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: Malnutrition is a major health problem in Iran. A nationwide survey (ANIS) in 1998 revealed that over 800 000 children in this country were suffering from moderate or severe malnutrition. The southern province of Hormozgan is one of the most severely affected regions, so there is a need to determine disease associations and risk factors for child malnutrition in this area.
Methods: In this case-control study, we selected 1725 children aged 6 to 30 months from both rural and urban areas of Hormozgan. Data for the study were obtained by filling questionnaires and studying family health files. Using the weight-for-age Z score (WAZ) as outcome measure, we examined the effects of 21 different variables, including putative risk factors, confounders, and background variables.
Results: Father's job (p<0.004), parents' education, interval between pregnancies, urban versus rural residence (p<0.001), family size (p<0.03), and misconceptions regarding the growth chart were recognized as risk factors for malnutrition. Moreover, the mean age of the cases was 2.3 years higher than that of the controls (p<0.001). Complete vaccination (p<0.018) and attending day care centers (p<0.005) emerged as protective factors.
Conclusions: Poverty (low-income jobs, rural residence, large family size, etc) is an important factor causing malnutrition among children in Hormozgan. In contrast, immunization and mother's knowledge of the child's growth chart are major protective factors. Therefore, the health system must continue its support for the current immunization program. It should also try to improve the quality of its health education programs targeted at mothers attending state-run health and medical clinics

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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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The term "health inequalities" is not a descriptive one: it refers to discrepancies in morbidity and mortality, life expectancy, disability life adjusted years, etc that are due to differences in such factors as socioeconomic status, gender and race/ethnicity. Socio-economic inequalities are the differences in health status (e.g. disease prevalence and incidence rates) across various socio-economic groups. In Europe, measuring socio-economic health inequalities has long been a major research topic. However, there have been relatively few experimental studies in Asia, especially in developing countries. In the social context, measurement of socio-economic status is based on income, educational level and employment status. Stratifying the socio-economic groups based on a hierarchy identifies the pattern of morbidity and mortality in each socio-economic stratum. It also shows the exact relationship between socio-economic status and health. The main data sources for determination of population health status and measuring health inequalities are registries and cross-sectional surveys. It seems that monitoring, prevention and evaluation of health inequalities, especially with a focus on socio-economic level has been neglected in developing countries, including Iran. Due to the lack of formal registries on population health status in these countries, designing cross-sectional and population-based studies would be a useful approach in the prevention and monitoring of health inequalities.

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Background & Objectives: Anemia is one of the most common disorders affecting all age groups. This cross-sectional study aimed to determine the prevalence of anemia and microcytic anemia in the population served by Asadabadi Health Center in Tabriz.
Methods: We used a systematic sampling method to select 1623 subjects out of a total of 233000 persons aged above 12 years. Measurements of hemoglobin, MCV (Mean Cell Volume) and in the case of anemia, serum iron, ferritin, TIBC (Total Iron Binding Capacity), together with hemoglobin electrophoresis and reticulocyte count were performed in reference laboratories. Data were analyzed using T tests and the Epi6 software package.
Results: The prevalence rate of anemia was 9.7% more than 75% of the cases were due to iron deficiency, while 11.4% were caused by minor thalassemia. Prevalence rates for iron deficiency anemia and minor thalassemia in studied population were 7.3% and 1.1% respectively.
Conclusion: Findings show that the degree of anemia- as defined in the WHO classification- is mild in this region. The most common cause of anemia is iron deficiency.

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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 and objective: Acute myocardial infarction (AMI) is the most prevalent cause of mortality in the world today. Sometimes before an acute phase of AMI there are certain prodromal symptoms. Since there are some social and cultural differences in Iranian population, this study was deigned to investigate the prodromal symptoms in patients with AMI in city of Birjand.
 Methods: In this analytic-descriptive research, 165 patients with first AMI who were hospitalized in the CCU and cardiac ward of the Valiassr Hospital in Birjand from the 2006-2007 were studied. A valid questionnaire which was designed by expert cardiologists was used. The T-test and ANOVA were used for data analysis, and p<0.05 was considered as the significant level.
Results: Among 165 subjects, there was 118 (71.5%) males and 102 patients (61.8%) had Anterior MI. 61 patients (37%) reported cardiac prodromal symptoms and 43 patients (26.1%) reported systemic prodromal symptoms. The most common cardiac prodromal symptom 2 days before AMI was chest pain in the right and left hemithorax (24.2%), and the most common systemic prodromal symptom was loss of appetite (12.7%). Women reported more cardiac (p=0.04) and systemic (p=0.00) prodromal symptoms than men. This difference was statistically significant (p <0.05).
 Conclusion: Careful attention to history and prodromal symptoms in patients with cardiac risk factors may be caused early diagnosis, efficient treatment plan and better prognosis of AMI in patients.

