[Entomological research and its specific course in Iran from 1935 to 2008]

Malaria remains an important vector-borne disease globally and is a threat for human life. Forty percent of the world's populations who are living in low-income countries are at risk of malaria. The disease exists in Iran and caused economic and social damages. As result of malaria control program that has been done during the past years, the disease is eliminated from the most parts of the country, so that it is only reporting from a small part in these years. During this study, all available papers, books and thesises were reviewed and articles from Iranmedex, DIS and PubMed databanks were also used. Furthermore the related reports from different sources were noted. The extensive studies have important information about malaria vectors. In this study the data about malaria vectors and related training courses are listed. During this study the related papers, Books and thesises which have been reviewed. Although efforts, surveillance system, diagnostic and treatment facilities, as well as knowledge and attitude of peoples regarding to health behavior are improved nowadays, there are significant improvements about decreasing the malaria cases. Risk of the disease exists because of population exchange and asymptomatic cases. The malaria can be studied with both public health and economical aspects. This paper represents entomological studies of malaria during 1935 by the end of 2008. our study revealed that, based on recent malaria national program, the authorities should make an emphasis on vector control monitoring, resistance management, malaria evaluation and because of weak supervision on all malaria operation at stage of elimination of malaria, accurate and careful suppersional require to reach the objective and goal of elimination

[Determinants of fruit and vegetable consumption among People in the Age Range of 18-70 Years in Arak, Iran]

High fruit and vegetable intake has been introduced as one of the key factors of healthy diet to prevent chronic disease. This study attempts to explore the fruit and vegetable intake in Arak city and its relationship with demography and socio-economic factors. In this cross sectional study, 660 people in 18 -70 age range were selected with a two-stage cluster sampling and were interviewed for demography and socio -economic questionnaires and a 56- items semi-quantitative food frequency questionnaire to assess fruit and vegetable intake. After univariate analysis, the association of the significant variables with fruit and vegetable intake was also evaluated with multiple linear regression. In this study, over 60 percent of subjects consumed less than the minimum recommended amount of fruit and vegetable [5 servings or 400 gr a day].The total consumption of fruit and vegetable indicated an inverse significant relationship with age [p =0.04 and beta = 0.02], and a direct significant relationship with economic status [p<0.001 and beta =0.10]. The father's educational level [beta=-0.005 and beta =0.38 for diploma level and beta =0.03 and beta=0.36 for academic education] and physical activity level [p =0.001 and beta -0.03 per hour] were factors associated with fruit consumption. The gender was only associated with vegetable consumption so that women had higher consumption in this study [p=0.03 and beta=0.23]. The findings of this study indicate low fruit and vegetable consumption in the population under study. In this study, age, physical activity, and socioeconomic status and fathers' education were the factors that were significantly associated with fruit and vegetable consumption

Residential segregation and infant mortality: a multilevel study using Iranian census data

There is a great amount of literature concerning the effect of racial segregation on health outcomes but few papers have discussed the effect of segregation on the basis of social, demographic and economic characteristics on health. We estimated the independent effect of segregation of determinants of socioeconomic status on infant mortality in Iranian population. For measuring segregation, we used generalized dissimilarity index for two group and multi group nominal variables and ordinal information theory index for ordinal variables. Sample data was obtained from Iranian latest national census and multilevel modeling with individual variables at level one and segregation indices measured at province level for socioeconomic status variables at level two were used to assess the effect of segregation on infant mortality. Among individual factors, mother activity was a risk factor for infant mortality. Segregated provinces in regard to size of the house, ownership of a house and motorcycle, number of literate individual in the family and use of natural gas for cooking and heating had higher infant mortality. Segregation indices measured for education level, migration history, activity, marital status and existence of bathroom were negatively associated with infant mortality. Segregation of different contextual characteristics of neighborhood had different effects on health outcomes. Studying segregation of social, economic, and demographic factors, especially in communities, which are racially homogenous, might reveal new insights into dissimilarities in health

[Factors affecting time to pregnancy, Kermanshah, Iran, 2011]

