Iranian Journal of Epidemiology

To Identify the Risk Factors in Prematurity Birth in Birjand, Iran: A Case – Control Study

GH Sharifzadeh

Background and Objectives: Preterm birth (PTB) is a major clinical problem which is known to be associated with perinatal mortality and morbidity. The aim of the present study is to identify risk factors associated with PTB in Birjand, Iran.
Methods: One hundred and thirty premature (<37 week) and 130 term newborns were enrolled in this case-control study. It was conducted in Birjand Hospitals during the year 2007. Potential risk factors such as type of delivery, maternal disease, placenta problems, previous history of abortion in mothers, maternal addiction, prenatal care were identified from medical files.
Results: Previous of premature labor (OR=4.68), cesarean section (OR=3.34), pre-eclampsia (OR=7.72), premature rupture of memberanes (OR=11.3), inadequate prenatal care (<4 one) (OR=4.15), and placenta previa (OR=8.96) were found to be risk factors for preterm birth. Polyhydramnios, previous abortion and cervical incompetent with prematurity were not shown to be risk factors for preterm birth.
Conclusion: These findings reinforce the need for control of risk factors of prematurity for better out come.

Applying Segmented Regression Model to Analysis the Trend of Tuberculosis Incidence Rate in Iran Between 1964 -2008

A Kazemnejad

Background & Objectives: Study trend of observed rates changes provide valuable information for need assessment, plan, reload programs and develop indicators of each country. The main objective of this paper is to determine the changes in tuberculosis incidence rate trend in Iran by applying segmented regression model.
Methods: In this study, segmented Linear Regression employed to analyze the trend of changes in pattern of Tuberculosis incidence rate during past 44 years (1964-2008) in Iran. We used least square method and permutation test and Bayesian Information Criteria to decide which of the two segment regression model and poison regression would be better. Data analyzed by Joinpoint3.4 and SAS9.1 software. Results: According the permutation test, it was detected that there were two breakpoints over 1977 and 1993 years (p=0.0108). Incidence rate of tuberculosis during the first 11 years of review had declined with annual percentage change = -10.1%, for second segment it rose upward with 4.3% increase in per year and for end segment TB incidence rate again declined with annually 4.5%. The average annual change of Tuberculosis incidence rate in Iran for at least 10 years has been estimated -4.5 percentages.
Conclusion: The findings of this study have shown that the incidence rate of Tuberculosis decreased after 1992 that interestingly this decline seems faster than estimated by international TB control program. This indicates that preventive and treatment of Tuberculosis programs have been successful in Iran.

Burden of Cesarean Section and Vaginal Delivery in Isfahan, Iran

Z Farajzadeghan

Background & Objectives: The Disability-Adjusted Life Year (DALY) was developed by the World Health Organization (WHO) to measure, compare, and analyze the burden of various diseases. The aim of this study was to estimate and compare the burden of cesarean section (CS) and normal delivery (ND) in Isfahan during 2008 year by employing DALY.
Methods: Burden of CS and ND was estimated based on information provided by hospitals located in Isfahan. The incidence of complications of both vaginal delivery and cesarean section at the time of delivery and 2, 4, 6 weeks after calculated by using hospitals files. Dismod II and STAT.10 software were used to calculate YLD, YLL and DALY of delivery and their complications.
Results: DALYs for cesarean and vaginal deliveries were estimated to be 20.70 years per 1000 deliveries and 8.89 years per 1000 with their complications, respectively. DALY from cesarean section was 23.404 years per 1000 deliveries in private hospitals and 15.67 years per 1000 deliveries for governmental hospitals. DALY from vaginal delivery was 8.98 in private hospitals and 8.137 years in governmental hospitals per 1000 deliveries.
Conclusion: This study showed a considerable burden for cesarean section particularly in private hospitals. This important finding should be considered by health policy makers in Iran.

Knowledge, Attitude and Application of Evidence Based Medicine (EBM) among Residents of Kerman Medical Sciences University

