The effect of obesity phenotype changes on cardiovascular outcomes in adults older than 40 years in the prospective cohort of the Tehran lipids and glucose study (TLGS): joint model of longitudinal and time-to-event data

BACKGROUND

Obesity is a worldwide health concern with serious clinical effects, including myocardial infarction (MI), stroke, cardiovascular diseases (CVDs), and all-cause mortality. The present study aimed to assess the association of obesity phenotypes and different CVDs and mortality in males and females by simultaneously considering the longitudinal and survival time data.

METHODS

In the Tehran Lipid and Glucose Study (TLGS), participants older than three years were selected by a multi-stage random cluster sampling method and followed for about 19 years. In the current study, individuals aged over 40 years without a medical history of CVD, stroke, MI, and coronary heart disease were included. Exclusions comprised those undergoing treatment for CVD and those with more than 30% missing information or incomplete data. Joint modeling of longitudinal binary outcome and survival time data was applied to assess the dependency and the association between the changes in obesity phenotypes and time to occurrence of CVD, MI, stroke, and CVD mortality. To account for any potential sex-related confounding effect on the association between the obesity phenotypes and CVD outcomes, sex-specific analysis was carried out. The analysis was performed using packages (JMbayes2) of R software (version 4.2.1).

RESULTS

Overall, 6350 adults above 40 years were included. In the joint modeling of CVD outcome among males, literates and participants with a family history of diabetes were at lower risk of CVD compared to illiterates and those with no family history of diabetes in the Bayesian Cox model. Current smokers were at higher risk of CVD compared to non-smokers. In a logistic mixed effects model, odds of obesity phenotype was higher among participants with low physical activity, family history of diabetes and older age compared to males with high physical activity, no family history of diabetes and younger age. In females, based on the results of the Bayesian Cox model, participants with family history of diabetes, family history of CVD, abnormal obesity phenotype and past smokers had a higher risk of CVD compared to those with no history of diabetes, CVD and nonsmokers. In the obesity varying model, odds of obesity phenotype was higher among females with history of diabetes and older age compared to those with no history of diabetes and who were younger. There was no significant variable associated with MI among males in the Bayesian Cox model. Odds of obesity phenotype was higher in males with low physical activity compared to those with high physical activity in the obesity varying model, whereas current smokers were at lower odds of obesity phenotype than nonsmokers. In females, risk of MI was higher among those with family history of diabetes compared to those with no history of diabetes in the Bayesian Cox model. In the logistic mixed effects model, a direct and significant association was found between age and obesity phenotype. In males, participants with history of diabetes, abnormal obesity phenotype and older age were at higher risk of stroke in the Bayesian Cox model compared to males with no history of diabetes, normal obesity phenotype and younger persons. In the obesity varying model, odds of obesity phenotype was higher in males with low physical activity, family history of diabetes and older age compared to those with high physical activity, no family history of diabetes and who were younger. Smokers had a lower odds of obesity phenotype than nonsmokers. In females, past smokers and those with family history of diabetes were at higher risk of stroke compared to nonsmokers and females with no history of diabetes in the Bayesian Cox model. In the obesity varying model, females with family history of diabetes and older ages had a higher odds of obesity phenotype compared to those with no family history of diabetes and who were younger. Among males, risk of CVD mortality was lower in past smokers compared to nonsmokers in the survival model. A direct and significant association was found between age and CVD mortality. Odds of obesity phenotype was higher in males with a history of diabetes than in those with no family history of diabetes in the logistic mixed effects model.

CONCLUSIONS

It seems that modifications to metabolic disorders may have an impact on the heightened incidence of CVDs. Based on this, males with obesity and any type of metabolic disorder had a higher risk of CVD, stroke and CVD mortality (excluding MI) compared to those with a normal body mass index (BMI) and no metabolic disorders. Females with obesity and any type of metabolic disorder were at higher risk of CVD(, MI and stroke compared to those with a normal BMI and no metabolic disorders suggesting that obesity and metabolic disorders are related. Due to its synergistic effect on high blood pressure, metabolic disorders raise the risk of CVD.

Association between metabolic syndrome and myocardial infarction among patients with excess body weight: a systematic review and meta-analysis

BACKGROUND

Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. Controversial views exist over the effects of metabolically unhealthy obesity phenotypes on CVDs. This study aimed to perform a meta-analysis to assess the association between metabolic syndrome and myocardial infarction (MI) among individuals with excess body weight (EBW).

METHODS

We searched PubMed/Medline, Scopus, and Web of Science databases as of December 9, 2023. Cohort studies involving patients with overweight or obesity that reported the relevant effect measures for the association between metabolic syndrome and MI were included. We excluded studies with incomplete or unavailable original data, reanalysis of previously published data, and those that did not report the adjusted effect sizes. We used the Newcastle Ottawa Scale for quality assessment. Random-effect model meta-analysis was performed. Publication bias was assessed by Begg's test.

RESULTS

Overall, nine studies comprising a total of 61,104 participants were included. There was a significant positive association between metabolic syndrome and MI among those with obesity (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.27, 2.22). Subgroup analysis showed higher HRs for obesity (1.72; 1.03, 2.88) than overweight (1.58; 1.-13-2.21). Meta-regression revealed no significant association between nationality and risk of MI (p = 0.75). All studies had high qualities. There was no significant publication bias (p = 0.42).

CONCLUSIONS

Metabolic syndrome increased the risk of MI in those with EBW. Further studies are recommended to investigate other risk factors of CVDs in EBW, in order to implement preventive programs to reduce the burden of CVD in obesity.

Classification and Diagnostic Prediction of Colorectal Cancer Mortality Based on Machine Learning Algorithms: A Multicenter National Study

INTRODUCTION

Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths. This study aimed to predict survival outcomes of CRC patients using machine learning (ML) methods.

MATERIAL AND METHODS

A retrospective analysis included 1853 CRC patients admitted to three prominent tertiary hospitals in Iran from October 2006 to July 2019. Six ML methods, namely logistic regression (LR), Naïve Bayes (NB), Support Vector Machine (SVM), Neural Network (NN), Decision Tree (DT), and Light Gradient Boosting Machine (LGBM), were developed with 10-fold cross-validation. Feature selection employed the Random Forest method based on mean decrease GINI criteria. Model performance was assessed using Area Under the Curve (AUC).

RESULTS

Time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type emerged as crucial predictors of survival based on mean decrease GINI. The NB (AUC = 0.70, 95% Confidence Interval [CI] 0.65-0.75) and LGBM (AUC = 0.70, 95% CI 0.65-0.75) models achieved the highest predictive AUC values for CRC patient survival.

CONCLUSIONS

This study highlights the significance of variables including time from diagnosis, age, tumor size, metastatic status, lymph node involvement, and treatment type in predicting CRC survival. The NB model exhibited optimal efficacy in mortality prediction, maintaining a balanced sensitivity and specificity. Policy recommendations encompass early diagnosis and treatment initiation for CRC patients, improved data collection through digital health records and standardized protocols, support for predictive analytics integration in clinical decisions, and the inclusion of identified prognostic variables in treatment guidelines to enhance patient outcomes.

Burden of injury due to occupational accidents and its spatiotemporal trend at the national and subnational levels in Iran, 2011-2018

PURPOSE

The spatiotemporal trend of the burden of injury due to occupational accidents in Iran, 2011-2018 were assessed at the national and subnational levels.

METHODS

The burden of occupational injury was estimated using three datasets of occupational injury data, the employed population, and duration and disability weight of injuries.

RESULTS

The disability-adjusted life years (DALYs), deaths, DALY rate, and death rate (per 100,000 workers) of occupational injury in Iran drastically decreased from 169,523, 2,280, 827, and 11 in 2011 to 86,235, 1,151, 362, and 5 in 2018, respectively. The DALY rates of occupational injury were significantly different by gender and age in a manner that the DALY rate of men was much higher than that of women and the DALY rates by age group in 2018 ranged from 98 for 50 y and over to 901 for 15-19 y. The shares of injury outcomes in the total DALYs in 2018 were as follows: 63.6% for fatal injuries, 17.4% for fracture, 7.9% for open wound, 7.3% for amputation, and 3.8% for other injuries. Over 83% of the DALYs was observed in three economic activity groups of construction, manufacturing, and community, social, and personal service activities. The three provinces with the highest DALY rates in 2018 were Markazi, West Azarbaijan, and East Azarbaijan, respectively.

