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Background: COVID-19 has been announced as an international public health emergency since February 2020 by the WHO. Objectives: The present study aimed to identify clinical manifestations and laboratory findings of COVID-19 patients and their relationship with severe outcomes. Methods: This cross-sectional study with descriptive and analytical purposes was conducted on 470 patients suspected of having COVID-19 infection hospitalized at Ganjavian hospital, one of the Referral Hospitals for COVID-19 patients, in Dezful, Iran. Patients’ records were reviewed for demographics and clinical manifestations, and the results of laboratory tests and severe outcomes from April to June 2020 were reviewed. The admission criterion was a definitive Coronavirus infection diagnosis, and the exclusion criteria were the medical records of patients who underwent three follow-up test appointments for any reason. Data were analyzed using SPSS version 22.0. Results: The mean age of patients was 56.05. The most prevalent symptoms among COVID-19 patients were dry cough, fever, and respiratory complications. The most significant laboratory findings were between the first and third test appointments in WBC, MCV, MCHC, HB, PLT, CRP, ESR, BUN, CR, LDH, and SGPT (P < 0.001). Age, fever, nausea, chills, underlying disease, and some laboratory factors with severe COVID-19 outcomes (ICU admission and death) had a significant relationship. Conclusions: Considering the main clinical manifestation of COVID-19, such as dry cough, Fever, and Dyspnea (need for oxygen) also, results of laboratory tests such as Hb and RDW can have a key role in early detection to progress to severe outcomes, thus decreasing COVID-19 mortality rate.

The present study was conducted to assess the short-term effects of the meteorological factors on the COVID-19 mortality in Qom, Iran. The GAM with a quasi-Poisson link function was used to evaluate the impact of temperature, DTR, relative humidity, and absolute humidity on the COVID-19 mortality, controlling potential confounders such as time trend, air pollutants, and day of the week. The results showed that the risk of COVID-19 mortality was reduced, in single-day lag/multiple-day average lag, per one-unit increase in absolute humidity (percentage change in lag 0=-33.64% (95% CI (-42.44, -23.49)), and relative humidity (percentage change in lag 0=-1.87% (95% CI (-2.52, -1.22)). Also, per one-unit increase in DTR value, COVID death risk increased in single-day and multiple-day average lag. This study demonstrated a significant relationship between the four meteorological variables and the COVID-19 mortality.

Diurnal temperature range (DTR) is one of the climate indicators likely to be related to human health. The purpose of this study was to investigate the relation between mortality and DTR in Kerman, Iran. The DLNM (Distributed Lag Non-linear Model)with a quas/i-Poisson regression model was used to evaluate the effect of DTR on mortality in age and sex groups by controlling the confounding variables (long-term trend of daily mortality, effect of day of the week, holidays, mean temperature, humidity, and air pollution). Since DTR effects on mortality may vary in cold and warm seasons, separate analyses were conducted for cold and warm seasons. DTR showed a non-linear relation with mortality. Mortality increased at the 90th percentile of DTR (CRR = 1.16, 95% CI 1.00–1.34), in lag 0–21 and at the 10th percentile of DTR in lag 0–13 (1.27, 95% CI 1.06–1.52), and lag 0–21 1.35 (95% CI 1.06–1.71). Increased mortality was more observed in the > 60 age group and in men. High levels of DTR after long lags (13 days) in the cold season were associated with increasing mortality. High and low diurnal temperature range may be a risk factor for mortality, especially in the men and elderly.

Purpose: The aim of this study was to evaluate the effect of a couple-coping intervention aiming to improve uncertainty tolerance in women diagnosed with breast cancer and their spouses on the patients’ mental adaption to their disease. Methods: The present study was conducted on 90 women with breast cancer referred to educational, medical and research centers in Urmia, IRAN, which 45 patients were randomly assigned to each treatment and control groups. Outcome measures were assessed at baseline and 6 weeks using short form mental adjustment to cancer (Mini-MAC) questionnaire. The intervention was performed in 6 group-based sessions consisting of patients and their spouses. Results: comparing the change from before to after intervention revealed that the effect of the intervention was significant in reducing hopeless-helpless (-5.42 ± 2.42 in intervention group VS -0.13 ± 0.46 in control group, PConclusion: Couple-centered intervention program based on increasing uncertainty tolerance can be used to improve the situation in order to increase the patients' adjustment and it has an effective support for breast cancer patients in helping to cope with cancer. Trial registration number: IRCT20150125020778N21.Date of registration: 2020-12-13.

