Epidemiology and Health System Journal
Volume:11 Issue: 2, Spring 2024

The Sina Electronic Health Record (SinaEHR) system was developed to support primary care delivery across Iran by enabling chronic disease monitoring, infectious disease surveillance, health policy decision-making, and quality improvement initiatives.

The SinaEHR system was implemented by Mashhad University of Medical Sciences which contains health records of over 5 million people across various regions of Iran. It utilizes the International Classification of Diseases (ICD) version 10, integrating laboratory results through a laboratory information system to facilitate real-time clinical decision-making.

Widespread implementation of the SinaEHR system has established an invaluable healthcare infrastructure resource for the improvement of primary care services across Iran. Strict security and confidentiality measures are enforced to protect sensitive patient information.

The SinaEHR system significantly advances Iran’s healthcare infrastructure by providing a comprehensive electronic health record platform to improve healthcare delivery and promote evidence-based decision-making.

Hemodialysis (HD) is associated with patients’ onset and acceleration of sarcopenia progression. Sleep disorders and mental health issues potentially increase the risk of sarcopenia in patients. However, these associations have not been adequately evaluated in HD patients. Therefore, the current study aimed to estimate the prevalence of sarcopenia and its association with sleep disorders, stress, anxiety, and depression in HD patients.

This cross-sectional study consisted of patients undergoing HD in two hospitals in Hamadan between May and July 2023. Demographic and socioeconomic information, along with data on depression, anxiety, and stress (using the Depression, Anxiety, and Stress Scale-21 Items, DASS-21), sleep disorders (using the Athens Insomnia Scale), and SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire were collected through face-to-face interviews. Data were analyzed using independent t tests, ANOVA, and Pearson correlation coefficient using Stata software version 14.

The study included 150 HD patients (age range: 18-88 years; 54.67% male). The results revealed a sarcopenia prevalence rate of 41.3%. Demographic and socioeconomic factors such as gender and education level were found to be associated with sarcopenia. Moreover, positive associations were identified between sarcopenia and various indicators such as stress (r=0.27, P<0.001), anxiety (r=0.49, P<0.001), depression (r=0.39, P<0.001), and sleep disorders (r=0.30, P<0.001).

The prevalence of sarcopenia among HD patients was observed to be high, particularly among females, less educated individuals, and those with elevated levels of depression, anxiety, stress, and sleep disorders.

Patients with acute stroke are vulnerable to infectious diseases due to low consciousness, aspiration, dysphagia, and underlying conditions. Zinc and selenium play critical roles in boosting the immune system. This study aimed to compare serum zinc and selenium levels in patients with stroke before and after infection.

The present prospective study was conducted on patients with stroke in Hamadan, west of Iran, from 2019 to 2020. Serum levels of zinc and selenium were measured before and after infection in patients with stroke. The calculated sample size for this study was 78 patients. A paired t-test was used to compare the mean zinc and selenium levels. The linear regression model was used to assess the association of clinical and para-clinical factors with the change in the serum level of selenium after infection. The level of statistical significance was 0.05.

The mean (±SD) age of participants was 71.33±14.27 years, and 55.1% of the participants were female. The mean (±SD) serum zinc levels before and after infection were 80.4±7.6 µg/dL and 74.3±7.9 µg/dL, respectively, indicating a significant difference (P<0.001). These values for selenium were 118.1±42.8 µg/dL and 78.4±29.4 µg/dL, respectively (P<0.001). There was a significant association between sepsis and decreases in the levels of selenium (-28.86 µg/dL, 95% CI: -56.13, -1.59) and zinc (-9.84 µg/dL, 95% CI: -16.12, -3.56).

Based on our results, the levels of zinc and selenium in patients with stroke significantly decrease after infection compared to before infection.

End-stage renal disease (ESRD) is a pervasive global health challenge with high mortality rates. This prospective study aimed to identify medical factors influencing mortality in ESRD patients.

Data from 149 ESRD patients registered at Imam Khomeini hospital in Kermanshah were analyzed. Only patients with a minimum of one-year follow-up were included. Univariate and multiple regression analyses were employed, and model evaluation utilized indicators such as the area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity.

Among 149 ESRD patients, 88 (59.1%) were male, and 37 (24.7%) experienced mortality. The average age of deceased patients was 63.59±15.74 years. Chronic glomerulonephritis was the underlying cause in 72 (48.3%) participants. Multiple regression revealed that age, diabetes, and a history of heart failure significantly correlated with mortality. ESRD patients with diabetes faced a 2.47-fold increased risk of death (95% confidence interval: 1.10 - 5.55). The model exhibited an area under the curve (AUC) of 0.70, with sensitivity and specificity of 51.35% and 75%, respectively.

Given the chronic nature of ESRD and elevated mortality, particularly among diabetic patients, intensified monitoring efforts are crucial for the prevention and management of diabetes in this population.

Child abuse is one of the major health and social problems in all countries, which is affected by a set of cultural, social, and family factors and some characteristics of children. The present study was performed to determine factors related to child abuse in Ilam province.

