Iranian Journal of

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Epidemiological studies of cancer is the corner stone of cancer control plans and necessary for setting goals, monitoring the progress, and evaluating the results of control efforts. Cancer is a generic name for a number of diseases that have different etiology, natural history, and outcome. Thus, control activities for each cancer is different and requires varied approaches. Primary prevention, i.e., controlling the initiation of cancers is now possible for a number of cancers including lung, stomach, liver, and cervix by controlling the use of tobacco, and infections with Helicobacter pylori, Hepatitis C, and Human papilloma viruses. Secondary prevention, i.e., early detection is mostly effective for the cancers of the breast (mammography), cervix (Pap test), prostate (digital rectal exam and PSA testing), colon and rectum (Colon- and Sigmoidscopy), and melanoma of the skin (clinical examination of the skin). Effective treatment is now possible for a large number of cancers with arrays of new medications such as Tamoxifen and Herceptin for breast cancer, Avastin for Colorectal and other cancers, and so on. Tertiary prevention, i.e., rehabilitation and hospice care is a necessary part of cancer control that is generally neglected. Cancer is a familial disease and when it struck, it affects the whole family. Health education and social support for the patients and their families is an integral part of cancer control activities and must be present in any effective cancer control program. Tertiary prevention not only includes proper palliative care, but also education and support for proper nutrition and improvement of the quality of life for the patient and the family.

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Background and Objectives:To compare three different methods of signal detection applied to the Adverse Drug Reactions registered in the Iranian Pharmacovigilance database from 1998 to 2005. Materials and Methods:All Adverse Drug Reactions (ADRs) reported to Iranian Pharmacovigilance Center from March 1998 through January 2005, were included in the analysis. The data were analyzed based on three different signal detection methods including Reporting Odds Ratios (PRRs), Bayesian Propagation Neural Network (BCPNN) and Reporting Odds Ratios (RORs). Signals detected by each method were categorized based on the number of reports per drug-adverse event combination, severity of the event and labeled or unlabeled ADRs. The methods applied to signal detection were then compared in recognizing different types of adverse events.
Results: A total of 6353 cases of ADR reports, describing 11130 reactions, were reported to Iranian Pharmacovigilance Center (IPC) during the study period. The dataset involved 4975 drug-event combinations, which were assessed for detecting signals. The counts of drug-event combinations was 1, 2 and 3 or more for 3470, 727 and 779 combinations, respectively. There were 500 drug items responsible for 468 reaction terms in the database. According to PRR and 95% Confidence Interval, there were 2838, 872 and 488 drug-event combinations known as a signal for the pairs with the reporting frequency of ³1, ³2 and ³3 reports, respectively. The signals detected with the criteria of PRR³2, c2³4 were 2930, 872 and 480 for the pairs with the same reporting frequencies. Estimates of RORs and the 95% Confidence Interval showed that 2722, 862 and 481 drug-event combinations were detected to be signal for the pairs with the reporting frequency of ³1, ³2 and ³3 reports, respectively, while measuring IC and IC-2SD detected 1120, 378 and 235 cases for the same reporting frequencies. There were 234 signals detected by all three methods.
Conclusion: Despite the similarities between data mining methodologies for signal detection, there are differences in the numbers of signals detected by each method. The study findings suggest that quantitative signal detection methods should be added to the routine Pharmacovigilance activities in Iran and the trends for quantitative measures over time should be monitored.

