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Background: Correctly estimating the prevalence of sexually transmitted infections (STIs) is crucial formonitoring andmanaging these diseases effectively. Objectives: This study aimed to estimate the prevalence of STI syndromes and evaluate the surveillance systems for STIs in Marvdasht. Methods:We conducteda cross-sectional study in2018 involvingapopulation-basedrandomsampleof 3 879participants aged18-50 in Marvdasht city. Genital ulcers and secretions in both genders were used as the primary outcomes to assess the completeness of the system and calculate the correction factor. A mathematical model was developed to estimate the correction factor for the prevalence of selected syndromes in each gender. The correction factor was determined by dividing the cases estimated through themathematicalmodel by the cases reported by the surveillance systems. Results: The estimated prevalence (with 95% confidence intervals [CI]) of urethral discharge in men and women, based on the model, was 25.32% (23.08 - 27.56) and 47.03% (39.93 - 54.13), respectively, and for genital ulcers, it was 5.16% (4.06 - 6.86) formen and 15.50% (9.5 - 21.5) for women. In both genders and for both syndromes, the reported prevalence by the care system(men: Discharge 0.09% [0.07 - 0.11], ulcer 0.04% [0.03 - 0.06];women: Discharge 0.12% [0.1 - 0.15], ulcer 0.19% [0.16 - 0.22])was severely underestimated. Thehighest andlowestunderreporting correctionratios inthenational STImonitoring systemwere observedforurethraldischarge inmen (124.5) and genital ulcers in women (7.26), respectively. Conclusions: The study revealed that the reported prevalence of STI syndromes in Iran is significantly underestimated compared to the actual prevalence in the population. Fundamental revisions are necessary to enhance the system's validity and completeness in detecting and reporting STIs. [ABSTRACT FROM AUTHOR]

Although the fundamental reasons for cognitive function disorders have been well documented, little is known about the impact of environmental exposures, such as pesticides, on children's cognitive function development. This study investigated the effect of exposure to organophosphate pesticides on children's cognitive function. In order to determine various factors of exposure, hair samples were collected from 114 elementary school children who lived in Boyer–Ahmad County in the province of Kohgiluyeh and Boyer–Ahmad, Iran. A detailed questionnaire was utilized to gather demographic information and exposure profile. Pesticides were detected in hair samples using a gas chromatography–mass spectrometer (GC–MS); also, cognitive function was assessed using the trail–making test (TMT), which was divided into two parts: TMT–part A and TMT–part B. Participants in the study were 10.12 ± 1.440 years old on average. Children in rural areas had higher mean total pesticide concentrations (13.612 ± 22.01 ng/g) than those who lived in the urban areas (1.801 ± 1.32). The results revealed that boys (46.44 s and 92.37 s) completed the TMT–part A and part B tests in less time than girls (54.95 s and 109.82 s), respectively, and showed better performance (2.14) on the cognitive function exam than girls (2.07). Diazinon and TMT–part B were positively correlated (p < 0.05). With the increase in pesticides, there was no discernible difference in cognitive function. Pesticide use throughout a child's development may affect certain cognitive function indicators. In order to assess causal relationships, group studies and case studies are required because the current research was cross–sectional in nature. [ABSTRACT FROM AUTHOR]

Introduction: The expansion of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic has been considered a serious issue globally, and the disease is currently a major contributing factor to morbidity and mortality rates in many developing countries. This study aimed to investigate survival rate of HIV-positive patients, and its' contributing factors among individuals receiving antiretroviral therapy in Southern Iran. Material and methods: A prospective cohort study was conducted among 1,327 HIV patients, who started antiretroviral therapy (ART) between June 2000 and March 2021. Kaplan-Meier analysis and Cox proportional hazard regression analyses were applied to define the survival rate of patients. Results: In this study, of 1,327 registered HIV/AIDS patients who were under ART, 30.6% died during the study period. The 1-, 2-, 5-, and 10-year survival rates of the patients were 90%, 87%, 78%, and 67%, respectively. Based on the results of multivariate Cox regression analysis, older age (HR≥40/<40 = 1.48), occupation (HRunemployment/employment = 1.29), history of addiction (ORyes/no = 1.64), route of transmission (HRIDU/sexual = 0.48), baseline CD4+ < 200 (HR< 200/> 500 = 2.91), clinical stage IV (HRIV/I = 1.70), ART adherence (HRadherence/non-adherence = 0.37), time on ART > 5 (HR> 5/< 1 = 0.06), and anemia (HR yes/no = 1.58) were directly associated with the survival in patients. Conclusions: Mortality in adults HIV-positive patients on antiretroviral therapy is relatively high in Iran. Age, history addiction, WHO clinical stage, low CD4+ count, and anemia are associated with poor survival in HIV patients. Concerned stakeholders should focus on early detection, timely ART onset, and adherence to treatment. [ABSTRACT FROM AUTHOR]

Introduction: Although combination of antiretroviral therapy (cART) has been successful in improving health outcomes of people living with HIV (PLWH), optimal treatment adherence is required to maintain the benefits. This study aimed to determine factors associated with treatment non-adherence among PLWH in Iran. Material and methods: In this cohort study, we included 988 PLWH (1997-2017) living in Southern Iran, Fars Province. Required demographic and clinical data was collected from patients' files. Non-adherence was defined by a physician of the center as skipping a visit or less than 90% intake of prescribed medicines (antiretroviral drugs) in the month preceding to the date of data collection. Results: Of the 988 participants, 70.54% were males. Mean (SD) age of the participants was 35.80 (SD = 8.58) years and treatment non-adherence was found in 17.81% of patients (n = 176). Multiple regression model showed that injection drug use (IDU) (AOR = 2.53, 95% CI: 1.11-5.74%), and history of incarceration (AOR = 4.20, 95% CI: 1.65-10.66%) increased the likelihood of treatment non-adherence, while taking medications for pneumocystis pneumonia (AOR = 0.34, 95% CI: 0.22-0.52%), duration of being under ART (AOR = 0.13, 95% CI: 0.08-0.21%) for 1-5 years, and (AOR = 0.06, 95% CI: 0.02-0.16%) for more than 5 years, decreased the likelihood of treatment non-adherence. Conclusions: These findings show that one in five PLWH did not adhere to cART. On the other hand, the likelihood of non-adherence was directly associated with IDU and incarceration history. Based on the results, tailored programs should be developed to improve adherence among individuals with a history of IDU or incarceration. [ABSTRACT FROM AUTHOR]

Background: The increasing rate of breast cancer (BC) incidence and mortality in Iran has turned this disease into a challenge. A delay in diagnosis leads to more advanced stages of BC and a lower chance of survival, which makes this cancer even more fatal. Objectives: The present study was aimed at identifying the predicting factors for delayed BC diagnosis in women in Iran. Methods: In this study, four machine learning methods, including extreme gradient boosting (XGBoost), random forest (RF), neural networks (NNs), and logistic regression (LR), were applied to analyze the data of 630 women with confirmed BC. Also, different statistical methods, including chi-square, p-value, sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC), were utilized in different steps of the survey. Results: Thirty percent of patients had a delayed BC diagnosis. Of all the patients with delayed diagnoses, 88.5% were married, 72.1% had an urban residency, and 84.8% had health insurance. The top three important factors in the RF model were urban residency (12.04), breast disease history (11.58), and other comorbidities (10.72). In the XGBoost, urban residency (17.54), having other comorbidities (17.14), and age at first childbirth (>30) (13.13) were the top factors; in the LR model, having other comorbidities (49.41), older age at first childbirth (82.57), and being nulliparous (44.19) were the top factors. Finally, in the NN, it was found that being married (50.05), having a marriage age above 30 (18.03), and having other breast disease history (15.83) were the main predicting factors for a delayed BC diagnosis. [ABSTRACT FROM AUTHOR]

Child abuse is a problem that needs to be addressed worldwide. This is a cross‐sectional study to estimate the prevalence of child abuse among children aged 3 to 6 years and its associated factors in southern Iran. In total, 5142 participants were selected using multi‐stage random sampling. The estimated prevalence rates of neglect and physical and verbal/emotional abuse among children were 26.4% (95% confidence interval [CI] 25.2–27.6), 59.4% (95% CI 58.1–60.6), and 63.9% (95% CI 62.6–65.1), respectively. The results of logistic regression models showed that the child's sex was associated with physical abuse (odds ratio [OR]boy/girl 1.25; 95% CI1.11–1.41) and verbal abuse (ORboy/girl 1.17; 95% CI 1.04–1.32). However, parents living together was inversely associated with physical abuse (OR 0.45; 95% CI 0.25–0.80), verbal abuse (ORboy/girl 0.46; 95% CI 0.25–0.84), and neglect (ORboy/girl 0.53; 95% CI 0.31–0.88). Mother's education (ORuniversity degree/illiterate 0.58; 95% CI 0.35–0.98) was also inversely associated with physical abuse. The prevalence of child abuse in southern Iran is significantly higher than in several other countries in the region and other parts of the world. Social and family factors, including mother's education and parents living together, are important in reducing child abuse and its related mental and physical disorders during childhood. It is essential to train parents of young children about abuse and its negative effects on the health and social performance of children. [ABSTRACT FROM AUTHOR]

