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17 "Case-control studies"
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Original Articles
Interaction between vitamin E intake and a COMT gene variant on colorectal cancer risk among Korean adults: a case-control study
Shinyoung Jun, Madhawa Gunathilake, Jeonghee Lee, Jae Hwan Oh, Hee Jin Chang, Dae Kyung Sohn, Aesun Shin, Jeongseon Kim
Epidemiol Health. 2023;45:e2023100.   Published online November 14, 2023
DOI: https://doi.org/10.4178/epih.e2023100
  • 1,833 View
  • 103 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Previous human trials have not supported the anticarcinogenic effect of vitamin E despite biological plausibility and considerable epidemiological evidence. A possible explanation for this inconsistency is the interactive effect of the catechol-O-methyltransferase (COMT) gene and supplemental vitamin E on cancer. We examined whether a COMT gene variant modulates the effect of dietary vitamin E intake on colorectal cancer (CRC) risk.
METHODS
In this case-control study of Korean adults (975 cases and 975 age- and sex-matched controls), dietary vitamin E density (mg/1,000 kcal) was measured using a semiquantitative food frequency questionnaire, COMT single nucleotide polymorphism (SNP) rs740603 (A>G) was genotyped, and CRC was verified histologically. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models with adjustments for potential confounders.
RESULTS
Higher vitamin E density was associated with a lower risk of CRC (highest vs. lowest quartiles: OR, 0.72; 95% CI, 0.55 to 0.96; p-for-trend=0.002). When stratified by COMT SNP rs740603 genotype, the inverse association between vitamin E density and CRC risk was confined to those with at least 1 A allele (≥median vs. <median: OR, 0.63; 95% CI, 0.51 to 0.78). The interaction between rs740603 and vitamin E density was significant (p-for-interaction=0.020). No direct association was observed between COMT SNP rs740603 and CRC risk (OR, 1.08; 95% CI, 0.83 to 1.41).
CONCLUSIONS
Our findings support a role for a genetic polymorphism in COMT in modifying the association between dietary vitamin E intake and CRC.
Summary
Korean summary
본 연구는 국립암센터에서 수집한 대장암 환자-대조군 자료를 활용하여, catechol-O-methyltransferase (COMT) 유전자의 단일염기다형성(SNP)에 따라 비타민 E 섭취와 대장암 위험 간의 연관성이 달라지는지 파악하고자 하였다. 분석 결과, COMT SNP rs740603의 유전자형에 따라 식이를 통한 비타민 E 섭취 밀도와 대장암 위험 간의 연관성이 다르게 나타나 COMT 유전자와 비타민 E 섭취 간의 상호작용이 대장암 발생 위험에 영향을 미칠 가능성이 있음을 제시하였다.
Key Message
In this case-control study of Korean adults, we examined whether a polymorphism in the catechol-O-methyltransferase (COMT) gene modulates the effect of dietary vitamin E intake on colorectal cancer risk. Our results suggest that the inverse association between vitamin E density and colorectal cancer risk is confined to carriers of the COMT rs740603 A allele. The findings of our study support the interactive effect of the COMT gene and vitamin E intake on colorectal cancer risk.
Association between PM2.5 exposure and risk of Parkinson’s disease in individuals with chronic obstructive pulmonary disease in Taiwan: a nested case-control study
Ci-Wen Luo, Yu-Hsiang Kuan, Wen-Ying Chen, Chun-Jung Chen, Frank Cheau-Feng Lin, Stella Chin-Shaw Tsai
Epidemiol Health. 2023;45:e2023094.   Published online October 17, 2023
DOI: https://doi.org/10.4178/epih.e2023094
  • 1,575 View
  • 104 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This cohort study investigated the correlation between Parkinson’s disease (PD) risk and chronic obstructive pulmonary disease (COPD) risk under particulate matter with an aerodynamic diameter ≤2.5 μm (PM<sub>2.5</sub>) exposure.
METHODS
Data from the National Health Research Institutes of Taiwan were used in this study. The Environmental Protection Administration of Taiwan established an air quality monitoring network for monitoring Taiwan’s general air quality. COPD was indicated by at least 3 outpatient records and 1 hospitalization for COPD. After the implementation of age, sex, and endpoint matching at a 1:4 ratio, 137 patients and 548 patients were included in the case group and control group, respectively. Based on the 2005 World Health Organization (WHO) standards, monthly air particle concentration data were classified into the following 4 groups in analyses of exposure–response relationships: normal level, and 1.0, 1.5, and 2.0 times the WHO level ([concentration ≥2]×25 μg/m<sup>3</sup>×number of exposure months).
