Iranian Journal of

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Background and Objective: On 26 December 2003, an earthquake measuring 6.5 on the Richter scale struck the city of Bam and the surrounding villages. This study was conducted to determine the needs of the affected population on the 19th and 20th days after the quake to help with the prioritization of relief activities and efficient resource allocation.
Materials and Methods: Following a feasibility study on 10 Jan 2004, a team consisting of volunteer students of School of Public Health at KUMS was assembled and trained. Each of the 8 groups consisted of 3-4 students with at least 1 man responsible for security on the field. On the 13th and 14th of January, using a cross-sectional design, 60 clusters including 420 households, 7 households in each cluster, were studied based on a Cluster Geographic-Based Sampling (GBS) Plan.
Results: Fifty-five households (13.1%) had children < 2 years, 81 (19.3 %) had children aged 2-5 years and 68 (16.2 %) contained people more than 65 years old. Thirty-seven households (8.9%, CI 95%: 6.4-11.7%) had changed their residence in Bam from one zone to another the main reason for this was poor environmental health conditions (85%). The main source of health and social messages for families was word of mouth 284 (67.6%). The most commonly needed items were bathrooms (73.8 %, CI 95%: 68.9-78.7%), food (68.8 %, CI 95%: 62.6-75.0%) and warm clothes (67.4 %, CI 95%: 60.9-73.8%). The most frequent illness was acute respiratory infection (59.8 %, CI 95%: 54.3-65.2%). Two hundred households (47.6%, CI 95%: 42.6-52.6%) complained of difficulties in obtaining health and medical services. The main barrier to access was transportation problems due to long distance (38.1%, CI 95%: 35.6-40.6%). 

Conclusion: We conclude that relief operations should be continued to provide basic public health facilities. Active delivery of health and medical services should be strengthened, and problems related to reproductive health should not be ignored. The GBS plan is a useful tool in the post-disaster surveys. Using volunteer university students was a rewarding experience and teaching and application of "Disaster Epidemiology" should be improved in this country.

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Background and Objectives: The campaign to eliminate measles and rubella (MR) is one of the most important current health projects in Iran. One of the basic requirements of this program is the creation of an efficient system for collecting data on MR morbidity and mortality, people's knowledge, attitude and practice (KAP) regarding MR prevention, and people's participation in the eradication drive. The present study was done to assess people's knowledge, attitude and practice in relation to the current anti-MR campaign.
Materials and Methods: This cross- sectional study was carried out fur months after the mass (anti-MR campaign (performed in May 2004). The target population included at the people aged 20-25y who lived in areas covered by Tehran University of Medical Sciences and Health Services. The calculated sample size was 384, using a 2-stage sampling procedure. We used X2 tests, odds ratios and confidence intervals to detect relationships between various categorical variables. We also performed Cronbach's alpha test to assess questionnaire reliability, and principal component analysis to ensure construct validity.
Results: Data were collected on 390 individuals. The percentages of people with an acceptable level of knowledge, attitude and practice were 63.3%, 53.6% and 93.1% respectively. After controlling for confounders in a logistic regression model, it became apparent that knowledge concerning the mass immunization campaign was related to the individual's own education and that of his/her mother. Attitude was found to be affected by factors such as education, marital status and the family's main income level. The practice component, on the other hand, was not significantly related to any of the variables included in this study.
Conclusion: The positive achievements of this program should be used in planning any future immunization campaigns. Particular attention should be paid to factors that affect overall coverage. These include human resources, equipment, vaccines and other materials, service uality, the cold chain, information provided to the public, and people's as well as providers' knowledge of the immunization program, the target diseases (s) and the vaccines.

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Background and Objectives: Noise-induced hearing loss is a prevalent work-related morbidity in the country. We determined the strength of association between hearing loss and occupational noise exposure as the first step in prevention programs.
Material and Methods: A historical cohort study involving 100 exposed and 31 non-exposed subjects was conducted. Noise exposure was estimated using sound level meter BSEN 60651, Type 2. Past noise exposure was estimated using the existing data on the place and type of work. Audiometry was used to assess hearing loss in each subject in 3- year intervals on an occupational cohort from 1993-2004.

