Iranian Journal of Epidemiology

Health Technology Assessment on Insulin Analogues: the Rapid Review of Second Type Studies

SH Doaee

Background and Objectives: analogues insulin is similar to human insulin but have differences in cell structure that leading to differences in characteristics of pharmacodynamics and pharmacokinetics.
Methods: A systematic review of published studies between 2009 until June 2010 in Cochrane Library (CENTRAL and Cochrane Systematic Reviews), DARE, NHS EEDs, and CRD databases were searched.
Results: Only nine articles were identified to be included in this review. Most of these studies demonstrated that there were no more or less risks caused by rapid acting insulin compared with human insulin in terms of safety. The risk of sever hypoglycemia significantly, reduced by using long acting insulin analogue. Although it has been shown that insulin analogues are not cost effective, some of these studies pointed out that that insulin Aspart 30 compared with other analogues has more cost effectiveness.
Conclusion: Although this type of insulin seems very effective for patients with diabetes, due to the less cost effectiveness in comparison to human insulin, it is recommended that government's resources for this technology will be allocated just to the children and elderly people.

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Application of FBAT-MM and FBAT-LC Multimarker Methods in Association of Selected Microsatellites With HDL-C in Families with Metabolic Syndrome Members: Tehran Lipid and Glucose Study

Y Mehrabi

Background & Objectives: Studying several linked markers provides more information on locating disease genes locus by using genetic association analysis. The aims of this study were to introduce Multimarker Family Base Association Tests (FBAT-MM) and its Linear Combination (FBAT-LC) in multimarker genetic association analysis and to examine the association of selected microsatellites with HDL-C in an Iranian population.
Methods: One hundred twenty five (125) families having at least one member with metabolic syndrome and at least two members with low HDL-C were selected from participants of the Tehran Lipid and Glucose Study (TLGS). Multimarker genetic association of HDL-C level with some microsatellites in the chromosomes 8, 11, 12, and 16 were examined using FBAT-MM and FBAT-LC methods.
Results: The families consisted of 563 individuals (269 males and 294 females). FBAT-MM showed significant genetic association only between HDL-C and three microsatellites in Chromosome 11 (P<0.05). The microsatellite D11S1304 was found as the significant factor for multimarker genetic association.
Conclusion: FBAT-MM and FBAT-LC did not show shortcomings such as excessive conservatism and low power which are, usually, observed in other multimarker methods. Finding microsatellites associated with HDL-C level can provide background for further researches on the role of predisposing genes in metabolic syndrome.

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Health-related Quality of Life among Elderly Member of Elderly Centers in Tehran

L Salehi

Background & Objectives: Aging and elderly population growth has been increased in Iran. Quality of life of older persons is important as a consideration in medical decisions and as a clinical outcome measure. Health related quality of life (HRQoL) is not well understood in this group therefore we designed this study to determine the quality of life among elderly populations of Tehran, Iran.
Methods: This cross-sectional study was conducted on a random sample of elderly people selected from the elderly centers in Tehran. The Iranian version of short-form Health survey (SF-36) and perceived social support questionnaires were employed as standard tools.
Results: Overall, 400 elderly people with the mean age of 64.07(SD =4.49) took part in this study. Of all participants, 298 individuals were women. The mean score of PCS (Physical Component summery) and MCS (Mental Component Summery) were 64.62 (SD= 12.68) and 63.35 (SD=4/7) respectively. The results of this study revealed that women compared to men had significantly higher scores in different dimensions of health related quality of life as physical function, social function, body pain and general health. Additionally, participants with lower body mass indexes, higher education level, married elderly, healthy aged participants and richer ones had higher scores of health related quality of life.
Conclusion: According to this study, there was correlation between mean PCS and social support as well as MCS and social support. Quality of life in female, individuals with higher education and socioeconomic status were higher than male, persons with lower education and socioeconomic status.

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Community Assessment of Shahin-Shar, Isfahan, I. R. Iran to Develop Community Health Action Plan

K Holakouie Naieni

Background & Objectives: Community assessment process is the foundation for developing the basis for effective community health strategies. The aim of this study was providing a framework for comprehensive and participatory community assessment in Shahin-Shar, Isfahan, Iran.
Methods: This assessment performed in Shahin Shar city based on some experiences of Community Medicine and Epidemiology and Biostatistics departments of Tehran University of medical sciences since 1989 and North Carolina Community Assessment Guide Book (2002). The community assessment team included wide ranges of key stakeholders and local people. Our community assessment team has three levels of participants: An advisory group, a work group and a project facilitator. Observation, interview, focus group discussion and summary list of health resources used for data collection. The map of asset was also provided. We reported data to community and Hanlon method -based on magnitude of the problem, seriousness of the consequences and feasibility of correcting- was used for selecting health priorities.
Results: Drug abuse, smoking among adults and depression were the important health priorities. After creating community assessment document, Based on the risk factors that contribute to each problem, the health action plans were developed.
Conclusion: The results of this study showed that community assessment could be the foundation for improving and promoting the health of community members. It could be the basis for effective community health strategies in Iran .