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Background & Objectives: The main purpose of this study was to assess the pulmonary reactions associated with occupational inhalation exposure to raw materials used in ceramic production (RMCP).
Methods: Thirty three male workers with current exposure to RMCP and 20 healthy male unexposed employees, ,with almost identical demographic and socioeconomic status were interviewed and respiratory symptom questionnaires were administered to them. Furthermore, they underwent chest X-ray and lung function tests. Additionally, personal dust monitoring was carried out at dusty work sites. To determine the chemical composition, possible silica phases and SiO2 contents of dust samples, they were analyzed by X-ray diffraction (XRD) and X-ray fluorescence (XRF) techniques.
Results: Atmospheric concentrations of dust, that contained 69% SiO2­, exceeded current permissible levels. Additionally, exposed workers had higher prevalence rates of regular cough, wheezing, phlegm and shortness of breath. Likewise, their chest radiographs showed some degrees of abnormalities. Furthermore, significant reductions in some parameters of pulmonary functions of exposed workers were noted.
Conclusions: The findings of this study indicate that a strong association exists between exposure to RMCP, prevalence of respiratory symptoms, abnormal changes in chest radiographs and functional impairments of the lungs.

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ackground & Objectives: In fact, economic growth, income inequality and health are integrated issues. Economic growth along with increasing income lead to individuals' health promotion and public health and has a positive impact on it, but if there is inappropriate policy to redistribute of these resources, it would have reverse effects. The purpose of this study was to examine the relationship between economic growth and ecological income inequality indices with health in Iran from 1978 to 2006.
Methods: An ecological study was designed and relevant data were gathered from the statistics center of Iran and Iran Central Bank. Results: The correlation between Gini coefficient and health indices was statistically significant (P<0.01). The association between economic growth and mortality rate of children under five years index (P<0.01) and with life expectancy (P<0.05) were statistically significant as well.
Conclusions: Economic development and decreasing income inequality should be considered as important determinant factors to have better health in Iranian society.

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Background & Objectives: Work-related Musculoskeletal Disorders (WMSDs) seen more in workers of manufacturing industry than others. This study was, therefore, conducted to determine prevalence rate of WMSDs symptoms among workers of a metal manufacturing industry in Shiraz.
Methods: In this study, nearly 50% of workers of the production units were randomly selected from corresponding list of each unit. Totally, 156 workers participated in this study. A self-administrated questionnaire was used to collect required data. T-test and Chi-square tests were used to analyze the data.
Results: The results showed that WMSDs occurred in considerable rate among the workers such that 76.9% of the workers studied suffered from some kind of symptoms during the last 12 months. The highest prevalence was reported in the lower back (54.5%) and knees (42.9%). Machine operators and welders reported the highest rate of symptoms. Statistical analyses revealed significant association between age, height, work tenure, weekly work hours, smoking, shift work and the symptoms (P<0.05).
Conclusions: WMSDs symptoms occurrence was prevalent among workers of this industry. To prevent WMSDs symptoms, more attention should be paid to working conditions of the machine operators and the welders, and risk factors for back and knee regions should be reduced.

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Background & Objectives: According on surveys in Iran more than two million persons have non insulin diabetes mellitus. There are evidences that good glycemic control reduces the risk of diabetic complications. This study was designed to evaluat the glycemic control by using fasting blood sugar and hemoglobin A1C estimation and their relation with some variables.
Methods: This cross sectional study carried out on 411 people with type 2 diabetes who referred to Tawhid diabetes center in Sanandaj. Demographic and other variables were gathered by a deigned questionnaire. Univariate analysis and multivariate analysis (logistic regression) were used. Results: In Univariate analysis FBS showed a significant relationship with education, job and referral style and HgA1c was statistically significant with sex, age, education, and job. But logistic regression showed other
Results: in final model FBS and HgA1c were associated with body mass index and referral style and HgA1c had association with only body mass index and referral style. Correlation confidence between FBS and glycated hemoglobin was (r = 0.54).
Conclusions: It is concluded that BMI and referral style have association with diabetes control.

