Search

Objective: Warfarin is a widely prescribed narrow therapeutic index anticoagulant. Determining proper warfarin dosage remains problematic due to its narrow therapeutic index and genetic variations from individual to individual. The administration of incorrect doses of warfarin can catastrophic adverse events. Observational studies have demonstrated single nucleotide polymorphisms in CYP2C9 and VK0RC1 significantly affect warfarin dose requirements. The present study aimed to examine the influences of various genotypes on warfarin dose requirements among Iranian patients. Methods: Blood samples were taken from 117 patients and stored in tubes containing EDTA. DNA extraction was performed on the blood samples and the different alleles and genotypes of the studied SNPs were identified and recorded by the PCR-RFLP technique. Results: Of the 117 patients, no significant differences in the mean daily warfarin dose requirement were found among the genotypes of polymorphism CYP2C9 * 3 (1075A> C). However, there were significant differences among the genotypes of CYP2C9 * 2 (430C> T). The mean daily warfarin dose requirements were significantly different among wild genotypes, heterozygotes and mutants in the two polymorphisms of VKORC1 (1173C> T) and VKORC1(1639G> A). Conclusion: The results of our study demonstrated that CYP2C9 and VKORC1 polymorphisms have significant effect on warfarin maintenance dose requirements in iranian patients which would help improve the prediction of warfarin dose requirements and minimize the chance of over-anticoagulation or under-anticoagulation. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore HIV risk perceptions and to examine the factors associated with the perceptions of HIV risk among people who inject drugs in Saveh, Iran. In this cross-sectional survey, 272 people who inject drugs in Saveh were recruited using a convenience snowball sampling method between April 2020 and May 2021. Two classes of HIV risk perception (high versus low) were identified using logistic regression to determine factors associated with individual HIV risk perception. Study participants were categorized as having a low (n = 181, 66.5%) or high (n = 91, 33.5%) risk perception for becoming infected with HIV. The odds of categorizing as high risk for HIV was significantly greater in participants who reported: injecting their drugs more than 2 times per day (AOR = 2.4, p <.05); receptive syringe sharing (AOR = 3.1, p <.05) and as HIV positive (AOR = 3.9, p <.05). Participants who smoked heroin (AOR = 0.4, p <.05) and who had received any psychosocial intervention in the previous 3 months (AOR = 0.3, p <.05) were less likely to perceive being at high for HIV risk. Interventional programs should focus on improving the perceptions of people who inject drugs toward HIV risk and reducing their HIV risk behaviors through increased HIV self-assessments. [ABSTRACT FROM AUTHOR]

Background: Kangaroo care (KC) is an effective technique to prevent injury in newborns due to prematurity and hospitalization. Mothers of preterm newborns experience their own set of physical and mental problems. Such circumstances call for another family member to take care of the newborn. This study compared the effect of KC by mothers and maternal grandmothers on the vital signs of preterm newborns. Methods: This parallel randomized controlled trial was done at the neonatal and NICU departments of the hospital in Kuhdasht in Iran. Eighty preterm neonates were selected through convenience sampling according to the eligibility criteria, then by stratified block randomization allocated to two groups. The control group received KC from the mother, and the intervention group received KC from the maternal grandmothers on the vital signs of preterm newborns. Vital signs were assessed 15 min before, during, and after the KC as the primary outcome. The data collection tools included a demographic questionnaire and a form to record the vital signs. Vital signs were measured by a pulse oximeter, an electronic thermometer, and observation. Data were analyzed by the chi-square test, the independent t-test, and the repeated measures ANOVA. Results: The vital signs of newborns in each group showed a significant difference before, during, and after receiving KC (P < 0.05). Nevertheless, the vital signs of the newborns did not differ significantly between the mother and the maternal grandmother KC groups (P > 0.05). Conclusion: KC by maternal grandmother may stabilize the vital signs of preterm newborns as much as when this type of care is provided by the mother. We, therefore, recommend the provision of KC by the maternal grandmother, as a support and substitute for the mother whenever she is incapable of being at the hospital and to enable the mother to rest. Trial registration: Iranian Registry of Clinical Trials IRCT20211225053516N1, March 31, 2022. [ABSTRACT FROM AUTHOR]

Empowering women with breast cancer leads to better adaptation to diagnosis and treatment, and reduces the symptoms of cancer. The purpose of the researchers is to determine the effect of a telephone counseling and follow-up program on empowerment of women with breast cancer undergoing chemotherapy. We used a non-randomized clinical trial design. Researchers applied the telephone counseling and follow-up to the intervention group for 8 weeks. At the end of study, the intervention group showed improvement in measures of cancer functional management and breast cancer specific function, along with satisfaction with the decision, general symptoms of cancer and specific symptoms of breast cancer. [ABSTRACT FROM AUTHOR]

