Publications by authors named "Masoud Salehi"

63 Publications

A Trend Study of Preterm Infant Mortality Rate in Developed and Developing Countries over 1990 to 2017.

Iran J Public Health 2021 Feb;50(2):369-375

Department of Foreign Languages, Shiraz Branch, Islamic Azad University, Shiraz, Iran.

Background: Preterm birth is the most important in children under 5 yr mortality. In this study, we used the Global Burden of Disease Data (GBD) to evaluate the trend of preterm infant mortality rate for all countries from 1990 to 2017 and to assess the effect of development factors on this trend.

Methods: The preterm infant mortality rate data from 196 countries of the world, from 1990 to 2017, were extracted from the GBD database. To study the trend of preterm infant mortality rate, a mixed-effects log-linear regression model was fitted separately for each IHME super-region. In the next step of data analysis, the development factor was included in the model to determine its effect on this trend for all countries under study.

Results: The average rate mortality rate has declined about 2% per year throughout the world over the mentioned period. The highest and lowest decreasing trends were observed in high-income countries (about 4.0%) and Sub-Saharan Africa (about 1.0%), respectively. Including the effect of development factor in the mentioned model revealed that in 1990, the rate of preterm infant mortality in developed countries was 2.2 times of this rate in developing countries and this rate ratio has increased to 2.69 in year 2017.

Conclusion: Although the preterm infant mortality rate were decreasing in all super regions, there is a remarkable gap in this rate between developing and developed countries yet. Therefore, preventative strategies are needed to reduce preterm birth and its burden, especially in the developing world.
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http://dx.doi.org/10.18502/ijph.v50i2.5353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956079PMC
February 2021

Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017.

BMC Public Health 2021 Feb 25;21(1):401. Epub 2021 Feb 25.

Department of Biostatistics, Health Management and Economics Research Center, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Background: Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-incidence ratio (MIR) across the world over 28 years.

Methods: The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990-2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.

Results: The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990-2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.

Conclusions: Generally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality.
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http://dx.doi.org/10.1186/s12889-021-10429-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905904PMC
February 2021

County-level longitudinal clustering of COVID-19 mortality to incidence ratio in the United States.

Sci Rep 2021 02 4;11(1):3088. Epub 2021 Feb 4.

Informatics Institute, University of Florida, Gainesville, FL, USA.

As of November 12, 2020, the mortality to incidence ratio (MIR) of COVID-19 was 5.8% in the US. A longitudinal model-based clustering system on the disease trajectories over time was used to identify "vulnerable" clusters of counties that would benefit from allocating additional resources by federal, state and county policymakers. County-level COVID-19 cases and deaths, together with a set of potential risk factors were collected for 3050 U.S. counties during the 1st wave of COVID-19 (Mar25-Jun3, 2020), followed by similar data for 1344 counties (in the "sunbelt" region of the country) during the 2nd wave (Jun4-Sep2, 2020), and finally for 1055 counties located broadly in the great plains region of the country during the 3rd wave (Sep3-Nov12, 2020). We used growth mixture models to identify clusters of counties exhibiting similar COVID-19 MIR growth trajectories and risk-factors over time. The analysis identifies "more vulnerable" clusters during the 1st, 2nd and 3rd waves of COVID-19. Further, tuberculosis (OR 1.3-2.1-3.2), drug use disorder (OR 1.1), hepatitis (OR 13.1), HIV/AIDS (OR 2.3), cardiomyopathy and myocarditis (OR 1.3), diabetes (OR 1.2), mesothelioma (OR 9.3) were significantly associated with increased odds of being in a more vulnerable cluster. Heart complications and cancer were the main risk factors increasing the COVID-19 MIR (range 0.08-0.52% MIR↑). We identified "more vulnerable" county-clusters exhibiting the highest COVID-19 MIR trajectories, indicating that enhancing the capacity and access to healthcare resources would be key to successfully manage COVID-19 in these clusters. These findings provide insights for public health policymakers on the groups of people and locations they need to pay particular attention while managing the COVID-19 epidemic.
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http://dx.doi.org/10.1038/s41598-021-82384-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862666PMC
February 2021

Effects of curcumin supplementation on blood glucose, insulin resistance and androgens in patients with polycystic ovary syndrome: A randomized double-blind placebo-controlled clinical trial.

Phytomedicine 2021 Jan 22;80:153395. Epub 2020 Oct 22.

Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Curcumin is a biologically active phytochemical ingredient found in turmeric. It has several pharmacologic effects that might benefit patients with polycystic ovary syndrome (PCOS).

Objective: We hypothesized curcumin to be effective in improving blood sugar levels, insulin resistance and hyperandrogenism in individuals with PCOS.

Methods: In a randomized double-blind placebo-controlled trial, individuals with PCOS were treated with curcumin (500 mg three times daily) or placebo for 12 weeks. Primary outcome measures were fasting plasma glucose (FPG), fasting insulin (FI), sex hormone levels, and hirsutism (Ferriman-Gallwey [mFG] score). Secondary outcomes included anthropometric measurements.

Results: Of 72 randomized individuals, 67 completed the trial. The two groups were comparable at baseline. At the end of the study, FPG and Dehydroepiandrosterone levels had decreased significantly in the intervention group compared to control (difference of change (post-pre) between intervention and placebo groups: -4.11 mg/dL; 95% CI: -8.35, -0.35 mg/dL; p = 0.033 and -26.53 microg/dL; 95% CI: -47.99, -4.34 µg/dL; p = 0.035, respectively). We also observed a statistically non-significant increase (p = 0.082) in Estradiol levels in the intervention group compared to control. No serious adverse events were reported throughout the trial.

Conclusions: Curcumin might be a safe and useful supplement to ameliorate PCOS-associated hyperandrogenemia and hyperglycemia. However, longer trials investigating different dosages in longer durations are needed to underpin these findings.
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http://dx.doi.org/10.1016/j.phymed.2020.153395DOI Listing
January 2021

Calorie restriction and synbiotics effect on quality of life and edema reduction in breast cancer-related lymphedema, a clinical trial.

