Search

Background Suicide is a significant public health problem caused by the interaction between demographic, socio-economic, and cultural factors. According to the World Health Organization, about 804,000 fatal suicides and several times this number of suicide attempts occurred worldwide in 2017. Evidence suggests that the incidence of suicide varies among Iran provinces. It is essential to know these differences to allocate resources and adopt the right policies.Methods We used data recorded by the Ministry of Health and the National Forensic Medicine Organization during the study years to provide information about the rate of suicide attempts in the provinces of Iran. To accurately calculate the under-reporting of suicide attempts according to the frequency of successful suicide, we used TSsmooth methods in STATA 14 software. We ran Exponential, Moving Average, and H Winter models and the best model was chosen according to the lowest root mean square error.Results There were 30,137 successful suicide attempts and 349342 unsuccessful suicide attempts during the eight-year study period. Around 18,684 suicides resulted in the death of males, and 11,453 were females. Among the unsuccessful suicide attempts, 237,552 cases were males, and 111,790 were females. The incidence rate of eight years of successful suicide based on age in the age group (15–25 years) was higher than in other groups.Conclusion Considering the current situation in Iran, it is suggested that interventional measures be designed to reduce the incidence of suicide attempts, especially in the age group of 15–49 years, and to conduct pilot studies in provinces with relatively higher incidence rates than other provinces of the country.

Background Critical limb ischemia (CLI) is associated with increased risk of tissue loss, leading to significant morbidity and mortality. Therapeutic angiogenesis using cell-based treatments, notably mesenchymal stem cells (MSCs), is essential for enhancing blood flow to ischemic areas in subjects suffering from CLI. The objective of this study was to evaluate the feasibility of using placenta-derived mesenchymal stem cells (P-MSCs) in patients with CLI. Methods This phase I dose-escalation study investigated P-MSCs in nine CLI patients who were enrolled into each of the two dosage groups (20 × 106 and 60 × 106 cells), delivered intramuscularly twice, two months apart. The incidence of treatment-related adverse events was the primary endpoint. The decrease in inflammatory cytokines, improvement in the ankle-brachial pressure index (ABI), maximum walking distance, vascular collateralization, alleviation of rest pain, healing of ulceration, and avoidance of major amputation in the target leg were the efficacy outcomes. Results All dosages of P-MSCs, including the highest tested dose of 60 × 106 cells, were well tolerated. During the 6-month follow-up period, there was a statistically significant decrease in IL-1 and IFN-γ serum levels following P-MSC treatment. The blood lymphocyte profile of participants with CLI did not significantly differ, suggesting that the injection of allogeneic cells did not cause T-cell proliferation in vivo. We found clinically substantial improvement in rest pain, ulcer healing, and maximum walking distance after P-MSC implantation. In patients with CLI, we performed minor amputations rather than major amputations. Angiography was unable to demonstrate new small vessels formation significantly. Conclusion The observations from this phase I clinical study indicate that intramuscular administration of P-MSCs is considered safe and well tolerated and may dramatically improve physical performance and minimize inflammatory conditions in patients with CLI. Trial registration: IRCT, IRCT20210221050446N1. Registered May 09, 2021.

Background: Community-based interventions can be effective due to the active participations of communities in pre- and post-disaster planning and management. Effective community-based disaster management for health promotion can be achieved by learning from the successful local and international experiences of community participations. Thus, this study is aimed to identify the community active participation approaches which were effective in promoting the health of disaster-affected communities. Methods: This systematic review was conducted and reported based on PRISMA guideline. Web of Sciences, PubMed and Scopus were searched using the selected keywords. The inclusion criteria were all forms of published articles which studied the approaches of community active participations for improving their health in disasters. The selection of articles was conducted using the titles and abstracts. Data analysis was done based on the categorization of different community-based disaster management approaches. Results: 10 articles were finally selected out of 2843 documents generated by initial search. Asian countries considered community involvements in disaster management the most (40%). The most community active participations in disaster management were conducted in the recovery phase (80%). Approaches of community-based disaster management for the health promotion were two-way university-community participation, focusing on empowering specific community groups, governance, and localizing community participation as well as strengthening social networks. Conclusion: Considering the capacities of academic institutions for active participation in community-based disaster management according to the Yokohama, Hyogo and Sendai Framework is highly suggested. Further research is needed to explore the challenges of community communication and information in disasters.

Background: COVID-19 is an international public health emergency in the world. Objectives: The aim of the present study is to determine the geographic pattern and temporal trend of Coronavirus disease 2019 incidence, fatality, and recovery rates worldwide. Methods: The present ecological study is a mixed exploratory study. The study population included Patients with COVID-19, recovered individuals, and deaths from COVID-19 from October 1, 2019, until June 30, 2021, worldwide. Descriptive analysis included the calculation cumulative incidence rate (CIR), case fatality rate (CFR), and case recovery rate (CRR) of COVID-19. Global Moran's I and Anselin Local Moran's I tests were used for spatial analysis. The joinpoint regression analysis was used to examine the time trend by ArcGIS, Joinpoint, and SPSS software. Results: The average cumulative incidence rate was 1077 in 106 individuals; also, the average case recovery rate and average case fatality rate were %72.81 and %3.21, respectively. Global Moran's I index measured for CIR was 0.159. The results of Anselin's local Moran's I, high-high cluster, consists of some countries in South America and in southern and Western Europe and central and western Asia. The temporal trend of changes in the incidence rate and CRR of COVID-19 were incremental, and the average annual percentage change from October 2019 to June 2021 increased by 44.4% and 3.2%, respectively (P < 0.001), but CFR decreased by -0.3% and was not significant (P > 0.05). Conclusions: As regards the specific spatial pattern of fatality and recovery rate of COVID-19, it seems essential to consider spatial conditions and environmental factors which are related to the incidence and fatality of COVID-19 in different regions, as well as the necessity of upgrading the care system in high-risk areas, in order to have better management and control of the pandemic and optimal function in early diagnosis, proper treatment, and high vaccination coverage.

