مجله اپیدمیولوژی ایران
سال چهاردهم شماره 1 (پیاپی 49، بهار 1397)

Cholera is one of the public health ththat has received attention due to climate change and weather variables. In the current study, the trend of cholera and its epidemics was assessed in the last 50 years in Iran based on climatic variables.
In a retrospective cohort study, all cholera cases and epidemics of the disease in the country (Iran) were assessed using the registry system of the Center for Communicable Disease Control in the Ministry of Health and Medical education (MOH&ME) from 1964 to 2014. Furthermore, the incidence of cholera was evaluated in 2005-2014 by province. The temperature and rainfall data were obtained from the provincial Meteorological Organization. The correlation coefficient test and mixed-effects binomial regression model were used for data analysis.
A significant positive correlation was found between cholera and rainfall (r = 0.168, P = 0.008). A one-millimeter increase in rainfall increased the incidence of cholera by 10.9% but temperature changes had no effect on cholera outbreaks. The incidence of cholera declined significantly by 14.7% each year from 2005 to 2014. The highest incidence of cholera was reported in Sistan-Baluchestan, Qom, Tehran, Kerman and Hormozgan provinces in a descending order.
In recent years, the the overall incidence of cholera has decreased. The occurrence of cholera is an outcome of rainfall in the previous year. Therefore, increased rainfall increases the number of cholera cases in the next year. However, temperature changes are not related to cholera outbreaks.

Drug abuse is one of the medical, social, economic and cultural problems in the present era that increases the morbidity, mortality, and disability among addicts. Iran, due to its adjacency to major centers of opiate drugs production, has a severe and critical condition. Therefore, epidemiological studies are essential for comprehensive management of drug abuse disorders.

In this descriptive cross-sectional study, demographic and epidemiological data of all people whose cause of death was drug abuse in 2013-14 (1392 Hijri) were extracted by two checklists. Data were then analyzed with SPSS software.
A total of 2957 deaths occurred during the study period. Most deaths occurred in unmarried young males with a low income and education level. The mean age of the subjects was 36.6 12.81 years. The mortality rate from opiate and psychoactive abuse in the whole country was 53.28 in 1000000 population. The most commonly used drugs in the study population were opium, crystal, and heroin in a descending order. Hamedan, Lorestan, and Zanjan provinces with a mortality rate of 150, 101, and 80.06 per 1,000,000 people had the highest mortality due to drug abuse.
Training programs and harm reduction approaches such as methadone treatment and naloxone distribution programs should be designed in high-risk groups to reduce mortality associated with drug abuse.

Colon cancer is the third most common cancer in the world and the fourth most common cancer in Iran. It is very important to predict the cancer outcome and its basic clinical data. Due to to the high rate of colon cancer and the benefits of data mining to predict survival, the aim of this study was to survey two widely used machine learning algorithms, Bagging and Support Vector Machines (SVM), to predict the outcome of colon cancer patients.
The population of this study was 567 patients with stage 1-4 of colon cancer in Namazi Radiotherapy Center, Shiraz in 2006-2011. Three hundred and thirty eight patients were alive and 229 patients were dead. We used the Support Vector Machines (SVM) and Bagging methods in order to predict the survival of patients with colon cancer. The Weka software ver 3.6.10 was used for data analysis.
The performance of two algorithms was determined using the confusion matrix. The accuracy, specificity, and sensitivity of the SVM was 84.48%, 81%, and 87%, and the accuracy, specificity, and sensitivity of Bagging was 83.95%, 78%, and 88%, respectively.
The results showed both algorithms have a high performance in survival prediction of patients with colon cancer but the Support Vector Machines has a higher accuracy.