Late diagnosis (LD) of HIV infection can give rise to suboptimal responses to antiretroviral treatment. The current study aimed to determine the prevalence and associated factors of HIV LD in Shiraz, Southern Iran. This retrospective cohort study was conducted from August 1997 to May 2018. Medical records were examined to extract required data. Individuals with time period less than three months from HIV diagnosis to an advanced phase of AIDS on CD4 < 350 were considered as LD. Multivariable logistic regression used to investigate the associated factors of late HIV diagnosis and adjusted odds ratios were reported. Of 1385 individuals, 1043 (75.3%) were considered as LD. The following factors were identified as the associated factors of LD: age at diagnosis (OR = 1.72, 95% CI: 1.22, 2.41), HCV co-infection (OR = 1.65, 95% CI: 1.23, 2.21), not living in Shiraz (OR = 1.36, 95% CI: 1.02, 1.82), increased likelihood of LD and being housewife (OR = 0.67, 95% CI: 0.47, 0.95) which decreased the likelihood of LD. Our results showed delayed diagnosis of a large proportion of individuals with HIV. It is critical to improve the HIV testing guidelines in Iran to identify individuals with HIV without delays in order to provide them with timely HIV medical care and treatment. [ABSTRACT FROM AUTHOR]

Intellectually disabled individuals are more prone to parasitic infections due to their unusual behaviors, immune and nutrient deficiencies, and living conditions. The current study is aimed at evaluating the prevalence of intestinal parasites in institutionalized intellectually disabled individuals in Bandar Abbas County in the south of Iran. Subjects of the study were 119 individuals, living in an intellectually disabled individual care center. Demographic features of the subjects including age, sex, intellectual disability type, and duration of their stay in the center were recorded. A stool sample was taken from each subject and evaluated by direct wet mount and formalin-ethyl-acetate concentration methods. Samples were also examined, using trichrome and modified acid-fast permanent staining. The mean age of the subjects was 27.6 (±2.24), ranging from 4 to 60 years old. Of the 119 participants, 55 (46.2%) were male, and 64 cases (53.8%) were female. Overall, 31 individuals (26.1%, 95% CI: 18.4-34.9) were found to be infected with at least one type of intestinal parasite. Blastocystis hominis, as the most common detected parasite, was detected in 13 (10.1%), Entamoeba coli in 12 (10.1%), Giardia lamblia in 5 (4.2%), Cryptosporidium in 2 (1.7%), Iodamoeba butchlii in 2 (1.7%), and Endolimax nana in 1 (0.8%) of participants. Three cases had coinfection with Blastocystis hominis and Entamoeba coli, one case was infected with Blastocystis hominis and Giardia lamblia, and one case was coinfected with Giardia lamblia and Entamoeba coli. There were no statistically significant associations between intestinal parasitic infection and gender, age, type of intellectual disability, or duration of stay in the care center (P > 0.05). The findings of the present study indicate a relatively high prevalence of parasitic infections in people with intellectual disabilities in Bandar Abbas, southern Iran. Noteworthy is the high prevalence of Blastocyst and also the presence of Cryptosporidium infection in these people. Periodic treatment of these people and improvement of their maintenance conditions can be considered for the prevention and control of intestinal parasitic infection in these people. [ABSTRACT FROM AUTHOR]

Despite the recommendation for early diagnosis and rapid initiation of HIV treatment, more than half of patients are in an advanced stage of HIV disease in Iran. This study aimed to investigate the factors related to baseline CD4 cell count and advanced HIV disease (AHD) in Southern Iran. The study comprised all adults between 15 and 87 years of age who were newly diagnosed with HIV in Southern Iran. Linear and logistic regressions were used to identify baseline CD4 cell count predictors and AHD, respectively. A total of 820 (53.9%) HIV-infected individuals over 15 years of age were at the AHD stage. Based on the results of the multiple logistic regression, older age at diagnosis (OR≥40/<30 = 2.68, 95% CI = 1.38–5.19), gender (ORfemale/male = 0.62, 95% CI = 0.44–0.85), HIV/TB coinfection (ORyes/no = 1.98, 95% CI = 1.29–3.02), HIV/HBV coinfection (ORyes/no = 1.58, 95% CI = 1.07–2.38), and hemoglobin (OR = 0.89, 95% CI = 0.85–0.92) were directly associated with AHD in HIV/AIDS patients. As suggested by a linear regression model, factors including gender (B Female = 44.12, 95% CI:17.86, 70.38), older age (B ≥40 = −111.99, 95% CI:−174.70, −49.27), higher education level (B = 35.65, 95% CI:5.34, 65.97), WHO clinical stage (BIV = −254.53, 95% CI−298.82, −210.24), and hemoglobin (B = 5.23, 95% CI:0.25, 10.20) were significantly associated with CD4 count.The prevalence of AHD in patients was high in Iran. Our results suggested that several demographic and clinical factors are significantly associated with the baseline CD4 cell count and AHD. Targeted HIV testing, implementation of screening programs for early detection, and access to care services to assure early ART are recommended to improve the clinical status and quality of life of the patients. [ABSTRACT FROM AUTHOR]

Purpose: Hypertension is a major cause of morbidity and mortality in the world. This study aimed to evaluate an intervention based on the Health Belief Model regarding the whole family's salt consumption and blood pressure among hypertensive patients in rural areas in Iran.Methods: This clinical multicenter trial (clinical and community) with a control and an intervention group was conducted on the residents of 14 villages covered by 14 health houses. Totally, 200 hypertensive patients (n = 100 in each group) were selected via multistage random sampling. The intervention included a two-day workshop on blood pressure and reducing salt consumption based on HBM structures for health personnel and an eight-session workshop on how to reduce salt intake and blood pressure for mothers who were responsible for the families' diets. Participants completed the questionnaires before and immediately after the intervention.Results: Compared to the control group, in the intervention group, a significant reduction was observed in salt consumption by the families (urine sodium and creatinine reduced by 35 mEq/l and 7.5 mg/dL, respectively). The results also revealed a significant decrease in blood pressure in the intervention group.Conclusion: The results showed that the mothers' model-based education could effectively improve the diet of the whole family members and, as a result, reduce the associated diseases. The main advantage of this study was the involvement of the rural health personnel, which helped run longer and larger-scale health-promotion programs in the communities. [ABSTRACT FROM AUTHOR]

Background: Among different common types of cancer, gastric cancer (GC) is a worldwide health priority in both developing and developed countries. The aim of this study was to map the distribution of incident cases of GC in Iran to provide a geographical presentation of the incidence of the disease.Methods: This study used the Iranian National Cancer Registry (INCR) data from 2004 to 2014. We calculated the crude and age-standardized incidence rates of GC for each province and also defined the frequency distribution of different types and locations of GC by the provinces.Results: According to the results of the present study, the patients were predominantly male 49,907 (70.0%) and the most prevalent type of tumour was A1 (almost 96.4%) and C3‌ (2.0%). Also, a significant difference was observed between males and females in the distribution of the types of tumour (P < 0.001). In addition, a comparison of the distribution of the types of GC in Iran suggested that a significant difference exists between the provinces (P < 0.001). A significant difference was observed when the distribution of the location of GC tumors was compared between males and females and provinces (P < 0.001). Accordingly, pylori and cardia are the most common location of GC cancer among the study population (28.1% and 31.3% respectively).Conclusions: The results of the current study suggested a higher rate of GC incidence in Iran when compared to the global figure in both females and males. Our study also revealed significant disparities between provinces with regard to the distribution of types, and location of GC. This may suggest involving different factors in GC in different parts of Iran. Further studies are needed to better understand the epidemiology and etiology of the disease in Iran. [ABSTRACT FROM AUTHOR]

