Iranian Journal of

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Background and Objectives: Domestic violence is the most common type of violence against women which leaves negative effects on the mental health of the mother, children, family, community, and the next generation directly and indirectly. Therefore, this study was conducted to assess the arte of domestic violence and some related factors in married women.
Methods: This cross-sectional descriptive research was carried out with participation of 623 married women attending health care centers of Abadan, Iran who were selected through random cluster sampling from in 2015. The data were collected by a demographic questionnaire and a women abuse scale checklist. Moreover, descriptive and analytical statistics (including T-Student Test, Pearson Correlation Coefficient, One-Way Variance Analysis, Chi-Square Test, and Fisher) were used for data analysis.
Results: The total prevalence of violence was 72.3%, and the porevalence of psychological, physical, life threatening, and sexual violence was 71.7%, 17.8%, 8.3%, and 7.1%, respectively. Moreover, a significant relationship was observed between violence and age, marital satisfaction, family behavior, financial situation, cigarette, alcohol, disease, domicile, occupation, place of birth, and criminal records.
Conclusion: Violence in the city of Abadan, eespecially psychological violence, is highly prevalent. Therefore, it is suggested that domestic violence against women be prevented using approaches such as life skills training starting before marriage such as anger management, proper communication, and problem solving.

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Background and Objectives: Brucellosis is one of the most important zoonosis diseases. The aim was to estimate the seroprevalence of brucellosis in rural cattle, sheep, and goat of Bushehr Province.
Methods: This cross-sectional study was conducted in 2012-2014. For the cattle population, a total of 118 villages and 891 cattle and for sheep and goat population, a total of 202 villages, 526 flocks, 3064 sheep, and 7182 goats were included. Samples were examined with Rose Bengal, 2-mercaptoethanol and wright tests.
Results: In the cattle population, 28 out of 118 villages (20.34%, CI 95%: 13.94%-28.73%) and 20 out of 891 cattle (3.36%, CI 95%:2.28-4.77%) were seropositive. Additionally, in the sheep and goat population, 89 out of 202 villages (44.06%, CI 95%: 37.10%-51.20%), 142 out of 526 flocks (27%, CI 95%: 23.25%-31%), and 335 out of 10246 sheep and goats (3.27%, CI 95%: 2.93%-3.63%) were seropositive.
The prevalence at the individual level of all animals was 3.53%in 2012 which was significantly higher than 2013 ( 2.59%) (P=0.02). Totally, in 3 years, the prevalence of brucellosis in sheep (3.88%) was significantly higher than goats (3%) (P = 0.02) and the prevalence in female animals (3.52%) was significantly higher than male animals (1.58%) (P <0.001).
Conclusion: Due to the reduction of the prevalence, the test and slaughter policy together with the could further reduce and control the spread of the disease in the animal population.

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Background and Objectives: Shift work could threaten health in the long term. The present research aimed to assess the association between shift work and body mass index (BMI) using the multilevel (hierarchical) model during a particular period of time.
Methods: The data of this longitudinal study were collected from a sample of Esfahan’s Mobarakeh steel and Polyacryl companies personnel during 2008 to 2011. Shift work schedule included day work and rotational shift work. The multilevel regression model was utilized for analysing the data and assessing the effect of shift work on BMI by controlling confounding variables including marital status, work expectation, age, company, and educational level.
Results: In this study, of 1368 workers, 42.3% (n=578) and 57.7% (n=790) were day workers and rotating shift workers, respectively. The mean (±SD) age of the day workers and rotating shift workers was 33.07 (±8.66) years and 33.31 (±8.70) years, respectively. After adjusting for confounding variables in a two-level hierarchical model, the association between shift work and BMI was not statistically significant (P=0.837). About 90% of total variation was related to personnel.
Conclusion: According to the results of the present study, no statistically significant relationship was found between shift work schedule and BMI. Thus, other similar studies with a longer follow up period (more than four years) and controlling more confounder factors are necessary to evaluate the relationship between shift work and BMI more accurately.

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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: Drug abuse is one of the medical, social, economic and cultural problems in the present era that increases the morbidity, mortality, and disability among addicts. Iran, due to its adjacency to major centers of opiate drugs production, has a severe and critical condition. Therefore, epidemiological studies are essential for comprehensive management of drug abuse disorders.   
   
