Analysis of ground water fluoride content and its association with prevalence of fluorosis in zarand/Kerman: [using GIS]

Statement of Problem: The concentration of fluoride in water is usually higher in areas around the coal mines. Zarand region in the south-east of Iran is known for its coal mines. Some studies have shown the high prevalence of fluorosis and some studies reported high levels of fluoride in the region

Objectives: This study aimed to use Geographic Information System [GIS] to assess the relationship between water fluoride content and the prevalence of fluorosis and its spatial distribution in Zarand region

Materials and Methods: This cross-sectional study aimed to recruit 550 people aged 7-40 years in Zarand. Dental examination for fluorosis was conducted based on the Dean's Index. The level of fluoride in the water was determined in samples of water taken from 35 areas. Information on fluorosis and fluoride content was mapped on GIS

Results: Most participants lived in rural areas [87.25%] and had an educational status of high school level [66%]. About 23% of the examined people had normal teeth, 10% had severe and 67% had mild to moderate fluorosis. Distribution of severe fluorosis was higher in areas with higher levels of fluoride in the water according to GIS map

Conclusions: GIS map clearly showed a positive relationship between the prevalence and severity of fluorosis with the level of fluoride in water in Zarand. The GIS analysis may be useful in the analysis of other oral conditions

Estimation of influenza and severe acute respiratory illness incidence [burden] in three provinces of the Islamic Republic of Iran, 2012 and 2013

There are few estimates of influenza burden in the WHO Region for the Eastern Mediterranean. In this study we estimated the burden of severe acute respiratory infection [SARI] and influenza-associated SARI [F-SARI] in selected provinces of Islamic Republic of Iran, the trends of SARI and confirmed cases of influenza [F-SARI] over 12 months [seasonality], and the age groups most at risk. Using the electronic Iranian influenza surveillance system and data of cases in sentinel hospitals of 3 selected provinces, we estimated the monthly trend [seasonality] of incidence for SARI and F-SARI, overall incidence of SARI and F-SARI and their disaggregation by age with the aid using the Monte Carlo technique. The age groups most at-risk were children aged under 2 years and adults older than 50 years

Accreditation the education development centers of medical-sciences universities: another step toward quality improvement in education

In order to improve the quality of education in universities of medical sciences [UMS], and because of the key role of education development centers [EDCs], an accreditation scheme was developed to evaluate their performance. A group of experts in the medical education field was selected based on pre-defined criteria by EDC of Ministry of Health and Medical education. The team, worked intensively for 6 months to develop a list of essential standards to assess the performance of EDCs. Having checked for the content validity of standards, clear and measurable indicators were created via consensus. Then, required information were collected from UMS EDCs; the first round of accreditation was carried out just to check the acceptability of this scheme, and make force universities to prepare themselves for the next factual round of accreditation. Five standards domains were developed as the conceptual framework for defining main categories of indicators. This included: governing and leadership, educational planning, faculty development, assessment and examination and research in education. Nearly all of UMS filled all required data forms precisely with minimum confusion which shows the practicality of this accreditation scheme. It seems that the UMS have enough interest to provide required information for this accreditation scheme. However, in order to receive promising results, most of universities have to work intensively in order to prepare minimum levels in all required standards. However, it seems that in long term, implementation of a valid accreditation scheme plays an important role in improvement of the quality of medical education around the country

trend of governmental support from post-graduated Iranian students in medical fields to study abroad

