Epidemiological and Spatiotemporal Descriptive Analysis of Patients with Nonsyndromic Cleft Lip and/or Palate: A 12-Year Retrospective Study in Southern Iran.

Objectives: The current study is aimed at evaluating epidemiological characteristics and spatiotemporal distribution of cleft lip and/or palate (CL/P) in the south of Iran. Methods: Data were extracted from the 1840 medical records of patients who were referred to the Cleft Lip and Palate Center of Shiraz University of Medical Sciences, from January 1, 2011, to September 1, 2022. The collected variables included demographic data (gender, birth date and season, place, birth order, and weight), cleft types and the subtypes, parental information (health status, education level, marital status, and age during the pregnancy), and other basic parameters. The chi-square test at a significance level of 0.05 was used to analyze collected data. The geographic information system (GIS) analysis was also used for analyzing the spatial distribution of CL/P patients. Results: Based on our inclusion criteria, 1281 nonsyndromic patients were included in this study. The most common type was cleft lip and palate (CLP) with 48.32%, whereas cleft palate (CP) and cleft lip (CL) accounted for 40.75% and 10.93% of the patients, respectively. There was a progressive increase in the frequency of all types of clefts, and most of them were male (P ≤ 0.001). The urban population outnumbered the rural ones in all provinces. Parents were mostly healthy (>80%) with low educational status (47.5%). Most born CL/P patients were from consanguineous marriages (58.9%), especially between first-degree relatives. A majority of CL/P patients (73.1%) were born in the first two gestations with a birth weight of 2500-4000 g (77.4%). Most infants with CL/P (84.3%) were born from mothers who had at least one of the predisposing factors. Conclusion: In this study, the frequency of cleft types and subtypes was similar to the existing literature. However, high rate of consanguineous marriage, especially between first-degree relatives, was the most notable feature of this population.

Alternative Water Resources Selection to Supply Drinking Water in Flood Disasters by Multicriteria Decision-Making Techniques (DANP and VIKOR).

Background: Emergency is generally caused by natural disaster and infectious disease outbreaks, or it is man-made. Floods are natural phenomena that generally appear in multiple parts of the world. Flooding is one of the most destructive naturally occurring environmental hazards and can cause public, infrastructural, and environmental damage. The purpose of this study is to select alternative water resources for supplying Bandar Abbas in flood disasters by multicriteria decision-making techniques. Methods: Information required includes possible water resources alternative for flood, quantitative and qualitative characteristics of the water resources, climatic circumstances, and demographic information used in organizations data and previous studies. After selecting and proposing water resources alternative for Bandar Abbas in flood, the subcriteria were weighed applying DANP (DEMATEL-ANP) techniques and water resources were prioritized with the VIKOR technique. According to the network structure and internal and external dependence of the criteria and subcriteria, the advantages of DANP in calculating weights have been used to adapt to more real-world problems. The VIKOR technique was developed for multicriteria optimization of complex systems. Results: After reviewing and extracting the criteria from various studies, 9 main criteria and 44 subcriteria were defined to select water resources in disasters and emergencies. According to field studies and related organizations' information, the proposed water resources for Bandar Abbas to use in flood disasters include humidity, sea (Persian Gulf), Sarkhoon plain, and wastewater treatment plant of Bandar Abbas. Conclusion: Results showed that the optimal water resources for Bandar Abbas in flood disasters are the sea and wastewater treatment plant effluent (after advanced treatment). The study proposed appropriate model to select optimal water resources for various natural disasters in different geographical areas. This model can help officials and decision-makers to plan for drinking water supply from disaster-prone areas before disasters occur.

Spatial Evaluation of Oral Lichen Planus Patients Referred to Shiraz Dental School, Iran: a Medical Geography Approach.

