Iranian Journal of

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Background & objective: In Iran, cutaneous leishmaniasis (CL) as a health problem is increasing and presenting two epidemiological forms Zoonotic CL (ZCL) and anthroponotic CL (ACL). The objective of the present study was to introduce the CL epidemic in Baft district, Kerman province.
Methods: This study was conducted in 3 villages Soltanabad, Vakilabad and Shahmaran as a census between spring and autumn of 1998 in Orzoeihe region, Baft district. Various epidemiological aspects of this epidemic including prevalence and related demographic factors, diagnosis by direct smears, identification of the causative species by immunological and biological methods were determined.
Results: Population of the 3 villages was 13721 mean 21.8±13.9 years, 50.7% males and 49.3% females.. The prevalence rate of 12.3% with mean age of 16.3±12.1 years were infected. Most of the cases were in 10-20 years of age and in Soltanabad (30.6%). The mean number of lesions was 2.58, majority with ≥2 lesions, frequently located on the legs and hands. No previous history of CL scar were observed. All 100 IFAT, 30 ELISA tests and 18 inoculated mice showed L.major as the overall causative agent.
Conclusions: This is the first epidemic of CL occurred in the southern villages of Baft district with high severity in all age and sex groups in a new agricultural region. Probably the source of infection was the new comers who arrived the region from endemic areas for agricultural purposes and infecting the gerbils. Thus, this new agricultural development has created an extraordinary suitable condition for propagation of rodents and sand fly populations, then the occurrence of the new epidemic in rural residence, consequently.

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London fog obviously revealed the role of air pollution in increasing mortality and morbidity rates associated with this phenomenon but several studies in the 70’s and 80’s couldn’t establish sufficient link between air pollution and death. In the 1990’s, time series studies conducted in a different locations, showed that air pollution levels, even at lower concentrations, were associated with increased rates of morbidity and mortality in several cities in all over the world. Since several studies have been designed for investigating the association between air pollution and health outcomes in recent years with controversial conclusions, this article reviews the latest studies in this field. We also will mention main strengths and weaknesses of epidemiological designs including time-series, case-crossover, cross sectional, panel and cohort studies in indoor and outdoor air pollution epidemiology.

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Background & Objective: the number of people with HIV/AIDS in Iran is increasing. Populations' knowledge and awareness are crucial steps to prevent HIV/AIDS epidemic. This systematic review aimed to assess the level of knowledge and attitude toward HIV/AIDS in Iranian population.
Methods: Reviewing related titles in national and international databanks resulted in 62 eligible studies published between 1998 and 2008. To explore the source(s) of heterogeneity, meta-regression model was used.
Results: Due to the methodological diversity of included studies (e.g. their sampling or data collection methods) pooled estimation of the results were hard to be applied. The mean for knowledge score among 24 eligible studies (including 24,011 individuals) varied between 14.7 and 84.0 out of 100. Among those 16 eligible studies (including 11,104 individuals), the reported mean for attitude varied between 32.6 and 78.4 out of 100.
Conclusion: In overall, it seems that the knowledge and attitude in Iranian population still need to be improved however, the results from our systematic review showed a considerable heterogeneity among the results that can be originated from the diversity of target populations and/or their methodology of included studies. Planning for further targeted programs and modifying public education for more effective schemes are necessary to be emphasized, as there was not a significant change in the level of knowledge or attitude based on the included studies.

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Normal 0 false false false EN-US X-NONE AR-SA Background & Objectives: Human papillomavirus (HPV) infection seems to be the most common sexually transmitted infection. High-risk (HR) human papillomavirus (HPV) prevalence has been shown to correlate well with cervical cancer incidence rates. Since there is little known about the epidemiology of this infection in Tehran, we designed to estimate the prevalence of HPV in some areas in Tehran. 
Methods: Cervical specimens were obtained from 825 married women aged 21-59 years from the general population of Tehran, Iran according to the standardised protocol of the IARC International HPV surveys. HPV was detected using a GP5+/6+ PCR-based assay.
Results: HPV prevalence in the general population was 7.8% (5.1% of high-risk types), with no statistically significant variations by age. Cervical intraepithelial neoplasia was diagnosed in 4.1% of women, of whom 35.3% were HPV-positive. HPV16 was confirmed as the most common type among women with both normal (1.8%) and abnormal (8.8%) cytology. HPV positivity was significantly higher among divorced women, women in polygamous marriages and those reporting husbands' extramarital affairs.
Conclusion: However the prevalence of HPV seems not high in comparison with other international data, more molecular and seroepidemiological survey in national level needs to have a better perspective.

