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Background and aims: The use of mental healthcare services in type 2 diabetes mellitus (T2DM) patients can depend on socioeconomic status (SES). The current study aimed to evaluate socioeconomic inequality in the perceived need for mental healthcare in patients with T2DM in Hamadan, Western Iran. Methods: This cross-sectional study was conducted between March and July 2023 in Hamadan, Western Iran. The study included T2DM patients who were referred to the Diabetes Center of Hamadan. The variables included in the study were demographics, SES, health insurance status, social support, and self-rated mental health. The outcome of interest was the perceived need for mental healthcare. The socioeconomic inequality was evaluated using concentration index and decomposition analysis. Results: A total of 393 patients (mean age: 56.48±10.65, 62% female and 88% urban inhabitants) were enrolled. The prevalence of perceived need for mental healthcare was 43%, and 50.30% of the patients (85) had delay/avoidance of mental healthcare services. The concentration index (95% confidence interval) of perceived mental healthcare needs was -0.24 (-0.18, -0.30), indicating that perceived needs are more concentrated in the socio-economically disadvantaged patients. Decomposition analysis revealed that low economic status and illiteracy were the main contributors to the inequality (approximately 50%). Cost, minimization, and stigma were the most frequently reported reasons for avoidance/delay of mental healthcare services, respectively. Conclusion: There was a pro-poor socioeconomic inequality in perceived need for mental healthcare among T2DM patients. Healthcare policies and facilities to reduce socioeconomic inequality should mainly focus on disadvantaged T2DM patients.

Abstract Objective Dental caries is a prevalent chronic disease globally, arising from an imbalance between tooth remineralization and demineralization. Early detection of lesions is crucial, with non-invasive methods preferred in the initial stages of caries for enamel remineralization and demineralization prevention. This study aimed to assess the impact of varying contents of boron-doped hydroxyapatite-chitosan nano-composite on the microhardness of demineralized enamel. Materials and methods Boron-doped hydroxyapatite-chitosan nano-composites at concentrations of 0%, 5%, 10%, and 15% were prepared using the sol-gel method. Thirty intact human premolars were collected to evaluate tooth remineralization. The teeth were divided into buccal and lingual halves, subjected to pH cycling for 14 days to demineralize the enamel surface. Subsequently, the specimens were randomly divided into four groups (n = 15) based on the application of remineralizing materials: Group 1 - Hydroxyapatite-chitosan nano-composite (HApC); Group 2 - Boron-doped hydroxyapatite-chitosan nano-composite (B@HApC) with 5% boron concentration; Group 3 - Boron-doped hydroxyapatite-chitosan nano-composite (B@HApC) with 10% boron concentration; and Group 4 - Boron-doped hydroxyapatite-chitosan nano-composite (B@HApC) with 15% boron concentration. Microhardness was measured at three points using a Vickers hardness test (300 g force for 10 s). Results The study revealed a significant difference between the nano-composite groups containing 5%, 10%, and 15% boron compared to the control group (p 0.05). Scanning electron microscope (SEM) results supported the microhardness findings, showing a mineral layer covering the porous structure resulting from enamel surface demineralization in the intervention groups, highlighting the effectiveness of boron in enhancing the microhardness of demineralized enamel. Conclusion The study demonstrated that a content of 15% boron in B@HApC and higher led to increased microhardness of demineralized enamel. Additionally, content of 5% and 10% boron in the nano-composite also improved microhardness, although not to a statistically significant extent.

Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors. Purpose This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews. Methods We conducted a systematic search of international databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist. Results A total of 207,221 children with ASD and 22,993,128 neurotypical children were included. Six meta-analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17–1.52), macrosomia (OR, 1.11; 95% CI, 1.05–1.18), low birth weight (OR, 1.63; 95% CI, 1.48–1.81), very low birth weight (OR, 2.25; 95% CI, 1.79–2.83), small for gestational age (OR,1.17; 95% CI, 1.09–1.24), jaundice (OR, 1.74; 95% CI, 1.42–2.12), male sex (OR, 1.47; 95% CI, 1.39–1.55) and 1-minuteApgar score

Abstract Introduction The constellation of pre and perinatal predictors are introduced as predictor for autism spectrum disorders (ASD), however, the information about the direction and strength of these predictors are lacking in Western, Iran. The current study aimed to determine the pre and perinatal predictors of ASD among children in this region. Methods This case-control study was conducted in Hamadan, Western Iran during January to March 2022. The study included 100 children with ASD who referred to the autism center as case group. Hundred children without ASD from registration system of health service centers were selected as control group and were matched (1:1) to cases by age and place of residency. A structured questionnaire about pre and perinatal predictors of ASD was developed by an expert panel. The questionnaire was administered by interviewing the mothers of children. Results Boy gender (OR: 3.51, 95% CI: 1.74–7.10, p-value

Background and aims: Hemodialysis (HD) is associated with patients’ onset and acceleration of sarcopenia progression. Sleep disorders and mental health issues potentially increase the risk of sarcopenia in patients. However, these associations have not been adequately evaluated in HD patients. Therefore, the current study aimed to estimate the prevalence of sarcopenia and its association with sleep disorders, stress, anxiety, and depression in HD patients. Methods: This cross-sectional study consisted of patients undergoing HD in two hospitals in Hamadan between May and July 2023. Demographic and socioeconomic information, along with data on depression, anxiety, and stress (using the Depression, Anxiety, and Stress Scale-21 Items, DASS-21), sleep disorders (using the Athens Insomnia Scale), and SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire were collected through face-to-face interviews. Data were analyzed using independent t tests, ANOVA, and Pearson correlation coefficient using Stata software version 14. Results: The study included 150 HD patients (age range: 18-88 years; 54.67% male). The results revealed a sarcopenia prevalence rate of 41.3%. Demographic and socioeconomic factors such as gender and education level were found to be associated with sarcopenia. Moreover, positive associations were identified between sarcopenia and various indicators such as stress (r=0.27, P

