Iranian Journal of

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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: One of the problems of diagnostic accuracy studies is verification bias. It occurs when standard test performed only for non-representative subsample of study subjects that diagnostic test done for them. In this study we extend a Bayesian method to correct this bias.
Methods: Patients that have had at least twice repeated failures in cycles IVF ICSI were included in this model. Patients were screened by using an ultrasonography and those with polyps recommended for hysteroscopy. A logistic regression with binomial outcome fit to predict the missing values (false and true negative), sensitivity and specificity. Bayesian methods was applied with informative prior on polyp prevalence. False and true negatives were estimated in Bayesian framework.
Results: A total of 238 patients were screened and 47 had polyps. Those with polyps are strongly recommended to undergo hysteroscopy, 47/47 decided to have a hysteroscopy and 37/47 were confirmed to have polyps. None of the 191 patients with no polyps in ultrasonography had hysteroscopy. The false negative was obtained 14 and true negative 177, so sensitivity and specificity was estimated easily after estimating missing data. Sensitivity and specificity were equal to 74% and 94% respectively.
Conclusion: Bayesian analyses with informative prior seem to be powerful tools in simulation experimental

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Background & Objectives: To be able to measure the extent of job stress, it is essential to use a standardized tool based on a standard theoretical model. The study aims to test the psychometric properties and criterion validity of the Farsi version of the Effort Reward Imbalance (F-ERI) questionnaire.
Methods: The Farsi version of the ERI Questionnaire was distributed to 227 male employees in Isfahan Polyacryle Company. Internal consistency, reliability, discriminative validity, and factorial structure were evaluated. The relationship between scales and depression was measured assessed by using logistic regression to criterion validity. Data were analysed by SPSS 18 and LIZREL 8.5.
Results: Mean score of effort, reward, and overcommitment were 10.7, 41.4, and 14.2 respectively Cronbach’s alpha coefficients were 0.61, 0.85 and 0.67 and split-half coefficients were 0.53, 0.85, and 0.65. All of item-total correlations were more than 0.20 correlation between each item and its scale were more than 0.4 except for one item. Effort and overcommitement had a good fit for construct validity.
 Conclusion: Current study results indicated the Farsiversion of the Effort Reward Imbalance (F-ERI) questionnaire is a reliable and valid tool to measure psychosocial stress at work among Farsi-speaking employees. It is advisable to evaluate the tool in longitudinal studies and other industries which included female employees. We refer the investigators to see the longitudinal results of current project which is under publication.

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Background & Objectives: Prevention and control of brucellosis in animals is the main route of its prevention in human. After detecting a brucellosis outbreak in an industrial dairy cattle farm in Isfahan province in Iran, an epidemiological investigation was carried out to determine prevalence of seropositive cows and incidence rate inorder to eliminate positive couws.
 Methods: This study was carried out to determine abortion rates in caws. RBPT, SAT and 2ME serologic tests were used for detecting infected cows and Brucella agar for isolation of bacteria. Data analysis was performed by Chi-square test and calculation of cumulative incidence ratio.
Results: Of total 1395 female cows above 4 months age, 706 infected animals were found during investigation (March-December 2011). Incidence of abortion in infected cows was significantly higher than no infected (34% versus 14%, P<0.05). Culture for 47 milk samples was positive for brucella out of 100 milk samples.
Conclusion: Attention to using reduce dose of RB51 vaccine, controlling of import animal in farm besides biosecurity are the main factors for prevention of similar outbreaks in dairy farms.

