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Background & Objective: In all of world, a portion of household income expends on health care cost. Amount and distribution of the proportion indicate financial burden of health care in the societies. WHO believes that one of the main determinants in health system efficiency is fairness of financial contribution. This study aimed distribution pattern of urban households’ income, health expenditure by cost types and measuring of equality on health care costs in the Gorgan district. Materials & Methods: In order to establish the population laboratory, this cross-sectional study assessed 1014 household in the Gorgan health posts (No 4 and 8) on January 2003. health insurance status, monthly household income and monthly health care cost gathered through interviewing with the husbandmans. Results: Health insurance coverage was 67% in highest and 44% in lowest income deciles (P<0.05). Median and mean of assessed households’ income and household health care cost were 1200000 Rls, (1669669±187300 Rls) and 80000 Rls, (281530±95124 Rls) respectively. Mean of median of out of pocket proportion health care cost per households’ income was 0.57±0.03 and 0.66 respectively. 13% of total income expended health care cost through out of pocket. This proportion in highest and lowest income decile was 7% and 28% (P<0.05). Gini coefficient of health care cost and out of pocket cost per total household income were 0.22 and 0.18 respectively. Conclusion: Low income households expended almost 40% of their income in order to purchasing of health care, in comparison to richest households, they spent 9% of total income. Instead of, additive development of health insurance systems and complementary insurance mechanisms, a half of health care cost in the population spend by out of pocket. According to WHO standards of health system performance, revising health insurance system and payment mechanisms are mandatory.

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Background & Objective: Colorectal cancer is the most common cancer of GI and 2nd most common cause of cancer death in the world. The purpose of this study was to determine epidemiologic aspect and tumor characteristics of colorectal cancer for patients and compare them in young (<50 yr) and older (>50 yr) patients. Materials & Methods: In this cross-sectional study during 3 yr the samples of malignant colorectal cancer presented in Gorgan endoscopy and pathologic centers were collected. Data evaluated by statistically method. Results: There were 101 cases of malignant colorectal cancer. 61 cases were male and 40 cases were female. The mean age was 56±13.65 yr. 13.9% of patients were <40 yr. The type of tumor in 94% was adenocarcinoma, 2.9% lymphoma and 2.9% undifferentiated carcinoma. The site of involvement in 30 cases were rectum and in 71 cases were colon. The most common symptom was abdominal pain, constipation and rectal bleeding. The time interval between onset of symptom to diagnosis of disease in 58 cases was >6 mth. Family history of cancer in 36 cases was positive. Right colon cancer in young patient was significantly more than older (P<0.05). Positive family history of cancer in right colon cancer was significantly more other than. Positive family history of cancer in young patient was more than other (P<0.05). Conclusion: According to this study, colorectal cancer was high. Therefore, it is necessary to pay more attention to the symptom of young patient and providing a screening program in patients over 50 years old and young patients with positive family history.

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Background&Objective: 15-20% of TB cases are extra pulmonary tuberculosis (EPTB). Abdominal TB is the most common type of extra intestinal TB. Signs and symptoms of abdominal TB are unspecific. In this study, we identified all GITB cases in Golestan province (Iran) between 1999 and 2003 and determined their demographic characteristics. Materials&Methods: We reviewed all new cases of TB reported during 1999-2003 from TB centers of Golestan province .Then EPTB and especially GI and abdominal TB cases were selected. We completed a questionnaire containing demographic information for each of them. The information entered the computer in SPSS-13 was used to analyze the data. Results: 30 patients had been treated for GI and abdominal TB, most of them were females (22 cases, 73.3%). Mean age of the patients was 32.03±13.73 with higher incidence in age before 40 years old (70%). Most common complaints of the patients were fatigue, weight loss, anorexia, fever and abdominal pain, respectively. In 66.7% of patients the diagnosis was pathologically documented. Conclusion: Our data suggest that 38.46% of all TB cases in Golestan province were EPTB, and this scale is higher than other studies. In this study, 5.27% of EPTB cases were GI and abdominal TB, higher than the world reports (3%).

