Iranian Journal of Epidemiology

Quantitative Evaluation of Public-Private Mix (PPM) Plan for Tuberculosis Combat Program in Iran

J Hassanzadeh

Background and Objectives: A great number of tuberculosis (TB) patients present to the private sector to receive care; therefore, integrating TB control programs into private sector activities can enhance the control of TB. The Public-Private Mix (PPM) program is suggested by the World Health Organization to engage the private sector in TB control programs. In this study, a plan designed for PPM was piloted Karaj, Alborz Province, Iran.

Methods: In this community trial, pre-intervention assessment covered 18 months prior to the study. The intervention was a PPM package that was integrated into the health system by Karaj County Health Center. Then, three-month post-intervention data were collected. Analysis was performed with the SPSS 16 software using chi-square test.

Results: After the intervention, there was an increase of 40.7% in suspected cases of TB per month and an increase of 101.7% in smear positive TB cases diagnosed by Karaj laboratories. The ratio of smear positive cases to all suspected TB patients was 4.57% before and 6.56% after the intervention. The percentage of three sputum sample positive patients was 75.5% and 89.9% before and after the intervention, respectively.

Conclusion: The developed PPM program markedly improved the case detection; therefore, it is suggested to fix the potential defects of the program and implement it in all parts of the country.

Comparison and Analysis of Road Traffic Injuries in Iran and the Eastern Mediterranean Region: Findings from the Global Status Report on Road Safety–2018

H Soori

Background and Objectives: The Eastern Mediterranean Region (EMR) has the third highest road traffic fatality rate in the world. This article evaluates the epidemiology of road injuries and some of its main control factors in Iran and compares them with other countries of the EMR.

Methods: This study was conducted to analyze and compare traffic injuries resulting in mortality using secondary data. Data from 175 countries and 19 members of the EMR were analyzed in this study. A review study was designed to provide policy options to improve the status of the measures.

Results: Mortality from traffic injuries in the region according to road users was 39% for four-wheelers, 34% for pedestrians, 15% for two-wheelers, 2% for cyclists and 10% for other users. The traffic-related mortality rate was higher for users of four-wheel motorcycles and pedestrians in the EMR compared to the global average. Moreover, deaths from traffic injuries in users of four-wheel vehicles and two-wheelers in Iran were higher than the regional average.

Conclusion: Although Iran and EMR member states have implemented some important preventive measures recommended by the World Health Organization, significant efforts are still needed to optimize the enforcement of existing road safety laws. Sufficient attention should be paid to the needs of pedestrians, cyclists, and motorcyclists that comprise about 50% of all road traffic fatality.

Explaining the Challenges, and Needs of Earthquake Victims in Kermanshah Province in 2017: A Qualitative Study

M Mohamadi Bolbanabad

Background and Objectives: On 12 November 2017, an earthquake with a magnitude of 7.3 on the Richter scale occurred in Kermanshah Province. Explaining the challenges and needs of the victims in such circumstances can be an important source of information for future planning and better management of such conditions. Thus, the purpose of this study was to explain the challenges and needs of the earthquake victims.

Methods: This study was a qualitative study. Twenty-nine semi-structured interviews were conducted with managers, policymakers, and health and emergency relief providers in earthquake areas, and 10 focused group discussions were held with earthquake victims from December to February 2016. The data were analyzed using conventional content analysis.

Results: The needs and challenges in Kermanshah earthquake were classified into three periods after the earthquake: 1. Challenges and needs in the first few days with three sub-categories including management, rescue services, and urgent care, 2- Challenges and needs in the first few weeks after the earthquake with three sub-categories including housing and emergency assistance, public health services, and access to health care; and 3. Needs and challenges in several months after the earthquake with four sub-categories including economic, social, infrastructural and health service needs.

Conclusion: Lack of unity of command was the main challenge in this earthquake. Another point was the health needs of victim earthquakes over time. Therefore, dispatching of aid forces to the affected areas during natural disasters should be based on planning and needs.

A Study of Gastroenteritis Outbreak in Hamadan District, Iran: A Case-Control Study

A Doosty Irani

Background and Objectives: Water and foodborne diseases are major causes of mortality worldwide. The aim of this study was to investigate the factors affecting an gastroenteritis outbreak in Hamadan county in summer of 2019.

Methods: This study was performed based on the outbreak investigation process. After producing hypotheses based on preliminary field studies, a case-control study was conducted on 45 cases and 45 controls to investigate the factors associated with the outbreak. New cases of the disease were included according to the case definition. A logistic regression model was used to investigate potential risk factors.