Statement of the Problem: Oral lichen planus (OLP) is an important inflammatory disease concerning its tendency to malignancy. The etiopathogenesis of this disease is still unknown. Medical geography uses geographic techniques to study factors related to location that cause uneven distribution of disease. Purpose: This study was conducted to map OLP in patients referred to Shiraz Dental School with medical geography techniques and investigate any possible relationship between the number of dentists and health-centers in different regions of Fars province with the number of referrals. Materials and Method: In this cross-sectional study, we evaluated the records of OLP patients referred to Shiraz Dental School from 2007 to 2018. Age, sex, place of residence, occupation, level of education, location of involvement, duration, and cutaneous involvement were recorded. The number of dentists and healthcare centers was obtained from the statistical records of Fars province. A Geographic Information System was used for the assessment of the spatial distribution of OLP. Ordinary least squares (OLS) and geographically weighted regression (GWR) indices were used for evaluating the relationship between the number of dentists and health centers with the number of referrals. Results: From 1006 records, 457 were studied, from which 71% were female (age range of 41-60). The regression coefficient was 0.937 for the number of dentists in each county compared to OLP referrals indicating a strong relationship. The regression coefficient was 0.983 for the number of health-centers. According to GWR analyses in Shiraz neighboring counties like Marvdasht, Sepidan, and Sarvestan, there is a positive relationship between the number of dentists and OLP patients. Conclusion: The results revealed that dentists and health care centers had a good cognition of referring patients with OLP (as a premalignant lesion) for definite diagnosis in Fars counties. But both groups need more education in this matter. Moreover, referrals from settlements near Shiraz were more common because of their easier access.

Comparison of the Effect of Alpha and Hydrocortisone Ointments on Prevention of Acute Skin Complications Due to Radiotherapy in Breast Cancer Patients.

BACKGROUND: Radiotherapy in breast cancer patients is associated with acute and delayed side effects. This study aimed to compare the effect of alpha and hydrocortisone 1% (H1%) ointments on prevention of acute skin complications due to radiotherapy in breast cancer patients. METHODS: This clinical trial was conducted on 86 patients with breast cancer in the radiotherapy center of Imam Reza Hospital of Kermanshah, Iran. Using the records, the patients were selected and randomly divided into alpha and H1% groups after obtaining informed consent. The severity of dermatitis, complications, and patient complaints during treatment were evaluated weekly for up to 6 weeks by RTOG criteria. Data were analyzed using SPSS-16 software. RESULTS: At the end of the third, fourth, fifth, and sixth weeks, 10 (11.7%), 25 (29.1%), 53 (61.6%), and 28 (32.6%) patients had skin complications, respectively. In weeks 5 and 6 in the H1 group, the incidence of complications was higher (P = 0.001). The frequency of pain and burning complaints at the end of the third, fourth, fifth, and sixth weeks was 15 (17.4%), 37 (43.0%), 52 (60.5%), and 1(1.2%), respectively. Pain and burning intensity in the fourth and fifth weeks in the H1 group was lower than alpha (P = 0010). Complaints of skin itching at the end of the third, fourth, and fifth weeks were 16 (18.6%), 25 (29.1%), and 28 (32.6), respectively. This complication was lower in the H1% group during these weeks (P < 0.05). CONCLUSION: Alpha ointment is more effective than H1% in relieving pain and burning, preventing complications except itching. It seems using an alpha ointment or combining it with H1% is an appropriate strategy to reduce the rate of injuries and skin complications of radiotherapy.

Urban Growth and urban need to fair distribution of healthcare service: a case study on Shiraz Metropolitan area.

OBJECTIVE: (1) To analyze urbanization development pattern in Shiraz after the year 1977; (2) To analyze hospital development model in Shiraz after the year 1977; (3) To review and prioritize location-allocation criteria for hospitals; and (4) To specify appropriate locations for the establishment of potential future general hospitals in Shiraz based on selected criteria. RESULTS: Although a significant expansion is seen from different geographical directions (particularly northwest and southeast of the city) in the urbanization model after the year 1977, the construction of hospitals has been limited to the central parts of the city and the areas around the city lack any hospitals. The "open access path to the hospital during incidents and disasters and a light traffic" criterion has enjoyed the highest priority amongst the 24 selected hospital location-allocation criteria. Appropriate locations for establishment of new hospitals in the future have been marked as colored maps. The present study has been able to determine and prioritize a comprehensive list of hospital location-allocation criteria. Moreover, the achieved maps from this study can be used by policy makers to develop new hospitals.

