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Health Education and Health Promotion Health Education and Health Promotion 2 70 70 2013/10/23 1392/8/1 2013/12/7 1392/9/16 محمد حسین باقیانی مقدم Mohammad Hossein Baghianimoghadam ## ##

Clinical Governance in Primary Care Principles, Prerequisites and Barriers: A Systematic Review Clinical Governance in Primary Care Principles, Prerequisites and Barriers: a Systematic Review 2 1 Introduction: Primary care organizations are the entities through which clinical governance is developed at local level. To implement clinical governance in primary care, awareness about principles, prerequisites and barriers of this quality improvement paradigm is necessary. The aim of this study is to pool evidence about implementing clinical governance in primary care organizations. Data sources: The literature search was conducted in July 2012. PubMed, Web of Science, Emerald, Springerlink, and MD Consult were searched using the following MESH keywords “clinical governance” and “primary care” Study selection: The search was limited to English language journals with no time limitation. Articles that were either quantitative or qualitative on concepts of implementing clinical governance in primary care were eligible for this study. Data extraction: From selected articles, data on principles, prerequisites and barriers of clinical governance in primary health care were extracted and classified in the extraction tables. Results: We classified our findings about principles of clinical governance in primary care in four groups general principles, principles related to staff, patient and communication. Prerequisites were categorized in eight clusters same as the seven dimensions of National Health System (NHS) models of clinical governance. Barriers were sorted out in five categories as structure and organizing, cultural, resource, theoretical and logistical. Conclusion: Primary care organizations must provide budget holding, incentivized programs, data feedback, peer review, education, human relations, health information technology (HIT) support, and resources. Key elements include enrolled populations, an interdisciplinary team approach, HIT interoperability and access between all providers as well as patients, devolution of hospital based services into the community, inter-sectorial integration, blended payments, and a balance of clinical, corporate, and community governance. 2 Introduction: Primary care organizations are the entities through which clinical governance is developed at local level. To implement clinical governance in primary care, awareness about principles, prerequisites and barriers of this quality improvement paradigm is necessary. The aim of this study is to pool evidence about implementing clinical governance in primary care organizations. Data sources: The literature search was conducted in July 2012. PubMed, Web of Science, Emerald, Springerlink, and MD Consult were searched using the following MESH keywords “clinical governance” and “primary care” Study selection: The search was limited to English language journals with no time limitation. Articles that were either quantitative or qualitative on concepts of implementing clinical governance in primary care were eligible for this study. Data extraction: From selected articles, data on principles, prerequisites and barriers of clinical governance in primary health care were extracted and classified in the extraction tables. Results: We classified our findings about principles of clinical governance in primary care in four groups general principles, principles related to staff, patient and communication. Prerequisites were categorized in eight clusters same as the seven dimensions of National Health System (NHS) models of clinical governance. Barriers were sorted out in five categories as structure and organizing, cultural, resource, theoretical and logistical. Conclusion: Primary care organizations must provide budget holding, incentivized programs, data feedback, peer review, education, human relations, health information technology (HIT) support, and resources. Key elements include enrolled populations, an interdisciplinary team approach, HIT interoperability and access between all providers as well as patients, devolution of hospital based services into the community, inter-sectorial integration, blended payments, and a balance of clinical, corporate, and community governance. 71 87 2013/10/232013/09/14 1392/6/23 2013/12/72013/10/14 1392/7/22 جعفر صادق تبریزی Jaafar Sadeq Tabrizi رعنا غلامزاده نیکجو Raana Gholamzadeh Nikjoo 1. Bodur S, Filiz E. A survey on patient safety culture in primary healthcare services in Turkey. Int Journal for Quality in Health Care. 2009; 21(5):348-55.##2. Allen P. 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Prevalence of Obesity and its Relationship with Birth Weight among High School Female Students in the City of Yazd Prevalence of Obesity and its Relationship with Birth Weight among High School Female Students in the City of Yazd 2 1 Introduction: The idea that factors during early critical periods of life affect on long term health is now a major public health concern. In this study, in addition to investigating obesity prevalence among female high school students in Yazd, the relationship between obesity and birth weight was examined. Materials and Methods: This cross sectional study was conducted on 312 female high school students. Random cluster sampling method was done among 6 high schools from two education districts in Yazd. According to the birth weight recorded on their growth cards, the students were divided to 3 weight groups of low birth weight (4000 g). Anthropometric measurements including weight, height and waist circumference were alsocarried out. In terms of the percentiles proposed by NCHS, BMI was considered as light weight (5th percentile≤), normal (5-85th percentile), overweight (85-95th percentile) and obese (95th percentile≥). In addition, 95th percentile≥for waist circumference was considered abdominal obesity. Finally, the data were analyzed by SPSS 16 software. Results: The samples' mean weight and BMI were higher than 50th percentile of NCHS and their mean height was lower than 50th percentile of NCHS. Based on the results, 5.7% of the samples were underweight, 73.4% were normal, 17.1% were overweight and 3.8% were obese. Abdominal obesity rate was measured as 18.7%. There was a significantly positive correlation between birth and current weight of students (p= 0.001 and r= 0.2) and their BMI (p= 0.005 and r= 0.15). Conclusion: Relatively high prevalence of obesity and overweight in this study and its positive relationship with birth weight necessitate preventive strategies and training during and even before pregnancy by relevant authorities for women at gestational age and other related groups. 