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تشخیص بهتر سلامت رانندگان با بهره گیری از شبکه عصبی مصنوعی Better Diagnosis of Health Status in Drivers by Using Artificial Neural Network 1 1 هدف: عدم کنترل سلامت رانندگان باعث مرگ انسان‌های سالم در بهترین دوره زندگی از نظر کارایی، تندرستی می‌شود و هزینه‌های مالی زیادی را بر کشور تحمیل می‌کند. هدف این مطالعه طراحی سیستم هوشمند با استفاده از شبکه عصبی MLP و RBF  جهت تشخیص سلامت رانندگان است. روش بررسی: 350  نمونه  از پرونده رانندگان مراجعه کننده به مرکز طب کار استان ایلام انتخاب گردید، سپس اطلاعات بالینی از پرونده رانندگان بصورت چک لیست با استفاده از نظر متخصصان براساس گاید لاین وزارت بهداشت با روش دلفی گردآوری شد. در این مطالعه شبکه هایMLP و  RBFبا تغییراتی درتعدادلایه‌های میانی، تعداد نرونها و الگوریتم‌های آموزش  MOMو LMوCG  به منظور تعیین سلامت راننده به کار گرفته شد. سپس با توجه به معیارهای سطح زیر منحنی راک، حساسیت، ویژگی برتر معرفی گردید. نتایج: در این پژوهش 20 متغیر ورودی و دو متغیر سالم و ناسالم خروجی تعیین گردید. شبکه عصبی  MLPو RBF با الگوریتم LM دارای بهترین عملکرد به ترتیب از ویژگی 7/66، 29  درصد، حساسیت 2/97، 100 درصد، صحت 1/91، 86درصد و سطح زیر منحنی راک برای سیستم عصبی MLP و RBF به ترتیب 02/91 و 1/88 بدست آمد. نتیجه گیری: با توجه به این مطالعه مدل شبکه عصبی  MLPبا الگوریتم آموزشی  LMدر مقایسه با سیستم عصبی RBF، در سنجش سلامت رانندگان می‌تواند نقش موثری در کمک به پزشکان داشته باشد و در مراکز طب کار برای بالا بردن دقت و سرعت و کاهش هزینه‌ها به کار گرفته شود. 2 Introduction: Uncontrolled health status of drivers, can lead to the death of healthy individuals who are living in their best periods of life in terms of performance and wellness and also it can impose huge financial costs on a country. The purpose of this study was to design an intelligent system using Multilayer perceptron (MLP) and radial basis function (RBF) neural networks in order to diagnose drivers’ health status Methods: In this study, we applied the MLP and RBF networks with some changes in the number of middle layers, neurons, as well as learning algorithms such as Momentum (MOM), Conjugate Gradient (CG), and Levenberg Marquardt (LM) in order to diagnose the health status of the drivers.) Then, the best model was introduced according to the area under receiver operating characteristics (ROC) curve, sensitivity, and precision criteria. Results: In this study, 20 variables were selected as inputs and two variables that include healthy and unhealthy status were determined as output parameters. MLP and RBF neural networks with LM algorithm have the best performance with 66.7% and 29% precision; 97.2% and 100% sensitivity; 91.1% and 86 % accuracy respectively. The area under ROC curve for the nervous system MLP and RBF estimated 91.02 for MLP and 88.1 for RBF. Conclusion: According to this study, the MLP neural network model with the LM learning algorithm compared to the RBF neural network can have an important role in helping physicians in order to diagnose drivers’ health status. Furthermore, such a model can be used in centers of occupational medicine to enhance the accuracy and the speed of diagnosis and reduce costs. 1 12 2016/08/5 1395/5/15 2016/10/4 1395/7/13 لیلا شاهمرادی Leila Shahmoradi دانشگاه علوم پزشکی تهران ایران Lshahmoradi@tums.ac.ir زهرا کهزادی Zahra Kohzadi دانشگاه علوم پزشکی تهران ایران z.kohzadi91@yahoo.com مریم سرایی Maryam Saraei دانشگاه علوم پزشکی تهران ایران m-saraei@tums.ac.ir Intelligent Systems Artificial Neural Networks Drivers’Health Status سیستم های هوشمند شبکه های عصبی مصنوعی سلامت رانندگان 1- Sadeghnyat KH IN, Bolori A, Naserbakht A, Mirzamohamadi E, Sohrabi M. Performing medical procedures and criteria for issuing drivers' health. Iran, Tehran: Health Department environmental and workplace health centers; 1390. p. 1-26.##2- Murray CJ, Lopez AD, Mathers CD, Stein C. The Global Burden of Disease 2000 project: aims, methods and data sources. Harvard Burden of Disease Unit, Center for Population and Development Studies Massachusetts, Boston, USA; 2001.##3- Saba A, Hamdolahi M, Adamnezhad SH, Reza G. Health and safety of drivers in road transport and offering effective strategies to improve it. Traffic Management Studies. 1388: 103-12.##4- Torres A, Nieto JJ. Fuzzy logic in medicine and bioinformatics. BioMed Research International. 2006; 2006.##5- Zolnoori M, Zarandi MHF, Moin M, Taherian M. Fuzzy rule-based expert system for evaluating level of asthma control. Journal of medical systems. 2012; 36(5): 2947-58. ##6- Szczepaniak, Piotr S Lisboa, Paulo JGKacprzyk, Janusz. Fuzzy systems in medicine. Springer Science & Business Media; 2000.##7- R Nayak, LC Jain, BK, H Ting. Artificial Neural Networks Biomedical Engineering: A Review. 2001.##8- Kay JW, Titterington DM, (eds). Statistics and neural networks: Advanced at the interface. Oxford: Oxford University Press, 1999.##9- Baxt WG. and Skora J. Prospective validation of artificial neural networks trained to identify acute myocardial infarction. Lancet 1996; 347: 12-5.##10- Mobley BA, Schecheer E, Moore WE, McKee PA, Eichner JE. Prediction of coronary artery enosis by artificial networks. Artif Intell Med 2000; 18: 187-203.##11- Warner B. and Manavendra M. Understanding neural networks as statistical tools. Am Stat 1996; 50: 284-293.##12- Ripely BD, Ripely RM. Neural Networks as Statistical Methods in Survival Analysis. Artificial Neural Networks: Prospects for Medicine (R. Dybowsky and V. Gant eds. 2007), Landes Biosciences Publishers, 1998.