Iranian Journal of

---

Background & Objectives: To determine the prevalence of HBV infection in the Golestan Province (southeastern part of the Caspian littoral, Iran).
Methods: A single cluster study was conducted in 2005, based on a sample of households, representative of the population aged 25-65 years in Golestan. All participants were invited for face-to-face interviews to gather demographic data. Blood samples were drawn and analyzed for serum markers of HBV infection such as HBsAg and HBcAb by the ELISA method. Factors associated with hepatitis B seroprevalence were analyzed using SPSS13 and STATA /8.
Results: A total of 1850 subjects were screened. The age- & sex-standardized prevalence for HBsAg positivity was 9.7% (95%CI=0.07-0.11). Rates were higher in males than in females (10.8% vs. 8.6%) (OR=1.28 95% CI=0.9-1.7). HBV seroprevalence in unmarried individuals was significantly higher than in those who were married (OR=2.13 95%CI=1.29-3.5). HBsAg(+) status was more frequent in urban areas (OR=1.46 95% CI=0.9-2.3). Thirty-six percent of population was HBcAb positive. HBcAb(+) prevalence was significantly higher in females (OR=1.46 95% CI=1.19-1.8) and married people (OR=1.58 95%CI=1.02-2.45), and also in urban areas (OR=1.34 95% CI=1.09-1.6).
Conclusions: This study shows that the prevalence of HBsAg(+) status in the Iranian province of Golestan is at a level regarded as "high" by the World Health Organization. It is higher than reported by pervious studies in Iran so it is important- especially for health providers and policy makers- to recognize risk factors and design appropriate prevention programs.

---

Background and objectives: People with thalessemia and chronic renal failure on maintenance hemodialysis are prone to blood-born infections, especially hepatitis C due to the long-term transfusion. Recently, hepatitis C has been one of the main health concerns in these patients. The aim of this study was to determine the prevalence of hepatitis C and its risk factors in these groups of patients in Kerman province of Iran.
Methods: HCV RNA in blood sample of 384 patients (203 hemodialysis cases and 181 thalassemia cases) was evaluated.
Results: One hundred thirty (130) out of 384 were infected by HCV. Infected male was predominant (83%).
Conclusions: It seems that the frequency of hepatitis C infection in Kerman is higher than the other provinces of Iran. Therefore more attention should be paid to screen of blood before transfusing for these group of patients.

---

Background & objectives: In the management of crush syndrome, the way of treating compartment syndrome is controversial. The aim of this study was to evaluate the outcomes of compartment syndrome treatment after Bam earthquake.
Methods: Clinical and laboratory findings of all fasciotomized patients in Bam earthquake were analyzed. Then nonfasciotomized patients with same characteristics were selected and the outcomes of two groups were compared.
Results: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.
Conclusions: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.

---

Background and Objectives: Each year almost 400,000 people are diagnosed with oesophageal cancer worldwide. Wide variation in incidence has been reported both between countries and in different ethnic groups and populations within a country. The area with the highest reported incidence for oesophageal cancer is the so-called Asian ‘oesophageal cancer belt’, which stretches from eastern Turkey through north-eastern Iran, northern Afghanistan and southern Russia to northern China. In the high risk area of Gonbad in Iran, world age-standardised rates are more than 200 per 100,000 and the male/female ratio is reported as 0.8:1.0.This study aimed to assess the risk factors and demographic factors influencing survival of patients with esophageal cancer in north of Iran using weibull and log-logistic regression models.
 Methods: Demographic and clinical data of 359 patients with confirmed diagnosis of esophageal cancer from Babol Cancer registry utilized for our model. parametric and weibull models were employed to analyze the data. The Akaike information criterion (AIC) was also considered as a criterion to select the best model(s). All p values as 0.05 were considered as statistically significant.
Results: The sample study consisted of 62.7% men and 37.3% women. Estimated survival rates in 1, 3, and 5 years following diagnosis were 23%, 15%, and 13% respectively. According to AIC criterion, the hazard rate of non-monotonic and rejection proportional hazards assumption (p<0.05), log-logistic model was more efficient than weibull model. Family history of having cancer in patients showed a significant difference in both models.
Conclusion: It is concluded that early detection of people with a family history of cancer can be effective as an important factor in reducing the risk of death in patients with esophageal cancer.

