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The contributions of Computerized Formative Assessment (CFA) to teachers' instructional practices and students' learning outcomes necessitate the development of valid and reliable instruments for measuring teachers' literacy. To address this necessity, this study adopted an exploratory sequential mixed-methods design via drawing on a dual deductive--inductive approach to develop and validate a Computerized Formative Assessment Literacy (CFAL) questionnaire for language teachers. The participants comprised 489 Iranian male and female English as a Foreign Language (EFL) teachers teaching from elementary to advanced levels at different language institutes in eight big cities across the country. The results of Exploratory Factor Analysis (EFA) revealed that CFAL consisted of six factors including practical, theoretical, socio-affective, critical, identity-related, and developmental. The results of Cronbach's alpha demonstrated that the questionnaire and its six components had satisfactory levels of reliability. The findings are discussed and implications for developing professional programs aiming at determining and promoting teachers' CFAL are presented.

Family support may be a protective factor against mental health issues during pregnancy. Little is known about the effect of family function on the mental health of pregnant women. This study aimed to examine the relationship between family functioning and the mental health of pregnant women. The research was conducted with 184 pregnant women. During prenatal care appointments, the participants completed five questionnaires: Family Assessment Device (FAD), State-Anxiety Inventory (SAI), Beck Depression Inventory (BDI-II), Prenatal Coping Inventory (Nu-PCI), and Revised Prenatal Distress Questionnaire (NuPDQ). The participants' mean age was 27.2 (SD = 5.2) years, with a range between 18 and 45 years. No association was found between demographic variables and anxiety/depression or coping strategies. Family dysfunction was a positive determinant of depression (β = 0.345, p <.001) and anxiety (β = 0.199, p =.007). However, family dysfunction was negatively associated with coping planning (β = −0.192, p =.009) and spiritual coping (β = −0.154, p =.037). Our findings suggest that during prenatal care visits, healthcare providers should consider the negative impact of family dysfunction on the mental health of pregnant women. [ABSTRACT FROM AUTHOR]

Since tourist behavior plays the primary role in protecting the environment, this study has been conducted to extend the psychological perspectives of visitors' environmentally responsible behavior (ERB) in one of the most important natural heritage sites in Iran (Damavand Mountain) in the COVID-19 pandemic timeline and provide awareness for destination environmentalists as well as managers on how to control visitors' behavior. Likewise, Robbins (2002) Organizational Behavior model has been tested on ERB in ecotourism. Generally, 260 reliable questionnaires have been analyzed by using PLS-SEM2.0. The findings showed that (1) Visitors' attitude and ability toward nature would positively affect their ERB; (2) Motivation and learning mediate the impact of visitors' attitude and ability on their ERB; (3) Ability plays a significant role in the formation of visitors' ERB. Thus, the best way to change visitors' behavior is to educate them to make ERB more like a habit. [ABSTRACT FROM AUTHOR]

Background: Bloodstream infections (BSI) are the major cause of morbidity and mortality in children in developing countries. The purpose of the current study was to establish the antimicrobial susceptibility pattern of bacterial isolates from bloodstream infections at Children's Medical Center Hospital (CMC), Tehran, Iran. Methods: We retrospectively recorded all positive blood cultures and antimicrobial susceptibility of all bloodstream isolates among children admitted to CMC, during 5 years. Specimen culture, bacterial identification, and antimicrobial susceptibility testing were performed according to standard laboratory methods. Results: From 3,179 pathogens isolated from the blood cultures 2,824 bacteria were cultured, with 1,312 cases being identified as Gram-positive bacteria (46%) and 1,512 cases as Gram-negative bacteria (54%). The most common Gram-negative bacteria isolated were as follows: Pseudomonas spp. (n = 266, 17.6%), Klebsiella pneumoniae (n = 242, 16%), Stenotrophomonas maltophilia (n = 204, 13.5%), Enterobacter spp. (n = 164, 10.8%), Escherichia coli (n = 159, 10.5%), Pseudomonas aeruginosa (n = 126, 8.3%), Serratia marcescens (n = 121, 8%), and Acinetobacter baumannii (n = 73, 4.8%). The most common Gram-positive bacteria isolated were coagulase-negative staphylococci (CONS) (n = 697, 53%), Streptococcus spp. (n = 237, 18%), Staphylococcus aureus (n = 202, 15%) and Enterococcus spp. (n = 167, 12.7%). 34% of bacterial strains were isolated from ICUs. The rates of methicillin resistance in S. aureus and CONS were 34% and 91%, respectively. E. coli isolates showed high resistance to cefotaxime (84%). All isolates of K. pneumoniae were susceptible to colistin and 56% were susceptible to imipenem. P. aeruginosa isolates showed high susceptibility to all antibiotics. Conclusions: Our findings emphasize the need of clinicians having access to up-to-date bacterial susceptibility data for routinely prescribed drugs. Continuous monitoring of changes in bacterial resistance will aid in the establishment of national priorities for local intervention initiatives in Iran. The increased risk of BSI caused by antibiotic-resistant organisms, emphasizes the significance of implementing appropriate antibiotic prescribing regulations and developing innovative vaccination techniques in Iran. [ABSTRACT FROM AUTHOR]

Background: Postoperative nausea and vomiting (PONV) is a common side effect associated with general anesthesia. Both ondansetron and aprepitant been effectively used to prevent PONV. However, there is a disagreement of opinions regarding the superiority of these two drugs. This study aims to compare the efficacy of aprepitant with ondansetron in preventing PONV following orthognathic surgeries. Methods: In this double-blinded clinical trial, 80 patients scheduled for orthognathic surgery at Imam Hossein Hospital, Tehran, Iran, were randomly assigned to two groups. A standardized anesthesia protocol was used for all patients. The first group received a placebo capsule administered one hour before the surgical procedure along with 4 mg (2 ml) of ondansetron intravenously after anesthesia induction. The second group was given 80 mg aprepitant capsules one hour before the surgery, followed by an injection of 2 ml intravenous distilled water after anesthesia induction. The occurrence and severity of PONV, the amount of rescue medication required, and the complete response of patients assessed within 24 h after the surgery. Results: There were no significant differences in demographic data between the two groups. Patients in the aprepitant group had a significantly lower incidence and severity of nausea (2.5% versus 27.5%), vomiting (5% versus 25%), and required fewer rescue medications (7.5% versus 62.5%) compared to the ondansetron group. Additionally, the aprepitant group showed a higher complete response rate (90% versus 67.5%) in the 0-2 and 12-24 postoperative hours. Conclusion: According to the findings of this study, aprepitant has demonstrated a greater efficacy in preventing PONV following orthognathic surgery, when compared to ondansetron. Trial registration: Iranian Registry of Clinical Trials (IRCT code: IRCT20211205053279N3), date of registration: 16/12/2022. [ABSTRACT FROM AUTHOR]

Background: To facilitate evidence‐based practice (EBP) in physiotherapy in Iran and guide future improvements, it is crucial to identify what barriers and facilitators exist in the current system from the physiotherapist's perspective. Therefore, the purpose of this study was to explore the barriers and facilitators of EBP in physiotherapy in Iran. Methods: This qualitative study was conducted using a phenomenological approach from January to July 2023 in Iran. The sampling process started with a purposive approach, and then an attempt was made to identify and interview more potential samples with the snowball approach. Thematic analysis was used to analyse the collected qualitative data. Results: 44 individuals, including 37 physiotherapists and seven faculty members, participated in this study. Several barriers and facilitators to evidence‐based physiotherapy practice in Iran were found and then put into three themes: (1) individual factors, (2) practice environment factors, and (3) extra‐organisational factors. The most common barriers were time/workload pressures, financial incentives, lack of motivation, weakness in English, managers' pressures, inadequate awareness among patients, infrastructure limitations, poor economic situation, Internet restrictions, inappropriateness of the educational curriculum, difficult access to scientific research, and lack of insurance coverage for up‐to‐date therapies. Conclusions: Although most of the participants had a very positive view of physiotherapy based on scientific evidence, various obstacles have prevented this approach from being well implemented in Iran. Therefore, it is necessary to move towards minimising the existing barriers at the individual, practice environment, and extra‐organisational levels by adopting effective multilateral policies. [ABSTRACT FROM AUTHOR]

