احمدرضا فرسار

Diarrhea outbreaks caused by contaminated water or food result in 1.8 million deaths worldwilde every year. This study aimed to identify factors associated with diarrhea outbreaks in Pardis city in 2014.
This case-control study was conducted with participation of residents of Phase One to Four of Pardis city in Tehran province in 2014. Of 5075 people with diarrhea, 250 were selected as cases. For each case, a control from the neighbors who was healthy and did not have diarrhea at the onset of the outbreak was selected. Data were collected by interviewing participants and using the standard questionnaire for water and food borne diseases outbreak designed by the Ministry of Health of Iran. Blood and stool samples were collected for laboratory tests. Data were analyzed using SPSS-21 software, and ChiSquare and Kruskal-Wallis tests were used to analyze the data.
Among all participants, 144 (57.7%) were women, and 106 (42.3%) were men. The mean (SD) age in the case and control group was 25.8 (2.1) and 29.8 (1.8) years respectively. Most participants who were affected by the diarrhea outbreak lived in Phase Three of Pardis city. They reported that diarrhea symptoms appeared on December 26th 2016 between 18:00 and 24:00. Drinking tap water instead of bottled water, (OR=5.94, 95% CI=3.45-10.21) and drinking of tap water at home after water supply reconnection (OR=4.20, 95% CI=1.56-11.30) had an impact on the incidence of diarrhea outbreaks among cases compared with controls at the time of outbreak (P The diarrheal outbreak in Pardis city was due to bacterial and viral pollution of water following water pipe fractures in the water distribution system of the city.

Acute gastroenteritis is mainly caused by some viruses and often NoVs. In January 2014, an outbreak of gastroenteritis occurred in Pardis City, in Tehran and that made 5064 patients visit health centers. The purpose of this study was to investigate the epidemiology of the disease in this region.
This cross sectional study was done to evaluate the outbreak of gastroenteritis in Pardis City in January 2014. In this outbreak, the data of 1150 out of 5064 patient was collected by health centers. The inclusion criterion was residing in the location for at least ten days before its occurrence. The exclusion criterion was incomplete recorded data. A number of 126 human samples underwent laboratory investigation. The data collection tool was was line listings and data analysis was done with Excel 2010 and SPSS21 software.
female and male patients comprised 57.8 and 42.2% of the study population and 59.7% of the subjects were under 27 years of age. The most prominent symptoms were vomiting (94.9%), diarrhea (37.7%), abdominal pain (18.8%), and fever (0.6%). The results showed that bacterial contamination, parasites, serologic tests for hepatitis E (IgM-HEV) and hepatitis A (IgM-HAV) and RT-PCR for hepatitis E and A were negative but 6 out of 9 fecal samples were positive for NoVs using molecular RT-PCR.
The results revealed the role of NoVs in Pardis City in 2014. Moreover, clinical and epidemiological characteristics of the population, season, and the environment of this diagnosis were confirmed.

Cancers are one of the most important public health issues and the third leading cause of mortality after cardiovascular diseases and injuries in Iran. The most common cancers reported in the recent years have been included skin, stomach, breast, colon, bladder, leukemia, and esophagus respectively. Control of cancer as one of the three main health system priorities of Iran, needs a specific roadmap and clear task definition for involved organizations. This study provides stakeholder analysis include determining the roles of Ministry of Healthand Medical Education as the custodian of the national health and the duties of other beneficiary organizations to reduce the risk of cancer for cooperation with a scientific approach and systematic methodology. This health system research project was performed by participation of Social Determinants of Health Research Center of Shahid Beheshti University of Medical Sciences, Office of the Non-Communicable Diseases of the Ministry of Health and Medical Education and other stakeholders in 2013. At first, the strategic committee was established and the stakeholders were identified and analyzed. Then the quantitative data were collected by searching in national database concern incidence, prevalence, and burden of all types of cancers. At the last with the qualitative approach, a systematic review of the studies, documents and reports was conducted as well as conversing for the national strategic plans of Iran and other countries and the experts’ views regarding management of the cancer risk factors. In practice, role and responsibilities of each stakeholder were practically analyzed. Then the risk factors identified and the effective evidence-based interventions were determined for each cancer and finally the role of the Ministry of Health were set as the responsible or co-worker and also the role of the other organizations separately clarified in each case.

