Socioeconomic inequalities in gastroesophageal reflux disorder: Results from an iranian cohort study

Background:Despite progress in the health indexes in recent years, health inequalities remain as a global challenge within and between regions and countries. This study is the first to quantify the socioeconomic inequity in gastroesophageal reflux disease [GERD] using the concentration index

Methods: In this cross-sectional study, we used baseline data [7012 subjects] from the Fasa Cohort Study [the Southern Iran]. The principal component analysis was used to construct socioeconomic status of the participants. The concentration index and concentration curve were used to measure socioeconomic- related inequality in GERD. Decomposition of concentration index was also done to identify the contribution of each explanatory variable to the wealth-related inequality in GERD prevalence

Results: The prevalence of GERD was 16.9% [95% CI: 15.9-17.7%]. The overall concentration index for GERD was 0.093 [95% CI: 0.062-0.166]. Correspondingly, this figure for men and women were 0.116 [95% CI: 0.062-0.171%] and 0.091 [95% CI: 0.044-0.137%], respectively. The main contributors of socioeconomic-related inequality in GERD prevalence were socioeconomic status [64.4%], alcohol drinking [29%], and age [8.4%]

Conclusion: GERD is significantly more concentrated among richest people. There was significant socioeconomic inequality in GERD according to some individual factors. These inequalities need to be addressed by policy makers to identify the vulnerable subgroups and to reduce the disease burden in the community

Decomposing Socioeconomic Inequality Determinants in Suicide Deaths in Iran: A Concentration Index Approach / 가정의학회지

BACKGROUND: It is recognized that socioeconomic status (SES) has a significant impact on health and wellbeing; however, the effect of SES on suicide is contested. This study explored the effect of SES in suicide deaths and decomposed inequality into its determinants to calculate relative contributions. METHODS: Through a cross-sectional study, 546 suicide deaths and 6,818 suicide attempts from January 1, 2010 to December 31, 2014 in Ilam Province, Western Iran were explored. Inequality was measured by the absolute concentration index (ACI) and decomposed contributions were identified. All analyses were performed using STATA ver. 11.2 (Stata Corp., College Station, TX, USA). RESULTS: The overall ACI for suicide deaths was −0.352 (95% confidence interval, −0.389 to −0.301). According to the results, 9.8% of socioeconomic inequality in suicide deaths was due to addiction in attempters. ACI ranged from −0.34 to −0.03 in 2010–2014, showing that inequality in suicide deaths declined over time. CONCLUSION: Findings showed suicide deaths were distributed among the study population unequally, and our results confirmed a gap between advantaged and disadvantaged attempters in terms of death. Socioeconomic inequalities in suicide deaths tended to diminish over time, as suicide attempts progressed in Ilam Province.

Suicide attempts in ham province, west of iran, 2010-2014: a time trend study

Background: Suicide has become an increasingly widespread form of morbidity in the developing countries. There has been an increasing trend in morbidity and mortality due to suicide in Iran over the past few decades. This study surveyed attempts and completed suicide over a 5-year period

Methods: Through a cross-sectional study, overall identified suicides by systematic registration suicide data [SRSD] in Ham Province, western Iran from 21 March 2010 to 11 December 2014 were enrolled. Multiple logistic regression analysis was used for measuring the association between the risk factors of interest and suicide. The statistical software package was Stata 11.2

Results: A Suicide attempts have slightly increased in Ham during 2010-2014, during which, 6,818 attempted suicides occurred of which 546 were completed. The odds of completed suicide was higher among older age groups than younger ones so that the crude OR estimates of completed suicide among people aged 50 to 59 yr against people aged <20 yr was [OR=6.99; 95% Cl: 3.02, 11.07]

The crude and adjusted odds ratio [OR] estimates of completed suicide in males against females were [OR=3.22; 95% Cl: 2.58, 3.93] and [OR=3.66; 95% Cl: 3.03, 4.11], respectively. Significant excess risk also appeared with academic against illiterate attempters [OR=2.31; 95% Cl: 1.35, 3.95]

Results showed no increasing trend in the suicide method. Some methods such as self-immolation had decreasing trend over time, although it was not statistically significant [P=0.089]

Conclusions: We observed the variety of suicide risk factors that calls for more diversity in preventative programs. Distribution of suicide methods is diverse across the period of the study

Health effects of long-term occupational exposure to whole body vibration: a study on drivers of heavy motor vehicles in Iran