Background: Myocardial infarction (MI) is one of the most important health problems in the world, including Iran. The rate of in-hospital mortality in MI patients ranges from 7.7% to 19.2% in different countries. Despite the promotion and utilization of new therapeutic approaches, MI-related morbidity and mortality have remained high . The recognition of risk factors for MI-related mortality plays an important role in reducing post-MI mortality. Methods: In this study, we used national MI registry data. In total, 33,831 patients who had been hospitalized in the coronary care unit of Iranian hospitals from 2012 to 2014 were analyzed. Using multivariable logistic regression, we estimated the impact of various risk factors on in-hospital mortality after MI. Results: The in-hospital mortality rate in patients with ST-elevation MI was higher than that of patients with non–ST-elevation MI. In-hospital mortality was most strongly associated with left-location MI (odds ratio [OR] relative to the non-ST-elevation MI group, 2.15), in comparison with middle-location MI (OR, 1.47) and right-location MI (OR, 1.43). Ventricular fibrillation (OR, 7.7) and ventricular tachycardia (OR, 2.78) were predictors of in-hospital mortality. Receiving treatment reduced the odds of death and age, sex, and diabetes were risk factors associated with in-hospital mortality after MI. Conclusions: Age, sex, right bundle branch block arrhythmia, atrial fibrillation, ventricular tachycardia, left bundle branch block arrhythmia, ventricular fibrillation, dyspnea, diabetes, and ST-elevation MI were associated with increased ORs for mortality after MI. Thus, patients with these factors require special attention during hospitalization.

Background: Clinical manifestations of COVID–19 are different. There are some risk factors for COVID–19. This study aimed to describe the epidemiological features, symptoms and mortality of the patients with COVID–19 in Iran. Methods: This were a cohort study performed on 103,179 patients with COVID–19. The demographic and clinical data were collected in selected provinces. The required data of all patients was extracted from the COVID registry system and analyzed using STATA version 14 and Excel 2016. Results: The mean age was 52.40 years for men and 52.41 years for women. About 55.2% of the study population were male and 44.8% were female. Totally, 60.9% (5085) of deaths happened in men and 39.1% (3263) in women. The mean time from onset of symptoms to hospitalization in men and women were 3.47 and 3.48 days, respectively. The mean time from onset of symptoms to isolation was 2.81 days in men and was 2.87 days in women, from onset of symptoms to death was 9.29 and 9.54 days, respectively, from onset of symptoms to discharge was 7.47 and 7.39 days, and from hospitalization to death was 6.76 and 7.05 days. Cough and shortness of breath were the most common symptoms in the patients. Conclusion: According to the results, the overall mortality rate was higher in men than women. Women with cardiovascular disease and diabetes were more likely to die. The mean time from onset of symptoms to hospitalization, isolation, and discharge was similar in men and women.

Background: The use of smokeless tobacco is a public health problem worldwide. The use of these substances can cause various diseases and increase mortality. Objectives: The aim of this qualitative study was to explain the reasons for using smokeless tobacco based on the grounded theory approach. Patients and Methods: We conducted a qualitative study using the grounded theory approach in 2020 - 2021. Participants were adult users of smokeless tobacco in Chabahar city, southeast Iran. The strategy for choosing participants was based on purposeful sampling and continued till theoretical saturation was achieved. Thirty adults who were smokeless tobacco users participated in the interviews voluntarily. We used techniques such as asking questions, constant comparisons, and writing memos to collect data, which were analyzed based on the grounded theory presented by Corbin and Strauss in 2008. Results: Two themes emerged from data analysis (the context of consumption and the need for effective supervision), each of which had several subcategories. The opportunity for consumption was the first main category of the contextual factors frequently mentioned by the participants, whose subcategories included consumption culture, individual and general beliefs, and consumption by family members. Insufficient supervision was the second main category, which included three subcategories, profitable market, insufficient supervision, and easy access. Conclusions: In general, two main themes explain the tendency of adults to consume smokeless tobacco: The context of consumption and the need for effective supervision. Concepts such as the consumer’s culture, individual and public beliefs, family members and friends being users, profitable market, the need for effective supervision, and easy access were the key factors pushing people of different ages toward using smokeless tobacco in Chabahar city.

Background: Given the increasing prevalence of methadone overdose and the growing number of deaths in Iran, the present study was conducted to determine the mortality rate of methadone detected in the cadavers brought to the Forensic Medicine Organization between 2015 and 2017. Methods: This cross-sectional study was performed on 7,486 cases of substance abuse deaths registered in the Forensic Medicine Organization during 2015-2017. In order to investigate the drug abuse, samples collected from the cadavers were initially examined for their drug contents, such as methadone, by standard screening methods and then confirmed by Thin Layer Chromatography (TLC). Using two checklists, the information collected about each cadaver consisted of the identity, autopsy and laboratory data. After data collection, they were entered into the Stata software version 14 MP. Results: The cadavers’ mean age was 36.6±12.6 years. Over the 3-year duration of the study, the standardized mortality rate increased from 35 to 39 cases per million per year. Of these cases, 6066 were randomly assigned to toxicology, 50.1% had used methadone one month before their death. Approximately 75% of the methadone abusers had taken another drug simultaneously, mostly morphine or methamphetamine. Conclusion: Considering the relatively high prevalence of methadone detected post-mortem, monitoring for methadone entry into public market and identifying the death-related factors in the drug abusers are considered as significant measures to improve upon the current alarming situation in the Iranian society.

