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

Malaria status in economic cooperation countries; achievement and gaps toward United Nations Millennium Development Goals

Evaluating the malaria status of the Economic Cooperation Organization [ECO] member countries relation to goal 6 of 3rd Millennium Development Goals [MDGs] which includes have halted by 2015 and begun to reverse the incidence of malaria. By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases [2,428/100,000] in Afghanistan and 59,284 cases [881/100,000] in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of people due to poor environmental and socioeconomic conditions conducive to the spread of disease. The main malaria endemic areas of Iran are in southeastern part of the country; consist of less developed provinces that are bordered in the east by Afghanistan and Pakistan. There are little valid information about proportion of population in malaria-risk areas using effective malaria prevention and treatment measures indicators. All ECO countries could achieve MDGs malaria indicators by 2015 except Pakistan and Afghanistan, unless preparing urgent intervention programs to fulfill the goals

Housewives' obesity determinant factors in Iran; national survey - stepwise approach to surveillance

Women suffer more from obesity than men in Iran do. In this study, we compared obesity risk and its contributors regarding the job categories as housewives [HWs] or employees to deeply explore the risk of obesity in housewives in Iran. Based on WHO stepwise approach, in 2005, 33472 women aged 15 to 65 years old [excluding all men] were examined for the major risk factors for non-communicable diseases. Obesity was determined by Body Mass Index>30kgm[-2] in adults [>20 years] and by girl BMI percentiles according to WHO 2007 Growth Reference 5-19 years in adolescents. We modeled obesity by logistic regression and entered all the known/potential predictors, including job categories. The participation rate was more than 99%. The weighted prevalence of overweight and obesity in HWs were 34.5% and 24.5% respectively. Employed women were about 4% and 10% less overweight and obese than the HWs, respectively [P< 0.01]. HWs vs. employed women had the adjusted OR 1.39 [CI95%, 1.18-1.63] for obesity. Older women, with higher educational level and socioeconomic status, lower physical activities and those living in urban areas were at risk of obesity. In comparison to HWs, working as an Official Clerk [OR=0.66] associated with a decrease in odds of obesity significantly, while others did not. Being as HW is an independent significant factor for obesity in women. Preventive health care programs to reduce risk of obesity in women should be applied, considering their occupation for achieving more effectiveness

[Effective of electronic education on knowledge attitude and self-care in patient's diabetic type 2 refer to diabetic center of Kerman university of medical science]

Diabetes disease due to a long process, patient participation in the care of their demands. The increase of prevalence and side effects, shows that the traditional education done, not enough. Electronic education the possibility for patients to a new type of communication, care, education and patient as pivotal experience. This is a quasi-experimental design that with the goal of determining effect of electronic education of self care on type 2 diabetic patients refer to diabetic center of Kerman university of medical science in the year 1387 has been done. 170 type 2 diabetic patients with simple method of choosing a random and then the two groups and 84 and 86 patients in the control and intervention group were divided. For control group, rooting education and for intervention group electronic education for three months was trained. Before and after the intervention on research society, information related by questionnaire is collected and blood samples to fasting blood sugar and HbA1c measurements. The mean and Standard Deviation knowledge, attitude and practice of the intervention group before education 19.3 +/- 2.4, 21.4 +/- 3.9, 24.1 +/- 7.1 and after education 20.6 +/- 5.5, 22.8 +/- 6.9, 32.2 +/- 6.5, that was just in intervention group is significant difference [P<0.05]. The mean and Standard Deviation fasting blood sugar and HbA1c in the intervention group before education 223.8 +/- 77.2 mg/dl, 9.5 +/- 1.9 percent and after education 167.5 +/- 55.2 mg/dl, 8.4 +/- 1.6 percent, and only in the intervention group is significant difference [P<0.01]. Electronic education improve the self care of type 2 diabetic patients in the intervention group after education, That has caused improve the mean fasting blood sugar and HbA1c. According to the benefits of electronic education, using and planning of this method is recommended

prevalence of honorary and ghost authorships in Iranian biomedical journals and its associated factors

