Iranian Journal of

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

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

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Background & Objectives: To determine the prevalence rates of refractive errors in Mashhad, Iran
Methods: In this population-based study, random cluster sampling was performed on the urban population of Mashhad and of 4453 selected individuals, 70.4% participated in the study. Refractive errors were assessed using cycloplegic refraction in participants who were ≤ 15 years of age and non-cycloplegic refraction in those who were > 15 years of age .
Results: The prevalence of myopia and hyperopia in individuals ≤ 15 years old was 3.64% (95% CI: 5.09 to 2.19) and 27.4% (95% CI: 31.09 to 23.72), respectively. The same measurements for individuals >15 years of age was 22.36% (95% CI: 24.66 to 20.06) and 34.21% (95 CI: 36.85 to 31.57), respectively. The prevalence of astigmatism and anisometropia were 25.64% and 5.84, respectively. Astigmatism and anisometropia were significantly more (p=0.005) and less (p=0.048) prevalent in females, respectively. Anisometropia, astigmatism and hyperopia were found to be increased with age.
Conclusions: This study highlighted the valuable information on refractive errors in Mashhad. Hyperopia was the most common refractive error. In addition to subjects who were between 5 to 15 years of age, refractive errors were also prevalent among older people therefore, more attention should be paid to the correction of refractive errors in these groups.

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Background and Objectives: Designing and application of experimental studies in veterinary medicine have been given paid more attention in recent years. This review aimed to evaluate the methodological quality of all published articles in Journal of the Faculty of Veterinary Medicine, University of Tehran between 2000 and 2009.
Methods: Evaluation studies with experimental designs were identified by reviewing titles and abstracts. Two reviewers coded reporting quality of articles.
Results: Of the 738 total published articles, 289 (39.16%) articles had experimental designs. Sample size was reported in 93.4% of studies, only 36% of studies explained their study design clearly and randomization was reported only in 33.6%. The ethical approval was mentioned in only two percent. Seventy six percent studies had comparison group.
Conclusion: The quality of reporting of experimental studies in the Journal of the Faculty of Veterinary Medicine was not generally acceptable. Therefore it is felt that authors should consider more necessary criteria for standard publication in veterinary journals.

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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: Despite an increased risk of obesity and CHD in people with spinal cord injury (SCI), there is little known about the dietary intake in this group, therefore the aim of this study was to examine nutrient intake and body mass index (BMI) in the spinal cord injury (SCI) population according to level of injury and related variables.
Methods: In this cross-sectional study, 162 patients with spinal cord injury participated from Brain and Spinal Injury Repair research Center, Tehran, Iran. Dietary intakes were assessed by means of a semi quantitative food frequency questionnaire.
Results: The mean age of study population was 34.1±0.6 years. Total energy and carbohydrate intake were higher in men than women (P<0.001). Incomplete injured consumed more MUFA (P=0.03). The elderly were consumed less total calorie, saturated fat, MUFA, cholesterol (P<0.01) and PUFA (P<0.05). Injured patients with longer times had lower total calorie, carbohydrate (P<0.01), total fat and MUFA intake (P<0.05). Based on new classification 60.5% were at the risk of obesity or obese. Central obesity was seen in 33.1%of man and 48.4% of women. BMI of the paraplegia group was greater than that of the tetraplegia group (P= 0.009).
Conclusion: Macronutrients balance is moved towards higher saturated fat intake and less complex carbohydrates and protein intake in SCI patient’s .The elderly and patients who had lived with SCI longer time tended to maintain healthier diets.

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Background & Objectives: Orthodontic treatment need and demand in 12-year-olds in Abadeh city has not previously been analysed in relation to geographic origin. The purpose of this study was to assess the12 year old students need and demand for orthodontic treatment.
Methods: Four hundred seventeen 12-year-old students was selected from public and private schools in Abade (Fars province, Iran). All the students were examined according to the AC and DHC component of Index of Orthodontic Treatment Need (IOTN) by a trained dentist. Students' and parents' perceived needs were also assessed using AC component and their demand for orthodontic treatment was asked through a questionair .
Results: Twenty two percent of the students were in "no need of treatment" group when assessed by DHC component, 29.5 % were in "average need" and 48.2% were in "definite need" group. When assessed by AC score, these percents were 61.9%, 29%, and 9.1%. Parents and students percieved need for definite orthodontic treatment according to AC score was 8.6% and 7.7%, respectively. The students and their parents’ demand for treatment were 40.6% and 44.9%, respectively.
Conclusion: Orthodontic treatment need in Abade is higher in comparison with other reports according to DHC. DHC is not correlated with orthodontic treatment demand of 12 years old students, but AC had a strong relationship with treatment demand.

