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Introduction: Preventive self-care behaviors such as home quarantine are very important in preventing COVID-19. The aim of this study was to explore the factors of non-compliance with home quarantine during the outbreak of COVID-19. Methods: This study was conducted with a qualitative content analysis approach in 2020 in Iran. In order to collect information, 24 samples were selected by purposive sampling method and semi-structured interviews were conducted with them. Interviews were recorded, transcribed and the collected data were analyzed using the contractual content analysis approach using Elo and Kingas method. Results: Analyzing the data revealed in six main themes and fourteen main categories, including: necessities for everyday activities and living (with subthemes providing the necessities of life, forced by work/job insecurity, need for fun/entertainment, sports), mental instability in adults/children (with subthemes of mental states, restlessness of children), spiritual and religious beliefs (with subthemes of belief in fate and immunity/disease immunity, right to know death), managerial problems/confusion (with subthemes of government mismanagement, expectations from the government, economic turmoil), marital incompatibility (with subthemes domestic violence), adherence to socio-cultural patterns (with the subthemes of sociocultural factors). Conclusion: According to the results, it should be noted that several factors are contributing to non-compliance with home quarantine that it is necessary for the relevant authorities to take measures to remove these obstacles and provide the necessary facilities.

Introduction: Communication skills are a set of behaviours through which aperson communicate with others in such a way leading to positive responses and the avoidance of negative responses. This study aims to predict the determinants of interpersonal communication skills among healthcare providers of Ahvaz city based on the extended theory of reasoned action. Methods: This cross-sectional descriptive study was condcuted on 160 healthcare providers of Ahvaz city in 2021using random sampling. Data collection tool was a researcher-made questionnaire. The data were analyzed by SPSS version 24 and AMOSS version 22 software, using correlation tests, regression analysis, independent samples t-test and paired t-test. Results: The mean age and work experience of the participants was 35.76± 6.55 and 10.31± 6.79 years, respectively. The results of Pearson correlation indicated a direct and significant correlation between attitude (r = 0.527), subjective norm (r = 0.243), and self-efficacy (r = 0.630) together and with behavioral intention. Among the constructs of the extended theory of reasoned action, self-efficacy (r = 0.630) and subjective norm (r = 0.243) had the highest and lowest correlation with behavioral intention of health care providers, respectively. Furthermore, this theory predicted 0.22 variance of attitude, 0.02 variance of subjective norm and 0.49 variance of self-efficacy. Self-efficacy was the strongest and subjective norms was the weakestpredictors of communications skills behavior, respectively. Conclusion: According to the results, it seems that in planning to implement behavioural interventions to promote interpersonal communication skills in healthcare providers, more emphasis should be placed on strategies related to increasing attitude, self-efficacy, and behavioural intention.

One of the main factors that causes health effects in humans such as hospital admissions for cardiovascular disease (HACVD), respiratory disease (RD), lung function, cardiovascular mortality (MCVD), lung cancer, and increased mortality is air pollution especially particulate matter (PM). This a systematic review and meta-analysis aims to investigate the effects of particulate matter on the occurrence of cardiovascular disease and mortality. A systematic review and meta-analysis of the literature was done from 2011 to 2021 based on various databases. Based on the result of this study, subgroup analysis based on temperature conditions showed a different estimation in cold cities (6.24, UR (4.36–8.12)), moderate cities (4.86, UR (3.57–6.15)) and warm cities (8.96, UR (7.06–10.86)). Test of group differences showed a significant difference (Q=12.22, p-value

Eye care is one of the most critical tasks of intensive care unit (ICU) nurses. Patients in this unit are exposed to potential ocular problems due to critical conditions. This study aimed to establish a new eye care protocol for preventing ocular surface disorders in patients admitted to ICU. This was a clinical trial study performed on patients admitted to ICU in 2019. The data gathering tools included the demographic questionnaire, the Schirmer test for dry eye, fluorescein staining and slit lamp manual for examining corneal ulcers, and slit lamp manual to check keratitis and conjunctivitis. A type of eye care protocol was performed on the patient's eyes. After five consecutive days of executing the protocol, the data were analyzed using SPSS software version 18. The use of eye care protocol reduced the risk of keratitis (P=0.027), conjunctivitis (P=0.012), eye dryness (P=0.001), and corneal ulcer (P=0.003) in patients admitted to ICU in the intervention group compared to the control group. Ophthalmology protocols reduced the incidence of keratitis, conjunctivitis, dry eye, and corneal ulcers in ICU patients. Therefore, using this method in ICU patients can improve nursing care.

