Iranian Journal of

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Background and Objectives:To compare three different methods of signal detection applied to the Adverse Drug Reactions registered in the Iranian Pharmacovigilance database from 1998 to 2005.
Materials and Methods:All Adverse Drug Reactions (ADRs) reported to Iranian Pharmacovigilance Center from March 1998 through January 2005, were included in the analysis. The data were analyzed based on three different signal detection methods including Reporting Odds Ratios (PRRs), Bayesian Propagation Neural Network (BCPNN) and Reporting Odds Ratios (RORs). Signals detected by each method were categorized based on the number of reports per drug-adverse event combination, severity of the event and labeled or unlabeled ADRs. The methods applied to signal detection were then compared in recognizing different types of adverse events.
Results: A total of 6353 cases of ADR reports, describing 11130 reactions, were reported to Iranian Pharmacovigilance Center (IPC) during the study period. The dataset involved 4975 drug-event combinations, which were assessed for detecting signals.
The counts of drug-event combinations was 1, 2 and 3 or more for 3470, 727 and 779 combinations, respectively. There were 500 drug items responsible for 468 reaction terms in the database. According to PRR and 95% Confidence Interval, there were 2838, 872 and 488 drug-event combinations known as a signal for the pairs with the reporting frequency of ³1, ³2 and ³3 reports, respectively. The signals detected with the criteria of PRR³2, c2³4 were 2930, 872 and 480 for the pairs with the same reporting frequencies.
Estimates of RORs and the 95% Confidence Interval showed that 2722, 862 and 481 drug-event combinations were detected to be signal for the pairs with the reporting frequency of ³1, ³2 and ³3 reports, respectively, while measuring IC and IC-2SD detected 1120, 378 and 235 cases for the same reporting frequencies. There were 234 signals detected by all three methods.
Conclusion: Despite the similarities between data mining methodologies for signal detection, there are differences in the numbers of signals detected by each method. The study findings suggest that quantitative signal detection methods should be added to the routine Pharmacovigilance activities in Iran and the trends for quantitative measures over time should be monitored.

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Background and Objective: Road traffic injuries are among the most important causes of death and disability in Iran, and the country has one of the highest prevalence of opioid drug use, especially among drivers. The effect of different situations related to opioid use needs great attention. The purpose of this study was to estimate the effect of driving in the withdrawal phase on the occurrence of traffic accidents leading to injury.
Materials and Methods: This is a Case-Crossover study on injured drivers of crashed motor vehicles in Kerman. Drivers having skipped one habitual drug dose within one hour of the driving session were considered as being in withdrawal. We compared the drivers' situation at the time of accident with their regular driving habits.
Results: Among 75 drivers who had history of regular use of opium, 15 were in withdrawal phase at the time of accident. The relative rate of occurrence of traffic injuries while driving in these circumstances was 2.67 (95% confidence interval: 1.52 - 4.68).
Conclusion: According to these findings we can conclude that habitual opioid users are at greater risk of traffic accidents while driving in withdrawal status this risk is more than two-fold relative to not being in withdrawal status.

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Background and Objectives: Hepatitis B virus (HBV) infection is a major public health problem worldwide. Islamic Republic of Iran is located in mesoendemic region (prevalence 2%-7%). The aim of this study was to assess prevalence of chronic HBV in Iran according to demographic characteristics.
Methods: Medline, Embase, Science Citation Index Expanded, Ovid, Google Scholar, IranMedex, SID, Magiran and The Scientific Journal of Iran Blood Transfusion Organization (SJIBT) from 2000 till May 2008 were searched. Cross-sectional studies concerning prevalence of hepatitis B infection in Iran were included irrespective of language and date. The outcome of interest was prevalence of chronic HBV infection detected by blood specimen positive for HBsAg.
Results: We icluded 34 studies. The prevalence of chronic HBV infection was estimated about 1.7% or lower in general population 0.8% (95% CI: 0.6%-0.9%) in blood donors and 3.2% (95% CI: 2.3% - 4.1%) in intravenous drug users. Prevalence of chronic HBV infection in beta thalassemic patients varied from zero to 1.5%. Prevalence of chronic HBV infection was higher in middle aged and elders than children, adolescent and youth and was 25% higher in males than females.
Conclusions: Since mass vaccination of hepatitis B in 1993, prevalence of chronic HBV infection has being reduced among children and adolescents. These age groups comprise a large proportion of general population and reduction of HBV infection in this age group may impact on total prevalence of hepatitis B infection, so that now Iran may be considered a hypoendemic region for HBV infection.