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Background and Objectives: analogues insulin is similar to human insulin but have differences in cell structure that leading to differences in characteristics of pharmacodynamics and pharmacokinetics.
Methods: A systematic review of published studies between 2009 until June 2010 in Cochrane Library (CENTRAL and Cochrane Systematic Reviews), DARE, NHS EEDs, and CRD databases were searched.
Results: Only nine articles were identified to be included in this review. Most of these studies demonstrated that there were no more or less risks caused by rapid acting insulin compared with human insulin in terms of safety. The risk of sever hypoglycemia significantly, reduced by using long acting insulin analogue. Although it has been shown that insulin analogues are not cost effective, some of these studies pointed out that that insulin Aspart 30 compared with other analogues has more cost effectiveness.
Conclusion: Although this type of insulin seems very effective for patients with diabetes, due to the less cost effectiveness in comparison to human insulin, it is recommended that government's resources for this technology will be allocated just to the children and elderly people.

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Background and Objectives: Colorectal cancer is the fourth most common cancer and the fifth cause of cancer-related mortality in Iran. This study aimed to determine the incidence of colorectal cancer in men and women and to investigate its relationship with the human development index (HDI) and its components in Iranian provinces.
Methods: This ecological study was conducted to assess the correlation between age-specific incidence of colorectal cancer in men and women and the Human Development Index. We used the data of the Iranian Cancer Registry and Statistical Centre of Iran. We used a bivariate correlation method to assess the correlation of ASR and HDI. P values less than 0.05 were considered significant. All reported P-values are two-sided. Statistical analyses were performed using the SPSS software version 23.
Results: The highest incidence of colorectal cancer in men was seen in Tehran (78.16), Eastern Azerbaijan (41.14), and Semnan (62.13), and the highest incidence of colorectal cancer in women was seen in Tehran (47.18), Semnan (80.14), and Eastern Azerbaijan (82.12), respectively. The results showed that the incidence of colorectal cancer in men (r = 0.605) and women (r = 0.661) had a positive significant correlation with the Human Development Index (P<0.001).
Conclusion: The incidence of colorectal cancer was high in provinces with a higher human development index. Therefore, evaluation of the incidence of cancer by the Human Development Index and its components can be used to show a clearer picture of the distribution of cancer in each country and may be useful for cancer prevention plans.

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Background and Objectives: Human resources is a key factor in achieving the Millennium Development Goals. Lack of indicators and standard tools for monitoring and evaluating human resources may cause limitations in achieving these goals. This study was done to develop evaluation indicators of human resources in the health sector.
Methods: The present study was carried out using the Delphi technique to extract the indicators of human resources evaluation in 2017. To conduct this study, three independent stages including a review of theoretical concepts, preparation of initial indicators of human resources evaluation, and consensus building were undertaken. The data were collected by a panel of 12 experts and representatives of related organizations in three rounds, with a scorecard designed to score from 1 to 10. In each round, the indexes that attained at least 8 out of 10 by two thirds of the experts were confirmed in the final model.
Results: In the first stage, 220 indicators were identified. The final model of human resources evaluation had 45 indicators in 11 main criteria. Four criteria were accepted at the stage of entrance to job market, (qualified applicants for health education, accreditation, capacity and outsourcing of health education institutions, approval and licensing). Five criteria were confirmed during the work (main indicators of availability and distribution, activity, productivity of labor force, waste and renewal, desirable governance on the information system of labor). Two criteria were accepted at the exit stage (transfer and withdrawal).
Conclusion: Despite the complexity of the human resources assessment, three different stages of the life cycle of the workforce (input, active labor force and output) should be considered for evaluation and monitoring. The indicators presented in this study make it possible to assess and monitor the health workforce.
 

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Background and Objectives: Quantitative and qualitative improvement of human resources inequality have a significant effect on achievement to health system goals. The purpose of this study was to investigate the trend of geographic, supply, and gender distribution inequality of human resources of the Ministry of Health and Medical Education (MOHME) in Iran.
Methods: In this descriptive study, the trend of human resources of the Ministry of Health during the years 2009-2015 was investigated based on gender, level of education, and type of employment. In order to study the inequality, Lorenz curve and Gini coefficient index were used. Data were collected from the Human Resources Office of the Deputy of Management Development and Resources of the MOHME and analyzed by Excel 2013 and Stata-14 software.
Results: In the present study, women had the highest portion with a growth rate of 6.66% in 2015 and a Gini coefficient of 0.29 except in 2011. The highest and lowest growth rate compared to the base year in 2010 was related to specialist doctors (83.12) and general practitioners (-19.61), respectively. The lowest and highest Gini coefficient was related to the associate degree (0.26) and subspecialty (0.45), respectively.
Conclusion: The present study was the first study to investigate the trend of changes in the human resources characteristics of the MOHME at a national level. Since this study only considered the quantity of the trend of human resources changes, it is recommended that the quality of human resources be investigated in the future studies.              

