مجله اپیدمیولوژی ایران
سال هفدهم شماره 2 (پیاپی 62، تابستان 1400)

Pre-natal mental health problems are major causes of disease burden, especially in lower socio-economic groups of population. The present study used data of a prospective cohort study to estimate the risk of mental health problems, including depression, anxiety, and stress, on birth weight.

This study used data of 398 pregnant women who were participants of the Bandar Abbas Pregnancy Cohort Study (BAPC) during 2017-2020. Data of depression, anxiety, and stress were collected using DASS-21items questionnaire in pregnancy. Low Birth Weight (LBW), as birthwieght below 2500 grams, was calculated according to infant`s vaccination log. Modified Poisson regression models with logarithm link function and significance level of 5% were applied to estimate the effect of depression, anxiety and stress on LBW.

Compared to the subjects without mental health problems, the risk of LBW increased by 8.03 times in the severe depression (95% CIs: 5.55-11.62), by 8.06 times in the moderate stress (95% CIs: 5.64-11.51), by 3.13 times in the severe anxiety (95% CIs: 1.18-8.31), and by 8.43 in the highly severe anxiety (95% CIs: 5.80-12.25).

Severe and moderate levels of depression, anxiety, and stress all had statistically significant effects on LBW. Pre-natal screening services can help mitigate the burden of mental health by timely detection and referral. Moreover, designing and implementing consultation programs for pregnant women and their fsmilies, expecially their spouses, to provide emotional support and to improve marital relationship are amongst the suggestions.

The spread of COVID-19 in the world has had adverse effects on all aspects of people´ life and social and economic development of the communities. The current study was conducted to determine the knowledge, attitudes, and practices toward COVID-19 in the general population of Qazvin province.

This cross-sectional study conducted on 1223 people above 15 years in Qazvin province between December and January 2020. We used multistage stratified random sampling to select the participants from urban and rural health centers. The questionnaires were completed by the patients as well as through phone interviews. The questions included demographic information and knowledge, attitude, and practice toward COVID-19.

In total, 1223 subjects with a mean (standard deviation) age of 35.6 ± 12.2 years participated in this study. The scores of knowledge, attitudes, and practice were 68%, 72% and 91%, respectively. The lowest score of knowledge was related to awareness of common symptoms of the disease (6%). Forty-two subjects believed they observed the principles of disease prevention. A distance of 2 meters was observed by 50.3%. The scores of knowledge (P=0.007) and practice (P=0.028) increased with age, and the scores of knowledge (P<0.001) and attitude (P=0.001) increased and decreased with an increase in the education level, respectively. Males had significantly lower knowledge (P=0.002) and practice (P<0.001) scores. Moreover, rural residents had higher attitude scores compared to urban residents (P=0.002).

The results suggest that the general population of Qazvin province had desirable knowledge, attitude and practice towards COVID-19 at the time of the epidemic.

Viral hepatitis is one of the most prevalent diseases and an important underlying cause of death and disability in the world. This case-control study was conducted to investigate the outbreak of hepatitis A in Boroujerd in 2019.

This case-control study was conducted to investigate the epidemic of hepatitis A in Boroujerd in 2019. Fifty hepatitis A patients were recruited. For each patient diagnosed, two controls with no history of the disease were selected from a neighboring village. Data were collected using a demographic questionnaire as well as the results of experiments. To investigate the association between the disease and risk factors, odds ratio and 95% confidence interval were used.

In this study, the odds ratios were significant for a number of risk factors including washing fruits and vegetables with a source other than tap water [OR = 3.2], washing dishes with a source other than tap water [OR = 3.7], non-sanitary toilets [OR = 8.3], using sources other than tap water when there is no tap water [OR = 4.4], being unaware of the disease and its transmission methods [OR = 4.8] and water well dug less than 15 m from the sewage well (OR = 4.1).

Increased public awareness and improved health status of the environment and rural sewage can preclude similar epidemics in the study area and other regions.

The incidence of rectal cancer is increasing in developing societies, especially in younger age groups. The aim of this study was to evaluate the factors affecting the survival of patients with rectal cancer in the presence of competing risks.

In this retrospective cohort study, the data of 121 patients with rectal cancer during 2001-2017 were studied. Death related to cancer progression was considered as the interest outcome and other causes of death were considered as competing risks. Cause-specific and sub-distribution hazard models were used to investigate the factors affecting patient survival in the presence of competing risk.

The mean (SD) age of the patients was 53.4 (13.9) years and 68 patients (56.2%) were male. The results of log-rank test showed that sex, age, metastasis, type of first treatment, rate of penetration into intestinal wall, tumor location, number of lymphomas involved and tumor size had significant effects on the patient survival (P<0.05). Based on cause-specific and sub-distribution hazard models, tumor stage, lymph node metastasis, and tumor grade had significant effects on death hazard due to the cancer progression (P<0.05).

