Publications by authors named "Abbas Rahimi Foroushani"

156 Publications

Impact of human rhinoviruses on gene expression in pediatric patients with severe acute respiratory infection.

Virus Res 2021 Apr 17:198408. Epub 2021 Apr 17.

Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Human rhinovirus (HRV) is one of the most common viruses, causing mild to severe respiratory tract infections in children and adults. Moreover, it can lead to patients' hospitalization. Nowadays, evaluation of gene expression alterations in host cells due to viral respiratory infections considered essential to understand the viral effects on cells.

Objective: In this study, we aimed to find important differentially expressed genes (DEGs) related to rhinitis and asthma exacerbation stimulated with Poly (I: C) and then to validate their expression in clinical samples of children how were less than 5 years old, hospitalized with severe acute respiratory infection (SARI) due to HRV infection in comparison with healthy cases.

Methods: Eight candidate genes involved in immunity, viral defense, inflammation, P53 pathway, and viral release processes were selected based on the analysis of a gene expression data set (GSE51392) and gene enrichment analysis. Then quantitative real-time PCR on cDNAs was performed for selected genes. The results were analyzed by Livak method and visualized by GraphPad prism software (8.4.3).

Result: CXCL10, CMPK2, RSAD2, SERPINA3, TNFAIP6, CXCL14, IVNS1AB, and ZMAT3 were selected based on the enrichment and topological analysis of the constructed protein-protein interaction (PPI) network. Laboratory validation by real-time PCR showed CXCL10, CMPK2, RSAD2, SERPINA3, and TNFAIP6 (belonged to immunity, inflammatory responses and viral defense) were up-regulated, whereas CXCL14 (related to immunity) and IVNS1AB, ZMAT3 (associated to Influenza and P53 pathway) were down-regulated.

Conclusion: Our results showed, that in children less than 5 years old affected by HRV and hospitalized with SARI, the inflammatory responses, antiviral defense, and type 1 interferon-signaling pathway have significantly affected by viral infection.
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http://dx.doi.org/10.1016/j.virusres.2021.198408DOI Listing
April 2021

Causal Effects of Body Mass Index and Maternal Age on Oocyte Maturation in Assisted Reproductive Technology: Model-Average Causal Effect and Bayesian LASSO Method.

Iran J Public Health 2020 Nov;49(11):2161-2169

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Body Mass Index (BMI) and maternal age are related to various disorders of the female reproductive system. This study aimed to estimate the causal effects of BMI and maternal age on the rate of meta-phase II oocytes (MII) using a new statistical method based on Bayesian LASSO and model averaging.

Methods: This investigation was a historical cohort study and data were collected from women who underwent assisted reproductive treatments in Tehran, Iran during 2015 to 2018. Exclusion criteria were gestational surrogacy and donor oocyte. We used a new method based on Bayesian LASSO and model average to capture important confounders.

Results: Overall, 536 cycles of 398 women were evaluated. BMI and Age had inverse relationships with the number of MII based on univariate analysis, but after adjusting the effects of other variables, there was just a significant association between age and the number of MII (adjusted incidence rate ratio (aIRR) of age =0.989, 95% CI: [0.979, 0.998], =0.02). The results of causal inference based on the new presented method showed that the overall effects of age and BMI of all patients were significantly and inversely associated with the number of MII (both <0.001). Therefore the expected number of MII decreased by 0.99 for an increase of 1 year (95% CI: [-1.00, -0.97]) and decreased by 0.99 for each 1-unit increase in BMI (95% CI: [-1.01, -0.98]).

Conclusion: Maternal age and BMI have significant adverse casual effects on the rate of MII in patients undergoing ART when the effects of important confounders were adjusted.
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http://dx.doi.org/10.18502/ijph.v49i11.4734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917504PMC
November 2020

Post-surgery Survival in Patients with Adenocarcinoma of Stomach Using Multistate Model.

J Gastrointest Cancer 2021 Feb 16. Epub 2021 Feb 16.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: Stomach neoplasms are the fifth common cancer worldwide. The related factors for survival following stomach neoplasms are well-studied; however, information on recurrent events is limited. This study aimed to identify the related factors on recurrent and deaths following stomach neoplasms.

Methods: In this cohort study, information on 672 patients with adenocarcinoma who were hospitalized during 1995-2012 was used. Multistate models were applied to determine the effective factors on recurrent and death events.

Results: Median of survival time (months) and 5-year survival was estimated as 24.5 and 25%, respectively. The probability of death was 57% for non-recurrent patients, which increased to 88% among recurrent patients. Hazard of death was 49% lower for females (Hazard Ratio (HR):0.51, P = 0.009) while females had higher hazard of death following recurrent (HR:3.55, P < 0.001). Male patients and those with cardia involvement had higher risk of recurrence. A significant effect of age on the risk of death among patients with and without recurrence was estimated (HR:1.02, 1.03; P = 0.001 for both). Age, cardia involvement, and disease stage are amongst the effective factors on non-recurrent death while complement treatments increased the non-recurrent and recurrent survival.

Conclusion: In patients, effects of some factors for survival may vary throughout the course of disease and depend on recurrence status. We found that while female patients experienced lower recurrence, they had higher risk of death following recurrence. Age, tumor location, and type of therapy were risk factors for non-recurrent death. Finally, tumor location and type of surgery had significant effects on recurrence.
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http://dx.doi.org/10.1007/s12029-021-00599-wDOI Listing
February 2021

Persian version of the Barkin Index of Maternal Functioning (BIMF): a cross-cultural adaptation and psychometric evaluation.

BMC Pregnancy Childbirth 2021 Jan 25;21(1):83. Epub 2021 Jan 25.

Mercer University School of Medicine, Mercer University, 1550 College Street, Macon, GA, 31207, USA.

Background: Postpartum maternal functioning has the potential to affect the quality of interaction between mother and child. A proper assessment of maternal functioning requires a comprehensive and accurate tool. The objective of this study was to prepare a Persian version of the Barkin Index of Maternal Functioning (BIMF) and evaluate its psychometric properties in order to determine its applicability in Iranian mothers.

Methods: The BIMF was translated into Persian and then culturally adapted for Iranian women. After evaluating face and content validity, to perform factor analysis, a cross-sectional study was conducted using the Persian version of BIMF. The data was collected from two unique groups of 250 mothers (in all 500 mothers) who had infants 2 to 12-months old and who were selected using a two-stage cluster sampling method. Factor analysis, Pearson's correlation, intra-class correlation coefficients (ICC), composite reliability (CR) and Cronbach's alpha were employed in order to evaluate structural validity and reliability.

