Iranian Journal of

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Background & Objectives: Cardiovascular disease is the leading cause of death worldwide and is predicted to retain this position until 2020. The aim of the present study was to map cardiovascular mortality rates in Kerman Province counties during 2004-2005.
Methods: In this descriptive study we collected all mortality data registered in various counties of Kerman Province. We calculated mortality rates and drew maps showing the geographical distribution of the dead cases.
Results: Total cardiovascular mortality was higher in the northern counties. The pattern is the same in males and females
Conclusions: The reasons for higher mortality in the northern regions of the province may include a greater prevalence of major cardiovascular risk factors such as physical inactivity, unhealthy diets, and smoking.

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Background & Objectives: The youth group is more prone to HIV infection. Education is a cornerstone to prevention. This study was conducted to compare the efficacy of peer education and traditional lectureship and distribution of pamphlet on high school students.
Methods: 1500 female high school students, third graders, were selected based on stratified random sampling studying in 21 high schools in Kermanshah. In each high school, 73 third grades were selected as the sample of the study. We designed a questionnaire as an assessment tool for interventions. Peer education was done by 502 students, and AIDS awareness pamphlet was distributed on 500 students, and the rest of students were attended a one-day workshop which was ran by a female physician in their high school.
Results: The mean average age was 16.78 (SD= ± 0.7) years. The mean scores of pretest and post-test in each groups were statistically significant different (P=0.0001). Mean score of difference in workshop by female physician was greater than peer education group, 10.7 and 8.8, respectively. The group whome received their knowledge about AIDS by pamphlet obtained the least mean score than other groups and this was statistically significant (P=0.0001).
Conclusions: The findings of this study indicate that educating students by general practitioners is more effective way to increase students’ knowledge about prevention of AIDS.

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

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مقدمه و اهداف: امروزه پزشکی مبتنی بر شواهد بعنوان یک رویکرد نوین و قابل اتکا در علوم پزشکی پذیرفته شده و جهت ارتقاء کیفیت مراقبت‌های بالینی بیماران مورد توجه قرار گرفته است. هدف این مطالعه تعیین میزان آگاهی و نگرش دستیاران بالینی دانشگاه علوم پزشکی کرمان در مورد مفهوم رویکرد پزشکی مبتنی بر شواهد و بررسی میزان کاربرد آن بود.
 روش کار: مطالعه به روش مقطعی و از طریق پرسشنامه‌ای که روایی و پایایی آن تایید شده بود، در آذر ماه سال 1388 انجام گرفت. داده‌ها با استفاده از نرم افزار SPSS مورد تجزیه وتحلیل قرار گرفتند.
نتایج: از مجموع 94 دستیار شرکت کننده در مطالعه 3/55% مرد، میانگین سن شرکت کنندگان 7/32 سال و متوسط زمان اتمام تحصیلات پزشکی عمومی آن‌ها 6/5 سال بود. 3/83 % شرکت کنندگان معتقد بودند که استفاده از EBM درمراقبت از بیماران مفید است، اما فقط 3/5% آن‌ها اظهار کردند که در بیش از نیمی از کارهای بالینی خود از رویکرد پزشکی مبتنی بر شواهد استفاده می‌کنند. 3/88% شرکت کنندگان به پیشرفت در زمینه EBM علاقمند بودند. منبع کسب اطلاعات برای تصمیم گیری بالینی، در6/59% دستیاران شرکت کننده کتاب، در 4/41% تجارب کلینیکی توام با کتب درسی و تنها در 2/19% آن‌ها مقالات بود.
نتیجه‌گیری: نتایج نشان داد که دستیاران دانشگاه علوم پزشکی کرمان شناخت کمی از پزشکی مبتنی بر شواهد دارند. لذا لزوم برنامه ریزی منسجم در زمینه آموزش پزشکی مبتنی بر شواهد و کاربرد عملی آن احساس می‌شود.

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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 and Objectives: Anthroponotic cutaneous leishmaniasis (ACL) is restricted to humans; thus, prompt diagnosis and early treatment are significant measures to control the disease. This study was conducted to determine the effect of direct active case- detection and early treatment on the control of ACL in Bam District.

Methods: This retrospective cohort study was performed based on intervention and nonintervention. After the 2003 earthquake, an equipped treatment center was established to actively detect CL cases following the CL epidemic. This intervention was carried out in 2007 and the suspected cases were referred to the center for diagnosis and treatment Another comparable CL treatment center was selected as the control in Kerman. The recorded data of the patients were analyzed with statistical tests at p<0.05.

Results: The incidence rate steadily increased to 30% from 2003 to 2007 whereas the incidence gradually decreased to 1% after the intervention. However, by contrast, the incidence rate increased significantly in the control area. The treatment failure and relapse rate of ACL showed no significant difference with the control group before and after the intervention. The effectiveness of the intervention was calculated to be 85%.

Conclusion: Active case-detection and early treatment of ACL could be an effective measure in controlling ACL, particularly during epidemics. Lessons learned from the 2003 Bam earthquake could be used as a suitable model for ACL endemic areas, nationally and globally.

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Background and Objectives: Cutaneous leishmaniasis (CL) is a public health problem in Iran and Kerman Province which is expanding to new foci. This study was conducted to estimate the incidence of CL by a simple and cost – effective method in a major focus of CL in the city of Kerman, southeastern Iran.

Methods: A combination of two longitudinal and cross – sectional studies was performed. First, the frequency of referred patients to the CL treatment clinic in 2009-2014 was assessed. Then, four highly infected zones consisting of 800 households in the city were selected. In addition, the relative proportions of referred and non – referred subjects were assessed. Eventually, the incidence of CL was calculated by dividing the number of CL cases over the total at risk population for the corresponding period (2009-2014).

