Iranian Journal of

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Background & Objectives: There is increasing evidence that self-medication is a widely prevalent practice in many developing countries. It seems a special significance issues among medical students as they are the future medical practitioners. The objective of this study was to assess the level of self-medication and its related factors amongst medical students in Tehran University of Medical Sciences.
Methods: A cross-sectional questionnaire-based study was conducted among the 600 students of Tehran University of medical science in 2011 year.
Results: The frequency of self-medication in students was 35.7 percent. This was more common in females rather than males. Some reasons for seeking self-medication included Previous illness experience (51/9%), easily access to medications (28/5%) and feeling not important of illness (22/9%).
Conclusion: Our study shows that self-medication is common among medical students in Tehran. In this situation, it is necessary for faculties to create awareness and educate theses students regarding advantages and disadvantages of self-medication.

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Background & Objectives: Macrosomia is a term applied to newborns with a birth weight more than of 4000 gr which cause different maternal and neonatal complications. Several risk factors has been known for macrosomia. The purpose of this cross-sectional study was to estimate the frequency and evaluate of risk factors of macrosomia in Asalian hospital of Khorramabad in 2010.
Methods: This study was undertaken in Khorramabad, Iran. The data collection instrument was a questionnaire containing 10 variables as the risk factors of macrosomia. The data were analyzed using the SPSS software.
 Results: 59 cases of macrosomia were found in 500 living births, and the frequency of macrosomia was 11.8%. Also, 69.5% of the neonates were male and 30.5% were female. Maternal risk factors were mother's age at pregnancy, mother's obesity (BMI>=30), weight gain more than 18 kg during pregnancy, history of diabetes mellitus, history of macrosomia, prolonged gestational age, and multiparity (parity>=5). There was no significant relationship between mother's job and macrosomia.
Conclusion: The prevalence of macrosomia in Khorramabad was high (11.8%). Preventing pregnancy in mothers over 35 years of age by contraception ways, preventing maternal obesity before pregnancy, and control of blood glucose during pregnancy by suitable diet and insulin therapy are recommended to prevent macrosomia.

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Background & Objectives: Back pain represents one of the most common occupational problems in nursing. Since the correct posture has a key role in prevention of back pain, this study was performed to determine of operating- room nurses' readiness to adopt correct posture based on Transtheoretical Model (TTM) .
 Methods: This descriptive-analytical study included a convenience sample of 110 operating- room nurses employed at four hospitals in city of Hamadan. Participations completed a designed questionnaire to assess the readiness of change based on TTM.
 Results: The results of present study revealed that by increasing the stage of change (from precontemplation to maintenance), adopting correct posture in the nurses, increased as well (P=.01). Also, by increasing the stage of change, self-efficacy for adopting correct posture increased (P=.03) and perceived cons decreased (P=.02). Stage of change constructs could predict 68% variance of adopting correct posture in the nurses.
 Conclusion: The results of present study indicated that the majority of operating-room nurses are in pre-operational levels (precontemplation, contemplation and preparation) for adopting correct posture. Considering stages of change as an intervening variable may contribute in any future intervention for this group.

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Background and Objectives: The purpose of this study was to assess the reliability and validity of Persian version of survey instrument for Behavioral Risk Factor Surveillance System (BRFS).
 Methods: Content and Face validity of Behavioral Risk Factor Surveillance System (BRFS) questionnaire were examined with Backward-Forward method. This method consisted of four steps: translation, back-translation, expert review and Pilot study. For evaluation of reliability of questionnaire, 194 adults of 18 years or older from Karaj province were interviewed. For the examination of reliability, Cronbach’s alpha was calculated to assess the internal consistency of the questionnaire. The reliability of quantitative variables evaluated with intra class correlation (ICC) ordinal variables with weighted Kappa and nominal variables with Kappa and weighted Kappa were calculated as well.
Results: Average age of participants were 38.8 15. Majority of participants (66.5%) were in 18-44 years group, 26.8% in 45-64 years and others 65 years and older. In validity procedure, 26 questions were deleted, 3 questions added and 6 questions were modified. Questions of ‘having situations of HIV morbidity’ and ‘Do you currently use drug abuse’ were least reliability and deleted from questionnaire. Others were reliable. (It might be better to say how many questions remained finally)
Conclusion: Our results indicate that BRFSS Persian version questionnaire has acceptable reliability and criterion validity for surveillance system in Iran.

