Publications by authors named "Maryam Nasirian"

23 Publications

  • Page 1 of 1

Fear and rumor associated with COVID-19 among Iranian adults, 2020.

J Educ Health Promot 2020 29;9:355. Epub 2020 Dec 29.

Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Context: At time of epidemics, fear and rumors in the community are the main obstacles to the success of prevention programs.

Aims: The aim of the study was to investigate the fear and rumors of coronavirus disease 2019 (COVID-19) among the Iranian population.

Settings And Design: This nationwide cross-sectional study was conducted on residents of six cities of Iran via street-based multistage sampling in March 2020.

Subjects And Methods: The eligible participants completed a self-administered questionnaire about rumor and fear related to COVID-19 epidemy.

Statistical Analysis Used: Data were analyzed through linear regression and survey analysis using Stata (version 11).

Results: A total of 2249 (49.3% women) were included. The main source of information was Iranian broadcasting (68.5%). The overall mean (standard deviation) score of fear and rumor among the Iranian population was 15.68 (0.46) and 39.24 (1.27), respectively. Educational level was associated with fear of COVID-19 ( = 0.001). Trusting to the rumors was affected by age (<0.0001), education level ( < 0.0001), underlying disease ( = 0.017), and workplace situation ( < 0.001).

Conclusions: The fear and rumor surrounding the epidemic of COVID-19 were common in society that could make an epidemic of COVID-19 difficult to control. Increasing public awareness via reliable mass media is recommended.
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http://dx.doi.org/10.4103/jehp.jehp_589_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871920PMC
December 2020

The association between serum omentin level and bodyweight: A systematic review and meta-analysis of observational studies.

Clin Nutr ESPEN 2020 10 12;39:22-29. Epub 2020 Jul 12.

Department of Epidemiology and Biostatistics, Health School, and Infectious Disease and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

Background And Aims: A number of studies have examined the association between omentin and body weight, but the findings have been inconclusive. Here in, we systematically reviewed available observational studies to elucidate the overall relationship between omentin and body weight, by comparison of serum omentin level in overweight/obese and normal weight subjects.

Methods: PubMed, Science direct, Scopus and ISI web of science databases were searched for all available literature until January 2020 for studies assessing the association between omentin and body weight. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of each study.

Results: A total of 27 articles met the inclusion criteria and were included in our systematic review and meta-analysis. There was a significant association between omentin serum level and body weight (Standard Mean Difference (SMD) -0.43; 95% CI, -0.70 to -0.15; P = 0.002; I = 93.2%). In order to find the probable source of heterogeneity subgroup analysis based on the participants' age (adolescent, adult), gender (male, female, both gender), health status (healthy, unhealthy), geographical location (Asian, non-Asian countries), study quality (low, medium, high), study design (case-control, cross-sectional), participants' health status (healthy, unhealthy) and BMI (obese, overweight) was carried out.

Conclusion: According to what was discussed, we found that serum omentin level is significantly lower in overweight subjects but not obese ones. This finding should be interpreted cautiously because of significant heterogeneity among included studies.
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http://dx.doi.org/10.1016/j.clnesp.2020.06.014DOI Listing
October 2020

Neutrophil-to-Lymphocyte ratio as a potential biomarker for disease severity in COVID-19 patients.

J Glob Antimicrob Resist 2020 09 15;22:862-863. Epub 2020 Aug 15.

Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

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http://dx.doi.org/10.1016/j.jgar.2020.07.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428697PMC
September 2020

Isfahan COvid-19 REgistry (I-CORE): Design and methodology.

J Res Med Sci 2020 30;25:32. Epub 2020 Mar 30.

Department of Medical Education, Medical Educational Research Center, Isfahan University of Medical Science, Isfahan, Iran.

Health authorities usually exploit after-action reports to collect data on their experience in responding to public health emergencies. To develop an effective approach to manage and learning from health emergencies, we have launched Isfahan COvid-19 REgistry for data collection during routine clinical care as a first "critical incident registry" in Iran. Registries can be employed to explain the natural history of the disease, learn about a particular disease in terms of patient outcomes, the cost-effectiveness of clinical management, monitoring the quality of health-care service, and developing research hypotheses.
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http://dx.doi.org/10.4103/jrms.JRMS_271_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306237PMC
March 2020

HIV Modes of Transmission in Sudan in 2014.

