بابک عشرتی

The burden of disease analysis can be used to measure the factors that are suitable for interventions for disease control. This study aims to calculate the burden of risk factors for common cancers among the elderly in Markazi Province of Iran in 2016.

This a retrospective descriptive-analytical study. Information was collected based on age and sex groups, which included the cancer incidence rate, cancer death rate, cancer disability rate based on the GBD standard table, which were collected from the website of Statistics Centre of Iran, the latest death report and the latest cancer report in 2016. The data analyses were done in Excel and DISMOD2 applications. The disease burden calculation formula was used in this study. To ensure the validity and reliability of the data, the data with wrong or useless codes were excluded.

For skin cancer, the highest burden was related to exposure to sunlight (526.71); for stomach cancer, family history (79305.88); for colon, lack of fruit consumption (4063.18); for breast cancer, lack of marriage (6488.58); and for prostate cancer, history of previous diseases (7244.08).

Family history of cancer, smoking, obesity, and physical inactivity are common risk factors of most cancers with a same burden.

The present study aimed to evaluate the lived experiences of patients with COVID-19, whether hospitalized or quarantined at home, their caregivers and treatment staff involved in the care and treatment of the patients with COVID-19 between 2020 to 2021 in Tehran.

This was a descriptive phenomenology study. A questionnaire guide was designed and piloted to be used for in-depth interviews. Interviews were conducted by telephone. All interviews were recorded and were coded based on the objectives of the study after completion. The report collected from all interviews was categorized according to key themes and sub-themes. In the end, similar themes were grouped together and eventually the main themes emerged.

Individual interviews were conducted with 14 patients, six medical staff (nurses and physicians) and three caregivers of the patients. The mean age of patients was 40.1±14. Ten main themes were identified for the patient group, five for the treatment staff and eight for the caregivers. Fear of spreading the disease to others and the experience of loneliness and being away from family was the biggest concern of the patients. The findings indicated lack of adequate and specific food services for patients with COVID-19 in the hospitals. In general, patients quarantined at home experienced more favorable conditions during the treatment period compared with hospitalized patients. Some of the participants complained about mistreatment of some members of the medical staff and the public regarding their illness. The economic burden imposed on the patients was another mentioned problem. Psychological and emotional support was the greatest expectation of patients with COVID-19 from those around them. They also called for community members to adhere to the protocols and help break the virus transmission chain.

The results of this study contain valuable points that can be used for future policy-making and will certainly be an aid for those in charge to provide effective and efficient services.

In Iran’s health system, with integration of medical education and ministry of health, medical universities have a variety of responsibilities apart from delivering medical education to university students. Medical universities are playing an essential role in management of the health system. They are in charge of providing the necessary prevention and treatment services in provincial levels, as well as management and oversight of the health services needed by the population. Meanwhile, medical universities are expected to maintain and improve population health through scientific and innovative methods. Although the indicators highlight the success of these universities in many of their tasks, sometimes they fail to fulfil the expected targets. Identifying problems and challenges that hinder universities’ performance and supporting them with innovative problem solving methods can help managers in achieving university goals. Therefore, recognizing and analyzing the university challenges are essential steps that should be taken for the strengthening the university system and empower them to respond more successfully to the existing and future needs and to assure that the university continues its pathway toward growth and development and keeps up the track of achieving its goals.

This study is an applied research project, which has been designed to identify and categorize the challenges that affect the performance of different sectors of Iran University of Medical Sciences. The participants of this qualitative study were experts, managers, directors and officers of different sectors of the university, including faculties, deputies, offices, hospitals and health centers. In the first step, an open-ended questionnaire was developed and evaluated to extract challenges and problems faced by different units in the university. Then, this open-ended questionnaire was distributed and the challenges and problems of different academic and non-academic units of the university were collected through questioning the managers and staff of all units and subunits about the most important challenges they face. For each challenge they mentioned, title of the challenge, description, and the rational of their importance and priority was provided. The process continued until no new themes emerged. At the end of this step, a list of existing challenges and problems along with their description and rational for selection were available. In the next step, the collected concepts were analyzed in order to investigate the limiting role of these challenges on the performance of different units in the university. After organizing the answers and reviewing the suggested items, similar and overlapping items were merged or removed.  Also, challenges that targeted a limited number of units or those targeting people (instead of problems or processes) were removed. In the following step, reviewing and coding was performed and themes were extracted by two independent researchers. Finally, the themes were summarized based on the opinions of different experts and by achieving consensus. At the end of this step, affecting factors were identified, categorized and presented. In the last step, three rounds of focus group discussions were held to evaluate the accuracy of the obtained data. In all steps of the study, in order to benefit from the views of a wide range of experts and managers and officers with different experiences, purposive sampling was performed. The data collection continued until data reached saturation. Content analysis was undertaken to provide a complete understanding of the collected data. For maintaining the ethical considerations, the names of the study units and any reference to specific people and occasions were removed from the reports and texts.

