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Background: Early stage gastric cancer diagnosis has ensued different approaches in resection strategies. In order to increase the proportion of cases which have undergone radical resection or have reduced the recurrence rate, different preoperative treatments have introduced. Here, we have verified an active preoperative chemotherapeutic regimen in locally advanced gastric cancer patients. Methods: Forty nine patients who have found eligible to enter this phase 2 trial have treated with oxaliplatin 100 mg/m2 IV, docetaxel 50 mg/m2 IV, plus capecitabine 625 mg/m2 PO (TOX). Clinical staging has been following the first 2 cycles of induction chemotherapy. Patients that have further undergone radical surgery, have evaluated for pathological response rate. Results: Anemia (10.2%), nausea (10.2%) and vomiting (6.1%) were the most frequent grade 3 or 4 adverse effects. Regarding the pathologic staging, 6 patients (12.2%) had complete response (95% CI 3% to 21.4%), 18 of them (36.7%) had partial response (95% CI 23.2% to 50.2%), then 3 patients (6.1%) had stable disease (95% CI 0%-12.8%). Among the patients who had surgery, 22% had pathologic complete response. Conclusion: Preoperative chemotherapeutic regimen of TOX seems to be an active and safe neoadjuvant therapy in non metastatic gastric cancer. It should further be considered with concurrent radiotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal hyperbilirubinemia is one of the most important factors affecting the auditory system and can cause sensorineural hearing loss. This study investigated the relationship between behavioral hearing thresholds in children with a history of jaundice and the maximum level of bilirubin concentration in the blood. Materials and Methods: This study was performed on 18 children with a mean age of 5.6 years and with a history of neonatal hyperbilirubinemia. Behavioral hearing thresholds, transient evoked emissions and brainstem evoked responses were evaluated in all children. Results: Six children (33.3%) had normal hearing thresholds and the remaining (66.7%) had some degree of hearing loss. There was no significant relationship (r=-0.28, P=0.09) between the mean total bilirubin levels and behavioral hearing thresholds in all samples. A transient evoked emission was seen only in children with normal hearing thresholds however in eight cases brainstem evoked responses had not detected. Conclusion: Increased blood levels of bilirubin at the neonatal period were potentially one of the causes of hearing loss. There was a lack of a direct relationship between neonatal bilirubin levels and the average hearing thresholds which emphasizes on the necessity of monitoring the various amounts of bilirubin levels. [ABSTRACT FROM AUTHOR]

Background and Aim: Preterm birth is one of the risk factors need comprehensive audiological assessment. In this study, the effect of sex and rate of stimulation on response of children with history of preterm birth was investigated by auditory brainstem response (ABR). Methods: This cross-sectional study was conducted using convenience sampling. Click-evoked auditory brainstem response test with both low (21.1 c/s) and high (51.1 c/s) stimulus rates was recorded in 30 children with a history of preterm birth and 30 ones with history of term labor, as controls. Results: Significant differences were observed in inter-peak latencies of I-III in both rates, III-V in the low rate, I-V in the high rate, and absolute latency of III wave between high and low stimulus rates (p<0.05 for all). Rate of stimulus affect on auditory brainstem response of preterm birth group was more than controls. Sex also affected on some parameters of auditory brainstem response test. Conclusion: Preterm birth group showed longer latencies than normal group in both rates. Rate of stimulus had significant effect on results of children with history of preterm birth compared normal group. These findings may reflect the negative effect of preterm birth on neural synchronization function in response to transient stimuli. [ABSTRACT FROM AUTHOR]

Introduction: The family of each hearing-impaired child has its own cultural, social, educational, and financial background, and its own special needs. The objectives of our study were to explore the information and support needs of parents of children with severe-to-profound hearing impairment and to investigate the effects of the parents' level of education and economic status on the score attained in the parents'-needs questionnaire. Materials and Methods: Fifty-one parents of children with severe-to-profound hearing loss (53% girls, 47% boys; mean age 47.96 months) who used the Auditory-Verbal Therapy approach were asked to complete the parents'-needs questionnaire. The questionnaire included demographic information and hearing-loss history and covered six domains which evaluated the information or support needs of parents. Parental needs with regard to different domains were evaluated separately in all participants. Results: Statistical analysis indicated that there was a significant decrease in the score attained in the parents'-needs questionnaire with increasing level of education of the child's parents (P<0.0001). Furthermore, the questionnaire score decreased as the parents' economic status increased (P<0.0001). Conclusion: The results of our study indicate that most parents of hearing-impaired children need adequate and appropriate information in all domains, and these findings support the positive effect of creating an appropriate educational environment by considering individualized needs. Furthermore, parents' levels of education and economic status have a significant effect on their parents' needs. [ABSTRACT FROM AUTHOR]

Background: One third of patients with Parkinson's disease (PD) have mentioned "dysphonia" as their most debilitating communication deficit. Patient-based measurements, such as Voice Handicap Index (VHI) add necessary supplementary information to clinical and physiological assessment. There are a few studies about relation between VHI and disease severity in PD, although none of them showed any significant correlation. The goal of this study was to find correlation between these variables in Iranian PD patients. Method: This cross-sectional, analytical and non-interventional study was done on 23 PD patients who reported a voice disorder related to their disease. They were selected from attendants of movement disorders clinic of Hazrat Rasool Akram Hospital. The relationship between disease severity (according to Hoehn and Yahr/H&Y and Unified Parkinson's Disease Rating Scale-part3 /UPDRS-III) and VHI questionnaire (and its 3 domains) was investigated based on patients' sex, UPDRS-III score H&Y and VHI. Results: Total VHI and its 3 domains had no relationship with disease severity (H&Y) in all patients and by sex separation. However, there was a positive correlation between VHI and disease severity (UPDRS-III) (r=0.485). There was also a relation between physical and functional domains of VHI and UPDRS (rp=0.530, rF=0.479) while no relationship observed regarding sex differences. 9 out of 18 UPDRS-III items had strong relationship with VHI (total and 3subscales). Conclusion: Iranian PD patients feel handicap according to voice disorder caused by PD. Patient satisfaction of voice decreases with the disease severity and progression. A larger sample size is necessary to find relationship in genders. VHI is an important issue could be offered to be used in PD beside other assessments [ABSTRACT FROM AUTHOR]