Context: During the COVID-19 pandemic and challenges, medical education with insight toward training competent students with a global vision has highlighted the necessity of a robust approach toward sustainable development (SD) on internationalization. Inevitable transformations in medical education and its internationalization component due to the COVID-19 pandemic have not yet been investigated. Accordingly, the objective of this study was to assess the current situation and propose the operational framework of internationalization for medical education with a global vision toward SD. Evidence Acquisition: A critical review was conducted on English papers extracted from Google Scholar, Scopus, PubMed, and Elsevier databases using the following search terms: Sustainable development, operational approach, educational environment, management strategies, internationalization, and COVID-19. Boolean operators were used to eliminate inappropriate hits with a focus on research goals. Ineligible studies were excluded by screening titles and abstracts. The knowledge management was applied to the related findings of the internationalization of medical education components. Results: Evidence presents a new order of internationalization components of internal and external dimensions with an educational paradigm shift to virtual programs. Assessing these dimensions indicated the requirement of implementing SD. The suggested pathway should initiate from the internal institution dimensions (facilities and budget component with generating income), followed by the external institution dimensions (sociocultural element and nation-building). Conclusions: The COVID-19 pandemic has forced educational institutions to shift to virtual education. The designed framework highlights educational activities toward virtual education and earning income, empowering faculties, and meeting social needs in medical education to achieve SD. [ABSTRACT FROM AUTHOR]

With the SARS-CoV-2 pandemic, the impact of recent coronavirus, especially in children, cannot be ignored. In this study, we evaluated the SARS-CoV-2 infection rates and associated features in children less than 18 years of age in "Fars" and "Kohgiluyeh and Boyer Ahmad", provinces, Iran. 5943 children who were suspected cases to SARS-CoV-2 infection were enrolled in this study. Demographic and clinical data of SARS-CoV-2 patients were collected from 16 February 2020 to 20 June 2021. Underlying conditions were considered in this study as well. Among 5943 patients suspected COVID 19 cases, 13.51% were confirmed by real-time PCR assay. The female/male ratio was 1:1.3 with a mean age of 5.71 years. 11.2% of confirmed patients were transferred and admitted in Pediatric ICU. COVID 19 was significantly higher in children with malignancy and diabetes rather than those with other underlying diseases. Children of all ages were susceptible to COVID 19, and there is no significant difference between both sexes. Most of the COVID 19 cases were in 10–18 years old group. Among a number of children with different underlying diseases, children with malignancy had the highest rate of SARS-CoV-2 infection, followed by those with diabetes. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC) is the most commonly diagnosed cancer and the leading cause of cancer death among women. Knowledge of the clinical characteristics of BC in a population may be informative for disease prediction or diagnosis and for developing screening and diagnostic guidelines. This study aimed to evaluate the clinical characteristics of female patients with BC who were admitted to academic surgical wards in Tehran, Iran. Methods: In this cross-sectional study, demographic information and clinical characteristics of Iranian females with BC who had undergone breast surgery from 2017–2021 in four academic Breast Surgery Units were extracted from medical files and recorded via a pre-designed checklist. Results: A total of 1476 patients with a mean age of 48.03 (± 11.46) years were enrolled. Among them, 10.4% were aged less than 35. In younger patients, Triple-negative and Her2-enriched subtypes of BC were significantly higher compared to older ones. Overall, 85.7% of tumors were invasive ductal carcinoma, 43.3% were grade 2, 41.4% were located in the UOQ, and 65.2% had presented with mass palpation. The mean pathologic tumor size was 28.94 mm, and the most common subtype was luminal B. Conclusions: Many characteristics of breast cancer in this study were similar to other countries and previous studies in Iran. However, a higher proportion of young BC compared with Western countries, and even with older studies in Iran, suggest a trend toward lower age for BC in recent years. These results indicate the need for preventive measures and screening in Iranian women at a younger age. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease (CKD) is a growing global health problem. Recently, an epidemic of CKD of unknown origin (CKDu), a form of CKD seen mostly in agricultural communities, has been emerged. One of the proposed causes of CKDu is pesticide use in farmers. On the other hand, the research on relation between indoor use of pesticides and CKDu is little. In this study, we aimed to investigate the association between indoor use of pesticide as well as the exposure time with CKDu. This study was done as part of the population-based cohort of Prospective Epidemiological Research Studies in Iran. We used the baseline data of the Zahedan Adult Cohort Study. All subjects with diabetes mellitus and/or hypertension, estimated glomerular filtration rate (eGFR) between 60–89 ml/min/1.73 m2, and unavailable creatinine measurement were excluded. Subjects with an eGFR of less than 60 ml/min/1.73 m2 were defined as having CKDu, and their data were compared with those with an eGFR of more than 90 ml/min/1.73 m2. Data regarding indoor pesticide use and duration of exposure were obtained through a questionnaire. After applying the exclusion criteria, 1079 subjects remained in the study. Female sex, single marital status, low physical activity, triglyceride (TG) levels of more than 150 mg/dl, body mass index (BMI) of more than 25 kg/m2, non-smokers, indoor pesticide use, and high pesticide exposure time were associated with CKDu. The effects of age, female sex, TG levels more than 150 mg/dl, pesticide use (OR 1.36; 95% CI 1.01–1.84), and high exposure time (third tertile of exposure time) compared to non-users (OR 1.64; 95% CI 1.07–2.51) remained significant in multivariable analysis. Conclusion: We found a positive association between pesticide use, as well as longer exposure time to pesticides, and impaired kidney function in cases without diabetes mellitus and hypertension. Further longitudinal studies should be carried out to confirm these findings. [ABSTRACT FROM AUTHOR]

Constant development of information technology in human lives has encouraged them to use technology in the field of educational sciences. This study aimed to investigate the effect of digital storytelling in online psychological services and its application using Rational Emotive Behavior Therapy (REBT) on reducing coronavirus anxiety and increase academic and social integration. The research design was based on quasi-experimental designs with pretest and posttest and follow-up with control group. The statistical population of the current study consisted of all undergraduate students in Tehran in 2020. For this purpose, 98 students were selected as the sample and randomly assigned into two experimental groups of digital storytelling and online psychology and a control group. The results showed that digital storytelling and online psychology groups have a significant effect on reducing coronavirus anxiety and increased academic and social integration. Comparison of the experimental groups showed that the digital storytelling group outperforms the online psychology group in reducing coronavirus anxiety and increased academic and social integration of students. According to the results of this study, it can be concluded that storytelling can be used in online psychological services and REBT is compatible with online psychology and digital storytelling. [ABSTRACT FROM AUTHOR]

Purpose: The Covid-19 pandemic has made it essential to explore the resilience factors specific to developing regions, not only because they pose threats of extreme poverty and offer a novel context but also because they play an important role in globalisation. Design/methodology/approach: A mixed-method approach was undertaken to address this novel pandemic situation. First, an open-ended structured questionnaire was developed, and data were collected from three neighbouring emerging economies: Pakistan, India and Iran. Experts' perspectives on vulnerabilities, response measures, resilience and restoration of supply chain activities, and the role of social capital were collected. Second, building upon the findings from phase one of the studies, a quantitative structured questionnaire using the supply chain operational reference (SCOR) model was used to collect data in a structured manner. This quantitative data were further analysed using frequency and contingency analysis. Findings: The findings from the first phase of the study inductively derive 36 resilience categories. Later, the contingency findings show that supply chain (SC) disruption is a major vulnerability for emerging economies, whereas solutions offered to combat it lay in the reconfiguration of resources, such as financial, technological, human, information and material. Additionally, supply network structure and social capital play an integral part in making SCs resilient against disruption. Research limitations/implications: The respondents comprise the academics/SC researchers, which make the findings interesting though they lack the industrial experts' perspectives, directly. Nevertheless, the propositions can be tested in industrial settings to see whether the results are limited to a specific industrial setting or are rather generalised. Practical implications: Similarly, practitioners and policy makers can incorporate the SCOR metrics/factors outlined in this study into their performance measurement systems and ensure continuous monitoring for firm's resilience. Originality/value: The study offers a holistic understanding of the developing regions' approaches to Covid-19. The paper also takes a social capital perspective to explain firms' resilience in these emerging economies. [ABSTRACT FROM AUTHOR]

