High Risk Behavior and Practice of Livestock and Meat Industry Employees Regarding Crimean-Congo Hemorrhagic Fever in Nur County, Northern Iran
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High Risk Behavior and Practice of Livestock and Meat Industry Employees regarding Crimean-Congo Hemorrhagic Fever in Nur County, Northern Iran Seyyed Payman Ziapour1,2, Sadegh Kheiri2,3, Reza Ali Mohammadpour4, Sadegh Chinikar5, Fatemeh Asgarian6, Ehsan Mostafavi7, Fariborz Yazdi8, Jalal Yazdani9, Mohammad Sarafrazi10, Mahmoud Fazeli-Dinan11, Seyed Hassan Nikookar12, Farzaneh Sahraei-Rostami13, Mohsen Aarabi14, Farhang Babamahmoodi15, Mohammad Reza Haghshenas16, Mahmood Moosazadeh17, Ahmadali Enayati18 1 PhD Student in Medical Entomology, Student Research Committee, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 2 Department of Parasitology, North Research Center, Pasteur Institute of Iran, Amol, Iran 3 MSc Student in Microbiology, Islamic Azad University, Science and Research Branch, Tehran, Iran 4 Professor, Department of Biostatistics, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 5 Associate Professor, National Reference Laboratory for Arboviruses and Viral Hemorrhagic Fevers, Pasteur Institute of Iran, Tehran, Iran 6 PhD Student in Medical Parasitology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 7 Associate Professor, Department of Epidemiology, Research Center for Emerging and Reemerging infectious diseases, Pasteur Institute of Iran, Tehran, Iran. 8 PhD student in Disaster and Emergency Health, Communicable Diseases Control and Prevention Unit, Nur Health Center, Mazandaran University of Medical Sciences, Nur, Iran 9 BSc Student of Occupational Health, Diseases Control and Prevention Unit, Tashkooh Health Care Service, Nur Health Center, Mazandaran University of Medical Sciences, Nur, Iran 10 Doctor of Veterinary Medicine, Animal Health and Diseases Control Unit, Mazandaran Provincial Veterinary Organization, Sari, Iran 