Five-year evaluation of chronic diseases in Hamadan, Iran: 2005-2009

Now the increasing growth of chronic diseases is the major health challenge worldwide. This survey was conducted to assess noncommunicable diseases related risk factors. A population-based cross sectional study was conducted in 2005 and repeated annually by 2009 in Hamadan province, the west of Iran using two-stage cluster sampling method. A total sample of 6500 subjects 15 to 64 years old were enrolled. The total prevalence of cigarette smoking was 18% [95% CI 17% to 19%], 35.1% in men versus 1.1% in women. The smokers consumed on average 15 cigarettes per day. Almost 26.3% [95% CI 24.8% to 27.7%] of the target population eat five or more servings of fruits and vegetables per day; 52.8% [95% CI 51.2% to 54.3%] had work related physical activity; 28.1% [95% CI 26.7% to 29.4%] had physical activity during leisure time; 80.3% [95% CI 79.0% to 81.5%] had transportation related physical activity; 47.2% [95% CI 46.0% to 48.4%] were either overweight or obese; 8.1% [95% CI 7.1% to 9.2%] had impaired fasting blood sugar or were confirmed diabetes; 33.7% [95% CI 31.9% to 35.5%] had hypercholesterolemia; and 15.6% [95% CI 13.0% to 18.3%] had hypertriglyceridemia. There was a statistically significant association of age and gender with body mass index, systolic and diastolic hypertension, hyperglycemia, hypercholesterolemia and hypertriglyceridemia. The evidences of the present survey promise a silent progressive epidemic of chronic diseases among Iranian citizens that may lead to an increasing growth of noncommunicable diseases in the next decade

Classification of death rate due to women's cancers in different countries

The two most frequently diagnosed cancers among women worldwide are breast and cervical cancers. The objective of the present study was to classify the different countries based on the death rates from sex specific cancers. In this cross-sectional study, we used dataset regarding death rate from breast, cervical, uterine, and ovarian cancers in 190 countries worldwide reported by World Health Organization. Normal mixture models were fitted with different numbers of components to these data. The model's parameters estimated using the EM algorithm. Then, appropriate number of components was determined and was selected the best-fit model using the BIC criteria. Next, model-based clustering was used to allocate the world countries into different clusters based on the distribution of women's cancers. The MIXMOD program using MATLAB software was used for data analysis. The best model selected with four components. Then, countries were allocated into four clusters including 43 [23%] in the first cluster, 28 [14%] in the second cluster, 75 [39%] in the third cluster, and 44 [24%] in the fourth cluster. Most countries in South America were to the first cluster. In addition, most countries in Africa, Central, and Southeast Asia were located to the third cluster. Furthermore, the fourth cluster consisted of Pacific continent, North America and European countries. Considering the benefits of clustering based on normal mixture models, it seems that can be applied this method in wide variety of medical and public heath contexts

Construction of knowledge, attitude and practice questionnaire for assessing plagiarism

This study was conducted to develop a questionnaire in order to evaluate knowledge, attitude and practice [KAP] of the faculty members and students toward plagiarism. A KAP study was conducted from June to October 2011 enrolling 390 volunteers anonymously [response rate 96%]. The questionnaire included the following four parts: [a] general characteristics like gender, academic degree and education level; [b] nine questions regarding knowledge [Min=0, Max=9]; [c] nine questions regarding attitude [Min=9, Max=27]; and [d] eight questions regarding practice [Min=0, Max=8]. A pilot study was conducted to assess reliability of the questions regarding knowledge and attitude. Cronbach's alpha coefficient for the knowledge and attitude questions was 0.70 and 0.74 respectively. The overall prevalence of at least once plagiarism commission was 38% [SD=0.035]. The overall mean score of knowledge, attitude and practice was 5.94 [SD=1.66], 24.12 [SD=2.99], and 0.66 [SD=1.15] respectively. Knowledge of plagiarism was significantly higher among higher academic degrees and females. Their negative attitude toward plagiarism was stronger too. No statistically significant difference regarding plagiarism commission was observed among different academic degrees in both sexes. According to linear regression analysis, plagiarism commission decreased 13% per one unit increase in score of knowledge [P=0.005] and 16% per one unit increase in score of attitude [P<0.001]. This knowledge, attitude, and practice [KAP] questionnaire was developed as a standard tool in order to assess perception of subjects toward plagiarism and to estimate the prevalence and the type of plagiarism commission