CONCLUSION

Despite the decreasing temporal trend, the burden of occupational injury in Iran in 2018 was high. The high-risk groups and hot spot provinces should be taken into more consideration for further reduction of the injury burden.

The effect of education based on health belief model on hand hygiene behavior in the staff of Tehran dentistry centers: A quasi-experimental intervention study

Background and Aims

Considering the increasing prevalence of dental services in the community and the impossibility of identifying each infected patient, hand sanitation is the most critical factor in controlling infection in these centers. Therefore, this study aimed to determine the effect of educational intervention on the hand health behavior of the staff of Tehran dentistry clinics based on the health belief model (HBM).

Methods

In this quasi-experimental study in 2017, 128 employees of the health centers were selected through a multistage sampling method and they were placed in two groups of intervention and control (each 64 people). The data was collected using a questionnaire devised by the researcher. The validity and reliability of the questionnaire were determined. The questionnaire consisted of demographics, knowledge, structures of the HBM, and behavior variables. Then, the intervention was administered based on HBM-based education. Data were analyzed by SPSS16 and independent t test, χ ², and repeated measurement analysis of variance.

Results

Before the intervention, the two intervention and control groups did not differ significantly in terms of demographic variables, mean scores of knowledge, constructs of HBM, and hand hygiene behavior (p > 0.05), while the intervention group was scored higher significantly compared to the control one after the intervention (p < 0.001).

Conclusion

According to the findings, the HBM can be used as a framework for designing educational interventions to improve hand hygiene behavior to control infection in health centers.

Spatiotemporal variations in childhood lymphoma cancer incidence and its survival rate in Iran, 2005-2015: a cross-sectional study

BACKGROUND

Childhood lymphoma is the second leading cause of cancer in children under 15 years of age in Iran. The aim of this study was to investigate the spatial and time variations in lymphoma incidence as well as the children's survival time in Iran.

METHOD

This cross-sectional study was conducted using lymphoma cases (children under 14 years of age) from 2005 to 2015, and the data were obtained from the National Cancer Registry Center. The frequency, age-standardised incidence rate (ASIR), spatial clustering in national level and the survival rate (1 year and 5 years) using Kaplan-Meier method were evaluated. We used Spatial and Temporal Scan statistics software in order to detect statistically significant clusters in spatial analysis.

RESULTS

A total number of 746 girls and 1610 boys were diagnosed with lymphoma during a 10-year period. ASIRs (per 100 000 people) for girls ranged from 0 in Ilam to 3.47 in Yasuj, and it ranged from 0.19 in Ilam to 5.91 in Yazd for boys from 2005 to 2015. Spatial analysis result showed a large statistically significant cluster (the most likely cluster) for both boys (relative risk (RR)=2.37) and girls (RR=2.49) located in the northwest of Iran. Fortunately, survival rate for both boys and girls was over 95.5%.

CONCLUSION

Lymphoma incidence rates had heterogeneous geographical distribution, and some significant clusters were identified which strengthens the role of possible aetiological factors, and further studies are needed to clarify this ambiguity. Fortunately, the survival rate of this cancer in Iran was good and it was similar to the high-income countries.

Irrational prescription and its costs in neonatal surfactant therapy: public and private hospitals of Iran in 2018

BACKGROUND

Irrational prescription and its subsequent costs are a major challenge worldwide. Health systems must provide appropriate conditions for the implementation of national and international strategies to prevent irrational prescription. The aim of the present study was to determine the irrational surfactant prescription among neonates with respiratory distress and the resulting direct medical costs for private and public hospitals in Iran.

METHODS

This was a cross-sectional descriptive study performed retrospectively using data belonged to 846 patients. Initially, the data were extracted from the patients' medical records and the information system of the Ministry of Health. The obtained data were then compared with the surfactant prescription guideline. Afterward, each neonatal surfactant prescription was evaluated based on the three filters listed in the guideline (including right drug, right dose, and right time). Finally, chi-square and ANOVA tests were used to investigate the inter-variable relationships.

RESULTS

The results showed that 37.47% of the prescriptions were irrational and the average costs of each irrational prescription was calculated as 274.37 dollars. It was estimated that irrational prescriptions account for about 53% of the total surfactant prescription cost. Among the selected provinces, Tehran and Ahvaz had the worst and the best performance, respectively. As well, public hospitals outperformed private hospitals in terms of the in drug selection, but they underperformed them in terms of the right dose determination.

CONCLUSION

The results of the present study are considered as a warning to insurance organizations, in order to reduce unnecessary costs caused by these irrational prescriptions by developing new service purchase protocols. Our suggestion is the use of educational interventions to reduce irrational prescriptions due to drug selection as well as using computer alert approaches to reduce irrational prescriptions caused by wrong dose administration.

White Noise and Its Potential Applications in Occupational Health: A Review

Background: White noise (WN), because of its unique behavior and characteristics, has different applications in different sciences. Nevertheless, the results of studies and reviews of the literature on occupational safety and health found that this type of noise is often used as a noise source to assess the effects of hearing and its physical characteristics. Its possible applications in this area have not received as much attention. The present review study aimed to answer the question, "Can WN be used as a means of promoting occupational safety and health at the workplace?". Methods: In this review, we reviewed the articles published in reputable databases from 1990 to 2020. Our study included 33 articles from 120 that were searched in full text and followed the inclusion and exclusion criteria. Results: Various applications were examined, including noise masking, white noise therapy, cognitive functions, and sleep. WN can enhance the work environment and meet occupational safety and health objectives based on the study's results. The results of this study will provide a basis for continuing research into the use of WN in the workplace as an engineering and management control method. Conclusion: WN is being used in various fields that may hold promise for its application in occupational health sciences and maintaining the well-being of workplace workers.

The influencing factors of elder-friendly public open spaces promoting older adults' health in deprived urban neighborhoods: Partial Least Square Structural Equation Modeling approach

Background

Public open spaces (POSs) is considered a feature of the built environment that is important for physical, mental, and social health during life and contributes to active aging. Hence, policymakers, practitioners, and academics have recently focused on indicators of elder-friendly environments, particularly in developing countries.

Objective

This study aimed to examine the attributes of POSs and socio-demographic status that positively influence older people's health in Tehran's deprived neighborhoods using a pathway model.

Methods

We employed a pathway model to explore the relationships between place function, place preferences, and process in the environment as the perceived (subjective) positive features of POSs associated with older adults' health, compared to the objective attributes of POSs. We also included personal characteristics, including physical, mental, and social dimensions, to explore how these factors are related to the health of older adults. To assess the subjective perception of POSs attributes, 420 older adults were asked to complete Elder-Friendly Urban Spaces Questionnaire (EFUSQ) from April 2018 to September 2018 in the 10th District of Tehran. We used the SF-12 questionnaire and "The self-Rated Social Health of Iranians Questionnaire to measure older people's physical and mental health and elder social health." Geographical Information System (GIS) measures (Street connectivity, Residential density, Land use mix, Housing quality) were derived as objective measures of neighborhood features.

Results

According to our findings, the personal aspect, socio-demographic status (such as Gender, Marital status, Education, Occupation as well as Frequency of being present in POSs), place preferences (Security, Fear of Falling, Way Finding and Perceived Aesthetics), and process in the environment's latent (Social Environment, Cultural Environment, Place Attachment, and Life Satisfaction)constructs collectively influenced the elders' health.

Conclusion

We found positive associations between Place preference, Process-in-environment, and personal health-related factors to elders' health (social, mental, and physical). The path model presented in the study could be guided in future research in this area and inform the development of evidence-based urban planning and design interventions for improve older adults health and social functioning and quality of life.

