Assessment of the knowledge and attitudes of the Iranian medical faculty toward plagiarism

This study is among the few investigations that assesses knowledge and attitudes of faculty members of medical sciences universities regarding plagiarism. This investigation focused on the relationship between personal factors and knowledge and attitudes toward plagiarism among Iranian faculty members of medical sciences affiliated with the Ministry of Health. This descriptive cross-sectional study was performed on 247 participants using demographic questionnaires that collected data on attitudes toward plagiarism and knowledge of plagiarism. The questionnaires were uploaded on Porsline. The subjects were provided with the purpose of the study, informed consent, and the link to the questionnaire through WhatsApp. The mean scores of knowledge variables and different domains of attitude were calculated, and then, the obtained averages were compared in terms of age, gender, and participation in ethics workshop using univariate tests. Finally, the MANCOVA was used considering five dimensions of the questionnaire to assess attitude, as multiple response variables, and independent variables, including gender and participation in the ethics workshop and control of knowledge and age. The mean age of the subjects in this study was 38.9 ± 8.4. 79.4% of the participants were women. Overall, 79.8% of people participated in ethics workshops, of whom 78% were women, and 86.5% were men. The mean score of knowledge in men and women was 1.35 ± 0.19 and 1.56. ± 0.24, respectively, which was higher in women than men (PV <0.001). The mean score of total attitudes was 3.19 ± 0.46. There was a high level of knowledge of plagiarism and positive attitudes toward plagiarism avoidance or prevention among participants in this study, which may spread to students, and help to promote integrity in the educational and clinical environment in Iran.

The concentration of phthalates in drinking water in Iran: A systematic review and meta-analysis

PAE and PC polymers, such as BPA, are utilized to make water bottles. Due to the lack of polymer-chemical interaction, PAE can enter drinking bottles during production, wrapping, and keeping. Phthalates can transfer from the bottle to the water depending on keeping conditions (temperature, time, sunlight intensity), pH, and bottle capacity. Since there haven't been previous studies published on the subject, the aim of this meta-analysis and systematic review research is to determine the level of phthalates in drinking water consumed in Iranian cities. Web of Science, Science of Direct, Scopus, and PubMed, databases have been used in this study. Eight studies were selected from 556 initial publications after screening for duplication and irrelevant information. Articles from January 1, 2000, to February 10, 2024, were found in the mentioned databases. Among the types of phthalates, the concentration of DEHP was reported higher than the others Because its concentration has been reported in seven out of eight studies. The highest concentration of DEHP was reported by Mehraie(2.22 µg/l), Zare Jeddi (0.8 µg/l), Yousefi (0.77 µg/l), Abtahi (0.76 µg/l), Zare Jeddi (0.42 µg/l), Abdolahnejad(0.15 µg/l), and Pourzamani (0.08 µg/l). The highest concentration of DEP, DBP, BBP, and PA was reported by Abtahi (0.77 µg/l) and Esteki (2.25 µg/l), Mehraie(0.93 µg/l), and Pourzamani (0.83 µg/l). The results of this study showed that the most important phthalates measured in drinking water include DEP, DEHP, DBP, BBP, and PA. According to the results of the present studies, the most important factor in the increase of phthalates is the storage conditions of drinking water (temperature, sunlight, and the type of pipe or bottle).

bactrianus) camels in Iran: A molecular epidemiology and review of available literature

BACKGROUND

Blastocystis sp. is a zoonotic protozoan parasite, and there is limited information about its molecular prevalence and subtypes (STs) distribution in camels globally, especially in Iran.

OBJECTIVES

This study aimed to examine the prevalence, STs distribution, and zoonotic potential of Blastocystis sp. in one-humped and two-humped camels in Ardabil province, northwestern Iran.

METHODS

A PCR-sequencing tool using the SSU rRNA gene was employed to examine the occurrence and genetic variation of Blastocystis sp. in 150 faecal samples from Bactrian (Camelus bactrianus, 50 samples) and Dromedary (Camelus dromedarius, 100 samples) camels in Ardabil province.

RESULTS

The overall prevalence of Blastocystis sp. in camels was determined to be 12% (18/150) through microscopy and PCR analyses. Phylogenetically, this study identified three distinct zoonotic STs: ST7, ST10, and ST14. ST10 was the most prevalent, comprising 50% (9/18) of the isolated STs from camels. ST14 closely followed with 38.9% (7/18), while ST7 made up 11.1% (2/18) of the total STs. In brief, ST10, ST14, and ST7 represented 50% (7/14), 35.7% (5/14), and 14.3% (2/14) of the Blastocystis-positive cases in one-humped camels, respectively. Further, each of the ST10 and ST14 accounted for 50% (2/4) of the Blastocystis-positive samples in two-humped camels. An analysis of the available data reveals that out of the 37-44 identified Blastocystis STs, 15 (ST1-ST7, ST10, ST14, ST15, ST21, ST24, ST25, ST26, and ST30) have been reported in camels. The predominant STs observed are ST10 and ST14. Furthermore, among the 15 zoonotic STs (ST1-ST10, ST12-ST14, ST16, and ST23) of Blastocystis reported thus far, nine zoonotic STs (ST1-ST7, ST10, and ST14) have been found in camels.

CONCLUSIONS

These findings indicate that camels serve as a proper reservoir for a diverse array of Blastocystis STs and thereby can play a significant role in the transmission of this protozoan infection to humans, animals, and water reservoirs.

Epidemiology of first- and second-line drugs-resistant pulmonary tuberculosis in Iran: Systematic review and meta-analysis

Drug resistance among Mycobacterium tuberculosis (MTB) strains is a growing concern in developing countries. We conducted a comprehensive search for relevant studies in Iran on PubMed, Scopus, and Embase until June 12, 2020. Our study focused on determining the prevalence of antibiotic resistance in MTB isolates, with subgroup analyses based on year, location, and drug susceptibility testing (DST) methods. Statistical analyses were performed using STATA software. Our meta-analysis included a total of 47 articles. Among new TB cases, we found the following prevalence rates: Any-resistance to first-line drugs: 31 % (95 % CI, 24-38), mono-drug resistance: 15 % (95 % CI, 10-22), and multidrug resistance to first-line drugs: 6 % (95 % CI, 4-8). There was a significant variation in the rate of MDR among new TB cases based on the year of publication, location, and DST methods (P < 0.0001). We observed substantial variability in multidrug-resistant TB rates among new cases across the studies. Stratified analyses revealed that publication years and DST methods significantly affected resistance rates. Studies from southern and central Iran reported higher any-drug resistance rates, suggesting regional differences. Among retreatment cases, the prevalence rates were as follows: Any resistance: 68 % (95 % CI 58-78), mono-resistance: 19 % (95 % CI 7-34), multidrug resistance: 28 % (95 % CI 15-43). Our study revealed that the prevalence of drug-resistant TB (DR-TB) among TB cases in Iran is higher than the global average. Particularly, MDR-TB among retreatment TB cases is a significant public health issue.

Seroprevalence of visceral leishmaniasis among pregnant women in Jahrom city in Fars province, southern Iran

Background

Visceral leishmaniasis (VL) is a public health issue in endemic countries with poor sanitation facilities. In this study, the seroprevalence rate and associated risk factors of VL were investigated during September 2020 to February 2021 in pregnant women referred to Ostad Mottahari and Peymanieh hospitals in Jahrom county, Fars province, southern Iran.

Material and methods

A total of 220 serum samples of pregnant women were assessed for the presence of Anti-Leishmania infantum antibodies by direct agglutination antigen (DAT). The associated risk factors were obtained using questionnaires.

Results

The overall seroprevalence of VL in pregnant women was 12.72% (28/220). Considering the antibody titer, titer 1:1600 was detected in 23 samples, titer 1:3200 in 4 samples, and titer 1:6400 in one sample. All 5 women with titer >3200 had mild fever. As such, there was a statistically significant difference regarding the age (≥39 years old with p-value: 0.01).

Conclusions

We recommend an appropriate health education program for pregnant women and serological screening of VL before pregnancy in endemic cities. Moreover, we believed a need for more epidemiological studies for better understand the status of VL in pregnant women.

A comprehensive review of HVS-I mitochondrial DNA variation of 19 Iranian populations

Iran is located along the Central Asian corridor, a natural artery that has served as a cross-continental route since the first anatomically modern human populations migrated out of Africa. We compiled and reanalyzed the HVS-I (hypervariable segment-I) of 3840 mitochondrial DNA (mtDNA) sequences from 19 Iranian populations and from 26 groups from adjacent countries to give a comprehensive review of the maternal genetic variation and investigate the impact of historical events and cultural factors on the maternal genetic structure of modern Iranians. We conclude that Iranians have a high level of genetic diversity. Thirty-six haplogroups were observed in Iran's populations, and most of them belong to widespread West-Eurasian haplogroups, such as H, HV, J, N, T, and U. In contrast, the predominant haplogroups observed in most of the adjacent countries studied here are H, M, D, R, U, and C haplogroups. Using principal component analysis, clustering, and genetic distance-based calculations, we estimated moderate genetic relationships between Iranian and other Eurasian groups. Further, analyses of molecular variance and comparing geographic and genetic structures indicate that mtDNA HVS-I sequence diversity does not exhibit any sharp geographic structure in the country. Barring a few from some culturally distinct and naturally separated minorities, most Iranian populations have a homogenous maternal genetic structure.

Utilizing supply-demand bundles in Nature-based Recreation offers insights into specific strategies for sustainable tourism management

Balancing supply and demand in Nature-based Recreation (NbR) has the potential to yield co-benefits across multiple Ecosystem Services (ES), helping to make tourism activities more sustainable. However, a comprehensive understanding of supply-demand mismatches in NbR is challenging due to the complex interaction among various social, economic and ecological factors. This paper investigates mismatches in NbR supply and demand to provide insights for informing spatial and regional planning to achieve sustainable tourism. To this end, the paper uses a wide range of indicators such as biophysical attributes, accessibility and social indicators to map and assess NbR supply and demand, followed by the application of spatial statistics to analyse supply-demand mismatches. Cluster analysis was performed based on the supply-demand relationship to identify a typology of NbR ES across the study area in the north of Iran. The paper proposes an innovative application of recreation ES bundles with potential implications for sustainable tourism in a region marked as a hot spot for tourism. The analysis generated a typology of five bundles of NbR ES with differing recreational opportunities. Bundles 1 and 2, characterized by a supply surplus and substantial ecological value, are suitable for NbR activities such as camping, hiking, climbing, and birdwatching. In contrast, bundle 4 and 5 associated with urban centres, experience a supply deficit, making them less suitable for NbR. Bundle 3, characterized by a mixture of natural and productive lands, plays an important role in maintaining a balanced supply-demand state. This region holds potential for diverse forms of tourism, including rural and agricultural recreation such as farm tours and farm life experiences. Based on findings, the paper provides valuable insights for spatial and regional planning by proposing targeted strategies to sustainably manage tourism activities.