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Background & Objectives: There is increasing evidence that self-medication is a widely prevalent practice in many developing countries. It seems a special significance issues among medical students as they are the future medical practitioners. The objective of this study was to assess the level of self-medication and its related factors amongst medical students in Tehran University of Medical Sciences.
Methods: A cross-sectional questionnaire-based study was conducted among the 600 students of Tehran University of medical science in 2011 year.
Results: The frequency of self-medication in students was 35.7 percent. This was more common in females rather than males. Some reasons for seeking self-medication included Previous illness experience (51/9%), easily access to medications (28/5%) and feeling not important of illness (22/9%).
Conclusion: Our study shows that self-medication is common among medical students in Tehran. In this situation, it is necessary for faculties to create awareness and educate theses students regarding advantages and disadvantages of self-medication.

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

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

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

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

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Background and Objectives: The current study was conducted to assess factor structure, validity, and reliability of the Persian version of the Drug Use Disorders Identification Test (DUDIT) among drug abusers in many city of Iran. It also assessed the DUDIT scores of a number of demographic factors.
Methods: The LDQ underwent forward translation to to Persian abackward translation to English. Furthermore, it was compared with the original scale. We made essential changes after it was used by 20 participants. Two hundred and eighty one drug abusers from prisons, dormitories, and rehabilitation camps completed the questionnaire. A demographic questionnaire as well as the Drug Use Disorders Identification Test (DUDIT), Severity of Dependence Scale (SDS), and Leeds Dependence Questionnaire (LDQ) were used to collect data. Methods used for data analysis included Confirmatory factor analysis, Cronbach’s alpha coefficient, Guttman split-half coefficient and convergent reliability.
Results: Findings supported the unidimensional structure of the DUDIT. The Cronbach’s alpha and Guttman scale score were 0.81 and 0.68, respectively. The convergent validity through calculation of the correlation coefficient of the DUDIT with LDQ and SDS was 0.61 and 0.46, respectively. History of drug abuse in the family, residence in rehabilitation camps, taking several substances simultaneously, and use several methods of drug abuse simultaneously obtained the highest score in the DUDIT.
Conclusion: The Persian version of the DUDIT has suitable psychometric properties in drug abusers. It is important to pay attention to the demographic factors affecting drug use disorders for prevention and treatment plans.

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Background and Objectives: A significant portion of the total health expenditure is related to medicines. Evaluation of medication system indicators forms a basis for modifying the consumption pattern and cost containment. Therefore, the present study was conducted to investigate the trend of medication consumption indicators in Iran.
Methods: In this descriptive-cross-sectional study, medicine consumption per capita was calculated based on the medicine type, medicine form, and treatment category. The data were extracted from the Pharmacological Statistics of the Food and Drug Administration and the Statistics Center of Iran between 2012 and 2015. Catzung categorization was used for treatment categories. Data were analyzed using descriptive statistics and annual growth index by Excel 2013 software.
Results: During the study years, the highest medicine consumption per capita was related to metformin 500 (18.52), ranitidine 150 (15.45), and adult cold (15.29). The highest average consumption per capita in different treatment categories was related cardiac medications (97.65). The lowest and highest growth rates were related to glibenclamide 80 with -12% in 2014 and metformin 500 with 16.9% in 2013, respectively. Tablets were the most widely used form of medicine.
Conclusion: According to the results, medicine consumption per capita in Iran is higher than developed countries. Cardiac and diabetes medications have a high consumption per capita in Iran compared to other medications. Therefore, in order to rationalize drug prescription, strengthening the clinical evaluation system is recommended by developing and implementing clinical guidelines for common and high-cost diseases.

