Iranian Journal of

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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 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: 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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Normal 0 false false false EN-US X-NONE AR-SA Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Epidemiological surveillance of infectious diseases through the mandatory-reporting system is crucial for disease prevention program and success in it related to physician, partnership. The aim of this study was to identify statues of notification system among general practitioners (physicians) in Qom.
Methods: In this analytical cross section study a self-administered questionnaire was used to assess knowledge and attitude of notifiable diseases, self-reported practices, reasons for noncompliance with reporting requirements, and suggestions to improve compliance. A total 140 general physicians completed the questionnaire. Appropriate statistical analyses were performed.
Results: 14/3% and 13/6% had a good knowledge and attitude about notification and only 47% had good performance. There was significant association between the participants' self-reported practices and knowledge total scores and participating in continuing medical education. The major barrier of reporting notifiable diseases was poor knowledge of the list of reportable diseases and reporting requirements. The most frequent suggestions for improving physicians' compliance with disease reporting were to simplify the reporting process and giving awareness about list of notifiable diseases.
Conclusion: Our findings suggest inappropriate knowledge, attitude and practices about disease notification requirements among GPs. Modifying physisicans' knowledge and motivation, eliminating barriers to disease reporting, and promoting some facilitating factors could help reduce the underreporting of notifiable diseases.

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Background & Objectives: The aim of this explorative study was to identify influencing factors as main causes of divorce among couples in Tehran
Methods: Three hundred persons from family court of Justice participated from March 2006 to March 2007 in this study. Structured interviews in addition a standard questionnaire were employed.
Results: The results indicated that the most causes were psychological factors (96.3%), socio-cultural factors (87.3%), sex problems (88%), economic factors (80.3%) and violence (84.3%) in participatnts.
Conclusion: Premarital counseling suggested for couples to prevent divorce in Iranian community.

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Background & Objectives: Obesity is associated with increased resistance to insulin, hypertension, hyperlipidemia, hyperinsulinemia, and cardiovascular diseases. The purpose of this study was to investigate some factors associated with overweight and obesity among normal, overweight, and obese women aged 30 to 50 years from Sabzevar.
Methods: A questionnaire with 56 questions was prepared. The Beck questionnaire was used to measure the physical activity level. Weight, height, and waist circumference of the participants were measured using standard methods. Overweight (BMI ≥25 kg/m2), obesity (BMI ≥30 kg/m) and abdominal obesity (WHR ≥0.85) were also evaluated. MANOVA, Tukey post-hoc test, Pearson and Spearman correlation coefficients, Kruskal-Wallis and chi-square test were used for the statistical analysis of test variables. P ≤0.05 was considered significant.
Results: The results showed that 22.5% of women had normal weight, 42.4 percent were overweight, 31.6 percent were obese, and only 3.5 percent of women were underweight.
Conclusion: Our results showed that the prevalence of overweight and obesity was 74% in women living in Sabzevar, indicating the necessity of using educational methods to familiarize people, especially women, with weight control issues and prevention of obesity. The findings revealed that age, number of children, number of pregnancies, age at menarche, number of family members, working with the computer, and high-fat meals may increase the risk of obesity. Lifestyle modification and physical activity, as the most affordable and safest methods of preventing obesity, require more attention.

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  Background and Objectives : Influenza is an acute, contagious, and zoonotic viral disease. It is caused by a virus of the Orthomyxoviridae family. This very infectious is caused by different subtypes of type A influenza virus in the poultry, turkey, and many other birds. In this study, the serum status of rural domestic poultry was investigated for influenza subtype H9N2.

 Methods: This cross sectional study was done from August to October in 2013 in Iranian villages through sampling domestic poultry. The sampling was accidental and was done based on the GIS 11-digit code. In each village, blood samples were taken from at least 28 birds from different species. Then, ELISA was used for screening followed by the HI test. A total of 397 villages and 11546 birds (10145 chickens, 1413 ducks, 397 turkeys, 10 pigeons, and 175 other species) were sampled.

