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Short and long intervals between successive births are associated with adverse birth outcomes, especially in low-income and middle-income countries, yet the birth intervals in high-income countries remain relatively understudied. The aim was to examine maternal factors associated with birth intervals in Australia.The sample comprised 6130 participants in the Australian Longitudinal Study on Women's Health who were born in 1973-1978, had two or more births, and responded to regular surveys between 1996 and 2018. Interbirth interval (IBI) was defined as the time between successive live births. Maternal factors were examined using accelerated failure time models.For women with only two births (n = 3802), the median time to the second birth was 34.0 months (IQR 23.1, 46.2) with shorter IBI associated with higher socioeconomic status (eg, university education (31.9 months), less income stress (31.1)), and longer IBI associated with age over 35 (39.7), fair/poor health (43.0), untreated fertility problems (45.5), miscarriage (39.4), or abortion (41.0). For women with three or more births (n = 2328), the median times to the second and third births were 31.2 months (19.9, 42.1) and 36.5 months (25.3, 50.1), respectively; some factors were consistent between the first IBI and second IBI (eg, university education and being married were associated with shorter IBI), whereas income stress was associated with longer first IBI but not with second IBI.Understanding maternal factors associated with birth intervals in a high-income country like Australia may enable more nuanced tailoring of guidelines for prepregnancy care.

The present study investigates different scenarios to project the chance of achieving SDG 3.4 in Iran. In this study, the Iranian Death Registry System data was employed to estimate the Unconditional Probability of Dying (UPoD) for the four major categories of NCDs; then, the Bayesian model averaging was used to project the UPoD at the national and sub-national levels. Also, the prevalence of the risk factors was projected by 2030 based on STEPs as well as some other study data. Plus, UPoD and the possibility of achieving the target were estimated once again based on the assumption that the global reduction in risk factors proposed by WHO would be adopted in Iran. The UPoDs for the four NCDs in Iran were 17.5% (95% UI: 16.3–19.2) and 14.7% (13.3–16.2) in 2010 and 2015 respectively and if the current trend continues, 2030 will mark the UPoD of 10.8% (7.9–14.3). However, If the risk factors are reduced to the WHO target level by 2030, the UPoDs will be reduced to 5.44% (3.51–7.39) and 6.55% (5.00–8.13) of the 2010 and 2015 baseline scenarios, respectively, to enable some provinces to meet SDG 3.4. If the current trend continues, Iran will and will not achieve the SDG 3.4 in 2010 and 2015 baseline scenarios, respectively. However, if the global target set for reducing risk factors is achieved, Iran will meet all expectations in SDG 3.4 except in Asthma and COPD. Therefore, effective interventions are recommended to be designed and followed to reduce Asthma and COPD.

Mixture cure rate models are commonly used to analyze lifetime data with long-term survivors. On the other hand, frailty models also lead to accurate estimation of coefficients by controlling the heterogeneity in survival data. Gamma frailty models are the most common models of frailty. Usually, the gamma distribution is used in the frailty random variable models. However, for survival data which are suitable for populations with a cure rate, it may be better to use a discrete distribution for the frailty random variable than a continuous distribution. Therefore, we proposed two models in this study. In the first model, continuous gamma as the distribution is used, and in the second model, discrete hyper-Poisson distribution is applied for the frailty random variable. Also, Bayesian inference with Weibull distribution and generalized modified Weibull distribution as the baseline distribution were used in the two proposed models, respectively. In this study, we used data of patients with gastric cancer to show the application of these models in real data analysis. The parameters and regression coefficients were estimated using the Metropolis with Gibbs sampling algorithm, so that this algorithm is one of the crucial techniques in Markov chain Monte Carlo simulation. A simulation study was also used to evaluate the performance of the Bayesian estimates to confirm the proposed models. Based on the results of the Bayesian inference, it was found that the model with generalized modified Weibull and hyper-Poisson distributions is a suitable model in practical study and also this model fits better than the model with Weibull and Gamma distributions.

Background: Breast cancer is a top biomedical research priority, and it is a major health problem. Therefore, the present study aimed to determine the prognostic factors of breast cancer survival using cure models. Methods: In this retrospective cohort analytic study, data of 140 breast cancer patients were collected from Ali Ibn Abi Taleb hospital, Rafsanjan, Southeastern Iran. Since in this study, a part of the population had long-term survival, cure models were used and evaluated using DIC index. The data were analyzed using Openbugs Software. Results: In this study, of 140 breast cancer patients, 23 (16.4%) cases died of breast cancer. Based on the findings, the Bayesian nonmixture cure model, with type I Dagum distribution, was the best fitted model. The variables of BMI, number of children, number of natural deliveries, tumor size, metastasis, consumption of canned food, tobacco use, and breastfeeding affected patients’ survival based on type I Dagum distribution. Conclusion: The results of the present study demonstrated that the Bayesian nonmixture cure model, with type I Dagum distribution, can be a good model to determine factors affecting the survival of patients when there is the possibility of a fraction of cure. In this study, it was found that adapting a healthy lifestyle (eg, avoiding canned foods and smoking) can improve the survival of breast cancer patients.

COVID-19 is spreading all over Iran, and Kerman is one of the most affected cities. We conducted this study to predict COVID-19-related deaths, hospitalization, and infected cases under different scenarios (scenarios A, B, and C) by 31 December 2021 in Kerman. We also aimed to assess the impact of new COVID-19 variants and vaccination on the total number of COVID-19 cases, deaths, and hospitalizations (scenarios D, E, and F) using the modified susceptible-exposed-infected-removed (SEIR) model. We calibrated the model using deaths reported from the start of the epidemic to August 30, 2021. A Monte Carlo Markov Chain (MCMC) uncertainty analysis was used to estimate 95% uncertainty intervals (UI). We also calculated the time-varying reproductive number ( R t ) following time-dependent methods. Under the worst-case scenario (scenario A; contact rate = 10 , self ‐ isolation rate = 30 % , and average vaccination shots per day = 5,000 ), the total number of infections by December 31, 2021, would be 1,625,000 (95% UI: 1,112,000–1,898,000) with 6,700 deaths (95% UI: 5,200–8,700). With the presence of alpha and delta variants without vaccine (scenario D), the total number of infected cases and the death toll were estimated to be 957,000 (95% UI: 208,000–1,463,000) and 4,500 (95% UI: 1,500–7,000), respectively. If 70% of the population were vaccinated when the alpha variant was dominant (scenario E), the total number of infected cases and deaths would be 608,000 (95% UI: 122,000–743,000) and 2,700 (95% UI: 700–4,000), respectively. The R t was ≥1 almost every day during the epidemic. Our results suggest that policymakers should concentrate on improving vaccination and interventions, such as reducing social contacts, stricter limitations for gathering, public education to promote social distancing, incensing case finding and contact tracing, effective isolation, and quarantine to prevent more COVID-19 cases, hospitalizations, and deaths in Kerman.

Understanding and measuring the burden of HIV faces several remaining challenges around the globe. HIV prevention, care, and treatment efforts, including advocacy for populations at risk of HIV, the design and implementation of national guidelines, monitoring the coverage of HIV programs and evaluating their impact, are not feasible without relatively precise estimates of the impact and magnitude of HIV among different subpopulations.

One of the requirements to calculate the size of a KP by the NSU method is to know the average social network size of the general population accurately (shown by C).