Breast 2020 Dec 27;54:37-45. Epub 2020 Aug 27.

Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran. Electronic address:

Background: Little evidence exists regarding the clinical value of synbiotics in the management of post-treatment complications of breast cancer especially breast cancer-related lymphedema (BCRL). This study aimed to investigate the effects of synbiotic supplementation along with calorie restriction on quality of life and edema volume in patients with BCRL.

Methods: This randomized, placebo-controlled, clinical trial was conducted on 135 overweight and obese women with BCRL aged 18-65 years old. Participants were randomly allocated to receive a calorie-restricted diet plus 10 CFU synbiotic supplement (CRS group; n = 45) or placebo (CRP group; n = 45), daily for 10 weeks. Also, a control group (n = 45) with no intervention was included in the trial. All of the participants received Complete Decongestive Therapy for lymphedema treatment. The quality of life score, edema volume and body mass index (BMI) were measured at baseline and end of the trial.

Results: A total of 121 subjects completed the trial. CRS group showed a significant decrease in the total quality of life score (P = 0.004), and it's psychosocial (P = 0.022) and functional (P = 0.002) domain scores, as well as edema volume (P = 0.002) and BMI (P < 0.001) in comparison to the control. However, there were no significant differences in changes in trial outcomes between the CRS and CRP groups.

Conclusion: Synbiotic supplementation along with a low-calorie diet was effective in quality of life, edema volume, and BMI improvement; mostly due to low-calorie diet. It seems that adding a dietitian consultation on the lymphedema management strategy may provide a better result in lymphedema control.
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http://dx.doi.org/10.1016/j.breast.2020.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486474PMC
December 2020

Lower folate levels in methamphetamine-induced psychosis: A cross-sectional study.

Drug Alcohol Depend 2020 02 28;207:107682. Epub 2019 Oct 28.

Research Center for Addiction and Risky Behaviors (ReCARB), Department of Psychiatry, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Folate deficiency is shown to be associated with schizophrenia. Folate profile in patients with psychosis due to stimulant use has not been investigated. We aim to determine whether there is an association between serum folate level and the presence of psychosis in patients with methamphetamine (METH) use disorder.

Methods: Forty patients diagnosed with METH-use disorder were included in this cross-sectional study. Serum folate levels were measured using enzyme immunoassay technique and compared between psychotic and non-psychotic subgroups (N = 25 and 15, respectively). We designed a logistic regression model to measure the extent of any association and also to adjust for potential confounders.

Results: We detected lower serum folate level in the psychotics [3.4 (IQR = 5.3)] compared to non-psychotic METH users [8.9 (IQR = 2.5)], p = 0.01. The model demonstrated that every 1-unit increase in serum folate decreases the odds of presence of psychosis by 27% (R = 53.5%, CI 12-64%, p = 0.006). The observed difference was not associated with the duration of METH use, patient's age at first METH use, or concurrent use of other substances.

Conclusions: Our findings suggest that low folate level in psychotic METH users does not correlate with previously established risk factors for meth-induced psychosis such as duration of use, age of onset of using, and poly-drug use. We assume that low folate levels may play a crucial role in the pathophysiology of psychosis.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.107682DOI Listing
February 2020

Comparing the effectiveness of vitamin D plus iron vs vitamin D on depression scores in anemic females: Randomized triple-masked trial.

Med J Islam Repub Iran 2019 3;33:64. Epub 2019 Jul 3.

Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.

Low levels of 25-hydroxyvitamin D (25(OH)D) have been related to depression and anxiety. It seems that anemia is associated with vitamin D deficiency. We aimed to evaluate the effects of iron-vitamin D co-supplementation versus vitamin D alone on depression scores in anemic females with low levels of serum 25-hydroxyvitamin D. This randomized controlled trial was conducted on eighty premenopausal females who were recruited between May 2015 and October 2015 from primary health care centers. Women with anemia and low concentrations of 25(OH)D were randomized to either 1000 IU/d vitamin D plus 27 mg/d iron (D-Fe) or vitamin D plus placebo supplements (D-P) for 12 weeks. Depressive and anxious symptoms were evaluated with the Beck Depression Inventory (BDI) with subscales 1-13 and 14-21 and Beck Anxiety Inventory (BAI). To compare the groups, Mann-Whitney or chi-squared tests were used and within groups comparison was performed using Wilcoxon signed ranks test. The study was registered on www.clinicaltrial.org as NC 01876563. The serum concentrations of 25(OH)D were increased significantly in both groups at the end of the study. In both groups, there was a significant improvement in total BDI, the BDI subscale, and the BAI scores (p<0.001). No differences were found between groups (p>0.05). Although the potential positive effect of vitamin D on mental health was evident, iron plus vitamin D co-supplementation did not demonstrate any significant benefits over vitamin D alone, neither in depression score reduction nor anxiety symptoms.
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http://dx.doi.org/10.34171/mjiri.33.64DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708107PMC
July 2019

Determination of effective factors on geographic distribution of the incidence of colorectal cancer in Tehran using geographically weighted Poisson regression model.

Med J Islam Repub Iran 2019 27;33:23. Epub 2019 Mar 27.

Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

This study aimed to determine effective factors on geographic distribution of the Incidence of Colorectal Cancer (CRC) in Tehran, Iran using Geographically Weighted Poisson Regression Model. This ecological study was carried out at neighborhood level of Tehran in 2017-2018. Data for CRC incidence was extracted from the population-based cancer registry data of Iran. The socioeconomic variables, risk factors and health costs were extracted from the Urban HEART Study in Tehran. Geographically weighted Poisson regression model was used for determination of the association between these variables with CRC incidence. GWR 4, Stata 14 and ArcGIS 10.3 software systems were used for statistical analysis. The total number of incident CRC cases were 2815 in Tehran from 2008 to 2011, of whom, 2491 cases were successfully geocoded to the neighborhood. The median IRR for local variables were : unemployed people over 15 year old (median IRR: 1.17), women aged 17 years or older with university education (median IRR: 1.17), women head of household (median IRR: 1.06), people without insurance coverage (median IRR: 1.10), households without daily consumption of milk (median IRR: 0.85), smoking households (median IRR: 1.07), household's health expenditure (median IRR: 1.39), disease diagnosis costs (median IRR: 1.03), medicines costs of households (median IRR: 1.05), cost of the hospital (median IRR: 1.09), cost of medical visits (median IRR: 1.27). The spatial variability was observed for most socioeconomic variables, risk factors and health costs that had effects on CRC incidence in Tehran. Spatial variability is necessary when interpreting the results and utterly helpful for implementation of prevention programs.
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http://dx.doi.org/10.34171/mjiri.33.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662539PMC
March 2019

Using discrete choice model to elicit preference for health-care priority setting.

