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Background: Colorectal cancers (CRCs) including colon, rectum and anal cancers are the third most prevalent cancers in the world. There are strong evidence showing the risk of the cigarette smoking, alcohol use, low physical activity and some types of diets in CRCs; however, few studies explored the relationship between opium use and CRCs. This study aimed to investigate the association between opioid use and the incidence of CRCs., Methods: In a population-based matched case-control study in Kerman, Iran, 175 patients with colorectal cancers and 350 healthy controls (matched for age, sex, and place of residence) were interviewed from Sep 2014 to Nov 2014. Opium and its derivatives, cigarette, alcohol, and diet use were collected using a valid and reliable questionnaire. Conditional logistic regression was used to estimate odds ratios with 95% confidence intervals., Results: The use of opioids was associated with an increased risk of CRCs (adjusted odds ratio= 4. 5, 95% CI: 2. 4-8. 7). In addition, a dose-response relationship was observed between the cumulative use of opioids and the incidence of CRCs (with low use OR=3. 7; 95% CI: 1. 5-8. 6 and high use OR= 8. 0; 95% CI: 2. 9-21. 7). This dose-response relationship was also strong in patients with colon cancers, with OR= 3. 9 (95% CI: 1. 5-9. 9) and 9. 4 (95% CI: 3. 3-27. 0) for the low and high uses of opioids, respectively., Conclusion: Opioid use can lead to an increased risk of CRCs. Therefore, it is necessary to implement preventive policies to control the use of opioids.

Background: Air pollution and weather are just two of many environmental factors contributing to traffic accidents (RTA)., Objectives: This study assessed the effects of these factors on traffic accidents and related mortalities in Ahvaz, Iran., Methods: In this ecological study, data about RTA, traffic-related mortalities, air pollution (including NO, CO, NO 2 , NO x PM 10 , SO 2 , and O 3 rates) and climate data from March 2008 until March 2015 was acquired from the Khuzestan State Police Force, the Environmental Protection Agency and the State Meteorological Department. Statistical analysis was performed with STATA 12 through both crude and adjusted negative binomial regression methods., Results: There was a significant positive correlation between increase in the monthly average temperature, the number of rainy days, and the number of frost days with the number of RTA (P < 0.05). Increased monthly average relative humidity, evaporation, and number of sunny days were negatively correlated with the frequency of RTA (P < 0.05). We also observed an inverse significant correlation between monthly average relative humidity, evaporation, and wind speed with traffic accident mortality (P < 0.05). Some air pollutants were negatively associated with the incidence rate of RTA., Conclusions: It appears that some weather variables were significantly associated with increased RTA. However, increased levels of air pollutants were not associated with increased rates of RTA and/or related mortalities. Additional studies are recommended to explore this topic in more detail.

Human exposure to organophosphorus (OP) pesticides is a serious health challenge. We conducted a systematic review by searching international and national databases for published literature on any human exposure to OPs in Iran from 1990 to March 2015. Qualified papers were in two categories including studies in which biomarkers of exposure were assessed (n = 13; total no. of subjects = 759) and studies that had reported prevalence of OPs-induced poisoning (OPP) and mortality (n = 26; total no. of subjects = 5428). The mean level of activity of acetyl-cholinesterase and butyryl-cholinesterase were 68.65% and 74.2%, respectively. Overall proportion (%) of OPP was estimated (16; 95% CI, 14 to 19).

Background and Objectives: Malaria is among the most important parasitic diseases, and is one of the endemic diseases in Iran. This disease is often known as a disease related to climate changes. Due to the health and economic burden of malaria and the location of Kerman province in an area with high incidence of malaria, the present study aimed to evaluate the effects of climatic factors on the incidence of this disease., Material and Methods: Data on the incidence of malaria in Kerman province was inquired from Kerman and Jiroft Medical Universities and climatic variables were inquired from the meteorological organization of Kerman. The data was analyzed monthly from 2000 to 2012. Variations in incidence of malaria with climatic factors were assessed with negative binomial regression model in STATA11software. In order to determine the delayed effects of meteorological variables on malaria incidence, cross-correlation analysis was done with Minitab16., Results: The most effective meteorological factor on the incidence of malaria was temperature. As the mean, maximum, and minimum of monthly temperature increased, the incidence rate raised significantly. The multivariate negative binomial regression model indicates that a 1 °C increase in maximum temperature in a given month was related to a 15% and 19% increase on malaria incidence on the same and subsequent month, respectively ( p -value = 0.001). Humidity and Rainfall were not significant in the adjusted model., Conclusion: Temperature is among the effective climatic parameters on the incidence of malaria which should be considered in planning for control and prevention of the disease.