##13- Haykin S. Neural networks: A Comprehensive Foundation, 2nd ed, Upper Saddle River, NJ: Prentice- Hall, 1999.##14- Basheer IA and Hajmeer M. Artificial neural networks: fundamentals, computing, design, and application. J Microbiologic Meth 2000; 43: 3-31.##15- Young SJ, Jamieson LM. Delivery methodology of the Delphi: A comparison of two approaches. Journal of Park and Recreation Administration 2001; 19 (1): 42-58. ##16- Privacy executive instructions how to do medical examinations and issuing of drivers' health; 2015, Iran Ministry of Health and Medical Education.##17- Lai KC, Chiang HC, Chen WC, Tsai FJ, Jeng LB. Artificial neural network-based study can predict gastric cancer staging. Hepatogastroenterology 2008; 55: 1859-1863.##18- Chien CW, Lee YC, Ma T, Lee TS, Lin YC, Wang W, Lee WJ. The application of artificial neural networks and decision tree model in predicting post-operative complication for gastric cancer patients. Hepatogastroenterology 2008; 55: 1140-45.##19- Er Orham Sc, Temurtas FCT. A Comparative study on chronic obstructive Pulmonary and pneumonia disease diagnosis using neural networks and artificial Immune system. Med Sys 2009; (33): 48-92.##20- Cao Y, Hu ZD, Liu XF, Deng AM, Hu CJ. An MLP classifier for prediction of HBV-induced liver cirrhosis using routinely available clinical parameters. Disease Markers 2013; 35(6): 653-60.##21- Launay CP, Rivière H, Kabeshova A, Beauchet O. Predicting prolonged length of hospital stay in older emergency department users: Use of a novel analysis method, the Artificial Neural Network. Euro J Internal Med 2015; 26(7): 478-82.##22- João Filho BD, de Seixas JM, Galliez R, de Bragança Pereira B, de Q Mello FC, dos Santos AM, Kritski AL. A screening system for smear-negative pulmonary tuberculosis using artificial neural networks. Int J Infectious Diseases 2016.##23- Aguiar FS, Torres RC, Pinto JV, Kritski AL, Seixas JM, Mello FC. Development of two artificial neural network models to support the diagnosis of pulmonary tuberculosis in hospitalized patients in Rio de Janeiro, Brazil. Med Biol Engineer Comput 2016: 1-9.## ##

شیوع اگزمای دست خود گزارشی در آرایشگران زن شهر ارومیه و عوامل موثر بر آن در سال 1394 Self-reported hand eczema prevalence in hairdressers of Urmia city and its associated factors in 2015 1 1 مقدمه: آرایشگران زن در حرفه خود در معرض مواد شیمیایی و حساسیت زاهای مختلفی قرار دارند که ممکن است اثرات نامطلوب پوستی مانند اگزمای دست را موجب گردند. پژوهش حاضر با هدف تعیین شیوع اگزمای خود گزارشی در نمونه ای از آرایشگران شهر اورمیه و عوامل موثر بر آن در سال 1394 انجام شد. روش بررسی: مطالعه از نوع توصیفی - تحلیلی به روش مقطعی بود که درآن 385 نفر آرایشگر زن و 385 نفر زن از جمعیت عمومی شهر ارومیه به ترتیب به عنوان گروه‌های مورد و کنترل انتخاب شدند. شیوع یک ساله اگزمای دست با استفاده از پرسشنامه پوست شغلی نوردیک و به طریقه مصاحبه حضوری بدست آمد. داده ها با استفاده از نرم افزار آماری SPSS نسخه 16 و با استفاده از آزمون‌های آماری توصیفی و آزمون‌های تحلیلی از قبیل کای دو،  تی زوجی مستقل و رگرسیون لجستیک تحلیل شدند. نتایج: میانگین و انحراف معیار سن و سابقه کار آرایشگران به ترتیب 2/7±16/33  و 7/5±72/8 سال بود. شیوع اگزمای یک ساله دست در آرایشگران و گروه کنترل به ترتیب (28/32-32/23=CI) 8/27% و(58/15-02/9=CI) 2/13% بود. نسبت شانس (OR) ابتلا به اگزمای دست در آرایشگران نسبت به گروه کنترل (64/3-72/1=CI) 52/2 بود. بر اساس تحلیل رگرسیون لجستیک، مصرف سیگار ((85/6-73/1) 44/3=OR) سن کمتر از 30 سال ((96/2-04/1) 76/1=OR) و سابقه کار کمتر از 10 سال ((04/6-63/1) 14/3=OR) شانس ابتلا به اگزمای دست را در آرایشگران زن افزایش داد. نتیجه گیری: بر اساس این مطالعه می توان نتیجه گرفت که آرایشگران زن - در مقایسه با جامعه عمومی- در معرض خطر بیشتر اگزمای دست می باشند. بنابراین در این حرفه باید اقدامات حفاظت شغلی بمنظور کاهش و کنترل اگزمای دست بکارگرفته شود. پیشنهاد می شود که آرایشگران جوان مراقبت های بیشتری را برای جلوگیری از مشکلات اگزمای دست انجام دهند 2 Introduction: Hairdressers in their occupation are exposed to different chemicals and sensitizers that may cause adverse skin effects such as hand eczema. The current investigation aimed to determin the self-reported hand eczema prevalence in a sample of hairdressers of Urmia city and its associated factors in 2015. Methods: The study was a cross-sectional case control design in which 385 hairdressers and 385 women from general population were selected as case and control groups, respectively. One-year prevalence of hand eczema was detemined using Nordic Occupational Skin Questionnaire by the face to face interview. Data were analyzed by SPSS 16 version using descriptive and analytical statistics such as chi-squered, T-test, and logistic regression. Results: The mean and standard deviation for age and work experience of hairdressers were 33.16±7.2 and 8.72 ±7/5, respectively.One-year prevalence of hand eczema in hairdressers and control group were %27.8 (CI=23.32-32.28) and %13.2 (CI=9.02-15.58). The odds ratio (OR) for hand eczema in hairdressers (their control group as the reference) was 2.52 (CI=1.72-3.64). Base on the logistic regression analysis, smoking (OR=3.44 (1.73-6.85)), age less than 30 years (OR=1.76 (1.04-2.96)), and work experience less than 10 years (OR=3.14 (1.63-6.04)) increased the chance of having hand eczema in hairdressers. Conclusions: According to this study, it could be concluded that hairdressers, compared to the general population, are at a higher risk of hand eczema. Therefore, occupational protective measures should be applied in this occupation to decline and control of hand eczema. It is proposed that young hairdressers would be more careful to prevent  skin problems such as hand eczema. 