Iranian Journal of

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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 & 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: Content validity is the first type of validity that has to be ensured during the design of a tool. Its prerequisite for other validities and its close relationship with the tool reliability place it in a vital position in the questionnaire design. However, since it has not been paid enough attention in national publications therefore in this paper we will explain the different steps in preparing an appropriate content for questionnaires and also their assessment.
Methods: The steps of the content validation process for designing valid and reliable questionnaires have been explained in this paper: development (domain identification, items generation and instrument construction), Judgment – quantification (determining the inter rater agreement among experts, determining the clarity and relevancy of each of the questions along with the clarity, relevancy and comprehensiveness of the tool as a whole) have been explained.
Conclusions: The benefits of performing the content validation in questionnaire development are not increasing the possibility of accessing desirable content validity indexes (relevancy, clarity, and comprehensiveness) only, but also improving the Reliability indexes of tool and decreasing need for resources (financial and temporal) are the other benefits of this approach. Although subjective nature of experts’ responses is the problematic issue in this process but the more quantitative steps of the content validation has reduced considerable part of previous worries about this process. These issues explain why content validation has become a suitable process for questionnaire

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Background & Objectives: Although it is important to study the association between caregiver burden and individual with dementia, a little has been paid attention to this issue in Iranian population therefore the aim of study was to investigate the frequency of psychiatric symptoms and patients with dementia and caregiver burden associated with individual with dementia.
Methods: In this study 84 patients who had referred to Iran Alzheimer’s Association, along with their caregivers were included in our study. Iranian Version of Caregiver Burden and NPI questionnaires were employed. Factors affecting factors on burden was analyzed by multivariate linear regression.
Results: Our findings showed that there was at least one psychiatric disorder in all patients. Among all psychiatric symptoms delusion and elation had the highest and lowest rates with 39.3 and 2.4 percentages, respectively. Linear regression indicated that “indifference” and “irritability” symptoms were the effective psychiatric symptoms on the amount of burden placed on the caregivers.
Conclusion: The symptom frequency of irritability and other symptoms showed a statistically significant positive correlation with caregiver's NPI-D score. These findings suggest that improvement of treatments for delusions, irritability among dementia patients may reduce caregiver burden.

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Background & Objectives: To assess vision related quality of life and determinants in patients afflicted with chronic eye disease.
Methods: In this analytical cross-sectional study, consecutive sampling was performed at Noor Eye Hospital between 2008 and 2009. A valid and standard 39-item visual functioning questionnaire (National Eye Institute visual functioning questionnaire, NEI-VFQ 39) was completed. The questionnaire consists of 11 domains related to vision and one domain about general health. The total score range from zero (0) to 100, where a higher score reflects better vision related quality of life. The independent t-test, pearson correlation coefficient as well as simple and multiple linear regression models were employed for statistical analysis.
Results: The mean overall score in patient and control groups were 54.5 [95% confidence interval (CI) 57.3 - 71.8] and 96.0 [95% CI: 88.2-103.9], respectively. Patients with cataracts had the highest score (64.6 95%CI: 57.3 - 71.8) and those with visual acuity of 20/70 or worse showed lowest scores (41.9 95%CI: 30.7 - 53.1). Age (P=0.006) and education level (0.001) were associated with quality of life score.
Conclusion: Based on our study findings, it could be concluded that low vision patients with a visual acuity of 20/70 or worse hardly received half of the total scores. Diabetic retinopathy, age related macular degeneration, glaucoma, and cataract stand in ascending rank order. The relatively lower scores as compared to results from other countries warrant further research into the causes of such differences.

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  Background & Objectives: Households governed by women have become an important phenomenon worldwide in the second half of the twentieth century. The study of female-headed households shows that this vulnerable social group faces many financial, physical, mental, and emotional problems and experiences stress and anxiety more than men-headed households. This study aimed to determine the quality of life in these households supported by District 9 of Tehran Municipality.

  Methods: This cross- sectional study was performed on female-headed households supported by District 9 of Tehran municipality during 14 months. Data collection tools included a demographic questionnaire, the Iranian version of World Health Organization Quality of Life (WHOQOL-BREF-BREF). The data was analyzed using SPSS software version 16 and descriptive- analytic tests such as mean, standard deviation, and a multiple regression analysis. The significance level in this study was considered α < 5% .

  Results : The mean age of the participants was 50.8 ± 13.8 years, and the majority of the female-headed households were unemployed (71.1 %). The findings in the four domains of quality of life showed that the domains of environment health and social relation received the lowest (9.87) and the highest (12.61) score, respectively. Using multiple regression models, it was shown that the only variables that affected the overall quality of life were age (P< 0.013) and current disease (P< 0.001).

  Conclusion : Findings demonstrated that the authorities should consider planning for effective interventions to improve the quality of life in this vulnerable group of society.

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  Background and Objectives : Health is the most common outcome in health research. In addition to the physician’s examinations as the gold standard, there are many questionnaires to assess objective and subjective health. One of the health indicators is the Self-Rated Health (SRH) which can evaluate health through one question. The use of this indicator is very easy and efficient therefore, it has become very common in health research. In this review, the biases and controversies in the interpretation of the SRH have been elaborated.

  Methods: In this narrative review, Medline and Iran-Med databanks were searched using self-rated or self reported health in the title in December 2013. The titles and abstracts of 1106 article were assessed and 106 articles were recognized as relevant articles. Some of the references of these articles were assessed and 16 articles were added to the list of relevant articles.