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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: Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infections could affect the prognosis of disease in patients with human immunodeficiency virus (HIV)/AIDS. We aimed to determine HBV/HCV co-infection in HIV-positive individuals; and to compare the characteristics of different subgroups of HIV/HBV/HCV.
 
Methods: In this cross-sectional study, 908 of 2134 newly-registered HIV-positive individuals in the Iranian Ministry of Health in 2016 were recruited. Participants were divided into four subgroups (HBV-/HCV-, HBV+/HCV-, HBV-/HCV+, and HBV+/HCV+). Demographic data and HIV transmission routes were compared between subgroups.
 
Results: Among908 participants, 505 (60.6%) were HBV-/HCV-, 20 (2.2%) were HBV+/HCV-, 318 (35%) were HBV-/HCV+, and 20 (2.2%) were HBV+/HCV+. Mean age of participants was 36.9 years; 67% were male and 47% were married. The commonest high-risk behaviors were unsafe sex (43.5%) and IV drug-abuse (34.4%). There was no statistically significant difference between the mean ages of subgroups. All HBV+/HCV+ ,92% of HBV-/HCV+, 50% of HBV+/HCV- and 52% of HBV-/HCV- were men and the difference between groups was statistically significant (p-value: <0.001). Seventy four percent of HBV-/HCV+ and 80% of HBV+/HCV+ reported IV drug-abuse. Thirty percent of HBV-/HCV- and 40% of HBV+/HCV- were spouse of HIV-positive or high-risk individuals.
 
Conclusion: More than 30% of newly registered HIV-positive individuals in the Iranian Ministry of Health in 2016 were co-infected with either HBV or HCV. Frequency of men, marital status and high-risk behaviors were different in various subgroups.

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Background and Objectives: Human Development Index (HDI) is an important indicator of a country’s development. On the other hand, mortality indicators are the most important indicators of the health of a society. This study aimed to examine the association between HDI and maternal, neonatal, infant, and under-five mortality rates in Iran between 2005 and 2016.
 
Methods: This longitudinal study was conducted using data collected from Iran Statistics Center, World Health Organization, and United Nations Development Program. SPSS software version 22 was used for data analysis. Pearson correlation test was applied to examine the correlation between HDI and mortality rates. Regression analysis was used to measure the effect of HDI on mortality rates.
 
Results: HDI increased from 0.690 in 2005 to 0.774 in 2016 (12% rise). Maternal, neonatal, infant, and under-five mortality rates decreased by 26, 41, 52, and 42% in 2016 compared to 2005, respectively. HDI had a significant indirect association with maternal (-0.973), neonatal (-0.983), infant (-0.739), and under-five mortality (-0.987). An increase of 0.01 in HDI reduced 1 maternal death per 100,000 births. An increase of 0.014, 0.009, and 0.008 in HDI decreased one neonatal, infant, and under-five death per 1000 births.
 
Conclusion: The results showed that increased HDI correlated with decreased mortality rates. Therefore, policy-makers should pay more attention to socio

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Background and Objectives: Gestational diabetes mellitus (GDM) is a medical problem in pregnancy, and its late diagnosis can cause adverse effects in the mother and fetus. The purpose of this research was to estimate the accuracy parameters of a biomarker for early prediction of gestational diabetes in the absence of a perfect reference standard test.
 
Methods: This study was conducted in 523 pregnant women who presented to Mahdieh Hospital and Taleghani Hospital affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran 2017-2018. As a predictor for detecting GDM, beta- human chorionic gonadotropin (β-hCG) measurements were recorded during 14-17th weeks’ gestation in a checklist. The Bayesian latent variable model was used to estimate the sensitivity, specificity, and area under receiver operating characteristic curve (AUC). Bayesian parameter estimation was calculated using the R2OpenBUGS package in R version 3.5.3.
 
Results: The median gestational age was 33 years. In the absence of a perfect reference test, the applied model had a sensitivity, specificity, and AUC of 78% (95% credible interval (CrI): 0.66-0.83), 83% (95% CrI: 0.74-0.89), and 0.72 (95% CrI: 0.64-0.88) for β-hCG, respectively. 
 
Conclusion: According to the results of this study, β-hCG may be an acceptable biomarker for early diagnosis of diabetes in pregnant women in the absence of a perfect reference test.

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Background and Objectives: The main purpose of this study was to compare the predictive power of the Inequality-adjusted Human Development Index (IHDI) with the Human Development Index (HDI) with regard to the share of deaths caused by Non-Communicable Diseases (NCD) among all deaths in the world and Iran.
 
