23-year analysis of dependency ratio in rural population in Fars province during 1990 - 2012: a trend analysis study

Background: The dependency ratio [DR] is defined as the ratio of the non-working population to the economically active population. Dependency ratio is calculated by the sum of population under fifteen years and over 65 years divided by 15-64 year old population. The interpretation of DR variation gives us the impact of health care services and some reproductive interventions. This study analyzed a 23-year DR trend in rural population of Fars province and the effect of some fertility variables on it

Methods: In this study, using data from vital horoscope and regression analysis, we analyzed a 23-year period of DR and some fertility indicators

Results: The total DR significantly declined from 102.5% in 1990 to 41.4% in 2012 [P<0.001]. Most of this reduction is attributed to reduction in young DR. Old dependency ratio [population of 65 years and more] was significantly growing [P<0.035]. Number of rural health house, family planning coverage, total fertility rate and general fertility rate was significantly associated with total dependency ratio [P<0.009]

Conclusion: We passed the first stage of demographic transition, i.e. young dependency ratio declining. But the old dependency ratio slowly increased; it is recommended that the health care services should be promoted in future, especially services for old age people

Unmet need for prevention of unwanted pregnancy in Shiraz

Background: Prevention of unwanted pregnancy is a key strategy to improve the women's health through spacing of birth and avoiding pregnancy at high-risk maternal ages. Unmet need by definition is the percentage of fecund married women who are not using contraceptives while they do not want to get pregnant. They do this due to unavailable quality services, limited choice of methods, lack of information, safety concerns or side-effects and partner disapproval. The present study aimed to assess the magnitude of unmet need for prevention of unwanted pregnancy in Shiraz

Methods: In this descriptive cross-sectional study, 2000 married women of childbearing age [10-49 years] were selected randomly in a survey in Shiraz. Data collection was done using a researcher-made questionnaire and the results were reported using descriptive statistical methods

Results: In the present study, 85.6% of the women used a contraceptive method. 58.7% of them used modern methods of contraception. Reported reasons for not using contraceptives included recent delivery [25%], intention to have more children [20.6%], lack of awareness about contraceptive methods or where such services were offered [6.3%] and irregular sexual intercourse with husband [4.5%]. Interrupted intercourse ranked the highest among the methods used. Finally, the unmet need for prevention of unwanted pregnancy in this study was reported to be 4.3 percent

Conclusion: Women in Shiraz had a relatively lower level of unmet need. Counseling is recommended for higher risk women with unmet need in order to keep the descending trend of unmet need for prevention of unwanted pregnancy in Shiraz

Measles outbreak in south of Iran, where vaccine coverage was high: a case-series study

Measles is a highly contagious viral disease that remains an important cause of mortality among children despite the availability of a safe and effective vaccine around the world. We aimed this study to show a measles out-break occurring. In early 2012, a report of measles outbreak was recorded on center for disease control [CDC] of Fars province, south of Iran. With this case-series study, characteristics of cases and network transition model were described. The primary case was an Afghan refugee who is likely to carry the measles virus from its country or from anywhere in Iran to Koordeh, a small village in south of Iran. Followed by the Afghan case, 6 secondary and tertiary cases including rural health worker, were occurred. Except a case of 35 year old, in which her vaccination status was unknown, all cases has had adherence to vaccination protocol. More immunologic and vaccine quality investigations are needed to find the main cause of the outbreak. Nonetheless, due to the warm weather, probable bad temperature management of cold chain and technical problem in vaccination are the main suspicious reasons of the outbreak

Islet amyloid polypeptide is not a target antigen for CD8+ T-cells in type 2 diabetes

