Publications by authors named "Behzad Kiani"

31 Publications

Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018.

BMC Public Health 2021 06 7;21(1):1093. Epub 2021 Jun 7.

Department of Geography and Urban Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.

Background: Effective reduction of tuberculosis (TB) requires information on the distribution of TB incidence rate across time and location. This study aims to identify the spatio-temporal pattern of TB incidence rate in Iran between 2008 and 2018.

Methods: This cross-sectional study was conducted on aggregated TB data (50,500 patients) at the provincial level provided by the Ministry of Health in Iran between 2008 and 2018. The Anselin Local Moran's I and Getis-Ord Gi* were performed to identify the spatial variations of the disease. Furthermore, spatial scan statistic was employed for purely temporal and spatio-temporal analyses. In all instances, the null hypothesis of no clusters was rejected at p ≤ 0.05.

Results: The overall incidence rate of TB decreased from 13.46 per 100,000 (95% CI: 13.19-13.73) in 2008 to 10.88 per 100,000 (95% CI: 10.65-11.11) in 2018. The highest incidence rate of TB was observed in southeast and northeast of Iran for the whole study period. Additionally, spatial cluster analysis discovered Khuzestan Province, in the West of the country, having significantly higher rates than neighbouring provinces in terms of both total TB and smear-positive pulmonary TB (SPPTB). Purely temporal analysis showed that high-rate and low-rate clusters were predominantly distributed in the time periods 2010-2014 and 2017-2018. Spatio-temporal results showed that the statistically significant clusters were mainly distributed from centre to the east during the study period. Some high-trend TB and SPPTB statistically significant clusters were found.

Conclusion: The results provided an overview of the latest TB spatio-temporal status In Iran and identified decreasing trends of TB in the 2008-2018 period. Despite the decreasing incidence rate, there is still need for screening, and targeting of preventive interventions, especially in high-risk areas. Knowledge of the spatio-temporal pattern of TB can be useful for policy development as the information regarding the high-risk areas would contribute to the selection of areas needed to be targeted for the expansion of health facilities.
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http://dx.doi.org/10.1186/s12889-021-11157-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186231PMC
June 2021

Factors affecting the quality of diagnosis coding data with a triangulation view: A qualitative study.

Int J Health Plann Manage 2021 May 25. Epub 2021 May 25.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Objective: The most important challenge in utilizing medical record codes is the quality of coding data. The present study aims to investigate factors affecting the quality of diagnosis coding from different aspects covering different stakeholders in a multi-dimensional approach.

Methods: First, we used Conventional Content Analysis to maximally gather all effective factors. As such, semi-structured interviews were conducted with medical record coders (N = 32) at the referral hospitals in Mashhad, Iran. Second, 86 hospital staff members from 25 provinces were surveyed using a web-based questionnaire. Finally, a focus group discussion was conducted among coders (N = 18) in different hospitals across the country.

Results: In general, the barriers to quality of inpatient record coding can be classified into three categories: (I) physician-related, (II) coder-related, and (III) managerial, financial and administrative factors.

Conclusion: A triangulation view (related to coders, physicians as well as managerial, financial and administrative dimensions) could be used to identify the barriers affecting the quality of diagnosis coding data. The results of this study may help policymakers in development and implementation of appropriate strategies and effective interventions to improve the quality of clinical coding.
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http://dx.doi.org/10.1002/hpm.3254DOI Listing
May 2021

Different configurations of the two-step floating catchment area method for measuring the spatial accessibility to hospitals for people living with disability: a cross-sectional study.

Arch Public Health 2021 May 22;79(1):85. Epub 2021 May 22.

Visualization and Decision Analytics (VIDEA) lab, Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.

Background: Poor spatial accessibility to hospital services is associated with higher morbidity and mortality rates among people living with disability. Improved methods to evaluate spatial accessibility are needed. This study measured the potential spatial accessibility of people living with disability by applying four configurations of the two-step floating catchment area (2SFCA) method to recommend the best model for use in health services research.

Methods: 2SFCA and an enhanced version (E2SFCA) were used to measure hospital accessibility for people living with disability. We also developed and embedded a non-spatial severity index into the two 2SFCA models. We used 16,186 records of people living with disability experience to evaluate the methodological performance across 68 neighbourhoods of the city of Ahvaz, located in south-western Iran. The models' performance were measured through correlation of the four accessibility scores with the distance to closest hospital for each neighbourhood centroid.

Results: Among the four models used to measure spatial accessibility, the E2SFCA integrated with the severity index displayed the best performance. Most people with disabilities lived in neighbourhoods located in the South-western and central areas of the city. Interestingly, south-western neighbourhoods had poor hospital accessibility score and were identified as unmet need areas for access to health services.

Conclusions: Inclusion of the severity factor in the E2SFCA improved access measurements. Identifying areas with poor levels of hospital accessibility can help policymakers design tailored interventions and improve accessibility to hospital-based care in urban settings for people living with disability.
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http://dx.doi.org/10.1186/s13690-021-00601-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141247PMC
May 2021

COVID19-CT-dataset: an open-access chest CT image repository of 1000+ patients with confirmed COVID-19 diagnosis.

BMC Res Notes 2021 May 12;14(1):178. Epub 2021 May 12.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Objectives: The ongoing Coronavirus disease 2019 (COVID-19) pandemic has drastically impacted the global health and economy. Computed tomography (CT) is the prime imaging modality for diagnosis of lung infections in COVID-19 patients. Data-driven and Artificial intelligence (AI)-powered solutions for automatic processing of CT images predominantly rely on large-scale, heterogeneous datasets. Owing to privacy and data availability issues, open-access and publicly available COVID-19 CT datasets are difficult to obtain, thus limiting the development of AI-enabled automatic diagnostic solutions. To tackle this problem, large CT image datasets encompassing diverse patterns of lung infections are in high demand.