  Results : Three hindered and forty nine (88%) out of 397 villages were positive on ELISA. In addition, 341 villages (86%) were positive and 56 (14%) were negative on the HI test for antibody titers. Also, among the considered variables, weather was a risk factor and the prevalence was significantly lower in villages near the rivers, lagoons and lakes (up to a radius of 3 Km).

  Conclusion: The high seroprevalence of influenza H9N2 in rural domestic poultry indicates that the disease is becoming endemic. As there is no eradication policy for influenza H9N2 in Iran, using effective vaccines can reduce the infection with influenza virus in domestic and rural poultry.

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Background & Objectives: The number of road traffic accidents (RTAs) and their mortality are increasing in the world. In Iran, RTAs have caused life losses and economical damages. Death is the most important consequence of the accidents in terms of social, economic, and even political expenditures. This paper reports the statistics of the mortality status in the last decade.

Methods: A 10-year study was conducted on national and provincial data of the last decade collected by Legal Medicine Research Center. The population information provided by the National Center of Statistics was used. SPSS 15.5 and Microsoft Office Excel 2007 were used for data analysis.

Results: Between 2001 and 2010, the annual average of 34.6 per hundred thousand people were killed in traffic accidents, more than 80% of the casualties are men. The highest number of deaths and injuries was observed in 2005 and the lowest occurred in 2001. RTAs had a descending trend trough the last decade but the rate of injuries increased. The death rates in Semnan, Qazvin, and Kerman were the highest and in Tehran, Ardabil, and West Azarbaijan were the lowest.

Conclusion: Although mortality rates due to RTAs declined during the last four years of the study period, direct and indirect costs of deaths resulting from RTAs in Iran are a sign of crisis.

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Calculation of Cronbach's Alpha which measures the internal reliability of a tool is easy, but misuse and misconception are widely observed. Common misunderstandings of the Cronbach's Alpha include inability to differentiate between being one-dimensional and consistency, and between raw and standardized alpha. Violations of the assumptions of alpha could also cause an increase or decrease in the calculated alpha. In this paper, we showed that a very large but confusing alpha coefficient could be obtained, particularly when the one-dimensional theory is violated. Also, the use of standard error measurement as an index of the reliability has been presented. Finally, the generalizability of alpha coefficient is also discussed.

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Background and Objectives: Different governance approaches have various definitions and systems about health. The purpose of this study was to compare the appropriateness of the health system performance with the ideology of the selected countries.
Methods: In this comparative study, liberal countries (America, Canada, France), social countries (Russia, China, Cuba) and mixed countries (Sweden, Norway, England) were selected purposefully. Data were obtained from World Bank and WHO’s published documents and discourse literature studies. Causal layered analysis framework was used for data analysis.
Results: Comparison of health indicators showed that mixed countries were in a better position than the other two groups. The health system’s stewardship of the liberal, mixed, and social countries were decentralized, semi-centralized, and centralized, respectively. Discourses of the liberal states were based on the capitalist economy, with lack of reliance on natural resources. Socialist countries, a socialist economy system emphasizes the use of natural resources. In these countries governmental involvement is maximum. Mixed countries have a constitutional monarchy government and benefit from both of these approaches to create welfare based on the ideology of liberalism and the welfare state approach.
Conclusion: Mixed countries with appropriate economic- social conditions, semi-centralized structure of service delivery, suitable financing system, and regional and local management of services (highlighting the role of municipalities), have better health status than other countries. The ideology of the countries forms the social, economic, and political structures as well health. Iran should consider various layers of metaphor, discourse, casual structures, and litany for redesigning the health system.

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Health and human rights are two inseparable and interrelated elements, whose provision and assurance enhance welfare in any society. Definition of welfare, human rights, and health as indicators of welfare development is controversial which is done in accordance with different approaches and discourses. Although the WHO definition is currently the only definition of health agreed upon by the member states of the Organization, it has been subject to criticism by the international society. In general, the most important criticisms include ambiguity, ideality, limitlessness, lack of comprehensiveness, lack of weighting to aspects of health, being non-operational, reductionism, and lack of a precise definition of the normal condition and disease. These criticisms would expose health systems to some challenges such as increased expectations of people, rapidly growing health expenditure, inconsistent expansion of technology-based systems, increased vulnerability to corruption, and equity and efficiency issues. Identifying and examining these criticisms can lead to a more informed decision to redefine health according to the favorable and context-sensitive discourse of the health doctrine in each country. This short review briefly describes the context and the most important criticisms of the WHO definition of health. Eventually, some policy suggestions are presented for redefining health according to Islamic-Iranian discourse.