Background and Objective: Pregnant women are susceptible to sleep disorders due to physiological and hormonal changes. Various demographic, socioeconomic and pregnancy-related factors affect the prevalence of disorders. Knowledge on prevalence of insomnia and related factors in Zahedan is lacking. Therefore, this study aimed to evaluate the prevalence of insomnia and its related factors in pregnant women. Materials and Methods: This study was a cross sectional design in Zahedan, Iran during August 2021 and February 2022. Healthy pregnant women referred to urban comprehensive health centers were recruited. Through a researcher-made checklist, demographic, socioeconomic status (SES) and pregnancy-related features were measured. Insomnia was evaluated using Sleep Condition Indicator (SCI) screening tool. Linear regression analysis was used to analyze the data. The significance level of the statistical tests was considered as P 30 min were 56.3% and 72.0%, respectively. Daytime functioning impairment had a prevalence rate of 57.5%. Multivariable analysis showed that insomnia disorder is more common in women from the middle (β =6.22, P-value=0.002) and second richest economic status (4.26, 0.04), with a weight of more than 75 kg (4.55, 0.04) and in the third trimester of pregnancy (3.39, 0.01). Conclusion: Insomnia symptoms are prevalent among pregnant women in Zahedan. Pregnant women from the middle and second richest economic status, those who are overweight, and in the third trimester should be the target of intervention and educational programs to reduce and manage sleep disorders.

Abstract The kidney cancer (KC) burden measures have changed dramatically in recent years due to changes in exposure to the determinants over time. We aimed to decompose the difference in the KC burden measures between 1990 and 2019. This ecological study included data on the KC burden measures as well as socio-demographic index (SDI), behavioral, dietary, and metabolic risk factors from the global burden of disease study. Non-linear multivariate decomposition analysis was applied to decompose the difference in the burden of KC. Globally, ASIR, ASMR, and ASDR of KC increased from 2.88 to 4.37, from 1.70 to 2.16, and from 46.13 to 54.96 per 100,000 people between 1990 and 2019, respectively. The global burden of KC was more concentrated in developed countries. From 1990 to 2019, the burden of KC has increased the most in Eastern European countries. More than 70% of the difference in the KC burden measures between 1990 and 2019 was due to changes in exposure to the risk factors over time. The SDI, high body mass index (BMI), and alcohol use had the greatest contribution to the difference in the KC burden measures. Changes in characteristics over time, including SDI, high BMI, and alcohol consumption, appear to be important in the evolving landscape of KC worldwide. This finding may help policymakers design policies and implement prevention programs to control and manage KC.

Background: In current years, the increase in older population has led to creating one of the main public health challenges, worldwide. Because of the special characteristics of older adults, this age group is exposed to possible problems, such as mental and physical disorders, that usually affect their functional independence. The study aimed to determine the psychosocial determinants (e.g., depression, social support, and self-efficacy) affecting functional independence among older population. Methods: Our search was conducted on three international databases (Web of Sciences, PubMed/Medline, and Scopus) for all the observational studies (cross-sectional, cohort or longitudinal designs) on the social and psychological determinants of functional independence among older adults. Papers published in English without limitation of time were reviewed from inception to 26 August 2023. The quality assessment tool was the Newcastle-Ottawa Scale (NOS). The I2 index was used to quantify the degree of heterogeneity among the studies. In the case of heterogeneity higher than 50%, the random effects model has been used for overall estimation of the effects; otherwise, the fixed effects model was used. The pooled associations were expressed as odds ratio (OR) and 95% confidence intervals (CIs). Stata version 14 software (StataCorp LP) was used for data analysis. The significance level was considered at 0.05. Results: In the initial search, 6978 articles were retrieved, and finally, considering the inclusion criteria, 46 articles were examined. Finally, 18 articles were eligible for meta-analysis. The findings indicated that among all the determinants affecting functional independence among older adults, depression could lead to a 76% increase in functional dependence. Conclusion: The findings provide a statistically significant relationship between psychosocial factors and functional independence. Depression was the strongest determinant of functional dependence among older adults.

Abstract Introduction and aims Many studies have investigated the relationship between social support and the prevention of elder abuse; however, their results are somehow inconsistent in terms of the association. This systematic review and meta-analysis aimed to investigate the published studies on the relationship between social support and the prevention of elder maltreatment. Materials and methods An electronic search was conducted until January 2023, using such databases as PubMed, Scopus, and Web of Science. The present research included cross-sectional, longitudinal, and case-control studies. Study selection, data extraction, and risk of bias assessment were conducted by two researchers independently. The Newcastle-Ottawa checklist was utilized to evaluate the quality of studies. The random effects model was employed to perform a meta-analysis. Results In total, 32 studies were included in this systematic review, out of which 26 articles were eligible for meta-analysis. The results showed that 68.75% of the studies were of high quality, and there is a significant relationship between social support and elder maltreatment. Accordingly, the lack of social support increased overall maltreatment (odds ratio: 1.24, 95% confidence interval: 1.16–1.33; I2 = 92.3%, p = 0.000)). Moreover, lack of social support had an increasing effect on the level of psychological abuse (1.55, 1.18–2.04; 88.7%, p = 0.000), physical abuse (1.31, 0.42–4.11; 76.3%, p = 0.005), and neglect (2.02, 0.86–4.72; 87.9%, p = 0.000), which shows heterogeneities among the results of the included studies. On the contrary, the lack of social support showed a decreasing effect on financial abuse (0.92, 0.70–1.21; 62.1%, p = 0.022). Conclusion This systematic review provides evidence that social support in the form of structural or functional support may plays an important role in improving the quality of life of the elderly.

Background Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is being encountered more frequently. Purpose In this study, by compiling the evidence from available meta-analyses, an umbrella systematic review was performed of the neonatal risk factors associated with ADHD. Methods The PubMed, Scopus, and Web of Science databases were searched for eligible studies. Only systematic reviews were included. Using a random-effects model, 95% prediction intervals were reported for each risk factor. Three studies were ultimately included in the review. Results Congenital heart disease, short-duration or incomplete breastfeeding, low birth weight, and 5-minute Apgar scores

Abstract Background One of the most common pathologic changes in older people is oral and dental problems. The oral health of older people is a public health concern. Promotion of good oral health for this cohort will have beneficial impacts on the longer-term quality of life. This study aimed to identify the types of health education interventions for the oral health of older people and to determine their effects on the oral and dental health of older people. Methods Potential articles were retrieved from four electronic databases (PubMed/Medline, Scopus, Web of Sciences, and Embase) up to 31 September 2022 in English without limit of time. Experimental and quasi-experimental interventional studies investigating the impact of educational interventions on oral and dental health among older people over 60 years old in both sexes were considered. The quality assessment tool was the Effective Public Health Practice Project (EPHPP). Results In the initial search, 1104 articles were retrieved. Finally, according to the inclusion criteria, 23 studies (seventeen randomized controlled trials (RCT) and six quasi-experimental studies) were reviewed. In this review, educational interventions for older people and their caregivers are classified. Theoretical frameworks were used in only three interventions related to older people. Outcome measures were both self-reported and objective measures. Fifteen of the included studies were of moderate quality. Conclusion This review provides evidence that the use of oral and dental health educational interventions was effective in improving the oral health of older people. Educational interventions were carried out both among older people and among their caregivers. Although a variety of interventions were used in the reviewed studies, more lectures were used in the interventions related to older people. In the interventions related to caregivers, in addition to lectures, practical education was also used. It is recommended to perform higher quality studies for assessing the effectiveness of interventions in this field.

