Iranian Journal of

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Background & Objectives: Exclusive breast-feeding during the first 6 months of life is the best type of nutrition for the infants in terms of fulfilling their its physical and emotional needs. The incidence of many kinds of infection decreases with breast-feeding. The aim of this study was to determine the prevalence of exclusive breast-feeding infants aged less than 6 months in Mash'had and to look at some factors that affect breastfeeding.
Methods: This population-based survey used a stratified cluster sampling method to draw 30 clusters containing a total of 1450 infants aged 7-12 months. Data collection was performed using both questionnaires and interviews with mothers. Exclusive breast-feeding was defined as nursing through the first 6 months of life without any other food intake except drugs and vitamin supplements.
Results: The study achieved a response rate of 87.4% in mothers 51.2% of the infants were male and the remaining 48.8% (618) were female. The overall prevalence of exclusive breast-feeding during the first 6 months was 56.4% with (95% CI: 49.7%-63.2%). The figure was 57.2% (95% CI: 49.9%-64.4%) for boys and 55.7% (95% CI: 48.7%-62.6%) for girls. In this survey, 91.7% of the infants (95% CI: 88.7%–94.7%) had received breast-feeding immediately after birth. In multiple logistic regression analysis, the mother's age, her awareness of the adequacy of her milk, and advice from others to use formulas were the factors that had a significant relationship with breast-feeding in the first 6 months.
Conclusions: Almost 43% of infants had received alternative nutrition such as family food or formula. Considering the important effect of breast-feeding, provision of educational programs by the Health Ministry to raise the mothers' awareness of breast feeding can be a priority in children's health.

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Background & Objectives: Men (husbands) play a very important role in family planning programs, especially in developing countries. The objective of this study was to determine the prevalence of different methods of contraception in women of reproductive age in Iranshahr in 2004-2005 and the extent of their husbands' participation in family planning.
Methods: This was a cross-sectional study focused on women who were married but not pregnant at the time of the research. We used multi-stage cluster sampling and a pre-tested questionnaire to record the method of contraception and to see if the husband was actually participating in family planning. We used the SPSS (13th version) software to calculated measures of location and dispersion.
Results: The total sample of 700 married women in the (10-49y) age group included 400 subjects in rural areas and 300 in cities. Of these, 696 agreed to take part in the research. Overall, 65.5% of these women were using at least one form of contraception the remaining 34.5% did not use any contraceptive methods. The percentage of unwanted pregnancies was estimated at 16%. The mean number of pregnancies was 7, with a median of 4.5. Sixty-three percent of the subjects reported good cooperation by their husbands. Logistic regression analysis showed that the probability of using contraception was significantly related to the husband's cooperation.
Conclusions: Our results underline the importance of men's support and cooperation in the success of family planning efforts.

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Background & Objectives: This research focused on estimating the mean of Neurological Soft Signs scores in children with Attention Deficit and Hyperactivity Disorder and comparing them with normal children.
Methods: We evaluated 25 children with Attention Deficit- Hyperactivity Disorder in the age group of 7-12 years (mean age: 10.16 ± 1.5y) using the DSM-VI Attention Deficit – Hyperactivity Disorder Questionnaire, Conner’s Parents’ Rating Scale, and the 28-item NES Questionnaire. There was no significant age difference between cases and controls. The mean total NES score was 11.4±4.14 in cases and 5.6± 2.79 in controls (P< 0.0001). Compared to the control group, the cases had significantly more problems with the glabellar reflex, rapid alternative movements and right-left discrimination.
Results: Soft Neurological signs are observed with greater frequency among children with ADHD compared to normal subjects and the difference is more significant in certain domains such as rapid alternative movements, right- left confusion, and glabellar reflex.
Conclusions: Considering the relatively high frequency of soft neurological signs in children with Attention deficit- Hyperactivity Disorder, earlier diagnosis and treatment of the disease might be possible through careful neurological examination.