2 Introduction: The idea that factors during early critical periods of life affect on long term health is now a major public health concern. In this study, in addition to investigating obesity prevalence among female high school students in Yazd, the relationship between obesity and birth weight was examined. Materials and Methods: This cross sectional study was conducted on 312 female high school students. Random cluster sampling method was done among 6 high schools from two education districts in Yazd. According to the birth weight recorded on their growth cards, the students were divided to 3 weight groups of low birth weight (4000 g). Anthropometric measurements including weight, height and waist circumference were alsocarried out. In terms of the percentiles proposed by NCHS, BMI was considered as light weight (5th percentile≤), normal (5-85th percentile), overweight (85-95th percentile) and obese (95th percentile≥). In addition, 95th percentile≥for waist circumference was considered abdominal obesity. Finally, the data were analyzed by SPSS 16 software. Results: The samples' mean weight and BMI were higher than 50th percentile of NCHS and their mean height was lower than 50th percentile of NCHS. Based on the results, 5.7% of the samples were underweight, 73.4% were normal, 17.1% were overweight and 3.8% were obese. Abdominal obesity rate was measured as 18.7%. There was a significantly positive correlation between birth and current weight of students (p= 0.001 and r= 0.2) and their BMI (p= 0.005 and r= 0.15). Conclusion: Relatively high prevalence of obesity and overweight in this study and its positive relationship with birth weight necessitate preventive strategies and training during and even before pregnancy by relevant authorities for women at gestational age and other related groups. 88 95 2013/10/232013/09/142013/09/14 1392/6/23 2013/12/72013/10/142013/09/22 1392/6/31 آزاده نجارزاده Azadeh Nadjarzadeh نیلوفرالسادات صدری مقدم Niloofar Sadat Sadri Moghadam niloofar_sadriii@yahoo.com حسن مظفری خسروی Hassan Mozaffari-Khosravi فریماه شمسی Farimah Shamsi 1. James PT, Leach R, Kalamara E, et al. The worldwide obesity. Obesity Research 2001; 9:228s-33s.##2. Rickert V. Adolescent nutrition . Assessment and management . New York: chapman & Hall; 1996. ##3. National Center for Health Statistics. Center for Disease Control among children and adolescents and adults. Hyattsville: United states; 2012.##4. Kelishadi R, Pour MH, Sarraf-Zadegan N, et al. Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program-Heart Health Promotion from Childhood. Pediatr Int. 2003; 45(4):435-42.##5. Mirmiran P, Mohammadi F, Alahverdian S, et al. Prevalence of overweight and underweight in East of Tehran and its relation to a group of teenagers get their food , Prospective Tehran Lipid and Glucose Study. J Res Med Sci. 2011 June; 16(6): 821-7. [Persian]##6. Poormoghim M, Abolghasem J. Evaluation and comparison nutritional status of adolescent girls in secondary school in the area north and south of Tehran, School of public health. Nutrition Sciences & Food Technology. 2008; 2(4) :67-8.##7. Parvin F, Janghorbani M. The Prevalence of obesity among female student in public high schools in Kerman. Epidemiologic Reviews. 1995: 34-39.##8. GargariBp, Behzad MH, Ghassabpour S, et al. Prevalence of overweight and obesity among high-school girls in Tabriz, Iran, in 2001. Food Nutr Bull. 2004. ; 25( 3) :288-91.##9. Power C, Lake JK, Cole TJ. Measurement and long-term health risks of child and adolescent fatness. Int J Obes Relat Metab Disord. 1997; 21(7):507-26.##10. Wright CM, Parker L, Lamont D, et al. Implications of childhood obesity for adult health: findings from thousands families cohort study. BMJ. 2001; 323(7324):1280-4. ##11. Frisancho AR. Prenatal compared with parental origins of adolescent fatness. Am J Clin Nutr. 2000; 72(5):1186-90. ##12. Barker DJP . fetal origins of adult disease. International Journal of Epidemiology. 2001; 31:1235-39.##13. Thomas Harder, Elke Rodekamp, Karen Schellong. Birth Weight and Subsequent Risk of Type 2 Diabetes. Am J Epidemiol. 2007; 165(8):849-57. ##14. Parsons TJ, Power C, Manor O. Fetal and early life growth and body mass index from birth to early adulthood in 1958 birth cohort : longitudinal study. BMJ. 2001 Dec 8; 323(7325):1331-5.##15. Soren HT, Sabore S, Rothman KJ, et al. Relation between weight and length at birth and body mass index in young adulthood : cohort study.BMJ. 1997; 315(7116): 1137.##16. Shaheen SO, Sterne JA , Montgomery SM , et al. Birth weight , body mass index and asthma in young adults. Thorax. 1999; 54(5):396-402.##17. Philips DIW, Young JB. Birth weight and the risk of obesity in adult life. Int J Obes Relat Metab Disord. 2000; 24:281-7.##18. Gillman MW, Rifas-Shiman S, Berkey CS, et al. Maternal gestational diabetes, Birth weight, and Adolescent obesity. Pediatrics. 2003; 111(3):221-6.##19. Gluckman PD, Hanson MA, Cooper C, et al. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008; 359:61-73..##20. Brufani C, Grossi A, Fintini D, et al. Obese Children With Low Birth Weight Demonstrate Impaired Beta Cell Function during Oral Glucose Tolerance Test. J Clin Endocrinol Metab. 2009; 94(11):4448-52##21. Must A, Dallal GE, Diet Z WH. References data for obesity: 85th percentile of body mass index and triceps skinfold thickness. Am J ClinNutr. 1997; 53:899-46.##22. Roberts SB, Dallah GE. The new childhood growth charts. Nutr Rev. 2001; 59(2):31-6.##23. Mohamad pour-Ahrangani B, Rashidi A, et al. Prevalence of overweight and obesity in adolescents Tehranian students , 2000-2001 on epidemic health peoblem. Public health nut. 2004; 7(5):642-8.##24. Shahidi N, Mirmiran P, Amir-Khani F. Prevalence of obesity, central obesity and its relationship with food consumption pattern of male adolescent in Tabriz. IMJM. 2013; (4) : 255-63.[Persian]##25. Khosh-Fetrat M. Evaluation and comparison of anthopometric and food intake in rural school boys of the ZarrinShahr. Department of Nutrition and food science, Payesh. Journal of The Iranian Institute For Health Sciences Research. 2007;6(2) :119-27..[Persian]##26. Johnson L.High Prevalence of obesity in low income and multiethenic school children : diet and physical activity assessment. J Nutr. 1997; 127(12):2310-5.##27. Hanley Ay, Harris SB, Gittelsohn J, et al. Overweight among children and adolescents in a Native Canadian community : prevalenc and associated factors. Am J clinNutr. 2000; 71(3):693-700.##28. Shomei S. The predictive value of childhood body mass index values for overweight at age 35y. Am J ClinNutr. 1994; 59: 810-19.