Publications by authors named "Hossein Safari"

43 Publications

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

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

Estimating Utility Values for Health States of DFU Patients Using EQ-5D-5L and cTTO.

Int J Low Extrem Wounds 2021 May 3:15347346211014392. Epub 2021 May 3.

48516Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Health-state utility values of diabetic foot ulcer (DFU) patients are necessary for clinical praxis and economic modeling. The purpose of this study was to estimate utility values in DFU patients using the EuroQol-5-dimension-5-level (EQ-5D-5L) and composite time trade-off (cTTO). The EQ-5D-5L and cTTO were used for estimating utility values. Data were collected from 228 patients referred to the largest governmental diabetes center in the South of Iran, Yazd province. When appropriate, independent sample -test or analysis of variance test was used to test the difference in the utility values in each of the demographic and clinical characteristics of the patients. Finally, the BetaMix was used to identify predictors of the utility values. The means of EQ-5D-5L and cTTO values were 0.55( 0.21) and 0.67( 0.23), respectively. Anxiety and pain were the most common problems reported by the patients. The difference between the mean EQ-5D-5L values was significant for age, grade of ulcer, number of comorbidities, and having complications. In addition, variables of gender, age, grade of ulcer, and having complications were significant predictors of the EQ-5D-5L. The difference between the mean cTTO values was significant for age, employment status, grade of ulcer, number of comorbidities, and having complications. Moreover, variables of gender, age, grade of ulcer, number of comorbidities, and developing complications were significant predictors of cTTO. The current study provided estimates of utility values for DFU patients for clinical praxis and economic modeling. These estimates, similar to utilities reported in other studies, were low. Identifying strategies to decrease anxiety/depression and pain in patients is important to improve the utility values.
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http://dx.doi.org/10.1177/15347346211014392DOI Listing
May 2021

Correction to: Psychometric properties of the SF-6Dv2 in an Iranian breast cancer population.

Breast Cancer 2021 Jul;28(4):944

Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

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http://dx.doi.org/10.1007/s12282-021-01243-yDOI Listing
July 2021

Psychometric properties of the SF-6Dv2 in an Iranian breast cancer population.

Breast Cancer 2021 Jul 5;28(4):937-943. Epub 2021 Mar 5.

Health Policy and Management Research Center, Department of Health Services Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Introduction: The Short-Form Six-Dimension version 2 (SF-6Dv2) is the newest preference-based instrument for estimation of quality adjusted life-years (QALYs). The aim of this study is to evaluate the validity and reliability of the SF-6Dv2 in an Iranian breast cancer population.

Methods: The SF-6Dv2 and FACT-B instruments were completed for 416 patients who were recruited from the largest academic center for cancer patients in Iran. The ceiling effects are computed as the proportion of participants reporting no problems in SF-6Dv2 index. Construct validity was evaluated using convergent validity, discriminant validity, and known-groups validity. Reliability was assessed using intra-class correlation coefficient (ICC) and Cohen's kappa value.

Results: The ceiling effects of the SF-6Dv2 was 2.16%. Higher scores of all subscales of the FACT-B were associated with patients who reported no problems in each of the SF-6Dv2 dimensions. The correlation between SF-6Dv2 dimensions and FACT-B subscales varied from 0.109 between the role limitation of the SF-6Dv2 and the SWB subscale of the FACT-B to 0.665 between the pain dimension of SF-6Dv2 and the PWB of FACT-B. The lower mean score of SF-6Dv2 was associated with patients with older age, higher education level, more severe current treatment status, and more severe cancer stage status. ICC for the SF-6Dv2 index scores was 0.66, and Kappa values varied from 0.33 for mobility to 0.66 for mental health dimensions.

Conclusions: The validity and reliability of the SF-6Dv2 were satisfaction in a breast cancer population and it can be employed in clinical practice or research.
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http://dx.doi.org/10.1007/s12282-021-01230-3DOI Listing
July 2021

Interim value set for the EQ-5D-5L in Iran using the Crosswalk method.

Med J Islam Repub Iran 2020 15;34:121. Epub 2020 Sep 15.

Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.