Results: Exploratory factor analysis resulted in a five-factor structure consisting of 20 items. Subsequently, confirmatory factor analysis (X / df = 1.61, RMSEA = 0.050, GFI = 0.91, CFI = 0.91) confirmed that the Persian version had satisfactory goodness of fit. Reliability and internal consistency were confirmed with a CR of 0.77, an ICC of 0.87 and a Cronbach's alpha of 0.81.

Conclusions: The findings indicated that the Persian version of the BIMF is a valid and reliable instrument for assessing maternal functioning among Iranian mothers.
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http://dx.doi.org/10.1186/s12884-021-03556-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836187PMC
January 2021

Detection and characterization of Enterobacteriaceae family members carried by commensal Rattus norvegicus from Tehran, Iran.

Arch Microbiol 2021 May 1;203(4):1321-1334. Epub 2021 Jan 1.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Wild rats are known to carry different microorganisms and are considered a reservoir of zoonotic pathogens worldwide. The urban rats were collected from five districts of Tehran and Gram-negative bacteria (GNB) were isolated from fecal samples and were identified using classical biochemical tests. The antibiotic susceptibility patterns of isolated bacteria were determined by Kirby-Bauer disk diffusion method, the results of which were interpreted in line with CLSI guideline. The frequency of antibiotic-resistant genes was identified using multiplex-PCR. Moreover, PCR method was used to identify the frequency of Escherichia coli O157:H7 and main categories of diarrheagenic E. coli including EPEC, ETEC, EIEC, EAEC, and STEC pathotypes. A total of 100 Rattus norvegicus were trapped and fecal samples were collected. Overall, 72 fecal samples were positive for GNB. E. coli (n = 46/72) had the highest frequency among the isolated GNB. Among E. coli isolates, the highest and lowest resistance rates belonged to ampicillin (56.5%) and ceftriaxone (0%), respectively. Klebsiella spp. was 100% resistant to imipenem, and streptomycin (0%) was the most effective antimicrobial agent on Klebsiella spp. Among surveyed genes, bla (95.8%) and bla (58.3%) had the highest frequency, while bla, and bla were not detected among Enterobacteriaceae. Herein, O157: H7 serotype was not detected and aEPEC (87%) was the most common pathotype detected. Results suggested that rodents might be a reservoir of antimicrobial-resistant pathogens and rodent control along with implementation of surveillance programs should be considered as a critical priority for urban health.
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http://dx.doi.org/10.1007/s00203-020-02126-0DOI Listing
May 2021

Human health and ecological risk assessment of heavy metal(loid)s in agricultural soils of rural areas: A case study in Kurdistan Province, Iran.

J Environ Health Sci Eng 2020 Dec 8;18(2):469-481. Epub 2020 May 8.

Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Agricultural soils pollution with heavy metal (loid) s (HMs) can create significant ecological and health problems. The aims of present study were to characterize HMs pollution profile of dry farmland soils in rural areas of Kurdistan province in Iran and evaluate potential associated ecological and health risks.

Methods: Different indices of Geo-accumulation index (I), Individual contamination factor (ICF), Nemerow composite pollution index (NCPI) and Potential Ecological Risk Index (PERI) were employed to assess the bio-accumulation of the HMs and evaluate associated ecological risks. Human health risks estimated with total hazard index (THI) and total carcinogenic risk (TCR) indices based on ingestion, inhalation and dermal exposure pathways for children and adults.

Results: As, Cd, Cr, Ni and Pb exceeded the soil standards. The spatial maps of the I showed that As pollution was at severe level in eastern part of the study region. According to the ICF results, the studied soils were extremely contaminated with As, Cd, Cr, Ni and Zn. Furthermore, based on the pollution indices, some of sampling sites were critically polluted by abovementioned HMs. For children and adults groups, the THI values in 13 and 97% of sampling sites were more than 1 and the TCR in 7 and 14% of sampling sites were more than 10, respectively. The farmland soil pollution of the study area by As and Cr were found to be quite serious and dangerous.

Conclusion: The findings of this study suggest that further attention should be paid by decision-makers to control the HMs pollution in the agricultural soils of the study area.
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http://dx.doi.org/10.1007/s40201-020-00475-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721949PMC
December 2020

Identification, Classification, and Prioritization of Effective Factors in Producing Thermal Strain in Men at Workplaces using Fuzzy AHP Technique.

Indian J Occup Environ Med 2020 May-Aug;24(2):106-113. Epub 2020 Aug 19.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Various factors can affect thermal strain at workplaces. To prevent heat illnesses due to the heat strain, one must identify and prioritize these factors. Therefore, the present study was aimed to determine the relative importance of the effective factors in producing thermal strain in men at workplaces using fuzzy AHP technique.

Materials And Methods: This qualitative practical study was performed in 2019. Effective factors in producing heat strain were identified by a literature review. Then, an expert panel reviewed the identified factors and omitted some of them. Further, the balance theory of job design was applied to classify the heat strain factors. Later, these factors were categorized into six groups, including environmental, personal, job, clothing, administrative, and lifestyle elements. In the end, the fuzzy analytical hierarchy technique was used for prioritizing the elements and factors involved in each of them.

Results: Based on the results, the environmental element had the highest relative weight and priority (0.178). Other priorities were assigned to the job element (0.171), clothing element (0.171), personal element (0.169), administrative element (0.169), and lifestyle element (0.142), respectively.

Conclusion: In general, the results showed that environmental factors are the most effective ones in producing heat strain. The results of the present study can be helpful in controlling the thermal strain.
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http://dx.doi.org/10.4103/ijoem.IJOEM_93_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703818PMC
August 2020

Effect of "motivational interviewing" and "information, motivation, and behavioral skills" counseling interventions on choosing the mode of delivery in pregnant women: a study protocol for a randomized controlled trial.

Trials 2020 Nov 25;21(1):970. Epub 2020 Nov 25.

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Cesarean section is an important surgical procedure, when normal vaginal delivery imposes a risk to mother and/or baby. The World Health Organization states the ideal rate for Cesarean section to be between 10 and 15% of all births. In recent decades, the rate has been increased dramatically worldwide. This paper explains the protocol of a randomized controlled trial that aims to compare the effect of "motivational interviewing" and "information, motivation, and behavioral skills" counseling interventions on choosing mode of delivery in pregnant women.