Introduction: Adenotonsillar hypertrophy is a typical cause of surgery in children. Evaluation and identification of patients as potential candidates tonsillectomy is a primary concern for otolaryngologists. This study focuses on the results of pulmonary function tests (PFTs) after tonsillectomy in children., Materials and Methods: This cross-sectional study examined 50 patients suffering from tonsillar hypertrophy in 2013. Full details and results of otolaryngology examinations were recorded. Moreover, patients were examined with respect to forced inspiratory flow at 50% of vital capacity (FIF50%), forced expiratory flow at 50% of vital capacity (FEF50%), forced expiratory volume in 1 second (FEV1)/peak expiratory flow rate (PEFR), and FEV1/forced expired volume in 0.5 seconds (FEV0.5) before and after surgery using spirometry. All data were analyzed using SPSS Software (version 19), and central descriptive measures, and data were compared by performing T-test and Chi-square tests., Results: According to tonsil size, patients were distributed as follows: 18 patients (36%) with +1 tonsil size, 18 patients (36%) with +2 tonsil size, and seven patients (14%) with +3 tonsil size, and seven patients (14%) with +4 tonsil size. Thirty-three (66%) and 17 patients (34%) were female and male, respectively, with a mean of age of 9.7[Formula: see text]2.97 years (range, 7-18 years). Seventy-eight percent of patients were aged 10 years or less. Moreover, 25 patients (50%), 17 patients (34%), and eight patients (16%), respectively, reported obstructive symptoms, recurrent tonsillitis, and both symptoms. In patients with +3 and +4 tonsil size, spirometric parameters indicated relief of symptoms of obstruction. Only in patients with +4 tonsil size were the changes statistically significant., Conclusion: Tonsillectomy can relieve obstructive symptoms in patients with tonsils larger than +3 to a great extent. Additionally, spirometry can identify patients with +3 and +4 tonsils who do not have clinical signs of an obstructive upper airway.

Objective: The number of road traffic injuries and fatalities in Iran is high. The aim of the present study was to investigate the rate of drivers' seat belt use and a number of related factors in Kashmar, Bardaskan, and Khalilabad (Iranian Safe Communities)., Methods: In 2014, driver observations were made at 48 road sites on intercity roads, main streets, side streets, and rural roads in these 3 cities., Results: A total of 10,255 vehicles were observed, with the overall rate of seat belt use being 51.8%. The rates in Kashmar, Bardaskan, and Khalilabad were 51.4, 56.3, and 47.7%, respectively. In Kashmar, the odds of seat belt use were higher among drivers who were female, older, and taxi drivers. Higher use was also found during the afternoon, and lower use was observed on rural roads. In Khalilabad the odds of seat belt use were higher among females, older drivers, taxis, and private car drivers. Seat belt use was also higher on weekends and during the morning but was significantly lower on rural roads. Similarly, in Bardaskan the odds of using a seat belt were higher among females, older drivers, taxis, and private car drivers. Seat belt use was also higher during the afternoon but was significantly lower on rural roads, in comparison to main streets and intercity roads., Conclusions: The rate of seat belt use in these 3 cities was found to be low, despite these cities being designated as International Safe Communities. Therefore, seat belt promotion programs, tougher regulations, stronger enforcement, public awareness campaigns, and more research are needed to promote seat belt use in these Iranian cities.

Background: Colorectal cancer (CRC) is the third most common cancer in the world, and the fourth in Iran in both genders. The aim of this study was to find predictive factors for CRC survival., Materials and Methods: Medical records of 570 patients referred to the radiotherapy oncology department of Shiraz Namazi hospital from 2005 to 2010 were retrospectively analysed. Data were collected by reviewing medical records, and by telephone interviews with patients. Survival analysis was performed using the Cox's regression model with survival probability estimated with Kaplan-Meier curve. The log-rank test was used to compare survival between strata. Data was analyzed with Stata 12., Results: The five-year survival rate and the mean survival time after cancer diagnosis were 58.5% and 67±1.4 months. On multivariate analysis, age of diagnosis, disease stage and primary tumor site, lymphovascular invasion and type of treatment (in colon cancer) were significant factors for survival., Conclusions: Age of diagnosis and type of treatment (adjuvant therapy in patients with colon cancer) were two modifiable factors related to survival of CRC patients. Therefore earlier diagnosis might help increase survival.

Background: Few studies worldwide have shown that climate factors such as temperature and humidity may contribute to injuries and sudden death. However, to the best of our knowledge no studies have been conducted on climate and traumatic deaths in Iran., Objectives: The aim of this study was to investigate the relationship between temperature and humidity and trauma deaths in Kerman, Iran., Materials and Materials: In this study, data of all trauma deaths from March 2006 to February 2011 were collected from the Kerman Health Ministry and categorized by causes. Trauma deaths were extracted and matched with data regarding temperature and humidity obtained from the Kerman Meteorology Office during the same time period. Negative binomial regression and Spearman correlation analysis were used to analyze the data using STATA10 and MiniTab16., Results: The findings of this study showed that the overall mortality caused by trauma is higher in the warm season. The highest correlation between mortality and temperature was seen in ages over 60 years (r = 0.301, P = 0.020) in trauma deaths and was statistically significant. An inverse significant correlation was observed between the incidence of trauma deaths and humidity and was highest in the over 60-year age group (r = -0.336, P = 0.009). The regression results also revealed an inverse significant relationship between humidity and trauma deaths in the over 60-year age group., Conclusions: High temperatures and low humidity increased the risk of trauma deaths in our study. However, more studies are needed to document this.