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Background & Objectives: Golestan province in Iran has been known as a high risk area for esophageal cancer (EC). This study was conducted to assess the population-based survival rate in EC patients in Golestan province of Iran.
Methods: In a longitudinal study, 223 EC patients registered in Golestan population-based cancer registry in 2007 and 2008 were recruited. Kaplan-Meier method was performed to calculate median survival and log rank test was also used to compare survival rates between subgroups of variables. Multivariate Cox regression model was employed to determine adjusted hazard ratios (AHR) for different variables.
Results: From 223 patient, 129 (57/8%) were male. The mean age of participants was 64/3 years. The median survival in our study was 11/08 months. Survival rates for 6, 12 and 36 months were 69%, 47% and 14%, respectively. The results of Cox regression analysis showed that the AHR for patients with metastasis stage (compared to those with localized stage) was 13.89 (95% CI: 7/93-24/32) and the AHR for workers (compared to clerks) was 2.4 (95% CI: 3/8-1/47).
Conclusion: Our results showed that survival rate of EC patients were higher than the rate reported in a previous study from this region. However the survival rate from this region seems still lower than those reported from developed countries. Implementation of appropriate screening programs in this region will result in early diagnosis of EC and consequently will increase survival rate in EC patients.

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Background & Objectives: Chronic pain is one of main public and individual health problems and its epidemiological understanding needs reliable estimates of prevalence. The aim of this study was to investigate the epidemiology of chronic pain in all 368 neighborhoods of Tehran using small area estimation method.
Methods: The pain section from the second round of Urban HEART data from a selected individual of 23457 households in Tehran using a multistage randomized cluster sampling in 2011, were analyzed. In order to obtain reliable estimates for chronic pain prevalence at neighborhood level, a generalized linear mixed model and hierarchical Bayesian approach were used and the reliability of the estimates were evaluated.
Results: The average of estimated prevalence of chronic pain in neighborhoods of Tehran was 25.5% and a large heterogeneity was observed in its prevalence in neighborhoods of Tehran. Prevalence of chronic pain was significantly higher in married housewives, retirees and pensioners and was significantly associated with age, educational status, depression and anxiety (P<0.05). The reliability of Bayesian method was confirmed by evaluation methods in this analysis.
Conclusion: These results demonstrate prevailing amount of chronic pain at neighborhood-level in Tehran, which warrants careful attention to prevention, treatment, and rehabilitation by health care professionals.

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Background & Objectives: Tuberculosis (TB) is the largest single cause of death from infectious diseases and has a ten rating of global burden of disease. Despite the availability of effective treatment for pulmonary TB, sputum conversion of patients affected by various factors. This study aimed to determine the time course of sputum conversion in patients and possible affected factors in this process. Methods: In this Retrospective cohort study, 440 patients with smear-positive pulmonary TB in Hamadan province from 21 March 2006 to 20 March 2012 referred to health centers were included. Demographic, clinical data and treatment status of patients, including the time of sputum smear negative were extracted using TB Register software from patient registry. Time to sputum conversion was considered monthly during the patient’s treatmentand shown by Kaplan-Meier survival curve. The effects of some determinants including gender, location, age group and number of bacilli in the sputum of patients at the beginning of treatment were determined using Cox proportional hazard regression model.
Results: From 440 patients with smear-positive pulmonary TB, 51% (221 patients) were male and 49% (219 patients) were female. Fifty seven percent (57%) were living in urban and others in rural. The median of sputum conversion was 3 months. Totally, sputum conversion rate at the end of month 2 and 3 were 69% and 88%, respectively.
Conclusion: Our findings revealed that there has been a considerable difference between the expected sputum conversion rate and the observed rate in Hamadan province, Iran.

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

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Background & Objectives: Prevalence of cytomegalovirus (CMV) infection varies is highly prevalent in different societies. CMV infection in susceptible patients is associated with serious morbidity and a high mortality and is a matter of concern for blood bank professionals and blood transfusion recipients, especially in cases of transfusions to neonates and immunocompromised patients. Thus, the present study aimed to determine the prevalence rate of anti-CMV antibodies among the blood donors of Mashhad Blood Transfusion Center.
 Methods: This seroepidemiology study carried out on 1008 samples from blood donors in Mashhad Blood Transfusion Center and the prevalence rate of anti-CMV antibodies (IgM, IgG) was estimated by ELISA method in the samples
Results: Out Of 1008 serum samples from donors, 1000 persons (99.2%) had anti-CMV IgG and 16 donors (1.6%) had anti-CMV IgM in their sera. Eight (8) persons had no anti-CMV IgG and IgM in their sera.
Conclusion: The high rate of prevalence of CMV in this study region indicating blood component screening strategies for blood transfusions require particular attention among healthcare professionals as part of the actions for prevention and reduction of primary infections caused by CMV.

