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Abstract Background Poor sleep quality is a significant issue among people who inject drugs (PWID). This study aimed to evaluate sleep quality and associated factors among PWID in Iran. Methods Using respondent-driven sampling, 2,652 PWID (2,563 male) were recruited in 11 major cities in Iran between 2019 and 2020. The Pittsburgh Sleep Quality Index was utilized to measure sleep quality, and logistic regression was used to assess associations in RDSAnalyst, a software designed for respondent-driven sampling. Results The overall prevalence of poor sleep quality was 68.4% (68.3% among males and 70.2% among females). Married PWID had higher odds of poor sleep quality (Adjusted Odds Ratio (AOR): 1.41; 95% CI: 1.05, 1.91). Lack of access to sufficient food in the past 12 months was also associated with poor sleep quality (AOR: 1.73; 95% CI: 1.17, 2.57 for sometimes having no access, and AOR: 2.95; 95% CI: 1.93, 4.52 for always having no access compared to always having access). Additionally, good self-rated health was significantly associated with lower odds of poor sleep quality (AOR: 0.19; 95% CI: 0.11, 0.31). Conclusion Poor sleep quality is prevalent among PWID in Iran. It is recommended to mitigate the adverse effects of this issue and enhance the overall quality of life for PWID. Supportive interventions aimed at preventing and treating poor sleep quality, as well as improving overall health outcomes, are essential.

Background: Considering the important factors contributing to different health-related quality of life (HRQoL) subscales is essential for implementing preventive measures to increase the HRQoL among women with osteoporosis. We here evaluated the variables related to the mental and physical HRQoL in a sample of Iranian osteoporotic women. Methods: In this cross-sectional study, the participants included 111 women with osteoporosis in 2013. Physical and mental of HRQoL were measured by the ECOS-16 questionnaire. Other variables included BMD t-score (Osteoporosis was diagnosed based on bone mineral density (BMD) with BMD t-score

Background: Inadequate lifestyle choices, such as insufficient physical activity, may be linked to adverse fertility outcomes. Given the profound influence of lifestyle on women’s reproductive health, this study was undertaken to compare the levels of physical activity and body composition among fertile and infertile Iranian women in 2022.Methods: This cross-sectional study encompassed 653 fertile women (mean age: 32.58±5.99 years, mean body mass index (BMI): 25.7±3.64 kg/m²) and infertile women (mean age: 32.59±5.38 years, mean BMI: 26.4±5.6 kg/m²) who sought assistance at infertility centers in six provinces (Guilan, Markazi, Hamedan, Sistan, and Baluchestan, Isfahan, and Khuzestan) during the research period spanning 2021 to 2022. Participants completed questionnaires regarding their lifestyle habits and physical activity levels, body composition was also assessed. Chi-square and multiple logistic regression tests were employed for data analysis.Results: Fertile women exhibited superior physical activity (P=0.04) and a lower BMI (P=0.001) than their infertile counterparts. Women with a high level of physical activity (OR=4.42, P=0.004) were more likely to experience infertility. Inactive women who spent more than 300 minutes per day sitting were 2.07 times more susceptible to fertility complications than their physically active peers (moderate activity) (OR=2.07, P=0.001).Conclusion: Given the simultaneous increase in obesity, inactivity, and infertility among Iranian women, it is imperative to place greater emphasis on lifestyle habits, including appropriate physical activity, to prevent and potentially treat infertility.

Background: Since most studies evaluating the prevalence of hospital malnutrition in Iran have only been conducted on a specific group of patients, the present study was designed to investigate the prevalence of malnutrition in several different hospital wards. Methods: The nutritional status of 284 hospitalized patients was evaluated using the PG-SGA short form and compared according to demographic data and body mass index (BMI). Demographic and SGA domains were compared across BMI categories. Malnutrition degree was also compared. Results: Among the participants, 37.0% (n=105) had moderate malnutrition and 51.1% (n=145) had severe malnutrition. Comparing differences within patients according to their BMI status, there were no significant differences according to age, hospitalization duration, and current food intake status. Only sex and cause of hospitalization showed significant differences. Most of male participants had normal weight and were hospitalized for non-GI disorders (P=0.001 and 0.031, respectively). As expected, the scores obtained from weight, food intake, and symptoms sections of the questionnaire were higher in underweight patients in comparison to other BMI categories. Comparison of the same characteristics as per malnutrition status showed that people with high risk of malnutrition were older (P= 0.023), had oral food intake (P=0.007) and normal BMI (P=0.001). Conclusion: The number of patients at high risk of malnutrition was relatively significant in the study. A high frequency of malnutrition was observed among individuals with normal BMI. Screening tools in addition to BMI should be used to detect patients at risk of malnutrition. Corresponding Author:Fatemeh Azizi-Soleiman View Orcid in Profile You can search for this author in PubMed Google Scholar Profile

Abstract Reliable obstructive sleep apnea (OSA) prevalence information in Iran is lacking due to inconsistent local study results. To estimate OSA prevalence and identify clinical phenotypes, we conducted a nationally representative study using multi-stage random cluster sampling. We recruited 3198 individuals and extrapolated the results to the entire Iranian population using complex sample survey analyses. We identified 3 clinical phenotypes as “sleepy,” “insomnia,” and “restless legs syndrome (RLS).” The prevalence of OSA was 28.7% (95%CI: 26.8–30.6). The prevalence of “sleepy,” “insomnia,” and “RLS” phenotypes were 82.3%, 77.8%, and 36.5% in women, and 64.8%, 67.5%, and 17.9% in men, respectively. “Sleepy” and “insomnia” phenotypes overlapped the most. Age (OR: 1.9), male sex (OR: 3.8), BMI (OR: 1.13), neck circumference (OR: 1.3), RLS (OR: 2.0), and insomnia (OR: 2.3) were significant OSA predictors (p-values: 0.001). In men, “sleepy” phenotype was associated with youth and unmarried status but not in women. The “insomnia” phenotype was associated with shorter sleep duration in women; cardiovascular diseases (CVD), urban residency, and shorter sleep duration in men. “RLS” phenotype was associated with shorter sleep duration and CVD in women and older age, lower educational level, CVD, and hypertension in men. The findings point to the need for funding of OSA screening in Iran, for a different assessment of men and women, and for future sleep research to consider overlapping phenotypes.

