Classification-based data mining for identification of risk patterns associated with hypertension in Middle Eastern population A 12-year longitudinal study

Hypertension is a critical public health concern worldwide. Identification of risk factors using traditional multivariable models has been a field of active research. The present study was undertaken to identify risk patterns associated with hypertension incidence using data mining methods in a cohort of Iranian adult population. Data on 6205 participants (44 men) age > 20 years, free from hypertension at baseline with no history of cardiovascular disease, were used to develop a series of prediction models by 3 types of decision tree (DT) algorithms. The performances of all classifiers were evaluated on the testing data set. The Quick Unbiased Efficient Statistical Tree algorithm among men and women and Classification and Regression Tree among the total population had the best performance. The C-statistic and sensitivity for the prediction models were (0.70 and 71) in men, (0.79 and 71) in women, and (0.78 and 72) in total population, respectively. In DT models, systolic blood pressure (SBP), diastolic blood pressure, age, and waist circumference significantly contributed to the risk of incident hypertension in both genders and total population, wrist circumference and 2-h postchallenge plasma glucose among women and fasting plasma glucose among men. In men, the highest hypertension risk was seen in those with SBP > 115mm Hg and age > 30 years. In women those with SBP > 114 mmHg and age>33 years had the highest risk for hypertension. For the total population, higher risk was observed in those with SBP > 114mm Hg and age > 38 years. Our study emphasizes the utility of DTs for prediction of hypertension and exploring interaction between predictors. DT models used the easily available variables to identify homogeneous subgroups with different risk pattern for the hypertension. Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All

An application of association rule mining to extract risk pattern for type 2 diabetes using tehran lipid and glucose study database

Background: Type 2 diabetes, common and serious global health concern, had an estimated worldwide prevalence of 366 million in 2011, which is expected to rise to 552 million people, by 2030, unless urgent action is taken. Objectives: The aim of this study was to identify risk patterns for type 2 diabetes incidence using association rule mining (ARM). Patients and Methods: A population of 6647 individuals without diabetes, aged � 20 years at inclusion, was followed for 10-12 years, to analyze risk patterns for diabetes occurrence. Study variables included demographic and anthropometric characteristics, smoking status, medical and drug history and laboratory measures. Results: In the case of women, the results showed that impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in combination with body mass index (BMI) � 30 kg/m2, family history of diabetes, wrist circumference > 16.5 cm and waist to height � 0.5 can increase the risk for developing diabetes. For men, a combination of IGT, IFG, length of stay in the city (> 40 years), central obesity, total cholesterol to high density lipoprotein ratio � 5.3, low physical activity, chronic kidney disease and wrist circumference > 18.5 cm were identified as risk patterns for diabetes occurrence. Conclusions: Our study showed that ARM is a useful approach in determining which combinations of variables or predictors occur together frequently, in people who will develop diabetes. The ARM focuses on joint exposure to different combinations of risk factors, and not the predictors alone. © 2015, Research Institute For Endocrine Sciences and Iran Endocrine Society

Measuring psychosocial exposures: Validation of the Persian of the copenhagen psychosocial questionnaire (COPSOQ)

Background: The effect of psychosocial work environment on personal and organizational aspects of employees is well-known; and it is of fundamental importance to have valid tools to evaluate them. This study aims to evaluate the reliability and validity of the Persian version of Copenhagen Psychosocial Questionnaire (COPSOQ). Methods: The questionnaire was translated into Persian and then back translated into English by two translators separately. The wording of the final Persian version was established by comparing the translated versions with the original questionnaire. One hundred three health care workers completed the questionnaire. Chronbach's alpha was calculated, and factor analysis was performed. Results: Factor analysis revealed acceptable validity for the five contexts of the questionnaire. Cronbach's alpha ranged from 0.73 to 0.82 in different contexts. Conclusion: This study revealed that the Persian version of COPSOQ is a reliable and valid instrument for measuring psychosocial factors at work

Sleep hygiene in medical students in Tehran; do they learn to attend to their own health?

Background: Poor sleep quality in medical students may negatively affect their professional training and deteriorate neurocognitive and academic performance. Objectives: In this study, we aim to determine the prevalence and determinants of poor sleep quality and its scales in a group of medical students in Tehran, Iran in 2017. Methods: In this cross-sectional study, Pittsburgh Sleep Quality Index (PSQI) was completed by 154 medical students in Tehran, Iran. Demographic characteristics were also gathered. Global PSQI and scales scores were calculated. Results: Median Global PSQI score was 5. Poor sleep quality was observed in 65 (42) students. Participants scored worst in sleep duration and daytime dysfunction scales, and 84.4 of the total participants reported some degree of daytime dysfunction. More than 90 of the participants reported no use of sleep medication. Neither of the variables sex, age, place of residence, being a freshman or having a history of sleep problems showed any significant association with sleep quality. When evaluating the scales, sleep duration problem was mostly observed in freshmen (P = 0.02), while medication use and daytime dysfunction were more common in second-year students (P = 0.04 and P = 0.01, respectively). Conclusions: The prevalence of poor sleep quality was high in this group of medical students in Tehran. The problem was largely observed in sleep duration and daytime dysfunction subscales of sleep quality. © 2020, Author(s)