we achieved a response rate of 90 percent through multiple reminders and follow ups we sent to unit managers. Based on the responses from units, 215 problems were identified from 38 participating units. The identified problems were categorized into three main themes. Most of the mentioned problems could be categorized under the general theme of lack of evidence-based management. In fact, issues related to lack of evidence-based management was mentioned by almost every participant. This theme includes issues such as Lack of effective monitoring and evaluation systems, and poor frameworks and process flows for applying evaluation results; excessive focus on quantitative approaches for evaluating performance of teams and individuals, and lack of efficient and fair rewarding and punishing systems. The second emerged theme was inefficient bureaucracy, where issues such as legal, managerial, structural and process problems are addresses. Organizational culture was the third extracted theme and defective staff education, communication and motivation, poor workforce performance and attitudes to organization; and insufficient professional commitment were among the most frequently indicated problems. Lack of meritocracy was an issue mentioned across all three themes by participants and was considered as an important determining topic linking all three themes. This topic highlighted lack of predefined approaches for selecting staff at different levels and unclear process of succession in different organizational levels and units.

According to the university workforce, the main problems and challenges that hinder university performance are rooted in an environment of interrelated factors which can be categorized mainly in absence of evidence-based management, inefficient bureaucratic structure, undefined and underdeveloped decision-making process at different levels of the organization, and some aspects of the organizational culture that may adversely affect the processes of the organization. Based on these results, it can be concluded that the university’s existing performance management system, is generally hindering the evidence based management, which in turn, results in shaping of an overall ineffective approach to the decision making processes and a rather static organizational status. Moreover, such cultural environment can consequently cause a attitude of resistance versus different efforts toward evidence based management. Finally, it can be concluded that if a sustainable and effective change is intended to occur in the management of the university, the probable concurrent effects of the designed interventions an all three hindering factors should be considered with high caution. This consideration is especially important because it is believed that implementing an evidence based decision making system in an organization requires detailed evaluation of organizational culture and characteristics; and failing to provide these information properly can result in a serious obstacles in success of the interventions.

The performance appraisal system is known as one of the factors affecting employeeschr('39') performance, and organizations are required to consider the components of organizational entrepreneurial orientation toward achieving effective goals and performance. This study aimed to investigate the relationship between performance appraisal and organizational entrepreneurial orientation in selected employees of Health Deputy at Iran University of Medical Sciences.

This descriptive-analytical and sectional study was conducted in 2020. The sample consisted of 102 employees with a score of last yearchr('39')s performance evaluation. The annual performance evaluation score and a standard questionnaire were used to assess the performance of employees and their organizational entrepreneurial orientation, respectively. Data analysis was performed using SPSS statistical software version 25.

The organizational entrepreneurial orientation was reported as moderate. The highest and lowest mean scores were related to the autonomy and competitive aggressiveness dimensions, respectively. Although there was a significant and negative relationship between performance and risk-taking, competitive aggressiveness and innovativeness variables, no significant relationship was found between proactive ness and autonomy variables.

The results showed that there was a significant negative relationship between performance appraisal and the organizational entrepreneurial orientation. It seems that this inverse relationship is due to the lack of necessary conditions for the tendency toward organizational entrepreneurship and also ignoring entrepreneurship in the axes and indicators of employee performance evaluation.

Correct and timely detection of the outbreaks of diseases with a short incubation period is of great importance in the health system. The aim of this study was to determine the detection of dysentery outbreaks using the cumulative sum method.

This time series study was conducted using the data of the National Surveillance System between 2014 and 2017. The outbreak alert threshold of each season and province was determined separately using the average of three years (1393 to 1395) in the same season and province. The dysentery outbreak in each season was exclusively predicted for Isfahan, Khuzestan, and Hamadan provinces in 2017 using the CUSUM method.