Purpose: Hypertension is one of the most important risk factors for premature mortality and morbidity in Iran. The objective of the Iranian blood pressure (BP) measurement campaign was to identify individuals with raised blood pressure and providing appropriate care and increase the awareness among the public and policymakers of the importance of tackling hypertension. Methods: The campaign was conducted in two phases. The first (communication) phase started on May 17th (International Hypertension Day). The second phase started on June 8th, 2019, and lasted up to July 7th during which, blood pressures were measured. The target population was Iranians aged ≥ 30 years. Participants voluntarily referred to health houses in rural and health posts and comprehensive health centers in urban areas in the setting of the Primary Health Care network. Additionally, over 13,700 temporary stations were set up in highly visited places in urban areas. Volunteer healthcare staff interviewed the participants, measured their BP, and provided them with lifestyle advice and knowledge of the risks and consequences of high blood pressure. They referred participants to physicians in case their BP was high. Participants immediately received a text message containing the relevant advice based on their measured BP and their past history. Results: Blood pressure was measured for a total of 26,678,394 participants in the campaign. A total of 13,722,148 participants (51.4%) were female. The mean age was 46 ± 14.1 years. Among total participants, 15,012,693 adults (56.3%) with no past history of hypertension had normal BP, 7,959,288 participants had BP in the prehypertension range (29.8%), and finally, 3,706,413 participants (13.9%) had either past medical history of hypertension, used medications, or had high BP measured in the campaign. Conclusion: The campaign was feasible with the objective to increase the awareness among the public and policymakers of the importance of tackling hypertension in Iran. [ABSTRACT FROM AUTHOR]

Background: The increasing trends in Diabetes prevalence and its attributed burden emphasized as an important issue that needs serious and urgent attention, all over the word. We estimated the mean Fasting Plasma Glucose (FPG) and the prevalence of Diabetes in aged 25 years or older Iranian adults, by sex, age, province, and year through the time period of 1990 to 2016. Methods: In order to access the most comprehensive relevant data at the same time the systematic data searched added to the data of 5 national surveys and 7 sub-national population based investigations. Two round of modeling, including the Age-Spatio-Temporal and Gaussian Process Regression were used for estimation of mean FPG trend and uncertainties. To estimate Diabetes estimations in target groups, a crosswalk model was applies to the FPG estimates. The model reiterated separately for women and men. All of estimations standardized based on the Iran national census population of 2016 by year, age groups and sexes at national and sub-national levels. Results: In 2016, the number of the diabetic population was 4.43 (3.93–4.99) million (2.38 million women). Between 1990 and 2016, the age-standardized mean of FPG increased from 84.69 mg/dl (79.8–89.8) to 100.5 mg/dl (97.9–103.3) in women and from 82.7 mg/dl (78.3–87.5) to 98.8 mg/dl (96.2–101.4) in men. Simultaneously, with considerable difference, the Diabetes prevalence, has increased from 6.1% (4.7–7.8) to 9.8% (8.7–11.1) in women and from 5.0% 18 (3.8–6.3) to 8.1% (7.2–9.2) in men (75% attributed to population growth). Considering the geographical patterns, the greatest increment in the prevalence of Diabetes detected in the northwestern and the central provinces. Conclusion: Significant increasing trends of Diabetes led to alarming threat, which can make the strategies and goals of our prevention programs out of control. We should plan for more effective communicative interventions for prevention and management of Diabetes, to be designed, implemented and monitored based on the updated scientific evidence. [ABSTRACT FROM AUTHOR]

Introduction: The internet has become a powerful worldwide information source that revolutionized access to knowledge, especially in the fields of health and medicine (health knowledge). Therefore, providing high-quality, accurate, reliable, and relevant information on dependable websites is a possible way of providing the patient with needed information and, thus, achieving the benefits of informed patients regarding outcomes. This study aimed to evaluate the quality and accuracy of breast cancer knowledge among Persian language websites. Methods: Two search engines were searched in the Persian language about breast cancer. The first 30 websites were selected for further evaluation based on the completeness, correctness, transparency, and accessibility of health knowledge. The DISCERN instrument was used to assess the quality of the Persian language websites on this issue. Results: Among the 30 websites, about 23% of websites provide completely correct information and about 30% provide mostly correct information. Sixty percent of the websites provided author information, and 46% of them had a healthcare professional or expert as the author. Sixty percent of the websites stated the creation date on the pages, while 40% of them did not provide any health knowledge. Scores on accessibility were always easy for most of the websites. Based on the quality rating system of DISCERN, about 60% of the websites were presented as very poor. Conclusion: Website rankings enable healthcare professionals to identify and signpost patients to reliable up-to-date websites to ensure that patients receive high-quality knowledge. This review has provided evidence of inadequate and inaccurate health knowledge about breast cancer on the Persian language websites. This issue requires further investigation to understand the barriers and solutions available to provide reliable information about breast cancer and how this information affects the patient's outcomes. Trial registration: The project was found to be in accordance with the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and date of IR.TUMS.IKHC.REC.1399.379 and 2021–01-01 respectively, and is registered with research project number 49890 in the Vice Chancellor for Research and Technology Development of Tehran University of Medical Sciences, Tehran, Iran. URL: https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=170978. [ABSTRACT FROM AUTHOR]

**Translator's note: Haifa implies that Iran is the only Muslim/ Arab country with compulsory hijab, which is not entirely accurate. I was raised and socialized as a woman, I was subjugated to physical, emotional and sexual abuse not only by the fascist regime of my country, but also by the patriotic household I was born into and was enabled by the Islamic regime. B PARASTOU FOROUHAR AND STATE VIOLENCE ON DISPLAY Bahar Noorizadeh b Graph Graph Graph B HAIFA ASADI b Graph Translation of Haifa Asadi's Twitter feed The elimination of mandatory hijab is not a luxurious demand. When you overlook these types of oppression and reduce the blood that is spilled in these lands to compulsory hijab - without explaining what the gender/ ethnicity/racial apartheid of this regime has done to the people of this land - you are practically turning compulsory hijab into a simple and obvious problem with a simple and obvious solution, when in fact, compulsory hijab is a complex and multi-layered political oppression. [Extracted from the article]

Purpose: We aimed to estimate the level and trend of plasma cholesterol and raised total cholesterol (TC > 200 mg/dl) prevalence at national and subnational level of Iran. Methods: Nine national surveys and 27 studies, encompassing 3,505 unique points on over 500,000 adults, aged > 25 years with a report of laboratory measurement of TC were found. Age-spatio-temporal model and Gaussian Process Regression were used to estimate mean TC for each sex, 5-year age groups, and 31 provinces from 1990 to 2016. Results: At national level, age-standardized prevalence of TC > 200 mg/dL has decreased from 57·2%(53·3–61·1) to 22·4%(20·5–24·3) in women and 53·2%(49·1–57·3) to 18·0%(16·4–19·6) in men. TC distribution presented a condensation between 170-200 mg/dL. At subnational level, decreasing and converging patterns of raised TC prevalence were detected. Conclusion: The decrease in raised TC is likely the result of statin widespread use, food industry improvements, and the expanded primary health care. [ABSTRACT FROM AUTHOR]