Due to the need to consider competing risks, the results of both competing risk methods showed that tumor grade, lymph node metastasis and stage increased the instantaneous hazard and hazard of cancer death. Therefore, to determine the specific risk factors for each cause of death in the survival analysis, competing risk methods should be used if there is more than one cause of death.

Valid, reliable, short, sensitive and accurate tool is needed to diagnose pain in dementia patients. This study aimed to determine the psychometric properties and diagnostic accuracy of short-form Persian version of Doloplus-2 (P-Doloshort) in pain assessment in elderly with dementia.

In this cross-sectional study, 100 elderly were selected using convenient sampling from private clinics and nursing homes in Kashan in 2018-19. Construct validity was determined by exploratory factor analysis, known-groups approach and convergent validity. Also, reliability was evaluated by internal consistency, equivalence, and stability. P-Doloplus-2 and P-Doloshort were used as the reference standard and the index test, respectively. Data were analyzed by SPSS-v16 using independent T-Test, linear regression, Pearson and intra-class correlation coefficients (ICC), Cronbach's alpha, ROC curve, and diagnostic test parameters.

Factor analysis identified the tool as a single-factor; it was able to explain 65.851% of total variance. P-Doloshort was able to differentiate between two groups with and without painful underlying diseases (P<0.0001). There was a positive and significant correlation between P-Doloshort score with P-Doloplus-2 score (r=0.975, P<0.0001) and PACSLAC-II-IR score (r=0.0001, P<0.0001). Cronbach's alpha, ICC and standard error of measurement were 0.898, 0.891 and ±1.183, respectively. The relative frequency of minimum and maximum possible score was less than 15%. At the cut-off point of 2.5, area under ROC curve, sensitivity, specificity, and overall diagnostic accuracy were estimated 0.985, 0.956, 1.000 and 0.970, respectively.

P-Doloshort can be used as a valid, reliable, sensitive and accurate tool for pain assessment in elderly with dementia.

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.

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.

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.

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.

Child growth health is one of the most important issues that determines the community health. Considering the importance of mothers in family and healthy society, the aim of this study was to evaluate the correlation between maternal employment status and infant growth during the 9-12 months in Ahwaz.

In this prospective cohort study, 345 nine-month infants of three groups of mothers including full time employees, part-time employees, and homemakers were selected using non-probability quotas sampling method. Data was collected using a researcher-made questionnaire and analyzed with the SPSS software version 22 using statistical tests such as chi-square, anova.

In the full-time job group, 54.2% of the infants had favorable weights and 45.8% had unfavorable weights. In the part-time group, 69.6% of the infants had favorable weights and 30.4% had unfavorable weights. In the homemaker group, 68.7% of the infants had favorable weights and 31.3% had unfavorable weights. There was a significant difference in the infant’s weight between full-time and part-time job groups
(P= 0.01) and the full-time job and homemaker group (P= 0.04) but there was no significant deference in the infant’s weight between the part-time job and homemaker group (P= 0.87). No significant association was found between maternal employment status and infant’s height (P= 0.11) and head circumference as well (0.08).

The growth status of infants with full-time working mothers was lower than that of infants with homemaker and part-time working mothers. It is recommended to reduce the working time of the mothers who have full-time jobs as long as they breastfeed their babies.

The Covid-19 prevalence can threaten self-care behaviors and disease control in people with type 2 diabetes (T2D) through increasing anxiety and stress levels and limited access to medical services. This study was conducted to investigate the association of the Covid-19 pandemic with self-care behaviors in patients with T2D.

The present study was conducted on 318 adults with T2D who participated in the Tehran Lipid and Glucose Study (TLGS) between 1397 and 1399 and completed the summary of diabetes self-care activities (SDSCA) questionnaire. Data on self-care activities during the Covid-19 pandemic were collected 3-4 months after the announcement of the epidemic in the country via telephone calls. For data analysis, a multiple linear regression model and paired t-test were used.

The mean total scores of self-care behaviors were 49.7±14.8 and 56.1±13.1 before and after the Covid-19 pandemic, respectively (P<0.001). After the Covid-19 pandemic, women's total self-care score increased with an increase in the diabetes duration (β= 0.31, P= 0.020) after adjusting for the aforementioned related conditions. This score showed a significant decrease in women with a high school education compared to those with higher education (β= -6.57, P= 0.024). Moreover, the diet and foot care subscales in both sexes and the blood glucose testing score in women were significantly higher after versus before the pandemic.

Following the Covid-19 pandemic, self-care behaviors, especially those related to diet, foot care, and blood glucose testing, improved in the short term

This study aimed to investigate the effective factors in the survival/hazard time of Covid-19 patients in three waves of epidemic.