This study aimed to identify risk and protective factors associated with substance use among Iranian university students. We searched for studies in English published from January 1, 1995 to February 20, 2021, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with substance use among university students. Out of 8,481 articles, 39 studies met eligibility criteria. Our findings showed a pooled prevalence rate of alcohol use 23% (95% CI, 8% 39%), smoking 21% (95% CI, 6% 37%) and other drug use 14% (95% CI, 10% 18%) in the last year among student. Hookah use, living alone, being a current cigarette smoker, and other drug use were significantly associated with alcohol use. The findings of the present study showed that being male, older age, alcohol use, had depression, had parents or friends who smoke, and religious beliefs were significantly associated with smoking among students. This meta-analysis also showed that living alone, alcohol use, history of drug use, and hookah use were significantly associated with drug use among students. Substance use prevention programs provided by universities could be improved by signifying high-risk populations addressed by the related literature. [ABSTRACT FROM AUTHOR]

Aim: To validate the Positions on Nursing Diagnosis scale developed by Lunney and Krenz (1992) in Persian language. Design: Cross‐sectional survey. Methods: A methodological study conducted in two stages of translation (by applying the forward and back‐translation method) and psychometric assessment was conducted in a western area of Iran. The scale was completed by 600 nurses selected by quota method from different wards of four provinces. Date of data collection is 1‐April‐2019 to 1‐Dec‐2019. Results: The Positions on Nursing Diagnosis scale showed acceptable content validity with index of 0.97. The 20 items of the Positions on Nursing Diagnosis scale load on four factors. The confirmatory factor analysis demonstrated the good fit of the model's indicators. Cronbach's alpha coefficient for the whole instrument was 0.85. The intraclass correlation coefficient was 0.86. [ABSTRACT FROM AUTHOR]

Background: Hydatidosis is a neglected global zoonotic disease, caused by larval stage of the cestode Echinococcus granulosus in human and animal. Because of high economic and medical importance of the disease, this study was performed to find the seroprevalence of human hydatidosis in Gorgan City, Golestan Province, northern Iran. Methods: In this cross-sectional study, blood samples were collected from people referring to Reference laboratory of Golestan University of Medical sciences in 2017. A relevant questionnaire was completed for demographic data for each person. Echinococcus IgG antibody was investigated by ELISA using native antigen B. The data were analyzed using SPSS software applying logistic regression. Results: Overall, 612 blood samples were collected. Cut-off was considered 0.29. Sixteen cases (2.6%) were seropositive for hydatidosis. The seroprevalence of hydatidosis was 2.3% and 4.7% among males and females, respectively. There was no statistically significant correlation between the hydatidosis and investigated variables such as sex, age, tribes, residence, education, etc. Conclusion: The prevalence of human hydatidosis shows approximately the same range as other regions of Iran. Although due to the neighboring the Mazandaran Province reported as the highest seroprevalence of hydatidosis, we expected more rate of seropositivity. [ABSTRACT FROM AUTHOR]

While the effect of temperature on risk of cardiovascular events is well documented, few studies report evidence from the Middle East. In this study, we investigate the short-term effect of ambient temperature on admissions for acute myocardial infarction (AMI) in Tehran, Iran. We used a case-crossover design combined with a distributed lag non-linear model to examine nonlinear and delayed associations between ambient temperature and AMI admissions from 2013 to 2016. We also examined hot and cold effects on AMI admission by gender and age categories (≤ 65 years old and > 65 years old). Both hot and cold temperatures increased the risk of AMI admissions. Effects of high temperature appeared immediately on the current day and lasted for 3 days, whereas cold effects became apparent after 2 days and persisted for about 8 days. The early acute increase in risk associated with high temperature was followed by a deficit, thus suggesting evidence of a harvesting effect. In additions, males and those aged ≤ 65 years old were more vulnerable to high temperatures. [ABSTRACT FROM AUTHOR]