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Background & objectives: Cardiopulmonary bypass often causes a stress hormonal response with subsequent changes in hemodynamic and organ perfusion. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate inflammatory and stress markers, without adverse effects. The aim of this study was to investigate whether low dose infusion of ketamine have hemodynamic stability effect in coronary artery bypass surgery.
Methods: In this double blind-controlled trial, 50 patients undergoing on-pump CABG were randomly assigned to receive either 1.25mcg/kg/min of ketamine infusion (Ketamine group, n=25) or normal saline infusion (Control group, n=25) during 48 hours after induction of anesthesia. hemodynamic measurement including blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, systemic venous resistance, arterial blood gas and lactate were measured previous to induction (T1), 4 h, 24h, and48h after the surgery (T2,T3 and T4). The data were evaluated with using of variance analyzing test and repeated measurement.
Results: There were significant interaction effect between time (pre operation, 4, 24 and 48 hours after operation) and group of study (ketamine and placebo) in assessment of systolic blood pressure (p=0.0001), diastolic blood pressure(p=0.0001), heart rate (p=0.004), central venous pressure (p=0.0001) and lactate (p=0.035). These indicate that ketamine caused decrement in tissue perfusion. Those interactions were not statistically significant for other parameters (p>0.05).
Conclusions: low dose ketamine during and 48 hours after operation not only didn`t show hemodynamic stability effect but also decreased tissue perfusion slightly.

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

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Background & Objectives: In the analysis of mortality trend in the Iran that is basically a sequences of observations sorted by time, there is a point where the statistical properties of the mortality trend change so that the first k₀ observations have a distribution of F₀ and other n-k₀ observations have a distribution of F₁. The point k₀ is unknown and called the change point. The aim of this paper was to detect the location of the change point and estimate it in the real mortality data of the country.

 

Methods: In this study, X_t indicated the number of mortality in time t (year) and because of the numeric nature of the variable, we considered the Poisson model for the variable X_t.

We assumed in early years (t0), X_t had a Poisson distribution with a mean of ʎ₀ and for later years (t>k₀), X_t had a Poisson distribution with a mean of ʎ₁ .In theory, we used the MIC method, a modification of the SIC method. For detecting more than one change point, we used the binary segmentation process in the mortality trend.

 

Results: The results showed that the change point occurred in 1993 and 1997.

 

Conclusion: The finding of this study showed three periods with different rates in the mortality trend of Iran.

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Background and Objectives: Determining and monitoring the age at myocardial infarction (MI) and its comparison in various regions is one of the vital and basic principles for the management of MI.This study was conducted to determine the age at the first MI in Iran.

Methods: In this cross-sectional, analytical study at a national level, the data of 20750 new MI patients registered in 2012 in 31 provinces of Iran according to the cardiologist’s diagnosis, World Health Organization criteria, and the codes ICD10: I21-I22 were used. The calculations were done using the Stata 12 software.

Results: The mean±SD of age at the first MI was 61.2±13.4 years in all patients in Iran. Moreover, 15033 (72.4%) patients were male with a mean age of 59.6±13.3 years. The mean age at MI in men was lower than women (65.4±12.6 years), showing a statistical significance (P<0.001).The mean age at MI was different among Iran provinces, with a statistical significance (P<0.001). The lowest mean age at the first MI was seen in the patients living in Semnan (59.1±12.9 years), followed by Tehran (60.4±13.5 years), Sistan va Balouchestan (60.3±13.9 years), and Lorestan (60.1±14.5 years), with a significant difference from the mean age of the patients in Ardabil (63.2±15.1 years) and Zanjan (64.4±112.8 years) (P<0.019).

Conclusion: Our study demonstrated that the age at MI was approximately five years younger in men than women. This studyprovided the ground for monitoring the age at MI, and more effective management of cardiovascular diseases in Iran.

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Background and Objectives: Ahvaz has become one of the most polluted cities in the world. Only on 11 November 2013, over one thousand residents in Khuzestan Province attended the nearest health center with severe symptoms, particularly shortness of breath, cough, wheezing, and high blood pressure. During a week, more than 7 thousand patients were registered with this syndrome. This study was conducted to investigate the evidence for the confirmation of an epidemic in acute respiratory syndrome among the residents of Ahwaz in November 2013.

Methods: In this cross-sectional study, we evaluated the data of the use of drugs related to acute respiratory attacks from November 2008 to 2013 in Ahvaz. Then, we conducted a descriptive study on the general population. The sample size was 120 and the study participants included different segments of the general population. The data collection tool was a researcher-made questionnaire and the data were analyzed using SPSS.18.

Results: The use of the respiratory drugs increased from 2008 to 2013. The drug consumption was markedly higher in November 2013. In the study of the general population, 93% of the participants declared that they had never seen a similar event, and 92.5% mentioned that they had never heard of a similar occurrence.

Conclusion: Due to the significant increase in respiratory medicine in November 2013 and the unexpected nature of the event, an epidemic seems to be obvious.

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Background and Objectives: Brucellosis in livestock has led to a significant reduction in the economic capital in Iran. Estimation of the economic losses due to this disease helps to highlight the importance of the disease and makes it easy to justify brucellosis control programs.

