Journal of School of Public Health and

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Visceral leishmaniasis (VL) has been found as an endemic disease in some areas in northwest and south parts of Iran during recent two decades. The species of the Leishmania has been characterized as L.infantum and the main sources of human infection in the endemic areas is dog. The majority of kala-azar cases are found among children in the age group of 1-4 years. As the delay in diagnosis and treatment of kala-azar cause high mortality in the patients, serological surveillance, using direct agglutination test (DAT), and treatment of seropositive cases who have clinical symptoms are carrying out with cooperation of Provincial Health Services in the endemic foci of Ardebil and East Azerbaijan Provinces in the northwest and Bushehr in the south parts of Iran since 1997.
DAT Leishmania antigen is made in the Protozoology Unit of the School of Public Health with the strain of L.infantum isolated from an infected dog in Iran. The finger prick blood samples are collected by trained Health Workers (Behwarz) from suspected kala-azar patients in the Rural Health Houses. The collected samples are transferred to the near district kala-azar laboratory and tested (using DAT) by the trained technicians. The sero -positive patients are referred to pediatricains or trained general physicians in district hospital or health center for clinical examination and treatment of the seropositive cases (DAT titers of 1:3200 or higher) with kala-azar clinical symptos. For the treatment, usually, meglomine antimongtc (Glucantime) is used via intra-muscular in dosss of 20mg/kg/day for 20 days.
In kala-azar case finding in the serological surveyed areas of Ardebil, East-Azerbaijan and Bushehr provinces during 1997-2001, altogether, 19693 blood samples were collected from suspected kala-azar patients and tested by DAT. Totally , 1274 cases (6.74%) were seropositive in titers of 1:3200 or higher. In the clinical examination of seropositive cases 690 patients (54.16% of sero-positive cases and 3.50% of the total samples) had kala-azar clinical symptoms and therefore they were treated.
This seroloeical surveillance of kala-azar in the endemic area as have detected high number of kala-azar patients among children up to 12 years old, who were subsequently treated on time . This ptoject has prevented the mortality of the disease in the studied areas.

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Malaria has been prevalent for a long time in Iran. About 1000 years ago, the Iranian physicians such as Avicenna (979-1037) were acquainted to the clinical feature of the disease. The scientific study of malaria in Iran was started by Latycheve in 1921. Later on up to 1944, malaria have been studied by some Iranian and foreign investigators and it was found hyper-endemic in some littoral parts of Caspian Sea in the north and Persian Golf in the south and hypo-or meso-endemic in the central parts of the country. From 1941 to 1948 the anti-malaria campaign were using quinine for chemotherapy and chemoprophylaxis as well as anti-larval measures for vector control. From 1949 DDT was used for the control of the Anopheles vectors which were determined at that time as A.maculipennis and A.superpictus in the north and some central parts of Iran, A. sacharovi in the west and A.stephensi and A. culicifacies in the south parts of the country. At the present time A.d&aposthali and A.fluviatilis are also considered as malaria vectors and A.pulcherrimus as a suspected vector in the south parts of Iran.
Spraying (using DDT) and malaria surveillance (case finding and treatment) caused a great reduction in malaria incidence in the malarious areas, particularly in the north and central parts of the country. The Institute of Malariology was established in the Department of Medical Parasitology, Medical School of Tehran University for training and research works on malaria in 1952.Malaria Eradication Programme (MEP) was recommended by the World Health Organization in 1956 and actually started in 1957 in Iran under General Office of Malaria Eradication (GOME) in the Ministry of Health.
Anti-malaria campaign in MEP during 1957-1971 caused interruption of transmission of malaria in the north parts of Zagross mountains, approximately, half north parts of Iran, and reduced, greatly, the incidence of the disease in the south parts of Iran which were considered as problem or refractory areas.
In 1973, GOME became a division of CDC in Ministry of Health and this integration caused some standstill in the activities of MEP. Thus, the incidence of malaria increased in the refractory areas in the south as well as in consolidation areas in the north parts of the country and the total diagnosed cases of malaria in Iran raised from less than 35,000 to approximately 100,000 cases per year. Therefore, the Ministry of Health strengthened the MEP again. Actually, from 1980 the anti-malaria campaign from MEP changed to malaria control programme , because in the refractory areas due to some behaviors or resistance of vectors to insecticides and, partly, due to the resistance of P.falciparum to chloroquine at RI & RII levels, the interruption of transmission was not possible. However, there was about 80% reduction of annual malaria incidence as well as percentage of P.falciparum during the recent decade. The prevalent species of Plasmodia are P.vivax & P.falciparum in the malarious areas of south and P.vivax in the north parts of Iran. P.malariae is rarely found at present time.

