Publications by authors named "Ghobad Moradi"

100 Publications

How is the iceberg of COVID-19? Results from a rapid literature review.

Med J Islam Repub Iran 2021 16;35:77. Epub 2021 Jun 16.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Given the various reports of the clinical spectrum of the disease, the aim of the present study was to determine possible scenarios of Coronavirus 2019 (COVID-19) iceberg using published articles. The present study was a rapid review of all international databases, including PubMed (Medline), Scopus, Web of Sciences, Embase, and Cochrane Library from January 1 to October 30, 2020. In this review, 7 scenarios were considered for COVID-19 iceberg, in which the range of fatality percentage was estimated to be 0.5% to 7%, the range of asymptomatic cases 1% to 88.6%, the range of cases with mild symptoms 8% to 78%, no symptoms 1 % to 90 %, the range of intensive care unit (ICU) admission was 0.5% to 14.2%, and finally the intubation percentage was estimated to be 0.2% to 12.2%. The Scenarios Diamond Princess Cruise Ship and Iceland are closer to the reality of the clinical spectrum of COVID-19 around the world, which represent 0.6% and 0.5% of deaths, 0.7% and 1% of intubations, 2.5% and 9.7% of ICU admissions, 1.1% and 6% of hospitalizations, 15% and 31% of cases with mild symptoms, and finally 56.9% and 75% of asymptomatic cases of COVID-19, respectively, which should now be considered as the basis of the clinical knowledge of the disease. Understanding the clinical spectrum and natural knowledge of the disease and paying attention to asymptomatic or mild-symptom cases can help to make better decisions and develop more effective interventions to control COVID-19.
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http://dx.doi.org/10.47176/mjiri.35.77DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285553PMC
June 2021

Geographical distribution of Typhoid using Geographic Information System (GIS) during 2009-2014 in Iran.

Med J Islam Repub Iran 2021 15;35:35. Epub 2021 Mar 15.

Department of Public Health,School of Medicine, Dezful University of Medical Sciences, Dezful, Iran.

Salmonella induced infections remain one of the most important health problems worldwide. The purpose of this study is to investigate the incidence and geographical distribution of typhoid using GIS and to predict its incidence in Iran in 2021. This study is a descriptive analytical study. Information on pertussis was obtained from the Center for Communicable Diseases Control during 2009-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency Therefore, using the Raster Calculator tool, the disease prediction map was drawn. The results showed that the highest incidence of typhoid during 2009-2014 was in Kermanshah, Lorestan, Hamadan, Kurdistan, and Ilam provinces. The incidence of typhoid in Iran increased during 2009-2010. The annual incidence of typhoid decreased from 0.85 per 100,000 in 2010 to 0.5 in 2014. Based on the modeling results for Iran, Kermanshah, Lorestan, Kurdistan, Ilam and Hamadan provinces with 92.17%, 46.56%, 31.74%, 25.62% and 22.96% of their areas (Km2) are at high risk for typhoid in the coming years, respectively. Considering that the provinces of Kermanshah, Lorestan, Kurdistan, Ilam, and Hamadan are at risk of typhoid incidence in the coming years in Iran, and given that salmonella infections have a direct relationship with the individual's health status and individual's environmental health and socioeconomic status, improving the health status and disease control in carriers as well as improving the socio-economic status of the population living in these areas can prevent the disease in the years to come.
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http://dx.doi.org/10.47176/mjiri.35.35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236083PMC
March 2021

Catastrophic health expenditures for children with disabilities in Iran: A national survey.

Int J Health Plann Manage 2021 Jun 29. Epub 2021 Jun 29.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Objective: The aim of this study was to investigate the percentage of households with disabled children aged 0-8 years who had faced catastrophic health expenditures (CHEs) due to the health costs of these children in Iran.

Methods: This cross-sectional study was carried out on 2000 households with disabled children aged 0-8 years in five provinces of Iran in 2020. Data were collected using the World Health Survey questionnaire and face-to-face interview. Determinants of CHE were identified using logistic regression.

Results: 32.7% of households with disabled children had faced CHE. Head of household being female (Adjusted OR = 18.89, 95%CI: 10.88-29.42), poor economic status of the household (Q1: Adjusted OR = 20.26, 95% CI, 11.42-35.94; Q2: Adjusted OR = 8.27, 95%CI, 4.45-15.36; Q3: Adjusted OR = 13.88, 95%CI, 7.89-24.41), lack of supplementary insurance by a child with disabilities (Adjusted OR = 6.13, 95%CI, 3.39-11.26), having a child with mental disability (Adjusted OR = 2.71, 95%CI, 1.60-4.69), and type of basic health insurance (having Iranian Health Insurance: Adjusted OR = 2.20, 95%CI, 1.38-3.49; having Social security insurance: Adjusted OR = 1.66, 95%CI, 1.06-2.61) significantly increased the chances of facing CHE.

Conclusion: A significant percentage of households with disabled children had faced CHE because of their disabled child's health costs. The key determinants of CHE should be considered by health policy-makers in order to more financial protection of these households.
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http://dx.doi.org/10.1002/hpm.3273DOI Listing
June 2021

Persistence assessment of SARS-CoV-2-specific IgG antibody in recovered COVID-19 individuals and its association with clinical symptoms and disease severity: A prospective longitudinal cohort study.

Int Immunopharmacol 2021 Jun 16;98:107893. Epub 2021 Jun 16.

Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran. Electronic address:

Background: Antibodies play an important role in neutralizing invading pathogens and protecting the host against re-infection. Thus, the accurate assessment of antibodies during a pandemic can provide important evidence for monitoring pathogen exposure, understanding the role of antibodies in protective immunity, and helping vaccine development.

Methods: In this study, 96 west Iranian recovered COVID-19 subjects were recruited and, based on clinical symptoms and disease severity, categorized into three different groups: mild, moderate, and severe. In addition, the presence and dynamic change of SARS-CoV-2-specific IgG antibody three, four-, and six months post symptom onset (PSO) were measured. Also, the association between IgG antibody titer with clinical symptoms and disease severity was examined.

Results: Although in real-time RT-PCR-positive samples negative IgG antibody results were found, most subjects mount humoral immune responses that could raise a robust SARS-CoV-2-specific IgG antibody. Furthermore, this antibody persisted in the serum of most recovered COVID-19 subjects at least six months PSO and demonstrated little to no decrease. Also, specific IgG antibody titer was strongly correlated with clinical symptoms and disease severity.

Conclusions: These results provide an insight into the presence and persistence of the SARS-CoV-2-specific IgG antibody. Although serological tests could not be used as the primary diagnostic test, they may support real-time RT-PCR results. Also, they could be used for diagnosing COVID-19 subjects tested later outside of the optimal period. Thus, the SARS-CoV-2-specific IgG antibody is an excellent marker of COVID-19 infection or vaccination and provides an additional diagnostic tool for verifying results and helps monitor and control COVID-19 spread.
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http://dx.doi.org/10.1016/j.intimp.2021.107893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206627PMC
June 2021

Correction to: The health-related quality of life in Iranian patients with COVID-19.

BMC Infect Dis 2021 Jun 7;21(1):538. Epub 2021 Jun 7.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

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http://dx.doi.org/10.1186/s12879-021-06246-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182992PMC
June 2021

The health-related quality of life in Iranian patients with COVID-19.

BMC Infect Dis 2021 May 20;21(1):459. Epub 2021 May 20.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Background: COVID-19 is a public health emergency with a high mortality rate and it reduces the patient's Health-Related Quality of Life (HRQoL) significantly. This effect is measured in the current study.

Methods: In a cross-sectional study in Iran, 320 randomly selected treated patients from COVID-19 were studied. To collect the required data, we applied a questionnaire that included socio-demographic factors, clinical characteristics, and questions on the patients' HRQoL. Time trade-off (TTO) approach was used to measure the lost HRQoL attributed to COVID-19. Besides, we applied a two-limit Tobit regression model to determine the effects of the socio-demographic factors on patients' health utility and the visual analogue scale approach was used to estimate the perceived total current health status.

Results: The overall mean (SE) and median (IQR) of the health utility values were 0.863 (0.01) and 0.909 (0.21) respectively. These values for the traders (those who were willing to lose a part of their remaining time of life to avoid the disease) were estimated at 0.793 (0.01) and 0.848 (0.17), respectively. The lowest amount of utility value belonged to the elderly (mean (SE) = 0.742 (0.04); median (IQR) = 0.765 (0.42)) and those living in rural areas (mean (SE)) = 0.804 (0.03); median (IQR) = 0.877 (0.30)). The univariate analysis showed that age, place of residence, and household size had a statistically significant effect on health utility. Moreover, findings of the regression analysis indicated that the participants' age and hospitalization status were the key determinants of COVID-19 health utility value.

Conclusion: COVID-19 is associated with a substantial and measurable decrease in HRQoL. This decline in HRQoL can be directly compared with that induced by systemic health states.
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http://dx.doi.org/10.1186/s12879-021-06170-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135385PMC
May 2021

The effect of climate variables on the incidence of cutaneous leishmaniasis in Isfahan, Central Iran.

Int J Biometeorol 2021 Apr 29. Epub 2021 Apr 29.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

In recent years, there have been considerable changes in the distribution of diseases that are potentially tied to ongoing climate variability. The aim of this study was to investigate the association between the incidence of cutaneous leishmaniasis (CL) and climatic factors in an Iranian city (Isfahan), which had the highest incidence of CL in the country. CL incidence and meteorological data were acquired from April 2010 to March 2017 (108 months) for Isfahan City. Univariate and multivariate seasonal autoregressive integrated moving average (SARIMA), generalized additive models (GAM), and generalized additive mixed models (GAMM) were used to identify the association between CL cases and meteorological variables, and forecast CL incidence. AIC, BIC, and residual tests were used to test the goodness of fit of SARIMA models; and R was used for GAM/GAMM. 6798 CL cases were recorded during this time. The incidence had a seasonal pattern and the highest number of cases was recorded from August to October. In univariate SARIMA, (1,0,1) (0,1,1) was the best fit for predicting CL incidence (AIC=8.09, BIC=8.32). Time series regression (1,0,1) (0,1,1) showed that monthly mean humidity after 4-month lag was inversely related to CL incidence (AIC=8.53, BIC=8.66). GAMM results showed that average temperature with 2-month lag, average relative humidity with 3-month lag, monthly cumulative rainfall with 1-month lag, and monthly sunshine hours with 1-month lag were related to CL incidence (R=0.94). The impact of meteorological variables on the incidence of CL is not linear and GAM models that include non-linear structures are a better fit for prediction. In Isfahan, Iran, meteorological variables can greatly predict the incidence of CL, and these variables can be used for predicting outbreaks.
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http://dx.doi.org/10.1007/s00484-021-02135-8DOI Listing
April 2021

Knowledge, attitudes, practices and fear of COVID-19 among Iranians: A quick online survey.