The EuroQol five-dimensional 5 level (EQ-5D-5L) value set is not currently available for the Iranian general public, while the value set for EuroQol five-dimensional 3 level (EQ-5D-3L) is available. The present study aimed to generate an interim EQ-5D-5L value set for the context of Iran. The Iranian interim EQ-5D-5L value set was generated using the crosswalk method, which maps EQ-5D-3L and EQ-5D-5L responses. The EQ-5D-3L value set has previously been estimated by Time Trade-Off (TTO) method. The interim value set obtained for EQ-5D-5L was compared with the value set of EQ-5D-3L by using measures of mean, median, and skewness.The analysis was done using STATA version 15. The mean and median scores of the Iranian interim value set were 0.499 and 0.451 for EQ-5D-5L and 0.455 and 0.459 for Iranian EQ-5D-3L, respectively. The range of value for both EQ-5D-3L and interim EQ-5D-5L was -0.113 to 0.919. Data skewness of EQ-5D-3L and interim EQ-5D-5L was-0.099 and -0.114, respectively. In addition, the figure of distribution of value sets for both data sets had a tail extended towards the left. The states of "good health"(i.e., states with value>0.8) for the EQ-5D-3L value set were proportionally more than the Iranian interim EQ-5D-5Lcrosswalk value set (2.47% vs. 0.448%). An EQ-5D-5L value set was generated using the crosswalk method for the Iranian general public, and now researchers and policy-makers can apply it to their economic and clinical analyses.
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http://dx.doi.org/10.34171/mjiri.34.121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787042PMC
September 2020

Health-Related Quality of Life and its Associated Factors in COVID-19 Patients.

Osong Public Health Res Perspect 2020 Oct;11(5):296-302

Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Objectives: Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients.

Methods: A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores.

Results: The mean score for the patients who completed the EQ-5D-5L questionnaire ( = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values.

Conclusion: The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.
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http://dx.doi.org/10.24171/j.phrp.2020.11.5.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577388PMC
October 2020

Exploring the consistency of the SF-6Dv2 in a breast cancer population.

Expert Rev Pharmacoecon Outcomes Res 2020 Dec 1:1-8. Epub 2020 Dec 1.

Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada.

: Short-Form Six-Dimension version 2 (SF-6Dv2) is a multi-attribute utility instrument that can be used in combination with the SF-36v2 (SF-6Dv2) or as an independent instrument in two forms: six questions (SF-6Dv2) and 10 questions (SF-6Dv2). The purpose of this research was to assess the consistency between the results of the SF-6Dv2 and the SF-6Dv2 in patients with breast cancer.: This cross-sectional study was carried out on 418 patients with breast cancer. The degree of agreement between the descriptive systems of instruments was calculated using Spearman's correlation coefficient, global consistency index (GCI), and identically classified index (ICI).: The average size of the Spearman's correlation coefficients between the descriptive systems of instruments was higher than 0.5. The results of the GCI revealed that the level of agreement between dimensions of the two instruments had a mean of 64.9 (range 32.45-86.8). The SF-6Dv2 generates statistically higher values than does the SF-6Dv2, and mean difference between the two instruments was 0.087 for model 3 and 0.027 for model 10.: This study provided evidence that the SF-6Dv2 and the SF-6Dv2 may produce different answers from patients with breast cancer and lead to a small difference in utility values.
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http://dx.doi.org/10.1080/14737167.2021.1842734DOI Listing
December 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 burden of preventable hospitalizations before and after implementation of the health transformation plan in a hospital in west of Iran.

Prim Health Care Res Dev 2019 07 1;20:e87. Epub 2019 Jul 1.

Assistant Professor in Health Policy, Maragheh University of Medical Sciences, Maragheh, Iran.

Background: Increased number of preventable hospitalizations (PHs) for ambulatory care sensitive conditions (ACSCs) represents less efficiency and low access to outpatient and primary health care, leading to waste of health system resources.

Aim: The purpose of this study is to assess the quality of outpatient and primary health care using the rate of PHs for ACSCs and to estimate the economic burden of ASCS before and after the implementation of the health transformation plan (HTP) in Iran.

Methods: This research was a before-after quasi-experimental study. The study population included all patients hospitalized in the largest general hospital of Kurdistan province with five diseases such as asthma, diabetes, hypertension, congestive heart failure, and chronic obstructive pulmonary disease in 2014 (before the implementation of the HTP) and 2015 (after the implementation of the HTP). Data were analyzed by SPSS v.20 using Chi-square test.