13 22 2016/08/52016/04/22 1395/2/3 2016/10/42016/10/24 1395/8/3 محمد حاج آقازاده Mohammad Hajaghazadeh دانشگاه علوم پزشکی ارومیه ایران شعله جعفری Shole Jafari ایران شیرین حکمتی راد Shirin Hekmatirad ایران hairdressers hand eczema skin problems Nordic Occupational Skin Questionnaire آرایشگران زن اگزمای دست مشکلات پوستی پرسشنامه پوست شغلی نوردیک 1- Deschamps F, Langrand J, Lesage FX. Health Assessment of Self-employed Hairdressers in France. J Occup Health 2014(56): 157-63.##2- Lind M-L, Albin M, Brisman J, Diab KK, Lillienberg La, Mikoczy Z, et al. Incidence of hand eczema in female Swedish hairdressers. Occup Environ Med 2007; (64): 191-5.##3- Bregnhøj A, Søsted H, Menn´e T, Johansen JD. Validation of self-reporting of hand eczema among Danish hairdressing apprentices. Contact Dermatitis 2011; (65): 146-50.##4- Hougaard G M, Winther L, Søsted H, Zachariae C, Johansen JD. Occupational skin diseases in hairdressing apprentices –has anything changed? Contact Dermatitis 2014; (72): 40-6.##5- Søsted H. Occupational Contact Dermatitis: Hairdressers, in Contact Dermatitis. Jahanson JD, Editor. 2011, Springer Berlin Heidelberg: denmark. p. 865-71.##6- Van der Walle H. Hairdressers, in Handbook of Occupational Dermatology, Kanerva L, Wahlberg JE., Editors. 2004, Verlag Berlin Heidelberg New York. 451-64.##7- Uter W, Pfahlberg A, Gefeller O, Schwanitz HJ. Risk of hand dermatitis among hairdressers versus office workers. Scand J Work Environ Health., 1999; 25(5): 450-6.##8- Kieć-Swierczyńska M, Krycisz B, Chomiczewska D. Occupational contact dermatitis in hairdressers. Med Pr 2009; 60(5): 377-82.##9- Mälkönen T, Jolanki R, Alanko K, Luukkonen R, Aalto-Korte K, Lauerma A, Susitaival P. A 6-month follow-up study of 1048 patients diagnosed with an occupational skin disease. Contact Dermatitis 2009; (61): 261-8.##10- Diepgen T, Coenraads P, The epidemiology of occupational contact dermatitis. Int Arch Occup Environ Health 1999; 72(8): 496-506.##11- Diepgen TL, Occupational skin-disease data in Europe. Int Arch Occup Environ Health 2003; 76(5):331-8.##12- HS Hansen, Søsted H, Hand eczema in Copenhagen hairdressers—prevalence and under‐reporting to occupational registers. Contact Dermatitis 2009; 61(6): 361-3.##13- Lysdal SH, Søsted H, Andersen KE, Johansen JD. Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences. Contact Dermatitis 2011; 65: 151-8.##14- Perkins JB, Farrow A. Prevalence of occupational hand dermatitis in UK hairdressers. Int J Occup Environ Health 2005; 11(3): 289-93.##15- Warshaw EM, Wang MZ, Mathias CT, Maibach HI, Belsito DV, Zug KA, et al. Occupational contact dermatitis in hairdressers/cosmetologists: retrospective analysis of North American Contact Dermatitis Group data, 1994 to 2010. Dermatitis 2012; 23(6): 258-68.##16- Coenraads P, Van Der Walle H, Thestrup‐Pedersen K, Ruzicka T, Dreno B, De La Loge C, et al. Construction and validation of a photographic guide for assessing severity of chronic hand dermatitis. Br J Dermatol 2005; 152(2): 296-301.##17- Bregnhøj A, Søsted H, Menn´e T, Johansen JD. Healthy worker effect in hairdressing apprentices. Contact dermatitis 2010; 64: 80-4.##18- Febriana SA, Soebono H, Coenraads P-J. Occupational skin hazards and prevalence of occupational skin diseases in shoe manufacturing workers in Indonesia. Occup Environ Health 2013; 87(2): 185-94 ##19- Flyvholm MA, Bach B, Rose M, Jepsen KF. Self-reported hand eczema in a hospital population. Contact Dermatitis 2007; 57(2):110-15.##20- adeghyan F, Zadeh MD, Moghadam HK, Zadeh SH. Prevantation of hand dermatitis and some relevant ingredient among care and midwefery personal. Daneshvarmed 2005; 14(67): 25-32. [Persian]##21- Susitaival P, Flyvholm MA, Meding B, Kanerva L, Lindberg M, Svensson A, et al. Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure. Contact Dermatitis 2003; (49): 70-6.##22- Bregnhøj A, Menné T, Johansen JD, Søsted H. Prevention of hand eczema among Danish hairdressing apprentices: an intervention study. Occup Environ Med 2012; 69(5): 310-6##23- Attwa, E. and El‐Laithy N., Contact dermatitis in car repair workers. J Eur Acad Dermatol Venereol 2009; 23(2): 138-45.##24- Alikhan A, Maibach H, Lachapelle JM. Textbook of Hand Eczema. 2014; Springer. p. 78##25- Kralj N, Oertel Ch, Doench NM, Nuebling M, Pohrt U, Hofmann F. Duration of wet work in hairdressers. Int Arch Occup Environ Health 2011; 84: 29-34.##26- Montnemery P, Nihlen U, Löfdahl CG, Nyberg P, Svensson Å. Prevalence of hand eczema in an adult Swedish population and the relationship to risk occupation and smoking. Acta Derm Venereol 2005; 85(5): 429-32.## ## ##