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Background&Objective: Celiac is a digestive disease. In this disease, small bowel is damaged and the absorption of nutrients are adversely affected. These patients do not absorb gluten. There is probably a correlation between esophagus cancer and celiac. The aim of this research was to study the seroepidemiology celiac disease in this area with high prevalency of esophagus cancer. Materials&Methods: This research was a descriptive study, which was performed on blood donors in Golestan province during the year 2005-06. blood samples were taken from 2547 subjects. tTG-IgA determination were carried out using ElISA technique, the titre<4U/ml, 4-10U/ml and >10Um/l were considered to be as negative, weakly positive and positive respectively. EMA antibody assessment were carried out on all sample population with more than 4U/ml, using IFA method. Results: 28 subjects (1.1%) had tTG-Ab positive test, out of this number 18 subjects (0.7%) were weakly positive and 10 persons (0.4%) were considered to be positive. EMA test were positive in 70% of subjects with tTG positive results. There was not any significant meaning between positive tTG test and ethnicity from weakly positive tTG, 15 subjects (83.3%) and 3 subjects (16.7%) were male and female respectively. The entire tTG positive were male subjects. Conclusion: In regard to high prevalency of esophagus cancer in the region and the relation of celiac disease with above cancer, it seems necessary to look more seriously at the celiac disease.

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Background&Objective: Silis (SiO2) is an oxide of silicon that its existence in food products is known as a contamination, classified as a human carcinogen. Some suggest it as an etiology of esophageal cancer. Golestan province has a high incidence and prevalence of esophageal cancer and is on the world belt of this disease. This study was designed to determine the concentration of silis in flour produced in Golestan province, north of Iran Materials&Methods: This descriptive study was done in spring 2005. Census method was used to gather flour samples from flour manufactures. Samples were transported to laboratory. Base-melting method in nickel cruise was used in 550°c and the extract was reduced with acid. The complex was evaluated with spectrophotometer. Data entered into SPSS-12, and the differences between silis concentration in various regions were compared with non-parametric Kruskul Walis test. Results: Median silis concentration was 0.0030 grams, mean concentration was 0.008760 with 0.004265 standard deviation, minimum was 0.003 and maximum was .018 grams in each 100 grams flour produced in province's factories. Mean silis concentrations were 0.012, 0.01 and 0.003 in Gorgan and the central part of the province, western and eastern part, respectively. The differences were not significant. Conclusion: Although in earlier reports it was shown that silis level in the flour is high, but the findings of this study indicated that the above element is in normal range.

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Background & Objective: The Acquired Immunodeficiency Syndrome (AIDS) is in its third decade and has become a pandemic disease that threatens the world population. Educational programs are well known as the most effective strategy to preventing the AIDS. The purpose of this study was to determine the knowledge and attitude of participants about AIDS and to test the effects of an AIDS education program on it. Materials & Methods: This case-control study was conducted during 2005. 149 Red Crescent personnel in Golestan, Iran. The sample subjects participated in a pre/post intervention study. The activity consisted of a workshop 90 minutes in length, in conjunction with educational material. A 13-item questionnaire was used as the gauging tool. Results: 47% of subjects had adequate knowledge about AIDS. Mean level of knowledge in post-test exam was significantly higher than pre-test one (P<0.0001). Individuals with higher educational level (high school and university) had lower knowledge in pre-test (P=0.001), but the difference in pos-test was not significant. A significant relationship was shown between the history of participation in previous AIDS education programs and subject's knowledge in pre-test (P<0.001). Conclusion: This study indicated that education program based on special traing considerably increase general awareness and attitde towards AIDS.

