M Yunesian , M Shariati , Gh Zamani ,
Volume 3, Issue 1 (4-2005)
Abstract
The purpose of this study was the creation and measurement of consensus regarding formation of a new Department of Health in Tehran University of Medical Sciences (TUMS).
Using a three-iteration Delphi procedure, consensus was built and measured among experts on different aspects of a possible merger between the current Medical Care and Health Care Departments and the formation of a new Department of Health in TUMS. Forty-two experts from the Ministry of Health, TUMS, other medical universities in Tehran, the Management and Planning Organization and other research bodies were included in this study. Feedback from the aggregate responses of the panel was used to construct questionnaires employed in subsequent iterations of the Delphi. We used a Likert scale for assessment of opinions consensus was defined as agreement or disagreement of at least two thirds of respondents on a particular subject.
Consensus was attained in 27 out of the 36 items presented in the third round of the study.
Consensus on the necessity and feasibility of the formation of the new department in TUMS was achieved after three rounds of the Delphi process. The panel converged to form a consensus on the need for a merger from different perspectives, including the overlapping responsibilities of the two departments, promoting a community-oriented approach, improving the quality of services and bringing the reforms in line with the policies of the Ministry of Health.
Conclusion: The experts who participated in this study achieved consensus on the necessity and feasibility of formation of a new Department of Health in TUMS.
G.h Veghari ,
Volume 3, Issue 1 (4-2005)
Abstract
Obesity is a major health and nutrition problem all over the world. This was a cross-sectional study and the sampling method was of the component type (cluster and simple sampling). 2854 women who had children under 5 years of age participated in this study. The data were recorded by 20 trained interviewers using a questionnaire. Subjects were weighed on scales and had their height, waist circumference, and hip circumference measured by a meter. Pregnant women were not included in this study. Economic status was categorized based on possession of 10 consumer items considered necessary for modern-day life (Low >=3, Moderate = 4-6 and Good = 7-10). Three ethnic groups were compared in this study: Fars (native), Turkmen, and Sistani.
The mean age was 28.2 y. Body Mass Index (BMI) in ranges of (25-29.9), (30-39.9) and (≥40) was observed in 28.3%, 15.9% and 0.5% of the subjects respectively. The frequency of BMI over 25 among Fars, Turkmen and Sistani mothers was 64.3%, 43.4%, and 32.9% respectively. The difference between the three groups was statistically significant (P<0.02). In 39.1% of these women, the Waist to Hip ratio (WHR) exceeded 0.8 and the index was higher in Turkmen women compared with other groups. The frequency in women with low, moderate and good economic status was 34.7%, 50.8% and 55.9% respectively, but these differences were not statistically significant. The prevalence of obesity in literate women is significantly higher than in illiterate women (p<0.04).
On the whole, this study indicates that obesity is a common health problem among women in the rural areas of Gorgan. There is a relationship between the prevalence of obesity and higher economic status. Therefore, educating women on optimal nutrition and changing their food habits would be very important.
M Mahmoodi , M Mohebali , H Hejazi , H Keshavarz , A.m Alavi Naeini , Sh Izadi ,
Volume 3, Issue 1 (4-2005)
Abstract
The purpose of this study was to determine toxoplasmosis seropositivity rates and to record ascending serologic titers in high-school girls. We also searched for possible risk factors.
This descriptive-analytic study used 414 serum specimens collected from high school girls in six different regions of Esfahan city through cluster random sampling. The sera were taken from the tip of the finger by hematocrite microtubes. Samples were studied by the Indirect Immunofluorescent Assay Test(IFAT) for estimation of serum titers. Data were analyzed using chi-square (X²) and t tests.
The overall seropositivity rate was 18.4% in 14-19 year-old girls and this rate increased with age. IFAT titers in 98% of the positive samples were at 1:100 the remaining 2% showed values above this threshold. For the latter group, we performed another titration test to determine exact titers .The supposed risk factors were age, place of residence, education level (parents and student), consumption of undercooked meat and raw liver, occupation and parent income, and exposure to contaminated material from cats and fowls. The highest positivity rates (27.5%) were recorded in District 1, while the lowest rates (14.5%) were seen in District 5. Significant relationships were found between seropositivity and exposure to cats and fowls.(P>0/05). No significant relationship was observed with the other factors. There was a low level of knowledge about toxoplasmosis and the relevant risk factors: only 2.4% of the subjects were relatively well-informed on this subject. There were not any acute cases.