IntroductionBreast cancer (BC) is the most common cancer among women worldwide. This study aimed to determine the disease-free interval (DFI) and the effect of risk factors and characteristics of first primary breast cancer survivors on the progression of contralateral breast cancer (CBC).MethodIn this retrospective cohort study, we identified 5003 women (containing 145 CBC and 4858 BC survivors) diagnosed with BC between 2000 and 2020 in the cancer research center. CBC was diagnosed at least 6 months after detection of primary BC. Kaplan–Meier method was used to indicate DFI and survival curves. To determine the risk factors of CBC, the Cox proportional hazard regression model was employed.ResultsThe median time interval among primary BC and CBC was 7.10 years (average: 7.57, range: 0.49-19.95). The 5-year DFI was 97%. The median age of CBC and primary BC patients was 47 (range 17-78) and 48 (range 17-90), respectively. ER+, PR+, and HER2+ were reported in 72.13%, 66.67%, and 30% of CBC patients. Also, 69.57% of patients had IDC pathology type and 81.90% and 83.64% of the patients were treated with adjuvant chemotherapy and external radiotherapy. More than half of the participants had no family history of BC (69.57%). The hazard ratio indicates that women 60-70 years old, a higher number of involved lymph nodes, and recurrence had significant relationships with CBC.ConclusionThis is the first study to investigate the risk factors of CBC and disease-free interval among BC survivors. Women with higher lymph node metastasis have a lower chance to develop CBC and patients with recurrence are at higher risk for CBC.

Resumo Fundamento: O índice de massa corporal (IMC) é o índice mais usado para categorizar uma pessoa como obesa ou não-obesa, e está sujeito a limitações importantes. Objetivo: Avaliar o efeito direto do IMC nos desfechos cardiovasculares em participantes sem obesidade central. Métodos: Esta análise incluiu 14.983 homens e mulheres com idades entre 45-75 anos do Estudo de Risco de Aterosclerose em Comunidades (ARIC). O IMC foi medido como obesidade geral e a circunferência da cintura (CC), a relação cintura-quadril (RCQ) e circunferência do quadril como obesidade central. A estimativa de máxima verossimilhança direcionada (TMLE, no acrônimo em inglês) foi usada para estimar os efeitos totais (TEs) e os efeitos diretos controlados (CDEs). A proporção de ET que seria eliminada se todos os participantes fossem não obesos em relação à obesidade central foi calculada usando o índice de proporção eliminada (PE). P

Summary Background Self-report is one of the most widely used techniques for the assessment of illicit drugs. Nonetheless, the data obtained from illicit drugs user through self-reports is associated with bias and random error. Therefore, validation of these kinds of studies should be determined. Objectives The aim of this study was to determine the agreement between family report of amphetamine/methamphetamine abuse by deceased individual and laboratory findings from autopsy. Methods In this cross-sectional study, demographic, epidemiological and laboratory data of people, whose cause of death was illicit drug use in Iran, between March 2015 and March 2018, were extracted by two checklists. Individuals with both laboratory results and family report regarding the amphetamine/methamphetamine use were extracted and agreement between their results was assessed using the Kappa index, sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve. Results The total number of people who died due to illicit drugs use were 7762. There were 3716 (47.8%) cases with both questionnaire responses and lab results; 88.8% were male and the rest were female. Family reports demonstrated moderately low validity with a low Kappa agreement rate 0.33 (95% CI: 0.30, 0.36), sensitivity 60.3% (95% CI: 56.9–63.7) and moderately high specificity 77.9% (95% CI: 76.4–79.4). Conclusion Results of this study imply that self-report of family cannot be used as a valid response for amphetamine usage in deceases related to illicit drugs use.

Background and aims To elucidate the effect modification of general and central obesity by sex and age on the risk of cardiovascular events. Methods The analysis included 14,983 males and females aged 45–75 years from the Atherosclerosis Risk in Communities study. Obesity was defined with body mass index (BMI), waist-to-hip ratio (WHR) and body shape index (BSI) which categorized the participants as obese and non-obese. Targeted maximum likelihood estimation was used to estimate the risk ratio (RR) with the tmle package in R software. Results After adjustment, the strongest effect of BMI on CHD was in females (RR (95%CI): 1.26 (1.11, 1.42)) and in age>54 (RR (95%CI): 1.16 (1.06, 1.27)) and for HF it was in age>54 (RR (95%CI): 1.18 (1.10, 1.26)) and in females (RR (95%CI): 1.17 (1.08, 1.28)). Regarding central obesity, WHR (RR (95%CI): 1.19 (1.05, 1.34)) had the strongest effects on CHD for males and BSI (RR (95%CI): 1.140 (1.02, 1.26)) for age ≤ 54, and for HF the WHR (RR (95%CI): 1.22 (1.10, 1.36)) and BSI (RR (95%CI): 1.18 (1.07, 1.30)) had the strongest effects for age≤54, respectively. Conclusion Among males and age≤54, WHR index was associated with a higher risk of CHD and HF while BMI was so for females and age>54.

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.