Type 2 diabetes [T2D] is a chronic metabolic disorder in which beta-cells are destroyed. The islet amyloid polypeptide [IAPP] produced by beta-cells has been reported to influence beta-cell destruction. To evaluate if IAPP can act as an autoantigen and therefore, to see if CD8+ T-cells specific for this protein might be present in T2D patients. Peripheral blood mononuclear cells [PBMC] were obtained from human leukocyte antigen [HLA]-A2+ T2D patients and non-diabetic healthy subjects. Cells were then screened for peptide recognition using ELISPOT assay for the presence of IFN-gamma producing CD8+ T-cells against two HLA Class I-restricted epitopes derived from IAPP [IAPP5-13 and IAPP9-17] and common viral antigenic minimal epitopes Flu MP 58-66, CMV495-503, EBV280-288 and HIV77-85 as controls. A total of 36.4% of patients and 56.2% of healthy subjects showed a response against IAPP5-13 peptide. No significant difference in response against this peptide was noted between the patients and the healthy donors. With respect to peptide IAPP9-17, although healthy subjects showed a higher mean number of spot forming cells than the patients, the difference was not significant; 36.4% of patients and 37.5% of controls responded to this peptide. The response of healthy subjects to the common viral peptides was stronger than that of the patients, though the result was not significant. It is unlikely that IAPP would be a target for CD8+ T-cells in diabetic patients; however, the trend observed toward a lower response of T2D patients against IAPP and common viral peptides may imply a decreased immune response in these patients

Iodine deficiency disorders in the South of Iran during 1989-2012: a surveillance system report

Background: Iodine deficiency disorders [IDD] have been recognized as a major public health problem worldwide. Consequences of IDD include goiter, hypothyroidism, and intellectual disability followed by retarded growth and development of the brain. This report aimed to determine the state of IDD in Fars province, south of Iran

Methods: In this study, we gathered data from all scientific papers, published and unpublished reports of IDD surveillance system, results of IDD-related surveys and all data from the center for disease control [CDC] at provincial and national levels during 1989-2012. Five main IDD indices are summarized, interpreted, and then organized in graphs and tables

Resuits: After formation of national committee of IDD followed by launching of extensive iodine delivery, most of IDD indices have improved. The percentage of iodized salt intake has increased from 0 to near 100%, and that of salt with adequate amount of iodine has increased to 94.5%. Median of urinary iodine concentration [UIC] has always been higher than the acceptable value [>/=100 microg/L] and 68% of people had a mean of UIC >/=100 microg/L. The percentage of TSH [Thyroid-Stimulating Hormone] >5 mU/L in the screened newborns has persistently been less than 1% during 2005-11. Prevalence of goiter has declined from 68% in 1989 to 1.3% in 2007

Conclusion: Present findings address those efforts to combat iodine deficiency which were effective. According to the small sample size and also the fact that some data have been derived at the national level, we recommend that a comprehensive population-based survey should be carried out with sufficient sample size to achieve information with high accuracy and precision

[20 - Year period [1990-2009] of infant mortality Rate in rural area of Fars province south lran: a time-series study]

Reforming and providing primary health care services in the past two decades had a wonderful impact on health indicators, particularly in rural communities. Infant Mortality Rate [IMR] always regarded as an important indicator of health system. This study conducted to show the twenty-year IMR tend and its relationship with some of socio-economic indicators in Fars province, south of lran, during 1990 -2009. In this time-series study, using ecological data from vital horoscope and also regression model, we showed trend of IMR and also affecting some health and non-health indicators on twenty-year IMR trend. P value under 0.05 was considered as significant level. During this 20-years period IMR had a downward trend from 31.5 to 16.2 in 1000 live births [p<0.001]. There is a significant relation [p<0.05] exist between IMR and predictive variables such as Gross Domestic Product [GDP], literacy of women above 15 and rate of deliveries in hospital, and IMR. Decreasing and improving IMR during the past two- decades period showed that the government health policy and investment had achieved a successful result. However, with promotion and renewing primary health cares, we can improve IMR and other health indicators than before.

H1N1 influenza infection complicated with diabetic ketoacidosis

The 2009 H1N1 Influenza virus was the first infectious pandemic of the 21[st] century which spread rapidly throughout the world. High-risk groups, such as diabetics, suffered more and showed higher hospital admission and death rates due to this virus. Patients with diabetes mellitus [DM] may develop the fulminant picture of their disease after being infected with influenza. From June to December 2009 at Nemazee Hospital, affiliated with Shiraz University of Medical Sciences, two patients with diabetic ketoacidosis [DKA] were admitted. The H1N1 influenza virus triggered DKA and its complications in these patients. Both patients were female, of ages 16 and 40 years. When admitted, they had signs of influenza-like illness [ILI], tachypnea, laboratory confirmation of acidosis, and high blood sugar levels. The 2009 H1N1 influenza viral RNAwas detected in their nasopharyngeal specimens by real time polymerase chain reaction [RT-PCR]. Both patients received oseltamivir, but eventually both died. This was the first report of an association between DKA and H1N1 influenza in Iran. Conclusively, rapid diagnosis of influenza by RT-PCR and early treatment with oseltamivir should be considered in diabetics and/or DKA patients with flu-like symptoms

prevalence of high blood pressure and its relationship with anthropometric indicators; a population based study in pars province, IR Iran