Data Description: In the present study, we provide an open-source repository containing 1000+ CT images of COVID-19 lung infections established by a team of board-certified radiologists. CT images were acquired from two main general university hospitals in Mashhad, Iran from March 2020 until January 2021. COVID-19 infections were ratified with matching tests including Reverse transcription polymerase chain reaction (RT-PCR) and accompanying clinical symptoms. All data are 16-bit grayscale images composed of 512 × 512 pixels and are stored in DICOM standard. Patient privacy is preserved by removing all patient-specific information from image headers. Subsequently, all images corresponding to each patient are compressed and stored in RAR format.
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http://dx.doi.org/10.1186/s13104-021-05592-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114670PMC
May 2021

Evaluation of zoonotic platyhelminthe infections identified in slaughtered livestock in Iran, 2015-2019.

BMC Vet Res 2021 May 5;17(1):185. Epub 2021 May 5.

Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Platyhelminth infections of livestock can result in considerable economic losses. This study aims to evaluate the spatial frequency of cystic echinococcosis (CE), dicrocoeliasis, and fascioliasis in livestock slaughtered in Iran during the years 2015-2019 and estimate direct costs associated with organ condemnation due to these parasites.

Methods: Abattoir data from 413 abattoirs representing all 31 Iranian provinces were collected from the Iran Veterinary Organization. Infection prevalence was calculated per year at the province level. The Local Moran's I statistic was performed to evaluate spatial autocorrelation of animals positive at slaughter for the years 2015-2019. Direct costs associated with condemned livers were calculated for each parasitic condition, with costs associated with condemned lungs also included for CE.

Results: Overall prevalence values for the study timeframe were as follows: sheep and goat fascioliasis 1.56% (95% CI: 1.56-1.56%), cattle fascioliasis 3.86% (95% CI: 3.85-3.88%), sheep and goat dicrocoeliasis 4.63% (95% CI: 4.62-4.63%), cattle dicrocoeliasis 3.08% (95% CI: 3.07-3.09%), sheep and goat CE 5.32% (95% CI: 5.32-5.33%), and cattle CE 7.26% (95% CI: 7.24-7.28%). Northwest Iran had the highest prevalence of CE and fascioliasis. High infection areas for Dicrocoelium spp. included the provinces of Zanjan, Gilan, Qazvin, and Tehran, which are located in northern Iran. Direct economic losses for sheep and goat fascioliasis, dicrocoeliasis, and CE for the study period were US$13,842,759, US$41,771,377, and US$22,801,054, respectively. Direct economic losses for cattle fascioliasis, dicrocoeliasis, and CE for the study period were US$1,989,200, US$1,668,986, and US$2,656,568, respectively.

Conclusion: Our findings provide valuable data for future monitoring of these important parasitic diseases in Iranian livestock. Disease control strategies are required to reduce the economic and public health impact of these platyhelminths.
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http://dx.doi.org/10.1186/s12917-021-02888-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097913PMC
May 2021

Association between heavy metals and colon cancer: an ecological study based on geographical information systems in North-Eastern Iran.

BMC Cancer 2021 Apr 15;21(1):414. Epub 2021 Apr 15.

Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Colorectal cancer has increased in Middle Eastern countries and exposure to environmental pollutants such as heavy metals has been implicated. However, data linking them to this disease are generally lacking. This study aimed to explore the spatial pattern of age-standardized incidence rate (ASR) of colon cancer and its potential association with the exposure level of the amount of heavy metals existing in rice produced in north-eastern Iran.

Methods: Cancer data were drawn from the Iranian population-based cancer registry of Golestan Province, north-eastern Iran. Samples of 69 rice milling factories were analysed for the concentration levels of cadmium, nickel, cobalt, copper, selenium, lead and zinc. The inverse distance weighting (IDW) algorithm was used to interpolate the concentration of this kind of heavy metals on the surface of the study area. Exploratory regression analysis was conducted to build ordinary least squares (OLS) models including every possible combination of the candidate explanatory variables and chose the most useful ones to show the association between heavy metals and the ASR of colon cancer.

Results: The highest concentrations of heavy metals were found in the central part of the province and particularly counties with higher amount of cobalt were shown to be associated with higher ASR of men with colon cancer. In contrast, selenium concentrations were higher in areas with lower ASR of colon cancer in men. A significant regression equation for men with colon cancer was found (F(4,137) = 38.304, P < .000) with an adjusted R of 0.77. The predicted ASR of men colon cancer was - 58.36 with the coefficients for cobalt = 120.33; cadmium = 80.60; selenium = - 6.07; nickel = - 3.09; and zinc = - 0.41. The association of copper and lead with colon cancer in men was not significant. We did not find a significant outcome for colon cancer in women.

Conclusion: Increased amounts of heavy metals in consumed rice may impact colon cancer incidence, both positively and negatively. While there were indications of an association between high cobalt concentrations and an increased risk for colon cancer, we found that high selenium concentrations might instead decrease the risk. Further investigations are needed to clarify if there are ecological or other reasons for these discrepancies. Regular monitoring of the amount of heavy metals in consumed rice is recommended.
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http://dx.doi.org/10.1186/s12885-021-08148-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048218PMC
April 2021

Use of geographical information systems in multiple sclerosis research: A systematic scoping review.

Mult Scler Relat Disord 2021 Mar 18;51:102909. Epub 2021 Mar 18.

Center for Mental Health Research College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia. Electronic address:

Introduction: Geographical information system (GIS) and spatial analysis have an emerging role in the understanding and management of health-related outcomes. However, there is a knowledge gap about the extent to which GIS has supported multiple Sclerosis (MS) research. Therefore, this review aimed to explore the types of GIS applications and the complexity of their visualisation in MS research.

Methods: A systematic scoping review was conducted based on York's five-stage framework. PubMed, Scopus and Web of Science were searched for relevant studies published between 2000 and 2020 using a comprehensive search strategy based on the main concepts related to GIS and MS. Grounded, inductive analysis was conducted to organize studies into meaningful application areas. Further, we developed a tool to assess the visualisation complexity of the selected papers.

Results: Of 3,723 identified unique citations, 42 papers met our inclusion criteria for the final review. One or more of the following types of GIS applications were reported by these studies: (a) thematic mapping (37 papers); (b) spatial cluster detection (16 papers); (c) risk factors detection (16 papers); and (d) health access and planning (two papers). In the majority of studies (88%), the score of visualisation complexity was relatively low: three or less from the range of zero to six.

