The vaccination coverage rate in under-5 children in Nasiriyah, Iraq before and during the COVID-19 pandemic / 한국역학회지

METHODS@#This cross-sectional study was conducted in the city of Nasiriyah in southeastern Iraq, with data collected from 79 primary healthcare facilities. This study evaluated the VCR in 3 periods (2018, 2019, and 2020) using multi-level random sampling. Pertinent data were extracted from the vaccination records of 598 children for Bacillus Calmette-Guérin (BCG); pentavalent 1, 2, and 3; measles; and activated oral poliovirus vaccine 1 and 2. Missing data were completed by telephone calls to participants’ parents. Logistic regression was applied to compare and estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between VCR and related factors. @*RESULTS@#The data showed the greatest decline in the studied vaccines in 2020. Among the vaccines studied, BCG had the highest rate in all 3 periods (100% VCR) and measles had the lowest rate (83.7%), reaching 63.6% in 2020 (p<0.001). The highest OR among all types of vaccine were found for the pentavalent-3 vaccine among city dwellers and those born in 2020 (OR, 2.67; 95% CI, 1.39 to 5.10 and OR, 2.34; 95% CI, 1.28 to 4.28, respectively). @*CONCLUSIONS@#The VCR for children decreased during the COVID-19 pandemic in Iraq, and new health policies are needed to increase the coverage rate. Improving the knowledge and attitudes of parents, as well as removing barriers or risk factors, can also be effective in improving the VCR.

A paradoxical change in economic inequality in presenting visual acuity between 2009 and 2014: a nonuseful decline

Background: Despite the widespread literate on health inequalities and their determinants, changes in health inequalities over time have not received enough attention. Aims: To measure and decompose the over-time changes in economic inequality in presenting visual acuity measured using Logarithm of the Minimum Angle of Resolution. Methods: We analyzed 4,706 participants who had complete data on presenting visual acuity and economic status in 2009 and 2014 in the Shahroud Eye Cohort Study. We measured changes in presenting visual acuity concentration indices and decomposed them the using a longitudinal approach. Results: Both the presenting visual acuity and economic status deteriorated between 2009 and 2014. The mean (standard deviation) for presenting visual acuity and economic status scores in 2009 versus 2014 were 0.090 (0.2) versus 0.103 (0.2) and 0.01 (1.0) versus 0.0005 ( 1.07), respectively. Presenting visual acuity concentration index (95% confidence interval) in the first versus second phases of the study were –0.245 (–0.212 to –0.278) versus –0.195 (–0.165 to –0.225), respectively. Longitudinal decomposition of this change in concentration indices during the 5-year period indicated that the most important contributor to reduction in economic inequality of presenting visual acuity was deterioration of presenting visual acuity among people with higher economic status due to their aging. Conclusion: Unexpectedly, reduction in economic inequality in presenting visual acuity was due to presenting visual acuity deterioration among the higher economic status group rather than its amelioration among the lower economic status group. Therefore, the needs of all socioeconomic groups should be considered separately to modify presenting visual acuity in each group and, consequently, reduce the economic inequality in presenting visual acuity.

The risk factors of COVID-19 in a longitudinal population-based study

The present longitudinal study aims to investigate the risk factors for getting COVID-19 in a population aged 50 to 74 years. Data were collected from Shahroud Eye Cohort Study and the electronic system of COVID-19 in Shahroud, northeast Iran. Participants were followed for about 13 months and predisposing factors for COVID-19 infection were investigated using log binomial model and by calculation of relative risks. From the beginning of the COVID-19 outbreak in Shahroud (February 20, 2020) to March 26, 2021, out of 4394 participants in the Eye Cohort Study, 271 (6.1%) were diagnosed with COVID-19 with a positive Reverse Transcription Polymerase Chain Reaction test on two nasopharyngeal and oropharyngeal swabs. Risk factors for getting COVID-19 were included male gender (Relative Risk (RR) = 1.51; 95% Confidence Intervals (CI), 1.15-1.99), BMI over 25 (RR = 1.03; 95% CI, 1.01-1.05) and diabetes (RR = 1.31; 95% CI, 1.02-1.67). Also, smoking (RR = 0.51; 95% CI, 0.28-0.93) and education (RR = 0.95; 95% CI, 0.92-0.98) had reverse associations. In conclusion men and diabetic patients and those who have BMI over 25, should be more alert to follow the health protocols related to COVID-19 and priority should be given to them considering COVID-19 vaccination.

