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Abstract Little is known about the role of diet in the risk of invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of the breast, the most common histological subtypes of breast cancer (BC). This is because, the majority of studies on the association of diet and the risk of BC are focused on single food items, and studies considering the overall diet in terms of dietary patterns are limited. Also, the potential heterogeneity in the impact of Western diet (WD) on histological subtypes of BC is not established. This, the age-frequency-matched case–control study included 1009 incident BC cases and 1009 healthy controls. The required data was obtained from the patients’ medical files and interviews using a previously validated researcher-designed questionnaire for collecting data on socio-economic and anthropometric statuses and a valid food frequency questionnaire (FFQ) to measure the participants’ dietary intake. We used multinomial logistic regression, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A positive and significant association was observed between higher adherence to a WD and risk of IDC (OR comparing highest with the lowest tertile: 2.45, 95% CI 1.88, 3.17; p-trend

Abstract Background Noncommunicable diseases (NCDs) are the first reason for death worldwide, in which poor diet is the leading risk factor. It is estimated that 20% of all death is related to food. The Unhealthy diet includes many foods with excessive salt, sugar and fat. This paper reports a national study on the socio-cultural determinants affecting salt, sugar and fat consumption in Iran. Methods This is a qualitative study. We conducted semi-structured interviews with 30 various purposefully identified key stakeholders to collect data from December 2018 until August 2019 in Iran. Results We identified socio-cultural determents of salt, fat and sugar consumption as follows: Inadequate structure of traditional medicine and people’s desire for traditional foods, low health literacy, the global trend of nutritional transition and its impact on Iranian society, The progressive decline of people’s trust in NGOs, and Inappropriate media management. Worse still, the global trend of nutritional transition and people’s tendency towards fast foods, unhealthy diet and junk foods, partially due to establishing children’s taste mainly with salty, high-fat and sweet foods, has jeopardized their desire to eat healthily during adulthood. Conclusion Reducing salt, fat and sugar consumption is problematic in Iran, mainly due to multi-dimensional socio-cultural determinants. In line with sustainable development goal (SDG) 3.4 to reduce 30% of premature death due to NCDs and related risk factors by 2030 in Iran, various stakeholders from multiple sectors need to initiate coherent series of interventions to alter people’s approach to select food so that they may reduce the consumption of foods with excessive salt, fat and sugar.

Salinity stress is of the critical abiotic stress factors in many parts of the world, especially in arid and semi-arid regions and drastically decrease the growth and productivity of the crop. Therefore, in order to maintain the crop productivity and ensure food security in salt-stress suffered regions; in the last decade, novel engineered nanoparticles were synthesized and then assayed for their potential effects concerned with the plant protection against stress conditions. Herewith the present study, we synthesized proline-functionalized graphene oxide nanoparticles (GO-Pro NPs). Then, the interaction effects of either GO-Pro NPs (50 and 100 mg L−1) or graphene oxide nanoparticles (50 and 100 mg L−1) and salinity stress (50 and 100 mM NaCl) on Vitis vinifera L. cv Sultana were evaluated by assaying an array of parameters, viz. photosynthetic pigments, electrolyte leakage, relative leaf water content, protein, proline, antioxidant defense systems, and oxidative stress markers. Accordingly, salinity critically reduced chlorophyll index and content as well as leaf water content, whilst it caused significant increases in electrolyte leakage, the enzyme activity of superoxide dismutase (SOD) as well as contents of proline, malondialdehyde (MDA) and hydrogen peroxide (H2O2). In stress-submitted plants, foliar application of proline-functionalized graphene oxide nanoparticles (100 mM) was effective against oxidative damage with increasing the activity of antioxidant enzymes, proline, and the relative water content of leaves and reducing electrolyte leakage (EL), H2O2, and MDA. The current findings revealed that the oxidative stress caused by salinity in Sultana cultivar grapes might be alleviated by foliar application of different levels of proline-functionalized graphene nanoparticles.

The present work was designed based on the new multi-component reaction, which forms 2-aryl/alkyl-quinazolin-4(3H)-ones in a one-pot reaction with good to excellent yields (86–97 %) using 2-aminobenzoic acid, organic acid, and ammonium hexafluorophosphate (NH4PF6). The advantages of the presented method include inexpensive and readily available starting materials, simple procedures, and easy workup. In this newly discovered method, ammonium hexafluorophosphate (NH4PF6) was used as a highly efficient reagent and catalyst for quinazolin-4(3H)-ones synthesis. All of the synthesized compounds were characterized by 1H NMR and 13C NMR techniques.

Objective: In order to achieve development goals, in addition to providing students with physical health, their mental and social health should be considered as a necessity and priority in development programs. This program, called the Nemad Project in Iran was formally established in 2015. This study aims to explore the challenges of the Nemad project in Iranian schools based on stakeholders' views. Method: The present qualitative study, with a contractual content analysis approach, was conducted on 21 experts in the field of social harm prevention and mental health promotion at the senior, intermediate, and operational levels in educational institutions and schools, Ministry of Health, the Judiciary and the Planning and Budget Organization. These experts also included project technical officers. Participants were selected using snowball and purposeful sampling methods. Data were collected through semi-structured interviews and analyzed by coding, classification, and extraction of the main themes. Results: Six main themes were derived that included inefficiency in resource management (with subcategories of inadequate facilities and equipment, inadequate human resource management, and information management system deficiencies), weakness in program organization (with subcategories of poor cross-sectoral and weak inter-sectoral subgroups), challenges of laws/regulations/policies (with sub-categories of defective protocols and guidelines and lack of specific task descriptions), barriers and challenges to implementation of policies (with macro and school policy implementation subcategories), structural factors (with subcategories of financial resources allocation problems, inconsistency in managerial levels, and deficiencies in decision-making principles), weaknesses in educational processes (with subcategories of inadequate teacher education, weaknesses in parenting courses, and weaknesses in student education), and ultimately, weaknesses in monitoring and evaluation (with the subcategory of lack of a monitoring and evaluation system). Conclusion: According to experts, implementation of mental and social programs in schools is not in a desirable situation and is faced with certain challenges. To enhance the management of the Nemad project in Iranian schools, it is necessary to compile flowcharts of service delivery and inter-device communication, allocate resources to meet the expectations of each organization, do performance-based budgeting, take a comprehensive look at parental issues, and design a system of monitoring and evaluating the requirements.

Abstract Background Several studies have investigated the relationship between dietary patterns and the risk of bladder cancer (BC) in different regions including Europe, the United States, and Asia, with no conclusive evidence. A meta-analysis was undertaken to integrate the most recent information on the relationship between a data-driven Western diet (WD), the Mediterranean diet (MD), and dietary-inflammatory-index (DII) and the risk of BC. Method We looked for published research into the relationship between dietary patterns and the incidence of BC in the PubMed/Medline, Cochrane Library, Web of Science, and Scopus databases up until February 2021. Using a multivariate random-effects model, we compared the highest and lowest categories of WD, MD and DII patterns and provided the relative risk (RR) or odds ratios (OR) and 95 percent confidence intervals (CIs) for the relevant relationships. Results The analysis comprised 12 papers that were found to be suitable after scanning the databases. Both case–control (OR 0.73, 95% CI: 0.52, 0.94; I2 = 49.9%, n = 2) and cohort studies (RR 0.93, 95% CI: 0.88, 0.97; I2 = 63%, n = 4) found a substantial inverse association between MD and BC. In addition, although cohort studies (RR 1.53, 95% CI 1.37, 1.70; I2 = 0%, n = 2) showed a direct association between WD and BC, case–control studies (OR 1.33, 95% CI 0.81, 1.88; I2 = 68.5%, n = 2) did not. In cohort studies, we found no significant association between DII and BC (RR 1.02, 95% CI 0.93, 1.12; I2 = 38.5%, n = 2). In case–control studies, however, a strong direct association between DII and BC was discovered (RR 2.04, 95% CI 1.23, 2.85; I2 = 0%, n = 2). Conclusion The current meta-analysis showed that MD and WD have protective and detrimental effects on BC risk, respectively. No significant association between DII and the risk of BC was observed. More research is still needed to confirm the findings. Additional study is warranted to better understand the etiological mechanisms underlying how different dietary patterns affect BC. Trial registration Protocol registration number: CRD42020155353. Database for protocol registration: The international prospective register of systematic reviews database (PROSPERO). Data of registration: August 2020.