Results: A total of 171 people were affected in this outbreak from 25 June 2019 to 01 July 2019. The at-risk population in this outbreak was 3410 individuals. The attack rate was 5.1%. Abdominal pain, vomiting, and nausea were the most common symptoms with a prevalence of 77.8%, 73.3% and 68.9%, respectively. The results of the case-control study showed that the consumption of tap and spring/well water increased the odds of disease by 4.63 and 4.13 times compared to boiled water, although these relationships were not statistically significant. The odds of diseases were significantly lower in people aged 30-45 years and 46-85 years compared people aged 15 years old and younger.

Conclusion: Based on the results of this study, the outbreak was related to contaminated water consumption. Therefore, regular monitoring of drinking water status is very important for the local health system.

Determinants of Diabetic Complications: A Population-Based Case-Control Study

B Beygi

Background and Objectives: Diabetes is considered as one of the most common endocrine disorders worldwide. The aim of this study was to investigate the factors associated with diabetic complications.

Methods: A case-control study was performed on the data of 70089 diabetic patients (4622 cases and 53613 controls) extracted from the SINA Electronic Health Record (SinaEHR®) in a population covered by Mashhad University of Medical Sciences in 2018. The effect of independent variables on the likelihood of diabetic complications was investigated using single-variable and multivariate logistic regression models with the control of the potential confounding effects.

Results: Using the multivariate logistic regression, the odds of developing diabetic complications were 0.35 (0.31-0.38) for living in the city, 0.73(0.67-0.79) for living in the suburbs and 0.31(0.28-0.33) for living in rural areas relative to the metropolises, 0.84 (0.78-0.91) for illiterate subjects, 0.70 (0.66-0.75) for physical activity, 1.51(1.34-1.71) for stage 1 hypertension and 1.87 (1.43-2.44) for stage 2 hypertension relative to normal blood pressure, 0.79(0.74-0.85) for uncontrolled low density lipoprotein and 1.42(1.33-1.51) for uncontrolled hemoglobin A1C.

Conclusion: Various risk factors were identified to increase the odds ratio of diabetic complications. The most important risk factors were uncontrolled glycosylated hemoglobin and stage 1 and 2 hypertension. Control of these factors can reduce the chance of diabetic complications in diabetic patients.

Relationship between Violence in Driving and Personality Traits among Drivers in Tehran

T Yousefinezhadi

Background and Objectives: Violence and aggressive behaviors are major risk factors for traffic accidents. The drivers' attitudes and behaviors can also be influenced by personality traits. The purpose of this research was to identify the relationship between violent behaviors in driving and personality traits.

Methods: In this study, a 20-item researcher-made questionnaire was used to collect data related to violence and the revised 60-item Neo Personality Inventory was used to collect data about personality traits including extraversion, agreeableness, conscientiousness, neuroticism, and openness. Psychometric evaluation was performed for data collection tools from September to January 2018. Descriptive statistics and non-parametric statistical analysis including Mann-Whitney and Kruskal were used to analyze the data.

Results: In this study, 87.3% of the participants were male and 12.7% were female. The mean age of the participants was 42 years. The dominant personality trait was conscientiousness among the drivers (30.2%). The results showed a significant correlation between the degree of violence and neuroticism (P= 0.02). Based on regression analysis, 19% of violence could be explained based on the personality trait.

Conclusion: Neuroticism can potentially indicate driving behavior and the degree of violence. Therefore, it is essential to predict the drivers’ behaviors to improve road safety. It can provide useful information regarding road safety interventions for road users to target drivers who are more exposed to undesirable driving behaviors.

Challenges in the Design, Conduct, Analysis, and Reporting of Randomized Clinical Trial Studies in Iran: A Qualitative Study

SH Rimaz

Background and Objectives: Randomized clinical trials are the gold standard for evaluating the effectiveness and safety of medical interventions. Some unpredictable challenges may affect the results of these studies. Therefore, the aim of this study was to identify the challenges of clinical trial studies in different stages including design, conduct, analysis, and reporting.

Methods: This study was a qualitative study using content analysis performed from 2017 to 2019. The study population included 13 clinical trial experts who were selected through purposeful sampling. Semi-structured interviews were conducted with all subjects. Data saturation was achieved after 13 interviews.

Results: Among the 4 steps of design, conduct, analysis, and reporting, the majority of the challenges were related to conducing randomized clinical trials. Lack of knowledge of researchers, subjects, sponsors and physicians and supervisory and ethical challenges were the main challenges related to performing these studies. Poor design and lack of clinical equipoise were considered as the main challenges in the design step. Inappropriate analytical methods due to the absence of statistician in these studies were considered as the most common challenge related to analysis. Finally, lack of familiarity with international guidelines was the most important challenge in reporting.