Methods: A four-armed, parallel-design randomized controlled trial will be conducted on pregnant women. One hundred and twenty women will be randomly assigned to four groups including three intervention groups and one control group. The intervention groups included the following: (1) motivational interviewing; (2) face-to-face information, motivation, and behavioral skills model; and (3) information, motivation, and behavioral skills model provided using a mobile application. The inclusion criteria include being literate, being in gestational age from 24 to 32 weeks, being able to speak Persian, having no complications in the current pregnancy, having no indications for Cesarean section, and having enough time to participate in the intervention. The primary outcome of the study is the mode of delivery. The secondary outcomes are women's intention to undergo Cesarean section and women's self-efficacy.

Discussion: The interventions of this protocol have been programmed to reduce unnecessary Cesarean sections. Findings may contribute to a rise in normal vaginal delivery, and the effective intervention may be extended for use in national Cesarean section plans.

Trial Registration: Iran Randomized Clinical Trial Center IRCT20151208025431N7 . Registered on December 07, 2018.
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http://dx.doi.org/10.1186/s13063-020-04865-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7687772PMC
November 2020

Development and validation of an environmental heat strain risk assessment (EHSRA) index using structural equation modeling based on empirical relations.

Environ Health Prev Med 2020 Oct 28;25(1):63. Epub 2020 Oct 28.

Department of Occupational Health Engineering, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Need to a simple, available, accurate, comprehensive, and valid indicator is felt to assess thermal effects. Therefore, the present study was aimed to develop and validate the environmental heat strain risk assessment (EHSRA) index using structural equation modeling (SEM) based on empirical relations.

Methods: This cross-sectional study was performed on 201 male workers in environments with various climatic conditions. The heart rate and tympanic temperature of the individuals were monitored at times of 30, 60, and 90 min after beginning the work. At these times, values of dry temperature, wet temperature, globe temperature, and air velocity were also measured and metabolism rate and clothing thermal insulation value were estimated. At the end, a theoretical model was depicted in AMOS software and obtained coefficients were applied to develop a novel index. The scores of this indicator were categorized into four risk levels via ROC curves and validate using linear regression analysis.

Results: Indirect effect coefficients of the globe temperature, dry temperature, wet temperature, air velocity, metabolism, and clothing thermal insulation variables on the tympanic temperature were computed by 0.77, 0.75, 0.69, 0.24, 0.49, and 0.39, respectively. These coefficients were applied to develop the index. Optimal cut-off points of boundaries between risk levels included 12.02, 15.88, and 17.56. The results showed that the EHSRA index justified 75% of the variations of the tympanic temperature (R = 0.75).

Conclusions: The novel index possesses appropriate validity. It was suggested that this indicator is applied and validated in various environments in the next studies.
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http://dx.doi.org/10.1186/s12199-020-00894-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594439PMC
October 2020

Epidemiology, laboratory diagnosis and clinical aspects of fungal pulmonary infections in 384 patients hospitalized in pulmonary units in Guilan province, Iran.

Iran J Microbiol 2020 Aug;12(4):353-363

Medical Biotechnology Research Center, School of Paramedicine, Guilan University of Medical Sciences, Rasht, Iran.

Background And Objectives: The respiratory tract is the most common site for developing fungal infections. People who have a weakened immune system are more susceptible to respiratory system involvement with fungi. Fungal infections of the respiratory tract are largely unrecognized and their true burden is elusive. Therefore, the aim of the current study was to evaluate the clinical spectrum, demographic characteristics, risk factors, and etiology of fungal respiratory infections in 384 patients hospitalized in pulmonary units of Razi hospital, Guilan province, Iran.

Materials And Methods: A total of 384 lung specimens (192 Bronchoalveolar lavages (BAL) and 192 sputa) were obtained from patients who met the inclusion criteria. All samples were analyzed by direct microscopy and culture. Fungal identification was accomplished by internal transcribed spacer (ITS) and beta-tubulin sequencing. Also, in patients suspected to invasive pulmonary aspergillosis BAL specimens were tested for galactomannan (GM) antigen. According to the host factors (clinical symptoms, radiology findings and predisposing factors which were defined as inclusion criteria), and the positive results in direct examination, culture and serology (GM for aspergillosis) the infection was confirmed.

Results: Fungal respiratory infection was confirmed in 137 cases (35.67%) including 86 (62.77%) males and 51 (37.23%) females and the highest prevalence of infection was found in the age group of 46-72 years (n=75, 54.74%). Cough (n=129, 94.16%), dyspnea (n=111, 81.02%), purulent sputum (n=85, 62.04%) and weight loss (n=77, 56.2%) were the predominant symptoms. Tuberculosis (n=34, 24.81%), taking chemotherapy regimen (n=30, 21.89%) and diabetes mellitus (n=27, 19.70%) were the predominant underlying conditions. (37.22%) and (21.89%) represent the two most commonly isolated species in the current study. Furthermore, according to revised EORTC/MSG (2008) definitions for invasive fungal infections, from 5 cases of pulmonary aspergillosis, 2 (40%) cases of probable invasive pulmonary aspergillosis (IPA) and 3 (60%) cases of possible IPA were diagnosed.

Conclusion: According to the results of this study, infected infants with congenital CMV infection could identify at early stage by testing Guthrie cards (within 21 days of life). Furthermore, since there is a lack of CMV knowledge in our population, educating and effective counseling by obstetricians/gynecologists to the pregnant women are recommended.
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http://dx.doi.org/10.18502/ijm.v12i4.3940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502145PMC
August 2020

Exploring spatial dependencies in the prevalence of childhood diarrhea in Mozambique using global and local measures of spatial autocorrelation.

Med J Islam Repub Iran 2020 8;34:59. Epub 2020 Jun 8.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Diarrhea in children under 5 years is generally considered as an important public health problem and the major cause of childhood morbidity and mortality in Sub-Saharan Africa. The purpose of this study was to present exploratory spatial data analyses to identify spatial clusters and outliers in the prevalence of childhood diarrhea in Mozambique. Using data from 2011 Mozambique Demographic and Health Survey, we calculated the prevalence of childhood diarrhea on the district level. Two exploratory spatial data analyses methods were applied, namely, global and local Moran's I statistics, providing spatial autocorrelation and spatial clusters/outlier in the prevalence of childhood diarrhea, respectively. Choropleth mapping and global Moran's I statistics showed that the prevalence of childhood diarrhea has clustered distribution across the study area. A local Moran's I index revealed spatial clusters within the province of Tete, Gaza, Cabo Delgado, and Zambezia. However, spatial outliers were confined within Sofala province. The exploratory spatial data analyses showed various spatial clustering and outliers present in the prevalence of childhood diarrhea, indicating interventions needed in targeted regions.
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http://dx.doi.org/10.34171/mjiri.34.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500418PMC
June 2020

Predicting the Survival of AIDS Patients Using Two Frameworks of Statistical Joint Modeling and Comparing Their Predictive Accuracy.