Health volunteers are the women who do charity work to prevent، protect and promote the health status of the covered neighbors and hereby cooperate with the health centers. The aim of this study was to compare the health volunteer''s performance in the covered health centers by Shahid Beheshti University of Medical Sciences. This descriptive- analytical study was performed by the participation of 2060 Health volunteers، who were cooperating with 90 covered health centers by Shahid Beheshti University of Medical Sciences. These include Shomal، Shargh، Shemiranat، Pakdasht، Damavand and Firoozkooh. We used census sampling method. Demographic data was gathered through interviews with the health volunteers and their performance evaluated by the supervisor of the volunteers; through the evaluation forms and these data gathered together. The mean (SD) of the health volunteers performance was 30. 9 (16. 4) in all centers. They were 35. 1 (22) in Shargh، 34 (14. 5) in Shomal، 32 (11. 3) in Firoozkooh، 28. 3 (14) in Shemiranat، 7. 9 (9. 2) in Damavand and 23. 6 (8. 5) in Pakdasht respectively. The mean (SD) of the efficacy of health volunteers was 8. 6 (9. 9) in all centers. They were 11. 7 (5. 6) in Firoozkooh، 10. 7 (15. 7) in Shargh، 9. 4 (6. 8) in Shomal، 7. 9 (4. 9) in Damavand، 7. 9 (6. 1) in Shemiranat and 4. 6 (4. 3) in Pakdasht respectively. Older and married volunteers with more experience performed better. There was no significant relationship between the efficacy of health volunteers with their literacy level، employment status and absorber of them. The health volunteers of Shomal، Shargh and Firoozkooh had the best performances respectively. The performances of those in Shemiranat، Damavand and Pakdasht were less than the overall health centers’ mean score. The efficacy score of Firoozkooh، Shomal and Shargh health centers were above the overall health centers’ mean score respectively. Considering all factors، it seems that the efficacy of the health volunteers of Shomal and Pakdasht were the most and least suitable respectively.

Nutrition is one of the effective factors in the protection of health and the prevention of disease. Therefore، determination of the relationship between nutrition choices and health of people is emphasized. The aim of this study is to determine the effectiveness of education and nutrition consultation on changing the unhealthy nutritional habits، and improving healthy nutrition behavior among the clients of Sardar-Jangal health center in 2012. This interventional study was performed with the participation clients of Sardar Jangal health center in 2012. The sample size was 1500 and the sampling method was census. Data was gathered through a questionnaire and interview. The questionnaire included information regarding age، sex، education، employment and nutritional status. The scores between 9-11، 5-8 and less than 5، respectively، were considered as favorable، relatively favorable and unfavorable nutritional status. The participants with relatively favorable and unfavorable status were referred to nutrition education and consultation classes. At the end of the consultation classes، their nutritional status were assessed again. The data was analyzed through SPSS 21، using T-Test. In the study، 1500 clients of Sardar Jangal health center participated. The sample included 383 (25. 6%) male and 1117 (74. 4%) female. The mean age of male and female was 38. 3±21. 1 and 36. 9±17. 4 respectively. Before participating in the nutrition education and consultation classes، the nutrition status of 343 (30. 7%) of females was favorable whilst for 775 (69. 3%)، the nutritional status was unfavorable. Among 114 (29. 8%) of males it was favorable and amongst 268 (70. 2%) it was unfavorable. Between the mentioned clients، the nutrition status of 144 (20. 1%) females and 28 (12. 7%) males improved after nutritional consultation (P < 0. 001). The results showed nutritional education and consultation are effective in improving the nutritional behavior and modifying the incorrect nutritional behavior.

Backgrounds and The purpose of this study is to investigate injuries resulting from accidents and incidents referred to medical centers and hospitals of Shahid Beheshti University of Medical Sciences. This study is a cross-sectional study. All cases admitted to hospitals'' of Deputy of Health of Shahid Beheshti University of Medical Sciences، due to accidents and injuries from March 2012 to March 2013 were reviewed. Categorization of accidents and injuries data was performed according to tenth version of international classification of diseases. SPSS V. 18 was used for analysis of data. The main variables in this study، the type of incident، type of accident، accident location and background variables that were studied included: gender، age. Data collected by means of forms and software injury register by Hospital emergency department staff to interview and hospital records، were completed. In total، 248438 cases were reviewed. 67. 7% were male and 32. 3% were female. Traumas، traffic accidents and falls were major causes of accidents and injuries. Accidents and injuries were more prevalent in 15-25 years age group. Individuals living in urban areas sustained more injuries compared to individuals from rural areas. A total of 722 deaths were reported due to accidents and injuries. Research results indicate that traffic accidents constitute a large proportion of accident and injuries. Also، men، young people were the most victims of accidents and injuries. Training of different groups، including before and during recruitment، training mothers and elderly it seems to be useful. Further studies on the improvement of accidents and injuries software is suggested for access to complete and reliable data. Promoting Knowledge and training، especially in the younger age group، intervention to resolve the accident prone spots and technical defects is recommended to reduce traffic accidents