The Association of Opioid Use Disorder and COVID-19 in Shahroud, Iran

BackgroundCOVID-19 quickly spread to the world, causing a pandemic. While some studies have found no link between Opioid Use Disorder (OUD) and COVID-19, the role of the opioid on COVID-19 is challenging. The present study aimed to determine the relationship between OUD and COVID-19. MethodsThis was a prospective cohort study. We used data from the third phase of the Shahroud eye cohort study on 4394 participants which started in September 2019 and ended before the COVID-19 epidemic in Shahroud in February 2020. The participants were followed for 10.5 months till November 2020. COVID-19 was detected by RT-PCR on swap samples from the oropharynx and nasopharynx. The incidence of COVID-19 compared in OUD and Non-OUD participants, and relative risk was calculated in Log Binomial Regression model. ResultsAmong the 4394 participants with a mean age of 61.1 years, 120 people had OUD. The incidence of COVID-19 in participants with OUD and Non-OUD were 3.3% and 4.5%, respectively. The relative risk of OUD for COVID-19 was 0.75 (95% Confidence intervals: 0.28 - 1.98; P= 0.555). ConclusionsOpioid use disorder was not associated with COVID-19. The claim that people with OUD are less likely to develop COVID-19 is not supported by this data.

Determining the Prevalence of and the Factors Associated with Antihypertensive Medication Non-Adherence in the Gaza Strip / 가정의학회지

Background@#This study aimed to estimate the prevalence of and determine the factors associated with antihypertensive medication (A-HTNM) non-adherence among hypertension care seekers attending primary health clinics in the Gaza Strip. @*Methods@#A cross-sectional survey was conducted as the recruitment phase of a clustered randomized controlled trial including 538 participants. The participants were randomly selected from 10 primary health care centers by two-stage cluster random sampling. A structured questionnaire was used to collect data through face-to-face interview. The questionnaire was developed based on the World Health Organization determinants for medication non-adherence and the Health Belief Model. The main outcomes of this study were the prevalences of A-HTNM non-adherence and its associated factors. Adherence status was assessed using the eight-item Morisky Self-Report Medication Adherence Scale. Data were analyzed by STATA ver. 14.0 (Stata Corp., College Station, TX, USA) using a standard complex survey, accounting for unresponsiveness and the clustering sampling approach. @*Results@#The overall prevalence of A-HTNM non-adherence was 65.8% (95% confidence interval [CI], 59.2–71.8). Among all studied predictors, only self-efficacy of participants (odds ratio [OR], 3.8; 95% CI, 1.79–2.84) and social support (OR, 2.26; 95% CI, 2.82–5.11) remained significantly associated with A-HTNM non-adherence after adjusting for age, education level, number and frequency of A-HTNM doses per day, and comorbidities. @*Conclusion@#The high prevalence of non-adherence highlights the need for serious intervention to enhance the adherence rate among hypertension patients. The associated factors can be considered when developing appropriate interventions.

Determining the Prevalence of and the Factors Associated with Antihypertensive Medication Non-Adherence in the Gaza Strip / 가정의학회지

Background@#This study aimed to estimate the prevalence of and determine the factors associated with antihypertensive medication (A-HTNM) non-adherence among hypertension care seekers attending primary health clinics in the Gaza Strip. @*Methods@#A cross-sectional survey was conducted as the recruitment phase of a clustered randomized controlled trial including 538 participants. The participants were randomly selected from 10 primary health care centers by two-stage cluster random sampling. A structured questionnaire was used to collect data through face-to-face interview. The questionnaire was developed based on the World Health Organization determinants for medication non-adherence and the Health Belief Model. The main outcomes of this study were the prevalences of A-HTNM non-adherence and its associated factors. Adherence status was assessed using the eight-item Morisky Self-Report Medication Adherence Scale. Data were analyzed by STATA ver. 14.0 (Stata Corp., College Station, TX, USA) using a standard complex survey, accounting for unresponsiveness and the clustering sampling approach. @*Results@#The overall prevalence of A-HTNM non-adherence was 65.8% (95% confidence interval [CI], 59.2–71.8). Among all studied predictors, only self-efficacy of participants (odds ratio [OR], 3.8; 95% CI, 1.79–2.84) and social support (OR, 2.26; 95% CI, 2.82–5.11) remained significantly associated with A-HTNM non-adherence after adjusting for age, education level, number and frequency of A-HTNM doses per day, and comorbidities. @*Conclusion@#The high prevalence of non-adherence highlights the need for serious intervention to enhance the adherence rate among hypertension patients. The associated factors can be considered when developing appropriate interventions.

