Iranian Journal of

Background & Objectives: The aim of this study was to investigate the trend of mortality of children under five years old in Kurdistan Province during 2007 to 2011.

Methods: The data of this descriptive-analytical study on deaths and births was collected from provincial deaths registry system and Civil Registration System during 2007 to 2011. The main indicators including under-five mortality, infant mortality, and neonatal mortality rate during the given period were studied. The relationship between variables was calculated using chi-square test.

Results: The neonatal mortality rate changed from 13.5 per thousand live births in 2007 to 12.2 per thousand live births in 2011. During the same period of time, the infant mortality rate and under-five mortality rate declined from 17.1 and 20.2 to 14.9 and 17.4 per thousand live births, respectively. A significant relationship was found between gender and infant mortality. Among the major causes of mortality, prenatal diseases, especially infant diseases, were the most common cause of death in the neonatal period.

Conclusion: According to the results of this study, although there was a reduction in the under-five mortality rate during these years, the observed decline, especially the decline in infant mortality rate, was very slow. There are still some preventable causes of death in children which require more attention by the health system and researchers

  Background & Objectives : Migraine is the most common type of headache in children. Over 30% of patients have disabilities, so early detection and timely treatment is necessary to prevent attacks, increase learning, and prevent absenteeism. The aim of the study was to determine the prevalence of migraine in children.

  Methods: In this cross - sectional study with two-stage stratified random cluster sampling the International Headache Society (IHS) for migraine diagnosis and (PedMIDAS) questionnaire were completed through interviews with the students’ parents. Data was analyzed with SPSS software and chi-square test.

  Results : Of 1117 children with a mean age of 41.1 ± 9 years, 551 (49.3) were female and 556 (50.7) were male of whom 185 (56.16%) had a headache and 40 (2.16%) had migraine. Most of the time, the pain started on the first day of the week with a moderate intensity. Aggravating factors were physical activity and stress, and alleviating factors were sleeping and resting. The pain was bilateral and was accompanied by nausea and vomiting. The mean number of headache attacks in the past three months was 8.85± 7.65 which lasted for a mean duration of 6.38 ± 8.02 hours with a mean interval of 24.70± 26.21days.

  The frequency of migraine in children by age and sex were not significantly different. More than of the children had a positive family history but were not visited by the doctor. About 79.37% of the students had first degree disability, %54.10 had second degree disability, %9.05 had third degree disability, and % 1.04 had fourth degree disability.

  Conclusion: Given the increasing prevalence of migraine with age and the risk of chronic diseases and individual and social impairment, it is important to prevent headache attacks through early identification and moderation of the aggravating factors and education of non-medical preventive methods.

  Background and Objectives : The aim of this study was to assess the disease trajectory and recurrence rate of pemphigus based on the analysis of the gap time between successive recurrent events. In this regard, the most important associated factors with the risk of recurrence could be explained.

  Methods: This longitudinal study was performed on 112 pemphigus patients who attended the dermatology department of Imam Khomeini Hospital, Tehran, Iran, from March 2006 to January 2013. The study duration was considered from the diagnosis of the disease to December 2013. Recurrent events were analyzed based on the gap time between successive events using the multivariate time dependent frailty model. The time between two recurrent gap times was determined monthly between two successive events.

  Results : Decreasing the gap times between two successive events indicates that the subsequent event after the first recurrence occurs with shorter time intervals. So, the disease trajectory represents an increase in the recurrence rate over time. Based on the results of multivariate frailty model, IgG antibody's level was the only effective factor on the recurrence hazard rate of the patients. Also, this model proved that the frailty effects were time dependent frailties.

  Conclusion: Assessing the disease trajectory and recurrence hazard rate can be achieved through analyzing the gap time between successive recurrent events. This analysis also identifies the factors that influence the risk of subsequent recurrent events.

  Background & Objectives : World Health Organization has recommended the main strategies for the prevention of road traffic injuries on some of the risk factors. This study aimed to prioritize the preventive interventions according to risk factors of road traffic injuries in Iran.

  Methods: The potential impact fraction (PIF) of the main strategies for prevention was analyzed from national traffic police data registry in 2011 in urban and rural roads. PIF was calculated for risk factors of road traffic injuries and joint effect at three counterfactual distributions: theoretical minimum risk level, plausible minimum risk level, and feasible minimum risk level. The priority setting of preventive intervention was performed based on contribution of each risk factor.

