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Context: Nearly 20 years ago, the family physician program (FPP) was established in Iran in rural areas and was expanded to some cities about 10 years ago. Different studies reported different challenges associated with the efficacy of human resources and their training or educational program. Objectives: This systematic review of the literature was conducted to comprehensively identify and collate the challenges associated with the education of family physicians in Iran. Evidence Acquisition: All published articles related to FPP in Iran were the subject of this study. The eligibility criteria included original articles, case studies, and reports published in English or Persian during 2011 - 2021 related to the challenges in the training and educational system of FPP in Iran. Data were extracted based on the SPIDER (sample, phenomenon of interest, design, evaluation, research type) technique and were reported based on the structure of PRISMA (preferred reporting items for systematic reviews and meta-analyses). International credible scholarly databases were searched. The search strategy was defined based on the search syntax and keywords. Results: The search strategy yielded 5570 potentially relevant articles and reports, of which 70 studies met the inclusion criteria. Following the full-text review, 58 studies were excluded, and, finally, 11 empirical studies and 1 report were included in the review. The study attempted to identify challenges associated with the educational system; knowledge and awareness of the FPs of the nature, activities, policies, and protocols of the FPP; and also challenges associated with the competencies of the FPs in areas like social conditions, clinical competencies, public health, and managerial skills. Conclusions: The current study identified consistent themes associated with the educational system and challenges encountered in preparing physicians for FPP upon graduation. These difficulties are not insurmountable.

The aim of this study was to report the evaluation of the pilot study of drug court, as the main approach to the Comprehensive, Systematic, and Integrated (CSI) model for organizing and managing homeless addicts in Iran. Drug court was established in six provinces of Iran, in mid-2018. Drug court establishment protocols and guidelines were developed by an extensive review of the national and international evidences and in-depth interviews and focus group discussions by a large number of experts in different related majors. Evaluation of the pilot of drug court was done by a mixed method of a quantitative and qualitative study (interview and field visit). Four stages were considered for the establishment of the drug courts. Totally, 756 cases were admitted to the drug courts for 6 months. The pilot study of drug courts in Iran showed that it could have promising results in the establishment of the CSI model for organizing and managing homeless addicts. However, there are some challenges that need to be addressed, like poor inter-sectoral and intra-sectoral collaboration and rapid changes in the management of the involved organizations.

Background: Socializing the health system is a new approach to participatory governance that aims to promote community health and enhance sustainable health equity in the community. This approach is a part of health system reform in the Islamic Republic of Iran. Aims: This study aimed to develop a conceptual framework for socializing the health system in the Islamic Republic of Iran as a theoretical basis for this reform. Methods: Data were gathered through a review of the literature, in-depth interviews, focus group discussions, and panel discussions. Participants were experts in the field of health systems within the health ministry and medical universities. Content analysis was used to analyse the data and identify core values, principles, and approaches for socializing the health system. Results: The core values identified included human dignity, equity, ethics, and trust. The principles were participation, empowerment, human rights, and responsiveness. The approaches identified were good governance, a health-oriented focus, capacity-building, a process-oriented method, and improvement in the social determinants of health. A strong political will was considered essential for socializing the health system. Conclusions: The conceptual framework outlines requirements for socializing the Iranian health system. As this is a new approach in health system governance, however, it needs to be refined and redefined through implementation and evaluation.

Background: Until recently, there was no center specialized for the treatment and rehabilitation of children with substance use disorder in Iran. However, recently, a new initiation in the ...

Objective: The aim of this study was to assess the prevalence of drug use among Iranian general households.Methods: A cross-sectional household survey was conducted in a sample of 61,000 individual...