The time needed to achieve a wanted pregnancy is referred to as time to pregnancy [TTP]. Due to differences in lifestyles and geographical locations in different countries, factors affecting TTP may be different in various countries. This study was conducted in 2011 to determine factors affecting time to TTP in Kermanshah, Iran. In this case-control study 174 women with TTP>12 months [cases] and 587 women with TTP/= high school diploma; OR=0.854, CI 95%=0.741-0.984], frequency of intercourse in a week [OR=0.728, CI95%=0.631-0.839], blood group A compared to O [OR=0.639, CI95%=0.405-1.01], and non-exposure to smoking [OR=0.606, CI95%=0.380-0.965]. On the other hand, factors increasing TPP were a woman's irregular menstrual cycle [OR=3.701, CI95%=2.127-6.441], lack of physical activity [OR=1.920, CI95%=1.263-2.918] and a body mass index [BMI] higher than 25 [OR=2.221, CI 95%=1.489-3.312]. According to the results of this study, a high BMI and lack of exercise increase, while factors such as frequency of intercourse decrease the length of TTP. Couples seeking medical intervention for pregnancy often disregard factors associated with TTP. It is recommended that care-providers support these couples, promote their awareness, and give them suitable advice

Multiple imputation to deal with missing clinical data in rheumatologic surveys: an application in the WHO-ILAR COPCORD study in Iran

The aim of the article is demonstrating an application of multiple imputation [MI] for handling missing clinical data in the setting of rheumatologic surveys using data derived from 10291 people participating in the first phase of the Community Oriented Program for Control of Rheumatic Disorders [COPCORD] in Iran. Five data subsets were produced from the original data set. Certain demographics were selected as complete variables. In each subset, we created a univariate pattern of missingness for knee osteoarthritis status as the outcome variable [disease] using different mechanisms and percentages. The crude disease proportion and its standard error were estimated sgscrately for each complete data set to be used as true [baseline] values for percent bias calculation. The parameters of interest were also estimated for each incomplete data subset using two approaches to deal with missing data including complete case analysis [CCA] and MI with various imputation numbers. The two approaches were compared using appropriate analysis of variance. With CCA, percent bias associated with missing data was 8.67 [95% CI: 7.81-9.53] for the proportion and 13.67 [95% CI: 12.60-14.74] for the standard error. However, they were 6.42 [95% CI: 5.56-7.29] and 10.04 [95% CI: 8.97-11.11], respectively using the MI method [M=15]. Percent bias in estimating disease proportion and its standard error was significantly lower in missing data analysis using MI compared with CCA [P< 0.05]. To estimate the prevalence of rheumatic disorders such as knee osteoarthritis, applying MI using available demographics is superior to CCA

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

Community assessment of shahin-shar, isfahan, i. R. Iran to develop community health action plan

Community assessment process is the foundation for developing the basis for effective community health strategies. The aim of this study was providing a framework for comprehensive and participatory community assessment in Shahin-Shar, Isfahan, Iran. This assessment performed in Shahin Shar city based on some experiences of Community Medicine and Epidemiology and Biostatistics departments of Tehran University of medical sciences since 1989 and North Carolina Community Assessment Guide Book [2002]. The community assessment team included wide ranges of key stakeholders and local people. Our community assessment team has three levels of participants: An advisory group, a work group and a project facilitator. Observation, interview, focus group discussion and summary list of health resources used for data collection. The map of asset was also provided. We reported data to community and Hanlon method -based on magnitude of the problem, seriousness of the consequences and feasibility of correcting- was used for selecting health priorities. Drug abuse, smoking among adults and depression were the important health priorities. After creating community assessment document, Based on the risk factors that contribute to each problem, the health action plans were developed. The results of this study showed that community assessment could be the foundation for improving and promoting the health of community members. It could be the basis for effective community health strategies in Iran

Deaths and injuries due to the earthquake in 2010 damghan's earthquake: a case study

