Iranian Journal of

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Background & Objectives: The objective of this study was to determine self efficacy, perceived benefit/ barriers to exercise of students in Hormozagan University of Medical sciences (HUMS).
Methods: This was a cross-sectional study. Using stratified sampling, 350 current students of HUMS were studied from November to December 2007 in Bandar Abbass, Iran. Data regarding self efficacy, perceived benefits/barriers to exercise among participants were assessed through Exercise self efficacy scale and Exercise Benefits/Barriers Scale. Data were analyzed by SPPS version 13.
Results: In all, the data of 249 participants with mean age of 21.7 ± 2.7 were analyzed. Among them 65 participants (26.5%) including 36 girls and 30 boys were doing physical activity. Mean scores of self efficacy, perceived benefits, perceived barriers were 23 ± 7.1, 96 ± 12.5 and 31.9 ± 6.1, respectively. There were statistically significant relationship between self efficacy and perceived barriers with physical activity (P<0.05).
Conclusions: This study revealed perceived barriers such as insufficient time, money and also tiredness due of exercise could decrease physical activity. However perceived self-efficacy and encouraging by friends and family members have a key role of doing regular physical activities.

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Background & Objectives: This study aimed to determine of the seroprevalence of visceral leishmaniasis to design a prevention and control program in Bojnoord district.
Methods: This was a descriptive and cross sectional study with multistage random sampling method. The study was carried out on children up to 12 years old and 10% of adult’s population in 8 rural areas of Bojnoord district in 2007. In total, 1608 blood samples were collected to detect anti-Leishmania antibodies. All the samples were tested by direct agglutination test (DAT). In order to determine Leishmania species, necropsy was performed on four suspected dogs in the studied areas. The species of Leishmania was determined by RAPD-PCR and PCR-RFLP methods using to amplify the ribosomal internal transcribed spacer 1 (ITS1).
Results: Thirty and eight (2.36%) out of 1608 collected blood samples had anti-Leishmania antibodies at titer 1:800 and nine (0.56%) were just positive at 1:3200 by DAT. There was no statistically significant difference between female and male seroprevalence (p<0/05). The seoprevalence in children <=12 years old compared to individuals greater than 12 years old did not show any statistically significant (p<0/05). Amastigotes were observed in all 4 necropsied dogs. The species of Leishmania isolated from 2 dogs, was determined as L.Infantum. Their ITS1 sequences were registered with Accession numbers EU810776 and EU810777 in NCBI.
Conclusions: These findings showed that visceral leishmaniasis has been circulated with low endemicity in Bojnoord district. Therefore an appropriate monitoring system is needed for health services in this area.

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Background and Objectives: The aim of this study was to assess the geographical distribution of Congenital Hypothyroidism (CH) in Iran using Geographic Information System
Methods: The incidence of Congenital Hypothyroidism in each city and province calculated based on national CH screening program and then the map of its distribution was depicted. The spatial distribution of CH was assessed in each city by employing binominal test and Hotspot Analysis. The map of distribution of CH was drawn by ArcGIS version 9.2 software.
Results: The national incidence of CH (including both transient and permanent types) has been estimated 2.2/1000 in screened new borne babies. The distribution of CH seems more or less equally around the country and its spatial variation was not statistically significant. We did not find any specific CH Hot Spot in Iran.
Conclusions: We did not find any particular explanation for high incidence of CH is Iran geographically therefore other explanations for such a high risk in screened neonates should be investigated including the non-environmental factors and factors related to quality of screening program in Iran.

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Background and objectives: Although in many developed and developing countries, self care is the most important part of primary care, in Iran it has not been supported as well as its values. The aim of this study was to assess the views of general people living in south of Tehran about self care.
Methods: This was a population based study in which 1200 individuals aged 15 years and over were interviewed using cluster sampling. A structured interview questionnaire which including 5 sections on regarding demographic characteristics, views on general health, views on self care knowledge, interest and practice, views on barrier and enabler factors for self care, and views on sources of information was used. Content validity and cronbach’s alpha coefficient was used for its validity and reliability. Data were analyzed through spss version 11.
Results: The mean age of participants was 27.9 ± 5.2 years. Six hundred and fifty eight respondents (55%) stated they were not knowledgeable on self care, 986 (82%) and 1035 (86%), were interested and self rated themselves active regarding healthy life style, respectively. In practice, only fifty three participants (4%) were actually active in eating ≥7 glasses of water daily, 31 (3%) stated they ate more than five portions of fruits daily and 51(4%) did physical activity more than 3 hours weekly.
Conclusions: The findings of this study have highlighted the significant role of information in doing self care activities.