Results: Noise-induced hearing loss was found in 49% (49 subjects) of the exposed group and 9.7 %( 3 subjects) of non-exposed group (p<.0001). Nobody used any form of hearing protection routinely in either group. Relative risk for noise-induced hearing loss was 5.1(CI95%: 1.7- 15.1).Time at risk was estimated 24.9 years (22.7-27.1) in exposed and 22.2 years (20.7-23.7) in unexposed group by survival analysis.
Conclusion: More legislation, hearing conservation programs, and surveillance and biological monitoring of work sites and workers are required to prevent occupational hearing loss. Planning strategies for noise assessment and control can help improve the work environment. Gross occupational exposure to noise has been demonstrated to cause hearing loss and the authors believe that occupational hearing loss in the country is a widespread problem.

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Background and objectives: Malnutrition is a major health problem in Iran. A nationwide survey (ANIS) in 1998 revealed that over 800 000 children in this country were suffering from moderate or severe malnutrition. The southern province of Hormozgan is one of the most severely affected regions, so there is a need to determine disease associations and risk factors for child malnutrition in this area.
Methods: In this case-control study, we selected 1725 children aged 6 to 30 months from both rural and urban areas of Hormozgan. Data for the study were obtained by filling questionnaires and studying family health files. Using the weight-for-age Z score (WAZ) as outcome measure, we examined the effects of 21 different variables, including putative risk factors, confounders, and background variables.
Results: Father's job (p<0.004), parents' education, interval between pregnancies, urban versus rural residence (p<0.001), family size (p<0.03), and misconceptions regarding the growth chart were recognized as risk factors for malnutrition. Moreover, the mean age of the cases was 2.3 years higher than that of the controls (p<0.001). Complete vaccination (p<0.018) and attending day care centers (p<0.005) emerged as protective factors.
Conclusions: Poverty (low-income jobs, rural residence, large family size, etc) is an important factor causing malnutrition among children in Hormozgan. In contrast, immunization and mother's knowledge of the child's growth chart are major protective factors. Therefore, the health system must continue its support for the current immunization program. It should also try to improve the quality of its health education programs targeted at mothers attending state-run health and medical clinics

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Background & Objectives: The DPT vaccine used in Iran is manufactured by the Razi Institute. So far, there have been no studies to determine the incidence and severity of adverse reactions to this vaccine. It was this lack of reliable information, plus concern for the unfavorable effects of such reactions on compliance with the vaccination schedule, that prompted the current study on DPT side effects.
Methods: In this cohort study, 1910 children aged 0 to 6 were divided into different groups (cohorts) on the basis of factors such as injection site and then monitored for the appearance of adverse effects. Data for this study were gathered through questionnaires filled by telephone or house-to-house interviews. We interviewed parents of children attending the 46 urban health clinics in Kermanshah. These interviews produced the data needed to fill the first part of the study questionnaire. The investigators then gave each parent an "information sheet" containing the data necessary for the second part of the questionnaire. The interviewee was asked to record on this sheet any adverse effects occurring over the following 48 hours. At the end of this period, the parent was contacted via telephone to fill the second part of the questionnaire. Data thus gathered were analyzed using the Statistical Package for Social Sciences (SPSS), version 11.5.
Results: In 1910 DTP immunizations given to children 0 to 6 years of age, followed for the development of adverse events occurring within 48 hours after immunization, the cumulative incidence rates were as follows: Swelling, 40.66% (38.43-42.89%) Redness, 43.08% (40.84-45.32%) Pain, 67.32% (65.20-69.40%) Fever (>38° C) 54.14% (51.89-56.40%) Fever (>40.5° C) 1.11% (0.64-1.59%) Drowsiness, 33.35% (31.21-35.48%) Persistent crying, 13.35% (11.81-14.88%) Local reactions, 75.79% (73.86-77.73%) and Systemic Reactions, 69.84% (67.76-71.97%). Only one child developed convulsion following immunization.
Conclusions: Varying reaction rates in different studies, such as high rate of pain and persistent crying in this study, may reflect the different preparations that were used or differenced in the methods for vaccine evaluation. Moreover, because of the severity of systemic reactions, DTP vaccine should be administered in the thigh region

