Iranian Journal of

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Background and Objectives: There are conflicting data on the effects of different types of fat on aortic atherosclerosis. This study used Wister rats to compare the atherogenic effects of a standard diet with a diet containing fish oil and another diet containing mixed oils (typical of the current consumption pattern in Iran).
Methods: Thirty female Wistar rats were randomly assigned to three diet groups: a standard diet (containing soy bean-oil as the only dietary fat), a diet containing fish oil and another diet which contained mixed oils and was designed on the basis of the current fat consumption pattern in Iran (butter, hydrogenated vegetable oil and sunflower oil). Mothers in each group were fed the same diet during pregnancy and lactation the litters were also weaned onto the same diet. Aortic samples were taken from the offspring at the time of weaning and puberty. Data were analyzed using SPSS software Kruskal-Wallis test was applied for comparison among groups.
Results: Rats that were fed soy bean oil showed less extensive fatty streaks and intimal thickening of aorta on weaning and at puberty. Rats fed fish oil and mixed oils showed more atherosclerosis lesions compared to those receiving soy bean oil.
Conclusions: It seems that diets with an omega-3 to omega-6 ratio of 0.6 can enhance aortic atherosclerosis. Diets with an Iranian fat consumption pattern also increase aortic atherosclerotic lesions because they contain substantial amounts of saturated fat.

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Background & Objectives: Hypertension is one of the most prevalent and important risk factor of cardio-vascular diseases. The aim of this research was to determine relative factors on hypertension in Kohrang.
 Methods: This survey was a population – based case - control study. The study population consisted of 415 patient with hypertension (cases) and 415 controls without any history of cardiovascular and or cerebrovascular diseases & hypertension. A systematic random sampling was used. The chi-square test and conditional logistic regression model was used and the data were analyzed by STATA.
Results: Family history of hypertension, age over 60, no physical activity, bmi≥30 were calculated as risk factors with odds ratio: 2.33 (95% CI 1.58-3.47), 2.01(95% CI 1.24-2.67), 1.8 (95% CI 1.2-2.7), 1.66 (95% CI 1.32-2.07) respectively (p<0.05). Fish consumption, unsaturated fat consumption and literacy were considered as protective factors with an odds ratio: 0.516 (95% CI 0.35-0.69), 0.514 (95% CI 0.36-0.72), 0.28 (95% CI 0.17-0.45) respectively (p<0.01).
Conclusions: The findings of this study highlight to plan appropriate health promotion programmes by health policy makers.

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Background and Objectives: The aim of this study was to assess the geographical distribution of Congenital Hypothyroidism (CH) in Iran using Geographic Information System
Methods: The incidence of Congenital Hypothyroidism in each city and province calculated based on national CH screening program and then the map of its distribution was depicted. The spatial distribution of CH was assessed in each city by employing binominal test and Hotspot Analysis. The map of distribution of CH was drawn by ArcGIS version 9.2 software.
Results: The national incidence of CH (including both transient and permanent types) has been estimated 2.2/1000 in screened new borne babies. The distribution of CH seems more or less equally around the country and its spatial variation was not statistically significant. We did not find any specific CH Hot Spot in Iran.
Conclusions: We did not find any particular explanation for high incidence of CH is Iran geographically therefore other explanations for such a high risk in screened neonates should be investigated including the non-environmental factors and factors related to quality of screening program in Iran.

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Background & Objectives: Food insecurity has been a global concern. The purpose of the present study was to examine the relationship between household food insecurity and depression in mothers with school children in Ray city.

Methods: A cross-sectional survey of 430 mothers of school children was conducted in 2010 in Ray city. We employed USDA food security questionnaire. The prevalence of depression in mothers was assessed by Beck Depression Inventory (DBI).
Results: Household food insecurity was identified approximately in fifty percent of participants and frequency of depression was 51.4% in mothers. Depression in ‘food secure' group was 34.6%, and in ‘food insecure with hunger' group was 77.8%. There was a positive relationship between depression and food insecurity in mothers having primary school children living in Ray.
Conclusion: The findings of this study revealed that level of food insecurity among mothers seems high. This study highlights the need to integrate programs addressing food insecurity and poor mental health for mothers.