Suburbanization is associated with an individual's health. This study aimed to investigate the effect of life skills training on the hope and health of women referred to comprehensive health service centers in the suburbs of Khoy city.quasi-experimental study (Pre-test/Post-test with a control group).in this study, out of 5 comprehensive health service centers, two centers were selected as intervention and comparison groups, and from each center, 37 women were randomly selected. At first, both groups completed the Goldberg general health questionnaire and the Miller hope questionnaire, and the intervention group was taught life skills. At the end of the training, both groups were re-evaluated. Descriptive statistics such as frequency distribution and dispersion indices were used in data analysis. Mann-Whitney and Wilcoxon Signed Ranks Tests were used in inferential statistics.Group training in life skills did not significantly affect hope (P.value = 0.972) and various aspects of health (P.value = 0.421).It seems that only interventions such as life skills training will not improve suburban women's hope and health. Perhaps improving social infrastructure and comprehensive living conditions in suburban areas will promote hope and health.

Background: Sexual health as an essential component of life, has been affected by COVID-19 pandemic. Changing in sexual life has consequences for couples and society. A critical review of current literature on sexual function in general populations will shed light on possible determinants as well as at-risk groups. Thus, the aim of this systematic review is to assess the consequences of COVID-19 on sexual and reproductive health. Methods/Design: A systematic review of literature on data reporting changings of individuals’ sexual life during the COVID-19 pandemic will be performed. The scientific databases of PubMed, Embase, Scopus, Web of Science, ScienceDirect, the World Health Organization, as well as protocols and guideline related to sexual health, behaviors, function and practices will be systematically searched from the onset of the disease in the world until August 15, 2021. We will consider, appraise, and synthesize studies including the change of sexual function and behaviour (physical, emotional, mental and relational health), SRH-care and services (contraception, birth control, STIs management), and sexual rights (gender-based and sexual minorities violence). Screening of search results and extraction of data from included studies will be conducted cooperatively by two authors. The quality of the studies will be appraised and documented. Results will be compiled and presented in evidence tables. Risk of bias (the quality assessment) will be evaluated by two review authors using the Critical Appraisal Skills Programme (CASP) tool. This protocol has been conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA-P) guidelines. Also, this protocol is registered in PROSPERO with number CRD42021275387.Discussion: Given the potential impacts of the COVID-19 pandemic on the people’s sexual life and reproductive health, this review aims to provide accurate information on different aspects of sexual function and behavior in populations from various age groups, cultures, and sexual orientations sexual health and reproductive care delivery (contraception, and birth control, SDTs management) and sexual rights (gender-based and sexual minority, sexual violence) to provide a better understanding of COVID-19 pandemic’s effect on people’s sexual lives The findings could be used by health planners and health care providers to address the adverse effects of this period on reproductive health and sexual lives. Systematic review registration: PROSPERO CRD42021275387

Background: Recent studies show that heatwaves pose risks to human health. Iran is exposed to heatwaves, but the evidence for the health impact of heatwaves is scarce. We aimed to evaluate the impact of heatwaves on daily deaths from non-accidental, cardiovascular, and respiratory in the city of Dezful in Iran from 2013 to 2019.Method: We collected daily ambient temperature and mortality and defined two types of heatwaves by combining daily temperature ³90thin each month of the study period or since 30 years with duration ³2 and 3 days. We used a distributed lag non-linear model to investigate the association between each type of heatwave definition and deaths from non-accidental, cardiovascular, and respiratory with lags up to 13 days.Results: Heat waves of both definitions were associated with a higher risk of non-accidental mortality. The association between heat waves and mortality appeared acutely and lasted for 3 and 4 days. The main effect and added effect are more pronounced among male and older adults than their counterparts. We found no evidence of an association of cardiovascular and respiratory deaths with heat waves.Conclusion: Dezful is a city with a hot climate. However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heat waves should provide the necessary warnings to all exposed groups, especially the elderly and the male groups.