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Background and Objectives:To compare three different methods of signal detection applied to the Adverse Drug Reactions registered in the Iranian Pharmacovigilance database from 1998 to 2005.
Materials and Methods:All Adverse Drug Reactions (ADRs) reported to Iranian Pharmacovigilance Center from March 1998 through January 2005, were included in the analysis. The data were analyzed based on three different signal detection methods including Reporting Odds Ratios (PRRs), Bayesian Propagation Neural Network (BCPNN) and Reporting Odds Ratios (RORs). Signals detected by each method were categorized based on the number of reports per drug-adverse event combination, severity of the event and labeled or unlabeled ADRs. The methods applied to signal detection were then compared in recognizing different types of adverse events.
Results: A total of 6353 cases of ADR reports, describing 11130 reactions, were reported to Iranian Pharmacovigilance Center (IPC) during the study period. The dataset involved 4975 drug-event combinations, which were assessed for detecting signals.
The counts of drug-event combinations was 1, 2 and 3 or more for 3470, 727 and 779 combinations, respectively. There were 500 drug items responsible for 468 reaction terms in the database. According to PRR and 95% Confidence Interval, there were 2838, 872 and 488 drug-event combinations known as a signal for the pairs with the reporting frequency of ³1, ³2 and ³3 reports, respectively. The signals detected with the criteria of PRR³2, c2³4 were 2930, 872 and 480 for the pairs with the same reporting frequencies.
Estimates of RORs and the 95% Confidence Interval showed that 2722, 862 and 481 drug-event combinations were detected to be signal for the pairs with the reporting frequency of ³1, ³2 and ³3 reports, respectively, while measuring IC and IC-2SD detected 1120, 378 and 235 cases for the same reporting frequencies. There were 234 signals detected by all three methods.
Conclusion: Despite the similarities between data mining methodologies for signal detection, there are differences in the numbers of signals detected by each method. The study findings suggest that quantitative signal detection methods should be added to the routine Pharmacovigilance activities in Iran and the trends for quantitative measures over time should be monitored.

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Background and Objective: Road traffic injuries are among the most important causes of death and disability in Iran, and the country has one of the highest prevalence of opioid drug use, especially among drivers. The effect of different situations related to opioid use needs great attention. The purpose of this study was to estimate the effect of driving in the withdrawal phase on the occurrence of traffic accidents leading to injury.
Materials and Methods: This is a Case-Crossover study on injured drivers of crashed motor vehicles in Kerman. Drivers having skipped one habitual drug dose within one hour of the driving session were considered as being in withdrawal. We compared the drivers' situation at the time of accident with their regular driving habits.
Results: Among 75 drivers who had history of regular use of opium, 15 were in withdrawal phase at the time of accident. The relative rate of occurrence of traffic injuries while driving in these circumstances was 2.67 (95% confidence interval: 1.52 - 4.68).
Conclusion: According to these findings we can conclude that habitual opioid users are at greater risk of traffic accidents while driving in withdrawal status this risk is more than two-fold relative to not being in withdrawal status.

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Background and Objective: On 26 December 2003, an earthquake measuring 6.5 on the Richter scale struck the city of Bam and the surrounding villages. This study was conducted to determine the needs of the affected population on the 19th and 20th days after the quake to help with the prioritization of relief activities and efficient resource allocation.
Materials and Methods: Following a feasibility study on 10 Jan 2004, a team consisting of volunteer students of School of Public Health at KUMS was assembled and trained. Each of the 8 groups consisted of 3-4 students with at least 1 man responsible for security on the field. On the 13th and 14th of January, using a cross-sectional design, 60 clusters including 420 households, 7 households in each cluster, were studied based on a Cluster Geographic-Based Sampling (GBS) Plan.
Results: Fifty-five households (13.1%) had children < 2 years, 81 (19.3 %) had children aged 2-5 years and 68 (16.2 %) contained people more than 65 years old. Thirty-seven households (8.9%, CI 95%: 6.4-11.7%) had changed their residence in Bam from one zone to another the main reason for this was poor environmental health conditions (85%). The main source of health and social messages for families was word of mouth 284 (67.6%). The most commonly needed items were bathrooms (73.8 %, CI 95%: 68.9-78.7%), food (68.8 %, CI 95%: 62.6-75.0%) and warm clothes (67.4 %, CI 95%: 60.9-73.8%). The most frequent illness was acute respiratory infection (59.8 %, CI 95%: 54.3-65.2%). Two hundred households (47.6%, CI 95%: 42.6-52.6%) complained of difficulties in obtaining health and medical services. The main barrier to access was transportation problems due to long distance (38.1%, CI 95%: 35.6-40.6%). 

Conclusion: We conclude that relief operations should be continued to provide basic public health facilities. Active delivery of health and medical services should be strengthened, and problems related to reproductive health should not be ignored. The GBS plan is a useful tool in the post-disaster surveys. Using volunteer university students was a rewarding experience and teaching and application of "Disaster Epidemiology" should be improved in this country.

