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Objective: Public health surveillance is an important aspect of outbreak early warning based on prediction models. The present study compares a hybrid model based on discrete wavelet transform (DWT) and ARIMA (Autoregressive Integrated Moving Average) for predicting incidence cases due to COVID-19. Methods: In the current cross-sectional stuady based on time-series data, the incidence data for confirmed daily cases of COVID-19 from February 26, 2019, to April 25, 2022, were used. A hybrid model based on DWT and ARIMA and a pure ARIMA model were used to predict the trend. All analyzes were performed by MATLAB 2018, stata 2015, and Excel 2013 computer software. Results: Compared to the ARIMA model, the prediction results of the hybrid model were closer to the actual number of incident cases. The correlation between predicted values by the hybrid model with real data was higher than the correlation between predicted values by the ARIMA model with actual data. Conclusions: Discreet Wavelet decomposition of the dataset was combined with an ARIMA model and showed better performance in predicting the future trend.

Objectives The burden of disease analysis can be used to measure the factors that are suitable for interventions for disease control. This study aims to calculate the burden of risk factors for common cancers among the elderly in Markazi Province of Iran in 2016. Methods & Materials This a retrospective descriptive-analytical study. Information was collected based on age and sex groups, which included the cancer incidence rate, cancer death rate, cancer disability rate based on the GBD standard table, which were collected from the website of Statistics Centre of Iran, the latest death report and the latest cancer report in 2016. The data analyses were done in Excel and DISMOD2 applications. The disease burden calculation formula was used in this study. To ensure the validity and reliability of the data, the data with wrong or useless codes were excluded. Results For skin cancer, the highest burden was related to exposure to sunlight (526.71); for stomach cancer, family history (79305.88); for colon, lack of fruit consumption (4063.18); for breast cancer, lack of marriage (6488.58); and for prostate cancer, history of previous diseases (7244.08). Conclusion Family history of cancer, smoking, obesity, and physical inactivity are common risk factors of most cancers with a same burden.

In the ever-evolving landscape of infertility science,clinical trials emerge as the cornerstone of progress. Thesetrials, propelled by the unwavering dedication of scientificpioneers, serve as the bedrock for innovation and discoveryin reproductive health. Through rigorous experimentationand meticulous analysis, they illuminate the path towardsnovel solutions for the complex challenges of infertility.

Objectiv(s): The aim of this study was to determine the effect of pre-service e-learning on health care providers’, knowledge in terms of family health cares. Methods: This was a pre- and post-test design study. The framework for developing the course was based on the stages of the General Educational Design Model (ADDIE). First, the content was designed and uploaded in Learning Management System (LMS). Then, using the census sampling method, all female health care providers who had started working as health care provider in the health care facilities affiliated to Iran University of Medical Sciences in a period of 6 months in 2021-2022 were included in the study. First, their knowledge of the course contents was measured. They received training upon entering the service electronically. Finally, their knowledge and skills were assessed by an exam. The level of their satisfaction and skills after participating in the course was also assessed. The data were analyzed by SPSS statistical software. Results: In all 73 trainee included in the study. The results of the study showed that the mean total score of health care providers' knowledge, after participating in the designed e-learning course significantly increased compared to before participating in the course (p = 0.01). The findings showed that the highest satisfaction score of the participants was related to the suitability of the evaluation with the content presented in the course (86% of the participants reported good to very good level). The lowest satisfaction was related to support in technical issues (47% of the participants was reported good to very good level). The most acquired skill was related to the ability to assess a child health status (100% of the participants reported good to very good level) and the least acquired skill was related to the ability to identify the health status of pregnant mother (45% of the participants reported good to very good level). Conclusion: This study showed that participating in pre-service e-learning training may increase the knowledge of female health care providers in various components of family health care.

The coronavirus 2019 (COVID-19) pandemic resulted in serious limitations for healthcare systems, and this study aimed to investigate the impact of COVID-19 surges on in-patient care capacities in Iran employing the Adaptt tool. Using a cross-sectional study design, our study was carried out in the year 2022 using 1-year epidemiologic (polymerase chain reaction-positive COVID-19 cases) and hospital capacity (beds and human resource) data from the official declaration of the pandemic in Iran in February 2020. We populated several scenarios, and in each scenario, a proportion of hospital capacity is assumed to be allocated to the COVID-19 patients. In most of the scenarios, no significant shortage was found in terms of bed and human resources. However, considering the need for treatment of non- COVID-19 cases, in one of the scenarios, it can be observed that during the peak period, the number of required and available specialists is exactly equal, which was a challenge during surge periods and resulted in extra hours of working and workforce burnout in hospitals. The shortage of intensive care unit beds and doctors specializing in internal medicine, infectious diseases, and anesthesiology also requires more attention for planning during the peak days of COVID-19.

Abstract Background Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Abstract Background and Aim Timely detection of outbreaks is one of the main purposes of the health surveillance system. The presence of appropriate methods in the detection of outbreaks can have an important role in the timely detection of outbreaks. Because of the importance of this issue, this study aimed to assess the performance of discrete wavelet transform (DWT) based methods in detecting influenza outbreaks in Iran from January 2010 to January 2020. Methods All registered influenza‐positive virus cases in Iran from January 2010 to January 2010 were obtained from the FluNet web base tool, the World Health Organization website. The combination method that includes DWT and Shewhart control chart was used in this study. All analyses were performed using MATLAB software version 2018a Stata software version 15. Results The Mean ± SD and median of reported influenza cases from January 2010 to January 2020 was 36 ± 108 and four cases per week. The combination of the DWT and Shewhart control chart with K = 0.25 had the most sensitivity. The most specificity in the detection of nonoutbreak days was seen in the combination of DWT and Shewhart control chart with K = 1.5, K = 1.75, and K = 2, respectively. The combination of DWT and Shewhart control chart with K = 0.5 had the best performance in the detection of outbreaks (sensitivity = 0.64, specificity: 0.90, Youden index: 0.54, and area under the curve [AUC]: 0.77). Conclusion The DWT‐based method in detecting influenza outbreaks has acceptable performance, but it is recommended that this method's performance be assessed in detecting outbreaks of other infectious diseases.

Abstract Background Vaccination is a key intervention to prevent COVID-19. Many vaccines are administered globally, yet there is not much evidence regarding their safety and adverse effects. Iran also faces this challenge, especially as data regarding the Sputnik V vaccine is sparse. Therefore, the aim of this study is to determine the adverse effects of the most commonly used vaccines in Iran. Methods Using a retrospective cohort study design, 6600 subjects aged 18 years or older who had received two doses of any of the three COVID-19 vaccines (Sinopharm, AstraZeneca, and Sputnik V) were selected using a random sampling method between March and August 2021. Subjects were asked about any adverse effects of the vaccines by trained interviewers via telephone interview. Vaccine-related adverse effects in individuals during the first 72 h and subsequently following both doses of the vaccines were determined. The demographic variables, type of administered vaccine, adverse effects, and history of the previous infection with COVID-19 were collected. Descriptive statistics (mean, standard deviation) and analytical statistics (Chi-squared and Wilcoxon tests) were performed at a 95% significance level using STATA software version 15 (STATA Corp, College Station, TX, USA). Results From 6600 participants, 4775 responded (response rate = 72.3%). Of the participants, 1460 (30.6%) received the AstraZeneca vaccine, 1564 (32.8%) received the Sinopharm vaccine and 1751 (36.7%) received the Sputnik V vaccine. 2653 participants (55.56%) reported adverse effects after the first dose and 1704 (35.7%) after the second dose. Sputnik V caused the most adverse effects with 1449 (82.7%) vaccine recipients reporting symptoms after the first or second dose, compared with 1030 (70.5%) for AstraZeneca and only 585 (37.4%) for the Sinopharm vaccine. The most common adverse effects after the first dose were fatigue (28.37%), chill/fever (26.86%), and skeletal pain (22.38%). These three adverse effects were the same for the second dose, although their prevalence was lower. Conclusions In this study, we demonstrate that the Sputnik V vaccine has the highest rate of adverse effects, followed by the AstraZeneca and Sinopharm vaccines. COVID-19 vaccines used in Iran are safe and there were no reports of serious adverse effects.