Funding: Bill & Melinda Gates Foundation. Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. Publisher PDF

Background and aims: Injection drug use is considered as an international public health threat that can lead to serious health-related outcomes. The aim of this study was to obtain a profile of injection drug users (IDUs) in Kermanshah, Iran, in 2017. Methods: This cross-sectional study was carried out on 606 male IDUs who were recruited from 2 drop-in centers in Kermanshah using a snowball sampling method. Continuous and categorical variables are expressed as the mean and standard deviation, as well as frequency and percentage, respectively. Results: The mean age of participants in this study was 36.7±8.51 years and at first drug injection was 29.35±8.04 years. In addition, the highest frequency of injection drugs belonged to heroin (99.00%), methamphetamine (86.00%), and opium (85.00%), respectively. However, the lowest injection drugs were opium syrup (0.50%), ecstasy (0.50%), and amphorphine (0.20%). Conclusion: Based on the findings of this study, heroin, methamphetamine, and opium had the highest frequency injection among male IDUs in Kermanshah, and the age of the first drug injection was low among these individuals. Accordingly, wider coverage prevention programs are highly recommended, including harm reduction programs, counseling centers with improved quality of services, treatment programs, and greater attention to human resource development-based counseling and education.

Background: Globally, the prevalence of HIV infection among People Who Inject Drugs (PWIDs) is higher than the general population due to high-risk behaviors. The aim of this study was to determine ...

Background: Sharing of injecting paraphernalia is known to contribute to hepatitis C virus (HCV) transmission amongst people who inject drugs.Objectives: In this paper, we identify the variables co...

Background: Hepatitis C virus (HCV) infection is global health problem with an estimated 415,000 deaths in 2015. The objective of this study was to explore the direct and indirect effects o...

Background End-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU). Methods This quasi-experimental study was conducted with a pretest–posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected based on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR). Results A significant difference was observed between the intervention and control groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P P Conclusions End-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

Background End-of-life care education is required for nurses to acquire the clinical competence necessary for the improvement of the quality of end-of-life nursing care. The aim of this study was to determine the effect of nursing care education based on End-of-Life Nursing Education Consortium (ELNEC) on the knowledge and performance of nurses working in the intensive care unit (ICU). Materials and Methods This quasi-experimental, randomized, controlled trial was conducted with a pretest-posttest design. From among nurses working in the ICU of Golestan and Imam Khomeini hospitals in Ahvaz, Iran, 80 nurses were selected bsed on the inclusion criteria. They were randomly assigned to the intervention and control groups (40 people in each group) using a table of random numbers. Data were collected using a demographic characteristics form, the ELNEC Knowledge Assessment Test (ELNEC-KAT), ‎and the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PCEP-GR‎). Results A significant difference was observed between the study groups in terms of the average knowledge score in all 9 modules including nursing care, pain management and control, disease symptom management, ethical/legal issues, culture, communication with the patient and his/her family, loss and grief, death, and quality of life (QOL) (P < 0.001). Moreover, the average performance score of nurses in the fields of preparation for providing palliative care, self-assessment of ability to communicate with dying patients and their relatives, self-assessment of knowledge and skills in palliative care increased significantly in the intervention group compared to the control group (P < 0.001). Conclusions End-of-life nursing education is recommended as an effective method for promoting knowledge, attitude, performance, and clinical competence among all nurses involved in end-of-life care.

