Journal of School of Public Health and

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Background and Aim: Some medically important species of Muscidae and Fanniidae families are among synanthropic flies and can be seen in human habitats therefore they can be mechanical vectors of different pathogenic microorganisms. Identification and determination of species of these flies is essential for any control program planning. This study was conducted to determine the faunal diversity of Muscidae and Fanniidae flies in Tehran, Iran.

Methods and Materials: This was a cross-sectional descriptive and taxonomic study, conducted in 2 phases, during 1996-97 (pilot study) and 2000-2002 (complementary study) in Tehran and suburbs. Medically important flies were captured and identified. A net-hashing was used to capture adult flies by the direct observing method. To determine the fauna of flies in different habitats, 4 biotopes, including corpse (human, birds, livestock), garbage and decaying organic matter, animal carcasses, and human indoor habitat, were selected. Big hashing nets (95 cm in diameter) were used for capturing adult flies.

Results: A total of 2418 adult flies belonging to 8 families of Muscidae, Fanniidae, Calliphoridae, Sarcophagidae, Tachinidae, Syrphidae, Conopidae, and Anthomyiidae were captured. Among these, 1279 belonged to the Muscidae and Fanniidae families. Four genera and 5 medically important species were identified from two families.

Conclusion: Based on the existing scientific documentation, 2 species of M. stabulans and F. scalaris are reported for the first time from Iran. However, M. stabulans is a common species, the presence of which in Iran seemed probable.

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Background and Aim: Domestic violence against women is a serious public health problem and women adopt different solutions to fight against it. This study was carried out to determine the prevalence of intimate partner violence and views of women
on adopting ways to fight against it in Arak city, Iran, year 2008.

Methods and Materials: In a cross-sectional study in Arak city in 2008, a total of 1037 women were interviewed. The data collected were analysed statistically.

Results: Findings showed that the common types of abuse were emotional (64.6%), verbal (57.1%), financial (32.3%), and physical (26.8%). The women mentioned that the most efficient ways they chose to counteract the abuses were as follows: resuming talking after the settlement of quarrels (93%), keeping silent on the part of one of the partners (81%), and seeking advice from the older members of the family (81%). The considered going into a temporary sulk (51%) and reciprocation (46%) ineffective methods. Correlations were found between violence on the one hand and education, job, addiction of the spouse, income of the spouse, mental disorder of the partner, and number of children on the other hand (p<0.05).

Conclusion: Results of this study show that a large number of women are subjected to different types of violence. It seems that increasing awareness of married women and girls concerning effective counteractive methods can be an effective step in solving this social problem.

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Background and Aim: Domestic violence against women is a serious public health problem and women adopt different solutions to fight against it. This study was carried out to determine the prevalence of intimate partner violence and views of women
on adopting ways to fight against it in Arak city, Iran, year 2008.

Methods and Materials: In a cross-sectional study in Arak city in 2008, a total of 1037 women were interviewed. The data collected were analysed statistically.

Results: Findings showed that the common types of abuse were emotional (64.6%), verbal (57.1%), financial (32.3%), and physical (26.8%). The women mentioned that the most efficient ways they chose to counteract the abuses were as follows: resuming talking after the settlement of quarrels (93%), keeping silent on the part of one of the partners (81%), and seeking advice from the older members of the family (81%). The considered going into a temporary sulk (51%) and reciprocation (46%) ineffective methods. Correlations were found between violence on the one hand and education, job, addiction of the spouse, income of the spouse, mental disorder of the partner, and number of children on the other hand (p<0.05).

Conclusion: Results of this study show that a large number of women are subjected to different types of violence. It seems that increasing awareness of married women and girls concerning effective counteractive methods can be an effective step in solving this social problem.

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Background and Aim: Despite the fact that the proportion of youth population is very high in Iran, there is no well designed, comprehensive reproductive health program for the youth. This prompted the health planners to evaluate all the existing centers that deliver reproductive health services to the youth in the country in order to identify the weaknesses and strengths of the services and the centers.