Sexual health literacy level and its related factors among married medical sciences college students in an Iranian setting: a web‑based cross‑sectional study

BACKGROUND

Sexual health literacy (SHL) leads to the development of personal ability, understanding, evaluation and use of information related to sexual health. The purpose of this study was to assess the sexual health literacy level and its related factors among married college students at Mazandaran University of Medical Sciences (MAZUMS).

METHODS

A web-based cross-sectional online study was conducted on married college students at Mazandaran University of Medical Sciences between January and November 2020. All students were included in the study by census, and the study method was explained by telephone. If they agreed to participate in the study, the online link to the questionnaire, including sociodemographic and clinical information and Sexual Health Literacy for Iranian Adults (SHELIA), was emailed. The Statistical Package for the Social Sciences (SPSS) software version 26 was used for data analysis. Univariate and multivariate logistic regression tests were used to assess factors related to sexual health literacy.

RESULTS

The sample consisted of 277 male and 123 female students. Sexual Health Literacy Level and all subscales are at the sufficient level (66.1-88). Among the participants, 20.5% had limited sexual health literacy. Multivariate analysis found factors related to sexual health literacy among students: economic status (OR 0.03; 95% CI 0.0-0.55) and faculty (OR 0.07; 95% CI 0.01-0.52) is related to decrease and subscription to social media for sexual health (OR 3.27; 95% CI 1.53-7.01), information source of channels and cyberspace (OR 3.23; 95% CI 1.41-7.39), educational level (OR 16.39; 95% CI 2.16-32.70), Internet search information source (OR 1.91; 95% CI 1.00-3.64) is related to increase, were statistically significant factors.

CONCLUSION

In Iran, medical sciences college students, who constitute a significant portion of the country's population, are responsible for sexual health education. Government agencies, with the collaboration of all stakeholders, should develop policies and programs for implementing and evaluating integrated and comprehensive sexual health literacy promotion programs for them.

Seromolecular study on the prevalence and risk factors of Toxoplasma gondii infection in pregnant women referred to a gynecology hospital in Urmia, northwest part of Iran in 2022

Toxoplasmosis is a frequent infection among the human population. The infection can cause devastating complications for the fetus during pregnancy. The present study aimed to determine the serological and molecular prevalence of the infection and molecular characterization of Toxoplasma gondii isolates among pregnant women referred to Kowsar Hospital, Urmia, Iran. In a cross-sectional study, 340 blood samples were collected from pregnant women referred to Kowsar Hospital, Urmia, Iran from May to July 2022. Anti-T. gondii IgG and IgM seropositivity were determined by enzyme-linked immunosorbent assay. PCR was carried out by targeting the GRA6 gene of the parasite on all patients' buffy coats. Anti-T. gondii IgG and IgM antibodies were positive in two (0.6%) women, and 101 (29.7%) women had anti-T. gondii IgG and 70.3% were seronegative. PCR was positive in two IgM-positive women, and both isolates belonged to T. gondii carrying the GRA6 allele of lineage I. The risk of infection was significantly higher in women who had constant contact with cats and soil, and who were residents of rural areas. The two IgM-positive women were asymptomatic regarding acute toxoplasmosis. According to the results of the present study, the prevalence of toxoplasmosis in pregnant women in Urmia is similar to its prevalence in other areas in northwestern Iran, and despite the low prevalence of acute infection, it should not be ignored.

Frequency of Fusion Inhibitor Resistance Mutations Among Therapy-Naïve HIV Patients

Glycoprotein 41 (gp41) of the human immunodeficiency virus type 1 (HIV-1) protein plays a critical role in membrane fusion. Gp41 binds to proteins in the plasma membrane of CD4+ T cells, particularly the T-cell antigen receptor (TCR). These findings indicate that gp41 is involved in the assembly of HIV-1 at the plasma membrane of T cells and affects the stimulation of the TCR. To control HIV-1, new inhibitors were introduced to target the gp41 protein. However, mutations in this region might reduce their efficacy. The Gp41 region was amplified from the sera of 30 patients using nested polymerase chain reaction. The sequences were analyzed by bioinformatics tools to identify mutations and gp41 structural features. Subtyping and the interaction between fusion inhibitors and gp41 proteins were also examined. As the first report from Iran, docking analysis between fusion inhibitors and Iranian gp41 proteins showed that mutations in gp41 could not reduce the efficacy of the fusion inhibitors. Most of the patients were infected with CRF35-AD. Several post-modification positions, including glycosylation and phosphorylation sites, were identified in the gp41 protein. Our findings revealed no known multinational drug resistance to gp41 inhibitors; thus, fusion inhibitors can effectively inhibit HIV in Iranian patients. In addition, the present study introduced a new gp41 region (36-44 aa), which considerably influences the interactions between gp41 inhibitors and the gp41 protein. This region may play a pivotal role in suppressing gp41 inhibitors in CFR35-AD. Furthermore, gp41 can be considered a good target for subtyping analysis via the phylogenetic method.

Health risk assessment of heavy metal pollutants in Iranian hen eggs: a systematic review and meta-analysis

Eggs are a high-quality, nutrient-dense source of protein that is available at a relatively low price and the contamination of eggs by heavy metals is an important issue in public health. This review aimed to assess the risk of heavy metal pollutants in Iranian hen eggs. Original full-text available studies in Iran, detecting levels of Pb, Cd, As, and Hg in whole or part of the egg, and published between January 2000 and March 2023 were selected based on the inclusion criteria. The random-effect model was used to estimate the pooled concentrations of Pb, Cd, As, and Hg in Iranian eggs in meta-analysis. The incremental lifetime cancer risk (ILCR) and the target hazard quotient (THQ) were estimated by both calculation and Monte Carlo simulations to determine the carcinogenic and non-carcinogenic risk of egg consumption, respectively. The pooled concentrations of heavy metals in Iranian hen eggs from nine articles (11 datasets: 10 studies on Pb, 7 on Cd, and 5 on As and Hg concentrations) were Pb 0.29 (95% CI 0.20-0.39) mg kg-1, Cd 0.04 (95% CI 0.03-0.06) mg kg-1, As 0.05 (95% CI 0.03-0.07) mg kg-1, and Hg 0.03 (95% CI 0.02-0.04) mg kg-1. THQ did not show the non-carcinogenic risk; however, the ILCR for Pb concentration showed the threshold carcinogenic risk (mean ILCR = 8.94e - 4 and 9.0E - 4 by calculation and Monte Carlo simulations, respectively), with the greater risk for Cd (mean ILCR = 2.02e - 2). The carcinogenic risk of Pb and Cd concentration in Iranian hen eggs shows the urgent need for programs and policies to lower the risk for consumers by providing healthier feeding.

Systematic review and meta-analysis of arsenic concentration in drinking water sources of Iran

Recent studies have found arsenic contamination of drinking water in some parts of Iran, as in many other countries. Thus, a comprehensive systematic review is necessary to assess the distribution and concentration of arsenic in drinking water sources. For this purpose, articles published from the first identification until December 2023, were retrieved from various national and international databases. Of all the studies examined (11,726), 137 articles were selected for review based on their conceptual relationship to this survey. A review of the extracted studies presented that ICP methods (ICP-MS, ICP-OES, 56%) and atomic absorption spectrophotometry (AAS, 34.1%) were the two most commonly used techniques for the analysis of arsenic in water samples. The order of arsenic content in the defined study areas is descending, as follows: northwest ˃ southeast ˃ southwest ˃ northeast. A review of studies performed in Iran depicted that provinces such as Kurdistan, Azerbaijan, and Kerman have the highest arsenic concentrations in water resources. Accordingly, the maximum concentration of arsenic was reported in Rayen, Kerman, and ranged from < 0.5-25,000 µg/L. The primary cause of elevated arsenic levels in water resources appears to be geologic structure, including volcanic activity, biogeochemical processes, sulfur-bearing volcanic rocks, Jurassic shale, the spatial coincidence of arsenic anomalies in tube wells and springs, and, to some extent, mining activities. The findings of the presented survey indicate that it is essential to take serious measures at the national level to minimize the health risks of arsenic contamination from drinking water consumption.

State Borders: Plant Foraging by Hawraman and Mukriyan Kurds in Western Iran

Plant foraging is a millennia-old activity still practiced by many people in the Middle East, particularly in the Fertile Crescent region, where several socioeconomic, ecological, and cultural factors shape this practice. This study seeks to understand the drivers of plant foraging in this complex region characterized by highly diverse linguistic, religious, and cultural groups. Our study aims to document the wild plants used by Kurds in Western Iran, identify similarities and differences among Hawraman and Mukriyan Kurdish groups in Iran, and compare our findings with a previous study on the Hawramani in Iraq. Forty-three semi-structured in-depth interviews were conducted in Kurdish villages of Western Iran. The results revealed the use of 44 wild food plant taxa, their preparation, and culinary uses. Among the reported taxa, 28 plant taxa were used by Mukriyani, and 33 by Hawramani. The study revealed a significant difference between the Hawraman and Mukriyan regions in Iran, whereas there is a high similarity between Hawramani Kurds in Iran and Iraq. We found that the invisible cultural border carries more weight than political divisions, and this calls for a paradigm shift in how we perceive and map the distribution of ethnobotanical knowledge.

