PURPOSE: The object of the present study was to examine the relationship of short stature and obesity with cardio-metabolic risk factors in children and adolescents from Iran. METHODS: Present nationwide cross-sectional study was conducted as a part of the fifth survey of CASPIAN study on 7 to 18 years old children and adolescents from 30 provinces of Iran in 2015. Short stature and excess weight were defined as age and sex-specific height lower than 5th percentile and BMI higher than 85th percentile respectively. The multivariate logistic regression model was applied to assess the aim of the study. RESULTS: A total of 3844 children and adolescents (52.4%: boys, 72.2%: urban areas) with an average age of 12.45 ± 3.04 years were enrolled in this study. The prevalence of short stature, excess weight and combined-short stature and excess weight was estimated as 15.8%, 17.6% and 2.2%. Odds of abdominal obesity in children with only short stature (OR: 2.11, 95%CI: 1.59-2.80), only excess weight (OR: 17.38, 95%CI: 13.89-21.75) and combined-short stature and excess weight (OR: 22.83, 95%CI: 13.93-37.39) were higher than children with normal-height and weight. Moreover, odds of high BP and metabolic syndrome were further in the students with combined excess weight and short stature compared to the normal-height and weight group. CONCLUSION: We found that abdominal obesity, hypertension, and metabolic syndrome in short stature and obese children and adolescents were greater than those with normal-height and weight. Further prospective evaluations are required to clarify the association between short stature and cardio-metabolic risk factors.
INTRODUCTION: Work-related musculoskeletal disorders (WRMSD) are considered the main cause of occupational diseases. Health care workers, nursing assistants, and service forces that perform manual labor are the most vulnerable to musculoskeletal disorders, especially low back pain, due to the nature of their jobs. The purpose of this study was to compare the effectiveness of corrective exercise training to ergonomic principles training on low back pain in nursing assistants and service forces. METHODS: A nonrandomized clinical trial study was done on 75 staff (nursing assistants and service forces) with low back pain. The participants were divided into three groups: corrective exercise training, ergonomic principles training, and control group. Pain intensity and disability questionnaires were completed before and after 8 weeks of intervention by each group and analyzed. RESULTS: The mean intensity of pain after intervention in corrective exercises group (3.8 ± 1.5) was markedly less than the ergonomic group (4.7 ± 1.4) and control group (5.5 ± 1.7) (P = 0.001). The mean disability score after intervention in the corrective exercises group (17.3 ± 9.6) was significantly less than the ergonomic group (21.8 ± 12.6) and control group (25.3 ± 11.2) (P < 0.001). CONCLUSION: While corrective exercises training and ergonomic principles training both have a significant effect on reducing the severity of pain and disability caused by low back pain, corrective exercises training is more effective than ergonomic principle training.
INTRODUCTION: Pharmacological interventions have not been successful in the treatment of childhood functional abdominal pain (FAP) hitherto. Buspirone is suggested to be efficacious in some of the abdominal pain-related functional gastrointestinal disorders based on evidences from the studies on adults. We aim to investigate the efficacy of buspirone on childhood FAP. METHODS: This randomized clinical trial was conducted on 117 patients with childhood FAP aged 6-18 years. We randomly assigned patients to receive buspirone or placebo for 4 weeks, with the adjusted dosage for age. Participants completed the questionnaires assessing pain, depression, anxiety, somatization, and sleep disturbances at baseline, at the end of the 4-week therapy (first follow-up), and at 8 weeks after medication discontinuation (second follow-up). The primary outcome was treatment response rate, defined as reduced pain score of ≥2 or reporting no pain at the follow-up assessments. RESULTS: Ninety-five patients completed the 4-week therapy (48 and 47 in buspirone and placebo groups, respectively). Both buspirone and placebo reduced pain after 4 weeks of treatment, and these effects were persistent 8 weeks after medication discontinuation (P < 0.001 for both groups at weeks 4 and 12). Treatment response rates for buspirone and placebo were 58.3% and 59.6% at week 4 (P = 0.902) and 68.1% and 71.1% at week 12 (P = 0.753), respectively. DISCUSSION: Buspirone effectively improves pain and associated psychological symptoms including depressive symptoms, anxiety, somatization, and sleep disturbances in childhood FAP but has no superiority over placebo. Further studies, with the higher doses of buspirone and longer follow-ups are recommended.