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Background & Objective: Hepatitis B virus (HBV) infection is one of the most important health problems all over the world. This study was conducted to determine the co-infection of hepatitis C virus (HCV), hepatitis D virus (HDV) in HBV infected patients in Golestan province of Iran. Materials & Methods: This population based cross sectional study was done in 2004. 139 HBsAg positive cases were assessed for co-infection with HCV and HDV. Serologic tests were done by ELISA method using available kits. Data were analyzed by SPSS-12 and STATA8 software. P-values of less than 0.05 were considered as significant. Results: Sixty eight (48.9%) of 139 cases were males and 71 (51.1%) were females. The mean (±SD) of participant's age was 41.89 (±11.3) years (range: 25-64 years). Anti-HCV and Anti-HDV antibodies were positive in 17 (12.3%) and 8 (5.8%) cases, respectively. Females were more infected with HCV and HDV than males. But the differences were not significant. Conclusion: The prevalence of co-infection with HCV and HDV in HBV infected cases is relatively high and notable in Golestan province of Iran. Because of negative effects of these co-infections in clinical outcome of the disease, it is recommended to assess possible HCV and HDV infection in individuals with HBV infection. This may result in more efficient management of the disease.

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Background and Objective: Esophageal and gastric cancers are among the most common and fatal cancers. These are diagnosed at the latest phase and the prognosis is too poor. Due to the importance and high incidence rate of the upper gastrointestinal cancers in Golestan province, this study was conducted to explore the overall survival rate of these patients in rural area of this region. Materials and Methods: In this descriptive cross-sectional study, a total of 121 pathologically confirmed esophageal or gastric cancers, with rural place of residence, were retrieved from the cancer registry at the health department in Gorgan. After conducting interview with patients or their relatives, analysis of their sociodemographic and clinicopathologic features was performed. The median survival rate was compared regarding age groups and gender using Kaplan-Meier statistical test. Results: Male to female ratio in esophageal and gastric group were 1.2 to 1 and 3.8 to 1, respectively. Short-term survival rates were 54.76% and 26.2% for esophageal cancer and 66.6% and 37.5% for gastric cancer. Collected information regarding patients’ sociodemographic and clinicophathologic factors did not have significant association with patients’ survival in both esophageal and gastric cancers. The mean survival rate in patient with gastric and esophageal cancers according to age and gender was not significant. Conclusion: This study showed that the overall short-term survival rates for upper gastrointestinal cancers are very low in Golestan province. Therefore the need for intervention the need and allocating more diagnosis and therapeutic resources for upper gastrointestinal cancers are required.

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Background and Objective: Stress has been known as an important causative factor in irritable bowel syndrome. Various studies have indicated the relationship between serum leptin levels and stress levels. This study was undertaken to investigate the relationship between serum leptin levels with irritable bowel syndrome. Materials and Methods: In This case-control study, eighty irritable bowel syndrome patients and 80 controls were recruited. All participants were asked to fill in a questionnaire included demographic information and medical history as well as a stress questionnaire. Serum leptin level was measured by ELISA method. Chi-square, student t-test, pearson correlation and logistic regression were used for investigating the relationships between variables. Results: Participants in irritable bowel syndrome group had significantly higher stress levels than controls (p<0.05). In the other hand, Serum leptin levels were significantly lower in irritable bowel syndrome group than the other one (p<0.05). Multivariate logistic regression analysis showed that after adjustment of stress level and body mass index, serum leptin level was still significantly lower in irritable bowel syndrome group (Odds ratio=0.9 CI95%:0.85-0.94). Conclusion: The present study indicated that there is a relationship between leptin and irritable bowel syndrome and serum leptin level is significantly lower in irritable bowel syndrome group than controls. This relationship is independent of other variables such as stress levels, BMI.

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Background and Objective: Colorectal cancer is the third common malignancy in the world. Personal habits including life style and nutrition have been proposed as risk factors of colorectal cancer. We conducted this study to assess the nutritional characteristics in colorectal cancer patients in Golestan province of Iran.

Materials and Methods: This case-control study was done on 47 colorectal cancer cases, diagnosed during 2004-05 and 47 healthy controls. A questionnaire containing socio-demographic and nutritional characteristics (FFQ) was filled for each of the participants. Chi square test was used to assess the relationship between variables.