What may encourage or deter health services utilization by people living with or at the risk of HIV/AIDS in special health centers? Qualitative evidence from a stigmatized community

BACKGROUND

Behavioral Diseases Counseling Centers (BDCCs) and Vulnerable Women's Counseling Centers (VWCCs) in Iran are the main peripheral centers that offer educational, counseling, diagnostic, preventive, curative and protective services to individuals living with or at high risk of contracting HIV/AIDS and female sex workers respectively. Due to the social stigma surrounding HIV in Iran, this study aims to identify the factors that may hinder or encourage HIV/AIDS patients and women with risky sexual behaviors from visiting these centers.

METHODS

Conducted in 2023, this qualitative study involved individuals visiting BDCCs and VWCCs in two western provinces of Iran, Ilam and Kermanshah. The study participants included 21 health staff members working in BDCCs and VWCCs and 20 HIV/AIDS patients and vulnerable women with unsafe sexual behaviors referring to these centers. Purposive, snowball and maximum variation sampling techniques were applied to interview the participants. Interviews were conducted between January 5th and May 21st, 2023, using a semi-structure guideline. Interviews were transcribed and content analysis approach was applied to analyze data using MAXQDA20 software.

RESULTS

According to the findings, the barriers and facilitators of visiting specialized centers for HIV/AIDS patients and vulnerable women were categorized into three main categories, 10 subcategories and 35 sub-subcategories including: Medical and operational processes (4 subcategories and 12 sub-subcategories), mutual interactions between the personnel and visitors (people living with and at the risk of getting HIV/AIDS) (3 subcategory and 13 sub-subcategories), and physical characteristics of the centers (3 subcategories and 10 sub-subcategories).

CONCLUSIONS

To improve the performance of BDCCs and VWCCs and encourage people living with and at the risk of contracting HIV/AIDS to visit these centers regularly, health policy makers should consider modifying clinical processes, physical features, personnel behaviors and visitors' concerns raised by the interviewees and the issues identified in this study.

Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030

This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be - 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were - 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of - 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001-2016 were - 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be - 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.

Heart surgery over two decades: what we have learned about results and changing risks

OBJECTIVES

Using the cardiac surgery database is of high importance in referral centers and can lead to a better quality of care for patients. Tehran Heart Center (THC) is a cardiovascular referral center that was inaugurated in 2001. In this report, we aimed to present the third report of trends in patients' cardiovascular risk factors and surgical procedures from 2002 to 2021 that have been gathered for all THC patients.

METHODS

This serial cross-sectional study was conducted at Tehran Heart Center from 2002 to 2021. All patients undergoing cardiac surgeries were eligible to enter the study (N = 63,974). Those with miscellaneous types of surgeries were excluded (N = 9556). The distribution of cardiac surgeries (including isolated coronary artery bypass graft (CABG), isolated valve, and CABG + valve surgeries) and their respective in-hospital mortality were recorded. Furthermore, 20-year trends in the prevalence of various cardiovascular risk factors (CVRFs) among the following groups were evaluated: a) isolated CABG, b) aortic valve replacement/repair for aortic stenosis (AS/AVR/r), and c) isolated other valve surgeries (IVS).

RESULTS

A total of 54,418 patients (male: 70.7%, age: 62.7 ± 10.8 years) comprised the final study population, with 84.5% prevalence of isolated CABG. Overall, the AS/AVR/r group was in between the CABG and IVS groups concerning CVRFs distribution. Excluding some exceptions for the AS/AVR/r group (in which the small sample size (N = 909) precluded observing a clear trend), all studied CVRFs demonstrated an overall rising trend from 2002 to 2021 in all three groups. Regarding in-hospital mortality, the highest rate was recorded as 4.0% in 2020, while the lowest rate was 2.0% in 2001.

CONCLUSIONS

Isolated CABG remained the most frequent procedure in THC. Notable, increasing trends in CVRFs were observed during this 20-year period and across various types of cardiac surgeries, which highlights the clinical and policy-making implications of our findings.

Exposure and biomonitoring of PAHs in indoor air at the urban residential area of Iran: Exposure levels and affecting factors

The concentration of polycyclic aromatic hydrocarbons (PAHs) in the air inside residential houses in Iran along with measuring the amount of 1-OHpyrene metabolite in the urine of the participants in the study was investigated by gas chromatography-mass spectrometry (GC-MS). Demographic characteristics (including age, gender, and body composition), equipment affecting air quality, and wealth index were also investigated. The mean ± standard error (SE) concentration of particulate matter 10 (PM10) and ∑PAHs in the indoor environment was 43.2 ± 1.98 and 1.26 ± 0.15 μg/m3, respectively. The highest concentration of PAHs in the indoor environment in the gaseous and particulate phase related to Naphthalene was 1.1 ± 0.16 μg/m3 and the lowest was 0.01 ± 0. 0.001 μg/m3 Pyrene, while the most frequent compounds in the gas and particle phase were related to low molecular weight hydrocarbons. 30% of the samples in the indoor environment have BaP levels higher than the standards provided by WHO guidelines. 68% of low molecular weight hydrocarbons were in the gas phase and 73 and 75% of medium and high molecular weight hydrocarbons were in the particle phase. There was a significant relationship between the concentration of some PAH compounds with windows, evaporative coolers, printers, and copiers (p < 0.05). The concentration of PAHs in houses with low economic status was higher than in houses with higher economic status. The average concentration of 1-hydroxypyrene metabolite in the urine of people was 7.10 ± 0.76 μg/L, the concentration of this metabolite was higher in men than in women, and there was a direct relationship between the amount of this metabolite in urine and the amount of some hydrocarbon compounds in the air, PM10, visceral fat and body fat. This relationship was significant for age (p = 0.01). The concentration of hydrocarbons in the indoor environment has been above the standard in a significant number of non-smoking indoor environments, and the risk assessment of these compounds can be significant. Also, various factors have influenced the amount of these compounds in the indoor air, and paying attention to them can be effective in reducing these hydrocarbons in the air.

Developing a responsive model to societal needs in medical education

BACKGROUND

Responsiveness is relevant in the context of treatment and the provision of medical services. However, if we delve deeper into the subject, we must establish and develop responsiveness within the medical sciences education system. This study aims to identify the dimensions that significantly impact responsiveness in the medical education system based on a comprehensive review and expert opinions in healthcare.

METHODS

The present research is descriptive-analytical in terms of its objective and follows a mixed-method approach. This study was conducted in three stages. Initially, we utilized relevant keywords related to education in databases, such as Web of Science, Scopus, ScienceDirect, OVID, CINHAL, EBSCO, Google Scholar, Iranmedex, SID, and Irandoc. Subsequently, in the expert panel session stage, the factors influencing responsiveness were identified in the comprehensive review stage, and with this thematic background, they were conceptualized. Finally, the Confirmatory Factor Analysis (CFA) technique was employed to coherently examine the relationships between variables and present the final model.

RESULTS

We obtained 32 articles from the comprehensive review of studies. Four components in planning, implementation, monitoring and evaluation, and intersectoral cooperation were identified based on expert panel opinions. Based on the standardized coefficients, the components of research-based educational planning, community-oriented education evaluation indicators, and utilization of modern educational methods are statistically significant.

CONCLUSION

The establishment and development of responsiveness in the medical sciences education system involve training specialized and responsive human resources through innovative educational methods that have sufficient familiarity with the multidimensional concepts of health and how to achieve them. This approach allows for practical and responsible steps toward training competent and committed physicians in line with the needs of society. On the other hand, responsiveness in the medical sciences education system can be improved by enhancing research-based educational planning and developing community-oriented evaluation indicators that can assess the number of revised educational programs based on societal needs. Therefore, understanding the critical elements in revising medical education programs, which play the most significant role in addressing societal needs and responding to changing disease patterns and new health priorities, is both a necessity and an important priority.

Kidney stones and dietary intake in adults: a population-based study in southwest Iran

BACKGROUND

The prevalence of kidney stones is on the rise globally. Several risk factors, including lifestyle, contribute to the formation of kidney stones. Nevertheless, there is a contentious debate about the relationship between diet and kidney stones. Therefore, our study aimed to assess the relationship between macronutrients and micronutrients and the formation of kidney stones.

METHODS

This population-based cross-sectional study was conducted in the baseline phase of the Hoveyzeh Cohort Study, focusing on adults aged 35-70 in southwest Iran. The information on demographic characteristics, anthropometrics, kidney stone history, and food frequency was collected. Chi-square and t-tests were utilized to assess the relationship between categorical and numerical variables with kidney stones. The ANCOVA and logistic regression models were used to evaluate the relationships while controlling for confounding factors.

RESULTS

Among 10,009 participants, the overall prevalence of kidney stones was 18.77% (95% CI: 17.99-19.53). A higher intake of carbohydrates [OR = 1.02 (95% CI:1.002-1.03), p = 0.026] and copper [OR = 1.04 (95% CI:1.01-1.09), p = 0.025] were found to be associated with kidney stones. No associations were found between the other assessed macronutrients or micronutrients and kidney stones (p-tvalues > 0.05).

CONCLUSION

Our study's findings indicate a correlation between diet and the formation of kidney stones. However, the relationship between dietary factors and kidney stones is complex, and further research is needed.

An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996-2023

Background

Diabetes mellitus (DM) poses a significant threat to public health, and the anticipated surge of over 100% in the age-standardized prevalence of type 2 diabetes in Iran between 2021 and 2050 underscores the pressing need for focused attention. The rationale for estimating the prevalence of type 2 diabetes in Iran becomes even more compelling when considering the potential cascading effects on the healthcare system, quality of life, and economic burden. The aim of this study was to estimate the prevalence and trends of DM from 1996 to 2023 in the Islamic Republic of Iran.

Methods

Up to July 2023, without deadlines, the search for appropriate articles in Persian and English. Iranian sources including SID, Magiran, and Element were included in the databases, along with foreign ones like PubMed/MEDLINE, Web of Science, Science Direct, Embase, Scopus, ProQuest, and Google Scholar. Using the JBI quality checklist, the study's level of quality was evaluated. Version 14 of STATA was used to carry out the statistical analysis. The Dersimonian and Liard random-effects models were used because of heterogeneity. To investigate the causes of heterogeneity, subgroup analysis and univariate meta-regression were utilized. Sensitivity analysis was then carried out to see how each study's findings affected the final findings. The prevalence pattern over time was also followed using cumulative meta-analysis.

