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Objective: The study was aimed to evaluate effectiveness of ‘home based training’service of CBR program which have been offered to physically disabled people and their families in Babolsar Rural areas during years 2002-2004.

Materials & Methods: 48 physically disabled people and their families were recruited from rural areas under coverage of CBR program as the case group.Matching for type and severity of disability ,age ,sex and education of care givers ,48 other disabled people & their families were recruited from rural areas where CBR program was not implemented as the control group. Knowledge & attitude of families about immobility consequences, disability & rehabilitation and their skills in preventing bedsore and joint stiffness, helping disabled people to achieve independence in mobilization and activities of daily living( ADL) were accessed by observation and asking questions ,gathered in data sheets , scored computed & analysed.

Results: There were no significant difference in knowledge of families about consequences of immobility, their attitude towards disability & rehabilitation or their skills in helping the disabled to reach independence in selfcare and mobilization between the two groups. However, families in case group were significantly more skillful in preventing joint stiffness & bedsore and positioning the disabled people(P=0.04) .

Conclusion: The program didn’t result in significant change in family attitude, knowledge or skills in help disabled people to achieve independence in ADL or ambulation in Babolsar, but family members’ skills in areas of performing passive rehabilitation techniques such as bedsore & joint stiffness prevention and positioning of the disabled , improved significantly.

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Objective: The present research has been done to study the affectability of executing the community based rehabilitation plan due to the way rural families with one or more handicapped members view to the handicapped and disability. Some other parameters such as the level of education, city of dwelling, presence or absence of community based rehabilitation plan execution, job, age, sex, and being acquainted with welfare have been considered in this regard.

Materials & Methods: The statistical community of the research include all rural families in Ardebil province in 2004. Using the “random multi - step sampling” method, 173 families and 346 people (two for each family) participated in the task. The research equipment was the researcher made questionnaire in which 31 questions on the basis of Likert scale, in addition to the demographic section, had been designed to measure the attitude of families, in this research “survey cross - section” approach has been used. Using the SPSS software, extracted data were analyzed, and in in formation describing section, the average score of the attitude towards the handicapped, variance of the scores, standard deviation of the scores, etc., and in the section for analyzing and reasoning, the one - way variance analyzing method (ANOVA), Scheffe Post Hoc, and regarding the two independent groups T testing have been used.

Results: from the research showed that in comparison with other areas, in areas where the community based rehabilitation plan has been executed, there is a more appropriate attitude towards the disability phenomenon. Also, some other variables such as the level of education, sex, being acquainted with welfare have been effective on viewing to wards the handicapped. Other variables showed no significant differences concerning the attitudes to wards the handicapped.

Conclusion: In areas where the community based rehabilitation plan has been executed, there is a more appropriate attitude towards the disability phenomenon.

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Objective: Congenital hearing loss occurs in 1 out of 1000 births and about 50% of all cases are estimated to be of genetic origin. About 70% of hereditary hearing loss is non-syndromic with autosomal recessive inheritance accounting for 80% of the genetic load. To assess the importance of other loci in the Iranian population, we screened 50 consanguineous families with ARNSHL for DFNB21, which was linked to ARNSHL in Middle East countries. 

Materials & Methods: 50 consanguineous families with at least three affected children, previously excluded by mutational analysis from GJB2 and GJB6 genes, were included in this study. We used three polymorphic markers including D11S1998, D11S4464, and D11S1299 in this study.

Results: Two families were linked to DFNB21 and two novel mutations have been detected so far. In two families a 266 Del T mutation and a large 9611bp deletion that starts from intron 9 and includes exon 10 in TECTA gene were detected.

Conclusion: This study showed that mutations in DFNB21 locus are the most common cause of ARNSHL in Iranian population. It seems that DFNB21 may play an important role in genetic load of ARNSHL in Iran. This will be confirmed by screening more families for this locus in Iranian deaf population.

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Objective: By taking into account that understanding the primary needs of disabled girls and women is essential in finding a suitable solution to their problems, the main objective of the current research was based on the investigation of the needs and the problems of girls and women with physical disabilities in Tehran (capital of Iran). 