11Assistant Professor, Department of Medical Entomology and Vector Control, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 12 PhD student in Medical Entomology, Student Research Committee, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 13 MSc in Medical Entomology, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran 14 Assistant Professor, Department of Social Medicine, Diabetes Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 15 Professor, Department of Infectious Diseases and Tropical Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran 16 Associate Professor, Department of Microbiology, Molecular Cell Biology Research Centre, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 17 Assistant Professor, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran 18 Professor, Department of Medical Entomology and Vector Control, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran (Received August 21, 2015 Accepted November 15, 2015) Abstract Background and purpose: Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-borne viral disease. In Iran human cases of the disease were reported in some regions including Nur County (Mazandaran Province, northern Iran). Therefore, this study investigated high risk behavior of people involved in meat industry and animal husbandry in different districts of Nur County. Materials and methods: A cross-sectional questionnaire-based study was conducted in 314 livestock and meat industry workers including shepherds and animal keepers, butchers, slaughters, chefs, veterinary physicians and veterinary staff to monitor their high risk behaviors regarding CCHF from July to December 2012 in Nur County. Statistical analyses were performed using Chi-square and binary regression test at 0.05 significance level. Results: Two hundred eighty nine individuals were interviewed and filled out the questionnaire with an average age of 43.7 ± 14.4 of whom 84.4% were male. Odds ratio (OR) of high risk practices