In Isfahan Province, the outbreak alert was higher in the spring and summer and lower in the autumn and winter using the current method compared to the CUSUM method. For Khuzestan Province, the current outbreak alert was significantly higher in all seasons compared to the CUSUM method, while the current outbreak alert was lower than the alert predicted by the CUSUM method in Hamadan Province in all the seasons.

Compared to constant threshold-based methods, using the CUSUM method seems to be a better way for reporting outbreaks, especially in areas with a high incidence.

Salmonella is considered as a main cause of community-acquired diarrhea in humans, however, sources of the multi-drug resistant (MDR) strains and their link with the disease are not well known.

This study aimed to investigate the frequency, serogroup diversity, and antimicrobial susceptibility patterns of Salmonella strains in poultry meat and stool samples of patients with community acquired diarrhea in Tehran.

We compared the frequency of non-typhoidal Salmonella serogroups, the similarities of their resistance patterns to 10 antimicrobial compounds, the prevalence of extended spectrum β-lactamase (ESBL) and ampicillinase C (AmpC) genetic determinants, and class 1 and 2 integrons in 100 chicken meat and 400 stool samples of symptomatic patients in Tehran during June 2018 to March 2019.

Salmonella was isolated from 75% and 5.5% of the chicken meats and human stool samples, respectively. The chicken meat isolates mainly belonged to serogroup C (88%, 66/75), while the human stool isolates were mainly related to serogroup D (59.1%, 13/22). The MDR phenotype and the most common rates of resistance to antibiotics, including tetracycline, trimethoprim/sulfamethoxazole (TS) and azithromycin, were detected in 4.5% and 45.3%, 59% and 13.6%, 43% and 9.1%, 42% and 9.1% of the human stool and chicken meat samples, respectively. Carriage of blaCTX, blaSHV, and blaPER genes in the meat isolate with ESBL resistance phenotype and blaACC, blaFOX, and blaCMY-2 among the 7 meat strains with AmpC resistance phenotype was not confirmed using polymerase chain reaction (PCR). High prevalence of class 1 and 2 integrons was characterized and showed a correlation with resistance to TS and chloramphenicol.

These findings showed a lack of association between chicken meats and human isolates due to discrepancy between the characterized serogroups and resistance phenotypes.

Tuberculosis (TB) is the 10th</sup> most common infectious disease in the world, and it is one of the major health problems in Iran despite the implementation of the National Tuberculosis Control Program.

Tuberculosis data in Iran were used in 2016 by the Ministry of Health and Treatment. The data on mortality and incidence of disease were determined by age groups, sex, and the provinces of country. Data were analyzed using Excel (2010) and SPSS software.

The overall incidence rate of tuberculosis in the country was 9.7 per 100000 population (10.7 in men and 8.7 in women). The highest incidence rate of TB and mortality in both sexes were over 80 years. The death rate was 1 person per 100,000 populations, 57.7% of whom were men. Most of the deaths were from pulmonary tuberculosis. The highest incidence and mortality rates were reported in Golestan and Sistan and Baluchestan provinces.

The incidence and mortality rate of TB has decreased in recent decades in Iran. Nevertheless, considering the raising trend of human immunodeficiency virus (HIV) among the patients with TB, and the neighborhood with endemic countries, TB should be noticed as one of the most important health priorities in the health system of the country.

This article provides an overview of the national nosocomial infection surveillance system in Iran and its current status, achievements, and challenges.
  All relevant reports, documents, and program guidelines, as well as published literature and surveillance data related to the nosocomial infection surveillance system in Iran were critically reviewed. Opinions of the key informants at local and governmental levels were also reviewed.
  The program was launched in 2006 covering 100 volunteer hospitals. Since 2016, participation in the program is obligatory, leading to the participation of 555 hospitals with >100 beds (56%). Major data collected in the program include demographic characteristics, infections and related risk factors, pathogens and their antimicrobial susceptibility/resistance, and patient outcome. Recently, device-associated infection rates are also calculated in the program. Since its establishment in 2006, the program has improved in terms of case finding and coverage. Implementation of the program has also had positive impacts on the stakeholders’ knowledge, attitude, and practice.
  Although the number of identified cases and program coverage have improved, a considerable proportion of the infected cases still remain undiagnosed. Implementation of the program has also improved the stakeholders’ awareness, attitude and practice. The program faces a number of challenges, including lack of appropriate scientific support from academics and executive issues. Integration of active and sentinel surveillance in selected hospitals, persuasion of physicians to actively participate in the program, and conducting incidence and prevalence surveys would help the program to better detect nosocomial infection cases.

