Evaluating the Effect of Socio-Economic Status on DMFT Index in Children Aged 12 in Iran through Zero-Inflated Poisson Regression

Introduction: The most common index in dental studies is the decayed, missing, or filled teeth (dmft)/DMFT. Risk factor evaluation in order to investigate the significant factors that affect this DMFT in children has an important role in dental epidemiological studies. The aim of this study was to investigate the association between socioeconomic factors and dental caries. Materials and Methods:  This cross-sectional study was a part of a national survey for assessing the oral health status of Iranian citizens in 2012. The target population was children aged. The data and oral examination results were collected by the clinical examination form and trained calibrated dental group (dentists and hygienists). A zero-inflated Poisson regression model (ZIP) with a random effect was utilized for evaluating the effect of socioeconomic status on DMFT. Results:  In general, 1564 subjects were studied. From the entire subject in this study, the frequency of zero was 4176 (67%). The result of the ZIP model with random effect in zero part showed that socioeconomic status (OR = 1.97; P-value <0.001) had a significant effect on zero DMFT occurrences. The variance component of the random intercept in zero part was significant too (σ2 =17.11, P < 0.001). Conclusion: The zero-inflated Poisson model with random effect in zero part was fitted to this data. Children from lower socioeconomic classes experienced more DMFT. &nbsp

Total Healthcare Expenditures from the 2017 Iran’s National Households Income and Expenditure Survey: The Application of Two-Part Models

 Introduction: Although the precise estimates of healthcare expenditures are critical for health policy-makers, the right-skewed distribution and a substantial number of zero values of the measures of healthcare expenditure make such estimates challenging. The present study used conventional two-part (CTP) and marginalized two-part (MTP) models to handle the skewness and zero-inflation in expenditure distribution as two serious challenges. Materials and Methods: Data was used from the 2017 Households Income and Expenditure Survey (HIES; 38,252 households), a national cross-sectional study in Iran. CTP and MTP models were utilized to estimate the medical supplies, outpatient, inpatient and total medical expenditures. The rural-urban difference in total medical expenditures and other health services were also examined.   All data analyses were performed using SAS. For all tests, two-sided p-values <0.05 were interpreted as statistically significant.Results: The mean (SD) out-of-pocket spending for total healthcare was $143 ($488) per capita, and $182 ($650) and $105 ($239) for urban and rural areas, respectively. The mean (SD) medical supplies cost per capita was $48 ($240), and the mean (SD) of outpatient cost per capita and inpatient cost per capita were $61 ($245) and $34 ($294), respectively. Both CTP and MTP models suggested that urban population spent more money on total expenditures than rural populations (p<0.05). Although both models gave the same set of parameter estimates, the AIC indicated that the MTP-GG model was a more appropriate fit.Conclusion: The marginalized models provided better estimates in documenting inequalities/healthcare expenditures. Unlike the CTP model, the estimation of covariate effects on the marginal mean of the whole population via using the MTP model is straightforward. However, the MTP model may not outperform the CTP model in all cases. The applications of such models need to be considered in the future research to provide better estimates/documentations of healthcare expenditure and healthcare inequalities. In addition, these findings suggest a substantial inequality in healthcare expenditures between urban and rural areas. Considering the differences in urbanity and rurality can be of interest to health economists and policymakers.     

Assessing the effect of shift work among petrochemical Industries staff at Mahshahr, Iran

This study aims to examine the effect of shift work on overweight and obesity, hypercholesterolemia and GHQ score (GHQ-28) as an indicator of psychological well-being in subjects working in petrochemical industry sited in Mahshahr, west of Iran. In This longitudinal study, population consisted of 2493 (1321 day workers and 1171 shift workers) whose mean ages were 46.18 years for day workers and 45.53 years for shift workers, during a four years period (from 2008 to 2011). All workers were investigated by Persian version of General Health Questionnaire-28 (GHQ-28) as screen tool. The serum cholesterol, height and weight were measured with definitions of hypercholesterolemia as serum total cholesterol 220 mg/dl, overweight and obesity as body mass index (BMI) 25 kg/m2 .A conditional joint random effects models approach was applied to explore the effect of shift working on multivariate responses over this period of time. Shift work was significantly associated with GHQ score and BMI. Results indicated that the shift workers had about 0.65 higher mean scores of GHQ than the day workers and 0.18 higher BMI (95% CI 0.17 to 1.14) and (95% CI 0.05 to 0.27), respectively. Shift work did not show significant relationship with hypercholesterolemia (95% CI -0.27 to 0.009). The results of the present study suggest that shift work may be directly responsible for increased body fatness and is associated with psychological problems

