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Background: Suicide poses a critical global public health concern, and distinguishing between suicides and suicide attempts underscores the need for targeted interventions. This investigation aimed to determine the pooled prevalence of factors contributing to suicide in Iran, including socio-economic, demographic, and geographical factors., Methods: A systematic search was conducted across Web of Science, Scopus, PubMed, SID, Magiran, Elmnet, ISC, Irandoc, and Noormags databases up to July 2023. We included primary observational studies of acceptable quality that examined the prevalence of factors contributing to suicide in Iranian regions. The findings were screened for eligibility and quality, followed by a review of selected articles, from which data were extracted and analyzed., Results: Out of 1646 initial articles, 68 were selected for review and 54 for meta-analysis. The pooled prevalence rates of contributing factors were calculated as follows: male gender (64.3, 95% CI: 62.6‒66.0%), age over 25 (57.9%, 95% CI: 51.0‒64.5%), under diploma education (73.4%, 95% CI: 62.1‒82.3%), employment issues (66.4%, 95% CI: 59.7‒72.5%), urban living (61.7%, 95% CI: 53.8‒69.1%), past medical history (8.5%, 95% CI: 4.9‒14.2%), past psychiatric history (20.7%, 95% CI: 15.5‒27.1%), past suicidal attempt (12.2%, 95% CI: 8.5‒17.0%), substance abuse history (28.4%, 95% CI: 20.1‒38.3%), spring season (29.8%, 95% CI: 26.7‒33%), and hanging method (46.1%, 95% CI: 41.6‒50.6%). Significant regional differences were observed in the prevalence of gender, age, and suicide methods between western and non-western areas., Conclusion: This study describes key factors of suicides in Iran. Despite higher rates among those over 25, many young individuals are affected. Urban living and low educational attainment are significant factors. Moreover, notable regional differences were observed in gender, age, and suicide methods between western and non-western areas. These findings highlight the need for additional research related to record-keeping challenges and can guide Iranian health policymakers in developing strategies for screening and treating vulnerable individuals., (© 2025 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background and Aims: Faculty members confront a variety of obstacles over time, the most recent of which is the coronavirus disease 2019 pandemic, which may increase their vulnerability to burnout (BO). This study aims to examine BO in medical school faculties, as well as the factors that lead to BO and well-being in them., Methods: This cross-sectional study was conducted in 2021 using online questionnaires completed by 222 faculty members of a medical university in Iran. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Well-being index (WBI) were used. Additionally, we gathered individual-level profiles (demographic, well-being) and occupational information (job profile, attitude toward work)., Results: A total of 60 (27%) faculties reported having high BO, and 112 (50.5%) reported having low well-being. Being female (odds ratio, OR = 2.69), having time to spend with the family (OR = .26), the intent of turnover (OR = 8.65), job recommendation to the offspring (OR = .26), and experiencing violence last year (OR = 2.97) were some of the individual-level factors and job-related attitudes associated with a higher BO. In the neural network for BO, the most important variables were the intention of turnover, followed by adequate family time., Conclusion: One third of the responding faculty reported severe BO, and BO was found to be significantly associated with lower well-being. The increased levels of BO and a decreased experience of well-being were both associated with a higher intention of turnover. According to the study, it is important to pay attention to both clinical and nonclinical field faculty members, female faculty members, those who have a high workload, and members who have experienced violence in the workplace. By acknowledging the unique challenges and experiences faced by these individuals, tailored measures can be developed to address their specific concerns and foster a supportive and inclusive environment., (© 2024 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Purpose: We sought to explore the common challenges across stakeholder groups and also to recognize interactions among them to improve the Iranian prosthetics and orthotics (P&O) sector., Materials and Methods: Interviews were performed from January to June 2019. Participants, including 13 prosthetists/orthotists and six P&O faculty members, were selected using purposive and snowball sampling. The collected data were analyzed using the framework analysis method. Additionally, a systems thinking approach was applied to theorize potential leverage points to improve P&O services in Iran., Results: Challenges in leadership and governance included lack of united stewardship, inappropriate inter-sectoral cooperation, and poor awareness among decision-makers. Financing challenges included high out-of-pocket payments, inadequate insurance coverage, and insufficient governmental funding. Service delivery challenges included lack of prosthetists and orthotists in hospitals and medical centers, corrupt activities and a weak referral system. Human resource challenges included insufficient practical skills of graduates, misalignment of theoretical and clinical training, and inadequacy of continuing education courses., Conclusions: This study provides the groundwork to develop and implement national strategies to address modifiable barriers and improve prosthetic and orthotic services.Implications for rehabilitationLack of united stewardship, inappropriate inter-sectoral cooperation, and poor awareness among decision-makers are the governance challenges of prosthetics and orthotics (P&O) and must be managed by the government.Government resources allocated to P&O services should increase, and P&O insurance coverage should improve.P&O services should be incorporated in health benefits packages to lessen the reliance on out-of-pocket payments.Planning should be done toward inclusion of P&O services in universal health coverage.Up-to-date scientific training and high-quality evidence are needed to enhance the practical skills of P&O graduates and consequently improve the quality of P&O services.Effective continuing training courses for P&O graduates are recommended.It is advantageous to provide P&O services in hospitals.

