seyedmorteza shamshirgaran

This study aimed to investigate the relationship between Vitamin D levels and Cardiovascular Diseases (CVDs) such as myocardial infarction (MI), stroke, and angina. Data for this cross-sectional study were collected as part of the Neyshabur Longitudinal Study on Ageing (NeLSA) between 2016 and 2018. The effect of Vitamin D on CVDs was analyzed in conjunction with socioeconomic and medical history variables. Statistical analysis was conducted using the Chi-square test and logistic regression in the R. Vitamin D levels were evaluated in 3414 participants (1527 men and 1889 women), with over two-thirds of participants showing insufficiency or deficiency of Vitamin D. Among them, 362 participants had self-reported diagnosed CADs. The study did not find a significant association between serum 25OH Vitamin D levels and the risk of CADs. Adjusted logistic regression revealed that male gender was a risk factor for MI (OR=4.7; 95% CI: 3.125-6), stroke (OR=1.75; 95% CI: 1.08-2.85), and angina (OR=1.6; 95% CI: 1.03-2.7). Additionally, having one or more medical conditions other than hypertension and diabetes was associated with angina (OR=7.14; 95% CI: 3.7-14.7), MI (OR=5; 95% CI: 2.97-8.3), and stroke (OR=2.7; 95% CI: 1.2-4.7). Participants aged over 70 years were more likely to experience angina (OR=2.43; 95% CI: 1.36-4.5) and stroke (OR=2.5; 95% CI: 1.35-4.5). The study revealed a high prevalence of Vitamin D deficiency and insufficiency. While the protective role of Vitamin D against CADs was not supported in this study, it does not discount the potential benefits of Vitamin D supplementation for overall health in older individuals.

 The quality of sleep has different physical and psychological consequences, and can affect students' academic achievement.

 This study aimed to explore factors associated with sleep quality in university students using panel regression.

 This study was conducted based on the data from a longitudinal study, namely the “Health and Lifestyle of University Students”. The Pittsburgh Sleep Quality Index (PSQI), a self-administered questionnaire containing general information about sleep quality, Beck Anxiety Inventory (BAI), a questionnaire consisting of information about anxiety, Healthy Lifestyle Scale for University Students (HLSUS), and a questionnaire including information about lifestyle were completed by students during the first eight weeks of their first semester. The Panel linear regression and frontier model were used to assess the association of sleep quality with sex, unit, residency, marital status, teeth brushing, drug use, alcoholic drinks, age, anxiety, and healthy lifestyle.

 A total of 706 individuals (46.8%) suffered from poor sleep quality. Between the two models of panel linear regression and frontier, the former (i.e., panel linear regression) was determined to be a more powerful model with the Akaike information criteria = 3790.68 and Bayesian information criteria = 3899.712, suggesting that the dormitory students with a high level of anxiety and low level of healthy lifestyle had significantly poor sleep quality.

 Residency, drug use, anxiety, and healthy lifestyle scale were found to be closely associated with sleep quality of university students by using panel linear regression model. Our finding may have been of valuable help to policymakers and planners in their effort to improve the sleep quality of university students.

In the presence of competing risks, patients with brain stroke (BS) experience death by various causes, such as diabetes, and heart disease, and other causes in the follow-up. This study aimed to model the survival in patients with BS in the presence of these competing risk of death using cumulative incidence function (CIF) and cause-specific hazard (CSH) models.

In the study, 332 patients with the definitive diagnosis of BS were followed up for 10 years, and their mortality status due to BS or other causes was evaluated. In addition, significance tests and parameters were estimated by using STATA 14 software by considering the CIF and CSH model.