Introduction. Today, improving lifestyles and promoting health are basic needs for human society. The main goal in promoting health is to achieve healthy lifestyle behaviors, and self-efficacy is one of the factors influencing people's lifestyle. Therefore, the impact of educational intervention based on self-efficacy theory on improving lifestyles of the female teachers in Galledar was investigated. Method. This study was a semiexperimental study with educational intervention with a control group that was performed on 120 teachers in Galledar. Data collection tools included demographic information questionnaires, health-promoting lifestyle questionnaires, and Sherry's self-efficacy questionnaire. Data were analyzed using SPSS 25 software. Result. The mean age and standard deviation of teachers in the control and intervention groups were 33.40 ± 5.68 and 32.83 ± 6.46 years, respectively. Health-promoting lifestyle variables are significant correlation with self-efficacy and overall lifestyle index. Six dimensions which consisted of spiritual growth and self-actualization, health responsibility, interpersonal relationships, stress management, exercise and physical activity, and nutrition showed significant statistical differences before and after educational intervention (P = 0.001). Conclusion. Due to the sensitive role of teachers as an effective human force in the development and evolution of society and their students' role modeling, the authorities should formulate policies, regulate educational interventions, and design strategies for promoting self-efficacy beliefs and promoting a healthy lifestyle for all teachers. We suggest that other methods and theories of behavior change be used in future studies to promote a healthy lifestyle. [ABSTRACT FROM AUTHOR]

Background: As an ethical principle, showing respect for human dignity is a professional duty of all nurses. The aggressive nature of severe burn injuries makes it hard to respect the existential values and dignity of burn patients. However, only a few studies have been conducted on the preservation of the dignity of burn patients. The purpose of this study is to identify and describe burn patients' dignity as perceived by nurses, family caregivers, and burn patients. Methods: The present study has a descriptive, qualitative research design. Nurses, family caregivers and patients in the biggest burns hospital in the south of Iran were selected via purposeful sampling from October 2017 to August 2018 (n = 25). Data were collected using semi-structured, in-depth, individual interviews. Thereafter, data analysis was performed through conventional content analysis. Results: Three main themes were extracted from the information obtained in the interviews: empathic communication, showing respect, and providing comprehensive support. Conclusion: The care provided to burn patients should be combined with effective communication, spending time with them, and attending to their repetitive requests, so that they can freely express their feelings and concerns. In addition, the patients' human values and beliefs should be respected and all aspects of their existence should be taken into account to preserve their dignity. Workshops designed based on the findings of the present study can help with improving the quality of burn nursing care. [ABSTRACT FROM AUTHOR]

Background: Compassionate care is emphasized within professional ethics codes for nursing and is a key indicator of care quality. The purpose of the present study is to develop and assess the psychometric properties of a compassionate care instrument for nurses. Methods: This methodological study was carried out in two phases -qualitative and quantitative-from February 2016 to October 2018. In the qualitative stage of the study, a content analysis approach was used to establish the concept of compassionate care through interviews with nurses, patients, and family caregivers. The initial draft of the questionnaire was developed based on the qualitative findings and a subsequent review of the literature. In the second phase, the psychometric properties of the questionnaire were assessed for validity and reliability. Data analysis was performed using descriptive and inferential statistics in SPSS v.16. Results: From the results of the qualitative phase and review of literature, 80 items were extracted. In the quantitative phase, after evaluation of the face and content validity, 40 items were kept. After measurement of the construct validity, 28 items whose factor loading was above 0.4 were retained. Measurement of convergent validity showed a moderate correlation between the questionnaire and the nurses' caring behaviors scale (r = 0.67, P = 0.01). The reliability of the 28-item questionnaire was tested by measuring its Cronbach's alpha coefficient and intra-class correlation coefficient which were found to be 0.91 and 0.94 for the whole questionnaire, respectively. Conclusion: The questionnaire has enough validity and reliability to be used for measuring the nurses' compassionate care. Therefore, the instrument can be used to measure and record the quality of nursing care. [ABSTRACT FROM AUTHOR]

Considering the rising incidence and mortality of thyroid cancer (TC) worldwide, the aim of our study was to determine the risk factors for TC in a province with the highest incidence of TC in the country located at the South of Iran. A population‐based case‐control study was performed on 708 participants (361 new cases and 347 controls). The case participants were selected from the Iranian National Cancer Registry database. Frequency matched for gender and age, and the control participants were selected randomly from the neighborhood of the cases. Based on the results of multiple logistic regression analysis, benign thyroid diseases (eg, hyperthyroidism ORyes/no = 14.06, 95% CI: 5.13‐38.51), family history of TC (ORyes/no = 3.54, 95% CI: 1.51‐8.26), radiation exposure of the head (ORyes/no = 1.92, 95% CI: 1.03‐3.60), family history of thyroid diseases (ORyes/no = 1.76, 95% CI: 1.19‐2.62) and family history of other types of cancer (ORyes/no = 1.67, 95% CI: 1.01‐2.74), significantly increased the risk of developing TC. On the other hand, high blood pressure (ORyes/no = 0.35, 95% CI: 0.19‐0.64), higher education (ORcollege/illiterate = 0.54, 95% CI: 0.30‐0.96), consumption of unsaturated fat (ORunsaturated/saturated = 0.59, 95% CI: 0.39‐0.87) and being married (ORmarried/single = 0.60, 95% CI 0.37‐0.98) were found to be protective factors. Some community‐based interventions, for example, reduction in radiation exposure and screening members of families with underlying thyroid diseases may help in preventing or early diagnosis of TC. More studies on the health effects of local herbs are highly recommended. What's new? Incidence and mortality of thyroid cancer is increasing worldwide, for reasons that are not fully known. Here, to better understand thyroid cancer risk in the general population, the authors examined possible risk factors in Kohgiluyeh and Boyer‐Ahmad, a province in Southern Iran with very high thyroid cancer incidence. Analyses identified individual and family history of thyroid disease, family history of thyroid cancer and other cancers, and radiation exposure to the head to be important risk factors for thyroid cancer. The findings suggest that routine screening of individuals with these risk factors could facilitate prevention and early detection of thyroid cancer. [ABSTRACT FROM AUTHOR]

Background: Growth retardation is a common health problem, which requires early prevention and detection. This study was conducted to define the approximate age at which stunting starts among the Iranian boys and girls. Method: The second phase of a population-based retrospective cohort nested case-control study on 400 children who were followed from birth to 7 years of age. This study was performed to define the pattern of growth among stunted and normal children and to reveal the age at which stunting starts in each gender. Results: Of the selected participants, 53% were girls. Also, about 18% of the children registered by the selected health centers were defined as stunted (under the 3rd percentile of the corresponding sex-age NCHS/WHO growth reference). For boys, the height was relatively similar between the two groups until the age of 6 months at which the difference in height between normal and stunted children starts to become significantly large (difference = 0.70 cm, P = 0.04). For girls, height in the two groups is relatively similar until the age of 9 months at which the difference starts to become significantly large (difference = 0.97 cm, P = 0.01). No significant difference in the weight of the girls was observed between the normal and stunted groups during the study period (difference = 283.21 g, P > 0.05). However, boys from the stunted group were lighter since almost the same time that they started to become significantly shorter (difference = 1265.19 g, P = 0.001). Conclusions: Soon after birth (at about the 6 months of age), the growth pattern of some (stunted) children starts to stumble and divert from normal. The sixth month of age is the age at which mothers start weaning with withdrawing breast milk and start supplementary foods and adult diet. A specially designed study is needed to understand the actual reason for observing such a phenomenon among Iranian children. [ABSTRACT FROM AUTHOR]

Introduction: All over the world, healthcare team members are recommended to respect patients' human dignity. However, the dignity of hospitalized patients is not preserved in many cases. Due to the abstract, complex, and cultural nature of the concept of human dignity, further studies are required to precisely determine the different aspects of this concept. Purpose: The aim of the present study was to explore the experiences and perceptions of physicians, nurses, family caregivers, and hospitalized patients with regard to patient dignity in Iranian clinical setting. Materials and Methods: This is a qualitative, exploratory study in which physicians, nurses, family caregivers, and patients were recruited from 2 educational hospitals located in an urban area in Iran from April 2016 to February 2017 using the purposive sampling method (n = 24). Data were collected through individual interviews and subsequently analyzed using conventional content analysis in the software MAXQDA 2007, VERBIO'. Results: Three major themes emerged from analyses of the data obtained from the interviews: a peaceful environment, respect, and comprehensive support. Conclusion: From the participants' point of view, in order for their dignity to be preserved, patients need to be hospitalized in a peaceful environment in which they are treated with empathy, they receive comprehensive support, and the care settings are managed properly. Furthermore, it is important to respect patient's values and beliefs, to provide unbiased care and treatment, and to maintain patient's autonomy in order to maintain hospitalized patients' dignity. [ABSTRACT FROM AUTHOR]