Int J Health Policy Manag 2020 03 1;9(3):108-115. Epub 2020 Mar 1.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman,Iran.

Background: In Sudan, where studies on HIV dynamics are few, model projections provide an additional source of information for policy-makers to identify data collection priorities and develop prevention programs. In this study, we aimed to estimate the distribution of new HIV infections by mode of exposure and to identify populations who are disproportionately contributing to the total number of new infections in Sudan.

Methods: We applied the modes of transmission (MoT) mathematical model in Sudan to estimate the distribution of new HIV infections among the 15-49 age group for 2014, based on the main routes of exposure to HIV. Data for the MoT model were collected through a systematic review of peer-reviewed articles, grey literature, interviews with key participants and focus groups. We used the MoT uncertainty module to represent uncertainty in model projections and created one general model for the whole nation and 5 sub-models for each region (Northern, Central, Eastern, Kurdufan, and Khartoum regions). We also examined how different service coverages could change HIV incidence rates and distributions in Sudan.

Results: The model estimated that about 6000 new HIV infections occurred in Sudan in 2014 (95% CI: 4651-7432). Men who had sex with men (MSM) (30.52%), female sex workers (FSW) (16.37%), and FSW's clients accounted (19.43%) for most of the new HIV cases. FSW accounted for the highest incidence rate in the Central, Kurdufan, and Khartoum regions; and FSW's clients had the highest incidence rate in the Eastern and Northern regions. The annual incidence rate of HIV in the total adult population was estimated at 330 per 1 000 000 populations. The incidence rate was at its highest in the Eastern region (980 annual infections per 1 000 000 populations).

Conclusion: Although the national HIV incidence rate estimate was relatively low compared to that observed in some sub-Saharan African countries with generalized epidemics, a more severe epidemic existed within certain regions and key populations. HIV burden was mostly concentrated among MSM, FSW, and FSW's clients both nationally and regionally. Thus, the authorities should pay more attention to key populations and Eastern and Northern regions when developing prevention programs. The findings of this study can improve HIV prevention programs in Sudan.
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http://dx.doi.org/10.15171/ijhpm.2019.91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093043PMC
March 2020

Attitudes and Practice of Health Care Workers about Human Immunodeficiency Virus in Isfahan, Iran.

Iran J Nurs Midwifery Res 2020 Mar-Apr;25(2):111-116. Epub 2020 Feb 24.

Department of Epidemiology and Biostatistics, Health School, and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Health Care Workers (HCWs) play a key role in the Human Immunodeficiency Virus (HIV) prevention program, care and treat People Living with HIV (PLHIV). The evaluation of the attitude and performance among HCWs is regarded as one effective method for preventing the (HIV) spreading. This study was aimed to assess the attitude and practice of HCWs about HIV in Isfahan.

Materials And Methods: In a cross-sectional study, we recruited 350 eligible participants from five academic hospitals, three academics dental clinics and six health centers by the convenience multistage sampling. A standard questionnaire was used to evaluate HIV attitudes among the HCWs in Isfahan. The variables were compared between males and females by Chi-square and -test. In addition, linear and logistic regression was utilized to investigate the factors affecting attitude.

Results: Respondents had a moderate level of attitude toward PLHIV About 2.00% of the respondents had a good attitude. Marital status (β=-11.79, = 0.048) was associated with attitude. Among women, wearing gloves was associated with attitude (β=5.96, = 0.041).

Conclusions: HIV attitude was not satisfactory among the HCWs in Isfahan. Therefore, the necessary measures and training are needed to improve the attitudes of health personnel and reduce stigma and discrimination toward PLHIV in health systems. Also, it is recommended to strongly monitor HIV infection control guidelines and instruction.
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http://dx.doi.org/10.4103/ijnmr.IJNMR_67_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055188PMC
February 2020

HIV and Other Sexually Transmitted Infections Among Female Sex Workers in Iran: A Systematic Review and Meta-Analysis.