Toxoplasma infection is very important because of its socioeconomic implications, so control measures seem crucial. All seronegative women should be know about this infection and its transmission routes. Education is the most important element in prevention and must be promoted via the mass media, other education systems and the health managers. The studied group in this survey were girls at the usual age of marriage or younger, and it is recommended that health system managers continue to offer education on practices that help prevent infectious diseases in general and toxoplasmosis in particular.
E Jaafari-Pooyan , F Akbari-Haghighi , M Mahmoodi ,
Volume 3, Issue 1 (4-2005)
Abstract
Evaluation assures the success of each project, program or activity. It is one of the most important components of any management process. Because of its high importance, loss of an effective evaluation mechanism in a hospital not only increases costs, but also endangers community health. The current study tries to assess the perceptions and expectations of hospital managers and decision-making boards in Hamedan regarding the evaluation system and to determine gap between them.
This is a cross-sectional study. Its target group in each hospital includes: head, manager, matron, emergency administrator, managers of medical records, laboratory, radiology, pharmacy sections plus the afternoon and night shift supervisors. The study took the form of a census, involving a total of about 400 subjects.The data were collected through a questionnaire and analyzed using the SPSS program .
Findings:
1. The highest levels of target group expectation regarding evaluation indices were related to the “patient safisfaction” index.
2. The highest levels of target group perception of the evaluation indices were related to the “ values and norms” index.
3. All the gaps detected between target group’s perception and expectation from evaluation indices were significant.
4.The highest percentage of difference between target group’s perception and expectation was related to the “staff satisfaction” index and the lowest one was related to the “values and norms” Index.
M Ghasemi , F Dehghan , A Rezasoltani , H Shaikhzadeh ,
Volume 3, Issue 1 (4-2005)
Abstract
The aim of this study was to detect the level of the workers’ knowledge and their function regarding the care of lumbar spine. Some researchers have reported that increased knowledge of the workers, even when they have received specific training, does not cause any major changes in their back’s health and function. However, some research has shown a significant relationship between increased knowledge and improved worker function. Other research has shown that Back School instruction is effective in raising the level of knowledge in workers.
This research was carried out using two questionnaires that assessed the level of knowledge and function of workers in a car company. The questions were designed in four groups relating to: (1) goods and load properties and methods of carrying and handling, (2) worker’s posture at work, (3) physical exertion, (4) tools and conditions of the workplace. Measures of outcome included the workers&apos function and the knowledge.
We found that the workers&apos knowledge fell into one of 3 categories: low (%11), moderate (57%), and high (%32). We also found that %52 of workers had weak function, while %18 had moderate, and %2 had high function levels. Twenty-eight percent of workers showed function levels below that of the “low” category.
In brief , our research showed that the level of the workers’ knowledge of the appropriate methods of work in relation to their back was in an acceptable range. However, this function level was associated with low knowledge levels. No significant relationship was found between the workers’ knowledge levels and their functional improvement.
M Rezaeian ,
Volume 3, Issue 1 (4-2005)
Abstract
Spatial autocorrelation statistics provide summary information about the spatial arrangement of data in a map. In fact, these statistics compare neighboring area values in order to assess the level of large scale clustering. Whenever a large number of neighboring areas have either relatively large or relatively small values, large scale clustering may be detected. Detecting such clustering is a very important issue because failure to take into account the spatial dependency of the data may bias the association between mortality and morbidity rates and their risk factors and erroneously suggest a direct relationship between them. The present article, therefore, explains the two most commonly used spatial autocorrelation statistics for continuous data including morbidity and mortality rates.
F Vaezi , H Pishrafti ,
Volume 3, Issue 1 (4-2005)
Abstract
UV radiation is selected as the primary disinfection technology in numerous water and wastewater treatment plants of EU and North American countries having different ranges of capacities. It is expected that the method, often regarded as the best available technology, will replace chemical disinfection. As UV is claimed to be the only modality with no detrimental health effects for operators, consumers and the environment -even in high doses- it is important for directors of treatment plants to know how to apply new design criteria for UV to meet the different objectives of treatment.
The recent guidelines are based on testing the UV system at various hydraulic loading rates (expressed in liters per minute per UV lamp) . The rate that corresponds to the desired germicidal dose is used in the design of the system. Other design factors include water quality and characteristics of the lamp and quartz sleeves. According to this new approach, the lamp’s output is assumed to drop by 50% over its lifetime. Besides, sleeve fouling seems to reduce nominal UV light intensity by 20%.
