Iranian Journal of

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

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Background & Objective: Physical activity is important for the health of all individuals, however, the determinants of physical activity behavior for elderly remain unexplored in Iran. The purpose of this investigation was to explore a range of factors that influence participation in physical activity for a group pf elderly people in Tehran in 2008.
Methods: This was a population-based study. Structured interviews with a valid questionnaire were employed for this survey. It was carried out on four hundred members of Healthy Association in Tehran. Multistage sampling was used.
Results: The mean age of participants was 64.07 ± 4.49. The prevalence of a sedentary lifestyle among elderly fifty-three (53%) estimated. The prevalence across the stages was as follows: 30.25% in pre contemplation, 12.75%in contemplation, 27.25% in preparation, 6.25% in action and 23.5% in maintenance. Inactive participants perceived that their laziness prevented them from being physically active. Meeting friends was the most important facilitator for participating in physical activity. The individuals who married, younger, lower body Mass index, having no chronic disease, and those with past history of exercise were more likely to adopt, initiate and maintain regular physical activity. Regression analysis showed that the greater knowledge of physical activity, higher Perceived health benefits, more Self efficacy were associated with physical activity.
Conclusion: Knowing the facilitators and barriers factors of physical activity in elderly would help to implement any future intervention for this group of people.

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Background & Objectives: Proceed model is widely used in health promoting program. The aim of this study was to investigate the effect of PRECEDE Model –based educational program on nutritional behaviors in a rural society.
Methods: This study was a quasi-experimental (before – after) study and conducted on one hundred eighteen women in eight rural areas in Fridan. Based on precede model, CHD mortality rate, incorrect nutritional habits and nutritional behaviors were identified as the most important indicators. During educational intervention, predisposing factors, enabling factors and reinforcement factors were noticed.The training content was designed based on precede model contains 3 educational sessions weekly for 2 months.
Results: Following the educational intervention, the mean score of knowledge, attitude were significantly increased and predisposing, Enabling and Reinforcing factors as well as behavior were improved. Approximately nine percent of participants perceived they are at risk of heart diseases and 12.96% believed that their regimes are not healthy (bad). Near 48% indicated that heart diseases are preventable diseases.
Conclusion: The finding of current study confirmed the practicability and effectiveness of the PRECEDE Model –based educational program on Behavioral.

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Background & Objectives: Osteoporosis is major public health concern affecting millions of adults particularly older adults and women worldwide. Designing effective educational intervention is principle in any health promotion program. The purpose of this study was to evaluate the efficacy of an educational intervention based on health belief model on knowledge about, attitudes toward and practice of prevention osteoporosis among women with low socioeconomic status in Isfahan.
Methods: The study population consisted of 14 women with low socioeconomic status and under 60 years old. A valid and reliable questionnaire developed and used as measurement tool for initial and final assessments in this program. In addition calcium intake and vitamin D, physical activity and exposure to the sun were assessed.
Results: The mean age of the participants were 40.8 ± 10.52 years. The mean score of all parts of health belief model (except for perceived barriers), knowledge, sun exposure, and physical activity after educational intervention compared to before intervention, were increased significantly. There was no statistically significant difference between daily calcium and vitamin D intake before and after intervention.
Conclusion: It is concluded that the HBM Model– based educational program on Knowledge and belief regarding Osteoporosis prevention seems practical and effective. However more research should be done to find out more effective intervention regarding optimal calcium and vitamin D intake.

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

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Background & Objectives: The aim of this study was to identify the quality of life (QOL) measures commonly used to assess disabled people compared to healthy individuals.
Methods: A cross-sectional study was conducted in 1000 disabled and healthy individuals aged between 15 to 75 years old during 2009 year. These groups were selected by random sampling method multistage cluster sampling from Crescent Comprehensive Rehabilitation Center located in Tehran. WHO's Quality of Life (WHOQOL-100) questionnaire was used to measure quality of life.
Results: The Mean age were 35.9±12.9 and 35.1±12.7 years amongst disabled and non disabled groups, respectively. There was a significant difference between two groups in terms of somatic health and independence of quality of life (P<0.001), in which the mean score in both domains were high in healthy individuals. No significant difference was observed between two groups in other scopes.
Conclusion: Findings of this study highlighted the lower quality of life in disabled people in Tehran, Therefore this group should be targeted for any relevant intervention in order to improve their care.