Background: Although the effect of temperature on the incidence of acute myocardial infarction (AMI) has been extensively documented, no study has previously investigated the association between temperature and AMI in the Middle Eastern countries. Objective: To examine the association between daily mean temperature and AMI admission rates in Tehran, Iran. Methods: Data on daily number of admissions of patients with AMI to Tehran hospitals between March 21, 2013 and March 19, 2016, were retrieved from the Iranian Myocardial Infarction Registry (IMIR). Over the same period, data on daily mean temperature and relative humidity were measured at Mehrabad International Airport weather station of the Islamic Republic of Iran Meteorological Organization. Time-stratified case-crossover design was employed to investigate the short-term association between the daily mean temperature and the number of daily admissions of patients with AMI, after adjusting for public holidays, relative humidity, and air pollution. Results: An interquartile range (IQR) increase in daily mean temperature was associated with 15.1% (95% CI 1.3 to 30.8%) and 13% (95% CI: 1.9% to 25.4%) increase in the risk of AMI hospitalizations during the entire year, and in the warm months of the year, respectively. There were no significant associations between IQR increase in the two-day cumulative average up to the six-day cumulative average of the daily mean temperature and AMI during the entire year, and warm or cold months of the year. Conclusion: An increase in temperature would increase the rate of AMI hospitalization. [ABSTRACT FROM AUTHOR]

Background: Water, sanitation and hygiene have a very important role in public health. Poor sanitation is the cause of water contamination, which causes many types of diseases. The aim of this paper was to present the attributable death and disability adjusted life year (DALYs) of untreated water and insanitary environments from 1990 to 2010 in Iran. Methods: In the Global Burden of Disease 2010 study, using the comparative risk assessment, the proportion of death and DALYs attributable to untreated water source and insanitary environment has been calculated in 1990 to 2010. The certain outcomes were intestinal infectious diseases for both untreated water source and insanitary environments. Estimated attributable deaths and DALYs were reported with 95% uncertainty interval (UI). Results: DALY number for untreated water source and insanitary environments was 5838 (95% UI: 198- 14837) in 1990, which decreased to 326 (95% UI: 9-863) in 2010 and the percent of decrease was 94.42%. In addition, DALY rate was 5667 (95% UI: 192-14402) DALY per 100,000 in 1990, which decreased to 453 (95% UI: 13-1199) DALY per 100,000 in 2010 and the percent of the reduction was 92.01%. The greatest percentage of decrease in the attributed number of deaths was also found in the late neonatal age group (95.45%). Conclusion: A significant decrease has occurred in a number of DALYs and deaths between 1990 and 2010, which was attributed to the development of new water systems and environmental sanitations in Iran. [ABSTRACT FROM AUTHOR]

Background: Mental health and smoking have been receiving increasing attention in adolescents all over the world. Although some studies have assessed the independent association of active/passive smoking with mental health, joint association of active and passive smoking with mental health remains unclear. Purpose: This study was designed to evaluate the joint association of smoking status (active and passive smoking) with psychiatric distress and violent behaviors in Iranian children and adolescents. Method: In this national survey, 13,486 students, aged 6-18 years, living in rural and urban areas of 30 provinces of Iran were selected via multistage, cluster sampling method. Psychiatric distress (including worthless, angriness, worrying, insomnia, confusion, depression, and anxiety), violence behaviors (including bullying, victim, and physical fight), and smoking status (nonsmoker, only passive smoker, only active smoker, and active and passive smoker) were assessed. The questionnaire was prepared based on the World Health Organization Global School-based Student Health Survey (WHO-GSHS). Data were analyzed by the Stata package. Results: Psychiatric distress and violent behaviors had linearly positive association with smoking status ( p trend < 0.001). Compared to 'nonsmoker' group, participants who were exposed to passive smoking besides active tobacco use were at increased risk of having angriness (odds ratio (OR) 2.55, 95 % confidence interval (CI) 1.86-3.48), worrying (OR 1.66, 95 % CI 1.24-2.20), and anxiety (OR 1.99, 95 % CI 1.52-2.61) and victim (OR 1.77, 95 % CI 1.34-2.33) and bully behaviors (OR 3.08, 95 % CI 2.33-4.07). Conclusion: The current findings suggest that active and passive tobacco smoking has synergistic effect on psychiatric distress. Since majority of smokers with psychiatric distress do not receive mental health services or counseling on smoking, strategies to address mental health problems and smoking prevention should be included as a part of school health services. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQoL) is a multidimensional concept with significant effects and children and adolescence; while physical activity (PA) and screen time (ST) have been suggested as its probable predictors. Present study aims to investigate the association of PA, ST and their combination, with HRQoL in a nationally-representative sample of Iranian children and adolescents.Methods: As for the estimated sample size, 25,000 students aged 6-18 years were selected via multi-stage cluster sampling from 30 provinces of Iran. Sociodemographic data was obtained by using the questionnaire of the World Health Organization-Global school based student health survey (GSHS). Persian Pediatric Quality of Life inventory (PedsQL) and Physical Activity Questionnaire for the pediatric age group (PAQ-A) were applied for evaluating HRQoL and PA, respectively. PA scores 1-1.9 and 2-5 were respectively considered as low and high PA. The average duration of time spent on watching TV and leisure time computer use were considered as ST behaviors. ST of less than 2 h was considered low.Results: Out of 25,000 invited individuals, 23,043 students (mean age: 12.5) completed the study (response rate: 92.17%). In linear regression models, ST duration had significant inverse association with total QoL (β: - 0.49, p < 0.05). PA showed positive significant associations with HRQoL total score (β: 1.8, p < 0.05). Joint association of PA and ST revealed the strongest association of "high PA-low ST" category with total HRQoL (β: 2.2, p < 0.05); while "high PA-high ST" showed better total HRQoL score (β: 1.3) compared to "low PA-low ST" subgroup.Conclusion: Both PA and ST are significantly and independently associated with HRQoL in Iranian children and adolescents; while the adverse effect of prolonged ST could be diminished by a high PA. [ABSTRACT FROM AUTHOR]

