مجله اپیدمیولوژی ایران
سال چهاردهم شماره 4 (پیاپی 52، زمستان 1397)

Despite the implementation of the health reform plan and the increasing number of comprehensive centers of health services in 2014 in Iran, many people still do not attend these centers for various reasons. The aim of this study was to determine the reasons why urban households do not attend comprehensive centers of health services in Sanandaj.   This study was carried out using two quantitative and qualitative approaches. In the quantitative section, data were collected through a checklist and interviews with 200 household heads who did not attend. In the qualitative section, the views of physicians, other health providers, and household heads were obtained using semi-structured interviews.   A feeling of no need for health services, paying more attention to treatment, working on morning shifts, physical problems, inappropriate location of centers, inadequate informing services to community members, inconsistency between existing services and clients’ needs, and inappropriate treatment of some health providers were the most important barriers to non-attendance of clients. Despite four years of implementation of the health reform plan in Iran, 53.5% and 60% of participants had no awareness about the presence of mental health and nutrition experts and their free services in the centers, respectively.   Although there are many reasons for people not attending comprehensive centers of health services in cities, informing and introducing services to the community and considering the clients’ needs are essential.

Prioritizing the list of required research, taking into account the real needs and problems of the health sector, provides a ground for justice; strengthens the link between research, action, and policy; and addresses the needs of vulnerable groups. The present study was done to formulate research priorities of Hamadan University of Medical Sciences using the opinions of experts in the field of health as a positive step towards proper allocation of research resources of the University to solve the problem.   In this study, the research priorities of Hamadan University of Medical Sciences in 13 domains during 2017 were ranked using 10 standard criteria according to the Essential National Health Research (ENHR) approach.   Forty inter and intra beneficiaries were participated in this study. During the sessions, using group training techniques (brain storming), the topics were discussed, resulting in identifying 122 topics in 13 domains. In each of these domains, top 10 topics with the highest ranks were determined as the research priorities of Hamadan University of Medical Sciences.   Determination of research priorities at a provincial level based on the ENHR approach was conducted in Hamadan University of Medical Sciences with the cooperation of all health stakeholders for the first time. The result of this study will play an important role in optimum use of resources of the research and technology domain of Hamadan University of Medical Sciences by directing research projects according to the identified priorities.

Evidences show an increase in the occurrence of road crashes and causalities in early stages of economic growth. This study aimed to evaluate the correlation between the incidence of motorcyclists’ crashes and the level of development of the provinces of Iran in the year of 2015.   This was an ecological study of the motorcyclists’ crashes in all provinces of Iran. Motorcyclists’ injuries were obtained from the database of traffic police and the report of population census in 2011 was used. Given that more than 99% of motorcycle-related crashes occurred in male motorcyclists, the population of males was used to adjust the results. The Pearson correlation coefficient was also applied.   Totally, 90,724 crashes occurred among motorcyclists. The highest rate was in the age group of 18 to 30 years with 46,944 crashes (51.7%). As for sex, men had 90363 crashes (99.6%). Among different provinces, Tehran and Ardabil had the highest and lowest incidence with 1129.84 and 77.37 per 100 thousand male populations, respectively. Significant correlations were found between the incidence of motorcycle crashes and Gross Domestic Product (GDP) (P value: 0.601) and Human Development Index (HDI) (P value 0.497), respectively (P<0.05).   Increased the incidence of motorcycle crashes is associated with the level of provincial economic development. In order to prevent the injuries and reducing its incidence, attention should be paid to the safety of roads and vehicles.

Human Development Index (HDI) is an important indicator of a country’s development. On the other hand, mortality indicators are the most important indicators of the health of a society. This study aimed to examine the association between HDI and maternal, neonatal, infant, and under-five mortality rates in Iran between 2005 and 2016.   This longitudinal study was conducted using data collected from Iran Statistics Center, World Health Organization, and United Nations Development Program. SPSS software version 22 was used for data analysis. Pearson correlation test was applied to examine the correlation between HDI and mortality rates. Regression analysis was used to measure the effect of HDI on mortality rates.   HDI increased from 0.690 in 2005 to 0.774 in 2016 (12% rise). Maternal, neonatal, infant, and under-five mortality rates decreased by 26, 41, 52, and 42% in 2016 compared to 2005, respectively. HDI had a significant indirect association with maternal (-0.973), neonatal (-0.983), infant (-0.739), and under-five mortality (-0.987). An increase of 0.01 in HDI reduced 1 maternal death per 100,000 births. An increase of 0.014, 0.009, and 0.008 in HDI decreased one neonatal, infant, and under-five death per 1000 births.   The results showed that increased HDI correlated with decreased mortality rates. Therefore, policy-makers should pay more attention to socio