Introduction: Breast cancer is one of the most common cancers and a leading cause of death worldwide and in Iran. Mammography is commonly used in breast cancer screening and diagnosis. This study was performed with aim to evaluate the efficacy and cost-effectiveness of mammography, especially the mobile type, in breast cancer screening in Iran. Methods: This study is an overview of reviews. After a systematic search in the databases of Cochrane Library, Trip, Pubmed, CRD and magiran, the appropriate, relevant and up-to-date reports including systematic review, health technology assessment, economic assessment and clinical guidance were found and used. Results: Mammography sensitivity for breast cancer screening in fixed type was reported between 84% and 96% and in mobile type between 77% and 98%. Its specificity has been reported between 50% and 100% in fixed type and between 92% and 95% in mobile type. In Iran, the use of mammography in the screening program increases the cost by about $ 37,000 per QALY (quality adjusted life years). Conclusion: Due to the incidence of the disease, mammography is not cost effective in breast cancer screening, although in certain communities, for example, with a relatively high incidence may be cost effective. Mobile mammography is usually more expensive than fixed mammography and its technical performance is not much different, so it may be less cost effective than fixed mammography.

Background and Objective: Compared to the general population, patients with psychiatric disorders, especially patients receiving electroconvulsive therapy due to its nature, and lack of psychiatric nursing counseling have worse physical health and lower self-esteem. The aim of this study was to determine the effect of psychiatric nursing counseling on self-esteem and health-promoting behaviors of patients receiving electroconvulsive therapy in hospitalized patients. Material and Methods: This clinical trial was conducted on 114 patients undergoing ECT at Farshchian Hospital in Hamadan, Iran, in 2019. The participants were divided into two groups of intervention (n=57) and control (n=57) by block randomization. Data collection tools included demographic, Rosenberg self-esteem, and health-promoting behaviors questionnaires. The intervention in the experimental group was held in the form of 4 sessions of individual counseling. Data were analyzed using frequency, percentage, mean and standard deviation statistics, Chi-square and t-tests in SPSS software version 20. Results: The mean (standard deviation) of self-esteem score before the intervention in the experimental group (4.01) 21.60 and control (3.51) 21.95 was not significantly different (P=0.542). But the mean score of self-esteem immediately after the intervention in the experimental group (25.47. 3.91) and in the control group (2.79) was 19.11 and two weeks after the intervention, which was significant (P

Abstract Gelatin methacryloyl (GelMA) is one of the most widely used photo-crosslinkable biopolymers in tissue engineering. In in presence of an appropriate photoinitiator, the light activation triggers the crosslinking process, which provides shape fidelity and stability at physiological temperature. Although ultraviolet (UV) has been extensively explored for photo-crosslinking, its application has been linked to numerous biosafety concerns, originated from UV phototoxicity. Eosin Y, in combination with TEOA and VC, is a biosafe photoinitiation system that can be activated via visible light instead of UV and bypasses those biosafety concerns; however, the crosslinking system needs fine-tuning and optimization. In order to systematically optimize the crosslinking conditions, we herein independently varied the concentrations of Eosin Y [(EY)], triethanolamine (TEOA), vinyl caprolactam (VC), GelMA precursor, and crosslinking times and assessed the effect of those parameters on the properties the hydrogel. Our data showed that except EY, which exhibited an optimal concentration (~ 0.05 mM), increasing [TEOA], [VA], [GelMA], or crosslinking time improved mechanical (tensile strength/modulus and compressive modulus), adhesion (lap shear strength), swelling, biodegradation properties of the hydrogel. However, increasing the concentrations of crosslinking reagents ([TEOA], [VA], [GelMA]) reduced cell viability in 3-dimensional (3D) cell culture. This study enabled us to optimize the crosslinking conditions to improve the properties of the GelMA hydrogel and to generate a library of hydrogels with defined properties essential for different biomedical applications.

COVID-19 is a global challenge that negatively affects the health–related quality of life (HRQoL) of the general population. The current study aimed to evaluate HRQoL and its associated factors among the Iranian general population during the COVID-19 pandemic. The data were collected in 2021 using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) and EQ-5D Visual Analog Scale (EQ VAS) questionnaires through an online survey. Participants were recruited via social media from the Fars province. The multiple binary logistic regression model was used to identify factors influencing participants' HRQoL. Kolmogorov-Smirnov, the t-test, ANOVA, and the chi-square test were used. All tests were conducted at a significance level of 5% using Stata 14.2 and SPSS 16. A total of 1,198 participants were involved in this cross-sectional study. The mean age of participants was 33.3 (SD:10.2), and more than half were women (55.6%). The mean EQ-5D-3L index value and EQ-VAS of the respondents were 0.80 and 77.53, respectively. The maximum scores of the EQ-5D-3L and EQ-VAS in the present study were 1 and 100, respectively. The most frequently reported problems were anxiety/depression (A/D) (53.7%), followed by pain/discomfort (P/D) (44.2%). Logistic regression models showed that the odds of reporting problems on the A/D dimension increased significantly with supplementary insurance, including concern about getting COVID-19, hypertension, and asthma, by 35% (OR = 1.35; P = 0.03), 2% (OR = 1.02; P = 0.02), 83% (OR = 1.83; P = 0.02), and 6.52 times (OR = 6.52; P = 0.01), respectively. The odds of having problems on the A/D dimension were significantly lower among male respondents, those in the housewives + students category, and employed individuals by 54% (OR = 0.46; P = 0.04), 38% (OR = 0.62; P = 0.02) and 41% (OR = 0.59; P = 0.03), respectively. Moreover, the odds of reporting a problem on the P/D dimension decreased significantly in those belonging in a lower age group and with people who were not worried about getting COVID-19 by 71% (OR = 0.29; P = 0.03) and 65% (OR = 0.35; P = 0.01), respectively. The findings of this study could be helpful for policy-making and economic evaluations. A significant percentage of participants (53.7%) experienced psychological problems during the pandemic. Therefore, effective interventions to improve the quality of life of these vulnerable groups in society are essential.

Background Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran. Methods This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software. Results We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME’s inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry. Conclusion In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people’s approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar.