IntroductionApproximately 0.5 million fatalities per year are attributed to substance use disorder (SUD). SUD is refractory to therapy and has a high relapse rate. Cognitive deficits are also common in patients with SUD. Cognitive–behavioural therapy (CBT) is a promising treatment that may build resilience and reduce relapse among people with SUD. Our planned systematic review aims to clarify the effect of CBT on resilience and the relapse rate in adult patients with SUD compared with treatment as usual or no intervention.Methods and analysisWe will search the Scopus, Web of Science, PubMed, Medline, Cochrane, EBSCO CINAHL, EMBASE and PsycINFO databases from inception to July 2023 for all relevant randomised controlled or quasiexperimental trials published in English. The follow-up period of included studies must be at least 8 weeks. The PICO (Population, intervention, control, and outcome) format was used to develop the search strategy. Search terms will be combined using boolean operators and have been customised for different databases. The Cochrane tool for randomised controlled trials will be used to assess the risk of bias in included studies. Extracted data will include bibliographic data, sample size, intervention method, summary of the findings, follow-up duration and effect sizes with standard errors. A random effects model will be used to combine effect measures. Subgroup analyses will be performed by CBT type, sex and SUD subtype, as applicable. I2statistics will be used to evaluate heterogeneity, and funnel plots will be used to address publication bias. If we detect significant heterogeneity, the findings will be reported as a systematic review without a meta-analysis.Ethics and disseminationEthical approval is not required for this study. The findings will be submitted for publication in a peer-reviewed journal.PROSPERO registration numberCRD42022344596.

Objectives: This study aims to investigate the risk factors associated with severity and death from COVID-19 through a systematic review and meta-analysis of the published documents in Iran. Methods: A systematic search was performed based on all articles indexed in Scopus, Embase, Web of Science (WOS), PubMed, and Google Scholar in English and Scientific Information Database (SID) and Iranian Research Institute for Information Science and Technology (IRA)NDOC indexes in Persian. To assess quality, we used the Newcastle Ottawa Scale. Publication bias was assessed using Egger's tests. Forest plots were used for a graphical description of the results. We used HRs, and ORs reported for the association between risk factors and COVID-19 severity and death. Results: Sixty-nine studies were included in the meta-analysis, of which 62 and 13 had assessed risk factors for death and severity, respectively. The results showed a significant association between death from COVID-19 and age, male gender, diabetes, hypertension, cardiovascular disease (CVD), cerebrovascular disease, chronic kidney disease (CKD), Headache, and Dyspnea. We observed a significant association between increased white blood cell (WBC), decreased Lymphocyte, increased blood urea nitrogen (BUN), increased creatinine, vitamin D deficiency, and death from COVID-19. There was only a significant relationship between CVD and disease severity. Conclusion: It is recommended that the predictive risk factors of COVID-19 severity and death mentioned in this study to be used for therapeutic and health interventions, to update clinical guidelines and determine patients’ prognoses.

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.

Background: Road traffic accidents (RTAs) have become an important public health problem and the mortality rate due to RTAs in Iran is significantly higher than the international standards. There is no accurate information about the mortality rate caused by heavy vehicles in Iran. Therefore, this study aimed at evaluating road traffic mortality caused by heavy vehicles in Iran. Materials and Methods: In this cross-sectional study, the mortality rate caused by heavy vehicles was evaluated regarding age, sex, marital status, education, place and type of accident, and traffic classification. The relative frequency percentage was used for descriptive analysis. T-test, Chi-square, and one-way ANOVA were used to examine the relationship between the variables. Results: A total of 3560 persons died only due to heavy vehicle accidents, and the age-standardized mortality rate was 4.34 per 100,000 populations. The mean age of the victims was 38.9 ± 20.8 years. Furthermore, 80% of the victims were male. Results showed that 83% of all deaths occurred outside cities, and the most common type of vehicle used by the victims was truck and trailer. The highest percentage (57.3%) of accidents was related to heavy and light vehicles. Conclusions: The rate of RTAs-related mortality rate caused by heavy vehicles in Iran is higher than the basic international rate, and there is a need to investigate the causes of this issue.

Background: In the classification of road accidents, type 2 traffic accidents and non-traffic accidents are not considered and in Iran so far no special study has been done in the field of type 2 traffic accidents and non-traffic accidents, so we aimed to investigate the incidence of type 2 traffic accidents and non-traffic accidents in Iran. Methods: This cross-sectional was conducted on all individuals referred to Forensic Medicine Organization (FMO) from all over Iran who suffered from non-traffic accidents and type 2 traffic accidents during 2013-2018. Demographic information, accident information and other information including the location of the impact, the final cause of death and the date of the accident were examined. The information received from the FMO was first checked and then analyzed using Stata 11 statistical software. Results: During the 6-year study period, 10882 people lost their lives in type 2 traffic accidents (4779 people) and non-traffic accidents (5287 people). In terms of age, the highest incidence of type 2 traffic accidents and non-traffic accidents was observed in the age group over 65 years. The incidence of type 2 traffic accidents has not been increasing, while the trend of non-traffic accidents has been increasing. Conclusion: With respect to the high rate of deaths due to traffic accidents, including type 2 traffic accidents and non-traffic accidents, it is necessary for the national media and relevant agencies to educate the people about first aid and also inform about free relief services, timely presence is important.