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To determine the prevalence of various intestinal parasitic infections, we examined 966randomly collected stool specimens from urban areas and 569 such samples from the ruralregions. These were examined using formalin-ether sedimentation and direct smearmethods. From the total of 1535 specimens, 143 that belonged to 1-6 years old childrenwere examined by scatch tape method.The results indicated that 53.2% of the subjects were infected with intestinal protozoa andhelminths with the following prevalence rates:Entamoeba histolytica 9.6%, E. coli 16%, E.hartmanni 7%, Endolimax nana 2.6%,Iodomoeba biitschlii 1.8%, Dientamoeba fragilis 1.5%, Chi/omastix mesnili 0.4%), Giardialamblia 18.8%, Blastocysts hominis 16.5%, Dicrocoelium dendriticum 0.1%, Taeniasaginata 0.2%, Hymenolopis nana 1.4%, Ascaris lambricodies 0.3%, Enterobiusvermincularis (using scatch tape method) 0.7%, E.vermicularis (using formalin - ethermethod) 28.7%,Trichostrongylusspp.0.1%,Strongyhidessiercorials 0.3% and Trichuristrichiura 0.1%.Rural people were significantly more likely to bear helminthic infections than urbanresidents (4.9% versus 2.1%).E.histofytica wasmore prevalent among men (11% versus 7.1%) and, interestingly,age-specific infection rates for giardiasis and amebiasis showed contrasting patterns in thisstudy

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Toxoplasmosis is a common disease caused by the protozoal parasite Toxoplasma gondii. Most human cases occur by 1) eating raw or undercooked meat containing T. gondii tissue cysts. 2) ingestion of oocysts from soil and 3) vertical transmission through the placenta. Immunocompetent adults are usually asymptomatic or present with self-limited fever and lymphadenopathy. Infection acquired during pregnancy can be transmitted to the fetus and may cause mental retardation, blindness, epilepsy, and abortion. In this cross-sectional study we determined the prevalence of toxoplasma infection in residents of Meshkin-Shahr in 2001-2002. We applied a cluster sampling method to family health files in local health centers to recruit a total of 909 individuals for this study. All family members were requested to complete the study&aposs questionnaire. For each individual, two separate blood samples were collected and placed in microhematocrite tubes. Titers of anti-toxoplasma antibodies were measured by IFA with levels in excess of 1/20 taken as positive. Questionnaire information and examination results were analyzed by the SPSS software package using chi-square tests. Results of this survey show the overall prevalence of toxoplasma infection to be around 18.3%. Figures for men and women were 19.7% and 17.2%, respectively but the difference was not statistically significant. Prevalence rates show a significant association with age (greater prevalence in higher age groups) and the type of meat consumed (P<0.05). But there were no significant associations with education level, occupation-keeping cats in the house, ingestion of meat and history of previous abortions. The most frequently occurring antibody titer was 1/20 (6.9%). and frequency decreased with higher antibody titers.
This study shows that toxoplasma infection is not as common in Meshkin-Shahr as in some parts of the country, with more than 80% of individuals being seronegative. Because of the low immunity level and the risk of vertical transmission, educating the public in prevention methods could be very important.

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This cross-sectional study was conducted from May to September 2003, with the aim of determining quality of service in 25 State-run family planning clinics in Hamadan city. A total of 400 consultations were observed and assessed using UNICEF quality checklists. Results showed that less than 50% of the clients are receiving service of a satisfactory quality areas of care where quality was worst included history taking, physical examination and counseling. It became apparent that care providers with higher education had lower performance levels compared to their less educated colleagues. Service for new clients was of poorer quality than for those who had requested a change of contraceptive method. Furthermore, earlier hours of a work shift (before 10 o’clock) were associated with better service quality than later hours. Altogether, the study reveals serious flaws in areas such as training of family health workers and human resource management within the current system. To address these shortcomings, we recommend a more client-oriented approach in health care, use of supplementary material to promote client knowledge, and training of health workers with due emphasis on effective communication and performance.