Epidemiology of pediatric sarcoma in Iran

BACKGROUND

Pediatric sarcomas are divided into two major groups of soft-tissue sarcomas (STSs) and malignant bone tumors (MBTs).

AIMS

The aim of the present study was to determine the incidence and survival rate of STSs and MBTs in the Iranian population based on diagnosis date, gender, age, and histological types.

METHODS AND RESULTS

Data was retrieved from Iran National Cancer Registry between 2008 and 2015. The dataset was classified according to the third edition of the International Classification of Childhood Cancer. The survival information was merely available for 291 (21% of total data), including 142 (49%) MBTs and 149 (51%) STSs. The age-standardized incidence rates (ASIRs) and five-year survival rates were calculated.

CONCLUSION

The present study is the first comprehensive study of pediatric sarcomas in Iran, in which a lower incidence and survival rate of MBTs and STSs compared with high-income countries were found. However, the survival rates of these malignancies were higher in high-income countries compared to Iran. This study showed the need to improve the quantity and quality of the population-based registry in Iran for acquiring progress in the prevention and control of sarcomas.

Irrational prescription of surfactant replacement therapy in neonatal respiratory distress

Purpose

Respiratory distress is known as one of the leading causes of neonatal death. In recent decades, surfactant therapy has revolutionized respiratory failure. Since the implementation of the health system reform plan as well as the allocation of new financial resources for health system in Iran, the rate of irrational prescription has increased and prescription of surfactant for neonates, has raised unexpectedly, which is thought to be due to irrational prescriptions partly. The present study aimed to determine the rate of irrational prescription of surfactant for neonates with respiratory distress.

Methods

This research was a cross-sectional descriptive study, which was conducted retrospectively. In the current study, determining the rate of irrational prescription was done in terms of the surfactant prescription guideline. Finally, the medical data of 846 neonates who underwent surfactant therapy in Iran in 2018, were extracted from the information system of the Ministry of Health and the neonatal medical records.

Results

The results show that drug selection index, dose index, and time index were irrational for 14.30%, 27.42%, and 1.06% of neonates, respectively. Moreover, the total index of drug prescription, which is a combination of the above-mentioned three components, was found to be irrational for 31.47% of neonates.

Conclusions

The results of the present study are considered as a warning to providers and decision makers in the field of neonatal health to reduce irrational prescriptions of surfactant for neonates. This study suggests the use of educational interventions in order to reduce irrational prescriptions due to drug selection as well as the use of computer alert approaches in order to reduce irrational prescriptions due to wrong dose.

Cost-effectiveness analysis of infliximab versus CinnoRA in the treatment of moderate to severe ulcerative colitis in Iranian patients

Introduction: As two biological agents, infliximab (IFX) and biosimilar adalimumab (CinnoRA®) are routinely used in the clinical management of ulcerative colitis (UC) in Iran. Objectives: This study was done to evaluate the cost-effectiveness of IFX versus CinnoRA for the treatment of moderate-to-severe UC patients. Patients and Methods: To accomplish this, we developed a hybrid decision-tree/microsimulation (MS) approach for modeling UC’s natural history. We populated our model with available data on probabilities, costs, utilities / disutilities, and emergent adverse effects. Costs were reported in Iranian Rial (IRR) and in April 2021 US dollars ($). One-way and multiple sensitivity analyses were used to determine the uncertainty of the model’s parameters. Results: For five, 10, and lifetime horizon times, patients on IFX received slightly more quality-adjusted life-year (QALY) per year in remission and experienced about 3 to 5 times less surgery than CinnoRA patients. With willingness-to-pay (WTP) thresholds of 1800 ($7826.08), 820($3565.21), and 520 ($2260.86) million IRR for these horizon times, IFX was cost-effective with 100% certainty. Our findings were highly sensitive to the number of adverse effects. Conclusion: Our results demonstrated that IFX is more effective and more costly than CinnoRA, and if we ignore the predicted surgeries, CinnoRA is nearly as effective as IFX. However, these findings should be cautiously interpreted without a robust clinical trial of CinnoRA in UC patients. Since the impact of CinnoRA may have been over/underestimated.

Short and Long-Term Survival Rates Following Myocardial Infarction and Its Predictive Factors: A Study Using National Registry Data

Background: Coronary artery disease is the most common cause of death worldwide as well as in Iran. The present study was designed to predict short and long-term survival rates after the first episode of myocardial infarction (MI).

Methods: The current research is a retrospective cohort study. The data were collected from the Myocardial Infarction Registry of Iran in a 12-month period leading to March 20, 2014. The variables analyzed included smoking status, past medical history of chronic heart disease, hypertension, diabetes, hyperlipidemia, signs and symptoms during an attack, post-MI complications during hospitalization, the occurrence of arrhythmias, the location of MI, and the place of residence. Survival rates and predictive factors were estimated by the Kaplan–Meier method, the log-rank test, and the Cox model.

Results: Totally, 21 181 patients with the first MI were studied. There were 15 328 men (72.4%), and the mean age of the study population was 62.10±13.42 years. During a 1-year period following MI, 2479 patients (11.7%) died. Overall, the survival rates at 28 days, 6 months, and 1 year were estimated to be 0.95 (95% CI: 0.95 to 0.96), 0.90 (95% CI: 0.90 to 0.91), and 0.88 (95% CI: 0.88 to 0.89). After the confounding factors were controlled, history of chronic heart disease (p<0.001), hypertension (p<0.001), and diabetes (p<0.001) had a significant relationship with an increased risk of death and history of hyperlipidemia (p<0.001) and inferior wall MI (p<0.001) had a significant relationship with a decreased risk of death.

Conclusion: The results of this study provide evidence for health policy-makers and physicians on the link between MI and its predictive factors.

Age at Natural Menopause; A Data Mining Approach (Data from the National Health and Nutrition Examination Survey 2013-2014)

Background

The timing of the age at which menopause occurs varies among female populations. This variation is attributed to genetic and environmental factors. This study aims to investigate the determinants of early and late-onset menopause.

Methods

We used data from the National Health and Nutrition Examination Survey 2013-2014 for 762 naturally menopause women. Data on sociodemographic, lifestyle, examination, and laboratory characteristics were examined. We used random forest (RF), support vector machine (SVM), and logistic regression (LR) to identify important determinants of early and late-onset menopause. We compared the performance of models using sensitivity, specificity, Brier score, and area under the receiver operating characteristic (AUROC). The top determinants were assessed by using the best performing models, using the mean decease in Gini.

Results

Random forest outperformed LR and SVM with overall AUROC 99% for identifying related factors of early and late-onset menopause (Brier score: 0.051 for early and 0.005 for late-onset menopause). Vitamin B12 and age at menarche were strongly related to early menopause. Also, methylmalonic acid (MMA), vitamin D, body mass index (BMI) were among the top highly ranked factors contributing to early menopause. Features such as age at menarche, MMA, sex hormone-binding globulin (SHBG), BMI, vitamin B12 were the most important covariate for late-onset menopause.

Conclusions

Menarche age and BMI are among the important contributors of early and late-onset menopause. More research on the association between vitamin D, vitamin B12, SHBG, and menopause timing is required which will produce invaluable information for better prediction of menopause timing.

Response to Fluvoxamine in the Obsessive-Compulsive Disorder Patients: Bayesian Ordinal Quantile Regression

Background:

Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric disorder associated with unpleasant thoughts or mental images, making the patient repeat physical or mental behaviors to relieve discomfort. 40-60% of patients do not respond to Serotonin Reuptake Inhibitors, including fluvoxamine therapy.

Introduction:

The aim of the study is to identify the predictors of fluvoxamine therapy in OCD patients by Bayesian Ordinal Quantile Regression Model.

Methods:

This study was performed on 109 patients with OCD. Three methods, including Bayesian ordinal quantile, probit, and logistic regression models, were applied to identify predictors of response to fluvoxamine. The accuracy and weighted kappa were used to evaluate these models.

