collaborations between the policymakers, the Welfare Organization, the Municipality, the Universities of Medical Sciences and the Police Force can help reduce and control addiction among children.

BACKGROUND: Outdoor air pollution has been considered as one of the most serious health concerns over the last decade. This study aimed to investigate the association between ambient air pollution and cardiovascular hospital admissions. METHODS: This investigation was carried out from January 1, 2010 to December 31, 2016, in the urban population of Arak, Iran. Daily records of concentrations of air pollutants including particulate matter less than 10 µm (PM10), nitrogen dioxide (NO2), particulate matter less than 2.5 µm (PM2.5), ozone (O3), carbon monoxide (CO), and sulfur dioxide (SO2) as well as the daily number of hospital admissions due to cardiovascular disease were inquired from the Arak Department of Environment and two major hospitals, respectively. Time-series regression analysis was used to evaluate the effect of the pollutants on cardiovascular hospital admissions with different lag structures, controlling for weather variables, seasonality and long-term time trends, and day of the week. RESULTS: Each 10 µg/m3 increase in PM10 and NO2 and 1 mg/m3 increase in CO concentrations at lag 0 (day) were significantly associated with an increase of 0.7% (P = 0.004), 3.3% (P = 0.006), and 9.4% (P < 0.001), respectively in overall cardiovascular hospital admissions. The elderly were more susceptible than those under 60 years to exposure to the pollutants (especially NO2) with regard to cardiovascular hospital admission. CONCLUSION: The results of this study showed that hospital admission for cardiovascular disease is partly related to the levels of ambient air pollutions in Arak. Susceptibility to air pollutants varies by age groups and sex.

Background: The reuse of treated municipal wastewater is an important source of water for different purposes. This study evaluated the efficiency of the electrocoagulation process in removing turbidity, total suspended solids (TSS), chemical oxygen demand (COD), nitrate, and phosphate from wastewater at the treatment facility in Karaj, Iran. Methods: This experimental study was performed at a pilot scale and in a batch system. A 4-liter tank made from safety glass with 4 plate electrodes made from aluminum was unipolarly connected to a direct current power supply with a parallel arrangement. Wastewater samples were taken from the influent at the Karaj wastewater treatment facility. Rates of turbidity, TSS, COD, nitrate, and phosphate removal under different conditions were determined. Results: The highest efficiency of COD, TSS, nitrate, turbidity, and phosphate elimination was achieved at a voltage of 30 volts and a reaction time of 30 minutes. The rates were 88.43%, 87.39%, 100%, 80.52%, and 82.69%, respectively. Conclusion: Based on the results of this study, electrocoagulation is an appropriate method for use in removing nitrate, phosphate, COD, turbidity, and TSS from wastewater.

Introduction: Allergic rhinitis and asthma can be related to occupation. The present study aimed to investigate the correlation between asthma or allergic rhinitis and employment in the palm tree gardens of Jahrom, Iran. Materials and Methods: This was a cross-sectional study including 50 palm tree garden workers and a control group of 50 office employees. Data collection included demographics, as well as standard International Study of Asthma and Allergies in Childhood (ISAAC) and A New Symptom-Based Questionnaire for Predicting the Presence of Asthma (ASQ) questionnaires. Data were analyzed using SPSS22. Descriptive statistics, chi-square test, t-test, and logistics regression were used to analyze data. Results: The correlation between asthma and occupation was significant ( P=0.046); and asthma prevalence was higher in palm tree garden workers. However, no relationship was observed between age, duration of employment, smoking cigarettes, hookah, or opium addiction with asthma. Furthermore, in this study, no significant relation was observed between the prevalence of asthma and contact with dust, contact with pets’ skin and hair, family history of asthma, or the use of perfume and air freshener. The symptoms of allergic rhinitis (including sneezing, runny nose, and blocked nose) were significantly greater in palm tree garden workers (P=0.038). These symptoms in both workers and office employees were higher in spring. Conclusion: In our study, allergic rhinitis and asthma were more common in palm tree garden workers than in the general population. According to our study, people working in this occupation should take necessary precautions.