Arch Sex Behav 2020 08 7;49(6):1923-1937. Epub 2019 Nov 7.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Given the high burden of HIV and other sexually transmitted infections (STIs) among female sex workers (FSW) and their potential role in bridging HIV/STIs into the general population, estimating the prevalence of HIV/STIs among FSW is essential for future research and policy developments. This systematic review and meta-analysis synthesize the available HIV/STIs data among FSW in Iran. We searched MEDLINE, PsycINFO, CINAHL, Embase, Web of Science, Google Scholar, and Iranian databases from inception through to January 2018. Inclusion criteria were original quantitative studies that measured HIV/STIs prevalence among FSW. Pooled prevalence estimates were calculated using random-effects meta-analyses. Out of a total of 299 screened studies, 12 were included with total study participants of 4328 FSW. Heterogeneity was present but meta-regression analyses revealed no significant association between HIV prevalence and year of publication, city, and age. Pooled HIV prevalence was 2.23% (95% confidence interval [CI] 0.82, 3.64). We estimated the prevalence of other STIs as 0.77% (95% CI 0.01, 1.53) for hepatitis B, 6.18% (95% CI 1.32, 11.04) for hepatitis C, 0.33% (95% CI 0.00, 0.66) for syphilis, 1.47% (95% CI 0.22, 2.71) for gonorrhea, 9.80% (95% CI 4.70, 14.91) for chlamydia, and 6.18% (95% CI 4.92, 7.43) for trichomonas vaginalis. Based on the existing evidence, HIV and STIs prevalence among FSW are relatively low in Iran. Strategies for timely diagnosis and treatment of HIV and other STIs among FSW and their sexual and injecting partners are needed to reduce the burden of HIV/STIs among these vulnerable populations in Iran.
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http://dx.doi.org/10.1007/s10508-019-01574-0DOI Listing
August 2020

The association between serum vitamin D, fertility and semen quality: A systematic review and meta-analysis.

Int J Surg 2019 Nov 24;71:101-109. Epub 2019 Sep 24.

Faculty of biostatistics and epidemiology, Isfahan university of medical sciences, Isfahan, Iran. Electronic address:

Purpose: A number of studies have examined the association between vitamin D, fertility and semen quality, however, findings have been inconclusive. Herein, we systematically reviewed available observational studies to elucidate the overall relationship between vitamin D, fertility and semen quality in adult population.

Methods: PubMed, Cochrane's Library, Science Direct, Scopus, Google Scholar and ISI Web of Science databases were searched until December 2018 for all available studies evaluating the association between vitamin D, fertility and semen quality. The Newcastle-Ottawa Quality Assessment Scale was used to examine the quality of each study.

Results: A total of 18 studies out of 1843 met our inclusion criteria and were included in our systematic review and meta-analysis. Serum 25(OH)D3 was significantly higher in fertile subjects compared to infertile ones (WMD -0.63; 95% CI, -1.06 to -0.21; P = 0.003). Furthermore, there was a significant association between serum 25(OH)D, sperm motility (WMD -5.84; 95% CI, -10.29 to -1.39; P = 0.01) and sperm progressive motility (WMD -5.24; 95% CI, -8.71 to -1.76; P = 0.003).

Conclusion: Our findings add to the existing literature supporting the concept that nutrition, especially vitamin D, plays an important role in men's sexual health. It should be noted that because of significant heterogeneity among the included studies, caution is warranted when interpreting the results. Further well-designed prospective cohort studies and clinical trials are needed for better understanding of the relationship between vitamin D and fertility and its components.
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http://dx.doi.org/10.1016/j.ijsu.2019.09.025DOI Listing
November 2019

The effect of omega-3 and vitamin E on oxidative stress and inflammation: Systematic review and meta-analysis of randomized controlled trials.

Int J Vitam Nutr Res 2020 Oct 23;90(5-6):553-563. Epub 2019 Aug 23.