Results:

Our result showed that rs3780413 (mean=-0.69, sd=0.39) and cleaning dimension (mean=-0.61, sd=0.20) had reverse effects on response to fluvoxamine therapy in Bayesian ordinal probit and logistic regression models. In the 75^th quantile regression model, marital status (mean=1.62, sd=0.47) and family history (mean=1.33, sd=0.61) had a direct effect, and cleaning (mean=-1.10, sd=0.37) and somatic (mean=-0.58, sd=0.27) dimensions had reverse effects on response to fluvoxamine therapy.

Conclusion:

Response to fluvoxamine is a multifactorial problem and can be different in the levels of socio-demographic, genetic, and clinical predictors. Marital status, familial history, cleaning, and somatic dimensions are associated with response to fluvoxamine therapy.

Designing a Predictive Model for Colorectal Neoplasia Diagnosis Based on Clinical and Laboratory Findings in Colonoscopy Candidate Patients

BACKGROUND

Health authorities have expanded two strategies to diminish CRC-related influence: CR screening and improve diagnostic process in symptomatic patients. The aim of the current study is to design a predictive model to identify the most important risk factors that can efficiently predict patients who have high risk of colorectal neoplasia.

METHOD

A cross-sectional study was constructed to include all patients who had positive test for FIT or had one or more risk factors for colorectal cancer based on the guidelines of detecting high-risk groups for colorectal cancer in Iran. Multivariable binary logistic regression model was constructed for prediction of colorectal neoplasia. We used sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio to check the accuracy. The Hosmer-Lemeshow test, chi-square test, and p value were used to determine the precision of model.

RESULT

Following an AIC stepwise selection model, only nine potential variables, namely gender, watery diarrhea, IBD, abdominal pain, melena, body mass index, depression drug, anti-inflammatory drug, and age, were found to be a predictor of colorectal neoplasia. The best cut-point probability in the final model was 0.27 and results of sensitivity and specificity, based on maximizing these two criteria, were 66% and 62%, respectively.

CONCLUSION

Overall, our model prediction was comparable with other risk prediction models for colorectal cancer. It had a modest discriminatory power to distinguish an individual's neoplasia colorectal risk.

Epidemiology of small intestine cancer in Iran

Background

Little is known about the epidemiology of small intestine (SI) cancer in Iran, a rare cancer entity worldwide.

Aims

The aim of the present study was to investigate the incidence patterns and survival rates of SI cancer in Iran through a population‐based study.

Methods and Results

Data on all reported cases of SI cancer were extracted from the Iran National Cancer Registry based on ICD‐O‐3 codes. Age‐standardized incidence rates (ASIR), age‐specific incidence rates, standardized rate ratios (SRR), time trends, and absolute survival rates were calculated.

During 2005–2015, a total of 4928 SI cancers (ASIR: 0.87/100 000) were diagnosed, including 2835 carcinomas (ASIR: 0.51), 214 neuroendocrine malignancies (ASIR: 0.04), 228 sarcomas (ASIR: 0.04), and 704 lymphomas (ASIR: 0.11). Carcinomas and lymphomas occurred more frequently in men than in women (SRR: 1.37/100 000 and 1.85/100 000, respectively), while the other two histological subtypes were almost equally distributed. 78% of carcinomas and 53% of neuroendocrine tumors were located in the duodenum. Sarcomas occurred most frequently in the jejunum (41%), while lymphomas were most frequently in the ileum (44%). From 2005 to 2015, the number of reported cases of SI cancer increased by 9.6% per year. The median age of diagnosis for women and men was 61. The absolute 5‐year survival rate was 35.3%, varying by sex, age, and subtype. Carcinomas had the lowest survival rate (24.1%) while neuroendocrine carcinomas had the highest survival rate (69.7%).

Conclusion

Epidemiological patterns of SI cancer in Iran differed slightly from patterns in the United States and the United Kingdom. In contrast to other countries, the neuroendocrine form is presented as the rarest subtype in Iran. The overall incidence of SI cancer was lower in Iran than in high‐income countries. In contrast, the average prognosis of SI cancer was worse in Iran, indicating the need to improve early detection, diagnosis, and treatment.

The Prevalence of Addiction to Social Network Among Students in Iran and its Factors Related: A Study Conducted in 2020

BACKGROUND

In the present era, the prevalence of addiction to social networks has shown that many users, including students, are detaching from the real world. Therefore, this study aims to estimate the prevalence of addiction to the social networks among students in Iran and its related factors.

METHODS

This is a cross-sectional study conducted in 2020 on 1000 students in Shahid Beheshti University of Medical Sciences, Tehran, Iran. The data collection tool was a standardized questionnaire about addiction to the social networks distributed online among students. Statistical data were analyzed using Stata software version 14.

RESULTS

Generally, 462 students (44%) had addiction to social networks, of which 449 (90.04%) had slight addiction and 13 (9.96%) had severe addiction. The results showed that age (p = 0.001), type of disciplines in the treatment-related subgroup (p = 0.03) and using nerve medicine (p = 0.0001) had significant relationships with addiction to social networks.

CONCLUSION

Considering that a high number of students in the present study are at high risk of addiction, it is suggested that educational programs should be implemented to improve the knowledge of parents and students for optimal use of social networks and raise awareness of the harmful consequences of addiction.

Urbanization Levels and Its Association with Prevalence of Risk Factors and Colorectal Cancer Incidence

Background:

Colorectal cancer is one of the most common cancers in the world. This study aimed to determine the relationship between risk factors and the incidence of colorectal cancer in Urbanization levels in Iran.

Methods:

This was a population-based study. Urbanization levels were determined using the census data of the Statistical Center in 2012. Data on risk factors for colorectal cancer were obtained from the information provided by the Iranian Non-Communicable Disease Control Center and the incidence of colorectal cancer from the data from the National Cancer Registry System. Negative binomial regression analysis was used to determine the relationship between colorectal cancer risk factors and urbanization levels with colorectal cancer incidence. For statistical analysis, SPSS and Stata software were used. A significant level of P≤0.05 was considered.

Results:

The relationship between urbanization levels and risk factors with the incidence of colorectal cancer, nutrition Status, tobacco use, and body mass index were not significant. There was a significant relationship between physical activity and incidence at different levels and between levels of urbanization and incidence rate, indicating a lower incidence rate of colorectal cancer at lower levels of urbanization.

Conclusion:

Colorectal cancer incidence is higher at higher levels of urbanization than lower levels. The difference between regions in terms of urbanization can have in flounce on access to facilities, health service, and counseling opportunities to modify the risk factors and access to proper screening and follow-up care.

The effects of combined exposure to road traffic noise and whole body vibration on types of attention among men

Background:

Noise and vibration are considered as harmful physical agents in the environment which have adverse effects on cognitive performance. One of the occupations at risk is driving, where there is a possibility of simultaneous exposure to road traffic noise and whole body vibration (WBV) transferred through the vehicle. This study aims to assess the effects of single and combined exposure to road traffic noise and WBV on different types of attention in men.

Methods:

The experiment was conducted on 24 men in 4 steps, executed on each participant inside an acoustic room. After recording a number of various attention scores at background conditions (27 dBA noise, no vibration) the participants were given single and combined exposure to noise levels at 55 and 85 dBA and vibration magnitude of 0.65 and 0.95 m/s² r.m.s.

Results:

As for combined exposure to noise and vibration, increasing vibration acceleration and noise levels at the same time compared to background condition caused a rise in the score of all visual attention types among groups exposed to low vibration acceleration and those exposed to medium acceleration and low noise. Nevertheless, when noise level and vibration acceleration is increased at the same time compared to background, auditory attention type scores mostly fell among groups with similar vibration accelerations.

Conclusions:

Overall, single and combined exposure to environmental stressors under investigation had a predominantly negative effect on auditory attention while the effects on visual attention were inconclusive. Definitive conclusions however require further systematic and comprehensive experiments.

Internet addiction theory-based intervention among university students: A case of health belief model

BACKGROUND

The phenomenon of Internet addiction has increased due to the delay between Internet technology and the culture of using it. According to the high prevalence of Internet addiction among students and its associated complications, the present study was conducted to determine the effect of education based on the health belief model on Internet addiction status among students in Tehran, Iran.