Background: Waste separation education is very important for students because of the important role of this group in attracting parental involvement. Therefore, this study was conducted to investigate the effect of educational intervention based on the theory of planned behavior on the promotion of waste separation at source behavior among the primary school students in Khorramabad City, Iran. Methods: This randomized controlled interventional study was conducted during the academic year of 2020-2021 among the primary school students in the city of Khorramabad. Eight schools were selected in a multi-stage method and the sample size was estimated at a total of 200 people, taking into account at least 100 samples in each group (test and control). Then, the educational intervention was performed based on the results of needs assessment for the experimental group during one month and in the form of three sessions of 60-minute training. The data were collected 2 months after the intervention and were analyzed using SPSS software by using independent t-test, paired t-test, and chi-square test. Findings: Before the educational intervention, except for the score of awareness variable, all variables were not significantly different between the two groups; however, after the intervention, the two groups had significant differences regarding all of the studies variables (P < 0.050). The performance of the intervention group before training was 2.34 ± 0.73, which increased significantly to 3.11 ± 0.45 after training (P < 0.001). Conclusion: Educational intervention based on the theory of planned behavior by promoting attitudes and evaluating the behavioral consequences of students in the field of waste separation behavior at source eventually improved the behavior of students; it is suggested that this educational method be implemented in other schools as well.

Background: The present research addressed the spatiotemporal variations in such pollutants as benzene, toluene, ethylbenzene, and xylene (BTEX) in the atmosphere of Arak, a city in central Iran. Also, the health risk evaluation and ozone formation potential (OFP) were assessed. Methods: The air samples were collected and evaluated through gas chromatography-mass spectrometry (GC-MS) over a one-year period. Results: The overall BTEX levels ranged between 2.7-256 µgr/m3. The seasonal levels showed considerable variations among benzene, toluene, ethylbenzene, and xylene, and the levels of total BTEX. Comparison of the air samples between morning and evening for the concentrations of BTEX components revealed that the values were higher in the evening; however, there were no significant differences observed among them. The spatial map indicated that the maximal concentration of BTEX components occurred in high-traffic zones of the city. The maximal and minimal OFP levels were recorded in the summer (254.8 µgr/m3) and autumn (64.9 µgr/m3), respectively. The average toluene/benzene (T/B) ratio found to be 4.3, indicating the fuel combustion was the major source of atmospheric BTEX from vehicles. Conclusion: The measured cancer risk value for benzene (6.68×10-5) was higher than those recommended by the WHO and U.S. Environmental Protection Agency. Therefore, exposure to atmospheric benzene had a carcinogenic risk for Arak inhabitants. This needs further investigation in future studies. The acceptable hazard quotients (

Background: Otitis media is the second most common pediatric disease in the world and family, especially mothers, play an important role in prevention of this disease in children. The present study aimed to determine the knowledge, attitude, and performance of mothers regarding preventive behaviors of otitis media in infants. Methods: This analytical cross-sectional study was conducted by random sampling method on 240 mothers of infants referring to health centers of Arak City, Iran, in 2021. Data were collected by a questionnaire whose reliability and validity were previously confirmed and were analyzed with SPSS software using descriptive and analytical statistical tests including Spearman correlation coefficient and independent t-test. P < 0.05 was considered as the significance level. Findings: The mean age of children was 11.40 ± 6.05 months and 194 (80.8%) mothers were housewives. 16.2% of mothers had desirable knowledge about otitis media and 67.1% had moderate knowledge. 92.5% of mothers had desirable attitude and 7.5% had moderate attitude. Besides, performance score was desirable in 58.3% of mothers, moderate in 39.2%, and weak in 2.5%. There was a significant relationship between knowledge score with attitude of mothers (r = 0.320, P < 0.001) and performance (P < 0.050). The demographic variables including mother’s education, number of children, family income, knowledge, and attitude predicted 0.118% of maternal performance variance in prevention of otitis media in infants. Conclusion: Most mothers had weak or moderate knowledge and performance about prevention of otitis media in infants. Mother's background factors including education and household income are effective in this field. Therefore, educational planning is necessary to improve the knowledge and performance of mothers.

Background: Climate change is one of the most complex human challenges in the future. One of the consequences of climate change is the exposure of people to heat stress, especially in the outdoor environments. The aim of this study was to model the changes in the trend of exposure to heat stress in outdoor environments in the coming decades in the context of climate change and global warming. Methods: The Wet Bulb Globe Temperature (WBGT) index, Canadian Earth System Model (CanESM2), and the Statistical Down Scaling Model (SDSM) were used in a semi-arid climate. In this study, Arak station was considered as a representative of Iran’s semi-arid climate. In this research, the daily data of the minimum and maximum temperatures, humidity, and WBGT index were used from 2011 to 2099. Results: The minimum and maximum air temperatures in the study station show an increasing trend in three time periods. Also, based on the three studied scenarios, air temperature and WBGT index have an upward and positive trend and relative humidity has a downward and negative trend in the coming decades. Conclusion: In general, increasing the exposure of people to heat stress at the study station in the coming decades and based on the simulations of atmospheric general circulation models (GCMs), will not be unexpected.

Background: It was aimed to adapt a 12-item questionnaire into Persian among people living with human immunodeficiency virus (PLHIV) in Markazi province. Material and Methods: Content validity was evaluated based on the opinions of the relevant experts, and by calculating the scale-level content validity index (S-CVI) and the item-level content validity index (I-CVI). Reliability was assessed via test–retest, intraclass correlation coefficient (ICC), and Cronbach's alpha. Results: The obtained scores on clarity and relevancy (I-CVI) ranged from 0.9 to 1. The S-CVI also had an acceptable validity of 0.99. The Cronbach's alpha index of the whole questionnaire was 0.84 and ranged from 0.69 to 0.82 for subscales. The ICC in test–retest for all questionnaires was 0.88 and for subscales ranged from 0.77 to 0.88. Conclusion: The Persian version of the 12-item human immunodeficiency virus-related stigma questionnaire was found to be, in addition to being short and comprehensive, acceptable reliability and high validity to use in order to determine the stigma related to Persian-speaker PLHIV.

Novel coronavirus disease 2019 (COVID-19) has become a public health concern with over 6.5 million cases and 390,000 deaths around the world. This research aimed to find an association between computed tomography (CT) scores and clinical and laboratory findings to estimate the extent of lung infection in patients with COVID-19. The study sample enrolled 129 patients diagnosed with COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, images were segmented and scored by the degree of involvement from 0 to 4, and the relationship between them and clinical and laboratory findings were analyzed statistically. This study included 74 men and 59 women with a mean age of 55.08 years. Different abnormalities were observed; the mean CT score was 8.52 (7.83 to 9.21) and the most frequent lesions were GGO and consolidation. Our results revealed significant differences between groups categorized by dyspnea, sore throat, and low oxygen saturation concerning CT scores. There was also a significant correlation between CT scores and WBC counts and CRP levels (P

Abstract Background We aimed to find the association between gastrointestinal (GI) and respiratory symptoms with mortality and hospitalization among COVID-19 patients. Methods We analyzed the registered data of COVID-19 patients from February 20, 2020, to March 10, 2021. Depending on the patients’ disease symptoms, four categories were defined: patients with only GI symptoms, patients with only respiratory symptoms, patients with both symptoms, and patients with other symptoms. Logistic regression analysis was used to assess the association of groups with outcomes. Results A total of 42,964 patients from 23 hospitals were included, of which 26.5% patients had at least one or more GI symptoms. Of total patients, 51.58% patients were hospitalized among which 22.8% had at least one or more GI symptoms. GI symptoms significantly decreased the odds of mortality (OR 0.72, 95% CI 0.56–0.92), but respiratory symptoms increased the odds for mortality (1.36: 1.24–1.50), compared with patients with other symptoms. Moreover, the odds ratio of patients who had both respiratory and GI symptoms increased (1.52: 1.31–1.78) compared with patients with other symptoms. The same results were observed for hospitalization as the outcome. Conclusions Our study showed that the presence of GI symptoms in COVID-19 at the time of admission was associated with a lower odds of hospitalization and mortality; however, this association had higher odds for respiratory symptoms.

