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 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 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: Breast cancer is a common malignancy in women in many parts of the world. The incidence of breast cancer in Iranian women is growing. Iranian patients are relatively younger than their western counterparts. We conducted a case-control study to determine roles of reproductive factors for breast cancer among women in Iran.
Methods: A hospital based case-control study was conducted in 2004 at a teaching hospital in Tehran, Iran. A total of 303 cases of breast cancer and 303 healthy controls were interviewed. Cases were identified through the oncology department of a university hospital and controls were recruited from other wards or out-patients clinics at the same hospital. Controls were matched to cases on age. Demographic and reproductive data were ascertained by personal interview using a structured questionnaire. Informed consent was obtained from cases and controls. Odds ratios and 95% confidence intervals for breast cancer were derived using logistic regression analysis.
Results: Mean ±SD age of cases and controls was 48.8 ±9.8 and 50.2 ± 11.1 years, respectively (range 24-84). The final model constructed after multivariate analysis indicated that factors such as never being married, menopause, older age at first live birth, parity, use of oral contraceptives, and history of chest X-ray between adolescence and the age of 30 yrs were significantly associated with breast cancer. Variables such as higher education, early age at menarche, abortion, breast feeding and its duration did not constitute significant risk factors.
Conclusions: Marital status, history of chest X-ray between adolescence and the age of 30, number of live births, and age at first live birth, menopause, and oral contraceptive use seem to increase the risk of developing breast cancer among women in Iran.

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Background and Objectives: Kala azar is a parasitic disease which belongs to the category of metazoonoses (a communicable disease which requires at least to an invertebrate host), In Iran canines are major reservoir for it and most of patients are 6 months to 2 years old. The aim of this study was evaluation of the clinical and epidemiologic aspects of visceral leishmaniasis in patients visiting the Children Medical Center over the 12 past years.
Methods: This study used the hospital records of a case series of 106 kala azar patients hospitalized in the Children's Medical Center between 1991 and 2001. We extracted and analyzed data on geographical location, background factors, clinical and laboratory findings, response to treatment and Glucantimeâ side effects.
Results: The greatest number of cases was seen in 1992 and the smallest number in 1993 and 2003 the number of cases peaked in the spring. Most patients referred to the Center are aged 1 to 4 years, and there is a strong preponderance of males (82.1% vs 17.9%). The majority of these children came from families in which the breadwinner was a peasants or a laborer. Common laboratory findings included anemia, rising ESR titers and thrombocytopenia. The most striking clinical signs and symptoms were fever, splenomegaly and hepatomegaly. Eighty-three percent of the patients had shown clinical improvement, 1.9% had died and 15.1% had relapsed. Moreover, in 52.8% of cases, the disease was treated successfully with within 2 weeks the incidence of Glucantimâ side effects was low. The cities of Khorramabad, Karaj and Saveh had produced the greatest numbers of cases.
Conclusions: Compared to other studies, our case series showed a higher proportion of male patients and a somewhat different clinical and laboratory profile. However, the most important achievement of this study was identification of major endemic foci in Ardabil province, northwestern parts of Ghom province, Khorramabad, and regions located south of the Alborz Mountains (e.g. Saveh

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Background & Objectives: Ecstasy is a methamphetamine derivative becoming increasingly popular throughout the world, particularly among adolescents and young adults. Iran, situated between eastern and western societies, can serve as a significant source of information on ecstasy use and on the users' profile. The purpose of this study was to determine the prevalence of ecstasy use and high-risk behavior among high school students in Lahidjan.
Methods: We conducted a cross-sectional study of a representative sample drawn from high school students of Lahidjan in 2005, using multi-stage stratified random sampling. The study questionnaire was administered to 2345 students in grades 8 through 12. The questionnaire was adapted from that used in "Monitoring the future" projects in the United States and ESPAD (The European School Survey Project on Alcohol and other Drugs). It included questions on demographic characteristics, family profile, social contacts, school life and the use of drugs. Data analysis was done with the SPSS software (version11.5), using χ2 tests and logistic regression methods.
Results: Of the 2345 students selected for the study, 2328 (92%) responded. Of these, 1327 (57.8%) were males and 970 (42.2%) were females. Lifetime prevalence of ecstasy use was 2.4% (55 students) 31 subjects had used ecstasy within the past month and 24 students reported using the substance in the preceding year. Ninety-two subjects (4.2%) had experience with other drugs. In χ2 tests, ecstasy use was significantly associated with gender, use of other substances, cigarette smoking, partying with friends, family structure and poor school performance in the past. There was no association with age, type of school (private or public) or the family's education level. In logistic regression, factors influencing ecstasy use were the use of other drugs, cigarette smoking and partying with friends (p< 0.0001).
Conclusions: Ecstasy use appears to be a serious problem in high schools. Whatever the causes behind the rise in ecstasy use, personalized and informative educational interventions should be organized in all schools.

