Iranian Journal of

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Background and Objective: On 26 December 2003, an earthquake measuring 6.5 on the Richter scale struck the city of Bam and the surrounding villages. This study was conducted to determine the needs of the affected population on the 19th and 20th days after the quake to help with the prioritization of relief activities and efficient resource allocation.
Materials and Methods: Following a feasibility study on 10 Jan 2004, a team consisting of volunteer students of School of Public Health at KUMS was assembled and trained. Each of the 8 groups consisted of 3-4 students with at least 1 man responsible for security on the field. On the 13th and 14th of January, using a cross-sectional design, 60 clusters including 420 households, 7 households in each cluster, were studied based on a Cluster Geographic-Based Sampling (GBS) Plan.
Results: Fifty-five households (13.1%) had children < 2 years, 81 (19.3 %) had children aged 2-5 years and 68 (16.2 %) contained people more than 65 years old. Thirty-seven households (8.9%, CI 95%: 6.4-11.7%) had changed their residence in Bam from one zone to another the main reason for this was poor environmental health conditions (85%). The main source of health and social messages for families was word of mouth 284 (67.6%). The most commonly needed items were bathrooms (73.8 %, CI 95%: 68.9-78.7%), food (68.8 %, CI 95%: 62.6-75.0%) and warm clothes (67.4 %, CI 95%: 60.9-73.8%). The most frequent illness was acute respiratory infection (59.8 %, CI 95%: 54.3-65.2%). Two hundred households (47.6%, CI 95%: 42.6-52.6%) complained of difficulties in obtaining health and medical services. The main barrier to access was transportation problems due to long distance (38.1%, CI 95%: 35.6-40.6%). 

Conclusion: We conclude that relief operations should be continued to provide basic public health facilities. Active delivery of health and medical services should be strengthened, and problems related to reproductive health should not be ignored. The GBS plan is a useful tool in the post-disaster surveys. Using volunteer university students was a rewarding experience and teaching and application of "Disaster Epidemiology" should be improved in this country.

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Background and Objectives: Kala azar is a parasitic disease which belongs to the category of metazoonoses (a communicable disease which requires at least to an invertebrate host), In Iran canines are major reservoir for it and most of patients are 6 months to 2 years old. The aim of this study was evaluation of the clinical and epidemiologic aspects of visceral leishmaniasis in patients visiting the Children Medical Center over the 12 past years.
Methods: This study used the hospital records of a case series of 106 kala azar patients hospitalized in the Children's Medical Center between 1991 and 2001. We extracted and analyzed data on geographical location, background factors, clinical and laboratory findings, response to treatment and Glucantimeâ side effects.
Results: The greatest number of cases was seen in 1992 and the smallest number in 1993 and 2003 the number of cases peaked in the spring. Most patients referred to the Center are aged 1 to 4 years, and there is a strong preponderance of males (82.1% vs 17.9%). The majority of these children came from families in which the breadwinner was a peasants or a laborer. Common laboratory findings included anemia, rising ESR titers and thrombocytopenia. The most striking clinical signs and symptoms were fever, splenomegaly and hepatomegaly. Eighty-three percent of the patients had shown clinical improvement, 1.9% had died and 15.1% had relapsed. Moreover, in 52.8% of cases, the disease was treated successfully with within 2 weeks the incidence of Glucantimâ side effects was low. The cities of Khorramabad, Karaj and Saveh had produced the greatest numbers of cases.
Conclusions: Compared to other studies, our case series showed a higher proportion of male patients and a somewhat different clinical and laboratory profile. However, the most important achievement of this study was identification of major endemic foci in Ardabil province, northwestern parts of Ghom province, Khorramabad, and regions located south of the Alborz Mountains (e.g. Saveh

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Background & Objectives: Although most occupational injuries are the result of stress-related human error, the association between job stress and work-related accidents has not been studied adequately. The aim of this study, carried out in 2004, was to look at the pattern of job stress among workers at Iran-Saipa car manufacturing plant, and to assess the relationship between stress and occupational injuries.
Methods: Data were collected randomly from 608 workers considered to be at risk. The sample was composed of 100 subjects with a history of work-related injury within the preceding year and 508 subjects without such history. Job stress was assessed by the Belkic Occupational Stress Index (OSI). We performed creatinine, cortisole, and 17-ketosteroid assays on 24-hour urine collection samples to check the validity of OSI questionnaires. All subjects were males.
Results: The prevalence of job stress was 21.3%. The main stressors were time pressure (78.5%), mode of payment and evaluation (56.4%), and interaction with people and machines (41.3%). The risk of injury for workers experiencing job stress was significantly higher than in those without job stress (odds ratio= 2.0). On the other hand, job stress was found to be responsible for 11.9% of all occupational injuries in this community.
Conclusions: In conclusion, job stress should be recognized as an important factor causing occupational injuries among car manufacturing workers. Full commitment and participation of managers at all levels and also behavioral and environmental modifications in the production line is important in promoting safety and injury prevention.