Results: The mean annual incidence was 175 per 100000 (943 patients) in the city of Kerman, while it was 500 per 100000 people (0.5%) in the new foci. The highest CL infection was observed among the <25-year-old individuals but there was no significant difference between the sexes.

Conclusion:The incidence rate probably increased significantly following the 2003 Bam earthquake because of the migration of CL patients to southern, eastern, and northeastern areas of the city of Kerman. Since only 50% of the cases were passively referred to the CL treatment clinic, health authorities should actively detect CL cases by house – to – house visit for effective treatment strategies.

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Background and Objectives: To preventing deaths, it is essential to recognize factors affecting the survival of road accident victims. This study was conducted to identify the factors affecting the mortality of road accident victims.
 
Methods: All pre-emergency mission forms and hospital records of road accident victims were analyzed. The dependent variable was the time interval between the accident and death or discharge from hospital. The forms included demographic variables, accident location, injury status, type of vehicle, type of trauma, mission time, and vital signs.
 
Results: Of 8920 injured persons, death occurred in 143 (95% CI: 0.014-0.019). Being over 65 years (Hazard Ratio (HR) 7.6, 95% CI: 3.14-18.4), accident on the main roads (HR 1.44, 95% CI: 0.6-3.5), tracheal intubation (HR 26.4, 95% CI: 3.05-227.6), a systolic and diastolic blood pressure above 100 (HR 0.4, 95% CI: 0.4-0.12) and 70 mm Hg (HR 0.53, 95% CI: 0.24-1.2), and heart rate>100/min (HR 3.0, 95% CI: 1.7-5.1) were associated with the risk of death.
 
Conclusion: In providing services, age, status of blood pressure, pulse, injury status, and type of trauma can affect the patients’ survival.

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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: Congenital hypothyroidism is one of the reasons for mental retardation and premature death of infants. Since identification of the determinants of hypothyroidism plays a significant role in its prevention, this study was conducted to determine the prevalence of congenital hypothyroidism and to investigate its determinants in newborn infants.
 
Methods: This study was a secondary analysis of the data of the neonatal congenital hypothyroidism screening program. Hypothyroidism was diagnosed based on the Thyroid Stimulating Hormone (TSH) level in the heel prick blood samples on the third to fifth day of life. The data of infants born in Jiroft hospitals were collected from Jiroft Health Center and analyzed using descriptive statistics and Poisson regression test.
 
Results: In this study, 4998 newborns (2450, 49.02% female, 2548, 98 / 50% male) were investigated. The study samples were newborns born from March to March 2016. The prevalence of congenital hypothyroidism was 1 in 135 live births. The prevalence of congenital hypothyroidism was higher in babies born by cesarean section (IRR = 2.2, 95% CI =1.1-4.1), newborns admitted to the NICU (IRR = 4.6, 95% CI=2.4-8.9), and babies with high birth weight (IRR = 5.3, 95% CI =3.5-8.1).
 
Conclusion: The prevalence of hypothyroidism was higher in this study compared to other studies. Its prevalence was higher in males than in females. Genetic and environmental differences may explain this difference. The prevalence of hypothyroidism was higher in infants born through cesarean section and newborns hospitalized in NICU.

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Background and Objectives: Cutaneous leishmaniasis (CL) is one of the health problems in Iran, especially in Kerman Province. The aim of this study was to determine the morbidity rate of CL in two new foci in the east and southeast of Kerman.
 
Methods: At the end of 2017, demographic data were obtained from the health centers of Kerman. Using cluster sampling, 800 households (40 clusters of 20 households) were studied in Allahabad (southeast) and Sarasiab (east), Keramn. From each subject, data were collected regarding age, sex, number and location of the ulcer(s), scarring, and time and place of infection. The collected data were analyzed using SPSS software.
 
Results: The prevalence of CL was 9.6 in Allahabad and 42.8 in Sarasiab and the incidence (new cases) was 3.2 and 3.8, respectively. The highest rate of infection was found in Allahabad in the age group under 6 years old and in the Sarasiab was over 40 years old. There was a significant difference in nationality and local transmission between the rwo regions (P <0.001).
 
Conclusion: The ratio of the prevalence to incidence in two regions showed that the focus in the east of Kerman was almost 12 years old, whilst a new focus is developing in the southeast. It is suggested that the health centers in the city of Kerman provide a regular program including active case- detection and free-of-charge treatment of patients in the aforementioned areas until complete recovery to achieve disease control.

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Background and Objectives: On 12 November 2017, an earthquake with a magnitude of 7.3 on the Richter scale occurred in Kermanshah Province. Explaining the challenges and needs of the victims in such circumstances can be an important source of information for future planning and better management of such conditions. Thus, the purpose of this study was to explain the challenges and needs of the earthquake victims.
 
Methods: This study was a qualitative study. Twenty-nine semi-structured interviews were conducted with managers, policymakers, and health and emergency relief providers in earthquake areas, and 10 focused group discussions were held with earthquake victims from December to February 2016. The data were analyzed using conventional content analysis.
 
Results: The needs and challenges in Kermanshah earthquake were classified into three periods after the earthquake: 1. Challenges and needs in the first few days with three sub-categories including management, rescue services, and urgent care, 2- Challenges and needs in the first few weeks  after the earthquake with three sub-categories including housing and emergency assistance, public health services, and access to health care; and 3. Needs and challenges in several months after the earthquake with four sub-categories including economic, social, infrastructural and health service needs.
 
Conclusion: Lack of unity of command was the main challenge in this earthquake. Another point was the health needs of victim earthquakes over time. Therefore, dispatching of aid forces to the affected areas during natural disasters should be based on planning and needs.

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