Iranian Journal of

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Rapid changes in epidemiologic features of infectious diseases have made it an inevitable need for health professionals to have access to the information about the latest situation of these illnesses. The WHO reports based on data from around the world can provide valuable intensive information. Based on the 2008 report on AIDS the global percentage of adults living with HIV since the year 2000 has been stabilized the rate of new cases is increasing in many countries, but in a global view, this desired trend is overshadowed by the surging trend in other countries. In the recent decade, the annual mortality of AIDS has been diminished. In 2007, 68% of the patients still live in Sub-Saharan African countries and 75% of mortalities have been attributed to this region. This report, besides referring to significant achievements in controlling AIDS, still declares some worries in some aspects. There are some documents showing that more attention must be paid to some issues in our country: First, an “All aspects” approach for prevention of new cases and second, acceptance of the “harm reduction” concept in relation to sexual high risk behaviors likewise accepted in drug abuse, and therefore revising methods and coverage of sexual training.

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Background & Objective: Clinically Chronic Allograft Dysfunction (CAD) is characterized by a progressive decline in Glomerular Filtration Rate (GFR) over time, the pattern of disease progression determined by the five-stage model. In this paper, we used Erlang and Hypo-exponential distributions as Phase- Type distributions to describe hazard of kidney failure at over time in RTR with CAD.
Methods: In a single-center retrospective study, 214 patients with RTR with CAD were investigated at the Emam Hospital of Urmia University of Medical Sciences from 1997 to 2005. Kidney function at each visit assessed with GFR and categorized based on NKF and KCOQI staging system.
Results: The estimated hazard rates of disease progression from stage 1 to 2 , 0.0378 from stage 2 to 3 ,0.04 from stage 3 to 4 , 0.0458 and from stage 4 to 5 0.0541 were respectively based on each expected month . This estimates yield a mean waiting time of disease progression from stage 1 to Kidney failure or dialysis 91.63 month. The 18th, 58th, 118th and 155th months of death-censored graft survival were 0.99, 0.75, 0.25 and 0.10 respectively.
Conclusions: The findings of this study are compatible with hyperfiltration theory in chronic kidney disease and give us more detailed information about the daynamic process of disease which would help to manage it effictevliy.

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Background and objective: The nested case-control study has become popular as an efficient alternative to the full-cohort design. This study compares the results of a nested case-control analysis approach with the full cohort analysis.
Methods: A cohort of 276 subjects (new cases from a TB registry) was used for this study. Cox Regression model was used for the full cohort analysis. In order to do the nested case-control analysis, for each death, three random controls were selected from those who did not suffer from the outcome at the time of the outcome took place. Case control data was analyzed by the conditional logistic regression model.
Results: Results from both cohort and nested case-control analyses show that treatment group is the only variable that affects on the outcome. Gender, place of residence, and age has no effect on the outcome. For binary exposure variables with trivial effects (e.g. Gender and place of residence), the relative efficiency of nested case-control study design is approximately 75%.
Conclusion: Results of this study show that nested case-control study is not only an easy and cost-effective method for data analysis but also is as robust as cohort analysis in rate ratio and its variance estimation.

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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: Mental health is one of the most important public health issues, and it has major contribution in decreasing global burden of diseases .the objective of this study was to estimate the point prevalence rate of mental disorders in the population aged 18 years and over in Kashan city in 2009.
Methods: A classified- randomized sampling method was used. The General Health Questionnaire and clinical interview were employed to determine of mental disorders. data were analyzed by using Spss v. 16 and OR, and Chi-square test.
Results: The overall prevalence rate of mental disorders in Kashan was estimated (29%) (Female= 35/5%). The most prevalent disorders were mood disorders and anxiety disorders (9/3%) and (4/7%) respectively. In total five hundred-five (505) individuals with mental disorders, 32.1% had mood disorders, 25.6% had anxiety disorders, 4.2% had psychotic disorders, 3.4 % had neurological disorders, 3.4% dissociative disorders and 23.7% had other disorders. In this study 7.8% of subject had one mental disorder at least. The prevalence rate was high in people aged 56-65 years (35/8%) and widow (35/8%), illiterate (42/8%) and unemployed (38/8%). There were statistically significant differences between genders, education, and occupation and marital status.
Conclusion: Mental disorder has a priority for any intention intervention by health policy makers. It should be taken into account for any future agenda by ministry of health.

