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Purpose Neutropenic fever remains a major complication in acute leukemia. Decolonization is assumed as a promising intervention for eradicating causative agents of infection Methods In this randomized clinical trial, 96 patients with acute leukemia were assigned randomly to mupirocin nasal drop 2% (n = 32), chlorhexidine mouthwash 0.2% (n = 33), and control group (n = 31). In control group patients did not receive any medication for decolonization. All patients received treatment for 5 days (2 days prior to chemotherapy until 3 days after chemotherapy). Pharynx and nasal swabs were taken prior to the intervention and at the end of decolonization period in all groups. Antibiotic susceptibility testing was performed by the disc diffusion method in order to identify bacterial isolates. Results Bacterial recovery of both nasal and pharynx swabs was observed after global decolonization with mupirocin nasal drop. Decolonization with mupirocin significantly eradicated Coagulase-negative staphylococci (CONS) in both nasal and pharynx swabs (p-value = 0.000). Moreover, mupirocin decreased pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) species. Chlorhexidine mouthwash significantly eradicated CONS in pharynx swabs (p-value = 0.000). In addition, both decolonization strategies decreased both antibiotic use and frequency of fever in leukemic patients. Conclusion Global decolonization with mupirocin nasal drop not only eradicates both nasal and pharynx microorganisms, but also reduces antibiotic requirement and frequency of fever in patients with acute leukemia. The protocol of the present study was approved on December 2016 (registry number: IRCT20160310026998N6).

Background In Iran, tracking of patients and its associated data recording in private healthcare centers are poor, and thus a majority of patients suffering from Covid-19 are treated without any control on the isolation and quarantine processes. The present study aims to investigate the factors contributed to referral to private healthcare centers that provide Covid-19 care services. Methods This cross-sectional study was conducted from November 2021 to January 2022 in Tabriz, Iran. We invited a total of 258 and 202 Covid-19 patients from governmental and private healthcare centers, respectively, to participate in the study. Applying a self-administered questionnaire, we collected data on the reason of referring to the healthcare centers, patient’s waiting time, quality of healthcare services received by the patients, patients’ level of satisfaction, accessibility, insurance coverage, perceived severity of the disease, and the level of staff compliance from health protocols. Logistic regression model was used for data analysis. Results Adjusted for other variables, higher socio-economic status (OR=7.5), older age (OR=1.02), referral of friends and family members (OR=1.93), shorter waiting time (OR=1.02) and higher satisfaction (OR=1.03) were contributed to referral to private centers. Better accessibility (OR=0.98) and wider insurance coverage (OR=0.98) were also contributed to referral to governmental centers. Conclusion Older age, higher socio-economic status, lower levels of waiting times for service provision, and higher levels of patient satisfaction were identified as determinant factors for patients’ referral to private healthcare centers. On the other hand, higher levels of accessibility to governmental healthcare centers and wider health insurance coverage reduced the possibility of referring to the private centers.

Background: Autonomous self-regulation is a proxy for adapting long-term healthy behaviors with major impact on prevention of chronic illnesses. The psychometric properties of the Treatment Self-Regulation Questionnaire- Persian version (TSRQ-P) was assessed in this study for use in examination of autonomous regulation among the Iranian type 2 diabetes patients. Methods: The preliminary draft of the TSRQ-P was prepared based on a standard translation/back translation procedure and 15 allied health specialists assessed its face and content validities. The internal consistency measure of the Cronbach’s alpha and Intraclass Correlation Coefficient (ICC) were estimated to verify the TSRQ-P’s content validity and reliability. The exploratory (EFA) and confirmatory factor (CFA) analyses were performed to check the scale’s structural components. Results: The calculated Cronbach’s alpha= 0.893 and ICC= 0.982 deemed the scale as content valid and acceptable in terms of measurement invariance. The EFA and CFA outputs yielded two distinct factor structure for the TSRQ-P (RMSEA=0.078, NFI=0.849, RFI=0.806, IFI=0.913, TLI=0.886, CFI= 0.911). Conclusion: The TSRQ-P indicated robust psychometric features for application among Persian-speaking type 2 diabetes patients. Due to cross-borders cultural diversity of the subgroups of Persian speaking populations, further psychometric scrutiny is recommended to prevent bias and sociolinguistic inconsistencies.