Abdominal Pain/drug therapy , Buspirone/therapeutic use , Serotonin Receptor Agonists/therapeutic use , Abdominal Pain/psychology , Adolescent , Anxiety/psychology , Child , Depression/psychology , Female , Humans , Male , Pain Measurement , Sleep Wake Disorders/psychology , Somatoform Disorders/psychology , Treatment Outcome
Obesity is commonly associated with immunometabolic dysfunctions. Activation of inflammatory macrophages through TLR4 (toll-like receptor 4) and the anti-inflammatory impact of exercise have been and are the new concerns among researchers. A new short-term combined high-intensity interval training was proposed in young sedentary overweight/obese females. All participants were allocated to one of two groups: the exercise group (EG) and the control group (CG), where the EG participated in a 2-week combined training and the CG continued its routine lifestyle. Gene expression levels of TLR4, NF-κB(nuclear factor κB), and IRF3 (interferon regulatory factor 3) were assessed by real-time PCR. Physiological, anthropometric, and biomedical metabolic factors were assessed. The between-group comparisons indicated a tendency to a decrease in NF-κB gene expression in the EG. The IRF3 levels were not significantly changed compared to CG and the levels before training. Fasting glucose levels and ß-cell function revealed a significant improvement in EG. These findings indicated that this protocol decreased meta-inflammation levels and improved insulin resistance independent of body composition changes. Consequently, combined training may be recommended as a therapeutic approach in metabolic diseases.
Gene Expression Profiling/methods , High-Intensity Interval Training/methods , Interferon Regulatory Factor-3/metabolism , NF-kappa B/metabolism , Obesity , Toll-Like Receptor 4/metabolism , Adult , Female , Humans , Insulin Resistance/immunology , Obesity/immunology , Obesity/metabolism , Obesity/therapy , Outcome Assessment, Health Care
BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the common gastrointestinal diseases with various side effects. Proton pump inhibitor (PPI) drugs are widely used for their treatment and long-term ingestion, which results in an electrolyte imbalance. This study investigates the changes in serum magnesium, calcium, sodium, and potassium after long-term use of omeprazole in children. MATERIALS AND METHODS: This cross-sectional study was conducted in 2016-2017 on 97 children and adolescents, aged 1-15 years, with GERD, in Isfahan, Iran. Enrolled were patients visiting a referral pediatric gastroenterology clinic (Imam Hossein and Amin Hospitals) examined by an academic pediatric gastroenterologist. Before and 4 weeks after omeprazole administration, clinical manifestations including lethargy, muscle spasm, dyspnea, nausea, vomiting, abnormal heartbeat and deep tendon reflexes, and Chvostek and Trousseau signs were recorded in a data-gathering form. In addition, fasting serum magnesium, calcium, sodium, and potassium were measured. RESULTS: The McNemar test results showed that omeprazole can reduce sodium, calcium, and magnesium levels statistically significantly (P < 0.05), but potassium levels do not have a meaningful reduction (P > 0.05). CONCLUSION: Consumption of omeprazole might cause asymptomatic hypomagnesemia, hypocalcemia, and hypernatremia in children. Such side effects should be considered in the follow-up of children under treatment with this medication.
BACKGROUND: Malignancy in thyroid nodules is a common clinical problem, and epidemiological studies have shown that it is increasing. Since malignancy is a very important problem in treating patients and misdiagnosis leads to many physical and financial damages, the importance of diagnostic methods becomes more important. Hence, the aim of this study was to investigate the sensitivity and specificity of the two dimensional-shear wave elastography (2D-SWE) diagnostic method in comparison with fine-needle aspiration (FNA) in determining the malignant thyroid nodules. MATERIALS AND METHODS: This study is cross-sectional which was performed on 57 thyroid nodules are proven by conventional ultrasound. Afterward, 2D-SWE images were taken with the help of a superSonic ultrasound machine. Then, FNA was performed from the thyroid nodules and the specimens were evaluated in a single specialized thyroid pathology center. The results of conventional sonography and 2D-SWE were compared with histopathologic results as a gold standard method. The elasticity quantity was recorded by measuring the amount of the appropriate quantities by a recording machine and analyzed using the SPSS and MedCalc software. RESULTS: From 57 nodules studied, 50 nodules were evaluated with benign diagnosis and 7 nodules with the malignant diagnosis. Among all the parameters recorded by the machine, SWE. ratio provided the highest surface area under the curve and the highest sensitivity and specificity with 0.94, 100% and 84%, respectively, and a cut-off point of 1.7. CONCLUSION: The 2D-SWE method and the conventional ultrasound can be good references for decision making about with the thyroid nodules.