Results

There were 53 studies in all, with a combined sample size of 1,244,896 people. Men were predicted to have a type 2 diabetes prevalence of 10.80% (95% CI: 9.1-12.4), while women were assessed to have a prevalence of 13.4% (95% CI: 11.6-15.3). Additionally, the prevalence of diabetes was much higher in the 55-64 age group, coming in at 21.7% (95% CI: 17.5-25.0). The anticipated prevalence of diabetes was 7.08% for 1988 to 2002, 9.05% for 2003 to 2007, 9.14% for 2008 to 2012, 15.0% for 2013 to 2017, and 13.40% for 2018 to 2023, among other time periods. Geographically, type 2 diabetes was most prevalent in Khuzestan (15.3%), followed by Razavi Khorasan (14.4%), Qazvin (14.3%), and Yazd (12.6%).

Conclusion

The prevalence of type 2 diabetes was estimated at 10.8%, highlighting variations across gender, age groups, and geographic regions that underscore the necessity for specific interventions. These findings advocate for proactive measures, including tailored screening and lifestyle modification programs. The notable temporal increase from 2013 to 2017 signals the need for policymakers and healthcare practitioners to develop effective strategies, anticipating and addressing the potential future burden on the healthcare system.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437506, identifier: CRD42023437506.

Potential distribution of Biscogniauxia mediterranea and Obolarina persica causal agents of oak charcoal disease in Iran's Zagros forests

In Iran, native oak species are under threat from episodes of Charcoal Disease, a decline syndrome driven by abiotic stressors (e.g. drought, elevated temperature) and biotic components, Biscogniauxia mediterranea (De Not.) Kuntze and Obolarina persica (M. Mirabolfathy). The outbreak is still ongoing and the country's largest ever recorded. Still, the factors driving its' epidemiology in time and space are poorly known and such knowledge is urgently needed to develop strategies to counteract the adverse effects. In this study, we developed a generic framework based on experimental, machine-learning algorithms and spatial analyses for landscape-level prediction of oak charcoal disease outbreaks. Extensive field surveys were conducted during 2013-2015 in eight provinces (more than 50 unique counties) in the Zagros ecoregion. Pathogenic fungi were isolated and characterized through morphological and molecular approaches, and their pathogenicity was assessed under controlled water stress regimes in the greenhouse. Further, we evaluated a set of 29 bioclimatic, environmental, and host layers in modeling for disease incidence data using four well-known machine learning algorithms including the Generalized Linear Model, Gradient Boosting Model, Random Forest model (RF), and Multivariate Adaptive Regression Splines implemented in MaxEnt software. Model validation statistics [Area Under the Curve (AUC), True Skill Statistics (TSS)], and Kappa index were used to evaluate the accuracy of each model. Models with a TSS above 0.65 were used to prepare an ensemble model. The results showed that among the different climate variables, precipitation and temperature (Bio18, Bio7, Bio8, and bio9) in the case of O. persica and similarly, gsl (growing season length TREELIM, highlighting the warming climate and the endophytic/pathogenic nature of the fungus) and precipitation in case of B. mediterranea are the most important influencing variables in disease modeling, while near-surface wind speed (sfcwind) is the least important variant. The RF algorithm generates the most robust predictions (ROC of 0.95; TSS of 0.77 and 0.79 for MP and OP, respectively). Theoretical analysis shows that the ensemble model (ROC of 0.95 and 0.96; TSS = 0.79 and 0.81 for MP and OP, respectively), can efficiently be used in the prediction of the charcoal disease spatiotemporal distribution. The oak mortality varied ranging from 2 to 14%. Wood-boring beetles association with diseased trees was determined at 20%. Results showed that water deficiency is a crucial component of the oak decline phenomenon in Iran. The Northern Zagros forests (Ilam, Lorestan, and Kermanshah provinces) along with the southern Zagros forests (Fars and Kohgilouyeh va-Boyer Ahmad provinces) among others are the most endangered areas of potential future pandemics of charcoal disease. Our findings will significantly improve our understanding of the current situation of the disease to pave the way against pathogenic agents in Iran.

A short-term economic evaluation of early insulin therapy compared to oral anti-diabetic drugs in order to reduce the major adverse events in type 2 diabetes patients in Iran

OBJECTIVE

While there are some recommendations about early insulin therapy in newly diagnosed Type 2 Diabetes Mellitus (T2DM) patients, there is not sufficient evidence on this strategy's cost-effectiveness. This study compared early insulin therapy versus oral anti-diabetic drugs (OADs) for managing T2DMusing a cost-effectiveness analysis approach in Iran.

METHODS

In this economic evaluation, a decision analytic model was designed. The target population was newly diagnosed type 2 diabetic patients, and the study was carried out from the perspective of Iran's healthcare system with a one-year time horizon. Basal insulin, Dipeptidyl peptidase-4 (DPP-4) inhibitors, and Thiazolidinediones (TZDs) were compared in this evaluation. The main outcome for assessing the effectiveness of each intervention was the reduction in the occurrence of diabetes complications. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and deterministic and probabilistic sensitivity analyses were carried out.

RESULTS

The DPP-4 inhibitors strategy was the dominant strategy with the highest effectiveness and the lowest cost. Early insulin therapy was dominated (ICER: $-53,703.18), meaning that it was not cost-effective. The sensitivity analyses consistently affirmed the robustness of the base case findings. The probabilistic sensitivity analysis indicated probabilities of 77%, 22%, and 1% for DPP-4 inhibitors, TZDs strategies, and early insulin therapy, respectively, in terms of being cost-effective.

CONCLUSION

In terms of cost-effectiveness, early insulin therapy was not cost-effective compared to OADs for managing newly diagnosed T2DM patients. Future studies in this regard, utilizing more comprehensive evidence, can yield more accurate results.

Prevalence and incidence of multiple sclerosis in Isfahan, Iran between 1996 and 2021: A population-based study

BACKGROUND

There has been no recent comprehensive epidemiological study on a large and stable population of multiple sclerosis (MS) in Isfahan. Therefore, we conducted this study to estimate the incidence and prevalence of MS in Isfahan province from 1996 to 2021.

METHOD

In this population-based study, we utilized the dataset from the Vice-Chancellor's Office of Isfahan University of Medical Sciences, which registers all people diagnosed with MS (PDWM) in Isfahan province, excluding those residing in Kashan city. We measured crude incidence and prevalence of MS, separated by sex, and based on age of MS onset, as well as changes in age of MS onset during observation.

RESULTS

A total of 9,909 PDWM were included in our study. The incidence during the time period of 1996-2000 was 5.4/100,000 (1.1/100,000 per year), which subsequently increased to 14.1 (2.8/100,000 per years) and 31.1 per 100,000 (6.2/100,000 per year) during 2001-2005 and 2006-2010, respectively. There was a further increase to 70.9/100,000 (14.2/100,000 per year) in 2011-2015, but it remained stable at 71.8/100,000 (12/100,000 per year) during the period of 2016-2021. In 2016, the age-standardized incidence rates of pediatric-onset, adult-onset, and late-onset MS were 1.8/100,000, 31.4/100,000, and 17.5/100,000, respectively. The prevalence of MS in 2021 was 183.9/100,000. The female/male new case ratio was 4.5 during 1996-2000, decreasing to 4.0, 3.9, 3.9, and 2.9 in the subsequent four five-year periods. The mean age of RRMS onset was 26.3 ± 8.1 between 1990 and 1999, 28.5 ± 8.3 during 2000-2009, and increased to 32.8 ± 9.6 in 2010-2019.

CONCLUSION

This study shows that Isfahan has one of the highest incidence rate and prevalence ratio of MS in the region. We observed an increase in the incidence rate during the first decade, followed by stability in the last two five- and six-year periods. Further studies are needed to identify the reasons behind the change in incidence of MS in Iran.

A Study of the Use of Medicinal Plants by Persons With Type 2 Diabetes in Iran

Medicinal plants are used by many people with Type 2 diabetes in Iran. The aim of this study was to explore why this is so, from their perspective. Sixteen persons with Type 2 diabetes in Yazd City, Iran, were interviewed in April and May 2020 for this study. A thematic analysis of the transcripts of those interviews was done using MAXQDA 10 software. Six themes were identified: beliefs about medicinal plants, psychological factors, accessibility and economic barriers, patients' knowledge and awareness, social pressure, and the role of family culture. The recommendation of the study is that health counselors and specialists should provide needed information and skills for the proper use of medicinal plants, and the pharmaceutical infrastructures need to be expanded to provide enough drugs to facilitate better access to needed medication and reduce reliance on medicinal plants for persons with Type 2 diabetes.

Electrocardiography changes and different stages of heart failure in central Iran: A cross-sectional study from Yazd Health Study

Background and Aims

Electrocardiography (ECG) is a widely accessible, noninvasive, and cost-effective diagnostic instrument used to evaluate patients with suspected heart failure (HF). The aim of this study is to investigate electrocardiographic changes in patients with different stages of HF in a random population of Yazd city.

Methods

This prospective cross-sectional study included 319 individuals, randomly selected, aged 40 years and more, registered in the Yazd Health Study was conducted from March 2022 to May 2023 at Afshar Hospitals. In accordance with the AHA/ACC guidelines, HF was classified into four stages (A, B, C, and D).

Results

The 159 individuals were classified in the stage 0 group, 77 were in Stage A, 65 were in Stage B, and 18 were in Stage C of HF. In the Stage 0, the PR interval (PRi) was 130.5 ± 18.1 ms, while in Stage C, it was 143.3 ± 21.9 ms, with a significant difference (p = 0.047). Similarly, the QRS interval (QRSi) increased with HF staging (p = 0.001). The frequency of diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), chronic heart disease, alcoholism, and PRi, QRSi, QT interval levels were independent predictors of HF stage in multivariate regression analysis.

Conclusion

The prevalence of HF stages, as classified by the AHA/ACC guidelines, was observed, with significant correlations between ECG parameters and HF progression. abnormal rhythms, left bundle branch block, ischemia, hypertrophy, and left atrial enlargement increased with higher HF stages. Major risk factors like DM and HTN exhibited a heightened prevalence in advanced HF stages, accentuating their pivotal role in the progression of HF.

