Iranian Journal of Epidemiology
Year:2019 | Volume:15 | Issue:2|Papers Count:12

Background and Objectives: Social marketing is a method that acts through identifying the needs and demands of the audience and specifying the components of the behavioral market using the results of developmental research. So far, social marketing has not been used to involve the private sector in the tuberculosis (TB) control program. The aim of this study was to design a Public-Private Mix (PPM) program using social marketing. Methods: This qualitative study was conducted using focused group discussions (FGD) with six different groups, including tuberculosis coordinator physicians, specialists from different fields in the private section, and managers of selected private laboratories and hospitals in Karaj in 2013 and the components of the PPM program were determined according to the results of the qualitative study. Results: Most of the participants believed that participation of the private sector in the TB program was associated with significant challenges, including the lack of a well-defined process for communicating with the private sector, lack of a suitable platform, lack of appropriate monitoring tools, private sector’ s lack of compliance, private sector’ s lack of familiarity with national TB program protocols, lack of appropriate incentive and punitive measures, lack of appropriate feedback to the private sector, and monopoly in laboratories. Conclusion: To run PPM in the TB program, it is necessary to involve laboratories in the program voluntarily. It is also essential to provide an informational and incentive package containing effective and low-volume tutorials; the package should facilitate feedback and promote respect for the private sector.

Background and Objectives: The Problematic Internet Use Questionnaire (PIUQ) is a scale for evaluating the adverse effects of high Internet usage. It was adopted into Persian in a previous study. The factorial structure of the adopted version was different from the original English version. The purpose of this study was to determine the factorial structure of the Persian version of the Problematic Internet Use Questionnaire. Methods: In this methodologic study, sampling was carried out in students of Iran University of Medical Sciences, University of Tehran, and Sharif University of Science and Technology. A total of 428 students completed the Problematic Internet Use Questionnaire. Exploratory factor analysis was performed using SPSS. Confirmatory factor analysis was carried out using AMOS. The reliability of the Scale was determined using Cronbach’ s alpha coefficient (α =0. 89). Results: Exploratory factor analysis showed four factors including online preoccupation, adverse effects, social interactions, and excessive use. The mean ± SD of the domains was 2. 12± 0. 81, 2. 01± 0. 86, 2. 18± 0. 85 and 2. 39± 0. 97 for online preoccupation, adverse effects, social interactions, and excessive use, respectively. Conclusion: The exploratory and confirmatory factor analysis showed that the Persian version of the Problematic Internet Use Questionnaire had a relatively similar structure with the English version. One dimension of the questionnaire was split to two new dimensions. This questionnaire can be a useful tool for measuring problematic behaviors related to the excessive use of the Internet.

Background and Objectives: Congenital heart disease (CHD) is the most common type of birth defect that accounts for 25% of all congenital anomalies. This study was conducted to identify the risk factors od congenital heart disease in southeast Iran. Methods: In this case-control study, 353 cases were selected from children aged 0 to 59 months who suffered from congenital heart disease and were referred to the Children’ s Heart Clinic of Zahedan. Moreover, 353 controls were selected from healthy children aged 0 to 59 months who presented to health centers in Sistan and Baluchistan Province. The cases and controls were matched for age, sex and place of residence. The data were collected using interviews with children’ s mothers and analyzed using independent t-test, chi-square test, and multiple logistic regression models. Results: This study showed that the lack of folic acid consumption in pregnancy (OR =11. 8), mot using multivitamins during pregnancy (OR = 4. 1), history of CHD in first-degree relatives of parents (OR=3. 4), history of abortion (OR =3. 4), presence of telecommunication rig in the vicinity of the house (OR=3) and exposure to secondhand smoke (OR=2. 9) significantly increased the chance of a CHD (P <0. 05). Conclusion: Effective planning, emphasis on the use of supplements during pregnancy, and improved awareness of the society, especially high risk women, can be helpful in decreasing CHD in this region. Providing education regarding preventive factors seems to be necessary for health and medical workers to control risk factors and reduce costs associated with CHD.

Background and Objectives: an important problem challenging cesarean section is its extensive use as a common method of delivery. Due to the growing trend of cesarean section in Iran in recent years, the natural delivery promotion program was implemented as one the programs incorporated in the Health System Reform Plan in 2014. In this study, the trend of changes in the percentage of CS delivery in Qom Province following the implementation of this program was evaluated. Methods: This trend analysis that was performed in all cesarean deliveries in Qom Province from 2005 to 2018 using a joinpoint regression method. Results: These results showed an annual increase of0. 4% in the CS percentage 95% CI:-0. 5 to 1. 2), which was not statistically significant. A significant decrease was observed in the rate of CS in governmental hospitals. Conversely, in non-governmental hospitals, the percentage of CS increased significantly. Conclusion: According to the findings of this study, after more than 3 years of implementation of health sector evolution plan, overall implementation of this plan failed to significantly reduce the overall process of cesarean delivery during this period in Qom province and achieve the predetermined goals.

