R Rad Goodarzi , A Rahimi Movaghar , E Sahimi Izadian , M.r Mohammadi , M Vazirian ,
Volume 3, Issue 3 (6-2005)
Abstract
The aims of the present study were to assess preparedness and function of health system in the management of withdrawal symptoms in opioid dependents after Bam earthquake, the methods that medical staff used for identification of dependents, the viewpoints of the medical staff as well as opioid dependents about the roles of health system, and the appropriate methods for managing opioid dependence after disaster.
This qualitative study was carried out in the city of Bam, one of its nearby villages and eight hospitals in Tehran and Kerman, admitting earthquake victims. Our analysis was based on 163 semi-structured interviews, with drug abusers, their family members, people living in Bam, service providers, and the authorities.
No specific training for drug abuse was reported by medical staff. No guideline or program was available for prevention and management of drug dependence in disasters. Most of the medical staff had negative attitudes toward involvement in treatment of opioid dependence. During the first two weeks after the earthquake, medical management of the withdrawal symptoms was inadequate. Most of the interviewees suggested managing the withdrawal symptoms with prescribing opioid agonists and then treating the opioid dependence following improvement of physical injuries and stability of social situation.
In disaster situations, the consequences of inadequate management of opioid dependence can be ominous. Such consequences consist of a change in incidence of substance use, intensity of use and dependence, type of substance and route of use to more dangerous ways. Therefore, a practical protocol (disaster planning) is needed for prevention and management of substance dependence in the times of crises.
M Yunesian , A Moradi ,
Volume 3, Issue 3 (6-2005)
Abstract
Traffic accidents compromises a large quantity of peoples annually, and is one of the most important causes of death in Iran. Human factors are amongst of the most leading causes of traffic accident mortality and morbidity and this study is conducted to evaluate the Knowledge, Attitude and Practice of drivers regarding driving laws in Tehran.
Two hundred and twenty drivers were selected randomly in this cross sectional study. Cluster sampling with 10 participant in each cluster was used for selection of participants. 22 points were defined using a random sample of telephone numbers. Distribution points was such as one point were selected in each zone of municipality zones. Ten consecutive drivers passing the specified point were interviewed by an interviewer and a senior officer of Traffic Control Organization of Tehran was responsible for assessment of practices. Reliability of questionnaire was evaluated using alpha chronbach coefficient and construct validity was assessed by Principal component Analysis method. Chi square and odds ratio (OR) were used for assessment of relation between qualitative variables, when appropriate.
Two hundred and twenty drivers were recruited in this study. Suitable Knowledge, Attitude and practice were seen in 67.7, 56.4 and 47.7 percent of respondents respectively. When adjusted using logistic regression analysis, we did not observe any relation between these three variables. There was a significant relation between knowledge and age and also between practice and education, marital status, occupation and type of automobile.
We conclude that practice of drivers of Tehran are weak regarding traffic laws and there is an emergent need for research and intervention in this regard.
Gh.r Jahed Khaniki , A Kamkar , M.a Tehrani ,
Volume 3, Issue 3 (6-2005)
Abstract
A study was carried out to estimate the prevalence of Coagulase – Positive Staphylococcus aureus in milk collected in the milk collecting center in Garmsar city. Ninety-six raw milk samples (84 composite samples and 12 bulk samples) were collected from Garmsar milk collecting center. Raw milk samples were transferred to laboratory in safe conditions. After serial dilution, the appropriate concentrations (10 -2 to 10 -6) were cultured on Baired- Parker agar medium. The plates were incubated at 37 oC for 2 days (48h). After 48 hours' incubation, the colonies with black centers and light areas were used for staphylococcal assay. The coagulase test was done with rabbit plasma and coagulate- positive colonies were then counted. The results showed that mean counts of coagulate-positive Staphylococcus aureus in composite and bulk milk were 5.4 ×10 5 cfu/ml and 3.2 × 105 cfu/ml, respectively. The counts ranged from 8.6 × 10 4 to 2.1 × 10 6 cfu/ml and 1.4 ×10 5to 5.5 × 10 5 cfu/ ml. The standard deviations were 3.5 × 10 5 cfu/ml and 1.4 × 10 5 cfu/ml respectively. It is clear that the milk collected at this facility was rather heavily contaminated with S. aureus. Therefore, it may constitute a health hazard because of the possible production of enterotoxin in the milk consumed by the people. In order to reduce staphylococcal contamination in milk, it is recommended to treat cases of clinical and subclinical staphylococcal mastitis in livestock. Also, it is necessary to use hygienic procedures during the production process as well as transportation and storage.
