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Community Assessment: A Current Essential Need 2 2 Health as a basic right of the people and essential demand should be considered as a joint responsibility of the government and people of a community. As much as the people of a community aware and involved in the individual health promotion and problem solving of their community in all dimensions, the probability of reaching to favorable health measurements is also increased. Community assessment is considered as a foundation for health improving and promoting the community members. The main objectives of community assessment are to identify factors that affect the health of a population and determine the availability of resources within the community to adequately address these factors. In this Vera, community leaders, public health agencies, businesses, hospitals, private practitioners, and academic centers have each one a defined role. These groups can begin to answer key questions such as (a) “What are the strengths in our community?” (b) “What health concerns do community members have?” and (c) “What resources are available and what do we need in the community to address these concerns? An important use of a community health assessment is to create Community Health Action to develop effective community health strategies. The health reform plan of Islamic Republic of Iran, started at the earlier months of the current year (2014), with establishing of the family physician program begun firstly at the level of rural regions, then will developed to cities with population 20000 to 500000 also borderlines of metropolitans cities and finally in the future, covering all urban eras of cities in the country aimed to executive the referral system with all its attributes. Being a full time physician along with a comprehensive teamwork including different prestigious health workers prepare a gold opportunity for implementation of community assessment in these regions. Although, some efforts have been accomplished in some parts of country by academic centers especially School of Public Health, Tehran University of Medical Sciences, under supervision and leadership of Professor Dr. Kourosh Holakouie- Naieni which appreciate these efforts. There is also an essential need in which all academic members in Universities of Medical Sciences of the country involve their students in this line, investment for the future. 79 79 2014/09/20 1393/6/29 2014/09/20 1393/6/29 محمدحسن لطفی Mohammad Hassan Lotfi 1- North Carolina Health Community Assessment Process. Office of Healthy Carolinians/Health Education and the State Center for Health Statistics North. North Carolina Department of Health and Human Services February 2002.##2- Holakouie naieni k, Ahmadvand A, Ahmadnezhad E, Alami A. A Community Assessment Model Appropriate for the Iranian Community. Iranian J Publ Health, Vol. 43, No.3, Mar 2014, pp.323-330 #### ##

Knowledge, attitude, and behavior regarding breast cancer screening among women referring to health centers of Yazd city آگاهی، نگرش و عملکرد زنان مراجعه‌کننده به درمانگاه‌های شهر یزد در مورد روش‌های غربالگری سرطان پستان 2 1 مقدمه: تشخیص زودهنگام سرطان پستان رابطه مستقیمی با آگاهی‌های زنان درباره سرطان پستان و روش‌های غربالگری آن دارد. هر چند سرطان پستان از اولویت‌های نظام بهداشتی استان یزد است، تاکنون آگاهی، نگرش و عملکرد زنان در یزد در این زمینه مورد بررسی قرار نگرفته است. هدف اصلی از انجام این مطالعه، بررسی سطح آگاهی، نگرش و عملکرد زنان مراجعه‌کننده به درمانگاه‌های شهر یزد در رابطه با روش‌های غربالگری سرطان پستان و رابطه آن با متغیرهای دموگرافیکی می‌باشد. مواد و روش‌ها: این مطالعه توصیفی-مقطعی در بین 438 زن مراجعه‌کننده به درمانگاه‌های شهر یزد در سال 1389 با استفاده از نمونه‌گیری خوشه‌ای انجام شد. برای جمع آوری اطلاعات پرسش نامه‌ای استاندارد حاوی اطلاعات دموگرفیک، تعیین سطوح آگاهی، نگرش و عملکرد، علل عدم انجام و انجام خودآزمایی پستان و منابع اطلاع‌رسانی در زمینه سرطان پستان و روش‌های غربالگری تنظیم و امتیازدهی شد. نتایج توسط آزمون‌های آماری نرم افزار SPSS آنالیز شد. یافته‌ها: در مورد روش‌های غربالگری سرطان پستان سطح آگاهی در حد متوسط تا ضعیف (%8/86)380 نفر و با سطح تحصیلات و سن رابطه معناداری دارد. نگرش در حد متوسط (%8/70)310 نفر و با سن و شغل رابطه معناداری دارد. عملکرد ضعیف (%8/65)288 نفر و با کلیه متغیرها به جز سابقه فامیلی سرطان پستان رابطه معناداری دارد. علت اصلی عدم انجام خودآزمایی پستان، عدم آگاهی از نحوه صحیح انجام خودآمایی پستان (%4/59)184 نفر گزارش شد. بااهمیت‌ترین منبع در خصوص اطلاع‌رسانی تلویزیون است. نتیجه‌گیری: بر اساس یافته‌های این مطالعه، زنان و دختران می‌بایست درباره این موضوع آموزش کافی کسب کنند. 2 Abstract: Background: Early detection of breast cancer has a direct relationship with women's knowledge about breast cancer and its screening methods. Knowledge, attitude, and behavior of women in Yazd haven't yet surveyed, however breast cancer is one of health institute's priorities. The objective of this study is to survey the knowledge, attitude, and behavior regarding breast cancer screening among women referring to health centers of Yazd city and its relationship with demographic variables. Material and Methods: This cross-sectional descriptive study was conducted on 438 women referring to health centers of Yazd city in 2010 by using cluster sampling. For collecting data, a standard questionnaire contains demographic characteristics, determination of knowledge attitude and behavior, reasons for not practicing and practicing breast self examination, and informing sources for breast cancer and screening techniques is designed and rated. The data are analyzed by statistical tests of SPSS software. Results: The knowledge of breast cancer screening techniques is about moderate to poor 380(86.8%) people and has a significant relationship with educational level and age. Attitude is about moderate 310(70.8%) people and has a significant relationship with age and job. Behavior is poor 288(65.8%) people and has a significant relationship with all variables other than familial history. The main reason for not practicing breast self examination is reported "not being aware of correct breast self examination practice" 184(59.4%) people. The most important source for informing is television. Conclusion: The Knowledge, attitude, and practice of women referring to health centers of Yazd are consistent with most studies. 80 95 2014/09/202014/08/31 1393/6/9 2014/09/202014/08/31 1393/6/9 سیدمصطفی شیریزدی Seyyed Mostafa Shiryazdi سعید کارگر Saeed Kargar علیرضا فرهبد Ali Reza Farahbod حسین نعمت زاده Hosein Neamatzadeh محدثه ابوئیان جهرمی Mohaddeseh Aboueian-Jahromi breast cancer screening Yazd knowledge attitude behavior. غربالگری سرطان پستان یزد آگاهی نگرش عملکرد. ##1. Nojomi M, Namiranian N, Myers RE, et al. Factors Associated with Breast Cancer Screening Decision Stage among Women in Tehran, Iran. Int J Prev Med. 2014;5(2):196–202.##2. Jafari-Koshki T, Schmid VJ, Mahaki B. Trends of breast cancer incidence in Iran During 2004-2008: A Bayesian space-time model. Asian Pac J Cancer Prev. 2014;15:1557-61.##3. 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.##4. Jarvandi S, Montazeri A, Harirchi I, et al. Beliefs and behaviours of Iranian teachers toward early detection of breast cancer and breast self-examination. Public Health. 2002;116(4):245-9.##5. Vakili M, Jafarizadeh M, Sadeghian MR, et al. Burden of breast cancer in females of Yazd province, 2006. KAUMS Journal ( FEYZ ). 