Background: In recent decades, the significant increase in the prevalence of obesity, both in developing and developed countries, suggests that obesity is a complex health problem. Environmental factors such as lack of physical activity, excessive TV watching and sedentary lifestyle, consumption of high-calorie foods, and side effects of different drugs, can cause overweight and obesity. Obesity is associated with severe health problems such as diabetes, hypertension, hyperlipidemia, asthma, arthritis, and even reduced life expectancy. Obesity also has a profound effect on people's mental health. Methods: After ethics committee approval from the Iran University of Medical Sciences (IR.IUMS.FMD.REC.1399.457), 395 healthy women between 20 to 50 years old entered the study. Questionnaires related to general information and assessment of individuals' status in terms of eating behaviors were completed on women from 20 to 50 years old who worked at the Iran University of Medical Sciences. Anthropometric variables including height, weight, body fat percentage, waist circumference, and hip circumference were measured and body mass index (BMI) and waist to hip ratio (WHR) were calculated. Then, a questionnaire related to perceived stress was completed by each participant. The 24-hour food recall questionnaire and the physical activity questionnaire were also conducted. Results: In contrast to other studies, anthropometric indices (weight, height, BMI, waist circumference, and hip circumference) were reported higher in people who ate breakfast than in those who did not. There is no significant relationship between eating behaviors (speed rate, eating breakfast or not eating breakfast, and eating with or without a screen) and perceived stress levels. Anthropometric indices increase with increasing food intake and decreasing physical activity, while there is no relationship between dietary intake and physical activity with perceived stress levels. Conclusion: Dietary behaviors and physical activity affect anthropometric indices, while, perceived stress levels do not affect dietary behaviors or anthropometric indices.

Background: Using personal protective equipment, including masks, is one of the most important ways to prevent coronavirus. The aim of this study was to estimate the prevalence and pattern of mask use and its relation to morbidity and mortality of Covid-19 in different area of Tabriz city.Methods: In this population-based study 6,600 pedestrians were selected by multi-stage proportional sampling method in 9 areas of Tabriz in 2021 in Tabriz. The data was collected using the observation method. For each subject, gender, approximate age, mask usage, type of mask and correct or incorrect use were recorded. The data of morbidity and mortality of Covid-19 for six months (from 21 March 2021 to 22 September 2021) were obtained from Integrated Syndromic Surveillance System (ISSS). Results: The overall prevalence rate of facial mask use was 56.8% (95% CI: 55.56 – 57.95). Out of 3421 men, 1599 (46.7%; 95%CI: 45.1-48.4) and out of 3179 women, 2147 (67.5%; 95%CI: 65.9-69.2) were use face mask (PConclusion: We conclude that the use of face masks in Tabriz is relatively low, especially among males and young people. There was no significant relationship was observed between the use of the mask in pedestrians, morbidity and mortality due to covid-19.

Metabolic syndrome (MetS) is the co-occurrence of several interconnected metabolic disorders and its prevalence is rising in the world. We hypothesized that blueberry (BB) feeding will have positive effects on components of MetS according to studies which used animal subjects. A systematic search for the studies in Science Direct, Embase, Cochrane and PubMed databases was done. The Studies which investigated effects of BB on components of MetS in animal models were included. Of 1030 potentially relevant studies, after investigation, 28 animal studies remained for further investigation. Of these, 1 study was conducted using pigs, one study using hamsters, 15 studies using mice and 11 studies using rats. 18 studies were eligible for the meta-analysis, and others were included in systematic review. The meta-analysis was done by Comprehensive Meta-analysis Software.The results of the meta-analysis demonstrated no significant effect of blueberry feeding on body weight [p = 0.65 CI95%: (-3.029, 1.892)]. However, a statistically significant improvement of systolic blood pressure [p Conclusion: this study showed that blueberry can be effective in ameliorating some components of metabolic syndrome in animal models. There is a need to conduct more studies on this subject in humans.

IntroductionInsulin resistance has been suggested as one of the known metabolic disorders during cachexia. This study hypothesized that cachexia in cancer patients might be due to insulin resistance as early as cachexia development. MethodThis study was performed on 46 patients with metastatic gastrointestinal cancer. Anthropometric characteristics and biochemical markers were assessed at baseline, second month, and third month. Insulin resistance was assessed using the HOMA IR method. SFQ-36 questions were used to assess the patients' quality of life at baseline, second and third months.ResultsPatients' anthropometric characteristic was significantly associated between pre-cachectic and non-pre-cachectic patients in the third month. Cholesterol (P-value: 0.93), albumin (P-value: 0.82), and serum creatinine (P-value: 0.88) in pre-cachectic patients decreased over three months. There was an increasing trend of insulin resistance between pre-cachectic and non-pre-cachectic patients in the third month. Cholesterol had an upward trend with a significant relation in cachectic patients [(P-value: 0.00), (P-value: 0.03), (P-value: 0.01)]. We detected a decreasing trend of insulin resistance between cachectic and non-cachectic patients from the second to the third month (Pvalue= 0.04). SFQ evaluation had no significant relation with cachectic status.ConclusionSignificant relation between anthropometric variables with pre-cachexia and cachectic conditions was concluded. Patients' outcome and its relation with insulin resistance (age of 30≤, and above 30≥) demonstrated a significant relation between the cachectic and non-cachectic patients in the third month. We also detected the increased serum cholesterol level in cachectic patients, moreover, higher cholesterol levels in expired cachectic patients than in the living.