Background Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic liver diseases. The aim of this study was to evaluate the effect of combined weight loss diet and cranberry supplementation on inflammatory, antioxidant and apoptosis biomarkers in patients with NAFLD. Methods In this randomized, double-blinded, controlled clinical trial, 41 NAFLD patients were supplemented with either a 288-mg cranberry tablet or a placebo tablet for 12 weeks. Both groups followed a diet of 500–1000 calories less than the estimated energy requirements. Serum levels of Total antioxidant capacity (TAC), Malondialdehyde (MDA), Cytokeratin 18-M30 (CK-18 M30), Chemokine C-C motif ligand 2 (CCL2) and Tumour necrosis factor alpha (TNF-α) were measured at both baseline and the end of the study. Results Significant improvements in TAC were observed in the cranberry group and between the two groups (p = 0.006 and p = 0.011 respectively), but the changes in the placebo group were not significant (p = 0.325). There were no statistically significant differences in the serum levels of MDA, CK-18 M30, CCL2 and TNF-α between the cranberry and the placebo groups (p > 0.05). Conclusions It seems that daily consumption of cranberry supplement would be beneficial in increasing serum levels of TAC. Further studies are needed to investigate the effects of anti-inflammatory and antioxidant properties of cranberry on NAFLD. Trial registration : Iranian Registry of Clinical Trial. http://www.irct.ir: IRCT20150124020765N2, January 2019.

Background: Urinary tract infection is one of the most common bacterial infections in children. Zinc is the second most abundant mineral in the body involved in the growth, cell division, and regulation of immune system activity. In studies, zinc administration has been effective in improving pneumonia and gastroenteritis in children, and today, zinc is used to treat acute gastroenteritis in children. Due to the increasing use of various supplements in children and the importance of urinary tract infection and its complications in children. Objectives: This study was performed to compare serum zinc levels between children with febrile urinary tract infection and healthy children. Methods: In this case-control study, serum zinc was measured in 60 healthy children and 60 children with febrile urinary tract infection, without any underlying disease, by an Auto analyzer. Data were analyzed by SPSS version 22 software. Results: The difference in serum zinc levels between the two groups was not statistically significant. There was no statistically significant difference in zinc deficiency between the groups. Serum zinc levels were not associated with sex, age, frequency of urinary tract infection, the severity of leukocytosis, the severity of ESR increase, CRP, and length of hospitalization. In the age group of 24 - 72 months, a significant linear relationship was observed between serum zinc levels and weight. The incidence of urinary tract infections was higher in girls, and this difference was statistically significant in all groups, except in age groups 6 - 12 months and above 72 months. Conclusions: This study showed that low serum zinc levels did not increase the risk of febrile urinary tract infection in children. Therefore, prescribing zinc supplements to treat or prevent urinary tract infections requires further studies.

Background and Objectives: The prevalence of HBV infection among injection drug users (IDUs) is higher than the general population due to high-risk sexual behaviors and the needle sharing. The aim of this study was to determine the prevalence of HBV infection and its effective factors among IDUs of Kermanshah Province in 2016. Methods: This ia descriptive-analytic study was performed in 606 male IDUs in Kermanshah Province in 2016. Data were collected through questionnaires and interviews. HBV was also evaluated through blood tests using the rapid test. Simple and multivariate logistic regression analyses were applied to investigate the factors affecting HBV infection. Data were analyzed using STATA-12 software. Results: The prevalence of positivity HBV antibody was 3% (95% CI: 1.61- 4.32) among male IDUs. According to the results of unit-variable logistic regression analysis, the duration of drug injection (OR = 1.08, 95% CI: 1.02-1.15) and the number of daily injections (OR = 1.38, 95% CI: 1.05-1.81) were risk factors for HBsAg positivity but there were no significant associations in the multivariate regression model. Conclusion: The prevalence of HBV is much higher among IDUs than in the general population. These populations are at risk for viral infections such as HBV; therefore, it is recommended to provide necessary education about the prevention methods as well as the necessary screening for them.

