Iranian Journal of Epidemiology

Validity & Reliability Assessment of Persian Version of Core Section of the Behavioral Risk Factor Surveillance System (BRFSS) Questionnaire

H Soori

Background and Objectives: The purpose of this study was to assess the reliability and validity of Persian version of survey instrument for Behavioral Risk Factor Surveillance System (BRFS).
Methods: Content and Face validity of Behavioral Risk Factor Surveillance System (BRFS) questionnaire were examined with Backward-Forward method. This method consisted of four steps: translation, back-translation, expert review and Pilot study. For evaluation of reliability of questionnaire, 194 adults of 18 years or older from Karaj province were interviewed. For the examination of reliability, Cronbach’s alpha was calculated to assess the internal consistency of the questionnaire. The reliability of quantitative variables evaluated with intra class correlation (ICC) ordinal variables with weighted Kappa and nominal variables with Kappa and weighted Kappa were calculated as well.
Results: Average age of participants were 38.8 15. Majority of participants (66.5%) were in 18-44 years group, 26.8% in 45-64 years and others 65 years and older. In validity procedure, 26 questions were deleted, 3 questions added and 6 questions were modified. Questions of ‘having situations of HIV morbidity’ and ‘Do you currently use drug abuse’ were least reliability and deleted from questionnaire. Others were reliable. (It might be better to say how many questions remained finally)
Conclusion: Our results indicate that BRFSS Persian version questionnaire has acceptable reliability and criterion validity for surveillance system in Iran.

Estimation of Survival Rate of Esophageal Cancer and Some of its Determinants in Golestan Province, North of Iran

P Yavari

Background & Objectives: Golestan province in Iran has been known as a high risk area for esophageal cancer (EC). This study was conducted to assess the population-based survival rate in EC patients in Golestan province of Iran.
Methods: In a longitudinal study, 223 EC patients registered in Golestan population-based cancer registry in 2007 and 2008 were recruited. Kaplan-Meier method was performed to calculate median survival and log rank test was also used to compare survival rates between subgroups of variables. Multivariate Cox regression model was employed to determine adjusted hazard ratios (AHR) for different variables.
Results: From 223 patient, 129 (57/8%) were male. The mean age of participants was 64/3 years. The median survival in our study was 11/08 months. Survival rates for 6, 12 and 36 months were 69%, 47% and 14%, respectively. The results of Cox regression analysis showed that the AHR for patients with metastasis stage (compared to those with localized stage) was 13.89 (95% CI: 7/93-24/32) and the AHR for workers (compared to clerks) was 2.4 (95% CI: 3/8-1/47).
Conclusion: Our results showed that survival rate of EC patients were higher than the rate reported in a previous study from this region. However the survival rate from this region seems still lower than those reported from developed countries. Implementation of appropriate screening programs in this region will result in early diagnosis of EC and consequently will increase survival rate in EC patients.

Epidemiology of Chronic Pain in Tehran Small Area Estimation of its Prevalence in Tehran Neighborhoods by Bayesian Approach (Urban HEART-2 study)

S Faghihzadeh

Background & Objectives: Chronic pain is one of main public and individual health problems and its epidemiological understanding needs reliable estimates of prevalence. The aim of this study was to investigate the epidemiology of chronic pain in all 368 neighborhoods of Tehran using small area estimation method.
Methods: The pain section from the second round of Urban HEART data from a selected individual of 23457 households in Tehran using a multistage randomized cluster sampling in 2011, were analyzed. In order to obtain reliable estimates for chronic pain prevalence at neighborhood level, a generalized linear mixed model and hierarchical Bayesian approach were used and the reliability of the estimates were evaluated.
Results: The average of estimated prevalence of chronic pain in neighborhoods of Tehran was 25.5% and a large heterogeneity was observed in its prevalence in neighborhoods of Tehran. Prevalence of chronic pain was significantly higher in married housewives, retirees and pensioners and was significantly associated with age, educational status, depression and anxiety (P<0.05). The reliability of Bayesian method was confirmed by evaluation methods in this analysis.
Conclusion: These results demonstrate prevailing amount of chronic pain at neighborhood-level in Tehran, which warrants careful attention to prevention, treatment, and rehabilitation by health care professionals.

Time to Sputum Conversion among Patients with Smear-Positive Pulmonary Tuberculosis and its Determinants: A Retrospective Cohort Study in Hamadan Province, Iran

M Karami

Background & Objectives: Tuberculosis (TB) is the largest single cause of death from infectious diseases and has a ten rating of global burden of disease. Despite the availability of effective treatment for pulmonary TB, sputum conversion of patients affected by various factors. This study aimed to determine the time course of sputum conversion in patients and possible affected factors in this process. Methods: In this Retrospective cohort study, 440 patients with smear-positive pulmonary TB in Hamadan province from 21 March 2006 to 20 March 2012 referred to health centers were included. Demographic, clinical data and treatment status of patients, including the time of sputum smear negative were extracted using TB Register software from patient registry. Time to sputum conversion was considered monthly during the patient’s treatmentand shown by Kaplan-Meier survival curve. The effects of some determinants including gender, location, age group and number of bacilli in the sputum of patients at the beginning of treatment were determined using Cox proportional hazard regression model.
Results: From 440 patients with smear-positive pulmonary TB, 51% (221 patients) were male and 49% (219 patients) were female. Fifty seven percent (57%) were living in urban and others in rural. The median of sputum conversion was 3 months. Totally, sputum conversion rate at the end of month 2 and 3 were 69% and 88%, respectively.
Conclusion: Our findings revealed that there has been a considerable difference between the expected sputum conversion rate and the observed rate in Hamadan province, Iran.