This article describes the types of data that must be collected through pilot testing on the site of treatment plant it also shows how to use these data in the process of system design. The main advantage of this approach is that variability in the most important parameters is reflected in the design. In addition, it makes it possible to determine the number of lamps required in worst–case conditions and to meet the most stringent treatment standards.
R Taghizadeh Asl , Mohammad K., R Majdzadeh ,
Volume 3, Issue 2 (5-2005)
Abstract
Awareness regarding incidence pattern of disease is an important issue for researchers. To
explore seasonal pattern of TB in Iran we decided to do this study.
This study have been done as an ecologic study .all notified TB cases during 1997 to 2001
have been included in this study .all data have been processed and analyzed by the Cosinor
analysis method.
We found 59756 registered TB cases during above mentioned years.
TB in this 5 year period has seasonal pattern (amplitude=11.73% ,acrophase=13 June(85.23) ,
p<0.000) .
Frequency of TB cases evaluated by sex in this model and found that there is seasonality by
sex too (p<0.000) , but different amplitudes found for female and male(13.35%, 10.5%) and
point estimate of acrophase for them were consequently 18 June and 8 June .
When we evaluate this pattern among smear positive and smear negative cases found that
smear positives have seasonal pattern (p<0.000) . Association of TB frequencies in quarters
and mean temperature of each quarter have been evaluated by ANOVA in different 4
temperature groups(p< 0.020) ,and a significant difference have been found between 10-20
and 20-30 temperature groups(p<0.051) .
According to this study there is a seasonal pattern in TB notification (incidence) in Iran which
should be notified in population based studies and surveys in this regards.
Comments:
We recommend performing more studies on patterns of pulmonary disease, other relevant
factors on TB involvement and also laboratory circulation to clarifying cause of existing
seasonality
S.j Shahtaheri , F Ghamari , F Golbabaei , A Rahimi Froushani , M Abdolahlli ,
Volume 3, Issue 2 (5-2005)
Abstract
In this study, parameters affecting on SPE of trance trance muconic acid (t,t-MA), including sample pH, sample concentration, sample volume, sample flow rate, washing solvent, elution solvent, and type of sorbent were evaluated. After sample preparation of muconic acid as urinary metabolite of benzene, it was determined by HPLC-UV. In chromatographic analysis, column was C18 (250 cm × 4.6 mm id, 0.5 µm), UV wave length was 259 nm, mobile phase was H2O/methanol/acetic acid (69:30:1 v/v/v) was run at flow rate of 1 ml/min. Through experimental evaluation, a strong anion exchange silica cartridge (SAX) has been found successful in simplifying sample preparation compare to C8 and C18. There were significant difference between recoverie of muconic acid when different washing solvent, sample volume, and sample flow rate were used (p< 0.001). An optimum recovery was obtained when sample pH was adjusted at seven. Other optimum conditions were: sample flow rate 1 ml/min washing solvent acetic acid 1% , and acetic acid 10% as elution solvent. In this study, there was no significant difference when different sample concentrations were used (p>0.05). Recovery of spiked urine sample at concentrations of 0.1, 1, 10 µg/ml were more than 95%. The limit of detection of the optimized method was 0.01 µg/ml, showing 20 times less than biological exposure index (BEI). The optimized method was then validated with three different pools of samples at above mentioned concentrations and showed a good reproducibility over six consecutive days as well as six within-days experiments.
A.r Dorosty , P Hodjat ,
Volume 3, Issue 2 (5-2005)
Abstract
Obesity is excessive body fat on a scale that adversely affects health. Childhood obesity is increasing world-wide and is an important risk factor for many chronic diseases. In order to explore the association between childhood obesity and putative risk factors among primary school girls, the present study was carried out.
In this study, all the obese students (according to Iranian references) from a sample of 835 school girls aged 8-11y were considered as the case group (n=134). 134 control students with normal weight (5th percentile < BMI ≤ 85th Percentile) were chosen randomly and obese children were matched with non–obese children by age, school and classroom. For each subject, we interviewed the mother and filled 3 questionnaires covering potential risk factors for obesity.
Results showed that obese children had significantly higher probability of having obese parents compared to controls. Daily energy and macronutrient intake and frequency of consuming fast foods and fizzy drinks were higher in the case group.