In this study response surface methodology (RSM) was discussed as an efficient method for optimization of chromium adsorption onto magnetic graphene oxide(GO-Fe3O4) nanocomposites functionalized with two chelating ligands of the phenopyridine (GFP) and 2-mercaptobenzothiazole (GFM). The obtained GFP and GFM nanocomposites characterized using TEM, SEM, FTIR, EDAX, AFM, DLS and TGA. The optimization of adsorption of Cr (VI) onto GFM and GFP was done with the aim of high adsorption performance, minimizing the adsorbent dose and increase of the initial Cr (VI) concentration. Results indicated reduced full second-order (for GFP) and full second-order (for GFM) models were well-fitted with the experimental data. The optimum operating points were achieved (pH, 6.55; adsorbent dosage, 0.098 g L−1; contact time, 178.4 min and Cr (VI) concentration, 1 mg L−1) and (pH, 6.79; adsorbent dosage, 2.98 g L−1; contact time, 118.6 min and Cr (VI) concentration, 4.41 mg L−1) for GFP and GFM, respectively. The both adsorbents indicated best fit with Langmuir model. Also, the kinetic models were followed pseudo second order model and pseudo first order model for GFP and GFM, respectively. The thermodynamic studies indicated the sorption of Cr (VI) onto GFP and GFM was endothermic and spontaneous.

Recently there has been a lot of interest in global warming and temperature variation's effect on health. This study evaluates the impact of Diurnal Temperature Range (DTR) on mortality in Tabriz, northwest of Iran. Distributed Lag Non-linear Models combined with a quasi-Poisson regression were used to assess the impact of DTR on cause, age and gender specific mortality, controlled for potential confounders such as long-term trend of daily mortality, day of week effect, holidays, mean temperature, humidity, wind speed and air pollutants. As the effect of DTR may vary between the hot season (from May to October) and cold season (from November to April of the next year), we conducted analyses separately for these two seasons. In high DTR values (all percentiles), the Cumulative Relative Risk (CRR) of Non-Accidental Death, Respiratory Death and Cardiovascular Death increased in the cold season. In full year and high DTR value (percentile 90), the CRR of respiratory deaths increased as well (CRR, Lag 0-6:1.32(1.006, 1.75). Although there was no clear significant effect in low DTR values, high values of DTR increase the risk of mortality in the cold season, in Tabriz, Iran.

Background: This study aimed to estimate hospitalization risk/number attributed to air extreme temperatures using time-stratified case crossover study and distributed lag non-linear model in a region of Iran during 2015-2019.Methods: A time-stratified case crossover design based on aggregated exposure data was used in this study. In order to have no overlap bias in the estimations, a fixed and disjointed window by using one-month strata was used in the design. A conditional Poisson regression model allowing for over dispersion (Quasi-Poisson) was applied into Distributed Lag Non-linear Model (DLNM). Different approaches were applied to estimate Optimum Temperature (OT). In the model, the interaction effect between temperature and humidity was assessed to see if the impact of heat or cold on Hospital Admissions (HAs) are different between different levels of humidity.Results: The cumulative effect of heat during 21 days was not significant and it was the cold that had significant cumulative adverse effect on all groups. While the number of HAs attributed to any ranges of heat, including medium, high, extreme and even all values were negligible, but a large number was attributable to cold values; about 10000 HAs were attributable to all values of cold temperature, of which about 9000 were attributed to medium range and about 1000 and less than 500 were attributed to high and extreme values of cold, respectively.Conclusion: This study highlights the need for interventions in cold seasons by policymakers. The results inform researchers as well as policy makers to address both men and women and elderly when any plan or preventive program is developed in the area under study.

Climate change may be associated with human morbidity and mortality through direct and indirect effects. Ahvaz is one of the hottest cities in the world. The aim of this study was to investigate the relation between physiological Equivalent Temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on death. The effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted.The results showed that in cold stress [1st percentile of PET (2.7 °C) relative to 25th percentile (11.9 °C)] the risk of total respiratory mortality, respiratory mortality in men, and mortality in people under 65 year olds, significantly decreased in the cumulative lags of 0–2, 0–6 and 0–13; but the risk of respiratory mortality increased in the elderly and in the final lags. In contrast, heat stress [99th percentile of PET (44.9 °C) relative to 75th percentile (43.4 °C)] significantly increased the risk of total cardiovascular mortality (CVD), cardiovascular mortality in men, ischemic heart disease and cerebrovascular disease mortality in lags 0 and 0–2. It seems that high PET values increase the risk of cardiovascular mortality, while low PET values increase respiratory mortality only among the elderly in Ahvaz.