A national registry-based study of ethnic differences in people with multiple sclerosis in Iran

OBJECTIVE

The relationship between MS and ethnicity has been understudied in the Middle East compared to the United States and Europe. As Iran as the highest prevalence of MS in the Middle East, we decided to investigate the demographic and clinical differences in people with MS (pwMS) from major ethnicities Iran.

METHODS

In a cross-sectional study using data from National Multiple Sclerosis Registry in Iran. PwMS from six provinces were chosen and interviewed for determining their ethnicity. Persians (Fars), Kurds, Lurs, Azeris and Arabs with a clear ethnic background were included. Recorded data from the registry was used to compare the demographic and clinical features.

RESULTS

A total of 4015 pwMS (74.2% female) were included in the study with an average age of 36.76 ± 9.68 years. Persians and Kurds had the highest percentage of pwMS in youngest and oldest age groups, respectively, with 2.9% and 5.7% (p<0.01). The highest average age of onset was seen in Persians (29.47 ± 8.89) and the lowest observed in Mazandaranis (26.82 ± 7.68, p<0.01). Azeris and Kurds had the highest proportions of pwMS diagnosed <18 and >55, at rates of 12% and 1.6%, respectively (p<0.01). There were statistically significant differences in distribution of phenotypes (p<0.01) and time to progression to secondary progressive MS (p<0.01) such that Persians had the highest rate of clinically isolated syndrome (CIS) at 19.3% and Arabs had highest rates of relapsing-remitting MS (86.2%) and secondary progressive MS (16.4%). Lurs, Azeris and Mazandaranis had significantly more patients progressing to secondary-progressive MS <5 years from diagnosis (p<0.01). There was a significant difference in number of relapses between the ethnicities (p<0.01) with Lurs having the highest proportion of participants reporting >4 relapses with 23.0% and Azeris having the highest percentage of pwMS reporting no relapse (53.0%). Kurds had the highest Expanded Disability Status Scale (EDSS) average at 2.93 ± 1.99 and Lurs had the lowest with 1.28 ± 1.25 (p<0.01). The differences in prevalence of positive family history for the whole cohort between ethnicities were significant (P=0.02), ranging from 12.8% in Kurds to 19.6% in Persians.

CONCLUSION

We found Persians to have higher rates of pediatric MS and higher rates of CIS. Kurds and Lurs had higher and lower EDSS scores, respectively. Lurs and Persian had higher annual relapse rates. We also found lower rates of SPMS among Arabs and earlier progression to SPMS in Lurs, Azeris and Mazandaranis. Such differences highlight the importance of the potential role of ethnicities in diagnosis and prognosis of MS, especially considering their observation within the geographical limits of a single country.

A fuzzy interval dynamic optimization model for surface and groundwater resources allocation under water shortage conditions, the case of West Azerbaijan Province, Iran

The allocation of water in areas which face shortage of water especially during hot dry seasons is of utmost importance. This is normally affected by various factors, the management of which takes a lot of time and energy with efforts falling infertile in many cases. In recent years, scholars have been trying to investigate the applicability of fuzzy interval optimization models in attempts to address the problem. However, a review of literature indicates that in applicating such models, the dynamic nature of the problem has mostly been overlooked. Therefore, the aim of the present study is to provide a fuzzy interval dynamic optimization model for the allocation of surface and groundwater resources under water shortage conditions in West Azerbaijan Province, Iran. In so doing, an optimization model for the allocation of water resources was designed and then was validated by removing surface and groundwater resources and analyzing its performance once these resources were removed. The model was then applied in the case study of ten regions in West Azerbaijan Province and the optimal allocation values and water supply percentages were determined for each region over 12 periods. The results showed that the increase in total demand has the greatest effect while the increase in groundwater industrial demand has the least effect on the supply reduction rate. The increase of uncertainty up to 50% in the fuzzy interval programming would lead to subsequent increases in groundwater extraction by up to 19% and decreases in water supply by up to 10%. The increase of uncertainty in the fuzzy interval dynamic model would cause an increase in groundwater extraction to slightly more than 10% and a decrease in water supply to 0.05%. Therefore, implementing the fuzzy interval dynamic programming model would result in better gains and would reduce uncertainty effects. This would imply that using a mathematical model can result in better gains and can provide better footings for more informed decisions by authorities for managing water resources.

Development and psychometric evaluation of a 360-degree evaluation instrument to assess medical students' performance in clinical settings at the emergency medicine department in Iran: a methodological study

BACKGROUND

In the Iranian context, no 360-degree evaluation tool has been developed to assess the performance of prehospital medical emergency students in clinical settings. This article describes the development of a 360-degree evaluation tool and presents its first psychometric evaluation.

METHODS

There were 2 steps in this study: step 1 involved developing the instrument (i.e., generating the items) and step 2 constituted the psychometric evaluation of the instrument. We performed exploratory and confirmatory factor analyses and also evaluated the instrument's face, content, and convergent validity and reliability.

RESULTS

The instrument contains 55 items across 6 domains, including leadership, management, and teamwork (19 items), consciousness and responsiveness (14 items), clinical and interpersonal communication skills (8 items), integrity (7 items), knowledge and accountability (4 items), and loyalty and transparency (3 items). The instrument was confirmed to be a valid measure, as the 6 domains had eigenvalues over Kaiser's criterion of 1 and in combination explained 60.1% of the variance (Bartlett's test of sphericity [1,485]=19,867.99, P<0.01). Furthermore, this study provided evidence for the instrument's convergent validity and internal consistency (α=0.98), suggesting its suitability for assessing student performance.

CONCLUSION

We found good evidence for the validity and reliability of the instrument. Our instrument can be used to make future evaluations of student performance in the clinical setting more structured, transparent, informative, and comparable.

The epidemiology of neck and low back pain in Iran: a national and sub-national analysis from 1990 to 2019

Background

Neck pain (NP) is a condition influenced by multiple factors. It places a significant burden on individuals suffering from NP and on social and economic systems. On a global scale, low back pain (LBP) stands out as a significant contributor to years lost to disability, and this burden is on the rise due to population growth and aging.

Methods

The Global Burden of Disease database was used to collect data on the prevalence, incidence, and years lived with disability (YLD) of NP and LBP between 1990 and 2019. Various factors, including age group, gender, Iran, and its 31 provinces, were used to classify the data.

Results

Iran accounted for 0.86 million incident cases of NP in 2019, with age-standardized incident rate per 100 000 population of 934.1. Tehran has the maximum age-standardized prevalence, incidence, and YLD. Iran accounted for the age-standardized incidence rate for LBP per 100 000 population of 3492.9, and it reduced to -8.35% from 1990. Mazandaran exhibits the highest levels of prevalence, incidence, and YLD for LBP in 2019. In Iran, the point prevalence of NP in 2019 was higher in females and increased with age up to 50-54 years for females and 70-74 years for males. However, there is only a slight difference between females and males in Iran regarding LBP prevalence.

Conclusions

In this study, the authors report the prevalence, incidence, YLD, and age-standardized rates for NP and LBP in the world's general population and Iran's population based on its sub-nations in 1990 and 2019.

Molecular identification, risk factor assessment, and phylogenetic analysis of tick-borne pathogens in symptomatic and asymptomatic cattle from South-Eastern Iran

Tick-borne pathogens (TBPs) represent a substantial threat to cattle globally, exerting adverse impacts on production, health, and economic viability. This study delves into the prevalence and implications of TTBPs in cattle sourced from resource-limited smallholder livestock farms situated in southeastern Iran, proximate to Afghanistan and Pakistan. Blood and tick specimens were systematically collected from a cohort of 230 cattle, comprising 150 asymptomatic and 80 symptomatic individuals. Genomic DNA isolated from blood samples underwent rigorous examination for the presence of key TBPs, including Anaplasma marginale, A. phagocytophilum, A. bovis, A. centrale, Babesia bigemina, and Theileria annulata, utilizing multiple genetic markers. Nucleotide sequence analysis facilitated the reconstruction of phylogenetic relationships. The study also evaluated various potential risk factors, such as clinical status, gender, age, breed, tick infestation, and management practices, to elucidate their associations with TTBPs. Among the cattle cohort, a staggering 87.8% (202/230) tested positive for at least one pathogen. Prevalence statistics encompassed A. marginale (72.2%), T. annulata (68.3%), A. phagocytophilum/A. platys-like complex (66.1%), A. centrale (16.7%), B. bigemina (10.0%), and A. bovis (6.1%). Remarkably, mixed infections involving two, three, and four pathogens were detected in 23%, 52.1%, and 2.2% of animals, respectively. Notably, all asymptomatic cattle were positive for at least one TBP. Tick infestation was observed in 62.2% (143/230) of cattle, predominantly caused by Hyalomma anatolicum (82.5%), Rhipicephalus (Boophilus) annulatus (13.1%), and R. sanguineus sensu lato (4.4%). Risk factors linked to TBPs encompassed tick infestation, older age, and crossbred animals. Clinical presentations among symptomatic cattle encompassed fever, anemia, weight loss, anorexia, jaundice, and enlarged superficial lymph nodes. This study underscores the pivotal role of asymptomatic carriers in the propagation of TTBPs within endemic regions. Furthermore, it emphasizes the potential for the implementation of molecular diagnostics to unmask subclinical infections, thereby affording the opportunity for targeted interventions aimed at ameliorating the burden of TTBPs in resource-constrained smallholder dairy farms.

Toxoplasma gondii seroprevalence in the Iranian blood donors: A systematic review and meta-analysis

Background

The present systematic review and meta-analysis was done to assess the rate of Toxoplasma gondii (T. gondii) exposure among Iranian healthy blood donors.

Methods

We searched four English (PubMed, Scopus, Web of Science, and Science Direct) and two Persian databases (Magiran and SID) as well as Google Scholar as a specialized article search engine using specific keywords for relevant papers from the inception up to November 30, 2023.