H Malek Afzali , A.s Forouzan , F Bahreini , A Mowla ,
Volume 3, Issue 4 (7-2005)
Abstract
Natural disasters cause millions of death and disability and major financial losses
world wide every year. The major concern of our health system has already been to
reduce physical mortality and morbidity. While such events may be a considerable
source of stress for the survivors and cause serious and long-lasting psychiatric
complications. The purpose of this study was to assess the function of rescuers in
mental health service delivery to survivors of Bam earthquake in four steps Rescuing,
Emergency services, Transportation of the injured survivors and Treatment in the first
2 weeks after the earthquake.
For reaching the purpose 4 groups of the survivors were selected: first group was the
healthy survivors (>15 years) living in Bam after the earthquake, the second group
was healthy survivors (<15 years) living in Bam after the earthquake, the third group
was the injured survivors admitted in Kerman and Tehran hospitals and the last group
was the Relatives who accompanied the injured survivors. 2 weeks after the
earthquake a questionnaire including questions about, demographic data, function of
rescuers in rescuing and emergency services steps, informing the survivors of their
relatives condition and Condoling with the survivors and mental health services
delivery was filled for each of the cases.
In all groups, more than 85% of the cases who needed help and rescued from the load
of the earthquake were rescued by their relatives and rescuers of the Red Crescent
Society or other governmental organization just had a little portion (5%)in this field.
Only 25%of the cases who needed help and rescuing from the load of the earthquake
were rescued in the first hour after the earthquake. Only 40% of the cases were
sympathized by their rescuers. About 65% of the cases had enough information about
their relatives. 40% of the cases were prevented from crying by rescuers. Only 30% of
the cases said that they knew addict individuals who were hot given alternative
materials. 30/% of the children had played during 2 weeks after earthquake and 42/%
of them had facilities for playing.
Regarding to all studied groups rescue activities, primary care services and transfers
have been performed by relatives and domestic people , therefore general training and
organizing CBO (community Based organization) for providing services in disasters
especially in regions which are at high risk of earthquake will be useful for reducing
the injuries. According to this research rescuers are in serious need of training in
mental health services and that major areas of education need are: using counseling
techniques, providing the necessary information for the survivors and stress
management techniques.
T Aghamolaei , H Eftekhar , K Mohammad , A Sobhani, D Shojaeizadeh , M Nakhjavani , F Ghofranipour ,
Volume 3, Issue 4 (7-2005)
Abstract
Diabetes is a chronic disease of lifelong duration, and its management requires a
fundamental change in the patient’s lifestyle. The aim of this study was to evaluate the
efficacy of a health education program on the knowledge, behavior, HBA1c and
health related quality of life of diabetic patients after following the patients’
participation in the program.
The study population consisted of type 2 diabetic patients attending at Bandar Abbas
diabetic clinic. Eighty patients were randomly selected and they were randomly
assigned to two groups, 40 to the intervention and 40 to the control group. At the
initial visit and 4 months after education, knowledge and behavior were assessed by
questionnaire HBA1c measured by colorimetric method and health-related quality of
life assessed by means of WHOQOL-BREF questionnaire. The education sessions for
intervention group were held at diabetic clinic. The 40 patients that assigned to the
control group gave the appropriate consent and completed questionnaires at baseline
and after 4 months.
The intervention group had statistically significant increase in the mean of knowledge
score from 6.7 to 15.8(p=0.000), physical health from 64.7 to 77.2 (p=0.000) and
psychological health from 56 to 71.4(p=0.000) and had statistically significant
reduction in the mean of HBA1c from 9.4 to 8.2 (p= 0.000).Also the intervention
group had statistically significant increase in self-monitoring blood glucose, weight
monitoring, exercise and diet. Patients in control group showed no significant changes
in the outcomes measured except for knowledge.