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This cross- sectional study was done to assess the prevalence of chronic cough by age and date of birth (age-period-cohort analysis). Using data from two National Health Surveys in 1991 and 1999 (involving cross-sectional general population samples), we studied all cases of chronic cough recorded during the period of 1991 to 1999 in people aged 2 to 70 years. A birth cohort analysis was performed on the data. Comparison with earlier surveys showed that the prevalence of chronic cough had fallen from 4.5% to 1.8%. Age-period-cohort analyses of the age effect revealed that prevalence rate of chronic cough increased with age but in every age group it actually decreased after the 8-year period. The fact that different trends are observed in cross-sectional and cohort data points to a strong cohort effect. the prevalence of chronic cough is strongly determined by a person’s year of birth. Also for any given age group, prevalence rates were lower in younger compared to older cohorts.

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One of the main problems in malaria control is the resistance of Plasmodium falciparum to chloroquine and some other antimalarial drugs. This resistance is now quite common in most regions where falciparum malaria is endemic. Between 1968 and 1976, two in-vivo studies were carried out in endemic areas in the south of Iran and they showed P. falciparum to be chloroquine-sensitive. In 1983, the Department of Protozoology in the School of Public Health undertook in vivo and in vitro studies on the response of P. falciparum to chloroquine and other antimalarials. In the Iran-Shahr region a few cases of in vivo resistance to chloroquine were found in 1983, and the rate of resistance was 5.7% at RI level. Between 1994 and 1996, resistance in this region gradually increased to 51.2% at RI, RII and RIII. In Bandar-Abbas and Kahnoudj areas, prevalence of chloroquine-resistant P. falciparum infection was 32.5% at RI and RII from 1986 to 1987 it increased to 64.8% at RI,RII and RIII levels from1994 to1996 and then altered between 68% and 84% at RI and RII levels in the 1997-2001 period. 88 chloroquine-resistant patients were treated with standard doses of sulfadoxine-pyrimethmine (Fansidar) alone or in combination with amodiaquine and then examined with 28-day in-vivo tests. In 13.6% of them resistance was observed at RI and RII levels. In micro in-vitro tests, using WHO standard kits, the rates of resistance of P. falciparum to chloroquine, amodiaquine, sulfadoxine-pyrimethamine, mefloquine and quinine were 33.4%, 15.2%, 17.9%, 2.2% and 0.0% in 281, 72, 39, 44 and 72 cases respectively. As mefloquine has never been used in the studied areas, the sporadic cases of in-vitro mefloquine resistance may be considered as cases of innate and/or imported resistance. Primary resistant casese was seen mostly among Afghan and Pakistani immigrants/passengers. Hence these individuals are likely to have introduced chloroquine–resistant malaria into this country. The in vivo response of Plasmodium vivax to chloroquine was also studied in 827 patients was also studied in the endemic areas of the South-East between 1995 and 2001. The mean parasite clearance time (MPCT) was 2.78 and no resistant cases were found. Most cases in these studies had been referred by the local Malaria Control Laboratories to the research facilities at Health Training and Research Centers in Bandar-Abbas and Iran-Shahr. Some had received chloroquine, and those with a good response had not been referred. Therefore, the high rates of chloroquine resistance found in these studies probably do not reflect overall resistance rates at population level. To determine true resistance levels in these areas, all eligible patients must undergo WHO’s simplified in-vivo tests performed by trained malaria microscopists or laboratory technicians.