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Background & Objective: Disability-Adjusted Life Years (DALY) summarizes the fatal and nonfatal outcomes of diseases and injuries in one number and gives a quantitative assessment of the health of a population. Estimating the burden of diseases and injuries in Iran in terms of DALY both nationwide and in 6 provinces.
Methods: We used slightly modified versions of the methods developed by the World Health Organization for estimating the burden of premature mortality, disability, and the DALY.
Results: The DALY rate per 100,000 was 21572 and 62% of this was life lost due to premature mortality the remaining 38% was due to disability from diseases and injuries. Fifty-eight percent of the total DALYs had been lost due to non-communicable diseases, 28% due to external causes (injuries), and 14% due to communicable, maternal/ perinatal and nutritional illnesses. The group of diseases and injuries with the highest burden in males waz intentional and unintentional injuries (2.789 million DALYs), while in the female population this position was held by mental disorders with 1.191 million DALYs. The single most important cause of burden was traffic accidents in males and ischemic heart disease in females. Disease burden showed considerable variability between different provinces.
Conclusion: The profile of health and disease in Iran has generally shifted from the predominance of communicable, maternal/perinatal, and nutritional illnesses towards predominance of non-communicable diseases and injuries at the national level. These figures on disease burden at population level are the most objective evidence that can be used in policy making and management of health programs, health research, and resource development within the health sector.

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Background & Objective: Malnutrition is one of the main nutritional problems among children under 5 years especially in developing countries. The effects of malnutrition in this range of age group includes disorder of mental and physical growth and development, increase in the morbidity and mortality, decrease of the learning capacity. A detailed epidemiological picture of the prevalent malnutrition status among children under 5 years in different regions of Iran enables health policy makers to identify priorities, establish political commitment and design appropriate interventional programs to prevent and control malnutrition and improve nutritional status of children. To determine the prevalence rate of malnutrition among children under 5 years.
Methods: Demographic data, weight and height of 34200 Iranian children between 0-72 months old in 28 provinces of the country in 2005 year based on a cluster sampling were gathered. The subjects' weight and height were measured by trained staff. Prevalence of underweight, stunting, and wasting indicators was determined by measuring the weight and height of subjects in urban and rural areas. EPI6 statistical software, version b6/04, was used for all statistical analyses.
Results: 4.7% of the children aged less than five years suffered from stunting (95% CI: 4.5- 4.9%) The prevalence of this type of malnutrition among urban children is significantly less than rural children (95% CI: 3.1- 3.5% and 6.5-7.1% respectively). Meanwhile the prevalence of underweight was 5.2% in the country (95% CI: 5.1-5.4% while the prevalence of this type of malnutrition was significantly less among urban children than those in rural ones. Moreover, the prevalence of wasting was 3.7% (95%CI: 3.5-3.9%) and there was a significant difference in this regard between the urban and rural children. Thus this indicator was significantly higher among urban children than those in rural areas (95%CI: 3.8-4.3% and 3.0-3.5% respectively).
Conclusion: The results of the study show that the prevalence of protein-energy malnutrition was low among Iranian children under five years old. In comparison with previous studies, it is felt that there has been a prudent decrease in all malnutrition in all levels. However, there were significant differences in the prevalence of malnutrition in different provinces, which has resulted in the differences in their developmental stages as well. It appears that subjective strategies are required to improve the nutritional and health status among children under five in all provinces.