2009;13(1):31-6.##6. Gerling GJ, Weissman AM, Thomas GW, et al. Effectiveness of a dynamic breast examination training model to improve clinical breast examination (CBE) skills. Cancer Detect Prev. 2003;27(6):451-6.##7. Bretthauer M, Kalager M. Principles, effectiveness and caveats in screening for cancer. Br J Surg. 2013;100(1):55-65.##8. Madan AK, Aliabadi-Wahle S, Babbo AM, et al. Education of medical students in clinical breast examination during surgical clerkship. The American journal of surgery. 2002;184(6):637-40.##9. Tria TM. Breast cancer screening update. Am Fam Physician. 2013;87(4):274-8.##10. Islam S, Aziz S. Mammography is the most effective method of breast cancer screening. Mymensingh medical journal: MMJ. 2012;21(2):366-71.##11. Nojomi M, Namiranian N, Myers RE, et al. Factors Associated with Breast Cancer Screening Decision Stage among Women in Tehran, Iran. Int J Prev Med. 2014;5(2):196.##12. Sunil T, Hurd T, Deem C, et al. Breast Cancer Knowledge, Attitude and Screening Behaviors Among Hispanics in South Texas Colonias. J Community Health. 2014;39(1):60-71.##13. DeSantis C, Siegel R, Bandi P, et al. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61(6):408-18.##14. Manassiev N, Whitehead MI. Female reproductive health: Parthenon Publishing Group; 2004.##15. Steward BW KP. World cancer report, World Health Organization Int Agen for Res on Cancer. Lyon IARC Press. 2003:12-8.##16. Kumar S, Imam AM, Manzoor NF, et al. Knowledge, attitude and preventive practices for breast cancer among health care professionals at Aga Khan Hospital Karachi. J Pak Med Assoc. 2009;59(7):474.##17. Nafissi N, Saghafinia M, Motamedi M, et al. A survey of breast cancer knowledge and attitude in Iranian women. J Cancer Res Ther. 2012;8(1):46.##18. Parsa P, Kandiah M, Mohd Zulkefli NA, et al. Knowledge and behavior regarding breast cancer screening among female teachers in Selangor, Malaysia. Asian Pac J Cancer Prev. 2008;9(2):221-7.##19. Vahabi M. Knowledge of breast cancer and screening practices among Iranian immigrant women in Toronto. J Community Health. 2011;36(2):265-73.##20. Mazloomi SS, Zare Joshghani M, Fesil M, et al. Effect rate of health training on knowledge, attitude, and practice of Yazd city guidance schools women teachers about breast cancer. Journal of Birjand University of Medical Sciences (JBUMS). 2006;13(1):9-15.##21. Haghighi F, Portaghali P, Rafaty Javanbakht L, et al. Knowledge, attitude, and practice of female teachers regarding breast cancer screening in Birjand. Modern care j. 2012;9(2):146-55.##22. Dandash KF, Al-Mohaimeed A. Knowledge, attitudes, and practices surrounding breast cancer and screening in female teachers of Buraidah, Saudi Arabia. Int J Health Sci (Qassim). 2007;1(1):61.##23. Behbahani BM, Tehrani TD, Gharibi F. P0228 Knowledge, attitude, and practice of Iranian women towards breast cancer screening methods. Eur J Cancer. 2014;50:e73.##24. 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):6.##25. Okobia MN, Bunker CH, Okonofua FE, et al. Knowledge, attitude and practice of Nigerian women towards breast cancer: a cross-sectional study. World J Surg Oncol. 2006;4(1):11.##26. Grunfeld E, Ramirez A, Hunter M, et al. Women's knowledge and beliefs regarding breast cancer. Br J Cancer. 2002;86(9):1373-8.##27. Banaeian S, Kazemian A, Kheiri S. Knowledge, attitude and practice about breast cancer screening and related factors among women referred to health care centers in Boroujen in 2005. J Shahrekord Univ Med Sci. 2006;7(4):28-34.##28. Donnelly TT, Al Khater A-H, Al-Bader SB, et al. Beliefs and attitudes about breast cancer and screening practices among Arab women living in Qatar: a cross-sectional study. BMC Womens Health. 2013;13(1):49.##29. Khalegnejad Tabari N, Khalegnejad Tabari A. The assessment of knowledge, attitude and behavior towards breast cancer screening methods among female teachers in Tehran. Iranian Journal of Surgery. 2008;16(1).##30. Godazandeh GA, Khani H, Khalilian AR, et al. Knowledge and practice of above 15 years old females towards breast cancer prevention in Sari township, 2004. J Mazandaran Univ Med Sci. 2006;16(52):64-74.##31. Othman A, Ahram M, Al-Tarawneh MR, et al. Knowledge, Attitudes and Practices of Breast Cancer Screening Among Women in Jordan. Health Care Women Int. 2014(just-accepted):00-.##32. Khani H, Moslemizadeh N, Montazeri A, et al. Knowlege, Attitude, and behavior level regarding to breast cancer prevention among health professional in south bank of Khazar. Iranian Journal of Breast Disease. 2008;1(2):28-37.##33. Ravichandran K, Al-Hamdan NA, Mohamed G. Knowledge, attitude, and behavior among Saudis toward cancer preventive practice. J Family Community Med. 2011;18(3):135.##34. Kadivar M, Joolaee S, Joulaee A, et al. Breast Cancer Knowledge, Attitudes and Screening Behaviors in Two Groups of Iranian Women: Physicians and Non-health Care Personnel. J Cancer Educ. 2012;27(4):770-3.##35. Donnelly TT, Al Khater A-H, Al-Bader SB, et al. Breast cancer screening among Arabic women living in the State of Qatar: Awareness, knowledge, and participation in screening activities. Avicenna. 2012(2012).#### ##

The Prevalence of Intestinal Parasites in Children Attending Day–Care Centers in Yazd City, Iran شیوع انگل های روده ای در کودکان مهدکودک های یزد 2 1 عفونت های انگلی روده‌ای در کشورهای در حال توسعه خیلی شایع است و عمدتا کودکان را مبتلا می‌سازد. مهدکودک ها مکان هایی هستند که کودکان برای کسب انگل های روده ای مستعدتر هستند. مواد و روش ها: این مطاله مقطعی برای تعیین شیوع انگل های روده ای در میان کودکانی که در مهدکودک های شهر یزد نگهداری می شوند انجام گرفت.180 کودک زیر 6 سال به صورت نمونه گیری خوشه ای انتخاب شدند. نمونه های تازه موضوع از هر کودک تهیه و به روش های مستقیم گسترش مرطوب و فرمالین- اتر آزمایش شدند. اطلاعات دموگرافیک و شاخص های تن سنجی کودکان نیز مثبت گردید. اطلاعات به دست آمده با استفاده از نرم افزار spss تجزیه و تحلیل گردید. نتایج: در مجموع 10 درصد از کودکان حداقل به یکی از انگل های روده ای آلوده بودند.میزان های عفونت بشرح ذیل بودند: بلاستوسیستیس هومی نیس 8/2درصد، ژیاردیا لامبلیا 8/2 درصد، آنتامبا کلی 1/1 درصد، کیلوماستیکس مسنیلی7/1 درصد و دی آنتامبافراژیلیس 1/1 درصد. میزان عفونت در پسران 9/12 درصد و در دختران 9/6 درصد بود. ارتباط بین سن، جنس، شاخص های تن سنجی و عقونت های انگلی از نظر آماری معنی دار نبود. یک تفاوت معنی دار به لحاظ آماری بین عفونت با تحصیلات والدین و شغل مادران مشاهده گردید (05/0> p) نتیجه گیری: نتایج این مطالعه، کاهش قابل ملاحظه ای در میزان عفونت های انگلی روده ای را در مقایسه با سایر مطالعات نشان داد. این کاهش ممکن است به دلیل ارتقاء بهداشت فردی و محیط باشد که بواسطه ارائه آموزش های عمومی، افزایش آگاهی های بهداشتی و بهبود تسهیلات بهداشتی ،دفع صحیح زباله و فاضلاب ، کنترل آب آشامیدنی و بهداشت مواد غذایی حاصل شده است. 2 Introduction: Intestinal parasitic infections are very common in developing countries and affect mostly children. Day care centers are places where children are more susceptible to acquire intestinal parasites. Material and Methods: This cross-sectional study was conducted to determine the prevalence of intestinal parasites among children who attend to day care centers in Yazd city. Eighty hundred children under six years old were selected by cluster sampling. Fresh faecal samples were collected from each child and examined by direct wet mount and formalin-ether techniques. Demography data and anthropometric indicators of children were also recorded. The obtained data were analyzed using SPSS software. Results: In total 10 % of children harbored at least one type of intestinal parasite. The rates of infection were as follows: Blastocystis hominis 2.8%, Giardia lamblia 2.8%, Entamoeba coli 1.1%, Chilomastix mesnili 1.7%, Dientamoeba fragilis 1.1.