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Abstract Background Hepatitis B virus (HBV) infection is a silent epidemic among people who inject drugs (PWID). HBV testing and vaccination are important for PWID to reduce the risk of infection, prevent chronic complications and contribute to public health efforts in addressing HBV transmission. Our objective was to assess the self-reported lifetime uptake of HBV testing and vaccination among PWID in Iran and their associated factors. Method This cross-sectional study was conducted among 2,684 PWID in 11 large cities from July 2019 to March 2020 using a respondent-driven sampling method. Participants were interviewed face-to-face and asked about their lifetime experience of HBV testing and vaccination uptake as the outcome. Logistic regression models were built to identify related factors for reporting HBV testing and vaccination uptake. Results The prevalence of HBV testing and vaccination uptake among PWID was 14.2% (95% confidence intervals [CI]: 12.8–15.6) and 16.4% (95% CI: 14.9–18.1), respectively. Shared needles, syringes, or equipment in the past 12 months decreased the odds of reporting lifetime HBV testing uptake (Adjusted odds ratio [AOR]:0.46, 95% CI: 0.29–0.72). However, having an academic education (AOR: 1.89, 95% CI: 1.09–3.30) and lifetime experience of homelessness (AOR: 1.58, 95% CI: 1.21–2.06) increased the odds of reporting lifetime HBV vaccination uptake. Conclusion Our study highlighted the low prevalence of HBV testing and vaccination uptake among PWID in Iran. It is essential to understand and address the obstacles preventing PWID from getting tested and vaccinated for HBV. Addressing these barriers could significantly reduce the burden of HBV among this socio-economically marginalized population.

Background: Abdominal surgery is considered a high-risk procedure for the development of surgical site infection (SSI). Few studies have evaluated the relative importance of surgical site infection risk factors in terms of consistency in abdominal surgery. Therefore, this comprehensive review article mapped and summarized the evidence aimed to determine the relative importance of the risk factors and incidence of SSIs in abdominal surgery.Methods: A literature review was conducted using electronic databases and search engines such as Scopus, PubMed, and Web of Science up to March 16, 2023. There was no language restriction for the papers to be included in the study. The relative consistency of the risk factors was measured and evaluated using the methodology of the Joanna Briggs Institute. Original peer-reviewed cohort and case-control studies were included if all types of SSIs were included. Meta-analysis was performed to determine the pooled estimates of SSI incidences.Results: Of 14,237 identified records, 107 articles were included in the review. The pooled incidence of SSI was 10.6% (95% CI: 9.02–12.55%, χ2=12986.44, P

Abstract Background The utilization of complementary and alternative medicine (CAM) is experiencing a global surge, accompanied by the adoption of national CAM policies in numerous countries. Traditional Persian medicine (TPM) is highly used as CAM in Iran, and the ongoing scientific evaluation of its interventions and the implementation of evidence-based medicine (EBM) encounters various barriers. Therefore, comprehending the characteristics and interactions of stakeholders is pivotal in advancing EBM within TPM policies. In this study, we utilized both classical stakeholder analysis and social network analysis to identify key stakeholders and potential communication patterns, thereby promoting EBM in TPM policy-making. Methods A cross-sectional nationwide stakeholder analysis was conducted in 2023 using snowball sampling. The interviews were carried out using a customized version of the six building blocks of health. Data were collected through semi-structured interviews. Stakeholders were assessed based on five factors (power, interest, influence, position, and competency). The connections and structure of the network were analyzed using degree, betweenness, closeness centrality, and modularity index to detect clusters of smaller networks. Results Among twenty-three identified stakeholders, the Ministry of Health and Medical Education (MOHME) and the Public were the most powerful and influential. The Iranian Academy of Medical Sciences was the most competent stakeholder. Social network analysis revealed a low density of connections among stakeholders. Pharmaceutical companies were identified as key connectors in the network, while the Public, supreme governmental bodies, and guilds acted as gatekeepers or brokers. The MOHME and Maraji were found to be high-ranking stakeholders based on four different centrality measures. Conclusion This study identifies powerful stakeholders in the network and emphasizes the need to engage uninterested yet significant stakeholders. Recommendations include improving competence through education, strengthening international relations, and fostering stronger relationships. Engaging key connectors and gatekeepers is essential for bridging gaps in the network.

Abstract This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be − 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were − 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of − 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001–2016 were − 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be − 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.

Background: Strengthening the functions of health research and taking a systematic approach to the development of science and technology are essential for overcoming current challenges in health sector. Therefore, the functional pathology of current research plays a crucial role in highlighting the gap between what is and what should be, thereby illuminating the path of scientific development in health sector with a focus on current challenges. Methods: In this study, interviews with experts, review of documents and conducting an expert panel were used. The method of data analysis is qualitative analysis with a framework analysis approach. A total of 32 experts were selected from heads of research centers, experts of the national innovation system, science and technology policy, health policy, graduate students and faculty members, senior researchers, NGOs and international experts. A review of relevant national and international documents has been done to strengthen and analyze the findings. The content analysis of the findings of two phases was carried out with a framework analysis approach and was presented in an expert panel consisting of representatives of the interviewees. The results of the panel were analyzed and to draw the future triangle consisting of the weight of the past, the push of the present and the pull of the future. Results: The findings of the study have been analyzed in the framework of the future triangle, including the weight of the history, the push of the present, and the pull of the future. The weight of the history and the push of the present were identified and analyzed in the form of past and present challenges of the health research system in seven main functions. Including stewardship and leadership, coordination of research and policymaking, translation of policies and upstream documents at the operational level of research, resource management, performance evaluation and monitoring, human resource empowerment, and evidence-informed policymaking. The pull of future includes the need to draw a coherent national macro image with a forward-looking, participatory and transparent approach, in which attention is paid to the management of conflict of interests, coherence in resource management and strengthening of intersectoral collaborations. Conclusion: The main solutions to address the current challenges in the country's health research system include agreement on concepts, a unified vision and stable procedures, strengthening the relationship between different levels of management (inter-ministerial, ministerial, and university), enhancing education and research at the level of medical ministry and universities, establishing appropriate structures for knowledge translation, strengthening national funds supporting the research, reforming the evaluation system, and undertaking a fundamental review of human resource empowerment model.