Conclusions: Although the number of studies using GIS techniques has dramatically increased in the last decade, the use of GIS in the areas of MS access and planning is still under-researched. Additionally, the capacity of GIS in visualising complex nature of MS care system is not yet fully investigated.
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http://dx.doi.org/10.1016/j.msard.2021.102909DOI Listing
March 2021

A Geospatial database of gastric cancer patients and associated potential risk factors including lifestyle and air pollution.

BMC Res Notes 2021 Mar 9;14(1):91. Epub 2021 Mar 9.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Objectives: Gastric cancer (GC) is a multifactorial disease and the fifth most frequent diagnosed cancer worldwide. It accounts for one third of cancer-related mortalities. Geospatial analysis using geographical information systems (GIS) can provide an efficient solution to identify spatial disparities associated with GC. As such, GIS enables policymakers to control cancer in a better way and identify the regions where interventions are needed. This study aims to publish a comprehensive dataset, which was applied to conduct a spatial analysis of GC patients in the city of Mashhad, Iran.

Data Description: We provide a personal geodatabase, a Microsoft Access database that can store, query, and manage both spatial and non-spatial data, which contains four feature classes. "Male_Stomach_Cancer_Patients" and "Female_Stomach_Cancer_Patients" are point feature classes, which show the age and geographical location of 1156 GC cancer patients diagnosed between 2014 and 2017. "Air_Polution_Mashhad" is another point feature class that reveals the amount of six air pollutants, which was taken from Mashhad Environmental Pollutants Monitoring Center between 2017 and 2018. Finally, "Stomach_Cancer_and_Risk_Factors" is a polygon feature class of neighborhood division of Mashhad, consisting of contributor risk factors including dietary habits, smoking, alcohol use, body mass index and population by age groups for all 165 city neighborhoods.
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http://dx.doi.org/10.1186/s13104-021-05506-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941611PMC
March 2021

Anisakis allergy: unjustified social alarm versus healthy diet; commentary to the "Letter to the Editor" of Drs Daschner, Levsen, Cipriani, and del Hoyo, referencing to "World-wide prevalence of Anisakis larvae in fish and its relationship to human allergic anisakiasis: a systematic review".

Parasitol Res 2021 05 2;120(5):1921-1923. Epub 2021 Mar 2.

School of Animal and Veterinary Sciences, Graham Centre for Agricultural Innovations, Charles Sturt University, Wagga Wagga, Australia.

Anisakiasis is an underrecognized condition globally, and accurate diagnosis remains problematic even in countries where the condition is well known. Our "systematic review" was conducted according to Prisma guidelines. The stated basis of our study was "syndromic surveillance." Both methods are recognized in published literature as valid to identify or predict disease and to make accessible large amounts of evidence from published literature. Our study identified Anisakis allergy "hot spots" and other geographical areas where fish are highly infected with Anisakis without commensurate studies of human allergy. Results of our study will open up new lines of enquiry. Norway, used as an example to discredit the scientific integrity of our article, has a cuisine thriving with raw fish dishes and many sushi restaurants. The peer reviewed data sets, confirmed A. simplex sensitization among the Norwegian population, although this has been overlooked by the authors of the "Letter to the Editor." The identification of hot spots in our study may be influential in many ways not the least in raising diagnostic suspicion to expedite accurate diagnosis.
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http://dx.doi.org/10.1007/s00436-021-07083-1DOI Listing
May 2021

Correction to: World-wide prevalence of Anisakis larvae in fish and its relationship to human allergic anisakiasis: a systematic review.

Parasitol Res 2021 May 1;120(5):1925-1926. Epub 2021 Mar 1.

School of Animal and Veterinary Sciences, Graham Centre for Agricultural Innovations, Charles Sturt University, Wagga Wagga, Australia.

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http://dx.doi.org/10.1007/s00436-021-07096-wDOI Listing
May 2021

First year with COVID-19: Assessment and prospects.

Geospat Health 2020 Nov 26;15(2). Epub 2020 Nov 26.

Biostatistics Unit, South African Medical Research Council; Department of Statistics, University of Pretoria, Pretoria.

The vision of health for all by Dr. Halfdan Mahler, Director General of the World Health Organization (WHO) 1973 to 1988, guided public health approaches towards improving life for all those mired in poverty and disease. Research on the Neglected Tropical Diseases (NTDs) of the world's poor was advancing strongly when the coronavirus disease 2019 (COVID-19) struck. Although work on the NTDs did not grind to a halt, the situation is reminiscent of the author Stefan Zweig's passionate account of culture destruction in his book The World of Yesterday from 1941, which gives an insight as to how the war ended traditional life. His thoughts parallel the present situation; however, this time societies are not torn apart by war but instead isolated by a pandemic. It comes upon today's scientists to move fast to make COVID-19 less devastating than the Spanish flu of 1918-1920 that killed more than 3% of the world population...
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http://dx.doi.org/10.4081/gh.2020.953DOI Listing
November 2020

Spatial-time analysis of cardiovascular emergency medical requests: enlightening policy and practice.

BMC Public Health 2021 01 4;21(1). Epub 2021 Jan 4.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Response time to cardiovascular emergency medical requests is an important indicator in reducing cardiovascular disease (CVD) -related mortality. This study aimed to visualize the spatial-time distribution of response time, scene time, and call-to-hospital time of these emergency requests. We also identified patterns of clusters of CVD-related calls.

Methods: This cross-sectional study was conducted in Mashhad, north-eastern Iran, between August 2017 and December 2019. The response time to every CVD-related emergency medical request call was computed using spatial and classical statistical analyses. The Anselin Local Moran's I was performed to identify potential clusters in the patterns of CVD-related calls, response time, call-to-hospital arrival time, and scene-to-hospital arrival time at small area level (neighborhood level) in Mashhad, Iran.