Epidemiology and Biostatistics Department, Health School; and Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Several studies have investigated the effect of omega-3 fatty acids and vitamin E on oxidative stress and inflammation, but their findings are inconsistent. The aim of this meta-analysis is to elucidate the overall effects of co-supplementation with omega-3 fatty acids and vitamin E on oxidative stress and inflammation. We searched titles, abstracts, and keywords of relevant articles indexed in PubMed, ISI, Scopus, and Google Scholar databases up to December 2018 to identify eligible RCT studies. Random effects model was used to estimate the pooled effect of co-supplementation with omega-3 fatty acids and vitamin E on oxidative stress and inflammation. Overall, 7 RCTs with 504 participants were included in this meta-analysis. We found that co-supplementation with omega-3 fatty acids and vitamin E decreased hs-CRP (weighed mean difference (WMD) = -2.15 mg/L; 95% CI: -3.40, -0.91 mg/L; P < 0.001) concentrations and increased total antioxidant capacity (TAC) (WMD = 92.87 mmol/L; 95% CI: 31.97, 153.77 mmol/L; P = 0.03), and nitric oxide levels (NO) (WMD: 6.95 μmol/L; 95% CI: 3.86, 10.04, P < 0.001) compared with control group. Omega-3 fatty acids and vitamin E had no significant effect on malondialdehyde (MDA) (WMD: 1.54 mmol/L; 95% CI: -1.29, 4.36; P = 0.196), and glutathione (GSH) (WMD: 20.87 mmol/L; 95% CI: -20.04, 61.6, P = 0.31) levels. The present meta-analysis found that omega-3 fatty acids and vitamin E co-supplementation significantly decreased hs-CRP and increased NO and TAC, although it had no significant effect on MDA and GSH.
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http://dx.doi.org/10.1024/0300-9831/a000599DOI Listing
October 2020

Latent class analysis of symptoms for sexually transmitted infections among Iranian women: Results from a population-based survey.

Health Care Women Int 2020 04 28;41(4):461-475. Epub 2019 Jan 28.

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

A preliminary symptom-based screening test would lower the financial burden of sexually transmitted infections (STIs) caused by clinical testing. To develop such a screening method, we should first identify the most specific STI symptoms. We aim to distinguish the specific STI symptom(s) that are most likely to be found in the truly infected individuals. We used data from a population-based survey that was conducted in Iran, in 2014. Using Latent Class Analysis (LCA) in R software, we classified 3049 Iranian women, 18-60 years old, with reference to seven self-reported STI-associated symptoms. Using LCA, we categorized nearly 1% of women as "probably STI-infected". Above 70% of participants reported the "seven symptoms" that are associated with STIs, except for genital ulcer. These symptoms could be used to distinguish healthy participants from infected ones. The "probably healthy" class incorporated about 77% of the participants. Lower abdominal pain and abnormal vaginal discharge were the most frequently reported symptoms of this class. The LCA determined classes along with the WHO syndromic guidelines for STI diagnosis can help physicians to make a more accurate diagnosis. Hence, cost-effectively, only patients who are classified as probably infected need to be referred to medical laboratories for further investigations.
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http://dx.doi.org/10.1080/07399332.2019.1566335DOI Listing
April 2020

Validation of the verbal autopsy questionnaire for adult deaths in Iran.

Med J Islam Repub Iran 2018 7;32. Epub 2018 Feb 7.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Verbal Autopsy Questionnaire (VA) is an important tool to estimate the cause of death among those populations lacking an appropriate death registration system. In this study, the validity and reliability of verbal autopsy were assessed. The Persian version of the questionnaire was prepared using the translation and back- translation method. In the first and second phases of the study, 213 and 198 families of deceased persons accepted an invitation to complete the questionnaire. A physician determined the cause of death. These causes were compared with the registered cause of death on the death certificate. Sensitivity, specificity, positive predictive value (PPV), as well as the kappa statistic (between the first verbal autopsy questioning and death registry) were calculated to determine the validity of the questionnaire. Kappa statistic was also used to determine the reliability between the first and second questioning. The sensitivity of the questionnaire varied from 75% among deaths due to diabetes to 100% Due to breast cancer. The specificity of the questionnaire for all causes of death was higher than 97%. PPV varied from 62.5% to 100% for all causes of death. The kappa statistic between causes of death derived from death certificate, and the first VA questioning for all causes of death was above 0.7 (p<0.001), and it was above 0.78 for the first and second verbal autopsy questioning (p<0.001). Although the Verbal Autopsy Questionnaire does not fully identify all causes of death, it can be a useful tool for diagnosing causes of death for those deceased persons who have no death certificate.
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http://dx.doi.org/10.14196/mjiri.32.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108282PMC
February 2018

