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: Multiple Sclerosis (MS) is the most prevalent autoimmune disease of the nervous system in young adults. There are currently more than 30000 cases in Iran and the number is increasing everyday.The objective of this study was to measure the amount of vitamin and mineral intake in MS patients and to compare it with reference values.
Methods: We randomly selected 108 relapsing-remitting MS patients from the Iranian MS society in Tehran in 2005. Two questionnaires- covering personal information and medical data- were filled for each patient. Food intake was assessed by three 24-hour recalls and a quantitative food frequency questionnaire for the year preceding the study. The food intake recorded on the original questionnaire was changed to values in grams using “Manual for Household Measures” and then converted to corresponding amounts of nutrient ingredients by the “Nutritionist 3” program. Data analysis was performed by the SPSS software package. We calculated means and standard deviations for intake levels and applied t tests to compare the results with reference values.
Results: Women with MS took excessive amounts of vitamin A and vitamin C, while their daily intake of folate, vitamin E, vitamin D, magnesium, iron, zinc, iodine and calcium was below reference values. Male patients had higher-than-recommended intake of vitamin A, phosphorous, manganese and iron. Their ingestion of folate, Vitamin D and E, magnesium, zinc, calcium and selenium was shown to be below the recommended amount.
Conclusions: In view of these results, higher intake of vitamin D and calcium is recommended. Women should be encouraged to take more iron and folate as many symptoms of anemia mimics MS symptoms. Considering the well-known role of oxidative stress in the pathogenesis of MS, men should be urged to increase their ingestion of antioxidant-rich foods. It appears that nutritional assessment, dietary counseling and education are necessary for Iranian MS patients.

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Background & Objectives: Iron is a major essential micronutrient during pregnancy and has an important role in intrauterine fetal growth and safe delivery. This survey was designed to study the status of anemia, iron deficiency and iron deficiency anemia in pregnant Iranian women. The results can help health policy-makers with the design and implementation of targeted strategies to overcome these problems.
Methods: This cross-sectional study involved 4368 women at gestational ages ranging from 6 to 9 months. Subjects were drawn through cluster sampling from 11 different regions of the country. Hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV) and serum ferritin levels were measured and the prevalence of anemia, iron deficiency and iron deficiency anemia (IDA) was determined both nationwide and separately in each region.
Results: Overall, 21.5% of the women suffered from anemia 42.7% were iron deficient and the prevalence of IDA was found to be 10.4%. The prevalence of anemia s was significantly greater in rural areas than in urban settings (22.2- 27.8% compared to 17.1 -21.6%, 95%CI). The highest prevalence of anemia and low Hct was seen in the women of region 5 (including Sistan and Baluchistan, South Kerman and South Khorasan with rates of 44.2% and 40.5% respectively). Region 6 (covering Isfahan, Yazd, Kohkilooyeh-Boyerahmad and North Kerman) had the lowest prevalence of anemia and low Hct (9% and 10.8% respectively). Use of iron supplements (even irregular) had a positive effect in reducing anemia. It affected Hct levels only when taken regularly.
Conclusions: Anemia is still a major health issue for pregnant Iranian women. Although supplementation should be continued, there is a need for more comprehensive interventions addressing all target groups, especially women of child-bearing age.

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Background & Objectives: Multiple Sclerosis (MS) is the most prevalent autoimmune disease of nervous system in young adults. The current number of diagnosed cases in Iran is above 40000 and is steadily increasing The objective of this study was to assess the daily macronutrient intake of MS patients and to compare this with reference values.
Methods: We randomly selected 108 relapsing-remitting patients were randomly from the Iranian MS society in 2005. Two questionnaires containing personal and medical information were filled for each patient. We assessed food intake by three 24-hour recalls and a semi-quantitative food frequency questionnaire dealing with intake over the past year. Using the Manual for Household Measures, the data were changed to values in grams and then turned to nutrient ingredients by applying Nutritionist-3. Data analysis was done using the SPSS package: m mean and standard deviation were computed for each nutrient and t tests were run to compare the figures with reference values.
Results: MS patients living in Tehran had a dietary intake of total fat, saturated fat and protein higher than recommended, while their intake of fibers was below the reference values. The body mass index was subnormal in 14.8% of the patients and above normal in 38%.
Conclusions: In light of the current pattern of macronutrient ingestion in MS patients in Tehran, a lower intake of total and saturated fat, consumption of vegetable proteins instead of animal protein and more dietary fiber are recommended. To meet this goal, vegetables, fruit, whole grains and beans are good suggestions. It seems that Iranian MS patients need nutritional assessment, counseling and education to improve their diet.

