Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic

Erfan Ayubi,Mohammad Ali Mansournia1,Ali Ghanbari Motlagh,Alireza Mosavi-Jarrahi,Ali Hosseini,Kamran Yazdani 한국역학회 2017 Epidemiology and Health Vol.39 No.-

OBJECTIVES: The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran. METHODS: The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters. RESULTS: There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p〈0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p〈0.001). CONCLUSIONS: Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.

Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes

Fatemeh Mehravar,Mohammad Ali Mansournia,Kourosh Holakouie-Naieni,Ensie Nasli-Esfahani,Nasrin Mansournia,Amir Almasi-Hashiani 한국역학회 2016 Epidemiology and Health Vol.38 No.-

OBJECTIVES: Diabetes is a major public health problem that is approaching epidemic proportions globally. Diabetes self-management can reduce complications and mortality in type 2 diabetic patients. The purpose of this study was to examine associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. METHODS: In this cross-sectional study, 562 Iranian patients older than 30 years of age with type 2 diabetes who received treatment at the Diabetes Research Center of the Endocrinology and Metabolism Research Institute of the Tehran University of Medical Sciences were identified. The participants were enrolled and completed questionnaires between January and April 2014. Patients’ diabetes self-management was assessed as an independent variable by using the Diabetes Self-Management Questionnaire translated into Persian. The outcomes were the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy), identified from the clinical records of each patient. A multiple logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between diabetes self-management and the microvascular complications of type 2 diabetes, adjusting for potential confounders. RESULTS: After adjusting for potential confounders, a significant association was found between the diabetes self-management sum scale and neuropathy (adjusted OR, 0.64; 95% CI, 0.45 to 0.92, p=0.01). Additionally, weak evidence was found of an association between the sum scale score of diabetes self-management and nephropathy (adjusted OR, 0.71; 95% CI, 0.47 to 1.05, p=0.09). CONCLUSIONS: Among patients with type 2 diabetes, a lower diabetes self-management score was associated with higher rates of nephropathy and neuropathy.

Misclassification Adjustment of Family History of Breast Cancer in a Case-Control Study: a Bayesian Approach

Moradzadeh, Rahmatollah,Mansournia, Mohammad Ali,Baghfalaki, Taban,Ghiasvand, Reza,Noori-Daloii, Mohammad Reza,Holakouie-Naieni, Kourosh Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.18

Background: Misreporting self-reported family history may lead to biased estimations. We used Bayesian methods to adjust for exposure misclassification. Materials and Methods: A hospital-based case-control study was used to identify breast cancer risk factors among Iranian women. Three models were jointly considered; an outcome, an exposure and a measurement model. All models were fitted using Bayesian methods, run to achieve convergence. Results: Bayesian analysis in the model without misclassification showed that the odds ratios for the relationship between breast cancer and a family history in different prior distributions were 2.98 (95% CRI: 2.41, 3.71), 2.57 (95% CRI: 1.95, 3.41) and 2.53 (95% CRI: 1.93, 3.31). In the misclassified model, adjusted odds ratios for misclassification in the different situations were 2.64 (95% CRI: 2.02, 3.47), 2.64 (95% CRI: 2.02, 3.46), 1.60 (95% CRI: 1.07, 2.38), 1.61 (95% CRI: 1.07, 2.40), 1.57 (95% CRI: 1.05, 2.35), 1.58 (95% CRI: 1.06, 2.34) and 1.57 (95% CRI: 1.06, 2.33). Conclusions: It was concluded that self-reported family history may be misclassified in different scenarios. Due to the lack of validation studies in Iran, more attention to this matter in future research is suggested, especially while obtaining results in accordance with sensitivity and specificity values.

Synthesis and Spectroscopic Characterization of the New Sitting-atop Complexes from Reaction of Zirconyl Nitrate and Free Base meso-Tetraarylporphyrins in Mild Conditions

Dehghani, Hossein,Mansournia, Mohammad Reza Korean Chemical Society 2009 Bulletin of the Korean Chemical Society Vol.30 No.8

A series of sitting-atop (SAT) complexes, [(ZrO)$H_2t(X)pp(NO_3)_2$], have been prepared via the reactions of free base meso-tetraarylporphyrins, $H_2$t(X)pp, with zirconyl nitrate hydrate, ZrO(N$O_3)_2{\cdot}xH_2$O. The products have been characterized by a variety of methods including $^1H\;NMR,\;^{13}C$ NMR, IR and UV-Vis spectroscopies, elemental analysis and conductance measurements. The data indicate that the meso-tetraarylporphyrins coordinate with two pyrrolenine nitrogen atoms to the zirconyl cation located above the distorted porphyrin plane and two protons remain on the pyrrole nitrogens. Such half sandwich-type sitting-atop complexes may be considered as models for the initial steps of the metallation of the macrocycles.

