Publications by authors named "Nader Esmailnasab"

20 Publications

  • Page 1 of 1

Investigation of Health-Related Consequences of Landmine Explosions During the Past 4 Decades (1979-2016): A Retrospective Cross-Sectional Study, Kurdistan, Iran.

Disaster Med Public Health Prep 2020 06 19;14(3):322-328. Epub 2019 Aug 19.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Objectives: Landmines remain a potential public health concern in the western and southern border regions of Iran. The aim of this study was to assess the health-related consequences of landmine explosions in Kurdistan Province during the past 4 decades.

Methods: This retrospective cross-sectional study was conducted in Kurdistan Province of Iran in 2016-2017. The data gathering process was questionnaire based. Survivors, or a member of the deceased's family, were interviewed, and 410 questionnaires were completed. Data analysis was performed by using descriptive or analytical tests in SPSS software V.22.

Results: Antipersonnel landmines caused death immediately after the explosion 32.1% of the time, and 67.9% survived with various disabilities, such as blindness, deafness, and limb amputation. Sixty-three percent of the injuries were related to limb amputation, which was the most prevalent injury among survivors. The adjusted regression test revealed a significant relationship between severity of injury and variables such as living in the villages, education, and occupation (P-value < 0.05).

Conclusions: Recognizing the mined areas and intensifying clearance measures are crucial for Kurdistan Province. Providing landmine awareness programs is likely to yield useful results in reducing casualties. Also, landmine survivors should have access to physical and social rehabilitation programs.
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http://dx.doi.org/10.1017/dmp.2019.56DOI Listing
June 2020

The effect of dairy consumption on the prevention of cardiovascular diseases: A meta-analysis of prospective studies.

J Cardiovasc Thorac Res 2017 18;9(1):1-11. Epub 2017 Mar 18.

Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.

There is no global consensus on the relationship of dairy products with cardiovascular diseases. This study was conducted to evaluate the effect of the consumption of dairy products on cardiovascular diseases, including stroke and coronary heart disease (CHD). Important electronic databases such as the Scopus, Science Direct, and PubMed were evaluated up to September 2014. All prospective cohort studies that evaluated the relationship between dairy products consumption and cardiovascular diseases were included regardless of their publication date and language. The study participants were evaluated regardless of age, sex, and ethnicity. The STROBE checklist was used to assess quality of the study. Two investigators separately selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effect model was used to combine the results. Meta-analysis was performed on 27 studies. There were 8648 cases of cardiovascular diseases (CVD), 11806 cases of CHD, and 29300 cases of stroke. An inverse association was found between total dairy intake and CVD (RR=0.90, 95% CI: 0.81-0.99) and stroke (RR=0.88, 95% CI: 0.82-0.95) while no association was observed between total dairy intake and CHD. The total diary intake was associated with decreased mortality of stroke (RR=0.80, 95% CI: 0.76-0.83) although it had no association with its incidence (RR=0.96, 95% CI: 0.88-1.04). This is the first meta-analysis of the relationship of total dairy intake with CVD. This study showed an inverse relationship between total dairy intake and CVD while no relationship was found for CHD. Considering the limited number of studies in this regard, more studies are required to investigate the effect of different factors on the association of dairy intake and CVD.
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http://dx.doi.org/10.15171/jcvtr.2017.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402021PMC
March 2017

Breast Cancer Survival Analysis Based on Immunohistochemistry Subtypes (ER/PR/HER2): a Retrospective Cohort Study.

Arch Iran Med 2016 Oct;19(10):680-686

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

Background: We conducted this study to estimate the prevalence of biomarkers, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) among patients with breast cancer and to explore their effects on disease mortality.

Methods: We conducted this registry-based retrospective cohort study in Tehran, in 2014, using the data on 1622 patients with breast cancer, diagnosed pathologically and registered with the Comprehensive Cancer Control Center from 1998 to 2013. The outcome of interest was the survival probability of patients with breast cancer based on receptor status along with other prognostic factors such as age, histopathology, stage/grade of tumor, metastatic status, and surgical procedures using the life table, Kaplan-Meier curves, and multivariate Cox proportional hazard model. We generated different subtypes based on expression of ER, PR, and HER2, positive (+) and/or negative (-).

