Journal of School of Public Health and

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Background and Aim: insecticides are widely used for protecting of agriculture and stored products. Organophosphorus insecticides are used more than other pesticides in agriculture. Therefore the residue of these insecticides in environment such as water may be hazardous to human health. Golestan Province is one of the important agricultural zones in north of Iran. In this area, azinphosmetyl and diazinon widely used for pest control. Garaso and Gorganrood are two important rivers of Golestan Province, which are exist in the near of agricultural lands and gardens, and therefore exposed to insecticides pollutions. Determination of this organophosphorus pesticide residue in water of rivers is important in this area.

Materials and Methods:This is a cross-sectional study, was performed for 1 year, during May 2006 to March 2007. In this research 152 samples from two rivers was sampling and tested. Water sampling from 3 detemined stations in among rivers was performed. azinphosmetyl and diazinon extracted from water samples with used of methylene chloride and acetone and so clean up and concentration phase was done. High performance Thin Layer Chromatography (HPTLC) was used for quantity and quality assay of insecticides.

Results:The residue of Diazinon and Azinphosmetyl in summer is significantly different from others seasons (P<0.05). The most of azinphosmetyl and diazinon residue was determined in summer. Three other seasons (spring, autumn and winter) are not significantly different in azinphosmetyl and diazinon residue (P>0.05). The means of azinphosmetyl residue in Garaso and Gorganrood in summer was 14.56ppm (±SD= 10.59) and 14.9(±11.67), respectively. The means of diazinon in Garaso and Gorganrood in summer was 22.4ppm (±18.62) and 6.74(±6.89), respectively.

Conclusion: The diazinon residue in spring and summer was more than allowed standard limitation in both rivers (Garaso and Gorganrood). But azinphosmetyl residue only in summer in Garaso river was more than allowed standard limitation.

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Background and Aim: Rabies, a viral and zoonotic disease, causes acute and fetal encephalitis in humans and other mammals and is a cause of death in developing countries. It is usually transmitted by animal bite, but other routes of transmission are mucus membranes, breathing, placenta, contaminated instruments, and organ implanting. This study shows the mapping of geographical distribution of animal bite cases, rabies, and death due rabies in 3 Caspian Sea littoral provinces, namely, Golestan, Mazandaran, and Gilan.

Materials and Methods: Data on human and animal rabies cases and animal bites were collected from the Reference Rabies Center of the Pasteur Institute in Tehran and the Rabies Diagnosis Section of the Amol Research Center during 2002-2007.The data was analyzed by the SPSS (11.5) software and mapping was done by Arc GIS 9.2.

Results: During the 6-year period, of the 670,743 animal bite cases reported in Iran 63890 (9.5%) had occurred in Golestan, 25,767 (3.8%) in Mazandaran, and 22,874 (3.4%) in Gilan. The distribution of animal bite cases in the 3 provinces was as follows: Agh ghala, Bandar Torkaman, Azad shahr and Kolaleh in Golestan Galugah, Behshahr, Ramsar and Neka in Mazandaran and Shaft, Masal, Siahkal and Fuman in Gilan. The data also showed that of the total 2,312 animal rabies cases, in Iran, 9.22% had been reported from Golestan, 4% from Mazandaran, and 2.6% from Gilan. Furthermore, animal rabies cases had occurred mostly in Gonbadekavoos, Bandar Torkaman, Gorgan and Kolaleh in the Golestan Province Behshahr, Neka and Chalus in the Mazandaran Province and Masal, Fuman and Rezvanshahr in the Gilan Province. The most important disease vector (91.3%) for both human and animal rabies was the dog. A total of 41 human deaths due to rabies had been reported during the period, 2 being from Mazandaran.

Conclusion: The results show that a more effective disease control and surveillance system is essential and can help improve planning for service provision in the health care centers.

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Background and Aim: The World Health Organization considers the implementation of the referral system to be a key step in improving the quality of services in health care systems. The purpose of this study was to explain the executive challenges of the electronic referral system in Golestan Province, Iran.
Materials and Methods: A qualitative study was conducted in Golestan Province, Iran in 2019 with a content analysis approach. The participants were family physicians, specialists, university staff managers, responsible health officers in the Offices of Deputy Ministers of Health, the General Directorate of Health Insurance, Department of Information Technology, Rural Health Network managers, health network managers and patients selected purposefully. Data were collected through semi-structured interviews and analyzed using the content analysis method.
Results: The main challenges of giving appointments to patients included the lack of time of family physicians, the irregular presence of specialists, difficulty in getting an appointment, and reverse referrals. As regards referrals and waiting times, the main challenges were found to be the lack of sufficient admissions following cancellation of the health insurance contract with the private sector, the delay of physicians in attending the health centers, long waiting times to be visited, and writing the feedback by the physicians. In addition, the main challenges of the visits and diagnosis included the short visiting times, the higher quality of the specialists' visits in the private sector, and the lack of clear guidelines. Finally, the main challenges as regards giving feedback were the reluctance and noncommitment of some specialists to provide feedback, as well as the low quality and lack of usability of the feedbacks given.
Conclusion: Based on the findings of this study, the following actions and measures may help improve the current situation as regards the current referral systems: allocating sustainable resources; allocating financial credits; designing and implementing a reward and punishment system; reforming the queuing system; empowering medical students; and equipping specialists with electronic pens for giving written feedback.