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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: Early detection can improve the outcome of visual impairment in children, and one method for early detection could be screening of pre-school children with visual acuity tests. The aim of this study was to determine the validity of these tests when they are used on children entering grade school.
Methods: For this cross-sectional study we drew 39 random clusters, comprising a total of 5721 school children. We then used 2158 student files to extract data on tests of vision performed by school health officers and compared these data with data generated by optometrists. Measurement of uncorrected visual acuity was done with the E Chart by both teachers and optometrists.
Results: The sensitivity and specificity of teacher-administered tests were 25.0% and 96.6%, yielding positive and negative predictive values of 13.4% and 98.4%, respectively. Sensitivity and specificity rates did not show any significant difference between male and female populations (P=0.356, P=0.258), but the difference between specificity in urban and rural areas was significant (P<0.001).
Conclusions: Screening tests for visual impairment did not attain the desired level of sensitivity or specificity for case detection in school children. More accurate procedures are required to minimize the number of false negative results.

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Background and Objectives: There are conflicting data on the effects of different types of fat on aortic atherosclerosis. This study used Wister rats to compare the atherogenic effects of a standard diet with a diet containing fish oil and another diet containing mixed oils (typical of the current consumption pattern in Iran).
Methods: Thirty female Wistar rats were randomly assigned to three diet groups: a standard diet (containing soy bean-oil as the only dietary fat), a diet containing fish oil and another diet which contained mixed oils and was designed on the basis of the current fat consumption pattern in Iran (butter, hydrogenated vegetable oil and sunflower oil). Mothers in each group were fed the same diet during pregnancy and lactation the litters were also weaned onto the same diet. Aortic samples were taken from the offspring at the time of weaning and puberty. Data were analyzed using SPSS software Kruskal-Wallis test was applied for comparison among groups.
Results: Rats that were fed soy bean oil showed less extensive fatty streaks and intimal thickening of aorta on weaning and at puberty. Rats fed fish oil and mixed oils showed more atherosclerosis lesions compared to those receiving soy bean oil.
Conclusions: It seems that diets with an omega-3 to omega-6 ratio of 0.6 can enhance aortic atherosclerosis. Diets with an Iranian fat consumption pattern also increase aortic atherosclerotic lesions because they contain substantial amounts of saturated fat.

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Background & Objectives: Malnutrition is widely regarded as one of the factors affecting quality of life. The adverse effects of malnutrition have been documented in various age groups. School problems, learning difficulties, humiliation and teasing from peers are some of the most common complications of obesity and excessive thinness. The goal of this study was to determine the BMI and some of the factors affecting it in the students of Dezfool.
Methods: In a cross-sectional study and using random cluster sampling, 5726 students from 39 clusters were selected and anthropometric measurements were performed in the schools and under standard conditions. Cases of obesity and thinness were identified using BMI percentiles for age and sex (NCHS). A Body Mass Index above the 95th and below the 5th percentile was defined as obesity and thinness respectively.
Results: This study involved the participation of 5508 students (96.2%). The prevalence of thinness was 33% (1716) with a 95% confidence interval of 27.3%-38.8%. The prevalence of obesity was 2.6% (157) with a 95% confidence interval of 1.7%-3.4%. There was no significant difference between the prevalence of obesity or thinness between the two sexes (P>0.05). The prevalence of obesity and thinness significantly increased and decreased respectively with aging (P<0.05).
Conclusions: Malnutrition among the students in Dezfool predominantly takes the form of thinness, while obesity is not a serious problem in this population overall, these findings indicate poor nutritional status. High-risk groups have been identified and they must become the target of interventions by the Health and Education Ministries.

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Background and objectives: Although in many developed and developing countries, self care is the most important part of primary care, in Iran it has not been supported as well as its values. The aim of this study was to assess the views of general people living in south of Tehran about self care.
Methods: This was a population based study in which 1200 individuals aged 15 years and over were interviewed using cluster sampling. A structured interview questionnaire which including 5 sections on regarding demographic characteristics, views on general health, views on self care knowledge, interest and practice, views on barrier and enabler factors for self care, and views on sources of information was used. Content validity and cronbach’s alpha coefficient was used for its validity and reliability. Data were analyzed through spss version 11.
Results: The mean age of participants was 27.9 ± 5.2 years. Six hundred and fifty eight respondents (55%) stated they were not knowledgeable on self care, 986 (82%) and 1035 (86%), were interested and self rated themselves active regarding healthy life style, respectively. In practice, only fifty three participants (4%) were actually active in eating ≥7 glasses of water daily, 31 (3%) stated they ate more than five portions of fruits daily and 51(4%) did physical activity more than 3 hours weekly.
Conclusions: The findings of this study have highlighted the significant role of information in doing self care activities.