Methods: In this descriptive cross-sectional study, demographic and epidemiological data of all people whose cause of death was drug abuse in 2013-14 (1392 Hijri) were extracted by two checklists. Data were then analyzed with SPSS software.

Results: A total of 2957 deaths occurred during the study period. Most deaths occurred in unmarried young males with a low income and education level. The mean age of the subjects was 36.6  12.81 years. The mortality rate from opiate and psychoactive abuse in the whole country was 53.28 in 1000000 population. The most commonly used drugs in the study population were opium, crystal, and heroin in a descending order. Hamedan, Lorestan, and Zanjan provinces with a mortality rate of 150, 101, and 80.06 per 1,000,000 people had the highest mortality due to drug abuse.

Conclusion: Training programs and harm reduction approaches such as methadone treatment and naloxone distribution programs should be designed in high-risk groups to reduce mortality associated with drug abuse.

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Background and Objectives: Colon cancer is the third most common cancer in the world and the fourth most common cancer in Iran. It is very important to predict the cancer outcome and its basic clinical data. Due to to the high rate of colon cancer and the benefits of data mining to predict survival, the aim of this study was to survey two widely used machine learning algorithms, Bagging and Support Vector Machines (SVM), to predict the outcome of colon cancer patients.
Methods: The population of this study was 567 patients with stage 1-4 of colon cancer in Namazi Radiotherapy Center, Shiraz in 2006-2011. Three hundred and thirty eight patients were alive and 229 patients were dead. We used the Support Vector Machines (SVM) and Bagging methods in order to predict the survival of patients with colon cancer. The Weka software ver 3.6.10 was used for data analysis.
Results: The performance of two algorithms was determined using the confusion matrix. The accuracy, specificity, and sensitivity of the SVM was 84.48%, 81%, and 87%, and the accuracy, specificity, and sensitivity of Bagging was 83.95%, 78%, and 88%, respectively.
Conclusion: The results showed both algorithms have a high performance in survival prediction of patients with colon cancer but the Support Vector Machines has a higher accuracy.

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Background and Objectives: Children’s well-being is a multidimensional construct that precedes various aspects of children's lives. This study sought to identify the main areas of children's wellbeing in Iran and their domains, components, and indicators that can be used to measure the well-being of children in Iran.
Methods: In this Delphi study, 30 experts that had educational, research, and executive experiences in various areas of children’s life were consulted. The dimensions, components, and indicators of children’s wellbeing were extracted through a review of the literature and views of the experts and children. The Delphi method was applied in three rounds. The dimensions and components with a higher-than-average score were selected and the percentage of Delphi members’ agreement with related indicators was measured.
Results: Generally, 25 components and 110 indicators related to 7 domains (physical health, safety and risks, economical situation, family, personal and social well-being, education, housing and living conditions) were selected by Delphi members. Consensus on the relevancy of indicators, proportionality, and comprehensiveness was 100%, 95%, and 86%, respectively.
Conclusion: The components and indicators suggested in this study can help to create a composite index for monitoring and comparing the status of the children’s wellbeing between different provinces of Iran in different times. It can also show the strengths and weaknesses of the policies and programs related to children’s wellbeing and help the government to adopt appropriate policies for the whole country as well as each province.

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Background and Objectives: People living with HIV (PLHIV) experience severe psychological pressure in most communities; however, this pressure is more prominent in women. Therefore, it is very important to monitor different aspect of psychological pressure and psychosocial supports in this group of patients. Based on this need, in this study, we assessed the status of mental health, hope, and social support in female PLHIVs visiting health centers of Kerman, Iran.
Methods: In a triangulation study comprising a combination of qualitative and quantitative components, PLHIV women were recruited and their information were collected using Goldberg’s General Health Questionnaire, Sarason’s Social Support Questionnaire, and the Miller’s Hope Scale.
Results: Our findings showed that female patients’ status improved markedly after visiting the health centers (hope: 92%, general health: 80%, social support: 93%). In addition, the results showed a strong positive the correlation between general health and hope (r=0.61, P<0.0001).
Conclusion: Our results showed that such multi-disciplinary service providing centers may substantially improve the quality of life and general health of these women who rigorously need social support.

