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Evaluating health system interventions for elderly care necessitates a context-specific, credible and dependable instrument. This research was dedicated to creating and validating a tool to assess the health system's age-friendliness. The study unfolded in two pivotal stages: the generation of items utilizing a hybrid model and the psychometric appraisal of the tool, encompassing both validity and reliability assessments. From an initial pool of 522 items derived from a systematic scoping review and qualitative analysis, a concise assessment tool emerged, featuring 52 items across 6 domains: governance, information, resources, service delivery, community engagement and outcomes. The 52-item tool offers a straightforward, substantiated and robust means to gauge age-friendliness, pinpoint health system deficiencies and facilitate strategic planning on the basis of its insights. [ABSTRACT FROM AUTHOR]

Formaldehyde, a known carcinogenic compound, is commonly used in various medical settings. The objective of this study was to assess the carcinogenic and non-carcinogenic risks associated with occupational exposure to formaldehyde. This study was conducted in the pathology labs of four hospitals in Tehran. Cancer and non-cancer risks were evaluated using the quantitative risk assessment method proposed by the United States environmental protection agency (USEPA), along with its provided database known as the integrated risk information system (IRIS). Respiratory symptoms were assessed using the American thoracic society (ATS) questionnaire. The results indicated that 91.23% of exposure levels in occupational groups exceed the NIOSH standard of 0.016 ppm. Regarding carcinogenic risk, 41.03% of all the studied subjects were in the definite carcinogenic risk range (LCR > 10−4), 23.08% were in the possible carcinogenic risk range (10−5 < LCR < 10−4), and 35.90% were in the negligible risk range (LCR < 10−6). The highest index of occupational carcinogenesis was observed in the group of lab technicians with a risk number of 3.7 × 10−4, followed by pathologists with a risk number of 1.7 × 10−4. Furthermore, 23.08% of the studied subjects were within the permitted health risk range (HQ < 1.0), while 76.92% were within the unhealthy risk range (HQ > 1.0). Overall, the findings revealed significantly higher carcinogenic and non-carcinogenic risks among lab technicians and pathologists. Therefore, it is imperative to implement control measures across various hospital departments to mitigate occupational formaldehyde exposure levels proactively. These findings can be valuable for policymakers in the health sector, aiding in the elimination or reduction of airborne formaldehyde exposure in work environments. [ABSTRACT FROM AUTHOR]

Background: Ecological conditions can change infection routes and increase the risks of outbreaks. The aim of this study is risk assessment of foodborne disease outbreaks based on dispersed regional climatic and demographic variables in Yazd Province, Iran. Methods: In this cross-sectional study, data of temporal climatic parameters and regional demographic factors linked to bacterial foodborne diseases were addressed. A multi-level regression analysis model was used to detect associations between the risk of outbreaks and ecological risk factors; the relationships were verified using (P<0.05). Results: Significant associations were observed between the outbreaks and age)P<0.001(, community type (P<0.001), temperature (P=0.04), rainfall (P=0.03) and dust pollution (P<0.001) in scattered parts of the province. The maximum rate of outbreaks was seen in spring, while the frequency of the outbreaks increased during April and October, compared to other months of the year (2012-2016). Conclusion: Consequences have revealed interventions of the environmental exposures in transmissions of microbial agents by complex ecological processes that caused the outbreaks. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, many non-COVID-19 emergency department (ED) visits were indirectly affected. ED visits and mortality were assessed during different pandemic time periods compared with pre-pandemic. Methods: The study used data from 41 million Iran Health Insurance Organization members. The outcomes were non-COVID-19 ED visits and associated mortality in 956 hospitals. An analysis of ED visits was conducted both for all-cause and cause-specific conditions: cardiovascular diseases (CVD), mental and substance use disorders, unintentional injuries, and self-harm. In addition, total in-hospital ED mortality was analyzed. A negative binomial regression and a Poisson regression with a log link were used to estimate the incidence rate ratio (IRR) of visits and mortality relative risk (RR). Results: 1,789,831 ED visits and 12,377 deaths were reported during the study. Pre-pandemic (Sep 2019 to Feb 2020), there were 2,767 non-COVID-19 visits rate per million person-month, which decreased to 1,884 during the first COVID-19 wave with a national lockdown from Feb 20 to Apr 19, 2020 (IRR 0.68, [0.56–0.84]). The non-COVID-19 ED mortality risk was 8.17 per 1,000 visit-month during the pre-pandemic period, rising to 12.80 during the first wave of COVID-19 (RR 1.57, [1.49–165]). Non-COVID-19 ED visit rates decreased during the first pandemic year from Sep 2020 to Feb 2021 (IRR 0.73, [0.63–0.86]), but increased after COVID-19 vaccination two years later from Sep 2021 to Feb 2022 (IRR 1.11, [0.96–0.17]). The total ED mortality risk for non-COVID-19 was significantly higher after the COVID-19 outbreak in the first (RR 1.66, [1.59–1.72]) and second years (RR 1.27, [1.22–1.32]) of the pandemic. The visit incidence rate for mental health and substance use disorders declined from 8.18 per million person-month to 4.57 (IRR 0.53, [0.32 to 0.90]) in the first wave. In the second year, unintentional injury visits increased significantly compared with pre-pandemic (IRR 1.63, [1.30–2.03]). As compared to before the pandemic, there was no significant change in CVD and self-harm visit rates during the pandemic. Cardiac arrest was the leading cause of death in Iran hospitals' EDs. Conclusion: In the first year of the COVID-19 pandemic, non-COVID-19 hospital ED visits declined and mortality risk increased. Despite two years since the COVID-19 outbreak, non-COVID-19 ED mortality risk remains high. [ABSTRACT FROM AUTHOR]

Background and Aim: Despite more affordable and advanced technologies for early detection of congenital hearing loss, unilateral hearing loss is the prevalent form of hearing loss affecting school-aged children. This study aimed to examine the impact of Words-in-Noise (WIN) training on speech perception of noise in children with unilateral hearing loss. Methods: Thirteen children aged 8 to 12 years with unilateral hearing loss underwent a WIN training program in noise. The participants were tested before and after training on word identification in noise and cortical auditory evoked potentials. Results: A comparison of the mean signal-to-noise ratio 50% between pre- and post-training indicated that signal-to-noise ratio 50% score decreased after training sessions. WIN training reduced the latency in N1 and P2 waves in the Fz electrode and the N1 wave in the Pz electrode and increased the amplitude of the waves in the Fz and Pz electrodes. The observed data suggest that all participants' performance improved on word identification in noise and some electrophysiological parameters. Cortical auditory evoked potentials components changes did not correlate with the WIN scores. Conclusion:The Persian version of the WIN training improved speech perception ability in the presence of competitive noise in children with unilateral hearing loss. Therefore, this software solution can partially solve speech comprehension problems with noise in these children. [ABSTRACT FROM AUTHOR]

Objectives: The main aim of this study is to estimate a national value set of the EQ-5D-5L questionnaire for Iran. Methods: The composite time trade-off (cTTO) and discrete choice experiment (DCE) methods; and the protocol for EuroQol Portable Valuation Technology (EQ-PVT) were used to estimate the Iran national value set. 1179 face-to-face computer-assisted interviews were conducted with adults that were recruited from five Iran major cities in 2021. Generalized least squares, Tobit, heteroskedastic, logit, and hybrid models were used to analyze the data and to identify the best fitting model. Results: According to the logical consistency of the parameters, significance levels and prediction accuracy indices of the MAE; a heteroscedastic censored Tobit hybrid model combining cTTO and DCE responses was considered as the best fitting model to estimate the final value set. The predicted values ranged from − 1.19 for the worst health state (55555) to 1 for full health (11111), with 53.6% of the predicted values being negative. Mobility was the most influential dimension on health state preference values. Conclusions: The present study estimated a national EQ-5D-5L value set for Iranian policy makers and researchers. The value set enables the EQ-5D-5L questionnaire to use to calculate QALYs to assist the priority setting and efficient allocation of limited healthcare resources. [ABSTRACT FROM AUTHOR]