J Educ Health Promot 2019 27;8:117. Epub 2019 Jun 27.

Department of Economics, Faculty of Economics, University of Tehran, Tehran, Iran.

Background: Regarding lack of resources in the health-care sector, prioritization of these resources is inevitable. The objective of the current study was to elicit public preference in prioritizing and allocating health resources using a discrete choice experiment technique, which is currently the most commonly applied method in this field of researches.

Methods: In this discrete choice study, five attributes were selected through interview with 25 health experts to elicit people preferences in Tehran (Iran) in 2017. Eighteen choice tasks were arranged within 3 blocks, and this would be achieved with a sample size of 579. Choice data were modeled using generalized estimating equation method and STATA 14 software.

Results: Five attributes including level of emergency, severity of disease, communicable, benefit from treatment, and age are the most important attributes in the prioritizing health resources from the expert's point of view. As well as among these attributes, communicable (odds ratio = 2.81) is the most important attributes from the public's point of view.

Conclusion: The results of this study could be very useful for prioritizing resources which is one of the most challenging measurements of the health system. By identifying the importance of each patient's characteristic, patients can be categorized in groups with different priorities, as well as the diagnosis-related group system, based on which resources are allocated.
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http://dx.doi.org/10.4103/jehp.jehp_404_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615128PMC
June 2019

Province-Level Prevalence of Psychiatric Disorders: Application of Small-Area Methodology to the Iranian Mental Health Survey (IranMHS).

Iran J Psychiatry 2019 Jan;14(1):16-32

Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

National surveys revealed a high prevalence of psychiatric disorders in Iran. Province-level estimates are needed to manage the resources and focus on preventive efforts more efficiently. The objective of this study was to provide province-level estimates of psychiatric disorders. In this study, Iranian Mental Health Survey (IranMHS) data (n = 7886) was used to produce province-level prevalence estimates of any psychiatric disorders among 15-64 year old males and females. Psychiatric disorders were diagnosed based on structured diagnostic interview of the Persian version of Composite International Diagnostic Interview (CIDI, version, 2.1). The Hierarchical Bayesian (HB) random effect model was used to calculate the estimates. The mental health status of half of the participants was also measured using a 28-item general health questionnaire (GHQ). A wide variation in the prevalence of psychiatric disorders was found among 31 provinces of Iran. The direct estimates ranged from 3.6% to 62.6%, while the HB estimates ranged from 12.6% to 36.5%. The provincial prevalence among men ranged from 11.9% to 34.5%, while it ranged from 18.4% to 38.8% among women. The Pearson correlation coefficient between HB estimates and GHQ scores was 0.73. The Bayesian small area estimation provides estimation with improved precision at local levels. Detecting high-priority communities with small-area approach could lead to a better distribution of limited facilities and more effective mental health interventions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505053PMC
January 2019

Predicting coronary artery disease: a comparison between two data mining algorithms.

BMC Public Health 2019 Apr 29;19(1):448. Epub 2019 Apr 29.

Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Background: Cardiovascular diseases (CADs) are the first leading cause of death across the world. World Health Organization has estimated that morality rate caused by heart diseases will mount to 23 million cases by 2030. Hence, the use of data mining algorithms could be useful in predicting coronary artery diseases. Therefore, the present study aimed to compare the positive predictive value (PPV) of CAD using artificial neural network (ANN) and SVM algorithms and their distinction in terms of predicting CAD in the selected hospitals.

Methods: The present study was conducted by using data mining techniques. The research sample was the medical records of the patients with coronary artery disease who were hospitalized in three hospitals affiliated to AJA University of Medical Sciences between March 2016 and March 2017 (n = 1324). The dataset and the predicting variables used in this study was the same for both data mining techniques. Totally, 25 variables affecting CAD were selected and related data were extracted. After normalizing and cleaning the data, they were entered into SPSS (V23.0) and Excel 2013. Then, R 3.3.2 was used for statistical computing.

Results: The SVM model had lower MAPE (112.03), higher Hosmer-Lemeshow test's result (16.71), and higher sensitivity (92.23). Moreover, variables affecting CAD (74.42) yielded better goodness of fit in SVM model and provided more accurate result than the ANN model. On the other hand, since the area under the receiver operating characteristic (ROC) curve in the SVM algorithm was more than this area in ANN model, it could be concluded that SVM model had higher accuracy than the ANN model.

Conclusion: According to the results, the SVM algorithm presented higher accuracy and better performance than the ANN model and was characterized with higher power and sensitivity. Overall, it provided a better classification for the prediction of CAD. The use of other data mining algorithms are suggested to improve the positive predictive value of the disease prediction.
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http://dx.doi.org/10.1186/s12889-019-6721-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489351PMC
April 2019

Identifying developmental trajectories of worldwide road traffic accident death rates using a latent growth mixture modeling approach.

PLoS One 2019 20;14(2):e0212402. Epub 2019 Feb 20.

Department of Foreign Languages, Iran University of Medical Sciences, Tehran, Iran.