Results: In each of the two groups, 40.4% were females and 59.6% were males. The mean±SD age of age in cases and controls were 52.4±13.4 and 52.1±13.1 years, respectively. Total energy expenditure of higher than 1837.5 Kcal/ day was significantly related to colorectal cancer (OR=3.8 95% CI: 1.2-11.3). Colorectal cancer risk was higher in individual with frying cooking method (OR=3 95% CI: 0. 8-11.1). The risk of colorectal cancer was 6.5 times higher in individuals with fat consumption of higher than 118.5 grams/day (95% CI: 1.5-28.8). No significant relationship was seen between vegetables consumption and the risk of colorectal cancer.

Conclusion: This study showed that high total energy expenditure, high fat consumption and using frying method for cooking are risk factors of colorectal cancer in Golestan prevince in Nothern of Iran.

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Background and Objective: Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. Materials and Methods: In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates (ASR). The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. Results: The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. Conclusion: This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area.

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Background and Objective: Irritable bowel syndrome (IBS) is a disturbance of colonic function characterized by abdominal pain or discomfort, bloating and abnormal bowel function, resulting in episodes of chronic diarrhea, chronic constipation, or both in alternation. It affects approximately 3 to 20 percent of the population. The aim of this study was to investigate the prevalence of Irritable bowel syndrome among the high school pupile in Gorgan, in North of Iran. Materials and Methods: In this descriptive-analytical cross sectional study, data was collected by clustering, quota and randomized sampling. 1080, 15-19 years old male and female high school pupiles, residing in Gorgan participated in the survey during 2007. The data collection tool was a demographic questionnaire and standard Rome-II criteria. Results: 1063 pupiles completed the questionnaire. The Irritable bowel syndrome prevalence according to Rome-II was 5.7%. The relation between ethnicity and Irritable bowel syndrome was significant (P<0.05). The rate of Irritable bowel syndrome was higher among the Turkmen students. There was no significant relation between Irritable bowel syndrome prevalence with gender, age and family income. Conclusion: This study showed that irritable bowel syndrome prevalence in this area is nearly similar to that reported in national studies in western Iran as well as with Asian countries.

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Background and Objective: Golestan province, located in north of Iran has been known as a high risk area for esophageal cancer. The relationship between esophageal cancer and Selenium (Se) has been assessed in previous studies. This study was conducted to assess the relationship between Soil selenium levels and development of esophageal cancer in Golestan province of Iran. Materials and Methods: In this ecologic study, Golestan province in northern Iran was divided into 135 blocks based on geographical altitude and longitude on the map. One Soil sample was collected from the center of each block. Selenium level in Soil samples was determined by flame atomic absorption spectrometry. Statistical analysis was performed by Pearson correlation and T-Student tests. Results: The mean±SD of Soil Selenium level in Golestan province was 3.7±1.61 mg/kg. There was a positive correlation between Soil level of Selenium and esophageal cancer rates in this area (P=0.03), (Pearson correlation coefficient=0.19). The Soil Selenium level for high risk and low risk area for esophageal cancer were (4.13 mg/kg) and (3.39 mg/kg) respectively (P=0.01). Conclusion: This study showed that there is high Soil Selenium level in Golestan province in north of Iran. Also it is found to be a significant positive relationship between Soil Selenium level and esophageal cancer rate in this area.

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Background and Objective: Helicobacter pylori (H.pylori) with positive Cytotoxin associated Gene A (CagA) have higher potential for pathogenesis. Cytotoxin associated Gene A (CagA) accelerate the pathogenecity of bacteria due to cytotoxin production stimulation. The aim of this study was to determine the prevalence of the anti-CagA antibody among H. pylori infected persons in Golestan province-North of Iran. Materials and Methods: This descriptive study was carried out on 676 H. pylori positive subjects in Golestan province, northern Iran during 2008. Anti CagA antibody were determined in H.pylori positive subjects. Data analyzed by SPSS-16 software and chi-square test. Results: Prevalence of anti CagA in Helicobacter pylori infected cases was 57.7% (390 cases: 179 males and 211 females) (95% CI: 53.9-61.4). According to age the highest and lowest cases of anti CagA antibody were seen in, 15-24 (63.4%) and under 5 years old (26.3%). The level of anti CagA antibody in Sistanian ethnicity group (67.2%) was more than other ethnic group. Anti CagA antibody in Rural area was more than urban regions. Sero prevalence of anti CagA antibody was highest in Minudasht twon (78%), located in East of province in comparison with Bandar Gaz (44%) in west of province. Conclusion: This study showed the prevalence of CagA positive Helicobacter pylori strains in this region is similar to other regions of Iran, Asia and Europe and higher than African population.