Background In Sudan, where studies on HIV dynamics are few, model projections provide an additional source of information for policy-makers to identify data collection priorities and develop prevention programs. In this study, we aimed to estimate the distribution of new HIV infections by mode of exposure and to identify populations who are disproportionately contributing to the total number of new infections in Sudan. Methods We applied the modes of transmission (MoT) mathematical model in Sudan to estimate the distribution of new HIV infections among the 15-49 age group for 2014, based on the main routes of exposure to HIV. Data for the MoT model were collected through a systematic review of peer-reviewed articles, grey literature, interviews with key participants and focus groups. We used the MoT uncertainty module to represent uncertainty in model projections and created one general model for the whole nation and 5 sub-models for each region (Northern, Central, Eastern, Kurdufan, and Khartoum regions). We also examined how different service coverages could change HIV incidence rates and distributions in Sudan. Results The model estimated that about 6000 new HIV infections occurred in Sudan in 2014 (95% CI: 4651-7432). Men who had sex with men (MSM) (30.52%), female sex workers (FSW) (16.37%), and FSW’s clients accounted (19.43%) for most of the new HIV cases. FSW accounted for the highest incidence rate in the Central, Kurdufan, and Khartoum regions; and FSW’s clients had the highest incidence rate in the Eastern and Northern regions. The annual incidence rate of HIV in the total adult population was estimated at 330 per 1 000 000 populations. The incidence rate was at its highest in the Eastern region (980 annual infections per 1 000 000 populations). Conclusion Although the national HIV incidence rate estimate was relatively low compared to that observed in some sub-Saharan African countries with generalized epidemics, a more severe epidemic existed within certain regions and key populations. HIV burden was mostly concentrated among MSM, FSW, and FSW’s clients both nationally and regionally. Thus, the authorities should pay more attention to key populations and Eastern and Northern regions when developing prevention programs. The findings of this study can improve HIV prevention programs in Sudan.

The objective of this study was to investigate the effect of a pre-eclampsia mobile application on the knowledge of pregnant women.Following development of a pre-eclampsia mobile application, we conducted a controlled before and after study during a three-month period in 2018. The study population consisted of pregnant women attended to obstetrician clinics and offices in Kerman, Iran of whom, 110 sample participants were divided into two intervention and control groups. The participants completed a questionnaire of pre-eclampsia knowledge at baseline and 1-month follow up. Data were analyzed using inferential statistics including chi-square, independent sample t-test, paired t-test and linear regression.A total of 108 pregnant women with an average age of 28 years participated in this study. There was no significant difference between the scores of the two groups before the intervention (p=0.94). Their difference after the intervention was highly significant (p0.001). The difference between the knowledge of the participants before and after the intervention was significant in the both groups (p0.05). The results showed that the knowledge score of the participants after the intervention was significantly associated with their group and assessment score before the intervention (p0.001).The results showed that the use of a mobile-based educational application improves the knowledge of pregnant women about pre-eclampsia. Increasing women's knowledge about pre-eclampsia may enables them to identify its signs and symptoms, resulting in the early detection and management of this condition, and likely reduction of its adverse consequences.IRCT2017050633837N1.

Globally, alcohol use is one of the leading contributors to the burden of disease. The aim of this study was to provide data on prevalence and correlates of lifetime alcohol use among Iranian adults living in urban areas. This cross-sectional study investigated knowledge, attitude, and practice (KAP) of Iranian adults towards drug and alcohol use. Participants were recruited from the capital cities of five provinces-Tehran, West Azerbaijan, Markazi, Kerman, and Khorasan Razavi-in 2015. We used multivariate logistic regression models to conduct data analysis. Completing the questionnaire were 2,065 participants (44.06% female). Prevalence of lifetime alcohol use was 28% (95% CI: 25-29%). Lifetime alcohol use was significantly associated with male gender (Odds Ratio (OR) = 1.74, 95% Confidence Interval (CI): 1.26- 2.39), positive attitude towards alcohol (OR = 2.15, CI: 1.60-4.34), lifetime stimulants use (OR = 5.73, CI: 3.56- 9.23), and lifetime opioids use (OR = 4.47, CI: 3.12- 6.39). Estimated lifetime prevalence of alcohol use in our study was higher than the regional average. Primary alcohol prevention programs need to target sub- populations who are at risk for alcohol use and provide services that impede the development of positive attitudes towards alcohol.

Drug abuse and addiction exist around the world. People addicted to drugs such as opium or heroin often encounter dehumanizing discriminatory behaviors and health-care systems that are reluctant to provide services. Experiencing discrimination often serves as a barrier to receiving help or finding a home or work. Therefore, it is important to better understand the mechanisms that lead to the stigmatization of drug addiction and who is more prone to stigmatizing behaviors. There is also a dearth of research on whether different patterns of stigma exist in men and women. Therefore, this study investigated factors affecting gender-specific stigmatization in the context of drug addiction. In our vignette study (NMensample = 320 and NWomensample = 320) in Iran, we experimentally varied signals and signaling events regarding a person with drug addiction (i.e., NVignettes = 32 per sample), based on Attribution Theory, before assessing stigmatizing cognitions (e.g., blameworthiness), affective responses (e.g., anger), and discriminatory inclinations (e.g., segregation) with the Attribution Questionnaire. We also tested assumptions from the Familiarity Hypothesis by assessing indicators of respondents' familiarity with drug addiction (e.g., knowledge about addiction). Results, for example, show higher stigma if the person used “harder” drugs, displayed aggressive behavior, or had a less controllable drug urge. Self-attributed knowledge about addiction or prior drug use increased some forms of stigma, but diminished others. These findings only partially converged between men and women. We suggest that anti-stigma initiatives should consider information about the stigmatized person, conditions of the addiction, and characteristics of stigmatizers.

Background & objectives: Insufficient treatment of cutaneous leishmaniasis (CL) by conventional drugs is a major barrier in control strategies. This study was aimed to evaluate Glucantime efficacy and the susceptibility of Glucantime unresponsive and responsive CL isolates in the field and laboratory. Methods: Chi-square test (x[2]) was used to determine the significance of difference between proportions in Glucantime-treated patients. The inhibitory activity of various concentrations of Glucantime against Leishmenia tropica stages was evaluated by a colorimetric cell viability MTT and macrophage assays. Mixed model, t-test and ANOVA were performed to determine the significance of difference between various concentrations of Glucantime unresponsive or responsive isolates and untreated control group and p

Background: The mortality rate of acute Hepatitis A increases from 0.1% in the children to 1.2%, in the adults. Hepatitis A is efficiently prevented by HAV-vaccine, but the strategy for distributing this vaccine among countries is dependent on their level of immunity to HAV. This study aimed to detect the level of immunity to HAV in Iran. Methods: In this population-based seroprevalence study, 5419 participants from 12 of provinces of Iran, including 57 urban and 120 rural areas were chosen through a multi-stage cluster random sampling. Participants were interviewed by filling checklists and 3 cc of blood sample was obtained from each of them. IBM SPSS statistics V.21 software was used for univariable and multivariable analysis of data. Results: Mean of age of Interviewees was 26.4 ± 16 years, ranging from 1 to 94 years with a male to female ratio 1.02. Overall, 3603 (66.5%) of subjects were seropositive for HAV-IgG. Among the age groups, 41.1% of children by the age 15 years and 82.6% of adults around 30 years old were immune to HAV. The Mid-point age of population immunity was 21 years. Residents of the borders of the country, people who had less access to the safe water or sanitary toilet, individuals with low socioeconomic status and persons who were a member of dense families had the most probability of seropositivity. Conclusions: This study showed that Iran is among HAV low endemic countries and vaccination against HAV is recommended only in the high-risk population, including patients with chronic liver diseases, patients with coagulopathy, travelers to the high endemic areas, and homosexuals. Establishment of national HAV surveillance system, concerning of health system about the occurrence of the HAV outbreaks, implementation of harm reduction strategies, improving economic indices and sanitation and access to the safe water in the deprived regions is recommended.