Earthquakes cause thousands of deaths and injuries worldwide every year. Islamic Republic of Iran has a deadly history of earthquakes. The aim of this study is to describe injuries rate, causes of injuries, structural characteristics of buildings and occupant actions immediately after earthquake in Damghan in 2010. This case-study was conducted one week after occurring the earthquake in five villages of Damghan city in Iran. We used the Physical Injuries Assessment Questionnaire which was particularly designed for injuries after earthquakes. Also for acquiring information about region and amount of losses, some interviews was conduct with local authorities. Four death and fifty six injuries occurred in five villages of Damghan city. There were three types of injuries including superficial injuries [50%], contusions [35%] and fractures [10%]. The findings of this study indicating building structural failure [87.4%], nonstructural factors [7.1%] and trapping [5.3%] seems the most possible cause of injuries in this region. This study showed that the building structural failure is the main cause of injuries [87.4%]. Increasing structural resistance of building especially in village regions and education about earthquake preparedness should encourage in order decreasing the total number of people affected by earthquake

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

Iranian Azeri's Y-chromosomal diversity in the context of turkish-speaking populations of the Middle East

The main goal of this study was to conduct a comparative population genetic study of Turkish speaking Iranian Azeries as being the biggest ethno-linguistic community, based on the polymorph markers on Y chromosome. One hundred Turkish-speaking Azeri males from north-west Iran [Tabriz, 2008-2009] were selected based on living 3 generations paternally in the same region and not having any relationship with each other. Samples were collected by mouth swabs, DNA extracted and multiplex PCR done, then 12 Single Nucleotide Polymorphisms [SNPs] and 6 Microsatellites [MS] were sequenced. Obtained data were statistically analyzed by Arlequin software. SNPs and Microsatellites typing were compared with neighboring Turkish-speaking populations [from Turkey and Azerbaijan] and Turkmens representing a possible source group who imposed the Turkish language during 11-15[th] centuries AD. Azeris demonstrated high level of gene diversity compatible with patterns registered in the neighboring Turkish-speaking populations, whereas the Turkmens displayed significantly lower level of genetic variation. This rate of genetic affiliation depends primarily on the geographic proximity. The imposition of Turkish language to this region was realized predominantly by the process of elite dominance, i.e. by the limited number of invaders who left only weak patrilineal genetic trace in modern populations of the region

[Associations of red blood corpuscle mean volume and hematocrit with severity of beta-globin gene mutations in beta-thalassemia carriers]

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. In this cross-sectional study, 30 beta-goblin gene mutations [beta[+] and beta°] 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. The results indicated that beta[+]-thalassemia carriers had higher MCV and MCH means than beta°-thalassemia carriers. These findings would certainly have practical implications in public health. The results show a significant correlation between two hematological indices and certain types of mutations in beta-thalassemia carriers

[Comparison of nested case-control and cohort analysis methodologies using a district TB registry data]

The nested case-control study has become popular as an efficient alternative to the full-cohort design. This study compares the results of a nested case-control analysis approach with the full cohort analysis. A cohort of 276 subjects [new cases from a TB registry] was used for this study. Cox Regression model was used for the full cohort analysis. In order to do the nested case-control analysis, for each death, three random controls were selected from those who did not suffer from the outcome at the time of the outcome took place. Case control data was analyzed by the conditional logistic regression model. Results from both cohort and nested case-control analyses show that treatment group is the only variable that affects on the outcome. Gender, place of residence, and age has no effect on the outcome. For binary exposure variables with trivial effects [e.g. Gender and place of residence], the relative efficiency of nested case-control study design is approximately 75%. Results of this study show that nested case-control study is not only an easy and cost-effective method for data analysis but also is as robust as cohort analysis in rate ratio and its variance estimation

[Spatial distribution of congenital hypothyroidism in Iran using geographic information system]

The aim of this study was to assess the geographical distribution of Congenital Hypothyroidism [CH] in Iran using Geographic Information System. The incidence of Congenital Hypothyroidism in each city and province calculated based on national CH screening program and then the map of its distribution was depicted. The spatial distribution of CH was assessed in each city by employing binominal test and Hotspot Analysis. The map of distribution of CH was drawn by ArcGIS version 9.2 software. The national incidence of CH [including both transient and permanent types] has been estimated 2.2/1000 in screened new borne babies. The distribution of CH seems more or less equally around the country and its spatial variation was not statistically significant. We did not find any specific CH Hot Spot in Iran. We did not find any particular explanation for high incidence of CH is Iran geographically; therefore other explanations for such a high risk in screened neonates should be investigated including the non-environmental factors and factors related to quality of screening program in Iran