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Background & Objectives: oxygen free radicals have been implicated as mediators of tissue damage in RA patients. This study was aimed to find the effects of vitamin A, C and zinc supplementations on oxidant–antioxidant, inflammatory and clinical indices in inactive RA patients.
Methods: We designed a randomized controlled trial. Forty nine (49) patients were randomly allocated in two groups group I received their conventional treatment plus 300 mg vitamin C, 5 mg Zinc daily and 25000 IU vitamin A every other day for 12 weeks, group II received their conventional treatment only for the same duration. Disease activity (using the rheumatoid arthritis disease activity index (RADAI) score), biochemical indices [malondialdehyde (MDA), total antioxidant capacity (TAC)] and inflammatory markers [erythrocyte sedimentation rate (ESR), c-reactive protein (CRP)] was evaluated before and after 12 weeks.
Results: Serum concentration of MDA and RADAI score (P<0.0001) and ESR (P=0.033) were significantly decreased and TAC levels (P<0.0001) were significantly increased in the first group in comparison to second group after 12 weeks. However, there were no statistically significant differences in serum CRP concentration of two groups (P>0.05).
Conclusions: This study indicates that adding antioxidants as supplementations with conventional medications in inactive RA patients plays an important role in improving oxidative stress and decreasing disease activity and inflammatory status.

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Background & Objectives: Work-related Musculoskeletal Disorders (WMSDs) seen more in workers of manufacturing industry than others. This study was, therefore, conducted to determine prevalence rate of WMSDs symptoms among workers of a metal manufacturing industry in Shiraz.
Methods: In this study, nearly 50% of workers of the production units were randomly selected from corresponding list of each unit. Totally, 156 workers participated in this study. A self-administrated questionnaire was used to collect required data. T-test and Chi-square tests were used to analyze the data.
Results: The results showed that WMSDs occurred in considerable rate among the workers such that 76.9% of the workers studied suffered from some kind of symptoms during the last 12 months. The highest prevalence was reported in the lower back (54.5%) and knees (42.9%). Machine operators and welders reported the highest rate of symptoms. Statistical analyses revealed significant association between age, height, work tenure, weekly work hours, smoking, shift work and the symptoms (P<0.05).
Conclusions: WMSDs symptoms occurrence was prevalent among workers of this industry. To prevent WMSDs symptoms, more attention should be paid to working conditions of the machine operators and the welders, and risk factors for back and knee regions should be reduced.

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Background and objective: Cigarette smoking in adolescent population seems a major public health issue. The goal of the present study was to identify the effect of socio-personal factors on transitions in the adolescent smoking.
Methods: A total of 1785 students were assessed twice during 12 months. with respect to stage of change. The predictor variables were measured when the students were in the 10th grade. Logistic regression was used to predict different smoking stages at grade 11.
Results: At the end of follow-up, 14.3 percent of non-smokers have had smoking experiment, and 16.5 percent of smokers have showed to be the regular smokers. Among non smokers, using alcohol, friendship with smoker group were predictors of being regular smokers.
Conclusion: Smoking prevention program should begin in adolescent age group.

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Methods: Thirty female Wistar rats were randomly allocated to three dietary groups: a standard diet (containing soy bean-oil), diet containing fish oil and diet containing mixed oil which was designed based on Iranian population fatty acid intake. Dams in each group were fed one of the diets during pregnancy and lactation and the pups were also weaned onto the same diet. Fasting serum glucose (Photometry) and insulin (ELISA) in pups were assessed and insulin sensitivity calculated on puberty.
Results: Fasting serum insulin in fish oil-fed group was significantly less than two other groups (P=0.018) and insulin sensitivity in fish oil-fed rats was significantly more than two other groups (P=0.002).
Conclusions: It seems a diet containing fish oil (rich in long chain omega-3 fatty acids) causes more insulin sensitivity comparing to diet containing soy bean oil (rich in omega-6 fatty acids) and diet with Iranian population fatty acid intake pattern (rich in saturated fatty acids).

