Iranian Journal of

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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 & 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: 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.

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Background & Objectives: There are near two million people from around the world have planning to journey for Hadje ceremony. Old age, Crowding dormitory, close contact, poor sanitation, poor health services, different community pattern, high temperature and other factors cause the infectious diseases particularly respiratory infection more than ever Influenza occur more common and cause more discomfort during this ceremony. This study in 1381 Clear the effect of influenza vaccine compare with placebo in this group of population Pilgrimage group.
Methods: This study had interventional randomize clinical design on 156 pilgrims in Abhar City. The pattern of the cases selection for reducing of bias effect was every other pilgrim for vaccine injection. All of the cases before, during and three week after return back from this ceremony had close health services. All the pilgrims had private document for recording the events.
Results: About 147 of pilgrims experienced had pulmonary infection (93% in case and 96% in control). There was no difference in either cases or control groups
Conclusions: There is no benefit for using influenza vaccine other than its indications in the patients but it needs additional studies.

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Background & Objectives: Tobacco smoking is known to cause a huge burden of disease throughout the world: smoking is responsible for 4 million deaths per year. This study is performed in order to fill the existing gaps in information regarding current trends for lifestyle and tobacco-related disease in Iran.
Methods: This was a cross-sectional study performed with the help of a questionnaire and using a multi-stage cluster sampling method. The final sample size, after the screening of the data, was 84706 out of 89457 records.
Results: From a total of 84706 people in this study, 49.7% were men, 52% were uneducated and 64.8% cane from urban areas 79.9% did not smoke, 15.3% smoked actively, 2.1% were non-active smokers and 2.7% were ex-smokers. The prevalence of smoking was higher in people aged 35 to 64 years (P<0.001). Quitting rates increased with age, especially in women (P<0.001). Smoking was more prevalent in men (P<0.001) and in rural areas (P<0.001). The average number of cigarettes smoked per day was 14.69. Smoking prevalence was lower among adults with higher levels of education compared to those with lower education levels (P<0.001).
Conclusions: This nationwide survey provides a baseline for future longitudinal studies of smoking in Iran. There is a need for effective smoking prevention and cessation programs with a focus on the young population.

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Background & Objectives: Although Cox regression is commonly used to detect relationships between patient survival and demographic/clinical variables, there are situations where parametric models can yield more accurate results. The objective of this study was to compare two survival regression methods, namely Cox regression and parametric models, in patients with gastric carcinoma registered at Taleghani Hospital, Tehran.
Methods: Using data from 746 patients who had received care at Taleghani Hospital from February 2003 through January 2007, we compared survival rates between different patient groups with both parametric methods and Cox regression models. The former group included Weibull, exponential and log-normal regression we used the Akaike Information Criterion (AIC) and standardized parameter estimates to compare the efficiency of various models. All the analyses were performed with the SAS software and the level of significance was set at P< 0.05.
Results: The results showed a significantly higher chance of survival in the following subgroups: those with age at diagnosis < 35 years, lower tumor size and those without metastases (P< 0.05). According to AIC, Cox and exponentials model are similar in multivariate analysis but in univariate analysis parametric models are more efficient than Cox, except in the case of tumor size. Log-normal appears to be the best model.
Conclusions: Cox and exponential models have similar performance in multivariate analysis. However, it seems that there is no single model that performs substantially better than others in univariate analysis. The data strongly supported the log-normal regression among parametric models it can give more precise results and can be used as an alternative for Cox in survival analysis of patients with gastric cancer.