Meat, poultry, and seafood such as fish are a valuable source of protein, vitamins and minerals. Considering their high consumption in the human diet, it is necessary to study pollutants (such as PAHs) in them. This present study has focused on the PAHs level and probabilistic risk of health in meat, poultry, fish and related product samples by MSPE-GC/MS technique (magnetic solid-phase extraction with gas chromatography-mass spectrometry). The maximum mean of 16 PAH was detected in smoked fish samples (222.7 ± 13.2 μg/kg) and the minimum mean of 16 PAH was detected in chicken (juje) kebab (112.9 ± 7.2 µg/kg μg/kg). The maximum mean of 4PAHs was detected in tuna fish (23.7 ± 2.4 µg/kg) and the minimum mean of 4PAHs was seen in grilled chicken and sausage samples (non-detected). Our results showed the 4PAHs and B[a]P were lower than the EU (European Union) standard levels (these standard levels were 30 and 5 μg/kg, respectively). Furthermore, the correlation among the type and concentrations of PAHs congeners was investigated through cluster analysis by heat map and principal component analysis. The 90th percentile ILCR (incremental lifetime cancer risk) of PAH compounds in fish, poultry, meat and related products samples was 3.39E-06, which was lower than the maximum acceptable level of risk (10–4). Finally, the highest ILCR was related to hamburger (4.45E-06). Therefore, there is no risk in consuming these foods in Iran, but it is necessary to monitor PAHs concentration in different types of foods. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is known to be the third leading cause of food poisoning in the world. Traditional ice cream is one of the dairy products in Iran and some countries in the world that should be controlled for Staphylococcus aureus contamination. The purpose of this review and meta-analysis is to determine the contamination of traditional ice cream with Staphylococcus aureus in different regions of Iran. Search terms "Staphylococcus aureus", "traditional ice Cream", and "Iran" were used in Science Direct, Pubmed, Scopus, Google Scholar, and SID, Magiran Magazine until 2018 published without time limitation selected. To review the original articles and remove duplicate articles and review titles and abstracts, articles that have the required qualities for this research were studied in this study. Data were analyzed by the random effects model in STATA (version 11) and MedCalc (version 13) software. Publication bias and sensitivity analysis were assessed by funnel and influence plots. According to a sample size of 3811 from 35 articles, the prevalence of Staphylococcus aureus is estimated 32% in Iran (95% CI: 25-38%, p<0.001). The heterogeneity in the estimation of the pooled prevalence among the studies demonstrated; Cochran Q test: 1577.39, p< 0.001, I² = 97.84%. Based on Begg's adjusted rank correlation test, publication bias was statistically significant (p <0.05). Epidemiological data is useful to determine the distribution of Staphylococcus aureus contamination and provide a broad picture of the prevalence of traditional ice cream Iran and can be used as an important indicator in the model of risk assessment of microbiologic. [ABSTRACT FROM AUTHOR]

Background: One of the key issues for women’s health is pregnancy. Healthy nutrition during pregnancy is a reliable guarantee for proper pregnancy and childbirth. This study sought to determine the impact of an educational intervention based on social cognitive theory on the nutritional behavior of pregnant women in Iran Methods: This randomized controlled trial study was carried out in women of reproductive age in Iran, from February to April 2020. The samples were divided into experimental (n = 150) and control (n = 150) groups. The questionnaire included demographic questions, questions related to the structures of social cognitive theory and nutritional behavior questionnaire. The data were analyzed through the SPSS20 and AMOS23 software. Results: The mean age of the women was 28.11 ± 6.54 and 28.83 ± 6.62 years in the intervention and control groups, respectively. The results of the Structural Equation Model showed that direct effect of self-efficacy, self-regulation, and mutual determinants on behavior were significant. After the educational intervention, nutritional behavior in the experimental group was increased significantly. Also, there was a significant difference between two groups in structures such as outcome expectations, outcome value, self-efficacy and knowledge. But there was no significant increase in the self-regulation and social support after educational intervention. Conclusion: Social cognitive theory as a theoretical framework is able to predict healthy eating behavior during pregnancy. Also educational intervention based on the structures of social cognitive theory, improved the behavior of pregnant mothers. Educational intervention based on social cognitive theory and providing simple and understandable training packages for pregnant women is recommended. [ABSTRACT FROM AUTHOR]

Objectives: Priority setting in health directly impacts the general public as payers and final consumers, so the public preferences must be considered. The present study aimed to provide public preferences about health intervention allocation criteria for the optimal allocation of public health budget in Iran.Methods: A choice-based survey method was used to assess the general public's preferences regarding 8 critical criteria with a societal aspect. One thousand sixty-four adult citizens of Tehran, Iran, participated in the study. Participants were asked to allocate a hypothetical budget between the two groups with differences in allocation criteria. Public preferences were inferred from absolute majority responses i.e., more than 50% of participants' allocation for a criterion. The Logistic Regression Model was used to investigate the factors affecting the preferences regarding the importance of allocation criteria.Results: Based on expressed participants' preferences, criteria of disease severity, age, daily care needs, Number of alternative interventions, individual's economic status, and diseases with absence from work were important. Thus, 77, 69, 61, 57, 54, and 51% of participants preferred to allocate the hypothetical budget to the treatment of patients with poor economic status, treatment of patients with diseases leading to absence from work, treating patients with severe diseases, treatment of diseases in need of daily care and treatment of children's diseases, respectively. Findings from the factors affecting participants' preferences regarding allocation criteria also showed that people with different characteristics had different preferences.Conclusions: Iranian general public pays special attention to the criteria of equitable allocation, including patients' economic status, criteria with societal aspects such as absenteeism from work and the need for daily care, as well as criteria with medical aspects such as disease severity and access to alternative interventions which may sometimes be less considered in decision making. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of patient facial masks on the occurrence of post-intravitreal injection (IVI) endophthalmitis in a real-word setting. Methods: In this retrospective cohort, patients receiving IVIs between 20 February 2019 and 20 February 2021; a 12-month period before the official beginning of COVID-19 epidemic in Iran and a 12-month period thereafter were included. In the pre-COVID era, patients underwent IVI without a facial mask while in the COVID era patients wore an untaped facial mask. Physicians and staff had facial mask in both periods. IVIs were administered in a dedicated operating room without a strict no talk-policy. The main outcome measure was the rate of post-IVI endophthalmitis. Results: A total number of 53,927 injections was performed during the study period: 34,277 in pre-COVID and 19,650 in COVID periods; with a 42.7% decrease in the number of injections. Endophthalmitis occurred in 7 eyes (0.020%) in pre-COVID and 7 eyes (0.036%) in COVID era (p = 0.40). In multivariate analysis, after adjustment for intercorrelations between the eyes and multiple injections in one patient, there was no statistically significant association between wearing facial masks by the patients and risk of endophthalmitis (relative risk = 1.47, 95% confidence interval of 0.97–2.22; p = 0.071). Conclusion: Patients' facial masking is not associated with an increased risk of post-injection endophthalmitis. [ABSTRACT FROM AUTHOR]

Background: It is well documented that, similar to active smokers, passive smokers are also at an increased risk of developing non-communicable diseases, and it could impose high financial costs on the healthcare system. This study aimed to evaluate the trend of passive smoking and related determinants during the three phases of a school-based surveillance program.Methods: This is a secondary study using the national data obtained from three phases of the surveillance program entitled The Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable Disease (CASPIAN) study, conducted from 2008 to 2014 on Iranian children and adolescents living in urban and rural areas of 30 provinces in Iran. Participants were selected by cluster multistage sampling method.Results: Overall, the study participants consisted of 33,288 students (50.5% boys) with a mean (± SD) age of 12.8 ± 3.2 years. The passive smoking rate was significantly increased from 35.6% in 2008 to 43.2% in 2015 among children and adolescents. According to the multivariate logistic regression, father's university education, mother's employment, life satisfaction, and socioeconomic status had a protective role regarding second-hand smoke exposure. In contrast, the father's self-employment had a positive role in increasing the rate of passive smoking.Conclusion: Considering the increasing trend of passive smoking and its considerable adverse health effects, it is necessary to implement large-scale public interventions to reduce the rate and hazards of exposure to tobacco smoke. [ABSTRACT FROM AUTHOR]

Aims: Investigate the genetic stability of the BCG vaccine produced in Iran from different batches compared to the reference strain. Methods and results: We comparatively analyzed the whole genome sequences of the vaccine batches from different years. Eleven vials of different batches from 2010, 2018, and 2019 were included. Complete genome analyses revealed no difference between the old (2010) and new (2018 and 2019) vaccine batches. Additionally, minor genetic changes include five single nucleotide polymorphisms (SNPs) and insertions/deletions (indels) were observed compared to the BCG Pasteur 1173P2 reference strain, which were shared among all batches. Besides, the batches were identical to the reference strain in terms of antibiotic resistance genes, prophage sequences, and clustered regularly interspaced short palindromic repeats (CRISPR)‐CRISPR‐associated (Cas) systems. Conclusions: High genetic stability of the BCG vaccine used in the national immunization program was confirmed, which indicates the optimal conditions in the vaccine production process. Significance and Impact of the Study: Genetic differences within and between vaccine strains have been declared as one of the main parameters related to the BCG vaccine variable protective efficacy. No study has been done to investigate the genetic variations of the vaccine batches at the single‐base level. [ABSTRACT FROM AUTHOR]

