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Introduction: Cardiovascular disease (CVD) is one of the most important health problems and the leading cause of mortality worldwide. This study aimed to estimate the risk of CVD using the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts. Methods: The demographic characteristics of all participants of this study aged 40-70 years who did not have a prior coronary event were collected. The 10-year CVD risk was estimated using the laboratory version of the WHO/ISH risk score charts. The risk scores for 11678 participants of the Azar cohort population were calculated. Participants were classified as low risk, moderate risk, or high risk. Results: According to the WHO/ISH charts, only 0.1 % of the population was classified as high-risk (≥40%), and 96.8% had a 10-year CVD risk of

Background and Objectives: The number of elderlies is increasing in Iran and the world dramatically. Noncommunicable diseases are the most common causes of morbidity and mortality among elderly people. This study was conducted to investigate the prevalence of obesity, hypertension, diabetes and hyperlipidemia among elderlies of Sahlan area of Tabriz, Iran. Material and Methods: This cross-sectional study was conducted on 245 elderlies who were 60 years of age or older (126 females, 119 males). The questionnaire of Ministry of Health on older people was formulated for them. The data were analyzed using SPSS version 23 software and chi-square test. Results: The results showed that 26.9% of the participants were in the normal range of weight, 31.02% were overweight and 42.04% had obesity. In total, the prevalence of hypertension was 42.44% which was 53.96% among women and 30.25% among men (P-value=0.04). The prevalence of diabetes was 20.81% which was 26.98% among women and 14.28% among men. The prevalence of hyperlipidemia was 50.6%, which was 56.34% among women and 44.53% among men. Conclusion: Assessing the screening of obesity, hypertension, diabetes and hyperlipidemia among elderlies of Sahlan area showed that the prevalence of overweight, obesity, hypertension, diabetes and hyperlipidemia was high. Therefore, the management of these problems needs education, follow-up and thoughtful planning.

Background and Objectives : Preeclampsia is one of the most threatening problems in pregnancy and potentially is followed by preterm birth, miscarriage, low birth weight and maternal mortality. Folic acid supplementation is commonly prescribed for women in child bearing age to reduce the prevalence of neural tube defects. However, its role in pre-eclampsia and hypertension is not proven and is debatable. The aim of this study was to evaluate the influence of folic acid on before pregnancy care on blood pressure in pregnancy. Material and Methods: This retrospective cohort study was conducted as census on all 1939 women referred to receive prenatal care between 2008 and 2013 in rural and urban healthcare centers in Sarab, Bostanabad and Khosroshahr. We compared blood pressure changes in two groups with folic acid consumption and another group, not consuming folic acid. Collected data were filled in the checklist and underwent statistical analysis of descriptive and analytical methods by SPSS 16. Results: The mean age of women in this study was 25.98±5.78 years. Ninety-two percent of mothers had regular consumption of folic acid during pregnancy. The peak period of high blood pressure was reported at weeks 37-35 with 8.2% in systolic blood pressure and diastolic blood pressure at week 37-35 and more than 37 weeks with 1.6%. Systolic and diastolic pressure in mothers taking folic acid was significantly lower (P Conclusion: Folic acid intake during pregnancy, as a part of prenatal care, significantly reduces the incidence of hypertension of pregnancy. During this period, folic acid intake can diminish pre-eclampsia and promote maternal and new born health.

Background and objectives: Familial Mediterranean Fever (FMF) is an autosomal recessive disease. Generally, the Mediterranean basin is the region where the first cases of FMF have been identified. The gene responsible for FMF is gene MEFV. Disease occurs due to mutations in the gene MEFV. Our aim was to determine the geographical distribution of the most frequent mutations in Familial Mediterranean Fever Disease in the world. Material and Methods: In this study, databases including Google Scholar, PubMed, Medline, Ovid, IranMedex, Irandoc, SID, Magiran and published papers were searched with no limitation in time. Then, all collected studies without any limitation were assessed to determine relevant studies. At the end, world map of the most frequent mutations of FMF was generated by Geographical Information System (GIS) software. Results: Although more than 290 mutations of the MEFV gene have been described, only four mutations (M694V, M694I, V726A, and E148Q) were prevalent among patients with FMF. Conclusion: The most frequent mutation associated with FMF mutation is M694V all over the world. E148Q mutation was found to be with mild clinical relevance.