N Khanjani

مقدمه و اهداف: امروزه پزشکی مبتنی بر شواهد بعنوان یک رویکرد نوین و قابل اتکا در علوم پزشکی پذیرفته شده و جهت ارتقاء کیفیت مراقبت های بالینی بیماران مورد توجه قرار گرفته است. هدف این مطالعه تعیین میزان آگاهی و نگرش دستیاران بالینی دانشگاه علوم پزشکی کرمان در مورد مفهوم رویکرد پزشکی مبتنی بر شواهد و بررسی میزان کاربرد آن بود.
روش کار: مطالعه به روش مقطعی و از طریق پرسشنامه ای که روایی و پایایی آن تایید شده بود، در آذر ماه سال 1388 انجام گرفت. داده ها با استفاده از نرم افزار SPSS مورد تجزیه وتحلیل قرار گرفتند.
نتایج: از مجموع 94 دستیار شرکت کننده در مطالعه 3/55% مرد، میانگین سن شرکت کنندگان 7/32 سال و متوسط زمان اتمام تحصیلات پزشکی عمومی آن ها 6/5 سال بود. 3/83 % شرکت کنندگان معتقد بودند که استفاده از EBM درمراقبت از بیماران مفید است، اما فقط 3/5% آن ها اظهار کردند که در بیش از نیمی از کارهای بالینی خود از رویکرد پزشکی مبتنی بر شواهد استفاده می کنند. 3/88% شرکت کنندگان به پیشرفت در زمینه EBM علاقمند بودند. منبع کسب اطلاعات برای تصمیم گیری بالینی، در6/59% دستیاران شرکت کننده کتاب، در 4/41% تجارب کلینیکی توام با کتب درسی و تنها در 2/19% آن ها مقالات بود.
نتیجه گیری: نتایج نشان داد که دستیاران دانشگاه علوم پزشکی کرمان شناخت کمی از پزشکی مبتنی بر شواهد دارند. لذا لزوم برنامه ریزی منسجم در زمینه آموزش پزشکی مبتنی بر شواهد و کاربرد عملی آن احساس می شود.

The Nested-PCR Based Detection of Cutaneous Leishmaniasis Vectors in Jask County, Hormozgan, Iran

K Azizi

Background & Objectives: The city of Jask in south east of Iran has been considered an endemic focus of leishmaniasis. PCR-based techniques can detect lower parasite burdens, reducing the number of false negatives and improving the quantification of Leishmania parasites in the sand fly. The aim of this epidemiological study was to detect vector(s) by PCR techniques in the city of Jask located in Hormozgan province.
Methods: Sand flies were captured using CDC miniature light traps and sticky papers during 2007-2008 and identified by their morphology. DNA extraction performed by Proteinase K and Phenol/Chloroform/Isoamyl Alcohol methods. Leishmania kinetoplast minicircle DNA was amplified by two Nested-PCR techniques using species-specific primers (LINR4-LIN17-LIN19) and (CSB1XR-CSB2XF-LiR-13Z).These primers could differentiate among Leishmania species of Iran.
Results: A total of 8123 sand flies were collected. The fauna was identified as eight species (3 Phlebotomus and 5 Sergentomyia). Phlebotomus papatasi, P. salehi and Sergentomyia theodori were the three most dominant species (59.91%, 17.21% and 7.32% respectively). 60, 50 and 40 parous unfed female specimens of P. papatasi, P. salehi and S. theodori were investigated for Leishmania DNA infection. Leishmania major DNA was detected in 3 (5%) specimens of P. papatasi and 2 (4%) specimens of P. salehi. Anthropophilic index of these two species were 29.6 & 18 percent, respectively.
Conclusion: This study was the first molecular study for detection of cutaneous eishmaniasis vectors in Hormozgan province in Iran. According to the findings of the present study P. papatasi and P. salehi are probable vectors of cutaneous leishmaniasis in this focus.

The Association of Myopia and Overweight in Elementary School Children : a Case- Control Study in Islamshahr, Iran

AR Dorosty

Background & Objectives: Increasing in prevalence of juvenile myopia in recent decades in eastern and western countries, especially in urban elementary school children, suggests that changing in early life style may play an important role in development of myopia. Our aim was to determine the relationships between myopia and overweight in elementary school children of Eslamshahr a city near Tehran, Iran Methods: In a case control study, 240 new myopic primary school children (grade 2-4) identified as cases and 240 children without myopia in the same schools enrolled as control group. Anthropometric information was completed from schools’. Other information about pre-entrancing to school was collected by interviewing their parents. Children having a Body mass index BMI>=85th CDC2000 percentile were identified as overweight. Adjusted odds ratio for overweight was estimated after adjusting other potential risk factors.
Results: Of total 53.3% were girls. 23.8% of children in case group and 10.1% of them in control group were categorized in overweight group. After adjusting for other potential risk factors (family history, breast milk intake, near works, mother`s job and financial position) being overweight was independently associated to myopia (OR: 3.10, 95% CI: 1.9-5.03).
Conclusion: It is concluded that overweight in children in preschool age, is independently associated with increased risk of myopia in primary school children. Therefore health promotion programs in order to change of the life style in this group of children should be considered.

Socioeconomic Inequality in Non-Communicable Disease Risk Factors in Shahroud, Iran

A Alami

Background & Objectives: Non-Communicable disease (NCD) is a main group of diseases which are responsible for a large proportion of the Global Burden of Disease around the world. Although disparities in the NCDs' risk factors can affect the goals of health for all, less attention has been paid so far on this topic. In this study, we investigated socio-economic inequality in the NCDs’ risk factors and evaluated the causes affecting on this inequality in Shahroud, Iran.
Methods: Conducting this survey, we used surveillance data for NCD of 1000 individuals who lived in Shahroud district during 2005. We determine a socio-economic variable which explained social and economic status of the people using Principal Component Analysis. We then evaluated each NCD risk factors at different levels of the socio-economic variable and calculated concentration index for the risk factors. The causes of the inequality were described by decomposition analysis of the concentration indices.
Results: Concentration indices for hypertension, smoking, insufficient physical activity, and unhealthy diet were -0.141, -0.191, -0.046 and -0.091, respectively. Differences of concentration curves of the risk factors from the line of equality were significant but not for diabetes, obesity and high blood cholestrol. Age, being a government employee, being unmarried, living in rural area and low economic status were the most important factors which influence on these inequalities.
Conclusion: Inequality in some NCD risk factors was significant in Shahroud district. More investigations with larger sample size and more appropriate variables to measure socioeconomic status are recommended.