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Myiasis is always resulted by depositionof egg or young larvae of cyclorrhapha flies’ in live tissus of human or animals,which follows by their Development. Although the survival of mentioned larves is depended on existance of livestock and wild animals, the flies can be seen in parks, dairy farms and certain plants and also solid wasts waiting for proper hosts. The frequent study was carried out in Tehran and suburb and adalt flies were netted in different areas, indoors and outdoors and taken to the laboratory for identification. Twenty-two species of flies were identified. Thirteen species were medically important and four species consisting: Calliphora vomitoria, Lucilia richardsi, sarcophaga fertoni, Sarcophaga peregrina were identified and reported for the first time in Iran.

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Nowadays the Quality of Life (QOL) among different groups of people, especially in disabled people, is recognized as a very important topic. In order to assess quality of life in people with spinal cord injuries, 86 members of Tehran spinal cord injury(SCI) society were selected randomly. Data were gathered through a questionnaire that consisted of two parts. The first part contained questions about sex, age, plus the cause, type and duration of injury. The second part contained questions that measured quality of life in an objective manner. The test was adapted from Lancashire and Wisconsin tests and modified to suit the cultural background of Iranian people. Results showed that %73.3 of people with SCI perceived their QOL as good or fair. In assessing different areas of quality of life, the highest scores were given to social relations (3.67 out of 5). In the married group the mean score for satisfaction in family relations was 3.95 out of 5 score. Sub-scores for work/education, finances, physical health and psychological health status were lower than the other ones. Results of study indicated that there was a significant difference in the mean QOL score between the two sexes: the score for women was higher (mean score was 3.3 for women and 2.9 for men). But Quality of Life was not significantly related to age, cause of SCI, type of SCI, or duration of SCI.

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Background and Aim: Visceral leishmaniasis (kala-azar), the most dangerous form of leishmaniasis, is endemic in some parts of Iran, e.g. Ardabil, Fars, East Azerbaijan, Bushehr and Qom provinces. In recent years, the incidence of VL has increased in the Nourabad-Mamassani district in Fars Province. This study was carried out to detect VL vectors and infection rates in this region over the 2003-2004 period.
Material and Methods: Sand flies were captured in the selected villages by means of sticky traps, aspirators and CDC miniature light traps. Heads and distal abdominal segments were used for species identification and other body parts were used for DNA extraction. We employed a semi-nested PCR technique to detect Leishmania, with specific kDNA primers (LIN R4 - LIN 17 – LIN19). Some specimens were dissected for leptomonad infection.
Results: A total of 12688 sand flies were collected. Phlebotomus (Paraphlebotomus) alexandri was the second most prevalent species (17.34%). The anthropophilic index of this species was 32.5%. Five cases (4.17%) of L. infantum infection were detected among the 120 P. alexandri examined by PCR method. We also observed two cases of leptomonad infection among the 112 dissected specimens.
Conclusion: High prevalence rates and anthropophilic index of P. alexandri plus its natural infection with L. infantum provide enough evidence to implicate this species as the main vector species of VL in the region and the second proven kala-azar vector in Iran. Besides, the Mahoor-Milaty district of Noorabad-Mamassani was identified as a new endemic focus.

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Background and Aim: Methyl tertiary butyl ether (MTBE) is an oxygenated additive chemical added to gasoline, which is as a substitute for tetra ethyl lead, to reduce discharge of pollutants from automobile exhausts. This organic chemical is present in water samples collected from areas where gasoline wastes are abundant. The objective of this study was to investigate the possibility of MTBE removal from drinking water at the point of use (POU) by using an Iranian granulated active carbon (GAC) bed.
Materials and Methods: Adsorption of MTBE from drinking water at POU was studied by using an Iranian GAC bed. The water samples treated by this filter adsorber were prepared synthetically at two concentrations (50 ppb and 100 ppb). In addition, the effects of residual chlorine at concentrations of 0.2 and 0.5 mg/L and of chloroform at a concentration of 100 ppb on removal of MTBE were determined.
Results: It was found that this filter adsorber could treat 375 liters of water containing 50 ppb MTBE, 100 ppb chloroform and 0.2 ppm residual chorine. If the residual chlorine content was increased to 0.5 ppb, the volume of water treated would be 335 liters. The filter could t eat 195 liters of water containing 100 ppb MTBE, 100 ppb chloroform and 0.2 ppm residual chlorine to acceptable levels for drinking, provided the amount of MTBE is below the respective standard.
Conclusion: Both residual chlorine and chloroform reduced the MTBE adsorption capacity on GAC due to occupation of adsorption sites. In addition, to the tendency of GAC to adsorb chloroform and chlorine was greater than that of MTBE.