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Background & Objectives: Tuberculosis (TB) is one of the major infectious diseases in Iran and has pulmonary and extra-pulmonary manifestations. Considering the differences in the distribution of the cases across different regions, we decided to study the geographical distribution, epidemiologic characteristics, and disease pattern in Lorestan.

 Methods: This ecologic (descriptive analytical) survey was done in Lorestan between 2002 and 2008. The data was collected from the Health Department of Lorestan University of Medical Sciences and included the history of 1481 patients suffering from TB. The study variables were sex, disease type, residential location, age, and year. The data were analyzed using statistical package SAS 9.2 and descriptive and inferential statistics were applied.

Results: From 1481 registered patients 58.4% were male and 41.6% were female among which 68.74% and 29.98% lived in urban and rural areas and 1.28% were nomads. The mean age of the patients was 41.87. The highest and lowest incidence rates were observed in Khoram Abad (19.38 per 100000) and Azna (7.04 per 100000), respectively. Using Poisson regression, it was observed that the effects of age structure and residency on the incidence rate were significant.

Conclusion: The percentage of nomads was identified as the most important demographic factor in the incidence rate of TB in Lorestan. Allocation of better resources and appropriate training can be effective in controlling and preventing the disease.

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  Background and Objectives : The aim of this study was to assess the disease trajectory and recurrence rate of pemphigus based on the analysis of the gap time between successive recurrent events. In this regard, the most important associated factors with the risk of recurrence could be explained.

  Methods: This longitudinal study was performed on 112 pemphigus patients who attended the dermatology department of Imam Khomeini Hospital, Tehran, Iran, from March 2006 to January 2013. The study duration was considered from the diagnosis of the disease to December 2013. Recurrent events were analyzed based on the gap time between successive events using the multivariate time dependent frailty model. The time between two recurrent gap times was determined monthly between two successive events.

  Results : Decreasing the gap times between two successive events indicates that the subsequent event after the first recurrence occurs with shorter time intervals. So, the disease trajectory represents an increase in the recurrence rate over time. Based on the results of multivariate frailty model, IgG antibody's level was the only effective factor on the recurrence hazard rate of the patients. Also, this model proved that the frailty effects were time dependent frailties.

  Conclusion: Assessing the disease trajectory and recurrence hazard rate can be achieved through analyzing the gap time between successive recurrent events. This analysis also identifies the factors that influence the risk of subsequent recurrent events.

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Background & Objectives: Community assessment is a key tool for improving and promoting the health of the community. The role of community assessment is to identify the most important factors affecting the population health. To get a comprehensive picture of problems, priorities and suggested community health action plans in Iran, this review aims to summarize community assessments in various areas of Iran conducted between 1992 – 2013.

Methods: This study was a retrospective review in which community assessments were compared and the results of several studies conducted in different regions of the country covering both rural and urban health centers were analyzed. Since 1999, department of Epidemiology and Biostatistics has conducted these community assessments in eight phases and follows 2002 North Carolina Community Health Assessment model. Assessment teams typically included MPH students and/ or PhD and masters (epidemiology) students from the School of Public Health. Data was collected through observation, interview, and focus group discussion. Assessment teams in each region prioritized the list of problems using Hanlon method and Nominal Group Technique.  

Results: The results identified substance abuse, economical, and water-related problems as the most important problems in different parts of the country which indicates the need for developing a comprehensive action plan andimplementing measures.

Conclusion: A review of the community assessments performed in this study shows the ability of community assessment to detect community health problems in all aspects. Therefore, this approach is recommended to evaluate and prioritize health problems and to formulate action plans.

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Background and Objectives: Diabetes is a chronic and common metabolic disease which has no curative treatment. Logistic regression (LR) is a statistical model for the analysis and prediction in multivariate statistical techniques. Discriminant analysis is a method for separating observations in terms of dependent variable levels which can allocate any new observation after making discriminating functions. The aim of this study was to compare and determine the effective variables in type 2 diabetes.

