Iranian Journal of

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Background & Objectives: Cancer has been traditionally regarded as a fatal disease it is a major public health problem in many countries throughout the world. In recent years, cancer morbidity and mortality has increased in our country and notably stomach cancer now ranks second or third among all cancers types with regard to morbidity.
Methods: Our study included all gastric cancer patients registered in the cancer registry of Fars province. The patients' survival status was followed using phone calls and death records from hospitals, other medical centers, and the city's cemetery. Data analysis involved the use of the nonparametric Kaplan-Meier and Cox proportional hazards models and was performed with the software package SPSS V.13.
Results: Of the 442 patients with gastric cancer, 303 cases (68.6 percents) were male, and the mean age of patients was 58.41 years (SD=14.46). In univariate analysis with the KM method, a statistically significant association was found between survival rates and the following factors: age at diagnosis (P<0.001), tumor grade (P=0.009), presence of metastases (P<0.001), and type of the initial treatment (P=<0.001). Factors without a significant relationship with the survival rate included sex, ethnicity, weight, BMI, tobacco use, history of cancer in close or distant relatives, place of residence, number of children, marital status, occupation, and income. In Cox regression, only age at diagnosis, tumor grade, and the presence of metastases showed a significant association with survival rates.
Conclusions: Our results imply that early detection of cancer at a lower age and in lower tumor grades could be important for increasing the patients' life expectancy.

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Background & Objectives: Today, the quality of life study has an important role in health care especially in chronic diseases, in clinical judgment and in medical resources supplying. Malignancies have a clinical and health importance in the world and Iran. Breast cancer has first order among women’s malignancies. Now, survival rate for this cancer is long. However Breast cancer has several complications that affected patient’s life. It is necessary that we studying the quality of life and related factors among this patients.
Methods: We conducted a cross-sectional study on 119 breast cancer patients that admitted and treated in chemotherapy ward of Namazi hospital in Shiraz.We used QLQ-C30 & QLQ-BR23 to assessment quality of life in these patients. We used univariate nonparametric tests and multiple linear regression model to identify associations between dependent variables and the quality of life and it’s different scales.All calculation performed by using SPSS.V.13.
Results: Mean age of patients was 48.27±11.42 with quality of life total score 64.92±24.28. Univariate analysis showed that occupation,duration of disease,grade of tumor,physical,emotional and cognitive functioning, also, symptoms such as fatigue,pain, nausea and vomiting , insomnia , constipation and financial difficulties, perspective were associated to quality of life. (P< 0.05). But in multivariate analysis, only occupation, menopause status, dyspnea , grade of tumor and financial difficulties perspective were related to quality of life (p<0.05).
Conclusions: With this finding, It is recommended that financial supports, also early detection are necessary for improvement of quality of life in these patients

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Background and objectives: Iranian family physician care program as a new program has begun since 2005 to deliver a better service particularly in primary health care. The objective this survey was to evaluate the impact of this program on family planning in Sari city between 2003-2007.
Methods: This survey was conducted among all women 15-49 years who married. Required data were collected from health files. The pattern of time trend evaluated and relevant indices compared before and after the family physician program.
Results: The application of condom, hormone injection, vasectomy and total modern contraceptives increased but employing the methods of tubectomy, IUD, OCP, Norplant and traditional method were descending. This variability for condom, tubectomy and traditional methods were statistically significant (p<0.05). However for other methods were not statistically significant (p>0.05). Difference of contraceptive using rates in pre and post of the application of program for condom, hormone injection, tubectomy and OCP were statistically significant (p<0.05) and for others were not statistically significant (p>0.05).
Conclusions: It seems relatively success of family physician program on family planning in Mazandaran province however more human resource should be allocated to family planning.

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Background and Objectives: Publication of scientific articles nowadays is one of the important indexes of knowledge production. This index plays a key role for ranking in academia. The aim of this study was to assess the how academic staff in Shiraz Medical Sciences University considered the principle of scientific writing.
Methods: In a cross-sectional study 200 published papers among 1104 paper registered to vice chancellor of research from 2002 to 2007 were selected with systematic random sampling method.
Results: Among 200 papers, 190 (95%) had corresponding author from faculty members. Twenty three percents (23%) of papers were in basic sciences field and 72% were in clinical field. In 19 (9.5%) of papers either an epidemiologists-biostatistician or social medicine specialists were coauthor. Forty five (22.5%) of published papers, consisted of descriptive studies and the rest were analytic studies. Maximum faults in descriptive studies were the missing of time interval stating (26%). In case-control studies, 59% of papers had not stated diagnosis criteria and disease definitions. In cohort studies and clinical trials, 90% and 85% of papers had not expressed the number of missed patients during study, respectively.
Conclusions: With regards to findings of this study, scientific writing and research methodology short course as continuing development professional for academic staff should be emphasized in academic institutes in Iran. Keywords: Scientific writing, Journals, Shiraz,Iran