Background: Drivers of heavy motor vehicles are occupationally exposed to intense whole body vibration [WBV] for several hours per day over their working lifetime. Therefore, they are at risk of WBV-induced occupational disorders. This study aimed to investigate health effects of long-term exposure to whole body vibration among a group of heavy vehicle drivers in Fars province, southwestern Iran

Methods: Data on vibration-induced health effects were gathered through a checklist specifically devised for this purpose, interview and medical records of 155 male heavy vehicle drivers as well as 70 referent subjects. Signs and symptoms were classified into 6 categories of neuropsychological, gastrointestinal, ocular, auditory and metabolic and cardiovascular disorders

Results: Symptoms such as neuropsychological, musculoskeletal, metabolic, visual and hearing disorders were significantly more prevalent among drivers than in referent individuals. Additionally, logistic regression analysis revealed that there were statistically significant associations between exposure to WBV and several outcomes

Conclusion: Findings of the study indicate that longterm occupational exposure to WBV is a risk factor for neuropsychological, musculoskeletal, metabolic, visual and hearing disorders

Analysis of survival data in thalassemia patients in Shiraz, Iran / 한국역학회지

OBJECTIVES: The survival rate of thalassemia patients has not been conclusively established, and the factors associated with survival remain unclear. This study aimed to determine the survival rate of thalassemia among patients in southern Iran and to identify the factors associated with mortality from thalassemia. METHODS: This retrospective cohort study was conducted based on a retrospective review of the medical records of 911 beta-thalassemia patients in 2014. Data analysis was conducted using the Kaplan-Meier method and Cox regression analysis. RESULTS: Overall, 212 patients (23.3%) died, and 26.8% had thalassemia intermedia. The 20-year, 40-year, and 60-year survival rates were 85%, 63%, and 54%, respectively. Both crude and adjusted analyses found that education, marital status, ferritin levels, and comorbidities were related to mortality. CONCLUSIONS: Sociodemographic and hematological factors were found to be significantly associated with the survival rate of thalassemia. Addressing these factors may help healthcare providers and physicians to provide the best possible care and to improve the survival rate.

Early Liver and Kidney Dysfunction Associated with Occupational Exposure to Sub-Threshold Limit Value Levels of Benzene, Toluene, and Xylenes in Unleaded Petrol

BACKGROUND: Unleaded petrol contains significant amounts of monocyclic aromatic hydrocarbons such as benzene, toluene, and xylenes (BTX). Toxic responses following occupational exposure to unleaded petrol have been evaluated only in limited studies. The main purpose of this study was to ascertain whether (or not) exposure to unleaded petrol, under normal working conditions, is associated with any hepatotoxic or nephrotoxic response. METHODS: This was a cross-sectional study in which 200 employees of Shiraz petrol stations with current exposure to unleaded petrol, as well as 200 unexposed employees, were investigated. Atmospheric concentrations of BTX were measured using standard methods. Additionally, urine and fasting blood samples were taken from individuals for urinalysis and routine biochemical tests of kidney and liver function. RESULTS: The geometric means of airborne concentrations of BTX were found to be 0.8 mg m-3, 1.4 mg m-3, and 2.8 mg m-3, respectively. Additionally, means of direct bilirubin, alanine aminotransferase, aspartate aminotransferase, blood urea and plasma creatinine were significantly higher in exposed individuals than in unexposed employees. Conversely, serum albumin, total protein, and serum concentrations of calcium and sodium were significantly lower in petrol station workers than in their unexposed counterparts. CONCLUSION: The average exposure of petrol station workers to BTX did not exceed the current threshold limit values (TLVs) for these chemicals. However, evidence of subtle, subclinical and prepathologic early liver and kidney dysfunction was evident in exposed individuals.

Socioeconomic inequity in health care utilization, Iran

Reducing poor-rich inequities in health is one of the priorities of both national and international organizations and is also one of the main challenges of health sectors in Iran. Since, in the view of policy making, quantifying the size of inequity in health care utilization [HCU] is a prerequisite for achieving this goal, the current study aimed to determine and compare the socioeconomic inequity in HCU by concentration [C] index and odds ratio [OR]. A total of 758 households, consisting of 2,131 subjects who were aged 15 or older, were involved in this cross-sectional study, and their data were gathered through interviews. Household economic index [HEI] was created by the factor analysis from the asset data. The C index and OR were used as measures to determine the overall inequity in HCU according to sex [male/female], living area [urban/rural], insurance, and types of HCU [general physician [GP], specialist, and Health Workers [HWs]]. The overall rate of HCU was 66.4%. The rates of using GP, specialist care, and HW care were 21.4%, 21.6% and 21.8%, respectively. The overall inequity in HCU was equal to 0.05 [95% confidence interval; -0.069 to 0.165]. The C indexes in HCU, according to the subgroups of HCU, were measured as 0.11 [0.09-0.12] for GP, 0.115 [0.01-0.13] for specialist and -0.065 [-0.08 to -0.05] for HWs. Although the rate of utilization increased from poor to rich quintiles, the inequity regarding sex and living area was also low and non-significant. People with higher HEI used more specialist and GP care, while people with lower HEI used more HW care. The inequity in HCU was low and non-significant in different quintiles of males, females, urban and rural, as well as those who were insured

