مجله اپیدمیولوژی ایران
سال یازدهم شماره 1 (پیاپی 37، بهار 1394)

Various studies have reported different survival rates of patients with gastric cancer in Iran, and there is no overall estimate of the survival rate. The aim of this study was to conduct a meta-analysis of one, three, and five-year survival rate of patients with gastric cancer in Iran. In this study, all of the national databases including Iran Medex, Magiran, SID, and Medlib and the English databases including Google Scholar and PubMed were searched by using the keywords “stomach cancer”, “survival rate” and other Persian and English synonymous keywords, in the period 1392-1339. Then, all articles with inclusion criteria and acceptable quality were investigated. Der Simonian and Laird random effects models were used to combine the results of all studies. Other analyses including subgroup analysis, sensitivity analysis, and assessment of publication bias were performed by using the funnel plot, and Beg’s and Egger’s tests. Finally, the data was analyzed using STATA software. Of the 235 articles found in the initial search, nine studies were eligible for this study. According to these studies, one, three and five-years survival rate of patients with gastric cancer was 0.57 (95% CI: 0.45-0.70), 0.29 (95% CI: 0.22-0.37), 0.17 (95% CI: 0.13-0.21), respectively. Researches conducted in different parts of Iran are limited and there are no exact statistics on the survival rate in other parts of Iran. Therefore, further studies in the whole country are required to obtain more precise estimates of the survival and factors affecting it.

In the analysis of mortality trend in the Iran that is basically a sequences of observations sorted by time, there is a point where the statistical properties of the mortality trend change so that the first k0 observations have a distribution of F0 and other n-k0 observations have a distribution of F1. The point k0 is unknown and called the change point. The aim of this paper was to detect the location of the change point and estimate it in the real mortality data of the country. In this study, Xt indicated the number of mortality in time t (year) and because of the numeric nature of the variable, we considered the Poisson model for the variable Xt. We assumed in early years (t0), Xt had a Poisson distribution with a mean of ʎ0 and for later years (t>k0), Xt had a Poisson distribution with a mean of ʎ1. In theory, we used the MIC method, a modification of the SIC method. For detecting more than one change point, we used the binary segmentation process in the mortality trend. The results showed that the change point occurred in 1993 and 1997. The finding of this study showed three periods with different rates in the mortality trend of Iran.

To adopt appropriate policies and strategies to maintain, preserve, and promote health, accurate information and indicators are required. In this study, the years of life lost due to premature death, which is considered one of the indicators of prioritization of health problems, was calculated and compared with other countries. This study was an applied cross-sectional investigation. We use death registry data of the Province of Qazvin and population estimation from the Statistical Center of Iran from 2004- 2008 and a standard life table. We calculated YLL and YLL rates by age, sex and cause of death. The leading cause of YLL (premature death) in different age groups in the years 2004-2008 (based on ICD10) showed that the most common causes of death in the neonatal period were perinatal disorders, congenital anomalies, and chromosomal disorders. The leading causes of death in the age group 5-14 years were unintentional injuries and in the age group 15-49 years were unintentional injuries and cardiovascular diseases. The main causes of death in the age group 50-64 years were cardiovascular diseases, cancer, and unintentional injuries. The leading causes of premature death in the Province of Ghazvin were unintentional injuries, cardiovascular diseases, perinatal disorders, and cancers. Several causes are preventable by lifestyle modifications such as reducing the tobacco use, increasing physical activity, and reducing stress.

Children who work or live on the street are one of key populations at risk for HIV and hard to reach for study or providing services. Here, as a methodological paper, we present the methods and steps of a rapid assessment and response (RARE) project conducted among street children in Tehran. We applied a mixture of qualitative (literature review, focus group discussion, in-depth interview) and quantitative (structure interview) methods to collect data from key informants in non-governmental and governmental agencies as well as street children. We applied targeted sampling to recruit key informants and time location sampling to recruit street children. The study was conducted in eight steps to recognize the involved stakeholders, define target population (street children) and to guide on how to approach them (steps 1 to 2: Initial Consultation, Study Area Profile), to map the venues and gathering spots and ethnographic findings crucial for further recruitment into surveys (steps 3 to 5: Contextual Assessment, Population and Setting Assessment, Health Issues Assessment), assess the risk behaviors (step 6: Assessment Behavior Risk and Health), evaluate the response (step 7: Intervention Assessment), and develop an operational plan for improving the services (step 8: Developing an Action Plan). RARE is a participatory mix research method with sufficient flexibility to study complex health problems such as stigmatized HIV risk behaviors among high risk and hard to reach populations and also to assess the health sector response.

Gastric cancer has a low survival and remains a serious threat to the health of human life, especially in developing countries such as Iran. The present study was performed to estimate the main effective factors in the survival rate of patients with gastric cancer in the Province of Kohgilouyeh & Boyerahmad. All cases of gastric cancer in Kohgiloyeh and Boyerahmad recorded in Provinces of Fars and Kohgiloyeh and Boyerahmad cancer registry were enrolled in this study. The impact of the independent variables on the survival was estimated by single and multivariate Cox regression controlled for the probable confounding variables. Survival analysis was performed using Kaplan Meier curves, the log-rank test, and Wilcoxon test to compare the results. Analysis of the data was performed by SPSS 19, and P-values less than 0.05 were considered significant. Among the 348 studied patients, 75.6% were male and the rest (24.4%) were female. In general, in this study, 1, 2, 3, 4, and 5-year survival rate of the patients was 37, 27, 20, 19, and 18%, respectively. By combining these end variables in regression models, three risk groups were identified. In the high risk group, the cumulative survival rate was 0% at the end of the fifth year. Execution of the down-staging program through public education, considering the low survival rate in this province seems essential especially for high-risk groups such as farmers, ranchers and regional nomadic populations.