Results: There were 84,239 CVD-related emergency request calls, 61.64% of which resulted in the transport of patients to clinical centers by EMS, while 2.62% of callers (a total of 2218 persons) died before EMS arrival. The number of CVD-related emergency calls increased by almost 7% between 2017 and 2018, and by 19% between 2017 and 2019. The peak time for calls was between 9 p.m. and 1 a.m., and the lowest number of calls were recorded between 3 a.m. and 9 a.m. Saturday was the busiest day of the week in terms of call volume. There were statistically significant clusters in the pattern of CVD-related calls in the south-eastern region of Mashhad. Further, we found a large spatial variation in scene-to-hospital arrival time and call-to-hospital arrival time in the area under study.

Conclusion: The use of geographical information systems and spatial analyses in modelling and quantifying EMS response time provides a new vein of knowledge for decision makers in emergency services management. Spatial as well as temporal clustering of EMS calls were present in the study area. The reasons for clustering of unfavorable time indices for EMS response requires further exploration. This approach enables policymakers to design tailored interventions to improve response time and reduce CVD-related mortality.
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http://dx.doi.org/10.1186/s12889-020-10064-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780406PMC
January 2021

Nitrite and Nitrate Levels in Groundwater, Water Distribution Network, Bottled Water and Juices in Iran : A systematic Review.

Curr Pharm Biotechnol 2020 Dec 3. Epub 2020 Dec 3.

Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad. Iran.

Background: Nitrate and nitrite can get into the body through the consumption of contaminated water either directly or indirectly. The accumulation of these compounds in the body, in the long run, leads to health problems, for example, digestive disorders, cancers, and even death threats in children. The aim of this review is to investigate nitrate and nitrite pollution levels in drinking water and fruit juices in Iran.

Methods: In this review data were collected through searching the Scientific Information Database, Science-Direct, Scopus, PubMed, Google Scholar, and Magiran databases using the keywords Nitrate, Nitrite, Drinking water, Drinking Water Resources, Juice and Iran. Finally, the location of the studies was geocoded through the Google My Maps (https://www.google.com/mymaps) software.

Results: Studies clearly indicated that the juices are safe in terms of nitrate. Nitrate and nitrite values were less than the national and international standards in all samples of bottled drinking water except for a few of the studies. The results of the reviewed studies also indicated that the nitrate content was higher than that written on the label in 96% of the samples, and nitrite was not labeled in 80% of them. The nitrate quantity was higher than the permissible limit, in the water distribution network of Bushehr, Gilan and Mazandaran Provinces. Talesh, Ardabil, Hashtgerd, Divandareh, and Kerman cities had high nitrate levels in more than 50% of wells.

Conclusion: Using nitrogen fertilizers and lack of a wastewater treatment system were the main reasons for the presence of nitrate and nitrite.
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http://dx.doi.org/10.2174/1389201021666201203160012DOI Listing
December 2020

Spatio-temporal mapping of breast and prostate cancers in South Iran from 2014 to 2017.

BMC Cancer 2020 Nov 30;20(1):1170. Epub 2020 Nov 30.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: The most common gender-specific malignancies are cancers of the breast and the prostate. In developing countries, cancer screening of all at risk is impractical because of healthcare resource limitations. Thus, determining high-risk areas might be an important first screening step. This study explores incidence patterns of potential high-risk clusters of breast and prostate cancers in southern Iran.

Methods: This cross-sectional study was conducted in the province of Kerman, South Iran. Patient data were aggregated at the county and district levels calculating the incidence rate per 100,000 people both for cancers of the breast and the prostate. We used the natural-break classification with five classes to produce descriptive maps. A spatial clustering analysis (Anselin Local Moran's I) was used to identify potential clusters and outliers in the pattern of these cancers from 2014 to 2017.

Results: There were 1350 breast cancer patients (including, 42 male cases) and 478 prostate cancer patients in the province of Kerman, Iran during the study period. After 45 years of age, the number of men with diagnosed prostate cancer increased similarly to that of breast cancer for women after 25 years of age. The age-standardised incidence rate of breast cancer for women showed an increase from 29.93 to 32.27 cases per 100,000 people and that of prostate cancer from 13.93 to 15.47 cases per 100,000 during 2014-2017. Cluster analysis at the county level identified high-high clusters of breast cancer in the north-western part of the province for all years studied, but the analysis at the district level showed high-high clusters for only two of the years. With regard to prostate cancer, cluster analysis at the county and district levels identified high-high clusters in this area of the province for two of the study years.

Conclusions: North-western Kerman had a significantly higher incidence rate of both breast and prostate cancer than the average, which should help in designing tailored screening and surveillance systems. Furthermore, this study generates new hypotheses regarding the potential relationship between increased incidence of cancers in certain geographical areas and environmental risk factors.
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http://dx.doi.org/10.1186/s12885-020-07674-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708260PMC
November 2020

A spatio-temporal geodatabase of mortalities due to respiratory tract diseases in Tehran, Iran between 2008 and 2018: a data note.

BMC Res Notes 2020 Oct 7;13(1):469. Epub 2020 Oct 7.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Objectives: Respiratory tract diseases (RTDs) are among the top five leading causes of death worldwide. Mortality rates due to respiratory tract diseases (MRRTDs) follow a spatial pattern and this may suggest a potential link between environmental risk factors and MRRTDs. Spatial analysis of RTDs mortality data in an urban setting can provide new knowledge on spatial variation of potential risk factors for RTDs. This will enable health professionals and urban planners to design tailored interventions. We aim to release the datasets of MRRTDs in the city of Tehran, Iran, between 2008 and 2018.

Data Description: The Research data include four datasets; (a) mortality dataset which includes records of deaths and their attributes (age, gender, date of death and district name where death occurred), (b) population data for 22 districts (age groups with 5 years interval and gender by each district). Furthermore, two spatial datasets about the city are introduced; (c) the digital boundaries of districts and (d) urban suburbs of Tehran.
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http://dx.doi.org/10.1186/s13104-020-05319-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539274PMC
October 2020

World-wide prevalence of Anisakis larvae in fish and its relationship to human allergic anisakiasis: a systematic review.

Parasitol Res 2020 Nov 6;119(11):3585-3594. Epub 2020 Oct 6.

School of Animal and Veterinary Sciences, Graham Centre for Agricultural Innovations, Charles Sturt University, Wagga Wagga, Australia.

