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BackgroundEstimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. However, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. In this study, we estimated the population size of these groups using the indirect Network Scale-Up (NSU) method in Iran from 2015 to 2016.MethodsUsing a self-administered questionnaire, we asked 15 124 individuals (54% men) about the number of people they know who used different types of drugs at least once in the past 12 months. Prevalence estimates were reported per 100 000 population. The uncertainty level (UL) was calculated using the bootstrap method.ResultsThe average age of the respondents was 33 years old, and 35.1% of them were unmarried. The most common drugs and their prevalence were as follows: opium (2534 [95% UL: 2467-2598]), hashish (849 [95% UL: 811-886]), stimulants (methamphetamine, ecstasy pills, cocaine, and Ritalin) (842 [95% UL: 802-879]), heroin/crack (578 [95% UL: 550-607]), and drug injection (459 [95% UL: 438-484]). Additionally, we estimated the prevalence of alcohol use as 2797 (95% UL: 2731-2861). On average, substance use was 5.23 times more prevalent among men than women. Opium use was more prevalent among individuals aged >50 years old. Moreover, alcohol use was more prevalent among participants between 18 and 30 years old (5164 per 100 000 population).ConclusionAlthough opium continues to be the most prevalent illicit drug in Iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. Age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups.

BackgroundThis study was aimed to determine the prevalence, predictors and cost of CAM practitioner use among traumatic patients in Iran.MethodsThis cross-sectional household survey of a nationally representative sample of Iranians 15 to 64 yr old was conducted in 2011, using a three-stage cluster sampling. Short Form Injury Questionnaire 7 (SFIQ7) was utilized through face-to-face interviews and data on demographics, history of injuries, mechanism, site and type of injury, type and place of the treatment were attained. Via telephone calls, service use and costs of treatment were also collected.ResultsThe prevalence of CAM practitioner use in injured people and victims seeking medical care was 0.7% and 4.1%, respectively in 3-month interval in 2011. There were no significant sociodemographic differences between victims who seek unconventional settings and those who seek conventional treatment. The most common injury description treated by CAM providers was as follows: fracture (type of injury), upper limb (site of injury), fall (mechanism of injury) and cast, splint, and physiotherapy (type of treatment). The average medical cost of CAM practitioner was US$14.7 while this amount in the conventional setting was US$195.5.ConclusionUse of CAM is not very common among injured people in Iran. However, due to lack of formal training, CAM usage has possible side effects.

BackgroundFew studies suggest that social network factors, including size of sexual network may associate with drug-related and sexual high-risk behaviors. The objective of this study is to investigate injecting and sexual networks and sociodemographic factors that might be associated with dual HIV risk (DHR) among people who inject drug (PWID).MethodsThe data from a cross-sectional study of 455 PWID that were recruited through peer-referral sampling were used in this study. The data were collected using a structured questionnaire consisted of modules on sociodemographic characteristics, sexual and injection-related risk behaviors during 12 months before the interview. DHR was defined as engaged in both using a syringe previously used by other PWIDs and unprotected sex during last 12 months. Data analysis was performed with descriptive and logistic regression. In final model, we considered variables with P < 0.500 as statistically significant. Finally, reported adjusted odds ratio (AOR) and confidence interval (95% CI) for variables that were significant in the final model.FindingsA total of 455 men who injected drugs participated in this study. The mean age ± standard deviation (SD) was 33.2 ± 7.3 (range 19-58) years. Overall, the prevalence of DHR In the last 12 months, 38% (95% CI: 18.3-51.2%). Multivariate model showed that regular visit to needle, syringe programs (NSPs) reduced odd of HDR to 50% when adjusted for other covariates, but still remained statistically significant (P < 0.050). The odds of reporting DHR was significantly higher in those ≥ 2 sex partners and injection partner (P < 0.010). Odds of DHR was higher (AOR: 2.3) among participants who had more than 2 injection per day but was not statistically significant (P > 0.050).ConclusionDHR was common in PWID in Kermanshah, Iran. Having multiple injecting and sexual partners increased the odds of engaging in dual risk behaviors, but regular visit of NSPs can reduce the DHR among PWID.