Background: Vaccination has been one of the most successful and cost-effective public health interventions in the last century and has saved millions of lives. In 1984, the Expanded Program on Immunization (EPI) was launched in Iran as one of the main components of Primary Health Care (PHC). Objectives: We aimed to investigate the burden of four vaccine-preventable diseases from 1990 to 2010 in Iran. Methods: GBD study 2010 includes death rates, Years of Life Lost (YLLs), Years Lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs). YLLs is calculated through multiplying the number of deaths in each age group by a reference life expectancy for the same age group, while YLDs can be obtained from the prevalence of a disease multiplied by the disability weight (DW) for the same disease. The sum of these two indices yields DALYs. In the present study, we tried to produce new graphs and explain more about Iran results. We also describe the GBD study limitations. Results: Regardless of gender differences, DALYs rates for measles at all ages were 86.1220 and 5.5703 per 100 000 in 1990 and 2010, respectively, indicating approximately 94% decrease in this disease. The maximum and minimum rates of deaths from whooping cough for males aged under 5 was 4.0674 and 0.2713 per 100 000 in 1990 and 2000, respectively, which shows 93% decline in whooping cough from in this period. Conclusion: This study demonstrated that vaccination has had a positive impact on the control of communicable diseases. But the results of this study have some limitations similar to GBD study which may pave the way for decision makers about other public health interventions. Moreover, since measuring the impact of various diseases on health plays an important role in public health, it can be an important step toward prioritization in health. [ABSTRACT FROM AUTHOR]

Background: The relationship between gender disparity and the risk of developing noncommunicable disease and other social health determinants has not been well researched in the Islamic Republic of Iran., Aims: To assess how gender disparity contributes to the overall risk of noncommunicable disease in the Islamic Republic of Iran., Methods: This was a secondary analysis of data on about 11 000 adults aged 15-69 years from the 2011 WHO STEPwise approach to NCD risk factor surveillance (STEPS) survey in the Islamic Republic of Iran. The outcome variable in our analysis was the noncommunicable disease risk factor index. We used an extension of the Blinder-Oaxaca decomposition model to decompose the predicted mean difference in this index. Sampling method, study design and sex were considered in the analysis. The predictor variables were age, household assets index, education, employment status, ethnicity, and residence., Results: The overall mean (standard deviation) noncommunicable disease risk score was 39.26 (22.4). The risk score for women was significantly higher than for men (41.75 versus 36.84; P < 0.001). About 35% of gender disparity in risk score was due to the differences in distribution of the predictor variables (explained component); of these, age contributed the most (23.79%), followed by education (7.82%). The different gender effects on work status and age made the largest contributions to the unexplained component of the disparity, 36.40% and 14.82%, respectively., Conclusions: Policies to reduce the risk of noncommunicable diseases need to consider gender groups and how gender affects social determinants such as employment status to make some gender subgroups more vulnerable than others., (Copyright © Authors 2023; Licensee: World Health Organization. EMHJ is an open access journal. This paper is available under the Creative Commons Attribution Non-Commercial ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: As a public health issue, non-fatal overdose (NFOD) is highly prevalent among people who inject drugs (PWID). This can lead to an elevated risk of future overdose, causing various harms including possible death. It is essential to improve knowledge concerning this problem and its associated risk factors to inform overdose prevention and assistance programs. The primary aim of the present study was to determine the prevalence of NFOD and associated risk factors among PWID in Saveh, Iran., Methods: In the present cross-sectional study, 272 PWID living in Saveh, Iran were interviewed face-to-face using a structured survey. Data concerning socio-demographics, substance use, risky behaviors, and services utilization data were collected. The outcome variable (i.e., NFOD) was assessed by answering "Yes" to the question: "In the past three months, have you ever overdosed (at least once) by accident?", Results: The prevalence of NFOD among PWID in the past three months was 54%. The characteristics and behaviors that were associated with an increased risk of experiencing NFOD in the past three months were being of older age (AOR = 5.2, p < 0.05), drug use initiation under the age of 22 years (AOR = 7.8, p < 0.05), being an alcohol user (AOR = 3.0, p < 0.05), and being a simultaneous multiple drug user (AOR = 5.8, p < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing a non-fatal overdose in the past three months. Findings also indicated that those who (i) attended a needle and syringe program (AOR: 0.3, p < 0.05), (ii) were visited by a general practitioner (AOR: 0.03, p < 0.05), and (iii) received a psychosocial intervention (AOR: 0.1, p < 0.05) were 0.3, 0.03 and 0.1 times less likely to report non-fatal overdosing than other participants, respectively., Conclusions: The results indicate that intervention and prevention initiatives seeking to reduce NFOD among PWID should not only be focused on the primary drug used but also the use of alcohol and polysubstance use. Specific and tailored psychological interventions combined with pharmacotherapy may be highly beneficial for PWID who experience more severe types of substance use, including alcohol use disorders and/or polysubstance abuse., (© 2022. The Author(s).)