​Background and objectives : Behçet's syndrome is an inflammatory disorder of unknown etiology that has a unique worldwide prevalence and distribution. The aim of this study was to estimate the prevalence of Behçet's syndrome in the world and in Iran using a systematic review and meta-analysis approach. Material and Methods: Data banks of Ovid, MEDLINE, Rheumatology, Google scholar, Springer, PubMed, Science direct, Wiley, Magiran, SID, Iranmedex and Irandoc from 1990 onwards were searched. All cross-sectional studies relevant to the prevalence of Behçet's in the world and in Iran were studied. Prevalence rate of Behçet's syndrome with 95% confidence limits was calculated. For statistical analysis, prevalence rates were entered in the Comprehensive Meta Analysis (CMA) software. The prevalence of Behçet's was mapped with the Geographic Information Systems (GIS). Results: In this study, 23 articles were finally accepted. The overall prevalence of Behçet's syndrome in the world was 42.4 per 100000 (95% CI: 0.382 -0.465). Heterogeneity rate with 23 studies was 1127.5, and with 21 studies were 490.3. The highest rates were reported from Turkey with the overall prevalence of 4.2 per 1000 (95% CI: 4.073- 4.327). Conclusion: Our findings showed that the highest occurrence of Behçet's disease was observed in Turkey, Palestine and Iran. It is also, however, common in Europe, America and other Asian countries.

​ Background and objectives : Familial Mediterranean fever (FMF) is an autosomal recessive disease. Generally, the Mediterranean basin is the region where the first cases of FMF have been identified. Yearly, some people undergo unnecessary surgery, due to misdiagnosis of doctors. In this study, our aim was to determine the prevalence rate and status of familial Mediterranean fever in the world and Iran which was done using meta-analysis method. Material and Methods : In this study, Google Scholar, Pubmed, Medline, Ovid, IranMedex, Irandoc, SID, Magiran databases and published written sources were searched without limit of time. Then, all the studies were collected without limitation, to determine the relevant studies were assessed. After verifying the quality of the studies, required data were extracted and analyzed using the method of meta-analysis (random effects model) in the CMA software. In the end, world map of the prevalence of familial Mediterranean fever disease was traced by the GIS software. Results : The primary search identified 400 studies which only 23 studies had the required quality for inclusion in the meta-analysis. Two of the studies were related to Iran.The results of the meta-analysis showed that the overall prevalence rate of familial Mediterranean fever in the world and in Iran along with their 95% confidence intervals (in parentheses) are 0.116% (0.088 - 0.144) and 0.018% (0.001 - 0.037), respectively. Since the studies were limited, the overall prevalence rate obtained from Iran does not have the capability of generalization to other regions of Iran. Conclusion : FMF in the world is prevalent in the Mediterranean and the Middle East region, among ethnic Turks, Armenians, Jews and Arabs, respectively. But FMF epidemiology is rapidly changing, due to population migrations from Mediterranean countries and the Middle East to the rest of the world and the increasing diagnostic sensitivity. The FMF has to be considered as a worldwide disease, even if it initially originated in the Mediterranean area.

​ Background and objectives : Phenylketonuria (PKU) is a metabolic error which is caused by the deficiency of phenylalanine hydroxylase (PAH) inverting phenylalanine to tyrosine. This disease is the most common form of hyperphenyalaninaemia stow which is inherited in a form of a predominant autosomal. Therefore, the aim of this study was to investigate the distribution of occurrence of phenylketonuria disease in the world by using the systematic review and meta-analysis. Material and Methods : The national and international databases such as Medline, CINAHL, Embase, PubMed and OVID, Google scholar, IranDOC, IranMedex, SID, Magiran, have been searched from 1990 onwards, without language restrictions and by using the key words: phenylketonuria, prevalence, incidence, congenital diseases. A total of 304 articles related with this topic were found. Finally, 62 studies were accepted. Data were analyzed by using Comprehensive Meta-Analysis software at 95% confidence level. The distribution of diseases was shown by using Geographic Information System software on the world map. Results : The findings showed that in 100000 people, the best estimate of the disease prevalence of phenylketonuria is 11.83 (95% CI: 10.22- 13.44) and the best estimate of the incidence of this disease is 8.2 (95% CI: 6.37- 10.03) in the world. The distribution of phenylketonuria disease has the highest rate in Europe and Asia and lowest rate in Africa and America, respectively. Conclusion : According to the findings of the present study, it can be said that there is a wide variety in the occurrence of phenylketonuria in the world and recent studies have confirmed his. Therefore, because of the irreversible consequences of the disease, the development of the appropriate training and control programs is recommended to reduce the occurrence of the disease.

