مجله اپیدمیولوژی ایران
سال سوم شماره 3 (پیاپی 8، پاییز و زمستان 1386)

A pregnancy can be considered high-risk if there are conditions that put the mother or the baby at higher-than-average risk of morbidity or mortality. Neonatal mortality rate is one of the most important indices of children's health status. The present study was conducted to evaluate the effects of high-risk states on neonatal mortality.

We performed a nested case-control study in the rural areas of Kohgiluyeh and Boyerahmad province. Within the study cohort, 97 cases and 97 controls were selected by a risk-set sampling method. Data were analyzed with univariate and multivariate conditional logistic regression models.

Neonatal mortality was shown to increase significantly in high-risk pregnancies. There were no substantial differences between crude odds ratios and those adjusted for the presence of other risk factors (crude odds ratio decreased from 5.5 to an adjusted figure of 3.25 for pregnancies with one risk factor and from 5.21 to adjusted level of 4.80 for pregnancies with more than one risk factor).

High-risk pregnancies need great attention in family health and prenatal care programs, especially in remote rural areas. Within our rural health network there are potential cohorts for use in nested case-control studies, especially in the evaluation of neonatal mortality risk factors.

The aim of present study is to compare Afghan refugees and Iranian residents in terms of their knowledge, attitude and practice concerning malaria transmission and protection in an endemic area in Southeast Iran. This cross sectional study was conducted over a period of 10 months (2004-2005) and involved a total of 775 people, including Iranian and Afghan subjects. The age range of participants was 15 to 55 years. Data collection was done through a structured questionnaire consisting of open and close questions and comprising several, namely personal characteristics details, history of malaria infection and treatments, type of residence, mobility, self protection, facilities, and access to health services. Both Iranians and Afghans were familiar with the three typical symptoms of the disease (fever, chills and muscle aches): 67.1% of Iranians and 78% of Afghans were able to name least one of the three typical symptoms. In both groups the majority of subjects were aware that malaria transmission occurs through mosquito bite but there was a significant difference regarding knowledge of malaria transmission (χ2 =142.2, P<0.001). Chi-square test for goodness of fit showed that the distribution of symptom indicators is significantly different between the two groups. For Iranians, the most important source of information about malaria was the health facilities (44.5% of the total) while most Afghans (65.3%) had obtained the information through friends and relatives. In both groups, the mass media had acted as the source of information in only 3.4%. Altogether, 24% of the participants reported the use of mosquito bed nets; almost 90% of Afghans and 62% of Iranians said that they did not used bed nets at all. However, the number of Iranians who used bed nets was four times greater than the Afghans who did so. Although the majority of subjects were familiar with malaria transmission and protection methods, they largely neglected safety precautions. Moreover, it seems that the high prevalence of malaria among Afghans is due to their life style rather than cross-border travel. The study also revealed that Afghan people have poor communication with the local health facilities, a point that must receive special attention in future malaria control programs.

Over the last few years, the province of Golestan has ranked second among all Iranian provinces in terms of TB prevalence after Sistan and Balochestan. The present study was done with the aim of evaluating the incidence of TB among different ethnic groups residing in Golestan. In a descriptive study, all TB patients including sputum smear-positive and negative, extra-pulmonary, and milliary cases were evaluated from 1999 to 2003. The incidence of all types of TB was compared among different ethnicities in the province. Forty-seven percent of the 2773 cases registered for Golestan Province in the Communicable Disease Control Center from1999 to 2003 were male. As regards the type of disease, 62.7% of the cases were sputum smear-positive, 16.4% were smear-negative, 20.7% had extra-pulmonary disease, and 0.1% were milliary TB cases. The incidence rate of all types of TB was 36 per 100000 population and the rate did not show any significant changes over the study period. As for the ethnic distribution of the cases, more than 50% of all TB cases were observed among Sistanis and Baluches, who together account for only 20% of all Golestan residents. The incidence in Sistanis was ten times that in Turks and Kurds, six times that in Persians, 4 times the rate in Torkamans, and 2.5 times that in Afghans living in the same region. The incidence rate of tuberculosis was significantly different among various ethnicities of Golestan province, being highest in Sistanis.