Methods: The data required for this cross-sectional ecological study were extracted from the reports of the United Nations Human Development Program and the WHO in 2015. Pearson correlation test was used to investigate the correlation of HDI and IHDI with the share of deaths caused by NCDs and linear regressions models were used to determine the associations of IHDI and HDI with the dependent variable.
 
Results: At a significant level of P<0.01, the dependent variable showed a strong positive correlation with HDI (0.892) and IHDI (0.899). Simple linear regression showed that HDI alone predicted the dependent variable well (Adj.R2=0.794, P<0.001).However, according to the multivariate linear regression model, when IHDI and HDI were included in the model, IHDI was able to predict the dependent variable well (Adj.R2=0.809, P=0.001), while the relationship between HDI and the dependent variable was no longer significant.
 
Conclusion: Although HDI alone is an important predictor of NCD status, it loses its influence in the presence of IHDI. Therefore, in addition to HDI, IHDI that illustrates the impact of inequality on human development can provide more information on the status of deaths caused by NCDs.
 

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Background and Objectives: Human resources, especially youth work force, are considered as the main capital for every society. Maintaining the quantity and quality of human resources is essential for every policymaking. The present study was conducted to estimate the Years of Life Lost (YLL) due to early death amongst the working age population (i.e. 15-64 years) of two provinces with very different levels of socio-economic development in Iran. For this purpose, premature mortality was compared between Yazd and Sistan & Baluchistan provinces in 2016.
 
Methods: This cross-sectional study used secondary data. The target statistical population of the study was all deaths registered in the age groups 15 to 64 years in the provinces of Yazd and Sistan & Baluchistan during March 2016 to March 2017. The mentioned provinces reflect completely different and unequal development at the national level: Yazd is amongst one of the highly developed regions of Iran, while Sistan & Baluchistan is as one of underdeveloped provinces. The data were obtained from health departments of Yazd and Sistan & Baluchistan provinces’ medical universities. The YLL was calculated according to the standard procedure provided by the World Health Organization.
 
Results: Our findings showed that the lost human capital due to early death was about two times higher in Sistan & Baluchistan compared to Yazd. The main causes of death were unintentional injuries in the younger working age group (15-44 years) and cardiovascular disease and cancers in the older working age group (45-64 years).
 
Conclusion: Causes of death were different in Yazd and Sistan & Baluchistan provinces according to the regional level of development. Therefore, health policies have to be implemented as regional policies. In general, the results showed that as the epidemiologic transition passes, the cause of death changes from causes that are less related to medical conditions and more related to social situations. Consequently, it is required to consider social policymaking when designing health policies.

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Background and Objectives: The health sector will face a shortage of manpower during crises. The sustainability and  retention of human resources during these conditions are vital. The purpose of this study was to explain possible policies and strategies to strengthen health workers during the crisis and prevent them from leaving the organizations and hospitals.
 
Methods: This was a scoping review research to find strategies for retention of human resources during epidemics. English and Persian databases were searched and relevant studies were selected and reviewed. The key pieces of information obtained were then categorized. Finally, suggested efficient policies and strategies were summarized and reported.
 
Results: A total of 168 different articles were collected. After excluding irrelevant studies, 21 articles were selected and fully reviewed. The results were classified into six main categories of policy-making as well as strategies to implement them.
 
Conclusion: Considering the epidemic situations, in order to strengthen and support human resources in times of crisis, it is recommended that policymakers and decision-makers of the health sector focus their attention on six major topics including education reform, financial support, psychological support, social and welfare support, professional support, and development of infrastructures in deprived and crisis-stricken areas. The important point about suggested strategies is that they need to be in accordance with the ongoing situation of their target societies, as we know that underdeveloped, developing and developed countries have a different set of circumstances and therefore require different priorities and policies.

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Background and Objectives: Due to the importance of cutaneous leishmaniasis, the national leishmaniasis project began in 2007 in Iran. The aim of the present study was to evaluate community interventions in changes in the incidence of cutaneous leishmaniasis in Isfahan Province from 2002 to 2018: an Interrupted time series regression analysis.
 
Materials and Methods: The present study was a repeated cross-sectional study. The incidence and 95% confidence interval were used to describe the disease trend. Data were entered into the Excel and analyzed using STATA14 software at a significance level of 5%. Intermittent time series regression analysis was used to evaluate community interventions in changes of leishmaniasis incidence.
 
Results: from 2002 to 2018, the data of 43,904 patients with leishmaniasis was registered in Isfahan Health Centers. The mean (standard deviation) age of the patients was 23.99 (19.03) years. The incidence had a decreasing trend after the interventions in all affiliated cities and the whole province.
 
Conclusion: The preventive intervention programs of the provincial health center have been rather successful and have reduced the incidence of the disease in the years after the intervention, so that despite the large number of confounding and influential factors regarding this disease, preventive intervention programs have led to disease control according to the reported annual incidence.

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