Iranian Journal of

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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 & 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: Orthodontic treatment need and demand in 12-year-olds in Abadeh city has not previously been analysed in relation to geographic origin. The purpose of this study was to assess the12 year old students need and demand for orthodontic treatment.
Methods: Four hundred seventeen 12-year-old students was selected from public and private schools in Abade (Fars province, Iran). All the students were examined according to the AC and DHC component of Index of Orthodontic Treatment Need (IOTN) by a trained dentist. Students' and parents' perceived needs were also assessed using AC component and their demand for orthodontic treatment was asked through a questionair .
Results: Twenty two percent of the students were in "no need of treatment" group when assessed by DHC component, 29.5 % were in "average need" and 48.2% were in "definite need" group. When assessed by AC score, these percents were 61.9%, 29%, and 9.1%. Parents and students percieved need for definite orthodontic treatment according to AC score was 8.6% and 7.7%, respectively. The students and their parents’ demand for treatment were 40.6% and 44.9%, respectively.
Conclusion: Orthodontic treatment need in Abade is higher in comparison with other reports according to DHC. DHC is not correlated with orthodontic treatment demand of 12 years old students, but AC had a strong relationship with treatment demand.

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Background and Objectives: Since there is inconsistency reports in relationship between shift work (SW) and blood pressure (BP), therefore we aimed to show any association between SW and BP by using of Bayesian Multilevel Modeling, which is a reliable method for this type of analysis.
 Methods: The profiles of 4145 workers in Polydactyl Iran Corporation were examined in historical cohort between 1996 until 2008. All relevant analysis was performed by Win Bugs software.
Results: Approximately 98 percent of study population was male. Of total 1886 (45.5%), 307(7.4%), 1952 (47.1%) of participation were day worker, two rotation shift worker and three rotation shift worker respectively. After controlling confounding factors, there was no significant relationship with Systolic BP (P=0.911) and Diastolic BP (P=0.278).
Conclusion: In general, the results of our historical cohort study do not support a relationship between SW and BP. We suggest multi center and prospective cohort studies with controlling more confounding factors in this area.

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Background and Objectives: Nowadays 60% of deaths and 47% of diseases load worldwide caused by chronic diseases. Considering the different results of the conducted studies, the current study was performed to review the effect of life style educational intervention on improving cardiovascular risk factors.

Methods: In this review, English and Persian databases were investigated. All types of studies were included. There was no time limit. The articles in any other languages but English (except for Persian), and also abstracts presented in international congresses and meetings were excluded. Other studies were included if they had an acceptable JADAD score.

Results: During the primary search, 194 articles were found which through investigations 43 articles were finally included. The articles were published from 1989 to 2013. There were 3 domestic papers. Only two articles (4.65%) did not show any improvement in the risk factors while the others suggested significant improvements in the risk factors following educational intervention.

 Conclusion: Considering the general findings of the reviewed articles, it seems that the majority of the articles confirmed the effect of lifestyle education on cardiovascular risk factors- blood cholesterol, systolic and diastolic blood pressure, and cigarette smoking along with knowledge and attitude in high risk patients. The finding shows the necessity of “lifestyle” educational intervention in patients at risk for cardiovascular events.

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  Background and Objectives : Previous studies have reported contradictory results regarding the association of Shift Work (SW) and Blood Cholesterol (BC). In this paper, we studied the relationship between SW and BC.

  Methods: The data of this historical cohort study was extracted from annual observations of the workers of Esfahan’s Mobarakeh Steel Company selected through cluster random sampling between 1996 and 2011. In this research, we assessed the effect of SW on BC with controlling BMI, age, work experience, marital status, smoking, and educational status.

  Results : Five hundered and seventy four male workers participated in this study with a mean (SD) age of 41.89 (7.51) and mean (SD) work experience of 16.75 (7.16) years. In this study, after controlling confounding factors, we found no significant relationship between SW and BC.

  Conclusion: Because our study showed no relationship between SW and BC, we can state that this relationship does not exist with more certainty.