Introduction: The need for privacy was deemed an essential human right. The aim of the study was to examining the level of respect for patients’ privacy from the perspective of operating room personnel and investigating the various factors that influence it. Methods: This cross-sectional study was conducted in OR Hospitals in Hamadan, Iran. A total of 650 Hospital Operating Room personnel were randomly selected. Data were collected using a standard questionnaire, with the reliability of the questionnaire confirmed by Cronbach’s alpha coefficient (alpha coefficient = 0.81). For data analysis, t-tests, ANOVA, and chi-square tests were performed, utilizing SPSS version 22. The significance level was set at 0.05. Results: The studies about 55.1 % were female, 94.3 % were under 25 years of age, and 83.80 % had less than 5 years of work experience. The study found significant differences in privacy adherence based on gender and education, with women and bachelor’s degree holders scoring higher on privacy measures. No significant differences were observed for marital status and age. The Pearson correlation indicated significant relationships between different aspects of privacy. Conclusion: Attention to patient privacy is crucial in hospitals to improve care quality and build patient trust among operating personnel.

Background Previous studies have been showed an association between previous abortion history and risk of Autism spectrum disorders (ASD). However, there is still controversy about true effect estimate of the association. Purpose This meta-analysis aimed to evaluate the association between previous abortion history and the risk of ASD. Methods A systematic search was performed using PubMed, Scopus, and Web of Sciences databases to identify potential studies published until December 2021. The presence of statistical heterogeneity was determined using the I2 value. In the case of substantial heterogeneity, the random-effects model meta-analysis was used to estimate the pooled relative risks. The publication bias was assessed using the Egger and Begg tests. Results Thirteen studies with a total of 331,779 children remained in the present meta-analysis. The estimated odds ratio of the risk of ASD associated with previous abortion history was 1.64 (95% confidence interval [CI], 1.28–2.0; I2=61.7%) in adjusted studies and 1.10 (95% CI, 1.01–1.20; I2=0.0%) in crude studies, based on the random effect model. There was moderate heterogeneity in adjusted studies. The p values for Egger and Begg regression among children with ASD were 0.393 and 0.056, respectively. Conclusion This meta-analysis suggests that children born from mothers with a history of previous abortion have an increased risk of development of ASD compared to children of mothers without a history of previous abortion.

Introduction: There is a strong association between ABO blood groups and increased susceptibility to certain diseases including cardiovascular events, viral and bacterial infections, colorectal cancer, intracranial aneurysms and thromboembolic diseases. The present study was performed aimed to investigate the relationship between maternal blood groups and adverse pregnancy complications. Methods: In this cross-sectional (descriptive-analytical) and retrospective study, the file of 400 pregnant women referred to the maternity hospital of Ali Ebn Abi Taleb Hospital of Zahedan from 2017 to 2019 were included. The variables of this study were ABO blood groups, preeclampsia, eclampsia, placental abruption, gestational diabetes mellitus, preterm labor and intrauterine growth restriction. The data collection tool included an information form in which the required information was entered. Data were analyzed by SPSS (version 22) and chi-square test. P

Abstract Background The present umbrella review evaluated risk factors prior to conception associated with placental abruption based on meta-analyses and systematic reviews. Methods We searched PubMed, Scopus, and Web of Science until June 25, 2021. All meta-analyses that had focused on assessing the risk factors associated with placental abruption were included. We calculated summary effect estimates, 95% CI, heterogeneity I 2, 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Results There was no risk factor in the present umbrella review with the high level of evidence (class I or II). Eight risk factors including maternal asthma (RR 1.29 95% CI 1.14, 1.47), prior cesarean section (RR 1.38, 95% CI 1.35–1.42), cocaine using (RR 4.55, 95% CI 1.78–6.50), endometriosis (OR 1.40, 95% CI 1.12–1.76), chronic hypertension (OR 3.13, 95% CI 2.04–4.80), advanced maternal age (OR 1.44, 95% CI 1.35–1.54), maternal smoking (OR 1.80, 95% CI 1.75–1.85) (RR 1.65, 95% CI 1.51–1.80), and use of assisted reproductive techniques (ART) (OR 1.87, 95% CI 1.70–2.06) were graded as suggestive evidence (class III). The other four risk factors including pre-pregnancy underweight (OR 1.38, 95% CI 1.12–1.70), preeclampsia (OR 1.73, 95% CI 1.47–2.04), uterine leiomyoma (OR 2.63, 95% CI 1.38–3.88), and marijuana use (OR 1.78, 95% CI 1.32–2.40) were graded as risk factors with weak evidence (class IV). Conclusion Maternal asthma, prior cesarean section, cocaine use, endometriosis, chronic hypertension, advanced maternal age, maternal smoking, and use of ART, pre-pregnancy underweight, preeclampsia, uterine leiomyoma, and marijuana use were risk factors associated with placental abruption. Although factors associated with placental abruption have been investigated, the current meta-analytic associations cannot disentangle the complex etiology of placental abruption mainly due to their low quality of evidence.

