مجله اپیدمیولوژی ایران
سال سیزدهم شماره 3 (پیاپی 47، پاییز 1396)

The current research tries to investigate the position of Iran in regional and global research of epidemiology.
To conduct this applied research, scientometric indicators were utilized. The study population comprised 53300 papers published by different countries during 2011 to 2015 indexed in Scopus database.
The results of the study revealed that Iranian Epidemiology researchers published 1196 international articles, making Iran the 16th country in the world and the first country in the Middle East region. Investigating the publication output of institutions showed that seven out of top ten institutions in the Middle East were from Iran. Iranian publications received 3.9 citations on average, while the mean number of citations for regional and global publications was 5.3 and 7.4, respectively. Moreover, the scientific output of Iranian researchers in epidemiology had a lower quality compared to the region and the world, based on three indicators: citedness rate, percentage of highly cited papers, and field-weighted citation impact.
Despite the notable position of the Islamic Republic of Iran in the quantity of the research output in epidemiology, the quality of these publications is relatively low in comparison with regional and global average.

Data plays a major role in a health care system in development planning and health services support if they are correct, timely and accessible. The data of the Ministry of Health are not readily available and the limited access reduces their value. The aim of this study was to explore the challenges of access to the data of the Iranian Ministry of Health.
This qualitative study was conducted in 2015. Twenty-three academic and administrative experts were selected purposefully. Semi-structured interviews were conducted to collect the data. The transcripts of the interviews were analyzed using content analysis.
The results of this study provided 4 main themes (challenges of access to the data of the surveillance system, challenges of access to the data of national surveys and ordered projects, challenges of access to the data of electronic health records, and challenges of access to confidential data) and 15 sub-themes.
Given the multiple challenges of access to the data of the Iranian Ministry of Health, it is suggested to design access mechanisms in a systematic manner in the form of guidelines and organizational structures for data access management.

We may sometimes measure the joint effect of correlated independent variables on several dependent variablesThe present study aimed to evaluate the performance of multivariate analysis of variance (MANOVA) and structural equation modeling (SEM) on complex relationships between variables.
The present study evaluated the knowledge and attitude of 15-18 year-old individuals towards narcotics (glass, ecstasy). The effect of independent variables on two latent variables of knowledge and attitudes was studied using SEM and MANOVA modelingThe mean square error of methods were compared.
The direction of associations was similar in both methods but their coefficients and p-values were different. only the effect of gender (P-value= 0.007) on knowledge in both methods was significant. Nevertheless, gender (P-value In the current studythe performance of SEM was better than MANOVA. Therefore, it is suggested that SEM to be used to study the multifactorial relationship between variables. In addition, only gender was effective on knowledge in both methods, while gender and marital status were effective on attitude in both methods.

In order to determine the workload of health workers(Behvarz), this research was conducted for work measurement and time assessment in rural health centers(health house).
This cross sectional study was conducted in 30 health centers during a routine working day in Saghez in 2015 using the “stop watch method”. The time and frequency of the processes were recorded in a checklist. We estimated and compared spent, standard, expected and pessimistic time, and also the mean repetition for each process per day and month as the unit of time.
The mean real working time was about 157.5 minutes (33%) per day, which was mostly (35.5 minutes) spent on the affairs of health volunteers. Care for non-communicable diseases was the most frequent task with an average of 2.4 times per day. In a month, family planning was undertaken more than other processes. The time of most activities like mother care, elderly care, care for communicable and non-communicable disease was significantly lower than the expected and pessimistic times (P The time spent by health workers was low and unscheduled, particularly for important activities of primary health care. It seems that it is necessary to revise the models and methods of service provision in health centers. Efficient use of existing personnel, reducing unnecessary activities and adding more service packages according to the health system priority seem to be important requirements in the first level of health system.

Tuberculosis is the most common cause of death among single-factor infectious diseases and is the tenth cause of death among all diseases in the world. The disease is spread mainly from an infected person through close contact with other people living in one place. The aim of this study was to investigate the relationship between the spatial correlation structure and the recovery time of patients with pulmonary tuberculosis in Iran.
In this applied study, the data of 20554 patients with sputum smear-positive pulmonary tuberculosis in Iran from 1389 to 1393 were used. A parametric accelerated failure time model with spatial frailty and batesian approach was used to analyze the data. The OpenBUGS 1.4 was used for programming and the ArcGIS 9.2 was used for mapping the environmental impact on tuberculosis.
The mean age of the patients was 50.35 years with a standard deviation of 21.6 years. The results showed that the geographical environment, gender, prison condition, degree of smear positivity at diagnosis and location (urban-rural) had a significant impact on the recovery time of pulmonary tuberculosis patients. The recovery time of patients with smear grade 1-9 bacilli, 1 and 2 who were treated was significantly shorter than the others.
According to the study, geographical environment and the location have a significant impact on smear positive patients’ recovery time. This impact depends on the degree of smear positivity in some provinces and is independent of it in some other provinces.