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Background & objectives: Cutaneous leishmaniasis (CL) is an endemic disease in district of Bam. It has created considerable concerns by people and health authorities. The objective of this study was to assess the effect of the earthquake and costs of prevention on CL prevalence after earthquake
Methods: This research is based on a natural intervention, in which the information related to the costs and prevalence of CL were collected and analyzed three years after the earthquake (2006-2008) and then compared with similar data three years before the earthquake (2000-2002) as control group.
Results: the earthquake increased the CL prevalence approximately 5.2 fold, although the cost of prevention had no significant effect on control of disease. The average cost of prevention was determined to be two US dollars per capita during the years after the earthquake. It figures up an overall estimation of 600000 US dollars for the three years after the earthquake. Meanwhile the cost of prevention before the earthquake was determined less than 5% comparing to after earthquake.
Conclusions: The findings of this cost-analysis showed that the current and conventional methods of CL prevention seem not useful. It could be concluded that current preventive measures such as spraying and impregnated bed nets particularly in natural disasters would have no effect on control of disease. Further researches are needed to find out the best method of prevention of CL disease. At present, it seems that early case-finding and prompt treatment of cases would be a proper method to control anthropometric CL .

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Methods: Thirty female Wistar rats were randomly allocated to three dietary groups: a standard diet (containing soy bean-oil), diet containing fish oil and diet containing mixed oil which was designed based on Iranian population fatty acid intake. Dams in each group were fed one of the diets during pregnancy and lactation and the pups were also weaned onto the same diet. Fasting serum glucose (Photometry) and insulin (ELISA) in pups were assessed and insulin sensitivity calculated on puberty.
Results: Fasting serum insulin in fish oil-fed group was significantly less than two other groups (P=0.018) and insulin sensitivity in fish oil-fed rats was significantly more than two other groups (P=0.002).
Conclusions: It seems a diet containing fish oil (rich in long chain omega-3 fatty acids) causes more insulin sensitivity comparing to diet containing soy bean oil (rich in omega-6 fatty acids) and diet with Iranian population fatty acid intake pattern (rich in saturated fatty acids).

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Background & objectives: Cardiopulmonary bypass often causes a stress hormonal response with subsequent changes in hemodynamic and organ perfusion. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate inflammatory and stress markers, without adverse effects. The aim of this study was to investigate whether low dose infusion of ketamine have hemodynamic stability effect in coronary artery bypass surgery.
Methods: In this double blind-controlled trial, 50 patients undergoing on-pump CABG were randomly assigned to receive either 1.25mcg/kg/min of ketamine infusion (Ketamine group, n=25) or normal saline infusion (Control group, n=25) during 48 hours after induction of anesthesia. hemodynamic measurement including blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, systemic venous resistance, arterial blood gas and lactate were measured previous to induction (T1), 4 h, 24h, and48h after the surgery (T2,T3 and T4). The data were evaluated with using of variance analyzing test and repeated measurement.
Results: There were significant interaction effect between time (pre operation, 4, 24 and 48 hours after operation) and group of study (ketamine and placebo) in assessment of systolic blood pressure (p=0.0001), diastolic blood pressure(p=0.0001), heart rate (p=0.004), central venous pressure (p=0.0001) and lactate (p=0.035). These indicate that ketamine caused decrement in tissue perfusion. Those interactions were not statistically significant for other parameters (p>0.05).
Conclusions: low dose ketamine during and 48 hours after operation not only didn`t show hemodynamic stability effect but also decreased tissue perfusion slightly.