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

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Background & Objectives: Food security (access to safe, nutritious, affordable food) is one of the important determinants of health status in human life. Since monitoring and assessing of associated factors to food security are essential for health planning, this study has tried to determine household food security status and food consumption amongst high school student families in Esfahan, Iran.
Methods: This cross-sectional study was conducted in autumn 2008 on 580 high school 14-17y students of Esfahan, Iran using a systematic cluster sampling. Food security and food frequency questionnaire were completed by interviewing mothers and students.
Results: The prevalence of household food insecurity was estimated as 36.6% (95%CI: 33-40%). Household food insecurity was positively associated with frequency of some food group intakes among students, including bread macaroni potato legume and eggs (P<0.05). In addition, negative associations were observed between food insecurity and frequency of other food group intakes including rice, red meat, sausage and hamburger, poultry, fish, green vegetables, root and bulb(colored) vegetables, melons, banana, pineapple, coconut, mango, apple, orange, milk, and yogurt (P<0.05).
Conclusion: The results of this study indicate that food insecurity is prevalent among (students) households in Esfahan. In addition, students living in food-insecure households more frequently consumed cheap foods containing high energy per kilogram. Therefore, appropriate nutritional programs should be designed to improve the quality of household food consumption.

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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.

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Background & Objectives: Sleep quality is an important factor in student life and affects in their learning process. Sleep problems are related to increased health concerns, irritability, depression, fatigue, attention and concentration difficulties, along with poor academic performance. The aim of this paper is to conduct a survey based on a questionnaire that would characterize the quality of sleep in students living in dormitories of Tehran University of Medical Sciences (TUMS).
Methods: We conducted a cross-sectional study using the stratified random sampling approach on 277 students residing in dormitories in Tehran. A demographic questionnaire and Pittsburgh Sleep Quality Index (PSQI) were used for data collection.
Results: Mean (CI) of PSQI in students was 8.57 (8.10- 9.04). Using the cut-off score of 6 for the PSQI global score, 73.3% (68.1%-78.5%) of students were described as poor sleeper. Female students had a worse quality of sleep compared to male. The mean duration of sleep in students was 5:15´± 105´ (hours). This was significantly higher in male students than female students. There were no significant relationships between demographic variables such as age, academic level, marital status and family income with and quality of sleep.
Conclusion: This study showed that poor sleep quality is prevalent among students living in dormitories of TUMS. Therefore it is necessary to provide effective educational interventions for this group in order to improve the quality of sleep.

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Background & Objectives: Burns is one the important injuries which may result vital impairment and disability. Burn injuries are still common particularly in developing countries. Assessment of the epidemiology of burns is very important to make effective preventive methods. This study was conducted in Fars province to assess and describe the epidemiology of burns including its main causes, and its demographic factors.
Methods: All epidemiological data of patients with burn admitted to the hospitals in Fars province during 2010 were analyzed in this descriptive study.
Results: Total of 328 patients with mean age 25.93±17.94 were included. It consisted of 178 male patients (54.3%) and 150 female patients (45.7%), The most common accident age was 26 years, the average percentage of burn was 36.63± 26.63%, average hospital stay in hospital was 13.40±12.72 days, 249 cases had unintentional injury (91/75%) and 79 cased had intentional (24.9%), The main reason for  intentional burns was divorce (16.76%), the most common month accident was December, the overall cumulative incidence of burn injuries was 7.28% in 100000 people (person per year) and the burn fatality rate was 29.88%
Conclusion: Epidemiology of burn injuries in Fars province indicates that effective public health programs on this issue would help to reduce the incidence of burn injuries in this region.

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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.

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Background & Objectives: There is increasing evidence that self-medication is a widely prevalent practice in many developing countries. It seems a special significance issues among medical students as they are the future medical practitioners. The objective of this study was to assess the level of self-medication and its related factors amongst medical students in Tehran University of Medical Sciences.
Methods: A cross-sectional questionnaire-based study was conducted among the 600 students of Tehran University of medical science in 2011 year.
Results: The frequency of self-medication in students was 35.7 percent. This was more common in females rather than males. Some reasons for seeking self-medication included Previous illness experience (51/9%), easily access to medications (28/5%) and feeling not important of illness (22/9%).
Conclusion: Our study shows that self-medication is common among medical students in Tehran. In this situation, it is necessary for faculties to create awareness and educate theses students regarding advantages and disadvantages of self-medication.