Introduction: Iran is host to one of the world's largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection., Methods: This qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees., Results: Findings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees., Conclusions: A number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Gastric Cancer (GC) is still one of the major causes of cancer mortality. Due to health-related transitions, the epidemiology of GC subtypes may change. These changes may have profound effects on clinical approaches as well as on public health management of GC. Iran, as a developing country, has experienced huge demographic and epidemiological transitions during the recent decades. This study aimed to investigate the subtype-specific population-based incidence trends of GC in southern Iran., Methods: We used data on GC incidence in southern Iran during 2001-2015. Data preparation and subtype grouping were done based on the ICD-O-3. The trends of Age-Standardized incidence Rate (ASR), truncated ASRs, incidence rate of adenocarcinoma, and cardia GC, and age-gender specific rates were analyzed using joinpoint regression modeling. Annual Percentage Change (APC) and its 95% Confidence Intervals (CIs) were estimated., Results: Overall APC was estimated as 7.2 for males and 8.7 for females. The estimated APCs for the trends of overall GC, and gastric adenocarcinoma were stable in both genders during 2009-2015. Nonetheless, cardia GC showed increasing trends in both genders. The estimated APCs for the trends of non-cardia GC was also stable., Conclusion: The overall trends of the GC incidence in southern Iran were stable during the past decade. However, significant and different changes have occured in the pattern of GC. Thus, etiological and prognostic studies are needed for the improvement of GC management in Iran., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Physiotherapy (PT) is a key component of the rehabilitative health strategy and an effective approach to the management and treatment of a wide range of health conditions. However, it remains underdeveloped and poorly implemented in many national health systems. Previous studies show that weak stewardship of rehabilitation services is, among others, a significant barrier to equitable access to services and supports in many parts of the world, including in Iran. This study investigated the common pitfalls and potential policy solutions to improve the stewardship of PT services in Iran from the perspective of key stakeholders. Semi-structured interviews were conducted by telephone, via the internet, and in face-to-face sessions in Iran with a purposive sample of health planners and policy decision-makers, university professors, rehabilitation managers, and physiotherapists. In total, 30 individuals agreed to participate. Participants identified several pitfalls across the six dimensions of stewardship: 1) strategy formulation; 2) inter-sectoral collaboration; 3) governance and accountability; 4) health system design; 5) policy and regulation; and 6) intelligence generation. In addition, several policy options and solutions to address critical deficiencies in the system were suggested to improve the stewardship of PT services. The study identified challenges and pitfalls affecting the stewardship of the PT sector in Iran as perceived by key stakeholders. Participants' insights can inform deliberative dialogue processes, agenda-setting, and strategy formulation to support the development, expansion, and implementation of PT services.

Background: Maximum willingness to pay (WTP) for a health benefit is related to perceived value. The goal of this study was to find out how much Iranian healthy people would be willing to pay to keep their natural teeth instead of having them pulled. This was done separately for the anterior and posterior teeth., Methods: The highest value was posed as an open-ended question in this cross-sectional analysis conducted in 2021. Four distinct scenarios for treating a tooth with a poor prognosis for natural tooth preservation versus extraction were offered. WTP for the preferred treatment option was asked for painful and painless anterior and posterior teeth separately. A two-stage hurdle approach was employed to determine factors influencing the WTP for a hopeless case. The level of significance was fixed at 0.05., Results: Out of 795 individuals, 355 (44.7%) were male and 209 (26.3%) had poor self-stated dental health. Over 65% of those interviewed said they wanted to keep their teeth. The mean WTP was highest for dental preservation up to 94 USD and the lowest was for extraction without replacement 19 USD. The WTP for anterior tooth therapy was greater than the WTP for posterior dental care, regardless of treatment type or tooth discomfort. Participants with higher education, jobs, income-to-expenditure matching, older age, preference for the treatment in a private office, and female gender (except for WTP for a painful posterior tooth) were more likely to have a WTP of at least 1 USD., Conclusion: The average WTP for treatment of teeth with a poor prognosis was lower than the average fee charged in dental facilities, and more than 65% of participants preferred to keep their teeth. Regardless of the treatment option or whether it was painful or not, WTP for anterior teeth treatment was higher than for posterior teeth. Generally, we found that sociodemographic factors influenced WTP decision-making the most. This study has practical implications for public oral health policymakers and insurance organizations., (© 2022. The Author(s).)