Background Abuse against women causes great suffering for the victims and is an important health problem among women. To date, a few screening instruments for wife abuse exist for married women in Iran, but they only assess some of the wife abuse components. The aim of this study was to investigate the psychometric properties and factor structure of the Haj-Yahia’s Questionnaire in a sample of married women residing in Tehran. Materials and methods This is a cross-sectional study with a population consisting of married women in Tehran, among which 471 individuals were selected using convenience sampling method. Psychometric properties of the questionnaire were evaluated using face validity, content validity, construct validity, internal consistency, and stability. Confirmatory factor analysis was performed using the weighted least square mean and variance adjusted. We performed confirmatory factor analysis using Mplus version 8 software and for other calculations, we used STATA V14. Results The quantitative results of face validity and content validity indicated that all items of the questionnaire were in acceptable range, and were retained in the study. In CFA results, the model fit indices were acceptable (TLI = 0.986, CFI = 0.987, RMSEA = 0.039 and SRMR = 0.057). Cronbach’s alpha coefficient for psychological abuse, physical abuse, sexual abuse, and economic abuse were estimated 0.90, 0.93, 0.79, and 0.78 respectively, and an alpha of 0.95 was found for the total questionnaire. The intra-cluster correlation index was 0.98. Conclusions Findings showed that the Persian version of the questionnaire of violence against women made it possible to evaluate various dimensions of violence using 4 factors and showed good construct validity and internal reliability in the female population in Iran; therefore, it can be used in future studies.

Background: Using dexmedetomidine (Dex) as a sedative agent may benefit the clinical outcomes of post-surgery patients. We reviewed randomized controlled trials (RCTs) to assess whether use of a Dex could improve the outcomes in post-surgery critically ill adults. Methods: We searched Medline, Embase, PubMed, and the Cochrane databases for RCTs comparing Dex with propofol or a placebo in post-operative patients, all included RCTs should be published in English before Jul 2016. Citations meeting inclusion criteria were full screened, and trial available data were abstracted independently and the Cochrane risk of bias tool was used for quality assessment. Results: Sixteen RCTs involving 2568 patients were subjected to this meta-analysis. The use of a Dex sedative regimen was associated with a reduce delirium prevalence [odd ratio (OR):0.33, 95% confidence intervals (CI): 0.24–0.45, I2= 5%, P

Introduction Population-based cancer registry (PBCR) plays a significant role in burden of cancer estimation. Estimating the completeness of cancer registry is one of the criteria to assess the quality of data (results). Also, Capture-recapture is one of the methods used to assess completeness of cancer registry. Objective This study was aimed to estimate the completeness of lung and bronchial cancer registry using three-source capture-recapture method in Khuzestan province. Materials and methods This study was carried out using three-source capture-recapture method and data were obtained from three sources including medical records, death certificates and pathology labs (reports) in Khuzestan. In this study, total new cases of lung and bronchial cancer registered by the three sources in 2011, were enrolled. Among the sources, the common cases were identified and the completeness rate of lung and bronchial cancer registry was calculated by log-linear method using R software, finally. Results Totally, 426 new cases for lung cancer had reported from the three sources in 2011. The completeness index of lung cancer registry was totally estimated 72%, as well as it was independently 40%, 25% and 37.6% for the medical records, pathology reports and death certificates sources, respectively. Conclusion According to the results, after collection and remove repetition of the cases related to lung cancer, it should be added their number registered by the pathology (labs), medical records and death certificates sources by 28%–40%, to estimate actual incidence of lung cancer. Also, the actual incidence of lung cancer cases related to each of medical records, pathology and death certificates was calculated by adding the reported values by 60%, 75% and 63%, respectively.

Background and aims: Cutaneous leishmaniasis (CL) is one of the most important parasitic diseases in the world. Sabzevar city is endemic area for CL in the north east of Iran. The aim of this study was to evaluate the time distribution of cutaneous leishmaniasis (CL) in Sabzevar County using the segmented regression model. Methods: This ecological study used the existing data related to the rural districts of Sabzevar County that were obtained from the Health Deputy of this county during 2011-2017. In addition, the segmented regression model was applied to evaluate the time trend of CLs. Finally, Joinpoint software was used for time series analysis. Results: A total of 1912 CL cases occurred in Sabzevar County from 2011 to 2017, with an incidence rate of 93.61 per 100000. The highest and lowest observed incidence rates were in 2011 (25 per 10000 persons) and 2015 (3.24 per 10000 persons), respectively. Based on the results, the annual incidence of CL in the intended region decreased and the annual percent change was equal to -22.40. Further, the time series analysis using segmented regression by rural districts showed a change point in the trend of the incidence of leishmaniasis in three rural districts (Pain Joveyn and Joghatai in 2014 and Qasabeh-ye Sharqi in 2013). In other words, the trend was different before and after the change point in the mentioned districts. Conclusion: In general, the results indicated that interventional, preventive, and therapeutic measures for breaking the chain of CL transmission in Sabzevar have been desirable in recent years. Eventually, it is suggested that further time-series studies be conducted at the level of the month or a longer interval in order to better evaluate the period effect and secular trend.

