Iranian Journal of

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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: Although most occupational injuries are the result of stress-related human error, the association between job stress and work-related accidents has not been studied adequately. The aim of this study, carried out in 2004, was to look at the pattern of job stress among workers at Iran-Saipa car manufacturing plant, and to assess the relationship between stress and occupational injuries.
Methods: Data were collected randomly from 608 workers considered to be at risk. The sample was composed of 100 subjects with a history of work-related injury within the preceding year and 508 subjects without such history. Job stress was assessed by the Belkic Occupational Stress Index (OSI). We performed creatinine, cortisole, and 17-ketosteroid assays on 24-hour urine collection samples to check the validity of OSI questionnaires. All subjects were males.
Results: The prevalence of job stress was 21.3%. The main stressors were time pressure (78.5%), mode of payment and evaluation (56.4%), and interaction with people and machines (41.3%). The risk of injury for workers experiencing job stress was significantly higher than in those without job stress (odds ratio= 2.0). On the other hand, job stress was found to be responsible for 11.9% of all occupational injuries in this community.
Conclusions: In conclusion, job stress should be recognized as an important factor causing occupational injuries among car manufacturing workers. Full commitment and participation of managers at all levels and also behavioral and environmental modifications in the production line is important in promoting safety and injury prevention.

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Background & Objectives: Job stress is common among different groups of professionals. It might be regarded as a defensive reaction allowing the individuals to cope with negative inputs and risk factors. Because of the rise in the mass production of motor vehicles in Iran over the last 2 decades, many managers in the car industry describe their jobs as highly stressful. However, there have not been any studies in Iran on the pattern of job stress in these managers. The aim of this study was to outline the epidemiologic pattern of job stress among managers of car companies in Iran.
Methods: This study was carried out among 496 managers of car industry in Iran. Using 12 different instruments the job stress of subjects was assessed. The main domains employed to assess job stress were time pressure, scheduling and timing, management at work, decision-making at work, organizational roles, development and structure, communication at work, work condition, and interaction between work and home duties.
Results: The mean age of subjects was 43.6 years with 12.1 years of job experience (SD=7.7). All subjects were males and 95% were married. The prevalence rate of job stress among subjects was 49.5%. The top four stressors were from decision-making at work (99.1%), time pressure (97.3%), time-table and scheduling (73.5%), and management at work place (50.5%). The prevalence of job stress was more common among the managers of lower level, and the younger ones (P<0.001). However, there was no significant difference by marital status and educational attainments.
Conclusions: This study showed that the Iranian managers working at car manufacture companies are at a higher risk of job stress and its effects compared to other managers in developed countries. Job stress may play a part in making them vulnerable to illness. It should be recognize as a priority of occupational health in this community. Stress management and appropriate interventions needs to be employed to control the negative effects of job stress among this group of managers.

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Background & Objectives: Trauma database in the form of a registry can provide necessary information for monitoring and modifying trauma care. These databases can be collected based on trauma and injury severity score (TRISS) method. The injury severity score (ISS) is based on an anatomic severity classification of injury called abbreviated injury scale (AIS). TRISS determines the probability of survival of patient from the ISS and revised trauma score (RTS). RTS is a physiological scoring system that consists of GCS, systolic blood pressure and respiratory rate. Our aim was to report trauma outcome based on TRISS method and compare the outcome with the registry data from major trauma outcome study (MTOS).
 Methods: All trauma patients admitted between 1 April 2004 to 30 September 2005 with ISS> 10 were evaluated by TRISS method according to medical records, CT scan, sonography and surgical records. We used W and Z statistic to evaluate match of injury severity between our patients and MTOS database.
 Results: From the 220 patients studied, there were 174 (79.1%) males and 46 (20.9%) females and their mean age was 30.2 and 40.2, respectively. Blunt injury accounted for 9.1% patients, and 66.4% were admitted in ICU. Traffic accidents were the main cause of trauma (80%). There were 47 deaths, but the expected and predicted number of deaths should have been 35 and 38 according to MTOS norms. The average probability of survival (Ps) was 82.7%. W statistic was calculated as -4 with a Z score of 0.11.
Conclusion: In our hospital, 4 deaths more than the MTOS database per 100 injured patients had occurred, and there was no other significant difference between our findings with the MTOS. In addition, the use of this model would be suitable for patient care in of pre-hospital, in-hospital and between hospital settings.