Abstract Background Due to the fact that pre-diabetic people are at higher risk of developing diabetes, it is possible to reduce the risk by taking preventive measures. Therefore, the present study aimed to determine the effect of theory-based education on promoting a healthy lifestyle and fasting blood sugar (FBS) in pre-diabetic women. Methods This is a cluster‐randomized controlled trial that was performed on 71 pre-diabetic women referred to Arak Comprehensive Health Service Center. Thus, using cluster sampling method, one center was randomly assigned to the intervention group and one center to the control group. The data collection tool was a questionnaire based on the theory of planned behavior (TPB) and healthy lifestyle behavior that was completed before and at least 3 months after training and FBS test was performed. The experimental group received 3 training sessions of 60 to 90 min and finally the data were analyzed using statistical software. Results After the intervention, the mean scores of knowledge (P

ObjectiveTo provide estimates on the regional and national burden of tracheal, bronchus, and lung (TBL) cancer and its attributable risk factors from 1990 to 2019 in the North Africa and Middle East (NAME) region.Methods and materialsThe Global Burden of Disease (GBD) 2019 data were used. Disability-adjusted life years (DALYs), death, incidence, and prevalence rates were categorized by sex and age groups in the NAME region, in 21 countries, from 1990 to 2019. Decomposition analysis was performed to calculate the proportion of responsible factors in the emergence of new cases. Data are presented as point estimates with their 95% uncertainty intervals (UIs).ResultsIn the NAME region, TBL cancer caused 15,396 and 57,114 deaths in women and men, respectively, in 2019. The age-standardized incidence rate (ASIR) increased by 0.7% (95% UI -20.6 to 24.1) and reached 16.8 per 100,000 (14.9 to 19.0) in 2019. All the age-standardized indices had a decreasing trend in men and an increasing trend in women from 1990 to 2019. Turkey (34.9 per 100,000 [27.6 to 43.5]) and Sudan (8.0 per 100,000 [5.2 to 12.5]) had the highest and lowest age-standardized prevalence rates (ASPRs) in 2019, respectively. The highest and lowest absolute slopes of change in ASPR, from 1990 to 2019, were seen in Bahrain (-50.0% (-63.6 to -31.7)) and the United Arab Emirates (-1.2% (-34.1 to 53.8)), respectively. The number of deaths attributable to risk factors was 58,816 (51,709 to 67,323) in 2019 and increased by 136.5%. Decomposition analysis showed that population growth and age structure change positively contributed to new incident cases. More than 80% of DALYs could be decreased by controlling risk factors, particularly tobacco use.ConclusionThe incidence, prevalence, and DALY rates of TBL cancer increased, and the death rate remained unchanged from 1990 to 2019. All the indices and contribution of risk factors decreased in men but increased in women. Tobacco is still the leading risk factor. Early diagnosis and tobacco cessation policies should be improved.

Background and Aim: AIDS (Acquired Immune Deficiency Syndrome) is a deadly disease that affects the human immune system. This study evaluated the Quality of Life (QoL) of Human Immunodeficiency Virus (HIV) patients in Markazi Province . Methods & Materials: This cross-sectional study was conducted in 2020-2021 in Markazi Province . The World Health Organization (WHO) questionnaire was used to determine the QoL in HIV patients. This questionnaire includes the physical, psychological, level of independence, social relationship, environment, and spirit. Statistical analysis was performed in STATA software. Ethical Considerations: This study was approved by the ethics committee of Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1398.008). Results: A total of 126 people with HIV were included in the study. The mean age of the subjects was 40.4±10.2 years. The mean score of each of the physical domains was 14.4±3.3, psychological 11.7±3.2, independence 13.3±3.8, social relationships 11.2±3.1, environment 0.8±0.3 10, spiritual was 13.2±3.3, and total QoL score was 12.1±2.6. In multivariate linear regression analysis, socioeconomic status and history of imprisonment significantly predicted higher scores of overall qualities of life. Conclusion: The total score of QoL in people with HIV in Markazi Province is average. Among the factors affecting it are gender, socioeconomic status, and history of imprisonment. It is suggested that QoL assessment of these patients be added to their care protocols to take effective measures to improve it.

Background and Aim: Different implant angulation, which is unavoidable in clinical situations, can affect the accuracy of impression. The aim of this study was to investigate the effect of fixture position on the accuracy of connecting impression coping to implants with internal hex. Materials and Methods: A gypsum model with 4 implants with internal hex connection was prepared. The implants were installed in different mesiodistal angles of 0, 15, 25 and 35 degrees to the longitudinal axis in the gypsum model. To simulate the gums, a gingival mask was injected around the implants to a height of 2 mm. After a training session for senior dental students on how to close the impression coping, forty students were asked to close the impression copings on four implants. The correctness of the impression coping was evaluated by an expert prosthodontist. Data were statistically analyzed using Cochran Q test. Significance level was considered 0.05. Ethical Considerations: this article is approved by ethics committee of Arak University of Medical Sciences. Findings: The correct performance of students in connecting the impression coping to the implant at angles of 0, 15, 25 and 35 degrees was equal to 85%, 72%, 52%, 35%, respectively. With the exception of 0 and 15 degree groups, a statistically significant difference was observed between different study groups. Conclusion: The fixture position has a significant effect on the accuracy of connecting impression coping to the implants with the internal hex and by increasing the implant angulation, the accurate connection the impression coping to the implant decreases.

BackgroundProstate cancer (PCa) is the second most prevalent cancer among men worldwide. This study presents estimates of PCa prevalence, incidence, death, years-of-life-lost (YLLs), years-lived-with-disability (YLDs), disability-adjusted-life-years (DALYs), and the burden attributable to smoking during 1990-2019 in North Africa and Middle East using data of Global Burden of Diseases (GBD) Study 2019.MethodsThis study is a part of GBD 2019. Using vital registration and cancer registry data, the estimates on PCa burden were modeled. Risk factor analysis was performed through the six-step conceptual framework of Comparative Risk Assessment.ResultsThe age-standardized rates (95% UI) of PCa incidence, prevalence, and death in 2019 were 23.7 (18.5-27.9), 161.1 (126.6-187.6), and 11.7 (9.4-13.9) per 100,000 population. While PCa incidence and prevalence increased by 77% and 144% during 1990-2019, respectively, the death rate stagnated. Of the 397% increase in PCa new cases, 234% was due to a rise in the age-specific incidence rate, 79% due to population growth, and 84% due to population aging. The YLLs, YLDs, and DALYs of PCa increased by 2% (-11.8-23.1), 108% (75.5-155.1), and 6% (-8.9-28.1). The death rate and DALYs rate attributable to smoking have decreased 12% and 10%, respectively. The DALYs rate attributable to smoking was 37.4 (15.9-67.8) in Lebanon and 5.9 (2.5-10.6) in Saudi Arabia, which were the highest and lowest in the region, respectively.ConclusionsThe PCa incidence and prevalence rates increased during 1990-2019; however, the death rate stagnated. The increase in the incidence was mostly due to the rise in the age-specific incidence rate, rather than population growth or aging. The burden of PCa attributable to smoking has decreased in the past 30 years.