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Background and Objectives: The campaign to eliminate measles and rubella (MR) is one of the most important current health projects in Iran. One of the basic requirements of this program is the creation of an efficient system for collecting data on MR morbidity and mortality, people's knowledge, attitude and practice (KAP) regarding MR prevention, and people's participation in the eradication drive. The present study was done to assess people's knowledge, attitude and practice in relation to the current anti-MR campaign.
Materials and Methods: This cross- sectional study was carried out fur months after the mass (anti-MR campaign (performed in May 2004). The target population included at the people aged 20-25y who lived in areas covered by Tehran University of Medical Sciences and Health Services. The calculated sample size was 384, using a 2-stage sampling procedure. We used X2 tests, odds ratios and confidence intervals to detect relationships between various categorical variables. We also performed Cronbach's alpha test to assess questionnaire reliability, and principal component analysis to ensure construct validity.
Results: Data were collected on 390 individuals. The percentages of people with an acceptable level of knowledge, attitude and practice were 63.3%, 53.6% and 93.1% respectively. After controlling for confounders in a logistic regression model, it became apparent that knowledge concerning the mass immunization campaign was related to the individual's own education and that of his/her mother. Attitude was found to be affected by factors such as education, marital status and the family's main income level. The practice component, on the other hand, was not significantly related to any of the variables included in this study.
Conclusion: The positive achievements of this program should be used in planning any future immunization campaigns. Particular attention should be paid to factors that affect overall coverage. These include human resources, equipment, vaccines and other materials, service uality, the cold chain, information provided to the public, and people's as well as providers' knowledge of the immunization program, the target diseases (s) and the vaccines.

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Background and Objectives: Noise-induced hearing loss is a prevalent work-related morbidity in the country. We determined the strength of association between hearing loss and occupational noise exposure as the first step in prevention programs.
Material and Methods: A historical cohort study involving 100 exposed and 31 non-exposed subjects was conducted. Noise exposure was estimated using sound level meter BSEN 60651, Type 2. Past noise exposure was estimated using the existing data on the place and type of work. Audiometry was used to assess hearing loss in each subject in 3- year intervals on an occupational cohort from 1993-2004.

Results: Noise-induced hearing loss was found in 49% (49 subjects) of the exposed group and 9.7 %( 3 subjects) of non-exposed group (p<.0001). Nobody used any form of hearing protection routinely in either group. Relative risk for noise-induced hearing loss was 5.1(CI95%: 1.7- 15.1).Time at risk was estimated 24.9 years (22.7-27.1) in exposed and 22.2 years (20.7-23.7) in unexposed group by survival analysis.
Conclusion: More legislation, hearing conservation programs, and surveillance and biological monitoring of work sites and workers are required to prevent occupational hearing loss. Planning strategies for noise assessment and control can help improve the work environment. Gross occupational exposure to noise has been demonstrated to cause hearing loss and the authors believe that occupational hearing loss in the country is a widespread problem.

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Background and Objectives: Missing data exist in many studies, e.g. in regression models, and they decrease the model's efficacy. Many methods have been suggested for handling incomplete data: they have generally focused on missing outcome values. But covariate values can also be missing.
Materials and Methods: In this paper we study the missing imputation by the EM algorithm and auxiliary variable and compare the result with case-complete analysis in a logistic regression model dealing with factors that influence the choice of the delivery method.
Our data came from a cross-sectional study of factors associated with the choice of the delivery method in pregnant women. The sample size in this cross-sectional study was 365 and the data were collected through interviews, using questionnaires covering several demographic variables, delivery history, attitude, and some social factors. We used standard deviations to compare the efficiency of the two methods.
Results: The results show that maximum likelihood analysis by EM algorithm is more effective than case-complete analysis.
The problem of missing data is common in surveys and it causes bias and decreased model efficacy. Here we show that the EM algorithm for imputation in logistic regression with missing values for a discrete covariate is more effective than case-complete analysis.
Conclusion: On the other hand if missing values occur for a continuous covariate then we have to use other methods or change the variable into a discrete one.