Objectives Users attitude toward a picture archiving and communication system (PACS) and their interaction with this system are among the most important factors that influence its acceptance. This study aimed to augment the user's interaction with the user's perspective to select a usable PACS among three systems available on the market. Methods We augmented the think aloud (TA) usability evaluation method with the Post-Study System Usability Questionnaire (PSSUQ) to compare user interaction problems of three PACS user interfaces. Four radiologists and four internist physicians participated in this study. Usability characteristics including efficiency, effectiveness, learnability, error, and satisfaction were used to assess the usability of each PACS. Results There was a significant difference in efficiency (p = 0.01), effectiveness (p = 0.005), learnability (p = 0.001), and satisfaction (p = 0.009). However, no significant difference in the number of errors (p = 0.18), mouse clicks and keystrokes (p = 0.12), and the number of usability problems (p = 0.6) were observed among the three PACS systems studied. Conclusions This study showed that applying the proposed approach to augment TA with the user's perspective addresses almost all of the theoretical aspects of usability and can be employed to select the most usable PACS.

Background Network Scale Up (NSU) is a promising tool for size estimation of sensitive issues. In this study we investigated the important methodological considerations to employ this method for estimating behaviors, such as abortion, which happens in a particular age-gender group. Methods We recruited 1250 males and 1250 females aged 18 to 50. Abortion rate was calculated through direct question and NSU methodology. The NSU was applied on three sub-samples (male, female and aggregate). Integrating replies to 25 reference groups, we estimated the network size (C) of respondents and its age-gender structure. To calculate the part of network that is subject to abortion, we compared two approaches: proportional and data based. The Visibility Factor (VF) was calculated through 222 females who had abortion. Direct estimate was considered as gold standard. Results Using C’s derived from proportional method, the Relative Bias (RB) in the male and female samples was 33 and 84. Applying the data-based C’s, the RB in the gender-specific and aggregate samples was 5 and 2. Conclusion The proportional method overestimates the prevalence. The data-based method to calculate the C is superior. The determination of the age-sex distribution of the network and the specific VF is essential. © 2019 Zamanian et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background In Islamic countries alcohol consumption is considered as against religious values. Therefore, estimation of frequency of alcohol consumptions using direct methods is prone to different biases. In this study, we indirectly estimated the frequency of alcohol use in Iran, in network of a representative sample using network scale up (NSU) method. Methods In a national survey, about 400 participants aged above 18 at each province, around 12 000 in total, were recruited. In a gender-match face to face interview, respondents were asked about the number of those who used alcohol (even one episode) in previous year in their active social network, classified by age and gender. The results were corrected for the level of visibility of alcohol consumption. Results The relative frequency of alcohol use at least once in previous year, among general population aged above 15, was estimated at 2.31% (95% CI: 2.12%, 2.53%). The relative frequency among males was about 8 times higher than females (4.13% versus 0.56%). The relative frequency among those aged 18 to 30 was 3 times higher than those aged above 30 (3.97% versus 1.36%). The relative frequency among male aged 18 to 30 was about 7%. Conclusion It seems that the NSU is a feasible method to monitor the relative frequency of alcohol use in Iran, and possibly in countries with similar culture. Alcohol use was lower than non-Muslim countries, however, its relative frequency, in particular in young males, was noticeable.

Background For a better understanding of the current situation of drug use in Iran, we utilized the network scale-up approach to estimate the prevalence of illicit drug use in the entire country. Methods We implemented a self-administered, street-based questionnaire to 7535 passersby from the general public over 18 years of age by street based random walk quota sampling (based on gender, age and socio-economic status) from 31 provinces in Iran. The sample size in each province was approximately 400, ranging from 200 to 1000. In each province 75% of sample was recruited from the capital and the remaining 25% was recruited from one of the large cities of that province through stratified sampling. The questionnaire comprised questions on demographic information as well as questions to measure the total network size of participants as well as the network size in each of seven drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier ratios. Results The most common type of illicit drug used was opium with the prevalence of 1500 per 100,000 population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350), methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more common among men than women. The use of opium, shire and injecting drugs was more common in individuals over 30 whereas the use of stimulants and hashish was largest among individuals between 18 and 30 years of age. Conclusion It seems that younger individuals and women are more desired to use new synthetic drugs such as crystal methamphetamine. Extending the preventive programs especially in youth as like as scaling up harm reduction services would be the main priorities in prevention and control of substance use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this affected population are needed.

This study aimed to assess using tree-based models the impact of different dimensions of religion and other risk factors on suicide attempts in the Islamic Republic of Iran. Three hundred patients who attempted suicide and 300 age- and sex-matched patient attendants with other types of disease who referred to Kerman Afzalipour Hospital were recruited for this study following a convenience sampling. Religiosity was assessed by the Duke University Religion Index. A tree-based model was constructed using the Gini Index as the homogeneity criterion. A complementary discrimination analysis was also applied. Variables contributing to the construction of the tree were stressful life events, mental disorder, family support, and religious belief. Strong religious belief was a protective factor for those with a low number of stressful life events and those with a high mental disorder score; 72 % of those who formed these two groups had not attempted suicide. Moreover, 63 % of those with a high number of stressful life events, strong family support, strong problem-solving skills, and a low mental disorder score were less likely to attempt suicide. The significance of four other variables, GHQ, problem-coping skills, friend support, and neuroticism, was revealed in the discrimination analysis. Religious beliefs seem to be an independent factor that can predict risk for suicidal behavior. Based on the decision tree, religious beliefs among people with a high number of stressful life events might not be a dissuading factor. Such subjects need more family support and problem-solving skills.

Background: Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People’s preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. Methods: This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care. Results: Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIs-associated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84). Conclusion: The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases.

Attempts to obtain the ideal body shape portrayed in advertising can result in behaviors that lead to an unhealthy reduction in weight. This study was designed to identify contributing factors that may be effective in changing the behavior of a sample of Iranian adolescents.Three hundred fifty adolescent girls from high schools in Kerman, Iran participated in a cross-sectional study based on a self-administered questionnaire. Multifactorial logistic regression modeling was used to identify the factors influencing each of the contributing factors for body management methods, and a decision tree model was constructed to identify individuals who were more or less likely to change their body shape.Approximately one-third of the adolescent girls had attempted dieting, and 37 % of them had exercised to lose weight. The logistic regression model showed that pressure from their mother and the media; father's education level; and body mass index (BMI) were important factors in dieting. BMI and perceived pressure from the media were risk factors for attempting exercise.BMI and perceived pressure from relatives, particularly mothers, and the media were important factors in attempts by adolescent girls to lose weight.