Abstract Background The Arbaeen Pilgrimage, a momentous religious journey drawing millions of participants annually, presents a profound spiritual experience. However, amidst its significance lie various health challenges that pilgrims encounter along the way. Addressing these challenges is vital to ensure the well-being of participants and the success of this extraordinary event. In light of this, the aim of this study is to examine the health challenges of the Arbaeen Pilgrimage, identify facilitators for solving these challenges, and propose effective solutions to enhance the overall pilgrimage experience for all involved. Methods The scoping review was performed by searching databases such as Web of Science, PubMed, Scopus, and Google Scholar search engine with a focus on the keywords “Arbaeen”, “Arbaeen walk” and “Arbaeen pilgrimage”. The search was not constrained by a specific time limitation in the databases. Data from studies were extracted using a data extraction form consisting of 9 fields. The selection of articles and data extraction were carried out by two researchers, adhering to predefined inclusion and exclusion criteria. Any disagreements were resolved through consultation with a third researcher. The study was reported following the PRISMA checklist. Results Out of 1619 retrieved articles, 9 were finally included in this study. All these studies were published since 2017 and conducted in Iraq and Iran. In total, 101 health challenges and facilitators were identified, comprising 61 challenges and 40 facilitators. The challenges with the highest frequency included “infectious disease outbreaks” (n = 7), “Poor management of Iraq’s health system in waste collection and disposal” (n = 4), “Rising incidence of walking injuries among pilgrims (e.g., burns, fractures, lacerations, wounds, and blisters)” (n = 4), and “Insufficient knowledge about personal and public health“(n = 4). The most important facilitators to solving the challenges were: “Customized pilgrim training and addressing their issues, with a focus on vital practices” (n = 6), “Coordinating mass gathering stakeholders, including health ministries and organizations” (n = 4), and “Implementing an agile syndromic system for rapid surveillance and identification of contagious illnesses” (n = 4). Conclusion The article discusses health challenges faced during the Arbaeen Pilgrimage and proposes facilitative measures for participants’ well-being. It emphasizes the significance of addressing health risks in large gatherings and suggests incorporating measures for a safer and enjoyable pilgrimage experience. Overall, understanding and managing these health factors can lead to a successful execution of the Arbaeen Pilgrimage, benefiting the physical and spiritual well-being of all involved.

Abstract Background This research article retrospectively analyses the agenda-setting approach of policies concerning high-risk sexual behaviours, stimulant and alcohol abuse among Iranian adolescents. Methods This qualitative case study policy analysis involved analysing 51 national documents and conducting interviews with 49 policy-makers and executives. Purposive sampling with a snowball strategy and semi-structured interviews were used. The data was analysed using the framework analysis method, with Kingdon’s multiple streams framework serving as the analytical framework. Results The study has identified the confluence of several factors, including the problem stream, the policy stream and the political stream. Within the problem stream, several factors contributed, such as the prevalence of high-risk behaviours, strong scientific evidence on these behaviours, changes in human immunodeficiency virus (HIV) transmission patterns, increased statistics of poisoning and deaths related to alcohol abuse, and the visit of Iran’s supreme leader to the slums of Mashhad city. The policy stream has two periods of denial and acceptance. The denial period includes considering these high-risk behaviours to be the consequences of western culture, emphasis on the religious aspects and sinfulness of these behaviours, resisting the prevalence of anomalous behavioural patterns, abstinence and religious obligation of chastity, and avoiding ethical corruption. The acceptance period includes adolescents training, fear messages, promotional and cultural activities, parent training, school staff training, providing psychiatric services for withdrawal, counselling and reference to receive specialized services. The political stream involves global attention towards non-communicable diseases and high-risk behaviours, and the significant impact of preventing these behaviours during adolescence on the health status of society. Also, the supreme leader’s attention to social harms, and the establishment of the National Committee for Prevention and Control of Alcohol, have played significant roles. Conclusions While the problem stream helped to highlight the problem and increase policy-makers’ attention, the politics stream played a significant role. Despite international evidence on the effectiveness of training in sexual issues in reducing high-risk behaviours, it did not succeed in being added to the agenda. The policy stream was heavily influenced by ideology and the political parties in power, affecting evidence-based policy-making. In countries with an ideological approach, the political stream plays a vital role in setting problems on the agenda.

It has always been argued that countries should not be inactive about the quality of health services. Therefore, a clear policy needs to be created regarding how quality of health services should be. The present scoping review was aimed to identify and map the available evidence regarding the National Quality Policy and Strategy (NQPS) of the health services in health systems of developing countries, graphically and tabularly. We followed the published methodological guidance of the Joanna Briggs Institute reviews. Also, we employed a narrative thematic synthesis integrated with the systematic analysis using the World Health Organization’s approach of NQPS, and the multiple-streams framework of Kingdon. We included 33 records that met the inclusion criteria; these records were published between 2010 and 2019. Meanwhile, government documents were the most frequent records (61%). Zimbabwe, Indonesia, and Sudan were the most frequent locations (each one 8%). The Ministry of Health was in charge of the ultimate responsibility for developing the NQPS in all identified countries. Besides, 82% of the countries were in the development phase of NQPS formulation, and convergence of three streams was observed in Indonesia, Sudan, and Tanzania. It seems that the African countries were informed about their quality issues, and the need for having NQPS have been more popular with them. We recommend that future research focuses on examining NQPS in terms of prioritizing in the agenda-setting phase of the policy-making cycle, and also, document analysis of all identified NQPS based on the core eight interdependent elements related to the NQPS approach.

BackgroundThe World Health Organization (WHO) declared a pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on 11 March 2020. Disability-adjusted life years (DALYs) combine the impact of morbidity and mortality, allowing for comprehensive comparisons of the population. The purpose of this study was to estimate DALYs due to COVID-19 in Iran for the first 2 years of the pandemic.MethodsDALYs were estimated as the sum of Years of Life Lost (YLLs) and Years Lived with Disability (YLDs) associated with COVID-19 in Iran from 19 February 2020 to 20 March 2022. The life expectancy for COVID-19 YLL estimations was based on the Global Burden of Disease (GBD) 2019 study.ResultsThere were 15,639,243 outpatients and 1,170,602 hospitalized confirmed cases, of which 120,965 deaths were as a direct result of COVID-19. DALYs were estimated to be 2,376,552. Overall, YLL contributed to 99.34% of the DALYs, while the remaining 0.66% was attributed to YLD.ConclusionCOVID-19 had a significant impact on population health in Iran during the first 2 years of the pandemic; this study provides a comprehensive depiction of COVID-19’s burden and is helpful for comparing its impact with other diseases in the population and across populations.

Background and purpose: Considering the importance of internationalization in medical education, adaptation of successful international and national models can help to promote it. This study aimed at explaining the achievement of the universities of medical sciences in internationalization of medical education in Iran. Materials and methods: This descriptive-adaptive study was conducted in the international relations office at Kerman University of Medical Sciences (KMU). At first, top three universities in England, Pakistan, Ireland, Cyprus, and Greece were selected based on The Times Higher Education World University Rankings. According to the land-use planning classification in Iran, KMU is the university to follow and assess the performance of higher education in these countries. Then, information about the policies of these universities in internationalization of higher education was obtained using their websites or by request. We also collected information of KMU as a representative of eight universities of medical sciences and its affiliated academic and research centers. Results: Data about the ownership of universities, student recruitment strategies, and internationalization policies of the universities were compared with those of KMU and the weaknesses and strengths of KMU were determined. Conclusion: The universities of medical sciences in Iran are suggested to revise their missions, goals, and performance and aim to practice internationalization of higher education as an important strategy in their university prospects.

Abstract Background Healthcare-associated infections (HAIs) are a threat to patients. Accurate surveillance is required to identify and prevent HAIs. To estimate the incidence rate, report the accuracy and identify the barriers of reporting HAIs using a mixed-method study. Methods In this quantitative study, we externally evaluated the incidence rate and accuracy of the routine surveillance system in one of the main hospitals by an active follow-up of patients from September to December 2021. We used in-depth interviews with 18 experts to identify the barriers of the routine surveillance system. Results Among 404 hospitalized patients, 88 HAIs were detected. The estimated rate of HAIs was 17.1 (95% Confidence Intervals 95: 14.1, 21.1) per 1000 patient-days follow-up. However, in the same period, 116 HAIs were reported by the routine surveillance system, but the agreement between the two approaches was low (sensitivity = 61.4%, specificity = 82.6%, negative predictive value = 89.7%, and positive predictive validity = 46.5%). The minimum and maximum positive predictive values were observed in urinary tract infection (32.3%) and surgical site infection (60.9%). The main barrier of reporting HAIs was lack of cooperation in reporting HAIs by infection control link nurses and laboratory supervisors. Conclusions The discrepancy between the longitudinal study findings and the routine surveillance might be related to the inaccessibility of the surveillance system to clinical information of patients. In this regard, decreasing the barriers, increasing the knowledge of infection control nurses and other nurses, as well as the development of hospital information systems are necessary.