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Background & Objectives: The rate of suicide varies amongst different parts of Iran. Since there is little knowledge about the risk factors for suicide attempts we carried out this study to determine the status of psychiatric disorders and risk factors of repeated attempted suicide in suicide attempters whom admitted to poisoning emergency in Isfahan, Iran.

Methods: Patients with having attempt to suicide, admitted to emergency ward in Khorshid Hospital in Isfahan and were interviewed by a trained psychiatrist during 2009 year. Interview was based on DSM-IV.

Results: Participants consisted of 703 individuals (424 of them were female) with mean age of 25.9±9.7. One hundred twenty five (125) had positive family history of suicide attempt, 501 people were first time suicide attempters, 106 second, 58 third, and the others were forth time or more suicide attempters. Bipolar spectrum disorders, unipolar depression and adjustment disorders were the more frequents psychiatric disorders respectively. Age, family history of suicide, kind of diagnosed psychiatric disorder and method of attempted suicide were meaningfully related to mean of attempt suicide frequency.

Conclusion: Bipolar spectrum disorders, especially recurrent depressive episodes is the major risk of repeated suicide attempt and co-morbidity of another psychiatric disorders increase highly the risk of suicide reattempt.

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Background and Objectives: Inequity in health is a universal term which used for showing current differences, variations and inequalities of people in access to health. But inequality in health refers to some inequities which seems are unfair or caused by some errors and biases. The current study aimed to describe some of the common health related inequity measures to be useful for the inequity researchers and other interested health coworkers.
Methods: The calculation, advantage and disadvantage of most common health-inequity indexes including slope index of inequity, relative index of inequality, Theil’s Index, mean log deviation, index of disparity, Gini coefficient, weighted utilization social welfare function, absolute and relative concentration index were assessed. Inequity size of these measures was calculated by using the health care utilization survey data.
Results: Average of health care utilization in in-need subjects was 66.4%. This indicator was in the first to fifth quintiles equal to 57.6%, 63.4%, 71.6%, 69.5% and 75.3%, respectively. Relative concentration index and Gini coefficient was calculated as 0.053 and 0.0062, respectively.
Conclusion: Inequity in health care utilization in Markazi province differs based on the types of inequity measures. Selection of the inequity indexes dependent to the objective and the scale of under study variable. Among discussed indexes, concentration index determine the more accurate and also show the gradient of inequity. Therefore it can be used as the best index.

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Background & Objectives: Relationship between jobs and different aspects of health, including quality of life has been considered by researchers however the employment aim has risen in Iranian women in Iran but there is little known about the quality of life in this group, therefore the aim of this study was to investigate the relationship between employment and quality of life of women in the city of Zabol. Methods: This cross-sectional study was carried out during 2009-2010 in Zabol, Iran. The sample consisted of 420 women selected randomly from health care centers. Health-related quality of life was assessed using the SF-36 and classified using k-means clustering method. The relationship between the independent variables with the quality of life was assessed by multinomial logistic regression. Results: The mean age of participants was 30.46 ± 8.75 years. Quality of life indicated as low (35.4%), medium (33.7%) and high classes (30.9%), respectively. The results indicated that employed women were more likely than housewives to hadhigher quality of life. An increase age, significantly reduced respectively five and four percent of chance to had moderate and high level of quality of life. Conclusion: More than half of women had medium and low quality of life. Increasing age was associated with decreased quality of life, but employment was an independent predictor for higher quality of life.