Health Soc Care Community 2021 Apr 23. Epub 2021 Apr 23.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

To control COVID-19, several strategies were proposed in Iran since the start of the outbreak. The number of reported infected people and its consequent death toll herald relative inadequacies in the quality and extent of the measures in curbing the COVID-19 transmission cycle. This study was conducted to investigate knowledge, attitude, precautionary practices and degree of fear related to COVID-19 in a sample of Iranian population. This study was conducted among 457 residents of Kurdistan Province, Iran, through social networks and social media (WhatsApp and Telegram). Knowledge, attitude and practice and fear of COVID-19 were collected using valid tools. Multiple logistic regression and multivariate linear regression analyses were used to identify factors associated with binary outcome attitudes, practices and continuous variables knowledge and fear of COVID-19, respectively. The mean (SD) age of participants was 37.86 (10.42); of them, 252 (55.1%) were men, and more than two-thirds were married (74.8%). About 10% of the respondents were in believed that COVID-19 could create a type of social stigma. Level of knowledge about COVID-19 in 77.8% of the study attendees was acceptable, and 352 of them (70%) were confident that the virus would eventually be successfully controlled in the world, but only 252 of the attendants (50%) had confidence about successful control of COVID-19 in Iran. Applying multiple logistic regression, knowledge (OR: 1.18, p = 0.028) and fear (OR: 1.04, p = 0.028) of COVID-19 were associated with positive attitude towards controllability of COVID-19. Gender (OR: 1.96, p = 0.012), sources of information (OR: 5.00, p = 0.005) and knowledge (OR: 1.27, p = 0.006) were also indicated association with taking precautionary practices to control COVID-19. Further studies are recommended to boost level of knowledge, strengthen positive attitude and ameliorate behavioural pattern for successful control of COVID-19 in Iran.
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http://dx.doi.org/10.1111/hsc.13382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251274PMC
April 2021

The Burden of Stroke in Kurdistan Province, Iran From 2011 to 2017.

J Prev Med Public Health 2021 Mar 1;54(2):103-109. Epub 2021 Feb 1.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Objectives: The aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017.

Methods: Incidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs).

Results: The burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively.

Conclusions: The burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.
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http://dx.doi.org/10.3961/jpmph.20.335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046604PMC
March 2021

Evaluating the quality of care for patients with type 2 diabetes mellitus based on the HbA1c: A national survey in Iran.

Heliyon 2021 Mar 17;7(3):e06485. Epub 2021 Mar 17.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Objective: The present study was conducted to evaluate the quality of care for type2 diabetic patients based on the HbA1c in Iran.

Materials And Methods: This cross-sectional study was conducted in 2019 among patients with type 2 diabetes in Iran. The data were collected through a three-part questionnaire including demographic information, disease-related records, and HbA1C status of patients. Multiple logistic regression was used to investigate the relationship between the outcome variable (HbA1c status) and the independent variables in Stata 12.

Results: The mean HBA1c was 8.01 ± 1.76% among 1,198 diabetic patients, and more than 66% of them had HBA1c above 7%, i.e. they had uncontrolled blood sugar levels. HBA1c has the highest average among people with more than 10 years of diabetes (8.47 ± 1.77%), self-employed people (8.36 ± 1.94%), illiterate people or those with elementary education (8.13 ± 1.76%) and people with poor economic status (8.12 ± 1.79%). Also, in the final model, people with more than 10 years of disease history had the highest prevalence of HBA1C > 7 with a chance ratio of 3.28 (P < 0.001, 95%CI: 2.37-4.53) and followed by illiterate people or those with elementary education with a chance ratio of 1.6 (P = 0.020, 95%CI: 1.08-2.39) compared to those with high school diploma or academic education.

Conclusion: The prevalence of adverse HBA1c in 66% of the studied subjects indicates an inappropriate status of diabetes control in Iran. This indicates the poor quality of services provided to the diabetics. This is a warning sign and requires appropriate interventions to improve the quality of services provided to diabetic patients.
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http://dx.doi.org/10.1016/j.heliyon.2021.e06485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980062PMC
March 2021

Measuring the constructs of health literacy in the Iranian adult Kurdish population.

BMC Public Health 2021 03 24;21(1):589. Epub 2021 Mar 24.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Background: Health literacy is essential to self-care, which is an important precedence to improve the quality of healthcare services and a key factor in health. It also plays a pivotal role in decision-making in various health fields. Therefore, policymakers consider health literacy to be a primary tool to promote community health and enhance the proper use of healthcare services. The present study aimed to assess the health literacy status of the Kurdish population in Kurdistan province, Iran based on the nine constructs of the Iranian health literacy questionnaire (IHLQ) individually and collectively and determine the significant effects of demographic variables on health literacy.

Methods: This cross-sectional study was conducted on the Iranian adult Kurdish population living in the urban and rural areas of Kurdistan province, willing to participate during April 2017-September 2018. Data were collected using the IHLQ. The sample size was determined to be 980 people, with 490 in the rural areas and 490 in the urban areas. The researchers visited potential participants at their doorstep, asking them to complete the questionnaire. The willing participants were assisted in completing the IHLQ in case they were illiterate; the questions and answers were read by the researchers to the participants, and the responses were recorded.

Results: About 50.4% (n = 494) of the Kurdish population had poor health literacy, while 34.0% (n = 333) had average health literacy, and 15.6% (n = 153) had good health literacy. Meanwhile, 60.2% of the participants obtained poor scores in the construct of health information access, and 74.1% (n = 726) obtained poor scores in the individual empowerment construct. In addition, the analysis of the adjusted model indicated that education level (lowest β = 7.42; P = 0.001) and in male participants (β = - 1.10; P = 0.001) were significantly associated with higher health literacy.

