ARCHIVES OF IRANIAN MEDICINE
Year:2014 | Volume:17 | Issue:3|Papers Count:14

Background: Worldwide, injuries are a major public health concern and make a considerable contribution to the disease burden. The present study is a component of the National and Subnational Burden of Diseases, Injuries, and Risk Factors from 1990 to 2013 (NASBOD) study in Iran, which was designed to investigate the burden of most important injuries (road traffic injuries, falls, burns, poisonings and drownings) at the national and sub-national levels in Iran. In this paper we explain definitions, organization, injuries selection process, data sources, data gathering methods, and data analyses of the national and sub-national burden of injuries study in Iran.Methods: The burden of most important injuries in current metric of DALYs at the national and sub-national levels in Iran over 1990-2013 will be estimated through comprehensive reviews of either published or national data sources. Statistical modeling will be used to impute the missing data on the burden of selected important injuries for each district-year.Conclusion: The results of present study can help health policy makers to plan more comprehensive and cost-effective strategies at national and sub-national level for prevention and control of burden caused by injuries.

Back ground: Non-communicable diseases, as the major public health problem, are caused by different risk factors. The main leading lifestyle risk factors for most diseases burden in Iran are unhealthy diet, physical inactivity, and smoking. The aim of this study is to provide data collection and methodology processes for estimating the trends of exposures to the selected lifestyle risk factors and their attributed burden at national and sub-national levels.METHODS: Systematic review will be performed through PubMed/MEDLINE, Scopus and ISI/Web of Science as well as Iranian databases such as IranMedex, Irandoc and Scientific Information Database (SID). In addition, hand searching of unpublished data sources will be used to identify relevant population-based studies. The searched studies will be included only if it is reasonably population-based and representative, and exposure data has been reported or could be plausibly obtained from the study. For risk factors with no surveys identified, other sources of potential data will be considered. The target population is healthy Iranian adult population living within Iran from 1990 to 2013. Other data sources include national censuses, national registration systems, and national and sub-national surveys. Spatio-temporal Bayesian hierarchical model and Bayesian multilevel autoregressive model will be used to overcome the problem of data gaps in provinces, and in some age or sex groups or in urban/rural areas. The problem of misaligned areal units will be also addressed in these models.CONCLUSION: National and sub-national assessment of major lifestyle risk factors such as unhealthy diet, physical inactivity, and smoking is necessary for priority setting and policy making in different regions of Iran.

BACKGROUND: Non-communicable chronic diseases are the greatest preventable cause of death. One of the most prevalent groups of chronic diseases, are oro-facial diseases. The major burden of oral diseases is caused by dental caries, periodontal diseases, tooth loss, oral cancer and oral clefts. The aim of the study is to present data collection and methodology processes for estimating the prevalence of the mentioned oral diseases and their attributed burden at national and sub-national levels in Iran, from 1990 to 2013.METHODS: Systematic review of published literature will be conducted, as well as using unpublished and grey literature. Three international databases (PubMed, ISI and Scopus) and three local databases (IranMedex, SID and Irandoc) will be used to provide the most comprehensive epidemiologic data bank. The study will be included if it is population-based and has reported diseases data. The target population is representative healthy Iranian population. A comprehensive assessment form in Epi-Info 7 will be designed to assess the quality of selected articles. Other main sources of data are National Oral Health surveys, “National Health Survey”, in addition to “Death Registry System” and “Cancer Registry System”. Two statistical models, Spatio-temporal Bayesian hierarchical and Bayesian multilevel auto-regressive, will be applied to overcome the problem of data gaps in provinces, and in some age or sex groups or in urban and rural areas.CONCLUSION: A national and sub-national oral diseases burden study needs a standardized protocol for systematic review, quality assessment of data, data extraction strategy, and an appropriate statistical analysis method.

BACKGROUND: To assess the burden of infectious diseases, it is necessary to utilize a systematic approach for data collection and deploying the sophisticated methods to estimate the burden of infectious diseases for health policy making at national level. The present study protocol is aimed to provide a comprehensive explanation of the general structure and method used in the national and sub-national burden of selected infectious diseases study in Iran from 1990 to 2013.METHODS: The trend, burden, and geographical inequality pattern of infectious diseases will be estimated through a comprehensive review of published and unpublished data. Different sources of data including health surveys, surveillance data, hospital data surveys, death registry system, census, household expenditure survey, and published manuscripts will be synthesized to calculate the estimates. All indicators will be reported by gender, age, and geographic area. Two different statistical models include “Spatio-Temporal” and “Bayesian multilevel autoregressive” will be applied to overcome the scarcity and misalignment of the obtained data.DISCUSSION: Estimating the prevalence trend and burden of infectious diseases would be helpful to use more cost-effective interventions considering sub-national variations. Additionally, the information obtained from these studies can depict the ability of health system authorities in controlling these types of diseases. Overall, the present applied models can be deployed as a part of inputs in further studies to estimate the burden of diseases, not only in Iran but also all around the Middle East countries.

