Journal of School of Public Health and

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Background and Aim: Hospitals are among the most important health and medical institutions responsible for promoting health, and provision of appropriate health services requires a healthy, hygienic and safe environment. This research was done with the aim of assessing the environmental health situation Qom hospitals in 2005.

Materials and Methods: This research is an applied descriptive - analytic study on hospitals in QOM Province. Data were gathered using survey and observation methods and a two-part questionnaire. The first part of the questionnaire consisted of 45 items covering demographic data on hospitals and hospital managers. The second part comprised 363 questions about the environmental health situation as well as diagnostic, treating and support services. The questionnaires were filled after validity and reliability tests in eight hospitals in Qom Province. For statistical analysis, we performed Mann-Whitney and Kruskal-Wallis tests and calculated Spearman's coefficient, using the software package SPSS.

Results: Poor environmental health was observed in 25% of the radiology wards, kitchens and laundries. The situation was assessed as "appropriate" in 12.5% of laboratories and central sterilization (CSR), 25% of emergency services, 50% of ICU wards and 71% of surgery and recovery rooms, and it was intermediate of the other wards. Overall, the level of compliance with the principles of environmental health was average, i.e. about 72.5 percent. Further analysis of data showed that the situation was better in private, non-teaching hospitals compared to government-run and teaching hospitals. However, environmental health was found to improve with an increase in the number of active hospital beds and the managers' experience in their current job. It declined with increasing hospital age and increasing age of the hospital managers.

Conclusion: Overall, the environmental health situation in Qom hospitals was found to be at an intermediate level. Hence, these hospitals have a long way to go before they can achieve the appropriate level of environmental health

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Background and Aim: Although there have been several epidemiologic studies on first permanent molar caries in Iranian students, the need for endodontic therapy has not been investigated so far.
The purpose of this study was to assess the need for first molar root canal therapy in 7- to 11-year-old schoolchildren and its association with age, gender, and parent education level.

Materials and Methods: We selected 885 students (572 girls and 313 boys) from 12 elementary schools, using a random cluster sampling method. We recorded the subjects' identities and examined their maxillary and mandibular first molars with a mirror and an explorer. In case of any doubts about the need for endodontic therapy, we performed vitality tests and/or obtained periapical radiography. Chi-square and Mann-Whitney tests were used for statistical analysis.

Results: In 26 students (3%) there was an indication for endodontic treatment of the first molars. Of these, 18 teeth were in mandible and 8 in the maxilla. The need for endodontic therapy was significantly related to the subjects' age and the parents' education level. We did not detect a significant association between gender and the need for endodontic therapy.

Conclusion: We recommend pit and fissure sealant plus fluoride therapy, beginning with the eruption of the first permanent molars- especially in the mandible.

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Background and Aim: Intestinal parasites cause significant morbidity and mortality and are considered by the World Health Organization as a public health problem of global importance. These agents are estimated to infect more than three billion people worldwide. In Iran, thanks to long-time efforts by the national health system (including environmental sanitation and public education campaigns), the frequency of the most intestinal parasitic infections has significantly declined in the recent decades. Our study aimed to determine the prevalence of intestinal parasites in a high-risk occupational group, namely the municipal workers in the city of Esfahan.

Materials and Methods: A survey was conducted to determine the prevalence of intestinal parasitic infections among municipal workers in several districts of Esfahan. Specimens were placed into fecal pots, labeled and kept cool before being transported to the Health Research Center Laboratory, affiliated to the School of Public Health & Institute for Public Health Research in Tehran University of Medical Sciences. The technique used for identifying infections was stool concentration by formalin & ether. All the slides were carefully studied using light microscopy with ×10, × 40, and ×100 magnification.

Results: The study results revealed that 24.6% of the workers harbored at least one parasitic species. The highest prevalence (36%) belonged to Giardia lamblia. Ascaris lumbricoides was the most common helminthic parasite (12.4%), followed by Hymenolepis nana (1.2%). The most common non-pathogenic protozoal species was Entamoeba coli (21.7%).