To explore the trend and composition of post-graduate Iranian students who received governmental scholarship during the last two decades. Detailed information about the awarded scholarships and also about the number of post graduate students in clinical and basic sciences in domestic universities were collected from the related offices within the ministry of health and medical education and their trends were triangulated. A sharp drop was observed in the number of awarded scholarships, from 263 in 1992 to 46 in 2009. In the beginning, almost all of scholarships fully supported students for a whole academic course; while in recent years most of scholarships supported students for a short fellowship or complementary course [more than 80%]. Students studied in a wide range of colleges within 30 countries; more than 50% in Europe. Although one third of students studied in UK in the first years, only 4% of students selected this country in recent years. conversely, the number of scholarships to Germany and sweden have increased more than 10 and 3 times during this period. In parallel, the capacity of domestic universities for training of post-graduate students has been expanded dramatically. Although expanding post-graduate education has been one of the main strategic objectives of the ministry of health and medical education in last two decades, it was obtained using different approaches. By time, more attention was to expanding the capacities of Iranian universities, and choosing less but more targeted students to continue their studies abroad

[Epidemiology of work-related accidents in Kerman coal mines during 1991-2006]

There are annually millions of work-related accidents leading to either loss of life or disability. Coal mine workers, due to the nature of their work, are at a higher risk of work accidents. With regard to the importance of health statue of skilled workers and prevention of work-related injuries, in this study work-related injuries in Kerman Coal Mines during 1991-2006 were analyzed. In this descriptive study, the recorded and approved data of accidents occurred during 1991-2006 were collected from the documents of Kerman coal mines office and Safety indices [frequency, severity and frequency-severity of accidents] were extracted and analyzed. There were a total of 3642 accidents during 16 years and an average of 228 accidents per year. From all accidents, 51 cases had resulted in death of which most cases were related to the years 1992, 1994, 1996, 1997 [each year one case]. Mean frequency percent, severity and frequency-severity were 31.3 +/- 25.9, 473.8 +/- 11275.1 and 9.3 +/- 12.4 respectively. according to the results of chart control, accident frequency percent except for the years 2002 and 1994 which were respectively a little more and less than the expected rates, in the other years was in the expected range. Severity and frequency-severity of accidents during the 16-year period were in the expected range. In whole, safety indices during the 16 years were stable and in the expected range. In other words, there has been no change for the improvement of safety conditions. Therefore, in order to achieve the required standards and to provide more safety for coal mines workers, it is required that all related organization take efficient coordinated measures

Coronary artery disease risk factors in an urban and peri-urban setting, Kerman, Southeastern Iran [KERCADR study]: methodology and preliminary report

This article was to present the sampling and measurements methods and the main preliminary findings of the KERCADR cohort study [first round] in an urban and peri-urban setting, Kerman, southeastern Iran2009-11. 5900 [3238 female] people aged between 15 to 75 years were recruited in the household survey by non-proportional to size one-stage cluster sampling. Trained internal specialists, general practitioners, clinical psychologists and dentists have assessed the study subjects by person-assisted questionnaires regarding different NCD risk factors including cigarette and opium smoking, physical activity, nutrition habits, anxiety, depression, obesity, hypertension and oral health. Blood samples were also collected for determining FBS, HbA1c, cholesterol and triglyceride. Weighted standardized prevalence estimates were calculated by STATA 10 survey analysis package. The participation rate was more than 95% in all subgroups. Cigarette smoking [18.4% vs. 1.2%], opium use [17.8% vs. 3.0%] and triglyceridemia [16.1% vs. 12.0%] were significantly higher among men than women. In contrast, women were presented with higher level of sever anxiety [29.1% vs. 16.7%], obesity [16.8% vs. 9.2%], low-physical activity [45.1% vs. 39.2%] and uncontrolled diabetes [60.2% vs. 31.0%]. More than 68% of all subjects have presented with moderate to severe gingival index scores. The first round of the KERCADR cohort with sufficient sample size and response rate provided precise estimates for the main clinical and para-clinical NCD risk factors. These evidences need to be translated into public health interventions and monitored in the next rounds of the cohort