MATERIALS AND METHODS

In this interventional study, two dormitories were divided into two groups of control and intervention in a completely random manner using the random cluster sampling method from a total of eight dormitories. Then 134 girls in each group answer two questionnaires of Young (about Internet addiction) and health belief model-based scale. After the need assessments of the primary results, intervention was performed in the experimental group in a way that a textbook based on the health belief model and ten educational text messages were sent to the students' E-mail. Two months later, questionnaires were again given to both groups. The results were analyzed with the help of independent t-test, Chi-square test, Fisher's exact test, Mann-Whitney test, analysis of covariance, and logistic regression with repetitive measures with GEE approach.

RESULTS

The average scores of knowledge (P < 0.001), perceived susceptibility (P < 0.001), perceived severity (P = 0.006), perceived barriers (P < 0.001), and self-efficacy (P = 0.002) between the two groups, had a significant difference after the intervention. The average scores of perceived benefits (P = 0.6), Internet addiction behavior (P = 0.11), and the frequency of Internet addiction (P = 0.63) after intervention did not have a significant difference in the two groups.

CONCLUSIONS

The results of this study show the effectiveness of educational intervention design based on the structures of health belief model on reducing the frequency of Internet addiction and adopting preventive behaviors.

The emerging epidemic of inflammatory bowel disease in Asia and Iran by 2035: A modeling study

BACKGROUND

The projection studies are imperative to satisfy demands for health care systems and proper response to the public health problems such as inflammatory bowel disease (IBD).

METHODS

To accomplish this, we established an illness-death model based on available data to project the future prevalence of IBD in Asia, Iran in particular, separately from 2017 to 2035. We applied two deterministic and stochastic approaches.

RESULTS

In 2035, as compared to 2020, we expected a 2.5-fold rise in prevalence for Iran with 69 thousand cases, a 2.3-fold increment for North Africa and the Middle East with 220 thousand cases, quadrupling of the prevalence for India with 2.2 million cases, a 1.5-fold increase for East Asia region with 4.5 million cases, and a 1.6-fold elevation in prevalence for high-income Asia-Pacific and Southeast Asia regions with 183 and 199 thousand cases respectively.

CONCLUSIONS

Our results showed an emerging epidemic for the prevalence of IBD in Asia regions and/or countries. Hence, we suggest the need for immediate action to control this increasing trend in Asia and Iran. However, we were virtually unable to use information about age groups, gender, and other factors influencing the evolution of IBD in our model due to lack of access to reliable data.

Effect of tonal noise and task difficulty on electroencephalography and cognitive performance

Objectives. The present study aimed to investigate the effect of tonal noise and task difficulty on electroencephalography (EEG) and cognitive performance. Methods. Twelve healthy volunteers participated in the present study. Four noise signals were generated by four prominence tone levels (0, 2, 5 and 9) at background noise levels of 55 dBA and frequency of 500 Hz using the Test Tone Generator from Esser Audio (USA). The participants were asked to perform the tasks with low, moderate and high levels of difficulty while exposed to the noises in an acoustics laboratory. The values of reaction time, correct rate and missed numbers were recorded during each step. Moreover, the EEG signals were measured. Results. The results showed that higher tone level and more task difficulty significantly decreased the correct rate, and increased the miss numbers. However, no significant effect was observed on reaction times. Furthermore, tone level and task difficulty significantly increased activity of the θ and β bands and decreased activity of the α band. Conclusion. Task difficulty and tone level could significantly affect the parameters of performance and the activity of EEG bands. Therefore, noise control can help sustain appropriate performance.

The Comparison between Visually and Auditory Oddball Tasks in the EEG Experiment with Healthy Subjects

Purpose: We compare the two oddball tasks for auditory and visually in the healthy subjects with the EEG experiment. In this regard, we compare three different dimensions of the EEG, including regional, longitudinal, and functional effects. The regional dimension defines as the region of the brain, the longitudinal dimension is the repetition of the stimuli, and the functional dimension is the whole curve of ERP, evoked related potential, instead of the only amplitude and latency of it. We also study the trial effects for each stimulus in each task. Materials and Methods: Seventeen healthy patients, 11 of whom are males, have participated in this study. The dataset was downloaded from the internet. The EEG dataset was cleaned. There are three trials and each has a total of 25 target stimuli per group. The functional data analysis, Hybrid principal component analysis, were used to estimate three effects among two different visually and auditory oddball tasks. The 95% Bayesian credible sets were estimated with three trials of each stimulus and each group. The Generalized Additive Mixed Model was used for studying the effect of trials as random effects. Results: The first eigenfunctions of functional and longitudinal dimensions and first and second eigenvector of regional dimensions were estimated. The 95% Bayesian credible sets indicated that the variability between trials exists and is different for each stimulus and each target. The GAMM model indicates that the interaction effects in the functional dimension are statistically significant for both tasks. The interaction effect in the longitudinal dimension is not statistically significant in the Auditory Task and is statistically significant in the visual task. The brain regions are statistically significant and the main effect of the target stimuli is significant for auditory (P-Value: <0.00) and is not significant for the visual tasks (P-Value: >0.06). The interaction effect for target stimuli and the region of the brain is only significant for Occipital, Parietal, and Right Temporal (P-values < 0.05) for the auditory task. The random effects of trials are statistically significant in most of them. Conclusion: The functional data analysis provides many statistical methods to analyze the EEG dataset. The HPCA can capture the functional-longitudinal and regional dimensions and we also study the new dimension, trials with GAMM. The different regions of the brain have not the same activity in these two tasks. The repeating of the stimuli has a positive effect on complex tasks. The between trial's variability are statistically significant, and we conclude to study this effect to show the stability of the trials.

Machine learning algorithms to predict seizure due to acute tramadol poisoning

INTRODUCTION

This study was designed to develop and evaluate machine learning algorithms for predicting seizure due to acute tramadol poisoning, identifying high-risk patients and facilitating appropriate clinical decision-making.

METHODS

Several characteristics of acute tramadol poisoning cases were collected in the Emergency Department (ED) (2013-2019). After selecting important variables in random forest method, prediction models were developed using the Support Vector Machine (SVM), Naïve Bayes (NB), Artificial Neural Network (ANN) and K-Nearest Neighbor (K-NN) algorithms. Area Under the Curve (AUC) and other diagnostic criteria were used to assess performance of models.

RESULTS

In 909 patients, 544 (59.8%) experienced seizures. The important predictors of seizure were sex, pulse rate, arterial blood oxygen pressure, blood bicarbonate level and pH. SVM (AUC = 0.68), NB (AUC = 0.71) and ANN (AUC = 0.70) models outperformed k-NN model (AUC = 0.58). NB model had a higher sensitivity and negative predictive value and k-NN model had higher specificity and positive predictive values than other models.

CONCLUSION

A perfect prediction model may help improve clinicians' decision-making and clinical care at EDs in hospitals and medical settings. SVM, ANN and NB models had no significant differences in the performance and accuracy; however, validated logistic regression (LR) was the superior model for predicting seizure due to acute tramadol poisoning.

Patients' attitude toward informal payments in Iran: an application of the cluster analysis method

INTRODUCTION

Attitude is a factor affecting the behaviour of consumers. In the literature, the effect of health care consumer's attitude on making informal payments has been highlighted. The purpose of this study was to investigate the attitude of Iranian patients regarding informal payments and socio-demographic factors associated with it.

METHODS

In this cross-sectional study, conducted in 2017 in Tehran, 450 patients who were admitted to the clinics of four public hospitals for post-surgical care and follow-up, were invited to participate in the study. The data collection tool was a questionnaire, which validity and reliability were confirmed. Cluster analysis was used to identify the main attitudinal groups. To investigate the effect of socio-demographic factors on patients' attitudes, generalized linear model regression analysis was carried out in SPSS 22.

