Reza Alaghehbandan

Epidemiology of childhood burn injuries in Fars province, Iran.

Childhood burn injuries are a major environmental agent responsible for significant morbidity and mortality in Iran. Thus, the objective of this study was to analyze the epidemiology and current causative factors of hospitalized burn injuries among the approximately 1.6 million children between the ages of birth through 15 years residing in the Fars province of Iran. These data will be used as a basis for developing a targeted preventive program to protect children from burns. Epidemiologic data for 760 children, aged 0 to 15 years, admitted to the two burn centers of Shiraz University of Medical Sciences, over a 4-year period, 1994 to 1998, were collected and analyzed. The overall hospitalization rate was 11.8 per 100,000 person-years (PY). The sex ratio (boys/girls) was 1.38. About 60% were children aged 7 years or younger. Children aged 2 years had the highest burn incidence rate (36.9/100,000 PY). A total of 77.4% of the children had body surface area burns less than 40%. Scalds accounted for 46.2% of the burns, whereas 42.9% were caused by flame. Most of the burn injuries occurred at home (93%). There were 31 burns from suicide attempts among children aged 11 to 15 years (1.4/100,000 PY), showing a major public health problem for these children in our society. During the period of the study, 131 children died of the consequences of burns (2/100,000 PY). The epidemiology of childhood burn injuries in the Fars province is similar to that reported in other economically developing countries. It is suggested that a public health education campaign on this issue would help to reduce the incidence of childhood burn injuries in this region.

PREVALENCE OF INTESTINAL PARASITES IN A POPULATION IN SOUTH OF TEHRAN, IRAN

The aim of this study was to describe epidemiologic characteristics of intestinal parasites in a population in south of Tehran, Iran. A retrospective cross-sectional study of patients with suspicious intestinal parasitic infections referred to the Zakaria Razi Laboratory in Shahre-Ray, southern Tehran, Iran, was conducted from April 21, 2004 to October 20, 2005. All stool samples were examined and socio-demographic informations were retrieved. Of 4,371 referred patients, 466 (239 males and 227 females) were laboratory diagnosed with intestinal parasites, with a period prevalence of 10.7%. Blastocystis hominis (B. hominis) and Giardia lamblia (G. lamblia) were the most frequent intestinal parasites. More than half of patients aged (3) 18 years had a low level of educational attainment (e.g. illiterate, primary school, high school) (170/331, 54.1%). Further, majority of patients were homemakers (42.3%, 140/331) or workers (28.1%, 93/331) employed in various business settings such as food industry and construction. Findings of this study showed that intestinal parasitic infections are still a major public health challenge in Iran that needs to be addressed. We believe that public education, improving sanitation conditions of underdeveloped areas/communities, community involvement, and supporting evidence-based practice/programs are the major keys to success in preventing the spread of intestinal parasitic infections in Iran.

Epidemiology of suicide by burns in the Province of Isfahan, Iran

The aim of the study was to determine epidemiologic features and factors associated with suicidal behaviors by burns requiring hospitalization in the province of Isfahan, Iran. A prospective population-based study of all suicidal behaviors by burns requiring hospitalization was conducted in the province of Isfahan, Iran, from March 21, 2005 to March 20, 2006. Data were obtained from patients, family members, and/or friends through interviews during the course of hospitalization. A total of 89 patients ages 13 to 62 years with suicidal behaviors by burns were identified during the study period, representing an overall incidence rate of 2.9 per 100,000 persons-year (P-Y; 95% confidence interval 2.3–3.5 per 100,000 P-Y). Females (4.7 per 100,000 P-Y) had a higher rate of suicidal behavior by burns than males (1.2 per 100,000 P-Y; P < .001). The age-specific rate of suicidal behavior by burns peaked at age group 20 to 29 years (6.3 per 100,000 P-Y). Among the population aged 15 to 29 years, married women had a higher rate of suicidal behavior by burns (9.3 per 100,000 P-Y) than single women (6.6 per 100,000 P-Y). The highest rate of suicidal behavior by burns was found among the unemployed population (17.7 per 100,000 P-Y). The most frequent precipitating factor for suicidal behavior was a quarrel with a family member, relative, and/or friend (61.8%). Depression and anxiety disorders were the most frequent psychiatric comorbidities associated with suicidal behaviors. Mortality rate caused by suicidal behavior by burns was 1.4 per 100,000 P-Y. A high rate of suicidal behavior among young and mostly married women in the province of Isfahan is a tragedy and great concern. Social, cultural, and economical factors may contribute to suicidal behavior in Isfahan, and they need to be addressed through education, support, and commitment. Findings of this study can be used for implementation of a preventive program(s) to reduce the incidence of suicide among high risk groups.