including slaughtering and contact with fresh flesh and blood of livestock of males compared with females was 3.35 (OR = 3.35, CI 95%: 1.73-6.47). High risk individuals living in rural and mountainous areas of Baladeh had significantly longer history of contact with livestock and had more high risk behaviors including slaughtering and contact with fresh flesh and blood of livestock, eating raw liver, and removing ticks from animals' body or squashing them with unprotected hand (P < 0.001). Lack of protective clothing in high risk individuals in highland areas (OR = 9.24, CI 95%: 2.66-32.13) and Baladeh district (OR = 9.80, CI 95%: 2.78-34.53) was significantly higher than the rest of the studied areas. Conclusion: The results clearly showed extensive high risk practice in individuals involved in livestock in Nur County. Such behaviors and lack of management programs may increase the occurrence and epidemics of CCHF in the region especially in West of Mazandaran Province where current CCHF cases are reported. Keywords: Crimean-Congo Hemorrhagic Fever, high risk occupational behavior, tick, Nur, Iran J Mazandaran Univ Med Sci 2016; 25(132): 49-61 (Persian). 49 ﭘﮋوﻫﺸﻲ ﻣﺠـــﻠــــﻪ داﻧـﺸـــﮕﺎه ﻋــﻠــــﻮم ﭘــﺰﺷــﻜــــﻲ ﻣــﺎزﻧــــﺪران دوره ﺑﻴﺴﺖ و ﭘﻨﺠﻢ ﺷﻤﺎره 132 دي ﺳﺎل 1394 (49-61) ﺑﺮرﺳﻲ رﻓﺘﺎرﻫﺎي ﭘﺮﺧﻄﺮ و ﻋﻤﻠﻜﺮد اﻓﺮاد ﺷﺎﻏﻞ در ﺻﻨﻌﺖ دام و ﮔﻮﺷﺖ در راﺑﻄﻪ ﺑﺎ ﺑﻴﻤﺎري ﺗﺐ ﺧﻮﻧﺮﻳﺰيدﻫﻨﺪه ﻛﺮﻳﻤﻪ - ﻛﻨﮕﻮ در ﺷﻬﺮﺳﺘﺎن ﻧﻮر، ﺷﻤﺎل اﻳﺮان ﺳﻴﺪ ﭘﻴﻤﺎن ﺿﻴﺎءﭘﻮر1و2 ﺻﺎدق ﺧﻴﺮي2و3 رﺿﺎ ﻋﻠﻲ ﻣﺤﻤﺪﭘﻮر4 ﺻﺎدق ﭼﻴﻨﻲ ﻛﺎر5 ﻓﺎﻃﻤﻪ ﻋﺴﮕﺮﻳﺎن6 اﺣﺴﺎن ﻣﺼﻄﻔﻮي7 ﻓﺮﻳﺒﺮز ﻳﺰدي8 ﺟﻼل ﻳﺰداﻧﻲ9 ﻣﺤﻤﺪ ﺳﺮاﻓﺮازي10 ﻣﺤﻤﻮد ﻓﺎﺿﻠﻲ دﻳﻨﺎن11 ﺳﻴﺪ ﺣﺴﻦ ﻧﻴﻜﻮﻛﺎر12 ﻓﺮزاﻧﻪ ﺻﺤﺮاﺋﻲ رﺳﺘﻤﻲ13 ﻣﺤﺴﻦ اﻋﺮاﺑﻲ14 ﻓﺮﻫﻨﮓ ﺑﺎﺑﺎﻣﺤﻤﻮدي15 ﻣﺤﻤﺪرﺿﺎ ﺣﻖ ﺷﻨﺎس16 ﻣﺤﻤﻮد ﻣﻮﺳﻲ زاده17 اﺣﻤﺪﻋﻠﻲ ﻋﻨﺎﻳﺘﻲ18 ﭼﻜﻴﺪه ﺳﺎﺑﻘﻪ و ﻫﺪف: ﺗﺐ ﺧﻮﻧﺮﻳﺰيدﻫﻨﺪه ﻛﺮﻳﻤﻪ -ﻛﻨﮕــﻮ ((Crimean-Congo Hemorrhagic Fever (CCHF) ﺑﻴﻤــﺎري وﻳﺮوﺳــﻲ ﻣﻨﺘﻘﻠﻪ از ﻛﻨﻪﻫﺎ ﺑﻮده ﻛﻪ وﻗﻮع اوﻟﻴﻦ ﻣﻮارد اﻧﺴﺎﻧﻲ اﺳﺘﺎن ﻣﺎزﻧﺪران در ﺷﻬﺮﺳﺘﺎن ﻧــﻮر ﻣــﺎ را ﺑــﺮ آن داﺷــﺖ ﻛــﻪ ﺟﻬــﺖ ﺟﻠــﻮﮔﻴﺮي از ﻃﻐﻴــﺎن اﺣﺘﻤﺎﻟﻲ ﺑﻴﻤﺎري، ﻣﻴﺰان