Introduction: The universal target under the Millennium Development Goals (MDGs) is to reduce the worldwide burden of tuberculosis (TB) 2015, and we wanted to evaluate development in TB control by assessment of the time trend in incidence and death rate in Tabriz, Iran. Methods: This was a retrospective trend analysis of the data have been recorded in East Azerbaijan State TB center during 10 years. Data were related to patients have been registered for treatment under the directly observed treatment, short-course (DOTS) strategy from 2001 to 2011. Results: In total, 3283 TB patients were treated under DOTS strategy during 2001-2011. Males constituted 55.0% of subjects. The risk was the highest among the productive age group (15-44 years). About 61.0% of cases had pulmonary, and 78.0% of pulmonary TB patients were found to be the sputum smear positive than 46.0% of them were new sputum smear positive, and 2.0% of them were relapse. On average, for sputum smear positive, TB cases from 2005 to 2011; the treatment success rate was 87.3%; the cure rate was 80.2%; the treatment failure rate was 0.5% and death rate was 10.3%. In general, the TB incidence rate for all TB cases was decreased from 11.9-8.1 a 100000 population and the smear-positive pulmonary TB incidence rate were decreased from 4.7 to 4.1 a 100000 population in eastern Azerbaijan province during 2001-2011. Conclusion: In general, we had a decrease in the incidence rate for all of TB cases. In addition, we had a fall in cure rate and had an increase in drug side effects rate in this year that can be because of elevated old people ratio and high death rate by other indirect causes and lack of regular visits and medications taking according to the treatment protocol.

Introduction: Improving of mother and child health is one of the most important and essential roles of public health agencies and millennium development goals. The aim of this study was to determine rates of prenatal care (PNC) utilization in Tabriz, Iran, from 1994-2013 and compare the two most commonly used models of PNC utilized in determining the proportion of the pregnant woman receiving inadequate PNC and comparing use of two indices. Methods: In this study, we conducted a descriptive cross-sectional study of 2834 women having a health record in care center of the rural region in Tabriz for 20 years. We used questioner that validated in the study Jabbari et al. for obtaining data. Random sampling quotes were done in 3 times during the years 1994-2013. Results: We found that 53% of mothers received adequate care by adequate PNC utilization (APNCU) index, but 17% by revised-GINDEX index but the most important objective of our study was identifying the relationship between adequacy of PNC and pregnancy outcome. On the other hand, the study indicated that between inadequate care and low birth weight (LBW), mother weight gaining, birth height exists significant association, but there is no meaningful correlation between birth weight and adequacy of care (P < 0.05). Conclusion: The study analyzed the effect of PNC utilization on birth outcomes and suggested that PNC decrease LBW through both increasing gestational age as well as improving fetal growth at the same time it improves birth height and mother weight gaining. All findings of this study emphasize the need for health policies to improve utilization and access PNC.

Introduction: Patient centered decision making is one of the main aspects of evidence –based medicine, in addition to being morally important. The aim of this study was to extract the experiences of clinicians on patient-centered decision making. Method: A qualitative study based on descriptive phenomenology method was done. Purposive sampling was used to select the clinicians from among faculty members of medical school. Focus Group Discussion (FGD) was used to gather the data .The discussion continued till the saturation of data was achieved. Content analysis was used for data analysis. Results: The participants of FGD were 6 clinicians from various specialties. 218 codes were extracted from the data and they were categorized in 4 themes and 16 subthemes. The main themes were: good relationship with patients, respect to the opinions and beliefs of the patients, taking into account the needs, preferences and experiences of the patients, comfort and safety of outpatient and inpatient setting for patient, shared decision making. Conclusion: Patient centeredness based on the experiences of clinicians in an educational hospital is similar to other studies but in developing countries like Iran clinicians have contextual and cultural barriers to apply it.