Under-five mortality (U5M) is an important indicator of the overall health and development of society. There is a wide gap in U5M among different countries and also within the countries. This study was carried out to assess the prevalence, as well as the socio-demographic, and health-related causes of U5M in the region of study. A cross-sectional study was conducted among all registered cases of U5M in rural areas of Khuzestan province, Iran, during the years 2011 to 2015. To assess the socio-demographic determinants of U5M, the sample surveyed consists of 320 families with at least one under-five death using a multistage random sampling method. Also, this study evaluated the number of variables, which may increase the chance of families to have more than one U5M. U5M was 26 per 1000 live births in 2011, but decreased to 22 per 1000 live births in 2015. With the highest cumulative incidence of 43 in Masjed Soleyman and the lowest of 15 in Dehdez, infant mortality constitutes 76% of all U5M. Prematurity and congenital anomalies were responsible for 46% of all causes of mortality (that is, U5). Maternal age at delivery 35 years (OR = 3.5; 95% CI, 1.29–6.22), marriage duration >9 years (1.85, 1.06–3.21), spouse age gap >5 years (2.32, 1.20–4.50), cesarean section (3.85, 1.19–5.74), delivery interval

Background Cervical cancer is a growing health concern, especially in resource-limited settings. Objective The objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach. Methods We used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD’s data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group. Results The absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively). Conclusions We found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.

BACKGROUND Cervical cancer is a growing health concern, especially in resource-limited settings. OBJECTIVE The objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach. METHODS We used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD’s data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group. RESULTS The absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively). CONCLUSIONS We found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.

Raising concern over health, safety and environmental issues in industries in recent years, has resulted in developing integrated Health Safety and Environment Management System (HSEMS) in many organizations including Iranian petroleum and gas related companies. Yet, there was no study on the level of observation and implementation of these guidelines in these industries; therefore, this study was conducted to evaluate the HSE management system in contracting companies of one of the petro-chemistry industries in Iran. This cross sectional study was conducted among 14 contracting companies and 483 randomly selected workers during 2013. Data collection tool included two forms, first form was related to HSEMS and the second was related to HSE related activities or indicators by workers. This study showed that HSEMS was established well, which is a reflection of the efficient regulatory monitoring of parent company; however, it was not sufficient for preventing injuries and ensuring health and safety of workers.

The safe management of hospital waste is a challenge in many developing countries.The aim of this study was to compare volatile organic compounds (VOCs) emissions and the microbial disinfectant safety in non-incineration waste disposal devices.VOC emissions and microbial infections were measured in four non-incineration waste disposal devices including: autoclave with and without a shredder, dry heat system, and hydroclave. Using NIOSH and US EPA-TO14 guidelines, the concentration and potential risk of VOCs in emitted gases from four devices were assessed. ProSpore2 biological indicators were used to assess the microbial analysis of waste residue.There was a significant difference in the type and concentration of VOCs and microbial infection of residues in the four devices. Emissions from the autoclave with a shredder had the highest concentration of benzene, ethyl benzene, xylene, and BTEX, and emissions from the hydroclave had the highest concentration of toluene. The highest level of microbial infection was observed in the residues of the autoclave without a shredder.There is an increased need for proper regulation and control of non-incinerator devices and for monitoring and proper handling of these devices in developing countries.

Subway transportation system is a new phenomenon in Iran. Noise annoyance interferes with the individual's task performance, and the required alertness in the driving of subway trains. This is the first study conducted to measure the level of noise and noise annoyance among conductors of subway organization in Tehran, Iran. This cross sectional study was conducted among 167 randomly selected train conductors. Information related to noise annoyance was collected by using a self-administered questionnaire. The dosimetry and sound metering was done for the conductors and inside the cabins. There were 41 sound metering measuring samples inside the conductors' cabin, and there were 12 samples of conductors' noise exposure. The results of sound level meter showed that the mean Leq was 73.0 dBA ± 8.7 dBA and the dosimetry mean measured Leq was 82.1 dBA ± 6.8 dBA. 80% of conductors were very annoyed/annoyed by noise in their work place. 53.9% of conductors reported that noise affected their work performance and 63.5% reported that noise causes that they lose their concentration. The noise related to movement of train wheels on rail was reported as the worst by 83.2% followed by the noise of brakes (74.3%) and the ventilation noise (71.9%). 56.9% of conductors reported that they are suffering from sleeplessness, 40.1% from tinnitus and 80.2% feeling fatigue and sleepy. The study results showed the high level of noise and noise annoyance among train conductors and the poor health outcome of their exposure to this level of noise.

