Iranian Journal of

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Background & Objectives: Studying several linked markers provides more information on locating disease genes locus by using genetic association analysis.  The aims of this study were to introduce Multimarker Family Base Association Tests (FBAT-MM) and its Linear Combination (FBAT-LC) in multimarker genetic association analysis and to examine the association of selected microsatellites with HDL-C in an Iranian population.
Methods: One hundred twenty five (125) families having at least one member with metabolic syndrome and at least two members with low HDL-C were selected from participants of the Tehran Lipid and Glucose Study (TLGS). Multimarker genetic association of HDL-C level with some microsatellites in the chromosomes 8, 11, 12, and 16 were examined using FBAT-MM and FBAT-LC methods.
Results: The families consisted of 563 individuals (269 males and 294 females). FBAT-MM showed significant genetic association only between HDL-C and three microsatellites in Chromosome 11 (P<0.05). The microsatellite D11S1304 was found as the significant factor for multimarker genetic association.
Conclusion: FBAT-MM and FBAT-LC did not show shortcomings such as excessive conservatism and low power which are, usually, observed in other multimarker methods.  Finding microsatellites associated with HDL-C level can provide background for further researches on the role of predisposing genes in metabolic syndrome.

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Background and Objectives: analogues insulin is similar to human insulin but have differences in cell structure that leading to differences in characteristics of pharmacodynamics and pharmacokinetics.
Methods: A systematic review of published studies between 2009 until June 2010 in Cochrane Library (CENTRAL and Cochrane Systematic Reviews), DARE, NHS EEDs, and CRD databases were searched.
Results: Only nine articles were identified to be included in this review. Most of these studies demonstrated that there were no more or less risks caused by rapid acting insulin compared with human insulin in terms of safety. The risk of sever hypoglycemia significantly, reduced by using long acting insulin analogue. Although it has been shown that insulin analogues are not cost effective, some of these studies pointed out that that insulin Aspart 30 compared with other analogues has more cost effectiveness.
Conclusion: Although this type of insulin seems very effective for patients with diabetes, due to the less cost effectiveness in comparison to human insulin, it is recommended that government's resources for this technology will be allocated just to the children and elderly people.

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Background & Objectives:
Nowadays the performance of hospital blood banks is assessed by cross-match to transfused unit ratio which it is recommended to be less than 2.0. The aim of this study was to evaluate the most common indications for blood transfusion in Qum University hospitals.
Methods: In this retrospective study 4370 blood order forms from March 2010 till April 2011 were assessed. To calculate C/T ratio, the number of cross-matched units was divided by the number of transfused units.
Results: Of total 4370 blood order, 57.1% were male. From all blood order forms, 16.42% (C/T : 1.196) were not transfused. The highest rate of blood orders pertained to surgery emergency and trauma (23.3%), hematology and oncology (14%), gynecology (11.3%), internal ward and nephrology (8%), infectious ward (6.9%), burn ward (5.9%), general surgery (4.4%), orthopedics (3.2%), ICU (2.3%) and pediatrics (8.6%).         Packed cell was the product with the highest order rate of 78.7% in Qom teaching hospitals however, out of this rate 44% remained untransfused.
Conclusion: According to the findings of this study the rate of non-transfused ordered blood components in Qom teaching hospitals seems very high. Thus, it is recommended to employ the international and/or national guidelines in order to reach to optimal rate.

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Background & Objectives: Food insecurity has been a global concern. The purpose of the present study was to examine the relationship between household food insecurity and depression in mothers with school children in Ray city.

Methods: A cross-sectional survey of 430 mothers of school children was conducted in 2010 in Ray city. We employed USDA food security questionnaire. The prevalence of depression in mothers was assessed by Beck Depression Inventory (DBI).
Results: Household food insecurity was identified approximately in fifty percent of participants and frequency of depression was 51.4% in mothers. Depression in ‘food secure' group was 34.6%, and in ‘food insecure with hunger' group was 77.8%. There was a positive relationship between depression and food insecurity in mothers having primary school children living in Ray.
Conclusion: The findings of this study revealed that level of food insecurity among mothers seems high. This study highlights the need to integrate programs addressing food insecurity and poor mental health for mothers.