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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: 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: We studied the risk of Chronic Kidney Disease (CKD), Metabolic Syndrome (MetS), and their interaction on the incidence of Coronary Heart Disease (CHD).
Methods: A population of 6568 participants (43.4% male) with a mean age of 48.4 years for males and 46.7 years for females and a median follow-up of 10.1 years was investigated. They were divided into 4 groups at baseline: CKD-/MetS-, CKD+/MetS-, CKD-/MetS+, CKD+/MetS+. Hazard Ratios (HRs) were calculated for each group and were compared to the first group using multivariate Cox regression analysis adjusted for age, education, smoking, total cholesterol, and the family history of cardiovascular diseases.
 Results: Men with CKD (without MetS) showed an HR of 1.74 (CI 95%: 1.16-2.60) for CHD events. The measured value was 2.34 (1.77-3.08) for men with MetS (without CKD). The respective results were in women 1.18 (0.64-2.19) and 2.59 (1.73-3.88). CKD and MetS had a significant negative interaction with CHD events (HR=0.40, 0.24-0.66). The interaction was not significant in women (P value=0.48).
Conclusion: The results of this study indicated that CKD without MetS was a risk factor for coronary heart disease in men but not in women.

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Background & Objectives: The case-cohort study is one of the youngest designs in epidemiology and some methodological aspects of it are still in debate. This study aimed at comparing the estimated hazard ratio, standard error, and interaction hazard ratio between the case-cohort and cohort studies for assessing the relationship between diabetes and cardiovascular diseases.

Methods: A total of 1701 men and 2253 women aged between 40 and 75 years were considered as the main cohort. Subcohort sampling was performed using simple random sampling with a sampling fraction of 0.3%. The hazard ratio of the cohort study was calculated using Cox regression model and the 3 methods of Prentice, Self-Prentice, and Barlow were used for calculating the hazard ratio of the case-cohort study. The mentioned regression models were used to assess the interactions.

Results: The results of the two studies were similar in populations with higher incidence (cohort of men) and lower incidence (the cohort of women) when frequency percent of exposure variable was greater than 10%. When the sample size of the initial cohort was less than 1250 subjects, discrepancies were observed between the results of the two studies. In addition, the standard error of the case-cohort study was higher than the cohort study. The results of both studies were similar in assessing the considered interactions.

Conclusion: The results are similar when the initial cohort sample sizes are sufficient. Meanwhile, unlike the percentage of exposure frequency, the outcome incidence has a negligible impact on the discrepancy between the results while the effect of the relative frequency of the exposure levels on the results discrepancy is noticeable.

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  Background & Objectives: Households governed by women have become an important phenomenon worldwide in the second half of the twentieth century. The study of female-headed households shows that this vulnerable social group faces many financial, physical, mental, and emotional problems and experiences stress and anxiety more than men-headed households. This study aimed to determine the quality of life in these households supported by District 9 of Tehran Municipality.

  Methods: This cross- sectional study was performed on female-headed households supported by District 9 of Tehran municipality during 14 months. Data collection tools included a demographic questionnaire, the Iranian version of World Health Organization Quality of Life (WHOQOL-BREF-BREF). The data was analyzed using SPSS software version 16 and descriptive- analytic tests such as mean, standard deviation, and a multiple regression analysis. The significance level in this study was considered α < 5% .

  Results : The mean age of the participants was 50.8 ± 13.8 years, and the majority of the female-headed households were unemployed (71.1 %). The findings in the four domains of quality of life showed that the domains of environment health and social relation received the lowest (9.87) and the highest (12.61) score, respectively. Using multiple regression models, it was shown that the only variables that affected the overall quality of life were age (P< 0.013) and current disease (P< 0.001).

  Conclusion : Findings demonstrated that the authorities should consider planning for effective interventions to improve the quality of life in this vulnerable group of society.

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Background & Objectives: Bovine Tuberculosis (BTB) is one of the most important zoonoses. Mycobacterium bovis is the responsible agent of BTB in the cattle. The current study was conducted to investigate the determination factors of BTB in dairy farms covered by the tuberculin screening test.

Methods: A herd level case- control study was carried out in 124 (62 cases & 62 controls) dairy farms in the provinces of Tehran, Alborz, Hamedan, Isfahan, Qazvin, Qom, Mazandaran and Semnan. The control farms were individually matched with case farms by farm capacity and distance. Statistical analyses were done by Stata 11.2 using conditional logistic regression.