Children’s well-being is a multidimensional construct that precedes various aspects of children's lives. This study sought to identify the main areas of children's wellbeing in Iran and their domains, components, and indicators that can be used to measure the well-being of children in Iran.
In this Delphi study, 30 experts that had educational, research, and executive experiences in various areas of children’s life were consulted. The dimensions, components, and indicators of children’s wellbeing were extracted through a review of the literature and views of the experts and children. The Delphi method was applied in three rounds. The dimensions and components with a higher-than-average score were selected and the percentage of Delphi members’ agreement with related indicators was measured.
Generally, 25 components and 110 indicators related to 7 domains (physical health, safety and risks, economical situation, family, personal and social well-being, education, housing and living conditions) were selected by Delphi members. Consensus on the relevancy of indicators, proportionality, and comprehensiveness was 100%, 95%, and 86%, respectively.
The components and indicators suggested in this study can help to create a composite index for monitoring and comparing the status of the children’s wellbeing between different provinces of Iran in different times. It can also show the strengths and weaknesses of the policies and programs related to children’s wellbeing and help the government to adopt appropriate policies for the whole country as well as each province.

People living with HIV (PLHIV) experience severe psychological pressure in most communities; however, this pressure is more prominent in women. Therefore, it is very important to monitor different aspect of psychological pressure and psychosocial supports in this group of patients. Based on this need, in this study, we assessed the status of mental health, hope, and social support in female PLHIVs visiting health centers of Kerman, Iran.
In a triangulation study comprising a combination of qualitative and quantitative components, PLHIV women were recruited and their information were collected using Goldberg’s General Health Questionnaire, Sarason’s Social Support Questionnaire, and the Miller’s Hope Scale.
Our findings showed that female patients’ status improved markedly after visiting the health centers (hope: 92%, general health: 80%, social support: 93%). In addition, the results showed a strong positive the correlation between general health and hope (r=0.61, P Our results showed that such multi-disciplinary service providing centers may substantially improve the quality of life and general health of these women who rigorously need social support.

This study assessed the validity and reliability of the Persian version of the standard "Problematic Internet Use" questionnaire to be used in epidemiological studies.
This cross-sectional study was performed in 2016. This questionnaire comprises five domains, including preference for online social interaction, mood regulation, cognitive preoccupation, compulsive Internet use, and negative outcomes. The questionnaire has 15 questions with a total score ranges from 15 to 105. A score of 15-45 indicates a normal state, a score of 46-65 shows a mild disorder, a score of 66-85 suggests a moderate disorder, and a score of 86-105 reveals a severe disorder.
Three hundred and seven students (31.1%) had a normal score, 445 (45.1%) had a mild disorder, 191 (19.4%) had a moderate disorder, and 43 (4.4%) had a severe disorder. Based on CVR, 10 questions had a validity of 100%, 3 questions had a validity of 80%, 1 question had a validity of 40%, and 1 question had a validity of zero. The overall validity of the questionnaire was 85.3%. Based on alpha coefficient, the reliability of the domain of preference for online social interaction, mood regulation, cognitive preoccupation, compulsive Internet use, and negative outcomes was 87.6%, 91.1%, 89.8%, 90.8%, and 86.2%, respectively. The overall reliability of the questionnaire was 92.5%.
The validity and reliability of the questionnaire were high; thus, it can be used as a standard tool in epidemiological studies to explore the pathology of injuries related to the Internet and social networks.

Among non-communicable diseases, endocrine, nutritional, and metabolic diseases have increased in recent decades, especially in developing countries. This study was conducted to evaluate and predict deaths from this group of diseases in Iran
In this analytical cross-sectional study, the study population comprised all deaths of endocrine, nutritional, and metabolic diseases recorded in the Ministry of Health and Medical Education during the years 2006 to 2016. In order to forecast the trend of cause of death, the Lee Carter model was employed in the demographic package 18/1 of the R software version 3/3/1.
The death rate from endocrine, nutritional, and metabolic diseases increased in all age and sex groups from 2006 to 2015. It was predicted that death rate of this group of diseases would reach 197/71 in 100,000 in the total population, 202/97 in 100,000 women, and 188/99 in 100,000 men in 2035.
Several factors play a role in endocrine and metabolic diseases, one of which is aging and aging population. Considering the change in the age structure of the population of Iran by 2035 and the increase in population’s age, an increasing trend is expected in the mortality rate due to these diseases. Because of this rapid increase, policymakers need to adopt intergovernmental population-based plans and policies in this regard.