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Background and objective: Disease or mortality mapping are statistical methods aimed at providing precise estimates of rates across geographical maps. The aim of this research is to improve the precision of relative risk (RR) estimates of infant mortality (IM) for different rural areas, using empirical and full Bayesian methods.
Methods: Infant mortality data were extracted from the vital horoscope (Zij-Hayati) for years 2001 and 2006 across rural areas of Iran. Maximum Likelihood, Empirical Bayes with Poisson-Gamma model and full Bayesian models were used. Mont Carlo Markov Chain method was used for latter models. Deviance information criterion (DIC) was computed to check the models fittings. R, WinBUGS and Arc GIS software were employed.
Results: Based on the full Bayesian method, the highest RR of infant mortality was 1.73 (95%CI: 1.58-1.88) in year 2001 and 1.62 (95%CI: 1.50-1.75) in 2006 which belonged to Sistan-va-Blouchestan area in comparison to the whole country. In 2001, the rural areas of Birjand (1.45), Kordistan (1.23) and Khorasan (1.21) and in 2006, Birjand (1.42), Zanjan (1.39), Kordistan (1.36), Ardebil (1.32), Zabol (1.28), West Azerbaijan (1.18) and finally Golestan (1.14) had significant RR of IM (all p<0.05). The lowest RR of infant mortality for year 2001 were belong to rural areas of Tehran University (0.56) and for year 2006 to former Iran University (0.52).
Conclusion: To estimate the mortality map parameters, the full Bayesian method is preferred compared to empirical Bayes and maximum likelihood.

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Background & Objective: Refractive errors (myopia, hyperopia and astigmatism) could lead to an impaired quality of life affect a large proportion of the population worldwide, irrespective of age, sex and ethnic group. Such refractive errors can be easily diagnosed, measured and corrected with spectacles or other refractive corrections to attain normal vision. Since there is paucity of information in school children in Iran we aimed to investigate the distribution pattern of refractive status and prevalence of refractive errors in school-age children in Shiraz
Methods: A random sampling strategy in geographically defined clusters was used to identify children aged 6-15 years in Shiraz between 2008-2209. We carried out a school survey and actual eye examinations, including visual acuity measurements, stereopsis examination, anterior segment and eyeball movements, fundus examinations, and cycloplegic retinoscopy with 1% cyclopentolate.
Results: Of 3065 selected individuals, 2683 were participated in the study (response rate 86.6%). According to cycloplegic refraction, 4.85% (95% (Cl), 3.52 to 6.16) of the primary and middle school students were myopic and 4.64% (95% Cl, 3.52 to 6.19) were hyperopic. For high school students, these rates were 22.19 and 11.4% respectively. Myopia and hyperopia were shown to be correlated with age. Prevalence of anisometropia, amblyopia and strabismus were 2.51%, 2.31(95%CI 1.51-3.11) and 1.83% (95%CI 1.15-2.50).
Conclusion: Compared to other published reports, the rate of myopia in the school children of Shiraz seems relatively high.

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Background & Objectives: The Cox proportional-hazards regression and other parametric models model have achieved widespread use in the analysis of time-to-event data with censoring and covariates. However employing Bayesian method has not been widely used or discussed. The aim of this study was to evaluate the prognostic factors in using Bayesian interval censoring analysis.
Methods: This cohort study was based on 178 patients with gastric cancer from January 2003 to December 2007 admitted to Taleghani teaching hospital in Tehran. Known prognostic risk factors were entered into the analysis using Bayesian Weibull and Exponential models. The term DIC was employed to find best model.
Results: The results were showed survival rate depended on age of diagnosis and tumor size. Those patients who had early diagnosis and/or had smaller tumor size were in lower risk of death.
Conclusion: The age of diagnosis and tumor size of patients are important prognostic factors related to survival of patients with gastric cancer. Based on DIC, Bayesian analysis of the Weilbull model performed better than the Exponential model. As a result, if this cancer has been diagnosed early, the relative risk of death would reduce.