Background and Objectives: One of the causes of neonatal death and death in children under the age of five is premature birth of infants. The purpose of this study was to identify the risk factors associated with preterm infant birth in pregnant women. Methods: This is a case-control study on mothers referring to comprehensive health centers in the provinces of the country. Descriptive analysis of variables was reported as percentage and frequency. In data analysis, logistic regression analysis was used at a significant level less than 0. 05. Results: In this study, 2463 pregnant women (668 cases as cases and 1795 as controls) were examined. There was a significant relationship between the place of residence (OR=0. 702, P=0. 002), level of maternal education (OR=1. 920, P=0. 027), degree of twin (OR=4. 953, P=0. 001), interval between pregnancies (OR=1. 821, P=0. 009), specific disease (OR=1. 694, P=0. 010), nutritional status of the mother (OR=1. 420, P=0. 024), physical activity (OR=1. 591, P=0. 001), Sleep patterns (OR=0. 634, P=0. 008) and history of stillbirth (OR=0. 247, P=0. 001) associated with the birth of premature infants. Conclusion: Preterm infant birth is one of the main causes of neonatal death. Therefore, some of the birth defects of the premature baby can be prevented. It is possible to reduce the risk factors for the birth of a premature baby by improving the quality of pregnancy care and changing the lifestyle of the pregnant mother, and by raising awareness and creating a healthy and safe environment for the mother.

Background and Objectives: In many medical situations, people can experience recurrent events with a terminal event. If the terminal event is considered a censor in this type of data, the assumption of independence in the analysis of survival data may be violated. This study was conducted to investigate joint modeling of frequent events and a final event (death) in breast cancer patients using a frailty model. Methods: In this retrospective cohort study, 443 patients with breast cancer registered at the Hospital of Shohadaye Tajrish Cancer Research Center were studied. The model of Liu (2004) was applied for joint modeling of recurrent events and a terminal event in which a shared frailty with gamma-distribution was used. Data modeling and data analysis were done using the R software. Results: Four hundred and forty three women with breast cancer were studied. Univariate and multivariate analysis were performed in these patients. Of these, 338 cases (76. 3%) had recurrence events, and 105 (23. 7%) were censored. The obtained results of joint frailty model indicated that the relative risk of relapse in patients with a positive first-degree family history was 36% higher than that of other people (P<0. 05). The relative risk of relapse in patients with stage 3 disease was 19% more than other stages and also the relative risk of relapse in patients with chemotherapy was 2. 5 times higher than those without chemotherapy. Conclusion: In this study, the presented model, in addition to simultaneous modeling capability of the event, could help prevent a higher prevalence of the terminal event (death) and thus reduce the adverse effects of reversible diseases.

Background and Objectives: Sleep disorders include problems involving the quality, timing and amount of sleep, which cause decreased functioning and discomfort during the daytime. Considering the importance of sleep in health and quality of life and the probability of the related disorders in the elderly, this study was conducted to investigate sleep disorders and their risk factors in an elderly population covered by Mashhad University of Medical Sciences. Methods: We conducted one of the largest population-based cross-sectional studies in an elderly population covered by Mashhad University of Medical Sciences in 2016. In this study, a total 8496 elderly people aged 60-90 years old with sleep disorders were compared with 35041 elderly subjects without complaints. Data were extracted from the Sina Electronic Health Record System. Bivariate and multivariate logistic regression analysis were carried out using the STATA ® version 14 to determine associations between independent variables and sleep disorders. Results: In multivariate analysis, male gender (AOR=0. 58; 95% CI: 0. 55-0. 61), being married (AOR=0. 88; 95% CI: 0. 83-0. 93), overweight and lightweight compared to normal weight (AOR=1. 27; 95% CI: 1. 21-1. 34 and AOR=1. 20; 95% CI: 1. 04-1. 38, respectively), smoking (AOR=2. 22; 95% C. I: 2. 05-2. 40), high blood pressure (AOR=1. 44; 95% C. I: 1. 37-1. 52), diabetes (AOR= 1. 49; 95% C. I: 1. 40-1. 58) and depression (AOR=3. 05; 95% C. I: 2. 74-3. 38) variable remained in the final model after adjusting for confounders. Conclusion: In this study, gender, marital status, body mass index, smoking, blood pressure, diabetes and depression were the main determinants of sleep disorders. It is necessary to identify the risk factors and perform appropriate interventions to improve the sleep.

Background and Objectives: Menopause is one of the most sensitive events in a woman's life. Health improvement in this period can bring women a better quality of life and has many effects. This study was conducted to investigate the relationship between the level of physical activity and the level of health of postmenopausal women in Kerman Province. Methods: A total of 536 postmenopausal women were selected from Kerman province. The Goldberg’ s General Health Questionnaire was used to measure the level of health and the general physical activity questionnaire (GPAQ) was applied to determine the amount of physical activity. The formula for measuring body mass index was used for BMI. Ultimately, the Spearman, Kruskal Wallis, and Bonferroni statistics were used because the data distribution was not normal. Results: The amount of physical activity in postmenopausal women in Kerman Province was lower than the WHO recommended. There was a significant relationship between physical activity with the level of health (r = 259), (P≤ 0. 001). Moreover, BMI and health level had an inverse relationship (-0. 186) (P≤ 0. 001). Conclusion: Based on the results, a significant relationship was found between physical activity and general health status of postmenopausal women. Considering the effect of physical activity on health, it can be concluded that increased physical activity of postmenopausal women in Kerman Province can improve their health and BMI.