Objective: The aim of the present study was to determine the relationship between temperature and air pollution, and preterm birth in Tehran, Iran., Methods: In this time series study, the daily data of preterm births, air pollution, and maximum, minimum and mean temperature from March 2015 to March 2018 were used. To evaluate the effect of air pollution and temperature with and without adjustment of their mutual effects on preterm birth in lags (days) 0-21, the Distributed Lag Non-linear Models (DLNM) was used. The relative risk (RR) was estimated for extreme, moderate and mild heat (99th, 95th, 75th percentile) and cold (1st, 5th, 25th percentile) compared with the median, and for each 10-unit increase in PM 2.5 , NO 2 , and O 3 , 5-unit increase in SO 2 , and 1-unit increase in CO., Results: The highest RR was seen in extreme (26.9 °C) and moderate (24.8 °C) heat of minimum temperature on lag 0 (RR = 1.17; 1.05-1.31, Adjusted RR = 1.16; 1.04-1.29, RR = 1.15; 1.05-1.26, Adjusted RR = 1.14; 1.03-1.25, respectively). In regard of cold, the only significant effect was for maximum temperature on lags 7-9 (RR = 1.02; 1.00-1.04). Each 10-unit increase in PM2.5 in Lag 0 (RR = 1.008; 1.001-1.014) and lag 1 (RR = 1.004; 1.001-1.007) and in NO 2 in lag 0 (RR = 1.006; 1.000-1.012) had significant effects., Conclusion: Maternal exposure to a minimum daily temperature of 26.9 and 24.8 °C compared to 13.2 °C increased the risk of preterm birth by 17 and 15% on the same day, respectively. This risk increased by 0.8 and 0.6%, on the same day for each 10-unit increase in PM 2.5 and NO 2 , respectively.

Background: The basic reproduction number (R0) is an important concept in infectious disease epidemiology and the most important parameter to determine the transmissibility of a pathogen. This study aimed to estimate the nine-month trend of time-varying R of COVID-19 epidemic using the serial interval (SI) and Markov Chain Monte Carlo in Lorestan, west of Iran., Study Design: Descriptive study., Methods: This study was conducted based on a cross-sectional method. The SI distribution was extracted from data and log-normal, Weibull, and Gamma models were fitted. The estimation of time-varying R0, a likelihood-based model was applied, which uses pairs of cases to estimate relative likelihood., Results: In this study, Rt was estimated for SI 7-day and 14-day time-lapses from 27 February-14 November 2020. To check the robustness of the R0 estimations, sensitivity analysis was performed using different SI distributions to estimate the reproduction number in 7-day and 14-day time-lapses. The R0 ranged from 0.56 to 4.97 and 0.76 to 2.47 for 7-day and 14-day time-lapses. The doubling time was estimated to be 75.51 days (95% CI: 70.41, 81.41)., Conclusion: Low R0 of COVID-19 in some periods in Lorestan, west of Iran, could be an indication of preventive interventions, namely quarantine and isolation. To control the spread of the disease, the reproduction number should be reduced by decreasing the transmission and contact rates and shortening the infectious period.