Background and Objectives: The purpose of this study was to present a summary of the rabies surveillance program in humans in the country, its achievements and its strengths and weaknesses. Methods: This study was a review of the countrychr('39')s plan for surveillance and control of rabies in humans. The sources of information included the data, reports, documents, and published guidelines. The viewpoints of stakeholders and experts were also reviewed in this study. Results: Since rabies is a zoonotic disease, its effective management requires a good collaboration between several organizations. Moreover, because Iran is located in an endemic region, there is a need for the development of regional and international cooperation for the success of disease prevention, control and management. Animal services for biting and rabies control are provided free of charge in more than 700 centers in the country. Major achievements of the program include timely preventive treatment for animal bite cases, knowledge of the geographical distribution of the disease, identification of high-risk provinces, and decreasing the percentage of human deaths. Conclusion: The program has performed well for rabies secondary prevention. Some aspects of the program, however, still need to be improved, including improvement of educational programs targeting general population and high-risk groups, animal bite prevention, vaccination of domestic dogs, controlling the population of stray dogs, rabies control in wild animals, and proper waste collection and disposal.

يرداق ميهاربا 1 يدارم دابق ، 1 يفرش ديعس ، 2 ينامحر دلاخ ، 3 يدمحا زانهش ، 4 نسحم دازهب ، روپ 5 يحصان ديشهم ، 6 1 ،يژولويمديپا رايشناد زكرم تاقيقحت لماوع يعامتجا رثؤم رب ،تملاس هدكشهوژپ هعسوت ،تملاس هاگشناد مولع يكشزپ ناتسدرك ناريا ،جدننس ، 2 يراميب تيريدم زكرم ،يمومع كشزپ يكشزپ شزومآ و نامرد ،تشادهب ترازو ،ريگاو ياه ناريا ،نارهت ، 3 اقيقحت زكرم ،يژولويمديپا رايداتسا ،دبك و شراوگ ت هدكشهوژپ هعسوت ،تملاس ناتسدرك يكشزپ مولع هاگشناد ا ،جدننس ، ي نار 4 يراميب تيريدم زكرم ،يمومع تشادهب سانشراك يكشزپ شزومآ و نامرد ،تشادهب ترازو ،ريگاو ياه ا ،نارهت ، ي نار 5 يراميب رايشناد ،ينوفع ياه زكرم تاقيقحت زونوئز ، هدكشهوژپ هعسوت ،تملاس اگشناد ه مولع يكشزپ ناتسدرك ا ،جدننس ، ي نار 6 يراميب تيريدم زكرم ،يژولويمديپا رايشناد يكشزپ شزومآ و نامرد ،تشادهب ترازو ،ريگاو ياه ناريا ،نارهت ، طبار هدنسيون : شهم ي د حصان ي كشزپ شزومآ و نامرد ،تشادهب ترازو ،نارهت :يناشن ، ي ، دم زكرم ي ر ي ت ب ي رام ي اه ي گاو ي ،ر اذج و لس هرادا :نفلت هرامش ،م 02133773234 ، نورتكلا تسپ ي ك : mnasehi@yahoo.com :تفايرد خيرات 23 / 04 / 97 ؛ :شريذپ 10 / 09 / 97

Background and Objectives: Iran started malaria elimination campaigns many years ago. The purpose of this study was to review the malaria surveillance system in Iran. Methods: The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, a review of records, documents, books and published articles, and also interviews with process owners and experts of malaria surveillance in 2017-2019. Results: The surveillance system of malaria in Iran has a coherent structure, in which all identified cases are reported and monitored from the environmental levels to the center by telephone instantly. Considering that the main goals of the malaria program including disease elimination have been obtained, the surveillance system in Iran is currently aiming at strengthening the elimination phase. In this stage, all new cases are also epidemiologically investigated in addition to examination, treatment and follow-up for categorization of the cases in categories of relapse, indigenous, introduced, and induced. Conclusion: The successful implementation of the surveillance system for malaria over time has caused indigenous cases of disease to be limited to three southeastern provinces of the country and there are fewer than 300 new cases a year. Despite success, since the goal of malaria surveillance in Iran is now disease elimination, continuous monitoring of correct implementation of all processes and evaluation of the applied strategies are necessary.

Background and Objectives: Elimination and eradication of measles requires designing and implementing an enhanced surveillance system. The purpose of this study was to review the measles surveillance system in Iran. Methods: The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control; a review of the records, documents, books, and published articles; and interviews with process owners and experts of measles surveillance in 2017-2019. Results: Iran has a surveillance plan to eliminate the measles. The current design for suspected cases of measles in Iran is a case-based surveillance system, in which for each identified case with fever and maculopapular rashes, some activities such reporting, laboratory confirmation, clinical and epidemiological investigation and case registration in individual forms are done. Conclusion: Complete surveillance of cases suspicious of measles and high coverage of vaccination in children less than 2 years in a cohesive surveillance system and rapid response to the outbreak have led to lack of occurrence of indigenous measles in Iran. Although the current status of the measles surveillance system in Iran seems to be favorable, since Iran is at the stage of measles elimination, it is essential to increase the sensitivity of the reporting system for suspected cases of measles and to maintain the status of vaccine coverage to save elimination status.