Background and Objectives: Congenital hypothyroidism is one of the reasons for mental retardation and premature death of infants. Since identification of the determinants of hypothyroidism plays a significant role in its prevention, this study was conducted to determine the prevalence of congenital hypothyroidism and to investigate its determinants in newborn infants. Methods: This study was a secondary analysis of the data of the neonatal congenital hypothyroidism screening program. Hypothyroidism was diagnosed based on the Thyroid Stimulating Hormone (TSH) level in the heel prick blood samples on the third to fifth day of life. The data of infants born in Jiroft hospitals were collected from Jiroft Health Center and analyzed using descriptive statistics and Poisson regression test. Results: In this study, 4998 newborns (2450, 49. 02% female, 2548, 98 / 50% male) were investigated. The study samples were newborns born from March to March 2016. The prevalence of congenital hypothyroidism was 1 in 135 live births. The prevalence of congenital hypothyroidism was higher in babies born by cesarean section (IRR = 2. 2, 95% CI =1. 1-4. 1), newborns admitted to the NICU (IRR = 4. 6, 95% CI=2. 4-8. 9), and babies with high birth weight (IRR = 5. 3, 95% CI =3. 5-8. 1). Conclusion: The prevalence of hypothyroidism was higher in this study compared to other studies. Its prevalence was higher in males than in females. Genetic and environmental differences may explain this difference. The prevalence of hypothyroidism was higher in infants born through cesarean section and newborns hospitalized in NICU.

Background and Objectives: Iran has long been considered to be one of the countries in the world with endemic brucellosis. The aim of this study was to review the surveillance system of brucellosis in Iran. Methods: Data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, the review of records, documents, books and published articles and also interviews with process owners and experts of brucellosis surveillance in 2017-2019. Results: In the current surveillance system in Iran, all patients with brucellosis will undergo standard treatment for at least 2 months. The patient identified at each site, private or public sector, reports to the health center of the city. After reporting cases to higher levels, city health center carried out required epidemiologic investigation in the place of reported case in collaboration with its environmental levels. Finally, the individual assessment form, epidemiologic investigation form, for reported case is completed and registered in national surveillance database. Conclusion: Although integration of the brucellosis surveillance program into the health system of the country and reporting and treatment of human cases in accordance with the country's protocol in recent years is well executed, brucellosis control in Iran requires the one health approach. Accordingly, it can be concluded that despite the decrease in the number of brucellosis cases in recent years, the weakness in livestock surveillance has led to many fluctuations in the health system's success in providing surveillance for human cases of brucellosis.

Background and Objectives: Iran is one of the Middle Eastern countries that implemented the HIV / AIDS control and surveillance program many years ago. The purpose of this study was to review the HIV / AIDS surveillance system in Iran. Methods: This was a review research to assess the processes, structures and achievements of the HIV/AIDS surveillance system in Iran. The information sources of this study included data from the surveillance system, reports and documentation, and published guidelines, reviewing existing structures and views of managers and practitioners of the HIV/AIDS surveillance system in Iran. Results: In Iran, all cases with HIV / AIDS as well as people with high risk behaviors are referred to behavioral disease counseling centers in order to receive health care services. Harm reduction in people with risky behaviors in the form of counseling centers, drug addicts' centers, and women's counseling centers in collaboration with governmental and non-governmental organizations, and attention to the second generation of HIV/AIDS surveillance, particularly conducting behavioral studies, are other components of the HIV / AIDS surveillance system in Iran Conclusion: Although the HIV / AIDS surveillance system in Iran has a large structure with many achievements in reducing new HIV cases, especially in some high-risk groups such as injecting drug users, as well as reducing HIV transmission from infected mothers to their children, strengthening this surveillance system, especially for sexual high-risk groups, is essential for controlling HIV/AIDS in the country.

Background and Objectives: Iran, like most other countries in the world, is always threatened with global epidemics and pandemics of influenza. The purpose of this study was to review the influenza surveillance system in Iran. Methods: Data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, the review of records, documents, books and published articles and also interviews with process owners and experts of influenza surveillance in 2017-2019. Results: Influenza surveillance in Iran Currently, a combination of surveillance methods, including caring for patients, laboratory care, hospital care and surveillance of respiratory disease epidemics and also border surveillance. Reporting of human influenza outbreaks, as well as suspected avian flu as main notifiable diseases carried out through telephone. For each suspect case, in addition to taking and sending a sample to diagnose and also detect subtypes of the virus, medical treatment is immediately initiated and tracking of possible contacts is also done. Conclusion: Although there is currently good coherence in the surveillance of influenza in Iran, but based on concerns about the emergence of influenza pandemics in the future, and considering the possible genetic variation of the flu viruses, the tracking of the flu virus circulation along with updating surveillance system especially emphasizing methods and formulas for rapid identification of disease outbreaks, as well as providing better health care and treatment is essential.