Introduction: Due to the obvious adverse effects of exposure to free crystalline silica and the high exposure level in silica-related occupations, the present study aimed at the investigation of renal symptoms in cement factory workers. Materials and methods: For this reason, 128 workers who were working cement factory with a determined occupational exposure to crystalline-free silica were selected as the case group, and 143 workers who were working in the Hamedan Province Rural Water and Wastewater company without being exposed to crystalline free silica were selected as controls. Various kidney-related parameters were evaluated and compared between the selected case and control groups. Results: The results of urine analysis between cases and control showed that there was a statistical difference between the cases and controls regarding Red Blood Cell (RBC), epithelial count, and bacteria (p

Background The results differ among published studies regarding exposure to meconium and the risk of developing autism spectrum disorders (ASDs). Purpose The present study pooled all of the epidemiologic studies retrieved from broader databases on the association between meconium exposure and risk of developing ASD in children. Methods The Web of Science, PubMed, Scopus, and Google Scholar databases were searched without language restrictions for articles published between their inception to February 20, 2020, using relevant keywords. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated as random-effect estimates of the associations among studies. A subgroup analysis was conducted to explore any potential sources of heterogeneity among studies. Results The pooled estimate of OR reported a weakly significant association between meconium exposure and ASD development in children (OR, 1.13; 95% CI, 1.03–1.24). There was low heterogeneity among the articles reporting risk for ASD among children (I2=19.3%; P=0.259). The results of subgroup analysis based on meconium exposure showed a significant association between a meconium-stained neonate and ASD development (OR, 1.18; 95% CI, 1.11–1.24). Couclusion Meconium exposure was weakly associated with an increased risk of ASD. However, more evidence based on large prospective cohort studies is required to provide conclusive evidence about whether meconium exposure is associated with an increased risk of ASD development.

The present study aimed to evaluate the effects of Nutrition Bio-shield Superfood (NBS) powder on the immune system function and clinical manifestations in patients with COVID-19. We compare the effects of NBS powder on the immune system function and clinical manifestations among two different groups: 1) intervention group receiving standard treatment scheduled according to treatment guidelines plus NBS powder, and 2) control group receiving only the same standard treatment. The serum levels of IL-2, IL-6, IL-17, IFNγ, and TNFα were determined after four weeks of treatment by specific ELISA kits according to the manufacturer’s instructions. Finally, the level of immune system stimulation and inflammatory markers were compared at baseline and after intervention in both groups. Data were analyzed using SPSS (version 22). A p-value of ≤ 0.05 was set as significant. A total of 47 patients with COVID-19 (24 patients in the intervention group and 23 patients in the control group) were included in this study. Results showed that the differences in the mean decrease of IL-2, IL-6, and TNF-α in the intervention group in comparison to the control group were 0.93, 10.28, and 8.11 pg/ml, respectively (P

This study aimed to investigate the effect of maternal smoking during pregnancy (MSDP) on the risk of bone fractures in the offspring through a systematic review and meta-analysis. The PubMed, Web of Science, and Scopus databases were systematically searched for relevant articles published through July 2019. According to heterogeneity, the pooled risk ratio (RR) and odds ratio (OR) and their corresponding 95% confidence interval (CI) were obtained using fixed or random effects models. The heterogeneity and quality of the included studies were assessed by the I-squared (I2) statistic and the Newcastle-Ottawa scale, respectively. Sensitivity analyses were performed to test the effect of MSDP misclassification on the results. The review of 842 search records yielded 5 studies including 8,746 mother-child pairs that were included in the meta-analysis. Pooling adjusted effect measures showed that MSDP was not associated with a later risk of bone fractures in the offspring (pooled RR, 1.15; 95% CI, 0.84–1.58; I2=66.8%; P=0.049). After the adjustment for misclassification, MSDP may be associated with a 27% increased risk of bone fracture (pooled OR, 1.27; 95% CI, 1.00–1.62; I2=0%; P=0.537). After the adjustment for misclassification, MSDP is associated with an increased risk of bone fractures among children whose mothers smoked during pregnancy.

Current studies have controversial reports about the effect of maternal smoking during pregnancy (MSDP) on the risk of psychiatric disorders among offspring. The purpose of this systematic review and meta-analysis was to assess the effect of MSDP on the risk of Tourette syndrome (TS) and chronic tic disorders (CTD) among offspring. A systematic search using PubMed, Scopus, and Web of Science was conducted up to July 2019 to retrieve potential studies in English. Fixed and random-effects meta-analyses was performed to estimate pooled relative risk (RR) with 95% confidence interval (CI) according to heterogeneity. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Heterogeneity among studies was explored using the I2 statistic. Of the 641 studies from the initial search, 7 were included in the quantitative synthesis (3 cohort and 4 case control studies). Overall, MSDP increased the risk of TS and CTD among the offspring by 35% (pooled RR, 1.35; 95% CI, 1.17–1.56; I2=45.8%; P-value=0.08). The results of this meta-analysis revealed that there is a significant association between MSDP and the risk of TS and CTD in offspring, and MSDP may be considered a potential risk factor for TS and CTD.

Background & Aim: Patients with heart failure experience some outcomes such as poor self-management, poor adherence to treatment and low quality of life. The aim of the current study was to evaluate the effect of self-management based discharge planning on treatment adherence in patients with heart failure. Methods & Materials: In this quasi-experimental research, 80 patients with heart failure hospitalized in teaching hospitals in Zahedan in 2019-2020, were selected by convenience sampling and were randomly allocated into either intervention or control groups. The self-management-based discharge plan consisted of four educational sessions in hospital for the intervention group. In order to follow up, the first call was made 2-3 days after discharge. Then, the patients or their family caregivers were contacted weekly in the first month and twice a month in the second and third month. Data were collected by the treatment adherence questionnaire and were analyzed using independent sample t-test, Fisher exact test, Chi-square and repeated measures ANOVA by the SPSS software version 16. Results: The two-way repeated measures analysis of variance showed a significant difference in the mean scores of treatment adherence over time (P

Background and aims: Cutaneous leishmaniasis (CL) is one of the most important parasitic diseases in the world. Sabzevar city is endemic area for CL in the north east of Iran. The aim of this study was to evaluate the time distribution of cutaneous leishmaniasis (CL) in Sabzevar County using the segmented regression model. Methods: This ecological study used the existing data related to the rural districts of Sabzevar County that were obtained from the Health Deputy of this county during 2011-2017. In addition, the segmented regression model was applied to evaluate the time trend of CLs. Finally, Joinpoint software was used for time series analysis. Results: A total of 1912 CL cases occurred in Sabzevar County from 2011 to 2017, with an incidence rate of 93.61 per 100000. The highest and lowest observed incidence rates were in 2011 (25 per 10000 persons) and 2015 (3.24 per 10000 persons), respectively. Based on the results, the annual incidence of CL in the intended region decreased and the annual percent change was equal to -22.40. Further, the time series analysis using segmented regression by rural districts showed a change point in the trend of the incidence of leishmaniasis in three rural districts (Pain Joveyn and Joghatai in 2014 and Qasabeh-ye Sharqi in 2013). In other words, the trend was different before and after the change point in the mentioned districts. Conclusion: In general, the results indicated that interventional, preventive, and therapeutic measures for breaking the chain of CL transmission in Sabzevar have been desirable in recent years. Eventually, it is suggested that further time-series studies be conducted at the level of the month or a longer interval in order to better evaluate the period effect and secular trend.