Background: Visceral leishmaniasis (VL) is a neglected infection currently occurring in some regions of Europe, Asia, Africa, and America. This study was an attempt to determine the temporal patterns of VL from January 2000 to December 2019 in the Ardabil Province of north-western Iran using the Markov Switching Models (MSM).Methods: This descriptive study used monthly data of 602 VL cases during the study period. The data were provided by the Leishmaniasis National Surveillance System (LNSS), the Iran Meteorological Organization (IMO), and Space Agency (SA), and two states were considered for such modelling. Given the Akaike and Bayesian information criterion, the two-state MSM with a five-month lag is an appropriate model.Results: The MSM showed that the probability of staying in the non-epidemic state is 67%, (P11), while that of staying in an epidemic state is 93% (P22). The mean absolute percentage error (MAPE) was 31.63%, and the portmanteau test (Q=19.03, P=0.66) for the residuals of the selected model revealed that the data were completely modelled. The total VL cases in the next 24 months forecasted 14 cases.Conclusion: The MSM has a relatively acceptable predictive power and is useful in planning future interventions with more information about different stages of the epidemic it provides to policymakers for early warning of epidemics.

Abstract Background The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points. Methods This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro. Results Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base. Conclusions Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework.

Abstract Background Incarcerated people are at an increased risk of contracting HIV and transmitting it to the community post-release. In Iran, HIV epidemics inside prisons were first detected in the early 1990s. We assessed the HIV prevalence and its correlates, as well as the continuum of care among incarcerated people in Iran from 2010 to 2017. Methods We used data collected in three national bio-behavioral surveillance surveys among incarcerated individuals in 2010 (n = 4,536), 2013 (n = 5,490), and 2017 (n = 5,785) through a multistage cluster sampling approach. HIV was tested by the ELISA method in 2010 and 2013 surveys and rapid tests in 2017. Data on demographic characteristics, risky behaviors, HIV testing, and treatment were collected via face-to-face interviews. HIV prevalence estimates along with 95% confidence intervals (CI) were reported. Using data from the 2017 round, multivariable logistic regression models were built to assess the correlates of HIV sero-positivity and conduct HIV cascade of care analysis. Results The HIV prevalence was 2.1% (95% CI: 1.2%, 3.6%) in 2010, 1.7% (95% CI: 1.3%, 2.1%) in 2013, and 0.8% (95% CI: 0.6%, 1.1%) in 2017 (trend P value

Abstract Background Fair access to health services is a vital issue in low-and middle-income countries. Therefore, the present study was conducted to evaluate the equity in access to primary health care (PHC) services in southeastern Iran. Methods This household-based survey was conducted on 1128 households in Kerman, southeastern Iran in 2019-20. A multistage probability method was used to select the samples. The online questionnaire was designed and its link was provided to the questioners. After receiving the training, the questioners went to the door according to the sampling guide. The collected data were analyzed at a significance level of 0.05, using the STATA software. The concentration index (CI) was also used to measure inequality in access to PHC services. Results The results showed that there was a significant difference between gender and location in access to PHC services (P 0.05). The mean rate of access to PHC services was 3.51 ± 0.53. Cultural access (3.76 ± 0.54) and timely receipt of PHC services (2.51 ± 0.72) accounted for the highest and the lowest access rates, respectively. The concentration index for the distribution of PHC services among the income-adjusted population was 0.014 (CI 95%: -0.022 to 0.051), indicating pro-rich inequalities in access to PHC services. Conclusion The results indicated that pro-rich inequality, but it was close to the equality line. Also, the access level was assessed as moderate to high. Therefore, planning and policy-making seems essential for reduce inequality, and development and promotion of access to PHC services, especially timely provision of services and organizational access.

Abstract Background Upper limb (UL) disabilities have attracted worldwide attention due to the high economic costs of health care and the negative effects on the quality of life of patients with these disabilities. Telerehabilitation technologies are one of the most important ways to reduce rehabilitation costs and increase the quality of life of patients. Therefore, the aim of this study was to investigate the role of telerehabilitation in improving the health status of patients with upper limb disabilities. Methods This scoping review was conducted by searching the Web of Science, PubMed, and Scopus until July 30, 2021. We used a data extraction form with 18 fields to extract data from primary studies. The selection of articles and data extraction was made by four researchers using a data collection form based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth and sixth researchers.Inclusion criteria were studies published in English, studies on upper limb disability, and telerehabilitation based on any technology (synchronous telerehabilitation, asynchronous, or both). Exclusion criteria were articles that did not focus on telerehabilitation and upper limb disabilities. Also, books, book chapters, letters to the editor, and conference abstracts were also removed. Results A total of 458 articles were retrieved, and after removing irrelevant and duplicate articles, 29 articles were finally included in this review. Most telerehabilitation was performed for patients with stroke (65%). Among the 15 different services provided with telerehabilitation technologies, "Evaluation of exercises and also a musculoskeletal function of patients by the therapist","Recording of patients' rehabilitation exercises and sending them to the therapist” and "Prescribing new rehabilitation exercises by the therapist" were the most widely used services, respectively. Virtual reality technologies, smart wearables, and robots were used to provide telerehabilitation services. Among the 13 types of evaluation used for telerehabilitation systems, “Evaluation and measurement of upper limb function” was the most used evaluation in the studies. "Improvement in musculoskeletal functions”, "Increasing patients' interest and motivation to perform rehabilitation exercises", and "Increasing adherence to rehabilitation exercises and greater participation in treatment processes" were the most important outcomes, respectively. Conclusion Our findings indicate that telerehabilitation provides individuals with equitable access to rehabilitation services, improves musculoskeletal function, and empowers individuals by providing a variety of rehabilitation capabilities.

Objectives: To present an assessment of key components and results of HIV surveillance activities relevant for understanding HIV epidemics in the countries of the World Health Organization (WHO) Eastern Mediterranean Region among key populations (KPs), which include men who have sex with men (MSM), sex workers, people who inject drugs and transgender people. Methods: We examined HIV surveillance data submitted by the National AIDS Programmes of all 22 countries of the WHO Eastern Mediterranean Region via an online database hosted by the WHO since 2011. We also examined journal articles available on PubMed and technical reports on surveillance activities. Results: Recent (i.e., since 2017) estimates of HIV indicators from integrated bio-behavioral surveys (IBBS) were available from only four countries (Lebanon, Morocco, Somalia, and Tunisia) and population size estimates from two (Afghanistan and Morocco). IBBS indicated an increase in HIV prevalence among KPs in Pakistan, among people who inject drugs and female sex workers in Tunisia, and among MSM in Lebanon.Information on size estimations of KPs was available from 11 countries, and population size estimation data since 2017 had been collected in only Afghanistan and Morocco. Conclusion: Although some countries have been able to progressively expand HIV strategic information systems, there were still few or no HIV data on KPs in almost a third of the countries.