Cost analysis for cancer subgroups in Kerman, Iran

The economic costs of cancer care are a burden to people diagnosed with cancer, their families, and society as a whole. Despite several studies about cancer in Iran, there is paucity of cost analysis in this area. The aim of this study was to estimate the cost of cancer subgroups in Kerman, Iran. A retrospective analysis of administrative 223 diagnosed patients with different cancers was undertaken. Monthly average cost of cancer was 3.32 thousand US dollars [average exchange rate in 2010: 10308 Iranian rials' 1 US dollar]. Breast cancer, with an average 4.30 thousand US dollars per month was the most expensive and cancer of male reproductive organs with average2.16 thousand US dollars were the cheapest cancer. The hidden monthly cost of all types of cancer was 2 thousand US dollars, breast cancer, lung, blood and female reproductive organs were costly and brain and peripheral nerves cancer, gastrointestinal tract and prostate were medium and male reproductive organs cancer was less costly. Economically impact and burden of cancer should be an important consideration in the health policy making in Iranian health service system

Lessons learnt from malaria epidemics in the Islamic Republic of Iran

The Islamic Republic of Iran is in the pre-elimination phase of malaria control, but malaria epidemics are still a concern in the south of the country. This retrospective study presents the epidemiological characteristics and predisposing factors of 60 of the malaria epidemics reported in Sistan va Baluchestan province during 2005-09. A zero-truncated negative binomial model was used to investigate the relation between predictor variables and the total number of malaria cases. Malaria epidemics occurred mainly in the southern part of the province, mostly between July and October, peaking in August. Most malaria epidemics were small-scale [8.3% were < 100 cases] and short [51.7% lasted < 1 month]. Plasmodium falciparum was present in 46.7% of the epidemics. An increase in the rainfall rate as well as population movements were the most significant predisposing factors. The results may help inform an epidemic investigation and reporting system as the country approaches the malaria elimination phase

HIV, HSV2 and syphilis prevalence in female sex workers in Kerman, South-East Iran; using respondent-driven sampling

We estimated the prevalence of HIV, sexually transmitted infections [STIs], and risky behaviors among female sex workers [FSW] in Kerman City, Iran. Women, 18 years or older, who reported selling sex for at least 6 months during their lifetime and had at least one sexual contact with a client in the recent 12 months were sampled using Responding Driven Sampling [RDS]. Participants were interviewed about their sexual behaviors and provided whole blood for HIV, syphilis, and Herpes simplex type 2 [HSV2] testing. Data were analyzed using RDSAT Version 6.0 software. Among samples of 177 FSW, we did not find any HIV positive cases. The weighted prevalence of syphilis and HSV2 were 7.2% and 18.0%, respectively. The reported STI syndromes for the proceeding year of the survey were 36%. Unprotected sexual contact was about 17-22% and link to injecting drug users through injection was about 18%. While this survey found no HIV, there were findings of risky sexual behaviors and STI, markers for potential infection for HIV. The prevalence of STI and sexual risk behaviors for HIV is considerably high in this subpopulation that alarming for an urgent public health preventive measures and national control-plan to be developed and implemented

Absence of asymptomatic malaria infection in endemic area of Bashagard district, Hormozgan province, Iran

A successful malaria elimination program calls for enough attention to parasite carriers, especially asymptomatic malaria, as well as the diagnosis and treatment of clinical cases. Asymptomatic malaria is an infection that patients do not show any symptom; thus, these patients play critical role in the concept of an elimination program. The current investigation was conducted to evaluate the presence of these cases in Bashagard District, formerly a high malaria transmission area in Hormozgan Province, Iran. Blood samples [n=500] were collected from symptomless individuals residing in Bashagard to evaluate Plasmodium infection by using microscopic, serological and nested-PCR techniques. Regarding the microscopic and nested-PCR analysis, no asymptomatic infection was detected among studied individuals. Totally, 1% of the studied population [5 of 500] had anti PvMSP-119-specific IgG antibody; however, only 0.2% [1 of 500] of the individuals was seropositive to recombinant PfMSP-119, using ELISA. This study showed no asymptomatic malaria infection in the studied population; hence malaria elimination is feasible and can be successfully carried out in this region