Background: Consequences of cerebral palsy in adulthood can affect physical, psychological capabilities and quality of life. The purpose of this study was to investigate the relationship between quality of life with spasticity and level of motor function in Iranian young adults with spastic cerebral palsy who were community dweller. Methods: In an analytical cross sectional study, 77 participants with spastic cerebral palsy (44 women? 33 men) with age range of 20 to 40 years; (mean age 26.19±5 yr) took part in this study. They were enrolled from three Raad Rehabilitation Goodwill complexes in Tehran and Karaj cities. All subjects were recruited through convenient sampling. Severity of Spasticity for knee flexors was measured with Modified Tardieu Scale. In addition, the level of motor function, and quality of life were assessed respectively through Gross Motor Function Classification System and World Health Organization Quality of life questionnaire (WHOQOL- BREF). To analyze data, Pearson and spearman correlation coefficient was used. Results: No correlation found between quality of life with knee flexor muscles spasticity and level of motor function (p> 0.05). Conclusion: Quality of life as a multi dimensional concept has been impacted by many factors such as physical status, environmental issues and culture. Possibly, severity of spasticity and level of function have a less pronounced effect on quality of life in community dwelling adults with cerebral palsy. [ABSTRACT FROM AUTHOR]

Background and Aim: Verb is one of the most important aspects of a sentence, and verb deficit is a noticeable part of developmental language disorders. In Iran, there is no standard test for evaluating this aspect of language in children. This study aimed to develop and evaluate a picture verb test for 36- 54 month-old normal Persian-speaking children, and assess its ability to differentiate between children. Methods: A list of verbs that could be depicted was collected and content validity was assessed by seven speech therapist. 55 verbs were selected. Then, three pictures were prepared for each verb and one of those pictures was chosen by the same seven specialists. 106 children aged 36-54 months participated in this study. They were divided into three groups (36-42, 42-48, and 48-54 months). Reliability of this test was assessed by Spearman's correlation and internal consistency. Correlation between children's scores and their age was calculated. Results: Content validity index of all verbs were 1. Spearman's correlation of 0.89 and internal consistency of 0.60 was obtained. By deletion of item method, the Kuder-Richardson score was enhanced to 0.71. There was a significant correlation between children's ability to respond and their age (r=0.76, p < 0.001). Conclusion: This test is a suitable tool for assessment of verbs in 36-54 month-old Persian-speaking children and can differentiate between three groups under study. [ABSTRACT FROM AUTHOR]

Background and Aim: Quality of printed papers in 4 four medical journals affiliated to one of the universities of medical sciences in Iran was assessed based on methodological and statistical methods. Materials and Methods: In this cross sectional study conducted in 2010, out of all articles published between the years 2002 to 2008 in one of the universities of medical sciences for affiliated journals that were equal to 1568, a sample of 162 articles were selected with Multi-stage stratified sampling method . For data collection, standard questionnaire was used to develop an information form. One sample t-test and Kruskal-Wallis test were used to compare scores from different parts of article. Results: Cross sectional studies with 61.7% (100 papers) formed most of studies. Median of authors and number of references for each article were 3 and 19, respectively and 10% of articles had more than 35 references. Material and methods with 3.53 points from 4 points (88.2%) earned the highest score which was of high quality and conclusion achieved the lowest score. Also p-value has been reported correctly in 102 articles (81.6%). In 95 articles (58.6%) results were not compare with the similar internal articles whereas only in 21 articles (13%) comparison was not made with similar external researches. Conclusion: The present study showed that the overall quality of the medical articles is not desirable. Hence, employing experts in research methods and statistics in various medical studies can improve the quality of articles in this branch of science. [ABSTRACT FROM AUTHOR]

Background: The Motricity Index was used to measure strength in upper and lower extremities after stroke. The weighted score based on the ordinal 6 point scale of Medical Research Council was used to measure maximal isometric muscle strength. There is dearth of articles dealing with the reliability of this method. Therefore, the aim of this study was to determine the test retest reliability of Motricity Index strength assessments for paret-ic lower limb in 20 chronic stroke patients with one week interval. Methods: In a cross sectional study, intrarater reliability of lower extremity Motricity Index strength assessments with one week interval were measured. Result: The SPSS 18 was used for analysis of data. Two-way random-consistency model of ICC was used for assessment of test-retest reliability. The ICC values showed high reliability of strength measurement of Motricity Index (ICC=0.93). Conclusion: The Motricity Index can be a reliable instrument for measuring the strength of involved lower extremity when assessment is done by one rater following chronic stroke. [ABSTRACT FROM AUTHOR]

In many communications systems, data can be divided into different importance levels. For these systems, unequal error protection (UEP) techniques are used to guarantee lower BER for the more important classes. In particular, if the precise characteristics of the channel are not known, UEP can be used to recover the more important classes even in poor receiving conditions. In this paper, we derive bounds on the performance of unequal error protecting turbo codes. These bounds serve as an important tool in predicting the performance of these codes. In order to derive the bounds, we introduce the notion of UEP-uniform interleaver which is a random interleaver that does not change the order of classes in the turbo code frame. We also present a method to derive the weight enumerating function for UEP turbo codes. [ABSTRACT FROM AUTHOR]

Describes an interleaver design for Turbo codes with short block length based on the distance spectrum of the code and the correlation between information input data and the soft output of each decoder corresponding to its parity bits. Deterministic interleaver suitable for Turbo codes; Simulation results; Conclusion.

Background: Sistan and Balouchestan province is one of areas in Iran that have the highest malaria incidence. We have tried to investigate the epidemiology of malaria in this province. Materials and Methods: In this study, we evaluated epidemiological data of all malaria cases from April 2008 to March 2011 in this province. Results: In our study Plasmodium vivax was the most type of malaria. Malaria incidence was more in men and rural than female and urban. 22.7% of all cases were foreigners. Malaria incidence has had two picks. Conclusion: Malaria control interventions should be focused on high risk group and based on incidence peak. [ABSTRACT FROM AUTHOR]