Materials and Methods: A descriptive analytic study was conducted from March 2006 to March 2007, in coordination with the Vice-chancellor for Health of Universities of Medical Sciences, through Offices for Health of the Youth and Schools (OHYS). Five health centers, namely, Tehran, Semnan, Bam, Chabahar, and Fassa Health Centers (the only centers delivering reproductive health services to the youth) were included in the study. They were assessed for structure and physical facilities, job satisfaction of the personnel, satisfaction of the youth consulting them, and the services (including consultative services) delivered. The data were gathered through questionnaires using a checklist and analyzed by the SPSS-13 software.

Results: The health center personnel thought that the quality of services delivered at the centers was low. They also believed that the physical facilities, including equipment in the clinical examination room, furniture, cleanliness of the premises, and entertainment facilities, were not of an acceptable standard. About 64% of the personnel of the health centers personnel expressed job satisfaction. On the other hand, 39% of the young people consulting the centers expressed full, and 54% relative, satisfaction with the services they were receiving the remaining 7% were not content at all. The highest rate of satisfaction was with the psychologist, physician, and midwife, so that 95% of the clients recommended the centers to other young people seeking reproductive health services. Finally, the clients said that in most of the centers paramedical personnel, including nutrition officers (50%) and midwives with a Master's degree (17.5%), were insufficient.

Conclusion: It is suggested that a comprehensive service package be developed to be used in all the health centers, rather than each center deliver services based on the existing facilities and individual preferences. Such a package should be based on the national reproductive health programs (according to the medical education curricula). Intersectoral collaboration (particularly from the Ministry of Education and cultural organizations) is also very essential.

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Background and Aim: Anemia is an important public health problem in Iran. The most prevalent type (50%) is iron-deficiency anemia. Flour fortification with iron and folic acid is one of the main strategies usually adopted to combat anemia. Two pilot projects were conducted in 2 Iranian provinces: the first one in Bushehr in 2001 and the second one in Golestan in 2007. The present study was conducted in January 2009 to evaluate the process and determine the effectiveness of the flour fortification pilot project in the 2 provinces.

Materials and Methods: To evaluate the effectiveness of the project, blood hemoglobin and ferritin levels were measured in a sample population of child-bearing women aged 15-49 years in Bushehr Province (n=600) and Golestan Province (n=625), selected by multi-stage sampling before and after the intervention. For process evaluation, the iron content in samples of flour and bread made from the flour were measured in a descriptive study.

Results: We found similar trends in the indicators of anemia/iron deficiency among the women in Bushehr and Golestan provinces. The flour fortification project appears to have had beneficial effects on the serum ferritin levels (low levels indicate iron deficiency) in both provinces. The prevalence of iron deficiency decreased from 22.2% to 15.7% (p<0.002) and from 26.7% to 14.6% (p<0.001), in Bushehr and Golestan, respectively. However, the prevalence of anemia was significantly higher after intervention in Golestan (p<0.001). Further analysis of the data also revealed that the intervention did not have any statistically significant effect on the prevalence of iron-deficiency anemia in either province. The coverages of fortified flour and bread were 90% and 98.7% in Bushehr and 94.1% and 95% in Golestan, respectively.

Conclusion: The flour fortification pilot project in Iran resulted in reducing prevalence of iron deficiency and improving body iron reserves in women, but it had no effect on anemia prevalence. It can be concluded that in circumstances where iron deficiency is not a major cause of anemia, interventions such as flour fortification with iron alone will not produce any significant effect.

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Background and Aim: Previous studies show that disability and mortality due to cardiovascular diseases are closely related to socioeconomic status in a community. The objective of this study was to determine the relationships between socioeconomic factors and coronary artery disease (CAD) among people under 45 years old at Shahid Rajaei Hospital, Tehran, Iran.

Materials and Methods: This case-control study was conducted in Shahid Rajaei Hospital, Tehran, Iran in summer 2008. The participants were 100 CAD cases (<45 years old, mean age = 41.2 years 85% men) and 100 controls from among accompanying persons matched for age and gender. In order to assess the risk of factors related to such variables as educational level, occupation, income, social exclusion, social support, stress, exercise, nutritional status, smoking, etc, odds ratio (95% CI) was used. Multinomial logistic regression was used to assess the synchronic effect of the risk factors, and the t-test was used to find differences between means.