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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 & objectives: In the management of crush syndrome, the way of treating compartment syndrome is controversial. The aim of this study was to evaluate the outcomes of compartment syndrome treatment after Bam earthquake.
Methods: Clinical and laboratory findings of all fasciotomized patients in Bam earthquake were analyzed. Then nonfasciotomized patients with same characteristics were selected and the outcomes of two groups were compared.
Results: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.
Conclusions: Fasciotomy for 107 injured out of 2962 hospitalized patients, was performed (46% female). Mean age of fasciotomized patients was 27.4±9.7 years (min=10, max=65 year). There were not significant differences in the final outcome of two groups with the same clinical, biochemical and demographic characteristics.

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Background & Objectives: Medical Tourism has been recently paid more attention. Individual practitioners and medical organizations must be able to provide accurate information about this rapidly evolving trend. Since there has been little known about this issue, we decided to assess the knowledge about and attitude towards medical tourism in Rafsanjan, Iran.
Methods: A questionnaire including XXX questions were completed by Rafsanjan Medical University staff. All information was analyzed by SPSS software.
Results: Only 8.3% of individuals sated that they studied some articles about Medical Tourism, and only 14.7% of them had deal with these kinds of patients. The majority of participants (80.7%) hadn’t had any idea about the quality of medical expenses by Medical Tourists. Mainly (68.7%) believed that development of Medical Tourism in Iran would not have any bad social consequences and 62% believed that its development in Iran could improve the knowledge of Iranian doctors. The majority (67.3%) agreed to arrange for inviting tourism to Iran in order to use of Medical Tourists and 54.3 of them believed that development of Medical Tourism could improve treatment of Iranian patients.
Conclusions: The knowledge of participants seems is very low therefore appropriate educational programs should be tailored by responsible organizations in Iran. However medical staff’s attitude towards medical Tourism seems is very positive which indicates having necessary potential for any activity in this regard in future.

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Background & Objective: First aid education constitutes a major priority area for the Iranian Red Crescent. The present study assessed the student volunteers' knowledge of first aid procedures and their attitudes concerning strategies for community education.
Methods: In this survey 5626 volunteers were selected based on a complex sampling design, in 5 different provinces of Iran.
Results: A total of 3581 students (63.7%) had attended the Red Crescent's first aid training courses. The mean knowledge score of the sample was 9.36 out of a maximum of 18 (CI 95%= 9.29-9.43), with only 674 subjects (11.9%) showing a high level of knowledge. Having training prior attending in this course and higher education were statistically significant related with their knowledge score (p<0.05). The mean score of their attitude was 33.60 out of a maximum of 45 (95% CI = 33.41-33.79), and only it was found to be related to previous training (p = 0.04).
Conclusion: IRCS should expand its first aid training for young volunteers. This health educational programs should be supported by multidisciplinary work by governmental organizations such as ministry of education.

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Background & objectives: Head injuries are the most sever kind of injuries in accidents. It is an important factor of disability in society. Having information about present situation and its determinant factors is the first step of programming for head injury reduction. This survey aimed to have an epidemiological aspect of head injury in Arak.
Methods: Relevant informations about severity of the impact, causes, demographic information and treatment results were extracted from medical files between 2005-2006 years.
Results: Of total 1105 patients with head injury 25.8% were in their first decade of life and 11.8% were reported as sever head injury. The most common injuries (18.4%) caused by downfall from low height. Men had more head injured 64.7% compared with women. In the period of hospitalization 12.8% of moderate head injuries and 43.1of sever head injury caused to death.
Conclusions: It is concluded that applying and administration of the safety rules in the society as a compulsory rules and educating by mass media, are necessary. It should also be taken into account more effective hospital care for sever head injuries to reach better outcomes.