Background: Folate deficiency is shown to be associated with schizophrenia. Folate profile in patients with psychosis due to stimulant use has not been investigated. We aim to determine whether there is an association between serum folate level and the presence of psychosis in patients with methamphetamine (METH) use disorder.Methods: Forty patients diagnosed with METH-use disorder were included in this cross-sectional study. Serum folate levels were measured using enzyme immunoassay technique and compared between psychotic and non-psychotic subgroups (N = 25 and 15, respectively). We designed a logistic regression model to measure the extent of any association and also to adjust for potential confounders.Results: We detected lower serum folate level in the psychotics [3.4 (IQR = 5.3)] compared to non-psychotic METH users [8.9 (IQR = 2.5)], p = 0.01. The model demonstrated that every 1-unit increase in serum folate decreases the odds of presence of psychosis by 27% (R2 = 53.5%, CI 12-64%, p = 0.006). The observed difference was not associated with the duration of METH use, patient's age at first METH use, or concurrent use of other substances.Conclusions: Our findings suggest that low folate level in psychotic METH users does not correlate with previously established risk factors for meth-induced psychosis such as duration of use, age of onset of using, and poly-drug use. We assume that low folate levels may play a crucial role in the pathophysiology of psychosis. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CADs) are the first leading cause of death across the world. World Health Organization has estimated that morality rate caused by heart diseases will mount to 23 million cases by 2030. Hence, the use of data mining algorithms could be useful in predicting coronary artery diseases. Therefore, the present study aimed to compare the positive predictive value (PPV) of CAD using artificial neural network (ANN) and SVM algorithms and their distinction in terms of predicting CAD in the selected hospitals.Methods: The present study was conducted by using data mining techniques. The research sample was the medical records of the patients with coronary artery disease who were hospitalized in three hospitals affiliated to AJA University of Medical Sciences between March 2016 and March 2017 (n = 1324). The dataset and the predicting variables used in this study was the same for both data mining techniques. Totally, 25 variables affecting CAD were selected and related data were extracted. After normalizing and cleaning the data, they were entered into SPSS (V23.0) and Excel 2013. Then, R 3.3.2 was used for statistical computing.Results: The SVM model had lower MAPE (112.03), higher Hosmer-Lemeshow test's result (16.71), and higher sensitivity (92.23). Moreover, variables affecting CAD (74.42) yielded better goodness of fit in SVM model and provided more accurate result than the ANN model. On the other hand, since the area under the receiver operating characteristic (ROC) curve in the SVM algorithm was more than this area in ANN model, it could be concluded that SVM model had higher accuracy than the ANN model.Conclusion: According to the results, the SVM algorithm presented higher accuracy and better performance than the ANN model and was characterized with higher power and sensitivity. Overall, it provided a better classification for the prediction of CAD. The use of other data mining algorithms are suggested to improve the positive predictive value of the disease prediction. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-incidence ratio (MIR) across the world over 28 years.Methods: The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990-2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.Results: The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990-2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.Conclusions: Generally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality. [ABSTRACT FROM AUTHOR]

In this paper, we propose regularized block diagonalization (RBD) precoding using artificial noise (AN) for physical layer security in downlink multi-user MIMO wireless networks. We derive secrecy sum rate and asymptotic secrecy sum rate for the proposed scheme. The optimum power allocation for legitimate users and the AN signal are derived in closed form for optimal asymptotic secrecy sum rate. Our analysis shows that to achieve best performance, it is more efficient to degrade the performance of the eavesdropper than improving legitimate users’ rates. We also study the impact of error in channel estimation on the system and derive closed-form SINR and secrecy sum-rate expressions for this case. Simulations show that the secrecy sum rate of RBD precoding outperforms the secrecy sum rate of regularized channel inversion by 0.5 bits/s/Hz. We also show that in the presence of channel estimation error, our approximate closed forms for secrecy sum rate are very closed to the actual secrecy sum rate over a wide range of SNR and channel estimation error values. [ABSTRACT FROM AUTHOR]

Background and aims: Although many models exist for designing knowledge translation interventions aimed at supporting evidence - based policy-making, no valid, reliable and domesticized measuring tool exists for assessing the changes taking place in utilization of research evidence by policy-makers and stakeholders. The goal of this study was to design and validate one such tool based on the Theory of Planned Behavior (TPB). This tool can then be applied to determine the status quo, design interventions and assess their impact. Methods: The study population consisted of all the technical units and their employees in the five deputies of the Ministry of Health and Medical Education in 2013. All those eligible to participate were included in the study, which comprised 373 persons. The reliability of the tool was determined through test-retest; its internal consistency and composite construct reliability and validity were determined by face, content, divergent, convergent, discriminant and construct validities. SPSS-20 and LISREL-8.8 were employed to analyze the data. To assess the fitness of the measurement models three groups of indices were used, absolute, relative and parsimonious. Results: The content & face validities of the tool were 83% and 67% respectively. The reliability was tested through internal consistency, where Cronbach's alpha of different constructs ranged from 0.7 to 0.9. In the test-retest method, the intra-class correlation was between 0.75 and 0.87. The composite reliability of all the constructs was higher than the acceptable value. Confirmatory Factor Analysis showed that the penta-factorial structure of the experimental data had acceptable fitness with the TPB (GFI=0.86, NFI=0.94, RSMEA=0.075). Conclusion: Based on our results, the TPB - based tool has relatively good reliability and validity to assess evidence utilization in health policy-making. [ABSTRACT FROM AUTHOR]

Background and aims: Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. Methods: In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policymaking. Results: 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Conclusion: Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior. [ABSTRACT FROM AUTHOR]

Objective: National surveys revealed a high prevalence of psychiatric disorders in Iran. Province-level estimates are needed to manage the resources and focus on preventive efforts more efficiently. The objective of this study was to provide province-level estimates of psychiatric disorders. Method: In this study, Iranian Mental Health Survey (IranMHS) data (n = 7886) was used to produce province-level prevalence estimates of any psychiatric disorders among 15-64 year old males and females. Psychiatric disorders were diagnosed based on structured diagnostic interview of the Persian version of Composite International Diagnostic Interview (CIDI, version, 2.1). The Hierarchical Bayesian (HB) random effect model was used to calculate the estimates. The mental health status of half of the participants was also measured using a 28-item general health questionnaire (GHQ). Results: A wide variation in the prevalence of psychiatric disorders was found among 31 provinces of Iran. The direct estimates ranged from 3.6% to 62.6%, while the HB estimates ranged from 12.6% to 36.5%. The provincial prevalence among men ranged from 11.9% to 34.5%, while it ranged from 18.4% to 38.8% among women. The Pearson correlation coefficient between HB estimates and GHQ scores was 0.73. Conclusion: The Bayesian small area estimation provides estimation with improved precision at local levels. Detecting high-priority communities with small-area approach could lead to a better distribution of limited facilities and more effective mental health interventions. [ABSTRACT FROM AUTHOR]

We derive the asymptotic ergodic secrecy sum rate (ESSR) of block diagonalization precoding for physical-layer security in downlink multi-user wireless networks that use artificial noise. First, we derive the ESSR of the system. Then, we derive the power allocation and the asymptotic ESSR as the number of antennas increases. After, we derive an approximate expression for the optimum ratio of the number of transmit antennas to the number of receive antennas ($\Psi $). We then introduce the user dropping factor (UDF) as a means to derive the optimum number of users in the system under different scenarios and then derive the asymptotic optimum UDF, which gives the optimum number of scheduled users. We also study the effect of imperfect channel state information and derive a closed-form ESSR. Simulation results show that these precoders outperform channel inversion (CI) and regularized CI schemes in terms of the ESSR at all SNRs. We also show that as the number of receive antennas of each user increases, the asymptotic ESSR gap also increases. [ABSTRACT FROM AUTHOR]