Background: Blood exchange transfusion (ECT) therapy is an essential part of the modern health care for high-risk icteric neonates. Objectives: Therefore, this study sought to examine the effectiveness of monitoring sodium disorders and the required interventions indicating the overall state of health of hospitalized jaundiced neonates. Methods: This prospective analytic study was performed on 49 neonates diagnosed with severe jaundice undergoing screened exchange blood transfusion from November 2018 to May 2019. Serum sodium ion concentrations testing was performed before the exchange, then 1 - 3 hours later, and again 24 hours after receiving ECT, using a sensitive ELISA kit in a laboratory. Using the newest version of SPSS 24 software program, the association between different numerical variables was calculated by a repeated-measure ANOVA test. P < 0.05 criterion was set as the threshold of significance. Results: Out of the total 49 neonates, 24 (48.5%) were girls and 25 (51.5%) were boys, of which 93.9% and 6.1% were term and preterm-born neonates, respectively. The average birth weight was 2843 ± 267/510 g and the mean period of hospital stay was 4.55 ± 2.399 days. The various causes of severe neonatal jaundice of all the hospitalized cases were 45% unknown, 43% combined ABO and Rh incompatibility, 10% breastfeeding pattern, and 2% G6PD deficiency. A continual fall in serum sodium was observed following banked blood exchange (P < 0.05). However, these reversible changes were outside the expected normal range. Despite a diminished sodium concentration, the mean sodium levels were within the laboratory reference range of serum (137 - 142 mEq/L) in all the three measured duration times. Moreover, variation in the amount of serum sodium was associated with an unknown underlying cause that led to neonatal jaundice (P = 0.04) and this difference did not reach statistical significance in terms of birth weight, gestational age, and other causes accounting for high bilirubin (P > 0.05). Conclusions: Given these facts, it was concluded that neonatal jaundice was significantly associated with post-exchange serum sodium changes within the laboratory reference range of serum.

Objective: Although comorbidity of psychotic disorders and substance use can lead to increase in mortality, less is known about the outbreak and predictors. Psychotic patients tend to be overlooked during assessment; hence, the possibility of an undertreated or missed condition such as increasing substance use. This investigation aimed to measure the prevalence of substance use in psychotic patients and to survey the powerful predictors. Method: In a 1-year cross-sectional study, 311 psychotic patients were assessed using the Structured Interview Based on DSM-5 for diagnostic confirmation as well as questions surveying prevalence and possible predictors of substance use. Results: Prevalence of substance use among psychotic patients was 37.9%. Several variables were identified as factors associated with drug abuse among the psychotic patients. These included male gender, younger age, being currently homeless, a history of imprisonment, and having family history of drug use. The strongest predictors of substance use, however, were family history of drug use, male gender, and being currently homelessness. Conclusion: Policymakers should note the importance of substance use among psychotic patients. Developing active screening strategies and comprehensive preventive plans, especially in the high-risk population, is suggested.

In this study, the therapeutic efficacy of quercetin in combination with remdesivir and favipiravir, were evaluated in severe hospitalized COVID-19 patients. Our main objective was to assess the ability of quercetin for preventing the progression of the disease into critical phase, and reducing the levels of inflammatory markers related to SARS-Cov-2 pathogenesis. Through an open-label clinical trial, 60 severe cases were randomly divided into control and intervention groups. During a 7-day period, patients in the control group received antivirals, i.e., remdesivir or favipiravir, while the intervention group was treated with 1000 mg of quercetin daily in addition to the antiviral drugs. According to the results, taking quercetin was significantly associated with partial earlier discharge and reduced serum levels of ALP, q-CRP, and LDH in the intervention group. Furthermore, although the values were in normal range, the statistical outputs showed significant increase in hemoglobin level and respiratory rate in patients who were taking quercetin. Based on our observations, quercetin is safe and effective in lowering the serum levels of ALP, q-CRP, and LDH as critical markers involved in COVID-19 severity. However, according to the non-significant borderline results in comparing the mortality, the ICU-admission rate, and the duration of ICU-admission, further studies can be helpful to compensate the limitations of our study and clarify the therapeutic potential of quercetin in COVID-19 treatments.