Background and Aim: Studying the recurrence of smear-positive pulmonary tuberculosis (TB) is a convenient way to evaluate the effectiveness of TB control programs and identify vulnerable patients. In the present study, the rate of recurrence of TB and its predictors were determined in Iran., Materials and Methods: This study was a retrospective cohort. Eligible people were patients with smear-positive TB who were diagnosed from 2002 to 2011. The end of the follow-up time was December 2013. The number of people who entered the cohort was 1,271 subjects. In order to determine the predictors of recurrence, multivariate logistic regression was used. Analysis was done using SPSS 20., Results: The recurrence incidence was 8.3% and in 85.9% of these patients, it occurred in the time interval of 1-5 years after successful treatment. The recurrence rate was not significantly related to gender, age group, and diabetes. But it was significantly higher in patients whose sputum smear grading before treatment was 2 + or more, patients with positive sputum smear at the end of the second month of the treatment, patients who had completed treatment, and patients who were smokers (P < 0.05)., Conclusions: Our study showed that a considerable percentage of smear-positive pulmonary TB patients experience recurrence and that some patients are at a higher risk of recurrence.

Metabolic syndrome is highly prevalent in type 2 diabetics and is a strong risk factor for cardiovascular diseases in such patients. The aim of this study was to determine the prevalence of metabolic syndrome according to the three criteria of ATPIII, IDF and the new criteria for metabolic syndrome diagnosis in Kerman, Iran. This cross-sectional study was performed on 950 diabetic type 2 patients. Data was analyzed by independent t-test, chi-square and logistic regression using the SPSS (revision 20) software. The prevalence of metabolic syndrome in Kerman was 73.4, 64.9, and 70.4%, according to the above criteria. Fasting blood sugar, gender, triglyceride, HDL, waist circumference, and systolic blood pressure were related to the prevalence of metabolic syndrome according to the above-mentioned criteria.The prevalence of metabolic syndrome is high in type 2 diabetic patients and the above-mentioned factors exacerbate the situation.

Background: Determining the temporal variation and forecasting the incidence of smear positive tuberculosis (TB) can play an important role in promoting the TB control program. Its results may be used as a decision-supportive tool for planning and allocating resources. The present study forecasts the incidence of smear positive TB in Iran., Methods: This a longitudinal study using monthly tuberculosis incidence data recorded in the Iranian National Tuberculosis Control Program. The sum of registered cases in each month created 84 time points. Time series methods were used for analysis. Based on the residual chart of ACF, PACF, Ljung-Box tests and the lowest levels of AIC and BIC, the most suitable model was selected., Results: From April 2005 until March 2012, 34012 smear positive TB cases were recorded. The mean of TB monthly incidence was 404.9 (SD=54.7). The highest number of cases was registered in May and the difference in monthly incidence of smear positive TB was significant (P<0.001). SARIMA (0,1,1)(0,1,1)12 was selected as the most adequate model for prediction. It was predicted that the incidence of smear positive TB for 2015 will be about 9.8 per 100,000 people., Conclusion: Based on the seasonal pattern of smear positive TB recorded cases, seasonal ARIMA model was suitable for predicting its incidence. Meanwhile, prediction results show an increasing trend of smear positive TB cases in Iran.

Background: Bladder cancer (BC) is the most common genitourinary system malignancy in humans. Consumption of opium and its derivatives, maybe a risk factor possibly in Iran. The aim of this study was to investigate the relationship between consumption of opium and its derivatives and the incidence of BC., Methods: In an individually matched case-control study in Shiraz (located in the south of Iran), 198 patients with BC and 396 healthy individuals (matched in age, sex and residence (urban/rural)) were investigated. Data about consumption of opium and its derivatives, tobacco, alcohol and diet were collected using a structured valid and reliable questionnaire. Crude and adjusted odds ratios (ORs) were computed using conditional logistic regression models., Results: Opium consumption was associated with an increased risk of BC with an adjusted OR = 3.9 (95% CI: 1.2 - 12.0). Moreover, a considerable dose-response relationship was observed between the opium consumption and its derivatives and the incidence of BC; comparing to no users, the odds ratios of low and high consumptions were 3.3 (95% CI: 0.5 - 23.1) and 4.9 (95% CI: 1.1 - 21.9) respectively., Conclusion: Opium consumption can be a potential strong risk factor for BC in Iran.

Introduction: Submucoperichondrial injection of botulinum neurotoxin A (BTA) in the nasal septum is a promising therapeutic option in the treatment of persistent allergic rhinitis (AR) and non-allergic rhinitis, and is safer and more effective than intraturbinate injection in reducing clinical symptoms., Materials and Methods: Forty patients diagnosed with persistent AR or non-allergic rhinitis referred to Shafa Medical Center affiliated to Kerman University of Medical Sciences were included in this study and were randomly allocated to the intervention or control groups. Patients received an injection of 80 units BTA (Dysport, Ipsen Ltd Company, UK) at a concentration of 200 mU/ml in normal saline on four spots in each side of the nose and were followed for 12 weeks. Data were analyzed using a chi-square or Fisher's test, and Mann Whitney U test., Results: The mean age of patients was 46.1±15.3 years, and the two groups did not differ significantly in demographic variables. The severity of rhinitis symptoms was reduced after 4 weeks of injections in the intervention group and then gradually decreased further until the 12th week. There was a statistically significant difference between the groups (P<0.05). No adverse effects were reported., Conclusion: Submucoperichondrial BTA injection can be considered an effective therapeutic option in patients with persistent AR and idiopathic rhinitis. In comparison with other injection techniques, submucoperichondrial BTA injection has fewer side effects with a longer period of effectiveness, and is easy to perform and is more tolerable for the patient.