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Background & Objectives: Food security (access to safe, nutritious, affordable food) is one of the important determinants of health status in human life. Since monitoring and assessing of associated factors to food security are essential for health planning, this study has tried to determine household food security status and food consumption amongst high school student families in Esfahan, Iran.
Methods: This cross-sectional study was conducted in autumn 2008 on 580 high school 14-17y students of Esfahan, Iran using a systematic cluster sampling. Food security and food frequency questionnaire were completed by interviewing mothers and students.
Results: The prevalence of household food insecurity was estimated as 36.6% (95%CI: 33-40%). Household food insecurity was positively associated with frequency of some food group intakes among students, including bread macaroni potato legume and eggs (P<0.05). In addition, negative associations were observed between food insecurity and frequency of other food group intakes including rice, red meat, sausage and hamburger, poultry, fish, green vegetables, root and bulb(colored) vegetables, melons, banana, pineapple, coconut, mango, apple, orange, milk, and yogurt (P<0.05).
Conclusion: The results of this study indicate that food insecurity is prevalent among (students) households in Esfahan. In addition, students living in food-insecure households more frequently consumed cheap foods containing high energy per kilogram. Therefore, appropriate nutritional programs should be designed to improve the quality of household food consumption.

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Background & Objectives: The experience of patients with breast cancer may vary in different cultures. The aim of this qualitative study was to explore the experiences of women with breast cancer in Iran.
Methods: Fifty one participants were recruited from a university-affiliated breast clinic in Tehran. In-depth interviews each lasting approximately one hour per participant were scheduled and conducted in a private room. The interviews intended to motivate the participants to reflect on their life experiences since the cancer diagnosis. The interviews were tape-recorded and were transcribed to elucidate the major themes encountered in the interviews.
Results: The mean age of patients was 48.8 years (SD = 10.5), 44 were married, one was single, and six were widowed or divorced. Forty-eight participants underwent radical mastectomy and 13 patients received breast-conserving surgery. Thirty-five (69%) patients received chemotherapy. Overall eight major themes emerged from the analysis. These were: importance of God and spiritual beliefs, importance of family support especially husbands and children during the diagnosis and treatment, difficult times during receiving mammography results, experiencing an ambiguous condition while losing their breasts, fear of recurrence, concerns about children, and chemotherapy as the worst experience during the course of treatment.

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Background & Objectives: Although it is important to study the association between caregiver burden and individual with dementia, a little has been paid attention to this issue in Iranian population therefore the aim of study was to investigate the frequency of psychiatric symptoms and patients with dementia and caregiver burden associated with individual with dementia.
Methods: In this study 84 patients who had referred to Iran Alzheimer’s Association, along with their caregivers were included in our study. Iranian Version of Caregiver Burden and NPI questionnaires were employed. Factors affecting factors on burden was analyzed by multivariate linear regression.
Results: Our findings showed that there was at least one psychiatric disorder in all patients. Among all psychiatric symptoms delusion and elation had the highest and lowest rates with 39.3 and 2.4 percentages, respectively. Linear regression indicated that “indifference” and “irritability” symptoms were the effective psychiatric symptoms on the amount of burden placed on the caregivers.
Conclusion: The symptom frequency of irritability and other symptoms showed a statistically significant positive correlation with caregiver's NPI-D score. These findings suggest that improvement of treatments for delusions, irritability among dementia patients may reduce caregiver burden.

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Background & Objectives: The city of Jask in south east of Iran has been considered an endemic focus of leishmaniasis. PCR-based techniques can detect lower parasite burdens, reducing the number of false negatives and improving the quantification of Leishmania parasites in the sand fly. The aim of this epidemiological study was to detect vector(s) by PCR techniques in the city of Jask located in Hormozgan province.
Methods: Sand flies were captured using CDC miniature light traps and sticky papers during 2007-2008 and identified by their morphology. DNA extraction performed by Proteinase K and Phenol/Chloroform/Isoamyl Alcohol methods. Leishmania kinetoplast minicircle DNA was amplified by two Nested-PCR techniques using species-specific primers (LINR4-LIN17-LIN19) and (CSB1XR-CSB2XF-LiR-13Z).These primers could differentiate among Leishmania species of Iran.
Results: A total of 8123 sand flies were collected. The fauna was identified as eight species (3 Phlebotomus and 5 Sergentomyia). Phlebotomus papatasi, P. salehi and Sergentomyia theodori were the three most dominant species (59.91%, 17.21% and 7.32% respectively). 60, 50 and 40 parous unfed female specimens of P. papatasi, P. salehi and S. theodori were investigated for Leishmania DNA infection. Leishmania major DNA was detected in 3 (5%) specimens of P. papatasi and 2 (4%) specimens of P. salehi. Anthropophilic index of these two species were 29.6 & 18 percent, respectively.
Conclusion: This study was the first molecular study for detection of cutaneous eishmaniasis vectors in Hormozgan province in Iran. According to the findings of the present study P. papatasi and P. salehi are probable vectors of cutaneous leishmaniasis in this focus.