Iran J Public Health 2020 May;49(5):949-958

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The present study aimed to estimate the survival of HIV-positive patients and compare the accuracy of two commonly used models, Shared Random-Effect Model (SREM) and Joint Latent Class Model (JLCM) for the analysis of time to death among these patients.

Methods: Data on a retrospective survey among HIV-positive patients diagnosed during 1989-2014 who referred to the Behavioral Diseases Consultation Center of Mashhad University of Medical Sciences was used in this study. Participants consisted of HIV-positive high-risk volunteers, referrals of new HIV cases from prisons, blood transfusion organization and hospitals. Subjects were followed from diagnosis until death or the end of study. SREM and JLCM were used to predict the survival of HIV/AIDS patients. In both models age, sex and addiction were included as covariates. To compare the accuracy of these alternative models, dynamic predictions were calculated at specific time points. The receiver operating characteristic (ROC) curve was used to select the more accurate model.

Results: Overall, 213 patients were eligible that met entry conditions for the present analysis. Based on BIC criteria, three heterogeneous sub-populations of patients were identified by JLCM and individuals were categorized in these classes ("High Risk", "Moderate Risk" and "Low Risk") according to their health status. JLCM had a better predictive accuracy than SREM. The average area under ROC curve for JLCM and SREM was 0.75 and 0.64 respectively. In both models CD4 count decreased with time. Based on the result of JLCM, men had higher hazard rate than women and the CD4 counts levels of patients decreased with increasing age.

Conclusion: Predicting risk of death (or survival) is vital for patients care in most medical research. In a heterogeneous population, such as HIV-positive patients fitting JLCM can significantly improve the accuracy of the risk prediction. Therefore, this model is preferred for these populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475620PMC
May 2020

Measuring Public Preferences for Changes in the Health Insurance Benefit Package Policies in Iran: A Survey Approach.

Iran J Public Health 2020 May;49(5):940-948

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: This study aimed to identify the public preference in health services, the principles that Iranian people consider important, and the aspects of tradeoffs between different values in resource allocation practices.

Methods: This quantitative study was conducted to investigate public preferences on Health Insurance Benefit Package (HIBP) in 2017. A structured questionnaire was used for data collection, including the preferences of the people who live in Tehran, were above 18 year, and were covered by basic insurance for the HIBP contents and premium. The sample size was calculated 430 subjects and SPSS Statistics was used for data analyzing.

Results: 81.6% of the sample population agreed with government allocating more money to the health sector compared to other sectors and organizations and 55% were willing to pay higher premiums for expanding the HIBP coverage. The highest and lowest score regarding prioritization of budget allocation between health services was related to hospitalization services (28.6%) and rehabilitation services (1.6%), respectively. The first priority of respondents regarding health care and life cycle, was "prevention in newborns" (15.9%), the second priority was "prevention in children" (14.6%), the third priority was "prevention in adults" (9.5%), and the last priority was "short-term care in newborns" (0.9%).

Conclusion: Iranian people believe that not only the principle of health maximization but also equal opportunities to access health care and a fair allocation of resources should be considered by authorities for effective health insurance policymaking. In this case, given the scarcity of resources, setting priorities for alternative resources is inevitable.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475621PMC
May 2020

Real-Life Incentives Driving Public-Private Partnership in Diagnostic Services.

Ethiop J Health Sci 2020 May;30(3):409-416

Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Diagnostic services are highly critical in the success of treatment processes, overly costly nonetheless. Accordingly, hospitals generally seek the private partnership in the provision of such services. This study intends to explore the incentives owned by both public and private sector in their joint provision of diagnostic services under the public-private partnership agreement.

Method: A qualitative, exploratory study was employed in Tehran hospitals from October 2017 to March 2018. Around 25 face-to-face, semi-structured interviews were conducted with the purposively recruited hospital managers, heads of diagnostic services and managers of private companies. Interviews were transcribed and analyzed using conventional content analysis, assisted by "MAXQDA-12".

Results: Three main categories and nine sub-categories represented the incentives of public sector, and four main categories and seven sub-categories signified those of private sector. The incentives of public sector included the status-quo remediation, upstream requirements, and personal reasons. As such, the individual, social and economic incentives and legal constraints were driving the behavior of the private sector.

Conclusions: Financial problem and gain were the most noted incentives by the partners. Attention to the either side's incentives and aims is likely to ensure the durability and effectiveness of such partnerships in the health sector.
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http://dx.doi.org/10.4314/ejhs.v30i3.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445953PMC
May 2020

Fungal Isolates of the Respiratory Tract in Symptomatic Patients Hospitalized in Pulmonary Units: A Mycological and Molecular Epidemiologic Study.

J Multidiscip Healthc 2020 22;13:661-669. Epub 2020 Jul 22.

Laboratory of Microbiology and Immunology of Infectious Diseases, Paramedicine Faculty, Guilan University of Medical Sciences, Langeroud, Iran.

Introduction: Fungal respiratory infections are being recognized with increasing frequency in parallel with an expanding population of immunocompromised patients. In most cases, colonization is the first step in the progression to pulmonary fungal infection. This study was designed to evaluate the distribution of fungal elements in the respiratory tract of symptomatic patients hospitalized in pulmonary units.

Methods: This descriptive cross-sectional study was carried out over a period of two years, from October 2017 to October 2019 in Guilan province, located in Iran's northern region. In the current study, bronchoalveolar lavage or sputum specimens were collected. All samples were analyzed by direct microscopy using KOH 10% and culture. Fungal identification was accomplished by internal transcribed spacer (ITS) and beta-tubulin sequencing. Also, in patients suspected of invasive pulmonary aspergillosis, BAL specimens were tested for galactomannan (GM) antigen.

