Stressful life events, socioeconomic status, and the risk of neuromyelitis optica spectrum disorder: A population-based case-control study.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is a multifactorial autoimmune disease caused by genetic susceptibility and exposure to environmental factors. There is not sufficient evidence to estimate potential environmental risk factors for NMOSD; therefore, many predisposing factors may remain unknown. OBJECTIVE: The present study assessed the possible associations of ethnicity, socioeconomic status (SES), and stressful life events with NMOSD risk after adjustment for sex and age in an Iranian population. METHODS: This population-based case-control study included NMOSD cases and healthy controls in Tehran, Iran. Diagnosis of disease was confirmed by neurologists based on the 2015 International Consensus Criteria (ICC). Controls were sex-matched with cases and had no history of any neurological disorders. The telephone interviews were administered to gather pertinent data. Matched logistic regression was used to estimate unadjusted and adjusted odds ratio (ORs) and 95% confidence intervals (CIs) using SPSS. RESULTS: This study recruited 153 NMOSD cases and 400 controls with the case-control ratio of 1: 2.61 and mean ages (SD) of 37.11 (10.90) and 33.67 (8.37) years, respectively (p < 0.001). Depression history (OR = 3.79; 95% CI (1.50 - 9.58), p = 0.01) and stressful life events including death of first-degree relatives (OR = 5.10; 95% CI (1.78 - 14.61), p < 0.01), family disruption (OR = 12.68; 95% CI) 3.53 - 45.46), p < 0.001), homelessness periods(OR = 4.35; 95% CI (1.18 - 14.74), p = 0.02), joblessness (OR = 4.24; 95% CI (1.91 - 5.15), p = 0.01), and divorce (OR = 14.18; 95% CI (1.91 - 23.15), p = 0.01) were more common among NMOSD cases than matched controls and may play a role in increasing risk of disease occurrence. Marriage (OR = 0.10; 95% CI (0.03 - 0.35), p < 0.001) and Conquer (Iranian national exam for university entrance) (OR = 0.31; 95% CI (0.11 - 0.88), p = 0.02) had a negative association with NMOSD risk. Other stressful life events including jail term, close family members' serious disease or suicide, death of spouse, being in debt, getting fired from work, migration, and retirement had no relation with NMOSD risk (P > 0.05). The total stress number and load were not significantly associated with the risk of NMOSD (P > 0.05). Self-rated health status was significantly higher in controls (p < 0.001). Socioeconomic status (SES), parental ethnicity, and parental educational level during subjects' adolescence were not among the significant predictors of NMOSD risk (P > 0.05). CONCLUSION: No association was identified between ethnicity, SES, and parental educational levels as risk factors for developing NMOSD in an Iranian population. The obtained evidence showed the association of some individual stressful life events like death of first-degree relatives, family disruption, homelessness periods, joblessness, and divorce with the risk of developing NMOSD while marriage had a negative association. Depression history was more common among cases than healthy controls and may play a role in increasing risk of NMOSD.

Health promoting hospitals in Iran: Persian translation, cultural adaptation, content and face validation of selfassessment form of the standards of health promoting hospitals affiliated to the World Health Organization.

Background: According to the World Health Organization, hospitals should assess their internal wards to improve health promotion services using self-assessment tools. To achieve this goal, standards of health promoting hospitals have been developed by the World Health Organization, and measurable elements and indicators have been defined to facilitate the practical application of these standards in planning, implementation, and evaluation of health promotion in hospitals. Moreover, a form has been developed for this self-assessment. Considering linguistic and cultural differences in various countries, standards must be written in equivalent texts and, then, their content and face validity should be examined. Performing this process in a systemic and scientific way can guarantee that the same tools have been used, and thus the results obtained from different hospitals are comparable. Methods: After the preparation phase (considering research aim, obtaining permission from the original designers, and determining the time), the following activities were done: translating the form from its original language to the target language, combining and compiling initial translations to a single translation, reversing the final version of the translation from the target language to the original language, obtaining cognitive information, revising and concluding, and determining the content and face validity of the translated form and final report. After filling in the form, face validity was calculated using impact score formula. Content validity was measured using content validity ratio (CVR) and content validity index (CVI). Results: After calculating the impact score, all 40 items showed a high impact score greater than 1.5, representing the fact that all items are important. The minimum value of CVR for each of the 40 items was estimated to be 0.64; CVI of all items was greater than 0.79. Conclusion: Given the input of the standards of health promoting hospitals affiliated to the World Health Organization in National Accreditation of Iranian hospitals, the form was translated and found to be valid according to content and face validity and is available in Persian to be used in Iranian hospitals (Appendix 1).

National population size estimation of illicit drug users through the network scale-up method in 2013 in Iran.

BACKGROUND: For a better understanding of the current situation of drug use in Iran, we utilized the network scale-up approach to estimate the prevalence of illicit drug use in the entire country. METHODS: We implemented a self-administered, street-based questionnaire to 7535 passersby from the general public over 18 years of age by street based random walk quota sampling (based on gender, age and socio-economic status) from 31 provinces in Iran. The sample size in each province was approximately 400, ranging from 200 to 1000. In each province 75% of sample was recruited from the capital and the remaining 25% was recruited from one of the large cities of that province through stratified sampling. The questionnaire comprised questions on demographic information as well as questions to measure the total network size of participants as well as the network size in each of seven drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier ratios. RESULTS: The most common type of illicit drug used was opium with the prevalence of 1500 per 100,000 population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350), methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more common among men than women. The use of opium, shire and injecting drugs was more common in individuals over 30 whereas the use of stimulants and hashish was largest among individuals between 18 and 30 years of age. CONCLUSION: It seems that younger individuals and women are more desired to use new synthetic drugs such as crystal methamphetamine. Extending the preventive programs especially in youth as like as scaling up harm reduction services would be the main priorities in prevention and control of substance use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this affected population are needed.