Background: The multi-state models help more closely study of the factors affecting the survival of patients with breast cancer. Method: We conducted the present retrospective cohort study on 2030 Iranian patients with breast cancer in 2020. The patients’ follow-up period ranged from 1 month to 15 years. Accordingly, the initial treatment, metastasis, and death were considered as the first, second, and absorbing states, respectively. The multi-state model was utilized for modeling and analyzing the data at a 95% significance level using the MSM package in R software. Results: The mean age (± standard deviation) of the patients included at diagnosis time was 55.3 (±12.07) years old. The first one year and 5 years adjusted transition probabilities for transitions from the treatment to metastasis estimated as 0.85 (0.15 – 0.89) and 0.45 (0.21 – 0.61), and for metastasis to death transitions, they were estimated as 0.15 (0.1 – 0.21) and 0.55 (0.41 - 0.69), respectively. Moreover, the average sojourn times were estimated as 0.27 and 74.85 months for the treatment and metastasis states, respectively. Conclusion: The obtained results revealed that over time, the transition probabilities of patients from surgery to metastasis state decreased, whereas the transition probabilities from metastasis to death state increased using the multi-state model.

BackgroundThe distribution of population-level real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values as a proxy of viral load may be a useful indicator for predicting COVID-19 dynamics. ObjectiveThe aim of this study was to determine the relationship between the daily trend of average Ct values and COVID-19 dynamics, calculated as the daily number of hospitalized patients with COVID-19, daily number of new positive tests, daily number of COVID-19 deaths, and number of hospitalized patients with COVID-19 by age. We further sought to determine the lag between these data series. MethodsThe samples included in this study were collected from March 21, 2021, to December 1, 2021. Daily Ct values of all patients who were referred to the Molecular Diagnostic Laboratory of Iran University of Medical Sciences in Tehran, Iran, for RT-PCR tests were recorded. The daily number of positive tests and the number of hospitalized patients by age group were extracted from the COVID-19 patient information registration system in Tehran province, Iran. An autoregressive integrated moving average (ARIMA) model was constructed for the time series of variables. Cross-correlation analysis was then performed to determine the best lag and correlations between the average daily Ct value and other COVID-19 dynamics–related variables. Finally, the best-selected lag of Ct identified through cross-correlation was incorporated as a covariate into the autoregressive integrated moving average with exogenous variables (ARIMAX) model to calculate the coefficients. ResultsDaily average Ct values showed a significant negative correlation (23-day time delay) with the daily number of newly hospitalized patients (P=.02), 30-day time delay with the daily number of new positive tests (P=.02), and daily number of COVID-19 deaths (P=.02). The daily average Ct value with a 30-day delay could impact the daily number of positive tests for COVID-19 (β=–16.87, P

Introduction WHO declared vaccine hesitancy as a global public health threat in 2019. Since even a slight reduction in vaccine coverage rates can lead to a decrease in herd immunity, it is imperative to explore the underlying factors affecting vaccine hesitancy. This qualitative study protocol aims to explore determinant factors that influence vaccine hesitancy in Iran from the parent’s perspective.Methods and analysis Descriptive-Interpretive Qualitative research will be conducted to gain an insight into vaccine hesitancy in the west of Tehran province in Iran. Participants in the study will be recruited from vaccine-hesitant parents of children under 5 years’ old who will be recognised as being hesitant to extract from the national health information system. The semistructured interviews and in-depth questions will be performed both face-to-face in an open space such as a park near their homes and via video call because of the COVID-19 pandemic and social distancing. Interviews will be conducted by a trained qualitative person. Transcribed data will be analysed through thematic analysis.Ethics and dissemination Ethics approval was obtained from the research ethics committee at the Iran University of Medical Sciences (Approval ID #IR.IUMS.REC.1399.273). The results of the study are expected to be presented by the end of 2022 year. A variety of dissemination methods will be employed to communicate research findings, including presentations at conferences and peer-reviewed publications.

Abstract Background Hospital-acquired infections (HAIs) are a well-known cause of morbidity and mortality in hospitalized patients. This study aimed at investigating the survival rate in patients with ICU-acquired infections (ICU-AIs) and its related factors in Iran’s hospitals. Methods Data were obtained from the Iranian Nosocomial Infections Surveillance (INIS), which registers all necessary information on the main types of infection from different units of each included hospital. One thousand one hundred thirty-four duplicate cases were removed from the analysis using the variables of name, father’s name, age, hospital code, infection code, and bedridden date. From 2016 to 2019, 32,998 patients diagnosed with ICU-AI from about 547 hospitals. All patients were followed up to February 29, 2020. Results The median age of patients with ICU-AIs was 61 (IQR = 46) years. 45.5, 20.69, 17.63, 12.08, and 4.09% of infections were observed in general, surgical, internal, neonatal and pediatric ICUs, respectively. Acinetobacter (16.52%), E.coli (12.01%), and Klebsiella (9.93%) were the major types of microorganisms. From total, 40.76% of infected patients (13,449 patients) died. The 1, 3, 6-months and overall survival rate was 70, 25.72, 8.21 1.48% in ICU-AI patients, respectively. The overall survival rate was 5.12, 1.34, 0.0, 51.65, and 31.08% for surgical, general, internal, neonatal and pediatric ICU, respectively. Hazard ratio shows a significant relationship between age, hospitalization-infection length, infection type, and microorganism and risk of death in patients with ICU-AI. Conclusions Based on the results, it seems that the nosocomial infections surveillance system should be more intelligent. This intelligence should act differently based on related factors such as the age of patients, hospitalization-infection length, infection type, microorganism and type of ward. In other words, this system should be able to dynamically provide the necessary and timely warnings based on the factors affecting the survival rate of infection due to the identification, intervention and measures to prevent the spread of HAIs based on a risk severity system.

Introduction: Patients admitted to intensive care units (ICUs) are particularly susceptible to hospital-acquired infections (HAIs). This study aimed to investigate factors related to the incidence of ICU-AIs in Iran. Materials and Methods: In this study, Iranian nosocomial infections surveillance and hospital statistics and information system were used to collect data on patients with HAIs in 2018. The data was expanded based on 12 months of the year (13,632 records in terms of “hospital-ward-month”) and then, the last observation carried forward method was used to replace the missing data. The generalized negative binomial regression with “patient-days” as an offset variable was used to identify the factors affecting the incidence of ICU-AIs. Results: Of the patients 22.92%, 5.76%, 13.62%, 43.41%, and 14.29% of were in neonatal ICU, pediatric ICU (PICU), internal ICU, general ICU, and surgical ICU (SICU), respectively. The most common ICU-AIs were ventilator-associated events (VAE) and urinary catheter-related infections (UTI). Based on multivariable regression, the number of death [incidence rate ratio (IRR)=1.02], the number of device-related infections (IRR=1.1), ward type [PICU (IRR=1.58), internal ICU (IRR=1.63), general ICU (IRR=1.53) and SICU (IRR=1.47)], bed occupancy rate indicator (IRR=1.17 for moderate conditions), hospital’s accreditation (IRR=1.23 and IRR=1.73 for accreditation 1 and 2, respectively) and hospital’s expertise were associated with an increase in ICU-AIs incidence. Conclusion: Based on the results, the most common ICU-AIs were VAE and UTI. Therefore, to reduce incidence of ICU-AIs, full hygiene control should be performed by the medical staff. Ventilators and catheters should be used in special circumstances with minimum duration.