  Results: There are different types of the SRH questions five or seven item questions, and comparative or non-comparative ones. However, the findings of these types of questions are similar and none is preferred over the others in the literature. On the other hand, the validity of this indicator is not similar in different socio-economic and ethnic groups. Thus, the estimated health difference between these groups is rated with bias.

  Conclusion: T his question still works in the research and clinical setting evaluations. The main point is paying attention to the socio-economic and cultural status of the study groups in SRH interpretation.

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Background & Objectives: To adopt appropriate policies and strategies to maintain, preserve, and promote health, accurate information and indicators are required. In this study, the years of life lost due to premature death, which is considered one of the indicators of prioritization of health problems, was calculated and compared with other countries.

Methods: This study was an applied cross-sectional investigation. We use death registry data of the Province of Qazvin and population estimation from the Statistical Center of Iran from 2004- 2008 and a standard life table. We calculated YLL and YLL rates by age, sex and cause of death.

Results: The leading cause of YLL (premature death) in different age groups in the years 2004-2008 (based on ICD10) showed that the most common causes of death in the neonatal period were perinatal disorders, congenital anomalies, and chromosomal disorders. The leading causes of death in the age group 5-14 years were unintentional injuries and in the age group 15-49 years were unintentional injuries and cardiovascular diseases. The main causes of death in the age group 50-64 years were cardiovascular diseases, cancer, and unintentional injuries.

Conclusion: The leading causes of premature death in the Province of Ghazvin were unintentional injuries, cardiovascular diseases, perinatal disorders, and cancers. Several causes are preventable by lifestyle modifications such as reducing the tobacco use, increasing physical activity, and reducing stress.

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Background and Objectives: People with high risk alcohol use disorders are influenced by behaviors that have devastating consequences for them and those around them. The main objective for alcohol screening is to identify people with alcohol use disorders, or people who are at high risk for progression to these disorders. Several screening tools have been designed for this purpose. The aim of this study was to introduce and review important screening tools for identification of alcohol use disorders and problems in the world.
Methods: In this narrative review study, we searched the Web of Science (ISI), PubMed, and Scopus databases using Alcohol, Tools or Instruments, Test, Problem, Use and Use disorder as keywords for finding screening tools for identification of alcohol use problems and disorders. Finally, 10 instruments were introduced.
Results: The most common screening tools for identification of alcohol use disorders and problems were Alcohol Use Disorder Identification Test (AUDIT), CAGE, Michigan Alcoholism Screening Test (MAST), as well as T-ACE and TWEAK that are specifically used for evaluation of alcohol consumption in pregnant women. The short forms of the AUDIT, RAPS, POSIT, and CRAFFT are other tests for alcohol consumption.
Conclusion: Several screening tools have been designed for identification of alcohol use disorders and problems; therefore, n appropriate screening test should be selected and implemented with regards to the purpose of screening, research questions, and study population.

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Background and Objectives: Using a random sample of women aged 15 to 50 years in Tehran, this study sought to estimate the lifetime prevalence of abortion (intentional and unintentional) and to identify its associated factors.
 
Materials and Methods: The control data of a population-based case-control study conducted in 2014 in Tehran was used in the present study. Data from 544 randomly selected women aged 15-50 living in municipality areas of Tehran were included in this study. A multiple logistic regression model was used to investigate factors associated with abortion and to estimate the adjusted odds ratios (ORs) and 95% confidence intervals.
 
Results: Overall, 102 women (18.8%, 95% CI (22.4% -15.8%)) reported a lifetime history of abortion. In the logistics regression model, being single (OR =3.46, 95% CI: 1.42-8.47) older age (OR = 1.07, 95% CI: 1.04-1.11) increased the odds of a positive lifetime history of abortion. However, having a child (OR = 0.27, 95% CI: 0.11-0.65)), more education years (OR = 0.89, 95% CI: 0.82-0.96)) and higher religious beliefs (OR = 0.65, 95% CI: (0.45-0.93)) decreased the odds of a positive lifetime history of abortion..
 
Conclusion: High reported lifetime prevalence of abortion in the present study and its subsequent risks to maternal health highlight the need for educational interventional programs taking into account the level of education and knowledge of mothers along with their religious.

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Background and Objectives: This qualitative study was conducted to identify reasons for not using condoms by people who inject drugs (PWID) in Iran.
 
Materials and Methods: Purposeful sampling was applied to recruit four groups [male PWID (n = 14), female PWID (n=6), service providers (n=8), and HIV/Addiction experts (n = 9)] into a qualitative study. Data were collected through focus group discussions (FGDs) or individual in-depth interviews. Data were analyzed using conventional content analysis.
 
Results: The mean age was 44.0 years for male and 38.2 for female PWID. Qualitative analysis showed 16 themes for not using a condom, which were grouped in three main categories, including knowledge (3 themes), accessibility (4 themes), and individual barriers to use condoms (9 themes). Poor knowledge included low perceived level of risk, insufficient training, and misconceptions. Lack of access to condoms resulted from the country's new policy for population growth control and decrease in the number of pharmacies and harm reduction centers and prisons where condoms were previously distributed free of charge. Common reported individual barriers to condom use were poverty, homelessness, depression, low self-care, and low self-esteem, less pleasure, having sex under the influence of drugs, and stigma.
 
Conclusion: Both structural and individual factors may play a role as barriers to condom use among PWID.