---

Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Human papillomavirus (HPV) infection seems to be the most common sexually transmitted infection. High-risk (HR) human papillomavirus (HPV) prevalence has been shown to correlate well with cervical cancer incidence rates. Since there is little known about the epidemiology of this infection in Tehran, we designed to estimate the prevalence of HPV in some areas in Tehran. 
Methods: Cervical specimens were obtained from 825 married women aged 21-59 years from the general population of Tehran, Iran according to the standardised protocol of the IARC International HPV surveys. HPV was detected using a GP5+/6+ PCR-based assay.
Results: HPV prevalence in the general population was 7.8% (5.1% of high-risk types), with no statistically significant variations by age. Cervical intraepithelial neoplasia was diagnosed in 4.1% of women, of whom 35.3% were HPV-positive. HPV16 was confirmed as the most common type among women with both normal (1.8%) and abnormal (8.8%) cytology. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husbands' extramarital affairs.
Conclusion: However the prevalence of HPV seems not high in comparison with other international data, more molecular and seroepidemiological survey in national level needs to have a better perspective.

---

Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: There is little known about the relation between metabolic syndrome and fiber intake are available in Iran. We evaluated the relation between total, and various types and sources of dietary fiber and the prevalence of the metabolic syndrome.
Methods: In this cross sectional study, 2457 adults, aged 19-84 years were studied. Total dietary fiber intake and its types and sources were assessed using a validated semi quantitative food-frequency questionnaire. Blood pressure, Anthropometric, and biochemical measurements were assessed. The metabolic syndrome was defined according to definition by Iranian National Committee of Obesity.
Results: In the multivariate-adjusted odds ratio, intakes of total (OR: 0.53 95% CI: 0.39-0.74), both soluble
(OR: 0.60 95% CI: 0.43-0.84) and insoluble dietary fiber (OR: 0.51 95% CI: 0.35-0.72), fruit fiber
(OR: 0.51 95% CI: 0.37-0.72), legume fiber (OR: 0.73 95% CI: 0.53-0.99) and cereal fiber
(OR: 0.74 95% CI: 0.57-0.97) were inversely associated with the metabolic syndrome. There was not significant association between using vegetable and nut fiber and prevalence of metabolic syndrome.
Conclusion: Total dietary fiber, both soluble and insoluble fibers, and especially fruit and legumes fibers, reduce the metabolic syndrome among adults in Tehran.

---

Background & Objectives: Despite decreasing the trend of coronary artery diseases in developed countries and outstanding improvements in clinical management of these patients, case fatality rate after an acute myocardial infarction (AMI) remains high in both genders. Identifying predicting factors of short-term survival in patients with AMI may play an important role in reducing mortality in these patients.
Methods: In this cohort study, all patients with acute myocardial infarction (AMI) admitted to all hospitals in Isfahan, Iran, during 2000-2008 which registered in Isfahan cardiovascular research Institute were analyzed. We used Cox regression models, uni- and multi-variable analysis. 
Results: Within the study period, 8800 AMI patients (73.6% male) were admitted with mean age of 61.85±12.5, and overall 28-day survival of 90.5%. Relative risk (RR) of death for 50-70 years old patients was 2.5 (CI:2-3.1), for over 70 years old RR=5 (CI:4-6.3), for women RR=1.7 (CI:1.5-1.9), for patients who had not received streptokinase RR=0.9 (CI:0.8-1.1), for inferior MI RR=4.2 (CI:2.2-7.8) and for anterior MI, RR was equal to 7.2 (CI:4-13.3).
Conclusion: Recognizing the predicting factors of short-term survival of AMI patients may help health professionals to provide better healthcare services for more at risk patients, i.e. elderly, women and patients with an anterior MI.