This descriptive-analytical study was designed in 2020 in Ilam province, Iran. Ninety-nine children who had a document of child abuse in social emergency centers were included in the study by the census method. In addition, one hundred and thirty-three children of similar age were selected from the community level by the multi-stage sampling method. The required data were collected using a researcher-made questionnaire whose validity and reliability were confirmed, and a significant level of less than 5% was considered statistically significant.

Overall, 53.5% of participants were in the non-abused group, and 46.5% were in the abused children group. Neglect and emotional abuse were the most common types among the abused children. A significant difference was reported between all kinds of child abuse in the abused and non-abused groups (P<0.001). There was a significant relationship between the number of family members with both sexual and nutritional child abuse (P<0.001).

Overall, family, economic, and social factors are related to child abuse. Social service counselors recommend the introduction of these factors during the consultation with parents.

Lead is one of the most dangerous toxic metals in the world. Therefore, this study aimed to investigate and assess the health risks of welders’ occupational exposure to lead fumes.

A cross-sectional, descriptive-analytic study was conducted on 47 automobile welders. In this study, sampling and analysis of air lead concentration (ALC) were performed using the NIOSH 7082 standard and flame atomic absorption spectrophotometer. Then, the blood lead concentration (BLC) was measured using the NIOSH 8003 method via graphite furnace atomic absorption spectrophotometer. Additionally, the health risk assessment of people was conducted using the Environmental Protection Agency (EPA) method.

Among the workers, 12.8% were smokers, and 66% used appropriate personal protective equipment (PPE). The average ALC and BLC of automobile welders were equal to 0.0458±0.0296 mg/m3 and 9.89±7.32 μg/dL, respectively. Although the Pearson coefficient showed a positive correlation between ALCs and BLCs, this correlation was not statistically significant (P=0.38, r=0.18). The value of chronic daily intake (CDI) and lifetime cancer risk (LCR) for lead fume exposure was 74×10-5 and 31×10-6, respectively.

This study found higher average BLC levels in smokers, those who did not use PPE and in individuals over 30 years of age compared to those under 30 years. The mean BLC and ALC were consistent with the American Conference of Governmental Industrial Hygienists (ACGIH) standards, and the carcinogenic risk of exposure to lead fume was within the possible risk range.

Non-Hodgkin’s lymphoma (NHL) is one of two main types of lymphoma. This present study aimed to investigate the survival rate in patients with NHL.

This analytical survival-type study examined 372 patients with NHL referred to Shahid Sadoughi Hospital in Yazd in 2009-2019. The data were extracted from patients’ files. STATA/17 software, the Kaplan-Meier method, and Bayesian parametric survival analysis were used for data analysis.

The overall survival rate and the mean overall survival time were 65% and 129±17.94 months, respectively. According to the Kaplan-Meier method, the survival rates of 1, 2, 3, 5, and 10 years were 86%, 80%, 76%, 69.5%, and 52%. The results revealed that men, people over 70 years old, patients with the NHL.T-cell subtype, patients with involvement in the chest, inguinal, and abdominal-pelvic regions, and patients in stage III or IV of the disease had a shorter survival time. In addition, survival time was shorter in patients with disease recurrence at the primary site. The variables of gender (hazard ratio [HR]=0.65; 95% confidence interval [CI]: 0.44‒0.93), type of treatment (HR=3.43; 95% CI: 1.58‒6.16), stage of disease (HR=2.87; 95% CI: 2.09‒3.57), and involvement site (HR=1.45:95%; CI: 1.03‒1.99) had a significant effect on survival time using the Bayesian parametric regression model.

If patients are identified at an early stage, they have the best chance of survival. In chronic lymphocytic leukemia (CLL) patients, the best survival is achieved without treatment. At the same time, in other types of cancer, chemotherapy offers the best survival.

The relationship between oral-genital infections caused by human papillomavirus (HPV) in men and women is not well studied. This systematic review and meta-analysis aimed to determine the prevalence of concurrent and concordant oral-genital HPV infection.

This systematic review and meta-analysis was conducted by selecting 89 articles from PubMed, Scopus, and Web of Science databases, exclusively searching for English studies published in international journals up to June 2023. The study summarized the percentages of concurrent (presence of any HPV in both oral and genital sites) and concordant (presence of the same types of HPV in both oral and genital sites) oral-genital HPV infections. The quality of these studies was evaluated using the Quality Assessment Tool for Quantitative Studies (QATQS). Moreover, meta-analysis was done using comprehensive meta-analysis (CMA) software with a random-effects method at a significant level of 0.05.

The meta-analysis incorporated a total of 86 articles. Based on QATQS, 83% of these studies achieved ‘Moderate’ ratings. The overall prevalence of concurrent oral-genital HPV infection was 15.5% (95% CI: 11.2–21) in women and 14% (95% CI: 8–23.3) in men. The concordance rate was 41.9% (95% CI: 33.8–50.5) in women and 32.2% (95% CI: 11–64.7) in men. Additionally, the prevalence of genital and oral HPV infections was 61% (95% CI: 21.3–90.6) and 9.5% (95% CI: 7.7–11.7), respectively.

This meta-analysis showed that the high prevalence of genital HPV and oral-genital HPV can be a reason for the possibility of self-contamination.