ABSTRACT
Objective: To establish an early warning system for cutaneous leishmaniasis in Fars province, Iran in 2016. Methods: Time-series data were recorded from 29 201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models. Different models were compared via Akaike information criterion/Bayesian information criterion statistics, residual analysis, autocorrelation function, and partial autocorrelation function sample/model. To decide on an outbreak, four endemic scores were evaluated including mean, median, mean + 2 standard deviations, and median + interquartile range of the past five years. Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included, and there were no exclusion criteria. Results: Regarding four statistically significant endemic values, four different cutaneous leishmaniasis space-time outbreaks were detected in 2016. The accuracy of all four endemic values was statistically significant (P<0.05). Conclusions: This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps: (i) to define endemic values based on which we could verify if there is an outbreak, (ii) to set different time-series models to forecast cutaneous leishmaniasis in future, (iii) to compare the forecasts with endemic values and decide on space-time outbreaks, and (iv) to set an alarm to health managers.
ABSTRACT
Objective: To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29 201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic (ROC) curve. SPSS version 22, ArcGIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters (P<0.05) resulted in finding seven significant and accurate endemic values (P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.
ABSTRACT
Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis (CL) or for malaria in Fars province, Iran in 2016. Methods: Using time-series data including 29 177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software. Results: A total of 5 359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied time-series models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria (P
ABSTRACT
Objective To assess the spatiotemporal trait of cutaneous leishmaniasis (CL) in Fars province, Iran. Methods Spatiotemporal cluster analysis was conducted retrospectively to find spatiotemporal clusters of CL cases. Time-series data were recorded from 29 201 cases in Fars province, Iran from 2010 to 2015, which were used to verify if the cases were distributed randomly over time and place. Then, subgroup analysis was applied to find significant sub-clusters within large clusters. Spatiotemporal permutation scans statistics in addition to subgroup analysis were implemented using SaTScan software. Results This study resulted in statistically significant spatiotemporal clusters of CL (P < 0.05). The most likely cluster contained 350 cases from 1 July 2010 to 30 November 2010. Besides, 5 secondary clusters were detected in different periods of time. Finally, statistically significant sub-clusters were found within the three large clusters (P < 0.05). Conclusions Transmission of CL followed spatiotemporal pattern in Fars province, Iran. This can have an important effect on future studies on prediction and prevention of CL.
ABSTRACT
Introduction: Teacher evaluation, as an important strategy for improving the quality of education, has been considered by universities and leads to a better understanding of the strengths and weaknesses of education. Analysis of instructors' scores is one of the main fields of educational research. Since outliers affect analysis and interpretation of information processes both structurally and conceptually, understanding the methods of detecting outliers in collected data can be helpful for scholars, data analysts, and researchers. The present study aimed to present and compare the available techniques for detecting outliers
Methods: In this cross-sectional study, the statistical population included the evaluation forms of instructors completed by the students of Shiraz School of Health in the first and second semesters of the academic year 2012-2013. All the forms related to these years [N=1317] were entered into analysis through census. Then, four methods [Dixon, Gauss, Grubb, and Graphical methods] were used for determining outliers. Kappa coefficient was also used to determine the agreement among the methods. Results: In this study 1317 forms were completed by 203 undergraduate and 1114 postgraduate students. The mean scores given by undergraduates and postgraduates were 17,24 +/- 3,04 and 18.91 +/- 1.82, respectively. The results showed that Dixon and Grubb were the most appropriate methods to determine the outliers of evaluation scores in small samples, because they had appropriate agreement. On the other hand, NPP and QQ plot were the most appropriate methods in large samples
Conclusion: The results showed that each of the studied methods could help us, in some way, determine outliers. Researchers and analysts who intend to select and use the methods must first review the observations with the help of descriptive information and overview of the distribution. Determination of outliers is important in evaluation of instructors, because by determining the outliers and removing the data that might have been recorded incorrectly, more accurate and reliable results can be obtained
Subject(s)
Humans , Students , Schools, Medical , Cross-Sectional Studies , Education , Teaching/standardsABSTRACT
Background: Intensified strategy includes special attention to the symptoms such as cough [more than two weeks], fever [more than three weeks], night sweats [more than three weeks], and weight loss [more than 3 kg per month]. If any of the above symptoms was positive, in suspected individuals for TB, more assessment should be done. The aim of this study was to compare between intensified and routine case finding for a better case selection method for diagnosis of pulmonary tuberculosis among HIV-Infected Persons
Methods: The sample size was calculated 237 patients [474 for the two groups]. In the current study, the patients were divided randomly into two groups: A] intensified case finding group and B] routine case finding group. Considering the sputum culture as the gold standard, we calculated the sensitivity and specificity, Positive predictive value [PPV], Negative predictive value [NPV] for fever, weight loss, coughing more than two week, night sweats, and PPD test