How and Where Do We Ask Sensitive Questions: Self-reporting of STI-associated Symptoms Among the Iranian General Population.

Int J Health Policy Manag 2018 08 1;7(8):738-745. Epub 2018 Aug 1.

HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Reliable population-based data on sexually transmitted infections (STI) are limited in Iran and self-reporting remains the main source of indirect estimation of STI-associated symptoms in the country. However, where and how the questions are asked could influence the rate of self-reporting. In the present study, we aimed to assess what questionnaire delivery method (ie, face-to-face interview [FTFI], self-administered questionnaire [SAQ], or audio self-administered questionnaire [Audio-SAQ]) and setting (ie, street, household or hair salon) leads to more reliable estimates for the prevalence of self-reported STI-associated symptoms.

Methods: This cross-sectional study was conducted in winter 2014 on a gender-balanced (50.0% men) sample of 288 individuals aged 18-59 years old in Kerman, Iran. Respondents were recruited in (a) crowded public places and streets, (b) their households, and (c) hair salons. Data was collected on history of current and 6-month (ie, past 6 months) STI-associated symptoms. Three different methods including FTFI, SAQ and or Audio-SAQ were applied randomly in households and non-randomly in streets and hair salons to collect data among the respondents. Generalized estimating equation (GEE) was used to compare the settings and methods separately.

Results: A total of 2.8% of men and 9.4% of women self-reported at least one STI-associated symptom. Respondents were significantly more likely to report STI-associated symptoms when completing questionnaires on the street compared to their household (P = .0001). While women were less likely to report symptoms in FTFI compared to SAQ (P = .036), no significant differences were found between men's responses across different methods (P = .064).

Conclusion: Further research is needed to evaluate the effect of different combinations of methods and settings to find the optimal way to collect data on STI-associated symptoms.
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http://dx.doi.org/10.15171/ijhpm.2018.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077285PMC
August 2018

Prevalence of Sexually Transmitted Infections and Their Risk Factors among Female Sex Workers in Isfahan, Iran: A Cross-Sectional Study.

J Int Assoc Provid AIDS Care 2017 Nov/Dec;16(6):608-614. Epub 2017 Oct 11.

1 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: Female sex workers (FSWs) are at high risk of sexually transmitted infections (STIs) and form a core group to facilitate STI spreading. We aimed to estimate the prevalence of STIs among FSWs who attended Female Harm Reduction Center of Isfahan, Iran, and to determine the association between risky behaviors and STIs.

Study Design: In a cross-sectional study, 99 FSWs were recruited and interviewed about demographic characteristics and risky behaviors. A trained midwife examined FSWs for genital ulcer, abnormal vaginal discharge, and cervicitis. Urine and genital specimens were collected and real-time polymerase chain reaction was performed to diagnose Neisseria gonorrhoeae, human papilloma virus (HPV), and Trichomonas Vaginalis. Data were analyzed via χ test and logistic regression in StataCorp software (version 11) with 95% confidence interval.

Results: Totally, 84.9% of FSWs reported STI symptoms, while 12.1% of them were infected with N gonorrhoeae, HPV, or T vaginalis. Human papilloma virus and gonorrhea prevalence rates were 5.7% and 8% in FSWs with STI-associated symptoms. Sexually transmitted infections showed significant association with duration of prostitution (odds ratio [OR] = 1.009 [95% confidence interval [95% CI: 1.004-1.01]; OR = 1.01 [95% CI: 1.00-1.01]) and condom usage (OR = 0.11 [95% CI: 0.012-0.98]; OR = 0.04 [95% CI: 0.005-0.33]).