This case-control study aimed to evaluate the possible association of MCP-1 − 2518A/G genetic polymorphism with Behcet's disease (BD) in the Iranian patients. This study was performed in 135 Behcet's patients (51 ocular and 84 non-ocular) and 79 healthy individuals. Peripheral blood samples were genotyped for MCP-1 − 2518A/G using the PCR-RFLP technique. The statistical analysis of MCP-1 − 2518A/G showed no significant differences in genotype/allele frequencies between Behcet's patients and controls. There was no significant association in genotype/allele frequencies between either ocular or non-ocular BD patients and controls. Also, different genotype/allele frequencies between ocular and non-ocular BD were not statistically significant. In this study, with a threshold P-value of 0.05 and an estimated power of 0.81 to detect a significant association (odds ratio ≥1.2), we did not observe any association of this variant with Behcet's disease. [ABSTRACT FROM AUTHOR]

Background: Diabetes is a major cause of worldwide morbidity and mortality. Diet and medication non-adherence are common among individuals with diabetes, making glycemic control difficult to attain. This study aimed to evaluate an intervention designed based on Health Action Process Approach (HAPA) to improve adherence to diet and medication among patients with type 2 diabetes in Tehran, Iran. Methods: The study was a randomized controlled trial. A total of 248 patients with type 2 diabetes who had low diet and medication adherence were randomly allocated into two intervention (n = 124) and control (n = 124) groups. Intervention group received educational intervention during three months. HAPA constructs, diet and medication adherence, and Hemoglobin A1c (HbA1c) levels were assessed at baseline, one month and six months after the intervention. Mixed Model Analysis was used to compare between and within group changes in the outcomes. Results: There was a statistically significant improvement in HbA1c levels after six months (7.77 ± 1.36% vs. 8.07 ± 1.52%, 95% CI, p < 0.001). Diet and medication adherence, intention, task self-efficacy, coping self-efficacy, recovery self-efficacy, action and coping planning, barriers, benefits and perceived social support were significantly improved one month and six months after the intervention (p < 0.001). Conclusion: Our intervention designed based on health action process approach led to improvements in diet and medication adherence, and HbA1c among the patients within one and six months. Trial registration: IRCT, IRCT20151208025431N4. Registered 10 March 2018, https://fa.irct.ir [ABSTRACT FROM AUTHOR]

Background: To assess the potential impact of a tax-induced cigarette price increase on financial and health outcomes by different socioeconomic groups. Methods: In a modeled condition using pooled cross-section data from Household Income and Expenditure Survey (2002–2017) and Iran 2019 population data, a methodology of an extended cost effectiveness analysis (ECEA) was applied to model the impact on cigarette consumption of hypothetically increased cigarette tax. The methodology was employed to evaluate: [1] health benefits (premature deaths averted); [2] health expenditures regarding smoking-related disease treatment averted; [3] additional tax revenues raised; [4] change in household expenditures on cigarettes; and [5] financial risk protection among male Iranian smokers in a time span of 60 years following a one-time increase in cigarette price of 75%. The Stata version 15.1 (StataCorp., College Station, TX, USA) was used to perform the relevant analysis and estimate regression models. Results: A 75% increase in cigarettes price through taxation would reduce the number of smokers by more than half a million, 11% of them in the poorest quintile; save about 1.9 million years of life (11% of which would be gained in the lowest quintile compared to 20% in the highest one); eliminate a total of US$196.4 million of health expenditures (9% of which would benefit the bottom quintile). Such a policy could raise the additional annual tax revenues by roughly US$ 1 billion, where the top two quintiles bear around 46% of the total tax burden. We estimated that the tax increase would avert an estimated 56,287 cases of catastrophic expenditure that wholly concentrated among the bottom two expenditure quintiles. Conclusion: Increasing cigarette tax can provide health and financial benefits, and would be pro-poor in terms of health gains, Out-of-Pocket (OOP) savings, and financial risk protection against smoking-related diseases. [ABSTRACT FROM AUTHOR]

Menopause is the last menstrual period associated with a decline in ovarian steroid secretion and follicular loss. Hormone profile changes during menopause include a decrease in the production of estrogen, dehydroepiandrosterone (DHEA), and prolactin (PRL), and an increase in thyroid-stimulating hormone (TSH) and cortisol. Herbal medicines are considered as alternatives to hormone therapy. The studies on postmenopausal women have shown that Elaeagnus angustifolia L. (called "Senjed" in Persian) has some efficacy in improving sex hormone and lipid profiles, joint pain, and cardiovascular function, as the decrease in luteinizing hormone, low-density lipoprotein, and heart rate was significant. The aim of the present study was to evaluate the effects of E. angustifolia on TSH, DHEA-S, PRL, and cortisol levels and their ratios in postmenopausal women. It is assumed that the eventual effects of hormones on the brain and other tissues are determined by the balance between interdependent hormones. In the present randomized double-blinded placebo-controlled trial (https://en.irct.ir/search/result?query=IRCT20170227032795N4), fifty-eight postmenopausal women were randomly assigned to one of two medicinal herb (15 g of the whole E. angustifolia fruit powder) and placebo (7.5 g isomalt + 7.5 g cornstarch) groups. After 10 weeks of the treatment, the serum levels of TSH, DHEA-S, PRL, cortisol hormones, and their ratios were measured. The increase in the TSH, and cortisol levels, and cortisol/DHEA-S ratio and the decrease in prolactin and DHEA-S and the PRL/TSH, PRL/cortisol, and DHEA-S/TSH ratios after E. angustifolia consumption were significant only based on within-group but not on the between-group analysis. Based on between-group analyses, the changes in the hormone profile were not significant in the placebo group. According to Iranian tradition and folklore, E. angustifolia fruit is a symbol of female fertility. Therefore, its consumption is highly recommended to maintain health in the elderly, especially women. However, the observed outcomes about the effect of E. angustifolia on menopause were not completely in line with the Iranian folklore. E. angustifolia consumption did not significantly affect the hormone profile and ratios at the end of the ten-week trial, possibly due to the small sample size, short time, and the fact that our participants were postmenopausal women. [ABSTRACT FROM AUTHOR]

Stenotrophomonas maltophilia exhibits wide spectrum of fluoroquinolone resistance using different mechanisms as multidrug efflux pumps and Smqnr alleles. Here, the role of smeDEF, smeVWX efflux genes and contribution of Smqnr alleles in the development of fluoroquinolone resistance was assessed. Ciprofloxacin, levofloxacin and moxifloxacin resistance were found in 10.9%, 3.5%, and 1.6% of isolates, respectively. More than four-fold differences in ciprofloxacin MICs were detected in the presence of reserpine and smeD, F, V expression was significantly associated with ciprofloxacin resistance (p = 0.017 for smeD, 0.003 for smeF, and 0.001 for smeV). Smqnr gene was found in 52% of the ciprofloxacin-resistant isolates and Smqnr8 was the most common allele detected. Fluoroquinolone resistance in S. maltophilia clinical isolates was significantly associated with active efflux pumps. There was no correlation between the Smqnr alleles and ciprofloxacin resistance; however, contribution of the Smqnr genes in low-level levofloxacin resistance was revealed. [ABSTRACT FROM AUTHOR]

Background: Malaria is the third most important infectious disease in the world. WHO propose programs for controlling and elimination of the disease. Malaria elimination program has begun in first phase in Iran from 2010. Climate factors play an important role in transmission and occurrence of malaria infection. The main goal is to investigate the spatial distribution of incidence of malaria during April 2011 to March 2018 in Hormozgan Province and its association with climate covariates. Methods: The data included 882 confirmed cases gathered from CDC in Hormozgan University of Medical Sciences. A Poisson-Gamma Random field model with Bayesian approach was used for modeling the data and produces the smoothed standardized incidence rate (SIR). Results: The SIR for malaria ranged from 0 (Abu Musa and Haji Abad districts) to 280.57 (Bandar–e-Jask). Based on model, temperature (RR= 2.29; 95% credible interval: (1.92–2.78)) and humidity (RR= 1.04; 95% credible interval: (1.03–1.06)) had positive effect on malaria incidence, but rainfall (RR= 0.92; 95% credible interval: (0.90–0.95)) had negative impact. Also, smoothed map represent hot spots in the east of the province and in Qeshm Island. Conclusion: Based on the analysis of the study results, it was found that the ecological conditions of the region (temperature, humidity and rainfall) and population displacement play an important role in the incidence of malaria. Therefore, the malaria surveillance system should continue to be active in the region, focusing on high-risk areas of malaria. [ABSTRACT FROM AUTHOR]