The purpose of this study was to detect the prevalence of ghost and honorary authors and its determinant factors in bio-medical journals of Iran. The study was done in 2009-10 in Tehran, Kerman, and Iran Medical Universities, Iran. We contacted the first or corresponding authors of the papers had published papers in the recent two issues of Iranian Journal of Public Health, Journal of Kerman University of Medical Sciences, and Tehran University Medical Journal. They explored the role of each coauthor and others who had done mouthing for the paper. Then, according to ICMJE criteria, we counted how many of them are real, honorary or ghost author. For the analysis, we utilized two databases. One included articles as the records and the other included authors as the records. From 124 articles, with 536 authors, 301 [56.1%] were honorary authors. Each article had 4.35 authors on average, while 2.4 of them were honorary authors. The percentage of honorary author in basic science articles was about 6% more than the articles of clinical sciences. Moreover, 89% of articles had at least one honorary author. About 20% of all articles had more than three honorary authors. Besides, 25 [21.43%] authors confessed they had colleague[s] omitted from the authors list, while only one [0.81%] of them met the authorship criteria. The percentage of agreement between the corresponding and the remaining authors on the number of honorary of the authors was about 47.4% [Kappa= 0.27, P= 0.01]. It seems that the present data might assist the authorities to make a decisive decision on amending the process of authorship in Iran

prevalence of obesity in Iran in recent decade: a systematic review and meta-analysis study

There is a great deal of descriptive studies on obesity in Iran, mostly assessed the prevalence and its relationship with various risk factors and chronic diseases. In order to obtain/give a better insight into the epidemiology of obesity in Iran in recent years and assess its heterogeneity around the country, we reviewed systematically all available studies and analyzed their findings using Meta-analysis. All published papers in Iranian and international journals, final reports of research projects, papers in relevant congresses, proceeding books and dissertations of students were reviewed. Those findings, which published between 1997 and 2007 and met eligible criteria, were entered in meta-analysis [Random Model]. Fifty eight eligible papers [out of 219] including 132864 individuals were entered into analysis. The overall prevalence of obesity for adults [>18 yrs] and children [<18 y] was 21.5% [CI95% 17.4-25.6] and 5.5% [CI95% 4.5-6.4], respectively. The prevalence of obesity in boys and girls [<18y] was 5.3% [CI95% 4.1-6.4] and 4.8% CI95%4.0-5.7], respectively. It increased in both adult men and women to 13.7% [CI 95% 10.9-16.7] and 27.3% [CI95% 21.3-33.4], respectively. Meta regression indicated that only age explained a considerable proportion of the observed heterogeneity among women. In overall, the risk of obesity was greater in women, but even in adults, the prevalence was less than that in developed countries. The percentage of obesity was increased by aging, especially in women. There were large variations in the reported prevalence of obesity in Iran; it is mainly because of the different in the distributions of age and sex among the subjects

[ concept of scholarship: educational scholarship and its application in Iran]

One of the notions entered in university fields in the last two decades is the concept of scholarship and especially educational scholarship. Due to the inclusion of this concept in the first article of faculty members' academic promotion bylaw and considering it as a mandatory component for academic promotion, great attention has been paid to this topic. Remarking the background and principles prevailing this almost new perspective, this short communication endeavors for developing a ground for familiarizing the readers with the concept of scholarship, especially educational scholarship, and its manner of evaluation. Moreover, a little note has been made about substructures needed for broadening scholarship activities in the field of education as well as the challenges before that

[Mapping of cutaneous leishmaniasis in Kerman city from 2002 to 2006 and its environmental risk factors by geographical information system]

Recent reports indicated an increase in cutaneous Leishmaniasis [CL] cases. We designed the study in the context of community assessment process to identify and address the major public health related issues by explore the risk map of CL and assessing the environmental risk factors in Kerman. All the registered CL in the only referral center for CL from 2002 to 2006, localized on Kerman digital map. The level of data dissemination was townships. Based on data from the national statistics organization, we determined the population and calculated the incidence of CL of each township. Secondly, the highest endemic townships were observed deeply with a specific checklist to determine the environmental risk factors. 771 cases were included. All the high endemic areas were located in the east part of Kerman. The eastern township, Sarasiyab, with 123 [15.9%] cases was the most infected region. The highest endemic townships were Sarasiyab, Emam and Sarbaz with 54.9, 52.8 and 51.2 cases per 10.000, respectively. Some minor endemic areas such as Shahab, Abouzar and Shahzadeh Mohammad [South and central regions] were going to be disappeared while Shariati, Naseriyeh-Seyedi [North and North-East regions] were the new high-risk townships [P<0.01]. The east and central part of Kerman, were always the high endemic regions. Some other new high-risk areas were also detected. The most environmental factors were the bare lands between the houses, ground passages and the timeworn architecture on the buildings

Using GIS in explaining spatial distribution of brucellosis in an endemic district in Iran

To check the feasibility of using geographical information system [GIS] methods, we linked the brucellosis data of human and animals. In a village-based ecological study in Bardsir- a district in Kerman Province located nearly to the central part of Iran- data of human brucellosis, socio-economic level, and livestock characteristics [2001-4] were linked by using GIS methods. Annual incidence of human brucellosis was 141.6 cases per 100,000 inhabitants. Most of the high risk villages were seen in the north and south of Bardsir [3.6% of villages]. A positive association was observed between the frequency of brucellosis and density of cattle [OR=1.81, P= 0.007]. In addition, the size of human population was an independent determinant factor [OR= 1.94, P< 0.001]. No association was found between frequency of the disease and socio-economic indicators and also the density of sheep. Our study showed that we could generate informative risk maps of brucellosis using health and veterinary data which might improve the quality of control programme in Iran