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Background and Objectives: This study assessed the validity and reliability of the Persian version of the standard "Problematic Internet Use" questionnaire to be used in epidemiological studies.
Methods: This cross-sectional study was performed in 2016. This questionnaire comprises five domains, including preference for online social interaction, mood regulation, cognitive preoccupation, compulsive Internet use, and negative outcomes. The questionnaire has 15 questions with a total score ranges from 15 to 105. A score of 15-45 indicates a normal state, a score of 46-65 shows a mild disorder, a score of 66-85 suggests a moderate disorder, and a score of 86-105 reveals a severe disorder.
Results: Three hundred and seven students (31.1%) had a normal score, 445 (45.1%) had a mild disorder, 191 (19.4%) had a moderate disorder, and 43 (4.4%) had a severe disorder. Based on CVR, 10 questions had a validity of 100%, 3 questions had a validity of 80%, 1 question had a validity of 40%, and 1 question had a validity of zero. The overall validity of the questionnaire was 85.3%. Based on alpha coefficient, the reliability of the domain of preference for online social interaction, mood regulation, cognitive preoccupation, compulsive Internet use, and negative outcomes was 87.6%, 91.1%, 89.8%, 90.8%, and 86.2%, respectively. The overall reliability of the questionnaire was 92.5%.
Conclusion: The validity and reliability of the questionnaire were high; thus, it can be used as a standard tool in epidemiological studies to explore the pathology of injuries related to the Internet and social networks.

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Background and Objectives: Among non-communicable diseases, endocrine, nutritional, and metabolic diseases have increased in recent decades, especially in developing countries. This study was conducted to evaluate and predict deaths from this group of diseases in Iran
Methods: In this analytical cross-sectional study, the study population comprised all deaths of endocrine, nutritional, and metabolic diseases recorded in the Ministry of Health and Medical Education during the years 2006 to 2016. In order to forecast the trend of cause of death, the Lee Carter model was employed in the demographic package 18/1 of the R software version 3/3/1.
Results: The death rate from endocrine, nutritional, and metabolic diseases increased in all age and sex groups from 2006 to 2015. It was predicted that death rate of this group of diseases would reach 197/71 in 100,000 in the total population, 202/97 in 100,000 women, and 188/99 in 100,000 men in 2035.
Conclusion: Several factors play a role in endocrine and metabolic diseases, one of which is aging and aging population. Considering the change in the age structure of the population of Iran by 2035 and the increase in population’s age, an increasing trend is expected in the mortality rate due to these diseases. Because of this rapid increase, policymakers need to adopt intergovernmental population-based plans and policies in this regard.

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Background and Objectives: Delivery is one of the most important services in the health systems, and increasing its effectiveness and efficiency are a health priorities. The aim of this study was to forecast the number of deliveries in order to design plans for using all facilities to provide patients with better services.
Methods: The data used in this study were the number of deliveries per month in Hakim Jorjani Hospital, Gorgan, Iran during the years 2010 to 2016. Due to the over-dispersion of the data and non-compliance with a Poisson distribution, the Poisson hidden Markov model was applied to predict the frequency of monthly deliveries. The model parameters were estimated using the maximum likelihood method and expectation maximization algorithm.
Results: The use of the Akaike criteria revealed the frequency of delivery in different months in the hospital followed a Poisson hidden Markov models with three hidden states, and the mean Poisson distribution in each component was 193.74, 236.05, and 272.61 labors, respectively.
Conclusion: The results of this study showed that government’s encouraging policies have had short-term, limited effects on increasing fertility with minimal effects on the results of the two-year forecast.