Conclusion: Infection with soil parasites is dependent on environmental conditions that allow parasites to complete their life cycle. Socioeconomic and cultural factors are important for the appearance and spread of intestinal parasites in communities where sanitary conditions and infrastructure are inadequate. However, soil-transmitted helminthiasis (STH) used to be prevalent throughout the country, especially in urban and rural population of the Esfahan Province. We investigated the prevalence of intestinal parasites by fecal examination of workers in Esfahan municipality, a group with a low-sanitation working environment close contact with soil contaminants. The lack of information on prevalence in the general population makes it difficult to arrive at any definite conclusions, but on the basis of unpublished data we can conclude that prevalence is somewhat higher in this occupational group compared to the population at large.

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Background and Aim: Patients with hemophilia and thalassemia are at high risk for hepatitis C virus (HCV) infections. Unscreened blood and blood products are thought to be the most important risk factors in these two groups.

Materials and Methods: Blood samples were collected from 98 thalassemia patients and 74 hemophiliacs in Markazi province. The presence of anti-HCV antibody was tested by a third generation enzyme immunoassay. All ELISA-reactive samples were tested with the confirmatory third-generation recombinant immunoblot assay RIBA. We used a specially designed questionnaire to obtain data from patients and the software package SPSS 11.5 for statistical analysis.

Results: HCV antibody was detected in 5 thalassemia patients (5.1%) and 31 hemophiliacs (41.9%). Anti-HCV positivity in patients with thalassemia was associated with the total volume of the transfusions, splenectomy, and the duration of treatment. In hemophiliacs, seropositivity was significantly associated with the duration of transfusion treatment (P=0.01) and disease severity (P=0.00). The prevalence of HCV antibody in thalassemia subjects dropped from 8.1% to 0% after the implementation of anti-HCV screening in1996.

Conclusion: In Markazi province, the current policy of screening donors for anti-HCV and the strict safety controls on factor concentrates can effectively protect thalassemia and hemophilia patients from HCV infection.

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Background and Aim: Exposure to hexavalent chromium in plating operations is associated with skin ulceration, contact dermatitis, respiratory tract irritation, cancer, and kidney damage. We investigated the possibility of using biological monitoring to assess exposure to hexavalent chromium in chrome-plating workers. We compared mean Cr6 concentrations in the breathing zone plus urine chromium, β2 microglobulin (B2M), and N-acetyl-B-D- glucosaminidase (NAG) at the end of the working shift. Then we assessed the correlation between exposure to hexavalent chromium and biological indicators.

Materials and Methods: This study involved 45 chrome platers (Cases) and 40 zinc platers (Controls) in Isfahan. Air and urine samples were collected at the end of the work shift. Measurement of Cr6 concentrations in the workers' breathing zone was performed using the NIOSH Methods 7600. Urine Cr levels were determined by atomic absorption spectrophotometry, with a graphite furnace (Shimadsu, AA680). B2M and NAG were measured by Kits.

Results: Overall, geometric mean of hexavalent chromium concentrations in the breathing zone was significantly higher among chrome platers (14.577 μg/m3) compared to zinc platers (0.862 μg/m3, p<0.001). Moreover, the mean urine Cr concentrations were higher in chrome platers (9.198 vs. 1.811 μg / g creatinine, p<0.001). Similarly, there were significant differences between mean NAG in chrome platers (12.608IU/gr creatinine) and zinc platers (6.824 IU/g creatinine, p<0.001). Differences in B2M concentrations were not significant (p>0.05). A significant correlation was found between Cr6 concentrations in the chrome platers' breathing zone and their urinary chromium levels (r= 0.838, p<0.001). A similar association was found between concentrations of Cr6 and NAG in the breathing zone (r= 0.304, p<0.05).

Conclusion: As urinary B2M concentration did not change significantly, it may not be a sensitive indicator in evaluating exposure to hexavalent chromium. There were significant differences between mean urinary Cr and NAG concentrations in the two groups. The significant correlations between Cr and NAG concentrations indicate that these markers may be suitable indicators of exposure to hexavalent chromium. Our results indicate that NAG is an early indicator of renal dysfunction in chrome platers.

