Kermanshah City Research Articles

Source apportionment, ecological and health risks of potentially toxic elements in street dusts across different land uses in city of Kermanshah, Iran

In this study, the contamination, ecological and human health risks as well as source apportionment of As, Cd, Co, Cr, Cu, Mn, Ni, Pb, Zn, and V in street dusts of different land-uses in Kermanshah, Iran were investigated. A total of 192 dust samples were taken from 16 sites and were analyzed for their elemental contents using ICP-OES. The computed mean values for the geo-accumulation index (I-geo) and the pollution index (PI) ranged from − 6.07 to 2.67 and from 0.023 to 9.58, respectively, indicating ‘unpolluted’ to ‘moderately to heavily polluted’, and ‘slight to very high polluted’ pollution levels, respectively. The pollution load index (PLI) with a cumulative mean value of 1.03 reflected moderate pollution levels across the entire study area. Moreover, the ecological risk (RI) of 135 indicated moderate ecological risks throughout the study region. The mean hazard index (HI) values for the analyzed potentially toxic elements (PTEs) for both adults and children were all within the safe limit (< 1). Furthermore, the total carcinogenic risk (TCR) values showed that the carcinogenic risks associated with As, Cd, Cr, and Ni for both target populations were at tolerable to unacceptable levels. The positive matrix factorization (PMF) model identified traffic emissions and sources, fossil fuel combustion and natural sources, and industrial emissions as the major sources of tested elements. Hence, a thorough investigation into the sources of ecological health risks associated with dust contamination from potentially toxic elements (PTEs) is recommended for future studies.

Socio-economic and Demographic Factors Associated with Psychological Distress Among Elderly

Background: Psychological distress is one of the most common mental health disorders in the elderly and can lead to major depression and anxiety disorders. Objectives: The aim of this study was to determine the prevalence, socio-economic and demographic factors associated with psychological distress among elderly in Kermanshah. Methods: The current research was a descriptive study that was conducted among the elderly over 60 years old covered by the pension funds of Kermanshah city in the winter of 2022. Sampling was done by multi-stage cluster sampling method. Data were collected using Kessler Psychological Distress Scale (K6) by interview. Data were analyzed by SPSS version 16 using Pearson correlation, chi-square and independent samples t-test at 95% significant level. Results: Twenty point six percent of the elderly had psychological distress. The correlation between age and psychological distress was positive and significant (r = 0.108 and P = 0.012). Psychological distress was significantly higher among men (P = 0.019), people with primary education (P = 0.001) and poor economic status (P &lt; 0.001). Conclusions: The prevalence of psychological distress among the elderly is noticeable. It is important to teach methods to help the elderly cope with psychological distress. Efforts to prevent and decrease psychological distress among the elderly in Kermanshah should prioritize individuals with low economic status and men.

Coronary Artery Disease Empowerment Scale (CADES): Persian translation and psychometric properties

IntroductionCoronary artery disease (CAD) is a leading cause of global mortality and a prevalent health issue in Iran. Assessing the empowerment of CAD patients during treatment and care is essential. However, no scale is available to measure empowerment in CAD patients in Iran. Therefore, this study aimed to evaluate the validity and reliability of the Persian version of the "Coronary Artery Disease Empowerment Scale" (CADES).MethodThis methodological and cross-sectional study was conducted on patients with CAD from June 2022 to April 2023 in Kermanshah City, Iran. The scale was translated using the forward–backward translation method. Construct validity was examined using Exploratory Factor Analysis (EFA) with 190 samples and Confirmatory Factor Analysis (CFA) with 344 samples, both selected through convenience sampling. Internal consistency was assessed using Cronbach's alpha coefficient, and reliability was evaluated using the test–retest method. SPSS version 27 and LISREL version 8 software were utilized for data analysis.ResultsThe EFA and CFA results confirmed the instrument with three factors and 25 items. The model's main indicators in factor analysis were all above 0.9, indicating a good fit for the model. The Pearson correlation coefficient between the items and subscales with the main scale showed a direct and significant relationship. Additionally, Cronbach's alpha coefficient (0.813) and test–retest reliability (0.763) confirmed the reliability of the Persian version of the CADES.DiscussionThe study's results suggest that the Persian version of CADES is both practical and acceptable for evaluating the empowerment of CAD patients. This tool can be relied upon as a valid and reliable method for assessing these patients' empowerment.