Compared to normal children, obese ones spent more time in front of the TV or the computer non-obese children the differences were statistically significant (P<0.05).
The duration of daily physical activity, energy and macronutrient intake per kilogram body weight, and parental education were all significantly higher in the control group (P<0.05). Most obese girls were born in winter or autumn while non–obese girls were born mostly in spring and summer (P<0.015).
Obesity is a multi-factorial syndrome involving genetic, environmental and behavioral alterations. In this study, daily energy and macronutrient intake, physical activity, parental education, season of birth, frequency for eating fast-foods and fizzy drinks and time spent watching T.V. and videos or working with computers turned out to be risk factors.
M Kargar , M Sarijlou , H Tabatabaei , F Abbassian , M Kargar , Sh Shahmahmoodi , K Holakouie Naieni , M Karimlo , M Nateghpour , H Sedighi , R Khavarinegad , T Mokhtari Azad, R Nategh ,
Volume 3, Issue 2 (5-2005)
Abstract
Human Enteroviruses replicate in gastrointestinal tract and are excreted to the sewage system through feces, so isolation of Enteroviruses from sewage can be considered as a sensitive indicator for virus cirulation in society. They are originally given the name of Enteroviruses, but the inadequacy of this term became apparent when some Coxackie and Echoviruses were also found in acute respiratory infections. Therefore, these viruses can produce acute or paraclinical infecions, the shedding of virus is more than 1010 virus per each gram of feaces.
In this study, 63 sewage samples were obtained from the 6 main sewage disposal systems in Tehran by grab sampling: Direct, Pellet, Two–phase methods in 2 sensitive cell lines (Hep2 & RD) and neutralization test were used to determine Enterovirus circulation in one year. None-Typable Enteroviruses, E11 and E25 were isolated more frequently than other Entroviruses. Out of 63 sewege specimens, we isolated 13 (20.63%), 25 (39.68%) & 27 (42.83%) Enteroviruses by Direct, Pellet and Two-phase methods respectively.
A Choobineh , F Golbabaie ,
Volume 3, Issue 2 (5-2005)
Abstract
The use of biological safety cabinets (BSCs) in laboratories has greatly increased over the last few decades. BSCs are used in laboratories to protect both the scientists and the experiments from contamination by biological hazards during tissue culture procedures. The function of BSCs depends upon the HEPA filtration, the fan performance and the airflow patterns in the cabinet. To ensure BSCs proper functioning, regular performance evaluation tests are necessary. Failure to observe this may lead to direct and indirect losses. The objective of this study which was conducted at a biological research center was to evaluate the performance of seven present BSCs used in different laboratories. Based on BS 5726 (1992), two sets of measurements were performed: a) Determination bioaerosol concentration in the cabinet and b) inflow and downflow velocity measurements at the cabinet.
The results revealed that the lowest and the highest bioaerosol concentrations were 0.2 cfu/m3 and 1.33 cfu/m3, respectively. The lowest inflow mean velocity was found to be 0.33 m/s which was far less than the recommended value in BS 5726 (0.7 m/s). The highest inflow velocity was 1.1 m/s. The lowest downflow velocity equaled to 0.09 m/s which was below the recommended value (0.25- 0.5 m/s). The highest downflow measured was 0.55 m/s.
As a conclusion, in general, none of the BSCs evaluated in this study provided sterile atmosphere at the cabinets. In no case, airflow patterns met the recommended values proposed in BS 5726.
G.h Omrani , H.a Asgharnia ,
Volume 3, Issue 2 (5-2005)
Abstract
In this research household herbal wastes transformed to compost by Eisenia foetida earth worm within 3 months. For this reason, first all herbal wastes were studied in term of Bacteria, parasites, heavy metals and herbal nutrient elements, namely Nitrogen (N), Phosphorus (P.) and potassium (K.).
Then, 3 samples of herbal wastes were selected from different points of compost pits with different dimensions, transported to laboratory, and were analysed. Finally, after compost processing within 3 months, sampling was repeated again and results showed raised herbal nutrient element and improvement ratio of C/N, from 29.5 up to 14.5 and substantial reduction in heavy metals, particularly chrome (Cr), Cadmium (Cd) and Lead (Pb) in riped compost.