Results: The odds ratio (95% CI) for smoking vs nonsmoking was 3.9 (1.9-7.9) for CAD. Individuals with a low educational level showed an odds ratio of 2.7 (1.9-7-9), compared to those with a high educational level. Eating fruits and vegetables at least seven servings a week has an odds ratio of 2.7 (1.01-7.4) vs eating fewer servings. Occupation, job grade and physical activity had statistically significant relationships with CAD. Mean BMI was different between cases and controls. The disease had no significant association with stress, social support, social exclusion or income.

Conclusion: Smoking, a low educational level and eating small amounts of fruits and vegetables were the most important socioeconomic factors contributing to coronary artery disease. Policymaking and planning aiming at improving the socioeconomic situation of the people, particularly those under 45 years old, seem essential.

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Background and Aim: The most important principles in an organization are continuous development and survival. Nowadays, creativity and innovation are vital for survival in a competitive world. The thinking style of a manager in an organization is an important factor in his/her creativity. The purpose of this study was to investigate the relationship between thinking style and organizational innovation in 84 senior and junior managers of Shiraz educational hospitals in 2008.

Materials and Methods: In this descriptive-analytical study 84 top and mid-level managers of Shiraz teaching hospitals were selected by the census method. Data were collected using two standard questionnaires, one for thinking style and one for innovation, the content validity and reliability of which had been confirmed. A preliminary test showed the Cronbach's alpha for the thinking style and organizational questionnaires to be 0.83 and 0.72, respectively. Data analysis was performed using Spearman correlation test.

Results: The Spearman correlation analysis showed a statistically significant, although weak, relationship between thinking style of senior and junior managers of Shiraz teaching hospitals and their organizational innovation. A pragmatic thinking style had the strongest association with organizational innovation.

Conclusion: The thinking style of a teaching hospital manager plays a vital role in his/her creativity. No thinking style is particularly preferred any thinking style may give desirable results as regards creativity of a manger, depending on the circumstances and conditions.

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Background and Aim: Self-efficacy and decisional balance in the Trans-theoretical Model play an effective role in oral self-care behavior. The objective of this study was to determine the impact of education on inter-dental cleaning behavior based on the Trans-theoretical Model in pre-universstudents in the city of Yazd, Iran in 2009.

Materials and Methods: This was an intervention study. Based on statistical calculations, 361 pre-university students (mean age 17.53±0.55 years) were randomly allocated into groups of intervention (n=185, 51.2%) and control (176, 48.8%). Data on demographic characteristics, self-efficacy, and decisional balancing (perceived benefits and perceived barriers) were collected using a questionnaire with confirmed validity and reliability. Based on the trans-theoretical model, a 3-month educational program was prepared with sections on self-efficacy and decisional balance and conducted. At the termination of the program variables of the model were evaluated and the gingival index was determined by a dentist. The data were analyzed using the SPSS software, the statistical tests being ANOVA, paired t-test, t-test, Fisher, and correlation coefficient.

Results: Implementation of the educational program resulted in a significant decrease in perceived barriers (p<0.001) and significant increases in perceived benefits (p<0.001) and self-efficacy (p<0.001). In addition, the gingival index improved in the intervention group (p=0.01). The final mean self-efficacy, perceived barriers, and gingival index were not significantly different between the case and control groups, but a significantly positive effect was noticed in perceived benefits (p=0. 01).

Conclusion: The findings indicate that the educational intervention influenced desirably the gingival index, self-efficacy and perceived benefits in the students. Since the self-efficacy factor is an important predictor in oral self-care behavior, it is suggested to use the trans-theoretical model in educational interventions aiming at improving self-efficacy, increasing perceived advantages, and reducing perceived obstacles.

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  Background and Aim: Human error often plays an important role in accident causation either through direct action or poor design . The focus of this work is was on prediction of human error probabilities during the process of emergency musters on in gas compressor stations . This paper aims to present a brief description of Human Error Probability Index (HEPI) for the on gas compressor station musters process.