ObjectivesPrevious studies suggested a higher rate of COVID-19 infection in patients with multiple sclerosis than in the general population, and limited studies addressed the impact of COVID-19 and its vaccination in patients with multiple sclerosis in Iran. We decided to investigate the factors associated with COVID-19 infection, the effects and side effects of the COVID-19 vaccination in patients with multiple sclerosis (MS).MethodsWe used the data of the patients with multiple sclerosis registered in a referral clinic in Kerman, one of the large cities in Iran (a population of 537,000 inhabitants), to explore the association between demographic variables, the history of COVID-19 vaccination, and the clinical outcomes.ResultsOf the 367 participants in this study, 88.3% received the COVID-19 vaccine, 35.4% were confirmed COVID-19 cases, and the incidence of COVID-19 was much higher before vaccination (24.5% before vaccination versus 10.1% after vaccination). The multivariable logistic regression model showed that male gender (OR = 2.64, 95% confidence interval: 1.21, 5.74) and current employment (OR = 3.04, 95% confidence interval: 1.59, 5.80) were associated with an increased risk of COVID-19. The only factor associated with the adverse effects of COVID-19 vaccination was the type of vaccine (AstraZeneca).ConclusionOur findings showed that the vaccination protected MS cases considerably against COVID-19. In addition, the side effects of the vaccines were not noticeably high in these cases as well. Among all COVID-19 vaccines, AstraZeneca had the most common side effects, so people must be aware of them before vaccination. The male gender and employment were the most important variables in the prevalence of COVID-19 in patients with multiple sclerosis in our study.

Abstract Background: To improve healthcare services’ quality, countries should measure their health systems’ efficiency and performance by robust methods. Objectives: We aimed to develop a national study to measure the efficiency of the health system in Iran. Methods: The literature review identified several methods for measuring efficiency; the most common one was data envelopment analysis (DEA). We adopted DEA, but its findings were simplistic and inaccurate, so we began to modify the method by determining the weight of each indicator. We identified the efficiency measurement indicators, in line with international standards and uniformed units, and then readjusted our input/output indicators according to the study context through four expert panels. We collected data and classified the input/output indicators, followed by determining each indicator’s weight and standard limits. Then we rationalized our previous results by applying the revised model. The initial new results of the refined model were valid, accurate, and consistent with previous studies, as approved by experts. We defined proper modeling to achieve the stated objectives. After investigating various DEA models, we finally designed a new model that was consistent with the existing data and conditions, entitled EDEA (extended DEA), to analyze other subprojects. Conclusions: The conventional DEA methods may not be accurate enough to measure health systems’ efficiency. By modifying modeling process, we propose a modified DEA with a very low error rate. We suggest that others interested in measuring health system efficiency adopt our modified approach to increase accuracy and create more meaningful policy-oriented results. Keywords: Efficiency; Health System; Productivity; Protocol

Objective This modelling study aimed to estimate the comorbidity burden for four common non-communicable diseases with ischaemic heart diseases (IHD) in Iran during a period of 28 years.Design Analysis of the burden of comorbidity with IHD based on data included prevalence rates and the disability weight (DW) average for calculating years lived with disability (YLDs) from the Iran population based on the Global Burden of Disease (GBD) study.Setting Population-based available data in GBD 2017 study of Iran population.Participant The source of data was the GBD 2017 Study. We evaluated IHD, major depressive disorder (MDD), diabetes mellitus (DM), ischaemic stroke (IS), and osteoarthritis (OA) age-standardised prevalence rates and their DW.Main outcome measures A new formula that modified the GBD calculator was used to measure the comorbidity YLDs. In the new formula, some multipliers were considered, measuring the departure from independence.Result The contribution of total comorbidity for each combination of IHD with DM, MDD, IS and OA was 2.5%, 2.0%, 1.6% and 2.9%, respectively. The highest YLD rates were observed for IHD_MDD, 16.5 in 1990 and 17.0 in 2017. This was followed by IHD_DM, from 11.5 to 16.9 per 100 000. The YLD rates for IHD_OA changed slightly (6.5–6.7) per 100 000, whereas there was a gradual reduction in the trends of IHD-IS, from 4.0–4.5 per 100 000.Conclusion Of the four comorbidities studied, the highest burden was due to the coexistence of MDD with IHD. Our results highlight the importance of addressing the burden of comorbidities when studying the burden of IHD or any other non-communicable disease.

Abstract Background and Aim: Air pollution is one of the most significant environmental problems that has a remarkable impact on the incidence of cardiovascular disease and associated mortality. It is essential to comprehend air pollution effects and the ways of emission and predict the number of patients with acute respiratory problems to eliminate and reduce air pollutants and associated mortality. This study aimed to investigate the relationship between different air pollutants and the number of cardiovascular disease patients in Mashhad. Materials and Methods: This study applied a neural network to model and analyze the relationship between CO, NO2, SO2, PM2.5, and PM10 and the number of patients with acute respiratory problems. The inputs were average temperature, humidity, wind direction, and wind speed and the output was the number of people referred per day by gender and age. The data set used included meteorological data from the Iran Meteorological Organization, air pollution data from the Mashhad Meteorological Organization, and the number of daily referrals of heart disease patients to the emergency department of Mashhad. Results: According to this study, the most effective air pollutants in Mashhad were PM2.5 and PM10, followed by NO2, CO, and SO2, respectively. Conclusion: Neural networks can be applied in the modeling of the relationship between environmental parameters and cardiovascular disease patients because they have a high ability to model nonlinear phenomena. These models show that the more airborne particles, the more rate of cardiovascular diseases in Mashhad

Objective: To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average (SARIMA) models and Markov switching model (MSM). Methods: This descriptive study employed yearly and monthly data of 49 364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province, located in the center of Iran from January 2000 to December 2019. The data were provided by the leishmaniasis national surveillance system, the meteorological organization of Isfahan province, and Iranian Space Agency for vegetation information. The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics. Results: The minimum relative humidity, maximum relative humidity, minimum wind speed, and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags (P

Background: We aimed to determine the generation time, the best model for estimating reproduction number (R), and to estimate the basic reproduction number (R0) and effective reproduction number (Rt) for COVID-19 in Iran. Methods: We used the daily incidence cases of COVID-19, hospitalized due to a probable diagnosis of COVID-19 from 19 February 2020 to 17 November 2020 in Iran. Four models, including maximum likelihood (ML), exponential growth (EG), time-dependent (TD), sequential Bayesian (SB) were evaluated. The weekly reproduction number with a 95% confidence interval (CI) was calculated. Results: TD model shows the best fit compared to other models for estimating reproduction number in Iran. The R0 in Iran in the first week of the epidemic, leading up to 21 February 2020 was 7.19, 95% CI: 5.56, 9.00. The lowest value for the Rt was equal to 0.77 between 3 to 10 March 2020 and 4 to 11 December 2020. From 11 June 2020 up to13 August 2020, the Rt was more than one but after then to 24 September 2021 was less than one. Conclusion: TD model was the best fit for estimating the R in Iran. The worst situation of the epidemic in Iran was related to the weeks leading up to 26 February 2020 and 28 October 2020, and better status was related to the weeks leading up to 10 March 2020 and 11 December 2020.