The infective stage of Anisakidae nematodes responsible for allergic reactions in humans is found in a variety of edible fish and cephalopods. The identification of geographical regions that are high risk for infected seafood may help prevent allergic reactions in humans. Despite an abundance of published literature which has identified anisakid larvae in an array of edible seafood as well as scattered reports of human allergic anisakiasis, the relationship between the two has not been fully explored. Therefore, a systematic spatio-temporal study was conducted to determine the prevalence of Anisakis spp. in fish from January 2000 to August 2020 firstly to explore the relationship between fish infection and cases of allergic anisakiasis and secondly to use fish infection data to map potential allergic anisakiasis 'hot spots'. A systematic literature search for original English text articles was conducted through search engines, Web of Science, Scopus, PubMed, Science Direct and Google Scholar. Out of 3228 articles which describe anisakid infection in fish, 264 were used for data extraction. Of 904 articles describing allergic anisakiasis, 37 were used for data extraction. A qualitative summary of the extracted data was performed using equal interval method (ArcMap software) in order to compare the global distribution of Anisakis-infected fish. Of the 152-identified fish hosts, five families were most commonly infected with Anisakis spp. These included Lophiidae (86.9%), Trichiuridae (77.05%), Zeidae (70.9%), Merlucciidae (67.8%) and Gadidae (56.8%). The hot spot areas for allergic anisakiasis were North and northeast of Atlantic Ocean, southwest of USA, west of Mexico, south of Chile, east of Argentina, Norway, UK and west of Iceland (confidence 99%). The highest rate of allergic anisakiasis was in Portugal and Norway with the prevalence rate of 18.45-22.50%. Allergologists should consider allergic anisakiasis as a public health issue particularly in high-risk countries where high prevalences in fish have been demonstrated.
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http://dx.doi.org/10.1007/s00436-020-06892-0DOI Listing
November 2020

A spatial database of colorectal cancer patients and potential nutritional risk factors in an urban area in the Middle East.

BMC Res Notes 2020 Oct 2;13(1):466. Epub 2020 Oct 2.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran.

Objectives: Colorectal cancer (CRC) is the third most common cancer across the world that multiple risk factors together contribute to CRC development. There is a limited research report on impact of nutritional risk factors and spatial variation of CRC risk. Geographical information system (GIS) can help researchers and policy makers to link the CRC incidence data with environmental risk factor and further spatial analysis generates new knowledge on spatial variation of CRC risk and explore the potential clusters in the pattern of incidence. This spatial analysis enables policymakers to develop tailored interventions. This study aims to release the datasets, which we have used to conduct a spatial analysis of CRC patients in the city of Mashhad, Iran between 2016 and 2017.

Data Description: These data include five data files. The file CRCcases_Mashhad contains the geographical locations of 695 CRC cancer patients diagnosed between March 2016 and March 2017 in the city of Mashhad. The Mashhad_Neighborhoods file is the digital map of neighborhoods division of the city and their population by age groups. Furthermore, these files include contributor risk factors including average of daily red meat consumption, average of daily fiber intake, and average of body mass index for every of 142 neighborhoods of the city.
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http://dx.doi.org/10.1186/s13104-020-05310-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532552PMC
October 2020

Mortality rates due to respiratory tract diseases in Tehran, Iran during 2008-2018: a spatiotemporal, cross-sectional study.

BMC Public Health 2020 Sep 17;20(1):1414. Epub 2020 Sep 17.

Ingerod, Brastad, Sweden (formerly with the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization), Geneva, Switzerland.

Background: Tehran, the 22nd most populous city in the world, has the highest mortality rate due to respiratory system diseases (RSDs) in Iran. This study aimed to investigate spatiotemporal patterns of mortality due to these diseases in Tehran between 2008 and 2018.

Methods: We used a dataset available from Tehran Municipality including all cases deceased due RSDs in this city between 2008 and 2018. Global Moran's I was performed to test whether the age-adjusted mortality rates were randomly distributed or had a spatial pattern. Furthermore, Anselin Local Moran's I was conducted to identify potential clusters and outliers.

Results: During the 10-year study, 519,312 people died in Tehran, 43,177 because of RSDs, which corresponds to 831.1 per 10,000 deaths and 5.0 per 10,000 population. The death rate was much higher in men (56.8%) than in women (43.2%) and the highest occurred in the > 65 age group (71.2%). Overall, three diseases dominated the mortality data: respiratory failure (44.2%), pneumonia (15.9%) and lung cancer (10.2%). The rates were significantly higher in the central and southeastern parts of the city and lower in the western areas. It increased during the period 2008-2018 and showed a clustered spatial pattern between 2008 and 2013 but presented a random geographical pattern afterwards.

Conclusions: This study provides a first report of the spatial distribution of mortality due to RSDs in Tehran and shows a significant increase in respiratory disease mortality in the last ten years. Effective control of the excess fatality rates would warrant a combination of urban prevention and treatment strategies including environmental health plans.
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http://dx.doi.org/10.1186/s12889-020-09495-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495408PMC
September 2020

Paediatric, pedestrian road traffic injuries in the city of Mashhad in north-eastern Iran 2015-2019: a data note.

BMC Res Notes 2020 Jul 31;13(1):363. Epub 2020 Jul 31.

Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Objectives: The leading factors of paediatric, pedestrian road traffic injuries (PPRTIs) are associated with the characteristics of immediate environment. Spatial analysis of data related to PPRTIs could provide useful knowledge for public health specialists to prevent and decrease the number of accidents. Therefore, we aim to release the datasets which have been used to conduct a multiple-scale spatial analysis of PPRTIs in the city of Mashhad, Iran, between 2015-2019.

Data Description: The data include four datasets. The base PPRTIs dataset includes motor vehicle accidents and their attributes in the city of Mashhad between March 2015 and March 2019. The attribute data includes the month, day of the week, hour of the day, place (longitude and latitude) of each accident, age range of the child and gender. Furthermore, three spatial datasets about the city of Mashhad are introduced; (1) the digital boundaries of Neighbourhood, (2) road network dataset (street lines) and (3) urban suburbs of Mashhad.
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http://dx.doi.org/10.1186/s13104-020-05203-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395334PMC
July 2020

Comparing spatio-temporal distribution of the most common human parasitic infections in Iran over two periods 2007 to 2012 and 2013 to 2018: A systematic quantitative literature review.