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Background & Objectives: White spot, as one of the infectious viral diseases, has made severe losses in shrimp ponds all over the world. Despite extensive efforts made to deal with and control the disease, white spot continues to be a major health problem in shrimp farms across Iran. In this work, the significance of the risk factors of white spot disease epidemic occurred in shrimp ponds of Choubdeh farming site in Khuzestan province of Iran is determined.
Methods: A cross sectional study was conducted from June 1, 2010, to September 22, 2010 in 223 shrimp ponds of the site. Data was collected on 17 variables, thought to be associated with the occurrence and epidemic of white spot, with the aid of the shrimp ponds owners and fisheries and veterinary organizations. The occurrence of white spot disease in the farming site was determined by clinical symptoms and the results of conventional PCR tests. the effectiveness of the risk factors was established by odds ratio (OR).
Results: It is found that poor management of birds fighting (OR=3.72), less educated farm foreman
(OR= 3.29) and poor filtration of the intake water (OR= 3.43) are significantly affected the occurrence of the disease while little changes in the salinity of shrimp ponds (OR= 0.16) decreases the odds of the disease.
Conclusion: These findings help better develop shrimp farming across Iran, especially in Khuzestan province. 

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Background & Objectives: The aim of this study was to identify the quality of life (QOL) measures commonly used to assess disabled people compared to healthy individuals.
Methods: A cross-sectional study was conducted in 1000 disabled and healthy individuals aged between 15 to 75 years old during 2009 year. These groups were selected by random sampling method multistage cluster sampling from Crescent Comprehensive Rehabilitation Center located in Tehran. WHO's Quality of Life (WHOQOL-100) questionnaire was used to measure quality of life.
Results: The Mean age were 35.9±12.9 and 35.1±12.7 years amongst disabled and non disabled groups, respectively. There was a significant difference between two groups in terms of somatic health and independence of quality of life (P<0.001), in which the mean score in both domains were high in healthy individuals. No significant difference was observed between two groups in other scopes.
Conclusion: Findings of this study highlighted the lower quality of life in disabled people in Tehran, Therefore this group should be targeted for any relevant intervention in order to improve their care.

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Background & Objectives: Despite decreasing the trend of coronary artery diseases in developed countries and outstanding improvements in clinical management of these patients, case fatality rate after an acute myocardial infarction (AMI) remains high in both genders. Identifying predicting factors of short-term survival in patients with AMI may play an important role in reducing mortality in these patients.
Methods: In this cohort study, all patients with acute myocardial infarction (AMI) admitted to all hospitals in Isfahan, Iran, during 2000-2008 which registered in Isfahan cardiovascular research Institute were analyzed. We used Cox regression models, uni- and multi-variable analysis. 
Results: Within the study period, 8800 AMI patients (73.6% male) were admitted with mean age of 61.85±12.5, and overall 28-day survival of 90.5%. Relative risk (RR) of death for 50-70 years old patients was 2.5 (CI:2-3.1), for over 70 years old RR=5 (CI:4-6.3), for women RR=1.7 (CI:1.5-1.9), for patients who had not received streptokinase RR=0.9 (CI:0.8-1.1), for inferior MI RR=4.2 (CI:2.2-7.8) and for anterior MI, RR was equal to 7.2 (CI:4-13.3).
Conclusion: Recognizing the predicting factors of short-term survival of AMI patients may help health professionals to provide better healthcare services for more at risk patients, i.e. elderly, women and patients with an anterior MI.

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Background & Objectives: Peritoneal dialysis is one of the most common types of dialysis in patients with renal failure. However multivariate analysis such as log- rank test and Cox have usually used to evaluate association of risk factors in survival of this group of patients, the aim of this study was to perform of Weibull, Gamma, Lognormal and Logistic Mixture cure models in survival analysis of these patients.
Methods: Data of 433 patients undergoing CAPD who registered in two centers in Tehran, Iran between 1997 to 2009 were used in this analysis. We investigated center, gender, age, cholesterol, Low Density Lipoprotein (LDL), High density lipoprotein (HDL), triglyceride, albumin, hemoglobin, creatinine, Fasting Blood Sugar (FBS), calcium and phosphorous as variables effect with Kaplan-Meier and cure model. CUREREGR module was used for survival analysis.
Results: Comparison of AIC (Akaike Information Criterion) of Weibull, Gama, Lognormal and Logistic Mixture cure models showed that Weibull distribution AIC is lower for almost all variables than other distributions. Weibull distribution has better fitness for data than others. In the multivariate Weibull model, age and albumin variables had significant effect on long-term survival of patients (P<0.01). Triglycerides effect on long-term survival had borderline (P = 0.065). Also HDL, FBS and calcium were significant on short term survival (P<0.01) but significance of LDL was borderline (P=0.088).
Conclusion: Cure models have the ability to analyze dialysis patients' survival data and can differentiate long-term survival from short- term survival. The interpretation of survival data with these statistical models could be more accurate and would help to make better prediction for patients by health care professionals.