[Quality assessment of the reporting of cohort studies before STROBE statement]

Observational studies are not often reported in detail and clear enough, so that assessment of the strengths and weaknesses of these studies is not straightforward. To improve the reporting of observational studies, a checklist of items called 'Strengthening the Reporting of Observational Studies in Epidemiology' [STROBE] was developed by some experts in October 2007. The aim of this study was to assess the quality of reporting of observational studies before STROBE statement. We included randomly sixty cohort studies published in six important international journals until October 2007. Then, we used STROBE checklist to assess the strengths and weaknesses of these included studies. On average, more than 81% [95% Cl: 77%-87%] of included studies pointed to 43 items of aim of this study. The most reported [100%] items were "scientific background" and "rationale for the investigation" and the less reported [30%] item was "flow chart". Although, the quality of reported cohort studies' results was acceptable, the type of study, journal and date of publication could influence on the quality of observational studies

Neonatal mortality risk factors in a rural part of Iran: a nested case-control study

Due to complex causal framework of neonatal mortality, improvement of this health indicator is quite gradual and it's decreasing trend is not as great as other health indicators such as infant and under 5 mortality rates.This study was conducted to evaluate neonatal mortality risk factors based on nested case-control design. The study population was 6900 neonates who were born in rural areas of Kohgiluyeh and Boyerahmad province [South of Iran]. They were under follow up till the end of neonatal period and the outcome of interest was neonatal death. By using risk set sampling method, 97 cases and 97 controls were selected in study cohort. Prematurity [OR = 5.57], LBW [OR= 7.68], C-section [OR = 7.27], birth rank more than 3 [OR = 6.95] and birth spacing less than 24 months [OR = 4.65] showed significant statistical association [P < 0.05] with neonatal mortality. The Population Attributable Fraction [PAF] was 0.45 for LBW, 0.40 for prematurity, 0.28 for C-section, 0.30 for birth rank more than 3, and 0.16 for birth spacing less than 24 months. Prematurity, low birth weight, C-section, birth spacing less than 24 months and birth rank more than 3 are important risk factors for neonatal mortality

[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

Nuclear ribosomal DNA ITS-2 sequence characterization of Fasciola Hepatica and Galba truncatula

Human fascioliasis is an important health problem in the province of Gilan, at the Caspian Sea, Iran. There is the overlapping of both fasciolid species, Fasciola hepatica and F. gigantica. Recent studies on both domestic animal and lymnaeid infection furnished evidence suggesting that F. gigantica and Radix gedrosiana may be the main fasciolid and lymnaeid involved in the disease in that province, controversy still being there concerning the presence and importance of F. hepatica and other lymnaeid species. The present paper includes the results of studies on Galba truncatula and the first finding of natural infection by F. hepatica in Gilan proved by molecular studies. Snail collections were carried out in summer, when their populations present the highest densities. Surveys on lymnaeids furnished the finding of a lymnaeid snail infected by trematode rediae and cercariae in the mountains of Talesh, in the Asalem district, western Gilan. Nuclear ribosomal DNA ITS-2 sequences proved that they were F. hepatica and G. truncatula. The liver fluke ITS-2 sequence was identical to that of F. hepatica from Spain and the Northern Bolivian Altiplano and that of G. truncatula to the haplotype H-2 known in Portugal, Spain, France and The Netherlands. This genetic characterization suggests that both may be also involved in human fascioliasis infection in Gilan

Trends in nested case- control studies as compared to case- control and cohort designs, 1996- 2005