H Zeraati , M Mahmoudi , K Mohammad, A Kazemnejad, M.a Mohagheghi , M.r Mir ,
Volume 3, Issue 4 (7-2005)
Abstract
In recent years the patterns of mortality have changed in Iran, and cancers are playing
a greater role in this regard in this country. Various reports indicate that gastric cancer
is highly prevalent it is the second most common cancer in men, and fourth in the
general population. The purpose of this study was to determine the five-year survival
rate of gastric cancer patients who had undergone surgical treatment at one of the
most important cancer treatment centers, the Iran Cancer Institute, and to assess its
associated factors.
Three hundred and 30 patients with gastric cancer who had been admitted to and
operated on at the Iran Cancer Institute between January 1996 and April 2000 were
enrolled in this study. The patients’ life expectancy after surgery was determined, and
its relationship with variables of age at the time of surgery, gender, and factors related
to the disease such as the cancer site, pathologic type, stage, presence of metastasis,
and sites of metastases were assessed.
The five-year survival rate and the median life expectancy in the studied patients were
23.6% and 19.90 months, respectively. Univariate analysis showed that gender,
cancer site, and pathologic type did not affect life expectancy significantly. But the
five-year survival rate significantly decreases with age. As expected, those involved
with metastasis had a significantly lower five-year survival rate, and the disease stage
significantly affected the patients’ life expectancy (P<0.001). The Cox proportional
hazards model was used to assess the effect of different variables simultaneously, and
it showed that age, distance metastasis, and disease stage influenced the rate of
survival.
Gastric cancer patients in Iran have a low five-year survival rate. One of the most
important reasons seems to be delayed consultation and diagnosis. Most patients are
seen first with the disease in the late stages. At this point, most have lymph node and
liver metastasis which makes treatment even more complex. Thus, it is necessary to
employ mass media for extensive public education about the early warning signs of
the disease and performing periodic examinations.
J Adl, A Ghahramani , J Nasel Saraji ,
Volume 3, Issue 4 (7-2005)
Abstract
stundy (HAZOP) and the component’s failures of major equipments were assessed by
Failure mode and Effect Analysis (FMEA).
Totally 68 hazards were identified and their risks were calculated. The highest risk
(60) was belonged to the reduction of gas temperature before entering to the refinery
and failure of DEA cooling system at the final node (DE). The failures of P-6 pump,
F.C.V.4 valve, L.C.V.2 and F.C.V.12 (all in the same node) and reduction of gas
temperature in nodes AB, BC and CD had the lowest calculated risk (12). Comparing
with the acceptable level of risk in the refinery which was 200, all of the identified
hazards risk were very low therefore did not need any appropriate measure of risk
reduction to be proposed.
For overcoming the fact that both HAZOP and FMEA techniques, instead of being
performed by a team was accomplished by both of us, we used the consultations given
us by the experienced exploitation engineers of under study unit. This consultation
was also very useful in fulfilling deficiencies of existing record keeping system.
Performing the protective maintenance and preparing a precise timing program for
P.M was given as a main proposal for risk reduction by decreasing the probability of
occurrence.
J Nasel Saraji , S.a Mosavi , S.j Shahtaheri , M Pourmahabadian ,
Volume 3, Issue 4 (7-2005)
Abstract
The exposure index was used to obtain integrated and concise assessment of the various risk factor analyzed and to classify occupational scenarios featuring significant and diversified exposure to risk factors.
In this study, an integrated procedure from four data gathering methods include observational methods (for jobs and tasks analyzing featuring repetitive movements) interview method (for asking about upper limbs musculoskeletal disorders), Nordic musculoskeletal questionnaire (NMQ) method and Occupational repetitive actions method (OCRA) were used .
A 385 persons group was studied, working in 33 various jobs in a textile factory. The results showed that, 0.86% of work tasks had low risk level, 87.93% of work task were located in moderate risk level and 11.21% of work task had a high risk level. Mean of exposure indices in four jobs include primary of spinning, spinning, primary of weaving, and weaving had significant difference (p=0.003). Also, the weaving job had a highest risk of occurrence upper extremity musculoskeletal disorders. Mean of right and left hand exposure indices showed a significant different (p<0.001). There was significant relationship between UEMSDs with age (p<0.05).