Results: Proper management of manure (OR=0.12 95% CI: 0.03-0.49), regular flaming of stalls (OR= 0.21 95% CI: 0.04-0.92) and complete fencing around the farm (OR= 0.17 95% CI: 0.03-0.81) decreased while the presence of rodents (rat) (OR= 4.90 95% CI: 1.04-23.01) increased the risk of infection. The interaction among these variables was not statistically significant

Conclusion: According to the results, there is an essential need to pay more attention to rodent control in farms.

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  Background and Objectives : In the current age, due to the increasing growth of knowledge and competition therein, evaluation of scientific products by means of scientometric methods has become a very important and necessary subject. Scientometrics, in simple words, is the science of measuring the knowledge. Scientometric indices are divided into three categories: productivity metrics that measure the productivity of the researchers or research groups, impact metrics that assess the quality (or performance) of journals, researchers, or research groups, and hybrid metrics that are used to summarize both productivity and effect metrics in one index. Scientometric studies help policy makers and managers of universities and heads of research centers in allocating budget, creating a balance between the budget and costs, making appointments, and promoting the researchers and institutes, and results in better recognition of weaknesses and strengths of their affiliated groups by evaluation of priorities, perspectives, and capacities. Meanwhile, this new knowledge can help with systematic evaluation and ranking of universities and research centers. This paper provides a review on scientometric concepts and its applications and discussed scientometric indices.

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  Background & Objectives : Gastric cancer has a low survival and remains a serious threat to the health of human life, especially in developing countries such as Iran. The present study was performed to estimate the main effective factors in the survival rate of patients with gastric cancer in the Province of Kohgilouyeh & Boyerahmad.

  Methods: All cases of gastric cancer in Kohgiloyeh and Boyerahmad recorded in Provinces of Fars and Kohgiloyeh and Boyerahmad cancer registry were enrolled in this study. The impact of the independent variables on the survival was estimated by single and multivariate Cox regression controlled for the probable confounding variables. Survival analysis was performed using Kaplan Meier curves, the log-rank test, and Wilcoxon test to compare the results. Analysis of the data was performed by SPSS 19, and P-values less than 0.05 were considered significant.

 Results: Among the 348 studied patients, 75.6% were male and the rest (24.4%) were female. In general, in this study, 1, 2, 3, 4, and 5-year survival rate of the patients was 37, 27, 20, 19, and 18%, respectively. By combining these end variables in regression models, three risk groups were identified. In the high risk group, the cumulative survival rate was 0% at the end of the fifth year.

 Conclusion: Execution of the down-staging program through public education, considering the low survival rate in this province seems essential especially for high-risk groups such as farmers, ranchers and regional nomadic populations.

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Background & Objectives: Some studies on chronic diseases have indicated that obesity may result in a paradoxically longer survival. The present study was aimed to investigate the effect of Chronic Kidney Diseases (CKD) and Metabolic Syndrome (MetS) on the incidence of Coronary Heart Disease (CHD).

Methods: In order to record time to CHD events, a sample of 6,507 individuals (mean age 47.4 years, 43.4% males) was followed for nearly 10 years. Participants were also categorized into four groups according to presence/absence of CKD and MetS. Then, using a Multivariate Cox Regression, the Hazard Ratio (HR) of each group was estimated relative to individuals free of both CKD and MetS separately for obese (BMI&ge27.1 Kg/m2) and non-obese persons (BMI<27.1 Kg/m2).

Results: HR for non-obese patients with CKD but not MetS was obtained 2.06 (95%CI: 1.28-3.31) in men and 2.56 (1.04-6.31) in women. However, these associations were not significant for obese patients. Furthermore, among non-obese men and women with MetS alone, HR was estimated 2.52 (1.71-3.73) and 4.68 (2.20-9.95), respectively. For obese patients, these values were 1.70 (1.05-2.78) and 1.90 (1.16-3.13), respectively.

Conclusion: The results reflect that among those who had MetS alone, the risk of CHD incidence was twice higher in non-obese individuals compared to obese patients.