Few studies have investigated the different extreme temperature effects (heat-cold) of one geographical location at the same time in Iran. This study was conducted to assess the impact of heat and cold waves on mortality in Urmia city, which has a cold and mountainous climate. Distributed Lag Non-linear Models combined with a quasi-Poisson regression were used to assess the impact of heat (HW) and cold waves (CW) on mortality in subgroups, controlled for potential confounders such as long-term trend of daily mortality, day of week effect, holidays, mean temperature, humidity, wind speed and air pollutants. The heat/cold effect was divided into two general categories A-main effect (the effect caused by temperature), B-added effect (the effect caused by persistence of extreme temperature). Results show that there was no relation between HW and respiratory and cardiovascular death, but in main effects, HW(H1) significantly increased, the risk of Non-Accidental Death (NAD) in lag 0 (Cumulative Excess Risk (CER) NAD = 31(CI; 4–65)). Also in added effects, HW had a significant effect on NAD (CER H1; NAD; lag;0-2 = 31(CI; 5, 51), CER H2; NAD; lag;0-2 = 26(CI; 6, 48)). There was no relation between CW and respiratory death and cardiovascular death, but in added effects, CW(C1) significantly decreased, the risk of non-accidental death in initial lags (CER C1; NAD; lag;0-2 = −19 (CI; −35, −2)). It seems that high temperatures and heat waves increase the risk of non-accidental mortality in northwest of Iran.

There are few epidemiological studies about climate change and the effect of temperature variation on health using human thermal indices such as the Physiological Equivalent Temperature (PET) Index in Iran. This study was conducted in Tabriz, the northwest of Iran and Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression models were used to assess the impacts of PET on mortality by using the DLNM Package in R Software. The effect of air pollutants, time trend, day of the week and holidays were controlled as confounders. There was a significant relation between high (30°C, 27°C) and low (-0.8°C, -9.2°C and -14.2°C) PET and total (non-accidental) mortality; and a significant increase in respiratory and cardiovascular deaths in high PET values. Heat stress increased Cumulative Relative Risk (CRR) for total (non-accidental), respiratory and cardiovascular mortality significantly (CRR Non Accidental Death, PET=30°C, lag 0-30=1.67, 95%CI: 1.31-2.13; CRR Respiratory Death, PET=30°C, lag 0-13=1.88, 95%CI: 1.30-2.72; CRR Cardiovascular Death, PET=30°C, lag0-30=1.67 95%CI: 1.16-2.40). Heat stress increases the risk of total (non-accidental), respiratory mortality, but cold stress decreases the risk of total (non-accidental) mortality in Tabriz which is one of the cold cities of Iran.

Objective: This study was designed to examine the effect of metabolic syndrome (MetS) on health-related quality of life (HRQOL) in patients with suspected nonalcoholic steatohepatitis (NASH). Subjects and Methods: Three hundred thirty-two patients (236 males and 96 females) with suspected NASH from the Amol cohort study were included in this study. MetS was diagnosed based on Adult Treatment Panel III criteria and HRQOL was measured using the 12-Item Short-Form Health Survey (SF-12) questionnaire (with 8 subscales and 2 summary components). A multivariable linear regression model was used to assess the independent effect of MetS on HRQOL. Results: The mean age of the study population was 42 ± 13 years (range 18–82). The prevalence of MetS was 43.4% (n = 144) and the mean scores on the Physical Component Summary (PCS) and the Mental Component Summary were 72.4 ± 20.86 and 42.7 ± 12.42, respectively. The multivariable linear regression model showed that MetS was negatively associated with 4 subscales of HRQOL that included: role limitations due to physical problems (RP) (B = –14.05, p = 0.004), bodily pain (BP) (B = –7.37, p = 0.02), vitality (VT) (B = –7.72, p = 0.022), and role limitations due to emotional problems (RE) (B = –12.67, p = 0.005) after adjustment for other variables. Also, MetS had a borderline association with the general health and mental health subscales and the PCS (p < 0.1). Conclusion: In this study, there was a strong association between MetS and 4 subscales (RP, BP, VT, and RE) of HRQOL in patients with suspected NASH; this could be considered as a part of health policy to improve general health.