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Background and Objectives: The effect of heart diseases on the quality of life is the issue needs attention of health care providers. Improving quality of life is considered as the goals of rehabilitative therapies. This study conducted to evaluate the McGill Quality of Life Questionnaire in patients with heart diseases.
Methods: In this cross-sectional study, 500 patients with heart diseases were recruited from BooAli Sina Hospital and Velayat Hospital affiliated with Qazvin University of Medical Sciences from May to August 2016. The participants completed the McGill Quality of Life Questionnaire. The construct validity (including convergent and discriminant validity) and Reliability using the Cronbach’s alpha, theta, and McDonald's Omega of the McGill Quality of Life Questionnaire were evaluated. The structure of the Questionnaire was assessed using factor analysis.
Results: Three factors, including overall view of the quality of life, physical aspect, and psychological dimension, were extracted. Model fit indexes confirmed a good fit of he McGill Quality of Life Questionnaire (Comparative of Fit Index: CFI=.918, incremental fit index: IFI=.919, Adjusted Goodness of Fit Index: AGFI=.844, RMSEA=.079, Minimum Discrepancy Function by Degrees of Freedom divided: CMIN/DF=2.97, Parsimonious Normed Fit Index: PNFI=.681, Parsimonious Comparative Fit Index: PCFI=.709). Convergent and divergent validity, internal consistency, and construct reliability of the questionnaire were confirmed.
Conclusion: The findings revealed that the three-factor model of the McGill Quality of Life Questionnaire has satisfactory validity and reliability. Thus, this questionnaire can be used in future studies to assess the quality of life of patients with heart diseases.

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Background and Objectives: Breast cancer is the most common cancer in Iran. It can be prevented by rapid diagnosis of the disease. Thus, it is necessary to determine the causal relationships between variables related to breast cancer. Bayesian network is a data mining tool that shows the causal relationship between different variables. In this paper, a Bayesian network was applied to find causal relationships between breast cancer variables using a genetic algorithm in a graphical model. 
 
Methods: in this applied study, data were collected from 900 breast cancer patients in Kerman Province from 1999 to 2008. For data analysis, we used a probabilistic graphical model representing the causal relationship between variables.
 
Results: The results showed that surgery was the most important treatment for breast cancer. Based on the conditional and marginal probabilities, the women who underwent surgery had higher hopes of living longer. Moreover, 81% of the patients who did not undergo surgery only received chemotherapy or radiotherapy were less likely to have long lives.
 
Conclusion: People aged 40-65 years are more likely to have breast cancer. Moreover, the variables of age, surgery, chemotherapy, and radiotherapy had a direct effect on the status of the patients and there were direct edges from these variables to the status of the patients.

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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: Tuberculosis is a chronic bacterial disease and a major cause of morbidity and mortality. It is caused by a Mycobacterium tuberculosis. Awareness of the incidence and number of new cases of the disease is valuable information for revising the implemented programs and development indicators. time series and regression are commonly used models for prediction but these methods require some assumptions. The purpose of this study was to predict new TB cases using the hidden Markov model which does not require many assumption.
 
Methods: The data used in this study was the monthly number of new TB cases during 2006-2016 identified and recorded in Hamedan Province. Rorecasting the number of new TB cases was done using hidden Markov models using the hidden Markov package in the R software.
Results: According to the AIC and BIC criterion, two states had the best fit to the data, i.e. the data of this study were a mixture of two Poisson distributions with average number of event 5.96 and 10.2 respectively. The results also predicted the number of new cases over the next 24 months based on the hidden Markov model would be between 8 and 9 new cases in each month.
Conclusion: The hidden Markov model is the best model for prediction using the Markov chain. This model, in addition to detection of an appropriate model for the available data, can determine the transition probability matrix, which can help physicians predict the future state of the disease and take preventive measures befor reaching advanced stages.

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Background and Objectives: The pandemic of HIV/AIDS is spreading rapidly in the Middle East, in particular in Iran. Designing an educational program involves assessment of the educational needs of people with valid and culture-based tools. This study was conducted with the aim of psychometric analysis of an instrument for assessment of HIV/AIDS knowledge based on the Iranian culture in different population groups.
 
Methods: In this psychometric analysis, 58 items related to AIDS knowledge were prepared based on a literature review. Then, the face validity  and content validity of the instrument was determent by the impact item score, content validity ratio (CVR), and content validity index (CVI). The reliability of the scale was assessed by Cronbach’s alpha coefficient and test-retest.
 
Results: Based on face validity and content validity, the research scale had 44 items with an item impact score > 1.5, a CVR > 0.49, and a CVI > 0.79. The Scale had three sections, general knowledge about HIV/AIDS (9 items), knowledge about HIV transmission (25 items), and knowledge about HIV/AIDS prevention (10 items). The Scale also had a high reliability (Cronbach’s alpha coefficient=0.77-0.91, ICC=0.88)
 
Conclusion: The results of the study showed the instrument was a valid and reliable scale for measurement of knowledge about HIV/AIDS.