---

Background & Objectives: Peritoneal dialysis is one of the most common types of dialysis in patients with renal failure. However multivariate analysis such as log- rank test and Cox have usually used to evaluate association of risk factors in survival of this group of patients, the aim of this study was to perform of Weibull, Gamma, Lognormal and Logistic Mixture cure models in survival analysis of these patients.
Methods: Data of 433 patients undergoing CAPD who registered in two centers in Tehran, Iran between 1997 to 2009 were used in this analysis. We investigated center, gender, age, cholesterol, Low Density Lipoprotein (LDL), High density lipoprotein (HDL), triglyceride, albumin, hemoglobin, creatinine, Fasting Blood Sugar (FBS), calcium and phosphorous as variables effect with Kaplan-Meier and cure model. CUREREGR module was used for survival analysis.
Results: Comparison of AIC (Akaike Information Criterion) of Weibull, Gama, Lognormal and Logistic Mixture cure models showed that Weibull distribution AIC is lower for almost all variables than other distributions. Weibull distribution has better fitness for data than others. In the multivariate Weibull model, age and albumin variables had significant effect on long-term survival of patients (P<0.01). Triglycerides effect on long-term survival had borderline (P = 0.065). Also HDL, FBS and calcium were significant on short term survival (P<0.01) but significance of LDL was borderline (P=0.088).
Conclusion: Cure models have the ability to analyze dialysis patients' survival data and can differentiate long-term survival from short- term survival. The interpretation of survival data with these statistical models could be more accurate and would help to make better prediction for patients by health care professionals.

---

Background & Objectives: To be able to measure the extent of job stress, it is essential to use a standardized tool based on a standard theoretical model. The study aims to test the psychometric properties and criterion validity of the Farsi version of the Effort Reward Imbalance (F-ERI) questionnaire.
Methods: The Farsi version of the ERI Questionnaire was distributed to 227 male employees in Isfahan Polyacryle Company. Internal consistency, reliability, discriminative validity, and factorial structure were evaluated. The relationship between scales and depression was measured assessed by using logistic regression to criterion validity. Data were analysed by SPSS 18 and LIZREL 8.5.
Results: Mean score of effort, reward, and overcommitment were 10.7, 41.4, and 14.2 respectively Cronbach’s alpha coefficients were 0.61, 0.85 and 0.67 and split-half coefficients were 0.53, 0.85, and 0.65. All of item-total correlations were more than 0.20 correlation between each item and its scale were more than 0.4 except for one item. Effort and overcommitement had a good fit for construct validity.
 Conclusion: Current study results indicated the Farsiversion of the Effort Reward Imbalance (F-ERI) questionnaire is a reliable and valid tool to measure psychosocial stress at work among Farsi-speaking employees. It is advisable to evaluate the tool in longitudinal studies and other industries which included female employees. We refer the investigators to see the longitudinal results of current project which is under publication.

---

Background & Objectives:: To assess inequity of childhood health care package provision according to the distance of health houses from the town and the provincial capital in Markazi province (Iran).
 Methods: We used 4 measures of childhood health care provision by family medicine program in randomly selected health houses in Markazi province. The measures included were monitoring of the childhood health by the GP (General Practitioner), childhood disease management according to the Iranian MOHME guidelines, good knowledge of the GP about the content of the guidelines and good knowledge of the GP about the 1-59 month death registration system. These measures were estimated by a predefined, interviewer administered questionnaire. The distance of each selected health house was determined in each district health center. To assess the inequity of the measures we estimated concentration index and its 95% confidence interval using covariance method. P Values of greater than 0.05 were considered as statistically insignificant.
 Results: About 46 health house were randomly selected. All of the estimated concentration indices about the childhood care measures were less than 0.1 and their differences with zero score were insignificant ( p value> 0.05 ).
Conclusion: according to the data of our study it seems there is no inequity between different health houses in accordance of their distance from district center and provincial capital. It seems necessary to measure other health indices to assess the inequity of the whole of the health care providing system.

