[ burden of traffic accidents in south Khorasan province, Iran in 2005]

Burden of disease studies have been implemented in many countries using the disability adjusted life year [DALY] to assess major health problems. This study was designed to assess the burden of transport accident in South Khorasan [SK] province of Iran for 2005. Years of life lost [YLLs], Years lived with Disability [YLDs] and DALYs were calculated by using methodology developed for the global burden of disease study [GBD] in 2003. The total population of SK was included in this study. In the 2005 year, the DALYs from transport accident in the south Khorasan province were 7456. DALYs for males and females were 5775[77%], 1 691 [23%] years respectively. The total rate of DALYs was 13.28 [per 1000] and with higher rates in age groups 30-44 years [20/86 per 1000], 15-29 years [16/96 per 1000] and 45-59 years [13/28 per 1000]. The age group 15- 44 years was more at risk of transport accidents and injuries than others. The findings suggest that adequate interventional programs for transport accidents prevention and control should be taken to minimize at different levels

[Bed occupancy rate modeling in Shiraz hospitals]

The Bed Occupancy Rate [BOR] among Iranian hospitals was reported to be 57.4% in 2001 indicative of a significance difference with standard index of 75%. To evaluate the bed occupancy rate modeling in Shiraz hospitals. This was a cross-sectional study carried out on random samples from different hospitals in Shiraz during the first half of 2004. The Poisson models including the negative binomials and mixture Poisson were used for BOR modeling. Hierarchical mixture Poisson, negative binomial and hierarchical two-component normal distribution were applied for the role of each hospital ward. Our findings showed that the average BOR was 66.4% in Shiraz hospitals. Regarding the relative hemogenity in observation of BOR in different hospitals, the hierarchical mixture Poisson and negative binomial models failed to accurately explain this variable and it was the hierarchical mixture two-component normal model which gave an accurate explanation for BOR found in our study. In this model, one of the components indicates the BOR observation close to mean and the other represents the outlier observations. The hierarchical modeling in which a hospital ward acts as a random component was shown to lead to the highest value for BOR

comparative study of reference data for body mass index of school children in Shiraz [Southern Iran] and CDC standards

Several methods have been used to estimate adiposity with high precision, but BMI has become the most common marker in identifying overweight and obese subjects. This study was performed to present reference data for body mass index [BMI] of school children aged 6.5-11.5 years in Shiraz, southern Iran. The data of present study are based on a random multi stage sample survey of 2397 healthy school children in Shiraz, southern Iran. The participants were 1268 boys and 1129 girls and their heights and weights were measured in 2002-2003 academic year. Joint height-weight measurements were available for 2195 [91.6%] including 1138 boys [89.7%] and 1057 girls [93.6%]. Healy-Rasbash-Yang [HRY] distribution-free method was applied to estimate BMI age-related centiles. Cubic polynomials in age are shown to adequately fit the BMI data [on log scale]. Children are now heavier than those born over ten years earlier. Boys BMI lie above girls to around 10 years of age, which is subsequently reversed for overweight and obese centiles. Comparison of these BMI curves with those of CDC charts showed substantial differences at every age and suggested the necessity for the use of locally based BMI norms for assessing body mass index of children in Shiraz, Southern Iran. Also, a positive secular trend in BMI is seen during the past decade in Iran

[ comparison of statistical modeling strategies for analyzing length of stay in Shiraz education hospitals]

The modeling of inpatient length of stay [LOS] has important implications in various aspects of health care management, such as hospital management and planning, the management of health care resources and the performance in hospital care. For many health care management systems, it is important to develop a comprehensive analysis of LOS and to identify hospital- and patient-related characteristics influencing LOS variations. By targeting relevant factors, appropriate policies can be developed to manage the hospital care and the health care resources effectively. Except a specific and limited study, a few studies have carried out on LOS modeling in Iran. This study has been carried out to compare different models for explaining LOS. A sample of 3546 patients was selected using randomized clustered sampling scheme from different wards of Shiraz educational hospitals in 2005 and their hospitalization [LOS] rate registered as response variable and other demographic variables. Advance statistical models such as Poisson regression, ZTP, ZTNB and percentile regression were applied to analyze and modeling the data. Mean +/- S.D of LOS were calculated as 8.4 +/- 13.7days. Over-dispersion for LOS was observed. Therefore, negative binomial, gamma, zero truncated Poisson [ZTP], zero truncated negative binomial [ZTNB] and percentile regression were applied. The results showed that ZTNB is an efficient model for explaining LOS in Shiraz's hospitals. Given heterogeneity in LOS in different wards in Shiraz hospitals, negative binomial model explains adequately the LOS values. Also, percentile regression model seems appropriate for LOS which was applied to our data. Application of the cited models here to other hospitals scattered around the country is suggested