Findings: Total number of hospitalizations before and after the implementation of the HTP was 1501 and 1405, respectively. Moreover, the proportion of PHs in all types of the hospital admissions before and after the implementation of the HTP was 47% and 49%, respectively. There was no statistically significant difference between the number of PHs before and after the HTP. In total, PHs imposed 885 798 US$ and 9920 bed-days on health system before and after the implementation of the HTP.

Conclusion: Despite the previous expectations of policy makers for improving quality, efficiency, and access to primary health care through implementation of the HTP, proportion of PHs is considerable and it imposes a lot of costs and bed-days on the health system both before and after the HTP.
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http://dx.doi.org/10.1017/S1463423618000841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609975PMC
July 2019

Mapping the cancer-specific FACT-B onto the generic SF-6Dv2.

Breast Cancer 2021 Jan 25;28(1):130-136. Epub 2020 Jul 25.

Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Introduction: The health-related quality of life (HRQoL) data extracted from cancer-specific questionnaires are often non-preference based, while patient preference-based utility data are required for health economic evaluation. This study aimed to map Functional Assessment of Cancer Therapy-Breast (FACT-B) subscales onto the Short Form six Dimension as an independent instrument (SF-6Dv2) using the data gathered from patients with breast cancer.

Methods: Data for 420 inpatient and outpatient patients with breast cancer were gathered from the largest academic center for cancer patients in Iran. The OLS and Tobit models were used to predict the values of the SF-6Dv2 with regard to the FACT-B subscales. Prediction accuracy of the models was determined by calculating the root mean square error (RMSE) and mean absolute error (MAE). The relationship between the fitted and observed SF-6Dv2 values was examined using the Intraclass Correlation Coefficients (ICC). Goodness of fit of models was assessed using the predicted R (Pred R) and adjusted R (Adj R). A tenfold cross-validation method was used for validation of models.

Results: Data of 416 patients with breast cancer were entered into final analysis. The model included main effects of FACT-B subscales, and statistically significant clinical and demographic variables were the best predictor for SF-6Dv2 (Model S3 of OLS with Adj R = 61.02%, Pred R = 59.25%, MAE = 0.0465, RMSE = 0.0621, ICC = 0.678, AIC = -831.324, BIC = -815.871).

Conclusion: The best algorithm developed for SF-6Dv2 enables researchers to convert cancer-specific instruments scores into preference-based scores when the data are gathered using cancer-specific instruments.
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http://dx.doi.org/10.1007/s12282-020-01141-9DOI Listing
January 2021

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

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

Experiences of rural women with damages resulting from an earthquake in Iran: a qualitative study.

BMC Public Health 2020 May 6;20(1):625. Epub 2020 May 6.

Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Background: Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. Therefore, the present study aimed to investigate the experiences of rural women with damages resulting from an earthquake in Iran.

Methods: In this research, a qualitative approach, as well as the conventional content analysis was employed. The study population consisted of rural women residing in the earthquake-stricken areas of Sarpol-e Zahab and Salas-e Babajani counties in Kermanshah Province, Iran. Semi-structured interviews were used for data collection. Moreover, sampling was purposeful, theoretical saturation was achieved by conducting 22 interviews, and the data analysis process was performed according to the steps proposed by Graneheim and Lundman. For the strength and transferability of the research, Lincoln and Guba's Evaluative Criteria were used.

Results: There were seven categories regarding the experiences of rural women after the earthquakes including neglecting the health needs; tension in the family and marital relations; gender inequality in the provision of assistance; feeling insecure; ignoring the ruling culture of the region; concealing needs for fear of stigmatization, and incoherent mourning as well as two categories regarding their reactions to and interaction with the earthquake consequences including positive and negative interactions.

Conclusions: Paying more attention to the needs of rural women, taking the culture governing the village into account at the time of service delivery, and helping them with positive adaptations are some indispensable measures that should be taken.
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http://dx.doi.org/10.1186/s12889-020-08752-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201637PMC
May 2020

Ultraviolet solar flare signatures in the framework of complex network.

Chaos 2020 Apr;30(4):043124

Department of Physics, University of Zanjan, P.O. Box 45371-38791, Zanjan, Iran.