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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: For those with a chronic illness, suffering may result not only from physical limitations, but also from the psychosocial consequences of having a chronic condition. Therefore, simply measuring physical health is not enough anymore. It is necessary to evaluate quality of life as an important clinical outcome in these patients. We conducted the present study to measure quality of life (QoL) in multiple sclerosis (MS) patients and its predictors in comparison with the general population in Tehran, using a generic and overall QoL instrument, the WHOQOL-BREF (World Health Organization Quality of Life-BREIF). This questionnaire comprises four domains including physical health, mental health, social relationships, and environmental health. For each domain, scores range from 4 to 20, higher scores corresponding to a more favorable QOL.
Methods: This study was of cross-sectional type and involved 145 selected systematically patients registered in the Iranian Multiple Sclerosis Society. The WHOQOL-Questionnaire was filled in for these patients through telephone interviews. The results were compared with quality of life scores from the general population obtained from a population-based study in Tehran. Multiple regression was used for data analysis.
Results: The response rate was 97% 73.8% of participants were female, the mean age of participants was 36.5 (SD = 10.4) years, and the mean years of their formal education was 12.5 (SD=3.6). Mean scores for physical health, psychological health, social relationship and environmental health were 11.5 (SD=3.2), 11.8 (SD=3.2), 12.7 (SD=3.1), and 11.5 (SD=2.7), respectively. In comparison with the general population, the patients' scores in all domains were significantly lower than in the general population. Severity of disease and education level had a relationship with domain scores in regression analysis.
Conclusions: The WHOQOL-BREF questionnaire can discriminate between these patients’ quality of life and that of the general population and show the effect of disease severity and demographic variables on quality of life. Therefore the questionnaire can be used in this group of patients, although it may be necessary to add some specific questions to make the tool more sensitive in evaluating quality of life from a clinical perspective. Educational interventions are recommended to improve quality of life in this group of patients.

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Background & Objectives: The widely differing casualty rates in earthquakes of similar magnitude indicate a need for assessing the factors that determine the extent of damage to life and property. The present study looks at the structural factors and individual characteristics that had an effect on the risk of death and injury directly caused by the December 2003 earthquake in Bam.
Methods: The study population consisted of the residents of Bam on the 19th and 20th days after the earthquake of December 25, 2003. Using a cluster sampling method based on geographic location, we selected 420 households for study and asked them for information on the family members who were inside their houses at the time of the quake. The information covered the following range of items: occurrence of death or injury leading to ambulatory treatment or hospitalization, and characteristics of the building. We used logistic regression and the software package Stata 8.0 for data analysis.
Results: A total of 2089 individuals, including 1089 men (52.1%) and 1000 women (47.9%) took part in this study. There were 369 cases of death (17.7%, 95%CI=12.6-17.8%), 122 injuries needing hospitalization (5.8%, 95%CI=4.5-7.1%), and 319 cases of injury treated on an ambulatory basis (15.3%, 95%CI=12.6-17.8%), all as a direct result of the earthquake. Factors associated with increased risk of death were building destruction (OR=6.34, 95%CI=3.56-11.29), living in adobe structures (OR=1.87, 95%CI =1.03-3.4), age under 6 years (OR=3.93, 95%CI=2.17-7.11) and age 56-65 years (OR=2.52, 95%CI=1.23-5.15). Risk factors for injuries were the same as for death, with the notable exception of the building material.
Conclusions: This was the first analytic study of the risk factors for earthquake-related deaths in Iran. It revealed that total building destruction, residing in houses built with non-resistant materials, and extremes of age are significant risk factors for death in an earthquake. As for injuries, the risk factors were total building destruction and extremes of age.

