Publications by authors named "Zahra Cheraghi"

35 Publications

Predicting the incidence of brucellosis in Western Iran using Markov switching model.

BMC Res Notes 2021 Mar 1;14(1):79. Epub 2021 Mar 1.

Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.

Objective: Brucellosis is a zoonosis almost chronic disease. Brucellosis bacteria can remain in the environment for a long time. Thus, climate irregularities could pave the way for the survival of the bacterium brucellosis. Brucellosis is more common in men 25 to 29 years of age, in the western provinces, and in the spring months. The aim of this study is to investigate the effect of climatic factors as well as predicting the incidence of brucellosis in Qazvin province using the Markov switching model (MSM). This study is a secondary study of data collected from 2010 to 2019 in Qazvin province. The data include brucellosis cases and climatic parameters. Two state MSM with time lags of 0, 1 and 2 was fitted to the data. The Bayesian information criterion (BIC) was used to evaluate the models.

Results: According to the BIC, the two-state MSM with a 1-month lag is a suitable model. The month, the average-wind-speed, the minimum-temperature have a positive effect on the number of brucellosis, the age and rainfall have a negative effect. The results show that the probability of an outbreak for the third month of 2019 is 0.30%.
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http://dx.doi.org/10.1186/s13104-020-05415-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923320PMC
March 2021

Prevalence and Incidence of Metabolic Syndrome in Iran: A Systematic Review and Meta-Analysis.

Int J Prev Med 2020 3;11:64. Epub 2020 Jun 3.

Department of Epidemiology, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.

Metabolic syndrome (MetS) is a predictor of several diseases such as cardiovascular diseases, diabetes, dyslipidemia, stroke, osteoarthritis, certain cancers, and death leading to public health concern in most societies. We aimed to estimate the pooled prevalence and incidence of MetS in Iranian population through a meta-analysis study. We included cross-sectional and cohort studies to estimate the overall prevalence and incidence rates of MetS in Iran National databases including MagIran, Science Information Database, IranMedex, and international databases including Medline, Web of Sciences, and Scopus were searched up to October 2017. Finally, 125 studies were included. The total sample size was 472,401 with a mean age of 38 ± 7.8 years. The overall pooled prevalence and incidence rate among the general population of Iran was 0.26 (95% CI: 0.26, 0.29) and 97.96 (95% CI: 75.98, 131.48), respectively. The pooled prevalence of MetS was higher in females and in urban areas. The highest and lowest prevalence of MetS was obtained by the Iranian definition criteria (0.43) and the NHANES III (0.12). The highest and lowest incidence rates of MetS were obtained by IDF (144.07 per 1000) and the JIS (89.73 per 1000). The prevalence of MetS was higher in women and those living in urban areas. Furthermore, the prevalence of MetS increased with increasing age in both genders.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_489_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297433PMC
June 2020

Forecasting the monthly incidence rate of brucellosis in west of Iran using time series and data mining from 2010 to 2019.

PLoS One 2020 12;15(5):e0232910. Epub 2020 May 12.

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

Background: The identification of statistical models for the accurate forecast and timely determination of the outbreak of infectious diseases is very important for the healthcare system. Thus, this study was conducted to assess and compare the performance of four machine-learning methods in modeling and forecasting brucellosis time series data based on climatic parameters.

Methods: In this cohort study, human brucellosis cases and climatic parameters were analyzed on a monthly basis for the Qazvin province-located in northwestern Iran- over a period of 9 years (2010-2018). The data were classified into two subsets of education (80%) and testing (20%). Artificial neural network methods (radial basis function and multilayer perceptron), support vector machine and random forest were fitted to each set. Performance analysis of the models were done using the Root Mean Square Error (RMSE), Mean Absolute Error (MAE), Mean Absolute Root Error (MARE), and R2 criteria.

Results: The incidence rate of the brucellosis in Qazvin province was 27.43 per 100,000 during 2010-2019. Based on our results, the values of the RMSE (0.22), MAE (0.175), MARE (0.007) criteria were smaller for the multilayer perceptron neural network than their values in the other three models. Moreover, the R2 (0.99) value was bigger in this model. Therefore, the multilayer perceptron neural network exhibited better performance in forecasting the studied data. The average wind speed and mean temperature were the most effective climatic parameters in the incidence of this disease.

Conclusions: The multilayer perceptron neural network can be used as an effective method in detecting the behavioral trend of brucellosis over time. Nevertheless, further studies focusing on the application and comparison of these methods are needed to detect the most appropriate forecast method for this disease.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232910PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217463PMC
July 2020

Epidemiological Features of Human Brucellosis in Iran (2011-2018) and Prediction of Brucellosis with Data-Mining Models.

J Res Health Sci 2019 Dec 4;19(4):e00462. Epub 2019 Dec 4.

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

Background: Brucellosis is known as the major zoonotic disease. We aimed to compare the performance of some data-mining models in predicting the monthly brucellosis cases in Iran.

Study Design: Population-based cohort study.

