Spatio-temporal analysis of COVID-19 incidence rate using GIS: a case study-Tehran metropolitan, Iran

COVID-19 has been distinguished as a zoonotic coronavirus, like SARS coronavirus and MERS coronavirus. Tehran metropolis, as the capital of Iran, has a high density of residents that experienced a high incidence and mortality rates which daily increase the number of death and cases. In this study, the IDW (Inverse Distance Weight), Hotspots, and GWR (Geography Weighted Regression) Model are used as methods for analyzing big data COVID-19 in Tehran. The results showed that the majority of patients and deaths were men, but the death rate was higher in women than in men; also was observed a direct relationship between the area of the houses, and the infected rate, to COVID-19. Also, the results showed a disproportionate distribution of patients in Tehran, although in the eastern regions the number of infected people is higher than in other districts; the eastern areas have a high population density as well as residential land use, and there is a high relationship between population density in residential districts and administrative-commercial and the number of COVID-19 cases in all regions. The outputs of local R² were interesting among patients and underlying disorders; the local R² between hypertension and neurological diseases was 0.91 and 0.79, respectively, which was higher than other disorders. The highest rates of local R² for diabetes and heart disease were 0.67 and 0.55, respectively. From this study, it can be concluded the restrictions must be considered especially, in areas densely populated for all people.

Machine learning algorithms to predict seizure due to acute tramadol poisoning

INTRODUCTION

This study was designed to develop and evaluate machine learning algorithms for predicting seizure due to acute tramadol poisoning, identifying high-risk patients and facilitating appropriate clinical decision-making.

METHODS

Several characteristics of acute tramadol poisoning cases were collected in the Emergency Department (ED) (2013-2019). After selecting important variables in random forest method, prediction models were developed using the Support Vector Machine (SVM), Naïve Bayes (NB), Artificial Neural Network (ANN) and K-Nearest Neighbor (K-NN) algorithms. Area Under the Curve (AUC) and other diagnostic criteria were used to assess performance of models.

RESULTS

In 909 patients, 544 (59.8%) experienced seizures. The important predictors of seizure were sex, pulse rate, arterial blood oxygen pressure, blood bicarbonate level and pH. SVM (AUC = 0.68), NB (AUC = 0.71) and ANN (AUC = 0.70) models outperformed k-NN model (AUC = 0.58). NB model had a higher sensitivity and negative predictive value and k-NN model had higher specificity and positive predictive values than other models.

CONCLUSION

A perfect prediction model may help improve clinicians' decision-making and clinical care at EDs in hospitals and medical settings. SVM, ANN and NB models had no significant differences in the performance and accuracy; however, validated logistic regression (LR) was the superior model for predicting seizure due to acute tramadol poisoning.

Risk assessment of mortality from silicosis and lung cancer in workers of machine factories and traditional brick production workshops with crystalline silica exposure

Introduction: Exposure to dust is an essential factor in the brick production industry. Determining the mortality rate from silicosis and lung cancer is very important in exposure to crystalline silica dust. Therefore, this study was conducted to risk assessment of workers in machine factories and traditional brick production workshops. Materials and Methods: This cross-sectional study was conducted in 2016 in a machine factory and five traditional active brick production workshops in Qarchak and Varamin city located in the southeast of Tehran. All employees of a brick-making machine factory (40 people) and five traditional brick-making workshops (30 people) were selected by census sampling. Their exposure to total respiratory dust and respirable crystalline silica was evaluated by the NIOSH0600 method and NIOSH7602 optimal method. Mortality risk assessment from silicosis and lung cancer was performed based on Mannetej and Rice models. Data were analyzed by t-test after entering SPSS19 software. Results: The average concentrations of crystalline silica and total respiratory dust in traditional workshops are 0.651 ±0.69 and 28.27 ± 23.05, and in a machine factory are 0.297± 0.27 and 17.6 ±8.6 mg / m3. The T-test showed a significant difference between the traditional and mechanical brick factory in occupational exposure to total respiratory dust (P=0.001). However, no significant difference was observed in exposure to crystalline silica (P=0.107). In both traditional and machine brick factory, the risk of death from silicosis and lung cancer is unacceptable. Conclusion: The results showed that the industry's mechanization has reduced exposure to total respiratory dust and crystalline silica and reduces the risk of death from lung cancer. But the risk of death from lung cancer and silicosis is still high in both traditional and mechanical factories

Cigarette smoking in patients newly diagnosed with pulmonary tuberculosis in Iran

BACKGROUND

The association between pulmonary tuberculosis (PTB) and tobacco smoke has been verified by most studies on the subject; figures from different countries for the prevalence of smoking among PTB patients vary.