---

  Background & Objectives : Longitudinal studies are used in many psychiatric researches to evaluate the effectiveness of treatment. The main characteristic of longitudinal studies is repeated measurements of the patients over time. Since observations from the same patient are not independent from each other, especial statistical methods must be used for analyzing the data. Missing data is an indispensable component in longitudinal. In this study, we examined the effect of comprehensive treatment on social-individual performance in patients with the first episode of psychosis.

  Methods : The data was from a clinical trial involving patients who were admitted to the clinics of Roozbeh Hospital between 2006_2008. We employed a random effect model for the analysis of longitudinal ordinal responses with non-monotone missingness using the R software version 3.0.2.

 Results: The results showed that comprehensive treatment with follow-up at home, age, and family history of the disease had a significant effect on the social-individual performance of the patients. The estimation of the coefficient of age and its standard deviation were 0.05 and 0.03, respectively. The estimation of the coefficient of family history of the disease was -0.82 with a standard deviation of 0.41, and the coefficient of comprehensive treatment with follow-up at home and its standard deviation, were estimated -1.04 and 0.44, respectively.

  Conclusion: The model used in this study showed that the comprehensive treatment with follow-up at home was better because individuals under this type of treatment are more likely to have social-individual performance.

---

Background and Objectives: One of the applications of population attributable risk percent (PAR%) is to estimate the disease burden in a population exposed to several risk factors. Therefore, this study was conducted to estimates the PAR% of the space-time clusters of pulmonary tuberculosis.

Methods: In this study, the data of pulmonary TB cases were obtained from the health department of Hamadan University of Medical Sciences. After detecting significant clusters using the spatiotemporal scan statistic, PAR% was used to analyze the clusters and to detect the location of clusters more accurately.

Results: Four primary space-time clusters and three secondary spatiotemporal clusters were detected for patients with pulmonary tuberculosis and 92% of the patients who did not have a clear state in term of HIV infection. Despite differences in the location of clusters and PAR%  attributed to them, the second primary cluster of pulmonary tuberculosis cases (consisting of the cities of Razan, Famenain and Kabudrahang) had the highest amount of PAR% that needs more attention.

Conclusion: The presence of significance spatiotemporal clusters in Hamadan highlights the necessity of the use of PAR% to distinguish cluster areas and to implement prevention and control policy. However, more analytical studies are needed to detect the on the determinants of the occurrence of pulmonary TB.

---

Background and Objectives: The Millennium Development Goals (MDGs) are common goals that were established by the United Nations in 2000. The aim of this study was to compare some of these indicators in Iran, the Eastern Mediterranean Region (EMR), and the world.

Methods: The existing data from the World Health Status in 2014 and some other available sources in Iran, EMR, and across the world were addressed. The most relevant health indicators included decreased childhood mortality, maternal well-being, prevention of AIDS, tuberculosis and other diseases, and environment quality assurance.

Results: The proportion of neonatal mortality to total mortality among those less than 5 years increased from 37 to 44 in the world compared to 39 to 46 in EMRO and 46 to 61 in Iran. About 14.5% (71000 out of 490000) of the AIDS/HIV cases reported in the EMRO belonged to Iran in 2002. The maternal mortality rate (MMR) showed a decline of 72.2%, 50% and 44% in Iran, EMRO and the World respectively. The proportion of delivery by skilled persons and the proportion of pre-delivery care had a positive trend in Iran and were higher as compared to EMRO and the world average.

Conclusion: Iran achieved many MDGs, however, despite a decline in the AIDS/HIV incidence rate, its prevalence rate has increased in Iran, EMRO and the world from 2001 to 2013. The proportion of neonatal mortality rate to under 5-year mortality rate has had an increasing trend. Decision-makers should give priority to indicators that have not achieved MDGs.