Randomization is one of the principles of correct clinical trial. The aim of this study was to determine the quality of randomization in the published articles of clinical trials in the Persian-language journals indexed in Scopus.   In this cross-sectional study, all clinical trials published in Persian journals indexed in Scopus during 2013-2017 were evaluated in terms of randomization using the Jadad scale. The score of the randomization item of this scale ranges from 0 to 2, with 0, 1, and 2 indicating poor, moderate, and good quality.   A total of 452 articles were evaluated. Random allocation was indicated in 423 articles (93.6%). Simple random assignment and blocked methods were used in 42.8% and 22% of randomizations, respectively. The randomization method was unknown in 34% and an incorrect method was used for randomization in 5.3% of the articles. According to the Jadad scale, 56.4% of the articles had good, 36.9% had moderate, and 6.6% had poor quality in terms of randomization. Methodologists were consulted in 40.7% of the articles, and their contributions led to increased transparency in the randomization report (P = 0.007).   The randomization method and its report are missing in many clinical trials. Therefore, considering the importance of randomization in validating the results of these studies, journals editors and researchers should pay attention to the quality of randomization and its report.

Satisfaction is a valuable measure of the quality of care and the patient-provider relationship. The Dental Satisfaction Questionnaire is a valid and international instrument for evaluating dental satisfaction. The aim of this study was to assess the validity and reliability of the Persian version of the Dental Satisfaction Questionnaire.   Upon assuring the precision of Persian translation, assessment of face and content validity was performed using the opinion of 10 patients and 10 experts. The validated questionnaire was then distributed among 300 patients attending the dental clinics using multistage cluster sampling. Factor analysis was used to assess the structure validity of the questionnaire and to elicit the factors predicting total satisfaction. Cronbach’s alpha was used for assessing the reliability of the questionnaire.    After some changes in some questions, the face and content validity of the questionnaire were confirmed. Factor analysis revealed 7 domains could determine 61.3% of total variance, including clinical quality, service quality, availability of care, pain management, cost, access, and empathy and responsiveness of dentists. Correlation of each domain with the total satisfaction was above 0.4. The mean satisfaction was 60.6 ±9.1. Cronbach’s alpha was 0.74.   The Persian version of the DSQ is a valid, reliable, and appropriate instrument for evaluation of dental satisfaction of Iranian population. The elicited domains could properly determine the total satisfaction.

Periodontal disease is one of the most common oral health problems. Clinical attachment loss occurs in sever periodontal cases (CAL>3). In this study, we applied a classic regression model and the models that consider the hierarchical structure of the data to estimate and compare the effect of different factors on CAL.   This cross-sectional study was performed in 375 pregnant women and 192 mothers of three-year-old children. The data were gathered from 16 health networks of Shahid Beheshti University of Medical Sciences, Tehran, Iran. CAL was determined for 6 teeth per person by a dentist according to WHO standard oral health examination form. Three-level and ordinary logistic regression analyses were applied for data analysis using the STATA software 14.   Of 3,402 examined teeth, 6.3% had CAL> 3mm. Based on the obtained results, the odds of CAL>3mm were 2.4 in the third semester compared to non-pregnant women. The odds of CAL>3mm were 2.86 in women without daily floss use compared to women with routine daily floss use. Posterior teeth were more likely to have CAL>3m than anterior teeth (OR = 1.65) (P-value < 0.05).   According to the AIC index, multi-level logistic regression model has a better fit than ordinary logistic regression model and can estimate the coefficients of factors related to CAL>3mm more precisely. The use of the ordinary logistic regression model in hierarchical data can result in underestimated standard errors of the estimated parameters.

One of the most common problems during pregnancy is sleep disorders, which is the result of physiological, hormonal and physical changes in pregnancy and can be the basis for many disorders before, during, and after delivery. The aim of this study was to determine the psychometric properties of the persion version of  Sleep Condition Indicator in a sample of Iranian pregnant women.   In present study, 300 pregnant women reffered to health center of Kowsar (affiliated to Qazvin University of Medical Sciences) that were gathered via accesible sampling method, completed the Sleep Condition Indicator in 2017. Face, content, and construct validity (convergent and divergent validity) and reliability of selected questionnaire were calculated.   The results of exploratory and confirmatory factor analysis showed two sustained and distinct factors, including quantity in sleep quality and the consequences of low sleep quality. The two-factor fit of Sleep Condition Indicator was approved based on standard indicators. Convergent and divergent validity were acceptable for all factors. Moreover, the internal consistency and reliability of the construct were also acceptable.   The results of this study showed that the Sleep Condition Indicator is valid and reliable among pregnant women, so it seems that this tool can be used to screen sleep disorders in women during pregnancy.