Background: Information regarding the prognosis and burden of diseases can be used by policymakers to determine competing health priorities. We aimed to assess the Relative Survival Rate (RSR) and loss of expectation of life (LEL) to evaluate the prognosis and burden of diseases in Hemodialysis (HD) patients. Study design: A retrospective cohort study. Methods: We recruited 648 HD patients referred to three referral centers in Kerman City, Iran, from 2008 to 2019. RSR, was defined as the ratio of the observed and the expected survival rates of general population for persons of the same age and sex as patients in the current study. LEL was determined as the difference between corresponding life expectancies (LE). The extended Cox proportional hazard model was used to identify variables associated with the outcome. Results: Variables associated with outcome were diabetic status and age. In the 5th year of the follow-up study, the overall RSR was 0.57. In general, for HD patients, the estimation of LE and LEL was 22.6 and 12.36 year, respectively. Conclusion: HD patients, especially older patients, showed a very poor prognosis, with a large amount of lost life expectancy. Therefore, they need more care and attention from health authorities. It is suggested to estimate the cost of eliminating the risk factors causing kidney diseases.

Background The epidemiology of Multiple sclerosis (MS) has changed in recent decades. Considering that the incidence and geographical variations of MS is not well known in Iran. The present study was conducted to investigate the incidence of MS and its geographic variations in Iran. Methods Data from a national registry, coordinated by the Ministry of Health (MOH), were collected for this study. In Iran, all MS patients are eligible to receive care and treatment services based on their records in this registry. Therefore, it seems that the related data are comprehensive with very high coverage, particularly in recent years. In this study, the annual incidence rates were calculated based on year of diagnosis of MS. Results In this registry, 32,633 new cases were recorded between 2011 and 2016. After standardized for age, the mean annual incidence rate was 6.5 per 100,000 populations. It was 10.2 and 2.9 in women and men respectively. This incidence ranged from 1.7 to 12.8 in provincial level, with a higher intensity in the central part of the country. Conclusion It seems that the incidence rate of MS and its ratio in females and males are more or less comparable with the dominant patterns in developed countries, although its variation within the country is very considerable.

Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.

The current study aimed at comparing the correlation coefficients between wet-bulb globe temperature (WBGT) and a number of parameters, including the discomfort index (DI), modified discomfort index (MDI), predicted mean vote (PMV), predicted percentage of dissatisfaction (PPD), predicted heat strain (PHS), physiological strain index (PSI) and physiological strain index heart rate (PSI

Background: Determining the epidemic threshold parameter helps health providers calculate the coverage while guiding them in planning the process of vaccination strategy. Since the trend and mechanism of influenza is very similar in different countries, we planned a study with the mentioned goal by using data of US from 2017 to 2018. Study design: A secondary study. Methods: R0 and corresponding vaccination coverage are estimated using the national and state-level data of the US from the 40th in 2017 to the 5th week in 2018. Four methods maximum likelihood (ML), exponential growth (EG), time-dependent reproduction numbers (TD), and sequential Bayesian (SB) are used to calculate minimum vaccination coverage. The gamma distribution is considered as the distribution and the generation of time. Results: The peak of epidemy in most states has occurred in the 15th week after the beginning of the epidemics. The generation time obey the Gamma distribution with mean and standard deviation of 3.6 and 1.6, respectively, was utilized for the generation time. The R0 (vaccination coverage) equaled 1.94 (48.4%), 1.80 (44.4%), 3.06 (67.3%), and 2.11 (52.6%) for EG, ML, SB, and TD methods at the national level, respectively. Conclusion: The R0 estimations were in the range of 1.8-3.06, indicating that an epidemic has occurred in the US (R0>1). Thus, it is required to vaccinate at least 44.4% to 67.3% to prevent the next epidemics of influenza. The findings of this study assist futures studies to apply disease control by vaccination strategies in order to prevent a national disaster.

This study aimed to estimate the prevalence of substance use among university students measured by direct and indirect methods, and to calculate the visibility factor (VF) defined as ratio of indirect to direct estimates of substance use prevalence.A cross-sectional study.Using a multistage non-random sampling approach, we recruited 2157 students from three universities in Kerman, Iran, in 2016. We collected data on substance use by individual face-to-face interview using direct (i.e. self-report of their own behaviors) and indirect (NSU: Network scale up) methods. All estimates from direct and indirect methods were weighted based on inverse probability weight of sampling university.The response rate was 83.6%. The last year prevalence of water pipe, alcohol, and cigarettes indirect method was 44.6%, 18.1%, and 13.2% respectively. Corresponding figures in NSU analysis were 36.4%, 18.2%, and 16.5% respectively. In the female population, VF for all types of substance was less than male.Considerable numbers of university students used substances like a water pipe, alcohol, and cigarettes. NSU seems a promising method, especially among male students. Among female students, direct method provided more reliable results mainly due to transmission and prestige biases.

Despite the importance of body satisfaction on one’s self image and well-being, little has been written about body image or how it affects people in Iran. The aim of this study is to assess body dissatisfaction and its risk factors in the general Iranian population. The sample size for this cross-sectional study included approximately 1,200 participants (both male and female) and was conducted in 2011. Body dissatisfaction (based on the Figure Rating Scale), demographic characteristics, socioeconomic status, body mass index (BMI) and use of the media were recorded. Nearly two thirds of the participants were included in the middle age group and roughly half of them had a university education. Approximately two thirds of the participants were satisfied with their body. The mean score of body dissatisfaction in women was greater than men (p < 0.0001). Age, gender, marital status and BMI had a significant relationship with body dissatisfaction. The finding of this study demonstrates that in Iran, body dissatisfaction and it consequences must be addressed. While the prevalence and pattern of body dissatisfaction in Iran is as high as other Asian countries, considering cultural variation within Asian countries is also important. Resumo: Apesar da importância da satisfação com o próprio corpo para a autoestima e o bem-estar, pouco tem sido publicado sobre auto-imagem e como afeta as pessoas no Irã. O objetivo do estudo é avaliar a dismorfofobia e fatores associados na população geral iraniana. A amostra nesse estudo transversal incluiu aproximadamente 1.200 participantes (homens e mulheres) em 2011. Foram registrados a dismorfofobia (baseada na Figure Rating Scale), características demográficas, nível socioeconômico, índice de massa corporal (IMC) e uso da mídia. Quase dois terços dos participantes foram classificados no grupo de meia idade, e cerca da metade tinha nível superior. Dois terços estavam satisfeitos com o próprio corpo. A média da dismorfofobia era mais alta em mulheres (p < 0,0001). Idade, gênero, estado civil e IMC mostraram relação significativa com a dismorfofobia. Os achados destacam a necessidade do enfrentamento da dismorfofobia e suas consequências no Irã. A prevalência da dismorfofobia é tão alta quanto em outros países asiáticos, mas é igualmente importante considerar as variações culturais dentro desses países. Resumen: A pesar de la importancia de la satisfacción con el propio cuerpo para la autoestima y el bienestar, poco ha sido publicado sobre la auto-imagen y como afecta a las personas en Irán. El objetivo del estudio es evaluar la dismorfofobia y sus factores asociados en la población general iraní. La muestra en ese estudio transversal incluyó aproximadamente 1.200 participantes (hombres y mujeres) en 2011. Se registró la dismorfofobia (basada en la Figure Rating Scale), características demográficas, nivel socioeconómico, índice de masa corporal (IMC) y uso de los medios de comunicación. Casi dos tercios de los participantes se clasificaron en el grupo de mediana edad, y cerca de la mitad tenía nivel superior. Dos tercios estaban satisfechos con el propio cuerpo. La media de la dismorfofobia era más alta en mujeres (p < 0,0001). Edad, género, estado civil e IMC mostraron una relación significativa con a dismorfofobia. Los hallazgos destacan la necesidad del enfrentamiento de la dismorfofobia y sus consecuencias en Irán. La prevalencia de la dismorfofobia es tan alta como en otros países asiáticos, pero es igualmente importante considerar las variaciones culturales dentro de esos países.

