Iranian Journal of

  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.

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 : 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 : 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 : Health risk behaviors in adolescence, such as alcohol consumption and smoking, can affect both short-term and long-term health. The aim of study was to estimate the prevalence of health risk behaviors among high school students of Qazvin.

  Methods : The target population of this descriptive study was all high school students of Qazvin who were enrolled in the 1390-91 academic year. The sample group included 160) 239 girls, 271 boys) students that were selected by randomly multistage sampling. The assessment instrument was the Youth Risk Behaviors Surveillance System (YRBSS) Questionnaire.

  Results: Findings indicated that use of hookah was the most popular in girls and boys (59%) as compared with cigarette smoking (32.7%), drug use (7.3%), and alcohol consumption (16.7%). The prevalence of physical violence in and outside the school in one year, carrying weapons to school in a month, cigarette smoking in the school in one month, smoking hookah, and alcohol and opioid use during one month were more frequently observed in boys than girls. The use of the seat belt was more common among girls than boys, and the total prevalence of using the seat belt was 23.7%.

  Conclusion : Given the high prevalence of high risk behaviors among high school students, it is necessary to develop a high risk behaviors surveillance system and use the obtained information to devise preventive measures at the individual, school, and family levels.

  Background and Objectives : Influenza is an acute, contagious, and zoonotic viral disease. It is caused by a virus of the Orthomyxoviridae family. This very infectious is caused by different subtypes of type A influenza virus in the poultry, turkey, and many other birds. In this study, the serum status of rural domestic poultry was investigated for influenza subtype H9N2.

 Methods: This cross sectional study was done from August to October in 2013 in Iranian villages through sampling domestic poultry. The sampling was accidental and was done based on the GIS 11-digit code. In each village, blood samples were taken from at least 28 birds from different species. Then, ELISA was used for screening followed by the HI test. A total of 397 villages and 11546 birds (10145 chickens, 1413 ducks, 397 turkeys, 10 pigeons, and 175 other species) were sampled.

  Results : Three hindered and forty nine (88%) out of 397 villages were positive on ELISA. In addition, 341 villages (86%) were positive and 56 (14%) were negative on the HI test for antibody titers. Also, among the considered variables, weather was a risk factor and the prevalence was significantly lower in villages near the rivers, lagoons and lakes (up to a radius of 3 Km).

  Conclusion: The high seroprevalence of influenza H9N2 in rural domestic poultry indicates that the disease is becoming endemic. As there is no eradication policy for influenza H9N2 in Iran, using effective vaccines can reduce the infection with influenza virus in domestic and rural poultry.

  Background and Objectives : Failure to gain weight (FTG) is one of the predominant health issues in children. The aim of this study is application of longitudinal transition model in determining the prognostic factors for failure to gain weight in children under two years.

  Methods: In this study, 363 children under 2 years that were visited at the health centers in the east of Tehran were studied. Samples were selected using the two stage clustering method. The study variables were measured repeatedly in 18 consecutive times. Since the data was longitudinal and are dependent, first order transition model was used to determine the risk factors of failure to gain weight. All analyses conducted in R.

  Results : The mean (±sd) birth weight was 3057gr(± 838) and 6.9% of the children weighed less than 2500gr at birth. Moreover, 231 children (63.6 %) had no FTW until 2 years of age while 23 ( 6.3 %) had three or more episodes of FTW. Diarrhea (P<0.001), weaning (P<0.001), catching cold (<0.001), and teething (P<.001) were significant risk factors of failure to gain weight. To measure the association between weight loss and the weight in the previous visit, the logarithm of odds ratios was used that was significant (P=0.039).

  Conclusion: The association between two consecutive measurements showed that any failure in weight would affect weight gain in the next period of time and the effect of weight deficiency remains for at least one month.

  Background and Objectives : Previous studies have reported contradictory results regarding the association of Shift Work (SW) and Blood Cholesterol (BC). In this paper, we studied the relationship between SW and BC.

  Methods: The data of this historical cohort study was extracted from annual observations of the workers of Esfahan’s Mobarakeh Steel Company selected through cluster random sampling between 1996 and 2011. In this research, we assessed the effect of SW on BC with controlling BMI, age, work experience, marital status, smoking, and educational status.

  Results : Five hundered and seventy four male workers participated in this study with a mean (SD) age of 41.89 (7.51) and mean (SD) work experience of 16.75 (7.16) years. In this study, after controlling confounding factors, we found no significant relationship between SW and BC.

