Journal of School of Public Health and Institute of Public Health Research

ORGANIZING MENTAL HEALTH SERVICES IN SCHOOLS: ASSESSING TEACHERS' ROLES

MH Kaveh

Approximately 21% of children and adolescents experience signs and symptoms of aDSM-1V disorder during the course of a school year, yet fewer than 20% of those needingmental health services actually receive any. Research suggests that schools and teacherscan help promote mental health, delect children at risk, and refer them for psychiatricassistance. This study aims to determine the effects of an educational intervention onteachers' knowledge, attitude, self-reliance and practice.This study was carried out in 24 State-run elementary schools in the city of Khorramabadin Lorestan province. Iran, during the academic years 2001 - 3.Of the 64 teachers initially selected, 57 agreed to participate in the study 27 of these wereplaced in the intervention group and the remaining 30 in the control group.The intervention group attended a 3-day workshop. Self- administered questionnaireswere filled before and after the workshop, and at the end of the project data were collectedfrom teachers and students. Statistical analysis was done by the SPSS package, usingmainly nonparametric tests.49% of the participants were men, 42% had a high school diploma and others haduniversity degrees. Findings showed significant improvements in teachers' knowledge.attitude, and practice in the intervention group. Nosuchimprovement was observed incontrols. Teachers in the intervention group were able to identify and refer 106 suspectedcases, of whom 79 had a mental disorder confirmed by a psychiatrist. Within the sameperiod, only 2 cases had been referred by the control group. Students' knowledge, themain criteria of teachers' practice in mental health education, had significantly improvedin the intervention but not in the control group. Results suggest that female teachers hadhigher KAP levels than their male colleagues.The study confirms that trained teachers have the capabilities required for participating inSchool - Based Mental Health Services. It also appears that schools are indeed a crucialplace for helping children in need of mental health services.

LONG - TERM PULMONARY COMPLICATIONS IN COMBATANTS EXPOSED TO SULFUR MUSTARD:A HISTORICAL COHORT STUDY

A Karimi Zarchi

Sulfur mustard is the most widely used chemical agent in the Iran-Iraq war .In a retrospective cohort study of 1337 soldiers with a history of sulfur mustard exposure, factors such as age, smoking habits, number of exposure episodes and the use of gas masks were determined, together with an assessment of their relationship with the occurrence of long-term pulmonary complications. The models suggested by Szklo,BresIow & Kahn were used to determine rates, rate ratios and confidence intervals. The mean age of the victims was 25.5 years (standard deviation = 9.1 years), and more than 96% had experienced only one exposure episode.
15.1% were cigarette smokers, and the majority (94.5%) had used protective gas masks at the time of exposure.
Cumulative incidence of lung complications was 31.6% the lowest rate was noted during the first year of follow-up (7.5/10000), and the highest in the 7th year (769/10000). Estimated rate ratios with 95% confidence intervals for various age groups were as follows: 1.12 (0.88-1.46) for those aged 21-25 years, 1.49 (1.1-2.01) for ages 26-30, 1.7 (1.2-2.4) forages 31-35, and 2.09 (1.55-2.77) for subjects aged 36 and above. Rate ratios with regard to other factors, i.e. more frequent versus single exposure, smoking vs non-smoking and unprotected exposure vs protective mask use were 0.69 (0.42-1.12), 1.08 (0.80-1.45) and 3.04 (2.20-4.20) respectively. Therefore, the estimated rale ratios were significant only for three out of four age groups and for those who had not worn gas masks (p<0.05). Therefore gas mask and age groups of veterans must be considered in assessing the potential consequences of a chemical attack.

DISCONTINUATION RATES OF INTRAUTERINE CONTRACEPTIVE DEVICE USE IN THE RURAL AREA OF URMEA PROVINCE OF IRAN

F Yosefi Majd

The Intrauterine device (IUD) is very effective in preventing pregnancy, it is the cheapestform of birth control in the long run, allows almost immediate return to normal life andwork, and it can be used as an alternative to hormonal methods of emergencycontraception.This study was designed to assess factors causing IUD iscontinuation. It is a cross-sectional study among 343 women in Urmia in 2001 who had had lUD'splanted back in 1998.Within 3 years, more than 50 percent had theirlUD's removed. The 1-year IUD survivalrate was 62 percent and the 3-year rate about 42 percent.54.5 percent of users had at least one complication (P=0.000). The main complications were: Bleeding 28.7% , Pain 27.3% and Infection 18.5%.In cases where the device was planted by a midwife, the overall removal rate was 62.5%(p= 0.009). Pregnancy rate was 0.49% per 100 woman - year and the IUD expulsion ratewas 6.5%o.Bleeding is clearly the most common complication. If cases are chosen more carefully, the effective life of device will probably increase.

A STUDY OF GROUND WATER QUALITY IN LENJAN TOWNSHIP OF ISFAHAN PROVINCE

H Pour Moghadas

Ground water is considered as a valuable resource for drinking, agricultural, and industrial uses. As human activities are known to affect water quality, studies of this source are necessary to maintain quality standards. Despite heavy agricultural and industrial activity in the Lenjanat region (Isfahan), there has been no evaluation of ground water quality in this area.In this research project, chemical parameters such as anions, cations and heavy metals were determined in 16 wells over four seasons. The yearly averages of the parameters calculated and displayed by the graphs.The results showed that "Lenjanat" ground water qualifies as very hard water. Most chemical parameters such as BOD, Cod: TDS, EC, S04 of wells number 1,2,3 and 14 exceed drinking water standards. The wastewater lagoons of the Isfahan Steel Mill may be polluting well No. 3 and the other three wells. Wells No.4 and 5, located in the lower areas of Munitions Factories, showed a vers' high COD.Due to the west-to-east direction of surface slopes (from munitions factories towards the above-mentioned wells) the water could be polluted by waste material from the industry. It seems that severe pollution of ground water exists around these factories and extensive studies are required to determine the type of organic and inorganic waste and the exact source of pollution in order to control groundwater quality.