Diurnal Temperature Range (DTR) is a meteorological index which represents temperature variation within a day. This study assesses the impact of high and low values of DTR on mortality. Distributed Lag Non-linear Models combined with a quasi-Poisson regression model was used to assess the impact of DTR on cause, age and gender specific mortality, controlled for potential confounders such as long-term trend of daily mortality, day of week effect, holidays, mean temperature, humidity, wind speed and air pollutants. As the effect of DTR may vary between the hot season (from May to October) and cold season (from November to April of the next year), we conducted analyses separately for these two seasons. In high DTR values (all percentiles), the Cumulative Relative Risk (CRR) of Non-Accidental Death, Respiratory Death and Cardiovascular Death increased in the full year and hot season, and especially in lag (0−6) of the hot season. In the cold season and high DTR values (all percentiles), the CRR of Non-Accidental Death and Cardiovascular Death decreased, but the CRR of Respiratory Death increased. Although there was no clear significant effect in low DTR values. High values of DTR increase the risk of mortality, especially in the heat season, in Urmia, Iran.

Background: Household food insecurity is one of the major public health issues that may affect an individual’s nutritional state, especially in patients with chronic diseases. The aim of this study was to evaluate the prevalence of household food insecurity and its association with sociodemographic and clinical factors among patients with HIV/AIDS in Kerman province, Iran. Methods: A cross sectional study was performed among the 179 patients with HIV/AIDS in Kerman province. Participants completed a questionnaire focusing on personal information, health, and clinical status. Also, household food security status was evaluated by the USDA (US Department of Agriculture) questionnaire. Data were analyzed using SPSS (Version 22) by descriptive, univariate, and multivariate logistic regression. P

BACKGROUND: Schizophrenia is a severe mental disorder with a prevalence of about 1% among the general population. It is listed among the top 10 causes of disability‐adjusted life years (DALYs) worldwide. Antipsychotics are the mainstay treatment. Piperacetazine has been reported to be as clinically effective as chlorpromazine, a well established 'benchmark' antipsychotic, for people with schizophrenia. However, the side effect profiles of these antipsychotics differ and it is important that an evidence base is available comparing the benefits, and potential harms of these two antipsychotics. OBJECTIVES: To assess the clinical and side effects of chlorpromazine for people with schizophrenia and schizophrenia‐like psychoses in comparison with piperacetazine. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Trials Register (6 June 2015 and 8 October 2018) which is based on regular searches of CINAHL, CENTRAL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and registries of clinical trials. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA: We included randomised controlled trials (RCTs) focusing on chlorpromazine versus piperacetazine for people with schizophrenia, reporting useable data. DATA COLLECTION AND ANALYSIS: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention‐to‐treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed‐effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS: We found 12 records referring to six trials. We included five trials, all from the 1970s, randomising 343 participants. We excluded one trial. The overall methodology and data reporting by the trials was poor. Only short‐term data were available. Results from the included trials found that, in terms of global state improvement, when rated by a psychiatrist, there was no clear difference between chlorpromazine and piperacetazine (RR 0.90, 95% CI 0.80 to 1.02; participants = 208; studies = 2; very low‐quality evidence). One trial reported change scores on the mental state scale Brief Psychiatric Rating Scale (BPRS); no clear difference was observed (MD ‐0.40, 95% CI ‐1.41 to 0.61; participants = 182; studies = 1; very low‐quality evidence). Chlorpromazine appears no worse or better than piperacetazine regarding adverse effects. In both treatment groups, around 60% of participants experienced some sort of adverse effect (RR 1.00, 95% CI 0.75 to 1.33; participants = 74; studies = 3; very low‐quality evidence), with approximately 40% of these participants experiencing some parkinsonism‐type movement disorder (RR 0.95, CI 0.61 to 1.49; participants = 106; studies = 3; very low‐quality evidence). No clear difference in numbers of participants leaving the study early for any reason was observed (RR 0.50, 95% CI 0.10 to 2.56; participants = 256; studies = 4; very low‐quality evidence). No trial reported data for change in negative symptoms or economic costs. AUTHORS' CONCLUSIONS: The results of this review show chlorpromazine and piperacetazine may have similar clinical efficacy, but data are based on very small numbers of participants and the evidence is very low quality. We can not make firm conclusions based on such data. Currently, should clinicians and people with schizophrenia need to choose between chlorpromazine and piperacetazine they should be aware there is no good quality evidence to base decisions. More high quality research is needed.

