Iranian Journal of

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Background and Objectives: Noise-induced hearing loss is a prevalent work-related morbidity in the country. We determined the strength of association between hearing loss and occupational noise exposure as the first step in prevention programs.
Material and Methods: A historical cohort study involving 100 exposed and 31 non-exposed subjects was conducted. Noise exposure was estimated using sound level meter BSEN 60651, Type 2. Past noise exposure was estimated using the existing data on the place and type of work. Audiometry was used to assess hearing loss in each subject in 3- year intervals on an occupational cohort from 1993-2004.

Results: Noise-induced hearing loss was found in 49% (49 subjects) of the exposed group and 9.7 %( 3 subjects) of non-exposed group (p<.0001). Nobody used any form of hearing protection routinely in either group. Relative risk for noise-induced hearing loss was 5.1(CI95%: 1.7- 15.1).Time at risk was estimated 24.9 years (22.7-27.1) in exposed and 22.2 years (20.7-23.7) in unexposed group by survival analysis.
Conclusion: More legislation, hearing conservation programs, and surveillance and biological monitoring of work sites and workers are required to prevent occupational hearing loss. Planning strategies for noise assessment and control can help improve the work environment. Gross occupational exposure to noise has been demonstrated to cause hearing loss and the authors believe that occupational hearing loss in the country is a widespread problem.

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Background & Objectives: Job stress is common among different groups of professionals. It might be regarded as a defensive reaction allowing the individuals to cope with negative inputs and risk factors. Because of the rise in the mass production of motor vehicles in Iran over the last 2 decades, many managers in the car industry describe their jobs as highly stressful. However, there have not been any studies in Iran on the pattern of job stress in these managers. The aim of this study was to outline the epidemiologic pattern of job stress among managers of car companies in Iran.
Methods: This study was carried out among 496 managers of car industry in Iran. Using 12 different instruments the job stress of subjects was assessed. The main domains employed to assess job stress were time pressure, scheduling and timing, management at work, decision-making at work, organizational roles, development and structure, communication at work, work condition, and interaction between work and home duties.
Results: The mean age of subjects was 43.6 years with 12.1 years of job experience (SD=7.7). All subjects were males and 95% were married. The prevalence rate of job stress among subjects was 49.5%. The top four stressors were from decision-making at work (99.1%), time pressure (97.3%), time-table and scheduling (73.5%), and management at work place (50.5%). The prevalence of job stress was more common among the managers of lower level, and the younger ones (P<0.001). However, there was no significant difference by marital status and educational attainments.
Conclusions: This study showed that the Iranian managers working at car manufacture companies are at a higher risk of job stress and its effects compared to other managers in developed countries. Job stress may play a part in making them vulnerable to illness. It should be recognize as a priority of occupational health in this community. Stress management and appropriate interventions needs to be employed to control the negative effects of job stress among this group of managers.

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Background & Objectives: Tobacco smoking is known to cause a huge burden of disease throughout the world: smoking is responsible for 4 million deaths per year. This study is performed in order to fill the existing gaps in information regarding current trends for lifestyle and tobacco-related disease in Iran.
Methods: This was a cross-sectional study performed with the help of a questionnaire and using a multi-stage cluster sampling method. The final sample size, after the screening of the data, was 84706 out of 89457 records.
Results: From a total of 84706 people in this study, 49.7% were men, 52% were uneducated and 64.8% cane from urban areas 79.9% did not smoke, 15.3% smoked actively, 2.1% were non-active smokers and 2.7% were ex-smokers. The prevalence of smoking was higher in people aged 35 to 64 years (P<0.001). Quitting rates increased with age, especially in women (P<0.001). Smoking was more prevalent in men (P<0.001) and in rural areas (P<0.001). The average number of cigarettes smoked per day was 14.69. Smoking prevalence was lower among adults with higher levels of education compared to those with lower education levels (P<0.001).
Conclusions: This nationwide survey provides a baseline for future longitudinal studies of smoking in Iran. There is a need for effective smoking prevention and cessation programs with a focus on the young population.