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Background & Objectives: Considering the lack of adequate basic information on risk factors for road traffic injuries in Iran, a study was conducted to determine the association between potential risk factors and the incidence of injuries in motor vehicle drivers.
Methods: We performed a population-based case-control study on Qazvin-Loshan road. Risk factors related to injury incidence were compared between 175 cases and 175 controls. Cases were drivers recently injured in road accidents. Controls did not have any injury and were selected systematically while the study was being conducted. Injury was defined as trauma needing medical or surgical treatment. Information was obtained through police reports and interviews with cases and controls. Data were analyzed by two methods bivariate analysis (crude) and by a multivariate unconditional logistic regression model.
Results: In bivariate analysis, risk factors for road traffic injuries risk were failure to wear seat belts or protective helmets, ejection from vehicle, severity of collision, number of crashes, motorcycle vs. other motor vehicle accidents, fire, rain and fog, and collision with fixed objects. In the logistic model, factors such as seat belt or helmet use with OR= 0.619 (0.376-1.018), ejection from the vehicle with OR= 2.952 (1.235-7.056), severe collision with OR= 5.413 (2.865-10.224), motorcycle vs. other motor vehicle accident with OR= 3.164 (1.05-9.537) and raining and fog vs. good weather with OR= 4.562 (1.663-12.514) were found to influence injury incidence. There was an interaction between severity of collision and weather status.
Conclusions: Better speed control, use of seat belts or helmets, not using motorcycles for road travel and equipping vehicles with fire extinguishing capsules are recommended to reduce road accident injuries.

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Background & Objectives: Multiple Sclerosis (MS) is the most prevalent autoimmune disease of the nervous system in young adults. There are currently more than 30000 cases in Iran and the number is increasing everyday.The objective of this study was to measure the amount of vitamin and mineral intake in MS patients and to compare it with reference values.
Methods: We randomly selected 108 relapsing-remitting MS patients from the Iranian MS society in Tehran in 2005. Two questionnaires- covering personal information and medical data- were filled for each patient. Food intake was assessed by three 24-hour recalls and a quantitative food frequency questionnaire for the year preceding the study. The food intake recorded on the original questionnaire was changed to values in grams using “Manual for Household Measures” and then converted to corresponding amounts of nutrient ingredients by the “Nutritionist 3” program. Data analysis was performed by the SPSS software package. We calculated means and standard deviations for intake levels and applied t tests to compare the results with reference values.
Results: Women with MS took excessive amounts of vitamin A and vitamin C, while their daily intake of folate, vitamin E, vitamin D, magnesium, iron, zinc, iodine and calcium was below reference values. Male patients had higher-than-recommended intake of vitamin A, phosphorous, manganese and iron. Their ingestion of folate, Vitamin D and E, magnesium, zinc, calcium and selenium was shown to be below the recommended amount.
Conclusions: In view of these results, higher intake of vitamin D and calcium is recommended. Women should be encouraged to take more iron and folate as many symptoms of anemia mimics MS symptoms. Considering the well-known role of oxidative stress in the pathogenesis of MS, men should be urged to increase their ingestion of antioxidant-rich foods. It appears that nutritional assessment, dietary counseling and education are necessary for Iranian MS patients.

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Background & Objectives: Multiple Sclerosis (MS) is the most prevalent autoimmune disease of nervous system in young adults. The current number of diagnosed cases in Iran is above 40000 and is steadily increasing The objective of this study was to assess the daily macronutrient intake of MS patients and to compare this with reference values.
Methods: We randomly selected 108 relapsing-remitting patients were randomly from the Iranian MS society in 2005. Two questionnaires containing personal and medical information were filled for each patient. We assessed food intake by three 24-hour recalls and a semi-quantitative food frequency questionnaire dealing with intake over the past year. Using the Manual for Household Measures, the data were changed to values in grams and then turned to nutrient ingredients by applying Nutritionist-3. Data analysis was done using the SPSS package: m mean and standard deviation were computed for each nutrient and t tests were run to compare the figures with reference values.
Results: MS patients living in Tehran had a dietary intake of total fat, saturated fat and protein higher than recommended, while their intake of fibers was below the reference values. The body mass index was subnormal in 14.8% of the patients and above normal in 38%.
Conclusions: In light of the current pattern of macronutrient ingestion in MS patients in Tehran, a lower intake of total and saturated fat, consumption of vegetable proteins instead of animal protein and more dietary fiber are recommended. To meet this goal, vegetables, fruit, whole grains and beans are good suggestions. It seems that Iranian MS patients need nutritional assessment, counseling and education to improve their diet.

