Ali Montazeri

The Short Form Health Survey (SF-36): translation and validation study of the Iranian version.

This was a large population-based study to develop and validate the Iranian version of the Short Form Health Survey (SF-36) for use in health related quality of life assessment in Iran. A culturally comparable questionnaire was developed and pilot tested. Then, the Iranian version of the SF-36 was administered to a random sample of 4163 healthy individuals aged 15 years and over in Tehran. The mean age of the respondents was 35.1 (SD=16.0) years, 52% were female, mostly married (58%) and the mean years of their formal education was 10.0 (SD=4.5). Reliability was estimated using the internal consistency and validity was assessed using known groups comparison and convergent validity. In addition factor analysis was performed. The internal consistency (to test reliability) showed that all eight SF-36 scales met the minimum reliability standard, the Cronbach’s α coefficients ranging from 0.77 to 0.90 with the exception of the vitality scale (α=0.65). Known groups comparison showed that in all scales the SF-36 discriminated between men and women, and old and the young respondents as anticipated (all p values less than 0.05). Convergent validity (to test scaling assumptions) using each item correlation with its hypothesized scale showed satisfactory results (all correlation above 0.40 ranging from 0.58 to 0.95). Factor analysis identified two principal components that jointly accounted for 65.9% of the variance. In general, the Iranian version of the SF-36 performed well and the findings suggest that it is a reliable and valid measure of health related quality of life among the general population.

The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version

BackgroundThe Hospital Anxiety and Depression Scale (HADS) is a widely used instrument to measure psychological morbidity in cancer patients. This study aimed to translate and test the reliability and validity of the Iranian version of the HADS.MethodsThe English language version of the HADS was translated into Persian (Iranian language) and was used in this study. The questionnaire was administered to a consecutive sample of 167 breast cancer patients and statistical analysis was performed to test the reliability and validity of the HADS.ResultsIn general the Iranian version of the HADS was found to be acceptable to almost all patients (99%). Cronbachs alpha coefficient (to test reliability) has been found to be 0.78 for the HADS anxiety sub-scale and 0.86 for the HADS depression sub-scale. Validity as performed using known groups comparison analysis showed satisfactory results. Both anxiety and depression sub-scales discriminated well between sub-groups of patients differing in clinical status as defined by their disease stage.ConclusionThis preliminary validation study of the Iranian version of the HADS proved that it is an acceptable, a reliable and valid measure of psychological distress among cancer patients.

Breast cancer in Iran: an epidemiological review.

Abstract:  Breast cancer is one of the most frequent malignancies among Iranian women, however; the epidemiological aspects of breast cancer among Iranian patients are uncertain. A literature review of the published articles from January 1998 to December 2005 was conducted using different search engines: MEDLINE, Scientific information data base of Academic Center for Education, Culture and Research, and over 2000 issues of 94 Persian medical journals. The headings “Breast Cancer,”“Breast Tumor,”“Breast Malignancy,” and “Breast Carcinoma” were combined with the word “Iran” to execute the search. In all, 85 full papers were reviewed. These findings showed that participants ranged from 15 to 84 years old, with those 40–49 being the most prevalent. The incidence of breast cancer in women was 22 per 100,000. The prevalence in this same population was 120 per 100,000. Stage I was diagnosed in 18%, stage II in 57% and stage III in 25% of the cases. About 72% of the patients were diagnosed with a tumor over 2 cm. Sixty‐three percent of the patients had lymph node involvement at the diagnostic time. Infiltrative ductal carcinoma was found to be the most common at 77% and lobular carcinoma the least at 5%. This review indicates that the epidemiological aspects of breast cancer in Iran are relatively well‐studied. Shortcomings in study of its clinical aspects are evident and need to be a central part of upcoming investigations.

The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions.

Study Design. Cross-cultural translation and psychometric testing were performed. Objectives. To cross-culturally translate the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and Quebec Back Pain Disability Scale (QDS) into Persian, and then investigate the psychometric properties of the Persian versions produced. Summary of Background Data. To the authors’ knowledge, there is no validated instrument to measure functional status in Persian-speaking patients with low back pain (LBP) in Iran. To our knowledge, the widely used back-specific measures, the ODI, RDQ, and QDS, have not been translated and validated for Persian-speaking patients with LBP. Methods. The translation and cross-cultural adaptation of the original questionnaires were performed in accordance with published guidelines. A total of 100 patients with chronic LBP were asked to complete a questionnaire booklet (the Persian versions of the ODI, RDQ, QDS, Short Form Health Survey (SF-36), and visual analog scale measure of pain). There were 31 randomly select patients with chronic LBP asked to complete the second questionnaire booklet 24 hours later. Results. The Cronbach-α for the ODI, RDQ, and QDS was 0.75, 0.83, and 0.92, respectively. The ODI, RDQ, and QDS showed excellent test-retest reliability (intraclass correlation coefficient = 0.91, 0.86, and 0.86, respectively) (P < 0.01). The correlation among the ODI, RDQ, QDS and physical functioning scales of the SF-36 was −0.66, −0.62, and −0.69, respectively (P < 0.001). The correlation among the ODI, RDQ, and QDS and visual analog scale was 0.54, 0.36, and 0.46, respectively (P < 0.001). Conclusions. The Persian versions of the ODI, RDQ, and QDS are reliable and valid instruments to measure functional status in Persian-speaking patients with LBP.They are simple and fast scales, and the use of them can be recommended in a clinical setting and future outcome studies in Iran.