This study examined the prevalence of behavioral disorders in middle and high school students in the Province of Qom. A cross-sectional descriptive design was employed to investigate 762 students (382 middle and 380 high school students) who were selected through a multi-stage cluster sampling method. Data collection was performed suing the Woodworth Personal Data Sheet (WPDS), and the data were analyzed using descriptive statistics and chi-square test. The finding showed that the prevalence of behavioral problems in the total sample, and middle and high school students was 19.82, 22.72, and 17.1%, respectively. The prevalence of behavioral problems was higher in boys versus girls, is the middle school versus the high school, and in urban areas versus rural areas. The aggressive disorder and obsessive-compulsive disorder – Psychasthenia had the highest and lowest prevalence in both the middle and high school students, respectively. The educational level of students, parental education, parental divorce, parental death, and family income had significant relationships with behavioral disorders. The prevalence of behavioral problems in the Province of Qom was found to be in the middle range in comparison with other studies conducted within and outside the country. However, attention should be paid to mental health policy-making in adolescents to decrease behavioral problems and prevent future issues.

Management of time-dependent variables is the advantages of survival analysis. This study compares time-dependent and -independent variables in survival analysis in culling of dairy cows. In this historical cohort, 7067 dairy cows in the Province of Tehran were recruited. Cows were followed to the next calving or culling. Data on the occurrence of health disorders, calving season, parity, and milk production was obtained. Model 1 treated diseases as time-independent covariates. In models 2, up to 5 diseases were considered time-dependent covariates. For each observation, we split follow-up time in intervals each corresponding to a different lactation month using Lexis expansion of the original dataset. Model 2 assumed that an animal experienced a certain disease from the beginning of the occurrence of that disease by the end of the period. Model 3 assumed that cows were at risk from the begging of the study until the disease occurred (inverse of model 2). In models 4 and 5, an animal was assumed to experience a certain disease for 1 month if the disease occurred during this period. In Model 4 assumed diseases occurred only one time, and in model 5, multiple disease occurrences at different months were considered as different episodes. AIC in model 1 and 5 was 10809 and 10366; moreover, BIC was 10926 and 10528. According to this numbers and the shape of the Cox-Snell Residuals, model 5 with Gompertz distribution was the best model. Models without time dependency tended to seriously underestimate the risk of a disease on culling.

Some studies on chronic diseases have indicated that obesity may result in a paradoxically longer survival. The present study was aimed to investigate the effect of Chronic Kidney Diseases (CKD) and Metabolic Syndrome (MetS) on the incidence of Coronary Heart Disease (CHD). In order to record time to CHD events, a sample of 6,507 individuals (mean age 47.4 years, 43.4% males) was followed for nearly 10 years. Participants were also categorized into four groups according to presence/absence of CKD and MetS. Then, using a Multivariate Cox Regression, the Hazard Ratio (HR) of each group was estimated relative to individuals free of both CKD and MetS separately for obese (BMI≥27.1 Kg/m2) and non-obese persons (BMI<27.1 Kg/m2). HR for non-obese patients with CKD but not MetS was obtained 2.06 (95%CI: 1.28-3.31) in men and 2.56 (1.04-6.31) in women. However, these associations were not significant for obese patients. Furthermore, among non-obese men and women with MetS alone, HR was estimated 2.52 (1.71-3.73) and 4.68 (2.20-9.95), respectively. For obese patients, these values were 1.70 (1.05-2.78) and 1.90 (1.16-3.13), respectively. The results reflect that among those who had MetS alone, the risk of CHD incidence was twice higher in non-obese individuals compared to obese patients.

financial protection against health expenditures is a major goal of health system policymaking. governments have focused on the risk that high health expenditures pose to the financial security of deprived and vulnerable populations. Health systems need to be sure that people receive health services and are protected from the financial burden of health costs. There is no accepted standard for measuring the degree of financial protection. In the literature, there are different approaches to measure the degree of financial protection. Measuring the extent of financial risk is complicated by the fact that the significance of a given risk depends on both the size of the risk and the economic status of the person incurring the risk. Another reason for this complication is that financial risk can also affect the health status. The seriously ill may not receive adequate care if the financial burden on them contributes to a decision not to seek care. Their injury from a lack of risk protection, therefore, may show up as diminished health status and not as a financial loss. The aim of this article is to provide the methodology of the assessment of financial protection against health costs with focus on catastrophic health expenditures. First, we describe and explaine the methodology of measuring the expenditures (based on the WHO approach). Then, we interpret variables used in estimating these costs. Finally, overall discussion and conclusions will be provided in relation to the subject.

The time series is a collection of observation data that are arranged according to time. The main purpose of setting up a time series is to predict future values. The first step in time series data is graphed. Using graphs can provide general information such as uptrend or downtrend, seasonal patterns, periodic presence, and outliers in time series graphs. After graphing the data, if a good forecast is required, stationary data can be used. Differencing or decomposition methods can be used to make the data stationary. Then, a correlogram can be used to identify the order moving average and autoregressive model. The parameters of the model are examined using T-test. If the parameters are significant and the residue is independence, the predicted values can be evaluated using the mean absolute percentage error.