Studying natural phenomena via the complex network approach makes it possible to quantify the time-evolving structures with too many elements and achieve a deeper understanding of interactions among the components of a system. In this sense, solar flare as a complex system with the chaotic behavior could be better characterized by the network parameters. Here, we employed an unsupervised network-based method to recognize the position and occurrence time of the solar flares by using the ultraviolet emission (1600 Å) recorded by the Atmospheric Imaging Assembly on board Solar Dynamics Observatory. Three different regions, the flaring active regions, the non-flaring active regions, and the quiet-Sun regions, were considered to study the variations of the network parameters in the presence and absence of flaring phases in various datasets over time intervals of several hours. The whole parts of the selected datasets were partitioned into sub-windows to construct networks based on computing the Pearson correlation between time series of the region of interest and intensities. Analyzing the network parameters such as the clustering coefficient, degree centrality, characteristic length, and PageRank verified that flare triggering has an influence on the network parameters around the flare occurrence time and close to the location of flaring. It was found that the values of the clustering coefficient and characteristic length approach those obtained for the corresponding random network in the flaring phase. These findings could be used for detecting the occurrence times and locations of the region at ultraviolet images.
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http://dx.doi.org/10.1063/1.5129433DOI Listing
April 2020

Prevalence and determinants of inappropriate admission and hospitalization in Iran: A systematic review and meta-analysis.

Med J Islam Repub Iran 2020 6;34. Epub 2020 Feb 6.

Health Promotion Research Center, Iran University of medical sciences, Tehran, Iran.

A huge portion of health expenditure is attributed to hospital services. Thus, it is important to use the resources appropriately. Many studies have measured inappropriate admissions and hospitalizations. The aim of this study was to review them systematically and determine the pooled quantity as well as the reasons behind such admissions and hospitalizations. PubMed, Scopus, Web of Science, Google scholar, and internal databases such as Sid, Magiran, and Barkat were searched in January 2018. Moreover, the grey literature was also performed. All studies which had assessed the appropriateness and inappropriateness of services were included. Newcastle-Ottawa scale was used for quality appraisal. I2 test, subgroup analysis, metaregression, and sensitivity analysis were performed. STATA was used for analysis. There was neither time limitation nor language limitation. The registration number in PROSPERO is CRD42019123401. Of 1576 studies, 15 met the inclusion criteria. The number of medical files ranged from 198 to 1815. Most of the studies (14) were performed in teaching hospitals. AEP was the most frequent tool for assessing inappropriateness of the services. The pooled inappropriate admission and hospitalization were 11% (95% CI= 8% - 14%)) and 13 % (95% CI= 10%-16%)), respectively. The most important determinants for inappropriate hospitalizations were attributed to physicians. A huge portion of health care services is inappropriate. Thus, it is highly recommended to monitor physicians more than before, as the more they are monitored, the less inappropriate the delivered services will be.
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http://dx.doi.org/10.34171/mjiri.34.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139265PMC
February 2020

Effect of female genital mutilation on mental health: a case-control study.

Eur J Contracept Reprod Health Care 2020 Feb 10;25(1):33-36. Epub 2020 Jan 10.

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

The study aimed to investigate the mental health status of women with female genital mutilation/cutting (FGM/C) and compare it with that of a similar group of women without FGM/C. A case-control study was carried out in 2018 among 122 women with FGM/C and 125 women without FGM/C who had been referred to one of the general health service centres in Kermanshah Province, western Iran. The 28 item General Health Questionnaire (GHQ-28) was used to collect data on participants' mental health. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with the outcome variable, mental health status. The mean age of the FGM/C and control groups was 35.7 (standard deviation [SD] 8.6) and 31.3 (SD 7.2) years, respectively. According to the GHQ-28 questionnaire, 65.6% ( = 80) of the FGM/C group and 52% ( = 65) of the control group had symptoms of a mental health disorder; the difference between the groups was statistically significant ( = .03). The prevalence of severe depression in the FGM/C group was significantly higher than in the control group ( = .021). Multivariate logistic regression showed that having a history of FGM/C (adjusted OR 1.79; 95% confidence interval [CI] 1.05, 3.05) and being in employment (adjusted OR 3.46; 95% CI 1.23, 9.74) had a significant effect on presentation with symptoms of a mental health disorder ( < .05). Women who suffer from FGM/C are more vulnerable to mental health disorders such as depression.
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http://dx.doi.org/10.1080/13625187.2019.1709815DOI Listing
February 2020

The Possible Role of Pathogenic and Non-Pathogenic Bacteria in Initiation and Exacerbation of Celiac Disease; A Comprehensive Review.