Study of the Relationship Between Death Anxiety and Quality of Life in Patients With Heart Failure.

This study aimed to investigate the relationship between death anxiety and QoL in a sample of Iranian heart failure (HF) patients. A cross-sectional correlational design was employed to examine this relationship in a sample of 296 HF patients. Participants were recruited using convenience sampling from teaching hospitals in Kermanshah City, western Iran, between October and December 2023. Data were collected using a demographic questionnaire, the Templer Death Anxiety Scale (TDAS), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Participants reported moderate to high levels of death anxiety (Mean [SD] = 7.54 [2.35]) on the TDAS and moderate to poor QoL (Mean [SD] = 36.24 [12.26]) on the MLHFQ. The statistical methods used in this study included descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Pearson correlation coefficient, multiple linear regression analysis, and the Kolmogorov-Smirnov test. All statistical analyses were performed using SPSS version 26, with a significance level set at 0.05. A significant positive correlation was found between death anxiety and QoL (r = 0.329, p < .001), indicating that higher levels of death anxiety were associated with lower QoL. These results underscore the importance of addressing death anxiety in HF patients to improve their QoL. Interventions targeting the reduction of death anxiety and the enhancement of QoL are essential for optimizing care for this vulnerable population. The study recommends the implementation of psychological interventions, support groups, comprehensive counseling, education, and regular assessments for this purpose.

Delayed Surgical Management of a Giant Rhabdomyomatous Meningioma: A Case Report

Background and Importance: Rhomboid meningioma (RM) is one of the rare and aggressive types of meningioma, typically classified as a central nervous system grade III anaplastic meningioma by WHO. In this report, we present an unusual case of RM. Case Presentation: The patient was a 67-year-old man, living in Kermanshah City, Iran. He came to a neurosurgery clinic with a chief complaint of a huge and unusual mass on his skull. Following the brain computed tomography scan and magnetic resonance imaging, the diagnosis of meningioma was considered. The patient underwent surgical intervention for the excision of the mass. Immunohistochemical findings demonstrated the diagnosis of RM (WHO grade III). Conclusion: RM is a rare and aggressive subtype of meningiomas with a high growth rate and poor prognosis. Early diagnosis and treatment especially in invasive ones can prevent many unpleasant and critical complications; although tumor location has a pivotal role in determining treatment strategy.

Translation and validation of the Persian version of the Nursing Practice Readiness Scale (NPRS) for new graduate nurses

BackgroundThe clinical readiness of newly graduated nurses is crucial in meeting the growing demand for health services. Consequently, it is essential to develop a scale that accurately evaluates the clinical readiness of these novice nurses.AimThis study aimed to translate and psychometrically evaluate the Persian version of the Nursing Practice Readiness Scale (NPRS) for new graduate nurses.MethodsThis methodological and cross-sectional study was conducted on new graduate nurses from June to November 2023 in Kermanshah City, Iran. The translation of the scale was performed using the forward–backward translation method. Construct validity was assessed using Exploratory Factor Analysis (EFA) with a sample of 180 participants and Confirmatory Factor Analysis (CFA) with a sample of 318 participants, both employing the convenience sampling method. The internal consistency of the tool was measured using Cronbach’s alpha coefficient. Additionally, the tool’s reliability was evaluated using the intraclass correlation coefficient (ICC). The analyses were conducted using SPSS version 27 and LISREL version 8 software.ResultsThe results of EFA and CFA confirmed the tool’s structure, comprising five factors and 35 items. The CFA results showed a well-fitting model (CFI = 0.96, NNFI = 0.96, GFI = 0.893, RMSEA = 0.062, SRMR = 0.049). Pearson’s correlation coefficient indicated a significant relationship between the items, subscales, and the main scale. Additionally, the Cronbach's alpha coefficient of the tool was 0.932, and the intraclass correlation coefficient (ICC) was 0.891(0.724–0.957).ConclusionThe Persian version of the Nursing Practice Readiness Scale (NPRS) is a valid and reliable tool, comprising 35 items and five factors. This scale can be effectively used to evaluate the clinical readiness of newly graduated nurses within the Iranian community.