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

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Background & Objectives: Pediculosis is a ubiquitous and contagious parasitic dermatosis. Throughout the world, infestation by the head louse (Pediculus humanus capitis) is more common among schoolchildren, especially in those aged 6-11 years. This descriptive/analytical study was carried out in 2003 to determine the prevalence of pediculosis capitis and risk factors involved in the epidemiology of pediculosis in primary school pupils in Amlash, Gilan province.
Methods: The children were selected by cluster random sampling of schools and classes, and then examined for head lice using hair conditioners and a fine-toothed head lice comb. We screened a total of 4244 pupils from 95 primary schools. We used a comprehensive questionnaire to evaluate the effects of school type and location, education level, parent job, regular baths, number of persons sharing the same bed, combing frequency, host sensitivity, family size, hairstyle, gender, and hair length.
Results: Statistical analysis using χ2 tests showed that school type, school location, parent job, regular baths, number of person who share the same bed, frequency of combing, gender, host sensitivity, family size, and hairstyle are significantly associated with infestation. Infestation rate showed no correlations with hair color, season, age, or education level. Results showed that pediculosis is more prevalent in rural than in urban areas. The average rate of infestation for the area was 9.2%, indicating an epidemic situation by standard criteria.
Conclusions: The high prevalence of P. capitis infestation among these children was probably due to poor environmental hygiene and scarcity of water. Hygienic controls of schoolchildren by nurses are important for elimination of Pediculus humanus capitis. This is the first community-based study describing in detail the epidemiology of head louse infestation in the Amlash district of Gilan province in Iran and confirms that Pediculosis capitis is still a problem in many environments, particularly those with low life standards and poor health care.

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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 & Objectives: The summer of 2005 witnessed an outbreak of cholera in Iran due to V. cholera, Inaba serotype. During the outbreak, there were 16 registered cases in Markazi Province. The aim of this study was to determine the risk factors for cholera outbreak in this part of the country.
Methods: This was a case-control study in which cases were matched to controls on age and sex. All of the reported cases were compared with controls from the same neighborhood, with 2 controls selected for each case. We used paired odds ratios and conditional logistic regression to show the effect of each putative risk factor, and p values of < 0.05 were considered as statistically significant. Results: Multivariate results from 16 cases and 32 controls showed significant associations between the cholera outbreak and the following set of factors: eating raw vegetable (OR=9, 95%CI: 2.25-35.98), proper warming of refrigerated food (OR=0.12, 95%CI: 0.015-1.022), inadequate washing of fruits and vegetables (OR=4.29, 95% CI: 0.88-21.06) , and eating non-pasteurized ice creams (OR=4.96, 95%CI: 0.99-24.83).
Conclusions: Although the number of reported cases was small in Markazi Province, the results show that education in personal hygiene is important in the prevention of a cholera outbreak.

