Iranian Journal of

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Background and Objectives: completeness of registration is used as one of the measures of the quality of a cancer registry, which is the degree to which reportable incident cases of cancer in the population of interest is actually recorded in the registry.

Methods: After removing the duplicates, a total of 471 new cases of esophagus cancer reported by three sources of pathology reports, medical records, and death certificates to Ardabil Province Cancer Registry Center in 2006 and 2008 were enrolled in the study. The incidence rate was estimated based on the capture-recapture method and the use of the log-linear models. BIC, G2 and Akaike statistics were used to select the best-fit model.

Results: In this study, a model with linkage between pathology reports and medical records and a model with death certificates alone, independent of the previous two sources, was the best fitted model. The estimated total completeness of esophagus cancer in 2006 and 2008 was 36% .The source that had the most completeness for esophagus cancers was pathology reports with 21.17%. The estimated incidence rate calculated by the log-linear method for the years 2006 and 2008 was 49.71 and 53.87 per 100,000 population, respectively.

Conclusion: Based on the obtained results, it can be concluded that the low degree of completeness in Ardabil Province requires some changes in data abstracting and case finding such as the use of personal national code and electronic health records to create a more accurate cancer registry.

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Background and Objectives: Colorectal cancer is the fourth leading cause of cancer death worldwide.  Annually 1430000 cases would be diagnosed and half of these people would die of the disease. In Iran, colorectal cancer is the fifth common cancer among men and is the thirdamong women. This study was designed to estimate survival rates for patients with colorectal cancer and related factors.  

Methods: During the 1384 to 1388 years 24,807 patients diagnosed with colorectal cancer were recorded in the Cancer Registry of the Ministry of Health and Medical Education. Age, gender, marital status, education, occupation, place of residence, tumor diagnosis, the clinical and demographic factors in colorectal cancer as effective on survival entered in Aalen’s additive hazard model and diagram Aalen's was used to study the effects of these factors over time. R 3.2.0 software was used for data analysis.

Results: Stage of tumor had a significant association with survival rates. In this study 1 to 5 year survival rate for patients with stage II tumors, was 100%, 98%, 96%, 93% and 93% respectively and for patients with stage III tumors 99%, 97%, 94%, 90% and 84%, respectively.

Conclusion: In spite of using Cox model in survival analysis by many researchers, Aalen’s model may yield new insights in prognostic studies of survival time of patients with colorectal cancer over time. Our results suggest that early detection of patients in primary stage is important to increase survival.

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Background and Objectives: Ahvaz has become one of the most polluted cities in the world. Only on 11 November 2013, over one thousand residents in Khuzestan Province attended the nearest health center with severe symptoms, particularly shortness of breath, cough, wheezing, and high blood pressure. During a week, more than 7 thousand patients were registered with this syndrome. This study was conducted to investigate the evidence for the confirmation of an epidemic in acute respiratory syndrome among the residents of Ahwaz in November 2013.

Methods: In this cross-sectional study, we evaluated the data of the use of drugs related to acute respiratory attacks from November 2008 to 2013 in Ahvaz. Then, we conducted a descriptive study on the general population. The sample size was 120 and the study participants included different segments of the general population. The data collection tool was a researcher-made questionnaire and the data were analyzed using SPSS.18.

Results: The use of the respiratory drugs increased from 2008 to 2013. The drug consumption was markedly higher in November 2013. In the study of the general population, 93% of the participants declared that they had never seen a similar event, and 92.5% mentioned that they had never heard of a similar occurrence.

Conclusion: Due to the significant increase in respiratory medicine in November 2013 and the unexpected nature of the event, an epidemic seems to be obvious.

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Background and Objectives: Taking into account the roles and positions of WHO Collaborating Centers (WHOCCs) in the furtherance of national goals and the great impact of their interaction as well as cooperative relations between these centres, this study was conducted to assess the current status of WHOCCs, identify opportunities and threats, and provide practical solutions to solve WHOCCs problems.

Methods: This cross-sectional study was conducted using an open-ended questionnaire in 2014. The questionnaire revolved around the WHOCCs' status in terms of goal achievement, manpower problems, financial resources, communications, as well as suggestions to solve problems in these domains. These findings were approved in the second convention of the heads of WHOCCs in Kerman in 2014 and the questionnaires of the second phase were distributed and completed by participants. Data were analyzed using the content analysis method.