Result: A total of eight positive cases of tuberculosis were detected in the intensified while four were found in the routine case finding group. Sensitivity, specificity, PPV, and NPV for cough in diagnosis of TB were 25%, 87%, 6%, and 97%, respectively. For weight loss, they were 62.5%, 83%, 10.8%, and 98.5% respectively while these amounts were, 7%, 85%, 97.6, 37.5 for night sweats. For fever, they were, 25%, 92.9%, 10.5%, and 97% respectively, and for PPD they were 87.5%, 40%, 4.6%, and 98.9%, respectively
Conclusion: Key symptom screening, such as cough, fever, weight loss and night sweats, has an important role in detecting TB among HIV-infected patients
ABSTRACT
Background: Proper training on how to correctly handle loads is one key point for prevention of low back disorders. This study was conducted with the objectives of assessing manual material lifting activities and comparing two methods of training intervention in a porcelain company
Methods: In this randomized controlled trial which was conducted in a porcelain company, all male employees with lifting activities [n=204] participated. The data were collected using Nordic Musculoskeletal Disorders Questionnaire and Lift/ Lower Force Risk Assessment software for assessing manual material lifting. Intervention methods included booklet and oral training. Data were analyzed using Mann-Whitney U and Chisquare tests using SPSS software [Version 17.0]
Results: The most prevalent musculoskeletal disorders symptoms were reported in the knee [52.5%], feet [45.1%], and lower back [43.6%]. Risk assessment before intervention showed that in 62.7% of the workers studied, the level of exposure to musculoskeletal risks was in Action Level [AL] 1, 31.9% in AL 2 and 5.4% in AL 3. The risk assessment after intervention showed that in 77.5% of the workers studied, the level of exposure to musculoskeletal risks was in Action Level [AL] 1, 20.6% in AL 2 and 2% in AL 3 [P<0.001]. Also, statistical analysis revealed that oral training [24.5%] was more effective than the booklet training [11.8%] [P=0.018]
Conclusion: This study showed that training intervention could be effective in correction of methods of manual material lifting of workers. It seems oral training for workers of porcelain industry is more effective than the booklet training
ABSTRACT
Background: Groundwater nitrate pollution is an important environmental problem in water resources management. In this regard, specific measures aiming at prevention of water pollution will be helpful to managers and decision-makers. Identification of aquifers' vulnerable areas and determination of groundwater protection zones using most widely used models, such as DRASTIC and CD, are one of the most useful approaches in water resources' hygiene
Objective: The present study aimed to assess the vulnerability of Shiraz plain's unconfined aquifer using the above-mentioned models
Methods: The main hydro-geologic factors affecting the transmission of pollution, including depth to water table, net recharge, aquifer media, soil media, topography, impact of the vadose zone, aquifer hydraulic conductivity, and land use parameters were rated, weighted, and integrated using GIS 9.3. Finally, the maps of Shiraz plain's unconfined aquifer vulnerability were prepared
Results: The vulnerability maps based on these two indexes showed very similar results, identifying the southeastern part of the aquifer, around Maharlu Lake, as the vulnerable zone. The observed nitrate concentrations from the wells in the underlying aquifer were in accordance with these findings. The results of sensitivity analyses indicated the depth parameter as the most effective parameter in vulnerability assessment of Shiraz plain
Conclusion: As Shiraz plain has been covered with fine-grained sediments, except for some central and south-east regions which have moderate vulnerability and high nitrate concentration, its vulnerability is low. Given the intensive agricultural activities and also the rise in groundwater level in southeastern regions, more attention should be paid to these areas
ABSTRACT
Background: Evidence shows that job stress potentially has adverse effect on individuals' health and organizational productivity. It has, therefore, become an important issue in the occupational health context. The aims of this study were to investigate job stress dimensions among nurses of Shiraz University of Medical Sciences [SUMS] hospitals and comparing the results with the findings of the previous studies conducted in other countries
Methods: In this cross-sectional study, 385 randomly selected nurses of SUMS participated. The Persian version of Job Content Questionnaire [P-JCQ] and demographic questionnaire were used for data collection. The linguistic validity and psychometric properties of P-JCQ have been assessed and approved in a previous study. One sample t-test was used to examine the differences between means of job stress dimension scores of the present and those of the previous studies carried out in other countries
Results: The means [SD] of decision latitude, psychological job demands, social support, physical job demands and job insecurity were found to be 58.15 [6.50], 38.19 [5.14], 22.67 [3.67], 16.03 [2.58], and 7.74 [3.85], respectively. The results revealed that decision latitude and social support dimensions were in a low level among the study subjects. In contrast, psychological job demand, physical job demand, and job insecurity dimensions were shown to be in a high level
Conclusion: The SUMS hospital environment collectively imposes higher job stress on the nurses as compared to that of other countries. To prevent harmful effects of job stress on the nurses' health and job performance, developing macro-ergonomic strategies in this working environment, such as enhancing job control, reducing job demands, and providing supportive climate, seem necessary
ABSTRACT
Background: Noise is one of the most pervasive hazards in industrial settings. This retrospective study was carried out to assess the effects of noise exposure on hearing status, blood lipids and blood pressure of employees of a local fireclay mine