A small number of objective function weight vectors is sufficient for automated treatment planning in prostate cancer.

Current practice for treatment planning optimization can be both inefficient and time consuming. In this paper, we propose an automated planning methodology that aims to combine both explorative and prescriptive approaches for improving the efficiency and the quality of the treatment planning process. Given a treatment plan, our explorative approach explores trade-offs between different objectives and finds an acceptable region for objective function weights via inverse optimization. Intuitively, the shape and size of these regions describe how 'sensitive' a patient is to perturbations in objective function weights. We then develop an integer programming-based prescriptive approach that exploits the information encoded by these regions to find a set of five representative objective function weight vectors such that for each patient there exists at least one representative weight vector that can produce a high quality treatment plan. Using 315 patients from Princess Margaret Cancer Centre, we show that the produced treatment plans are comparable and, for [Formula: see text] of cases, improve upon the inversely optimized plans that are generated from the historical clinical treatment plans.

Spatial modeling of colonic lesions with geographic information systems.

BACKGROUND: Geographic information system (GIS) software has been used in health care systems to display and analyze spatial pattern of diseases and health services. OBJECTIVES: This study was performed to assess spatial patterns of colon's pathologic lesions based on the pathologic reports and assess whether it is possible to use GIS software in health services. PATIENTS AND METHODS: Archives of pathology of Namazi and Faghihi hospitals, two main referral centers of south-west of Iran, were obtained and reviewed between January 2009 and September 2011 for biopsy reports of patients who underwent colonoscopy. Abnormal biopsies were categorized into five different subgroups according to the type of pathologic specimens. By GIS, spatial patterns of colon biopsies were plotted in different maps and spatial auto-correlation of colon biopsies was calculated using the Moran's Index. RESULTS: A total of 4815 biopsies from 2663 different patients were reviewed, 53.8% of which were men. Abnormal biopsies were 2781 of all specimens (57.8%). Neoplastic lesions, inflammatory bowel diseases and polyps were 9.3%, 19.3% and 29.2% of total biopsies, respectively. Pathologic biopsies were more common in the distal colon. Maps of all biopsies and maps of specific pathologies were manifested in GIS. CONCLUSIONS: Our study showed that left-sided lesions are still more common in the Iranian population. On the other hand, surveying the right side of colon is as important as the distal part, which necessitates total colonoscopy.

Location of Road Emergency Stations in Fars Province, Using Spatial Multi-Criteria Decision Making.

OBJECTIVES: To locate the road emergency stations in Fars province based on using spatial multi-criteria decision making (Delphi method). METHODS: In this study, the criteria affecting the location of road emergency stations have been identified through Delphi method and their importance was determined using Analytical Hierarchical Process (AHP). With regard to the importance of the criteria and by using Geographical Information System (GIS), the appropriateness of the existing stations with the criteria and the way of their distribution has been explored, and the appropriate arenas for creating new emergency stations were determined. In order to investigate the spatial distribution pattern of the stations, Moran's Index was used. RESULTS: The accidents (0.318), placement position (0.235), time (0.198), roads (0.160), and population (0.079) were introduced as the main criteria in location road emergency stations. The findings showed that the distribution of the existing stations was clustering (Moran's I=0.3). Three priorities were introduced for establishing new stations. Some arenas including Abade, north of Eghlid and Khoram bid, and small parts of Shiraz, Farashband, Bavanat, and Kazeroon were suggested as the first priority. CONCLUSION: GIS is a useful and applicable tool in investigating spatial distribution and geographical accessibility to the setting that provide health care, including emergency stations.

The geographical clusters of gastrointestinal tract cancer in fars province, southern iran.