Results: The majority of the centres assessed their performance regarding the national goals (11.59) in comparison with international goals (14.20), and self-regulated goal setting (14.7o) in an unfavorable condition. Financial problems and lack of recruitment were the most important problems for WHOCCs. The support of the Ministry of Health, WHO, supporting universities, and establishing research networks at national and international levels to foster communication, contracts to share experiences and resources, considering the authors' rights as well as introducing the competencies of centres at national and international levels, were some of the suggestions proposed.

Conclusion: It seems that more support of the WHO, Ministry of Health, and supporting universities is needed to increase financial resources and recruit staff.

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Background and Objectives: In studies in which each person may experience an event at different times, they are recurrent events.One of the most popular approaches in analyzing recurrent event is obtaining an estimate of the means/rate of events at different times. In this context,one of the things that could help to better understand the effect of this factor on the response is determining the variability due to quantitative variables in the rate of events over time. In this study,we applied kernel and B-spline methods to estimate coefficients in the time dependent-coefficients rate model and showed its application in data of psoriasis.

Methods: In this study,data of patients with psoriasis who had a relapse leading to hospitalization in the Dermatology Department of Imam Khomeini Hospital,between 2005 and June 2013 were used. To investigate the relapse rate during these years,time-dependent coefficients rate model was used and the variability of these effects was assessed using the Wald test. Both b-Spline and kernel methods were used for estimating time varying coefficients in the time-dependent rate model.Finally,the results of the methods were compared based on estimates obtained.

Results: The results of this study showed that according to Wald test,the effect of the variables such as the season on the occurrence of psoriasis was significantly different (P-value<0.01).Also, according to the estimated coefficients from both methods,there was a little difference between them.

Conclusion: When the effect of a variable on the occurrence of the events is different at different time, then time-dependent coefficients rate model may provide a better estimate of the effect of variable on response.

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Background and Objectives: By identifying the causes of death, interventions can be designed and implemented to reduce the risk factors of different diseases. The aim of this study is to determine the trend of ten leading causes of death in the Islamic Republic of Iran in 2011.

Methods: The study population comprised all deaths recorded in the death registration system of the Ministry of Health and Medical Education (MOHME) from 2006 to 2011. The data related to causes of death reviewed and modified in terms of quality, underreporting of deaths, and garbage codes using the Global Burden of Disease study methods. Finally, the data were analyzed by sex and age groups.

Results: The leading causes of death were cardiovascular diseases (46.12%), cancers and tumors (13.63%) and unintentional injuries (11.55%) in 2011. The 10 leading causes of death in the general population were myocardial infarction, stroke, transportation-related accidents; blood pressure induced heart disease, other cardiovascular diseases, diabetes, chronic pulmonary and bronchial diseases, gastric cancer, other heart diseases and renal failure.

Conclusion: Deaths from non-communicable diseases still account for a large proportion of total deaths. According to the Heath System Reform Plan in Iran and the need for new interventions, it is very important to register the exact causes of death to design service packages and also evaluate the success rate of ongoing interventions.

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Calculation of Cronbach's Alpha which measures the internal reliability of a tool is easy, but misuse and misconception are widely observed. Common misunderstandings of the Cronbach's Alpha include inability to differentiate between being one-dimensional and consistency, and between raw and standardized alpha. Violations of the assumptions of alpha could also cause an increase or decrease in the calculated alpha. In this paper, we showed that a very large but confusing alpha coefficient could be obtained, particularly when the one-dimensional theory is violated. Also, the use of standard error measurement as an index of the reliability has been presented. Finally, the generalizability of alpha coefficient is also discussed.

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Background and Objectives: Changes in ideals and aspirations of childbearing are important factors in fertility behavior. Nowadays, fertility rate reduction below the replacement level and decreased childbearing ideals are the most common fertility challenges in Iran. So, with the decrease in the fertility rate, it is necessary to be aware of the ideal number of children and its determinants in order to adopt suitable population policies contexts. The main objective of this study was to investigate factors affecting the ideal number of children using Poisson regression model.
Methods: In 2012, 389 ever married women aged 15-49 in Semnan Province were selected using two-phase stratified random sampling method and studied through applying a structured questionnaire. To model the ideal number of children by Poisson regression model, marriage duration has taken as offset and the number of children, job status, education level, marriage type, and resident place were considered as predictors. The model was fitted with SPSS software version 22.
Results: All predictors in this study had significant effects on ideal number of children in Semnan (p-value <0.05). Women’s ideal number of children who had 2 or fewer children, were employed, and had university education with consanguineous and rural  marriage was higher than those who had 3 and more children, were unemployed, and had elementary and secondary education with inter-family and urban marriage.
Conclusion: To model the ideal number of children, since it is discrete and count, a Poisson regression model is more efficient as compared to linear regression model.