BackgroundIt is unclear whether knowing of current HIV status is associated with change in injecting behaviors among people who inject drugs (PWID) in Iran. The objective of the present study was to determine whether awareness of HIV positive status is associated with a reduction in injecting risk behaviors, after matching for socio-demographic characteristics.MethodsFive hundred male PWID were recruited in 2014 from two drop-in centers (DICs) in Kermanshah west of Iran. 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 primary exposure of interest was awareness of HIV status, used to group participants into three categories: positive, negative, unaware. We used coarsened exact matching to make the three groups statistically equivalent based on age, place of residence, education and income, and then compared them regarding the proportion of borrowing, lending and reuse of syringes.ResultsMatched sample (n=320) had a mean age ± standard deviation (SD) of 33.5 ±7.6 yr. Overall, 25% (95% CI: 14%, 32%) of participants reported "borrowing a syringe" in the past month and 15% (95% CI: 7%, 22%) of them reported "lending a used syringe" to others in the past month. In comparison to PWID who were unaware of their HIV status, those knew they were HIV positive (OR 1.68, CI95%1.32-2.81) or negative (OR 1.54; 95% CI: 1.28, 2.71) were both more likely to report borrowing syringes in past month.ConclusionsPWID WHO know they are positive for HIV are more likely to borrow another person's syringe, to report reuse of their own used syringes and less likely to report lending their syringes to others. Strategies to scale up HIV testing and counseling for PWID, which also increase awareness of HIV status, may decrease injecting related the risk behaviors.

Background: From March to April 2019, a flood occurred in several regions of Iran. The most affected provinces were Golestan, Lorestan, and Khuzestan. Aims: The present study aimed to determine the prevalence and determinants of psychological distress and depression among the affected adult population 6 months after the event. Methods: A cross-sectional household survey with face-to-face interview was carried out on a random sample of 1,671 adults aged above 15 years living in the flood-affected areas from August to September 2019. We applied GHQ-28 and PHQ-9 for the assessment of psychological distress and depression, respectively. Results: The prevalence of psychological distress and depression were 33.6% (95% CI [29.5, 37.7]) and 23.0% (95% CI [19.4, 26.7]), respectively. Determinants of psychological distress were a history of mental disorders (Adjusted odds ratio [AOR] = 4.7), primary (AOR = 2.9) or high school (AOR = 2.4) education (vs. university), no compensation received (AOR = 2.1), high damage to assets (AOR = 1.8), the house flooded more than 1 m (AOR = 1.8), female gender (AOR = 1.8), and limited access to health care services (AOR = 1.8). Determinants of depression were unemployment (AOR = 5.3) or being a housewife (AOR = 2.7), a history of mental disorders (AOR = 4.1), high damage to assets (AOR = 2.5), no compensation received (AOR = 2.0), the house flooded more than 1 m (AOR = 1.8), limited access to health care services (AOR = 1.8), and high wealth index (AOR = 1.7). Conclusion: The results of this study revealed a high prevalence of psychological distress and depression in the flood-affected adult population. The high-risk group, particularly flood victims who had a history of mental disorders, and those exposed to severe damages of flood, should be prioritized for screening, and mental health services. [ABSTRACT FROM AUTHOR]

Hotspot mapping of People Who Inject Drugs (PWIDs) is important for harm reduction program planning. The aim of this study is to estimate the numbers of PWIDs and their geographic distribution in Iran. We used the hotspot mapping and size estimation method to estimate the number of drug users in four cities of Iran from December 2017 to January 2019. We calculated three estimates in each hotspot: a) Key Affected Population Key Informant (KAP-KI) estimate (drug users met in the hotspot), b) Non-KAP KI estimate (e.g., taxi drivers, shopkeepers nearby the hotspot); c) estimation made by field observers. Locations of hotspots were recorded by the field team and ArcGIS software was used for mapping. A total number of 335 hotspots were identified in four cities and 1524 key informants were interviewed. The forty four per cent of identified hotspots received harm reduction services. Ahvaz had the highest estimated number of PWIDs (843, range: 703–887), followed by Sari (346, range: 307–666), Yazd (228, range: 221–471) and district 2 of Tehran (18, range: 18–34). Findings highlight the need to use hotspot mapping to identify new PWIDs hotspots and best location for drop-in centers (DIC) and to provide targeted harm reduction programs. [ABSTRACT FROM AUTHOR]