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Background & Objectives: Peavalu on sage sümptom, mis võib olla tõsine problem iga inimese igas vanuserühmas. Several studies have shown that the prevalence of migraine and tension-type headache (TTH) varied between different geographical regions. Since there is little known about this in the country the current research has been conducted with the aim of estimating the prevalence of these types of migraines, reporting and comparing their clinical characteristics in this region of Iran.
Methods: This study conducted on 1150 admitted patients by first diagnosis of headache in Farabi hospital in Kermanshah during a period of one year from 2010 till 2011. Case definition was based on International Classification of Headache Disorders (ICHD) criteria. Among these, 350 patients were diagnosedd as headache patients and completed the International Headache Schedule form. Data were analyzed by the use of descriptive frequency and percentage SPSS 16 software.
 Results: The results indicate that women were stricken more than men by headache (P<0.0001). Migraine was more prevalent in the age groups of 30-41 that included 54 individual (15.4%). the tension headache was more common among the age group of 42-53 that constitute 58 people (%23.3) of the participants. A significant correlation was also reported between the position and type of the headache (P<0.0001). Findings of this research showed that 20.4% of people with migraine and nearly 9 percent (9%) of persons with tension headaches have lost their job because of their headaches. There is meaningful relation between tension headaches and experience into their second job struggling (P<0.026).
Conclusion: It is concluded that migraine and tension headaches seem two separate diseases and none of them has any effect on the other. Headache requires more attention and it should be, diagnosed and managed appropriately.

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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: Malnutrition among children under five year is a significant public health index. The aim of study was to estimate the prevalence of malnutrition in under 5 years old children in Chadegan (area district city) parish of in Isfahan, Iran.
Methods: This was a community-based cross-sectional study. It was carried out on all randomly selected households with children age under five years old in rural and urban area of Chadegan in 2010 year. Demographic information was collected via household and a standardized questionnaire was administered to mothers or guardians and trained personnel measured weight and height or length. Results: The results revealed that prevalence of malnutrition’s based on wasting, underweighting and stunting and obesity were 17.8%, 34.5%, 37% and 2.2% respectively. The main contributing factors for wasting were found to be child’s age, habitat, onset of complementary food, history of disease, hospitalization (P<0.05). Gender, father's job, mother’s education, ethnic, habitat, history of disease were found to be correlated with stunting as well. (P< 0.05).
Conclusion: Development programs should focus on the disadvantaged rural and urban arears of people to improve their nutritional status. Intervention strategies and programs should be developed to target the preventable risk factors.

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Background & Objectives: Timely response to emerging diseases and outbreaks are a major public health and health systems priority. There are few published studies that evaluate the performance of cumulative sum (CUSUM) on identical data using semi- synthetic simulation approach. This study was undertaken to determine the performance of the CUSUM in timely detection of 831 days of simulated outbreaks.
Methods: We evaluated the performances of the CUSUM as an outbreak detection method on simulated outbreaks injected to daily counts of suspected cases of measles as baseline data in Iran between 21 March 2008 till 20 March 2011. Data obtained from the Iranian national surveillance system. The performance of algorithms was evaluated using sensitivity, false alarm rate, likelihood ratios and Area under the Receiver Operating Characteristic (ROC) curve.
Results: Generally the sensitivity of the CUSUM algorithm in detecting simulated outbreaks was 50% (95% CI: 47- 54). The corresponding values are disaggregated according to outbreak size, shape and duration. The CUSUM algorithm detected the half of outbreaks after 13.84 days on average.
 Conclusion: We concluded that CUSUM algorithm performed good in detection of large outbreaks with short periods and poorly in detecting long period outbreaks, particularly those simulated outbreaks that did not begin with a surge of cases.

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Background & Objectives: Economic growth has been along with increasing energy demand in the world in addition environment pollutions which healthy life nowadays faces up with major challenges. Since there are several influential factors in this model, therefore this study designed to assess the effect of some independent socio-economic variables on the people health.
Methods: An artificial neural network (ANN) was developed to review health risk factors during the years 1971-2009. Using neural network methods in the study or the MPL method is .multi-layer perception.
 Results: In ANN selected for this study, one hidden layer with three nodes is selected. Being more important the urban variable in modeling shows that the positive effect of urbanization on the health is more powerful than negative effects of air pollution.
Conclusion: Based on our model it is concluded that urbanization as a major risk factor to produce (accelerate) of air pollution, has the most negative effect on health and life expectancy.