---

Background and Objectives: Using the anthropometric indicators of children is one of the ways of monitoring their growth. Because of the racial divisions and levels of health and welfare, comparing these indicators with the global reference is not reasonable; therefore, designing a local reference seems necessary. This study aimed to evaluate the growth indices for boys and girls aged 5 to 18 years old living in Isfahan and to compare the indices with standard values.
Methods: In this cross-sectional study, 53,839 subjects were included. Percentiles of body mass index, height, and weight were calculated using the LMS method in the LMS Light software. After normalization of the growth indices, their mean and standard deviation were calculated for each age group and anthropometric indices curves were plotted versus the 5th, 50th and 95th percentiles of the NCHS reference.
Results: In all age categories, the mean SDS scores of BMI in boys and girls was -0.004 ± 0.029 and 0.014 ± 0.062, respectively, indicating no difference with reference values. However, the 95th percentile of the body mass index for the reference population was consistent with the 90th percentile for the population studied. Also, weight in boys below 13 years of age was higher than the reference line while in girls, weight was always higher than the reference value.
Conclusion: Due to differences in the pattern of growth and also lower anthropometric values, particularly among boys, it seems that a national growth curve can be a better guide for future decisions.

---

Background and Objectives: Improving the efficiency and productivity of the higher education, especially in the field of research on health sciences, is one of the characteristics of sustainable development in today's societies. This study aimed to measure the efficiency and productivity of Iran's Medical Sciences Universities (MSU) in the research function.
Methods: In a descriptive study, the research function of fourty five MSUs in Iran was evaluated using data envelopment analysis (DEA) method and Malmquist index in 2010, 2013, and 2016 years. Measurement of both efficiency and Malmquist index was developed and modeled based on the assumption of variable returns to scale (VRS) and output-oriented. Also, the ranking of efficient units was done using Anderson-Patterson's model.
Results: The mean research efficiency was estimated to be 0.86. Findings of Malmquist index showed that between 2010 and 2013, there was a 6% growth in the productivity; while the performance of universities had a 12% drop in research function from 2013 to 2016. Also, the average total productivity during two periods is 0.96, indicating 4% reduction in research efficiency which technology efficiency growth has dropped by 8% and other components of total productivity had a positive growth.
Conclusion: The results of the study showed that universities do not work efficiently and average productivity has been decreasing which was mainly due to a decline in the efficiency of technology, which despite the development of technology in recent years could be the result of the lack of effective use of it.
 

---

Background and Objectives: Research plays an important role in solving health problems in the community. One main mission of higher education institutions is developing research tailored to the needs of the community by providing equal and fair opportunities for research sectors. The present study aimed to measure inequality in the rea of research in Iranian medical sciences universities.
Methods: In this descriptive study, the Gini Coefficient (GC) was used to measure inequality from 2010 to 2016. The indexes included the number of published papers, citations, citation per paper, self-citation, Scimago Journal Rank (SJR), Source Normalized Impact per Paper (SNIP), Citescore, Hirsch
(h-index), number of faculty members, number of students, and educational and research budget. Stata 14 software was used for data analysis.
Results: During the study years, the GC of SJR, SNIP, and Citescore varied from 0.65 to 0.73, 0.62 to 0.73, and 0.61 to 0.72, respectively. In addition, The GC of international papers, total articles, self-citation, citation per article, Hirsch index, and total citations varied from 0.62 to 0.70, 0.56 to 0.66, 0.22 to 0.27, 0.12 to 0.28, 0.33 to 0.39, and 0.57 to 0.72, respectively. The GC of the number of faculty members and budget ranged from 0.26-0.40 and 0.34-0.67, respectively.
Conclusion: Inequality in self-citation and citation per article was relatively fair, while Hirsh and the number of faculty members had intermediate inequality. Other indicators had a high and very high inequality. To reduce inequality, developing of the balanced research infrastructures in medical universities is recommended.