Results: ER+/PR+/HER2- subtype (51.5%) was the most common form of breast cancer cells. Compared to the ER+/PR+/HER- subtype, the hazard ratio (95% confidence interval) of cancer mortality was 2.14 (1.13, 4.03) for ER-/PR-/HER2- subtype, 1.92 (1.03, 3.59) for ER-/PR-/HER2+ subtype and 5.19 (1.51, 17.86) for ER-/PR+/HER2+ subtype.

Conclusion: In this study, breast cancer cases with ER-/HER2+ tumors had shorter survival than those with ER+/PR+/HER2- tumors. Triple negative tumors were the only other subtype with a statistically significant poorer prognosis. The results of this study in a middle-income country further indicate the importance of receptor status, in particular HER2 status, in the prognosis of breast cancer.
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http://dx.doi.org/0161910/AIM.003DOI Listing
October 2016

Survival of Patients with Stomach Cancer and its Determinants in Kurdistan.

Asian Pac J Cancer Prev 2016 ;17(7):3243-8

Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Email :

Background: Stomach cancer is the fourth most common cancer and the second leading cause of death from cancer in the world. In Iran, this type of cancer has high rates of incidence and mortality. This study aimed to assess the survival rate of patients with stomach cancer and its determinants in Kurdistan, a province with one of the highest incidence rates of stomach cancer in the country.

Materials And Methods: We studied a total of 202 patients with stomach cancer who were admitted to Tohid Hospital in Sanandaj from 2009 to 2013. Using KaplanMeier nonparametric methods the survival rate of patients was calculated in terms of different levels of age at diagnosis, gender, education, residential area, occupation, underweight, and clinical variables including tumor histology, site of tumor, disease stage, and type of treatment. In addition, we compared the survival rates using the logrank test. Finally, Cox proportional hazards regression was applied using Stata 12 and R 3.1.0 software. The significance level was set at 0.05.

Results: The mean age at diagnosis was 64.7 ± 12.0 years. The survival rate of patients with stomach cancer was 43.9% and 7% at the first and the fifth year after diagnosis, respectively. The results of logrank test showed significant relationships between survival and age at diagnosis, education, disease stage, type of treatment, and degree of being underweight (P<0.05). Moreover, according to the results of Cox proportional hazards regression model, the variables of education, disease stage, and type of treatment were associated with patient survival (P<0.05).

Conclusions: The survival rate of patients with stomach cancer is low and the prognosis is very poor. Given the poor prognosis of the patients, it is critical to find ways for early diagnosis and facilitating timely access to effective treatment methods.
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February 2017

Risk factor of preterm labor in the west of iran: a case-control study.

Iran J Public Health 2014 Apr;43(4):499-506

2. Kurdistan Research Center for Social Determinants of Health, Kurdistan University of Medical Sciences , Sanandaj, Iran.

Background: Prematurity is the most common cause of neonatal death. Risk factors of premature birth can be related with ethnicity and genetic. There is no comprehensive high sample size study in Kurdish ethnicity to determine risk factors related to prematurity. This study evaluated risk factors of preterm labor in Kurdish ethnicity.

Methods: This case-control study was conducted in 200 preterm infants (case group) and 400 term infants (control group), in Besat Hospital, Sanandaj, Iran, in the year 2012. Data was analyzed using SPSS software and analysis was performed by Chi-square, Mann-Whitney and logistic regression tests.

Results: In univariate analysis, mother's own prematurity, history of previous preterm labor, prematurity in the first-degree family members, history of dead children, premature rupture of membranes, multiple pregnancies, overt diabetes, chronic hypertension, preeclampsia and eclampsia, infertility and cervical incompetence had significant relation-ship with preterm labor. However, multivariate analysis results showed that abnormal amniotic fluid, premature rupture of membranes, double and multiple pregnancies, chronic hypertension, family history of premature birth, mothers age over 35 years, and cervical incompetence (P<0.05) had significant relationship with the premature birth.

