Iranian Journal of Epidemiology
Year:2017 | Volume:13 | Issue:1|Papers Count:11

Background and Objectives: Leishmaniasis encompasses a wide range of clinical complaints from skin injury to fatal visceral infections. Detailed information about the economic burden of the disease can help health care decision makers to estimate the magnitude of the problem, economic advantages obtained from the prevention of this disease, resource allocation, and disease management. The study was conducted to determine the economic burden of leishmaniasis in humans and animals in Iran in 2013.Methods: The cost unit was determined through public service tariffs determined by the Ministry of Health and Medical Education and interviews with experts, and service costs were calculated by multiplying the cost unit for one person by all infected cases. The course of the disease and the services provided to patients were obtained from the review of the literature and records and interview with experts.Results: The economic burden of leishmaniasis was estimated more than IRR 213 billion ($6,700,000). Moreover, 39%, 27%, 18%, and 16% of the costs were related to indirect costs, direct medical costs, indirect medical costs, and dogs, respectively. The average direct medical cost of cutaneous and visceral leishmaniasis was IRR 3381186 ($106) and IRR 9392832 ($295) per person, respectively.Conclusion: The economic burden of leishmaniasis compared to some diseases such as hydatid cyst showed a smaller number (232.3 million$). It is recommended that Iranian health politicians consider the economic burden of other diseases.

Background and Objectives: Internet addiction is a social-physiological event with emotional disturbance, depression, and disruption of social relationships. In addition, Internet addiction has a negative effect on the efficacy of the affected people. The aim of this study was to determine the prevalence of Internet addiction in students and graduates of medical sciences.Methods: This cross-sectional study was conducted on the sideline of epidemiology, microbiology and pediatric diseases congresses from May to October 2013. The participants included the students and graduates of epidemiology, clinical sciences, and other basic sciences from all medical universities of throughout Iran. The Young’s addiction questionnaire was used to assess Internet addiction.Results: One hundred and thirty one students and graduates with a mean age 36.1 ( ±8.4) years participated in this study. The prevalence of mild and moderate Internet addiction was 61.83% (95% CI: 40.53, 70.26) and 26.95% (95% CI: 26.95, 33.56), respectively. None of the participants suffered from severe Internet addiction.Conclusion: Severe Internet addiction was not observed in our study. However, a high proportion of the participants had mild and moderate Internet addiction. Therefore, many participants may be at risk of severe addiction. It seems that planning for preventive measures, especially in academic groups, is necessary.

Background and Objectives: One of the applications of population attributable risk percent (PAR%) is to estimate the disease burden in a population exposed to several risk factors. Therefore, this study was conducted to estimates the PAR% of the space-time clusters of pulmonary tuberculosis.Methods: In this study, the data of pulmonary TB cases were obtained from the health department of Hamadan University of Medical Sciences. After detecting significant clusters using the spatiotemporal scan statistic, PAR% was used to analyze the clusters and to detect the location of clusters more accurately.Results: Four primary space-time clusters and three secondary spatiotemporal clusters were detected for patients with pulmonary tuberculosis and 92% of the patients who did not have a clear state in term of HIV infection. Despite differences in the location of clusters and PAR% attributed to them, the second primary cluster of pulmonary tuberculosis cases (consisting of the cities of Razan, Famenain and Kabudrahang) had the highest amount of PAR% that needs more attention.Conclusion: The presence of significance spatiotemporal clusters in Hamadan highlights the necessity of the use of PAR% to distinguish cluster areas and to implement prevention and control policy. However, more analytical studies are needed to detect the on the determinants of the occurrence of pulmonary TB.

Background and Objectives: Evaluation is one of the main components of communicable diseases surveillance. Despite the World Health Organization’s emphasis for preparation of evaluation tools, there is no suitable tool in Iran. This study aimed to prepare a tool for evaluation of communicable diseases surveillance in hospitals and to pilot it.Methods: Items were prepared in the first step and the first version of questionnaire was developed. Face validity and content validity were checked. Piloting of the questionnaire was done in Tabriz hospitals. Data were entered into SPSS 18. For evaluation of reliability, internal consistency was measured using Cronbach's a and Kuder-Richardson.Results: According to the results, we developed a questionnaire containing 29 questions in 5 domains with 20 indexes. Fifteen hospitals (78.9%) had a communicable diseases reporting system. The goals of reporting system were not described in these hospitals and only 2 (13.3%) hospitals had supporting laws. None of the hospitals had complete access to the surveillance system and reporting tools.Conclusion: The developed questionnaire can be a useful tool to evaluate the communicable diseases surveillance system in hospitals. The reporting systems in the hospitals are not complete.