Results: A total of 384 lung specimens (192 bronchoalveolar lavage (BAL) and 192 sputum samples) were obtained from symptomatic patients hospitalized in pulmonary units. Of these, 137 (35.67%) were positive in direct examination and culture. Among the 137 positive cases, most isolates were from male patients 86 (62.77%) and most of them were between 46 and 72 years. (37.22%) and (21.89%) represent the two most commonly isolated species in the current study. Cough (94.16%), dyspnea (81.02%), purulent sputum (62.04%) and weight loss (56.2%) were the predominant symptoms and tuberculosis (24.81%), chemotherapy (21.89%) and diabetes mellitus (19.70%) were the predominant underlying conditions. Also, 5 cases of invasive pulmonary aspergillosis and 1 case of mucormycosis were diagnosed.

Conclusion: was the most common fungal species isolated from symptomatic patients hospitalized in pulmonary units. Tuberculosis, chemotherapy and diabetes mellitus were important underlying conditions for pulmonary fungal colonization and/or infection.
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http://dx.doi.org/10.2147/JMDH.S252371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383022PMC
July 2020

A comprehensive model of health education barriers of health-care system in Iran.

J Educ Health Promot 2020 28;9:106. Epub 2020 May 28.

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: According to the importance of health education (HE) in disease control and prevention and inadequacy of HE in the Iran's health-care system, clarifying the HE barriers is necessary.

Objectives: This study aimed to clarifying the comprehensive model of HE barriers of health-care system in Iran.

Methods: This qualitative study was conducted in 2019. Twenty-one health experts and physicians at different levels of the health system, a former health deputy of the Ministry of Health, and 26 community health workers (CHWs) were selected through purposive sampling. Data were collected through semi-structured individual interviews and group discussions and analyzed simultaneously by conventional content analysis.

Results: Five themes were extracted including individual barriers (most important categories: inadequate ability of CHWs in HE, poor motivational factors at individual level, and educator's wrong beliefs), interpersonal (most important categories: weakness of other health-care providers in the education of CHWs, lack of proper understanding by health authorities of scientific and correct HE, inappropriate communication, unrealistic expectations from CHWs, problems with monitoring and supervision, poor work commitment, and client-related problems), organizational (most important categories: high workload of CHWs, problems related to educational resources, inappropriate attitude of managers and officials, and inappropriate evaluation and monitoring), community (most important categories: not believing CHWs by people, people's disinterest and lack of motivation in education, cultural problems, problems with the Internet and virtual social networks, and weak cross-sectoral cooperation), and contextual barriers (most important categories: barriers related to universities, broadcasting, the nature of HE science, as well as gap between practical education and theory).

Conclusion: Considering the multidimensional barriers such as individual, interpersonal, organizational, community, and contextual barriers, compiling and executing a comprehensive document with the participation of authorities, specialists, and service providers is recommended to remove barriers. This is in line with the Ottawa Charters' "reorienting health services."
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http://dx.doi.org/10.4103/jehp.jehp_23_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325757PMC
May 2020

Phylogenetic and phylodynamic study of Human T-cell lymphotropic virus Type 1 (HTLV-1) in Iran.

Infect Genet Evol 2020 11 16;85:104426. Epub 2020 Jun 16.

Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Human T-lymphotropic virus type-1 (HTLV-1) is a retrovirus that causes the neurological disorder HTLV-1 associated myelopathy/ tropical spastic paraparesis (HAM/TSP) and/or adult T-cell leukemia/lymphoma (ATLL). Iran is one of the endemic regions of the HTLV-1 in the Middle East. To infer the origin of the virus in Iran and to follow the movements of human population and routes of virus spread to this country, phylogenetic and phylodynamic analyses were performed. To this purpose, the long terminal repeat (LTR) region of HTLV-1 was used. New LTR sequences were obtained from 100 blood samples which infected with HTLV-1. Moreover, all Iranian LTR sequences which have been reported so far, were obtained from GenBank database. Sequences were aligned and maximum-likelihood and Bayesian tree topologies were explored. After identification of Iranian specific cluster, molecular-clock and coalescent models were used to estimate time to the most recent common ancestor (tMRCA). Bayesian Skyline Plots (BSP), representing population dynamics HTLV-1 strains back to the MRCA, were estimated using BEAST software. Phylogenetic analysis demonstrated that the Iranian, Kuwaiti, German, Israelite and southern Indian isolates are located within the widespread "transcontinental" subgroup A clade of HTLV-1 Cosmopolitan subtype a. Molecular clock analysis of the Iranian cluster dated back their respective tMRCA to be 1290 AC with a 95% HPD confidence intervals (918, 1517). BSPs indicated a rapid exponential growth rate in the effective number of infections prior the 15th century. Our results support the hypothesis of a multiple introductions of HTLV-1 into Iran with the majority of introductions occurring in prior the 15th century, at the same time the Mongol invasion of Iran. Our results further suggest that HTLV-1 introduction into Iran was facilitated by the commercial/migratory linkage as known as the ancient Silk Road which linked China to Antioch (now in Turkey).
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http://dx.doi.org/10.1016/j.meegid.2020.104426DOI Listing
November 2020

Development of a personal heat strain risk assessment (PHSRA) index in workplaces and its validation.

BMC Public Health 2020 Jun 3;20(1):837. Epub 2020 Jun 3.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: There is not a comprehensive heat stress index to screen the people susceptible to heat disorders and illnesses in hot workplaces. The present study was aimed to develop a personal heat strain risk assessment (PHSRA) index in workplaces and validate it.

Methods: This cross-sectional study was carried out on 201 Iranian male employees under various thermal conditions. At first, the demographical data of participants were gathered. After that, the heart rate and tympanic temperature of the subjects were carefully measured at times of 30, 60, and 90 min of starting the work. Environmental factors were measured simultaneously. The metabolism rate and insulation value of clothes were also estimated. At the end, a novel index of the heat strain was developed using structural equation modeling in AMOS and validated using linear regression analysis in SPSS.

Results: Indirect effect coefficients of personal factors including age, body mass index, maximum aerobic capacity, and body surface area were equal to 0.031, 0.145, - 0.064, and 0.106, respectively. The coefficients of main factors including dry temperature, wet temperature, globe temperature, wind speed, metabolism, and clothing thermal insulation were obtained as 0.739, 0.688, 0.765, 0.245, 0.482, and 0.383, respectively. These coefficients and normalized values of the factors were used to develop a novel index. The total score of the index was categorized into four levels by optimal cut-off points of 12.93, 16.48, and 18.87. Based on the results of regression analysis, this index justifies 77% of the tympanic temperature as a dependent variable (R = 0.77).