Methods: Three data mining techniques including the Support Vector Machine (SVM), Multivariate Adaptive Regression Splines (MARS), and Random Forest (RF) besides to one classic model including Auto-Regressive Integrated Moving Average (ARIMA) was used to predict the monthly incidence of brucellosis in Iran during 2011-2018. We used several criteria (root mean square error (RMSE), mean absolute error (MAE), coefficient of determination (R2) and intra-class correlation coefficient (ICC) for appraising the accuracy of prediction and performance of our models. All analysis was done using free statistical software of R3.4.0 RESULTS: Overall 118867 cases (with a mean age of 34.01±1.65 yr) of brucellosis were observed and seven-year incidence rate of brucellosis in Iran was 21.78 (95% CI: 21.66, 21.91). The majority of patients (58.84%) were male and 25-29 yr old. The first three provinces with the highest incidence rate of brucellosis included the following; Kurdistan (71.39 per 100000), Lorestan (68.09 per 100000) and Hamadan (56.24 per 100000).

Conclusion: Brucellosis was more common in males, 25-29 aged yr, western provinces and spring months. The disease had a decreasing trend in the last years. MARS model was more appropriate rather than data mining models for prediction of monthly incidence rate of brucellosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183567PMC
December 2019

Risk factors for stomach cancer: a systematic review and meta-analysis.

Epidemiol Health 2020 2;42:e2020004. Epub 2020 Feb 2.

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

Objectives: This report provides information on 14 behavioral and nutritional factors that can be addressed in stomach cancer prevention programs.

Methods: PubMed, Web of Science, and Scopus were searched through December 2018. Reference lists were also screened. Observational studies addressing the associations between stomach cancer and behavioral factors were analyzed. Between-study heterogeneity was investigated using the χ2, τ2, and I2 statistics. The likelihood of publication bias was explored using the Begg and Egger tests and trim-and-fill analysis. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model.

Results: Of 52,916 identified studies, 232 (including 33,831,063 participants) were eligible. The OR (95% CI) of factors associated with stomach cancer were as follows: Helicobacter pylori infection, 2.56 (95% CI, 2.18 to 3.00); current smoking, 1.61 (95% CI, 1.49 to 1.75); former smoking 1.43 (95% CI, 1.29 to 1.59); current drinking, 1.19 (95% CI, 1.10 to 1.29); former drinking, 1.73 (95% CI, 1.17 to 2.56); overweight/obesity, 0.89 (95% CI, 0.74 to 1.08); sufficient physical activity, 0.83 (95% CI, 0.68 to 1.02); consumption of fruits ≥3 times/wk, 0.48 (95% CI, 0.37 to 0.63); consumption of vegetables ≥3 times/wk, 0.62 (95% CI, 0.49 to 0.79); eating pickled vegetables, 1.28 (95% CI, 1.09 to 1.51); drinking black tea, 1.00 (95% CI, 0.84 to 1.20); drinking green tea, 0.88 (95% CI, 0.80 to 0.97); drinking coffee, 0.99 (95% CI, 0.88 to 1.11); eating fish ≥1 time/wk 0.79 (95% CI, 0.61 to 1.03); eating red meat ≥4 times/wk 1.31 (95% CI, 0.87 to 1.96), and high salt intake 3.78 (95% CI, 1.74 to 5.44) and 1.34 (95% CI, 0.88 to 2.03), based on two different studies.

Conclusions: This meta-analysis provided a clear picture of the behavioral and nutritional factors associated with the development of stomach cancer. These results may be utilized for ranking and prioritizing preventable risk factors to implement effective prevention programs.
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http://dx.doi.org/10.4178/epih.e2020004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056944PMC
March 2020

The effect of alcohol on osteoporosis: A systematic review and meta-analysis.

Drug Alcohol Depend 2019 04 27;197:197-202. Epub 2019 Feb 27.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, 6517838695, Iran. Electronic address:

Background: Osteoporosis is a multifactorial disease hallmarked by the interaction of genetic, nutritional and environmental factors. We aimed to assess the effect of alcohol consumption on the osteoporosis by undertaking a systematic review and meta-analysis.

Methods: We searched electronic databases including MEDLINE, Scopus, and Web of Science until June 2018. We identified all pertinent observational studies that examined the risk of OSTEOPOROSIS with alcohol use including cohort, case-control and cross-sectional studies. Relative risks (RR) for cohort studies and odds ratios (ORs) for case-control studies were pooled using the random effects model. Risk of bias was assessed using the Newcastle-Ottawa scale.

Results: From a pool of 3479 studies identified six met the study inclusion criteria (three case control, two cohorts and one cross-sectional study). Compared with abstainers of alcohol, persons consuming 0.5-1 drinks per day had 1.38 times the risk of developing osteoporosis (adjusted RR = 1.38, 95% CI: 0.90-2.12), persons consuming 1-2 drinks per day had 1.34 times the risk of developing OSTEOPOROSIS (adjusted RR = 1.34, 95% CI: 1.11-1.62), and persons consuming two drinks or more per day had 1.63 times the risk of developing osteoporosis (adjusted RR = 1.63, 95% CI: 1.01-2.65). We found a positive association between alcohol consumption and osteoporosis in the case-control studies (adjusted OR = 2.95, 95% CI: 1.78-4.90).

Conclusion: Our study demonstrates a positive relationship between alcohol consumption and osteoporosis.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.01.025DOI Listing
April 2019

The Prevalence and risk factors of osteoporosis among the elderly in Hamadan province: A cross sectional study.

Med J Islam Repub Iran 2018 11;32:111. Epub 2018 Nov 11.