Background: This study sought to determine the anatomical variations of the mental foramen (MF) and the mandibular canal (MC) in the full edentulous Iranian subpopulation using cone-beam computed tomography (CBCT). These variations can have significant clinical implications in dental implant surgery. Methods: This descriptive cross-sectional study evaluated the mandible CBCT scans of 384 completely edentulous patients that required dental implant treatment. The CBCT scans were retrieved from four radiology clinics in Tehran, Iran, using quota sampling. The reconstructed images were evaluated to determine the dimensions and position of the MC and its cortication at the site of the mandibular first molar, the branching of the MC, the existence of the anterior loop of the mental nerve, and anatomical variations of the MF. The correlations of variables with age and gender were analyzed using the independent t-test, chi-square test, and analysis of variance based on the type of the variable. Results: The cortication of the MC at the site of the mandibular first molar was present in 72.9% of the cases and was significantly more common in male patients (P= 0.0001). Bifid mandibular canal, accessory MF, and anterior loop of mental nerve were present in 9.9%, 65%, and 54.7% of the samples, respectively, and they had no significant correlation with age/gender. The mean MC diameter, the mean MF height, and the mean distance from the inferior border of the mandible to the center of MF were all significantly higher in male patients (P<0.05). The mean distance between the MC and the buccal and lingual cortical plates had no correlation with age/gender. The mean height between the superior part of the MC and the alveolar crest was significantly lower in female patients and those within the age range of 71-95 years (P<0.05). The MC opened in the MF superiorly in 40.1% of the patients with no significant correlation with age/gender. Conclusions: Anatomical variations in the course and location of the MC and MF necessitate the precise assessment of the edentulous ridge by CBCT prior to the placement of implants. [ABSTRACT FROM AUTHOR]

Background: Lipoid proteinosis (LP) or Hyalinosis Cutis et Mucosae or Urbach–Wiethe disease is a rare autosomal recessive genodermatosis characterized by an amorphous hyaline material deposition in the skin mucosa and viscera. The clinical symptoms of this disease often begin in childhood, which persist throughout life. Skin manifestations include inflammation, scaling, acne, and eventually ulceration, and hyaline amorphous deposits in these areas of the wound cause a waxy and thick appearance on the skin. In addition, wounds leave atrophic scars like chickenpox. Aim: Herein, we present the first case of LP in the north of Iran; although LP is a sporadic disease, it occurs all around the world, with about 400 cases worldwide having been reported thus far. Patient: We report the case of a 28‐year‐old female patient with a history of skin lesions on her face, scalp, extremities, and buttock, as well as hoarse cry, respiratory problems, dysphagia, and migraine since childhood. There was no evidence of other clinical presentations. A biopsy was taken from the lesions, and the patient was diagnosed with LP. A laryngeal laser was performed for the patient, and peeling creams were used for her skin lesions. Result: According to previous findings, there has been no case report of LP with systemic symptoms in the north of Iran. [ABSTRACT FROM AUTHOR]

Given the growing universal demand for sustainable development in recent years, ecotourism has become one of the top effectual actions that can be employed to reconcile environmental conservation with economic growth. Therefore, sustainable development can be supported by assessing ecotourism ecosystem services at the landscape scale. In this regard, we presented a new technique that considers a potential model of ecotourism along with a landscape resilience measurement to identify the priority areas for sustainable ecotourism development. For this purpose, a multi-criteria fuzzy model with a geographic information system (GIS) and analytical hierarchy process (AHP) was first used to evaluate potential zones for ecotourism. The landscape ecological risk index (ERI) was then applied to measure the landscape resilience. The usefulness of our novel technique was then tested in a case study in the Chaharmahal and Bakhtiari province (Ch & B), situated in the central part of the Zagros Mountain Chains, Iran. The area has a coarse terrain with climate that varies considerably, which results in high potential for ecotourism development. The results indicated that about half of the provincial area had high potential for developing ecotourism and attracting tourists. However, when considering the landscape resilience, approximately 33% of the study area near the western and central regions had both high potential for ecotourism and the high values of landscape resilience, making these locations suitable for sustainable ecotourism development. Overall, the present study demonstrated that utilizing the integrated models and the ecotourism potential model, together with the landscape resilience assessment, might provide a powerful tool for ecotourism prioritization for the purpose of sustainable development. [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: Since 1990, neonatal, infant, and child mortality has substantially decreased in Iran. However, estimates for mortality by cause at subnational scale are not available. Methods: This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report the number and rates of neonate, infant, and child deaths by cause across provinces of Iran from 1990 to 2019. Results: Between 1990 and 2019, the neonatal mortality rate per 1000 live births decreased from 31.8 (95% UI: 28.1--35.5) to 6.8 (6.1--7.4). The child mortality rates decreased from 71.2 (63.6--79.1) to 11.1 (10.2--12.0) per 1000 live births. Mortality rates among neonates per 1000 live births ranged from 3.1 (2.6--3.7) to 10.0 (9.2--10.8) across provinces in 2019. Child mortality rate per 1000 live births ranged from 5.5 (4.6--6.5) to 17.9 (16.4--19.4) across provinces in 2019. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of mortality in almost all provinces of Iran. The majority of neonatal disorders were due to neonatal preterm birth and neonatal asphyxia, trauma, and infections. The trends of mortality across provinces from 1990 to 2019 were converging and decreased along with increase in sociodemographic index (SDI). Conclusions: All provinces achieved the Sustainable Development Goal 3.2 of neonatal mortality less than 12 and child mortality less than 25 per 1000 live births. However, disparities still exist across provinces, specifically in low-SDI provinces. [ABSTRACT FROM AUTHOR]

Background: Environmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings. Methods: We collected data on individual and environmental risk factors for a multiethnic cohort of 50,045 individuals in a low-income region in Iran. Environmental risk factors included: ambient fine particular matter air pollution; household fuel use and ventilation; proximity to traffic; distance to percutaneous coronary intervention (PCI) center; socioeconomic environment; population density; local land use; and nighttime light exposure. We developed a spatial survival model to estimate the independent associations between these environmental exposures and all-cause and cardiovascular mortality. Findings: Several environmental factors demonstrated associations with mortality after adjusting for individual risk factors. Ambient fine particulate matter air pollution predicted all-cause mortality (per μg/m3, HR 1.20, 95% CI 1.07, 1.36) and cardiovascular mortality (HR 1.17, 95% CI 0.98, 1.39). Biomass fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.23, 95% CI 0.99, 1.53) and cardiovascular mortality (HR 1.36, 95% CI 0.99, 1.87). Kerosene fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.09, 95% CI 0.97, 1.23) and cardiovascular mortality (HR 1.19, 95% CI 1.01, 1.41). Distance to PCI center predicted all-cause mortality (per 10km, HR 1.01, 95% CI 1.004, 1.022) and cardiovascular mortality (HR 1.02, 95% CI 1.004, 1.031). Additionally, proximity to traffic predicted all-cause mortality (HR 1.13, 95% CI 1.01, 1.27). In a separate validation cohort, the multivariable model effectively predicted both all-cause mortality (AUC 0.76) and cardiovascular mortality (AUC 0.81). Population attributable fractions demonstrated a high mortality burden attributable to environmental exposures. Interpretation: Several environmental factors predicted cardiovascular and all-cause mortality, independent of each other and of individual risk factors. Mortality attributable to environmental factors represents a critical opportunity for targeted policies and programs. [ABSTRACT FROM AUTHOR]

Background: The magnitude of the health problems caused by leishmaniasis has been a major driving factor behind the development and implementation of leishmaniasis control programs by the national authorities in Iran, with a priority for health and environmental management. Such programs are not achievable unless all of the factors leading to the infection, including the parasite's life-cycle, vectors and reservoirs, are recognized. So far in Iran, humans and rodents have been considered the principal reservoirs of Leishmania tropica and Leishmania major, respectively, both associated with cutaneous leishmaniasis (CL), with domestic dogs considered to be the main reservoir for Leishmania infantum, associated with visceral leishmaniasis (VL). The role of other mammals in maintaining the Leishmania parasite has remained unclear. This study aimed to investigate Leishmania infection among livestock in endemic areas of VL and CL in Fars province, southern Iran, using serological and molecular methods. Methods: Blood samples from 181 clinically healthy livestock, including 49 sheep, 114 goats, 16 cattle and two donkeys, were screened to detect Leishmania DNA and anti-Leishmania antibodies using qPCR (quantitative PCR) and the direct agglutination test (DAT), respectively. Four qPCR-positive samples were amplified using the internal transcribed spacer one (ITS1) primers in conventional PCR and sent for directional sequencing. Results: Of the 181 livestock tested, 51 (28.2%) were infected with Leishmania, using serological and molecular methods. Anti-Leishmania antibodies were detected in 70 (38.7%) (95% confidence interval [CI]: 31.5–46.2) and Leishmania DNA in 93 (51.4%) (95% CI: 43.9–58.9) livestock. The identified Leishmania spp. were L. infantum and L. major. Conclusions: The findings of the present study show a relatively high prevalence of Leishmania infection among livestock in endemic areas of the disease, in Fars province, southern Iran. Given the large population of this group of animals and the fact that they live in the vicinity of the main reservoirs of the disease and vectors, it seems that sand flies regularly bite these animals. Further studies are needed to determine the role of livestock in the parasite's life-cycle and the epidemiology of Leishmania infection. [ABSTRACT FROM AUTHOR]

