مجله دانشکده بهداشت و انستیتو تحقیقات بهداشتی
سال سوم شماره 4 (پیاپی 12، زمستان 1384)

Natural disasters cause millions of death and disability and major financial losses world wide every year. The major concern of our health system has already been to reduce physical mortality and morbidity. While such events may be a considerable source of stress for the survivors and cause serious and long-lasting psychiatric complications. The purpose of this study was to assess the function of rescuers in mental health service delivery to survivors of Bam earthquake in four steps; Rescuing, Emergency services, Transportation of the injured survivors and Treatment in the first 2 weeks after the earthquake. For reaching the purpose 4 groups of the survivors were selected: first group was the healthy survivors (>15 years) living in Bam after the earthquake, the second group was healthy survivors (<15 years) living in Bam after the earthquake, the third group was the injured survivors admitted in Kerman and Tehran hospitals and the last group was the Relatives who accompanied the injured survivors. 2 weeks after the earthquake a questionnaire including questions about, demographic data, function of rescuers in rescuing and emergency services steps, informing the survivors of their relatives condition and Condoling with the survivors and mental health services delivery was filled for each of the cases. In all groups, more than 85% of the cases who needed help and rescued from the load of the earthquake were rescued by their relatives and rescuers of the Red Crescent Society or other governmental organization just had a little portion (5%)in this field. Only 25%of the cases who needed help and rescuing from the load of the earthquake were rescued in the first hour after the earthquake. Only 40% of the cases were sympathized by their rescuers. About 65% of the cases had enough information about their relatives. 40% of the cases were prevented from crying by rescuers. Only 30% of the cases said that they knew addict individuals who were hot given alternative materials. 30/% of the children had played during 2 weeks after earthquake and 42/% of them had facilities for playing. Regarding to all studied groups rescue activities, primary care services and transfers have been performed by relatives and domestic people, therefore general training and organizing CBO (community Based organization) for providing services in disasters especially in regions which are at high risk of earthquake will be useful for reducing the injuries. According to this research rescuers are in serious need of training in mental health services and that major areas of education need are: using counseling techniques, providing the necessary information for the survivors and stress management techniques.

Diabetes is a chronic disease of lifelong duration, and its management requires a fundamental change in the patient’s lifestyle. The aim of this study was to evaluate the efficacy of a health education program on the knowledge, behavior, HBA1c and health related quality of life of diabetic patients after following the patients’ participation in the program. The study population consisted of type 2 diabetic patients attending at Bandar Abbas diabetic clinic. Eighty patients were randomly selected and they were randomly assigned to two groups, 40 to the intervention and 40 to the control group. At the initial visit and 4 months after education, knowledge and behavior were assessed by questionnaire; HBA1c measured by colorimetric method and health-related quality of life assessed by means of WHOQOL-BREF questionnaire. The education sessions for intervention group were held at diabetic clinic. The 40 patients that assigned to the control group gave the appropriate consent and completed questionnaires at baseline and after 4 months. The intervention group had statistically significant increase in the mean of knowledge score from 6.7 to 15.8(p=0.000), physical health from 64.7 to 77.2 (p=0.000) and psychological health from 56 to 71.4(p=0.000) and had statistically significant reduction in the mean of HBA1c from 9.4 to 8.2 (p= 0.000).Also the intervention group had statistically significant increase in self-monitoring blood glucose, weight monitoring, exercise and diet. Patients in control group showed no significant changes in the outcomes measured except for knowledge. The decrease of HBA1c and increase of physical and psychological health mostly are due to change in behavior. This program is clinically worthwhile for patients with type 2 diabetes, and is an aid to physicians. Also This Approach is cheap, well-suited for primary care clinical, and applicable.

In recent years the patterns of mortality have changed in Iran, and cancers are playing a greater role in this regard in this country. Various reports indicate that gastric cancer is highly prevalent; it is the second most common cancer in men, and fourth in the general population. The purpose of this study was to determine the five-year survival rate of gastric cancer patients who had undergone surgical treatment at one of the most important cancer treatment centers, the Iran Cancer Institute, and to assess its associated factors. Three hundred and 30 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 surgery was determined, and its relationship with variables of age at the time of surgery, gender, and factors related to the disease such as the cancer site, pathologic type, stage, presence of metastasis, and sites of metastases were assessed. The five-year survival rate and the median life expectancy in the studied patients were 23.6% and 19.90 months, respectively. Univariate analysis showed that gender, cancer site, and pathologic type did not affect life expectancy significantly. But the five-year survival rate significantly decreases with age. As expected, those involved with metastasis had a significantly lower five-year survival rate, and the disease stage significantly affected the patients’ life expectancy (P<0.001). The Cox proportional hazards model was used to assess the effect of different variables simultaneously, and it showed that age, distance metastasis, and disease stage influenced the rate of survival. Gastric cancer patients in Iran have a low five-year survival rate. One of the most important reasons seems to be delayed consultation and diagnosis. Most patients are seen first with the disease in the late stages. At this point, most have lymph node and liver metastasis which makes treatment even more complex. Thus, it is necessary to employ mass media for extensive public education about the early warning signs of the disease and performing periodic examinations.

The risks of process hazards and equipment failures were calculated in a gas refinery – sweetening unit. The process hazards were identified by Hazard and operability stundy (HAZOP) and the component’s failures of major equipments were assessed by Failure mode and Effect Analysis (FMEA). Totally 68 hazards were identified and their risks were calculated. The highest risk (60) was belonged to the reduction of gas temperature before entering to the refinery and failure of DEA cooling system at the final node (DE). The failures of P-6 pump, F.C.V.4 valve, L.C.V.2 and F.C.V.12 (all in the same node) and reduction of gas temperature in nodes AB, BC and CD had the lowest calculated risk (12). Comparing with the acceptable level of risk in the refinery which was 200, all of the identified hazards risk were very low therefore did not need any appropriate measure of risk reduction to be proposed. For overcoming the fact that both HAZOP and FMEA techniques, instead of being performed by a team was accomplished by both of us, we used the consultations given us by the experienced exploitation engineers of under study unit. This consultation was also very useful in fulfilling deficiencies of existing record keeping system. Performing the protective maintenance and preparing a precise timing program for P.M was given as a main proposal for risk reduction by decreasing the probability of occurrence.

The exposure index was used to obtain integrated and concise assessment of the various risk factor analyzed and to classify occupational scenarios featuring significant and diversified exposure to risk factors. In this study, an integrated procedure from four data gathering methods include observational methods (for jobs and tasks analyzing featuring repetitive movements) interview method (for asking about upper limbs musculoskeletal disorders), Nordic musculoskeletal questionnaire (NMQ) method and Occupational repetitive actions method (OCRA) were used. A 385 persons group was studied, working in 33 various jobs in a textile factory. The results showed that, 0.86% of work tasks had low risk level, 87.93% of work task were located in moderate risk level and 11.21% of work task had a high risk level. Mean of exposure indices in four jobs include primary of spinning, spinning, primary of weaving, and weaving had significant difference (p=0.003). Also, the weaving job had a highest risk of occurrence upper extremity musculoskeletal disorders. Mean of right and left hand exposure indices showed a significant different (p<0.001). There was significant relationship between UEMSDs with age (p<0.05). It was concluded that, the OCRA methods can be a useful method for evaluation of UEMSDs in repetitive activities.