  Materials and Methods : Due to a lack of human error databases, and in particular human error data on gas compressor station musters, an expert judgment technique, the Success Likelihood Index Methodology (SLIM), , was adopted as a means to predict human error probabilities Two muster scenarios of varying severity (gas release, fire and explosion) were studied in detail . A total of 34 reference graphs provided data for both the weighting and rating of six performance shaping factors and the data were subsequently processed by means of SLIM to calculate the probability of success for 16 muster actions ranging from point of muster initiator to the final actions in the temporary safe refuge (TSR). The actions were categorized into 4 phases, namely, awareness, evaluation, egress, and recovery phases. The six performance shaping factors considered in this work were stress, complexity , training, experience, event factors, and atmospheric factors .

  Results: Human error probabilities in the egress phase were highest, followed by those in the evaluation phase the lowest were in the awareness phase.

  Conclusion: The HEPI can be applied to limit the chances of human error occurrence and mitigate the consequences of such errors through changes in training, design, safety systems, and procedures, resulting in a more error-tolerant design and operation .

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Background and Aim: The aims of this study was to explore the feasibility of improving efficiency of the wastewater treatment system of the Fars Pegah Dairy Industries (FPDI) and propose ways to upgrade it in 2006-2007. The FPDI wastewater treatment system was of a successive anaerobic-aerobic type using anaerobic stabilization ponds and conventional and extended aeration activated sludge. Due to improper design and operation, it did not meet the required standards with regard to disposal to the surrounding cultivated land.
Materials and Methods: To overcome the problem and eliminate the bad smell, modifications were made, such as changing the entries and exits of the ponds, adjustment of the activated sludge process, and converting the conventional activated sludge F/M to a step-feed activated sludge shift. The efficiency of the system was assessed before and after these modifications
Results: The efficiency of the system to eliminate biochemical oxygen demand (BOD5), chemical oxygen demand (COD), total dissolved solids (TDS), total suspended solids (TSS), total coliform, and fecal coliform increased from 82.42%, 86.87%, 64.18%, 20.23%, 54.56% and 50.87% to 97.34%, 98.61%, 90.4%, 28.44%, 90.09% and 89.95%, respectively.
Conclusion: The findings show improvements in the efficiency of the wastewater treatment system due to the changes made in it. It was also observed that efficiencies of the feed-step aeration and the extended aeration are similar. This means that application of the extended aeration in the treatment system of the plant would result in waste of money and energy.

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Background and Aim: The hospital is considered as the biggest and the most costly unit of a health care system. Therefore, paying full attention to its cost efficiency is very important. The objective of this study was to assess the technical efficiency of hospitals affiliated with Tehran University of Medical Science by data envelopment analysis method.

Materials and Methods: Technical efficiency in hospitals affiliated with Tehran University of Medical Sciences was assessed by Data Envelopment Analysis (DEA) from 1996 to 2006. The input-oriented form of variable return-to-scale (VRS) was used to collect the data using 4 inputs (number of beds, nursing staff, medical personnel, and other personnel) and 4 outputs (outpatient admissions, hospitalized-patient days, bed occupations, and the number of surgical operations performed). The software used for data analysis was Deap 2.1.

Results: The DEA results indicate that: 1.There is a potential to improve the hospital technical efficiency by 3 % (the mean technical efficiency of the hospitals was 0.972) 2. Constant return-to-scale (CRS) exists in the production process, meaning that production in the hospitals is at its optimum level 3. Hospital services have suffered from extra production factors, especially human resources (specifically the nursing staff).

Conclusion: With proper planning, limiting the number of personnel can reduce greatly health care costs and hospital expenditures. It is suggested to conduct studies to determine the effects of the quality of services delivered in hospitals and patient satisfaction on hospital technical efficiency.

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Background and Aim: Agricultural and industrial activities, as well as population growth, have resulted in increases in the amounts of pollutants in the environment, the human body, and other organisms. Cadmium is one of the common heavy metals entering the biological cycles through different paths causing disease in humans, animals and plants. This study aimed at determining cadmium levels and physicochemical and biological factors in water and sediment samples, as well as determining relationships between culturable bacterial counts and cadmium toxicity and assessing bacterial resistance/tolerance spectrum through MIC and MBC.

