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Discharge is the process of transferring a patient from hospital which involves a transfer in responsibility from inpatient service providers or hospitalist to the patient and primary care physicians. Inappropriate follow up after discharge will increase the risk of readmission and re-hospitalization which leads to the poor performance of the health system. The aim of this study was to determine the effect of physicians caring after discharge on readmission and referral to doctors. This study was conducted as a clinical trial on patients with early intervention for educational instruction. The clinical trial was conducted at a later stage on 120 patients with heart failure who were hospitalized in Taleghani Hospital, Tehran. For a period of five months after discharge, using block randomization the subjects were divided into two groups, including intervention and control groups. At the time of discharge, the patients in the intervention group received instructions and were trained by physicians, while no intervention was applied for the subjects in the control group. In addition to demographic questions, the patients were asked about two main outcomes i.e. readmission and referral to doctors; to collect the required data the subjects in both groups were contacted via telephone calls (nine times) every week in the first month after discharge and two times per week in the following two months. Generalized linear mixed effects model method was used for evaluating the effect of physicians caring after discharge on readmission and re-hospitalization. The results of this study showed that with the passage of time (weekly) after discharge, there was a significant increase in the rate of readmission in the control group, while there was no significant increase in re-hospitalization. There was no statistical evidence showing a significant difference between the rates of readmission along with the time in the treatment intervals. In other words, the patients in the control group experienced a significant increase in the odds ratio of readmission over the time. [ABSTRACT FROM AUTHOR]

Low birth weight (neonate weighing less than 2500 g) is associated with several maternal and fetal factors, all interrelated with each other [1]. This study is aimed to survey maternal risk factors associated with low birth weight neonates using data mining (Random Forest) to account for interactions between them. We also intended to compare Random Forest with traditional Logistic regression. The dataset used in the present study consisted of 600 volunteer pregnant women. This cross-sectional study was carried out in Milad hospital, Tehran, during 2005-2009. Ten potential risk factors that are commonly associated with low birth weight were selected by using Random Forest technique. Several criteria such as the area under ROC curve were considered in comparing Random Forest with Logistic Regression. According to both criteria, four top rank variables identified by Random Forest were pregnancy age, body mass index during the third three months of pregnancy, mother's age and body mass index during the first three months of pregnancy, respectively. In addition, in terms of different criteria the Random Forest technique outperformed the Logistic regression (area under ROC curve: 93% ; Total Accuracy:95% ; Kappa Coefficient: 66%).The results of the present study showed that using Random Forest improved the prediction of low birth weight compared with Logistic Regression. This is because of the fact that the former accounts for all interactions between covariates. Therefore, this approach is a promising classifier for predicting low birth weight. [ABSTRACT FROM AUTHOR]

Background: Cancer, a common disease in adulthood, is a rare albeit slowly increasing condition among children. Currently, limited data are available on the incidence, prevalence, and mortality of these diseases in many regions, including developing countries. Herein, we are reporting national and sub-national estimates on deaths due to childhood cancers between 2000 and 2015 in Iran. Methods: Cancer mortality rates were estimated using the national death registration system's data after addressing its incompleteness and misclassification, using demographic (complete birth history and summary birth history) and statistical analysis (spatiotemporal, Gaussian process regression, and generalized linear mixed models). We included data from cemeteries of two cities (Tehran and Isfahan) that were not included in the death registration system. We used census data and household expenditure and income surveys for data on population and other covariates used in the modeling. Results: The overall age-standardized death rate (ASDR) of childhood cancers have decreased by 69.52% (80.67-49.71) in Iran (equal to an annual percent change of -3.63 [-4.53- -2.24]), declining from 12.24 (95% UI: 10.52-14.49) in 2000 to 3.73 (2.8-5.29) deaths per 100 000 in 2015. This decrement was equal to an annual percent change of 4.35% over these years. Leukemia, brain, and nervous system malignancies accounted for about 66% of all cancer-related mortalities among children and adolescents in 2015, which had a 10% increase compared to 2000. Moreover, trends at the sub-national level showed that the highest and lowest ASDR of childhood cancers ranged from 2.12 to 4.99 across provinces of Iran in 2015. Conclusion: Although the overall mortalities have decreased, there is still inequality in the distribution of the recorded deaths. This inequality should be addressed with the improvement of the quality of care and better access to pediatric hospitals and oncologists in these areas. [ABSTRACT FROM AUTHOR]

Background: Inequity in megacities is a real concern in public health perspective. Tehran is a megacity with more than 8 million population that is divided into 22 regions (counties) with considerable diversity in socioeconomic status. On the other hand, spatial cluster detection is an important tool in disease surveillance for identifying areas of elevated risk and generating hypotheses about disease or mortality etiology. The present research aims to identify high or low-risk clusters for five non-communicable leading causes of death in 22 regions of Tehran province. Methods: Cause-specific mortality rates were extracted from Behesht-e-Zahra registry system for Tehran province in 2011. Spatial scan statistic was chosen as the most common method in spatial cluster detection to detect clusters with elevated risk of death. Given the observed and expected number death in each region, a log likelihood ratio (LLR) criterion was used to test whether a cluster is significant. Result: Two high-risk and two low-risk clusters were detected for each cause of death. All these clusters were statistically significant with P values less than 0.05. Mapping these clusters shows substantial differences between regions in Tehran. For mortality due to ischemie heart diseases, cerebrovascular diseases, hypertensive diseases, respiratory diseases, and stomach cancer, the high-risk clusters concentrated in the southern half of Tehran and low-risk clusters were in the northern half of Tehran. In the most situations, regions 2, 3, and 5 seemed to have lower rates of death compared with other regions. On the other hand, regions, 16,19, and 20 were in the high rate clusters. Conclusion: There was substantial disparity between regions of Tehran for five non-communicable causes of death studied in this article. Identifying factors affecting the observed differences is useful to set effective preventive interventions and can be investigated in future researches. [ABSTRACT FROM AUTHOR]

Background: Due to its specific socio-cultural and geographical situation, Iran has a major public health problem in terms of drug and alcohol use. The aim of this study is to report and critique the burden of drug and alcohol use disorders in Iran, and to compare these measurements with similar findings. Methods: This study used data for Iran for the years 1990, 2005, and 2010 derived from the Global Burden of Disease study conducted by the Institute for Health Metrics and Evaluation (IHME) in 2010. The burden of drug and alcohol use disorders was evaluated in terms of disability adjusted life years (DALYs), years of life lost to premature mortality (YLLs), and years lived with disability (YLDs). Results: All rates were reported per 100,000 individuals. Death rates attributed to drug and alcohol use disorders were 7.7 and 0.16 for men, and 0.62 and 0.02 for women, respectively. YLL rates regarding drug use disorders were 351.8 and 24.8 for men and women, while these figures were 5.8 and 1.0 for alcohol use disorders for men and women, respectively. YLD rates of drug use disorders were 452.6 for men and 202.1 for women, and 105.8 for men and 23.7 for women for alcohol use disorders. DALY rates attributed to drug use disorders were 804.5 for men and 227 for women, while these rates were 111.7 for men and 24.7 for women, related to alcohol use disorders. Conclusions: Similar to the cases in many other countries, the burden of both drug and alcohol use disorders is higher for men than women in Iran. Although prevention policies and programs for drug and alcohol use are required for both genders, the need for drug and alcohol use intervention seems more urgent for men in Iran. [ABSTRACT FROM AUTHOR]