Int J Health Plann Manage 2020 Sep 22;35(5):1023-1040. Epub 2020 Jun 22.

Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

This study analyses the spatio-temporal trend of the prevalence of the four most prevalent parasitic diseases in Iran over two periods, 2007 to 2012 and 2013 to 2018, indicating high-risk and low-risk areas. Out of 19 126 articles, we selected 220 articles for data extraction and calculated the pooled prevalence for cutaneous leishmaniasis, human toxoplasmosis, giardiasis and blastocystosis for all 31 provinces in the country. Anselin local Moran's I was used to identify clusters and outliers in the prevalence rates. The mean prevalence of cutaneous leishmaniasis patients was found 35.12 per 100 000 in 2007 to 2012 but fell to 19.12 per 100 000 in the 2013 to 2018 period. The mean prevalence of acute and chronic toxoplasmosis was 2.36% and 32.5%, respectively, in 2007 to 2012, which changed to 2.28% and 31.14% in 2013 to 2018. The total prevalence of giardiasis declined from 9.8% in 2007 to 2012 to 4.8% in 2013 to 2018, while the mean prevalence of blastocystosis declined from 8.9% in 2007 to 2012 to 6.76% in the 2013 to 2018 period. There was only one high-high cluster in 2007 to 2012 and that was due to giardiasis, while there were two in 2013 to 2018, one for blastocystosis and one for chronic toxoplasmosis. The total prevalence of blastocystosis, giardiasis and cutaneous leishmaniasis in Iran has continually declined since 2007. In contrast, the prevalence of toxoplasmosis in pregnant Iranian women has not been changed. Iran's Midwest has more parasitic infections compared to the Mideast, which may be explained by the existence of vast deserts and consequently dry and hot climate in the latter part of the country.
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http://dx.doi.org/10.1002/hpm.3010DOI Listing
September 2020

Multiple-scale spatial analysis of paediatric, pedestrian road traffic injuries in a major city in North-Eastern Iran 2015-2019.

BMC Public Health 2020 May 19;20(1):722. Epub 2020 May 19.

Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Paediatric, pedestrian road traffic injuries (PPRTIs) constitute a major cause of premature death in Iran. Identification of high-risk areas would be the primary step in designing policy intervention for PPRTI reduction because environmental factors play a significant role in these events. The present study aims to determine high-risk areas for PPRTIs at three different geographical scales, including the grid network, the urban neighbourhood and the street levels in Mashhad, Iran during the period 2015-2019.

Methods: This cross-sectional retrospective study was based on all pedestrian accidents with motor vehicles involving children (less than 18 years of age) between March 2015 and March 2019 in the city of Mashhad, which is the second-most populous city in Iran. The Anselin Local Moran's I statistic and Getis-Ord Gi* were performed to measure spatial autocorrelation and hotspots of PPRTIs at the geographical grid network and neighbourhood level. Furthermore, a spatial buffer analysis was used to classify the streets according to their PPRTI rate.

Results: A total of 7390 PPRTIs (2364 females and 4974 males) were noted during the study period. The children's mean age was 9.7 ± 5.1 years. Out of the total PPRTIs, 43% occurred on or at the sides of the streets, 25 of which labelled high-risk streets. A high-high cluster of PPRTI was discovered in the eastern part of the city, while there was a low-low such cluster in the West. Additionally, in the western part of the city, older children were more likely to become injured, while in the north-eastern and south-eastern parts, younger children were more often the victims.

Conclusions: Spatial analysis of PPRTIs in an urban area was carried out at three different geographical scales: the grid network, the neighbourhood and the street level. The resulting documentation contributes reliable support for the implementation and prioritization of preventive strategies, such as improvement of the high-risk streets and neighbourhoods of the city that should lead to decreasing numbers of PPRTIs.
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http://dx.doi.org/10.1186/s12889-020-08911-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236119PMC
May 2020

Concept based auto-assignment of healthcare questions to domain experts in online Q&A communities.

Int J Med Inform 2020 05 6;137:104108. Epub 2020 Mar 6.

Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address:

Background: Healthcare consumers are increasingly turning to the online health Q&A communities to seek answers for their questions because current general search engines are unable to digest complex health-related questions. Q&A communities are platforms where users ask unstructured questions from different healthcare topics.

Objectives: This study aimed to provide a concept-based approach to automatically assign health questions to the appropriate domain experts.

Methods: We developed three processes for (1) expert profiling, (2) question analysis and (3) similarity calculation and assignment. Semantic weight of concepts combined with TF-IDF weighting comprised vectors of concepts as expert profiles. Subsequently, the similarity between submitted questions and expert profiles was calculated to find a relevant expert.

Results: We randomly selected 345 questions posted by consumers for 38 experts in 13 health topics from NetWellness as input data. Our results showed the precision and recall of our proposed method for the studied topics were between 63 %-92 % and 61 %-100 %, respectively. The calculated F-measure in selected topics was between 62 % (Addiction and Substance Abuse) and 94 % (Eye and Vision Care) with a combined F-measure of 80 %.

Conclusions: Concept-based methods using unified medical language system and natural language processing techniques could automatically assign actual health questions in different topics to the relevant domain experts with good performance metrics.
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http://dx.doi.org/10.1016/j.ijmedinf.2020.104108DOI Listing
May 2020

An age-integrated approach to improve measurement of potential spatial accessibility to emergency medical services for urban areas.

Int J Health Plann Manage 2020 May 3;35(3):788-798. Epub 2019 Dec 3.

Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran.

Objective: This study aimed to develop an age-included approach to measure the potential accessibility to Emergency medical services (EMS) across urban and suburban areas of Mashhad city in Iran.

Methods: We used an improved version of two-step floating catchment area (2SFCA) and enhanced 2SFCA (E2SFCA) methods to measure the potential accessibility to EMS services with inclusion of age factor. This enabled us to better model accessibility of the older population to the EMS. We used 22 800 records of EMS enquiries from July to September 2018 to evaluate and assess the potential improvement in access to the EMS with incorporating age in the model.