  Results : Based on the potential impact fraction of death (PIF calculated using odds ratio of death) the priorities were as follows in order: wearing a helmet by the motorcycle passenger, wearing a helmet by motorcycle rider, and lack of speed management. Risk factors in this study were more important in urban roads and joint effects of risk factors were close to 100 percent

  Conclusion: It is strongly recommended that future interventions focus on the use of the helmet by motorcycle passengers and riders, the use of the seat belt by the passengers, and speed management. Our findings indicated that laws and legislations should be pursued more seriously. Calculation of the potential impact fraction is better than the population attributable fraction and allows for more accurate prediction of the future.

  Background & Objectives : Suicide is a conscious attempt to end one’s life. Evidence suggests that nearly one million people die due to suicide worldwide each year. The aim of present study was to describe the epidemiological and demographic data of suicide victims and related factors in Fars Province.

  Methods: In this cross-sectional study, the demographic and epidemiological data of suicide victims in Fars Province during the 5-year period from April 2007 to March 2011 was collected by a questionnaire. Finally, the data was statistically analyzed.

  Results : The victims were 934 cases. The mean and standard deviation of age for the cases was 32.12 ± 81.29 years. About 72.5% & 27.3% were men & women, respectively. The most common methods of suicide were hanging (n=472, 5.50%) for men and self burning (n=103, 16%) for women. Most of the people who committed suicide (n=411, 44%) were in the third decade of life (20 to 29 years). The most common etiology (53.5%) was unknown.

  Conclusion: Due to the high incidence of suicide in young people and unmarried individuals, authorities need to consider these groups in social planning in Fars Province.

Knowing the population size of rare diseases or special subpopulations like injection drug users (IDUs) is one of the most important challenges in public health and health surveillance systems but it is difficult to estimate these groups. During the last few years, new methods have been suggested to estimate hidden or hard-to-reach populations, one of which is the network scale-up method (NSUM). The NSUM itself includes measuring the personal network size and estimating the prevalence of hidden and hard-to-count populations. In this paper, we basically discussed the indirect methods of calculating the population size, and the history of NSUM and its concepts, and then addressed the estimation of hidden populations with NSUM and the applicable notes for such populations.

Background & Objectives: The standard methods for the comparison of two drugs in a randomized controlled clinical trial in the presence of non-compliance are intention-to-treat or per-protocol approaches. Both approaches have problems with estimation of drug effects, and researchers are not still certain to adopt which one. In this study, the bias of intention-to-treat and per-protocol approaches was calculated using Monte-Carlo simulation. We tried to choose the best approach (based on the AIC index) for comparing Risperidone plus Celecoxib and Risperidone plus Placebo.

Methods: This secondary study was conducted to compare the effect of Risperidone plus Celecoxib and Risperidone plus Placebo among 60 schizophrenic patients. To choose between the intention-to-treat and per-protocol approaches, Monte-Carlo simulation with Ackaike (AIC) and Baysian (BIC) indices was used.

Results: The results of Monte-Carlo simulation showed that when the sample size was small (n=30 or n=60) under fixed conditions of non-compliance equal to 5% and 10%, intention-to-treat had a better goodness of fit than per-protocol based on AIC and BIC. However, increasing the sample size in active and placebo groups (e.g., n=100) showed that per-protocol had a better goodness of fit than intention-to-treat.

Conclusion: When the sample size is large, the per-protocol approach may have a better goodness of fit than intention-to-treat to address the effects of non-compliance in randomized clinical trials.

Background & Objectives: Keeping various species of reptiles as pets has become popular in Iran alongside other parts of the world. On the other hand, Salmonellosis is one of the most important zoonotic diseases and reptiles have been known as reservoirs of Salmonella. Therefore, this study was designed to assess Salmonella infection in reptile pets of Tehran.

Methods: Fecal samples were collected and cultured for Salmonella isolation from 270 reptiles referred to the specialized veterinary clinics in Tehran. Statistical analysis was conducted on the data.

Results: Salmonella was cultivated from 142 samples (52.6%). Salmonella isolates belonged to a variety of serogroups however, more than half of them belonged to serogroups B and C. Most tested reptiles were healthy and most owners were unaware of the risk of Salmonella. Possible contact of these animals with immune-compromised people was recorded in many cases.

Conclusion: The results of this study revealed that considering the fact that reptile pets are becoming more popular in Iran, educating reptile owners who are mostly unaware of the reptile’s safe keeping methods is a necessity. Finally, more studies are suggested to further investigate the role of reptiles in the epidemiology of human salmonellosis in Iran.

  Background & Objectives : The identification of risk factors and their interactions is important in medical studies. The aim of this study was to identify the interaction of risk factors of cerebral palsy in 1-6 years-old children with classification regression methods.

