Journal of School of Public Health and

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 are 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.

Background and Aim: Unwanted pregnancy is a widespread problem globally and in Iran, which can lead to low birth weight (LBW)-one of the most important causes of mortality in newborns. This study was conducted to assess the risk factors among women with unwanted pregnancies leading to delivery of LBW infants. Other LBW risk factors were also studied.

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 χ2 tests. Also, multiple logistic regression was 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 `1234t5weight 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 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 were identified: Physa sp . (29%), Gyraulus sp. (19%), Melanoides sp. (16%), Bellamya sp. (14%), Melanopsis sp. (12%), L. gedrosiana, (7%)L. truncatula(2%). No Bulinus truncatus 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.

Background and Aim: Factors determining the health care-seeking behaviors of an individual are social, cultural, and economic (treatment costs). Utilization of a health care system by a person will, on the whole, depend mainly on the socio-economic and demographic factors, cultural beliefs and practices, gender discrimination and women's status, the economic and political systems, environment, patterns of illness, and the health care system itself. The main objective of the present study was to examine current patterns of health care-seeking behavior in residents of Tehran, Iran in 2007.

Methods and Materials: In a cross-sectional study a two-stage cluster sampling method was used to select neighborhoods at the first stage and households at the second. The sample included a total of 1882 individuals over 18 years old in the households. The data were collected using a questionnaire. For analysis of the data the exact fisher test, X2, and multivariate logistic regression were used the software used was SPAA.3

Results: About 22/9% (431 persons) of the participants reported 1-2 illnesses during the previous month. Multivariate logistic regression indicated that age, sex, perceived severity of the illness, educational level, and marital status were all statistically associated with an attempt to seeking care, whether self-treatment or consulting a health center. The effects of different variables on decisions related to seeking care from a health care center versus self-care were also examined. The data showed that age, sex, perceived severity of the illness, income, educational level, household size, and method of payment were statistically the most significant variables affecting seeking care from a health center.

Conclusion: Based on these findings, it may be concluded that increasing social awareness about side effects of medicines, potential dangers of self-treatment, continuous education and training of physicians and pharmacists, improving health insurance systems and universal insurance coverage will be appropriate strategies for better utilization of health care services by the people.

Background and Aim: Thalassemia is one of the most common worldwide single-gene diseases. On the molecular level, it is a heterogeneous disease. So far, beside large deletions, more than fifty point mutations have been identified for this disease around the world. Four to ten percent of Iranians are carriers of thalassemia-affected genes. In this study we determined the relationship between the value of MCV/MCH and the type and severity of mutations in alpha thalassemia carriers.

Methods and Materials: The major abnormality in alpha thalassemia carriers is decreased values of MCV and MCH. A total of 104 adult alpha thalassemia heterozygotes, 20-40 years old, including 33 persons from Khoozestan Province and 71 from Khorasan Province, were included in the study. Two hundred and eight chromosomes were isolated from peripheral blood leukocytes using standard procedures. DNA samples were amplified by Gap-PCR.

Results: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

Conclusion: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

Background and Aim: Adolescence is the transition period between childhood and adulthood, a period in life that begins at puberty. It is one of the fastest growth periods in a person's life. During this time, physical changes affect the body's nutritional needs, while changes in one's lifestyle may affect eating habits and food choices. Nutritional health during adolescence is important for supporting the growing body and for preventing future health problems. In Iran, the prevalence of anemia, obesity, and other chronic nutritional diseases has increased in recent years due to undesirable eating habits. This survey was conducted to determine consumption of the four major food groups (vegetables, fruits, milk products, and meat) among a group of high school students in Zanjan Province, Iran.

Methods and Materials: A descriptive, cross-sectional study was carried out on 1500 students, selected by random cluster sampling, in Zanjan high schools, Iran in 2005. The daily intakes of the 4 food groups during the previous week were determined using a food frequency questionnaire. The potential determinants of the pattern of food consumption were also determined.

Results: The proportions of the students not having consumed fruits, vegetables, and meat during the weak were 16%, 6.8%, and 10%, respectively. More than 95% of the students said that they had consumed milk/milk products at least once a day. Only 8.7% consumed fruits and 27% consumed vegetables 3 times or more daily.

Conclusion: The consumption of the 4 food groups of large proportions of Zanjan Province adolescents is below the current recommendations. Health and nutrition educational programs would be a valuable tool to correct erroneous food habits of the adolescents leading to improvements in their nutritional status.

