Iranian Journal of

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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 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 & Objective: Population-based unit research in urban areas utilze possible commmunity-based researches in oder to empower people to have a healthy life. In order to achive this goal this study carried out to prirotise the common health problems from the point of view of experts and habitants in Kerman population-based research center in 2007.
Methods: Cluster sampling was employed and an standard questionnaire was completed by participants.
Results: A population with total of 1289 persons from 324 family were included in this survey. The mean of age 26.8 ± 19.2. Fifty one percent were male and 15.7% had college education, 3.8% were illiterate, 35.8% were housewife or unemployed. Near seven percent had at least a chronic disease in their family. Most complaint of health environment were shooting garbage and stray dogs (48.7% and 42.5%). Unemployment and inflation were most worrying issues from people point of view (85% and 24%).
Conclusions: It is concluded that to allow people to participate in decision making for any health promotion program is very important and it should be taken into account by health policy makers.

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In the previous paper, the basic concepts of sample size calculation were presented. This paper explores main post-calculation adjustments of the sample size calculation in special circumstances such as multiple group comparisons, unbalanced studies (with unequal number of subjects in different groups) sample size correction for missing data, and adjustment for finite population size. In addition, the concept of design effect in multi-stage sampling

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Cardiovascular disease is the first cause of death and third place in disease burden in Iran. This study estimates population attributable fraction (PAF) of cardiovascular risk factors in Tehran population. PAF is one of the important parameters of measuring population affect of risk factors and evaluating potential impact of preventive strategies in community level.
Methods: In this study 5868 participants above 30 years old of Tehran lipid and glucose study (TLGS) were employed and 501 CVD events detected during 10 years follow-up. Direct estimate of adjusted PAFs using logistic regression which is one of less biased exist methods of PAF calculation were applied.
Results: Highest modifiable cardiovascular risk factor PAFs, in sequence, was smoking (14.16%), hypertension (11.73%), diabetes (7.32%), hypercholesterolemia (6.85%) and central obesity (5.91%) for men, and hypertension (19.25%), diabetes (18.82%), central obesity(9.88%) and hypercholesterolemia (7.95%), for women. Also PAF of hazardous age and premature family history of CVD, as most important nonmodifiable CVD risk factors, were 36.09%, 16.61% and 3.95%, 7.56% for men and women respectively.
Conclusion: According to the difference of risk factors PAFs ranking in men and women, it is suitable that CVD preventive interventions to be prioritized by sex separately. In this regard, besides special attention to control tobacco use in men, hypertension and diabetes in both sexes and high cholesterol in men and central obesity in women respectively, should be given in priority of preventive strategies.

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Background & Objectives: Some case-report studies in Iran showed probable association between anthracosis and smoke exposure due to baking homemade bread, population. Therefore we estimated the population attributable fraction (PAF) for this probable association in Iranian population.
Methods: A hospital-based case-control study, including 83 anthracotic subjects (cases) with 72 controls from surgical ward which were matched by age, conducted in Imam Khomeini hospital in Tehran (From September 2009 to December 2010). Patients in both case and control groups were interviewed according to "American Thoracic Society" guideline. Exposure to smoke was considered both as a binary and continuous variable (number of years being exposed to smoke) and the population attributable fraction (PAF) were estimated due to smoke exposure.
Results: Univariate analysis showed that exposure to smoke as binary variables, age and occupation exposure to dust and education were associated with anthracosis. After Adjusting, only smoke exposure (OR: 3.35, 95% CI: 1.49-7.55) remain significant. Univariate logistic regression model showed exposure to smoke as continuous variable has significant association with anthracosis. In multiple logistic  model only duration (years) of smoke exposure remained significant (OR: 1.05, 95%CI: 1.01-1.09). PAF due to smoke exposure estimated approximately 48% in our population.
Conclusion: Based on the findings of this study, it could be concluded that approximately half of the anthracotic cases are attributed to smoke exposure.