RESULTS

Our findings showed that 57.3% of patients had agreeing attitude, 24.2% indifferent attitude, and 18.4% opposing attitude toward informal payments. Patients from rural areas and those from the high-income group had higher odds of having an agreeing attitude. There was a significant association between informal payment history and attitude. The odds of having agreeing attitude among patients with a history of informal payment were two times higher than among patients who did not have an informal payment history (p ≤ 0.05).

CONCLUSION

A positive attitude towards informal payments is an obstacle to the fight against this phenomenon. Therefore, changes in public attitudes regarding informal payments will be an essential strategy, among other strategies, for eradicating these payments. This could be achieved through public campaigns for raising people's awareness and knowledge.

Comparison of pre-hospital emergency services time intervals in patients with heart attack in Arak, Iran

Background:

After cardiac arrest, the possibility of death or irreversible complications will highly increase in the absence of cardiac resuscitation within 4 to 6 minutes. Accordingly, measuring the pre-hospital services time intervals is important for better management of emergency medical services delivery. The purpose of this study then was to investigate pre-hospital time intervals for patients with heart attack in Arak city, based on locations and time variables.

Methods:

This is a retrospective descriptive cross-sectional study, which was conducted at the Arak Emergency Medical Services (EMS) during 2017-2018. Data were analyzed by SPSS version 13.

Results:

The total number of heart attack patients registered in Arak emergency medical services was 2,659 of which 51% of patients were males. Six percent of patients were under 25 and about 49 percent were between 46 and 65 years old. The average of activation, response, on-scene, transportation, recovery and total time intervals were 3:30, 7:56, 15:15, 13:34, 11:07, 12:11, and 41:25, respectively. In the city area, the shortest and longest average response time intervals were in spring and winter, respectively. In out of the city area, the shortest average response time interval was in summer and the longest one in autumn. The shortest and the longest average response time intervals in the city area were in June and March, respectively, and in out of the city area, the shortest average response time interval was in June and the longest one in April.

Conclusions:

The shorter response and delivery time interval compared to the other studies may indicate improvement in the provision of EMS. Special attention should be paid to the facilities and equipment of vehicles during cold seasons to be in the shortest possible time. Also, training and informing the staff more about the code of cardiac patients along with general public education can help improve these intervals.

Description of the inflammatory bowel disease natural history in Tehran province, Iran: Mixed panel approaches

AIM

Description of the inflammatory bowel disease natural history in Tehran province.

BACKGROUND

Inflammatory bowel disease (IBD) is a non-homogeneous disorder with an unpredictable natural history that impairs a patient's quality of life over the course of their life. As a result, providing evidence for efficient patient management is critical.

METHODS

In this case series study, 198 IBD patients who were visited in our clinic at least three times routinely from Oct 2015 to May 2020 were included. Then, two panel-based approaches, the Multi-State Model (MSM) and random-effect ordered logistic, were used to deduce the clinical course of IBD, which included remission, mild, moderate to severe, and surgical states.

RESULTS

For ulcerative colitis (UC), women had a slightly poorer condition for remission but better for moderate to severe and a faster transition from moderate to severe to mild (HR=1.490, 95% CI: 1.02-2.16) compared to men. For Crohn's disease (CD), they had a better condition for remission but a slightly poorer condition for the severe state and higher transition from mild to moderate to severe (HR=1.221, 95% CI: 0.471-3.22) than men. Oral 5-ASA had better efficacy in people with remission and/or mild states but not for those with moderate to severe states, especially in CD (mild to moderate to serve, HR=1.526, 95% CI: 0.59-3.89). Immunosuppressive drugs were better for patients with lower disease severity, especially with UC (mild to remission, HR=1.258, 95% CI: 0.75-2.09).

CONCLUSION

Panel approaches have the potential efficacy to tackle the unpredictable clinical course of IBD (UC/CD). Hence, we highly recommend that our findings be included into the Iranian routine clinical environment of IBD and/or that related studies be conducted in Iran and other regions to gain a better understanding of the natural history of IBD.

Investigation of work ability index (WAI) and its relationship with maximal aerobic capacity (VO2max) among cement industry employer

Introduction: Given the importance of adapting workers' physical and mental capabilities to their job needs, measuring their ability to work, maintaining, and upgrading, it has become an essential task. This study aimed to investigate WAI and its relationship with VO2max at one of the cement companies. Materials and Methods: This cross-sectional study was conducted among 130 employees of a cement company in Iran in 2018. For data collection, the WAI, Queens's test for maximum oxygen consumption, and a questionnaire designed by researchers (socio-demographic and work-related factors) were used. SPSS 21 was used to analyze the data.  Results: The results showed that the mean ± standard deviation of WAI in staff was 39.35 ± 4.64. Among the demographic and related variables, sports activity (P > 0.04) and sleep quality (P < 0.001), and work experience (P> 0.046) were significantly correlated with WAI. There was a significant positive correlation between the mean score of WAI and Vo2max (r = 0.21, p < 0.05). Regression modeling showed that Vo2max was the only significant predictor of WAI. Conclusion: According to the results of the study, to control and enhance the ability of the staff of the study, occupational intervention programs should focus on improving sleep quality and increased exercise. Also, considering the positive relationship of Vo2max to the WAI of the surveyed staff, it is recommended to select suitable employees in terms of aerobic capacity according to the workload of the job.

Profile of Injection Drug Users in Kermanshah, Iran

Background and aims: Injection drug use is considered as an international public health threat that can lead to serious health-related outcomes. The aim of this study was to obtain a profile of injection drug users (IDUs) in Kermanshah, Iran, in 2017. Methods: This cross-sectional study was carried out on 606 male IDUs who were recruited from 2 drop-in centers in Kermanshah using a snowball sampling method. Continuous and categorical variables are expressed as the mean and standard deviation, as well as frequency and percentage, respectively. Results: The mean age of participants in this study was 36.7±8.51 years and at first drug injection was 29.35±8.04 years. In addition, the highest frequency of injection drugs belonged to heroin (99.00%), methamphetamine (86.00%), and opium (85.00%), respectively. However, the lowest injection drugs were opium syrup (0.50%), ecstasy (0.50%), and amphorphine (0.20%). Conclusion: Based on the findings of this study, heroin, methamphetamine, and opium had the highest frequency injection among male IDUs in Kermanshah, and the age of the first drug injection was low among these individuals. Accordingly, wider coverage prevention programs are highly recommended, including harm reduction programs, counseling centers with improved quality of services, treatment programs, and greater attention to human resource development-based counseling and education.

Modification of the effect of ambient air temperature on cardiovascular and respiratory mortality by air pollution in Ahvaz, Iran

OBJECTIVES

This study investigated the modification of temperature effects on cardiovascular and respiratory mortality by air pollutants (particulate matter less than 2.5 and 10 µm in diameter [respectively], ozone, nitrogen dioxide, carbon monoxide, and sulfur dioxide).

METHODS

Poisson additive models with a penalized distributed lag non-linear model were used to assess the association of air temperature with the daily number of deaths from cardiovascular and respiratory diseases in Ahvaz, Iran from March 21, 2014 to March 20, 2018, controlling for day of the week, holidays, relative humidity, wind speed, air pollutants, and seasonal and long-term trends. Subgroup analyses were conducted to evaluate the effect modification for sex and age group. To assess the modification of air pollutants on temperature effects, the level of each pollutant was categorized as either greater than the median value or less than/equal to the median value.

RESULTS

We found no significant associations between temperature and cardiovascular and respiratory mortality. In the subgroup analyses, however, high temperatures were significantly associated with an increased risk of cardiovascular mortality among those 75 years old and older, with the strongest effect observed on day 0 relative to exposure. The results revealed a lack of interactive effects between temperature and air pollutants on cardiovascular and respiratory mortality.

CONCLUSIONS

A weak but significant association was found between high temperature and cardiovascular mortality, but only in elderly people. Air pollution did not significantly modify the effect of ambient temperature on cardiovascular and respiratory mortality.

How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time

OBJECTIVES

Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis.

METHODS

An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas.

RESULTS

The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables.

