Iranian Journal of Epidemiology
Year:2021 | Volume:16 | Issue:4|Papers Count:13

Background and Objectives: A nosocomial infection (NI) is defined as an infection occurring in a patient after 48 hours of hospitalization or up to 72 hours after discharge from the hospital, which was not present or incubating at the time of admission. NIs increase hospital mortality, decrease patient satisfaction, reduce hospital productivity, and increase health system costs. This study was conducted to determine the prevalence of NIs in Iranian hospitals. Methods: This study was performed using a systematic literature review and meta-analysis. Seven electronic databases and two search engines were searched using appropriate key words to identify research studies on NIs published in Persian and English languages from April 1997 to March 2019 in Iran. Finally, 15 empirical studies out of 89 records were reviewed. Data were analyzed using the Comprehensive Meta-Analysis software. Results: The studies reported a prevalence of 0. 32% to 9. 1% for NIs in Iranian hospitals. The pooled prevalence of NIs in Iranian hospitals was 0. 01 % (95% CI 0. 0%-0. 02%). The most common type of infection was urinary tract infection and the most common microorganism was Escherichia coli. The highest rate of nosocomial infections was seen in the intensive care unit, internal medicine ward and hematology ward. Suction was the most important risk factor for nosocomial infections. Conclusion: The prevalence of NIs in Iranian hospitals is low according to the published studies. Appropriate strategies should be implemented to prevent and control NIs.

Background and Objectives: Correct and timely detection of the outbreaks of diseases with a short incubation period is of great importance in the health system. The aim of this study was to determine the detection of dysentery outbreaks using the cumulative sum method. Methods: This time series study was conducted using the data of the National Surveillance System between 2014 and 2017. The outbreak alert threshold of each season and province was determined separately using the average of three years (1393 to 1395) in the same season and province. The dysentery outbreak in each season was exclusively predicted for Isfahan, Khuzestan, and Hamadan provinces in 2017 using the CUSUM method. Results: In Isfahan Province, the outbreak alert was higher in the spring and summer and lower in the autumn and winter using the current method compared to the CUSUM method. For Khuzestan Province, the current outbreak alert was significantly higher in all seasons compared to the CUSUM method, while the current outbreak alert was lower than the alert predicted by the CUSUM method in Hamadan Province in all the seasons. Conclusion: Compared to constant threshold-based methods, using the CUSUM method seems to be a better way for reporting outbreaks, especially in areas with a high incidence.

Background and Objectives: Immune deficiency syndrome is an epidemic disease. During immunodeficiency caused by HIV, infections such as tuberculosis, hepatitis B and hepatitis C may occur. Given that the transmission of these infections is similar to that of HIV, the risk of HIV infection with these infections is high. The purpose of this study was to determine the prevalence of common HIV infections and the related risk factors in HIV positive individuals. Method: This study was conducted as a retrospective cohort study performed on 3047 HIV patients at Imam Khomeini Counseling Center in Tehran who have been admitted in 2004-2018. Required data were extracted from patient records and entered into Excel software. For data analysis, SPSS version 21 was used. Results: The mean age of the patients was 44. 24 ± 9. 46 years and 77. 3% of them were male. Of them, 98 (3. 2%) were co-infected with hepatitis B, 961 (31. 5%) were co-infected with hepatitis C, and 415 (13. 6%) were co-infected with tuberculosis. According to the results, hepatitis B and hepatitis C had a significant association with age, marital status, gender, education, prison history, history of injection, history of addiction, and needle sharing. Conclusion: Due to the common route of HIV transmission and these infections, there is the possibility of coinfection. The demographic variables and behavioral factors are the most effective risk factors for developing co-infections.

Background and Objectives: The purpose of this study was to adopt and calibrate the fracture risk assessment algorithm FRAX® for the Iranian population and to provide the required guidance on how to apply it in clinical practice. Methods: The age-specific ten-year probability of major osteoporotic fractures was calculated in women with an average BMI to determine the fracture probability at two potential intervention thresholds. The first threshold was the age-specific fracture probability associated with a femoral neck T-score of-2. 5 SD and the other was age-specific fracture probability in women with a history of fracture without BMD. Current Iranian guidelines were used to define these thresholds. The effect of adding BMD values to the assessment of these thresholds was also evaluated separately. Results: Similar to women with a previous fracture, the 10-year probability of a major osteoporotic fracture increased from 4. 9% at the age of 50 years to 17% at the age of 80 years. When using a BMD T-score of ≤ − 2. 5 SD as the intervention threshold, the FRAX probability was twice as high in women aged 50 years as in women of the same age with an average BMD and no risk factor. The FRAX probability increased with age but a T-score of-2. 5 SD was actually protective after 80 years or age. Conclusion: Intervention thresholds based on BMD alone cannot effectively identify high-risk women for fracture, particularly in advanced ages. Using fracture probability based on ‘ fracture threshold’ can help to improve the identification of these women.