Background: Recently, people have recognized the post-acute phase symptoms of the COVID-19. We investigated the long-term symptoms associated with COVID-19, (Long COVID Syndrome), and the risk factors associated with it. Methods: This was a retrospective observational study. All the consecutive adult patients referred to the healthcare facilities anywhere in Fars province from 19 February 2020 until 20 November 2020 were included. All the patients had a confirmed COVID-19 diagnosis. In a phone call to the patients, at least three months after their discharge from the hospital, we obtained their current information. The IBM SPSS Statistics (version 25.0) was used. Pearson Chi square, Fisher’s exact test, t test, and binary logistic regression analysis model were employed. A P value of less than 0.05 was considered to be significant. Results: In total, 4,681 patients were studied, 2915 of whom (62.3%) reported symptoms. The most common symptoms of long COVID syndrome were fatigue, exercise intolerance, walking intolerance, muscle pain, and shortness of breath. Women were more likely to experience long-term COVID syndrome than men (Odds Ratio: 1,268; 95% Confidence Interval: 1,122-1,432; P=0.0001), which was significant. Presentation with respiratory problems at the onset of illness was also significantly associated with long COVID syndrome (Odds Ratio: 1.425; 95% Confidence Interval: 1.177-1.724; P=0.0001). A shorter length of hospital stay was inversely associated with long COVID syndrome (Odds Ratio: 0.953; 95% Confidence Interval: 0.941-0.965; P=0.0001). Conclusion: Long COVID syndrome is a frequent and disabling condition and has significant associations with sex (female), respiratory symptoms at the onset, and the severity of the illness.

Abstract Background The present study has been undertaken with the aim to evaluate performance and ranking of various universities of medical sciences that are responsible for providing public health services and primary health care in Iran. Methods Four models; Weighted Factor Analysis (WFA), Equal Weighting (EW), Stochastic Frontier Analysis (SFA), and Data Envelopment Analysis (DEA) have been applied for evaluating the performance of universities of medical sciences. This study was commenced based on the statistical reports of the Ministry of Health and Medical Education (MOHME), census data from the Statistical Center of Iran, indicators of Vital Statistics, results of Multiple Indicator of Demographic and Health Survey 2010, and results of the National Survey of Risk Factors of non-communicable diseases. Results The average performance scores in WFA, EW, SFA, and DEA methods for the universities were 0.611, 0.663, 0.736 and 0.838, respectively. In all 4 models, the performance scores of universities were different (range from 0.56–1, 0.53–1, 0.73–1 and 0.83–1 in WFA, EW, SFA and DEA models, respectively). Gilan and Rafsanjan universities with the average ranking score of 4.75 and 41 had the highest and lowest rank among universities, respectively. The universities of Gilan, Ardabil and Bojnourd in all four models had the highest performance among the top 15 universities, while the universities of Rafsanjan, Ahvaz, Kerman and Jiroft showed poor performance in all models. Conclusions The average performance scores have varied based on different measurement methods, so judging the performance of universities based solely on the results of a model can be misleading. In all models, the performance of universities has been different, which indicates the need for planning to balance the performance improvement of universities based on learning from the experiences of well-performing universities.

Abstract Background Many stakeholders are involved in the complicated process of policy making in integrated early childhood development (IECD). In other words, there are many challenges for IECD policy making in developing countries, including Iran. The aim of this study was to identify potential stakeholders and their interactions in IECD policy making in Iran. Method A mixed-methods study was conducted in two phases in 2018. First, forty semi-structured interviews and a review of IECD-related documents were conducted to identify potential stakeholders and their roles. Second, using a designed checklist, these stakeholders were assessed for power, interest, and position in IECD policy making. Then, a map of stakeholders and a three-dimensional stakeholder analysis figure were designed. Results The results of this study showed that various stakeholders, including governmental, semi-governmental, social, non-governmental and international organizations, potentially influence IECD policy in Iran. They were found to have diverse levels of power, interest and position in this regard, leading to their different impacts on the process. This diversity is assumed to have affected their levels of participation and support. Also, we found that the stakeholders with a high-power level do not have a high level of interest in, or support for, IECD policy. In general, organizational competition, complicated inter-sectoral nature of this process, insufficient budget, insufficient awareness about the importance of IECD, lack of priority given to IECD in relevant organizations, economical views rather than developmental perspectives, and lack of commitment among top managers are the reasons why this policy enjoys a low degree of support. Conclusions There are weaknesses in effective interactions and relationships among IECD policy stakeholders. This will lead to the lack of equal opportunities for optimal early childhood development. To improve this process, advocacy from high-level authorities of the organizations, negotiation with child-friendly groups, establishing a body to coordinate and oversee children’s affairs, using the capacity of non-governmental organizations, strengthening inter-sectoral collaboration by clarifying the roles and responsibilities of stakeholders and the relationships between them, and increasing public awareness can be helpful.

Introduction: Death anxiety and low self-esteem are major problems in patients with Multiple Sclerosis (MS). Spiritual interventions, along with other nursing interventions, can restore the balance between body and soul. Objective: This study aimed to determine the effect of the spiritual care program on death anxiety and self-esteem in MS patients. Materials and Methods: In this clinical trial, 60 patients with MS were randomly assigned into the intervention (n=30) and control (n=30) groups. The intervention group received spiritual care program in four sessions. Templer death anxiety and Rosenberg self-esteem scale were completed by samples before and after the intervention. Data analysis was performed using the independent t test, Chi-square, and Fisher exact tests. The significance level is considered less than 0.05. Results: The Mean±SD ages of the intervention and control group samples were 32.8±6.39 and 35.1±8.35 years, respectively. The Mean±SD scores of death anxiety in the control group 12.27±0.85 and the intervention group 11.8±0.88 before the intervention were not significantly different. After the intervention, the difference between the Mean±SD scores of the control group 12.10±0.61 and the interventional group 8.13±0.71 was statistically significant (P=0.001). The Mean±SD scores of self-esteem in the control group 14.63±1.51 and the interventional group 15.5±1.5 before the intervention were not significantly different. The difference between the Mean±SD scores of self-esteem in the control group 14.67±1.9 and the interventional group 18.03±1.85 was significant after the intervention (P=0.001). The results of ANCOVA demonstrated a significant difference between the control and intervention groups in terms of death anxiety (F=6.41, P=0.014, partial Eta2=0.101) and self-esteem (F=13.079, P=0.001, partial Eta2=0.187) of MS patients. Conclusion: Since spiritual care intervention in patients with MS reduced their death anxiety and increased their self-esteem, this simple and low-cost care program can be recommended for those suffering from this disease.

Abstract Background: To improve healthcare services’ quality, countries should measure their health systems’ efficiency and performance by robust methods. Objectives: We aimed to develop a national study to measure the efficiency of the health system in Iran. Methods: The literature review identified several methods for measuring efficiency; the most common one was data envelopment analysis (DEA). We adopted DEA, but its findings were simplistic and inaccurate, so we began to modify the method by determining the weight of each indicator. We identified the efficiency measurement indicators, in line with international standards and uniformed units, and then readjusted our input/output indicators according to the study context through four expert panels. We collected data and classified the input/output indicators, followed by determining each indicator’s weight and standard limits. Then we rationalized our previous results by applying the revised model. The initial new results of the refined model were valid, accurate, and consistent with previous studies, as approved by experts. We defined proper modeling to achieve the stated objectives. After investigating various DEA models, we finally designed a new model that was consistent with the existing data and conditions, entitled EDEA (extended DEA), to analyze other subprojects. Conclusions: The conventional DEA methods may not be accurate enough to measure health systems’ efficiency. By modifying modeling process, we propose a modified DEA with a very low error rate. We suggest that others interested in measuring health system efficiency adopt our modified approach to increase accuracy and create more meaningful policy-oriented results. Keywords: Efficiency; Health System; Productivity; Protocol

Introduction Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers’ ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors. Methods This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach’s alpha of 85%. Data were analyzed using SPSS software version 16. Results The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05. Conclusion Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.

