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Background: Rabies remains a public health problem in middle-income countries like Iran, despite being preventable. This study aimed to evaluate the six-year incidence of animal bites in the southern Caspian Sea region from 2016 to 2022, and focus on estimating the direct costs of animal bite cases using the incidence-based method. Methods: A multicenter, registry-based study was conducted using surveillance data of animal bites. Results: Of the 40 922 cases reported during the study period, 65.9% were male and 34.1% were female. Animal bites were most frequent among individuals over 50 years of age (23.5%), while children under 10 years of age had the lowest frequency of animal bites (2.3%). Animal bites were most common in June. Dogs were responsible for 33 277 (81%) cases, cats for 5,624 (13.7%) cases, cows for 1054 (2.5%) cases, and other animals for the remaining cases. During the six-year study period, four deaths due to rabies were reported in the study area. The annual bite incidence rate was 386.3 per 100 000 people in northern Iran. The males-to-female ratio was highest in 2019 (M/F ratio = 2.4, 95% CI = 1.2-3.4). Conclusion: The elderly are at higher risk of animal bites, especially in rural areas. It is important to emphasize the use of protective clothing, washing wounds with soap water and rabies vaccination as initial treatment. Targeted vaccination efforts for eligible animals should be prioritized to minimize unnecessary financial burden. Educating farmers about rabies prevention programs, especially in cases of cow bites, is also important. [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI). Methods: The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website. Results: Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91 000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five. Conclusion: This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures. [ABSTRACT FROM AUTHOR]

Background: While there has been extensive research on colorectal cancer (CRC) incidence and its associated factors in Iran, a significant gap exists in studies predicting its future trends. Our study aimed to thoroughly report CRC incidence across Iran from 2014 to 2017, by sex, age, and geographical regions, and provide a projection for 2025. Methods: This retrospective study utilized data from the Iranian National Population-based Cancer Registry (INPCR). Patients with the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes C18 to C21 were included. The age-standardized incidence rate (ASR), was calculated per 100 000 individuals annually, and crude incidence rates were retrieved for various demographic groups and years. Results: Between 2014 and 2017, a total of 43 580 new CRC cases (55.96% males) were registered. Men exhibited an ASR of 134.45, while women's ASR was 94.85. The highest ASRs were observed in Tehran, Qom, and Ilam (18.99, 18.26, and 18.06, respectively). Incidence rates surpassed 20 after age 50 for both genders, reaching their peak within the 80-84 age group. Adenocarcinoma was the most frequent histological type of CRC in nearly all provinces. Case numbers and ASRs are projected to continuously rise until 2025, with a predominance of male cases. Conclusion: The anticipated increase in CRC incidence in Iran emphasizes the need for additional studies to better identify risk factors. Furthermore, implementing screening programs is recommended for individuals at a higher risk of CRC, including men, the elderly population, and those residing in regions with a notable prevalence of CRC. [ABSTRACT FROM AUTHOR]

Background: Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation. Methods: Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥ 50 years). The results were correlated to patient's age and other data and evaluated with statistical analysis. Results: During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age. Conclusion: Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps. [ABSTRACT FROM AUTHOR]

Background: Neoadjuvant chemotherapy (NCT) has become an increasingly popular approach in management of breast cancer (BC). This study was conducted to evaluate the pathologic response and 36-month recurrence and survival rates of patients with human epidermal growth factor receptor 2 (HER2)-negative BC treated with different NCT regimens. Methods: A total of 163 female patients with HER2-negative BC who received NCT during 2017-2020 were identified from the Clinical Breast Cancer Registry of Iran and entered the study. The prescribed NCT regimens included 4 cycles of doxorubicin plus cyclophosphamide, 4 cycles of doxorubicin plus cyclophosphamide followed by 4 cycles of paclitaxel, 4 cycles of doxorubicin plus cyclophosphamide followed by 4 cycles of docetaxel or 6 cycles of doxorubicin plus cyclophosphamide plus docetaxel (TAC). Results: Thirty-two patients (19.6%) experienced pathologic complete response (pCR). TAC regimen, triple negative-BC and ki67 > 10% were significantly associated with increased pCR. The recurrence, overall survival (OS) and disease-free survival (DFS) rate at 36 months for all patients were 16.6%, 84.7% and 79.8%, respectively. Type of neoadjuvant regimen as well as age, hormone receptor status, Ki67, grade, clinical stage, type of surgery and pathologic response to chemotherapy did not significantly influence the survival and recurrence; however, TAC results in improved recurrence, OS and DFS rates. Conclusion: This study provides further evidence that NCT is a viable treatment option for patients with HER2-negative BC. The TAC regimen resulted in a significantly higher pCR rate compared to other regimens, but did not result in a significant improvement in recurrence, OS and DFS rates. [ABSTRACT FROM AUTHOR]

Background: Growing evidence shows the undisputable role of non-HDL-C and remnant cholesterol (remnant-C) in cardiovascular disease (CVD) risk assessment and treatment. However, the reference interval (RI) for these lipid parameters is not readily available. The aim of the present investigation was to determine the age and sex-specific RIs for non-HDL-C and remnant-C as well as other lipid parameters among a healthy population in southern Iran. We also report the RI of lipid parameters in rural and urban residents, smokers and post-menopausal women. Methods: Among 14 063 participants of Bandare Kong and Fasa cohort studies, 792 healthy subjects (205 men and 578 women) aged 35-70 years were selected. Fasting blood samples were used for determination of total cholesterol (TC), triglycerides (TG) and HDL-C using colorimetric methods. Non-HDL-C and remnant-C were calculated using the valid formula. The 2.5th and 97.5th percentiles were calculated and considered as RI. Results: In the total population (n = 792, age 35-70), RIs for non-HDL-C and remnant-C was 74.0-206.8 and 8.0-52.7 mg/dL, respectively. Age (35-44 and ≥ 45 years) and gender-specific RIs for serum non-HDL-C and remnant-C were determined. Remnant-C and non-HDL-C level were different between sex and age categories. The mean value of all lipid parameters except HDL-C was higher in men, urban residents, subject with age ≥ 45 years and smokers. Conclusion: This is the first study in which the RIs for non-HDL-C and remnant-C in southern Iran are reported. This may help physicians to conveniently use these lipid parameters for patient care and better cardiovascular risk assessment. [ABSTRACT FROM AUTHOR]

Background: Epidemiological research on the high-risk population might be helpful in early detection and prevention of biliary tract malignancies. This study assesses the prevalence of biliary tract cancer (BTC) in the Golestan province, northeastern Iran, between 2004 and 2016. Methods: The current study used information from the Golestan Population-based Cancer Registry (GPCR) to access the epidemiology of BTC across a 13-year period while taking into account temporal and geographic differences. The number of cases, crude rates, age-standardized incidence rates (ASRs) per 100,000 person-years, average annual percent change (AAPC), age-specific incidence rates, and 95% confidence intervals (CI) were reported for each year with respect to gender and place of residence. Results: Totally, 224 instances of BTC overall (54% of whom were females) were reported throughout the research period. The ASR of BTC was 1.7 (95% CI: 1.4-2) for females and 1.4 (95% CI: 1.1-1.6) for men, respectively. Males exhibited a growing time trend in incidence (AAPC: 7.18; CI: 0.06-14.81; P-value:0.048), whereas females had a decreasing trend (AAPC: 0.82; CI: -5.94-4.57; P value: 0.740). Both sexes saw an increase in age-specific incidence rates starting at the age of 45; however, males experienced a significant increase in incidence in the age group of 75 to 79 while the female rates grew steadily. Conclusion: The focus for cancer control in this region may be given to demographic groups with a combination of risk factors, including male gender, older age, and urban residence. [ABSTRACT FROM AUTHOR]