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Background and Objectives: Drug abuse is one of the medical, social, economic and cultural problems in the present era that increases the morbidity, mortality, and disability among addicts. Iran, due to its adjacency to major centers of opiate drugs production, has a severe and critical condition. Therefore, epidemiological studies are essential for comprehensive management of drug abuse disorders.   
   
Methods: In this descriptive cross-sectional study, demographic and epidemiological data of all people whose cause of death was drug abuse in 2013-14 (1392 Hijri) were extracted by two checklists. Data were then analyzed with SPSS software.

Results: A total of 2957 deaths occurred during the study period. Most deaths occurred in unmarried young males with a low income and education level. The mean age of the subjects was 36.6  12.81 years. The mortality rate from opiate and psychoactive abuse in the whole country was 53.28 in 1000000 population. The most commonly used drugs in the study population were opium, crystal, and heroin in a descending order. Hamedan, Lorestan, and Zanjan provinces with a mortality rate of 150, 101, and 80.06 per 1,000,000 people had the highest mortality due to drug abuse.

Conclusion: Training programs and harm reduction approaches such as methadone treatment and naloxone distribution programs should be designed in high-risk groups to reduce mortality associated with drug abuse.

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Background and Objectives: Accidents are one of the global concerns in public health. About 1.24 million people die in traffic accidents annually. Road accidents are the leading cause of years of life lost in Iran and motorcyclists are the riskiest group of road users. Drug abuse is one of the main causes of road traffic accidents and motorcycling is more popular in drug abusers. So, this study was conducted to compare the riding behavior of normal and drug abuser motorcyclists.
 
Methods: This historical cohort was performed in 411 motorcyclists in 3 study groups: 100 methadone consumer motorcyclists, 100 methamphetamine consumer motorcyclists, and 211 normal motorcyclists. The participants in three groups were matched for age and area of residence. A motorcycle riding behavior questionnaire was used to collect the data. Then, the collected data were analyzed with the SPSS (V-20) software using descriptive and analytic statistics. Multivariate linear regression was applied for statistical analysis.
 
Results: There was a significant difference in the riding behavior score between normal motorcyclists and methamphetamine user and methadone user motorcyclists (P<0.0001), but the difference between drug user motorcyclists was not significant (P=0.292). The most frequent violation in all three groups was speeding.
 
Conclusion: the results showed speeding was the most frequent violation in all three groups followed by traffic errors. It was found that drug abuse (methamphetamine and methadone) could have an impact on motorcyclists’ riding behaviors as it could increase the riding behavior score in drug user motorcyclists compared to normal motorcyclists.

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Background and Objectives: The Cox model is one of the methods used in survival data; however, the use of hierarchical data, such as the data of this study, violates the assumption of independence, the the Cox model cannot be used  assuming independence of observations. One of the important methods for analyzing survival hierarchy data is the use of the multilevel Cox model. In this method, in addition to modeling the response variable, regression coefficients are also modeled and the measurement error resulting from the lack of data independence is reduced. The present study used a multilevel Cox model to investigate the effect of the retention of antihypertensive drugs in people with hypertension.
 
Methods: This longitudinal survival study was conducted in 346 workers with hypertension in Mobarakeh Steel Company in Isfahan. During the years 1390-1394, when the staff attended the health center in the factory, they were treated with six drugs, including captopril, losartan, atenolol, propranolol, amlodipine, and hydrochlorothiazide. In order to examine the relationship of the retention of drugs with job experience, body mass index, and drug history, a two-level Cox model was used as h_ij (t)=h_0 (t)exp⁡(α_g+x_ij β_j), where i and j is the first and second level units, respectively.
 
Results: During five years, the findings of model fitting showed the effect of body mass index (P = 0.019), atenolol (P=0.046), and amlodipine (P=0.021) in a single form, and the effect of losartan-amlodipine ¬(P=0.042) and atenolol-hydrochlorothiazide (P = 0.003) in a combination form were significant.
 