##29. Al-NuaimAR , Bang boy EA. The pattern of growth and obesity in Saudi Arabia male school children. Int J Obes Relat Metab Disord. 1996; 20(11):1000-5.##30. Barsh GS, Farooqi IS, Orahilly S. Genetics of body weight regulation, Nature. 20006; 404(6778); 644-51.##31. Serdula MK ,Ivery D, Coates RJ, et al. Do obese children become obese adults? A review of the literature. PrevMed . 1993; 22(2):161-77.##32. Guo SS, Roche AF, Chumlea WCet al. The predictive value of childhood body mass index value for overweight at age 35y. Am J ClinNutr. 1994; 59(4): 810.##33. Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescents, and adulthood in a birth cohort. Matern Child Health J. 2011 Nov; 15(8):1166-75.##34. Fall CH, Sachdev HS, Osmond C, et al. Adult Metabolic Syndrome and Impaired Glucose Tolerance Are Associated With Different Patterns of BMI Gain During Infancy. Diabetes Care. 2008 Dec; 31(12):2349-56.##35. Rachel Novotny, vinothaVijayadeva , John Grove, Unhee lim. Birth size and later centeral obesity among adolescent girls of Asian, white, and mixed ethnicities. Hawaii J Med Public Health. 2013; 72(2):50-5. ## ##

Potential investigation of Reusing Ardabil Municipal Wastewater Treatment Plant Sludge Based on AHP and TOPSIS Models Potential investigation of Reusing Ardabil Municipal Wastewater Treatment Plant Sludge Based on AHP and TOPSIS Models 2 1 Introduction :By ever-increasing of population, shortage of water resources and the necessity of wastewater treatment, huge volumes of sludge that is a byproduct of wastewater treatment, requires to be disposed in environmentally secure ways. The target of specifying strategic preferences of reuse of sludge has been to find the correct way of disposal or beneficial use of sludge. Material and methods: In this study, to select the best alternative for reuse of wastewater sludge two systematic methods are introduced, which four alternatives for reuse of sludge (use in agriculture, use in green space, biogas, desert combat) are introduced and they are compared by four main parameters including: 1- physicochemical 2-biological 3 - economic, social and cultural, and 4 - environmental pollution situation, that each contains some criteria. In this study, first each of the related parameters and criteria are compared by the expert groups of and through questionnaire. Then these weights are entered into Expert Choice software for the analyze of AHP model and paired comparisons and weightings have been done on the related parameters and criteria. Ultimately, the output of the software is entered into TOPSIS software for the analyze of TOPSIS model until the best alternative is selected. Results: sludge of Ardabil municipal wastewater treatment plant, according to standards and EPA regulations is eligible to class B, and due to the chemical in terms of heavy metals have special (excellent) quality and contains considerable quantities of organic substance, nutrients and micronutrients which indicates the fertilizer value of the sludge. Conclusion: The result of this comparison has shown that the application of sludge in green spaces is the most appropriate alternative and then use in agriculture, biogas alternative, and desert combat alternative are, respectively, placed in the second to fourth preference for the reuse of sludge derived from municipal wastewater treatment plant. 2 Introduction :By ever-increasing of population, shortage of water resources and the necessity of wastewater treatment, huge volumes of sludge that is a byproduct of wastewater treatment, requires to be disposed in environmentally secure ways. The target of specifying strategic preferences of reuse of sludge has been to find the correct way of disposal or beneficial use of sludge. Material and methods: In this study, to select the best alternative for reuse of wastewater sludge two systematic methods are introduced, which four alternatives for reuse of sludge (use in agriculture, use in green space, biogas, desert combat) are introduced and they are compared by four main parameters including: 1- physicochemical 2-biological 3 - economic, social and cultural, and 4 - environmental pollution situation, that each contains some criteria. In this study, first each of the related parameters and criteria are compared by the expert groups of and through questionnaire. Then these weights are entered into Expert Choice software for the analyze of AHP model and paired comparisons and weightings have been done on the related parameters and criteria. Ultimately, the output of the software is entered into TOPSIS software for the analyze of TOPSIS model until the best alternative is selected. Results: sludge of Ardabil municipal wastewater treatment plant, according to standards and EPA regulations is eligible to class B, and due to the chemical in terms of heavy metals have special (excellent) quality and contains considerable quantities of organic substance, nutrients and micronutrients which indicates the fertilizer value of the sludge. Conclusion: The result of this comparison has shown that the application of sludge in green spaces is the most appropriate alternative and then use in agriculture, biogas alternative, and desert combat alternative are, respectively, placed in the second to fourth preference for the reuse of sludge derived from municipal wastewater treatment plant. 96 106 2013/10/232013/09/142013/09/142013/09/14 1392/6/23 2013/12/72013/10/142013/09/222013/10/29 1392/8/7 بیژن مقصودلو کمالی Bizhan Maghsoudlou Kamali محمد تقی قانعیان Mohammad Taghi Ghaneian طالب عبدالهی Taleb Abdollahi abdollahi_67@yahoo.com . Farzadkia M. The study of stability condition and reuse capability of disposal sludge in four small refinery of Tehran municipal wastewater treatment. Scientific magazine of medicine and health & cure Services University of human.2002; 9(2): 55-62. [Persian]##2. Cherenisinoff PN. Sludge management and disposal. Englewood cliffs: prentice hall; 1994. ##3. Davis ML, Cornwell DA. Introduction Environmental Engineering. WCB McGraw-Hill Inc;1998. ##4. Sulivsn, D, Cogger C, Bary A. Fertilizing with bio solids. 2007. [cited 2010 21 Apr]. Available from: http://extension.oregonstate.edu/catalog/pdf/pnw/pnw508-e.pdf .##5. Payne M. Land Application of sewage bio-solids for crop production. Environmental science & Engineering, September. 2001.[ cited 2013 Apr 10]. Available from: http://www.esemag.com/archive/0901/land.html##6. Vaseghi S, Afyuni M, Shariatmadari H, et al. The effect of wastewater sludge on nutrition material density and the chemical characteristic of soil. Water and Wastewater Magazine.2005; 53:18-25.##7. Debosz K, Peterson SO, Kure LK, et al. Evaluation Effects of Sewage Sludge and Household Compost on Soil Physical, Chemical and Microbiological Properties. APP. Soil Ecol. 2002; 19(3):237-48.