BACKGROUND: Over the last decades, childhood obesity has become a worldwide epidemic health problem. Identifying the barriers to a healthy lifestyle among children and adolescents is necessary for further effective intervention to prevent overweight and obesity. This study aims to assess the barriers to healthy lifestyle habits, including physical activity (PA), eating, and sleep among adolescents from the perspective of their parents. METHODS: In this cross-sectional study, the parents of obese and overweight middle school students were enrolled. Data were collected using a questionnaire about barriers of healthy nutrition and PA. RESULTS: Overall, 172 parents completed the questionnaire. Lack of access to affordable facilities for PA, lack of access to the appropriate place for PA, and lack of sufficient information on how to do or increase PA were the main barriers to PA. The barrier factors for healthy eating were media advertisement of unhealthy foods, lack of motivation to use healthy nutrition, and lack of adequate information about healthy eating. Regarding poor sleep, lack of knowledge about the benefits of sleep, prolonged watching television, and late sleep time of family members were reported as the main barriers. These findings were not statistically different according to the family socioeconomic level. CONCLUSION: Our findings propose that for improving healthy lifestyle in obese children and adolescents, access to facilities, and appropriate places for PA should be provided at the community level. Moreover, training parents and students about healthy lifestyle behaviors is necessary for families of all socioeconomic levels.
BACKGROUND: Type 1 diabetes mellitus (T1DM) and its related comorbidities are considered an important health issue. This study aimed to evaluate the impact of glycemic control on lipid profile variables in children with T1DM. MATERIALS AND METHODS: This study included 274 children (≤19 years of age) with T1DM who had referred to the outpatient clinics of endocrinology in Emam-Hossein Hospital of Isfahan, Iran. Based on American Diabetes Association criteria, patients were divided into two groups including optimal glycemic control (OGC) and poor glycemic control (PGC). Mean lipid level and frequencies of lipid profile abnormalities between the two studied groups were compared. RESULTS: Mean age of the studied population was 13 ± 5.9 years and 133 (48.5%) were boys. A total of 162 (59.1%) and 112 (40.9%) patients had PGC and OGC, respectively. Hypercholesterolemia was the most common dyslipidemia in both groups (33 [29.1%] of OGC and 63 [39.1%] of PGC patients). The frequency of high low-density lipoprotein (LDL) was significantly higher in patients with PGC than those with OCG (P = 0.007). The frequencies of hypercholesterolemia, hypertriglyceridemia, and low levels of high-density lipoprotein were also higher in PGC group, but did not reach the significant threshold. CONCLUSION: It is suggested that glycemic control is in association with lipid profile abnormality in patients with T1DM. High LDL was significantly more frequent in patients with PGC than those with OGC. It is recommended to investigate the role of glycemic control on other cardiometabolic risk factors of T1DM patients. Our findings could be used for planning preventative strategies for reducing T1DM-related cardiovascular disease.
BACKGROUND: Anthropometric indices are one of the ways to assess physical growth and nutritional status of children and adolescents considering the importance of nutrition in children and the role of healthy nutrition in preventing diabetes, obesity and other chronic diseases, the objective of this study is determine the relationship between nutritional knowledge and anthropometric indices in children and adolescents in Isfahan. MATERIALS AND METHODS: This survey conducted using multistage cluster sampling on 1776 students aged 15-7 years old in Esfahan province in 2015. Nutritional knowledge was measured by questionnaire and height, weight, and body mass index (BMI) were measured as anthropometric index. Pearson and Spearman coefficients, regression, and T Independent were used to analyze the data; regression analysis was used to adjust the variables. RESULTS: The mean age of students were 12.6 ± 1.9 years. About 50.3% of students were male, and most of them were studying in 5th grade of elementary school (23.8%). Most of them had normal status in terms of BMI (60.6%) and height (77.8%). There was no significant relationship between the level of BMI and height of children and adolescents, and the total score of nutritional knowledge and its domains (P > 0.05), direct and significant relationship was found between nutritional knowledge in two domains of meals and food habits and age. CONCLUSION: As no relationship between nutritional knowledge and anthropometric index in our study, other factors are effective in this regard, and studies are required to be conducted to examine the nutritional attitude and performance, in addition to knowledge.