The median follow-up time was 20.68 months for patients who died due to BS and 68.50 months for patients who died due to other causes. In the CIF model, Sex [BS: cumulative incidence hazard ratio (SHR) = 2.35, 90% confidence interval (CI) = (1.76-3.14)], Employment status [BS: 2.04(1.50-2.75)], History of blood pressure[BS: 1.64(1.25-2.14)], Heart disease[BS: 1.47(1.13-1.94)], Cerebrovascular accident type[BS: 0.77(0.69-0.87)]; age [Other case: 59-68 years, 2.61 (1.13-6.06) and ≥76 years: 3.03 (1.32-6.92)] were directly related to hazard of death. The CSH model resulted in similar estimates except for age [BS: 69-75 years; 1.31(1.18-1.45), ≥76 years; 1.37(1.23-1.53); other case: age 59-68 years 1.91 (1.22-2.99) and 69-75 years; 1.89 (1.21-2.96) and ≥76 years: 2.14 (1.36-3.37)], Sex[BS: 1.38(1.07-1.79)], History of blood pressure [BS: 1.57(1.20-2.05)], Heart disease [BS:1.44(1.09-1.91)] were directly related to hazard of death.

The estimation of CIF analysis, along with CSH one for the competing risks, is suggested to provide more precise information about patients’ status in order to support adopted clinical decisions when aiming at assessing health related to a specific cause economically and determining the probability of occurring an intended event among other causes.

This study aimed to assess the association between the survival of patients and outcomes in Brain Stroke (BS) in the presence of competing risks utilizing a Weibull parametric model.

In this longitudinal study, 332 patients with BS were attended from Imam Khomeini Hospital in Ardabil, Iran. The stroke was diagnosed according to the medical history, current symptoms, and brain imaging during June 2008 and 2018. The survival of the patients, as the primary outcome, was modeled utilizing the best-chosen Weibull model in the presence of competing risks, including stroke and other factors (heart disease, blood pressure, etc.).

Older age at diagnosis (59-68 years: hazard ratio [HR]=2.27; 90% confidence interval [CI]: 1.65 to 3.12; 69-75 years: HR=4.79; 95% CI: 3.56 to 6.44; ≥76 years: HR, 4.92; 95% CI: 3.55 to 6.80), being a male (HR, 1.39; 95% CI: 1.11 to 1.75), being unemployed (HR, 1.44; 95% CI: 1.39 to 1.82), having heart disease (HR, 1.68; 95% CI: 1.38 to 2.06), and hemorrhagic stroke (HR, 2.21; 95% CI: 1.378to 2.75) were directly related to death from BS. Older age at diagnosis (59-68 years: HR, 18.01; 90% CI, 5.33 to 64.92; 75-69 years: HR, 18.56; 95% CI: 6.97 to 86.57; ≥76 years: HR, 28.90; 95% CI: 15.77 to 218.49), and urban residence (HR, 0.46; 90% CI, 0.28 to 0.77) were directly related to death from other causes.

The recognition of the influential factors on the mortality of BS patients can allow increasing their survival.

The artificial intelligence field is obtaining ever‑increasing interests for enhancing the accuracy of diagnosis and the quality of patient care. Deep learning neural network (DLNN) approach was considered in patients with brain stroke (BS) to predict and classify the outcome by the risk factors.

A total of 332 patients with BS (mean age: 77.4 [standard deviation: 10.4] years, 50.6% – male) from Imam Khomeini Hospital, Ardabil, Iran, during 2008–2018 participated in this prospective study. Data were gathered from the available documents of the BS registry. Furthermore, the diagnosis of BS was considered based on computerized tomography scans and magnetic resonance imaging. The DLNN strategy was applied to predict the effects of the main risk factors on mortality. The quality of the model was measured by diagnostic indices.

The finding of this study for 81 selected models demonstrated that ranges of accuracy, sensitivity, and specificity are 90.5%–99.7%, 83.8%–100%, and 89.8%–99.5%, respectively. Based on the optimal model (tangent hyperbolic activation function with the minimum–maximum hidden units of 10–20, max epochs of 400, momentum of 0.5, and learning rate of 0.1), the most important predictors for BS mortality were time interval after 10 years (accuracy = 92.2%), age category (75.6%), the history of hyperlipoproteinemia (66.9%), and education level (66.9%). The other independent variables are at moderate importance (66.6%) which include sex, employment status, residential place, smoking habits, history of heart disease, cerebrovascular accident type, blood pressure, diabetes, oral contraceptive pill use, and physical activity.