Upper gastrointestinal (UGI) cancer, including esophageal and gastric, is one of the most common cancers in the world. Hence, the determination of risk factors of UGI helps to reduce the economic and social burden of this cancer in communities. In Iran, the consumption of opium because of its neighborhood with Afghanistan are considerable. In this study, we examine the causal effect of opium use on the time to UGI cancer death. Based on the Golestan Cohort Study (GCS) in northeastern of Iran, about 50000 adults were enrolled to the study for four years (2004–2008) and followed annually until July 2018. We used "parametric g-formula" to study the causal effect of opium use on the time to death due to UGI. In this study, the information of 49946 individuals due to missingness were analyzed. So the median of follow-up time was 144 months and the prevalence of opium use was 17% (about 8489 persons). During the follow-up period, 593 (1.2%) death from upper gastrointestinal cancer were reported. The study showed that the effect of opium use on the time to UGI death was statistically significant (adjusted risk-ratio based on parametric g-formula = 1.31, 95% CI: [1.04, 1.65]). Additionally, the Population Attributable Fraction (PAF) in UGI cancer deaths of opium use was estimated 5.3% (95% CI: [0.6%, 11.3%]). Our results showed a causal effect of opium use on the intensity of upper gastrointestinal cancer death. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the current study was to determine the upper threshold number of cases for which pertussis infection would reach an outbreak level nationally in Iran. Methods: Data on suspected cases of pertussis from the 25th February 2012 to the 23rd March 2018 from the Center for Disease Control and Prevention in Iran was used. The national upper threshold level was estimated using the exponentially weighted moving average (EWMA) method and the Poisson regression method. Results: In total, 2,577 (33.6%) and 1,714 (22.3%) cases were reported in the Spring and Summer respectively. There were 1,417 (18.5%) and 1,971 (25.6%) cases reported in the Autumn and Winter, respectively. The overall upper threshold using the EWMA and the Poisson regression methods, was estimated as a daily occurrence of 8 (7.55) and 7.50 (4.48-11.06) suspected cases per 10,000,000 people, respectively. The daily seasonal thresholds estimated by the EWMA and the Poisson regression methods were 10, 7, 6, 8 cases and 10, 7, 7, 9 cases for the Spring, Summer, Autumn, and Winter, respectively. Conclusion: The overall and seasonal estimated thresholds by the 2 methods were similar. Therefore, the estimated thresholds of 6-10 cases in a day, per 10,000,000 people could be used to detect pertussis outbreaks and epidemics by health policymakers. [ABSTRACT FROM AUTHOR]

Background: The initiation age and prevalence of smoking water-pipe are two important parameters for establishing preventive policies. Thus, the present study was conducted to introduce a new approach for estimating and evaluating the effect of demographic variables on the initiation age and prevalence of smoking water-pipe. Materials and Methods: The STEPwise approach for non-communicable disease risk factors surveillance (STEPS) 2011 data were used and daily smokers and non-smokers with the age range of 16 to 70 years were included in the study. A survival mixture cure rate model with doubly censoring was used. Results: Totally, 9764 individuals were enrolled in the study. No significant association was observed between the initiation age and gender (HR=1.07, 95% CI: 0.76, 1.58), whereas there was a significant difference between initiation age and area of residence (HR=0.62, 95% CI: 0.44, 0.88). The mean age of starting smoking was 25.82 years (95% CI: 24.13, 27.63). The odds of smoking in men were higher than in women (OR=2.34, 95% CI: 1.79, 3.7). The prevalence of smoking had a significant association with socioeconomic status (OR=0.84, 95% CI: 0.72, 0.97), but no association with the level of education (OR=1.06, 95% CI: 0.97, 1.15) and place of residence (OR=1.2, 95% CI: 0.93, 1.57) was found. The estimated prevalence of smoking water-pipe in total, men, and women was 4.8% (95% CI: 4.19%, 5.51%), 7.77% (95% CI: 6.76%, 8.86%), and 3.47% (95% CI: 2.8%, 4.25%). Conclusion: A new statistical methodology was applied to estimate and evaluate the effect of demographic variables on the initiation age and prevalence of water-pipe smoking. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence and associated factors of AMD in an Iranian population in 2014. Methods: In this population-based cross-sectional study, a total of 2975 Iranian residents (age: ≥50 years) from the urban and rural areas of Gilan province were included. The prevalence of different grades of AMD was determined using the International Age-Related Maculopathy Epidemiological Study Group grading system. Results: Of 2975 eligible individuals, 2587 (87.0%) subjects participated and 2275 (76.5%) subjects (62.6 ± 8.8 years old) had gradable fundus photographs. Age- and sex-standardized prevalence of early and late AMD based on the 2016 Iran census were 13.2% (95% confidence interval [CI], 10.6–16.2) and 0.7% (95% CI, 0.4–1.3), respectively. In multivariate analysis, each decade increase in age was associated with the adjusted odds of any (adjusted odds ratio [AOR] = 1.31, 95% CI, 1.09–1.56; P =.0031), early (AOR = 1.27, 95% CI, 1.06–1.53; P =.012) and late AMD (AOR = 2.39, 95% CI, 1.08–5.28; P =.031). Hyperopia was identified to be less frequent in late AMD (AOR = 0.20, 95% CI, 0.04–0.80; P =.024). No significant association was found between AMD and sex, smoking, outdoor working, diabetes, hypertension, pseudophakia, hyperlipidemia and myopia. Conclusion: Gilan Eye Study demonstrated the first estimate of age-specific AMD prevalence in Iran being compatible with other WHO regions. With the expected increase in the life expectancy and aging of Iranians, the number of people affected by AMD will be increasing in future. Healthcare policy makers should be advised to provide more efficient eye care services and preventive strategies in this regard. [ABSTRACT FROM AUTHOR]

Objective: To define the level of alarm threshold for pertussis aberrations and to detect the aberrations of the reported suspected cases of pertussis from the Mazandaran province in the north of Iran. Methods: The included cases were composed of the suspected pertussis patients who came from Mazandaran province and registered in the Center for Disease Control and Prevention from 20 March 2012 to 20 March 2018. A discrete wavelet transform- based method was used to detect the aberrations. All analyses were performed using MATLAB Software version 2018a and Excel 2010. Results: A total of 1 162 cases were recruited in the study, including 545 (46.90%) males and 617 (53.10%) females, with median age of 1.47 (0.22-9.56) years. The median age of males was 1.18 (0.21-8.24) years, while that of females was 1.82 (0.21-10.75) years. Concerning the level of the alarm threshold, it was 1.28 case/d when k=2, while it was 1.34 case/d when k=3. The total detected aberration days were 123 d and 57 d by considering k=2 and 3, respectively. The most defined alarm threshold was related to spring (>2 cases/d) and summer (>1 case/d), respectively. Conclusions: The sensitivity of the surveillance system is subjected to a different time. Thus, determining the level of alarm threshold periodically using different methods is recommended. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the correlation of the visual acuity and diabetic retinopathy stage using optical coherence tomography and optical coherence tomography angiography metrics. Methods: In this prospective study, optical coherence tomography and optical coherence tomography angiography images of patients with different stages of diabetic retinopathy were obtained. In optical coherence tomography angiography images, the size of foveal avascular zone, central macular thickness, and vessel density at superficial and deep capillary layers of the macula were measured. In optical coherence tomography images, the presence of intraretinal cyst, disorganization of retinal inner layer, and ellipsoid zone and external limiting membrane disruption were evaluated. The associations between the variables with visual acuity and diabetic retinopathy stage were analyzed. Results: In total, 68 eyes of 38 patients with a mean age of 58.96 ± 10.59 years were included. In total, 34 eyes were categorized as non-proliferative diabetic retinopathy, 14 as active, and 20 as regressed proliferative diabetic retinopathy. Univariate analysis showed deep parafoveal vessel density, central macular thickness, ellipsoid zone disruption, disorganization of retinal inner layer, and external limiting membrane disruption had a significant relationship with visual acuity. However, in multivariate analysis, only central macular thickness and ellipsoid zone disruption had significant association with visual acuity (p = 0.02 and p = 0.01, respectively). There was a significant difference in deep parafoveal vessel density (p = 0.04), but not in foveal avascular zone area, between different stages of diabetic retinopathy. Conclusion: In this study, the foveal avascular zone area did not correlate with visual acuity and different stages of diabetic retinopathy. Structural abnormalities on optical coherence tomography images with especial focus on outer retinal disruption provided more reliable predictors for visual acuity outcomes in patients with diabetic retinopathy. [ABSTRACT FROM AUTHOR]