Background: Human Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. Up to now, little is known about mortality and its determinants among people living with HIV in the Middle East and North Africa (MENA) region, including Iran. The purpose of this study was to assess the risk factors of AIDS-Related Mortality (ARM) and Non-AIDS-Related Mortality (NARM) among people with HIV in Iran.Methods: This 20-year retrospective study was conducted on 1160 people with HIV whose data were collected from 1997 to 2017. The association of the study outcomes (ARM and NARM) with various study variables, including demographic status at the time of diagnosis and clinical indexes during the follow-up were examined to define the predictors of mortality among the patients. Regarding, Cox proportional hazard and competing risk models were fitted and Adjusted Hazard Ratios (AHR), Sub-distribution Hazard Ratio (SHR) and the 95% Confidence Intervals (CI) were reported.Results: during the follow-up period, 391 individuals (33.7%) died with 86,375 person-years of follow-up. Of the total deaths, 251 (64.2%) and 140 (35.8%) were ARM and NARM, respectively. Rates of the mortality caused by AIDS and non-AIDS were 3.2 and 4.5 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis, reduced the hazard of ARM and NARM. However, older age, late HIV diagnosis, and last HIV clinical stages increased the hazard of AIDS related to mortality. Additionally, male gender, older age, incarceration history, and last HIV clinical stages increased the non-AIDS mortality.Conclusions: Mortality caused by AIDS and non-AIDS remains high among people with HIV in Iran, particularly among males and those with late diagnosis. It seems that applying effective strategies to identify infected individuals at earlier stage of the infection, and targeting individuals with higher risk of mortality can decrease the mortality rate among HIV infected people. [ABSTRACT FROM AUTHOR]

Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of the breast are the most common histological subtypes of breast cancer. However, the associations and heterogeneity between histological subtypes and their risk factors are not well established. This study aimed to investigate risk factors for IDC and ILC. This case–control study included 1,009 incident breast cancer cases and 1,009 hospital controls, frequency‐matched by age. Data were obtained from the patients' medical files and an interview administered via a questionnaire. Multinomial logistic regression was used and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The heterogeneity of the associations was assessed using the Wald test. Family history of breast cancer was associated with IDC (OR 2.64, 95% CI: 1.97–3.55) but not ILC (OR 0.81, 95% CI: 0.42–1.57; p for heterogeneity <0.001). Conversely, a history of miscarriage was associated with ILC (OR 1.71, 95% CI: 1.17–2.51) but not IDC (OR 1.18, 95% CI: 0.95–1.46; p for heterogeneity = 0.04). Similarly, type 2 diabetes was associated with ILC but not IDC (p for heterogeneity = 0.02). Age at first delivery and breastfeeding were significantly associated with IDC but not ILC, though p values for heterogeneity did not reach the significance level. Deliberate weight loss and age at menarche were significantly associated with ILC but not IDC (p for heterogeneity ≥0.27). Smoking, history of benign breast disease and BMI were associated with both subtypes. The present study supports the hypothesis that IDC and ILC are etiologically distinct tumours. What's new? Different subtypes of breast cancer may have different risk factors. These authors investigated the diversity of risk factors relevant in "less‐developed" countries, where patients tend to be younger than in wealthier countries. They conducted a case‐control study comparing risk factors for invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) among 2,000 women in Iran. Many risk factors differed between the two, indicating that IDC and ILC are etiologically different diseases. Factors associated with ILC included type 2 diabetes and history of miscarriage, while IDC risk factors included family history of breast cancer and age at first childbirth. [ABSTRACT FROM AUTHOR]

Background: Compassion is the core of nursing care and the basis of ethical codes. Due to the complex and abstract nature of this concept, there is a need for further investigations to explore the meaning and identify compassionate nursing care. Objectives: The purpose of this study was to identify and describe compassionate nursing care based on the experiences of nurses, patients, and family caregivers. Research design: This was a qualitative exploratory study. Data were analyzed using the conventional content analysis method. Participants and research context: Nurses, hospitalized patients, and family caregivers in different educational hospitals in an urban area of Iran were selected from February 2016 to December 2017 using a purposeful sampling method (n = 34). In-depth and semi-structured interviews, focus group interviews, and field notes were used for data collection. Ethical considerations: The study was approved by the University's Ethics Committee. The participants were informed about the aim and method of the study, reasons for recording the interviews, confidentiality of data, and voluntary nature of participation in this study. Findings: Data from interviews and filed notes were analyzed and classified into three themes: "effective interaction," "professionalism," and "continuous comprehensive care." Discussion and conclusion: Emerged themes of this study involved holistic care in the current literature on nursing with an emphasis on effective interaction and professionalism. Nurses can understand patients' and family caregivers' comprehensive needs through interaction skills. In addition, clinical proficiency, maintaining professional ethics' standards along with holism, and continuity in care are examples of compassionate care. Education program about compassionate care can enhance the quality of nursing care. [ABSTRACT FROM AUTHOR]

Objective: It is estimated that road traffic accidents are globally responsible for approximately 1.2 million deaths and 20 to 50 million injuries. About 70% of traffic incidences (TIs) occur in developing countries and among countries with high TI rates; Iran is the first. The aim of this study was to measure the association between being responsible for a traffic accident and some vehicle, human; and environmental related factors in Yasuj, a city with a high incidence of road traffic injuries and deaths in Iran.Methods: This is a time-, date-, and place-matched case-control study conducted in 2015 using all traffic accidents registered and investigated by police during 2012. In total, 194 drivers were considered the at-fault driver in a traffic accident and the 194 drivers in the same collisions were included in the analysis.Results: Based on the results from multivariate conditional logistic regression, significant associations between vehicle maneuver (ORTurn to right or left/Moving forward = 11.10, 95% confidence interval [CI], 1.77-69.58, P = .01) and age (odds ratio [OR] = 1.11, 95% CI, 1.004-1.22, P = .04) and the chance of being an at-fault driver were found.Conclusion: Driver behavior-related interventions including training and law enforcement seem to be more effective in reducing road traffic accidents in Iran. [ABSTRACT FROM AUTHOR]

Background: Parasitic infections are still a significant health problem in rural areas in developing countries including Iran. There is no recent population-based data about the prevalence of human intestinal parasites in most rural areas of Iran. The current study aimed to determine the prevalence of intestinal protozoan infection in inhabitants of rural areas of Boyer-Ahmad district, Southwestern Iran. Methods: A total of 1025 stool samples were collected from the inhabitant of 50 randomly selected villages in Boyer-Ahmad Township. The stool samples were evaluated by parasitological methods including, direct wet-mounting, formalin ethyl acetate concentration, zinc sulfate floatation, and Trichrome permanent stain for detection of protozoan infections. Diarrheic samples were further evaluated with a modified Ziehl-Neelsen staining method for detection of coccidian parasites. Results: The prevalence of both pathogenic and nonpathogenic intestinal parasites in the population was 37.5% (385 out of 1025 cases), some individual with multiple infections. Giardia lamblia was detected in 179 (17.46%), Blastocystis hominis in 182 (17.76%), Entamoeba histolytica/dispar in 9 (0.87%), Endolimax nana in 216 (21.07%), Entamoeba coli in 151 (14.73%), Ioedamoeba butschlii in 45 (4.39%), Chillomastix mesnili in 22 (2.14%), Trichomonas hominis in 2 (0.19%) and Dientamoeba fragillis in 2 (0.19%) of cases. Multivariate logistic regression revealed significant associations between protozoan infection (pathogenic protozoa) and contact with animals (OR yes/no = 2.22, p < 0.001) and educational status (OR higher/illiterate = 0.40, P = 0.01). Conclusion: Findings of this study demonstrated that protozoan infection rate in rural areas of southwestern Iran is still high and remained as a challenging health problem in these areas. [ABSTRACT FROM AUTHOR]

Background: The survival in Iranian HIV/AIDS patients based on data from Iran National HIV/AIDS Case Registry System has not been evaluated. This study assessed the survival rates and associated factors among people living with HIV/AIDS in Iran. Materials and Methods: The population in this observational study included 32168 patients diagnosed with HIV/AIDS registered in Iran disease registry system between 1986 and 31 December 2015. Data until June 2016 (the cutoff date of our last data linkage) were investigated to estimate survival and related factors following HIV diagnosis. Results: Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively. Cumulative proportion surviving was significantly lower in males than in females (P = 0.0001). A higher rate of survival was seen in female patients, who diagnosed after 2010, infected in sexual route, and had CD4 cell count more than 500, nonconfected patients with tuberculosis (TB), and those who received antiretroviral therapy (ART). Based on multivariate model, the mortality risk in female patients, those with CD4 cell count more than 500, patients who received ART, and those with TB and injection drug uses (IDUs) was higher. Conclusion: The survival in studied patients increased in recent time periods, and ART reduced AIDS-related mortality in these patients. The survival can be increased by focus on improvements in patient care among male patients, IDUs, and patients with TB coinfection. [ABSTRACT FROM AUTHOR]