Conclusion: Screening of newborns at risk of preterm labor could be achieved by these risk factors: family history of prematurity, mother's own history of prematurity and previous preterm labor, history of previous neonatal death, decreased amniotic fluid, multiple pregnancies, overt diabetes, hypertension, preeclampsia, infertility and cervical incompetence, however some of these factors are not the direct cause of prematurity. Our study suggests genetic' s role in preterm labor.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433732PMC
April 2014

Levels of alarm thresholds of meningitis outbreaks in Hamadan Province, west of Iran.

J Res Health Sci 2015 ;15(1):62-5

Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: Few studies have focused on syndromic data to determine levels of alarm thresholds to detection of meningitis outbreaks. The purpose of this study was to determine threshold levels of meningitis outbreak in Hamadan Province, west of Iran.

Methods: Data on both confirmed and suspected cases of meningitis (fever and neurological symptom) form 21 March 2010 to 20 March 2012 were used in Hamadan Province, Iran. Alarm threshold levels of meningitis outbreak were determined using four different methods including absolute values or standard method, relative increase, statistical cutoff points and upper control limit of exponentially weighted moving average (EWMA) algorithm.

Results: Among 723 reported cases, 41 were diagnosed to have meningitis. Standard level of alarm thresholds for meningitis outbreak was determined as incidence of 5/100000 persons. Increasing 1.5 to two times in reported cases of suspected meningitis per week was known as the threshold levels according to relative increase method. An occurrence four cases of suspected meningitis per week that equals to 90th percentile was chosen as alarm thresholds by statistical cut off point method. The corresponding value according to EWMA algorithm was 2.57 i.e. three cases.

Conclusions: Policy makers and staff of syndromic surveillance systems are highly recommended to apply the above different methods to determine the levels of alarm threshold.
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December 2015

Levels of alarm thresholds of meningitis outbreaks in Hamadan Province, west of Iran.

J Res Health Sci 2015 ;15(1):62-5

Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: Few studies have focused on syndromic data to determine levels of alarm thresholds to detection of meningitis outbreaks. The purpose of this study was to determine threshold levels of meningitis outbreak in Hamadan Province, west of Iran.

Methods: Data on both confirmed and suspected cases of meningitis (fever and neurological symptom) form 21 March 2010 to 20 March 2012 were used in Hamadan Province, Iran. Alarm threshold levels of meningitis outbreak were determined using four different methods including absolute values or standard method, relative increase, statistical cutoff points and upper control limit of exponentially weighted moving average (EWMA) algorithm.

Results: Among 723 reported cases, 41 were diagnosed to have meningitis. Standard level of alarm thresholds for meningitis outbreak was determined as incidence of 5/100000 persons. Increasing 1.5 to two times in reported cases of suspected meningitis per week was known as the threshold levels according to relative increase method. An occurrence four cases of suspected meningitis per week that equals to 90th percentile was chosen as alarm thresholds by statistical cut off point method. The corresponding value according to EWMA algorithm was 2.57 i.e. three cases.

Conclusions: Policy makers and staff of syndromic surveillance systems are highly recommended to apply the above different methods to determine the levels of alarm threshold.
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December 2015

Acute flaccid paralysis and its differential diagnosis in in kurdistan province, Western iran; an 11-year surveillance.

Iran J Pediatr 2014 Apr;24(2):131-9

Center for Disease Control and Prevention, Kurdistan University of Medical Sciences , Sanandaj, Iran.

Objective: The surveillance of acute flaccid paralysis (AFP) is a key strategy for monitoring the progress of poliomyelitis eradication and is a sensitive measure for detecting potential cases of poliomyelitis and poliovirus infection. This study was conducted to describe the characteristics of patients reported with AFP, and to evaluate the performance of the surveillance system in Kurdistan province, western Iran, using indicators recommended by the World Health Organization (WHO).

Methods: This observational study was conducted from January 2000 to December 2010 at the Kurdistan Center for Disease Control and the Department of Pediatrics. All children who fulfilled the WHO definition for AFP were included in our study. The stool samples of all the children were sent for poliovirus isolation. All the patients were evaluated for 60 days after the onset of symptoms to identify the signs of residual weakness.