Abstract Background In order to prevent oral diseases, the use of appropriate oral health education at childhood is one of the most important strategies for improving oral health knowledge and by extension positive oral health habits. Therefore, the present study aimed to evaluate the effect of animations and games as a strategy for improving oral health self-efficacy and self-care behaviors among 6–12-aged students. Methods In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for the control group. The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis. Results Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p 0.05). Conclusion The use of animation combined with other strategies for oral health self-care education can positively influence the students' performance and self-efficacy. IRCT registration number This trial was registered at IRCT. IRCT2017042133565N1 Registration date: 2017–05-17 https://en.irct.ir/trial/25851

Background and aims: Prediabetic individuals are more at risk for developing diabetes mellitus (DM). Physical activity (PA) is a significant factor contributing to health maintenance and promotion. This study aimed to assess the factors affecting PA among prediabetic women based on the Theory of Planned Behavior (TPB). Methods: This cross-sectional study was conducted in 2019 on 100 prediabetic women selected from comprehensive healthcare centers in Arak, Iran. A demographic questionnaire, a TPB-based questionnaire, and Godin-Shephard Leisure-Time Physical Activity Questionnaire were used for data collection. Data were analyzed through the Spearman’s correlation analysis and the linear regression analysis with the backward method. Results: The mean score of PA was 0.56±0.8 (in the possible range of 0–2). Around 61% of participants had limited PA, 16% of them had moderate PA, 19% of them had adequate PA and 4% no response. Perceived behavioral control explained 5.5% of the variance of the PA behavior. Conclusion: Given the significant effects of perceived behavioral control on PA, TPB-based educations may be helpful in promoting PA among prediabetic women.

Abstract Background Symptoms in multiple sclerosis (MS) can lead to different types and ranges of sexual dysfunction in MS patients. Studies in different parts of the world have reported a high range of sexual dysfunction in men with MS. This study aimed to estimate pooled prevalence of sexual dysfunction in men with MS. Methods The authors searched Web of Science, PubMed, Scopus, Embase, Magiran, SID, and Iran Medical Papers Database using the keywords “multiple sclerosis”, “sexual dysfunctions”, “men”, “prevalence”, and their synonyms systematically. Meta-analysis was performed using the random effects model with inverse variance-weighted method to estimate the overall prevalence of sexual dysfunction in men with MS. The protocol for this meta-analysis is available in PROSPERO (ID CRD42020199005). Results A total of 351 documents were identified, and 20 articles published from 1996 to 2019 were analyzed. The articles used sample sizes from 9 to 101 individuals. However, two studies conducted online used 388 and 1568 samples. Prevalence of sexual dysfunction in all studies was reported from 31 to 92%, and the pooled prevalence of sexual dysfunction in men with MS in all studies was 62.9% with a 95% confidence interval 53 to 72.7% (heterogeneity: I 2 = 96.3%, Q-statistic = 12.48, P value

Background: The first case of Coronavirus Disease (COVID-19) was reported in Iran on February19, 2020. This study aimed to assess the characteristics and reproduction number (R) of COVID-19 inMarkazi province in Iran.Methods: This is a cross-sectional study. Confirmed cases (N=2430) in the regions covered by ArakUniversity of Medical Sciences from Feb 20 to Aug 26, 2020 were enrolled in the study. The includedvariables were clinical and demographic characteristics of COVID-19 patients. The case fatality rate(CFR), incidence rates, and R were estimated based on the daily reported data. For estimating R,generation time was assumed on multi scenarios. R was estimated by R0-package. Moreover, Chisquare test was applied. All the analyses were performed in STATA, Excel, ArcMap and R. A p-valueless than 0.05 was considered as statistically significant.Results: The mean age of the participants was 51.78±20.58 years, and 206(8.50%) cases were amonghealthcare workers. Among the patients, 499 (20.50%) had a history of cardiovascular diseasesand 337(13.90%) diabetes type 2. The most prevalent symptoms were cough 1347(55.40%), fever1233(50.70%), and dyspnea 960 (39.50%). The highest incidence rate of COVID-19 in the study area(Delijan) was 575.35 per 100,000 persons. CFR was 205(8.40%). At the end of the study period, R wascalculated as 1.04 (CI 95%: 1.00, 1.08) in all districts of Arak University of Medical Sciences. Thehighest R (1.08, 95% CI: 1.06, 1.10) was observed in Farahan.Conclusion: As R is slightly high, the risk of epidemic has reduced gradually. However, observingsocial distance and related guidelines are still recommended.

Abstract Background Diabetic retinopathy is the most common microvascular complication of diabetes and it is a leading cause of visual impairment and blindness among patients with diabetes. This study aimed to investigate the effect of educational program based on Theory of Planned Behavior (TPB) on promoting retinopathy preventive behaviors in patients with type 2 diabetes. Methods The present study is an educational randomized controlled trial research that was conducted on 94 patients with type 2 diabetes who had gone to diabetes clinic. The samples were randomly assigned to the intervention (N = 47) and control groups (N = 47). Data collection instrument was a researcher-made questionnaire based on TPB and FBS and HbA1C tests. Then, educational program was performed for the intervention group through four educational sessions. After 3 months, data collection was repeated for the two groups and FBS, HbA1C testes were done again and data were analyzed. Results The performance of the intervention group on preventive behaviors of retinopathy increased from 2.48 ± 1.42 to 4.48 45 1.45 after the education (p

Abstract Background Diabetes is the most prevalent disease resulted from metabolic disorders. This study aimed to investigate the effect of training based on health belief model (HBM) on oral hygiene-related behaviors in patients with type 2 diabetes mellitus. Methods This study was conducted as an educational randomized controlled trial (single blind) on 120 patients with type 2 diabetes referring to a diabetes clinic selected through systematic sampling, who were assigned to two groups of control (N = 60) and intervention (N = 60). The data collection tool was a valid and reliable questionnaire based on HBM which was completed by both groups before the intervention. Then, the intervention group received 4 sessions of educational program based on HBM in 1 month, and the same questionnaire was completed again after 3 months and the data were analyzed through SPSS version 20 software with inferential statistics, t-test, paired t-tests, Chi square, Mann-Whitney test, and Wilcoxon test analysis. Results Three months after the intervention, awareness of the patients and perceived susceptibility, benefits, self-efficacy, internal cue to action, and performance in oral and dental hygiene-related behaviors had a significant increase in the intervention group (p