  Conclusion: Because our study showed no relationship between SW and BC, we can state that this relationship does not exist with more certainty.

  Background & Objectives : Children who work or live on the street are one of key populations at risk for HIV and hard to reach for study or providing services. Here, as a methodological paper, we present the methods and steps of a rapid assessment and response (RARE) project conducted among street children in Tehran.

  Methods : We applied a mixture of qualitative (literature review, focus group discussion, in-depth interview) and quantitative (structure interview) methods to collect data from key informants in non-governmental and governmental agencies as well as street children. We applied targeted sampling to recruit key informants and time location sampling to recruit street children.

 Results: The study was conducted in eight steps to recognize the involved stakeholders, define target population (street children) and to guide on how to approach them (steps 1 to 2: Initial Consultation, Study Area Profile), to map the venues and gathering spots and ethnographic findings crucial for further recruitment into surveys (steps 3 to 5: Contextual Assessment, Population and Setting Assessment, Health Issues Assessment), assess the risk behaviors (step 6: Assessment Behavior Risk and Health), evaluate the response (step 7: Intervention Assessment), and develop an operational plan for improving the services (step 8: Developing an Action Plan).

  Conclusion: RARE is a participatory mix research method with sufficient flexibility to study complex health problems such as stigmatized HIV risk behaviors among high risk and hard to reach populations and also to assess the health sector response.

financial protection against health expenditures is a major goal of health system policymaking. governments have focused on the risk that high health expenditures pose to the financial security of deprived and vulnerable populations. Health systems need to be sure that people receive health services and are protected from the financial burden of health costs. There is no accepted standard for measuring the degree of financial protection. In the literature, there are different approaches to measure the degree of financial protection. Measuring the extent of financial risk is complicated by the fact that the significance of a given risk depends on both the size of the risk and the economic status of the person incurring the risk. Another reason for this complication is that financial risk can also affect the health status. The seriously ill may not receive adequate care if the financial burden on them contributes to a decision not to seek care. Their injury from a lack of risk protection, therefore, may show up as diminished health status and not as a financial loss. The aim of this article is to provide the methodology of the assessment of financial protection against health costs with focus on catastrophic health expenditures. First, we describe and explaine the methodology of measuring the expenditures (based on the WHO approach). Then, we interpret variables used in estimating these costs. Finally, overall discussion and conclusions will be provided in relation to the subject.

Background & Objectives: This study was conducted to evaluate the completeness and geographical representativeness of the hepatitis B surveillance system between 2007 and 2013 in Hamadan Province.

Methods: In this descriptive study, all reported cases in Hamadan Province were extracted. The analytical literature review method was used to examine completeness. We used studies on the prevalence and incidence of hepatitis in Iran published between 2007 and 2013. Sensitivity analysis of the results was performed by simulation program using the R software. Geographical representativeness was assessed and plotted by the ArcGIS software, as well.

Results: Totally, 1378 cases were reported to the hepatitis B surveillance system in Hamadan Province. Most cases were from urban areas and were men, married, and housewives mostly in the age group 20 to 29 and 30 to 39 years. Completeness of the hepatitis B surveillance system was 77%. The hepatitis B surveillance system was not representative in terms of occupation but was representative in terms of age, sex, marital status, and place of living.

Conclusion: We concluded that the hepatitis B surveillance system had a relatively good performance. Moreover, findings of the analytical literature review method are affected by the included studies and interpretation of the results should be performed with caution.

Background and Objectives: Disorders of height and weight growth are the most important health disorders affecting children younger than two in developing societies. Failure to treat these disorders can lead to the increased mortality and mental, emotional or physical disability. The objective of this study was to investigate the growth trends of children and the factors affecting it.

Methods: This retrospective cohort study was conducted on 2030 children younger than two in Khorramabad, Iran who were selected using stratified and cluster sampling. Based on household records, the weight growth trend was recorded as a four-level variable (decline, stagnation, slowness and desirable) and the the height growth trend was recorded as a three-level variable (stagnation, slowness and desirable); finally, the data were modeled using a longitudinal marginal model and the SAS software version 9.2.

Results: The incidence of at least one decline in the weight growth curve and one stagnation in the height growth curve was 14.2% and 10.4%, respectively. The child’s age and the maternal educational level had a significant effect on the growth trends. However, the sex, parity and the exclusive breastfeeding during the first six months had no significant relationship with the growth trends.