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Background and Aim: Type 2 diabetes mellitus is a heterogeneous disorder resulting from a combination of genetic and environmental factors which contribute to pathogenesis by influencing beta cell function and tissue insulin sensitivity. Protein tyrosine phosphatase 1B (PTP1B)" efficiently dephosphorylates the insulin receptor and attenuates insulin signaling. Recently, a 1484insG variant of the PTP1B gene was linked to increased risk of the metabolic syndrome in an Italian population, but this was not confirmed in subsequent studies. The purpose of this research was to investigate the association of 1484insG polymorphism of the PTP1B with obesity, insulin resistance, type 2 diabetes and other cardiovascular-related traits in an Iranian population.

Materials and Methods: The genotypes of 1484insG variant were determined by the PCR-RFLP method in 242 unrelated subjects, including 171 individuals with normal glucose tolerance and normal fasting glucose levels, and 71 type 2 diabetics. Insulin resistance was assessed using the homeostasis assessment model.

Results: The allelic frequency of the 1484insG polymorphism among type 2 diabetic patients and non-diabetic individuals was 6.3% and 3.8%, respectively (p=0.205). None of the subjects were homozygous for the 1484insG allele. Concerning quantitative traits in non-diabetic subjects, carriers of 1484insG allele had significantly higher body mass index (p=0.01), diastolic blood pressure (p=0.012), and HOMA-IR (p= 0.041) levels compared to those carrying the wild-type genotype. In type 2 diabetics, carriers of 1484insG allele had only significantly higher HOMA-B (P= 0/04) level compared to the individuals with the wild-type genotype.

Conclusion: Our results from a sample of Iranian type 2 diabetes cases and controls provide evidence that the 1484insG genotype of the PTP1B gene may be associated with obesity and insulin resistance.

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Background and Aim: The scattered state of the rural populations- in terms of both the distance between villages and the distance between residential units within a single village- has made the task of supply, distribution and monitoring the quality of water a difficult one. In this study we looked at the bacteriological quality as well as access to safe potable water in selected villages of Tehran Province. This research started in February 2006 and ended in July the same year.

Materials and Methods: In this cross-sectional field study, sampling points were specified on the basis of the populations of the villages served by the Tehran Rural Water and Wastewater Company. After systematic sampling, the specimens were transferred to the laboratory for testing. Data were analyzed using the SPSS and Microsoft Excel software packages.

Results: Drinking water contamination with E. coli was observed in 5.99% of the villages. The degree of contamination was highest in the districts of Pakdasht, Savojblagh and Damavand, with rates of 33.34, 13.69 and 13.32 percent respectively. For 99.36% of the Tehran rural population the turbidity was lower than the standard value of 1053 set by the Iranian Institute of Standards and Industrial Research. Values in Savojblagh and Varamin were relatively higher, with rates of 96.51% and 99.30% respectively. Given the standard value of 1053, the residual chlorine levels were unacceptably low for 92.39% of the rural residents, with figures in the districts of Pakdasht, Damavand and Robatkarim reaching 75.67, 85.45 and 83.98 percent respectively.

Conclusion: Based on WHO guidelines concerning the microbial quality of water published in 2006, the average indicator for lack of E.coli in rural water of Tehran was 94.01%, i.e. at an excellent level. Levels were good for Damavand and Savojblagh, low in Pakdasht and excellent in all other districts.

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Background and Aim: There are no occupational health data concerning the prevalence of mental disorders in Iranian hospital nurses. Such information may be a prerequisite for efficient occupational mental health interventions. The aim of this study was to determine mental health status among shift work hospital nurses.

Materials and Methods: This paper reports the findings of a cross-sectional survey that was part of a larger quasi-experimental study. We selected and evaluated 1195 nurses in 12 general hospitals in Shiraz (capital of Fars Province), using the 28-item version of the General Health Questionnaire (GHQ). We used structured observations in accordance with an occupational health checklist to assess working environment during the work period.

