Iranian Journal of Epidemiology
Year:2020 | Volume:15 | Issue:4|Papers Count:9

Background and Objectives: Iran started malaria elimination campaigns many years ago. The purpose of this study was to review the malaria 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 records, documents, books and published articles, and also interviews with process owners and experts of malaria surveillance in 2017-2019. Results: The surveillance system of malaria in Iran has a coherent structure, in which all identified cases are reported and monitored from the environmental levels to the center by telephone instantly. Considering that the main goals of the malaria program including disease elimination have been obtained, the surveillance system in Iran is currently aiming at strengthening the elimination phase. In this stage, all new cases are also epidemiologically investigated in addition to examination, treatment and follow-up for categorization of the cases in categories of relapse, indigenous, introduced, and induced. Conclusion: The successful implementation of the surveillance system for malaria over time has caused indigenous cases of disease to be limited to three southeastern provinces of the country and there are fewer than 300 new cases a year. Despite success, since the goal of malaria surveillance in Iran is now disease elimination, continuous monitoring of correct implementation of all processes and evaluation of the applied strategies are necessary.

Background and Objectives: Kurdistan Province has always been one of the areas of interest in national disease control programs due to a high number of human brucellosis cases. This study was conducted to explore some of the epidemiological indexes and the trend of the incidence of human brucellosis in this area from 2009 to 2016. Methods: The target population of this cross-sectional study included the human brucellosis patients living in Kurdistan Province whose disease was diagnosed between 2009 and 2016. The data of 6918 patients were analyzed. The incidence was calculated in 100, 000 at-risk population. Results: The highest incidence was 103. 54 in 100, 000 in 2014 and the lowest was 23. 86 in 100000 in 2010. According to 8-year analysis, the highest incidence rate was seen in Bijar. Male gender, rural dwellers, farmers, ranchers, housewives, and those aged 24-25 years were at a higher risk of the disease based on the results. Most of the patients reported contact with livestock. Conclusion: Comprehensive measures should be taken to control the infection transmission from domestic animals and their products to humans; moreover, preventing measures should be devised by health policy-makers, especially for villagers, housewives, and men.

Background and Objectives: Alcohol consumption among various occupations' staff leads to many problems. Therefore, due to the importance of the issue, this comprehensive study was conducted to determine the prevalence of alcohol consumption among industrial workers. Methods: In this descriptive cross-sectional study, the data were collected using a structured questionnaire through interview based on the workers’ self-reports. The participants included 13, 128 workers across the country selected by multi-stage cluster sampling according to the population of labor workers and industrial centers in each province. The data were reported according to the consumption prevalence in the 10 spatial planning zones. Results: In the optimistic situation, wokers in Ardebil (10. 7%), Kermanshah (10. 6%) and Guilan (7. 1%) reported the highest frequency of alcohol consumption. The country’ s mean prevalence of current consumption was 3. 2% and the prevalence of alcohol consumption in life was up to 12. 4% in the workers. Conclusion: The data are based on the self-report of the participants. Therefore, the estimated prevalence rate is considered optimistic and below the actual prevalence. In the work environments of the country, especially in provinces with the highest frequency, special policies and interventions are needed to reduce the prevalence of alcohol consumption and minimize the harms caused by it.

Background and Objectives: In survival analysis, using the Cox model to determine the effective factors requires the assumptions whose failure of leads to biased results. The aim of this paper was to determine the factors affecting the survival of metastatic gastric cancer patients using the non-parametric method of Randomized Survival Forest (RSF) model and to compare its result with the Cox model. Methods: In this retrospective cohort study, 201 patients with metastatic gastric cancer were evaluated in Hamadan Province. Patient survival was calculated from diagnosis to death or end of study. Demographic characteristics (such as gender and age) and clinical variables (including stage, tumor size, etc. ) were extracted from the patient records. Factors affecting survival were determined using the Cox model and RSF. Data analysis was performed using the R3. 4. 3 software and RandomForestSRC and survival packages. Results: The mean (SD) age of patients was 61. 5 (12. 9) years old. The Cox model showed that chemotherapy (p=0. 033) was effective in survival, and the results of fitting the RSF model showed that the most important variables affecting survival were type of surgery, location of metastasis, chemotherapy, age, tumor grade, surgery, number of involved lymph nodes, sex and radiotherapy. Based on the model appropriateness, the RSF model with log-rank split rule had a better performance compared to the Cox model. Conclusion: If the number of variables is high and there is a relationship between the variables, the RSF method identifies the important and effective variables on survival with high accuracy without requiring restrictive assumptions compared to the Cox model.