OBJECTIVE

To assess the prevalence of and factors associated with smoking among TB patients in Iran.

DESIGN

In this cross-sectional study, subjects were included on a first-come, first-served basis from among newly diagnosed PTB patients using a multistage cluster sampling method during 2012-2014. Data were collected during face-to-face interviews and a questionnaire was used to gather information on smoking habits.

RESULTS

Of 1127 newly diagnosed PTB patients included in the study (mean age 50.0 ± 19.8 years), 228 (20.2%) were daily smokers, 20 (1.8%) were occasional smokers and 93 (8.9%) had quit before diagnosis. Simultaneous drug use (P < 0.001, OR 75.21), increasing age (P = 0.001), being single (P < 0.001, OR 16.95), being an Iranian national (P < 0.001, OR 6.26) and living in a rural area (P < 0.001, OR 5.85) were found to be independent risk factors for smoking in study patients.

CONCLUSION

The prevalence of smoking among PTB patients in Iran is relatively high. It is therefore necessary to include smoking cessation interventions in the National TB Programme.

Incidence of acute myocardial infarction in Islamic Republic of Iran: a study using national registry data in 2012

Population-based data on myocardial infarction rates in the Islamic Republic of Iran have not been reported on a national or provincial scale. In a cross-sectional study, data were collected on 20 750 new cases of myocardial infarction (ICD10 codes I21-22) admitted to hospitals and registered by the Iranian Myocardial Infarction Registry in 2012. The crude and age-adjusted incidence for the 31 provinces and the whole country were directly calculated per 100 000 people using the WHO standard population. Overall, males comprised 72.4% of cases and had a significantly lower mean age at incidence than women [59.6 (SD 13.3) years versus 65.4 (SD 12.6) years]. The male:female incidence ratio was 2.63. The age-standardized myocardial infarction incidence rate was 73.3 per 100 000 in the whole country (95% CI: 72.3%-74.3%) and varied significantly from 24.5 to 152.5 per 100 000 across the 31 provinces. The study provides baseline data for monitoring and managing cardiovascular diseases in the country.

Estimating the contribution of selected risk factors in attributable burden to stroke in iran

BACKGROUND

Knowledge of the magnitude of avoidable burden by risk factors is needed for health policy, priority setting, and preventing stroke. The aim of this study was to estimate the contribution of selected risk factors including hypertension, overweight, obesity, tobacco use, and physical inactivity to the attributable burden of stroke in Iran.

METHODS

The World Health Organization Comparative Risk Assessment (CRA) methodology was employed to calculate the Potential Impact Fraction (PIF) and percentage of avoidable burden of stroke, which attributed to its risk factors among Iranian adults in 2009. Prevalence of risk factors was obtained from the 5(th) STEPS survey of chronic disease risk factors which conducted in 2009. PIF was estimated on both theoretical minimum and feasible minimum risk. A simulation procedure incorporating sources of uncertainty was used to estimate the uncertainties for the attributable burden.

RESULTS

About 15.7% (95% uncertainty intervals: 5.8- 23.5) of attributable Disability Adjusted Life Years (DALYs) to stroke in adult males and 15.8% (95% uncertainty intervals: 5.8- 23.5) in adult females are avoidable after changing the current prevalence (16.0% and 16.1% for males and females, respectively) of hypertension to 10% in both sexes.

CONCLUSION

This work highlighted the important role of hypertension and overweight. Accordingly, policy makers are advised to consider these risk factors once implementing interventional program in Iran.