Results: Results indicated that 28.7% of nurses were in poor mental health. Mental disease was more common among females than males (p<0.05). Prevalence rates for anxiety and somatic symptoms were 42.2% and 35.5% respectively. The prevalence of depression was 11.9% and social dysfunction, 79.5%. There was a significant relationship between shift work and anxiety as well as sleep disorders (p< 0.05). Associations were also found between marital status and depression and between gender and social dysfunction (p< 0.001).

Conclusion: Prevalence figures for mental disorders are similar to those from nationwide surveys but it seems that social dysfunction and anxiety disorders are more common in nurses compared to the general population aged 15 and over. More attention must be paid to the health of shift work nurses (especially female staff). This can take the form of shift work health education programs, occupational health counseling, and periodic examinations.

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Background and Aim: Breast carcinoma is the most common type of cancer in women. It has been estimated that 8-9 percent of all women will develop breast cancer during their lifespan. According to The Iranian Ministry of Health and Medical Education, the incidence of breast cancer in Iran has risen between 1984 and 1988 and the current mortality rate from this kind of cancer ranks fifth in the country.

Materials and Methods: In this case-control study, 110 patients with breast cancer (ages 20-60 yrs) were compared with a similar number of age- and sex-matched women hospitalized for other reasons. Cases were women with histologically confirmed in situ or invasive breast cancer diagnosed no more than 1 year before the interview and with no previous diagnosis of cancer at other sites. Controls were drawn from either patient relatives or from women with no history of cancer admitted to Imam Hospital for acute, non-neoplastic, non-gynecologic conditions unrelated to hormonal or digestive tract disease or to long-term diet modifications. We calculated odds ratios and performed Mantel-Haenzel as well as logistic regression tests to control for potential confounding factors.

Results: Odds ratios [with 95% confidence intervals] for total fat, saturated fatty acids, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA) and cholesterol were 1.97 [1.062-3.67], 1.19 [0.64-2.14], 2.2 [1.17-4.13], 4.11 [2.2-7.65] and 0.45 [0.25-0.83], respectively. After adjusting for energy, macronutrients, weight, age at first full-term pregnancy and the socioeconomic status, it emerged that the intake of PUFA (OR=6.38 and 95%CI: 1.95-20.83) had a positive association with breast cancer while cholesterol (OR=0.22 and 95%CI: 0.09-0.55) showed a negative relationship, though the latter finding only applies to menopaused women.

Conclusion: Undoubtedly, dietary factors involved in the etiology of breast cancer take many years to cause any pathologic changes in any organ. Nonetheless, one-year frequency of lipid intake is a good measure of individual's dietary habit throughout his/her adult life. Based on this, the present study suggests that increased PUFA intake- probably due to its high pro-oxidant potential- can be considered as a key factor in the rising incidence of breast cancer in Iran.

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Background and Aim: In the past few years publications in the field of medicine have increased considerably in Iran and knowledge production in this country shows the greatest growth rate in the entire Middle East region. Considering the fact that 12% of all faculty members in the health and medical sector in Iran are employed by Tehran University of Medical Sciences, this university is regarded as the country's leading research institution. This study is focused on the behavior of the researchers in this university in terms of collaboration in research and factors that affect such behavior.

Materials and Methods: Our samples included all research projects in Tehran University of Medical Sciences that had obtained grants from inside and outside the university in 2004, had registered their contracts, had been finished by the time of this study (October 2006- March 2007) and whose final reports had been submitted (315 projects). The data collecting forms were filled for 301 files. The researcher's questionnaire was sent to the principal investigators of the projects and eventually 208 questionnaires were collected. We used the SPSS software package and the usual statistical tests (frequency ratio, chi square, analysis of variance and multiple linear regression with the Enter method) to assess the factors affecting the participation scores of individuals. Based on the data gathered from the forms, we used the UNICET software to analyze the 'cooperation network' between project directors and their principal co-workers and the relationship between different sections of the university.