Objectives This study aims to assess the prevalence of hypertension (HTN), and determine the relationship between HTN and anthropometric indices including fat distribution, body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in Shiraz Heart Study.Setting In this cross-sectional study, subjects were enrolled in 25 clinics in Shiraz. I.R. Iran between 2019 and 2021.Participants A total number of 7225 individuals were selected, aged between 40 and 70 years of whom 52.3% were female. Among the people living in Shiraz, individuals living far from clinics, cases of mental or physical disabilitiy and documented cardiovascular diseases were excluded.Primary and secondary outcome measures Primary outcome: The association of body composition, WHR, WHtR and BMI with HTN.Secondary outcome: The sensitivity and specificity of the WHtR for the prediction of HTN.Results HTN prevalence was 19.3%. Obesity prevalence was estimated to be 28.5%. WHR and lean body mass showed a significant association with HTN (p

Background: Cystic echinococcosis (CE) is one of the most important parasitic infections in subgroup seven common neglected diseases of humans and animals. It is in the list of 18 neglected tropical diseases of the WHO. We aimed to analyze the situation of the disease in Iran using Geographical Information System (GIS) and satellite data analysis. Methods: The data obtained from the Ministry of Health and Medical Education, Tehran, Iran and other related centers from 2009 to 2018 were analyzed using GIS. Then, the spatial distribution maps of the disease were generated, and the hot spots of the disease in Iran were determined using spatial analysis of ArcGIS10.5 software. Geographically weighted regression (GWR) analysis in ArcGIS10.5 was used to correlate the variables affecting the disease including temperature, relative humidity, normalized different vegetation index (NDVI) and incidence of hydatidosis. Data analysis was performed by Linear regression analysis and SPSS 21 software using descriptive statistics and chi-square test. Results: Zanjan, Khorasan Razavi, North Khorasan, Chaharmahal Bakhtiari, Hamedan, Semnan, and Ardabil provinces were the hot spots of CE. The results of geographical weighted regression analysis showed that in Khorasan Razavi, North Khorasan, Chaharmahal Bakhtiari, Hamedan, Semnan, Ardabil, Zanjan, Qazvin, and Ilam provinces, the highest correlation between temperature, humidity, vegetation density and the incidence of hydatidosis was observed (P

Abstract Background Osteoporotic fractures impose significant costs on society. The objective of this study was to estimate the direct costs of the hip, vertebral, and forearm fractures in the first year after fracture incidence in Iran. Methods We surveyed a sample of 300 patients aged over 50 years with osteoporotic fractures (hip, vertebral, and forearm) admitted to four hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2017 and were alive six months after the fracture. Inpatient cost data were obtained from the hospital patient records. Using a questionnaire, the data regarding outpatient costs were collected through a phone interview with patients at least six months after the fracture incidence. Direct medical and non-medical costs were estimated from a societal perspective. All costs were converted to the US dollar using the average exchange rate in 2017 (1USD = IRR 34,214) Results The mean ± standard deviation (SD) age of the patient was 69.83 ± 11.25 years, and 68% were female. One hundred and seventeen (39%) patients had hip fractures, 56 (18.67%) patients had vertebral fractures, and 127 (42.33%) ones had forearm fractures. The mean direct cost (medical and non-medical) during the year after hip, vertebral and forearm fractures were estimated at USD5,381, USD2,981, and USD1,209, respectively. Conclusion The direct cost of osteoporotic fracture in Iran is high. Our findings might be useful for the economic evaluation of preventive and treatment interventions for osteoporotic fractures as well as estimating the economic burden of osteoporotic fractures in Iran.

Abstract Background Diseases have undeniable effects on Health-Related Quality of Life (HRQoL). Chronic diseases, in particular, limit the productive potentials and HRQoL of individuals. EQ-5D is a very popular generic instrument, which can be used to estimate HRQoL scores in any diseases. The current study investigates mean HRQoL scores in certain chronic diseases and examines the relationship between utility scores and chronic diseases in Iran. Method This cross-sectional study was carried out among the general adult population of Tehran. 3060 individuals were chosen by a stratified probability sampling method. The EQ-5D-5L questionnaire was applied. The utility scores were estimated using the Iranian crosswalk-based value set. The effect of chronic diseases on the HRQoL scores was derived by the Ordinary Least Squares (OLS) method. Data was analyzed using Stata version 13 software. Results The mean ± standard deviation utility and EQ-VAS scores were 0.85 ± 0.14 and 76.73 ± 16.55 in the participants without any chronic conditions. The scores were 0.69 ± 0.17 and 61.14 ± 20.61 in the participants with chronic conditions. The highest and lowest mean utility scores were related to thyroid disease (0.70) and Stroke (0.54), respectively. Common chronic conditions had significant negative effects on the HRQoL scores. Stroke (0.204) and cancer (0.177) caused the most reduction in the EQ-5D-5L utility scores. Lumbar disc hernia, digestive diseases, osteoarthritis, breathing problems, and anxiety/nerves cause 0.133, 0.109, 0.108, 0.087, and 0.078 reductions, respectively, in the EQ-5D-5L utility scores. Conclusion This study provides insight into some common chronic conditions and their effects on the HRQoL. Policymakers and planners should pay attention to the effects of chronic conditions especially high prevalence one. They should adopt effective interventions to control this issue and increase health. The results of this study can also be beneficial in economic evaluation studies.

Abstract Background Integrated early childhood development (IECD) is a comprehensive approach to optimal development of children in different developmental domains from fetal stage to eight years of age. The aim of this study was to identify the factors affecting the process of policy-making for early childhood development and to clarify how these factors affect decision-making and create challenges in this regard. Method In a qualitative study, we used two main data sources including document analyses and interviews. Using purposive sampling, forty semi-structured interviews with policymakers and informants in the fields related to children were conducted in Tehran from October 2017 to June 2018. Also, 62 national and 10 international relevant documents were reviewed. A deductive-inductive approach was used to analyze the data. We used the MAXQDA11 software for data management. Results we identified 13 themes and 29 subthemes related to the stages of policymaking process including: Agenda setting (problem stream, policy stream, politics stream), Policy formulation (formulation and approval process, policy sustainability, mechanisms of stakeholders’ participation in policymaking), Policy implementation (conceptual ambiguity, intersectoral and trans-sectoral issues, structural capacities, mobilization of resources), and Policy evaluation (continuous and routine data registry system, comprehensiveness of indexes). We propose 19 policy recommendations to improve the situation. Conclusion As a multidisciplinary and multi-sectoral field with different domains, early childhood development (ECD) requires a more active role on the part of policymakers in governmental levels in supporting the related policies. Unless policymakers change their approach to decrease nonintegrated and non-comprehensive policymaking for ECD, child development will be compromised, which endangers the eventual sustainability of the society since improved IECD policy-making process improves developmental outcomes in children. In this regard, attention should be paid to the role of reinforcing intersectoral collaboration through incorporating it in the missions and the evaluation items of organizations, creating commitment in high organizational levels, and developing an inter-ministerial policymaking framework that clearly specifies the roles and responsibilities of every single sector and their interactions and collaborations.

