Epidemiology and Health System Journal
Volume:8 Issue: 2, Spring 2021

Dear Editor, Education is a complex issue and there is a need to consider a several factors to provide an effective training program. Regarding the issue of road traffic crashes, there are some contradictory findings about the efficacy of education, which may cause mistrust among professional circles and experts.   Some scientists believe that most of the training programs do not necessarily cover all aspects of crashes and only address some of the concerns. Road traffic crashes are a multidimensional issue and can be influenced by various political, economic, social and cultural factors, and thus the efficacy of an education program can be reduced. The low efficiency of educational programs can have several reasons, which are mentioned below:1.Non-use of Specific Educational Theory The efficacy of some educational interventions poses a serious challenge for researchers. A simple search in scientific databases will result in various studies aiming to offer educational programs for different road users about the road traffic safety. These educational programs are sometimes designed and implemented without sufficient scientific evidence or without relying on specific educational theory. Some researchers believe that designing an educational intervention without considering the guiding theory in education is like prescribing a medication to a patient regardless of his/her physiology. The use of educational theories entails identifying the audience properly, presenting the educational content in an appropriate manner, and evaluating its feedback. It also helps audiences to gain a better understanding about the safety in relation to their own behavior as road users.   2.Non-use of Various Methods for Providing the Educational Content Some educational interventions are based on learning context-dependent methods. However, learning context-dependent methods is not easily generalized among the target group. This type of educational delivery method is not adequately effective for some age groups, including children. Adopting various training methods tailored to the content and target groups such as role-playing, as well as using animation, cartoons, computer games, simulators, virtual reality technologies and augmented reality in training of traffic safety can increase the efficacy of such educational methods.3.Insufficient Attention to the Causation Network of Traffic Crashes Some believe that educational programs only emphasize on one topic, and generally fail to take into account the effect of other interventions. On the other hand, the designed educational intervention may focus on the wrong variable (as a factor influencing the occurrence of traffic crashes or the resulting injuries). For example, some drug abuse resistance education interventions focus on peer pressure as a variable with a direct causal effect, while the effect of the peer pressure in some studies is pale and other factors have a stronger causal effect. As for the road safety issue, some educational interventions focus on a number of factors, such as vehicle control skills, while these factors may or may not be the main factors responsible for some of the road traffic crashes. The road safety educational programs may focus only on traffic behaviors such as driving speed and may neglect other behavioral aspects such as smoking, alcohol, and drug consumption. In such cases, and even if the trainees demonstrate the positive aspects of driving speed in their behavior, the impact of the negative aspects of other behaviors such as alcohol consumption causes the risk of road traffic crashes to remain in the target group. 4.Insufficient Knowledge of Audience Gaining sufficient knowledge about the target group, as well as paying due attention to the characteristics of individual receiving an education are important factors for deepening learning in the audience. Recognition of the audience usually takes place over a long period of time. However, it has been shown that educational activities are often short-lived, and short-term interventions may be less effective for the audience. Some educational interventions only provide safety information without giving the drivers an accurate understanding of their behavior as road users. On the other hand, some educational interventions focus on high-risk behaviors of the drivers without considering the underlying reasons for these behaviors. Many drivers who display an unsafe behavior are aware of the fact that their behavior is not safe; however, they keep displaying the unsafe behavior.   The issue of education has conflicting aspects that should be addressed. For example, raising risk awareness may strongly discourage some people to follow educational topics; while it may be attractive for others and may even encourage them to include their acquired education in their behavior. For instance, education providers focus on quitting high-risk health behaviors such as smoking, alcohol consumption, and speeding that culminate in adolescence, while some training recipients may be curious and think about following these behaviors. It is argued that sometimes extensive financial resources to run inefficient educational program may deviate the resources from more effective community-based initiatives. Therefore, it is recommended that the researchers and policymakers in this field consider the theoretical and scientific principles when designing and implementing the educational interventions in order to increase their efficacy.   Ethical Approval Not applicable. Conflict of Interest Disclosures None.