Cholera is one of the public health ththat has received attention due to climate change and weather variables. In the current study, the trend of cholera and its epidemics was assessed in the last 50 years in Iran based on climatic variables.
In a retrospective cohort study, all cholera cases and epidemics of the disease in the country (Iran) were assessed using the registry system of the Center for Communicable Disease Control in the Ministry of Health and Medical education (MOH&ME) from 1964 to 2014. Furthermore, the incidence of cholera was evaluated in 2005-2014 by province. The temperature and rainfall data were obtained from the provincial Meteorological Organization. The correlation coefficient test and mixed-effects binomial regression model were used for data analysis.
A significant positive correlation was found between cholera and rainfall (r = 0.168, P = 0.008). A one-millimeter increase in rainfall increased the incidence of cholera by 10.9% but temperature changes had no effect on cholera outbreaks. The incidence of cholera declined significantly by 14.7% each year from 2005 to 2014. The highest incidence of cholera was reported in Sistan-Baluchestan, Qom, Tehran, Kerman and Hormozgan provinces in a descending order.
In recent years, the the overall incidence of cholera has decreased. The occurrence of cholera is an outcome of rainfall in the previous year. Therefore, increased rainfall increases the number of cholera cases in the next year. However, temperature changes are not related to cholera outbreaks.

Family is the most important component of community and family health leads to spiritual excellence and intellectual growth. The high and still growing figures of divorce highlights the importance of emotional and sexual intimacy, which culminates in sexual satisfaction, and development and promotion of knowledge about sexual compatibility in couples as the most important and efficient approach. A conventional approach is currently being implemented in premarital counseling centers. The aim of this study is to investigate the effect of acceptance commitment therapy (ACT)-based premarital counseling on sexual satisfaction in comparison with a conventional approach.
The study population of this clinical trial consisted of all couples referring to premarital counseling centers across Isfahan, Iran. Sixty couples were selected and then randomly divided into two groups of 30 each: experimental and control. The data were analyzed by SPSS 21and Mann-whitney test.
No significant difference was seen in effect on the couple's sexual satisfaction between the couples undergoing ACT-based counseling and conventional premarital counseling (P>0.02).We need more research with samples and select a target that last between one and five years of their marriage, be considered.
It seems that choosing a very short time before common life or immediately afterwards was not effective in teaching with methods such as an acceptance and commitment approach, because at this time couples have a special excitement And still have not faced with encounters the problems that make them need to get advice.

Family is the most important component of community and family health leads to spiritual excellence and intellectual growth. One of the debates in current society is to enhance the bases of marital life. More than half of the sexual problems which cause family life and marital relationships abolishment are due to insufficient knowledge or erroneous beliefs about sexual relationships. The aim of this study is to investigate the effect of acceptance commitment therapy (ACT)-based premarital counseling on the couples’ sexual function.

The study population of this clinical trial consisted of all couples referring to premarital counseling centers of Isfahan in 2015. Sixty couples were selected and then randomly divided into two groups, an experimental group(30 couples) and a control group(30 couples). Then they completed a questionnaire of sexual function. The data were analyzed by SPSS 21 using the Mann-Whitney test.

The results of this study with the aforementioned condition showed the lack of significant difference in the couple’s sexual function between premarital counseling and the approach based on acceptance and commitment. So, it seems that performing a research with more samples and a target group having 1-5 marital experience would be necessary.

The results showed no significant difference between the effect of premarital counseling acceptance and commitment therapy – based approach on the couples’ sexual fanction in comparison with a premarital conventional approach(p>0.02).