Abstract Background Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. Methods For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of “hospital-ward-month”), and then, the last observation carried forward method was used to replace the missing data. Results The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran’s hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83% of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. Conclusions HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier.

Abstract Background Surgical Site Infections (SSIs) are among the leading causes of the postoperative complications. This study aimed at investigating the epidemiologic characteristics of orthopedic SSIs and estimating the under-reporting of registries using the capture-recapture method. Methods This study, which was a registry-based, cross-sectional one, was conducted in six educational hospitals in Tehran during a one-year period, from March, 2017 to March, 2018. The data were collected from two hospital registries (National Nosocomial Infection Surveillance System (NNIS) and Health Information Management database (HIM)). First, all orthopedic SSIs registered in these sources were used to perform capture-recapture (N = 503). Second, 202 samples were randomly selected to assess patients` characteristics. Results Totally, 76.24% of SSIs were detected post-discharge. Staphylococcus aureus (11.38%) was the most frequently detected bacterium in orthopedic SSIs. The median time between the detection of a SSI and the discharge was 17 days. The results of a study done on 503 SSIs showed that the coverage of NNIS and HIM was 59.95 and 65.17%, respectively. After capture-recapture estimation, it was found that about 221 of orthopedic SSIs were not detected by two sources among six hospitals and the real number of SSIs were estimated to be 623 ± 36.58 (95% CI, 552–695) and under-reporting percentage was 63.32%. Conclusion To recognize the trends of SSIs mortality and morbidity in national level, it is significant to have access to a registry with minimum underestimated data. Therefore, according to the weak coverage of NNIS and HIM among Iranian hospitals, a plan for promoting the national Infection Prevention and Control (IPC) programs and providing updated protocols is recommended.

IntroductionThe prevalence of self-medication of antibiotics has been revealed in various studies. The main aim of this work is to investigate the frequency of self-medication in children under 6 years and the factors affecting it.MethodsThis is a population-based cross-sectional study conducted in the Arak metropolitan in the center of Iran from January 2019 to January 2020. We used stratified random sampling to determine recruitment criteria. As 1754 households were invited to the study that 1483 were approved to participate. Children's data were obtained by the interview with their mothers. In order to define self-medication consumption of antibiotics, it was adapted between annually maternal self-reported consumption of antibiotics among their children and history of received antibiotics registered in insurance services during the same time period. Logistic regression models were exploited to obtain odds ratios and 95% confidence intervals.ResultsMean age of mothers was 31.8 years (SD = 5.4), 52.1% of the children were boys. Annually self-medication of antibiotic consumption was estimated 61.6% (n = 914). Based on the logistic regression analysis, in the adjusted analysis, girls were associated with self-medication consumption of antibiotics lower than boys' children (p = 0.016). Older mothers were lower self-medication consumption of antibiotics than youngers (p = 0.001). Moreover, the permanent job of fathers was associated with lower self-medication consumption of antibiotics than temporarily and unemployment (p = .001). The odds of self-medication consumption of antibiotics were increasing with the increase in age of children (OR: 1.21, CI95%: 1.12, 1.31 and p = 0.001). The increase in parity has been a significant association with the self-medication consumption of antibiotics (OR: 1.64, CI95%: 1.38, 1.95and p = 0.001).ConclusionResults of this study show that some factors such as children's age, gender, mother's age, father's occupational status, and parity are the determinants that significantly impact the self-medication prevalence.

Background: Tuberculosis (TB) is the 10th most common infectious disease in the world, and it is one of the major health problems in Iran despite the implementation of the National Tuberculosis Control Program. Methods: Tuberculosis data in Iran were used in 2016 by the Ministry of Health and Treatment. The data on mortality and incidence of disease were determined by age groups, sex, and the provinces of country. Data were analyzed using Excel (2010) and SPSS software. Findings: The overall incidence rate of tuberculosis in the country was 9.7 per 100000 population (10.7 in men and 8.7 in women). The highest incidence rate of TB and mortality in both sexes were over 80 years. The death rate was 1 person per 100,000 populations, 57.7% of whom were men. Most of the deaths were from pulmonary tuberculosis. The highest incidence and mortality rates were reported in Golestan and Sistan and Baluchestan provinces. Conclusion: The incidence and mortality rate of TB has decreased in recent decades in Iran. Nevertheless, considering the raising trend of human immunodeficiency virus (HIV) among the patients with TB, and the neighborhood with endemic countries, TB should be noticed as one of the most important health priorities in the health system of the country.

Abstract Background Antimicrobial resistance (AMR) is currently causing various challenges for all countries around the world. Accordingly, the WHO is placing a great emphasis on the global partnership and allinaces to drive countries towards developing policy guidances and a strategic framework for AMR contatiment. This study thus seeks to elaborate on the international factors underlying AMR management in Iran. Methods Semi-structured interviews were conducted with managers from the Ministry of health (n = 14), Iran veterinary organization (n = 4), the national professional associations (n = 3) and researchers (n = 3), between November 2018 and July 2019. Participants were selected using purposeful and snowball sampling. Interviews were recorded and transcribed verbatim and were subsequently coded and analyzed thematically using MAXQDA software (V.18) and reported. Results International enabling and predisposing factors were identified in relation to the AMR control in the country. Enabling factors included knowledge transfer, facilitation in policy agenda setting, formulation and implementaion process, and AMR monitoring. Predisposing factors, alternatively, encompassed the migration of infectious patients, trafficking of medicine and livestock from neighboring countries, and the imposed sanctions. Conclusion Nowadays, AMR is taken cognizance of as a global challenge, thus to be addressed effectively, needs an international consensus more than ever. This harmony would not certainly underrate national efforts, but instead, is needed to reinforce such efforts through e.g. technical and financial assistance. It is suggested for policymakers to use all available political and legal means such as health diplomacy to establish humanitarian channels in order to enhance global convention and remove possible barriers as the sanctions and reduce their adverse consequences for AMR control.

BackgroundMany factors contribute to the spreading of hospital-acquired infections (HAIs). ObjectiveThis study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. MethodsIn this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70%) and testing (30%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs. ResultsThe mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95% CI 0-0.09), 1.02 (95% CI 0.95-1.09), 0.93 (95% CI 0.85-1.007), and 0.91 (95% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected. ConclusionsThe results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system.

Introduction: Particulate Matter (PM), also known as aerosol, is the sum of all particles suspended in droplets floating in the air, which can have harmful impacts on humans all over the world. This cross-sectional study set out to evaluate the potential health effects of over-exposure to PM10 and PM2.5 on aggravating mortality and hospitalization due to cardiovascular and respiratory diseases among Arak citizens. Materials and methods: In this cross-sectional survey, AirQ+ model was used to estimate the health impacts of two particulate air pollutants (PM10 and PM2.5) based on Relative Risk (RR), and Baseline Incidence (BI) obtained from reference documents. Results: According to the calculations, the attributable proportion percentage (AP%) and attributable excess cases (persons) for total mortality from PM10 were 3.3% (95% CI, 2.8%-3.8%) in 2014 vs. 4.9% (95% CI, 4.1%-5.6%) in 2015 and 99 persons in 2014 vs. 148 persons in 2015, respectively. Likewise, the AP (%) and the number of excess cases (persons) calculated for total mortality from PM2.5 were 3.3% (95% CI, 2.6%-4.1%) in 2014 vs. 1.1% (95% CI, 0.8%-1.3%) in 2015 and 99 persons in 2014 vs. 33 persons in 2015, respectively. Conclusion: In this study, it was found that dominant west winds could increase the particle matters produced from power plants, petrochemical plants, and western dust storm, leading to a surge in the mortality and morbidity related to particulate air pollutants in Arak.