Health Vice-Chancellors, Hamadan University of Medical Sciences, Hamadan, Iran.

Osteoporosis is the most common metabolic bone disease and is a public health issue, particularly among the elderly, across the world. Given the significance of the disease in causing disability and, in particular, its dangers in old age, we aimed to examine osteoporosis and its determinant factors among the elderly. We conducted a cross sectional study in the province of Hamadan from September 2015 to March 2016 on all the elderly men and women covered by 'Integrated and Comprehensive Elderly Care Program'. The data required for this study was collected through an aging health care checklist. To estimate the adjusted association of potential risk factors and other confounding variables of osteoporosis, multiple logistic regression was used at a significance level of 5%. In this cross sectional study, 1779 elderly men and women aged 6o years and over were studied. The prevalence of osteoporosis was 7.99% (95%CI:7.79-8.18), which was higher among women than in men (8.08% vs. 7.83%). The factors that raised the probability of osteoporosis were as follow: aging (OR= 1.05, 95% CI: 1.02-1.07, p<0.001), low education (OR=1.96, 95% CI:1.02-3.84, p=0.04), living in urban areas (OR=2.82, 95% CI:1.93-4.11, p<0.001), smoking (OR=2.39, 95% CI:1.42-4.04, p<0.001), and family history of osteoporosis (OR=1.95, 95% CI:1.07-3.54, p=0.03). Based on our results, aging, low education level, living in urban areas, being a cigarette smoker, and having a family history of osteoporosis were all predicting factors for osteoporosis among the elderly.
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http://dx.doi.org/10.14196/mjiri.32.111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387806PMC
November 2018

Quality of life in Iranian elderly population using the SF-36 questionnaire: systematic review and meta-analysis.

East Mediterr Health J 2019 Jan 23;24(11):1088-1097. Epub 2019 Jan 23.

Department of Epidemiology, School of Public Health, Hamadan University of Medical Science, Hamadan, Islamic Republic of Iran.

Background: Ageing is a major known risk factor that is a threat to human health. To date, many studies have investigated quality of life (QOL) among the elderly population in the Islamic Republic of Iran. However, their results were inconsistent.

Aims: We designed this systematic review and meta-analysis to estimate the overall mean score of QOL based on the Short Form 36 Health Survey Questionnaire (SF-36) among the Iranian elderly population.

Methods: We searched international databases (Medline, Scopus and Science Direct) and national databases (Science In-formation Database, MagIran, IranMedex and Irandoc) up to February 2015. We included all cross-sectional studies that evaluated QOL among the Iranian elderly population using SF-36.

Results: Of 2150 studies identified, 15 were included in the meta-analysis. The mean scores for QOL in the 8 scales were: 47.58, 51.75, 55.42, 55.78, 59.55, 51.54, 47.85 and 51.31 for physical-role, physical function, mental health, bodily pain, social functioning, emotional-role, general health, and vitality, respectively.

Conclusions: Our results indicated that health-related QOL decreased with increasing age. QOL was worse in women than in men, especially in physical-role and general health scales. Elderly people who lived in a nursing home had lower QOL than those who lived in their own home. So, health policy-makers should design comprehensive programmes to improve health-related QOL for the Iranian elderly population.
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http://dx.doi.org/10.26719/2018.24.11.1088DOI Listing
January 2019

Effects of food items and related nutrients on metabolic syndrome using Bayesian multilevel modelling using the Tehran Lipid and Glucose Study (TLGS): a cohort study.

BMJ Open 2018 12 18;8(12):e020642. Epub 2018 Dec 18.

Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.

Objectives: Diet and nutrition might play an important role in the aetiology of metabolic syndrome (MetS). Most studies that examine the effects of food intake on MetS have used conventional statistical analyses which usually investigate only a limited number of food items and are subject to sparse data bias. This study was undertaken with the goal of investigating the concurrent effect of numerous food items and related nutrients on the incidence of MetS using Bayesian multilevel modelling which can control for sparse data bias.

Design: Prospective cohort study.

Setting: This prospective study was a subcohort of the Tehran Lipid and Glucose Study. We analysed dietary intake as well as pertinent covariates for cohort members in the fourth (2008-2011) and fifth (2011-2014) follow-up examinations. We fitted Bayesian multilevel model and compared the results with two logistic regression models: (1) full model which included all variables and (2) reduced model through backward selection of dietary variables.

Participants: 3616 healthy Iranian adults, aged ≥20 years.

Primary And Secondary Outcome Measures: Incident cases of MetS.

Results: Bayesian multilevel approach produced results that were more precise and biologically plausible compared with conventional logistic regression models. The OR and 95% confidence limits for the effects of the four foods comparing the Bayesian multilevel with the full conventional model were as follows: (1) noodle soup (1.20 (0.67 to 2.14) vs 1.91 (0.65 to 5.64)), (2) beans (0.96 (0.5 to 1.85) vs 0.55 (0.03 to 11.41)), (3) turnip (1.23 (0.68 to 2.23) vs 2.48 (0.82 to 7.52)) and (4) eggplant (1.01 (0.51 to 2.00) vs 1 09 396 (0.152×10 to 768×10)). For most food items, the Bayesian multilevel analysis gave narrower confidence limits than both logistic regression models, and hence provided the highest precision.