Background: The problem of substance use disorder in Iran is of great national concern. The aim of this study was to measure the association between substance use disorder and demographic, social and behavioral factors in Yasuj city, located at southwest of Iran.Methods: As the second phase of a previously published study, this case-control study was conducted in 2015-2016 on 362 addicted participants and 207 controls (with no history of substance use disorder). The control group was selected from male hospital visitors in Yasuj city during the same period of selection of the case group. The required information was collected via a self-administered questionnaire.Results: Based on the results of multivariate analysis, significant associations were found between the number of sisters (OR = 0.82, 95%CI = 0.68 to 0.99, P = 0.04), history of smoking (ORyes/no = 19.89, 95%CI = 10.02 to 39.49, P < 0.001), leisure time activity (ORwith friends/home = 8.98, 95%CI = 3.99 to 20.19, P < 0.001) and substance use disorder.Conclusion: This study introduced smoking, number of sisters, education and way of spending leisure time as predictors of substance use disorder. Among these factors, smoking was the most powerful risk factor and spending leisure time with family and having sister were the most powerful preventive factors for substance use disorder. [ABSTRACT FROM AUTHOR]

Background: Substance dependence is considered as an important health disorder with a wide and serious range of psychosocial effects. With regard to the large number of people with substance dependency in Iran and high failure rate of quitting attempts, the aim of this study was to identify contributing factors to quitting substance dependency among patients in Yasuj the capital of Kohgilooyeh and Boyerahmad province.Methods: This case-control study was conducted on 150 current substance users (as control group) and 187 patients who voluntarily introduced themselves to governmental and private residential treatment camps (as case group). The participants in the case group were selected via two stage cluster sampling among those admitted to residential treatment camps. Those in the control group were selected via snowball sampling among current substance users.Results: Based on the results from multiple logistic regression analysis, significant associations were observed between attempting to withdraw substance use and father's education (OR high school or university /illiterate = 0.36, 95%CI: 0.18 to 0.72, P = 0.004) and smoking (OR yes/no = 4.26, 95%CI = 1.90 to 9.57, P < 0.001) were identified.Conclusions: This study introduced father's education as an obstacle to attempting to quit substance dependency. This finding can be justified by easier access to money and therefore less financial pressure in providing drugs among those with wealthier families. Also, smoking was more common among those who registered with the camps. This is possibly due to the quitters attempt to replace the drugs with cigar smoking as an alternative. Training families in helping their members in preventing or quitting substance dependency is a potentially useful approach. Studies are needed to define whether the common belief that smoking helps in withdrawing substance use is helpful. [ABSTRACT FROM AUTHOR]

Background: Detection of Hepatitis C virus (HCV)-infected people in each community assists with infection prevention and control. This study aims to evaluate the prevalence of HCV infection among high risk groups in Kohgiloyeh and Boyerahmad Province, Southwest Iran. Methods: This was a cross-sectional study conducted from 2009-2010 in Kohgiloyeh and Boyerahmad Province. High risk groups for HCV were the subjects of this study. Blood samples were taken from 2009 individuals at high risk for HCV that included inmates, injecting drug users (IDUs), health care workers, patients on maintenance hemodialysis, hemophilic patients, and those with histories of blood transfusions. Patients were residents of Yasuj, Gachsaran, and Dehdasht (3 main townships in the province). Samples were analyzed by ELISA for anti-HCV antibodies. Demographic features of participants were recorded by a questionnaire during sample collection. Data were analyzed by SPSS version 13 software. Results: Of 2009 subjects, HCV antibodies were detected in 172 (8.6%). Rate of infection was higher in males (11.4%) compared to females (3.2%). Rate of infection in inmates was 11.7% while this rate was 42.4% in IDUs, 4.2% in health care workers, and 6.1% in thalassemic patients. Significant correlation was found between HCV infection, history of imprisonment, and thalassemia. Conclusion: Results of this study have provided epidemiologic features of HCV and its risk factors in Kohgiloyeh and Boyerahmad Province, Southwest Iran. This information may assist in preventing the spread of HCV infection in this and other similar settings in the region. The findings of this study may help in improving surveillance and infection control in the community through management and monitoring of infected individuals. [ABSTRACT FROM AUTHOR]

The growing fetus is very sensitive to environmental conditions. There is limited and conflicting evidence about the short-term effects of exposure to air pollutants on the pregnancy outcome. In this time-stratified case-crossover study, the effect of several air pollutants (i.e. O3, CO, NO2, SO2, and PM2.5) on the occurrence of stillbirth was evaluated in Tehran (the capital of Iran) between December 2018 and March 2023. Using a quasi-Poisson regression model and distributed lag nonlinear models (DLNM), we estimated the effect of exposure to air pollutants measured as lags (0 to 7 days) and cumulative average days (0-2, 0-6, and 0-14-day lag) before delivery on stillbirth. The association was adjusted for potential confounding factors including meteorological factors. During the study period in Tehran, 5311 stillbirths were reported. In single-pollutant models, during the entire year, SO2 (lag 1 day) and NO2 (lag 2 days) were found to have a direct and significant relationship with stillbirth. In the warm seasons, we found direct and inverse relationships between NO2 (lag 2 days) and PM2.5 (lag 4 days), respectively. In cold seasons, PM 2.5 (lag 1 day) and cumulative lag (0-2 days), SO2 (lag 1 day), and cumulative lag (0-2 and 0-6 days) were found to have direct and significant relationships with stillbirth. In two-pollutant models, SO2 & CO, and SO2 & O3, direct and significant associations were observed between SO2 exposures and stillbirth for the entire year. A similar pattern was observed for PM2.5 in combinations with NO2, and O3 and for NO2 in the two-pollutant model (O3 & NO2). However, in warm seasons, inverse associations were observed between PM2.5 and stillbirth in combinations with O3, NO2, and SO2, while NO2 showed a direct association in combinations with PM2.5, CO, and O3. In the cold seasons, direct and significant associations were observed between SO2 and stillbirth in model combinations with CO, O3, and NO2. This relationship was observed for PM2.5 in combination with CO, and NO2. Also, for CO in the two-pollutant model of CO & NO2. As a result, this study showed evidence of a relationship between short-term exposure to ambient air pollution before birth, especially SO2, NO2, PM2.5, and CO with increased risk of stillbirth., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study was approved by the Shiraz University of Medical Sciences (SUMS) Local Ethics Committee by the code: IR.SUMS.SCHEANUT.REC.1402.108., (© 2024. The Author(s).)

Chronic kidney disease (CKD) is a non-communicable disease that includes a range of different physiological disorders causing abnormal renal function and progressive decline in the glomerular filtration rate (GFR). This study aimed to investigate the associations of several Environmental factors with CKD in the Iranian population. This is the second phase of a hospital-based case-control study, which was conducted on 700 participants (350 CKD cases and 350 controls, age and gender frequency matched). Multiple logistic regression was applied to measure the associations between the selected factors and CKD. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. All p-values were two-sided and the results were considered statistically significant at p < 0.05. The results suggested that environmental factors including proximity of residence to mines (OR yes/no =3.98, 95%CI: 2.20-7.21, p < 0.001), proximity of residence to mobile antenna (OR yes/no =2.20, 95%CI: 1.24-3.89, p = 0.006), and exposure to chemicals (OR chemical/no =4.40, 95%CI: 2.27-8.53, p < 0.001), were significantly associated with a higher risk of CKD. The present study covered a large number of factors in association with CKD and highlighted the importance of some environmental factors in development of CKD.‌ One of the main causes of heat in the work environment being a risk factor is dehydration caused by high heat. In order to reduce damage to the kidneys in jobs that deal with high heat, the following tips are recommended: drinking fluids, reducing working hours and shifts, proper ventilation in the workplace, using suitable clothes and heat protection., (© 2024. The Author(s).)