It was concluded that, the OCRA methods can be a useful method for evaluation of UEMSDs in repetitive activities.
S Molai, M Mohebali, B Akhoundi , Z Zarei ,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: In this study, we compared a latex agglutination test (KatexR) with the direct agglutination test (DAT) for the diagnosis of human visceral leishmaniasis (HVL) in an area with a high prevalence of zoonotic visceral leishmaniasis (ZVL) in Iran.
Materials and Methods: The validity of the KatexR (Kalon Biological Ltd, England) for detection of urinary Leishmania antigens in HVL was compared with standard direct agglutination test on 92 visceral leishmaniasis patients (29 were acute and 65 were chronic phase) and 90 healthy controls over a period of one year.
Results: We detected a sensitivity of 82.7% and a specificity of 98.9% in the acute phase. As for the chronic phase, the test showed a sensitivity of 6.15% and a specificity of 98.9% at a 1:3200 cut-off titer. Concordance between KatexR and DAT was 94 .9% in the acute phase and 59. 3% in the chronic phase. As the rapid, noninvasive Katex does not require much expertise or elaborate equipment.
Conclusion: It can be used for screening and diagnosis of human visceral leishmaniasis in remote endemic foci.
M Baniasadi , Gh.r Babaie , H Zeraati , F Memari ,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: The purpose of this study was to assess the accuracy of the bootstrap method in logistic regression and to explore the method's use in logistic regression models in cases where the sample size is insufficient.
Materials and Methods: We use data from 150 patients who had undergone surgery at the Cancer Institute, Emam Khomeini hospital during from 1999 to 2001. Then we drew repeated samples of size 50 from these 150 patients.
Results: Applying ordinary logistic regression, an appropriate model we fitted to the initial data. Then confidence intervals and standard errors were computed for all regression coefficients.
There are many situations where the sample size is insufficient and conditions for using ordinary logistic regression are not met. In these cases the use of the bootstrap method not only produces more accurate estimations of regression coefficients, but with repeated sampling, produces estimates very close to the true values. This holds for the estimation of regression coefficients, confidence intervals and standard errors of coefficients.
Conclusion: In this study we show the optimal number of replications and the optimal sample size when using the bootstrap method in studies involving relatively small sample sizes.
F Koohdani , J Baghdadchi , F Sasani , K Mohammad , P Mehdipour ,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: In order to elucidate the role of vitamin D in the genesis of lung tumors, we used an experimental model of lung lesions in mice induced by the administration of urethane.
Materials and Methods: A total of inbred balb/c mice (male and female) 9-11 weeks old, were studied. They were divided into 3 groups. The first and second groups (U and U+D) were injected with urethane i.p, 600 mg/kg/day with 48 hours intervals for three times. The second group was given 3.5 mg/kg (6.3 mg/1000 ml) vitamin D with drinking water for 4 weeks after starting the injection by urethane.
Results: The third group served as control. Total remaining mice were killed after 20 weeks. Lung lesions were histopathologically characterized by hyperplasia, adenoma and adenocarcinoma in different groups.
Tumor formation significantly increased in the urethane group as compared with control group (p<0.05) but there was not any difference between those receiving the (U+D) treatment group and the controls.
Conclusion: It seems vitamin D inhibites genesis of lung tamors induced by the administration of urethane.
K Holakouie Naeini , A Ardalan , M Mahmoudi , A Motevallian , Y Yahyapour ,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: Breast cancer is the leading cause of cancer death among women, both in Iran and worldwide. The wide variation in breast cancer incidence in different geographical areas calls for studies to clarify the role of potential risk factors. In this study we looked at some factors that could be involved in the pathogenesis of breast cancer.
Material and Methods: This matched case-control study was carried out in the summer of 2004, and it drew on data recorded in Babol (Caspian) Cancer Registry. We investigated 250 biopsy-proven cases of breast cancer, together with 500 controls chosen from the neighbors of cases. We matched the subjects with regard to age (with 3 years intervals). Crude and adjusted odds ratios and relevant 95% confidence intervals were calculated through conditional logistic regression, using STATA 8.0.