A double-blind placebo-controlled randomised clinical trial was conducted on 41 patients with non-alcoholic fatty liver disease (NAFLD). Participants were randomly allocated to receive either a cranberry supplement or a placebo for 12 weeks. Both groups were assigned to follow a weight loss diet. At the end of the study, alanine aminotransferase and insulin decreased significantly in both groups (

introduction: HIV and HCV is a health concern in the word. Therefore, this systematic review and meta-analysis protocol study is aimed to estimate the incidence of HIV and HCV among People who inject drugs (PWID) by applying mathematical modeling. The primary purpose of this systematic review is to identify and review existing studies of HIV and HCV incidence in people who inject drugs, that use mathematical modeling. Methods and analysis: Studies including cohort, cross-sectional, case–control studies which were conducted to estimate incidence of HIV and HCV based on mathematical or evaluated effectiveness of mathematical models will be considered to enroll the review; a comprehensive search with Cochrane approach would be applied to identify relevant studies in electronic databases in the period of 2000 to 2019. This protocol was prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and we will search PubMed, EMBASE, Opengrey, WOS, SCOPUS, and Cochrane Library with no restriction of language. Study selection and data extraction will be performed by two independent reviewers. Assessment of risk of bias will be implemented using three quality test tools including Newcastle Ottawa Scale and ROBIS scale for cross-sectional studies and quantitative studies quality test tool for observational and interventional studies for other study Publication bias will be assessed by funnel plots, Begg’s and Egger’s tests. Heterogeneity will be evaluated using the I2 statistic and the χ2 test. In addition, subgroup analyses will be conducted for population and the secondary outcomes.

Background Although comorbidity of substance use and psychotic disorders can lead to increase in morbidity and mortality, less is known about the prevalence and predictors. Patients with psychosis tend to be overlooked during clinical assessment, therefore, the possibility of a missed or undertreated condition such as substance use increases. This study aims to measure the prevalence of substance use in patients with psychosis and to assess the strongest predictors.Method In a 1 year observational study (October 2017- November 2018), 311 patients with psychosis who were admitted to Razi Psychiatry Hospital; Tehran; Iran were surveyed through The Structured Interview Based on DSM-5 (SCID) for diagnostic confirmation as well as questions assessing prevalence and possible predictors of substance use.Results Prevalence of Substance Use among Psychiatric Patients with Psychosis was 37.9%. In bivariate analysis, several variables were identified as factors correlated with drug abuse among the participants. These included younger age, male gender, being currently homeless, having family history of drug use, and a history of imprisonment. The most powerful predictor of substance use, however, were male gender, Family history of drug use and being currently homelessness.Conclusion The prevalence of substance use was high among all psychotic disorders, therefore, it is suggested that professionals note the importance of substance use among psychotic patients. The most powerful predictors were male gender, history of imprisonment, and family history of drug use. Active investigation and comprehensive preventive plans are suggested in all patients with psychosis especially among high risk population.

Background. Infection with intestinal parasites is widespread worldwide, especially in developing countries. Intestinal parasites are known as one of the leading causes of diarrhea in both immunocompetent and immunocompromised subjects, but cancer patients are highly susceptible to contamination, and it can be deadly for them. This study aimed to estimate the prevalence of intestinal parasites in immunocompromised patients in Ahvaz. Material and Methods. In this descriptive cross-sectional pilot case-control study, fecal samples were collected from 52 children with malignancies hospitalized in Baqaei2 hospital in Ahvaz. A questionnaire including demographic information, type of cancer, type of gastrointestinal symptoms, and laboratory diagnosis was completed for each patient. The collected specimens were examined by direct smear, Logul staining, and concentration. Result. The 52 stool samples were collected, 46% were female and 54% male. The age range of children enrolled in the study was from 4 months to 16 years. Of these stool samples, 38.38% were infected with a variety of parasitic intestinal infections (helminths and protozoa). In this study, protozoan parasites, Blastocystis (23%), Chilomastix mesnili (1.92%), Endolimax nana (7.7%), and Entamoeba coli (1.92%), and helminth infection, Strongyloides stercoralis (3.84%), were observed and statistical analysis showed that there was a significant relationship between gastrointestinal symptoms and parasitic infection in children with cancer. Conclusion. Blastocystis and Endolimax nana are the most prevalent gastrointestinal parasitic protozoans that infect individuals admitted to Baqaei2 Hospital of Ahvaz, Iran. Since parasitic intestinal infections in immunocompromised patients lead to fatal diarrhea, children with parasitic infections must be carefully identified and treated.