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Background & Objectives: There is geographic variability in the prevalence of asthma. Since there is inadequate of study on asthma in Iran, this study was performed in order to determine the prevalence of asthma in Kurdistan province.
Methods: This cross-sectional study was performed as part of Iranian national survey to determine the risk factors of non communicable disease.
Results: This study includes 500 men and 500 women. Prevalence of history of asthma was 2.3%. There was no statistically significant association between asthma and place of residence, smoking and body mass index. Asthma were found in 6 (1.8%) of men and 17(5%) of women (p=0.02). Prevalence of asthma increased with increasing age (p<0.001)
 Conclusions: The prevalence of asthma in this study was similar with other studies in Iran and seems lower than similar countries.

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Background and Objectives: Making an accurate clinical diagnosis can be a great challenge with pediatricians. We aimed to compare the initial diagnosis and final diagnosis for hospitalized children in one teaching hospital in Iran.
Methods: In this cross-sectional study, patients’ clinical files were used. The relationship between variables was assessed by ANOVA and X2 statistical tests. The agreement rate between final and primary diagnosis was evaluated by Kappa coefficient.
Results: A total of 1310 patients’ hospital files were reviewed. There were 1244 (94.9%) cases with complete agreement, 12 (0.9%) with relatively agreement and 54 (4.2%) cases without agreement. The overall Kappa coefficient for primary and final diagnosis was 0.88.
Conclusions: The agreement rate between primary and secondary diagnosis in this teaching hospital was high. This might be due to academic atmosphere in teaching children hospital

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Background & objectives: The trend of stunting indicates of long term health status and the efficacy of different health interventions for chronic malnutrition in children. The objective of this study was to investigate the trends of stunting prevalence in preschool children living in rural area of Robat-Karim.
Methods: The method of Age-Period-Cohort analysis was utilized. Existing height data of all children whom registered in health houses of Robat-Karim health network were converted to Standard Deviation Scores (SDS) using Anthro2005 software The SDS≤ -2 for height-for-age was defined to be the moderate/severe forms of stunting. Age-Period-Cohort analysis was done with two graphical and statistical methods. The statistical method was based on logistic regression modeling in which stunting was assumed to be the dependent variable and age, birth cohort and time period were independent variables.
Results: Growth data of 970 (51.9%) boys and 898 (48.1%) girls were analyzed. The overall stunting prevalence was estimated 8.0%. This estimation by Logistic regression models (P<0.001) and graphical analyses were similar and showed that the prevalence of stunting has a decreasing trend in different birth cohorts and time periods. The prevalence of stunting was higher in the 2nd and 5th-6th years of life. The stunting prevalence was significantly higher in boys (9.3%) and non-Iranian children (9.5%) (P<0.001).
Conclusions: The prevalence of stunting appears to be decreasing in the investigated population. Appropriate interventions is thought to be essential for reducing stunting of 2nd and 5th-6th years of life, boys, and non-Iranian children.

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Background & objectives: Urinary Tract Infection (UTI) which unfortunately has no clear symptoms in many cases is the second prevalent infection among children after respiratory infection. This study carried out in order to determine the frequency of asymptomatic UTI among elementary school girls in one of Tehran’s suburbs (Mahalat town).
Methods: In a cross sectional study, all elementary school girls (n=1216) of study town who were between 6 to 11 years of age, were screened with urinary strip dipstick test method and urinary culture test was carried out on persons who had urinary PH> 7 and positive nitrite, as cases were doubtful to UTI. Afterwards, positive culture cases were referred to a urology specialist for investigating symptoms and, asymptomatic UTI samples were recognized.
Results: Among 67 students who were doubtful to UTI (based on dipstick strip test), 14 cases out of (%1.15 from 1216 samples), that is %1.15, were suffering from UTI. Regarding symptoms of UTI, just %35.72 of infected persons possessed at least one symptom of UTI and most of them that is %64.28, possessed asymptomatic UTI and the percentage of these people were obtained %0.74 for whole screened statistical society.
Conclusions: Since asymptomatic UTI and its probable complications might be recurrent, screening in dipstick method which is effective, rapid and inexpensive is completely necessary to improve the level of public health especially for children.