Background: Exposure to air pollution is a major health problem worldwide. This study aimed to investigate the effect of the level of air pollutants and meteorological parameters with their related lag time on the transmission and severity of coronavirus disease 19 (COVID-19) using machine learning (ML) techniques in Shiraz, Iran. Study Design: An ecological study., Methods: In this ecological research, three main ML techniques, including decision trees, random forest, and extreme gradient boosting (XGBoost), have been applied to correlate meteorological parameters and air pollutants with infection transmission, hospitalization, and death due to COVID-19 from 1 October 2020 to 1 March 2022. These parameters and pollutants included particulate matter (PM2), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), nitric oxide (NO), ozone (O 3 ), carbon monoxide (CO), temperature (T), relative humidity (RH), dew point (DP), air pressure (AP), and wind speed (WS)., Results: Based on the three ML techniques, NO 2 (lag 5 day), CO (lag 4), and T (lag 25) were the most important environmental features affecting the spread of COVID-19 infection. In addition, the most important features contributing to hospitalization due to COVID-19 included RH (lag 28), T (lag 11), and O 3 (lag 10). After adjusting for the number of infections, the most important features affecting the number of deaths caused by COVID-19 were NO 2 (lag 20), O 3 (lag 22), and NO (lag 23)., Conclusion: Our findings suggested that epidemics caused by COVID-19 and (possibly) similarly viral transmitted infections, including flu, air pollutants, and meteorological parameters, can be used to predict their burden on the community and health system. In addition, meteorological and air quality data should be included in preventive measures., (© 2024 The Author(s); Published by Hamadan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Objectives: Injurious falls, especially those leading to bone fracture, are major causes of death and disability among older people. Our aim was to measure the association of nutritional factors and physical activity with falls leading to fracture among Iranian older adults., Methods: This is the second phase of a previously published case-control study on 300 patients and 590 controls., Results: In addition to the socio-economic factors that were reported before, our results revealed that consumption of fish, vegetables, fruits, and nuts reduced the risk of falling, whereas consumption of cheese, red meat, and sweets raised the risk of falls among the participants., Conclusion: The results of our study suggested that diets rich in fish meat fruits and vegetables should be encouraged in the everyday life of older adults. We suggest health officials to take these important results into consideration when planning protective measures., (© 2023. The Author(s).)

Introduction: A major shift in the routes of HIV transmission seams to be taking place in Iran. Our study aimed to investigate the 30-year trend of major HIV related behaviors in Iran., Methods: The national HIV/AIDS registry database (from September 1986 to July 2016 with data on 32,168 people newly diagnosed with HIV) was used to study the 30 years trend and demographic determinants of major HIV related behaviors., Results: The highest rate of drug injection (DI) among people living with HIV (PLHIV) was reported during 1996 to 1999 ( p -for trend < 0.001) while the highest rate of sexual activity by minorities or hard to reach groups was during 2004 to 2011 ( p -for trend < 0.001). Among males, drug injection was directly associated with being single (OR single/married = 1.34), being unemployed (OR unemployed/employed = 1.94) and having lower level of education (OR = 2.21). Regarding females, drug injection was associated with being housewife (OR housewife/employed = 1.35) and lower level of education (OR = 1.85). In females, condomless sexual contact was more common among those younger (OR 20-29/<20 = 6.15), and married (OR married/single = 7.76). However, among males those being single (OR married/single = 0.82), being more educated (OR ≥ highschool /< highschool = 1.24), and being unemployed (OR unemployed/employed = 1.53) reported more sexual activity by minoritised or hard to reach groups., Discussion: The pattern of major HIV related behaviors among Iranian males and females have been rapidly changing and people living with HIV (PLHIV) are being diagnosed at a younger age. Health education to younger individuals is an essential HIV controlling strategy among Iranian population. Implementation of surveys in hidden and hard-to-reach populations is also recommended., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gheibi, Fararouei, Afrashteh, Akbari, Afsar Kazerooni and Shokoohi.)

Background: Investigations on food insecurity have shown that food insecurity is inversely associated with health. We examined the association of food insecurity and cardiometabolic risk factors in women living in Shiraz, Iran., Methods: The cross-sectional study was performed on 190 females. Food insecurity was assessed by Household Food Insecurity Access Scale. Cardiometabolic risk factors including anthropometric characteristics, blood pressure, and serum glucose and lipids were measured. Metabolic syndrome score was calculated according to the criteria described for Iranian adults. The association of food insecurity and cardiometabolic risk factors was assessed by linear regression., Results: The prevalence of food security, and mild, moderate, and severe food insecurity was 42.6%, 40.5%, 15.8%, and 1.1%, respectively. Cardiometabolic risk factors worsened with increasing severity of food insecurity. Among the risk factors, body mass index (BMI) had the strongest association with food insecurity. After controlling demographic factors and BMI, fasting blood glucose, triglycerides, total, LDL, and HDL cholesterols, and metabolic syndrome score still showed significant associations with food insecurity (P < 0.01) but systolic and diastolic blood pressure were no longer associated with food insecurity after adjustment for BMI., Conclusion: Overall, although BMI was strongly associated with food insecurity, cardiometabolic risk factors including blood glucose, triglycerides, total, HDL, and LDL cholesterols, and metabolic syndrome score were associated with food insecurity independent of BMI, suggesting that other factors such as lifestyle and diet may have contributed to the exacerbated cardiometabolic risk in food insecure participants of this study. Future studies need to clarify underlying factors in the association of food insecurity and cardiometabolic risk factors., (© 2022. The Author(s).)

Purpose: Polycyclic Aromatic Hydrocarbons (PAHs) have been identified as carcinogenic and endocrine disrupter compounds that cause Metabolic Syndrome (MetS). Oxidative stress can lead to carcinogenesis and MetS in exposed people. Therefore, the relationship between urinary metabolite of PAH (OH-PAHs) level and the oxidative stress biomarker (Malondialdehyde) effect as the mediator in increasing the risk of MetS due to PAH exposure and risk assessment was investigated in Shiraz, Iran., Methods: The first morning void urinary and blood samples were obtained from participants and analyzed. Physical examinations and anthropometric measurements were performed on the day of sampling. An automatic biochemistry analyzer was used to measure the blood cells. The participants' socio-demographic information was gathered using a questionnaire and direct interviews with participants., Results: The MetS prevalence was 26%. Malondialdehyde could act as a mediator between exposure to 1-HydroxyPyrene and increase in fast blood sugar, exposure to 2-HydroxyNaphthalene and increase in systolic blood pressure and exposure to 2-HydroxyFluorene and increase in SBP. Hazard quotients varied from 0.009 to 14.92 in women, and from 0.005 to 8.43 for Fluorene and Naphthalene in men, respectively. The Hazard Indexes were greater than one meaning that the non-cancer health risk related to the PAH exposure could be identified in the participants., Conclusion: Although oxidative stress has been suggested to lead to MetS and the high HI levels obtained in the current study, future researches are essential to achieve more reliable findings and monitoring the environmental influencing factors in PAH exposure., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: This study aimed to investigate the impact of social and clinical factors on the diagnostic delay of chronic kidney disease (CKD) among Iranian patients., Materials and Methods: Our study was conducted on 350 CKD patients who were referred to Faghihi and Motahari clinics (the two largest kidney diseases referral centers in Shiraz the capital of Fars province). Data were collected via an interviewer-administered questionnaire. A multiple linear regression model was used to measure the effect of factors affecting the delay of CKD diagnosis., Results: The medians and Interquartile ranges (IQR) of all delays, patient delay, and doctor delay were 6.5 (0-12.2), 5.1 (0-11.2), and 0.9 (0-3.1) months, respectively. The results showed that women were diagnosed 1.61 months earlier than men (p < 0.05). The duration of all delays in patients residing in the rural areas was 1.28 months longer than patients residing in the urban areas (p < 0.05). Also, patients with perceived good economic status were diagnosed 1.30 months earlier than patients who reported having very poor economic status (p < 0.05)., Conclusions: The delay is in part due to the neglect and misinterpretation of symptoms by both patients and physicians. It is necessary to improve the awareness of CKD among general public and medical professionals., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objectives: Late initiation of antiretroviral therapy (ART) is associated with poor outcome among people living with HIV (PLHIV) and higher risk of transmission of infection. This study was conducted to identify the determinants of late ART initiation among PLHIV in Southern Iran., Methods: A historical cohort study was conducted on 1,326 PLHIV of ≥15 years of age who were registered with the behavioral diseases counseling center (BDCC) in southern Iran from August 1997 to March 2021. Late ART initiation was defined as a CD4 cell count <200 cells/mm 3 or having a clinical AIDS diagnosis at the time of ART initiation. The required demographic and clinical data were collected from the patients' medical records. Multiple regression analysis was conducted to define late ART initiation associated factors., Results: Late ART initiation was found among 81.9% of patients. Based on the results of the multivariate analysis, older age (odds ratio [ OR ] = 1.02, 95% CI = 1.00-1.04), being single ( OR single/married = 1.80, 95% CI = 1.17-2.78), history of drug use ( OR yes/no = 1.64, 95% CI = 1.02-2.62), year of ART initiation ( OR 2011-2013/2018-2021 = 3.65, 95% CI = 2.28-5.86), and possible route of transmission ( OR druginjection/sexual = 7.34, 95% CI = 1.16-46.21) were directly associated with the risk of late ART initiation., Conclusions: The results show that the prevalence of late ART initiation was alarmingly high. For better infection control and better prognosis of infection, people at high risk need to be provided with timely services (e.g., diagnosis, treatment, training, and social support)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Afrashteh, Fararouei, Ghaem and Gheibi.)