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Background and Aim: Thalassemia is one of the most common worldwide single-gene diseases. On the molecular level, it is a heterogeneous disease. So far, beside large deletions, more than fifty point mutations have been identified for this disease around the world. Four to ten percent of Iranians are carriers of thalassemia-affected genes. In this study we determined the relationship between the value of MCV/MCH and the type and severity of mutations in alpha thalassemia carriers.

Methods and Materials: The major abnormality in alpha thalassemia carriers is decreased values of MCV and MCH. A total of 104 adult alpha thalassemia heterozygotes, 20-40 years old, including 33 persons from Khoozestan Province and 71 from Khorasan Province, were included in the study. Two hundred and eight chromosomes were isolated from peripheral blood leukocytes using standard procedures. DNA samples were amplified by Gap-PCR.

Results: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

Conclusion: Only one ° mutation (MED) was found in 2.9% of the population. The carriers of this mutation had virtually identical ranges of MCV and MCH. In contrast, + mutations were associated with significant differences in mean MCV and MCH values. The various mean MCV/MCH ratios of ° carriers were statistically significantly lower than those of + heterozygote. The results indicated that the degree of reduction in MCV and MCH is directly related to the severity of the mutations. Deviations, in cases, were associated with lower numbers of the carriers.

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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: 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: 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: Sex education of children, a complex issue in any culture, has always been a controversial subject. Schools can play a vital role in imparting sex education to children, particularly in more conservative communities. The objective of this study was to find out primary school teachers' beliefs, attitudes, values, and understandings regarding sex education of school pupils.

Materials and Methods: In this qualitative study we employed a community-based approach to design the project. Purposeful, voluntary and maximum variation sampling was used to recruit 22 teachers from selected schools in Western Tehran (21 female and 1 male teacher). Information was collected in 4 focus-group discussion sessions. Grounded theory and thematic analysis were used.

Results: Findings revealed three major themes: 1) organizational role, 2) institution construction, and 3) individual characteristics. These themes were described by subthemes as follows: 1. for organizational role: organizational culture and policies 2. for institution construction: family and educational institutions 3. for individual characteristics: biology, gender, instincts, curiosity, knowledge, and behaviors.

Conclusion: From the participants' point of views, the school and the family are two important institutions in children sex education. However, teachers are not sufficiently competent in sex behavior education. Inappropriate policies, resource limitations, and the family cultural structure are obstacles in sex education of children in schools. The participants believe the following are priorities in children's sex education: changing cultural attitudes in organizations and institutions, such as cultural diffusion sound training approaches in sex-related topics providing sufficient resources improving knowledge and skills of teachers in the area of sex education of pupils and effective interaction between families and school authorities.

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Background and Aim: This study was undertaken to determine the effectiveness of a safe community program, as an international community-based program, for injury prevention and safety promotion, in Kashmar

Materials and Methods: In this retrospective study, the data on injured patients consulting hospital emergency wards in Kashmar and 44 other districts (as control) for a period of 3 years (March 20 2005 to March 19, 2008) were analyzed and compared.

Results: The number of injuries/100,000 population in Kashmar was 4654.6, 4570.9, and 4949.2 in March 2005-2006, 2006-2007, and 2007-2008, respectively. The corresponding figures (means) for the control districts were 822.7, 1130.0 and 1245.5. The injury- related fatality rate in the emergency ward for the 3 periods was 57.6, 52.9, and 44.2 per 100,000 in Kashmar and 12.2, 13, and 11.9 per 100,000 in the control districts. The injury rate showed an increase and the injury- related fatality rate showed a decrease in both Kashmar and the control districts over the 3 year period, but there was a statistically significant difference between the decreased injury-related fatality rate in Kashmar (p<0.0001).

Conclusion: The Kashmar International Safe Community Program resulted in no significant decrease in the rate of injuries in Kashmar. However, as compared to the control distrcts, it caused a decrease in the injury-related fatality rate over the 3-year period. Long-term studies are necessary to confirm these results.