Conclusion: There are many challenges in different steps of clinical trial studies. Therefore, additional education sessions focusing on the related guidelines and standards as well as GCP workshops for researchers can be helpful.

Quality of Reporting of Cohort Studies Investigating Preconception Risk Factors of Gestational Diabetes According to the STROBE Statement

R Bayrami

Background and Objectives: The results of cohort studies could be used in evidence-based medicine in case they have a good quality and robust methodology. Therefore, this study was conducted to assess the quality of cohort studies investigating preconception risk factors of gestational diabetes.

Methods: In this cross-sectional study, the cohort studies investigating the preconception risk factors of gestational diabetes during 2008-2018 indexed in PubMed, Scopus and Science Direct were searched. Keywords used for search included cohort study, pre pregnancy, preconception, risk factor and gestational diabetes. Out of 312 retrieved articles, 26 were critically appraised using the STROBE checklist. The maximum and minimum score that each article could obtain was 34 and 0, respectively. Data were analyzed using SPSS version 16.

Results: Of 26 articles that were reviewed, the overall agreement rate with STROBE was 78.8%. Of these, 18 articles (69/23%) were rated as moderate and eight articles (30.76%) were graded as good quality. The method and result sections were the weakest parts of the published articles.

Conclusion: The quality of the reported cohort studies investigating preconception risk factors of gestational diabetes is not optimal. It is recommended that chief editors, reviewers, and authors as well as obstetricians and midwives use the STROBE criteria to appraise articles critically, before using their findings in clinical practice.

Validation of the Persian Version of a Scale for Screening Internet Anxiety in Students

F Tanhaye Reshvanloo

Background and Objectives: The widespread use of the Internet has created new issues in the field of psychological studies. One of these emerging constructs is Internet anxiety. The purpose of the present study was to investigate the construct validity of the Internet Anxiety Scale in students.

Methods: In a descriptive, validation study, 206 and 289 students from Farhangian University Branches of Mashhad were selected through multi-stage sampling and completed the Internet Anxiety Scale and Internet Self-efficacy scale, respectively. Internal consistency, exploratory and confirmatory factor analysis, criterion and constructive validity were evaluated using SPSS.25 and AMOS.24 software.

Results: The results showed that the scale had a two-factor structure with an explained variance of 55.82%. Confirmatory factor analysis was confirmed. The scale had good construct reliability. The divergent validity confirmed in relation to Internet self-efficacy (P<0.01). There was no significant difference in age (P>0.05). Gender differences were significant for fear of negative evaluation (F=6.53, P<0.01) and internet anxiety score (F=7.22, P<0.01), and girls had higher mean scores. Differences were significant according to field (P <0.01) and Science and Foreign Language students had the lowest and the highest mean score, respectively (21.37 and 27.05).

Conclusion: It seems that the Internet Anxiety Scale has a good reliability and validity in students.

Assessment of Ten Life Skills and General Health Level and Their Relationship in Clients Presenting to Health, Treatment and Counseling Centers

P Yavari

Background and Objectives: Studies investigating life skills and general health have mainly focused on some skills or parts of health. In this study, ten components of skills and three components of general health were examined in patients presenting to veterans’ health and counseling centers in Tehran and the relationship between each skill and multiple levels of general health was assessed.

Methods: this cross-sectional study was performed on 600 randomly selected service users. Data were collected using two standard questionnaires and analyzed using t-test, one-way ANOVA, Tukey post hoc and multivariate regression. Lisrel-8 path analysis and software were used to investigate the causal relationships between variables and the way a skill affected general health.

Results: The highest mean scores of skills were related to emotion management, critical thinking, social support and creative thinking, decision making, stress management, self-awareness, empathy and effective communication and problem solving. The results of path analysis showed a strong link between overall life skills and general health. The effect of skills on social performance was more than other components of health.

Conclusion: The contribution of emotion management, creative thinking, effective communication, and stress management skills to the prediction of general health was more than other life skills. Considering the importance of general health, it is recommended that educational programs be implemented with focus on these population subgroups to improve their skills and general health level.

Needs for Further Assessments of the Effect of Health Policies on Social Interventions against COVID-19 in Iran

M Zamanian

COVID-19 has now turned into a global crisis affecting all sections of economy and investment. Many interventions have been applied to control the COVID-19 epidemic. It seems that these measures and plans need to be assessed in the coming weeks and months to determine whether or not they have been effective. Each of these interventions started in their appropriate time during the epidemic; some of them are still in progress and some have been lifted. Nevertheless, improved public knowledge, attitude, and practice has played the most important role in controlling the COVID-19 epidemic. Future studies should take into account such interventions.