Abstract Background Urinary tract infection is one of the most common infectious diseases in children, which can lead to serious complications for a child. The purpose of this study was to investigate the impact of Theory Planned Behavior (TPB) -based education on the promotion of preventive behaviors of urinary tract infection in mothers with a daughter under age two. Methods The present study is an educational randomized controlled trial that its sample consisted of 100 mothers who had a daughter under age two. They were selected through convenience sampling and then were randomly assigned to the intervention and control groups (each group included 50 participants). The data collection tool was a reliable and valid questionnaire based on TPB constructs. First, in both groups, the pre-test was administrated and then the educational intervention in the intervention group was conducted in the form of four educational sessions in 1 month (based on the pre-test need assessment) and then 3 months after the intervention (according to the ideas of Panel of Experts), post-test in both groups was administrated and then the data were analyzed through SPSS version 23 software with inferential statistics (independent t-test, paired t-test, and chi-square). The significance level was considered 0.05. Results Three months after the intervention, the mean score of the constructs of TPB in the intervention group was significantly higher than the control group. The performance of prevention of urinary tract infection in the intervention group before the education increased from 2.85 ± 0.51 to 3.74 ± 0.29 (out of 4) (p = 0.001). Conclusions TPB-based education with active and interventional follow-up was effective in promoting the preventive behaviors of urinary tract infection. Therefore, due to the side effects of UTI, especially in vulnerable periods such as childhood, it is recommended that trainings based on this model be carried out in other health care centers in order to maintain children health. Trial registration This trial has been registered at IRCT, IRCT2017031533090N1. Registered on 9 July 2017, https://en.irct.ir/trial/25621

Background: By identifying the local foci and clusters of diseases, it can be hoped to reduce the incidence and deaths of the disease by making the necessary interventions. It was aimed to detect possible colorectal cancer incidence clusters using spatial analyses at point-level data at small census units in Arak, Iran from 2009 to 2014. Methods: In this ecologic study, recorded data on colorectal cancer in Arak have been collected from the Arak Cancer Registry. All records have been evaluated one-by-one using various methods to detect and resolve any probable error events or duplicated records. Then SaTScan software was used to explore spatial clusters. Discrete Poisson-based Probability Model was used to analyze the clusters. Results: 398 incidence cases of colorectal cancer was included. Three spatial clusters of colorectal cancer using individual geocodes were detected. The most high-risk cluster was located in the near of south highway of Arak, the highway with transit road of heavy and light vehicles(p=0.0004). The second significant high-risk cluster was a district located in the vast part of the center of Arak. The identified third high-risk cluster was an area in suburb of Arak, Proximity of Farmahin-Arak road and Northern highway. Conclusion: This study has identified three important clusters for the high incidence of colorectal cancer in Arak. Residents of these clusters need to be screened and trained to learn a healthy lifestyle. It is recommended that analytical studies at the individual level be designed and implemented to find the risk factors for colorectal cancer.

IntroductionThe prevalence of self-medication of antibiotics has been revealed in various studies. The main aim of this work is to investigate the frequency of self-medication in children under 6 years and the factors affecting it.MethodsThis is a population-based cross-sectional study conducted in the Arak metropolitan in the center of Iran from January 2019 to January 2020. We used stratified random sampling to determine recruitment criteria. As 1754 households were invited to the study that 1483 were approved to participate. Children's data were obtained by the interview with their mothers. In order to define self-medication consumption of antibiotics, it was adapted between annually maternal self-reported consumption of antibiotics among their children and history of received antibiotics registered in insurance services during the same time period. Logistic regression models were exploited to obtain odds ratios and 95% confidence intervals.ResultsMean age of mothers was 31.8 years (SD = 5.4), 52.1% of the children were boys. Annually self-medication of antibiotic consumption was estimated 61.6% (n = 914). Based on the logistic regression analysis, in the adjusted analysis, girls were associated with self-medication consumption of antibiotics lower than boys' children (p = 0.016). Older mothers were lower self-medication consumption of antibiotics than youngers (p = 0.001). Moreover, the permanent job of fathers was associated with lower self-medication consumption of antibiotics than temporarily and unemployment (p = .001). The odds of self-medication consumption of antibiotics were increasing with the increase in age of children (OR: 1.21, CI95%: 1.12, 1.31 and p = 0.001). The increase in parity has been a significant association with the self-medication consumption of antibiotics (OR: 1.64, CI95%: 1.38, 1.95and p = 0.001).ConclusionResults of this study show that some factors such as children's age, gender, mother's age, father's occupational status, and parity are the determinants that significantly impact the self-medication prevalence.

Introduction: The indoor environment of dental clinics may endanger dental patients and personnel and due to a great variety of air pollutants throughout the usual dental operation. The purpose of the present cross-sectional study was the evaluation of Indoor Air Quality (IAQ) and factors affecting it in a dentistry faculty of Arak University of Medical Sciences. Material and methods: The IAQ of five dental active wards and the patient waiting room was evaluated. The concentrations of Total Volatile Organic Compounds (TVOC), CO2, particulate matter, and bioaerosols were measured. Results: The TVOCs concentration in sampling locations ranged between 817 to 3670 μg/m3 during dental work and exceeded the Leadership in Energy and Environmental Design (LEED) guideline in all sampling locations. The highest values of Particulate Matter (PM) for PM10, PM2.5, and PM1 were observed in the periodontics ward, while the lowest values were observed in the endodontics ward. The PM2.5 concentrations exceeded the WHO limit in periodontics and pediatric wards. TVOC levels had a significant positive correlation with temperature (r=0.374, p