Background: Vaccination seems to be the most critical means of halting the COVID-19 pandemic. It is crucial to understand the factors that influence COVID-19 vaccine acceptance to avoid low vaccination rates. This study intended to monitor the COVID-19 vaccine acceptance and its association with socio-demographic factors and prior diagnosis of COVID-19 in Iranian adults during the COVID-19 pandemic. Methods: The study utilized data from the COVID-19 Population Survey of Iran (COPSIR), a repeated national survey designed to monitor COVID-19-related behavioral insights. From April 2020 to November 2021, thirteen iterations of a series of crosssectional studies involving computer-assisted telephone interviews were conducted. Results: The COVID-19 vaccine acceptance rate remained above 80% until the ninth wave in February 2021, when it dropped to 62.9%. However, throughout the next four surveys, it rose gradually from 72.0% to 85.7%. The multilevel regression model revealed that the COVID-19 vaccine acceptance was significantly and positively linked with age and education. Conclusion: Despite the relatively high COVID-19 vaccine acceptance rate among Iranian adults, after the emergence of vaccines on the global market and controversies about their safety in Iran, the initially high vaccine acceptance rate dropped significantly, and then increased over time and returned to its peak level (85%). According to the Commodity Theory, this rise in vaccine acceptance can be attributed to the COVID-19 vaccine shortage in the country between January and July 2022. For Iranian adults to accept vaccines more readily, health promotion programs should target the youth and the less literate adults. [ABSTRACT FROM AUTHOR]

Background: Anemia is a serious public health problem which may be associated with cardiovascular diseases (CVDs) and brain damage. This survey aims to determine the prevalence of anemia and its association with demographic and biochemical factors and metabolic syndrome in a human sample derived from the MASHAD cohort study. Methods: This survey was conducted on a sub-sample of 9847 individuals aged 35 to 65 as part of the MASHAD cohort study. Demographic characteristics and biochemical and anthropometrics indices were recorded. Data were analyzed using SPSS version 20. Results: Anemia was seen in 11.5% of the population. Anemia was significantly more prevalent in younger subject (P < 0.001), females (P < 0.001) and those with elevated body mass index (BMI) (P < 0.001). Mean high-density lipoprotein (HDL) was higher in anemic participant (P = 0.032). The incidence of anemia was significantly lower in smokers (P < 0.001) and also participant with hypertension (HTN) (P < 0.001), diabetes mellitus (DM) (P < 0.001) and metabolic syndrome (MetS) (P < 0.001). Mean FBG (P < 0.001), TG (P < 0.001), total cholesterol (P < 0.001), LDL (P < 0.001) and uric acid (P < 0.001) were significantly lower in anemic subjects. Cholesterol, MetS, low-density lipoprotein (LDL), BMI, uric acid, diabetes mellitus and also TG remained significantly different after multivariate analysis between anemic and healthy participants. Conclusion: The studied population had a lower prevalence of anemia compared to the previous WHO report for Iranians. Iron deficiency is recognized as the most important cause of anemia in Iran; however, further investigations will be need to confirm this pattern. We demonstrated that anemia is adversely associated with MetS and DM. [ABSTRACT FROM AUTHOR]

Background: Breast cancer accounted for 28.1% of all female cancers in 2020 in Iran. This study was conducted to evaluate the time trend of breast cancer incidence and to identify the changes of breast cancer incidence in age, period, and birth cohorts in Iran, in the 2009--2017 timeframe. Methods: Annual cancer statistics for female breast cancer were obtained from the Iranian National Population-based Cancer Registry (INPCR) database from 2009 to 2017. The age-period-cohort (APC) analysis was used to evaluate the time trend of breast cancer incidence in age, period and birth cohorts between 2009 and 2017. R package (Epi) was used to analyze data. Results were considered statistically significant at P < 0.05. Results: The age effect showed an increased incidence of breast cancer until the age of 45, and after this age the speed of increase was slower until 65 years. There was an increased diagnosis in 2015--2017 (period effect) for many age groups, especially in the 70- and over 80-year-old group. Conclusion: Our findings indicated that breast cancer incidence peaks in the age of 45 in Iranian women, which is a decade earlier compared to the Western world. The period effect in 2015--2017 can be explained by the fact that in 2014, the former Iranian pathology-based cancer registry was upgraded to a population-based cancer registry, which resulted in improved coverage of cancer registry and case finding. [ABSTRACT FROM AUTHOR]

Background: Long-term complications of stroke, persisting for more than 6 months after the initial event, substantially reduce the quality of life (QoL) in a significant percentage of stroke survivors. In this paper, we studied the prevalence of long-term urinary incontinence (UI) in post-stroke patients. In addition, we attempted to identify patient characteristics which were associated with higher UI prevalence, higher UI severity, and less UI-associated QoL. Methods: Medical records in a tertiary referral hospital were used to contact patients who had experienced a stroke between 6 to 32 months before the study date. The patients were given the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) questionnaire for determining the presence of UI and its severity. UI-positive patients were then given the I-QOL questionnaire to determine their QoL. Results: The prevalence of UI in our study population (n = 189) was 31%. Older age at the time of stroke was associated with higher UI severity (r = 0.290) and lower QoL (r = -0.265). Furthermore, the presence of movement limitation was associated with higher UI prevalence (P < 0.001, OR = 3.89) and severity (P = 0.002, d = 1.05). Movement limitation also significantly impacted the psychological and social aspects of UI-associated QoL (P = 0.035, d = -0.74). Conversely, higher body mass indices (BMIs) were associated with lower UI severity (r = -0.346) and higher QoL (r = 0.281). Conclusion: In conclusion, UI continues to be prevalent in stroke survivors long after the cerebrovascular accident (CVA). As a result, these patients require continuous monitoring and UI prevention. [ABSTRACT FROM AUTHOR]

Background: The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort. Methods: We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires. Results: The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR = 1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM. Conclusion: The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran. [ABSTRACT FROM AUTHOR]

Background: Despite the evidence for validity of body image pictogram (BIP) to discriminate overweight, obese, and normal individuals, there is little evidence on the probable effect of socio-demographic variables on its validity. To investigate the effects of socioeconomic status (SES), age, ethnicity, and educational level on the validity of BIP to discriminate normal weight, overweight, and obese people. Methods: We used the Pars Cohort Study (PCS) data. Stunkard's BIP score was used as test measure. Participants were classified as normal (body mass index [BMI] < 25), overweight (BMI = 25 to 29.9), and obese (BMI ≥ 29.9) based on their BMI (kg/m2). Area under curve (AUC) and its 95% CI were estimated and compared. Optimal cutoff points and their sensitivity, specificity, and likelihood ratio were reported. Results: A total of 9232 participants with a female/male ratio of 1.03 were included. The prevalence of overweight and obesity was 37.4% and 18.2%, respectively. Regardless of socio-demographic levels, the optimal cut-points to discriminate normal BMI from overweight, and overweight from obese participants were BIP score of four and five, respectively. Estimated AUC correlated with ethnicity (P < 0.001) for both genders, and with SES for females (P < 0.05). Conclusion: Although BIP may be a valid measure to categorize the general adult population into normal, overweight and obese, its validity depends on SES and ethnicity. BIP may be available as a proxy measure for BMI categories in socio-demographically homogeneous populations but not in heterogeneous populations. [ABSTRACT FROM AUTHOR]

Background: Prophylactic central lymph node dissection (CLND) in papillary thyroid carcinoma (PTC) is still controversial. This study aimed to analyze the factors related to the patient and tumor characteristics affecting central lymph node metastasis (CLNM) in PTC patients and to evaluate the contribution of the results to shaping the surgical treatment algorithm. Methods: Two hundred and fifty-five PTC patients who underwent total thyroidectomy and CLND were evaluated retrospectively. Histopathology reports were examined to reveal tumor characteristics. The CLNM ratio and the relationship between CLNM with clinicopathological and demographic characteristics were analyzed. Results: The incidence of CLNM was 54.9% (95 CI%: 49-60.8). Male gender (P = 0.027), age < 45 years (P = 0.016), tumor size ≥ 9.5 mm (P < 0.001), lymphovascular invasion (P < 0001) and extracapsular invasion (P = 0.007) were factors that increased the risk of metastasis. The follicular variant decreased the risk (P = 0.010). There was no relationship between CLNM and focality (P = 0.054). A low-to-moderate correlation was found between tumor diameter and the metastatic lymph node (MLN) number/total lymph node number ratio (r = 0.396, P < 0.001). Conclusion: A selective prophylactic CLND strategy can be applied in cN0 patients. As the tumor diameter increases in PTC, both the risk of CLNM and the number of MLN increase. Lymphovascular and extracapsular invasion are other factors that increase the risk. The follicular variant is associated with a lower risk of CLNM. Male patients who are under the age of 45 and have a tumor diameter of 9.5 mm or more are definite candidates for prophylactic CLND. [ABSTRACT FROM AUTHOR]