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Background and Objectives: Each year almost 400,000 people are diagnosed with oesophageal cancer worldwide. Wide variation in incidence has been reported both between countries and in different ethnic groups and populations within a country. The area with the highest reported incidence for oesophageal cancer is the so-called Asian ‘oesophageal cancer belt’, which stretches from eastern Turkey through north-eastern Iran, northern Afghanistan and southern Russia to northern China. In the high risk area of Gonbad in Iran, world age-standardised rates are more than 200 per 100,000 and the male/female ratio is reported as 0.8:1.0.This study aimed to assess the risk factors and demographic factors influencing survival of patients with esophageal cancer in north of Iran using weibull and log-logistic regression models.
 Methods: Demographic and clinical data of 359 patients with confirmed diagnosis of esophageal cancer from Babol Cancer registry utilized for our model. parametric and weibull models were employed to analyze the data. The Akaike information criterion (AIC) was also considered as a criterion to select the best model(s). All p values as 0.05 were considered as statistically significant.
Results: The sample study consisted of 62.7% men and 37.3% women. Estimated survival rates in 1, 3, and 5 years following diagnosis were 23%, 15%, and 13% respectively. According to AIC criterion, the hazard rate of non-monotonic and rejection proportional hazards assumption (p<0.05), log-logistic model was more efficient than weibull model. Family history of having cancer in patients showed a significant difference in both models.
Conclusion: It is concluded that early detection of people with a family history of cancer can be effective as an important factor in reducing the risk of death in patients with esophageal cancer.

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Background & Objectives: Evaluating the performance of outbreak detection methods using real data testing provide the highest degree of validity. The aim of this study was to determine the performance of the Exponentially Weighted Moving Average (EWMA) in real time detection of two local outbreaks in Iran.

Methods: The EWMA algorithm (both ƛ= 0.3 and 0.6) applied on daily counts of suspected cases of measles to detect local outbreaks which had been occurred in Mashhad and Bandar Abbas cities during 2010. The performance of The EWMA algorithms were evaluated using real data testing approach and reported by correlation analysis.

 Results: Mashhad outbreak was detected with a delay of about 2 to 7 days using EWMA algorithms as outbreak detection method while the utility of EWMA algorithms in real time detection of Bandar Abbas’ outbreak were on time good optimal. Maximum correlation value for EWMA 2 in relation to Mashhad outbreak was 0.60 at lag 2.

Conclusion: Applying the EWMA algorithm as an outbreak detection method at local levels is not suggested. However the characteristics of data are determinant of the performance of such detection methods.

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Background & Objectives: Golestan province in Iran has been known as a high risk area for esophageal cancer (EC). This study was conducted to assess the population-based survival rate in EC patients in Golestan province of Iran.
Methods: In a longitudinal study, 223 EC patients registered in Golestan population-based cancer registry in 2007 and 2008 were recruited. Kaplan-Meier method was performed to calculate median survival and log rank test was also used to compare survival rates between subgroups of variables. Multivariate Cox regression model was employed to determine adjusted hazard ratios (AHR) for different variables.
Results: From 223 patient, 129 (57/8%) were male. The mean age of participants was 64/3 years. The median survival in our study was 11/08 months. Survival rates for 6, 12 and 36 months were 69%, 47% and 14%, respectively. The results of Cox regression analysis showed that the AHR for patients with metastasis stage (compared to those with localized stage) was 13.89 (95% CI: 7/93-24/32) and the AHR for workers (compared to clerks) was 2.4 (95% CI: 3/8-1/47).
Conclusion: Our results showed that survival rate of EC patients were higher than the rate reported in a previous study from this region. However the survival rate from this region seems still lower than those reported from developed countries. Implementation of appropriate screening programs in this region will result in early diagnosis of EC and consequently will increase survival rate in EC patients.