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Background & Objectives: Arsenicosis is a serious environmental disease caused by chronic exposure to arsenic- usually from drinking water. Signs and symptoms of chronic arsenic poisoning include hyperkeratosis, hyper- or hypopigmentation, and ulcers. Also, the incidence of cancer is increased in the exposed population. There is some evidence of high arsenic levels in drinking water in the village of Ghopuz, located in Hashtrud District, East Azerbaijan province. We evaluated the genetic and health effects of chronic arsenic exposure in the residents of Ghopuz.
Methods: In this cross-sectional study we determined the prevalence of hyperkeratosis, hyperpigmentation and hypertension in Ghopuz village. The study involved 101 individuals in Ghopuz and 107 in the adjacent village of Mayan, who were all visited by a trained physician. A total of 46 blood samples were collected for kariotyping. The level of heavy metals in water was determined by the Inductively Coupled Plasma (ICP) method.
Results: We detected high arsenic levels in the drinking water at Ghopuz (mean concentration in water = 1.03 mg/L). There were chromosomal defects in the exposed group. Mean systolic blood pressure at Ghopuz (137mmHg, 95% CI: 132-142) was significantly higher than in Mayan (107, 95% CI: 99.9-114). Also, mean diastolic blood pressure at Ghopuz (82, 95% CI: 79-85) was significantly higher than in Mayan (71, 95% CI: 66-75). Hyperkeratosis was 34 times more frequent in the exposed population (OR = 34, P< 0.001). Also, hyperpigmentation was significantly more frequent in the exposed population (OR = 2.4, P < 0.007).
Conclusions: Water arsenic and nitrate levels at Ghopuz were higher than the maximum permissible levels. The prevalence of skin lesions and hypertension is increased at Ghopuz village due to arsenic exposure. There is also some evidence of chromosomal defects in the exposed group. Affected people need appropriate medical care, and safe drinking water should be provided to reduce arsenic exposure.

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Background & Objectives: Men (husbands) play a very important role in family planning programs, especially in developing countries. The objective of this study was to determine the prevalence of different methods of contraception in women of reproductive age in Iranshahr in 2004-2005 and the extent of their husbands' participation in family planning.
Methods: This was a cross-sectional study focused on women who were married but not pregnant at the time of the research. We used multi-stage cluster sampling and a pre-tested questionnaire to record the method of contraception and to see if the husband was actually participating in family planning. We used the SPSS (13th version) software to calculated measures of location and dispersion.
Results: The total sample of 700 married women in the (10-49y) age group included 400 subjects in rural areas and 300 in cities. Of these, 696 agreed to take part in the research. Overall, 65.5% of these women were using at least one form of contraception the remaining 34.5% did not use any contraceptive methods. The percentage of unwanted pregnancies was estimated at 16%. The mean number of pregnancies was 7, with a median of 4.5. Sixty-three percent of the subjects reported good cooperation by their husbands. Logistic regression analysis showed that the probability of using contraception was significantly related to the husband's cooperation.
Conclusions: Our results underline the importance of men's support and cooperation in the success of family planning efforts.

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Background & Objectives: This study aimed to determine of the seroprevalence of visceral leishmaniasis to design a prevention and control program in Bojnoord district.
Methods: This was a descriptive and cross sectional study with multistage random sampling method. The study was carried out on children up to 12 years old and 10% of adult’s population in 8 rural areas of Bojnoord district in 2007. In total, 1608 blood samples were collected to detect anti-Leishmania antibodies. All the samples were tested by direct agglutination test (DAT). In order to determine Leishmania species, necropsy was performed on four suspected dogs in the studied areas. The species of Leishmania was determined by RAPD-PCR and PCR-RFLP methods using to amplify the ribosomal internal transcribed spacer 1 (ITS1).
Results: Thirty and eight (2.36%) out of 1608 collected blood samples had anti-Leishmania antibodies at titer 1:800 and nine (0.56%) were just positive at 1:3200 by DAT. There was no statistically significant difference between female and male seroprevalence (p<0/05). The seoprevalence in children <=12 years old compared to individuals greater than 12 years old did not show any statistically significant (p<0/05). Amastigotes were observed in all 4 necropsied dogs. The species of Leishmania isolated from 2 dogs, was determined as L.Infantum. Their ITS1 sequences were registered with Accession numbers EU810776 and EU810777 in NCBI.
Conclusions: These findings showed that visceral leishmaniasis has been circulated with low endemicity in Bojnoord district. Therefore an appropriate monitoring system is needed for health services in this area.