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Background & Objectives: According on surveys in Iran more than two million persons have non insulin diabetes mellitus. There are evidences that good glycemic control reduces the risk of diabetic complications. This study was designed to evaluat the glycemic control by using fasting blood sugar and hemoglobin A1C estimation and their relation with some variables.
Methods: This cross sectional study carried out on 411 people with type 2 diabetes who referred to Tawhid diabetes center in Sanandaj. Demographic and other variables were gathered by a deigned questionnaire. Univariate analysis and multivariate analysis (logistic regression) were used. Results: In Univariate analysis FBS showed a significant relationship with education, job and referral style and HgA1c was statistically significant with sex, age, education, and job. But logistic regression showed other
Results: in final model FBS and HgA1c were associated with body mass index and referral style and HgA1c had association with only body mass index and referral style. Correlation confidence between FBS and glycated hemoglobin was (r = 0.54).
Conclusions: It is concluded that BMI and referral style have association with diabetes control.

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Background & objectives: Head injuries are the most sever kind of injuries in accidents. It is an important factor of disability in society. Having information about present situation and its determinant factors is the first step of programming for head injury reduction. This survey aimed to have an epidemiological aspect of head injury in Arak.
Methods: Relevant informations about severity of the impact, causes, demographic information and treatment results were extracted from medical files between 2005-2006 years.
Results: Of total 1105 patients with head injury 25.8% were in their first decade of life and 11.8% were reported as sever head injury. The most common injuries (18.4%) caused by downfall from low height. Men had more head injured 64.7% compared with women. In the period of hospitalization 12.8% of moderate head injuries and 43.1of sever head injury caused to death.
Conclusions: It is concluded that applying and administration of the safety rules in the society as a compulsory rules and educating by mass media, are necessary. It should also be taken into account more effective hospital care for sever head injuries to reach better outcomes.

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Background & Objectives: The epidemic of HIV has been become worldwide. Infected people with HIV which are most intravenous drug users (IDUs) and/or people who have unsafe sex are important source of transmission of infection to other persons in a community. Since there is little known about the knowledge and attitudes of HIV positives about HIV in Iran, therefore we decided to measure the level of knowledge and attitudes of this group in Golestan province in compare with individuals with risky behavior.
Methods: This cross-sectional study was conducted on 54 HIV+ persons and 134 people with high risk behavior individuals in 2007 year. Results: Our study showed that HIV- (High risk group) cases had higher education level (P=0.034). Rate of jobless was higher in HIV+ persons (P<0.001). HIV+ cases had lower income (P=0.037). Both groups had moderate knowledge and poor attitude on HIV/AIDS. Level of attitude in HIV+ positive persons was lower than high risk group (P=0.05).
Conclusion: It is concluded that these susceptible persons and also infected individuals with HIV regardless of their socio-economic levels need more continuous education in structured programs.

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Background & Objectives: Despite an increased risk of obesity and CHD in people with spinal cord injury (SCI), there is little known about the dietary intake in this group, therefore the aim of this study was to examine nutrient intake and body mass index (BMI) in the spinal cord injury (SCI) population according to level of injury and related variables.
Methods: In this cross-sectional study, 162 patients with spinal cord injury participated from Brain and Spinal Injury Repair research Center, Tehran, Iran. Dietary intakes were assessed by means of a semi quantitative food frequency questionnaire.
Results: The mean age of study population was 34.1±0.6 years. Total energy and carbohydrate intake were higher in men than women (P<0.001). Incomplete injured consumed more MUFA (P=0.03). The elderly were consumed less total calorie, saturated fat, MUFA, cholesterol (P<0.01) and PUFA (P<0.05). Injured patients with longer times had lower total calorie, carbohydrate (P<0.01), total fat and MUFA intake (P<0.05). Based on new classification 60.5% were at the risk of obesity or obese. Central obesity was seen in 33.1%of man and 48.4% of women. BMI of the paraplegia group was greater than that of the tetraplegia group (P= 0.009).
Conclusion: Macronutrients balance is moved towards higher saturated fat intake and less complex carbohydrates and protein intake in SCI patient’s .The elderly and patients who had lived with SCI longer time tended to maintain healthier diets.