Materials and Methods: Surface water and sediment samples were taken from five stations in areas believed to be polluted along the Kor River. The stations included 1. Dorudzan Dam outflow, 2. Petrochemistry Bridge, 3. Khan Bridge, 4. Doshakh Bridge, and 5. the mouth of the Kor River to the Bakhtegan Lake. Two sets of samples were taken. Set 1was used for measuring cadmium level, physicochemical and biological factors, while Set 2 was used for the isolation and identification of cadmium resistant/tolerant bacteria and determination of their resistance spectrum. Pure cultures of each bacterial species were prepared and the more resistant bacteria were identified by exposure to media with different cadmium concentrations.

Results: Stations 2 and 3 were found to be significantly more polluted with cadmium than the other 3 stations (p<0.001). The cadmium level in sediments of all the stations was higher than in water (p<0.001) and quite high as compared with the existing standards. The data also showed a lower BOD/COD ratio in the last 2 stations and higher phosphate levels in the last 4 stations. As compared to control, the bacterial count decreased in the presence of 1 mM cadmium chloride solution (p<0.001). Cadmium-resistant bacterial counts were higher in stations 3 and 5 than in the others (p<0.001). The most cadmium-resistant/tolerant bacteria were P. aeruginosa ETs and Bacillus ABs with MIC 6 and 4 and MBC 7 and 5 mM, respectively. The most resistant bacteria were gram-negative, isolated from the sediments.

Conclusion: Cadmium pollution, especially in stations 2 and 3, are due to man's activities. Although many bacterial types were found to be sensitive to cadmium in this study, some of them showed resistance/tolerance to it to different extents. Our findings also show that unlike water, which is an unstable environment, sediments are stable and provide a suitable environment for bacteria to form biofilms as a way to reduce cadmium accumulation. The most resistant bacteria were found in the stations with the highest cadmium concentrations. This may be a result of cadmium-resistant gene expression in the presence of this heavy metal. The use of these resistant strains in biofilters and wastewater bioremediation can potentially help to reduce cadmium pollution, a problem in some rivers.

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Background and Aim: Monitoring and evaluation are basic components of any health program. Control charts show clearly the process performance trend longitudinally and help managers and staff to detect general and specific variations and evaluate the process performance correctly. This study was conducted to design and utilize control charts in the primary health care (PHC) system.

Materials and Methods: This study was conducted in two stages. In the first stage, the average weekly, monthly and seasonal delays in receiving health services were compared retrospectively. In the second stage, appropriate control charts were introduced with due consideration of the PHC system.

Results: More than 95% of the weekly average delays were below the upper control limit, while in 100% of the cases the monthly and seasonal averages were under the upper control limit.

Conclusion:  Desirable health outcomes result from appropriate services. It is necessary to monitor health processes coverage and performance with simple and specific indicators. With regard to the health process outputs in the PHC system, it is suggested that the R-X, np and C charts be used in monitoring processes.

The control charts help the service providers to determine and manage process performance by gathering simple, applicable data. Some of the advantages of using these charts are the possibility of longitudinal surveys, simplicity of the calculation methods, and their high applicability. 

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Background and Aim: Weight status perception is an important factor in nutritional behavior. The aim of this study was to determine Islamshahr women's self-perception of their obesity status and perception of their husbands' opinions regarding women's obesity status, as compared with the actual central obesity status of the women.

Materials and Methods: This was a cross-sectional (descriptive-analytical) study carried out in 2003 on a cluster sample of Islamshahr women aged 20-65 years (n = 704). Data were collected by interviews and weight, height, and waist and hip circumferences were measured. A waist-to-hip ratio (WHR) greater than 0.849 was considered as central obesity. Based on the body mass index [BMI=weight/height²(kg/m²)],  underweight,  normal, overweight, and obese were defined as a BMI <18.5,  18.5-24.9 ,  25-29.9, and  ≥30, respectively.