Prevalence of migraine and tension-type headache and their correlations in Shiraz primary school children [2003]

Studies of headache prevalence are numerous, and findings have varied according to the specific population and regions involved. No data are available regarding headache prevalence among Iranian children aged 6-13 years. The purpose of this study was to determine the prevalence rates of the various causes of headache in school children, with special emphasis on migraine, tension-type headache and their correlates in primary schools of Shiraz. A cross-sectional study was carried out on 2226 school children. Subjects were selected by multistage random sampling procedure. Data was collected by screening IHS questionnaire followed by clinical interviews, general physical and neurological examination, and diagnostic criteria of the international headache society. The overall prevalence rate of headache was estimated to be 31% [95% CI, 29-32.9]. Migraine and tension-type headache rates were estimated as 1.7% [95% CI, 1.2- 2.2] and 5.5% [95% CI, 4.6 - 6.4], respectively. The prevalence of headache types increases with age. There was no difference in prevalence of migraine between girls and boys [p>0.05] and prevalence of tension type headache was more in girls [p<0.05]. Positive family history of headache and abnormal sleep pattern showed significantly association with migraine. The prevalence of tension type headache in Iran compared to other countries is higher. So it is concluded that sleep disturbances and family history of headache had most significant effects on the occurrence of migraine and tension-type headache

[Blood pressure reference values on height for 6-12 years old children in Shiraz/Iran]

Blood pressure [BP] in children could be affected by a lot of factors such as environmental, cultural, social and genetic factors. Therefore it is dynamic and varies from each society or era to another. This study was conducted to compare BP of Iranian children with the American standard and for the first time BP smoothed centiles on height in 6-12 elementary school children were determined. Height, systolic and diastolic BP were measured with standard methods in 2494 elementary school children selected by multi stage sampling. BP percentiles on height percentiles were determined and compared with National High Blood Pressure Education Program [NHBPEP] results by using its suggested regression equation. Meanwhile BP smoothed centiles on height were drawn by Healy-Rasbash-Yang [HRY] method. The results of this study showed that BP levels in Shiraz children are lower than American standard and BP in children was not related to age by controlling of height. It is suggested that in each society local standards are used and in order to have more accurate diagnosis of hypertensive cases it would be better to calculate BP centiles on height instead of age

[Cost- income analysis of oral health units of health care centers in Fars province and evaluation of oral health indices in 2001-2003]

Increasing demands for health care services on one hand, and limited resources on the other hand brings about pressure over governments to find out a mechanism for fair and appropriate distribution of resources. Economic analysis is one of the appropriate tools for policy making on this priority. The objective of this study was to assess capital and consumption expenditure of Oral Health Units of Health Care Centers in Fars province and its effectiveness on oral health indices. The data were collected by statistical forms in urban and rural Health Care Centers which were sent to Provincial Health Care Centers every 3 months from 2001 to 2003. Oral Health Unit service expenses had been 6,871,471,160 Rials in 2001, 6,243,026,540 Rials in 2002 and 7,009,570,880 Rials in 2003 respectively. Income/cost ratio was 20% in 2001 and it was 25% and 26% in 2002 and 2003 respectively. In spite of this high expenses, the oral health statues of 6-12 year old children did not improve during the survey period. Regarding the low tariff of dentistry services and also subsidiary payment to target groups, the Oral Health Unit expenses are always more than its income. These costs had no effect on oral health indices [dmft, DMFT] in Fars province

Prevalence of migraine and tension-type headache in primary-school children in Shiraz

From January to June 2003 we determined the prevalence of the various types of headache in 2226 schoolchildren in Shiraz [age 6- 13 years] selected by multistage random sampling. Data were collected by questionnaire and clinical examination. International Headache Society criteria were used for diagnosis. The overall prevalence of headache was 31%. Prevalence rates of migraine and tension- type headache were 1.7% and 5.5% respectively. The prevalence of headache increased with age and girls were significantly more likely to report tensions-type headache. Positive family history of headache and abnormal sleep pattern were significantly associated with migraine

Sociodemographic factors and age at natural menopause in Shiraz, Islamic Republic of Iran

With increasing life expectancy, menopause is an increasingly important aspect of women's health. We recorded the age at natural menopause among women in a population-based cross-sectional study in Shiraz, Islamic Republic of Iran, in summer 2000. Interviews with 948 randomly selected menopausal women showed the mean [st and ard deviation] age at menopause was 48.3 [5.3] years [95% CI: 48.0-48.6], median 49 years. The sociodemographic and health behaviour factors that were significantly related to early mean age of menopause were: never married [44.7 years], low income level [47.4 years], low social class [45.8 years], tobacco use [47.9 years] and non-consanguineous husb and [48.1 years]

double triangular sequential test to assess the effect of local heat on postoperative sore throat after endotracheal intubation