Results

In total, 19 studies enrolling 8226 apparently healthy blood donors were examined regarding T. gondii-specific IgG and/or IgM antibodies, among which 2666 [32.9% (95% CI: 25.3%-41.6%)], 168 [1.4% (95% CI: 0.9%-2.1%)], and 83 [1.7% (95% CI: 1.3%-2.1%)] subjects were seropositive regarding IgG, IgM, and both IgG/IgM antibodies, respectively. Five risk factors were significantly associated with T. gondii seroprevalence, including gender (OR = 1.98; 95% CI: 1.52-2.58; P < 0.001), contact with cat (OR = 2.41; 95% CI: 1.70-3.41; P < 0.001), contact with soil (OR = 2.83; 95% CI: 1.07-7.45; P = 0.035), consuming raw/undercooked meat (OR = 1.95; 95% CI: 1.03-3.70; P = 0.039), and raw/unwashed vegetables (OR = 1.70; 95% CI: 1.25-2.31; P = 0.001).

Conclusion

A moderate rate of T. gondii exposure was found in the Iranian blood donors, with the association of several risk factors, including gender, contact with cat, contact with soil, consumption of unwashed vegetables and/or undercooked meat. Still, more studies are recommended regarding T. gondii exposure among blood donors in Iran.

Impact of health literacy and illness perception on medication adherence among older adults with hypertension in Iran: a cross-sectional study

Background

Adherence to medication is an essential factor in controlling and reducing the side effects of non-communicable diseases, particularly hypertension. Medication adherence varies in older adults due to the effects of various factors. The research aimed to examine the determinants of medication adherence among older adults with hypertension.

Methods

This cross-sectional study was performed among 300 people aged 60 years or older referring to health centers in Sarab, Iran, between February and May 2023. To collect data, valid and reliable tools were applied.

Results

There was a significant association between age groups, level of education, and monthly income status with adherence to medication (p-value <0.05). According to the results of hierarchical regression, demographic variables collectively explained 3.2% of the variance in adherence to therapeutic regimens (p-value = 0.143). The inclusion of illness perception at step 2, along with demographic variables, led to a further significant increase in 9.6% of the variance (p-value <0.001). In the final step, health literacy dimensions were added, which explained an additional 8.7% of the variance (p-value <0.001). In total, demographic variables, illness perception, and HL dimensions explained 21.5% of the variance in adherence to therapeutic regimens.

Conclusion

According to the results, demographic variables, illness perception, and HL dimensions were the main determinants of medication adherence among older adults. Health educators should focus on creating interventions that improve medication adherence by addressing illness perception and health literacy dimensions in this particular population.

Phylogenetic analysis and antimony resistance of Leishmania major isolated from humans and rodents

Cutaneous Leishmaniasis (CL) is one of the world's neglected diseases which is caused by Leishmania spp. The aim of this study was to assess molecular profile and antimony resistance of Leishmania isolated from human and rodent hosts. Samples were collected from suspected CL patients referred to health centres and wild rodent's traps in Gonbad-e-Qabus region, north-eastern Iran. Smears were subjected to PCR-RFLP to identify Leishmania species. In addition, ITS1-PCR products were sequenced for phylogenetic analysis. Clinical isolates and rodent samples were subjected to MTT assay to determine IC50 values and in vitro susceptibilities. Expression levels of antimony resistance-related genes were determined in CL isolates. Out of 1,949 suspected patients with CL and 148 rodents, 1,704 (87.4%) and 6 (4.05%) were positive with direct smear, respectively. Digestion patterns of BusRI (HaeIII) endonuclease enzyme were similar to what expected for Leishmania major. Phylogenetic analysis revealed that the highest interspecies similarity was found between current L. major sequences with L. major obtained from Russia and Uzbekistan. Out of 20 L. major samples tested, 13 (65%) were resistant to meglumine antimoniate (MA) treatment, with an activity index (AI) exceeding 4. The remaining 7 samples (35%) responded to MA treatment and were classified as sensitive isolates, with a confirmed sensitive phenotype based on their AI values. The comparison expression analysis of three major antimony resistance-associated genes in unresponsive clinical isolates demonstrated significant fold changes for TDR1 (4.78-fold), AQP1 (1.3-fold), and γ-GCS (1.17-fold) genes (P < 0.05). Herein, we demonstrate genetic diversity and antimony resistance of L. major isolated from human and reservoir hosts in north-eastern Iran, which could be the basis for planning future control strategies.

Spatiotemporal assessment of sustainable groundwater management using process-based and remote sensing indices: A novel approach

This study aims to develop a process-based method for evaluating groundwater sustainability and use the results in an archetypal analysis to fundamentally frame and understand sustainable development interactions in a river basin scale and sub-basin resolution. This method was applied in the Tashk-Bakhtegan-Maharloo (TBM) basin of Iran between 2003 and 2018; anthropogenic and natural factors were considered. With its 31 aquifers in 27 sub-basins, the TBM basin has repeatedly suffered severe droughts and water shortages over the past half a century, highlighting the importance of sustainable groundwater management. This study quantified anthropogenic and natural factors affecting groundwater dynamics to address sustainability and defined representative and relative indices, including climatological and drought conditions, vegetation cover, land cover, and population, to assess groundwater sustainability (GWS). Relative indices, prepared using measured data and remote sensing analysis, were chosen to explain groundwater-related situations, whereas representative indices, such as groundwater level and total dissolved solids, were used to explain the groundwater situation. GWS was spatially monitored using a couple-indicator trend-line slope comparison method to analyze process-based indices. Then, archetypal interaction patterns and their drivers in the groundwater system were investigated using results from process-based indices analyses results. The results showed that the TBM basin has moved towards unsustainable levels because of drought, increased irrigated croplands, unbalanced development of the sub-basins up- and downstream in the river's path, and over-exploitation of groundwater. These findings indicate that a deeper understanding of groundwater problems and stakeholder associations is required in order to adapt to the changing groundwater conditions.

Barriers and enabling factors for utilizing physical rehabilitation services by Afghan immigrants and refugees with disabilities in Iran: a qualitative study

INTRODUCTION

Individuals with a migrant background often underutilize physical rehabilitation services (PRS) compared to the host population. This disparity is attributed to various barriers, including limited access to information, language barriers, illiteracy, and cultural factors. To improve PRS utilization by Afghan immigrants and refugees in Iran, it is crucial to identify these barriers and enabling factors. In response, this study explored the barriers and enabling factors for utilizing PRS among Afghan immigrants and refugees with disabilities in Iran.

METHODS

This qualitative study was conducted in Iran between January and March 2023. Participants were selected through convenient and snowball sampling. Individual, semi-structured interviews were carried out both in face-to-face and online formats. Data analysis occurred concurrently with data collection, using the directed content analysis approach.

RESULTS

Findings from our research indicate that common barriers to PRS utilization among Afghan immigrants and refugees include insufficient insurance coverage, high service costs, expensive transportation and accommodation, limited knowledge about Iran's health system, inadequate awareness of available supports, restricted access to PRS in remote areas, impatience among PRS providers, fear of arrest and deportation, a lack of trust in modern treatments, stringent immigration rules, high inflation rates limiting the ability to pay for PRS, and limited social support. On the other hand, several enabling factors were identified, such as strengthening insurance coverage, utilizing the capacities of charities and NGOs, providing information about available services, promoting respectful behavior by healthcare providers towards patients, facilitating cultural integration, and increasing immigrants' awareness of available services and eligibility criteria.

CONCLUSION

The barriers and enabling factors uncovered in this study offer valuable insights into the complexities surrounding PRS utilization by Afghan immigrants and refugees with disabilities in Iran. Understanding and addressing these factors is essential for developing targeted interventions and policies that can improve access and utilization, ultimately leading to enhanced health outcomes for this vulnerable population.

Economic burden of diabetic foot ulcer: a case of Iran

BACKGROUND

Diabetic foot ulcer (DFU) is known as a serious complication of diabetes mellitus in patients with diabetes, imposing heavy medical costs on healthcare systems due to its chronic nature. patients with severe diabetic foot ulcer are often disabled to work, and some of them may even die, leading to associated productivity losses. Since no previous study has investigated the economic burden of DFU in Iran, this study is to estimate the economic burden of diabetic foot disease in Iran.

METHODS

In this descriptive cross-sectional study, randomly selected samples consisted of 542 patients with DFU, hospitalized in the hospitals of Shahid Beheshti University of Medical Sciences. The demographic profile and cost data used in this analysis were derived from a researcher-designed checklist. Lost productivity was calculated based on Human Capital Approach, and the total economic cost of DFU was determined using patient-level data on costs and prevalence data from the global burden of diseases reports. All analyses were performed using SPSS software (Version 23), and Microsoft Excel (Version 19).

RESULTS

The economic burden of DFU in Iran in two scenarios of discounting future costs and not discounting them was about $8.7 billion and $35 billion, respectively (about 0.59 and 2.41% of GDP). 79.25% of the estimated costs in this study were indirect costs and productivity losses, of which 99.34% (7,918.4 million Dollars) were productivity losses due to premature death. 20.75% (2,064.4 million dollars) of the estimated costs in this study were direct costs. The average length of stay (LOS) was 8.10 days (SD = 9.32), and 73.3% of patients recovered and were discharged after hospitalization and 7.6% died. The majority of the costs are imposed on the age group of 60-69 year (53.42% of the productivity lost due to hospital length of stay, 58.91% of the productivity lost due to premature death & 40.41% of direct costs).

CONCLUSIONS

DFU represents a heavy burden to patients, Iran's health system, and the economy. Early prevention strategies need to be prioritized in making public health policies. These policies and decisions can be in the area of changing lifestyle, health education, changing people's behavior, and encouraging physical activity that targeted high-risk populations in order to reduce the prevalence of diabetic foot and resulting substantial economic burden.

A gender-specific geodatabase of five cancer types with the highest frequency of occurrence in Iran

OBJECTIVES

Cancer is a global health challenge with complex characteristics. Despite progress in research and treatment, a universally effective prevention strategy is lacking. Access to reliable information, especially on occurrence rates, is vital for cancer management. This study aims to create a database containing individual and spatially integrated data on commonly diagnosed cancers in Iran from 2014 to 2017, serving as a valuable resource for spatial-epidemiological approaches.

DATA DESCRIPTION

This database encompasses several files related to cancer data. The first file is an Excel spreadsheet, containing information on newly diagnosed cancer cases from 2014 to 2017. It provides demographic details and specific characteristics of 482,229 cancer patients. We categorized this data according to the International Agency for Research on Cancer (IARC) reporting rules to identify cancers with the highest incidence. To create a geodatabase, individual data was integrated at the county level and combined with population data. Files 2 and 3 contain gender-specific spatial data for the top cancer types and non-melanoma skin cancer. Each file includes county identifications, the number of cancer cases for each cancer type per year, and gender-specific population information. Lastly, there is a user's guide file to help navigate through the data files.