BACKGROUND: Gastrointestinal tract cancer (GI.C) is one of the common cancers in world-wide. The incidence rate of it is different in various geographical regions. This study was performed to assess spatial clusters of the occurrence of GI.C in Fars Province. METHODS: In this cross-sectional study, the new cases were 4569 cases from 2001 to 2009. The crude incidence rates were standardized based on world population for both sexes. The spatial analysis was conducted using the geographical information systems. We used the local Indicators of spatial association measure, in order to identify local spatial clusters. RESULTS: From a total of the new cases, 62.8% cases were male. The most common GI.Cs were stomach and colorectal cancer in men and women respectively. The significant cluster patterns were discovered from 2002 to 2007. The common type of spatial clustering was a high-high cluster, that to indicate from North-west to South-east of Fars Province. CONCLUSIONS: Analysis of the geographical distribution of GI.C will provide opportunities for policymakers for applying preventive measures. Furthermore, it could be helpful for researchers for future epidemiological studies for investigation of etiological agents in regions with significant spatial clustering of high incidence of cancer.

Spatial Prevalence of Intellectual Disability and Related Socio-Demographic Factors in Iran, Using GWR: Case Study (2006).

BACKGROUND: Although intellectual disability (ID) is a common disability in Iran, there is no investigation on the spatial distribution pattern of these patients in national level and the spatial maps for recognition the areas with higher prevalence of IDs and local neighborhoods of these regions or effect of socio-demographic factor on this scattering is not still available. This proposition motivated us to assess the population with ID in our country. METHODS: In a cross-sectional study, we applied Moran's Index (Moran's I) which includes information about the strength of the neighboring association between counties, as global univariate distribution assessment. A geographically weighted regression was used to explore relation between ID patient's prevalence and some socio-demographic factors (migration and illiteracy rate, physician number (PN)/10,000 people and health-care centers (HCCs)/10,000 people). RESULTS: We found that spatial clusters of ID patients exist among Iran counties (Moran's I = 0.36, P < 0.01) and in a rural area population groups (Moran's I = 0.20, P < 0.01). Further, we detected spatial associations between ID patients and all of our investigated socio-demographic factors in national scale. In rural areas, illiteracy has high association with ID especially in the south region of Iran. Urban area has random pattern of ID patients both within and between the Iran counties (Moran's I = 0.01, P > 0.3). CONCLUSIONS: According to the results, our Initial hypothesis about the existence of spatial clusters in distribution of people with ID in Iran was proven. Spatial autocorrelation between migration and illiteracy rate and prevalence of patients with ID was shown and was in agreement with our hypothesis. However, our supposition that the prevalence should have inverse relationship with PN and HCC was rejected.

The evaluation of time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah.

This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients' cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents.

The Spatial Distribution of Cancer Incidence in Fars Province: A GIS-Based Analysis of Cancer Registry Data.

BACKGROUND: Cancer is a major health problem in the developing countries. Variations of its incidence rate among geographical areas are due to various contributing factors. This study was performed to assess the spatial patterns of cancer incidence in the Fars Province, based on cancer registry data and to determine geographical clusters. METHODS: In this cross sectional study, the new cases of cancer were recorded from 2001 to 2009. Crude incidence rate was estimated based on age groups and sex in the counties of the Fars Province. Age-standardized incidence rates (ASR) per 100,000 was calculated in each year. Spatial autocorrelation analysis was performed in measuring the geographic patterns and clusters using geographic information system (GIS). Also, comparisons were made between ASRs in each county. RESULTS: A total of 28,411 new cases were diagnosed with cancer during 2001-2009 in the Fars Province, 55.5% of which were men. The average age was 61.6 ± 0.5 years. The highest ASR was observed in Shiraz, which is the largest county in Fars. The Moran's Index of cancer was significantly clustered in 2004, 2005, and 2006 in total, men, and women. The type of spatial clustering was high-high cluster, that to indicate from north-west to south-east of Fars Province. CONCLUSIONS: Analysis of the spatial distribution of cancer shows significant differences from year to year and between different areas. However, a clear spatial autocorrelation is observed, which can be of great interest and importance to researchers for future epidemiological studies, and to policymakers for applying preventive measures.