Abstract Background and Aims Primary care and the use of a referral system are essential components of any health system. The aim of this study was to investigate and identify the challenges affecting the performance of the primary health‐care system in Iran. Methods This qualitative study was carried out consisting of 14 interviews with experts and those familiar with the primary care system and its function. Purposive and snowball sampling was used to identify the samples. The recorded files were transcribed and entered into the MAXQDA‐11 software to be analyzed. The conventional content analysis approach was used for data analysis. Results The findings of this study included 72 initial codes classified into 7 main themes and 18 subthemes. Seven main themes consist of governance, manpower, resources, financial management, services delivery, trans‐sectional, and social and cultural. The greatest challenges for Iran's primary health care (PHC) system are governance and human resources problems. Conclusion Various dimensions of Iran's primary care system especially governance and human resources are facing several challenges that threaten its performance and efficiency. Policymakers and planners must address challenges fundamentally and do not get satisfied with superficial reforms that have short‐term and soothing effects. In this regard, enhancing governance functioning can profoundly solve numerous challenges of Iran's primary care system. We also suggest the strengthening of intersectoral collaboration.

Abstract Background The present study was conducted to determine the trend and projection of premature mortality from gastrointestinal cancers (GI cancers) at national and subnational levels in Iran. Methods Employing the data obtained from Iranian Death Registry System (DRS) and population data from census, the mortality rates of GI cancers was calculated among 30–70 age groups. The trends of esophageal, colon and rectum, gallbladder, pancreases, stomach, and liver cancer premature mortalities were estimated and projected at the national and subnational levels from 2001 to 2030. Then, Spatio-temporal model was used to project spatial and temporal correlations. Results The overall mortality rate of GI cancers was higher in males than in females, indicating 6.1, 3.9 and 3.9% per 100,000 individuals among males in 2001, 2015 and 2030 respectively and 3.8, 3.1 and 3.7 per 100,000 individuals among females in the same time-frame. The overall mortality rate of GI cancers in males was decreasing until 2015 and will remain stationary into 2030; however, the rate will be increasing among females in both time-frames. Also, there was a considerable variation in the mortality trends of different cancers. Pancreatic, gallbladder, and liver cancers were shown to have an increasing trend while a drop was observed in the mortality rates of stomach, colon and rectum, and esophageal cancers. Conclusion Variation of GI cancers patterns and trends around the country indicated that a more comprehensive control plan is needed to include the predicted variations.

Background: Visceral leishmaniasis in human (VLH) also known as kala-azar is a neglected disease of humans that mainly occurs in more than 50 countries mostly located in the Eastern Mediterranean and the Northern America. Objective: The purpose of this study was to determine the temporal patterns and predict of occurrence of VL in Ardabil Province, in northwestern Iran using autoregressive integrated moving average (ARIMA) models. Methods: This descriptive study employed yearly and monthly data of 602 cases of VLH in the province between January 2000 to December 2019, which was provided by the leishmaniasis national surveillance system. The monthly occurrences case constructed the ARIMA model of time-series model. The insignificance of the correlation in the lags of 12, 24 and 36 months, and Chi-square test showed the occurrence of VLH does not have a seasonal pattern. Eleven potential ARIMA models were examined for VLH cases. Finally, the best model was selected with the lower Akaike Information Criteria (AIC) and Bayesian information criterion (BIC) value. Then, the selected model was used to forecast frequency of monthly occurrences case. The forecasting precision was estimated by mean absolute percentage error (MAPE). Data analysis was performed using Stata14 and its package time series analysis. Results: ARIMA (5, 0, 1) model with AIC (25.7) and BIC (43.35) was selected. The MAPE value was 26.89% and the portmanteau test for white noise was (Q = 23.02, P = 0.98) for the residuals of the selected model showed that the data were fully modelled. The total cumulative VLH cases in the next 24 months' in Ardabil province predicted 14 cases (95% CI: 4-54 case). Conclusion: The ARIMA (5, 0, 1) model can be a useful tool to predict VLH cases as early warning system and the results are helpful for policy makers and primary care physicians in the readiness of public health problems before the outbreak of the disease.

The main indicators of higher education (HE) internationalization in the field of awarding degrees are the international development of disciplines and interdisciplinary sciences, new educational and learning methods, new and updated curricula, and their correct ways of sharing. This study aimed to examine the system of awarding degrees in health HE of Iran and the United Kingdom. This descriptive-comparative study focused on the field of medical sciences and its related disciplines. The vital information about the variables was collected by visiting the official websites of the UK universities and related or joint organizations. The related information to the Kerman University of Medical Sciences as a sample of Iran medical universities was obtained from the university’s Farabar system. All data extraction steps were performed manually. There were differences in the mechanism of setting up a new discipline and the process of students’ admission, diversity of degrees’ titles and curriculums, stability of disciplines over the time, creativity in creating competition between different disciplines, the reason for establishing a discipline and the requirements for certification and awarding of degrees in health sciences disciplines in Iran and the United Kingdom were described. Propelling of medical education in the health sciences area towards standard awarding degree systems can be responsible for the requirements of internationalization of higher education.

Abstract Background Evidence shows that the prevalence of risky sexual practice, drug abuse, and alcohol consumption behaviors in low and middle income countries such as Iran is not in a favorable condition. Preventive programs against these behaviors in Iran are very rare, and the results are unclear, which may be due to the lack of deeply and systematically understanding of the determinants of these behaviors. Evidence suggests that these behaviors are coincidence. So all of these behaviors were examined together. The present study was conducted aiming at determining the reasons for the occurrence of these behaviors among 15–19-year-old adolescents in Iran. Methods The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to review published and unpublished studies in Iran. The databases used were Scopus, PubMed, Web of Science, and Cochrane Library. The query terms were “Synthetic Drug” OR “Designer Drug”, AND Adolescents OR Teenagers OR Juvenile, AND Iran. The Joanna Briggs Institute Critical Appraisal Checklist was employed for critical appraisal. The quantitative studies using the regression model to analyze the factors affecting these behaviors were studied as the form of the theme. For analyzing the data, narrative synthesis and thematic analysis were used. Results Twelve studies were meticulously reviewed. The findings were classified into five main themes (including individual, family, friends, school, and community) and 26 sub-themes. The most frequent main theme and sub-themes were respectively Family, Higher age, Male gender, Weak religious beliefs, Low self-esteem, Anti-social behaviors in family, Mother’s employment, Parenting style, Poor intimacy of parents, Absence of parents, Peer pressure, and Lack of appropriate recreation. No primary study has referred to the political, economic, or policy factors affecting such behaviors. Conclusions The most identified sub-themes belong to family factors. Iran is a country with ideology of Islam; however, being Muslim does not guarantee adherence to all Islamic guidelines. So being Muslim is not a good reason to prevent these behaviors. Iran needs precise policy making in this area through considering family structure. It is also suggested that primary studies referring to the political, economic, or policy factors affecting such behaviors should be carried out.