Concerns of Women of Reproductive Age with Multiple Sclerosis: A Qualitative Study

AbstractIntroduction: Psychological disorders are the leading cause of disabilities, socialharms, and reduced quality of life in patients with Multiple Sclerosis (MS). Thisqualitative study was conducted to describe the concerns of females with MS.Methods: In this qualitative study, 16 females with MS at the reproductive agewith medical records at the MS Society of Tabriz were selected using the purposivesampling technique and underwent semi-structured in-depth individual interviews.All interviews were recorded, transcribed, and analyzed using conventional contentanalysis.Results: In this study, 23 codes were identified from transcribed interviews andcategorized to two sub-categories, fears and feelings. These two sub-categories formedthe main category, named concerns.Conclusions: Regarding concerns of these patients, their regular health monitoring byphysicians and healthcare providers is recommended in an attempt to alleviate theseconcerns

Determinants of Households Health Expenditure : A Population-Based Study

Studies have shown that the determinants of households’ health expenses are in doubt in Iran. Patients deal with pain and trouble while facing with increasing health services payments. Thus, their quality of life decreases in all aspects. The objective of this research lies on the analysis of Iranian households’ health expenditure (HHE) using multilevel modelling methodology. Data collected through Household Income and Expenditure Survey by Statistical Center of Iran. A total of 38299 Iranian households were sampled. This nationally-representative cross-sectional survey collected information from March 2013 to March 2014 using a three-staged cluster sampling method. Descriptive statistics and multilevel modelling employed for data analysis. Data analysis was performed using R programming language version 3.3.2 and SPSS version 20. P < 0.05 was considered as statistically significant. Our findings indicated that families spent about seven percent of their annual income on HHE. Annual median of medical expenses and income per capita were 1020 and 44460 thousand rials, respectively. Family income, age, and activity status of household head had significant positive effects on annual HHE (P<0.05). Female headed families spent about 10% less health expenses than male headed households annually (P<0.001). Although, rural and illiterate heads experienced lower health expenses, their effects were not statistically substantial (P>0.05). More attention on HHE will be needed from researchers and politicians, as it has proved to be no easy matter in the low-income and deprived areas

How to test normality distribution for a variable: a real example and a simulation study

Many commonly used statistical methods require that the population distribution be nearly normal. Unfortunately, in some papers the one-sample Kolmogorov-Smirnov test has been used for testing normality while the assumptions of applying this test are not satisfied. To conduct this test, it is assumed that the population distribution is fully specified. In practical situation where the mean and SD of population distribution is not specified in advance, one can use a modification of the K-S test for checking the normality assumption which is called, Lilliefors test. In this paper, we explain the method of computing this test with some common statistical softwares such as SPSS, S-PLUS, R and StatXact and utilize a dermatology dataset from Skin Research Center of Shohada-e-Tajrish hospital to illustrate how the use of the one-sample K-S (with the mean and SD estimated from the sample) instead of its modification can be misleading in practice. We also use Monte Carlo simulation to compare the approximate power of the one-sample K-S test (with the estimated population mean and SD) with Lilliefors test in some common specified continuous distributions. The result indicates that one should not use the one-sample K-S test for assessing the normality assumption in practical situation.