Aim: Food insecurity is common in both developed and developing countries affecting from 5% to 25% of the general population. Food insecurity has been found to have significant impacts on physical, so cial, and psychological status of individuals in communities suffering from that. The purpose of this study was to determine the role of household composition on the household food insecurity. Method: This cross-sectional study was conducted on 2503 households selected from Qaresoo region in the northwest of Iran. Household food security status was measured by a validated short questionnaire including six questions. Chi-square and logistic regression were used for data analysis. Result: Of 2503 households, 1012 (40.4%) were identified as food se cure and the remaining 1492 (59.6%) were food insecure. There was a significant relation between family structure & size and household food security status (p

Background Schizophrenia is a severe mental disorder with a prevalence of about 1% among the general population. It is listed among the top 10 causes of disability-adjusted life years (DALYs) worldwide. Antipsychotics are the mainstay treatment. Piperacetazine has been reported to be as clinically effective as chlorpromazine, a well established 'benchmark' antipsychotic, for people with schizophrenia. However, the side effect profiles of these antipsychotics differ and it is important that an evidence base is available comparing the benefits, and potential harms of these two antipsychotics. Objectives To assess the clinical and side effects of chlorpromazine for people with schizophrenia and schizophrenia-like psychoses in comparison with piperacetazine. Search methods We searched the Cochrane Schizophrenia Group's Trials Register (6 June 2015 and 8 October 2018) which is based on regular searches of CINAHL, CENTRAL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and registries of clinical trials. There are no language, date, document type, or publication status limitations for inclusion of records in the register. Selection criteria We included randomised controlled trials (RCTs) focusing on chlorpromazine versus piperacetazine for people with schizophrenia, reporting useable data. Data collection and analysis We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Main results We found 12 records referring to six trials. We included five trials, all from the 1970s, randomising 343 participants. We excluded one trial. The overall methodology and data reporting by the trials was poor. Only short-term data were available.Results from the included trials found that, in terms of global state improvement, when rated by a psychiatrist, there was no clear difference between chlorpromazine and piperacetazine (RR 0.90, 95% CI 0.80 to 1.02; participants = 208; studies = 2; very low-quality evidence). One trial reported change scores on the mental state scale Brief Psychiatric Rating Scale (BPRS); no clear difference was observed (MD -0.40, 95% CI -1.41 to 0.61; participants = 182; studies = 1; very low-quality evidence). Chlorpromazine appears no worse or better than piperacetazine regarding adverse effects. In both treatment groups, around 60% of participants experienced some sort of adverse effect (RR 1.00, 95% CI 0.75 to 1.33; participants = 74; studies = 3; very low-quality evidence), with approximately 40% of these participants experiencing some parkinsonism-type movement disorder (RR 0.95, CI 0.61 to 1.49; participants = 106; studies = 3; very low-quality evidence). No clear difference in numbers of participants leaving the study early for any reason was observed (RR 0.50, 95% CI 0.10 to 2.56; participants = 256; studies = 4; very low-quality evidence). No trial reported data for change in negative symptoms or economic costs. Authors' conclusions The results of this review show chlorpromazine and piperacetazine may have similar clinical efficacy, but data are based on very small numbers of participants and the evidence is very low quality. We can not make firm conclusions based on such data. Currently, should clinicians and people with schizophrenia need to choose between chlorpromazine and piperacetazine they should be aware there is no good quality evidence to base decisions. More high quality research is needed.

Food insecurity is frequent in both developed and developing countries, affecting from 5% to 25% of the general population. The aim of this study was to assess food insecurity, its influencing factors and control measures in the northwest of Iran. A total population of 15,070 (2,911 households) were studied. A short questionnaire was used for the screening of food insecurity and energy intake in this study. After the screening programme, those families identified as having food insecurity were recruited for the second part of the study which was a community trial. We organized small training campaigns (through peer education) for target households. Six months later, the same techniques were applied again to assess the impact of educational intervention in reducing the rate of food insecurity. Total prevalence of food insecurity in the study population was 59.3 percent (95% confidence interval: 57.4-61.3). Logistic regression showed that apart from the mother's age and smoking status of the head of the family, there was a significant association between household food insecurity and other variables in the model (mainly economic factors). The prevalence of food insecurity reduced by 7.3 percent after the intervention (p0.10). The high prevalence of food insecurity in this study indicates that there is an urgent need for a close collaboration between governmental, international and local leadership to identify and implement the key interventional programmes to overcome this ever increasing health problem. According to our findings, a special attention should be paid on the economic improvement in the region.