Study of Factors Affecting First Birth Interval Using Modified Gompertz Cure Model in West Azarbaijan Province, Iran

M Mahmoodi

Background & Objectives: Although several studies have been carried out for evaluation of the first birth interval, none of them has considered the presence of infertile women within the sample. Therefore, the aim of this study was to employ survival analysis to study the first birth interval and its determinant factors more accurately.
Methods: In Data from 1068 married women of reproductive age in west Azarbaijan province were considered in this investigation. Two-stage sampling design was used to collect data via a questionnaire, modified Gompertz model, a special kind of cure models, was employed in this study. For descriptive and analytical data analysis, SPSS 16 and R 2.12 were used respectively.
Results: In this study, the average interval between marriage and first birth was 3.9± 0.7 (± SD) years. Using modified Gompertz model, among all demographic factors only mother’s education had significant effect on the first birth interval so that with increasing mother’s educational level, the first birth interval had also increased. (P =0.007). In addition, the estimation of the proportion of women who did not have any children was 0.062 that showed a positive trend with increasing mother’s educational level.
Conclusion: This study revealed that due to the presence of infertility among married women the use of Modified Cured Gompertz model is an appropriate method for evaluation of the first birth intervals and it's determinant factors.

Prevalence of Anti-CMV Antibodies in Blood Donors in Mashhad, Iran

F Tehranian

Background & Objectives: Prevalence of cytomegalovirus (CMV) infection varies is highly prevalent in different societies. CMV infection in susceptible patients is associated with serious morbidity and a high mortality and is a matter of concern for blood bank professionals and blood transfusion recipients, especially in cases of transfusions to neonates and immunocompromised patients. Thus, the present study aimed to determine the prevalence rate of anti-CMV antibodies among the blood donors of Mashhad Blood Transfusion Center.
Methods: This seroepidemiology study carried out on 1008 samples from blood donors in Mashhad Blood Transfusion Center and the prevalence rate of anti-CMV antibodies (IgM, IgG) was estimated by ELISA method in the samples
Results: Out Of 1008 serum samples from donors, 1000 persons (99.2%) had anti-CMV IgG and 16 donors (1.6%) had anti-CMV IgM in their sera. Eight (8) persons had no anti-CMV IgG and IgM in their sera.
Conclusion: The high rate of prevalence of CMV in this study region indicating blood component screening strategies for blood transfusions require particular attention among healthcare professionals as part of the actions for prevention and reduction of primary infections caused by CMV.

The Epidemiology and Clinical Characteristics of Migraine and Tension Headaches among the Patients Referred to Farabi Hospital in Kermanshah City in Year 2011

B Behrouz

Background & Objectives: Peavalu on sage sümptom, mis võib olla tõsine problem iga inimese igas vanuserühmas. Several studies have shown that the prevalence of migraine and tension-type headache (TTH) varied between different geographical regions. Since there is little known about this in the country the current research has been conducted with the aim of estimating the prevalence of these types of migraines, reporting and comparing their clinical characteristics in this region of Iran.
Methods: This study conducted on 1150 admitted patients by first diagnosis of headache in Farabi hospital in Kermanshah during a period of one year from 2010 till 2011. Case definition was based on International Classification of Headache Disorders (ICHD) criteria. Among these, 350 patients were diagnosedd as headache patients and completed the International Headache Schedule form. Data were analyzed by the use of descriptive frequency and percentage SPSS 16 software.
Results: The results indicate that women were stricken more than men by headache (P<0.0001). Migraine was more prevalent in the age groups of 30-41 that included 54 individual (15.4%). the tension headache was more common among the age group of 42-53 that constitute 58 people (%23.3) of the participants. A significant correlation was also reported between the position and type of the headache (P<0.0001). Findings of this research showed that 20.4% of people with migraine and nearly 9 percent (9%) of persons with tension headaches have lost their job because of their headaches. There is meaningful relation between tension headaches and experience into their second job struggling (P<0.026).
Conclusion: It is concluded that migraine and tension headaches seem two separate diseases and none of them has any effect on the other. Headache requires more attention and it should be, diagnosed and managed appropriately.

Readiness to Adopting Correct Posture in Operating- room Nurses based on Transtheoretical Model (TTM) in Hamadan city in 2011

T Dehdari

Background & Objectives: Back pain represents one of the most common occupational problems in nursing. Since the correct posture has a key role in prevention of back pain, this study was performed to determine of operating- room nurses' readiness to adopt correct posture based on Transtheoretical Model (TTM) .
Methods: This descriptive-analytical study included a convenience sample of 110 operating- room nurses employed at four hospitals in city of Hamadan. Participations completed a designed questionnaire to assess the readiness of change based on TTM.
Results: The results of present study revealed that by increasing the stage of change (from precontemplation to maintenance), adopting correct posture in the nurses, increased as well (P=.01). Also, by increasing the stage of change, self-efficacy for adopting correct posture increased (P=.03) and perceived cons decreased (P=.02). Stage of change constructs could predict 68% variance of adopting correct posture in the nurses.
Conclusion: The results of present study indicated that the majority of operating-room nurses are in pre-operational levels (precontemplation, contemplation and preparation) for adopting correct posture. Considering stages of change as an intervening variable may contribute in any future intervention for this group.