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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 and Objectives: Social capital consists of individuals' communicational networks, social norms such as mutual trust and cooperation in social networks. The aim of this study was to develop a model to assess the implication of different determinants such as age, gender, occupational status, mental and physical health on social capital components to draw a correlation network for social capital determinants.
Methods: For the purpose of this study, data was used from ‘social capital' section of Urban HEART-1 survey, which included 22,500 households from all 22 districts of Tehran, who were approached in a randomized multistage cluster sampling method. Path analysis is a statistical method to test hypothetical causal models, which requires various causal (path) diagrams. To demonstrate the causal models of social capital, the hypothetical paths of various components were developed and the final model of social capital was drawn using multiple regression analyses.
Results: Path analysis indicated that social capital components are influenced by various variables: A) Individual trust, by occupational status, marital status, and physical component of health-related quality of life B) Cohesion and social support, by education, age, and marital status C) Collective trust and associative relation, by family size, age and physical health. Direct effect of these variables on social capital components was more than their indirect effects (through mental health and physical health).
Conclusion: Social capital components are directly affected by occupational, marital, educational status, family size, physical health and duration of local residency. Planning to improve educational and occupational status, strengthening family bonds and provision of local facilities, may improve social capital.

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Background & Objectives: Knowledge of the magnitude of attributable burden of cardiovascular diseases (CVDs) due to diabetes is necessary for health policy, priority setting and preventing CVD deaths. Our study aimed at estimating the attribute of proportion of diabetes to the burden of cardiovascular diseases in Kermanshah, West of Iran.

Methods: World Health Organization Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). Data on the Prevalence of newly diagnosed diabetes mellitus (People who have fasting plasma glucose (FPG) equal or greater than 126 mg/dl) were obtained from 3rd Iranian surveillance of risk factors of non- communicable diseases and data on corresponding measures of effect were derived from a national- specific study with age and multivariate adjusted hazard ratios.

Results: Based on multivariate- adjusted hazard ratios, by reducing the percent of women with diabetes from 8.1 percent to the zero level and the feasible minimum risk level i.e. 4 percent, 11.2% and 5.7% of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable, respectively. The corresponding value for men at the theoretical (zero level) and feasible minimum risk level (3 percent) were 5.6% and 2.9%, respectively.

Conclusion: To better planning, decision making and priority setting, PIF should be applied to updated and revised burden of CVDs in Iranian Health system.

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Background & Objectives: The rate of suicide varies amongst different parts of Iran. Since there is little knowledge about the risk factors for suicide attempts we carried out this study to determine the status of psychiatric disorders and risk factors of repeated attempted suicide in suicide attempters whom admitted to poisoning emergency in Isfahan, Iran.

Methods: Patients with having attempt to suicide, admitted to emergency ward in Khorshid Hospital in Isfahan and were interviewed by a trained psychiatrist during 2009 year. Interview was based on DSM-IV.

Results: Participants consisted of 703 individuals (424 of them were female) with mean age of 25.9±9.7. One hundred twenty five (125) had positive family history of suicide attempt, 501 people were first time suicide attempters, 106 second, 58 third, and the others were forth time or more suicide attempters. Bipolar spectrum disorders, unipolar depression and adjustment disorders were the more frequents psychiatric disorders respectively. Age, family history of suicide, kind of diagnosed psychiatric disorder and method of attempted suicide were meaningfully related to mean of attempt suicide frequency.

Conclusion: Bipolar spectrum disorders, especially recurrent depressive episodes is the major risk of repeated suicide attempt and co-morbidity of another psychiatric disorders increase highly the risk of suicide reattempt.

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Background & Objectives: One of the most common anxiety disorders in children is separation anxiety disorder (SAD). The purpose of the present study was to investigate the epidemiology of separation anxiety disorder in Isfahan primary school male student.
Methods: The present study was a descriptive study. The statistical population was all the male students from 7 to 9 years old, studying in second and third grades in primary schools of Isfahan. The sample of study consisted of 1514 male student, who were selected randomly by multi-stage sampling method. The instruments of this study consisted of the Separation Anxiety Disorder Scale, Spence Children's Anxiety Scale and Clinical Interview. Data obtained were analyzed by using descriptive statistics and chi-square and logistic regression.
Results: The findings showed that the rate of separation anxiety disorder in male (7 to 9 year- old student) was %6/93. SAD were more common in 7 years old (7.4%). Children having record of hospitalization, immigration, single-parent households and close relatives of mortality had a higher rate of separation anxiety disorder.
Conclusion: This study shows that separation anxiety disorder among primary school male students is significantly high. Therefore it is important to consider the potential utility of early anxiety prevention/intervention programs, especially for children at this age group.