Background: Limited studies exist on risky sexual behaviors and sociodemographic variables among people who use drugs. Understanding the social determinants of risky sexual behaviors is important f...

Background: The basic reproduction number (R 0 ) is an important concept in infectious disease epidemiology and the most important parameter to determine the transmissibility of a pathogen. This study aimed to estimate the nine-month trend of time-varying R of COVID-19 epidemic using the serial interval (SI) and Markov Chain Monte Carlo in Lorestan, west of Iran. Study design: Descriptive study. Methods: This study was conducted based on a cross-sectional method. The SI distribution was extracted from data and log-normal, Weibull, and Gamma models were fitted. The estimation of time-varying R 0 , a likelihood-based model was applied, which uses pairs of cases to estimate relative likelihood. Results: In this study, R t was estimated for SI 7-day and 14-day time-lapses from 27 February-14 November 2020. To check the robustness of the R 0 estimations, sensitivity analysis was performed using different SI distributions to estimate the reproduction number in 7-day and 14-day time-lapses. The R 0 ranged from 0.56 to 4.97 and 0.76 to 2.47 for 7-day and 14-day time-lapses. The doubling time was estimated to be 75.51 days (95% CI: 70.41, 81.41). Conclusions: Low R 0 of COVID-19 in some periods in Lorestan, west of Iran, could be an indication of preventive interventions, namely quarantine and isolation. To control the spread of the disease, the reproduction number should be reduced by decreasing the transmission and contact rates and shortening the infectious period.

Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors...

Understanding and increasing awareness on individual risk for HIV infection as well as HIV risk perception’s effects on different behavioral outcomes for people who inject drugs (PWID) is important for policymaking and planning purposes. The objectives of the present study were to determine whether HIV risk perception was associated with greater injection and sexual risk-taking behaviors among PWIDs. We surveyed 460 PWID in Kermanshah regarding their demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Three classes of HIV risk perception were identified using ordinal regression to determine factors associated with HIV risk perception. Study participants were categorized as follows: “low” (n = 100, 22%), “moderate” (n = 150, 32%), and “high” (n = 210, 46%) risk perception for becoming infected with HIV. The odds of categorizing as “high” risk for HIV was significantly greater in PWID that reported unprotected sex (adjusted odds ratio (AOR) 2.4, p value 0.02), receptive syringe sharing (AOR 1.8, p value 0.01), and multiple sex partners (AOR 1.4, p value 0.03). PWID who reported unprotected sex had 2.7 times the odds of “high” risk perception when compared to PWID with “low” risk perception. Findings show that PWID could rate their HIV risk with acceptable accuracy. Additionally, perceived HIV risk was associated with many risk factors for transmission of HIV, emphasizing the importance of developing targeted prevention and harm reduction programs for all domains of risk behaviors, both sexual and drug-related use.

Introduction: Due to the complexity of the situation and rapid changes in patients' clinical status in intensive care units, it is necessary to teach decision-making skills to nurses, alongside critical thinking. The aim of this study was to evaluate critical thinking training by using critical thinking cards on clinical decision-making of nurses in cardiac care units (CCU). Methods: In this quasi-experimental study, 74 CCU nurses from the selected hospitals affiliated to Ahvaz and Dezful Universities of Medical Sciences were selected based on the inclusion criteria and were assigned to either the intervention or the control group by using permuted block randomization. The data were entered into SPSS V22 and analyzed. Results: There was no statistically significant difference between the demographic characteristics of the two groups (P < 0.05). The mean total score of nurses' clinical decision-making before training sessions in the intervention group was calculated to be 141.59 ± 10.76, which was lower compared to a score of 148.56 ± 10.95 in the control group (P = 0.011). Therefore, covariance analysis was used to modify the results. The mean total score of nurses' clinical decision-making after the training in the intervention group was calculated as 163.82 ± 8.83, indicating a significant increase compared to a score of 154.50 ± 11.25 in the control group (P < 0.001). Conclusion: The findings of the present study show that the education of critical thinking by using the critical card tool leads to improved clinical decision-making in CCU nurses.