اختلال عملکرد شناختی در مواجهه با صدای ترافیک Study of cognitive dysfunction in exposure to traffic noise 1 1 هدف: رانندگی از جمله مشاغل دارای وظایف شناختی (Cognitive task) پیچیده است که نیازمند سطح بالایی از هوشیاری و واکنش به هنگام در شرایط اضطراری می‌باشد. هر عاملی که منجر به تخریب عملکرد شناختی در پردازش ذهنی راننده شود، ریسک رخداد تصادف را افزایش می‌دهد صدای ترافیک از جمله عوامل مخرب عملکرد شناختی است که در این مطالعه مورد بررسی قرار گرفت. روش بررسی: در این مطالعه نمونه ای به حجم 80 نفر(40 مورد و 40 شاهد) از دانشجویان دانشکده بهداشت علوم پزشکی تهران بصورت سیستماتیک انتخاب شدند. صدای ترافیک ضبط شده با میانگین تراز فشار صوت معادل 9/72 دسی بل در اتاق اکوستیک به مدت 2 ساعت برای شرکت کنندگان پخش شد. به منظور اندازه‌گیری زمان عکس‌العمل و خطا در تخمین زمان جابجایی به ترتیب از نرم افزارهای RT و ZBA استفاده شد. نتایج: نتایج نشان می‌دهد که زمان عکس‌العمل بعد از مواجهه با صدای ترافیک بطور معنادرای افزایش یافت. همچنین بین خطا در تخمین زمان جابجایی قبل و بعد از صدای ترافیک تفاوت معناداری وجود نداشت. نتیجه گیری: با توجه به نتایج بدست آمده می‌توان گفت فعالیت‌های ذهنی مانند سرعت و قدرت پردازش اطلاعات تحت تاثیر صدای ترافیک تغییرات متفاوتی رانشان می‌دهد. 2 Introduction: driving is such a complex cognitive task that requires a high level of vigilance and response to an emergency. Anything that leads to cognitive performance degradation in the driver's mental processing, increases crash risks. Traffic noise as one of the most destructive elements of cognitive function was examined in this study. Methods: In this study, the sample consisted of 80 patients (40 cases and 40 controls) who were students of Tehran University of medical sciences that were selected through systematic sampling and then the average sound pressure level recorded traffic noise was played for participants in the acoustics room. To Measure reaction time and error in time movement anticipation, the RT and ZBA softwares were used ,respectively. Results: The results revealed that reaction time increased significantly after exposure to traffic noise. The error time movement after exposure to traffic noise has not significant difference. Conlusions: According to the results it can be concluded that mental activities such as speed and power of information processing are affected by traffic noise and in a confrontation with traffic noise show different changes. 23 31 2016/08/52016/04/222015/08/23 1394/6/1 2016/10/42016/10/242016/10/24 1395/8/3 مجتبی ذکایی Mojtaba Zokaei ایران ایرج علیمحمدی Iraj Alimohammadi ایران فاطمه ابارشی Fatemeh Abareshi ایران محسن فلاحتی Mohsen Flahati ایران یوسف فقیه نیا ترشیزی Freshte Tahery ایران حامد جلیلیان Hamed Jalilian ایران علی اصغر خواجه وندی Ali asghar Khajevandi ایران Cognitive performance Traffic noise Reaction time Error in time movement anticipation عملکرد شناخنی صدای ترافیک؛ رانندگان 1- Gianclaudio C, Mike M, Martin K, Lutz J. The relation between performance in on-road driving, cognitive screening and driving simulator in older healthy drivers. Transportation Research Part F. 2014:22: 232–244.##2- Mark J.R, Gary N, Kelly W. The relationship between cognitive performance, perceptions of driving comfort and abilities, and self-reported driving restrictions among healthy older drivers. Accident Analysis and Prevention. 2013: 61:288-95.##3- Elise V, Paul F, Nicole J, Danny H. Neurobehavioral effects of exposure to traffic-related air pollution and transportation noise in primary schoolchildren. Environ Res 2012: 115:18-25.##4- Thompson JP, Baldock M, Mathias JL, Wundersitz LN. An examination of the environmental, driver and vehicle factors associated with the serious and fatal crashes of older rural drivers. Accident Analysis and Prevention. 2013:50: 768–775.##5- Blanchard R.A, Myers A.M. Examination of driving comfort and self-regulatory practices in older adults using in-vehicle devices to assess natural driving patterns. Accident Analysis and Prevention. 2010: 42:1213–1219.##6- Antonio S, Melo B, Maria R, Alves C. (2005) Hearing loss among workers exposed to road traffic noise in the city of Sa˜o Paulo in Brazil. Auris Nasus Larynx. 32:17–21.##7- Boer E, Schroten A. Traffic noise reduction in Europe. http://www.cenl.2007##8- Socan G, Bucik V. Relationship between speed of information-processing and two major personality dimensions - extraversion and neuroticism Personality and Individual Differences. 1998: 25: 35-48.##9- Aljanahi A.A.M, Rhodes A. Metcalfe. Speed, speed limits and road traffic accidents under free flow conditions. Accident Analysis & Prevention. 1999:31(1-2):161-168##10- Duric P., Filipovic D. Reaction time of drivers who caused road traffic accidents. Accident Analysis & Prevention. 2009: 62 (3-4):114-9.##11- Racioppi F, Eriksson L, Tingvall C, Villaveces A. Pereventing road traffic injury: a public health perspective for Europe, Text editing: Publications WHO Regional Office for Europe Scherfigsvej DK-2100 Copenhagen, Denmark.##12- Chraif M. The effects of radio noise in multiple time reaction tasks for young students. Procedia - Social and Behavioral Sciences:2012: 33:1057-1062.##13- Strick S, Music Effects on Drivers' Reaction Times. Australian Road Research. : 2000:(4), 68-69.##14- Han, L, Wu XY, Li, XY, Zhang S, Wang T, Li XJ. Effect of noise on human mental performance. Space Med Med Eng (Beijing). 2005:12:28-31.##15- Belojevic G, Jakovljevic B, Slepcevic V. Noise and mental performance: Personality attributes and noise sensitivity. 2003:21 : 77-89.##16- Bellinger D, M. Budde B. The effect of cellular telephone conversation and music listening on response time in braking. Transportation Research Part F. 2009:12: 441–451.##17- Belojevic G, Slepcevic V, Jakovljevic B,.Mental Performance in noise: the role of introversion. Journal of Environmental Psychology.2001:21:2. 209-213.## ##