The burden of non-communicable diseases is rising globally. The present study was carried out to examine the relationship between different anthropometric indices and blood pressure in the Iranian population. A cross-sectional descriptive study was conducted on 3916 subjects including 1976 males and 1940 females, aged 15-64 years from a healthy population in Shiraz, IR Iran. Anthropometric variables of each person including weight, height, waist circumference [WC], waist to height ratio [WHR] and body mass index [BMI] were calculated along with measuring systolic and diastolic blood pressures [BP]. The relationship between blood pressure and different anthropometric variables was determined in both genders. The mean +/- SD systolic blood pressures were 123.9 +/- 20.0 and 121.2 +/- 17.7 mmHg while the mean diastolic blood pressures were 78.3 +/- 11.9 and 77.4 +/- 12.9 mmHg in men and women respectively [P<0.001]. The prevalence of hypertension in men [23.8%] was significantly more than that of women [21.1%]. Mean systolic and diastolic blood pressures increased with age and BMI in both genders. Anthropometric indices showed a positive association with systolic and diastolic blood pressures. The BMI and WC showed a strong association with systolic and diastolic blood pressure. The suggested lower cut-off values of the anthropometric indicators will cover maximum of the population with higher odds of having hypertension and may help reduce the levels of populations mean blood pressure

Serologic evidence of pertussis infection in vaccinated Iranian children

It seems that the incidence of pertussis-like illnesses is considerably increasing despite the wide coverage of immunization with the whole cell pertussis vaccine. We aimed to investigate the occurrence of pertussis in vaccinated children by measuring anti-pertussis antibodies. In this cross-sectional study, blood samples were taken from vaccinated children aged 2, 4, 6, 12, 18, and 72 months. Anti-pertussis IgG and IgA were measured by ELISA. P < 0.05 was considered significant. 725 children were enrolled in the study. Geometric mean titers for IgG that showed a slight decease after 2 months of age and increased distinctly in children aged 72 months. The frequency of the individuals whose IgG was above the determined cut-off [derived from mean+2SD] was observed in 1% of the 2, 4, and 6-month-old infants, 6% of the 12 and 18-month-olds and 12% of the 6-year -old children. Positive IgA titers were detected in 5, 9, 6, 23, 11, and 8% of children aged 2, 4, 6, 12, 18, and 72 months, respectively. Since a considerable percentage of children had high levels of anti-pertussis IgG antibodies [>/=2 SD], positive anti-pertussis IgA, and most importantly an increased level of anti-pertussis IgG geometric mean titer at 6 years of age, further investigations regarding the protection provided by the presently used pertussis vaccine seems necessary

neurological manifestations of H1N1 influenza infection; diagnostic challenges and recommendations

World Health Organization declared pandemic phase of human infection with novel influenza A [H1N1] in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection. The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of Shiraz, Iran from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay. Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillan-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy. The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1 influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms

[Childhood cancer epidemiology based on cancer registry's data of Fars province of Iran]

Childhood cancers are very rare diseases and accounting for about one percent of all cancers, also it is one of the main causes of death among children. The aim of this paper was to ascertain of childhood cancers epidemiology in Fars province. In this epidemiological study that Fars province cancer registry was used, frequency distribution of childhood cancers in less than 19 year old in 2001up to 2008 was evaluated and incidence rates were calculated per 1000,000 people a year. Data were analyzed by running SPSS software, version 16 [SPSS Inc., Chicago, IL] and M.S. Excel version 2007. Out of 1610 registered new cancer cases that were resident of Fars province, blood cell cancers were most common type of cancers. 57% of cases were male and 15-18 year old age group in comparison to other groups has been the most frequent [30.7%]. The mean age of cases at diagnose time was 10.3 years old. Over in eight years period, lowest and highest age standardized incidence rate was 64 [year 2001] and 235 [year 2006] cases per every one million person, respectively. Based on this paper's results, and despite of our prospect, childhood cancer incidence rate in less than 19 year age in Fars province was similar to developed countries