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Background and Objectives: Tuberculosis is the most common cause of death among single-factor infectious diseases and is the tenth cause of death among all diseases in the world. The disease is spread mainly from an infected person through close contact with other people living in one place. The aim of this study was to investigate the relationship between the spatial correlation structure and the recovery time of patients with pulmonary tuberculosis in Iran.
Methods: In this applied study, the data of 20554 patients with sputum smear-positive pulmonary tuberculosis in Iran from 1389 to 1393 were used. A parametric accelerated failure time model with spatial frailty and batesian approach was used to analyze the data. The OpenBUGS 1.4 was used for programming and the ArcGIS 9.2 was used for mapping the environmental impact on tuberculosis.
Results: The mean age of the patients was 50.35 years with a standard deviation of 21.6 years. The results showed that the geographical environment, gender, prison condition, degree of smear positivity at diagnosis and location (urban-rural) had a significant impact on the recovery time of pulmonary tuberculosis patients. The recovery time of patients with smear grade 1-9 bacilli, 1+ and 2+ who were treated was significantly shorter than the others.
Conclusion: According to the study, geographical environment and the location have a significant impact on smear positive patients’ recovery time. This impact depends on the degree of smear positivity in some provinces and is independent of it in some other provinces.

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Background and Objectives: Today, justice is one of the main priorities of policy makers, and equitable distribution of health is one of their concerns. The concept of justice is a health policy objective. International human rights framework places particular emphasis on moving towards equity in health through attention to social determinants of health. In this study, for better recognition of available social determinants of health models, seven common determinants of health frameworks are presented.
Methods: This was a comparative study. The research environment included all social determinants of health models in the world, of which seven models were selected by targeted search. The criteria for selection were justice, evidence-based decision-making, strategic and comprehensive approach, and importance of family in health. The models were studied in detail.
Results: In this study, seven models were identified and investigated in terms of level, type, basis and focus area.
Conclusion: There are many models around the world to demonstrate the determinants of health, and each of these models has its advantages and disadvantages. Wider Determinants of Health Model is the most frequently used model in Iran. This research can help policy makers and researchers in selecting models for analyzing social determinants of health according to the dominant discourse.

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Background and Objectives: Menarche is an important issue for teenagers and dysmenorrhea is a common problem in adolescence. This study aimed to determine the menstruation pattern and prevalence of dysmenorrhea in second high school students in the city of Ardabil.
Methods: This research was a cross-sectional study. The study population included all second high school girls in districts one and two of Ardabil in 1394. A sample of 1,600 girls was selected by a two-stage cluster sampling method from 5 schools in district one and 7 schools in district two. A researcher- made questionnaire and a visual analogue scale were used for data collection.
Results: According to the results, the mean age at the first menstruation was 12.88 years. The prevalence of dysmenorrhea was 91.9% (95% CI: %90 - %92). Dysmenorrhea was severe in 25% of the girls. The pattern of menstrual characteristics in students showed that 61.2%, 88%, and 93.2% had regular menstrual cycles, normal menstrual bleeding days, and normal duration of the menstrual cycle, respectively. In this research, 84.8% of the girls stated that their activities were affected by menstruation and 29.7% of the girls were absent due to menstrual pain.
Conclusion: The prevalence of dysmenorrhea is high. It is a common problem in adolescent girls which affects their activities and school attendance. Therefore, it is necessary to educate students regarding menstrual hygiene, and menarche pain control methods.