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Background & Objectives: Considering the importance of CVD risk factors in diabetic and non-diabetic populations and the high prevalence of diabetes and cardiovascular risk factors, we studied the trend of anthropometric indexes, blood pressure, smoking and lipids in diabetic and non-diabetic populations.

Methods: The data of Tehran Lipid and Glucose Study was used in this investigation. The study population comprised 1045 diabetic and 5136 non-diabetic subjects. To investigate the secular longitudinal trends, the Generalized Estimation Equation method was employed. All statistical models were adjusted for age to eliminate the potential confounding effect of age. The interaction between the diabetes status and each phase of the study was checked in a separate model in GEE.

Results: Over a decade, the serum levels of TC, TGs, LDL-C and non HDL-C decreased although about 60% of the diabetic population did not reach the therapeutic goals of non-HDL-C and LDL-C levels until 2011. Control of hypertension was more successful in females, but about 60% of both males and females with diabetes were still hypertensive at the end of follow-up period. Smoking increased during the follow-up.

Conclusion: This study showed that among CVD risk factors, healthcare professionals paid more attention to hypercholesterolemia neglecting other risk factors including hypertension and central obesity.

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Background & Objectives: The aim of the study was to determine age, period, and cohort effects on trend of alcohol and drug use in the students of Tehran University of Medical Sciences from 2006 to 2009.

Methods: Between 2006 and 2009, the students of Tehran University of Medical Sciences were surveyed annually using a structured self-administered and anonymous questionnaire. Intrinsic estimator, which is a new method for resolving linear dependency between age, period, and cohort in linear regression models, was used for data analysis.

Results: In the present study, in the descriptive method, the prevalence of alcohol consumption increased in males and females with an increase in age. The prevalence of illicit drug use was higher in 2007 in comparison with other periods for males and females. In the analytical method (intrinsic estimator), there were no age, period and cohort effects for alcohol and drug use for females. For males, the age effect exhibited an increasing-decreasing-increasing trend and period and cohort effects showed a decreasing trend for alcohol use. As for drug use, the age effect exhibited gradual increases. The period effect displayed an increasing-decreasing trend and the cohort effect exhibited an increasing-decreasing-increasing trend.

Conclusion: The IE method showed no age, period and cohort effects for alcohol and drug use in females. The prevalence of drug and alcohol use increased with an increase in age in males. The high prevalence of drug use could be due to easy accessibility and low price of drugs.

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Background and Objectives: Children immunization program is one of the most successful and most cost-effective public health interventions and medical programs. The study was designed and conducted in order to assess the vaccination coverage in areas covered by Tehran University of Medical Sciences (TUMS).

Methods: This study was a cross-sectional study of children aged 24 months to 6 years living in urban areas and high-risk and marginal areas covered by TUMS. Six hundred and thirty children were sampled in 90 clusters in urban areas and cluster sampling as probability proportional to size sampling was performed in high risk areas and a sample size of 768 children was determined. The questionnaires were completed by interview.

Results: In high risk 750 children (97.7%, 95% CI: 96.32-98.60%) and 616 children (97.8%, 95% CI: 96.3-98.78%) in urban areas had complete immunization histories. Furthermore, 98.4% of the Iranian children and 95.0% of foreign children (P=0.019) in marginal areas and 98.1% of the Iranian children and 92.1% of the foreign children (P=0.046) in urban areas had complete immunization histories.Ignorance of immunization program (%50) was addressed as the main reason for incomplete immunization.

Conclusion: Universal mass vaccination coverage of the children and equal coverage in marginal and urban areas indicated the success of the authorities in the implementation of this program. Organizing training courses for mothers on the immunization program, providing the required facilities and services, monitoring and supervision of vaccination and also considering the immunization status of foreign children seem to be essential in maintaining and improving the existing status.

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Background and Objectives: Q fever is a zoonosis with a worldwide distribution; this disease is a public health concern in many countries. The aim of this study was to determine the association between risk factors with Q fever seropositivity among veterinarians and vet staff in Southern Khorasan.