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Background & Objectives: Triglyceride/HDL-cholesterol ratio (TG/HDL-C) has been shown as an indicator for metabolic syndrome (MetS). This study aimed to detect the role of this ratio to predict coronary heart disease (CHD) outcome in an Iranian men population with high prevalence of MetS.
Methods: 1824 men ≥ 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol (TC), HDL-C, TG, and risk factors of CHD including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study.
Results: During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio (HR) of 1.85 (95% CI, 1.07-3.17). Combined HR for TC and TG/HDL-C (men in the top quartiles of both TC and TG/HDL-C relative to first quartiles) after adjustment for other risk factors was 6.13 (95% CI, 2.37-15.86).
Conclusions: The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male population.

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Background and objectives: Iranian family physician care program as a new program has begun since 2005 to deliver a better service particularly in primary health care. The objective this survey was to evaluate the impact of this program on family planning in Sari city between 2003-2007.
Methods: This survey was conducted among all women 15-49 years who married. Required data were collected from health files. The pattern of time trend evaluated and relevant indices compared before and after the family physician program.
Results: The application of condom, hormone injection, vasectomy and total modern contraceptives increased but employing the methods of tubectomy, IUD, OCP, Norplant and traditional method were descending. This variability for condom, tubectomy and traditional methods were statistically significant (p<0.05). However for other methods were not statistically significant (p>0.05). Difference of contraceptive using rates in pre and post of the application of program for condom, hormone injection, tubectomy and OCP were statistically significant (p<0.05) and for others were not statistically significant (p>0.05).
Conclusions: It seems relatively success of family physician program on family planning in Mazandaran province however more human resource should be allocated to family planning.

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Background and Objectives: Measuring the quality of life is one of the important indicators in evaluating health. The chronic disease is a one of the main cause of reduction in quality of life. The aim of this study was to assess the quality of life and its influential factors in 15-64 years old people in Kurdistan province, Iran.
Methods: In this cross-sectional study EUROHIS-QOL 8-item questionnaire was employed. Data was analyzed by SPSS statistical package.
Results: After adjusting the possible confounders, the mean score of quality of life was less in smoker 1.41 score versus non-smoker, in women 1.52 score versus men, in hypertension patients 1.41 score versus non-hypertension. The mean score of quality of life was reduced 0.05 per each year.
Conclusions: It is recommended to implement some interventions to manage properly current chronic diseases in order to increase the quality of life. It also seems that EUROHIS-QOL (8-item) is a suitable tool to measure the QOL in Iranian culture.

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Background & objectives: Cigarette smoking is the one of unhealthy behaviors in human societies which it’s over increasing prevalence, particularly among students, has produced many concerns. The present study seeks to describe the scale of cigarette smoking attitude (CSA) and its correlation with social determinants among high school students in the Ghaemshahr city.
Methods: This cross-sectional study is conducted via survey method and data has been collected through a self-administered questionnaire. The subjects of the study were 400 third-grade students of Ghaemshahr city’s high schools who have been selected randomly on the basis of proportional stratified random sampling method. A self-administered questionnaire with 32-items including cognitive, emotional, and behavioral aspects of CSA applied.
Results: 82.6 percent of students reported negative CSA (anti-smoking), while 5.6 percent of them declared positive CSA. Descriptive results showed that students’ awareness about negative effects of cigarette smoking was relatively low and insufficient. Furthermore, the results of the Analysis of Variance (ANOVA) showed that there were significant correlations between having positive CSA and subject of the study in high school, level of father’s education, social class of the family, and especially having smoker friends and parents.
Conclusions: It is concluded that students had low awareness and information about negative effects of cigarette smoking therefore more educational interventions should be implemented in high schools to increases the awareness and change their attitudes, Moreover, it should be emphasized that social environment, especially family and peer group (friends), play vital role in the formation of positive CSA and finally cigarette smoking.