Background A non-inferiority multi-centre parallel randomized double-blind trial was implemented in Zahedan district, Sistan-va-Baluchestan province, Iran, to compare the performance of the two measles vaccines which are in use in the National Immunization Programme of Iran and are of two different measles virus vaccine strains: Edmonston-Zagreb (EZ) strain vs. AIK-C strain. The main outcome measure was appearance of anti-measles antibody in sera. Methods 200 infants, 8–12 months old, whose parents consented for their children to be included in the study, were randomized in permutation blocks of size 4–8 in four Urban Health Clinics. Having given a pre-vaccination blood sample, they received measles-rubella vaccine containing one of the vaccine strains mentioned before. After 60 days, the second blood sample was taken. The sera of the pre- and post-vaccination blood samples were tested for anti-measles antibodies in the National Reference Measles Laboratory. Parents, laboratory technicians and statistician were blind to groupings. Results Of the 200 children equally randomized in the two arms, 185 who were seronegative before vaccination (88 in the EZ arm and 97 in the AIK-C arm) were entered in the final analysis. The seroconversion rate in the EZ arm was 76.1% (95% CI: 60.2–85.2%), and that in the AIK-C arm was 58.7%; (95% CI: 48.8–68.7%). The absolute rate difference was 17. 4% (4.1–30.9%; P-value: .012), and the relative seroconversion rate of EZ to AIK-C was 1.3 (95% CI: 1.1–1.6; P-value: .012). No adverse events were reported during the study period. Conclusion A considerable difference in the seropositivity of different measles containing vaccines could be demonstrated in the first year of life. Trial Registration: Iranian Registry of Clinical Trials Registration Number: IRCT2016032827144N1 ; May 10, 2016 ( www.who.int/ictrp/network/irct/en/ ) [ABSTRACT FROM AUTHOR]

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

Background: In recent decades there has been increasing focus on developing and localizing quality of life (QOL) instruments in different societies. In this study, we aim to translate WHO's Quality of Life WHOQOL-100 questionnaire into the Persian language and assess the validity and reliability of the translated version. Methods: We used a forward-backward procedure to translate the questionnaire. A pilot sample of 60 university students was recruited to assess the repeatability and construct validity of the instrument. To assess the construct validity, 60 university students filled out both the WHOQOL-100 and WHOQOL-BREF questionnaires. Then, 500 healthy and 500 disabled individuals were randomly selected using a multistage sampling technique. The internal consistency of the Persian version of the WHOQOL-100 was evaluated using Cronbach's alpha in the sample. In addition, a multiple linear regression model was utilized for assessing the discriminant validity of this instrument, adjusting for different confounders. Results: Test-retest analysis of data from the pilot sample showed that the Persian version of the WHOQOL-100 has acceptable repeatability (ICCs for all six domains were higher than 0.7). In addition, computation of the correlation between the domains of WHOQOL-100 and WHOQOL-BREF showed satisfactory construct validity. Analyzing the data from 500 healthy and 500 disabled persons revealed that all domains of WHOQOL-100 met the minimum level of acceptable internal consistency. Multiple regression results showed acceptable discriminant validity for all domains of the Persian version, except for the spiritual domain. Conclusion: In general, the Persian version of the WHOQOL-100 had satisfactory reliability and validity for assessing QOL of Iranian people. However, we recommend further research for challenging the problem of the spiritual domain. [ABSTRACT FROM AUTHOR]

Background: Gestational Diabetes Mellitus (GDM) is an underlying cause of maternal and newborn morbidity and mortality all around the world. Timely diagnosis of GDM plays an important role in reducing its adverse consequences and burden. This study aimed to determine diagnostic accuracy of multiple indicators in complete blood count (CBC) test for early prediction of GDM.Methods: In this prospective cohort study, the data from 600 pregnant women was analyzed. In the study sample, the two-step approach was utilized for the diagnosis of GDM at 24-28 weeks of gestation. We also used the repeated measures of hemoglobin (Hb), hematocrit (Hct), fasting blood sugar (FBS) and red blood cell count (RBC) in the first and early second trimesters of pregnancy as the longitudinal multiple indicators for early diagnosis of GDM. The classification of pregnant women to GDM and non-GDM groups was performed using a statistical technique based on the random-effects modeling framework.Results: Among the sample, 49 women (8.2%) were diagnosed with GDM. In the first and early second trimester of pregnancy, the mean HcT, Hb and FBS of women with GDM was significantly higher than non-GDMs (P < 0.001). The concurrent use of multiple longitudinal data from HcT, Hb, RBC and FBS in the first and early second trimester of pregnancy resulted in a sensitivity, specificity and area under the curve (AUC) of 87%, 70% and 83%, respectively, for early prediction of GDM.Conclusions: In general, our findings showed that the concurrent use of repeated measures data on Hct, Hb, FBS and RBC in the first and early second trimester of pregnancy might be utilized as an acceptable tool to predict GDM earlier in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Type 1 diabetes is a main health burden with several related comorbidities. It has been shown that endothelial function, vascular structure, and metabolic parameters are considerably disrupted in patients with type 1 diabetes. Omega-3 as an adjuvant therapy may exert profitable effects on type 1 diabetes and its complications by improving inflammation, oxidative stress, immune responses, and metabolic status. Because no randomized clinical trial has examined the effects of omega-3 consumption in children and adolescents with type 1 diabetes; the present study aims to close this gap.Methods: This investigation is a randomized clinical trial, in which sixty adolescents with type 1 diabetes will be randomly assigned to receive either omega-3 (600 mg/day) or placebo capsules for 12 weeks. Evaluation of anthropometric parameters, flow-mediated dilation (FMD) as an endothelial function marker, carotid intima-media thickness (CIMT) as a vascular structure marker, proteinuria, biochemical factors including glycemic and lipid profile, blood urea nitrogen (BUN), creatinine, high-sensitivity C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR), as well as blood pressure will be done at the baseline and end of the trial. Also, dietary intake and physical activity will be assessed throughout the study. Statistical analysis will be performed using the SPSS software (Version 24), and P < 0.05 will be considered statistically meaningful.Discussion: It is hypothesized that omega-3 supplementation may be beneficial for the management of type 1 diabetes and its complications by reducing inflammation and oxidative stress and also modulating immune responses and glucose and lipid metabolism through various mechanisms. The present study aims to investigate any effect of omega-3 on patients with type 1 diabetes.Ethical Aspects: This trial received approval from Medical Ethics Committee of Iran University of Medical Sciences, Tehran, Iran (IR.IUMS.REC.1400.070).Trial Registration: Iranian Registry of Clinical Trials IRCT20210419051010N1 . Registered on 29 April 2021. [ABSTRACT FROM AUTHOR]

Purpose: Although the business model field of study has been a focus of attention for both researchers and practitioners within the past two decades, it still suffers from concern about its identity. Accordingly, this paper aims to clarify the intellectual structure of business model through identifying the research clusters and their sub-clusters, the prominent relations and the dominant research trends. Design/methodology/approach: This paper uses some common text mining methods including co-word analysis, burst analysis, timeline analysis and topic modeling to analyze and mine the title, abstract and keywords of 14,081 research documents related to the domain of business model. Findings: The results revealed that the business model field of study consists of three main research areas including electronic business model, business model innovation and sustainable business model, each of which has some sub-areas and has been more evident in some particular industries. Additionally, from the time perspective, research issues in the domain of sustainable development are considered as the hot and emerging topics in this field. In addition, the results confirmed that information technology has been one of the most important drivers, influencing the appearance of different study topics in the various periods. Originality/value: The contribution of this study is to quantitatively uncover the dominant knowledge structure and prominent research trends in the business model field of study, considering a broad range of scholarly publications and using some promising and reliable text mining techniques. [ABSTRACT FROM AUTHOR]