Abstract Background Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP). Methods The data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country. Results Age-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively. Conclusions This study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.

Abstract Background Salinity is an important global problem with destructive impacts on plants leading to different biochemical and metabolic changes in plants through induced oxidative stress that disturbs metabolism, growth, performance and productivity of plants. Given that putrescine (Put) and carbon quantum dots (CQDs), individually, have promising effects in different plant processes, the idea of their combination in a nano-structure “Put-CQD” lead to its synthesis to evaluate the potential exertion of synergistic effects. The current study aimed to investigate the application of newly-synthesized nanoparticles (NPs) consisting of CQDs and Put in grapevine (Vitis vinifera cv. ‘Sultana’) under salinity stress conditions. For this purpose, Put, CQDs and Put-CQD NPs at 5 and 10 mg L− 1 concentrations were applied as chemical priming agents in ‘Sultana’ grapevine 48 h prior salinity stress imposition (0 and 100 mM NaCl). Results Salinity significantly decreased (P ≤ 0.05) morphological parameters, photosynthetic pigments, chlorophyll fluorescence parameters and membrane stability index. In addition, salinity enhanced MDA, H2O2, proline content and antioxidant enzyme activity. Results revealed that Put-CQD NPs, particularly at 10 mg L− 1 concentration, alleviated the destructive impacts of salinity stress by improving leaf fresh and dry weights, K+ content, photosynthetic pigments, chlorophyll fluorescence and SPAD parameters, proline content, total phenolics and antioxidant enzymatic activities (CAT, APX, GP and SOD), while decreasing Na+ content, EL, MDA and H2O2 levels. Conclusion To conclude, Put-CQD NPs represent an innovative priming treatment that could be effectively applied on grapevine to improve plant performance under salinity stress conditions.

Abstract Background Global concerns regarding the significant burden of non-communicable diseases and injuries (NCDIs) exist from both public health and economic perspectives. Our research focuses on the reduction of fatal risks due to NCDIs and the citizens’ preferences about health programs and intervention to reduce premature death due to NCDIs. Governments and health authorities need reliable evidence and information to prioritize the interests of their citizens. One crucial piece of evidence to justify the resources spent on NCDIs is the value derived from the interventions on prevention and NCDIs control. This concept is usually called “Value of Statistical Life” (VSL), meaning the monetary value that individuals place on changes in the risk levels of life- threatening events. To the best of our knowledge, for the first time, our study will estimate the statistical value of life for selected interventions for the prevention and control of NCDIs at both national and sub-national levels in the context of Iran. This paper reports the development of a national protocol through Discrete Choice Experiments (DCEs) method. Methods and designs Our study comprises several stages: (a) a literature review to identify the attributes and levels of the prevention programs and Willingness to Pay (WTP) for reducing the NCDI’s fatal risks; (b) experimental design to assessing, prioritizing, and finalizing the identified attributes and levels; (c) instrumental design to conduct face-to-face structured survey interviews of 3180 respondents aged 18–69 across the entire country; (d) statistical analysis to estimate the results through the Mixed Multinomial logit (MMNL) model. Discussion We anticipate that our findings will help build a stronger empirical basis for monetizing the value of small changes in selected fatality risks. It paves the way for other national or vast VSL estimates for NCDIs, as well as other major causes of morbidity and mortality in the context of Iran, and perhaps other low and middle-income countries (LMICs).

Abstract A method based on the concept of exergy-return on exergy-investment is developed to determine the energy efficiency and CO2 intensity of polymer and surfactant enhanced oil recovery techniques. Exergy is the useful work obtained from a system at a given thermodynamics state. The main exergy investment in oil recovery by water injection is related to the circulation of water required to produce oil. At water cuts (water fraction in the total liquid produced) greater than 90%, more than 70% of the total invested energy is spent on injection and lift pumps, resulting in large CO2 intensity for the produced oil. It is shown that injection of polymer with or without surfactant can considerably reduce CO2 intensity of the mature waterflood projects by decreasing the volume of produced water and the exergy investment associated with its circulation. In the field examples considered in this paper, a barrel of oil produced by injection of polymer has 2–5 times less CO2 intensity compared to the baseline waterflood oil. Due to large manufacturing exergy of the synthetic polymers and surfactants, in some cases, the unit exergy investment for production of oil could be larger than that of the waterflooding. It is asserted that polymer injection into reservoirs with large water cut can be a solution for two major challenges of the energy transition period: (1) meet the global energy demand via an increase in oil recovery and (2) reduce the CO2 intensity of oil production (more and cleaner energy).

Abstract In this study, (1 − x) BFO-xCFO (CFO, x = 0.00, 0.05, 0.10 and 0.30) ceramics were synthesized by a solid-state reaction method; their compositions were driven by structural, microstructural, vibrational, electrical, magnetic properties; their enhanced magneto capacitance (MC) effect have also been carried out. Reitveld refinement studies of X-ray diffraction data shows composition-driven structural phase transformation from rhombohedral (R3c) to tetragonal (P4mm). Two phonon scattering Raman modes were observed for the higher wavenumber which supports the crystal structural transition in the BFO-CFO. Ferroelectric polarization shows that the polarization increased with increasing CFO concentration, which describes the changes of the polar symmetry of the crystal structure from rhombohedral (R3c) to tetragonal (P4mm). In Further, the maximum efficiency of energy density (η = 68.65%), reversible energy density of 0.138 J/cm3 and the strong magneto capacitance was observed in 0.9BFO-0.1CFO, which belongs to the morphotropic phase boundary (MPB) region near to the BiFeO3-rich region. The magnetic response analysis has shown, the saturation magnetization (Ms) values of 83 emu/gm and 139 emu/gm for pure CFO and 0.7BFO-0.3CFO composite, respectively, and their magnetic behaviours were also confirmed with Arrott–Belov–Kouvel (ABK) plot.

Abstract Introduction Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. Methods An explanatory mixed-method approach will be used in two phases. In the quantitative phase, the performance of the Iranian health financing system will be assessed using a well-established set of indicators to draw on progress over 5-year intervals starting in the year 2000 up to the present. Data will be extracted from the global health expenditure database using a specific form and will be classified in accordance with each indicator. A qualitative phase will then take place considering the Kutzin et al. framework and by using health financing progress matrices. The qualitative phase will consist of two successive stages; first, a descriptive overview on the major health coverage schemes along with key attributes of each scheme. This initial mapping will be the underlying background for the second stage. In the second stage, the matrices comprised of a series of questions and relevant to the core functions of health financing and cross-cutting options will be invested in enhancing the evaluation of the ongoing reforms or policies. In this phase, data will be collected by reviewing national policy documents and in-depth interviews with key informants who will be recruited using purposive sampling. Finally, a policy discussion with key stakeholders will be held in order to review and verify the consistency between the current health financing policy and UHC goals. Discussion This study will provide a comprehensive image about the current status of the national health financing system progress towards achieving UHC in Iran. Such assessment will give detailed insight about the performance of the current financing system through identifying encountered challenges. Furthermore, some other defects in the design of the financing system are expected to appear. In all likelihood, the results will be fruitful enough to make informed decisions about interventions and policies in relation to UHC. Ethics and dissemination The study protocol has been approved by the Ethics Committee for Research at Tehran University of Medical Sciences. Informed consent will be obtained from all key informants and the data will be collected and transcribed anonymously in order to maintain utmost confidentiality. The results will be disseminated in peer-reviewed journals and presented in national and international conferences and meetings.