BACKGROUND: This study aimed to evaluate the impact of Vitamin D supplementation on prevention of recurrent urinary tract infections (UTIs) in the pediatrics. MATERIALS AND METHODS: This randomized, triple-blind, placebo-controlled clinical trial was conducted in 2014 among 68 children and adolescents with recurrent UTI. They were randomly assigned to two groups, receiving either Vitamin D (1000 IU/daily) or placebo for 6 months. The serum concentration of Vitamin D before and after the study and the frequency of UTI during the study were recorded. RESULTS: Overall 33 patients in the group of receiving Vitamin D and 32 in the placebo group completed the trial. The mean serum level of Vitamin D had a significant increase in the intervention group (15.80 ± 8.7 vs. 20.56 ± 8.30 ng/mL, P < 0.001) and significant decrease in the placebo group (20.43 ± 13.28 vs. 17.43 ± 9.99 ng/mL, P = 0.041). During the trial, the frequency of UTI was not significantly different between the two groups studied (P = 0.72). Both before and after the trial, the frequency of Vitamin D deficiency, insufficiency, and adequacy was not significantly different within and between groups (P > 0.05). CONCLUSION: The findings of this trial revealed that Vitamin D supplementation with the mentioned dose have not significant impact on preventing recurrent UTI. Future studies with higher doses of Vitamin D and longer follow-up are suggested.
BACKGROUND: The relation between interleukin-33 (IL-33) and asthma is not precisely known yet. The present study set to compare the serum level of IL-33 in patients with asthma and controls and study the relation with the severity of disease. METHODS: The serum level of IL-33 and total IgE in 89 asthmatic patients and 57 controls were analyzed. The association of levels of IL-33 with the severity of disease, levels of total IgE, measures of spirometry (forced expiratory volume in 1 s [FEV1]), age, sex, presence or absence of other allergic diseases, and the disease duration was evaluated. RESULTS: Higher levels of IL-33 and total IgE were detected in asthmatic patients compared with controls (P = 0.0001 and P = 0.008, respectively). In the asthmatic group, a significant direct association of IL-33 with age (P = 0.02, R = 0.23) and with total IgE level (P = 0.003, R = 0.31) were observed, but there was no relationship between other variables. Comparison of mean level of IL-33 in different asthma groups concerning the disease severity showed the statistically significant difference between them and a significant increased serum level of total IgE was observed in more severe disease. The results showed a significant negative correlation between FEV1 and total IgE (P = 0.028, R = -0.23) and IL-33 level (P = 0.0001, R = -0.83). CONCLUSIONS: IL-33 is suggested as a new inflammatory marker of severe and refractory asthma. Therefore, it may be a unique therapeutic target in these patients.
BACKGROUND: Exposure to smoking or passive smoking is one of serious health problems especially in the pediatric age group. OBJECTIVES: To compare the prevalence and determinants of passive smoking in a nationally representative sample of Iranian children and adolescents according to their socioeconomic status (SES). MATERIALS AND METHODS: This nationwide study was conducted in 2011 - 2012 among 14880 students aged 6 - 18 years, living in 30 provinces in Iran. Exposure to the smoke of hookah or cigarette was documented by using validated questionnaires. Possible influencing factors were determined and the frequency of passive smoking was compared according to the regional and familial SES. RESULTS: Participants consisted of 13,486 children and adolescents including 49.2% girls and 75.6% urban inhabitants (90.6% participation rate). The mean age of participants was 12.47 ± 3.36 years. Overall, 43.87% of them (44.07% of boys and 43.66% of girls) were exposed to second hand smoke at home. Exposures to hookah or cigarette smoke at home were respectively reported in 21.46% and 34.49% of participants. The prevalence of passive smoking was lower in children of families with higher SES level, but higher in high SES regions of the country than in low SES ones, and ranged from 39.2% in the region with lowest SES to 49.05% in the highest SES region. Higher education levels of fathers and mothers were significantly associated with lower frequency of passive smoking. CONCLUSIONS: Exposure to second hand smoke is a major problem among Iranian children and adolescents. Low family SES and low parental education increased the frequency of passive smoking. Appropriate public health education and legislation for smoke free home as well as family-centered counseling should be strengthened.