Objectives: Hyperglycemia with unknown mechanism plays a predictive role in determining the prognosis of multiple trauma patients. The exact time of blood sugar measurement and the role of blood sugar changes in the monitoring of these patients have not been well established. Methods: This follow-up study was done on multiple trauma patients (> 18 years) with an Injury Severity Scores (ISS) > 16. These patients didnʾt have any history of diabetes, underlying disease, or drug or alcohol use. Data collection was done by the questionnaire (checklist), and the patients were followed by the medical records. Cox regression was used to measure the effect of independent variables on the patients' hospital mortality. Results: Of a total of 963 patients, 280 patients were enrolled. Of those, 202 were male (72.1%) and 78 were female (27.9%). Hospital mortality was 18 (6.4%). Cox regression analysis suggested that those who had high blood sugar 3 h after admission had higher hospital mortality (P = 0.04). Changes in blood sugar, ΔBS (BS 3 h after admission – BS on admission), in these patients was also significantly correlated with hospital mortality (P < 0.001). The multivariate model using the backward conditional method showed that ΔBS (P < 0.001), international normalized ration (INR) (P < 0.001), and heart rate (P = 0.036) were significantly correlated with hospital mortality. Conclusions: In multiple trauma patients, blood sugar changes in the early hours of admission to the emergency department may help predict hospital mortality, but further studies are needed. Blood sugar monitoring in these patients during this time frame may be helpful in predicting these patients' outcomes. In addition, coagulopathy and tachycardia were significantly associated with hospital mortality.

Background The network scale up (NSU) method is an indirect size estimation method that has received remarkable attention in estimating the sensitive behaviors. Using methadone maintenance therapy (MMT), which is a treatment for opioid use disorder, is a sensitive topic in many societies. The aim of this manuscript was to estimate the number of MMT users and its failure ratio using the NSU method in the city of Kerman, Iran, in 2016. Methods In this cross-sectional study, 1275 men and 1275 women which were aged >18 years and who had lived in the city of Kerman for at least 5 years were recruited via multistage sampling. Data was collected via face-to-face interviews using a questionnaire that was included questions for estimating the network size of the residents of Kerman as well as the number of MMT users and the existing failure among them. Results In total, the average network size of the citizens of Kerman was 235; among them, 97 were men and 138 were women. Overall, the numbers of MMT users and failures were estimated at about 5289 and 2731, respectively, leading to a failure ratio about 52%. The treatment failure ratio in the women and men was equal to 55% and 51%, respectively. Among the men, the failure ratio in all age groups was equal to ˜50%. Among the women, the failure ratio in those who were aged Conclusion The considerable failure ratio indicates the need for conducting studies on MMT services in order to understand the reasons which exist regarding this failure. This is of particular importance in specific groups, such as in young women. Further, the comparable results with other direct methods indicate that the NSU method could be used in the size estimation of MMT failure ratios.

Background: Stigma of suicide attempt (SA) results in not asking friends and relatives for help. Others’ awareness of an individual’s SA sometimes can solve his/her problems and reduce rates of SA. This study is intended to examine the degree of SA visibility through deliberate self-poisoning (DSP), which is the most common method of SA in Iran. Methods: In order to study visibility, all individuals who had attempted to suicide by DSP and had been referred to the western Iran poisoning center during April-June, 2016 were entered to the study. A female and a male interviewer experienced in role-plaing were recruited to interview clients, each with clients of their own gender, in order to increase compliance and information accuracy. Multivariate Poisson Regression was used to identify visibility determinants. Results: Among 100 subjects interviewed, 10 denied SA. Regardless of those denying SA, self-poisoning visibility factor (SVF) was 26.6% (21.7-31.5) which decreased to 23.9% (19.7-28.1) after considering those individuals who denied SA. The highest values of SVF were observed in subjects poisoned by toxins, alcohol and illegal drugs, respectively. In the multivariate model, the value of SVF increased with an increase in age (IRR=1.03, 95% CI: 1.02-1.04), having history of SA (IRR=1.18, 95% CI: 1.07-1.30), and being married (IRR=1.70, 95% CI: 1.05-1.29). Conclusions: Lower values of SVF of DSP indicate that individuals committing suicide do not ask others for help and saying their SA intents. The higher the degree of visibility, the lower the rates of committing and repeating SAs. To increase the visibility of SA, therefore, the one way is to prevent and reduce SA repetition.

Surgical repair of varicocele has long been a procedure to correct spermatogenesis. However, the outcome has been reported to be inadequate. We combined varicocelectomy with supplement therapy to evaluate the concurrent effect of these procedures.A prospective randomized controlled study was undertaken to investigate the effects of zinc sulfate, folic acid and zinc sulfate/folic acid on sperm quality, protamine content and acrosomal integrity following surgical repair of varicocele. Male subjects with palpable varicocele were included in the study and randomized into four groups. Subjects received Zinc sulfate, Folic acid, Zinc sulfate/Folic acid or placebo for 6 months. A semen sample was obtained before surgery and 3 and 6 months after surgical repair. Semen samples were evaluated for sperm parameters as well as chromatin content and acrosomal integrity.Most of the evaluated parameters showed a mild improvement after varicocelectomy in the placebo group. Interestingly, co-administration of Zinc sulfate and folic acid improved most factors significantly. Folic acid administration but not zinc sulfate could increase sperm number. Hence, Zinc sulfate was better than folic acid when change in morphology was assessed, and none of them was significantly effective in sperm motility. In Zinc sulfate and Folic acid groups, protamine content and halo formation rate significantly improved.We may conclude that co-administration of zinc and folic acid significantly improved sperm parameters and increased varicocelectomy outcomes. So, medical treatment with compatible drugs after surgery might be advantageous for obtaining acceptable results.

Varicocele is among the most common problems which may lead to male infertility. Spermatogenesis is impaired as a consequence of this vascular defect, through mechanisms that are not well described. This study aimed to evaluate serum hormonal level (inhibin B, FSH and testosterone) and seminal plasma antioxidant defence levels after folic acid and zinc sulphate administration in varicocelectomised patients. Participants were randomly allocated to four experimental groups. Our randomisation schedule was as follows: zinc sulphate/folic acid, folic acid, zinc sulphate and placebo. The patients underwent varicocelectomy, before which a blood and semen sample were obtained and also three and six months after varicocelectomy for evaluation of blood hormonal level (FSH, testosterone, inhibin B) and seminal oxidative stress status (nitric oxide, superoxide dismutase, total antioxidant capacity). Patients in different groups took orally one capsule per day after dinner following varicocelectomy for 6 months. A significant rise in peripheral blood inhibin B and seminal plasma activity was detected in the zinc sulphate/folic acid group after 6 months. The present clinical trial indicates a change in the hormonal status of varicocelectomised patients following long-term administration of zinc sulphate and folic acid.