##8. Loo R. The Delphi Method: a Powerful Tool for Strategic Management. Journal of Police Strategies & Management. 2002; 25:762-9.##9. Dunham RB. The Delphi Technique. 1998. [cited 2012 21 Jun]Available from: http://instruction.bus.wisc.edu/obdemo.reading/delphi.htm. ##10. Makvandy R, maghsoudlou B, Mohammad Fam I. Having the multi criteria decision making in evaluation of the environmental outcomes of oil refinery by emphasize on the effects on environment polluters condition (case study: heavy oil refinery of Khuzestan) [MSc thesis]. Khuzestan: Islamic Azad university – science and researches branch of Khuzestan; 2011.##11. Hwang C L, Yoon KP. Multiple attribute decision making: an Introduction. London: Sage Publications; 1995.##12. Saaty TL. Decision making for managers. [A.Tofigh trans]. Tehran: Tehran University press; 2008. [Persian] ##13. Saaty TL. Transport planning with multiple criteria: The analytic hierarchy process application and progress review. J Adv Transp.1995; 29(1):81-126.##14. Saaty TL, Vargas LG. Prediction, Projection and Forecasting. Dordrecht: Kluwer Academic Publishers;1991.##15. Asgharpour M. Multi Criteria Decision Making (MCDM). Tehran: Tehran University press; 2011. #### ##

Performed a Qualitative and Quantitative of Breast Self-Examination: a Checklist Approach Performed a Qualitative and Quantitative of Breast Self-Examination: a Checklist Approach 2 1 Introduction: Breast neoplasia is the most common cancer among women in both in the developed and the developing country. Over 1.15 million women worldwide are detected with breast neoplasia each year and the mortality rate is 502,000 cases from this cancer. This study designs to describe how Iranian women perform breast self-examination. Materials and Methods: In this cross, sectional study 447 participants who referred to five-health center of Shahid Sadoughi University of Medical Sciences were chosen. The questionnaire and checklist were completed from all participants through a face-to-face interview. If she obtains 0-6 total score, she has weak Performance, if she obtains 7-12 total score, she has acceptable Performance and if she obtains 13-18 total score, she has good Performance of breast self-examination. Statistical analysis was carried out using Statistical Analysis Software (SAS) version 16. A P-value of <0.05 was considered statistically significant. Non-parametric tests such as Mann–Whitney were adopted. Results: In our study 92% of women heard about breast self-examination, but only 17.4% of them perform it monthly. From all 348 (77.9%) had poor, 78 (17.4%) moderate and only 21 (4.7%) had good performance. From all participants 189(42%) by health worker 36(8.1%) by family and 70(15.7%) by media learn how to perform breast self-examination. Conclusion: Study showed although most of women heard about Breast Self Examination but it was not a routine screening in developing country. This study confirmed that Iranian women have poor knowledge about how to perform breast self-examination. There is need for adequate health education on breast cancer and breast self-examination among Iranian women. 2 Introduction: Breast neoplasia is the most common cancer among women in both developed and developing countries. Over 1.15 million women in the world detecting with breast neoplasia each year and the mortality rate is 502,000 cases from this cancer. The purpose of this study was to describe how Iranian women perform breast self-examination. Materials and methods: In this cross-sectional study 447 participants referred to five health center of Shahid Sadoughi University of Medical Sciences were chosen. The questionnaire and checklist were completed by all participants through a face-to-face interview. If she obtains 0-6 total score, she has weak performance, if she obtains 7-12 total score, she has acceptable performance and if she obtains 13-18 total score, she has good performance of breast self-examination. Statistical analysis carried out using Statistical Analysis Software (SAS) version 16. A P-value of <0.05 was considered statistically significant. Non-parametric tests such as Mann–Whitney were adopted. Results: In our study, 92% of women heard about breast self-examination, but only 17.4% of them performed it monthly. Of 447 participants, 348 (77.9%) had poor, 78 (17.4%) moderate and only 21 (4.7%) had good performance. From all participants, 189(42%) by health worker, 36(8.1%) by family and 70(15.7%) by media learned how to perform breast self-examination. Conclusion: The study showed that although most of women heard about breast self-examination but it was not a routine screening in developing country. This study confirmed that Iranian women have poor knowledge about how to perform breast self-examination. There is need for adequate health education on breast cancer and breast self-examination among Iranian women. 107 116 2013/10/232013/09/142013/09/142013/09/142013/09/14 1392/6/23 2013/12/72013/10/142013/09/222013/10/292013/11/2 1392/8/11 مهشید بوکایی Mahshid Bokaie محمد حسن لطفی Mohammad Hassan Lotfi mhlotfi56359@ssu.ac.ir Breast Self-Examination Breast Breast Neoplasms Women Neoplasms 1. WHO Health Topics; Breast Cancer Awareness Month. [Cited 2013 Jan 14]. Available from: http://www.who.int/cancer/en/.##2. ٌWHO Health Topics; Cancer. [Cited 2013 Jan 14]. Available from: http://www.who.int/mediacentre/factsheets/fs297/en. accessed 30.07.2008.##3. Suh MA AJ, Fuh EA, Eta VA. Breast self-examination and breast cancer awareness in women in developing countries: a survey of women in Buea, Cameroon. BMC Res Notes. 2012; 9(5(:627-32.##4. Globocan . Breast Cancer Incidence and Mortality Worldwide in 2008. [Cited 2013 Jan 14]. Available from: http://globocan.iarc.fr/factsheets/cancers/breast.asp##5. Al-Naggar RA, Al-Naggar DH, Bobryshev YV, et al. Practice and barriers toward breast self-examination among young Malaysian women. Asian Pac J Cancer Prev. 2011; 12(5):1173-8.##6. Harirchi I, Ebrahimi M, Zamani N, et al. Breast cancer in Iran: a review of 903 case records. Public health. 2000; 114(2):143-5.##7. Mousavi SM, Montazeri A. Breast cancer in Iran: an epidemiological review. The breast journal. 2007; 13(4):383-91.##8. WHO. Breast cancer: prevention and control[Cited 2013 Jan 14]. Available from: http://www.who.int/cancer/detection/breastcancer/en/##9. WHO. Breast Cancer Awareness Month in October [Cited 2013 Jan 14]. Available from: www.who.int/entity/mediacentre/multimedia/podcasts/2009/en/ - 36k##10. Rao RS, Nair S, Nair NS, et al. Acceptability and effectiveness of a breast health awareness programme for rural women in India. Indian J Med Sci. 2005; 59(9):398-402.