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Background & objective: In Iran, cutaneous leishmaniasis (CL) as a health problem is increasing and presenting two epidemiological forms Zoonotic CL (ZCL) and anthroponotic CL (ACL). The objective of the present study was to introduce the CL epidemic in Baft district, Kerman province.
Methods: This study was conducted in 3 villages Soltanabad, Vakilabad and Shahmaran as a census between spring and autumn of 1998 in Orzoeihe region, Baft district. Various epidemiological aspects of this epidemic including prevalence and related demographic factors, diagnosis by direct smears, identification of the causative species by immunological and biological methods were determined.
Results: Population of the 3 villages was 13721 mean 21.8±13.9 years, 50.7% males and 49.3% females.. The prevalence rate of 12.3% with mean age of 16.3±12.1 years were infected. Most of the cases were in 10-20 years of age and in Soltanabad (30.6%). The mean number of lesions was 2.58, majority with ≥2 lesions, frequently located on the legs and hands. No previous history of CL scar were observed. All 100 IFAT, 30 ELISA tests and 18 inoculated mice showed L.major as the overall causative agent.
Conclusions: This is the first epidemic of CL occurred in the southern villages of Baft district with high severity in all age and sex groups in a new agricultural region. Probably the source of infection was the new comers who arrived the region from endemic areas for agricultural purposes and infecting the gerbils. Thus, this new agricultural development has created an extraordinary suitable condition for propagation of rodents and sand fly populations, then the occurrence of the new epidemic in rural residence, consequently.

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Background and objective: Acute myocardial infarction (AMI) is the most prevalent cause of mortality in the world today. Sometimes before an acute phase of AMI there are certain prodromal symptoms. Since there are some social and cultural differences in Iranian population, this study was deigned to investigate the prodromal symptoms in patients with AMI in city of Birjand.
 Methods: In this analytic-descriptive research, 165 patients with first AMI who were hospitalized in the CCU and cardiac ward of the Valiassr Hospital in Birjand from the 2006-2007 were studied. A valid questionnaire which was designed by expert cardiologists was used. The T-test and ANOVA were used for data analysis, and p<0.05 was considered as the significant level.
Results: Among 165 subjects, there was 118 (71.5%) males and 102 patients (61.8%) had Anterior MI. 61 patients (37%) reported cardiac prodromal symptoms and 43 patients (26.1%) reported systemic prodromal symptoms. The most common cardiac prodromal symptom 2 days before AMI was chest pain in the right and left hemithorax (24.2%), and the most common systemic prodromal symptom was loss of appetite (12.7%). Women reported more cardiac (p=0.04) and systemic (p=0.00) prodromal symptoms than men. This difference was statistically significant (p <0.05).
 Conclusion: Careful attention to history and prodromal symptoms in patients with cardiac risk factors may be caused early diagnosis, efficient treatment plan and better prognosis of AMI in patients.

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Background & Objectives: Self-poisoning is one of the oldest and most common forms of self-harm and a frequent incident of referring to hospital poisoning wards. Especially for cases involving suicidal intention, incidence and secular trends are closely related to the types of drugs and substances available.
Methods: This research was conducted in 2004 to examine the epidemiology of attempted suicide by poisoning and the total case load of hospital poisoning wards. The study involved 723 poisoning cases in major referral hospitals located in cities of Tehran, Shiraz, Tabriz, Kermanshah, Mashad, and Esfahan.
 Results: Seventy-six percent of the cases were identified as suicide attempts the most common substances used for this purpose were medications (80.9%), chemical poisons (10.7%), psychotropic substances (5.1%), and other chemicals such as detergents and bleaching agents (3.2%). Notably, about a third of the cases were due to benzodiazepine ingestion. The most common cause of accidental poisoning was psychotropic substance overdose (44.2%), predominantly opioids.
 Conclusions: Considering the prevalent use of medications and psychotropic agents in suicide attempts and the relatively high proportion of suicide cases in hospital poisoning wards indicating strategies for primary, secondary and tertiary prevention of this common and urgent problem.

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Background & Objectives: Adolescence is an important period of human development. Developmental traits in this period could be predisposing to behavioral problems, delinquency substance abuse and mental disorder. So this survey was designed to study the mental health status of adolescence in Kashan .
Methods: This cross sectional study involved 400 adolescent from Kashan high schools. They were chosen through randomized stratified sampling. SCL-90-R Questionnaire was used. Demographic information such as age, sex, birth order, history of addiction and any mental disorders ,educational level, age of parent were also asked . Descriptive and analytic statistics were done by SPSS software.
Results: Overall 10% of the high school adolescents had mental disorders. Common psychopathology demonstrations were as follows: Paranoid thought, interpersonal sensitivity, depression, anxiety, and aggression. There were significant relation between family history of addiction and mental disorder, history of physical abuse and age of adolescence with mental health (p<0/05). Total GSI in boys who were substance abuse was 1.9 while in boys who were not was 0.87 (p <0.05). There was not statically significant relation between total mean of GSI and gender however there were statistically significances between girls and boys in interpersonal sensitivity, depression, anxiety and depression.
 Conclusion: The responsible authorities should take steps in addressing these problems by initiating School Counseling Centers and also by including study material in the field of psychiatry and psychology in the adolescent students school curriculum.