Road safety in the Eastern Mediterranean Region--findings from the Global Road Safety Status Report

A secondary data analysis using the Global Status Report on Road Safety (GSRRS) was carried out to assess the epidemiology of road traffic injuries (RTIs) and preventive strategies in the Eastern Mediterranean egion (EMR). EMR countries ranked equal first in the world for the highest number of fatalities due to RTIs (32.2 per 100 000 population). The region had about 4% of the world's vehicles with 0.097 registered vehicles per person. The number of injured cases in EMR was 210.1 per 100 000 population. Only 15% of EMR countries had a funded, independent, multisectoral body for road safety. Only 25% had mandatory seat-belt laws for both front-seat and rear-seat passengers, 60% had mandatory helmet laws for both drivers and passengers of motorized two-wheelers and 10% had child restraint laws. Road safety in EMR countries needs more attention and consideration.

Association between mandatory seatbelt laws and road traffic injuries in Iran

This study investigated the efficacy of mandatory seatbelt legislation on traffic injuries and intensity of road traffic injuries (RTIs). We carried out a before- after interventional study. Data regarding road traffic accidents and injuries one year before and one and two years after the implementation of mandatory seatbelt legislation were obtained from the traffic police database. Traffic accident mortality was 13.0% of all RTIs during the year prior to implementation. This decreased to 9.7% and 11.4% during the first and second years after implementation, respectively (p < 0.001). The mortality rate was not consistent for seatbelt use since there was a slight increase in the mortality rate in second year after implementation of mandatory seatbelt use although this level was lower than the pre- implementation rate. Our findings suggest mandatory seatbelt use reduces the intensity of RTIs and reduces the crude number of RTIs.

Road traffic injuries in Iran: the role of interventions implemented by traffic police

INTRODUCTION

In Iran there are about 70 deaths per day from road traffic injuries (RTIs). Despite some interventions having been implemented during the past 5 years, the impacts of these interventions on mortality and morbidity rates have not been well evaluated.

OBJECTIVE

To ascertain and describe the epidemiological pattern of RTIs in Iran for the years 2004 to 2007 and to compare the epidemiological trends of RTIs, before and 2 years after four road safety programs were put into place.

METHODS

A 4-year database from two sources, the traffic police and medico-legal data, was employed. The morbidity and death rates per 10,000 vehicles and per 100,000 populations were calculated as were the odds ratios (ORs) for before and after these national interventional programs. The four interventions concurrently/simultaneously put into place in 2005 were (1) enforcement of laws on the mandatory fastening of seat belts, (2) enforcement of the laws on use of motorcycle helmets, (3) enforcement of general traffic laws, and (4) mass media educational campaigns on national radio and television.

FINDINGS

There was a significant decrease in RTI-related death and morbidity rates in Iran, after the intervention programs were conducted (P < 0.001). The death rate decreased from 38.2 per 100,000 in 2004 to 31.8 in 2007 (OR = 0.83, 95% CI = 0.82-0.85). The death rate per 10,000 vehicles also showed a significant decline from 24.2 to 13.4 (OR = 0.56, 95% CI = 0.55-0.57). Similar reductions were seen among nonfatal RTIs.

CONCLUSION

These findings demonstrate the role of traffic police interventions, initiated simultaneously on a national level, in RTI prevention. Though these reductions may not be solely attributable to the interventions implemented, they do highlight the importance of the contribution made by law enforcement and mass education campaigns.

Occupational stress and work-related unintentional injuries among Iranian car manufacturing workers

This study in 2004 and 2005 aimed to present the pattern of job stress among car manufacturing workers in one factory in the Islamic Republic of Iran, and to assess its relationship with occupational injuries. Data were collected from 608 male workers (508 at-risk general workers and 100 with injuries in the last year). Job stress was assessed by the Belkic occupational stress index. The prevalence of job stress was 21.3%. The main occupational stressors were time pressure (78.5%), mode of payment and evaluation (56.4%), and interaction with people and machines (41.3%). The risk of injury among those with job stress was significantly higher than those without job stress (OR = 2.0; 95% CI: 1.20-3.30). Job stress was responsible for 11.9% of all occupational injuries in this group.