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Background and Objectives: In 1995, a huge revolution occurred in Iran’s health system when the entire medical-related educa-tion program was integrated into the Ministry of Health. This paper was conducted to provide a review of all studies investigating this integration and to synthesize their results.
Methods: This study was a systematic review and qualitative meta-synthesis of the papers on integration using the Walsh and Downe process. An extensive search of the databases of ScienceDirect, PubMed, EMBASE, ISI, Google Scholar, Scopus, SID, Magiran, and Irandoc revealed 187 articles of which 25 were selected. The content of the studies was analyzed and combined using the Walsh and Downe technique.
Results: The results showed 5 main concepts, including the goals and reasons of the medical education integration, integration achievements, challenges, and barriers to achieving the goals of integration, and the future of integration. The greatest success of the integration program was related to health services, while the least positive effects were related to medical education and research.
Conclusion: A review of available documents shows that not all dimensions of integration have been well analyzed and their economic, social, developmental and scientific effects have not been studied. The majority of the limited studies in this regard were surveys and overview studies and few studies used economic analysis and modeling. Therefore, the effects of the integration cannot be evaluated using the available studies.

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Background and Objectives: Quantitative and qualitative improvement of human resources inequality have a significant effect on achievement to health system goals. The purpose of this study was to investigate the trend of geographic, supply, and gender distribution inequality of human resources of the Ministry of Health and Medical Education (MOHME) in Iran.
Methods: In this descriptive study, the trend of human resources of the Ministry of Health during the years 2009-2015 was investigated based on gender, level of education, and type of employment. In order to study the inequality, Lorenz curve and Gini coefficient index were used. Data were collected from the Human Resources Office of the Deputy of Management Development and Resources of the MOHME and analyzed by Excel 2013 and Stata-14 software.
Results: In the present study, women had the highest portion with a growth rate of 6.66% in 2015 and a Gini coefficient of 0.29 except in 2011. The highest and lowest growth rate compared to the base year in 2010 was related to specialist doctors (83.12) and general practitioners (-19.61), respectively. The lowest and highest Gini coefficient was related to the associate degree (0.26) and subspecialty (0.45), respectively.
Conclusion: The present study was the first study to investigate the trend of changes in the human resources characteristics of the MOHME at a national level. Since this study only considered the quantity of the trend of human resources changes, it is recommended that the quality of human resources be investigated in the future studies.              

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Concurrent with globalization, some changes have been created in the performance of the universities in developed countries that have turned them into a power source for economic development. In this study, generation changes of Iranian universities in the health sector were analyzed by the layer analysis (CLA) framework. The results showed that the status of universities in Iran is moving from the first and second university generations (i.e. education and research oriented) to the third generation (wealth creation). Too much concentration on indexes such as expert human resources training and number of papers and citations in the Iranian universities has led to stagnation in litany and structural layers. Obtaining scientific authority and technology development requires fundamental evolutions of sciences in deeper layers such as Islamic world view, governance of valuable contexts and evolution in the relationship among higher education and the research and technology system with other sectors.     

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Background and Objectives: Cholera is one of the public health ththat has received attention due to climate change and weather variables. In the current study, the trend of cholera and its epidemics was assessed in the last 50 years in Iran based on climatic variables.
Methods: In a retrospective cohort study, all cholera cases and epidemics of the disease in the country (Iran) were assessed using the registry system of the Center for Communicable Disease Control in the Ministry of Health and Medical education (MOH&ME) from 1964 to 2014. Furthermore, the incidence of cholera was evaluated in 2005-2014 by province. The temperature and rainfall data were obtained from the provincial Meteorological Organization. The correlation coefficient test and mixed-effects binomial regression model were used for data analysis.
Results: A significant positive correlation was found between cholera and rainfall (r = 0.168, P = 0.008). A one-millimeter increase in rainfall increased the incidence of cholera by 10.9% but temperature changes had no effect on cholera outbreaks. The incidence of cholera declined significantly by 14.7% each year from 2005 to 2014. The highest incidence of cholera was reported in Sistan-Baluchestan, Qom, Tehran, Kerman and Hormozgan provinces in a descending order.
Conclusion: In recent years, the the overall incidence of cholera has decreased. The occurrence of cholera is an outcome of rainfall in the previous year. Therefore, increased rainfall increases the number of cholera cases in the next year. However, temperature changes are not related to cholera outbreaks.

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Background and Objectives: Life satisfaction is one of the important dimensions of health, which is influenced by health determinants. The aim of this study was to investigate the status of socioeconomic inequalities in satisfaction with life in women aged 15-54 in Iran.
 
Methods: In this cross-sectional study, randomized multistage cluster sampling with equal clusters was done to select the participants. A total of 35,305 women aged 15-55 were enrolled in the study. Data analysis was done in two stages. In the first stage, social and economic inequalities were investigated using the concentration index and concentration curve method. In the second stage, a multilevel method was used to identify the determinants.
 