CONCLUSIONS

The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.

Seizure Prediction Model in Acute Tramadol Poisoning; a Derivation and Validation study

INTRODUCTION

Seizure is a common complication of tramadol poisoning and predicting it will help clinicians in preventing seizure and better management of patients. This study aimed to develop and validate a prediction model to assess the risk of seizure in acute tramadol poisoning.

METHODS

This retrospective observational study was conducted on 909 patients with acute tramadol poisoning in Baharloo Hospital, Tehran, Iran, (2015-2019). Several available demographic, clinical, and para-clinical characteristics were considered as potential predictors of seizure and extracted from clinical records. The data were split into derivation and validation sets (70/30 split) via random sampling. Derivation set was used to develop a multivariable logistic regression model. The model was tested on the validation set and its performance was assessed with receiver operating characteristic (ROC) curve.

RESULTS

The mean (standard deviation (SD)) of patients' age was 23.75 (7.47) years and 683 (75.1%) of them were male. Seizures occurred in 541 (60%) patients.  Univariate analysis indicated that sex, pulse rate (PR), arterial blood Carbone dioxide pressure (PCO₂), Glasgow Coma Scale (GCS), blood bicarbonate level, pH, and serum sodium level could predict the chance of seizure in acute tramadol poisoning. The final model in derivation set consisted of sex, PR, GCS, pH, and blood bicarbonate level. The model showed good accuracy on the validation set with an area under the ROC curve of 0.77 (95% CI: 0.67-0.87).

CONCLUSION

Representation of this model as a decision tree could help clinicians to identify high-risk patients with tramadol poisoning-induced seizure and in decision-making at triage of emergency departments in hospitals.

Relationship between heat stress exposure and some immunological parameters among foundry workers

Occupational exposure to heat stress may lead to changes in blood cell count. The objective of this retrospective descriptive-analytical field study is to investigate the relationship between heat stress exposure and some immunological parameters among foundry workers. This study was carried out on 55 subjects of which, 35 were working in a foundry unit (exposed group) and 20 were working in a computer numerical control (CNC) machining unit (control group). The measurement method consisted of taking 10 cc of the subjects' blood between 10 am and 2 pm and then performing the automated blood cell counting and enzyme-linked immunosorbent assay (ELISA) on the sample. Environmental parameters such as noise levels, lighting, and the wet-bulb globe temperature (WBGT) index were measured at the subjects' workstations. All measurements were made in the first half of the month of July. The mean WBGT index was 22.5 ± 2.16 °C for the control group and 32.97 ± 3.22 °C for the exposed group. The laboratory test results show a significant decrease in white blood cell count and lymphocyte levels and a significant increase in neutrophil levels and neutrophil to lymphocyte ratio in exposed group compared with control ones (P < 0.05). IgM levels decrease under heat stress, but we do not observe significant differences between IgG and IgA levels between two groups. A significant negative correlation was observed between white blood cell count, lymphocyte levels, and IgM concentration with WBGT index and significant positive correlation was observed between neutrophil and neutrophil to lymphocyte ratio with WBGT index. No significant correlation was observed between sound pressure levels and light intensity with studied immunological parameters. In conclusion, under heat stress conditions, leukocytes levels and immunoglobulin concentration may reduce and it may weaken and suppress the human immune system.

Guessability of U.S. pharmaceutical pictograms in Iranian prospective users

Objective:

This study examined the gueassability of US pharmaceutical pictograms as well as associated demographic factors and cognitive design features among Iranian adults.

Methods:

A total of 400 participants requested to guess the meaning of 53 US pharmaceutical pictograms using the open-ended method. Moreover, the participants were asked to rate the cognitive design features of each pictorial in terms of familiarity, concreteness, simplicity, meaningfulness and semantic closeness on a scale of 0-100.

Results:

The average guessability score (standard deviation) was 66.30 (SD=24.59). Fifty-five percent of pharmaceutical pictograms understudy met the correctness criteria of 67% specified by ISO3864, while only 30% reached the criterion level of 85% set by ANSIz535.3. Low literate participants with only primary school education had substantial difficulty in the interpretation of pharmaceutical pictograms compared to those completed higher education levels. Younger adults of <30 years significantly performed better in the interpretation of pharmaceutical pictograms as compared to >31 years old participants. ‘Home patient care’ and ‘daily medication use’ had no effect on guessability performance. Concerning cognitive design features, meaningfulness better predict geussability score compared to the others.

Conclusions:

Several USP pictograms fail to be correctly interpreted by Iranian users and need to be redesigned respecting cognitive design features. Interface designers are recommended to incorporate more familiar and concrete elements into their graphics in order to create more meaningful pictorial symbols and to avoid any misinterpretation by the user. Much effective medication use is expected to be achieved by means of this approach, through the improvement of the communication property of pharmaceutical pictograms.

Estimating population cause-specific mortality fractions in the Islamic Republic of Iran: validation of Murray's method

Background

Vital civil information is recorded in only 25% of middle-income countries.

Aims

To estimate the number and causes of deaths expected in the population, using hospital mortality data and comparing them with data from the Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran.

Methods

Hospital mortality data for 2011-2015 were extracted and were corrected qualitatively through reference to medical records. Using Murray's proposed method, an estimate of the expected deaths was obtained according to cause of death.

Results

During 2011-2015, 12 704 deaths were recorded in the hospital and Murray's method estimated 28 768 deaths for the entire population. The most frequent cause of death was ischemic heart disease. The results were compared with data from the Ministry of Health and Medical Education, which had a relative error of 6.9% and -13.5% respectively. The mortality rates registered by the Civil Registration Office were higher than those estimated in the present study. The mortality rates registered by the Ministry of Health and Medical Education were lower than those in the present study.

Conclusions

Considering the importance of registering deaths, alternative methods, with efficiency and low cost, are needed to estimate the number and causes of death in a population.

Impact of secondhand smoke exposure in former smokers on their subsequent risk of coronary heart disease: evidence from the population-based cohort of the Tehran Lipid and Glucose Study

OBJECTIVES

Cigarette smoking is an established, strong, and modifiable risk factor for coronary heart disease (CHD). However, little research has investigated CHD risk in former smokers who continue to be exposed to others’ cigarette smoke (former & secondhand smokers).

METHODS

In the Tehran Lipid and Glucose Study, a prospective population-based cohort (n=20,069) was followed up for a median period of 14.6 years. A subset of 8,050 participants of 30 years of age and older was analyzed, with first CHD events as the study outcome. Participants were categorized as never, former, current, secondhand, and former & secondhand smokers. Data on smoking intensity (cigarette/d) were also collected. A Cox proportional hazards regression model was applied to estimate the risk of CHD, taking into account the main potential confounders.

RESULTS

The mean age of participants was 46.10 ±11.38 years, and they experienced 1,118 first CHD events (with most CHD cases in former smokers) during the follow-up period. The risk of CHD was highest in current smokers, followed in order by former & secondhand, former, and secondhand smokers (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.65 to 2.39; HR, 1.55; 95% CI, 1.15 to 2.08; HR, 1.39; 95% CI, 1.12 to 1.72; HR, 1.27; 95% CI, 1.07 to 1.51, respectively), compared to never smokers. The risk of CHD increased with smoking intensity, which has been proposed as a preferable measure of smoking, indicating a dose-response pattern.

CONCLUSIONS

The elevated risk of CHD in former & secondhand smokers was a noteworthy finding, with possible implications for health policy; however, further research is needed.