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Background & Objectives: White spot, as one of the infectious viral diseases, has made severe losses in shrimp ponds all over the world. Despite extensive efforts made to deal with and control the disease, white spot continues to be a major health problem in shrimp farms across Iran. In this work, the significance of the risk factors of white spot disease epidemic occurred in shrimp ponds of Choubdeh farming site in Khuzestan province of Iran is determined.
Methods: A cross sectional study was conducted from June 1, 2010, to September 22, 2010 in 223 shrimp ponds of the site. Data was collected on 17 variables, thought to be associated with the occurrence and epidemic of white spot, with the aid of the shrimp ponds owners and fisheries and veterinary organizations. The occurrence of white spot disease in the farming site was determined by clinical symptoms and the results of conventional PCR tests. the effectiveness of the risk factors was established by odds ratio (OR).
Results: It is found that poor management of birds fighting (OR=3.72), less educated farm foreman
(OR= 3.29) and poor filtration of the intake water (OR= 3.43) are significantly affected the occurrence of the disease while little changes in the salinity of shrimp ponds (OR= 0.16) decreases the odds of the disease.
Conclusion: These findings help better develop shrimp farming across Iran, especially in Khuzestan province. 

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Background & Objectives: Although several studies have been carried out for evaluation of the first birth interval, none of them has considered the presence of infertile women within the sample. Therefore, the aim of this study was to employ survival analysis to study the first birth interval and its determinant factors more accurately.
Methods: In Data from 1068 married women of reproductive age in west Azarbaijan province were considered in this investigation. Two-stage sampling design was used to collect data via a questionnaire, modified Gompertz model, a special kind of cure models, was employed in this study. For descriptive and analytical data analysis, SPSS 16 and R 2.12 were used respectively.
Results: In this study, the average interval between marriage and first birth was 3.9± 0.7 (± SD) years. Using modified Gompertz model, among all demographic factors only mother’s education had significant effect on the first birth interval so that with increasing mother’s educational level, the first birth interval had also increased. (P =0.007). In addition, the estimation of the proportion of women who did not have any children was 0.062 that showed a positive trend with increasing mother’s educational level.
Conclusion: This study revealed that due to the presence of infertility among married women the use of Modified Cured Gompertz model is an appropriate method for evaluation of the first birth intervals and it's determinant factors.

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Background & Objectives: The world population is growing old. The rising proportion of the elderly is creating new health care challenges in the current century. This study aimed to determine the quality of life and the associated factors in the elderly population of Azerbaijan district in the city of Tehran, Iran.

Methods: This cross-sectional study was conducted on 287 elderly persons aged 60 and older. Participants were selected through systemic random sampling. The WHOQOL-BREF questionnaire, the Activities of Daily Living (ADL) questionnaire, and a questionnaire for demographic characteristics were used for data collection. Each domain was given a score between 0 to100 based on the WHO manual. The final variables were determined in a multivariate linear regression model using SPSS16.

Results: The mean score of the 4 domains of quality of life (physical, psychological, environmental, and social health) of the elderly population living in Azerbaijan district was 58.41, 53.13, 59.53, and 42.82, respectively.

Conclusion: A variety of correlates affect the quality of life of the elderly. Recognizing and considering these factors are important for planning more effective programs for the elderly and empowering them.

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Background & Objectives: Bovine Tuberculosis (BTB) is one of the most important zoonoses. Mycobacterium bovis is the responsible agent of BTB in the cattle. The current study was conducted to investigate the determination factors of BTB in dairy farms covered by the tuberculin screening test.

Methods: A herd level case- control study was carried out in 124 (62 cases & 62 controls) dairy farms in the provinces of Tehran, Alborz, Hamedan, Isfahan, Qazvin, Qom, Mazandaran and Semnan. The control farms were individually matched with case farms by farm capacity and distance. Statistical analyses were done by Stata 11.2 using conditional logistic regression.

Results: Proper management of manure (OR=0.12 95% CI: 0.03-0.49), regular flaming of stalls (OR= 0.21 95% CI: 0.04-0.92) and complete fencing around the farm (OR= 0.17 95% CI: 0.03-0.81) decreased while the presence of rodents (rat) (OR= 4.90 95% CI: 1.04-23.01) increased the risk of infection. The interaction among these variables was not statistically significant

Conclusion: According to the results, there is an essential need to pay more attention to rodent control in farms.