ObjectiveTo determine the maternal risk factors associated with preterm delivery in Iran.MethodsA population-based case-control study was conducted including 48 women having preterm delivery (case group) and 100 women having term delivery (control group) between March 2007 and March 2012 in the maternity hospitals of the Selseleh County, Lorestan province, Iran. Information regarding maternal risk factors was collected by structured interview and reviewing the medical records. The maternal risk factors associated with preterm delivery were identified using univariate and multivariable logistic regression analysis after adjusting the sparse data bias. The area under the receiver operating characteristic (ROC) curves was estimated to evaluate the discrimination power of the statistical models.ResultsMultivariable analysis demonstrated that multiparty (odds ratio [OR], 14.23; 95% confidence interval [CI], 1.60–127.05), history of gestational diabetes (OR, 0.10; 95% CI, 0.01–0.99), thyroid dysfunction (OR, 97.32; 95% CI, 5.78–1,637.80), urinary tract infection (OR, 16.60; 95% CI, 3.20–85.92), and taking care during pregnancy (OR, 0.12; 95% CI, 0.03–0.50) had significant impact on preterm delivery after adjusting the potential confounders. The area under the ROC curve for the aforementioned maternal risk factors was 0.86 (95% CI, 0.80–0.92).ConclusionOur study provides evidence for the associations between multiparty, history of gestational diabetes, thyroid dysfunction, urinary tract infection, as well as taking care during pregnancy, and preterm delivery.

Background: Unintentional injuries are one of the major causes of death in Iranian children. Information on epidemiological pattern of injury among one-to 5-year-old children is limited in Hamadan. The aim of this study was to clarify the person, space and time pattern of injury among 1–5-year-old children in Hamadan Province. Methods: All registered incidence cases of injury among 1–5 year-old children in Hamadan Province from March 2009 to March 2015 were included in this cross-sectional study. We analyzed the data on county, gender, age category, type of injury, season and outcome of injury. Temporal trend was explored using time series regression with accounting autocorrelation, seasonality, and short-term variation. Results: This study included 4523 injury cases. During the studied period, urban residents and boys had a higher number of injuries. Motor vehicle-related injuries were the most common type of injury. A seasonality pattern was found so that most of the cases were occurred in summer months. The lowest and highest incidence rate ratios (IRRs) were occurred in January 2011 (IRR = 0.61 with 95% confidence interval [CI]: 0.31, 1.18) and May 2014 and August 2013 (IRR = 6.78 with 95% CI: 4.38, 10.51), respectively. Conclusion: In Hamadan Province, childhood injury has a variation in person, place, and time pattern, as some groups such as boys and urban residents among 1–5 year-old children are at a higher risk for the incidence of injury. Therefore, it is recommended that health service managers and health policymakers devote more healthcare and resources to the high-risk groups.

Objective: Effective rehabilitation and better quality of life among stroke patients are functions of several factors such as quality and pattern of sleep. The present study aimed to evaluate sleep quality and related determinants in such patients. Method: The present cross-sectional study was performed from October to December 2019 among stroke patients who were admitted to Sina Hospital, Hamadan, Iran. We used the Pittsburgh Sleep Quality Index (PSQI) questionnaire to determine sleep quality in these patients. Significant determinants of the global score of PSQI were identified via multivariable linear regression. Results: A total of 97 stroke patients (age 67±79 years, 55.7% male) were enrolled into the study. Prevalence of poor sleep was 0.84 (95% CI: 0.75, 0.91) in stroke patients. Patients with nervous tension and those with surgical treatment and with Non-hemorrhagic CT scan had a predicted increase of 1.65, 2.91 and 3.25 in the mean of the global PSQI score (P ≤ 0.05), respectively. Conclusion: Nervous tension, treatment method, results of CT scan and cardiac problems may be associated with post-stroke sleep disorder.

Backgrounds and Aims: Stomach cancer (SC) is the fourth most common cancer and the second leading cause of death due to cancer in the world. The aim of this study was to investigate the provincial distribution as well as age-specific incidence of SC in both genders across Iran. Materials and Methods: This ecological study was conducted according to re-analysis of medical records aggregated to provinces from National Registry of Cancer and Disease Control and Prevention report of the Ministry of Health and Medical Education for SC in 2008. For each province, the average annual age-standardised rate (ASR) for the incidence of SC was calculated. Results: Our findings showed that in Iran, adenocarcinoma, not otherwise specified, was the most common histological type of SC in both genders (59% in males and 56% in females), while intestinal type of adenocarcinoma had the lowest prevalence (14% in males and 12% in females). In age groups above 45 years, there was a steady upward trend, and the highest ASR in both genders was related to 80–84 years of age with 292.14 and 112/100,000 in males and females, respectively. Conclusion: The assessment of geographical distribution showed that there is a wide geographical variation in the incidence of SC across the 31 provinces of Iran, and the ASR of SC in South-East and North-West parts of Iran was higher than any other areas. Thus, development access to screening services and carryout of prevention programs should be considered for high-risk groups in these areas.