بررسی تاثیر سناریوی آموزشی ترکیبی در افزایش مدت زمان استفاده کارگران از وسایل حفاظت شنوایی Study the effect of mixed training scenario in increasing the duration of using of hearing protection devices by workers 1 1 چکیده مقدمه: آخرین راه جهت کنترل صدا استفاده از وسایل حفاظت شنوایی می باشد که یکی از پارامترهای مهم در برنامه حفاظت شنوایی، میزان مدت زمان استفاده از گوشی توسط کارگران می باشد. که در صنایع به این موضوع اهمیتی داده نمی شود. لذا هدف مطالعه بررسی میزان اثر بخشی سناریوی آموزشی به دو شیوه تئوری وعملی در افزایش مدت زمان استفاده کارگران از وسایل حفاظت شنوایی می باشد. روش بررسی: در این مطالعه مداخله ای، با توجه به نتایج بدست آمده از مرحله اولیه تکمیل پرسشنامه، آموزش در گروه مداخله (50 نفر) به صورت 5 جلسه آموزشی (تئوری– عملی)، هر یک به مدت 30- 45 دقیقه داده شده است و کارگران گروه کنترل (50 نفر) در این مطالعه هیچ آموزشی دریافت نکرده اند. و مدت زمان استفاده از گوشی به صورت قبل ازمداخله و 3 ماه بعداز مداخله در دو گروه مداخله و کنترل ثبت گردید و مقایسه شد. یافته ها: نتایج نشان می دهد که در گروه مداخله تعداد کارگرانی که قبل از مداخله به صورت تمام وقت از گوشی استفاده می کردند 1 نفر(2%) و بعد از مداخله 33 نفر (66%) بود و همچنین مدت زمان استفاده از گوشی در گروه مداخله نسبت به قبل از مداخله آموزشی افزایش یافته است که از نظر آماری معنادار است(P_value=<0/001). و در گروه کنترل تغییری نکرده است. نتیجه گیری: با توجه به یافته های این پژوهش، می توان گفت که سناریوی آموزش ترکیبی در افزایش مدت زمان استفاده از گوشی با موفقیت همراه بوده و می تواند در سایر مداخلات بهداشتی نیز مورد استفاده قرار گیرد. 2 Introduction: The latest way to control the use of hearing protection devices is sound. The amount of time spent on the phone by workers is one of the most important parameters in hearing conservation programs. The aim of the study is to evaluate the effectiveness of training scenario in theoretical and practical ways to increase using the hearing protection devices for workers. Materials and methods: In this experimental study, according to the results of the initial stage of the questionnaire, in the experimental group (n= 50) for 5 sessions (practical theory), each shown for 30 to 45 minutes, and workers in the control group (n= 50) in this study have not received any training, and time spent on the phone before and 3 months after intervention in both groups were recorded and compared. Results: The results show that before intervention only 1 worker (2%) used the device for all time and after intervention 33 workers (66%), which reflect positive effect of training intervention on using the devices. All the conditions were the same for two groups the control group did not reflect significant changes due to lack of training program. Conclusion: According to the findings, it can be said that the training scenario has been successful in increasing the use of hearing protection devices and also can be used in other health interventions. 32 40 2016/08/52016/04/222015/08/232016/01/2 1394/10/12 2016/10/42016/10/242016/10/242016/10/31 1395/8/10 محمد رضا منظم اسماعیل پور Mohammadreza Monazamesmailpour دانشگاه علوم پزشکی تهران ایران علیرضا فلاح Alireza Fallah دانشگاه علوم پزشکی شهید صدوقی یزد ایران فریدون لعل Fereidoun Laal دانشگاه علوم پزشکی زاهدان ایران ولی سرسنگی Vali Sarsangi ایران روح اله فلاح مدواری Rouhollah Fallahmedvari دانشگاه علوم پزشکی شهید بهشتی ایران Hearing loss Hearing protection devices Training scenario افت شنوایی وسایل حفاظت شنوایی سناریوی آموزش 1- Smith AW. The World Health Organization and the prevention of deafness and hearing impairment caused by noise. Noise Health 1998; 1: 6-12.##2- Borchgrevink HM. Does health promotion work in relation to noise? Noise Health 2003; 5: 25-30.##3- Brink LL, Talbott EO, Burks JA, Palmer CV. Changes over time in audiometric thresholds assembly workers with a hearing conservation program. AIHA J 2002; 63: 482-487.##4- Behnood F, Emami F. Study Of Protective Devices and Effective Parameters on Hamadan Province Workers Community 2002-2003. Hamadan: 2003. 2-5##5- Oloqe FE, Akande TM, Olajide TG. Noise exposure, awareness, attitudes and use of hearing protection in a steel rolling mill in Nigeria. Occup Med. 2005; 55(6): 487-9.##6- Warwick Williams. Is It Reasonable to Expect Individuals to Wear Hearing Protectors for Extended Periods. Int J Occupa Safety nd Ergonomic (JOSE) 2009; 15(2) 175-81.##7- Lusk SJ , Ronis DL , Baer LM. Gender differences in blue collar workers .use of hearing protection. Women Health 1997; 25(4): 69-89.##8- Rabinowitz PM. Noise induced hearing loss. 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Subjects in health education process. 1st ed. Tehran: Zmani Naser publication; 2003. P. 94-101. [Persian]##15- Araujo-soares V, McIntyre T, Sniehotta FF. Predicting changes in physical activity among adolescents: the role of self-efficacy, intention, action planning and coping planning. Health Educ Res. 2009; 24: 128-39.##16- Quick L, Stephenson MT, Witt k. An examination of antecedents to coal miners' hearing protection behaviors: A test of the theory of planned behavior. J Safety Res 2008; 39: 329-38. ##17- Chaleshgar M, Morowaty M, Abasi M, Sharifi R. Factors associated with the use of hearing protection devices in pinning factories of Yazd city based on the Theory of Planned Behavior. J Occupation Med 2012; 5(2): 32-42.[Persian]##18- Melamed S, Rabinowit2 S, Feiner M, Weisberg E, Ribak J. Usefulness of the Protection Motivation Theory in Explaining Hearing Protection Device Use Among Male Industrial Workers. Health psychol; 1996, 15(3): 209-15.##19- Morowaty M, Jozi F, Barkhordari A. Related factors to workers use of hearing protection device in knitting and pinning factories of Yazd city based on Protection Motivation Theory. Iran Occupational Health 2009; 6(3): 47-54.