ASSESSMENT OF OCCUPATIONAL EXPOSURE TO AIRBORN ASBESTOSE DUST IN THE BRAKE SHOE MANUFACTUREFACTORY

H Kakooei

This study has been done in a raajor brake-shoe factor.'. Air samples were taken and dustlevels determined according to OSHA code, revealing a dust load in weighting and shootingsaloons ranging from 2 to 16.88 mg/nr Measurement and counting of asbestos fibers weredone using OSHA ID 160/ code and permissible exposure levels. Asbestos fiber counts in sampled areas were higher than the time weighted average level(TWA) and even higher than action level.Particle size distribution was also determined. It turned out that of the 3000 counted particles,%90 of non-fibers and %10 are fiber-shaped. Also size of %60.4 of counted fibers is lowerthan 10 x that %80 of them are fibers.The results of this study showed significantly thai the maximum pollution loads occur in theweighting section, especially in the mixers. Heavy pollutant load. low air flow (face velocity)and use of canopies with the lowest enclosure may be regarded as potential mechanisms.

COMPARISON OF BIOCHEMICAL AND BIOASSAY METHODS IN ASSESSING ORGANOPHOSPHATE RESISTANCE IN BLATTELLA GERMANICA

M Abolhasani

In this study we employed two methods for gauging the sensitivity of B. germanica strains to organophosphorus insecticides: an in-vivo bioassay that used linear regression analysis (with mortality on a probit scale and logarithm of concentration) and an in-vitro enzyme assay.
In the bioassay method, B. germanica nymphs of stage 1 (2-3 days old) were exposed to patches of paper impregnated with 2% diazinon and propoxur. Compared to the sensitive (reference) strains, all but one of the tested strains showed resistance to diazinonzinon with resistance ratios of 0.97 to 1.67. As for propoxur, all strains were sensitive with the exception of one subject that showed a resistance ratio of 1.6. The enzyme assays used common esterase and acetylcholine esterase methods. Comparison of in-vivo and in-vitro tests on stage 1 nymphs of B. germanica shows that both methods are reasonably sensitive in measuring resistance/sensitivity ratios. In addition, the bioassay modality makes it possible to gauge the degree of insecticide sensitivity while the in-vitro method can only determine quantitative or qualitative changes in enzymes effected by carbamates and organophosphates. This study is the first of its kind, conducted by the school of Public Health in Tehran University of Medical Sciences.

SEROEPIDEMIOLOGIC STUDY OF HUMAN TOXOPLASMA INFECTION IN RESIDENTS OF MESHKIN - SHAHR

M Soltan Mohammad Zadeh

Toxoplasmosis is a common disease caused by the protozoal parasite Toxoplasma gondii. Most human cases occur by 1) eating raw or undercooked meat containing T. gondii tissue cysts. 2) ingestion of oocysts from soil and 3) vertical transmission through the placenta. Immunocompetent adults are usually asymptomatic or present with self-limited fever and lymphadenopathy. Infection acquired during pregnancy can be transmitted to the fetus and may cause mental retardation, blindness, epilepsy, and abortion. In this cross-sectional study we determined the prevalence of toxoplasma infection in residents of Meshkin-Shahr in 2001-2002. We applied a cluster sampling method to family health files in local health centers to recruit a total of 909 individuals for this study. All family members were requested to complete the study&aposs questionnaire. For each individual, two separate blood samples were collected and placed in microhematocrite tubes. Titers of anti-toxoplasma antibodies were measured by IFA with levels in excess of 1/20 taken as positive. Questionnaire information and examination results were analyzed by the SPSS software package using chi-square tests. Results of this survey show the overall prevalence of toxoplasma infection to be around 18.3%. Figures for men and women were 19.7% and 17.2%, respectively but the difference was not statistically significant. Prevalence rates show a significant association with age (greater prevalence in higher age groups) and the type of meat consumed (P<0.05). But there were no significant associations with education level, occupation-keeping cats in the house, ingestion of meat and history of previous abortions. The most frequently occurring antibody titer was 1/20 (6.9%). and frequency decreased with higher antibody titers.
This study shows that toxoplasma infection is not as common in Meshkin-Shahr as in some parts of the country, with more than 80% of individuals being seronegative. Because of the low immunity level and the risk of vertical transmission, educating the public in prevention methods could be very important.

THE SEVERE ACUTE RESPIRATORY SYNDROME

M Mardani

Severe Acute Respirators&apos Syndrome (SARS), an emerging infectious disease first reported from the Chinese province of Guangdong, has already caused one worldwide outbreak. The syndrome spread across the globe by travelers. The etiologic agent was unknown at the beginning, but because of the rapid spread of the disease, an infectious agent with high transmission potency was suspected. Later workers at the Center for Disease Control and Prevention (CDC) and World Health Organization (WHO) succeeded in isolating a new coronavirus with a distinct genome from SARS patients. This new virus spread all over the world in a few weeks and the epidemic peaked in March and April. Within a short period of lime, the epidemic inflicted huge economic losses on the involved countries, especially in Asia. Finally the outbreak was contained in July, 2003. But is this really the end of SARS? The are no easy answers.
Considering this new disease and the probability of its reemergence, it is necessary for all health care workers to be familiar with some features of the syndrome (clinical and laboratory findings, approach to patients, routes of transmission, pre and post-travel recommendations and ways to control the infection).
We will provide you with some important information about this new emerging disease from a variety of sources.