Methods: The data included 5357 persons obtained through a cohort study in Kerman, southeastern Iran, in 2009-11. Diabetes was considered the response variable. The independent variables after deleting colinearity and correlated variables included height, waist circumference, age, gender, occupation, education, drugs, systolic blood pressure, HDL, LDL, drug abuse, activities, and triglyceride. Sensitivity, specificity, accuracy, and ROC curve were applied for determining and comparing the prediction power of the models.

Results: The results in the reduced model with extracted significant variables from the full model, the sensitivity of the LR model and DA was 74% and 22.4%, the specificity of the LR model and DA was 71.1 % and 95.4 %, the prediction accuracy of the LR model and DA was 71.5% and 85.3%, and the ROC curve of the LR model and DA was 80.3% and 80.1%, respectively.Simulation showed the sensitivity, specificity, accuracy, and ROC curve was 99.18%, 98.49%, 98.59%, and 99.9% for the LR model and 92.62%, 99.19%, 98.26%, and 99.56% for DA, respectively.

Conclusion: The results showed that the risk factors of diabetes in the logistic regression reduced model were waist circumference, age, gender, LDL level, systolic pressure, and drugs. Also, the sensitivity of the LR model was more than DA while DA had a higher specificity and prediction accuracy. Comparison of the ROC curve showed that the prediction estimated values were rather similar in both models, but the two models were the same asymptotically.

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Background and Objectives: Determining and monitoring the age at myocardial infarction (MI) and its comparison in various regions is one of the vital and basic principles for the management of MI.This study was conducted to determine the age at the first MI in Iran.

Methods: In this cross-sectional, analytical study at a national level, the data of 20750 new MI patients registered in 2012 in 31 provinces of Iran according to the cardiologist’s diagnosis, World Health Organization criteria, and the codes ICD10: I21-I22 were used. The calculations were done using the Stata 12 software.

Results: The mean±SD of age at the first MI was 61.2±13.4 years in all patients in Iran. Moreover, 15033 (72.4%) patients were male with a mean age of 59.6±13.3 years. The mean age at MI in men was lower than women (65.4±12.6 years), showing a statistical significance (P<0.001).The mean age at MI was different among Iran provinces, with a statistical significance (P<0.001). The lowest mean age at the first MI was seen in the patients living in Semnan (59.1±12.9 years), followed by Tehran (60.4±13.5 years), Sistan va Balouchestan (60.3±13.9 years), and Lorestan (60.1±14.5 years), with a significant difference from the mean age of the patients in Ardabil (63.2±15.1 years) and Zanjan (64.4±112.8 years) (P<0.019).

Conclusion: Our study demonstrated that the age at MI was approximately five years younger in men than women. This studyprovided the ground for monitoring the age at MI, and more effective management of cardiovascular diseases in Iran.

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Background and Objectives: Anthropometric indices, especially weight, provide useful information for the care and treatment of newborn infants and can be used to identify infants at risk. Therefore, this study was conducted to examine the mean weight, height and head circumference measurements of infants and some related factors.
 
Methods: This cross-sectional study was performed to investigate the anthropometric indices (weight, height and head circumference), demographic characteristics, and delivery data of 1484 newborns in 2016 using multi-stage sampling. Moreover, the predictors of these indices were analyzed using a linear regression model.
 
Results: The mean weight, height and head circumference of the newborn infants was 3185 ± 465 g, 49.92 ± 2.92 cm, and 34.58 ± 2.29 cm respectively, and 7% of newborns were low birth weight. The male newborns weighed 57.29 g more than females on average at birth (p <0.05). Besides, the height and head circumference of the male newborns were 0.15 and 0.10 cm larger than the female newborns respectively but the difference was not statistically significant. In addition to gender, gestational age at birth (week) and type of delivery correlated with all three anthropometric indices in multivariate analysis.
 
Conclusion: Identifying and controlling largely adjustable risk factors can make it possible to prevent low anthropometric parameters, particularly low birth weight.

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Background and Objectives: Alcohol consumption among various occupations' staff leads to many problems. Therefore, due to the importance of the issue, this comprehensive study was conducted to determine the prevalence of alcohol consumption among industrial workers.
 
Methods: In this descriptive cross-sectional study, the data were collected using a structured questionnaire through interview based on the workers’ self-reports. The participants included 13,128 workers across the country selected by multi-stage cluster sampling according to the population of labor workers and industrial centers in each province. The data were reported according to the consumption prevalence in the 10 spatial planning zones.
 