Conclusions: In general, the results indicated that the novel index developed by the personal and main factors had proper validity in the prediction of thermal strain.
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http://dx.doi.org/10.1186/s12889-020-08874-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268248PMC
June 2020

Development of a comprehensive communication skills curriculum bases on intervention mapping in response to an urgent need for community health workers' education reform: A study protocol.

J Educ Health Promot 2020 31;9:75. Epub 2020 Mar 31.

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Communication skills are one of the most important competencies required for community health workers (CHWs); however, there is no systematic evidence-based communication training course for them. In this study, we aim to develop a comprehensive communication skills curriculum for CHWs based on the intervention mapping (IM) approach.

Materials And Methods: We used the IM approach to develop a systematic evidence-based communication skills curriculum for CHWs. First, we will determine the required competencies (by a literature search, a qualitative study, and a Delphi study), and then, we will develop a questionnaire for need assessment, and finally, we will implement the course and evaluate its efficacy by conducting a randomized controlled trial. This study was designed according to the steps of IM.

Conclusion: This protocol reports an example of developing a training course using IM. This course could be applied for similar health workers across the world, as well as the CHWs.
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http://dx.doi.org/10.4103/jehp.jehp_492_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256344PMC
March 2020

Effect of probiotic supplementation on migraine prophylaxis: a systematic review and meta-analysis of randomized controlled trials.

Nutr Neurosci 2020 May 18:1-8. Epub 2020 May 18.

Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

The prevalence of migraine is higher in patients with gastrointestinal disorders. Possible underlying mechanisms could be increased intestinal permeability and systemic inflammation. Probiotics may reduce gut permeability as well as inflammation, and therefore may improve the clinical features of migraine. This systematic review and meta-analysis aimed to evaluate the impact of probiotic supplementation on the frequency and severity of migraine attacks. A systematic review of the literature was conducted using ISI Web of Science, PubMed/Medline, Scopus, Cochrane Library, EMBASE, Google Scholar, Magiran.com and Sid.ir to identify eligible studies published up to October 2019. A meta-analysis of eligible trials was performed using the random-effects model to estimate pooled effect size. Three randomized controlled trials with 179 patients (probiotic group = 94, placebo group = 85) were included. Probiotic supplementation had no significant effect on frequency (weighted mean difference (WMD) = -2.54 attacks/month, 95%CI: -5.31-0.22,  = 0.071) and severity of migraine attacks (WMD = -1.23 visual analog scale (VAS) score, 95%CI = -3.37-0.92,  = 0.262) with significant heterogeneity among the studies ( = 98%,  < 0.001). A pooled analysis of available randomized controlled clinical trials showed that probiotic supplementation had no significant effect on the frequency and severity of episodic migraine attacks.
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http://dx.doi.org/10.1080/1028415X.2020.1764292DOI Listing
May 2020

Molecular characterization of fungi causing colonization and infection in organ transplant recipients: A one-year prospective study.

Curr Med Mycol 2020 ;6(1):30-35

Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background And Purpose: Organ transplant recipients are vulnerable to fungal infections. The aim of this study was to determine the prevalence of fungal colonization and infections among patients who underwent various transplantations and molecularly characterize the etiological agents.

Materials And Methods: This study was conducted on candidates for transplantation in Imam Khomeini Hospital, Tehran, Iran, from April 2017 to April 2018. All patients were monitored for fungal colonization or infections before and after transplantation. Isolated fungi were identified using molecular methods.

Results: A total of 125 patients, including 86 males and 39 females, with the mean age of 52.2 years participated in the study (age range: 15-75 years). Out of 125 patients, 84 (67.2%) cases had fungal colonization that appeared pre- and post-transplantation in 21 and 63 cases, respectively (alone or concurrent with another infection in 55 and 29 cases, respectively). In addition, a total of 39 episodes of fungal infections were diagnosed in 36 (28.8%) recipients (alone or concurrent with colonization in 7 and 29 cases, respectively). Out of the 39 fungal infections, 9 cases appeared pre-transplantation, while the other 30 cases occurred post-transplantation. However, no fungal colonization or infection was observed in 34 (27.2%) patients. Oral candidiasis (n=20) was the most common type of infection, followed by funguria (n=7), onychomycosis (n=5), candidemia (n=3), rhinocerebral mucormycosis (n=1), cutaneous mucormycosis (n=1), cutaneous aspergillosis (n=1), and peritonitis (n=1). Six yeast species were recovered from colonization cases with the dominance of both before and after transplantation. The observed fungal infections were caused by 11 distinct species, including the members of (i.e., , , , , and ), (i.e., and ), (i.e., and ), and The results also indicated that the development of a fungal infection post-transplantation was associated with fungal colonization (r=0.0184; ).

Conclusion: Based on the results, fungal colonization was a common finding in transplant recipients at Imam Khomeini Hospital. However, the incidence of fungal infections was comparable with those of other centers. As the oral cavity was the most common site of colonization and infection, it might be beneficial to take further care about the oral health of patients using effective mouthwash.
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http://dx.doi.org/10.18502/cmm.6.1.2505DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217253PMC
January 2020

Treatment-related complications in patients with esophageal cancer: A systematic review and network meta-analysis.

Surgeon 2021 Feb 21;19(1):37-48. Epub 2020 Mar 21.

Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: The aim of this review was to compare the available treatments of esophageal cancer, in terms of pulmonary, cardiovascular complications, anastomotic leakage, and esophagitis after treatment in patients with esophageal squamous cell carcinoma (SCC).

Methods: Medline, Web of Science, Scopus, the Cochrane Library and Embase were searched. The randomized controlled trials (RCT) that had compared the treatment -related complications of treatments for esophageal SCC were included. We included 39 randomized control trials in a network meta-analysis. The Chi2-test was used to assess of heterogeneity. The loop-specific and design-by-treatment interaction methods were used for assessment of consistency assumption. The risk ratio with 95% confidence interval (CI) was used to report the effect-sizes in the network meta-analysis.

Results: The pulmonary complication, cardiac complication, anastomotic leakage, and esophagitis were reported in 31, 11, 17, and 15 RCTs respectively. Video-assisted thoracoscopy + laparoscopy (VATS) was rank as the first and second treatment in terms of lower risk for pulmonary complication and anastomotic leakage. There was no statistically significant difference between treatments in terms of lower risk of cardiovascular complications. However, Surgery + Cisplatin + Fluorouracil (SCF) was ranked as better treatment. 3-dimensional conformal radiotherapy + Docetaxel + Cisplatin (3DCRTDC) was the best treatment in terms of lower risk for esophagitis.