Curr Pharm Biotechnol 2020 ;21(6):452-466

Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Celiac Disease (CD) is an immune-mediated enteropathy, generally of the proximal intestine, that occurs in genetically susceptible individuals triggered by the ingestion of gluten. The incidence and frequency of CD are increasing, and it is predicted that CD affects approximately 1% of the people worldwide. The common clinical manifestations of CD are divided in two sections, including classic and non-classic symptoms that can be created in childhood and adulthood. The relationship between pathogenic and non-pathogenic bacteria with CD is complex and multidirectional. In previous published studies, results demonstrated the triggering impact of bacteria, viruses, and parasites on initiation and development of Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS). Different studies revealed the inducing effect of pathogenic and non-pathogenic bacteria on CD. However, increasing evidence proposes that some of these microorganisms can also play several positive roles in CD process. Although information of the pathogenesis of the CD is quickly expanding, the possible role of bacteria needs further examination. In conclusion, with respect to the possible correlation between different bacteria in CD, the current review-based study aims to discuss the possible relationship between CD and pathogenic and non-pathogenic bacteria and to show various and significant aspects of mechanisms involved in the CD process.
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http://dx.doi.org/10.2174/1389201021666191219160729DOI Listing
July 2020

Cost-effectiveness analysis of PCSK9 inhibitors in cardiovascular diseases: a systematic review.

Heart Fail Rev 2020 11;25(6):1077-1088

School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Aims: To assess the cost-effectiveness of pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in cardiovascular disease.

Methods And Results: We performed a comprehensive search strategy in electronic databases from January 2015 to January 2019. Out of 475 articles, 16 were entered into the study. Quality-adjusted life year, life years gained (LYG), annual cost, and the incremental cost-effectiveness ratio (ICER) regarding the use of PCSK9 inhibitors were considered as the key outcomes. The cost-effectiveness threshold varied from $45,000 in Spain to $150,000 in the USA. The annual cost of PCSK9 inhibitors for studies undertaken in the USA was in the range of $14,000 to $15,000, while it was about $7000 for other developed countries. The results showed that reduction in the price of PCSK9 inhibitors changed from 20 to 88%. The means of QALY were 0.65 and 0.67 in the Markov and Cardiovascular Disease Policy Modeling (CVDPM) models; also, the ICER means were $197,707 and $625,555 for the Markov and CVDPM model, respectively.

Conclusion: According to the current study, the effectiveness of PCSK9 inhibitors is well documented, although all studies pointed out a higher cost of these inhibitors.

Trial Registration: This study was registered within the International Prospective Register of Systematic Reviews (PROSPERO) database of the University of York (CRD42018088472).
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http://dx.doi.org/10.1007/s10741-019-09874-2DOI Listing
November 2020

Policy Analysis Of Iranian Pharmaceutical Sector; A Qualitative Study.

Risk Manag Healthc Policy 2019 7;12:199-208. Epub 2019 Nov 7.

School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Improving public health through providing affordable and accessible pharmaceuticals is among the concerns of governments worldwide. This study aimed to analyze Iran's pharmaceutical sector policies in order to identify the challenges and suggest some strategic solutions to overcome such challenges.

Methods: Top managers (15), middle managers (10), and operational managers (5) working in the Food and Drug Administration of Iranian Ministry of Health along with community pharmacists (5) participated in a qualitative study using semi-structured in-depth interviews. Data were recorded, transcribed, and then analyzed via MAXQDA 10 software.

Results: Policies for national pharmaceutical sector were divided into four groups of "research & development", "import & export", "pharmaceutical procurement", and "pharmaceutical supply and distribution". Then, the challenges faced by each sector were extracted. Considering the challenges, some policy options were recommended for growth and development of national pharmaceutical sector.

Conclusion: Iran's pharmaceutical sector has managerial and administrative differences compared with overseas pharmaceutical sectors. These differences are the main reasons for the current status of Iran's pharmaceutical sector and have put Iran behind foreign pharmaceutical sectors. Iran's pharmaceutical sector has endured many critical periods during recent decades and has gained great experience during these stages. Therefore, it is believed that Iran's pharmaceutical sector, with its experience and potential, is capable of producing world-level medicines.
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http://dx.doi.org/10.2147/RMHP.S209318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6847995PMC
November 2019

Global prevalence of colistin resistance in clinical isolates of Acinetobacter baumannii: A systematic review and meta-analysis.