Background and Objectives: At present, investigation of extensive contact of tuberculosis (TB) patients’ families is not a routine part of TB control efforts in most countries. This study was conducted to evaluate the effective contacts of TB cases to assess the potential risk of transmission and its determinants in their families. Methods: In this cross-sectional study, registered TB cases in Kerman, Iran provided information about their family size and type and frequency of unprotected effective contacts with their families from 2014 to 2015. The unprotected effective contact was defined using the Centre for Disease Control (CDC) classification (2005) based on the close, frequent, and long-term contact of TB cases. The demographic variables and the frequency of effective contact were analyzed using a logistic regression model with Stata version 12 with 95% confidence intervals. Results: Overall, among 407 contacts of 74 TB cases, 73% had effective contacts. Having an effective contact was significantly higher among females (Adjusted Odds Ratio (AOR)=5. 1; 95% CI: 1. 9-13. 7); those with a lower education level (AOR=4. 0; 95% CI: 1. 4-15. 1), lower income (AOR=7. 7; 95% CI: 2. 2-27. 0), and a house size ≤ 80 m2 (AOR=16. 6; 95% CI: 5. 1-54. 3); Afghan patients (AOR=30. 2; 95% CI: 3. 4-272. 1); and those living in the rural areas (AOR=4. 9; 95% CI: 1. 8-21. 9). Conclusion: It seems that unprotected effective contact with the family members is high among TB patients, which can be a serious concern for the control of TB in this area. Reducing these unprotected effective contacts through educating patients and their families besides screening of the family members can help the health sector to decrease the burden of TB in Iran.

Background and Objectives: Psychological distress is one of the minor psychiatric disorders that can be used as a predictor of serious mental illnesses such as depressive and anxiety disorders. These disorders are predictors of death from cardiovascular disease, stroke, and cancer. This study was conducted to evaluate the prevalence of psychological distress and its related factors. Methods: This descriptive-analytical cross-sectional study was conducted in 2018. The study population included 1103945 subjects aged 18-65 years old that presented to the health centers of Khorasan Razavi. In this study, demographic checklists and the six-item Kessler Psychological Distress Scale (K-6) were used. Results: The prevalence of psychological distress was 10. 10%. The mean age of the subjects was 35. 99 ± 10. 46 years old, 62. 10% were female, 86% were married, and 78. 90% had a high school education or less. The response rate was 98. 6%. Logistic regression analysis showed a significant relationship between psychological distress and age, gender, marital status, education, location, and occupation. Conclusion: In this study, the prevalence of psychological distress was low. According to the odds ratio (OR), divorced women, illiterate women, housewives, and big city dwellers were high-risk groups for psychological distress. Considering the relatively large sample size, it is necessary to develop appropriate strategies for prevention and treatment, and training of these groups.

Background and Objectives: Avian influenza (AI) is one of the most important respiratory diseases in the poultry industry that causes huge economic impacts and plays an important role in public health. H9N2 Avian Influenza Virus (H9N2 AIV) has a broad circulation and causes endemic infections in the poultry industry of the country. Methods: A cohort study was conducted from July 2016 to November 2017 in broiler chicken farms of Qazvin Province, Iran to detect H9N2 AIV infection determinants in broiler chicken farms. Results: Sixteen out of 34 units that were included in the study had positive PCR results. Some variables such as “ type of fence around the unit” , “ biosecurity” , “ cooling system status” , “ mean maternal antibody titers” , “ location height” , “ proximity to public traffic lanes” and “ number of units within a radius of 1 km” had significant effects on the infection occurrence in poultry units according to univariate statistical analyses (P<0. 05). However, only two of them (“ biosecurity” and “ cooling system status” ) were statistically significant in multi-variable analyses (P<0. 05). Conclusion: Biosecurity measures should be implemented more seriously and strictly in broiler farms to reduce the impact of H9N2 AIV infection.

Background and Objectives: In June 2018, 537 residents of a rural area in Khuzestan Province presented to the regional Comprehensive Health Service Center for gastroenteritis symptoms. This study was designed to determine the extent and cause of the outbreak. Methods: A case-control study was performed after random selection of the case and control groups (80 cases and 88 controls). Clinical and water samples were analyzed for parasitic, bacterial and viral pathogens in local, provincial and national laboratories. Odds ratios with corresponding 95% confidence intervals were used to assess the relationship between disease and exposure. Results: The odds ratio of rural plumbing water consumption as a risk factor was 3. 3 (95% CI: 1. 7-6. 2). Using in vitro methods, Shigella sonnei was isolated in clinical samples and enterohemorrhagic Escherichia coli and enteropathogenic Escherichia coli were isolated from both clinical samples and water samples taken from the intake basin of water supply facilities. Conclusion: Consumption of rural plumbing water Since 26 June 2018 as well as the water stored in domestic tanks at certain water-shut-off times is associated with gastroenteritis outbreak. To prevent similar outbreaks, continuous chlorination of drinking water during distribution through rural pipelines should be done. To prevent secondary outbreaks after the epidemic phase, educating and informing people about personal hygiene is essential.

