Age of Natural Menopause and Related Factors among the Tabari Cohort

Objectives@#The age of menopause is affected by several factors. In this study we aimed to identify the age of natural menopause and its related factors in a large-scale population-based cohort in Iran. @*Methods@#In this study, a subset of data collected during the enrollment phase of the Tabari cohort study was utilized. Reproductive history and other related data were collected using a structured questionnaire. Blood samples were obtained from all participants. Data were analyzed using chi-square test, independent t test, and ANOVA as well as a multivariate linear regression model. @*Results@#Among participants of the Tabari cohort, 2,753 were menopausal women. The mean age of natural and induced menopause was 49.2 ± 4.7 and 43.2 ± 6.4 years, respectively (P = 0.001). The number of pregnancies, duration of breastfeeding, level of education, residency, presence of thyroid disease, and body mass index affected the age of menopause. After adjustments for confounding variables, the number of pregnancies remained significantly associated with late menopause. @*Conclusions@#The age of natural menopause in this study was similar to that in other studies, and the number of pregnancies was positively associated with the age of menopause after adjustments for confounding variables.

Estimating the Survival of Patients With Lung Cancer: What Is the Best Statistical Model? / 예방의학회지

OBJECTIVES:: Investigating the survival of patients with cancer is vitally necessary for controlling the disease and for assessing treatment methods. This study aimed to compare various statistical models of survival and to determine the survival rate and its related factors among patients suffering from lung cancer. METHODS:: In this retrospective cohort, the cumulative survival rate, median survival time, and factors associated with the survival of lung cancer patients were estimated using Cox, Weibull, exponential, and Gompertz regression models. Kaplan-Meier tables and the log-rank test were also used to analyze the survival of patients in different subgroups. RESULTS:: Of 102 patients with lung cancer, 74.5% were male. During the follow-up period, 80.4% died. The incidence rate of death among patients was estimated as 3.9 (95% confidence [CI], 3.1 to 4.8) per 100 person-months. The 5-year survival rate for all patients, males, females, patients with non-small cell lung carcinoma (NSCLC), and patients with small cell lung carcinoma (SCLC) was 17%, 13%, 29%, 21%, and 0%, respectively. The median survival time for all patients, males, females, those with NSCLC, and those with SCLC was 12.7 months, 12.0 months, 16.0 months, 16.0 months, and 6.0 months, respectively. Multivariate analyses indicated that the hazard ratios (95% CIs) for male sex, age, and SCLC were 0.56 (0.33 to 0.93), 1.03 (1.01 to 1.05), and 2.91 (1.71 to 4.95), respectively. CONCLUSIONS:: Our results showed that the exponential model was the most precise. This model identified age, sex, and type of cancer as factors that predicted survival in patients with lung cancer.

Freshwater snails as the intermediate host of trematodes in Iran: a systematic review / 한국역학회지

Freshwater snails, as the first intermediate hosts of trematodes, can cause health hazards in animals and humans. Recently, the World Health Organization has included Iran in a list of 6 countries known to have serious problems with fascioliasis. In addition, cercarial dermatitis is a job-related disease that is seen often in paddy workers, agricultural labourers, and fishermen in Iran, particularly in Mazandaran Province. Many studies have been conducted in Iran to survey larval trematodes in freshwater snails. However, to the best of our knowledge, no comprehensive data exist regarding infections in gastropods. Therefore, the aim of the present study was to estimate the types and prevalence of cercarial infections in snails in Iran. Electronic English-language and Persian-language databases were searched to identify 24 published articles reporting the prevalence of trematode infections in snails (9 species from 6 families) in various provinces of Iran. In total, 4.4% of gastropods were infected with the larval stages of trematodes. According to the studies reviewed in this meta-analysis‚ the highest infection prevalence was found in Radix auricularia (9.9%). Twelve larval species of trematodes were identified, and the highest prevalence of cercariae was found for Echinostomatidae cercariae (4.3%). Among the provinces explored, West Azerbaijan had the highest prevalence of infected snails (16.9%). The presence of trematodes in snails could pose a serious health problem in Iran. Thus, further studies are necessary to characterize these infections in other provinces.