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Zoonoses are disease and/or infection naturally transmissible between vertebrate animals and humans. Emerging zoonoses are defined by the WHO/FAO/OIE joint consultation on emerging zoonotic disease held in Geneva, 3-5 may 2004 as "diseases which are newly recognized or newly evolved or that have occurred previously but show an increase in incidence or expansion in geographical, host or vector range". The number of emerging zoonoses has increased dramatically over the last few decades, with potentially serious human and economic impact worldwide. Many factors are behind the emergence of these zoonotic diseases. Intensive animal husbandry and changes in the production and distribution of food and other commodities, climatic and environmental changes, rapid transportation of human and animals, changes in life style and increased animal contacts are some of the factors that could introduce a new disease in a particular area. Viral infectious agents are more prone to mutation and sudden or gradual change and expansion to new geographical areas or hosts. In this article we briefly discuss some of the zoonotic diseases which may have potential health effects in Iran, such as avian influenza, West Nile viruses, Rift Valley fever, Congo-Crimean hemorrhagic fever, Lassa fever, Sars, and Ebola Marburg hemorrhagic disease.

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Background & Objectives: Breast cancer is a common malignancy in women in many parts of the world. The incidence of breast cancer in Iranian women is growing. Iranian patients are relatively younger than their western counterparts. We conducted a case-control study to determine roles of reproductive factors for breast cancer among women in Iran.
Methods: A hospital based case-control study was conducted in 2004 at a teaching hospital in Tehran, Iran. A total of 303 cases of breast cancer and 303 healthy controls were interviewed. Cases were identified through the oncology department of a university hospital and controls were recruited from other wards or out-patients clinics at the same hospital. Controls were matched to cases on age. Demographic and reproductive data were ascertained by personal interview using a structured questionnaire. Informed consent was obtained from cases and controls. Odds ratios and 95% confidence intervals for breast cancer were derived using logistic regression analysis.
Results: Mean ±SD age of cases and controls was 48.8 ±9.8 and 50.2 ± 11.1 years, respectively (range 24-84). The final model constructed after multivariate analysis indicated that factors such as never being married, menopause, older age at first live birth, parity, use of oral contraceptives, and history of chest X-ray between adolescence and the age of 30 yrs were significantly associated with breast cancer. Variables such as higher education, early age at menarche, abortion, breast feeding and its duration did not constitute significant risk factors.
Conclusions: Marital status, history of chest X-ray between adolescence and the age of 30, number of live births, and age at first live birth, menopause, and oral contraceptive use seem to increase the risk of developing breast cancer among women in Iran.

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Background and Objectives: Kala azar is a parasitic disease which belongs to the category of metazoonoses (a communicable disease which requires at least to an invertebrate host), In Iran canines are major reservoir for it and most of patients are 6 months to 2 years old. The aim of this study was evaluation of the clinical and epidemiologic aspects of visceral leishmaniasis in patients visiting the Children Medical Center over the 12 past years.
Methods: This study used the hospital records of a case series of 106 kala azar patients hospitalized in the Children's Medical Center between 1991 and 2001. We extracted and analyzed data on geographical location, background factors, clinical and laboratory findings, response to treatment and Glucantimeâ side effects.
Results: The greatest number of cases was seen in 1992 and the smallest number in 1993 and 2003 the number of cases peaked in the spring. Most patients referred to the Center are aged 1 to 4 years, and there is a strong preponderance of males (82.1% vs 17.9%). The majority of these children came from families in which the breadwinner was a peasants or a laborer. Common laboratory findings included anemia, rising ESR titers and thrombocytopenia. The most striking clinical signs and symptoms were fever, splenomegaly and hepatomegaly. Eighty-three percent of the patients had shown clinical improvement, 1.9% had died and 15.1% had relapsed. Moreover, in 52.8% of cases, the disease was treated successfully with within 2 weeks the incidence of Glucantimâ side effects was low. The cities of Khorramabad, Karaj and Saveh had produced the greatest numbers of cases.
Conclusions: Compared to other studies, our case series showed a higher proportion of male patients and a somewhat different clinical and laboratory profile. However, the most important achievement of this study was identification of major endemic foci in Ardabil province, northwestern parts of Ghom province, Khorramabad, and regions located south of the Alborz Mountains (e.g. Saveh