Materials & Methods: This research has been carried out in a descriptive manner. The participants of this research were 216 girls and women with physical disability who were selected among 1395 clients of the welfare organization in Tehran through a systematic randomized method. Data collection was carried out using an 82-question questionnaire designed by the researchers. The questionnaire compiled by reviewing current resources on the subject and based on discussions carried out within focus groups. It was finalized after determining its validity and reliability.

Results: Examining the needs and problems of girls and women with physical disability, in general, made clear their priorities in each area. Priorities for educational needs: promoting the awareness of society through education, providing vocational training employment needs: accessible transportation, allocation of special employment opportunities for them (quota system) need for starting a family: the possibility of meeting their future husbands before marriage provided by their families, consultation before marriage their main needs regarding transportation: improving pedestrian pavements and public pathways, provision of a special transport service taking account of their particular disability need for rehabilitation services: rehabilitation aids and educational services leisure time: financial help for using sports-recreational facilities, provision of sports facilities for girls and women with physical disability their needs for establishing communication:, receiving a normal reaction from non-disabled people while dealing with their needs and problems and believing in their abilities rather than their disabilities, presence of a family member when in public places. The following comprises their priorities of problems in the different fields. Educational field: difficulties of transportation and mobility, the lack of educational resources and facilities employment: again the problems of transportation and mobility, the lack of legislative protection of their employment problems in marital life: the interference of others, domestic tasks Violence: violent behaviour and indifference mobility and transportation: the unsuitability of public transport in regards to their specific needs, pedestrian pavements and public pathways difficulties in spending their leisure time: the absence of special or appropriate transport for access to recreational places, the financial shortage for using the facilities of these places.

Conclusion: The findings of our research revealed the priorities of needs and problems of girls and women with physical disabilities from their point of view. In the different fields including: Oeducation, employment, martial life, transportation, treatment and rehabilitatin, leisure timeo and communication.

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Objective: Hereditary hearing loss (HHL) is a very common disorder. When inherited in an autosomal recessive manner, it typically presents as an isolated finding. Interestingly and unexpectedly, in spite of extreme heterogeneity, mutations in one gene, GJB2, are the most common cause of congenital severe-to-profound deafness in many different populations. In this study, we assessed the contributions made by GJB2 mutations and deletion in a portion of GJB6 to the autosomal recessive non-syndromic deafness genetic load in Iran.

Materials & Methods: In this descriptive and cross – sectional study1605 probands from 1605 different nuclear families with autosomal recessive non-syndromic hearing loss were investigated. Hearing loss tests and clinical examination were done and 10 ml blood was drawn as DNA source. After study of 35delG mutation by ARMs PCR, negative or heterozygote individuals were sent to IOWA University for detection of other GJB2 mutations. 

Results: GJB2-related deafness was found in 243 families (15.1%).

Conclusion: Varient geographic pattern for GJB2-related deafness has considerable results in Iran in comparable with other study in Europe and our neighboring countries and deletion in GJB6. [∆ (GJB6-D13S1830)] hasn't been detected in our studied population.

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Objective: However rehabilitation and disability in their modern concept are found in ancient world and medical textbook to a limited rate, the background of treatment and rehabilitation is obviously found in the history of the most ancient territories to coincide with religious beliefs. The aim of this research is study of the effects and reliable documentations remained from ancient times regarding the abovementioned title so that we can evaluate and determine the role of Iranian civilization in the formation of rehabilitations and empowering in the world today on the basis of scientific evidences and proofs.

Materials & Methods: In this qualitative research, reviews in historical documents has been used. After defining the objective and making given hypotheses, data has been collected form reliable sources which were then verified through internal and external critic.

Results: In ancient Iran, Ahuramazda is the source and origin of all goods while all pains, suffering, disabilities are Devil temptations. Iranian civilization is among the earliest civilizations using scientific methods and herbal drugs for treatment and empowering. Gondi Shapor University was among the first medical universities proceeding to treatment and rehabilitation. As well there had been some places at that time where disabled people were maintained and kept.