One of the recommended strategies for preventing tuberculosis is to screen high-risk populations with respect to Mycobacterium tuberculosis (TB) infection. The aim of the present study was to investigate latent infection and active tuberculosis in people with close household contact. It was a cross-sectional descriptive, analytical study with the sample size of 668 people from homes with one infected resident. In order to diagnose tuberculosis latent infection, the PPD test was done. To determine patients with smear-positive pulmonary tuberculosis, three sputum samples were taken from every patient and were examined using direct microscopy and culture. Data was analyzed by SPSS20 software. The prevalence of latent tuberculosis infection and smear-positive pulmonary tuberculosis were 42.8% and 0.9% respectively. The prevalence of latent tuberculosis infection and smear-positive pulmonary tuberculosis in people with close household contact were less than that of other studies. However, smear-positive pulmonary tuberculosis in people with close household contact was 199.5 times more than that of the general population.

The present study developed a Persian version of the Adolescent Road User Behaviour Questionnaire (ARBQ) and investigated the psychometric properties of the scale in a sample of school students in the province of Tehran (Iran). In total 1111 adolescents completed the Persian version of the ARBQ. Exploratory factor analysis, using the shortened 21-item version of the scale revealed the presence of three reliable factors which were also supported using confirmatory factor analysis. According to this research, engagement in dangerous playing in the road was significantly higher among males, residents of large urban areas, students from private schools, students in the south of Tehran, those who reported relatives or friends had been killed in a road crash and those with a personal history of road accidents. Moreover, older adolescents, those who reported relatives or friends having been killed in a road crash and those with a traffic accident history reported higher involvement in unsafe crossing behaviour. Females, older adolescents, residents of small urban areas, students from schools in small urban areas and those with an accident history also reported less frequent engagement in planned protective behaviours. This study confirms that the ARBQ is a useful framework for investigating adolescents' on-road behaviours in Iran. This research also showed that adolescents put themselves at risk by engaging in hazardous behaviours. As is the case in most countries, this study revealed the need for interventions, such as education and enforcement to improve the on-road safety culture amongst Iranian adolescents., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Tuberculosis (TB) can affect patients' life even after successful treatment. In this study, we aimed to determine the survival rate of patients with smear positive TB after successful treatment and identify the predictors of mortality., Methods: This was a prospective study. The source of data was the TB registry system in Iran and 964 patients were eligible for the study. The life table was used to determine the annual survival rate. Survival curves were estimated using Kaplan-Meier and were compared using the log-rank test. In order to determine the predictors of survival, four models of Cox regression, exponential, Weibull and log-logistic fitted and finally exponential model with minimum akaike information criteria and Bayesian information criterion values were selected. Then, variables with significant levels <0.2 in univariate analysis were entered into the multivariate model. Hazard ratios with a confidence interval of 95% were used to measure the association., Results: A total of 149 patients (15.5%) died during the follow-up period. The median of survival time after successful treatment was 10.5 years and survival probability for 11 years after successful treatment was 70%. Furthermore, previous TB treatment, high age, suffering from kidney failure and cancer were predictors of mortality after successful treatment., Conclusions: This study showed that positive smear pulmonary tuberculosis even after successful treatment has an adverse effect on the patients' survival and leads to a decrease in their survival rate in the long run. Furthermore, individuals with a history of previous TB treatment had much lower survival rates.

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

Background: Predicting the incidence of tuberculosis (TB) plays an important role in planning health control strategies for the future, developing intervention programs and allocating resources., Objectives: The present longitudinal study estimated the incidence of tuberculosis in 2014 using Box-Jenkins methods., Materials and Methods: Monthly data of tuberculosis cases recorded in the surveillance system of Iran tuberculosis control program from 2005 till 2011 was used. Data was reviewed regarding normality, variance equality and stationary conditions. The parameters p, d and q and P, D and Q were determined, and different models were examined. Based on the lowest levels of AIC and BIC, the most suitable model was selected among the models whose overall adequacy was confirmed., Results: During 84 months, 63568 TB patients were recorded. The average was 756.8 (SD = 11.9) TB cases a month. SARIMA (0,1,1)(0,1,1)12 with the lowest level of AIC (12.78) was selected as the most adequate model for prediction. It was predicted that the total nationwide TB cases for 2014 will be about 16.75 per 100,000 people., Conclusions: Regarding the cyclic pattern of TB recorded cases, Box-Jenkins and SARIMA models are suitable for predicting its prevalence in future. Moreover, prediction results show an increasing trend of TB cases in Iran.