Results: Only in 2.2 percent of the projects whose contracts were arranged in 1383 there has been some cooperation between the project director/principal coworkers and non-academic organizations. This ratio reaches 2.5% for collaboration with other universities. Among all projects, health system research programs show a better status of collaboration. Linear regression analysis showed that another important factor affecting the participation score is the "method for choosing the research topic". University-affiliated research centers only collaborate with the Schools of Medicine and Public Health, while in the School of Rehabilitation and Physical Medicine all projects are defined within the School's own structure, with virtually no collaboration with any other sections of the university.

Conclusion: The present study showed that research programs in this university include little collaboration with organizations outside the university or with other universities. Part of this is related to the current structure of the research sector in the country, which is largely financed by the government with hardly any participation by the private sector. Current potentials within the University make it possible to embark upon joint research initiatives with other academic institutions. As the possible effect of intervention on health system research has been shown, policies can be implemented to promote effective collaborative research at university and national level.

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Background and Aim: Discharge of Wastewater of Cleaning Industries to environment with special physicochemical characteristics has negative effects and in the other hand is not easily biodegradable because in these wastewaters ratio BOD5/COD is low and therefore biological treatment of them is difficult. Nowadays best method for degradation of Wastewater is advance oxidation processes .In this study investigated efficiency of Fenton process in remove anionic detergent and COD and improved from ratio of BOD5/COD.

Materials and Methods: This investigating is descriptive- empirical study that paksan factory was local sampling of wastewater. 30 wastewater composite sample24hr were taken during study period and then chemical characterization was performed by determining the following parameters: (COD, BOD, MBAS, PH, T) Then Sample of row wastewater were prepared and used in the experiments for determining the efficiency of Fenton process in treatment. Treatment experiments performed by use of various concentrations of H2O2 and ferrous iron at constant pH of 3and temperature of 25 in a jar test apparatus adjusted at 200 rpm and for contact time 60 min. Fe+2 on removal (COD, MBAS & BOD ) applied ANOVA. and after that for analysis of effect H2O2

Results: The results of analyze showed that the concentrations of COD, ranging from 6254-13040 mg/l and concentration of BOD was 2590-3200mg/l and concentrations of MBAS were 245-1120 mg/l and results showed that the BOD5/COD ratio was 0.34±0.09. At constant pH of 3 and temperature of 25 for contact time 60 min, about 40% of MBAS with first concentration 470 mg/l removed by H2o2 with concentration1800and fe+2 with concentration 340 mg/l .concentration of COD reduced from 8750 to 5998 mg/l, and the ratio of BOD5/COD improved from 0.334 to 0.340.

Conclusion: Wastewater from this industry has quality characteristics with deferent ranging and high organic load and because of high concentration of foaming that prohibit of oxygen infiltration in wastewater and nonbiodgredable material. These wastewaters are not easily subjected to conversation system of biological treatment therefore suitable method for treatment of this wastewater should reduce organic load foaming and improve ratio of BOD5/COD advance oxidation process is one method with good efficiency for treatment of this wastewater.

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Background and Aim: Due to importance of employing native and traditional medicinal plants with good efficacy against malaria parasite, an ethanolic extract of Otostegia persica, was tested on Plasmodium berghei in sourian mice and a comparison was made with the effect of chloroquine on the same parasites.

Materials and Methods: In this Study 80 Sourian mice were divided in-to 8 groups , each consists ten animals. The first 7 groups were infected with P.berghei and the last group was used as control. The first seven groups were given chloroquine, Otostegia persica . at four different concentration (20,100 ,300,450mg /kg) and placebo.respectively and the seventh group did not receive any treatment. The evaluation was done by Rane test.In each group the level of parasitemia was determined on day 4 & 7 , and compard with values from day (just before treatment) in order to record the decline parasitemia in treated groups. Result were anylased using SPSS software and T-test.

Results:The result indicated that 450 mg/kg concentration Otostegia persica significantly decreased P.berghei parasitaemia in the infected mice (P<0.05), but not as sharp as chloroquine.