Background and Objectives: The Millennium Development Goals (MDGs) are common goals that were established by the United Nations in 2000. The aim of this study was to compare some of these indicators in Iran, the Eastern Mediterranean Region (EMR), and the world.Methods: The existing data from the World Health Status in 2014 and some other available sources in Iran, EMR, and across the world were addressed. The most relevant health indicators included decreased childhood mortality, maternal well-being, prevention of AIDS, tuberculosis and other diseases, and environment quality assurance.Results: The proportion of neonatal mortality to total mortality among those less than 5 years increased from 37 to 44 in the world compared to 39 to 46 in EMRO and 46 to 61 in Iran. About 14.5% (71000 out of 490000) of the AIDS/HIV cases reported in the EMRO belonged to Iran in 2002. The maternal mortality rate (MMR) showed a decline of 72.2%, 50% and 44% in Iran, EMRO and the World respectively. The proportion of delivery by skilled persons and the proportion of pre-delivery care had a positive trend in Iran and were higher as compared to EMRO and the world average.Conclusion: Iran achieved many MDGs, however, despite a decline in the AIDS/HIV incidence rate, its prevalence rate has increased in Iran, EMRO and the world from 2001 to 2013. The proportion of neonatal mortality rate to under 5-year mortality rate has had an increasing trend. Decision-makers should give priority to indicators that have not achieved MDGs.

Background and Objectives: One of the most common anxiety disorders in children is social anxiety disorder (SAD). The purpose of the present study was to investigate the epidemiology and clinical characteristics of social anxiety disorder in students in Kermanshah, Iran.Methods: The present study was a cross-sectional study. The statistical population was all school students aged 13-17 years old in the secondary schools of Kermanshah. According to Krejcie and Morgan Table and multistage cluster sampling, 760 students were selected who completed a questionnaire on demographic variables as well as the Social Anxiety Scales for Children and Adolescents (SAS-CA). The data were analyzed using descriptive statistics, chi-square test, and logistic regression analysis with the SPSS-19 software. P values£0.05 were considered significant.Results: The results showed that the prevalence of social anxiety disorder in the whole population was 80.18%. The prevalence was higher in female students than male students. The severity of social anxiety disorder was moderate in 12.25%, severe in 4.90%, and very severe in 1.70% of the students. Parental education, parental occupation, number of family members, average household income, and family history of psychiatric disorders had a significant relationship with the prevalence of SAD in students (P<0.05) but this relationship was not significant for the mode of delivery (P>0.05).Conclusion: This study shows that the prevalence of social anxiety disorder is significantly high among middle school students. Therefore, it is important to consider early anxiety prevention/intervention programs, especially for children in this age group.

Background and Objectives: The cancer of the pancreatic head and Ampulla of Vater is a malignant disease usually seen in advanced stages with symptoms caused by stomach and biliary obstruction. Curative treatment is possible in the early stage. Unfortunately, most symptomatic patients are in the advanced stage and have an unrespectable tumor; therefore, they should undergo palliative surgery. This study was performed to determine the complications and survival rate of patients who underwent palliative surgery for advanced stages of cancer in the Ampulla Vater and pancreatic head.Methods: In this study, 49 patients with advanced stages of cancer in the Ampulla of Vater and pancreatic head who had undergone palliative surgery from 2003 to 2014 at Baqiyatallah Hospital were studied and the complications and survival rate were determined.Results: Eleven patients (22.44%) underwent biliary bypass, 6 (12.24%) underwent gastric bypass, and 32 (65.32) underwent both procedures. Twelve (24.49%) patients developed complications. Anastomotic leak and peritonitis were the most common complications seen in 6 (12.2%). Seven patients (14.28%) died in the hospital. The mean survival was 5.47±8.38 months. Upon follow up, survival was significantly longer in older patients (P=0.01).Conclusion: In one-fourth of the patients with advanced stages of cancer, palliative surgery of the pancreatic head and Ampulla of Vater caused complications, and the mean survival rate was less than six months. The results of this study recommend the use of less invasive procedures such as biliary stenting in the advanced stages of the disease.

Standard methods for estimating exposure effects in longitudinal studies will result in biased estimates of the exposure effect in the presence of time-dependent confounders affected by past exposure. In the present review article, we first described the assumptions required for estimating the causal effect in longitudinal studies and their structure regarding various types of exposure and confounders; then, we explained the bias of standard methods in estimating the causal effect. Two types of bias, i.e. over-adjustment bias and selection bias, occur in estimating the effect of time-varying exposure in the presence of time-dependent confounders affected by previous exposure using standard regression analysis. Standard regression methods cannot sufficiently modify time-dependent confounders and estimate the total causal effect of the exposure.