Child mortality rates are considered to be one of the key indicators of child health.The main objective of this research was to calculate child mortality rates (CMRs) indirectly, using census data, and to investigate using spatial pattern analysis the presence of any clustering patterns among provincial regions.The Trussell version of the Brass method and Coale-Demeny West model were used to estimate CMRs and life expectancy (LE) at birth. The analyses were performed using the QFive program of MORTPAK 4 software. For cluster analysis, local and global Moran's I indexes were measured.Infant mortality rate, under-5 mortality rate, 1-4 mortality rate and LE at birth were estimated as 21.9, 26, 4.1 (deaths per 1000 live births) and 72.1 years, respectively. Global Moran's I index was calculated as 0.09, 0.09, 0.08 and 0.12, respectively.Special attention must be paid in provinces with high clusters regarding the evaluation of public health programmes, and the cause of failure of these programmes in reduction of childhood mortality indices.التقدير غير المباشر لوفيات الأطفال باستخدام بيانات تعداد السكان لعام 2011 في جمهورية إيران الإسلامية.ياسر مخيري، سيد رياحي، إلهه رفيعى، زهرا اسدكل، سيد هاشمي نظرى.يُعتبر معدل وفيات الأطفال أحد المؤشرات الرئيسية لصحة الأطفال.كان الهدف الأساسي من هذا البحث هو حساب معدلات وفيات الأطفال بطريقة غير مباشرة، باستخدام بيانات تعداد السكان، والاستقصاء بشأن وجود أنماط التكتل على مستوى المناطق الإقليمية باستخدام تحليل النمط المكاني.استُخدمت نسخة تروسل الخاصة بطريقة براس ونموذج كول – ديمنى وست لتقدير معدلات وفيات الأطفال ومأمول العمر عند الميلاد. ولقد أُجريت التحليلات باستخدام برنامج QFive لبرمجيات MORTPAK4. ولتحليل التكتلات، قِيسَت مؤشرات موران I المحلية والعالمية.قُدِّر معدل وفيات الرضَّع، ووفيات الأطفال أقل من 5 سنوات، ومعدل وفيات الأطفال من عمر سنة إلى 4 سنوات ومأمول العمر عند الميلاد بما مقداره 21.9، و26، و4.1 (الوفيات لكل 1000 مولود حيٍّ) و72.1 عاماً على التوالي. وجاءت نتائج حساب مؤشر موران I العالمي 0.09، و0.0.9، و0.08 و0.12 على التوالي.يجب إيلاء عناية خاصة في الأقاليم ذات التكتلات المرتفعة في ما يتعلق بتقييم برامج الصحة العامة، وسبب إخفاق هذه البرامج في خفض مؤشرات وفيات الأطفال.Estimation indirecte de la mortalité juvénile à l’aide des données du recensement de 2011 en République islamique d’Iran.Les taux de mortalité juvénile sont considérés comme l’un des indicateurs clés de la santé de l’enfant.La présente recherche visait principalement à calculer les taux de mortalité juvénile de façon indirecte, à partir des données du recensement. Elle avait aussi pour objectif de rechercher la présence de tendances de regroupement dans les régions provinciales au moyen d’une analyse de la structure spatiale.La version de Trussell du modèle de Brass et le modèle Ouest des tables de Coale et Demeny ont été utilisés pour estimer les taux de mortalité juvénile et l’espérance de vie à la naissance. Les analyses ont été réalisées à l’aide du programme QFive du logiciel MORTPAK 4. Pour l’analyse en grappes, les indices de Moran local et global ont été mesurés.Le taux de mortalité infantile, le taux de mortalité des moins de 5 ans, le taux de mortalité des enfants de 1 à 4 ans et l’espérance de vie à la naissance ont été estimés à 21,9, 26, 4,1 (décès pour 1 000 naissances vivantes) et 72,1 ans, respectivement. L’indice global de Moran I a été calculé à 0,09, 0,09, 0,08 et 0,12, respectivement.Une attention particulière doit être portée aux provinces présentant des grappes importantes en ce qui concerne l’évaluation des programmes de santé publique et la cause de l’échec de ces derniers en termes de réduction des taux de mortalité juvénile.

Background and Objectives: According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 360,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 90% of unintentional drowning deaths. This study aimed to calculate the rate of drowning mortality rate and to investigate its trend in Iran. Materials and Methods: Information on death due to drowning in Iran was extracted from Iranian Legal Medicine Organization. The crude mortality rate was calculated each year according to gender and province of the country. To examine the trend for different years, joinpoint regression was used. Results: From 2013 to 2018, a total of 5853 persons suffered from fatal drowning in Iran. The crude mortality rate in men was significantly higher than in women. The drowning mortality rate has decreased during the study period in both genders. The annual percent change in mortality rate was 3.2%. Conclusions: Although the death rate from drowning has declined in the country, targeted scale-up of known effective interventions such as swimmers supervision and basic survival skills are still needed for reducing mortality due to drowning, particularly in provinces with high mortality rates.

Background Critical inter-provincial differences within Iran in the pattern of non-communicable diseases (NCDs) and difficulties inherent to identifying prevention methods to reduce mortality from NCDs have challenged the implementation of the provincial health system plan. The Shahrekord Cohort Study (SCS) was designed to address these gaps in Chaharmahal and Bakhtiari, a province of high altitude in the southwest of Iran, characterized by its large Bakhtiari population, along with Fars and Turk ethnicity groups. Methods This ongoing cohort, a prospective, large-scale longitudinal study, includes a unique, rich biobank and was conducted for the first time in Chaharmahal and Bakhtiari Province in Iran. SCS is a part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort. The study began in 2015, recruited 10075 participants (52.8% female, 47.2% male) from both urban (n=7034) and rural (n=3041) areas, and participants will be annually followed up for at least 15 years. A cross-sectional analysis was conducted using baseline data from the SCS, using descriptive statistics and logistic regression. Data analysis was performed using Stata software. Results The prevalence of NCDs was 9.8% for type 2 diabetes, 17.1% for hypertension, 11.6% for thyroid disease, 0.2% for multiple sclerosis and 5.7, 0.9 and 1.3% for ischemic heart disease, stroke and myocardial infarction, respectively. The prevalence of multimorbidity (≥2 NCDs) was higher in women (39.1%) than men (24.9%). The means (standard deviations) of age, BMI, systolic blood pressure and fasting blood glucose were 49.5 (9) years, 27.6 (4.6) kg/m2, 115.4 (17.3) mmHg and 96.7 (27.3) mg/dL, respectively. Logistic regression models showed that older age, female gender, living in an urban area, non-native ethnicity, high wealth index, unemployment, obesity, low physical activity, hypertriglyceridemia, high fasting blood sugar, alkaline urine pH and high systolic and diastolic blood pressure were associated with increased prevalence of NCDs. Conclusions The SCS provides a platform for epidemiological studies that will be useful to better control NCDs in the southwest of Iran and to foster research collaboration. The SCS will be an essential resource for identifying NCD risk factors in this region and designing relevant public health interventions.