BACKGROUND: Calculation of burden of diseases and risk factors is crucial to set priorities in the health care systems. Nevertheless, the reliable measurement of mortality rates is the main barrier to reach this goal. Unfortunately, in many developing countries the vital registration system (VRS) is either defective or does not exist at all. Consequently, alternative methods have been developed to measure mortality. This study is a subcomponent of NASBOD project, which is currently conducting in Iran. In this study, we aim to calculate incompleteness of the Death Registration System (DRS) and then to estimate levels and trends of child and adult mortality using reliable methods.METHODS: In order to estimate mortality rates, first, we identify all possible data sources. Then, we calculate incompleteness of child and adult morality separately. For incompleteness of child mortality, we analyze summary birth history data using maternal age cohort and maternal age period methods. Then, we combine these two methods using LOESS regression. However, these estimates are not plausible for some provinces. We use additional information of covariates such as wealth index and years of schooling to make predictions for these provinces using spatio-temporal model. We generate yearly estimates of mortality using Gaussian process regression that covers both sampling and non-sampling errors within uncertainty intervals. By comparing the resulted estimates with mortality rates from DRS, we calculate child mortality incompleteness. For incompleteness of adult mortality, Generalized Growth Balance, Synthetic Extinct Generation and a hybrid of two mentioned methods are used. Afterwards, we combine incompleteness of three methods using GPR, and apply it to correct and adjust the number of deaths.CONCLUSION: In this study, we develop a conceptual framework to overcome the existing challenges for accurate measuring of mortality rates. The resulting estimates can be used to inform policy-makers about past, current and future mortality rates as a major indicator of health status of a population.

BACKGROUND: The measurement of population-based dimensions of mental disorders and their effects on the population health is one of the major public health concerns. There is some evidence on the trend and point estimations of mental disease and substance abuse for many specific groups of Iranian population but there is a progressive requirement to documents on their exposure distribution at sub-national level, information about their trends, and their effects on the population health.METHODS: The present protocol is aimed to provide the standards of data collection and methodology processes for estimating the trends of selected mental disorders and their attributed burden at national and sub-national levels. For nine categories of mental disorders, we will estimate 1990 to 2013 trends of prevalence, Years of Life Lost due to premature mortality (YLLs), and Years Lived with Disability (YLDs) and Disability-Adjusted Life Years DALYs by sex, age group, and province. We will also quantify the uncertainty intervals for the estimates of interest.CONCLUSION: The study of National and sub-national prevalence, trend, and burden of mental disorders and substance abuse in Iran provides valuable convincing evidences for policy makers and other stakeholders for more evidence-based priority setting, resource allocation, interventions, service providing, and evaluation at both national and sub-national levels. The results also could be used for future complementary global, regional, national, and sub national studies.

BACKGROUND: Searching for the latest methods of estimating mortality rates is a major concern for researchers who are working in burden of diseases. Child mortality is an important indicator for assessing population health care services in a country. The National and Sub-national Burden of Diseases, Injuries, and Risk Factors (NASBOD) is conducted in Iran with comparative methods and definitions of Global Burden of Disease (GBD) 2010 to estimate major population health measures including child mortality rate. The need to have accurate and valid estimation of under-5 mortality rate led to apply more powerful and reliable methods.METHOD: The available datasets consist of under-five mortality rates from different sources including death registration systems and summary birth history (SBH) questions from censuses and Demographic Health Survey. These datasets are gathered at national and sub-national levels. We have five time series of under-five mortality rates from SBH method that each one contains 25-year time period. We also calculated Child mortality rates from death registration for 5 years. The main challenge is how to combine and integrate these different time series and how to produce unified estimates of child mortality rates during the course of study. By synthesizing the result of other models, Gaussian Process Regression (GPR) is used as the final stage for generating yearly child mortality rates in this study. GPR is a Bayesian technique that uses data information and defines several hierarchical prior parameters for model. In corporation of GPR and MCMC methods, predicted rates are updated using data and defined parameters in model. This method, also captures both sampling and non-sampling errors and provides uncertainty intervals. The existence of uncertainty for predicting mortality rate is one of the considerable advantages of GPR that distinguish it from other alternative methods.DISCUSSION: Estimating accurate and reliable child mortality rates at national and sub-national levels is one of the important parts of NASBOD project in Iran. Gaussian Process Regression with its special features improves achievement of this goal. GPR is a serious competitor for other supervised mortality predictive methods. This article aims to explain the application and preferences of GPR method in estimating child mortality rate.