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Background & Objectives: Non-Communicable disease (NCD) is a main group of diseases which are responsible for a large proportion of the Global Burden of Disease around the world. Although disparities in the NCDs' risk factors can affect the goals of health for all, less attention has been paid so far on this topic. In this study, we investigated socio-economic inequality in the NCDs’ risk factors and evaluated the causes affecting on this inequality in Shahroud, Iran.
Methods: Conducting this survey, we used surveillance data for NCD of 1000 individuals who lived in Shahroud district during 2005. We determine a socio-economic variable which explained social and economic status of the people using Principal Component Analysis. We then evaluated each NCD risk factors at different levels of the socio-economic variable and calculated concentration index for the risk factors. The causes of the inequality were described by decomposition analysis of the concentration indices.
Results: Concentration indices for hypertension, smoking, insufficient physical activity, and unhealthy diet were -0.141, -0.191, -0.046 and -0.091, respectively. Differences of concentration curves of the risk factors from the line of equality were significant but not for diabetes, obesity and high blood cholestrol. Age, being a government employee, being unmarried, living in rural area and low economic status were the most important factors which influence on these inequalities.
Conclusion: Inequality in some NCD risk factors was significant in Shahroud district. More investigations with larger sample size and more appropriate variables to measure socioeconomic status are recommended.

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Background & Objectives: To assess vision related quality of life and determinants in patients afflicted with chronic eye disease.
Methods: In this analytical cross-sectional study, consecutive sampling was performed at Noor Eye Hospital between 2008 and 2009. A valid and standard 39-item visual functioning questionnaire (National Eye Institute visual functioning questionnaire, NEI-VFQ 39) was completed. The questionnaire consists of 11 domains related to vision and one domain about general health. The total score range from zero (0) to 100, where a higher score reflects better vision related quality of life. The independent t-test, pearson correlation coefficient as well as simple and multiple linear regression models were employed for statistical analysis.
Results: The mean overall score in patient and control groups were 54.5 [95% confidence interval (CI) 57.3 - 71.8] and 96.0 [95% CI: 88.2-103.9], respectively. Patients with cataracts had the highest score (64.6 95%CI: 57.3 - 71.8) and those with visual acuity of 20/70 or worse showed lowest scores (41.9 95%CI: 30.7 - 53.1). Age (P=0.006) and education level (0.001) were associated with quality of life score.
Conclusion: Based on our study findings, it could be concluded that low vision patients with a visual acuity of 20/70 or worse hardly received half of the total scores. Diabetic retinopathy, age related macular degeneration, glaucoma, and cataract stand in ascending rank order. The relatively lower scores as compared to results from other countries warrant further research into the causes of such differences.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Human papillomavirus (HPV) infection seems to be the most common sexually transmitted infection. High-risk (HR) human papillomavirus (HPV) prevalence has been shown to correlate well with cervical cancer incidence rates. Since there is little known about the epidemiology of this infection in Tehran, we designed to estimate the prevalence of HPV in some areas in Tehran. 
Methods: Cervical specimens were obtained from 825 married women aged 21-59 years from the general population of Tehran, Iran according to the standardised protocol of the IARC International HPV surveys. HPV was detected using a GP5+/6+ PCR-based assay.
Results: HPV prevalence in the general population was 7.8% (5.1% of high-risk types), with no statistically significant variations by age. Cervical intraepithelial neoplasia was diagnosed in 4.1% of women, of whom 35.3% were HPV-positive. HPV16 was confirmed as the most common type among women with both normal (1.8%) and abnormal (8.8%) cytology. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husbands' extramarital affairs.
Conclusion: However the prevalence of HPV seems not high in comparison with other international data, more molecular and seroepidemiological survey in national level needs to have a better perspective.