With the increasing life expectancy and aging density of population in some communities, the world's older population is rapidly increasing. With age, there is a gradual reduction in physical activities thereby leading to an increased prevalence of chronic diseases and reduced individual and social performance in elderly individuals. The importance of this present study can be noted from the factors including changing epidemiological pattern of disease in the elderly, susceptibility to the chronic diseases and increasing number of seniors facing relative health issues but deprived from healthcare needs. In order to optimize the management and careful planning of the healthcare services for the rural elderly, there is a need for extensive research in this field. The aim of this study was to evaluate the health status of elderly patients living in the rural cities of Ashtian city, Markazi Province.
Methods & Materials: This cross-sectional and descriptive-analytical study included 200 elderly people from Ashtian villages selected using the cluster sampling technique. After gaining consent from the participants, the required information was collected through questionnaire, physical examination, and laboratory tests. The results of the tests were processed using SPSS software. Chi-square test was also used, and P This study consisted of 126 females and 74 males of which 156(78%) were illiterates, 52(26%) were widows, 2(1%) were single, 32(16%) were living alone, and 10(5%) were smokers. The prevalence of disease noted in this study is given below: osteoarthritis, 163(81.5%); static and dynamic imbalance, 138(69%); hypertension, 120(60%); hyperlipidemia, 111(55.5%); urinary disorders, 99(49.5%); depression, 95(47.5%); cognitive disorders, 92(46%); hearing problems, 88(44%); nutritional problems, 83(41.5%); sleep disorders, 76(38%); angina, 67(33.5%); and diabetes, 18(9%). Moreover, there was a significant relationship with widowhood (P The findings of this study suggested that physical diseases and functional limitations among elderly people in rural areas are a very crucial matter. Based on the results of this research and high frequency of chronic diseases in the rural elderly, especially osteoarthritis, imbalance, depression, hypertension, nutritional problems, vision and hearing problems- and angina diseases, the screening and monitoring activities for these diseases should be duly executed. The study also revealed that certain sections of the society including women, elderly, less educated, and unemployed, either living in celibacy or in the village are faced with several health problems. Thus, special attention should be paid to the vulnerable groups in terms of the health policies dedicated for their welfare.

Play oriented development provide an opportunity to achieve a state of good performance, and individual and social wellbeing. The current study was conducted to analyze the early childhood development policy, and to propose the play-oriented interventions.
In this Multi Methods research, health policy analysis triangle was applied to analyze the policy and develop the interventions. Situation analysis was performed according to the national and international archives, texts and websites, and in-depth interviews were used to stakeholders’ analysis.
According to review of the documents and interviews with 21 stakeholders, the most common problems indicating the necessity of the policy agenda setting retrieved as following: lack of national trustee organization for management, planning, inter-sectorial coordination, monitoring and evaluation of children's play and toys; the shortage of knowledge and attitudes of policy makers, managers, community, teachers, and parents; and lack of high quality and standardized toys and play facilities with unequal geographic, age and vulnerable groups distribution. Therefore, in the policy draft three major strategic targets were set, and interventions were proposed accordingly for each involving sector and community participation program.
Finalizing the policy draft by holding consensus sessions with representatives of the stakeholder organizations, it’s legitimizing, the formation of national council of children's play with attendance of important stakeholders, and following up the implementation of the proposed interventions could provide the possibility of achieving the policy objectives to reduce the social inequalities and meet the health equity.

Continuing education of human resources is an integral part of medical universities’ tasks to offer desirable services and meet the society’s needs which is achieved through various ways including workshops. Therefore, the purpose of this study was to examine the extent of compliance with principles of designing and implementing educational workshops by the vice chancellor for health of Arak University of Medical Sciences.
This descriptive, cross-sectional study was performed in 2014. The population and sample consisted of in-service all of educational workshops for the staff of the vice chancellor for health of Arak University of Medical Sciences which were calculated at 28 workshops Data collection tool was a researcher-made checklist whose validity and reliability had been confirmed. Also, a survey questionnaire was randomly distributed among 20 learners in each workshop leading to a total number of 560 learners. Data were analyzed by central tendency and dispersion indices.
The mean score of design was at a desirable level (78.18±9.07 out of 100), while that of implementation was average (60.47±7.72). The highest score of design was related to content-goal compatibility (4.71±0.76 out of 5), while the lowest scores were related to the appropriate number of participants (2.67±0.72), learners’ knowledge of prerequisites (2.95±1.57) and proportion of the time of theoretical subjects and group work (3±0.94). As to implementation, the highest scores were related to the behavior and impact of teachers in learning (4.23±0.72) and clarity of goals (4.18±0.74), while the lowest scores were related to the content’s scientific accuracy (1.95±0.99), the lack of complete relevance of contents to learners’ needs (2.02±1.24) and improper implementation of group work (3.23±1.48).
The results indicate the desirability of workshops’ design but most of the learners had an average evaluation of the implementation. Therefore, it is suggested that besides holding training courses for directors about the implementation of workshops, special attention should be given to overcoming the weaknesses of workshops’ design.