Results: This study involved 250 incident cases of breast cancer and 500 age-matched controls. The mean age of the cases was 48.7 (±11.37) years with 48, 22 and 80 years as median, min. and max. values, respectively. Mean age in the controls was 48.0 (±11.46) years with 47.5, 19 and 77 years as median, min. and max. values, respectively. In the multivariate analysis, the following variables were found to be risk factors: university education (OR=5.89, 95%CI: 1.73-20.09), menopause (OR=3.98, 95%CI: 2.29-6.91), induced abortion (OR=1.56, 95%CI: 1.02-2.22), BMI (OR=1.02, 95%CI: 1.01-1.03) and longer duration of breast feeding was determined as protective factor against breast cancer (OR=0.995, 95%CI: 0.990-0.999).
Conclusion: Modifiable risk factors should be considered in the community-based preventive interventions. The following areas could serve as topics for community education in Mazandaran: the role of high BMI and induced abortion in increasing the chance of breast cancer and also the protective role of breast feeding on this issue.
Salari M.h., Sharifi M.r., Golzari M., Sarabadi A.a., Kafilian H,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: As the population of the world increases, it is essential that food production keep pace. It will be necessary not only to produce more food, but also to maintain this food so that it is safe and wholesome for human consumption. The purpose of this study was to investigate the rate of Coliform, Staphylococcus aureus, Mould, Yeast and other aerobic and mesophilic bacteria as contaminats of milk and milk products in Yazd province.
Material and Methods: In this study a total of 198 different samples including Milk (24.2%), Yoghurt (21.2%), Cream (12.1%), Cheese (18.2%), Ice cream (12.1%) and dairy powders (12.1%) were investigated by culture method and biochemical tests. Then obtained data were analyzed by SPSS and χ2 programs.
Results: On the basis of our findings, of the total samples, 136 cases (68.7%) were desirable, 48 cases (24.2%) acceptable and 14 cases (7.1%) undesrable. Microbial contaminants of undesrable samples were coliform (7.1%), Staphylococcus aureus (6.1%) and yeast (6.1%). Meanwhile, the results of χ2 Statistical analysis test, showed significant different between contamination rate and kind of Milk products (df = 5, χ2 = 17.75, P<0.005(.
Conclustion: It seems that despite the efforts, which have been done for prevention of food contamination in Yazd province, it is still considered as a threat for people Health.
M Mahami, M Moheb Ali, H Keshavarz, H Hajaran, B Akhoondi, Z Zarei, S Charedar,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: As the population of the world increases, it is essential that food production keep pace. It will be necessary not only to produce more food, but also to maintain this food so that it is safe and wholesome for human consumption. The purpose of this study was to investigate the rate of Coliform, Staphylococcus aureus, Mould, Yeast and other aerobic and mesophilic bacteria as contaminats of milk and milk products in Yazd province.
Material and Methods: In this study a total of 198 different samples including Milk (24.2%), Yoghurt (21.2%), Cream (12.1%), Cheese (18.2%), Ice cream (12.1%) and dairy powders (12.1%) were investigated by culture method and biochemical tests. Then obtained data were analyzed by SPSS and χ2 programs.
Results: On the basis of our findings, of the total samples, 136 cases (68.7%) were desirable, 48 cases (24.2%) acceptable and 14 cases (7.1%) undesrable. Microbial contaminants of undesrable samples were coliform (7.1%), Staphylococcus aureus (6.1%) and yeast (6.1%). Meanwhile, the results of χ2 Statistical analysis test, showed significant different between contamination rate and kind of Milk products (df = 5, χ2 = 17.75, P<0.005(.
Conclustion: It seems that despite the efforts, which have been done for prevention of food contamination in Yazd province, it is still considered as a threat for people Health.
T Shafieezadeh , K Holakuei Naieni , A Fotohi , M Mahmoodi ,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: The aim of this study is to evaluate the familial aggregation of esophageal cancer in a defined population under coverage of Babol Research Station, Institute of Public Health Research, Tehran University of Medical Sciences, in one of the high incidence areas in north of Iran and to assess the risk of disease associated with first degree familial relationship.
Material and Methods: In this study, the data of family members of three to four successive generations and family history of esophageal and other cancers were collected from esophageal cancer cases which occurred between 2001-2003 in Babol district. The pairwise odds ratio of logistic regression method with GEE2 approach used for familial aggregation of esophageal cancer within first degree family. The results have been adjusted on covariates of age and sex of each family member and age and sex of the proband .
