Iranian Journal of Epidemiology

To Determine the Prognostic Factors in Esophageal Cancer using Log-Logistic Regression Model in Iran

M Mahmoodi

Background and Objectives: Each year almost 400,000 people are diagnosed with oesophageal cancer worldwide. Wide variation in incidence has been reported both between countries and in different ethnic groups and populations within a country. The area with the highest reported incidence for oesophageal cancer is the so-called Asian ‘oesophageal cancer belt’, which stretches from eastern Turkey through north-eastern Iran, northern Afghanistan and southern Russia to northern China. In the high risk area of Gonbad in Iran, world age-standardised rates are more than 200 per 100,000 and the male/female ratio is reported as 0.8:1.0.This study aimed to assess the risk factors and demographic factors influencing survival of patients with esophageal cancer in north of Iran using weibull and log-logistic regression models.
Methods: Demographic and clinical data of 359 patients with confirmed diagnosis of esophageal cancer from Babol Cancer registry utilized for our model. parametric and weibull models were employed to analyze the data. The Akaike information criterion (AIC) was also considered as a criterion to select the best model(s). All p values as 0.05 were considered as statistically significant.
Results: The sample study consisted of 62.7% men and 37.3% women. Estimated survival rates in 1, 3, and 5 years following diagnosis were 23%, 15%, and 13% respectively. According to AIC criterion, the hazard rate of non-monotonic and rejection proportional hazards assumption (p<0.05), log-logistic model was more efficient than weibull model. Family history of having cancer in patients showed a significant difference in both models.
Conclusion: It is concluded that early detection of people with a family history of cancer can be effective as an important factor in reducing the risk of death in patients with esophageal cancer.

Exploring the Experiences of Iranian Women with Breast Cancer: A Qualitative Study

AS Sajadian

Background & Objectives: The experience of patients with breast cancer may vary in different cultures. The aim of this qualitative study was to explore the experiences of women with breast cancer in Iran.
Methods: Fifty one participants were recruited from a university-affiliated breast clinic in Tehran. In-depth interviews each lasting approximately one hour per participant were scheduled and conducted in a private room. The interviews intended to motivate the participants to reflect on their life experiences since the cancer diagnosis. The interviews were tape-recorded and were transcribed to elucidate the major themes encountered in the interviews.
Results: The mean age of patients was 48.8 years (SD = 10.5), 44 were married, one was single, and six were widowed or divorced. Forty-eight participants underwent radical mastectomy and 13 patients received breast-conserving surgery. Thirty-five (69%) patients received chemotherapy. Overall eight major themes emerged from the analysis. These were: importance of God and spiritual beliefs, importance of family support especially husbands and children during the diagnosis and treatment, difficult times during receiving mammography results, experiencing an ambiguous condition while losing their breasts, fear of recurrence, concerns about children, and chemotherapy as the worst experience during the course of treatment.

Public Health Customers’ Experiences of Health Accessibility: A Phenomenological Study

S Parvizy

Background & Objectives: Custom-orienting is a critical issue for public health service. Peoples with a variety of developmental health care needs and perspectives are health care clients. Health accessibility through “Primary health care” has been approved and emphasized in Alma Ata in 1978. It is important to have a clear and transparent understanding of clients’ health needs and problems that would enable us to address such needs and prevent the negative consequences that might otherwise ensue. The aim of this study was to understand and gain deeper insight into health service customers’ lived experience of public health accessibility.
Methods: This study has been conducted with a phenomenological approach. Max van Manen six steps method of hermeneutic-phenomenology has been used. Nine health care clients were selected purposefully and interviewed semi-structured.
Results: The results of this experiment revealed the following six themes: to encounter with holistic learning chance, custom-oriented communications, qualified health care service, appropriate time-place health services, equality- orienting, and individual participation.
Conclusion: The participants believed that health accessibility is something more than just to have health services. Therefore, health education and social equality will bring about optimum health services. To develop multi-dimensional learning and to promote individual participation will be useful for more community empowerment.