Background: Size estimation of hidden populations are complicate with direct methods. This study aimed to size estimate groups at high risk of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in men, using Network Scale Up in South of Iran. Methods: 500 men between 18 and 45 years old were recruited. 8 populations at high risk of HIV were defined: opium users, unknown drug users, ecstasy users, alcohol users, injection drug users (IDUs), men who have extramarital sex with females (MSF), men who have sex with female sex workers (MFSW), and men who have sex with other men (MSMs). We asked respondents whether they know anybody in their social networks of the above subpopulation (probability method), If yes, how many people do they know (frequency method). Findings: Estimates derived in the frequency method were higher than the probability method. Based on the frequency method, 4.38% [95% confidence interval (CI): 2.58%-6.17%] of men used alcohol at least once in last year. 2.16% (95% CI: 0.88%-3.43%) had extramarital sex, 1.94% (95% CI: 0.73%-3.14%) were opium users, 1.88% (95% CI: 0.68%-3.07%) had experience of unknown drug consumption, 1.64% (95% CI: 0.52%-2.75%) had sex with a female sex worker, 0.48% (95% CI: 0.12%-1.08%) were ecstasy drugs user, 0.34% (95% CI: 0.17%-0.85%) had sex with other men, and 0.26% (95%CI:0.18%-0.70%) were injection drug users. Conclusion: The size of the population of alcohol users and men who have extramarital sex is higher than other high-risk groups. Developing a special preventive program is needed to control HIV transmission based on the frequency of high-risk groups in each region.

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Background and purpose: Reproductive and sexual health related problems constitute one third of health problems among women aged 15 to 44 years. Sexually transmitted infections are a significant challenge for human development. We aimed to assess the prevalence of STIs and identify factors associated with among Iranian women. Materials and Methods: Through a cross-sectional study, 399 women aged 10-49 years were recruited. These were women who referred to urban and rural health centers in a city in Iran. Through a behavioral questionnaire, high-risk behaviors of the sample were asked about. Syndromic STIs were also assessed through clinical examination. T-test and multivariable Modified Poisson Regression was used to estimate the Prevalence Risk Ratios (PRRs) in Stata 13. P-values less than 0.05 were considered as statistically significant. Results: About 64.2% of the participants had at least one of the STIs. STI prevalence was significantly higher among women who self-reported not using condoms in their last sexual contact (75% vs. 39.8%), whose spouse/sexual partners (SSP) had extramarital sex (87.7% vs. 59.6%), whose SSP had a past-year history of illicit substance use (72.9%vs. 60.9%), and whose SSP had a history of incarceration (91.5% vs. 59.1%). In multivariable analysis, it was shown that having first sexual intercourse before 20 years of age, history of abortion in the past year, low family income, not using condom in last sexual contact, and the partner’s incarceration history were identified as significant predictors. Conclusions: The knowledge produced from the current research can serve as evidence for the promotion of interventions and healthcare services related to sexual and reproductive health for Iranian women and their SSPs. The findings from the current study also support research on improving strategies for STI diagnosis and STI management.

Iran, despite its size, geographic location and past cultural influence, has largely been a blind spot for human population genetic studies. With only sparse genetic information on the Iranian population available, we pursued its genome-wide and geographic characterization based on 1021 samples from eleven ethnic groups. We show that Iranians, while close to neighboring populations, present distinct genetic variation consistent with long-standing genetic continuity, harbor high heterogeneity and different levels of consanguinity, fall apart into a cluster of similar groups and several admixed ones and have experienced numerous language adoption events in the past. Our findings render Iran an important source for human genetic variation in Western and Central Asia, will guide adequate study sampling and assist the interpretation of putative disease-implicated genetic variation. Given Iran's internal genetic heterogeneity, future studies will have to consider ethnic affiliations and possible admixture.

Introduction Pediatric anxiety disorders are the most common mental health disorders in the middle-childhood age group. The purpose of this study is to assess anxiety disorder symptoms, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), in a large community sample of low socioeconomic level rural children and to investigate some of the psychometric properties (internal consistency, construct and convergent validity and items rated as often or always experienced) of the Malay version of the Spence Children's Anxiety Scale - Child version (SCAS-C). Method Six hundred children aged 9-11 and 424 of their parents completely answered the child or parent versions of the SCAS. Results Results indicated that the internal reliability of subscales were moderate to adequate. Significant correlations between child and parent reports supported the measure's concurrent validity. Additionally, anxiety levels in this Malaysian sample were lower than among South-African children and higher than among their Western peers. There were both similarities and differences between symptom items reported as often or always experienced by Malaysian students and by children from other cultures. Confirmatory factor analysis provided evidence of the existence of five inter-correlated factors for anxiety disorders based on SCAS-C. Conclusion Although some of the instrument's psychometric properties deviated from those observed in some other countries, it nevertheless appears to be useful for assessing childhood anxiety symptoms in this country.

BACKGROUND AND AIM: Measuring child abuse and adverse experiences is a critical task with regard to its long-term impact on the health of individuals and communities. The purpose of this study was to validate the Persian version of the International Adverse Childhood Experiences Abuse Short Form (ACE-ASF) in Iranian society. MATERIALS AND METHODS: This cross-sectional study was conducted in Kerman, southeast of Iran, in 2019, on 494 students from Kerman University of Medical Sciences, selected by convenience sampling method. Psychometric properties of the questionnaire were examined after the forward and backward translation processes. The factor structure of the questionnaire was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The concurrent validity of the questionnaire was assessed using the childhood trauma questionnaire (CTQ). Cronbach's alpha and corrected item-total correlation were used to measure reliability. RESULTS: The mean age of participants was 24.3 ± 5.3 years. Based on EFA, two physical–emotional abuse and sexual abuse factors were obtained. The CFA fit indices well supported two extracted factors. The CFA showed acceptable factor loadings. The internal consistency coefficient of Cronbach's alpha was 0.75 for the physical–emotional abuse factor and 0.77 for the sexual abuse factor. The correlation coefficient of ACE-ASF and CTQ was r = 0.56. The reliability index of intraclass correlation coefficient was 0.73 (95% confidence interval: 0.60–0.84). CONCLUSION: The Persian version of the ACE-ASF questionnaire has acceptable psychometric properties.

Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.

We conducted this study to obtain a comprehensive picture of molecular epidemiology of HIV-1 in three neighboring countries, i.e. Afghanistan, Iran, and Pakistan as a basis for discussing possible hypothesis regarding between-country virus transmission. Our results showed that subtype composition differs between these countries with more variation in Pakistan than Iran and Afghanistan. The CRF35-AD clade was predominant in Afghanistan and Iran while the A1 subtype was predominant in Pakistan. HIV-1 sequences obtained from Pakistan (belonging either to B, A1, or CRF35_AD clades) did not group with the sequences obtained from Afghanistan and Iran. However, CRF35_AD clades from Afghanistan made two significant clusters with those strains from Iran. The results also showed that CRF35_AD clades from Afghanistan had more diversity than those in Iran suggesting its older presence in this country. Putting these findings together and considering drug trafficking/immigration events from Afghanistan to Iran we hypothesized that HIV epidemics might have been transmitted from Iran to Afghanistan. However, the reverse order might also be true but with less support from the existing evidence. There was no indication of Iran-Pakistan HIV transmission. Performing sophisticated evolutionary analysis is needed to test these hypotheses about the origin and transmission pattern of the virus among these countries.

Introduction: Anxiety among children has increased in recent years. Culturally adapted questionnaires developed to measure the level of anxiety are the best screening instruments for the general population. This study describes the scientific translation and adaptation of the Spence Children's Anxiety Scale (SCAS) into the Malay language.Method: The process of scientific translation of this selfreport instrument followed the guidelines of the Task Force for Translation and Cultural Adaptation of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).Results: The Malay version and its adaptation for a new cultural context are described.Conclusion: The Malay version achieved the aims of the original version and its conceptual and operational equivalence. It may be used as the first Malay instrument to measure anxiety among children in research and in clinical and community settings.

