Iranian Journal of Epidemiology

Validity of Vital Horoscope Reports for Maternal and the Under-Five Mortalityin Rural Areas of Iran, 2007

M Movahedi

Background and Objectives: Due to the importance of mortality statistics for planning, setting priorities and equal allocation of health services in population it is essential to assess quality of reporting mortality data in health systems. The aim of this study was to evaluate the completeness and accuracy of the Iranian Vital Horoscope reports for maternal and the under-five mortality (U5M) in rural areas through its comparison with other data sources in Iran.

Methods: The mortality data of Vital Horoscope reported from 30 selected cities over country was compared with the related data obtained from other data sources including Vital Horoscope's Fieldwork reports, Death Registration System and Maternal Mortality Surveillance System of Ministry of Health and Medical Education.

Results: Overall completeness of Vital Horoscope's Fieldwork reports for U5M in rural areas was about % 62.1. In terms of cause of death in children under-five,estimated sensitivity values were % 47.2 (95% CI: 22.9-72.2), % 66.6(95% CI: 22.7-95.7), %78.2 (95% CI: 64.3-89.3)for respiratory infections, diarrhea and vomiting, and injuries-burning and poisoning respectively. The vital horoscope reports had 12.5% misclassification in determining the cause of maternal death.

Conclusion: Our findings indicate the Vital Horoscope's data might need some corrections because of underestimating of the mortality indicators. The comparison of this source with Death Registration System report for causes of death in children under-five (reported by Vital Horoscope) suggests that the vital horoscope might have suboptimal quality.

Detecting and Removing the Explainable Patterns of the Daily Counts of Suspected Cases of Measles as a Prediagnostic Data Source in Iran

H Soori

Background & Objectives: Knowledge of the presence of seasonal trends and other explainable patterns in the prediagnostic data sources and removing such patterns before applying outbreak detection methods seem very important. This study aimed to detect and remove the explainable patterns such as seasonality, day-of-week (DOW) and holiday effects of the daily counts of suspected cases of measles in Iran.Methods: Data on daily counts of suspected cases of measles as a pre-diagnostic data source were obtained from Iranian national surveillance system between 21 March 2008 and 20 March 2011. We used lines plot, moving average chart, autocorrelation and partial autocorrelation functions for detecting explainable patterns. Moving average (MA) and Holt- Winters (HW) exponential smoothing method are used for removing explainable patterns.

Results: Our findings indicate the presence of seasonality, DOW effect, holidays and weekend effects in the daily counts of suspected cases of measles. The good performance of HW exponential smoothing technique in removing seasonal patterns is evident. MA technique showed better performance regarding assumption violation on outbreak detection methods.

Conclusion: Because of the presence of explainable patterns in the daily counts of suspected cases of measles, considering such patterns before applying outbreak detection algorithms is very important. Implementing both MA (7 days) techniques for its simplicity as a pre- processing method and HW method for its efficacy in removing seasonal patterns is recommended.

Evaluating the Performance of the Exponentially Weighted Moving Average in Measles Outbreak Detection using Real Data Testing

H Soori

Background & Objectives: Evaluating the performance of outbreak detection methods using real data testing provide the highest degree of validity. The aim of this study was to determine the performance of the Exponentially Weighted Moving Average (EWMA) in real time detection of two local outbreaks in Iran.

Methods: The EWMA algorithm (both ƛ= 0.3 and 0.6) applied on daily counts of suspected cases of measles to detect local outbreaks which had been occurred in Mashhad and Bandar Abbas cities during 2010. The performance of The EWMA algorithms were evaluated using real data testing approach and reported by correlation analysis.

Results: Mashhad outbreak was detected with a delay of about 2 to 7 days using EWMA algorithms as outbreak detection method while the utility of EWMA algorithms in real time detection of Bandar Abbas’ outbreak were on time good optimal. Maximum correlation value for EWMA 2 in relation to Mashhad outbreak was 0.60 at lag 2.

Conclusion: Applying the EWMA algorithm as an outbreak detection method at local levels is not suggested. However the characteristics of data are determinant of the performance of such detection methods.

Estimating the Contribution of Diabetes on the Attributable Burden of Cardiovascular Diseases in Kermanshah, West of Iran

F Najafi

Background & Objectives: Knowledge of the magnitude of attributable burden of cardiovascular diseases (CVDs) due to diabetes is necessary for health policy, priority setting and preventing CVD deaths. Our study aimed at estimating the attribute of proportion of diabetes to the burden of cardiovascular diseases in Kermanshah, West of Iran.