What is known and objective: Fingerprinting is recognized as an easily accessible means of personal identification; however, fingerprints can be damaged after administration of some chemotherapy agents that result in hand and foot syndrome (HFS). Fingerprint loss may also be due to reasons unrelated to HFS. This study evaluated the incidence of fingerprint changes in patients treated with capecitabine‐containing chemotherapy regimens and its relations to various grades of HFS. Methods: Seventy‐one patients who received chemotherapy with or without capecitabine as part of their regimen were enrolled in the study. Fingerprints were collected once before the initiation of chemotherapy and once after the third course of chemotherapy. The fingerprints were examined by the Iranian Society of Forensic Physicians, for probable changes in the post‐chemotherapy states. Results and discussion: Thirty‐seven patients were enrolled in the capecitabine group and 34 in a comparison group. Fingerprint changes were observed in 25 (67.6%) of the 37 patients in the capecitabine group and none in the comparison group. There was no correlation between the occurrence or severity of HFS and fingerprint changes (P = 0.880). In capecitabine group, the total dose and course numbers of capecitabine were not significant in patients with and without fingerprint changes. What is new and conclusion: Based on our findings, we recommend notifying patients who are considered for capecitabine therapy about the risk of fingerprint changes before the initiation of treatment, as this may have legal implications. [ABSTRACT FROM AUTHOR]

Background: Community-acquired pneumonia (CAP) is a common disease considered as a major public health problem. It causes considerable morbidity and mortality despite antibiotic treatments. Hospital admission of CAP patients is a significant financial burden and many efforts are ongoing to decrease hospital stay durations. Vitamin D deficiency is associated with increased risk of respiratory infections. This study was designed to determine the association of vitamin D status with hospitalized CAP patient mortality and disease severity. Methods: This prospective cohort study examined 180 CAP patients admitted to a teaching Hospital in Tehran, Iran during 2016-2017. Their demographic and anthropometric characteristics were recorded. The disease severity was evaluated based on CURB-65. Vitamin D status was determined by measuring by serum 25-hydroxylated vitamin D (25(OH)D) with ELISA. The patients were followed for 30 days to evaluate their vitality. Results: One hundred and eighty pneumonia patients, including 104 males and 84 females, were recruited from respiratory disease, infectious disease, emergency, and ICU wards. Nearly 18% of the patients were current smokers. The CAP severity, evaluated by CURB-65, was determined to be non-severe in 74.4% of the patients. Patients were classified as vitamin D sufficient, insufficient, or deficient. Thirty percent of the patients were vitamin D sufficient, 18% were insufficient, and 52% were deficient. Thirty-day mortality was 40% (72 cases). Mortality was greater in males than in females (47.1% vs. 30.3%, p=0.03). The disease was significantly less severe in the patients who survived than in those who did not. The vitamin D status differed between males and females (p=0.027). The vitamin D status was lower in the more severe cases than in the less (p=0.036), and vitamin D deficiency was more prevalent in patients who died than in those who lived. Vitamin D concentration was negatively correlated with hospital stay duration. The 25(OH)D concentration was significantly greater in patients who survived than in those who did not (p<0.001). Conclusions: Pneumonia severity and mortality risk were greater and hospital stays longer in vitamin D-deficient patients than in those with higher vitamin D status. [ABSTRACT FROM AUTHOR]

Purpose. To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb. Methods. In this mixed model study, a web application called the "Iranian Retinopathy Teleophthalmology Screening (IRTOS)" was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital. Results. Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively. Conclusions. Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs. [ABSTRACT FROM AUTHOR]

Introduction: Economic evaluation of healthcare interventions usually needs accurate data on utility and health-related quality-of-life scores. The aim of this study is to map QLQ-C30 scale score onto EQ-5D-5L and SF-6D utility values in colorectal cancer (CRC) patients.Methods: EQ-5D-5L, SF-6D, and QLQ-C30 were completed by 252 patients with CRC who were referred to three cancer centers in Tehran between May and September 2017. Moreover, OLS, Tobit, and CLAD models were used to predict EQ-5D-5L and SF-6D values. The goodness of fit of models was evaluated using Pred R2 and Adj R2. In addition, their predictive performance was assessed by MAE, RMSE, ICC, MID, and Spearman's correlation coefficients between observed and predicted EQ-5D-5L and SF-6D values. Models were validated using a 10-fold cross-validation method.Results: Considering the goodness of fit and predictive ability of models, the OLS Model 2 performed best for EQ-5D-5L (Adj R2 = 58.09%, Pred R2 = 58.93%, MAE = 0.0932, RMSE = 0.129) and the OLS Model 3 performed best for SF-6D (Adj R2 = 54.90%, Pred R2 = 55.62%, MAE = 0.0485, RMSE = 0.0634).Conclusion: Our results demonstrated that algorithms developed based on OLS Models 1 and 2 are the best for predicted EQ-5D-5L and SF-6D values, respectively. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) is one of the treatments provided to end-stage renal disease (ESRD) patients. A few studies have investigated the survival rate of HD patients in Iran. Hence, we decided to investigate the survival rate and it is predictors among Iranian ESRD patients. Methods: This is a retrospective cohort study conducted in 165 HD patients in Tuyserkan city (Hamadan province) during 20 years from 1996 to 2015. The checklist used to gather information was comprised of patients' demographic and clinical information. The analysis was performed using Kaplan-Meier curves, log-rank test, and cox regression model. Results: The most prevalent cause of ESRD was reported to be high blood pressure (32.7%). The probability of survival rate at the end of 1st, 5th, and 10th year was 0.65, 0.16, and 0.05, respectively. Results of multivariate cox regression showed that old age, catheter vascular access, and high hemoglobin level have a negative significant effect on survival of HD patients (P < 0.05). Conclusions: Overall, the survival of HD patients seems to be low in Tuyserkan as compared to other studies. Age, ESRD cause, vascular access, marital status, and hemoglobin level among other factors are proved to have a significant effect on survival probability. [ABSTRACT FROM AUTHOR]

Background Cervical cancer screening reduced cancer morbidity and mortality in developed countries. Health education interventions are expected to enhance screening and early detection. Thus, this review is aimed to see the effectiveness of the interventions in cervical cancer screening uptake. Methods Online databases (PubMed/MEDLINE/PubMed Central, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar) were searched for all published eligible research articles in the past 12 years (as of January 2005–2017). A total of 17 research articles were included. The interventions were classified as 'individual level', 'community level' and 'cultural sensitive educations' which contains various interventions in their content as compared with usual care. A quality coding system was assessed using Cochrane checklists and rated by each researcher independently and the average score was given accordingly. This study was registered in PROSPERO 2017: CRD42017060405. Results The review dovetailed 17 studies. Ten studies (58.82%) were conducted in the United States, three in Iran (17.65%) and one each in Malaysia, China, Cameroon and Nigeria (23.53%). Almost all levels of the interventions boosted the screening uptake and the Pap test. However, the individual level health education interventions were prioritized in many of the studies. Conclusion The review indicated that health education interventions have immense contributions in boosting the screening uptake. However, the effectiveness varies with study setting, populations and the way of delivery. Therefore, the limited quality of the studies indicated that further research is required to develop a simple and effective intervention to boost cervical cancer screening uptake. [ABSTRACT FROM AUTHOR]

Objectives: Ataxia-telangiectasia (A-T) is an autosomal recessive multisystem disorder characterised by cerebellar degeneration, telangiectasia, radiation sensitivity, immunodeficiency, oxidative stress and cancer susceptibility. Epidemiological research has shown that carriers of the heterozygous ataxia-telangiectasia mutated (ATM) gene mutation are radiosensitive to ionising irradiation and have a higher risk of cancers, type 2 diabetes and atherosclerosis. However, there is currently no fast and reliable laboratory-based method to detect heterozygous ATM carriers for family screening and planning purposes. This study therefore aimed to evaluate the ability of a modified G2-assay to identify heterozygous ATM carriers in the families of A-T patients. Methods: This study took place at the Tehran University of Medical Sciences, Tehran, Iran, between February and December 2017 and included 16 A-T patients, their parents (obligate heterozygotes) and 30 healthy controls. All of the subjects underwent individual radiosensitivity (IRS) assessment using a modified caffeine-treated G2-assay with G2-checkpoint abrogation. Results: The mean IRS of the obligate ATM heterozygotes was significantly higher than the healthy controls (55.13% ± 5.84% versus 39.03% ± 6.95%; P <0.001), but significantly lower than the A-T patients (55.13% ± 5.84% versus 87.39% ± 8.29%; P = 0.001). A receiver operating characteristic (ROC) curve analysis of the G2-assay values indicated high sensitivity and specificity, with an area under the ROC curve of 0.97 (95% confidence interval: 0.95–1.00). Conclusion: The modified G2-assay demonstrated adequate precision and relatively high sensitivity and specificity in detecting heterozygous ATM carriers. [ABSTRACT FROM AUTHOR]