[Persian]##20- Loukzade Z, Mehrparvar A, Shojaodini A. Evaluation of effective factors of hearing protection use in tile workers. Occupational Medicine 2011; 3(1): 8-13.[Persian]##21- Madadzade N. The effect of educational intervention base on BAZNEF on safe behavior of workers in Esfahan Steel Company. [MSc Thesis]. Isfahan, Isfahan University of medical Sciences, 2005. [Persian]##22- Taghdisi MH, Madadzadeh N, Shadzi Sh, Hassanzadeh A. Effects of education interventions on the Coke workers' immune performances on Baznef model basis at Isfahan melting factory, 2005. Sci J Ilam Univ Med Sci 2008; 16(3). [Persian]##23- Ozer EM, Bandura A. Mechanisms governing empowerment effect: Aself-efficacy analysis. 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تاثیر هشت هفته تمرین های اصلاحی بر اختلالات عضلانی– اسکلتی کارمندان زن شهرداری اصفهان The effect of eight weeks of corrective exercises on musculoskeletal disorders in female staff of the Isfahan municipality 1 1 مقدمه: اختلالات عضلانی-اسکلتی مرتبط با کار، به عنوان اختلالاتی متعاقب کار تعریف می شوند که باعث مشکلاتی نظیر محدودیت حرکتی، خستگی، فرسودگی، از دست دادن کار و یا حتی تغییر شغل، می گردند. نظر به اهمیت ارتقا سطح سلامت زنان، هدف تحقیق حاضر بررسی تاثیر هشت هفته تمرین های اصلاحی بر اختلالات عضلانی- اسکلتی زنان بود. روش بررسی: در مجموع 97 نفر از کارمندان با استفاده از پرسشنامه نوردیک مورد ارزیابی قرار گرفتند، تعداد 30 نفر به صورت هدفمند انتخاب و به طور تصادفی به دو گروه مساوی تقسیم شدند. نمونه ها(گروه تجربی) به مدت هشت هفته تحت تمرینهای اصلاحی ویژه(ایزومتریک، انعطاف پذیری و مقاومتی) قرار گرفتند. گروه کنترل در این مدت، هیچ گونه تمرین و فعالیت بدنی خاصی انجام ندادند. میزان اختلالات عضلانی- اسکلتی نواحی گردن، شانه، کمر و زانو قبل و بعد از هشت هفته تمرین اندازه گیری شد. از آزمون t وابسته و ویلکاکسون برای تجزیه و تحلیل آماری داده ها استفاده شد(05/0>P). نتایج: ناحیه گردن (3/93 درصد) ، پس از آن شانه (3/73 درصد)، کمر (70 درصد) و زانو ( 60درصد) بالاترین فراوانی اختلال عضلانی- اسکلتی را داشتند. در نواحی ذکر شده بهبود معنی داری (05/0>P) بعد از هشت هفته تمرین های اصلاحی مشاهده شد. نتیجه گیری: شیوع اختلالات عضلانی- اسکلتی در کارمندان مورد مطالعه نسبتا بالا بود و اقدامات اصلاحی اعمال شده موجب کاهش اختلالات عضلانی- اسکلتی در آنان شد، از این رو گنجاندن تمرینات اصلاحی در برنامه روزانه کارمندان و اصلاح وضعیت پوسچر در انجام وظایف کاری توصیه می شود. واژه های کلیدی: اختلالات عضلانی- اسکلتی، تمرینات اصلاحی، کارمندان زن 2 Introduction: Work-related musculoskeletal disorders are defined as subsequent work-related disorders that can cause problems such as limited mobility, fatigue, exhaustion, job loss or even change job. Considering the importance of Improvement of the women's health, the aim of this study was to investigate the effect of eight weeks of corrective exercise on musculoskeletal disorders of female staff of the Isfahan municipality. Methods: A total of 97 cases were evaluated using Nordic questionnaire. Among them, 30 cases with MSDs were chosen, and were divided randomly into two groups. The samples participated in particular corrective exercises (isometric exercises, flexibility and strength) for eight weeks. The control group in this period of time did not do any physical activity and specific exercise. The amount of musculoskeletal disorders of the neck, shoulder, back and knee were measured before and after eight weeks of training. Correlative t test and Wilcoxon test were used to analyze data (p<0.05). Results: Results showed that, most disorders were pertaining to neck (93. 3%), shoulder (73. 3%), low back (70%) and knee (60%). In the mentioned body parts, significant improvement was observed after eight weeks of corrective exercises (p<0.05). Conclusion: the prevalence of musculoskeletal disorders was relatively high in studied staff, and applied corrective measures reduced musculoskeletal disorders of them, hence the inclusion of corrective exercises in the daily routine program of staff and Improvement of the posture in work tasks are recommended. 41 53 2016/08/52016/04/222015/08/232016/01/22016/11/22 1395/9/2 2016/10/42016/10/242016/10/242016/10/312017/04/29 1396/2/9 مریم سیروانی Maryam Sirvani ایران نادر رهنما Nader Rahnama ایران Musculoskeletal disorders Corrective exercises Female اختلالات عضلانی- اسکلتی تمرین های اصلاحی کارمندان زن 1- Darragh AR, Huddleston W, King P. Work-related musculoskeletal injuries and disorders among occupational and physical therapists. Am J Occup Ther 2009; 63(3): 351-62.##2- Arthritis Research UK [homepage on the Internet].‎ Prevention and cure of arthritis; c1998-2016. 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پیش‌بینی میگرن با دو الگوی عدم توازن تلاش- پاداش و عدم توازن تقاضا -کنترل در شغل Predicting migraine by two models effort reward imbalance and control-demand imbalance in job 1 1 مقدمه: میگرن شایع‌ترین نوع سردرد مزمن است. استرس سبب بروز میگرن شده و طول مدت حمله میگرن را نیز تحت تأثیر قرار می­دهد. یکی از منابع استرس شغلی، طرح شغلی نامناسب است. هدف مقاله حاضر بررسی بروز نمونه ی جدید میگرن با توجه به دو الگوی عدم توازن تلاش- پاداش و عدم توازن تقاضا -کنترل در شغل بود. روش: دو طرح کاری یعنی مدل عدم توازن تلاش پاداش و مدل عدم توازن تقاضا کنترل برای پیش‌بینی نمونه­های جدید میگرن بکار رفت. نمونه های مورد بررسی 3338 نفر بودند که شاغل در شرکت­های صنعتی در ایران بودند. چهار ابزار بکار گرفته شد (استرس شغلی، پرسشنامه ERI، تقاضا کنترل و پرسشنامه خود اظهاری میگرن). سن و وضعیت اقتصادی به عنوان متغیرهای همگام استفاده شدند. برای تحلیل آماری از تحلیل رگرسیون لجستیک دوگانی و نسبت شانس استفاده شد. تحلیل آماری داده ها با