Introduction The current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors).Methods Various data sources from different countries, including vital registration and cancer registries were used to generate estimates. Mortality data and incidence data transformed to mortality estimates using the mortality to incidence ratio (MIR) were used in a cause of death ensemble model to estimate mortality. Mortality estimates were divided by the MIR to produce incidence estimates. Prevalence was calculated using incidence and MIR-based survival estimates. Age-specific mortality and standardised life expectancy were used to estimate years of life lost (YLLs). Prevalence was multiplied by disability weights to estimate years lived with disability (YLDs), while disability-adjusted life years (DALYs) are the sum of the YLLs and YLDs. All estimates were presented as counts and age-standardised rates per 100 000 population.Results Globally, there were 524 000 bladder cancer incident cases (95% uncertainty interval 476 000 to 569 000) and 229 000 bladder cancer deaths (211 000 to 243 000) in 2019. Age-standardised death rate decreased by 15.7% (8.6 to 21.0), during the period 1990–2019. Bladder cancer accounted for 4.39 million (4.09 to 4.70) DALYs in 2019, and the age-standardised DALY rate decreased significantly by 18.6% (11.2 to 24.3) during the period 1990–2019. In 2019, Monaco had the highest age-standardised incidence rate (31.9 cases (23.3 to 56.9) per 100 000), while Lebanon had the highest age-standardised death rate (10.4 (8.1 to 13.7)). Cabo Verde had the highest increase in age-standardised incidence (284.2% (214.1 to 362.8)) and death rates (190.3% (139.3 to 251.1)) between 1990 and 2019. In 2019, the global age-standardised incidence and death rates were higher among males than females, across all age groups and peaked in the 95+ age group. Globally, 36.8% (28.5 to 44.0) of bladder cancer DALYs were attributable to smoking, more so in males than females (43.7% (34.0 to 51.8) vs 15.2% (10.9 to 19.4)). In addition, 9.1% (1.9 to 19.6) of the DALYs were attributable to elevated fasting plasma glucose (FPG) (males 9.3% (1.6 to 20.9); females 8.4% (1.6 to 19.1)).Conclusions There was considerable variation in the burden of bladder cancer between countries during the period 1990–2019. Although there was a clear global decrease in the age-standardised death, and DALY rates, some countries experienced an increase in these rates. National policy makers should learn from these differences, and allocate resources for preventative measures, based on their country-specific estimates. In addition, smoking and elevated FPG play an important role in the burden of bladder cancer and need to be addressed with prevention programmes.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.

Background: Some treatment reported for cutaneous leishmaniasis. The studies examined the impact of the paromomycin has different characteristics and results. The aim of the present study was to conduct a systematic review and meta-analysis of all randomized clinical trials evaluating the effectiveness of paromomycin in the treatment of cutaneous leishmaniasis in Iran.Methods: Literature search was conducted using MEDLINE, Web of Science, Scopus, Scientific Information Database, IranMedex, Magiran, Iranian Registry of Clinical Trials (from February 2000 to May 2016), and references cited in the text of selected studies. Search terms used were “paromomycin”, “cutaneous leishmaniasis”, “randomized”,” aminosidine”, “controlled trial”, and “clinical trial”. Random effects models were used to calculate the measure of association, with 95% confidence intervals, to analyze the efficacy of paromomycin in the treatment of cutaneous leishmaniasis.Results: Initial search yielded 76 citations. Of these original results, 9 met our specific selection criteria. Four of the randomized controlled trials compared the efficacy of paromomycin in the treatment of cutaneous leishmaniasis with that of a placebo; they were included in the meta-analysis. The success rate of treatment with paromomycin was higher than that with the placebo (pooled RR=4.50, 95% CI: 2.54 to 8.02; P=0.001 and I2=26.7%), whereas the difference with the non-placebo treatments was nonsignificant (pooled RR=0.79, 95% CI: 0.58 to 1.073; P=0.131 and I2=83.3%).Conclusion: No significant difference was observed between paromomycin and the other treatments in their effectiveness in the treatment of cutaneous leishmaniasis. Because no single drug is effective against all the forms of leishmaniasis, we suggest multidrug therapy.

Background: The spread of the coronavirus disease 2019 (COVID-19) pandemic has imposed high threats on global health, life and work style, and social and economic development. The current study aimed to extract knowledge, attitudes, and practices related to COVID-19 among the general population in the central area of Iran.Method: A cross-sectional study was conducted in Arak City between April and May 2020. Stratified random sampling was applied to select the study participants. Phone interview was applied to collect the data. Data were collected using a questionnaire that was constructed and validated in this study. The questionnaire included demographic variables and items about knowledge, attitudes, and practices toward COVID-19. Descriptive and inferential analyses were conducted in STATA software.Results: In total, 544 participants completed the questionnaire; 76% of the participants accounted COVID-19 as a high threat 1 month from the onset of COVID-19. From the maximum attainable scores of 1, 6, and 6, for COVID-19-related knowledge, attitudes, and practices, means of 0.77 (0.13), 4.97 (0.63), and 5.35 (0.70) were obtained, respectively. Females had a higher practice score (5.4 ± 0.6). The participants with a family history of heart and respiratory diseases had significantly higher attitude and practice scores. SMS from the Ministry of Health had a significant impact on knowledge, attitude, and practice scores (p < 0.05).Conclusion: Higher attention should be given to increase the knowledge, attitudes, and practices of men and the housewife group. COVID-19 preventive messaging from the Ministry of Health was among the most influential methods of increasing knowledge that attracted public attention.

Background: A better understanding of the spatial pattern of stomach cancer can be helpful in the implementation of preventive strategies. This study is one of the first studies to establish a study unit based on the smallest possible size for cluster analysis. This study includes a novel evaluation of spatial differences in different geographical areas of Arak. The present study seeks to discover the spatial clusters of stomach cancer from 2009 to 2014 in Arak. Methods: All of the addresses of the stomach cancer cases were geocoded. After that, the number of stomach cancer cases in each census block was calculated to be entered in the SaTScan software. A discrete Poisson-based probability model was used to analyze this cluster. Results: In Arak, there are 5502 census blocks with a population of about 526,182. The number of identified and registered stomach cancer cases with an acceptable residence address was 392. Totally, 11 stomach cancer clusters were established in the area of Arak, from these; two clusters were detected statistically significant. Relative risks of the first and second clusters were 1.75 (P = 0.01) and 17.60 (P = 0.04) and those are located within the radius of 1.73 and 0.085 km, respectively. Conclusions: Our results have confirmed that two areas are at a higher risk than others. However, based on the results of this study, community-based interventions in certain geographical areas can be designed to reduce and control the incidence of stomach cancer.

Background and Aim: Iron deficiency is one of the most common nutritional problems during pregnancy. The purpose of this study was to assess the theory of planned behavior structures on nutritional prophylactic treatment of anemia in pregnant women of Arak city in 2018. Materials and Methods: This is a cross-sectional study that was carried out on 199 pregnant women in Arak city using simple random sampling in 2018. The data were gathered with valid and reliable researcher-made questionnaire including demographic information and the theory of planned behavior structures. The study was conducted to determine the most important predictive constructs of pregnant womens’ behavior using a multivariate linear regression model. Findings: The finding showed that mean age of mothers was 28.81 ± 5.1 years and the mean weekly gestation was 28.04 ± 8.9 weeks and the gestational interval with previous pregnancy was 5.18 ± 3.9 years. Mean±standard deviation of attitude score (3.61 ± 0.62), subjective norm (3.60 ± 0.74), perceived behavior control (3.50 ± 0.58), behavioral intention (3.49 ± 0.61), performance (3.55 ± 0.76) and awareness (0.57±0.2) were observed. Linear regression model showed that the performance score of pregnant women improved for each unit of attitude and subjective norms and perceived behavioral control, respectively, by 0.463, 0.343 and 0.347, respectively. Conclusion: The results emphasize the provision of educational programs on the prevention of anemia in pregnant women with an emphasis on attitudinal structures, mental norm, and perceived behavioral control. It is suggested that at the time of designing interventions to improve the prevention of anemia in pregnancy, the structures of the theory of planned behavior should be considered.