Conclusion: According to the results, the investigated Kurdish population mostly had average or low health literacy. Therefore, proper strategies should be adopted to enhance the health literacy of this population and increase their access to health information. Furthermore, effective training should be provided to these individuals (especially vulnerable social groups) to improve their individual capabilities to compensate for poor health literacy.
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http://dx.doi.org/10.1186/s12889-021-10589-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992981PMC
March 2021

Clinical manifestation and maternal complications and neonatal outcomes in pregnant women with COVID-19: a comprehensive evidence synthesis and meta-analysis.

J Matern Fetal Neonatal Med 2021 Feb 18:1-14. Epub 2021 Feb 18.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Objectives: There is little known about pregnancy-related complications and comorbidity in this group of women. Therefore, this systematic review and meta-analysis were performed to find out whether COVID-19 may cause different manifestations and outcomes in the antepartum and postpartum period or not.

Material And Methods: We searched databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid, and CINHAL to retrieve all articles reporting the prevalence of maternal and neonatal complications, in addition to clinical manifestations, in pregnant women with COVID-19 that published with English language January to November 2020.

Results: Seventy-four studies with total 5560 pregnant women included in this systematic review. The results show that the pooled prevalence of neonatal mortality, lower birth weight, stillbirth, premature birth, and intrauterine fetal distress in women with COVID-19 was 4% (95% Cl: 1 - 9%), 21% (95% Cl: 11 - 31%), 2% (95% Cl: 1 - 6%), 28% (95% Cl: 13 - 43%), and 14% (95% Cl: 4 - 25%); respectively. Moreover, the pooled prevalence of fever, cough, diarrhea, and dyspnea were 56% (95% Cl: 32 - 81%), 29% (95% Cl: 21 - 38%), 9% (95% Cl: 2 - 16%), and 3% (95% Cl: 1 - 6%) in pregnant women with COVID-19. Two studies reported that pregnant women with severe COVID pneumonia have higher levels of d-dimer. Also, COVID pneumonia is more common in pregnant women than non-pregnant.

Conclusion: According to this meta-analysis, pregnant women with COVID-19 with or without pneumonia, are at a higher risk of preeclampsia, preterm birth, miscarriage and cesarean delivery. Furthermore, the risk of LBW and intrauterine fetal distress seems to be increased in neonates. In addition, our evaluations are investigative of higher risk of COVID-19 in the third trimester in pregnant women comparing to the first and second trimester. It can be due to higher BMI in the third trimester causing to increase the likelihood of disease deterioration, which can trigger a cascade of side effects starting with coagulation, pneumonia, hypoxemia affecting the placenta leading to ICU admission, fetal distress, premature birth and higher rates of C-section.
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http://dx.doi.org/10.1080/14767058.2021.1888923DOI Listing
February 2021

The determinants of methadone maintenance treatment in opioids dependence users: A survival analysis study.

Med J Islam Repub Iran 2020 4;34:149. Epub 2020 Nov 4.

Department of Clinical Psychology , Kurdistan University of Medical Sciences, Sanandaj, Iran.

Staying in treatment is one of the basic principles in maintenance treatment with methadone and it is considered as a success criterion in the treatment procedure. This study aimed at analyzing effective determinants on staying in treatment in methadone treatment procedure. This was a retrospective cohort study, in which 6 MMT centers were randomly selected to be studied. The data were collected using the patients' medical records. Therefore, 1008 medical record files belonging to the patients who received methadone treatment from April 2013 to August 2017 were investigated. Proportional hazard Cox regression (extended) was used to specify the determinants of the methadone maintenance treatment and STATA 11 was used for data analysis. The patients' mean age was 38.8 years (±1.08), and 75.8% were married and only 39.1% had full-time jobs. The mean age for the first substance abuse was at 24.31years (±7.93). The average time of staying in the treatment was 28.8 months. The results of the adjusted Cox proportional hazards regression showed among the 14 variables entered into the model, in the 1-12-month interval age of first drug use (HR=0.945, 95 % CI=0.908-0.983, p=0.005), specific drug use (HR=1.14, 95 % CI=1.026-1.268, p=0.014), and the frequency of treatment (HR=0.974, 95 % CI=0.959-0.990, p=0.002) were significantly correlated with survival status. The 13-36- month interval drug use (HR=0.931, 95 % CI=0.886-0.978, p=0.005) was significantly correlated with survival status. Also, the range of 37-53 month drug use (HR=1.058, 95 % CI=1.001-1.119, p= .044) had a significant relationship with survival status. This study showed age of first drug use, specific drug use, the frequency of treatment and drug use were correlated with a decrease in staying duration in treatment. Therefore, taking these factors into consideration in designing and administering various interventions in addiction treatment and consulting centers is of paramount importance.
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http://dx.doi.org/10.47176/mjiri.34.149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787028PMC
November 2020

How Can the Epidemic Curve of COVID-19 in Iran Be Interpreted?

J Res Health Sci 2020 Oct 4;20(3):e00491. Epub 2020 Oct 4.

Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.

Background: Iran is one of the countries most affected by COVID-19. This review provides possible interpretations of the observed trend of COVID-19 in Iran.

Study Design: A rapid review METHODS: We reviewed the daily new cases of COVID-19 based on hospitalized and outpatients, reported deaths, and diagnostic testing in Iran.