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Background and Objectives: Evidence suggests that underlying diseases increase the severity of influenza and lead to hospitalization or death. This study was conducted to determine the risk factors associated with hospitalization of patients in Afzalipour Hospital, Kerman, Iran during an outbreak of H1N1 influenza in December 2015.
 
Methods: In this case-control study, the case group comprised 85 patients who were hospitalized for influenza and the control group included 51 patients who had influenza symptoms and were discharged after required evaluations and check-up. The data were collected from both groups on a daily basis for two weeks. For data analysis, descriptive analysis, logistic regression analysis, Lasso Regression, and likelihood ratio were used. Analysis was performed using the Stata version 12 and R software.
 
Results: Among the variables examined, after removal of additional variables, 12 variables were introduced into the multivariate regression. The history of pulmonary disease and diabetes increased the odds of hospitalization following influenza by more than 11 (OR = 11.6, P. value = 0.003) and 9 times (OR = 9, P. value = 0.01), respectively.
 
Conclusion: Underlying disease and factors play a major role in exacerbating the disease. Therefore, the health system should take the necessary preventive measures when outbreaks occur.

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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: Identification of statistical models has a great impact on early and accurate detection of outbreaks of infectious diseases and timely warning in health surveillance. This study evaluated and compared the performance of the three data mining techniques in time series prediction of brucellosis.
 
Methods: In this time series, the data of the human brucellosis cases and climatology parameters of Hamadan, west of Iran, were analyzed on a monthly basis from 2004 (March/April) to 2017 (February/March). The data were split into two subsets of train (80%) and test (20%). Three techniques, i.e. radial basis function (RBF) and multilayer perceptron (MLP) artificial neural network methods as well as K Nearest neighbor (KNN), were used in both subsets. The root mean square errors (RMSE), mean absolute errors (MAE), mean absolute relative errors (MARE), determination coefficient (R2) and intra-class correlation coefficient (ICC) were used for performance comparison.
 
Results: Results indicated that RMSE (23.79), MAE (20.65) and MARE (0.25) for MLP were smaller compared to the values of the other two models. The ICC (0.75) and R2 (0.61) values were also better for this model. Thus, the MLP model outperformed the other models in predicting the used data. The most important climatology variable was temperature.
 
Conclusion: MLP can be effectively applied to diagnose the behavior of brucellosis over time. Further research is necessary to detect the most suitable method for predicting the trend of this disease.
 

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Background and Objectives: Epidemics of diarrhea caused by contaminated food and water occur frequently worldwide, especially in developing countries. The aim of this study was to identify the factors contributing to the development and spread of diarrhea epidemics caused by Shigella  flexneri  in Isfahan in the spring of 2015.
 
Methods: Following the first reports and activation of the surveillance system, a matched case-control study was conducted in 360 cases with diarrhea and 360 controls. Data were gathered using a questionnaire, and conditional logistic regression was used to provide adjusted odds ratios and 95% confidence intervals.
 
Results: Consumption of contaminated fresh vegetable (OR=4.50, 95% CI=2.88-7.01) was the source of the epidemic. Contact with similar patients (OR=7.19, 95% CI=4.26-12.12), presence of similar patients in the family (OR=33.2, 95% CI=13.64-80.82), food consumption on special events (party, wedding ceremony, funeral, etc.) (OR=1.67, 95% CI=1.06-2.62), being a government employee (OR=3.08, 95% CI=1.64-5.78) and being illiterate (OR=2.91, 95% CI=1.10-7.67) were the risk factors of the spread of the epidemic.
 
Conclusion: In this study, consumption of fresh vegetable contaminated with Shigella flexneri was the source of the infection. According to the Epidemic Management Team, contamination occurred due to non-standard wastewater irrigation of agricultural lands. Therefore, it is important to consider the standards of agricultural production and compilation of a comprehensive program to improve the status of the wastewater purification system in the environmental sciences by the relevant organizations to prevent diarrhea epidemics.