Conclusion: At the time western world and other nations involved ignorance and unawareness, frightening from hard diseases, threw disabled people to the sea, Iran was the cradle of civilization, wisdom and the biggest medical university. As there are very limited documents and evidences with discrete subjects on the matter, any point and statement in this research work indicate important, critical and undeniable facts the interpretation and description of which is put for the future researches and readers.

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Objective: Hearing impairment is the most frequent sensorineural defect in 2 forms, syndromic and non–syndromic. The aim of this study is haplotype analysis of seven loci of non–syndromic autosomal recessive hearing loss in Iranian families.

Materials & Methods: In this descriptive study, forty one Iranian families with 2 or more affected individuals segregating as an autosomal recessive non–syndromic hearing loss were selected simply and conveniently. The patients have been tested negative for the following loci, DFNB1, DFNB2, DFNB3, DFNB4, DFNB6, DFNB7/11, DFNB8/10, DFNB9, DFNB12, DFNB16, DFNB18, DFNB21, DFNB23, DFNB29 and DFNB4 previously. The subjects have been investigated additional 7 loci (DFNB22, DFNB28, DFNB30, DFNB31, DFNB36, DFNB37 and DFNB67) , to determine the prevalence of these genes involve in these loci. Homozygosity mapping was applied using number of STR (Short Tandem Repeat) markers.

Results: Three families linked to the following loci DFNB28, DFNB30 and DFNB 31.

Conclusion: In this research, the cause of additional 7% of non–syndromic hearing loss was determined in Iranian population.

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Objective: Chronic Pelvic Pain (CPP), a common health problem in women, characterized by any lower abdominal pain that lasted at least six months or more, with no relation to pregnancy, menstruation and intercourse. The pain can affects on activities of daily living negatively and lead to medical or even surgical treatment. According to our knowledge, there are limited studies related to CPP in Iran. Therefore, present study was aimed to survey on CPP in women attending Pelvic Floor Clinic at the Imam Khomeini University Hospital.

Materials & Methods: This cross-sectional study was conducted on 516 married women (who were not virgin). Participants completed a designed questionnaire, which included demographic information and questions regarding involvement of gynecologic, urinary, gastrointestinal, musculo - skeletal and psychological systems. After collecting data, binary logistic regression was used to analysis the data. Values of p<0.05 were considered to be significant.

Results: 27/9% of women reported current pain in the pelvic area unrelated to menstruation and sexual intercourse, while totally 17/6% suffered from pain over the past 6-12 months or CPP .There were a significant relationship between CPP, chronic low back pain and dyspareunia (p=0.04 and p=0.03 respectively). Our data did not show significant difference between the prevalence of CPP, types of delivery and history of having trauma to the spine and pelvis.

Conclusion: This comprehensive study provided an extensive and multidimensional approach regarding to CPP in our society. As for to estimation 27.9% pelvic pain and 17.6% CPP and their relationship with gynecological, urinary, musculoskeletal and gastrointestinal systems, we suggest doing more population-based epidemiological studies ,also emphasis on multidisciplinary approach for managing these patients.

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Objective: The main purpose of this study was to investigate the prevalence and socio-economic correlates of disabilities in Iran.

Materials & Methods: Secondary analysis of aggregate and micro data (in individual and household level) from the Iranian 2006 census is used. Micro-data collection contains representative sample including 19,848 disabled people and 1,235,445 non-disabled people in individual level, and 17,166 households with a disabled person and 298,741 households with non-disabled person in household level. Bivariate and multivariate statistical analyses were used for data analysis with SPSS software.

Results: The prevalence of disability was 14.4 per 1000 in Iran. Disability was higher in rural area than in urban area, and also, was more common among men than women. Research findings show disabled people had lower levels of socio-economic status compared to non-disabled people. In addition, results indicated economic and welfare status of household was statistically significant association with disability. Logistic regression analysis showed that female-headed households were more likely to have a disabled person in the household. And also, the education and occupation of the head of the household, welfare index of household and rural-urban residence were significantly associated with having a disabled person in the household.