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Background and Objectives: Shift work could threaten health in the long term. The present research aimed to assess the association between shift work and body mass index (BMI) using the multilevel (hierarchical) model during a particular period of time.
Methods: The data of this longitudinal study were collected from a sample of Esfahan’s Mobarakeh steel and Polyacryl companies personnel during 2008 to 2011. Shift work schedule included day work and rotational shift work. The multilevel regression model was utilized for analysing the data and assessing the effect of shift work on BMI by controlling confounding variables including marital status, work expectation, age, company, and educational level.
Results: In this study, of 1368 workers, 42.3% (n=578) and 57.7% (n=790) were day workers and rotating shift workers, respectively. The mean (±SD) age of the day workers and rotating shift workers was 33.07 (±8.66) years and 33.31 (±8.70) years, respectively. After adjusting for confounding variables in a two-level hierarchical model, the association between shift work and BMI was not statistically significant (P=0.837). About 90% of total variation was related to personnel.
Conclusion: According to the results of the present study, no statistically significant relationship was found between shift work schedule and BMI. Thus, other similar studies with a longer follow up period (more than four years) and controlling more confounder factors are necessary to evaluate the relationship between shift work and BMI more accurately.

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Background and Objectives: The Cox model is one of the methods used in survival data; however, the use of hierarchical data, such as the data of this study, violates the assumption of independence, the the Cox model cannot be used  assuming independence of observations. One of the important methods for analyzing survival hierarchy data is the use of the multilevel Cox model. In this method, in addition to modeling the response variable, regression coefficients are also modeled and the measurement error resulting from the lack of data independence is reduced. The present study used a multilevel Cox model to investigate the effect of the retention of antihypertensive drugs in people with hypertension.
 
Methods: This longitudinal survival study was conducted in 346 workers with hypertension in Mobarakeh Steel Company in Isfahan. During the years 1390-1394, when the staff attended the health center in the factory, they were treated with six drugs, including captopril, losartan, atenolol, propranolol, amlodipine, and hydrochlorothiazide. In order to examine the relationship of the retention of drugs with job experience, body mass index, and drug history, a two-level Cox model was used as h_ij (t)=h_0 (t)exp⁡(α_g+x_ij β_j), where i and j is the first and second level units, respectively.
 
Results: During five years, the findings of model fitting showed the effect of body mass index (P = 0.019), atenolol (P=0.046), and amlodipine (P=0.021) in a single form, and the effect of losartan-amlodipine ¬(P=0.042) and atenolol-hydrochlorothiazide (P = 0.003) in a combination form were significant.
 
Conclusion: Based on the study results, the most effective drugs for hypertension control are amlodipine monotherapy, amlodipine-losartan combination therapy, and atenolol monotherapy, respectively.

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Background and Objectives: Social marketing is a method that acts through identifying the needs and demands of the audience and specifying the components of the behavioral market using the results of developmental research. So far, social marketing has not been used to involve the private sector in the tuberculosis (TB) control program. The aim of this study was to design a Public-Private Mix (PPM) program using social marketing.
 
Methods: This qualitative study was conducted using focused group discussions (FGD) with six different groups, including tuberculosis coordinator physicians, specialists from different fields in the private section, and managers of selected private laboratories and hospitals in Karaj in 2013 and the components of the PPM program were determined according to the results of the qualitative study.
 
Results: Most of the participants believed that participation of the private sector in the TB program was associated with significant challenges, including the lack of a well-defined process for communicating with the private sector, lack of a suitable platform, lack of appropriate monitoring tools, private sector’s lack of compliance, private sector’s lack of familiarity with national TB program protocols, lack of appropriate incentive and punitive measures, lack of appropriate feedback to the private sector, and monopoly in laboratories.
 
Conclusion: To run PPM in the TB program, it is necessary to involve laboratories in the program voluntarily. It is also essential to provide an informational and incentive package containing effective and low-volume tutorials; the package should facilitate feedback and promote respect for the private sector.