Prevalence of breast cancer in a defined population of Iran

Prevalence of breast cancer In Asian developing countries is much lower than western developed countries. The main aim of this study was to measure breast cancer prevalence in a defined population of Iran. A total of 25201 women who were under coverage of [Imam Khomeini Relief Foundation [IKRF]], which is an organization for delivering supportive social and cultural services to the deprived and poor subgroups of the society, were involved in the study. The study was conducted during years 2007 and 2008. All subjects were interviewed for their sociodemographic features and underwent precise clinical and paraclinical breast examination. Mean age was 47 years with standard deviation 10 ranging from 11 to 88 years. Subjects were from deprived subgroups of the community; were mainly illiterate or had primary school education [86%] and majority of them [93%] had their first full-term pregnancy at age less than 26 years and also were multiparous. With confirmed diagnosis by breast biopsy, breast cancer prevalence was 0.15% [95%CI; 0.10-0.20]. Compared with developed countries, Asian developing countries have been at a lower risk of breast cancer development. It is seen that more deprived subgroups are at much lower risk. The more industrialized life is accompanied with more hazards

Low incidence of colorectal cancer in Kerman province, Iran

In Iran colorectal cancer [CRC] incidence varies among various places. But we do not have any validate data that deeply explored the difference of CRC in Kerman province by national average. The aim of this study was to evaluate the incidence of colon cancer within a 12-year period in Kerman province and to find whether the incidence of CRC in Kerman compared with the total incidence found in Iran. Data on colorectal cancer was collected from all histopathology departments around the Kerman Province during 1991 - 2002 retrospectively. The crude and age-standardized incidence rates per 1 million populations were calculated based on the 1996 census data and the population growth rate. During this study total number of 551 new cases of colorectal cancer in Kerman province had been diagnosed. Age Standardized Rate of colon cancer in males and females were 50 [95% CI: 44-56] and 53 [95% CI: 46-59] cases per 1,000,000 population per year, respectively. The risk ratio in females relative to males was not significant in any type of colon cancer. We did not find any difference for each year during the entire study period. The ASR of colorectal cancer in Kerman province was quite lower than the average rate in the whole country. This study showed that, the risk of acquiring colon cancer was constant. We concluded that the risk of colorectal cancer in Kerman province was much lower than the entire country

[Ultra analysis of prevalence of osteoporosis in Iranian women "a systematic review and meta-analysis"]

There are many descriptive studies on osteoporosis in Iran, mostly assessing the prevalence of the disease and its associations with various risk factors. In order to gain a better insight into the epidemiology of osteoporosis in Iran and its heterogeneity around the country, we systematically reviewed all the studies available and analyzed their findings using meta-analysis methods. All published papers in Iranian and international journals, final reports of research projects, papers presented in relevant congresses, and all dissertations of medical students were reviewed using standard methods and sensitive keywords. After Quality Assessment the main results of studies published during 2000-2008, which met the eligibility criteria, were extracted and Combined with the Random Effect Model, and were entered into metaanalysis. In 21 primary, eligible studies, minimum and maximim prevalence rates in the femur region were 1.5 and 43 respectively and in the Spinal Region these values were 3.2 and 51.3, respectively. The prevalence of osteoporosis in the femur using the Random Effect Model in Iranian Women was 18.9 CI [15- 22.7] and in the Spinal reqion was 18.91 CI [14.6- 23.2] in metaregrresion analysis, with place and sample size as the main heterogenous factors [p<0.01]. Osteoporosis, an important health challenge, increases with age and changes in life style. The prevalence of osteoporosis in Iran, compared to other countries, was lower