Estimating the number of key populations at risk of HIV is essential for planning, monitoring, and evaluating prevention, care, and treatment programmes. We conducted this study to estimate the number of female sex workers (FSW) in major cities of Iran.We used three population size estimation methods (i.e., wisdom of the crowds, multiplier method, and network scale-up) to calculate the number of FSW in 13 cities in Iran. The wisdom of the crowds and multiplier methods were integrated into a nationwide bio-behavioural surveillance survey in 2015, and the network scale-up method was included in a national survey of the general population in 2014. The median of the three methods was used to calculate the proportion of the adult female population who practice sex work in the 13 cities. These figures were then extrapolated to provide a national population size estimation of FSW across urban areas.The population size of FSW was 91,500 (95% Uncertainty Intervals [UIs] 61,400-117,700), corresponding to 1.43% (95% UIs 0.96-1.84) of the adult (i.e., 15-49 year-old) female population living in these 13 cities. The projected numbers of FSW for all 31 provincial capital cities were 130,800 (95% UIs 87,800-168,200) and 228,700 (95% UIs 153,500-294,300) for all urban settings in Iran.Using methods of comparable rigor, our study provided a data-driven national estimate of the population size of FSW in urban areas of Iran. Our findings provide vital information for enhancing HIV programme planning and lay a foundation for assessing the impact of harm reduction efforts within this marginalized population.

Background & Objective: Evaluation of academic progress is done by comparing the results of measuring the performance of learners with educational goals and learning objectives The aim of this study was to survey the predictions of academic achievement evaluation of Rafsanjan University of Medical Sciences Iran based on the students course experience Methods: This crosssectional study was performed in 20122013 Medicine dentistry nursing and paramedical students were selected based on their filed of study and gender by stratified random sampling from the Rafsanjan University of Medical Sciences (n = 370) Data gathering tool was a Course Experience Questionnaire (CEQ) The questionnaire fields included good teaching clear and standards goals appropriate assessment workload and general skills one question about satisfaction of course was used to measure their course experience Students grade point average (GPA) in previous semesters was used as an index for academic achievement Results: 318% of participants were boys and the rest (682%) were girls Statically significant difference existed between GPA of boys and girls (P = 0001) Nursingmidwifery students had the highest score (1523 ± 330) in five course experience variables and medical students the lowest (1406 ± 435) (P = 0001) CEQ and GPA had significant and positive correlation (P = 0004 r = 0164) Predictor factors of GPA were clear and standard goals and appropriate assessment Conclusion: This study represents the importance of appropriate assessment ( particular emphasis on understanding until know something from memory) and of clear and standards goals at the beginning of the semester by teachers to promote academic achievement and performance of students Thus teachers should can promote and provide students progress with teaching appropriate intervention

Background & Objective: Social accountability medical education in all fields considers health problems priorities in specified countries Health provision (social accountability) encounters many challenges in its delivery due to more reasons and faculty innovations seem essential in promotion of education This study was designed in order to investigate social accountability medical education and innovations of clinical faculty members Methods: In a crosssectional and triangulation study point of view of 72 clinical faculty members in Kerman University of Medical Sciences Iran about social accountability medical education and their innovations was investigated by two separated questionnaires Results: Situation analysis of social accountability medical education in Kerman University of Medical Sciences showed that this form of education is in weaknessthreatened status The score of strengths was significantly difference among men and women and score of weakness was significantly difference among different educational groups and academic degrees (P < 005) There was no significant difference between situation analysis of social accountability medical education innovation and other demographic and educational variables Conclusion: Status of social accountability medical education (weaknessthreatened) is not appropriate in Kerman University of Medical Sciences in order to its promotion there must be an appropriate mechanism In addition potentials of faculty members must be considered about innovation for social accountability medical education

Background & Objective: Neglect to the principles study principles has reduced the level of human productivity and efficiency and is a cause of demoralization and loss of selfesteem research boredom and disenchantment Some learning special skills such as methods of receiving storing and recalling the correct content are needed to perform an effective study This study aimed to show the role and impact of academic learning skills and study strategies in improving students study styles and their selfefficacy and satisfaction Methods: This interventional study using preand posttraining tests was conducted on 75 newentrant nursing and midwifery students of Kerman University of Medical Sciences Iran in 2011 Students completed a researchermade questionnaire including four parts: demographic information learning and study strategies selfefficacy and satisfaction before and after the training The data were analyzed using paired ttest Results: There were significant difference between the mean pre (105 ± 26) and postintervention (136 ± 18) learning strategies pre (106 ± 18) and postintervention (133 ± 13) study strategies pre (105 ± 32) and postintervention (123 ± 24) selfefficacy and pre (94 ± 34) and postintervention (1208 ± 29) satisfaction scores Conclusion: Learning and study strategies can be taught and learned Upgrading learning and study strategies increases students sense of selfefficacy and satisfaction According to our results designing a course for training study and learning strategies is suggested to improve college students learning and study skills

Introduction: Most experts consider learning approach as the fundamental basis of learning dividing it into two parts of deep learning approach and surface learning approach. This is an endeavor to investigate the relationship between learning and study approaches with academic achievement among students in Rafsanjan University of Medical Sciences. Methods: This descriptive cross-sectional study was performed in 2012 on a sample of medicine, dentistry, nursing, and allied health students (n=370) selected through stratified random sampling in Rafsanjan University of Medical Sciences. Data gathering tool was a revised two-factor Study Process Questionnaire (R-SPQ-2F) graded based on 5point Likert Scale. Students’ total grade point average (GPA) was considered to evaluate their academic achievement. Data analysis was performed using descriptive and inferential statistics (Independent t-test, ANOVA, Spearman correlation coefficient, and multiple linear regression). Results: Mean and standard deviation of deep learning approach (3.21±0.054) was significantly higher than surface learning approach (2.92±0.064) (t=6.65, p

Background: Primary healthcare system in Iran has played an extensive role in promoting people health in the past decades. However, regarding universal developments in the different global aspects effective on health, the performance of this system has been influenced significantly. The aim of the present research is to identify the future trends of the primary health care in Iran. Methods: The participants of this qualitative case study were experts in primary healthcare, which were selected and interviewed through purposive sampling method. The interview process was saturated after 25 interviews, so we stopped the process at this point. Framework analysis based on STEEP model used to analysis the interviews. Results: The most important social/value, technological, economic, environmental, and political future trends of primary healthcare in Iran included demographic transition, epidemiological transition, social and cultural changes, emergence of modern and advanced technologies, internet and cyberspace, budgeting limitations, resource management, changing paradigm from volume to value in providing health services, environmental pollutions, natural disasters, health governance, intellectual paradigm of senior officials, regional security, international development, and other internal factors of the health system. Conclusions: The identified factors can be turned into opportunities for Iran primary healthcare system if health planners and policymakers have a deep and accurate look at these influential factors and manage them properly.