Background and Objectives: Investigation of child mortality is one of the most important strategies for improving children's health. The purpose of this study was to investigate the age distribution, trends, and projections of mortality in children under 5 years old in Khorasan Razavi province. Methods: The study population included under-5 mortality data from Khorasan Razavi Province during 2012-2017 extracted from the Causes and Mortality Classification System of Vice-Chancellery of Health, Mashhad University as well as five universities and faculties. Cause of mortality was classified according to the ICD10 codes. Data were controlled using the ANACod software. Descriptive statistics methods and autoregressive integrated moving average (ARIMA) modeling were applied to explore the mortality trend during the time of study using the Minitab. 15 and STATA16. Results: According to the results, the highest mortality rate for children under five was in 2014 and the lowest in 2017. Using the differencing method, the data were stabilized. Finally, the ARIMA model (1, 1, 2) was identified as a suitable model using the MINITAB software. Conclusion: The mortality rate of children under five has declined sharply in the last four years in Khorasan Razavi Province. It is predicted that this reduction will continue according to fitted model. However, we are still far from mortality rates in developed and some developing countries; therefore, efforts should be made to reduce the under-five mortality rate by increasing the level of health services, the awareness level of families, and improving maternal and childbirth care.

Background and Objectives: Diabetes is one of the most expensive chronic diseases and a global public health problem. One of the objectives of implementing the Health Reform Plan (HRP) was to reduce the out-of-pocket payments for hospitalized patients. The present study was carried out with the aim of determining the direct medical costs in hospitalized diabetic patients after implementation of the HRP. Methods: This cross-sectional descriptive-analytical study was conducted in 2019. The records of diabetic patients hospitalized in Imam-Ali Hospital of Zahedan from March 2017 to June 2018 was reviewed by the census method and the direct medical costs were recorded in a researcher-made checklist. Data were analyzed using the SPSS version 22 Results: In this study, the direct medical costs of 704 hospitalized diabetic patients were evaluated. The majority of the study population was female (517, 73/5%) and 237 had gestational diabetes. The mean direct medical cost per hospitalized diabetic patient was 29, 264, 465 Rials and the mean out-of-pocket payment was 11. 8%. Moreover, direct medical costs of diabetic patients increased with age (P<. 001). Conclusion: Diabetic hospital care imposes a high burden on basic health insurance. Despite the HRP, out-ofpocket payments for hospitalized diabetics are still significant. Government subsidies should focus on expanding access to care for diabetics, financial protection for disadvantaged residents and expanding public education on diabetes.

Background and Objectives: Understanding and analyzing the socio-economic factors affecting mental health is important for mental health policy-making in metropolitan areas. The aim of this study was to investigate the relationship between socio-economic factors and mental health of households living in Tehran. Methods: This cross-sectional descriptive-analytical study was conducted on 650 households from 22 districts of Tehran using mixed sampling method. Mental health measures were collected using the standard SF-36 questionnaire and socioeconomic measures of the household were collected using a researcher-made questionnaire. The face validity of the questionnaire was measured by qualitative method and its content validity was confirmed by quantitative method. The test-retest method was used to test the questionnaire reliability. Regression models were estimated using ordinary least squares (OLS) and weighted least squares (WLS) methods. The Stata software was used for data analysis. Results: Among the socioeconomic variables, four variables including years of education, health behaviors (regular physical activity, healthy eating habits), not-smoking, and social capital had a positive and significant relationship with all mental health measures (social role, emotional role, mental health and vitality ). The relationship between not-smoking and all mental health measures was more than other socioeconomic variables (P <0. 05). Conclusion: Mental health policymakers should place extra emphasis on the development of social capital in metropolitan cities, promotion of the citizens' health behaviors, and particularly on tobacco use and the related behavioral disorders.

Background and Objectives: Today, happiness and life satisfaction play a crucial role in women’ s health in every society. This study was conducted to compare the level of happiness and life satisfaction between employed women and housewives and to examine the factors affecting it. Methods: This cross-sectional study was conducted on 720 employed women and housewives in Kerman, Iran in 2017. The Oxford Happiness Inventory (OHI), Diener Life Satisfaction Questionnaire, and a demographic profile were used for data collection. Regression analysis was used to determine the correlation of different factors with happiness and life satisfaction. Results: The mean ± standard deviation of the total happiness and life satisfaction score was 42/6 ± 13/2 out of 87 (43/3 ± 13/6 in employees and 42/7 ± 12/7 in housewives, P =0/21) and 23/5 ± 6/1 out of 35 (23/8 ± 6/3 in employees and 23/2 ± 5/8, in housewives, P = 0/24), respectively. Additionally, most of the subjects (55%) reported a moderate level of happiness. Regression analysis indicated that married women who had a university education and those who spent their free time on leisure and traveling had higher scores of happiness and life satisfaction. As for the employed women, those with limited work records and those who were officially employed had significantly higher levels of happiness and life satisfaction. Conclusion: This study showed a moderate level of happiness and life satisfaction in women. Furthermore, there was no significant difference in the level of happiness and life satisfaction between employed women and housewives.