Introduction The current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors).Methods Various data sources from different countries, including vital registration and cancer registries were used to generate estimates. Mortality data and incidence data transformed to mortality estimates using the mortality to incidence ratio (MIR) were used in a cause of death ensemble model to estimate mortality. Mortality estimates were divided by the MIR to produce incidence estimates. Prevalence was calculated using incidence and MIR-based survival estimates. Age-specific mortality and standardised life expectancy were used to estimate years of life lost (YLLs). Prevalence was multiplied by disability weights to estimate years lived with disability (YLDs), while disability-adjusted life years (DALYs) are the sum of the YLLs and YLDs. All estimates were presented as counts and age-standardised rates per 100 000 population.Results Globally, there were 524 000 bladder cancer incident cases (95% uncertainty interval 476 000 to 569 000) and 229 000 bladder cancer deaths (211 000 to 243 000) in 2019. Age-standardised death rate decreased by 15.7% (8.6 to 21.0), during the period 1990–2019. Bladder cancer accounted for 4.39 million (4.09 to 4.70) DALYs in 2019, and the age-standardised DALY rate decreased significantly by 18.6% (11.2 to 24.3) during the period 1990–2019. In 2019, Monaco had the highest age-standardised incidence rate (31.9 cases (23.3 to 56.9) per 100 000), while Lebanon had the highest age-standardised death rate (10.4 (8.1 to 13.7)). Cabo Verde had the highest increase in age-standardised incidence (284.2% (214.1 to 362.8)) and death rates (190.3% (139.3 to 251.1)) between 1990 and 2019. In 2019, the global age-standardised incidence and death rates were higher among males than females, across all age groups and peaked in the 95+ age group. Globally, 36.8% (28.5 to 44.0) of bladder cancer DALYs were attributable to smoking, more so in males than females (43.7% (34.0 to 51.8) vs 15.2% (10.9 to 19.4)). In addition, 9.1% (1.9 to 19.6) of the DALYs were attributable to elevated fasting plasma glucose (FPG) (males 9.3% (1.6 to 20.9); females 8.4% (1.6 to 19.1)).Conclusions There was considerable variation in the burden of bladder cancer between countries during the period 1990–2019. Although there was a clear global decrease in the age-standardised death, and DALY rates, some countries experienced an increase in these rates. National policy makers should learn from these differences, and allocate resources for preventative measures, based on their country-specific estimates. In addition, smoking and elevated FPG play an important role in the burden of bladder cancer and need to be addressed with prevention programmes.

Background: We aimed to provide data regarding COVID-19 infection and mortality rates within different specialties of physicians and general medical practitioners in a longitudinal nationwide study and to compare the results with general population. Methods: Data on COVID-19 infection and mortality of medical physicians in Iran was actively gathered through the Iranian Medical Council (IRIMC). Population COVID-19 cumulative incidence and mortality data were extracted from WHO situation analysis reports and data on Iranian population were obtained from the Statistical Center of Iran. Results: As of Jul 27th 2020, COVID-19 infection and mortality rates were 0.680% and 0.0396% among 131223 physicians. The highest cumulative infection rates as of 27th July 2020, were observed in specialists of infectious diseases (3.14%) followed by neurology (2.18%), and internal medicine (2.13%). The highest cumulative mortality rates as of Nov 3rd 2020 were observed in specialties of forensic medicine (0.314%), anesthesiology (0.277%), urology (0.237%), and infectious diseases (0.20%). Male physicians comprised 95% of cumulative mortality as of Nov 3rd. The physicians’ COVID-19 mortality in July and November were 49% and 23% higher than the general population respectively. Conclusion: Infection and mortality rates in Iranian physicians were higher than the general population, however the magnitude of difference was narrowing in longitudinal investigation. Provision of personnel protective equipment should be prioritized to specialists of infectious diseases, forensic medicine, anesthesiology, internal and emergency medicine, and urology.

BackgroundKnowledge about the distribution of Escherichia Coli (E. coli) pathotypes in Iran is limited. This nation-wide survey aims to provide a comprehensive description of the distribution of five pathogenic E. coli in Iran.MethodsStool samples were collected from 1,306 acute diarrhea cases from 15 provinces (2013-2014). E. coli-positive cultures underwent PCR testing for the detection of STEC, ETEC, EPEC, EAEC, and EIEC pathotypes. Pathotype frequency by province, age-group, and season was estimated.Results979 diarrhea samples (75.0%) were culture-positive for E. coli (95% CI: 72.6, 77.3%), and 659 (50.5%) were pathogenic E. coli (95% CI: 47.8, 53.2%). STEC was the most frequent pathotype (35.4%). ETEC (14.0%) and EPEC (13.1%) were the second and the third most frequent pathotypes, respectively. EAEC (4.3%) and EIEC (0.3%) were not highly prevalent. Fars (88.7%) and Khorasan-e-Razavi (34.8%) provinces had the highest and lowest frequencies, respectively. E. coli pathotypes were more frequent in warmer than cooler seasons, showed the highest frequency among children under five years of age (73%), and had no significant association with participants' gender.ConclusionsDiarrheagenic E. coli may be an important cause of acute diarrhea in adults and children in Iran. STEC and ETEC seem to be widespread in the country with a peak in warmer seasons, impacting the recommended use of seasonal STEC and ETEC vaccines, especially in high-risk groups. Monitoring the incidence of E. coli pathotypes, serotypes, and antibiotic resistance over time is highly recommended for evaluation of interventions.

Objective: we aimed to carry out an applied methodological tool, using Root-Cause Analysis (RCA), to determine the main causes of maternal mortality in Fars province, south of Iran, in 2014. Materials and methods: This is a case-series study and was conducted based on a careful examination of records and verbal autopsy with the family of the deceased person and their medical care team. Using RCA, quantitative dynamic modeling was done to display the overall impacts of different causes on maternal mortality. Finally, sensitivity analysis was done to determine the magnitude of contribution of each root-cause of maternal mortality. Results: Totally, all 10 maternal deaths with Maternal Mortality Rate (MMR) of 13.4 per 100.000 births, were recorded in the maternal surveillance system during 2014. The RCA results revealed that the root-causes of maternal mortality were ignorance and negligence (50%), delay in diagnosis (30%), delay in service provision in the first 24 hours after delivery (10%), and undesirable health care (10%). The results of sensitivity analysis in different scenarios revealed that medical negligence had the highest contribution to maternal mortality. Conclusion: Although maternal surveillance system stated some causes such as hemorrhage to be responsible for maternal deaths, the RCA showed that root-causes such as medical neglects had a fundamental role. Therefore, maternal mortality can be prevented by reforming the health care system and training all service providers, especially for high-risk mothers

Summary: Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Funding: Bill & Melinda Gates Foundation.