Translation and psychometric evaluation of the Persian version of the nurses' quality of life scale: a validation study in Iran

BACKGROUND

The quality of life for nurses can be significantly impacted by various occupational factors that Influence their working conditions and professional performance. The current study aimed to translate and validate the Persian version of the Nurses' Quality of Life Scale.

MATERIAL AND METHOD

In this cross-sectional research, the Nurses' Quality of Life Scale (NQOLS) was utilized to assess the quality of life among 500 employed nurses in hospitals in the cities of Gonabad and Sabzevar. The translation process of the NQOLS followed the model proposed by Wild et al. The content validity of the Persian version of the scale was evaluated using the Content Validity Index (CVI) and Content Validity Ratio (CVR). Structural validity was assessed using exploratory and confirmatory factor analyses. Internal consistency reliability was assessed using Cronbach's alpha, while test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC). Data analysis was conducted using SPSS version 26 and LISREL version 8.8 software.

RESULTS

The exploratory factor analysis of the Persian version of NQOLS revealed six factors that accounted for 62.15% of the total variance. The structural validity of the extracted factors was confirmed through confirmatory factor analysis. The Cronbach's alpha coefficient and ICC for the entire questionnaire were 0.91 and 0.95, respectively.

CONCLUSION

The findings of the present study suggest that the Persian version of the NQOLS exhibits sufficient validity and reliability. Therefore, it can be used as an effective tool for measuring and examining the quality of life among nurses in Iran.

Development of New PCR Protocols to Detect Genetic Diversity in the Metronidazole Metabolism Genes in Susceptible and Refractory Clinical Samples of Giardia duodenalis

PURPOSE

Investigating the genetic variation in thioredoxin reductase (TrxR) and nitroreductase (NR) genes in both treatment-resistant and -sensitive Giardia duodenalis isolates can provide valuable information in identifying potential markers of resistance to metronidazole. The rapid increase in metronidazole treatment failures suggests the presence of genetic resistance mechanisms. By analyzing these genes, researchers can gain insights into the efficacy of metronidazole against G. duodenalis and potentially develop alternative treatment strategies. In this regard, four G. duodenalis isolates (two clinically sensitive and two clinically resistant to metronidazole) were collected from various hospitals of Shiraz, southwestern Iran.

METHODS

Parasitological methods including sucrose flotation and microscopy were employed for the primary confirmation of G. duodenalis cysts in stool samples. Microscopy-positive samples were approved by SSU-PCR amplification of the parasite DNA. All four positive G. duodenalis specimens at SSU-PCR were afterward analyzed utilizing designed primers based on important metronidazole metabolism genes including TrxR, NR1, and NR2.

RESULTS

Unlike TrxR gene, the results of NR1 and NR2 genes showed that there are non-synonymous variations between sequences of treatment-sensitive and -resistant samples compared to reference sequences. Furthermore, the outcomes of molecular docking revealed that there is an interaction between the protein sequence and spatial shape of treatment-resistant samples and metronidazole in the position of serine amino acid based on the NR1 gene.

CONCLUSION

This issue can be one of the possible factors involved in the resistance of Giardia parasites to metronidazole. To reach more accurate results, a large sample size along with simulation and advanced molecular dynamics investigations are needed.

Unveiling the nexus of climate change, adaptation strategies, and food security: Insights from small-scale farmers in zagros mountains in Iran

In today's world, climate change and its unprecedented impact on food and nutrition security have emerged as a significant and formidable global challenge. This study aimed to investigate the effect of adaptation strategies on the food security of small-scale farmers in Khorramabad city, Iran, using a survey-based analysis. To assess the food security level, the Household Food Security Survey Module (HFSSM) was employed. Additionally, Structural Equation Modeling was utilized to examine the relationship between adaptation dimensions and food security. The findings revealed that households without children exhibited a higher level of food security (48%) compared to households with children (6%). Moreover, the results demonstrated a positive and significant correlation between the food security of households, regardless of whether they had children, and the different adaptation components. Despite a satisfactory level of knowledge regarding climate change adaptation in the study area, the actual implementation of such measures remained low. While weed management, agricultural crop insurance, and access to meteorological information were identified as the top three strategies employed by farmers, the results suggested that sustainable-oriented operations and organic-oriented practices could serve as more effective strategies for both climate change resilience and enhancing food security status.

in Urban Rodents of Different Districts in Southwestern Iran: Subtype Distribution and Possible Zoonotic Potential

PURPOSE

Rodents are one of the most abundant and diverse species of mammals and have recently been identified as carriers of numerous human pathogens. The current study was conducted to assess the prevalence, subtype (STs) distribution, and zoonotic potential of Blastocystis spp. in various species of rodents in Shiraz, southwestern Iran.

METHODS

For this aim, a total of 120 fresh fecal samples were collected from Mus musculus (n = 40), Rattus norvegicus (n = 40), and Rattus rattus (n = 40) in various municipality districts of Shiraz (6 out of 10 districts) between February and November 2020. Upon detecting parasites using light microscopy, a DNA fragment of the Blastocystis SSU rDNA gene was amplified using conventional PCR.

RESULTS

By employing direct wet mount examination, 8 out of 120 fecal samples (6.7%; 2 from house mice, 3 from black rats, and 3 from brown rats) tested positive. Similarly, 5% (2/40) of house mice, 7.5% (3/40) of black rats, and 7.5% (3/40) of brown rats tested positive using the molecular method. Phylogenetic analysis revealed that the Blastocystis infecting different rodent species in Shiraz belonged to two potentially zoonotic STs (ST1 and ST4). Accordingly, rodents should not be overlooked as potential reservoirs of zoonotic Blastocystis infections. Different sampled urban districts and their statistical association with reported prevalence rates were analyzed separately.

CONCLUSION

 Overall, the issue of the frequency and ST distribution of Blastocystis in urban rodents of Iran is still open to question and for a proper understanding, wider and more comprehensive studies are needed.

Exploring biodiversity patterns at the landscape scale by linking landscape energy and land use/land cover heterogeneity

Agricultural Biodiversity dynamics has been evaluated by social metabolism or by landscape structure-function analysis. In this study, by using ELIA modeling, we used both methods in combination to understand how the interplay between social metabolism and landscape structure-function can affect biodiversity pattern distribution. We used energy reinvestment (E) as an indicator of social metabolism and landscape heterogeneity (Le) as an indicator of landscape structure-function. We propose a research hypothesis to analyze biodiversity patterns considering four different clusters identified based on high or low E or Le. As cluster 1, we defined E as high and Le as low and associated natural ecosystems to it. These ecosystems are expected to contain high species abundance but low richness. As cluster 2, both E and Le were defined as high and semi-natural ecosystems were associated to it, where nature friendly farm system developed. In these ecosystems, high species abundance and richness are expected. Cluster 3 with low E and Le was associated intensive farmland, which is due to the simplification of the landscape. Here, low energy reinvestment and landscape heterogeneity confirm that ecosystem services related to biodiversity have been drastically reduced. Lastly, cluster 4 with low E but high Le refers to intensive mosaics of farmland and pasture. In this cluster, the biodiversity richness index is high due to spatial landscape diversity, but the biodiversity abundance index is low due to the lack of energy reinvestment. We evaluate the proposed hypothesis for biodiversity analysis in the Qazvin province, emphasizing the interplay between energy availability and landscape heterogeneity in shaping ecological communities. This study highlights the importance of understanding biodiversity patterns at spatial scale and emphasizes the need for interdisciplinary research to address conservation and sustainability challenges. Our approach would be very useful where there is lack of biodiversity data.

Prevalence of medication errors and its related factors in Iranian nurses: an updated systematic review and meta-analysis

BACKGROUND

Nurses may make medication errors during the implementation of therapeutic interventions, which initially threaten the patient's health and safety and prolong their hospital stay. These errors have always been a challenge for healthcare systems. Given that factors such as the timing, type, and causes of medication errors can serve as suitable predictors for their occurrence, we have decided to conduct a review study aiming to investigate the prevalence of medication errors and the associated factors among Iranian nurses.

METHODS

In this systematic review and meta-analysis, studies were searched on PubMed, Web of Science, Scopus, Google Scholar, IranMedex, Magiran, and SID databases using a combination of keywords and Boolean functions. The study that reported the prevalence of medication errors among nurses in Iran without time limitation up to May 2023 was included in this study.

RESULTS

A total of 36 studies were included in the analysis. The analysis indicates that 54% (95% CI: 43, 65; I2 = 99.3%) of Iranian nurses experienced medication errors. The most common types of medication errors by nurses were wrong timing 27.3% (95% CI: 19, 36; I2 = 95.8%), and wrong dosage 26.4% (95% CI: 20, 33; I2 = 91%). Additionally, the main causes of medication errors among nurses were workload 43%, fatigue 42.7%, and nursing shortage 38.8%. In this study, just 39% (95% CI: 27, 50; I2 = 97.1%) of nurses with medication errors did report their errors. Moreover, the prevalence of medication errors was more in the night shift at 41.1%. The results of the meta-regression showed that publication year and the female-to-male ratio are good predictors of medical errors, but they are not statistically significant(p > 0.05).

CONCLUSIONS

To reduce medication errors, nurses need to work in a calm environment that allows for proper nursing interventions and prevents overcrowding in departments. Additionally, considering the low reporting of medication errors to managers, support should be provided to nurses who report medication errors, in order to promote a culture of reporting these errors among Iranian nurses and ensure patient safety is not compromised.

Psychometric properties of the exercise addiction inventory (EAI) questionnaire among physically active young adults

BACKGROUND

Exercise addiction (EA) is a pathological behavior pattern in which a person loses control over his exercise habits and exercises excessively and suffers negative consequences for his health and even his social life. One of the best tools to measure EA is EAI. The aim of this study was to examine the psychometric properties of the EAI among Iranian physically active young adults.