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Background and objectives: Malnutrition is a major health problem in Iran. A nationwide survey (ANIS) in 1998 revealed that over 800 000 children in this country were suffering from moderate or severe malnutrition. The southern province of Hormozgan is one of the most severely affected regions, so there is a need to determine disease associations and risk factors for child malnutrition in this area.
Methods: In this case-control study, we selected 1725 children aged 6 to 30 months from both rural and urban areas of Hormozgan. Data for the study were obtained by filling questionnaires and studying family health files. Using the weight-for-age Z score (WAZ) as outcome measure, we examined the effects of 21 different variables, including putative risk factors, confounders, and background variables.
Results: Father's job (p<0.004), parents' education, interval between pregnancies, urban versus rural residence (p<0.001), family size (p<0.03), and misconceptions regarding the growth chart were recognized as risk factors for malnutrition. Moreover, the mean age of the cases was 2.3 years higher than that of the controls (p<0.001). Complete vaccination (p<0.018) and attending day care centers (p<0.005) emerged as protective factors.
Conclusions: Poverty (low-income jobs, rural residence, large family size, etc) is an important factor causing malnutrition among children in Hormozgan. In contrast, immunization and mother's knowledge of the child's growth chart are major protective factors. Therefore, the health system must continue its support for the current immunization program. It should also try to improve the quality of its health education programs targeted at mothers attending state-run health and medical clinics

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Background & Objectives: The DPT vaccine used in Iran is manufactured by the Razi Institute. So far, there have been no studies to determine the incidence and severity of adverse reactions to this vaccine. It was this lack of reliable information, plus concern for the unfavorable effects of such reactions on compliance with the vaccination schedule, that prompted the current study on DPT side effects.
Methods: In this cohort study, 1910 children aged 0 to 6 were divided into different groups (cohorts) on the basis of factors such as injection site and then monitored for the appearance of adverse effects. Data for this study were gathered through questionnaires filled by telephone or house-to-house interviews. We interviewed parents of children attending the 46 urban health clinics in Kermanshah. These interviews produced the data needed to fill the first part of the study questionnaire. The investigators then gave each parent an "information sheet" containing the data necessary for the second part of the questionnaire. The interviewee was asked to record on this sheet any adverse effects occurring over the following 48 hours. At the end of this period, the parent was contacted via telephone to fill the second part of the questionnaire. Data thus gathered were analyzed using the Statistical Package for Social Sciences (SPSS), version 11.5.
Results: In 1910 DTP immunizations given to children 0 to 6 years of age, followed for the development of adverse events occurring within 48 hours after immunization, the cumulative incidence rates were as follows: Swelling, 40.66% (38.43-42.89%) Redness, 43.08% (40.84-45.32%) Pain, 67.32% (65.20-69.40%) Fever (>38° C) 54.14% (51.89-56.40%) Fever (>40.5° C) 1.11% (0.64-1.59%) Drowsiness, 33.35% (31.21-35.48%) Persistent crying, 13.35% (11.81-14.88%) Local reactions, 75.79% (73.86-77.73%) and Systemic Reactions, 69.84% (67.76-71.97%). Only one child developed convulsion following immunization.
Conclusions: Varying reaction rates in different studies, such as high rate of pain and persistent crying in this study, may reflect the different preparations that were used or differenced in the methods for vaccine evaluation. Moreover, because of the severity of systemic reactions, DTP vaccine should be administered in the thigh region

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Background and Objectives: Logistic regression is one of the most widely used generalized linear models for analysis of the relationships between one or more explanatory variables and a categorical response. Strong correlations among explanatory variables (multicollinearity) reduce the efficiency of model to a considerable degree. In this study we used latent variables to reduce the effects of multicollinearity in the analysis of a case-control study.
Methods: Our data came from a case-control study in which 300 women with breast cancer were compared to 300 controls. Five highly correlated quantitative variables were selected to assess the effect of multicollinearity. First, an ordinary logistic regression model was fitted to the data. Then, to remove the effect of multicollinearity, two latent variables were generated using factor analysis and principal components analysis methods. Parameters of logistic regression were estimated using these latent as explanatory variables. We used the estimated standard errors of the parameters to compare the efficiency of models.
Results: The logistic regression based on five primary variables produced unusual odds ratio estimates for age at first pregnancy (OR=67960, 95%CI: 10184-453503) and for total length of breast feeding (OR=0). On the other hand, the parameters estimated for logistic regression on latent variables generated by both factor analysis and principal components analysis were statistically significant (P<0.003). The standard errors were smaller than with ordinary logistic regression on original variables. The factors and components generated by the two methods explained at least 85% of the total variance.
Conclusions: This research showed that the standard errors of the estimated parameters in logistic regression based on latent variables were considerably smaller than that of model for original variables. Therefore models including latent variables could be more efficient when there is multicollinearity among the risk factors for breast cancer.