Results: Suburb areas had less potential accessibility compared with central urban due to the high density of EMS stations in the city center areas. Our model showed slight improvement in potential accessibility measurement as a result of the proposed age-integrated method.

Conclusion: An age-integrated index of accessibility method takes into account the age distribution of the population in service area is highly associated with actual measures of accessibility to EMS services. Identifying areas with poor access to EMS will help policymakers to design better policy planning to allocate resources and improve provision of EMS services.
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http://dx.doi.org/10.1002/hpm.2960DOI Listing
May 2020

Colorectal cancer risk factors in north-eastern Iran: A retrospective cross-sectional study based on geographical information systems, spatial autocorrelation and regression analysis.

Geospat Health 2019 11 6;14(2). Epub 2019 Nov 6.

Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad.

Colorectal cancer (CRC) is the second most common cancer among females and the third most common malignancy in males in the world. No single risk factor has been identified, but there are many interrelated factors that together cause the disease. This retrospective, cross-sectional study aimed to identify potential spatial factors contributing to its geographical distribution. Data concerning 1,089 individuals with CRC from the Khorasan-Razavi Province in Iran, located in the North-East of the country, were obtained from the national CRC registry. Local Moran's I statistic was performed to identify clustered areas of CRC occurrence and ordinary least squared regression was calculated to predict frequency of the disease based on a set of variables, such as diet, body mass index (BMI) and the proportion of the population ≥50 years of age. Some dissimilarities related to the geography in the province and also some neighbourhood-related similarities and dissimilarities of CRC occurrence in the city of Mashhad were found. A significant regression equation was found (F (4,137)=38.304, P<.000) with an adjusted R2 of 0.6141. The predicted CRC frequency was -58.3581 with the coefficients for average BMI=+1.594878; fibre intake=-0.610335; consumption of red meat +0.078970; and ≥50-year age group =+0.000744. All associations were statistically significant, except the consumption of red meat one. The study results illuminate the potential underlying risk factors in areas where the CRC risk is comparatively high and how the CRC risk factors may play a role in CRC geographic disparity. Further research is required to explain the patterns observed. We conclude that people should include more fibre in their daily diet and decline their BMI to decrease risk of CRC.
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http://dx.doi.org/10.4081/gh.2019.793DOI Listing
November 2019

Similarity of medical concepts in question and answering of health communities.

Health Informatics J 2020 06 22;26(2):1443-1454. Epub 2019 Oct 22.

Mashhad University of Medical Sciences, Iran.

The ability to automatically categorize submitted questions based on topics and suggest similar question and answer to the users reduces the number of redundant questions. Our objective was to compare intra-topic and inter-topic similarity between question and answers by using concept-based similarity computing analysis. We gathered existing question and answers from several popular online health communities. Then, Unified Medical Language System concepts related to selected questions and experts in different topics were extracted and weighted by term frequency -inverse document frequency values. Finally, the similarity between weighted vectors of Unified Medical Language System concepts was computed. Our result showed a considerable gap between intra-topic and inter-topic similarities in such a way that the average of intra-topic similarity (0.095, 0.192, and 0.110, respectively) was higher than the average of inter-topic similarity (0.012, 0.025, and 0.018, respectively) for questions of the top 3 popular online communities including NetWellness, WebMD, and Yahoo Answers. Similarity scores between the content of questions answered by experts in the same and different topics were calculated as 0.51 and 0.11, respectively. Concept-based similarity computing methods can be used in developing intelligent question and answering retrieval systems that contain auto recommendation functionality for similar questions and experts.
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http://dx.doi.org/10.1177/1460458219881333DOI Listing
June 2020

Enhancing the security of patients' portals and websites by detecting malicious web crawlers using machine learning techniques.

Int J Med Inform 2019 12 25;132:103976. Epub 2019 Sep 25.

Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address:

Introduction: There is increasing demand for access to medical information via patients' portals. However, one of the challenges towards widespread utilisation of such service is maintaining the security of those portals. Recent reports show an alarming increase in cyber-attacks using crawlers. These software programs crawl web pages and are capable of executing various commands such as attacking web servers, cracking passwords, harvesting users' personal information, and testing the vulnerability of servers. The aim of this research is to develop a new effective model for detecting malicious crawlers based on their navigational behavior using machine-learning techniques.

Method: In this research, different methods of crawler detection were investigated. Log files of a sample of compromised web sites were analysed and the best features for the detection of crawlers were extracted. Then after testing and comparing several machine learning algorithms including Support Vector Machine (SVM), Bayesian Network and Decision Tree, the best model was developed using the most appropriate features and its accuracy was evaluated.

Results: Our analysis showed the SVM-based models can yield higher accuracy (f-measure = 0.97) comparing to Bayesian Network (f-measure = 0.88) and Decision Tree (f-measure = 0.95) and artificial neural network (ANN) (f-measure = 0.87)for detecting malicious crawlers. However, extracting proper features can increase the performance of the SVM (f-measure = 0.98), the Bayesian network (f-measure = 0.94) and the Decision Tree (f-measure = 0.96) and ANN (f-measure = 0.92).

Conclusion: Security concerns are among the potential barriers to widespread utilisation of patient portals. Machine learning algorithms can be accurately used to detect malicious crawlers and enhance the security of sensitive patients' information. Selecting appropriate features for the development of these algorithms can remarkably increase their accuracy.
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http://dx.doi.org/10.1016/j.ijmedinf.2019.103976DOI Listing
December 2019

Comparing potential spatial access with self-reported travel times and cost analysis to haemodialysis facilities in North-eastern Iran.

Geospat Health 2018 11 9;13(2). Epub 2018 Nov 9.

Vascular and Endovascular Surgery Research Center; Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad.