The best means for dropping the BS load is effective BS prevention. DLNN strategy showed a surprising presentation in the prediction of BS mortality based on the main risk factors with an excellent diagnostic accuracy. Moreover, the time interval after 10 years, age, the history of hyperlipoproteinemia, and education level are the most important predictors for BS.

Data on the factors affecting long‑term mortality following a stroke in Iran are scarce. The current research aimed at investigating the extent of 2‑year mortality following a stroke and the factors affecting it in the northwest of Iran.

This prospective cohort study was conducted in Tabriz, Northwest of Iran. Patients with computed tomography/magnetic resonance imaging confirmed the first‑ever stroke were included in this study and followed up to 2 years. Clinical examinations, including the severity of the stroke using the modified National Institutes of Health Stroke Scale (mNIHSS), were conducted by a neurologist. The general characteristics, lifestyle factors, and laboratory tests were also completed. To estimate the survival, Kaplan–Meier analysis was used; and for group comparison, the log‑rank method was applied. To identify the factors predicting 2‑year mortality, semiparametric Cox regression analysis was used.

A total of 1036 first‑ever stroke patients were included in the present study. The mortality rates of stroke in 6‑month, 1‑year, and 2‑years follow‑up periods were 31.6%, 34.5%, and 38%, respectively. The two‑year mortality rate was 33.6% in ischemic and 58.7% in hemorrhagic stroke (P < 0.001). In the multivariate Cox model, variables age, type of stroke, diabetes, and severity of the stroke, according to the mNIHSS index, were identified as factors predicting 2‑year mortality following the stroke.

The 2‑year mortality following acute stroke was relatively high compared to that of in developed countries. Implementation of secondary prevention is recommended to better management of modifiable predictors of mortality.

Malnutrition is extensively prevalent amongst critically ill patients afflicted by ischemic stroke (IS). This study purpose was to evaluate the protein whey effect on inflammatory and antioxidant markers and functional prognosis in acute IS patients.

out of 42 patients with acute IS who were referred to Imam Reza Educational Hospital, Tabriz, Iran, 40 patients participated in the study. Twenty-one patients as control group received the hospital routine formula, and 19 patients as intervention group received 20 g/daily of whey protein through oral gavage. Inflammation and oxidative stress indicators (e.g., albumin, malondialdehyde (MDA), total antioxidant capacity (TAC), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and high sensitivity C reactive protein (hs-CRP)and clinical variables included in were evaluated using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) during admission and also 3 weeks after intervention.

Whey protein supplementation significantly decreased the NIHSS and mRS scores, TNF-α, IL-6, and hs-CRP by passing 3 weeks from intervention (P < 0.05). However, whey formula had no significant effect on other markers including albumin, and MDA. The hs-CRP (P = 0.02) reduction was significantly higher in whey protein group in comparison with control group.

Whey protein supplementation reduced inflammation markers in those patients with IS. However, these changes should be studied in larger-scale trials.

Frailty is a common geriatric syndrome. Studies of frailty and old age have been able to help reduce its underlying causes and complication. Understanding the frailty and its associated factors in developing countries such as Iran, can help gather information on conditions of the elderly and better plan for this age population. Therefore, the present study was implemented to investigate the prevalence and determinants of frailty in the rural elderly population of Shabestar, East Azarbayjan, Iran.

This cross-sectional study was conducted among 565 rural older people in Shabestar, Iran during 2018-2019. The data collection tool was the Tilburg Frailty Indicator. The participants were selected by using stratified and simple random approach. Descriptive statistics, t-test, one-way ANOVA and logistic regression were used to perform data analysis.