OBJECTIVES Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections. METHODS This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models. RESULTS In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females). CONCLUSIONS We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

Objective: Cervical cancer (CC) is the third most common cancer in women after breast and colorectal cancers and is one of the leading causes of cancer death among women in the world. The aim this study is associations of cervix cancer incidence and mortality rates with Human Development Index (HDI). Methods: The Information of the incidence and mortality rates of CC obtained from the GLOBOCAN cancer project in year 2012 and data for the HDI 2013 obtained from the World Bank database. The linear regression models were used for assessment of the HDI effect on CC occurrence rates. Inequality in the age-specific incidence and mortality rates (ASR) of CC according to the HDI were assessed by using concentration index. Results: The results of this study that incidence and mortality rates of CC were very higher in regions with low & median HDI as compared to regions that had very high & high HDI, indeed Death and incidence from CC were more concentrated in low HDI countries. There was significant negative association between cervix cancer incidence and mortality rates with all the components of HDI including life expectancy (B= -0.98, P

Introduction: The objectives of this study were to provide an estimate of the prevalence of metabolic syndrome (MetS) and its components among women with PCOS; and calculate the odds ratio (OR) for MetS (using different definitions of MetS) in women with PCOS, compared to healthy controls. Methods: All of the relevant databases were used to search for appropriate articles that were published during the period 2003-2016. We included observational studies (cross-sectional, comparative cross-sectional) among women who met the inclusion criteria. The random-effect models were used to pool the prevalence of MetS and its components among PCOS women. This model was also applied to the pooled OR assessing the association between MetS and PCOS. Results: The pooled prevalence of MetS among PCOS women was found to be 26.30% (95% CI: 23.68–28.93), but varied from 7.10% (95% CI: 1.64-12.56) to 37.50% (95% CI: 28.84-46.16), depending upon the diagnostic criteria used. Low high-density lipoprotein cholesterol (HDL) - 61.87% (95% CI: 53.31–70.43) and high waist circumference (WC)- 52.23% (95% CI: 43.84–60.61) were the most common components of MetS in PCOS women. Compared to healthy controls, the overall pooled (OR) of MetS in PCOS patients was 2.09 (95% CI: 1.67-2.60), but this ranged from 0.31 (95% CI: 0.13-0.74) to 4.69 (95% CI: 2.09-10.52), depending upon the diagnostic criteria used. Conclusion: Women with PCOS had a much higher prevalence of MetS than was found among the healthy controls. Furthermore, as low HDL and high WC were the most common components of MetS in PCOS women, these two components specifically need to be addressed in prevention strategies.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the main causes of severe liver failure worldwide. This study was conducted to evaluate the incidence rate and trend of these infections over six successive years from 2008 to 2013 in Ilam Province, western Iran. Methods: We studied the registered data of HBV and HCV based on the National Notifiable Diseases Surveillance System in Ilam Province from 2008 to 2013. Incidence rate per 100,000 populations was estimated for HBV and HCV infections through location, years and age groups of patients. Results: The overall incidence rate per 100,000 populations from 2008 to 2013 for HBV infection was 9.57, 5.83, 16.26, 12.44, 21.89 and 13.93, respectively. The corresponding values for HCV infection were 0.55, 0.72, 1.44, 2.69, 1.24 and 1.93, respectively and these trends for both the HBV and HCV infections were increasing. The major distribution of HBV and HCV infections was 25-44 years of age. Both HBV and HCV infections were more common in males, urban areas and married patients. Forty-one percent of cases were carriers and history of surgery was the common risk factor. Conclusions: Our results showed that HBV and HCV are prevalent in the middle-age group. Despite effective vaccination against hepatitis B, optimized blood donor screening and better sterilization procedures for blood products, trend of HBV and HCV in Ilam are increasing. Further studies should address the role other risk factors in the trend of HBV and HCV.

Background: Regarding the geographical variations of the disease and recent changes of ecosystems, this study aimed to investigate the geographic patterns and trends of human brucellosis in Hamadan province, west of Iran. Methods: This is a cross-sectional study on brucellosis cases recorded by provincial authorities of brucellosis national surveillance system at Hamadan University of Medical Sciences from March 2009 to March 2015. Cochran–Armitage test and Poisson regression models were used to obtain standardised rates for the disease. Results: Of all 9318 recorded cases, 62.83% were female and 81% were rural residents. The observed number of cases exceeded expected in almost all of the cities, except for Hamadan, Bahar and Asadabad. Conclusion: The clusters of disease occurrence were more evident in areas of the province with better agriculture coverage. This finding provides more in-depth clues to detect special transmission routes and would help mobilise educational and preventive measures for specific occupational groups.

Background: Lung cancer is one of the most common cancers and most frequent cause of cancer-related death worldwide. In Iran, this cancer ranks second in cancerrelated deaths for men and third for women. The aim of this study is to discover the geographic distribution of the age-standardized incidence rate for lung cancer in both genders in Iran. Methods: This ecological study used re-analysis medical records aggregated to provinces from the National Registry of Cancer and Disease Control and Prevention Report of the Ministry of Health and Medical Education for lung cancer in 2008. For each province, we calculated the average annual age-standardized incidence rate. Results:Our study showed that squamous cell carcinoma and adenocarcinoma were the most common histological types of lung cancer in males (28.6%) and females (28.8%). The central and southern Iranian provinces had the highest age-standardized incidence rates for lung cancer. The highest age-standardized incidence rates in both genders related to the 80-84 year age group for both males (131.51) and females (38.82). Conclusion: The central and southern Iranian provinces are lung cancer hot zones. Thus, implementation of prevention programs and increased access to screening services should be considered.

Background: Human brucellosis and recurrent brucellosis is an ever-increasing public health concern, especially in endemic areas like Iran. Nevertheless, little is known regarding the epidemiology and determinants of recurrent brucellosis. Therefore, the objective of this study was to investigate epidemiological patterns and potential determinants of recurrent brucellosis in Hamadan Province during the years 2009–2015. Methods: Data on reported cases of new and recurrent brucellosis from 2009 to 2015 were obtained from the provincial Notifiable Diseases Surveillance System at Hamadan University of Medical Sciences. Incidence rates per 100 000 were estimated at the county level. Binary logistic regression was used to estimate the effects of background characteristics and recurrent brucellosis. The power of discrimination of the model for recurrent brucellosis was assessed using the area under the curve (AUC). Results: Among 7318 brucellosis cases, the total frequency (%) of recurrent cases was 472 (6.45%). The rate of recurrent brucellosis was higher in females, people aged 50 years and over, people with a history of consuming unpasteurized dairy products with no history of contact with animals, and in the winter season. Multivariable logistic regression analysis showed that female sex (adjusted odds ratio (AOR) 1.36, 95% confidence interval (CI) 1.13–1.65), age ≥55 years (AOR 4.15, 95% CI 2.32–7.42), consumption of unpasteurized dairy products (AOR 1.16, 95% CI 0.96–1.40), and winter season (AOR 1.32, 95% CI 1.03–1.71) are potential risk factors for recurrent brucellosis. The final model that involved all the determinants showed moderate discrimination (AUC 0.61). Conclusions: Female sex, older age, and winter months were found to be significant determinants of recurrent human brucellosis. Enhanced surveillance systems with an emphasis on these population characteristics will allow effective preventive and protective measures to be implemented and might alleviate the recurrence of brucellosis in the country.