All 880 Covid-19 patients were included in this prospective cohort study using the census method. Polymerase chain reaction was used to diagnose Covid-19. The survival status of these patients was followed up for 4 months. The analysis of this study was based on the time of infection in three epidemic waves in IRAN. To analyze the data, the Kaplan-Meier nonparametric approach and Cox proportional hazards regression model were used. Survival distributions were compared in three epidemic waves using the R software (version 3.6.2) (P<0.05).

We diagnosed 880 positive case of Covid-19 using PCR test on 2269 susspected people who had respiratory symptomps. At the end of 1-year follow-up, cumulative incidence (risk) of Covid-19 was estimated 7%. Effective factors in the survival time of patients with Covid-19 based on Cox multivariate regression model were: 1- Age 2- Intensity of infection (Hospitalization) 3- Heart disease 4- Epidemic Wave and 5- Transmission mode of the disease (P <0.05). The Kaplan-Meier approach and log rank test (Mantel-Cox) showed a significant difference in the survival rate in three epidemic waves (P = 0.018).

Elderly patients, especially those with a history of heart disease, are at higher risk of death than other groups. In addition to regular screening, these patients will need active monitoring, especially at the time of hospitalization.

low utility of health care services is one of the main determinants of not achieving desired health indicators in urban areas. This study aimed to investigate the barriers and facilitators of receiving health services from health centers in Kerman city, Iran.

This study was a qualitative study with a content analysis approach conducted in 2020. After selecting health centers with the experience of desirable or low utility services, purposive sampling continued until information saturation. A total of 78 staff members, recipients, and non-recipients of services citizens were interviewed semi-structured and face-to-face at health centers. All interviews were recorded and coded manually and then reviewed and analyzed using directional content analysis.

The essential services for children and mothers, free services, and service providers' behavior were mentioned as facilitators of referral. Distance and physical factors, knowledge of different types of services, preference of private centers, time access, view of people on regular visits to centers, addresses and telephone numbers registered in the system, responsiveness to health needs, fear of disease disclosure, lack of human resources in the centers, and service providers' behavior, were among the barriers of visiting the centers.

According to the results of this study, an accurate understanding of the under-coverage people's views and perceptions can help national and local planners and policymakers design the necessary strategies to increase the use of health services in urban health centers.

It is necessary to apply appropriate coping methods to reduce destructive physical and psychological effects of stress during Covid-19 pandemics. This study was conducted to explore nurses' experiences of stress coping techniques during the Covid-19 pandemic.

The present study used a qualitative methodology with interpretive phenomenology method. Purposive sampling was used. The participants, including nurses working in hospitals affiliated to Tehran University of Medical Sciences, shared their experiences through in-depth, individual and semi-structured interviews. The transcripts of interviews were analyzed based on the Dickelmann's approach using the MAXQDA 12 software.

The participants included nine nurses (six females and three males) with a mean age of 45 ± 5.3 years. The results of data analysis showed four main categories and fifteen subcategories conceptually named based on their nature. The main categories were self-support, family shelter, hospital support umbrella, and community support on both extremes.

The participants practiced different coping strategies to deal with stress and anxiety. In addition to individual mechanisms, nurses sought help from other sources of support, such as family, workplace, and community. Based on the experiences of nurses participating in the study, it is recommended to teach nursing staffs coping methods with stress, especially in times of crisis such as the Covid-19 pandemic.

Pulmonary consequences of exposure to low concentrations of ammonia have been less studied. The purpose of this study was to model the pulmonary consequences of exposure to low concentrations of ammonia.

This historical cohort study was conducted in the fertilizer industries in 2019. The participants were divided into two groups of exposed (n=98) and non-exposed (n=105). The exposure level, pulmonary symptoms, and pulmonary function parameters were assessed using the NMAM 6016 and American Thoracic Society and European Respiratory society (ATS&ERS) protocols. Data analysis was performed using the IBM SPSS v. 22.0, and multivariate linear and logistic regression models.

The ammonia exposure level was 4.80±1.54 ppm in the exposed group. There was no significant difference in most of the individual variables between the two groups (P>0.05). The frequency of all pulmonary symptoms was significantly higher in the exposed group compared to the non-exposed group (P<0.05). The highest prevalence of pulmonary symptoms in the exposed group was for cough (25.51%), wheezing (19.39%) and shortness of breath (18.37%). All lung function parameters were significantly lower in the exposed group versus the non-exposed group (P<0.05). The values of lung function parameters in the exposed group including FVC, FEV1 and FEV1 / FVC were 86.0%, 82.47% and 81.97%, respectively. Regression modeling results showed that ammonia exposure had a significant relationship with all pulmonary symptoms and lung function parameters (P<0.05).

The findings indicated that exposure to low concentrations of ammonia should be considered as a major risk factor in the prevalence of pulmonary symptoms and reduced lung function parameters.