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 objectives: Although in many developed and developing countries, self care is the most important part of primary care, in Iran it has not been supported as well as its values. The aim of this study was to assess the views of general people living in south of Tehran about self care.
Methods: This was a population based study in which 1200 individuals aged 15 years and over were interviewed using cluster sampling. A structured interview questionnaire which including 5 sections on regarding demographic characteristics, views on general health, views on self care knowledge, interest and practice, views on barrier and enabler factors for self care, and views on sources of information was used. Content validity and cronbach’s alpha coefficient was used for its validity and reliability. Data were analyzed through spss version 11.
Results: The mean age of participants was 27.9 ± 5.2 years. Six hundred and fifty eight respondents (55%) stated they were not knowledgeable on self care, 986 (82%) and 1035 (86%), were interested and self rated themselves active regarding healthy life style, respectively. In practice, only fifty three participants (4%) were actually active in eating ≥7 glasses of water daily, 31 (3%) stated they ate more than five portions of fruits daily and 51(4%) did physical activity more than 3 hours weekly.
Conclusions: The findings of this study have highlighted the significant role of information in doing self care activities.

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Background and Objectives: Lack of nutritional knowledge is one of the most important reasons of nutritional problems worldwide and consequently, improper practice which can lead to several complications such as: malnutrition and non-contagious diseases. This study has been designed to investigate the knowledge, attitude and practices of the urban households regarding practical principals of nutrition in Boushehr, Golestan, and Sistan & Balouchestan provinces in 2004.
Methods: Evaluation of knowledge, attitude and practice of urban households towards practical principals of nutrition in mentioned provinces was carried out by this cross sectional study. The sampling method at the level of the households in each province was the single-stage cluster sampling with equal size clusters. The necessary data were gathered with a structured questionnaire and via the interviews between the questioners and the eligible people in each household.
Results: A total of 1154 individuals were participated in this survey. Approximately seventy percent of individuals were aware about having basic four food groups and 45% of them were also aware of role of food group in human body. Majority of people had acceptable attitudes toward nutrition. Based on standard criteria consumption of meat was rare and consumption of fish was in medium level, legumes in high level, fruits and vegetables, milk & dairy products were in acceptable level. Consumption of carbonated beverages, junk foods and sugar were in high level.
Conclusion: The findings of this study imply a need for effective implementation of nutritional community interventions by health policy makers in Iranian health systems.

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Background & Objectives: The aim of this study was carried out to compare knowledge, attitude and practice of urban and rural households towards osteopenia and osteoporosis in Golestan, Sistan & Balouchestan and Boushehr provinces in Iran.
Methods: single-stage cluster sampling was used. The questions about knowledge about, attitude toward and practice of nutritional factors related to osteopenia and osteoporosis were asked by a structured interview.
Results: A total of 2306 households have been selected as overall sample size. Knowledge level of urban households about calcium as a preventive factor of osteoporosis & osteopenia was more in Sistan & Balouchestan, Golestan and Boushehr provinces. Knowledge level of urban households about calcium food courses: (Milk, Yogurt, Cheese and Dairy alternatives) was also better than that of rural habitants (P<0.01). Urban residents' attitude toward osteoporosis compared to rural residents was better (P 0.01>). Consumption of pasteurized milk had been paid more attention in urban households (P<0.001). The difference of daily milk intake in rural and urban households with pregnant or lactating women was not significant. Exposure of infant to sun as preventive factor was not satisticaly significant between rural and urban habitants.
Conclusion: It is concluded that the level of knowledge, attitude and practice of rural households toward osteoporosis and osteopenia was weaker than urban households.

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Background & Objectives: Medical Tourism has been recently paid more attention. Individual practitioners and medical organizations must be able to provide accurate information about this rapidly evolving trend. Since there has been little known about this issue, we decided to assess the knowledge about and attitude towards medical tourism in Rafsanjan, Iran.
Methods: A questionnaire including XXX questions were completed by Rafsanjan Medical University staff. All information was analyzed by SPSS software.
Results: Only 8.3% of individuals sated that they studied some articles about Medical Tourism, and only 14.7% of them had deal with these kinds of patients. The majority of participants (80.7%) hadn’t had any idea about the quality of medical expenses by Medical Tourists. Mainly (68.7%) believed that development of Medical Tourism in Iran would not have any bad social consequences and 62% believed that its development in Iran could improve the knowledge of Iranian doctors. The majority (67.3%) agreed to arrange for inviting tourism to Iran in order to use of Medical Tourists and 54.3 of them believed that development of Medical Tourism could improve treatment of Iranian patients.
Conclusions: The knowledge of participants seems is very low therefore appropriate educational programs should be tailored by responsible organizations in Iran. However medical staff’s attitude towards medical Tourism seems is very positive which indicates having necessary potential for any activity in this regard in future.

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

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Background & Objectives: The epidemic of HIV has been become worldwide. Infected people with HIV which are most intravenous drug users (IDUs) and/or people who have unsafe sex are important source of transmission of infection to other persons in a community. Since there is little known about the knowledge and attitudes of HIV positives about HIV in Iran, therefore we decided to measure the level of knowledge and attitudes of this group in Golestan province in compare with individuals with risky behavior.
Methods: This cross-sectional study was conducted on 54 HIV+ persons and 134 people with high risk behavior individuals in 2007 year. Results: Our study showed that HIV- (High risk group) cases had higher education level (P=0.034). Rate of jobless was higher in HIV+ persons (P<0.001). HIV+ cases had lower income (P=0.037). Both groups had moderate knowledge and poor attitude on HIV/AIDS. Level of attitude in HIV+ positive persons was lower than high risk group (P=0.05).
Conclusion: It is concluded that these susceptible persons and also infected individuals with HIV regardless of their socio-economic levels need more continuous education in structured programs.