Background: Lack of accurate menstrual knowledge, attitude, and practices leave female adolescents ignorant of the necessary health behaviors during menstruation. This study aimed to develop a menstrual health-seeking behavior questionnaire based on the theory of planned behavior to evaluate its psychometric properties in female adolescents in Tehran. Methods: This study was conducted on 578 female adolescents aged 12-15 years in Tehran. The first draft of the menstrual health-seeking behavior questionnaire containing 52 items was developed based on the theory of planned behavior (TPB). The content and face validity of the questionnaire was assessed by a panel of experts. Construct validity was also assessed using exploratory factor analysis (KMO=0.73) with varimax rotation. Cranach's alpha and test-retest were used to examine the reliability of the questionnaire. All statistical analysis was performed using SPSS 23.0 and AMOS 23.0. Results: The content and face validity of the 42 items were finally confirmed. Content validity index was greater than 0.73 for all six TPB constructs. Explanatory factor analysis yielded an acceptable fit for the six-factor model (RMSE=0.053, 95% CI 0.042-0.064). These factors jointly explained 65% of the variance in the outcome variables. Cranach's alpha coefficients ranged from 0.79 to 0.91, demonstrating an excellent internal consistency and high reliability of the questionnaire. Test-retest reliability was also satisfactory for all items (ICC=0.86-0.94). Conclusion: The results illustrate that the menstrual health-seeking behavior questionnaire is psychometrically adequate and highly reliable. This theoretically grounded questionnaire can be well applied in future interventions for female adolescents to assess their menstrual health-related knowledge, attitude, and practices. [ABSTRACT FROM AUTHOR]

Background: Hookah and cigarette smoking have adverse effects on individuals' health and therefore place a great burden on public health. The aim of this study was to measure inequalities in socioeconomic position to determine contributing factors on cigarette and hookah smoking in Iran. Methods: In this study, secondary analysis of the Iran's sixth national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) was conducted for 10,572 individuals aged 15 to 70 years old. Subjects were categorized into three groups according to their socioeconomic status (low, middle and high) in order to assess their inequalities using principal component analysis. At the end, the gap between the low and high socioeconomic groups was decomposed using Blinder-Oaxaca decomposition technique. Results: The prevalence of cigarette and hookah smoking in high, middle, and low socioeconomic groups was 11.8%, 13.2%, and 13.1% (P = 0.158), and 2.6%, 3.3% and 4.3%, (P < 0.001), respectively. Blinder-Oaxaca decomposition technique showed a lower prevalence of hookah smoking in high socioeconomic group compared to low socioeconomic group (P < 0.001). The gap between the two mentioned groups was measured to be 1.7%. However, this gap for cigarette smoking (1.5%) was not significant (P = 0.093). Conclusion: The finding indicates the importance of socioeconomic status in hookah smoking. After decomposition of the gap between the 2 socioeconomic groups, age, gender and education level were reported to be the major contributors to the differences observed between the 2 groups. [ABSTRACT FROM AUTHOR]

Objective:To evaluate an intervention programme based on the Health Action Process Approach and designed to increase the intake of fruit and vegetables (F&V) among Iranian adolescents aged 13 to 18. Design:A randomised controlled trial with three arms examined the short- (1 month) and long-term (6 months) effects of the intervention. There were two intervention groups (one included adolescents only [A group;n = 510]; the second included mothers and adolescents [M + A group;n = 462]) and a control group (n = 483). All participants were recruited from schools. Main outcome measures:Social cognitions, self-regulatory processes and F&V intake. Results:The intervention led to an increase in F&V intake for adolescents in the short and long terms. Adolescents in the M + A group increased their F& V intake more than adolescents in the A group. Outcome expectancies, self-monitoring, intentions, action and coping planning, perceived social support and behavioural automaticity mediated the effect of the intervention on F&V intake. Conclusion:The theory-based intervention led to an increase in F&V intake and promoted more positive social cognitions and self-regulatory processes among Iranian adolescents. The findings also provide evidence that involving mothers in an intervention can confer additional benefit. [ABSTRACT FROM PUBLISHER]

Background: Hemodialysis (HD) represents the main way of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients in Iran. Few studies have investigated the survival of HD patients in Iran. Objectives: This study conducted to reach better understanding predictors of survival for HD patients. Patients and Methods: This is a retrospective cohort study conducted in 1142 HD patients in Hamadan province during 11 years from 2007 to 2017. The checklist used to gather information was comprised of patient's demographic and clinical information. The analysis was carried out using Laplace regression and Cox regression model. Results: The most prevalent causes of ESRD were reported to be high blood pressure (BP) (28.9%) and diabetes (24.34%). The probability of survival at the end of 1st, 5th, and 10th year was 0.81, 0.4 and 0.13, respectively. Results of multivariate Cox regression showed that being rural dweller, low albumin, ferritin and hemoglobin level and having positive CRP at diagnosis have a negative significant impact on survival of HD patients (P < 0.05). Conclusions: Being rural dweller, low albumin and hemoglobin level and having positive CRP at diagnosis amongst other factors were possible factors affecting the survival of HD patients in this study. Considering the low survival probability of these patients, efforts should be made to real-time diagnosis of the cause of renal diseases. [ABSTRACT FROM AUTHOR]

Background: To determine the rate of zero and five end-digit preference (EDP) for systolic and diastolic blood pressures (SBP and DBP, respectively) and risk factors amongst a representative sample of Iranian adults in the year 2011. Methods: Data gathered from 7997 Iranian adults aged 25-70 were extracted from the database of the sixth Survey of Surveillance of Risk Factors of Non-communicable Diseases, which surveyed a total of 11,864 individuals aged 6 to 70 years. Multilevel multiple logistic regression was used to identify the independent factors associated with zero or five EDP. Results: The prevalence of three serial zero or five EDP for SBP and DBP were 18.5% (95% CI: 11.3%-25.7%). SBP ≥140 mmHg (OR = 0.78; 95% CI: 0.65-0.95), DBP ≥90 mmHg (OR = 0.71; 95% CI: 0.58-0.88), and a positive family history of diabetes (OR = 0.77; 95% CI: 0.66-0.9) were found as protective factors against zero or five EDP in blood pressure recording the male gender (OR = 1.18; 95% CI: 1.04-1.35) was found to be its independent risk factor. Conclusion: Sex, SBP, DBP and family history of diabetes were found to be the main independent determinants of EDP in our country which underscores the importance of assessing the many patient-related factors in the studies involving EDP as part of BP monitoring in public health care. [ABSTRACT FROM AUTHOR]

Objective: To test the applicability of existing retinopathy of prematurity (ROP) guidelines on Iranian patients and to develop novel ROP screening criteria in Iran.Methods: Both eyes of 1932 infants born ≤37 weeks of gestation and/or weighting ≤3000 g were included in this prospective cohort study that was conducted across nine neonatal intensive care units and a tertiary eye hospital ROP clinic. The patients were examined for ROP and the need for treatment (type 1 ROP or worse). All the patients were screened 4 weeks after birth or at 31 weeks of postmenstrual age, whichever was later. The patients were followed until retinal vascularisation was completed or the patients reached 50 weeks of gestational age (GA) without prethreshold ROP. A receiver operating characteristic curve was used to determine the best screening criteria for ROP. Screening criteria from other countries were applied to our patient data to determine their ability to appropriately detect ROP.Main Outcome Measure: Patients with ROP requiring treatment.Results: The mean GA±SD and birth weight (BW)±SD of the screened patients were 32±2.7 weeks and 1713±516 g, respectively. Using criteria of GA≤32 weeks or BW ≤2000 yielded sensitivity and specificity of 100% and 26.7%, respectively, for treatment requiring ROP regardless of clinical comorbidities. Using screening recommendations of American Academy of Pediatrics would miss 25.4% of ROP and 8.4%ROP requiring treatment in our cohort.Conclusions: Other countries screening recommendations would result in a significant amount of missed cases of treatment requiring ROP when applied to Iran. As a result, we have proposed new guidelines for premature babies in Iran. [ABSTRACT FROM AUTHOR]