Background: Virtual education today is about to become one of the most important educational methods in nursing. However, there have been few studies that examine the effectiveness of virtual education to increase knowledge towards breast cancer among nurses in Iran. Purpose: The aim of this study was to compare the knowledge towards breast cancer among nurses who were provided with two different methods of virtual training. Methods: This quasi-experimental study was conducted among 182 nurses in two hospitals in Tehran, Iran, who were randomly selected and divided into two groups of 91 nurses. Participants of the first group got virtual training about breast cancer in two sessions within two weeks by Skyroom. In the second group, the content was sent as educational messages by WhatsApp within two weeks. Participants' knowledge in both groups was measured using valid and reliable questionnaires developed by the researchers as a pretest and three posttests, and the satisfaction of the participants was also measured. To analyze the data, analysis of variance, standard deviation, t-test and Tukey test were performed. Results: According to the average score observed in the post-test period, the score of the WhatsApp group was 7.62, significantly higher than the Skyroom group of 6.25. The scores of the three post-test were higher than the pre-test in the two groups (with no significant difference between the two groups, p-value = 0.825 in the first post-test), but the scores declined from the first to third tests, showing a decline in the learning effect with time. However, the slope was gentler in the WhatsApp group, indicating a more persistent learning effect. Conclusion: This study showed that teaching with educational messages through WhatsApp had a greater impact on the sustainability of learning than teaching via lecturing through Skyroom. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a common benign but painful gynecologic condition. Studies suggest that the risk of some types of malignancies such as breast cancer is higher in women with endometriosis. Mammographic breast density (MBD) is known as an important predictor for breast cancer. The present study aimed to investigate the potential relationship between endometriosis and MBD.Methods: This cross-sectional study was conducted on 370 women over 40 years of age. Laparoscopic surgery was carried out for the diagnosis of endometriosis. MBD was classified into four categories according to the ACR BI-RADS classification. Statistical analysis was performed using SPSS software to evaluate the potential association between variables.Results: The mean age of all participants was 47.2 ± 6.4 years, and most participants (76.8%) were premenopausal. Multivariate analysis of the potential predictors of MBD, including age, body mass index, oral contraceptive consumption, progesterone consumption, family history of breast cancer and endometriosis showed that age (P value = 0.002), history of progesterone consumption (P value = 0.004) and endometriosis (P value = 0.006) were independent factors for MBD.Conclusion: This study indicated that endometriosis had an inverse association with MBD. Age and history of progesterone use were also independent influential factors for MBD. This finding shows that the positive association between breast cancer and endometriosis is not mediated through MBD. [ABSTRACT FROM AUTHOR]

Background: Determining the risk of Cardiovascular Disease (CVD) is a necessity for timely preventive interventions in high-risk groups. However, laboratory testing may be impractical in countries with limited resources. This study aimed at comparison and assessment of the agreement between laboratory-based and non-laboratory-based WHO risk charts models.Methods: This study was performed using the baseline data of 8138 participants in the pars cohort study who had no history of CVD and stroke. The updated 2019 WHO model was used to determine the 10-year fatal and non-fatal CVD risks. In general, there are two types of new WHO risk prediction models for CVD. The scores were determined based on age, sex, smoking status, diabetes, Systolic Blood Pressure (SBP), and total cholesterol for the laboratory-based model and age, sex, smoking status, SBP, and Body Mass Index (BMI) for the non-laboratory-based model. The agreement of these two models was determined via kappa statistics for the classified risk (low: < 10%, moderate: 10-< 20%, high: ≥ 20%). Correlation coefficients (r) and scatter plots was used for correlation between scores.Results: The results revealed very strong correlation coefficients for all sex and age groups (r = 0.84 for males < 60 years old, 0.93 for males ≥ 60 years old, 0.85 for females < 60 years old, and 0.88 for females ≥ 60 years old). In the laboratory-based model, low, moderate, and high risks were 76.10%, 18.17%, and 5.73%, respectively. These measures were respectively obtained as 77.00%, 18.08%, and 4.92% in the non-laboratory-based model. Based on risk classification, the agreement was substantial for males < 60 years old and for both males and females aged ≥ 60 years (kappa values: 0.79 for males < 60 years old, 0.65 for males ≥ 60 years old, and 0.66 for females ≥ 60 years old) and moderate for females < 60 years old (kappa = 0.46).Conclusions: The non-laboratory-based risk prediction model, which is simple, inexpensive, and non-invasive, classifies individuals almost identically to the laboratory-based model. Therefore, in countries with limited resources, these two models can be used interchangeably. [ABSTRACT FROM AUTHOR]

In this cross-sectional population-based study, we used the baseline data of the Prospective Epidemiologic Research Studies in IrAN cohort study collected in Iran from 2014 to 2020. The main outcomes were the prevalence of hypertension and proportion of awareness, treatment, and control based on the 2017 ACC/AHA guideline compared to the seventh report of the Joint National Committee (JNC7). Of the total of 163,770 participants, aged 35–70 years, 55.2% were female. The sex-age standardized prevalence of hypertension was 22.3% (95% CI 20.6, 24.1) based on the JNC7 guideline and 36.5% (31.1, 41.8) based on the ACC/AHA guideline. A total of 24,312 participants [14.1% (10.1, 18.1)] were newly diagnosed based on the ACC/AHA guideline. Compared to adults diagnosed with hypertension based on the JNC7 guideline, the newly diagnosed participants were mainly young literate males who had low levels of risk factors and were free from conventional comorbidities of hypertension. About 30.7% (25.9, 35.4) of them (4.3% of the entire population) were eligible for pharmacologic intervention based on the ACC/AHA guideline. Implementation of the new guideline may impose additional burden on health systems. However, early detection and management of elevated blood pressure may reduce the ultimate burden of hypertension in Iran. [ABSTRACT FROM AUTHOR]

Background: Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region. Methods: We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models' discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level. Results: After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766- 0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%). Conclusion: Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women. [ABSTRACT FROM AUTHOR]

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Background: COVID-19 has affected the training programs and the clinical schedules of surgical wards in many countries, including Iran. Also, the continuous involvement with COVID-19 patients has caused stress in health care workers; among them, residents are on the frontlines of care delivery. Therefore, we designed a study to assess the mental effects of these circumstances, and the effects on General Surgery and Obstetrics & Gynecology residency training in the busiest surgical departments of our university. Methods: Participants of this cross-sectional study were residents of General Surgery and Obstetrics & Gynecology of Tehran University of Medical Sciences, and the conventional sampling method was used. We used a questionnaire consisting of 47 questions (mostly using multiple choice questions and answers on the Likert scale) about personal, familial, and demographic characteristics; training activities, and mental effects of COVID-19. Results: The response rate was 63.5%. (127 filled questionnaires). Around 96% of the residents had emotional problems, 85.9% were highly stressed about contracting COVID-19, 81.3% were worried about transferring it to their families; and 78% believed that their residency training had been impaired. Conclusion: Overall, our study shows the negative impact of COVID-19 on mental health and the training of residents. We propose that appropriate emotional support and suitable planning for compensation of training deficits is provided for residents. [ABSTRACT FROM AUTHOR]