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Background & Objective: Clinically Chronic Allograft Dysfunction (CAD) is characterized by a progressive decline in Glomerular Filtration Rate (GFR) over time, the pattern of disease progression determined by the five-stage model. In this paper, we used Erlang and Hypo-exponential distributions as Phase- Type distributions to describe hazard of kidney failure at over time in RTR with CAD.
Methods: In a single-center retrospective study, 214 patients with RTR with CAD were investigated at the Emam Hospital of Urmia University of Medical Sciences from 1997 to 2005. Kidney function at each visit assessed with GFR and categorized based on NKF and KCOQI staging system.
Results: The estimated hazard rates of disease progression from stage 1 to 2 , 0.0378 from stage 2 to 3 ,0.04 from stage 3 to 4 , 0.0458 and from stage 4 to 5 0.0541 were respectively based on each expected month . This estimates yield a mean waiting time of disease progression from stage 1 to Kidney failure or dialysis 91.63 month. The 18th, 58th, 118th and 155th months of death-censored graft survival were 0.99, 0.75, 0.25 and 0.10 respectively.
Conclusions: The findings of this study are compatible with hyperfiltration theory in chronic kidney disease and give us more detailed information about the daynamic process of disease which would help to manage it effictevliy.

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Background and objective: The nested case-control study has become popular as an efficient alternative to the full-cohort design. This study compares the results of a nested case-control analysis approach with the full cohort analysis.
Methods: A cohort of 276 subjects (new cases from a TB registry) was used for this study. Cox Regression model was used for the full cohort analysis. In order to do the nested case-control analysis, for each death, three random controls were selected from those who did not suffer from the outcome at the time of the outcome took place. Case control data was analyzed by the conditional logistic regression model.
Results: Results from both cohort and nested case-control analyses show that treatment group is the only variable that affects on the outcome. Gender, place of residence, and age has no effect on the outcome. For binary exposure variables with trivial effects (e.g. Gender and place of residence), the relative efficiency of nested case-control study design is approximately 75%.
Conclusion: Results of this study show that nested case-control study is not only an easy and cost-effective method for data analysis but also is as robust as cohort analysis in rate ratio and its variance estimation.

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Background & objectives: Cardiopulmonary bypass often causes a stress hormonal response with subsequent changes in hemodynamic and organ perfusion. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate inflammatory and stress markers, without adverse effects. The aim of this study was to investigate whether low dose infusion of ketamine have hemodynamic stability effect in coronary artery bypass surgery.
Methods: In this double blind-controlled trial, 50 patients undergoing on-pump CABG were randomly assigned to receive either 1.25mcg/kg/min of ketamine infusion (Ketamine group, n=25) or normal saline infusion (Control group, n=25) during 48 hours after induction of anesthesia. hemodynamic measurement including blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, systemic venous resistance, arterial blood gas and lactate were measured previous to induction (T1), 4 h, 24h, and48h after the surgery (T2,T3 and T4). The data were evaluated with using of variance analyzing test and repeated measurement.
Results: There were significant interaction effect between time (pre operation, 4, 24 and 48 hours after operation) and group of study (ketamine and placebo) in assessment of systolic blood pressure (p=0.0001), diastolic blood pressure(p=0.0001), heart rate (p=0.004), central venous pressure (p=0.0001) and lactate (p=0.035). These indicate that ketamine caused decrement in tissue perfusion. Those interactions were not statistically significant for other parameters (p>0.05).
Conclusions: low dose ketamine during and 48 hours after operation not only didn`t show hemodynamic stability effect but also decreased tissue perfusion slightly.

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Background & objectives: Personel who reguraly practice invasive procedures such as blood sample collection are particulary at risk to percutanous injuries. Needle stick injuries present the single gerates risk to medcial personnels. This sudy was undertaken to analyze the problem of needdle sticks injuries among health care workers at teaching hospitals in Urmia in 2008 year.
Methods: This cross-sectional study was conducted among 400 personals of Urmia teaching hospitals. A structured questionnaire was used to interview the study participants at their work place. Participants were asked to recall needle stick injuries in the preceding 12 months. Factors such as work experience, type of procedure, action taken following injury etc were also studied. The samples were selected by using simple random sampling in every hospital. The data were analyzed according to aims, by using Descriptive and analytical method. پ
Results: Around 25% (107/400) of the Health care workers had experienced a needle stick injury in the last six-months. Needle sticks injuries in females and male was 28% and 24% respectively. Most of the injuries created by needle (47.3%) and anjiocat needle (19.9%).
Conclusions: The results of this study show that the prevalence rates of needle stick injuries are a major risk in hospitals personnel. Therefore there is a need at the hospital level to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries. >