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Background & Objectives: Osteoporosis is major public health concern affecting millions of adults particularly older adults and women worldwide. Designing effective educational intervention is principle in any health promotion program. The purpose of this study was to evaluate the efficacy of an educational intervention based on health belief model on knowledge about, attitudes toward and practice of prevention osteoporosis among women with low socioeconomic status in Isfahan.
Methods: The study population consisted of 14 women with low socioeconomic status and under 60 years old. A valid and reliable questionnaire developed and used as measurement tool for initial and final assessments in this program. In addition calcium intake and vitamin D, physical activity and exposure to the sun were assessed.
Results: The mean age of the participants were 40.8 ± 10.52 years. The mean score of all parts of health belief model (except for perceived barriers), knowledge, sun exposure, and physical activity after educational intervention compared to before intervention, were increased significantly. There was no statistically significant difference between daily calcium and vitamin D intake before and after intervention.
Conclusion: It is concluded that the HBM Model– based educational program on Knowledge and belief regarding Osteoporosis prevention seems practical and effective. However more research should be done to find out more effective intervention regarding optimal calcium and vitamin D intake.

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Background & Objectives: Benzodiazepines (BDZs) can have both beneficial and adverse effects and are the largest-selling drug group in the world. The potential of dependence with BDZ has been known for almost three decades now. The risk of misuse of and dependence on these drugs seems higher in countries where laws against unlicensed sale of BDZ are not implemented strongly. Since there is little know about the pattern of using BDZ in Iran therefore we designed this study to investigate to find out more about the prevalence of BDZ use in psychiatric patients in Mashhad, Iran.
Methods: Twenty pharmacies were chosen for this study carried out a cross-sectional survey over 3 months in outpatient of pharmacy in Mashad, Iran. Besides basic socio-demographic data the participants were asked if they were taking a BDZ at present and if yes, the frequency, route and dosage of the drug, who had initiated the drug and why it had been prescribed.
Results: Out of a total of 400 participants 17.5% of the participants had been currently using at least one BDZ for 4 weeks or longer. Only 45% of cases the BDZ had been initiated by a doctor. Gender, Educational status, employment status and smoking were associated with an increased likelihood of using BDZ.
Conclusion: The study shows most of the users were taking it for duration and with a frequency which puts them at risk of becoming dependent on BDZ. In most of the cases it had not been initiated by a doctor. Both patients and doctors need to be made aware of the risk of dependency associated with the use of BDZ.

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In the previous paper, the basic concepts of sample size calculation were presented. This paper explores main post-calculation adjustments of the sample size calculation in special circumstances such as multiple group comparisons, unbalanced studies (with unequal number of subjects in different groups) sample size correction for missing data, and adjustment for finite population size. In addition, the concept of design effect in multi-stage sampling

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Background & Objectives: Study trend of observed rates changes provide valuable information for need assessment, plan, reload programs and develop indicators of each country. The main objective of this paper is to determine the changes in tuberculosis incidence rate trend in Iran by applying segmented regression model.
Methods: In this study, segmented Linear Regression employed to analyze the trend of changes in pattern of Tuberculosis incidence rate during past 44 years (1964-2008) in Iran. We used least square method and permutation test and Bayesian Information Criteria to decide which of the two segment regression model and poison regression would be better. Data analyzed by Joinpoint3.4 and SAS9.1 software. Results: According the permutation test, it was detected that there were two breakpoints over 1977 and 1993 years (p=0.0108). Incidence rate of tuberculosis during the first 11 years of review had declined with annual percentage change = -10.1%, for second segment it rose upward with 4.3% increase in per year and for end segment TB incidence rate again declined with annually 4.5%. The average annual change of Tuberculosis incidence rate in Iran for at least 10 years has been estimated -4.5 percentages.
Conclusion: The findings of this study have shown that the incidence rate of Tuberculosis decreased after 1992 that interestingly this decline seems faster than estimated by international TB control program. This indicates that preventive and treatment of Tuberculosis programs have been successful in Iran.