RESULTS
A multivariate logistic regression revealed that the 1.0 and 1.5 WHO level groups did not significantly differ from the normal level group, but the 2.0 WHO level did (odds ratio, 4.091; 95% confidence interval, 1.180 to 14.188; p=0.038).
CONCLUSIONS
Elevated PM<sub>2.5</sub> concentrations were significantly correlated with an increased risk of PD among patients with COPD. Furthermore, exposure to high PM<sub>2.5</sub> levels can further increase the risk of PD.
Summary
Key Message
This nested case-control study, utilizing data from Taiwan's National Health Research Institutes and after meticulous matching, found that higher exposure to PM2.5 was associated with an increased risk of developing Parkinson's disease among individuals with chronic obstructive pulmonary disease, with those exposed to PM2.5 levels at 2 times the WHO standards having a 4 times higher odds of Parkinson's disease compared to those exposed to normal levels, indicating that air pollution may exacerbate neurological disease risk in those with existing respiratory conditions.
Epidemiologic Investigation
Investigation of a human brucellosis outbreak in Douz, Tunisia, 2018
Nejib Charaa, Rabaa Ghrab, Aicha Ben Othman, Mohamed Makhlouf, Hejer Ltaief, Nissaf Ben Alaya, Mohamed Chahed
Epidemiol Health. 2022;44:e2022048.   Published online May 18, 2022
DOI: https://doi.org/10.4178/epih.e2022048
  • 6,562 View
  • 322 Download
  • 3 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
In 2017, the incidence of human brucellosis in Tunisia was 9.8 per 100,000 population. In the Douz district, 2 cases were reported in March 2018. Prior to that date, the last indigenous cases to be reported in Douz had been in 2015. This study aimed to identify the source of this new contamination and recommend control interventions.
METHODS
This case-control study included residents of Douz who presented with clinical symptoms of brucellosis and had a subsequent Wright test antibody titer ≥ 1/160. The controls were neighbors of the infected cases who had a negative Rose Bengal test. Univariate and multivariate analyses were performed to estimate the odds ratios of risk factors. Goats belonging to the cases and controls were actively screened.
RESULTS
Twenty-five infected cases and 52 uninfected controls were enrolled. All infected cases had consumed goat milk and 92% had purchased it from the same breeder. Consumption of goat milk from this breeder (adjusted odds ratio [aOR], 30.78; 95% confidence interval [CI], 6.47 to 235.91) and overall consumption of raw goat milk (aOR, 14.84; 95% CI, 2.04 to 310.44) were independent risk factors for brucellosis. The breeder had 18 goats, 5 of which were smuggled from a neighboring country. Three of those goats were diagnosed with brucellosis.
CONCLUSIONS
Consumption of raw milk from smuggled sick goats was the main risk factor in this outbreak. The sick goats were slaughtered and an education campaign was conducted. Vaccination, control of cross-border animal movements, and control of goat milk sales must be strengthened to prevent the spread of brucellosis in southwestern Tunisia.
Summary
Key Message
Human brucellosis, despite being a major economic and health problem and the availability of proven control methods, is still endemic in North African countries. The scarcity of epidemiological data, under-reporting, certain weaknesses in surveillance systems and the lack of well-conducted outbreak investigations, contribute to this endemic state. This field epidemiological investigation of a human brucellosis outbreak highlighted the importance of serological surveillance, the slaughter of infected animals, vaccination, control of animal movements across borders and pasteurization of milk in the fight against this disease.

