Iranian Journal of Epidemiology
Year:2020 | Volume:16 | Issue:1|Papers Count:10

Background and Objectives: The study aimed to analysis the psychometric properties of the health system resilience scale, assessing it and to introduce a conceptual model for qualitative analysis of Iran health system in the face of the civid-19 crisis. Methods: In this Mixed-method study, the determination of face and content validity was performed using 8 experts. The structure validity was investigated in a cross-sectional study through an electronic survey of 178 actors in the Iran health system. Resilience has been assessed in five dimensions using 5point Likert scale. Results: The percentage mean score of the Iranian health system resilience in the face of the Covid19 crisis was 41/08 and in the moderate level. The percentage mean score (standard deviation) for 5 dimension include awareness 39/2 (21), diversity 38/7 (21), self-regulation 36 (20/6), integration 39/9 (21/5) and adaptation 41/2 (21/8). Confirmatory factor analysis indicated the appropriate fit of the information with the fivecomponent structure. Conclusion: The maximum score of resilience dimension belongs to adaptation and the lowest to the selfregulation indicating that it requires interventions to involve the private sector, and to design a new delivery system for crisis situations. The questionnaire can be used as a standard instrument for assessing the health system resilience.

Background and Objectives: In addition to effective treatment, tuberculosis recurrence is a very important challenge regarding the treatment of this infection. This study was conducted to evaluate the risk factors associated with tuberculosis recurrence. Methods: In this nested case-control study, 202 tuberculosis patients with recurrence and 202 matched controls in terms of age, sex and place of residence were studied. The cases and controls were selected from a cohort of tuberculosis patients in Sistan and Baluchestan province between 2011 and 2018. The data were collected using interviews and patients’ records. The independent t-test, chi-square and multiple conditional logistic regression were used to analyze the data. Results: The drug abuse history (OR=6. 1), 3+ smear positive (OR=3. 03), chest X-ray suggestive of tuberculosis (OR=4. 9), drug resistance (OR=7. 3), low socioeconomic status (OR=3. 9), weight loss (OR=3. 1), chest pain (OR=3. 2), history of digestive disease (OR=22. 1), smoking (OR=6. 1), and imprisonment (OR=3. 7) significantly increased the chance of recurrence among tuberculosis patients (p<0. 05). On the other hand, the chance of recurrence was significantly lower in patients with coughs (OR=0. 29) and a small family size (OR=0. 28). Conclusion: According to the results, tobacco use, drug use, low socio-economic status, life conditions, and disease conditions are the most important determinants of tuberculosis recurrence. In general, epidemiologic factors related to tuberculosis recurrence are not similar in different regions; therefore, educational programs for patients and their families and prevention methods should be considered based on related factors in different regions.

Background and Objectives: Rheumatoid arthritis is a chronic, progressive disease of the joints that presents with articular and systemic symptoms. The purpose of this study was to determine the quality of life in patients with rheumatoid arthritis and its relationship with body mass index. Methods: This descriptive-analytical study was performed in 195 patients with rheumatoid arthritis in Tohid Hospital, Sanandaj, Iran. The data collection tool was a questionnaire including demographic and clinical characteristics. The SF-36 instrument was used to evaluate the quality of life. Results: In the study, 40% of men and 58% of women had a disease severity higher than 2. 6 according to the Disease Activity Score 28. There was a significant difference in all dimensions of quality of life including physical function, energy / fatigue and general health between men and women (P <0. 05). All dimensions of quality of life were inversely correlated with BMI. There was a significant relationship between the disease severity and each of the dimensions of pain, general health and general changes (P <0. 05). Conclusion: Quality of life in patients with rheumatoid arthritis is correlated with body mass index and severity of rheumatoid arthritis; therefore, it seems that health policy makers or clinical practitioners need to pay more attention to these two factors to increase the patients’ quality of life.

Background and Objectives: The purpose of this study was to present a summary of the rabies surveillance program in humans in the country, its achievements and its strengths and weaknesses. Methods: This study was a review of the country's plan for surveillance and control of rabies in humans. The sources of information included the data, reports, documents, and published guidelines. The viewpoints of stakeholders and experts were also reviewed in this study. Results: Since rabies is a zoonotic disease, its effective management requires a good collaboration between several organizations. Moreover, because Iran is located in an endemic region, there is a need for the development of regional and international cooperation for the success of disease prevention, control and management. Animal services for biting and rabies control are provided free of charge in more than 700 centers in the country. Major achievements of the program include timely preventive treatment for animal bite cases, knowledge of the geographical distribution of the disease, identification of high-risk provinces, and decreasing the percentage of human deaths. Conclusion: The program has performed well for rabies secondary prevention. Some aspects of the program, however, still need to be improved, including improvement of educational programs targeting general population and high-risk groups, animal bite prevention, vaccination of domestic dogs, controlling the population of stray dogs, rabies control in wild animals, and proper waste collection and disposal.