Objectives Abortion is a sensitive issue; many cultures disapprove of it, which leads to under-reporting. This study sought to estimate the rate of abortion visibility in the city of Kerman, Iran—that is, the percentage of acquaintances who knew about a particular abortion. For estimating the visibility rate, it is crucial to use the network scale-up method, which is a new, indirect method of estimating sensitive behaviours more accurately. Materials and methods This cross-sectional study was conducted in Kerman, Iran using various methods to ensure the cooperation of clinicians and women. A total of 222 women who had had an abortion within the previous year (74 elective, 74 medical and 74 spontaneous abortions) were recruited. Participants were asked how many of their acquaintances were aware of their abortion. Abortion visibility was estimated by abortion type. 95% CIs were calculated by a bootstrap procedure. A zero-inflated negative binomial regression analysis was conducted to assess the variables related to visibility. Results The visibility (95% CI) of elective, medical and spontaneous abortion was 8% (6% to 10%), 60% (54% to 66%) and 50% (43% to 57%), respectively. Women and consanguineal family were more likely to be aware of the abortion than men and affinal family. Non-family members had a low probability of knowing about the abortion, except in elective cases. Abortion type, marital status, sex of the acquaintance and closeness of the relationship were the most important determinants of abortion visibility in the final multifactorial model. Conclusions This study shows the visibility rate to be low, but it does differ among social network members and by the type of abortion in question. This difference might be explained through social and cultural norms as well as stigma surrounding abortion. The low visibility rate might explain the low estimates of abortion rates found in other studies.

Mental rotation is a cognitive motor process which was impaired in different neurologic disorders. We investigated whether there were deficits in response pattern, reaction time and response accuracy rate of mental rotation in multiple sclerosis (MS) patients compared to healthy subjects and whether cognitive dysfunctions in MS patients were correlated with mental rotation deficits. Moreover, we showed whether there was a difference between upper and lower-limbs mental rotation in MS patients. Thirty-five MS patients and 25 healthy subjects performed hand mental rotation (HMR) and foot mental rotation (FMR) tasks. Visual information processing speed, spatial learning and memory ability, and visuospatial processing were assessed by Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), and Judgment of Line Orientation Test (JLO) respectively in MS patients. Reaction time for both hand and foot stimuli increased, and response accuracy rate for hand stimuli decreased in MS patients compared to healthy subjects, but response pattern of mental rotation in MS patients persisted. Similar to healthy subjects, MS patients performed upper-limbs mental rotation more easily than a lower-limbs mental rotation with more speed and response accuracy rate. Reaction time and response accuracy rate were correlated with the mentioned cognitive functions. MS patients made use of the correct response pattern for problem solving of increasing orientation from upright stimuli. Reaction time and response accuracy rate altered in these patients and this alteration might occur along with impairment in motor planning. Subjects' better responding to hand stimuli was due to more familiarity with hand stimuli. The correlation of mental rotation ability with cognitive functions indicates the possible role of cognitive functions in mental rotation.

BACKGROUND: Self-immolation is one of the most violent methods of suicide in developing countries. The objective of the present study was to investigate the survival rate and factors affecting survival of self-immolation patients. METHODS: All people either died or hospitalized for intentional burns were assessed in Kermanshah province between 2010 and 2013. Required information was gathered from two sources, Kermanshah province legal medicine and burn center of Imam Khomeini Hospital. Survival function was assessed through Cox regression. The data were analyzed with Stata 12 software. RESULTS: Between 2010 and 2013 (three years), 446 people attempted self-immolation, of which 370 were females (83%). In general, 276 people (61.8%) died due to severity of the burns. The median of survival time was 47±5 days. The survival rate after one day, one week, and 21 days after accident was 86%, 52%, and 38%, respectively. Multivariate analysis demonstrated that burn was the most powerful risk factor, sothe risk in those with over 70% burns is 17 times more than those with burns less than 30%. CONCLUSION: Burn percentage is the strongest risk factor, those with high burns percentage should be hospitalized quickly and without waste of time. Language: en

Background. Tree models provide easily interpretable prognostic tool, but instable results. Two approaches to enhance the generalizability of the results are pruning and random survival forest (RSF). The aim of this study is to assess the generalizability of saturated tree (ST), pruned tree (PT), and RSF.Methods. Data of 607 patients was randomly divided into training and test set applying 10-fold cross-validation. Using training sets, all three models were applied. Using Log-Rank test, ST was constructed by searching for optimal cutoffs. PT was selected plotting error rate versus minimum sample size in terminal nodes. In construction of RSF, 1000 bootstrap samples were drawn from the training set.C-index and integrated Brier score (IBS) statistic were used to compare models.Results. ST provides the most overoptimized statistics. Mean difference betweenC-index in training and test set was 0.237. Corresponding figure in PT and RSF was 0.054 and 0.007. In terms of IBS, the difference was 0.136 in ST, 0.021 in PT, and 0.0003 in RSF.Conclusion. Pruning of tree and assessment of its performance of a test set partially improve the generalizability of decision trees. RSF provides results that are highly generalizable.

According to the world population increase and demand on transportation in mega cities, modern and low-cost technologies are remarkably considered. Meanwhile, subway system, as a means to transfer a large population of people, is extremely welcomed due to its particular advantages including time and cost savings, traffic jam avoidance, and unaffected by weather. Nevertheless, despite the benefits of these technologies, such devices also have been associated with disadvantages for human. In many subway systems, noisy environments are clearly observed; therefore, workers and even the passengers are exposed to higher noise levels than permissible limit. In this research, noise measurements were performed at Imam Khomeini Station as the most crowded intersection subway station in Tehran. In this descriptive-sectional survey, the amount of noise pollution was investigated at both stories of Imam Khomeini Intersection Station. A variety of noise pollution indicators such as L(eq) 10 min were separately measured at each storey through five measurement points from 7 A.M. to 10 P.M. It was shown that the equivalent sound level range at Imam Khomeini station towards Elmo Sanat and Imam Khomeini towards Mirdamad were between 70.56-79.54 and 68.35-79.12 dB (A), respectively. It was indicated that except for the entrance stairs to the subway waiting platform and the first section of the platform on both stories, other measurement stations have the same equivalent sound levels.

Background & objectives: Atopic dermatitis (AD) is one of the most common pathologic conditions of skin in children. The effect of breastfeeding on the risk of AD remains controversial. The aim of this study was to determine the counts of cytokine-producing cells in the mothers' breast milk of infants with and without AD to assess association, if any. Methods: Breast milk samples (10 ml) were obtained from mothers of 25 infants with AD and of 26 healthy infants as a control group. The number of cytokine-producing cells including interferon-gamma (IFN-γ), tumour necrosis factor-alpha (TNF-α), interleukin-13 (IL-13) and IL-4 in the milk samples was determined using an enzyme-linked immunospot assay technique. Results: The mean of IL-13-producing cells in milk was significantly lower in mothers of AD-affected infants in comparison with mothers of normal infants (324.91±255.45 vs. 538.93±465.39, P

In order to generate local evidence, a case-control study was designed to explore risk factors for suicide attempts (SA) in one of the larger cities in the southeast of Iran-Kerman.From one of the main referral hospitals, 300 cases and 300 age- and sex-matched controls were recruited. On top of demographic variables, the following variables were compared in the two groups: personality traits, psychological condition, religiosity, coping skills, general health, and recent stressful events.Having adjusted for recent stressful events as the most important factor (OR = 1.66, P-value0.001), the main significant variables were: general health (1.04, P = 0.02), the support of friends (OR = 0.95, P-value = 0.04), being problem-focused mentality (OR = 0.88, P-value = 0.005), and intrinsic religiousness (OR = 0.86, P-value = 0.01).Although, recent stress increased the risk of SA considerably, other factors such as general health, friends' support, and being problem-focused may predispose subjects independently. Conversely, intrinsic religious beliefs and close social networks may have protective effects. Therefore, a multi-disciplinary approach is recommended to minimize the burden of SA in Iran.