%. Infection rate in male was 12.9% and in female it was 6.9%. The relationship between sex, age, anthropometric indicators, and parasitic infection was not statistically significant. A statistically significant difference was observed between infection, parents’ education and mothers' job (P<0.005). Conclusion: The results of this study, showed a considerable decrease in the rate of intestinal parasitic infections in comparison with other studies. This may be owing to the improvements in personal environment, and health which have occurred through public education campaigns, health information raising, sanitation facilities improvement, proper waste and wastewater disposal, control of drinking-water, and food safety. 96 102 2014/09/202014/08/312014/08/26 1393/6/4 2014/09/202014/08/312014/08/26 1393/6/4 محمدحسین انوری تفتی Mohammad Hosein Anvari Tafti محمدمهدی میرجلیلی Mohammad Mehdi Mirjalili مهدی اقاباقری Mahdi Aghabagheri Intestinal Parasites Children Day–Care Centers Yazd انگل های روده ای کودکان مهدکودک ها یزد 1. 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Prevalence of intestinal parasites in day – care centers of Bam. Journal of Rafsanjan University of Medical Sciences and Health. 2002; 2(2):102-11.##18. Klantari N. Prevalence of intestinal parasites in day – care centers children in Babol, MSPH Thesis, Tehran University of Medical Sciences – School of Public Health. (1997).##19. Newman RD, Moore SR, Lima AA, et al. A longitudinal study of Giardia lamblia infection in north-east Brazilian children. Tropical Medicine & International Health. 2001; 6(8): 624–34.##20. Utzinger J, NGoran EK, Marti HP, et al. Intestinal amoebiasis, giardiasis and geohelminthiases: their association with other intestinal parasites and reported intestinal symptoms. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1999; 93(2):137–41.##21. Doyle PW, Helgason MM, Mathias RG , et al. Epidemiology and pathogenicity of Blastocystis hominis. Journal of Clinical Microbiology 1990, Vol. 28(1),pp: 116–21.##22. Fabiana lara, CarolinaM. Giardiosis in children –BMC Public health. 2002; 2(1):5-11. ##23. Machado RC, Maraci E. Giardiosis and helminthiasis in children of both public and private day-care centers in the city of Mitassol, Saopaulo state, Brazil Rev Sec Bras Med Trop. 1999; 32(6): 697-99.##24. Markell K, Voge M. Medical Parasitology, 8th edition1998. Saunders Company Publication, 1998;37--374##25. Atayian A. Survey of intestinal parasites in day-care center and primary school children in Zanjan –MSPH Thesis – School of Public Health, Tehran University of Medical Science. (1994).##26. Esfandiari F. Investigate the relationship between intestinal parasitic infections and nutritional status in children 13-60 month's old city of Sabzevar. Master Thesis in Nutrition and Health Sciences, School of Public Health, Tehran University of Medical Science. (1989).##27. Masloomi A. Prevalence of intestinal parasites in rural areas of Tabriz city and the role of health homes and water piped in control that. Master Thesis in medical parasitology, Tarbiat Modarres University, Tehran. (1988).##28. Ghorbani J. Investigate the relationship between intestinal parasitic infections and nutritional status in children 25-60 months old in villages of Tonekabon and Ramsar. Master Thesis in Nutrition and Health Sciences, School of Public Health, Tehran University of Medical Science. (1991),##29. Mosayebi M., Shahmoradi A. Survey of intestinal parasitic infections in underweight children under 5 years in rural regions of Borkhar and Meimeh, Isfahan province, Journal of Rahavard Danesh.1999;7(3):29-32.##30. Eigil S, Mahroof I, DKC. The effect of the availability of latrines on soil_ transmitted nematode infections in the plantation sector in Serilanka. Am J Trop Med Hyg. 1994; 51(1): 36-9.## ##

Performance Evaluation of Bauxite Activated Mines in Yazd Province in Order to Remove Fluoride from Drinking Water (Case Study: Kuhbanan Water) بررسی کارایی سنگ معادن فعال بوکسیت استان یزد در حذف فلوراید از آب زیرزمینی: مطالعه موردی آب کوهبنان 2 1 مقدمه: دریافت غلظت بالای فلوراید باعث مشکلات بهداشتی در سلامت انسان است، لذا یافتن راهی برای حذف فلوراید مازاد از اهداف مهم در پروژه های تأمین آب است. مطالعه با هدف بررسی کارایی بوکسیت معادن فعال استان یزد در حذف فلوراید آب آشامیدنی انجام گرفت. روش ها: مطالعه تجربی است، از اردیبهشت تا آبان سال 1392 روی نمونه سنتتیک و آب منطقه کوهبنان در مرکز تحقیقات مهندسی بهداشت محیط دانشگاه علوم پزشکی کرمان انجام شد. بوکسیت از معادن صدرآباد و شمال یزد استان یزد تهیه شد. آنالیز بوکسیت با روش طیف سنجی فلوئورسانس اشعه ایکس و طیف سنجی تفرق اشعه ایکس انجام گرفت. تاثیر پارامترهای pH ، زمان تماس، مقدار جاذب و غلظتهای مختلف فلوراید روی حذف بررسی گردید. شرایط بهینه روی نمونه واقعی انجام شد. به منظور درک بهتر فرایند جذب، سنتیک و ایزوترم جذب بررسی شد. میزان فلوراید به روش اسپادنس تعیین شد. تجزیه و تحلیل داده ها توسط نرم افزار Excel انجام شد. یافته ها: حداکثر راندمان حذف در pH 7، زمان تماس 180 دقیقه توسط 25 گرم در لیتر بوکسیت معدن صدرآباد 31/75 درصد و 30 گرم در لیتر بوکسیت معدن شمال یزد 90/59 درصد بدست آمد. راندمان حذف در نمونه واقعی در شرایط بهینه به ترتیب 21/51 و 68/36 درصد است. ایزوترم فروندلیچ با ضریب همبستگی بیشتر از 99 درصد برای هر دو نوع بوکسیت نتایج بهتری را نشان داده است. نتیجه گیری: بوکسیت معدن صدرآباد کارایی بالاتری نسبت به بوکسیت معدن شمال یزد است. 2 Introduction: A high concentration of fluoride causes health problems in man. How to remove excess fluoride from water is the objective of this project. The study focuses on an evaluation of the performance of activated bauxite mines in Yazd province in order to remove fluoride from drinking water. Materials and Methods: This study was an experimental one and conducted on synthetic samples and water from May to November of 2013 in Kuhbanan region at the Environmental Health Engineering Research Center. Bauxite was taken from Sadr Abad and Shomal-e-Yazd mines. Bauxite analysis was performed using X- Rey Fraction and X-Ray Diffraction. The effects of pH, contact time, adsorbent dose and different concentrations of fluoride on defluoridation were determined. The optimal conditions were performed on real samples. In order to better understand the processes of absorption, synthetic and adsorption isotherms were studied. Fluoride content was determined by the SPADNS method and data analysis was performed by Excel. Results: The maximum removal efficiency for synthetic solution was obtained by 25g/L bauxite of Sadr Abad mine and 30g/L bauxite of Shomal-e-Yazd mine at pH 7, the contact time of 180 minutes as 75.31% and 59.90%, respectively and removal efficiency of actual samples in optimum conditions was 51.21% and 36.68%. Freundlich isotherm with a correlation coefficient greater than 99% showed better results for both types of bauxite. Conclusion: bauxite from Sadr Abad mine is more efficient in comparison to bauxite from Shomal-e-Yazd mine. 103 114 2014/09/202014/08/312014/08/262014/08/26 1393/6/4 2014/09/202014/08/312014/08/262014/08/26 1393/6/4 محمد ملکوتیان Mohammad Malakootian مرضیه جاودان Marzie Javdan فرناز ایرانمنش Farnaz Iranmanesh Adsorption isotherm removal of fluoride Shomal-e-Yazd Bauxite Sadr Abad Bauxite ایزوترم جذب حذف فلوراید بوکسیت صدرآباد بوکسیت شمال یزد 1. Meenakshi, Maheshwari. Fluoride in drinking water and its removal. J Hazard Mater 2006; 137(1):456-63.