JOURNAL OF SCHOOL OF PUBLIC HEALTH AND INSTITUTE OF PUBLIC HEALTH RESEARCH
Year:2009 | Volume:7 | Issue:1|Papers Count:10

Background and Aim: Environmental health impact assessment of industrial estates will help greatly in better planning for sustainable development and reducing disease risk in a community. The objective of this study was to assess the positive and negative effects of establishing an industrial estate in Jovein, Sabzevar, Iran in 2006-7 and suggest managerial strategies to reduce undesirable environmental health impacts.Methods and Materials: A modified Leopold Matrix and Scaling checklist method was used.The existing environmental situation was investigated and then environmental impact assessment alternatives were determined, bearing in mind the amounts and kinds of predicted pollutants in the construction and operational phases. The assessment was made considering the immediate, direct, and indirect impacts in the short and long terms. It was attempted to use a wide range of values of different factors (-5, +5) in order to estimate the impact of all activities on the environmental status.Results: The results of the study are presented with two alternatives, i.e., "No" (conducting the project with no concern for environmental issues), and "Yes" (performance of the project with application of methods to reduce the environmental harmful impacts), when establishing the industrial estate, in the construction and operation phases. The impact assessment with the "No" alternative scored -791, meaning that execution of the project had to be rejected. However, after reducing the harmful impacts the score rose to +252, indicating that the project would be accepted.Conclusion: The method of reducing harmful environmental impacts along with environmental management programs introduced is accepted in this study. It is recommended that the Ministry of Health and Medical Education and The Iranian Environmental Protection Agency collaborate closely in the area of environmental health impact assessment of industries and industrial estates.

Methods and Materials: This was a prospective cohort study performed during March 2004 to April 2005 in the health centers of Shemiran, north of Tehran, Iran. A sample of 180 mothers, 15-49 years old, with an unwanted pregnancy (case group) and 430 mothers, in the same age group, with a wanted pregnancy (control group) were compared. To determine the effect of unwanted pregnancy three major type of variables (background, maternal, and neonatal variables) were selected, and the mothers were followed up for 11-12 months (from the first referral for prenatal care to about 2 months after delivery). Statistical univariate analyses were performed using the t- and c2 tests. Also, multiple logistic regressions were employed to identify the risk factors associated with LBW. SPSS 11.5 for windows was used for data analysis.Results: The unwanted pregnancy prevalence was 11.7%. The mean of Apgar score was 8.6 in the case group and 8.9 in the control group, the difference being statistically significant (p<0.001). Mean birth 1234t5 weight of neonate in the case group was about 2.984kg vs. 3.14kg in the control group, and the difference was statistically significant (p<0.001). Univariate analysis showed that LBW was related to unwanted pregnancy (p<0.001), gestational age (p<0.001), mother's age (p<0.001), mother's marriage age (p<0.001), birth order (p<0.001), number of past pregnancies (p<0.001), family size (p<0.001), number of abortions (p<0.001), attempt to abort (p<0.001), high blood pressure (p<0.001), and diabetes (p<0.001). Finally, multivariable analysis revealed that LBW was only associated with unwanted pregnancy, high blood pressure, and diabetes in mothers, with adjusted odd ratios of 2.22, 2.81 and 3.55, respectively (p<0.05).Conclusion: Prevention of unwanted pregnancies, increased gestational age, and appropriate management of mothers' chronic diseases can reduce the risk of LBW.

Background and Aim: Tuberculosis (TB) remains a major public-health problem in Iran, despite employing the DOTS (directly observed treatment short course) strategy in the National Tuberculosis Program (NTP). The aim of this study was to determine the role of teaching hospitals in improving NTP indices.Materials and Methods: In a retrospective cross-sectional study, the medical files of treated TB patients in Tehran Razi Teaching Hospital and the Khuzestan Provincial Health Center were reviewed. Diagnosis, treatment and follow-up were based on the NTP procedures. The patients hospitalized for at least the first 2 weeks of treatment were placed in the hospitalized TB (HTB) group and the outpatients in the outpatient TB (OTB) group. The NTP indices (the sputum smear positive, fully cured, treatment failure, defaulted, and death rates) and pre-treatment counseling were compared between the 2 groups. Data related to demographic characteristics, risk factors, and the treatment outcome were compared by SPSS 11.5 using the chi square and fisher's tests.Results: A total of 235 patients (mean age 38 years), 67 of whom were hospitalized TB patients, were studied. 122 men (51.9 %) and 42 women (17.9%) had a history of imprisonment, among whom 20 (47.6%) were positive for human immunodeficiency virus (HIV), 53 (22.5%) injection drug users, and 120 (51.1%) smear-positive for pulmonary TB. The rates of cured cases, treatment failures, defaulted and death were, respectively, 80.6%, 8.9%, 4.5%, and 5.9%, in the HTB group, and 66.6%, 17.3%, 10.1%, and 5.9% in the OTB group. Pre-treatment counseling had been done in 75% of the HTB and 52% of the OTB cases.Conclusion: Teaching hospitals can have an important role in improving pre-treatment counseling and NTP indices, such as increased sputum positivity, cured rate, and, probably, decreased treatment failure and defaulted rate.