In this experiment, Mean and S.D. of measured was criteria calculated by SPSS software and Mean & S.D. of initial herbal wastes and processed compost (Vermicompost) also compared by statistical Mann- Whitney. Staisdical test. The number of earthworms increased from 5000 – in the beginning of the experiment – fo 13000 during 3 months of compost processing.
Electric conductivity (EC) raised from 1813.33 µs/cn in the initial herbal wastes to 907.33 µs/cn in vermicompost. which shows less salinity in processed compost. It is reported that some salts came be removed by Eisenia foetida during compost processing.
N. Rafati , P Yavari, Y Mehrabi , A Montazeri ,
Volume 3, Issue 2 (5-2005)
Abstract
The population of most countries in the word has been growing older during the last 30
years. This trend is important because it leads to a predictable increasing burden of
diseases, political, social and economic challenges. The objective of this study was to
assess health related quality of life and relating factors in institutionalized elderlies living
in “Kahrizak Charity Institution for elder people, in Tehran, Iran”.
In this cross sectional research 202 persons aged 65 years and above who were residing in
the institution for at least 6 months and able to answer our questions were studied. We used
the Iranian version of the SF-36 questionnaire to measure quality of life. Data were
collected by face to face interviews. For comparing quality of life between different groups
we used non-parametric tests.
The mean age of participants was 76.8 (SD=±7.6) years and 58.5% were female.The
results showed significant relation between the participants’quality of life scores and
variables such as gender, educational level, working in the institution’s workshop,
receiving pension, having different types of fractures, deformities, and arthrosis.
The study findings indicated that quality of in this group of elderly people was poor and it
needs to be improved.
H Nahrevanian , M Assmar , S. M Ghorbani ,
Volume 3, Issue 2 (5-2005)
Abstract
Cryptosporidiosis is a parasitic zoonosis prevalent all over the world and recognized as one
of the important causes of diarrhea in children and immunodeficient subjects. The
manifestations range from self-limited acute diarrhea in immunocompetent individuals to
fatal chronic diarrhea in immunocompromised patients. In this study, conducted in Greater
Tehran, 214 patients in 7 disease categories in 10 hospitals were investigated. Samples
were collected from both patients with immune deficiency symptoms (Test group) and
those with an intact immune system (Control group).
Overall, 22.4% of patients had diarrhea and 77.6% had stools with a normal consistency.
1.4% of immunocompromised patients and 6.3% of those with diarrhea were found to
harbor Cryptosporidium infections. These Cryptosporidium-positive cases included one
patient with AML and two AIDS patients. The incidence rate of infection in AML and
AIDS patients who had diarrhea was 11.1% and 33.4%, respectively. While the infection is
usually self-limited in immunocompetent subjects, it could be fatal in immunodeficiency
states. Therefore attention must be paid to effective disease prevention in
immunocompromised subjects.
H Shahandeh , R Wameghi , N Hatamizadeh , A Kazemnejad ,
Volume 3, Issue 3 (6-2005)
Abstract
Nowadays the Quality of Life (QOL) among different groups of people, especially in disabled
people, is recognized as a very important topic.
In order to assess quality of life in people with spinal cord injuries, 86 members of Tehran
spinal cord injury(SCI) society were selected randomly. Data were gathered through a
questionnaire that consisted of two parts. The first part contained questions about sex, age,
plus the cause, type and duration of injury. The second part contained questions that measured
quality of life in an objective manner. The test was adapted from Lancashire and Wisconsin
tests and modified to suit the cultural background of Iranian people.
Results showed that %73.3 of people with SCI perceived their QOL as good or fair.
In assessing different areas of quality of life, the highest scores were given to social relations
(3.67 out of 5). In the married group the mean score for satisfaction in family relations was
3.95 out of 5 score.
Sub-scores for work/education, finances, physical health and psychological health status were
lower than the other ones.
Results of study indicated that there was a significant difference in the mean QOL score
between the two sexes: the score for women was higher (mean score was 3.3 for women and
2.9 for men). But Quality of Life was not significantly related to age, cause of SCI, type of
SCI, or duration of SCI.
M Ghasi - Khansari , M Khaksar , S.a Ebrahym Zadeh Mosave , A Cheraghali , S Hashemje Javade ,
Volume 3, Issue 3 (6-2005)
Abstract
Polystyrene plastic material is a part of important packaging materials that is widely used. In recent decades, It is excessively applied in manufacturing of disposable drinking containers. Temprature is an important factor in determination the stability styrene monomer. The migration of styrene monomer in to hot drinks may cause chronic toxic effect in nervous system, liver and other organ of body.