Conclusion: Based on the study results, the most effective drugs for hypertension control are amlodipine monotherapy, amlodipine-losartan combination therapy, and atenolol monotherapy, respectively.

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Background and Objectives: The prevalence of HBV infection among injection drug users (IDUs) is higher than the general population due to high-risk sexual behaviors and the needle sharing. The aim of this study was to determine the prevalence of HBV infection and its effective factors among IDUs of Kermanshah Province in 2016.
 
Methods: This ia descriptive-analytic study was performed in 606 male IDUs in Kermanshah Province in 2016. Data were collected through questionnaires and interviews. HBV was also evaluated through blood tests using the rapid test. Simple and multivariate logistic regression analyses were applied to investigate the factors affecting HBV infection. Data were analyzed using STATA-12 software.
 
Results: The prevalence of positivity HBV antibody was 3% (95% CI: 1.61- 4.32) among male IDUs. According to the results of unit-variable logistic regression analysis, the duration of drug injection (OR = 1.08, 95% CI: 1.02-1.15) and the number of daily injections (OR = 1.38, 95% CI: 1.05-1.81) were risk factors for HBsAg positivity but there were no significant associations in the multivariate regression model.
 
Conclusion: The prevalence of HBV is much higher among IDUs than in the general population. These populations are at risk for viral infections such as HBV; therefore, it is recommended to provide necessary education about the prevention methods as well as the necessary screening for them.

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Background and Objectives: This qualitative study was conducted to identify reasons for not using condoms by people who inject drugs (PWID) in Iran.
 
Materials and Methods: Purposeful sampling was applied to recruit four groups [male PWID (n = 14), female PWID (n=6), service providers (n=8), and HIV/Addiction experts (n = 9)] into a qualitative study. Data were collected through focus group discussions (FGDs) or individual in-depth interviews. Data were analyzed using conventional content analysis.
 
Results: The mean age was 44.0 years for male and 38.2 for female PWID. Qualitative analysis showed 16 themes for not using a condom, which were grouped in three main categories, including knowledge (3 themes), accessibility (4 themes), and individual barriers to use condoms (9 themes). Poor knowledge included low perceived level of risk, insufficient training, and misconceptions. Lack of access to condoms resulted from the country's new policy for population growth control and decrease in the number of pharmacies and harm reduction centers and prisons where condoms were previously distributed free of charge. Common reported individual barriers to condom use were poverty, homelessness, depression, low self-care, and low self-esteem, less pleasure, having sex under the influence of drugs, and stigma.
 
Conclusion: Both structural and individual factors may play a role as barriers to condom use among PWID.

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Background and Objectives: Drug use not only affects a person's physical and mental health, but also affects the health of others in the community. Various variables, including demographic and social factors, affect drug use. The present study was conducted to investigate the prevalence of drug use and related factors in the participants of Shahedieh Cohort Study.

Methods: A descriptive study was performed using the first phase of Shahedieh cohort study on 10194 adult residents of Shahdieh, Zarch, and Ashkezar in 2015-2016. The aim of the cohort study was to assess the prevalence of non-communicable diseases and their risk factors in adults aged 35-70 years. Data were analyzed with the SPSS 20 using chi-square and logistic regression.

Results: The prevalence of illicit drug use in the present study was 15.5% with a mean age of onset of 31.5 ± 9.2 years. The most common drug was opium (98.2%). The most common method of drug use was inhalation (98.1%). The logistic regression showed that male gender (P< 0.001), age 40 to 49 years (P<0.001), low education (below high school diploma) (P<0.001), positive history of smoking (P<0.001) and alcohol consumption (P<0.001) were the most important factors associated with drug use. In addition, a positive history of ischemic heart disease (P=0.007) and psychiatric disorders (P=0.02) were the diseases related to drug use.

Conclusion: The prevalence of drug use was high in the study population. There is an urgent need for intervention and preventive measures to solve this complex social problem.
 

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