Epidemiology of deaths from injuries in the Islamic Republic of Iran

A 1-year study of fatal injuries was carried out in 10 provinces of the Islamic Republic of Iran based on a population of 16 740 637 in 2000-01. All reported deaths were compared and validated with other sources of death registration. Out of 66 846 deaths, 9733 (58/100 000) resulted from injuries. Overall, 14.9% of all deaths with 26.9% of years of lost life were from injuries. Most fatal injuries were unintentional (48.0/100 000). Deaths from traffic injuries (30.0/100 000) are the highest in the world. Of 1693 intentional fatal injuries, 61% were due to suicide, at a mean age of 29 years.

Children's indoor and outdoor play patterns in Ahwaz City: implications for injury prevention

A cross-sectional study in Ahwaz city, Islamic Republic of Iran, described children's indoor and outdoor play patterns. A total of 952 pupils aged 7 and 9 years and 942 parents completed questionnaires. Children's favourite activities were: playing football (22.3%), cycling (13.2%) and watching television (12.3%). This differed from those perceived by the parents who reported watching television (20.3%), playing football (13.3%) and playing in street (11.4%). Children reported their favourite places to play were: street (27.4%), park/playground (18.3%) and home (17.8%). There were significant differences in play patterns by age and sex. The play patterns of older children and boys exposed them to more hazardous situations than younger children and girls.

Epidemiology of children’s cycling injuries in Ahwaz, Islamic Republic of Iran

A one-year study was carried out in Ahwaz, Islamic Republic of Iran to investigate the epidemiology of children’s cycling injuries. Children 15 years old or younger taken to the accident and emergency [A and E] departments of all urban hospitals due to cycling injury were investigated, and their parents interviewed by questionnaire. During the study, 1079 children presented to A and E departments with cycling injuries [78.8% boys and 21.2% girls], representing 4.9% of all children presenting with injuries. The most frequent injury sites were the street [51.9%] and the home [42.3%], and the head was the part of the body most frequently injured [55.0%]. None of the injured children was using a cycling helmet at the time of injury. This study suggests mandatory helmet use, safety regulations and educational programmes for bicycle riders should be established in our community.

Parental permission for children's independent outdoor activities. Implications for injury prevention

BACKGROUND

Parental supervision is an important factor related to childhood injuries. However, little research has been done on; what outdoor activities children believe they are allowed or their parents allow them to do; parents' ideas about the age children can do activities, and the age they would allow their children to do them. This study described children's independent outdoor activities after-school, comparing age groups (school year 5 and 3), boys with girls, and the less socio-economically well off with the better off.

METHODS

A cross-sectional study using questionnaires completed by 476 children aged seven and nine years and 471 parents in nine primary schools in Newcastle-upon-Tyne, England.

RESULTS

Children reported they were permitted many outdoor activities such as cycling (78.8%), playing (78.6%) and roller skating in the street (62.7%). Parents of older children, boys, and more socio-economically deprived children were more likely than their comparison groups to allow children to do outdoor activities independently e.g. 34% of 9-year-olds were allowed to cross a road without an adult compared with 8% of 7-year-olds. Mostly, parents of boys and socio-economically deprived children, perceived children can do outdoor activities slightly younger than parents of girls and the socio-economically better off.

CONCLUSION

Children and parents value and support children's independent outdoor activity. Differences in children's and parents' understanding of what activities are permissible and in their judgements about the appropriate age for children's independent activities, may partly underline variations by sex, age and socio-economic status in injury patterns.

Epidemiology of children's cycling injuries in Ahwaz, Islamic Republic of Iran

A one-year study was carried out in Ahwaz, Islamic Republic of Iran to investigate the epidemiology of children's cycling injuries. Children 15 years old or younger taken to the accident and emergency (A&E) departments of all urban hospitals due to cycling injury were investigated, and their parents interviewed by questionnaire. During the study, 1079 children presented to A&E departments with cycling injuries (78.8% boys and 21.2% girls), representing 4.9% of all children presenting with injuries. The most frequent injury sites were the street (51.9%) and the home (42.3%), and the head was the part of the body most frequently injured (55.0%). None of the injured children was using a cycling helmet at the time of injury. This study suggests mandatory helmet use, safety regulations and educational programmes for bicycle riders should be established in our community