Methods: Questionnaires were prepared and 92 blood samples were obtained from all veterinary staff in the South Khorasan (East of Iran). The serum samples were tested with an indirect ELISA kit (anti body phase II); then, SPSS version 19.0 was employed to analyze the data using descriptive statistics and a confidence interval of 95%, chi-square test, and logistic regression.

Results: The results showed that 50 serum samples (54.35%) were positive and the results of data analysis with logistic regression indicated an association between seropositivity and contact with animal secretions and abortive materials. There was no correlation between seroprevalence and age, gender, work experience, education, use of unpasteurized dairy products, knowledge of disease, and clinical findings.

Conclusion: In conclusion, the present study showed a high seropositivity rate among vet staff which indicates that further attention should be paid to this disease in these groups.

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In epidemiologic studies, the measurement of characteristics of interest is almost always subject to random measurement error. This error and its effects are usually overlooked by researchers. One of its effects is a widespread statistical phenomenon that is well known as regression to the mean. This phenomenon occurs whenever an extreme group of people is selected from a population based on their measurements of a variable. If a second measurement is taken in this group, the mean of the second measurement will be closer to the mean of the population.  In interventional studies, this increase (decrease) might be regarded as the effect of intervention, when in fact it has had no effect. Ignoring regression to the mean will lead to the erroneous conclusions and interpretation of the results of epidemiologic studies and affects the decisions in evidence-based medicine and planning for preventive and public health measures. This paper highlights the importance of this problem and its effects in epidemiologic studies and the ways to avoid it.

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Background and Objectives: Ahvaz has become one of the most polluted cities in the world. Only on 11 November 2013, over one thousand residents in Khuzestan Province attended the nearest health center with severe symptoms, particularly shortness of breath, cough, wheezing, and high blood pressure. During a week, more than 7 thousand patients were registered with this syndrome. This study was conducted to investigate the evidence for the confirmation of an epidemic in acute respiratory syndrome among the residents of Ahwaz in November 2013.

Methods: In this cross-sectional study, we evaluated the data of the use of drugs related to acute respiratory attacks from November 2008 to 2013 in Ahvaz. Then, we conducted a descriptive study on the general population. The sample size was 120 and the study participants included different segments of the general population. The data collection tool was a researcher-made questionnaire and the data were analyzed using SPSS.18.

Results: The use of the respiratory drugs increased from 2008 to 2013. The drug consumption was markedly higher in November 2013. In the study of the general population, 93% of the participants declared that they had never seen a similar event, and 92.5% mentioned that they had never heard of a similar occurrence.

Conclusion: Due to the significant increase in respiratory medicine in November 2013 and the unexpected nature of the event, an epidemic seems to be obvious.

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Background and Objectives: Cutaneous leishmaniasis (CL) is a public health problem in Iran and Kerman Province which is expanding to new foci. This study was conducted to estimate the incidence of CL by a simple and cost – effective method in a major focus of CL in the city of Kerman, southeastern Iran.

Methods: A combination of two longitudinal and cross – sectional studies was performed. First, the frequency of referred patients to the CL treatment clinic in 2009-2014 was assessed. Then, four highly infected zones consisting of 800 households in the city were selected. In addition, the relative proportions of referred and non – referred subjects were assessed. Eventually, the incidence of CL was calculated by dividing the number of CL cases over the total at risk population for the corresponding period (2009-2014).

Results: The mean annual incidence was 175 per 100000 (943 patients) in the city of Kerman, while it was 500 per 100000 people (0.5%) in the new foci. The highest CL infection was observed among the <25-year-old individuals but there was no significant difference between the sexes.

Conclusion:The incidence rate probably increased significantly following the 2003 Bam earthquake because of the migration of CL patients to southern, eastern, and northeastern areas of the city of Kerman. Since only 50% of the cases were passively referred to the CL treatment clinic, health authorities should actively detect CL cases by house – to – house visit for effective treatment strategies.