OBJECTIVEs. The aim of this study was to assess the relationship between occupational cognitive failures (OCFs) and unsafe behaviors, accidents and driving offences among municipal bus drivers in Tehran, Iran. METHODS. Systematic random sampling was used to select 190 drivers from 3 transport and traffic Tehran districts. Data were collected with the occupational cognitive failure questionnaire (OCFQ), the driver behavior questionnaire and a data collection form. RESULTS. The mean (SD) numbers of driving-related offences and road traffic accidents were 1.5 (2.6) and 0.37 (1.0), respectively. The mean (SD) numbers of deliberate driving violations, unintended violations, driving slips and mistakes were 6.97 (5.5), 1.61 (1.5), 13.6 (9.0) and 4.53 (3.28), respectively. The mean (SD) number of the OCFs was 28.9 (20.5). A significant correlation was found between occupational cognitive error and unsafe driving behavior subscales. The stepwise logistic regression results showed that, while controlling the effects of confounding factors, the OCF predicts 6%, 9%, 15% and 9% of deliberate violations, unintended violations, driving slips and driving mistakes, respectively. CONCLUSION. The results of this study show that the score of the OCFQ is a predictor of unsafe driving behaviors and its subscales. Language: en

Most injury-related studies in developing countries are hospital based. In India, where there is a high level of poverty, limited access to the health care, many unregistered slums and pavement dwellers, this study attempted to use an innovative sampling method to identify the magnitude of injuries in a population of an urban city in India. Totally, 9014 individuals (2100 households), representative of more than 3.5 million population were selected from 14 administrative wards of the city of Pune. Semi-structured questionnaires were used to elicit information. The annual incidence rate of unintentional injuries was 174 (95% CI 164-184) per 1000 individuals. There were 26 reported cases of death in a recall period of 5 years. Maximum number of unintentional injuries were due to road traffic accidents (49.5%) followed by falls (24.9%). These results showed the magnitude of unintentional injuries among the population. The study sampling method can be employed as a reference for similar studies in other developing countries.

Background: Seafaring is a risky occupation that is associated with a high incidence of lifestyle-related diseases. The present study was carried out to examine health promotion behaviour and its associated factors in seafarers of the National Iranian Tanker Company. Materials and methods: A cross-sectional study was performed on 200 Iranian male seafarers in 2015. A self-administered socio-demographic and Health Promotion Lifestyle Profile II (HPLP-II) questionnaire was completed. One-way analysis of variance was used to identify significant differences among the various departments. The t-test was utilised to compare the HPLP-II scores according to the demographic variables. Multiple linear regression analysis was performed to assess the association between demographic variables and the overall HPLP-II score, in addition to the six health-promoting lifestyle subscale scores. Results: The mean age of the participants was 35.93 ± 9.51 years. Most of the seafarers were categorised as having a moderate (32%) or good lifestyle (61.5%). The mean lifestyle score was 136.14 ± 19.90, with the subscale spiritual growth showing the highest score (26.16 ± 5.03) and the subscale exercise behaviour showing the lowest score (19.95 ± 4.23). The lowest score for nutrition was found among the seafarers working in the engine department (engine: 20.41 ± 4.50, deck: 23.52 ± 4.97, and galley: 24.83 ± 4.64) (p

Background: Antimicrobial resistance (AMR) adversely impacts the prevention and treatment of a wide range of infections and is considered as a serious threat to global public health. Occupational-related AMR is a neglected area of research.Objective: To assess exposure to penicillin dust, penicillin active materials, and to report the frequency of penicillin resistance among pharmaceutical workers in Tehran, Iran.Methods: A quasi-experimental study was conducted among workers on a penicillin production line in a pharmaceutical company (n = 60) and workers in a food producing company (n = 60). Data were collected via survey, air sampling, and throat swab.Results: The mean overall concentrations of penicillin dust and penicillin active material were 6.6 and 4.3 mg/m3, respectively, in the pharmaceutical industry. Streptococcus pneumoniae (S. pneumoniae) was detected in 45% (27) individuals in the exposed group, 92.6% of which showed penicillin resistance. Resistance was significantly higher among workers in...