This investigation was prompted by the growing importance of nested case-control studies and the increasing frequency with which they are done in epidemiologic research. After a brief explanation of nested case-control studies, we evaluate the trends in research methodology over the last decade, especially with regard to cohort, case-control, and nested case-control designs. Data for this study were extracted from the PubMed database, using these keywords: Nested Case-Control, Risk-Set Sampling and Density Sampling. The search was confined to the 10-year period from 1996 to the end of 2005. As for other methodologies, we used keywords Cohort and Case-Control for a search over the same time period. The search itself was performed on April 25, 2006. We found 201 1 articles reporting nested case-control studies. There were 95 such articles in 1996; the number had increased to 289 in 2005. Case-control and cohort designs accounted for 68456 and 60479 articles, respectively. The number of case-control articles rose from 4378 in 1996 to 10270 in 2005, while that of cohort articles increased from 2981 to 9771 over the same period. The number of cohort and nested case-control articles followed similar upward trends over the last decade and their rate of increase was greater than that of simple case-control articles

Risk factors for road traffic injuries on Qazvin-Loshan road, 2005

Considering the lack of adequate basic information on risk factors for road traffic injuries in Iran, a study was conducted to determine the association between potential risk factors and the incidence of injuries in motor vehicle drivers. We performed a population-based case-control study on Qazvin-Loshan road. Risk factors related to injury incidence were compared between 175 cases and 175 controls. Cases were drivers recently injured in road accidents. Controls did not have any injury and were selected systematically while the study was being conducted. Injury was defined as trauma needing medical or surgical treatment. Information was obtained through police reports and interviews with cases and controls. Data were analyzed by two methods; bivariate analysis [crude] and by a multivariate unconditional logistic regression model. In bivariate analysis, risk factors for road traffic injuries risk were failure to wear seat belts or protective helmets, ejection from vehicle, severity of collision, number of crashes, motorcycle vs. other motor vehicle accidents, fire, rain and fog, and collision with fixed objects. In the logistic model, factors such as seat belt or helmet use with OR- 0.619 [0.376-1.018], ejection from the vehicle with OR= 2.952 [1.235-7.056], severe collision with OR= 5.413 [2.865-10.224], motorcycle vs. other motor vehicle accident with OR= 3.164 [1.05-9.537] and raining and fog vs. good weather with OR- 4.562 [1.663-12.514] were found to influence injury incidence. There was an interaction between severity of collision and weather status. Better speed control, use of seat belts or helmets, not using motorcycles for road travel and equipping vehicles with fire extinguishing capsules are recommended to reduce road accident injuries

[Experience of a population- based study on needs and health status of affected people in Bam earth Quake]

On 26 December 2003, an earthquake measuring 6.5 on the Richter scale struck the city of Bam and the surrounding villages. This study was conducted to determine the needs of the affected population on the 19[th] and 20[th] days after the quake to help with the prioritization of relief activities and efficient resource allocation. Following a feasibility study on 10 Jan 2004, a team consisting of volunteer students of School of Public Health at KUMS was assembled and trained. Each of the 8 groups consisted of 3-4 students with at least 1 man responsible for security on the field. On the 13th and 14[th] of January, using a cross-sectional design, 60 clusters including 420 households, 7 households in each cluster, were studied based on a Cluster Geographic-Based Sampling [GBS] Plan. Fifty-five households [13.1%] had children < 2 years, 81 [19.3%] had children aged 2-5 years and 68 [16.2%] contained people more than 65 years old. Thirty-seven households [8.9%, CI 95%: 6.4-11.7%] had changed their residence in Bam from one zone to another; the main reason for this was poor environmental health conditions [85%]. The main source of health and social messages for families was word of mouth 284 [67.6%]. The most commonly needed items were bathrooms [73.8%, CI 95%: 68.9-78.7%], food [68.8%, CI 95%: 62.6-75.0%] and warm clothes [67.4%, CI 95%: 60.9-73.8%]. The most frequent illness was acute respiratory infection [59.8%, CI 95%: 54.3-65.2%]. Two hundred households [47.6%, CI 95%: 42.6-52.6%] complained of difficulties in obtaining health and medical services. The main barrier to access was transportation problems due to long distance [38.1%, CI 95%: 35.6-40.6%]. We conclude that relief operations should be continued to provide basic public health facilities. Active delivery of health and medical services should be strengthened, and problems related to reproductive health should not be ignored. The GBS plan is a useful tool in the post-disaster surveys. Using volunteer university students was a rewarding experience and teaching and application of [Disaster Epidemiology] should be improved in this country