Citations

Citations to this article as recorded by  
  • Long ignored but making a comeback: a worldwide epidemiological evolution of human brucellosis
    Zhiguo Liu, Liping Gao, Miao Wang, Min Yuan, Zhenjun Li
    Emerging Microbes & Infections.2024;[Epub]     CrossRef
  • Native circulating Brucella melitensis lineages causing a brucellosis epidemic in Qinghai, China
    Hongmei Xue, Zhijun Zhao, Jianling Wang, Li Ma, Jiquan Li, Xuxin Yang, Lingling Ren, Liqing Xu, Zhiguo Liu, Zhenjun Li
    Frontiers in Microbiology.2023;[Epub]     CrossRef
Original Articles
Bacillus of Calmette and Guérin (BCG) and the risk of leprosy in Ciudad del Este, Paraguay, 2016-2017
Nancy Carolina Cuevas, Victor M. Cardenas
Epidemiol Health. 2021;43:e2021060.   Published online September 8, 2021
DOI: https://doi.org/10.4178/epih.e2021060
  • 7,123 View
  • 93 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Paraguay has experienced a 35% reduction in the detected incidence of leprosy during the last ten years, as the vaccination coverage against tuberculosis (Bacillus of Calmette and Guérin [BCG] vaccine) reached ≥95% among infants. The objective of this case-control study was to evaluate the protective effect of BCG on the risk of leprosy.
METHODS
We used a population-based case-control study of 20 leprosy confirmed cases reported among residents of Ciudad del Este, Paraguay, diagnosed in 2016-2017. Three controls were selected from a random sample of households from the city. We assessed vaccine effectiveness using 1- odds ratio [OR], and confounding for age, gender, education, occupation, and marital status using stratified and exact logistic regression, and explored if there was effect modification calculating the synergy factor (SF) and relative excess risk due to interaction (RERI).
RESULTS
After controlling for age, gender, education, occupation and marital status, the OR of BCG scar on the risk of leprosy was 0.10 (95% confidence interval [CI], 0.02 to 0.45), for an estimate of vaccine effectiveness of 89.5% reduced risk of leprosy (95% CI, 55.2 to 98.1). There was evidence of heterogeneity by which the effectiveness of BCG seemed stronger among younger persons (Breslow-Day and Z-test of the SF had a p<0.05), and both the RERI and SF indicated a less then multiplicative and additive interaction of BCG and younger age.
CONCLUSIONS
BCG vaccination was associated with a decreased risk of leprosy in the study population, particularly in persons born after 1980.
Summary
Key Message
Paraguay had the second highest reported incidence in the Americas, but no previous study had investigated the topic of BCG for leprosy in Paraguay. We confirmed that BCG protected from leprosy, hence it may have contributed to the observed decline of leprosy.

Citations

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  • BCG and SARS-CoV-2—What Have We Learned?
    Jakub Kulesza, Ewelina Kulesza, Piotr Koziński, Wojciech Karpik, Marlena Broncel, Marek Fol
    Vaccines.2022; 10(10): 1641.     CrossRef
Risk factors associated with the recent cholera outbreak in Yemen: a case-control study
Fekri Dureab, Albrecht Jahn, Johannes Krisam, Asma Dureab, Omer Zain, Sameh Al-Awlaqi, Olaf Müller
Epidemiol Health. 2019;41:e2019015.   Published online April 21, 2019
DOI: https://doi.org/10.4178/epih.e2019015
  • 18,965 View
  • 489 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
The cholera outbreak in Yemen has become the largest in the recent history of cholera records, having reached more than 1.4 million cases since it started in late 2016. This study aimed to identify risk factors for cholera in this outbreak.
METHODS
A case-control study was conducted in Aden in 2018 to investigate risk factors for cholera in this still-ongoing outbreak. In total, 59 cholera cases and 118 community controls were studied.
RESULTS
The following risk factors were associated with being a cholera case in the bivariate analysis: a history of travelling and having had visitors from outside Aden Province; eating outside the house; not washing fruit, vegetables, and khat (a local herbal stimulant) before consumption; using common-source water; and not using chlorine or soap in the household. In the multivariate analysis, not washing khat and the use of common-source water remained significant risk factors for being a cholera case.
CONCLUSIONS
Behavioural factors and unsafe water appear to be the major risk factors in the recent cholera outbreak in Yemen. In order to reduce the risk of cholera, hygiene practices for washing khat and vegetables and the use and accessibility of safe drinking water should be promoted at the community level.
Summary