Introduction: Over the past decades prevalence of diabetes has increased in Iran and other countries. This study aimed to update the prevalence of diabetes and prediabetes in Iran and to determine associated sociodemographic risk factors, as well as diabetes awareness and control. Methods: This is a nationally representative cross-sectional survey that included 163,770 Iranian adults aged 35–70 years, from different ethnic backgrounds, between 2014 and 2020. Diabetes was diagnosed at fasting blood sugar of ≥ 6.99 mmol/L (126 mg/dL), or receiving blood glucose-lowering treatment. Multivariable logistic regression was applied to detect determinants associated with prevalence of diabetes and prediabetes, as well as predictors of diabetes awareness and glycemic control. Results: Sex- and age-standardized prevalence of diabetes and prediabetes was 15.0% (95% CI 12.6–17.3) and 25.4% (18.6–32.1), respectively. Among patients with diabetes, 79.6% (76.2–82.9) were aware of their diabetes. Glycemic control was achieved in 41.2% (37.5–44.8) of patients who received treatment. Older age, obesity, high waist to hip ratio (WHR), and specific ethnic background were associated with a significant risk of diabetes and prediabetes. Higher awareness of diabetes was observed in older patients, married individuals, those with high WHR, and individuals with high wealth score. Moreover, glycemic control was significantly better in women, obese individuals, those with high physical activity, educational attainment, and specific ethnic background. Conclusions: The prevalence of diabetes and prediabetes is increasing at an alarming rate in Iranian adults. High proportion of uncontrolled patients require particular initiatives to be integrated in the health care system. [ABSTRACT FROM AUTHOR]

Background: In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) provided a new guideline for hypertension prevention and management. We aimed to update the prevalence, awareness, control, and determinants of hypertension based on this guideline in Khuzestan province, southwest of Iran, and to estimate the number of people who are eligible for non-pharmacologic and pharmacologic intervention. Methods: This population-based cross-sectional study was conducted in Khuzestan, a large province in the southwest of Iran. Comprehensive information about the potential relating factors of hypertension was collected, blood pressure was measured, and anthropometric measurements were obtained. Moreover, the dietary pattern was evaluated in 2830 individuals, using a qualitative food frequency questionnaire. Results: Among 30,506 participants, 30,424 individuals aged 20–65 years were eligible for the study. In comparison with the previous guideline released by the Joint National Committee (JNC8), the prevalence of hypertension in Khuzestan dramatically increased from 15.81 to 42.85% after implementation of the ACC/AHA guideline, which was more dominant in the male population and the 45–54 age group. The sex and age adjustment of the hypertension prevalence was estimated to be 39.40%. The percentage of hypertension awareness, treatment, and control were 45.85%, 35.42%, and 59.63%, which dropped to 22.72%, 26.37%, and 28.94% after implementation of new guideline, respectively. Conclusions: In the ACC/AHA guideline, a higher number of individuals with the pre-hypertension condition were shifted into the hypertension category and the level of awareness, treatment, and control were dramatically decreased, which highlight a great need to expand the public health infrastructure for further managing the substantial increased burden on healthcare system. However, further studies with population over 65 years are required to estimate the eligibility for antihypertensive treatment in this province after implementation of new guideline. [ABSTRACT FROM AUTHOR]

Aim: The present study implemented an RT-qPCR assay for the detection and quantification of human cosavirus in stool specimens from pediatric patients involved in acute gastroenteritis. Background: Human cosavirus is a newly recognized virus that seems to be partly related to acute gastroenteritis in pediatric patients. However, the relationship between human cosavirus and diseases in humans is unclear Methods: From January 2018 to December 2019, a total of 160 stool samples were collected from pediatric patients presenting with acute gastroenteritis in a hospital in Karaj, Iran. After viral RNA extraction, RT-qPCR was performed to amplify the 5'UTR region of the human cosavirus genome and viral load was analyzed. Results The human cosavirus genomic RNA was detected in 4/160 (2.5%) stool samples tested. The maximum viral load was determined to be 4.6*106 copies/ml in one sample obtained from a 4-year-old patient. Conclusion: The human cosavirus as a new member of the Picornaviridae family was illustrated in fecal samples from pediatric patients with acute gastroenteritis in Iran. This is the first documentation of human cosavirus circulation in Iranian children. [ABSTRACT FROM AUTHOR]

Assessing distribution patterns of valuable taxa plays an important role in the biodiversity conservation of these taxa. The genus Crocus L. (Iridaceae) comprises about 100 species that are distributed mainly in the Mediterranean region and western Asia. The present study purposed to assess the distribution patterns of Iranian Crocus species (including C. sativus L. and 8 wild species) and their conservation status in Iran as one of diversity centers of Crocus in the Middle East. A set of geographic distribution data was compiled through field studies, and reviews of herbarium specimens, iNaturalist, and various Flora. Localities were marked on geo-referenced maps (1/106) of Iran using ArcView version 3.2 (Esri, 2000). The distribution patterns of the taxa were mapped per 0.25° × 0.25° universal transverse Mercator grid cells (25 km2 with the exception of boundary area). Based on the species distribution (SDI) (33%) and species specialization (SSI) (44%) indices, those Iranian Crocus species that are threatened are mainly distributed in Irano-Turanian region. The mountainous ecosystems of Almeh and Western Alborz are important distribution centers of these taxa. Iranian Crocus species with SSI < 0.5 (C. almehensis, C. gilanicus, C. michelsonii, and C. caspius) have the highest conservation value. [ABSTRACT FROM AUTHOR]

Background and Objectives: Brucellosis and Q fever are considered as occupational hazards to people in contact with domestic animals or their carcasses. The present cross-sectional study was carried out to determine the seroprevalence of brucellosis and Q fever among professions at risk in the North Khorasan Province, northeastern Iran during 2020. Materials and Methods: In this study, 185 sera samples were collected from butchers, slaughterhouse workers, farmers, and veterinarians in different counties of the province. The collected sera were tested by ELISA test for the detection of IgG antibodies against Coxiella burnetii and Brucella spp. A questionnaire was filled for each participant to investigate demographic characteristics information (i.e., age, gender, educational status, occupation, years of occupational experience, and location), and any exposure to risk factors (animals Keeping, consumption of unpasteurized dairy products, exposure to ill or dead animals, tick bite, splashing animal fluids, travel history, and use of personal protective equipment) that could be associated with these infections. Results: The seroprevalence of antibodies against C. burnetii and Brucella spp. were 17.2% and 19.4%, respectively. Twelve participants also had Q fever and brucellosis co-infection, with a prevalence of 6.4%. Conclusion: Based on the results, it is concluded that brucellosis and Q fever occur among the high-risk populations in this area and it needs more surveillance to control the diseases by public health and veterinary authorities. [ABSTRACT FROM AUTHOR]

Purpose: The lung cancer incidence in Iran has increased almost ten times over the past three decades. In addition to the known causes such as smoking and certain occupational exposure, dietary quality has been suggested to play a role in lung cancer. We aim to explore the association between dietary pattern and lung cancer risk among a Middle East population. Methods: Data came from Golestan Cohort Study which included 48,421 participants with 136 lung cancer cases diagnosed during a median follow-up of 12 years. Multivariable Cox proportional hazards regression models were used to calculate the HRs and 95% CI of lung cancer risk by tertile of the four dietary index scores—the Health Eating Index (HEI)-2015, the Alternative Health Eating Index (AHEI)-2010, the Alternative Mediterranean Diet (AMED), and the Dietary Approach to Stop Hypertension (DASH)-Fung. Results: A higher DASH-Fung score was inversely associated with risk of lung cancer after adjusting for potential confounders (tertile three vs. tertile one: HR = 0.59 (0.38–0.93); p for trend = 0.07), and pinteraction with smoking was 0.46. Similar findings were observed among current smokers with the HEI-2015 score (tertile three vs. tertile one: HR = 0.22 (0.08–0.60): p for trend < 0.01), and pinteraction between smoking and the HEI-2015 score was 0.03. Conclusion: In the GCS, consuming a diet more closely aligned with the DASH diet was associated with a reduced risk of lung cancer, which appeared to be independent of smoking status. There was also an inverse link between the HEI-2015 score and lung cancer risk among current smokers. Our finding is particularly important for the Middle East population, as diet may play an important role in cancer prevention and overall health. [ABSTRACT FROM AUTHOR]