Improvement of nutrition like fish and sea products is influential in preventing from non-contagious diseases. The transtheoretical model is one of the models for effective investigation on nutrition behaviors. This study was done with the aim of investigating fish consumption among women 30 to 50 years old based on the transtheoretical model.
This study was an analytical and cross sectional analysis which was conducted in 2014 on 360 women 30 to 50 years in Arak city. The data have been collected by using researcher-made questionnaires which its validity and reliability was assessed in accordance to the transtheoretical model were obtained by visiting houses. Then the collected data were analyzed by pearson correlation test.
The average age of the respondents was 39.34±7.5. The average of fish consumption was 0.62 ±0.83 times a week. 64 % of people in consumption of at least two servings of fish a week were in the two first stages of change (pre-contemplation and contemplation).The average score of self-efficacy in fish consumption was a total of 10.58 ±3.12 out of 15 and the average score of cons of fish was 26.35 ±4.78 and the average score of pros of fish was 21.6 ±2.67 out of 25. Pearson correlation indicates that the amount of fish consumption with constructs of the self-efficacy, stages of change and pros of fish had respectively the most positive correlation (p≤0.05). Fish consumption had no significant difference with age, education, Body Mass Index, occupation, monthly income and marital status.
Fish consumption despite its high level of perceived benefits is really low and to eliminate these barriers, education and cultural-building especially in women who are influential people in family nutrition is necessary.

Osteoporosis is the most prevalent metabolic bone disease which is characterized by low bone mass and increased risk of fracture. The present study was conducted to assess the prevalence of osteoporosis and T-score discordance between femur and lumbar spine as well as their risk factors in a group of healthy postmenopausal women and men older than 50 years old based on Iranian Multicenter Osteoporosis Study data in phase 3 compared to phase 1. This research is a cross-sectional study. 295 men and 397 women in IMOS 3 from Arak and Sanandag، and 868 men and 685 women from Tehran، Mashad، Tabriz، Shiraz and Bushehr were recruited based on randomized cluster sampling osteoporosis and osteopenia prevalence in men were 32% and 50% respectively، which were more in IMOS 3 compared to IMOS 1 (28% and 49. 3%) but no statistical significance was noticed p=0. 258. In postmenopausal women there were no difference in osteoporosis and osteopenia prevalence between IMOS 3 and IMOS1. There were no difference in discordance prevalence in IMOS 3 compared to IMOS 1. Logistic regression analysis revealed body mass index and physical activity had protective role against osteoporosis and osteopenia. It seems osteoporosis in men has greater rate compared to women. Lifestyle changes especially physical activity and nutrition can play a significant role in the prevention of osteoporosis. And based on T-score discordance between femur and lumbar spinebperforming BMD at two different sites is necessary for the Iranian population.

Nowadays, solid waste management is one of the major concerns among the human societies. The aim of this study was to assess the viewpoint of people in different professions about waste management in developing educational methods. This is an analytical study that was carried out on 275 workers and 667 staff in offices of Arak city in 2012. Data was collected by questionnaire including knowledge, attitude, practice and appropriate source of education for waste management. Finally, data was analyzed by statistical chi-square and T- test. The mean of awareness among workers and offices was 4.5± 2.1 and 6.7± 1.9 respectively with a significant difference (p=0.041). Moreover the mean in attitude was 18± 5.6 and 26.12± 7.1 respectively that was with a significant difference (p=0.025). There was a significant relationship between level of awareness, job and level of education (p<0.05). 39% of workers had said that television and radio were the most influential sources in educating waste management. According to the low awareness of different professions and considerable waste volume, fundamental and technical modifications in waste managements are necessary.