Of the participants, 46.7% were detected as being frail. The associations between the prevalence of frailty and sociodemographic characteristics such as age, gender, marital status, types of lifestyle, educational level, and income status were statistically significant (p < 0.05). Regression analysis showed that age (β = -0.84, p < 0.05), the number of medications used (β = -2.72, p < 0.001), hypertension (β = -0.633, p < 0.006), diabetes (β = -535, p < 0.045) and the history of fall during the last year (β = -4.21, p < 0.001) were the most important predictors of frailty among non-institutionalized rural older people.

The study confirms the importance of common chronic medical conditions and sociodemographic characteristics in the development of frailty syndrome among older adults. The descriptive nature of the study implies observational trials to clarify more deeply relationship between frailty and the determinants found.

Stroke is the second leading cause of death worldwide and the number of stroke cases has increased remarkably over the last 20 years. This study aimed at identifying predictors of with 6‑month mortality of first‑ever stroke patients and the factors contributing to it in East Azerbaijan province.

A closed cohort study was carried out from April 2014 to December 2014. All cases of first‑ever diagnosed stroke were included in the study. Any transient ischemic attack, silent brain infarctions, and the stroke cases which were neither associated with trauma, blood disease nor with malignancy were excluded from the study. The variables of this study include participants’ demographic characteristics, stroke severity National Institutes of Health Stroke Scale (NIHSS), and stroke risk factors. Patients were followed up within 6 months. To determine the survival time, the log‑rank method was applied to compare intergroup differences. The tests include the univariate and multivariate analysis Cox regression. P < 0.05 were considered as statistically significant.

A total of 576 cases of stroke were included in this study. Average age of ischemic and hemorrhagic stroke was 70.15 ± 13.0 and 67.79 ± 12.69, respectively. Case‑fatality rate (CFR) of stroke patients was 49.2 and 21.7% in hemorrhagic and ischemic stroke types, respectively. Factors contributing to stroke mortality events include the severity of stroke (NIHSS categories 15–19 and ≥20), age over 65, being female, high body mass index and hyperlipidemia. In the final model, the severity of stroke (with NIHSS 15–19 with hazard ratio (HR) 4.22 (95% confidence interval [CI] 2.36–7.56) and NIHSS ≥20 with HR 5.34 (95% CI: 2.81–10.12) and age above 65 with HR 1.61 (95% CI: 1.02–2.51) were the most important predictors of 6‑month mortality.

Severity of stroke by NIHSS was the most prominent factor in stroke patients’ mortality. By increasing the follow‑up time, a better evaluation of the predictors of mortality after stroke can be achieved.

The present study aimed at assessing the validity of self-reported drug use in people aged 35 and older in a pilot phase of a population-based cohort study.
A total of 1038 adults over 35 years old in Khamene city in East Azerbaijan province were recruited for the pilot phase of Azar cohort; a province-level of a nationwide PERSIAN cohort study completing a questionnaire and providing biological samples from October to December 2014. Information about the history and duration of smoking tobacco, using drug and medication were obtained by the physician. The validity of the drug use was assessed through comparing the questionnaire response with three urine strip tests for the detection of morphine, amphetamine and methamphetamine among 259 randomly selected subjects.
The prevalence of drug use according to self-report was 2.6% (95% CI: 1.7%-3.8%).One-step drug test as the gold standard for the use of drug self-reported demonstrated a sensitivity(95% CI) and specificity 15% (10-22) and 99.7% (98.9%-99.9%) respectively. All participants with positive self-report were male; however, in the urine analysis drug test, it was positive for 7out of 68 randomly selected women.
The validity of self-reported drug use in this population was low; therefore, the self reported use of the drug should be used with caution in this population. It is recommended to use alternative techniques to improve the validity of data using the self-report procedure.

There is remarkable alteration in hypertension prevalence and awareness, and their correlates among various geographic locations and ethnic groups. The aim of this study was to report hypertension prevalence, awareness, and its correlates as well as hypertension treatment, and control among Azari people aged 35 years and older.