Investigating the Association between Coping Styles and Social Identity in Adolescents of Marginal and Non-Marginal Areas

Objective: This study aimed to investigate the relationship between coping styles and social identity among adolescents residing in marginal and non-marginal areas. Method: A cross-sectional study design with a descriptive-analytic approach was utilized. The study population consisted of adolescents aged 12 to 19 from Kermanshah city, with 222 participants evenly distributed between marginal and non-marginal areas. Adolescents were enrolled in the study using a multi-stage sampling method (stratified cluster, simple randomized method). Data were collected using the Standard Social Identity questionnaire and Lazarus and Folkman's Coping Styles questionnaire. The data were analyzed statistically in the SPSS software environment (version 25) using appropriate statistical tests. Results: The results of the study showed that there is a significant relationship between the components of social identity and coping styles in adolescents (P &lt; 0.05). Emotion-focused and problem-focused coping styles had the ability to explain social identity in the adolescents of Kermanshah city. Also, in comparing the coping styles and social identity between adolescents from marginalized and non-marginalized areas in the city of Kermanshah, there was no significant difference (P &lt; 0.05). Conclusion: This study underscores the importance of understanding how coping strategies influence social identity among adolescents across different socio-environmental contexts. The findings highlight the need for further research to explore the mechanisms underlying these relationships and consider the role of contextual factors in shaping adolescent development.

Which factor, food literacy or health promotion literacy, predicts women’s healthy eating habits better? Results of a study in western Iran

ABSTRACT The objective of this study was to examine the individual contributions of food literacy and health promotion literacy components to healthy eating habits. By exploring these relationships, we aim to enhance our understanding of the factors that shape individuals’ dietary choices and behaviors. In 2022, a cross-sectional study was conducted using survey methodology. The study sample was selected using the cluster sampling method, and data was collected using a standardized questionnaire among women aged 18 and older in Kermanshah city in western Iran. The findings of the study revealed that 26.4% of women demonstrated high levels of food knowledge, 44.4% exhibited high food skills, and 28.4% displayed high resilience. Additionally, 38.5% of participants demonstrated high health promotion literacy, while 47.9% exhibited high levels of healthy eating habits. Furthermore, the results indicated a significant relationship between the components of food literacy and healthy eating habits. Notably, an increase in health promotion literacy was found to positively correlate with improved healthy eating habits. Given that a significant proportion of women in the study exhibited low levels of food knowledge, it becomes crucial to prioritize efforts to enhance women’s understanding of nutrition and food-related information.

Hybrid energy-based electric vehicles charging station integrated with INVELOX wind turbine: A case study of Kermanshah

Global warming from fossil fuels is a growing concern for governments. A potential solution is using renewable energy microgrids, which reduce dependence on the power grid. On the other hand, Electric vehicles are a solution to combat environmental pollution as they emit no harmful pollutants compared to conventional vehicles. However, charging these vehicles can lead to congestion, reliability, and resiliency issues for power systems. To address this issue, renewable energy sources are being utilized to ease the burden of electric vehicles on power grids. Therefore, this paper assumes a proposed microgrid's planning and management in Kermanshah city and uses unique renewable energy sources such as the INVELOX wind turbine and common photovoltaic panels by utilizing Homer software. Results show that for the first scenario, excluding PV panels, the NPC is $432,173. Adding PV panels reduces the optimized NPC by 53 % to $282,523. Sensitivity analysis highlights the impact of inflation, fuel prices, and PV longevity. In the second scenario with the INVELOX wind turbine, the NPC without PV is $373,199, with $26,070 in annual repairs. Adding PV panels decreases the NPC to $253,405 and maintenance to $14,288, showing significant cost reductions. Novel technologies like INVELOX and PV panels enhance microgrid cost efficiency and environmental impact.

