Iranian Journal of Epidemiology

Investigation of Factors Associated with Anemia in Pregnant Women Referring to Comprehensive Health Service Centers in Northeastern Iran

Maryam Mohammadi

Background and Objectives: Anemia is a major public health concern among pregnant women and is associated with adverse outcomes such as preterm birth, low birth weight, and increased maternal mortality. This study aimed to investigate factors associated with anemia among pregnant women attending comprehensive health service centers in Sarakhs, Northeast Iran.
Methods: In this cross-sectional analytical study, data from 904 pregnant women registered in the Sina system in 2023 were analyzed. Demographic, clinical, and laboratory data were extracted. Anemia was defined as a hemoglobin level below 11 g/dL, and logistic regression analysis was used to assess associations between potential predictors and anemia.
Results: The mean age of participants was 27.2 ± 6.8 years. The prevalence of anemia among pregnant women in Sarakhs was 17.7% (95% CI: 15.2%–20.5%). In multivariable analysis, rural residence was associated with lower odds of anemia (OR = 0.58, P = 0.01), as was non-Sistani ethnicity compared with Sistani ethnicity (OR = 0.44, P = 0.003). A history of low birth weight (<2500 g) significantly increased the odds of anemia (OR = 7.14, P < 0.001). Compared with underweight mothers (BMI <18), those with normal weight, overweight, and obesity had 58%, 71%, and 78% lower odds of anemia, respectively (OR = 0.42, 0.29, and 0.22). Absence of kidney disease (OR = 0.22, P = 0.03) and iron supplementation before pregnancy (OR = 0.50, P = 0.05) were also protective. No other variables showed significant associations with anemia.
Conclusion: These findings highlight the importance of ethnic and geographic factors in the prevention of anemia in pregnancy and underscore the need for targeted interventions, including thalassemia screening and strengthening preconception and antenatal iron supplementation programs, to reduce anemia and improve maternal and child health outcomes.

Investigating the Relationship between Economic, Social, and Psychological Factors and the Resilience of Women Who Have Experienced Violence

Majid Babaei

Background and Objectives: In recent years, the psychological resilience of women who have experienced violence has emerged as a major public health concern. The present study aimed to explain the role of socioeconomic factors, emotion management, and communication skills in predicting the psychological resilience of women who have experienced violence in West Azerbaijan province.
Methods: This cross sectional analytical study was conducted in 2023 among 98 women who had been subjected to violence and were residing in welfare centers. Standardized questionnaires were used to assess resilience, socio economic status, emotion management, and communication skills. Pearson correlation and multiple linear regression analyses were applied to examine the relationships between variables using SPSS version 16.
Results: The results of the correlation test showed that there is a significant relationship between socio-economic factors, communication skills, and emotion management, and the level of resilience of women who have experienced violence. So between education (P<0.001,r=0.53), income (P<0.001,r=0.70), job (P<0.001,r=0.58), re-evaluation management (P=0.010,r=0.26), suppression management (P=0.001,r=0.34), ability to receive and send messages (P=0.015,r=0.25), emotional control (P=0.006,r=0.28), listening skills (P=0.012,r=0.30), insight into the communication process (P=0.001,r=0.36) and communication Combined with assertiveness (P=0.001,r=0.33) with women's resilience, a positive and significant relationship And between the household dimension (P<0.001,r=-0.68) and resilience negative and significant relationship was observed. On the other hand, the results of the regression test showed that all variables, except listening skills, were significantly able to predict the resilience of women who had experienced violence.
Conclusion: According to the findings, it is recommended that health policymakers design and implement effective interventions by identifying risk factors and reducing social harms through providing necessary training to families and building a culture. It is also recommended to implement intervention programs aimed at improving the economic situation and raising women's awareness of their social rights.

The Prevalence of Borderline Personality Traits and Their Relationship with the Family Emotional Climate among High School Students in Public Schools of Urmia (2021–2022): A Cross Sectional Study

Nasim Talebi Azar

Background and Objectives: Borderline personality disorder is a prevalent psychiatric disorder and this study was conducted to examine the prevalence of borderline personality traits and their relationship with the family emotional climate among high school students.
Methods: This cross-sectional, correlational study involved 583 students from public high schools in Urmia city, selected using a multi-stage cluster sampling method. Data collection included a demographic information checklist, the Borderline Personality Scale for Children (BPFS-C), and the Alfred B. Hillburn Family Emotional Climate Questionnaire. Data analysis was performed using SPSS version 18 software, utilizing descriptive statistics (mean, standard deviation), Pearson correlation tests, and one-way analysis of variance.
Results: The study found that the overall average of borderline personality traits across all disciplines was moderate, with higher levels observed in the humanities field compared to other fields. Borderline personality scores were higher among eleventh-grade students. The prevalence of borderline personality traits in the sample was low (26.9%), moderate (58.1%), and high (15%). Most students reported a high emotional atmosphere within their families (89.5%). An inverse and significant relationship was observed between family emotional climate and all dimensions of borderline personality traits. There were significant differences in family emotional climate across different grades, with the eleventh grade reporting the lowest average. Differences in borderline personality traits were also noted across educational levels. While the emotional atmosphere within families was higher among girls compared to boys, there was no significant gender difference in borderline personality traits. Additionally, there were no differences in family emotional climate across educational regions, but the average borderline personality traits were higher in region one.
Conclusion: Overall, the emotional climate within the family serves as a crucial protective factor against the development of borderline traits in adolescents. Educational and psychosocial interventions should prioritize strengthening parent-child emotional connections, fostering empathy, and teaching emotion regulation within families.