Purpose Peripheral neuropathy is a complication of taxane that in severe cases can limit the optimal treatment. The aim of this study was to evaluate the efficacy of memantine in prevention of docetaxel induced peripheral neuropathy in patients with breast cancer. Methods In this randomized clinical trial, 40 women between the ages of 18 and 64 years with non-metastatic breast cancer (stages I to III) were included (registry number: IRCT20160310026998N9 and registry date: 26 March 2019). All patients were treated with the AC-T regimen (with docetaxel). Patients in intervention group received memantine at a dose of 20 mg for 8 weeks at the beginning of the first cycle of docetaxel. Patients in control group did not take any medication for neuropathy prevention. To assess the neuropathy, DN4 and CTCAE questionnaires were used at baseline, one months, three months and six months after the intervention. Results The DN4 questionnaire score was remarkably less in memantine group in follow up one (p-value: 0.033) and three (p

Air pollution data are large-scale dataset which can be analyzed in low scales by clustering to recognize the pattern of pollution and have simpler and more comprehensible interpretation. So, this study aims to cluster the days of year 2017 according to the hourly O3 and PM10 amounts collected from four stations of Tabriz by using spatio-temporal mixture model-based clustering (STMC). Besides, mixture model-based clustering with temporal dimension (TMC) and mixture model-based clustering without considering spatio-temporal dimensions (MC) were utilized to compare with STMC. To evaluate the efficiency of these three models and obtain the optimal number of clusters in each model, BIC and ICL criteria were used. According to BIC and ICL, STMC outperforms TMC and MC. Three clusters for O3 and four clusters for PM10 were selected as the optimal number of clusters to fit STMC models. Regarding PM10, the average concentration was the highest in cluster 4. Regarding O3, all summer days were in cluster 3 and the average concentration of this cluster was the highest. Cluster 2 had the lowest concentration with a high difference from clusters 1 and 3 and its average temperature was the lowest. Autumn days make up about 84% of this cluster. The clustering of polluted and clean days into separate groups and observing the effect of meteorological factors on the amount of concentration in each cluster clearly prove the efficiency of the model. Results of STMC showed that efficiency of clustering in air pollution data increases by considering both spatio-temporal dimensions.

Background: Identifying patterns and hidden relationships among fatal pedestrian road traffic accident (FPRTA) features can be effective to reduce pedestrian fatalities. This study aimed to detect the patterns of FPRTA in the East Azerbaijan province of Iran.Methods: The present study is a descriptive-analytic study based on the data of all 1782 FPRTAs that occurred in East Azerbaijan province of Iran during the years 2010 to 2019 collected by the forensic organization. CATPCA (Categorical Principal Component Analysis) was performed to recognize hidden patterns in the data by extracting principal components from the set of 13 features of FPRTA. The importance of each component was assessed by using the variance accounted for (VAF) index. Results: The optimum number of components to fit the CATPCA model was six with a 71.09% explanation of the total variation. The first and most important component with VAF=22.04% contained the demographic and socioeconomic characteristics of the pedestrians. The second-ranked component with VAF=12.96% was about the injury. The third component with VAF=10.56% was about the severity of the accident. The fourth component with VAF=9.07% was somehow related to the knowledge and observance of the traffic rules. The fifth component with VAF=8.63% was about the quality of medical relief and finally, the sixth component with VAF=7.82% was about environmental conditions. Conclusion: CATPCA revealed hidden patterns of FPRTA data in the format of six components. The revealed patterns showed that some interactions between correlated features led to a higher mortality rate.