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Background & Objectives: Obesity is associated with increased resistance to insulin, hypertension, hyperlipidemia, hyperinsulinemia, and cardiovascular diseases. The purpose of this study was to investigate some factors associated with overweight and obesity among normal, overweight, and obese women aged 30 to 50 years from Sabzevar.
Methods: A questionnaire with 56 questions was prepared. The Beck questionnaire was used to measure the physical activity level. Weight, height, and waist circumference of the participants were measured using standard methods. Overweight (BMI ≥25 kg/m2), obesity (BMI ≥30 kg/m) and abdominal obesity (WHR ≥0.85) were also evaluated. MANOVA, Tukey post-hoc test, Pearson and Spearman correlation coefficients, Kruskal-Wallis and chi-square test were used for the statistical analysis of test variables. P ≤0.05 was considered significant.
Results: The results showed that 22.5% of women had normal weight, 42.4 percent were overweight, 31.6 percent were obese, and only 3.5 percent of women were underweight.
Conclusion: Our results showed that the prevalence of overweight and obesity was 74% in women living in Sabzevar, indicating the necessity of using educational methods to familiarize people, especially women, with weight control issues and prevention of obesity. The findings revealed that age, number of children, number of pregnancies, age at menarche, number of family members, working with the computer, and high-fat meals may increase the risk of obesity. Lifestyle modification and physical activity, as the most affordable and safest methods of preventing obesity, require more attention.

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  Background & Objectives: Zagros Mountains, which are between the flatlands of Mesopotamia and the Iranian plateau, surround the western border of the country. This region was the cradle of great civilizations like Mesopotamia and Elam. This study aimed to test the boundary role of the Zagros Mountains in the genetic structure of the region through evaluating the paternal lineages inheritance and patterns of genetic polymorphisms.

  Methods: Two hundred and ninety seven blood samples were collected from unrelated men of the different local areas of the northwest of Iran. Haplogroup frequencies were used to calculate and compare the population genetic parameters as genetic distance and genetic diversity.

  Results : In this research distribution time and entrance of the haplogroup G2-M406 estimated around 8800 years before present, the age of first human residential in the Zagros mountains area, Frequency of central Asian lineages in the eastern side of the mountains observed notable more than west side. While, European paternal lineages in the western side was more than eastern side of the mountains.

  

  Conclusion : This research emphasized the westward distribution and migration from Iranian plateau to the Europe through Turkey and Caucasus. This research has drown reliable phylogenetic tree of the surrounding population and showed an important geographic barrier role for these mountains to gene flow from neighboring regions and free movements of the local people. Moreover, the important role of the Zagros Mountains as a geographic barrier to gene flow from neighboring regions clearly highlighted in this research

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  Background and Objectives : Knowledge transition is an important issue in social epidemiology. Taking into account the importance of knowledge translation network among vulnerable young people in closed environments, this study was conducted to recognize and survey knowledge transition in school lessons. The study aimed at teenagers residing in orphanages in the city of Kerman, using social network analysis.

  Methods: The study samples of this cross-sectional study were all teenagers aged 12-18 years old residing in orphanages. Data was collected via a checklist. In order to study the structural cohesion of social networks and the position of teenagers, density and centrality indices were calculated. Local structure of networks was studied using the triad census method. Finally, the effects of independent variables on indegree index were investigated using a mixed model.

  Results : The mean density in knowledge transition was 0.34 (0.42 and 0.27 in girls and boys, respectively. (P=0.2)). Completely null and completely mutual triads were 17.1% and 11.2% in girls and 33.7% and 0.09% in boys, respectively. Indegree increased with an increase in age (P<0.001), the average of the scores in school exams (P=0.002), and studying non school materials (P=0.04).

  Conclusion: Age, average score of school exams, and studying non school materials were important factors in indegree. In general, density of social network was rather low. The rate of knowledge transition was small. Therefore, activities are required to enhance knowledge sharing and transition.