Burnout among healthcare professionals during COVID-19 pandemic: a cross-sectional study

BackgroundThe unpredictable nature of the new COVID-19 pandemic and the already alarming incidence of healthcare workers being affected can have a significant impact on the psychological well-being of the staff. ObjectiveTo describe the prevalence of burnout among healthcare professionals and the associated factors. DesignCross-sectional survey. SettingEight university affiliated hospitals in the capital city of Tehran, Iran. ParticipantsAll healthcare workers at the study sites who had been taking care of COVID-19 patients. MeasurementsAge, gender, marital status, having children, hospital, job category, experience, and work load, as well as the level of burnout in each subscale. Results326 persons (53.0%) experienced high levels of burnout. The average score in emotional exhaustion, depersonalization and lack of personal accomplishment was 26.6, 10.2, and 27.3, respectively. The level of burnout in the three subscales varied based on the personal as well as work related factors and gender was the only variable that was associated with high levels of all three domains. LimitationsThere was no control group and thus we cannot claim a causal relationship between COVID-19 and the observed level of burnout. Not all confounding factors might have been accounted for. ConclusionsBurnout is prevalent among healthcare workers caring for COVID-19 patients. Age, gender, job category, and site of practice contribute to the level of burnout that the staff experience. Funding sourceNone

Estimation of Case Fatality Rate during an Epidemic: an Example from COVID-19 Pandemic

The case fatality rate (CFR) is an important index in epidemics and policymakers need to be aware of this statistic for making sound decisions. However, there are some uncertainties in the calculation of the fatality rate and the true case fatality rate can be calculated after an epidemic subsides, we calculated the fatality rate for 20 countries which had the highest number of confirmed cases with three scenarios. In this study, we provided detailed information to discuss the studies that calculate the case fatality rate during the COVID-19 pandemic and highlight the estimation bias in these studies.

Assessment of a serological diagnostic kit of sars-cov-2 availble in Iran

BackgroundThe SARS-CoV-2 epidemic broke out in December 2019 and now is characterized as a pandemic. The effective control of this infectious disease requires access to diagnostic techniques, both for case finding and epidemic size estimation. The molecular technique is routinely being used worldwide. Although it is the "standard" case detection and management method, it has its own shortcomings. Thus, some easy-to-use rapid serological tests were developed. MethodsOne hundred and fourteen positive RT-PCR-diagnosed patients were tested by VivaDiag Kit, a brand of rapid serological kits available in hospitals affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. Frozen serum specimens taken from healthy people in summer and autumn 2019, were also tested as negative controls. ResultsThe test sensitivity was 47.9% (95% confidence interval [CI]: 38.8-56.9) for IgM and 47.0% (95% CI: 38.0-56.0) for IgG. There was no difference between IgG and IgM seropositivity except in one case. Specificity was calculated as 99.0% (95% CI: 96.4-99.9) for IgM and of 100.0% (95% CI: 0.98.2-100.0) for IgG. Sensitivity was higher in men and older participants. ConclusionThis test can be used for epidemiological investigations especially for the estimation of the level of infection in the community, after it is properly corrected for sensitivity and specificity. The low sensitivity could be attributed to the technical limitation of the kits or low levels of antibodies after infection. The different sensitivity in age and sex groups supports the hypothesis that different people show different immune responses to this virus.

Socioeconomic inequality in smoking and its determinants in the Islamic Republic of Iran

Background: The role of socioeconomic inequality and related factors has not been well reported in tobacco consumption. Aims: To investigate the socioeconomic inequality in smoking and its associated factors in the Islamic Republic of Iran. Methods: Data were collected from surveillance for noncommunicable diseases in 2005, which included 89 404 people aged 15–65 years. Economic status was defined by principal component analysis on variables related to socioeconomic status. Concentration index and slope index of inequality were used to determine the inequality value. The gap between the high and low economic status groups was decomposed using the Oaxaca–Blinder decomposition method for explained and unexplained components. Results: The total prevalence of smoking was 17.0%; 28.0% in males, and 5.8% in females, 15.8% in urban and 19.1% in rural areas. The concentration index was –0.032 in the whole of country; –0.098, in males, –0.246 in females, 0.014 in urban and –0.059 in rural areas and varied in different provinces of country. The smoking rate was 18.0% for the first quintile and 13.5% for the fifth quintile, a gap of 4.5%. The major part of this gap was related to differences in education level, sex, marital status and age in economic groups. Conclusion: There was a pro-rich socioeconomic inequality in smoking, especially in females and in the southern provinces. Increase in education level and empowering females of low socioeconomic status are sound interventions for alleviating inequality and for tobacco control

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES: The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.METHODS: In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.RESULTS: The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.CONCLUSIONS: Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Transition in tobacco use stages and its related factors in a longitudinal study