Background Pedestrians are among the most vulnerable groups in traffic accidents. This study investigates the determinants of traffic behaviors of pedestrians. Methods In this cross-sectional study, the behavior of 600 pedestrians in the city of Urmia, northwestern Iran, was evaluated from May to October 2018, using a pedestrian traffic behavior questionnaire consisting of five dimensions: traffic violations, traffic distraction, adherence to traffic rules, aggressive behavior, and positive behaviors. Cluster sampling was conducted among 30% of the health centers in each district of the city. Thereafter, individuals were randomly selected from each center depending on the covered population. Results Although 17% of the pedestrians demonstrated safe traffic behaviors, over 85% were distracted, more than 80% did not comply with traffic laws, the majority violated rules and displayed no positive traffic behaviors, and half of the participants were aggressive. Age, gender, marital status, education level, daily walking rate, and transportation mode were significant predictors of traffic behavior. Conclusion Most pedestrians demonstrate unsafe traffic behaviors. The youth, those who were single, those with lower education, and those with less walking rate showcased higher unsafe behaviors. Training and intervention programs should be implemented to improve all domains of pedestrian traffic behaviors factoring in age and other predictors.

Background: In order to understand how people perceive, process, and respond to COVID-19 risk information, a valid and reliable instrument is needed. This study aimed to develop an instrument to measure the risk perceptions of people about COVID-19 based on the Extended Parallel Process Model (EPPM). Methods: This cross-sectional study was conducted in Tabriz, Iran. First, a comprehensive literature review was conducted to develop the initial draft of Risk-percept COVID-19. Then, in order to obtain a pre-final version of the instrument, face and content validity were conducted. After that, construct validity (exploratory and confirmatory), internal consistency using test-retest reliability and Cronbach’s alpha of the instrument were measured. Results: Forty two item were initially generated. During the content validity, it was reduced to 29 items. The exploratory factor analysis (EFA) revealed four factors (perceived response efficacy, perceived threats (severity and susceptibility), perceived self-efficacy, and defensive responses (denial, avoidance and reactance) that accounted for 49.97 of the observed variance. The confirmatory factor analysis (CFA) designated a model with appropriate fitness for the data. Cronbach’s alpha coefficient for the dimensions ranged from .697 to .793, and the Intraclass Correlation Coefficient (ICC) ranged from .71 to .80 within acceptable ranges. Conclusion: the current findings show that the Risk-percept COVID-19 is a valid and reliable instrument to assess the cognitions and perceptions of adults.

Background Despite the current endeavors in the prevention and treatment of diabetes, it is, still, one of the leading causes of mortality, morbidity, and health system costs worldwide. The aim of this study was to determine the prevalence of pre-/diabetes, awareness, treatment, and control of diabetes and its correlates among people participating in the pilot phase of the Azar cohort study in the Northwest of Iran.Methods A total of 1038 adults aged 35 years and older in Khamene city, East Azerbaijan province, Northwest of Iran, were recruited for the pilot phase of Azar cohort; a province-level of a nationwide PERSIAN cohort study. A comprehensive questionnaire including sociodemographic and clinical information was completed, and biological samples were collected. The quantities of HbA1C and FBS were adopted as benchmarks for assessing the status of subjects about having diabetes and pre-diabetes. All analyses were performed using STATA (version 14), the statistical software.Results The overall prevalence of diabetes and pre-diabetes was 18.2% and 34.8%, respectively. The result of the multivariate regression model showed, females had a better awareness (2.00 (CI: 0.94–4.26)), and their reception of diabetes’ medicine was higher: 2.57 (CI: 1.25–5.29). Having at least one comorbid condition was associated with an increased awareness of diabetes (3.13 (CI: 1.47–6.66)); in addition, here, the possibility of receiving medication was,also, higher: 4.54 (CI: 2.21–9.32). Furthermore, people who were smokers had a lower awareness. There was a significant increase in diabetes’ control among people with secondary and high school education (2.4 (CI: 0.92–6.23).Conclusions The current study demonstrated the increased prevalence of pre-/diabetes as well as low awareness, inadequate treatment and control. More effective and corrective factors in reducing the risk of diabetes and its control require more attention.