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Background & Objectives: In the chain of vehicles, human and environment, the human factors are the most complex element in the causes of road traffic injuries (RTIs). Unauthorized speeding and overtaking are considered as the main human factors resulting RTIs. This study estimated the population attributablefraction of two human factors, the most common risk factors of rural roads, of RTIs.
 Methods: To calculate the population attributable risk, the prevalence of unauthorized speeding and overtaking registered in Police data was employed. Effect size related to odds ratio was employed using Logistic regression. Joint effect of related risk factors also calculated and reported. Dasta were taken from national traffic police using the KAM 114 froms.
Results: The percentage of population attributable risk of unauthorized speeding for deaths at crash scene was 20.9 and for injured cases was 16.6. These values were 13.5 and 13.4 for unauthorized overtaking respectively. Corresponding for joint effects the population attributable risk was 31.6 for deaths and 27.8 for injuries.
 Conclusion: The results illustrate the importance of speed control and unauthorized overtaking as a priority of RTIs in Iran. It is recommended that related laws and legislations should be pursued more seriously, and followed by more effectively.

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Background & Objectives: Bam is one of the old CL centers and this study aimed to determine and compare the period prevalence among its population and housing units in two periods of 1990-92 and 2010-2012.
Methods: In this descriptive–analytical study, data were collected in the questionnaires through door-to-door visits environmental hygiene, and inquiring the history of the CL disease. A questionnaire was completed for each household, the data were analyzed using SPSS software and t- and X2 tests. P<0.05 was considered significant.
Results: The prevalence rates in the periods 1998-1999 and 2010-2012 were 10.3% and 2.1%, in the study population and 33.6% and 5.5% in the residential units in the period of the last 3 years, respectively with a very significant difference (P<0.0001). The environmental hygiene of the houses in terms of vector breeding was significantly lower in the period 1990-1992 than 2010-2012 (P<0.0001). The mean score of environmental hygiene was 11.5 and 16.6 out of 20 during the two periods, respectively.
Conclusion: According to the results of this study, urban CL is extremely reflective of the environmental changes and probably the best preventive measure is to improve the environmental hygienic conditions in and around the households. Public participation and commitment of the health authorities in this regard could be an important measure for planning preventive programs.

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Knowing the population size of rare diseases or special subpopulations like injection drug users (IDUs) is one of the most important challenges in public health and health surveillance systems but it is difficult to estimate these groups. During the last few years, new methods have been suggested to estimate hidden or hard-to-reach populations, one of which is the network scale-up method (NSUM). The NSUM itself includes measuring the personal network size and estimating the prevalence of hidden and hard-to-count populations. In this paper, we basically discussed the indirect methods of calculating the population size, and the history of NSUM and its concepts, and then addressed the estimation of hidden populations with NSUM and the applicable notes for such populations.

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  Background & Objectives : Considering the high prevalence of hypertension and its increasing trend in Iran as the most important known modifiable risk factor of stroke, this study was performed to determine the pattern of hypertension and the related population attributable fraction (PAF) of stroke in Hamadan Province.

  Methods: Blood pressure data of over-19-year-old population of Hamadan Province from 2005 to 2009 was extracted from the non-communicable diseases risk factors surveillance system . The point prevalence and 95% confidence interval (95% CI) of hypertension was reported in the study population according to sex and age groups. The trend of hypertension was depicted using a line plot. To calculate PAF, the data of the prevalence of hypertension in 2009 was used. Corresponding hazard ratio was obtained from the available literature.

  Results : The prevalence of hypertension was 9.4 (8.2 – 10.6) in 2005, 7.5 (5.9 – 9.3) in 2006, 14.2
(12.1 – 16.5) in 2007, 13.8 (11.7 – 16.1) in 2008, and 12.2 (10.3- 14.5) in 2009. The mean and standard deviation of systolic blood pressure was 120.88 (19.73) and 124.19 (19.24) in the participants in 2005 and 2009, respectively. The study results showed that 19.84% of the strokes in Hamadan Province were due to hypertension .

  Conclusion: The results of this study confirmed the considerable contribution of hypertension to stroke in Hamadan Province. Accordingly, policy makers are strongly recommended to consider controlling and preventive strategies for hypertension as a priority .

