مجله اپیدمیولوژی ایران
سال سیزدهم شماره 4 (پیاپی 48، زمستان 1396)

To acknowledge the scientific scholars who have contributed to the advancement of knowledge and service without sacrifice to the homeland, it is necessary to to document their biography in a way to highlight their prominent personal characteristics for next generations.
Prof. Abolhassan Nadim, the retired professor of epidemiology and the founder of modern epidemiology in Iran, holding PhD in Parasitology, Epidemiology and Laboratory Sciences, has carried out brilliant activities in the field of epidemiology and health at national, regional and international levels. His activities have been carried out in various areas of epidemiology and health, and his major activities are in various aspects of Leishmaniosis and phlebotomouses distibution. With more than 45 years of service, most of the graduates of epidemiology in the country, directly or indirectly, had been his students.
A glimpse over the great life of Prof. Abulhassan Nadim, shows that the abundant knowledge, the constant effort and the love and interest in the honest service in their lives are the enlightening of the people who are walking in this way.

Satisfaction of health care recipients is always considered by policy makers and implementers as an indicator of measuring the quality and determining the effectiveness of services. This study aimed to determine the satisfaction of mothers from first level of Iranian network system.
This cross-sectional study was conducted to assess the incidence of maternal mortality in six provinces of Iran in 2015. Twenty-four public health centers were randomly stratified and selected. In each center, 15 to 20 mothers who were covered by prenatal care were examined. The data were collected through a researcher-made questionnaire whose validity and reliability were confirmed, interviews with mothers, and their medical records. SPSS version 17 was used for analysis. P values less than 0.05 were considered significant.
Of 2722 mothers participating in the study, 2187 (80.3%) were satisfied with the condition and facilities of health units and service providers and 535 (19.7%) were dissatisfied. The highest level of satisfaction in mothers was observed in the areas of behavior, complete services, training of health professionals, and adequacy of pharmaceutical products while the lowest level of satisfaction was related to the adequacy of the medical education and the distance between the health unit and home. There was a significant relationship between 16 demographic variables and maternal satisfaction (P This study showed that about one fifth of pregnant mothers are still not satisfied with the first level of network systems in Iran and many factors have an impact on their satisfaction. It is recommended to design and implement interventional programs to increase their satisfaction.

Food-borne diseases are serious problems in public health. Since the outbreaks can be prevented, we need to take action in the prevention of such infection. On 28 June, 2014 cases of gastroenteritis occurred in students living in dormitories of a medical university; therefore, this study aimed to investigate the outbreak of gastroenteritis to determine its risk factors.
This case - control study was performed to evaluate students. A total of 70 patients with gastroenteritis in the outbreak of 16 June 2014 were selected. A total of 70 students without any gastrointestinal complaints in the weeks before the outbreak were also selected as the control group using convenient sampling.
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.
According to the results, having lunch prepared by the university on 16 June was the likely cause of the outbreak on 17 June in student living in dormitories. Hygiene in cooking and food storage, especially in public places such as schools and universities are important in the prevention of food-borne outbreaks.

Breast cancer is the leading cause of death from cancer among women. In developing countries, the patients’ survival is less than developed countries. Metastasis, as an intermediate event, affects the survival of breast cancer patients. This study aimed to evaluate the survival of patients after surgery considering metastasis, as the intermediate event, using the illness-death model.
In this study, 165 cases of Iranian breast cancer patients who underwent surgery during 2006-2014 were investigated. The patients’ characteristics and their intermediate and final status were collected from their medical records. The illness-death model was used to assess prognostic factors in all stages of disease.
The risk of metastasis in patients with tumor size between 2-5 cm was 3.8 times higher than patients whose tumors were below 2 cm (P=0.009). Patients who had 3 to 6 lymph nodes involved were 3.1 times more likely to have metastases that those with less than 2 lymph nodes (P=0.003). Also, the grade of tumor and HER-2 had a significant role in metastasis (P=0.04).
Using the illness-death model that is suitable for the analysis of such data, it was found that lymph node involved and tumor size had a significant role in metastasis. So, early detection of cancer is required to prevent metastasis and death.