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Background and Objectives: Preterm birth (PTB) is a major clinical problem which is known to be associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with PTB in Birjand, Iran.
Methods: One hundred and thirty premature (<37 week) and 130 term newborns were enrolled in this case-control study. It was conducted in Birjand Hospitals during the year 2007. Potential risk factors such as type of delivery, maternal disease, placenta problems, previous history of abortion in mothers, maternal addiction, prenatal care were identified from medical files.
Results: Previous of premature labor (OR=4.68), cesarean section (OR=3.34), pre-eclampsia (OR=7.72), premature rupture of memberanes (OR=11.3), inadequate prenatal care (<4 one) (OR=4.15), and placenta previa (OR=8.96) were found to be risk factors for preterm birth. Polyhydramnios, previous abortion and cervical incompetent with prematurity were not shown to be risk factors for preterm birth.
Conclusion: These findings reinforce the need for control of risk factors of prematurity for better out come.

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Background & Objectives: Increasing in prevalence of juvenile myopia in recent decades in eastern and western countries, especially in urban elementary school children, suggests that changing in early life style may play an important role in development of myopia. Our aim was to determine the relationships between myopia and overweight in elementary school children of Eslamshahr a city near Tehran, Iran Methods: In a case control study, 240 new myopic primary school children (grade 2-4) identified as cases and 240 children without myopia in the same schools enrolled as control group. Anthropometric information was completed from schools’. Other information about pre-entrancing to school was collected by interviewing their parents. Children having a Body mass index BMI>=85th CDC2000 percentile were identified as overweight. Adjusted odds ratio for overweight was estimated after adjusting other potential risk factors.
Results: Of total 53.3% were girls. 23.8% of children in case group and 10.1% of them in control group were categorized in overweight group. After adjusting for other potential risk factors (family history, breast milk intake, near works, mother`s job and financial position) being overweight was independently associated to myopia (OR: 3.10, 95% CI: 1.9-5.03).
Conclusion: It is concluded that overweight in children in preschool age, is independently associated with increased risk of myopia in primary school children. Therefore health promotion programs in order to change of the life style in this group of children should be considered.

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Background & Objectives: Cutaneous leishmaniasis (CL) is one the major health problem in tropical and sub– tropical countries. Bam district in Iran is an old focus of anthroponotic CL (ACL). The aim of this survey was to assess the prevalence rate of CL by case– finding, treatment of cases and training of primary school children in the city and suburb of Bam in 2010.

Methods: All school children in three levels (18501 children) were included. Children were physically examined for presence of sores or scars. Suspected cases were referred to the center for cutaneous leishmaniasis control (CCLC) for diagnosis and the CL positive children were treated, accordingly. School children were trained and also educational and informative pamphlets were given to their parents.

Results: After initial physical examination ,117 suspected school children (6.9%) were referred to the CCLC and 48 children (28 per 10000) diagnosed as CL patients, comprising of 19 females (39.5%) and 29 males (60.5%). Fifteen (31.2%) school children were identified as lupoid leishmaniasis, failure to treatment or non – healing cases.

Conclusion: The prevalence rate was decreased about 18– fold as compared to the previous investigation in 2005. Establishment of the CCLC, active case– finding and subsequent treatment, seem to be a successful model for controlling CL in the endemic countries.