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Background & Objectives: There have been several reports showing that the rate of anabolic-androgenic steroids abuse has increased in athlete and non-athlete adolescents. Therefore, the objective of this study was to assess, attitude and awareness of side-effects of these drugs in male bodybuilders.
Methods: 227 bodybuilders completed a tridimensional questionnaire that investigated demographic information, prevalence of anabolic-androgenic steroids (AAS) and attitude towards steroids abuse.
Results: Forty percent of participants (40.1%) of bodybuilders had used anabolic-androgenic steroids at least one time. The main reasons for taking this medication were strength, muscle mass, speed and endurance, respectively and 7.73% did not know the reason of using it. 32.6% of bodybuilders believed that anabolic steroids increased muscle size without exercise and without proper exercise and nutrition. The mean score of awareness and attitude of athletes who used these drugs were significantly higher than the athletes who did notuse (P=0.001). Athletes with Championship history were more aware regard to adverse effects of steroids than athletes with no history of championship.
 Conclusion: The findings of this indicating that that abusing AAS seems to be increased and become a public health concern that implies the need to implement educational programs by health care professionals and sport specialists.

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  Background & Objectives: This study examined the prevalence of behavioral disorders in middle and high school students in the Province of Qom.

  Methods: A cross-sectional descriptive design was employed to investigate 762 students (382 middle and 380 high school students) who were selected through a multi-stage cluster sampling method. Data collection was performed suing the Woodworth Personal Data Sheet (WPDS), and the data were analyzed using descriptive statistics and chi-square test.

  Results: The finding showed that the prevalence of behavioral problems in the total sample, and middle and high school students was 19.82, 22.72, and 17.1%, respectively. The prevalence of behavioral problems was higher in boys versus girls, is the middle school versus the high school, and in urban areas versus rural areas. The aggressive disorder and obsessive-compulsive disorder – Psychasthenia had the highest and lowest prevalence in both the middle and high school students, respectively. The educational level of students, parental education, parental divorce, parental death, and family income had significant relationships with behavioral disorders.

  Conclusion: The prevalence of behavioral problems in the Province of Qom was found to be in the middle range in comparison with other studies conducted within and outside the country. However, attention should be paid to mental health policy-making in adolescents to decrease behavioral problems and prevent future issues.

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Background & Objectives: In recent years, different decision support systems (DSS) have been used to predict and diagnose diseases. The purpose of this paper was to compare some DSSs and to evaluate their accuracy in predicting diabetes. 

Methods: In this research, determination and optimization of the weights of the neural network were undertaken using genetic algorithm and Levenberg-Marquardt (GALM). Traditional and K-Fold Cross Validation were used to verify the models. Finally, the proposed model (i.e. GALM) was compared using logistic regression and genetic algorithm based on area under curve (AUC), and Confusion Matrix.

Results: After evaluating the results, the model based on the GALM algorithm showed better sensitivity and specificity in comparison with models based on the logistic regression (LR) and genetic algorithm (GA). Furthermore, among other models, the proposed model had a high sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and a small negative likelihood.

Conclusion: The results showed that the GALM model with a sensitivity, specificity, PPV, NPV, and AUC of 98.7, 90.01, 91.8, 98.3 and 0.979 respectively was an appropriate model for predicting diabetes in comparison with models of GA and LR.

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Background & Objectives: Community assessment is a key tool for improving and promoting the health of the community. The role of community assessment is to identify the most important factors affecting the population health. To get a comprehensive picture of problems, priorities and suggested community health action plans in Iran, this review aims to summarize community assessments in various areas of Iran conducted between 1992 – 2013.

Methods: This study was a retrospective review in which community assessments were compared and the results of several studies conducted in different regions of the country covering both rural and urban health centers were analyzed. Since 1999, department of Epidemiology and Biostatistics has conducted these community assessments in eight phases and follows 2002 North Carolina Community Health Assessment model. Assessment teams typically included MPH students and/ or PhD and masters (epidemiology) students from the School of Public Health. Data was collected through observation, interview, and focus group discussion. Assessment teams in each region prioritized the list of problems using Hanlon method and Nominal Group Technique.  