In this study, 51 samples of hot water (100oC) Standing for 60 min were used. Then extraction and distilation of samples were down. thereafter, 50 μlit of preprated sample were injected into HPLC (high performance liquid chromatogarphy) for determination of styrene monomer.The response of the detection system is linear for styrene monomer from 0/25 to 5 ng/ml.This method offer a quick, Sensitive and reliable procedure for specifically for determining of styrene monomer.For the reproducibility of method performed studies of within-day and day to day from independently prepared sample by spiking blank with amount of analyte.The results of the recovery study for styrene monomer were mean 94/58%(range 94/31-95/23%) . The limit detection of 0.001 mg/kg (1ppb). The mean contant of styrene monomer was 7/61±0/1 ng/kg (range 7/07 - 9/56).
The concentration of styrene monomer in this study was above the EPA recommended levels. More study are needed to further elucidate this finding.
M Assmar , A Ter Hovanessian , S.r Naddaf , N Piazak , H Masomi ,
Volume 3, Issue 3 (6-2005)
Abstract
A total of 509 Anopheles Stephensi and 20 Anopheles Culicifacies mosquitoes were collected during two seasonal activity peaks (June, July, August and September) in the years 2000 and 2001, from 36 localities around Minab, Iranshahr and Kahnouj cities. The identity of specimens was confirmed using Shahgodian PAN morphological key. DNA was extracted from the head and thorax of all specimens and subjected to nested PCR using species-specific primers for Plasmodium vivax and Plasmodium falciparum. Three An. Stephensi mosquitoes from Minab and one An. Culicifacies mosquito from Iranshahr were positive for P. vivax, while one An. Stephensi was shown to harbor both P. vivax and P. falciparum.
M Mokhtari , K Naddafi , A.h Mahvi , S Naseri ,
Volume 3, Issue 3 (6-2005)
Abstract
There is a need for simple and inexpensive water supply systems in small communities, mainly because of high costs and water resource shortages. Ceramic filters used as a Point-of-Use (POU) system could serve as a safe and inexpensive means for supplying water. In this research we looked at the possibility of using Iranian traditional ceramics as filters for drinking water, bearing in mind the importance of ceramic filters as a POU system. A number of parameters relating to water quality were measured before and after filtration through a ceramic pipe wall. We used ceramic pipes made of clay (with 90% purity). It turned out that ceramic filters are capable of eliminating indicator microorganisms and turbidity to a considerable degree. They can also remove 70% of the water's color. But this system could not eliminate Dissolved Solids, Electrical Conductivity, Hardness and the Nitrate ion content of water. Using Mann-Withney U Test and T- Test, it is confirmed that increasing the thickness and number of ceramic pipes is not effective for improving some water parameters. This research showed ceramic filters can be useful for household water treatment in places where there is microbial pollution or high turbidity.
R Rad Goodarzi , A Rahimi Movaghar , E Sahimi Izadian , M.r Mohammadi , M Vazirian ,
Volume 3, Issue 3 (6-2005)
Abstract
The aims of the present study were to assess preparedness and function of health system in the management of withdrawal symptoms in opioid dependents after Bam earthquake, the methods that medical staff used for identification of dependents, the viewpoints of the medical staff as well as opioid dependents about the roles of health system, and the appropriate methods for managing opioid dependence after disaster.
This qualitative study was carried out in the city of Bam, one of its nearby villages and eight hospitals in Tehran and Kerman, admitting earthquake victims. Our analysis was based on 163 semi-structured interviews, with drug abusers, their family members, people living in Bam, service providers, and the authorities.
No specific training for drug abuse was reported by medical staff. No guideline or program was available for prevention and management of drug dependence in disasters. Most of the medical staff had negative attitudes toward involvement in treatment of opioid dependence. During the first two weeks after the earthquake, medical management of the withdrawal symptoms was inadequate. Most of the interviewees suggested managing the withdrawal symptoms with prescribing opioid agonists and then treating the opioid dependence following improvement of physical injuries and stability of social situation.
In disaster situations, the consequences of inadequate management of opioid dependence can be ominous. Such consequences consist of a change in incidence of substance use, intensity of use and dependence, type of substance and route of use to more dangerous ways. Therefore, a practical protocol (disaster planning) is needed for prevention and management of substance dependence in the times of crises.