Background and Objectives: : According to the global strategy for polio eradication, targeted surveillance of the disease is one of the main tasks of the health system. The purpose of this study was to review the status and surveillance of poliomyelitis/acute flaccid paralysis (AFP) in Iran. Methods: The present study was a review on the processes, structures and achievements of the poliomyelitis/AFP surveillance system in Iran during 2017-2019. The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control; a review of the records, documents, books and published articles; and interviews with process owners and experts of poliomyelitis/AFP surveillance. Results: The polio eradication program in Iran is based on the action plan of the World Health Organization that was introduced initially in 1988. Currently, the surveillance system of AFP is active at three levels: country, university, and city. The number of poliomyelitis cases in the country decreased from 50 cases per year in 1985 to zero in 2001, and Iran has been a polio-free country since 2001. The final report on polio eradication in Iran was approved by the regional commission on polio detection in April 2006. Conclusion: The surveillance system of AFP has had a proper effectiveness throughout the country. Maintaining this situation in the country requires an increase in the sensitivity of the surveillance system of the disease, regular monitoring of vaccine coverage, strict implementation of international health regulations, especially on the eastern borders of the country, and providing technical assistance to neighboring countries.

Background and Objectives: To provide an overview of the national program of Crimean-Congo hemorrhagic fever surveillance in Iran, its current achievements, and challenges. Methods: In this mixed method study, the relevant reports, documents, and guidelines, as well as published literature and surveillance data were gathered and critically reviewed. The opinions of the key informants at local and governmental levels were assessed through structured interviews. Results: The program was integrated into Iran’s primary healthcare (PHC) network in 1999. The involved organizations include CDC, medical universities, Pasteur Institute of Iran (PII), and Veterinary Organization. Case finding is based on standard definitions of suspected, probable, and confirmed cases. Laboratory confirmation is necessary for diagnosis and is provided within 48 hours after receipt of the specimen by the National Reference Laboratory of PII. CCHF treatment is primarily supportive. Antiviral therapy with ribavirin is also considered. Both therapeutic services are free. Education mainly focuses on high-risk groups and healthcare workers. Major achievements of the program include rapid diagnosis and treatment of cases, prevention of nosocomial transmission, identification of high-risk provinces and major transmission routes, improved outbreak preparedness, development of laboratory tests for detection of other arboviruses, and reduction of CCHF case fatality rate. Conclusion: Program implementation has had a positive impact on early detection and proper control of annual outbreaks. However, some aspects of the program still need improvement, including promotion of the general and high-risk populations’ awareness and regional collaborations (especially among neighboring countries) for infection control in humans, livestock, and vectors.

Background and Objectives: Despite the implementation of the health reform plan and the increasing number of comprehensive centers of health services in 2014 in Iran, many people still do not attend these centers for various reasons. The aim of this study was to determine the reasons why urban households do not attend comprehensive centers of health services in Sanandaj. Methods: This study was carried out using two quantitative and qualitative approaches. In the quantitative section, data were collected through a checklist and interviews with 200 household heads who did not attend. In the qualitative section, the views of physicians, other health providers, and household heads were obtained using semi-structured interviews. Results: A feeling of no need for health services, paying more attention to treatment, working on morning shifts, physical problems, inappropriate location of centers, inadequate informing services to community members, inconsistency between existing services and clients’ needs, and inappropriate treatment of some health providers were the most important barriers to non-attendance of clients. Despite four years of implementation of the health reform plan in Iran, 53.5% and 60% of participants had no awareness about the presence of mental health and nutrition experts and their free services in the centers, respectively. Conclusion: Although there are many reasons for people not attending comprehensive centers of health services in cities, informing and introducing services to the community and considering the clients’ needs are essential.

Background and Objectives: Iran is one of the Middle Eastern countries that implemented the HIV / AIDS control and surveillance program many years ago. The purpose of this study was to review the HIV / AIDS surveillance system in Iran. Methods: This was a review research to assess the processes, structures and achievements of the HIV/AIDS surveillance system in Iran. The information sources of this study included data from the surveillance system, reports and documentation, and published guidelines, reviewing existing structures and views of managers and practitioners of the HIV/AIDS surveillance system in Iran. Results: In Iran, all cases with HIV / AIDS as well as people with high risk behaviors are referred to behavioral disease counseling centers in order to receive health care services. Harm reduction in people with risky behaviors in the form of counseling centers, drug addictschr('39') centers, and womenchr('39')s counseling centers in collaboration with governmental and non-governmental organizations, and attention to the second generation of HIV/AIDS surveillance, particularly conducting behavioral studies, are other components of the HIV / AIDS surveillance system in Iran Conclusion: Although the HIV / AIDS surveillance system in Iran has a large structure with many achievements in reducing new HIV cases, especially in some high-risk groups such as injecting drug users, as well as reducing HIV transmission from infected mothers to their children, strengthening this surveillance system, especially for sexual high-risk groups, is essential for controlling HIV/AIDS in the country.