Background The transition from non-injection to injection drug use dramatically increases the risk of transmitting HIV and other blood borne infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). The aim of this study was to explore factors associated with the transition from first illicit drug use to first injection among drug users. Methods Using snowball sampling and convenience sampling through needle and syringe programmes (NSPs), we recruited 500 people who inject drugs (PWID) in Kermanshah, between September and December 2014. Trained interviewers collected data on socio-demographic characteristics, HIV testing and drug-related risk behaviors over the last month prior to interview using a structured questionnaire. Our main outcome variable was first illicit drug use to first injection (TIJ). TIJ was calculated by subtracting age at first drug injection from age of first illicit drug use. Results Overall, the average age at first drug use and injection were 21.4 [standard deviation (SD 5.6)] and 22.8 (SD 8.9), respectively. The average duration of injection was 6.0 (SD 4.6) years. Overall, the mean of TIJ for participants was 1.4 (IQR = 2, 4) years. Age of first injecting drug use negatively correlated with TIJ (R 2 = 0.219, p = 0.001). Education level and socioeconomic status (SES), and negatively correlated with TIJ. Conclusion Some demographic factors and drug use characteristics including educational level, SES, knowledge of HIV status, age of initiating drug use, being a poly drug user and using methamphetamine were predictors of the time to transition.

Background: Infection with hepatitis C virus (HCV) is increasingly recognized as a major global health problem. Objectives: The aim of this study was to measure the prevalence of HCV infection and determine the risk factors associated with HCV among male people who inject drugs (PWID) in Kermanshah, Iran. Methods: In this cross sectional study, the samples were recruited from 2 drop-in centers and related community outreach sites, using snowball sampling. The questionnaire consisted of 3 sections, including demographics, drug use patterns, and risky behaviors. HCV infection was tested in venous blood samples, collected from the participants, using the ABON rapid test kit. Logistic regression analysis was used to determine the association between HCV status and the associated factors, reported as odds ratio (OR) and 95% confidence interval (CI). Results: The mean age of the participants was 36.7 ± 8.5 years (range, 18 - 65 years). Over half of the participants (54.8%) tested positive for HCV antibodies; in other words, they had been exposed to the virus. Adjusted OR for people reporting shared equipments within the past month was 3.36 times higher than the OR of people who reported no shared equipments (P = 0.000). The adjusted OR of positive HCV among those who injected twice or more per day was 4.33 (P = 0.000), compared to those who injected only once a day (or less). With over half the participants having evidence of HCV exposure, there is a need to increase the coverage of harm-reduction programs, especially sterile injection equipment programs. Moreover, increasing access to harm-reduction programs and HCV treatment can ultimately reduce the opportunities for HCV transmission.

Burn is the most common pediatric injuries all over the world. The aim of this study was to study the epidemiology of burn in under 15-year-old Iranian children by applying a systematic review. The related articles published before 2016 have been gathered from international databases by using the keywords in term of pediatric burns such as ScienceDirect, PubMed, Iranmedex, Google Scholar, Embase, Magiran, and SID. The checklists of STROBE have been applied to evaluate the quality of the reviewed data. A total of 35 relevant studies were extracted and evaluated. In most studies, the incidence of pediatric burns in male patients was more than female patients by 9.5 to 50 cases in 100,000 per children. Mortality rate of pediatric burn was between 1.7 and 18.5%. The most common cause of pediatric burn was hot water or other hot liquids. Pediatric burn in urban areas was higher and the highest number of pediatric burns occurred at home. Burn is considered as one of the major incidents related to children's health that required planning to reduce its incidence, especially in the lower age groups as well as male patients who are more active and susceptible to burn.