Pattern of dietary behaviour and obesity in Ahwaz, Islamic Republic of Iran

To study behavioural factors associated with diet and to investigate body mass index distribution, a cross-sectional survey was carried out in Ahwaz. A composite dietary behaviour score obtained from self-reported responses to a 24-item food-frequency questionnaire was used to categorize eating habits as more/less healthy. Responders were 1600 heads of households from 150, 000 randomly selected residences. Less healthy diets were shown to be associated with age and economic status, and greater obesity with women and age [reversed after ages > 65 years]. Interventions targeted at less healthy eaters need to be evidence-based, and further research into factors determining access to healthy diets in developing communities is required.

Developmental risk factors for unintentional childhood poisoning

OBJECTIVE

To identify main risk factors for unintentional childhood poisoning in Ahwaz, Iran and to suggest possible causes and preventative measures.

METHODS

This is an epidemiological description and a case-control study. The study was undertaken in Ahwaz, Iran in 1996-1997. Cases were 100 children who were taken to one of the 17 Accident and Emergency Departments due to poisoning. For every case two controls were selected. Age, gender, hospital and date of attendance to Accident and Emergency Department were matched between cases and controls. All parents of the children were interviewed by using a questionnaire that included demographic and poisoning characteristic information.

RESULTS

Children without adult supervision (odds ratio = 4.8), and those with previous poisoning (odds ratio = 5.2) were at increased risk of poisoning (P < 0.05). Drug poisoning was more common among children (60%), and most poisoning occurred inside the home (89%). Boys (65%), and children aged 2-4 years (79%) had more poisoning than others. In 75% of cases, poisonous products were accessible.

CONCLUSION

Adequate parental supervision and safe packing, storage and disposal of potentially hazardous substances could be the most important activities for prevention of childhood poisoning. Furthermore, manufactures and traders must by law put certain toxic household products and drugs in child resistant containers, and mark toxic medicines with warning labels or signs.

Pattern of dietary behaviour and obesity in Ahwaz, Islamic Republic of Iran

To study behavioural factors associated with diet and to investigate body mass index distribution, a cross-sectional survey was carried out in Ahwaz. A composite dietary behaviour score obtained from self-reported responses to a 24-item food-frequency questionnaire was used to categorize eating habits as more/less healthy. Responders were 1600 heads of households from 150,000 randomly selected residences. Less healthy diets were shown to be associated with age and economic status, and greater obesity with women and age (reversed after ages > 65 years). Interventions targeted at less healthy eaters need to be evidence-based, and further research into factors determining access to healthy diets in developing communities is required.

Children's risk perception and parents' views on levels of risk that children attach to outdoor activities

OBJECTIVE

Higher rates of outdoor injuries are found in older children, boys and children from more deprived areas. Some of the causes of these variations have been studied in some age groups and in different situations. To study children's perception of safety and danger and parents' views on the level of risk that their children attach to outdoor activities comparing age groups, boys and girls, and the less economically well off with the better off in order to understand outdoor accidental injuries.

METHODS

A cross-sectional study, obtained information from children aged 7 and 9 (n=471) and their parents (n=416) were living in Newcastle upon Tyne by self-completed questionnaires. Nine schools in different socio-economic areas were selected. Children were asked to paste different stickers on to the pictures in the classrooms. The parents' questionnaires were delivered by children and then returned to school after completion. The deprivation of an individual was accessed by Z-score of the households.

RESULTS

Older children compared to younger ones, boys versus girls and more economically deprived children compared to less deprived children had less perception of the dangers of outdoor activities. For example, older children compared to younger ones were more likely to perceive crossing a busy road with their friends (38.0% vs. 26.4%, P=0.007) as being safe. Boys compared to girls were more likely to perceive climbing wall (31.5% vs. 13.2%, P<0.001) as being safe. More economically deprived children were more likely to perceive cycling without a helmet (25.8% vs. 11.2%, P<0.001) as being safe than less economically deprived children.