Background: Brucellosis is one of the most frequently occurring zoonotic diseases of veterinary and a public health problem in developing countries. It affects human and animal health and has measurable effects on the productive and reproductive performance of livestock. Therefore, the main purpose of this study was to develop a community-based intervention program for brucellosis prevention and control. A two-arm parallel cluster randomized controlled trial investigated the effectiveness of the program over six months in a rural population in Ahar, East Azerbaijan, Iran. A total of 16 village health houses were randomly allocated to the intervention and the control groups (eight per arm), and 400 participants were recruited via household health records in the health houses. The PRECEDE model, which is an acronym for Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation, was used to design, implement, and evaluate the brucellosis prevention and control program. Knowledge, attitudes, self-efficacy, social support, environmental enabling, and behavioral factors were measured at the baseline and the six-month follow-up. A generalized mixed effects model was used to analyze data. Results: The mean ages (SD) of the intervention and control group respondents were 35.9 (11.87) and 37.28 (11.04) years, respectively. After the six-month intervention, significant between-group differences were found on all PRECEDE variables, adjusted for education, history of brucellosis, and family history of brucellosis. Conclusion: There is a need to consolidate collaborative health and veterinary sector efforts, as well as increase regular vaccination practices and financial resources to support farmers willing to slaughter animals and/or offer slaughter facilities. The present study was able to demonstrate which educational and ecological factors influence behaviors and environments related to brucellosis and, as such, provide evidence of the effectiveness of interventions based on the PROCEDE model.

Background: Poor oral hygiene can lead to serious diseases, like periodontitis, tooth decay, pain and discomfort in teeth or gums, infection, and loss of teeth. In Iran, particularly adults between 50 years and older experience oral health problems, and this age group will grow the next decades. Despite increasing attention into healthy aging, there is less emphasis on oral hygiene. This survey aimed to investigate oral health status among Iranian adults. This knowledge may provide vital information to those who are planning strategies of oral health care. Method: A population-based household survey was conducted to recruit a representative sample of adults. This study was carried out among adults aged 18-65 years between May and October 2016 in Tabriz, Iran. The study population was sampled using a multi-stage cluster sampling design. The WHO’s oral health questionnaire (WHO’s OHQ) was used for measuring oral health status and oral health behavior. Results: In total, 2310 respondents completed the survey. The mean age (SD) of the participants was 41.6(23.4) years. About 48.8% of participants were male and 51.2% were female. 187(8.1%) were edentulous, and 152 (20.7%) of those participants were aged 50 to 65 years. 72.3% of the sample were dentate in that they had 20 or more teeth. Half of adults aged 50-65 years said they had 20 or more teeth. In general, about one-third of the participants reported that they don’t brush their teeth daily (23% for 18-35-year-old adults, 35.9% for 36-50-year-old adults, and 44.6% for 51- to 65-year-old adults). In our sample, 39.4% of 18-35-year-olds, 34.1% of 36-50-year-olds, and 26.6% of 51-65-year-olds had visited a dentist less than six months ago. One-third of participants eat sweets every day and frequently consume tea with sugar. Conclusion: The oral health status indicates that even though the majority of Iranian people assess their dental health positively, only a minority of participants have regular dental visits. Visits to the dentist decline by increasing age, and oral health problems increase. The study findings underline the importance of dental visits and that poor oral health may increase the risk of adverse health outcomes, particularly as age increases.

Background: Brucellosis is one of the most frequently-occurring zoonotic diseases of veterinary and public health in developing countries. It affects human and animal health and has measurable effects on productive and reproductive performance of livestock. Thus the main purpose of this study is to develop a community-based intervention program for prevention and control of brucellosis. The two-arm parallel cluster randomized controlled trial investigated the effectiveness of an integrated prevention program over six months on brucellosis in a rural population in Ahar, East Azerbaijan, Iran. Health houses were selected of villages and randomly allocated into the intervention and the control groups (16 Health Houses in all, eight per arm). Participants were recruited via household health records in the health houses presented in the villages. The PRECEDE-PROCEED model was used to design, implement and evaluate of brucellosis prevention and control program. The appropriate strategy and intervention were matched with the project priority changes according to policies, resources, and organizational situations. Social support, knowledge, attitudes, self-efficacy, behavioral and environmental factors were measured at the baseline and 6-months follow-up. Generalized mixed effects-model was used to analyze data. Results: A total of 400 individuals from the study answered the questions in the present study. The mean age (SD) of the respondents in the intervention and control groups were 35.9 (11.87) and 37.28 (11.04) years, respectively. There were significant differences between intervention and control group for Precede model-base variables after six month of intervention program adjusted for adjusted for education, history of brucellosis and family history of brucellosis. Conclusion: there is a need to consolidate collaborative efforts from the health and veterinary sectors, as well as to strengthen regular vaccination and financial resources to support farmers willing to compensate or offering slaughter facilities. This diagnostic study of educational and ecological factors influencing behaviors and environments related to brucellosis will identify where and how interventions can be most effective.