Conclusion: Low levels of welfare and poor living conditions of households increase the likelihood of disability. Thus, social welfare programs for lower income and vulnerable households and also delivery specific services packages for disabled people are recommended.

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Objective: Demographic and epidemiological changes in the 21st century have created new challenges such as aging and the rising trend of non-communicable diseases. The high prevalence of disability (due to the growing aging population), non-communicable diseases, and accidents have increased the demand for rehabilitation services. However, there are not enough resources to meet all current needs in many parts of the world. The purpose of this study is to investigate the inequality in the utilization of rehabilitation services between Iranian households in urban and rural areas.
Materials & Methods: This is a descriptive-analytical study with a cross-sectional design using the household expenditure, income survey data from the Statistics Center of Iran in 2018. The used instrument was a questionnaire surveying the expenditure and income of urban and rural households (social characteristics of household members, place of residence and main living facilities, food/non-food expenses, and household income), which was completed through interviewing the household head or a member over 15 years of age. The study samples were 18610 households in rural areas and 20348 households in urban areas. After extracting and refining the data, 38958 households were included in the study. Factors affecting their utilization of rehabilitation services and the inequality in utilization were analyzed using the Chi-square test and the concentration index (CI), respectively. Data were extracted in MS Access 2013 and MS Excel 2013 applications and were analyzed in STATA V.14.1 software. The geographic distribution of the service utilization was plotted using ArcGIS Map V. 10 software.
Results: A total of 258 households (0.77%) used rehabilitation services. Of these, 226 (87%) had a male head, and 32 (13%) had a female head. About 60% had 3-4 members, and 239 (92%) had insurance coverage, and others (8%) had no insurance coverage. Also, 173 (67%) had an employed head. Finally, 55% were living in rural areas, and 45% in urban areas. Uninsured households had less use of rehabilitation services (P<0.05). Also, 1.32% of the fifth income quintile (highest income) used rehabilitation services, while this rate was 0.35% for households in the first quintile (P<0.001). Zanjan, Qazvin, Khuzestan, Isfahan, Lorestan, Bushehr, and Semnan provinces had the lowest service utilization rates in urban/rural areas and the whole country. Qom province had a better status regarding service utilization in urban areas, while East Azerbaijan, Mazandaran, Golestan, Yazd, Fars, and Hormozgan provinces had higher service utilization rates in rural areas. Overall, East Azerbaijan, Mazandaran, and Qom provinces had a higher rate of utilization. The CI value for the whole country was reported at 0.24 (95% CI: 0.17-0.30), indicating a higher inequality in utilization in favor of the rich. The CI values for rural and urban areas were 0.27 and 0.19, respectively (P<0.001).
Conclusion: There is inequality in the utilization of rehabilitation services in favor of the rich households in Iran, and low-income households have lower access to these services. The inclusion of rehabilitation services in the primary health insurance package with appropriate pricing and population coverage, and fair distribution of rehabilitation services following the needs of public and private sectors, can increase the access and utilization of rehabilitation services.

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Objective: Aging is one of the critical and growing stages in Iran. Falling is one of the most common problems in this period that leads to mobility, social limitations and even death. To increase the awareness and prevent secondary hazards due to falls, this study was conducted as a review article aiming the prevalence of falls based on evidence and related factors in Iranian elderly.
Materials & Methods: In this study, the Prism method includes research published from 2008 to 2018 focusing on the prevalence of falls based on evidence and related factors in the Iranian elderly and the keywords prevalence, falls, falls-related factors, the elderly In the scientific database of PubMed and Scopus, Google Scholar, SID, Magiran, Irandoc. After reviewing the studies, 394 articles were obtained and finally, by reviewing the abstracts, 14 articles were selected.
Results: The results of Iranian studies were reported very differently. There was a significant relationship between aging, marriage, education, neurological diseases, painkillers, and home safety.
Conclusion: The findings of this review study show an increase in the frequency of falls in the Iranian elderly that it is worthwhile to consider one of the health policies in this period of life to prevent and reduce the causes of falls at this age to reduce costs. Reduce the health caused by fall related injuries. Since prevention and education programs are not implemented in the elderly, the results of this study can help identify the importance of treatment costs and the harmful status.