Purpose: To investigate physiotherapists', academics', and relevant decision- and policy-makers' experiences regarding the impacts of the Health Transformation Plan (HTP) on the physiotherapy sector in Iran., Materials and Methods: This qualitative study was conducted using in-depth semi-structured interviews. The participants were selected using both purposive and snowball sampling strategies with maximum diversity. The sampling procedure continued until data saturation was achieved. The collected data were analyzed using thematic content analysis in accordance with Braun and Clarke's methodology., Results: The findings showed that the physiotherapy sector has faced several challenges after the implementation of HTP in five control knobs: (1) financing (a decline in the government budget and insufficient health insurance coverage), (2) payment (delayed payments and setting a tight ceiling for reimbursements), (3) behaviors (a decrease in the motivation of physiotherapists, the tendency toward misbehaviors such as absenteeism and providers' unwillingness to cooperate with insurance companies), (4) organization (difficulty in clinical education and ignoring the preventive effects of physiotherapy interventions), and (5) regulation (absence of stakeholders in political processes and inconsistency of upstream documents)., Conclusion: HTP has posed various challenges on the physiotherapy sector in Iran. Promoting the policymakers' awareness and aligning the health reforms such as HTP with the current upstream documents would diminish the existing challenges.IMPLICATIONS FOR REHABILITATIONMore government budgets and better insurance coverage are needed to strengthen the physiotherapy sector.Timely payment and modification of limitations for reimbursements of physiotherapy services are recommended.It is recommended to adopt strategies to increase the motivation of physiotherapists and reduce the risk of professional misconduct in the physiotherapy sector.Problems in clinical physiotherapy training should be addressed by policy-makers, and the preventive effects of physiotherapy interventions deserve more attention.Enhanced participation of physiotherapy stakeholders in relevant legislative processes is recommended to improve their services.

Background: The novel coronavirus disease 2019 has severely affected communities around the world. Fear and stress of being infected, along with pressure caused by lockdown, prevention protocols, and the economic downturn, increased tension among people, which consequently led to the rise of domestic violence (DV). Therefore, this study was conducted to determine the rate of change in DV and its associated factors during the COVID-19 epidemic in Shiraz, Iran., Methods: In this cross-sectional study, 653 individuals with the age of over 15 years from Shiraz were participated through snowball sampling and filled out an online questionnaire through the WhatsApp platform. A 51-item, self-administered and multidimensional (knowledge, attitude, and practice) questionnaire was designed and assessed 653 participants. The gathered data was analyzed using SPSS software (version 25), and variables with a p-value of less than 0.05 were considered statistically significant., Results: In this study, 64.2% of the respondents were within the age range of 31-50 years, and 72.6% of the subjects were female. Furthermore, 73.8 and 73.0% of the individuals were married and educated for over 12 years, respectively. The DV increased by 37.5% during the quarantine period, compared to before the pandemic. The emotional type was the most common type of violence; the sexual type was the least frequent. Multivariate analysis indicated that infection with COVID-19, drug use, high level of co-living observation of anti-COVID prevention protocols, and lower level of physical activity during the quarantine period had a positive and significant association with the occurrence of DV., Conclusion: Based on the obtained results, it is required to implement effective harm-reduction policies and measures in the community due to the increasing rate of DV during the COVID-19 epidemic., (© 2022. The Author(s).)