Microb Pathog 2020 Feb 22;139:103887. Epub 2019 Nov 22.

Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Introduction: Acinetobacter baumannii antimicrobial resistance is a public health concern in developing and developed countries, especially in the hospital setting. Understanding the antibiotic resistance profile can help to provide better guidelines for the prescription of appropriate antibiotics, reduction of antibiotic resistance, and introducing new and effective treatment options.

Method: Using the PRISMA guidelines, databases of PubMed, Embase, and Cochrane Library were searched systematically from January 1, 2000, to January 1, 2018. All statistical analyses were carried out via Comprehensive Meta-Analysis Software Version 2.0 (Biostat, Englewood, NJ). Depending on the heterogeneity test, either random or fix effect models were used for determining the pooled prevalence of drug resistance.

Result: A total of 150 studies were included from 41 countries of six different WHO regional offices worldwide. The highest and the lowest rate of resistance were observed for cefotaxime (99%, 95% CI: 95-99.9) in Africa and colistin (1.1%, 95% CI: 0.3-4.5) in Western Pacific, respectively. Lebanon (17.5%, 95% CI: 16-19) and China (12%, 95% CI: 3.5-32.5) had the highest and Germany (0.2%, 95% CI: 0-2.5) had the lowest rate of resistance for colistin.

Conclusion: Our analysis showed that prevalence and rate of increased colistin resistance in South-East Asia and Eastern Mediterranean countries are higher than other regions of the world. Therefore, the establishment of appropriate antibiotic usage guidelines should be essential in these countries.
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http://dx.doi.org/10.1016/j.micpath.2019.103887DOI Listing
February 2020

Are intestinal helminths playing a positive role in tuberculosis risk? A systematic review and meta-analysis.

PLoS One 2019 15;14(10):e0223722. Epub 2019 Oct 15.

Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Co-infection of intestinal helminthic infections (IHIs) and tuberculosis (TB) has appeared as a public health issue, especially in developing countries. Some recent studies have been carried out on the possible relevance of IHIs to TB. The current systematic review and meta-analysis was conducted to assess the prevalence and odds ratio (OR) of IHIs among TB patients and clarify the relationship between IHIs and TB disease.

Methods: For the purpose of the study, five English databases including PubMed, Science Direct, Scopus, Web of Science (ISI), and Google scholar were searched (up to January 30, 2019) in order to find the related studies. Random-effects meta-analysis model was used to estimate the pooled prevalence, odds ratio (OR), and 95% confidence interval (CI). Inclusion and exclusion criteria were applied.

Results: A total of 20 studies including 10 studies with case-control design (2217 patients and 2520 controls) and 10 studies with cross-sectional design (a total of 2415 participants) met the eligibility criteria. As shown by the random-effects model, the pooled prevalence of IHIs in TB patients was estimated to be 26% (95% CI, 17-35%; 1249/4632). The risk of IHI was higher in TB patients compared to controls but this was not statistically significant. However, according to genus/species, the pooled OR of Strongyloides stercoralis (S. stercoralis) (OR, 2.68; 95% CI, 1.59-4.54) had a significantly higher risk in TB patients compared to controls. Nevertheless, the results of random effects model showed no statistically significant association between overall pooled OR of IHIs in TB patients compared to controls in case-control studies (OR, 1; 95% CI, 0-1).

Conclusions: It is highly recommended that more precise studies should be carried out by researchers in order to better understand this association. Also, it is of great importance to include the periodic screenings for IHIs in the routine clinical care of these patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0223722PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6793940PMC
March 2020

Evaluation of Ameliorative Potential of Vitamins E and C on DNA Double Strand Break (DSB) in Patients Undergoing Computed Tomography (CT): A Clinical Study.

Int J Mol Cell Med 2018 4;7(4):226-233. Epub 2019 Mar 4.

Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.