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Objective: This study aims to identify the challenges for public participation in health legislation in Iran.
Materials & Methods: This is an exploratory and qualitative study. The study data were collected by using semi-structured interviews. The participants were experts in the field of health law with at least ten years of work experience. They had both experience and enough knowledge about the country’s health system. All interviews were transcribed verbatim after recording and then analyzed using thematic analysis.
Results: We identified five main categories (themes) and 26 subcategories related to challenges. The main themes included legal barriers, infrastructure barriers, sociocultural barriers, people’s barriers, and legislators’ barriers. The legal barriers had three subcategories of parliament’s structure, legal requirements for participation, and facilitating laws. The infrastructure barriers had seven subcategories of the existence of mass media and communication networks, informing, ability to access to/meet the legislators, ability to categorize opinions, the possibility of electronic participation, financial resources, and structural facilities. The sociocultural barriers had three subcategories of people’s desire to participate, belief in teamwork, and social capital. Barriers related to people included eight subcategories of access to information, access to legislators, getting answers or feedback from legislators, feeling safe after participation, people’s awareness of their rights, education, ability to exchange views, and the existence of a highly-skilled expert team. Barriers related to legislators had nine subcategories of the desire to use others’ opinions, capacity to accept different opinions, party-related factors, regional factors, administrative health, education, opportunity, priorities, and motivational factors.
Conclusion: Iranian citizens have several challenges to participate in health legislation. Regarding legal challenges, it is necessary to determine the participation right of citizens in the legal system. Besides, members of parliament should be educated to use the capacity of public participation. On the other hand, people should speak freely with the legislators and gain health knowledge as well.

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Objective: As age increases, different physical and mental problems, including sleep disorders, occur in the elderly. The Person-Environment-Occupation (PEO) model is one of the most common practical models in occupational therapy. The current study aims to review negative factors affecting the sleeping quality of the elderly in Iran based on the PEO model.
Materials & Methods: According to PRISMA (the preferred reporting items for systematic reviews and meta-analyses) guidelines and in this systematic review study, we searched Google Scholar, Scopus, PubMed, Magiran, IranMedex, and SID databases using the keywords of “Elderly”, “aging”, “geriatric”, “older adult”, “Iran”, and “sleep” in English and Persian articles published from 2010 to 2019. Studies on the sleep problems of other age groups, letters to the editor, duplicate studies, studies on non-Iranian seniors, studies published in languages other than Persian and English, and those with unavailable full-texts were excluded. In the next stage, the titles and abstracts of the retrieved articles were independently reviewed by two researchers to identify the studies that meet the inclusion criteria. The dispute was resolved through discussion and reaching an agreement. Then, the full text of eligible articles was retrieved. Articles approved based on at least 20 out of 22 items of the STROBE (strengthening the reporting of observational studies in epidemiology) checklist were included in the study. Finally, 24 articles that were in line with the research objectives were selected for an in-depth review.
Results: Out of 24 studies, 11 reported quantitative sleep problems, 9 of which claimed that more than 70% of the elderly had sleep problems. The negative factors affecting the sleep quality of Iranian older adults were presented and categorized based on personal, environmental, and occupational factors. Eighteen articles addressed personal factors, where the most common factor was related to personal health issues. Eleven articles reported environmental factors, where the most common factor was related to the physical environment. In three articles, the factors that had a negative effect on sleeping are occupational and included the change of sleeping place and not talking to others before going to bed.
Conclusion: Personal factors (e.g. aging, female gender, disease), environmental factors (e.g. lack of communication with relatives and friends, inappropriate physical environment, and living in a nursing home), and occupational factors (e.g. change of sleeping place, hospitalization, and not talking to others before going to sleep) are negative factors affecting the sleep quality of the elderly in Iran.