Polycyclic aromatic hydrocarbons (PAHs) are persistent toxic substances that have ubiquitous presence in water, air, soil, and sediment environments, posing serious environmental risks. The present study aimed to investigate the concentrations of urinary PAHs and their health effects in individuals living near restaurants via a health risk assessment analysis. This cross-sectional study was performed on 57 people living near restaurants and 30 individuals as the control group. Five urinary metabolites of PAHs were monitored. In order to evaluate the effects of the urinary metabolites of PAHs on Malondialdehyde (MDA) concentration, Total Anti-oxidation Capacity (TAC) in urine samples, and C-Reactive Protein (CRP) in serum samples, regression model was used by considering the effects of the possible confounding factors. Non-carcinogenic health risk was calculated, as well. The median concentration of urinary PAHs was 1196.70 and 627.54 ng/g creatinine in the people living near restaurants and the control group, respectively. Among the metabolites, the lowest and highest mean concentrations were related to 9-OHPhe and 1-OHP, respectively in the two study groups. Moreover, PAHs were significantly associated with MDA level and TAC (p < 0.05). Hazard Quotient (HQ) and Hazard Index (HI) were less than 1. Long-term studies are required to determine the actual health effects by identifying the sources of PAHs emission and to find ways to decrease the production of these compounds., (© 2022. The Author(s).)

Bone mineral density is a crucially important index for skeletal health. A low amount of bone density (osteoporosis) is a common health problem among men and especially women. Among different parts of the body, women's face is the area on which many types of (facial) cosmetics are routinely applied. The aims of this study were to measure the association of cosmetic use with BMD of the lumbar spine and femoral neck among young female students. This is a cross-sectional study on 65 female students in the 2017 academic year. The study participants were students at Shiraz University of Medical Sciences who were selected randomly using phone directory sampling method. Based on the results of multiple linear regression, adjusted for several important covariates, cosmetic use is inversely associated with the BMD z-scores. Lead was significantly associated with trochanteric z-score (B = -0.002 to 95% CI = -0.004 to -0.0003, p = 0.02) and total lumbar z-score (B = -0.002 to 95% CI = -0.004 -0.0005, p = 0.01). In the present study, duration of using cosmetics was significantly associated with BMD of key skeletal regions. The big market of cosmetics in many countries especially those in the Middle East is highly a vastly neglected health issue. Many more observational prospective or interventional studies are required to understand the benefits and hazards caused by cosmetics in women., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Chronic kidney disease (CKD) is a non-communicable disease that includes a range of different physiological disorders that are associated with abnormal renal function and progressive decline in glomerular filtration rate (GFR). This study aimed to investigate the associations of several behavioral and health-related factors with CKD in Iranian patients., Methods: A hospital-based case-control study was conducted on 700 participants (350 cases and 350 controls). Logistic regression was applied to measure the association between the selected factors and CKD., Results: The mean age of cases and controls were 59.6 ± 12.4 and 58.9 ± 12.2 respectively (p = 0.827). The results of multiple logistic regression suggested that many factors including low birth weight (OR yes/no  = 4.07, 95%CI: 1.76-9.37, P = 0.001), history of diabetes (OR yes/no  = 3.57, 95%CI: 2.36-5.40, P = 0.001), history of kidney diseases (OR yes/no  = 3.35, 95%CI: 2.21-5.00, P = 0.001) and history of chemotherapy (OR yes/no  = 2.18, 95%CI: 1.12-4.23, P = 0.02) are associated with the risk of CKD., Conclusions: The present study covered a large number of potential risk/ preventive factors altogether. The results highlighted the importance of collaborative monitoring of kidney function among patients with the above conditions., (© 2022. The Author(s).)

Background: Multiple Sclerosis (MS) imposes significant burdens on patients, their families, and national healthcare systems particularly when there is a resource constraint. Proper prioritization and resource allocation are therefore essential for any effective disease management. Accordingly, we sought to assess the temporal profile of MS incidence over the past two decades in southeast Iran., Methods: A longitudinal design was employed using data from the Iranian multiple sclerosis registry system from March 2001 to March 2019 (n=6034). Annual age-standardized incidence rates of MS (cases of clinically isolated syndrome were also included) were calculated and the trend of incidence from 2001 to 2018 was analyzed., Results: The age-adjusted incidence rate of MS raised from 1.72/100,000 in 2001 to 11.29/100,000 in 2018 (average of 18-year incidence rate was 6.30/100,000), indicating a notable rise in the incidence of MS (P-Value<0.001). However, the female to male ratio of 3.62 remained relatively stable during the study period., Conclusion: Our study suggests that, in Fars province, the incidence of MS has been remarkably rising over the past two decades. We recommend further studies to better understand the determinants of this pattern. Implementing effective policies in lowering the burden of MS is another important step in this regard., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: One of the most important environmental factors affecting academic achievement and performance is the family especially mothers. The purpose of this study was to determine the relationship between quality of life (QOL) and the academic achievement of pupils with the employment status of their mothers., Methods: This cross-sectional study was conducted on 9th-grade students in Shiraz. A sample of 400 individuals was selected through a multi-stage sampling method from among the 9th-grade students and a questionnaire on academic achievement and quality of life was completed for them. Then data was entered into spss23 software and analyzed. The value of P < 0.05 was considered a significant statistical level., Results: There was no significant difference between students who have employed and Housewife mothers about the student's academic achievements ant QOL score (P > 0.05). According to the results of multivariate analysis, none of the variables was a significant predictor of the QOL and academic achievement in the students., Conclusion: In spite of lack of association between the quality of life and academic achievement of students with their mothers' occupation but it should be regarded that more attention to students and spent more time by students can be very helpful in the academic achievement of students., Competing Interests: Conflicts of interest statement The authors declare no conflict of interest., (©2021 Pacini Editore SRL, Pisa, Italy.)

Cosmetics are applied widely by women and men for different proposes mainly beauty and skin care. However, the biologically active substances which are used in these products and their health effects are not fully known. The aims of this study were, first, to estimate the prevalence of cosmetics use, and second, to examine if any association exists between cosmetic use and serum levels of lead and cadmium (two heavy metals with major health effects) among young women. This is a cross-sectional study conducted on 65 female students during the first semester of 2017 academic year. Study sample was selected randomly using phone numbers. About 70% of the study participants started using cosmetics under age 20 years (about 14% under 15), and 50% were using the products on a daily base. After adjusting for possible confounders, significant associations were found between the participants age (B = - 0.0008, CI = - 0.001 to - 4.71, P = 0.03) and duration of using cosmetics (B = 0.0006, CI = 0.0001 to 0.115, P = 0.01) with the level of cadmium in their serum samples. Duration of using cosmetics (B = 0.008, CI 0.001 to 0.01, P = 0.01) was the only variable which was significantly associated with serum level of lead in the participants. According to the results of the present study, most Iranian girls start using cosmetics at a very young age making them more vulnerable to the potential hazards of the ingredients of cosmetic products including heavy metals and preservatives. The association between duration of using cosmetics and serum level of lead and cadmium may cause serious health problems for women at young ages and their fetus or children via placenta and breast milk. The big market of cosmetics in many countries especially Middle East is highly important.