Health related quality of life among adolescents with premenstrual disorders: a cross sectional study

BackgroundPremenstrual disorders usually refer to premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This study was designed to evaluate health-related quality of life (HRQOL) in a sample of Iranian adolescents with premenstrual disorders.MethodsThis was a cross sectional study. A sample of adolescent schoolgirls aged between 14 and 19 years were included in the study. Premenstrual disorders were indicated according to the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Health-related quality of life was measured using the Short Form Health Survey (SF-36). The data were analyzed in a descriptive fashion and were compared among subgroups of the study sample.ResultsIn all 602 female students were studied. All students reported at least one premenstrual symptom. Of these, 224 (37.2%) met the diagnostic criteria for premenstrual dysphoric disorder (PMDD). Comparing the SF-36 scores between female students with and without PMDD, it was found that there were significant differences between these two groups in all measures (P < 0.001) except for physical functioning (P = 0.274). These differences were more evident on role emotional, role physical, social functioning and bodily pain.ConclusionThe study findings affirm the fact that adolescents with premenstrual disorders suffer from poor health-related quality of life. In order to improve quality of life in female adolescents appropriate support should be provided for this population especially for those who suffer from more severe premenstrual disorders.

Road-traffic-related mortality in Iran: a descriptive study

Road traffic accidents are considered to be the second highest cause of mortality in Iran. A study was conducted to describe road-traffic-related mortality data in Iran in a given period. All Iranian mortality data on road traffic accidents between March 1999 and 2000 (one complete Iranian calendar year) were obtained. The main variables studied were deceaseds gender, age, education level, status (i.e. driver, car occupant, etc.), cause and place of death. A total of 15?482 individuals died from road traffic accidents in Iran in the study period. A disproportionate number of deceased individuals were male (79%), mostly aged 40 years or less (65%), and who were pedestrians or car occupants (62%). Head injury was the most common cause of road-traffic-related mortality (66%) in males and females of all ages. Following road traffic accidents, 57% of deaths occurred pre-hospital. Head injury is the most common single cause of mortality attributable to road traffic accidents in Iran, and since most deaths occur pre-hospital, it seems many are preventable. To overcome this major public health problem, there is an urgent need to develop a comprehensive injury control policy and strategy in Iran.

Determinants of health-related quality of life in elderly in Tehran, Iran

BackgroundAs Iran started to experience population ageing, it is important to consider and address the elderly peoples needs and concerns, which might have direct impacts on their well-being and quality of life. There have been only a few researches into different aspects of life of the elderly population in Iran including their health-related quality of life. The purpose of this study was to measure health-related quality of life (HRQoL) of elderly Iranians and to identify its some determinant factors.MethodsThis was a cross-sectional survey of a random sample of community residents of Tehran aged 65 years old and over. HRQoL was measured using the Short From Health Survey (SF-36). The study participants were interviewed at their homes. Uni-variate analysis was performed for group comparison and logistic regression analysis conducted to predict quality of life determinants.ResultsIn all, 400 elderly Iranian were interviewed. The majority of the participants were men (56.5%) and almost half of the participants were illiterate (n = 199, 49.8%). Eighty-five percent of the elderly were living with their family or relatives and about 70% were married. Only 12% of participants evaluated their economic status as being good and most of people had moderate or poor economic status. The mean scores for the SF-36 subscales ranged from 70.0 (SD = 25.9) for physical functioning to 53.5 (SD = 29.1) for bodily pain and in general, the respondents significantly showed better condition on mental component of the SF-36 than its physical component (mean scores 63.8 versus 55.0). Performing uni-variate analysis we found that women reported significantly poorer HRQoL. Multiple logistic regression analysis showed that for the physical component summary score of the SF-36, age, gender, education and economic status were significant determinants of poorer physical health-related quality of life; while for the mental component summary score only gender and economic status were significant determinants of poorer mental health-related quality of life. The analysis suggested that the elderly peoples economic status was the most significant predictor of their HRQoL.ConclusionThe study findings, although with a small number of participants, indicate that elderly people living in Tehran, Iran suffer from relatively poor HRQoL; particularly elderly women and those with lower education. Indeed to improve quality of life among elderly Iranians much more attention should be paid to all aspects of their life including their health, and economic status.