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Sampling hidden populations is challenging due to the lack of convenience statistical frames. Since most populations exposed to special diseases are hidden and hard to reach, sampling methods that produce representative and efficient samples from the populations have become a study subject for researches all over the world. Because of the unknown probability of selecting samples in conventional sampling methods and also invalidity of generalizing the results of non-probability sampling methods to the statistical population, the necessity of introducing probability chain-referral sampling methods, such as the respondent driven sampling method becomes imperative. In this article, besides introducing the respondent driven sampling method, some of the advantages of this method as relative decrease of the bias of estimates, declining the non-response rate by paying incentives and allocating weights proportional to reciprocal of the social network size of respondents to produce unbiased estimates are described. Moreover, some disadvantages of this method such as lack of producing differential samples by selecting similar seeds, lack of reaching more efficient method than snowball sampling by implementing this method improperly and lack of achieving to equilibrium by existing weak social networks among members of interested population are stated. Another aim of this article is to compare sampling methods of hidden population with the respondent driven sampling method which are the results of implementing this method in different surveys and existing simulations.

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Background and Objectives: One of the applications of population attributable risk percent (PAR%) is to estimate the disease burden in a population exposed to several risk factors. Therefore, this study was conducted to estimates the PAR% of the space-time clusters of pulmonary tuberculosis.

Methods: In this study, the data of pulmonary TB cases were obtained from the health department of Hamadan University of Medical Sciences. After detecting significant clusters using the spatiotemporal scan statistic, PAR% was used to analyze the clusters and to detect the location of clusters more accurately.

Results: Four primary space-time clusters and three secondary spatiotemporal clusters were detected for patients with pulmonary tuberculosis and 92% of the patients who did not have a clear state in term of HIV infection. Despite differences in the location of clusters and PAR%  attributed to them, the second primary cluster of pulmonary tuberculosis cases (consisting of the cities of Razan, Famenain and Kabudrahang) had the highest amount of PAR% that needs more attention.

Conclusion: The presence of significance spatiotemporal clusters in Hamadan highlights the necessity of the use of PAR% to distinguish cluster areas and to implement prevention and control policy. However, more analytical studies are needed to detect the on the determinants of the occurrence of pulmonary TB.

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Background and Objectives: Using the anthropometric indicators of children is one of the ways of monitoring their growth. Because of the racial divisions and levels of health and welfare, comparing these indicators with the global reference is not reasonable; therefore, designing a local reference seems necessary. This study aimed to evaluate the growth indices for boys and girls aged 5 to 18 years old living in Isfahan and to compare the indices with standard values.
Methods: In this cross-sectional study, 53,839 subjects were included. Percentiles of body mass index, height, and weight were calculated using the LMS method in the LMS Light software. After normalization of the growth indices, their mean and standard deviation were calculated for each age group and anthropometric indices curves were plotted versus the 5th, 50th and 95th percentiles of the NCHS reference.
Results: In all age categories, the mean SDS scores of BMI in boys and girls was -0.004 ± 0.029 and 0.014 ± 0.062, respectively, indicating no difference with reference values. However, the 95th percentile of the body mass index for the reference population was consistent with the 90th percentile for the population studied. Also, weight in boys below 13 years of age was higher than the reference line while in girls, weight was always higher than the reference value.
Conclusion: Due to differences in the pattern of growth and also lower anthropometric values, particularly among boys, it seems that a national growth curve can be a better guide for future decisions.

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Background and Objectives: The awareness of the health knowledge level of a population and the weaknesses in people's health literacy is essential for educational planning. This community assessment study, which was conducted to develop an appropriate infrastructure for educational planning, examined the level of health literacy in Hormuz Island’s residents.
Methods: This analytical cross-sectional study was done on a sample of people over 18 years in Hormuz Island. Data were collected by two questionnaires which included basic information such as age, sex, marital status, age at marriage, and also indirect questions regarding the economic status of the individuals. Also, the Short Test of Functional Health Literacy in Adult (S-TOFLHA) was used to measure the patient's ability to read and understand health-related concepts. The linear regression analysis was performed.
Results: The data provided by 486 individuals were analyzed in this study. The mean age was 39 years (18-79) and 48% were female. The mean household size was 4.5 people. The mean score of the subjects was 58.06. Thirty-five percent had less-than-sufficient health literacy, 18.21% had sufficient health literacy, 12.29% had insufficient, and 7.14% had higher health literacy. Education level (P<0.001), economic status (P<0.001), and age (P<0.001) were the main variables influencing health literacy in the sample.
Conclusion: Community assessment showed that older age groups did not have sufficient health literacy. Low economic status accompanied by low levels of literacy makes individuals less motivated to improve their health knowledge and, consequently, leads to low levels of health literacy in Hormuz.