Results: Iran reported its first peak in the number of cases in late March, 2020. From the 1 April to 3 May 2020, the downward trend in the number of cases was started. The death trend also showed a peak in early April as well as a downward trend in late April. During May, the number of death cases showed a stable trend with a daily number of deaths ranging between 50 and 75 cases. Then the number of deaths gradually increased.

Conclusion: The epidemic curve in Iran is a function of different factors such number of total tests, change in mitigation policies, and heterogeneities among different provinces in the country. Therefore it should be interpreted under the light of the effect of such factors.
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http://dx.doi.org/10.34172/jrhs.2020.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585769PMC
October 2020

Prevalence of and risk factors for HBV and HCV among incarcerated people who inject drugs in Iran: A cross sectional study.

BMC Infect Dis 2020 Oct 31;20(1):806. Epub 2020 Oct 31.

Student Research Committee, Faculty of Medicine, Kurdistan University of Medical Sciences, Pasdaran Ave, Sanandaj, Iran.

Background: This study aimed at determining the prevalence of and risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) among incarcerated people who inject drugs (PWID) in Iran in 2015-16.

Methods: The required data was collected from a database provided by Iranian national bio-behavioral surveillance surveys (BBSSs) on 11,988 prisoners selected from among 55 prisons in 19 provinces in 2015-16. The data on demographics and behavioral variables were collected through interviews and the status of exposure to HBV and HCV were determined using ELISA blood test. A total of 1387 individuals with a history of drug injection in their lifetime were enrolled into the study. Data were analyzed using the survey package in Stata/SE software, Version 14.0. Univariate and multivariate logistic regression tests were used to investigate the relationships between risk factors and outcomes.

Results: The mean age of the incarcerated PWID was 36.83 ± 8.13 years. Of all the studied subjects, 98.46% were male and 50.97% were married. The prevalence of HCV and HBV among the subjects were 40.52 and 2.46%, respectively. The prevalence of HCV was associated with age ≥ 30 years, being single, illiteracy and low level of education, prison term> 5 years, history of piercing, and extramarital sex in lifetime (P < 0.05).

Conclusions: The prevalence of HCV is alarmingly high. In general, it is recommended to adopt measures to screen and treat patients with HCV and vaccinat incarcerated PWID without a history of vaccination against HBV.
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http://dx.doi.org/10.1186/s12879-020-05541-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603667PMC
October 2020

The prevalence of physical inactivity in Iranian adolescents and the impact of economic and social inequalities on it: results of a National Study in 2018.

BMC Public Health 2020 Oct 2;20(1):1499. Epub 2020 Oct 2.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Pasdaran Ave, Sanandaj, Iran.

Background: This study aims to determine the prevalence of physical inactivity in Iranian adolescents aged 10-12 years and the impact of socioeconomic inequality on it.

Methods: In this descriptive study, the study population consisted of 10-12 years old adolescents from an Iranian population from Kurdistan, Fars and Markazi provinces in 2018. The sample size was 1590 individuals. The sampling method was cluster sampling. Data was collected using demographic questionnaire, modifiable activity questionnaire (MAQ) and socioeconomic questionnaire. Cut points on the MAQ for light activity, moderate activity and heavy activity were MET< 3, MET = 3-6 and MET> 6, respectively. Linear and logistic regression were used to estimate the final model and the Oaxaca analysis method was applied. All analyses were performed in Stata/SE 14.0.

Results: Of the 1590 participants, 52.82% were male. The results showed that 25.79% of the subjects were physically inactive and 7.30% engaged in moderate physical activity during the week. The average physical activity during 1 week was more in boys than in girls (P-value< 0.05). Adolescents of mothers with secondary and high school education were more likely to have physical inactivity than mothers with a high school diploma or higher (AOR: 1.35, 95% CI: 1.02-1.77). The concentration index was -.11, indicating a greater concentration of physical inactivity in adolescents with low socioeconomic levels.

Conclusion: One-fourth of the study population had physical inactivity in this age group. Socioeconomic levels, parental literacy, and sex of adolescents were associated with the level of physical activity.
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http://dx.doi.org/10.1186/s12889-020-09618-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532599PMC
October 2020

The role of in preterm delivery: a case-control study in Besat Hospital, Sanandaj, Iran (2018-2019).

Iran J Microbiol 2020 Aug;12(4):325-330

Department of Microbiology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Background And Objectives: Preterm delivery is an important subject in gynecology, obstetrics and pediatrics. It is defined as regular uterine contractions every five to eight minutes or less, lasting for 30 seconds. It is associated with progressive changes in the cervix, resulting in delivery after 22 weeks and before 37 weeks of gestation. This study aimed to evaluate the role of infection in women with preterm delivery.

Materials And Methods: This case-control study was performed on 75 women with preterm delivery (case group) and 75 women with term delivery (control group). The research tools included a questionnaire, polymerase chain reaction (PCR) assay of cervical swab samples and ELISA assay of umbilical cord blood samples. Fisher's exact test and t test were also performed to compare qualitative variables between the two groups.

Results: In this study, the mean age of subjects was 26.55 ± 0.53 years in the control group and 26.76 ± 0.56 years in the case group. The prevalence of in the cervical swab samples was 7 (9.33%) in the control group and 2 (2.67%) in the case group. There was no IgM antibody in either of the groups, while there was 1 (1.33%) IgG antibody in both groups.

Conclusion: The results of the present study showed that there was no significant relationship between infection and preterm delivery.
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http://dx.doi.org/10.18502/ijm.v12i4.3936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502151PMC
August 2020

Perceived stress due to COVID-19 in Iran: Emphasizing the role of social networks.