Background: Chitosan is one of dietary fiber that has received great attention in improving obesity-related markers, but little is known on its effects on adolescents. Objectives: To analyze the effects of chitosan supplementation on obesity-related cardiometabolic markers and appetite-related hormones in adolescents with overweight or obesity. Methods: A randomized clinical trial was performed on 61 adolescents with overweight and obesity, who were randomly allocated to receive chitosan supplementation (n = 31) or placebo as control (n = 30) for 12 weeks. Anthropometric measures, lipid and glycemic profiles, and appetite-related hormones were examined. Results: Chitosan supplementation significantly improved anthropometric indicators of obesity (body weight: -3.58±2.17 kg, waist circumference: -5.00±3.11 cm, and body mass index: -1.61±0.99 kg/m² and -0.28±0.19 Zscore), lipid (triglycerides: -5.67±9.24, total cholesterol: -14.12±13.34, LDL-C: -7.18±10.16, and HDL-C: 1.83±4.64 mg/dL) and glycemic markers (insulin: -5.51± 7.52 μIU/mL, fasting blood glucose: -5.77±6.93 mg/dL, and homeostasis model assessment of insulin resistance: -0.24±0.44), and appetite-related hormones (adiponectin: 1.69±2.13 ng/dL, leptin -19.40±16.89, and neuropeptide Y: -41.96±79.34 ng/dL). When compared with the placebo group, chitosan supplementation had greater improvement in body weight, body mass index (kg/m² and Z-score), waist circumference, as well as insulin, adiponectin, and leptin levels. Differences were significant according to P-value <0.05. Conclusion: Chitosan supplementation can improve cardiometabolic parameters (anthropometric indicators of obesity and lipid and glycemic markers) and appetite-related hormones (adiponectin, leptin, and NPY) in adolescents with overweight or obesity. [ABSTRACT FROM AUTHOR]

Background and purpose: Vaso-cardiac diseases are among the most Prevalent causes of death in the world. According to the studies it is expected that they become the main cause of death until 2020. Materials and methods: The aim of this research is preparing the geographical maps of the relative death rate out of Vaso-cardiac diseases in cities of the Mazandaran province in 2008 Method: In this research, we have analyzed data related to the registered death rate of Mazandaran province's cities in 2008 caused by Vaso-cardiac diseases, using statistical winbas software. Results: The highest estimated risk among females related to Juibar town and lowest to Noshahr the highest and lowest risk among males related to Tonekabon and Mahmud Abad respectively. Conclusion: The relative death rate prevalence caused by vasco-cardiac diseases is not symmetric in the whole Mazandaran province, in general. This rate is higher in western areas; but is nearly the same among males and females. [ABSTRACT FROM AUTHOR]

Abstract: Work-related accidents are considered as a major health problem worldwide. The aim of present study was to determine the epidemiological pattern of occupational accidents among workers insured by the Iranian Social Security Organization (ISSO) between 2001 and 2005. Subjects consisted of all workers and drivers who had a work-related accident during 2001–2005 and were registered in the Iranian Social Security Organization (ISSO) database according to the inspection reports. An ordinal logistic regression model (proportional odds regression model) was used to assess the concurrent effects of independent variables on accident outcomes. Overall, 86,437 work-related accidents were investigated. The accidents were more frequent in metal workplaces and electrical industries, respectively. More than half of the accidents were due to incautious activities. Workers’ age (age at the time of accident) (OR=0.99, CI: 0.989–0.994), gender (OR=1.3, CI: 1.191–1.683), marital status (OR=1.25, CI: 1.143–1.675) as well as accident setting (OR=1.88, CI: 1.728–1.975) had significant effect on accident outcomes. Pattern of occupational injuries in Iran was consistent with the global pattern for accident outcomes. [Copyright &y& Elsevier]

Background: Appropriate supervision, along with availability of an effective system for monitoring and evaluation, is a crucial requirement to guarantee sufficient coverage and quality of malaria vector control procedures. This study evaluated the efficacy of self-assessment practice as a possible innovative method towards achieving high coverage and excellent quality of larviciding operation in Iran. Methods: The research was conducted on the randomly selected rural health centre of Kanmbel Soliman with 10 staff and 30 villages, in three main steps: (i) assessment of effectiveness of larviciding operations in the study areas before intervention through external assessment by a research team; (ii) self-assessment of larviciding operations (intervention) by staff every quarter for three rounds; and, (iii) determining the effectiveness of applying self-assessment of larviciding operations in the study areas. Two toolkits were used for self-assessment and external evaluation. The impact of self-assessment of larviciding operations was measured by two indicators: percentage of missed breeding habitats and cleaned breeding habitats among randomly selected breeding sites. Moreover, the correlation coefficients were measured between self-assessment measures and scores from external evaluation. The correlation coefficient and Mann Whitney test were used to analyse data. Results: Following the utilization of self-assessment, the percentage of missed breeding habitats decreased significantly from 14.23% to 1.91% (P <0.001). Additionally, the percentage of cleaned breeding habitats among randomly selected breeding sites increased from 66.89% to 95.28% (P <0.001). The external evaluation also showed significant effects of self-assessment in performance of vector control; the maximum effect of intervention were seen in an action plan for monitoring and evaluation of larviciding operations at field level, geographical reconnaissance for the registration of breeding habitats and worker skills related to larviciding. Before intervention, the results of self-assessment practice were compatible with external evaluation in 76.3% of 139 reviewed reports of self-assessment. After intervention, the findings of self-assessment and external evaluation were similar in the vast majority of reviewed reports (95%). Conclusion: The self-assessment tool seems to be valid and reliable in improving effectiveness of larviciding operations. Furthermore, the result of self-assessment is more compatible with external evaluation results if it would be applied frequently. Therefore, it can be used as an alternative assessment technique in the evaluation of larviciding operations in addition to traditional assessment methods. [ABSTRACT FROM AUTHOR]