Delayed vaccination and related predictors among infants

Vaccination status is more often evaluated by up-to-date vaccination coverage rather than timeliness of immunization. This study was conducted to evaluate delayed vaccination during infancy period and to determine the predictors effecting on vaccination delay. This cross-sectional study was conducted from June to September 2011 in Hamadan Province, the west of Iran, recruiting 2460 children from 12 to 24 months of age via stratified cluster random sampling with 123 clusters of 20 persons. Data on vaccination were extracted from children's vaccination card. Additional data were collected through interview. Vaccination coverage of infants was >99.4% for all vaccines. However, 42% to 67.6% of infants received vaccine with delay. The delay time was longer in urban areas [P<0.001], among children with high educated mothers [P<0.001] and for the vaccines delivered at the end of infancy period. Delay time had a direct correlation with vacci-nators education level [P<0.001] and an inverse correlation with the number of periodical visits of health centers [P<0.001]. No correlation was detected between delay time and gender [P=0.507] and distance from health centers [P=0.627]. Considerable number of the infants received delayed vaccine, although, vaccination coverage was nearly completes. This issue indicates that delay time is very problematic to be resolved in any given situation even in areas with nearly full vaccination coverage and may require a major effort to be corrected. Furthermore, this study assessed the effect of some factors on delayed vaccination which may help policy makers who plan immunization programs

Metaplot: a novel stata graph for assessing heterogeneity at a glance

Heterogeneity is usually a major concern in meta-analysis. Although there are some statistical approaches for assessing variability across studies, here we present a new approach to heterogeneity using "MetaPlot" that investigate the influence of a single study on the overall heterogeneity. MetaPlot is a two-way [x, y] graph, which can be considered as a complementary graphical approach for testing heterogeneity. This method shows graphically as well as numerically the results of an influence analysis, in which Higgins' I2 statistic with 95% [Confidence interval] CI are computed omitting one study in each turn and then are plotted against reciprocal of standard error [1/SE] or "precision". In this graph, "1/SE" lies on x axis and "I2 results" lies on y axe. Having a first glance at MetaPlot, one can predict to what extent omission of a single study may influence the overall heterogeneity. The precision on x-axis enables us to distinguish the size of each trial. The graph describes I2 statistic with 95% CI graphically as well as numerically in one view for prompt comparison. It is possible to implement MetaPlot for meta-analysis of different types of outcome data and summary measures. This method presents a simple graphical approach to identify an outlier and its effect on overall heterogeneity at a glance. We wish to suggest MetaPlot to Stata experts to prepare its module for the software

[Quality assessment of the reporting of cohort studies before STROBE statement]

Observational studies are not often reported in detail and clear enough, so that assessment of the strengths and weaknesses of these studies is not straightforward. To improve the reporting of observational studies, a checklist of items called 'Strengthening the Reporting of Observational Studies in Epidemiology' [STROBE] was developed by some experts in October 2007. The aim of this study was to assess the quality of reporting of observational studies before STROBE statement. We included randomly sixty cohort studies published in six important international journals until October 2007. Then, we used STROBE checklist to assess the strengths and weaknesses of these included studies. On average, more than 81% [95% Cl: 77%-87%] of included studies pointed to 43 items of aim of this study. The most reported [100%] items were "scientific background" and "rationale for the investigation" and the less reported [30%] item was "flow chart". Although, the quality of reported cohort studies' results was acceptable, the type of study, journal and date of publication could influence on the quality of observational studies