Arsenicosis is a serious environmental disease caused by chronic exposure to arsenic- usually from drinking water. Signs and symptoms of chronic arsenic poisoning include hyperkeratosis, hyper- or hypopigmentation, and ulcers. Also, the incidence of cancer is increased in the exposed population. There is some evidence of high arsenic levels in drinking water in the village of Ghopuz, located in Hashtrud District, East Azerbaijan province. We evaluated the genetic and health effects of chronic arsenic exposure in the residents of Ghopuz. In this cross-sectional study we determined the prevalence of hyperkeratosis, hyperpigmentation and hypertension in Ghopuz village. The study involved 101 individuals in Ghopuz and 107 in the adjacent village of Mayan, who were all visited by a trained physician. A total of 46 blood samples were collected for kariotyping. The level of heavy metals in water was determined by the Inductively Coupled Plasma (ICP) method. We detected high arsenic levels in the drinking water at Ghopuz (mean concentration in water = 1.03 mg/L). There were chromosomal defects in the exposed group. Mean systolic blood pressure at Ghopuz (137mmHg, 95% CI: 132-142) was significantly higher than in Mayan (107, 95% CI: 99.9-114). Also, mean diastolic blood pressure at Ghopuz (82, 95% CI: 79-85) was significantly higher than in Mayan (71, 95% CI: 66-75). Hyperkeratosis was 34 times more frequent in the exposed population (OR = 34, P< 0.001). Also, hyperpigmentation was significantly more frequent in the exposed population (OR = 2.4, P < 0.007). Water arsenic and nitrate levels at Ghopuz were higher than the maximum permissible levels. The prevalence of skin lesions and hypertension is increased at Ghopuz village due to arsenic exposure. There is also some evidence of chromosomal defects in the exposed group. Affected people need appropriate medical care, and safe drinking water should be provided to reduce arsenic exposure.

Malocclusion is not a disease but rather a set of dental deviations, which in some cases can influence quality of life. The aim of this study was to assess the frequency of various dento–facial anomalies. In this cross-sectional study in 2006 we assessed a sample of 600 randomly selected schoolchildren, with a mean age of 11.97 years, who were attending secondary school in various districts of Karaj. We used questionnaires to obtain information on extracted teeth, crowding, spacing, diastem, the severest disorders in anteriors (maxilla and mandible), overjet, negative overjet, open space between two jaws and antero-posterior molar relationship. Ninety-nine percent of children had no extracted teeth in maxillary anteriors, while 98.3% had no extracted teeth in mandibular anteriors. In 41.2% of the subjects there was no crowding, and 57.7% of the sample had no spacing. The mean diastem was 0.36 mm and the mean of the most severe disorders in anteriors was 1.08 mm in the maxilla and 0.78 mm in the mandible. Mean overjet was 1.98 mm, mean negative overjet 0.03 mm, and mean open space between two jaws was 0.28 mm. In 58.5% of the subjects the antero–posterior molar relationship was normal. The DIA ranged form 13 to 63, with a mean of 24.12. This study indicates that over than one-third of the population needs different degrees of orthodontic treatment.

Malnutrition is widely regarded as one of the factors affecting quality of life. The adverse effects of malnutrition have been documented in various age groups. School problems, learning difficulties, humiliation and teasing from peers are some of the most common complications of obesity and excessive thinness. The goal of this study was to determine the BMI and some of the factors affecting it in the students of Dezfool. In a cross-sectional study and using random cluster sampling, 5726 students from 39 clusters were selected and anthropometric measurements were performed in the schools and under standard conditions. Cases of obesity and thinness were identified using BMI percentiles for age and sex (NCHS). A Body Mass Index above the 95th and below the 5th percentile was defined as obesity and thinness respectively. This study involved the participation of 5508 students (96.2%). The prevalence of thinness was 33% (1716) with a 95% confidence interval of 27.3%-38.8%. The prevalence of obesity was 2.6% (157) with a 95% confidence interval of 1.7%-3.4%. There was no significant difference between the prevalence of obesity or thinness between the two sexes (P>0.05). The prevalence of obesity and thinness significantly increased and decreased respectively with aging (P<0.05). Malnutrition among the students in Dezfool predominantly takes the form of thinness, while obesity is not a serious problem in this population; overall, these findings indicate poor nutritional status. High-risk groups have been identified and they must become the target of interventions by the Health and Education Ministries.