Road Traffic Accidents (RTA) are a major worldwide public health problem. The aim of this study was to use the growth mixture model for clustering countries on the basis of the mortality rate patterns of RTAs from 2007 to 2013. We obtained the data on RTA death rates from World Health Organization reports and Human Development Index (HDI) of United Nations Development Programme reports for the years 2007, 2010 and 2013. Simple Latent Growth Models (LGM) in 181 countries were applied to estimate overall RTA mortality rate growth trajectories and the latent growth mixture modeling utilized to cluster them. According to non-linear LGM, the overall mortality rate of RTAs showed a decrease from 2007 to 2010 followed by an increase from 2010 to 2013. The HDI covariate had a significant negative and positive effect on intercept and slope of the LGM, respectively. The extracted mixture model appeared to have seven classes with different trends in RTA mortality rates. The worldwide countries were clustered into seven classes. Further studies on each of the seven classes are suggested to provide recommendations for reducing the mortality rate of the RTAs. Additionally, increasing HDI in some countries could have a significant effect on reducing the RTA death rates.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212402PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382161PMC
November 2019

Psychosocial and biological paternal role in pregnancy outcomes.

J Matern Fetal Neonatal Med 2020 Jan 22;33(2):243-252. Epub 2018 Jul 22.

Faculty of Medicine, University of Exeter, Exeter, UK.

Pregnancy outcomes are affected by many different factors. One of the influential factors on pregnancy outcomes is the male partner as an important person to mother's wellbeing. The aim of the present study was to investigate the effects of male partner's role including socioeconomic support, emotional support, accompanying pregnant women during prenatal care visits (PNC) and labor, and the level of pregnant women's satisfaction from their partners' support and involvement during pregnancy on pregnancy outcomes. Two hundred first gravid pregnant women with mean age of 23.2 ± 4.3 were studied. Primary outcomes were total maternal and neonatal adverse outcome (TMNAO), total maternal adverse end result (TMAE), and total neonatal adverse outcome (TNAO), regardless of the type of outcomes. Preterm labor and delivery; premature rupture of membrane (PROM) and preterm premature rupture of membrane (PPROM); preeclampsia and eclampsia; placental abruption; chorioamnionitis; stillbirth; meconium passage; maternal death; postpartum hemorrhage; poor progression labor; abnormal vaginal bleeding in third trimester of pregnancy; low birth weight and neonatal need for CPR or intubation, neonatal anomaly, NICU admission, and neonatal mortality were also analyzed as subgroup outcomes. One hundred twenty-seven (63.5%) participants showed a kind of total maternal and neonatal adverse outcome (TMNAO), 72 (36%) deliveries resulted in a kind of neonatal adverse outcome (TNAO), and 104 (52%) of participants had a kind of maternal adverse end result (TMAE). Iranian fathers showed a significantly higher rate of TMNAO than Afghan fathers did (82 versus 69%, odds ratio: 2.9, 95% CI 1.0-7.8, : .01). Mother's nationality showed the same result (82 versus 64%, odds ratio: 2.6, 95% CI 0.9-6.8, : .03). Iranian fathers showed a significantly higher rate of TMAE than Afghan fathers did (79 versus 58%, odds ratio: 2.7, 95% CI 1.1-6.3, : .01). Mother's nationality showed the same result (78 versus 60%, odds ratio: 2.4, 95% CI 1.0-5.6, : 0.02). Neonates with Iranian fathers showed significantly more TNAO than those with Afghan fathers (50 versus 31%, odds ratio: 2.21, 95% CI 0.9-5.5, : .04). The same trend was observed among Iranian mothers in comparison to Afghan mothers (50 versus 32%, odds ratio: 2.11, 95% CI 0.9-4.6, : .06). Of mother's age, mother's BMI, father's age, father's BMI, and mother's nationality, only father's BMI contributed significantly to the binary logistic regression model ( = 116, : 9%, : .028). It was found that for each decreased unit in BMI, the risk of TNAO was increased by 16%, : .03. Moreover, Father's family history of preeclampsia resulted in a higher prevalence of total neonatal adverse outcome (TNAO) in comparison with lack of such family history (87 versus 43%, odds ratio: 8.9, 95% CI 1.1-74.5, : .02). Besides, mothers' participation in prenatal care (PNC) visits, assessed by caregivers, was significantly more satisfactory in neonates without any adverse outcome than those with neonatal adverse outcomes (median (IQR) = 2 (1-2) versus 2 (2-3), : .04). PROM, pre-eclampsia, NICU admission, neonatal intubation, low Apgar score minute 0, and low Apgar score minute 5 were significantly more prevalent in participants revealing positive father's family history of pre-eclampsia. Regarding psychosocial exposures, placental abruption was more prevalent in mothers with exposure to verbal aggression versus non-exposed ones (9 versus 2%, odds ratio: 4.0, 95% CI 0.9-24.6, : .04). Moreover, a weak positive association between neonatal gestational age at birth and quality of mother's participation in PNC visits (: +0.3, : .01) as well as mother's satisfaction from father's commitment to PNC visits was found (: +0.1, : .03). Male partners may play a key role in pregnant women and fetus's heath.
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http://dx.doi.org/10.1080/14767058.2018.1488167DOI Listing
January 2020

Exploring Spatial Patterns of Colorectal Cancer in Tehran City, Iran

Asian Pac J Cancer Prev 2018 Apr 27;19(4):1099-1104. Epub 2018 Apr 27.

Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. Email:

Objectives: Colorectal cancer (CRC) may now be the second most common cancer in the world. The aim of this study was to determine whether clusters of high and low risk of CRC might exist at the neighborhood level in Tehran city. Methods: In this study, new cases of CRC provided from Cancer Registry Data of the Management Center of Ministry of Health and Medical Education of Iran in the period from March 2008 to March 2011 were analyzed. Raw standardized incidence rates (SIRs) were calculated for CRC in each neighborhood, along with ratios of observed to expected cases. The York and Mollie (BYM) spatial model was used for smoothing of the estimated raw SIRs. To discover clusters of high and low CRC incidence a purely spatial scan statistic was applied. Results: A total of 2,815 new cases of CRC were identified and after removal of duplicate cases, 2,491 were geocoded to neighborhoods. The locations with higher than expected incidence of CRC were northern and central districts of Tehran city. An observed to expected ratio of 2.57 (p<0.001) was found for districts of 2, 6 and 11, whereas, the lowest ratio of 0.23 (p<0.001) was apparent for northeast and south areas of the city, including district 4. Conclusions: This study showed that there is a significant spatial variation in patterns of incidence of CRC at the neighborhood level in Tehran city. Identification of such spatial patterns and assessment of underlying risk factors can provide valuable information for policymakers responsible for equitable distribution of healthcare resources.
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http://dx.doi.org/10.22034/APJCP.2018.19.4.1099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031791PMC
April 2018

Spatial Inequalities in the Incidence of Colorectal Cancer and Associated Factors in the Neighborhoods of Tehran, Iran: Bayesian Spatial Models.