Decision tree-based modelling for identification of potential interactions between type 2 diabetes risk factors: A decade follow-up in a Middle East prospective cohort study

Objective: The current study was undertaken for use of the decision tree (DT) method for development of different prediction models for incidence of type 2 diabetes (T2D) and for exploring interactions between predictor variables in those models. Design: Prospective cohort study. Setting: Tehran Lipid and Glucose Study (TLGS). Methods: A total of 6647 participants (43.4 men) aged >20 years, without T2D at baselines ((1999- 2001) and (2002-2005)), were followed until 2012. 2 series of models (with and without 2-hour postchallenge plasma glucose (2h-PCPG)) were developed using 3 types of DT algorithms. The performances of the models were assessed using sensitivity, specificity, area under the ROC curve (AUC), geometric mean (G-Mean) and F-Measure. Primary outcome measure: T2D was primary outcome which defined if fasting plasma glucose (FPG) was �7 mmol/L or if the 2h-PCPG was �11.1 mmol/L or if the participant was taking antidiabetic medication. Results: During a median follow-up of 9.5 years, 729 new cases of T2D were identified. The Quick Unbiased Efficient Statistical Tree (QUEST) algorithm had the highest sensitivity and G-Mean among all the models for men and women. The models that included 2h-PCPG had sensitivity and G-Mean of (78 and 0.75) and (78 and 0.78) for men and women, respectively. Both models achieved good discrimination power with AUC above 0.78. FPG, 2h-PCPG, waist-toheight ratio (WHtR) and mean arterial blood pressure (MAP) were the most important factors to incidence of T2D in both genders. Among men, those with an FPG�4.9 mmol/L and 2h-PCPG�7.7 mmol/L had the lowest risk, and those with an FPG>5.3 mmol/L and 2h-PCPG>4.4 mmol/L had the highest risk for T2D incidence. In women, those with an FPG�5.2 mmol/L and WHtR�0.55 had the lowest risk, and those with an FPG>5.2 mmol/L and WHtR>0.56 had the highest risk for T2D incidence. Conclusions: Our study emphasises the utility of DT for exploring interactions between predictor variables

Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks

Background: Neonatal mortality accounts for more than 47 of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks. Methods: We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country. Results: We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer. Conclusions: To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer. © 2021, The Author(s)

Design and validation of an instrument for evaluating the social capital of faculty members

Background: Social capital refers to the degree and quality of connections in a certain community. The effect of social capital on productivity, absenteeism, and health of employees is reported by studies conducted in a variety of work environments. Objectives: The current study aimed to, firstly, provide a better understanding of social capital conceptualized by the faculty members in Iran and, secondly, developing an instrument for its evaluation. Methods: In this mixed-method study, initially, a search was performed to identify relevant literature for determinants of social capital at the workplace. Then, a semi-structured interview was performed with faculty members and experts. Afterward, a group of experts evaluated the obtained list of subscales and commented on the degree of relevance, importance, and grouping. Then, the questionnaire was developed based on the finalized list of determinants and expert opinions. Ten faculty members evaluated the questionnaire, comprised of 38 items, and after obtaining their approval, the questionnaire was completed by 32 faculty members from different universities. Results: Identified determinants were categorized into five categories of ability and tendency to participate in workplace activities, trust in the workplace, social cohesion, access to information, and participation in groups and networks. Exploratory factor analysis revealed a structure corresponding to the theoretical dimensions previously extracted, and Cronbach�s alpha ranged from 0.724 to 0.959. Conclusions: According to our findings, the social capital of faculty members can be evaluated by measuring ability and willingness to participate in workplace activities, trust and social cohesion in the workplace, access to workplace information, and membership in work-related groups and networks. We also provided a 38-item questionnaire for its evaluation, with acceptable internal consistency and conformity with the theoretical constructs. Copyright © 2021, Author(s)

Randomized controlled trial: The effects of short message service on mothers� oral health knowledge and practice

Objective: Mobile health has provided an effective means to educate, empower, and provide access to health services for individuals and groups. This study aimed to compare the effects of gain-frame and loss-frame SMS on the knowledge and practice of mothers with children under the age of six years regarding pediatric oral health. Research design: This randomized controlled trial was conducted in kindergartens and preschool centers of Shiraz, Iran in 2016. There were 71 mothers in the gain-frame group, 66 in the loss-frame group and 74 in the control group. The data were collected before and three-four weeks after the intervention. Data analysis used descriptive statistics, independent t-test, ANOVA, Pearson correlation test, ANCOVA, and post-hoc LSD test (Least Significant Difference). Results: There was a significant difference between the control (8.83±2.03) and gain-frame (11.8±2.17, p<0.001) and loss-frame (12.09±1.94, p<0.001) groups for post-test knowledge scores. A difference was also observed between the control group (56.27±11.53) and gain-frame (60.8±7.77, p<0.001) and loss-frame (60.25±8.96, p<0.001) groups for post-test practice scores. No difference was found between the gain-frame and loss-frame groups for the post-test scores (p=0.69). Conclusion: Gain-frame and loss-frame SMS had similar impacts on the mothers� knowledge and practices about their children�s oral health. However, both improved the mothers� knowledge and practice. Therefore, regardless of the style of text message framing, this method may be useful for educating mothers. © BASCD 2020