Marzieh Gharanjiki, Abdolhalim Rajabi, Taghi Amiriani, Gholamreza Roshandel, Mohammadali Vakili,
Volume 21, Issue 2 (9-2025)
Abstract
Background and Objectives: Colorectal cancer is the most common gastrointestinal malignancy worldwide, and its incidence is increasing in Iran. Competing risk analysis offers a refined approach to identify factors influencing Colorectal cancer-specific mortality. Therefore, This study was designed and conducted to determine the survival of patients with colorectal cancer and its associated factors.
Methods: The study was a historical cohort. Data of patients diagnosed with colorectal cancer between 2013 and 2019 at Golestan University of Medical Sciences were collected, and patients were followed up until May 4, 2024. Patient survival was estimated, and the cumulative incidence function, as well as competing risk models of cause-specific hazards and subdistribution hazards, were applied for competing risk analysis. Model adequacy was assessed using the Akaike Information Criterion. Analyses were performed in STATA version 17 (α = 0.05).
Results: Of the 811 patients, 366 (45.13%) were women and the rest were men. The mean age and standard deviation were calculated as 58.54 ± 13.87 years. In the multivariable analysis of factors associated with colorectal cancer mortality in the presence of competing risks, variables including gender, age, literacy, ethnicity, and metastasis were statistically significant in both models. Findings indicated that the cause-specific hazard model provided a better fit for analyzing survival outcomes in colorectal cancer.
Conclusion: Competing risk analysis based on cause-specific hazards is recommended in the multivariable analysis of factors associated with colorectal cancer mortality, particularly in the presence of competing risks of death from other causes.
Ebrahim Ghaderi, Ghobad Moradi, Mostafa Salehi-Vaziri, Manoochehr Karami, Ehsan Mostafavi,
Volume 21, Issue 3 (12-2025)
Abstract
Background and Objectives: Over the past century, multiple pandemics have caused the deaths of millions and inflicted serious harm upon the global economy, and humanity is still concerned about the emergence of future pandemics. This paper aims to provide an overview of the upcoming challenges in public health by reviewing previous pandemics and threats, examining past experiences, and analyzing current conditions.
Methods: In this non-systematic review, the Google Scholar search engine was searched using suitable keywords, and studies relevant to the subject were selected.
Results: With increasing population and closer human interactions, the risk of outbreaks of infectious diseases is felt more than in the past. The existence of thousands of pathogens in wildlife, along with the impacts of climate change, globalization, lifestyle, hunting, and environmental destruction, raises the probability of human exposure to these agents. If these encounters lead to genetic changes in pathogens and create new species, the risk of emerging and transmissible diseases to humans will increase. In addition to natural factors, human-related factors including bioterrorism and drug resistance (while not considered direct human actions, they result from human misconduct) must also be considered.
Conclusion: Among various pathogenic microorganisms, viruses are highlighted as the principal agents of future pandemics due to their ability for rapid mutation, persistence in wildlife reservoirs, and the lack of effective preventive and therapeutic tools. What is crucial for countries is to utilize the lessons learned from previous pandemics to increase preparedness through strengthening health systems, employing the one health strategy, and mobilizing all capacities for future pandemics.
Abouzar Raeisvandi, Ladan Mohammadizadeh, Mahsasadat Darb Emamiye, Sakineh Rezaeipoor Kopte, Mahsa Moghanni Yazdi, Elahe Jafari, Marziyeh Amjadi, Zahra Hosseinkhani,
Volume 21, Issue 3 (12-2025)
Abstract
Background and Objectives: Suicidal thoughts and depression during adolescence present significant challenges that have major negative consequences for public health. The current study aimed to assess the effectiveness of a cognitive-behavioral therapy-based strategic program for preventing suicide and depression in adolescents.
Methods: This randomized controlled trial was conducted in the winter of 2025 on 36 adolescents with suicidal thoughts and depression in Qazvin province, Iran. Participants were randomly assigned to either an intervention or a control group. The intervention group received cognitive-behavioral therapy for 6 weeks, while the control group received the standard treatment protocol designed by the Ministry of Health for 4 weeks. Comparisons between groups were made before, immediately after, and three months following the intervention. The Beck Scale for Suicidal Ideation and the Beck Depression Inventory-II were used to assess suicidal thoughts and depression.
Results: The mean difference in suicidal ideation and depression scores (with 95% confidence intervals) in the intervention group compared to the control group was 2.96 (1.19, 4.74) and 5.84 (0.86, 10.81), respectively, immediately after the intervention, and 6.06 (4.51, 7.61) and 11.62 (7.24, 15.99), respectively, at the three-month follow-up. Cognitive therapy had a significant effect only on reducing depression (p = 0.022). Furthermore, the pattern of change in suicidal thoughts over time differed significantly between the two groups (p = 0.021).
Conclusion: The cognitive-based strategic program significantly reduced depression levels among adolescents. These findings highlight the importance of incorporating cognitive therapy into depression treatment programs in health and medical centers. Additionally, intervention programs aiming to reduce suicidal thoughts should be designed with consideration of changing patterns of suicidal ideation over time.