Findings: One-hundred thirty nine children aged <15 years were reported to the Center for Diseases Control with AFP. In 138 (99%) stool samples no poliovirus was isolated. None of the patients was diagnosed as having acute poliomyelitis or polio-compatible paralysis. Guillain-Barré syndrome was the most frequent final diagnosis (79 cases) followed by Transverse Myelitis (7 cases) and Encephalitis (6 cases). By detecting 1.3 to 3.6 (mean 3.2) AFP cases per 100 000 population in Kurdistan during the study period, we achieved the WHO target for AFP surveillance. All performance indicators but one consistently met the WHO requirements and therefore demonstrated the effectiveness of the AFP surveillance program in Kurdistan.

Conclusion: The effective surveillance system in Kurdistan and its evaluation may serve as a model for the surveillance of other infectious diseases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268831PMC
April 2014

Predictors of tuberculosis and human immunodeficiency virus co-infection: a case-control study.

Epidemiol Health 2014 30;36:e2014024. Epub 2014 Oct 30.

Kurdistan Research Center for Social Determinants of Health, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Objectives: The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis co-infection is a major global challenge. It is not clear why some HIV-positive people are co-infected with tuberculosis (TB) while others are not. This study addressed that question.

Methods: This case-control study was conducted in Tehran, Iran in June 2004, enrolling 2,388 HIV-positive people. Cases were selected from those who were co-infected with TB and controls from those without TB. Multiple logistic regression analysis was performed to assess the association between M. tuberculosis/HIV co-infection and several predictors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated.

Results: In this study, 241 cases were compared with 2,147 controls. Sex, age, marital status, educational level, imprisonment, smoking, narcotic use, route of HIV transmission, previous TB infection, isoniazid preventive therapy (IPT), antiretroviral therapy (ART), and low CD4 count (<350 cells/mm(3)) were independently associated with M. tuberculosis/HIV co-infection (p<0.001). However, after adjusting for all other variables in the model, only the association between M. tuberculosis/HIV co-infection and the following predictors remained statistically significant: imprisonment (odds ratio [OR], 3.82; 95% confidence interval [CI], 2.11-6.90), previous TB infection (OR, 5.54; 95% CI, 1.99-15.39), IPT (OR, 0.13; 95% CI, 0.06-0.31), ART (OR, 1.81; 95% CI, 1.26-2.61), and CD4 count <350 cells/mm(3) (OR, 2.34; 95% CI, 1.36-4.02).

Conclusions: Several predictors are associated with M. tuberculosis/HIV co-infection, but only a few indicators were significantly associated with M. tuberculosis/HIV co-infection. It is estimated that a number of predictors of M. tuberculosis/HIV co-infection remain unknown and require further investigation.
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http://dx.doi.org/10.4178/epih/e2014024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258718PMC
December 2014

Gender differences in risk factors of congenital hypothyroidism: an interaction hypothesis examination.

Int J Endocrinol Metab 2014 Apr 1;12(2):e13946. Epub 2014 Apr 1.

Kurdistan Research Center for Social Determinants of Health (KRCSDH), School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, IR Iran.

Background: Several studies have demonstrated an increased risk of congenital hypothyroidism (CH) in girls in comparison to boys.

Objectives: The aim of this study was to determine the potential interactions that are able to change the effect of gender on congenital hypothyroidism.

Patients And Methods: We conducted a matched 1:4 case-control study in Hamadan Province, western of Iran, from 2005 to 2011. Based on screening program data, neonates with TSH ≥ 10 mU/L and T4 ≤ 6.4 μg/dL were considered as congenital hypothyroidism (Cases). Cases and controls were matched regarding the year and place of birth. Data was analyzed using two different approaches including propensity score and multiple conditional logistic regression model.

Results: A total of 277 cases and 1036 controls were included in the study. Girls accounted for 57.4% of the cases and 51.2% of controls (P = 0.065). Based on the multiple conditional logistic regressions, only the interaction of gender (girl) and birth season (summer) increased the likelihood of CH significantly (OR = 3.09; 95% CI: 1.09-8.74; P = 0.034). On the other hand, the ORs of the interaction of gender and all other factors (except for birth season) were not statistically significant in CH.