Background and objectives : Safe pregnancy is among the goals and missions of reproductive health which has an important part in Millennium Development Goals. Unfortunately, bad conditions in reproductive health are the major cause of women mortality in fertility age all over the world especially in developing countries. Congenital anomalies are pregnancy problems that in case of early diagnosis, the anomaly will be done according to list 51. The aim of this study was to determine families’ demographic situations, frequency of congenital anomalies types and the factors of legally termination of pregnancy to suggest solutions in order to reduce anomalies and promote reproductive health. Material and Methods : This is a case-control study carried out for 1 year period from 2010 to 2011 in which 603 pregnant women that were diagnosed/recommended to the Legal Medicine Organization for the termination of pregnancy as having a fetus with some types of birth defect(s). Among them, 201 were categorized as case group (receiving termination permission because their pregnancy was before week 20) and 402 of them were categorized as control group 1 (not receiving termination permission because their pregnancy was after week 20) and 200 women as control group 2 who referred to Alzahra hospital to give childbirth. A questionnaire containing demographic and geographical information was made for all the women in those three groups. Results : The average age of mothers in this study was 27.2 years (15-47 years old). In 100 % of women, at least 1 ultrasound examination was performed and genetic and Amniocentesis tests were conducted in 2.1 % and 3.5 % respectively in order to diagnose anomaly. In total, 33 % of pregnant women with congenital anomalies received pregnancy termination permission. The majority of congenital anomalies were neural tube defects 16.9 %, hydrocephaly 8.6 %, limb deformation 7.7 % and Down syndrome 6.4 %. Mother’s age, the history of anomaly in previous child and Folic acid usage during pregnancy, according to the meaningfulness of both regression models, are the main predictive independent factors. (P Conclusion : By determining the causing factors of congenital anomalies and removing the shortcomings and weaknesses, it is possible to reduce the number of these anomalies and take major actions to promote the health of mothers and children. ​

​Background and objectives : Implementation of Family physician program in Iran provided appropriate capacity to improve community participation and intersectoral collaboration to public health in recent years. The aim of this study was to determine the family physician impact on community participation and intersectoral collaboration in health care centers in Tabriz University of Medical Sciences. Material and Methods : This cross-sectional descriptive study was conducted in three health centers of three districts in the East Azerbaijan province. Data were extracted from records of two periods of time; before and after implementing family physician program. Data were analyzed using SPSS 16 software. Results : The results showed that the trend of community initiatives and actions in public health field are growing slowly. After implementation of family physician program, the number of agreements for operational and completed collaborations in intersectoral collaboration is increased. Conclusion : In spite of doubling the number of physicians after implementation of family physician program, the trend of community initiatives and intersectoral collaboration in the field of environmental health are slow. As a result, revising the physicians’ roles and performance evaluation checklists in these fields are essential.

Background and Objectives : Family physician as the leader of health team is responsible for monitoring water quality, food and cosmetic preparation settings. This study was carried out to determine the effect of family physician program on the performance of health centers in the mentioned processes in urban areas of East Azerbaijan, Iran. Materials and Methods : In this cross-sectional descriptive study, three health centers of the East Azerbaijan province were selected as samples and data were extracted from environmental health records files for water and sampling was used for food and cosmetic distributors for two periods of time: before and after implementing family physician plan. Data were analyzed using SPSS 16 software. Results : The results showed that monitoring of chlorine in drinking water was doubled and microbial sampling of water was increased one and a half time. Furthermore, the monitoring processes of health regulations in food and cosmetic preparation settings after implementing family physician program were improved. Conclusion : In spite of improvements in drinking water monitoring process after family physician program implementation, it is necessary to revise the family physician responsibilities and performance evaluation checklists in this section.