Conclusion: Due to the literature gap on the Iranian FSWs' sexual health and the intense stigma around this subject, in Iran, our results would be useful for developing an efficient intervention program. The prevalence of STIs in Isfahan FSWs can be controlled with programs such as consistent condom use and STI treatment. In addition, as just one-tenth of FSWs with an STI symptom were positive for an STI, symptomatic diagnosis of STIs might be insufficient.
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http://dx.doi.org/10.1177/2325957417732836DOI Listing
September 2018

Estimation of the prevalence of chronic kidney disease: The results of a model based estimation in Kerman, Iran.

Med J Islam Repub Iran 2016 5;30:338. Epub 2016 Mar 5.

MD, PHD of Epidemiology and Biostatistics, Research Center for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: Chronic kidney disease is asymptomatic until its last stages and though it is increasing globally, we are faced with paucity of a population-based model to assess this disease, particularly in developing countries. Therefore, the aim of this study was to estimate the prevalence and trends of CKD according to a new estimation method.

Methods: Using multiplier method, we estimated the numbers of different stages of CKD based on the number of patients with end stage renal failure from 2006 to 2016. The required multipliers were extracted from a simulation of the disease in Kerman following a dynamic model. The 95% uncertainty interval was computed using Monte-Carlo technique with 10,000 iterations.

Results: The prevalence of CKDA (GFR<=90mL/min/1.73m2) and CKDB (GFR less than 60mL/min/1.73m2) patients were estimated to be 7.6% (95% uncertainty interval (UI), 5.7-9.1%) and 1.1% (95% UI, 0.8-1.3%), respectively in 2011. The method revealed that the prevalence may rise up to 25.7% (95% UI, 18.2-32.5%) and 3.7% (95% UI, 2.7-4.5%) for CKDA and CKDB, respectively in 2016, indicating approximately 3.3 times increase for both figures.

Conclusion: This study predicted an increase in the prevalence of CKD in the future. This may be due to the increasing life expectancy of the population, the increase in the prevalence of non- communicable diseases such as hypertension and diabetes, or patients' survival due to receiving better support. Therefore, the policymakers should be concerned and well informed about this increase.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898837PMC
July 2016

Effective Interventions to Improve Triangular Clinic Services.

Addict Health 2016 ;8(1):67

General Practitioner, Deputy for Health, Kerman University of Medical Sciences, Kerman, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836765PMC
June 2016

Prevalence of anxiety and depression symptoms and their relationship with other coronary artery disease risk factors: A population-based study on 5900 residents in Southeast Iran.

Asian J Psychiatr 2016 Apr 8;20:55-60. Epub 2016 Jan 8.

Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran; Global Health Sciences, University of California, San Francisco, CA, USA.

Introduction: Anxiety and depression are reported as the most prevalent psychiatric disorders worldwide. Here, we studied the prevalence of such disorders with co-morbidities of coronary artery disease (CAD) risk factors in an urban population in Iran.

Methods: 5900 people were selected from 15 to 75-years-olds through single-stage cluster sampling. In addition to examining them for CAD risk factors, Beck anxiety and depression inventories were used to measure anxiety and depression symptoms. The standardized population prevalence of such disorders is reported and the predictors of having anxiety or depression were assessed using Poisson regression model.

Results: Overall 25.4% had moderate and 22.7% had severe anxiety. Severe anxiety significantly and constantly increased by age groups (p=0.01). The risk for anxiety was higher among females (Adjusted Risk Ratio, ARR 1.2), and those who were student/soldier (ARR 1.07). Those with high level of physical activity were at lower risk for anxiety (ARR 0.92). The risk of depression (any level) was higher among females (ARR 1.3), those holding high-school level of education (ARR 1.41), and those who used opium either occasionally (ARR 1.17) or frequently (ARR 1.3). Both anxiety and depression were significantly associated with two main CAD risk factors, low physical activity and opium use.