Med J Islam Repub Iran 2020 30;34:55. Epub 2020 May 30.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

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http://dx.doi.org/10.34171/mjiri.34.55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481856PMC
May 2020

Incidence and Intensity of Catastrophic Health-care Expenditure for Type 2 Diabetes Mellitus Care in Iran: Determinants and Inequality.

Diabetes Metab Syndr Obes 2020 18;13:2865-2876. Epub 2020 Aug 18.

Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Background: The present study aimed to assess the prevalence and intensity of catastrophic health-care expenditures (CHE) relating to type 2 diabetes mellitus care and inequality in facing such expenditures in Iran.

Methods: A total of 1065 type 2 diabetes patients were included in this cross-sectional study. A multistage sampling method was used to select the samples. Data on sociodemographic characteristics, economic status, health and diabetic costs were collected using a self-constructed questionnaire. We used capacity to pay (CTP) of households to calculate the incidence of CHE due to diabetic care at four different thresholds. The mean positive overshoot (MPO) and overshoot were used to assess the intensity of CHE. The relative concentration index and slope index of inequality (SII) were used to measure socioeconomic-related inequalities in incidences of CHE. In addition, decomposition methods were used to identify the main factors affecting observed inequality in CHE.

Results: The incidence of CHE at the 10, 20, 30, and 40% of CTP thresholds for type 2 diabetes mellitus care was 57.5, 28.9, 16.5, and 11.4%, respectively. The results of CI and SII indices for CHE due to diabetic care indicated that the incidence of CHE was more prevalent among patients with lower socioeconomic groups. The decomposition analysis showed that the socioeconomic status, marital status and gender of patients were the main factors contributing to socioeconomic inequality in incidence of CHE among the poor.

Conclusion: Our study demonstrated that the incidence and intensity of CHE due to diabetic care were relatively high, particularly among socioeconomically disadvantaged patients. Modification to the present health care financing strategies is recommended in order to protect lower socioeconomic groups against the financial burden of diabetic care.
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http://dx.doi.org/10.2147/DMSO.S263571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450415PMC
August 2020

The Prognostic Factors Affecting the Survival of Kurdistan Province COVID-19 Patients: A Cross-sectional Study From February to May 2020.

Int J Health Policy Manag 2020 Aug 22. Epub 2020 Aug 22.

Department of Infectious Disease, Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Background: Coronavirus disease 2019 (COVID-19) is a new viral disease and in a short period of time, the world has been affected in various economic, social, and health aspects. This disease has a high rate of transmission and mortality. The aim of this study is to investigate the factors affecting the survival of COVID-19 patients in Kurdistan province.

Methods: In this retrospective study, the data including demographic features and the patient's clinical background in terms of co-morbidities such as diabetes, cancer, chronic lung disease (CLD), coronary heart disease (CHD), chronic kidney disease (CKD) and weak immune system (WIS) were extracted from electronic medical records. We use Cox's regression proportional hazard (PH) to model.

Results: In this study, out of 1831 patients, 1019 were males (55.7%) and 812 were females (44.3%) with an average age of 52.74 ± 22.16 years. For survival analysis, data from people infected with COVID-19 who died or were still being treated were used. According to Cox's regression analysis, age variables (hazard ratio [HR]: 1.03, CI: 1.02-1.04), patients with a history of diabetes (HR: 2.16, CI: 1.38-3.38), cancer (HR: 3.57, CI: 1.82-7.02), CLD (HR: 2.21, CI: 1.22-4) and CHD (HR: 2.20, CI: 1.57-3.09) were significant and affected the hazard of death in patients with COVID-19 and assuming that the other variables in the model are constant, the hazard of death increases by 3% by increasing one unit (year), and the hazard of death in COVID-19 patients with CHD, diabetes, cancer, CLD is 2.16, 3.57, 2.2 and 2.21, respectively.

Conclusion: According to findings, it is necessary to evaluate the prevalence of COVID-19 in patients with CLD, diabetes, cancer, CHD, and elder, as patients with these characteristics may face a greater risk of death. Therefore, we suggest that elders and people with those underlying illnesses need to be under active surveillance and screened frequently.
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http://dx.doi.org/10.34172/ijhpm.2020.155DOI Listing
August 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
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http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

The Urgency of Conducting Serological Studies for COVID-19.

J Res Health Sci 2020 May 30;20(2):e00479. Epub 2020 May 30.

Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: COVID-19 has been the most priority of the world since the early 2020s. We aimed to investigate the importance, urgency and value of serological tests for monitoring and evaluation of COVID-19.

Study Design: Rapid review.

Methods: This study was conducted through a review of seroepidemiological studies to evaluate their strength and weakness in monitoring and predicting the epidemic situation of COVID-19.

Results: Conducting serological studies is an important measure to determine the status of the COVID-19 in affected countries. These studies may also be used to estimate cumulative incidence of the disease, and to get an impression about the level of the epidemic.

Conclusion: If an accurate serological test is available it can be used for seroepidemiological studies and epidemic investigation in special context, but given the current situation, it may not be possible to be used for screening the normal population and in care and treatment. This research highlighted the importance and urgency of conducting serological studies for monitoring the COVID-19 situation and evaluation of the interventions.
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http://dx.doi.org/10.34172/jrhs.2020.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585750PMC
May 2020

Global prevalence of HCV and/or HBV coinfections among people who inject drugs and female sex workers who live with HIV/AIDS: a systematic review and meta-analysis.