Background: Until now, there was no available study on the knowledge and practice of the people of Iran with regard to the coronavirus disease 2019 (COVID-19) pandemic., Objective: This study aimed to investigate the knowledge and preventive practices of Iranians toward the COVID-19 pandemic., Methods: This is a cross-sectional study of 925 people who completed an online questionnaire in March 2020. The study used 21 and 14 questions, respectively, to assess the knowledge and preventive practices of the population in regard to COVID-19. Cronbach's alpha was 0.75 for the knowledge scale and 0.71 for the practice scale. To determine the importance of each independent variable in explaining the participant's practice, a multiple regression model was applied., Key Results: The results indicated a moderate level of knowledge and preventive practices in regard to COVID-19 in most of the respondents (56.8% and 56.5%, respectively). According to the multiple regression analysis, knowledge showed the highest effect on the practice of the participants (β = 0.479). The determination coefficient for the model (R 2 = 0.509) also showed approximately 51% of the variance in practice was explained by gender, occupational status, knowledge, cost of hand sanitizer, and the belief in the effectiveness of using such necessities., Conclusions: Acceptable rates of knowledge and practice were observed in most Iranians. However, approximately 10% of the participants were unaware of the effective measures for preventing the infection, which can cause active transmission of the virus. In addition to considering the importance of high community awareness in prevention and isolation measures, the government should provide disinfectants and other materials at a low price to reduce the transmission, as this may lead to effective practice to break the chain of transmission of COVID-19. [HLRP: Health Literacy Research and Practice. 2021;5(1):e15-e23.] PLAIN LANGUAGE SUMMARY: This study sought to evaluate the knowledge and preventive practices of Iranians toward the coronavirus disease 2019 pandemic. Findings of this research demonstrate acceptable rates of knowledge and practice in most Iranians; however, about 10% of them were unaware of the true prevention practices, which can cause active transmission of the virus., (©2021 Heydari, Joulaei, Zarei, et al.)

Objective: A long diagnostic delay in multiple sclerosis (MS) reduces the chance of early access to disease modifying therapies with potential to impact on disease trajectory. The aims of this study were to determine the delay in diagnosis of MS and its associated factors in Iran., Methods: Our study was conducted on 536 MS patients who were selected from Multiple sclerosis registry database and neurology clinics in southern part of Iran. Data were collected via a face-to-face interview administered questionnaire. A multiple linear regression model was used to control for the effect of potential confounding factors on the delay of MS diagnosis., Results: The mean of diagnostic delay was 7.0 months. Single patients were diagnosed on average 1.33 months later compared with those who were married (P = 0.007). Those who were registered with a family physician reported an average of 1.42 months longer delay in diagnosis than others (P = 0.004). For each year of older age at diagnosis, the delay was 1.04 months longer (P < 0.001). On the other hand, those who had migraine were diagnosed 1.58 months earlier than others (P < 0.001). Participants with a vision problem as the initial symptom were diagnosed 1.48 months earlier than those with sensory symptoms (P < 0.001), and 1.28 months earlier than those with headache/dizziness (P = 0.093). It was also suggested that the diagnostic delay was shortened over the study period (on average 1.06 months per year, P < 0.001)., Conclusion: Easy access to a neurologist, raising health literacy in the general population, and improving the family physicians' alertness about MS symptoms can shorten the delay of MS diagnosis., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Fat mass and obesity-associated gene (FTO) is the most studied obesity-related gene up to date. We aimed to assess anthropometric indices in carriers of FTO rs9939609 polymorphism with overweight across Iranian population (Shiraz) to find out the associations of this polymorphism with obesity indices., Methods: This was a cross-sectional study conducted on 198 overweight healthy adults aged 20-45 years old. We assessed the body composition of the participants using bioelectrical impedance analyzer. In addition, we measured the waist circumference (WC) and hip circumference (HC). Waist to hip ratio (WHR) and waist to height ratio (WHtR) were also calculated by equations. The participants' genotype was determined by ARMS-PCR. Also, data analysis was performed using SPSS software version 20 and R software version 3.6.2., Results: The mean values of body mass index (BMI) and age of the participants were 26.93 ± 1.13 kg/m 2 and 33.33 ± 6.35 years old, respectively. Homozygous carriers of A-allele had significantly higher values for BMI (0.60 kg/m 2 , p = 0.026), WHR (0.04 unit, p = 0.003), and WHtR (0.02 unit, p = 0.030) than the homozygous carriers of T-allele. Individuals with AA genotype had greater WC (2.66 cm, p = 0.042, and 4.03 cm, p = 0.002), fat mass (2.24 kg, p = 0.004, and 3.02 kg, p = 0.001), and trunk fat (1.53 kg, p = 0.001, and 2.08 kg, p = 0.001) compared to those with AT and TT genotypes, respectively. Interestingly, after adjustment of the confounders, significant associations were observed among rs9939609 polymorphism and BMI, Wt, WC, trunk fat percentage, WHR, and WHtR., Conclusions: A-allele of the FTO rs9939609 polymorphism was indicated to be associated with greater general and central obesity in adult population of Shiraz, Iran.

Background: Several studies conducted in developed countries introduced diet and physical inactivity as major risk factors for several types of cancers. However, the impact of diet and physical inactivity on the risk of breast cancer (BC) is understudied, and the limited findings are controversial. In addition, no or limited knowledge is available from the developing world., Patients and Methods: This case-control study was performed from November 2014 to March 2016 on 1010 young women aged 20 to 50 years who were newly diagnosed with BC. Data was obtained via a validated questionnaire and the global physical activity questionnaire (GPAQ2). Also, patients' medical and histopathology reports were reviewed., Results: The results of multiple logistic regression suggested that, except for the common risk factors for BC (older marital age, family history of BC, smoking, and being a passive smoker), eating red meat (adjusted odds ratio [aOR] >8 portions/week [p/w] vs. 0-2 p/w, 1.15; 95% confidence interval [CI], 1.04-1.28); eating fish (aOR >8 p/w vs. 0-2 p/w, 1.55; 95% CI, 1.12-2.76), fruit consumption (aOR 0-4 p/w vs. >8 p/w, 1.96; 95% CI, 1.07-3.82), pickle consumption (aOR >8 p/w vs. 7-8 p/w, 1.46; 95% CI, 1.31-1.70), and intensity of physical activity (aOR light vs. vigorous, 1.68; 95% CI, 1.47-1.98) were directly associated with a higher risk of BC in young women., Conclusion: Our study supported the hypothesis that unhealthy dietary habits and physical inactivity are risk factors for BC. We found that a healthy diet containing low fat and high fruits and vegetables with regular exercise are effective ways to reduce the risk of BC among young women., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: Depression, which is the most common comorbidity in breast cancer (BC) patients, has adverse effects on patients' quality of life, disease progress, and survival., Methods: The protocol of this study was registered in PROSPERO (registration No. CRD42019121494). We electronically searched published studies through January 2019 with the aim of finding articles that investigated the prevalence of depression among BC survivors. Web of Science, Scopus, PubMed/MEDLINE, Science Direct, and Google Scholar were searched to obtain relevant published studies. This review included 14 cross-sectional and 4 cohort studies published from 2000 to 2018. We used a random-effects model to conduct the meta-analysis and generated a summary estimate for the pooled prevalence with 95% confidence intervals (CIs). A subgroup analysis was also conducted based on the depression assessment tool used and the study design., Results: The total sample size of the studies contained 2,799 women with BC, including 1,228 women who were diagnosed with depression. The pooled prevalence of depression among Iranian women with BC was 46.83% (95% CI, 33.77 to 59.88) with significant heterogeneity (I2 =98.5%; p<0.001). The prevalence of depression ranged from 14.00% (95% CI, 4.91 to 23.09) to 95.90% (95% CI, 91.97 to 99.83). The results of the subgroup analyses suggested that the depression assessment tool, year of publication, and study design were sources of heterogeneity., Conclusions: Our findings indicate a high prevalence of depression among BC patients, underscoring the urgent need for clinicians and health authorities to provide well-defined social and psychological supportive care programs for these patients.

The current study was performed to find out the seroprevalence of Toxocara infection in children living in a rural community in Fars province, southern Iran. Venous blood was taken from 617 children and evaluated for anti-Toxocara antibodies, using an ELISA system. Of the 617 studied children, 318 (51.5%) were boys and 299 (48.5%) were girls. Mean age of the participants was 9.2 (±10.7) years. Most cases of the recruited subjects (37.4%) were in the age group of 0-5 years. Anti-Toxocara antibodies were detected in sera of 39 (6.3%) of children. From these, 23 (62.2%) were boys and 14 (37.8%) were girls. The infection rate was almost the same in different age groups. No statistically significant differences were seen between seropositivity to Toxocara infection and gender or age of the participants. Dogs or cats ownership was not associated with Toxocara seropositivity. The adjusted associations of the study variables suggested that the visceral leishmaniasis (VL) seropositivity is significantly associated with the seroprevalence of Toxocara infection (P < 0.001). Findings of the current study revealed that Toxocara infection is a common infection among children in the studied rural community in Iran. Preventive measurements are necessary to minimize the rate of Toxocara infection in children in such communities., (© 2018 John Wiley & Sons Ltd.)