Citations

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  • Knowledge, attitudes, and practices toward COVID-19 prevention in Yemen: a community-based cross-sectional study
    Ola El Hajj Hassan, Ahmed Asa’ad Al-Aghbari, Maureen McGowan, Maureen Dar Iang, Huda Omer Basaleem, Khaled Abdulla Al-Sakkaf, Dalia Hyzam, Albrecht Jahn, Fekri Dureab
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Inadequate Hand Washing, Lack of Clean Drinking Water and Latrines as Major Determinants of Cholera Outbreak in Somali Region, Ethiopia in 2019
    Jemal Mussa Challa, Tamirat Getachew, Adera Debella, Melkamu Merid, Genanaw Atnafe, Addis Eyeberu, Abdi Birhanu, Lemma Demissie Regassa
    Frontiers in Public Health.2022;[Epub]     CrossRef
  • Determining factors associated with cholera disease in Ethiopia using Bayesian hierarchical modeling
    Tsigereda Tilahun Letta, Denekew Bitew Belay, Endale Alemayehu Ali
    BMC Public Health.2022;[Epub]     CrossRef
  • Cholera outbreak investigation report in Mille woreda, Afar region, Ethiopia, 2019
    Hana Mekonen, Kefyalew Amene, Dr Samrawit Bisrat, Tesfahun Abye
    MOJ Women s Health.2022; 11(2): 63.     CrossRef
  • Risk Factors of Cholera Transmission in Al Hudaydah, Yemen: Case-Control Study
    Abdulqawi Mohammed Qaserah, Mohammed Abdullah Al Amad, Abdulwahed Abduljabbar Al Serouri, Yousef Saleh Khader
    JMIR Public Health and Surveillance.2021; 7(7): e27627.     CrossRef
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    Ali M. Aqlan, Musaed Aklan, Abdulmalik E. Momin
    Energy Reports.2021; 7: 2245.     CrossRef
  • Cholera Outbreak in Hadhramout, Yemen: The Epidemiological Weeks 2019
    Eidha Ali Bin-Hameed, Huda Ameen Joban
    International Journal of Epidemiologic Research.2021; 8(1): 40.     CrossRef
  • Knowledge on and preventive practices of cholera in Al-Mahweet – Yemen, 2018: a cross-sectional study
    Fekri Dureab, Yasameen Al-Qadasi, Hani Nasr, Marwah Al-Zumair, Taha Al-Mahbashi
    Journal of Water and Health.2021; 19(6): 1002.     CrossRef
  • Reinventing the Wheel of Echinococcus granulosus sensu lato Transmission to Humans
    Francesca Tamarozzi, Peter Deplazes, Adriano Casulli
    Trends in Parasitology.2020; 36(5): 427.     CrossRef
Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran
Behjat Marzbani, Javad Nazari, Farid Najafi, Behnaz Marzbani, Sara Shahabadi, Mahin Amini, Mehdi Moradinazar, Yahya Pasdar, Ebrahim Shakiba, Saeed Amini
Epidemiol Health. 2019;41:e2019003.   Published online January 24, 2019
DOI: https://doi.org/10.4178/epih.e2019003
  • 19,432 View
  • 825 Download
  • 31 Web of Science
  • 31 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran.
METHODS
All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata.
RESULTS
The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk.
CONCLUSIONS
Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.
Summary