Fertility Intention after Divorce: A Study of Iranian Pre Second Union Women

Arezoo Bagheri

Background and Objectives: In societies where first marriage and childbearing are delayed, divorce can lead to a decrease in the number of children. Considering the declining fertility rate and increasing divorce in recent years in Iran, it is important to study the intention to have children of divorced women in their second marriages, considering the role of them in fertility. The aim of the present study is to investigate the factors affecting the fertility intention of these women.
Methods: In this study, 410 divorced women under 40 years' old who are in pre-second union were considered. Data were collected through a structured questionnaire from the marriage and divorce survey conducted by the National Civil Registration Organization in 2017-2018. A Cumulative-Logit model was used to examine the effect of selected covariates on women's fertility intentions, and the data were analyzed using SPSS.26.
Results: Based on the results, 7.7%, 49.9%, and 42.4% of women intend to be childless, have one child, and have two or more children in their second marriage, respectively. Province of residence, ethnicity, family income level, housing ownership, couple's childbearing status in the first marriage, number of children from the first marriage, and age have significant relationships with women's fertility intentions.
Conclusion: Given the potential capacity of divorced women of fertility age who remarry, planners and policymakers in society can create the possibility of remarriage for these women by establishing cultural, social, and legal frameworks.

Analysis of Incidence and Mortality Trends of Prostate Cancer in Iran Using Age, Period, and Cohort Approach

Mehdi Moradinazar

Background and Objectives: Prostate cancer is one of the most common cancers among Iranian men and has shown a marked increase in both incidence and mortality over recent decades. This study aimed to analyze temporal trends in prostate cancer incidence and mortality in Iran using an Age–Period–Cohort (APC) analytical framework.
Methods: Data were extracted from the Global Burden of Disease Study 2021 for Iranian males aged 45 years and older during 1992–2021. Data were stratified into eight 5-year age groups and six 5-year time periods. APC analysis was conducted using the second-order difference method, and Joinpoint regression was employed to assess temporal trends in risk factors.
Results: In 2021, the age-standardized incidence rate reached 30.05 per 100,000 population, and the mortality rate reached 10.66 per 100,000 representing increases of 105.96% and 14.99%, respectively, compared to 1992. Age effects were positively associated with both incidence and mortality. The period effect peaked during 2002–2006. Cohort analysis revealed that younger birth cohorts exhibited a slower acceleration in incidence rates. Among risk factors, the disease burden attributable to smoking increased by 17.1%, while the protective effects of low calcium intake and low milk consumption diminished over time.
Conclusion: Rising incidence and mortality are shaped by age, period, and cohort effects. The relative decline in younger cohorts underscores the need for targeted prostate cancer screening programs. Strengthening public health education policies and improving access to diagnostic services can reduce the disease burden.

In Honor of Dr. Kiumarss Nasseri, One of the Pioneers and Honorees of Iranian Epidemiology

Ehsan Mostafavi

Background and Objectives: Dr. Kiumarss Nasseri, a veterinarian and epidemiologist, is one of the prominent figures in epidemiology and public health in Iran. This paper reviews his invaluable contributions and professional legacy in these fields.
Methods: Information about Dr. Kiumarss Nasseri and his valuable activities was collected from various sources, including documents, articles, and interviews with individuals.
Results: From 1970 to 1989, Dr. Nasseri served as a faculty member in the Department of Epidemiology at the School of Public Health, University of Tehran. Following the Islamic Revolution, he held several key academic and administrative positions, including membership in the Coordinating Council of the School of Public Health, Deputy for Education at the School of Public Health, Director of the International MPH course in collaboration with the World Health Organization, and Head of the Health Group at Iran University Press. He continued his academic and research activities in cancer epidemiology at the University of California, Los Angeles (UCLA), California State University, Northridge (CSUN), and as a lecturer in epidemiology at the University of Liverpool in England. Professionally, he served as a senior epidemiologist with the California Cancer Registry at the California Department of Public Health. He has authored numerous books in the fields of epidemiology, public health, and zoonoses.
Conclusion: Reviewing Dr. Nasseri’s distinguished career and contributions can provide valuable insight and inspiration for scholars and future students in epidemiology and public health in Iran.

Missing Data in Medical Research: A Practical and Illustrated Review for Researchers and Students

Mohammad Heidari

Missing data is a common and unavoidable challenge in medical and epidemiological research, often leading to biased estimates, reduced statistical power, and misleading interpretations when not properly addressed. Despite its importance, accessible and practical educational resources on this topic remain limited in Persian. This educational article provides a clear and structured overview of the fundamental concepts of missing data, including definitions, common patterns (univariate and multivariate), and the three major mechanisms of missingness: MCAR, MAR, and MNAR. A range of widely used approaches for handling missing data is summarized, from basic methods such as case deletion and simple imputation to more advanced techniques including multiple imputation and likelihood-based procedures (EM and MLE). Practical examples and visual illustrations are incorporated to facilitate conceptual understanding. The ultimate goal of this article is to provide a practical framework for researchers and students, enabling them to select the appropriate approach for dealing with missing data in the design and analysis of their research and to prevent analytical errors.