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Background & Objectives: For those with a chronic illness, suffering may result not only from physical limitations, but also from the psychosocial consequences of having a chronic condition. Therefore, simply measuring physical health is not enough anymore. It is necessary to evaluate quality of life as an important clinical outcome in these patients. We conducted the present study to measure quality of life (QoL) in multiple sclerosis (MS) patients and its predictors in comparison with the general population in Tehran, using a generic and overall QoL instrument, the WHOQOL-BREF (World Health Organization Quality of Life-BREIF). This questionnaire comprises four domains including physical health, mental health, social relationships, and environmental health. For each domain, scores range from 4 to 20, higher scores corresponding to a more favorable QOL.
Methods: This study was of cross-sectional type and involved 145 selected systematically patients registered in the Iranian Multiple Sclerosis Society. The WHOQOL-Questionnaire was filled in for these patients through telephone interviews. The results were compared with quality of life scores from the general population obtained from a population-based study in Tehran. Multiple regression was used for data analysis.
Results: The response rate was 97% 73.8% of participants were female, the mean age of participants was 36.5 (SD = 10.4) years, and the mean years of their formal education was 12.5 (SD=3.6). Mean scores for physical health, psychological health, social relationship and environmental health were 11.5 (SD=3.2), 11.8 (SD=3.2), 12.7 (SD=3.1), and 11.5 (SD=2.7), respectively. In comparison with the general population, the patients' scores in all domains were significantly lower than in the general population. Severity of disease and education level had a relationship with domain scores in regression analysis.
Conclusions: The WHOQOL-BREF questionnaire can discriminate between these patients’ quality of life and that of the general population and show the effect of disease severity and demographic variables on quality of life. Therefore the questionnaire can be used in this group of patients, although it may be necessary to add some specific questions to make the tool more sensitive in evaluating quality of life from a clinical perspective. Educational interventions are recommended to improve quality of life in this group of patients.

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Background & Objectives: The widely differing casualty rates in earthquakes of similar magnitude indicate a need for assessing the factors that determine the extent of damage to life and property. The present study looks at the structural factors and individual characteristics that had an effect on the risk of death and injury directly caused by the December 2003 earthquake in Bam.
Methods: The study population consisted of the residents of Bam on the 19th and 20th days after the earthquake of December 25, 2003. Using a cluster sampling method based on geographic location, we selected 420 households for study and asked them for information on the family members who were inside their houses at the time of the quake. The information covered the following range of items: occurrence of death or injury leading to ambulatory treatment or hospitalization, and characteristics of the building. We used logistic regression and the software package Stata 8.0 for data analysis.
Results: A total of 2089 individuals, including 1089 men (52.1%) and 1000 women (47.9%) took part in this study. There were 369 cases of death (17.7%, 95%CI=12.6-17.8%), 122 injuries needing hospitalization (5.8%, 95%CI=4.5-7.1%), and 319 cases of injury treated on an ambulatory basis (15.3%, 95%CI=12.6-17.8%), all as a direct result of the earthquake. Factors associated with increased risk of death were building destruction (OR=6.34, 95%CI=3.56-11.29), living in adobe structures (OR=1.87, 95%CI =1.03-3.4), age under 6 years (OR=3.93, 95%CI=2.17-7.11) and age 56-65 years (OR=2.52, 95%CI=1.23-5.15). Risk factors for injuries were the same as for death, with the notable exception of the building material.
Conclusions: This was the first analytic study of the risk factors for earthquake-related deaths in Iran. It revealed that total building destruction, residing in houses built with non-resistant materials, and extremes of age are significant risk factors for death in an earthquake. As for injuries, the risk factors were total building destruction and extremes of age.