Background: Nurses are among the most important groups engaged in casualty support, regardless of the cause, and they are one of the largest care groups involved in disasters. Consequently, these workers should gain proper support and skills to enable effective, timely, responsible and ethical emergency responses., Objectives: In this study, we investigated the needs of nurses for proper casualty support in disasters, to facilitate better planning for disaster management., Materials and Methods: This was a qualitative content analysis study. Interviews were performed with 23 nurses, at educational hospitals and the Faculty of Nursing at Kerman Medical University, who had a minimum of five years working experience and assisted in an earthquake disaster. Intensity and snowball sampling were performed. Data was collected through semi-structured interviews. Interviews were transcribed and coded into main themes and subthemes., Results: Four major themes emerged from the data; 1) psychological support, 2) appropriate clinical skills education, 3) appropriate disaster management, supervision and programming, and 4) the establishment of ready for action groups and emergency sites. The participants' comments highlighted the necessity of training nurses for special skills including emotion management, triage and crush syndrome, and to support nurses' families, provide security, and act according to predefined programs in disasters., Conclusions: There are a wide range of requirements for disaster aid. Proper aid worker selection, frequent and continuous administration of workshops and drills, and cooperation and alignment of different governmental and private organizations are among the suggested initiatives.

Background: Nowadays there are more concerns about drug treatment of methamphetamine abusers whereas quality of life (QOL) related supportive psychotherapy is less credited., Objectives: This study aimed to evaluate the effects of family-centered empowerment model on social support and QOL of methamphetamine users and their families., Patients and Methods: This study was a randomized clinical trial; individuals were randomly allocated to three groups: a group for educating methamphetamine users in recovery (95 subjects), a group for educating a family member of methamphetamine users in recovery (95 subjects) and a control group (95 subjects). Data collecting instruments were standard questionnaires of social support and health-related quality of life (HRQOL). Data were analyzed using χ2-test, t-test, paired t-test, Pearson's correlation and ANOVA., Results: Mean scores of QOL and social support dimensions changed significantly in two intervention groups (P < 0.0001), but didn't change in the control group (P > 0.05). Also, there was a positive significant relation (P < 0.05) between total social support and all dimensions of QOL for all study groups., Conclusions: Family-centered empowerment model, easily adapted to methamphetamine users and their families, leads to improved social supports and QOL.

Background: Gastrointestinal cancers, including esophageal, gastric, liver and pancreatic are relatively common in Iran. Furthermore, consumption of opium and its derivatives (O&D) are considerable. This study, aimed to examine the association between consumption of O&D and the incidence of upper gastrointestinal (UGI) cancers., Methods: In a matched case-control study in Kerman (located in southeast of Iran), 142 patients with UGI cancers and 284 healthy people (matched in terms of age, sex and residence (urban/rural)) were recruited. Variables (using O&D, smoking, alcohol use and diet) were collected using a structured questionnaire. Conditional logistic regression models were used to assess the above mentioned association., Results: Opium use was associated with an increased risk of UGI cancers with an adjusted OR 4.0 (95% CI=2.2-7.0). A very strong dose-response relation was observed between consumption of O&D and the incidence of UGI cancers. (Three consumption levels-none, low and high; OR=18.7; 95% CI=5.5-63.3). This dose-response relationship was also strong even in patients with gastric cancers (OR=9.2; 95% CI=2.5-33.7)., Conclusion: The results of this study showed that opium consumption can be a strong risk factor for UGI cancers in Iran.

The incidence of road crash deaths is high in Iran. Seat belts can reduce the risk of death or serious injury. This study aimed to estimate the rate of seat belt use and its related factors for car drivers in Tehran, Iran after proclamation of the 2011 legislation. A roadside observational study was conducted in 2012 and 10,752 cars and taxis commuting in different streets of Tehran were screened in regard to drivers' seat belt wearing. Other variables including gender, age range, type of street, district, time of day and day of week were also collected. The rate of seat belt use was 70.9%, and was significantly higher in females, elders and on freeways and significantly less in afternoon hours, side streets and in taxi drivers. The rate of seat belt use in Tehran (a representative of Iran) is still low despite the implementation of new legislations. More initiatives are needed to increase this rate especially in certain groups and areas.

Noise is one of the most harmful agents in the workplace. In addition to the adverse effects of noise on the auditory system, as a stressor it may cause increased blood pressure, cardiovascular disease, anxiety, and impaired secretion of hormones. The purpose of this study was to evaluate changes in urinary catecholamines in workers exposed to industrial noise. This is an experimental study of the workers at the smelter section of Sarcheshmeh Copper Industries done on two separate days. During the first day, urine samples from 20 workers who did not use any hearing protection device, were collected during an 8-h work shift and on the second day the same was done but they were asked to use earplugs. Also 20 people were selected as a control group from people who were not exposed to noise at work. Urinary catecholamine levels were measured with ELISA kits. The mean urinary epinephrine and norepinephrine levels in the workers (without earplugs) was respectively 8.69 and 35.56 μg/8h on the first day and on the second day (with earplugs) dropped to 6.45 and 30.95 μg/8h. Noise reduction by earplugs led to almost significant reductions in urinary epinephrine (p = 0.05) and significant reductions in norepinephrine (p = 0.02). The results showed that with noise reduction the urinary excretion of stress hormones, especially norepinephrine significantly decreases and workers are probably less prone to stress-related disorders.