Results: About 35% of the women with central obesity considered themselves underweight or normal. Married women's perception of husbands' opinions regarding their  obesity status showed about 45% misclassification. Women with central obesity who thought their husbands would assess them as underweight or normal were more likely [OR=18.6, 95% CI: 9.1 to 38.2] to underestimate their obesity status as well.

Conclusion: Misperception of obesity status is common among Islamshahr women. Considering the role of central obesity in metabolic diseases, menstrual disorders and increasing serum androgens, conducting nutrition education programs is essential for prevention and control of central obesity in the region studied.

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Background and Aim: Community involvement is the most important strategy in development. In health program planning, community assessment is a process in which society members get a thorough understanding of all matters, problems, resources, weaknesses, strengths, needs, and surveillance related to health by collecting, analyzing, and publishing relevant data and information. This study was conducted to identify and prioritize problems of the Chahestani region, a poor region in Bandar-Abbas city, Iran, with active participation of the people.

Materials and Methods: The study was based on a model designed in North Carolina, US.  In this model, the assessment process is performed in eight steps.  In the first seven steps problems are identified and prioritized, and in step 8 a plan of action is developed to deal with the problem selected.

Results: A total of 60 problems were identified, of which the following were considered to be top priorities: lack of responsibility of the authorities, insecurity, unemployment, poverty, sewerage disposal, insufficient water, insufficient electricity,  unpaved roads, lack of green space, and dirty streets and passages.  

Conclusion: Most of the problems identified were non-health problems, including social, cultural, and economic issues.

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Background and Aim: Formaldehyde is an organic chemical with widespread applications as a raw material in many industries. Industrial effluents with high contents of formaldehyde should be treated because of their carcinogenic and mutagenic effects. The objective of this study was to determine the efficacy of the anaerobic sequence batch biofilm reactor (ASBBR) for formaldehyde biodegradation.

Materials and Methods: A laboratory-scale ASBBR with a total volume of 6 liters was used.  The efficacy of the reactor was determined in 9 stages with organic loading rates of 0.54 to 7.09 Kg COD/m³.d.

Results: The best removal efficiency for COD and formaldehyde were 94% and 99%, respectively, with an organic loading of 0.54 KgCOD/m³.d.The lowest efficiencies were 48% and 63.1%, respectively, with an organic loading of 7.09 KgCOD/m³.d.

Conclusion: Based on the findings, it can be concluded that ASBBR is a viable, efficient and reliable technology for treatment of industrial wastewaters containing formaldehyde.

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Background and Aim: Today in many work environments, such as nuclear, military and chemical industries, human errors may result in disasters. Accidents in different parts of the world bear evidence to this examples are the Chernobyl disaster (1986), the Three Mile Island accident (1974), and the Flixborough explosion (1974). Thus, identification of human error, especially in complex and intricate systems, and devising control measures are essential.

Materials and Methods: This project was a case study conducted in Zagross Methanol Company in Asalouye (South Pars), Iran. The walking-talking-through method was used to collect the required data and complete the Systematic Human Error Reductive and Predictive Approach (SHERPA) worksheets. The process experts and control room operators were interviewed and technical documents of the Company examined.

Results: Analysis of the SHERPA worksheets indicated that the majority (48.62%) of the 222 errors identified were action errors, followed by checking errors (31.97%), retrieval errors (6.75%), selection errors (0.9%), and communication errors (11.7%).

Conclusion: The results of this study show that the method can be used effectively in different industries, especially chemical industries, to identify human errors that may potentially lead to dangerous situations and accidents.

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Background and Aim: In the raw furniture preparation workshops, in which the workers usually have an undesirable postures when at work, ergonomic assessment and the work environment improvement seem essential. Developing checklists and calculating ergonomic indices would be useful in this assessment. This study was conducted with the objectives of assessing musculoskeletal disorders (MSDs) risk factors and determining types of corrective measures in raw furniture preparation workshops.

Materials and methods: After conducting task analysis, 268 workers were assessed using an ergonomic checklist developed for the purpose and ergonomic indices were calculated. The Nordic musculoskeletal disorders questionnaire was used to determine the prevalence rate of MSDs among the workers. Data were analyzed using the t-test and the test of proportions.