Conclusion: We found that the majority of residents in Kerman, particularly women, are suffering from mild to server depression and anxiety symptoms. Public health interventions to increase public awareness on such symptoms, screening and delivery of prevention and treatment services are required to prevent from the growing burden of such disorders and cardiovascular diseases.
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http://dx.doi.org/10.1016/j.ajp.2016.01.004DOI Listing
April 2016

Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey.

Int J Health Policy Manag 2015 Aug 9;5(1):5-11. Epub 2015 Aug 9.

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

Background: Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People's preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system.

Methods: This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care.

Results: Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIs-associated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84).

Conclusion: The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases.
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http://dx.doi.org/10.15171/ijhpm.2015.146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676971PMC
August 2015

Estimation of Prevalence and Incidence of Sexually Transmitted Infections in Iran; A model-based approach.

J Res Health Sci 2015 ;15(3):168-74

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

Background: Routine reporting of sexually transmitted infections (STIs) in Iran is one of the main information sources on STIs, endures some diminution under influence of several factors. We aimed to adjust registered STI data with a model-based approach and estimate the incidence and prevalence of STIs in Iran.

Methods: In this cross-sectional study, we developed a stochastic compartmental model considering effects of influential factors on STI reporting process to adjust registered STI data. We reviewed literature and used Delphi method to collect data and estimate model parameters. We calibrated the model using Monte Carol simulation with 95% confidence interval (CI). Finally, we validated the models by comparing their output with investigational data.

Results: The estimated prevalence of male urethral discharge was 0.40% (95% CI: 0.26%, 0.65%); the prevalence of genital ulcers was 3.68% (95% CI: 2.31%, 6.43%) in women and 0.16% (95% CI: 0.10%, 0.27%) in men. The estimated incidence for Neisseria gonorrhoeae, Chlamydia trachoma and syphilis per 1000 women was 2.44 (95% CI: 1.17, 6.65), 5.02 (95% CI: 2.78, 10.16) and 0.04 (95% CI: 0.02, 0.05) respectively; the corresponding figures per 1000 men were 0.43 (95% CI: 0.26, 0.80), 0.82 (95% CI: 0.42, 1.92) and 0.005 (95% CI: 0.003, 0.008).

Conclusions: Various factors are responsible for the obvious underestimation in the number of STIs registered in Iran. Notwithstanding this underestimation, our models offer an indirect method of estimating the prevalence of STIs in the country. Providing policymakers and STI experts with more realistic estimates might prompt policymakers and STI experts to recognize the importance of STIs in Iran and help them to develop appropriate prevention and control programs.
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July 2016

Population-based survey on STI-associated symptoms and health-seeking behaviours among Iranian adults.

Sex Transm Infect 2016 May 23;92(3):232-9. Epub 2015 Sep 23.

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

Background: Qualified decision-making for the improved management of sexually transmitted infections (STIs) requires various sources of information. We aimed to estimate the STI-associated symptom prevalence and care-seeking patterns in the general population of Iran.

Methods: In 2014, using a street-based survey with a standard gender-specific questionnaire on STI-associated symptoms and willingness to seek treatment, we interviewed 9166 Iranian participants, who were selected from among the 18-60-year-old population using multistage sampling. Data were analysed via generalised estimating equation and survey analysis, taking into account a 95% confidence coefficient.

Results: About 67.3% of participants, mean age 33 years, were 'assumed sexually active' and were therefore eligible for inclusion. Approximately 39.9% (95% CI 28.4% to 51.4%) of women and 17.6% (95% CI 13.9% to 21.6%) of men reported at least one STI-associated symptom in the current week. The occurrence of symptoms decreased with an increase in age in both genders (p<0.05). About 21.2% (95% CI 13.3% to 29.1%) of women and 7.1% (95% CI 5.4% to 7.8%) of men treated symptoms themselves after symptoms first appeared. Of the women and men with symptoms, 37.4% (95% CI 24.8% to 50.0%) and 46.8% (95% CI 39.7% to 51.4%), respectively, sought care. Most women visited a gynaecologist and midwife; men tended to visit a general practitioner and urologist after their symptoms appeared.