Background: Gastrointestinal cancers account for a significant number of deaths and new cancer cases worldwide. Our aim is to investigate stratum-specific incidence trends of esophageal cancer in southern Iran considering age, gender, and morphological (adenocarcinoma/squamous cell carcinoma) subtypes., Method: We used data on esophageal cancer incidence in the catchment area of Shiraz Population-Based Cancer Registry. New cancer cases with ICD-O-3 codes of C15.0 to C15.9 were retrieved and prepared. New annual cases were counted for categories defied based on age group, gender, and morphology. Average annual percentage change (AAPC) and its 95% CI was estimated for each trend using joinpoint regression., Results: The total number of esophageal cancer was higher in males than females. It is an increasing rate in esophageal adenocarcinoma in females and this increase was more prominent in older ages. Also, our study showed that SCC has a decreasing trend in females and a steady trend in males., Discussion: Taken together, the increasing trend in adenocarcinoma in females in our study can be related to the increasing rate of obesity and smoking in females in recent years in our region. The incidence trend of different morphologic types of esophageal cancer is changing. This can be a consequence of alterations in the incidence trend of different risk factors. It is necessary to conduct more studies evaluating these risk factors., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Recent studies on burnout (BO) have included both individual and situational factors, referred to as job-person fit (JPF). The present study aimed to evaluate the prevalence rate of BO in the hospital staff working at a tertiary referral hospital in southwest Iran and then to highlight the importance of the person in the context of his/her work life. This cross-sectional study was conducted in 2020 on all hospital staff using a three-part questionnaire comprised of personal and work-situational factors, the Perceived Stress Scale (PSS), and the Psychological Empowerment Scale (PES). The partial least squares (PLS) path modelling and the neural network (NN) model were used to identify the significant variables within the BO dimensions. A total of 358 staff completed the questionnaire and were recruited for the study. Emotional exhaustion (EE) was seen in 137 medical staff (38.3%) and depersonalization (DP) was observed in 75 individuals (20.1%). Thinking about job change was the most important factor positively correlated with EE. Positive stress and work experience were among the most significant factors negatively associated with PA and DP, respectively. The hospital staff experienced BO in a way comparable to the national results. Work-situational and personal variables interacted with the three dimensions of BO in the hospital staff. More experienced staff also felt more accomplished and successful, resulting in the identification of a decreased level of DP and elevated PA., Competing Interests: The authors have declared that no competing interests exist.

Background: Road Traffic injuries (RTIs) are major global health issues, but they have been neglected. RTIs are multi-faceted in nature and, like many injuries, are costly but preventable. Iran has one of the highest rates of deaths due to traffic accidents among middle-income countries. Hence, there is a need for effective and preventive approaches in road safety management. One of the new approaches to road safety is the Vision Zero. The aim of this study was to design a Vision Zero implementation model in Iran., Methods: This present study was conducted using the qualitative grounded theory approach. Purposive, snowball and maximum variety sampling were used to select participants. In-depth interviews were used to collect data. Grounded theory method was used to analyze the data using Corbin and Strauss method., Results: In this study, 19 interviews were conducted with 17 participants. Based on data analysis, a total of 4 main categories and 13 subcategories were obtained. According to the participants, the lead agency was recognized as the core category. Other concepts were categorized as causal conditions, intervening conditions, contextual conditions, action/interaction strategies, and consequences., Conclusions: Establishing a lead agency with inter-organizational coordination through political support and legislation and changing the approach of road safety can be effective in implementing a Vision Zero. Also, improving the safety attitude of the stakeholders and changing their approach through training and advocacy from various organizations related to road safety is effective in creating a lead agency and implementing a vision zero. In addition, in order to implementation of the model, it is very important to pay attention to the economic, political and ethical underlying factors towards human beings.

Background: Colectomy is considered as a part of therapeutic armamentarium in ulcerative colitis. The availability of new biologic treatments might have affected the trend of using this modality., Methods: The hospital records of all tertiary centers in Shiraz, which are the main centers for the treatment of ulcerative colitis (UC) in southern Iran, were reviewed to estimate the total number of admissions for the treatment of severe UC and colectomy among patients from 2009 to 2019. In this historical cohort study, information about the current status of the patients was collected by phone calls during December 2019., Results: Totally, 111 (4%) UC patients, out of 2933 admissions, underwent colectomy. Sixty-five (54.6%) UC colectomy patients were female. The results revealed an upward trend for the ratio of the frequency of colectomies to total UC admissions (Z = 3.39, P < 0.001). Colectomy complications occurred in 44 patients (40%), and most of the patients 38 (34%) had late complications, leading to readmission. Seven patients (6.3%) had died from colectomy during the follow-up calls. Most of the dead patients underwent urgent surgery and were young., Conclusion: Despite the use of biologics during the past decade in southern Iran, there was a rising trend among the UC patients' colectomies. The frequencies of post-operative complications and mortality was considerable, highlighting the need for refinement of UC care in this region., (© 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Competing Interests: Conflict of interest statement The authors declare no conflict of interest.