METHODS

Participants were randomly selected from sports clubs in Tabriz, Iran. A total of 200 questionnaires were completed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted along with tests of convergent validity. Reliability was assessed using Cronbach's alpha and test-retest methods.

RESULTS

EFA indicated a one-factor structure explaining 40.43% of variance. CFA confirmed the one-factor model with good fit (Root Mean Square Error of Approximation [RMSEA] = 0.076; Comparative Fit Index [CFI] = 0.968). Internal consistency was acceptable (Cronbach's alpha = 0.71) and convergent validity was adequate. Test-retest reliability was also adequate (intraclass correlation coefficient [ICC] = 0.71).

CONCLUSION

The results of our study show that the Persian EAI has satisfactory psychometric properties and can be used as a valid tool to assess EA.

Application of Nested-qPCR-High Resolution Melting (HRM) Technology on Strongyloides stercoralis Isolates from Iran

PURPOSE

Strongyloides stercoralis is a parasite with special characteristics presenting it as a unique nematode. Iran is an endemic area for S. stercoralis. In this study, nested-qPCR-high resolution melting (HRM) technology was applied on some human isolates of S. stercoralis from this country by focusing on evolutionary genetics analysis.

METHODS

Twelve human isolates of S. stercoralis were collected from four endemic provinces of Iran. Genomic DNA was extracted from a single filariform larva for every isolate. Using specific primers targeting partial regions in cox1 gene, nested-qPCR-HRM was performed and melting-curve profiles were analyzed alongside the evaluation of genetic proximity and phylogenetic analysis using MEGA7 and DnaSP5 software.

RESULTS

The melting temperature (Tm) values of the isolates were 77.9 °C-78.3 °C. All isolates from Guilan, Mazandaran, and Khouzestan Provinces shared Tm values of 78.2 °C to 78.3 °C, while the isolates from Hormozgan Province showed Tm values of 77.9 °C, 78.0 °C, and 78.1 °C. The phylogenetic tree illustrated that the sequences of the current study included nine haplotypes. Tajima's D index analyses showed that cox1 gene in S. stercoralis isolates was negative (Tajima's D = - 0.27).

CONCLUSION

The isolates were divided into five temperature groups. Although HRM assay compared to PCR sequencing identified more limited genetic changes, it revealed that the mean of Tm of the isolates from Hormozgan Province was lower than those of other provinces and represented specific haplotypes for this geographical region on the phylogenetic tree.

Cultural adaptation, validation, and standardization of a developmental screening tool (ASQ-3) in Iranian children

Objectives

This study aimed at culturally adapting, validating, and standardizing the Ages and Stages Questionnaire, third edition (ASQ-3) by implementing a nation-wide cross-sectional methodological study in order to provide a valid and reliable tool for determining the developmental status of Iranian children.

Materials & Methods

This cross-sectional and methodological study was conducted on Iranian children between 1-66 months. The ASQ-3 tool was translated; following that, its face and content validity, as well as the cross-cultural adaptation were assessed by 51 specialists and experts in the field of pediatrics and child development. In order to determine the reliability of the ASQ-3 (using Cronbach's alpha), and cut-off points. All statistical analyses were performed using STATA software.

Results

This study was enrolled in 2 phases. The face and content validity, as well as the cultural relevance of the Persian version of ASQ-3 was confirmed using panel of specialists views then researchers investigated 11,740 children aged 1-66 months in order to evaluate the reliability of the tool. The Cronbach's alpha coefficients (reliability) determined for the ASQ-3 and the cut-off points for the ASQ-3 of different age groups and domains were determined by calculating one and two SDs below the mean; the latter represents the main cut-off point, and the interval between the two represents the monitoring zone according to the ASQ-3 technical manual.

Conclusion

The results of this study showed that the Iranian version of ASQ-3 is valid and reliable; moreover, the cut-off points designated for it can be implemented in the Iranian children community to assess their developmental status.

Health-related quality of life measured using the EQ-5D-3L: iranian population norms

BACKGROUND

Normative values are valuable for comparing a specific population with the general population, making them particularly useful in disease burden studies and cost-effectiveness analysis. The objective of this study was to estimate HRQoL normative values for the EQ-5D measure in Iran.

METHODS

The analysis was performed using a sample (n = 27,704) of the Iranian adult population, which was extracted from a nationwide survey conducted in 2021. Participants assessed their health-related quality of life using the EQ-5D-3 L instrument and a visual analogue scale (EQ VAS). Multivariable regression analyses were performed to examine the relationships between utility scores, EQ VAS scores, and various socio-demographic factors.

RESULTS

The mean utility and EQ VAS scores of the total sample were 0.87 (95% CI: 0.86, 0.88) and 72.9 (95% CI: 72.7, 73.1), respectively. Almost half of the respondents (46.8%) reported a health state without any problems. The most prevalent problems were pain/discomfort (38.3%) and anxiety/depression (35.2%). Furthermore, EQ-5D values and EQ VAS scores were associated with gender, age, employment status, education level, marital status, and chronic illness.

CONCLUSIONS

This study provided normative values for the general population in Iran. Policymakers and researchers can use these values as a reference for population norms in economic assessments and studies focusing on the population's health.

PErspective and current status of Radiotherapy Service in IRan (PERSIR)-1 study: assessment of current external beam radiotherapy facilities, staff and techniques compared to the international guidelines

BACKGROUND AND PURPOSE

Radiotherapy (RT) is an essential treatment modality against cancer and becoming even more in demand due to the anticipated increase in cancer incidence. Due to the rapid development of RT technologies amid financial challenges, we aimed to assess the available RT facilities and the issues with achieving health equity based on current equipment compared to the previous reports from Iran.

MATERIALS AND METHODS

A survey arranged by the Iran Cancer Institute's Radiation Oncology Research Center (RORC) was sent to all of the country's radiotherapy centers in 2022. Four components were retrieved: the reimbursement type, equipment, human resources, and patient load. To calculate the radiotherapy utilization rate (RUR), the Lancet Commission was used. The findings were compared with the previous national data.

RESULTS

Seventy-six active radiotherapy centers with 123 Linear accelerators (LINACs) were identified. The centers have been directed in three ways. 10 (20 LINACs), 36 (50 LINACs), and 30 centers (53 LINACs) were charity-, private-, and public-based, respectively. Four provinces had no centers. There was no active intraoperative radiotherapy machine despite its availability in 4 centers. One orthovoltage X-ray machine was active and 14 brachytherapy devices were treating patients. There were 344, 252, and 419 active radiation oncologists, medical physicists, and radiation therapy technologists, respectively. The ratio of LINAC and radiation oncologists to one million populations was 1.68 and 4.10, respectively. Since 2017, 35±5 radiation oncology residents have been trained each year.

CONCLUSION

There has been a notable growth in RT facilities since the previous reports and Iran's situation is currently acceptable among LMICs. However, there is an urgent need to improve the distribution of the RT infrastructure and provide more facilities that can deliver advanced techniques.

Molecular and phenotypical findings of a novel de novo SYNGAP1 gene variant in an 11-year-old Iranian boy with intellectual disability

OBJECTIVE

Intellectual developmental disorder (IDD) type 5 is an autosomal dominant (AD) disorder and is characterized by intellectual disability (ID), psychomotor developmental delay, variable autism phenotypes, microcephaly, and seizure. IDD can be caused by mutations in the SYNGAP1 gene, which encodes a Ras GTPase-activating protein. This study revealed a novel de novo nonsense variant in SYNGAP1. The identification of such variants is essential for genetic counseling in patients and their families.

METHODS

Exome sequencing implicated the causative variant. Sanger sequencing and cosegregation analyses were used to confirm the variant. Multiple in silico analysis tools were applied to interpret the variant using the American College of Medical Genetics and Genomics and the Association for Molecular Pathology guidelines.

RESULTS

The de novo NM_006772.3(SYNGAP1):c.3685C>T variant was identified in an 11-year-old boy with severe intellectual disability, neurodevelopmental delay, speech disorder, ataxia, specific dysmorphic facial features, and aggressive behavior.

CONCLUSION

The current study findings expand the existing knowledge of variants in SYNGAP1 that have been previously associated with nonsyndromic intellectual disability and autism, extending the spectrum of phenotypes associated with this gene. The data have implications for genetic diagnosis and counseling in similar phenotypic presentations.

Efficacy of a facial-aging web app on sun protection behaviors among primary school students in Iran: a randomized controlled trial

BACKGROUND

Skin cancers resulting from excessive exposure to solar ultraviolet (UV) radiation are on the rise. This study aims to investigate the impact of facial-aging app intervention on promoting safe and healthy behaviors and its influence on reducing students' UV exposure.

METHOD

Utilizing a Pretest-Posttest repeated-measures design, we developed a theory-guided web app on the WhatsApp platform, named the Sunshine and Skin Health app. This app allows users to visualize their altered faces in three stages of adolescence, middle age, and old age based on sun protection behavior. The intervention continued within WhatsApp, incorporating 27 health messages grounded in the PMT theory, eight educational files, and a skin cancer video clip. The primary outcome is the change in sun protection behavior between the two groups (intervention and control) immediately after the intervention (T2) and the secondary outcome is the change in sun protection behavior between the two groups at 3 months follow-up (T3). The data are analyzed in SPSS 22 and a significance level of 0.05 is considered.

RESULTS

The results revealed no significant difference between the two groups before the intervention. However, in the intervention group, there were significant differences in the utilization of sunglasses, hats, and sunscreen in the last month, as well as sunscreen reapplication after washing their hands and face, both immediately after the intervention and at the 3-month follow-up, compared to the control group (P = 0.001). Furthermore, a significant intervention effect, time effect, and interaction effect between group and time were observed in behaviors related to using sunscreen in the last month and sunscreen reapplication after washing hands and face (P = 0.001). Specifically, the intervention group exhibited a significant difference from Time 1 to 2 and from Time 1 to 3 (p = 0.001), but no significant difference from Time 2 to 3. In contrast, the control group did not show any significant differences over time.

CONCLUSIONS

This study indicated that the Facial-Aging web app can effectively encourage safe behaviors in sunlight. To ensure the maintenance and sustainability of these behaviors over the long term, it is crucial to consider implementing booster sessions.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20200924048825N1. Registered prospectively on 8 February 2021.