Social health refers to the quantity and quality of interaction of an individual with society to promote the well-being of individuals in the society. This interaction promotes social capital and social security, and reduces poverty and injustice. So far, no study has been ever done on the social health situation in Chaharmahal and Bakhtiari province. This study aimed to investigate the social health status in Chaharmahal and Bakhtiari province in 2019.   In this cross-sectional and descriptive-analytical study, the data from the prospective epidemiological study of Shahrekord cohort study in Chaharmahal and Bakhtiari province in 2019 were used. In order for measuring social health, a valid Iranian social health questionnaire with a score range of 33-165 was used. ANOVA and t test in SPSS version 22 were employed for analyzing the data in order to compare the mean values.   By way of explanation, 597 individuals out of 600 samples completed the social health questionnaire (99.5% response rate). The mean ± standard deviation age of participants was 48.54±9.33 years and the mean ± standard deviation score of their social health was 115.71±22.7. This score was higher in men than in women (P = 0.038). Social health score was significantly higher in urban areas than in rural areas (P = 0.001). Social health was highest in civil servants, and lowest in unemployed participants (P = 0.001). Social health score was lower in obese and high body mass index (BMI) individuals than in normal BMI individuals (P = 0.047).   Social health in the studied population was moderate and, therefore, deserves the attention of health policy makers and planners. Social health can be improved by holding training classes for villagers and teaching them how to interact with each other – especially with family members, furthering participation of women in social affairs and increasing their social relationships, giving advice on diets and social health to people with non-normal BMI, as well as by holding post-retirement training classes for retirees.

Previous studies have shown that the intestinal parasites have the high prevalence in Hamadan province. However, this problem has not been addressed properly yet and, therefore, there is not up-to-date information about it. This study aimed to determine the prevalence of intestinal parasites in different residential areas of Hamadan Province (urban and rural areas) and compare the obtained findings with the results from previous studies on these parasites in this region and other parts of Iran.  

In this cross-sectional study, a total of 2948 fecal samples were collected from all rural and urban inhabitants of the province (including 12 cities) by cluster random sampling method. Fecal samples were examined using the direct smear and formalin ether concentration techniques. A questionnaire was used to collect relevant epidemiologic information about the study population.  

Overall, 52.2% of the samples were from rural areas, and the rest were from urban areas. As for the gender of study population, 50.6% were male and 49.4% were female (Mean age 29±12.3). The infection rate was 4.9% for both pathogenic and non-pathogenic parasites. Only 4 specimens were positive for ova (Ascaris lumbricoides, Hymenolepis nana, and pinworm). A total of 69 specimens (2.3%) were positive for pathogenic parasites, and 73 specimens (2.5%) were positive for non-pathogenic (E. coli). The most important intestinal parasite in this region was found to be Giardia lamblia. It was also discovered that totally 2.3% of the studied population was infected with this parasite.  

According to the results from this study, this area was not faced with a problem caused by the intestinal parasites at the time. In addition, only G. lamblia was found to have been a moderate parasitic problem in the province.

Violence is recognized as a significant public health problem throughout the world. The present study aimed to evaluate the prevalence of violence-related behaviors and its relationship with other risky behaviors, family support, and religiosity among students in Bushehr.  

This cross-sectional study was conducted on a total of 977 students in Bushehr city, southern Iran, in 2016. Required data were collected using a self-administered questionnaire on violence-related behaviors and other risky behaviors. The validity of the questionnaire was measured by MPH students with a Cronbach’s alpha of 0.90. Additionally, family support scale and religious belief questionnaire were applied. Data analysis was performed using chi-square, t test, and logistic regression model in SPSS version 16.0.  

The overall prevalence rates of weapon carrying and physical fighting were reported to be 9.1% and 7.1%, respectively. The findings of this study revealed that hookah use (OR: 2.93), physical fight (OR: 5.64), and having unsafe sex (OR: 2.42) were associated with weapon carrying (P < 0.001). Moreover, male gender (OR: 3.36), illicit drug use (OR: 3.64), weapon carrying (OR: 5.24), and family support (OR: 0.97) were shown to be associated with physical fight (P < 0.001).  

The results of the present study suggested co-occurrence nature of risky behaviors. Given the high prevalence of violence-related behaviors, the implementation of preventive interventions for college students is of great importance.

Acanthamoeba spp. as opportunistic microorganisms are widespread in a wide range of environmental sources in the world and may cause severe diseases in immune-deficient patients. The aim of this study was to determine the prevalence and genotypes of Acanthamoeba spp. in hemodialysis patients in Shahrekord county of Chaharmahal and Bakhtiari province.   In this cross-sectional study, 79 oral swabs were collected from the mouth of patients with chronic renal disorder undergoing hemodialysis from June to October 2018. The samples were then cultured on non-nutrient agar and examined by Giemsa staining, polymerase chain reaction (PCR), sequencing, and tolerance testing methods.   Morphological investigations indicated that 30.4% (24/79) of the subjects were infected with some free-living amoebae (FLA), and the PCR showed that only 3 samples contained Acanthamoeba spp. The sequencing of the latter samples demonstrated that these isolates belonged to T2 and T4 genotypes. After performing the assay tolerance test, 2 of these 3 isolates were related to T4 genotypes representing a high pathogenic potance.   The infection of hemodialysis patients with some of Acanthamoeba spp. particularly, the T4 genotype should be considered important for these patients. Therefore, it is recommended that dialysis machines and dialysis units in hospitals be checked and disinfected periodically.