##2. Nie Y, Hu C, Kong C. Enhanced fluoride adsorption using Al (III) modified calicium hydroxyapatite. J Hazard Mater 2012; 233-234:194-9.##3. Bhatnagar A, Kumar E, Sillanpaa M. Fluoride removal from water by adsorption—A review. Chem Eng J 2011; 171(3):811-40.##4. Mahvi AH, Boldaji MR, Dobaradaran S. [Evaluating the Performance of Iron Nano-particle Resin in Removing Fluoride from Water]. J Water & Wastewater (W.W.C.E) 2010; 4:33-7.##5. Daifullah A, Yakout S, Elreefy S. Adsorption of fluoride in aqueous solutions using KMnO4-modified activated carbon derived from steam pyrolysis of rice straw. J Hazard Mater 2007; 147(1-2):633-43.##6. Mohapatra M, Anand S, Mishra B, Giles DE, Singh P. Review of fluoride removal from drinking water. J Environ Manag 2009; 91(1):67-77.##7. Lavecchia R, Medici F, Piga L, Rinaldi G, Zuorro A. Fluoride Removal from Water by Adsorption on a High Alumina Content Bauxite.Chem Eng 2012; 26:1-6.##8. Nagendra Rao C. Fluoride and environment-a review. Proceedings of the 3th International Conference on Environment and Health, York University, Chennai, India 2003:386-399.##9. Dou X, Mohan D, Pittman CU, Yang S. Remediating fluoride from water using hydrous zirconium oxide. Chem Eng J 2012; 198-199:236-45.##10. Chidambaram S, Ramanathan A, Vasudevan S. Fluoride removal studies in water using natural materials: technical note. Water SA 2004; 29(3):339-44.##11. Sajidu S, Kayira C, Masamba W, Mwatseteza J. Defluoridation of Groundwater Using Raw Bauxite: Rural Domestic Defluoridation Technology. Environ Natur Resource Res 2012; 2(3):1-9.##12. Kumar E, Bhatnagar A, Kumar U, Sillanpaa M. Defluoridation from aqueous solutions by nano-alumina: Characterization and sorption studies. J Hazard Mater 2011; 186(2–3):1042-9.##13. Li W, Cao CY, Wu LY, Ge MF, et al. Superb fluoride and arsenic removal performance of highly ordered mesoporous aluminas. J Hazard Mater 2011; 198:143-50.##14. Das N, Pattanaik P, Das R. Defluoridation of drinking water using activated titanium rich bauxite. J Colloid Interf Sci 2005; 292(1):1-10.##15. Peter KH. Defluoridation of high fluoride waters from natural water sources by using soils rich in bauxite and kaolinite. J Eng Appl Sci 2009; 4(4):240-6.##16. Sujana MG, Anand S. Fluoride removal studies from contaminated ground water by using bauxite. Desalination 2011; 267(2–3):222-7.##17. Sadeghkasmaei l, Gorgin n, Fekrikohbanani m. Survey the amount of fluoride in Kohbanan (Kerman—Iran) soil and water and them effect on dental health. 1th international water crisis conference; 2008; Zabol University: Iran.##18. Standard Methods For the Examination of Water and Wastewater. 20th ed. Washington, 1998.##19. Gomoro K, Zewge F, Hundhammer B, Megersa N. Fluoride removal by adsorption on thermally treated lateritic soils. B Chem Soc Ethiopia 2012; 26(3):361-72.##20. Gulnaz O, Saygideger S, Kusvuran E. Study of Cu (II) biosorption by dried activated sludge: effect of physico-chemical environment and kinetics study. J Hazard Mater 2005; 120(1):193-200.##21. Malakootian M, Fatehizadeh A, Yousefi N, et al. Fluoride removal using Regenerated Spent Bleaching Earth (RSBE) from groundwater: Case study on Kuhbonan water. Desalination 2011; 277(1):244-9.##22. Sujana M, Pradhan H, Anand S. Studies on sorption of some geomaterials for fluoride removal from aqueous solutions. J Hazard Mater 2009; 161(1):120-5.##23. Mohapatra D, Mishra D, Mishra S, Chaudhury GR, Das R. Use of oxide minerals to abate fluoride from water. J Colloid Interf Sci 2004; 275(2):355-9.## ##

The Effect of Educational Intervention on Selection of Delivery Method Based on Health Belief Model. بررسی تاثیر مداخله آموزشی مبتنی بر مدل اعتقاد بهداشتی در انتخاب روش زایمان 2 1 مقدمه: تولد فرایندی طبیعی است که می تواند منجر به حوادث مرگبار و صدمات جدی به مادر و جنین شود. زمانی که امکان زایمان طبیعی برای مادر وجود ندارد وامکان خطربرای مادرویاکودک وجوددارد، زایمان با سزارین انجام می شود .در بسیاری از موارد ضرورت پزشکی منجر به زایمان به روش سزارین نیست بلکه ناآگاهی ، عقاید ، رفتارها و نگرش های غیر آزمون شده و غلط تعیین کننده نوع زایمان بوده است روش کار: مطالعه حاضر از نوع تجربی است که در مراکز بهداشتی درمانی شهر یزد انجام شده است.نمونه ها 130 نفر از زنان باردار نخست زا (65 نفر در هر یک از دو گروه نجربی و غیرتجربی)بودند که به روش نمونه گیری تصادفی انتخاب شدند. ابزار جمع آوری داده ها پرسشنامه ای محقق ساخته و مشتمل بر 4 بخش بود. قبل از اجرای مداخله آموزشی پرسشنامه مربوطه توسط دو گروه تکمیل شد. سپس گروه تجربی، مداخله آموزشی مبتنی بر مدل اعتقاد بهداشتی طی جلسات 45 دقیقه ای دریافت کردند. زنان هر دو گروه 2ماه بعد از مداخله، مجدداپرسشنامه های مربوطه را تکمیل کردند.داده های گرداوری شده با استفاده از نرم افزار آماری spss نسخه 18 و با استفاده از شاخصهای میانگین و انحراف معیار توصیف شد. رابطه بین سازه ها و متغیرهای دموگرافیک با استفاده از آزمونهای من ویتنی،کروسکال والیس و کای اسکوئر آنالیز شد. یافته ها:در این پژوهش میانگین سنی زنان 73/3±36/24 و میانگین سن بارداری 35/2±53/31 بود.یافته های بدست آمده نشان می دهد که اختلاف معنی داری در میانگین نمرات حساسیت درک شده(001/0=P)،شدت درک شده(001/0=P)،منافع درک شده(01/0=P)، موانع درک شده(01/0=P)و آگاهی(001/0=P)زنان گروه تجربی نسبت به زنان گروه غیرتجربی بعد از اجرای آموزش وجود داشت، در حالیکه اختلا ف معنی دارآماری بین سازه خودکارامدی درک شده (069/0P=) و نوع زایمان انجام شده بین دو گروه بعد از مداخله آموزشی مشاهده نشد. نتیجه گیری: در پژوهش حاضر اجرای مداخله آموزشی مبتنی بر مدل اعتقاد بهداشتی باعث افزایش آگاهی زنان باردار شده ،اما بر عملکرد آنها موثر نبوده است. از آنجا که در انتخاب روش زایمان عوامل متعددی غیر از آگاهی دخیل است ، لذا پیشنهاد می گردد بمنظور ارتقاء کارایی این الگو بطور همزمان از الگوهای دیگری که بر سایر عوامل نیز موثر باشد استفاده گردد. 2 Introduction- Pregnancy is a natural process that can lead to fatal accidents and serious injuries to the mother and fetus. When there is no possibility of vaginal delivery for the mother and There is a possible risk to the mother and children, Cesarean delivery is performed. In many cases there is no medical necessity for a cesarean delivery But ignorance, beliefs, behaviors and attitudes of non-false test has been determiner the method of delivery . Materials and methods-This was an experimental study that was done on pregnant women who were referee to health centers of Yazd city .The samples were 130 first pregnant mothers that were divided in two groups(65 case group and 65 control group). The samples were selected by random sampling. The data was collected by a researcher making questionnaire include 4 section. At first ,two groups completed the questionnaires , then the intervention was conducted for case group based on the Health Belief Model in given 45-minute sessions. about 2month after intervention , two groups completed the questionnaires twice. The data was analyzed with SPSS18 and describing Parameters the mean and the standard deviation . The relationship between structural and demographic variables were analyzed using Mann-Whitney, Kruskal-Wallis and Chi-square were analyzed. Results- In this study, the mean age of women was 24.36 ± 3.73 and the mean gestational age 31.53 ± 2.35, respectively.The results showed that there was significant difference between case and control groups after intervention in Perceived susceptibility(p=0.001),perceived threat(p=0.001),perceived benefit(p=0.01), perceived barrier(p=0.01) and knowledge(p=0.001).There was no significant difference between self efficacy (p=0.069)and methods of delivery between two group after intervention. Discussion- In this study educational intervention based on health belief model increased the awareness of pregnant women, However ,it has not been effective on their performance. Because many factors other than knowledge are involved in the choice of delivery method, It is proposed to enhance the efficiency of this model simultaneously different patterns that can be used effectively on other factors. 