Social hidden groups size analyzing: application of count regression models for excess zeros.

BACKGROUND: In the case of sensitive questions such as number of alcoholics known, majority of respondents might give an answer of zero. Poisson regression model (P) is the standard tool to analyze count data. However, P provides poor fit in the case of zero inflated counts, when over-dispersion exists. Therefore, the questions to be addressed are to compare performance of alternative count regression models; and to investigate whether characteristics of respondents affect their responses. METHODS: A total of 700 participants were asked about number of people they know in hidden groups; alcoholics, methadone users, and Female Sex Workers (FSW). Five regression models were fitted to these outcomes: Logistic, P, Negative Binomial (NB), Zero Inflated Poisson (ZIP), and Zero Inflated Negative Binomial (ZINB). Models were compared in terms of Likelihood Ratio Test (LRT), Vuong, AIC and Sum Square of Error (SSE). RESULTS: Percentages of zero were 35% for number of alcoholics, 50% for methadone users, and 65% for FSWs. ZINB provided the best fit for alcoholics, and NB provided the best fit for other outcomes. In addition, we noticed that young respondents, male and those with low education were more likely to know or reveal sensitive information. CONCLUSIONS: Although P is the first choice for modeling of count data in many cases, it seems because of over-dispersion of zero inflated counts in the case of sensitive questions, other models, specifying NB and ZINB, might have better goodness of fit.

Descriptive Aspects of Injection Drug Users in Iran's National Harm Reduction Program by Methadone Maintenance Treatment.

BACKGROUND: The Ministry of Health, Treatment and Medical Education of Iran has recently announced an estimated figure of 200,000 injecting drug users (IDUs). The aim of this study was to pilot a national program using demographics, types of drug abuse and prevalence of blood-borne infections among IDUs. METHODS: In order to elicit data on demographics, types of drug abuse and prevalence of blood-borne infections among IDUs, a questionnaire was designed in the Bureau of Mental-Social Health and Addiction in collaboration with Iran's Drug Control Headquarters of the Police Department. Therapeutical alliance of addiction in Shafagh Center was based on Methadone Maintenance Therapy (MMT). RESULTS: Among 402 reported IDUs most of them were male, single and in age range of 20 to 39 years old with 72.7% history of imprisonment. Most of them had elementary and high school education and a history of addiction treatment. The majority were current users of opioid, heroin and crack. The prevalence of blood-borne infections was 65.9% and 18.8% for HCV and HIV/AIDS infections, respectively. CONCLUSION: Prevention programs about harm reduction, treatment and counseling should include young IDUs as a core focus of their intervention structure.

The estimation of active social network size of the Iranian population.

OBJECTIVES: The size of active network (C) of Iranian population is a very important parameter to estimate the size of unknown population using Network Scale Up (NSU) technique. However, there is little information about this parameter not only in Iran but also in other countries in Middle East region. Based on these needs, the aim of this paper is to estimate C for the Iranian population. METHODS: Based on available national statistics, 23 reference groups, with known population sizes were selected. Using multistage sampling method, 7454 individuals were recruited randomly around the country. We asked from our samples how many people they knew from each of the reference groups. Using NSU formulae, we maximized the goodness of fit of our estimation about the size of the reference groups by fitting the best C. However, the final C was set by excluding some of the reference groups with no added information; these inappropriate groups were selected by two techniques; regression, and ratio based approaches. RESULTS: Applying regression and ratio based approaches the estimated C was 308 and 380 respectively. The Pearson correlation coefficient between the real and estimated size of reference groups (based on our C) in both methods was above 0.95. However, results of ratio based had better performance. We saw that the network of males, singles, younger age groups, and those with higher education was larger than those in other groups. CONCLUSION: It seems that C in Iran is higher than that in developed countries, possibly because of its social structure. Because of cultural and social similarities in Middle East courtiers, C in other countries also might be higher than that in developed countries.

Living near overhead high voltage transmission power lines as a risk factor for childhood acute lymphoblastic leukemia: a case-control study.

This study aimed to investigate association of living near high voltage power lines with occurrence of childhood acute lymphoblastic leukemia (ALL). Through a case-control study 300 children aged 1-18 years with confirmed ALL were selected from all referral teaching centers for cancer. They interviewed for history of living near overhead high voltage power lines during at least past two years and compared with 300 controls which were individually matched for sex and approximate age. Logistic regression, chi square and paired t-tests were used for analysis when appropriate. The case group were living significantly closer to power lines (P<0.001). More than half of the cases were exposed to two or three types of power lines (P<0.02). Using logistic regression, odds ratio of 2.61 (95%CI: 1.73 to 3.94) calculated for less than 600 meters far from the nearest lines against more than 600 meters. This ratio estimated as 9.93 (95%CI: 3.47 to 28.5) for 123 KV, 10.78 (95%CI: 3.75 to 31) for 230 KV and 2.98 (95%CI: 0.93 to 9.54) for 400 KV lines. Odds of ALL decreased 0.61 for every 600 meters from the nearest power line. This study emphasizes that living close to high voltage power lines is a risk for ALL.