Iranian Journal of

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Background & Objectives: The DPT vaccine used in Iran is manufactured by the Razi Institute. So far, there have been no studies to determine the incidence and severity of adverse reactions to this vaccine. It was this lack of reliable information, plus concern for the unfavorable effects of such reactions on compliance with the vaccination schedule, that prompted the current study on DPT side effects.
Methods: In this cohort study, 1910 children aged 0 to 6 were divided into different groups (cohorts) on the basis of factors such as injection site and then monitored for the appearance of adverse effects. Data for this study were gathered through questionnaires filled by telephone or house-to-house interviews. We interviewed parents of children attending the 46 urban health clinics in Kermanshah. These interviews produced the data needed to fill the first part of the study questionnaire. The investigators then gave each parent an "information sheet" containing the data necessary for the second part of the questionnaire. The interviewee was asked to record on this sheet any adverse effects occurring over the following 48 hours. At the end of this period, the parent was contacted via telephone to fill the second part of the questionnaire. Data thus gathered were analyzed using the Statistical Package for Social Sciences (SPSS), version 11.5.
Results: In 1910 DTP immunizations given to children 0 to 6 years of age, followed for the development of adverse events occurring within 48 hours after immunization, the cumulative incidence rates were as follows: Swelling, 40.66% (38.43-42.89%) Redness, 43.08% (40.84-45.32%) Pain, 67.32% (65.20-69.40%) Fever (>38° C) 54.14% (51.89-56.40%) Fever (>40.5° C) 1.11% (0.64-1.59%) Drowsiness, 33.35% (31.21-35.48%) Persistent crying, 13.35% (11.81-14.88%) Local reactions, 75.79% (73.86-77.73%) and Systemic Reactions, 69.84% (67.76-71.97%). Only one child developed convulsion following immunization.
Conclusions: Varying reaction rates in different studies, such as high rate of pain and persistent crying in this study, may reflect the different preparations that were used or differenced in the methods for vaccine evaluation. Moreover, because of the severity of systemic reactions, DTP vaccine should be administered in the thigh region

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

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Background & Objectives: Men (husbands) play a very important role in family planning programs, especially in developing countries. The objective of this study was to determine the prevalence of different methods of contraception in women of reproductive age in Iranshahr in 2004-2005 and the extent of their husbands' participation in family planning.
Methods: This was a cross-sectional study focused on women who were married but not pregnant at the time of the research. We used multi-stage cluster sampling and a pre-tested questionnaire to record the method of contraception and to see if the husband was actually participating in family planning. We used the SPSS (13th version) software to calculated measures of location and dispersion.
Results: The total sample of 700 married women in the (10-49y) age group included 400 subjects in rural areas and 300 in cities. Of these, 696 agreed to take part in the research. Overall, 65.5% of these women were using at least one form of contraception the remaining 34.5% did not use any contraceptive methods. The percentage of unwanted pregnancies was estimated at 16%. The mean number of pregnancies was 7, with a median of 4.5. Sixty-three percent of the subjects reported good cooperation by their husbands. Logistic regression analysis showed that the probability of using contraception was significantly related to the husband's cooperation.
Conclusions: Our results underline the importance of men's support and cooperation in the success of family planning efforts.

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Background & 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 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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Background & Objectives: Triglyceride/HDL-cholesterol ratio (TG/HDL-C) has been shown as an indicator for metabolic syndrome (MetS). This study aimed to detect the role of this ratio to predict coronary heart disease (CHD) outcome in an Iranian men population with high prevalence of MetS.
Methods: 1824 men ≥ 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol (TC), HDL-C, TG, and risk factors of CHD including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study.
Results: During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio (HR) of 1.85 (95% CI, 1.07-3.17). Combined HR for TC and TG/HDL-C (men in the top quartiles of both TC and TG/HDL-C relative to first quartiles) after adjustment for other risk factors was 6.13 (95% CI, 2.37-15.86).
Conclusions: The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male population.

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Methods: Thirty female Wistar rats were randomly allocated to three dietary groups: a standard diet (containing soy bean-oil), diet containing fish oil and diet containing mixed oil which was designed based on Iranian population fatty acid intake. Dams in each group were fed one of the diets during pregnancy and lactation and the pups were also weaned onto the same diet. Fasting serum glucose (Photometry) and insulin (ELISA) in pups were assessed and insulin sensitivity calculated on puberty.
Results: Fasting serum insulin in fish oil-fed group was significantly less than two other groups (P=0.018) and insulin sensitivity in fish oil-fed rats was significantly more than two other groups (P=0.002).
Conclusions: It seems a diet containing fish oil (rich in long chain omega-3 fatty acids) causes more insulin sensitivity comparing to diet containing soy bean oil (rich in omega-6 fatty acids) and diet with Iranian population fatty acid intake pattern (rich in saturated fatty acids).