There are insufficient accurate data on the prevalence of substance use among children in Iran. WHO is conducting a survey to study the prevalence of substance use among children in Iran. This manuscript describes the method that was used for developing the tools for the aforementioned survey. A literature review was done on the risk factors, existing scales, and special considerations in conducting a substance use survey on children. The identified risk factors were then prioritized, and standard scales were selected for each. Based on the priority and the cultural and psychosocial properties of each age group, the methods of the survey were defined. Then, a qualitative assessment on content validity was done, and the tool was piloted among 90 participants. The tool contained 104 items for the 9- to 12-year-olds age group, and 168 items for each of the 12- to 15-year-olds and 15- to 18-year-olds age groups, respectively. The results of the Cronbach's Alpha analysis showed a coefficient of 0.754 for the 9- to 12-year-olds age group, 0.735 for 12- to 15-year-olds, and 0.889 for the 15- to 18-year-olds. The developed tool considered socio-cultural acceptability, cognitive, and ethical standards and showed high reliability and validity. [ABSTRACT FROM AUTHOR]

Background: Estimating the number of people using illicit drugs and alcohol is necessary for informing health policy and programming. However, it is often challenging to reliably estimate the size of these marginalized populations through direct methods. In this study, we estimated the population size of these groups using the indirect Network Scale-Up (NSU) method in Iran from 2015 to 2016. Methods: Using a self-administered questionnaire, we asked 15 124 individuals (54% men) about the number of people they know who used different types of drugs at least once in the past 12 months. Prevalence estimates were reported per 100 000 population. The uncertainty level (UL) was calculated using the bootstrap method. Results: The average age of the respondents was 33 years old, and 35.1% of them were unmarried. The most common drugs and their prevalence were as follows: opium (2534 [95% UL: 2467-2598]), hashish (849 [95% UL: 811-886]), stimulants (methamphetamine, ecstasy pills, cocaine, and Ritalin) (842 [95% UL: 802-879]), heroin/crack (578 [95% UL: 550-607]), and drug injection (459 [95% UL: 438-484]). Additionally, we estimated the prevalence of alcohol use as 2797 (95% UL: 2731-2861). On average, substance use was 5.23 times more prevalent among men than women. Opium use was more prevalent among individuals aged >50 years old. Moreover, alcohol use was more prevalent among participants between 18 and 30 years old (5164 per 100 000 population). Conclusion: Although opium continues to be the most prevalent illicit drug in Iran, the patterns of illicit drug use are heterogeneous among different age groups, genders, and provinces. Age-gender specific and culturally appropriate interventions are warranted to meet the needs of people in different subgroups. [ABSTRACT FROM AUTHOR]

Background and Objectives: As a health emergency of the 21st century, Diabetes is associated with an increased risk of cardiovascular diseases, stroke, diabetic nephropathy, neuropathy, retinopathy, pregnancy complications, psychological problems, lower quality of life experience, as well as a high economic burden and high risk of premature death. This study aimed to develop psychological interventions headings for patients referring to healthcare service centers based on local needs assessment through content analysis method of experts' opinion to provide services in the primary healthcare system. Material and Methods: This study was conducted on 19 mental health specialists, professors, and the health team providing services in healthcare service centers (family doctor and mental health expert) in 2018-19. The data obtained from the semi-structured interviews were analyzed using the directed content analysis technique. Results: The essential finding themes related to the closed headings of psychological interventions in diabetes for improving disease management included "collaborative care," "psychological assessment," the importance of "diabetes coexistence with psychiatric disorders," "creating health behaviors," "self-management training," and "intervention" In crisis" for the management of type 2 diabetes. Conclusion: This qualitative study was conducted with the participation of mental health experts. Therefore, the mentioned themes and categories can be used in developing the headings of psychological intervention programs for type 2 diabetic patients, focusing on the needs of Iranian patients and the structure of the health system. [ABSTRACT FROM AUTHOR]