115 123 2014/09/202014/08/312014/08/262014/08/262014/08/26 1393/6/4 2014/09/202014/08/312014/08/262014/08/262014/08/26 1393/6/4 محمدحسین باقیانی مقدم Mohammad Hossein Baghianimoghadam طاهره هاشمی فرد Tahere Hashemifard سمیرا جعفری Samira Jafari پروین یدالهی Parvin Yadolahi Malihe هاشمی فرد Malihe Kamali moradzadah ملیحه کمالی مرادزاده Faeze Hashemifard فائزه هاشمی فرد Education HBM Method of Delivery and Pregnant Women آموزش مدل اعتقاد بهداشتی روش زایمان زنان باردار 1. Hajjian, K. The Assessment of Trend Changes in Cesarean Delivery Rate in Private Medical Centers in Babol City.Journal of ShahidBeheshti University of Medical Sciences.2002;26(3):175-179 .[In Persian]##2. WHO: Trends in maternal mortality: 1990-2008. World Health Organization Geneva; 2010 [http://whqlibdoc.who.int/publications/2010/ 9789241500265_eng.pdf].##3. Koblinsky M, Conroy C, Kureshy N, et al: Issues in programming for safe motherhood.2000 [http://pdf.usaid.gov/pdf_docs/PNACK513.pdf].##4. Nadham K, , Naael H. Intestinal Parasitic (Including Cryptosporidium) Infections in Day-Care Centers. Bahrain Medical Bulletin December. 2002; 24( 4):1-7.##5. Besharati F, Hazavehei SMM, Moeini B, et al. Effect of Educational Interventions Based on Theory of Planned Behavior (TPB) in Selecting Delivery Mode among Pregnant Women Referred to Rasht Health Centers. ZUMS Journal .2011; 19(77):94-106.[Persian]##6. Karami K, Najafian M, Shahri P, et al. Comparison of Frequency Vaginal and Cesarean Deliveries. Iranian J Pub Health. 2009; 38(4): 97-102. [Perisan]##7. Landon M.B C, Hauthj KJ, Leveno M.W. Maternal and prenatal outcomes associated with a trial of laborafter prior cesarean delivery. Engl Med. 2004; 351(3): 2581-89.##8. Richardson DK, Corcoran JD, Escobar GJ, et al. SNAP-II and SNAPPE-II. Simplified newbornillnessseverity and mortality risk scores. J Pediatr 2001; 138(4): 92-100.##9. Matias JP, Parpinelli MA, Cecatti JG. Factors associated with mode of delivery among primipara women with one previous cesarean section and undergoing a trial of labor. Rev Assoc Med Bras. 2007; 53(2): 109-15.##10. Glanz KA, Glanz K, Rimer BK, et al. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass. 2008; 14(1):12-71.##11. Guvenc G, AkyuzA ,Açikel CH. Health Belief Model Scale for Cervical Cancer and Pap Smear Test: Psychometric testing. Journal of Advanced Nursing. 2011; 67(2): 428-37.##12. Sharifirad Gh, Hassavei MM, Hasanzadeh A. The effect of health education based on HBM on preventive actions of smoking in gradeone middle school students.RahavardDaneshJournal. 2007; 17(65):59-66. [In Persian]##13. Ghafari M, Niknami SH, Kasemnejad A .Design and validity HIV/AIDS questionnaire inteen Kermanshah. Journal of Behbood, 2005; 11(1): 38-43. [In Persian]##14. Rahmati F, Niknami SH, Aminshokravi F. Evaluation HBM Model on planning preventive of HIV/AIDS in the students. Tehran University. The 3nd National Congress on Health EducationandPromotion.Hamedan; Hamedan University of Medical Sciences, 2008. [In Persian]##15. Saffari M, Shojaeizade D, GhofranipourF,Heydarnia AR, et al. Health education and promotion: Theories, models, methods. 1ed.Tehran: Sobhan: Pub; 2009. [In Persian]##16. Rahimikian F, Mirmohamadali M, Mehran A, et al. Effect of Education Designed based on Health Belief Model on Choosing Delivery Mode. Journal of Hayat 2008; 14(3-4): 103.##17. Tahvildari S. Usage of health belief model in breast self-examination. Health Education Ph.D Thesis, University of TarbiatModarres, 1999. (Persian)##18. Afshari A, Ghafari M.A. survey about the selection of delivery be the mothers in first delivery at Samirom city based on HBM. IJOGI. 2013; 16( 4748): 22-29.##19. Amidei M, Akbar Zadeh K. Effect of education on knowledge and attitude of pregnant women about cesarean. Journal of Ilam University of Medical Science. 2005; 13(4): 40-6.##20. Sharifi-rad GhR, Hazavei MM, Hasan- zadeh A, et al. The effect of health education based on health belief model on preventive actions of smoking in grade one, middle school students. Rahavard Danesh Journal of Arak Unit Med Sci. 2007; 1(10): 79-86. [persian]##21. Negahban T, Ansari Jaberi A, Kazemi M. Preference methods of delivery and its relevant causes in view of pregnant women referring to public and private clinics in Rafsanjan city. J of Rafsanjan Unit Med Sci. 2006; 5(3):161-8.##22. Howharn C. Effects of childbirth preparation classes on self-efficacy in coping with labor pain. Doctor of philosophy thesis. School of nursing, The University of Texas at Austin. 2008.##23. Khorsandi M, Ghofanipour F, Hidarnia A, et al. Effects of childbirth education classes on self-efficacy of nulliparous women in coping with labor pain. Bio Info Bank Library.2008; 5(4): 56-65.##24. Karimy M, Hasani M, Khorram R,et al. The effect of education, based on health belief model on breast self-examination in the Health volunteer in Zarandieh. TabibeShargh; J ZahedanUniv Med Sci. 2008; 10(4):79-87(persian).##25. Ganji F, Raeesi R, Khosravi SH,et al. Effect of participatory intervention on unnecessary cesareans in Shahr-e-kord. Journal of Shahre-kord University of Medical Sciences. 2006; 8(1): 14-18.##26. Fathian Z, Sharifirad GR. Effect of behavioral intention model-based education on cesarean reduction among pregnant women of Komeinishahr [MSc Thesis]. Isfahan: School of Health, Isfahan University of Medical Sciences; 2004:p. 39.##27. Ghaffari M,Sharifirad Gh,Akbari z, et al. Health Belief Model-Based Education & Reduction of Cesarean among Pregnant Women: An Interventional Study. Health System Research. 2011; 7(2):200-208.###### ##