Background and Aim: By providing the greatest amount of direct service to patients, nurses play an extremely valuable and unmatched role in the quality and efficiency of care and curative services. Workplace violence is regarded as one of the factors which can reduce job satisfaction and the quality of working life of nurses and their interaction with patients, as well as the work efficiency of nurses and hospitals. In this study, after translating and validating tools of violence measurement in the health sector, the exposure of nurses to psychological violence was measured in a large teaching hospital in Tehran

Methods and Materials: A descriptive-cross sectional design was used in this study in summer of 2009 (1387). The study population included all the nurses (n=413) working in a large teaching hospital in Tehran. The questionnaire used for collecting data was adopted from a standardized questionnaire designed jointly in 2003 by the International Labor Office, the World Health Organization, the International Council of Nurses, and the Public Services International. Analysis of the data was made using the descriptive statistical methods and the Chi square- and t-tests.

Results: Sixty-nine percent of the nurses had experienced workplace violence. The most common forms of violence were verbal abuse (%64) and bullying-mobbing (%29). On the whole, 26% of the nurses had experienced both forms of violence in the previous year, while 335 had not faced any form of violence in their workplace. Nurses working in outpatient clinics and emergency wards experienced the highest number of encounters with verbal abuse. Encounters with bullying and mobbing were more common among female nurses than the male ones. Overall most of the violent behaviors were committed by patients and their relatives.

Conclusion: Exposure of nurses to psychological violence is considerable and comparable to that reported by previous investigators in other countries. Thus it is highly crucial to adopt appropriate management policies aiming, particularly, at educating the medical personnel in ways of preventing and reporting violent behaviors.

Background and Aim: Organizational centralization, an important concept/system in management, relates to hierarchy of authority and degree of participation in decision-making. In this study we aimed to determine the extent of organizational centralization in hospitals affiliated with Tehran University of Medical Sciences (TUMS), Tehran, Iran and identify factors affecting the organizational centralization at the level of executive managers.

Methods and Materials: All the managers and head nurses of 13 TUMS hospitals (26 subjects) were included in this cross-sectional study in 2005. Data, collected using questionnaires, were analyzed using the following tests: t-test, ANOVA, Pearson and Spearman, the software being the SPSS. The extent of organizational centralization was categorized into centralized, semi-centralized, and uncentralized.

Results: Five of the 5 variables studied were statistically significantly associated with organizational centralization. They were gender (p=0.001), organizational position (p=0.005), attending management courses (p=0.001), and financial burden of decisions (p=0/03) in the hospital managers group, and possibility of controlling the decision (p=0.014) in the head-nurses group.

Conclusion: The average organizational centralization in the hospitals was 75.38% it was 76.3% and 73.38% for hospital managers and head-nurses, respectively. On the whole, the management system of TUMS hospitals is a semi-centralized system.

Background and Aim: Breast cancer is the most common cancer worldwide and the cause of about 18% of all malignancies in females. By breast self-examination (BSE) it is possible to diagnose a breast tumor in the preliminary stages and treat it. Basic changes in the knowledge, attitude and practice of women as regards regular BES and follow-up will lead to considerable success in campaigns against breast cancer. Considering the role and responsibilities of community health workers (CHWs) in the health services delivery system in the Islamic Republic of Iran, this study aimed at determining the knowledge, attitude and practice of female CHWs as regards BSE in 2006.

Methods and Materials: This was a cross-sectional study conducted on 89 female CHWs in the Iranian Mako township health houses. The data was collected through interviews using a questionnaire consisting of 4 sections, the first section containing 10 demographic questions, and the second to fourth sections containing 33 questions on knowledge, attitude, and practice. The validity and reliability of the questionnaire were confirmed using the repeat testing with r=85%. The data were analyzed using the SPSS software (version 11).

Results: The data showed that the BSE knowledge of 50.6% and 49.4% of the subjects was good and moderate, respectively 76.4% of them had a positive attitude towards BSE. The reasons for not self-examination were as follows: inability to do it alone (12.4%) fear of a positive result, i.e., existence of a tumor (1.1%) having no time (2.2%) fear of increased anxiety (5.6%) not believing in BSE, even if it was likely to have a tumor (11.2%). Further analysis of the data showed the practice of the subjects to be good, moderate, and weak in 9%, 61.8%, and 29.2% of the cases, respectively.
There were significant associations between knowledge and a positive attitude (p=0.038), between attitude of the unmarried subjects towards performing BSE as compared to the married subjects (p=0.00), and between attitude and practice (p=0.045).

Conclusion: This study showed a moderate to good knowledge, a relatively good attitude, and a moderate practice among female CHWs in the Makoo Township, Iran, with regard to BSE. Considering the role of CHWs, improving their knowledge, attitude , and practice of BSE is essential.

Background and Aim: In the initial preparation stage, before feeding worms with organic wastes, the wastes are pre-composted for some time. This was done so that the thermophilic phase of organic wastes degradation is passed, no harm is done to the worms which are sensitive to high temperatures, production of fertilizer faster is quicker, and biological contamination is reduced. The length of this preparation time is important with regard to the quality of the compost obtained, the vermicomposting process, and space and facilities needed. The purpose of this study was to determine the effect of preparation time of food wastes on the vermicomposting process without any preliminary action or continuous aeration.