Seroepidemiology of Human Hydatidosis by ELISA Method in East-Azarbaijan Province in Iran in Year 2009

Y Garedaghi

Background & Objectives: the aim of this study is seroepidemiological survey of human Hydatidosis by ELISA method in East-Azarbaijan province. Methods: Totally 1500 serum samples were collected from patients referred to different health centers in 8 cities of East-Azarbaijan province. All the sera were examined using ELISA test.
Results: Nineteen cases (1.28%) were positive for human hydatidosis in East-Azarbaijan province using ELISA test. From these cases, 8 cases (0.93%) were from urban areas and 11 cases (1.8%) were from rural areas. 1.76% of females and 0.83% of males were positive and age group 30-40 years old had the highest rate of positivity (1.66%). There were no statistically significant different between gender and age groups and residency area.
Conclusion: According to results of this study the highest rate of positivity was seen in Sarab city (2.17%). The possible reason of this difference could be to live the highest rate of rural population of East-Azarbaijan province dwelling in this city.

To Evaluate of Efficacy of Education based on Health Belief Model on Knowledge, Attitude and Practice among Women with Low Socioeconomic Status Regarding Osteoporosis Prevention

L Salehi

Background & Objectives: Osteoporosis is major public health concern affecting millions of adults particularly older adults and women worldwide. Designing effective educational intervention is principle in any health promotion program. The purpose of this study was to evaluate the efficacy of an educational intervention based on health belief model on knowledge about, attitudes toward and practice of prevention osteoporosis among women with low socioeconomic status in Isfahan.
Methods: The study population consisted of 14 women with low socioeconomic status and under 60 years old. A valid and reliable questionnaire developed and used as measurement tool for initial and final assessments in this program. In addition calcium intake and vitamin D, physical activity and exposure to the sun were assessed.
Results: The mean age of the participants were 40.8 ± 10.52 years. The mean score of all parts of health belief model (except for perceived barriers), knowledge, sun exposure, and physical activity after educational intervention compared to before intervention, were increased significantly. There was no statistically significant difference between daily calcium and vitamin D intake before and after intervention.
Conclusion: It is concluded that the HBM Model– based educational program on Knowledge and belief regarding Osteoporosis prevention seems practical and effective. However more research should be done to find out more effective intervention regarding optimal calcium and vitamin D intake.

Pattern of Drowning and its Burden in Northern Provinces of Iran (Gilan and Mazandaran) in 2008

H Soori

Background & Objectives: Drowning is a major and serious public health problem in the northern provinces of Iran. It has significant opportunities for prevention. The aim of this study was to review the epidemiological pattern and burden of drowning in northern area f Iran.
Methods: To examine the incidence and characteristics of drowning in recreational water settings, we analyzed all available data from death registry in 2008 year in Mazandaran and Gilan provinces, located in north of Iran, through a retrospective study. Collective form was based on standard World Health Organization and then the burden of drowning was calculated.
Results: During 2008, 158 indigenous (88.6% male and 11.4% female) people from these provinces died due to drowning. The mean age of the drowned was 26.4 (SD=16.2) years. The drowning death rate was 2.9 per 100,000 population in two provinces. Most of cases (85.4%) of drowning occurred in sea and majority of death was in August (29.7 percent). Number of years lost was 4110 equivalent of 76.1 per 100,000 respectively. Most DALYs was seen to age group 10-19 years.
Conclusion: It is highly recommended the findings of this project should be considered for any future preventive plan by health authorizes in those provinces.