Psychological distress among Bam earthquake survivors in Iran: a population-based study

BackgroundAn earthquake measuring 6.3 on the Richter scale struck the city of Bam in Iran on the 26th of December 2003 at 5.26 A.M. It was devastating, and left over 40,000 dead and around 30,000 injured. The profound tragedy of thousands killed has caused emotional and psychological trauma for tens of thousands of people who have survived. A study was carried out to assess psychological distress among Bam earthquake survivors and factors associated with severe mental health in those who survived the tragedy.MethodsThis was a population-based study measuring psychological distress among the survivors of Bam earthquake in Iran. Using a multi-stage stratified sampling method a random sample of individuals aged 15 years and over living in Bam were interviewed. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12).ResultsIn all 916 survivors were interviewed. The mean age of the respondents was 32.9 years (SD = 12.4), mostly were males (53%), married (66%) and had secondary school education (50%). Forty-one percent reported they lost 3 to 5 members of their family in the earthquake. In addition the findings showed that 58% of the respondents suffered from severe mental health as measured by the GHQ-12 and this was three times higher than reported psychological distress among the general population. There were significant differences between sub-groups of the study sample with regard to their psychological distress. The results of the logistic regression analysis also indicated that female gender; lower education, unemployment, and loss of family members were associated with severe psychological distress among earthquake victims.ConclusionThe study findings indicated that the amount of psychological distress among earthquake survivors was high and there is an urgent need to deliver mental health care to disaster victims in local medical settings and to reduce negative health impacts of the earthquake adequate psychological counseling is needed for those who survived the tragedy.

Translation and validation study of Chinese versions of the neck disability index and the neck pain and disability scale.

Study Design. Cultural translation and psychometric testing. Objective. To translate and validate the Iranian versions of the Neck Disability Index (NDI-IR) and the Neck Pain and Disability Scale (NPDS-IR). Summary of Background Data. The widely used the NDI and the NPDS scales have not been translated and validated for Persian-speaking patients with neck pain. This was to provide a validated instrument to measure functional status in patients with neck pain in Iran. Methods. The translation and cultural adaptation of the original questionnaires were carried out in accordance with the published guidelines. One hundred and eighty-five patients with neck pain were participated in the study. Patients were asked to complete a questionnaire booklet including the NDI-IR, the NPDS-IR, the Iranian SF-36, and a visual analog scale (VAS) of pain. To carry out the test-retest reliability, 30 randomly selected patients with neck pain were asked to complete the questionnaire booklet 48 hours later for the second time. Results. Cronbach &agr; coefficient for the NDI-IR was 0.88 and for the 4 subscales of the NPDS-IR was found to be satisfactory (ranging from 0.74 to 0.94). The NDI-IR and the NPDS-IR subscales showed excellent test-retest reliability (intraclass correlation coefficient ranged from 0.90 to 0.97; P < 0.01). The correlation between the NDI-IR and the NPDS-IR subscales and functional scales of the SF-36 showed desirable results, indicating a good convergent validity (Pearson correlation coefficients ranged from −0.31 to −0.70). The correlation between the NDI-IR and the VAS was 0.71 and between the NPDS-IR subscales and the VAS ranged from 0.63 to 0.79 (P < 0.01). Conclusion. The Iranian versions of the NDI and NPDS are reliable and valid instruments to measure functional status in Persian-speaking patients with neck pain in Iran. They are simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian speaking communities.

The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version

BackgroundThe Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument to measure postnatal depression. This study aimed to translate and to test the reliability and validity of the EPDS in Iran.MethodsThe English language version of the EPDS was translated into Persian (Iranian language) and was used in this study. The questionnaire was administered to a consecutive sample of 100 women with normal (n = 50) and caesarean section (n = 50) deliveries at two points in time: 6 to 8 weeks and 12 to 14 weeks after delivery. Statistical analysis was performed to test the reliability and validity of the EPDS.ResultsOverall 22% of women at time 1 and 18% at time 2 reported experiencing postpartum depression. In general, the Iranian version of the EPDS was found to be acceptable to almost all women. Cronbachs alpha coefficient (to test reliability) was found to be 0.77 at time 1 and 0.86 at time 2. In addition, test-rest reliability was performed and the intraclass correlation coefficient was found to be 0.80. Validity as performed using known groups comparison showed satisfactory results. The questionnaire discriminated well between sub-groups of women differing in mode of delivery in the expected direction. The factor analysis indicated a three-factor structure that jointly accounted for 58% of the variance.ConclusionThis preliminary validation study of the Iranian version of the EPDS proved that it is an acceptable, reliable and valid measure of postnatal depression. It seems that the EPDS not only measures postpartum depression but also may be measuring something more.