The current study was conducted to assess factor structure, validity, and reliability of the Persian version of the Drug Use Disorders Identification Test (DUDIT) among drug abusers in many city of Iran. It also assessed the DUDIT scores of a number of demographic factors.
The LDQ underwent forward translation to to Persian abackward translation to English. Furthermore, it was compared with the original scale. We made essential changes after it was used by 20 participants. Two hundred and eighty one drug abusers from prisons, dormitories, and rehabilitation camps completed the questionnaire. A demographic questionnaire as well as the Drug Use Disorders Identification Test (DUDIT), Severity of Dependence Scale (SDS), and Leeds Dependence Questionnaire (LDQ) were used to collect data. Methods used for data analysis included Confirmatory factor analysis, Cronbach’s alpha coefficient, Guttman split-half coefficient and convergent reliability.
Findings supported the unidimensional structure of the DUDIT. The Cronbach’s alpha and Guttman scale score were 0.81 and 0.68, respectively. The convergent validity through calculation of the correlation coefficient of the DUDIT with LDQ and SDS was 0.61 and 0.46, respectively. History of drug abuse in the family, residence in rehabilitation camps, taking several substances simultaneously, and use several methods of drug abuse simultaneously obtained the highest score in the DUDIT.
The Persian version of the DUDIT has suitable psychometric properties in drug abusers. It is important to pay attention to the demographic factors affecting drug use disorders for prevention and treatment plans.

Today, justice is one of the main priorities of policy makers, and equitable distribution of health is one of their concerns. The concept of justice is a health policy objective. International human rights framework places particular emphasis on moving towards equity in health through attention to social determinants of health. In this study, for better recognition of available social determinants of health models, seven common determinants of health frameworks are presented.
This was a comparative study. The research environment included all social determinants of health models in the world, of which seven models were selected by targeted search. The criteria for selection were justice, evidence-based decision-making, strategic and comprehensive approach, and importance of family in health. The models were studied in detail.
In this study, seven models were identified and investigated in terms of level, type, basis and focus area.
There are many models around the world to demonstrate the determinants of health, and each of these models has its advantages and disadvantages. Wider Determinants of Health Model is the most frequently used model in Iran. This research can help policy makers and researchers in selecting models for analyzing social determinants of health according to the dominant discourse.

Menarche is an important issue for teenagers and dysmenorrhea is a common problem in adolescence. This study aimed to determine the menstruation pattern and prevalence of dysmenorrhea in second high school students in the city of Ardabil.
This research was a cross-sectional study. The study population included all second high school girls in districts one and two of Ardabil in 1394. A sample of 1,600 girls was selected by a two-stage cluster sampling method from 5 schools in district one and 7 schools in district two. A researcher- made questionnaire and a visual analogue scale were used for data collection.
According to the results, the mean age at the first menstruation was 12.88 years. The prevalence of dysmenorrhea was 91.9% (95% CI: %90 - %92). Dysmenorrhea was severe in 25% of the girls. The pattern of menstrual characteristics in students showed that 61.2%, 88%, and 93.2% had regular menstrual cycles, normal menstrual bleeding days, and normal duration of the menstrual cycle, respectively. In this research, 84.8% of the girls stated that their activities were affected by menstruation and 29.7% of the girls were absent due to menstrual pain.
The prevalence of dysmenorrhea is high. It is a common problem in adolescent girls which affects their activities and school attendance. Therefore, it is necessary to educate students regarding menstrual hygiene, and menarche pain control methods.

Colorectal cancer is the fourth most common cancer and the fifth cause of cancer-related mortality in Iran. This study aimed to determine the incidence of colorectal cancer in men and women and to investigate its relationship with the human development index (HDI) and its components in Iranian provinces.
This ecological study was conducted to assess the correlation between age-specific incidence of colorectal cancer in men and women and the Human Development Index. We used the data of the Iranian Cancer Registry and Statistical Centre of Iran. We used a bivariate correlation method to assess the correlation of ASR and HDI. P values less than 0.05 were considered significant. All reported P-values are two-sided. Statistical analyses were performed using the SPSS software version 23.
The highest incidence of colorectal cancer in men was seen in Tehran (78.16), Eastern Azerbaijan (41.14), and Semnan (62.13), and the highest incidence of colorectal cancer in women was seen in Tehran (47.18), Semnan (80.14), and Eastern Azerbaijan (82.12), respectively. The results showed that the incidence of colorectal cancer in men (r = 0.605) and women (r = 0.661) had a positive significant correlation with the Human Development Index (P The incidence of colorectal cancer was high in provinces with a higher human development index. Therefore, evaluation of the incidence of cancer by the Human Development Index and its components can be used to show a clearer picture of the distribution of cancer in each country and may be useful for cancer prevention plans.

In Iran, rainbow trout farms exist in almost all provinces. Viral hemorrhagic septicemia is one of the most important infectious diseases of the rainbow trout which is a serious threat to the farming industry. This study was conducted to investigate outbreaks in 2014 and identify important determinants of the agent entry and disease occurrence in the farms.
Data were collected using a structured questionnaire and the disease was detected based on clinical signs and laboratory investigations by PCR methods.
During 52 weeks of the study in 2014, 114 of 1140 (12.63%) farms were affected within 78 zones in 14 provinces. In multivariable analysis, illegal entrance of fries (odds ratio: 7.81, 95% CI: 3.63-16.8), illegal entrance of fish (odds ratio: 5.60, 95% CI: 3.03-10.35) and use of river as the water supply (odds ratio: 2.46, 95% CI: 1.51-4.02) were detected as risk factors associated with virus entry and disease outbreak in farms.
Observing biosecurity measures in the farm level, applying risk-based surveillance based on known risk factors, and assessing these factors on a regular basis are important in prevention and control of VHS.