مجله اپیدمیولوژی ایران
سال یازدهم شماره 2 (پیاپی 38، تابستان 1394)

Managers need the results of scientific researches for executive planning. Considering some methodological errors in reported studies in Iran and the lack of specific and summarized references، this article aims to provide practical considerations in elderly studies. In this narrative review، we conducted a comprehensive search in all accessible electronic data bases using “epidemiology” or “methodology” and “elderly” or their synonyms as keywords. Related papers and books were selected. After review، considerable notes were extracted and presented. Considering attrition، death، and non-response rates in sample size calculation، proportional sampling from all strata، and considering differences in clinical manifestations and diagnosis are important. Matching for main confounders، considering recall bias، creating a quiet and comfortable environment to conduct the interview، allocating a certain percentage of participants to high risks، registering age and other quantitative variables in detailed and non-categorized formats، home visit for interview after receiving informed consent from the elderly or their guardians، interview at the closest location to the elderly’s residence، avoiding long interviews، considering bold and legible words in designing the questionnaire، data re-checking with proxy and documents، applying age and sex adjustment for rates، evaluating the functional status، appropriate interpretation related to odds ratio and considering the cost of the studies are the most essential considerations in aging studies. Using epidemiological methods with respect to the characteristics of the elderly enhances the quality of the collected data. Well designed studies provide policy makers with reliable evidence for planning.

The number of road traffic accidents (RTAs) and their mortality are increasing in the world. In Iran, RTAs have caused life losses and economical damages. Death is the most important consequence of the accidents in terms of social, economic, and even political expenditures. This paper reports the statistics of the mortality status in the last decade.

A 10-year study was conducted on national and provincial data of the last decade collected by Legal Medicine Research Center. The population information provided by the National Center of Statistics was used. SPSS 15.5 and Microsoft Office Excel 2007 were used for data analysis.

Between 2001 and 2010, the annual average of 34.6 per hundred thousand people were killed in traffic accidents, more than 80% of the casualties are men. The highest number of deaths and injuries was observed in 2005 and the lowest occurred in 2001. RTAs had a descending trend trough the last decade but the rate of injuries increased. The death rates in Semnan, Qazvin, and Kerman were the highest and in Tehran, Ardabil, and West Azarbaijan were the lowest.

Although mortality rates due to RTAs declined during the last four years of the study period, direct and indirect costs of deaths resulting from RTAs in Iran are a sign of crisis.

Considering the importance of CVD risk factors in diabetic and non-diabetic populations and the high prevalence of diabetes and cardiovascular risk factors, we studied the trend of anthropometric indexes, blood pressure, smoking and lipids in diabetic and non-diabetic populations. The data of Tehran Lipid and Glucose Study was used in this investigation. The study population comprised 1045 diabetic and 5136 non-diabetic subjects. To investigate the secular longitudinal trends, the Generalized Estimation Equation method was employed. All statistical models were adjusted for age to eliminate the potential confounding effect of age. The interaction between the diabetes status and each phase of the study was checked in a separate model in GEE. Over a decade, the serum levels of TC, TGs, LDL-C and non HDL-C decreased although about 60% of the diabetic population did not reach the therapeutic goals of non-HDL-C and LDL-C levels until 2011. Control of hypertension was more successful in females, but about 60% of both males and females with diabetes were still hypertensive at the end of follow-up period. Smoking increased during the follow-up. This study showed that among CVD risk factors, healthcare professionals paid more attention to hypercholesterolemia neglecting other risk factors including hypertension and central obesity.

Home-related traumas are the most common traumas and are ranked the second among different types of traumas. This study aimed to determine the status of home-related traumas in patients referred to medical centers in Kashan in 2010-2012. In this cross-sectional study, 1028 patients referred to Kashan emergency medical centers were evaluated. The continuous sampling method was used for patient selection. The data collection tool was a researcher made questionnaire with two sections: demographic information and a checklist to evaluate the domestic trauma. Information was obtained by trained nurses through direct interviews with the patients and hospital records. Data was analyzed using SPSS version 0.16. Location patterns of incidents showed that the hall (27.7%), kitchen (20.3%) and yard (18.4%) were the most common injury sites. Recklessness (80.8%) was the most common cause of trauma. Most of the accidents were caused by falls (27.90%) and cutting tools (25.08%). Orthopedic injuries (50.2%) and hemorrhagic events (34.70%) were the most common traumas. The results showed that domestic traumas often occurred following reckless behaviors. As a result, these traumas could be predicted and prevented by concentration and attention during working. To reduce the incidence of domestic traumas, people should receive information and training on health and safety issues in the home setting.