Background: Iran was one of the first countries to become an epicenter of the coronavirus disease 2019 (COVID-19) epidemic. However, there is a dearth of data on the outcomes of COVID-19 and predictors of death in intensive care units (ICUs) in Iran. We collected extensive data from patients admitted to the ICUs of the one of the tertiary referral hospitals in Tehran, Iran, to investigate the predictors of ICU mortality. Methods: The study population included 290 COVID-19 patients who were consecutively admitted to the ICUs of the Sina hospital from May 5, 2021, to December 6, 2021, a period that included the peak of the epidemic of the delta (δ) variant. Demographic data, history of prior chronic diseases, laboratory data (including markers of inflammation), radiologic data, and medication data were collected. Results: Of the 290 patients admitted to the ICUs, 187 (64.5%) died and 103 (35.5%) survived. One hundred forty-one (141, 48.6%) were men, and the median age (10th percentile, 90th percentile) was 60 (41, 80). Using logistic regression models, older age, history of hypertension, high levels of inflammatory markers, low oxygen saturation, substantial lung involvement in computed tomography (CT) scans, and gravity of the disease as indicated by the WHO 8-point ordinal scale were primary predictors of mortality at ICU. The use of remdesivir and imatinib was associated with a statistically non-significant reduction in mortality. The use of tocilizumab had almost no effect on mortality. Conclusion: The findings are consistent with and add to the currently existing international literature. The findings may be used to predict risk of mortality from COVID-19 and provide some guidance on potential treatments [ABSTRACT FROM AUTHOR]

Background: Since 1990, maternal mortality ratio (MMR) has significantly decreased in Iran. However, estimates for mortality and morbidity by cause at subnational scale are not available. Methods: This study is part of the Global Burden of Diseases study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 31 provinces of Iran from 1990 to 2019. Results: Since 1990, MMR declined from 44.5 (95% UI: 38.6-50.1) to 15.9 (14.7--17.3) per 100 000 live births in Iran. In 1990 MMR ranged from 18.5 (11.2--26.4) to 76.9 (38.4--114.7) per 100 000 live births across provinces. Respective figures for 2019 were 7.1 (5.2--9.3) to 34.0 (25.1--44.7) per 100 000 live births. In 2019, MMR was higher in young women (aged 10 to 14) and older women (aged 45 or more). Percentages of deaths under 25 years was 24.8% in 1990 and 16.0% in 2019. There was remarkable decline in years lost due to premature death (YLL) rates from 1990 to 2019. While the decline was modest for years lived with disability (YLD) rates. Indirect maternal deaths and other maternal deaths ranked first or second in almost all provinces. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic Index (SDI) from 1990 to 2019 in all provinces and an evident convergence across provinces. Conclusion: MMR has declined to levels much lower than Sustainable Development Goals in all provinces. Although there was a convergence in trends, there are still disparities across provinces. The decline in disabilities caused by maternal disorders is not as significant as mortality, which needs further actions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the relationship between personal and clinical characteristics of adults in the Tehran Lipid and Glucose Study (TLGS) with depression, anxiety, and stress. Methods: Data of 2272 adults participating in the 6th phase of TLGS were used for univariate analysis to investigate the association between socio-demographic, behavioral, and clinical characteristics and participants' emotional states. Thereupon, the predictors with a P value < 0.20, at least for one of depression, anxiety, and stress in the primary analysis, were included in the model for multivariate modeling. Results: The mean age of participants was 47.23 ± 14.87. The mean scores of depression, anxiety, and stress were higher in women (P value: < 0.001, < 0.001, and 0.004) than in men. Higher age was associated with lower anxiety (β = -0.04, P = 0.004) and stress (β = -0.13, P < 0.001) in men, but only lower stress in women (β = -0.07, P = 0.001). Highly educated participants experienced lower depression (β = -2.26, P = 0.01, β = -2.26, P = 0.003). Although married men robustly experienced lower depression than others (β = -1.69, P = 0.009), a less powerful relationship existed between being married and depression in women (β = -1.37, P = 0.05). All cigarette smokers experienced higher depression, anxiety, and stress, but only female hookah smokers had higher anxiety and stress. Physical activity and chronic disorders had no relationship with emotional states. Obesity was associated with stress in women (β = 1.95, P = 0.001). Conclusion: This study provides an update on factors associated with mental health outcomes in a large general population. Examining the factors associated with depression, anxiety, and stress through a sex-sensitive lens could help clinicians diagnose and plan the best preventive and therapeutic approach. [ABSTRACT FROM AUTHOR]

Background: Hypothyroidism is the most common hormonal deficiency worldwide; however, there is limited data about its prevalence in the children and adolescents of the Middle East. Methods: The prevalence of hypothyroidism were calculated by dividing the number of patients purchasing levothyroxine in 1397 Solar-Hijri year (Correlate with March 2018-February 2019) by the population at risk (per 10 000 persons). Data were collected from the Iran health insurance organization registration records and family physician databases of health vice-chancellor of Shiraz University of Medical Sciences. Results: The present study shows that the prevalence of levothyroxine treated population aged under 18 years is 13 in 10 000 in the Fars province and it is more common in females (17 in 10 000 in females versus 9 in 10 000 in males). This study also revealed that the prevalence of hypothyroidism was different in various age groups and increased in older children and adolescents after pubertal ages. Also, an increase in the female: male ratio of prevalence was more obvious during and after puberty. Conclusion: Our study showed that the prevalence of congenital hypothyroidism was 3/10 000 in southern Iran. Also, the prevalence of hypothyroidism in children and adolescents was totally 13/10 000 population, and this prevalence increased in older age and female gender. This prevalence was close to the data from iodine sufficient areas in Europe and the United States. [ABSTRACT FROM AUTHOR]

Background: To evaluate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and its cardiometabolic risk factors in the southern Iranian adult population. Methods: This is a population-based cross-sectional survey on 3944 middle-aged and elderly adults (35--70 years) from Bandare- Kong. The participants were recruited from 2016 to 2018 and the first phase data of the Bandare-Kong Cohort as a part of the PERSIAN Cohort were used for analysis. Results: Among the 3944 included adults, the age-adjusted prevalence of T2DM and IFG was 17.40% and 20.61%, respectively. Mean FPG was higher among those older than 55 years, females, rural residents, current cigarette smokers, hypertriglyceridemia, hypercholesterolemia, unemployed and low educational level in subjects with diabetes and pre-diabetes. T2DM and IFG were more prevalent in women and men, respectively. Also, those with higher waist circumference (WC), higher body mass index (BMI), lower educational levels, rural residents, former cigarette smokers, hypertension (HTN), hypercholesterolemia, hypertriglyceridemia and age older 45 years, had a higher T2DM and IFG prevalence. Multivariable regression analysis showed that older age, higher WC, HTN and hypertriglyceridemia and living in rural regions were statistically significant predictors of T2DM and pre-diabetes while BMI ≥ 25 kg/m² was the only significant risk factor for IFG. Conclusion: The current study illustrated that T2DM and IFG have a high prevalence among the middle-aged and elderly adult Iranian population, particularly in rural dwellers. Hence, prevention strategies should be implemented to reduce diabetes and pre-diabetes, especially in rural areas. [ABSTRACT FROM AUTHOR]