The pilot phase of the Azar Cohort Study; a state level of a nationwide PERSIAN cohort study was conducted in Khameneh city between October 2014 and January 2015. All people 35 years of age and above were invited to take part in this study. A comprehensive range of different biomarkers, lifestyle, socioeconomic factors, and health‑related factors was collected. Blood pressure was measured by a trained nurse/midwife. Descriptive statistical methods were used to present general characteristics of the study population as frequency tables. Separate multiple logistic regression models were built to assess the predictors of hypertension prevalence.

A total of 1038 people were included in this study. The overall prevalence of hypertension was 22.9%. Awareness of hypertension was 60.5% and in those with known hypertension, 84% were using the antihypertensive medications, of those 68.5% had controlled hypertension. After adjustment; age (odds ratios [OR] adj = 1.12 95% confidence interval [CI]: 1.09–1.15), gender (ORadj = 1.65 95% CI: 1.08–2.51), obesity ORadj = 2.51 (1.40–4.88), waist‑to‑hip ratio (WHR) (ORadj = 1.70 (1.05–2.75), and comorbidities (ORadj = 2.51 (1.72–3.66) were independent predictors of hypertension.

Age, sex, body mass index, WHR, and comorbidities were known as predictors of hypertension in this study, health promotion strategies including lifestyle modification to reduce overweight/obesity and secondary prevention programs for early detection of hypertension in high‑risk groups according to age, gender, and disease profile are recommended.

Variations in learning styles among students could explain many differences in students’ acquisition of knowledge. This study examined the association between learning styles and academic achievement among students at Tabriz University of Medical Sciences in the northwest of Iran. This research is part of a longitudinal study entitled, "Health and Lifestyle of University Students" among undergraduate, medical, dentistry, and pharmacy students at Tabriz University of Medical Sciences who entered the university in October 2014. A self-administered questionnaire that consisted of general information and Kolb’s learning style was completed by these students during the first eight weeks of their first semester. Academic achievement was assessed using grade point average (GPA) in the following semesters (1 and 2) of the academic year. A total of 452 students were included in this study with a mean age of 19.16 ±1.03. The most prevalent learning style was convergent and the second most common was accommodative.The average GPA of the students was 15.74 ± 1.57 out of a possible 20. The results of a multivariate regression showed that the effect of learning style on academic achievement, in the presence of other variables, was not statistically significant. Sex was able to predict academic progression (β = 0.188, P = 0.001). In addition, GPA was higher among dentistry students(β = 0.128, P = 0.012) and lower among nursing and medical students (β = =-0.211, P = 0.001;β = -0.127, P = 0.015 respectively). Although students’ academic achievement was correlated with their learning style, the popularity of convergent and accommodative styles should be considered in that acknowledging the prevailing learning styles of students could promote academic achievement.

Functional limitation is one of the most important health - related concerns of diabetic patients. This study aimed to identify the factors associated with functional limitation among diabetic patients using generalized additive model (GAM) as a flexible technique to reveal the non - linear and non - monotonic association between the response and a set of independent variables.
The source data belonged to two cross - sectional studies conducted in 2014. A total of 694 people with type 2 diabetes in the age range of 31 - 70 years were selected via convenience sampling from diabetes clinics in Ardabil and Tabriz. The data were collected by interviewers using structured questionnaires and checklists. The functional capacity was measured using the physical functioning subscale of the Medical Outcomes Study Short Form 36 - Item Health Survey (SF36). Participants with a total functional capacity of less than 90 were considered to have “moderate or high level of functional limitation.” To identify the factors associated with functional limitation and reveal the shape of associations, the GAM procedure with “logit” link function was applied to the dataset of 378 diabetic patients without any missing data by smoothening of the effect of underlying factors. The Akaike information criterion (AIC) as the relative quality of the model’s criterion was computed for GAM and compared with AIC of the simple logistic regression.
Sex (P = 0.029), age (P In our sample, GAM could identify some linear and nonlinear associations between underlying factors and functional limitation in diabetic patients. These complex associations could relatively increase the fit quality of the GAM when compared to logistic regression.