Conclusions: This study demonstrates that conventional regression methods do not perform well and might even be biased when assessing highly correlated exposures such as food items in dietary epidemiological studies. Despite the complexity of the Bayesian multilevel models and their inherent assumptions, this approach performs superior to conventional statistical models in studies that examine multiple nutritional exposures that are highly correlated.
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http://dx.doi.org/10.1136/bmjopen-2017-020642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303646PMC
December 2018

Preventive measures for fire-related injuries and their risk factors in residential buildings: a systematic review.

J Inj Violence Res 2019 Jan 11;11(1):1-14. Epub 2018 Nov 11.

Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Every year, a large number of people lose their lives or become injured seriously as a result of fires. Fires in buildings pose a great threat to resident safety. The aim of this systematic review is to identify preventive measures for fire-related injuries in residential buildings, taking into account associated risk factors.

Methods: In this study, a systematic review was performed of all studies conducted in the field of residential building fires, influencing factors and available safety procedures. From the earliest record up to 7 July 2017, databases of PubMed, Web of Science/Knowledge, and Scopus were searched and selected articles included in the study.

Results: A total of 5,613 published articles were examined, of which 30 were finally found to meet the inclusion criteria. The findings of the study were included in two main groups of preventive measures and risk factors for residential building fires and related injuries. Regarding preventive measures, the factors to reduce the risk of fire-related injuries raised in the studies under review included rule amendments, changes and modification of the environment, behavior change such as emergency evacuation during fire occurrence, improvements to emergency medical services, and awareness-raising. Also, many of the studies showed that areas with a large number of young children, older people, people with physical and mental disabilities, alcohol and drug addicts, smokers, single-family households and low-income families were particularly at risk of fire-related injuries and deaths.

Conclusions: There are features in residential buildings and attributes among residents that can be related to fire hazard and fire-related injuries and deaths. The most important point of this study is to focus on preventive strategies including environmental modification, promotion of safety rules and changes in risk behavior among residents. Policy makers should pay more attention to these important issues in order to promote safety and injury prevention in relation to building fires.
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http://dx.doi.org/10.5249/jivr.v11i1.1057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420922PMC
January 2019

The High Prevalence of Osteoporosis as a Preventable Disease: The Need for Greater Attention to Prevention Programs in Iran.

Iran J Public Health 2018 Aug;47(8):1220-1221

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

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123598PMC
August 2018

Occupational health of Iranian farmworkers: A public health priority.

Med J Islam Repub Iran 2017 18;31:105. Epub 2017 Dec 18.

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

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http://dx.doi.org/10.14196/mjiri.31.105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014791PMC
December 2017

Quality of Life in Elderly Iranian Population Using Leiden-Padua Questionnaire: A Systematic Review and Meta-Analysis.

Int J Prev Med 2017 25;8:55. Epub 2017 Jul 25.

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

The world population is getting old rapidly; the aging population is the new phenomenon in Iran too. The aim of this meta-analysis was to estimate the overall and subscales mean score of quality of life (QOL) based on the Leiden-Padua (LEIPAD) questionnaire among the elderly population of Iran. The major international and national databases including; Medlin, Scopus, Science Direct, SID, MagIran, IranMedex, and Irandoc was searched. All cross-sectional studies, which measured the QOL among the elderly population in Iran using the LEIPAD questionnaire, were included. Furthermore, we used the following key words, "Quality of life," "aging," "aged," "elderly," and "Iran." Of 2155 records, four articles reminded for the meta-analysis, which involved 628 participants with a mean age of 71.73 ± 4.28 years. The mean scores of QOL in each scale were as follows: 10.80 (9.30-12.31) for physical health, 13.51 (6.81-20.21) for self-care scale, 8.60 (5.07-12.14) for depression and anxiety, 12.48 (10.39-14.58) for cognitive functioning scale, 2.19 (0.67-3.72) for sexual functioning scale, 10.98 (5.87-16.09) for life satisfaction scale, and 5.90 (3.64-8.16) for social desirability scale. This study revealed that the total QOL for the elderly population is relatively low in Iranian society. It is appeared to provide social support, and upgrade their QOL seems to be essential for the elderly population.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_265_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553249PMC
July 2017

Risk of Coronary Heart Events Based on Rose Angina Questionnaire and ECG Besides Diabetes and Other Metabolic Risk Factors: Results of a 10-Year Follow-up in Tehran Lipid and Glucose Study.

Int J Endocrinol Metab 2017 Apr 24;15(2):e42713. Epub 2017 Apr 24.

Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: High-risk individuals for CHD could be diagnosed by some non-invasive and low-priced techniques such as Minnesota ECG coding and rose angina questionnaire (RQ).

Objectives: The present study aimed at determining the risk of incident CHD according to ECG and RQ besides diabetes and other metabolic risk factors in our population.

Methods: Participants comprised of 5431 individuals aged ≥ 30 years within the framework of Tehran lipid and glucose study. Based on their status on history of CHD, ECG, and RQ at baseline, all participants were classified to 5 following groups: (1) HistoryRoseECG (the reference group); (2) HistoryRoseECG; (3) HistoryRoseECG; (4) HistoryRoseECG; and (5) History. We used Cox regression model to find the role of ECG and RQ on CHD, independent of other risk factors.

