مجله اپیدمیولوژی ایران
سال یازدهم شماره 4 (پیاپی 40، زمستان 1394)

Responsiveness is a response to the reasonable expectations of people about non-clinical aspects of the health system. The purpose of this paper was to assess the responsiveness of the health system after the first year of the health system reform in Sanandaj in 2015.
This descriptive-analytic and cross-sectional study was conducted on 646 households in Sanandaj. The World Health Survey (WHS) questionnaire was used to collect the data. The data was analyzed with SPSS 16 as well as descriptive statistics and ANOVA.
All dimensions of responsiveness, except for choice, were 100% important according to the respondents. In inpatient services, social support (100%) and confidentiality (96%) had the best performance while communication had the worst performance (49%). In outpatient services, confidentiality (100%) and autonomy (42%) had the best and worst performance, respectively. In inpatient wards, a significant difference only in “quick attention” dimension was observed among responsiveness dimensions with regards to proprietorship of the health care center (P-value=0.03). On the contrary, this difference was not significant in outpatient wards.
In this study, communication (time to ask questions about health problem/treatment, clarity of providers explanations), autonomy (participation in treatment decision-making, possibility of obtaining information on other types of treatment) and quality of basic amenities (cleanliness inside the health facility, available space in waiting and examination rooms) were identified as priority areas for actions to improve the responsiveness of the health care services.

Children immunization program is one of the most successful and most cost-effective public health interventions and medical programs. The study was designed and conducted in order to assess the vaccination coverage in areas covered by Tehran University of Medical Sciences (TUMS).
This study was a cross-sectional study of children aged 24 months to 6 years living in urban areas and high-risk and marginal areas covered by TUMS. Six hundred and thirty children were sampled in 90 clusters in urban areas and cluster sampling as probability proportional to size sampling was performed in high risk areas and a sample size of 768 children was determined. The questionnaires were completed by interview.
In high risk 750 children (97.7%, 95% CI: 96.32-98.60%) and 616 children (97.8%, 95% CI: 96.3-98.78%) in urban areas had complete immunization histories. Furthermore, 98.4% of the Iranian children and 95.0% of foreign children (P=0.019) in marginal areas and 98.1% of the Iranian children and 92.1% of the foreign children (P=0.046) in urban areas had complete immunization histories.Ignorance of immunization program (%50) was addressed as the main reason for incomplete immunization.
Universal mass vaccination coverage of the children and equal coverage in marginal and urban areas indicated the success of the authorities in the implementation of this program. Organizing training courses for mothers on the immunization program, providing the required facilities and services, monitoring and supervision of vaccination and also considering the immunization status of foreign children seem to be essential in maintaining and improving the existing status.

Colorectal cancer is the fourth leading cause of cancer death worldwide. Annually 1430000 cases would be diagnosed and half of these people would die of the disease. In Iran, colorectal cancer is the fifth common cancer among men and is the thirdamong women. This study was designed to estimate survival rates for patients with colorectal cancer and related factors.
During the 1384 to 1388 years 24,807 patients diagnosed with colorectal cancer were recorded in the Cancer Registry of the Ministry of Health and Medical Education. Age, gender, marital status, education, occupation, place of residence, tumor diagnosis, the clinical and demographic factors in colorectal cancer as effective on survival entered in Aalen’s additive hazard model and diagram Aalen's was used to study the effects of these factors over time. R 3.2.0 software was used for data analysis.
Stage of tumor had a significant association with survival rates. In this study 1 to 5 year survival rate for patients with stage II tumors, was 100%, 98%, 96%, 93% and 93% respectively and for patients with stage III tumors 99%, 97%, 94%, 90% and 84%, respectively.
In spite of using Cox model in survival analysis by many researchers, Aalen’s model may yield new insights in prognostic studies of survival time of patients with colorectal cancer over time. Our results suggest that early detection of patients in primary stage is important to increase survival.

Acute gastroenteritis is mainly caused by some viruses and often NoVs. In January 2014, an outbreak of gastroenteritis occurred in Pardis City, in Tehran and that made 5064 patients visit health centers. The purpose of this study was to investigate the epidemiology of the disease in this region.
This cross sectional study was done to evaluate the outbreak of gastroenteritis in Pardis City in January 2014. In this outbreak, the data of 1150 out of 5064 patient was collected by health centers. The inclusion criterion was residing in the location for at least ten days before its occurrence. The exclusion criterion was incomplete recorded data. A number of 126 human samples underwent laboratory investigation. The data collection tool was was line listings and data analysis was done with Excel 2010 and SPSS21 software.
female and male patients comprised 57.8 and 42.2% of the study population and 59.7% of the subjects were under 27 years of age. The most prominent symptoms were vomiting (94.9%), diarrhea (37.7%), abdominal pain (18.8%), and fever (0.6%). The results showed that bacterial contamination, parasites, serologic tests for hepatitis E (IgM-HEV) and hepatitis A (IgM-HAV) and RT-PCR for hepatitis E and A were negative but 6 out of 9 fecal samples were positive for NoVs using molecular RT-PCR.
The results revealed the role of NoVs in Pardis City in 2014. Moreover, clinical and epidemiological characteristics of the population, season, and the environment of this diagnosis were confirmed.