Background and Aim: Like other cancers, gastric cancer is due to uncontrolled growth of tissues. Although there are different therapy methods to treat it, such as surgery, radiation therapy, chemotherapy, and multimodality therapy, relapse and death may occur. Reports show that in Iran gastric cancer is the first cause of death among deaths due to cancers. The purpose of this study was to determine the two-year survival rate after relapsing and its associated factors among gastric cancer patients who had undergone surgical treatment in Iran Cancer Institute, one of the most important cancer treatment centers in Iran.Methods and Materials: A total of 330 patients with gastric cancer who had been admitted to and operated on at the Iran Cancer Institute between January 1996 and April 2000 were enrolled in this study. The patients' life expectancy after relapse was determined. Survival was defined as the elapsed time between the two successive events, relapse and death, neither of which can be determined exactly; therefore the data are doubly censored failure time data. Thus, the relationships between life expectancy at relapse and such variables as age, gender, and factors related to the disease, such as the cancer site, pathologic type, stage, and sites of metastases were determined using the Cox proportional hazards model.Results: The two-year survival rate after relapsing and the median life expectancy after relapsing were 15% and 10.15 months, respectively. Univariate analysis showed that except disease stage, no other variable (age, gender, cancer site, pathologic type and sites of metastases) affected life expectancy after relapsing significantly. The Cox proportional hazards model for doubly censored failure time data showed that age, gender, and pathologic type had the highest influence, in a decreasing order, on the rate of survival after relapsing.Conclusion: Two-year survival rate after relapsing is very low in gastric cancer patients. One of the most important reasons seems to be delayed consultation and diagnosis. Most patients seek medical advice first with the disease in the late stages, when most have lymph node, liver or even distant metastasis which makes treatment even more complex, and when the risk of relapse and death would be increased. Thus, early diagnosis and therapy for a common stomach illness could help prevent a potential gastric cancer.

Background and Aim: The prevalence of congenital hypothyroidism (CH), one of the main causes of preventable mental handicap in neonates, is much higher in Iran than the global average.The objective of this study was to identify risk factors for congenital hypothyroidism (CH) by using the screening program in Fars Province, Iran, during the period 2003-2006.Methods and Materials: A case-control study was carried out, the samples being 126 cases and 401 controls. The neonates were those born between 2003 and 2006, under coverage of the National Congenital Hypothyroidism Program. The data were analyzed using the univariate and multivariate analysis tests.Results: An increased risk for CH was detected in infants with consanguine parents, by a multivariate analysis test (odds ratio (OR)=2.9, 95% confidence interval (CI):1.8-4.8). The test also confirmed previously reported statistically significant associations with additional birth defects OR=2.2 (1-4.6), birth defects in first-degree relatives OR=4.7 (1.6-4.8), female gender OR=1.9 (1.1-3), and twin births. Although not significant, an increased risk for CH was observed among infants with gestational age<30 weeks (preterm delivery) (OR=1.7 (0.9-1.3)).Conclusion: This study identified risk factors contributing to the etiology of CH. In particular, our results suggest a multifactorial origin of CH, in which both genetic and environmental factors play a role.