Conclusion:We can concluded that the effectiveness O.persica as P.berghei in 450 mg/kg concentration can be considered, for futures studies.

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Background and Aim: To determin the most sensitive tissues to carcinogenic effect of urethane and co-carcinogenic effect of sodium nitrite by investigation of histopathological variations in different tissues of balb/c mice.

Materials and Methods: An experimental study in 40 inbred balb/c mice aged 9-11 weeks was designed. The samples were classified into 4 groups: The first group was mice treated with 50 mg/l sodium nitrite in 0.9% NaCl instead drinking water SN&NaCl). The urethane group (U) was characterized by intraperitoneal injection of 3 times urethane (600 mg/ kg/day at 48 hour intervals). The third group was given 50 mg/l sodum nitrite in drinking water (U&SN) following the same intake of urethane as the second group, and the forth one was the control group. All mice were sacrificed after 20 weeks tissues were removed and examined for histopathological changes. Data analyzed by Fisher exact test.

Results: The formation of lung tumor was, significantly, increased in the urethane group as compared with the control group & (NS+Nacl) groups ( respectively P<.004 & P<.02) and in (U+NS) group as compared with the control group & (NS+Nacl) groups ( respectively P<.003 & P<.02). In females mice also The formation of lung tumor was, significantly, increased in the urethane group as compared with the control group & (NS+NaCl) groups (P<.05) and in the (U+NS) group was significantly higher than those in (C) & (NS+NaCl) groups (P<.009). The formation of lung adenocarcinomas was, significantly, increased in the (U+NS) group as compaired with the (C) & (NS+Nacl) groups (P<.003). In females mice also the formation of lung adenocarcinomas was, significantly, increased in the (U+NS) group as compaired with the (C) & (NS+Nacl) groups (P<.009) and (U) group (p<.05).The frequencies of stomach and testis hyperplasia and metaplasia in different groups did not show any significant differences. There was no histopathological variation in other tissues.

Conclusion: Our results showed the tumorigenic effect of urethane in lung tissue. Sodium nitrite increases tumorogenic effect of urethan. Sodium nitrite increases carcinogenic effect of urethan (This result is the first study that suggest sodium nitrite increases carcinogenic effect of urethan).Urethan increases co-carcinogenic effect of sodium nitrite.

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Background and Aim: Work-related Musculoskeletal Disorders (WMSDs) are the most prevalent occupational diseases and injuries. The aim of this investigation was WMSDs risk factors study in building construction industry by PATH (Posture, Activity, Tools and Handling) method.

Materials and Methods: This analytical-descriptive and cross-sectional study was conducted in four construction sites. A total of 3100 observations of 89 workers in 14 jobs were obtained. The percent of time determined for trunk, legs and hands postures, and manual material handling activities, used tools and handling in job tasks.

Results: Trunk, legs and hands postures, tools and objects weight differed significantly between stages (P<0.0001). Neutral trunk posture was observed frequently. Neutral legs and hands postures were observed greater than %50 and %80 of the time respectively in studied workers. Tools are used with different frequency in studied jobs. Loads with less than 5 Kg were handled repeatedly.

Conclusion: The result of this study can be used to reduce musculoskeletal disorders in construction workers. This study revealed construction workers spent more time with neutral postures. But ergonomic interventions should be accomplished in specified jobs.

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Background and Aim: This study aimed to determine dietary patterns in district 13 of Tehrani adults and evaluate its association with socio-demographic and lifestyle factors

Materials and Methods: This cross-sectional study was conducted on 343 male and 453 female aged 18-65 years who participated in Tehran Lipid and Glucose study. Usual dietary intakes were assessed with food frequency questionnaire. Dietary patterns were determined by factor analysis based on 24 food groups identified by similarity of nutrients. Three major dietary patterns were identified: healthy (HDP), western (WDP) and traditional (TDP). Lifestyle and socio-demographic characteristics gathered with pre-tested questionnaires. Multiple regression models separately for men and women were fitted to assess the relationships.