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Background and Aim: Inequality in the distribution of hospital recourses is a great obstacle in planning and provision of health care. This inequality in mainly observed in the government hospitals in a country. The objective of the present study was to determine the distribution of specialized physicians and active beds in the Iranian government hospitals between 2001 and 2006

Materials and Methods: The method used in the study was retrospective, descriptive- analytical. The data were analyzed (Lorenz Curve and Gini index estimation), using the Excel Software.

Results: Based on the Gini coefficient, the distribution of specialized physicians during the 5-year period (2001-2006) was 0.0876, 0.0874, 0.0909, 0.0329, 0.0951, and 0.0520, respectively. The corresponding figures for active beds were 0.024, 0.0171, 0.0208, 0.0251, 0.0212, and 0.084.

Conclusion: The findings of the study indicate that, in spite of differences in the proportions of specialized physicians and active beds among the provinces with regard to their populations, the distributions in the government hospitals have been equitable. The results of this study can provide useful insights for the country's Health Ministry policy-makers.

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Background and Aim: Thalassemia, a heterogeneous disease, is one of the most common single-gene diseases worldwide. The aim of this study was to find associations between hematological indices and severity of beta-globin gene mutations in beta-thalassemia carriers.
Materials and Methods: In this cross-sectional study, 30 beta-goblin gene mutations (b+ and b○) in 1206 unrelated beta-thalassemia carriers were investigated. In addition, their hematological indices, including CBC and electrophoresis results, were determined. The association between genetic findings and hematological parameters (mean corpuscular volume (MCV) and mean hematocrit corpuscular hematocrit (MCH)) were determined using the SPSS software, the statistical test being the t-test.
Results: The results indicated that b+-thalassemia carriers had higher MCV and MCH means than b○-thalassemia carriers. These findings would certainly have practical implications in public health.
Conclusion: The results show a significant correlation between two hematological indices and certain types of mutations in beta-thalassemia carriers.

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Background and Aim: Many researchers have studied survival (time to death) of gastric cancer patients. Although gastric cancer diagnosed in early stages can be cured by surgery, chance of relapse still exists after operation. Hence, we should consider both events, that is, relapse of the disease and death, in order to be able to make a more precise estimation for survival of the patients. The purpose of this study was to use the competing risks method to estimate the cumulative incidence functions (CIF) of the relapse of disease and death and consequently to estimate the postoperative disease-free survival.
Materials and Methods: A total of 330 patients admitted to Iran Cancer Institute and operated between March 1995 and March 1999 were enrolled in the study. They were followed up for at least 5 years to estimate their 5-year disease-free survival. Information on their demographic, clinical, and therapeutic characteristics, as well as on the type and time of occurrence of the first event (relapse of disease or death) after surgery was collected from their medical records. The direct parametric method was applied to estimate CIFs of relapse of the disease and death, while to adjust the effects of some covariates the parametric regression model was used. Data analysis was done using the R software and a p-value <0.05 was considered statistically significant. The findings were compared with the results obtained on the basis of data analysis in which the competing events were not considered.
Results: The median follow-up time was 37.9 months. Of all the patients 13% experienced relapse and 60.9% death as the first event after surgery. The CIFs of relapse of disease and death 5 years after operation, with due consideration of covariates, were estimated at 11.0% and 68.6%, respectively. Age, stage of disease, and complementary treatment were statistically associated with the CIF of death, while only complementary treatment was related to the CIF of relapse. Older patients and those in more advanced stages of disease were more likely to die after operation. Moreover, while complementary treatment after operation decreased the CIF of relapse of disease, it increased the CIF of death. The disease-free survival of patients 5 years after surgery was 20.(consideringtheeffectsofsomecovariates).
Conclusion: The competing risks method is recommended for analyzing survival data because of its capability in considering different events and, therefore, making it possible to make more precise estimations. By using this method, considering smaller variance estimates for model parameters and also narrow confidence intervals for the cumulative incidence functions of competing events, it is expected to obtain more precise results. Unfortunately, the results have revealed that the disease-free survival of gastric cancer patients is low in Iran.