Nutritional Status of Working Children as a Neglected Group in Kermanshah West of Iran بررسی وضعیت تغذیه ای کودکان کار در شهر کرمانشاه 2 1 مقدمه: شروع کار از سنین کودکی می تواند اثر منفی بر فرآیند رشد و وضعیت تغذیه ایجاد نماید. کودکان کار به علت مخاطرات شغلی در معرض انواع بیماریهای واگیردار و غیر واگیر دار همانند سوءتغذیه، کم خونی و عقب افتادگی در رشد هستند. این مطالعه با هدف تعیین وضعیت تغذیه و شیوع کم خونی در کودکان کار و غیر کار در شهر کرمانشاه انجام گرفت. روش کار: این مطالعه یک بررسی مورد- شاهدی بود که بر روی 90 پسر کار و 90 پسر عادی 18-8 ساله در شهر کرمانشاه انجام شد. پرسشنامه جمعیتی و پرسشنامه بسامد مصرف ابزارهای جمع آوری داده ها بودند. شاخصهای انتروپومتریک (تن سنجی) با استفاده از ابزارهای استاندارد اندازه گیری شدند. 5 میلی لیتر خون برای انجام آزمایش زیست شاخص های خونی از افراد شکت کننده در مطالعه گرفته شد. یافته ها: میانگین قد و وزن کودکان کار به ترتیب 7/3 سانتی متر و 7/5 کیلوگرم کمتر از کودکان غیر کار بود (0.02 = P) . شیوع فقر آهن در کودکان کار دو برابر کودکان غیر کار بود (28٪ در مقابل 3/11٪، 0.01 = P). غلظت هموگلوبین در کودکان کار در مقایسه با کودکان غیر کار بطور معنی داری کمتر بود (0.05 = P).مصرف تمامی گروه غذایی بجز گروه نان وغلات درکودکان کار به طور معنی داری کمتر از کودکان غیر کار بود (0.001 = P). نتیجه گیری: کودکان کار در معرض خطر ابتلا به سوءتغذیه و کم خونی هستند به همین دلیل نیازمند حمایت های ضروری تغذیه ای می باشند. 2 Introduction: Working at an early age can have adverse consequences on health. Working children due to their occupational hazards are at risk of communicable and non-communicable diseases such as malnutrition, anemia and growth retardation. This study aimed to determine the nutritional status and prevalence of anemia in working and non-working children. Methods: This case-control study was carried out as cross-sectional, on 90 working and 90 non-working 8-18 year-old boys in Kermanshah. The data gathering tools were demographic and food frequency questionnaires (FFQ). Anthropometric parameters were measured using standard tools. 5 ml blood for blood biomarkers test was collected from the participants. Results: Average height and weight of working children were respectively 3.7 cm and 5.7 kg less than of the non- working children (P = 0.02). Prevalence of iron deficiency in working children was more than double in the non-working children (28% vs 11.3%, P = 0.01). Hemoglobin concentration was less significantly in working children compare to non-working children (p=0.05). The working children as significantly consumed all of the food groups except the bread and cereals less than the non-working children (P <0.001). Conclusions: Working children are at risk to develop anemia and malnutrition so they need to emergencies nutritional supports. 124 131 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/26 1393/6/4 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/26 1393/6/4 یحیی پاسدار Yahya Pasdar میترا دربندی Mitra Darbandi سیدمصطفی نچواک Seyyed Mustafa Nachvak Working children nutritional status anemia & amp anthropometry. کودکان کار وضعیت تغذیه ای کم خونی و تن سنجی 1. Edmonds EV, Pavcnik N. Child Labor in the Global Economy. Journal of Economic Perspectives. 2005; 19(1): 199–220.##2. Turkmen M, Okyay P, Ata O, Okuyanoglu S. A descriptive study on street children living in a southern city of Turkey. Turk J Pediatr. 2004; 46(2):131-36.##3. Roggero P, Mangiaterra V, Bustreo F, RosatiF. The health impact of child labor in developingcountries: evidence from cross-country data. Am J Public Health. 2007; 97(2):271-5.##4. Gulzar SA, Vertejee S, Pirani L. Child labour: a public health issue. J Pak Med Assoc. 2009;59(11):778-81.##5. Hawamdeh H, Spencer N. Work, family socioeconomic status, and growth among working boys in Jordan. Arch Dis Child. 2001; 84(4):311-4.##6. Caglayan C, Hamzaoglu O, Yavuz CI, et al. Working conditions and health status of child workers: cross-sectional study of the students at an apprenticeship school in Kocaeli. PediatrInt. 2010;52(1):6-12.##7. El-Sahn F. Dietary patterns and nutritional assessment of working children at Abou El-Dardar industrial area in Alexandria City. J Egypt Public Health Assoc. 1992;67(1-2):119-45.##8. Hawamdeh H, Spencer N. Effect of work related variables on growth among working boys in Jordan. J Epidemiol Community Health. 2003;57(2):154-8.##9. United nation children’s fund (UNICEF). The state of the world’s children, Report United nation children’s fund (UNICEF) February 2012.##10. Azadbakht L, Esmaillzadeh A.R. Red meat intake is associated with metabolicsyndrom and the protein concentration in women. J Nutr plasma c-reactive. 2009;139(2):335-39.##11. Cable CT, Colbert CY, Showalter T, et al. Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? SurgObesRelat Dis. 2011;7(2):134–9.##12. Joshi SK, Sharma P. Peak expiratory flow rate of carpet weaving children. Indian Pediatr. 1996;33(2):105-8.##13. Ozener B, Duyar I. The effect of labour on somatotype of males during the adolescent growth period. Homo. 2008;59(2):161-72.##14. Omokhodion FO, Omokhodion SI. Health status of working and non-working school children in Ibadan, Nigeria. Ann Trop Paediatr. 2004;24(2):175-8.##15. Darmon N, Drewnowski A.Does social class predict diet quality?. Am J Clin Nutr. 2008 ;87(5):1107-17. ##16. Barakat AA, Nada KH, Ezzat DA. Prevalence and determining factors of anemia and malnutrition among Egyptian children. Indian J Med Sci. 2013; 67(7):168-77##17. Esin MN, Bulduk S, Ince H. Work related risks and health problems of working children in urban Istanbul, Turkey. J Occup Health. 2005;47(5):431-6.##18. Fallah F, Karimi A, Eslimi G, et al. The assessment of hepatitis B and C prevalence in street children of Tehran from Farvardin to 20007. Journal of Medical Research. 2008;32(2):147-51.##19. Tzannatos Z. Child labor and school enrollment in Thailand in 1990. Economic of education review 2003;22(1):523-36.## ##

Inequality in the Distribution of Health Expenditures in 22 Districts of Tehran نابرابری در توزیع مخارج سلامت در مناطق 22 گانه شهر تهران 2 1 زمینه و هدف: سازمان جهانی بهداشت (WHO) در سال 2000 یکی از اهداف سه گانه نظام سلامت را مشارکت عادلانه برای تامین مالی هزینه های سلامت اعلام کرده است. اما مطالعات صورت گرفته در کشور بیانگر وضعیت نامطلوب عدالت در تامین مالی هزینه های سلامت می باشد. هدف از مطالعه حاضر مطالعه اندازه نابرابری در مخارج سلامت با رویکردهای متفاوت است. مواد و روش ها: مطالعه حاضر یک پژوهش توصیفی-تحلیلی مقطی و مبتنی بر جمعیت است که نمونه آن 792 خانوار ساکن شهر تهران می باشد. ابزار گرداوری داده ها پرسشنامه سازمان جهانی بهداشت می باشد. جهت اندازه گیری نابرابری در مخارج سلامت از شاخص های FFC، شاخص تمرکز در مخارج سلامت، منحنی لورنز و هزینه های اسف بار سلامت می باشد. جهت انجام محاسبات ریاضی از نرم افزار Excel استفاده شده است. یافته ها: شاخص FFC با روش بهینه برابر با 57/0 و با روش معمول برابر با 62/0 محاسبه شد، شاخص تمرکز در مخارج سلامت سرپایی 105/0-، در مخارج سلامت بستری برابر با 015/0 و برای کل مخارج سلامت برابر با 044/0- بود. همچنین 2/7 درصد از خانوارها با مخارج اسف بار سلامت مواجه شده بودند. نتایج نشان داد بیمه خود می تواند عامل بوجود آمدن هزینه های اسف بار سلامت باشد. نتیجه گیری: نتایج نشان دهنده فاصله بسیار زیاد در وضعیت عدالت در سلامت کشور و اهداف برنامه های چهارم و پنجم توسعه کشور دارد. لذا باز نگری جدی در سیاست های تامین مالی، بیمه ای و ساختاری در نظام سلامت کشور نیاز می باشد. 2 Background and purpose: In 2000 World Health Organization (WHO) has announced the fairness of financial contribution to health care costs, as one of the three goals of health systems. However, conducted studies in Iran reflect the dire situation in the context of health equity in terms of financing health care costs. The aim of the present study is to determine the disparities in health expenditures by means of different approaches. Materials and Methods: The present study is a descriptive - analytic cross sectional population based study. The Sample consisted of 792 households residing in Tehran. Data was collected by WHO questionnaire. Indices of FFC, CI in health expenditure, Lorenz curve and catastrophic health care expenditure were used for measuring inequality in the distribution of health expenditures. Excel software was used to perform mathematical calculations. Results: FFC index was 0.57 by optimized method and was equal to 0.62 by ordinary formulas. Concentration index in outpatient services was -0.105, CI in inpatient services was 0.015 and for total health expenditures was equal to -0.044. Also, 7.2 present of households were faced with catastrophic health expenditures. Moreover results showed that insurance can be a reason of catastrophic expenditures by itself. Conclusion: Results indicated that there is a deep gap between the status of equity which is outlined in the 4th and 5th national plans of development and our current situation. So reforming in financial, insurance and structural policies is crucially needed. 