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Background & Objectives: Brucellosis is a zoonotic infection transmitted from animals to humans by the ingestion of infected food products, direct contact with an infected animal or inhalation of aerosols. This study aimed to describe the trend and to assess the effect of livestock vaccination rates on reported brucellosis in human across Iran.
Methods: Trends in the epidemiology of human and animal brucellosis in Iran were investigated by analyzing national surveillance data between 1991 till 2008.
Results: The average annual incidence of human brucellosis was 43.24 per100000 population. On average, approximately 27500 new cases have been reported in the country. There was a fall in the incidence rate of Brucellosis over recent years(r=-0.79, P<0.001). In different provinces there was a significant association between the annual incidence of human brucellosis and the annual infection rate of sheep and goats
(r =0.347, P<0.001), the annual incidence of human brucellosis and the annual infection rate of cattle (r =0.327, P<0.001) and the annual incidence of human brucellosis and the percentage of vaccinated cows (r=0.098, P=0.031).
Conclusion: As the prevalence of human brucellosis depends closely with the prevalence of brucellosis in animals, control of the disease in human population needs the cooperation between different public health organizations.

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Background & Objectives: Earthquakes cause thousands of deaths and injuries worldwide every year. Islamic Republic of Iran has a deadly history of earthquakes. The aim of this study is to describe injuries rate, causes of injuries, structural characteristics of buildings and occupant actions immediately after earthquake in Damghan in 2010.
Methods: This case-study was conducted one week after occurring the earthquake in five villages of Damghan city in Iran. We used the Physical Injuries Assessment Questionnaire which was particularly designed for injuries after earthquakes. Also for acquiring information about region and amount of losses, some interviews was conduct with local authorities.
Results: Four death and fifty six injuries occurred in five villages of Damghan city. There were three types of injuries including superficial injuries (50%), contusions (35%) and fractures (10%). The findings of this study indicating building structural failure (87.4%), nonstructural factors (7.1%) and trapping (5.3%) seems the most possible cause of injuries in this region.
Conclusion: This study showed that the building structural failure is the main cause of injuries (87.4%). Increasing structural resistance of building especially in village regions and education about earthquake preparedness should encourage in order decreasing the total number of people affected by earthquake.

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Background & Objectives: The economic costs of cancer care are a burden to people diagnosed with cancer, their families, and society as a whole. Despite several studies about cancer in Iran, there is paucity of cost analysis in this area. The aim of this study was to estimate the cost of cancer subgroups in Kerman, Iran.
Methods: A retrospective analysis of administrative 223 diagnosed patients with different cancers was undertaken.
Results: Monthly average cost of cancer was 3.32 thousand US dollars (average exchange rate in 2010: 10308 Iranian rials= 1 US dollar). Breast cancer, with an average 4.30 thousand US dollars per month was the most expensive and cancer of male reproductive organs with average2.16 thousand US dollars were the cheapest cancer.
The hidden monthly cost of all types of cancer was 2 thousand US dollars, breast cancer, lung, blood and female reproductive organs were costly and brain and peripheral nerves cancer, gastrointestinal tract and prostate were medium and male reproductive organs cancer was less costly.
Conclusion: Economically impact and burden of cancer should be an important consideration in the health policy making in Iranian health service system.

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Background & Objectives: Sleep quality is an important factor in student life and affects in their learning process. Sleep problems are related to increased health concerns, irritability, depression, fatigue, attention and concentration difficulties, along with poor academic performance. The aim of this paper is to conduct a survey based on a questionnaire that would characterize the quality of sleep in students living in dormitories of Tehran University of Medical Sciences (TUMS).
Methods: We conducted a cross-sectional study using the stratified random sampling approach on 277 students residing in dormitories in Tehran. A demographic questionnaire and Pittsburgh Sleep Quality Index (PSQI) were used for data collection.
Results: Mean (CI) of PSQI in students was 8.57 (8.10- 9.04). Using the cut-off score of 6 for the PSQI global score, 73.3% (68.1%-78.5%) of students were described as poor sleeper. Female students had a worse quality of sleep compared to male. The mean duration of sleep in students was 5:15´± 105´ (hours). This was significantly higher in male students than female students. There were no significant relationships between demographic variables such as age, academic level, marital status and family income with and quality of sleep.
Conclusion: This study showed that poor sleep quality is prevalent among students living in dormitories of TUMS. Therefore it is necessary to provide effective educational interventions for this group in order to improve the quality of sleep.