OBJECTIVES@#Considering the increase in the non-communicable diseases associated with tobacco use in recent decades in Iran, it is necessary to have a general view of the current condition. This study aimed to identify factors associated with tobacco use and to estimate the probability of a 5-year transition in the stages of tobacco use in an adult population.@*METHODS@#In this study, 5190 people in the 40-64-year-old population of Shahroud (North East of Iran) were interviewed in 2009 and 2014 on tobacco smoking. The association of independent variables with tobacco smoking was evaluated using the population-averaged logit model. We calculated smoking transition probabilities from non-smoking to current smoking and past-smoking stages during a 5-year span.@*RESULTS@#The prevalence of current tobacco smoking in 40-69-years age group was 11.1% (95% CI 10.3-12.0), 1% among women (95% CI 0.8-1.3) and 25.6% among men (95% CI 23.7-27.6). During this 5-year period, the probability of transition of a non-smoker to an overall current tobacco smoker was 2.3%. Meanwhile, 18.5% of the overall current tobacco smokers had changed into past smokers. Unemployed (OR = 2), male gender (OR = 53.9), widow/widowers (OR = 5.4), divorces (OR = 3.3), and high economic status (OR = 1.2) are associated to tobacco smoking.@*CONCLUSIONS@#Compared with the other studies, the prevalence of tobacco use in this population is low but transition rate of non-smokers into current smokers or past smokers is high. Conducting interventions on determinants of starting and quitting smoking and education and awareness raising on the risk and harms of smoking seems necessary.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES@#The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes.@*METHODS@#In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education.@*RESULTS@#The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively.@*CONCLUSIONS@#Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Pre-hypertension and the risk of diabetes mellitus incidence using a marginal structural model in an Iranian prospective cohort study / 한국역학회지

OBJECTIVES: The aim of this study was to evaluate the effect of pre-hypertension and its sub-classification on the development of diabetes. METHODS: In this cohort study, 2,941 people 40 to 64 years old without hypertension or diabetes were followed from 2009 through 2014. According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC)-7 criteria, we classified participants into normal and pre-hypertension groups. The effect of pre-hypertension on the 5-year incidence rate of diabetes was studied using inverse probability of treatment weighting. We modeled the exposure and censored cases given confounding factors such as age, sex, body mass index, smoking, economic status, and education. RESULTS: The 5-year incidence rate of diabetes among people with pre-hypertension and those with normal blood pressure (BP) was 12.7 and 9.7%, respectively. The risk ratio (RR) for people with pre-hypertension was estimated to be 1.13 (95% confidence interval [CI], 0.90 to 1.41). The RRs among people with normal BP and high-normal BP, according to the JNC-6 criteria, compared to those with optimal BP were 0.96 (95% CI, 0.73 to 1.25) and 1.31 (95% CI, 1.01 to 1.72), respectively. CONCLUSIONS: Our results showed that participants who had higher levels of BP (high-normal compared to optimal BP) had a higher risk of diabetes development. With regard to the quantitative nature of BP, using the specifically distinguishing of stage 1 hypertension or high-normal BP may be a more meaningful categorization for diabetes risk assessment than the JNC-7 classification.

Factors affecting survival of patients with oesophageal cancer: a study using inverse Gaussian frailty models

<p><b>INTRODUCTION</b>Oesophageal cancer is one of the most common causes of cancer mortality in developing countries, including Iran. This study aimed to assess factors affecting survival of patients with oesophageal cancer using parametric analysis with frailty models.</p><p><b>METHODS</b>Data on 359 patients with oesophageal cancer was collected from the Babol Cancer Registry for the period 1990-1991. By 2006, the patients had been followed up for a period of 15 years. Hazard ratio was used to interpret the risk of death. To explore factors affecting the survival of patients, log-normal and log-logistic models with frailty were examined. The Akaike Information Criterion (AIC) was used for selecting the best model(s). Cox regression was not suitable for this patient group, as the proportionality assumption of the Cox model was not satisfied by our data (p = 0.007).</p><p><b>RESULTS</b>Multivariate analysis according to parametric models showed that family history of cancer might increase the risk of death from cancer significantly. Based on AIC scores, the log-logistic model with inverse Gaussian frailty seemed more appropriate for our data set, and we propose that the model might prove to be a useful statistical model for the survival analysis of patients with oesophageal cancer. The results suggested that gender and family history of cancer were significant predictors of death from cancer.</p><p><b>CONCLUSION</b>Early preventative care for patients with a family history of cancer may be important to decrease the risk of death in patients with oesophageal cancer. Male gender may be associated with a lower risk of death.</p>