Journal of School of Public Health and

Background and Aim: The prevalence of congenital hypothyroidism (CH), one of the main causes of preventable mental handicap in neonates, is much higher in Iran than the global average.
The objective of this study was to identify risk factors for congenital hypothyroidism (CH) by using the screening program in Fars Province, Iran, during the period 2003-2006.

Methods and Materials: A case-control study was carried out, the samples being 126 cases and 401 controls. The neonates were those born between 2003 and 2006, under coverage of the National Congenital Hypothyroidism Program. The data were analyzed using the univariate and multivariate analysis tests.

Results: An increased risk for CH was detected in infants with consanguine parents, by a multivariate analysis test (odds ratio (OR) = 2.9, 95% confidence interval (CI):1.8-4.8). The test also confirmed previously reported statistically significant associations with additional birth defects OR = 2.2 (1-4.6), birth defects in first-degree relatives OR = 4.7 (1.6-4.8), female gender OR = 1.9 (1.1-3), and twin births. Although not significant, an increased risk for CH was observed among infants with gestational age<30 weeks (preterm delivery) (OR = 1.7(0.9-1.3)).

Conclusion: This study identified risk factors contributing to the etiology of CH. In particular, our results suggest a multifactorial origin of CH, in which both genetic and environmental factors play a role.

  Background and Aim: Measuring the hand's grip strength and comparing it with its normative data is a valid method for detecting intensity of the numerous damages of hand. In addition, co mparing grip strength of people in different regions can reveal hidden facts resulting from genetic and environmental factors . Therefore , the present study was carried out with the aim of comparing grip strengths and three types of pinch (tip, key and palmar) strengths of healthy people living in five Iranian cities and determining normative data of grip strengths of citizens of these cities.

  Materials and Methods: This was an applied cross-sectional study. The study population included 1008 healthy adults (526 males and 482 females) from the Fars (Persian) ethnic populations in five cities of Iran ( Mashhad, Isfahan, Shiraz , Kerman and Yazd ). The American Society of Hand Therapists (ASHT) recommendations were followed to establish normative data of grip and pinch strengths . Jamar dynamometer and Seahan pinch gauge were used to measure grip and pinch strengths. In addition, the effect of body mass index (BMI) and other anthropometric variables (hand length, height and weight) on grip strengths was assesed.

  Results: In the present study, no significant differences were found between grip and pinch strengths of adults in the five cities. From among the parameters studied , height and hand length had the most influence on the grip strengths .

  Conclusion: The findings of this study show that populations of any particlular ethnic group have similar grip strength despite living in different geographical areas. The normative data of grip strength obtained in this study are important for ergonomists helping them to optimize work programs and designing tools, as well as for therapists helping them to reach the goals of treatment, assessing the body response to medical treatment, and detecting good function of the upper extremities .

  Background and Aim: Work ability reflects the interactions among personal characteristics, working conditions, employees' functional capabilities, and also employees' health status. Hence, the aim of the present study was to provide the Farsi version of Work Ability Index and to validate it among Iranian workers.

  Materials and Methods: In the first stage, Backward Translation method was used for linguistic validation of the questionnaire. Cross sectional survey of a sample of 645 workers from some Iranian companies were conducted. The study estimated the reliability of the questionnaire by means of test-retest, as well as the construct validity using factor analysis. In order to determine discriminant capacity, the mean scores of different dimensions of work ability index were compared between workers with and without sick leave.

  Results: Accordingly, the questionnaire showed a good internal consistency. ICC coefficients for the questionnaire were acceptable. Moreover, factor analyses related to the questionnaire items indicated that only one question is sufficient for each item of "work ability in relation to the demands of the job" and "mental resources". Also, questions related to the item of "number of current diseases diagnosed by physician" can be integrated in six questions. A good level of discriminant validity was observed for all dimensions except for the item of "work ability regarding work demands".

  Conclusion: According to the acceptable validity and reliability of Work Ability Index, obtained in the present study, using this questionnaire for evaluating workers' work ability in all Iranian work environments, especially in industrial settings, is recommended.

Background and Aim: The most important healthcare reform in Iran during the last decade has been implementation of the family physician and referral system in rural areas and small towns with a population of less than 20000. The program was expanded (as a pilot project), with small modifications, to rural areas of 2 provinces, namely, Fars and Mazandaran. This study was initiated to assess the achievements, challenges and weak points of the pilot project before deciding to expand it to other provinces.

Materials and Methods: This qualitative study was conducted in winter 2013. Data were collected using document desk reviews, semi-structured interviews with key informants, and focus-group discussions. Relevant family health policy makers, managers and service providers in the two provinces were invited to the meetings. The data were analyzed and categorized based on the content analysis method.

Results: The data showed that the family physician program is faced with several challenges regarding objectives; stewardship; service providing; and human, financial and information resources. It is to be noted, however, that the program has had achievements such as increased access to services, increased coordination among insurance organizations and medical universities, and organizing and managing health files.  

Conclusion: The program should not be expanded to other provinces before redesigning in order to assure that it is more complete and comprehensive and create commitment and adequate guarantee among stakeholders. It is essential that all the stakeholders agree on general and specific objectives of a 5-year program and prepare an operational plan for each specific objective. 

Background and Aim: Considering the importance of cutaneous leishmaniasis in Iran, this study was conducted to present the epidemiological characteristics of patients with cutaneous leishmaniasis, the time trend and the mapping of the disease in the cities under the supervision of Shiraz University of Medical Sciences.

Materials and Methods: Data was collected from the Heath deputy of Shiraz University of Medical Sciences and Health Centers of cities from 2005 to 2014; and was analyzed using Excel and SPSS19 software. Chi square test and Poisson regression were used for analysis.

Results: The incidence of the disease increased from 109 cases per 100,000 in 2005 to 218 in 2008 and decreased to 110 in 2014. The 0-9 age group was the most vulnerable and housewives were the most involved occupational group. Most people had a wet wound. The hands were the most affected. The highest incidence of disease was in the autumn. Zoonotic Cutaneous Leishmaniasis (ZCL) was the dominant type. Cutaneous leishmaniasis was more in northern than southern regions of the province in the recent years.

Conclusion: In the last years of the study, unlike in the early years, the incidence of disease in the northern region of the province was more than the southern regions. This finding could be a warning signal that the disease could be relocating and spreading in areas where the disease was not endemic before.