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Background & Objectives: The effects of air pollutants on respiratory mortality and morbidity are among the major concerns today. Few studies have been published on the association between mortality and air pollution in Iran.
 Methods: This study was undertaken in Kerman, Iran. Mortality data was inquired from the Kerman City Health Authority (from March 2006 till Sept 2010) and air pollution data was requested from the Kerman Province Environmental Protection Agency (EPA). The Kerman Province EPA collects daily data on 7 air pollutants which are SO2, NO2, NO, NOx, PM10, CO and O3 by its urban measurement station. Results: The relation between respiratory disease mortality and air pollution was determined by negative binomial regression. The daily mean of PM10 in Kerman was above 150 μgr/m³(unhealthy) on some days of the year. The results showed a significant relationship between increased male respiratory mortality and increase in ambient dust (p=0.03), O3 (p=0.004) and SO2 (p=0.03), but did not show a significant increase in female mortality death for any pollutant.
Conclusion: As there seems to be a significant relationship between increased ambient dust, O3, SO2 and respiratory mortality, susceptible people and those with background respiratory diseases should practice caution in case of increases in these air pollutants.

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Background and Objectives: Since there is inconsistency reports in relationship between shift work (SW) and blood pressure (BP), therefore we aimed to show any association between SW and BP by using of Bayesian Multilevel Modeling, which is a reliable method for this type of analysis.
 Methods: The profiles of 4145 workers in Polydactyl Iran Corporation were examined in historical cohort between 1996 until 2008. All relevant analysis was performed by Win Bugs software.
Results: Approximately 98 percent of study population was male. Of total 1886 (45.5%), 307(7.4%), 1952 (47.1%) of participation were day worker, two rotation shift worker and three rotation shift worker respectively. After controlling confounding factors, there was no significant relationship with Systolic BP (P=0.911) and Diastolic BP (P=0.278).
Conclusion: In general, the results of our historical cohort study do not support a relationship between SW and BP. We suggest multi center and prospective cohort studies with controlling more confounding factors in this area.

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Background & Objectives: In the chain of vehicles, human and environment, the human factors are the most complex element in the causes of road traffic injuries (RTIs). Unauthorized speeding and overtaking are considered as the main human factors resulting RTIs. This study estimated the population attributablefraction of two human factors, the most common risk factors of rural roads, of RTIs.
 Methods: To calculate the population attributable risk, the prevalence of unauthorized speeding and overtaking registered in Police data was employed. Effect size related to odds ratio was employed using Logistic regression. Joint effect of related risk factors also calculated and reported. Dasta were taken from national traffic police using the KAM 114 froms.
Results: The percentage of population attributable risk of unauthorized speeding for deaths at crash scene was 20.9 and for injured cases was 16.6. These values were 13.5 and 13.4 for unauthorized overtaking respectively. Corresponding for joint effects the population attributable risk was 31.6 for deaths and 27.8 for injuries.
 Conclusion: The results illustrate the importance of speed control and unauthorized overtaking as a priority of RTIs in Iran. It is recommended that related laws and legislations should be pursued more seriously, and followed by more effectively.

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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: In the last decade, there have been some claims about hazards of Sodium bicarbonate in bread, in public and scientific sites. Currently, the use of sodium bicarbonate in bread processing is forbidden in Iran. Therefore, the present study sought to assess the current evidence on the adverse effects of sodium bicarbonate use from oral route on public health.
Methods: Different databases, including Scopus, Pubmed, and Ovid were searched for hazards of sodium bicarbonate in baking.
Results: Based on this systematic review, there was no study showing any adverse effects of Sodium bicarbonate when used in producing bread. However, we found many studies about the use and medical application of it. The reported adverse effects mostly included gastrointestinal and electrolytes implications at medical doses which are significantly higher than those used in bakery, or some complications due to accidental or excessive oral ingestion of sodium bicarbonate.
 Conclusion: Not only was there no evidence on the adverse effects of sodium bicarbonate on public health, but at medical doses, many useful effects were also reported in clinical trial studies. Therefore, it is assumed that the use of Sodium bicarbonate at normal doses does not have any adverse effects on human and can be used for bakery in Iran.

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

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