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Background & Objective: Because of uncertainty in interpretation of some tests for diagnosing TB, decision making for the tuberculosis treatment is based on multiple diagnostic tests. This study was conducted to assess the accuracy of Quanti FERON-TB Gold test in tuberculosis diagnosis.
Methods: The study was carried out on 30 cases and 46 controls. Statistical indices of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios, odds ratio and Receiver Operating Characteristics (ROC) curve were estimated.
Results: Sensitivity of QFT-G was 90.0% (95% CI=73.0-97.6), specificity 95.7% (95% CI=83.8-99.3), positive predictive value 93.1% (95% CI=76.3-98.9), negative predictive value 93.6% (95% CI=81.3-98.4). The area under ROC curve was 0.942 (95% CI=0.88-1.00), that significantly differed from chance diagonal area (P<0.0001). The optimum cut point for the Quanti FERON-TB Gold test was 0.35 IU/ml, with sensitivity of 0.90 and specificity of 0.957.
Conclusions: The Quanti FERON-TB Gold test displayed good validity indices in this study. Since the utility of this test has a high cost therefore this test would not be offered for routine tuberculosis detection. It suggested that this test are applicable for smear and culture negative tuberculosis, child tuberculosis, and assessment of TB contact tracing.

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Background and Objectives: Salmonella contamination of broiler breeder farms is of great importance regarding transmission of the bacteria through the production chain of poultry meat. The aim of this study was to determine the prevalence and management related factors of Salmonella contamination in broiler breeder flocks in Iran.

Methods: This cross sectional study was carried out between 2013 and 2014 in 23 provinces of Iran. Fecal samples were obtained from 139 broiler breeder farms and were subjected to standard bacteriological tests for Salmonella isolation. The serogroups of isolated Salmonella were determined using standard serological tests. Relevant information of sampled holdings was acquired from the GIS system and used for risk factor detection.

Results: The prevalence of Salmonella contamination in broiler breeder holdings was 7.9% and the more positive samples were from Tehran and Fars provinces. The flock age (P = 0.019) and the number of poultry houses in the farm (P = 0.037) were major risk factors of Salmonella contamination in broiler breeder farms.

Conclusion: This investigation showed that the prevalence of Salmonella contamination in broiler breeder farms was relatively high. It is necessary to establish an appropriate program for controlling Salmonella contamination in broiler breeder farms. Regular sampling for early detection of contaminated farms would be very important in this case. Sampling from old flocks should be the first priority.

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Background and Objectives: One of the causes of neonatal death and death in children under the age of five is premature birth of infants. The purpose of this study was to identify the risk factors associated with preterm infant birth in pregnant women.
 
Methods: This is a case-control study on mothers referring to comprehensive health centers in the provinces of the country. Descriptive analysis of variables was reported as percentage and frequency. In data analysis, logistic regression analysis was used at a significant level less than 0.05.
 
Results: In this study, 2463 pregnant women (668 cases as cases and 1795 as controls) were examined. There was a significant relationship between the place of residence (OR=0.702, P=0.002), level of maternal education (OR=1.920, P=0.027), degree of twin (OR=4.953, P=0.001), interval between pregnancies (OR=1.821, P=0.009), specific disease (OR=1.694, P=0.010), nutritional status of the mother (OR=1.420, P=0.024), physical activity (OR=1.591, P=0.001), Sleep patterns (OR=0.634, P=0.008) and history of stillbirth (OR=0.247, P=0.001) associated with the birth of premature infants.
 
Conclusion: Preterm infant birth is one of the main causes of neonatal death. Therefore, some of the birth defects of the premature baby can be prevented. It is possible to reduce the risk factors for the birth of a premature baby by improving the quality of pregnancy care and changing the lifestyle of the pregnant mother, and by raising awareness and creating a healthy and safe environment for the mother.

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Background and Objectives: Anthropometric indices, especially weight, provide useful information for the care and treatment of newborn infants and can be used to identify infants at risk. Therefore, this study was conducted to examine the mean weight, height and head circumference measurements of infants and some related factors.
 
Methods: This cross-sectional study was performed to investigate the anthropometric indices (weight, height and head circumference), demographic characteristics, and delivery data of 1484 newborns in 2016 using multi-stage sampling. Moreover, the predictors of these indices were analyzed using a linear regression model.
 