Conclusion: According to the results of this study, it seems the risk of pulmonary, cardiovascular, anastomotic leakage and esophagitis complications for VATS, SCF, surgery + radiotherapy (SRT), and 3DCRTDC was lower than other treatments respectively in the networks.
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http://dx.doi.org/10.1016/j.surge.2020.01.010DOI Listing
February 2021

Association between dietary patterns with kidney function and serum highly sensitive C-reactive protein in Tehranian elderly: An observational study.

J Res Med Sci 2020 20;25:19. Epub 2020 Feb 20.

Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.

Background: Accumulating evidence suggests that diet is associated with kidney function. This study was carried out to examine the association between a posteriori dietary patterns and kidney function in older adults.

Materials And Methods: In a cross-sectional study, 266 older adults, aged 60-83 years, were included. Anthropometric measures were recorded. Biochemical measurements of blood and urine samples were measured. Information on diet was collected using a validated semi-quantified food frequency questionnaire with 168 food items and factor analysis performed to derive major dietary patterns. Estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease (CKD) Epidemiology Collaboration equation.

Results: A total of 266 participants with mean body mass index (BMI) 29.75 ± 4.53 kg/m and age, 66.2 ± 5.3 years, were included in the current study. Three major dietary patterns were identified using factor analysis based on intake data (28% of the total variance of food intake in the population). After adjustment for age, sex, BMI, and energy intake, we found a positive significant relationship between the first pattern and eGFR ( = 0.031). A positive significant association between adherence to the traditional dietary pattern and urine creatinine was also observed ( = 0.035). In addition, in logistic regression model and after control for covariates, a positive association was observed between adherence to traditional dietary pattern with odds of eGFR < 60 ml/min/1.73 m ( = 0.043) and urinary albumin-to-creatinine ratio ≥ 30 mg/g ( = 0.038).

Conclusion: It is concluded that higher adherence to the healthy dietary pattern may improve renal function while Iranian traditional pattern was associated with significantly increased odds of incident CKD and albuminuria.
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http://dx.doi.org/10.4103/jrms.JRMS_812_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053158PMC
February 2020

Whole Genome Sequencing Results Associated with Minimum Inhibitory Concentrations of 14 Anti-Tuberculosis Drugs among Rifampicin-Resistant Isolates of from Iran.

J Clin Med 2020 Feb 7;9(2). Epub 2020 Feb 7.

Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417653911, Iran.

Accurate and timely detection of drug resistance can minimize the risk of further resistance development and lead to effective treatment. The aim of this study was to determine the resistance to first/second-line anti-tuberculosis drugs in rifampicin/multidrug-resistant (RR/MDR-MTB) isolates. Molecular epidemiology of strains was determined using whole genome sequencing (WGS)-based genotyping. A total of 35 RR/MDR-MTB isolates were subjected to drug susceptibility testing against first/second-line drugs using 7H9 Middlebrook in broth microdilution method. Illumina technology was used for paired-end WGS applying a Maxwell 16 Cell DNA Purification kit and the NextSeq platform. Data analysis and single nucleotide polymorphism calling were performed using MTBseq pipeline. The genome-based resistance to each drug among the resistant phenotypes was as follows: rifampicin (97.1%), isoniazid (96.6%), ethambutol (100%), levofloxacin (83.3%), moxifloxacin (83.3%), amikacin (100%), kanamycin (100%), capreomycin (100%), prothionamide (100%), D-cycloserine (11.1%), clofazimine (20%), bedaquiline (0.0%), and delamanid (44.4%). There was no linezolid-resistant phenotype, and a bedaquiline-resistant strain was wild type for related genes. The Beijing, Euro-American, and Delhi-CAS were the most populated lineage/sublineages. Drug resistance-associated mutations were mostly linked to minimum inhibitory concentration results. However, the role of well-known drug-resistant genes for D-cycloserine, clofazimine, bedaquiline, and delamanid was found to be more controversial.
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http://dx.doi.org/10.3390/jcm9020465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073636PMC
February 2020

SCC Genotypes of Methicillin-Resistant in Nasal Carriage of Multiple Sclerosis Patients in Iran.

Iran J Public Health 2019 Dec;48(12):2270-2276

MS Research Center, Neuroscience Institute, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Asymptomatic nasal colonization of Methicillin-Resistant is common in Multiple Sclerosis patients. SCC types I to III are mainly attributed to HA-MRSA strains whereas SCC types IV and V have commonly been reported in CA-MRSA infections. Here, we assessed the frequency of nasal carriage of MRSA in MS patients. This study aimed to evaluate MRSA SCC typing in MS nasal carriage.

Methods: A cross-sectional descriptive study was conducted from Feb and Jun 2017 in MS Research Center, Tehran University of Medical Sciences (TUMS), Iran. Overall, 620 nasal swabs were collected (325 from MS patients and 295 from control group). Antimicrobial susceptibility test was performed using the disk diffusion and E-test method. Presence of gene was confirmed by PCR assay and multiplex PCR was performed for SCC typing of MRSA isolates.

Results: The frequency of MRSA among the MS patients and control group was almost equal (9.2% and 10.1%, respectively). SCC typing detected only types III, IV and V in both groups and type IV was the most predominant type in MS patients and control group. SCC type III was more prevalent in control group than MS patients (40% vs. 20%). Moreover, the frequency of SCC type V in MS patients was significantly higher than control group (36.7% vs. 3.3%).

Conclusion: Although most MRSA isolates were collected from inpatients, interestingly there is a high frequency of SCC types IV and V in MS group. Moreover, MRSA isolates were not resistant to more antibiotics in type III than types IV-V.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974861PMC
December 2019

Survival Analysis in Patients with Chronic Traumatic Spinal Cord Injury.

Iran J Public Health 2019 Dec;48(12):2260-2269

Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: The goal of this study was to determine hazard rate of death rate and the causes of death in Iranian patients with Traumatic spinal cord injury (TSCI).

Methods: Overall, 1024 patients with chronic traumatic spinal cord injury referred to Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran from Jan 2013-2017 were enrolled. Epidemiological and neurological data, along with secondary complications were recorded for all participants. In the case of death, the cause, and the date of death were recorded. The Kaplan-Meier method was used for survival analysis. A log-rank test was carried out to compare survival due to different risk factors. Risk factors and relative risk estimates associated with death were assessed by means of a Cox regression model.