Summary: Background: Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lymphatic filariasis as a public health problem. This study aims to produce the first geospatial estimates of the global prevalence of lymphatic filariasis infection over time, to quantify progress towards elimination, and to identify geographical variation in distribution of infection. Methods: A global dataset of georeferenced surveyed locations was used to model annual 2000–18 lymphatic filariasis prevalence for 73 current or previously endemic countries. We applied Bayesian model-based geostatistics and time series methods to generate spatially continuous estimates of global all-age 2000–18 prevalence of lymphatic filariasis infection mapped at a resolution of 5 km2 and aggregated to estimate total number of individuals infected. Findings: We used 14 927 datapoints to fit the geospatial models. An estimated 199 million total individuals (95% uncertainty interval 174–234 million) worldwide were infected with lymphatic filariasis in 2000, with totals for WHO regions ranging from 3·1 million (1·6–5·7 million) in the region of the Americas to 107 million (91–134 million) in the South-East Asia region. By 2018, an estimated 51 million individuals (43–63 million) were infected. Broad declines in prevalence are observed globally, but focal areas in Africa and southeast Asia remain less likely to have attained infection prevalence thresholds proposed to achieve local elimination. Interpretation: Although the prevalence of lymphatic filariasis infection has declined since 2000, MDA is still necessary across large populations in Africa and Asia. Our mapped estimates can be used to identify areas where the probability of meeting infection thresholds is low, and when coupled with large uncertainty in the predictions, indicate additional data collection or intervention might be warranted before MDA programmes cease. Funding: Bill & Melinda Gates Foundation.

Background: Botulism is a severe neuroparalytic disease caused by toxins produced by several Clostridium species. This work presents the surveillance results of botulism in Iran, with the distribution of the cases by regions and by vehicle of transmission. Methods: We describe the findings of the Centers for Disease Control and Prevention (CDC) surveillance on 2037 suspected cases of food-borne botulism during 2007–2017. Results: A total of 252 (12.3%) cases were confirmed to food-borne botulism. The mean annual incidence per 100,000 Iranian Natives was 7.1 cases for male individuals and 3.3 cases for female individuals. All botulism events were confirmed to be foodborne. The most commonly implicated food was home-prepared traditional processed fish product, followed by the consumption of commercially canned products and non-pasteurized dairy products. Forty-eight (19%) fatal botulism were reported which, the case-fatality rate declined from 4.5% to 0.7% during the study period. Conclusion: Laboratory-based diagnosis of botulism is an imperative procedure to elucidate cases, particularly food-borne botulism, to identify toxins in food and confirm clinical diagnosis, helping sanitary control measures. In addition, educational materials related to botulism prevention should be disseminated to different communities.

Background. The onset of breastfeeding has a high success rate in most countries, but the time for termination of breastfeeding varies between countries. Objective. This survey was aimed to determine the effective factors on the early termination of breastfeeding. Methods. This study was conducted in 2018, in Iran. About 410 mothers were enrolled in the study. All considered factors were evaluated as factors influencing the continuity of breastfeeding. Survival analysis was used to analyze data. Results. The mean age of the mothers was equal to 29.48 ± 5.8 years. The frequency of termination of breastfeeding before the first 2 years was equal to 34%. The mean of breastfeeding duration was equal to 21.49 ± 5.3 months. The percentage of infants who had been breastfed for 24 months was equal to 65.8%. An infant’s birth weight (2500–4000 gr) (hazard ratio: 0.54), neonatal birth order (hazard ratio: 0.69), neonatal pathologic jaundice (hazard ratio: 1.52), starting time of using complementary food (hazard ratio: 2.45), using pacifier (hazard ratio: 2.82), and the status of using artificial milk (hazard ratio: 3.29) were significantly associated with cessation of breastfeeding before 24 months of age. The probability of termination of breastfeeding at 6, 12, 18, and 24 months of age was reported by 6%, 8%, 15%, and 34%, respectively. Conclusions. There were notifiable variations in breastfeeding rates both in national and international levels. Nevertheless, in this study, the mean of breastfeeding duration was longer compared to a number of countries and previous national studies.

Background. High blood pressure (HBP) is a proven risk factor for cardiovascular diseases. So, determining the extent of the contribution of the factors associated with HBP seems to be necessary. Accordingly, this study aimed to investigate how much the prevalence of HBP attributed to obesity and high blood glucose (HBG). Methods. Data were collected from 7612 participants extracted from a screening program in 2018, in Iran, which was conducted on the subjects with the age of 30 years old and older to investigate the prevalence of HBP and their associated risk factors. To collect data, we used a standard checklist in terms of the WHO STEPS manual, and a stratified multistage sampling method was also applied. The adjusted population attributable risk of overweight, obesity, and HBG for HBP was calculated by the logistic regression model using the aflogit module. Results. Among the studied people, 7.4% of male and 10.8% of female subjects were hypertensive. The adjusted analysis showed that, in men, 27% and 41% and, among women, 19% and 37% of HBP prevalence rates were attributable to obesity (BMI ≥ 30) and fast blood sugar (FBS) (≥126), respectively. In people with both obesity and HBG, 59% of the prevalence rate of HBP in men and 46% of the prevalence in women were due to the abovementioned risk factors altogether. The results show that, if obesity and HBG were eliminated, the prevalence of HBP could be theoretically decreased from 7.4% to 5.4% and 4.3% in male subjects and from 10.8% to 8.7% and 6.8% in female subjects, respectively. Conclusions. Our findings indicate that how much the prevalence of HBP attributes to obesity and HBG in middle-age and older population. It seems that the prevention programs should be administered in the general population, and excess body weight prevention programs should also be implemented in childhood.

Abstract Background: Family is the most important component of community and family health leads to spiritual excellence and intellectual growth. One of the debates in current society is to enhance the bases of marital life. More than half of the sexual problems which cause family life and marital relationships abolishment are due to insufficient knowledge or erroneous beliefs about sexual relationships. The aim of this study is to investigate the effect of acceptance commitment therapy (ACT)-based premarital counseling on the couples’ sexual function. Materials and Methods: The study population of this clinical trial consisted of all couples referring to premarital counseling centers of Isfahan in 2015. Sixty couples were selected and then randomly divided into two groups, an experimental group(30 couples) and a control group(30 couples). Then they completed a questionnaire of sexual function. The data were analyzed by SPSS 21 using the Mann-Whitney test. Conclusion: The results of this study with the aforementioned condition showed the lack of significant difference in the couple’s sexual function between premarital counseling and the approach based on acceptance and commitment. So, it seems that performing a research with more samples and a target group having 1-5 marital experience would be necessary. Results: The results showed no significant difference between the effect of premarital counseling acceptance and commitment therapy – based approach on the couples’ sexual fanction in comparison with a premarital conventional approach(p>0.02).

Background: Given the competitive environment prevailing in the market, service organizations are looking for loyal customers and hospitals are no exception. In the meantime, attention to relationships’ quality and establishment of long term relationships have an important role. The objective of the present study is to examine the effect of relationships’ quality on loyalty of patients in selected state hospitals. Methods: The present cross-sectional research was conducted in 2014 in selected state hospitals of Arak and Yazd. The population consisted of 160 patients in the selected hospitals. Simple random sampling was conducted to choose participants. Data were collected through two questionnaires; a part of Hon and Gruning’s measurement of relationships questionnaire with four dimensions (satisfaction, trust, commitment, and mutual control) and loyalty questions as a part of the Parasuraman et al.’s behavioral tendencies with one dimension (loyalty dimension). Data were analyzed with SPSS19 using Spearman correlation coefficient and regression. Results: Results from Spearman correlation indicated a positive and significant relationship between relationships quality and loyalty (r = 0.722, P-value = 0.001). In addition, results from regression indicated that 60% of the variance of patients’ loyalty is explained by satisfaction. Conclusion: Findings revealed that strategies to improve the quality of relationships with patients could lead to loyalty in patients.