Background & Objective: PhD by research is one of the highest postgraduate education degrees in Iran There are educational and researchbased courses in this program There was a need for revision in these courses because of some controversies in running the program This study aimed to determine the required courses their credit and objective of each course in the program Methods: The study was done by the Delphi approach in two rounds In the first round the current program was evaluated by an internet survey and an expert panel The expert panel consisted of professors and PhD by research students of medical sciences universities in Iran At the end of the first round the curriculum of the program was prepared The curriculum consisted of course titles credits objective and core or noncore curriculums In the second round the curriculum was sent to PhD by research supervisors and students and their feedbacks were collected via email Results: At the end of the study the list of current courses (per credit) was confirmed Advanced statistics (3) advanced research (2) ethics in research (1) and documentation (2) were considered as core courses This was suggested to change project management (2) and research projects (4) to noncore courses The electronic data management (2) knowledge transfer (2) laboratory techniques (2) and course thesis were suggested to consider as noncore courses Conclusion: The essential courses that students need for their research were considered as core and the courses which require the educational center point of view were considered as noncore courses

INTRODUCTION:The evidence is mixed on the HIV knowledge, attitude, and practices of youth in Iran. The aim of the current study was to assess knowledge, attitudes, and practices of Iranian youth towards HIV through a national survey. MATERIALS AND METHODS:Through a cross-sectional study with multistage cluster sampling, we administered a pilot-tested standard questionnaire to assess the levels of HIV knowledge, attitudes and practices of individuals aged 15-29 years old. Participants were recruited from 13 provinces in Iran and consisted of 2456 men and 2412 women. RESULTS:Only 37.3% of the participants had a high knowledge score. Most participants knew the main routes of HIV transmission; however, misconceptions existed about the transmission of HIV through mosquito bites across all age groups (31.7% correct response). Positive levels of attitude wereobserved among 20.7% of the participants. Most participants believed that people living with HIV (PLHIV) should be supported (88.3%) while only 46.3% were ready to share a table with them. Among those aged 19-29 years old, the main source of HIV information was mass media (69.1%), only 13.1% had ever tested for HIV, around 20.8% had ever had extramarital sex (31.7% male vs. 9.6% female),1.8% ever injected drugs (2.9% male vs. and 0.7% female). Among sexually active subjects in this age group, only 21.8% (26.1% male vs. 7.1% female) were consistent condom users. CONCLUSIONS:The findings showed that Iranian youth and young adults have relatively insufficient overall knowledge and negative attitudes about HIV and PLHIV. Novel strategies involving schools and youth's networks could be employed to deliver a culturally sensitive sexual health program.

Background: HIV is a multidimensional problem. Therefore, prioritization of research topics in this field is a serious challenge. We decided to prioritize the major areas of research on HIV/AIDS in Iran. Materials ans Methods : In a brain-storming session with the main national and provincial stakeholders and experts from different relevant fields, the direct and indirect dimensions of HIV/AIDS and its related research issues were explored. Afterward, using the Delphi method, we sent questionnaires to 20 experts (13 respondents) from different sectors. In this electronic based questioner, we requested experts to evaluate main topics and their subtopics. The ranges of scores were between 0 and 100. Results: The score of priorities of main themes were preventive activities (43.2), large scale planning (25.4), the estimation of the HIV/AIDS burden (20.9), and basic scientific research (10.5). The most important priority in each main theme was education particularly in high risk groups (52.5), developing the national strategy to address the epidemic (31.8), estimation of the incidence and prevalence among high-risk groups (59.5) and developing new preventive methods (66.7), respectively. Conclusions: The most important priorities of researches on HIV/AIDS were preventive activities and developing national strategy. As high risk groups are the most involved people in the epidemic, and they are also the most hard-to-reach sub-populations, a national well designated comprehensive strategy is essential. However, we believe with a very specific and directed scheme, special attention to research in basic sciences is necessary, at least in limited number of institutes.

Introduction: Iran, similar to other countries, had faced H1N1 flu outbreak in 2009. In order to assess its transmission dynamic, we estimated its force of infection (β) and basic reproductive number (R 0 ). Methods: Within a middle size primary school in Iran, we actively followed students and detected flu-like syndrome among students and their families in the first three months of academic year; October through December 2009. We estimated the probability of disease transmission within families (β) fitting random effects Poisson regression model. Moreover, R 0 within the school was computed based on the number of detected cases. Results: In 452 students, 204 influenza-like syndromes were detected. The estimated β within families was 0.10; increasing one infectious member within each family was associated with 30% increase in this number. The estimated R 0 for the first month was 1.21 (95% C.I.: 0.99, 1.47); corresponding numbers for the first two and first three months were 1.28 (95% C.I.: 1.05, 1.54) and 1.32 (95% C.I.: 1.11, 1.59), respectively. Conclusion: It seems that the dynamic transmission of H1N1 virus was more or less comparable with that in other seasonal species. Our findings showed that the virus mainly circulated among students within schools. In addition, it seems that the transmission rate within families was relatively high.

Background: Population aging and more prevalent westernized lifestyle would be expected to result in a markedly rising burden of colorectal cancer (CRC) in the future years. The aim of this study is to estimate the limited-time prevalence of CRC in Iran between 2015 and 2020. Materials and Methods: Aggregated CRC incidence data were extracted from the Iranian national cancer registry (IR.NCR) reports for 2003–2009 and from GLOBOCAN-2012 database for 2012. Incidence trends were analyzed by age groups, genders, histopathologic, and topographic subtypes to estimate annual percentage changes. Incidence was projected for 2020. The prevalence was estimated applying an adopted version of a previously introduced equation to estimate limited–time prevalence based on the incidence and survival data. Monte Carlo sensitivity analyses were applied to estimate 95% uncertainty levels (ULs). In each scenario, incidence, survival, annual percentage changes, and completeness of case ascertainment at IR.NCR were replaced under pre-assumed distributions. Results: Number of estimated within 1, 2-3 and 4-5-year CRC patients in 2015 were 13676 (95% UL: 10051–18807), 20964 (15835–28268), and 14485 (11188–19293), respectively. Estimated 5-year prevalence for 2020 (99463; 75150–134744) was 2.03 times of that for 2015. Highest 5-year prevalence was estimated in ages 55–59 for females and 75 + for males. Adenocarcinoma (41376; 31227 55898) was the most prevalent histologic subtype. The most prevalent tumor location was colon (30822, 23262–41638). Conclusion: A substantial growth in the prevalence of CRC survivors is highly expected for future years in Iran. Establishment of specialized institutes is highly recommended to provide medical and especially social supports for Iranian CRC survivors.

Background:In this paper, we are presenting the basic concepts of data analysis in a very simple but practical approach. We believe that the content of this paper may help nearly all of researchers in writing their results. Coherent is one of the main considerations in nearly all of scientific scripts and as a general rule, all researchers have to pay enough attention to this issue in all steps. This means that all of sections and subsections have to have direct relationship with the main objective. We recommend that the analysis starts from simple descriptions of the main variables. In the next step, assessment of the relationship between paired variables is recommended. As the last step, sometimes you may need to use multivariable analysis to explore the relationships between your main variables adjusting for the confounding effects of other variables. Tables and graphs are very efficient tools to present your findings in an attractive way and grasp the attention of readers; however, you have to use simple but clear tables and graphs. Repetition of findings in graphs, tables and body text of the results is one of the main pitfalls. We hope by reading this paper you learn more how to approach to your data and write your results more attractive. Keywords: statistical analysis, results, scientific writing, multivariate analysis, coherent