Enrolment Phase Results of the Tabari Cohort Study: Comparing Family History, Lipids and Anthropometric Profiles Among Diabetic Patients

OBJECTIVES: Different factors are responsible for the silent epidemic of diabetes mellitus in developing and developed countries. This study aimed to determine the role of demographic factors, lipid profile, family history (the estimation of genetic association) and anthropometric factors on diabetes onset. METHODS: Data from the enrolment phase of the Tabari Cohort study was applied for this study and included 10,255 participants aged between 35–70 years. Anthropometric variables were measured by trained staff using standard tools. Blood specimens were collected for lipid profile and blood glucose measurements. Data analyses were performed using SPSS version 24, with univariate and multivariate logistic regression. RESULTS: The prevalence of diabetes mellitus was estimated to be 17.2% in the cohort population, 15.6% in men, and 18.3% in women. The adjusted odds ratios (95% confidence intervals) for age groups 40–49, 50–59 and over 60 were 2.58 (2.20–3.69), 5.80 (4.51–7.48) and 8.72 (6.67–11.39), respectively. In addition, the odds ratios (95% confidence intervals) for 2 (or more), and 1 affected family member were 4.12 (3.55–4.90) and 2.34 (2.07–2.65), respectively. Triglyceride concentrations more than 500, and abnormal high-density lipoprotein levels increased the odds of diabetes mellitus by 3.29- and 1.18-fold, respectively. CONCLUSION: The current study showed that old age and a family history were strong predictors for diabetes mellitus.

Freshwater snails as the intermediate host of trematodes in Iran: a systematic review / 한국역학회지

Freshwater snails, as the first intermediate hosts of trematodes, can cause health hazards in animals and humans. Recently, the World Health Organization has included Iran in a list of 6 countries known to have serious problems with fascioliasis. In addition, cercarial dermatitis is a job-related disease that is seen often in paddy workers, agricultural labourers, and fishermen in Iran, particularly in Mazandaran Province. Many studies have been conducted in Iran to survey larval trematodes in freshwater snails. However, to the best of our knowledge, no comprehensive data exist regarding infections in gastropods. Therefore, the aim of the present study was to estimate the types and prevalence of cercarial infections in snails in Iran. Electronic English-language and Persian-language databases were searched to identify 24 published articles reporting the prevalence of trematode infections in snails (9 species from 6 families) in various provinces of Iran. In total, 4.4% of gastropods were infected with the larval stages of trematodes. According to the studies reviewed in this meta-analysis‚ the highest infection prevalence was found in Radix auricularia (9.9%). Twelve larval species of trematodes were identified, and the highest prevalence of cercariae was found for Echinostomatidae cercariae (4.3%). Among the provinces explored, West Azerbaijan had the highest prevalence of infected snails (16.9%). The presence of trematodes in snails could pose a serious health problem in Iran. Thus, further studies are necessary to characterize these infections in other provinces.

Estimating the Survival of Patients With Lung Cancer: What Is the Best Statistical Model? / 예방의학회지

OBJECTIVES@#: Investigating the survival of patients with cancer is vitally necessary for controlling the disease and for assessing treatment methods. This study aimed to compare various statistical models of survival and to determine the survival rate and its related factors among patients suffering from lung cancer.@*METHODS@#: In this retrospective cohort, the cumulative survival rate, median survival time, and factors associated with the survival of lung cancer patients were estimated using Cox, Weibull, exponential, and Gompertz regression models. Kaplan-Meier tables and the log-rank test were also used to analyze the survival of patients in different subgroups.@*RESULTS@#: Of 102 patients with lung cancer, 74.5% were male. During the follow-up period, 80.4% died. The incidence rate of death among patients was estimated as 3.9 (95% confidence [CI], 3.1 to 4.8) per 100 person-months. The 5-year survival rate for all patients, males, females, patients with non-small cell lung carcinoma (NSCLC), and patients with small cell lung carcinoma (SCLC) was 17%, 13%, 29%, 21%, and 0%, respectively. The median survival time for all patients, males, females, those with NSCLC, and those with SCLC was 12.7 months, 12.0 months, 16.0 months, 16.0 months, and 6.0 months, respectively. Multivariate analyses indicated that the hazard ratios (95% CIs) for male sex, age, and SCLC were 0.56 (0.33 to 0.93), 1.03 (1.01 to 1.05), and 2.91 (1.71 to 4.95), respectively.@*CONCLUSIONS@#: Our results showed that the exponential model was the most precise. This model identified age, sex, and type of cancer as factors that predicted survival in patients with lung cancer.