Computed tomography (CT) is one of the most important diagnostic X-ray procedures which plays an important role in increasing the patient dose values. The purpose of this clinical study was to evaluate the efficacy of vitamins E and C in lowering down the level of DNA double strand break (DSB) caused by CT scan. Sixty patients for abdomen/pelvic enhanced CT scan were randomly assigned to placebo (control), vitamin C, and vitamin E groups. The patient blood samples were taken before and immediately after the CT scan. Counting the number of DSB was performed using γ-H2AX method as a sensitive biomarker. Immediately after the CT scan, the mean number of DSBs/cell increased in all three groups of control (131%, P<0.001), vitamin C (103%, P <0.001), and vitamin E (66%, P<0.001) compared to their mean before the CT scan. Furthermore, the results showed that vitamin E decreased the mean number of DSBs/cell by 22% in comparison with the control group (P =0.023), whereas vitamin C had no significant effect on reducing the DSB (<3%, P =0.741). It is concluded that the administration of vitamin E one hour before the CT scan, significantly decreases DSB levels.
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http://dx.doi.org/10.22088/IJMCM.BUMS.7.4.226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709935PMC
March 2019

Are Viruses and Parasites Linked to Celiac Disease? A Question that Still has no Definite Answer.

Curr Pharm Biotechnol 2019 ;20(14):1181-1193

Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Celiac Disease (CD) is a complex autoimmune enteropathy of the small intestine that commonly occurs in genetically predisposed individuals due to intake of gluten and related proteins. Gluten consumption, duration of breast-feeding, various infections, especially frequent intestinal infections, vaccinations and use of antibiotics can be linked to CD. It is predicted that it affects 1% of the global population and its incidence rate is increasing. Most of the people with the HLA-DQ2 or HLADQ8 are at a higher risk of developing this disease. The link between infections and autoimmune diseases has been very much considered in recent years. In several studies, we explained that pathogenic and non-pathogenic microorganisms might have multiple roles in initiation, exacerbation, and development of Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). In various studies, the relationship between infections caused by viruses, such as Epstein-Barr Virus (EBV), Rotavirus, Hepatitis C (HCV), Hepatitis B virus (HBV), Cytomegalovirus (CMV), and Influenza virus, and parasites including Giardia spp. and Toxoplasma gondii with CD has been raised. However, increasing evidence proposes that some of these microorganisms, especially helminths, can also have protective and even therapeutic roles in the CD process. Therefore, in order to determine the role of microorganisms in the process of this disease, we attempted to summarize the evidence suggesting the role of viral and parasitic agents in pathogenesis of CD.
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http://dx.doi.org/10.2174/1389201020666190828124924DOI Listing
February 2020

Global estimate of Neisseria meningitidis serogroups proportion in invasive meningococcal disease: A systematic review and meta-analysis.

Microb Pathog 2019 Sep 1;134:103571. Epub 2019 Jun 1.

Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran. Electronic address:

Using the PRISMA guideline, 102 studies were included in this study. The highest and the lowest proportion of N. meningitidis serogroups in invasive meningococcal disease (IMD) was for NmB with 48.5% (95% CI: 45-52) and NmX with 0.7% (95% CI: 0.3-1.7). Among the WHO regional offices, serogroup NmW with 57.5% (95% CI: 35-77.5) in Eastern Mediterranean, and NmZ with 0.1% (95% CI: 0-0.9) in America had the highest and the lowest proportion of N. meningitidis serogroups in IMD. NmC with 9.7% (95% CI: 5.6-16.2) and NmB with 9.5% (95% CI: 0.2-3.8) had the highest proportion in 1-4 and <1 year age groups, respectively. Our analysis showed that NmB had the highest proportion of N. meningitidis serogroups in IMD worldwide. However, proportion of N. meningitidis serogroups in IMD varied noticeably across countries and age groups. Therefore, establishing appropriate control guidelines depending on the geographical regions and age groups is essential for prevention of IMD.
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http://dx.doi.org/10.1016/j.micpath.2019.103571DOI Listing
September 2019

Oxidative stress and Parkinson's disease: conflict of oxidant-antioxidant systems.

Neurosci Lett 2019 09 30;709:134296. Epub 2019 May 30.

Department of Clinical Biochemistry and Laboratory Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address:

Parkinson's disease (PD) is defined as a chronic neurodegenerative disorder which is diagnosed mostly by its clinical manifestations. Reactive oxygen species (ROS) are considered as key modulators in the development of PD. Despite the intensive investigations, antioxidant-dependent molecular mechanisms of initiation and development of PD are controversial. Free radicals cause serious damage and death of dopamine producing cells when antioxidant capacity of the cells is reduced against oxidative stress (OxS). Many intracellular reactions create ROS, including activation of NADPH oxidase (NOX), mitochondrial dysfunction, and hydrogen peroxide (H₂O₂) decomposition. On the contrary, natural antioxidants, vitamins, proteins, and antioxidant signaling pathways are major factors to neutralize ROS and its destructive effects. The functional role of nuclear factor E2-related factor 2, Heme oxygenase-1, and selenium against ROS-dependent initiation and progression of PD is elucidated. In this review, we collected multiple factors that play the main role in the initiation, development, and pathogenesis of PD and we discussed their function in the PD.
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http://dx.doi.org/10.1016/j.neulet.2019.134296DOI Listing
September 2019

Staphylococcus aureus versus neutrophil: Scrutiny of ancient combat.