Conclusions: Birth season might act as an interaction that is able to increase the risk of CH in girls. Accordingly, awareness of the birth season could help policymakers who plan preventive programs to reduce the false negative results among neonates, especially girls.
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http://dx.doi.org/10.5812/ijem.13946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005272PMC
April 2014

Prevalence of osteoporosis in Iran: A meta-analysis.

J Res Med Sci 2013 Sep;18(9):759-66

Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: Several studies have investigated the prevalence of osteoporosis among general population in several parts of Iran. However, the results have been inconsistent. This meta-analysis was conducted to estimate the overall prevalence of osteoporosis.

Materials And Methods: International and national electronic databases were searched until April 2012, including Web of Knowledge, Medline, Scopus, Ovid, ScienceDirect, Science Information Database, IranMedex, MagIran, as well the relevant conference databases. The reference lists of included studies were screened as well. The cross-sectional studies addressing the prevalence of osteoporosis among Iranian general population were retrieved irrespective of age and sex. Bone mineral density (BMD) based on T-score was classified as follows: (a) normal (T-score ≥-1); (b) osteopenia (-2.5SD < T-score <-1SD); (c) osteoporosis (T-score ≤-2.5). Study quality was assessed using the recommended checklist of STROBE.

Results: Of 2598 retrieved studies, 31 studies comprising 34,814 people was used for meta-analysis. The overall prevalence of osteoporosis in lumbar spine was 0.17 (95% CI: 0.13, 0.20) and that of osteopenia was 0.35 (95% CI: 0.30, 0.39). The prevalence was higher in older age groups, in women, and in the northern regions of the country, with an increasing trend in recent years.

Conclusion: This meta-analysis indicated that osteoporosis and osteopenia are common problems among Iranian population older than 30 years. Furthermore, increasing trend of the diseases in recent years is promising a critical public health problem in Iran in the near future. However, due to the heterogeneity between the studies' results, further evidence based on a national survey is needed to estimate the exact prevalence of the diseases in the country.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872583PMC
September 2013

Use of Health Care Services and Associated Factors among Women.

Iran J Public Health 2014 Jan;43(1):70-8

3. Dept. of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences , Tehran, Iran.

Background: To estimate the prevalence and analyze factors associated with both public and private health services utilization in women population in a western district of Iran.

Method: A cross-sectional study with 1200 individuals aged 18-49 years carried out in different districts of Sanandaj City, western Iran, in 2012. The main outcome variable was use of health service in the previous 12 months. The in-dependent variables were age, education level, place of residence, marital and pregnancy status, household wealth, oc-cupation and duration time of employment, and rating of quality of health services.

Results: The prevalence of public and private health services utilization were 60.8% [95%CI: 57.8, 63.8] and 53.8% [95%CI: 50.8%, 56.8%], respectively (P=0.001). After controlling other investigated factors using logistic regression; the academic educational level (OR=1.36, 95%CI: 1.03, 1.80; OR=1.76, 95%CI: 1.33, 2.33), residents of urban (OR=1.65, 95%CI: 1.10, 2.47; OR=1.60, 95%CI: 1.10, 2.42), pregnancy status (OR=2.38, 95%CI: 1.60, 3.55; OR=2.36, 95%CI: 1.61, 3.47), and high level of quality of health services (OR=1.61, 95%CI: 1.15, 2.27; OR=1.70, 95%CI: 1.20, 2.40) were found to be predictors of utilization of both public and private health care respectively. There was also statistically relation between high level of household wealth (OR=3.01, 95% CI: 2.00, 4.57) and private health services utilization.

Conclusions: Prevalence of health services utilization varied according to the individual and social factors of popula-tion studied. Present study emphasizes the need to develop care models that focus on the characteristics and demands of the subjects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454030PMC
January 2014

The status of diabetes control in Kurdistan province, west of Iran.

J Res Health Sci 2013 Sep 17;13(2):194-200. Epub 2013 Sep 17.

Kurdistan Research Center for Social Determinants of Health (KRCSDH), Kurdistan University of Medical Sciences, Sanandaj, Iran.

Background: Based on some estimation more than two million peoples in Iran are affected by Type 2 diabetes. The present study was designed to evaluate the status of diabetes control among Type 2 diabetes patients in Kurdistan, west of Iran and its associated factors.