Background: Most data on the effect of inflammatory bowel disease (IBD) and its treatments on coronavirus disease 2019 (COVID-19) outcomes have not had non-IBD comparators. Hence, we aimed to describe COVID-19 outcomes in IBD compared to non-IBD patients. Methods: We conducted a prospective cohort study of registered IBD patients with confirmed COVID-19 from six provinces in Iran from February to April 2020. Proven COVID-19 patients were followed up at four weeks and the frequency of outcomes was assessed. Multivariable logistic regression was used to assess associations between demographics, clinical characteristics and COVID-19 outcomes. Results: Overall, 2159 IBD patients and 4721 household members were enrolled, with 84 (3.9%) and 49 (1.1%) participants having confirmed COVID-19, respectively. Household spread of COVID-19 was not common in this cohort (1.2%). While hospitalization was significantly more frequent in IBD patients compared with non-IBD household members (27.1% vs. 6.0%, P = 0.002), there was no significant difference in the frequency of severe cases. Age and presence of IBD were positively associated with hospitalization in IBD compared with non-IBD household members (OR: 1.06, 95% CI: 1.03-1.10; OR: 5.7, 95% CI: 2.0216.07, respectively). Age, presence of new gastrointestinal symptoms, and 5-aminosalicylic acid (5-ASA) use were associated with higher hospitalization rate in IBD patients (OR: 1.13, 95% CI: 1.05-1.23; OR: 6.49, 95% CI: 1.87-22.54; OR: 6.22, 95% CI: 1.90-20.36, respectively). Anti-tumor necrosis factor (TNF) was not associated with more severe outcomes. Conclusion: Age, presence of new gastrointestinal symptoms and use of 5-ASA were associated with increased hospitalization rate among IBD patients, while anti-TNF therapy had no statistical association. [ABSTRACT FROM AUTHOR]

Background: Suicide is a major public health concern with diversity in epidemiological aspects and applied methods. In this study, we estimate years of life lost (YLLs) related to completed suicidal in the Fars province, southern Iran. Methods: Our study included data of all mortality events during 2011-2018 from Fars Suicide Surveillance System (FSSS). The validity of qualitative and quantitative variables was assessed through contrasting data between different sources and phone call justification. Case-fatality rates, age-specific and gender-specific mortality rates, ASR (age standardized rate), and YLLs through WHO's 2015 "YLL template" were calculated. Results: During the study period, 2384 mortalities with a mean age of 32.73 ± 15.65 had been registered. Most of them were males (male: 70.05% vs. female: 29.95%; male-female ratio: 2.33), hanging was the most frequent method (29.94%), and an increasing pattern in successful suicidal attempts was observed. The total YLLs were calculated to be 58 669 years (14.71 per 1000 persons). Regardless of year or gender, suicide had the largest YLLs amongst those aged 15-29 years. Conclusion: Regarding the increasing trend in YLLs and observing the highest rate of successful suicidal attempts amongst active and productive members of community, a comprehensive inter organizational reaction is demanded. [ABSTRACT FROM AUTHOR]

Background: Coronary sinus dimension is an important factor for diagnosing some types of cyanosis as well as congenital heart diseases and insertion of some devices into the coronary sinus if required. This study was designed to access the diameter and Z-score of the coronary sinus among children under 18 years of age. Methods: In this cross-sectional study on 95 individuals, the coronary sinus diameter was measured by transthoracic echocardiography in the four-chamber view at the connection to the right atrium, middle part, and distal end. The linear regression equation was utilized to determine age-adjust reference values, Z-scores, and the relationship between the individuals' coronary sinus diameter age, height, and body surface area. The study was conducted from March to July 2020 in Namazi hospital clinic of Shiraz University of Medical Sciences, Shiraz, Iran. Results: The mean age of the persons who entered this study was 5.87 ± 4.25 years. The mean coronary sinus diameter was 4.91 ± 1.29 mm at the site of connection to the right atrium, 4.50 ± 1.44 mm at the middle part, and 3.74 ± 1.32 mm at the distal end. Coronary sinus diameter correlates positively with the participants' age, weight, height, and body surface area (P < 0.001). Conclusion: Coronary sinus diameter significantly correlates with the age, height, and body surface area of the cases. These features are useful in diagnosing some congenital heart diseases and insertion of suitable devices through it. [ABSTRACT FROM AUTHOR]

Background: Considerable variability in survival rate after ST-segment elevation myocardial infarction (STEMI) is present and outcomes remain suboptimal, especially in low- and middle-income contraries. This study aimed to investigate predictors of 30-day mortality after STEMI, including reperfusion therapy, in a tertiary hospital in western Iran. Methods: In this registry-based cohort study (2016-2019), we investigated reperfusion therapies - primary percutaneous coronary intervention (PPCI), pharmaco-invasive (thrombolysis followed by angiography/percutaneous coronary intervention), and thrombolysis alone - used in Imam-Ali hospital, the only hospital with a PPCI capability in the Kermanshah Province. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs), using Cox proportional-hazard models, to investigate the potential predictors of 30-day mortality including reperfusion therapy, admission types (direct admission/referral from non-PPCI-capable hospitals), demographic variables, coronary risk factors, vital signs on admission, medical history, and laboratory tests. Results: Data of 2428 STEMI patients (mean age: 60.73; 22.9% female) were available. Reperfusion therapy was performed in 84% of patients (58% PPCI, 10% pharmaco-invasive, 16% thrombolysis alone). Only 17% of the referred patients had received thrombolysis at non-PPCI-capable hospitals. Among patients with thrombolysis, only 38.2% underwent coronary angiography/ percutaneous coronary intervention. The independent predictors of mortality were: no reperfusion therapy (HR: 2.01, 95% CI: 1.36-2.97), referral from non-PPCI-capable hospitals (1.73, 1.22-2.46), age (1.03, 1.01-1.04), glomerular filtration rate (0.97, 0.96-0.97), heart rate > 100 bpm (1.94, 1.22-3.08), and systolic blood pressure < 100 mm Hg (4.92, 3.43-7.04). Mortality was lower with the pharmaco-invasive approach, although statistically non-significant, than other reperfusion therapies. Conclusion: Reperfusion therapy, admission types, age, glomerular filtration rate, heart rate, and blood pressure were independently associated with 30-day mortality. Using a comprehensive STEMI network to increase reperfusion therapy, especially pharmaco- invasive therapy, is recommended. [ABSTRACT FROM AUTHOR]

Background: Liver cancer (LC) is among the most common and fatal cancers worldwide. A four-fold increasing trend is reported for LC age-standardized mortality rate (ASMR) in Iran within 1990-2015. In the present study, we aimed to report the incidence rate of LC during the 13-year establishment of the Golestan population-based cancer registry (GPCR). Methods: Age-standardized incidence rate (ASIR) per 100 000 person-years was calculated using CanReg5 software. The Joint point regression analysis was used to assess the temporal trends in incidence rate of LC. Results: During the study period, GPCR registered 575 of LC cases, of which 373 (64.9%) were men and 297 (51.6%) lived in rural areas. The mean (SD) age of LC in men and women were 60.3 (17.2) and 58.0 (17.1), respectively. The ASIR of LC was significantly higher in men than women (4.7 vs. 2.6; P value < 0.01) and a minimal increasing trend in LC incidence was observed in both sexes. The incidence rate of LC was significantly higher in rural areas compared to the urbans (3.91 vs. 3.40; P value = 0.04). In the last 13 years, rural population had a significant increasing trend in ASIR of LC (average annual percent change [AAPC] = 7.85, P value = 0.005). Conclusion: LC was more prevalent in men among both urban and rural populations. The results showed a significant increasing trend in rural areas that requires Golestan health care system to take action in controlling the burden of LC in rural areas. [ABSTRACT FROM AUTHOR]

Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100 000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). Results: In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR -- a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100 000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3-1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100 000, respectively. In 2017, there were 185.3 thousand (UI 170.8-200.6) transport-related fatalities in the EMR -- a substantial increase since 1990 (140.4 thousand; UI 118.7-156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1-31.9) per 100 000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8-47.3). In 2017, Somalia (54; UI 30-77.4) and Lebanon (7.1; UI 4.8-8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5-1651.3) per 100 000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1-2,589.9). In 2017, the highest DALY rate was found in Pakistan (3 454 121; UI 2 297 890-4 342 908) and the lowest was found in Bahrain (8616; UI 7670-9751). Conclusion: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100 000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently. [ABSTRACT FROM AUTHOR]