Background: The healthcare system in Iran has undergone several reforms to achieve the objectives of universal health coverage (UHC). Some reforms have delivered positive benefits, however, still many challenges remain. Hence, the current study assessed the progress and outcomes of these reforms over the past three decades., Methods: The present nationwide macro-qualitative study was conducted in Iran during 2016-2017. Data were collected through 32 in-depth interviews with 30 high-ranking policymakers and healthcare providers at the national and provincial levels to identify their experiences and perceptions of the reforms. The data were analyzed using the constant comparative analysis method., Results: Analysis of the interview data resulted in two main themes, six categories, and 18 sub-categories. The extracted themes were adverse situational context and the chaotic healthcare system. The results showed that the Iranian healthcare system reforms could be characterized as incoherent and passive, and that these were the main reasons for not achieving the objectives of UHC reforms. It was revealed that the implemented reforms lacked a comprehensive approach and at times were counterproductive. Moreover, the situational context adversely hindered the successful implementation of the reforms., Conclusion: Despite many efforts to improve the Iranian healthcare system through reforms, the situational context and organizational factors have prevented achieving the main objectives. Iran's health policymakers should consider a phased implementation of small-scale reforms based on a comprehensive master plan that takes social, political, and economic factors into account. This approach would minimize potential risks and encourages the cooperation of the main stakeholders., (Copyright: © Iranian Journal of Medical Sciences.)

Objectives: We aimed to determine outcomes and predictors of intraoperative-detected portal vein thrombosis in liver transplant recipients., Materials and Methods: We retrospectively analyzed 806 adult liver transplant recipients from Shiraz, Iran, to determine those with intraoperative-detected portal vein thrombosis. Patients with this complication were compared with age- and sex-matched patients without this complication. Background diseases, surgery parameters, hospital admission, reoperation, rethrombosis, acute rejection, and use of antico-agulants were assessed. Cox proportional hazards, logistic regression, and random classification forest and random survival forest plots were used for data analyses., Results: Mean age of patients was 44.7 ± 13.2 years. Patients with intraoperative-detected portal vein thrombosis (n = 91; 11.3%) had mortality ratio of 2.9 (range, 1.0-8.6) and 2-year survival of 78% versus 2-year survival rate of 92% in patients without this disease. Median time of survival in patients with this complication who died was 2 weeks versus 10 months in patients who died and did not have this complication. Random classification forest plots showed that high fasting blood sugar, autoimmune hepatitis, low prothrombin time, and cryptogenic cirrhosis were (in order) the main predictors of this complication. Random survival forest plots revealed that low prothrombin time, having intraoperative-detected portal vein thrombosis, Model for End Stage Liver Disease score, primary sclerosing cholangitis, diabetes mellitus, and hepatocellular carcinoma were (in order) the main predictors of death in liver transplant recipients. Low body mass index was associated with mortality in patients with intraoperative-detected portal vein thrombosis (by Cox proportional hazards)., Conclusions: One of every 9 liver transplant patients had intraoperative-detected portal vein thrombosis. Hazard of death was 2.9, and death occurred far earlier in patients with this complication. Improvements in diabetes mellitus care, prothrombin time, Model for End-Stage Liver Disease score, and body mass index may improve outcomes of these patients.

Background: Nursing managers have a critical role at the hospitals. The current study aims to investigate different experiences of nursing managers., Method: This is a qualitative study that investigates the experiences of 11 nursing managers in Shiraz, Iran. Semistructured interviews and thematic analysis were, respectively, applied for data collection and analysis., Results: It could be found from the current investigation that nursing managers have a critical role at the hospitals, and their creativities have more impacts on procedures compared to organizational orders. There are four major challenges faced by nursing managers including nursing shortage, structural deficiencies, lack of authorities, and burnout. Although shortage is considered as the most important challenge, there are more emphasizes on the improvement of their controlling power in order to prevent their fatigue and burnout., Conclusion: This study showed that creativity of nursing managers is the most important factor of system management; also, shortage and deficiencies are recognized as the most significant challenges faced by them. According to the current study, the shortage of nursing staff is the central issue that has to be considered., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Ahmad Kalateh Sadati et al.)