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

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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 and Objectives : Knowledge transition is an important issue in social epidemiology. Taking into account the importance of knowledge translation network among vulnerable young people in closed environments, this study was conducted to recognize and survey knowledge transition in school lessons. The study aimed at teenagers residing in orphanages in the city of Kerman, using social network analysis.

  Methods: The study samples of this cross-sectional study were all teenagers aged 12-18 years old residing in orphanages. Data was collected via a checklist. In order to study the structural cohesion of social networks and the position of teenagers, density and centrality indices were calculated. Local structure of networks was studied using the triad census method. Finally, the effects of independent variables on indegree index were investigated using a mixed model.

  Results : The mean density in knowledge transition was 0.34 (0.42 and 0.27 in girls and boys, respectively. (P=0.2)). Completely null and completely mutual triads were 17.1% and 11.2% in girls and 33.7% and 0.09% in boys, respectively. Indegree increased with an increase in age (P<0.001), the average of the scores in school exams (P=0.002), and studying non school materials (P=0.04).

  Conclusion: Age, average score of school exams, and studying non school materials were important factors in indegree. In general, density of social network was rather low. The rate of knowledge transition was small. Therefore, activities are required to enhance knowledge sharing and transition.

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Background and Objectives: The pandemic of HIV/AIDS is spreading rapidly in the Middle East, in particular in Iran. Designing an educational program involves assessment of the educational needs of people with valid and culture-based tools. This study was conducted with the aim of psychometric analysis of an instrument for assessment of HIV/AIDS knowledge based on the Iranian culture in different population groups.
 
Methods: In this psychometric analysis, 58 items related to AIDS knowledge were prepared based on a literature review. Then, the face validity  and content validity of the instrument was determent by the impact item score, content validity ratio (CVR), and content validity index (CVI). The reliability of the scale was assessed by Cronbach’s alpha coefficient and test-retest.
 
Results: Based on face validity and content validity, the research scale had 44 items with an item impact score > 1.5, a CVR > 0.49, and a CVI > 0.79. The Scale had three sections, general knowledge about HIV/AIDS (9 items), knowledge about HIV transmission (25 items), and knowledge about HIV/AIDS prevention (10 items). The Scale also had a high reliability (Cronbach’s alpha coefficient=0.77-0.91, ICC=0.88)
 
Conclusion: The results of the study showed the instrument was a valid and reliable scale for measurement of knowledge about HIV/AIDS.

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Background and Objectives: Cancer is a complex disease with a lengthy and expensive course of treatment that causes many problems for the community. Knowledge of oral cancer plays an important role in early diagnosis. The aim of this study was to determine the level of knowledge about the symptoms and risk factors of oral cancer and assess the related factors.
 
Methods: In this study, 671 parents of primary school children were randomly selected from primary schools in four districts of Tehran. The participants were asked to answer questions related to demographic characteristics and knowledge of the risk factors and symptoms of oral cancer. Data analysis was done using Poisson regression model and multi-level Poisson regression model using SPSS and STATA software. The AICI Akaike Information Criterion (AIC) was applied to evaluate the models.
 
Results: The mean score of knowledge was 3.7 with a standard deviation of 6.7. Among the studied variables, female gender, advanced age, a higher SES score, and a higher welfare index had positive effects on oral cancer knowledge (P <0.05).
 
Conclusion: The results of this study showed that demographic, social and economic factors of parents were effective on oral cancer. It can be statistically concluded that a multilevel Poisson regression model is more suitable for analyzing this data.
 

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Background and Objectives: The spread of COVID-19 in the world has had adverse effects on all aspects of people´ life and social and economic development of the communities. The current study was conducted to determine the knowledge, attitudes, and practices toward COVID-19 in the general population of Qazvin province. 
 
Methods: This cross-sectional study conducted on 1223 people above 15 years in Qazvin province between December and January 2020. We used multistage stratified random sampling to select the participants from urban and rural health centers. The questionnaires were completed by the patients as well as through phone interviews. The questions included demographic information and knowledge, attitude, and practice toward COVID-19. 
 
Results: In total, 1223 subjects with a mean (standard deviation) age of 35.6 ± 12.2 years participated in this study. The scores of knowledge, attitudes, and practice were 68%, 72% and 91%, respectively. The lowest score of knowledge was related to awareness of common symptoms of the disease (6%). Forty-two subjects believed they observed the principles of disease prevention. A distance of 2 meters was observed by 50.3%. The scores of knowledge (P=0.007) and practice (P=0.028) increased with age, and the scores of knowledge (P<0.001) and attitude (P=0.001) increased and decreased with an increase in the education level, respectively. Males had significantly lower knowledge (P=0.002) and practice (P<0.001) scores. Moreover, rural residents had higher attitude scores compared to urban residents (P=0.002).
 
Conclusion: The results suggest that the general population of Qazvin province had desirable knowledge, attitude and practice towards COVID-19 at the time of the epidemic.

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