##11. Weiss NS. Breast Cancer Mortality in Relation to Clinical Breast Examination and Breast Self‐Examination. Breast J. 2003; 9 Suppl 2:S86-9.##12. DeSantis C, Siegel R, Bandi P, et al. Breast cancer statistics, 2011. CA: a cancer journal for clinicians. 2011; 61(6):408-18.##13. Tirona MT. Breast cancer screening update. Am Fam Physician. 2013; 87(4):274-8.##14. Montazeri A, Vahdaninia M, Harirchi I, et al. Breast cancer in Iran: need for greater women awareness of warning signs and effective screening methods. Asia Pac Fam Med. 2008; 7(1):1-7.##15. Mojahed M, firozabadi RD, Dafei M. kowlege and practice about breast self exam in nurses and midwifes in Yazd. Journal of Shahid Sadoughi University of Medical Sciences. 1380; 9(1):82-8.##16. Godazandeh G, Khani H, Khalilian A, et al. Knowledge and practice of above 15 years old females towards breast cancer prevention in Sari township. J Mazandaran Univ Med Sci. 2006; 16(52):64-76.##17. Nafissi N, Saghafinia M, Motamedi MHK, et al. A survey of breast cancer knowledge and attitude in Iranian women. J Can Res. 2012; 8(1):46-9.##18. Erbil N, Bölükbaş N. Beliefs, attitudes, and behavior of Turkish women about breast cancer and breast self-examination according to a Turkish version of the Champion Health Belief Model Scale. Asian Pac J Cancer Prev. 2012; 13(11):5823-8.##19. Al-Naggar RA BY, Al-Jashamy K. Practice of breast self-examination among women in Malaysia. Asian Pac J Cancer Prev. 2012; 13(8):3829-33.##20. Alwan N, Al Attar W, Eliessa R, et al. Knowledge and practices of women in Iraqi universities on breast self examination. East Mediterr Health J. 2012; 18(7):742-8. [Arabic]##21. Al-Dubai SA, Ganasegeran K, Alabsi AM, et al. Exploration of barriers to breast-self examination among urban women in Shah Alam, Malaysia: a cross sectional study. Asian Pac J Cancer Prev. 2012; 13(4):1627-32. ##22. Isara A, Ojedokun C. Knowledge of breast cancer and practice of breast self examination among female senior secondary school students in Abuja, Nigeria. J Prev Med Hyg. 2011; 52(4):186-90. Dahlui M, Ng C, Al Sadat N, et al. Is breast self examination (BSE) still relevant? A study on BSE performance among female staff of University of Malaya. Asian Pacific Journal of Cancer Prevention. 2011; 12(2):369-72.##23. Yoo B-N, Choi KS, Jung K-W, et al. Awareness and practice of breast self-examination among Korean women: results from a nationwide survey. Asian Pac J Cancer Prev. 2012; 13:123-5.##24. Yadollahie M, Simi A, Habibzadeh F, et al. Knowledge of and Attitudes toward Breast Self-Examination in Iranian Women: A Multi-Center Study. Asian Pac J Cancer Prev. 2011;12(8):1917-24. Alwan NA A-AW, Eliessa RA, Madfaie ZA, et al. Knowledge, attitude and practice regarding breast cancer and breast self-examination among a sample of the educated population in Iraq. East Mediterr Health J. 2012; 18(4):337-45.##25. Cubas MR, Felchner PC. Analysis of information sources about breast self examination available on the Internet. Cien Saude Colet. 2012 Apr;17(4):965-70.[ Portuguese] ##26. Özkan A, Malak AT, Gürkan A, et al. Do Turkish Nursing and Midwifery Students Teach Breast Self-Examination to Their Relatives?. Asian Pac J Cancer Prev. 2010; 11(6):1569-73.##27. Rosmawati N. Knowledge, attitudes and practice of breast self-examination among women in a suburban area in Terengganu, Malaysia. Asian Pac J Cancer Prev. 2010; 11(6):1503-8.##28. Parsa P KM, Parsa N. Factors associated with breast self-examination among Malaysian women teachers. East Mediterr Health J. 2011; 17(6):506-9.##29. Maheu C, Apostolidis T, Petri-Cal A, et al. French women’s breast self-examination practices with time after undergoing BRCA1/2 genetic testing. Familial cancer. 2012; 11(2):269-78.##30. Miller AB, Baines CJ. The role of clinical breast examination and breast self-examination. Preventive Medicine. 2011; 53(3):118-20.##31. Loh SY, Chew S. Awareness and practice of breast self examination among Malaysian women with breast cancer .Asian Pacific Journal of Cancer Prevention. 2011; 12(1):199-202.#### ##

The Immunization Coverage of Afghan Children at the Health Centers Supported by the United Nation Higher Commission in Kerman, Iran The Immunization Coverage of Afghan Children at the Health Centers Supported by the United Nation Higher Commission in Kerman, Iran 2 1 Introduction: Immunization is one of the most important health programs in first level prevention and is also one of the most cost-effective prevention programs in the entire world. This study evaluates the situation of immunization in fewer than one year old Afghan refugee children in Kerman, Iran. Materials and Methods: This was a cross-sectional study. Data was extracted from the records of the health centers supported by the higher commission of refuges in Kerman. The BCG, polio 0, DTP 3, polio 3, Hepatitis B 3 and MMR 1 was calculated and compared with the vaccine coverage in Iran and Afghanistan. Stata 11 and Excel 2007 and the chi-square statistics were used for the analysis. Results: The coverage of all BCG, Polio 0, DTP 3, Polio 3, Hepatitis B 3 and MMR 1 vaccines in the Afghan immigrants residing in Kerman between 2010 and 2012 was more than 95%. This coverage was not significantly different from the vaccine coverage of Iranian children, but was significantly higher than the vaccine coverage of children residing in Afghanistan. Conclusion: The vaccine coverage of Afghan children residing in Kerman is similar to Iranian children and is high and satisfactory. These results show part of The Islamic Republic of Iran’s commitment for providing health requirements for Afghan refugees residing in Iran. 2 Introduction: Immunization is one of the most important health programs in first level prevention and is also one of the most cost-effective prevention programs in the entire world. This study evaluates the situation of immunization in fewer than one year old Afghan refugee children in Kerman, Iran. Materials and Methods: This was a cross-sectional study. Data was extracted from the records of the health centers supported by the higher commission of refuges in Kerman. The BCG, polio 0, DTP 3, polio 3, Hepatitis B 3 and MMR 1 was calculated and compared with the vaccine coverage in Iran and Afghanistan. Stata 11 and Excel 2007 and the chi-square statistics were used for the analysis. Results: The coverage of all BCG, Polio 0, DTP 3, Polio 3, Hepatitis B 3 and MMR 1 vaccines in the Afghan immigrants residing in Kerman between 2010 and 2012 was more than 95%. This coverage was not significantly different from the vaccine coverage of Iranian children, but was significantly higher than the vaccine coverage of children residing in Afghanistan. Conclusion: The vaccine coverage of Afghan children residing in Kerman is similar to Iranian children and is high and satisfactory. These results show part of The Islamic Republic of Iran’s commitment for providing health requirements for Afghan refugees residing in Iran. 117 123 2013/10/232013/09/142013/09/142013/09/142013/09/142013/09/14 1392/6/23 2013/12/72013/10/142013/09/222013/10/292013/11/22013/10/14 1392/7/22 عزیزالله دهقان Azizallah Dehghan نرگس خانجانی Narges Khanjani روح الله زحمتکش Rouhollah Zahmatkesh 1.WHO Health Topics; Immunization. [Cited 2013 Jan 14]. Available from: http://www.who.int/topics/immunization/en/.