The aim of this study is evaluation of breast cancer risk factors distribution in two groups of healthy people referral to cancer registry and Shahid Mottahari center in Iran. This study is cross-sectional study which is part of the study to estimate Gene-Environment Interaction in women with breast cancer with case-control studies in Shiraz. In this study, two control groups have been used. The sample size of 300 was specified for each group. Selection sources of groups include Cancer Registry Center and referred people to surgical and internal ward of Shahid Mottahari Clinic. Information collect tools have included Form No. 1 in Cancer Registry Center which includes information of age, use of oral contraceptives history, breastfeeding history, number of live births, age at menarche, age at first childbirth, etc. Considering the results obtained, it was showed that the highest frequency (144) in the group of Cancer Registry Center belongs to high school education, but the highest frequency of Shahid Mottahari Clinic is related to primary education (176).There is statistically significant difference between the two groups in terms of education, history of breast cancer in first-degree relatives and age at first birth, (P

Abstract Background: Human need for food is one of the inherent or physiological needs that, along with the ability to eat and drink, is the most important factor of health, survival and longevity. Children with cerebral palsy suffer from severe maladjustment in the nutritional mechanism and the creation of unsafe, even risky, conditions for life, due to deficiencies in the disease. Because of the importance of Eating and Drinking Ability Classification System (EDACS) in the research and treatment of children with cerebral palsy, the purpose of this study was to determine the psychometric properties of the Persian version of this system. Materials and Methods: After the forward and backward translation procedures and investigation of face and content validity, test–retest reliability was assessed between parents and therapists using the intra-class correlation coefficient (ICC). 130 Children (3 to 20 years, mean age 52.35 months and standard deviation 33.96; 73 boys, 57 girls) with various types of CP were classified according to EDACS by both parents and therapists. Results: The test–retest reliability was high and significant; the ICC related to parents and occupational therapists was 0.98, and the ICC related to speech therapists (0.99) was higher than 0.90 that both of them showed high correlation. Conclusion: The Persian version of the EDACS is found to be valid and reliable, and is suggested to be appropriate for the assessment of eating and drinking ability in children with cerebral palsy.

Background: Physical activity has multiple health benefits, yet its association with female fertility remains unclear. Considering the critical effects of lifestyle on reproductive health, this study aimed to compare the physical activity and body composition of fertile and infertile women in Arak during 2021. Methods: This study is a case-control study that was performed on 200 fertile and infertile women (20 to 40 years old) referred to the infertility center in Arak who was selected through the convenience sampling. Participants completed self-administered questionnaires on sociodemographic and lifestyle characteristics, physical activity and sedentary behavior. Anthropometric characteristics and body composition were also measured. Multivariable logistic regression was used to analyze the association of fertility with physical activity level, sedentary behavior and body composition. Results: The level of physical activity (P=0.001) and body mass index (P=0.03) in infertile women were lower and higher compared to fertile women, respectively. In women with moderate level of physical activity (odds ratio 4.42 and 95% confidence interval: 1.60, 12.99 and P=0.004) the chance of infertility decreases. Women who spend more than 300 minutes a day sedentary are 2.07 times more likely to have fertility problems than women who are physically active (odds ratio 2.07 and 95% confidence interval: 1.36, 3.14 and P=0.001). Conclusion: This study shows that low physical activity, sedentary lifestyle and obesity are independent risk factors associated with infertility, so to prevent and even treat infertility, more attention should be paid to lifestyle behaviors in women.

Abstract Background: One of the problems in children with cerebral palsy is impaired eating and drinking liquids. The purpose of this study is to compare the effect of oral motor stimulations on feeding function in the children with spastic cerebral palsy by two medical and family centered approaches. Materials and Methods: This research was a descriptive-analytical cross sectional study that performed on 40 children 2-8 year olds with spastic Cerebral Palsy from the rehabilitation clinics in the city of Arak. They were selected by simple and purposeful sampling. Applied instruments were Gross Motor Measure Function Classification System Expanded & Revised (GMFCS E&R) and oral motor assessment scale(OMAS). Data were analyzed by statistical tests such as: Kolmogorov-Smirnov, reporting mean, standard deviation, data analysis frequncy distribution table, independent t-test, dependent t-test, chi-square and MANOVA. Results: The difference of swallowing function assessed by OMAS in both groups managed by family centered and clinician centered approach prior and post management statistialy was meaningful (p=0.001(. The difference between swallowing function of both groups post intervention was not meaningful in view of first and second assessor, also it had no statistical significance(p=0.89 , p=0.07) Conclusion: In general, we can conclude that oral motor stimulation is effective on swallowing function of cerebral palsy children in both treated groups. The effect of these stimulations on swallowing function in children with cerebral palsy between clinician centered and family centered approaches was equal.

Background: The monitoring of reproduction number over time provides feedback on the effectiveness of interventions and on the need to intensify control efforts. Hence, we aimed to compute basic (R0) and real-time (Rt) reproduction number and predict the trend and the size of the coronavirus disease 2019 (COVID-19) outbreak in the center of Iran. Materials and Methods: We used the 887 confirmed cases of COVID-19 from February 20, 2020, to April 17, 2020 in the center of Iran. We considered three scenarios for serial intervals (SIs) with gamma distribution. Rt was calculated by the sequential Bayesian and time-dependent methods. Based on a branching process using the Poisson distributed number of new cases per day, the daily incidence and cumulative incidence for the next 30 days were predicted. The analysis was applied in R packages 3.6.3 and STATA 12.0. Results: The model shows that the Rt of COVID-19 has been decreasing since the onset of the epidemic. According to three scenarios based on different distributions of SIs in the past 58 days from the epidemic, Rt has been 1.03 (0.94, 1.14), 1.05 (0.96, 1.15), and 1.08 (0.98, 1.18) and the cumulative incidence cases will be 360 (180, 603), 388 (238, 573), and 444 (249, 707) for the next 30 days, respectively. Conclusion: Based on the real-time data extracted from the center of Iran, Rt has been decreasing substantially since the beginning of the epidemic, and it is expected to remain almost constant or continue to decline slightly in the next 30 days, which is consequence of the schools and universities shutting down, reduction of working hours, mass screening, and social distancing.