Methods: Estimation was done based on the data received from the Iran Veterinary Organization and statistics book of the Iranian Ministry of Agriculture. Economic Loss was estimated assuming the equality of the incidence of the disease in total livestock population with its incidence in tested livestock. The direct costs of culled brucella positive animals, reduced milk production, reduced weight of animal, abortion, and reduced fertility were calculated based on the price of the animal or the product in each year. Due to inflation, the costs were adjusted using the discount rate. Therefore, the losses were compared in each year.

Results: The maximum loss due to brucellosis in the studied period occurred in 2014. Comparison of the losses due to bovine and ovine brucellosis showed that the total economic loss in the sheep and goat population was 5.53 times greater than the loss in the cattle population. Estimation of total economic loss in 12 years of the study was 8,129,116 million IRR (1 USD≅35000 IRR).

Conclusion: More serious attention should be paid to animal brucellosis from both health and economic points of view. Prevention from massive economic losses and human brucellosis control and eradication will not be possible without controlling the disease in the animal population.

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Background and Objectives: Leishmaniasis encompasses a wide range of clinical complaints from skin injury to fatal visceral infections. Detailed information about the economic burden of the disease can help health care decision makers to estimate the magnitude of the problem, economic advantages obtained from the prevention of this disease, resource allocation, and disease management. The study was conducted to determine the economic burden of leishmaniasis in humans and animals in Iran in 2013.

Methods: The cost unit was determined through public service tariffs determined by the Ministry of Health and Medical Education and interviews with experts, and service costs were calculated by multiplying the cost unit for one person by all infected cases. The course of the disease and the services provided to patients were obtained from the review of the literature and records and interview with experts.

Results: The economic burden of leishmaniasis was estimated more than IRR 213 billion ($6,700,000). Moreover, 39%, 27%, 18%, and 16% of the costs were related to indirect costs, direct medical costs, indirect medical costs, and dogs, respectively. The average direct medical cost of cutaneous and visceral leishmaniasis was IRR 3381186 ($106) and IRR 9392832 ($295) per person, respectively.

Conclusion: The economic burden  of leishmaniasis compared to some diseases such as hydatid cyst showed a smaller number( 232.3 million$). It is recommended that IIranian health politicians consider the economic burden of other diseases.

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Background and Objectives: Life satisfaction is one of the important dimensions of health, which is influenced by health determinants. The aim of this study was to investigate the status of socioeconomic inequalities in satisfaction with life in women aged 15-54 in Iran.
 
Methods: In this cross-sectional study, randomized multistage cluster sampling with equal clusters was done to select the participants. A total of 35,305 women aged 15-55 were enrolled in the study. Data analysis was done in two stages. In the first stage, social and economic inequalities were investigated using the concentration index and concentration curve method. In the second stage, a multilevel method was used to identify the determinants.
 
Results: The mean life satisfaction was 12.81±4.23. The concentration index for dissatisfaction with life was -0.06 [95% CI: -0.1, -0.02], indicating dissatisfaction with life in low socioeconomic groups. The results of multilevel analysis showed that age, marital status, occupation, place of living, education, and the economic class correlated with dissatisfaction with life in women (P<0.05).
 
Conclusion: There is inequality in dissatisfaction with life. Dissatisfaction is concentrated in the poorer groups of the society and varies in different provinces. Socioeconomic variables affect inequality in satisfaction with life in women, which need to be addressed to reduce inequalities.

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Background and Objectives: Epidemics of diarrhea caused by contaminated food and water occur frequently worldwide, especially in developing countries. The aim of this study was to identify the factors contributing to the development and spread of diarrhea epidemics caused by Shigella  flexneri  in Isfahan in the spring of 2015.
 
Methods: Following the first reports and activation of the surveillance system, a matched case-control study was conducted in 360 cases with diarrhea and 360 controls. Data were gathered using a questionnaire, and conditional logistic regression was used to provide adjusted odds ratios and 95% confidence intervals.
 
Results: Consumption of contaminated fresh vegetable (OR=4.50, 95% CI=2.88-7.01) was the source of the epidemic. Contact with similar patients (OR=7.19, 95% CI=4.26-12.12), presence of similar patients in the family (OR=33.2, 95% CI=13.64-80.82), food consumption on special events (party, wedding ceremony, funeral, etc.) (OR=1.67, 95% CI=1.06-2.62), being a government employee (OR=3.08, 95% CI=1.64-5.78) and being illiterate (OR=2.91, 95% CI=1.10-7.67) were the risk factors of the spread of the epidemic.
 
Conclusion: In this study, consumption of fresh vegetable contaminated with Shigella flexneri was the source of the infection. According to the Epidemic Management Team, contamination occurred due to non-standard wastewater irrigation of agricultural lands. Therefore, it is important to consider the standards of agricultural production and compilation of a comprehensive program to improve the status of the wastewater purification system in the environmental sciences by the relevant organizations to prevent diarrhea epidemics.