In recent years, different decision support systems (DSS) have been used to predict and diagnose diseases. The purpose of this paper was to compare some DSSs and to evaluate their accuracy in predicting diabetes. In this research, determination and optimization of the weights of the neural network were undertaken using genetic algorithm and Levenberg-Marquardt (GALM). Traditional and K-Fold Cross Validation were used to verify the models. Finally, the proposed model (i.e. GALM) was compared using logistic regression and genetic algorithm based on area under curve (AUC), and Confusion Matrix. After evaluating the results, the model based on the GALM algorithm showed better sensitivity and specificity in comparison with models based on the logistic regression (LR) and genetic algorithm (GA). Furthermore, among other models, the proposed model had a high sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and a small negative likelihood. The results showed that the GALM model with a sensitivity, specificity, PPV, NPV, and AUC of 98.7, 90.01, 91.8, 98.3 and 0.979 respectively was an appropriate model for predicting diabetes in comparison with models of GA and LR.

Urinary calculi are a common problem worldwide. The pattern of fluid consumption in healthy people and patients with renal calculi is not totally clear. The aim of this study was to determine the association between the amount of fluids intake and urinary calculi. In this case-control study, cases were the patients with urinary calculi admitted to Emam-Hossein Hospital, Shahroud, Iran. The controls were selected among the patients admitted to other wards of the hospital except for dialysis and ICU wards. The association between independent variables and urinary calculi was investigated using logistic regression analysis. A total of 127 people (60 cases and 67 controls) participated in this study. The mean age of the participants was 44.6 years (SD = 1.7). The mean intake of tea, natural juice, alcohol free beer, and total fluid intake were higher in cases compare to controls. In participants with a negative history of urinary calculi, the total intake of fluid (P=0.021) and natural juice (P=0.006) was higher in cases. The male gender (OR=3.2), higher BMI (OR=1.2), and a positive family history of urinary calculi (OR=3.5) were associated with renal calculi in a multivariate logistic regression model, while the milk intake (OR=0.995) was a protective factor in this model. Milk intake is a protective factor and the male gender, higher BMI and a positive family history are the risk factors for urinary calculi.

Measuring the impact of various diseases on Life Expectancy(LE) is an important step toward prioritization in health. The present study was conducted to measure the impact of heart diseases, neoplasm, and respiratory diseases on life expectancy (LE) in 2010. Data on death and population for all 22 districts of Tehran were obtained from the main cemetery of Tehran and statistical center of Iran, respectively. Age-specific mortality rates and consequently LE were calculated for all 22 districts and both genders. Finally, the death probability assuming complete elimination of the diseases was calculated and the resulting life tables were obtained. The LE at birth was estimated 74.6 and 78.4 years for total males and females in Tehran, respectively. The maximum and minimum LE at birth was 80 years in females and 72.7 years in males, respectively. Assuming complete elimination of heart diseases, the LE increased to 82.39 and 85.51 years in males and females, respectively while complete elimination of neoplasm resulted in an increase in LE to 76.27 years in men and 80.49 years in women. Finally, elimination of respiratory diseases increased the LE of men to 75.98 years and the LE of women to 79.97 years. The results indicated the high impact of the diseases on LE, especially the heart diseases. As a main result, LE will upgrade to more focus on this category.

Community assessment is a key tool for improving and promoting the health of the community. The role of community assessment is to identify the most important factors affecting the population health. To get a comprehensive picture of problems, priorities and suggested community health action plans in Iran, this review aims to summarize community assessments in various areas of Iran conducted between 1992 – 2013. This study was a retrospective review in which community assessments were compared and the results of several studies conducted in different regions of the country covering both rural and urban health centers were analyzed. Since 1999, department of Epidemiology and Biostatistics has conducted these community assessments in eight phases and follows 2002 North Carolina Community Health Assessment model. Assessment teams typically included MPH students and/ or PhD and masters (epidemiology) students from the School of Public Health. Data was collected through observation, interview, and focus group discussion. Assessment teams in each region prioritized the list of problems using Hanlon method and Nominal Group Technique. The results identified substance abuse, economical, and water-related problems as the most important problems in different parts of the country which indicates the need for developing a comprehensive action plan andimplementing measures. A review of the community assessments performed in this study shows the ability of community assessment to detect community health problems in all aspects. Therefore, this approach is recommended to evaluate and prioritize health problems and to formulate action plans.

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

The aim of the study was to determine age, period, and cohort effects on trend of alcohol and drug use in the students of Tehran University of Medical Sciences from 2006 to 2009. Between 2006 and 2009, the students of Tehran University of Medical Sciences were surveyed annually using a structured self-administered and anonymous questionnaire. Intrinsic estimator, which is a new method for resolving linear dependency between age, period, and cohort in linear regression models, was used for data analysis. In the present study, in the descriptive method, the prevalence of alcohol consumption increased in males and females with an increase in age. The prevalence of illicit drug use was higher in 2007 in comparison with other periods for males and females. In the analytical method (intrinsic estimator), there were no age, period and cohort effects for alcohol and drug use for females. For males, the age effect exhibited an increasing-decreasing-increasing trend and period and cohort effects showed a decreasing trend for alcohol use. As for drug use, the age effect exhibited gradual increases. The period effect displayed an increasing-decreasing trend and the cohort effect exhibited an increasing-decreasing-increasing trend. The IE method showed no age, period and cohort effects for alcohol and drug use in females. The prevalence of drug and alcohol use increased with an increase in age in males. The high prevalence of drug use could be due to easy accessibility and low price of drugs.