Comparison of community and healthcare-associated MRSA in Iran

To characterize and compare the epidemiological and microbiological aspects of community and healthcare-associated MRSA [CA-MRSA, and HA-MRSA] cases in Iran, this prospective cohort study was conducted from January to December 2008 in seven hospitals. Staphylococci were isolated from 109 hospitalized patients. MRSA isolates were classified into HA-MRSA and CA-MRSA based on clinical features. Antibacterial susceptibility patterns of the isolates to eight antibiotics routinely used to treat infected patients were determined according to standard agar dilution methods. Staphylococcal Cassette Chromosome mec [SCCmec] type of isolates and their correlation with antimicrobial susceptibility patterns in CA and HC isolates were determined. Of 109 isolates, 15[13.7%] were community-associated and 94 [86.3%] were healthcare-associated MRSA. The most frequent SCCmec types in the studied hospitals were SCC mec type I [56.9%] and type II [22%]. Relatively sulfamethoxazole, clindamycin, rifampin, erythromycin, tetracycline and doxycycline were noticed. To our knowledge, this is the first time that the analysis of SCCmec type is carried out in Iran according to the clinical criteria. Difference in the prevalence of HC-MRSA and CA-MRSA based on the clinical and epidemiological features may indicate the need for revisiting the classification of MRSA. The high prevalence of multi-drug resistant MRSA could be as a result of the excessive use of antibiotics in the hospitals. Therefore, periodical assessment of antibacterial susceptibility patterns of the MRSA strains is warranted

High titers of hemagglutination inhibition antibodies against 2009 H1N1 influenza virus in southern Iran

Pandemic flu had at least two waves in Iran. Knowing how many of the general population were already exposed to this infection has a major impact on national preventive measures. As of December 30, 2009, a total of 3672 confirmed cases of human infection with a novel Influenza A [2009 H1N1] virus had been reported in Iran with 140 deaths. In this study we aim to measure, as a pilot study, the seroprevalence of positive antibody titer [humoral immunity] against 2009 H1N1 virus in Iranian population in Shiraz, Southern Iran. Through cluster random sampling of families residing in Shiraz, 2553 subjects were selected and after a medical interview blood samples were taken and checked for polyclonal antibody against 2009 H1N1 antigen using hemagglutination inhibition assay. An antibody titer of more than 1:40 dilution was considered positive. Data were analyzed considering the demographic characteristics of the population and were compared among different age groups. 1504 [58.91%] samples were tested positive for the presence of polyclonal antibody against 2009 H1N1 virus. The prevalence of positive titers were significantly higher in 60 to 64 years old group and significantly lower in 20 to 24 years old group [p<0.05]. Data did not differ based on other demographic characteristics or the history of flu like illnesses in the past 6 months. High seroprevalence of antibody against 2009 H1N1 in the sera of our subjects describes either a high level of preexisting immunity against H1N1 in Iranian population or a high rate of asymptomatic infection in our area compared to other countries

Influenza A [H1N1] Pandemic in Iran: report of First Confirmed Cases from June to November 2009

Since the declaration of a swine flu pandemic by the World Health Organization [WHO], the Islamic Republic of Iran has launched a surveillance system to test all suspected cases, both in community and hospital settings. From June 1[st] to November 11[th], 2009, there were 2662 [1307 females and 1355 males] RT-PCR confirmed cases of pandemic influenza A [H1N1] detected in Iran. Of these cases, 75% were 5-40 years-old. During this period, 58 patients [2.18%] died. Of the total number of cases, 33 were pregnant women with no reported mortalities amongst them. The prevalence of death had no significance correlation with sex and age [P=0.720 and 0.194, respectively]. Geographic distribution of the reported cases showed the highest rates in central and eastern provinces of Iran. There were two disease phases until November 2009, including an initial exogenous wave which blended into a second wave of indigenous disease, with a peak of cases after the start of the educational year. A review of the epidemiology of these initial phases of disease in Iran can help for better planning and more efficient action in future phases of the disease. It is of utmost importance to strengthen the surveillance system for this disease and appropriately transfer the resultant knowledge to the medical professionals, stakeholders and the general population, accordingly