Results: In the optimistic situation, wokers in Ardebil (10.7%), Kermanshah (10.6%) and Guilan (7.1%) reported the highest frequency of alcohol consumption. The country’s mean prevalence of current consumption was 3.2% and the prevalence of alcohol consumption in life was up to 12.4% in the workers.
 
Conclusion: The data are based on the self-report of the participants. Therefore, the estimated prevalence rate is considered optimistic and below the actual prevalence. In the work environments of the country, especially in provinces with the highest frequency, special policies and interventions are needed to reduce the prevalence of alcohol consumption and minimize the harms caused by it.

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Background and Objectives: Over the past decades, the Iran’s anti-tuberculosis campaign has become highly structured and many achievements have been made. The purpose of this study was to describe the characteristics of the TB surveillance system and its components in the Islamic Republic of Iran.
 
Methods: The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, a review of the records, documents, books and published articles, and also interviews with process owners and experts of TB surveillance during 2017-2019.
 
Results: Case finding and treatment and follow-up of TB patients and their household contacts are done In the TB surveillance system. The implementation of the DOTS, (DIRECTLY OBSERVED TREATMENT SHORT-Course) is a major component of the TB surveillance system. Patient registration is done in an online application, which allows extracting and reporting the important indicators of the program. In this surveillance system, there is a special sensitivity to the treatment of patients, so the incidence of multi drug-resistant TB in the country is lower than that of the neighbors. The presence of regional laboratories that cover the entire region of the country is one of the strengths of the TB surveillance program in Iran.
 
Conclusion: Despite budget problems, the anti-TB program in Iran has many achievements. However, new strategies need to be considered to reduce the incidence of TB.

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Background and Objectives: Vaccine acceptance could seriously affect global efforts to control the Covid-19 pandemic. The aim of this study was to estimate the Covid-19 vaccine acceptance and its related factors in Tehran and Kermanshah.
 
Methods: A population-based cross-sectional study was conducted on 850 participants in Tehran and Kermanshah using the random digit dialing method. Multiple logistic regression was used to estimate the adjusted odds ratio of factors related to vaccine acceptance.
 
Results: The frequency of the Covid-19 vaccine acceptance was 66.47% (95% confidence interval: 69.57%, 63.21%). Moreover, 86.02% of the participants stated that they would use any type of (Iranian / foreign) vaccine approved by the Iranian Ministry of Health. However, 13.98% of the participants stated that they only preferred foreign approved vaccines (if available). The variables of age, fatalism, and socioeconomic status had significant associations with the Covid-19 vaccine acceptance.
 
Conclusion: Based on the results of this study, the Covid-19 vaccine acceptance was moderate. In order to achieve herd immunity by vaccination faster in our society, the strategy of prioritizing vaccination can be planned based on the related variables such as religious beliefs and fatalism, younger age groups, and people with higher socio-economic status that are willing to receive the vaccine.

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Background and Objectives: low utility of health care services is one of the main determinants of not achieving desired health indicators in urban areas. This study aimed to investigate the barriers and facilitators of receiving health services from health centers in Kerman city, Iran.
 
Methods: This study was a qualitative study with a content analysis approach conducted in 2020. After selecting health centers with the experience of desirable or low utility services, purposive sampling continued until information saturation. A total of 78 staff members, recipients, and non-recipients of services citizens were interviewed semi-structured and face-to-face at health centers. All interviews were recorded and coded manually and then reviewed and analyzed using directional content analysis.
 
Results: The essential services for children and mothers, free services, and service providers' behavior were mentioned as facilitators of referral. Distance and physical factors, knowledge of different types of services, preference of private centers, time access, view of people on regular visits to centers, addresses and telephone numbers registered in the system, responsiveness to health needs, fear of disease disclosure, lack of human resources in the centers, and service providers' behavior, were among the barriers of visiting the centers.
 
Conclusion: According to the results of this study, an accurate understanding of the under-coverage people's views and perceptions can help national and local planners and policymakers design the necessary strategies to increase the use of health services in urban health centers.

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