Background: Laboratory services play an important role in optimizing patient care today, and the importance of clinical laboratories is now widely accepted in medical practice. A critical value, originally described by Lundberg more than 30 years ago, refers to an abnormal test result that can lead to a serious life threat if not reported in a timely manner. In this study, we tried to determine the importance of critical values that can lead to a serious life threat with regard to their prevalence and frequency in laboratory tests of Iranian patients. Methods: In this cross-sectional study, the frequency of critical values in laboratory tests were determined and compared according to the type of laboratory parameter, age, sex, the inpatient/outpatient status, the related clinical ward, recurrence of critical values in the patient's test results, and the sampling working shift in Shahid Bahonar hospital in Kerman, Iran, in 2017 and 2018. Results: Among the tests, 0.2% had critical results. There was a significant relationship between the frequency of critical results with the patients' age (P = 0.002) and sex (P = 0.001) as well as with sampling working shift (P = 0.030) and admission ward (P = 0.001). Among the tests with critical values, the urea test was the most common with 32.2% critical value incidence. Conclusion: To maintain patient safety, proper recording of the results in laboratory tests and prompt reporting of critical values to the health care staff before repeating the test should be emphasized. [ABSTRACT FROM AUTHOR]

Background: Tracheobronchomalacia (TBM), presenting with the softening of the walls of trachea and bronchi, can cause respiration problems. Despite the importance of TBM, data on its prevalence and related factors are limited. In the current study, the prevalence and predictive factors of this illness were investigated. Methods: This cross-sectional study was conducted on patients who were bronchoscopy candidates in the diagnostic department of pulmonary diseases in Afzalipour hospital in Kerman, Iran, from May 2017 to May 2018. First, all patients diagnosed with TBM were assessed based on their demographic variables, spirometry indices, anthracofibrosis and TBM severity. TBM was defined as a 50% or higher decrease in the diameter of the main tracheal and bronchial walls on expiration. These patients constituted the case group. Other patients for whom the bronchoscopy findings were not in concordance with TBM were selected through convenience sampling as control group to equal the number of patients in the case group. Data were analyzed using SPSS version 23. Results: In this study, 132 (9.38%, 95% CI: 8--11) of the total 1406 cases who underwent bronchoscopy had tracheomalacia. Also, 22 patients (16.66%) had bronchomalacia, at the same time. Based on the multivariable logistic test results, age (P = 0.03, 95% CI: 1.00--1.04, OR = 1.02) and having anthracofibrosis (P < 0.0001, 95% CI: 1.26--4.68, OR = 2.43) were identified as predictive factors for tracheomalacia. Conclusion: The findings of the present study suggest that the presence of anthracotic plaques can be considered as a possible predictive factor for TBM. [ABSTRACT FROM AUTHOR]

Background: The heterogeneous nature of hematopoietic sarcoma has restricted the diagnosis and treatment of this disease to the extent that annually, several patients lose their lives. Given the lack of comprehensive epidemiologic information on the incidence of hematopoietic sarcoma in the Iranian population, we designed the present study to evaluate the distribution pattern of this disease. Methods: In this national population-based cancer registry study, we collected data from patients diagnosed with hematopoietic sarcoma who were registered in the Iran National Cancer Registry (INCR) between 2009 and 2013. For each patient, the variables of age, sex, province, year of diagnosis, site of involvement and morphology were collected. Results: In 45 cases from 18 provinces of Iran, we found that the incidence rate of the disease was 0.60 (95% CI: 0.44--0.80) per million persons. Among all provinces, Ilam had the highest incidence of hematopoietic sarcoma with a rate of 2 (95% CI: 0.05--11.14) per million persons, while Isfahan had the lowest incidence with a rate of 0.21 (95% CI: 0.01--1.16) per million persons. The incidence rate of the disease increased with age and the disease was slightly more common in men (0.63 [95% CI: 0.41--0.94] vs. 0.56 [95% CI: 0.35--0.86] per million persons). The frequency of hematopoietic sarcoma in connective and soft tissues was higher than other anatomical sites and we found that myeloid morphology was the most prevalent morphology. Conclusion: The resulting data provided a valuable perspective on the distribution pattern of hematopoietic sarcoma in Iran; however, further studies are required to confirm these results. [ABSTRACT FROM AUTHOR]

Background: To better manage the COVID-19 pandemic, it is necessary to carefully study information about patients with COVID-19. Objective: To report clinical and epidemiological characteristics of COVID-19 patients in southern Iran. Methods: This cross-sectional retrospective study was conducted based on data extracted from the COVID-19 registry of Hormozgan. Data from patients with confirmed COVID-19 based on CT-scan results or real-time reverse transcriptase-polymerase chain reaction (RT-PCR) results until September 25, 2020, were analyzed for this study (2351 inpatients). We reported demographics, signs and symptoms on admission, comorbidities, and treatments, as well as clinical outcomes, hospital stay, and intensive care unit (ICU) admission. Results: Most of patients were men (1235/2351; 52.5%) and the most common signs and symptoms included cough (1343/2351; 57.1%), shortness of breath (1224/2351; 52.1%) and fever. The most common comorbidities included hypertension (410/2351 (17.4%), diabetes (343/2351; 14.6%) and chronic cardiac disease (282/2351; 12%). Also, 228 patients (9.7%) were hospitalized in the ICU. The mortality rate was 12.5% (295/2351) among all patients and 64.5% (147/228) in ICU wards, respectively. The number of cases with comorbidities including hypertension, chronic cardiac disease, diabetes, chronic neurological disorders, chronic kidney disease, chronic hematologic disease, malignant neoplasm, moderate or severe liver disease, dementia and fauvism in the ICU was significantly higher than the general wards. Conclusion: Most characteristics of our patients were similar to those reported in other studies; however, our patients were younger and suffered from a less severe disease. The mortality rate in the ICU was higher than other studies. [ABSTRACT FROM AUTHOR]

Background: Raised blood pressure is a serious risk factor for several non-communicable diseases (NCDs) in Iran. In this study, we aimed to estimate the mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and subsequently, the prevalence of hypertension by sex, age, province, and year in Iran. Methods: We conducted a systematic review using PubMed, Web of Science, and Scopus databases through December 2017. We also used individual level data from eight national surveys, aggregated data from seven subnational population-based studies, and extracted data reported in 52 published studies. We used a two-stage model including Age-Spatio-Temporal and Gaussian process regression (GPR) to estimate mean systolic and diastolic blood pressure and used a crosswalk model to estimate the prevalence of hypertension by sex, age, province, and year. Results: The number of hypertensive adults increased in Iran from 1.8 million (882 thousand in women) in 1990 to 13.6 million (7.2 million in women) in 2016. The national age-standardized prevalence of hypertension increased from 8.7% (7.8--9.7) to 28.8% (27.7--30.0) in women and from 8.0% (7.2--8.9) to 24.2% (23.1--25.3) in men from 1990 to 2016. Mean systolic and diastolic blood pressures show a similar increasing trend. Conclusion: During the past 27 years, we observed an increase in the age-standardized prevalence and mean levels of blood pressure. If the current trend in levels of blood pressure and prevalence of hypertension continue in the coming years, Iran will not achieve the sixth target of the Global Action Plan by 2020 and the Sustainable Development Goals (SDGs) by 2030. Keywords: Epidemiology, Hypertension, Iran, Public Health [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis E infection has been reported in solid organ transplant recipients following acute hepatitis due to the compromised immune status. Almost all reports are from areas where hepatitis E virus (HEV) genotypes 3 and 4 are the dominant genotypes. This study was conducted to investigate the role of hepatitis E infection as an etiology for liver enzymes elevation in liver transplant recipients from the largest liver transplant program in Iran. Methods: In a prospective study from June to December 2015, in a single liver transplantation center in Iran, all adult liver recipients who were investigated for the etiology of persistent elevation of liver enzymes were tested for HEV serology status. Results: Of 122 patients included in the study, 19 (15.6%) were positive for HEV serology. Seropositive patients were significantly older than seronegative ones (mean age 43.79 vs. 31.58, P < 0.001); however, they were not different in other characteristics including sex distribution and mean of liver enzymes in each occasion. Liver biopsies were done in 16 HEV seropositive patients and none of the biopsies showed evidence for acute or chronic viral hepatitis. Conclusion: In this study, with 15.6% rate of HEV seropositivity in liver recipients with persistent elevation of liver enzymes, we were not able to confirm any clinical evidence for active acute or chronic hepatitis E infection. This could theoretically be attributed to the fact that the dominant prevalent HEV genotype in our endemic area is not associated with a chronic form of infection. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) has become a pandemic health problem worldwide. In this study, we attempted to explain the clinical and laboratories characteristics of non-surviving patients, to identify the probable factors affecting disease progression. Methods: In a retrospective study, we assessed the data from dead adult patients who were hospitalized and laboratory diagnosed with COVID-19 during March 2020. The data were obtained from electronic medical records. Moreover, a checklist including demographic, clinical, laboratorial, imaging, and treatment data was completed for each one of the patients. In case of lack of information, a member of the research team contacted the first-degree relatives via phone. Results: Totally, 50 patients were enrolled in this study. The mean age was 68.0 ± 14.1 years. Of them, 29 (58%) patients were male. Notably, the median (IQR) hospitalization time was 4.0 (2.7--6.2) days and the duration between the first symptoms to death was 10.0 (5.0--14.5) days. Also, pre-existing morbidity was reported in 42 (84%) patients, and hypertension was the most common one with 28 (54%) patients. Interestingly, body temperature more than 37.5°C was reported in only 20 (40%) patients. Nevertheless, neutrophilia (≥7109 /L) and lymphopenia (<1.0 109/L) were observed in 27 (54%) and 29 (58%) patients, respectively. Also, elevated levels of creatinine, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were common, which may be indicators of aggravation of the patients' status. Conclusion: Besides age and underlying diseases, elevated creatinine level, neutrophil count, and the inflammatory indices along with the reduced lymphocyte count can be considered as indicators of disease progression. Hence, they should be considered for admission and surveillance of patients. [ABSTRACT FROM AUTHOR]