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  Background and Objectives : In the current age, due to the increasing growth of knowledge and competition therein, evaluation of scientific products by means of scientometric methods has become a very important and necessary subject. Scientometrics, in simple words, is the science of measuring the knowledge. Scientometric indices are divided into three categories: productivity metrics that measure the productivity of the researchers or research groups, impact metrics that assess the quality (or performance) of journals, researchers, or research groups, and hybrid metrics that are used to summarize both productivity and effect metrics in one index. Scientometric studies help policy makers and managers of universities and heads of research centers in allocating budget, creating a balance between the budget and costs, making appointments, and promoting the researchers and institutes, and results in better recognition of weaknesses and strengths of their affiliated groups by evaluation of priorities, perspectives, and capacities. Meanwhile, this new knowledge can help with systematic evaluation and ranking of universities and research centers. This paper provides a review on scientometric concepts and its applications and discussed scientometric indices.

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Background & Objectives: The aim of the study was to determine age, period, and cohort effects on trend of alcohol and drug use in the students of Tehran University of Medical Sciences from 2006 to 2009.

Methods: Between 2006 and 2009, the students of Tehran University of Medical Sciences were surveyed annually using a structured self-administered and anonymous questionnaire. Intrinsic estimator, which is a new method for resolving linear dependency between age, period, and cohort in linear regression models, was used for data analysis.

Results: In the present study, in the descriptive method, the prevalence of alcohol consumption increased in males and females with an increase in age. The prevalence of illicit drug use was higher in 2007 in comparison with other periods for males and females. In the analytical method (intrinsic estimator), there were no age, period and cohort effects for alcohol and drug use for females. For males, the age effect exhibited an increasing-decreasing-increasing trend and period and cohort effects showed a decreasing trend for alcohol use. As for drug use, the age effect exhibited gradual increases. The period effect displayed an increasing-decreasing trend and the cohort effect exhibited an increasing-decreasing-increasing trend.

Conclusion: The IE method showed no age, period and cohort effects for alcohol and drug use in females. The prevalence of drug and alcohol use increased with an increase in age in males. The high prevalence of drug use could be due to easy accessibility and low price of drugs.

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Background and Objectives: Diabetic patients are always at risk of hypertension. In this paper, the main goal was to design a native cost sensitive model for the diagnosis of hypertension among diabetics considering the prior probabilities.

Methods: In this paper, we tried to design a cost sensitive model for the diagnosis of hypertension in diabetic patients, considering the distribution of the disease in the general population. Among the data mining algorithms, Decision Tree, Artificial Neural Network, K-Nearest Neighbors, Support Vector Machine, and Logistic Regression were used. The data set belonged to Azarbayjan-e-Sharqi, Iran.

Results: For people with diabetes, a systolic blood pressure more than 130 mm Hg increased the risk of hypertension. In the non-cost-sensitive scenario, Youden's index was around 68%. On the other hand, in the cost-sensitive scenario, the highest Youden's index (47.11%) was for Neural Network. However, in the cost-sensitive scenario, the value of the imposed cost was important, and Decision Tree and Logistic Regression show better performances.

Conclusion: When diagnosing a disease, the cost of miss-classifications and also prior probabilities are the most important factors rather than only minimizing the error of classification on the data set.

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Background and Objectives:Among health sector resources, hospital beds are the primary unit of calculation for the capacity of the health service and vital capacity in patient care. Lack of appropriate distribution in different parts of the country leads to transfer of patients and irreparable problems. The aim of this study was to provide accurate information on the number and distribution of hospital beds in the country in 2016 and to estimate the number of beds required by 2026.
Methods:This descriptive-analytic study was conducted in 2016. The population of the study comprised 439 counties covered by 46 medical universities of the country. In this study, the data of 2016 were used and information about the number and ownership of beds and the size of hospitals were obtained from the treatment deputies of medical universities.
Results:The number of active beds in the country was 117580 in 2016, and it is estimated that in order to meet the needs of the community, this number should reach 194471 beds by 2026. There were 1.47 beds for 1,000 people in 2016, which will increase to 2.9 in 2026 by implementing the NEDA project. The coefficient of variation in 2016 was 36%, which will reach 19% by 2026 according to estimates in the Iran's roadmap project.
Conclusion:The distribution of beds was differed in different regions of the country and there are not enough hospital beds in some areas. If the Iran roadmap is implemented, 2026 beds will be distributed more evenly across the country.

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Background and Objectives: Iran is a large country that is often an importer of major medical equipment. There is no comprehensive databank of the status of the equipment in the country. The present study provides a clear description of the dispersal status of major medical equipment in the country in 2016 and the estimated number of required devices in 2026.
 