Freshwater snails as the intermediate host of trematodes in Iran: a systematic review / 한국역학회지

Freshwater snails, as the first intermediate hosts of trematodes, can cause health hazards in animals and humans. Recently, the World Health Organization has included Iran in a list of 6 countries known to have serious problems with fascioliasis. In addition, cercarial dermatitis is a job-related disease that is seen often in paddy workers, agricultural labourers, and fishermen in Iran, particularly in Mazandaran Province. Many studies have been conducted in Iran to survey larval trematodes in freshwater snails. However, to the best of our knowledge, no comprehensive data exist regarding infections in gastropods. Therefore, the aim of the present study was to estimate the types and prevalence of cercarial infections in snails in Iran. Electronic English-language and Persian-language databases were searched to identify 24 published articles reporting the prevalence of trematode infections in snails (9 species from 6 families) in various provinces of Iran. In total, 4.4% of gastropods were infected with the larval stages of trematodes. According to the studies reviewed in this meta-analysis‚ the highest infection prevalence was found in Radix auricularia (9.9%). Twelve larval species of trematodes were identified, and the highest prevalence of cercariae was found for Echinostomatidae cercariae (4.3%). Among the provinces explored, West Azerbaijan had the highest prevalence of infected snails (16.9%). The presence of trematodes in snails could pose a serious health problem in Iran. Thus, further studies are necessary to characterize these infections in other provinces.

Seroprevalence of Toxoplasma gondii infection among Iranian pregnant women: a systematic review and meta-analysis

Background: Toxoplasmosis is a great public health concern due to its capacity for prenatal transmission. Serologic studies have reported various estimates for seroprevalence of toxoplasmosis among Iranian pregnant women. Estimation of the pooled prevalence of this infection is necessary for policy-making.

Aims: The aim of this study was to estimate the prevalence of Toxoplasma gondii infection in Iranian pregnant women using systematic review and meta-analysis.

Methods: We searched national and international databases to identify relevant studies. To enhance the search sensitivity, we evaluated all references and interviewed relevant researchers and research centres. The final studies for meta-analysis were selected according to the quality assessment as well as inclusion/exclusion criteria. Because of the heterogeneity of the primary results, random effects models were used to estimate the pooled prevalence of T. gondii. We included 43 studies with a total sample size of 22 644 in the meta-analysis.

Results: The pooled seroprevalence of overall toxoplasma infection, IgG antibody and IgM antibody was estimated at 41.3% [95% CI: 35.8–46.8], 39.2% [95% CI: 33.3–45.1] and 4.0% [95% CI: 3.1–4.9] respectively.

Conclusions: Our study showed that a considerable proportion of Iranian pregnant women are at high risk for toxoplasmosis.

Vitamin D and fibromyalgia: a meta-analysis

Vitamin D is a cofactor responsible for autoimmune disorders. There is no agreement in the studies investigating the association between vitamin D and fibromyalgia. This study aims to combine the conflicting results of the primary studies which compared these patients with control groups regarding the serum concentration of vitamin D. This meta-analysis has been designed based on PRISMA guidelines. Relevant keywords were searched in PubMed, Science direct, Scopus, Cochrane, and Google scholar and primary studies were selected. After screening the eligible studies according to inclusion/exclusion criteria, we investigated the risk of bias in the selected studies and also the heterogeneity between the primary results using Cochrane (Q) and I-squared (I2) indices. The primary results were combined using inverse variance method and Cohen statistics as well as a random effects model. Publication bias was assessed using Egger test. Sensitivity analysis was applied to investigate the influence of each primary study on the final result of the meta-analysis. Suspected factors in the heterogeneity were assessed using meta-regression models. We entered 12 eligible studies in the meta-analysis including 851 cases compared with 862 controls. The standardized mean difference of Vitamin D between the two groups was −0.56 (95% confidence interval: −1.05, −0.08). Our meta-analysis showed that vitamin D serum levels of patients with fibromyalgia was significantly lower than that of control group.