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Background & Objectives: Ecstasy is a methamphetamine derivative becoming increasingly popular throughout the world, particularly among adolescents and young adults. Iran, situated between eastern and western societies, can serve as a significant source of information on ecstasy use and on the users' profile. The purpose of this study was to determine the prevalence of ecstasy use and high-risk behavior among high school students in Lahidjan.
Methods: We conducted a cross-sectional study of a representative sample drawn from high school students of Lahidjan in 2005, using multi-stage stratified random sampling. The study questionnaire was administered to 2345 students in grades 8 through 12. The questionnaire was adapted from that used in "Monitoring the future" projects in the United States and ESPAD (The European School Survey Project on Alcohol and other Drugs). It included questions on demographic characteristics, family profile, social contacts, school life and the use of drugs. Data analysis was done with the SPSS software (version11.5), using χ2 tests and logistic regression methods.
Results: Of the 2345 students selected for the study, 2328 (92%) responded. Of these, 1327 (57.8%) were males and 970 (42.2%) were females. Lifetime prevalence of ecstasy use was 2.4% (55 students) 31 subjects had used ecstasy within the past month and 24 students reported using the substance in the preceding year. Ninety-two subjects (4.2%) had experience with other drugs. In χ2 tests, ecstasy use was significantly associated with gender, use of other substances, cigarette smoking, partying with friends, family structure and poor school performance in the past. There was no association with age, type of school (private or public) or the family's education level. In logistic regression, factors influencing ecstasy use were the use of other drugs, cigarette smoking and partying with friends (p< 0.0001).
Conclusions: Ecstasy use appears to be a serious problem in high schools. Whatever the causes behind the rise in ecstasy use, personalized and informative educational interventions should be organized in all schools.

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Background & Objectives: Although most occupational injuries are the result of stress-related human error, the association between job stress and work-related accidents has not been studied adequately. The aim of this study, carried out in 2004, was to look at the pattern of job stress among workers at Iran-Saipa car manufacturing plant, and to assess the relationship between stress and occupational injuries.
Methods: Data were collected randomly from 608 workers considered to be at risk. The sample was composed of 100 subjects with a history of work-related injury within the preceding year and 508 subjects without such history. Job stress was assessed by the Belkic Occupational Stress Index (OSI). We performed creatinine, cortisole, and 17-ketosteroid assays on 24-hour urine collection samples to check the validity of OSI questionnaires. All subjects were males.
Results: The prevalence of job stress was 21.3%. The main stressors were time pressure (78.5%), mode of payment and evaluation (56.4%), and interaction with people and machines (41.3%). The risk of injury for workers experiencing job stress was significantly higher than in those without job stress (odds ratio= 2.0). On the other hand, job stress was found to be responsible for 11.9% of all occupational injuries in this community.
Conclusions: In conclusion, job stress should be recognized as an important factor causing occupational injuries among car manufacturing workers. Full commitment and participation of managers at all levels and also behavioral and environmental modifications in the production line is important in promoting safety and injury prevention.

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Background & Objectives: This investigation was prompted by the growing importance of nested case-control studies and the increasing frequency with which they are done in epidemiologic research. After a brief explanation of nested case-control studies, we evaluate the trends in research methodology over the last decade, especially with regard to cohort, case-control, and nested case-control designs.
Methods: Data for this study were extracted from the PubMed database, using these keywords: Nested Case-Control, Risk-Set Sampling and Density Sampling. The search was confined to the 10-year period from 1996 to the end of 2005. As for other methodologies, we used keywords Cohort and Case-Control for a search over the same time period. The search itself was performed on April 25, 2006.
Results: We found 2011 articles reporting nested case-control studies. There were 95 such articles in 1996 the number had increased to 289 in 2005. Case-control and cohort designs accounted for 68456 and 60479 articles, respectively. The number of case-control articles rose from 4378 in 1996 to 10270 in 2005, while that of cohort articles increased from 2981 to 9771 over the same period.
Conclusions: The number of cohort and nested case-control articles followed similar upward trends over the last decade and their rate of increase was greater than that of simple case-control articles.