The patterns of Non-communicable disease Multimorbidity in Iran: A Multilevel Analysis

The prevalence of non-communicable diseases is increasing worldwide. Multimorbidity and long-term medical conditions is common among these patients. This study aimed to investigate the patterns of non-communicable disease multimorbidity and their risk factors at the individual and aggregated level. Data was inquired from the nationwide survey performed in 2011, according to the WHO stepwise approach on NCD risk factors. A latent class analysis on multimorbidity components (11 chronic diseases) was performed and the association of some individual and aggregated risk factors (urbanization) with the latent subclasses was accessed using multilevel multinomial logistic regression. Latent class analysis revealed four distinct subclasses of multimorbidity among the Iranian population (10069 participants). Musculoskeletal diseases and asthma classes were seen in both genders. In males, the odds of membership in the diabetes class was 41% less by increasing physical activity; but with increased BMI, the odds of membership in the diabetes class was 1.90 times higher. Tobacco smoking increased the odds of membership in the musculoskeletal diseases class, 1.37 and 2.30 times for males and females, respectively. Increased BMI and low education increased the chances of females' membership in all subclasses of multimorbidity. At the province level, with increase in urbanization, the odds of membership in the diabetes class was 1.28 times higher among males (P = 0.027). Increased age, higher BMI, tobacco smoking and low education are the most important risk factors associated with NCD multimorbidity among Iranians. Interventions and policies should be implemented to control these risk factors.

Estimating the cure proportion of colorectal cancer and related factors after surgery in patients using parametric cure models

AIM

This study aimed to estimate the cure proportion and effects of related factors on colorectal cancer in Iranian patients after surgery.

BACKGROUND

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the fourth leading cause of cancer death. The relative survival of CRC varies worldwide given the quality of care, including surgical techniques.

METHODS

This retrospective cohort study was conducted on 490 patients, aged 20-94 years, with colorectal cancer. All the colorectal cancer patients undergoing surgery in Faghihi hospital, Shiraz University of Medical Sciences were prospectively followed-up for 8 years from 2008 to March 8, 2016. We used parametric cure model (mixture and non-mixture) to estimate the cure proportion and the adjusted hazard ration (HR) for colorectal cancer mortality after surgery. Data were analyzed by the "flexsurvcure" package in R software (version 3.4.2).

RESULTS

The median age of patients was 57.5 (interquartile range =18) years. Specifically, 56.33% of the patients were male. The median time of follow-up in patients was 618 days. The cumulative survival proportion varied from 0.90 to 0.49 which indicated a reduction followed by a flat line in the probability of survival by sex. The flexible survival for adjusted cure proportion (%) was 68.3. Only obesity was associated with a decreased risk of mortality (HR=0.34; 95% CI: 0.12-0.97).

CONCLUSION

The overall eight-year survival proportion and adjusted cure proportion for CRC were 49% and 68.3%, respectively. Knowing the cure proportion and its related factors in patients with CRC, better services can be provided. Thus, early detection and screening strategies are required to reduce mortality and increase survival of patients.

Correction to: Effects of noise on mental performance and annoyance considering task difficulty level and tone components of noise

[This corrects the article DOI: 10.1007/s40201-019-00353-2.].

Effects of Hypothetical Interventions on Ischemic Stroke Using Parametric G-Formula

Background and Purpose—

Standard analytic approaches (eg, logistic regression) fail to adequately control for time-dependent confounding and, therefore, may yield biased estimates of the total effect of the exposure on the outcome. In the present study, we estimate the effect of body mass index, intentional physical activity, HDL (high-density lipoprotein) cholesterol, LDL (low-density lipoprotein) cholesterol, hypertension, and cigarette smoking on the 11-year risk of ischemic stroke by sex using the parametric g-formula to control time-dependent confounders.

Methods—

Using data from the MESA (Multi-Ethnic Study of Atherosclerosis), we followed 6809 men and women aged 45 to 84 years. We estimated the risk of stroke under 6 hypothetical interventions: maintaining body mass index <25 kg/m 2 , maintaining normotension (systolic blood pressure <140 and diastolic <90 mm Hg), quitting smoking, maintaining HDL >1.55 mmol/L, maintaining LDL <3.11 mmol/L, and exercising at least 210 minutes per week. The effects of joint hypothetical interventions were also simulated.

Results—

In men, the 11-year risk of ischemic stroke would be reduced by 85% (95% CI, 66–96) for all 6 hypothetical interventions. In women, this same effect was estimated as 55% (95% CI, 6–82).

Conclusions—

The hypothetical interventions explored in our study resulted in risk reduction in both men and women.

Job Burnout and Related Factors among Health Sector Employees

Objective: Job burnout can cause physical and psychological damage and reduce job efficiency, especially in difficult jobs such as health care fields. This study aimed to assess the association between the level of job burnout and some contributing factors among health care providers in Iran. Method : This study was performed on the data derived from 1807 participants from the first phase of the employees' health cohort in 2017-2018. The data were collected using as a self-administrated tool utilizing Maslach Burnout Inventory. The questionnaire scores ranged from never to everyday, with 3 levels of burnout as well as burnout itself; then, the scores were categorized as low, moderate, or high. Ordinal logistic regression model was used to adjust ordinal dependent variables. Results: The mean score of the total burnout was 16.5±7.77 and was associated with work experience and age group (p < 0.001). The components of burnout consisted of emotional exhaustion (8.9± 9.0), depersonalization (23± 2.9), and personal accomplishment (34± 8.6). Emotional exhaustion was related to sex (less among males, OR=0.48) and type of job (less among officials compared to health care staff, OR=0.488). Composite burnout was more common among younger staff (OR= 3.85). Depersonalization was associated with duty shift workers (OR=2.42). Conclusion: Job burnout is a major concern, and lack of personal accomplishment, as a component of burnout, was highly prevalent among Iranian health care employees. Being a single woman, health care provider, and having more than 20 years of work experience with a duty shift were contributing factors for burnout experience. Monitoring symptoms of burnout and its associated factors in the workplace and proposing an alternative organizational and behavioral system and sharing it with relevant authorities may help prevent or reduce job burnout and its deleterious effects.

The Effect of Noise Exposure on Cognitive Performance and Brain Activity Patterns

BACKGROUND:

It seems qualitative measurements of subjective reactions are not appropriate indicators to assess the effect of noise on cognitive performance.

AIM:

In this study, quantitative and combined indicators were applied to study the effect of noise on cognitive performance.

MATERIAL AND METHODS:

A total of 54 young subjects were included in this experimental study. The participants’ mental workload and attention were evaluated under different levels of noise exposure including, background noise, 75, 85 and 95 dBA noise levels. The study subject’s EEG signals were recorded for 10 minutes while they were performing the IVA test. The EEG signals were used to estimate the relative power of their brain frequency bands.

RESULTS:

Results revealed that mental workload and visual/auditory attention is significantly reduced when the participants are exposed to noise at 95 dBA level (P < 0.05). Results also showed that with the rise in noise levels, the relative power of the Alpha band increases while the relative power of the Beta band decreases as compared to background noise. The most prominent change in the relative power of the Alpha and Beta bands occurs in the occipital and frontal regions of the brain respectively.

CONCLUSION:

The application of new indicators, including brain signal analysis and power spectral density analysis, is strongly recommended in the assessment of cognitive performance during noise exposure. Further studies are suggested regarding the effects of other psychoacoustic parameters such as tonality, noise pitch (treble or bass) at extended exposure levels.

The effects of combined exposure to noise and heat on human salivary cortisol and blood pressure

Purpose. Noise and heat are the most important physical hazardous agents that can affect physiological parameters. This study investigated the independent and combined effects of noise and heat exposure on human saliva cortisol and blood pressure. Methods. In this experimental study, 72 students were exposed to noise (at sound pressure levels of 45, 75, 85 and 95 dB(A)) and heat (at wet bulb globe temperatures [WBGTs] of 22, 29 and 34 °C) for 30 min. Samples of saliva and blood pressure were taken before and after each independent and combined exposure. Results. The results revealed that the average saliva cortisol and blood pressure in male and female subjects increased significantly after independent exposure to noise at 95 dB(A) and a WBGT of 34 °C. The combined exposure to noise and heat increased saliva cortisol and blood pressure, which was statistically significant for three combinations of 95 dB(A) at 34 °C, 95 dB(A) at 29 °C and 85 dB(A) at 34 °C. Conclusions. Combined exposure to noise and heat could affect saliva cortisol and blood pressure in both male and female groups. Further studies are recommended to capture other combinations of physical hazardous agents, especially in the field.