نرم افزار  M plus 4/2 انجام شد. نتایج:یافته­ها نشان داد که خطر افزایش یافته میگرن در بین افرادی که عدم توازن بالایی در تلاش پاداش دارند (نسبت شانس 28/1 نسبت به گروه مرجع)، کسانی که بر شغل خود کنترل و مهار اندکی دارند(نسبت شانس 11/1 نسبت به گروه مرجع) و افرادی که تعهد افراطی نسبت به کار خود دارند (نسبت شانس 17/1 نسبت به گروه مرجع)بیشتر است. نتیجه گیری: بروز نمونه­ی جدید میگرن می­تواند از طرح نامناسب کار پدید آمده باشد. بنابراین طراحی مجدد کار بخصوص در بین کارکنانی که عدم توازن تلاش پاداش را تجربه می­کنند احتمالاً به کاهش نمونه­های جدید میگرن منجر خواهد شد. 2 Introduction: Migraine is the most common type of chronic headache. Stress can trigger migraine and effect on the duration of migraine attacks. . One of the main reasons of job stress is inappropriate job design. The aim of the current study was to investigate the new cases of migraine regarding models of effort-reward imbalance and demand-control imbalance in job. Methods: Two job designs namely effort-reward imbalance and demand-control imbalance models were applied to predict new-onset migraine. Samples were 3338 persons who worked in industrial companies in Iran. Four instruments were used (job stress, ERI questionnaire, demand control and Self-reported questionnaire for migraine) Age and the economic status were used as covariate variables. Binary logistic regression analysis and odd ratio were used for analyzing the data. Statistical analysis was performed in M plus 4.2 Software. Results: The findings indicated that risk of increasing migraine was increased among those with high effort-reward imbalance (odd ratio 1/28 to the reference group) and those who have little control over their jobs (odd ratio 1.11 to the reference group)  as well as people who are strongly committed to their work (odd ratio 1.17 to the reference group). Conclusion: Migraine could be produced by inappropriate work design. Therefore, work redesign especially among the persons experienced the effort-reward imbalance may decline new onset migraine. 54 68 2016/08/52016/04/222015/08/232016/01/22016/11/222015/12/24 1394/10/3 2016/10/42016/10/242016/10/242016/10/312017/04/292016/10/24 1395/8/3 حمید رضا عریضی Hamidreza Oreyzi دانشگاه اصفهان ایران hr.oreyzi@gmail.con سیمین دخت کلنی Simin dokht Kalani دانشگاه تربیت مدرس ایران simin.kalani@yahoo.com Migraine Effort-Reward Imbalance Demand-Control Imbalance میگرن عدم توازن تلاش-پاداش شغلی عدم توازن تقاضا-کنترل شغلی 1- Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL. Harrison’s Principles of Internal Medicine. New York: McGraw Hill; 2005.##2- Lipton RB, Biggal ME. Migrain:epiemiology, impact, and risk factors for progression. Headache. 2005; 45: 3-13.##3- Haag G. Individual medical relevance of headaches. Comorbidities and quality of life. 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طراحی و اعتبار سنجی یک روش غربالگری جهت شناسایی افراد مستعد حادثه در صنایع Design and validation of a screening method to identify accident - proneness in industry 1 1 مقدمه: بررسی آمار و ارقام حوادث نشان می‌دهد که پراکندگی حوادث در اشخاص در معرض خطر یکنواخت نبوده و در شرایط مساوی سه چهارم از حوادث برای یک چهارم از افراد در معرض خطر اتفاق می‌افتند. این مطالعه با هدف طراحی و اعتبار سنجی یک پرسشنامه جهت غربالگری افراد مستعد حادثه در صنعت انجام گرفت. روش بررسی: این مطالعه در 5 مرحله: تولید آیتم، ارزیابی روایی محتوایی، تحلیل پایایی، تحلیل روایی سازه و تحلیل روایی معیار در بین 230 نفر از کارگران حادثه‌دیده و حادثه‌ندیده، 19 صنعت شهر اصفهان انجام شد. به منظور تحلیل داده‌ها از نرم‌افزار آماری SPSS و Amos نسخه 22 استفاده گردید. نتایج: در مرحله تولید آیتم یک پرسشنامه 195 سئوالی طراحی شد. در ارزیابی محتوایی 13 آیتم حذف، 15 آیتم اصلاح و 79 آیتم در هم ادغام و تبدیل به 14 آیتم شدند. آلفای کرونباخ جهت تعیین سازگاری درونی پرسشنامه 86/. بدست آمد. نتایج حاصل از تحلیل عاملی تائیدی نشان داد که شاخص‌های برازش مدل ارائه شده در حد قابل قبول بودند (0/99 CFI=، 0/96GFI =، 0/066RMSEA=، 0/022RMR= ). آزمون T مستقل  نشان داد، میانگین نمره افراد حادثه‌دیده بطور معنی‌داری بیشتر از میانگین نمره افراد حادثه‌ندیده است که نشان ‌دهنده جهت‌گیری درست پرسشنامه طراحی شده با یک ملاک معتبر (بالا بودن میزان نمره) است(0/001p<). نتیجه‌گیری: نتایج حاصل از تحلیل عاملی تائیدی نشان داد که بین مدل ارائه شده و داده‌های میدانی همخوانی مناسبی برقرار است. پایایی و روایی سازه نشان داد که پرسشنامه طراحی شده برای غربالگری افراد مستعد حادثه یک روش روا و مناسب است. 2 Introduction: Investigations show that the scattering of accidents in individuals is not the same, and three quarters of all accident occur to one quarter of accident prone individuals. The aim of the study was to design and validate a questionnaire for screening out the accident prone individuals. Methods: This study in 5 stages of item generation, content validity assessment, reliability, construct validity, and criterion validity was performed among 230 workers who had and who had not experienced accident in 19 industries of Isfahan, Iran. For data analysis SPSS and Amos 22 were used. Results: 195 items were identified during item generation stage. In content validity evaluation stage 13 items were removed, 15 items were modified and 79 items were merged and convered to 14 items. Internal consistency (Cronbach's alpha) of the remained items was 0.86. The results of confirmed validation showed that comparative fit index was acceptable. (CFI=0.99, GFI=0.96, RMSEA=0.066, RMR= 0.022). T test showed that the mean scores of the workers who had accident were significantly higher than the workers who had not experienced accident (p<0.001). Conclusion: The result of confirmed validation showed that there is a good agreement between the proposed model and the field data. Reliability and construct validity showed that the current questionnaire is suitable for screening out the accident prone individuals. 