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Background and Objective: Celiac is a hereditary disease presented with chronic inflammation of small intestine. Several studies supposed a relationship between Celiac disease and Inflammatory Bowel Disease (IBD). Tissue trans-glutaminase antibody is one of the best serological markers in Celiac disease. This study was designed to evaluate the association of Celiac and IBD using tissue trans-glutaminase antibody.

Materials and Methods: In this descriptive study 127 confirmed IBD patients who were referred by gastroentrologists 2005-08 enrolled into the study. A questionnaire was completed and tissue trans-glutaminase antibody was evaluated with ELISA method with a Cut-off=12 U/ml.

Results: Among 127 referred patients, serum samples of 102 patients were collected. Mean±SD of age was 36.17±15.2 years and 48% were males. Ulcerative colitis, Crohn’s disease and other colitis were observed in 76 (74.5%), 7 (6.9%) and 19 (18.6%) of patients, respectively. Tissue trans-glutaminase antibody was positive (19.8 U/L) in one 46-years-old male patient with ulcerative colitis.

Conclusion: Tissue trans-glutaminase antibody titer was not significantly different between IBD patients and controls, thus it seems not appropriate to suggest as one of the routine tests in IBD patients.

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Background and Objective: Hydroalcholic extract of Peppermint is traditionally used for gastrointestinal disorders. This study was done to evaluate the effect of Peppermint extract on the mice colon motor activity following immobilization stress.

Methods: In this experimental study, 30 male Albino mice were randomly allocated into the three groups; including control, stress and stress + Peppermint oil groups (n=10). The second group as a stress group exposed to immobilization stress for four hours during three days. Third group as stress plus Peppermint oil group was exposed to stress in addition to administration of 27 mg/kg/bw Peppermint oil intraperitoneally prior to stress. After three days, intestinal and peristaltic activity was recorded using pressure transducer from in vitro segments of colon (4-5 cm in length. Also, fecal weight, food intake and body weight was measured for each mouse for in vivo condition.

Results: The mean±SD of fecal weight after three times stress immobilization was 1.36±0.71, 1.06±0.6 and 0.47±0.39 gr in control, stress and Stress + Peppermint oil groups, respectively (P<0.05). The mean±SD of internal luminal pressure after three times stress immobilization was 4.47±1.15, 3.48±1.25 and 0.77±0.37 mm/hg in control, Stress and stress + Peppermint oil groups, respectively (P<0.05).

Conclusion: Peppermint oil is a strong inhibitor for colon motor activity following immobilization stress.

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Background and Objective: Considering the importance of coverage and quality of data in Golestan population-based Cancer Registry (GPCR), northern Iran. This study was conducted to determine the effect of the referral of cancer patients to medical centers outside Golestan province on the coverage of the population-based cancer registry program.
Methods: This descriptive-analytic study was performed on all cancer patients registered in the diagnostic centers of Golestan province, northern Iran during 2008-10. Data of patients referred to the centers of the province from the bank of the Golestan province cancer registry program and data of patients referred to the centers outside the province were received from the Ministry of Health Department of Cancer. Data were analyzed using the record linkage method.
Results: A total of 6083 new cases of cancer were registered in Golestan province. According to the cancer data, 678 (11%) of them were referred to outside of Golestan province centers. 343 of these 678 patients (50.6%) were found as duplicate records between the two datasets. The most frequent cases were gastric cancers (70.4%), breast (63.5%) and esophagus (62.5%).
Conclusion: This study suggested that referrals of cancer patients to centers outside the Golestan province may result in an underestimation of about 5% in GPCR. This level of underestimation seems to have no considerable effects on completeness and quality of data in the GPCR.