Introduction A life-threatening respiratory disease, coronavirus 2019 (COVID-19), has spread across the globe since December 2019. Many prognostic factors have already been put forward to predict the risk of death and other outcomes. The current study is evaluating the survival rate between hypertensive and non-hypertensive infected patients. Methods Patients who were included in this study were admitted between 20 February to 1 March 2020 in Fars (southwest of Iran) province hospitals. Data were collected from the electronic base registry which contained demographic information, medical symptoms, and signs, underlying diseases, CT scan results, and final outcome. Results Of all 1239 positive cases, 159 (12.83%) had known with hypertension ant this group was significantly older than non-hypertensive patients (66.1 years Vs 48.95 years, p

The purpose of the present study is to explain the criteria for the guardianship of the Islamic Jurist with an emphasis on the political ideas of Imam Khomeini. To this aim, descriptive analysis was used in this study to make an enquiry about the essence and arguments of the guardianship of the Islamic jurist, the jurists’ obligation to establish an Islamic state, the virtues and vices of the Islamic jurist’s political ethics, as well as the responsibility and authority of the Islamic jurist. Based on the triplet classification model in Islam and the framework of Imam Khomeini’s political ideology, the subject under study that is the guardianship of the Islamic jurist was classified into 3 aspects of political philosophy, political ethics, and political jurisprudence. In general, 33 criteria for different aspects of the guardianship of the Islamic jurist were extracted including 9 criteria about political philosophy, 15 criteria about political ethics, and 9 criteria about political jurisprudence. Furthermore, the results showed that there is a logical relationship between the 3 above-mentioned classified aspects, that is to say the imperfection and perfection of each aspect is effective on the others as well.

Abstract Background The outbreak of a new virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has now become the main health concern all over the world. Since effective antiviral treatments have not been developed until now, SARS-CoV-2 is severely affecting countries and territories around the world. Methods At the present review, articles in PubMed were searched with the following terms: mesenchymal stem cells, exosomes, coronavirus, and SARS-CoV-2, either alone or in a combination form. The most relevant selected functions were mesenchymal stem cell-derived exosomes and SARS-CoV-2 virus infection. Results SARS-CoV-2 could damage pulmonary cells and induce secretion of different types of inflammatory cytokines. In the following, these cytokines trigger inflammation that damages the lungs and results in lethal acute respiratory distress syndrome (ARDS). The main characteristic of ARDS is the onset of inflammation in pulmonary, hyaline formation, pulmonary fibrosis, and edema. Mesenchymal stem cell-derived exosomes (MSC-Exo) are believed to have anti-inflammatory effects and immune-modulating capacity as well as the ability to induce tissue regeneration, suggesting a significant therapeutic opportunity that could be used to SARS-CoV-2 pneumonia treatment. Besides, exosomes may serve as a biomarker, drug delivery system, and vaccine for the management of the patient with SARS-CoV-2. Conclusion MSC-Exo may serve as a promising tool in the treatment of SARS-CoV-2 pneumonia. However, further work needs to be carried out to confirm the efficacy of exosomes in the treatment of SARS-CoV-2 pneumonia.

The aim of this study was investigating the stress levels of mental health professionals in the process of diagnosis and treatment of mental disorders based on the Kuhlthau's Information Search Process (ISP). The present study was an applied research project and used a quasi-experimental method. The population consists of psychologists and psychiatrists with more than two years of treatment experience. The sample includes 30 therapists who are chosen in a public call during a competition called Top Therapists. The competition was held at Atieh Clinic in 2018. To gather data, some tools such as Questionnaire, Stress Response Evaluation, and Morae software were used. The findings show that the therapists, contrary to the Kuhlthau's view, experience a certain amount of stress at all stages of Kuhlthau's ISP. This level of stress, which is significantly different from the baseline stress of therapists, does not change considerably in most stages of Kuhlthau's ISP. This stress is seen as a useful and effective one, based on the focus and excitement of the therapists in the diagnosis and treatment process. In addition, all demographic variables except gender may have a significant effect on stress. Finally, it can be concluded that by relying on modern neuroscience and information technology tools, one can provide a better understanding of the moment-by-moment process of therapists' information seeking behavior.

Introduction: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a global concern for public health. Having sufficient data is the first step to understand the behavior of contagious diseases such as the COVID-19 pandemic. Although various studies have assessed COVID-19 features, there are many limitations about patients’ characteristics, complications, and outcomes in different countries including Iran. The present study reported launching an electronic database for COVID-19 patients in Fars province, Iran. Method: A comprehensive web-based multicenter registry was designed and launched by Shiraz University of Medical Sciences in order to collect all information about COVID-19 hospitalized patients in Fars province, Iran. Results: In this registry, patients’ demographic characteristics, chest computed tomography scan findings, laboratory tests, complications during hospitalization, treatments, and disease course in Intensive Care units are recorded on a web-based electronic database. The virtual statues of the patient’s family are evaluated by telephone calls, and the proceeding will be implemented for quarantine and hospitalization if required. Conclusion: The registry is hoped to help all scientists to understand the current challenges and be prepared for possible future waves of the epidemic. Finally, this registry is a resource for all researchers who are interested in coronavirus and plays an important role in supporting the scientific community on the frontlines of combating the virus.

Abstract Background Eukaryotic cells demonstrate two tightly linked vesicular transport systems, comprising intracellular vesicle transport and extracellular vesicle transport system. Intracellular transport vesicles can translocate biomolecules between compartments inside the cell, for example, proteins from the rough endoplasmic reticulum to the Golgi apparatus. Whereas, the secreted vesicles so-called extracellular vesicles facilitate the transport of biomolecules, for example, nucleic acids, proteins and lipids between cells. Vesicles can be formed during the process of endocytosis or/and autophagy and not only act as mediators of intra- and inter-cellular communication but also represent pathological conditions of cells or tissues. Methods In this review, we searched articles in PubMed, published between 2000 and 2020, with following terms: autophagy, autophagocytosis, transport vesicles, lysosomes, endosomes, exocytosis, exosomes, alone or in different combinations. The biological functions that were selected based on relevancy to our topic include cellular homeostasis and tumorigenesis. Results The searched literature shows that there is a high degree of synergies between exosome biogenesis and autophagy, which encompass endocytosis and endosomes, lysosomes, exocytosis and exosomes, autophagocytosis, autophagosomes and amphisomes. These transport systems not only maintain cellular homeostasis but also operate synergically against fluctuations in the external and internal environment such as during tumorigenesis and metastasis. Additionally, exosomal and autophagic proteins may serve as cancer diagnosis approaches. Conclusion Exosomal and autophagy pathways play pivotal roles in homeostasis and metastasis of tumor cells. Understanding the crosstalk between endomembrane organelles and vesicular trafficking may expand our insight into cooperative functions of exosomal and autophagy pathways during disease progression and may help to develop effective therapies against lysosomal diseases including cancers and beyond.