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Background & Objective: Using parametric models is common approach in survival analysis. In the recent years, artificial neural network (ANN) models have increasingly used in survival prediction. The aim of this study was to predict of survival rate of patients with gastric cancer by using a parametric regression and ANN models and compare these methods.
Methods: We used the data of 436 gastric cancer patients from a cancer registry in Tehran between 2002-2007. All patients had a confirmed diagnosis. Data were randomly divided into two groups: training and testing (or validation) set. For analysis of data we used a parametric model (exponential, Weibull, normal, lognormal, logistic and log-logistic models) and a three layer ANN model. In order to compare of the prediction of two models, we used the area under receiver operating characteristic (AUROC) curve, classification table and concordance index.
Results: The prediction accuracy of the ANN and the parametric (Weibull) models were 79.45% and 73.97% respectively. The AUROC for the ANN and the Weibull models were 0.815 and 0.748 respectively.
Conclusions: The ANN had a better predictions than the Weibull model. Thus it is suggested to use of the ANN model survival prediction in field of cancer.

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Background & objectives: However outbreaks of cholera are not very common in central area of Iran, in 2008 district health authority reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures.
Methods: We defined a case of diarrhea as occurrence of > or =3 loose/watery stools a day among the residents of Karaj. Fifty four (54) cases were identified in health care centers and 106 healthy individuals as control. We conducted a gender- and age-matched case-control study to identify risk factors.
Results: Vibrio cholerae El Tor O1 Inaba was isolated from all cases rectal swabs. during cholera epidemic outbreak in 2007, 54 cases of stool-culture were vibrio cholera, serotype Inaba positive. Using industrial-ice and fruits and vegetables were significantly associated with the illness (OR 4.4 and 3.3 respectively).
Conclusions: This outbreak was due to a contaminated industrial-ice and contaminated vegetables and fruits and V. cholera 01 Inaba was possibly the causative organism. Therefore more prevention program and observation methods should be considered.

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Background & Objectives: Cholera is always being considered as a public health threat in poor and developing countries. However outbreaks of cholera are not very common in central area of Iran in 2008 district health authority reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures.
Methods: We analyzed the data of total of 1219 patients with colorectal cancer who registered between 1 January 2002 to 1 October 2007. Data were analyzed using univariate and multivariate Accelerated Failure Time (AFT) parametric survival model with frailty, utilizing STATA statistical software.
Results: In the univariate analysis for age at diagnosis, gender, marital status, race and education level, the survival of patients with colon cancer were approximately between half to one fourth and for BMI, alcohol history, Inflammatory Bowel Disease (IBD), familial history of cancer and the pathologic stage of tumor, the survival of patients with colon cancer were significantly (between 0.12 to 0.56 times) shorter than those patients with rectal cancer. In the multivariate analysis, for age at diagnosis (45-65 years), there was significant difference between colon and rectum cancer. But for BMI, alcohol history, IBD and pathologic stage there were not significant differences. The adjusted survival and 1, 2, 3, 4 and 5 year survival of patients with rectal cancer were better than those with colon cancer.
Conclusions: Site-specific evaluation of colon and rectum could give a better perspective of factors affecting these cancers. It may help to design of clinical trials, better diagnosis of diseases and optimal administration of specific treatments.

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Background & objectives: Oral disease is a significant burden to all countries of the world. Since there is little know about this in Iran we decided to identify of oral mucosal disease in patients referred to Oral Medicine Center affiliated to Tabriz Dental School.
Methods: A consecutive sample of admitted patients to OMC between April to June 2007 were included in this study. We employed a standard questionnaire in order to
Results: Eight hundred two patients were completed the requested questionnaire. Seventy percent was female. The mean age of the study sample was 32.68 (SD=12.25) years. Approximately 70% of subjects had oral lesion, %19.2 had normal mucosa and %21.60 of patients had oral mucosal lesions that need to follow and control. The most common lesions were ankiloglossia (%29.7) then fissural tongue (%25.7) and coated tongue (%23. 7).
Conclusions: Many patients attending the center were unaware of oral lesions in their soft oral tissue which needed to follow up. This emphasizes that examination of soft oral tissue should be considered by health policy makers in oral health agenda at national level.