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Background & Objectives: Changing the pattern of mortality gives important perspective of health determinants. The aim of this study is to detect location and time of mortality pattern change in country using statistical change point method during 1971-2009 Years.
Methods: We assume for years before and after 0 k , t y has a Poisson distribution with means 0 l and 1 l , respectively. We used several methods for estimation change point in real data by assume Poisson model.
Results: Using two simulated and real data analysis showed that the change point has been occurred in year 1993 and this confirmed by all methods.
Conclusion: Our findings have shown that the change pattern of mortality trend in Iran is related to improvement of health indicators and decreasing mortality rate in Iran.

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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: One of the most common anxiety disorders in children is separation anxiety disorder (SAD). The purpose of the present study was to investigate the epidemiology of separation anxiety disorder in Isfahan primary school male student.
Methods: The present study was a descriptive study. The statistical population was all the male students from 7 to 9 years old, studying in second and third grades in primary schools of Isfahan. The sample of study consisted of 1514 male student, who were selected randomly by multi-stage sampling method. The instruments of this study consisted of the Separation Anxiety Disorder Scale, Spence Children's Anxiety Scale and Clinical Interview. Data obtained were analyzed by using descriptive statistics and chi-square and logistic regression.
Results: The findings showed that the rate of separation anxiety disorder in male (7 to 9 year- old student) was %6/93. SAD were more common in 7 years old (7.4%). Children having record of hospitalization, immigration, single-parent households and close relatives of mortality had a higher rate of separation anxiety disorder.
Conclusion: This study shows that separation anxiety disorder among primary school male students is significantly high. Therefore it is important to consider the potential utility of early anxiety prevention/intervention programs, especially for children at this age group.

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Background & Objectives: Back pain represents one of the most common occupational problems in nursing. Since the correct posture has a key role in prevention of back pain, this study was performed to determine of operating- room nurses' readiness to adopt correct posture based on Transtheoretical Model (TTM) .
 Methods: This descriptive-analytical study included a convenience sample of 110 operating- room nurses employed at four hospitals in city of Hamadan. Participations completed a designed questionnaire to assess the readiness of change based on TTM.
 Results: The results of present study revealed that by increasing the stage of change (from precontemplation to maintenance), adopting correct posture in the nurses, increased as well (P=.01). Also, by increasing the stage of change, self-efficacy for adopting correct posture increased (P=.03) and perceived cons decreased (P=.02). Stage of change constructs could predict 68% variance of adopting correct posture in the nurses.
 Conclusion: The results of present study indicated that the majority of operating-room nurses are in pre-operational levels (precontemplation, contemplation and preparation) for adopting correct posture. Considering stages of change as an intervening variable may contribute in any future intervention for this group.

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Background and Objectives: Inequity in health is a universal term which used for showing current differences, variations and inequalities of people in access to health. But inequality in health refers to some inequities which seems are unfair or caused by some errors and biases. The current study aimed to describe some of the common health related inequity measures to be useful for the inequity researchers and other interested health coworkers.
Methods: The calculation, advantage and disadvantage of most common health-inequity indexes including slope index of inequity, relative index of inequality, Theil’s Index, mean log deviation, index of disparity, Gini coefficient, weighted utilization social welfare function, absolute and relative concentration index were assessed. Inequity size of these measures was calculated by using the health care utilization survey data.
Results: Average of health care utilization in in-need subjects was 66.4%. This indicator was in the first to fifth quintiles equal to 57.6%, 63.4%, 71.6%, 69.5% and 75.3%, respectively. Relative concentration index and Gini coefficient was calculated as 0.053 and 0.0062, respectively.
Conclusion: Inequity in health care utilization in Markazi province differs based on the types of inequity measures. Selection of the inequity indexes dependent to the objective and the scale of under study variable. Among discussed indexes, concentration index determine the more accurate and also show the gradient of inequity. Therefore it can be used as the best index.

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Background & Objectives: Although the population of elderly is increasing in Iran, few studies carried out on this group. The aim of this study was to identify life expectancy and contributory risk factors for the Tehranian elderly of ages above 60 years.
Methods: Individuals above 60 years old whom were recruited in the primary phase of the Tehran Lipid and Glucose Study (TLGS) during 1998-2001 were followed up for 12 years and their vital status were registered (1998-2011). Age and sex mortality rates for age groups (60-69, 70-79, 80+) were calculated and by using Cox proportional hazard model the mean of survival time and hazard rates with respect to risk factors were estimated.
Results: Life expectancy for females and males after crossing 60 years of age reaches to 81 and 80 years, respectively without any statistically significant differences between these two groups. Cox model showed that diabetes, BMI>33Kg/m2 and non ischmecic heart disease reduced survival time in women significantly. While diabetes, smoking, hypertension, ischemic heart disease, history of MI, stroke or sudden death of father, brother or son, lack of physical activity and antihypertensive medications are among the hazardous risk factors for men.
 Conclusion: Among the variables studied, only three (ABC) of them were found as risk factors of women's life, while for men seven risk factors were identified. It seems that more studies are needed to determine the risk factors for women.