Background & objectives: Species identification and information on transmission pattern of malaria parasite in any malaria endemic area is key to success for a malaria control programme. In this investigation, malaria diagnosis using molecular method was used to assess the transmission pattern of malaria parasite in three malaria endemic regions: Afghanistan, Iran and Pakistan. Methods: Blood samples were collected from the patients presenting with vivax malaria from Afghanistan (n = 108), Iran (n = 200) and Pakistan (n = 199). Malaria parasite detection was made by the gold standard (microscopy) and also nested-PCR assay, using 18S small sub-unit ribosomal RNA (ssrRNA) gene. Results: Based on microscopy method, the level of mixed infection was zero to 2.5 per cent; however, nested-PCR assay detected 6.5, 22 and 23.5 per cent mixed infections in samples collected from Afghanistan, Iran and Pakistan, respectively. The present results showed that the co-infection of P. vivax with P. falciparum was frequent in malaria endemic regions of Iran and Pakistan. Interpretation & conclusion: The present data suggest the need for improving microscopy diagnosis method and the clinician should also have careful clinical observation, along with the reports on Giemsa-stained thick blood films, particularly in summer time when P. vivax is predominant. Also sharing information on transmission pattern of mixed infection among these countries may help in designing better control strategies for malaria. [ABSTRACT FROM AUTHOR]

Abstract: In this study, the diversity of Plasmodium vivax populations circulating in Pakistan and Iran has been investigated by using circumsporozoite protein (csp) and merozoite surface proteins 1 and 3α (msp-1 and msp-3α) genes as genetic markers. Infected P. vivax blood samples were collected from Pakistan (n =187) and Iran (n =150) during April to October 2008, and were analyzed using nested-PCR/RFLP and sequencing methods. Genotyping pvmsp-1 (variable block 5) revealed the presence of type 1, type 2 and recombinant type 3 allelic variants, with type 1 predominant, in both study areas. The sequence analysis of 33 P. vivax isolates from Pakistan and 30 from Iran identified 16 distinct alleles each, with one allele (R-8) from Iran which was not reported previously. Genotyping pvcsp gene also showed that VK210 type is predominant in both countries. Moreover, based on the size of amplified fragment of pvmsp-3α, three major types: type A (1800bp), type B (1500bp) and type C (1200bp), were distinguished among the examined isolates that type A was predominant among Pakistani (72.7%) and Iranian (77.3%) parasites. PCR/RFLP products of pvmsp-3α with HhaI and AluI have detected 40 and 39 distinct variants among Pakistani and Iranian examined isolates, respectively. Based on these three studied genes, the rate of combined multiple genotypes were 30% and 24.6% for Pakistani and Iranian P. vivax isolates, respectively. These results indicate an extensive diversity in the P. vivax populations in both studies. [Copyright &y& Elsevier]

Abstract: Objective: Hepatitis B virus (HBV) infection is a major global public health problem. Approximately 2 billion people are infected worldwide and more than 350 million of these individuals are chronic carriers of HBV. Approximately 15–40% of infected patients will develop cirrhosis, liver failure, or hepatocellular carcinoma (HCC). Alpha 1 antitrypsin (AAT) deficiency is one of many factors that may be involved in abnormalities such as liver and lung disease, inflammatory joint diseases, and inflammatory eye diseases. In the present study, the role played by AAT in HBV infected individuals is analyzed. Methods: AAT phenotyping and trypsin inhibitory capacity (TIC) experiments were performed on 281 HBV infected patients who were referred to Tehran and Zahedan Hepatitis Center for a period of 3 years from June 2001 to September 2003. The same tests were performed on 257 individuals who did not suffer from any systemic diseases (control group). The case group was subdivided into three groups: carrier (36.7%), chronic (50.5%), and cirrhotic (12.8%). Results: The results showed that AAT phenotypes, MS, MZ, M1Z, and M1S, were significantly higher in the HBV group (p <0.01). In addition, there was a significant difference in AAT phenotypes (MS, MZ, and M1Z) among inactive carriers and individuals in the chronic and cirrhotic group (p <0.001). Conclusions: There is a high prevalence of moderate AAT (MS, M1S, and MV) and severely deficient (MZ and M1Z) phenotypes in Iranian HBV individuals. In addition, AAT deficiency might be a risk factor for infected HBV individuals progressing from the carrier stage to chronic and cirrhotic stages. [Copyright &y& Elsevier]

Abstract: Pectinate beads containing trimethyl chitosan chloride (TMC) as an absorption enhancer were prepared using Coomassie Brilliant Blue G 250 (CB) as a relatively high molecular weight water-soluble model drug. Effects of different formulation variables, such as cross-linker type, cross-linking time, cross-linker concentration, TMC: pectin ratio, pectin concentration and voltage of the bead generator, were assessed on in vitro bead characteristics by release and swelling–erosion studies. The bead formulation was optimized by factorial design. Some measures were taken to improve the bead characteristics and prolong their integrity during the gastrointestinal transit, such as biomineralization of the beads or coating them with high-methoxy pectin (PHM) or Eudragit L30-D 55 (EU). Possible CB-TMC complexation was investigated by Job''s Plot method. The suitable system was obtained by coating the optimized core formulation with PHM or EU. TMC was found to form a complex with CB as a model anionic drug. Therefore, TMC-drug interactions can be used to modify the release characteristics of dosage forms. [Copyright &y& Elsevier]

Summary: Objective: The objective of this study was to determine the frequency of dhfr and dhps resistance-associated haplotypes in Plasmodium falciparum isolates, three years after the introduction of sulfadoxine–pyrimethamine (SP) as the first-line antimalarial treatment in Iran. Methods: Blood samples (N =182) were collected from patients presenting with falciparum malaria from southeastern Iran, and analyzed by nested-PCR/restriction fragment length polymorphism, followed by sequencing analysis. Results: In pfdhfr, double mutation at positions 59R and 108N was a predominant allele with a prevalence of 95.7%. The pure double mutations of pfdhfr (I 51N108) were detected, and showed an increase from 0.7% to 4.3% after the introduction of SP as first-line drug. Furthermore, a significant decrease in double mutations/wild-type of pfdhfr/pfdhps (R 59 N 108/A437) was observed from 2004 (83.5%) to 2008 (44%) after changes in treatment policy. With regards to pfdhps, the results showed a rapid increase in frequency of the single pure form of pfdhps at position 437G (54.4%) and that of triple pfdhfr/pfdhps (R 59 N 108/G 437) mutant haplotype (51.7%) after three years. Conclusions: The absence of quintuple mutations in the examined isolates supports the continued use of SP as the treatment of choice for uncomplicated malaria as a partner drug to artemisinin combination therapy in Iran. However, the increase in the triple pfdhfr/pfdhps (R 59 N 108/G 437) mutant haplotypes indicates that the P. falciparum parasite populations have the potential to evolve into dhfr/dhps quintuple mutants in the near future. Therefore, monitoring the status of dhps alleles as a predictor of the development of clinical resistance to sulfadoxine should be a high priority in this region. [ABSTRACT FROM AUTHOR]