Background: The unknowingness of COVID-19 compared to other respiratory diseases and gaining an overview of its diagnostic criteria led to this study, which was designed to summarize the signs and symptoms along with the clinical tests that described these patients. Methods: PubMed\MEDLINE, Web of Science, Core Collection, Scopus, and Google Scholar were systematically searched on September 27, 2020. After screening, we selected 56 articles based on clinical characteristics and laboratory and imaging findings in confirmed COVID-19 patients as eligibility criteria. To evaluate risk of bias, the Newcastle Ottawa scale, for publication bias, Egger’s test, and for heterogeneity, I2 and tau test were used;and finally, random-effects models were used for pooled estimation. Results: Pooled estimates for frequently clinical symptoms were as follows: fever (78% [95% CI, 74-82]), cough (60% [95% CI, 57-63]), and fatigue (31% [95% CI, 26-36]);and they were as follows for laboratory findings in lymphocyte (1.02 [95% CI, 0.92-1.12]), CRP (19.64 [95% CI, 13.96-25.32]), and platelet count (175.2 [95% CI, 165.2-185.2]);they were as follows for imaging findings in bilateral pneumonia (64% [95% CI, 56-72]), and ground glass opacity (60% [95% CI, 48-7]). Also, in the subgroup analysis, bilateral pneumonia with 18% and fatigue with 15%, had the highest difference in values between the groups. Conclusion: According to Forest plots, the CI and dispersion among studies were smaller in laboratory findings than in symptom and imaging findings, which might indicate a high alignment in the laboratory findings among studies. © Iran University of Medical Sciences

Background: Traffic accidents are one of the most common causes of mortality and physical disabilities, endangering the lives of many people all over the world annually and are among the top public health problems worldwide. In the present study, we aimed to investigate the trend of mortality rate due to traffic accidents in the provinces of Iran.Methods: In this cross-sectional study, all the deaths caused by traffic accidents in Iran during 2006-2018 were investigated. Using the population of the country by age, sex, and provinces of the country, the mortality rate was calculated and the trend of 13-year changes was studied. The negative binomial regression was used to analyze the linear or nonlinear trend of reduction in mortality rate during the study years. Microsoft Excel 2016 and Stata version 14 software were used to analyze the data.Results: During the study period, 259995 traffic accidents deaths occurred in Iran, of which 78.6% were men and 21.4% were women. The mean age of the deceased was 37.6 ± 20.7 years (37.4 ± 20 years in men and 38.6 ± 23 years in women). The number of the deaths in these years has decreased from 27,567 in 2006 to 17,183 in 2018 and the mortality rate has dropped from 39 per 100,000 in 2006 to 21 per 100,000 in 2018.Conclusion: Despite the decreasing trend in the mortality rate of traffic accidents in Iran during the study years, this trend was different across the provinces. Therefore, it seems necessary to design epidemiological studies to be conducted in different area and provinces of a country, to better and more accurately determine the factors affecting the occurrence of these deaths.

BACKGROUND Many factors contribute to the spreading of hospital-acquired infections (HAIs). OBJECTIVE This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. METHODS In 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. RESULTS The 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. CONCLUSIONS The 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.

Background Many factors contribute to the spreading of hospital-acquired infections (HAIs). Objective This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. Methods In 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. Results The 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. Conclusions The 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.

We determined the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an affected area in northern Iran in April 2020. Antibodies to SARS-CoV-2 were detected in 528 persons by using rapid tests. Adjusted prevalence of SARS-CoV-2 seropositivity was 22.2% (95% CI 16.4%–28.5%).

Recent studies reported that some recovered COVID‐19 patients have tested positive for virus nucleic acid again. A systematic search was performed in Web of Science, PubMed, Scopus, and Google Scholar up to March 6, 2021. The pooled estimation of reinfection, recurrence, and hospital readmission among recovered COVID‐19 patients was 3, 133, and 75 per 1000 patients, respectively. The overall estimation of reinfection among males compared to females was greater. The prevalence of recurrence in females compared to males was more common. Also, hospital readmission between sex groups was the same. There is uncertainty about long‐term immunity after SARS‐Cov‐2 infection. Thus, the possibility of reinfection and recurrence after recovery is not unexpected. In addition, there is a probability of hospital readmission due to adverse events of COVID‐19 after discharge. However, with mass vaccination of people and using the principles of prevention and appropriate management of the disease, frequent occurrence of the disease can be controlled., Highlights The pooled estimation of re‐infection rate among recovered COVID‐19 patients was 3 per 1000 patients.The pooled estimation of recurrence rate among recovered COVID‐19 patients was 133 per 1000 patients.Hospital readmission among recovered COVID‐19 patients was 75 per 1000 patients.The possibility of re‐infection, recurrence and hospital readmission after recovery is not unexpected. Thus, adherence to principles of prevention besides vaccination is essential.