Materials and Methods: The Eisenia Foetida species was used for vermicomposting. Food waste preparation times of 0,6,12 and 18 days were attempted, and factors such as pH, C%, N%, C/N ratio, and the process rate were monitored during the process.

Results: The lowest and highest final C/N ratios were seen on days 6 and 18 of preparation, respectively. The data also showed that the highest reduction (64.93) in this ratio was observed on 6 day and the lowest (36.56) on day18.

Conclusion: On the basis of these findings it can be concluded that there is a significant difference among various food waste preparation times with regard to C/N ratio (p-value<0.05), the preparation time is effective on the C/N ratio, and the most appropriate length of time for preparation is 6-12 days.

Background and Aim: Determination of the age of vector mosquitoes is of particular importance in epidemiological studies of diseases transmitted by them, such as viral and parasitic diseases. The objective of this study was to determine the daily age of Anopheles stephensi based on changes in pteridine concentration in female mosquito cuticles by liquid chromatography (HPLC).

Methods and Materials: Females of Anopheles stephensi were raised in an insectary (28° C, 70% relative humidity). At 1, 5, 10, 15, 25, 30 days post-emergence they were divided into groups of 10 mosquitoes each. The mosquitoes in each age group were further divided into 3 subgroups of 10 each for chromatographic (HPLC, emotion = 355 nm and excitation= 465 nm) pteridine extraction. The chromatograms obtained were compared with the respective standards to determine the types of pteridines.

Results: Four types of pteridines were detected in the cuticle of Anopheles stephensi, including isoxanthopteridine, pteridine-6-carboxylic acid, biopteridine, and xanthopteridine. They were all present in all the cuticle of the mosquitoes however, no biopteridine in the head or xanthopteridine in the thorax were found. Generally, as the age of the mosquitoes increased, pteridine concentrations kept declining, such that after 30 days the total concentration reached 10% of the original.

Conclusion:The findings indicate that there is a negative correlation between the concentration of pteridines in the cuticle and daily age of female mosquitoes. The method described can be used as a standard method to determine the daily age of Anopheles, as well as of other mosquito species, since it is fast and precise and needs small samples. Its major limitation is non-availability of HPLC in many parts of the country, although it is possible to freeze dead mosquitoes and transfer them to centers where HPLC is available.

Background and Aim: High concentrations of organic compounds and ammonia and entry of toxic pollutants lead to a low efficiency of direct biological treatment of landfill leachate. The aim of this study was to determine the efficiency of a repeated fed-batch biological reactor with powdered active carbon (PAC) for landfill leachate treatment.

Methods and Materials: Raw leach ate was pretreated by coagulation and flocculation processes and, then, the ammonia was removed by air stripping at a high pH, before biological treatment. The pretreated leach ate was treated bio-treated in an aeration tank by the repeated fed-batch method. Three cycles of 1×40, 5×8, and 4×10 hours were attempted in the absence and presence of 2 g PAC /L.

Results: Results indicate that the presence of PAC increased the COD removal efficiency significantly. The initial COD effluent was 3900 mg/L. Its values were 169 mg/L and 622 mg/L in the presence and absence of 2 g/L PAC, respectively, for the cycle of 5×8 h.

Conclusion: Based on the results of this study and findings of other investogations in this field, it can be concluded that repeated fed-batch bio-reactor has is quite effective for treatment of pretreated leachate.

Background and Aim: The large volume of reports and statistics in the literature on the prevalence of musculoskeletal disorders (MSDs) in Iran and other countries indicates that it is essential to assess the ergonomic situation in different occupations. These disorders can be caused by long-term exposure to different agents or by trauma to the musculoskeletal system. A large part of the work force in Iran is engaged in general construction and dam construction workshops. The postures of these workers while working in the workshops are unsuitable postures. The objective of this study was to assess the ergonomic situation of workers in dam construction workshops.

Methods and Materials: This was a cross-sectional study conducted in 2008. The sample included 110 randomly selected male-workers in a dam construction workshop in Takab City, Iran, engaged in 25 different jobs. Data were collected using the Nordic Musculoskeletal Questionnaire and the National Institute of Occupational Health-Center to Protect Worker Rights Checklist (NIOSH-CPWR), both developed by the National Institute of Occupational Health-Center to Protect Workers Rights. The software used to analyze data was SPSS.

Results:The average service record of the workers was 36.6 ± 86.8 months. The data show that the most common (55.5%) MSDs were in the low back region. There were statistically significant positive associations between prevalence of MSDs and many independent variables, namely, age, weight, education level, service record, smoking, type of job, lengths of time of standing and sitting at work, total duration of work, work pressure, undesirable postures, and surface for walking.