Results: Overall, 562 CHD events were detected during the median of 10.3 years follow-up. CHD incidence rates were 55.9 and 9.09 cases per 1000 person-year for participants with and without history of CHD, respectively. Hazard ratios (HRs) (95% CIs) were 4.11 (3.27 - 5.11) for History + and 2.18 (1.63 - 2.90), 1.92 (1.47 - 2.51), and 2.48 (1.46 - 4.20) for HistoryRoseECG, HistoryRoseECG, and HistoryRoseECG, respectively. RQ and ECG had the same HRs as high as those for hypertension and hypercholesterolemia; however, diabetes showed statistically and clinically more effects on CVD than RQ and ECG.

Conclusions: RQ in general and, ECG especially in asymptomatic patients, were good predictors for CHD events in both Iranian males and females; however, their predictive powers were lower than that of diabetes.
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http://dx.doi.org/10.5812/ijem.42713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556326PMC
April 2017

Prevalence of the Skipping Breakfast among the Iranian Students: A Review Article.

Iran J Public Health 2017 Jul;46(7):882-889

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

Background: Adolescence is an important period since the establishment of dietary pattern can also affect the adulthood. This study aimed to estimate the overall prevalence of skipping breakfast among Iranian students.

Methods: The international and national databases, including Medline, Scopus, Science Direct, Embase, Web of sciences, Google Scholar, MagIran, and SID were searched 1945-2016 as per case. All studies addressing the prevalence of skipping breakfast among Iranian students were extracted.

Results: Out of 322 records, 24 articles remained for meta-analysis. The total pooled prevalence of skipping the breakfast was 0.216 (95% CI: 0.213-0.22), the girls had a higher percentage for skipping breakfast compared with boys (26% vs. 18%).

Conclusion: Skipping breakfast is more prevalent in girls. Interventions are required to promote breakfast consumption in the targeted Iranian students, especially the girls.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563869PMC
July 2017

Occupational risk factors among Iranian farmworkers: a review of the available evidence.

Epidemiol Health 2017 2;39:e2017027. Epub 2017 Jul 2.

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

Farming is one of the most important components of most economies. No comprehensive picture exists of the health status of Iranian farmers and the work-related hazards that affect them. We aimed to determine the gaps in the current knowledge regarding the occupational health of Iranian farmworkers. Electronic databases including Medline, Web of Science, Scopus, and Embase, as well as national databases including the Scientific Information Database, MagIran, and Barakat Knowledge System, were searched for articles published through March 2017. All epidemiologic studies regarding the occupational health of farmworkers in Iran were reviewed, regardless of their design, language, time of publication, and location. Of the 86 retrieved articles, 39 studies were ultimately analyzed. Most studies were conducted in Fars, Kerman, and Mazandaran provinces. According to the results of this review, chemical, physical, and biological hazards, along with work-related injuries, may be the main factors threatening the health of farmworkers. The unsafe use of pesticides was related to male infertility, eye and digestive complications, pesticide poisoning, pesticide absorption, hematological changes, non-Hodgkin lymphoma, and multiple myeloma. Chemical hazards (e.g., the unsafe use of pesticides), physical hazards, injuries, and biological hazards (e.g., work-related infectious diseases) threaten the health of Iranian farmworkers. Moreover, farmworkers lack adequate knowledge about the occupational hazards they face and the relevant risk factors.
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http://dx.doi.org/10.4178/epih.e2017027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543294PMC
August 2017

Quality of Life among General Populations of Different Countries in the Past 10 Years, with a Focus on Human Development Index: A Systematic Review and Meta-analysis.

Iran J Public Health 2017 Jan;46(1):12-22

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

Background: The current study was conducted to estimate the integrated mean of Quality Of Life (QOL) of the general population of different countries around the world and to compare them on the grounds of the Human Development Index (HDI).

Methods: Well-known international databases such as Medline, Scopus, Science Direct, Google Scholar & Google, and domestic databases including SID, IranMedex, Irandoc & Magiran were searched in 2015. The data were analyzed with the Random Effect Model, using Stata 11 software.

Results: Ninety-seven studies were selected for the final analysis. The overall QOL mean in the very high HDI subgroup was 74.26 (CI=72.40-76.12), which was the highest value. The lowest mean score was observed in the psychological domain (M=67.37; CI=66.23-68.52). In the high HDI subgroup, the highest mean was observed in the social relationships domain (M=64.16; CI=61.99-66.34), and the lowest mean was observed in the environment domain (M=58.76; CI=56.50-61.03). In the medium HDI subgroup, the highest mean was calculated for the overall QOL score (M=62.62; CI=56.35-68.92), and the lowest mean was estimated for the environment domain (M=56.98; CI=53.54-60.43). The highest mean in the low HDI subgroup was observed in the physical health domain (M=68.17; CI=67.43-70.52), and the lowest mean was calculated for the environment domain (M=53.14; CI=51.57-54.72). There was considerable heterogeneity in all the subgroups and domains; the values reported here are the weighted means of QOL for different countries.

Conclusion: Overall, the highest means of various QOL domains were observed in the very high HDI subgroup.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5401920PMC
January 2017

Obesity As a Risk Factor for Anthracyclines and Trastuzumab Cardiotoxicity in Breast Cancer: Methodologic Issues to Avoid Misinterpretation in the Meta-Analysis.