This paper introduces the Blinder-Oaxaca decomposition method to be applied in explaining inequality in health outcome across any two groups. In order to understand every aspect of the inequality, multiple regression model can be used in a way to decompose the inequality into contributing factors. The method can therefore be indicated to what extent of the difference in mean predicted outcome between two groups is due to differences in the levels of observable characteristics (acceptable and fair). Assuming the identical characteristics in the two groups, the remaining inequality can be due to differential effects of the characteristics, maybe discrimination, and unobserved factors that not included in the model. Thus, using the decomposition methods can identify the contribution of each particular factor in moderating the current inequality. Accordingly, more detailed information can be provided for policy-makers, especially concerning modifiable factors. The method is theoretically described in detail and schematically presented. In the following, some criticisms of the model are reviewed, and several statistical commands are represented for performing the method, as well. Furthermore, the application of it in the health inequality with an applied example is presented.

Objectives: We aimed to estimate the space-time distribution of the risk of suicide mortality in Iran from 2006 to 2016.Methods: In this repeated cross-sectional study, the age-standardized risk of suicide mortality from 2006 to 2016 was determined. To estimate the cumulative and temporal risk, the Besag, York, and Mollié and Bernardinelli models were used.Results: The relative risk of suicide mortality was greater than 1 in 43.0% of Iran’s provinces (posterior probability >0.8; range, 0.46 to 3.93). The spatio-temporal model indicated a high risk of suicide in 36.7% of Iran’s provinces. In addition, significant upward temporal trends in suicide risk were observed in the provinces of Tehran, Fars, Kermanshah, and Gilan. A significantly decreasing pattern of risk was observed for men (β, -0.013; 95% credible interval [CrI], -0.010 to -0.007), and a stable pattern of risk was observed for women (β, -0.001; 95% CrI, -0.010 to 0.007). A decreasing pattern of suicide risk was observed for those aged 15-29 years (β, -0.006; 95% CrI, -0.010 to -0.0001) and 30-49 years (β, -0.001; 95% CrI, -0.018 to -0.002). The risk was stable for those aged >50 years.Conclusions: The highest risk of suicide mortality was observed in Iran’s northwestern provinces and among Kurdish women. Although a low risk of suicide mortality was observed in the provinces of Tehran, Fars, and Gilan, the risk in these provinces is increasing rapidly compared to other regions.

Objective To assess whether drowsy driving can increase road traffic accident related deaths and injuries. Design Systematic review and meta-analysis. Data sources Cochrane Injuries Group Specialized Register, Cochrane Central Register of Controlled Trials, EMBASE, Medline, National Technical Information service, Psychlit, International Road Research Documentation, Transport Research Information Service, and web sites related to the road safety organization were searched; experts were contacted, conference proceedings were hand searched, and relevant reference lists were checked. Inclusion criteria We sought to identify all epidemiological studies, published in English language, which assessed the association between fatigued or sleepy driving and the occurrence of car crashes lead to death or injury. Methods We conducted a systematic literature review with meta-analysis using PubMed, Google scholar and other valid databases to search for articles published from January 1980 through September 2016 to identify precise effect of drowsy driving on road traffic accidents. For each study odds ratio was calculated, the ratio of event odds in the drivers with drowsy driving divided by the drivers without drowsy driving, which were pooled to obtain an overall estimate using a fixed and random effects models. Findings Fourteen articles satisfying inclusion criteria were identified that all of them were included in quantitative synthesis. Pooled odds ratio obtained by fixed and random effect models was 1.29 (95% CI 1.24 to 1.34) and 1.34 (95% CI 1.25 to 1.43), respectively. Conclusion Our findings that obtained from meta-analysis (with high level of evidence) suggest a significant association between crash involvement and drowsy driving. It seems that establishment of strategies to reduce any risk factors of road traffic accident such as drowsy driving can be effective in decreasing traffic crashes.

Objectives: Considering the high mortality rate of pedestrians in traffic accidents in Iran, the present study aimed to determine the high-risk and low-risk areas of accidents resulting in pedestrian deaths and the spatial analysis of their mortality rates. Methods: This cross-sectional study included 4,371 deceased pedestrians reported by the Legal Medicine Organization in Iran from March 2012 to March 2013. For spatial analysis, the collected data were entered into ArcGIS software version 10.2 and a spatial map of the mortality rate was drawn according to the distribution of data in the provinces. Using this software, high-risk and low-risk areas were identified by calculating the spatial autocorrelation of the data. The Moran's index of road accident patterns was surveyed and high-risk and low-risk points were identified using the local Getis index. Results: The age-standardized incidence rate was 6.8 per 100,000. After analyzing the data using ArcGIS software, the local Moran's index showed a cluster pattern with a high mortality rate in 3 provinces of Mazandaran, Gilan, and Qazvin. In identifying high-risk and low-risk points, the local Getis index showed 3 hot spots with a confidence interval of 99% in Qom, Qazvin, and Mazandaran and 5 hot spots with a 95% confidence interval in Markazi, Tehran, Zanjan, Gilan, and Golestan provinces. Conclusions: According to the cluster pattern of accidents in the 3 provinces and the presence of hot spots in 9 provinces, it is necessary to identify factors that increase the risk of death in the study provinces in order to reduce the mortality rate among pedestrians due to traffic accidents. Therefore, to reduce the pedestrian mortality rate, especially in high-risk provinces, some studies need to be conducted to determine the risk factors in pedestrian mortality.