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Background & Objectives: Recognition of epidemiology of acute myocardial infraction (AMI) in every region could be a need for design the programs for prevention of AMI. In this study we assessed the epidemiology of changes in AMI from 2002-2006 in Birjand(east of Iran).
Methods: All of the patients which hospitalized by AMI diagnosis from 2002-2006 years, included in this study. We compared mean of age, gender, location of living, medications used, condition at discharge and cardiac risk factors in this period.
Results: From 1233 patients, 880 were male (71.4%). Overall, mean age of patients was 62/2±12/8 years and in five years was increased (from 61.7±13/2 in 2002 to 63.5±12/4 in 2006 & p=0.37). The most risk factors in patients were: Hypertension (HTN) (34/8%) ,cigarette smoking (32/1%) & dyslipidemia (24%). These risk factors did not show any significantly changes during 5 years. But the the prevalence of HTN (30/9% in 2002 to 38% in 2006, p=0/62) and DM (15/5% in 2002 to 21% in 2006, p=0/23) raised. Cardiac drugs use tended to increase during 5 years, however only this increase about STK & Statin was statistically significant. The hospital mortality rate was decreased in 5 years (11.3%) but it was not statistically significant (p= 0.48).
Conclusions: Regarding the accelerating the rate of AMI, designing an appropriate prograrme for prevention and modifying cardiac risk factors is recommended.

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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 & Objectives: Triglyceride/HDL-cholesterol ratio (TG/HDL-C) has been shown as an indicator for metabolic syndrome (MetS). This study aimed to detect the role of this ratio to predict coronary heart disease (CHD) outcome in an Iranian men population with high prevalence of MetS.
Methods: 1824 men ≥ 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol (TC), HDL-C, TG, and risk factors of CHD including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study.
Results: During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio (HR) of 1.85 (95% CI, 1.07-3.17). Combined HR for TC and TG/HDL-C (men in the top quartiles of both TC and TG/HDL-C relative to first quartiles) after adjustment for other risk factors was 6.13 (95% CI, 2.37-15.86).
Conclusions: The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male population.

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Background and Objectives: Injury by sharp instruments and needles are major occupational health hazard for healthcare workers. This study was conducted to determine the prevalence rate and causes of injuries due to needle stick in healthcare workers in Zahedan University of Medical Sciences.
Methods: In a cross-sectional study, 231 healthcare workers of university hospitals of Zahedan University of Medical Sciences were selected at random in 2007. Data were collected through questionnaire and were analyzed by SPSS 13.
Results: From all cases 77.1% were female 56.4% of them were expert, and 50.7% were nurses. Their mean age were 34±8.1 years. Needle stick prevalence was 64.9% during the whole history of career, and 57.2% of them had experiences of needle stick more than twice. Most cases of injuries were related to using needle 55.4%, and they were mostly prone to injury during injection and phlebotomy, 55.6%. The multivariate regression analysis showed that injury due to sharp instruments in university graduates was 60% less compared to those with high school or less, and the injury risk increases 5% in each year of increase in working experience.
Conclusions: The findings of this study highlight the importance of training and preventive measures in healthcare centers particularly among high risk group.