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  Background & Objectives : In recent years, the World Health Organization has paid more attention to the relationship between health and social conditions as determining the factors affecting people's health in the society. Social health factors (conditions in which people are born, grow up, work, and become old, and also the health system available for them) have caused inequalities in health and require more attention in health development. The purpose of this research was to identify the determining social and economic factors which are effective in mortality in these selected countries during 1998-2009.

  Methods: Countries were divided into 3 groups based on the human development index and 10 countries out of each group were studied randomly. The dependent variable in this research was overall mortality and the explanatory variables were Gini coefficient, unemployment rate, per capita Health expenditure, and also the result of multiplication of per capita income and Gini coefficient. To evaluate and assess the data, the generalized method of moment by Eviews 6 was used.

 Results: The findings showed that the most determining elements affecting the mortality rate in countries with a very high human development index were Gini coefficient (0.02), unemployment rate (0.0001), and the variable obtained by multiplying the Gini coefficient by per capita income (-8.1*10-6). In countries with a high human development index, the most determining elements affecting the mortality rate were unemployment rate (0.005), per capita expenditure (-0.0002), and the variable obtained by multiplying Gini coefficient by per capita income (-3.22*10-6). Also, in countries with a medium human development index, the most determining elements affecting the mortality rate were per capita expenditure (-0.0008), and multiplication of Gini coefficient and per capita income (1.47*10-6).

  Conclusion: It can be concluded that based on the level of development of the countries, various economic and social factors can affect the mortality and health level of those countries. Therefore, it is necessary for the countries to plan for their health system if they wish to eradicate or reduce inequalities and injustices. This plan should be based on their level of development, the factors determining mortality, and the health system of those countries.

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  Background & Objectives : Leadership power and management are discussed as sensitive and key elements in the safety issue. A safety leader can provide the necessary incentives for hard work, efficiency, and more productivity in the organization which includes various working groups and also strengthening a sense of individual responsibility to promote the safety performance in order to achieve the organizational goals. This study aimed to determine the validity and reliability of the Safety Leadership Questionnaire in the vehicle manufacturing industry.

  Methods : This cross-sectional study was conducted on 260 employees of Pars-Khodro Company in the manufacturing lines. All samples were selected randomly. The validity of the questionnaire was determined by statistical methods such as exploratory factor analysis, confirmatory factor analysis, and the heterogeneity between questions. Also, the Cronbach's alpha was used in order to investigate the reliability of the questionnaire.

  Results: The results of exploratory factor analysis showed three factors including decision making, control, and incentives explained 66 percent of the total variance. Confirmatory factor analysis represented the appropriate fitness of information with a three-component structure (P<0.001, df = 2, 𝜒 2 = 5.36, CFI = 0.957, RMSEA = 0.089). The Cronbach's alpha coefficient was higher than 0.7 for all three factors.

  Conclusion : In this research, decision making was an important factor in measuring safety leadership. Moreover, the present study represented an indicator which could be used in the other surveys of safety and industrial psychology.

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  Background and Objectives : Awareness of the cancer incidence is essential for cancer prevention and control programs. Capture-recapture methods have been recommended for reducing bias and increasing the accuracy of cancer incidence estimation. This study aimed to estimate the incidence of gastric cancer by the capture-recapture method based on Ardabil population-based cancer registry data.

 Methods: All new cases of gastric cancer reported by three sources, i.e. pathology reports, death certificates, and medical records, reported to Ardabil population-based cancer registry between 2006 and 2008 were enrolled in the study. The duplicate cases based on the similarity of the first name, surname, and father's name were identified among sources. The estimated incidence was calculated by the log-linear method using the Stata 12 software.

  Results : A total 857 new cases of gastric cancer were reported from three sources. After removing duplicates, the reported incidence rate was 35.3 and 32.5 per 100,000 population for the years 2006 and 2008, respectively. The estimated incidence rate calculated by the log-linear method for these years was 96.2 and 90.4 per 100,000 population, respectively.

  Conclusion: The results showed that none of the sources of pathology reports, death certificates, and medical records, individually or collectively, fully covered the incidence of gastric cancer. We can obtain more accurate estimates of the incidence rate using the capture-recapture method.