Results:The mean age(SD) of men and women were 40(13) and 36(12) respectively. WDP characterized by a higher consumption of salty snacks, sauces, sweetened beverages, processed meats and refined grains, and the HDP characterized by greater intakes of vegetables, low fat meats, tea and coffee, legumes and nuts.WDP had the most variance among 3 dietary patterns. The mean factor score of HDP was higher in women than in men(P<0.05) after adjusting for age and total energy intake. Adherence to a WDP was higher among younger participants (men: β=-0.46, women:-0.34, P<0.001). The percent of married individuals were the most in fourth quartiles of HDP score among the other quartiles (P<0.01) and married men were less likely to follow WDP (β=-0.25, P<0.01).

Conclusion:Three major dietary patterns were found with factor analysis: western, healthy and traditional. Younger and single individuals had more adherence to WDP and women had higher score in HDP.

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Background and Aim: Considering the fact that injecting drug is the most common way of HIV transmission and having the point in mind that in spite of syringes availability, many of the IDUs still continue sharing needles, determining behaviors which lead them not to use HR packages seems invaluable. Determining the influential factors in sharing needles among IDUs who are Kermanshah's DIC clients and are provided with training program and HR Packages (syringes, needles, bleaching and condoms).

Materials and Methods: These subjects were studied in 2 steps. The first FGD (focus group discussions) and the second a cross sectional study. To gather data that we use a questionnaire based an FGG which includes: general characteristics, characteristics related to drug abuse and information about HIV.

Results: out 437 of cases that took part in the interview, 367 cases were IDUS. Among whom 28% individuals shared needles. The medium age was 33/4 and there was no significant difference between the two age groups. Only 27% were married. 61% of cases were unemployed. The unemployment rate among IDUs who share needles and syringes was a lat more significant (p=000) than those who don't share needles (P=000). The percentage of IDUs who share needles and don't living houses was higher than of those who live in houses (P=000). Most of cases started taking drugs before they were 20 years old.

Conclusion: Low Education degree unemployed, no married. Live in street, start IDUs in low age the period of referring to DIC were the most important factors for share needles injection

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Background and Aim: Food and nutrition is one of the most essential needs of human societies and gaining sufficient and suitable food for all people is based on food security. Children are one of the most volnurable groups, so researchers and nutritionest emphasize on studying and analyzing of different aspects, effects and associated facters on prevalence of food insecurity and obesity among children. This study aimed to determine the association between obesity and food security and some related family factors inYazd primery school children.

Materials and Methods: Using two stage cluster sampling from 35 Yazd primary schools, a total of 3245 students aged 9-11y (1587 boys & 1658 girls) were randomly selected. Then 187 students 9-11y who had a BMI 95th percentile of Hosseini et al. (1999) reference, were identified as obese and 187 same age and gender pupils (having 15th<85th percentile) were studied as controls. Data were collected by demographic and USDA questionnaires.

Results: We found that the prevalence of obesity among student aged 9-11 years was 13.3% and the prevalence of food insecurity was 30.5%. Data analysing indicated that with adjusting variables such as "paternal education and occupation, economic status" there was a significant association between obesity and food insecurity in these levels: father's educated by secondary school, self-employment and low and moderate level of economic status. However, no significant association was observed between obesity and food insecurity when family size and maternal education were adjusted.

Conclusion: Paternal education and occupation, and family economic status were recognised as associated factors with food insecurity but other factors didn,t show significant relationship. There is lack of published information regarding some factors affecting food security therefore, it is necessary to performe such studies in other regions too.