Familial aggregation of coronary heart disease risk factors in kerman province

There is no shortage of evidence linking coronary heart disease [CHD] to various genetic and environmental factors. Nonetheless, exploring the familial aggregation of major risk factors in the Iranian population could add valuable information to the existing body of knowledge. We received data on 656 families [1614 individuals] from the Provincial Health Authority in Kerman. The data had been originally collected in a nationwide non-communicable disease control project, under the auspices of the Health Ministry's Public Health Department. In this study, we divided subjects into high- and low-risk groups based on the 75 [th] percentiles of risk factor levels. Using a random-effect Poisson regression model, we looked at the association between risk factors within families. In all models, the risk ratios [RR] were adjusted for the age gap between parents and children. Excessive weight in children showed a stronger association with overweight in the father than with the same problem in the mother [RR: 2.35 versus 1.59]. Risk of high blood pressure in the father was significantly related to the risk in the mother and the child. The risk of high blood glucose showed a significant association only between parents. Similarly, hypercholesterolemia did not show a significant association between parents and children, but its RR in parent-parent associations was around 2. We did not find any significant familial aggregation for smoking. However, physical exercise in mothers doubled the rate of exercise in other family members. Although our sample size was relatively small, we found stronger associations within parent couples than between parents and children. This implies that common lifestyle may be a more prominent factor than genetic make-up

[Estimating the time trend of adjusted incidence of opioid dependency and multiple factors related to the lag time: backward calculation method]

For evidence based decision-making and designing more accurate health system planes for effective prevention on drug dependency, incidence rate and time trend of number of new cases are necessary. This survey was conducted based on data of Kerman drug detoxification agencies in order to determine the time trend of incidence rate of opioid dependency and the effects of various factors on lag time [the time between onset of substance use and first treatment request]. In this retrospective cohort study, 4309 opioid users visiting Kerman Welfare Organization between 1997 and 2004 were analyzed. Subgroups were shaped according to the first year of consumption. Estimated incidence of addiction was determined by using backward calculation method. The Effect of various factors on lag time was calculated by multivariable regression method. Relative incidence of addiction between 1997 and 1999 was increased by 70% annually, followed by a slightly decrease to 540 persons in 2000. The minimum estimated number was seen in 2003 [400 cases] and it peaked to the maximum in the next year [1145 cases]. The average of lag time was 7.98 +/- 6.47 years with median 6 years. The lag time of opium users was 7.81 +/- 6.48 and for opium syrup - a liquid prepared from the ashes of smoked opium - users was 8.32 +/- 6.17 years [p=0.001]. Individuals who have consumed both opium and opium syrup simultaneously, had a more lag [p=0.0001]. Men with lag time of 8.1 +/- 6.41 years, had a significant longer lag time than women [7.05 +/- 6.78 years].In compare with cases with 20-30 ages [7.86 +/- 6.38 years] and cases older than 30 years [7.7 +/- 6.44 years], the lag time for persons less than 20 years old [8.62 +/- 6.68 years] was significantly more [p=0.0001]. The lag time for illiterates [10.73 +/- 7.59 years] was more than cases with academic education [7.87 +/- 7.27 years]. The lag time for married persons [8.87 +/- 6.8 years] was significantly more than singles [4.9 +/- 3.76 years]. Time trend of addiction can be divided into two parts in recent years. First part is from 1997 to 1999; in this period the number of new cases of addiction increased but from 2000 to 2002 it is fairly constant. Some factors such as being women, younger, more literate, single and simply opium users have a negative correlation with lag time

Establishment of new evaluation and accreditation system for graduate medical education in Iran

Graduate Medical Education is one of the stage of the continuum of medical education in Iran. At present, near 5500 residents are being trained in 24 specialties and 21 subspecialties in 26 Universities of Medical Sciences. Based on a special Act of National Parliament in 1973, the Iranian Council for Graduate Medical Education is responsible for supervision on the quality of Graduate Medical Education. Despite significant activities in this field during last three decades, there has been no integrated effort for evaluation and accreditation of specialty education units, yet. In this regard, the Secretary of the Council appointed a committee for preliminary studies and presentation of new approaches. In this article, the authors first describe the details of the activities of this committee. Thereafter, challenges of Graduate Medical Education and relevant supervisory bodies have been discussed. In the end, activities for the establishment of new accreditation system of Graduate Medical Education in Iran have been described