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Normal 0 false false false EN-US X-NONE AR-SA The relationship between two things if one is another originator or creator, called causality. Although this concept is not specified to Medical Sciences and Epidemiology, the importance of this issue is more highlighted in the field of epidemiology. Causation is the most basic concepts in empirical sciences and is still under discussion because it is dependent on the basis of any scientific laws without acceptance something cease causality is impossible. With the increasing development of science as well as epidemiology, causality has found a broader concept and its application in analytical studies and logical interpretation of the results of this type of study, has a wider dimension. Due to developing new epidemiology courses at medical universities and increase the number of students, it is felt to talk more about the causality concept. In this review causality concepts in the humanities is overviewed, its history is briefly described, the causality of Medical Epidemiology and also Islamic religion is considered, then the causality framework, and models to interpret the conventional causality will be discussed.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Dental fluorosis is a kind of hypoplasia, enamel and dentin deficiency due to fluoride overuse. Since there is little known about this important dental problem in Southeast area in Iran we designed an analytic descriptive study to estimate the dental flurosis prevalence in 7-10 years old students.
Methods: Three hundred thirty four (334) children attending to community dentistry center during year 2006, were studied to evaluate the prevalence of dental fluorosis. Dental index (fluorosis rates) identified by a trained dentist. Criteria for definite diagnosis were existence of enamel defects with spread bilaterally and symmetrically. Children with hyperplasia tetracycline -induced, acute febrile illness in childhood and fetal birth  dental defects (Dentinogenesis imperfecta, Amelogensis imperfect) were excluded from this study.
Results: The prevalence of dental flurosis estimated to be 30.8 percent in this sample. Dental fluorosis protests in the subjects were so: enamel opacities (70. 6%),discoloration(14.2%), pit(1.36%), enamel opacities and discoloration(12.9%),enamel opacities and pit (1 %). Superior anterior teeth were the most effected by fluorosis. There are significant difference in dental fluorosis between boys and girls (P=0.004), and intensity was higher in boys (37.5% versus 22.6%). fluorosis pattern no clear difference in both sexes (P=0.27).
Conclusion: The prevalence of fluorosis was estimated 30.8% and intensity was higher in boys in Zahedan. Therefore it is essential that fluoride source and amount of fluoridation of drinking water be considered in Zahedan city.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Tuberculosis (TB) is an important issue which its control is still unsatisfactory at global level. Traditional diagnostic techniques for active TB diagnosis are inadequate: the diagnostic gold standard is the cultural exam which suffers from lengthy processing and requires highly specialized laboratories. Nowadays more specific tests have been recommended. The aim of this study is to evaluate the performance of Quanti FERON-TB (QFT)Gold In Tube-Test as a substitute for specific test tuberculin skin test for diagnosis of latent tuberculosis infection in high risk groups.
Methods: One hundred thirty four (134) individuals who worked in Bo-Ali hospital (Zahedan) enrolled in this study. They had no active tuberculosis. TST and QFT tests were performed. The cut-off point of TST was considered based on 15 (mm) or more indurations as positive. The result of QFT was evaluated by manufactured guidelines. Multivariate logistic regression was used to identify the putative risk factors of positive tests.
Results: Proportion of employees with latent TB were 111(82.8%) were positive by either TST or QFT, and 76(56.7%) were positive by both tests. Agreement between the tests was high (73.8%, k=0.39 95%CI:
0.21-0.44). Positive family history of Tuberculosis was significant risk factor for both positive tests. 
Conclusion: This study showed high latent tuberculosis infection prevalence in hospital workers and high agreement between TST and QFT. Decision to select one of the tests will be depended on the population, purpose of study and availability of resources. The results revealed that the QFT can be appropriate alternative test for high risk group.  

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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: Years of life lost (YLL) was designed by the World Health Organization (WHO) to measure and analyze the burden of various diseases. Intentional and unintentional injuries, is the second cause of death in Iran. Since there is little know about the burden of injuries, this study designed to measure YLL in this group as a key indicator of population health and priority setting in health. 
Methods: Years of life lost was calculated based on death data from Death Registration system in Mazandaran province.
Results: During the year 1387 in Mazandaran province, 39,421 years lost due to intentional and unintentional injury. 30,498 years that related to men and 8923 years related to women. In this province injury has been the first cause of YLL in both sexes and age groups 20-24, 25-29 and 15-19 years, respectively.
Conclusion: Considering the results of this study and the high number of years lost due to accidents in the province, especially in men, it seems that more appropriate interventions programs for at risk age group of men in province is required.

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Background and Objectives: Diabetes is a major health issue worldwide. This study evaluates whether a community-based participatory program may improve diabetes care in adult in west area of Yasouj.
Methods: A community based participatory research was designed. A local leading group was established consisted of academic researchers, local leaders, health providers and public representatives. All the 30-65 years old residents of designated area (2569 persons) were screened for detecting diabetes anthropometric measurements and biochemical tests were measured. Educational interventions about improving the diet and physical activities were performed for high risk individuals through a 3-months period.
Results: Out of 2569 individuals, 1336 were at high risk. Approximately 228 persons (17%) identified having diabetes. After the intervention, the mean FBS, HbA1C, TG and cholesterol of participant significantly decreased (p<0.05), decreasing in systolic and diastolic blood pressure and body mass index were seen however this was not statistically significant. The mean physical activity and exercise increased and consumption of frying foods, saturated oil decreased significantly.
Conclusion: Community-Based Participatory cares could be a feasible model for control of diabetes and its risk factors.