##2.Fall in MMR vaccine coverage reported as further evidence of vaccine safety is published. Commun Dis Rep CDR Wkly; 9(26):227-30.##3.Salmaso S, Rota MC, Ciofi Degli, et al. Infant immunization coverage in Italy: estimates by simultaneous EPI cluster surveys of regions. Bull World Health Organ. 1999; 77(10):843-51.##4.Labaf-ghasemi R. Evaluation and monitoring of EPI program.In:Comprehensive public health. Tehran: Arjemand; 2007. ##5.Naimi E, Chaman R, Afshoon E. Vaccination coverage of children under 1year of age in the tribal community of kohgiloyeh and BoyerAhmad Province ArmaghanE Danesh. 2006; 10(38):66-77. [Persian]##6.Moradi A, Sangi M, Raziabadi F. Immunization of children under 2 years in the population covered by Tehran University of Medical Sciences 2006. Payesh. 2011; 9(2):155-64. [Persian]##7.Ramazani A, Miri MR, Hanafi H, et al. Estimates of immunization coverage for children and mothers and causes of discontinuation Delayed immunization of children and mothers in South Khorasan Province in 2006. Iranian Journal of Epidemiology. 2009; 5(1):1-7.##8. Iran (Islamic Republic of): WHO and UNICEF estimate of immunization coverage: 2012 revision. [cited 2012 Jan 14]. Available from: http://www.who.int/immunization_monitoring/data/irn.pdf##9. Afghanistan: WHO and UNICEF estimate of immunization coverage: 2012 revision. [cited 2012 Jan 14]. Available from:http://www.who.int/immunization_monitoring/data/afg.pdf##10.Findley SE, Irigoyen M, Schulman A. Children on the Move and Vaccination Coverage in a Low-Income, Urban Latino Population. Am J Public Health. 1999; 89(11):1728-31.## ##

Evaluation of knowledge, Attitude and Practice between Periodontal Disease and Diabetes Evaluation of knowledge, Attitude and Practice between Periodontal Disease and Diabetes 2 1 Introduction: The importance of the periodontal health maintenance and promotion in diabetes mellitus has been supported. Evidence showed that many patients are unaware about effects of diabetes mellitus on oral health. The aim of this study is to evaluate knowledge, attitudes and practice of diabetic patients concerning the risk of periodontal disease and prevention. Materials and Methods: In this cross sectional study, 156 diabetic patients referring to Yazd Diabetic Research Center were recruited by random selection. Patients completed questionnaires, which included 29 questions about their knowledge, attitude and practice of oral health in diabetes mellitus. The data was scored and analyzed. Result: The results showed knowledge (58.64) and attitude (46.86) scores of diabetic patients were moderate, while their practice (24.3) score were poor. There is statistical significant relation between mean scores of knowledge, attitude and practice of patients with their educational level and age. Conclusion: This study showed knowledge, attitude and practice level of diabetic patients were insufficient on oral health care. 2 Introduction: The importance of the periodontal health maintenance and promotion in diabetes mellitus has been supported. Evidence showed that many patients are unaware about effects of diabetes mellitus on oral health. The aim of this study is to evaluate knowledge, attitudes and practice of diabetic patients concerning the risk of periodontal disease and prevention. Materials and Methods: In this cross sectional study, 156 diabetic patients referring to Yazd Diabetic Research Center were recruited by random selection. Patients completed questionnaires, which included 29 questions about their knowledge, attitude and practice of oral health in diabetes mellitus. The data was scored and analyzed. Result: The results showed knowledge (58.64) and attitude (46.86) scores of diabetic patients were moderate, while their practice (24.3) score were poor. There is statistical significant relation between mean scores of knowledge, attitude and practice of patients with their educational level and age. Conclusion: This study showed knowledge, attitude and practice level of diabetic patients were insufficient on oral health care. 124 130 2013/10/232013/09/142013/09/142013/09/142013/09/142013/09/142013/09/14 1392/6/23 2013/12/72013/10/142013/09/222013/10/292013/11/22013/10/142013/10/14 1392/7/22 فاضله عطرباشی مقدم Fazele Atarbashi Moghadam احمد حائریان Ahmad Haerian مریم سادات سلامی Maryam Sadat Salami محمد حسن اخوان کرباسی Mohammad Hasan Akhavan Karbasi رهام فخر طباطبائی Roham Fakhr-Tabatabayi فرزانه وزیری Farzane vaziri farzane.vaziri@gmail.com 1. Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol. 2011 28; 7(12):738-48.##2. Weinspach K, Staufenbiel I, Memenga-Nicksch S, et al. Level of information about the relationship between diabetes mellitus and periodontitis - results from a nationwide diabetes information program. Eur J Med Res. 2013; 18(1):6.##3. Xiong X, Buekens P, Fraser WD, et al. Periodontal diseases and adverse pregnancy outcomes: a systematic review. BJOG. 2006; 113(2):135-43.##4. Gilowski Ł, Kondzielnik P, Wiench R, et al. Efficacy of short-term adjunctive subantimicrobial dose doxycycline in diabetic patients – randomized study. Oral Diseases. Oral Dis. 2012; 18(8):763-70.##5. Patil VA, Shivaraya R, Desai MH. Prevalence and severity of periodontal disease in type II diabetes mellitus (noninsulin-dependent diabetes mellitus) patients in Gulbarga, Karnataka, India: an epidemiological study. J Contemp Dent. 2013; 3(1):32-5.##6. Mirza KM, Khan AA, Ali MM, et al. Oral Health Knowledge, Attitude, and Practices and Sources of Information for Diabetic Patients in Lahore, Pakistan. DIABETES CARE. 2007; 30(12):3046-7.##7. Smith RM, Fleming LE, Arheart KL, et al. Periodontal Disease and Diabetes: and Attitudes Assessment Project. Florida Public Health Review, 2007; 4:12-7.##8. Grossi SG. Treatment of periodontal disease and control of diabetes: An Assessment of the Evidence and Need for future research. Ann Peridontal. 2001; 6(1):138-45.##9. Al-Khabbaz AK, Al-Shammari KF, Al-Saleh NA. Knowledge About the Association Between Periodontal Diseases and Diabetes Mellitus: Contrasting Dentists and Physicians. J Periodontal. 2011; 82(3):360-6.##10. Papapanou PN. Periodontal disease: epidemiology. Ann Periodontal. 1996; 1(1):1-36.