Background: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. Methods: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters. Results: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63--38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06--10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00--8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64--3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07--2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study. Conclusion: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups. [ABSTRACT FROM AUTHOR]

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

Background: Violence is a challenging modern epidemic worldwide. Less evidence is available on the populations most affected by violence in recent decades. The aim of the study was to ecologically investigate temporal trends of the global burden of violence according to gender, age group, and socio-demographic development. Methods: Data on the age- and gender-specific rates of country-level disability adjusted life years (DALYs) attributable to different types of violence i.e. interpersonal violence (IV), and collective violence (CV) and legal interventions were retrieved from online database provided by the global burden of diseases project. Countries were categorized according to their socio-demographic index (SDI). Incidence rate ratio (IRR) per one year was estimated according to age groups, genders and SDI categories applying Poisson regression modeling. Results: The highest decrease of the DALYs attributable to IV was observed for the under-five-years age group and then for 5-14-years in both genders, globally. Considering the CV, estimated IRRs were significant only for the under-five-years age group, which was at 1.30 (95% CI: 1.20, 1.40, per 10 years) for girls and 1.29 (95% CI: 1.21, 1.39, per 10 years) for boys. Conclusion: The rate of DALYs due to IV has been more decreasing among women and children during the recent decades. By the next 10 years, the attributed DALYs to CV would increase up to 120%. Children, adolescents and women are highly affected by CV in countries with middle-low and middle social development in the recent decades. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B infection is the major risk factor for liver cancer in Iran. There is no comprehensive population-based study on the prevalence of hepatitis B by regional distribution. Moreover, systematic reviews of hepatitis B prevalence lack knowledge of some regions. We aimed to estimate the prevalence of hepatitis B and its temporal trends over 17 years by sex, age and geographical distribution. Methods: We used the Iranian Blood Donors data in addition to systematic reviews on population-based studies at national and provincial levels and statistical methods (A two-stage spatio-temporal model and crosswalk approach) to address the missing points of hepatitis B prevalence among the general population. The direct age-standardized approach was applied using Iran's national population in 2016. Results: At national level, age-standardized hepatitis B prevalence in Iran decreased from 3.02% (95% uncertainty interval; 2.26 to 3.96) in 2000 to 1.09% (95% uncertainty interval; 0.85 to 1.37) in 2016, with a total -64.84% change. Hepatitis B prevalence was more than 1.3 times greater in males than females in 2016. Overall, the prevalence of hepatitis B increased with increasing age. At provincial level, in 2016, the province with the highest prevalence had a nearly 11-time greater rate compared to the lowest prevalence. The declining annual percent change (APC) of the prevalence trend varied between -11.53% to -0.5% at provincial level from 2000 to 2016. Only one province did not witness a downward trend in which the APC was 0.5% (95% UI:0.47-0.54). Conclusion: The downward trend in prevalence of hepatitis B infection indicates the effectiveness of strategies and preventive measures adapted in Iran. Nevertheless, we need to eradicate this infection. In this regard, re-evaluating preventive measures, especially in high-risk age groups of the population, is recommended. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid carcinoma (PTC) is a common subtype of thyroid carcinoma with a rising incidence rate. The purpose of this study was to provide a better understanding of age and PTC using the Surveillance, Epidemiology, and End Results (SEER) Program. Methods: The study derived patients' information from the SEER Program (2010-2015). Chi-square or Fisher exact tests, and Kaplan-Meier method were used to analyze survival. Prognostic factors associated with survival were analyzed by Cox multivariate regression. Results: A total of 1738 records were included from SEER, with 1079 PTC in the age group <55 years, and 659 PTC in the age group ≥55 years. The 5-year survival rate was 94% and the overall survival (OS) curve in different age groups indicated that patients younger than 55yr have a longer survival time (P < 0.05). In multivariate Cox regression, age, M stage and surgery treatment were independent risk factors (P < 0.05). Regarding PTC-specific survival, age and surgery treatment were the two main independent prognostic factors in multivariate regression. However, AJCC and M stage were not in the disease specific survival. Conclusion: Age is a prognostic factor in OS and PCT specific survival. AJCC I stage and surgery treatment are also significant in predicting prognosis. [ABSTRACT FROM AUTHOR]

Background: Clostridium tetani is an anaerobic, gram-positive bacillus that causes tetanus infection. It usually enters the body through injury with contaminated objects. Tetanus differs from other diseases that can be prevented by vaccination in that it is not contagious and does not spread from person to person. The aim of this study is to evaluate the levels of Tetanus IgG in trauma patients admitted to the emergency department (ED). Methods: The study was planned as cross-sectional, prospective, and single-center. The study was conducted from January to July 2018 in the Kahramanmaraş Sütçü İmam University Hospital. Totally, 178 patients aged ≥18 years were included. For measurement of the level of Tetanus IgG, Clostridium tetani toxin 5S IgG kit (NovaLisa, NOVATEC) was used to quantitatively detect IgG type antibodies by micro-ELISA method in accordance with the manufacturer's recommendation. Results: In total, 143 cases were male and 35 were female. The mean age of the cases was 40 ± 16 years. Tetanus IgG levels were found to be 0.29 ± 0.6 IU/mL in cases from rural areas and 2.14 ± 1.64 IU/mL in cases from urban areas (P < 0.001). There was a negative correlation between age and Tetanus IgG level (r: (-) 0.479; P < 0.001). The protective level of Tetanus IgG was observed to be even lower, especially in patients aged ≥40 years (n = 43, 78.9%). Conclusion: Measurements of Tetanus IgG levels should be performed as far as possible in the ED. In this way, unnecessary vaccination can be avoided. [ABSTRACT FROM AUTHOR]

Background: Projection of mortality rates is essential for policy making and planning of health services. Premature mortality, as an important index, commonly refers to deaths occurring before 70 years of age. This study was conducted to estimate the trend of premature deaths from 2006-2015 and to project premature deaths for the 2016-2030 period. Methods: We used national mortality data collected by the Ministry of Health and Medical Education's Deputy of Health, and population data from the Statistical Center of Iran. Mortality and population data were categorized based on sex and 5-year age groups. The Bayesian hierarchical model was used to project future premature mortality rates through 2030. Results: Age-standardized all-cause premature mortality declines from 414.3 per 100 000 persons in 2010 to 300.3 per 100 000 persons in 2030 (27.5%) for men, and from 230.6 per 100 000 persons in 2010 to 197.2 per 100 000 persons in 2030 (14.5%) for women. In all age groups, the percent reduction of premature mortality was greater for men than women. Conclusion: Overall, it is projected that premature mortality will witness a declining trend in both sexes in Iran. Accordingly, we would expect to achieve less than a third reduction in premature mortality by 2030, which is one of the Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

The article discusses a study that examined the value of pregnancy-associated plasma protein-A (PAPP-A) within the first trimester for predicting pregnancy outcome in Ahvaz, Iran. Highlights include the serum level of PAPP-A during pregnancy, the screening of all Iranian women at the end of the first trimester of pregnancy for trisomy 21 according to the routine nationwide program, and ROC curve analysis to determine the value of PAPP-A to predict small for gestational age.