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Background and Objectives: Muscle weakness and fatigue decrease the functional capacity and quality of life of multiple sclerosis patients. Although routine exercise is acceptable in these patients, its impact has not been proven. The aim of this study was to assess the effect of exercise on muscular performance and function, degree of disability, fatigue, and quality of life of patients with MS.
Methods: Twenty-four women aged 20-50 years old with multiple sclerosis and an expanded disability status scale (EDSS) of 2- 5 were randomly divided into two groups of control (12 patients) and case (12 patients). The training program included three sessions per week, lasting for 12 weeks (two sessions of aerobic training and one session of resistance training).
Results: The results showed that 12 weeks of combined training caused a significant improvement in lower body strength (P=0.019), upper body strength (P=0.001), dynamic balance (P=0.025), gait speed (P=0.008), endurance (P=0.0001), quality of life (P=0.007) and a significant decrease in the degree of disability (P=0.007) and fatigue (P=0.001). 
Conclusion: In general, a combined training program, including aerobic and resistance training, in three non-consecutive days per week is helpful for women with MS and improves their sensorimotor function. The relevant specialists can use these exercises along drug therapy to reduce the clinical complications of MS.

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Background and Objectives: Correct and timely detection of the outbreaks of diseases with a short incubation period is of great importance in the health system. The aim of this study was to determine the detection of dysentery outbreaks using the cumulative sum method.
 
Methods: This time series study was conducted using the data of the National Surveillance System between 2014 and 2017. The outbreak alert threshold of each season and province was determined separately using the average of three years (1393 to 1395) in the same season and province. The dysentery outbreak in each season was exclusively predicted for Isfahan, Khuzestan, and Hamadan provinces in 2017 using the CUSUM method.
 
Results: In Isfahan Province, the outbreak alert was higher in the spring and summer and lower in the autumn and winter using the current method compared to the CUSUM method. For Khuzestan Province, the current outbreak alert was significantly higher in all seasons compared to the CUSUM method, while the current outbreak alert was lower than the alert predicted by the CUSUM method in Hamadan Province in all the seasons.
 
Conclusion: Compared to constant threshold-based methods, using the CUSUM method seems to be a better way for reporting outbreaks, especially in areas with a high incidence.

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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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Background and Objectives: Pulmonary consequences of exposure to low concentrations of ammonia have been less studied. The purpose of this study was to model the pulmonary consequences of exposure to low concentrations of ammonia.
 
Methods: This historical cohort study was conducted in the fertilizer industries in 2019. The participants were divided into two groups of exposed (n=98) and non-exposed (n=105). The exposure level, pulmonary symptoms, and pulmonary function parameters were assessed using the NMAM 6016 and American Thoracic Society and European Respiratory society (ATS&ERS) protocols. Data analysis was performed using the IBM SPSS v. 22.0, and multivariate linear and logistic regression models.
 
Results: The ammonia exposure level was 4.80±1.54 ppm in the exposed group. There was no significant difference in most of the individual variables between the two groups (P>0.05). The frequency of all pulmonary symptoms was significantly higher in the exposed group compared to the non-exposed group (P<0.05). The highest prevalence of pulmonary symptoms in the exposed group was for cough (25.51%), wheezing (19.39%) and shortness of breath (18.37%). All lung function parameters were significantly lower in the exposed group versus the non-exposed group (P<0.05). The values of lung function parameters in the exposed group including FVC, FEV1 and FEV1 / FVC were 86.0%, 82.47% and 81.97%, respectively. Regression modeling results showed that ammonia exposure had a significant relationship with all pulmonary symptoms and lung function parameters (P<0.05).
 
Conclusion: The findings indicated that exposure to low concentrations of ammonia should be considered as a major risk factor in the prevalence of pulmonary symptoms and reduced lung function parameters.

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