  Methods : The data of this cross-sectional study which was conducted on 225 children aged 1-6 years was collected during 2008- 2009. Classification regression methods (classification and regression tree (CART), adapting boosting (AdaBoost), bagging, and C4.5 algorithm) were used to identify interactions between risk factors. Data analysis was carried out with R3.0.1 software.

  Results : The identified interactions of the factors by a) the AdaBoost method were (consanguinity: sex, previous pregnancies: vaginal delivery, consanguinity: sex: preterm, history of the disease: preterm: asphyxia, consanguinity: sex: asphyxia, history of the disease: sex: small size relative to gestational age, neonatal infection: asphyxia: small size relative to gestational age, history of the disease: sex: asphyxia, preterm: asphyxia: vaginal delivery) by b) the bagging method were (consanguinity: asphyxia, consanguinity: preterm: asphyxia), by c) the C4.5 algorithm were (asphyxia: preterm, asphyxia: consanguinity: history of the disease: preterm), and by d) the CART method were (asphyxia: consanguinity). The sensitivity and specificity of the AdaBoost method was better than other methods (0.941±0.029 and 0.951±0.030, respectively).

  Conclusion : The AdaBoost method could better recognize and model potential interactions between risk factors of cerebral palsy.

  Background & Objectives : In recent years, the World Health Organization has paid more attention to the relationship between health and social conditions as determining the factors affecting people's health in the society. Social health factors (conditions in which people are born, grow up, work, and become old, and also the health system available for them) have caused inequalities in health and require more attention in health development. The purpose of this research was to identify the determining social and economic factors which are effective in mortality in these selected countries during 1998-2009.

  Methods: Countries were divided into 3 groups based on the human development index and 10 countries out of each group were studied randomly. The dependent variable in this research was overall mortality and the explanatory variables were Gini coefficient, unemployment rate, per capita Health expenditure, and also the result of multiplication of per capita income and Gini coefficient. To evaluate and assess the data, the generalized method of moment by Eviews 6 was used.

 Results: The findings showed that the most determining elements affecting the mortality rate in countries with a very high human development index were Gini coefficient (0.02), unemployment rate (0.0001), and the variable obtained by multiplying the Gini coefficient by per capita income (-8.1*10-6). In countries with a high human development index, the most determining elements affecting the mortality rate were unemployment rate (0.005), per capita expenditure (-0.0002), and the variable obtained by multiplying Gini coefficient by per capita income (-3.22*10-6). Also, in countries with a medium human development index, the most determining elements affecting the mortality rate were per capita expenditure (-0.0008), and multiplication of Gini coefficient and per capita income (1.47*10-6).

  Conclusion: It can be concluded that based on the level of development of the countries, various economic and social factors can affect the mortality and health level of those countries. Therefore, it is necessary for the countries to plan for their health system if they wish to eradicate or reduce inequalities and injustices. This plan should be based on their level of development, the factors determining mortality, and the health system of those countries.

  Background & Objectives: Households governed by women have become an important phenomenon worldwide in the second half of the twentieth century. The study of female-headed households shows that this vulnerable social group faces many financial, physical, mental, and emotional problems and experiences stress and anxiety more than men-headed households. This study aimed to determine the quality of life in these households supported by District 9 of Tehran Municipality.

  Methods: This cross- sectional study was performed on female-headed households supported by District 9 of Tehran municipality during 14 months. Data collection tools included a demographic questionnaire, the Iranian version of World Health Organization Quality of Life (WHOQOL-BREF-BREF). The data was analyzed using SPSS software version 16 and descriptive- analytic tests such as mean, standard deviation, and a multiple regression analysis. The significance level in this study was considered α < 5% .

  Results : The mean age of the participants was 50.8 ± 13.8 years, and the majority of the female-headed households were unemployed (71.1 %). The findings in the four domains of quality of life showed that the domains of environment health and social relation received the lowest (9.87) and the highest (12.61) score, respectively. Using multiple regression models, it was shown that the only variables that affected the overall quality of life were age (P< 0.013) and current disease (P< 0.001).

  Conclusion : Findings demonstrated that the authorities should consider planning for effective interventions to improve the quality of life in this vulnerable group of society.

Background and Objectives: Nowadays 60% of deaths and 47% of diseases load worldwide caused by chronic diseases. Considering the different results of the conducted studies, the current study was performed to review the effect of life style educational intervention on improving cardiovascular risk factors.

Methods: In this review, English and Persian databases were investigated. All types of studies were included. There was no time limit. The articles in any other languages but English (except for Persian), and also abstracts presented in international congresses and meetings were excluded. Other studies were included if they had an acceptable JADAD score.