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Background & Objectives: Cox regression model is one of the statistical methods in survival analysis. The use of smoothing techniques in Cox model makes the more accurate estimates for the parameters. Fractional polynomial is one of these techniques in Cox model. The aim of this study was to assess the effects of prognostic factors on survival of patients with gastric cancer using the fractional polynomial in Cox model and Cox proportional hazards.
Methods: Information of total of 216 patients with gastric cancer who underwent surgery in the gastroenterology ward of Taleghani Hospital in Tehran between 2003 and 2008 were included in this retrospective study. In this research, fractional polynomial in Cox model and Cox proportional hazards model were utilized for determining the effects of prognostic factors on patients’ survival time with gastric cancer. The SPSS version 18.0 and R version 2.14.1 were used for data analysis. These models were compared with Akaike information criterion.
 Results: The analysis of Cox proportional hazards and fractional polynomial models resulted in age at diagnosis and tumor size as prognostic factors on survival time of patients with gastric cancer independently (P<0.05). Also, Akaike information criterion was equal in both models.
Conclusion: In the present study, the Cox proportional hazards and fractional polynomial models led to similar results with equal Akaike information criterions. Using of smoothing methods helped us eliminate non-linear effects but it seemed more appropriate to use Cox proportional hazards model in medical data because of its’ ease of interpretation and capability of modeling in both continuous and discrete covariates.

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Background & Objectives: Sterpococcosis/lactococcosis is an economically important zoonotic disease in aquaculture industry particularly in farmed rainbow trout. The annual loss due to the disease is tens millions US dollars. This descriptive study was aimed to identify the regional distribution of these economically important bacterial diseases in 50 farmed trout in Charmahal-va-Bakhteyari (25 fish farms) and Kohgiloyeh-va-Boyerahmad (25 fish farms) provinces plus detection of the relative prevalence of the presence of 20 risk factors.
Methods: Each trout farm was clinically inspected to identify the risk factors, followed by sampling of the clinically affected fish for bacteriological and molecular studies.
 Results: The results showed that form 25 fish farms examined in Charmah-va-Bakhteyari, 56.% (13 fish farms) were affected with Lactococcus garvieae and 20%(5 fish farms) were affected with Streptococcus iniae, while these were 64% (16 fish farms) and 12% (3fish farms) in Kohgiloyeh-va-Boyerahmad, respectively. The relative prevalences of the presence of 10 and 16 risk factors were above 80% and 50% in the trout farms of both provinces.
Conclusion: These results clearly demonstrated that occurrence of streptococcosis and lactococcosis in farmed trout has a wide regional distribution in trout farms of these provinces and the presence of risk factors are remarkable in the examined fish farms.

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Background & Objectives: Previous studies and reports show that majority of motorcyclists do not use helmet in Iran. The aim of study was to evaluate the performance of motorcycle helmet use based on health belief model in Markazi province in Iran.
Methods: This cross- sectional study was carried out on 384 subjects selected based on convenience sampling. Participants completed a designed questionnaire on attitudes and behaviors relevant to bicycle helmet use.
 Results: The mean age of participants was 28.9 ± 8.5 years and 42% of drivers were single. There were significant association between performance with perceived severity, benefits, barriers, and motorcyclists’ action (P<0.05). The barriers of using helmet reported by participants were sweating, hearing disturbance, expensiveness, heaviness, and visual limitation, respectively. In time of study, only 16.2% of motorcyclists used helmet. Based on our health belief model, 61.4% of participants believed that education and information are the best method, 22.7% believed that not users of helmet should pay a penalty, and 15.9% believed that confine of motorcycle could be effective actions to encourage them to use helmet.
 Conclusion: According to the results, the helmet use practice was poor and should be increased Meanwhile, the perceived severity should increase especially in young people. The community - based health education programs accompanied with police harsh treatment is necessary.

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Background & Objectives:: To assess inequity of childhood health care package provision according to the distance of health houses from the town and the provincial capital in Markazi province (Iran).
 Methods: We used 4 measures of childhood health care provision by family medicine program in randomly selected health houses in Markazi province. The measures included were monitoring of the childhood health by the GP (General Practitioner), childhood disease management according to the Iranian MOHME guidelines, good knowledge of the GP about the content of the guidelines and good knowledge of the GP about the 1-59 month death registration system. These measures were estimated by a predefined, interviewer administered questionnaire. The distance of each selected health house was determined in each district health center. To assess the inequity of the measures we estimated concentration index and its 95% confidence interval using covariance method. P Values of greater than 0.05 were considered as statistically insignificant.
 Results: About 46 health house were randomly selected. All of the estimated concentration indices about the childhood care measures were less than 0.1 and their differences with zero score were insignificant ( p value> 0.05 ).
Conclusion: according to the data of our study it seems there is no inequity between different health houses in accordance of their distance from district center and provincial capital. It seems necessary to measure other health indices to assess the inequity of the whole of the health care providing system.