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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: People with thalessemia and chronic renal failure on maintenance hemodialysis are prone to blood-born infections, especially hepatitis C due to the long-term transfusion. Recently, hepatitis C has been one of the main health concerns in these patients. The aim of this study was to determine the prevalence of hepatitis C and its risk factors in these groups of patients in Kerman province of Iran.
Methods: HCV RNA in blood sample of 384 patients (203 hemodialysis cases and 181 thalassemia cases) was evaluated.
Results: One hundred thirty (130) out of 384 were infected by HCV. Infected male was predominant (83%).
Conclusions: It seems that the frequency of hepatitis C infection in Kerman is higher than the other provinces of Iran. Therefore more attention should be paid to screen of blood before transfusing for these group of patients.

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

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Background and Objectives: Lack of nutritional knowledge is one of the most important reasons of nutritional problems worldwide and consequently, improper practice which can lead to several complications such as: malnutrition and non-contagious diseases. This study has been designed to investigate the knowledge, attitude and practices of the urban households regarding practical principals of nutrition in Boushehr, Golestan, and Sistan & Balouchestan provinces in 2004.
Methods: Evaluation of knowledge, attitude and practice of urban households towards practical principals of nutrition in mentioned provinces was carried out by this cross sectional study. The sampling method at the level of the households in each province was the single-stage cluster sampling with equal size clusters. The necessary data were gathered with a structured questionnaire and via the interviews between the questioners and the eligible people in each household.
Results: A total of 1154 individuals were participated in this survey. Approximately seventy percent of individuals were aware about having basic four food groups and 45% of them were also aware of role of food group in human body. Majority of people had acceptable attitudes toward nutrition. Based on standard criteria consumption of meat was rare and consumption of fish was in medium level, legumes in high level, fruits and vegetables, milk & dairy products were in acceptable level. Consumption of carbonated beverages, junk foods and sugar were in high level.
Conclusion: The findings of this study imply a need for effective implementation of nutritional community interventions by health policy makers in Iranian health systems.

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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 and Objectives: Incidence of neurocognitive and psychologic disorders in elderly seems to become high There are numerous factors affecting neurocognitive functions like vascular factors, Vitamin B12 and folate and homocysteine levels. The aim of this study was to assess the relation between neurocognitive- psychologic markers and homocystein (Hcy), V.B12 (Cobalamin) and folate in serum.
Methods: Two hundred eighty elderly people admitted to Emam Reza Teaching Hospital in Mashahd, Iran. neurocognitive-psychologic disorders was diagnosed by a trained physician. Serum cobalamin, folate and homocystein measured by RIAand ELIZA methods, respectively.
Results: Based on Hcy>15 µmol/l level, cut off point <330 pg/ml for serum cobalamin and <6.5 ng/ml for folate deficiency defined as deficiency. The correlation between cobalamin and folate was statistically significant (p=0.000). Hemocystein correlated inversely to cobalamin (p=0.001) and folate (p=0.044). There were no statistical significant between Cobalamin, Folate and Hcv>15µmol/l and neurocognitive & psychologic markers unless Deep Tendon reflex test (P=0.04). All patients with dementia had hyperhemocysteinemia.
Conclusions: Despite the plausible biochemical mechanism, further diagnostic studies, based on clinical, neuropsychological, laboratory features will be necessary to better understand this fascinating biochemical challenge.

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Background and Objectives: Measuring the quality of life is one of the important indicators in evaluating health. The chronic disease is a one of the main cause of reduction in quality of life. The aim of this study was to assess the quality of life and its influential factors in 15-64 years old people in Kurdistan province, Iran.
Methods: In this cross-sectional study EUROHIS-QOL 8-item questionnaire was employed. Data was analyzed by SPSS statistical package.
Results: After adjusting the possible confounders, the mean score of quality of life was less in smoker 1.41 score versus non-smoker, in women 1.52 score versus men, in hypertension patients 1.41 score versus non-hypertension. The mean score of quality of life was reduced 0.05 per each year.
Conclusions: It is recommended to implement some interventions to manage properly current chronic diseases in order to increase the quality of life. It also seems that EUROHIS-QOL (8-item) is a suitable tool to measure the QOL in Iranian culture.