The Epidemiology of Cutaneous Leishmaniasis in the City and Suburb of Bam in 2010: Active case - Finding, Treatment and Health Education of the School Children

I Sharifi

Background & Objectives: Cutaneous leishmaniasis (CL) is one the major health problem in tropical and sub– tropical countries. Bam district in Iran is an old focus of anthroponotic CL (ACL). The aim of this survey was to assess the prevalence rate of CL by case– finding, treatment of cases and training of primary school children in the city and suburb of Bam in 2010.

Methods: All school children in three levels (18501 children) were included. Children were physically examined for presence of sores or scars. Suspected cases were referred to the center for cutaneous leishmaniasis control (CCLC) for diagnosis and the CL positive children were treated, accordingly. School children were trained and also educational and informative pamphlets were given to their parents.

Results: After initial physical examination ,117 suspected school children (6.9%) were referred to the CCLC and 48 children (28 per 10000) diagnosed as CL patients, comprising of 19 females (39.5%) and 29 males (60.5%). Fifteen (31.2%) school children were identified as lupoid leishmaniasis, failure to treatment or non – healing cases.

Conclusion: The prevalence rate was decreased about 18– fold as compared to the previous investigation in 2005. Establishment of the CCLC, active case– finding and subsequent treatment, seem to be a successful model for controlling CL in the endemic countries.

Barriers to the Reporting of Needlestick/Sharps Injuries among Nursing and Midwifery Students in Arak, Iran

N Baghcheghi

Background & Objectives: Nursing and midwifery students are at risk needlestick/sharps injuries (NSIs/Sis). Actual number of NSIs/SIs among students due to insufficient reporting it is not clear in Iran. The aim of this study was to explore the barriers of not reporting of NSIs/SIs among nursing students.
Methods: This descriptive cross-sectional study was conducted in Arak University of Medical Sciences in 2009. 207 and 68 nursing and midwifery students were participated in study, respectively. A questionnaire, consisting two sections of demographic information and questions about exposure to (NSIs/SIs) and frequency and barrier reporting of NSIs/SIs, was completed by students.
Results: According to the findings, 43% and 20.5% of nursing and midwifery students had experienced at least one contaminated NSIs/Sis in the past 12 months. Only 44.9 % (n=40) and 50% (n=7) of the nursing and midwifery who had experienced NSIs/Sis in the previous year, were reported all exposures to NSIs/Sis, respectively. The most important the reasons for not reporting injuries consisted of low probabilities of the infection risk of the injury source, not familiar with reporting process and fear of decreasing evaluation score.
Conclusion: NSIs/SIs and non-reporting of NSIs/SIs were highly prevalent in nursing and midwifery students. More education programs should be directed at students to increase their awareness of about NSIs/SIs. Also nursing and midwifery student’s instructors should give positive responses to nursing students for reporting NSIs/SIs.

Necessity of Standard Classification of Occupation by Researches

B Moghimi Dehkordi

Dear Editor We read with interest the recent original article by Esmailnasab and his colleagues (1) discussing the issue of influencing factors on type 2 diabetes in Sanandajd. The authors are to be congratulated for conducting such an important topic both for healthcare providers and researchers. We have noticed that in that interesting paper the occupational status was classified unclearly into four categories as "housekeeper", "employee", "farmer and free job" and "unemployed" that the journals reviewers have been overlooked this easily. Since one of the main characteristic of occupation is making money, some groups such as "student" and "housekeeper" are excluded from this category. There are several international classifications for occupational status that can be used for national studies in Iran. These categorizations also called "social class" that considered to occupational exposure, amount of income and some other components. One of these classifications is presented by the International Labor Organization (ILO). A number of countries have localized this classification and many countries have used it without changes (2). The latest revised classification (ISCO) has been revealed 11 occupational groups (major group) provides the following (3): 1- Legislators, senior officials and managers, 2- Professionals, 3- Technicians and associate professionals, 4- Clerks, 5- Service workers and shop and market sales workers, 6- Skilled agricultural and fishery workers, 7- Craft and related trade workers, 8- Plant and machine operators and assemblers, 9- Elementary occupations, 11- Armed forces. It seems that with modification of such classifications, we could obtain a national standard categorization for occupation and then would be able to better understanding the role of occupation in development of disease and health problems.