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The Concept and Application of the Joinpoint Regression Model in Analyzing the Time Trend in Epidemiological Studies (Case: Liver Cancer due to Alcohol Use in Iran)
Mohammadreza Balooch Hasankhani, Aliakbar Haghdoost, Yunes Jahani,
Volume 19, Issue 2 (9-2023)
Abstract
Background and Objectives: Time trend analysis of factors such as disease and mortality rates is a crucial component of health planning for any community. It allows for a more accurate interpretation of changes over time. This study was conducted to examine the performance of the Joinpoint regression model in analyzing time trends.
Methods: This study aims to first provide a simplified understanding of the Joinpoint regression model and then demonstrate its application on data regarding the 30-year trends of liver cancer mortality due to alcohol consumption in Iran.
Results: The results of the time trend analysis indicate that the age-standardized mortality rate of liver cancer due to alcohol use consumption has decreased by an average of 0.8% per year over the 30-year period in Iran (1990 to 2019). The projections also suggest that this declining trend will continue.
Conclusion: In general, the main advantage of the Joinpoint regression model over other models is its ability to identify periods where significant changes in trends have occurred. Based on the results, the mortality rate of liver cancer due to alcohol use consumption over the 30-year period in Iran can be divided into five periods with different rates of change.

Investigating the Relationship Between Sleep Quality, Sleep Duration, and Frailty Syndrome Among Older Adults in Naqadeh, 2020
Aysan Amrahi Tabieh, Parvin Sarbakhsh, Shamsedin Namjoo, Hossein Akbari, Hamid Allahverdipour,
Volume 19, Issue 4 (3-2024)
Abstract
Background and Objectives: Frailty syndrome significantly impacts the health of older adults, and sleep quality is likely a pertinent clinical factor. Therefore, this study aims to investigate the relationship between sleep quality and sleep duration with frailty syndrome in the older adults of Naqadeh City.
Methods: This cross-sectional study enrolled 347 older adults aged 60 years and above in Naqadeh city in 2020 using 2-stage sampling (first, stratified, and then simple random sampling. Data collection tools included demographic questionnaires, the Edmonton Frail Scale, and the Pittsburgh Sleep Quality Index. Statistical analysis was performed using SPSS25 software.
Results: The study revealed that 30.3% of older adults were frail. Furthermore, a statistically significant correlation was observed between sleep quality and duration with older adults' frailty (r=0.635, p<0.001 and r=-0.170, p<0.001, respectively). Additionally, all frailty domains exhibited a significant relationship with sleep quality, with the most notable associations found in mood, medication use, and cognition domains (r = 0.487, r = 0.397, r = 0.381, respectively).
Conclusion: Probably, the quality and duration of sleep affect the frailty syndrome, so it is necessary to design and implement effective interventions to improve the quality of sleep and ultimately reduce the frailty of older adults, especially in the domains of cognition and mood.

Challenges of the Field of Epidemiology and the Reasons for the Migration of Epidemiologists in Iran: A Qualitative Study
Shoboo Rahmati, Zahra Abdolahinia, Sakineh Narouee, Naser Nasiri, Reza Goujani, Ali Akbar Haghdoost,
Volume 19, Issue 4 (3-2024)
Abstract
Background and Objectives: Given the significant migration of educated individuals, particularly epidemiologists, throughout the country, it is crucial to investigate the underlying causes. This article presents the findings of an extensive study that sought to explore this issue by gathering insights from experts in the field.
Methods: The study was conducted using qualitative methods, employing content analysis. Data were collected between summer and autumn 2023 through semi-structured interviews with 32 epidemiologists in the country. Analysis followed the steps outlined by Lundman and Graneheim, with coding facilitated by MAXQDA software.
Results: The main challenges of epidemiology in Iran were divided into six main categories. In the field of graduate students, problems in recruitment and employment due to the lack of suitable careers, infrastructure and structural problems of the system, research problems and insufficient knowledge about the performance of this field are the most important challenges, and in the field of students, education problems, structural and infrastructure problems were reported. Also, the main reasons for the migration of epidemiologists were the lack of meritocracy and specialization, inappropriate privileges (including the application of unconventional recruitment quotas), lack of a job market and opportunities for graduates, and inadequate compensation and benefits.
Conclusion: Based on the results of this study, it seems that the migration of epidemiologists as a valuable human resource abroad is a serious concern and problem. The lack of a suitable job position and ambiguity in the path to career advancement due to non-adherence to the meritocracy and skill-building system have increased the motivation to migrate in this group.

Different Types of Migration among Skilled Medical Professionals
Aliakbar Haghdoost, Samira Emadi, Azam Bazrafshan,
Volume 20, Issue 2 (9-2024)
Abstract
The migration of elites has become a major challenge worldwide. In Iran, in recent years, there has been a remarkable increase in the number of immigrants. Migration often occurs in different ways including educational migration within geographical borders, field migration, experts avoiding professional activities, and forced or semi-forced migration. Due to the fact that each form of migration can lead to diverse problems, it is imperative to pay attention to the nature and complications of each type of migration in the discussion of human resources management.

Investigating the Factors Related to the Migration of Patients from Iranshahr to Other Regions of Iran for Hospital Care in 2023–2024
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.

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