Epidemiology and Health System Journal
Volume:7 Issue: 4, Autumn 2020

Dear Editor,   We have witnessed many advances in all fields of science over the years, especially in the field of health. However, various facts can be obtained in times of adversity. Although programs usually work well until a crisis occurs, they do not well continue during the crises. In addition, there are some experiences in every crisis although they are insufficiently used in future plans. Accordingly, we frequently experience various problems in face of similar crises. The outbreak of coronavirus is considered as one of these crises. The world has embraced a new unknown virus called the novel coronavirus disease 2019 (COVID-19) since late December 2019.The first outbreak of this virus was reported in Wuhan, China. Further, it has been reported in all countries worldwide as a pandemic. In the information era, conflicting news exists about the origin of the disease and there is still no general agreement in this respect although we do not intend to discuss it clinically in this article. Some helpful lessons on managing the condition are as follows. From this point of view, the virus revealed some interesting facts about governments and health systems around the world. First, this pandemic showed us that we cannot claim that health systems are capable of responding to emergencies. There are several reasons regarding the inability of a system to respond to a crisis. The weaknesses of governance in health systems worldwide are considered among the substantial reasons. Many health systems do not yet have a clear arrangement, and health decisions are outside the purview of health professionals. For example, when it comes to quarantine a city, many factors affect it and different institutions have to consider it no matter whether they have a health professional. Furthermore, the second point is about how we think about health. Various countries still do not view health as a universal phenomenon and have not realized that their decisions at the level of one country and one system can affect all systems worldwide. Whether or not, there is good thinking among health leaders although the absence of systemic thinking is undeniable. For example, some countries are still blaming each other for the statistics and how they manage the disease after several months of illness and are more looking for the culprit than the solution. Moreover, there are rumors that some countries do not publicly announce their achievements in disease management. The third point is the transparency of governments and health systems in presenting the realities of a disease or crisis. Many health systems in different countries of the world either do not have or publish accurate statistics, and this can be related to a variety of economic, private, political, and other reasons. Additionally, the next point is the lack of cross-sectoral cooperation that can be observed at all international, national, and regional levels. The lack of proper collaboration leads to scattered decisions confusing the general population in a society. The most important issue in times of crisis is to keep calm although this calmness must be accompanied by the expression of reality instead of concealment.   Crises have been permanently present and will continue to exist from epidemics to disasters, war, and the like. However, the question remains why responding to a crisis and being prepared for it are always considered as a challenge. Many crises occur unnoticeably and unexpectedly, which is true for China. Nonetheless, the question arises whether the rest of the world consider this crisis as an unexpected one. The other question is why countries are not taking advantage of Chinese experiences and delaying reality.   It is assumed that policymakers, especially those in the health area, need to address the behavioral causes of this issue and provide sound and rational decision-making models in times of crisis. The era of hopeful closure is over, and the international community requires a holistic approach for decision making. It should be noted that the implementation of any program necessitates a mutual commitment between the government and the community, and even the best advice will not work well without the commitment of people in the community. Accordingly, it is necessary to comprehensively study why the people of society do not pay enough attention to the recommendations of the government and health systems.

Parasitic infections, especially opportunistic parasites, can cause serious problems for immunocompromised patients. In this regard, this study aimed to evaluate parasitic infections in cancer patients undergoing chemotherapy after referring to Kashani hospital of Shahrekord from January to May 2018.   In this cross-sectional descriptive study, 750 stool samples were collected from 250 cancer patients undergoing chemotherapy (three fecal samples from each patient) and sent to the Parasitology Laboratory of Shahrekord University of Medical Sciences. All samples were examined macroscopically and microscopically through the direct method and a specific acid-fast staining method. To confirm the microscopic results, DNA was extracted from isolated parasites and amplification was performed by the polymerase chain reaction with the specific primers on positive samples.   In this study, 106 (42.4%) and 144 (57.6%) patients were males and females, respectively. In addition, 187 (74.8%) and 63 (25.2%) of them were living in urban and rural areas, respectively. In terms of the education level, most patients had a low level of literacy. Further, 12 (4.8%) patients were infected with intestinal parasites that including, 7 (2.8%), and 5 (2%) samples were infected with Blastocystis hominis and Giardia lamblia, respectively.   The results of this study showed that B. hominis and G. lamblia are the most prevalent parasites in cancer patients undergoing chemotherapy. Although the prevalence of intestinal parasites in cancer patients was low, these findings should not be contrary to the need for healthcare regarding the prevention of parasitic infections in cancer patients.