Introduction: Tooth extraction initiates a cascade of homeostatic and structural modifications within the periodontal tissues, culminating in alveolar ridge resorption. To prevent ridge resorption following extraction and facilitate successful placement of an implant-supported prosthesis, alveolar ridge preservation was performed., Methods: In this study, the biocompatibility of a nanocomposite consisting of self-assembling peptide nanofibers (organic phase) and tri-calcium phosphate-nano hydroxyapatite (mineral phase), was evaluated in rabbits. Subsequently, the nanocomposite was grafted onto a model of alveolar bone repair in patients., Results: The in vivo findings revealed no significant differences in the irritation ranking score and average thickness of the reaction zone between the nanocomposite and control groups. Furthermore, there were no significant differences in the appearance of necrosis, granulation tissue, fibroplasia, neovascularization, and hemorrhage as well as in the number of neutrophils, mast cells, lymphocytes, macrophages, and giant cells between the two groups. The defect area was completely filled with newly formed bone trabeculae and cavities containing bone marrow, indicating angiogenesis, while remnants of the scaffold were observed in the deeper region of the defects, adjacent to the bone marrow, considered osteoinductive. The clinical trial findings (TRN: IR.IUMS.REC.1401.355) demonstrated robust bone regeneration after 3.5 months of socket preservation, whereas the bone in the control group experienced atrophy. The nanocomposite facilitated soft tissue healing without any signs of infection or other periodontal malfunction., Conclusion: The application of nanotechnology has enhanced the bio-functionality of alloplastic materials, positioning this nanocomposite a promising alternative to autografts and allografts in alveolar bone repair., Competing Interests: The authors declare no financial and nonfinancial conflict of interest., (© 2024 The Author(s).)

Background: In recent years, hypertension has been one of the most important noncommunicable diseases worldwide. In this context, identifying the predictors of this disease can help health policymakers to reduce its burden. This study aimed to identify some of the most important influential factors of hypertension and present a model to predict this disease in the data from a large sample cohort study., Methods: The data set included 10,138 people from the baseline phase of the Fasa cohort study during 2014 and 2016. The main outcome under study was having hypertension in the baseline phase of the study according to self-reports or medical examinations. To identify the related factors of hypertension, logistic regression, classification tree, and random forest models were utilized. Statistical analyses were performed in R., Results: Among the 10,138 people examined, 2819 (27.8%) had hypertension. In the initial screening, 39 variables were regarded as potential indicators of hypertension. After preliminary analysis, 11 variables were recognized as important predictors based on the importance index: history of cardiovascular disease, cardiac disease, waist circumference to height ratio, body mass index, sex, hypertension in a first-degree relative, weight, fatty liver, cardiac disease in a first-degree relative, diabetes in a first-degree relative, and energy intake. The area under the receiving operating characteristic (ROC) curve for predicting hypertension using logistic regression, classification tree, and random forest models was about 72.8%, 73%, and 87.6%, respectively. Also, the accuracy of these models was 65.2%, 67.4% and 77.8%, respectively., Conclusion: In general, our findings showed that machine learning-based approaches, such as random forest models, outperformed classical methods, such as logistic regression in predicting hypertension. Regarding the rather high prevalence of hypertension in the population under study, there is an urgent need to pay more attention to its indicators for early diagnosis of the patients and reducing the burden of this silent disease in our country., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)

Introduction: Low socioeconomic status (SES) is identified as a pivotal risk factor for mental health. Objective socioeconomic status (OSS) is measured by tangible resources, whereas subjective social status (SSS) reflects an individual's perception of their OSS. A paucity of literature exists that elucidates the specific psychosocial mechanisms or pathways linking OSS with mental illness via SSS. This research aimed to explore the mediating role of SSS in the OSS-mental health association, utilizing data from the Iranian Mental Health Survey (IranMHS)., Methods: This study is a secondary analysis of data from IranMHS, a national survey conducted in 2011 through face-to-face interviews with 7,886 Iranian adults aged 15-64. As part of the original survey, the General Health Questionnaire-28 (GHQ-28) was randomly administered to half of these participants. We focused our analysis on data from 3,759 participants who completed all items of the GHQ-28. OSS was evaluated using education, occupation, wealth, and a combined OSS index, while SSS was measured using the MacArthur Scale. We examined how SSS mediates the associations between OSS factors and GHQ scores, including its four dimensions-somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression- while adjusting for demographic variables and conducting gender-stratified analyses., Results: Among the 3759 respondents, 2157 (57.4%) were women, 2110 (56.1%) lived in urban areas, with an average age of 33.1 years (SD=12.1). SSS mediated the associations between wealth and the overall GHQ score (mediation percentage: 92.3%), education (75.4%), OSS index (66.7%), and occupation (34.0%) on the GHQ score. The most significant mediation effects were observed for wealth on the somatic symptoms, social dysfunction, and depression dimensions, with SSS accounting for more than 80% of these associations., Conclusion: The findings indicate a significant mediating role of SSS in the relationship between OSS and mental health. Enhancing our comprehension of the social determinants that moderate the relationship between objective and subjective socioeconomic status may contribute to a more nuanced understanding of the impact of SES on mental health outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nasirpour, Jafari, Habibi Asgarabad, Salehi, Amin-Esmaeili, Rahimi-Movaghar and Motevalian.)

Alzheimer's Disease and Related Dementias (ADRD) affect millions of people worldwide, with mortality rates influenced by several risk factors and exhibiting significant heterogeneity across geographical regions. This study aimed to investigate the impact of risk factors on global ADRD mortality patterns from 1990 to 2021, utilizing clustering and modeling techniques. Data on ADRD mortality rates, cardiovascular disease, and diabetes prevalence were obtained for 204 countries from the GBD platform. Additional variables such as HDI, life expectancy, alcohol consumption, and tobacco use prevalence were sourced from the UNDP and WHO. All the data were extracted for men, women, and the overall population. Longitudinal k-means clustering and generalized estimating equations were applied for data analysis. The findings revealed that cardiovascular disease had significant positive effects of 1.84, 3.94, and 4.70 on men, women, and the overall ADRD mortality rates, respectively. Tobacco showed positive effects of 0.92, 0.13, and 0.39, while alcohol consumption had negative effects of - 0.59, - 9.92, and - 2.32, on men, women, and the overall ADRD mortality rates, respectively. The countries were classified into five distinct subgroups. Overall, cardiovascular disease and tobacco use were associated with increased ADRD mortality rates, while moderate alcohol consumption exhibited a protective effect. Notably, tobacco use showed a protective effect in cluster A, as did alcohol consumption in cluster B. The effects of risk factors on ADRD mortality rates varied among the clusters, highlighting the need for further investigation into the underlying causal factors., (© 2024. The Author(s).)