69 83 2016/08/52016/04/222015/08/232016/01/22016/11/222015/12/242015/10/14 1394/7/22 2016/10/42016/10/242016/10/242016/10/312017/04/292016/10/242016/10/24 1395/8/3 عظیم کریمی Azim Karimi دانشگاه علوم پزشکی اصفهان ایران احسان اله حبیبی Ehsanollah Habibi دانشگاه علوم پزشکی اصفهان ایران habibi@hlth.mui.ac.ir حبیب اله دهقان شهرضا Habibollah Dehghan shahreza دانشگاه علوم پزشکی اصفهان ایران بهزاد مهکی Behzad Mahaki دانشگاه علوم پزشکی اصفهان ایران ابوالقاسم نوری Abolghasem Nouri دانشگاه اصفهان ایران فاطمه امینائی Fatemeh Aminaei دانشگاه علوم پزشکی شهید صدوقی یزد ایران Occupational Accidents safety Safety Screening حوادث شغلی ایمنی صنعتی پرسشنامه استعداد حادثه‌پذیری 1- Bigdeli Z. 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شناسایی خطرات زیست محیطی تجهیزات صنعت نورد گرم فولاد کویر به روش What if و ارزیابی ریسک آن به روش ویلیام فاین Equipment´s environmental risks identification and assessment in the Hot-rolling kavir steel industry using Wath if and William Fine Methods 1 1 مقدمه: یکی از الزامات ارزیابی ریسک زیست محیطی صنعت نورد، بررسی عملکرد تجهیزات و دستگاه‌های موجود در این صنعت و شناسایی خطرات زیست محیطی متعاقب آن می‌باشد. این مطالعه، خطرات زیست محیطی فرایند نورد گرم را با تکتیک "چه می‌شود اگر؟" شناسایی و سپس ارزیابی ریسک آنرا به روش ویلیام فاین انجام داده است. روش بررسی: این مطالعه قبل و بعد (نیمه تجربی) است ، پس از طبقه بندی تجهیزات موجود در سالن تولید صنعت نورد گرم فولاد کویر، عملیات شناسایی خطرات زیست محیطی با توجه به رویکردهای مدنظر ایزو 14001 (نظیر: انتشار آلاینده ها به هوا و آب، مصرف انرژی، استهلاک تجهیزات و ...)، با تکتیک "چه می‌شود اگر؟" طی بازدید میدانی انجام شد سپس تیم کارشناسی ارزیابی ریسک اولیه به روش ویلیام فاین انجام داد و راهکارهای اصلاحی را پیشنهاد و RAC2 را محاسبه نمود. برای آنالیز داده ها از نرم افزار SPSS نسخه 19 استفاده گردید. نتایج: 280خطر زیست محیطی مربوط به کارکرد صحیح و معیوب تجهیزات شناسایی شد که بیشترین تعداد خطرات مربوط به ماشین‌آلات تولید (2/29%) و سپس تجهیزات مکانیکی(2/24%) بود. بیشترین دسته خطر زیست محیطی شناسایی شده (21%) مربوط به ایجاد و پراکندگی پسماند و سپس خطر انتشار آلاینده ها به هوا (5/18%) و کمترین درصد(5/2%)خطر خوردگی و استهلاک تجهیزات بود. بیشترین فراوانی خطر مربوط به ایجاد و پراکندگی پسماند (73 مورد) و کمترین آن مربوط به خوردگی و استهلاک تجهیزات (1 مورد)می باشد. نتیجه‌گیری: استقرار مدیریت جامع زیست محیطی در صنعت نورد با تکیه بر پایش مستمر تجهیزات در قالب تدوین برنامه‌های نگهداری و تعمیرات جهت پیشگیری از ایجاد نواقص فنی اثرگذار بر محیط زیست؛ نقش مهمی در کنترل انتشار آلودگی ها به محیط متأثر از این صنعت خواهد داشت.  2 Introduction: One of the requirements of the environmental risk assessment of hot rolling industry is the evaluation of the performance of equipment and devices in the industry and identifying subsequent environmental risks. Methods: This was a quasi-experimental study. After classification of the equipments in the production hall of hot rolling at the Kavir Steel Complex, some operations were conducted to identify the environmental risks according to the ISO 14001 approaches (such as pollutant emissions to air and water, energy consumption, equipment depreciation, etc.), using "What happens If?" technique. Then, a team of experts conducted the initial risk assessment using William Fine method; they also proposed the corrective strategies and calculated RAC2. Data were analyzed using SPSS version 19. Results: 280 environmental risks related to the proper functioning and defective equipment were identified, which the largest number of risks was related to the production machinery (29.2%), and mechanical equipment (24.2%), respectively. The most category of identified environmental risk (21%) was related to the creation and distribution of waste and the risk of pollutant emissions into the air (18.5%), and the lowest percent (2.5%) was related to the risk of corrosion and depreciation of equipment. Conclusion: The establishment of environmental management in rolling industry will play an important role in controlling emissions arising from the industry to the environment, if it relys on the continuous equipment monitoring in the framework of the maintenance and repairing plan in order to prevent technical defects affecting the environment. 84 95 2016/08/52016/04/222015/08/232016/01/22016/11/222015/12/242015/10/142015/12/1 1394/9/10 2016/10/42016/10/242016/10/242016/10/312017/04/292016/10/242016/10/242016/10/24 1395/8/3 محمدحسن احرام پوش Mohammadhassan Ehrampoush دانشگاه علوم پزشکی شهید صدوقی یزد ایران ehramposh@ssu.ac.ir غلامحسین حلوانی Gholamhossein Halvani دانشگاه علوم پزشکی شهید صدوقی یزد ایران halvanig@yahoo.com محمد تقی قانعیان Mohammadtaghi Ghaneian دانشگاه علوم پزشکی شهید صدوقی یزد ایران mtghaneian@yahoo.com علی دهقانی Ali Dehghani دانشگاه علوم پزشکی شهید صدوقی یزد ایران adehghani42@yahoo.com مسعود شفیعی Masoud Shafie مجتمع فولاد کویر ایران محسن حسامی آرانی Mohsen Hesami Arani مجتمع فولاد کویر ایران hesami.mohsen110@gmail.com Environmental hazards Risk assessment Williamfine kavir steel complex What if Technique. مجتمع فولاد کویر خطر زیست محیطی ارزیابی ریسک تکنیک چه می شود اگر ویلیام فاین 1- Heidi M, Bushell, Lenard. 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