Conclusion: The results of this study generally confirm findings of previous investigators. It can be concluded that ergonomic assessment of jobs may give valuable information to be used by occupational health and safety authorities in planning preventive and educational programs.

Background and Aim: By definition, the ratio of output to input in any firm is called efficiency. In general, there are two main approaches for measuring efficiency ─ parametric and non-parametric. The objective of this study was to assess the efficiency of Health Services Workshops in Iran in 2006.

Methods and Materials: The efficiency of Health Services Workshops in Iran in 2006 was assessed using the non-parametric method, based on linear programming. More specifically, the Data Envelopment Analysis (D.E.A) was used. The most important feature of the Data Envelopment Analysis (D.E.A) is its applicability for the firms that operate under a multiple input-and-output framework. Assessment of efficiency was based on 2 assumptions, namely, fixed and variable efficiency.

Results: The data show that, based on fixed efficiency, the efficiency in the Bushehr, Fars, Kerman, Mazandaran and Yazd provinces is the highest, the average being 80%, which means that the idle capacity is 20% . Based on the variable efficiency. assumption, in Ilam, Chahar Mahal-and-Bakhtiari, Semnan, and Kohgiluyeh Boyerahmad provinces the efficiency is 85% (idle capacity = 20%).

Conclusion: On the whole, the Chaharmahal-Bakhtiyari province is the most efficient in holding Health Services Workshops in Iran. Therefore, other provinces should follow this province as an example when planning to increase their efficiency.

Background and Aim: Based on WHO reports, there are about 100-150 million people with asthma around the world and the number is increasing. Asthma is a prevalent disease and permanent self-management is needed in order to control the symptoms and maintain the normal action of the lungs and a normal level of activity. The Green's Model of Health Education Planning provides a systematic process for planning, implementation and evaluation of population health promotion programs and is used in a broad range of issues in health promotion, including self-management in asthma. This study was carried out with the aim of determining predictors of self-management behaviors in patients with asthma in Yazd, Iran, based on the above-mentioned model.

Methods and Materials: In this cross-sectional study convenience sampling was employed to recruit 94 outpatients with asthma from among those referring to Shaheed-Sadooghi Clinic in Yazd, Iran. Data were collected using a questionnaire based on the Green's Model constructs, consisting of predisposing, reinforcing, and enabling factors and self-management behaviors. Reliability and validity of the questionnaire were assessed prior to data collection.

Results: The subjects acquired 49.5%, 68.6%, 67.3%, and 61.2 % of the earnable scores for self-management behavior, predisposing factors, reinforcing factors, and enabling factors, respectively. Predisposing, reinforcing, and enabling variables had positive correlations with self-management behaviors (p<0.01) and accounted for 34.6% of the self-management variance. Predisposing factors were the strongest predictor (β = 0.480).

Conclusion: It is concluded that the Green's Model of Health Education Planning can be used in developing countries, such as Iran, as a framework for planning intervention programs in an attempt to improve the self-management behaviors of patients with asthma. Designing and implementing educational programs aiming at promoting self-management behaviors in asthmatic patients with emphasis on predisposing factor enhancement is recommended.

Background and Aim: Natural organic matter (NOMs), measured on the basis of organic carbon, produces disinfection by-products precursors (DBPs) during the chlorination process. Some DBPs are carcinogenic. NOMs are not completely removed by conventional water treatment. As a result, in addition to forming DBPs, they support bacterial regrowth in the water distribution systems and cause unpleasant odor and taste and other problems. The objective of this study was to determine organic carbon concentration and DBPs formation potential in drinking water of the water distribution system in Tehran, Iran.

Methods and Materials: Water sampling was done by standard methods, monthly between August 2006 and Feb 2007, at four points of the drinking water distribution system in Tehran. Quantitative parameters, including pH, EC, UV254 (UV absorbance at a wavelength of 254nm), dissolved organic carbon (DOC), and specific UV absorbance (SUVA) were determined. DOC and UV-254 of the samples were determined using a Total Organic Carbon (TOC) analyzer and a Lambda 25 UV/Vis spectrophotometer, respectively. SUVA (L/mg.m) was calculated as thea ratio of the UV absorbance at 254 nm (1/m) to DOC (mg/ L).

Results: The water content of DOC at the four points of the distribution system was less than 0.7 mg /L. The mean DOC concentration was 0.3±0.14mg/L, ranging between 0.12 and 0.687mg/L, with no monthly variation. The mean SUVA was 1.3±0.7.

Conclusion: It can be concluded that the Tehran water treatment systems cannot eliminate completely natural organic matter. SUVA values show, however, that the system can eliminate the majority of hydrophobic compounds. Therefore, formation of haloacetic acids is more probable than that of trihalomathanes.