This study aimed at analyzing the epidemiological features and complications of different types of maxillofacial traumas in patients who referred to Alzahra hospital, Isfahan during 2005-2019.   This descriptive-analytical cross-sectional study included all patients with maxillofacial traumas who had been admitted to Alzahra hospital from March 1, 2005 to February 31, 2019. Several parameters were registered, consisting of patients’ demographic information, and time, location and the etiology of the accident, and clinical details related to injury and treatment procedures were recorded as well. Finally, the data were analyzed using chi-square and Fisher exact tests, and P < 0.05 was considered statistically significant.   A total of 1677 documents of traumatized patients were evaluated, including 79.66% men (n=1336) and 20.33% women (n=341). The statistical difference between the number of male and female patients was significant (P < 0.001) and maxillofacial traumas were more prevalent in the third decade of life (35.4%). Eventually, the highest number of referents was from Isfahan province (79.2%).   In general, traumatic accidents related to face and jaws are more prevalent in 21-30-year-old male patients mostly due to driving accidents, and driving accidents with vehicles was the most frequent cause of trauma.

 Suicide is one of the most important complications of the industrialized world. The purpose of this study was to investigate the status of suicide attempt and suicide deaths in the population covered by Dezful University of Medical Sciences (DUMS).    In this cross-sectional study, the registered data of 3958 suicide attempts and 205 suicide deaths in Dezful from 2012 to 2018 were used. Gender, suicide method, residence, marital status, age, and education were used as the explanatory variables. The chi-square test was used to determine the relationship between qualitative variables in SPSS 22.0. A simple time series chart for suicide cases was drawn using the simple time series plot.   A total of 3958 suicide attempts and 205 suicide deaths were recorded in the study population. The suicide trend during 2012-2018 years was declining. Most of the suicides cases were female (60.1%), used drugs (65.3%), lived in cities (51.8%), were in the age group of 15-24 years (49.6%), and were middle school educated (26.8%). Drug abuse was reported more frequently than other methods (p ≥0.001).    In this study, most of the suicide cases were females, married persons, adolescents, middle school educated persons, and drug users. It is suggested that the cultural, social, and economic problems of the families, especially women, be considered important and the families and the vulnerable groups receive the appropriate training.

Von Willebrand disease (VWD) is an inherited disorder of blood clotting in humans. The prevalence of VWD is different among various populations. The prevalence of this disorder in women with menorrhagia is less reported in Asia and Iran. The present study aimed to determine the prevalence of VWD in women of reproductive age with heavy menstrual bleeding (HMB).   A total of 160 women in the reproductive age group (15-45 years) with HMB who referred to the hematology clinic of Kashan Shahid Beheshti hospital during 2019 participated in this cross-sectional study. Demographic characteristics, clinical testing, and physician-reported problems of each participate including age, menstrual cycle length, uterine myoma, and polyp were collected using a questionnaire, sonography, and physical examination of women by a physician. The laboratory tests included hemoglobin (Hb), ferritin, iron, and total iron-binding capacity (TIBC).   Fifteen patients (9.3%) with severe menstrual bleeding had VWD with a mean age of 34.60±6.85 years. The frequency of the uterine fibroid (myoma) in women with VWD was significantly higher than that in patients without VWD (p =0.03). The mean ferritin level among 15 women with VWD and 145 women without VWD was 23±4.28 ug/dL and 30.68±4.46 ug/dL, respectively (p =0.001). The mean serum iron in total participants was 35.3±11.48 ug/dL and VWD patients had a lower iron level compared to those without VWD (p =0.001). There was not a significant difference in TIBC level between women with and without VWD (p =0.6).   Based on the results, 9.3% of women of reproductive age with HMB in Kashan, Iran, had VWD, which is lower compared to other regions of Asia.