Background: Esophageal cancer is the second most common malignancy in Iranian men and third most common in Iranian women.The aim of this study is to discover the geographic distribution for age-standardized incidence rate of esophageal cancer among both genders in Iran. Methods: This ecological study used re-analysis medical records aggregated to provinces from the National Cancer Registry and Disease Control and Prevention Report of the Ministry of Health and Medical Education for esophageal cancer in 2008. For each province, we calculated the average annual age-standardized incidence rate. Results: Squamous cell carcinoma was the most common histological type of esophageal cancer in males (65.4%) and females (75%). The age-standardized incidence rate for esophageal cancer in Western, Northwest, Northern and Northeast provinces of Iran were higher than other provinces. We observed the highest agestandardized incidence rate in both genders in the 80-84 year age group with 147.5 in males and 114.5 in females. Conclusion: Given that the Western, Northwest, Northern, and Northeast provinces were hot zones for esophageal cancer in Iran, increased access to screening services and implementation of prevention programs should be considered.

BACKGROUND: Obesity is considered as a major health problem of children and adolescents. The present meta-analysis was conducted by extensive search of studies on the prevalence of obesity among school-aged children and youth aged 6-18 years in Iran. METHODS: All conducted cross-sectional studies on the prevalence of obesity in Iranian students in all grades were extracted, without applying any restriction on time in national and international databases including Magiran, Iranmedex, SID, Scopus, Google Scholar, and PubMed. Statistical software Stata 12 was used to analyze the data and to obtain the prevalence of obesity among Iranian students. The heterogeneity between the results was determined using statistical test I2. RESULTS: In this meta-analysis, 51 papers met our inclusion criteria and were therefore considered for the analysis. The prevalence of obesity was equal to 5.82% [95% confidence interval (CI): 5-6.66] in Iranian students. The prevalence of obesity was higher in boys than in girls (6.85% compared to 5.13%) (P = 0.300). The highest prevalence of obesity was related to students living in the North and Northwest areas with 7.07% (95% CI: 4.35-9.78). CONCLUSION: The prevalence of obesity among Iranian students is not high when compared to Western countries. However, due to lifestyle changes in recent years, it is necessary to plan intervention programs within families and schools to improve dietary patterns and physical activity of this age group.

Background: Geographic differences in the incidence of cancers may suggest unique genetic or environmental exposures that impact the risk of acquiring cancer. This research aims to determine the incidence rate and geographical distribution of common cancers among Iranian children. Methods: In this ecological study, we extracted data that pertained to the incidence rate of common cancers among children from reports by the National Registry of Cancer and Disease Control and Prevention in 2008. A map of the cancer incidence rates was designed by using geographic information system. Results:The most common cancer sites among children were the hematology system, brain and central nervous system, and lymph nodes. The central provinces had the lowest cancer incidences. Conclusion: The considerable variation in incidence of childhood cancers in Iran suggests a possible potential environmental risk factor or genetic background related to this increased risk among children.

Introduction: Identifying factors that delay diagnosis of tuberculosis (TB) are important for the health system when timely patient treatment and reducing TB transmission are desirable goals. Aim of this study was to investigate the prognostic factors that delay TB diagnosis. Material and methods: This retrospective cohort study used National TB Program (NTP) data from 1056 TB patients during 2006–2014 in Hamadan province, western Iran. The Cox regression model was performed to determine associations between baseline explanatory variables and survival outcome with Hazard Ratio HRs (95% CIs). Results: N (%) of delay in TB diagnosis more than 90 days was significantly higher in male patients, new case patients and pulmonary positive cases. After adjustment for covariates, HR (95% CI) in relapsed TB compared to new cases was 0.67 (0.53, 0.85) and these figures for positive pulmonary cases and extra pulmonary cases in compared to negative pulmonary cases were 0.80 (0.68, 0.94) and 0.84 (0.73, 0.98) respectively. Conclusion: A high proportion of patients had delays in diagnosis exceeding three months. Our findings suggest that male gender, new cases, positive and extra pulmonary cases might increase the risk for delayeddiagnosis among TB patients.

Background: The association of the mobile phone use and risk of brain tumor remains controversial among radiation epidemiologists. Methods: We hypothesized if an association between brain tumor and mobile phone use exists, this association will be manifested as a cohort effect (as a proxy of association between mobile phone use and brain tumor) in the incidence rates of brain tumor during the period of 1990 to 2009. We used age-period-cohort methodology (generalized log-linear model) and compared the distribution of cohort effects in the observed rates of brain tumor from 1990 to 2009 to the cohort effects from rates driven based on epidemiological study results that reported a positive association between brain tumor and mobile phone use in the Nordic population. Three latency period of 1-4 years with odds ratio (OR) of 1.2, latency period of 5-9 years with OR of 1.3, and latency period of more than 10 years with OR of 2.7 were used to estimate expected rates. Results: The distribution of cohort effects between observed and expected rates were more similar among the males compared with females. A shorter latency was more con¬sistent to observed rates. Conclusion: Our study supports a possible a weak association between mobile phone use and brain tumor; further fueling the controversies in association.

Objective: To describe the current situation of animal bites in the Babol County, North of Iran. Methods: This was a cross-sectional study based on recently collected data of 3798 victims bitten (656 females and 3142 males) from 2010 to 2014 in the Health Center of Babol, Iran. The interest variables in the study included demographic variables, characteristics of animal, some of the time patterns, and some clinical patterns provided to victims. Results: The average age of victims was (33.68 ± 17.23) years. The age group with the max proportion (for males, 32.1%; for females, 26.2%) of bites occurred in 18–30 years old group for males and 30–45 years for females. The ratio of male victims to female ones was 4.78. In terms of place of incident, 2502 (65.9%) cases of animal bites occurred in rural areas. Dogs and cats were the most dominant biters with 3340 (87.9%) and 395 (10.4%) bites, respectively. For the kinds of biters, 3643 (95.9%) were pets, 133 (3.5%) were strays and 22 (0.6%) were wild animals. Most of the lesions were on shoulder as well as upper organs (46.9%) and lower organs (41.0%), respectively. Conclusions: Since the average age of the subjects with injuries on the head and upper organs was lower than that of victims with other organs injured and since that pet dogs were the major biter, structured monitoring programs that focus on specified target groups in collaboration with other organizations are essential to control the animal bites.