Estimating Tuberculin Skin Test Reactions among Children and Teenagers Who Received the Bacillus Calmette-Guerin Vaccination at Birth: A Meta-analysis

OBJECTIVES: Tuberculin skin reaction size is one indicator of bacillus Calmette-Guérin (BCG) vaccine efficacy and a way to diagnose latent infection. Several primary studies have examined this issue. Combining the results of these studies using a meta-analysis will provide reliable evidence regarding this indicator for policymakers. This study aimed to estimate the total frequency of different tuberculin skin test reactions among Iranian children and teenagers who received the BCG vaccination at birth. METHODS: National and international databanks were searched using relevant keywords. After the search strategy was restricted and duplicates were excluded, the titles and abstracts of the remaining papers were screened. All included studies included healthy children who received the BCG vaccine without confirmed tuberculosis exposure. Heterogeneity of the results was assessed using the Cochrane test and I² index showed the random effects model as the best model for estimating the pooled results. RESULTS: We combined the results of 14 primary studies including purified protein derivative reaction test measures of 26,281 Iranian children. The frequencies (95% confidence intervals) of the reactions were 8.5% (6.2–10.8) for patients with a reaction size ≥ 10 mm, 29.9% (22.3–37.4) for a reaction size of 5–9 mm, and 60% (48.9–71.1) for a reaction size < 5 mm. CONCLUSION: Our study showed that large numbers of Iranian children and teens have no positive BCG vaccine reaction and a considerable number of children have been exposed to Mycobacterium tuberculosis.

Prevalence of Enterobius vermicularis among Children in Iran: A Systematic Review and Meta-analysis

OBJECTIVES: Enterobius vermicularis is a parasitic disease that is common in crowded areas such as schools and kindergartens. Primary investigations of electronic evidence have reported different prevalences of E. vermicularis in Iran. Therefore, we aimed to estimate the total prevalence of this infection among Iranian children using a meta-analysis. METHODS: Relevant studies were identified in national and international databases. We selected eligible papers for meta-analysis after investigating titles, abstracts, and full texts; assessing study quality; and applying inclusion/exclusion criteria. Data were extracted by two independent researchers. The results were combined using a random effects model in Stata v. 11 software. RESULTS: Among 19 eligible articles including 11,676 participants, the prevalences of E. vermicularis among all children, boys, and girls were 1.2%–66.1%, 2.3%–65.5%, and 1.7%–65.5%, respectively. Pooled prevalences (95% confidence interval) of E. vermicularis among all children, boys, and girls were 17.2% (12.6%–21.8%), 17.2% (12.6%–21.8%), and 16.9% (9.03%–24.8%), respectively. CONCLUSION: This meta-analysis showed that a great majority of Iranian children are infected with E. vermicularis, possibly due to poor public health.

Denture stomatitis and candida albicans in iranian population: a systematic review andmeta-analysis

Statement of the Problem: Denture stomatitis is the common form of oral candidiasis, which is seen in the form of diffused inflammation in the areas covered by dentures. Many primary studies report the prevalence of denture stomatitis and candida albicans among patients in the Iranian population; therefore, using meta-analysis is valuable for health policy makers

Purpose: The purpose of the present study is to determine the prevalence of denture stomatitis and candida albicans in Iran

Materials and Method: Using relevant keywords, national and international databases were searched. After limiting the search strategy and deleting the duplicates, the remaining papers were screened by examining the title and abstract. In order to increase the sensitivity of search reference lists of papers were examined. Finally the index of heterogeneity between studies was defined using Cochran test [Q] and Isquared [I2]. According to heterogeneity, the random effects model was used to estimate the prevalence of denture stomatitis and candida albicans in Iran

Result: The prevalence of denture stomatitis in 12 studies, and the prevalence of candida albicans in patients with denture stomatitis have been reported in 6 studies. The number of sample under investigated and its age range among primary studies included meta- analysis was 2271 individuals and 32.7 till 87.5 years respectively. The prevalence of denture stomatitis in preliminary studies imported to a meta-analysis varied from 1.9% to 54.6%, and its rate in Iran using the meta-analysis was estimated 28.9 % [CI 95%: 18.2-39.6]. Also the overall prevalence of candida albicans in patients with denture stomatitis in Iran was estimated 60.6% [CI 95%:50.1-71.2]

Conclusion: This study showed that the prevalence of denture stomatitis and candida albicans among patient infected denture stomatitis is relatively significant in Iran

prevalence of herpes simplex virus type 1 and 2 infection in Iran: a meta-analysis

Background: Seroepidemiologic studies indicate a high prevalence of herpes simplex virus [HSV] infection. This infection leads to ophthalmic, dermatologic, oral, neurologic, vaginal and cervical problems. Different studies have been carried out to estimate the HSV seroprevalence in Iran. Combining the results of these studies would be useful for health policy-making

Objective: This study aims to estimate the pooled prevalence of HSV infection using meta-analysis