End-stage renal disease patients regularly need haemodialysis three times a week. Their poor access to haemodialysis facilities is significantly associated with a high mortality rate. The present cross-sectional study aimed to measure the potential spatial access to dialysis services at a small area level (census tract level) in North Khorasan Province, Iran. The patients were interviewed to obtain their travel information. The two-step floating catchment area (2SFCA) method was used to measure the spatial accessibility of patients to the dialysis centres. The capacity of the dialysis centre was defined as the number of active dialysis facilities in each centre and the haemodialysis patients in each area were considered as the users of dialysis services. The travel cost from each patient's residence to the haemodialysis facilities was visualized by the Kriging interpolation algorithm in the study area. Spatial accessibility to the dialysis centre was poor in the northern part of the study area. Fortunately, there were not many haemodialysis patients in that area. Patients' travel costs were high in the northern areas compared to the rest of study area. We observed a statistically significant reverse correlation between the self-reported travel time and computed spatial accessibility (-0.570, P value <0.01, two-tailed spearman test). This study supports the notion that the 2SFCA method could be associated with revealed access time to dialysis facilities, especially in low traffic and in flat areas such as northern Khorasan. The mapping of patients' distribution and interpolated travel cost to the haemodialysis facilities could help policymakers to allocate health resources to the areas where the need is greater.
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http://dx.doi.org/10.4081/gh.2018.703DOI Listing
November 2018

Prevalence and clinicopathological characteristics of mismatch repair-deficient colorectal carcinoma in early onset cases as compared with late-onset cases: a retrospective cross-sectional study in Northeastern Iran.

BMJ Open 2018 08 30;8(8):e023102. Epub 2018 Aug 30.

Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran.

Objectives: Lynch syndrome (LS), a genetically inherited autosomal disorder, increases the incidence of colorectal carcinoma (CRC). We aimed to perform a universal strategy to assess the prevalence and clinicopathological characteristics of early onset CRCs at high risk of LS versus late-onset ones in the Iranian population.

Setting: A local population-based study from Northeastern Iran.

Participants: 321 consecutive CRCs and pathology specimen screened between 2013 and 2016.

Primary And Secondary Outcome Measures: Retrospectively, information regarding the clinical criteria was obtained by interviewing the patients with CRC or, their families. Pathologists tested tumours with immunohistochemistry (IHC) staining of four mismatch repair (MMR) proteins ( and ). Tumours with absent IHC staining of were tested for BRAF mutations to exclude sporadic CRCs. Prevalence of early onset CRCs at high risk of LS and familial CRC type X were assessed as primary and secondary outcome measures, respectively.

Results: Of 321 CRCs (13/123 (10.57%), early onset vs 21/198 (10.6%) late-onset) were detected to be MMR-deficient (dMMR). Nine early onset cases and 14 late-onset ones with a loss of underwent testing for the BRAF mutation, none of the early onset and four (2.02%) late-onset were recognised as sporadic. The difference in the outcome of IHC-analysis between early and late-onset CRCs at high risk of LS was not statistically significant (p=0.34). Majority of the suspected LS tumours from early onset patients had arisen in distal part (8/11 (72.72%) vs 8/14 (57.14%)), all of which were occurred in the rectum or sigmoid.

Conclusion: Clinically, these findings suggest that in case of limitation for BRAF testing, the practitioner in Iran may consider managing early onset dMMR cases like LS until access to BRAF testing becomes available to them, before germline testing to accurately diagnose LS.
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http://dx.doi.org/10.1136/bmjopen-2018-023102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119423PMC
August 2018

Access to dialysis services: A systematic mapping review based on geographical information systems.

Geospat Health 2018 05 7;13(1):577. Epub 2018 May 7.

Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran; Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad.

Equitable access to healthcare services constitutes one of the leading priorities of healthcare provision and access to dialysis services (ADS) has an essential impact on patients depending on renal dialysis. The many existing GIS-based ADS evaluations include various spatial and non-spatial factors affecting ADS. We systematically mapped and reviewed the available literature with reference to this area identifying gaps in current GIS-based ADS measurements and developing recommendations for future studies. A threestep, systematic mapping review of the available GIS-related evidence in PubMed, Embase, Web of science, Scopus, Science Direct and IEEE Xplore was performed in May 2016 and the information collected updated October 2017 by two independent selection processes. The quality of the studies was assessed using an informal, mixed-approach scoring system. Out of 1119 literature references identified, 36 were identified and used for final review after removal of duplicates, study screenings and applying inclusion/exclusion criteria. Given the contents of the selected studies, three study groups were identified and 41 factors with potential effects on ADS determined. These studies mainly addressed the potential and/or spatial aspects of ADS. Our systematic mapping review of the evidence revealed that current GIS-based measures of ADS tend to calculate potential ADS instead of a realized one. It was also noted that listed factors affecting ADS were mainly nonspatial bringing forth the hypothesis that designing an integrated ADS index could possibly produce better ADS score than those currently advocated. Some primary and secondary research suggestions are made and a list of recommendations offered.
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http://dx.doi.org/10.4081/gh.2018.577DOI Listing
May 2018

Revealed access to haemodialysis facilities in northeastern Iran: Factors that matter in rural and urban areas.

Geospat Health 2017 11 7;12(2):584. Epub 2017 Nov 7.

Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad.

Poor access to haemodialysis facilities is associated with high mortality and morbidity rates. This study investigated factors affecting revealed access to the haemodialysis facilities considering patients living in rural and urban areas without any haemodialysis facility (Group A) and those living urban areas with haemodialysis facilities (Group B). This study is based on selfreported Actual Access Time (AAT) to referred haemodialysis facilities and other information regarding travel to haemodialysis facilities from patients. All significant variables on univariate analysis were entered into a univariate general linear model in order to identify factors associated with AAT. Both spatial (driving time and distance) and non-spatial factors (sex, income level, caregivers, transportation mode, education level, ethnicity and personal vehicle ownership) influenced the revealed access identified in Group A. The non-spatial factors for Group B patients were the same as for Group A, but no spatial factor was identified in Group B. It was found that accessibility is strongly underestimated when driving time is chosen as accessibility measure to haemodialysis facilities. Analysis of revealed access determinants provides policymakers with an appropriate decision base for making appropriate decisions and finding solutions to decrease the access time for patients under haemodialysis therapy. Driving time alone is not a good proxy for measuring access to haemodialysis facilities as there are many other potential obstacles, such as women's special travel problems, poor other transportation possibilities, ethnicity disparities, low education levels, low caregiver status and low-income.
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http://dx.doi.org/10.4081/gh.2017.584DOI Listing
November 2017