Prostate neoplasms have various geographical distribution in the world as well as in Iran. This study aimed to investigate the epidemiology of prostate neoplasms in Maragheh due to the lack of literature on the subject in this city.   This study is a descriptive-analytical, cross-sectional study in which the epidemiological status of prostate neoplasms was investigated in Maragheh during 2014-2019. All available records in the form of a census were included in the study. A checklist made by the researcher was used as a special tool for collecting data from prostate neoplasms medical records. The collected data were analyzed by statistical tests of chi-square, unpaired t test, Kruskal–Wallis test, and Cohen’s kappa coefficient using SPSS 25 software.   By way of explanation, 107 medical records on prostate neoplasms were recorded between 2014 and 2019. The mean and median ages were 71.33 ± 9.37 and 70 years. The highest frequency was observed in the 60-70 age group with a frequency of 41.1% (44 cases). All patients had been undergoing clinical examination (first) and pathological examination (after prostatectomy). For 12.1% of individuals, benign prostatic hyperplasia (BPH) had been diagnosed in the clinical diagnosis, and cancer and prostatitis had been diagnosed in the pathological test. Cohen’s kappa coefficient was obtained 20.4%, which was statistically significant (p ≤0001). The results showed a significant relationship between the number of prostate neoplasms and age groups (p ≤0001).   Taking the results of this study into account, it is recommended that more attention be paid to other laboratory and radiological tests such as the PSA test, ultrasound, etc. In addition to clinical examination, it is also suggested that screening programs be particularly developed for the age group ≥50 using a specific prostate antigen against this cancer.

Since ventricular septal defect (VSD) is the most common congenital heart disease, this study aimed to investigate its prevalence, characteristics, and associated diseases in a referral children’s heart clinic in south of Iran.  

In this cross-sectional study that was conducted based on the databases of children with heart diseases, patients under 18 years of age referring to Imam Reza clinic were examined. All patients with at least one record of VSD in echocardiography during 2016-2017 were included. Demographic and echocardiographic characteristics including size of VSD, shunt gradient, pulmonary hypertension (PH), aortic regurgitation, and associated cyanotic and acyanotic defects were analyzed.  

The prevalence of VSD found in 7458 echocardiography records was 12%, the median age of patients was 9.3, and the male/female ratio was 1.08. The perimembranous VSDs were determined to be the most common types of VSD. The most common associated complication with VSD was detected to be PH followed by aortic regurgitation. Sub-pulmonic showed the highest association with aortic failure. Atrial septal defect and tetralogy of Fallot (TOF) were the most common acyanotic and cyanotic heart defects, respectively. Only 0.5% of the patients had Eisenmenger syndrome.  

Fortunately, the prevalence of the complication of VSD was not high in south of Iran, and the number of Eisenmenger syndrome was low. The types of VSD and the number of its complications identified in study population were similar to those in other populations.

Congenital toxoplasmosis is assumed to play a role in developing schizophrenia in human. This study aimed to estimate the relationship between Toxoplasma infection and schizophrenia by using enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR).   In this case-control study, 46 schizophrenic patients forming our case group as well as 40 healthy relatives of schizophrenic patients forming our control group were selected from among 456 inpatients with schizophrenia in Ibn Sina and Hejazi hospitals in Mashhad from June 2016 to February 2017. The blood samples from both groups were collected for serological and molecular tests. Different statistical methods such as Chi-square, independent t test, and logistic regression models were used in the present study.   In the present study, the seroprevalence of T. gondii was 54% in case group and 45% in control (OR=1.44, 95% CI: 062- 3.40, P = 0.38). There was no significant association between the seroprevalence of T. gondii infection and age, gender, and season as the risk factors in the case group. Furthermore, a poor agreement was observed between the microscopy and PCR methods. Non-significant differences were found between the mean levels of interferon gamma (IFN-γ), C-reactive protein (CRP), and white blood cell (WBC) in two groups.   Contrary to the reports from some studies, no association was found between Toxoplasma infection and the schizophrenia. In order to better understand the effect of Toxoplasma on schizophrenia, it is necessary to develop laboratory methods to differentiate acquired toxoplasmosis from congenital one.