Cancer is one of the leading causes of death worldwide and among Iranian population; cancer is the third important causes of death. It is a critical issue to identify sex and age group difference of cancer pattern for planning and management of cancer patients, therefore the aim of present study was to examine sex and age difference in cancer incidence during 2003-2008 in Iran. The National Cancer Registry (NCR) reports from 2003 to 2008 have been applied to test trend of cancer incidence and illustrating sex-age disparity of most common cancers in Iran. Direct adjustment method was used for computing the age-specific rates (ASRs) and Cochran-Armitage tests for trends were used to test statistical significance of cancer incidence rate in both genders during 2003-2008. Our findings indicated that male and female incidence rate is increased from 64.2 to 117.5 and from 50.1 to 105.8, respectively during 2003-2008 (P for trend

OBJECTIVES This study aimed to map the incidence of cutaneous leishmaniasis (CL) in Iranian army units (IAUs) and to identify possible spatial clusters. METHODS This ecological study investigated incident cases of CL between 2014 and 2017. CL data were extracted from the CL registry maintained by the deputy of health of AJA University of Medical Sciences. The standardized incidence ratio (SIR) of CL was computed with a Besag, York, and Mollié model. The purely spatial scan statistic was employed to detect the most likely high-and low-rate clusters and to obtain the observed-to-expected (O/E) ratio for each detected cluster. The statistical significance of the clusters was assessed using the log likelihood ratio (LLR) test and Monte Carlo hypothesis testing. RESULTS A total of 1,144 new CL cases occurred in IAUs from 2014 to 2017, with an incidence rate of 260 per 100,000. Isfahan and Khuzestan Provinces were found to have more CL cases than expected in all studied years (SIR>1), while Kermanshah, Kerman, and Fars Provinces were observed to have been high-risk areas in only some years of the study period. The most significant CL cluster was in Kermanshah Province (O/E, 67.88; LLR, 1,200.62; p

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Introduction: Liver cancer (LC) is one of the most common malignant tumors worldwide which have been a major public health challenge worldwide. This study aimed to identify the globally effect of HDI in the incidence and mortality rates of liver LC. Material & Methods: Data about the incidence and mortality rate of LC for the year 2012 was obtained from the global cancer project for 172 countries. Data about the HDI and other indices were obtained for 169 countries from the United Nations Development Programme database in 2012. Linear regression models were used for assessment of the HDI effect on LC occurrence rates. Inequality in the age-specific incidence and mortality rates (ASR) of LC according to the HDI were assessed by using concentration index. Results: Linear regression model showed that increasing of HDI had a negative effect on increase in both incidence (B=-12.2, P=0.03) and mortality (B=-12.7, P=0.015) rates of LC. The mean of life expectancy at birth, mean years of schooling, GNI per capita, percent of urbanization, and age standardized obesity had also a negative effect on increasing in both incidence and mortality rates. Conclusion: incidence and mortality rate of LC are significantly concentrated in regions with medium and low HDI. Negative relationship between LC incidence and mortality with HDI and its component can be considered as targets for prevention and treatment intervention or tracking geographic disparities. Keywords: Liver cancer, Human Development Index, Incidence, Mortality

Background: Knowledge about risk or protective factors for post-treatment outcomes in Cutaneous Lishmaniosis are rare, especially in endemic areas such as Iran. The present study aimed to evaluate the association between the outcome of infection, clinical manifestation, and treatment with adverse post-treatment outcomes in Cutaneous Lishmaniosis patients. Methods: This was a cross sectional study based on recently collected data of 9077 Cutaneous Lishmaniosis patients (4585 female and 4492 male) from March 2003 to March 2011 in the Bam area, Iran. Multivariable multinomial logistic regression was applied to assess the effect of outcome of infection, clinical manifestation and treatment on relapse, treatment after interruption, treatment failure and clinical resistance. Results: Head lesions were strongest risk factor for relapse (Odds Ratio, OR=4.21; CI 95%: 3.56-4.98), treatment after interruption (2.00; 1.70-2.35), treatment failure (6.61; 5.17-8.45) and clinical resistance (2.62; 2.00-3.44). Family occurrence (yes vs. no), intra lesion therapy method, treatment duration (>3 v. ≤ 3 week) and source of detection by Surveillance (active vs. passive), were the most protective factors for relapse (OR=0.58; CI 95%: 0.46-0.74), treatment after interruption (0.36; 0.31-0.42) treatment failure (0.24; 0.20-0.29) and clinical resistance (0.24; 0.09-0.67). Conclusion: Head lesions and treatment variables (e.g. therapy method and duration) could predict the occurrence of adverse post-term outcomes of Cutaneous Lishmaniosis. Further longitudinal studies have to clarify cause and effect relationships.

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Province Disparity on Female Breast Cancer in Iran

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The effect of socioeconomic status on adolescent smoking behaviors is unclear, and sparse studies are available about the potential association. The present study aimed to measure and explain socioeconomic inequality in smoking behavior among a sample of Iranian adolescents. In a cross-sectional survey, a multistage sample of adolescents ( n = 1,064) was recruited from high school students in Zanjan city, northwest of Iran. Principal component analysis was used to measure economic status of adolescents. Concentration index was used to measure socioeconomic inequality in smoking behavior, and then it was decomposed to reveal inequality contributors. Concentration index and its 95% confidence interval for never, experimental, and regular smoking behaviors were 0.004 [−0.03, 0.04], 0.05 [0.02, 0.11], and −0.10 [−0.04, −0.19], respectively. The contribution of economic status to measured inequality in experimental and regular smoking was 80.0% and 68.8%, respectively. Household economic status could be targeted as one of the relevant factors in the unequal distribution of smoking behavior among adolescents.

OBJECTIVES The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran. METHODS The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters. RESULTS There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p