Self-medication, as the most common method of self-care, is one of the major problems in treatment in many countries in the world. The present study was designed to determine the prevalence of self-medication and identify the factors associated with casual medication use among students of Larestan University of Medical Sciences in Iran in 2020.

This is a cross-sectional descriptive-analytical study conducted in 2020. The study was conducted at Larestan University of Medical Sciences and 147 students entered the study through convenience sampling. The data collection tool was a researcher-made self-treatment questionnaire. After collecting the data, the SPSS software version 25.0 was used to analyze the data. Fisher’s exact test, independent t test, and chi-square test were used to investigate the relationship between the variables. A P value of less than 0.05 was considered statistically significant.

The prevalence of self-medication was 62.5%. The most common sources of self-medication were pharmacies and previous prescriptions. The most common illnesses treated with over-thecounter medications include colds, headaches, and digestive problems. The most important over-thecounter medications include painkillers, anti-colds, antibiotics, iron pills, calcium supplements, and antihistamines. A comparison of students’ attitudes towards medication showed that attitudes “I feel my problem has been treated with over-the-counter medications” and “I feel I have enough information about diseases and how to treat them” (the group who did have self-medication and the group who did not have self-medication) had a significant difference between the two groups (P<0.05).

The results of the present study showed a high prevalence of self-medication among students. We recommend holding special training classes for the communities in order to provide information about the irreparable effects of self-medication and create new policies for prescribing and delivering medicine

Dysmenorrhea is one of the most common problems that women experience. Dysmenorrhea brings about psychological problems for women and adversely affects their performance. Therefore, providing, maintaining, and promoting the health of women is an important goal. The present study was conducted to determine the relationship between general health and Dysmenorrhea in students of Shahrekord University in 2018.

In the present cross-sectional study, 245 female students were selected by random cluster sampling method from Shahrekord University in 2018. Data were collected using the GHQ28, visual analogue scale (VAS), and a reliable and valid questionnaire designed by the researchers to determine menstrual pattern. Data were analyzed using descriptive statistics, chi-square test, and independent samples t test.

The mean age at menarche was 13.5 years. Dysmenorrhea was observed in 82.8% of students. The severity of pain was measured by the VAS scale, indicating that 22.3% of the participants had severe menstrual pain. The prevalence of dysmenorrhea in participants with a family history of Dysmenorrhea was greater and statistically significant. The result of the t-test showed that there is a relationship between dysmenorrhea and the general health of the participants (P=0.036). There was also a significant relationship between menstrual cycle regularity and physical characteristics of the participants (P=0.019). Significant relationships were also found regarding the interval between menstrual cycles and physical symptoms (P=0.026), and depression and general health (P=0.0001).

Due to the importance of dysmenorrhea and its high prevalence among female students, it is important to provide education and control on this disorder to improve the quality of life of women. It is also beneficial to create counseling centers to raise awareness of the psychological health of female students suffering from dysmenorrhea

Patient information leaflets (PILs) are the best form of written information transfer. The aim of this study was to investigate the sources of drug information and the reading rate of PILs among medical sciences students.  

Three hundred students were entered in this cross-sectional study via simple random sampling at the Faculty of Paramedical, Nursing and Midwifery of Guilan University of Medical Sciences in 2018.  

The participants considered the physician as the most reliable source for receiving drug information. Pharmacists, PILs, and the Internet were mentioned as the next sources, respectively. About 15.3% of people always read PILs. Students used PILs along with other sources of drug information.  

The type of medication and the individuals’ need for the type of information, along with the structure and presentation of the materials in the PILs, are all contributing factors.