Background and Objectives: Congenital anomalies are also known as birth defects and congenital disorders. Congenital anomalies occur in about 3-7% of the newborn babies worldwide. The purpose of this study was to determine the incidence of congenital anomalies and their determinants in hospitals affiliated with Isfahan University of Medical Sciences in 1395. Methods: This cross-sectional study was conducted in all infants born in 1395. The data were analyzed with the SPSS software version 20 using Binary logistic regression. Results: Of 5455 births in Isfahan hospitals, 121 neonates were diagnosed with major congenital anomalies. The total incidence of major congenital anomalies was 2. 2 per 100 births. The results showed a statistically significant relationship between maternal blood group, consanguinity, sex and height of infant with congenital anomalies in newborns (P <0. 05). Moreover, 26. 7% of all abnormalities were related to limbs and the lowest percentage was related to genetic abnormalities, digestive system, anus, and spine with an incidence of 0. 7% for each. Conclusion: More attention should be paid to premarital genetic counseling in order to identify the consanguinity factor as a risk factor for genetic abnormalities. Moreover, pregnant women should be educated about the timely intake of micronutrients to control abnormalities.

Background and Objectives: After the introduction of the pneumococcal vaccine, an increase has been observed in the disease due to nonspecific stereotypes of the vaccine. This study was conducted to determine the spatial distribution of pneumococcal vaccine coverage and common stereotypes of streptococcus pneumonia after vaccine introduction in the vaccine recipient countries. Methods: The Web of Sciences, Medline, and Scopus were searched using a designed search strategy. Studies that reported the prevalence of the stereotypes of streptococcus pneumonia and replacement of the stereotypes were included. In addition, the coverage of pneumococcal vaccination in the countries was extracted from the reports of the World Health Organization. The spatial distribution of vaccine recipient countries and vaccination coverage were determined using the ArcGIS 10. 6. 1. Results: Of 6989 retrieved references, 325 studies were included. The highest proportion of vaccine recipient countries were in the African, European and Western Pacific regions. The vaccination coverage increased up to 2017 in the vaccine recipient countries. The common specific vaccine serotypes after the introduction of vaccine were 19A, 5, 3, 14, 19F, 7F, 23F, 6B. In addition, common nonspecific vaccine serotypes were 11A, 15A/B, 8, and 12F. Conclusion: The results indicated pneumococcal vaccination is not included in the immunization program in many countries. In addition, common serotypes after vaccine introduction of include 19A, 5, 3, 14, 19F, 7F, 23F, 6B. Therefore, it is recommended the health policymakers have a plan for pneumococcal vaccine introduction based on the pattern of the commonly detected stereotypes.

Background and Objectives: Gestational diabetes mellitus (GDM) is a medical problem in pregnancy, and its late diagnosis can cause adverse effects in the mother and fetus. The purpose of this research was to estimate the accuracy parameters of a biomarker for early prediction of gestational diabetes in the absence of a perfect reference standard test. Methods: This study was conducted in 523 pregnant women who presented to Mahdieh Hospital and Taleghani Hospital affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran 2017-2018. As a predictor for detecting GDM, beta-human chorionic gonadotropin (β-hCG) measurements were recorded during 14-17th weeks’ gestation in a checklist. The Bayesian latent variable model was used to estimate the sensitivity, specificity, and area under receiver operating characteristic curve (AUC). Bayesian parameter estimation was calculated using the R2OpenBUGS package in R version 3. 5. 3. Results: The median gestational age was 33 years. In the absence of a perfect reference test, the applied model had a sensitivity, specificity, and AUC of 78% (95% credible interval (CrI): 0. 66-0. 83), 83% (95% CrI: 0. 74-0. 89), and 0. 72 (95% CrI: 0. 64-0. 88) for β-hCG, respectively. Conclusion: According to the results of this study, β-hCG may be an acceptable biomarker for early diagnosis of diabetes in pregnant women in the absence of a perfect reference test.

Background and Objectives: Elimination and eradication of measles requires designing and implementing an enhanced surveillance system. The purpose of this study was to review the measles surveillance system in Iran. Methods: The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control; a review of the records, documents, books, and published articles; and interviews with process owners and experts of measles surveillance in 2017-2019. Results: Iran has a surveillance plan to eliminate the measles. The current design for suspected cases of measles in Iran is a case-based surveillance system, in which for each identified case with fever and maculopapular rashes, some activities such reporting, laboratory confirmation, clinical and epidemiological investigation and case registration in individual forms are done. Conclusion: Complete surveillance of cases suspicious of measles and high coverage of vaccination in children less than 2 years in a cohesive surveillance system and rapid response to the outbreak have led to lack of occurrence of indigenous measles in Iran. Although the current status of the measles surveillance system in Iran seems to be favorable, since Iran is at the stage of measles elimination, it is essential to increase the sensitivity of the reporting system for suspected cases of measles and to maintain the status of vaccine coverage to save elimination status.

Background and Objectives: A large proportion of the data of cause of death is registered in hospitals in Iran. Assessment of the death data can help to identify the problems of cause of death registration system and improve it. Therefore, this study was conducted to review the quality of cause of death registration in Iranian hospitals in 2016. Methods: All hospital deaths in 2016 were reviewed and classified by age group and sex using the Ministry of Health’ s death registration system. Analysis of Causes of National Deaths for Action (ANACONDA) was used to evaluate the quality of the data of cause of death. Results: About 24% of the recorded hospital deaths were assigned to garbage code categories. The highest percentage of this group was seen in the age group over 70 years old and the highest percentage of welldefined causes of death was seen in the age group below one year. Moreover, among the five groups of garbage code causes of death, the group with insufficient details of the cause of death based on ICD classification had the highest percentage in all age groups. Conclusion: Since a substantial proportion of the causes of deaths registered in the Iranian hospitals are categorized in the garbage code categories and cannot be used for planning and health policy making, it is necessary to design a comprehensive plan to implement interventions such as implementation of process evaluation programs and training programs for physicians and coders.