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    Sau Har Lee, Brianna
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    Hilal Pekmezci, Burhan Basaran
    Foods.2023; 12(12): 2320.     CrossRef
  • The importance of SOCS1 − 1478 CA/del polymorphism and expression in breast cancer: a case–control study in the north of Iran
    Habibbullah Paeiz, Zivar Salehi, Farhad Mashayekhi, Hamid Saeidi Saedi, Laleh Mirzanejad
    Breast Cancer Research and Treatment.2023; 202(2): 389.     CrossRef
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    Anna Kleczka, Radosław Dzik, Agata Kabała-Dzik
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  • Investigation of Breast Cancer Risk Factors in the Imam Hossein and Shohada-E Tajrish Hospitals of Tehran in 2019–2022: A case–control study
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    Burçak ÇUBUKÇU, Fatma TAYHAN KARTAL, Gözde EDE
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  • Effect of vitamin D supplementation on inflammatory markers and total antioxidant capacity in breast cancer women using a machine learning technique
    Marzieh Tahmasebi, Masoud Veissi, Seyed Ahmad Hosseini, Amir Jamshidnezhad
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  • Dietary Patterns and Risk of Invasive Ductal and Lobular Breast Carcinomas: A Systematic Review and Meta-analysis
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Epidemiologic Investigation
Epidemiologic research on lung damage caused by humidifier disinfectants
Moo-Song Lee, Hwa Jung Kim
Epidemiol Health. 2016;38:e2016031.   Published online July 20, 2016
DOI: https://doi.org/10.4178/epih.e2016031
  • 15,992 View
  • 276 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
In April 2011 a tertiary hospital located in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. A hospital based case-control study was conducted to indicate that humidifier detergent use was the cause of the outbreak. This information led the Ministry of Health and Welfare of Korea issued an order that humidifier detergents should be withdrawn from the market. Here, we describe the major events of planning, execution, and interpretation of the study, and discussions between researchers and public authorities following the decision to perform an epidemiologic study, chronologically.
Summary
Korean summary
본 역학조사는 일개 병원에서 신고한 질병 유행에 대해 다학제적 연구 결과로써, 질병의 임상적 특성과 역학적 원인 파악 후 정책적 대책으로 이어진 사례이다. 향후 가습기 살균제 이외에도 일반국민의 건강에 영향을 미칠 수 있는 다양한 생활환경요인에 관심을 가지고, 필요 시 적극적인 조사와 대응이 필요할 것이다.

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Original Articles
The incidence of congenital hypothyroidism and its determinants from 2012 to 2014 in Shadegan, Iran: a case-control study
Ehsan Keshavarzian, Ali Asghar Valipoor, Mohammad Reza Maracy
Epidemiol Health. 2016;38:e2016021.   Published online May 26, 2016
DOI: https://doi.org/10.4178/epih.e2016021
  • 15,309 View
  • 278 Download
  • 7 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Congenital hypothyroidism (CH) is one of the major causes of preventable mental retardation in infants. The aim of this study was to determine the incidence of CH in Shadegan, Khuzestan Province, Iran from 2012 to 2014 and to identify the risk factors associated with CH.
METHODS
A total of 203 cases were confirmed from 2012 to 2014 in Shadegan, with 66, 86, and 51 patients reported in 2012, 2013, and 2014, respectively. A total of 3,900, 3,991, and 4,050 live births occurred in 2012, 2013, and 2014, respectively. The controls (n=657) were selected using a random number table, and a case-control study was carried out to determine the risk factors for neonatal CH, including demographic, environmental, and medical factors.
RESULTS
The incidence of CH was 17.0 per 1,000 live births in 2012, 21.5 per 1,000 live births in 2013, and 12.6 per 1,000 live births in 2014. This study showed that the likelihood of CH in children born to parents with a history of consanguineous marriage was 2.41 times greater than in children born to parents with no such history (odds ratio, 2.41; 95% confidence interval [CI], 1.65 to 3.53). This study also found that CH was 3.4 times more likely (95% CI, 2.29 to 5.20) in infants born in urban settings than in infants born in rural areas.
CONCLUSIONS
The incidence of CH in Shadegan from 2012 to 2014 was approximately 17 times greater than the expected incidence in Iran. CH was associated with a history of consanguineous marriage and urbanization.
Summary