Background and Objectives: The aim of this study was to determine the predictability of the PLS-SEM model for injuries resulting in hospitalization in motorcyclists using a mediator variable in a case-control study. Methods: In this case-control study, 300 cases and 156 controls were randomly selected from 150 clusters using random cluster sampling. The data were collected using the motorcycle riding behavior (MRB) questionnaire, adult attention deficit hyperactivity disorder (ADHD) questionnaire (subscales) and a checklist containing motorcycle related variables. Results: The motorcycle riding behavior, adult ADHD, motorcycling related variables and some demographic variables were found to be the predictors of injury. There were significant positive relationships between injury and motorcycling related variables (B=0. 20, P=0. 001) and ADHD (B=0. 33, P=0. 001), between MRB and motorcycling related variables (B=0. 51, P=0. 001) and ADHD (B=0. 52, P=0. 001), and between ADHD and motorcycling related variables (B=0. 39, P=0. 001). Conclusion: Considering the more accurate results of PLS-SEM, the intervention programs should especially address those who have hyperactive children, those who use the cellphone while riding, and those who ride in dark hours of the night.

Background and Objectives: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder in pregnancy. In case of early detection, some of its complications can be prevented. The aim of this study was to investigate early prediction of GDM by logistic regression (LR), discriminant analysis (DA), decision tree (DT) and perceptron artificial neural network (ANN) and to compare these models. Methods: The medical files of 420 pregnant women (2010-12) in Kermanshah health centers were evaluated using convenience sampling. Demographic data, pregnancy-related variables, lab tests results, and a diagnosis of GDM according to a fasting blood sugar level of 92 or more were collected from their files. After fitting the four models, the performance of the models was compared and according to the criteria of accuracy, sensitivity and specificity (based on the ROC curve), the superior model was introduced. Results: Following the fitting of LR, DA, DT and perceptron ANN models, the following results were obtained. The accuracy of the above models was 0. 81, 0. 83, 0. 78 and 0. 83, respectively, the sensitivity of the models was 0. 50, 0. 63, 0. 58 and 0. 58, the specificity of the models was 0. 96, 0. 93, 0. 87 and 0. 94, and the area under the ROC curve was 0. 86, 0. 78, 0. 73 and 0. 87, respectively. Conclusion: In predicting and categorizing the presence of GDM, the ANN model had a lower error rate and a higher area under the ROC curve compared to other models. It can be concluded that this model offers better predictions and is closer to reality than other models.

Background and Objectives: Progressive muscle relaxation (PMR) training as part of an educational program for patients involved in pathologic and physiological events (PPE) can have important physiological and psychological benefits for the patients, and can affect various dimensions of their lives including the quality of life. This systematic review and meta-analysis was conducted to determine the effect of PMR on the quality of life of patients involved in PPE. Methods: Through searching the words “ PMR” and “ quality of life (QOL)” in Persian databases including SID, MagIran, IranMedex, and IranDoc and international databases including Google Scholar, Scopus, PubMed, Web of Science, ProQuest, and ScienceDirect, all studies published on the effect of PMR on the QOL were extracted. The methodological quality of the papers was examined using Cochrane risk of bias. Data analysis was carried out using a random-effects model and heterogeneity was assessed by I2. The data were analyzed using the STATA software version 14. 0. Results: Of 495 studies, only 10 explored the effect of PMR on the QOL of patients. The pooled mean of the QOL and all dimensions were statistically significant, including physical functioning (0. 339), physical role limitation (0. 378), bodily pain (0. 341), general health (0. 598), social functioning (0. 873), mental health (0. 736), emotional role limitation (0. 791), vitality (0. 706), total physical dimensions (0. 652), total mental dimensions (1. 316), and total QOF score (0. 480). Only one study had a low risk of bias. Conclusion: Implementation of PMR has a significant effect on the quality of life of patients involved in PPE. PMR is recommended to improve the QOL of the patients.

Background and Objectives: Over the past decades, the Iran’ s anti-tuberculosis campaign has become highly structured and many achievements have been made. The purpose of this study was to describe the characteristics of the TB surveillance system and its components in the Islamic Republic of 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 also interviews with process owners and experts of TB surveillance during 2017-2019. Results: Case finding and treatment and follow-up of TB patients and their household contacts are done In the TB surveillance system. The implementation of the DOTS, (DIRECTLY OBSERVED TREATMENT SHORT-Course) is a major component of the TB surveillance system. Patient registration is done in an online application, which allows extracting and reporting the important indicators of the program. In this surveillance system, there is a special sensitivity to the treatment of patients, so the incidence of multi drug-resistant TB in the country is lower than that of the neighbors. The presence of regional laboratories that cover the entire region of the country is one of the strengths of the TB surveillance program in Iran. Conclusion: Despite budget problems, the anti-TB program in Iran has many achievements. However, new strategies need to be considered to reduce the incidence of TB.