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Background & Objectives: The aim of the study was to determine age, period, and cohort effects on trend of alcohol and drug use in the students of Tehran University of Medical Sciences from 2006 to 2009.

Methods: Between 2006 and 2009, the students of Tehran University of Medical Sciences were surveyed annually using a structured self-administered and anonymous questionnaire. Intrinsic estimator, which is a new method for resolving linear dependency between age, period, and cohort in linear regression models, was used for data analysis.

Results: In the present study, in the descriptive method, the prevalence of alcohol consumption increased in males and females with an increase in age. The prevalence of illicit drug use was higher in 2007 in comparison with other periods for males and females. In the analytical method (intrinsic estimator), there were no age, period and cohort effects for alcohol and drug use for females. For males, the age effect exhibited an increasing-decreasing-increasing trend and period and cohort effects showed a decreasing trend for alcohol use. As for drug use, the age effect exhibited gradual increases. The period effect displayed an increasing-decreasing trend and the cohort effect exhibited an increasing-decreasing-increasing trend.

Conclusion: The IE method showed no age, period and cohort effects for alcohol and drug use in females. The prevalence of drug and alcohol use increased with an increase in age in males. The high prevalence of drug use could be due to easy accessibility and low price of drugs.

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Background and Objectives: Productivity and efficiency are the most important and the most common mechanisms of evaluation and measurement of the performance of an enterprise including the Social Security Organization. In the past decades, performance evaluation of various economic sectors has been attractive to researchers in different disciplines. Thus, the aim of this study was to measure the efficiency of the direct treatment section of treatment management units of Social Security Organization by data envelopment analysis method. 

Methods: This descriptive- analytic study was conducted to measure the efficiency of the direct treatment section of treatment management units of Social Security Organization through the data envelopment analysis (DEA) method in 2014. Data and relevant statistics were collected from the Statistical Center of Social Security Organization. The Deap2.1 software was used to calculate the efficiency and the EMS software was used to calculate the super efficiency. Then, the hypotheses of the research were studied using the Stata software.

Results: The average technical efficiency, managerial efficiency, and scale efficiency in 2014 was 0.924, 0.992, and 0.932, respectively. Twelve decision making units (DMUs) had the maximum technical efficiency (1), 16 DMUs had technical efficiency between 0.8 and 1, and 3 units had technical efficiency less than 0.8.

Conclusion: This study introduces a functional pattern to managers of Social Security Organization that enables them to have more accurate planning for the development and saving of resources.

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Good governance promotion in the health sector needs effective policies and evidence-based decision making. Using efficient and effective information is an important issue so that planners will not be confused amid many figures and numbers and also the main problem will not be marginalized. Hence, having a common language and consensus between policy makers and decision makers about the cycle (collecting and processing information, analysis, and judgment) and decision-making tools (criterion, indicator, index, and variable) is an initial and crucial step in evidence-based decision making. The main challenge for creating such an information system is the lack of a common language among scientific and executive experts; so the aim of this study was to provide a perspective of the concept of decision-making and the main components of its cycle and tools and to review these concepts in health care financing system.

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Background and Objectives: Determining and monitoring the age at myocardial infarction (MI) and its comparison in various regions is one of the vital and basic principles for the management of MI.This study was conducted to determine the age at the first MI in Iran.

Methods: In this cross-sectional, analytical study at a national level, the data of 20750 new MI patients registered in 2012 in 31 provinces of Iran according to the cardiologist’s diagnosis, World Health Organization criteria, and the codes ICD10: I21-I22 were used. The calculations were done using the Stata 12 software.

Results: The mean±SD of age at the first MI was 61.2±13.4 years in all patients in Iran. Moreover, 15033 (72.4%) patients were male with a mean age of 59.6±13.3 years. The mean age at MI in men was lower than women (65.4±12.6 years), showing a statistical significance (P<0.001).The mean age at MI was different among Iran provinces, with a statistical significance (P<0.001). The lowest mean age at the first MI was seen in the patients living in Semnan (59.1±12.9 years), followed by Tehran (60.4±13.5 years), Sistan va Balouchestan (60.3±13.9 years), and Lorestan (60.1±14.5 years), with a significant difference from the mean age of the patients in Ardabil (63.2±15.1 years) and Zanjan (64.4±112.8 years) (P<0.019).