##11. Emrich LJ, Shlossman M, Genco RJ. Periodontal disease in non-insulin dependent diabetes mellitus. J Periodontal. 1991; 62(2):123-31.##12. Loe H. periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care. 1993; 16(1):329-34.##13. Allen EM, Ziada HM, Ohalloran D, et al. Attitude, awareness and oral health- related quality of life in patients with diabetes. J Oral Rehabil. 2008; 35(3):218-23.##14. Al Habashneh R, Khader Y, Hammad MM, et al. Knowledge and awareness about diabetes and periodontal health among Jordanians. J Diabetes Copmlications. 2010; 24(6):409-14.##15. Gilbert AD, Nuttall NM. Self- reporting of periodontal health statues. Br DENT J. 1999; 186 (5):241-4.##16. Sreebny L, Yu A, Green A, Valdini A. Xerostomia in Diabetes Mellitus. Diabetes care. 1992; 15(7):900-4.##17. Yuen HK, Wolf BJ, Bndyopadhyay D, et al. Oral health knowledge and behavior among adults with diabetes. Diabetes Res Clin Pract. 2009; 86(3):239-46.##18. Karikoski A, Ilanne- Parikka P, Murtomma H. oral self-care and periodontal health indicators among adults with diabetes in Finland. Acta Odontal Scand. 2001; 59(6): 390-5.##19. Karikoski A, Ilanne- Parikka P, Murtomma H. oral self-care among adults with diabetes in Finland. Community Dent Oral Epidemiol 2002; 30(3): 216-23.##20. Ayanbadejo PO, Savage Ko, Jeboda SO. Awareness of periodontal disease amongst Nigerian diabetics. Odontostomatol Trop. 2004; 27(105):13-6.#### ##

Attitude of Supervisors of Yazd Educational Hospitals towards the Role of Personnel Element on the Market Share of Hospital Services Attitude of Supervisors of Yazd Educational Hospitals towards the Role of Personnel Element on the Market Share of Hospital Services 2 2 Introduction: Quality of services extremely depends on how personnel have contact and interaction with the clients. Moreover, the personnel’s attitudes and their behaviors with the clients significantly affect clients’ perception of quality of services and consequently influence their satisfaction as well as their absorption to the services of an institution. This study intends to investigate the supervisor’s attitude towards the effect of persons or the personal element (as one of the elements of the service marketing mix) on choosing the hospital by the patients and their companions. Materials and Methods: This cross-sectional descriptive study conducted in the winter of 2012. The study participant involved 35 supervisors in Yazd educational hospitals of Shahid Sadoughi University of Medical Sciences Shahid Rahnemoun and Afshar. The research data were gleaned via a researcher-made questionnaire on factors of the marketing mix which its validity and reliability were confirmed. Data analysis was performed using SPSS software. Results: Results revealed that supervisor’s belief in the increasing of market share of a hospital services in public hospitals are consist of: 1-Physical evidence 2- Service or product 3- People or persons 4- Efficiency and quality 5- Process 6- Distribution 7-Promotion or propagation and 8- Price. Therefore, the significance of the personnel role in absorption of a definite patient involves the third element in choosing the hospital by the patients. Conclusion: Based on this study, since the third factor in clients’ (patients, etc.) choices of hospital are the personnel and persons who provide services, it is confirmed that in service-based organizations like hospitals, the most important elements of quality of services in retaining and absorbing new clients and surviving the organization are the personnel activities who has been connected with organization clients. Moreover, it is regarded as a vital factor in developing effective relationships with the clients as well as their absorption in the hospital. 131 137 2013/10/232013/09/142013/09/142013/09/142013/09/142013/09/142013/09/142013/09/28 1392/7/6 2013/12/72013/10/142013/09/222013/10/292013/11/22013/10/142013/10/142013/10/22 1392/7/30 محمد زارع زاده Mohammad Zare Zadeh محمد رضا وفائی نسب Mohammad Reza Vafaei Nasab نجمه حاجیان Nadjme Hajian Hospital Marketing mix Personnel Service Supervisors 1. Mousavi SA, Khorvash F, Fathi H, et al. Survey the Average of Cost in out Patient and Imaging in Alzahra Hospital and Comparing with Service's Tar. Health Inf Manage. 2010; 7(2):235.[Persian]##2. Pamela LA, Robert BS. Strategies for building consumer brand preference. Journal of Product & Brand Management. 1999; 8(2):130-44.##3. Berkowitz EN. Essentials of health care marketing. 3th ed. Jones and Bartlett Publishers; 2011.##4. Sadagiani E. Organization and administration of Hospital. Tehran: Jahanrayaneh; l997.[Persian]##5. Yassi A, Wickstrom GJ, Palacios M. Globalization and the health of the health care workforce. Int J Occup Environ Health. 2004; 10(4):355-9.##6. Teh I, Chu C . Supplementing growth with medical tourism. APBN. 2005; 9(8):306-11.##7. Ramakrishnan R. CRM and four P’s of Marketing. Paper presented at: National Seminar On Customer Relationship Management; 25th February 2006.##8. Salehnia M, Mustafa K, JaziAhmadzad S. Effect of physical environment on mental image of the hospital: the consumer's perspective. Hakim Research Journal. 2012; 15(4): 321-7. [Persian]##9. Lovelock C, Wright L. Principles of Marketing Services. 2nd ed. Prentice Hall; 2002.##10. Simmons F, James A. Management Service: Strategy, Operations and Information Technology. [SM Arabi, D Izadi,trans]. Tehran: Office of Cultural Research Publication; 2005. [Persian]##11. Hopson B, Lugar J, Gatrvyd SM, et al. Service management: customer orientation culture. [M. Irannejadeparizi, trans]. 2nd ed. Tehran: modiran; 2005. [Persian]##12. TaghiPoorian MJ, Khazaeipool A. The role of physical evidence and the competence of staff in satisfaction, recruitment and retention of clients in banking services marketing. Proceedings of the 4th International Conference of banking service marketing; 2012; Tehran.[Persian]##13. Sabahi-Bidgoli M, Mousavi GA, Kebriaei A, et al. The Quality of Hospital Services in Kashan Educational Hospitals during 2008. Feyz Journal. 2011; 15(2): 146-52. [Persian]##14. Quli poor A. prioritizes the marketing mix factors in the hotel industry based on ahp technique. Business Reviews Journal. 2008; 33:34-41. [Persian]##15. Satyendra S. Impact of color on marketing. Management Decision. 2006; 44(6):783-9.##16. Taylor R, Pringle M, Coupland C. Implications of offering patient choice for routine adult surgical referrals. Research Report. London: 2004:122-41.##17. Haghparast MR. Evaluation and selection of appropriate promotion mix for marketing research companies (based on AHP group decision-making technique) [MSc Thesis]. Tehran: University of Modarres; 2000. [Persian]##18. Goodrich JN. Socialist Cuba: a study of health tourism. J Travel Res. 1993; 32(1):36-41.##19. Muller H, Kaufmann EL. Wellness tourism: market analysis of a special of health tourism segment and implications for the hotel industry. J Vacation Mark. 2001; 7(1):5-17. ## ##