J Clin Oncol 2017 03 23;35(8):923. Epub 2017 Jan 23.

Zahra Cheraghi, Hamadan University of Medical Sciences, Hamadan, Iran; Erfan Ayubi, Shahid Beheshti University of Medical Sciences and Tehran University of Medical Sciences, Tehran, Iran; and Amin Doosti-Irani, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1200/JCO.2016.71.0715DOI Listing
March 2017

Quality of Life in Elderly Iranian Population Using the QOL-brief Questionnaire: A Systematic Review.

Iran J Public Health 2016 Aug;45(8):978-985

Dept. of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Due to the increase in the elderly population in different societies, their primary needs, physical and mental health, and quality of life, is important. This study aimed to estimate the overall mean score of the QOL based on the Qol-Brief questionnaire in the elderly population of Iran.

Methods: The international and national databases, including; Medline, Scopus, Science Direct, MagIran, and SID were searched up to Feb 2015. All studies, addressed the quality of life among the healthy Iranian elderly population using WHO-QOL-BRIEF questionnaire, were included. The random effect model was used for data analysis and the results were reported with a 95% confidence.

Results: Out of 2150 studies, seven studies involved 1366 elderly participants were included in the meta-analysis. The pooled mean score of total QOL was 60.1±4.6. The pooled mean score of quality of life for physical health was 55.13 [51.03, 59.22], for environmental was 51.80 [45.50, 58.10], for psychological was 56.68 [53.29, 60.08] and for the social relationship was 57.82 [55.79, 59.86]. The men had a better status and in two health domains, including; physical and psychological health.

Conclusion: The results of this study stress the necessity of attention to the quality of life in the domains of physical health (especially in women), and environmental health in the elderly population.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139978PMC
August 2016

The prevalence of dental fluorosis and exposure to fluoride in drinking water: A systematic review.

J Dent Res Dent Clin Dent Prospects 2016 17;10(3):127-35. Epub 2016 Aug 17.

PhD Student in Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background. Regarding the lack of comprehensive systematic review on the efficacy of water fluoridation and prevalence of dental fluorosis, the aim of the current research was to systematically study the prevalence of dental fluorosis at different levels of water fluoride in the world and lay emphasis on the amount of fluoride in drinking water. Methods. Studies were searched in PubMed, Scopus, SID, and IranMedex, with regard to inclusion criteria. Study validity was assessed with some checklists, and analyses were performed to ascertain the prevalence of dental fluorosis among individuals categorized in age groups. Results. Investigation of the heterogeneity and analysis of the subgroups revealed that in the 6-18 year age group, when water fluoride level was less than 0.7 ppm and there was exposure to water fluoride in the first 6-8 years of life, no significant heterogeneity was detected among the studies in this subgroup. Thus, the pooled estimation of dental fluorosis prevalence in this subgroup was 12.9% (95% CI: 7.5-18.3%). Furthermore, meta-regression indicated that the exposure time to fluoride in drinking water, or exposure to fluoride in supplements, diets, air, etc as well as the quality of studies had a significant relation to the difference in the prevalence of dental fluorosis. Conclusion. The results revealed no heterogeneity in just 2 subgroups, and the results of subgroups could be pooled in them. Furthermore, the number of studies included in this review considerably decreased by considering all the detected confounding factors, whereas other similar systematic reviews mentioned at most 2 factors.
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http://dx.doi.org/10.15171/joddd.2016.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025212PMC
September 2016

The association between nutritional exposures and metabolic syndrome in the Tehran Lipid and Glucose Study (TLGS): a cohort study.

Public Health 2016 Nov 5;140:163-171. Epub 2016 Aug 5.

Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: This study was conducted with the goal of investigating the effect of various food consumption on the incidence of metabolic syndrome (MetS).

Study Design: Prospective cohort study.

Methods: This study conducted on 3616 healthy adults aged ≥20 years, who were not affected with MetS. Nutritional intake was determined at the beginning of the study (2008-2011) by the Food Frequency Questionnaire (FFQ), and the incidence of MetS was investigated after a median of 24.6 months follow-up. Data were analyzed by multiple logistic regression, with 95% confidence interval.

Results: After adjusting the effect of other variables in the model many foods in the whole grains group such as Sangak bread (OR = 0.35, 95% CI: 0.11-1.56), multiple types of vegetables and fruits - such as peach (OR = 0.11, 95% CI: 0.01-0.75), and mushroom (OR = 0.28, 95% CI: 0.11-0.71) had protective effects against MetS. From the dairy group yoghurt (OR = 0.43, 95% CI: 0.18-1.01) and ice cream (OR = 0.35, 95% CI: 0.12-1.06) had similar such effects.

Conclusion: Based on our findings, there was a significant rise in the incidence of MetS in Iran. The daily consumption of foods from the whole grains, dairy, vegetable and fruit groups can help reduce the odds of MetS.
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http://dx.doi.org/10.1016/j.puhe.2016.07.003DOI Listing
November 2016

The Prevalence of Asymptomatic Bacteriuria in Iranian Pregnant Women: A Systematic Review and Meta-Analysis.

PLoS One 2016 23;11(6):e0158031. Epub 2016 Jun 23.

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

Background: Asymptomatic bacteriuria (ASB) is defined as the presence of bacteria in urine without having signs and symptoms. The aim of this meta-analysis was to estimate the overall prevalence of asymptomatic bacteriuria among Iranian pregnant women.