Bladder cancer (BC) is the most common genitourinary system malignancy in humans. Consumption of opium and its derivatives, maybe a risk factor possibly in Iran. The aim of this study was to investigate the relationship between consumption of opium and its derivatives and the incidence of BC.In an individually matched case-control study in Shiraz (located in the south of Iran), 198 patients with BC and 396 healthy individuals (matched in age, sex and residence (urban/rural)) were investigated. Data about consumption of opium and its derivatives, tobacco, alcohol and diet were collected using a structured valid and reliable questionnaire. Crude and adjusted odds ratios (ORs) were computed using conditional logistic regression models.Opium consumption was associated with an increased risk of BC with an adjusted OR = 3.9 (95% CI: 1.2 - 12.0). Moreover, a considerable dose-response relationship was observed between the opium consumption and its derivatives and the incidence of BC; comparing to no users, the odds ratios of low and high consumptions were 3.3 (95% CI: 0.5 - 23.1) and 4.9 (95% CI: 1.1 - 21.9) respectively.Opium consumption can be a potential strong risk factor for BC in Iran.

Due to the lack of nationwide population-based cancer registration, the total cancer prevalence in Iran is unknown. Our previous work in which we used a basic network scale-up (NSU) method, failed to provide plausible estimates of total cancer prevalence in Kerman. The aim of the present study was to estimate total and partial prevalence of cancer in southeastern Iran using an adapted version of the generalized network scale-up method. A survey was conducted in 2014 using multi-stage cluster sampling. A total of 1995 face-to-face gender-matched interviews were performed based on an adapted version of the NSU questionnaire. Interviewees were asked about their family cancer history. Total and partial prevalence were estimated using a generalized NSU estimator. The Monte Carlo method was adopted for the estimation of upper/lower bounds of the uncertainty range of point estimates. One-yr, 2-3 yr, and 4-5 yr prevalence (per 100,000 people) was respectively estimated at 78 (95%CI, 66, 90), 128 (95%CI, 118, 147), and 59 (95%CI, 49, 70) for women, and 48 (95%CI, 38, 58), 78 (95%CI, 66, 91), and 42 (95%CI, 32, 52) for men. The 5-yr prevalence of all cancers was estimated at 0.18 percent for men, and 0.27 percent for women. This study showed that the generalized familial network scale-up method is capable of estimating cancer prevalence, with acceptable precision.

Network scale up (NSU) is a novel approach to estimate parameters in hard to reach populations through asking people the number of individuals they know in their active social network. Although the method have been used in hidden populations, advantages of NSU indicate that exploration of applicability to disease like cancer might be feasible. The aim of this study was to assess the application of NSU to estimate the size of the population of breast, ovarian/cervical, prostate, and bladder cancers in the South-east of Iran. A total of 3,052 (99% response rate) Kermanian people were interviewed in 2012-2013. Based on NSU, participants were asked about if they know any people on their social network who suffered from breast, ovarian/cervical, prostate, and bladder cancers, if yes, they should enumerate them. A total of 1,650 persons living with four types of cancers (breast, ovary/cervix, prostate, and bladder) were identified by the respondents. Totally, the prevalence of people living with the four types of cancers was 228.4 per 100,000 Kermanian inhabitants. The most prevalent cancer was breast cancer, at 168.9 per 100,000, followed by prostate cancer with 116.9, ovarian/cervical cancer with 99.8, and bladder cancer with 36.3 per 100000 Kerman city population. NSU values provide a usable but not very precise way of estimating the size of subpopulations in the context of the four major cancers (breast, ovary/ cervix, prostate, and bladder).

Background: The predictors of missing data when parents fill out questionnaire about their children′s diet are not defined. The aim of this study was to evaluate predictors which affect unresponsiveness to diet questions based on " Oral Health Situation of Iranian Children" Survey carried out in 1998. Materials and Methods: A dummy variable was created as dependent variable according to responding eight questions relating to diet. Then predictors of missing data were defined using multivariable logistic regression and classification tree method. To evaluate goodness of fit of logistic regression model, sensitivity and specificity were assessed. Classification tree analysis was done by Quest growing method. Significance level was set at 0.05 in logistic regression analysis. Observations and Results: "Missing data" variable was marked as missing in 616 (7.2%) of questionnaires. In logistic regression model revealed that, gender, mother′s education level and father′s education level didn′t affect "missing data" variable (P > 0.05). But, dmf index (OR = 0.94), Area of living (OR = 0.49), number of children in the family (OR = 1.19), sibling order (OR = 0.85), brushing (OR = 0.84) and visiting dentist (OR = 0.59) had statistically significant association with dependent variable (P < 0.05). Classification tree analysis showed that questionnaires related to children in urban area whose dmf index is under 5 and haven′t visited dentist are predicted to have missing data more than other groups. Conclusions: Area of living, dmf index, number of children in the family, sibling order, brushing and visiting dentist are significant variables for predicting the risk of missing data when asking parents about their children′s diet.

This prospective cross-sectional study was aimed to evaluatethe prevalence of IgM and IgG anti-T. gondii antibodiesand the associated risk factors among healthy blood donorsin Kerman province, south-eastern Iran. Structured questionnaires(before the donors gave blood) were used to obtaininformation on risk factors for infection. Totally, 500 serumsamples from healthy blood donors of Kerman Blood TransfusionOrganization (KBTO) at Kerman, Iran, werescreened for IgG and IgM anti-T. gondii antibodies byenzyme-linked immunosorbent assay (ELISA) and RocheElecsys Toxo IgM assay. Real-time PCR was used to detectDNA of T. gondii in the IgM-positive samples. Seroprevalenceof IgG and IgM anti-T. gondii antibodies was 288%and 32%, respectively. In the multiple logistic regression, itcould be observed that living in rural regions, having B bloodtype, being in contact with cats, consuming raw vegetablesand raw milk/egg and doing agricultural activities were independentrisk factors for Toxoplasma seropositivity. T. gondiiDNA was also found in one (90%) of IgM-positivesamples. In this study, it was found that T. gondii infectionwas present among healthy blood donors in south-east ofIran. Therefore, it is suggested to design screeningprogrammes for preventing transfusion-transmittedtoxoplasmosis.Keywords blood transfusion, IgG antibody, IgM antibody,Real-Time PCR, toxoplasmosis