Relationship between mercury exposure and psychological health status of dentists

Background/Objective: This study was undertaken to address psychological health effects of dentists' exposure to low ambient levels of mercury

Methods: One hundred and six dentists and 94 general practitioners were randomly selected from clinics in Shiraz city, Iran. Subjects were asked to complete the Persian version of General Health Questionnaire. The data were analyzed using ?2 test, independent sample t-test and Mann-Whitney's U test

Results: Both groups were similar as far as all demographic variables, except age, were concerned. No significant difference was noted between the dentists' mean total score of GHQ-28 [17.9] and that of referent subjects [16.34]. These scores were significantly lower than the cut-off point of 23 [P<0.01]. The mean scores for somatic symptoms, anxiety and insomnia, and depression were significantly higher in dentists than in the referent subjects. The results also showed a significant association between GHQ-28 total scores and length of exposure to mercury [P=0.034]; with increase in the job tenure, GHQ-28 total score also increased, indicating a decrement in psychological health status

Conclusion: The current findings revealed that, in general, the dentists' psychological health status was poorer than the referent subjects. Additionally, in all GHQ subscales, the dentists' scores were significantly different from those of their counterparts. Given the fact that exposure to mercury is the most important differentiating variable between both groups, and that neuropsychological disorders are the most common toxic effect of mercury, the difference between psychological health status of the two groups is likely to be related to exposure to mercury

introduction to common systematic errors in medical research

Considering the continuous increase in number of published articles by Iranian researchers in recent years, the matter of quality in design, implementation, analysis and publication of articles is receiving its relevant attention. Of issues in quality of articles and studies are methodological errors. There are different kinds of errors that a researcher may fall into during various phases of a study. Of these errors systematic ones [or biases] can be counted. In this paper we aim to shortly introduce various sorts of biases that might happen in medical research. These biases are of two categories; selection and information biases.

comparison of case-control and case-only designs to investigate gene-environment interactions using breast cancer data

The traditional methods of studying the gene-environment interactions need a control group. However, the selection of an appropriate control group has been associated with problems. Therefore, new methods, such as case-only design, have been created to study such interactions. The objective of this study was to compare the case-only and case-control designs using data from patients with breast cancer. The interaction of genetic and environmental factor as well as the ratio of control to population odds ratio was calculated for case-only [300 patients with breast cancer] and case-control [300 cases of breast cancer and 300 matched controls] designs. The confidence intervals and -2log likelihood in all variables in case-only design was smaller than those in the matched case-control design. In case-only design, the standard errors of some variables such as age at menarche, the first delivery at the age of 35 yrs and more or no delivery, the history of having live birth, use of oral contraception pills, breastfeeding history were less than those in the matched case-control design. The findings indicate that the case-only design is an efficient method to investigate the interaction of genetic and environmental factors

[ trend of lung cancer incidence rate based on Fars Province cancer registry's data, 2001-2008]

Objective[s]: To determine the trend of crude and age standardized incidence rate of lung cancer in Fars province, southern Iran, from 2001 to 2008. In this epidemiological study, using Fars province cancer registry data the incidence rates were calculated per 100,000 people a year and age standardized incidence rate was performed by direct method using the world standard population

Methods: Data were analyzed by SPSS, version 16 and Microsoft Excel version 2007. Out of 743 lung cancer cases, 72 percent were male and 28 percent were female

Results: The results showed that through an eight-year period the age standardized incidence rate has increased 3.9 times from 1.5 in 2001 to 5. 9 in 2008 per 100,000 people a year. Also, the lung cancer incidence rate in Fars province exhibited an increasing trend and proved to be higher in male and elderly age groups

Conclusion: According to the results, Fars province considered as low incidence rate area in terms of age standardized incidence rate of lung cancer