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Population Attributable Fraction of Bronchial Anthracosis due to Smoke Exposure while Baking Home-made Bread in Ground Oven

M Yunesian

Background & Objectives: Some case-report studies in Iran showed probable association between anthracosis and smoke exposure due to baking homemade bread, population. Therefore we estimated the population attributable fraction (PAF) for this probable association in Iranian population.
Methods: A hospital-based case-control study, including 83 anthracotic subjects (cases) with 72 controls from surgical ward which were matched by age, conducted in Imam Khomeini hospital in Tehran (From September 2009 to December 2010). Patients in both case and control groups were interviewed according to "American Thoracic Society" guideline. Exposure to smoke was considered both as a binary and continuous variable (number of years being exposed to smoke) and the population attributable fraction (PAF) were estimated due to smoke exposure.
Results: Univariate analysis showed that exposure to smoke as binary variables, age and occupation exposure to dust and education were associated with anthracosis. After Adjusting, only smoke exposure (OR: 3.35, 95% CI: 1.49-7.55) remain significant. Univariate logistic regression model showed exposure to smoke as continuous variable has significant association with anthracosis. In multiple logistic model only duration (years) of smoke exposure remained significant (OR: 1.05, 95%CI: 1.01-1.09). PAF due to smoke exposure estimated approximately 48% in our population.
Conclusion: Based on the findings of this study, it could be concluded that approximately half of the anthracotic cases are attributed to smoke exposure.

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The Relationship Between Household Food Insecurity Status and Depression in Mothers with School Children living in Ray in 2010

AR DorostyMotlagh

Background & Objectives: Food insecurity has been a global concern. The purpose of the present study was to examine the relationship between household food insecurity and depression in mothers with school children in Ray city.

Methods: A cross-sectional survey of 430 mothers of school children was conducted in 2010 in Ray city. We employed USDA food security questionnaire. The prevalence of depression in mothers was assessed by Beck Depression Inventory (DBI).
Results: Household food insecurity was identified approximately in fifty percent of participants and frequency of depression was 51.4% in mothers. Depression in ‘food secure' group was 34.6%, and in ‘food insecure with hunger' group was 77.8%. There was a positive relationship between depression and food insecurity in mothers having primary school children living in Ray.
Conclusion: The findings of this study revealed that level of food insecurity among mothers seems high. This study highlights the need to integrate programs addressing food insecurity and poor mental health for mothers.

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A study on Risk Factors of WSD Outbreak in Choubdeh – Abadadan Shrimp Farming Site in 2010

D Saadati

Background & Objectives: White spot, as one of the infectious viral diseases, has made severe losses in shrimp ponds all over the world. Despite extensive efforts made to deal with and control the disease, white spot continues to be a major health problem in shrimp farms across Iran. In this work, the significance of the risk factors of white spot disease epidemic occurred in shrimp ponds of Choubdeh farming site in Khuzestan province of Iran is determined.
Methods: A cross sectional study was conducted from June 1, 2010, to September 22, 2010 in 223 shrimp ponds of the site. Data was collected on 17 variables, thought to be associated with the occurrence and epidemic of white spot, with the aid of the shrimp ponds owners and fisheries and veterinary organizations. The occurrence of white spot disease in the farming site was determined by clinical symptoms and the results of conventional PCR tests. the effectiveness of the risk factors was established by odds ratio (OR).
Results: It is found that poor management of birds fighting (OR=3.72), less educated farm foreman
(OR= 3.29) and poor filtration of the intake water (OR= 3.43) are significantly affected the occurrence of the disease while little changes in the salinity of shrimp ponds (OR= 0.16) decreases the odds of the disease.
Conclusion: These findings help better develop shrimp farming across Iran, especially in Khuzestan province.

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Deaths and Injuries due to the Earthquake in 2010 Damghan's Earthquake: A Case Study

K Holakouie Naieni

Background & Objectives: Earthquakes cause thousands of deaths and injuries worldwide every year. Islamic Republic of Iran has a deadly history of earthquakes. The aim of this study is to describe injuries rate, causes of injuries, structural characteristics of buildings and occupant actions immediately after earthquake in Damghan in 2010.
Methods: This case-study was conducted one week after occurring the earthquake in five villages of Damghan city in Iran. We used the Physical Injuries Assessment Questionnaire which was particularly designed for injuries after earthquakes. Also for acquiring information about region and amount of losses, some interviews was conduct with local authorities.
Results: Four death and fifty six injuries occurred in five villages of Damghan city. There were three types of injuries including superficial injuries (50%), contusions (35%) and fractures (10%). The findings of this study indicating building structural failure (87.4%), nonstructural factors (7.1%) and trapping (5.3%) seems the most possible cause of injuries in this region.
Conclusion: This study showed that the building structural failure is the main cause of injuries (87.4%). Increasing structural resistance of building especially in village regions and education about earthquake preparedness should encourage in order decreasing the total number of people affected by earthquake.