Exclusive breast-feeding during the first 6 months of life is the best type of nutrition for the infants in terms of fulfilling their its physical and emotional needs. The incidence of many kinds of infection decreases with breast-feeding. The aim of this study was to determine the prevalence of exclusive breast-feeding infants aged less than 6 months in Mashhad and to look at some factors that affect breastfeeding. This population-based survey used a stratified cluster sampling method to draw 30 clusters containing a total of 1450 infants aged 7-12 months. Data collection was performed using both questionnaires and interviews with mothers. Exclusive breast-feeding was defined as nursing through the first 6 months of life without any other food intake except drugs and vitamin supplements. The study achieved a response rate of 87.4% in mothers; 51.2% of the infants were male and the remaining 48.8% (618) were female. The overall prevalence of exclusive breast-feeding during the first 6 months was 56.4% with (95% CI: 49.7%-63.2%). The figure was 57.2% (95% CI: 49.9%-64.4%) for boys and 55.7% (95% CI: 48.7%-62.6%) for girls. In this survey, 91.7% of the infants (95% CI: 88.7%–94.7%) had received breast-feeding immediately after birth. In multiple logistic regression analysis, the mother's age, her awareness of the adequacy of her milk, and advice from others to use formulas were the factors that had a significant relationship with breast-feeding in the first 6 months. Almost 43% of infants had received alternative nutrition such as family food or formula. Considering the important effect of breast-feeding, provision of educational programs by the Health Ministry to raise the mother's awareness of breast feeding can be a priority in children's health.

Men (husbands) play a very important role in family planning programs, especially in developing countries. The objective of this study was to determine the prevalence of different methods of contraception in women of reproductive age in Iranshahr in 2004-2005 and the extent of their husband's participation in family planning. This was a cross-sectional study focused on women who were married but not pregnant at the time of the research. We used multi-stage cluster sampling and a pre-tested questionnaire to record the method of contraception and to see if the husband was actually participating in family planning. We used the SPSS (13th version) software to calculated measures of location and dispersion. The total sample of 700 married women in the (10-49y) age group included 400 subjects in rural areas and 300 in cities. Of these, 696 agreed to take part in the research. Overall, 65.5% of these women were using at least one form of contraception; the remaining 34.5% did not use any contraceptive methods. The percentage of unwanted pregnancies was estimated at 16%. The mean number of pregnancies was 7, with a median of 4.5. Sixty-three percent of the subjects reported good cooperation by their husbands. Logistic regression analysis showed that the probability of using contraception was significantly related to the husband's cooperation. Our results underline the importance of men's support and cooperation in the success of family planning efforts.

Today, the quality of life study has an important role in health care especially in chronic diseases, in clinical judgment and in medical resources supplying. Malignancies have a clinical and health importance in the world and Iran. Breast cancer has first order among women’s malignancies. Now, survival rate for this cancer is long. However Breast cancer has several complications that affected patient’s life. It is necessary that we studying the quality of life and related factors among this patients. We conducted a cross-sectional study on 119 breast cancer patients that admitted and treated in chemotherapy ward of Namazi hospital in Shiraz.We used QLQ-C30 & QLQ-BR23 to assessment quality of life in these patients. We used univariate nonparametric tests and multiple linear regression model to identify associations between dependent variables and the quality of life and it’s different scales.All calculation performed by using SPSS.V.13. Mean age of patients was 48.27±11.42 with quality of life total score 64.92±24.28. Univariate analysis showed that occupation,duration of disease,grade of tumor,physical,emotional and cognitive functioning, also, symptoms such as fatigue,pain, nausea and vomiting, insomnia, constipation and financial difficulties, perspective were associated to quality of life. (P< 0.05). But in multivariate analysis, only occupation, menopause status, dyspnea, grade of tumor and financial difficulties perspective were related to quality of life (p<0.05). With this finding, It is recommended that financial supports, also early detection are necessary for improvement of quality of life in these patients

We evaluated 25 children with Attention Deficit- Hyperactivity Disorder in the age group of 7-12 years (mean age: 10.16 ± 1.5y) using the DSM-VI Attention Deficit – Hyperactivity Disorder Questionnaire, Conner’s Parents’ Rating Scale, and the 28-item NES Questionnaire. There was no significant age difference between cases and controls. The mean total NES score was 11.4±4.14 in cases and 5.6± 2.79 in controls (P< 0.0001). Compared to the control group, the cases had significantly more problems with the glabellar reflex, rapid alternative movements and right-left discrimination. Soft Neurological signs are observed with greater frequency among children with ADHD compared to normal subjects and the difference is more significant in certain domains such as rapid alternative movements, right- left confusion, and glabellar reflex. Considering the relatively high frequency of soft neurological signs in children with Attention deficit- Hyperactivity Disorder, earlier diagnosis and treatment of the disease might be possible through careful neurological examination.