Aim and Scope: Health monitoring is important component of the employee health maintenance program, which is performed by periodic examinations in accordance with Article 92 of the Labor Law. Thus, the aim of this study was to investigate the barriers of performing periodic examinations in the industries of Kashan in 2019. Materials and Methods: This descriptive study was conducted on 200 people (employer, health inspector, and medicine physician and industry health experts). A researcher-made questionnaire used to collect the data. Barriers were prioritized based on the scores of each group. Then, a weighting technique was used to accumulate the opinions and final prioritization. To analyze the data, SPSS 16 software was used. Results: Out of 200 subjects the number (percentage) of employers, inspectors, occupational medicine physicians and industry experts were 103 (51.5%), 31 (15.5%), 5 (2.5%) and 61 (31.5%) respectively. Using AHP (hierarchical analysis) and Expert Choice software. Final weight for the perspective of occupational health inspectors, employer, occupational medicine physician, and industry expert was obtained at 0.38, 0.257, 0.195, and 0.168, respectively. After applying the weight from the perspective of the four groups, the final priorities were obtained as the high cost of examinations, lack of awareness of workers about the importance of examinations, and lack of a comprehensive plan to reduce occupational diseases in industry, respectively. Conclusion: It is recommended that examinations be performed in clinics covered by the University of Medical Sciences at a lower cost. And train employers about the benefits and importance of occupational examinations. [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: Autosomal recessive non-syndromic hearing loss (ARNSHL) is genetically and phenotypically heterogeneous with over 110 genes causally implicated in syndromic and non-syndromic hearing loss. Here, we investigate the genetic etiology of deafness in two GJB2 and GJB6 negative patients presenting with pre-lingual, progressive, severe hearing loss. Methods: Targeted exome sequencing (TES) using Next Generation Illumina Sequencing was used to analyze the exonic and some other important genomic regions of 154 genes in the proband. Subsequently, the mutation found was confirmed by Sanger sequencing in other affected sibling and healthy family members. The possible impact of the reported mutation on the corresponding protein was also evaluated by using bioinformatics tools. Moreover, the affected patients underwent audiological and ophthalmic evaluations. Results: TES identified a novel homozygous missense mutation c.251T>C (p.I84T) in exon 3 of PDZD7 gene. In addition, segregation and phenotype-genotype correlation analysis as well as in-silico evaluations confirmed the autosomal recessive inheritance pattern and disease-causing nature of mutation found. Conclusions: In overall, our finding could expand the pathogenic mutations spectrum and strengthens the clinical importance of the PDZD7 gene in ARNSHL patients. It can also aid to conduct genetic counseling, prenatal diagnosis and clinical management of these types of genetic disorders. [ABSTRACT FROM AUTHOR]

Fertility preservation counseling has a high priority in young breast cancer (BC) patients. Cytotoxic chemicals used for chemotherapy in these patients increased the risk of premature ovarian failure. This study evaluated the anti-mullerian hormone (AMH) level at the time of diagnosis and within a month after the end of chemotherapy, while predicting the time of the return of ovarian function in BC cases (n=46) younger than 46 years for the first time in Iran. Cases were selected from those attending the breast oncology clinic of the two hospitals with a newly diagnosed in situ or invasive BC. The present study results showed AMH levels were significantly decreased in almost all women within a month after chemotherapy. It seems that the need for fertility preservation depends on patient age and baseline AMH level, but counseling should be offered by the clinician in young breast cancer patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Three billion people burn nonclean fuels for household purposes. Limited evidence suggests a link between household fuel use and gastrointestinal (GI) cancers. OBJECTIVES: We investigated the relationship between indoor burning of biomass, kerosene, and natural gas with the subsequent risk of GI cancers. METHODS: During the period 2004–2008, a total of 50,045 Iranian individuals 40–75 years of age were recruited to this prospective population-based cohort. Upon enrollment, validated data were collected on demographics, lifestyle, and exposures, including detailed data on lifetime household use of different fuels and stoves. The participants were followed through August 2018 with <1% loss. RESULTS: During the follow-up, 962 participants developed GI cancers. In comparison with using predominantly gas in the recent 20-y period, using predominantly biomass was associated with higher risks of esophageal [hazard ratio (HR): 1.89; 95% confidence interval (CI): 1.02, 3.50], and gastric HR: 1.83; 95% CI: 1.01, 3.31) cancers, whereas using predominantly kerosene was associated with higher risk of esophageal cancer (HR: 1.84; 95% CI: 1.10, 3.10). Lifetime duration of biomass burning for both cooking and house heating (exclusive biomass usage) using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.14; 95% CI: 1.07, 1.21), esophageal (10-y HR: 1.19; 95% CI: 1.08, 1.30), gastric (10-y HR: 1.11; 95% CI: 1.00, 1.23), and colon (10-y HR: 1.26; 95% CI: 1.03, 1.54) cancers. The risks of GI cancers combined, esophageal cancer, and gastric cancer were lower when biomass was burned using chimney-equipped heating-stoves (strata difference 푝-values = 0:001, 0.003, and 0.094, respectively). Duration of exclusive kerosene burning using heating-stoves without chimney was associated with higher risk of GI cancers combined (10-y HR: 1.05; 95% CI: 1.00, 1.11), and esophageal cancer (10-y HR: 1.14; 95% CI: 1.04, 1.26). DISCUSSION: Household burning of biomass or kerosene, especially without a chimney, was associated with higher risk of some digestive cancers. Using chimney-equipped stoves and replacing these fuels with natural gas may be useful interventions to reduce the burden of GI cancers worldwide. [ABSTRACT FROM AUTHOR]

Introduction: Daily use of public restrooms may have a significant impact on spreading infectious diseases. Human society could be affected by spreading of transitional infectious diseases through feces, urinary tract infection and poor personal hygiene. According to the World Health Organization reports, plenty of people's developed diseases caused by contaminated public restrooms that may result in severe health problems. Methods: This descriptive cross-sectional study was conducted on 7,482 samples that were collected randomly in 6 months (spring and summer 2019) in different regions of Tehran. The Data were obtained by analyzing 804 restroom's indoor and outdoor handles, 1062 toilet faucet, 826 washbasin taps, 1,062 toilet hoses, 804 flush tank levers, 643 soap dispenser bottoms, 643 liquid soaps, 99 bar soaps, 169 toilet papers and paper towels, and 50 hand dryer machines. Samples which were tested, based on bacteriology standard methods. Result: 7,482 samples were gathered of which 6,678 contaminated cases (89.25%) were observed and 804 cases (10.75%) were found non-contaminated. Escherichia coli with 28.48% and Pseudomonas with 0.39% were the most and the least common bacteria, respectively, in this study. Conclusion: The required tests to identify the bacteria that cause contamination through the use of public restrooms have been done. It is essential to inform the public of the mentioned items and teach how to prevent infectious diseases. [ABSTRACT FROM AUTHOR]

Leishmaniases are worldwide zoonotic infectious diseases caused by different types of intracellular protozoan species of the genus Leishmania. Leishmaniasis as an important vector‐borne parasitic disease is transmitted between mammalian hosts by female sandflies. There are three main clinical forms of disease with varied severity: visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucocutaneous leishmaniasis (MCL). MCL is the most uncommon form of this syndrome in the Old World. Accordingly, the reports have characterized that patients with the involvement of mucous membranes are rare even in endemic areas. It is well‐known that MCL is a rare clinical manifestation in Iran, but there have been several different cases of patients with mucosal (ML) or MCL in some parts of Iran during the past 50 years. Therefore, we aimed to report and present clinical and epidemiological features of ML or MCL in different regions of the country. Also, we demonstrated specified Leishmania species causing the ML in some cases. The present narrative review indicates that ML or MCL is not unexpected in Iran. Based on the findings of the recent studies, it is concluded that diagnosis of ML should be considered by physicians in Iran. [ABSTRACT FROM AUTHOR]