Antimicrobial resistance profile and prevalence of Mycobacterium tuberculosis complex in Western Iran using spoligotyping method

Tuberculosis (TB) is a chronic infectious disease with multiple manifestations and gradual progression that remains a major health problem and a leading cause of death worldwide. In recent years, a number of DNA fingerprinting techniques have been developed to identify strains of the Mycobacterium tuberculosis (MTB) complex. Spoligotyping is one of the first PCR-based genotyping methods. Information on the number and identification of common strains among MTB complex samples in clinical samples from Kermanshah city is needed to develop more effective therapeutic strategies.This is a descriptive cross-sectional study of 41 sample patients with TB referred to Kermanshah Tuberculosis Centre between December 2021 and June 2022, including sputum, aspiration, urine, etc. First, the susceptibility of the developed bacteria to culture media was compared with that of isoniazid using the proportional method, and rifampin was determined according to the standard protocol. Demographic data of patients referred to the Centre for the Control of Lung Diseases were also recorded.In the next step, spoligotyping was carried out using the standard method and each strain pattern was recorded as an OCTAL code and compared with the information available at the World Bank on spoligotyping and its strains. Forty-one patients with pulmonary TB were tested using spoligotyping. Four MTB strains were identified, including H4, CAS, T1 and H1.The H4 strain also had the highest frequency with 16 samples (39%) among the MTB complex strains isolated using spoligotyping.The highest frequency of strains isolated using spoligotyping was associated with the H4 strain. It can be concluded that spoligotyping is very cost effective, simple, repeatable and highly sensitive.

Microplastic Pollution in Compost Derived from Mixed Municipal Waste in Kermanshah City: Abundance, Characteristics, and Ecological Risk Evaluation

Microplastic Pollution in Compost Derived from Mixed Municipal Waste in Kermanshah City: Abundance, Characteristics, and Ecological Risk Evaluation

Kermāšāni: The Kurdish Dialect of Kermanshah

Spoken in the city of Kermanshah and environs in western Iran, Kermāšāni is a variety of Southern Kurdish, which has received far less scholarly attention than Central Kurdish (Sorani) or Northern Kurdish (Kurmanji). This study aims to elucidate some lesser-known aspects of Southern Kurdish by providing a systematic sketch grammar of Kermāšāni based on newly collected fieldwork data. One particularly challenging area explored is verb morphology, especially how stems ending in vowels exhibit distinct conjugation classes. The study investigates the interdependence among passive past stems, the imperfect, and the past subjunctive, all marked by the formant -yâ-. Additionally, three appended texts offer insights into the sociolinguistic aspects of Kermāšāni and discuss challenges in adapting dialect into classical Persian prosody.

A quasi-experimental study to assess the impact of green gardens on elderly anxiety: A socio-ecological perspective

ABSTRACT By 2050, it’s projected that the elderly population will make up approximately 14% of the global populace. United Nations forecasts indicate a notable increase in the average age of Iran’s population, expected to rise from 29.5%–49.4% by 2100, presenting significant societal and environmental challenges for the future. Given this demographic shift, addressing the implications of an aging population in Iran is paramount, underscoring the necessity for a socio-ecological approach. This experimental study seeks to explore the effects of green gardens on the mental well-being of the elderly, employing practical experience and a socio-ecological perspective. The study cohort consisted of elderly individuals residing in eldercare facilities in Kermanshah city, located in western Iran. Utilizing a purposive sampling method, 80 individuals were carefully selected and included in the study. Participants were then randomly divided into two groups: an experimental group (n = 40) and a control group (n = 40), ensuring demographic homogeneity. Adopting a quasi-experimental research design with pre-test/posttest measures and a control group, data were gathered through the Geriatric Anxiety Inventory (GAI) questionnaire. The results revealed statistically significant differences in anxiety variables—cognitive (p < .01, d = 0.78), arousal (p < .01, d = 1.64), and somatic (p < .01, d = 0.85) aspects—both before and after the implementation of green garden initiatives in eldercare facilities among the experimental group. Conversely, no significant changes were observed in these variables within the control group before and after the intervention. The practical application of the socio-ecological approach has the potential to strengthen the connection between the elderly and their environment, leading to substantial changes in human resources concerning psychological characteristics and contributing to the development of green spaces in urban areas. This research provides valuable insights into addressing the health and well-being of the aging population through socio-ecological interventions. Furthermore, this study has practical and theoretical implications by addressing urban agriculture practices. Overall, this study contributes to urban agriculture practice on one hand and has a significant impact on the health of the elderly on the other hand.