BACKGROUND: The consumption of tobacco through a hookah is growing in popularity, especially among children and adolescents, but little is known about the determinants of hookah smoking. OBJECTIVES: The current study aimed to assess the determinants of tobacco smoking and hookah smoking in a nationally representative sample of Iranian children and adolescents. PATIENTS AND METHODS: This study was conducted as part of the fourth cross-sectional survey of a national school-based program. Using a cluster random sampling method, a validated questionnaire was completed anonymously by 14,880 students who were aged 6 - 18 years and living in urban and rural areas of 30 provinces in Iran. RESULTS: The final study group consisted of 13,486 children and adolescents (participation rate of 90.6%), of whom 49.2% were girls and 75.6% were urban residents. The mean age was 12.47 ± 3.36 years. According to the self-reports of the students, 2.6% (3.5% of boys and 1.7% of girls) were current tobacco smokers, 5.9% (7.5% of boys and 4.2% of girls) were ever tobacco smokers, and 1.8% (2.49% of boys and 1.14% of girls) were current hookah smokers. Based on a multiple logistic regression (MLR) model, the following factors increased the risk of current smoking: age, number of days spent with friends per week, hookah smoking or cigarette smoking by the father, hookah smoking by siblings, hookah smoking by other members of the family, and screen time. The age, number of days spent with friends, hookah or cigarette smoking by the father, hookah smoking by siblings, and screen time increased the risk of hookah smoking. Female gender and living in rural areas decreased the risk of current tobacco and hookah smoking. CONCLUSIONS: Preventive measures against tobacco use should be underscored for Iranian families. The preparation of strategies on the promotion of a healthy lifestyle should be considered a health priority.
BACKGROUND: Iran is facing an epidemiologic transition, with one of its features being the tendency towards smoking by adolescents. The findings of previous studies in Iran have shown that the pervasiveness of tobacco products among school students is high. No previous study has reported the prevalence and determinants of smoking in various socioeconomic statuses (SESs) and at the subnational level in Iran. OBJECTIVES: To compare the prevalence of smoking and the factors that influence the initiation and continuation of tobacco use in a nationally representative sample of Iranian adolescents living in different regions with diverse socio-demographic patterns. PATIENTS AND METHODS: This nationwide, cross-sectional study was conducted in 2011 - 2012 among 14,880 students, aged 6 - 18 years, selected by cluster sampling from 30 provinces. Anonymous questionnaires were completed about tobacco use and the main psychological determinants of initiation and continuation to smoke. The questionnaire was modeled on the world health organization global school-based student health survey (WHO-GSHS). The sub-national regions were defined by the criteria of geography combined with SES. According to this classification, the lowest to highest SESs were considered for the southeast, north-northeast, west, and central regions, respectively. Data were analyzed using the STATA statistical software package. RESULTS: Overall, 13,486 students completed this survey (participation rate of 90.6%). They consisted of 50.8% boys, 75.6% urban residents, with a mean age of 12.47 ± 3.36 years. According to the self-report of students, 2.6 % (3.5% of boys and 1.7% of girls) were current smokers, and5.9% (7.5% of boys and 4.2% of girls) had ever been smokers. The current use of tobacco was higher in participants aged 14 - 18 years (6.11%) than in those aged 10 - 13.9 years (1.18%) and 6 - 9.9 years (0.51%). Current and past tobacco use, respectively, had the lowest prevalence in the region with the lowest SES (2.2%, 3.7%) and the greatest prevalence in the highest SES region (4.3%, 8.9%). Entertainment was the most common reason for smoking initiation (83.65% of smokers) and continuation (77.01% of smokers), followed by feelings of pleasure, and enjoying the tobacco smell. These influencing factors did not differ significantly according to SES or gender. CONCLUSIONS: Smoking is a health problem for Iranian adolescents, and has a higher prevalence in areas with higher SES. Entertainment and feeling pleasure were the commonest reasons for initiation and continuation of smoking. Tobacco-control programs should begin from childhood and family-centered preventive counseling should be intensified in Iran.
OBJECTIVE: Metabolic disorders, which involve many different organs, can be ascribed to enzyme deficiency or dysfunction and manifest with a wide range of clinical symptoms. This study evaluated some of the demographic and clinical findings in pediatric patients affected by organic acidemia. MATERIALS & METHODS: This cross-sectional study was part of a larger study conducted in patients with metabolic disorders during a period of 7 years from 2007 to 2014 in Isfahan Province, Iran. Our study covered a wide range of cases from newborn infants (one-week old) to adolescents (children up to the age of 17 years). This study evaluated patients' demographic information, history of disease, developmental and educational status, clinical and general conditions. Phone and in-person interviews were used to gather information. RESULTS: Out of 5100 patients screened in this study, 392 patients were affected by one of the different metabolic disorders and 167 individuals were diagnosed as organic acidemia. Propionic acidemia/methyl malonic acidemia (PA/MMA) was the most prevalent form of this metabolic disorder. The frequency of consanguinity was 84.7% in the group of patients. The mortality rate was 18.8% in patients with organic academia. CONCLUSION: Each of the metabolic diseases, as a separate entity, is rare; nevertheless, in aggregate they have a somewhat high overall prevalence. These diseases result in mental and developmental disorders in the absence of quick diagnosis and initiation of treatment. Furthermore, more mutations should be identified in societies affected by consanguinity. Further research should also be conducted to determine worthwhile and more-efficient screening methods as well as long term neurological prognosis.