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  • Risk factors for transient and permanent congenital hypothyroidism: a population-based case-control study
    Fariba Abbasi, Leila Janani, Malihe Talebi, Hosein Azizi, Lotfali Hagiri, Shahnaz Rimaz
    Thyroid Research.2021;[Epub]     CrossRef
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    Nur Rochmah, Muhammad Faizi, Carrina Dewanti, Ahmad Suryawan
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    Hale TUHAN
    Turkish Journal of Pediatric Disease.2019; : 1.     CrossRef
  • The role of season and climate in the incidence of congenital hypothyroidism in Kerman province, Southeastern Iran
    Narges Khanjani, Ahmad Ahmadzadeh, Bahram Bakhtiari, Farzan Madadizadeh
    Journal of Pediatric Endocrinology and Metabolism.2017; 30(2): 149.     CrossRef
Risk factors for heart failure in a cohort of patients with newly diagnosed myocardial infarction: a matched, case-control study in Iran
Ali Ahmadi, Koorosh Etemad, Arsalan Khaledifar
Epidemiol Health. 2016;38:e2016019.   Published online May 17, 2016
DOI: https://doi.org/10.4178/epih.e2016019
  • 19,535 View
  • 215 Download
  • 13 Web of Science
  • 10 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Risk factors for heart failure (HF) have not yet been studied in myocardial infarction (MI) patients in Iran. This study was conducted to determine these risk factors.
METHODS
In this nationwide, hospital-based, case-control study, the participants were all new MI patients hospitalized from April 2012 to March 2013 in Iran. The data on 1,691 new cases with HF (enrolled by census sampling) were compared with the data of 6,764 patients without HF as controls. We randomly selected four controls per one case, matched on the date at MI and HF diagnosis, according to incidence density sampling. Using conditional logistic regression models, odds ratios (ORs) with a 95% confidence interval (CI) were calculated to identify potential risk factors.
RESULTS
The one-year in-hospital mortality rate was 18.2% in the cases and higher than in the controls (12.1%) (p<0.05). Significant risk factors for HF were: right bundle branch block (RBBB) (OR, 2.86; 95% CI, 1.95 to 4.19), stroke (OR, 2.00; 95% CI, 1.39 to 2.89), and coronary artery bypass grafting (CABG) (OR, 2.03; 95% CI, 1.34 to 3.09). Diabetes, hypertension, percutaneous coronary intervention (PCI), atrial fibrillation, ventricular tachycardia, and age were determined to be the factors significantly associated with HF incidence (p<0.05). The most important factor in women was diabetes (OR, 1.41; 95% CI, 1.05 to 1.88). Age, hypertension, PCI, CABG, and RBBB were the most important factors in men.
CONCLUSIONS
Our findings may help to better identify and monitor the predictive risk factors for HF in MI patients. The pattern of risk factors was different in men and women.
Summary

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A cholera outbreak in Alborz Province, Iran: a matched case-control study
Ghobad Moradi, Mohammad Aziz Rasouli, Parvin Mohammadi, Elham Elahi, Hojatollah Barati
Epidemiol Health. 2016;38:e2016018.   Published online May 14, 2016
DOI: https://doi.org/10.4178/epih.e2016018
  • 19,126 View
  • 253 Download
  • 7 Web of Science
  • 10 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks.
METHODS
An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs) using the logistic regression method.
RESULTS
In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72).
CONCLUSIONS
Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.
Summary