Reducing poor–rich inequities in health is one of the priorities of both national and international organizations and is also one of the main challenges of health sectors in Iran. Since, in the view of policy making, quantifying the size of inequity in health care utilization (HCU) is a prerequisite for achieving this goal, the current study aimed to determine and compare the socioeconomic inequity in HCU by concentration (C) index and odds ratio (OR). Methods: A total of 758 households, consisting of 2,131 subjects who were aged 15 or older, were involved in this cross-sectional study, and their data were gathered through interviews. Household economic index (HEI) was created by the factor analysis from the asset data. The C index and OR were used as measures to determine the overall inequity in HCU according to sex (male/female), living area (urban/rural), insurance, and types of HCU (general physician [GP], specialist, and Health Workers [HWs]). Results: The overall rate of HCU was 66.4%. The rates of using GP, specialist care, and HW care were 21.4%, 21.6% and 21.8%, respectively. The overall inequity in HCU was equal to 0.05 (95% confidence interval; −0.069 to 0.165). The C indexes in HCU, according to the subgroups of HCU, were measured as 0.11 (0.09–0.12) for GP, 0.115 (0.01–0.13) for specialist and −0.065 (−0.08 to −0.05) for HWs. Although the rate of utilization increased from poor to rich quintiles, the inequity regarding sex and living area was also low and non-significant. Conclusion: People with higher HEI used more specialist and GP care, while people with lower HEI used more HW care. The inequity in HCU was low and non-significant in different quintiles of males, females, urban and rural, as well as those who were insured.

Background: Diarrhea is a major cause of public health burden, especially in children under 5 yr of age. This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Acute Watery Diarrhea (AWD) in Iran from 2009 to 2016. Methods: This study was conducted in 2018. The data on the incidence and mortality from 2009 to 2016 was obtained from AWD surveillance system of the Centre for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran. Disability Adjusted Life Years (DALYs) was used to estimate the burden of AWD. The DALYs-related AWD was calculated using a method developed by WHO. The average duration of the disease and its disability weight, respectively, were set at 5 d (0.0137 years) and 0.093 for all age groups. Results: The incidence of AWD had an ascending trend over the studied period. Forty cases of deaths from AWD were reported. The lowest and highest burdens of AWD, respectively, were 436.1 DALYs in 2010 and 975.9 DALYs in 2015. The incidence and burden of AWD did not have an equal distribution across the country, between the provinces. Conclusion: The incidence of AWD had an ascending trend over the studied period that can be attributed to the improvements in the disease surveillance system. Moreover, the incidence, mortality, and burden of AWD did not have an equal distribution in Iran. Hence, it is recommended to strengthen AWD surveillance system. In addition, it is suggested to adopt proper interventions for controlling the disease in areas with a high burden of AWD.

Objectives: With the increasing life expectancy and aging density of population in some communities, the world's older population is rapidly increasing. With age, there is a gradual reduction in physical activities thereby leading to an increased prevalence of chronic diseases and reduced individual and social performance in elderly individuals. The importance of this present study can be noted from the factors including changing epidemiological pattern of disease in the elderly, susceptibility to the chronic diseases and increasing number of seniors facing relative health issues but deprived from healthcare needs. In order to optimize the management and careful planning of the healthcare services for the rural elderly, there is a need for extensive research in this field. The aim of this study was to evaluate the health status of elderly patients living in the rural cities of Ashtian city, Markazi Province. Methods & Materials: This cross-sectional and descriptive-analytical study included 200 elderly people from Ashtian villages selected using the cluster sampling technique. After gaining consent from the participants, the required information was collected through questionnaire, physical examination, and laboratory tests. The results of the tests were processed using SPSS software. Chi-square test was also used, and P

Introduction: Continuing education of human resources is an integral part of medical universities’ tasks to offer desirable services and meet the society’s needs which is achieved through various ways including workshops. Therefore, the purpose of this study was to examine the extent of compliance with principles of designing and implementing educational workshops by the vice chancellor for health of Arak University of Medical Sciences. Methods: This descriptive, cross-sectional study was performed in 2014. The population and sample consisted of in-service all of educational workshops for the staff of the vice chancellor for health of Arak University of Medical Sciences which were calculated at 28 workshops Data collection tool was a researcher-made checklist whose validity and reliability had been confirmed. Also, a survey questionnaire was randomly distributed among 20 learners in each workshop leading to a total number of 560 learners. Data were analyzed by central tendency and dispersion indices. Results: The mean score of design was at a desirable level (78.18±9.07 out of 100), while that of implementation was average (60.47±7.72). The highest score of design was related to content-goal compatibility (4.71±0.76 out of 5), while the lowest scores were related to the appropriate number of participants (2.67±0.72), learners’ knowledge of prerequisites (2.95±1.57) and proportion of the time of theoretical subjects and group work (3±0.94). As to implementation, the highest scores were related to the behavior and impact of teachers in learning (4.23±0.72) and clarity of goals (4.18±0.74), while the lowest scores were related to the content’s scientific accuracy (1.95±0.99), the lack of complete relevance of contents to learners’ needs (2.02±1.24) and improper implementation of group work (3.23±1.48). Conclusion: The results indicate the desirability of workshops’ design but most of the learners had an average evaluation of the implementation. Therefore, it is suggested that besides holding training courses for directors about the implementation of workshops, special attention should be given to overcoming the weaknesses of workshops’ design.

Abstract Background: Improvement of nutrition like fish and sea products is influential in preventing from non-contagious diseases. The transtheoretical model is one of the models for effective investigation on nutrition behaviors. This study was done with the aim of investigating fish consumption among women 30 to 50 years old based on the transtheoretical model. Materials and Methods: This study was an analytical and cross sectional analysis which was conducted in 2014 on 360 women 30 to 50 years in Arak city. The data have been collected by using researcher-made questionnaires which its validity and reliability was assessed in accordance to the transtheoretical model were obtained by visiting houses. Then the collected data were analyzed by pearson correlation test. Results: The average age of the respondents was 39.34±7.5. The average of fish consumption was 0.62 ±0.83 times a week. 64 % of people in consumption of at least two servings of fish a week were in the two first stages of change (pre-contemplation and contemplation).The average score of self-efficacy in fish consumption was a total of 10.58 ±3.12 out of 15 and the average score of cons of fish was 26.35 ±4.78 and the average score of pros of fish was 21.6 ±2.67 out of 25. Pearson correlation indicates that the amount of fish consumption with constructs of the self-efficacy, stages of change and pros of fish had respectively the most positive correlation (p≤0.05). Fish consumption had no significant difference with age, education, Body Mass Index, occupation, monthly income and marital status. Conclusion: Fish consumption despite its high level of perceived benefits is really low and to eliminate these barriers, education and cultural-building especially in women who are influential people in family nutrition is necessary.