Results: Nineteen percent were lost to follow up. During the follow-up period, 22 out of 830 remaining cases (2.6%) died. Deaths were only observed in patients with cervical injuries (59% in C1-C4 level and 41% in C5-C7 level). Kaplan-Meier Log-rank test showed that probability of survival was significantly less in females, complete injury cases, patients with cervical spine injury, depression, and ADR (Autonomic dysreflexia). Controlling for age, sex and education level, Cox regression model showed that hazard rate of death was significantly affected by the categorical variables such as level of injury (HR=0.2, 95% CI=0.12-0.39), severe ADR.

Conclusion: Probability of survival is lower in female individuals, cases with complete injuries, patients with cervical spine injury, individuals with depression (BDI>10), and clients who experience ADR.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974852PMC
December 2019

Estimate General Practitioners Active Supply in Iran: Capture-Recapture Method for Three Data Sources.

Iran J Public Health 2019 Dec;48(12):2240-2248

Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Accurate estimation of active general practitioners (GPs) is a concern for health authorities to estimate requirements. This study aimed to accurately estimate GPs active supply in Iran using three sources capture-recapture (CRC) method.

Methods: This cross-sectional study collected data during 2015-2016, targeting all GPs registered in three independent data sources; a national survey from all hospitals, database of human resource management office at health ministry and physicians' offices databank. Variables including medical council codes, GP names, surnames and national ID codes were used for data linkage among the three sources. Three sources CRC method was applied using log-linear models to estimate the total number of active GPs in STATA software.

Results: Overall, 27,048 GPs were identified after removing the duplicate records. Based on CRC three sources data, the total number of GPs were 53,630 in 2015-2016. Distribution of GPs per 1,000 population among the provinces indicates that provinces of Kohgiluyeh & Boyer Ahmad, Mazandaran, Golestan and Yazd with ratios of 1.28, 1.28, 1.21 and 1.17 physicians rank the highest proportion of GPs and the provinces of Sistan & Baluchestan, Ilam, Zanjan, Alborz, North Khorasan with corresponding ratios of 0.24, 0.40, 0.40, 0.43 and 0.45 GPs ranked the lowest.

Conclusion: CRC method is known to be the best and rapidest method to estimate active GP due to its compatibility for the current situation of databanks in Iran. Therefore, this method is a good application in human resource distribution and planning.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6974864PMC
December 2019

Effect of Meteorological Factors on Species Composition and Their Host Preference, Seasonal Prevalence and Infection Status to Crimean-Congo Haemorrhagic Fever in Iran.

J Arthropod Borne Dis 2019 Sep 30;13(3):268-283. Epub 2019 Sep 30.

Mamasani Health Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The impact of environmental factors and host on spp. community structure and abundance in the main Crimean-Congo haemorrhagic fever (CCHF) foci of Iran is largely unknown.

Methods: Biotic and abiotic factors, including host, temperature, humidity, altitude, Köppen-Geiger climate types, season, and precipitation on spp. community structure and abundances in 11 provinces of Iran were investigated. Additionally, the possible infection of ticks with CCHF virus was evaluated using reverse transcription PCR technique.

Results: Species analyses demonstrated the presence of , , , , and in the study area. was the dominant species in the southern and northern parts, whereas was distributed mostly in central parts of the country. The highest tick infestation was recognized in hot season. Spatial variation in tick relative density was observed between habitat types where more ticks were collected in deserts, semi-deserts, and Mediterranean habitats. Except for , which was more prevalent on camel (P= 0.044), there were no significant variations in the frequencies of other species on different hosts. , frequencies had significant positive and negative association with temperature and precipitation respectively. Also humidity has positive impact on frequency.

Conclusion: Data presented here will help improve ecological models to forecast the distribution of spp. ticks, to evaluate the risk of CCHF and other tick-borne diseases, and to design proper vector control measures to suppress populations in Iran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928388PMC
September 2019

Detection of Diazinon Residue in Honey and Honey Bee () in Bandar-Abbas and Meshkinshahr, Iran.

J Arthropod Borne Dis 2019 Jun 24;13(2):185-190. Epub 2019 Jun 24.

Department of Environmental Chemical Pollutants and Pesticides, Institute of Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.

Background: The excessive use of pesticides for crops by farmers, their destructive effects on beneficial organisms, such as bees, have become a big problem today. This study was designed to find out if the honey bee () and the honey be affected by diazinon.

Methods: Six hives were purchased, 3 hives in Bandar-Abbas and remaining were considered for Meshkinshahr. Plants around the hive were sprayed with diazinon at a concentration of 2/1000. Sampling took place 15d after spraying, and diazinon residue was measured by the HP TLC. The study was conducted in 2017-2018.

Results: The amount of diazinon residue in honey and honey bee was measured and compared with existing studies. The amount of diazinon residue in honey bee was found to be 0.017mg/kg in Bandar Abbas, and 0.005mg/kg in Meshkinshahr hives. There was nothing in honey.

Conclusion: Honey is safe for consumers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885143PMC
June 2019

Phage Therapy as an Approach to Control Salmonella enterica serotype Enteritidis Infection in Mice.

Rev Soc Bras Med Trop 2019 14;52:e20190290. Epub 2019 Nov 14.

Division of Medical Bacteriology, Department of Pathobiology, School of Public Health (TUMS), Tehran, Iran.

Introduction: Salmonella enterica serotype Enteritidis (S. Enteritidis) is a cause of food-borne human illness. Given the prevalence of antibiotic resistance of Salmonella Enteritidis and the lack of antibiotic efficacy in future years, its replacement with other agents is necessary. One of the most useful agents is bacteriophages.

Methods: S. Enteritidis was identified using a multiplex polymerase chain reaction assay. The effective bacteriophages were isolated from hospital wastewater samples. The effects of the bacteriophages were evaluated both in vitro and in vivo.

Results: The phage SE20 belonged to the Podoviridae family, and the genome size was 40 kb. The evaluation of phage SE20 at variable pH ranges showed its susceptibility to pH < 3 and pH > 12. The animal model showed that mice infected with S. Enteritidis developed hepatomegaly and splenomegaly, but did not experience gastrointestinal complications after receiving the bacteriophages.

Conclusions: The results of this study suggest that phage SE20 is a promising candidate for controlling salmonellosis caused by Salmonella Enteritidis.
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http://dx.doi.org/10.1590/0037-8682-0290-2019DOI Listing
January 2020