Background: Motorcycle drivers are among the most vulnerable road users, accounting for a large proportion of global traffic accidents. This study aimed to investigate the association between the score of adult attention-deficit/hyperactivity (ADHD) traits and risky driving behaviors (RDB) with alcohol intake (AI) and narcotics consumption (NC) among motorcyclists in Iran., Methods: This multi-center cross-sectional study encompassed 1747 motorcyclists from three cities in Iran. A random sampling method was applied in this study, and the required data was collected using three standard questionnaires on ADHD, substance abuse, and RDB. Independent sample t-test, covariance analysis, and quantile regression (QR) were used to analyze the data., Results: The results of t-test and analysis of covariance indicated that AI and NC were significantly associated with ADHD score and RDB among the motorcycle drivers. Additionally, the QR models showed that these effects were significant at all quantiles of ADHD and RDB, even for individuals who were at lower quantiles., Conclusions: Considering the potential dangers of driving after AI and NC, appropriate measures should be adopted before certifying a driving license to screen ADHD as a predisposing factor for substance abuse and RDB. Furthermore, it is essential to equip traffic police with adequate diagnosis kits and establish heavy penalties for the offenders. In this regard, all interventions aimed to reduce traffic accidents among motorcycle drivers should be done considering the interrelationship between ADHD, RDB, and substance abuse.

Studying the people's expectations of government measures to control and manage the coronavirus disease 2019 (COVID-19) can help to prepare for future crises. This study aimed to investigate the opinion of the Iranian people on authorities' management during a crisis, such as the COVID-19 pandemic. This qualitative study was conducted on 70 Iranian citizens in Shiraz to explore their opinion about the government response to the COVID-19 outbreak in February and March 2020. Based on saturation criteria, the data was collected by 1 open-end question: "What is your attitude toward the readiness of the officials and government in this epidemic?" Thematic analysis was conducted to explore themes. At the first step of the outbreak, people had critical opinions on their authorities' management. Four themes were studied, including trust and responsiveness, policymaking during a health crisis, economic management, and epidemic management. Although the citizens' expectation is dynamic, our study showed that there are still high demands from citizens toward the authorities, even in a new crisis that was not perceived before. One of the best ways to respond to these demands is appropriate risk communication.

This study aimed to investigate the clarithromycin resistance and its associated molecular mechanisms among Helicobacter pylori isolates from dyspeptic patients in Shiraz, Iran. From January to May 2014, 100 H. pylori strains were isolated from patients with gastroduodenal disorders. The resistance to clarithromycin was quantitatively evaluated, using Epsilometer (E-test) method. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed on all the isolates to detect A2143G and A2142G mutations in 23S rRNA gene. The H. pylori isolation rate was found to be 31.4%. E-test showed that 20% of isolates were resistant to clarithromycin (MIC ≥ 1 mg/L). MIC of clarithromycin ranged between 0.016 and 24 mg/L. Findings of PCR-RFLP showed that the A2142G was the most (90%) frequently point mutation, followed by the A2143G (10%). No statistically significant difference was found between H. pylori clarithromycin resistance point mutations and patients' gender or age. To the best of our knowledge, this is the first report of high frequency of A2142G point mutation in Iran and probably in other regions of the world. Considering the increasing trend of H. pylori resistance to clarithromycin due to these mutations, it is crucial to investigate the new therapeutic approaches against H. pylori infection., (© 2016 APMIS. Published by John Wiley & Sons Ltd.)

Background: Injuries and deaths from road traffic crashes are one of the main public health problems throughout the world. This study aimed to identify determinants of fatality traffic accident in Iran for the twenty-span year from 1991 to 2011., Methods: A time series analysis (1991-2011) was used to examine the effects of some of the key explanatory factors (GDP per capita, number of doctors per 10,000 populations, degree of urbanization, unemployment rate and motorization rate) on deaths from road traffic in Iran. In order to examine long- and short-run effects of variables, we employed autoregressive distributed lag (ARDL) approach and error correction method (ECM). The data for the study was obtained from the Central Bank of Iran (CBI), Iranian Statistical Center (ISC) and Legal medical organizations (LMO)., Results: GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate had a significant impact on fatality from road traffic in Iran. We did not observe any short- and long-term effects of the unemployment rate on fatality from road traffic., Conclusion: GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate were identified as main determinant of fatality from road traffic accidents in Iran. We hope the results of the current study enable health policy-makers to understand better the factors affecting deaths from road traffic accidents in the country.