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Background & Objectives: To determine the prevalence rates of refractive errors in Mashhad, Iran
Methods: In this population-based study, random cluster sampling was performed on the urban population of Mashhad and of 4453 selected individuals, 70.4% participated in the study. Refractive errors were assessed using cycloplegic refraction in participants who were ≤ 15 years of age and non-cycloplegic refraction in those who were > 15 years of age .
Results: The prevalence of myopia and hyperopia in individuals ≤ 15 years old was 3.64% (95% CI: 5.09 to 2.19) and 27.4% (95% CI: 31.09 to 23.72), respectively. The same measurements for individuals >15 years of age was 22.36% (95% CI: 24.66 to 20.06) and 34.21% (95 CI: 36.85 to 31.57), respectively. The prevalence of astigmatism and anisometropia were 25.64% and 5.84, respectively. Astigmatism and anisometropia were significantly more (p=0.005) and less (p=0.048) prevalent in females, respectively. Anisometropia, astigmatism and hyperopia were found to be increased with age.
Conclusions: This study highlighted the valuable information on refractive errors in Mashhad. Hyperopia was the most common refractive error. In addition to subjects who were between 5 to 15 years of age, refractive errors were also prevalent among older people therefore, more attention should be paid to the correction of refractive errors in these groups.

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Background & Objectives: Custom-orienting is a critical issue for public health service. Peoples with a variety of developmental health care needs and perspectives are health care clients. Health accessibility through “Primary health care” has been approved and emphasized in Alma Ata in 1978. It is important to have a clear and transparent understanding of clients’ health needs and problems that would enable us to address such needs and prevent the negative consequences that might otherwise ensue. The aim of this study was to understand and gain deeper insight into health service customers’ lived experience of public health accessibility.
Methods: This study has been conducted with a phenomenological approach. Max van Manen six steps method of hermeneutic-phenomenology has been used. Nine health care clients were selected purposefully and interviewed semi-structured.
Results: The results of this experiment revealed the following six themes: to encounter with holistic learning chance, custom-oriented communications, qualified health care service, appropriate time-place health services, equality- orienting, and individual participation.
Conclusion: The participants believed that health accessibility is something more than just to have health services. Therefore, health education and social equality will bring about optimum health services. To develop multi-dimensional learning and to promote individual participation will be useful for more community empowerment.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Cardiovascular disease is the first cause of death and third place in disease burden in Iran. This study estimates population attributable fraction (PAF) of cardiovascular risk factors in Tehran population. PAF is one of the important parameters of measuring population affect of risk factors and evaluating potential impact of preventive strategies in community level.
Methods: In this study 5868 participants above 30 years old of Tehran lipid and glucose study (TLGS) were employed and 501 CVD events detected during 10 years follow-up. Direct estimate of adjusted PAFs using logistic regression which is one of less biased exist methods of PAF calculation were applied.
Results: Highest modifiable cardiovascular risk factor PAFs, in sequence, was smoking (14.16%), hypertension (11.73%), diabetes (7.32%), hypercholesterolemia (6.85%) and central obesity (5.91%) for men, and hypertension (19.25%), diabetes (18.82%), central obesity(9.88%) and hypercholesterolemia (7.95%), for women. Also PAF of hazardous age and premature family history of CVD, as most important nonmodifiable CVD risk factors, were 36.09%, 16.61% and 3.95%, 7.56% for men and women respectively.
Conclusion: According to the difference of risk factors PAFs ranking in men and women, it is suitable that CVD preventive interventions to be prioritized by sex separately. In this regard, besides special attention to control tobacco use in men, hypertension and diabetes in both sexes and high cholesterol in men and central obesity in women respectively, should be given in priority of preventive strategies.