Q fever is a zoonosis with a worldwide distribution; this disease is a public health concern in many countries. The aim of this study was to determine the association between risk factors with Q fever seropositivity among veterinarians and vet staff in Southern Khorasan.
Questionnaires were prepared and 92 blood samples were obtained from all veterinary staff in the South Khorasan (East of Iran). The serum samples were tested with an indirect ELISA kit (anti body phase II); then, SPSS version 19.0 was employed to analyze the data using descriptive statistics and a confidence interval of 95%, chi-square test, and logistic regression.
The results showed that 50 serum samples (54.35%) were positive and the results of data analysis with logistic regression indicated an association between seropositivity and contact with animal secretions and abortive materials. There was no correlation between seroprevalence and age, gender, work experience, education, use of unpasteurized dairy products, knowledge of disease, and clinical findings.
In conclusion, the present study showed a high seropositivity rate among vet staff which indicates that further attention should be paid to this disease in these groups.

Diabetic patients are always at risk of hypertension. In this paper, the main goal was to design a native cost sensitive model for the diagnosis of hypertension among diabetics considering the prior probabilities.
In this paper, we tried to design a cost sensitive model for the diagnosis of hypertension in diabetic patients, considering the distribution of the disease in the general population. Among the data mining algorithms, Decision Tree, Artificial Neural Network, K-Nearest Neighbors, Support Vector Machine, and Logistic Regression were used. The data set belonged to Azarbayjan-e-Sharqi, Iran.
For people with diabetes, a systolic blood pressure more than 130 mm Hg increased the risk of hypertension. In the non-cost-sensitive scenario, Youden's index was around 68%. On the other hand, in the cost-sensitive scenario, the highest Youden's index (47.11%) was for Neural Network. However, in the cost-sensitive scenario, the value of the imposed cost was important, and Decision Tree and Logistic Regression show better performances.
When diagnosing a disease, the cost of miss-classifications and also prior probabilities are the most important factors rather than only minimizing the error of classification on the data set.

The aim of this study was to analyze the risks of local recurrence, second primary tumor, and metastasis in oral squamous cell carcinoma (OSCC) patients and to present their prognosis after treatment.
In this retrospective cohort study, 147 patients with oral squamous cell carcinoma (OSCC) who were older than 40 years were included using the data of 1973–2010 Surveillance, Epidemiology, and End Results (SEER) Program in the United States. The variables included gender, race, stage, histologic grade, tumor site, treatment modalities, and dates of diagnosis and death. Markov Multistate model was used for analysis.
At a median follow-up of 33 months, local recurrence, second primary tumor, and distant metastasis rates were 34.01%, 85.03%, and 17.01% respectively and 40.13% of the patients died. Patients with cervical lymph nodes were at risk of second primary tumor 1.37 (1.05-2.05) times higher than early stage patients and were 2.33 (1.29-4.18) times more likely to die. After one year, the risk of death for patients with local recurrence or second primary tumor was almost similar but after 5 years, the risk of death was higher for local recurrence than second primary tumor.
Awareness of the next state and its time with respect to the patient’s clinical status can be one of the appropriate methods for timely diagnosis and treatment to reduce the mortality rate of OSCC patients.

In epidemiologic studies, the measurement of characteristics of interest is almost always subject to random measurement error. This error and its effects are usually overlooked by researchers. One of its effects is a widespread statistical phenomenon that is well known as regression to the mean. This phenomenon occurs whenever an extreme group of people is selected from a population based on their measurements of a variable. If a second measurement is taken in this group, the mean of the second measurement will be closer to the mean of the population. In interventional studies, this increase (decrease) might be regarded as the effect of intervention, when in fact it has had no effect. Ignoring regression to the mean will lead to the erroneous conclusions and interpretation of the results of epidemiologic studies and affects the decisions in evidence-based medicine and planning for preventive and public health measures. This paper highlights the importance of this problem and its effects in epidemiologic studies and the ways to avoid it.