Fatemeh-Sadat Hosseini, Farzad Younesian, Masud Yunesian,
Volume 21, Issue 3 (12-2025)
Abstract
Mahboobeh Naroui, Parya Jangipour Afshar, Aliakbar Haghdoost,
Volume 21, Issue 3 (12-2025)
Abstract
Background and Objectives: This study was conducted to determine the rate and examine factors associated with the migration of patients from Iranshahr to other regions of Iran for hospital care during 2023–2024.
Methods: This cross-sectional study employed an indirect approach. First, patients registered in the SIB system were asked about the size of their close family network. If the patient or their first-degree relatives had traveled outside Iranshahr to receive medical services, they were interviewed. Ultimately, 159 individuals were included. Factors and challenges associated with patient migration were scored on a scale from 0 to 20.
Results: The proportion of individuals who migrated from Iranshahr for hospital services in the past year was 5.9% (95% CI: 5.0, 6.7), equivalent to 6,785 people. The leading factor for migration was the type of illness, with a score of 19.1 (95% CI: 18.5, 19.5). Most patients traveled for gastrointestinal, cancer, and cardiac diseases, with referrals mainly to Kerman and Yazd provinces. Satisfaction with services received, with a score of 17.1 (95% CI: 16, 17.5), was the main reason for repeat referrals. The principal challenges were transportation costs (score 16.6) and accommodation costs (score 16.3).
Conclusion: Poor quality, limited effectiveness, and lack of diagnostic infrastructure were the main drivers of patient migration. To promote access and social equity, strengthening the healthcare infrastructure in this region must be prioritized.
Fatemeh Sedghi, Sahar Mohammadnabizadeh, Fereshteh Najafi, Maryam Mohammadi,
Volume 21, Issue 4 (3-2026)
Abstract
Background and Objectives: Anemia is a major public health concern among pregnant women and is associated with adverse outcomes such as preterm birth, low birth weight, and increased maternal mortality. This study aimed to investigate factors associated with anemia among pregnant women attending comprehensive health service centers in Sarakhs, Northeast Iran.
Methods: In this cross-sectional analytical study, data from 904 pregnant women registered in the Sina system in 2023 were analyzed. Demographic, clinical, and laboratory data were extracted. Anemia was defined as a hemoglobin level below 11 g/dL, and logistic regression analysis was used to assess associations between potential predictors and anemia.
Results: The mean age of participants was 27.2 ± 6.8 years. The prevalence of anemia among pregnant women in Sarakhs was 17.7% (95% CI: 15.2%–20.5%). In multivariable analysis, rural residence was associated with lower odds of anemia (OR = 0.58, P = 0.01), as was non-Sistani ethnicity compared with Sistani ethnicity (OR = 0.44, P = 0.003). A history of low birth weight (<2500 g) significantly increased the odds of anemia (OR = 7.14, P < 0.001). Compared with underweight mothers (BMI <18), those with normal weight, overweight, and obesity had 58%, 71%, and 78% lower odds of anemia, respectively (OR = 0.42, 0.29, and 0.22). Absence of kidney disease (OR = 0.22, P = 0.03) and iron supplementation before pregnancy (OR = 0.50, P = 0.05) were also protective. No other variables showed significant associations with anemia.
Conclusion: These findings highlight the importance of ethnic and geographic factors in the prevention of anemia in pregnancy and underscore the need for targeted interventions, including thalassemia screening and strengthening preconception and antenatal iron supplementation programs, to reduce anemia and improve maternal and child health outcomes.
Rasoul Gholamiveis, Fatemeh Heydarpour, Mehdi Moradinazar,
Volume 21, Issue 4 (3-2026)
Abstract
Background and Objectives: Prostate cancer is one of the most common cancers among Iranian men and has shown a marked increase in both incidence and mortality over recent decades. This study aimed to analyze temporal trends in prostate cancer incidence and mortality in Iran using an Age–Period–Cohort (APC) analytical framework.
Methods: Data were extracted from the Global Burden of Disease Study 2021 for Iranian males aged 45 years and older during 1992–2021. Data were stratified into eight 5-year age groups and six 5-year time periods. APC analysis was conducted using the second-order difference method, and Joinpoint regression was employed to assess temporal trends in risk factors.
Results: In 2021, the age-standardized incidence rate reached 30.05 per 100,000 population, and the mortality rate reached 10.66 per 100,000 representing increases of 105.96% and 14.99%, respectively, compared to 1992. Age effects were positively associated with both incidence and mortality. The period effect peaked during 2002–2006. Cohort analysis revealed that younger birth cohorts exhibited a slower acceleration in incidence rates. Among risk factors, the disease burden attributable to smoking increased by 17.1%, while the protective effects of low calcium intake and low milk consumption diminished over time.
Conclusion: Rising incidence and mortality are shaped by age, period, and cohort effects. The relative decline in younger cohorts underscores the need for targeted prostate cancer screening programs. Strengthening public health education policies and improving access to diagnostic services can reduce the disease burden.
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Volume 1111, Issue 0 (9-2021)
Abstract