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Background & Objectives: Recent evidence suggests that long-term exposure to air pollution contributes to progression of atherosclerosis and the risk of cardiac morbidity and mortality short-term exposure may also lead to thrombosis and acute ischemic events. To evaluate the relation between the levels of major air pollutants (CO and PM10) and hospital admission for acute coronary syndrome (ACS) in Tehran, we performed a case-crossover design and checked whether individual characteristics act as effect modifiers.
Methods: We selected 250 Tehran residents who had been hospitalized with an acute coronary syndrome from 4th of April to 10th of June, 2007. The following individual data were gathered: sex, age, date of hospitalization, and coexisting illnesses (hypertension, diabetes). Daily air pollution data were taken from the Air Quality Control Center. Temperature, humidity, stress, physical activity and weekend days were treated as confounding variables, and a conditional logistic regression model was used for statistical analysis.
Results: We found a positive association between ACS and average 24-hour CO levels. The OR for each unit increase of the average 24-hour CO was 1.18 (95%CI: 1.03-1.34). The relation between ACS and 24-hour average PM10 did not reach statistical significance (OR for average 24-hour PM10 was 1.005, 95%CI: 0.99-1.01). The association between ACS and 24-hour average CO tended to be stronger in women (OR=1.68 for each unit increase, 95%CI: 1.25-2.26). The relation between 24-hour average PM10 and ACS did not change across the layers of the effect modifiers.
Conclusions: The results suggest that an increase in average 24-hour CO levels will augment the risk of ACS, and the effect is stronger in females. On the other hand, we were unable to document an association between ACS and average 24-hour PM10 levels.

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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: 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 & Objectives: Arsenicosis is a serious environmental disease caused by chronic exposure to arsenic- usually from drinking water. Signs and symptoms of chronic arsenic poisoning include hyperkeratosis, hyper- or hypopigmentation, and ulcers. Also, the incidence of cancer is increased in the exposed population. There is some evidence of high arsenic levels in drinking water in the village of Ghopuz, located in Hashtrud District, East Azerbaijan province. We evaluated the genetic and health effects of chronic arsenic exposure in the residents of Ghopuz.
Methods: In this cross-sectional study we determined the prevalence of hyperkeratosis, hyperpigmentation and hypertension in Ghopuz village. The study involved 101 individuals in Ghopuz and 107 in the adjacent village of Mayan, who were all visited by a trained physician. A total of 46 blood samples were collected for kariotyping. The level of heavy metals in water was determined by the Inductively Coupled Plasma (ICP) method.
Results: We detected high arsenic levels in the drinking water at Ghopuz (mean concentration in water = 1.03 mg/L). There were chromosomal defects in the exposed group. Mean systolic blood pressure at Ghopuz (137mmHg, 95% CI: 132-142) was significantly higher than in Mayan (107, 95% CI: 99.9-114). Also, mean diastolic blood pressure at Ghopuz (82, 95% CI: 79-85) was significantly higher than in Mayan (71, 95% CI: 66-75). Hyperkeratosis was 34 times more frequent in the exposed population (OR = 34, P< 0.001). Also, hyperpigmentation was significantly more frequent in the exposed population (OR = 2.4, P < 0.007).
Conclusions: Water arsenic and nitrate levels at Ghopuz were higher than the maximum permissible levels. The prevalence of skin lesions and hypertension is increased at Ghopuz village due to arsenic exposure. There is also some evidence of chromosomal defects in the exposed group. Affected people need appropriate medical care, and safe drinking water should be provided to reduce arsenic exposure.

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Background & Objectives: Malocclusion is not a disease but rather a set of dental deviations, which in some cases can influence quality of life. The aim of this study was to assess the frequency of various dento–facial anomalies.
Methods: In this cross-sectional study in 2006 we assessed a sample of 600 randomly selected schoolchildren, with a mean age of 11.97 years, who were attending secondary school in various districts of Karaj. We used questionnaires to obtain information on extracted teeth, crowding, spacing, diastem, the severest disorders in anteriors (maxilla and mandible), overjet, negative overjet, open space between two jaws and antero-posterior molar relationship.
Results: Ninety-nine percent of children had no extracted teeth in maxillary anteriors, while 98.3% had no extracted teeth in mandibular anteriors. In 41.2% of the subjects there was no crowding, and 57.7% of the sample had no spacing. The mean diastem was 0.36 mm and the mean of the most severe disorders in anteriors was 1.08 mm in the maxilla and 0.78 mm in the mandible. Mean overjet was 1.98 mm, mean negative overjet 0.03 mm, and mean open space between two jaws was 0.28 mm. In 58.5% of the subjects the antero–posterior molar relationship was normal. The DIA ranged form 13 to 63, with a mean of 24.12.
Conclusions: This study indicates that over than one-third of the population needs different degrees of orthodontic treatment.