Redefining Ph.D. education in Iran: a systematic review of literature

Reviewing the scientific literature concerning the analysis of different aspects of PhD education systems can help improve the knowledge promotion system in Iran. Different PhD training models around the world and their advantages and disadvantages have been investigated. The study explored the published papers using a systematic approach. Promotion plans in other countries were also investigated. Main databanks between 1998 and 2008 were systematically reviewed using ten standard and sensitive keywords. In the next step, the contents of eligible papers were analyzed and classified. Thirty-two eligible papers were included in the final analysis. The main themes in these papers were about the student admission, supervision of PhD students and evaluation methods. In addition, these papers discussed how universities might improve the links between their PhD students and the community and industry. Moreover, we found information about the variety of training method between different countries, the trends in the number of PhD students and their age, sex and ethnic compositions. Major challenges for Ph.D education include: discipline, law and order in Ph.D programs, quality of supervision, completion time, drop-out rates, increasing number of students, preparation for employment, labor market qualifications and skills, cost of education, inter- university student exchange programs and foreign students admission. Based on our findings, we need to pay more attention to diversify PhD training schemes particularly research-based PhD and professional PhD and to provide PhD education systems appropriate to the present and future needs of our society

[How to estimate the sample size in special conditions? [part two]]

In the previous paper, the basic concepts of sample size calculation were presented. This paper explores main post-calculation adjustments of the sample size calculation in special circumstances such as multiple group comparisons, unbalanced studies [with unequal number of subjects in different groups]; sample size correction for missing data, and adjustment for finite population size. In addition, the concept of design effect in multi-stage sampling and its impact on the sample size are presented. We then focused on the sample size estimation when we have to use non-parametric statistical tests for data analysis. The concept of power-efficacy of parametric versus non-parametric methods and its use in the correction of sample size has been explained

[Comparison of the outcomes of three detoxification methods [clonidin, methadon, rapid] in opioid-dependents referred to Kerman Shaheed Beheshti Hospital in a 6-month follow-up]

In this study the efficacy of traditional method, methadone tapering method and rapid method as three opiate detoxification treatments was compared based on demographic features and naltrexone consumption in a 6-month follow up. This Cohort prospective study was performed on 140 opioid addict men referred to opiate detoxification center of Shahid Beheshti Hospital, Kerman/ Iran from 2005-2007. They were divided into three groups of traditional method [n=61], methadone tapering [n=34] and rapid treatment [n=45] and followed up for 6 months in order to evaluate the results of detoxification treatments. At the end of the first month, the rate of abstinence in whole was 80.7%, and this rate was 83.6% in traditional treatment group, 82.4% in methadone group and 75.6% in rapid treatment group that shows no significant difference. After the 6th month the rate of abstinence was 12.8% in whole, 16.7% in traditional treatment group, 16.7% in methadone group and 6.3% in rapid treatment group. These rates, too, show no significant difference among three groups. The rate of naltrexone consumption at the end of the 1st month was 75.7% in whole, 52.5% in traditional group, 47.1% in methadone group and 97.8% in rapid treatment group that shows significant difference among three groups [P<0.05]. There was no case of naltrexone consumption at the end of the 6th month

[Knowledge and attitude concerning HIV/AIDS among Iranian population: a systematic review and meta- analysis]

The number of people with HIV/AIDS in Iran is increasing. Populations' knowledge and awareness are crucial steps to prevent HIV/AIDS epidemic. This systematic review aimed to assess the level of knowledge and attitude toward HIV/AIDS in Iranian population. Reviewing related titles in national and international databanks resulted in 62 eligible studies published between 1998 and 2008. To explore the source[s] of heterogeneity, meta-regression model was used. Due to the methodological diversity of included studies [e.g. their sampling or data collection methods] pooled estimation of the results were hard to be applied. The mean for knowledge score among 24 eligible studies [including 24,011 individuals] varied between 14.7 and 84.0 out of 100. Among those 16 eligible studies [including 11,104 individuals], the reported mean for attitude varied between 32.6 and 78.4 out of 100. In overall, it seems that the knowledge and attitude in Iranian population still need to be improved; however, the results from our systematic review showed a considerable heterogeneity among the results that can be originated from the diversity of target populations and/or their methodology of included studies. Planning for further targeted programs and modifying public education for more effective schemes are necessary to be emphasized, as there was not a significant change in the level of knowledge or attitude based on the included studies