​Background and Objectives : Providing and promoting children's health is a major task of family physicians in Iran’s health care system. This study was carried out to determine the impact of family physician program on health indicators of children in the rural area of Tabriz city. Materials and Methods : This cross-sectional descriptive study was conducted on children born in rural region of Tabriz city from 2003 to 2008. A total number of 751 samples were selected (12% of total population) using stratified sampling. Data were collected using a valid checklist that was constructed and performed by the researcher in the last research. The data were extracted from family health file records (child care forms) for two periods of time: before and after implementing family physician plan. Data were analyzed by SPSS 16 software. Results : The results showed that there was a significant difference in children's health indicators including the number of cares for child, micronutrient supplementation, child's age in the first time health care, the number of referrals and hospitalization case before and after implementing family physician plan. Meanwhile, the continuity of breastfeeding, anthropometric index of height and weight were not significantly different in the improvement of indicators after the implementation of family physician program. (p Conclusion : The presence of doctors and midwives in health team had a significant effect on some components of child care. However, there was no reliable evidence to prove its impact on child health indicators. Therefore, revision of the family physician responsibilities, reform of the family health information system and further studies to determine the exact impact of the plan is recommended.

Background and Objectives : The aim of this study was to evaluate the impact of using folic acid during pregnancy for the reduction of neural tube defects (NTDs) in the northwest region of Iran. Material and Methods : In this study, 243 pregnant women that were identified by medical diagnostic tests as having a fetus with some types of congenital anomalies were evaluated. They were referred to Legal Medicine Organization of East Azarbaijan province to get permission for therapeutic termination of pregnancy. Results : The prevalence of NTDs among pregnant women who were referred for therapeutic termination of pregnancy was 24.7%. Consumption of folic acid prevented NTDs by 79% (Odds Ratio = 0.21, CI 95%: 0.12–0.40) and 94% (Odds Ratio = 0.06, CI 95%: 0.03–0.15) compared to pregnancies complicated by other anomalies and normal pregnancies, respectively. Hydrops fetalis, hydrocephaly, Down syndrome and limb anomalies did not have any significant association with use folic acid. Conclusion : Along with the advice for the consumption of folic acid for pregnant women, they should be offered prenatal screening or diagnostic tests to identify fetal abnormalities for possible termination of pregnancy for maternal and child health promotion. ​

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In order to reduce behavioral risk factors in the 21st century accurate and valid information is required on these factors and also about protective factors during these so called stormy years. . Attention to life-long behavioral risk factors and protective factors provides an alternative paradigm. Indeed, efforts to improve adolescent and pre-adolescent health typically features interventions designed to address specific health risk behaviors, such as physical inactivity, tobacco use, alcohol and drug use, violence, unintentional injuries and early sexual activities .As we know, the Global School-based Student Health Survey (GSHS) was developed by the World Health Organization and conducted among adolescents, aged 13–17 years, at a country level to obtain accurate information on behavioral risk factors and protective factors, with 335 items in 10 core questionnaire modules addressing the leading causes of morbidity and mortality among children and adults worldwide, including alcohol and tobacco use, dietary behaviors, drug use, hygiene, mental health, physical activity, violence and unintentional injuries, sexual behaviors that contribute to HIV infection and other sexually-transmitted infections, unintended pregnancy and protective factors .We found that internal consistency (Cronbach's alpha) in 2 modules of dietary behaviors (0.25) and physical activity (0.22) had the lowest reliability in comparison with other items.This finding suggests that although the tool that uses GSHS is accurate, it is necessary to pay more attention to issues in adolescent health-related contexts and it seems essential to pay more attention to and exercise caution in interpretation of data regarding items about dietary behavior and physical activity in using this questionnaire despite transcultural adaptation and validation of the GSHS questionnaire in Persian.This school-based self-report survey provided critical information for implementation across culturally diverse adolescents; therefore, culturally sensitive and locally valid questionnaires are essential to local health behavior risk factors and concerns in the global context. In addition, comparative cultural data on dietary behavior and physical activity are necessary to map the causal pathways and identify contributions of other risk factors such as peer pressure.