Epidemiological studies on air pollution, diabetes, and hypertension conflict. This study examined air pollution, diabetes, and hypertension in adults in 11 metropolitan areas of Iran (2012-2016). Local environment departments and the Tehran Air Quality Control Company provided air quality data. The VIZIT website and Stepwise Approach to Chronic Disease Risk Factor Surveillance study delivered chronic disease data. Multiple logistic regression and generalized estimating equations evaluated air pollution-related diabetes and hypertension. In Isfahan, Ahvaz, and Tehran, PM 2.5 was linked to diabetes. In all cities except Urmia, Yasuj, and Yazd, PM 2.5 was statistically related to hypertension. O 3 was connected to hypertension in Ahvaz, Tehran, and Shiraz, whereas NO 2 was not. BMI and gender predict hypertension and diabetes. Diabetes, SBP, and total cholesterol were correlated. Iran's largest cities' poor air quality may promote diabetes and hypertension. PM 2.5 impacts many cities' outcomes. Therefore, politicians and specialists have to control air pollution.

Background: Success in COVID-19 vaccination depends on understanding why people refuse or hesitate to take the vaccine. This study aims to explore vaccine refusal and hesitancy among Iranians who participated in the national COVID-19 vaccine hesitancy survey., Methods: A qualitative content analysis approach was used. Twenty-six participants were selected by purposive sampling. In-depth, semi-structured telephone interviews were conducted during the year 2022. A directed content analysis approach was used for analyzing the data by extracting the codes, subcategories, and categories., Results: Four major categories and their respective subcategories related to refusal and/ or hesitancy against COVID-19 vaccination emerged: "lack of confidence" (distrust in policymakers and pharmaceutical companies, distrust in national media, belief in conspiracy theory, and lack of confidence in the vaccine's safety and effectiveness), "complacency" (Fatalism and philosophical beliefs, low perceived risk, and belief in the adequacy of the precautionary principles), "constrains" (personal and psychological barriers), and "coercion" (coercion by relatives and unsteady imposed mandatory vaccination by the government)., Conclusion: Distrust, fatalism, low perceived risk, and overconfidence in traditional Persian medicine were important barriers to COVID-19 vaccine acceptability needing a variety of measures for improving COVID-19 vaccine uptake, including enhancing public trust in government and policymakers, clarifying vaccine safety and effectiveness, dealing with religious fatalism, and regulating anti-science messages on social media., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)

Background Due to the emergence of new COVID-19 mutations and an increase in re-infection rates, it has become an important priority for the medical community to identify the factors affecting the short- and long-term survival of patients. This study aimed to determine the risk factors of short- and long-term survival in patients with COVID-19 based on mixture and non-mixture cure models. Methodology In this study, the data of 880 patients with COVID-19 confirmed with polymerase chain reaction in Fereydunshahr city (Isfahan, Iran) from February 20, 2020, to December 21, 2021, were gathered, and the vital status of these patients was followed for at least one year. Due to the high rate of censoring, mixture and non-mixture cure models were applied to estimate the survival. Akaike information criterion values were used to evaluate the fit of the models. Results In this study, the mean age of the patients was 48.9 ± 21.23 years, and the estimated survival rates on the first day, the fourth day, the first week, the first month, and at one year were 0.997, 0.982, 0.973, 0.936, and 0.928, respectively. Among the parametric models, the log-logistic mixed cure model with the logit link, which showed the lowest Akaike information criterion value, demonstrated the best fit. The variables of age and prescribed medication type were significant predictors of long-term survival, while occupation was influential in the short-term survival of patients. Conclusions According to the results of this study, it can be concluded that elderly patients should observe health protocols more strictly and consider receiving booster vaccine doses. The log-logistic cure model with a logit link can be used for survival analysis in COVID-19 patients, a fraction of whom have long-term survival., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committees of Iran University of Medical Sciences issued approval IR.IUMS.REC.1400.219. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kamalzade et al.)

Background and Objectives: Due to an increased rate of inflammation in generalized anxiety disorder (GAD), insight into the mediating factors in the onset and recurrence of the inflammatory response can help to achieve novel treatments for alleviating the risk of GAD. In the current study, we aimed to evaluate the possible relationship between visceral adipose tissue (VAT) as an important intermediary in inflammation pathways and GAD in participants of the Employees' Health Cohort Study of Iran (EHCSIR)., Method: We analyzed the data from 3889 included participants aged > 18 years in the EHCSIR study, which were collected from 2017 to 2020. Lifetime and 12-month GAD were assessed using the Composite International Diagnostic Interview (CIDI-2.1) questionnaire. The adjusted prevalence ratio was computed to evaluate the association between GAD and visceral adiposity index (VAI), GAD and visceral fat area (VFA), GAD and body mass index (BMI) and ultimately GAD and waist circumference (WC) in males and females using STATA software., Results: Log-binomial analysis showed a higher prevalence ratio of 12-month GAD associated with VFA in women [PR: 1.42, CI: 1.07-1.87, P: 0.015]. The prevalence of lifetime GAD was higher in obese women (BM1 > 30) [PR: 2.35, CI: 1.07-5.13, P:0.03] than in women with normal BMI. Women with higher VAI were also significantly more likely to suffer lifetime GAD [PR: 1.25, CI: 1.05]. 1.48, P:0.01]. In males, the prevalence of lifetime diagnosed GAD per 1 standard deviation increase in VFA was 0.65 [CI: 0.46-0.91, P: 0.01]., Conclusion: Visceral adiposity as a positive agent was associated with GAD prevalence in women. The presence of GAD symptoms showed no relationship to VFA in men., (© 2024. The Author(s).)

Introduction: Pediatric obsessive-compulsive disorder (OCD), attention-deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS) are often concurrent. This study explores the temperament profile of complex OCD phenotypes., Methods: A clinical registry recorded demographic data, psychiatric diagnoses, and temperament traits, including novelty seeking (exploratory behaviors), harm avoidance (fear of uncertainty), reward dependence (sentimentality), and persistence (perseverance). Temperament data were accrued from the Junior Temperament and Character Inventory (JTCI). Participants were divided into (1) OCD only; (2) OCD+ADHD or TS; and (3) OCD+ADHD+TS to compare temperament., Results: Participants include 126 youths with OCD (61.9% male, 88.9% white) between the ages 6 and 18 years (12.7 ± 3.1). Among the three groups, the complex neurodevelopmental disorder group OCD+ADHD+TS expresses the highest novelty seeking and lowest persistence. Harm avoidance is increased in all groups compared to reference controls, irrespective of concurrent ADHD or TS. For the OCD+ADHD+TS group, contamination and washing symptoms have higher novelty seeking (p &lt; 0.01), while counting and ordering have lower novelty seeking (p &lt; 0.05). Harm avoidance is increased with aggressive, somatic, and checking symptoms in OCD only (p &lt; 0.01), while persistence is increased with repeating and counting symptoms in the comorbid groups (OCD+ADHD or TS, OCD+ADHD+TS)., Discussion/conclusion: The complex subtype, OCD+ADHD+TS, is associated with high novelty seeking and low persistence, while high harm avoidance is linked to pediatric OCD irrespective of ADHD or TS co-occurrence. In sum, pediatric OCD with ADHD and TS confers a unique temperament profile, further refining complex phenotypes of pediatric OCD for future research., (© 2024 S. Karger AG, Basel.)