J Prev Med Public Health 2018 Jan;51(1):33-40

Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Objectives: The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models.

Methods: This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis.

Results: The Moran index was statistically significant for all the variables studied (p<0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively.

Conclusions: Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in atrisk areas.
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http://dx.doi.org/10.3961/jpmph.17.167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797719PMC
January 2018

Head-to-head immunogenicity comparison of Edmonston-Zagreb vs. AIK-C measles vaccine strains in infants aged 8-12 months: A randomized clinical trial.

Vaccine 2018 01 27;36(5):631-636. Epub 2017 Dec 27.

National Reference Laboratory for Measles and Rubella, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: A non-inferiority multi-centre parallel randomized double-blind trial was implemented in Zahedan district, Sistan-va-Baluchestan province, Iran, to compare the performance of the two measles vaccines which are in use in the National Immunization Programme of Iran and are of two different measles virus vaccine strains: Edmonston-Zagreb (EZ) strain vs. AIK-C strain. The main outcome measure was appearance of anti-measles antibody in sera.

Methods: 200 infants, 8-12 months old, whose parents consented for their children to be included in the study, were randomized in permutation blocks of size 4-8 in four Urban Health Clinics. Having given a pre-vaccination blood sample, they received measles-rubella vaccine containing one of the vaccine strains mentioned before. After 60 days, the second blood sample was taken. The sera of the pre- and post-vaccination blood samples were tested for anti-measles antibodies in the National Reference Measles Laboratory. Parents, laboratory technicians and statistician were blind to groupings.

Results: Of the 200 children equally randomized in the two arms, 185 who were seronegative before vaccination (88 in the EZ arm and 97 in the AIK-C arm) were entered in the final analysis. The seroconversion rate in the EZ arm was 76.1% (95% CI: 60.2-85.2%), and that in the AIK-C arm was 58.7%; (95% CI: 48.8-68.7%). The absolute rate difference was 17. 4% (4.1-30.9%; P-value: .012), and the relative seroconversion rate of EZ to AIK-C was 1.3 (95% CI: 1.1-1.6; P-value: .012). No adverse events were reported during the study period.

Conclusion: A considerable difference in the seropositivity of different measles containing vaccines could be demonstrated in the first year of life.

Trial Registration: Iranian Registry of Clinical Trials Registration Number: IRCT2016032827144N1; May 10, 2016 (www.who.int/ictrp/network/irct/en/).
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http://dx.doi.org/10.1016/j.vaccine.2017.12.048DOI Listing
January 2018

Factors that Influence The Occurrence of Multiple Pregnancies after Intracytoplasmic Injection Cycles with Two or Three Fresh Embryo Transfers.

Int J Fertil Steril 2017 Oct 27;11(3):191-196. Epub 2017 Aug 27.

Health Management and Economics Research Center, Department of Statistics and Mathematics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.

Background: Multiple pregnancies are an important complication of assisted reproductive technology (ART). The present study aims to indentify the risk factors for multiple pregnancies independent of the number of transferred embryos.

Materials And Methods: This retrospective study reviewed the medical records of patients who underwent intracytoplasmic sperm injection (ICSI) cycles in Royan Institute between October 2011 and January 2012. We entered 12 factors that affected the number of gestational sacs into the poisson regression (PR) model. Factors were obtained from two study populations-cycles with double embryo transfer (DET) and cycles that transferred three embryos (TET). We sought to determine the factors that influenced the number of gestational sacs. These factors were entered into multivariable logistic regression (MLR) to identify risk factors for multiple pregnancies.

Results: A total of 1000 patients referred to Royan Institute for ART during the study period. We included 606 eligible patients in this study. PR analysis demonstrated that the quality of transferred embryos and woman's age had a significant effect on the number of observed sacs in patients who underwent ICSI with DET. There was no significant predictive variable for multiple pregnancies according to MLR analysis. Our findings demonstrated that both regression models (PR and MLR) had the same outputs. A significant relation existed between age and fertilization rate with multiple pregnancies in patients who underwent ICSI with TET.

Conclusion: Single embryo transfer (SET) should be considered with the remaining embryos cryopreserved to prevent multiple pregnancies in women younger than 35 years of age who undergo ICSI cycles with high fertilization rates and good or excellent quality embryos. However, further prospective studies are necessary to evaluate whether SET in women with these risk factors can significantly decrease multiple pregnancies and improve cycle outcomes.
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http://dx.doi.org/10.22074/ijfs.2017.4718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582147PMC
October 2017

Some probable factors affecting the malaria situation before and at the beginning of a pre-elimination program in southeastern Iran.

J Parasit Dis 2017 Jun 15;41(2):503-509. Epub 2016 Sep 15.

Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

The area southeast of Iran still copes with malaria as an unstable infectious disease and includes the most autochthonous malaria reports in the country. This comprehensive study was carried out for the evaluation of environmental factors, welfare indicators and health facilities on the malaria situation before and at the beginning of a pre-elimination programme in this area. The probable factors affecting the malaria situation, including the water-pipe network, electricity, rainfall, long-lasting integrated nets (LLINs), indoor residual spraying and malaria diagnosis-treatment centres were analysed using SPSS software. The Pearson correlation test showed no significant correlation between some factors such as piped water networks, annual precipitation, number of sprayed villages and autochthonous cases as well as autochthonous foci. But a significant correlation between electricity coverage, number of diagnoses of malaria-treatment centres and autochthonous cases\foci was observed. Also, the number of distributed LLINs didn't have any correlation with the number of total malaria cases, but a significant correlation between LLINs and autochthonous foci was seen. Detailed studies on the correlation of various variables, such as piped water, spraying coverage and number of malaria diagnosis centres, with the malaria situation is limited in Asia and other parts of the world. This study and others like it can help malaria managers and directors in the more accurate allocation of financial resources.
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http://dx.doi.org/10.1007/s12639-016-0838-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447615PMC
June 2017

A PRECEDE-PROCEED based educational intervention in quality of life of women-headed households in Iran.

Med J Islam Repub Iran 2016;30:417. Epub 2016 Sep 26.

PhD, Assistant Professor Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran.

Women-headed households are more exposed to social damages than other women. Such condition remarkably influences the women's health-related life quality. The present study is aimed to investigate the effect of an educational intervention in quality of life of women-headed households under protection of Tehran Welfare Organization, in 2015. In this quasi-experimental study with control group, 180 women-headed households participated. Sampling method was random allocation. Data collection tools were Life Quality standard questionnaire (WHOQOL-BREF) and a researcher-made questionnaire about structures of ecological and educational diagnosis phase of PRECEDE-PROCEED model. Validity and reliability of the questionnaire approved in a primary study. Based on the results obtained from the primary study, the intervention was performed in the case group only. Participants were followed one and three months after intervention. Data were analyzed through SPSS v. 15 software using descriptive and analytical tests. Before intervention no significant difference was observed among the mean scores of life quality, behavioral factors, and knowledge, enabling, and reinforcing factors in the two groups. But, one month and three months after intervention a significant difference was observed between the mean scores of these variables (in five instances p<0.001). Intervention through the PRECEDE-PROCEED model improved the women-headed households' quality of life. The innovation of this study is using such intervention on quality of life in women-headed households for the first time.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5307607PMC
September 2016

Measurement Properties of the Persian Translated Version of Graves Orbitopathy Quality of Life Questionnaire: A Validation Study.

Ophthalmic Epidemiol 2017 02 21;24(1):3-10. Epub 2016 Dec 21.

d Department of Biostatistics, School of Public Health , Iran University of Medical Sciences , Tehran , Iran.

Purpose: To determine the measurement properties of the Persian language version of the Graves orbitopathy quality of life questionnaire (GO-QOL).

Methods: Following a systematic translation and cultural adaptation process, 141 consecutive unselected thyroid eye disease (TED) patients answered the Persian GO-QOL and underwent complete ophthalmic examination. The questionnaire was again completed by 60 patients on the second visit, 2-4 weeks later. Construct validity (cross-cultural validity, structural validity and hypotheses testing), reliability (internal consistency and test-retest reliability), and floor and ceiling effects of the Persian version of the GO-QOL were evaluated. Furthermore, Rasch analysis was used to assess its psychometric properties.

Results: Cross-cultural validity was established by back-translation techniques, committee review and pretesting techniques. Bi-dimensionality of the questionnaire was confirmed by factor analysis. Construct validity was also supported through confirmation of 6 out of 8 predefined hypotheses. Cronbach's α and intraclass correlation coefficient (ICC) were 0.650 and 0.859 for visual functioning and 0.875 and 0.896 for appearance subscale, respectively. Mean quality of life (QOL) scores for visual functioning and appearance were 78.18 (standard deviation, SD, 21.57) and 56.25 (SD 26.87), respectively. Person reliabilities from the Rasch rating scale model for both visual functioning and appearance revealed an acceptable internal consistency for the Persian GO-QOL.

Conclusion: The Persian GO-QOL questionnaire is a valid and reliable tool with good psychometric properties in evaluation of Persian-speaking patients with TED. Applying Rasch analysis to future versions of the GO-QOL is recommended in order to perform tests for linearity between the estimated item measures in different versions.
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http://dx.doi.org/10.1080/09286586.2016.1255974DOI Listing
February 2017

The association between parental consanguinity and primary immunodeficiency diseases: A systematic review and meta-analysis.

Pediatr Allergy Immunol 2017 05 22;28(3):280-287. Epub 2017 Feb 22.

Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.

Background: We aimed to establish the prevalence of parental consanguinity among patients with primary immunodeficiency diseases (PID) and compare the prevalence with the general population.

Method: We searched PubMed, EMBASE, and Scopus for studies mentioning parental consanguinity prevalence in patients with PID and calculated the prevalence odds ratio (POR) of parental consanguinity in each study, compared to a matched healthy population.

Results: We identified 21 eligible studies with a total population of 18091 accounting for sample overlap. The POR among studies on a sample of mixed patients with PID ranged from 0.6 to 21.9 with the pooled POR of 3.0 (p < 0.001; I = 89%, 95% CI: 2.5-3.7).

Conclusion: PIDs with an autosomal recessive pattern of inheritance had significant odds of parental consanguinity compared to the healthy population, a phenomenon not observed in other inheritance patterns. Determining the extent of the impact that consanguinity imposes upon the progeny paves the way for convincing healthcare policymakers in highly consanguineous communities to act more diligently in informing the masses about the consequences of practicing inbreeding.
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http://dx.doi.org/10.1111/pai.12685DOI Listing
May 2017

Sexually Transmitted Infections Among Hospitalized Patients With Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in Zahedan, Southeastern Iran.

Int J High Risk Behav Addict 2016 Sep 2;5(3):e28028. Epub 2016 Jul 2.

Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran.

Background: Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS.

Objectives: This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection.

Patients And Methods: In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of < 0.05 were considered significant.