Methods: In our cross sectional study conducted in 2010, 411 Type 2 diabetes patients were randomly recruited from Sanandaj, Capital of Kurdistan. Chi square test was used in univariate analysis to address the association between HgAlc and FBS status and other variables. The significant results from Univariate analysis were entered in multivariate analysis and multinomial logistic regression model.

Results: In 38% of patients, FBS was in normal range (70-130) and in 47% HgA1c was <7% which is normal range for HgA1c. In univariate analysis, FBS level was associated with educational levels (P=0.001), referral style (P=0.001), referral time (P=0.009), and insulin injection (P=0.016). In addition, HgA1c had a relationship with sex (P=0.023), age (P=0.035), education (P=0.001), referral style (P=0.001), and insulin injection (P=0.008). After using multinomial logistic regression for significant results of univariate analysis, it was found that FBS was significantly associated with referral style. In addition HgA1c was significantly associated with referral style and Insulin injection.

Conclusions: Although some of patients were under the coverage of specialized cares, but their diabetes were not properly controlled.
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September 2013

Risk factors of congenital hypothyroidism using propensity score: a matched case-control study.

J Res Health Sci 2013 Sep 17;13(2):151-6. Epub 2013 Sep 17.

Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: The aim of this study was to investigate the relationship between congenital hypothyroidism and several variables using two different adjustment methods.

Methods: This matched case-control study was conducted in Hamadan Province, the west of Iran, in 2012 enrolling neonates born between 2005 and 2011 and covered by screening program for congenital hypothyroidism. The neonates with TSH titer more than 10 mU/l or T4 titer less than 6.4 μg/dl were considered as cases. Each case was individually matched for birth place and year with four neonates with normal TSH and T4 titers as controls. The data were analyzed using two different approaches including propensity score and multiple conditional logistic regression model.

Results: Of 1313 enrolled neonates, 277 (159 girls) were cases and 1036 (531 girls) were controls. The most important prognostic factors which had significant effect on congenital hypothyroidism included twin, birth season, maturity, jaundice at birth, birth weight, age at pregnancy, maternal anemia and goiter, gestational age, delivery type, father's education and smoking status, and consanguinity. The associations reported by logistic regression were stronger that of than propensity score analysis in most items, although the differences were not statistically significant.

Conclusions: We addressed the effect of numerous potential risk factors on congenital hypothyroiditis and the impact of these factors on the disease occurrence. However, future prospective studies are needed to test these findings and hypothesis and to investigate the true effect of these potential risk factors on congenital hypothyroiditis.
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September 2013

Long-term survival rate of kidney graft and associated prognostic factors: a retrospective cohort study, 1994-2011.

Ann Transplant 2013 Apr 5;18:153-60. Epub 2013 Apr 5.

Department of Epidemiology and Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: Despite several studies conducted to detect predisposing factors of graft rejection, results are inconsistent and limited. This study was performed to estimate long-term survival rate of kidney transplantation and to detect associated prognostic factors.

Material And Methods: This retrospective cohort study was conducted in Hamadan Province, in western Iran, enrolling 475 patients who had undergone kidney transplantation from 1994 to 2011. Data were extracted from patients' medical records using a checklist. Chronic nonreversible graft rejection was considered as the event of interest. The duration of time between kidney transplantation and rejection was considered as the survival time. Life table, Kaplan-Meier curve, log-rank test and Cox proportional hazard model were used for data analysis.

Results: Out of 475 transplantations, 55 episodes of rejection occurred. One-, 5-, 10-, 15-, and 18-year survival rates of transplantation were 97.1%, 92.3%, 86.2%, 77.6%, and 60.3%, respectively. The hazard ratio of graft rejection per 1-year increase in recipient age was 0.92 (P=0.001). The hazard ratio of graft rejection was 5.47 for grafts from deceased donors compared to grafts from living donors (P=0.025), and 3.54 (P=0.025) and 47.99 (P=0.001) in patients with episode of acute and hyperacute rejection compared to those without rejection episode, respectively.