Introduction Estimating the number of key populations at risk of HIV is essential for planning, monitoring, and evaluating prevention, care, and treatment programmes. We conducted this study to estimate the number of female sex workers (FSW) in major cities of Iran. Methods We used three population size estimation methods (i.e., wisdom of the crowds, multiplier method, and network scale-up) to calculate the number of FSW in 13 cities in Iran. The wisdom of the crowds and multiplier methods were integrated into a nationwide bio-behavioural surveillance survey in 2015, and the network scale-up method was included in a national survey of the general population in 2014. The median of the three methods was used to calculate the proportion of the adult female population who practice sex work in the 13 cities. These figures were then extrapolated to provide a national population size estimation of FSW across urban areas. Results The population size of FSW was 91,500 (95% Uncertainty Intervals [UIs] 61,400–117,700), corresponding to 1.43% (95% UIs 0.96–1.84) of the adult (i.e., 15–49 year-old) female population living in these 13 cities. The projected numbers of FSW for all 31 provincial capital cities were 130,800 (95% UIs 87,800–168,200) and 228,700 (95% UIs 153,500–294,300) for all urban settings in Iran. Conclusions Using methods of comparable rigor, our study provided a data-driven national estimate of the population size of FSW in urban areas of Iran. Our findings provide vital information for enhancing HIV programme planning and lay a foundation for assessing the impact of harm reduction efforts within this marginalized population.

More than a billion people have some form of disabilities worldwide. Persons living with a disability have many needs (including physically, mentally, and socially needs). Estimating the size of disabled population is a challenge in health systems. An innovative indirect method to estimate the size of populations is network scale up (NSU) having widely used for hidden populations. The method is based-on the social network of individuals. We assessed the capability of NSU to estimate persons living with a disability being a middle population (neither non-hidden nor hidden populations) in the Southeast of Iran (Kerman City, southeast Iran).A total of 3052 of Kermanian people over 20 year old were interviewed by simple random sampling. We asked them whether they knew acquaintances with complete blindness, severe visual impairment, deafness, severe hearing impairment, limb defects, and mental retardation, if yes; we wanted them to count them.Based on the network scale up method, the prevalence of the populations was estimated at 5.21/1000 in Kerman City where severe visual impairment was 1.35, mental retardation was 1.039, severe hearing impairment was 1.005, limb defects was 0.78, deafness was 0.59, and complete blindness was 0.56 (per 1000 inhabitants).The results were not exactly comparable to previous studies using different methods such as surveys. Although the method has some limitations, considering its easiness and cost-effectiveness, modified NSU could be used when direct methods are not practicable.

INTRODUCTION: The results of the network scale-up (NSU) method in estimating the size of key populations for HIV might be biased if the recruited subjects are not fully informed of the risky behaviors of people in their networks (low visibility), or key populations have a smaller social network (low popularity). We aimed to measure such biases in the size estimation of people who inject drugs (PWIDs), and female sex workers (FSWs) in Iran. METHODS: We interviewed 163 male PWIDs, 76 FSWs (known as egos) and 600 subjects from the general population. We selected twenty first-names (ten males and ten females) and asked the study subjects separately how many people they knew with one of these names (known as alters). Visibility Factor (VF) was defined as the percentage of FSW or PWID alters that were aware of their behavior. In addition, the popularity factor (PF) was calculated by dividing the number of alters reported by FSWs and PWIDs into that of the general population. The 95% uncertainty intervals (UI) were calculated using bootstrap technique. RESULTS: The VF was estimated at 54% (95% UI: 52%-56%) for PWID and 45% (95% UI: 42%- 48%) for FSW. The VF among the peer alters was significantly higher than non-peer ones. The PF for PWID and FSW was 69% (95% UI: 66%-73%) and 77% (95% UI: 72%-83%), respectively. The cross-validation and name splitting analysis showed that our estimates were not influenced by any single name. CONCLUSIONS: Both correction factors, particularly VF were far from one, and NSU results without correction, could lead to up to 4 times underestimation of the sizes. Therefore, applying these coefficients is necessary in NSU projects. Language: en

To generate the Persian version of the Perceived Socio-cultural Pressure Scale.The study, done in Kerman, Iran, from November 2010 to February 2011, comprised 1200 volunteers. After translation and back-translation, the questionnaire's internal consistency, criterion and construct validity were evaluated, individual and global scores of the Perceived Socio-cultural Pressure Scale were assessed between people with and without eating disorders.The mean scores for comparison were 14.7 +/- 6.64 and 21.84 +/- 10.65, giving a p-value of 0.0001. Internal and inter-item consistency were acceptable. Item-total correlation ranged from 54% to 80%. Construct and criterion validity of the scale were also acceptable.The Persian version of the Perceived Socio-cultural Pressure Scale is a competent tool for use in the general population and in individuals with eating disorders.

Methadone maintenance treatment and buprenorphine maintenance treatment are the two main therapeutic options considered for opioid replacement therapy. This study was conducted to examine the effectiveness of methadone maintenance treatment and buprenorphine maintenance treatment in Iran under usual clinical conditions.In this outcome research, 311 patients consented to participate in the study (77.8% response rate). The Opioid Treatment Index, General Health Questionnaire and WHOQOL-BREF questionnaire were used to assess the effectiveness of the therapeutic programs. Drop-out rate was calculated after two and six months of treatment.Mean dose of methadone was in an acceptable range; however, doses for buprenorphine maintenance treatment patients seemed low. The rates of attrition after two and six months of treatment were 24.2% and 44.0% in the methadone maintenance treatment group and 41.3% and 65.4% in the buprenorphine maintenance treatment group, respectively (P 0.001). Drug use, HIV risk-taking behaviour, and mental and physical health improved in both groups at six months of treatment, while quality of life improved only in the methadone maintenance treatment group.The retention seen in the buprenorphine group may in part be related to the low buprenorphine doses used. As a whole, the positive results provide support to continuation of maintenance programs.

Inflammatory bowel disease, an autoimmune disease, has two clinical manifestations including Crohn's disease and ulcerative colitis (UC). IL-17 has been the target of intensive research in autoimmune diseases. The influence of Toll like receptor 4 (TLR-4) gene polymorphisms on IL-17 production has also been revealed in UC patients and tissue inflammation in mice.To investigate the association between the TLR-4 gene polymorphisms, Asp299Gly and Thr399Ile and IL-17 serum levels with ulcerative colitis. Additionally, we aimed to study modulation effects of forenamed gene polymorphisms on IL-17 serum levels in UC patients and controls.A total of 256 healthy controls and 85 UC patients enrolled in our study. DNA was extracted and PCR-RFLP technique was employed to determine Asp299Gly and Thr399Ile polymorphisms in TLR-4 gene and IL-17 serum levels were measured by ELISA method.There was no significant difference between the frequency of Asp299Gly AG and Thr399Ile CT in UC patients and controls. While IL-17 serum levels in UC patients were significantly higher than controls (p=0.003), no significant difference in IL-17 levels between different genotypes existed. Additionally, a significant inverse relationship was observed between hemoglobin level and IL-17 serum levels in UC patients (p=0.039).Increased IL-17 serum levels in our UC patients might be explained through the synergistic activity of IL-17/IL-23 axis and pro-inflammatory cytokines, causing severe clinical outcome in patients with IBD. The prolonged excretion of blood in stool driven by inflammatory process which causes iron metabolism disorder and anemia may elucidate the inverse correlation between hemoglobin and IL-17 serum levels in UC patients. Lack of association between the TLR-4 gene polymorphisms and UC in our study was consistent with the results from other Caucasian populations.