Conclusion: Our study demonstrated that the age at MI was approximately five years younger in men than women. This studyprovided the ground for monitoring the age at MI, and more effective management of cardiovascular diseases in Iran.

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Background and Objectives: Anthroponotic cutaneous leishmaniasis (ACL) is restricted to humans; thus, prompt diagnosis and early treatment are significant measures to control the disease. This study was conducted to determine the effect of direct active case- detection and early treatment on the control of ACL in Bam District.

Methods: This retrospective cohort study was performed based on intervention and nonintervention. After the 2003 earthquake, an equipped treatment center was established to actively detect CL cases following the CL epidemic. This intervention was carried out in 2007 and the suspected cases were referred to the center for diagnosis and treatment Another comparable CL treatment center was selected as the control in Kerman. The recorded data of the patients were analyzed with statistical tests at p<0.05.

Results: The incidence rate steadily increased to 30% from 2003 to 2007 whereas the incidence gradually decreased to 1% after the intervention. However, by contrast, the incidence rate increased significantly in the control area. The treatment failure and relapse rate of ACL showed no significant difference with the control group before and after the intervention. The effectiveness of the intervention was calculated to be 85%.

Conclusion: Active case-detection and early treatment of ACL could be an effective measure in controlling ACL, particularly during epidemics. Lessons learned from the 2003 Bam earthquake could be used as a suitable model for ACL endemic areas, nationally and globally.

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Background and Objectives: One of the decentralized models that has been formed based on universal health coverage is the model of health complexes in Tabriz. This study was conducted to evaluate the model.
 
Methods: This case study was conducted in 2017. Beside observation, 28 individuals, including informed experts in the field of establishment of health complexes in Tabriz University of Medical Sciences, were purposefully selected and semi-structured interviews were also conducted. To analyze the interviews and the results of observations, the framework analysis was used based on the components of the Primary Care Evaluation Tool (PCET) model.
 
Results: The strengths of the health complex model are decentralized planning, strengthening the private sector participation, have more appropriate methods for assessing the performance of the health team, creating a sense of delivering effective services in providers, using electronic information registration system, using the prospective payment method, strengthening the referral system, enhancing service continuity, and facilitating financial and geographical access, especially in marginalized areas. However, there are some problems such as lack of some facilities and equipment, lack of some workforces and high workload, financial instability, and lack of insurance organizations cooperation with the plan.
 
Conclusion: The health complex model has improved organizational, financial, and geographic access to health services. It seems that if the resources are more stable and by cooperation of basic insurances, the results of this project will be better.
 

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Background and Objectives: The aim of this study was to provide a clear description of the pre-hospital emergency setting and risk management in accidents and disasters in accordance with current Iran’s standards in different regions of the country. This study was part of the national project "Iran Roadmap (Neda 2026)".
 
Methods: The data of the major medical equipment was gathered from 48 medical universities covering all of the country's 32 provinces. Goal standards were obtained from the “Ministry of Health” and the “Department of Statistics for Medical Accident and Emergency Management Centers” in all universities. Coefficient of dispersion was calculated to evaluate any dispersion in major medical equipment.
 
Results: The results of this study showed that in 2017, the highest and lowest coefficient in “pre-hospital facilities” was related to the ambulance engine (301%) and the operational base personnel (93%), respectively. Nio national standards were implemented in “Risk Management in accidents and disasters needs” in most provinces of Iran. In 2026 estimates, all of the factors improved and dispersion decreased.
 
Conclusion: Despite the poor distribution of prehospital indicators in 2017, forecasting showed desirable conditions in distribution of facilities in the pre-hospital emergency and risk management of accidents and disasters.