Methods: This study was conducted in 2016 in Iran. The study included 8 MRI, CT scan, gamma camera, linear accelerator, PET scan, cardiac angiography, peripheral angiography, and CT angiography devices. The data of the number of equipment in each city were collected through a census of devices.
 
Results: At the beginning of the year 2016, 3.5 MRI devices, 6.93 CT scans, 2.18 gamma cameras, 1.23 linear accelerators, 0.04 PET scans, 2.3 cardiac angiography devices, 0.27 peripheral angiography devices, and 0.25 CT angiography devices per million population were active in Iran. CT scan and MRI devices were the most available equipment. It is estimated that the same pattern should be maintained in 2026, but the distribution of devices as well as the total number of devices in the country should improve.
 
Conclusion: In 2016, for most of the devices, the proportion of the device to the population in the whole country was close to the global average, but there was a large accumulation of devices in large cities. This problem has been identified and interventions have been planned to move towards reducing inequalities In Iran's Health Roadmap.

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Background and Objectives: One of the decentralized models that has been formed based on universal health coverage is the model of health complexes in Tabriz. This study was conducted to evaluate the model.
 
Methods: This case study was conducted in 2017. Beside observation, 28 individuals, including informed experts in the field of establishment of health complexes in Tabriz University of Medical Sciences, were purposefully selected and semi-structured interviews were also conducted. To analyze the interviews and the results of observations, the framework analysis was used based on the components of the Primary Care Evaluation Tool (PCET) model.
 
Results: The strengths of the health complex model are decentralized planning, strengthening the private sector participation, have more appropriate methods for assessing the performance of the health team, creating a sense of delivering effective services in providers, using electronic information registration system, using the prospective payment method, strengthening the referral system, enhancing service continuity, and facilitating financial and geographical access, especially in marginalized areas. However, there are some problems such as lack of some facilities and equipment, lack of some workforces and high workload, financial instability, and lack of insurance organizations cooperation with the plan.
 
Conclusion: The health complex model has improved organizational, financial, and geographic access to health services. It seems that if the resources are more stable and by cooperation of basic insurances, the results of this project will be better.
 

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Background and Objectives: The imbalance between the existing human resources and future needs of the health system disturb the service delivery process. The present study aimed at determining human resources needs in the health sector for a 10-year planning program. For this purpose, the researchers examined the geographical distribution of different groups of health system staff in 2016 and 2026.
 
Methods: This descriptive-analytic study was carried out in 2016. The population of this study included 46 universities of medical sciences. Data of the number and distribution of health care staff working in public, private, charity, and semi-public sectors of medical departments of medical universities were collected. The Qlik View software was used for data integration and designing information dashboards.
 
Results: At the beginning of 2016, the ratio of nurses, nursing groups, midwives, pharmacists, dentistry and general physician per 100,000 individuals was 133, 199, 32, 17, 22, and 53 respectively, which are estimated to reach 223, 272, 37, 26, 27, and 79 in 2025, respectively. The coefficient of dispersion variation of the above was 39%, 32%, 43%, 33%, 43%, and 44% in 2016, respectively, which are estimated to reduce by 2026 if the Iran medical roadmap is implemented.
 
Conclusion: The high dispersion index of the medical personnel relative to the population in the cities covered by medical universities indicates unbalanced distribution. If the estimates of the Iran's 2026 medical roadmap are implemented, more appropriate distribution of the medical staff is expected.

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Background and Objectives: The aim of this study was to provide a clear description of the pre-hospital emergency setting and risk management in accidents and disasters in accordance with current Iran’s standards in different regions of the country. This study was part of the national project "Iran Roadmap (Neda 2026)".
 
Methods: The data of the major medical equipment was gathered from 48 medical universities covering all of the country's 32 provinces. Goal standards were obtained from the “Ministry of Health” and the “Department of Statistics for Medical Accident and Emergency Management Centers” in all universities. Coefficient of dispersion was calculated to evaluate any dispersion in major medical equipment.
 
Results: The results of this study showed that in 2017, the highest and lowest coefficient in “pre-hospital facilities” was related to the ambulance engine (301%) and the operational base personnel (93%), respectively. Nio national standards were implemented in “Risk Management in accidents and disasters needs” in most provinces of Iran. In 2026 estimates, all of the factors improved and dispersion decreased.
 
Conclusion: Despite the poor distribution of prehospital indicators in 2017, forecasting showed desirable conditions in distribution of facilities in the pre-hospital emergency and risk management of accidents and disasters.