[Relationship between body image and eating disorders]

Adolescents face special problems which are less common during childhood. Their self image that is influenced by their body changes during this period could cause eating disorders. The aim of present study was undertaken to asses the relationship between body image and eating disorders among female students in Kerman's high schools. Using a correlational study design, 650 female students drawn from high schools were selected. Data were collected through demographic, eating disorders and body image questionnaires. Data was analyzed using Central and distributional indices, T-test, one-way analysis of variance, linear and logistic regression. Total mean score of body image was 64.02%. The highest scores belonged to the upper part of body such as hair, ears, hands and chest. 6.3% of students had eating disorder, consisting of 1.7% anorexia nervosa, 1.7% bulimia nervosa and 2.9% eating disorder not otherwise specified. Comparison of body image score and type of eating disorders showed significant differences except for anorexia nervosa. Linear regression and logistic regression showed a two-directional relationship between eating disorder variables and body image score. Only BMI was predictive factor for probability of eating disorders [P=0.02]. The relationship between body image and eating disorder is two-directional. Therefore, observing the symptoms of one disorder suggests the probability of the presence of the other one. So educating people like parents and teachers and caregivers by community health nurse regarding nutritional problems can be effective in early diagnosing and identifying such disorders

[Relationship between nurse's knowledge and practice regarding the principles of nursing documentation among nurses affiliated to Kerman medical university hospitals]

Documentation is one of the most important practices in nursing. It sounds that nothing can reflect the total amount of nursing care giving patients as documentation does. Studies indicate that nurses spend on estimated 1/3 of total shift of activities. The aim of this study was to determine relationship between nurse's knowledge and practice regarding the principles of nursing documentation among nursing stuff affiliated to hospitals of Kerman medical university. Using descriptive- analytic study method, 226 nurses who were working in one of the four hospitals of Kerman medical university were selected through quota sampling. The data were collected through a researcher-made instrument that consisted of demographic characteristics, a questionnaire assessing their knowledge and a checklist for their practice. Descriptive and inferential static were used to analyze the data. All statistics were computed by SPSS software using Indices of central and dispersion and Kruscal Wallis, man-whiney u and spearman correlation coefficient. The study indicated that 46.5% of nurses had moderate knowledge and also 85% of nurses had poor practice. It was demonstrated that there is a significant difference between nurse's knowledge and practice regarding the principles of nursing documentation [P<0.001] with positive correlation coefficient. However the value [r=0.24] didn't show a strong relationship between them. It was also a significant difference between passing educational course of nursing documentation and nurse's knowledge [P<0.001]. The rest of demographic characteristics didn't have any significant difference with their knowledge and practice. The study revealed a weak relationship between knowledge and practice. Besides knowledge and applying it in practice, other contributor issues should be recognized and meet appropriately

Vulnerable household women's health assessment [VH-WHAT]: protocol design and implementation

The gender-based approach can identify women's health problems on the basis of biological differences and their social, familial and individual roles. Unequal power relationship between men and women, fewer chances of education and employment, repeated pregnancies, longer life-spans, a greater proportion of the world's poor, inappropriate familiarity with their health risks increase their need to better benefit from primary healthcare. As determinants of health, poverty and social class indicate that women and especially deprived women require a greater focus on their health. This study attempts to identify modifiable health risk factors of these individuals. The women-headed households under cover in 11 provincial centers were included in the study. Medical consultation, general physical examination, fasting blood sugar level, blood cell count, lipid profile and systematic examinations, specific examinations of breast, pelvis, mammography and Pap Smear were performed according to the protocol. As a pilot study, 2730 individuals were assessed and their demographic features were obtained. The mean age of participants in the pilot study was 47.6 +/- 10.2 years ranging from 22 to 88 years of age. We expect that the study's findings would provide the opportunity to compare the differences of the special subgroups of vulnerable women with the data available in the country, and if necessary implement changes suitable with the vulnerable groups' health status