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Objective: Multiple sclerosis (MS) is one of the most common chronic progressive neurological diseases. It is the non-traumatic cause of neurological disability in adults. This disease increases the patient’s need for care due to the progressive course of disease that intensifies the symptoms over time. Family caregivers of these patients have different challenges and needs for caregiving. The present study aims to investigate the supportive needs of family caregivers of patients with MS in Iran.
Materials & Methods: This is a qualitative study conducted in MS Association of Isfahan, Iran in 2018-2019 for 8 months. Participants were selected by a purposive sampling method who included 8 patients, 13 family caregivers, and 4 treatment staff. Semi-structured interviews were used to survey the supportive needs of caregivers. Interviews took about 30-60 minutes. Sampling and data collection were saturated after 25 interviews. We used Guba and Lincoln’s criteria (credibility, dependability, transferability, and conformability) to evaluate and validate the data. The contract content analysis technique was used to analyze the data.
Results: The results of analysis yielded 795 initial codes. After merging these codes based on common features, 562 codes were remained. The supportive needs of family caregivers of MS patients were presented in three main categories (creating interaction opportunities to reduce isolation, empathetic interaction with peers and treatment staff, and financial support) and nine sub-categories.
Conclusion: Most of the family caregivers of MS patients in Iran do not receive adequate social and systemic supports from health care providers and do not have access to support resources. Policymakers and health caregivers should provide the required supporting programs for these caregivers so that they can optimally play their role in caregiving MS patients, especially at home, while receiving appropriate social and systemic supports.
 

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ore than a billion people suffer from different disabilities and require special healthcare due to their special condition compared to others; however, they usually receive less healthcare and face difficulties accessing health and medical services which, in return, can result in adverse health consequences for them.

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Objective: Social isolation is one of the important concerns in the elderly population which can negatively affect their quality of life and health. The present study aims to determine the prevalence of social isolation among older adults aged 60 years and older in Tehran, Iran and find its associated factors.
Materials & Methods: This is a secondary analysis study on data obtained from a large cross-sectional study conducted on older adults in Tehran in 2020. The Persian version of lubben social network scale (LSNS-6) was used to measure social isolation. The demographic characteristics (age, gender, marital status, living arrangements, and number of children), socio-economic status (educational level, employment status, and household income) and health-related information (history of chronic diseases and use of assistive devices) were collected using a checklist. Data were analyzed in SPSS v. 23 software using multivariate logistic regression analysis. The significance level was set at
Results: The data were related to 1280 older adults aged 60 years and older (Mean±SD age=70.97±8.07 years). The prevalence of social isolation was 30.8%. The results of chi-square test revealed that living arrangement (P<0.001, X2=46.93), marital status (P<0.001, X2=26.91), household income (P<0.001, X2=67.44), level of education (P<0.05, X2=20.26), employment status (P <0.001, X2=29.21), musculoskeletal problems (P<0.001, X2=15.47), respiratory problems (P<0.05, X2=10.43), vision problems (P<0.05, X2=4.4), hyperlipidemia (P<0.001, X2=13.53), and wearing glasses (P<0.05, X2=3.92) had significant association with social isolation. The regression analysis model could significantly predict social isolation (X2=188.35, P<0.001). The model revealed that being male (P<0.05, OR=1.7), living with spouse (P<0.05, OR=0.4), musculoskeletal disease (P<0.05, OR=1.42), diabetes (P<0.05, OR=1.41), household income (P<0.001, OR=5.82), being unemployed (P<0.001, OR=2.13), having hyperlipidemia (P<0.001, OR=0.58), and living in developed areas (P<0.001, OR=2.02) significantly predicted the social isolation.
Conclusion: There is a strong association between social isolation and some socio-economic, demographic-health related factors in older adults. Health policymakers and healthcare experts can develop the screening and prevention programs related to the mental and social health of older adults in Tehran, Iran in order to moderate and control these factors. 
 

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