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Background & Objectives: To determine the prevalence of HBV infection in the Golestan Province (southeastern part of the Caspian littoral, Iran).
Methods: A single cluster study was conducted in 2005, based on a sample of households, representative of the population aged 25-65 years in Golestan. All participants were invited for face-to-face interviews to gather demographic data. Blood samples were drawn and analyzed for serum markers of HBV infection such as HBsAg and HBcAb by the ELISA method. Factors associated with hepatitis B seroprevalence were analyzed using SPSS13 and STATA /8.
Results: A total of 1850 subjects were screened. The age- & sex-standardized prevalence for HBsAg positivity was 9.7% (95%CI=0.07-0.11). Rates were higher in males than in females (10.8% vs. 8.6%) (OR=1.28 95% CI=0.9-1.7). HBV seroprevalence in unmarried individuals was significantly higher than in those who were married (OR=2.13 95%CI=1.29-3.5). HBsAg(+) status was more frequent in urban areas (OR=1.46 95% CI=0.9-2.3). Thirty-six percent of population was HBcAb positive. HBcAb(+) prevalence was significantly higher in females (OR=1.46 95% CI=1.19-1.8) and married people (OR=1.58 95%CI=1.02-2.45), and also in urban areas (OR=1.34 95% CI=1.09-1.6).
Conclusions: This study shows that the prevalence of HBsAg(+) status in the Iranian province of Golestan is at a level regarded as "high" by the World Health Organization. It is higher than reported by pervious studies in Iran so it is important- especially for health providers and policy makers- to recognize risk factors and design appropriate prevention programs.

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Background & Objectives: Pediculosis is a ubiquitous and contagious parasitic dermatosis. Throughout the world, infestation by the head louse (Pediculus humanus capitis) is more common among schoolchildren, especially in those aged 6-11 years. This descriptive/analytical study was carried out in 2003 to determine the prevalence of pediculosis capitis and risk factors involved in the epidemiology of pediculosis in primary school pupils in Amlash, Gilan province.
Methods: The children were selected by cluster random sampling of schools and classes, and then examined for head lice using hair conditioners and a fine-toothed head lice comb. We screened a total of 4244 pupils from 95 primary schools. We used a comprehensive questionnaire to evaluate the effects of school type and location, education level, parent job, regular baths, number of persons sharing the same bed, combing frequency, host sensitivity, family size, hairstyle, gender, and hair length.
Results: Statistical analysis using χ2 tests showed that school type, school location, parent job, regular baths, number of person who share the same bed, frequency of combing, gender, host sensitivity, family size, and hairstyle are significantly associated with infestation. Infestation rate showed no correlations with hair color, season, age, or education level. Results showed that pediculosis is more prevalent in rural than in urban areas. The average rate of infestation for the area was 9.2%, indicating an epidemic situation by standard criteria.
Conclusions: The high prevalence of P. capitis infestation among these children was probably due to poor environmental hygiene and scarcity of water. Hygienic controls of schoolchildren by nurses are important for elimination of Pediculus humanus capitis. This is the first community-based study describing in detail the epidemiology of head louse infestation in the Amlash district of Gilan province in Iran and confirms that Pediculosis capitis is still a problem in many environments, particularly those with low life standards and poor health care.

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Background & Objectives: Tobacco smoking is known to cause a huge burden of disease throughout the world: smoking is responsible for 4 million deaths per year. This study is performed in order to fill the existing gaps in information regarding current trends for lifestyle and tobacco-related disease in Iran.
Methods: This was a cross-sectional study performed with the help of a questionnaire and using a multi-stage cluster sampling method. The final sample size, after the screening of the data, was 84706 out of 89457 records.
Results: From a total of 84706 people in this study, 49.7% were men, 52% were uneducated and 64.8% cane from urban areas 79.9% did not smoke, 15.3% smoked actively, 2.1% were non-active smokers and 2.7% were ex-smokers. The prevalence of smoking was higher in people aged 35 to 64 years (P<0.001). Quitting rates increased with age, especially in women (P<0.001). Smoking was more prevalent in men (P<0.001) and in rural areas (P<0.001). The average number of cigarettes smoked per day was 14.69. Smoking prevalence was lower among adults with higher levels of education compared to those with lower education levels (P<0.001).
Conclusions: This nationwide survey provides a baseline for future longitudinal studies of smoking in Iran. There is a need for effective smoking prevention and cessation programs with a focus on the young population.