Materials and Methods: Using relevant keywords, national and international data banks were searched. Restricting the search strategy, excluding duplicates and investigating the titles and abstracts, relevant articles were identified

To increase the search sensitivity, the lists of references were investigated. To find un-published studies, specialized experts as well as research centers were interviewed

The heterogeneity between the results was assessed using Cochrane test and I-squared indicator

The pooled prevalence of HSV infection was estimated using random effects model

Results: We recruited 33 eligible papers investigated 7762 individuals

The total prevalences [95% confidence intervals] of HSV1, HSV2 and HSV infections were estimated as of 42.04% [20.9-63.1], 6.5% [4.7-8.2] and 25.7% [8.8-42.5] respectively

Conclusion: This meta-analysis showed that the HSV2 seroprevalence among Iranian people is considerably lower than HSV1 infection

Angiolymphoid hyperplasia with eosinophilia: a case report

Angiolymphoid hyperplasia with eosinophilia [AHE] has an unknown pathogenesis but is considered a reactive phenomenon, possibly in response to or in association with an underlying vascular malformation. There is history of trauma in some cases, and hyperestrogenemia [e.g. pregnancy, oral contraceptive use] may foster lesion growth. T-cell monoclonality has been reported in few cases. We report such a case in a 39-year-old male who visited our hospital with multiple nodules on the occipital of his head.

Prevalence of G6PD deficiency in Iran, a mata-analysis

Search results show that numerous primary studies have been carried out in different parts of Iran regarding prevalence of G6PD deficiency; if results of these studies are combined, a reliable estimation of prevalence of this factor will be achieved in Iran. Thus, present study, aimed to determine the prevalence of G6PD deficiency by combining findings of qualified primary studies using meta-analysis and taking into account heterogeneity considerations. Searching the relevant keywords in Iranian and International databases, primary studies were selected. After quality appraisal and applying inclusion and exclusion criteria, relevant primary studies were selected. In each study, standard error of prevalence of G6PD was calculated according to binominal distribution formula. Finally, heterogeneity index was determined among studies using Cochran's test. Prevalence of G6PD in Iran was estimated by STATA software ver 11 using fixed or random effect model based on heterogeneity results. 148916 subjects in 36 primary studies which entered this meta-analysis were examined. G6PD deficiency prevalence was 6.7% in Iran [men: 8.8% and women: 2.2%]. Also, this deficiency in the present study was four times higher in men than in women. Its prevalence was adjusted in different parts of Iran and it was shown that it was between 0.8 and 15.2 using Bayesian analysis. This meta-analysis showed that Iran is among countries with high frequency of G6PD deficiency and there is a significant difference in prevalence of G6PD in different parts of Iran. According to these results, screening newborn children seems very vital. Carrying out other primary studies regarding prevalence of G6PD seems unnecessary

Does tuberculosis have a seasonal pattern among migrant population entering Iran?

There are few quantitative documents about the seasonal incidence of tuberculosis [TB] among immigrant populations. Concerning the significant role of recognizing seasonal changes of TB in improving the TB control program, this study determines the trend and seasonal temporal changes of TB among immigrants entering Iran. In this longitudinal study, data from the Iranian TB register Program [from 2005 to 2011] was used. The aggregated number of monthly and seasonal TB cases was obtained by adding the daily counts. Data was analyzed by Chi-square, Independent T-test, ANOVA, and Poisson regression using Stata 11 and SPSS 20 software. Among 74,155 registered patients with TB, 14.3% [10,587] were non-Iranian who had immigrated to Iran from 29 different countries. The highest aggregated number of seasonal and monthly incidence of TB in immigrants was observed in spring [2824, P= 0.007] and in May [1037, P< 0.001]. The number of non-Iranian patients with TB increased significantly over the years [beta= 0.016, P= 0.001]. This study shows that immigrants constitute a significant portion of TB patients recorded in Iran and this trend is increasing. Also, the peak incidence of this disease is the second month of the spring

Prevalence of smoking in 15-64 years old population of north of Iran: meta-analysis of the results of non-communicable diseases risk factors surveillance system