Background: Age-related macular degeneration (AMD) is a complex disorder which results in irreversible vision loss and progressive impairment of central vision. Disease susceptibility is influenced by multiple genetic and environmental factors. Single nucleotide polymorphisms (SNP) in the complement factor H gene are the most important genetic risk factors. We conducted a case-control study to investigate the association four SNPs (dbSNP ID: rs800292, rs1061170, rs2274700 and rs3753395) ofCFHgene with AMD in the Iranian population. Materials and Methods: We recruited 100 AMD patients and 100 age- and sex-matched normal controls. Direct sequencing for three SNPs (rs800292, rs2274700 and rs3753395) and restriction fragment length polymorphism utilized for rs1061170. Allele and genotype frequencies of SNPs were calculated and tested for departure from Hardy–Weinberg equilibrium using the Chi-square test. An allelic and genotypic association was compared by logistic regression analysis using the SNPassoc. Results: According to our results, the frequencies of risk allele for all SNPs (G, G, A, and C alleles of rs800292, rs2274700, rs3753395 and rs1061170, respectively) were significantly higher in AMD patients (pvalue < 0.001). AMD individuals who had at least one copy of the C allele of rs1061170 had an increased risk of disease compared with cases with the T allele. Other studied polymorphisms showed the same association. Conclusion: Our results suggest the contribution of all four predictedCFHpolymorphisms in AMD susceptibility among the Iranian population. This association withCFHmay lead to early detection and new strategies for prevention and treatment of AMD. [ABSTRACT FROM PUBLISHER]

Background: Metabolic syndrome is a growing public health problem worldwide. Several interventions have been proposed to specifically target the problem. This study evaluated the effectiveness of an interactive web-based lifestyle for management of metabolic syndrome.Methods: This randomized controlled trial was conducted from June through August 2012 in Tehran, Iran. Participants were individuals with metabolic syndrome who had registered on the study website. Interested eligible participants were invited for a free clinic visit and clinical assessment. They were randomly assigned to the intervention (n =80) or control (n = 80) group. The intervention group received an interactive web-based program called the Healthy Heart Profile and were followed for 6 months. The control group received general information on metabolic syndrome. Anthropometric measures, glycemic status, and lipid profile were evaluated at baseline, and at 3- and 6-month follow-up assessments. Metabolic syndrome was defined according to The National Cholesterol Education Program Adult Treatment Panel (ATP) III report except for waist circumference, which was modified to ≥90 cm for both genders for the Iranian population.Results: In total, 1,437 individuals registered on the study website. The mean age of participants was 44.2 years (SD  = 10.0). There were no significant differences between the intervention and control groups on any baseline variable except that participants in the intervention group recorded higher levels of LDL. The results showed a decrease in metabolic syndrome in both groups. These reductions were significantly greater in the intervention group at the 3- and 6-month follow-ups. The intervention group showed significantly greater decreases (P < 0.05) over the control group for, respectively, systolic blood pressure (3-month: -10 versus -6 mmHg; 6-month: -11 versus -8 mmHg), diastolic blood pressure (3-month: -10 versus -4 mmHg; 6-month: -11 versus -6 mmHg), weight (3-month: -2 versus -1 kg; 6-month: -4 versus -1 kg), body mass index (3-month: -0.5 versus -0.2 kg/m(2); 6-month: -1.1 versus -0.4 kg/m(2)) and improvement in HDL (3-month: 2 versus 0.64 mg/dl; 6-month: 6 versus 4 mg/dl).Conclusion: The findings suggest that the web-based interactive program was beneficial for individuals with metabolic syndrome. Comprehensive interactive web-based prevention programs are promising to help involve patients in improving management of metabolic syndrome and adopting a healthy lifestyle.Trial Registration: IRCT201111198132N1 . Registered 27 May 2013. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of second-eye senile cataract surgery (SECS) as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. Materials and Methods: In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years (2006-2009) was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected (1,585 out of 10,517 records). Results: First- and second-eye operations were performed in 1,139 (71.9%; 95% confidence interval [CI], 69.5-74.1) and 446 eyes (28.1%; 95% CI, 25.9-30.35), respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 (P = 0.017). The median (interquartile range) interval between the two operations was 9 (4-24) months, which remained stable during the study period. The SECS rate was 10.4% higher (P = 0.01) and the time interval was 13 months shorter (P = 0.007) in patients who underwent phacoemulsification than extracapsular cataract extraction. Conclusion: The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time. [ABSTRACT FROM AUTHOR]

Background: Iran is one of the fastest ageing countries in the world. The model of Active Ageing (AA) could be a strategy contributing in addressing the problem of population ageing in Iran. This study measured the status of AA in Iran and examined its associations with the health-related quality of life of older people. Methods: A quantitative cross-sectional survey of a random sample of 623 people aged 55 + years resident in Tehran was conducted. In total, 590 people responded. The AA was measured using the Active Ageing Index (AAI) questionnaire and the health-related quality of life was measured using SF-36 questionnaire. Associations between the domains and the overall AAI scores with the quality of life were examined by MANCOVA analysis in four models using the STATA software. Results: The score of overall AAI was calculated at 26.8 (men 33.9 vs. women 20.6) out of 100. We found a stronger association of the AAI with the physical component than the mental component of the SF-36. Generally the 1st (employment) and the 2nd (participation in society) domains of the AAI showed little or no association with SF-36, but there was an association between the 3rd domain (enabling environment for active ageing) and the SF-36 and a particularly strong associations with the 4th domain (independent, healthy and secure living capacity). Conclusions: Iranian elderly, particularly women, are experiencing relatively inactive life, which negatively influence on their health-related quality of life. To improve the AAI status in Iran, some aspects including "enabling environment" and "independent, healthy and secure living capacity" need special attention. [ABSTRACT FROM AUTHOR]

Background: Using data from different health centers can provide more accurate knowledge of the survival prognostic factors and their effect on the patient's survival. In this multicenter study, we aimed to investigate the role of prognostic factors on breast cancer survival with large data set. Methods: This historical cohort study was carried out using data from 1785 participants with breast cancer. Data were gathered from medical records of patients referring to 4 breast cancer research centers in Tehran, Iran, between 1997 and 2013. Age at diagnosis (year), size of the tumor, involve lymph nodes, tumor grade, type of surgery, auxiliary treatment of chemotherapy, radiotherapy, recurrence, and metastasis were the prognosis factors considered in this study. A shared frailty model with a gamma distribution for frailty term was used. Results: The median follow-up period was 29.71 months with the interquartile range of 19 to 61 months. During the follow-up period, 337 (18.9%) patients died from breast cancer and 1448 (81.1%) survived. The 1-, 3-, 5-, and 10-year survival rates were 96%, 84%, 76%, and 58%, respectively. In the Cox model by centers, in Center A, the type of surgery, number of nodes involved, and the grade 3 tumor; in center B, age, radiotherapy, metastasis, and between 1 and 3 involved nodes; in center C, age, radiotherapy, recurrence, metastasis, tumor size, and grade 3 tumor; and in center D, chemotherapy, metastasis, and lymph nodes involved were significant. Shared frailty model showed that type of surgery, number of lymph nodes involved, metastasis, radiotherapy, and the tumor grade are the prognostic factors survival in breast cancer. The frailty variance was significant, and it affirmed there was significant variability between centers. Conclusions: This study showed it is necessary to consider the frailty term in modeling multicenter survival studies and confirmed the importance of early diagnosis of cancer before the involvement of lymph nodes and the onset of metastasis and timely treatment could lead to longer life and increased quality of life for patients. [ABSTRACT FROM AUTHOR]

Patients with heart failure experience high hospitalization. However, patients cannot recognize symptoms according to current approaches, which needs to be improved by new self-monitoring instruments and strategies. Thus, we aimed to assess a self-monitoring traffic light diary on outcomes of patients with heart failure. This was a single-blind, two-arm parallel group randomized controlled trial at the heart failure clinic of Tehran Heart Center (Tehran, Iran). Adult patients with a definitive diagnosis of heart failure with reduced ejection fraction (i.e., ejection fraction of less than 40 %), and New York Heart Association functional classes II–IV were included. A block-balanced randomization method was used to assign eligible subjects to the intervention or control group. Baseline data were collected before random allocation. Participants in the intervention group received a comprehensive intervention consisting of (1) self-care education by an Australian Heart Foundation booklet on heart failure, (2) regular self-monitoring of weight and shortness of breath at home, and (3) scheduled call follow-ups for three months. Patients in the control group received usual care. The primary outcome was heart failure self-care; the secondary outcomes were heart failure quality of life, knowledge, and all-cause hospitalization. From June to August 2017, 68 patients were included in the study. The overall age of participants was 55 (13.6) years old, and 71 % of patients were male. A significant association between the intervention and self-care maintenance (β 5.1; 95 % CI 2.50 to 7.70, P < 0.001), self-care management (β 10.6; 95 % CI 6.50 to 14.8, P < 0.001), self-care confidence (β 8.0; 95 % CI 5.0 to 11.0, P < 0.001) and heart failure knowledge (β 1.7; 95 % CI 1.30, 2.04; P < 0.001) was found. However, there was no association between the intervention and quality of life (β 2.5; 95 % CI − 0.79, 5.88, P 0.135) and hospitalization-free survival of the two groups (Log-Rank P 0.540). A self-monitoring traffic light diary can improve self-care behaviors and heart failure knowledge in patients with heart failure with reduced ejection fraction. Iranian Registry of Clinical Trials IRCT2017021032476N1. PMCID: PMC6262204. [ABSTRACT FROM AUTHOR]