Comparison of Oral Diadochokinesis in Two- and Three-Syllable Structures Consisting of Consonants and Vowel /a/ with Two- and Three-Syllable Structures Consisting of Consonants and Vowel /u/ in 7-9-Year-Old Children of Kermanshah, Iran

Background and Objective: Diadochokinesis tasks, as a traditional component of speech-motor assessment, are an indicator of the evaluation of oral motor skills. This study aimed to help determine a criterion for the evaluation of the speed of consecutive movements by determination of diadochokinesis in normal children aged 7 to 9 years. Moreover, by creating syllabic assignments, consisting of closed and open vowels, it was possible to compare the speed of production in reciprocal movement conditions. Materials and Methods: The current descriptive-analytical study used a cross-sectional design. It was conducted on 210 primary school students in three age groups of 7, 8, and 9 years old in Kermanshah City, Iran, who were randomly selected. Students had to repeat two-syllable structures 15 times and three-syllable structures 10 times. The structures consisted of consonants and vowels/a/ and /u/ to determine their durations. Results: The production speed of the two-syllable structures /pata/ and /paka/ was significantly higher, compared to that of /putu/ and /puku/, respectively (P=0.002). However, in the two-syllable structures /taka/ and /tuku/ (P=0.09) and trisyllable structures /pataka/ and /putuku/ (P=0.11), the difference of the mean diadocokinesis was not significant. Therefore, the vowel /a/ increased the ability of diadochokinesis in some syllabic combinations but had no effect on some other combinations. Conclusion: With the increase of age, the ability to produce two- and three-syllable structures quickly and accurately increases. Usage of the vowel /a/, compared to the vowel /u/ in some syllabic combinations increased the speed of diadochokinesis but had no effect in some syllabic combinations

Evaluation and analysis of the quality of geomorphology of Qarasu River in the area of Kermanshah city

Evaluation and analysis of the quality of geomorphology of Qarasu River in the area of Kermanshah city

Poisoning in children and adolescents in Kermanshah city, Iran

BackgroundPoisoning among children and adolescents is a public health problem worldwide. To take preventive measures, the pattern of this problem should be determined. This study aimed to describe the demographic characteristics of poisoning in children and to investigate the relationship between the types of poisoning and demographic factors in children in Kermanshah province.MethodsThis cross-sectional, descriptive-analytical study was conducted on 250 children and adolescents under 18 years of age who were referred to Mohammad Kermanshahi Pediatric Hospital in Kermanshah province due to poisoning during 2019–2022. The demographic and epidemiological data of patients were extracted from their medical files and analyzed.ResultsOut of 250 cases of poisoning, 173 (69.2%) cases were unintentional, 96 (55.5%) of whom were boys. Further, 77 (30.8%) cases of poisoning were intentional, of whom 49 (63.6%) were girls. There was a significant difference between gender and intentional and unintentional poisonings (p-value = 0.005). The median age of unintentional poisoning was 3 (IQR = 2.5) and that of intentional poisoning was 14 (IQR = 2). Most cases of poisoning were in cities, 145 (83.8%) of them were unintentional and 66 (85.7%) were intentional. Most cases of intentional and unintentional poisonings occurred in spring 2017 (35.1%) and autumn 2016 (34.6%), respectively. The most common causes of poisoning were narcotics (n = 36, 34.3%) and drugs (n = 35, 33.3%) in the age group 0–3 years and drugs (n = 46, 66.9) in the age group 11–18 years.ConclusionsThe most common causes of poisoning were narcotics and drugs in children and drugs in adolescents. To prevent poisoning in children, parents are required to increase their knowledge of the safe storage of narcotics and drugs, such as not storing methadone in a water bottle. Targeted evaluation and preventive measures are also needed in adolescent poisoning.

Relationship between coping styles (problem-oriented, emotion-oriented, and avoidance-oriented) with psychological well-being in people with coronavirus-2019 experience in Kermanshah city

BACKGROUND: Considering the epidemic status of the COVID-19 virus, the discussion of the psychological effects of this disease on the mental health of people at different levels of society is of great importance. Therefore, this study was conducted to investigate the relationship between coping (problem-oriented, emotion-oriented, and avoidance-oriented) with psychological well-being in people with coronavirus disease. MATERIALS AND METHODS: In this correlational study, the statistical population consisted of all individuals with experience of coronavirus in 2021 in Kermanshah city. In total, 220 people were selected as the sample using an available sampling method. The instruments used in this study were Reef Psycho-Welfare Questionnaire (PWBQ) and Andler and Parker Coping Styles (CISS-SF). Data were analyzed using Pearson’s correlation coefficient and simultaneous regression. RESULTS: Multiple correlations of coping variables (problem-oriented, emotion-oriented, and avoidance-oriented) with psychological well-being (R = 0.671; P = 0.01) are significant. Problem-oriented coping style (beta = 0.329; P = 0.05), emotional coping style (beta = 0.329; P = 0.05); avoidant coping style (beta = 0.144; P = 0.05) had a significant relationship with psychological well-being. CONCLUSION: According to the obtained results, the importance of paying attention to coping styles in psychological well-being is felt more than before. Psychological well-being seems to be influenced by other factors and their interactive effects as well.