Results: The proportion of having a positive family history of esophageal cancer in first relatives is 3.09% (3.8 % in men and 2.3 % in female relatives).
The pairwise odds ratio was 1.79 (95% CI :1.1 , 2/93) in first degree family and odds ratio between parent – offspring was 2.21 (95%CI :1.1 , 4/44)and relation between sibling was 1.92(95%CI: 0.87, 4.24) . It was not possible to look for any parent – parent pattern.
Conclustin: We found a familial aggregation between first degree relatives in this area.The association between parent–offspring suggests the presence of a genetic component in this disease.
H Sadrzadeh-Yeganeh , P Angoorany , S.a Keshavarz , A Rahimi , B Ahmady ,
Volume 4, Issue 1 (4-2006)
Abstract
Background and Aim: Children, who go to school without breakfast or have breakfast that is not nutritious enough, will not be able to meet their nutritional needs for growth. Nutrition education can be instrumental in providing knowledge, desirable attitude, and changing behavior concerning breakfast. The purpose of this study was to compare two method of nutrition education – booklet and lecture- on practice of fourth grade girls.
Material and Methods: Using three stage random sampling a total of 150 students were randomly selected and divided into 3 equal groups booklet, lecture, and control. At the beginning of the study, an assessment of practice was conducted for all groups. Education through booklet and lecture was provided. Two weeks after the education, an assessment of practice was conducted again. To collect data two types of questionnaires - general and practice - were used.
Results: The result showed a significant difference of means of practice (P=0.002) score among three groups. The mean score of practice in the lecture against the control group and that of the booklet against control group increased 0.84 (P=0.005), 0.76 (P=0.014) respectively, but no significant increase was observed between lecture against the booklet group. After omitting the effect of independent variables in question, education still increases the difference of means of practice scores significantly (P=<0.05). Lectures are a more dynamic method for nutrition education.
Conclustion: Considering the large number of students in primary schools and lack of access to a direct method of education, using booklets is an appropriate method.
Ahmadi B., Farzadi F., Shariati B., Alimohamadian M., Mohammad K.,
Volume 4, Issue 2 (5-2006)
Abstract
Background and Aim: Looking at population pyramid from the 1996 census and its estimates for the years 2003 and 2004, it is clear that the size of the elderly population will be greater in men than in women. According to Iran’s Ministry of Health, the life expectancy for women is greater than that for men. This article is devoted to the discussion and analysis of this paradox.
Materials and Methods: Analysis of the population sex ratio.
Results: Its trend- based on data generated by censuses from 1956 to 1996- indicate that a large proportion of women did not live beyond the age of 35 women were most likely to die in years 35-45 of their life. It is possible that this age group, which included many women who were still of reproductive age, suffered the effects of war and socioeconomic crises of the 1940's. The trend had improved by the time of the 1376 census and there is no singe of an increase in the sex ratio thereafter. This change is probably due to the improvement in socioeconomic status and the development of an effective health care system.
Conclusion: Since the life expectancy estimates are based on the probability of death and are thus affected by socioeconomic conditions, the apparent incompatibility between the population age pyramid and life expectancy among elderly women and men is due to higher mortality among women of reproductive age before the 1970’s.
A Ardalan , K Holakouie Naieni , M Mahmoudi , R Majdzadeh , P Derakhshandeh Peykar ,
Volume 4, Issue 2 (5-2006)
Abstract
Background and Aim: Limitations of the traditional methods for assessing G*E interaction- including case-control studies- led to development of several non-traditional approaches. This study aims to assess the interaction between the genetic background (history of breast cancer in first degree relatives) and environmental influences (reproductive/menstrual factors) in patients with breast cancer we also compare the statistical efficiency and power of case-control and case-only designs in this setting.
Materials and Methods: In a matched case-control study in Mazandaran province (Iran), 250 incident biopsy-proven cases of breast cancer and 250 age-matched neighbor controls were interviewed. History of breast cancer in mother and/or sister(s) was taken as a surrogate measure of genetic predisposition, while age at first birth, parity, breast feeding, age at menarche and irregular menstruation were considered as relevant environmental factors. For the matched case-control design, we used a conditional logistic regression model to examine main effects and the G*E interaction. In the case-only design, logistic regression analysis was applied to obtain an estimate of G*E interaction, after checking for the independence assumption. We also calculated the power for detecting the interaction by matched case-control and case-only analyses.