Stroke is one of the important causes of death and disability in Iran. This study aimed to examine the factors influencing the short-term mortality of stroke in Northwest of Iran.
Study population were all patients with confirming the diagnosis of the first-ever stroke who were hospitalized in two referral teaching hospitals from October 2013 to March 2015. They were followed up to 30 days after onset of stroke. A neurology year three resident was responsible for extracting the clinical data and assessment of stroke severity on admission using National Institute of Health Stroke Scale (NIHSS), and information about risk factors and socio-demographic factors were collected using face to face interview. Data were analysed using Cox proportional regression by STATA software version 14.
A total of 1036 consecutive patients with first-ever stroke were included in this study. Of them, 228 patients (22%) died within 30 days after stroke accordance. Advanced age was significantly associated with a hazard for early mortality (HR=1.05 95% CI 1.09–1.04), the inverse was true for education level; mortality decreased as the education level increased; it was 25.7 percent among illiterate and 14.3 among patients with higher education. The NIHSS score on admission for 30-days mortality and hemorrhagic stroke were associated with HR=1.11 (95% CI 1.09–1.13) and HR= 1.65 (95% CI 1.15–2.36) respectively.
Advanced age, stroke subtype and high NIHSS score are the independent predictors of early mortality in this study. This provides important implications for the clinicians to target the high-risk patients for the specific therapies and management strategies.

The area under the ROC curve (AUC) is a common criterion to assess the overall classification performance of the markers. In practice, due to the limited classification ability of a single marker, we are interested in combining markers linearly or nonlinearly to improve classification performance. Ramp AUC (RAUC) is a new statistical AUC-based method which can find such optimal combinations of markers. In this study, RAUC was used to find the optimal combinations of care indicators related to functional limitation as a complication of diabetes and accurately discriminate this outcome based on its underlying markers.
This cross-sectional study was conducted on 378 diabetic patients referred to diabetic centers in Ardebil and Tabriz during 2014 and 2015. To have an accurate classification of diabetic patients according to their functional limitation status, RAUC method with RBF kernel was employed to look for an optimal combination of care indicators. Classification performance of the model was evaluated by AUC and compared with logistic regression, support vector machine (SVM) and generalized additive model (GAM) via training and test validation method.
Out of 378 diabetics, 67.46% had functional limitation. RAUC had an AUC of 1 for the test dataset and outperformed logistic (AUC = 0.079), GAM (AUC = 0.082), SVM with linear kernel (AUC = 0.67) and was slightly better than SVM with RBF kernel (AUC = 0.98).
There was a strong nonlinearity in data and RAUC with RBF kernel which is a nonlinear combination of markers could detect this pattern.

Sleep deprivation and drowsiness are very common among university students. The aim of this study was to examine the sleep quality and academic achievement among university students across all medical disciplines in Northwest of Iran.
This study was based on data from a longitudinal study, the "Health and Lifestyle of University Students" (HeLiS). The Pittsburgh Sleep Quality Index (PSQI), a self-administered questionnaire consisting of general information about sleep quality, was completed by students during the first eight weeks of the first semester and academic achievement was assessed via Grade Point Average (GPA) in the two semesters following the administration of the PSQI.
The mean age of students was 19.16±1.04 and the majority were female (64%). The mean overall score on the PSQI was 6.87±2.25; the majority of students (70%) had a global PSQI score greater than 5, indicating they were poor sleepers. Only 28% reported getting over 7 hours of sleep. Female students had higher scores than male students in subjective sleep quality, which was statistically significant (2.15 vs. 1.95 respectively, P = 0.01); however, there was no difference between males and females on other component scores or on the global score. Results of a multiple regression model showed that PSQI score was a predictor of academic achievement (β=-.07, P=0.035), which implies that GPA will be lower among students whose quality of sleep is lower.
Based on our sleep quality should be considered and assessed, and sleep hygiene should be promoted among medical university students in order to improve academic achievement.