Relationship between Lung Function and Flour Dust in Flour Factory Workers Relationship between Lung Function and Flour Dust in Flour Factory Workers 2 2 Introduction: Exposure to flour dust is an important risk factor in occurrence of allergic airway disorders among mill workers. The purpose of this study was to determine the prevalence of respiratory symptoms and its relation with exposure to respirable dust. Materials and Methods: In this study, all of 35 workers who worked in the flour producing section of three factories were chosen as case group and 20 unexposed people were selected as the control group. Exposure to total and respirable dust were measured with standard methods. Spirometry was used for determining lung function disorders and the America Lung Society Questionnaire was used for assessment of prevalence of respiratory symptoms. The results were analyzed by t-test, correlation and linear regression. Results: The average total and respirable dust exposure in the exposed group was 8.06 and 5.09 mg/m3 and was higher than the threshold limit value recommended by American Conference of Governmental Industrial Hygienists(ACGIH). 52% of workers had sputum in the morning and during waking up, 44% felt tightness of breath or pressure in the chest, 55% felt short of breath while walking fast and work and in 52% cough during work was experienced. There was a significant and negative correlation between total and respirable dust with Forced Vital Capacity(FVC), Forced Vital Capacity Percent(%FVC) and Forced Expiratory Volume in one second(FEV1). Conclusion: The results of this study indicate that exposure to respirable dust was more than 10 times higher than the threshold limit and caused a high prevalence of respiratory symptoms and lung function disorders among mills workers. 138 146 2013/10/232013/09/142013/09/142013/09/142013/09/142013/09/142013/09/142013/09/282013/10/13 1392/7/21 2013/12/72013/10/142013/09/222013/10/292013/11/22013/10/142013/10/142013/10/222013/10/13 1392/7/21 مجید باقری حسین آبادی Majid Bagheri Hosseinabadi جواد کروژده Javad Krozhdeh نرگس خانجانی Narges Khanjani احمدرضا زمانی Ahmadreza Zamani arzamani2005@gmail.com ملیحه رنجبر Malihe Ranjbar مصطفی محمدیان Mostafa Mohammadian 1. Meijster T, Warren N, Heederik D, et al. Application of a dynamic population-based model for evaluation of exposure reduction strategies in the baking industry. Journal of Physics: Conference Series.2009; 1(151): IOP Publishing.##2. Meijster T, Tielemans E, Schinkel J, et al. Evaluation of peak exposures in the Dutch flour processing industry: implications for intervention strategies. Annals of occupational hygiene. 2008; 52(7):587-96.##3. Meijster T, Tielemans E, Heederik D. Effect of an intervention aimed at reducing the risk of allergic respiratory disease in bakers: change in flour dust and fungal alpha-amylase levels. Occupational and environmental medicine. 2009; 66(8):543-9.##4. Elms J, Robinson E, Rahman S, et al. Exposure to flour dust in UK bakeries: current use of control measures. Annals of Occupational Hygiene. 2005; 49(1):85-91.##5. Kakooei H, Marioryad H. Exposure to Inhalable Flour Dust and Respiratory Symptom of Workers in a Flour Mill in Iran. Iranian Journal of Environmental Health Science & Engineering. 2005; 2(1)50-5.##6. Meijster T, Tielemans E, de Pater N, et al. Modelling exposure in flour processing sectors in the Netherlands: a baseline measurement in the context of an intervention program. Annals of occupational hygiene. 2007; 51(3):293-304.##7. Karpinski EA. Exposure to inhalable flour dust in Canadian flour mills. Applied occupational and environmental hygiene. 2003; 18(12):1022-30.##8. Meo SA, Al-Drees AM. Lung function among non-smoking wheat flour mill workers. Int J Occup Med Environ Health. 2005; 18(3):259-64.##9. Brisman J. Baker's asthma. Occup Environ Med. 2002; 59(7):498-502.##10. Smith T, Parker G, Hussain T. Respiratory symptoms and wheat flour exposure: a study of flour millers. Occupational medicine. 2000; 50(1):25-9.##11. Bulat P, Myny K, Braeckman L, Van Sprundel M, et al. Exposure to inhalable dust, wheat flour and α-amylase allergens in industrial and traditional bakeries. Annals of Occupational Hygiene. 2004; 48(1):57-63.##12. Warren N, Meijster T, Heederik D, et al. A dynamic population-based model for the development of work-related respiratory health effects among bakery workers. Occupational and environmental medicine. 2009; 66(12):810-7.##13. Mirmohammadi S, Moghaddasi Y. Indoor Air Pollution Modeling Based on Flour Dust in Industrial and Traditional Bakeries. World Applied Sciences Journal. 2011; 12(7):951-7.##14. Hur GY, Koh DH, Kim HA, et al. Prevalence of work-related symptoms and serum-specific antibodies to wheat flour in exposed workers in the bakery industry. Respiratory medicine. 2008; 102(4):548-55.##15. Patouchas D, Efremidis G, Karkoulias K, et al. Lungfunction measurements in traditional bakers. Acta Biomed. 2008; 79(3):197-203.##16. Baatjies R, Lopata A, Sander I, et al. Determinants of asthma phenotypes in supermarket bakery workers. European Respiratory Journal. 2009; 34(4):825-33.##17. Baatjies R, Meijster T, Lopata A, et al. Exposure to flour dust in South African supermarket bakeries: modeling of baseline measurements of an intervention study. Annals of occupational hygiene. 2010; 54(3):309-18.##18. Brant A, Berriman J, Sharp C, et al. The changing distribution of occupational asthma: a survey of supermarket bakery workers. European Respiratory Journal. 2005; 25(2):303-8.##19. Peretz C, de Pater N, de Monchy J, et al. Assessment of exposure to wheat flour and the shape of its relationship with specific sensitization. Scand J Work Environ Health. 2005; 31(1):65-74.##20. Eller PM, Cassinelli ME. NIOSH manual of analytical methods. DIANE Publishing; 1994.##21. Neghab M, Soltanzadeh A, Alipour A. Relationship between spirometry results and respiratory complaints to flour dust in flour mill workers. Iran Occupational Health. 2010; 7(2):45-51.##22. Skjold T, Dahl R, Juhl B, et al. The incidence of respiratory symptoms and sensitisation in baker apprentices. European Respiratory Journal. 2008; 32(2):452-9.##23. Wagh ND, Pachpande BG, Patel VS, et al. The influence of workplace environment on lung function of flour mill workers in Jalgaon urban center. Journal of occupational health. 2006; 48(5):396-401.##24. American Conference of Governmental Industrial Hygienists. Threshold limit values for chemical substances and physical agents and biliological exposure indices. Cincinnati (OH): ACGIH; 2010.## ## ##