Methods: Major national and international databases were searched up to November 2015, including Scientific Information Database, MagIran, Web of Science, Medline, Scopus, Science Direct and Ovid. The checklist of the STROBE statement was used for evaluating the quality of reporting. The extracted data were analyzed and the results were reported using a random-effects model with 95% confidence interval (CI).

Results: From 3709 obtained studies, 20 included in the meta-analysis, which involved 15108 pregnant women. The overall prevalence of ASB was 0.13 (95% CI: 0.09, 0.17). The prevalence of ASB in the northern and southern regions of Iran was 0.13 (95% CI: 0.09, 0.18) and 0.11 (95% CI: 0.05, 0.16), respectively.

Conclusion: Prevalence of ASB among Iranian pregnant women is considerable. Due to the complications of ASB for pregnant women and their children, preventative planning and control of ASB among pregnant women in Iran is necessary.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158031PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919037PMC
July 2017

Simultaneous Comparison of Efficacy and Adverse Events of Interventions for Patients with Esophageal Cancer: Protocol for a Systematic Review and Bayesian Network Meta-analysis.

Asian Pac J Cancer Prev 2016 ;17(2):867-72

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran E-mail :

Background: Esophageal cancer is one of the most serious malignancies. Due to the aggressive nature of this cancer, the prognosis is poor. A network meta-analysis with simultaneous comparison of multiple treatments can help determine better treatment options that have higher effects on overall survival of patients with lower adverse events. The aim of this review is to simultaneously compare efficacy and adverse events of treatment interventions for esophageal cancer.

Materials And Methods: In this review, only randomized control trials (RCT) will be considered for network meta-analysis. All international electronic databases including Medline, Web of Sciences, Scopus, Cochran's library, EMBASE and Cancerlit will be searched to find randomized control trials which compared two or more treatment interventions for esophageal cancer. A network plot will be drawn for visual representation of all available treatment interventions. Bayesian approach will be used to combine the direct and indirect evidence. Treatment effects (e.g. hazard ratio for time to event outcomes, risk ratio for binary outcomes, and rate ratio for count outcomes with 95% credible interval) will be reported. Moreover, cumulative probability of the treatment ranks will be reported using the surface under the cumulative ranking (SUCRA) graphs. Consistency assumption will be assessed by the loop-specific and design-by-treatment interaction approaches.

Conclusions: The results of this study may be helpful for the patients, clinicians and health policy makers in selecting treatments that have the best effect on survival and lowest adverse events.
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http://dx.doi.org/10.7314/apjcp.2016.17.2.867DOI Listing
January 2017

Prevalence of Preeclampsia and Eclampsia in Iran.

Arch Iran Med 2016 Jan;19(1):64-71

Faculty of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran.

Background: Several studies have been conducted to investigate the prevalence of preeclampsia and eclampsia in Iran. These studies have yielded different results. This meta-analysis was aimed to estimate the prevalence of preeclampsia and eclampsia in Iran.

Methods: International and national electronic databases were searched up to August 2014 including PubMed, Science Direct, Scopus, Science Information Database, MagIran, and IranMedex as well as conference databases. All studies, in which the prevalence or cumulative incidence of preeclampsia in Iran was reported, were included in this meta-analysis. Thirty-six separate studies were assessed involving overall 132,737 participants, of which 4360 had preeclampsia and 49 had eclampsia.

Results: Overall prevalence of preeclampsia and eclampsia was 0.05 (95% CI: 0.05, 0.06) and 0.23% (95% CI: 0.12%, 0.33%) respectively. The prevalence of preeclampsia, increased from 0.04 (95% CI: 0.03, 0.05) during 1996 to 2005 to 0.07 (95% CI: 0.04, 0.09) during 2010 to 2013, while the prevalence of eclampsia decreased from 0.30% (95% CI: 0.15%, 0.45%) to 0.01% (95% CI: 0.01%, 0.01%), during the same period.

Conclusions: The preeclampsia prevalence had an increasing growth and the eclampsia prevalence had declining growth in recent years. In addition, despite many studies aimed the prevalence of preeclampsia and eclampsia in Iran, there is a significant variation between the results. So, it is difficult to give an exact estimation of the preeclampsia and eclampsia prevalence in Iran.
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http://dx.doi.org/0161901/AIM.0012DOI Listing
January 2016

Burden Assessment of Thyroid cancer in Iran from 1990 to 2010: Lessons Obtained from Global Burden of Disease Report 2010.

Asian Pac J Cancer Prev 2015 ;16(17):7743-8

Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran E-mail :

Background: Thyroid tumors are generally regarded as rare malignancies. Nowadays, however, their global incidence is growing continuously partially due to western life style and utilization of more sensitive methods of early detection. It is approximately three times more prevalent in females than in males. Most cases of thyroid cancer are asymptomatic nodules or just have local cervical symptoms or adenopathy in early stages.

Materials And Methods: The Global Burden of Diseases report 2010 study (released 3/2013) profited from 100 collaborators worldwide and used a vast network of data on health outcomes, vital registries, and population surveys. It shared many of the Global Burden of Diseases 1990 principal databases such as all available data on injuries, diseases, risk factors, as well as comparable metrics, and used different scientific approved methods to estimate important health status data like: death rate, life expectancy, healthy adjusted life expectancy, disability-adjusted life years (DALY), years of living lost due to premature death and years of life with disabilities.