Background: Ischemic stroke is a major cause of mortality and morbidity worldwide. Various studies on the etiology of this disease are in progress. Some studies have suggested that opium abuse may is associated with increased risk of ischemic stroke. The present study aimed to analyze the frequency of opium addiction and to compare cerebrovascular ultrasound patients' changes to non-addicts., Methods: This cross-sectional study was performed on 97 patients with ischemic stroke. The diagnosis was confirmed by imaging and paraclinical studies. All the patients underwent cerebrovascular ultrasound in the first 4 days of symptoms onset. A questionnaire containing demographic data, opium use information [based on the 4th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria], and vascular ultrasound findings were completed for each patient and the results were analyzed using descriptive statistics and chi-square test., Findings: In this study, 38 patients (39.18%) were addicted to opium and the remaining were non-addicts. Among the addicted patients, 31 patients were male and 7 patients were female, while 26 and 33 patients of non-addicts were male and female, respectively (P < 0.01). Among the risk factors for stroke, smoking was higher in the addicts than in non-addicts (P = 0.04). Frequency of vascular stenosis and stenosis location did not show a statistical significant difference between the addicted and non-addicted patients., Conclusion: More than one-third of the patients with stroke were addicted to opium which was higher than general population; although the pattern of stenosis in these patients was similar to the non-addicts.

Electricity generation from microbial fuel cells which treat food processing wastewater was investigated in this study. Anaerobic anode and aerobic cathode chambers were separated by a proton exchange membrane in a two-compartment MFC reactor. Buffer solutions and food industry wastewater were used as electrolytes in the anode and cathode chambers, respectively. The produced voltage and current intensity were measured using a digital multimeter. Effluents from the anode compartment were tested for COD, BOD5, NH3, P, TSS, VSS, SO4 and alkalinity. The maximum current density and power production were measured 527mA/m(2) and 230mW/m(2) in the anode area, respectively, at operation organic loading (OLR) of 0.364g COD/l.d. At OLR of 0.182g COD/l.d, maximum voltage and columbic efficiency production were recorded 0.475V and 21%, respectively. Maximum removal efficiency of COD, BOD5, NH3, P, TSS, VSS, SO4 and alkalinity were 86, 79, 73, 18, 68, 62, 30 and 58%, respectively. The results indicated that catalysts and mediator-less microbial fuel cells (CAML-MFC) can be considered as a better choice for simple and complete energy conversion from the wastewater of such industries and also this could be considered as a new method to offset wastewater treatment plant operating costs., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Recognizing mortality pattern and observing its trend will help us in determining health priorities, allocating health resources and priorities in health section, eliminating main factors of premature deaths and carrying out epidemiological research., Objective: The aim of this research was to determine avoidable mortality in Kerman province., Materials and Methods: The present study was carried out longitudinal. A checklist was applied for data collection. Avoidable mortalities were examined in Kerman province between 2004 and 2010. Statistical universe of this research was all deaths registered in statistical unit of health deputy of Kerman University of Medical Sciences; they were all studied through a census method. Data analysis was carried out using descriptive and analytical test by SPSS18.0., Results: Two thousand and one hundred -ninety seven deaths were examined. Of them, 210 deaths were unavoidable and 19987 were avoidable. In this study, most unavoidable deaths were due to pancreases cancer and ovary cancer., Conclusions: Relative high number of avoidable deaths indicates that performance of health system was not desirable in Kerman during the studied years. Examining trend of avoidable deaths showed that these mortalities are increasing although it is not significant nowadays. However, if this trend continues, it will be very alarming for health care authorities in this region.

Many studies have suggested that cardiovascular and respiratory disease mortality may change with fluctuations in temperature. In this study the relation between temperature and mortality has been studied in a city with desert climate. Four years data on daily temperature, cardiovascular, respiratory mortality and air pollution was acquired for Kerman, Iran. Time series, regression and correlation analyses were performed. Results showed an inverse relationship between mortality and temperature in Kerman, in which decreases in temperature were associated with increases in mortality. This pattern is similar to some foreign studies which show acclimatization of people living in southern warmer climates and less negative effects of warm temperatures. Among the pollutants only dust (p=0.003) and SO2 (p<0.001) showed a positive correlation with respiratory mortality.