Prostate cancer is one of the most common cancers among men, that is increasing in incidence and mortality. Considering the epidemiologic trend of prostate cancer, the aim of this study was to investigate the incidence of prostate cancer in the years 2005-2010 in Markazi Province. In this analytical study, which data was derived from the Cancer Registry of Markazi Province, crude incidence per 100 thousand persons and age-standardized incidence in the method of direct standardization using the world standard population were calculated. Data Analysis was conducted using the Cochran-Armitage and winpepi software version 2.1. In this study among 182 patients with prostate cancer in 2005–2010, 144 patients (%79) inhabited in city and others in rural. Regarding age, 16 persons (%8.8) were between 50-60 and majority 84(%46) were 70-80 years old. In the 6- year study, 182 cases of prostate cancer were recorded. Age-standardized incidence rate during the years 2005 to 2010 was respectively: 3.24, 3,3.44,5.05,5.75, 5.61 cases per hundred thousand people which shows an increase in the disease. The highest observed incidence in the age group was above 70. The standardized incidence rate of prostate cancer in Markazi province in comparison with the world, particularly developed countries, is much less that can be due to lack of screening programs or the incomplete records.

W aste management is a major concern in human societies. Citizen’s awareness and positive attitudes towards the issue can facilitate accurate and efficient measures. The aim of this study was to assess knowledge, attitude, practice and educational needs of mothers in households about the disposal of waste in Arak in 2011. This was a cross-sectional study in which 1215 women were recruited. Participants were selected from three different areas of the city. Data were collected via a questionnaire including knowledge, attitude, practice and appropriate resource of education items on the waste management. Data were analyzed using proper statistical tests. The mean knowledge of mothers was 5.8±2.3 (out of 8). The mean attitude was 26.1±7.8 (out of 35). Most of the women (35%) believed that waste should be collected around 10-11 p.m. There were significant relationships between the knowledge with job and level of education (p<0.05). Most of the women living in the third area of the city (70%) believed in waste recycling and 89.9% believed in separately collecting the recycled waste (p=0.01). There were significant differences between the three areas of the city on proposed educational strategies to enhance citizens knowledge on waste management (p=0.00). Our study showed that the knowledge of women about the waste management was adequate. Further research should be carried out to clarify the barriers of collaboration of people in the waste management. Appropriate strategies should also be designed through health centers and/or media to improve the performance of the people on the issue.

To determine the sensitivity, specificity, and predictive value of visual screening examination in students living in urban areas of Iran. The first grade students of 7 cities of Iran were randomly selected in a population based cross sectional study in 2013 using multistage cluster sampling. After obtaining consent from the students’ parents, examinations including corrected and uncorrected visual acuity, cycloplegic and non-cycloplegic refraction, and cover test were performed for all students by an optometrist. The criterion for visual problem was a cut point of 20/32 or worse for uncorrected visual acuity. In addition, the validity of the uncorrected visual acuity measured in the national screening program, which is recorded in the students’ health profiles, was calculated. Out of total 4157 individuals who were selected for the study, uncorrected visual acuity was measured in 3645 participants. The sensitivity and specificity of uncorrected visual acuity measured in the national screening program was 35.3% (95% CI 29.2%-41.7%) and 93.9% (95% CI 93.04%-94.7%), respectively. The lowest sensitivity was observed in Dezful (19.6%) and the highest was observed in Ardebil (83.3%). The predictive value of the examinations was 28.8% (95% CI 23.6%-34.3%) and the best cut point of uncorrected visual acuity was recorded as 20/25 in the national screening program. The validity of the visual screening program which is performed before the first grade of primary school is very low. It should be noted that since many families trust these examinations, they do not follow up their children’s condition any more based on the results of these examinations. Therefore, the validity of these examinations, especially their sensitivity, should increase through training the examiners or using more specialized methods.

This study aimed to compare the efficacy and safety of insulin versus oral hypoglycemic drugs for gestational diabetes treatment, using evidence based medicine approach. This secondary study was conducted by selecting a comprehensive systematic review through searching the Cochrane library. To calculate the number needed to treat (NNT), outcomes such as cesarean section, macrosomia, birth weight more than 90th percentile, operative vaginal delivery, labor induction, post partum hemorrhage, and shoulder dystocia has been considered while neonatal hypoglycemia, NICU hospitalization and fetal distress were considered for calculating number needed to harm (NNH). To calculate the likelihood of helped versus harmed (LHH), macrosomia and hypoglysmia were selected. Data were analyzed with Wilson score test. The NNT for above outcomes; were 3, -14, -5, 16, -3, 31, and 32, respectively. Among them cesarean section was significance. Calculated NNH for side effects were 6, 15, and -17 which only was significance for neonatal hypoglycemia (p<0.05). The LHH was estimated -0.43. Considering LHH, it seems that the benefit of insulin in management of gestational diabetes is more than metformin. But with respect to issues such as low sample size of trials, lack of assessment the maternal hypoglysemia as complication of insulin therapy, the findings should be considered cautiously.