Suicidal behavior by burns among adolescents in Kurdistan, Iran: a social tragedy

The aim of this study was to identify the epidemiologic features and current etiological factors of suicidal behavior by burns among adolescents in Kurdistan, Iran. A prospective population-based study was carried out on patients with suicidal behaviors by burns requiring hospitalization among adolescents during 2000-2001 in Kurdistan, Iran. Sociodemographic and etiological factors were obtained through interviews with each patient or with family, relatives, or friends of the patient. Of 54 hospitalized burn patients aged 13-19 years, 40 (74.1%) patients were hospitalized because of suicidal behaviors by burns (6 males and 34 females). The incidence rate of these behaviors was 18.1 per 100,000 person-years (P-Y) and varied by gender (the incidence rates for females and males were 31.6 and 5.3 per 100,000 P-Y, respectively, p(2) = .000004). Most of the patients (60%) were single, 70% were homemakers, and 60% were either illiterate or had a low level of education. The most common precipitating factors for suicidal behaviors by burns were a quarrel with a family member or relative (47.5%) and marital conflict (17.5%). Most of the patients who were able to communicate regretted their suicidal behaviors (85.7%). Adolescents in Kurdistan are at higher risk of suicidal behaviors by burns compared to adolescents in other areas of Iran. Factors likely to be associated with suicidal behaviors by burns include lower socioeconomic status and family problems. These factors should be investigated further to better elucidate the etiology of these events. It also is necessary to implement prevention programs and strategies known to be effective to reduce the incidence of suicide in this region.

Characteristics of dermatophytoses among children in an area south of Tehran, Iran

The aim of this study was to determine the prevalence and etiological agents of dermatophytoses, and also their distribution according to age, gender, and body site among children in an area south of Tehran. A total of 382 children aged ≤16 years suspected to have dermatophytic lesions were examined over a period of 3 years (1999–2001). The incidence rate of dermatophytoses was 6.6 per 100 000 person‐years. Trichophyton violaceum was the most frequent isolate (28.3%) followed by Microsporum canis (15.1%), Epidermophyton floccosum (15.1%), T. rubrum (13.2%), T. mentagrophytes (11.3%), M. gypseum (7.5%), and T. verrucosum (5.7%). Tinea capitis (39.6%) was the most common type of infection, followed by tinea corporis (30.2%), tinea faciei (18.9%), and tinea manuum (7.5%).

Adverse Drug Events in Adult Patients Leading to Emergency Department Visits

Background Adverse drug events (ADEs) occurring in the community and treated in emergency departments (EDs) have not been well studied. Objective To determine the prevalence, severity, and preventability of ADEs in patients presenting at EDs in 2 university-affiliated tertiary care hospitals in the Canadian province of Newfoundland and Labrador. Methods A retrospective chart review was conducted on a stratified random sample (n = 1458) of adults (≥18 y) who presented to EDs from January 1 to December 31, 2005. Prior to the chart review, the sample frame was developed by first eliminating visits that were clearly not the result of an ADE. The ED summary of each patient was initially reviewed by 2 trained reviewers in order to identify probable ADEs. All eligible charts were subsequently reviewed by a clinical team, consisting of 2 pharmacists and 2 ED physicians, to identify ADEs and determine their severity and preventability. Results Of the 1458 patients presenting to the 2 EDs, 55 were determined to have an ADE or a possible ADE (PADE). After a sample-weight adjustment, the prevalence of ADEs/PADEs was found to be 2.4%. Prevalence increased with age (0.7%, 18–44 y; 1.9%, 45–64 y; 7.8%, ≥65 y) and the mean age for patients with ADEs was higher than for those with no ADEs (69.9 vs 63.8 y; p < 0.01). A higher number of comorbidities and medications was associated with drug-related visits. Approximately 29% of the ADEs/PADEs identified were considered to be preventable, with 42% requiring hospitalization. Cardiovascular agents (37.4%) were the most common drug class associated with ADEs/PADEs. Conclusions Adult ADE-related ED visits are frequent in Newfoundland and Labrador, and in many cases are preventable. Further efforts are needed to reduce the occurrence of preventable ADEs leading to ED visits.

Long-Term Prognosis and Comorbidities Associated with Psoriasis in the Newfoundland and Labrador Founder Population:

Background: Psoriasis is a common chronic immune-mediated inflammatory disorder of the skin with several associated comorbidities. Objective: To assess the prevalence of comorbidities in a cohort of psoriasis patients within the Canadian province of Newfoundland and Labrador (NL). Methods: This cross-sectional observational study investigated hospital-coded comorbidities associated with psoriasis in comparison to the general NL hospitalized population. Results: Patients died significantly younger than the general population, with patients having an earlier disease onset (≤ 25 years) dying at a younger age than those with a later onset (> 25 years; 59.3 vs 71.2; p = .001). Patients were hospitalized more frequently for several system disorders than the general population, and a potential association was observed between prognostic factors such as age at onset, disease severity, and HLA-Cw6 genotype and certain comorbid conditions. Conclusion: This study supports an association between psoriasis and other conditions, such as circulatory and endocrine diseases.