Child abuse is a widespread social phenomenon with serious life-time consequences. Since parents bring their children to healthcare centers for growth screening and vaccinations, Community Health Workers play an important role in identifying and reporting child abuse cases. Thus, the current study aimed to investigate knowledge, attitude and performance of Community Health Workers regarding child abuse in Tabriz.
This is a descriptive (cross-sectional) study; census method was used for sampling. Study population consists of 265 people, employed at units of family health and vaccination in Tabriz healthcare centers in 2015-2016. A questionnaire was used to collect the data. Data analysis was carried out using SPSS, version 23 through descriptive (mean and standard deviation) and analytical (Two Independent Samples T-test and analysis of variance) statistics.
Findings indicate that 58.5 percent of Community Health Workers had good knowledge about causes of child abuse and 45 percent had good knowledge of the signs, symptoms and complicationsof child abuse. Their total knowledge was good (57%). The mean score of awareness (knowledge) was significant according to the variable of training participation (P=0.04). The participants had a favorable attitude toward dealing with child abuse (91.3 %); the mean score of attitude was significant according to the educational field (P Community Health Workers had good knowledge regarding child abuse, favorable attitude toward dealing with child abuse, and poor performance in dealing with child abuse. This may be due to fear of side issues to deal with child abuse, or lack of clear legal guidelines regarding this.

Unhealthy lifestyle behaviors during young adulthood can have negative impacts on health for the rest of a person’s life. University students are in a transition stage to adulthood and face considerable changes in their life during their time at university. Therefore, the evaluation of their lifestyle and its changes over time using a valid and reliable tool is very important. This study aimed at assessing reliability and validity of the Persian version of the Healthy Lifestyle Scale for University Students (HLSUS).
The HLSUS was developed by Wong et al., based on Pender’s Health Promotion Model, and was translated into Persian using forward/backward translation methods. Content validity of the scale was assessed by a panel of eleven experts. Moreover, Cronbach alpha coefficient was calculated to examine internal consistency. The construct validity was assessed via detecting the factor structure of measurements on a sample of 400 students from different faculties of Tabriz University of Medical Sciences. Scale-item correlations and known group analyses were used to evaluate. convergent and discriminant validity.
The HLSUS demonstrated good content validity (content validity index [CVI] values 0.80-1.00 and content validity ratio [CVR] values 0.71-1.00), internal consistency (α = 0.87) and test–retest reliability (intraclass correlation coefficient [ICC] = 0.89). Based on exploratory factor analysis, it was determined that the eight factor solution was optimal for distinguishing the underlying factors.
The Persian version of the HLSUS demonstrated initial reliability and validity.

Competency-based education has been recommended in training and education of public health to reduce the gap between traditional teaching and the competencies required in practice. Epidemiology as a fundamental of public health science has come to attention. The aim of this study was to introduce a complementary core competency program for Master of Science (MSc) in epidemiology students in Iran.
A workgroup in the department of statistics and epidemiology of Tabriz University of Medical Sciences including five epidemiologists and three biostatisticians prepared an outline of complementary core competencies for epidemiology MSc students. In the first step several discussion rounds were done to review the current curriculum, then the workgroup sought students’ opinions to find out about their needs. In addition, a review of the current literature around the topic was done. In the final step the program components were developed by the workgroup and initially implemented.
A complementary program consists of eight domains: general knowledge, problem finding, data analysis and interpretation, communications, management, consultation, leadership skills and professionalism. This program focused on basic competencies and those competencies outside the major field for a graduate of epidemiology to enhance their knowledge, attitude and skills. The program was scheduled to run in the third semester and approximate time for completion was three months.
The development and initial implementation of the complementary core competency program was successful and the authors will attempt to extend the program and evaluate the implementation phase.