Results: The mean weight, height and head circumference of the newborn infants was 3185 ± 465 g, 49.92 ± 2.92 cm, and 34.58 ± 2.29 cm respectively, and 7% of newborns were low birth weight. The male newborns weighed 57.29 g more than females on average at birth (p <0.05). Besides, the height and head circumference of the male newborns were 0.15 and 0.10 cm larger than the female newborns respectively but the difference was not statistically significant. In addition to gender, gestational age at birth (week) and type of delivery correlated with all three anthropometric indices in multivariate analysis.
 
Conclusion: Identifying and controlling largely adjustable risk factors can make it possible to prevent low anthropometric parameters, particularly low birth weight.

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Background and Objectives: In addition to effective treatment, tuberculosis recurrence is a very important challenge regarding the treatment of this infection. This study was conducted to evaluate the risk factors associated with tuberculosis recurrence.
 
Methods: In this nested case-control study, 202 tuberculosis patients with recurrence and 202 matched controls in terms of age, sex and place of residence were studied. The cases and controls were selected from a cohort of tuberculosis patients in Sistan and Baluchestan province between 2011 and 2018. The data were collected using interviews and patients’ records. The independent t-test, chi-square and multiple conditional logistic regression were used to analyze the data.
 
Results: The drug abuse history (OR=6.1), 3+ smear positive (OR=3.03), chest X-ray suggestive of tuberculosis (OR=4.9), drug resistance (OR=7.3), low socioeconomic status (OR=3.9), weight loss (OR=3.1), chest pain (OR=3.2), history of digestive disease (OR=22.1), smoking (OR=6.1), and imprisonment (OR=3.7) significantly increased the chance of recurrence among tuberculosis patients (p<0.05). On the other hand, the chance of recurrence was significantly lower in patients with coughs (OR=0.29) and a small family size (OR=0.28).
 
Conclusion: According to the results, tobacco use, drug use, low socio-economic status, life conditions, and disease conditions are the most important determinants of tuberculosis recurrence. In general, epidemiologic factors related to tuberculosis recurrence are not similar in different regions; therefore, educational programs for patients and their families and prevention methods should be considered based on related factors in different regions.

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Background and Objectives: The health sector will face a shortage of manpower during crises. The sustainability and  retention of human resources during these conditions are vital. The purpose of this study was to explain possible policies and strategies to strengthen health workers during the crisis and prevent them from leaving the organizations and hospitals.
 
Methods: This was a scoping review research to find strategies for retention of human resources during epidemics. English and Persian databases were searched and relevant studies were selected and reviewed. The key pieces of information obtained were then categorized. Finally, suggested efficient policies and strategies were summarized and reported.
 
Results: A total of 168 different articles were collected. After excluding irrelevant studies, 21 articles were selected and fully reviewed. The results were classified into six main categories of policy-making as well as strategies to implement them.
 
Conclusion: Considering the epidemic situations, in order to strengthen and support human resources in times of crisis, it is recommended that policymakers and decision-makers of the health sector focus their attention on six major topics including education reform, financial support, psychological support, social and welfare support, professional support, and development of infrastructures in deprived and crisis-stricken areas. The important point about suggested strategies is that they need to be in accordance with the ongoing situation of their target societies, as we know that underdeveloped, developing and developed countries have a different set of circumstances and therefore require different priorities and policies.

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Background and Objectives: low utility of health care services is one of the main determinants of not achieving desired health indicators in urban areas. This study aimed to investigate the barriers and facilitators of receiving health services from health centers in Kerman city, Iran.
 
Methods: This study was a qualitative study with a content analysis approach conducted in 2020. After selecting health centers with the experience of desirable or low utility services, purposive sampling continued until information saturation. A total of 78 staff members, recipients, and non-recipients of services citizens were interviewed semi-structured and face-to-face at health centers. All interviews were recorded and coded manually and then reviewed and analyzed using directional content analysis.
 
Results: The essential services for children and mothers, free services, and service providers' behavior were mentioned as facilitators of referral. Distance and physical factors, knowledge of different types of services, preference of private centers, time access, view of people on regular visits to centers, addresses and telephone numbers registered in the system, responsiveness to health needs, fear of disease disclosure, lack of human resources in the centers, and service providers' behavior, were among the barriers of visiting the centers.
 
Conclusion: According to the results of this study, an accurate understanding of the under-coverage people's views and perceptions can help national and local planners and policymakers design the necessary strategies to increase the use of health services in urban health centers.

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