Conclusion: Given the results and the relatively high prevalence of growth disorders among children, it seems that increasing the awareness of low literate women about feeding of the children is the most important approach to manage growth disorders. Additionally, health-care professionals should mostly focus on monitoring the growth of children older than 12 months.

Background and Objectives: Children immunization program is one of the most successful and most cost-effective public health interventions and medical programs. The study was designed and conducted in order to assess the vaccination coverage in areas covered by Tehran University of Medical Sciences (TUMS).

Methods: This study was a cross-sectional study of children aged 24 months to 6 years living in urban areas and high-risk and marginal areas covered by TUMS. Six hundred and thirty children were sampled in 90 clusters in urban areas and cluster sampling as probability proportional to size sampling was performed in high risk areas and a sample size of 768 children was determined. The questionnaires were completed by interview.

Results: In high risk 750 children (97.7%, 95% CI: 96.32-98.60%) and 616 children (97.8%, 95% CI: 96.3-98.78%) in urban areas had complete immunization histories. Furthermore, 98.4% of the Iranian children and 95.0% of foreign children (P=0.019) in marginal areas and 98.1% of the Iranian children and 92.1% of the foreign children (P=0.046) in urban areas had complete immunization histories.Ignorance of immunization program (%50) was addressed as the main reason for incomplete immunization.

Conclusion: Universal mass vaccination coverage of the children and equal coverage in marginal and urban areas indicated the success of the authorities in the implementation of this program. Organizing training courses for mothers on the immunization program, providing the required facilities and services, monitoring and supervision of vaccination and also considering the immunization status of foreign children seem to be essential in maintaining and improving the existing status.

Background and Objectives: Diabetic patients are always at risk of hypertension. In this paper, the main goal was to design a native cost sensitive model for the diagnosis of hypertension among diabetics considering the prior probabilities.

Methods: In this paper, we tried to design a cost sensitive model for the diagnosis of hypertension in diabetic patients, considering the distribution of the disease in the general population. Among the data mining algorithms, Decision Tree, Artificial Neural Network, K-Nearest Neighbors, Support Vector Machine, and Logistic Regression were used. The data set belonged to Azarbayjan-e-Sharqi, Iran.

Results: For people with diabetes, a systolic blood pressure more than 130 mm Hg increased the risk of hypertension. In the non-cost-sensitive scenario, Youden's index was around 68%. On the other hand, in the cost-sensitive scenario, the highest Youden's index (47.11%) was for Neural Network. However, in the cost-sensitive scenario, the value of the imposed cost was important, and Decision Tree and Logistic Regression show better performances.

Conclusion: When diagnosing a disease, the cost of miss-classifications and also prior probabilities are the most important factors rather than only minimizing the error of classification on the data set.

Background and Objectives: Catastrophic health expenditure (CHE) is a key indicator for measuring  households' financial protection in the health system. This study was conducted to measure the incidence and intensity of CHE in Iranian provinces 2008-2014.

Methods: When the out-of-pocket (OOP) spending of each household amounts to at least 40% of the household's capacity to pay, it is called a catastrophe. The incidence of CHE in Iranian provinces was estimated using the data obtained from household-expenditure-and-income-surveys. The intensity was calculated as the average extent to which OOPs exceeded the 40% threshold. Descriptive statistics and Mann-WhitneyU test were used for data analysis. The index of disparity(ID) was also calculated for geographical disparities across the provinces.

Results: On average, the lowest and highest CHE incidence and intensity were seen in Fars and South Khorasan provinces respectively. However, the highest and lowest rate for CHE households that actually experienced catastrophe at the 40% threshold belonged to Fars and Kurdistan provinces. The incidence of CHE in rural was more than urban areas. ID of CHE incidence for targeted amount was high and had no constant trend.

Conclusion: CHE incidence had a remarkable difference in different provinces and in the rural area compared to the urban area. Due to the importance of this index in promoting health financial protection, like indexes such as OOP, its distribution in rural and urban areas as well as in different provinces is considerable. It requires a structured format to identify the disadvantaged and low-income groups and provide financial-support and insurance for them.

Background and Objectives: Universities of medical sciences play a vital role in promoting population health and without a doubt, their performance should be measured and evaluated.

Methods: The study was a mixed method study (consecutive combination) and the universities were examined by census. In the qualitative phase of the study, by examining the documents and focused group discussions, the basic framework of the performance evaluation model and its associated challenges were elicited. Then, the policies, objectives, and strategies related to each dimension were extracted and finally, key indicators were selected. Finally, by running Analytic Hierarchy Process method, the weight of dimensions and their key aspects were calculated and the model was implemented.