Background: Dietary amino acids have been associated with blood pressure (BP) in previous studies; we conducted this study to examine the association between dietary branched chain amino acids (BCAAs) and the incidence of hypertension among participants of the Tehran Lipid and Glucose Study (TLGS). Methods: Analyses were conducted on 4,288 participants aged 20--70 years, who were free of hypertension at baseline (2008-2011) and were followed for 3 years (2011--2014) to ascertain incident hypertension. Dietary intakes of BCAAs including, valine, leucine, and isoleucine were collected at baseline using the food frequency questionnaire (FFQ). Odds ratio (OR) of hypertension were determined by logistic regression across quartiles of BCAAs, adjusted for sex, age, smoking status, physical activity, body mass index (BMI), diabetes, and some dietary factors. Results: The mean ± standard deviation for age and BMI of participants (41.9% men) were 39.7 ± 12.8 years and 26.9 ± 4.6 kg/ m², respectively. The median intakes of total BCAAs, valine, leucine, and isoleucine was 17.9, 5.5, 7.8, and 4.5 percentage of total amino acids intake, respectively. We documented 429 (10%) hypertension incident cases. The multivariable adjusted OR for the highest vs lowest quartiles of BCAAs was 1.54 (95% confidence interval (CI):1.03-2.32; P for trend = 0.05); furthermore, the OR (95% CI) of hypertension for the highest vs the lowest quartile of valine was 1.61 (1.10-2.36; P for trend = 0.009) in the fully adjusted model. However, we found no significant association between leucine and isoleucine with incidence of hypertension. Conclusion: Findings indicated that higher BCAA intake, in particular valine, is associated with higher risk of incident hypertension. [ABSTRACT FROM AUTHOR]

Background: Enterobius vermicularis (EV) is the most common helminthic infection in the world. This small parasite is predominant in the pediatric population. The presence of EV in the appendix can cause or mimick appendicitis. The aim of our study was to compare patients with EV infection and those without EV infection, and to identify predictive factors that may help the diagnosis of EV infection in patients presenting with right iliac fossa pain and avoid negative appendectomy. Methods: A retrospective analysis of all the appendices removed between January 2012 and December 2016 was conducted at the department of pediatric surgery, Hedi Chaker Hospital, Sfax, Tunisia. According to the final histopathological diagnosis, patients with EV infection were compared to those without EV infection. Data including age, sex, white blood cell (WBC) count, neutrophil count, eosinophil count, C-reactive protein, and ultrasound results for both groups were analyzed and compared. The study protocol was approved by the local hospital ethics committee. Statistical analysis was performed using IBM SPSS, version 20. Descriptive analysis in the form of mean and standard deviation was performed on demographic information. Differences between groups were assessed using the student t-test for continuous variables and the χ² test and Fisher exact test where appropriate for categorical variables. Results: In total, 540 pediatric appendectomies were performed. Overall, 63.5% of patients were male and 36.5% were female. Mean age was 9.28 ± 2.77 years. 22.2% of procedures were completed laparoscopically, 76.5% were open and 1.3% were converted. The negative appendectomy rate was 11.1%. EV was present in 9.8% of cases. Comparison of clinical, biological, and ultrasound findings between two groups of patients with EV (EV+) and those without EV (EV-) shows a statistical significance for pruritus ani (P < 0.001), WBC count (P < 0.001), neutrophil count (P < 0.001), C-reactive protein (CRP) (P = 0.001), positive ultrasound (P < 0.001), perforation rate (P = 0.009), and negative appendectomy rate (P < 0.001). No significant difference between the two groups was seen when comparing gender (P = 0.271), vomiting (P = 0.130), eosinophil count (P = 0.915), and procedure (P = 0.536) Conclusion: EV was seen in 9.8% of pediatric appendectomies in our study. Pruritus ani, normal WBC count, normal neutrophil count, and normal CRP level at presentation could predict EV infection in children who present with right iliac fossa pain. [ABSTRACT FROM AUTHOR]

Background: Due to significant achievements in reducing mortality and increasing life expectancy, the issue of disability from diseases and injuries, and their related interventions, has become one of the most important concerns of health-related research. Methods: Using data obtained from the GBD 2015 study, the present report provides prevalence and years lived with disability (YLDs) of 310 diseases and injuries by sex and age in Iran and neighboring countries over the period 1990-2015. Age-standardized rates of all causes of YLDs are presented for both males and females in 16 countries for 1990 and 2015. Wfe present the percentage of total YLDs for 21 categories of diseases and injuries, the percentage of YLDs for age groups, as well as the ranking of the most prevalent causes and YLDs from the top 50 diseases and injuries in Iran. Results: In 2015, the burden of 310 diseases and injuries among the Iranian population was responsible for 8,357,878 loss of all-age total years, which is equal to 10.58% of total years lived per year. This differs from the neighboring countries, as it ranges from 9.05% in Turkmenistan to 13.36% in Russia. During the past 25 years, a remarkable decrease was observed in all-cause YLD rates in all 16 countries. Meanwhile, in all countries, the age-standardized rate of all causes of YLDs was higher in females than males. Conclusion: Based on our findings, one of the remarkable changes in NCDs observed among the studied age groups was increased rate of YLDs from mental disorders, which was replaced by musculoskeletal disorders in older age groups in 2015. [ABSTRACT FROM AUTHOR]

Objective: The present investigation aims to evaluate the prevalence of IgM and IgG anti-7, gondii antibodies and the associated risk factors among healthy blood donors in Mashhad city, Razavi Khorasan province, Iran. Methods: We screened a total of 500 serum samples by census method from apparently healthy blood donors of the Mashhad Blood Transfusion Organization (MBTO) for IgG and IgM anti-T gondii antibodies by enzyme linked immunosorbent assay (ELISA). Results: We found that 29.6%, 25%, 1.4%, and 3.2% of tested donors were positive for anti-T gondii antibodies, only IgG antibody, both IgM and IgG, and IgM antibody alone, respectively. Several risk factors which were significantly related to T gondii seropositivity in the univariate analysis at P < 0.05 included female gender (OR = 3.222, P < 0.001), age more than 40 years (P = 0.026), and sausage/hot dog consumption (OR = 4.472, P < 0.001). Conclusions: The results of this study can be a warning for blood transfusion organizations to pay special attention to toxoplasmosis among blood donors and also design screening programs for prevention of transfusion-transmitted toxoplasmosis. sis [ABSTRACT FROM AUTHOR]