Animal bites are potentially harmful for people. The present study was conducted to describe some of epidemiological patterns and analyse some aspects of animal bites in Maku County in time period 2003-2012.
Material and The longitudinal study was done on recording medicals in Health Center of Maku County, during 2003-2012 years. Interested variables in the study included: demographic characteristics, time patterns, place of injuries, type of injuries incurred to the children, and receiving health care after of bites were gathered. The results presented with descriptive indices such as mean (±SD), frequency (Relative frequency); and analytical statistics presented with the chi-square test and independent t-test.
Age mean of participants was 7.06 (± 2.40) years. 75% of victims were boys and sex ratio of boy to girl was 2.99. The highest percentage of the animal bites occurred by the domestic animals, 93.49% of injuries by the dogs and the highest proportion in the regional rural were occurred. 41.16% of animal bites were happened afternoon (12-18 p.m.). Site of the body injury 60.95% of injuries were from lower extremities. 73.5% of injuries, systematically, referred to receiving services of rabies vaccine.
The present results showed that the most animal bites were related to dogs, and the highest percentage of animal bites was happened in rural area, consideration should be done to control and prevent this health threat.

Prevalence of depression in patients with diabetes is 2-3 times more than patients without diabetes. Hence, the aim of the current study was to evaluate the reliability and validity of Persian version of the 10-item Kessler Scale (K10) in assessment of mental health status among patients with type 2 diabetes in Ardabil, Northwest of Iran.
This cross-sectional methodological study was conducted in Ardabil on a total of 70 patients with type 2 diabetes. K10 was translated into Persian by backward-forward method, and content validity was evaluated by a panel of experts in the field of psychiatry, psychology and epidemiology. Concurrent validity examined by the correlation between K10 and general health questionnaire-12 (GHQ-12). The reliability and stability evaluated by Cronbach¢s alpha and intraclass correlation coefficient (ICC) (test-retest method). The total score was computed from 10-items, which were classified into four categories (well, mild, moderate and severe). The analysis was performed using SPSS the level of significance was set at 0.05.
The total average content validity ratio (CVR) and content validity index (CVI) were 0.88 and 0.95; correlation between K10 and GHQ-12 was significant (r = 0.63, P The Persian version of K10 is valid and reliable for evaluation of mental health status among patients with type 2 diabetes.

Animal bites are considered to be an important threat to human health. Ardabil province in north-western Iran has the highest incidence rate of animal bites in Iran. This study was an attempt to investigate the epidemiological features of animal bites in Ardabil province during a one-year period from April 1999 to April 2000. In this descriptive study a special questionnaire was filled for all cases of animal bites reported during a one year period in Ardabil province. The questionnaire included questions regarding rabies, age, sex, job, etc. The data were analyzed using SPSS software (release 9). Descriptive statistics was used in the form of frequency tables and graph in order to summarize the data. The total number of exposed persons to animal bites were 4331. Males comprised 75% of cases (3259) and 1072 persons (25%) were females. The highest incidence rate was seen among 30-50 year-olds. Animal bites were more common in summer. In 3078 cases (17%), legs were the main site of bite. Dog bite was the most common type (95%). This study confirms that animal bite such as dog bite is an important public health problem in Ardabil province. Regarding the importance of this issue it is necessary to take serious measures in order to control and prevent this health thereat.

Hepatitis C Virus is the most common cause of post-transfusion hepatitis. This study was conducted to evaluate the prevalence of hepatitis C in multiply transfused patients. 45 patients with B- thalassemia major, 4 patients with hemophilia and 1 patient with aplastic anemia were studied prospectively during 2000. An initial questionnaire was used to collect the data regarding age, sex, duration and interval of at blood translation family history and the type of blood product received and the date of first infusion and then a blood sample was taken for detection of antibody against HCV. 62% of the subjects were male and 38% of them were female with the age range of 6 months- 29 years old. 92% of the patients used packed red blood cells. 27 patients had a positive family history of thalassemia and two seropositive patients (4%) had thalassemia. Duration and mean amount of blood transfused were significantly higher in patients with HCV infection. Data analysis showed now significant relationship among variables of the study and hepatitis C cases. It is concluded that multiply transfused thalassemic patients are at high risk for HCV infection. Thus, routine screening of blood and anti- HCV test in these patients is necessary.