Results: BSC was designed in accordance with the universities. In this model, four main aspects including population health, services, finance, and development were identified. Then, by reviewing the documents, key policies and strategies, key policies and criteria, primary and secondary strategies were extracted. 13 key indicators were chosen as the final indexes. Moreover, 3 main challenges and 11 secondary challenges were identified. The results of the AHP-BSC model indicated that categorizing (ranking) universities had an impact on their functional status.

Conclusion: The main challenge for evaluating the performance of universities was the presence of a logical connection between policies, strategies, and criteria to have comprehensive and concise indexes for evaluation and ranking.

Background and Objectives: Hirschsprung's disease is one of the congenital movement disorders of the bowel whose accurate and timely diagnosis in childhood is important. The disease occurs due to lack of ganglion cells in the distal part of the digestive system and leads to functional obstruction of the colon. Recently, by the frozen section method, the diagnosis and treatment of the disease is possible through one-stage surgery with fewer complications and lower costs without the need for early colostomy. The aim of this study was to evaluate the validity of frozen section in Hirschsprung's disease.

Methods: this retrospective study was done on 406 frozen section results obtained from patients admitted to Mofid Hospital during 1389-90. We evaluated the frequency of “positive” and “negative” samples and compared them with the results of the permanent section. Moreover, the validity, sensitivity, specificity, and positive and negative predictive value of frozen section were calculated.

Results: After examining 406 frozen section samples and comparison with the results of permanent section, the results were consistent for both methods in 369 cases (90.89%) while the results were inconsistent in 37 cases (9.11%). Frozen section showed 7 (1.7%) false negative and 30 false positive (7.3%) cases. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen section was 94.44%, 89.29%, 79.87%, and 97.28%, respectively.

Conclusion: Frozen section is a good tool for screening and diagnosis. Its power to rule out the disease is rather more than its power to confirm its presence. so it is capable of ruling out the disease in 97% and confirming its presence in 80% of the cases.

Sampling hidden populations is challenging due to the lack of convenience statistical frames. Since most populations exposed to special diseases are hidden and hard to reach, sampling methods that produce representative and efficient samples from the populations have become a study subject for researches all over the world. Because of the unknown probability of selecting samples in conventional sampling methods and also invalidity of generalizing the results of non-probability sampling methods to the statistical population, the necessity of introducing probability chain-referral sampling methods, such as the respondent driven sampling method becomes imperative. In this article, besides introducing the respondent driven sampling method, some of the advantages of this method as relative decrease of the bias of estimates, declining the non-response rate by paying incentives and allocating weights proportional to reciprocal of the social network size of respondents to produce unbiased estimates are described. Moreover, some disadvantages of this method such as lack of producing differential samples by selecting similar seeds, lack of reaching more efficient method than snowball sampling by implementing this method improperly and lack of achieving to equilibrium by existing weak social networks among members of interested population are stated. Another aim of this article is to compare sampling methods of hidden population with the respondent driven sampling method which are the results of implementing this method in different surveys and existing simulations.

Background and Objectives: The Haemophilus influenzae (Hib) conjugate vaccine (HibCV) using a pentavalent formulation was introduced to the Iranian routine immunization program from November 2014. Iran is preparing to include Pneumococcal conjugate vaccines (PCV), as well. Measuring and monitoring the impact of HibCV and PCV are necessary to provide evidence for introduction and sustained administration of this vaccine.

Methods: We addressed the possibility of implementing the "3-tiered approach to IB VPD surveillance" as proposed by the World Health Organization using a feasibility study. Expert opinions were asked to address published literature regarding the study design and methods of measuring the impact of newly introduced vaccines.

Results: There are different methods and study designs to measure the impact of new vaccines, including population based active surveillance systems and vaccine effectiveness studies. The results of the feasibility study and expert opinions highlighted the superiority of a sentinel hospital-based surveillance system in Iran.

Conclusion: It is necessary to conduct some systematic reviews and meta-analyses to provide evidence for the trend of Hib and Streptococcus pneumonia related diseases, i.e. invasive bacterial diseases including meningitis, pneumonia, and sepsis. To monitor indirect effects of the PCV vaccine, implementing periodic surveys on the prevalence of nasopharyngeal carriers are recommended.