CONCLUSION

These findings may partly explain the higher rate of accidental injuries among older children, boys and more deprived children. The results may inform how education of primary schoolchildren about dealing with activities such as crossing a busy road, climbing walls and playing in street and how parents should be conscious of their children's outdoor activities.

Iranian rural health workers (behvarz) and risk factors of childhood injury

The role of health professionals in childhood injury prevention has been recognized. This study aimed to assess the knowledge of and attitudes to childhood injury epidemiology and prevention of behvarz [rural health workers]. A self-administered questionnaire was sent to 210 behvarz, randomly selected from rural areas of Khuzestan province. Many behvarz were not aware of the epidemiology of childhood injuries. However, they had positive attitudes towards all injury prevention activities. There was a positive correlation between their knowledge and attitude scores [P < 0.01]. Childhood injury prevention programmes should be included in the training of behvarz and covered by primary health care programmes in the Islamic Republic of Iran

Iranian rural health workers (behvarz) and risk factors of childhood injury

The role of health professionals in childhood injury prevention has been recognized. This study aimed to assess the knowledge of and attitudes to childhood injury epidemiology and prevention of behvarz (rural health workers). A self-administered questionnaire was sent to 210 behvarz, randomly selected from rural areas of Khuzestan province. Many behvarz were not aware of the epidemiology of childhood injuries. However, they had positive attitudes towards all injury prevention activities. There was a positive correlation between their knowledge and attitude scores (P < 0.01). Childhood injury prevention programmes should be included in the training of behvarz and covered by primary health care programmes in the Islamic Republic of Iran.

Deaths from unintentional injuries in rural areas of the Islamic Republic of Iran

Deathsfrom accidental injury in the rural areas of 13 provinces in the Islamic Republic of Iran from 1993 to 1994 were investigated. The crude mortality rate was 4.33 per 1000 and the number of deaths from unintentional injuries was 5213 [10.7% of all deaths]. There were more deaths among males than females [65.7 per 100, 000 versus 26.1 per 100, 000]. After the age of 1 year, over 65-year-olds had the highest average of deaths resulting from injuries [111.9 per 100, 000]. The leading causes of death were traffic accidents [55.0%], drowning [10.1%], falls [9.5%]and burns and scalding [9.5%]. Since most injuries are preventable, their reduction should be considered a priority

Deaths from unintentional injuries in rural areas of the Islamic Republic of Iran

Deaths from accidental injury in the rural areas of 13 provinces in the Islamic Republic of Iran from 1993 to 1994 were investigated. The crude mortality rate was 4.33 per 1000 and the number of deaths from unintentional injuries was 5213 (10.7% of all deaths). There were more deaths among males than females (65.7 per 100,000 versus 26.1 per 100,000). After the age of 1 year, over 65-year-olds had the highest average of deaths resulting from injuries (111.9 per 100,000). The leading causes of death were traffic accidents (55.0%), drowning (10.1%), falls (9.5%) and burns and scalding (9.5%). Since most injuries are preventable, their reduction should be considered a priority.

Childhood deaths from unintentional injuries in rural areas of Iran

OBJECTIVES

To determine the incidence of children's fatal unintentional injuries in rural areas of Iran.

SETTING

Thirteen provinces of Iran, with a total population of 11.3 million for 1993-94.

METHODS

A descriptive epidemiological study, which obtained information about all deaths using a questionnaire from 6267 Health Houses (rural health centres) for one year, 1993-94. Subjects were residents who died from unintentional injuries.

RESULTS

Crude mortality rate was 4.33 per 1000. The number of childhood deaths from unintentional injuries was 1832 (16.6% of all deaths), more among males than females (43.7 v 31.2 per 100,000). Those under 1 had the highest rate, 114.7 per 100,000. The top three causes of deaths were traffic accidents (37.5%), drowning (17.9%), and burns and scalds (12.1%).

CONCLUSIONS

During the past decade there has been a marked decline in deaths from infectious diseases in Iran. However, at present, a high proportion of childhood deaths in rural areas are from unintentional injuries. Because all age groups and both sexes are victims of unintentional injuries, and most injuries are preventable, they must be considered as a priority health problem in Iran.