Examining the Causal Pattern of Cognitive emotion Regulation and Impulsiveness with the Mediating Role of Executive Functions, Working Memory, and Stress Coping Strategies in Female Students with Conduct Disorder

Objective: This study aimed to examine the causal pattern of cognitive emotion regulation and impulsiveness with the mediating role of executive functions, working memory, and stress coping strategies in female students with conduct disorder. Methods and Materials: This study can be examined from two perspectives: from the perspective of implementation method, it falls under descriptive research of a predictive correlational type, and from the perspective of purpose, it is considered applied research. The statistical population of this study included all first-year high school female students in the city of Kermanshah in the academic year 2022-2023, from which 200 individuals were selected as the sample. A simple random sampling method was used. In the data collection domain, both library and field methods were employed. In the field section, for collecting the necessary research information, the following questionnaires were used: Behavioral Problems of Quay and Peterson (2013), Emotion Regulation of Gross and John (2003), Impulsiveness of Barratt (1995), Behavioral Rating Inventory of Executive Functions of Gioia et al. (2000), Working Memory of Daneman and Carpenter (1980), and Coping Strategies of Moos and Billings (1981). Subsequently, SPSS22 and PLS statistical software were used for data analysis. Findings: The study results indicated that cognitive emotion regulation affects the impulsiveness of female students with conduct disorder. Executive function affects the impulsiveness of female students with conduct disorder. Working memory affects the impulsiveness of female students with conduct disorder. Stress coping strategies affect the impulsiveness of female students with conduct disorder. Conclusion: The results showed that cognitive emotion regulation affects the impulsiveness of female students with conduct disorder with the mediation of executive function. Cognitive emotion regulation affects the impulsiveness of female students with conduct disorder with the mediation of working memory. Additionally, the results indicated that cognitive emotion regulation affects the impulsiveness of with the mediation of stress coping strategies.

Associations of Sleep Problems and Self-regulation With Interpersonal Aggression Among Healthcare Workers

Background and Purpose: Sleep problems and aggression are common among healthcare workers due to shift work and constant interaction with patients and their relatives. The present study examined the associations between sleep problems, self-regulation, and interpersonal aggression among healthcare workers. Materials and Methods: In this cross-sectional study, 400 healthcare workers were selected from four state-run hospitals in Kermanshah City, Iran, using a multi-stage random sampling between March 2021 and March 2022. The sample size was selected using the N&gt;50+8m standard formula. The participants completed several standard scales, including the Pittsburgh sleep quality index, the Berlin questionnaire, the insomnia severity index, the self-regulation questionnaire, and the Buss-Perry aggression questionnaire. The obtained data were analyzed using the Pearson correlation, hierarchical multiple regression techniques, and standardized z scores. Results: The Mean±SD age of the participants was 32.5±8.8 years and 70% were female. All sleep problems, including poor sleep quality, sleep apnea, and insomnia severity, are significantly related to the total score of interpersonal aggression and all its subfactors (P&lt;0.001). The results showed that adding self-regulation to sleep problems to predict aggression greatly reduces the effect of sleep problems, especially the insomnia severity (P&lt;0.001). Conclusion: The results showed that self-regulation is not only a protective factor for aggression but also indirectly protects against aggression by controlling the severity of insomnia. Because both sleep problems and self-dysregulation are modifiable risk factors for interpersonal aggression, psychological interventions can target these risk factors.

The Amount of Alcohol Consumption and Its Quantitative Risk Assessment through Wastewater-Based Epidemiology: a Case Study in Kermanshah City

The Amount of Alcohol Consumption and Its Quantitative Risk Assessment through Wastewater-Based Epidemiology: a Case Study in Kermanshah City