The purpose of this study was to predict the mortality rate of colorectal cancer in Iranian patients and determine the effective factors  on the mortality of patients with colorectal cancer using random forest and logistic regression methods.   Data from 304 patients with colorectal cancer registry from the Gastroenterology and Liver Research Center of Shahid Beheshti University of Medical Sciences during the years 2009 to 2014 were used as a retrospective study. Data analysis was performed using random forest and logistic regression methods. To analyze the data, R software version 3.4.3 was considered.   Ten important variables related to colorectal cancer deaths were selected by random forest method. Several criteria such as the area under the characteristic curve (AUC) were used to compare the random forest method with logistic regression. According to both criteria, five important variables ranked by random forest were Cancer stage, age of diagnosis, patient's age, HLA, and degree of differentiation (tumor differentiation). In terms of different criteria, the random forest method had better performance than logistic regression (Area under the ROC curve for random forest and logistic regression methods was: 98%; 80% respectively).   Variables such as Cancer stage, age of diagnosis, patient's age, HLA, and degree of differentiation are considered as the most important factors affecting mortality in colorectal cancer, that the patients' longevity can be increased with the early diagnosis of cancer and screening programs.

HPAI has economic and public health importance. Aquatic and shore migratory birds are the main reservoirs and the cause of the spread of viruses across countries. The aim of study was risk assessment of the spread of the avian influenza H5 viruses.   In this qualitative study, structured interviews and focus group discussions were used to assess the risk of the introduction and spread of highly pathogenic avian influenza viruses (H5-subtypes) into Iran.   Over 300 wetlands, natural and artificial lakes, ponds, and more than 517 bird species (swans, geese, ducks, and coots) are identified in Iran. Weakness in detecting virus entry windows, weakness in passive surveillance of migratory birds, inadequate supervision on hunting of migratory wild birds, movement of  hunted birds without any criteria without the control of the Veterinary Organization, inability to monitor the supply of migratory birds in the LBMs, law weaknesses in dealing with offenders, lack of training for people, presence of suitable conditions for close contacts between wild birds and backyard and industrial poultry, and weakness of research on AI in migratory birds were the most important factors influencing the spread of these viruses.   HPAI will be one of the most important challenges for the poultry industry and public health.  Solving this challenge requires national determination, overhead organizational views, collaborative and practical cooperation of related organizations, and short and long-term planning based on the realities of the country.

Analysis of ordinal data outcomes could lead to bias estimates and large variance in sparse one. The objective of this study is to compare parameter estimates of an ordinal regression model under maximum likelihood and Bayesian framework with generalized Gibbs sampling. The models were used to analyze ovarian hyperstimulation syndrome data.   This study used the data from 138 patients of a clinical trial phase III to compare the efficacy of intravenous Albumin and Cabergoline in prevention of ovarian hyperstimulation syndrome. The original study was done between 2010 to 2011 in Royan institute. We compared maximum likelihood and Bayesian estimation with generalized Gibbs sampling for an ordinal regression model based on confidence intervals and standard errors. The model were fit through R 3.3.2 software version.   Markov Chain Monte Carlo results reduced the standard errors for estimates and consequently, narrower confidence intervals. Autocorrelations for generalized Gibbs sampler reached to zero in compare to standard Gibbs sampler for shorter time.   It seems that confidence intervals of an ordinal regression model are shorter for generalized Gibbs sampler in compare to standard Gibbs and maximum likelihood. It suggests doing more studies to warrant the results.

Cholera is one of the communicable diseases that should be reported immediately as a public health threat. This study was conducted to study the probable risk factors of cholera outbreak in Qom, central Iran, during 2017.   In a case-control study, 37 cholera patients diagnosed based on para - clinical tests and 37 control samples were evaluated. Charts, frequency tables, regression logistic, Chi-square and t-test in SPSS software ver.25 were used for data analysis. The causative agent in the Qom cholera outbreak was Vibrio cholerae serotype Inaba. Most of the patients (54%) were in the age range 21-40 years. Most of the cholera cases were males (87%), Iranians (81%), and school or college students (30%). The peak of the epidemic occurred in the third week of November 2017, coinciding with a religious event. Nearly half of the patients were identified at the cross-border surveillance centers. The most important risk factors for the outbreak were a history of travel to Iraq in order to attend the Arbaeen religious event (95%), (OR=75, P-value<0.001), and a history of consuming unreliable foods and water (94% and 50%, (OR=66, CI=8-410, P-value=0.00 and OR=11, CI=2.7-46)), respectively.    Cross-border surveillance of cholera in common borders with Iraq, especially in the Arbaeen religious event, played a vital role in identifying patients suspected of cholera. The surveillance of communicable diseases should be strengthened when entering and leaving the Arbaeen event.