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Background & Objectives: There is no shortage of evidence linking coronary heart disease (CHD) to various genetic and environmental factors. Nonetheless, exploring the familial aggregation of major risk factors in the Iranian population could add valuable information to the existing body of knowledge.
Methods: We received data on 656 families (1614 individuals) from the Provincial Health Authority in Kerman. The data had been originally collected in a nationwide non-communicable disease control project, under the auspices of the Health Ministry's Public Health Department. In this study, we divided subjects into high- and low-risk groups based on the 75th percentiles of risk factor levels. Using a random-effect Poisson regression model, we looked at the association between risk factors within families. In all models, the risk ratios (RR) were adjusted for the age gap between parents and children.
Results: Excessive weight in children showed a stronger association with overweight in the father than with the same problem in the mother (RR: 2.35 versus 1.59). Risk of high blood pressure in the father was significantly related to the risk in the mother and the child. The risk of high blood glucose showed a significant association only between parents. Similarly, hypercholesterolemia did not show a significant association between parents and children, but its RR in parent-parent associations was around 2. We did not find any significant familial aggregation for smoking. However, physical exercise in mothers doubled the rate of exercise in other family members.
Conclusions: Although our sample size was relatively small, we found stronger associations within parent couples than between parents and children. This implies that common lifestyle may be a more prominent factor than genetic make-up.

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Background and objectives: Data on transitions in health status are among the most important types of information used for promotion of health and social development. Health transition comprises two elements: demographic and epidemiologic transition. This paper depicts the health transition in I.R. Iran over the last few decades.
Methods: We used demographic data gathered over the last 45 years in order to get an idea of the demographic transition. Several other sources were used to gather data on mortality and fertility patterns, occurrence of communicable and non-communicable diseases, etc to trace epidemiologic transition.
Results: Indices relating to mortality and fertility patterns have undergone marked changes parallel with rising income levels, urbanization, industrialization, and access to health care. Also notable are decreasing under-5 and maternal mortality rates, aging of the population, and a shift from communicable to non-communicable diseases.
Conclusions: Because of the uneven rate of social development, epidemiologic transition has followed varying patterns across different regions. It is crucial that these differences be taken account of in future health programs.

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Background & Objectives: Considering the lack of adequate basic information on risk factors for road traffic injuries in Iran, a study was conducted to determine the association between potential risk factors and the incidence of injuries in motor vehicle drivers.
Methods: We performed a population-based case-control study on Qazvin-Loshan road. Risk factors related to injury incidence were compared between 175 cases and 175 controls. Cases were drivers recently injured in road accidents. Controls did not have any injury and were selected systematically while the study was being conducted. Injury was defined as trauma needing medical or surgical treatment. Information was obtained through police reports and interviews with cases and controls. Data were analyzed by two methods bivariate analysis (crude) and by a multivariate unconditional logistic regression model.
Results: In bivariate analysis, risk factors for road traffic injuries risk were failure to wear seat belts or protective helmets, ejection from vehicle, severity of collision, number of crashes, motorcycle vs. other motor vehicle accidents, fire, rain and fog, and collision with fixed objects. In the logistic model, factors such as seat belt or helmet use with OR= 0.619 (0.376-1.018), ejection from the vehicle with OR= 2.952 (1.235-7.056), severe collision with OR= 5.413 (2.865-10.224), motorcycle vs. other motor vehicle accident with OR= 3.164 (1.05-9.537) and raining and fog vs. good weather with OR= 4.562 (1.663-12.514) were found to influence injury incidence. There was an interaction between severity of collision and weather status.
Conclusions: Better speed control, use of seat belts or helmets, not using motorcycles for road travel and equipping vehicles with fire extinguishing capsules are recommended to reduce road accident injuries.