Background and Aim: The lack of balance between job needs and workers' physical capacity may lead to work-related musculoskeletal disorders (Wises). WMSDs are one of the most important occupational health problems in developing countries. These problems are due to risk factors such as poor work postures, excessive force applied, repetitive movements, vibration, prolonged work duration, and psychological factors, leading, ultimately, to disorders ranging from mild low back pain to severe disabilities. This study aimed at determining the prevalence of WMSDs in different body regions, assessing posturing, and detecting ergonomic and individual risk factors causing musculoskeletal disorders, in Araki bakery workers in Arak, Iran.Methods and Materials: In this cross - sectional study 233 randomly selected bakery workers in Arak were included, and the prevalence of symptoms of musculoskeletal disorders and their risk factors, with particular emphasis on work posture, was determined in them. The method used was OWAS and the NMQ Questionnaire.Results: The highest prevalences of musculoskeletal disorders were in the knees (62.2%), low back (58.8%), legs (53.9%) and shoulders (44.6%) of the workers. Low back and shoulder injuries in Shaaters (workers in charge of baking the bread) and elbow, thigh and low back disorders in Choongeers (workers in charge of dividing and rounding the dough) were more prevalent than in other occupations. There is a positive association between type of occupation and these disorders (p<0.05). According to the OWAS's classification, the distribution of bakery workers' working postures was as follows: 58.5% in the action category 1 (natural posture), 34.7% in the action category 2 (stress posture), 4% in the action category 3 (harmful posture), and 2.5% in the action category 4 (very harmful posture). There was a significant relation between work service record and neck, elbow, shoulder, and knee disorders (p<0.05).Conclusion: This study revealed that the working postures of 42.2% of Aaraki bakery workers were slightly to very harmful postures; in addition, there was a high prevalence of WMSDS in different body regions of the workers. Ergonomic interventions are essential to improve the situation and protect better the health of the workers.

Background and Aim: The association between particulate matter (PM) and cardiovascular diseases (CVD) was shown in the mid-1990's through several epidemiological studies. Increased hospital admissions of patients with cardiovascular and respiratory problems in days when, due to high concentrations of PM, air pollution is high, bears witness to this. In this study we measured concentrations of the PM fractions in the air in the central part of Tehran city, Tehran, Iran.Methods and Materials: The concentrations of suspended particles (PM10, PM2.5 and PM1) were measured during February-June 2007 in two stations in central Tehran. Stations1 was in the Enghelab Square, a crowded part of the city with highly polluted air, where many educational institutes (e.g. Tehran University) are located, while station 2 was located near the Nasr Bridge, through which one of the most important highways (Martyr Chamran Highway) passes. The MP concentrations were measured once every 3 days, twice each day, once during the morning traffic rush hour (9-11 AM) and once during the afternoon traffic rush hour (4-6 PM), using a portable device, e.g., Environmental Dust Monitor Model GRIMM107.Results: One-way ANOVA tests showed significant differences (p<0.05) between PM concentration in the two stations. The daily mean concentrations of PM10, PM2.5 and PM1.Were, respectively, 77.67, 44.46 and 26.89 mmm-3, in station 1, and 55.31, 28.15 and 19.12 mmm-3, in station 2.Conclusion: The concentrations of PM10, PM2.5 and PM1 were lower in both stations than the respective USEPA 24-hour primary NAAQS standards, established in 1987 for PM10 and in 1999 for PM2.5. However, the proportions of the total samples with PM concentrations exceeding the new EPA standards established in 2006 were 67% and 25% in stations 1 and 2, respectively. The air quality index (AQI) was unhealthy in 32% and 10.5% of the samples in stations 1 and 2, respectively. In addition, PM2.5 was the indicator pollutant in 87% of the samples in station 1 and 82% of the samples in station 2.

Background and Aim: The role of fresh water snails as the intermediary host in transmitting parasitic infestations in man and animals is well known. In Iran, urinary schistosomisasis is known to be endemic in the Khuzestan Province, south-west of the country. Considering the Egyptian experience concerning the negative effects of Aswan Dam construction on expanding the prevalence of human bilharziasis, the possible role of huge agro-industrial sugar-cane projects on eliminating schistosomiasis in the only known endemic province of Khuzestan in Iran came to our attention.The main objective of this study was to identify the species of fresh water snails in a vast area under cultivation of sugar cane in Khuzestan province, S.W. Iran.Methods and Materials: Thirty locations (points) under cultivation of sugar-cane in the area were selected for snail collection. In the selected localities there existed drains, canals, ditches, and water stands. Preliminary identification of snails was performed at the time of collection. A more complete taxonomical study was made after the samples were transferred to the laboratory of Dezful Health Research station.Results: The total number of snails collected was 3825 snails, and seven different species wereidentified:Physasp. (29%), Gyraulus sp. (19%), Melanoides sp. (16%), Bellamya sp. (14%), Melanopsis sp. (12%), L. gedrosiana, (7%) L. truncatula (2%). No Bulinus truncates was seen.Conclusion: Most of these snails are capable of getting involved in the life cycle of some zoonotic helminth parasites, e.g., Fasciolid and Heterophyd. These findings are encouraging. However, in order to avoid any possible undesirable effects on the public's health, constant monitoring, as well as annual malacological surveys, is essential.