BACKGROUND: Cancer registry can be a very important component of health information system in developing countries. Routine collection of data and ongoing monitoring of their quality can have a crucial role in priority setting and evidence-based policy making for controlling cancers and trends follow-up in low and middle-income countries. Evaluation of cancer registered data consists of four important components including: comparability, completeness, validity, and timeliness. Similar frameworks are utilized in different countries all over the world.METHODS AND MATERIALS: We will use the national annual cancer registry reports in Iran alone or perhaps along with other Iranian published reports about childhood cancer incidence to determine the stability and trend of incidence rates over time and compare above mentioned reports with childhood cancer incidence data reported by other countries through a systematic review as well as in some cases meta-analysis in order to assess data quality. Data will also be collected from other sources such as death certificates to estimate mortality rates and other different methods will also be additionally applied, by use of which death certificates would be utilized to assess the quality of data, too.CONCLUSION: As the first step for proper measuring incidence rate of all types of cancers all over the country, we will assess and evaluate reported national cancer registry data in Iran in order to estimate the national burden of cancers in 1990-2013.

BACKGROUND: It is widely accepted that maternal mortality is a proxy for maternal health status. Maternal deaths only represent the top of the iceberg; morbidity due to maternal causes apart from maternal mortality, poses a huge burden on women’s families. There is an excessive need to widen the research on maternal morbidity. Here, we explain the framework of our study on maternal conditions and their burden in Iran as a part of the National and Sub-national Burden of Diseases (NASBOD) study.METHODS: A systematic search will be carried out for both published and unpublished data on maternal mortality and morbidity reported between 1985 and 2013. Data collected through systematic review and those obtained from national and sub-national surveys will be extracted in a data set. Two statistical models will be applied: Bayesian Autoregressive Multi-level models and Spatio-Temporal Regression models. Models will be used to overcome the problem of data gaps across provinces, years and age groups.DISCUSSION: In order to control and manage maternal conditions and to make more efficient and cost-effective policies, there is an excessive need for data on the burden of such diseases. There are a few sub-national analyses of the burden of disease. In the current study, burden of maternal conditions will be assessed at national and sub-national levels in Iran between 1990 and 2013. The results of this study are undoubtedly required to provide comprehensive information at the national and provincial levels to administer interventions more effectively, since the priority based policies need regional assessments and comparisons.

Neurofibromatosis type-1 (NF1), also known as Von Recklinghausen disease, is an autosomal dominant disorder with incidence of one per 4000. Neurofibromas are benign, heterogeneous, peripheral nerve sheath tumors coming up from the connective tissue of peripheral nerve sheaths, particularly the endoneurium. Visceral involvement in disseminated neurofibromatosis is considered rare. Neurofibroma occurs most frequently in the stomach and jejunum, but colon and anorectal canal may also be involved. Gastrointestinal neurofibromas may lead to bleeding, obstruction, intussusception, protein-losing enteropathy and bowel perforation. We encountered a case of diffusely involving the anorectal area by huge neurofibroma, which resulted in pelvic pain with watery diarrhea and urgency.

PURPOSE: to introduce five different type of orbital involvement by hydatid cyst in 8 consecutive patients.DESIGN: descriptive case series.METHODS: Herein 8 patients with slowly progressive proptosis from 2 to 4months earlier at their first presentation are introduced. Complete ophthalmic examinations were done. Complete blood count, serologic test, ESR (erythrocyte sedimentation rate), CT scan and MRI were requested. Surgical removal of the lesions performed in all patients.RESULT: The hydatid cysts found in the extraconal (2 patients) and intraconal space (3 patients), lacrimal gland (1 patient), medial rectus (1 patient) and intraosseous of orbital wall (1 patient). The diagnosis of the isolated orbital hydatid cyst without any lesion in other parts of the body was confirmed in all patients. The recurrence was not observed in any patients during 2-6 years follow up.CONCLUSION: Although the most common site of involvement of orbital hydatid cyst is intraconal, it can invade various locations within the orbit.

Primary aneurysmal bone cyst (ABC) in the hands is rare. It occurs more commonly in metacarpal bones and involvement of carpal bones is very uncommon. We report the third case of ABC in the capitate, its clinical presentation, imaging findings and treatment.

A 65-year-old woman was admitted to the hospital because of rectorrhagia and hypotension. Her hemoglobin level was 5 g/dL at the time of admission. After resuscitation, upper gastrointestinal endoscopy and total colonoscopy were performed and revealed no abnormality. Push enteroscopy was performed and the following lesion was found in the proximal jejunum.

The proportion of older people in the general population is steadily increasing worldwide, with the most rapid growth in low- and middle-income countries.1 This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population aging also has important implications for society-in diverse areas including health systems, labor markets, public policy, social programs, and family dynamics.2 A successful response to the aging population will require capitalizing on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterized by poor health outcomes and very high health care costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease and stroke-all of which are key causes of death and disability in older people.3 Since the prevalence of CKD is higher in older people, the health impact of population aging will depend in part on how the kidney community responds.