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Exposure to pistachio pesticides and stillbirth: a case-control study
Saeid Razi, Mohsen Rezaeian, Fatemeh Ghani Dehkordi, Azita Manshoori, Reza Goujani, Reza Vazirinejad
Epidemiol Health. 2016;38:e2016016.   Published online April 30, 2016
DOI: https://doi.org/10.4178/epih.e2016016
  • 15,882 View
  • 199 Download
  • 6 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Stillbirth is an undesirable outcome of pregnancy. In light of the increasing use of pesticides and growing concerns about the possible health effects of agricultural pesticides, we investigated the effect of exposure to pistachio pesticides on stillbirth in pregnant mothers.
METHODS
This case-control study was conducted in Rafsanjan, Iran from 2011 to 2012. A total of 125 females who had a recent stillbirth were included as the case group, and 250 controls were selected from females who had a recent live birth. For each case, two controls with the nearest propensity score to the case were selected. Data were collected using a protocol developed by the researcher that involved interviewing respondents and reviewing their medical records. Conditional multivariate and univariate logistic regression analysis were performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
RESULTS
The ORs of stillbirth in mothers living in pistachio gardens and those who were exposed to sprayed pesticides, in comparison to the controls, were 14.1 (95% CI, 3.3 to 63.4) and 5.0 (95% CI, 1.2 to 28.6), respectively. No significant differences were found in stillbirth rates according to the distance between the mother’s residence and a pistachio garden or involvement in agricultural activities.
CONCLUSIONS
The results of our study showed that exposure to pistachio pesticides during pregnancy may increase the likelihood of stillbirth in mothers.
Summary

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    Jungao Huang, Liqin Hu, Juan Yang
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    María Mercedes Milesi, Virginia Lorenz, Milena Durando, María Florencia Rossetti, Jorgelina Varayoud
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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
Epidemiol Health. 2015;37:e2015044.   Published online October 5, 2015
DOI: https://doi.org/10.4178/epih/e2015044
  • 18,866 View
  • 285 Download
  • 16 Web of Science
  • 15 Crossref
AbstractAbstract PDF
Abstract
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.
Summary

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Predictors of miscarriage: a matched case-control study
Jalal Poorolajal, Parvin Cheraghi, Zahra Cheraghi, Masoomeh Ghahramani, Amin Doosti Irani
Epidemiol Health. 2014;36:e2014031.   Published online November 20, 2014
DOI: https://doi.org/10.4178/epih/e2014031
  • 20,262 View
  • 198 Download
  • 12 Web of Science
  • 10 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
The risk factors for miscarriage vary across communities and countries. This study was conducted to investigate the predictors of miscarriage in the west of Iran.
METHODS
This matched case-control study was conducted in Hamadan Province from April 2013 to March 2014. Cases were selected from women who had a recent spontaneous abortion and controls were selected from women who had a recent live birth. Two controls were selected for every case and matched for date of pregnancy and area of residence. Multivariate conditional logistic regression analysis was performed and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
RESULTS
Five hundred fifty cases were compared with 1,091 controls. The OR of miscarriage was 1.58 (95% CI=1.30-1.92) for every five-year increase in age, 0.20 (95% CI=0.14-0.28) for every live birth, and 3.43 (95% CI=2.03-5.79) for a history of previous spontaneous abortion. Compared to nulliparous women, primiparous or multiparous women had an OR of 17.85 (95% CI=6.65-47.91) for miscarriage. There was a strong association between miscarriage and abnormal amniotic status (OR, 2.46; 95% CI, 0.46-13.09) and also abnormal placenta status (OR, 10.44; 95% CI, 0.95-114.92); however, these associations were not statistically significant. No significant associations were observed between miscarriage and body mass index, previous history of stillbirth, low birth weight, congenital anomaly, ectopic pregnancy, impaired thyroid function, or high blood pressure.
CONCLUSIONS
Our study suggests that miscarriage is a multifactorial outcome associated with several modifiable and non-modifiable risk factors that may vary among different communities.
Summary

