مجله اپیدمیولوژی ایران
سال نهم شماره 2 (پیاپی 30، تابستان 1392)

Inequity in health is a universal term which used for showing current differences، variations and inequalities of people in access to health. But inequality in health refers to some inequities which seems are unfair or caused by some errors and biases. The current study aimed to describe some of the common health related inequity measures to be useful for the inequity researchers and other interested health coworkers. The calculation، advantage and disadvantage of most common health-inequity indexes including slope index of inequity، relative index of inequality، Theil’s Index، mean log deviation، index of disparity، Gini coefficient، weighted utilization social welfare function، absolute and relative concentration index were assessed. Inequity size of these measures was calculated by using the health care utilization survey data. Average of health care utilization in in-need subjects was 66. 4%. This indicator was in the first to fifth quintiles equal to 57. 6%، 63. 4%، 71. 6%، 69. 5% and 75. 3%، respectively. Relative concentration index and Gini coefficient was calculated as 0. 053 and 0. 0062، respectively. Inequity in health care utilization in Markazi province differs based on the types of inequity measures. Selection of the inequity indexes dependent to the objective and the scale of under study variable. Among discussed indexes، concentration index determine the more accurate and also show the gradient of inequity. Therefore it can be used as the best index.

Relationship between jobs and different aspects of health، including quality of life has been considered by researchers however the employment aim has risen in Iranian women in Iran but there is little known about the quality of life in this group، therefore the aim of this study was to investigate the relationship between employment and quality of life of women in the city of Zabol.

This cross-sectional study was carried out during 2009-2010 in Zabol، Iran. The sample consisted of 420 women selected randomly from health care centers. Health-related quality of life was assessed using the SF-36 and classified using k-means clustering method. The relationship between the independent variables with the quality of life was assessed by multinomial logistic regression.

The mean age of participants was 30. 46 ± 8. 75 years. Quality of life indicated as low (35. 4%)، medium (33. 7%) and high classes (30. 9%)، respectively. The results indicated that employed women were more likely than housewives to hadhigher quality of life. An increase age، significantly reduced respectively five and four percent of chance to had moderate and high level of quality of life.

More than half of women had medium and low quality of life. Increasing age was associated with decreased quality of life، but employment was an independent predictor for higher quality of life.

Malnutrition among children under five year is a significant public health index. The aim of study was to estimate the prevalence of malnutrition in under 5 years old children in Chadegan (area district city) parish of in Isfahan، Iran. This was a community-based cross-sectional study. It was carried out on all randomly selected households with children age under five years old in rural and urban area of Chadegan in 2010 year. Demographic information was collected via household and a standardized questionnaire was administered to mothers or guardians and trained personnel measured weight and height or length. The results revealed that prevalence of malnutrition’s based on wasting، underweighting and stunting and obesity were 17. 8%، 34. 5%، 37% and 2. 2% respectively. The main contributing factors for wasting were found to be child’s age، habitat، onset of complementary food، history of disease، hospitalization (P<0. 05). Gender، father''s job، mother’s education، ethnic، habitat، history of disease were found to be correlated with stunting as well. (P< 0. 05). Development programs should focus on the disadvantaged rural and urban arears of people to improve their nutritional status. Intervention strategies and programs should be developed to target the preventable risk factors.

Timely response to emerging diseases and outbreaks are a major public health and health systems priority. There are few published studies that evaluate the performance of cumulative sum (CUSUM) on identical data using semi- synthetic simulation approach. This study was undertaken to determine the performance of the CUSUM in timely detection of 831 days of simulated outbreaks. We evaluated the performances of the CUSUM as an outbreak detection method on simulated outbreaks injected to daily counts of suspected cases of measles as baseline data in Iran between 21 March 2008 till 20 March 2011. Data obtained from the Iranian national surveillance system. The performance of algorithms was evaluated using sensitivity، false alarm rate، likelihood ratios and Area under the Receiver Operating Characteristic (ROC) curve. Generally the sensitivity of the CUSUM algorithm in detecting simulated outbreaks was 50% (95% CI: 47- 54). The corresponding values are disaggregated according to outbreak size، shape and duration. The CUSUM algorithm detected the half of outbreaks after 13. 84 days on average. We concluded that CUSUM algorithm performed good in detection of large outbreaks with short periods and poorly in detecting long period outbreaks، particularly those simulated outbreaks that did not begin with a surge of cases.

Economic growth has been along with increasing energy demand in the world in addition environment pollutions which healthy life nowadays faces up with major challenges. Since there are several influential factors in this model، therefore this study designed to assess the effect of some independent socio-economic variables on the people health. An artificial neural network (ANN) was developed to review health risk factors during the years 1971-2009. Using neural network methods in the study or the MPL method is. multi-layer perception. In ANN selected for this study، one hidden layer with three nodes is selected. Being more important the urban variable in modeling shows that the positive effect of urbanization on the health is more powerful than negative effects of air pollution. Based on our model it is concluded that urbanization as a major risk factor to produce (accelerate) of air pollution، has the most negative effect on health and life expectancy.

Cox regression model is one of the statistical methods in survival analysis. The use of smoothing techniques in Cox model makes the more accurate estimates for the parameters. Fractional polynomial is one of these techniques in Cox model. The aim of this study was to assess the effects of prognostic factors on survival of patients with gastric cancer using the fractional polynomial in Cox model and Cox proportional hazards.

Information of total of 216 patients with gastric cancer who underwent surgery in the gastroenterology ward of Taleghani Hospital in Tehran between 2003 and 2008 were included in this retrospective study. In this research، fractional polynomial in Cox model and Cox proportional hazards model were utilized for determining the effects of prognostic factors on patients’ survival time with gastric cancer. The SPSS version 18. 0 and R version 2. 14. 1 were used for data analysis. These models were compared with Akaike information criterion.

The analysis of Cox proportional hazards and fractional polynomial models resulted in age at diagnosis and tumor size as prognostic factors on survival time of patients with gastric cancer independently (P<0. 05). Also، Akaike information criterion was equal in both models.

In the present study، the Cox proportional hazards and fractional polynomial models led to similar results with equal Akaike information criterions. Using of smoothing methods helped us eliminate non-linear effects but it seemed more appropriate to use Cox proportional hazards model in medical data because of its’ ease of interpretation and capability of modeling in both continuous and discrete covariates.

Sterpococcosis/lactococcosis is an economically important zoonotic disease in aquaculture industry particularly in farmed rainbow trout. The annual loss due to the disease is tens millions US dollars. This descriptive study was aimed to identify the regional distribution of these economically important bacterial diseases in 50 farmed trout in Charmahal-va-Bakhteyari (25 fish farms) and Kohgiloyeh-va-Boyerahmad (25 fish farms) provinces plus detection of the relative prevalence of the presence of 20 risk factors. Each trout farm was clinically inspected to identify the risk factors، followed by sampling of the clinically affected fish for bacteriological and molecular studies. The results showed that form 25 fish farms examined in Charmah-va-Bakhteyari، 56. % (13 fish farms) were affected with Lactococcus garvieae and 20% (5 fish farms) were affected with Streptococcus iniae، while these were 64% (16 fish farms) and 12% (3fish farms) in Kohgiloyeh-va-Boyerahmad، respectively. The relative prevalences of the presence of 10 and 16 risk factors were above 80% and 50% in the trout farms of both provinces. These results clearly demonstrated that occurrence of streptococcosis and lactococcosis in farmed trout has a wide regional distribution in trout farms of these provinces and the presence of risk factors are remarkable in the examined fish farms.