Introduction and Cancer is the third leading cause of death after Coronary Artery Disease and accidents in Iran. This Research has been carried out to Study the epidemiology of gastrointestinal cancers (Stomach, esophageal, colorectal) in Markazi province during 2005-2010. This is an analytical cross-sectional study that was carried out on cancer registry data collected from Markazi province between 2005-2010 years. Cancer incidence adjusted based on the age structure and agespecific incidence rates were calculated. Most statistics on the Morbidity of gastric cancers in the study was 642 patients (51.2) that associated with gastric cancer and after which the CRC 444(35.4%) patients and esophageal numbers of 169 (13.5%) patients. in this study 61.8 % (801 patients) of cases in the age group 80-70 years,male, 387 cases (30.8%) and the highest 77.1% living in urban areas has been observed in terms of location. mean age at estimated time of diagnosis was 69 years. Rates age standardized incidence of digestive cancers in males and female was 141.04 and 73.39 respectively. Identification of risk factors and prevention of gastrointestinal cancers in Markazi province is required. Training programs related to the prevention of cancer in people at high risk should be presented.

poly chlorinated biphenyls (PCB) are occupational and environmental pollutants and hazardous organic compounds that have created major environmental and occupational challenge. PCB compounds are caused the different health effects in human depending of sex، age، route of entry، intensity and frequency exposure. This study was conducted to determine the effect of microwave rays، hydrogen peroxide، TiO2، catalyst and ethanol on the composition of PCB in order to reduce occupational hazards.

In this experiment used a MW oven، Pyrex vessel reactor (250ml volume)، Pyrex tube connector and condensing system. A hole was pierced on the top portion of the oven and the Pyrex vessel reactor was connected with the Pyrex tube connector. Ray powers used in 540، 720 and 900W. pH and temperature was continuously monitored. The experiments were repeated three times. The PCB were analyzed by GC-ECD and spss version 16 software package was used for statistical analysis.

The degradation of total PCB in terms of 540،720 and 900W was 83. 85، 88. 89 and 96. 33% respectively. The degradation of total PCB in terms of ratio to solvent with oil transformer in 1:1، 2:1 and 3:1 was 54. 19، 79. 16 and 95. 07% respectively. The degradation of total PCB in terms of not using of / and using 10% of and 0. 05، 0. 1، 0. 15 and 0. 2g was 70. 72، 89. 43، 90. 40، 91. 59and 93. 21% respectively. The degradation of total PCB in terms of not using / and using 20% of and 0. 05، 0. 1، 0. 15 and 0. 2 g was 70. 72، 94، 95. 07، 96. 33 and 97. 17% respectively. Discussion&

The results of this experiments showed that using microwave Rays،H2O2 oxidant and TiO2 catalyst lead to a degradation efficiency of PCBs only in the presence of ethanol. Increasing the concentration of ethanol and H2O2 and also amount of TiO2 should increase the generation rate of hydroxyl radical and thus the oxidation and dechlorination of the PCBs.

Different studies performed in the world and Iran reported the educational level of the mother، history of more than four pregnancies، living in rural areas، receiving no prenatal health care، and lack of access to maternal emergency services as the most important factors affecting maternal mortality rate. Few studies have determined contribution of indirect causes of maternal deaths. This study aimed to determine the contribution of indirect causes of a maternal death in Markazi province. This is a retrospective and descriptive-analytical study. Case report method and Root Cause Analysis (RCA)، as an important method used in clinical epidemiology، were applied to describe and analyze a maternal mortality occurred in Markazi province، respectively. This approach deals with identification and solving the root causes of health problems (Sentinel Event). Data were collected by interview and inspection of written documents. Bayesian analysis and calculation of the conditional probabilities were applied using Netica 5. 08 software. Receiving no maternal prenatal care، not following the ministerial and provincial guidelines، lack of team working and coordination between medical specialists in the treatment of high-risk pregnant women in the hospital were identified as indirect causes of the maternal death. Indirect causes accounted for 43% of the maternal death. Indicating cardiomyopathy as a cause of death on death certificate of the mother was incorrect. Determining the principal cause of the death، Root Cause Analysis، and eliminating the indirect causes of the death play important roles on decreasing 50% of the maternal deaths.