Ischemic heart disases are the main cause of mortality and morbidity in Iran. Diabetes mellitus (DM) is one of the most prevalent diseases in Yazd. However, little is known about the share of CHD associated with DM in Yazd.This study aimed to determine the potential impact fraction of ischemic heart disease associated with diabetes mellitus in Yazd-Iran.
The potential impact fraction (PIF) equation was used to calculate the estimates of CHD associated with DM in Yazd. Prevalence diabetes in Yazd were calculated from Yazd Health Study (YAHS) data, conducted in 2013- 2014 in Yazd Greater Area. The relative risk eof IHD associated with DM was extracted from Tehran Lipid and Glucose study.
According to this study, by hypothetical reduction of DM prevalence in women from the 20.6 percent to null or optimistically to a minimum risk level of 20.3 percent, 23.6% and 0.3% of IHD will be reduced consequently. The corresponding value for men considering the DM prevalence of 15.9 percent at the theoretical zero level and feasible minimum prevalence of 17.7 percent, were 10.6% and -1.2%, respectively.
Given the high prevalence of DM and CHD in Yazd, more interventions to control DM is needed in Yazd by the health section.

The presence of biological aerosols in the air of medical centers is more than other enclosed spaces. Determining the role and importance of such factors has always attracted the attention of health and medical researchers. This study aimed to evaluate the bacterial density of surgical and infectious wards in two important hospitals of Kermanshah and environmental factors affecting them.
In this study, a total of 160 samples were selected. One hundred and twenty eight samples were related to the air of surgical and infectious wards in two stages before and after disinfection of wards and 32 samples were related to the hospital outdoor air as the control sample. MCS Flite (SKC) air sampling pump was equipped with a Biostage 225 (SKC) microbial sampling cassette made in the USA. Data were analyzed with SPSS 19.
The highest bacterial density in the air was measured in Imam Khomeini Hospital (402.7± 200.3 CFU/m3) and the lowest was in Imam Reza Hospital (258.6 ± 90.5 CFU/m3). There was a significant inverse relationship between air temperature and total bacterial density and a significant direct relationship between the whole population and bacterial density.
It seems that reduced bacterial density in wards’ air with increased temperature occurs due to increasing the air volume and replacing air in wards. The presence of people in the ward plays an important role in increased bacterial density.

Shift work as a pervasive phenomenon in various industrial sectors is one of the most stressful factors in the workplace. Considering the contradictory reports on the relationship of shift work and hypertension, the main objective of the present study was to investigate the relationship between these two variables among petrochemical industry staff of Mahshahr, Iran.
In this longitudinal study, 3254 petrochemical staff were investigated during 2008-2011. According to work schedule, shift workers were divided into two groups of shift work and day work (1872 day workers and 1382 shift workers). The aim of this research was to assess the effect of shift work on hypertension by adjusting confounding variables such as gender, age, body mass index, and smoking. The data were analyzed using a random-effects logistic regression model.
Of 3254 (3142 males and 112 females) subjects, 37.85% (860 subject) were hypertensive. The random effects model, with controlling covariates, showed no significant relationship between shift work and hypertension (OR=1.04, 95% CI= (0.98, 1.10). Moreover, the variance of the random effects was significant.
Generally, according to the results of this study, shift work is not a significant risk factor for hypertension.