Results: The mean life satisfaction was 12.81±4.23. The concentration index for dissatisfaction with life was -0.06 [95% CI: -0.1, -0.02], indicating dissatisfaction with life in low socioeconomic groups. The results of multilevel analysis showed that age, marital status, occupation, place of living, education, and the economic class correlated with dissatisfaction with life in women (P<0.05).
 
Conclusion: There is inequality in dissatisfaction with life. Dissatisfaction is concentrated in the poorer groups of the society and varies in different provinces. Socioeconomic variables affect inequality in satisfaction with life in women, which need to be addressed to reduce inequalities.

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Background and Objectives: The cause of death in children under one year can be an important tool for designing prevention strategies and reducing the mortality rate. The aim of this study was to estimate the number of deaths in children under one year using the Mr. Murray’s estimation index in Mazandaran Province, and to compare this estimation with reported cases of civil registration organization.
 
Methods: All deaths of children under one year between 2011 to 2014 registered in hospitals across Mazandaran Province were included in this study. The cause of death as coded in the International Classification of Diseases (ICD-10) was converted to Murray classification. The coefficients in each of the Murray levels were used to estimate actual death cases. We compared this estimation with the number of deaths that is reported annually by civil registration organization. 
 
Results: Seven hundred and sixty four deaths occurred in this period. The leading causes of death in children under one year were conditions of the perinatal period, congenital anomalies and chromosomal disorders, respiratory diseases, and diseases of the cardiovascular system. The Murray method estimated 1711 deaths for the entire Province.
 
Conclusion: the Murray method predicted that from 2011 to 2014, 390-445 children under one year died in Mazandaran Province annually. There is a controversy between the estimates obtained in this study and the number of deaths reported by the civil registration organization, which may indicate a defect in a complete registration of deaths by this organization.

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Background and Objectives: HPAI has economic and public health importance. Aquatic and shore migratory birds are the main reservoirs and the cause of the spread of viruses across countries. The aim of study was risk assessment of the spread of the avian influenza H5 viruses.
 
Methods: In this qualitative study, structured interviews and focus group discussions were used to assess the risk of the introduction and spread of highly pathogenic avian influenza viruses (H5-subtypes) into Iran.
 
Results: Over 300 wetlands, natural and artificial lakes, ponds, and more than 517 bird species (swans, geese, ducks, and coots) are identified in Iran. Weakness in detecting virus entry windows, weakness in passive surveillance of migratory birds, inadequate supervision on hunting of migratory wild birds, movement of  hunted birds without any criteria without the control of the Veterinary Organization, inability to monitor the supply of migratory birds in the LBMs, law weaknesses in dealing with offenders, lack of training for people, presence of suitable conditions for close contacts between wild birds and backyard and industrial poultry, and weakness of research on AI in migratory birds were the most important factors influencing the spread of these viruses.
 
Conclusion: HPAI will be one of the most important challenges for the poultry industry and public health.  Solving this challenge requires national determination, overhead organizational views, collaborative and practical cooperation of related organizations, and short and long-term planning based on the realities of the country.

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Background and Objectives: This research was conducted to investigate the socioeconomic and geographical inequality in mortality from road traffic accidents in Iran in 2016.
 
Methods: In this descriptive cross-sectional study, the data of 16,584 people that died from road traffic accidents in 2016 were received from the Legal Medicine Organization. Theil entropy index was used to determine inequality in geographic areas. Moreover, relative and absolute concentration indices were used to measure inequality in mortality from RTAs across educational levels.
 
Results: The mortality rate from road traffic accident was 21.5 per 100,000 people. Theil index was 0.66 for traffic-related deaths among the provinces, indicating an unequal distribution of traffic injuries caused by traffic accidents among the provinces. When inequality was measured at smaller geographical levels, i.e., among cities in each province, the results indicated a fair distribution across smaller geographic levels. The focus index also indicated a fair distribution of traffic accidents among the deceased sub-classes (concentration index & 95% CI: -0.13 (-0.41; 0.16).
 
Conclusion: Our findings showed that the distribution of mortality from road traffic accidents was unequal at provincial positions. According to our findings, mortality from traffic accidents was distributed equally among the socioeconomic and urban levels. Therefore, health managers can use the findings of this study to develop interventions to reduce inequalities. In addition to targeting factors contributing to known social inequalities in the health and social status, other factors should be considered and applied to evaluate their interventions in the future.

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