132 144 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/262014/08/26 1393/6/4 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/262014/08/26 1393/6/4 محمدحسین غفوری Mohammad Hossein Ghafoori فربد عبادی فرد آذر Farbod Ebadifard Azar محمد عرب Mohammad Arab محمد محمودی Mahmood Mahmoodi نگار یوسف زاده Negar Yusef Zadeh عزیز رضاپور Aziz Rezapour Inequality FFC index Concentration Index Catastrophic Health Expenditures. نابرابری شاخص FFC شاخص تمرکز هزینه های اسف بار سلامت. 1. The world health report 2000. health systems: improving performance. Geneva: The World Health Organization; 2000.##2. Auerbach AJ, Card DE, Quigley JM. Public policy and the income distribution. New York: Russell Sage Foundation; 2006. p. 289-316.##3. Folland C,Allen C,Miron G.The Economics of Health and Health Care 7th ed. USA, Oakland university, 2012.##4. Semnani S. estimating justice in health services costs in Gorgan. journal of Gorgan university of medical sciences. 2003;5(12):9-53.[persian]##5. Fazaeli AA. survey equity in health financing in irans households. health administration. 2010;13(14):1-122. [persian]##6. Spinaci S, Currat L, Shetty P, et al. Tough choices: investing in health for development. India:World Health Organization. 2006.##7. Fourth Five-Year Development Plan set. Tehran: presidence, 2005.[Persian]##8. Razavi M, Hasanzadeh A, Basmangi k. Fairness in Financial Contribution. Tehran: Ministry of Health and Medical Education; 2005.[Persian]##9. Karami M, Najafi F, Karami Matin B. Catastrophic health expenditures in Kermanshah, west of Iran: magnitude and distribution. Journal of research in health sciences. 2009; 9(2):36-40.##10. Makinen M, Waters H, Rauch M, et al. Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition. Bulletin of the World Health Organization. 2000;78(1): 55-65.##11. Culyer AJ. The dictionary of health economics. UK, Edward Elgar Publishing, 2008.##12. Bredenkamp C, Mendola M, Gragnolati M. Catastrophic and impoverishing effects of health expenditure: new evidence from the Western Balkans. Health policy and planning. 2011; 26(4): 56-349.##13. Salti N, Chaaban J, Raad F. Research Health equity in Lebanon: a microeconomic analysis. 2010;9(11):1-21.##14. Falkingham J, Akkazieva B, Baschieri A. Trends in out-of-pocket payments for health care in Kyrgyzstan: 2001–2007. Journal of Health policy and planning. 2010; 25(5):36-427.##15. López-Cevallos DF, Chi C. Health care utilization in Ecuador: a multilevel analysis of socio-economic determinants and inequality issues. Journal of Health policy and planning. 2010;25(3):18-209.##16. Yardim MS, Cilingiroglu N, Yardim N. Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2010; 94(1):26-33.##17. Gotsadze G, Zoidze A, Rukhadze N. Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC health services research. 2009; 9(1): 1-69.##18. Angel-Urdinola D, Cortez R, Tanabe K. Equity, access to health care services and expenditures on Health in Nicaragua. Washington DC: World Bank; 2008. p. 21-32.##19. Morris S, Sutton M, Gravelle H. Inequity and inequality in the use of health care in England: an empirical investigation. Social science & medicine. 2005;60(6):66-1251.##20. Mendoza-Sassi R, Béria JU, Barros AJD. Outpatient health service utilization and associated factors: a population-based study. Revista de saúde pública. 2003; 37(3): 8-372.##21. Dunlop S, Coyte PC, McIsaac W. Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey. Social science & medicine. 2000;51(1): 33-123.##22. Xu K. Distribution of health payments and catastrophic expenditures Methodology/by Ke Xu. World Health Organization. 2005; 2(5):1-7.##23. Wagstaff A. Measuring financial protection in health. World Bank Policy Research Working Paper Series. 2008;4554:1-31.##24. Ammar W, Kasparian R. What is fair in financing fairness? Le Journal médical libanais The Lebanese medical journal. 2001;49(3):1-126.##25. Navarro V. Assessment of the world health report 2000. The Lancet. 2000; 356(9241): 601-1598.##26. Szwarcwald CL. On the World Health Organisation's measurement of health inequalities. Journal of Epidemiology and Community Health. 2002;56(3):82-177.##27. Göçmez Ö. Out of Pocket Payments for Healthcare in Turkey and Equity in Financing. 2003 - 2006. Erasmus University; 2010:1-53.##28. Galárraga O. The impact of universal health insurance on catastrophic and out-of-pocket health expenditures in Mexico: A model with an endogenous treatment variable. Health Econometrics and Data Group Working Paper. 2008:12(8):2-32.##29. Sparrow R, Suryahadi A, Widyanti W. Social Health Insurance for the Poor: Targeting and Impact of Indonesia’s Programme. Social science & medicine; 2012; 96(2013):264-271.##30. Murray CJL, Knaul F, Musgrove P, et al. Defining and measuring fairness in financial contribution to the health system. World Health Organization: GPE Discussion Paper Series; 2001; 24: 1-38.##31. Xu K, Evans DB, Kawabata K, et al. Household catastrophic health expenditure: a multicountry analysis. The Lancet. 2003;362(9378):111-7.##32. Kavosi Z, Rashidian A, Pourreza A, et al. Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health policy and planning. 2012; 27(7): 23 - 613.##33. Limwattananon S, Tangcharoensathien V, Prakongsai P. Catastrophic and poverty impacts of health payments: results from national household surveys in Thailand. Bulletin of the World Health Organization. 2007;85(8): 6-600.##34. Fazaeli AA. Measuring Equity in health care financing in Iran(2003-2006). Tehran: health deputy of ministry of health, Applied research center; 2007.##35. Asefzadeh S, Alijanzadeh M, Gholamalipoor S, et al. Households Encountering with Catastrophic Health Expenditures in Qazvin, Iran. Health information management. 2013; 10(1): 146-153. ##36. Nekoeimoghadam M, Akbari-Javar M, Amiresmaili M, et al. Households Exposure to Catastrophic Health Expenditures and the Affecting Factors in Kerman Province, Iran. Journal of Management and Medical Information School. 2014; 1(2): 74-85.[persian]##37. Lee T-J. 