Iranian Journal of

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Background & Objectives: There is little doubt about the importance of accurate statistics and reliable information in the promoting community health and optimizing health care. Therefore, the existence of a correct, accurate and up to date database is an absolute necessity. Accurate identification of the cause in death certificates can make an invaluable contribution to the development of such a database. The purpose of this research was to assess the current defects and shortcomings in death certificates and to evaluate the degree of agreement between the diagnoses recorded in hospital files those figuring on death certificates.
Methods: This was an analytic cross-sectional study. In this survey of 659 medical records of dead patients in Loghman Hospital, during 2005, 290 medical records were selected using a systematic sampling method. The selection of these records were based on record numbers in the archives and involved the extraction of the following data: the physician's field of specialty, the patient's identity, code for the main diagnosis, the code for the external cause on the admission form, and the code for the cause of death on the death (as defined in ICD-10) was recorded. The agreement between primary and final diagnoses and also the agreement between final diagnosis and the cause of death were assessed in relation with the physician's specialty using Fisher's Exact Test. Overall agreement between different diagnoses was measured using the kappa statistic.
Results: The degree of agreement between primary and final diagnosis was very good (k = 0.83) and agreement between final diagnosis and cause of death was excellent (k = 0.95). Fisher's exact test showed that agreement between primary and final diagnoses and between final diagnoses and cause of death doesn't depend on the physician's specialty (in both cases p>0.01). In 62% percent of the cases death had occurred without interference from an external cause. Among the 38% in which there was an external cause, 21% involved poisoning with suicidal intent, 12% were due to accidental poisoning, 4% were motor accidents, and 1% were due to other reasons.
Conclusions: There was a high degree of agreement between different diagnoses in some specialties, while didn't observe such agreement in other specialties. Since accurate diagnosis helps in identifying the cause of death and death information is an important indicator of health at community level, we recommend that physicians pay greater attention to accurate recording of the cause of death. This will make it possible to draw meaningful comparisons between the causes of death in Iran and those in other countries.

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Background & Objectives: The aim of present study is to compare Afghan refugees and Iranian residents in terms of their knowledge, attitude and practice concerning malaria transmission and protection in an endemic area in Southeast Iran.
Methods: This cross sectional study was conducted over a period of 10 months (2004-2005) and involved a total of 775 people, including Iranian and Afghan subjects. The age range of participants was 15 to 55 years. Data collection was done through a structured questionnaire consisting of open and close questions and comprising several, namely personal characteristics details, history of malaria infection and treatments, type of residence, mobility, self protection, facilities, and access to health services.
Results: Both Iranians and Afghans were familiar with the three typical symptoms of the disease (fever, chills and muscle aches): 67.1% of Iranians and 78% of Afghans were able to name least one of the three typical symptoms. In both groups the majority of subjects were aware that malaria transmission occurs through mosquito bite but there was a significant difference regarding knowledge of malaria transmission (χ2 =142.2, P<0.001). Chi-square test for goodness of fit showed that the distribution of symptom indicators is significantly different between the two groups. For Iranians, the most important source of information about malaria was the health facilities (44.5% of the total) while most Afghans (65.3%) had obtained the information through friends and relatives. In both groups, the mass media had acted as the source of information in only 3.4%. Altogether, 24% of the participants reported the use of mosquito bed nets almost 90% of Afghans and 62% of Iranians said that they did not used bed nets at all. However, the number of Iranians who used bed nets was four times greater than the Afghans who did so.
Conclusions: Although the majority of subjects were familiar with malaria transmission and protection methods, they largely neglected safety precautions. Moreover, it seems that the high prevalence of malaria among Afghans is due to their life style rather than cross-border travel. The study also revealed that Afghan people have poor communication with the local health facilities, a point that must receive special attention in future malaria control programs.

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Background and objective: Numerous studies have reported beneficial effects of smoking cessation in terms of decreased cardiovascular mortality in patients with coronary heart disease. This paper aimed to determine a valid estimate for the relative risk of mortality in subjects who quit smoking compared to those continued smoking.
Methods: All relevant prospective cohort studies of chronic heart disease published during 1975 to 2008 were considered. Studies with at least two years follow-up were eligible for analysis. The qualities of studies were assessed independently by two reviewers. In addition, to obtain a precise estimate, we used the sample size and the follow-up duration of each study as the covariates in the Bayesian meta-analysis model. The Winbugs and Boa softwares were utilized for fitting the Bayesian meta-analysis model.
Results: The estimate of relative risk of mortality for those who quit smoking compared to those continued smoking was 0.64 (95%CI: 0.57-0.70). We also did not find any significant relationship between the estimate of risk reduction and the described covariates.
Conclusions: Using this Bayesian meta-analysis, a 36% reduction in relative risk of mortality was found for those who quit smoking compared to those continued smoking, after eliminating the effects of study sample size and follow-up duration.

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Background and Objectives: The purpose of this study was to assess the reliability and validity of Persian version of survey instrument for Behavioral Risk Factor Surveillance System (BRFS).
 Methods: Content and Face validity of Behavioral Risk Factor Surveillance System (BRFS) questionnaire were examined with Backward-Forward method. This method consisted of four steps: translation, back-translation, expert review and Pilot study. For evaluation of reliability of questionnaire, 194 adults of 18 years or older from Karaj province were interviewed. For the examination of reliability, Cronbach’s alpha was calculated to assess the internal consistency of the questionnaire. The reliability of quantitative variables evaluated with intra class correlation (ICC) ordinal variables with weighted Kappa and nominal variables with Kappa and weighted Kappa were calculated as well.
Results: Average age of participants were 38.8 15. Majority of participants (66.5%) were in 18-44 years group, 26.8% in 45-64 years and others 65 years and older. In validity procedure, 26 questions were deleted, 3 questions added and 6 questions were modified. Questions of ‘having situations of HIV morbidity’ and ‘Do you currently use drug abuse’ were least reliability and deleted from questionnaire. Others were reliable. (It might be better to say how many questions remained finally)
Conclusion: Our results indicate that BRFSS Persian version questionnaire has acceptable reliability and criterion validity for surveillance system in Iran.

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