Sore throat is a common complication after intubation. The objective of this study,from the clinical viewpoint, is the evaluation of the local heat on postoperative sore throat. Alsothis study, from the methodological viewpoint, is an attempt to introduce the ethical andeconomical advantages of sequential analysis that was used for the first time in Iran. In this clinical trial patients were randomly assigned to eitherexperimental or control group. In the experimental group a small electrical blanket with thetemperature of 40° C was used during the general anesthesia. The sequuntial double triangulartest was used to analyse and monitor clinical trial. This study was stopped after the forth analysis [80 patients evaluated: 40 with electricalblanket and 40 without it] in favor of electric blanket. Whereas the sample size required by thesingle-stage-design was 160. Our findings showed that local heat on the tracheal area could reduce the incidenceof postoperative sore throat. Also, from methodological viewpoint, using the double triangulartest leading to a 50% reduction in sample size, which is more effective from health economicsviewpoint

[An epidemiologic model for risk factors of migraine and tension type headaches among Primary Schools Teachers of Shiraz, 2003]

This study was conducted to estimate the prevalence of migraine and tension-type headaches among Shiraz primary schools teachers and to provide an epidemiologic model for them. A random sample of 538 teachers, constituting a 10% sample of the primary schools teachers' population, was evaluated on the basis of the diagnostic criteria of the International Headache Society [HIS] as well as clinical diagnosis. The estimated prevalence was 10% [54 subjects] for migraine, 24% [129 subjects] for tension-type headache and 5.2% [28 subjects] for coexisting headaches. In a case-control study, each case of migraine, tension-type and coexisting headache was matched for age, sex and educational region to respectively two, one and three controls selected among headache-free teachers and conditional logistic regression model was used for univariate and multivariate analyses of the relationships between each type of headache and the considered variables. The relationship between the studied headaches and measures of general health questionnaire [GHQ-28] were also determined. Significant associations were found between migraine and positive family history of headache, anxiety and abnormal sleeping pattern. Tension-type headache was significantly associated to positive family history of headache, anxiety, depression, marital status and social dysfunction. Significant associations were found between the coexisting ?headache and positive family history of headache, anxiety, depression, abnormal sleeping pattern and social dysfunction. No association was found between any type of headaches and blood pressure, body mass index, birth order, study position, cigarette smoking and level of education. Improving general health measures including physical status, social performance, anxiety and depression alleviation in home and school in cases with tension-type headache and correction of sleeping pattern and stress alleviation in subjects with positive family history of migraine headaches are recommended for prevention and treatment of these headaches

[An evaluation of the quality of published clinical trials in Iranian medical journals during 2001-2004]

A clinical trial cannot be adequately interpreted without information about the methods used in the design of the study and the analysis of the results. The goal of this study was to assess the quality of published clinical trials in the Iranian medical journals. In this cross sectional study, all 227 randomized clinical trials published in the 25 Iranian Medical Journals were surveyed. In these trials, the methods of randomization, determination of sample size, blinding and ethical issues were examined. Results showed that only 14[6.2%] out of 227 published clinical trials reported the sample size calculations. The information about the type of randomization and the methods of blinding were reported in 3[1.3%] and 113 [49.8%] respectively. Of these figures, 27[11.9%] were single-blind and 86 [37.9%] double-blind. One hundred ninety three [85%] of the trials reported the statistical methods used. Finally, the issue of the informed consent was reported in 92[40.5%] trials. Published clinical trials are poorly designed and reported in Iranian medical journals. Therefore, it is recommended that editors, reviewers and authors should improve the standards of reporting clinical trials using a standard protocol

Age at natural menopause and its determinants in Shiraz

The mean age at natural menopause among women of Shiraz in relation to socio-demographic factors was calculated. The data were obtained from a population-based, cross-sectional study carried out in the year 2000. Interviews were carried out and observations made with women in Shiraz, who had undergone a natural menopause. Chosen at random basis from a sample using postal zones housing framework. The most important results include mean +/- SD age at menopause in the population of 48.3 +/- 5.3 years [95% CI: 47.97-48.62] with a median of 49 years. Groups of women with an average early menopause were those with never married [44.7 years, P < 0.006], low income level [47.4 years P < 0.002], low social class [45.8 years, P < 0.000], tobacco use [47.9 years, P < 0.014] non consanguine husband [48.1 Year, P < 0.027]. This phenomenon must be documented in Iran because of it's strong links with morbidity and mortality of the growing number of women who are reaching advanced ages and whose survival is calculated at a quarter century after menopause