Introduction: Electroconvulsive therapy (ECT) is an effective treatment for many mental disorders, especially severe and persistent depression, bipolar disorder, and schizophrenia. The aim of this study is to compare the effect of dexmedetomidine and alfentanil on agitation, satisfaction, seizure duration, and patients hemodynamic after ECT. Materials and Methods: In a three phase crossover randomized clinical trial, 75 patients aged between 18 and 50 years and candidate for ECT were enrolled and assigned into three groups (25 patients in each group). All patients, respectively, took premedication of dexmedetomidine, alfentanil, or saline in three consecutive phases. Patients received 0.5 μg/kg dexmedetomidine, 10 μg/kg alfentanil or normal saline intravenously, 10 min before induction. Finally, seizure and recovery duration, satisfaction and agitation score, and hemodynamic parameters were evaluated. Results: There was no significant difference about seizure duration, agitation score, and hemodynamic parameters between groups but recovery duration was significantly lower in the control group than dexmedetomidine (P = 0.016) and alfentanil group (P = 0.0001). Patients′ satisfaction was significantly higher in intervention groups (alfentanil and dexmedetomidine groups) (P = 0.0001). Conclusion: Given the equal effects of alfentanil and dexmedetomidine, it seems that choosing one of these two drugs for premedication of patients undergoing ECT is appropriate. Drug choice is influenced by numerous factors such as accessibility of each drug and the dominance of anesthesiologist and psychiatrist.

Background and Objectives: Food insecurity may be associated with poor nutrition, which in turn can increase the risk of adverse nutrition and health outcomes among infants and toddlers. This study was undertaken in 2008 to gain an insight of mothers' views on complementary feeding practices and food security. Materials and Methods: In this qualitative study, data were collected through 10 Focus Group Discussions (FGDs) with groups of mothers who had under two-year-old children in the urban areas of Damavand (7 FGDs; n=51) and Varamin (3 FGDs; n=29). Each FGD was held in the presence of a moderator, two note takers, and an observer. All notes were collected, and the emerging themes were reported. Results: In the study, nine general themes were identified: 1) The mothers viewed adequate food as a food, which is useful for health in both quality and quantity; 2) Households have limited access to adequate food because they cannot afford it; 3) In hard situations, household’s strategies are: changing the type and amount of food, and buying cheaper foods; 4) In case of poverty, mothers abstain from eating to save food for their children; 5) The mothers viewed complementary feeding as soft, simple and light foods, which are especially made for children; 6) The best time for introducing complementary feeding was 6 months of age; 7) There were no complementary local foods in the region; 8) For under one-year-old children, a different type of food was separately prepared; 9) Home-made complementary food was preferred over the readymade type. Conclusions: Despite mothers' sufficient knowledge about the advantages of complementary feeding, the majority of them had not good performance. This qualitative study provides a foundation and valuable information for future studies on the nutritional health of children in food insecure households. Keywords: Household food security, Belief, Infant feeding, Mothers, Infants, Qualitative research, Iran

Background and Aims: Prostate cancer is one of the most common cancers among men, that is increasing in incidence and mortality. Considering the epidemiologic trend of prostate cancer, the aim of this study was to investigate the incidence of prostate cancer in the years 2005-2010 in Markazi Province.Methods: In this analytical study, which data was derived from the Cancer Registry of Markazi Province, crude incidence per 100 thousand persons and age-standardized incidence in the method of direct standardization using the world standard population were calculated. Data Analysis was conducted using the Cochran-Armitage and winpepi software version 2.1.Results: In this study among 182 patients with prostate cancer in 2005–2010, 144 patients (%79) inhabited in city and others in rural. Regarding age, 16 persons (%8.8) were between 50-60 and majority 84(%46) were 70-80 years old. In the 6- year study, 182 cases of prostate cancer were recorded. Age-standardized incidence rate during the years 2005 to 2010 was respectively: 3.24, 3,3.44,5.05,5.75, 5.61 cases per hundred thousand people which shows an increase in the disease. The highest observed incidence in the age group was above 70.Conclusion: The standardized incidence rate of prostate cancer in Markazi province in comparison with the world, particularly developed countries, is much less that can be due to lack of screening programs or the incomplete records.*Corresponding Author: Mohsen Shamsi, Department of Public Health, Faculty of Public Health, Arak University of Medical Sciences, Arak, Iran.Email: dr.shamsi@arakmu.ac.ir.

Introduction and Aims: Cancer is the third leading cause of death after Coronary Artery Disease and accidents in Iran. This Research has been carried out to Study the epidemiology of gastrointestinal cancers (Stomach, esophageal, colorectal) in Markazi province during 2005-2010.Methods: This is an analytical cross-sectional study that was carried out on cancer registry data collected from Markazi province between 2005-2010 years. Cancer incidence adjusted based on the age structure and agespecific incidence rates were calculated.Results: Most statistics on the Morbidity of gastric cancers in the study was 642 patients (51.2) that associated with gastric cancer and after which the CRC 444(35.4%) patients and esophageal numbers of 169 (13.5%) patients. in this study 61.8 % (801 patients) of cases in the age group 80-70 years, male, 387 cases (30.8%) and the highest 77.1% living in urban areas has been observed in terms of location. mean age at estimated time of diagnosis was 69 years. Rates age standardized incidence of digestive cancers in males and female was 141.04 and 73.39 respectively.Conclusion: Identification of risk factors and prevention of gastrointestinal cancers in Markazi province is required. Training programs related to the prevention of cancer in people at high risk should be presented.*Corresponding author: Assistant Professor, Department of Public Health, School of Public Health, University of Medical Sciences, Arak, Iran.Email: Mohsen_shamsi1360@yahoo.com

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60–80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts. Funding: Bill & Melinda Gates Foundation.

Introduction: Level of mothers’ literacy, pregnancy history of more than four times, residence in villages, lack of receiving intensive care during pregnancy, as well as inaccessibility to obstetric emergency services have been reported, in Iran and the world, as major factors for maternal mortality. Considering significance of identifying indirect causes of maternal mortalities, the present study was aimed to determine the contribution of indirect causes to maternal mortalities in Markazi province, Iran. Methods: This retrospective, descriptive-analytical study analyzes root causes and sentinel events through describing a case of maternal mortality reported in Markazi province. The data were gathered through interviews and documents’ investigation, and Bayesian analysis and calculation of conditional probability in Netica 5.08 software were used. Results: Findings on a 36-year-old mother, in the 37th week of her third pregnancy and suffering from cardiomyopathy, indicated that lack of receiving prenatal care on time, insensitivity of health and medical personnel to pursuing the patient’s timely referrings according to Ministry of Health and Medical Education guidelines, lack of coordination and monitoring on the part of team of specialists responsible for the pregnant mother’s treatment in hospital, and indifference toward appropriate management of treatment were determined as indirect causes of the mother’s death. Conclusion: While cardiomyopathy was registered as direct cause of death, according to root cause analysis indirect causes had a 43% contribution to the mother’s death. Thus, planning for determination of major causes and eliminating indirect causes are very important for reducing maternal mortalities.

Background: Poly chlorinated biphenyls (PCBs) are a class of chlorinated organic chemicals that do not easily degrade in the environment. This study was conducted to determine the effect of microwave rays, hydrogen peroxide, dioxide titanium and ethanol solvent on the degradation of PCBs. Methods: A 900w domestic MW oven with a fixed frequency of 2450 MHZ was used to provide MW irradiation. Ray powers were used in 540, 720, and 900w. A hole was made on the top portion of the oven and a Pyrex vessel reactor (250ml volume) was connected to condensing system with a Pyrex tube connector. The PCBs were analyzed by GC-ECD. Results: The degradation of total PCBs was 54.62%, 79.71%, and 95.76% in terms of their ratio to solvent with transformer oil at 1:1, 2:1, and 3:1, respectively. The degradation of total PCBs was 84.27%, 89.18%, and 96.1% when using 540, 720, and 900W microwave radiation, respectively. The degradation of total PCBs was 70.72%, 93.02%, 94.16, 95.23% and 96.1% when not using H2O2/ Tio2 and using 20% H2O2 and 0.05, 0.1, 0.15, and 0.2g Tio2, respectively. Conclusion: In the present study, the optimum conditions to decompose PCBs efficiently included 50 ml volume of ratio to solvent with transformer oil (3:1), sodium hydroxide solution (0.2N) 1 cc, use of 20% hydrogen peroxide of total volume of samples, dioxide titanium (0.2g), and irradiation for 9 minutes. Under these optimum conditions, efficiency of PCBs decomposition increased.