Results: The results identified substance abuse, economical, and water-related problems as the most important problems in different parts of the country which indicates the need for developing a comprehensive action plan andimplementing measures.

Conclusion: A review of the community assessments performed in this study shows the ability of community assessment to detect community health problems in all aspects. Therefore, this approach is recommended to evaluate and prioritize health problems and to formulate action plans.

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Background and Objectives: The main question that arises in ‘Quality of Life’ (QOL) studies is how people assess this phenomenon and what factors affect it. Using these answers, we can better analyze the findings of QOL studies in our country.

Methods: In this content analysis, we carried out semi-structured interviews, and applied maximum variation opportunistic sampling in terms of gender, age, education, ethnicity, and economic status. First, we asked the participants to answer the question on QOL by thinking aloud. Then, they were asked to discuss the factors that affected their choice a posteriori. Finally, the inductive qualitative analysis was done and the mental model of the participants was extracted.

Results: We extracted five main categories and 33 themes. These categories included physical factors, psychological factors, socioeconomic factors, family issues, and environmental factors. Physical health, expectations, satisfaction, community engagement, financial problems, environmental pollution, leisure and recreation, family environment, family relationships and the role of the wife were the most important factors affecting the QOL in the participants’ opinions.

Conclusion: In addition to the health status, family issues such as the family environment and financial problems affected the QOL. Moreover, the participants believed environmental health was an integral part of QOL.

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Background and Objectives: Cholera is one of the public health ththat has received attention due to climate change and weather variables. In the current study, the trend of cholera and its epidemics was assessed in the last 50 years in Iran based on climatic variables.
Methods: In a retrospective cohort study, all cholera cases and epidemics of the disease in the country (Iran) were assessed using the registry system of the Center for Communicable Disease Control in the Ministry of Health and Medical education (MOH&ME) from 1964 to 2014. Furthermore, the incidence of cholera was evaluated in 2005-2014 by province. The temperature and rainfall data were obtained from the provincial Meteorological Organization. The correlation coefficient test and mixed-effects binomial regression model were used for data analysis.
Results: A significant positive correlation was found between cholera and rainfall (r = 0.168, P = 0.008). A one-millimeter increase in rainfall increased the incidence of cholera by 10.9% but temperature changes had no effect on cholera outbreaks. The incidence of cholera declined significantly by 14.7% each year from 2005 to 2014. The highest incidence of cholera was reported in Sistan-Baluchestan, Qom, Tehran, Kerman and Hormozgan provinces in a descending order.
Conclusion: In recent years, the the overall incidence of cholera has decreased. The occurrence of cholera is an outcome of rainfall in the previous year. Therefore, increased rainfall increases the number of cholera cases in the next year. However, temperature changes are not related to cholera outbreaks.

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Background and Objectives: To provide an overview of the national program of Crimean-Congo hemorrhagic fever surveillance in Iran, its current achievements, and challenges.
 
Methods: In this mixed method study, the relevant reports, documents, and guidelines, as well as published literature and surveillance data were gathered and critically reviewed. The opinions of the key informants at local and governmental levels were assessed through structured interviews.
 
Results: The program was integrated into Iran’s primary healthcare (PHC) network in 1999. The involved organizations include CDC, medical universities, Pasteur Institute of Iran (PII), and Veterinary Organization. Case finding is based on standard definitions of suspected, probable, and confirmed cases. Laboratory confirmation is necessary for diagnosis and is provided within 48 hours after receipt of the specimen by the National Reference Laboratory of PII. CCHF treatment is primarily supportive. Antiviral therapy with ribavirin is also considered. Both therapeutic services are free. Education mainly focuses on high-risk groups and healthcare workers. Major achievements of the program include rapid diagnosis and treatment of cases, prevention of nosocomial transmission, identification of high-risk provinces and major transmission routes, improved outbreak preparedness, development of laboratory tests for detection of other arboviruses, and reduction of CCHF case fatality rate.
 