Background: Functional dyspepsia (FD) is a common gastrointestinal disease that is highly prevalent worldwide. Because of its heterogeneous pathophysiology, treatment options for FD can be difficult to choose; in this context, complementary and alternative medicine modalities have been suggested as promising options., Aim: To evaluate the efficacy of a traditional Persian medicine, jollab, in reducing patients' FD symptoms., Methods: In a double-blind randomized clinical trial, 160 patients with a diagnosis of FD were enrolled and treated with either jollab or placebo (15ml, t.i.d., four weeks, orally). The outcomes reported were changes in symptom frequency and severity as recorded in patients' diaries and evaluated with the Short Form of the Leeds Dyspepsia Questionnaire (SF-LDQ), and physical examination., Results: The response rate was higher in the treatment group (78%) than in the placebo group (31%) according to per-protocol sample analysis (P < .001). Symptoms of FD disappeared significantly more frequently, and the rate of concomitant synthetic drug consumption was significantly lower, in the jollab group compared to the placebo group at the end of the trial. Mean total symptom frequency and severity according to the SF-LDQ score was 1.55 ± 2.78 in the treatment group versus 5.61 ± 3.80 in the placebo group at the last follow-up time point (P < .001). A promising safety profile for jollab was observed throughout the trial., Conclusions: In patients with FD, jollab appeared to be more effective than the placebo. Complementary and alternative therapies such as the use of this traditional medicinal substance may be beneficial in relieving symptoms of dyspepsia [ACTRN12613000584730]., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: Drop In Centers (DICs) are organizations in which health and social services are delivered to drug users on the basis of harm-reduction strategies. The aim of this epidemiological study was to estimate the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection at these centers over a 6-year period., Methods: All of the DICs (7 in total) visited were located in Shiraz, the capital city of Fars province, southern Iran. Every patient record in these centers was studied between April 2006 and April 2011. Complementary information on the frequency of HIV was collected from the Voluntary Counseling and Testing services. A logistic regression model was applied to data analysis. The study explored risk factors associated with HIV and HCV infections, which were primarily high-risk sexual behavior., Results: This study examined 1,327 people, 79.5% of whom were males. The mean age of first substance use and the first injection among intravenous drug users (IDUs) were 20.24 ± 6.11 and 26.5 ± 7.3 years, respectively. In total, 13.5% and 20.2% of the subjects who registered at the DICs were infected with HCV and HIV, respectively. Shared injection, history of imprisonment, maleness, unsafe sex, inadequate housing, and low education were risk factors for HIV infection. Shared injection, unsafe sex, history of imprisonment, and maleness were predisposing factors for HCV infection. A history of imprisonment and substance use upon registration at the DIC were significant risk factors for female sex workers., Conclusions: Our study emphasized the implementation of preventive measures like education and needle exchange program as harm-reduction strategies. Drop in Centers are important for the management of health problems, including HIV infection and social problems such as crime. Periodic epidemiological studies on DICs are necessary to monitor and modulate the services delivered by these centers.

Objective: Nonimmune pregnant women are at risk of developing congenital rubella syndrome and measles complications. We aimed to identify pregnant women susceptible to rubella or measles in order to determine the need for immunity screening and supplemental immunization in women of childbearing age., Method: This seroprevalence survey was conducted by convenience sampling in obstetric hospitals affiliated with Shiraz University of Medical Sciences (southern Iran). Serum IgG levels were measured by ELISA., Result: Mean age of the 175 pregnant women was 27.3±5.3 (range 16 to 42) years. The geometric mean concentration of anti-rubella IgG was 14.9 IU/mL (CI 95%,14.1-15.5), and that of anti-measles IgG was 13.8 IU/mL (CI 95%, 13-14.5). One hundred sixty-eight women (96%) had a protective serologic level (>11 IU/mL) of IgG against rubella, and 143 (81.7%) had a protective level against measles. Except for a significant inverse correlation that was showed by univariate analysis between anti-rubella IgG and the women's age (P = 0.01), immunity did not correlate with demographic or obstetric characteristics or medical history. There was no significant correlation between anti-rubella and anti-measles IgG levels (P = 0.25)., Conclusion: Nearly a decade after Iran's nationwide measles-rubella vaccination campaign for the population aged 5-25 years, most pregnant women up to 34 years of age had humoral immunity against rubella. We recommend rubella immunity screening or catch-up immunization for women older than 35 years who wish to become pregnant, and measles immunity screening and appropriate vaccination for all women of childbearing age.