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Cost Analysis for Cancer Subgroups in Kerman, IRAN

K Holakouie Naieni

Background & Objectives: The economic costs of cancer care are a burden to people diagnosed with cancer, their families, and society as a whole. Despite several studies about cancer in Iran, there is paucity of cost analysis in this area. The aim of this study was to estimate the cost of cancer subgroups in Kerman, Iran.
Methods: A retrospective analysis of administrative 223 diagnosed patients with different cancers was undertaken.
Results: Monthly average cost of cancer was 3.32 thousand US dollars (average exchange rate in 2010: 10308 Iranian rials= 1 US dollar). Breast cancer, with an average 4.30 thousand US dollars per month was the most expensive and cancer of male reproductive organs with average2.16 thousand US dollars were the cheapest cancer.
The hidden monthly cost of all types of cancer was 2 thousand US dollars, breast cancer, lung, blood and female reproductive organs were costly and brain and peripheral nerves cancer, gastrointestinal tract and prostate were medium and male reproductive organs cancer was less costly.
Conclusion: Economically impact and burden of cancer should be an important consideration in the health policy making in Iranian health service system.

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Evaluation of Blood Utilization in Teaching Hospitals Affiliated to Qom University

M Akhavan Sepahi

Background & Objectives:
Nowadays the performance of hospital blood banks is assessed by cross-match to transfused unit ratio which it is recommended to be less than 2.0. The aim of this study was to evaluate the most common indications for blood transfusion in Qum University hospitals.
Methods: In this retrospective study 4370 blood order forms from March 2010 till April 2011 were assessed. To calculate C/T ratio, the number of cross-matched units was divided by the number of transfused units.
Results: Of total 4370 blood order, 57.1% were male. From all blood order forms, 16.42% (C/T : 1.196) were not transfused. The highest rate of blood orders pertained to surgery emergency and trauma (23.3%), hematology and oncology (14%), gynecology (11.3%), internal ward and nephrology (8%), infectious ward (6.9%), burn ward (5.9%), general surgery (4.4%), orthopedics (3.2%), ICU (2.3%) and pediatrics (8.6%). Packed cell was the product with the highest order rate of 78.7% in Qom teaching hospitals however, out of this rate 44% remained untransfused.
Conclusion: According to the findings of this study the rate of non-transfused ordered blood components in Qom teaching hospitals seems very high. Thus, it is recommended to employ the international and/or national guidelines in order to reach to optimal rate.

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To Explore Identifying the Influencing Factors of Divorce in Tehran

N Abedinia

Background & Objectives: The aim of this explorative study was to identify influencing factors as main causes of divorce among couples in Tehran
Methods: Three hundred persons from family court of Justice participated from March 2006 to March 2007 in this study. Structured interviews in addition a standard questionnaire were employed.
Results: The results indicated that the most causes were psychological factors (96.3%), socio-cultural factors (87.3%), sex problems (88%), economic factors (80.3%) and violence (84.3%) in participatnts.
Conclusion: Premarital counseling suggested for couples to prevent divorce in Iranian community.

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Trend of Brucellosis in Iran from 1991 to 2008

E Mostafavi

Background & Objectives: Brucellosis is a zoonotic infection transmitted from animals to humans by the ingestion of infected food products, direct contact with an infected animal or inhalation of aerosols. This study aimed to describe the trend and to assess the effect of livestock vaccination rates on reported brucellosis in human across Iran.
Methods: Trends in the epidemiology of human and animal brucellosis in Iran were investigated by analyzing national surveillance data between 1991 till 2008.
Results: The average annual incidence of human brucellosis was 43.24 per100000 population. On average, approximately 27500 new cases have been reported in the country. There was a fall in the incidence rate of Brucellosis over recent years(r=-0.79, P<0.001). In different provinces there was a significant association between the annual incidence of human brucellosis and the annual infection rate of sheep and goats
(r =0.347, P<0.001), the annual incidence of human brucellosis and the annual infection rate of cattle (r =0.327, P<0.001) and the annual incidence of human brucellosis and the percentage of vaccinated cows (r=0.098, P=0.031).
Conclusion: As the prevalence of human brucellosis depends closely with the prevalence of brucellosis in animals, control of the disease in human population needs the cooperation between different public health organizations.

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