Background: Monitoring of food insecurity is a critical issue for planners and policymakers in the public and private sectors in developing countries. Due to the multifactorial and multidimensional nature of food security and a lack of clarity concerning the causes, specific signs, and consequences of food insecurity, developing a reliable food security index is the major challenge related to monitoring food security. Objectives: The objective of this study was to identify the most appropriate indicators of food security at the provincial level in Iran through the application of an integrated approach including Delphi (classic Delphi) and analytic hierarchy process (AHP) from March to September 2013. Materials and Methods: The sample included 43 senior-level managers and experts at the national and provincial levels from different fields of related sciences; they were selected purposively as Delphi and AHP panel members based on the experts’ opinions and snowballing. In the first round of Delphi, out of 103 identified indicators, 38 were selected by the experts; the indicators were ranked in the second round. In the AHP study, 25 experts assigned weights in a pairwise comparison of the 20 indicators that had the highest priority based on the Delphi results. Using AHP matrix calculations, this list of indicators was ranked based on priority. Results: Out of 38 indicators identified in Delphi, 8 were related to the availability dimension, 14 were related to the access dimension, and 16 were related to the utilization dimension. Out of 20 indicators that were ranked in the AHP study, 6 indicators were related to availability, 7 were related to utilization, and 7 were related to access dimensions. However, the indicators related to availability had an overall higher rank compared to indicators related to access or utilization. Conclusions: This study identified and ranked 20 indicators as the most appropriate indicators of food security measurements at the provisional level in Iran.

The purpose of this study was to assess living and workplace safety conditions of construction workers in Tehran, Iran.This cross-sectional study was conducted among 410 construction sites in a municipal area of Tehran whose municipal building permits were issued in 2011. Data on ventilation, workplace safety and hygiene were collected by direct observation and interviews with site foremen. Noise levels were estimated from 10 sound-level-meter stations in the municipality area.Lack of ventilation in the workers' rooms was abundant. Bathrooms were unhygienic and minimum requirements such as lighting and ventilation did not exist in 80% of the cases. In nearly 50% of large construction sites, sewage and garbage disposal were inappropriate. Elevator safety was poor at all sites and no measures for fall prevention were present in over 88% of active construction sites. This study showed that the mean 24-h equivalent continuous sound level Leq was over 70 dB in 80% of the sites during weekdays.The results of this study revealed poor health and safety living and working conditions of construction workers in Tehran.

BACKGROUND: In the last 30 years lung transplantation has proven to be a lifesaving therapeutic option for patients with end-stage lung disease. The objective of this study was to perform a bibliometric analysis of lung transplantation research articles. METHOD: A bibliometric evaluation of the evolution of scientific production in the field of lung transplantations between 1989 and 2009 was conducted using the ISI Web of Science. The search terms selected were "lung transplant" OR "pulmonary transplant". Specific features including year of publication, language, geographical distribution, first author, main journal publishing these articles, journals publishing highly cited articles, and institutional affiliation were analyzed. The citation characteristics of articles were additionally analyzed. RESULTS: A total of 6409 (58.0 %) research articles were found. The time trend of the number of articles showed an increase of more than 6.81 between 1989 and 2009. North America contributed 50.4 % and Europe contributed 46.0 % of published articles. The greatest number of contributions came from the USA (43.6 %), followed by England (9.1 %) and Germany (8.6 %). There were 104 522 citations of these articles by 25 July 2010. The average citation per article was 16.31. The New England Journal of Medicine ranked first with regard to the number of articles and the number of highly cited articles. G. A. Patterson, Washington University, and the US National Institutes of Health (NIH) were the top author, institution and funding agency, respectively. CONCLUSION: The number of publications and the scientific interest in lung transplantation has increased rapidly in recent years. Citations of articles published in the field of lung transplantation are increasing and the numbers of uncited articles are fewer compared to the average citations of articles and uncited articles in the field of medicine.

Introduction: Behavior pattern influences the risk of unintentional injuries. This study was conducted to identify the pattern of household unsafe behavior in different socioeconomic strata, in Pune city, India. Materials and Method: Population-based, cross-sectional study. Behaviors influencing the risk of burn, poisoning, drowning, and road traffic injuries were questioned from 200 randomly selected households. Results: Nearly 28% of the households did not have a separate kitchen, 37.5% cooked at the ground level, 33.5% used a kerosene pressure stove, 12% used unprotected open fire as a source of warmth in winter, and 34.5% stored inflammable substances at home. Ninety one percent of the households reported storing poisonous chemicals in places that could not be locked. In 68.3% of the households with children below five years, these chemicals were kept in places accessible to children. Nearly 21% of the individuals, who could swim, did so in unsafe places and 25.2% of them were not trained in swimming. In 35.5% of the households, children used streets as playgrounds. Among all two-wheeled vehicle riders, 35.6% reported not having a helmet and 57.7% of those who had a helmet did not use it regularly. Socioeconomic status was strongly associated with the unsafe behaviors related to burns, drowning, and road traffic injuries. Conclusion: The study identifies the sociocultural and behavioral factors leading to unsafe behaviors, placing individuals at risk of unintentional injuries, which can be used as a first step toward prevention.