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Physicians’ awareness in Yazd province about Biological Effects of ionizing radiation applied in radiological imaging procedures آگاهی پزشکان استان یزد درباره اثرات بیولوژیک پرتوهای یونیزان مورد استفاده در روشهای تصویربرداری رادیولوژی 2 1 زمینه: پرتوهای یونیزان دارای خطرات دراز مدتی بویژه سرطان می باشند. از آنجا که پزشکان برای بیماران آزمونهای رادیولوژی را درخواست می نمایند، آنها باید از منافع و خطرات این آزمونها آگاه باشند. هدف از انجام این مطالعه، ارزیابی آگاهی پزشکان استان یزد درباره خطرات پرتوهای یونیزان مورد استفاده در روشهای تصویربرداری رادیولوژی بود. روش بررسی: در یک مطالعه توصیفی با استفاده از یک پرسشنامه شامل 25 سوال، آگاهی پزشکان در زمینه پرتوهای یونیزان و خطرات سرطانزایی آن در روشهای تصویربرداری رادیولوژی مورد ارزیابی قرار گرفت. همچنین سوالاتی در زمینه اطلاعات جمعیت شناسی شامل سن، جنس، تخصص و سابقه کار پرسیده شد. پرسشنامه ها در بین پزشکان شاغل در استان یزد توزیع و توسط آنها تکمیل شد. سپس پرسشنامه های تکمیل شده با نرم افزار آماری مناسبی مورد تجزیه و تحلیل قرار گرفت. نرمال بودن توزیع داده ها با استفاده از آزمون شاپیرو، ویلکس و آزمون کولموگروف اسمیرنوف بررسی شد. برای متغیرهای پیوسته و مقایسه تفاوت میانگین نمرات برای متغیرهای دو بخشی از آزمون t استفاده شد. ضریب همبستگی اسپیرمن برای یافتن رابطه بین متغیرهای سن و تجربه با آگاهی پزشکان انجام شد. نتایج: میانگین نمره کل آگاهی 15/3 ± 14 از 25 سوال، و یا 6/12% ± 56% بود و محدوده نمرات از 5/11% تا 81% بود. میانگین نمره کل با سن و سابقه کار همبستگی نداشت، اما بین مردان و زنان(P value= 0.001) و همچنین بین دو گروه پاسخ دهنده اصلی یعنی پزشکان عمومی و متخصصین (P value= 0.012) تفاوت معنی داری وجود داشت. آگاهی پزشکان در مورد اثرات زیانبار اشعه شامل اثرات قطعی و اثرات تصادفی بسیار ضعیف بود. نتیجه گیری: آگاهی پزشکان در مورد پرتوها به طور کلی ناکافی است. آموزش کافی به پزشکان در مورد خطرات ناشی از آزمونهای رادیولوژی ضروری به نظر می رسد، و تجدید نظر در برنامه درسی دانشجویان پزشکی در این زمینه توصیه می شود. 2 Introduction: Ionizing radiation has long-term risks, especially cancer. Since physicians request radiological examinations for patients, they need to be aware of its benefit and also risks. The aim of this study was to assess the overall knowledge of physicians in Yazd province about the radiation risks associated with diagnostic imaging procedures. Material and Methods: In this descriptive study a questionnaire containing 25 questions was used to evaluate physicians’ knowledge of radiation doses received from radiological procedures and risks of cancer from diagnostic imaging. Their demographics such as age, sex, specialty and experience (years of practice) was also asked. Normality of data distribution was assessed using the Shapiro–Wilks test and the Kolmogorov–Smirnov test. A t-test was used for continuous variables and comparison of mean differences in scores for dichotomous variables. Spearman's correlation coefficient was carried out to look for any relationship between variables of age and experience with the knowledge of the physicians. Results: The overall mean knowledge score was 14 ± 3.15 out of 25 questions, or 56% ± 12.6%, and the scores ranged from 11.5% to 81%. The total mean score did not correlate with age and experience, but there was a significant difference (P value= 0.001) between men and women and also among the two main respondent groups, general practitioners and specialists (P value= 0.012). Physicians’ knowledge about detrimental effects of radiation including both deterministic and stochastic effects was very weak. Conclusion: The awareness of physicians about radiation is generally inadequate. Adequate training to practicing physicians about risks of radiological examinations seems needed, and revision of the curriculum of medical students in this area is recommended. 145 152 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/262014/08/262014/07/8 1393/4/17 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/262014/08/262014/07/8 1393/4/17 علی چاپاریان Ali Chaparian ali_chaparian@yahoo.com حسین حکمتی مقدم Hosain Hekmati moghadam مهسا منصوریان Mahsa Mansourian Physicians Awareness Ionizing radiation Imaging procedures Cancer پزشکان؛ آگاهی؛ پرتوهای یونیزان؛ روشهای تصویربرداری سرطان 1. McCusker MW, de Blacam C, Keogan M, et al. Survey of medical students and junior house doctors on the effects of medical radiation: is medical education deficient? Irish journal of medical science. 2009; 178(4): 479-83. ##2. Beir V. Health risks from exposure to low levels of ionizing radiation. BEIR VII phase. 2006; 2.##3. Ron E. Cancer risks from medical radiation. 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Photocatalytic Degradation of Humic Acid by Ag/ZnO Nanoparticles under UVC Irradiation from Aqueous Solutions Photocatalytic Degradation of Humic Acid by Ag/ZnO Nanoparticles under UVC Irradiation from Aqueous Solutions 2 1 Introduction: Humic acid (HA) is one the original disinfection byproducts processors in water treatment. So, removing it is necessary before water chlorination. In the present study, photodegredation of humic acid in water using Ag/ZnO nano particle under UVc irradiation in batch system was investigated. Material and Methods: Photocatalytic study was carried out to evaluate the effect of UVc (15w), irradiation time of (10 - 40min), pH (5 - 9), initial humic acid concentration of (10-50 mg/L) and Ag/ZnO dosage of (0.2 – 0.8 g/L) on humic acid removal. HA concentration was monitored spectrophotometrically by measuring the HA absorbance at 254 nm. Results: HA removal efficiency was obtained 88% at pH 7, Ag/ZnO dosage 0.6 g/L, initial humic acid concentration 25 mg/L and irradiation time 40 min. The removal of HA from aqueous solution increased by increasing irradiation time and decreasing initial HA concentration. Also, the kinetic study was consistent with pseudo-first order reaction. Conclusion: The results showed that photocatalytic degredation process using Ag/ZnO nanoparticles can be used efficiently for HA removal from aqueous solutions. 2 Introduction: Humic acid (HA) is one the original disinfection byproducts processors in water treatment. So, removing it is necessary before water chlorination. In the present study, photodegredation of humic acid in water using Ag/ZnO nano particle under UVc irradiation in batch system was investigated. Material and Methods: Photocatalytic study was carried out to evaluate the effect of UVc (15w), irradiation time of (10 - 40min), pH (5 - 9), initial humic acid concentration of (10-50 mg/L) and Ag/ZnO dosage of (0.2 – 0.8 g/L) on humic acid removal. HA concentration was monitored spectrophotometrically by measuring the HA absorbance at 254 nm. Results: HA removal efficiency was obtained 88% at pH 7, Ag/ZnO dosage 0.6 g/L, initial humic acid concentration 25 mg/L and irradiation time 40 min. The removal of HA from aqueous solution increased by increasing irradiation time and decreasing initial HA concentration. Also, the kinetic study was consistent with pseudo-first order reaction. Conclusion: The results showed that photocatalytic degredation process using Ag/ZnO nanoparticles can be used efficiently for HA removal from aqueous solutions. 153 161 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/262014/08/262014/07/82014/07/8 1393/4/17 2014/09/202014/08/312014/08/262014/08/262014/08/262014/08/262014/08/262014/07/82014/07/8 1393/4/17 محمدتقی قانعیان Mohammad Taghi Ghaneian معصومه طباطبایی Masoumeh Tabatabaee پوران مروتی Pouran Morovati P.Morovaty@yahoo.com محمدحسن احرامپوش Mohammad Hassan Ehrampoush علی دهقانی Ali Dehghani Keywords: Humic acid water treatment Ag/ZnO nanoparticle photocatalytic oxidation Keywords: Humic acid water treatment Ag/ZnO nanoparticle photocatalytic oxidation ##1. Valencia S, Marín J.M, Restrepo G, Frimmel F.H. Evaluations of the TiO2/simulated solar UV degradations of XAD fractions of natural organic matter from a bog lake using size-exclusion chromatography. Water Research. 2013; 47(14): 5130–5138##2. 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