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Background and Aim: Domestic violence against women is a major health problem, as well as a violation of human rights. It adversely affects the physical, mental, and social well being of women, families and communities. This phenomenon exists in all countries around the world. Although its prevalence, strength, types, effects, and risk factors are different, it is not limited to any geographical zone or distinct social class. This article presents the views of Tehrani couples and experts on underlying factors causing domestic violence against women in Iran and action to be taken for prevention.
Materials and Methods: This qualitative study was carried out through eight FGD meetings, in 2 days, with the participation of 50 couples. The couples were divided into 8 groups based on sex, education, and history of violence. Results of the FDGs were categorized and analyzed. Data were discussed in group meetings of 50 experts in different fields, such as health, medicine, law, education, and Islamic studies, from academic, policy making, governmental executive, and women's affairs organizations, divided into three groups of community general education and information dissemination, health system, and judiciary system. Results were discussed and finalized in a general meeting.
Results: The couples and experts identified underlying factors in 4 categories socio-cultural, economic, legal, and medical. Actions to be taken for prevention and control were believed to be educational, legal, and supporting services.
Conclusion: On the basis of the findings of this study, it was suggested that strategies/actions/services to solve the problem and reduce harm should include providing appropriate information and education for couples and the community emphasizing the health system responsibility empowering physicians and other health personnel to help women who are victims or susceptible to domestic violence legal transparency and reforms meeting legal needs law reinforcement and implementation providing safe shelters for victims and establishment of a national center for research and planning on violence.

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Backgrounds and Aim: One of the remuneration methods in the hospital system in Iran is per case, based on a classification system termed Global system (GS). The GS, supported by Iran's Ministry of Health and Medical Education (MOHME), was established in 1999 and is now used for cost reimbursement in the second- and third-levels of health care services. In this system, patients are classified into 60 categories, based on the most frequent surgical operations. However, it now appears, that there are many questions about this system. This study aims to compare the global operations reimbursement rates with actual costs in the Cancer Institute, Tehran, in 2003 and 2004.
Materials and Methods: This survey was a retrospective, analytical-descriptive one aiming at comparing the global operations reimbursement rates with actual costs in 646 global operations carried out in the Cancer Institute in 2003 and 2004. The global-operations and actual-costs data were gathered from Hospital Information Systems (HIS) and High Council of Insurance annual regulations, respectively, and analyzed using SPSS 11.5 software and the Wilcoxon non-parametric test.
Results: The differences between the cost reimbursement rates of global operations and their actual costs were lower in 2004 as compared to those in 2003. Also, the actual costs of operations were higher than the global operations reimbursement rates in both years and the difference was significant statistically in either year (P<0/001).
Conclusion: Some of the MOHME and Cancer Institute's authorities and experts believe that the decrease in differences between the cost reimbursement rates of global operations and their actual costs in 2003 compred to 2004 is due to increased awareness of physicians and the accounting and discharge units' personnel of the global operations and related regulations, as well as increasing global operations reimbursement rates. Also, they believe that the differences between the global operations reimbursement rates and their actual costs in either year could be attributed to not considering the actual inflation rate, hospital types, patients' co-morbidities, etc. in calculating the global operations reimbursement rates. It is suggested to make more realistic calculations, taking into account such variables as the actual inflation rate, hospital types, patient co-morbidities, etc.

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Backgrounds and Aim: Increased life expectancies and decreased fertility rates have led to ageing populations worldwide. This phenomenon is one of the most important public health challenges of the current century. Previous studies have shown that identifying factors affecting lifestyle and educational needs help in designing new strategies for health promotion. This study was conducted to investigate the preparedness of the elderly to adopt a healthy lifestyle and factors affecting it in the City of Tehran in 2007.
Materials and Methods: This qualtative study included 60 elderly persons from Tehran elderly centers, using the focus group discussion method. Sampling was targeted and a qualitative methodology was used for analysis of the data collected.
Results: The results shows that different elderly persons have different views with regard to what physical and mental health is and what factors cause healthiness. They believe that regular physical activity is very beneficial but that there are many difficulties in performing regular physical activity. Most of the subjects are in the prepation, action and maintenance stages as regards physical activity. On the other hand, nearly all the subjects are in the precontemplation stage with regard to fruit and vegetable consumption, despite the many obstacles in following a healthy diet.
Conclution: The findings of this study show that many factors influence adoption of a healthy lifestyle by the elderly. Bearing these factors in mind, appropriate educational strategies aiming at facilitating adoption of a healthy lifestyle can be designed.