Methods: Two hundred and forty male workers were studied. Data on audiometric measurements, blood lipids and blood pressure were derived from the workers' medical records and analyzed. Furthermore, area noise measurements were performed. Data were analyzed using SPSS version 16.0
Results: Workers were exposed to a mean noise level of 91 +/- 15 dB. The means of triglyceride [TG], total cholesterol [TC], systolic and diastolic blood pressure [SBP and DBP] were within the normal range for the first three years of the study. However, a slight, non-significant increase in TG level was noted in 2010. Most of the participants [63.6%] suffered from moderate hearing loss [HL]. About 23.6% and 12.7% of the employees had developed severe and mild HL, respectively. A statistically significant difference was noted in the number of workers with high-frequency noise-induced HL. Furthermore, a statistically significant association was found between the mean of highfrequency HL and log-transformed TG values in 2009 and 2010
Conclusions: High frequency HL could be used as a biomarker for identifying workers exposed to excessive noise levels. Highfrequency HL developed over a 4-year exposure to noise was associated with hypertriglyceridemia. Implementing a hearing conservation program seems to be mandatory to prevent further increases in the number of workers who are already in the severe HL group
ABSTRACT
Cooperation of all health sectors and early diagnosis of the disease are the key factors for controlling tuberculosis. This study assesses the patterns of reported tuberculosis cases in Iran. This was a cross sectional study. Tuberculosis cases were defined according to World Health Organization and Iran's national TB guidelines. Final data were prepared for analysis using SPSS16 software. Public hospitals, public and private outpatient clinics reported 4111 [39.1%], 3007 [28.6%] and 2839 [27%] cases of TB, respectively. The highest number of reported TB cases was from the public healthcare system. One third of TB cases were reported by private outpatient clinics. It is essential to make a plan such as public-private mix model in Iran. Because of high coverage of private physicians in our country and even in rural areas, it is quite necessary to involve private system in tuberculosis program
Subject(s)
Humans , Female , Male , Cross-Sectional Studies , Hospitals, Public , Private Sector , Public Sector , Cross-Sectional StudiesABSTRACT
Shiftwork that affects diverse aspects of human life is arranged in various schedules. The main purpose of this study was to compare psycho-social problems among employees working in different 12-hour shift schedules of Iranian petrochemical industries. This cross-sectional study was carried out at eight petrochemical companies in Asalooyeh area. The study population consisted of 549 shift workers. Data on personal details, shift schedule, and adverse effects of shift work were collected by anonymous questionnaire. Statistical analyses were performed using SPSS, version 11.5. Among 549 studied shift employees, 39.6% worked in 4N-7D-3N-7R [4 nights- 7 days- 3 nights- 7 rests], 29.1% in 7N-7 D-7R, and 31.3% in 7D-7N-7R schedules. Psychosocial problems among 7D-7N-7R schedule shift workers were significantly more prevalent than other schedules [p<0.05]. Prevalence rates of psychosocial problems among all schedules were high, but odds ratios of problems among 7D-7N-7R schedule shift workers were significantly more than those of the two other ones were. This schedule should be changed therefore to decrease such problems
ABSTRACT
Fatigue is a common and frequently disabling symptom in cancer patients. Fatigue may be caused by the disease itself, by treatment for the disease, by physical symptoms or conditions resulting from the disease or its treatment. The aim of this study was to assess fatigue and related factors in breast cancer patients. We conducted a cross-sectional study on 119 random samples of breast cancer patients. The Iranian version of QLQ-C30 and QLQ-BR23 questionnaires were used. Univariate methods and multiple regression analysis were performed to identify predictors of fatigue. Overall, 78% of the patients indicated that they were experiencing fatigue to some degree. The mean score on the fatigue subscale was 41.74 +/- 26.91. Of all functional subscales, fatigue showed the strongest influence on social functioning. Linear regression analyses showed that total fatigue was best predicted by pain, appetite loss, body image and type of treatment. Our results support the notion that fatigue in cancer patients is a major problem, which deserved yet more attention from health professionals, and that quality of life in cancer patients might be improved markedly by interventions that effectively reduce fatigue
ABSTRACT
Obesity is currently the most prevalent nutritional disease of children and adolescents, prevention and treatment of which, is required. The purpose of this study was to identify the effect of dietary behavior modification on anthropometric indices in the obese adolescent female students of Shiraz, 2007. In this Quasi-experimental research, 53 obese adolescent girls [BMI>95th percentile], aged 11 to 15 years, participated in a behavior modification program which lasted for 16 weeks [4 hours each week]. The Subjects were chosen from two different schools and were assigned to two groups of experimental [=24] and control [=29] randomly. The Program included teaching problem solving, stress management [yoga], teaching healthy eating, physical behavior and parent education. Anthropometric indices were assessed just before and after the program and also two months later for follow up. The data were analyzed by SPSS 11.5 by using descriptive and analytic test and the statistical significance was considered at P<0.05. There were significant differences in changes in body weight [-2.75 kg vs. 0.62 kg], BMI [-1.07 kg/m2 vs. 0.24 kg/m2] and arm circumference [-2.31 cm vs. 0.5 cm] in the experimental versus the control group [P<0.001]. This study reveals that behavioral modification program has a great effect on decreasing the body mass index. Parents, school nurses and other support groups should be encouraged to participate in this program