Background: Considering the renewed emphasis on women’s health, attention to the new aspects of their health, such as equity, among different groups is warranted. The aim of this study was to investigate the economic inequalities among women with osteoporosis-related bone fractures (ORBFs) in Sanandaj, Iran. Methods: In this cross-sectional study, convenient sampling was employed to recruit 220 women with osteoporosis referring to the only rheumatology clinic in Sanandaj (the center of Kurdistan province in Iran) from January to April 2013. Main outcome was the history of fractures due to osteoporosis. Concentration index decomposition (CID) and logistic regression were used for data analysis. Results: In multivariate logistic analysis, the fourth and fifth quintiles of family economic status were found to be significantly associated with ORBFs. Risk difference and confidence interval (CI) for the relation between the history of bone fracture and family economic status was -0.115 (95% CI: -0.209, -0.021; P = 0.016), which reflected the higher prevalence of bone fractures among women with the lower economic levels. About 25% out of all ORBFs were happened among 20% of the women with low economic status. Conclusion: It was concluded that economic status plays an important role in happening ORBFs among underprivileged women. A reorientation on women’s health care services in Iran with a focus on underprivileged postmenopausal women seems to be necessary. There is a need for inter-sectoral coalition between the policymakers of the health system and those of other organizations to reduce the economic inequalities among osteoporotic women.

Abstract Background: The speech disorders may produce irreparable damage to childs speech and language development in the psychosocial view. The voice, speech sound production and fluency disorders are speech disorders, that may result from delay or impairment in speech motor control mechanism, central neuron system disorders, improper language stimulation or voice abuse. Materials and Methods: This study examined the prevalence of speech disorders in 1393 Arakian students at 1 to 6th grades of primary school. After collecting continuous speech samples, picture description, passage reading and phonetic test, we recorded the pathological signs of stuttering, articulation disorder and voice disorders in a special sheet. Results: The prevalence of articulation, voice and stuttering disorders was 8%, 3.5% and%1 and the prevalence of speech disorders was 11.9%. The prevalence of speech disorders was decreasing with increasing of student’s grade. 12.2% of boy students and 11.7% of girl students of primary school in Arak had speech disorders. Conclusion: The prevalence of speech disorders of primary school students in Arak is similar to the prevalence of speech disorders in Kermanshah, but the prevalence of speech disorders in this research is smaller than many similar researches in Iran. It seems that racial and cultural diversity has some effect on increasing the prevalence of speech disorders in Arak city.

Background: There are no studies on the trend of gastric cancer (GC) incidence in Kurdistan, a province in the west of Iran. We aimed to estimate the trend, age-standardized incidence rate (ASR), and annual percentage change (APC) of GC in this province during 2001–2014. Materials and Methods: The data of newly diagnosed GC patients were obtained from the regional Cancer Registering Database. The ASRs were calculated per 100,000 population during 2001–2014. Direct standardization and 95% confidence intervals (CI) were calculated by an efficient method. The temporary changes in ASRs were determined based on the APC by the joinpoint regression model. Results: Overall, 2225 newly diagnosed GC patients were identified. The ASRs ranged from 13.5 (95% CI: 10.4–17.3) to 29.0 (95% CI: 24.5–34.0). The highest ASRs were related to the men and women lived in Divandareh as 32.26 and 13.66, respectively. The respective APC value of GC incidence in women demonstrated a nonsignificant increase during 2001–2008 and a nonsignificant decrease during 2008–2014 (P = 0.1). Accordingly, the incidence of GC in men increased during 2001–2004 (P = 0.1) and decreased during 2004–2014 (P = 0.001). Conclusion: The incidence of GC showed nonsignificant and significant decreasing trends in women and men in Kurdistan province, respectively. Despite such decreasing trends, the Kurdistan province is still considered as one of the regions with high incidence of GC in Iran. Therefore, it is necessary to implement screening programs in the province to early diagnose GC.

OBJECTIVES The aim of this study was to measure income-related inequality in completed suicide across the provinces of Iran. METHODS This ecological study was performed using data from the Urban and Rural Household Income and Expenditure Survey-2010 conducted by the Iranian Center of Statistics, along with data on completed suicide from the Iranian Legal Medicine Organization in 2012. We calculated the Gini coefficient of per capita income and the completed suicide rate, as well as the concentration index for per capita income inequality in completed suicide, across the provinces of Iran. RESULTS The Gini coefficients of per capita income and the completed suicide rate in the provinces of Iran were 0.10 (95% confidence interval [CI], 0.06 to 0.13) and 0.34 (95% CI, 0.21 to 0.46), respectively. We found a trivial decreasing trend in the completed suicide incidence rate according to income quintile. The poorest-to-richest ratio in the completed suicide rate was 2.01 (95% CI, 1.26 to 3.22). The concentration index of completed suicide in the provinces of Iran was -0.12 (95% CI, -0.30 to 0.06). CONCLUSIONS This study found that lower income might be considered as a risk factor for completed suicide. Nonetheless, further individual studies incorporating multivariable analysis and repeated cross-sectional data would allow a more fine-grained analysis of this phenomenon.

Background: The traditional methods of studying the gene-environment interactions need a control group. However, the selection of an appropriate control group has been associated with problems. Therefore, new methods, such as case-only design, have been created to study such interactions. The objective of this study was to compare the case-only and case-control designs using data from patients with breast cancer.Methods: The interaction of genetic and environmental factor as well as the ratio of control to population odds ratio was calculated for case-only (300 patients with breast cancer) and case-control (300 cases of breast cancer and 300 matched controls) designs. Results: The confidence intervals and -2log likelihood in all variables in case-only design was smaller than those in the matched case-control design. In case-only design, the standard errors of some variables such as age at menarche, the first delivery at the age of 35 yrs and more or no delivery, the history of having live birth, use of oral contraception pills, breastfeeding history were less than those in the matched case-control design. Conclusion: The findings indicate that the case-only design is an efficient method to investigate the interaction of genetic and environmental factors.

Introduction: Society needs are constantly changing. As a result, it seems to be necessary to make changes in education as well. The viewpoints of faculty members as the educators and the most authentic group involved in medical education system are of significant influence. This study was conducted to investigate the determinants of effective teaching from non-clinical teachers' viewpoint in Kurdistan University of Medical Sciences in year 2009. Methods: In this descriptive cross-sectional study, the entire 72 non-clinical teachers in academic year 2009 were selected for investigation. Data collection tool was a questionnaire made by researcher which was validated and reliable. Faculties’ viewpoints toward educational status of the university were collected via this questionnaire. After completion of the questionnaire by these non-clinical teachers, data was collected and codified. Then the SPSS software v.11.5 was used to analyze the data using descriptive statistical tests (frequency and percent). Results: Nonclinical teachers believed that: having scientific capability (97.2%), oratory competency (97.2%), having communication skills (95.9%), the capability to develop critical thinking in the students (91.6%), the role of professional degree (88.8%), and the ability to motivate students for problem solving (84.7%) are respectively the most important factors determining effective teaching. Meanwhile, 68.1% of the respondents believed that the teacher’s research activity is considered significant in his educational success. Conclusion: The results of the study revealed that several factors may influence the effective teaching of non-clinical teachers. Considering these factors at the time of developing educational plans and retraining workshops for teachers may help these workshops to be more effective and successful. Our results may also be an emphasis on the necessity of including courses like the basics and teaching methods in the curriculums of master degree and PhD.