Abstract Objectives EQ-5D is the most commonly used generic preference-based health-related quality of life (HRQoL) measure. The current study aimed at estimating the HRQoL index scores using EQ-5D-5 L measure in the capital of Iran; moreover, identifying some determinants of the HRQoL. Methods A sample of 3060 subjects was selected by a stratified random sampling method from the general adult population of Tehran. Face-to-face interview was conducted to fill out the questionnaire, in this cross-sectional survey. EQ-5D-5 L utility score were estimated using an interim value set, based on a crosswalk methodology. Additionally, the relationships between HRQoL and sociodemographic characteristics were tested by generalized linear model, using STATA version 13. Results The mean ± standard deviation utility and EQ-VAS scores were 0.79 ± 0.17 and 71.72 ± 19.37. The utility scores ranged 0.61 ± 0.19 in > 69 year-old females to 0.88 ± 0.12 in

The transition from rural highways that afford higher speeds, to urban communities with lower speed limits and wide ranges of road users is a critical safety issue in Northern Iran that such transitions are frequent along a high-way running approximately parallel to the Caspian Sea shoreline and linking >50 urban communities. This study aims to investigate the efficiency of 4 low-cost traffic calming measurements (TCM) at a simulated 1.5 km length of this rural highway as a representative. 39 participants with at least 3 years of driving experience took part in this study, and comparisons of driver behaviors in case of speed and lateral position as a safety index in 4 scenarios and base scenario were outputted. MANOVA analysis was conducted on speed and lateral position data outputted from the simulator device, at the entry into the urban community. Comparison of mean speed results obtained revealed that all 4 treatments significantly reduced the mean speed of drivers. In this respect, the benefits of modified road signs were proven to be as successful as road surface markings. As another criterion for safety, the investigation showed road signs and transverse rumble strips increased lateral position, but the pattern of peripheral hatched markings significantly reduced the lateral position. In case of speed reduction, maintaining the reduced speed is another issue that has been resulted that as soon as TCMs end up, the speed increases, however, does not reach the former values. Keywords: Driving simulator, Traffic calming, Speed, Lateral position, Safety

Background: equality in access of health care services is one of the most important goals of Health system .In this study, we provided a description of the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Materials & Methods: This descriptive-analytical study was conducted in 2017 to describe the distribution of Otorhinolaryngology Head & neck surgery specialists in the Provinces of Iran in 2017. Data were gathered through Ministry of Health and Statistical Center of Iran. Gini Coefficient, Concentration Curve ,Multiple Regression and Geographic Maps used by Microsoft R Version 3-6-0 for data analysis. Results: The highest and lowest ratio of Otorhinolaryngology Head & neck surgery specialists per population in the year 2017 was reported in Tehran (2.31 per 100,000 populations) and Hormozgan (0.39 per 100,000 populations). Conclusion: There was a considerable disparity between different regions of the country in terms of access to Otorhinolaryngology specialists.

This study is to explore the cognitive components of therapists' information seeking behavior in the diagnosis and treatment of mental disorders. According to the high power of neuroscience tools in the analysis of immediate cognitive components, Quantitative Electroencephalography (QEEG) was used. Following, five of the therapists were selected by random sampling from a variety of researchers and entered in the research process. To gather data, some tools such as QEEG and Morae software were used. The findings showed that the brain waves of the therapists in the early stages of Kuhlthau's ISP revealed extensive cognitive activities. As the therapists moved on to the final stages of Kuhlthau's ISP, these cognitive activities diminished and the brain emotions overcame. Based on the findings, the best step for librarian intervention to guide and assist clinicians was the stage 3 of Kuhlthau’s ISP. Also, the findings indicated that the therapists’ information seeking behavior in the cognitive actions section was similar to the Kuhlthau's ISP Model. Finally, it can be concluded that based on modern neuroscience and information technology tools, one can provide a better understanding of the up-to-the-minute process of therapists' information seeking behavior, and due to smart and personalized systems , provide at the right moment, the appropriate information to the users. This evolution can be a major step in promoting information seeking behavior and advancing in the user information needs momently.

Introduction: Using the rapid antigen test (RAT) before exhausting the reverse transcriptase-polymerase chain reaction (RT-PCR) test’s capacity is crucial to enhance suitable detection of patients and timely reception of results. Therefore, this study was done to evaluate the sensitivity and specificity of RAT and compare it with the RT-PCR method in the diagnosis of Coronavirus disease-2019 (COVID-19). Materials and Methods: This study was performed on 634 individuals referred to public sampling centers performing the COVID-19 test in Shiraz City, Fars Province, Southern Iran. The sampling process was done following a multi-stage stratified protocol. The COVITECH® one-step real-time RT-PCR kit method as the reference standard test was compared with the RAT using E-Health Barakat Company® rapid antigen kit in the pharyngeal specimens. The trained personnel collected the data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value, and the accuracy of the RAT were calculated using the MedCalc software. Moreover, the Kappa value was used to assess the level of agreement between RT-PCR and RAT. Results: According to the results of the RT-PCR method as a reference test; sensitivity, specificity, Kappa value, and accuracy of the RAT were 81.82%, 92.28%, 63.8%, and 91.01%, respectively in the diagnosis of COVID-19. In asymptomatic individuals, the specificity and the PPV of the RAT were 100%. Conclusion: In conclusion, our results suggested that a positive RAT provides considerable information for diagnosing COVID-19 in adults. As a result, in general, due to the high sensitivity, specificity, and accuracy of the RAT, it can be replaced with the RT-PCR test considering factors such as time, cost, and speed.

Background: Identifying effective biomarkers plays a critical role on screening; rapid diagnosis; proper managements and therapeutic options, which is helpful in preventing serious complications. The present study aimed to compare the liver laboratory tests between alive and dead hospitalized cases for prediction and proper management of the patients. Methods: This retrospective, cross sectional study consists of all deceased patients admitted in one center in Shiraz, Iran during 19 Feb 2020 to 22 Aug 2021. For further comparison, we selected a 1:2 ratios alive group randomly. Results: Overall, 875 hospitalized cases died due to COVID-19. We selected 1750 alive group randomly. The median age was significantly higher in died group (65.96 vs 51.20). Regarding the laboratory findings during the hospitalization ALT, AST, Bili.D were significantly higher in non-survivors than survivors but Albumin was less in deceased patients. It was revealed elevated levels of Albumin, AST, Bili.T and Bili.D were associated with increasing the risk of in hospital death. Moreover, the predictive effect of ALP and Bili.D had significantly more than others with high sensitivity and specify. Conclusion: We found patients with COVID-19 have reduced serum albumin level, and increase ALT and AST. The current results revealed abnormal liver chemistries is associated with poor outcome, which highlighted the importance of monitoring these patients more carefully and should be given more caution.

Cancer is the main cause of death worldwide. The limitations in traditional cancer therapies provoked the advance and use of several nanotechnologies for more effective and nontoxic cancer treatment. Along with synthetic nanocarriers, extracellular vesicles (EVs)-mediated drug delivery systems have aroused substantial interest. The term EVs refers to cell-derived nanovesicles, such as exosomes, with phospholipid-bound structures, participating in cell-to-cell communication. Exosomes are 30–150 nm vesicles that can transfer many biological molecules between cells. From a drug delivery standpoint, exosomes can be loaded with various therapeutic cargo, with the several advantages of low immunogenicity, high biocompatibility, transformative, and effective tumor targeting aptitude. The exosomal surface can be functionalized to improve tumor targeting ability of them. Researchers have genetically expressed or chemically linked various molecules on the surface of exosomes. Despite extensive investigation, clinical translation of exosome-based drug delivery remains challenging. In this review, we discuss various methods used to loading exosomes with therapeutic cargo. We describe examples of functionalized exosomes surface using genetic and chemical modification methods. Finally, this review attempts to provide future outlooks for exosome-based targeted drug delivery.