Background: Determining the temporal variations and seasonal pattern of diseases and forecasting their incidence can help in promoting disease control and management programs. This study was performed to determine the seasonal variation of tuberculosis and forecast its incidence until the year 2015 in one of the northern provinces of Iran., Materials and Methods: A longitudinal time series study was conducted. The study interval was from March 2001 to March 2011. The sum of daily registered cases in each month created 132 time points. The Box-Jenkins methods were used for determining the model. The best model was selected by analyzing the residuals and calculating the AIC and BIC., Results: A total of 3,313 patients were diagnosed and recorded during this time. The highest number of cases was registered in May and the difference in monthly incidence of tuberculosis was significant (P=0.007). The incidence of tuberculosis was higher in spring and summer than winter (P=0.04). According to the best model which was SARIMA (0, 1, 1)(0, 1, 1)12 , the average incidence of tuberculosis in 2015 is estimated to be 12 in 100,000 persons per year., Conclusion: The results of this study showed that in the north of Iran the incidence of tuberculosis has a cyclic pattern and the maximum incidence is in spring (May). Also, the trend of tuberculosis incidence is increasing and needs attention.

Objectives: To evaluate the duties of regional healthcare workers (Behvarzes) regarding healthcare of pupils in the rural areas of Iran., Method: This descriptive, cross-sectional study was conducted in 2007-2008 on 384 pupils and their school managers in the rural areas of Sharbabak in Kerman, Iran. The research population was evaluated with separate questionnaires for the managers and the pupils. The results were analysed using descriptive statistical methods., Results: The study showed that 250 (65%) of the total participants believed that the Behvarzes performed the minimum required duties for supervision of the pupil's personal health, and 257 (67%), 173 (45%), 269 (70%) and 269 (70%) thought they performed the minimum for promoting the environmental health status of the school, for pupils' nutrition, for accident prevention, and for disease control respectively., Conclusion: Behvarzes have been very successful in promoting healthcare among villagers in Iran, but they should pay more attention to the nutritional status of the students.

Introduction: Rhinoplasty is a popular cosmetic surgical procedure. Informal statistics show that Iran has one of the highest rates of rhinoplasty in the world. However, rhinoplasty like any other surgery can have complications., Materials and Methods: In this cross-sectional study, 320 female students were selected by multistage cluster-stratified sampling from high schools in Kerman, Iran and each completed a questionnaire., Results: More than half of the students said they would like to undergo rhinoplasty. The main reasons for wanting rhinoplasty were beauty and because it is fashionable. However, more than half of the interested students did not know about the possible postoperative complications of rhinoplasty. There was no relation between interest in having rhinoplasty and parents' education, city of birth or economic status., Conclusion: Many teenagers are interested in having rhinoplasty in Iran. As the number of teenagers and young adults who choose to have cosmetic surgery increases, surgeons should consider their expectations, motivations and awareness of postoperative complications before surgery.

Introduction: The increasing trend in waste production and its improper disposal in the environment have led to mismanagement of national resources and hazards to the natural environment. Therefore the recycling of solid waste can help prevent economic and bioenvironmental disasters. The aim of this study was to evaluate the health literacy of the student of the Kerman Public Health School, about the management and recycling of solid waste., Methods: This was a cross-sectional study and the target population was all of the students of the Kerman Public Health School (421 students), in five fields. A questionnaire including demographic and health literacy questions was distributed among the students., Results: The male students answered the questions significantly more than female students (P < 0.001). The Environmental Health students acquired a higher score than all other students and health literacy significantly increased as the student's studying degree promoted (P < 0.001). Also as the number of trimesters increased, health literacy significantly increased (P < 0.001). The parents' education, the family income and number of people in the family had no significant effect on health literacy. All students believed recycling is important and more than 50% had acquired their knowledge from their academics., Conclusion: This survey showed that students in health related fields although confirm its necessity, but need more education in health literacy as they are supposed to be the promoters of public health in the society in the near future.

Background: In the Middle East, including Iran, breast cancer is the most frequent malignancy among women. Without treatment, a malignant breast tumor advances in stage, diminishing a woman's chances of survival. In this study we aimed to gain insight into the causes of delay in seeking treatment in patients with breast cancer., Methods: The participants in this qualitative, content analysis study were 10 women in whom a diagnosis of breast cancer in the stages of II b, III or IIV had been made. They were selected from patients of a major oncology clinic in Kerman, Iran. Data were collected by means of semi-structured interviews that lasted between 20 to 30 minutes. Sampling was discontinued when data saturation was achieved. Content analysis was conducted by classifying the data into themes and sub-themes., Results: The results of our study revealed several factors that interfered with patients' professional consultation seeking and prompt treatment. These factors included; lack of knowledge, fear of being diagnosed with cancer, not seeing oneself at risk, mental preoccupation and wrong diagnosis by physicians., Conclusions: This study suggests that women and even physicians need further information about breast cancer symptoms. Women need encouragement to seek medical advice when they encounter suspicious symptoms. Additionally, women may benefit from awareness of the pros of early detection and reassurance about the improvements in the success of breast cancer treatment.