Conclusions: Rejection of kidney transplantation is shaped by several prognostic factors, the most important of which are recipient age, type of donor (living vs. deceased), and episode of post-transplantation acute and hyperacute rejection.
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http://dx.doi.org/10.12659/AOT.883873DOI Listing
April 2013

Social Determinants of Health Associated with Self-Reported HIV Testing among Women.

Iran J Public Health 2013 1;42(4):436-42. Epub 2013 Apr 1.

Dept. of Epidemiology and Biostatistics, School of Public Heath, Hamadan University of Medical Sciences, Hamadan, Iran.

Background: There currently is lack of knowledge about HIV testing practices in Iran. The purpose of this pilot study was to evaluate the prevalence of self-reported HIV testing and its associated factors among women.

Methods: This cross-sectional study was conducted in Sanandaj City, located in the west of Iran, in 2012. Data were collected using self-administered questionnaire including demographics characteristics and the main outcome variable was self-reported HIV testing. The univariate and multivariate logistic regression models using STATA software was used for data analysis.

Results: A total of 1200 women were interviewed during the study (Response rate=87.5%). The mean age was 29.67 years (SD: 7.01 years), 49% were aged 28 years or younger, 39.2% were single, 16.9% were pregnant and 60% did not have academic education. The proportion of women that were HIV-tested was, 32.1% (CI 95%: 29.2%, 35.0%). HIV testing was associated with younger age, knowledge of HIV/AIDS, household wealth, pregnancy, academic education, occupation and duration time of occupation, rating of quality of health services and substance use history in her husband.

Conclusion: The self-reported HIV testing rate among our sample women is 32.1%, lower than the HIV testing rate in other studies. Therefore, interventions to expand HIV testing and increase awareness of HIV risk are urgently needed in Iran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684732PMC
June 2013

Effect of body mass index on breast cancer during premenopausal and postmenopausal periods: a meta-analysis.

PLoS One 2012 7;7(12):e51446. Epub 2012 Dec 7.

Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Objective: There is no universal consensus on the relationship between body mass index (BMI) and breast cancer. This meta-analysis was conducted to estimate the overall effect of overweight and obesity on breast cancer risk during pre- and post-menopausal period.

Data Sources: All major electronic databases were searched until April 2012 including Web of Knowledge, Medline, Scopus, and ScienceDirect. Furthermore, the reference lists and related scientific conference databases were searched.

Review Methods: All prospective cohort and case-control studies investigating the association between BMI and breast cancer were retrieved irrespective of publication date and language. Women were assessed irrespective of age, race and marital status. The exposure of interest was BMI. The primary outcome of interest was all kinds of breast cancers confirmed pathologically. Study quality was assessed using the checklist of STROBE. Study selection and data extraction were performed by two authors separately. The effect measure of choice was risk ratio (RR(i)) and rate ratio (RR(a)) for cohort studies and odds ratio (OR) in case-control studies.

Results: Of 9163 retrieved studies, 50 studies were included in meta-analysis including 15 cohort studies involving 2,104,203 subjects and 3,414,806 person-years and 35 case-control studies involving 71,216 subjects. There was an inverse but non-significant correlation between BMI and breast cancer risk during premenopausal period: OR = 0.93 (95% CI 0.86, 1.02); RR(i) = 0.97 (95% CI 0.82, 1.16); and RR(a) = 0.99 (95% CI 0.94, 1.05), but a direct and significant correlation during postmenopausal period: OR = 1.15 (95% CI 1.07, 1.24); RR(i) = 1.16 (95% CI 1.08, 1.25); and RR(a) = 0.98 (95% CI 0.88, 1.09).

Conclusion: The results of this meta-analysis showed that body mass index has no significant effect on the incidence of breast cancer during premenopausal period. On the other hand, overweight and obesity may have a minimal effect on breast cancer, although significant, but really small and not clinically so important.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0051446PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517558PMC
June 2013

Estimation of the Frequency of Intravenous Drug Users in Hamadan City, Iran, Using the Capture-recapture Method.

Epidemiol Health 2012 31;34:e2012006. Epub 2012 Oct 31.

Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Objectives: The number of illicit drug users is prone to underestimation. This study aimed to use the capture-recapture method as a statistical procedure for measuring the prevalence of intravenous drug users (IDUs) by estimating the number of unknown IDUs not registered by any of the registry centers.