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    Abdelmageed Elmugabil, Duria A. Rayis, Ishag Adam, Mohamed F. Lutfi
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Risk factors for maternal mortality in the west of Iran: a nested case-control study
Jalal Poorolajal, Behnaz Alafchi, Roya Najafi Vosoogh, Sahar Hamzeh, Masoomeh Ghahramani
Epidemiol Health. 2014;36:e2014028.   Published online November 8, 2014
DOI: https://doi.org/10.4178/epih/e2014028
  • 16,968 View
  • 146 Download
  • 7 Web of Science
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AbstractAbstract PDF
Abstract
OBJECTIVES
With a gradual decline in maternal mortality in recent years in Iran, this study was conducted to identify the remaining risk factors for maternal death.
METHODS
This 8-year nested case-control study was conducted in Hamadan Province, in the west of Iran, from April 2006 to March 2014. It included 185 women (37 cases and 148 controls). All maternal deaths that occurred during the study period were considered cases. For every case, four women with a live birth were selected as controls from the same area and date. Conditional logistic regression analysis was performed and the odds ratio (OR) and its 95% confidence interval (CI) were obtained for each risk factor.
RESULTS
The majority of cases were aged 20-34 years, died in hospital, and lived in urban areas. The most common causes of death were bleeding, systemic disease, infection, and pre-eclampsia. The OR estimate of maternal death was 8.48 (95% CI=1.26-56.99) for advanced maternal age (≥35 years); 2.10 (95% CI=0.07-65.43) for underweight and 10.99 (95% CI=1.65-73.22) for overweight or obese women compared to those with normal weight; 1.56 (95% CI=1.08-2.25) for every unit increase in gravidity compared to those with one gravidity; 1.73 (95% CI=0.34-8.88) for preterm labors compared to term labors; and 17.54 (95% CI= 2.71-113.42) for women with systemic diseases.
CONCLUSIONS
According to our results, advanced maternal age, abnormal body mass index, multiple gravidity, preterm labor, and systemic disease were the main risk factors for maternal death. However, more evidence based on large cohort studies in different settings is required to confirm our results.
Summary

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Predictors of tuberculosis and human immunodeficiency virus co-infection: a case-control study
Leila Molaeipoor, Jalal Poorolajal, Minoo Mohraz, Nader Esmailnasab
Epidemiol Health. 2014;36:e2014024.   Published online October 30, 2014
DOI: https://doi.org/10.4178/epih/e2014024
  • 18,988 View
  • 184 Download
  • 25 Web of Science
  • 17 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis co-infection is a major global challenge. It is not clear why some HIV-positive people are co-infected with tuberculosis (TB) while others are not. This study addressed that question.
METHODS
This case-control study was conducted in Tehran, Iran in June 2004, enrolling 2,388 HIV-positive people. Cases were selected from those who were co-infected with TB and controls from those without TB. Multiple logistic regression analysis was performed to assess the association between M. tuberculosis/HIV co-infection and several predictors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated.
RESULTS
In this study, 241 cases were compared with 2,147 controls. Sex, age, marital status, educational level, imprisonment, smoking, narcotic use, route of HIV transmission, previous TB infection, isoniazid preventive therapy (IPT), antiretroviral therapy (ART), and low CD4 count (<350 cells/mm3) were independently associated with M. tuberculosis/HIV co-infection (p<0.001). However, after adjusting for all other variables in the model, only the association between M. tuberculosis/HIV co-infection and the following predictors remained statistically significant: imprisonment (odds ratio [OR], 3.82; 95% confidence interval [CI], 2.11-6.90), previous TB infection (OR, 5.54; 95% CI, 1.99-15.39), IPT (OR, 0.13; 95% CI, 0.06-0.31), ART (OR, 1.81; 95% CI, 1.26-2.61), and CD4 count <350 cells/mm3 (OR, 2.34; 95% CI, 1.36-4.02).
CONCLUSIONS
Several predictors are associated with M. tuberculosis/HIV co-infection, but only a few indicators were significantly associated with M. tuberculosis/HIV co-infection. It is estimated that a number of predictors of M. tuberculosis/HIV co-infection remain unknown and require further investigation.
Summary

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