Background: The increasing trend in waste production and its improper disposal in the environment have led to mismanagement of national resources and hazards to the natural environment. Therefore, the recycling of solid waste can help prevent economic and bio-environmental disasters. The aim of this study was to evaluate the health literacy of the students of the Kerman Public Health School about the management and recycling of solid waste., Materials and Methods: This was a cross-sectional study and the target population was all of the students of the Kerman Public Health School (421 students) in five fields. A questionnaire including demographic and health literacy questions was distributed among the students., Results: The male students answered the questions significantly more than female students (P<0.001). The Environmental Health students acquired a higher score than all other students and health literacy significantly increased as the student's studying degree promoted (P<0.001). Also, as the number of trimesters increased, health literacy significantly increased (P<0.001). The parents' education, the family income, and number of people in the family had no significant effect on health literacy. All students believed recycling is important and more than 50% had acquired their knowledge from their academics., Conclusion: This survey showed that although students in health-related fields confirm the necessity of recycling solid waste, they still need more education in health literacy as they are supposed to be the promoters of public health in the society in the near future.

Background: Using Evidence Based Medicine (EBM) in clinical practice is an important strategy for improving and updating medical services. Therefore, EBM has recently attracted a lot of attention in many medical schools around the world. In this study we tried to evaluate the familiarity of clinical residents who are one of the main clinical decision makers in public hospitals and also the next generation of specialists with EBM and EBM databases., Methods: This was a cross-sectional study in 2010 in which clinical residents of Kerman Medical University (KMU) participated. Residents were asked about the four main EBM databases. The data was collected by a self-administered questionnaire., Results: The data showed that from the respondents only 26.6% knew about EBM and only 28.7% of the respondents were familiar with "Up to Date", 22.3% were familiar with "Ovid EBM Reviews", 6.4% were familiar with "Cochrane" and 5.3% were familiar with "BMJ Clinical Evidence". The frequencies of those that actually used the databases for clinical decision making and could answer the search questions were even less., Conclusions: The results showed most of the residents lack sufficient knowledge about EBM and its databases. The reason is probably the inexistence of a systematic and comprehensive curriculum for EBM education during their residency program or undergraduate program. Thus, due to the importance of learning EBM in this group, there is a necessity to plan a comprehensive and proper education schedule for EBM and EBM database use at the beginning or further stages of residency.

Polychlorinated biphenyls used previously in industry are widespread environmental contaminants under scrutiny for their possible reproductive effects in humans. In this study, 200 breast milk samples from eligible Victorian mothers were used for measuring maternal contamination and their possible effect on the offspring was investigated. No significant association was found between maternal PCB contamination and low birth weight, small for gestational age and previous miscarriage or stillbirth. The elevated odd ratios of prematurity, increased with increase in contamination level but were nonsignificant. Higher PCB contamination was not in favor of any gender in the offspring. Our results suggest that chronic, low contamination with PCBs does not pose a reproduction threat in humans.

Cyclodienes are a group of organochlorine pesticides that have been the focus of increasing numbers of breast cancer etiology studies in recent years. The aim of this systematic review and meta-analysis was to summarize and pool the results of breast cancer and cyclodiene insecticide contamination studies. We used databases from 1966 to 7/2006 and included 21 case-control studies. Pooled odds ratios or differences in means as geometric means ratios were calculated. Meta-analysis of the chemicals did not reveal any statistically significant association except for heptachlor. The heterogeneity among the different studies and the methodology limitations are discussed.

The effects of organochlorines on human reproduction have been recently under scrutiny. Some negative effects on animal reproduction have been reported. In this study we aimed to evaluate the effect of maternal contamination with a certain group of organochlorines, which are cyclodienes, HCB (hexachlorobenzene) and beta-BHC (beta-hexachlorocyclohexane) on human reproduction. Breast milk samples from 815 eligible Victorian mothers were used for measuring maternal contamination and the reproductive outcomes such as birth weight, head circumference and prematurity were taken from health files. Our study did not show any significant negative effect on outcomes such as birth weight, small for gestation age, previous miscarriage or still birth, head circumference or sex ratio. An inconsistent increase across oxychlordane exposure levels for prematurity was found. We also found an inverse association between the highest levels of HCB and oxychlordane with previous miscarriage or still birth; but this was based on small numbers and may be explained by loss of contaminants through the aborted fetus. These results suggest that the declining contamination levels of these chemicals do not impose a threat to human reproduction.

A number of studies have suggested that environmental contamination with organochlorine pesticides may be related to risk of breast cancer. To investigate this association in a rural part of Australia, organochlorine contamination data from a breast milk organochlorine study conducted in the state of Victoria in 1993 were used. The state was divided into 11 statistical divisions. Standardized incidence ratios (SIRs) for the 11 regions were calculated using breast cancer incidence data from 1983 to 2002. During that time, 47,250 breast cancer cases occurred in Victoria, which had an average population of 2,147,409 women. The Ovens-Murray region, which was the region most contaminated with organochlorine pesticides, showed an elevated SIR of 1.10 (95%CI, 1.03-1.17), although two other regions with lower organochlorine contamination levels also had elevated SIRs. The rural part of the Ovens-Murray region, where the main pesticide use occurred, had the highest SIR, 1.15 (95%CI, 1.07-1.23). We did not find any significant correlation between organochlorine contamination and the age-standardized rate of breast cancer across all regions. But a positive dose-response relationship using an adjusted negative binomial model was detected for heptachlor epoxide. Our study may provide limited support for the role of environmental contamination with organochlorine pesticides in the development of breast cancer.