Methods: This study was conducted in Hamadan City, the west of Iran, in 2012. Three incomplete data sources of IDUs, with partial overlapping data, were assessed including: (a) Volunteer Counseling and Testing Centers (VCTCs); (b) Drop in Centers (DICs); and (c) Outreach Teams (ORTs). A log-linear model was applied for the analysis of three-sample capture-recapture results. Two information criteria were used for model selection including Akaike's Information Criterion and the Bayesian Information Criterion.

Results: Out of 1,478 IDUs registered by three centers, 48% were identified by VCTCs, 32% by DICs, and 20% by ORTs. After exclusion of duplicates, 1,369 IDUs remained. According to our findings, there were 9,964 (95% CI, 6,088 to 17,636) IDUs not identified by any of the centers. Hence, the real number of IDUs is expected to be 11,333. Based on these findings, the overall completeness of the three data sources was around 12% (95% CI, 7% to 18%).

Conclusion: There was a considerable number of IDUs not identified by any of the centers. Although the capture-recapture method is a useful and practical approach for estimating unknown populations, due to the assumptions and limitations of the method, the results must be interpreted with caution.
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http://dx.doi.org/10.4178/epih/e2012006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495251PMC
November 2012

The Burden of Premature Mortality in Hamadan Province in 2006 and 2010 Using Standard Expected Years of Potential Life Lost: A Population-based Study.

Epidemiol Health 2012 31;34:e2012005. Epub 2012 Aug 31.

Research Center for Health Sciences, Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Objectives: Examining the premature death rate represents the first step in estimating the overall burden of disease, reflecting a full picture of how different causes affect population health and providing a way of monitoring and evaluating population health. The present study was conducted to assess the burden of premature mortality in Hamadan Province, Iran in 2006 and 2010.

Methods: To calculate years of potential life lost (YPLL), the dataset was categorized into 5-year age groups based on each person's age at death. Then the age groups were subtracted from the relevant age-based life table produced by the World Health Organization in 2009. The YPLL for each individual were then added together to yield the total YPLL for all individuals in the population who died in a particular year. Finally, we calculated the YPLL for all sex-, age-, and cause-specific mortality rates and reported them as percentages.

Results: We analyzed 18,786 deaths, 9,127 of which occurred in 2006 and 9,659 in 2010. Mortality rates were higher in men than women for all age groups both in 2006 and 2010. In addition, age-specific mortality rates in both genders for all age groups were higher in 2010 than in 2006. The percentage of YPLL from ischemic heart diseases, cerebrovascular diseases, transport accidents, and intentional self-harm were among the greatest sources of premature death.

Conclusion: The results of the present survey indicate that the eight major causes of premature death in both 2006 and 2010 were non-communicable diseases, especially ischemic heart diseases, cerebrovascular diseases, transport accidents, and intentional self-harm. Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.
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http://dx.doi.org/10.4178/epih/e2012005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437377PMC
October 2012

Prevalence of skin lesions and exposure to arsenic in drinking water in Iran.

Sci Total Environ 2008 Feb 13;390(1):69-76. Epub 2007 Nov 13.

School of Public Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran.

Prevalence of skin lesions was investigated among 752 participants in eight villages in Kurdistan province in Iran with emphasis on total lifetime intake of arsenic from drinking water (TLIA). The participants were selected from eight villages with different exposure levels using a cluster-sampling technique. TLIA was calculated for each individual taking into account the type of water supply and their mean annual arsenic concentration. The study showed that 49 persons (6.5%) were suffering from hyperkeratosis and 20 persons (2.7%) from hyperpigmentation. The correlation between hyperkeratosis and hyperpigmentation was significant (R=0.325, p<0.01). Using the logistic regression model it was found that the relationship between TLIA and hyperkeratosis (OR=1.14, 95% CI=1.039-1.249), and hyperpigmentation (OR=1.254, 95% CI=1.112-1.416) was also significant. In conclusion, TLIA can be applied as a reliable indicator for the assessment of exposure.
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http://dx.doi.org/10.1016/j.scitotenv.2007.09.035DOI Listing
February 2008