Under 5-years mortality year is one of the most important indicators of development and health in the countries. Therefore, generating accurate picture of child mortality in order to evaluate the death causes and identifying the avoidable factors for designing the interventions and preventing similar death is necessary. The present study aimed to investigate the causes of deaths in 1 to 59 months children in the area covered by Shahid Beheshti University of Medical Sciences in 2012. In this descriptive cross-sectional study that conducted from March 2012 to March 2013, all of 1 to 59 months children deaths in the area covered by Shahid Beheshti University of Medical Sciences were investigated. Required data was extracted from registration forms of the child health office of ministry of health and medical education. The total number of deaths in 1 to 59 months children was 383. The highest frequency of death was observed in the children who aged between 1 to 12 months (57.8%). More than half of the children who died were boy (52.5%). Totally, the most common causes of death were congenital and chromosomal abnormalities (17.5%), injuries (15.4%) and cancers (11.2%). Based on the results, designing interventions such as genetic counseling in high risk couples, training of the parent and children for prevention of injuries and public awareness about the warning symptom of the cancers and respiratory system disease in order to reduce the children deaths is essential.

Healthy People plan that is expressed by WHO stipulated that by 2000 at least 50% of the children and by 2010, 90% of 6-5 year-old children should be with no caries in their primary teeth. The present study investigated the prevalence of teeth decay of D, E and related factors in 6 and 7 years old children. This cross-sectional study was conducted in 2013 to assess the bases covered by student Shemiranat health center. Study population including 5000 students aged 6 and 7 and the sample size of 450 patients was available in sampling method. Data in a form that was designed for this study were collected and analyzed using Epi data and SPSS software. The index dmft (Decayed Missed Filled Teeth) in primary teeth D and E is equaled to 2.46 and prevalence of dental caries E and D were estimated 63.4%. There is significant relationship between decay of teeth D and E and father education (Pvalue<0.001) and mother education (Pvalue 0.001) children age (Pvalue<0.001) locality of children whether they live in rural or urban regions (Pvalue 0.001) economic condition of families (P value<0.001) and social status (Pvalue<0.001) with number of decay teeth. The results imply on high prevalence of teeth caries among the children molar covered by Shemiranat health center so that the number of teeth without caries is far from the global measures and WHO. Likewise there is a significant relationship between social and economical status with children decay teeth and there is a need to pay more attention to mouth health in poor regions from the social and economical point of views.

Backgroun and The scarce water resources and Poor quality drinking water with the lack of a proper sewage collection and disposal system and increasing management problems due to rapid population growth made Islamic Republic of Iran to pay priority attention to the water and sewerage problems of districts in its five-year development plan. In this regard, water and sewerage project in Bandar Anzali became a priority by Guilan province Urban Water and Sewerage Company with the government partnership and World Bank financial support. The objective of this study is to complete the first phase of a two-phase study to determine the impact of using an urban sewerage system on acute Diarrhoea in children under five years of age in Bandar-Anzali in the Guilan province.Materails and The study is a concurrent control before and after field trial which is carried out in two stages: before (phase I) and after (phase II). Sampling for phase I was performed in the middle month of each season, November and February 2009 and May and August 2010. The incidence of acute Diarrhoea was measured with the participation of 2400 mothers of children under 5 years old in the city of Bandar-Anzali in two groups: the intervention group (inside the sewerage system project perimeters) and the control group (outside the project perimeters). Data were collected by local female general practitioners and medical students in each city, under supervision of the community medicine department and by door-to-door interview with mothers. Data were analyzed using the SPSS 11.5 software package and the Pearson Chi-Square was used to compare qualitative variables between groups, and the t-test and One-Way ANOVA was used to compare quantitative variables. The annual incidence of acute diarrhoea in children under five years old was 11.9%. The seasonal pattern of acut diarrheoa incidence was 12.6% in May, 13.3 in August, 11.5% in November, and 10.3% in February respectively. The highest incidence of acute diarrhoea was seen in children from 2 to 5 years of age. The study showed the incidence of acute diarrhoea on children under five years old in Bandar-Anzali city is moderate and it follows a seasonal pattern. The highest rate was seen in summer and the lowest rate in winter. It is expected to decrease with the initiation of the sewerage system program.

It is obvious due to lack of resources،resources; we should devote our limited resources to priorities in order to reach an acceptable level of health. The objective of this study is research priority setting for Pediatric Surgery Research Center with the participation of all stakeholders. This is a Health System Research (HSR) project. In order to apply governance and leadership issues with the participation of 41 people including faculty members in Pediatric Surgery Research Center of Shahid Beheshti University of Medical Sciences، other pediatric specialists and health system stakeholders and the people associated with the health system inside and outside of the university. This study was performed with little change in 2010 using the Council on Health Research for Development (COHRED) model. Based on the model، at first the stakeholders were identified and the field situation of pediatric surgery was analyzed. Then، research areas and titles were specified and research priorities were setup by giving scores according to the criteria. The seven obtained research areas in order of priority are pediatric trauma، pediatric cancers، pediatric urology diseases، undescended testicles in children، developmental genetics and congenital defects، emergency in children and application of laparoscopic surgery in children. SinceBecause each of the research areas are composed of multiple subareas. Finally we specified 43 research subareas as research priorities. These subareas include epidemiology، risk factors، prevention، screening، diagnosis، treatment، follow-up، complications، knowledge and attitudes of parents، quality of life، economy aspects and data bank for further research. ‍ In this project، research priorities were setup for Pediatric Surgery Research Center of Shahid Beheshti University of Medical Sciences with the participation of all the stakeholders based on the recommended model of WHO (COHRED). It seems that reliability of the priorities is in moderate level، but there is a certaincertain validity in obtaining the best content in terms of the study conditions.