BACKGROUND: Oral mucositis is a debilitating side effect of cancer treatment for which there is not much successful treatments at yet. We evaluated the effectiveness of topical morphine compared with a routine mouthwash in managing cancer treatment-induced mucositis. MATERIALS AND METHODS: Thirty head and neck cancer patients with severe mucositis (World Health Organization Grade III or IV) were randomized into the morphine and magic mouthwash groups. Patients received morphine sulfate 2% or magic solution (contained magnesium aluminum hydroxide, viscous lidocaine, and diphenhydramine), 10 ml for every 3 h, six times a day, for 6 days. Both groups received same dietary and oral hygiene instructions and care. Mucositis was graded at baseline and every 3 days after treatment. Patients' satisfaction and drug effect maintenance were also evaluated. RESULTS: Twenty-eight patients (mean age of 49.5 ± 13.2 years, 63.3% female) completed the trial; 15 in the morphine group and 13 in the magic group. There was a decrease in mucositis severity in both of the morphine (P < 0.001) and magic (P = 0.049) groups. However, at the 6(th) day, more reduction was observed in mucositis severity in the morphine compared with magic group (P = 0.045). Drug effect maintenance was similar between the two groups, but patients in the morphine group were more satisfied by their treatments than those in the magic group (P = 0.008). CONCLUSIONS: Topical morphine is more effective and more satisfactory to patients than the magic mouthwash in reducing severity of cancer treatment-induced oral mucositis. More studies with larger sample size and longer follow-up are required in this regard.
BACKGROUND: This study aims to assess the frequency of some hygienic behaviors that is, tooth brushing and hand-washing, in Iranian school students at national level. METHODS: This nationwide study was conducted in 2011-2012 among 14,880 elementary, secondary and high school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. We used the global school-based health survey questionnaire of the World Health Organization. RESULTS: The population of this survey consisted of 13,486 children and adolescents (participation rate of 90.6%) including 49.2% girls and 75.6% urban inhabitants. The mean age of participants was 12.5 years (12.3-12.6, 95% confidence interval) According to the self-report of students, 26.9% of them (20.2% of boys and 33.9% of girls) brushed their teeth more than once a day, 37.8% of boys and 42.1% of girls brushed their teeth once a day. In general, girls brushed their teeth more than boys. The frequency of those students who never brushed their teeth was twice in rural than in urban students (11.4% vs. 6.2%, respectively). In total, 3.4% of the students stated that their school had not an appropriate place for washing hands after toilet, with three-fold higher frequency in rural than in urban schools (6.8% vs. 2.3%, respectively). 85% of students (87% of girls vs. 83% of boys) reported that they had always washed their hands after toilet, 10.1% did it occasionally and 4.1% did not. CONCLUSIONS: This nationwide survey revealed that Iranian students have an acceptable level of hygienic behaviors both in urban and rural areas; however, still it is necessary to improve school health facilities and hygienic habits in Iranian students.
Natural disasters are tragic incidents originating from atmospheric, geologic and hydrologic changes. In recent decades, millions of people have been killed by natural disasters, resulting in economic damages.Natural and complex disasters dramatically increase the mortality and morbidity due to communicable diseases. The major causes of communicable disease in disasters are categorized into four sections: Infections due to contaminated food and water, respiratory infections, vector and insect-borne diseases, and infections due to wounds and injuries. With appropriate intervention, high morbidity and mortality resulting from communicable diseases can be avoided to a great deal.THIS REVIEW ARTICLE TRIES TO PROVIDE THE BEST RECOMMENDATIONS FOR PLANNING AND PREPARING TO PREVENT COMMUNICABLE DISEASE AFTER DISASTER IN TWO PHASES: before disaster and after disaster.