Arch Virol 2020 Sep 2;165(9):1947-1958. Epub 2020 Jul 2.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Coinfections of hepatitis C virus (HCV) and/or hepatitis B virus (HBV) with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with high morbidity and mortality and poor prognosis. The main objective of this study was to evaluate the prevalence of HCV and/or HBV coinfections among people who inject drugs (PWID) and female sex workers (FSWs) who live with HIV/AIDS worldwide. Data sources were searched from January 2008 to October 2018 in different databases, including PubMed, Scopus, Web of Science, Embase, and Ovid. Data were analyzed in Stata 14 software using the Metaprop command. The results showed that the prevalence of HCV among PWID and FSWs with HIV/AIDS was 72% (95% CI: 59%-83%) and 40% (95% CI: 0%-94%), respectively. The prevalence of HBV among PWID and FSWs with HIV/AIDS was 8% (95% CI: 5%-13%) and 2% (95% CI: 0%-7%), respectively, and the prevalence of HCV/HBV in PWID with HIV/AIDS was 11% (95% CI: 7%-15%). The highest prevalence of HCV was observed in PWID in the Eastern Mediterranean and Europe regions, and the lowest was observed in the Africa region. The South-East Asia region had the highest prevalence of HBV among PWID, and the Africa region had the lowest prevalence. The high prevalence of HCV coinfection among PWID and FSWs with HIV/AIDS was an alarming health problem and requires appropriate interventions. Therefore, considering that these populations are key populations for HCV elimination, it is recommended to screen them regularly for HCV. In addition, harm reduction and HBV vaccination should be carefully considered.
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http://dx.doi.org/10.1007/s00705-020-04716-1DOI Listing
September 2020

Can judgments according to case fatality rate be correct all the time during epidemics? Estimated cases based on CFR in different scenarios and some lessons from early case fatality rate of coronavirus disease 2019 in Iran.

Med J Islam Repub Iran 2020 29;34:26. Epub 2020 Mar 29.

Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.

The new Coronavirus disease (COVID-19) was first identified in China in 2019. Case fatality rate (CFR) indicator of the disease is one of the most important indices noticed by experts, policymakers, and managers, based on which daily evaluations and many judgments are made. CFR can change during epidemics. This study aimed to estimate the actual number of COVID-19 cases in Iran and to calculate the early CFR for the disease based on official statistics. This was a descriptive study whose data were obtained from the website of the Ministry of Health and Medical Education of Iran from February 20, 2020 until March 26, 2020. CFR has been obtained by dividing the total number of deaths by the total number of confirmed cases at one point in time. In this study, the actual number of COVID-19 cases in Iran was estimated based on the mortality model in 4 scenarios. Excel 2013 software was used to analyze the data. According to the findings of this study, In Iran, until March 26, 2020, a total of 27 017 people have been infected by COVID-19 and 2077 died of it. However, CFR indicator had a descending trend in Iran: 100%, 18.6%, 8.8%, 3.3%, 6.9%, and 7.7% on days 1, 5, 10, 20, 30, and 35, respectively. The actual number of COVID-19 cases in Iran was estimated to be 4 789 454, 2 873 673, 1 436 836, and 718418 as of March 26, 2020 according to the 4 scenarios, respectively. In emerging epidemics, CFR indicator must not be used as a basis to judge the performance of a health system unless that epidemic condition has been clarified. Moreover, it is suggested that in the outbreak of an epidemic, specifically emerging diseases, CFR must not be the base of judgment. Making judgments, specifically in the outbreak of emerging epidemics, based on fatality rate can lead to information bias. It is also possible to estimate the total number of patients based on the CFR in circumstances where little information is available on the disease.
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http://dx.doi.org/10.34171/mjiri.34.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293816PMC
March 2020

Prevalence of Smoking among Iranian Adults: Findings of the National STEPs Survey 2016.

Arch Iran Med 2020 06 1;23(6):369-377. Epub 2020 Jun 1.

Non-Communicable Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Tobacco smoking is one of the most important avoidable causes of mortality from non-communicable diseases (NCDs). This study aimed to report the crude and standardized prevalence of current, ever, and secondhand smoking at national and provincial levels.

Methods: This study was performed through an analysis of the results of the STEPs survey 2016, which was conducted as a cross-sectional national study. The samples were selected via multistage cluster sampling and they were representative of general population aged ≥18 years in all provinces of Iran. All the data were analyzed via survey analysis while considering population weights. Age-standardized prevalence was also calculated for the Iranian national population in 2016 and the World Health Organization (WHO) Population 2000-2025.

Results: A total of 29963 subjects aged ≥18 years from all provinces of Iran, except for Qom, participated in this study. The age standardized prevalence of current tobacco smoking among adult males and females were 24.4% (95% CI: 23.6%-25.1%) and 3.8% (95% CI: 3.5%-4.1%), respectively. Among the participants, the majority of the current smokers were among those aged 45-54 years (14.5%; 95% CI: 13.6%-15.5%). With increase in age, the prevalence of secondhand smoking decreased to 34.8% (95% CI: 33.3%-36.7%) among people aged 18-24 years and to 22·6% (95% CI: 21.0%-24.3%) among subjects over 70 years.

Conclusion: The result of the study can be used to inform policy makers about the status of smoking and help them to design policies for setting rules on and limiting the import of cigarettes and their components to the country.
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http://dx.doi.org/10.34172/aim.2020.29DOI Listing
June 2020

Assessing horizontal equity in health care utilization in Iran: a decomposition analysis.