Results: During the primary search, 194 articles were found which through investigations 43 articles were finally included. The articles were published from 1989 to 2013. There were 3 domestic papers. Only two articles (4.65%) did not show any improvement in the risk factors while the others suggested significant improvements in the risk factors following educational intervention.

 Conclusion: Considering the general findings of the reviewed articles, it seems that the majority of the articles confirmed the effect of lifestyle education on cardiovascular risk factors- blood cholesterol, systolic and diastolic blood pressure, and cigarette smoking along with knowledge and attitude in high risk patients. The finding shows the necessity of “lifestyle” educational intervention in patients at risk for cardiovascular events.

  Background & Objectives : Multiple Sclerosis is a chronic progressive disease with several disabilities for patients. Its distribution in the world can be an important clue to study racial, genetic, and environmental factors thus, epidemiologic studies have been a very attractive concept for recent papers.

  Methods: We conducted this retrospective study to determine the prevalence of multiple sclerosis in different geographic areas of Fars (south of Iran). We first evaluated 11 large cities for the prevalence of the disease. In the second stage, we searched for five clinical subtypes of the disease (relapsing remitting, clinical isolated syndrome, progressive relapsing, primary progressive and secondary progressive) in both men and women.

  Results : From 2535 patients, 523 (20.6%) were men and 2012 (79.4%) were women. The prevalence of the disease in the total population of Fars was 54.3 / 100,000. Shiraz had the highest and Firoozabad had the lowest number of patients for each sex. The most common clinical subtype was relapsing remitting in each city, as well. The female-male ratio was 3.8 / 1.

  Conclusion: Fars is a medium to high risk area for multiple sclerosis and women are affected more than men. The most common clinical subtype of multiple sclerosis is relapsing remitting (71%) followed by clinical isolated syndrome (22%).

Recently, capture-recapture studies have been used and researchers tend to use these studies in the health field. Therefore, we discussed the basic concepts of these studies. First, we described capture-recapture studies. Then, the important assumptions and calculations were presented according to the close population assumption. Statistical formulas were presented for two-capture methods and dependency between the two lists was discussed. Then, we addressed more than two capture methods.

  Background and Objectives : recent years, considerable attention has been paid to statistical models for classification of medical data according to various diseases and their outcomes. Artificial neural networks have been successfully used for pattern recognition and prediction since they are not based on prior assumptions in clinical studies. This study compared two statistical models, artificial neural network and logistic regression, to predict the survival of patients with breast cancer.

  Methods: Two models were applied on cancer registry data, Kerman, southeast of Iran, to predict survival. The data of 712 breast cancer patients in the age group 15 to 85 years was used in this study. The logistic regression and three-layer perceptron neural network models were compared in terms of predicting the survival. Sensitivity, specificity, prediction accuracy, and the area under ROC curve were used for comparing the two models.

  Results : In this study, the sensitivity and specificity of logistic regression and artificial neural network models were (0.594, 0.70) and (0.621, 0.723), respectively. Prediction accuracy and the area under ROC curve for two models were (0.688, 0.725) and (0.70, 0.725), respectively.

  Conclusion: Although there were insignificant differences in the performance of the two models for predicting the survival of the patients with breast cancer, the corresponding results of artificial neural network were more appropriate for predicting survival in such data.

Background & Objectives: After an earthquake, casualty information is needed for planning and providing health care. However, developing countries do not have an efficient health information system even in normal conditions. In these countries, health information systems become worse in critical conditions. The aim of this study was to estimate the number of mortalities, limb amputations, and spinal cord injuries after the Bam earthquake.

Methods: In this cross sectional study, the network scale up method was used to estimate the number of casualties. We selected 80 residents of Bam and asked them whether they knew any one with spinal cord injury or limb amputation in three houses on the right and three houses on the left.

Results: The total estimated number of deaths was 54,041 in the earthquake. The number of people with spinal cord injury and limb amputation was 622 and 519, respectively.

Conclusion: For tertiary prevention measures and better resource allocation, an accurate health information system is needed. In the absence of such a system, there are limitations in using direct methods. It sounds that the network scale up method is an appropriate method for estimating such casualties.

Background & Objectives: Bovine Tuberculosis (BTB) is one of the most important zoonoses. Mycobacterium bovis is the responsible agent of BTB in the cattle. The current study was conducted to investigate the determination factors of BTB in dairy farms covered by the tuberculin screening test.

Methods: A herd level case- control study was carried out in 124 (62 cases & 62 controls) dairy farms in the provinces of Tehran, Alborz, Hamedan, Isfahan, Qazvin, Qom, Mazandaran and Semnan. The control farms were individually matched with case farms by farm capacity and distance. Statistical analyses were done by Stata 11.2 using conditional logistic regression.