Microb Pathog 2019 Jun 16;131:259-269. Epub 2019 Apr 16.

Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Staphylococcus aureus (S.aureus) is a Gram-positive bacterium that causes many infections and diseases. This pathogen can cause many types of infections such as impetigo, toxic shock syndrome toxin (TSST1), pneumonia, endocarditis, and autoimmune diseases like lupus erythematosus and can infect other healthy individuals. In the pathogenic process, colonization is a main risk factor for invasive diseases. Various factors including the cell wall-associated factors and receptors of the epithelial cells facilitate adhesion and colonization of this pathogen. S. aureus has many enzymes, toxins, and strategies to evade from the immune system either by an enzyme that lyses cellular component or by hiding from the immune system via surface antigens like protein A and second immunoglobulin-binding protein (Sbi). The strategies of this bacterium can be divided into five groups: A: Inhibit neutrophil recruitment B: Inhibit phagocytosis C: Inhibit killing by ROS, D: Neutrophil killing, and E: Resistance to antimicrobial peptide. On the other hand, innate immune system via neutrophils, the most important polymorphonuclear leukocytes, fights against bacterial cells by neutrophil extracellular trap (NET). In this review, we try to explain the role of each factor in immune evasion.
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http://dx.doi.org/10.1016/j.micpath.2019.04.026DOI Listing
June 2019

The effect of Iran's health transformation plan on utilization of specialized outpatient visit services: An interrupted time series.

Med J Islam Repub Iran 2018 5;32:121. Epub 2018 Dec 5.

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

Health Transformation Plan (HTP) has been one of the biggest reforms in Iran's health system over the past 3 decades. The plan has been implemented since May 2014 and includes several packages that can affect the utilization of health care services. We aimed to assess the effect of implementation of HTP on utilization of specialist outpatient visit rate in clinics affiliated to university hospitals. We chose Kurdistan province to collect monthly specialist outpatient visit data for 50 months because this province was not a patient referral hub. An interrupted time series (ITS) analysis and segmented regression analysis were used to evaluate the effects of HTP on specialist outpatient visit rates. Statistical analyses were conducted using STATA version 13. A significant increase was observed in the specialist outpatient visit rate (12.1 outpatient visit per 1000 population) in the first month after the implementation of HTP (p= 0.000, 95% CI= 6.36-17.83). Also, after the implementation of HTP, a significant increase was observed in the monthly trend of specialist outpatient visit rate equivalent to about 0.53 every month per 1000 population compared to the monthly trend in specialist outpatient visit rate before the intervention (p= 0.033, 95% CI= 0.04-1.01). HTP has significantly increased the specialist outpatient visit rate in clinics affiliated to university hospitals in Kurdistan province. Thus, it is necessary to perform some comprehensive studies on all public, private, and semi-private sectors in different parts of the country to provide a better and more comprehensive picture of the effects of HTP on utilization of specialist outpatient visit services.
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http://dx.doi.org/10.14196/mjiri.32.121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387799PMC
December 2018

Advanced strategies for combating bacterial biofilms.

J Cell Physiol 2019 Jan 29. Epub 2019 Jan 29.

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

Biofilms are communities of microorganisms that are formed on and attached to living or nonliving surfaces and are surrounded by an extracellular polymeric material. Biofilm formation enjoys several advantages over the pathogens in the colonization process of medical devices and patients' organs. Unlike planktonic cells, biofilms have high intrinsic resistance to antibiotics and sanitizers, and overcoming them is a significant problematic challenge in the medical and food industries. There are no approved treatments to specifically target biofilms. Thus, it is required to study and present innovative and effective methods to combat a bacterial biofilm. In this review, several strategies have been discussed for combating bacterial biofilms to improve healthcare, food safety, and industrial process.
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http://dx.doi.org/10.1002/jcp.28225DOI Listing
January 2019
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