Adverse effect of children's epilepsy on family members, especially mothers, is an issue that has been less considered. One of these effects is anxiety increase in mothers. This study has been done with the purpose of determining frequency of worry and anxiety in epileptic children's mothers and recognizing the factors affecting it. This descriptive cross-sectional study has been done with the participation of epileptic children's mothers referred to Mofid Neurology Clinic of Medical Training and Therapy Center of Children. Anxiety level was determined by the State Trait Anxiety Inventory (STAI) standard questionnaire. The data was analyzed using t-test, Mann-Whitney test and one-way ANOVA and in all cases, p<0.05 considered as significant. In this study, 206 mothers were surveyed. The mean anxiety scores of mothers was 45±9.5. 84 subjects (40.7%) had mild anxiety, 71 (34.5%) had moderate anxiety and 51 (24.8%) had severe anxiety. Anxiety of mothers was significantly higher in cases such as education of child in special school (p=0.018), the high number of antiepileptic drugs (AEDs) consumed for controlling epilepsy (p=0.011), worry of death (p<0.001), permanent brain damage (p=0.036), drug side effects (p<0.01) and paralysis of child (p=0.030). Mothers who had been previously trained about epilepsy in center, had lower anxiety (p<0.001).‍ This study showed that the majority of epileptic children's mothers had moderate and severe anxiety. This phenomenon will be higher in cases like child’s education in special school, multi medication therapy and worries of side effects of epilepsy and will be lower by increasing mothers’ awareness.

Allocation of limited resources to research proposals with high priority helps achievement of acceptable level of health. Therefore، priority setting in research centers is a necessary action. The objective of this study is to report the research priorities of the Cardiovascular Research Center of Shahid Beheshti University of Medical Sciences in 2009.

This study involved 48 faculty members and other stakeholders in 2009. There were five basic principles including stakeholders’ participation and consensus، situation analysis، need assessment، defining research priority topics، and scoring the criteria. This is a modified version of the proposed model of “The Council on Health Research for Development (COHRED).

Twenty diseases were determined as research priorities of the cardiovascular research center of Shahid Beheshti University of Medical Sciences. These priorities included myocardial infarction، hypertension، unstable angina، atherosclerosis، dyslipidemia، heart failure، stable angina، metabolic syndrome، coronary bypass complications، pulmonary embolism، heart valve diseases، prevention of deep vein thrombosis، rheumatic fever، cardiogenic shock، cardiac arrhythmia، cardiac arrest and sudden cardiac death، Peripheral vascular disease، syncope، angioplasty and valvuloplasty، cardiovascular diseases: epidemiology، etiology، risk factors، prevention، rehabilitation، socioeconomic factors، knowledge، attitude، and practice to risk factors and prevention. ‍

Providing researchers with a list of research priorities and commitment to it، conduct research topics toward priorities and consequently the most productivity is achieved from the limited resources.

Acute diarrheal infections are one of the most important health problems in developing countries. Despite of the decrease in mortality and morbidity during the last decade, prevalence, incidence, hospital costs, and sometimes mortality rates, are still high for developing countries. The aim of this clinical trial was to determine the effect of lactobacillusadded yogurt (probiotic yogurt) on the duration of acute diarrheal diseases and anorexia of children.Methods and This double blind randomized controlled trial was performed with two concurrent control groups and by the participation of mothers who had children aged 1-3 years old, during the summer of 2009. Patients were randomly allocated into three groups; group oneconsisted of probiotic yogurt users, group two were regular yogurt users, and group three were the controls (without any recommendation for yogurt consumption). To assess outcomes, duration of diarrhea and anorexia were compared in the three groups. After the intervention and assessing outcomes, the mean duration of diarrhea in probiotic, regular yogurt, and control groups were 1.5±1.9, 2.4±1.4, and 3.3±1.4, respectively, which means the duration of diarrhea in the probiotic group, was significantly less than the two other groups (P< 0.001). In other words, the consumption of probiotic yogurt reduced the duration of diarrhea by 55% in the control group and by 37% compared to regular yogurt. In addition, although the duration of anorexia in the probiotic group was less than the other two groups, but it was not statistically significant. The study shows that the use of probiotic yogurt can decrease the duration of