Simultaneous Comparison of Efficacy and Adverse Events of Interventions for Patients with Esophageal Cancer: Protocol for a Systematic Review and Bayesian Network Meta-analysis

Doosti-Irani, Amin,Mansournia, Mohammad Ali,Rahimi-Foroushani, Abbas,Cheraghi, Zahra,Holakouie-Naieni, Kourosh Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.2

Background: Esophageal cancer is one of the most serious malignancies. Due to the aggressive nature of this cancer, the prognosis is poor. A network meta-analysis with simultaneous comparison of multiple treatments can help determine better treatment options that have higher effects on overall survival of patients with lower adverse events. The aim of this review is to simultaneously compare efficacy and adverse events of treatment interventions for esophageal cancer. Materials and Methods: In this review, only randomized control trials (RCT) will be considered for network meta-analysis. All international electronic databases including Medline, Web of Sciences, Scopus, Cochran's library, EMBASE and Cancerlit will be searched to find randomized control trials which compared two or more treatment interventions for esophageal cancer. A network plot will be drawn for visual representation of all available treatment interventions. Bayesian approach will be used to combine the direct and indirect evidence. Treatment effects (e.g. hazard ratio for time to event outcomes, risk ratio for binary outcomes, and rate ratio for count outcomes with 95% credible interval) will be reported. Moreover, cumulative probability of the treatment ranks will be reported using the surface under the cumulative ranking (SUCRA) graphs. Consistency assumption will be assessed by the loop-specific and design-by-treatment interaction approaches. Conclusions: The results of this study may be helpful for the patients, clinicians and health policy makers in selecting treatments that have the best effect on survival and lowest adverse events.

The effects of water-pipe smoking on birth weight: a population-based prospective cohort study in southern Iran

Shahrzad Nematollahi1,,Mohammad Ali Mansournia,Abbas Rahimi Foroushani,Mahmood Mahmoodi,Azin Alavi,Mohammad Shekari,Kourosh Holakouie-Naieni 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: Consecutive community health assessments revealed that water-pipe smoking in women and impaired growth in children were among the main health concerns in suburban communities in southern Iran. The aim of the present study was to identify the effects of water-pipe smoking during pregnancy on birth weight. METHODS: Data from a population-based prospective cohort study of 714 singleton live pregnancies in the suburbs of Bandar Abbas in southern Iran in 2016-2018 were used in this study. Data about water-pipe smoking patterns and birth weight were collected by questionnaires during and after the pregnancy. Low birth weight (LBW) was defined as a birth weight below 2,500 g. Statistical analyses were performed using generalized linear models, and the results were presented in terms of relative risk (RR) and 95% confidence intervals (CI). RESULTS: Fifty (8.2%) of the study subjects smoked water-pipe. The adjusted risk of LBW increased 2-fold in water-pipe smokers (adjusted RR [aRR], 2.09; 95% CI, 1.18 to 3.71), and by 2.0% for each 1-year increase in the duration of water-pipe smoking (aRR, 1.02; 95% CI, 0.99 to 1.05). CONCLUSIONS: Our results showed that water-pipe smoking during pregnancy was an important risk factor for LBW in this population sample from southern Iran. The introduction of regulations onto prevent water-pipe smoking and the implementation of community health action plans aiming at empowering women and increasing women’s knowledge and awareness regarding the health consequences of water-pipe smoking are proposed.