Smoking is known as a major cause of chronic obstructive pulmonary disease [COPD] and hence immediate and effective interventions are required for its elimination. This study aimed to collect valid data with regard to cigarette smoking in adult population of north of Iran for policy making by a meta-analysis of the documents of national non-communicable disease risk factors surveillance system. We investigated relevant evidences by searching in published and non-electronic databases. Data were extracted based on variables such as year of the study, sex, age group and prevalence of smoking habit. Based on results of heterogeneity, we applied fixed or random effects model to estimate the overall prevalence of cigarette smoking. All analyses were performed using STATA 11 software. A total of 20747 subjects [10381 males and 10366 females] in five age groups 15-24, 25-34, 35-44, 45-54 and 55-64 years were interviewed. Meta-analysis in men and women showed prevalence of 19.2% [15.8-22.6%] and 0.3% [0.2-0.5%] respectively. Results of the present meta-analysis showed as much as one fifth of male population of north of Iran are smoker. Subgroup analysis also revealed that the rate of smoking was higher among the middle-aged men

Identification of mutation of glucose-6-phosphate dehydrogenase [G6PD] in Iran: meta-analysis study

Glucose-6-phosphate dehydrogenase is one of the most common genetic deficiencies, which approximately 400 million people in the world suffer from. According to authors' initial search, numerous studies have been carried out in Iran regarding molecular variants of this enzyme. Thus, this meta-analysis presented a reliable estimation about prevalence of different types of molecular mutations of G6PD Enzyme in Iran. Keywords "glucose 6 phosphate dehydrogenase or G6PD, Mediterranean or Chatham or Cosenza and mutation, Iran or Iranian and their Persian equivalents" were searched in different databases. Moreover, reference list of the published studies were examined to increase sensitivity and to select more studies. After studying titles and abstracts of retrieved articles, excluding the repeated and unrelated ones, and evaluating quality of articles, documents were selected. Data was analyzed using STATA. After performing systematic review, 22 papers were entered this meta-analysis and 1698 subjects were examined concerning G6PD molecular mutation. In this meta-analysis, prevalence of Mediterranean mutation, Chatham mutation and Cosenza mutation in Iran was estimated 78.2%, 9.1% and 0.5% respectively. This meta-analysis showed that in spite of prevalence of different types of G6PD molecular mutations in center, north, north-west and west of Iran, the most common molecular mutations in people with G6PD deficiency in Iran, like other Mediterranean countries and countries around Persian Gulf, were Mediterranean mutation, Chatham mutation and Cosenza mutation. It is also recommended that future studies may focus on races and regions which haven't been taken into consideration up to now

Meta-analysis of prevalence of smoking in 15-64 year old population of west of Iran

Cigarette Smoking is a recognized cause of systemic disorders such as bronchogenic, carcinoma, and cardiovascular diseases and hence prompt and effective interventions are required for its elimination. Thus, This Meta analysis was carried out for an adult population of west of Iran in order to estimate of prevalence smoking in this area. We examined related to documentation by searching in published and non electronic databases. Data were extracted based on variables such as the year of the study, sex, age group, and the prevalence of smoking. Based on the results of heterogeneity, we used fixed or random effects model to assessment the overall prevalence of cigarette smoking. All analyses were accomplished via STATA 11 software. Totally, 25,990 subjects [13005 males] were investigated. Meta analysis in men and women indicated prevalence of 22.9 [20.6 25.2] and 0.6 [0.3 0.9] respectively. It was found that more than one fifth of men from 15 year to 64 year old of west of Iran smoked cigarette. Providing an education on harmful effects of smoking to the adult population would be a valuable means for reducing destructive consequences of smoking

[ effect of family physician program on customer reference load in health centers of Mazandaran university of medical sciences]

Family physician plan is one of the most important methods of improving access and equitable utilization of the health services for public. Therefore, this study, investigated the rate of customer load before and after implementation of the family physician program. In this cross-sectional study, existing data have been described and analyzed. Data were collected and entered into excel spreadsheet. To evaluate trend of customer load during the study period and to compare customer load before and after implementation of family physician, linear and column chart were used respectively. Absence of error bar line overlap, was considered as significant criterion. Mean of customer load for physician, midwife, laboratory and pharmacy before and after implementation of family physician program were 0.3, 0.06, 0.2, 0.03 and 1.3, 0.4, 0.58 and 0.08, respectively. Findings showed that rate of customers reference load to family physician team were very impressive and remarkable. Maximum increase of customer load after implementation of family physician was attributable to midwifery services, physician visits, laboratory and pharmacy respectively. Therefore, it is expected that this increase of customer load create positive impact on health sector indicators. Thus, it is suggested to investigate the components of this program systematically