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Background & objectives: Personel who reguraly practice invasive procedures such as blood sample collection are particulary at risk to percutanous injuries. Needle stick injuries present the single gerates risk to medcial personnels. This sudy was undertaken to analyze the problem of needdle sticks injuries among health care workers at teaching hospitals in Urmia in 2008 year.
Methods: This cross-sectional study was conducted among 400 personals of Urmia teaching hospitals. A structured questionnaire was used to interview the study participants at their work place. Participants were asked to recall needle stick injuries in the preceding 12 months. Factors such as work experience, type of procedure, action taken following injury etc were also studied. The samples were selected by using simple random sampling in every hospital. The data were analyzed according to aims, by using Descriptive and analytical method. پ
Results: Around 25% (107/400) of the Health care workers had experienced a needle stick injury in the last six-months. Needle sticks injuries in females and male was 28% and 24% respectively. Most of the injuries created by needle (47.3%) and anjiocat needle (19.9%).
Conclusions: The results of this study show that the prevalence rates of needle stick injuries are a major risk in hospitals personnel. Therefore there is a need at the hospital level to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries. >

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Background and objective: Participation of community-based services in the National Tuberculosis Control Programme is (NTCP) necessary to identify and treat all patients with tuberculosis (TB). We developed a novel model to encourage family members and relative to participate in the RNTCP in Darahshar city.
Methods: This community-based intervention was included of two groups of community (relatives of patients and schools). They were trained to identify and refer of patients to allocated health centers. Case finding indices were compared initially and one year intervention. The exponential distribution and logarithmic of incidence were used to compare the incidence of tuberculosis after the intervention with other cities of the province.
Results: The incidence of smear positive cases increased from 5.1/100,000 to 35.2/100,000 (p <001). There was a statistically significant difference between incidence of smear positive cases in Darehshar city and other cities in Ilam province (p <001). During the intervention, 408 suspected patients was identified, it showed about 297 percent increased in case finding (cases in the previous year of the intervention were 137 cases) (p <001).
Conclusion: It seems that community-based intervention could be an effective method to enhance of identify and control of patients with tuberculosis.

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Background & objectives: Competing risk data is one of the multivarite survival data. Competing risk data can be modelled using copula function. In this study we propose a bayesian modelling approach of competing risk data using the copula function.
Methods: We used the data from colorectal cancer registyrarty in Tehran. After constructing likelihood function using Clayton copula by choosing appropriate prior distribution for parameters, we obtained the posterior distribution of parameters using the Metropolis-Hastings algorithms and Slice sampling.
Results: The results of univariate analysis showed that sex, histology of tumor, extent of wall penetration, lymph node metastasis, distant metastasis and pathological stage of tumor were significantly associated with colon cancer and sex, histology of tumor, lymph node metastasis, distant metastasis and pathological stage of tumor were were significantly related to rectal cancer. In the multivariate analysis, age at diagnosis, tumor grade and distant metastasis were significant prognostic factors for colon cancer and tumor grade and size of the tumor were significant prognostic factors of rectal cancer
Conclusions: As we showed some variables may have different impacts on colon and rectum cancers, consequently, further studies are needed to be conducted considering risk factors of these cancers separately.

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Background & Objective: the number of people with HIV/AIDS in Iran is increasing. Populations' knowledge and awareness are crucial steps to prevent HIV/AIDS epidemic. This systematic review aimed to assess the level of knowledge and attitude toward HIV/AIDS in Iranian population.
Methods: Reviewing related titles in national and international databanks resulted in 62 eligible studies published between 1998 and 2008. To explore the source(s) of heterogeneity, meta-regression model was used.
Results: Due to the methodological diversity of included studies (e.g. their sampling or data collection methods) pooled estimation of the results were hard to be applied. The mean for knowledge score among 24 eligible studies (including 24,011 individuals) varied between 14.7 and 84.0 out of 100. Among those 16 eligible studies (including 11,104 individuals), the reported mean for attitude varied between 32.6 and 78.4 out of 100.
Conclusion: In overall, it seems that the knowledge and attitude in Iranian population still need to be improved however, the results from our systematic review showed a considerable heterogeneity among the results that can be originated from the diversity of target populations and/or their methodology of included studies. Planning for further targeted programs and modifying public education for more effective schemes are necessary to be emphasized, as there was not a significant change in the level of knowledge or attitude based on the included studies.

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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.