BMC Public Health 2020 Jun 12;20(1):914. Epub 2020 Jun 12.

Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Background: Despite the goal of horizontal equity in Iran, little is known about it. This study aimed i) to assess socioeconomic inequality and horizontal inequity in the healthcare utilization; and ii) to explore the contribution of need and non-need variables to the observed inequalities.

Methods: This study used national cross sectional dataset from Utilization of Health Services survey in 2015. Concentration Index (C), Concentration Curve (CC) and Horizontal Inequity index (HI) were calculated to measure inequality in inpatient and outpatient health care utilization. Decomposition analysis was used to determine the contribution of need and non-need factors to the observed inequalities.

Result: Results showed the pro-poor inpatient services in both rural (C = - 0.079) and non-rural areas (C = - 0.096) and the pro-rich outpatient services in both rural (C = 0.038) and non-rural (C = 0.007). After controlling for need factors, HI was positive and significant for outpatient services in rural (HI = 0.039) and non-rural (HI = 0.008), indicating that for given need, the better off especially in rural make greater use of outpatient services. The HI was pro-poor for inpatient services in both rural (HI = - 0.068) and non-rural (HI = -0.090), was significant only in non-rural area. Non-need factors were the most important contributors to explain inequalities in the decomposition analysis.

Conclusion: Disentangle the different contribution of determinants, as well as greater HI in rural areas for outpatient and in non-rural areas for inpatient services, provide helpful information for decision makers to re-design policy and re-distribute resource allocation in order to reduce the socioeconomic gradient in health care utilization.
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http://dx.doi.org/10.1186/s12889-020-09071-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291751PMC
June 2020

Is reporting many cases of COVID-19 in Iran due to strength or weakness of Iran's health system?

Iran J Microbiol 2020 Apr;12(2):73-76

Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244828PMC
April 2020

Systematic Review and Meta-Analysis of Global Prevalence of HBsAg and HIV and HCV Antibodies among People Who Inject Drugs and Female Sex Workers.

Pathogens 2020 May 31;9(6). Epub 2020 May 31.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran.

The main objective of this study was to evaluate the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C virus (HCV) and hepatitis B virus (HBV) and their co-infections among people who inject drugs (PWID) and female sex workers (FSWs). Data sources were searched from January 2008 to October 2018 in different databases. Data were analyzed in Stata 16 software using the Metaprop command. The results showed that the prevalence of HIV, HCV and HBV among PWID was 15%, 60% and 6%, respectively. The prevalence of HIV, HCV and HBV among FSWs was 5%, 1% and 3%, respectively. The prevalence of HIV/HCV, HIV/HBV, HCV/HBV and HIV/HCV/HBV co-infections among PWID was 13%, 2%, 3% and 2%, respectively. The prevalence of HIV/HCV and HIV/HBV co-infections among FSWs was 3% and 1%, respectively. The results show that the prevalence of HCV and HIV infections in PWID and the prevalence of HIV in FSWs is higher than their prevalence in the general population. Interventions for the prevention of HIV and HCV in PWID appear to be poor, and may not be sufficient to effectively prevent HIV and HCV transmission.
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http://dx.doi.org/10.3390/pathogens9060432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350380PMC
May 2020

Estimating utility value for female genital mutilation.

BMC Public Health 2020 May 29;20(1):811. Epub 2020 May 29.

Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Background: Female genital mutilation/cutting (FGM/C) is a clear violation of women's rights and can have adverse and irreversible health effects as well. Worldwide, more than 200 million women and girls have undergone FGM/C. Utility value of FGM/C has not been estimated yet, so we designed this study to extract the health utility value of FGM/C for the first time in the world.

Methods: In a cross-sectional study in Iran, 125 girls and women who underwent FGM/C procedure were examined by the trained midwives in order to determine its type. In addition, a questionnaire was completed for identifying the socio-demographic factors and extracting the health utility of these individuals. Health utility was measured using Time Trade-off method and also to determine the effects of the socio-demographic factors on the health utility a two-limit censored regression model was applied.

Results: The mean and median of the health utility of women with FGM/C were 0.971 (SE: 0.003) and 0.968 (IQR: 1-0.95), respectively. Number of non-traders was 58 (46.4%) who reported perfect health utility. However, the mean of health utility among traders was 0.946 (SE: 0.002). Only type 1 (Clitoridectomy) and type 2 (Excision) FGM/C were seen in this study. Women with Type 1 FGM/C had significantly lower health utility value (Mean: 0.968, Median: 0.957) than their type 2 counterparts (Mean: 0.987, Median: 1.00). Moreover, women in the age group of 31-45 years (Mean: 0.962, Median: 0.956), single (Mean: 0.950, Median: 0.954), divorced (Mean: 0.951, Median: 0.950), employed (Mean: 0.959, Median: 0.956), and with supplementary insurance (Mean: 0.962, Median: 0.950) had significantly lower health utility than their counterparts.

Conclusion: FGM/C affects physical and psychological well-being of these individuals, resulting in a lack of personal and marital satisfaction, which ultimately leads to a 3% reduction in their health related quality of life. Therefore, preventing from this practice is very important and should be considered by health system policy makers more than before.
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http://dx.doi.org/10.1186/s12889-020-08947-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260824PMC
May 2020

Do the current cases reported to the WHO provide a realistic incidence rate of countries infected with COVID-19?

Infect Ecol Epidemiol 2020 10;10(1):1751917. Epub 2020 Apr 10.

Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

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http://dx.doi.org/10.1080/20008686.2020.1751917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178870PMC
April 2020
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