An Exploration of the Maternal Experiences of Breast Engorgement and Milk Leakage after Perinatal Loss

Introduction and Purpose: Perinatal loss is one of the toughest events of life. Physiological milk secretion after perinatal loss adds to complicacy of the hardships of the event. The present study is aimed at exploring women’s experience with breast problems and milk leakage after perinatal loss. Methods: The Study was carried out through explorative quality approach with 18 participants. Sampling method was purposeful and selecting the participants from widest variety was ensured. Data gathering was through deep semi-structured interview and data analyses were done by conventional content analysis. Reliability and validity of the data were ensured by collecting data from a wide range of participants and frequent revisions. Findings: Data analysis indicated four themes including beyond pain, longing being mother, insufficiency of provided information and coping Strategies, and beliefs and values regarding milk leakage and breast engorgement. Conclusion: The findings suggested that health care givers needed to inform the patients about probability milk leakage and breast engorgement and remedies to reduce pains and problems of breast engorgement

The Evaluation of organizational climate in college libraries and its relation with clients’ satisfaction

Purpose: Healthy organizational climate have an important role in the promotion of customer services. The aim of this research is to evaluate the organizational climate of the college libraries and its relation to the clients’ satisfaction. Methodology: Research population is the staff and the clients of the college libraries of Shahid Beheshti University of Medical Sciences. The climateQUAL questionnaire was used to assess the libraries organizational climate. A researcher-made questionnaire was used to evaluate clients’ satisfaction. Descriptive statistics and Spearman’s correlation coefficient were applied in SPSS 19 for data analysis. Findings: The organizational climate score of the libraries was more than average (4.42 of 7). “The climate for customer service” was ranked the first and the climate for justice was ranked the last. The clients’ satisfaction of the libraries was a little more than average (3.3 of 5). “Physical and welfare services” of the libraries was ranked the first in the user satisfaction dimensions. There was no meaningful relation between clients’ satisfaction and organizational climate scores. Conclusion: The managers of libraries should pay more attentions to the various dimensions of organizational climate and clients’ satisfaction to improve them in the libraries

The Evaluation of organizational climate in college libraries and its relation with clients’ satisfaction

Purpose: Healthy organizational climate have an important role in the promotion of customer services. The aim of this research is to evaluate the organizational climate of the college libraries and its relation to the clients’ satisfaction. Methodology: Research population is the staff and the clients of the college libraries of Shahid Beheshti University of Medical Sciences. The climateQUAL questionnaire was used to assess the libraries organizational climate. A researcher-made questionnaire was used to evaluate clients’ satisfaction. Descriptive statistics and Spearman’s correlation coefficient were applied in SPSS 19 for data analysis. Findings: The organizational climate score of the libraries was more than average (4.42 of 7). “The climate for customer service” was ranked the first and the climate for justice was ranked the last. The clients’ satisfaction of the libraries was a little more than average (3.3 of 5). “Physical and welfare services” of the libraries was ranked the first in the user satisfaction dimensions. There was no meaningful relation between clients’ satisfaction and organizational climate scores. Conclusion: The managers of libraries should pay more attentions to the various dimensions of organizational climate and clients’ satisfaction to improve them in the libraries

Using Data Mining Algorithm for Assigning Family-Centered Empowerment Model as to Improve the Quality of Life in Cardiac Infarction Patients

Introduction: Today, cardiovascular disease is a major threat to advanced human societies, and is acting as a major cause of disability in many aspects of a patient and family members' lives, including their quality of life. Therefore, the aim of the present study is to provide models for classifying and determining the factors influencing the allocation of family-centered empowerment model to further improve the psychological quality of life of these patients.  Materials and Methods: In this study, data from a clinical trial study were used in which 70 patients with myocardial infarction who randomly received a family-centered empowerment pattern and control group. A model of linear mixed effects and then learning algorithms were used to predict the success or failure of the empowerment model. Results: In this study, the decision tree model was able to accurately predict more than 96% of patients (Kappa=0.828, ROC=0.96).  Physical functions, walking status, creatinine level, EF level, employment status, gender, stress level and body mass index were identified as the effective factors in assigning a family-centered empowerment pattern (P value <0.05). This process was done through software of SPSS24, SAS9.1 and WEKA 3.6.9 Conclusion: The decision tree model was able to correctly classify more than 96% of patients; if a family-centered empowerment model was assigned, this model would improve the psychological dimension of their quality of life. &nbsp