Results: Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for VDRL. The FTA-Abs was positive for all patients who were positive for VDRL. Gonorrhea was found in seven patients (17%) and three cases had genital herpes in clinical examinations. All patients who had positive test results for these STIs were male. Eleven patients (26.8%) had HBV infection (three females and eight males). hepatitis C virus (HCV) was found in 13 cases (31%). Eighty percent of patients were unemployed. Seventy-eight percent of patients with HIV/STI were aged between 18 and 38 years. There was a significant difference between sex and becoming infected with HIV and also STI (P < 0.05).

Conclusions: Patients with HIV/AIDS are more likely to acquire other STIs, because the same behaviors that increase the risk of becoming HIV infected can also increase the risk of acquiring STIs. Having a sore on the skin due to an STI can make the transmission of HIV to the sex partner more likely than people who don't have such sore in their genital area.
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http://dx.doi.org/10.5812/ijhrba.28028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5086419PMC
September 2016

Artificial neural networks versus bivariate logistic regression in prediction diagnosis of patients with hypertension and diabetes.

Med J Islam Repub Iran 2016 3;30:312. Epub 2016 Jan 3.

Professor, Antimicrobial Resistance Research Center, Rasoul-e-Akram Hospital, Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Background: Diabetes and hypertension are important non-communicable diseases and their prevalence is important for health authorities. The aim of this study was to determine the predictive precision of the bivariate Logistic Regression (LR) and Artificial Neutral Network (ANN) in concurrent diagnosis of diabetes and hypertension.

Methods: This cross-sectional study was performed with 12000 Iranian people in 2013 using stratified- cluster sampling. The research questionnaire included information on hypertension and diabetes and their risk factors. A perceptron ANN with two hidden layers was applied to data. To build a joint LR model and ANN, SAS 9.2 and Matlab software were used. The AUC was used to find the higher accurate model for predicting diabetes and hypertension.

Results: The variables of gender, type of cooking oil, physical activity, family history, age, passive smokers and obesity entered to the LR model and ANN. The odds ratios of affliction to both diabetes and hypertension is high in females, users of solid oil, with no physical activity, with positive family history, age of equal or higher than 55, passive smokers and those with obesity. The AUC for LR model and ANN were 0.78 (p=0.039) and 0.86 (p=0.046), respectively.

Conclusion: The best model for concurrent affliction to hypertension and diabetes is ANN which has higher accuracy than the bivariate LR model.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898876PMC
July 2016

A systematic review and meta-analysis of the application of platelet rich plasma in sports medicine.

Electron Physician 2016 May 25;8(5):2325-32. Epub 2016 May 25.

Ph.D. of Health Care Management, Assistant Professor, Department of Management Sciences and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: In recent years, platelet rich plasma (PRP) has been receiving increasing attention for the treatment of soft tissue injuries. These numerous applications have raised a great deal of questions and debate about the effectiveness of this method. This study aimed to determine the efficacy of PRP in improving sports injuries and subsequently throw some light on these controversies.

Methods: A systematic review of the literature and meta-analysis of results were undertaken. All related databases, such as PubMed, Cochrane Database of Systematic Reviews, DARE, and EMBASE, were searched on the use of PRP on athletes and in sports medicine. The search was conducted from June 2013 to February 2014.

Results: Our search retrieved 905 studies, of which 13 randomized control trials (RCT) met our inclusion criteria for systematic review and meta-analysis. All articles were appraised by Critical Appraisal Skills Program (CASP) checklist for RCT studies. The analysis of the results of pain scores and physical activity/functions did not show any superiority for PRP as opposed to the other options.

Conclusions: The meta-analysis showed no more effectiveness for PRP application in sports-related injuries in terms of physical function improvement and pain relief. Therefore, the extensive use of PRP for such injuries should be limited. Well-designed RCTs are needed to support the findings.
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http://dx.doi.org/10.19082/2325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930250PMC
May 2016

Relationship between personal characteristics of specialist physicians and choice of practice location in Iran.

Rural Remote Health 2016 Apr-Jun;16(2):3412. Epub 2016 May 6.

Ministry of Health and Medical Education, Tehran, Iran.

Introduction: Uneven geographic distribution of physicians is a major healthcare issue in Iran. This study aimed to explore the relationship between personal characteristics of the recently graduated specialist physicians in Iran and their choice of practice location.

Methods: A cross-sectional study was conducted to extract information with regard to 3825 recently graduated specialist physicians from all medical schools across Iran between 2009 and 2012. The relationship between physicians' personal attributes and their desire to practise in underdeveloped areas was analyzed using χ2 test and logistic regression analysis.

Results: Birthplace, sex, exposure to rural practice before residency program, place of residence, and year of graduation were associated with physicians' desire to practise in an underdeveloped area. The logistic regression showed that female physicians were less likely to choose underdeveloped areas to practise as compared with their male counterparts (OR=0.659, 95%CI, 0.557-0.781, p≤0.001). Physicians who lived in underdeveloped areas were nine times more likely to choose underdeveloped areas to practise as compared with those living in other areas (OR=8.966, 95%CI, 4.717-17.041, p≤0.001). Physicians who did not have previous exposure to rural practice were 28% less likely to choose to serve in the underdeveloped areas as compared to those who had such exposure (OR=0.780, 95%CI, 0.661-0.922, p=0.004). Neither physicians' marital status nor their success in the board certification exam was associated with their choice of practice location.

Conclusions: It seems that increasing the enrollment of physicians with a rural background in residency programs may solve the problem of uneven distribution of specialist physicians in Iran. Because female physicians are less willing to work in the underdeveloped areas than male physicians, increasing the number of male student admissions to residency programs, particularly in certain specialties that are more in demand in the underdeveloped areas, could alleviate the problem of uneven distribution of physicians in the short run. Further, programs that support raising the admissions of female students with a rural background into local medical universities along with providing incentives to encourage them to live and work in rural areas should be put on the policy agenda.
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January 2017

Diabetes Knowledge Translation Status in Developing Countries: A Mixed Method Study Among Diabetes Researchers in Case of Iran.

Int J Prev Med 2016 8;7:33. Epub 2016 Feb 8.

Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Background: Despite considerable investment in research, the existing research evidence is frequently not implemented and/or leads to useless or detrimental care in healthcare. The knowledge-practice gap proposed as one of the main causes of not achieving the treatment goals in diabetes. Iran also is facing a difference between the production and utilization of the knowledge of diabetes. The aim of this study was to assess the status of diabetes knowledge translation (KT) in Iran.

Methods: This was a survey that executed in 2015 by concurrent mixed methods approach in a descriptive, cross-sectional method. The research population was 65 diabetes researchers from 14 diabetes research centers throughout Iran. The research was carried out via the self-assessment tool for research institutes (SATORI), a valid and reliable tool. Focus group discussions were used to complete this tool. The data were analyzed using quantitative (descriptive method by Excel software) and qualitative approaches (thematic analysis) based on SATORI-extracted seven themes.

Results: The mean of scores "the question of research," "knowledge production," "knowledge transfer," "promoting the use of evidence," and all aspects altogether were 2.48, 2.80, 2.18, 2.06, and 2.39, respectively. The themes "research quality and timeliness" and "promoting and evaluating the use of evidence" received the lowest (1.91) and highest mean scores (2.94), respectively. Except for the theme "interaction with research users" with a relatively mediocre scores (2.63), the other areas had scores below the mean.

Conclusions: The overall status of diabetes KT in Iran was lower than the ideal situation. There are many challenges that require great interventions at the organizational or macro level. To reinforce diabetes KT in Iran, it should hold a more leading and centralized function in the strategies of the country's diabetes research system.
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http://dx.doi.org/10.4103/2008-7802.175992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763462PMC
March 2016

Zero inflated Poisson and negative binomial regression models: application in education.

Med J Islam Repub Iran 2015 17;29:297. Epub 2015 Nov 17.

Professor, Antimicrobial Resistance Research Center, Rasoul-e-Akram Hospital, Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Background: The number of failed courses and semesters in students are indicators of their performance. These amounts have zero inflated (ZI) distributions. Using ZI Poisson and negative binomial distributions we can model these count data to find the associated factors and estimate the parameters. This study aims at to investigate the important factors related to the educational performance of students.

Methods: This cross-sectional study performed in 2008-2009 at Iran University of Medical Sciences (IUMS) with a population of almost 6000 students, 670 students selected using stratified random sampling. The educational and demographical data were collected using the University records. The study design was approved at IUMS and the students' data kept confidential. The descriptive statistics and ZI Poisson and negative binomial regressions were used to analyze the data. The data were analyzed using STATA.

Results: In the number of failed semesters, Poisson and negative binomial distributions with ZI, students' total average and quota system had the most roles. For the number of failed courses, total average, and being in undergraduate or master levels had the most effect in both models.

Conclusion: In all models the total average have the most effect on the number of failed courses or semesters. The next important factor is quota system in failed semester and undergraduate and master levels in failed courses. Therefore, average has an important inverse effect on the numbers of failed courses and semester.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764272PMC
February 2016

An Exploration of the Role of Hospital Committees to Enhance Productivity.

Glob J Health Sci 2015 Aug 6;8(3):199-209. Epub 2015 Aug 6.

.

Productivity is the main concern of hospitals as organizations providing health services. As the role of hospital committees is increasing and their productivity and performance improvement is very important, the present study was performed to identify weaknesses and strengths of committee sessions. This analytical-descriptive study was conducted cross- sectional from January to April in 2012. Summary of 405 committee session's agendas related to 11 kinds of committees in 8 hospitals (out of 23 hospitals) of capital cities in 3 provinces of Sistan and Balouchestan, South Khorasan and Khorasan Razavi in Iran were extracted. Data was collected through a form and was analyzed by SPSS16 software using descriptive statistics and variance analysis and content analysis technique. This study showed that the number of hospital committee's sessions holding in 2012 was more than 2011.The differences between public and private hospitals in terms of the following subjects were significant (P-Value < 0.001). In terms of the number of selected policies, participants of the committees, and the duration of the sessions the public hospitals had better conditions. And regarding documentation process, feedback of decisions to personnel and the implementation of the formulated policies in the committees, private hospitals performed better. According to the results of this study, to improve the productivity of hospital committees, it is suggested to motivate senior, tactical and operational managers to appropriately participate in the committees and necessary planning for the committees in advance is mandatory.
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http://dx.doi.org/10.5539/gjhs.v8n3p199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804034PMC
August 2015

Health Care Expenditure and GDP in Oil Exporting Countries: Evidence From OPEC Data, 1995-2012.

Glob J Health Sci 2015 Jun 11;8(2):93-8. Epub 2015 Jun 11.

Department of Health Economic, school of health management and information sciences, Iran University of Medical Sciences, Tehran. Iran.

Background: There is a large body of literature examining income in relation to health expenditures. The share of expenditures in health sector from GDP in developed countries is often larger than in non-developed countries, suggesting that as the level of economic growth increases, health spending increase, too.

Objectives: This paper estimates long-run relationships between health expenditures and GDP based on panel data of a sample of 12 countries of the Organization of the Petroleum Exporting Countries (OPEC), using data for the period 1995-2012.

Patients & Methods: We use panel data unit root tests, cointegration analysis and ECM model to find long-run and short-run relation. This study examines whether health is a luxury or a necessity for OPEC countries within a unit root and cointegration framework.

Results: Panel data analysis indicates that health expenditures and GDP are co-integrated and have Engle and Granger causality. In addition, in oil countries that have oil export income, the share of government expenditures in the health sector is often greater than in private health expenditures similar developed countries.

Conclusions: The findings verify that health care is not a luxury good and income has a robust relationship to health expenditures in OPEC countries.
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http://dx.doi.org/10.5539/gjhs.v8n2p93DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803949PMC
June 2015

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

Glob J Health Sci 2015 May 17;8(1):165-72. Epub 2015 May 17.

Department of Health Economics, School of Health Management and Information Science, Iran ?University of Medical Sciences, Tehran, Iran.

Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system.

Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎

Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎

Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components.

Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.
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http://dx.doi.org/10.5539/gjhs.v8n1p165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803948PMC
May 2015