Background: Hajj is a mass gathering undertaken annually in Mecca, Saudi Arabia. The 2009 Hajj coincided with both the pandemic influenza A/H1N1 2009 (A(H1N1)pdm09) and seasonal types of influenza A viruses. The interaction between pandemic influenza and Hajj could cause both a high level of mortality among the pilgrims and the spread of infection in their respective countries upon their return home., Objective: The present study attempted to determine the point prevalence of A(H1N1)pdm09 among returning Iranian pilgrims, most of whom had been vaccinated for seasonal influenza but not A(H1N1)pdm09., Methods: Pharyngeal swabs were collected from 305 pilgrims arriving at the airport in Shiraz, Iran. RNA was extracted from the samples and A(H1N1)pdm09 and other seasonal influenza A viruses were detected using TaqMan real-time PCR. For A(H1N1)pdm09-positive samples, the sensitivity to oseltamivir was also evaluated., Results: Subjects included 132 (43.3%) men and 173 (56.7%) women, ranging in age from 24 to 65 years. The A(H1N1)pdm09 virus was detected in five (1.6%) pilgrims and other influenza A viruses in eight (2.6%). All the A(H1N1)pdm09 were sensitive to oseltamivir., Conclusions: Only five cases were found to be positive for A(H1N1)pdm09, and it seems unlikely that the arrival of infected pilgrims to their homelands would cause an outbreak of a new wave of infection there. Thus, the low morbidity and mortality rates among the pilgrims could be attributed to the characteristics of A(H1N1)pdm09, which causes morbidity and mortality in a way similar to the seasonal influenza infections, absence of high-risk individuals among the Iranian pilgrims, and the instructions given to them about contact and hand hygiene, and respiratory etiquette., (© 2012 Blackwell Publishing Ltd.)

Background: Pandemic flu had at least two waves in Iran. Knowing how many of the general population were already exposed to this infection has a major impact on national preventive measures. As of December 30, 2009, a total of 3672 confirmed cases of human infection with a novel Influenza A (2009 H1N1) virus had been reported in Iran with 140 deaths., Objective: In this study we aim to measure, as a pilot study, the seroprevalence of positive antibody titer (humoral immunity) against 2009 H1N1 virus in Iranian population in Shiraz, Southern Iran., Methods: Through cluster random sampling of families residing in Shiraz, 2553 subjects were selected and after a medical interview blood samples were taken and checked for polyclonal antibody against 2009 H1N1 antigen using hemagglutination inhibition assay. An antibody titer of more than 1:40 dilution was considered positive. Data were analyzed considering the demographic characteristics of the population and were compared among different age groups., Results: 1504 (58.91%) samples were tested positive for the presence of polyclonal antibody against 2009 H1N1 virus. The prevalence of positive titers were significantly higher in 60 to 64 years old group and significantly lower in 20 to 24 years old group (p<0.05). Data did not differ based on other demographic characteristics or the history of flu like illnesses in the past 6 months., Conclusion: High seroprevalence of antibody against 2009 H1N1 in the sera of our subjects describes either a high level of pre-existing immunity against H1N1 in Iranian population or a high rate of asymptomatic infection in our area compared to other countries.

Hepatitis B (HBV) and C (HCV) viruses are the most important infections transmitted by the parenteral route in patients receiving maintenance dialysis. The prevalence varies markedly from country to country. The aim of this study is to review the efficacy of the strategies to reduce the incidence of these infections and the trend of results in Iran. As a routine, all hemodialysis patients in Iran have biannual blood samples for assessment of serum HBSAg, HBS Abs, and HCV Abs. The data are collected in the Ministry of Health. For statistical analysis, prevalence, and incidence were calculated. There is an increasing prevalence/incidence of end-stage renal disease (ESRD) in Iran, from 238/49.9 pmp in 2000 to 357/63.8 pmp in 2006. The prevalence of positive HBSAg and HCV Abs decreased from 3.8% and 14.4% in 1999 to 2.6% and 4.5% in 2006, respectively. Regarding the genotype distribution in Iran, no one was found with genotype 2. On the subject of decreasing HBV infection, our next strategy should be mandatory vaccination in dialysis centers and in the pre-ESRD period. Concerning HCV infection prevention, 2 approaches may be recommended: the first is decrease of duration of the hemodialysis period by possible early transplantation of suitable patients. The next is a strictly enforced isolation policy for HCV-positive patients, which may play a role in limiting HCV transmission in HD units, and universal precaution in dialysis units should be under constant close surveillance.

The Shiraz Organ Transplant Center in southern Iran has been performing all liver transplantations in Iran and certain neighboring countries for 12 years. This study evaluated the 140 operations performed from April 1993 through November 2004. Sixty-one percent of the recipients were men and 39% were women. The average recipient age was 29.9 +/- 14.0 years. One hundred twenty-eight patients has a full-size cadaveric transplant. Most frequent causes of cirrhosis were cryptogenic and viral. An acute rejection episode occurred in 47.5% of cases, and two episodes in 8%. Most frequent short-term complications included respiratory, neurologic, and biliary problems. The 1-, 2-, and 3-year patient survival rates were 92%, 89%, and 85%, respectively. The experience that the Shiraz Organ Transplant Center has had with liver transplantation indicated success comparable to that noted in other reports. The calculated trend suggests that a goal of 100 transplantations for 2005 is within reach.