Suicidal Behavior by Burns in the Province of Fars, Iran

BACKGROUND While suicide by burns is a relatively uncommon form of suicide in developed countries, it is one of the most common methods of suicide in the Middle East region including Iran. AIMS To describe epidemiologic characteristics of suicidal behaviors by burns in the province of Fars, Iran. METHODS A prospective population-based study of all suicidal behaviors by burns requiring hospitalization was conducted in the province of Fars, Iran, from March 21, 2005 to March 20, 2006. Data were obtained from patients, family members, and/or significant others through interviews during the course of hospitalization. RESULTS A total of 125 patients with suicidal behavior by burns requiring hospitalization were identified during the study period, representing an overall incidence rate of 4.3 per 100,000 (95% Confidence Interval [CI]: 3.6-5.1). Females (6.2 per 100,000) had a higher rate of suicidal behavior by burns than males (2.4 per 100,000; p < .001). The age-specific rate of suicidal behavior by burns peaked at age 20-29 years (10.1 per 100,000). The rate of suicidal behavior by burns was higher among single (7.2 per 100,000) vs. married persons (4.2 per 100,000; p = 0.03). Single males aged 20-39 years and young married women aged 15-29 years were at greatest risk of suicidal behavior by burns. The most common precipitating factor (74.4%) for suicidal behavior was a quarrel with a family member, a relative, and/or a friend. CONCLUSIONS The high rate of suicidal behavior by burns among young/married women in Fars is of concern. Social, cultural, and economic factors may contribute to suicidal behavior and need to be addressed through education, support, and commitment.

Obesity predicts primary health care visits: a cohort study.

The objective of this study was to explore the relationship between body mass index (BMI), its association with chronic disease, and its impact on health services utilization in the province of Newfoundland and Labrador, Canada, from 1998 to 2002. A data linkage study was conducted involving a provincial health survey linked to 2 health care use administrative databases. The study population comprised 2345 adults between the ages of 20 and 64 years. Self-reported height and weight measures and other covariates, including chronic diseases, were obtained from a provincial survey. BMI categories include: normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese class I (BMI 30-34.9), obese class II (BMI ≥ 35), and obese class III (BMI ≥ 40). Survey responses were linked with objective physician and hospital health services utilization over a 5-year period. Weight classifications in the study sample were as follows: 37% normal, 39% overweight, 17% obese, and 6% morbidly obese. The obese and morbidly obese were more likely to report having serious chronic conditions after adjusting for age and sex. Only the morbidly obese group (BMI ≥ 35 kg/m(2)) had a significantly higher number of visits to a general practitioner (GP) over a 5-year period compared to the normal weight group (median 22.0 vs. 17.0, P<0.05). Using multivariate models and controlling for the number of chronic conditions and other relevant covariates, being morbidly obese remained a significant predictor of GP visits (P<0.001), but was not a predictor for visits to a specialist or any type of hospital use. The increase in the prevalence of obesity is placing a burden at the primary health care level. More resources are needed in order to support GPs in their efforts to manage and treat obese adults who have associated comorbidities.

Suicide attempts and associated factors in Newfoundland and Labrador, 1998-2000.

Objective: This study examined the epidemiology and associated factors for suicide attempts requiring hospitalization in the province of Newfoundland and Labrador. Method: We extracted data from the provincial hospital separation database. Outcome measures included incidence rates (IRs) of suicide attempts by age, sex, and geographical region of residence. We also analyzed sociodemographic data to determine associated factors. Results: A total of 978 patients who were hospitalized owing to suicide attempts were identified for 1998–2000, giving an overall IR of 68.7 per 100 000 person-years (P-Y). The age-specific rate for people aged 15 to 19 years was much greater, at 143.0 per 100 000 P-Y. The overall female-to-male ratio was 1.3, with an attempted suicide rate of 76.1 per 100 000 P-Y for female patients and 60.3 per 100 000 P-Y for male patients (P = 0.001). Labrador (210.2 per 100 000 P-Y), a region with a high Aboriginal population, had a higher rate of suicide attempts, compared with the island portion of the province (59.0 per 100 000 P-Y) (P < 0.001). More than 70% of hospitalizations were associated with psychiatric diagnosis. Poisoning was the most frequent method of attempting suicide. Higher IRs of suicide attempts were found among people who were divorced or separated and among those who were less educated (P < 0.001). Conclusions: Suicide attempt represents a significant public health concern in the province, particularly in Labrador. An increased risk of suicide attempts was associated with single status, female sex, younger age (teen or young adult), and low educational level during the index attempt. Further research is needed to explicate these findings and increase our understanding of attempted suicide.