Objective (s): To determine the pattern of incidence and survival rates of cancers in elderly adult in the period of five years to obligate the screening and therapeutic aged care services to old people.Methods: This is a historical cohort study based on the data analysis years (2001 to 2005) and cancer registries reporting survival rates for these cancers in people aged 60 years and older. Collecting data was through observation and data gathering Cancer Research Center, Shaheed Beheshti University of Medical Sciences. The inclusion criteria were cancer patients 60+ years registered through the annual reports of cancer cases and survival patients followed. To compare the survival and separation of sex Kaplan Meier coax method was used. The death and death of the relative risks of various cancers were calculated by regression model.Results: Based on data 33.5% of women surveyed aged 60 years and older and 66.5% were elderly men. The mean age was 71.2 years. Mean survival in this study was 88.2 years. The highest incidence of skin cancer was 5 years old. The geographical distribution of incidence was bladder cancer among elderly in Kermanshah province. Yazd province was the highest prevalence of common cancers in elderly. The average of five-year survival in Lorestan province was the highest and the Ardabil province had the lowest. The relationships between sex and death from cancers were (0.84 to 0.95), and the relationships between the relative risks of death from cancers (1.03 to 1.09) which were significant.Conclusion: The risks of cancer death among nine provinces were varied comparision to Tehran metropolitan. In oderwords survival rate of cancers in the nine provinces significantly were less than Tehran province.

Background: Poly chlorinated biphenyls (PCBS) are the groups of organicchemical material and toxic, persistent, bio accumulate and pose a risk of causingadverse effects to human health and the environment. PCB compounds arecaused the different health effects in human depending of age, sex, route of entry,intensity and frequency exposure. This study was conducted to determine theeffect of microwave rays, hydrogen peroxide, TiO2 catalyst and ethanol on theDecomposition of PCBS.Methods: In this experiment used a MW oven, Pyrex vessel reactor (250mlvolume), Pyrex tube connector and condensing system. A 900w domestic MWoven with a fixed frequency of 2450 MHZ was used to provide MW irradiation. Raypowers used in 540، 720 and 900w. The PCBS were analyzed by GC-ECDResults: The degradation of total PCBS in terms of 540, 720 and 900W was85.03%, 90.32% and 96.87% respectively. The degradation of total PCBS in termsof ratio to solvent with transformer oil in 1:1، 2:1 and 3:1 was 53.97%، 78.98% and95.13% respectively. The degradation of total PCBs in terms of not using of H2O2/TiO2 and using 20% of H2O2 and 0.05, 0.1, 0.15 and 0.2 g TiO2 was 68.78%,93.97%, 95.13%, 96.18% and 96.87 % respectively.Conclusion: The Microwave thermal reaction was applied for the dechlorinationof PCBs and high efficiencies were obtained. Microwave power and amounts ofreactants added are important factors influencing dechlorination efficiency.

Objective: To assess the impact of gender and living area on cardiovascular risk factors in the context of a comprehensive lifestyle intervention program. Design: Data from independent sample surveys before (2000--2001) and after (2007) a community trial, entitled the Isfahan Healthy Heart Program (IHHP) were used to compare differences in the intervention area (IA) and reference area (RA) by gender and living area. Setting: The interventions targeted the population living in Isfahan and Najaf-Abad counties as IA and Arak as RA. Participants: Overall, 12 514 individuals who were more than 19 years of age were studied at baseline, and 9570 were studied in postintervention phase. Interventions: Multiple activities were conducted in connection with each of the four main strategies of healthy nutrition, increasing physical activity, tobacco control, and coping with stress. Main Outcomes: Comparing serum lipids levels, blood pressure, blood glucose and obesity indices changes between IA and RA based on sex and living areas during the study. Results: In IA, while the prevalence of hypertension declined in urban and rural females (P < 0.05). In IA, the prevalence of hypercholesterolemia and hypertriglyceridemia decreased in both females and males of urban and rural areas except for hypercholesterolemia in rural males (P < 0.01). In RA, the significant changes include both decrease in the hypercholesterolemia among rural males (P < 0.001) and hypertriglyceridemia in urban females (P < 0.01), while hypertriglyceridemia was significantly increased in rural females (P < 0.01). Conclusions: This comprehensive community trial was effective in controlling many risk factors in both sexes in urban and rural areas. These findings also reflect the transitional status of rural population in adopting urban lifestyle behaviors.

Introduction: Overweight and obesity are the most important factors in the development of chronicdiseases and have a great impact on the health and quality of life of individuals. World HealthOrganization (WHO) encourages the countries continually for calculation burden of diseases at nationallevel as the best guideline for take policy in health system. Therefore, this study was conducted todetermine the attributable burden of risk factors in non-contagious diseases in Markazi providence ofIran.Materials and Methods: Death registered data in Markazi providence were applied for calculationyears of life lost (YLL) based on comparison risk assessment (CRA) method of WHO. Attributableburden of obesity and overweight was calculated by multiply the impact fraction of any risk factors byYLL of any diseases in counterfactual analysis method.Results: From 7176 registered death, 252214 years lost from preterm death. The total of YLL infemale and male were 102245 years and 149969 years, respectively. In this study, the most importantcauses of YLL were attributable obesities to brain stroke, and cardiovascular diseases and attributableoverweight to cardiovascular diseases in females, respectively.Conclusion: This study showed the importance and necessity of diagnosis for obesity and over weightas one of the most important risk factors in non-contagious diseases, especially in women. Therefore, itseems there is a necessity for developing and conducting comprehensive intervention programs aboutthese risk factors and then assessing the programs.

Background Premature ovarian failure (POF) is a disorder of multi causal etiology. Autoimmunity has been proposed as a mechanism for some cases of ovarian follicle dysfunction which is evident in POF. The aim of this study was to identify the level of auto-antibodies in POF and familial POF patients. Materials and methods In this study, auto-antibodies including anti-ovarian antibody (AOA), anti thyroid peroxidase (TPO) and anti thyroglobulin (TG) antibodies were assessed in the sera of 43 cases with spontaneous POF including 12 cases affected by familial POF. The control samples were obtained from sera of 39 women with normal ovulatory or post menopause women. Results AOA were detected in 46.5% of the POF group, 41.7% of the familial POF group and 41% of the control group without significant statistical difference between the three groups. Thyroid peroxidase (TPO) antibody was found in 32.6% of the POF group, 41.6% of the familial POF group and 10.3% of the control group. Anti TPO was detected significantly high in both POF and familial POF groups (p

Background: The etiology of infertility has direct influence on the plan and outcome of its management. In this paper we showed the effect of history of tuberculosis (TB) on female infertility among infertile couples admitted to Royan infertility management center. Material and Methods: This case control study was performed on cases that were diagnosed with female infertility (308 women). Controls were women whose husbands were infertile due to some male factor (314 women). Those who had both female and male infertility were excluded from the study. The observed variables were BMI>25 kg/m2, positive history of smoking, tuberculosis, sexually transmitted disease and pelvic inflammatory diseases. Results: The age adjusted odds ratio of history of tuberculosis for female infertility was 6.21(95 CI: 1.31-29.56).The attributable risk in exposed group was about 1%. Conclusion: According to our study, positive history of tuberculosis may be responsible for female infertility.