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) are one of the major problems in industrial societies. Awkward postures in theworkplace are considered as a main reasons for these disorders. Therefore, the study and investigation of postures to improve them (in the workplace) have a significant role in appropriate intervention. OBJECTIVE: This study aimed to design an ergonomic chair for near-ground welding operations and evaluate its impact on the electromyography (EMG) activity of a select group of lower limb muscles. METHODS: The EMG activity of lower limb muscles was measured in eight postures consisting of three postures identified via observing welders at work, and five on-chair postures suggested for chair use during welding. The usability of the designed chair was evaluated through the use of the System Usability Scale (SUS). RESULTS: The results showed that the suggested on-chair postures had significantly lower mean muscle activity compared with the identified postures (p < 0.001). Among the identified postures, kneeling posture had the lowest mean muscle activity (p < 0.01), still significantly higher than the mean activity of the on-chair postures (p < 0.001). Applying a 15° slope to the seat pad led to a decrease in muscle activity and an increase in usability score. The usability score of the chair was acceptable in all postures except KCC-90 posture. CONCLUSIONS: Using a suitable chair or support for different work postures can prevent detrimental muscle activities during work and the development of musculoskeletal disorders caused by intense muscle activity due to awkward postures. [ABSTRACT FROM AUTHOR]

Background: Whether pre-diabetes in the absence of hypertension (HTN) or dyslipidemia (DLP) is a risk factor for occurrence of major adverse cardiovascular events (MACE) is not fully established. We investigated the effect of impaired fasting glucose (IFG) alone and in combination with HTN, DLP or both on subsequent occurrence of MACE as well as individual MACE components.Methods: This longitudinal population-based study included 11,374 inhabitants of Northeastern Iran. The participants were free of any cardiovascular disease at baseline and were followed yearly from 2010 to 2017. Cox proportional hazard models were fitted to measure the hazard of IFG alone or in combination with HTN and DLP on occurrence of MACE as the primary endpoint.Results: Four hundred thirty-seven MACE were recorded during 6.2 ± 0.1 years follow up. IFG alone compared to normal fasting glucose (NFG) was not associated with an increase in occurrence of MACE (HR, 0.87; 95% CI, 0.19-4.02; p, 0.854). However, combination of IFG and HTN (HR, 2.88; 95% CI, 2.04-4.07; p, 0.000) or HTN + DLP (HR, 2.98; 95% CI, 1.89-4.71; p, 0.000) significantly increased the risk for MACE. Moreover, IFG + DM with or without HTN, DLP, or both was also associated with an increase in the incidence of MACE.Conclusion: IFG, per se, does not appear to increase hazard of MACE. However, IFG with HTN or HTN + DLP conferred a significant hazard for MACE in an incremental manner. Moreover, IFG without HTN, adjusted for DLP, can be associated with an increase in the risk for CVD- death. [ABSTRACT FROM AUTHOR]

Introduction: Smell Identification Tests (SIT) are routinely utilized for the clinical evaluation of olfactory function. Since Iran consists of various ethnic subgroups, the reliability and validity of this test as a national SIT are required to be evaluated across the country. Materials and Methods: This cross-sectional study evaluated the cultural adaptation of SIT administered to 420 healthy volunteers from 6 various ethnic subgroups (i.e., Fars, Turk, Kurd, Lor, Baluch, and Arab) living in 7 cities (one city for each subgroup, and Tehran [capital of Iran] with mixed ethnicities). The SIT consists of pens pre-filled with 24 odorants. The correct identification response rate was evaluated in all and each subgroup. The test was performed twice on 60 participants with a 2-week interval to assess its reliability. The SIT was further administered to 150 cases with documented abnormal olfactory function to evaluate its validity. Results: The correct identification response rate was estimated at 70% for all odorants in all and each subgroup. The mean odor identification score was 21.41±1.37 (score range: 17- 24) with no significant difference among various subgroups. Moreover, the test-retest correlation coefficient was obtained at 0.77. The mean odor identification score in patients with olfactory impairment was 10.69±3.76, which was significantly different from that in healthy participants (P<0.001). The best cut-point for the beginning of olfactory impairment was 17.5 (95% CI: 9-100, Sensitivity=99, Specificity=81). Females obtained higher scores of odor identification, compared to males (P=0.025). Conclusion: The results indicated the reliability and validity of the SIT, which can be used nationally for the assessment of olfactory function in various ethnic subgroups across the country. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and overall and cause-specific mortality in the Golestan Cohort Study (GCS).Methods: A total of 50 045 participants aged 40 years or older were recruited from Golestan Province, Iran, from 2004 to 2008 and followed for a mean of 10.64 years. The DASH diet score was calculated for each individual based on food groups. The primary outcome measure was death from any cause.Results: During 517 326 person-years of follow-up, 6763 deaths were reported. After adjustment for potential confounders, DASH diet score was inversely associated with risk of death from all causes and cancers [hazard ratio (HR): 0.86; 95% confidence interval (CI): 0.75, 0.98; and HR: 0.65; 95% CI: 0.47, 0.90, respectively]. A higher DASH diet score was associated with lower risk of gastrointestinal cancer mortality in men (HR: 0.55; 95% CI: 0.30, 0.99). A greater adherence to DASH diet was also associated with lower other-cancer mortality in women (HR: 0.50; 95% CI: 0.24, 0.99). No association between DASH diet score and cardiovascular disease mortality was observed, except that those dying of cardiovascular disease were younger than 50 years of age and smokers.Conclusions: Our findings suggest that maintaining a diet similar to the DASH diet is independently associated with reducing the risk of total death, cancers, and especially gastrointestinal cancers in men. [ABSTRACT FROM AUTHOR]

More than 8.5 million people live in Tehran, the capital of Iran, with 111 pollutant days during 2016. Based on Iranian 2016 energy balance sheet, more than 76% of SPM was emitted by gas oil combustion. To determine the main pollutant fuel-consuming sector, the amount of gas oil consumption and SPM production are investigated. Therefore, the transportation and power plant sectors are determined as the main gas oil users with 51.1% and 30.5% of its total consumption. Next, the reduced external cost of implementing biodiesel instead of gas oil for mobile and fixed sources is deliberated. Finally, by comparing the external cost of gas oil consumption and Iran's gross domestic production in 2016, it is revealed that by replacing gas oil with biofuels, 3.935 billion dollars (0.95% of gross domestic production of Iran in 2016) can be reduced. [ABSTRACT FROM AUTHOR]

Background: The co-occurrence of attention-deficit/hyperactivity disorder (ADHD) with atopic dermatitis (AD) has been well described in some recent association studies; however, we did not have any perspective on this relationship in our country. Aim and Objective: Hence, the present study aimed to assess the prevalence of ADHD in children with AD. Materials and Methods: This cross-sectional study was performed on 95 consecutive children and adolescents (aged 4–18 years) who were referred to dermatology clinics at the two hospitals in Tehran during 2017 with atopic dermatitis. The evidence of atopy was assessed using the 2003 National Survey of Children's Health. The diagnosis of ADHD was based on the Conner Rating Scale. The sleep disorder was also assessed by the Pittsburg sleep quality questionnaire. Results: The prevalence of hyperactivity and attention deficit in our AD patients was 20.0% and 29.47%, respectively. Furthermore, patients with sleep problem were significantly more likely to have hyperactivity disorder (odds ratio [OR]: 2.91, 95% confidence interval [CI]: 1.04–8.16, P = 0.04). According to the results of multiple logistic regression analyses, flexor involvement was the only predictor of hyperactivity disorder in the final model. The univariate and multivariate analyses showed that having attention deficit was associated with having cheek involvement (OR = 3.63, 95% CI: 1.44–9.14, P = 0.01) and sleep problem (OR = 3.68, 95% CI: 1.45–9.33, P = 0.01). Conclusion: It seems that neurocognitive disturbances due to sleep restriction in AD children may be one of the main trigger, especially for attention deficit. [ABSTRACT FROM AUTHOR]