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Background and Objectives: Human errors are the most important factors for RTIs, which have been addressed in few quantitative studies. The objective of this study was to calculate the annual population attributable fraction (PAF) of the most important human risk factor for RTIs in the streets and highways of the Great Tehran.
 
Methods: In this study, the data of 124518 individuals registered in the COM114 form of the Police Information and Communication Technology (ICT- FAVA) data system of the country were employed in 2014. A regression model was applied to estimate the magnitude of the impact of traffic violations of drivers with RTIs using the adjusted relative risk ratio. To estimate the PAF, the prevalence and effect size were calculated based on the risk ratio (RR) using the baseline method or the Miettinen formula.
 
Results: The PAF of driving in reverse gear and failure to observe safe distance was 1.98% and 1.93%, respectively. Driving in the reverse gear and failure to observe the safe distance increased RTIs by 22% and 23%, respectively. On the highways of the Great Tehran, the largest proportion of PAF was related to driving in reverse gear (1.96%), sudden movement of the car (1.90%), speeding (1.87%). Speeding increased the risk of RTIs by 23%.
 
Conclusion: Monitoring traffic violations can decrease road crashes by 10% in the streets. Moreover, on highways, use of strategies to prevent traffic violations can decrease RTIs by up to 15%.

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Background and Objectives: One of the data sources for monitoring the progress towards Sustainable Development Goals and Universal Health Coverage (UHC) is household surveys such as Multiple Indicator Cluster Survey (MICS) and Demographic and health Survey (DHS).  This study was conducted to assess the implementation of these surveys in the Eastern Mediterranean Region (EMR) to evaluate the experience of Iran in conducting these surveys and to propose one of them as the best option for implementation in Iran.
 
Methods: In this review article, by reviewing the databases of the relevant organizations, the implementation history, instructions, protocols, and the generated indicators of these two surveys were assessed.
 
Results: So far, 26 standard DHS and 56 standard MICS have been implemented in the EMR. Iraq implemented the highest number of MICS and Egypt carried out the highest number of DHS. In the global reports, no DHS/MICS surveys were conducted in Iran after 2000 However, according to the official reports, Iran conducted two rounds of a survey called MIDHS (a combination of DHS and MICS) in 2010 and 2015.
 
Conclusion: The EMR has performed well in implementing these surveys. According to the findings, DHS is more suitable for Iran. However, right now, what is important is not to decide which survey to be conducted. Considering the international commitments for monitoring the progress towards UHC, it is important to conduct either one in 2020 in Iran.
 

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Background and Objectives: Using a random sample of women aged 15 to 50 years in Tehran, this study sought to estimate the lifetime prevalence of abortion (intentional and unintentional) and to identify its associated factors.
 
Materials and Methods: The control data of a population-based case-control study conducted in 2014 in Tehran was used in the present study. Data from 544 randomly selected women aged 15-50 living in municipality areas of Tehran were included in this study. A multiple logistic regression model was used to investigate factors associated with abortion and to estimate the adjusted odds ratios (ORs) and 95% confidence intervals.
 
Results: Overall, 102 women (18.8%, 95% CI (22.4% -15.8%)) reported a lifetime history of abortion. In the logistics regression model, being single (OR =3.46, 95% CI: 1.42-8.47) older age (OR = 1.07, 95% CI: 1.04-1.11) increased the odds of a positive lifetime history of abortion. However, having a child (OR = 0.27, 95% CI: 0.11-0.65)), more education years (OR = 0.89, 95% CI: 0.82-0.96)) and higher religious beliefs (OR = 0.65, 95% CI: (0.45-0.93)) decreased the odds of a positive lifetime history of abortion..
 
Conclusion: High reported lifetime prevalence of abortion in the present study and its subsequent risks to maternal health highlight the need for educational interventional programs taking into account the level of education and knowledge of mothers along with their religious.

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