Occupational Violence in Nursing Students in Arak, Iran

A Abedi

مقدمه و اهداف: در اغلب موارد دانشجویان پرستاری در بالین مورد خشونت فیزیکی و کلامی قرار می گیرند. اگر چه در مطالعات قبلی خشونت علیه پرستاران مورد بررسی قرار گرفته است ولی با این حال توجه بسیار کمی به بررسی خشونت نسبت به دانشجویان پرستاری شده است. هدف از این مطالعه تعیین شیوع و ابعاد خشونت محل کار نسبت به دانشجویان پرستاری در محیط بالینی است.
روش کار: در این مطالعه توصیفی، 271 دانشجوی پرستاری با روش سرشماری شرکت کردند. اطلاعات با استفاده از پرسشنامه ای که با روش اعتبار محتوا و آزمون و آزمون مجدد مورد پایایی و روایی قرار گرفت، جمع آوری گردید.
نتایج: به طور کلی به ترتیب 9/74 % و 38/7% از دانشجویان سابقه خشونت کلامی، فیزیکی را در طی سال گذشته داشتند. اکثر خشونت های فیزیکی توسط بیماران صورت گرفته بود در حالی که بیشتر خشونت کلامی توسط همراهان بیمار صورت گرفته بود. به ترتیب بیشترین پاسخ به خشونت کلامی و فیزیکی این واکنش بود که "متقابلاً داد و بیداد کردم" و "به مربی یا مافوق خود گزارش دادم". از دیدگاه دانشجویان پرستاری شایع ترین عامل مساعدکننده خشونت محل کار، کمبود آگاهی مردم در خصوص وظایف دانشجو در بیمارستان ها بود. بین جنس و ترم تحصیلی دانشجویان با خشونت رابطه معنی داری یافت نشد.
نتیجه گیری: دانشجویان پرستاری اغلب در محیط کارآموزی مورد خشونت قرار می گیرند. باید راه های پیشگیری از خشونت و همچنین نحوه واکنش به خشونت به دانشجویان پرستاری آموزش داده شود و این مباحث در سرفصل درسی دانشجویان پرستاران گنجانده شود.

Psychiatric Symptoms in Patients with Dementia: Prevalence and their Relationship with Caregiver Burden

I Abdollahpour

Background & Objectives: Although it is important to study the association between caregiver burden and individual with dementia, a little has been paid attention to this issue in Iranian population therefore the aim of study was to investigate the frequency of psychiatric symptoms and patients with dementia and caregiver burden associated with individual with dementia.
Methods: In this study 84 patients who had referred to Iran Alzheimer’s Association, along with their caregivers were included in our study. Iranian Version of Caregiver Burden and NPI questionnaires were employed. Factors affecting factors on burden was analyzed by multivariate linear regression.
Results: Our findings showed that there was at least one psychiatric disorder in all patients. Among all psychiatric symptoms delusion and elation had the highest and lowest rates with 39.3 and 2.4 percentages, respectively. Linear regression indicated that “indifference” and “irritability” symptoms were the effective psychiatric symptoms on the amount of burden placed on the caregivers.
Conclusion: The symptom frequency of irritability and other symptoms showed a statistically significant positive correlation with caregiver's NPI-D score. These findings suggest that improvement of treatments for delusions, irritability among dementia patients may reduce caregiver burden.

Pattern of Benzodiazepine use in Outpatients in Mashad, Iran

SH Saeidinejat

Background & Objectives: Benzodiazepines (BDZs) can have both beneficial and adverse effects and are the largest-selling drug group in the world. The potential of dependence with BDZ has been known for almost three decades now. The risk of misuse of and dependence on these drugs seems higher in countries where laws against unlicensed sale of BDZ are not implemented strongly. Since there is little know about the pattern of using BDZ in Iran therefore we designed this study to investigate to find out more about the prevalence of BDZ use in psychiatric patients in Mashhad, Iran.
Methods: Twenty pharmacies were chosen for this study carried out a cross-sectional survey over 3 months in outpatient of pharmacy in Mashad, Iran. Besides basic socio-demographic data the participants were asked if they were taking a BDZ at present and if yes, the frequency, route and dosage of the drug, who had initiated the drug and why it had been prescribed.
Results: Out of a total of 400 participants 17.5% of the participants had been currently using at least one BDZ for 4 weeks or longer. Only 45% of cases the BDZ had been initiated by a doctor. Gender, Educational status, employment status and smoking were associated with an increased likelihood of using BDZ.
Conclusion: The study shows most of the users were taking it for duration and with a frequency which puts them at risk of becoming dependent on BDZ. In most of the cases it had not been initiated by a doctor. Both patients and doctors need to be made aware of the risk of dependency associated with the use of BDZ.

How to Estimate the Sample Size in Special Conditions? ( Part two)

M Marzban

In the previous paper, the basic concepts of sample size calculation were presented. This paper explores main post-calculation adjustments of the sample size calculation in special circumstances such as multiple group comparisons, unbalanced studies (with unequal number of subjects in different groups) sample size correction for missing data, and adjustment for finite population size. In addition, the concept of design effect in multi-stage sampling