Conclusions: The prevalence of STI-associated symptoms in Iranian adults is considerable. The results emphasise the need for appropriate and timely STI care and more attention to sexual health promotion to mitigate onward and future infections. Attention to the care-seeking pattern is fundamental to policymaking and planning.
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http://dx.doi.org/10.1136/sextrans-2015-052060DOI Listing
May 2016

HIV in Iran.

Lancet 2014 Mar;383(9922):1040

Regional Knowledge Hub and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(14)60518-3DOI Listing
March 2014

Why is the number of HIV/AIDS-related publications low in the MENA region?

Sex Transm Infect 2013 Nov 8;89 Suppl 3:iii10. Epub 2013 Jun 8.

Regional Knowledge Hub for HIV/AIDS Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, , Kerman, Iran.

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http://dx.doi.org/10.1136/sextrans-2013-051199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841724PMC
November 2013

Research priorities in the field of HIV and AIDS in Iran.

J Res Med Sci 2012 May;17(5):481-6

Associate Professor, Research Centre for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran.

Background: HIV is a multidimensional problem. Therefore, prioritization of research topics in this field is a serious challenge. We decided to prioritize the major areas of research on HIV/AIDS in Iran.

Materials And Methods: In a brain-storming session with the main national and provincial stakeholders and experts from different relevant fields, the direct and indirect dimensions of HIV/AIDS and its related research issues were explored. Afterward, using the Delphi method, we sent questionnaires to 20 experts (13 respondents) from different sectors. In this electronic based questioner, we requested experts to evaluate main topics and their subtopics. The ranges of scores were between 0 and 100.

Results: The score of priorities of main themes were preventive activities (43.2), large scale planning (25.4), the estimation of the HIV/AIDS burden (20.9), and basic scientific research (10.5). The most important priority in each main theme was education particularly in high risk groups (52.5), developing the national strategy to address the epidemic (31.8), estimation of the incidence and prevalence among high-risk groups (59.5) and developing new preventive methods (66.7), respectively.

Conclusions: The most important priorities of researches on HIV/AIDS were preventive activities and developing national strategy. As high risk groups are the most involved people in the epidemic, and they are also the most hard-to-reach sub-populations, a national well designated comprehensive strategy is essential. However, we believe with a very specific and directed scheme, special attention to research in basic sciences is necessary, at least in limited number of institutes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634277PMC
May 2012

Modeling of human immunodeficiency virus modes of transmission in Iran.

J Res Health Sci 2012 Dec 13;12(2):81-7. Epub 2012 Dec 13.

Regional Knowledge Hub for HIV/AIDS Surveillance, Kerman University of Medical Sciences, Iran.

Background: Main technique to control acquired immunodeficiency syndrome (HIV) infection is the effective preventive programs among high-risk groups. Modeling is one of the effective methods where there is inadequate data. We used the modes of transmission (MOT) model to predict the transmission of HIV infection in Iran.

Methods: We systematically searched published and grey literature to find values for the input parameters of MOT in 2010. The data were discussed by experts before being fed into the model. Using the Monte Carlo simulation, we computed the 95% confidence interval (CI) for the outputs of the MOT.

Results: The MOT estimates that 9136 new HIV infections would have occurred in Iran in 2010 (95% CI: 6831, 11757). About 56% (95% CI: 47.7%, 61.6%) of new infections were among intravenous drug users (IDUs) and 12% (95% CI: 9.5%, 15%) among their sexual partners. The major routes of direct and indirect HIV transmission in Iran are unsafe injection (68%) and unprotected sexual contact (34% unprotected heterosexual and 10% homosexual) respectively. If current coverage for safe injection among IDUs increases from 80% to 95%, new HIV infections in this group would decrease around 75%.

Conclusion: IDUs remain at highest risk of HIV infection in Iran, so the preventive program coverage for IDUs and their spouses needs to be increased. As the sexual transmission of HIV contributes increasingly to the pool of new infections, serious measures such as harm reduction program are required to reduce sexual transmission of HIV among the relevant key populations.
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December 2012