Background: Serum creatinine is the most widely used marker for estimating glomerular filtration rate (GFR). The aim of this study was to determine pédiatrie reference values for serum creatinine levels and eGFR values using data from a population-based study in Iran. Methods: Serum creatinine of 1594 subjects, aged 3-18 years, participating in phase 4 of the Tehran Lipid and Glucose Study (2008 - 2011) was measured using the conventional Jaffe method. The non-parametric method of Schwartz and Counahan-Barratt equations were used to calculate eGFR. CLSI/IFCC guidelines were used to determine reference values. Results: In both genders, serum creatinine concentration was significantly increased with age and had a positive correlation with age (boys (r = 0.786, n = 778, P < 0.001 ) and girls (r = 0.638, n = 724, P < 0.001 )). In addition, mean serum creatinine concentration was significantly higher in boys, compared to girls (0.86 ± 0.01 vs. 0.80 ± 0.01 mg/dL, P < 0.001). Based on these results, we proposed the following formula: serum creatinine (mg/dL) = k x age (year) + 0.5, where k was 0.03 for boys and 0.02 for girls. Conclusions: This study presents pédiatrie reference values in Iranian boys and girls for serum creatinine levels to be 0.6 - 1.20 mg/dL and 0.6-1.00 mg/dL and for eGFR values to be 81 -154 mL/min/1.73 m² and 80 - 129 mL/min/1.73 m², respectively. These values can be used for diagnostic and therapeutic purposes. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking and exposure to second-hand smoke in the indoor environment are major public health risks worldwide. The aim of this paper is to report and critique a global assessment of smoking prevalence, smoking-attributable deaths, and disability adjusted life years (DALYs) extracted from the Global Burden of Disease study 2010, by sex and age in Iran from 1990 to 2010. Methods: The Global Burden of Disease Study 2010 estimated the distributions of exposure and relative risks per unit of exposure by systematically reviewing and analyzing published and unpublished data. These assessments were used, together with estimates of death and DALYs due to specific risk factors, to calculate the attributed burden for each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of attributable mortality and burden. In this study, our aim was to reformulate the GBD 2010 data, produce new graphs, and explain the results for Iran in greater detail. Results: Between 1990 and 2010, the prevalence of tobacco smoking at all ages increased by 1 % in men and declined by 2% in women in Iran, but the overall prevalence in the general population was unchanged (12%). A reduction was observed in the age-standardized death and DALY rates (per 100,000 population) attributed to tobacco smoking, including second-hand smoke. The attributed DALY rate was greater for Iranian men than for Iranian women. The highest rates of DALYs because of tobacco smoking were found in smoker men and women aged 70+, but exposure to second-hand smoke had the most significant burden in children under 5 years old. In 1990, the three leading disease burdens attributed to tobacco smoking, including second-hand smoke, were ischemic heart disease; communicable, maternal, neonatal, and nutritional disorders; and chronic respiratory diseases. In 2010, three leading burden of diseases attributed to tobacco smoking belonged to ischemic heart disease, chronic respiratory disease, and cerebrovascular diseases, respectively. Conclusion: Despite a reduction in the rate of tobacco smoking, including second-hand smoke, since 1990, smoking exposure remained the fifth leading risk factor for death and DALYs in Iran in 2010. Overall, our data clearly show the need for new efforts in Iran to reduce the and disease burden attributed to tobacco smoking. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) is the foremost cause of deaths attributable to cirrhosis and hepatocellular carcinoma. The Global Burden of Disease study from 2010 (the GBD study 2010) quantifies and compares the degree of health loss as a result of diseases, injuries, and risk factors by age, sex, and geography overtime. This study aimed to present and critique the burden of hepatitis C and its trend in Iran between 1990 and 2010 by using the GBD study 2010. Methods: We used results of the GBD study 2010 between 1990 and 2010 for Iran to measure rates and trends of mortality, causes of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability adjusted life years (DALYs) due to hepatitis C. Hepatitis C was defined as the presence of hepatitis C virus in the serum. Data were presented in three categories: acute hepatitis C, cirrhosis secondary to hepatitis C, and liver cancer secondary to hepatitis C. Results: HCV infection (including the three categories of the study) led to 57.29, 59.92, and 66.45 DALYs (per 100,000 population) in 1990, 2000, and 2010, respectively. DALYs and death rates showed a slight decreasing trend for HCV cirrhosis; however, DALYs and death rates increased for acute hepatitis and liver cancer due to patients with HCV. The majority of deaths and DALYs were in individuals aged 70 years and above in all three categories of HCV. YLLs made the greatest contributions to DALYs. Conclusion: DALYs due to HCV infection are increasing in Iran according to the GBD study 2010; however, the estimations of DALYs using the GBD study 2010 are mostly from model-based data and there are significant uncertainties for extrapolated data. In this regard, a comprehensive study such as the National and Subnational Burden of Diseases (NASBOD) study would be needed to estimate and calculate precisely prevalence and burden of HCV-related diseases at national and subnational levels. [ABSTRACT FROM AUTHOR]

Background: Hemoglobinopathies are known as the most common genetic disorders in Iran. The paper aims to provide global estimates of deaths and disability adjusted life years (DALYs) due to hemoglobinopathies in Iran by sex and age during 1990 to 2010 and describe the challenges due to limitations of the Global Burden of Diseas study 2010 (the GBD study 2010). Methods: The GBD study 2010 estimates of the numbers of deaths and years of life lost (YLLs) due to premature mortality were calculated using the Cause of Death Ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplication of prevalence, the disability weight for occurrence of sequelae, and the duration of symptoms. Prevalence was estimated through a systematic search of published and available unpublished data sources, with a Bayesian meta-regression model developed for GBD study 2010. Disability weights were produced using collected data from population-based surveys. Uncertainty from all inputs was incorporated into the computations of DALYs using simulation methods. We aim to prepare and criticize the results of the GBD study 2010 and provide some recommendations for reaching better conclusions about the burden of hemoglobinopathies in Iran. Results: Between 1990 and 2010, the overall deaths attributed to hemoglobinopathies decreased from 0.51% to 0.36% of total deaths, with the corresponding burden declining from 1 % to 0.82% of total DALYs. There was a reduction in deaths and DALYs rates for all ages and the rates attributed to all ages followed the same pattern in Iranian men and women. The highest DALYs for hemoglobinopathies, thalassemia, sickle cell disorder, and glucose-6-phosphate dehydrogenase deficiency (G6PD-D) were found in those aged less than 5 years. The collective burden of all of these hemoglobin disorder was lower in 2010 than in 1990. Conclusion: Although the screening programs in Iran have been very successful in reducing the number of thalassemia patients between 1990 to 2010, in order to provide a better estimation of the burden of hemoglobin disorders, it is necessary to perform a national and sub-national study of hemoglobinopathies using multiple national and sub-national surveys. [ABSTRACT FROM AUTHOR]

Background: Substance abuse and its consequences are a matter of great concern in South-East Asian countries, especially Pakistan and Afghanistan. Due to contamination of Naswar with copper, or by any other physiological mechanism, there is a great chance of copper poisoning in addicts. Keeping in view the literature, there is no comparative study on serum copper levels (SCuL) in Naswar addicts. Therefore, it is very important to evaluate SCuL in this population. Methods: The current study was performed in September 2016 where a total of 75 volunteers (selected from villages near the University of Peshawar, Pakistan) were grouped as Naswar addicts (n = 45) and the control group (n = 30). The addicts were compared to controls for age, weight, BMI, FBS and creatinine clearance. For serum analysis, about 3mL of blood was collected from which the serum was separated, digested, and then evaluated for SCuL using flame atomic absorption spectroscopy at the Department of Pharmacy and Centralized Resource Laboratory of University of Peshawar. Results: The SCuL in addicts had a range of 2.6 to 11.1 µg/dL with a mean of 5.1 ± 2.4 µg/dL. In the healthy control group, SCuL was between 1.7 to 3.9 µg/dL with a mean of 2.6 ±0.1 µg/dL. The mean difference between the two study groups was statistically significant (P = 0.005); the duration of addiction and quantity of drug consumptions per day correlated positively with SCuL. Conclusion: Serum level of copper in Naswar addicts is elevated compared to the Control group. The exact cause of SCuL elevations and the mechanisms involved must be studied in large group samples. [ABSTRACT FROM AUTHOR]

Background: Inappropriate admission and hospitalization days are the factors that impose more costs to hospitals. By considering current condition of hospitals, it is vital to have an insight into the data on inappropriate admission and hospitalization days in order to eliminate obstacles to the proper and appropriate hospitalization. Methods: In this study, 198 patients who were admitted to receive surgical or non-surgical treatment in Sina public hospital were selected. An appropriateness Evaluation Protocol (AEP) was used for data collection. The validity of AEP is well established by the preceding studies. In order to achieve the study objectives, binary logistic regression test was used. Results: According to our findings, 39.4% of hospitalization days and 16.2% of admissions are inappropriate. In this study, inappropriate admission was observed among married patients eight times more than among single ones. Inappropriate hospitalization days were 12 times more prevalent among patients from provinces than among those from Tehran. With increasing age of the patient the probability of inappropriate admission decreases slightly, i.e. the probability of inappropriate admission decreases 10% as the age increases one year. The number of hospitalization days was significantly correlated to the following parameters: type of admission, patient's city of residence, type of treatment, and length of stay (P< 0.05). Conclusion: Regarding the results of this study, a large number of admissions and specially hospitalization days are inappropriate. According to other studies, with suitable programming many inappropriate admissions and hospitalization days are preventable. [ABSTRACT FROM AUTHOR]