Results: Proper management of manure (OR=0.12 95% CI: 0.03-0.49), regular flaming of stalls (OR= 0.21 95% CI: 0.04-0.92) and complete fencing around the farm (OR= 0.17 95% CI: 0.03-0.81) decreased while the presence of rodents (rat) (OR= 4.90 95% CI: 1.04-23.01) increased the risk of infection. The interaction among these variables was not statistically significant

Conclusion: According to the results, there is an essential need to pay more attention to rodent control in farms.

  Background & Objectives : Leadership power and management are discussed as sensitive and key elements in the safety issue. A safety leader can provide the necessary incentives for hard work, efficiency, and more productivity in the organization which includes various working groups and also strengthening a sense of individual responsibility to promote the safety performance in order to achieve the organizational goals. This study aimed to determine the validity and reliability of the Safety Leadership Questionnaire in the vehicle manufacturing industry.

  Methods : This cross-sectional study was conducted on 260 employees of Pars-Khodro Company in the manufacturing lines. All samples were selected randomly. The validity of the questionnaire was determined by statistical methods such as exploratory factor analysis, confirmatory factor analysis, and the heterogeneity between questions. Also, the Cronbach's alpha was used in order to investigate the reliability of the questionnaire.

  Results: The results of exploratory factor analysis showed three factors including decision making, control, and incentives explained 66 percent of the total variance. Confirmatory factor analysis represented the appropriate fitness of information with a three-component structure (P<0.001, df = 2, 𝜒 2 = 5.36, CFI = 0.957, RMSEA = 0.089). The Cronbach's alpha coefficient was higher than 0.7 for all three factors.

  Conclusion : In this research, decision making was an important factor in measuring safety leadership. Moreover, the present study represented an indicator which could be used in the other surveys of safety and industrial psychology.

  Background & Objectives : Considering the high prevalence of hypertension and its increasing trend in Iran as the most important known modifiable risk factor of stroke, this study was performed to determine the pattern of hypertension and the related population attributable fraction (PAF) of stroke in Hamadan Province.

  Methods: Blood pressure data of over-19-year-old population of Hamadan Province from 2005 to 2009 was extracted from the non-communicable diseases risk factors surveillance system . The point prevalence and 95% confidence interval (95% CI) of hypertension was reported in the study population according to sex and age groups. The trend of hypertension was depicted using a line plot. To calculate PAF, the data of the prevalence of hypertension in 2009 was used. Corresponding hazard ratio was obtained from the available literature.

  Results : The prevalence of hypertension was 9.4 (8.2 – 10.6) in 2005, 7.5 (5.9 – 9.3) in 2006, 14.2
(12.1 – 16.5) in 2007, 13.8 (11.7 – 16.1) in 2008, and 12.2 (10.3- 14.5) in 2009. The mean and standard deviation of systolic blood pressure was 120.88 (19.73) and 124.19 (19.24) in the participants in 2005 and 2009, respectively. The study results showed that 19.84% of the strokes in Hamadan Province were due to hypertension .

  Conclusion: The results of this study confirmed the considerable contribution of hypertension to stroke in Hamadan Province. Accordingly, policy makers are strongly recommended to consider controlling and preventive strategies for hypertension as a priority .

  Background & Objectives : Longitudinal studies are used in many psychiatric researches to evaluate the effectiveness of treatment. The main characteristic of longitudinal studies is repeated measurements of the patients over time. Since observations from the same patient are not independent from each other, especial statistical methods must be used for analyzing the data. Missing data is an indispensable component in longitudinal. In this study, we examined the effect of comprehensive treatment on social-individual performance in patients with the first episode of psychosis.

  Methods : The data was from a clinical trial involving patients who were admitted to the clinics of Roozbeh Hospital between 2006_2008. We employed a random effect model for the analysis of longitudinal ordinal responses with non-monotone missingness using the R software version 3.0.2.

 Results: The results showed that comprehensive treatment with follow-up at home, age, and family history of the disease had a significant effect on the social-individual performance of the patients. The estimation of the coefficient of age and its standard deviation were 0.05 and 0.03, respectively. The estimation of the coefficient of family history of the disease was -0.82 with a standard deviation of 0.41, and the coefficient of comprehensive treatment with follow-up at home and its standard deviation, were estimated -1.04 and 0.44, respectively.

  Conclusion: The model used in this study showed that the comprehensive treatment with follow-up at home was better because individuals under this type of treatment are more likely to have social-individual performance.