وﻓﻮر رﻓﺘﺎرﻫﺎي ﭘﺮﺧﻄﺮ اﻓﺮاد ﺷﺎﻏﻞ در ﺻﻨﻌﺖ دام و ﮔﻮﺷﺖ ﺷﻬﺮﺳﺘﺎن ﻧﻮر را ﺑﺮرﺳﻲ ﻧﻤﺎﺋﻴﻢ. ﻣﻮاد و روشﻫﺎ: ﻳﻚ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ - ﻣﻘﻄﻌﻲ ﺑﺎ اﺳﺘﻔﺎده از ﭘﺮﺳﺸﻨﺎﻣﻪ ﻣﺤﻘﻖ ﺳﺎﺧﺘﻪ از ﺗﻴﺮ ﻟﻐﺎﻳﺖ دي ﻣﺎه 1391 در ﺷﻬﺮﺳﺘﺎن ﻧﻮر ﺑﺮ روي 314 ﻧﻔﺮ داﻣﺪار، ﻗﺼﺎب، ﻛﺎرﮔﺮ ﻛﺸﺘﺎرﮔﺎه، آﺷﭙﺰ و ﻛﺎرﻛﻨﺎن داﻣﭙﺰﺷﻜﻲ ﺟﻬﺖ ﺳﻨﺠﺶ رﻓﺘﺎرﻫﺎي ﭘﺮﺧﻄﺮ آن ﻫﺎ ﻧﺴــﺒﺖ ﺑــﻪ ﺑﻴﻤــﺎري CCHF ﻃﺮاﺣﻲ ﺷﺪ و ﺗﻮﺳﻂ آزﻣﻮنﻫﺎي آﻣﺎري ﻣﺠﺬور ﻛﺎي و رﮔﺮﺳﻴﻮن دوﺗﺎﻳﻲ در ﺳﻄﺢ ﻣﻌﻨﻲداري 05/0 ﻣﻮرد آﻧﺎﻟﻴﺰ ﻗﺮار ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪﻫﺎ: 289 ﻧﻔﺮ از ﺷﺎﻏﻠﻴﻦ ﺻﻨﻌﺖ دام وﮔﻮﺷﺖ ﺷﻬﺮﺳﺘﺎن ﻧﻮر وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ، ﺑﻪﻃﻮريﻛﻪ 4/84 درﺻﺪ آنﻫﺎ از ﺟﻨﺲ ﻣﺬﻛﺮ و ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﺑﺮاﺑﺮ ﺑﺎ 4/14 ± 7/43 ﺳﺎل ﺑﻮد. رﻓﺘﺎر ﭘﺮﺧﻄﺮ ذﺑﺢ دام ﻳﺎ ﺗﻤﺎس ﺑﺎ ﮔﻮﺷﺖ درﻣﺮدان 35/3 ﺑﺮاﺑﺮ زﻧﺎن ﺑــﻮد(CI %95: 1/73- 6/47، OR = 3/35). در ﻣﻘﺎﻳﺴﻪ ﺑﺎ دﻳﮕﺮ ﻣﻨﺎﻃﻖ ﺷﻬﺮﺳﺘﺎن ﻧﻮر، ﻧﻮاﺣﻲ روﺳﺘﺎﻳﻲ، ﻛﻮﻫﺴﺘﺎﻧﻲ و ﻧﻴﺰ ﺑﺨﺶ ﺑﻠﺪه ﺗﻤﺎس ﺑﻴﺶﺗﺮي ﺑﺎ دام داﺷﺘﻪ و ﺳﺎﺑﻘﻪ ﺑﻴﺶﺗﺮي در اﻧﺠﺎم رﻓﺘﺎرﻫﺎي ﭘﺮﺧﻄﺮ از ﻗﺒﻴﻞ ذﺑﺢ دام و ﺗﻤﺎس ﺑﺎ ﺧﻮن آن، ﺧﻮردن ﺟﮕﺮ ﺧﺎم و ﺟﺪاﺳﺎزي ﻳﺎ ﻟﻪﻛﺮدن ﻛﻨــﻪ از ﺳــﻄﺢ دام ﺑــﺎ دﺳﺖ ﺑﺮﻫﻨﻪ داﺷﺘﻪاﻧﺪ(p < 0/001). ﻋﺪم اﺳﺘﻔﺎده از ﭘﻮﺷﺶ ﻣﺤﺎﻓﻈﺘﻲ درﺷﺎﻏﻠﻴﻦ ﻣﻨﻄﻘﻪ ﻛﻮﻫﺴﺘﺎﻧﻲ (OR = 9/24 ،CI %95: 2/66 - 32/13) و ﻧﻴﺰ ﺑﺨﺶ ﺑﻠﺪه ﺑﻪ ﻃﻮر ﻣﻌﻨﻲ داري ﺑﺎﻻﺗﺮ از ﺑﻘﻴﻪ ﻧﻮاﺣﻲ و ﺑﺨﺶﻫﺎي ﺷﻬﺮﺳﺘﺎن ﻧﻮر ﺑﻮد (OR = 9/80 ،CI %95: 2/78 - 34/53). اﺳﺘﻨﺘﺎج: ﻣﻄﺎﻟﻌﻪ ﻣﺎ وﻓﻮر رﻓﺘﺎرﻫﺎي ﭘﺮﺧﻄﺮ در ﺑﻴﻦ ﻣﺸﺎﻏﻞ ﻣﺮﺗﺒﻂ ﺑﺎ دام را ﻧﺸﺎن ﻣﻲدﻫﺪ، ﻟﺬا ﺑﺎ ﺗﻮﺟﻪ ﺑــﻪ ﻛــﺎﻧﻮن ﮔــﺰارش ﺑﻴﻤــﺎري در ﻏﺮب اﺳﺘﺎن، ﺗﺪاوم اﻳﻦ اﻣﺮ و ﻋﺪم ﺑﺮﻧﺎﻣﻪرﻳﺰيﻫﺎي ﻛﻨﺘﺮﻟﻲ ﺳﺒﺐ اﻓﺰاﻳﺶ اﺣﺘﻤﺎل وﻗﻮع اﭘﻴﺪﻣﻲ ﺑﻴﻤﺎري CCHF در اﻳﻦ ﻣﻨﺎﻃﻖ ﻣﻲﮔﺮدد. واژه ﻫﺎي ﻛﻠﻴﺪي: ﺗﺐ ﺧﻮﻧﺮﻳﺰيدﻫﻨﺪه ﻛﺮﻳﻤﻪ-ﻛﻨﮕﻮ (CCHF)، رﻓﺘﺎرﻫﺎي ﺷﻐﻠﻲ ﭘﺮﺧﻄﺮ، ﻛﻨﻪ، ﻧﻮر، اﻳﺮان ﻣﻘﺪﻣﻪ ﺑﻴﻤـــﺎري ﺗـــﺐ ﺧـــﻮﻧﺮﻳﺰيدﻫﻨـــﺪه ﻛﺮﻳﻤـــﻪ-ﻛﻨﮕـــﻮ ﻳﻜــﻲ از ﺑﻴﻤــﺎريﻫــﺎي ﻣﻬــﻢ آرﺑﻮوﻳﺮوﺳــﻲ ﻣﻨﺘﻘﻠــﻪ از ﻛﻨــﻪ ((Tick-borne disease) (Crimean-Congo Hemorrhagic Fever (CCHF) و ﻣﺸﺘــﺮك ﺑﻴــﻦ اﻧـﺴــﺎن و دام ﻣﻮﻟﻒ ﻣﺴﺌﻮل: اﺣﻤﺪﻋﻠﻲ ﻋﻨﺎﻳﺘﻲ - ﺳﺎري: ﻛﻴﻠﻮﻣﺘﺮ 18 ﺟﺎده ﺧﺰر آﺑﺎد، ﻣﺠﺘﻤﻊ داﻧﺸﮕﺎﻫﻲ ﭘﻴﺎﻣﺒﺮ اﻋﻈﻢ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، ﻛﺪﭘﺴﺘﻲ: E-mail: [email protected] 48471- 93697 1. داﻧﺸﺠﻮي دﻛﺘﺮي ﺗﺨﺼﺼﻲ ﺣﺸﺮه ﺷﻨﺎﺳﻲ ﭘﺰﺷﻜﻲ، ﻛﻤﻴﺘﻪ ﺗﺤﻘﻴﻘﺎت داﻧﺸﺠﻮﻳﻲ، ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻋﻠﻮم ﺑﻬﺪاﺷﺘﻲ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 2. ﺑﺨﺶ اﻧﮕﻞ ﺷﻨﺎﺳﻲ، ﭘﮋوﻫﺸﻜﺪه ﺷﻤﺎل ﻛﺸﻮر، اﻧﺴﺘﻴﺘﻮ ﭘﺎﺳﺘﻮر اﻳﺮان، آﻣﻞ، اﻳﺮان 3. داﻧﺸﺠﻮي ﻛﺎرﺷﻨﺎﺳﻲ ارﺷﺪ ﻣﻴﻜﺮوﺑﺸﻨﺎﺳﻲ، واﺣﺪ ﻋﻠﻮم و ﺗﺤﻘﻴﻘﺎت، داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ، ﺗﻬﺮان، اﻳﺮان 4. اﺳﺘﺎد، ﮔﺮوه آﻣﺎر زﻳﺴﺘﻲ، ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻋﻠﻮم ﺑﻬﺪاﺷﺘﻲ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 5. داﻧﺸﻴﺎر، آزﻣﺎﻳﺸﮕﺎه رﻓﺮاﻧﺲ ﻛﺸﻮري آرﺑﻮوﻳﺮوسﻫﺎ و ﺗﺐﻫﺎي ﻫﻤﻮراژﻳﻚ وﻳﺮوﺳﻲ، اﻧﺴﺘﻴﺘﻮ ﭘﺎﺳﺘﻮر اﻳﺮان، ﺗﻬﺮان، اﻳﺮان 6. داﻧﺸﺠﻮي دﻛﺘﺮي ﺗﺨﺼﺼﻲ اﻧﮕﻞ ﺷﻨﺎﺳﻲ ﭘﺰﺷﻜﻲ، داﻧﺸﻜﺪه ﭘﺰﺷﻜﻲ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺟﻨﺪي ﺷﺎﻫﭙﻮر اﻫﻮاز، اﻫﻮاز، اﻳﺮان 7. داﻧﺸﻴﺎر، ﺑﺨﺶ اﭘﻴﺪﻣﻴﻮﻟﻮژي و ﭘﺎﻳﮕﺎه ﺗﺤﻘﻴﻘﺎﺗﻲ ﺑﻴﻤﺎريﻫﺎي ﻧﻮﭘﺪﻳﺪ و ﺑﺎزﭘﺪﻳﺪ، اﻧﺴﺘﻴﺘﻮ ﭘﺎﺳﺘﻮر اﻳﺮان، ﺗﻬﺮان، اﻳﺮان 8.. داﻧﺸﺠﻮي دﻛﺘﺮي ﺗﺨﺼﺼﻲ ﺳﻼﻣﺖ در ﺑﻼﻳﺎ و ﻓﻮرﻳﺖ ﻫﺎ؛ واﺣﺪ ﭘﻴﺸﮕﻴﺮي و ﻣﺒﺎرزه ﺑﺎ ﺑﻴﻤﺎرﻳﻬﺎي واﮔﻴﺮ، ﺷﺒﻜﻪ ﺑﻬﺪاﺷﺖ و درﻣﺎن ﺷﻬﺮﺳﺘﺎن ﻧﻮر، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﻧﻮر، اﻳﺮان 9. داﻧﺸﺠﻮي ﻛﺎرﺷﻨﺎﺳﻲ ﺑﻬﺪاﺷﺖ ﺣﺮﻓﻪ اي، واﺣﺪ ﭘﻴﺸﮕﻴﺮي و ﻣﺒﺎرزه ﺑﺎ ﺑﻴﻤﺎريﻫﺎ، ﻣﺮﻛﺰ ﺑﻬﺪاﺷﺘﻲ درﻣﺎﻧﻲ ﺗﺎﺷﻜﻮه، ﺷﺒﻜﻪ ﺑﻬﺪاﺷﺖ و درﻣﺎن ﺷﻬﺮﺳﺘﺎن ﻧﻮر، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﻧﻮر، اﻳﺮان 10. دﻛﺘﺮي ﺣﺮﻓﻪ اي داﻣﭙﺰﺷﻜﻲ، واﺣﺪ ﺑﻬﺪاﺷﺖ دام و ﻣﺒﺎرزه ﺑﺎ ﺑﻴﻤﺎريﻫﺎي داﻣﻲ، اداره ﻛﻞ داﻣﭙﺰﺷﻜﻲ اﺳﺘﺎن ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 11. اﺳﺘﺎدﻳﺎر، ﮔﺮوه ﺣﺸﺮه ﺷﻨﺎﺳﻲ ﭘﺰﺷﻜﻲ و ﻣﺒﺎرزه ﺑﺎ ﻧﺎﻗﻠﻴﻦ، ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻋﻠﻮم ﺑﻬﺪاﺷﺘﻲ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 12. داﻧﺸﺠﻮي دﻛﺘﺮي ﺗﺨﺼﺼﻲ ﺣﺸﺮه ﺷﻨﺎﺳﻲ ﭘﺰﺷﻜﻲ، ﻛﻤﻴﺘﻪ ﺗﺤﻘﻴﻘﺎت داﻧﺸﺠﻮﻳﻲ، ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻋﻠﻮم ﺑﻬﺪاﺷﺘﻲ، داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ، داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﻣﺎزﻧﺪران، ﺳﺎري، اﻳﺮان 13. ﻛﺎرﺷﻨﺎس ارﺷﺪ ﺣﺸﺮه ﺷﻨﺎﺳﻲ ﭘﺰﺷﻜﻲ، ﻣﺮﻛﺰ ﺗﺤﻘﻴﻘﺎت ﻋﻠﻮم ﺑﻬﺪاﺷﺘﻲ، داﻧﺸﻜﺪه