Assessing measurement error in surveys using latent class analysis: application to self-reported illicit drug use in data from the Iranian Mental Health Survey

Kazem Khalagi,Mohammad Ali Mansournia,Afarin Rahimi-Movaghar,Keramat Nourijelyani,Masoumeh Amin-Esmaeili,Ahmad Hajebi,Vandad Sharifi,Reza Radgoodarzi,Mitra Hefazi,Abbas Motevalian 한국역학회 2016 Epidemiology and Health Vol.38 No.-

Latent class analysis (LCA) is a method of assessing and correcting measurement error in surveys. The local independence assumption in LCA assumes that indicators are independent from each other condition on the latent variable. Violation of this assumption leads to unreliable results. We explored this issue by using LCA to estimate the prevalence of illicit drug use in the Iranian Mental Health Survey. The following three indicators were included in the LCA models: five or more instances of using any illicit drug in the past 12 months (indicator A), any use of any illicit drug in the past 12 months (indicator B), and the self-perceived need of treatment services or having received treatment for a substance use disorder in the past 12 months (indicator C). Gender was also used in all LCA models as a grouping variable. One LCA model using indicators A and B, as well as 10 different LCA models using indicators A, B, and C, were fitted to the data. The three models that had the best fit to the data included the following correlations between indicators: (AC and AB), (AC), and (AC, BC, and AB). The estimated prevalence of illicit drug use based on these three models was 28.9%, 6.2% and 42.2%, respectively. None of these models completely controlled for violation of the local independence assumption. In order to perform unbiased estimations using the LCA approach, the factors violating the local independence assumption (behaviorally correlated error, bivocality, and latent heterogeneity) should be completely taken into account in all models using well-known methods.

Synthesis and Spectroscopic Characterization of the New Sitting-atop Complexes from Reaction of Zirconyl Nitrate and Free Base meso-Tetraarylporphyrins in Mild Conditions

Hossein Dehghani,Mohammad Reza Mansournia 대한화학회 2009 Bulletin of the Korean Chemical Society Vol.30 No.8

A series of sitting-atop (SAT) complexes, [(ZrO)H2t(X)pp(NO3)2], have been prepared via the reactions of free base meso-tetraarylporphyrins, H2t(X)pp, with zirconyl nitrate hydrate, ZrO(NO3)2·xH2O. The products have been characterized by a variety of methods including 1H NMR, 13C NMR, IR and UV-Vis spectroscopies, elemental analysis and conductance measurements. The data indicate that the meso-tetraarylporphyrins coordinate with two pyrrolenine nitrogen atoms to the zirconyl cation located above the distorted porphyrin plane and two protons remain on the pyrrole nitrogens. Such half sandwich-type sitting-atop complexes may be considered as models for the initial steps of the metallation of the macrocycles.

Risk factors for amputation in patients with diabetic foot ulcer in southwest Iran: a matched case-control study

Mohammad Kogani,Mohammad Ali Mansournia,Amin Doosti-Irani,Kourosh Holakouie-Naieni 한국역학회 2015 Epidemiology and Health Vol.37 No.-

OBJECTIVES: Amputation is a multifactorial complication in diabetic patients. The aim of this study was to determine the risk factors associated with amputation in patients with diabetic foot ulcers. METHODS: This matched case-control study was conducted based on new cases of amputation from March 2012 to November 2014. We selected new cases who had undergone amputation, and the control group was chosen from the cities or areas where the cases resided. Each case was matched with two controls based on the duration of diabetes and location. Conditional logistic regression was used to evaluate the associations between potential risk factors and amputation. RESULTS: A total of 131 cases were compared with 262 controls. The results of the adjusted model showed that sex (odds ratio [OR], 8.66; 95% confidence interval [CI], 2.68 to 27.91), fewer than two hemoglobin A1c (HbA1c) tests per year (OR, 13.97; 95% CI, 4.97 to 39.26), unsuitable shoes (OR, 5.50; 95% CI, 2.20 to 13.77), smoking (OR, 3.44; 95% CI, 1.45 to 8.13), and body mass index (OR, 1.20; 95% CI, 1.03 to 1.41) were associated with amputation in diabetic patients. CONCLUSIONS: The most important factors associated with amputation were females, irregular monitoring of HbA1c levels, improper footwear, and smoking. Developing educational programs and working to ensure a higher quality of care for diabetic patients are necessary steps to address these issues.

Assessment of the risk factors associated with multidrug-resistant tuberculosis in Sudan: a case-control study

Adel Hussein Elduma,Mohammad Ali Mansournia,Abbas Rahimi Foroushani,Hamdan Mustafa Hamdan Ali,Asrar M A,Salam Elegail,Asma Elsony,Kourosh Holakouie-Naieni 한국역학회 2019 Epidemiology and Health Vol.41 No.-

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.