Conclusion: Program implementation has had a positive impact on early detection and proper control of annual outbreaks. However, some aspects of the program still need improvement, including promotion of the general and high-risk populations’ awareness and regional collaborations (especially among neighboring countries) for infection control in humans, livestock, and vectors.

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Background and Objectives: In June 2018 , 537 residents of a rural area in Khuzestan Province presented to the regional Comprehensive Health Service Center for gastroenteritis symptoms. This study was designed to determine the extent and cause of the outbreak.
 
Methods: A case-control study was performed after random selection of the case and control groups (80 cases and 88 controls). Clinical and water samples were analyzed for parasitic, bacterial and viral pathogens in local, provincial and national laboratories. Odds ratios with corresponding 95% confidence intervals were used to assess the relationship between disease and exposure.
 
Results: The odds ratio of rural plumbing water consumption as a risk factor was 3.3 (95% CI: 1.7-6.2). Using in vitro methods, Shigella sonnei was isolated in clinical samples and enterohemorrhagic Escherichia coli and enteropathogenic Escherichia coli were isolated from both clinical samples and water samples taken from the intake basin of water supply facilities.
 
Conclusion: Consumption of rural plumbing water Since 26 June 2018 as well as the water stored in domestic tanks at certain water-shut-off times is associated with gastroenteritis outbreak. To prevent similar outbreaks, continuous chlorination of drinking water during distribution through rural pipelines should be done. To prevent secondary outbreaks after the epidemic phase, educating and informing people about personal hygiene is essential.

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Background and Objectives: It is necessary to apply appropriate coping methods to reduce destructive physical and psychological effects of stress during Covid-19 pandemics. This study was conducted to explore nurses' experiences of stress coping techniques during the Covid-19 pandemic.
 
Methods: The present study used a qualitative methodology with interpretive phenomenology method. Purposive sampling was used. The participants, including nurses working in hospitals affiliated to Tehran University of Medical Sciences, shared their experiences through in-depth, individual and semi-structured interviews. The transcripts of interviews were analyzed based on the Dickelmann's approach using the MAXQDA 12 software.
 
Results: The participants included nine nurses (six females and three males) with a mean age of 45 ± 5.3 years. The results of data analysis showed four main categories and fifteen subcategories conceptually named based on their nature. The main categories were self-support, family shelter, hospital support umbrella, and community support on both extremes.
 
Conclusion: The participants practiced different coping strategies to deal with stress and anxiety. In addition to individual mechanisms, nurses sought help from other sources of support, such as family, workplace, and community. Based on the experiences of nurses participating in the study, it is recommended to teach nursing staffs coping methods with stress, especially in times of crisis such as the Covid-19 pandemic.

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Background and Objectives: Epidemiological studies have indicated the prevalence of a wide spectrum of diffused pigment lesions throughout the world and Iran. The aim of this study was to determine the frequency distribution of oral diffused pigment lesions in patients presenting to Oral Diseases Department of Isfahan Dental School.

Methods: A cross-sectional descriptive study was conducted on 303 patients presenting to Oral Diseases Department of Isfahan Dental School during the first three-month period of 2019. The demographic data, location of lesions, and type of lesions were recorded in a checklist and analyzed with the SPSS version 22 using Chi square, Mann Whitney test, Fisher's exact test, and spearman correlation coefficient. The level of significance was set at 5%.

Results: In this study, 303 patients were examined of whom 93 (30.69%) were diagnosed with diffused pigment lesions. As for the pigmentation severity, the patients were grouped into low, moderate, and high with 54 persons (58%), 13 persons (14%) and 26 persons (28%) in each group, respectively. The most frequent site was labial gingiva and the most common type was the physiologic type. The results showed that gender had no effect on the frequency distribution (P=0.09) but gender and age had significant effects on the severity of pigmentation (P=0.047, r=0.459 and P<0.001 respectively). Skin color had a significant effect on the type of pigmentation
(P < 0.001).

Discussion: The frequency of oral diffuse pigmentation in patients presenting to the Isfahan dental school was noticeable.