Young adulthood body mass index and weight-for height reference curves for southern Iran

Obesity is becoming a public health problem in Iran and is a risk factor for many chronic diseases. The objectives were to present two simple tools namely, weight-for-height [WFH] and Body Mass index [BMI] centile charts to evaluate obesity in young married adults of Shiraz, the most developed city of Southern Iran and examine its correlates. This was a cross-sectional study of the southern Iran. A random sample of 596 subjects [295 males aged 23 to 43 years and 301 females aged 18 to 35 years] was selected and their heights, weights, and arm circumferences measured. The HRY distribution-free method was applied to estimate percentiles of WFH and BMI. Weight-for-height charts independent of age presented for both sexes. Age related and sex specific BMI charts displayed which show cut-off points for thinness [5[th] percentile], overweight [85[th] percentile] and obese [95[th] percentile]. Female subjects had become heavier and more obese than before, while males weight and obesity stayed almost constant. Females social class associated with their BMI. Weight-for-height and BMI charts are useful tools to study shape of adults. While the former may be used when age is unknown, the latter is more useful to study age related thin, overweight and obese young adults. Due to data representativeness and structural similarity, the charts provide local reference curves for clinical work public health purposes in urban areas of Iran

Nutritional assessment of lactating women in Shiraz in relation to recommended dietary allowances

Tables of food frequency and nutrient intake were created for a r and om sample of 266 lactating women from different areas of Shiraz city, Islamic Republic of Iran. Women were interviewed at home in 1998 and nutrient intake was calculated from a food frequency questionnaire and 24-hour dietary recall. On average, daily consumption was 2 servings of dairy foods, 4 of bread/rice, 2 of vegetables and 3 of fruits; weekly consumption was 5 servings of meat and 3 of legumes. Estimated average daily energy intake was 2250 kcal. Protein and vitamin C intake were significantly higher than United States recommended dietary allowances [RDA], while iron and calcium intake were significantly lower. Protein intake was insufficient among 9.0% of women, calcium in 35.7%, iron in 18.8% and vitamin C in 15.0%

Obesity indices among infants and their parents, Shiraz, Iran

Infantile obesity is becoming increasingly recognized as one of the public health problems in Iran. Obesity charts of a cohort of 317 healthy infants and their parents living in Shiraz [Southern Iran] are presented and the familial pattern of infants' obesity with that of its parents explored. An adjusted weight-for-height index was used to develop power type obesity indices, Ip=W/Hp. Polynomial modelling was used by applying the Healy-Rasbash-Yang [HRY] nonparametric method to estimate age-related smoothed centiles of obesity and dynamic obesity charts for infants and their parents are presented. Principal component analysis [PCA] was applied to the data as continuous variables to analyse familial pattern of parent-infant obesity structurally. The optimal value of p was found to be 2.5 for infants and 1 for their parents. Infants' obesity increases from birth to six months of age and decreases thereafter until the age of 21 months when it became stable. Obesity indices and circumferences sizes were reduced to two principal components interpreting infants as well as family obesity. The first principal component evaluates infants' obesity as a combination of obesity index as well as their arm, chest and head circumferences. Also the second principal component combines mothers' obesity and her arm circumference, while father obesity did not influence familial obesity structure significantly. Obesity is an age related phenomenon and dynamic charts presented herein are appropriate practical tools to assess obesity in both infants less than two years of age and their parents

Deteminants of age at natural menopause in Shiraz

The mean age at natural menopause and its determinants among Shirazi women [southern Iran] was calculated. The data were obtained from a population- based cross-sectional study carried out in the year 2000. Interviews were carried out and observations made on 948 women who had incurred natural menopause. They were randomly chosen using postal zones housing sample framework of Shiraz. Mean +/- SD age at menopause in the studied group was 48.3 +/- 5.3 [95% CI: 48.0-48.6] years with a median of 49.0 years. Arm circumference, height, weight, BMI, place of birth, handedness, ancestry, family background, level of education, level of daily physical activities, smoking habit, history of abortion, age at first marriage, age at first full-term pregnancy, menstrual cycle interval/duration, age at menarche, dysmenorrhea, mid-cycle spotting, were rewrded. It was found that the number of pregnancies were not significantly related to age at menopause. Age at natural menopause significantly correlated with menstrual cessation pattern, age at last full-term pregnancy, consanguinity of marriage, place of birth, and use of hormones before menopause