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  Background and Objectives : Health is the most common outcome in health research. In addition to the physician’s examinations as the gold standard, there are many questionnaires to assess objective and subjective health. One of the health indicators is the Self-Rated Health (SRH) which can evaluate health through one question. The use of this indicator is very easy and efficient therefore, it has become very common in health research. In this review, the biases and controversies in the interpretation of the SRH have been elaborated.

  Methods: In this narrative review, Medline and Iran-Med databanks were searched using self-rated or self reported health in the title in December 2013. The titles and abstracts of 1106 article were assessed and 106 articles were recognized as relevant articles. Some of the references of these articles were assessed and 16 articles were added to the list of relevant articles.

  Results: There are different types of the SRH questions five or seven item questions, and comparative or non-comparative ones. However, the findings of these types of questions are similar and none is preferred over the others in the literature. On the other hand, the validity of this indicator is not similar in different socio-economic and ethnic groups. Thus, the estimated health difference between these groups is rated with bias.

  Conclusion: T his question still works in the research and clinical setting evaluations. The main point is paying attention to the socio-economic and cultural status of the study groups in SRH interpretation.

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  Background and Objectives : Various studies have reported different survival rates of patients with gastric cancer in Iran, and there is no overall estimate of the survival rate. The aim of this study was to conduct a meta-analysis of one, three, and five-year survival rate of patients with gastric cancer in Iran.

  Methods: In this study, all of the national databases including Iran Medex, Magiran, SID, and Medlib and the English databases including Google Scholar and PubMed were searched by using the keywords “stomach cancer”, “survival rate” and other Persian and English synonymous keywords, in the period 1392-1339 . Then, all articles with inclusion criteria and acceptable quality were investigated. Der Simonian and Laird random effects models were used to combine the results of all studies. Other analyses including subgroup analysis, sensitivity analysis, and assessment of publication bias were performed by using the funnel plot, and Beg’s and Egger’s tests. Finally, the data was analyzed using STATA software.

  Results: Of the 235 articles found in the initial search, nine studies were eligible for this study. According to these studies, one, three and five-years survival rate of patients with gastric cancer was 0.57 (95% CI: 0.45-0.70), 0.29 (95% CI: 0.22-0.37), 0.17 (95% CI: 0.13-0.21), respectively.

  Conclusion : Researches conducted in different parts of Iran are limited and there are no exact statistics on the survival rate in other parts of Iran. Therefore, further studies in the whole country are required to obtain more precise estimates of the survival and factors affecting it.

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Background & Objectives: Measuring the impact of various diseases on Life Expectancy( LE) is an important step toward prioritization in health. The present study was conducted to measure the impact of heart diseases, neoplasm, and respiratory diseases on life expectancy (LE) in 2010.

Methods: Data on death and population for all 22 districts of Tehran were obtained from the main cemetery of Tehran and statistical center of Iran, respectively. Age-specific mortality rates and consequently LE were calculated for all 22 districts and both genders. Finally, the death probability assuming complete elimination of the diseases was calculated and the resulting life tables were obtained.

Results: The LE at birth was estimated 74.6 and 78.4 years for total males and females in Tehran, respectively. The maximum and minimum LE at birth was 80 years in females and 72.7 years in males, respectively. Assuming complete elimination of heart diseases, the LE increased to 82.39 and 85.51 years in males and females, respectively while complete elimination of neoplasm resulted in an increase in LE to 76.27 years in men and 80.49 years in women. Finally, elimination of respiratory diseases increased the LE of men to 75.98 years and the LE of women to 79.97 years.

Conclusion: The results indicated the high impact of the diseases on LE, especially the heart diseases. As a main result, LE will upgrade to more focus on this category. 

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Background & Objectives: This study was conducted to evaluate the completeness and geographical representativeness of the hepatitis B surveillance system between 2007 and 2013 in Hamadan Province.

Methods: In this descriptive study, all reported cases in Hamadan Province were extracted. The analytical literature review method was used to examine completeness. We used studies on the prevalence and incidence of hepatitis in Iran published between 2007 and 2013. Sensitivity analysis of the results was performed by simulation program using the R software. Geographical representativeness was assessed and plotted by the ArcGIS software, as well.

Results: Totally, 1378 cases were reported to the hepatitis B surveillance system in Hamadan Province. Most cases were from urban areas and were men, married, and housewives mostly in the age group 20 to 29 and 30 to 39 years. Completeness of the hepatitis B surveillance system was 77%. The hepatitis B surveillance system was not representative in terms of occupation but was representative in terms of age, sex, marital status, and place of living.

Conclusion: We concluded that the hepatitis B surveillance system had a relatively good performance. Moreover, findings of the analytical literature review method are affected by the included studies and interpretation of the results should be performed with caution.