---

Background and Objectives: The higher education system plays an important role in the socio-economic development of the country due to its mission in training the required human resources. Therefore, performance evaluation of different sectors of higher education is of great importance. The present study was conducted to evaluate the educational efficiency and productivity changes of Iranian medical sciences universities.
Methods: This descriptive study was conducted in 2011, 2014, and 2017 to evaluating the performance of 43 Iranian medical universities using Data Envelopment Analysis and output oriented approach. In addition, productivity changes were measured using the Malmquist index. For this purpose, Deap 2.1 software was used. The Anderson Patterson Model and EMS software were also used to rate the units accurately.
Results: The average educational efficiency of medical universities was 0.97 in the study years. The average total productivity based on the Malmquist Index was 1.05, and educational productivity of the universities showed an average growth of 5% over the study years. This growth was 1% from 2011 to 2014 and 10% from 2011 to 2017.
Conclusion: The results of the study showed the acceptable efficiency of the education sector of Iranian medical sciences universities. Moreover, a positive increasing trend was observed in the productivity of the education sector during the study years. Further research using quality and quantity measures are necessary to assess the educational performance of medical universities more accurately.

---

Background and Objectives: Access to equal educational opportunities is one of the fundamental rights in each country, and elimination of inequalities, especially in the higher education system, is one of the most important priorities. This study aimed to measure educational inequality in the medical sciences sector in Iranian provinces.
Methods: In this study, educational inequality in medical sciences was measured using the Gini coefficient. The study indexes included the number of students, faculty members, staff, majors and educational budget. Data were analyzed using Stata 14 software.
Results: During the study years, the Gini coefficient of the number of female students, male students, and faculty members showed a more or less decreasing trend from 0.51 to 0.46, from 0.53 to 0.46, and from 0.59 to 0.53, respectively. However, the values of inequality in the number of personnel working in educational sector and educational budget showed a slight increasing trend from 0.49 to 0.50 and from 0.53 to 0.54, respectively. According to the academic majors, the lowest Gini coefficient was related to non-continuous bachelor’s degree that varied from 0.13 to 0.17, and the highest value was related to fellowship degree ranging from 0.66 to 0.69 in the study years.    
Conclusion: Despite reduced inequality in some educational indicators, there is a high inequality in the number of academic majors of some postgraduate degrees, number of students by gender, and educational budget, which requires policy makers to focus more on balanced distribution of educational infrastructures among provinces to provide equal educational opportunities.

---

Concurrent with globalization, some changes have been created in the performance of the universities in developed countries that have turned them into a power source for economic development. In this study, generation changes of Iranian universities in the health sector were analyzed by the layer analysis (CLA) framework. The results showed that the status of universities in Iran is moving from the first and second university generations (i.e. education and research oriented) to the third generation (wealth creation). Too much concentration on indexes such as expert human resources training and number of papers and citations in the Iranian universities has led to stagnation in litany and structural layers. Obtaining scientific authority and technology development requires fundamental evolutions of sciences in deeper layers such as Islamic world view, governance of valuable contexts and evolution in the relationship among higher education and the research and technology system with other sectors.     

---

 
Background and Objectives: One of the most common problems during pregnancy is sleep disorders, which is the result of physiological, hormonal and physical changes in pregnancy and can be the basis for many disorders before, during, and after delivery. The aim of this study was to determine the psychometric properties of the persion version of  Sleep Condition Indicator in a sample of Iranian pregnant women.
 
Methods: In present study, 300 pregnant women reffered to health center of Kowsar (affiliated to Qazvin University of Medical Sciences) that were gathered via accesible sampling method, completed the Sleep Condition Indicator in 2017. Face, content, and construct validity (convergent and divergent validity) and reliability of selected questionnaire were calculated.
 
Results: The results of exploratory and confirmatory factor analysis showed two sustained and distinct factors, including quantity in sleep quality and the consequences of low sleep quality. The two-factor fit of Sleep Condition Indicator was approved based on standard indicators. Convergent and divergent validity were acceptable for all factors. Moreover, the internal consistency and reliability of the construct were also acceptable.
 
Conclusion: The results of this study showed that the Sleep Condition Indicator is valid and reliable among pregnant women, so it seems that this tool can be used to screen sleep disorders in women during pregnancy.