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Background and Objectives: There are conflicting data on the effects of different types of fat on aortic atherosclerosis. This study used Wister rats to compare the atherogenic effects of a standard diet with a diet containing fish oil and another diet containing mixed oils (typical of the current consumption pattern in Iran).
Methods: Thirty female Wistar rats were randomly assigned to three diet groups: a standard diet (containing soy bean-oil as the only dietary fat), a diet containing fish oil and another diet which contained mixed oils and was designed on the basis of the current fat consumption pattern in Iran (butter, hydrogenated vegetable oil and sunflower oil). Mothers in each group were fed the same diet during pregnancy and lactation the litters were also weaned onto the same diet. Aortic samples were taken from the offspring at the time of weaning and puberty. Data were analyzed using SPSS software Kruskal-Wallis test was applied for comparison among groups.
Results: Rats that were fed soy bean oil showed less extensive fatty streaks and intimal thickening of aorta on weaning and at puberty. Rats fed fish oil and mixed oils showed more atherosclerosis lesions compared to those receiving soy bean oil.
Conclusions: It seems that diets with an omega-3 to omega-6 ratio of 0.6 can enhance aortic atherosclerosis. Diets with an Iranian fat consumption pattern also increase aortic atherosclerotic lesions because they contain substantial amounts of saturated fat.

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Background & Objectives: The aim of present study is to compare Afghan refugees and Iranian residents in terms of their knowledge, attitude and practice concerning malaria transmission and protection in an endemic area in Southeast Iran.
Methods: This cross sectional study was conducted over a period of 10 months (2004-2005) and involved a total of 775 people, including Iranian and Afghan subjects. The age range of participants was 15 to 55 years. Data collection was done through a structured questionnaire consisting of open and close questions and comprising several, namely personal characteristics details, history of malaria infection and treatments, type of residence, mobility, self protection, facilities, and access to health services.
Results: Both Iranians and Afghans were familiar with the three typical symptoms of the disease (fever, chills and muscle aches): 67.1% of Iranians and 78% of Afghans were able to name least one of the three typical symptoms. In both groups the majority of subjects were aware that malaria transmission occurs through mosquito bite but there was a significant difference regarding knowledge of malaria transmission (χ2 =142.2, P<0.001). Chi-square test for goodness of fit showed that the distribution of symptom indicators is significantly different between the two groups. For Iranians, the most important source of information about malaria was the health facilities (44.5% of the total) while most Afghans (65.3%) had obtained the information through friends and relatives. In both groups, the mass media had acted as the source of information in only 3.4%. Altogether, 24% of the participants reported the use of mosquito bed nets almost 90% of Afghans and 62% of Iranians said that they did not used bed nets at all. However, the number of Iranians who used bed nets was four times greater than the Afghans who did so.
Conclusions: Although the majority of subjects were familiar with malaria transmission and protection methods, they largely neglected safety precautions. Moreover, it seems that the high prevalence of malaria among Afghans is due to their life style rather than cross-border travel. The study also revealed that Afghan people have poor communication with the local health facilities, a point that must receive special attention in future malaria control programs.

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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 & 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 & Objectives: Children are highly vulnerable to TB and childhood tuberculosis is a sign of TB transmission in community. This study aimed to determine the epidemiologic trend of this disease in Iranian children.
Method: A Trend Study was conducted to evaluate all Iranian patients aged below 14 who had been diagnosed with pulmonary or extrapulmonary TB from 1992 to 2005. Statistical relationships were tested using chi square tests (c²) and the software package SPSS (version 11.5).
Results: Out of the 6168 cases studied, 2528 (40.1%) were boys. Patients were assigned to three groups based on disease type: there were 1812 (29.4%) sputum- positive, 1920 (31.1%) sputum-negative, and 2449(39.7%) extrapulmonary cases.The incidence of sputum-positive TB declined from 0.8 per 100000 in 1992 to 0.2 per 100000 in 2005. A similar declining trend was observed for the overall TB incidence and in the incidence of sputum-negative and extrapulmonary cases. There was significant difference in TB incidence between girls and boys in the 10-14 year age group (P<0.001), but no sex difference was observed in 0-4y and 5-9y age groups.
Discussion: The incidence of sputum-positive TB decreased by 75 percent over the study period. This could be partly due to improvements in health status, better disease knowledge and the effects of Iran's National TB Control Program.
Conclusions: In children aged below 10 years, there was no significant difference in the incidence of tuberculosis between girls and boys. At puberty, the incidence of all types of TB was higher in girls. Based on these findings, further studies are needed to elucidate the gender distribution of childhood tuberculosis in Iran.

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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 & 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 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.