Methods: World Health Organization Comparative Risk Assessment methodology was used to calculating Potential Impact Fraction (PIF). Data on the Prevalence of newly diagnosed diabetes mellitus (People who have fasting plasma glucose (FPG) equal or greater than 126 mg/dl) were obtained from 3rd Iranian surveillance of risk factors of non- communicable diseases and data on corresponding measures of effect were derived from a national- specific study with age and multivariate adjusted hazard ratios.

Results: Based on multivariate- adjusted hazard ratios, by reducing the percent of women with diabetes from 8.1 percent to the zero level and the feasible minimum risk level i.e. 4 percent, 11.2% and 5.7% of attributable Disability Adjusted Life Years (DALYs) to CVD are avoidable, respectively. The corresponding value for men at the theoretical (zero level) and feasible minimum risk level (3 percent) were 5.6% and 2.9%, respectively.

Conclusion: To better planning, decision making and priority setting, PIF should be applied to updated and revised burden of CVDs in Iranian Health system.

Risk Factors of Suicide Reattempt in Patients Admitted to Khorshid Hospital, Isfahan, Iran, 2009

MR Maracy

Background & Objectives: The rate of suicide varies amongst different parts of Iran. Since there is little knowledge about the risk factors for suicide attempts we carried out this study to determine the status of psychiatric disorders and risk factors of repeated attempted suicide in suicide attempters whom admitted to poisoning emergency in Isfahan, Iran.

Methods: Patients with having attempt to suicide, admitted to emergency ward in Khorshid Hospital in Isfahan and were interviewed by a trained psychiatrist during 2009 year. Interview was based on DSM-IV.

Results: Participants consisted of 703 individuals (424 of them were female) with mean age of 25.9±9.7. One hundred twenty five (125) had positive family history of suicide attempt, 501 people were first time suicide attempters, 106 second, 58 third, and the others were forth time or more suicide attempters. Bipolar spectrum disorders, unipolar depression and adjustment disorders were the more frequents psychiatric disorders respectively. Age, family history of suicide, kind of diagnosed psychiatric disorder and method of attempted suicide were meaningfully related to mean of attempt suicide frequency.

Conclusion: Bipolar spectrum disorders, especially recurrent depressive episodes is the major risk of repeated suicide attempt and co-morbidity of another psychiatric disorders increase highly the risk of suicide reattempt.

The Epidemiology of Separation Anxiety Disorder in Isfahan Primary School Male Students

A Talebpour

Background & Objectives: One of the most common anxiety disorders in children is separation anxiety disorder (SAD). The purpose of the present study was to investigate the epidemiology of separation anxiety disorder in Isfahan primary school male student.
Methods: The present study was a descriptive study. The statistical population was all the male students from 7 to 9 years old, studying in second and third grades in primary schools of Isfahan. The sample of study consisted of 1514 male student, who were selected randomly by multi-stage sampling method. The instruments of this study consisted of the Separation Anxiety Disorder Scale, Spence Children's Anxiety Scale and Clinical Interview. Data obtained were analyzed by using descriptive statistics and chi-square and logistic regression.
Results: The findings showed that the rate of separation anxiety disorder in male (7 to 9 year- old student) was %6/93. SAD were more common in 7 years old (7.4%). Children having record of hospitalization, immigration, single-parent households and close relatives of mortality had a higher rate of separation anxiety disorder.
Conclusion: This study shows that separation anxiety disorder among primary school male students is significantly high. Therefore it is important to consider the potential utility of early anxiety prevention/intervention programs, especially for children at this age group.

Air Pollution and Respiratory Deaths in Kerman, Iran (from 2006 till 2010)

N Khanjani

Background & Objectives: The effects of air pollutants on respiratory mortality and morbidity are among the major concerns today. Few studies have been published on the association between mortality and air pollution in Iran.
Methods: This study was undertaken in Kerman, Iran. Mortality data was inquired from the Kerman City Health Authority (from March 2006 till Sept 2010) and air pollution data was requested from the Kerman Province Environmental Protection Agency (EPA). The Kerman Province EPA collects daily data on 7 air pollutants which are SO2, NO2, NO, NOx, PM10, CO and O3 by its urban measurement station. Results: The relation between respiratory disease mortality and air pollution was determined by negative binomial regression. The daily mean of PM10 in Kerman was above 150 μgr/m³(unhealthy) on some days of the year. The results showed a significant relationship between increased male respiratory mortality and increase in ambient dust (p=0.03), O3 (p=0.004) and SO2 (p=0.03), but did not show a significant increase in female mortality death for any pollutant.
Conclusion: As there seems to be a significant relationship between increased ambient dust, O3, SO2 and respiratory mortality, susceptible people and those with background respiratory diseases should practice caution in case of increases in these air pollutants.