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Background and Objectives: A pregnancy can be considered high-risk if there are conditions that put the mother or the baby at higher-than-average risk of morbidity or mortality. Neonatal mortality rate is one of the most important indices of children's health status. The present study was conducted to evaluate the effects of high-risk states on neonatal mortality.
Methods: We performed a nested case-control study in the rural areas of Kohgiluyeh and Boyerahmad province. Within the study cohort, 97 cases and 97 controls were selected by a risk-set sampling method. Data were analyzed with univariate and multivariate conditional logistic regression models.
Results: Neonatal mortality was shown to increase significantly in high-risk pregnancies. There were no substantial differences between crude odds ratios and those adjusted for the presence of other risk factors (crude odds ratio decreased from 5.5 to an adjusted figure of 3.25 for pregnancies with one risk factor and from 5.21 to adjusted level of 4.80 for pregnancies with more than one risk factor).
Conclusions: High-risk pregnancies need great attention in family health and prenatal care programs, especially in remote rural areas. Within our rural health network there are potential cohorts for use in nested case-control studies, especially in the evaluation of neonatal mortality risk factors.

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

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Background & Objective: Disability-Adjusted Life Years (DALY) summarizes the fatal and nonfatal outcomes of diseases and injuries in one number and gives a quantitative assessment of the health of a population. Estimating the burden of diseases and injuries in Iran in terms of DALY both nationwide and in 6 provinces.
Methods: We used slightly modified versions of the methods developed by the World Health Organization for estimating the burden of premature mortality, disability, and the DALY.
Results: The DALY rate per 100,000 was 21572 and 62% of this was life lost due to premature mortality the remaining 38% was due to disability from diseases and injuries. Fifty-eight percent of the total DALYs had been lost due to non-communicable diseases, 28% due to external causes (injuries), and 14% due to communicable, maternal/ perinatal and nutritional illnesses. The group of diseases and injuries with the highest burden in males waz intentional and unintentional injuries (2.789 million DALYs), while in the female population this position was held by mental disorders with 1.191 million DALYs. The single most important cause of burden was traffic accidents in males and ischemic heart disease in females. Disease burden showed considerable variability between different provinces.
Conclusion: The profile of health and disease in Iran has generally shifted from the predominance of communicable, maternal/perinatal, and nutritional illnesses towards predominance of non-communicable diseases and injuries at the national level. These figures on disease burden at population level are the most objective evidence that can be used in policy making and management of health programs, health research, and resource development within the health sector.

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Background & Objectives: Recent reports indicated an increase in cutaneous Leishmaniosis (CL) cases. We designed the study in the context of community assessment process to identify and address the major public health related issues by explore the risk map of CL and assessing the environmental risk factors in Kerman.
Methods: All the registered CL in the only referral center for CL from 2002 to 2006, localized on Kerman digital map. The level of data dissemination was townships. Based on data from the national statistics organization, we determined the population and calculated the incidence of CL of each township. Secondly, the highest endemic townships were observed deeply with a specific checklist to determine the environmental risk factors.
Results: 771 cases were included. All the high endemic areas were located in the east part of Kerman. The eastern township, Sarasiyab, with 123 (15.9%) cases was the most infected region. The highest endemic townships were Sarasiyab, Emam and Sarbaz with 54.9, 52.8 and 51.2 cases per 10,000, respectively. Some minor endemic areas such as Shahab, Abouzar and Shahzadeh Mohammad (South and central regions) were going to be disappeared while Shariati, Naseriyeh-Seyedi (North and North-East regions) were the new high-risk townships (P<0.01).
Conclusions: the east and central part of Kerman, were always the high endemic regions. Some other new high-risk areas were also detected. The most environmental factors were the bare lands between the houses, ground passages and the timeworn architecture on the buildings.

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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: Observational studies are not often reported in detail and clear enough, so that assessment of the strengths and weaknesses of these studies is not straightforward. To improve the reporting of observational studies, a checklist of items called ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) was developed by some experts in October 2007. The aim of this study was to assess the quality of reporting of observational studies before STROBE statement.
Methods: We included randomly sixty cohort studies published in six important international journals until October 2007. Then, we used STROBE checklist to assess the strengths and weaknesses of these included studies.
Results: On average, more than 81% (95% CI: 77%-87%) of included studies pointed to 43 items of aim of this study. The most reported (100%) items were "scientific background" and "rationale for the investigation" and the less reported (30%) item was “flow chart”.
Conclusions: Although, the quality of reported cohort studies’ results was acceptable, the type of study, journal and date of publication could influence on the quality of observational studies.