Background and Objectives: Iran has long been considered to be one of the countries in the world with endemic brucellosis. The aim of this study was to review the surveillance system of brucellosis in Iran. Methods: Data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, the review of records, documents, books and published articles and also interviews with process owners and experts of brucellosis surveillance in 2017-2019. Results: In the current surveillance system in Iran, all patients with brucellosis will undergo standard treatment for at least 2 months. The patient identified at each site, private or public sector, reports to the health center of the city. After reporting cases to higher levels, city health center carried out required epidemiologic investigation in the place of reported case in collaboration with its environmental levels. Finally, the individual assessment form, epidemiologic investigation form, for reported case is completed and registered in national surveillance database. Conclusion: Although integration of the brucellosis surveillance program into the health system of the country and reporting and treatment of human cases in accordance with the countrychr('39')s protocol in recent years is well executed, brucellosis control in Iran requires the one health approach. Accordingly, it can be concluded that despite the decrease in the number of brucellosis cases in recent years, the weakness in livestock surveillance has led to many fluctuations in the health systemchr('39')s success in providing surveillance for human cases of brucellosis.

Background and Objectives: Iran, like most other countries in the world, is always threatened with global epidemics and pandemics of influenza. The purpose of this study was to review the influenza surveillance system in Iran. Methods: Data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, the review of records, documents, books and published articles and also interviews with process owners and experts of influenza surveillance in 2017-2019. Results: Influenza surveillance in Iran Currently, a combination of surveillance methods, including caring for patients, laboratory care, hospital care and surveillance of respiratory disease epidemics and also border surveillance. Reporting of human influenza outbreaks, as well as suspected avian flu as main notifiable diseases carried out through telephone. For each suspect case, in addition to taking and sending a sample to diagnose and also detect subtypes of the virus, medical treatment is immediately initiated and tracking of possible contacts is also done. Conclusion: Although there is currently good coherence in the surveillance of influenza in Iran, but based on concerns about the emergence of influenza pandemics in the future, and considering the possible genetic variation of the flu viruses, the tracking of the flu virus circulation along with updating surveillance system especially emphasizing methods and formulas for rapid identification of disease outbreaks, as well as providing better health care and treatment is essential.

Correlation between the Dimensions of Constructivist Learning ‎Environment and Self-directed Learning among the Students of ‎Medical Sciences

Background and Objectives: Road Traffic Injuries (RTI) in Iran is considered as a major health problem and a major cause of mortality. In the present study we attempted to assess the traffic fatalities trend and potential factors related to the hospital and pre-hospital deaths during years 2006 to 2012, in Iran. Materials and Methods: In this cross-sectional study, we analyzed all deaths resulted from RTI (including hospital and pre-hospital deaths) during years 2006 to 2012 in Iran. The pattern of RTI occurrence was specified and then logistic regression was used to evaluate the association between potential factors related to pre-hospital deaths in comparison with hospital deaths. Results: During the years 2006 - 2012, in Iran 159,227 people died in traffic accidents, with the mean age of 37 years (and the standard deviation of 20.5) which 20.83% and 79.17% of them were females and males, respectively. Deaths from traffic accidents have decreased over these years, from 27,567 in 2006 to 19,089 in 2012. There was a significant association between sex and hospital/pre-hospital deaths and men more than women died before reaching the hospitals. Also pre-hospital deaths were increased with increasing of age: OR=1.005 (p less-than 0.001). RTI deaths occurred before reaching the hospital were more in the years of 2009, 2010 and 2011 compared to the year of 2006. Conclusion: It may be concluded that despite the decreaing pattern in the trend of RTI deaths in Iran in the years of the study, there was observed no decrease in the pre-hospital deaths compared to the hospital deaths More attention to the pre-hospital care and also conducting of local studies is essential in Iran. Key words: Road traffic injuries, Mortality, Pre-hospital, Hospital, Iran Funding: This research was funded by Safety Promotion and Injury Prevention Research Center in Shahid Beheshti University of Medical Sciences. Conflict of interest: None declared. Ethical approval: The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the study How to cite this article: Rahmani Kh, Hashemi Nazari SS, Ghadirzadeh MR. Trend Analysis of Traffic Accidents Deaths in Iran During 2006 – 2012: Hospital or Pre-Hospital Occurred Deaths. J Rafsanjan Univ Med Sci 2016; 15(2): 115-28. [Farsi]