The Prevalence of Depression among Caregivers of Stroke Survivors and Related Factors in Arak

HR Koohestani

Background & Objectives: Despite the extensive interest shown in depression occurring in stroke patients, little attention has been paid focus on depression of caregivers of stroke survivors particularly in Iran therefore this study was designed to assess the prevalence of depressive symptoms among caregivers of stroke survivors and to determine putative risk factors.
Methods: This cross-sectional analytic study was carried out among 140 caregiver's stroke patients were admitted in Valiasr Hospital affiliated to Arak University of Medical Sciences. The caregivers were interviewed before discharge, at 1 month and 3 months after that. Depression was evaluated with the Beck Depression Inventory. The ability of the person with a stroke to perform their activities of daily living was measured using the Modified Barthel Index (MBI).
Results: Most of the caregivers were the spouse of the patient (70.71% n= 95). The mean age of them was 57.1 (SD=11.2) years old. A total of 33.57% to 42.16% of all caregivers were depressed during the follow-up. During the follow-up, caregivers’ scores for depression statistically significant were increased. Caregiver depression was associated with stroke modified barthel index score and age of the patient.
Conclusion: The depressive symptoms of caregivers seem to have high rate. This suggests that assessment of caregivers' social, and emotional needs should be included as part of the general rehabilitation plan of the stroke patient.

Validation and Localization of Farsi Version of Effort-Reward Imbalance Questionnaire to Measure Job Stress among Employees of Isfahan Polyacryle Corporation

GH Yadegarfar

Background & Objectives: To be able to measure the extent of job stress, it is essential to use a standardized tool based on a standard theoretical model. The study aims to test the psychometric properties and criterion validity of the Farsi version of the Effort Reward Imbalance (F-ERI) questionnaire.
Methods: The Farsi version of the ERI Questionnaire was distributed to 227 male employees in Isfahan Polyacryle Company. Internal consistency, reliability, discriminative validity, and factorial structure were evaluated. The relationship between scales and depression was measured assessed by using logistic regression to criterion validity. Data were analysed by SPSS 18 and LIZREL 8.5.
Results: Mean score of effort, reward, and overcommitment were 10.7, 41.4, and 14.2 respectively Cronbach’s alpha coefficients were 0.61, 0.85 and 0.67 and split-half coefficients were 0.53, 0.85, and 0.65. All of item-total correlations were more than 0.20 correlation between each item and its scale were more than 0.4 except for one item. Effort and overcommitement had a good fit for construct validity.
Conclusion: Current study results indicated the Farsiversion of the Effort Reward Imbalance (F-ERI) questionnaire is a reliable and valid tool to measure psychosocial stress at work among Farsi-speaking employees. It is advisable to evaluate the tool in longitudinal studies and other industries which included female employees. We refer the investigators to see the longitudinal results of current project which is under publication.

Validity of Vital Horoscope Reports for Maternal and the Under-Five Mortalityin Rural Areas of Iran, 2007

M Karami

Background and Objectives: Due to the importance of mortality statistics for planning, setting priorities and equal allocation of health services in population it is essential to assess quality of reporting mortality data in health systems. The aim of this study was to evaluate the completeness and accuracy of the Iranian Vital Horoscope reports for maternal and the under-five mortality (U5M) in rural areas through its comparison with other data sources in Iran.
Methods: The mortality data of Vital Horoscope reported from 30 selected cities over country was compared with the related data obtained from other data sources including Vital Horoscope's Fieldwork reports, Death Registration System and Maternal Mortality Surveillance System of Ministry of Health and Medical Education.
Results: Overall completeness of Vital Horoscope's Fieldwork reports for U5M in rural areas was about % 62.1. In terms of cause of death in children under-five,estimated sensitivity values were % 47.2 (95% CI: 22.9-72.2), % 66.6(95% CI: 22.7-95.7), %78.2 (95% CI: 64.3-89.3)for respiratory infections, diarrhea and vomiting, and injuries-burning and poisoning respectively. The vital horoscope reports had 12.5% misclassification in determining the cause of maternal death.
Conclusion: Our findings indicate the Vital Horoscope's data might need some corrections because of underestimating of the mortality indicators. The comparison of this source with Death Registration System report for causes of death in children under-five (reported by Vital Horoscope) suggests that the vital horoscope might have suboptimal quality.

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