Background and Objectives: Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries. Methods: The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS. Results: The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P= .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P= .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P= .52). Conclusions: This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts. [ABSTRACT FROM AUTHOR]

Background: Dual practice (DP) by medical specialists is a widespread issue across health systems. This study aims to determine the level of DP engagement among Iran's specialists.Methods: A pre-structured form was developed to collect the data about medical specialists worked in all 925 Iran hospitals in 2016. The forms were sent to the hospitals via medical universities in each province. The data were merged at the national level and matched using medical council ID codes, national ID codes, and eventually a combination of the first name, surname, and father's name.Results: A total of 48 345 records were collected for 30 273 specialists from 858 (93%) hospitals out of total 925 hospitals. Sixteen thousand eight hundred forty-nine (69% of) specialists were non-faculty members and 6317 (26% of) specialists were employed on a contract basis. Eleven thousand six hundred and thirty-eight (47.7% of) specialists were engaged in DP on total. Female specialists had 0.78 times less DP chance; faculties compared to non-faculties had 0.65 times more DP chance and full-time geographic specialists compared to non-full-time specialists had 0.15 times more DP chance. DP was more frequent in specialists with higher age and more job experience and in provinces with more population, deprivation, and higher number of specialists per facility (P < 0.05).Conclusions: The level of DP is relatively high among Iran medical specialists, especially in geographic full-time specialists. However, they are totally banned and they receive extra payment for being full-time; restrictive regulations and financial incentives without considering other factors might not eliminate DP in specialists and it should be addressed based on conditions of each country and regions inside the country. [ABSTRACT FROM AUTHOR]

Background: Adolescents are increasingly at risks of HIV infection through high-risk sexual behaviors. This paper aimed to assess the effectiveness of a HIV/AIDS educational intervention among female adolescents in Tehran. Methods: A randomized controlled trial was conducted among high school girls aged 12-16 years studying in Tehran in 2016-17. The sample was selected using multistage random cluster sampling. Four schools per district were randomly selected using probability-proportional to size. Adolescents were randomly assigned to the experimental (n=289) and the control (n=289) groups. The theory of planned behavior (TPB) was the basis of both the intervention and the evaluation phase. Both experimental and control groups completed a questionnaire designed for HIV related behaviors for female adolescents (HBQFA) at baseline and after six months follow up. A theory-based educational program was implemented for the experimental group. Results: The mean age of participants was 14.1 years (SD=0.96). In the experimental group, significant improvements were shown in adolescents' HIV knowledge (31.9%, 95% CI: 28.8- 35.0), attitudes towards HIV (16.6%, 95% CI=14.4-18.8), subjective norm (16.8%, 95% CI=12.9-20.6) and perceived behavioral control (19.1%, 95% CI=16.2-22.1), perceived parental support (17%, 95% CI=13.8-20.2), behavioral intention to prevent HIV (19%, 95% CI=16.3-21.6), and HIV preventive behavior (17.3%, 95% CI=13.9-20.6) (p<0.001). Conclusion: Theory-based educational intervention on HIV/AIDS prevention can significantly protect adolescents from misconceptions, wrong attitudes and risky behaviors and unsupportive social environment that expose them to greater HIV risk. Health policy -makers are advised to consider effective training programs related to HIV/AIDS prevention behaviors in the school system. [ABSTRACT FROM AUTHOR]

Background: The initiation age and prevalence of cigarette smoking are two important parameters in any smoking-related policymaking domain. Methods: Dataset was extracted from STEPs survey, a population-based study conducted in Iran in 2016. A total of 27612 participants were included in the current study. We used a spatial parametric survival mixture rate cure model with doubly censoring to simultaneously assess the initiation age and prevalence of smoking. Results: The entire study population, men and women had the estimated median initiation age of 23.3 (95% CI: 22.2-24.5), 21.9 (95% CI: 21.3-22.5), and 25.5 (95% CI: 22.8-28.7) years, and the prevalence of 10.11% (95% CI: 9.3%-11.0%), 22.3% (95% CI: 21.0%-23.6%), 0.78% (95% CI: 0.62%-0.97%), respectively. The hazard of smoking initiation in men was 66% which was higher than in women (hazard ratio [HR] = 1.66, 95% CI: 1.15-2.48). The odds of smoking in men was 36.5 times greater than that of women (odds ratio [OR] = 36.5, 95% CI: 29.66-45.52). Odds of smoking decreased by 32% in the entire study population and 14% with one level increase in their education (OR = 0.68, 95% CI: 0.65-0.72) and socioeconomic status (OR = 0.86, 95% CI: 0.82-0.94), respectively. The geographical distribution of smoking initiation age varied from 21.5 to 26.37 years for the entire study population, 20.2 to 24.8 years for men, and 23.53 to 28.91 years for women. The geographical distribution of smoking prevalence varied from 5.46% to 14.98% for the entire study population, 12.82% to 30.98% for men, and 0.4% to 1.2% for women. Conclusion: The geographical distribution of smoking initiation age and prevalence showed that in different parts of the country, the initiation age and rate of smoking are different which should be considered in any preventative policy making. [ABSTRACT FROM AUTHOR]

Backgrounds: To assess the role of socio-economic inequality in visual impairment (VI) in Varamin district, Iran. Patients and Methods: Using multistage cluster sampling method, 60 clusters (each with 50 subjects) were recruited and underwent clinical eye examinations. Socio-economic status (SES) was identified based on education, occupation, family assets and housing conditions that were measured at the participants' households using a semi-structured questionnaire and a two-step cluster analysis model. In addition, principal component analysis and the concentration index were used to identify the gap between high and low SES groups. Results: Participants were categorized in high (522, 24.4%), moderate (974, 43.1%) and low (763, 33.7%) socio-economic levels. In these levels, the prevalence of VI was 5.9% (95% CI: 3.3 to 8.6), 10.4% (95% CI: 8.4-12.4), and 12.6% (95% CI: 10.1 to 15.1), respectively. The prevalence of VI in people with low SES was significantly greater than those in high SES level. The proportions of avoidable causes were relatively high in all SES levels (more than 80%) with no significant difference between different levels. Conclusions: There is significant inequality in VI prevalence in Varamin district. Avoidable causes are high in all SES groups. Therefore, community-based modalities and preventive programs with a specific notice to poorer SES groups are recommended to improve eye health in this district. [ABSTRACT FROM AUTHOR]

Background: Metabolic-associated fatty liver disease (MAFLD) is a common cause of liver-related mortality and morbidity worldwide. However, there is a paucity of literature on the relationship between cardiovascular disease (CVD) risk factors and quality of life (QoL) in patients with MAFLD. Objectives: This study aimed to examine the association between QoL and CVD risk factors in an Iranian MAFLD population. Methods: This study was conducted on MAFLD patients, referred to the gastroenterology clinic of a general hospital from September 2017 until September 2018. The QoL and Framingham Risk Score (FRS) were determined using the WHOQOL-BREF questionnaire and an online web calculator, respectively. A hierarchical multiple linear regression model was developed to evaluate the association between QoL and FRS after adjusting for the sociodemographic characteristics. Results: This study was performed on 200 participants. All domains of QoL were associated with older age, hypertension, smoking, diabetes mellitus, higher systolic blood pressure, and lower high-density lipoprotein levels in the univariate regression analysis (P < 0.05 for all). Meanwhile, FRS was adversely correlated with the total QoL score (correlation coefficient: -0.49; 95% CI: -0.61, -0.35; P < 0.001). After adjusting for the sociodemographic variables, the results of the hierarchical multiple linear regression model showed that age, smoking, diabetes mellitus, hypertension, and FRS were correlated with the overall QoL score (P < 0.05 for all). Hypertension was the main predictor of the total QoL score (B = -5.51, 95% CI: -7.18, -3.68; P < 0.05). A higher FRS was inversely associated with the physical domain of QoL (B = -0.05, 95% CI: -0.09, -0.01; P < 0.05), the environment domain of QoL (B = -0.04, 95% CI: -0.09, -0.01; P < 0.05), and the total score of QoL (B = -0.04, 95% CI: -0.08, -0.02; P < 0.05). Conclusions: According to the results of this study, a higher risk of developing CVD may reduce QoL in patients with MAFLD. Hypertension, diabetes mellitus, and smoking were the key predictive determinants of QoL in this population. Further studies are suggested to determine if modification of the mentioned risk factors can improve QoL in MAFLD patients. [ABSTRACT FROM AUTHOR]