Delivery is one of the most important services in the health systems, and increasing its effectiveness and efficiency are a health priorities. The aim of this study was to forecast the number of deliveries in order to design plans for using all facilities to provide patients with better services.
The data used in this study were the number of deliveries per month in Hakim Jorjani Hospital, Gorgan, Iran during the years 2010 to 2016. Due to the over-dispersion of the data and non-compliance with a Poisson distribution, the Poisson hidden Markov model was applied to predict the frequency of monthly deliveries. The model parameters were estimated using the maximum likelihood method and expectation maximization algorithm.
The use of the Akaike criteria revealed the frequency of delivery in different months in the hospital followed a Poisson hidden Markov models with three hidden states, and the mean Poisson distribution in each component was 193.74, 236.05, and 272.61 labors, respectively.
The results of this study showed that government’s encouraging policies have had short-term, limited effects on increasing fertility with minimal effects on the results of the two-year forecast.

The effect of heart diseases on the quality of life is the issue needs attention of health care providers. Improving quality of life is considered as the goals of rehabilitative therapies. This study conducted to evaluate the McGill Quality of Life Questionnaire in patients with heart diseases.
In this cross-sectional study, 500 patients with heart diseases were recruited from BooAli Sina Hospital and Velayat Hospital affiliated with Qazvin University of Medical Sciences from May to August 2016. The participants completed the McGill Quality of Life Questionnaire. The construct validity (including convergent and discriminant validity) and Reliability using the Cronbach’s alpha, theta, and McDonald's Omega of the McGill Quality of Life Questionnaire were evaluated. The structure of the Questionnaire was assessed using factor analysis.
Three factors, including overall view of the quality of life, physical aspect, and psychological dimension, were extracted. Model fit indexes confirmed a good fit of he McGill Quality of Life Questionnaire (Comparative of Fit Index: CFI=.918, incremental fit index: IFI=.919, Adjusted Goodness of Fit Index: AGFI=.844, RMSEA=.079, Minimum Discrepancy Function by Degrees of Freedom divided: CMIN/DF=2.97, Parsimonious Normed Fit Index: PNFI=.681, Parsimonious Comparative Fit Index: PCFI=.709). Convergent and divergent validity, internal consistency, and construct reliability of the questionnaire were confirmed.
The findings revealed that the three-factor model of the McGill Quality of Life Questionnaire has satisfactory validity and reliability. Thus, this questionnaire can be used in future studies to assess the quality of life of patients with heart diseases.

Muscle weakness and fatigue decrease the functional capacity and quality of life of multiple sclerosis patients. Although routine exercise is acceptable in these patients, its impact has not been proven. The aim of this study was to assess the effect of exercise on muscular performance and function, degree of disability, fatigue, and quality of life of patients with MS.
Twenty-four women aged 20-50 years old with multiple sclerosis and an expanded disability status scale (EDSS) of 2- 5 were randomly divided into two groups of control (12 patients) and case (12 patients). The training program included three sessions per week, lasting for 12 weeks (two sessions of aerobic training and one session of resistance training).
The results showed that 12 weeks of combined training caused a significant improvement in lower body strength (P=0.019), upper body strength (P=0.001), dynamic balance (P=0.025), gait speed (P=0.008), endurance (P=0.0001), quality of life (P=0.007) and a significant decrease in the degree of disability (P=0.007) and fatigue (P=0.001).
In general, a combined training program, including aerobic and resistance training, in three non-consecutive days per week is helpful for women with MS and improves their sensorimotor function. The relevant specialists can use these exercises along drug therapy to reduce the clinical complications of MS.