Results: Age at first delivery did not meet the assumption of independence (p=0.02), and so was not included in the case-only analysis. No statistically significant interaction effect was seen in the case-control analysis, while case-only analysis showed significant negative interaction between disease in first-degree relatives on the one hand and parity and breast feeding on the other. We also detected a significant positive interaction between genetic predisposition and age at menarche. All the estimated 95% confidence intervals for OR in G*E interactions were narrower in the case-only analysis. For all factors, the power for detecting G*E interaction was greater in the case-only analysis compared to the case-control analysis, with ratios ranging from 1.08 to 2.23.
Conclusion: The case-only design is more efficient and powerful than the case-control design for detecting gene-environment interaction under the assumption of independence. Baseline disease risk, interactions and independent effects should be considered in using the control data for checking the assumption of independence. Considering the existence of another explanatory variable, eg. a mutant gene which may have passed unnoticed, would be the safest approach in a case-only study.
M Karimlou , K. Mohammad , M. R Meskhani , G.r Jandaghi , K Nouri , E Pasha , K Azam ,
Volume 4, Issue 2 (5-2006)
Abstract
Background and Aim: Logistic regression is an analytic tool widely used in medical and epidemiologic research. In many studies, we face data sets in which some of the data are not recorded. A simple way to deal with such "missing data" is to simply ignore the subjects with missing observations, and perform the analysis on cases for which complete data are available.
Materials and Methods: We consider methods for analyzing logistic regression models with complete data recorded for some covariates (Z) but missing data for other covariates (X). When data on X are Missing At Random (MAR), we present a likelihood approach for the observed data that allows the analysis as if the data were complete.
Results: By this approach, estimation of parameters is done using both Maximum Likelihood and Bayesian methods through the Markov Chain Monte Carlo numerical computation scheme and the results are compared.
The illustrative example considered in this article involves data from lung auscultations as part of a Health Survey in Tehran.
Conclusion: In comparing different methods, Bayesian estimates using the model described in this study are much closer to those generated by analysis of the full data by the standard model.
B Ahmadi , M Alimohamadian , B Golestan , A Bagheri Yazdi, D Shojaeezadeh ,
Volume 4, Issue 2 (5-2006)
Abstract
Background and Aim: Domestic violence against women is a major public health problem throughout the world. Feelings of shame, guilt and fear on the part of women, together with an unresponsive health care system continue to silence and isolate women who suffer abuse and negligence- with major effects on their physical and mental health. Mental health consequences include depression, anxiety, stress disorders, and somatization. This study estimates the prevalence of domestic violence and its associated effects on the victims' mental health.
Materials and Methods: This cross-sectional study used data from 1189 married women over the age of 15, selected randomly among the residents of Tehran.
Results: The overall prevalence of domestic violence was 35.7%. Thirty percent of the subjects had experienced physical violence, 29% suffered mental violence and 10% had been victims of sexual violence many of these women had suffered all the three types. The most frequent types of physical violence included beating in the form of kicks, punches, and slaps (91%) common types of mental abuse included humiliation, verbal abuse and insults (93%), and threats of violence (83%). Data on mental health status indicate that overall, as many as 34.1% of women could be suffering from disorders such as depression and anxiety. The risk of psychiatric disease was 3.5 times higher in victims of violence compared to other women (OR = 3.5, CI 95% = 2.72 - 4.58). Major factors contributing to domestic violence were husband addiction, low economic status, and the number of children (P<0.001). These results are consistent with the current literature on domestic violence and illustrate the high prevalence of this phenomenon. Victims are commonly depressed and have a higher rate of anxiety.
Conclusion: Violence is an important indicator of women’s health. Screening programs for domestic violence could be effective, along with community support and referral to health care and legal facilities. It is also crucial to promote knowledge and awareness of violence among health care providers. This study shows that a community-wide effort to establish links between health care settings and community services may be important in addressing the needs of victims.