Background: Human hydatidosis as a public concern has increased in a number of countries that have reduced control programs for the disease due to lack of resources or policies. We aimed to estimate Disability-Adjusted Life Years (DALYs) for human hydatidosis in Iran in 2018. Methods: Data were collected from the Center of Communicable Diseases Control, Ministry of Health &Medical Education, Tehran, Iran in 2018. To calculate DALYs, years of life lost due to premature death (YLL) with years of life with disability (YLD) were calculated according to the formula as DALY = YLL + YLD. The standard life expectancy lost method (SEYLL) was used to calculate the years lost due to premature death. Results: DALYs for human hydatidosis was calculated as 1210.12 years (YLD equals to 177.12 and YLL equals to 1033) in Iran for the year 2018. It was estimated to be 700.2 years for men and 509.8 years for women. DALYs in men were significantly different from women (P= 0.001) so DALYs were more in men than women were. YLD was calculated at 78.228 years in men and 98.892 years in women and in both men and women at 177.12 years. YLD was significantly different in women compared to men (P=0.001), so YLD in women was more than in men. Conclusion: We reached considerable indices for hydatidosis in our study. Therefore, disease prevention and control programs in Iran seem necessary by the policy makers.

Humans do different behaviors to meet their needs constantly. These behaviors are different and each of them constitute subject of disciplines such as psychology, sociology, management, art, knowledge and information science, and some specialized sub disciplines of them. Investigating information behaviors and knowledge behaviors are favorite subjects in knowledge and information science. These behaviors show the main elements of user activity in interact with information and knowledge as well as retrieval systems. This paper with Considering the importance of these concepts, tries to review of literature through analytical and discussed concepts such as data, information, knowledge, wisdom, and intelligence. Afterwards express the prerequisites for the formation of knowledge seeking behavior and be provided the definition of knowledge seeking behavior and differentiation with information seeking behavior. The surveys showed the concept of knowledge seeking behavior, an important concept and are very wide, in order that we can expect the new area opens in literature and research in various fields especially in knowledge and information science. It seems that the efforts in developing and regulates a framework is essential in this field.

Background The preferences of Iranians concerning the attributes of health insurance benefit packages are not well studied. This study aimed to elicit health insurance preferences among insured people in Iran during 2016. Methods A mixed methods study using a discrete choice experiment (DCE) approach was conducted to elicit health insurance preferences on a total sample of 600 insured Iranians residing in Tehran. The final design of the DCE included 8 health insurance attributes. Data were analyzed using conditional logistic regression models. Results The final model of this DCE study included 8 attributes, and the findings indicated statistically significant (P < .001) increase in the odds ratio (OR) of choosing health insurance at all levels of cost coverage except for the rehabilitation and para-clinical benefits, where at 70% cost coverage there was insignificant (P = .485) disutility (OR = 0.95). With the increase in cost coverage level, the probability of choosing health insurance was significantly (P < .001) the highest for the private hospitals’ benefits (OR = 2.82) followed by public hospitals’ benefits (OR = 2.02) and outpatient benefits (OR = 1.75), and the premium revealed statistically significant (P < .001) disutility (OR = 0.96). Conclusion Our findings revealed that participants would be willing to choose health insurance plans with higher cost coverage of healthcare services and with lower premiums. However, the demographic characteristics, income, and health status of the insured individuals affected their health insurance preferences. The findings can contribute to the design of better health insurance policies, improve the participation of individuals in health insurance, and increase the insured individuals’ utility from the insurance benefits packages.

Objective People with disabilities are more likely to experience poorer health status, compared to the general population; however, their health issues do not receive enough attention from policymakers. This article aimed to identify the factors that hinder the health problems of people with disabilities to be on the national agenda in Iran. Materials & Methods This phenomenological qualitative research was conducted in Tehran City, Iran, from September 2015 to March 2017. We conducted 22 quasi-structured face to face interviews with relevant policymakers at the national level. Snowball sampling method was applied to identify the interviewees. The interviewees were well-informed and had long and valuable experiences in the field of policymaking for people with disabilities. The policymakers from a verity of public organizations, ministries, non-governmental organizations, Islamic Consultative Assembly, Tehran municipality and the health insurance organizations participated in the study. We used an interview guide in data collection process which covered the main study questions. On average, the interviews lasted about 30 minutes to 1.5 hours. The validity of the study was assessed through member checking. Thematic analysis was performed in three steps to identify the main concepts of the study. In open coding, identifying, naming and describing phenomena in the text were performed. Following open coding, codes were grouped into several subcategories. Then, the main concept of the study was created by formulating a general description of generated subcategories. We used MAXQDA to analyze the obtained data. Results We found three main categories and 13 subcategories. In the influence category, three subcategories were created; low influence in the policy process, the lack of structural independence, the inferiority of associations and nongovernmental organizations’ positions for policymakers and the low ability in lobbying and networking. In the minority category, we found 6 subcategories consisting of more attention to public health issues by policymakers, neglect of the specific needs of minority groups by health policymakers, policymakers’ unattractiveness in the health problems of people with disabilities, the lack of significant financial and political benefits for policymakers, the lack of awareness about the health issues of people with disabilities, and the inferiority of disability issues for policymakers. In the category of lack of integrated voice, three subcategories were created, including a lack of integration among people with disabilities, inattention to personal and group interests and the lack of coherent communication networks. Conclusion To meet their requirements, it is essential to enhance the influence of people with disabilities, associations and the welfare organization in the policymaking process. This can be achieved by increasing the interaction of significant individuals in the disability area with other key policymakers in other sectors. Running campaigns, engaging with celebrities as well as experienced and influential managers, and the systematic use of media and social networks may improve policymakers' attention to prioritizing health issues of people with disabilities.

Background: Hospital accreditation is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. Accreditation has an important role in improving the quality, safety, effectiveness and efficiency of hospital services. This study aimed to examine the effects of hospital accreditation program from hospitals managers’ perspective. Methods: This descriptive and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire designed to examine accreditation effects on hospital performance, hospital employees, patients, and the society. The study population consisted of 914 hospital managers in Iran. Overall, 547 hospital managers were surveyed through stratified random sampling. Results: About 71% of hospitals achieved grade one and above accreditation status. The mean score of accreditation positive effects in hospitals was 3.16±0.66 out of 5 (Average). Almost 38% of managers were satisfied with the accreditation results in their hospitals. Hospital accreditation program was successful in improving patient and staff safety, reducing medical errors and enhancing staff competencies. Its success in improving communication, promoting organizational culture, continuous quality improvement, resource utilization, and reducing nosocomial infections and hospital mortality rates was moderate. Accreditation was less successful in improving staff satisfaction, getting physicians involved in process improvement, practicing evidence based medicine, attracting patients and increasing hospital income. A statistically significant correlation was found between hospital size and accreditation results (P=0.038, r=-0.090). There was no correlation between using quality management models and getting better accreditation results (P=0.085). However, there was correlation between using accreditation consultants and positive accreditation results (P=0.045, r=-0.087). Utilizing hospital resources, organizational learning, continuous quality improvement and effective communication had the most effect on accreditation success. Conclusion: The accreditation program had a moderate effect on hospital performance. It is costly to implement accreditation standards in hospitals. Hence, changes should be made to the accreditation system including accreditation standards and methods in order to have more positive effects on the staff and hospitals’ performance.

Objectives The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions. Methods This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework. Results The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage. Conclusions A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.