Results: The highest prevalence was in the lower back (38.4%) and the knees 36.2%). Statistical analysis revealed that there were significant associations between MSDs and calculated ergonomic indices (p<0.001). In addition, calculation of OR revealed that ergonomic conditions were associated with MSDs in different body parts (OR=2.90-9.49, p<0.001). On the whole, the working conditions of 32.46% of the workers studied were poor from an ergonomic point of view.

Conclusion: The checklist developed was found to be an appropriate and low-cost tool for ergonomic assessment. The most important problems in the workshops were due to inappropriate general working conditions, inappropriate organization, and unsuitable work stations.

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Background and Aim: Rapid growth of Iran's population attracted attention of the authorities after the 1986 national census. This led to population control and family planning programs to be considered as a priority. Appropriate strategies of the family planning program led to a very fast decrease in population growth and fertility indices: and use of contraceptive techniquies rate increased from 49% in 1989 to 73.8% in 2007. This study aimed at reviewing family planning program in Iran (FPPI) during the last four decades and discussing the reasons for its success, as it can be a guide for future efforts aimed at improving other aspects of reproductive health.

Materials and Methods: The method used was systematic reviewing of articles indexed in Medline and University Jihad Scientific Database, reports of the Demographic and Health Project, the Iranian Statistical Center National Censuses, and the Ministry of Health and Medical Education reports on knowledge, attitude and practice.

Results: FPPI initiated officially in 1966 faced with limited success. Following the 1986 national census, population control was announced as a public policy, supported by the leaders. A supportive environment was created by mass media. Establishment of the Departments of Population and FP in the Ministry of Health made possible reorganizing family planning services: expanding coverage of PHC services, including FP services training skilled personnel providing free contraceptives and vasectomy and tubectomy services. Involvement of volunteers and NGOs helped in strengthening community actions. In order to develop personal skills, in addition to face-to-face FP counseling in the health centers, FP education in schools, colleges, workplaces, army and pre-marriage classes was also imparted. Promotion of men's participation in FPPI, by providing male methods of contraception, such as vasectomy or condom use, was also considered. There was also cooperation and support on the part of nongovernmental and international organizations.

Conclusion: Based on the findings, it may be concluded that the principles of health promotion can explain the FPP achievements in Iran. This model can be used in expanding other reproductive health programs in Iran.

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Background and Aim: The most common cancer in Iran is digestive system cancer, the highest incidence of which is reported from the Caspian Sea littoral. This study aimed to determine factors affecting the survival of patients with gastrointestinal cancer using the Cox and parametric models the 2 models were compared.

Materials and Methods: This survey was a prospective study conducted between 1990 and 1991. Data were collected through the Cancer Registry Center in Babol, which functions under supervision of the School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences. We tried to identify cases of gastrointestinal cancers. The individual characteristics of 484 patients, namely, age, sex, family history, marital status, smoking status, occupation, ethnicity, medication status, education, residence (urban, rural), and type of cancer were recorded. The patients were followed up for a period of 15 years, i.e., until 2006 year. To determine the effective factors on survival of patients, the Cox model and parametric models such as exponential, weibull, log-normal, log-logistic, and the AIC criteria and residuals were used to compare the effectiveness of the models. The SAS and STATA software were used for data analysis, with a significant level of 0.05.

Results: Sixty-six percent of the patients (total n=484) were males and 34% females, with a mean age of 59 and 55 years, respectively. Their distribution according to type of cancer was as follows: esophageal cancer, 359 (74.2%) stomach cancer, 110 (22.7%) colorectal cancer, 15(3.1%). Estimated one-, three-, and five-year survival rates were 24%, 16% and 15%, respectively.

Conclusion: The results of this study reveal that gender and family history can be strong risk factors for GI cancer. Log-normal and log-logistic models in multivariate and univariate analyses gave almost similar results. However, based on AIC criteria and residuals analysis, the log-logistic model gives the best fit as compared to other parametric models and can be used instead of the Cox model for determining factors affecting survival of patients with gastrointestinal tract cancer.