Systematic and cooperative interactions among parent industry and contractors are necessary for a successful health, safety, and environmental management system (HSE-MS). This study was conducted to evaluate the HSE-MS performance in contracting companies in one of the petrochemical industries in Iran during 2013. Managers of parent and contracting companies participated in this study. The data collection forms included 7 elements of an integrated HSE-MS (leadership and commitment; policy and strategic objectives; organization, resources, and documentation; evaluation and risk management; planning; implementation and monitoring; auditing and reviewing). The results showed that mean percentage of the total scores in seven elements of HSE-MS was 85.7% and 87.0% based on self-report and report of parent company, respectively. In conclusion, this study showed that HSE-MS was desirably functioning; however, improvement to ensure health and safety of workers is still required.

Al-Anon self-help group is the sole source of assistance for families whose members suffer from alcohol abuse problems in Iran.To assess the effects of Al-Anon meeting attendance on family function and quality of life of women living with husbands with alcohol use disorders.The study was conducted among two groups of women first time participants in Al-Anon (n = 40) and participants who had attended Al-Anon for at least six months (n = 40) in Mashhad, Iran. Participants were administered the Quality of Life Short Form (QOL SF-36) and Family Assessment Device (FAD).There was a significant group difference in the QOL SF-36 total as well as in the sub-scores of role limitations due to physical problems, role limitations due to emotional problems, vitality, pain, and social functioning sub-scores. No significant group differences were observed in FAD sub-scores, except for the subscale of problem solving.These findings suggest Al-Anon, when other structured therapeutic interventions are not available, may be of particular benefit for quality of life issues in women attendees.

Survival analysis for patients with end-stage renal disease and factors influencing their survival is crucial due to the increase in the number of these patients along with their high mortality rate. This study aimed to analyse the survival rate of patients in north of Iran undergoing hemodialysis and to assess factors influencing their survival.A historical cohort study was conducted on 500 patients on maintenance hemodialysis in 3 hospitals of 2 cities (Sari and Babol) in Mazandaran province during a 6-year period from 2007 to 2013. The Cox regression analysis was used to assess the impact of sex, age, education, smoking habit, primary cause of kidney failure, living with family, cardiovascular diseases, weight, age at diagnosis, and age at initiating hemodialysis on survival of the patients.The median survival time for the 500 hemodialysis patients was 108 months. Death occurred in 174 patients (34.8%). History of smoking, age, being unemployed, being illiterate, and renal cyst, congenital diseases, and unspecified diseases as the cause of kidney failure were the associated factors with survival of the patients. The 1-, 2-, 3-, 5-, 10-, and 12-year survival for these patients was estimated to be 84%, 77%, 71%, 58%, 43%, and 33%, respectively.This study showed a high level of mortality and poor survival prognosis for patient undergoing maintenance hemodialysis. History of smoking, age, being unemployed, being illiterate, and renal cyst, congenital diseases, and unspecified conditions as the cause of kidney failure were the associated factors with survival of these patients.

Objective: The annual mortality of road traffic injuries (RTIs) is estimated to be over 80,000 in India; however, there is not enough information about the magnitude, pattern, and factors associated with RTIs in a population-based scenario, where the police and hospital records suffer from severe underreporting. This study was conducted with the aim of identifying the burden, pattern, and risk factors of RTIs in the population of Pune City. Method: A population-based cross-sectional study was conducted among 9014 individuals in a randomly selected and representative sample of the population from 14 administrative wards of the city from March 2008 to April 2009. Results: The annual incidence rate of RTIs was 93.2 (95% confidence interval [CI], 83.2–103.2) per 1000 individuals and after adjustment for age it was 76.4 per 1000 individuals. Injury occurrence was significantly more among the age group 15–30, males, and students and workers. Univariate analysis showed a significant association between RTIs and age, gender, occupation, mode of transport, driving a vehicle, and alcohol abuse. Multivariate analysis showed that only age, driving a vehicle, and alcohol abuse were the factors associated with RTIs. Conclusion: The magnitude of RTIs in India is very high, which is not reflected in police registration reports.