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Background & objectives: The trend of stunting indicates of long term health status and the efficacy of different health interventions for chronic malnutrition in children. The objective of this study was to investigate the trends of stunting prevalence in preschool children living in rural area of Robat-Karim.
Methods: The method of Age-Period-Cohort analysis was utilized. Existing height data of all children whom registered in health houses of Robat-Karim health network were converted to Standard Deviation Scores (SDS) using Anthro2005 software The SDS≤ -2 for height-for-age was defined to be the moderate/severe forms of stunting. Age-Period-Cohort analysis was done with two graphical and statistical methods. The statistical method was based on logistic regression modeling in which stunting was assumed to be the dependent variable and age, birth cohort and time period were independent variables.
Results: Growth data of 970 (51.9%) boys and 898 (48.1%) girls were analyzed. The overall stunting prevalence was estimated 8.0%. This estimation by Logistic regression models (P<0.001) and graphical analyses were similar and showed that the prevalence of stunting has a decreasing trend in different birth cohorts and time periods. The prevalence of stunting was higher in the 2nd and 5th-6th years of life. The stunting prevalence was significantly higher in boys (9.3%) and non-Iranian children (9.5%) (P<0.001).
Conclusions: The prevalence of stunting appears to be decreasing in the investigated population. Appropriate interventions is thought to be essential for reducing stunting of 2nd and 5th-6th years of life, boys, and non-Iranian children.

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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: 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: Community assessment process is the foundation for developing the basis for effective community health strategies. The aim of this study was providing a framework for comprehensive and participatory community assessment in Shahin-Shar, Isfahan, Iran.
Methods: This assessment performed in Shahin Shar city based on some experiences of Community Medicine and Epidemiology and Biostatistics departments of Tehran University of medical sciences since 1989 and North Carolina Community Assessment Guide Book (2002). The community assessment team included wide ranges of key stakeholders and local people. Our community assessment team has three levels of participants: An advisory group, a work group and a project facilitator. Observation, interview, focus group discussion and summary list of health resources used for data collection. The map of asset was also provided. We reported data to community and Hanlon method -based on magnitude of the problem, seriousness of the consequences and feasibility of correcting- was used for selecting health priorities.
Results: Drug abuse, smoking among adults and depression were the important health priorities. After creating community assessment document, Based on the risk factors that contribute to each problem, the health action plans were developed.
Conclusion: The results of this study showed that community assessment could be the foundation for improving and promoting the health of community members. It could be the basis for effective community health strategies in Iran .

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Background & Objectives: Aging and elderly population growth has been increased in Iran. Quality of life of older persons is important as a consideration in medical decisions and as a clinical outcome measure. Health related quality of life (HRQoL) is not well understood in this group therefore we designed this study to determine the quality of life among elderly populations of Tehran, Iran.
Methods: This cross-sectional study was conducted on a random sample of elderly people selected from the elderly centers in Tehran. The Iranian version of short-form Health survey (SF-36) and perceived social support questionnaires were employed as standard tools.
Results: Overall, 400 elderly people with the mean age of 64.07(SD =4.49) took part in this study. Of all participants, 298 individuals were women. The mean score of PCS (Physical Component summery) and MCS (Mental Component Summery) were 64.62 (SD= 12.68) and 63.35 (SD=4/7) respectively. The results of this study revealed that women compared to men had significantly higher scores in different dimensions of health related quality of life as physical function, social function, body pain and general health. Additionally, participants with lower body mass indexes, higher education level, married elderly, healthy aged participants and richer ones had higher scores of health related quality of life.
Conclusion: According to this study, there was correlation between mean PCS and social support as well as MCS and social support. Quality of life in female, individuals with higher education and socioeconomic status were higher than male, persons with lower education and socioeconomic status.

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