Results: DALY as thyroid cancer burden per 100,000 Iranian populations had increased by about 14% during 1990 to 2010 in all ages; from 6.1 (95% UI 4.2-9.74) years in 1990 to 6.95 (95% UI 5.06-9.18) years in 2010 in both sex. The 2010 peak age-group was estimated at 45-49 years in males and 40-45 years in females.
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http://dx.doi.org/10.7314/apjcp.2015.16.17.7743DOI Listing
September 2016

Burden of Cancers in Iran from 1990 to 2010: findings from the Global Burden of Disease study 2010.

Arch Iran Med 2015 Oct;18(10):629-37

Department of Hematology and Oncology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Cancer is one of the most common non-communicable diseases in both sexes and a major cause of disability and death around the world, as well as in Iran. The aim of the present manuscript is to report the results of the Global Burden of Disease study 2010 (the GBD 2010) to compare the results with the other similar findings. The paper also discusses the existing deficiencies of the GBD study. Our aim was to describe and criticize the attributed burden of cancers according to the GBD results by sex and age.

Methods: The GBD 2010 has profited from 100 collaborators worldwide and provides a vast network of data on health outcomes, vital registries, and population surveys. The GBD has used various scientific-approved methods to estimate important health statuses like death rates, life expectancy, and healthy adjusted life expectancy, disability-adjusted life years, years of living lost due to premature death and years of life with disabilities. In the present study, we extracted and graphed the GBD results for Iran in order to present a better scheme for readers.

Results: The mortality rate of cancers in Iranians has increased by about 8.5%, the disability-adjusted life year rates have declined by about 9%, and years lost due to premature death have also decreased by about 10% from 1990 to 2010 compared to an 85% increase in years of life with disabilities in the same time period.

Conclusion: The burden of all non-communicable diseases (NCDs) including cancers showed decrease during the past two decades. However, these diseases still remain worldwide health challenge. Prevention should be considered as an important priority and responsibility. The health authorities also need to determine the burden of cancers at the national and sub-national levels for implementation of effective preventive strategies.
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http://dx.doi.org/0151810/AIM.004DOI Listing
October 2015

Predictors of miscarriage: a matched case-control study.

Epidemiol Health 2014 20;36:e2014031. Epub 2014 Nov 20.

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

Objectives: The risk factors for miscarriage vary across communities and countries. This study was conducted to investigate the predictors of miscarriage in the west of Iran.

Methods: This matched case-control study was conducted in Hamadan Province from April 2013 to March 2014. Cases were selected from women who had a recent spontaneous abortion and controls were selected from women who had a recent live birth. Two controls were selected for every case and matched for date of pregnancy and area of residence. Multivariate conditional logistic regression analysis was performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results: Five hundred fifty cases were compared with 1,091 controls. The OR of miscarriage was 1.58 (95% CI=1.30-1.92) for every five-year increase in age, 0.20 (95% CI=0.14-0.28) for every live birth, and 3.43 (95% CI=2.03-5.79) for a history of previous spontaneous abortion. Compared to nulliparous women, primiparous or multiparous women had an OR of 17.85 (95% CI=6.65-47.91) for miscarriage. There was a strong association between miscarriage and abnormal amniotic status (OR, 2.46; 95% CI, 0.46-13.09) and also abnormal placenta status (OR, 10.44; 95% CI, 0.95-114.92); however, these associations were not statistically significant. No significant associations were observed between miscarriage and body mass index, previous history of stillbirth, low birth weight, congenital anomaly, ectopic pregnancy, impaired thyroid function, or high blood pressure.

Conclusions: Our study suggests that miscarriage is a multifactorial outcome associated with several modifiable and non-modifiable risk factors that may vary among different communities.
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http://dx.doi.org/10.4178/epih/e2014031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282085PMC
December 2014

Quality evaluation of national cancer registry system in Iran: study protocol.

Arch Iran Med 2014 Mar;17(3):193-7

Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, TehranUniversity of Medical Sciences, Tehran, Iran, Endocrinology and Metabolism Research center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Cancer registry can be a very important component of health information system in developing countries. Routine collection of data and ongoing monitoring of their quality can have a crucial role in priority setting and evidence-based policy making for controlling cancers and trends follow-up in low and middle-income countries. Evaluation of cancer registered data consists of four important components including: comparability, completeness, validity, and timeliness. Similar frameworks are utilized in different countries all over the world.

Methods And Materials: We will use the national annual cancer registry reports in Iran alone or perhaps along with other Iranian published reports about childhood cancer incidence to determine the stability and trend of incidence rates over time and compare above mentioned reports with childhood cancer incidence data reported by other countries through a systematic review as well as in some cases meta-analysis in order to assess data quality. Data will also be collected from other sources such as death certificates to estimate mortality rates and other different methods will also be additionally applied, by use of which death certificates would be utilized to assess the quality of data, too.

Conclusion: As the first step for proper measuring incidence rate of all types of cancers all over the country, we will assess and evaluate reported national cancer registry data in Iran in order to estimate the national burden of cancers in 1990 - 2013.
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http://dx.doi.org/0141703/AIM.0010DOI Listing
March 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