Background: Air pollutants of iron- and steel-making operations have historically been an environmental and health hazard. These pollutants include gaseous substances such as sulfur oxide, nitrogen dioxide, and carbon monoxide. The Iran National Steel Industrial Group beam rolling mills factory has two production lines viz. line 630 and line 650, with different beam production capabilities and is capable of producing different types of beams. Materials and Methods: A retrospective cross-sectional study on 400 workers in different exposure levels to environmental pollution was performed during 2005 to determine the mean value of respirable particulate matter (RPM) concentrations and its effects on the health status of workers. To elicit information regarding the health status of the worker, the National Institute for Occupational Safety and Health standard questionnaire was used. Fisher's exact test was performed to assess the relative risk (RR) of exposure to air pollution on cardiovascular diseases, chest tightness, cough, difficulty in retention, i.e. loss of memory, tension, occupational fatigue, and occupational stress in exposed workers. Results: There was significant difference in RPM pollution level between two product lines. The RR of exposure to air pollution on cardiovascular diseases, chest tightness, cough, difficulty in retention, i.e. loss of memory, tension, occupational fatigue, and occupational stress in exposed workers were 2.78, 2.44, 2.15, 1.92, 1.57, 3.90, and 2.09, respectively.

Objectives: The study objective was to assess hydration status by measuring USG among construction workers in Iran. Materials and Methods: The study design was comparative and experimental. Sixty participants were randomly selected from the construction workers from a construction campus with a similar type of work, climate and diet and formed 2 groups (individuals exposed to the sun and non-exposed individuals). TWL and USG were measured in both groups on 2 consequent days, at the beginning, mid and end of the work shift. Results: USG test showed that mean USG was 1.0213±0.0054 in the control group and in the exposed group, where it was significantly higher, it amounted to 1.026±0.005. In the exposed group, 38% of workers had a USG level between 1.026-1.030, representing a higher risk of heat illness and impaired performance and 12.72% had a USG level above 1.030 representing a clinically dehydrated status, while this proportion in the control group was 15.2% and 0.58%, respectively. The mean TWL index measure was 215.8±5.2 W/m2 for the control group and 144±9.8 W/m2 for the exposed group, where, again, it was significantly higher. The Pearson correlation measure showed a significant correlation between USG and TWL. Conclusions: Strong correlation between TWL, as an indicator of thermal stress and USG shows that USG can be considered as a predictor of thermal stress. The difference between USG among the exposed and non-exposed workers and the increase in USG during midday work show the sensitivity of this measure in different thermal and climatic conditions, whereas, the high level of dehydration among workers despite acceptable TWL level, shows that heat stress management without considering the real hydration status of workers, is insufficient.

Chronic shortage of clotting factor concentrates, exorbitant treatment costs and the poor economic status of patients makes disability an inevitable consequence of haemophilia in India. The prevalence and risk factors for disability were studied in 148 patients with severe haemophilia A registered at five haemophilia clinics in the country. Disability was measured using a scoring method that used a compilation of functional ability, mobility and range-of-motion scores for each patient. Patients ranged in age from 5 to 55 years. Only nine of 148 patients were free of disability. The proportion of disability free patients in the 5-12, 13-24 and 25+ age groups were 14.3%, 4.4% and 0% respectively. The risk factors significantly associated with disability were patients age, socio-economic status, number of persons in the family, family history of haemophilia, frequency of physiotherapy exercises, home use of coagulation factor concentrate and type of blood product(s) used, that is clotting factor concentrate or cryoprecipitate. The study highlights the need to provide coagulation factor concentrates in sufficient amounts to prevent disability, the beneficial role of physiotherapy exercises and the advantage of older patients as peer educators for younger patients. The most important utility of the data is to demonstrate the widespread prevalence of disability amongst patients, its social costs in terms of incomplete education and unemployment, which justifies the need to include haemophilia as one of the conditions under the Disability Act of India.