Domestic violence is the most common type of violence against women which leaves negative effects on the mental health of the mother, children, family, community, and the next generation directly and indirectly. Therefore, this study was conducted to assess the arte of domestic violence and some related factors in married women.
This cross-sectional descriptive research was carried out with participation of 623 married women attending health care centers of Abadan, Iran who were selected through random cluster sampling from in 2015. The data were collected by a demographic questionnaire and a women abuse scale checklist. Moreover, descriptive and analytical statistics (including T-Student Test, Pearson Correlation Coefficient, One-Way Variance Analysis, Chi-Square Test, and Fisher) were used for data analysis.
The total prevalence of violence was 72.3%, and the porevalence of psychological, physical, life threatening, and sexual violence was 71.7%, 17.8%, 8.3%, and 7.1%, respectively. Moreover, a significant relationship was observed between violence and age, marital satisfaction, family behavior, financial situation, cigarette, alcohol, disease, domicile, occupation, place of birth, and criminal records.
Violence in the city of Abadan, eespecially psychological violence, is highly prevalent. Therefore, it is suggested that domestic violence against women be prevented using approaches such as life skills training starting before marriage such as anger management, proper communication, and problem solving.

Brucellosis is one of the most important zoonosis diseases. The aim was to estimate the seroprevalence of brucellosis in rural cattle, sheep, and goat of Bushehr Province.

This cross-sectional study was conducted in 2012-2014. For the cattle population, a total of 118 villages and 891 cattle and for sheep and goat population, a total of 202 villages, 526 flocks, 3064 sheep, and 7182 goats were included. Samples were examined with Rose Bengal, 2-mercaptoethanol and wright tests.

In the cattle population, 28 out of 118 villages (20.34%, CI 95%: 13.94%-28.73%) and 20 out of 891 cattle (3.36%, CI 95%:2.28-4.77%) were seropositive. Additionally, in the sheep and goat population, 89 out of 202 villages (44.06%, CI 95%: 37.10%-51.20%), 142 out of 526 flocks (27%, CI 95%: 23.25%-31%), and 335 out of 10246 sheep and goats (3.27%, CI 95%: 2.93%-3.63%) were seropositive.
The prevalence at the individual level of all animals was 3.53%in 2012 which was significantly higher than 2013 ( 2.59%) (P=0.02). Totally, in 3 years, the prevalence of brucellosis in sheep (3.88%) was significantly higher than goats (3%) (P = 0.02) and the prevalence in female animals (3.52%) was significantly higher than male animals (1.58%) (P

Due to the reduction of the prevalence, the test and slaughter policy together with the could further reduce and control the spread of the disease in the animal population.

Shift work could threaten health in the long term. The present research aimed to assess the association between shift work and body mass index (BMI) using the multilevel (hierarchical) model during a particular period of time.
The data of this longitudinal study were collected from a sample of Esfahan’s Mobarakeh steel and Polyacryl companies personnel during 2008 to 2011. Shift work schedule included day work and rotational shift work. The multilevel regression model was utilized for analysing the data and assessing the effect of shift work on BMI by controlling confounding variables including marital status, work expectation, age, company, and educational level.
In this study, of 1368 workers, 42.3% (n=578) and 57.7% (n=790) were day workers and rotating shift workers, respectively. The mean (±SD) age of the day workers and rotating shift workers was 33.07 (±8.66) years and 33.31 (±8.70) years, respectively. After adjusting for confounding variables in a two-level hierarchical model, the association between shift work and BMI was not statistically significant (P=0.837). About 90% of total variation was related to personnel.
According to the results of the present study, no statistically significant relationship was found between shift work schedule and BMI. Thus, other similar studies with a longer follow up period (more than four years) and controlling more confounder factors are necessary to evaluate the relationship between shift work and BMI more accurately.

One of the traditional methods used for the analysis of survival data is the Cox regression technique. This method calculates the conditional risk ratio. However, when the aim of the study is to estimate the effect of exposure in the total population level, using these conditional methods is not apposite. Furthermore, the hazard ratio has disadvantages of its own such as being non-collapsible, having the risk of structural selection bias and variability in time. Given the limitations, it is recommended to use the marginal hazard ratio, which estimates the average causal effect of exposure in the total population level.
This study introduces the inverse probability treatment weighting (IPTW) as a method of estimating the marginal causal effect. Finally, to illustrate IPTW method, we used Golestan Cohort Study and estimated the marginal causal effect of smoking on time to death due to the upper gastrointestinal cancer (esophageal-gastric).