Vaccination frequency in people newly diagnosed with multiple sclerosis.

BACKGROUND: Infections are discussed as risk factor for multiple sclerosis (MS) development and relapses. This may lead to decreased vaccination frequency in newly diagnosed patients. OBJECTIVE: The aim of this study was to evaluate the relation of MS diagnosis to subsequent vaccination frequency. METHODS: Based on German ambulatory claims data from 2005 to 2019, regression models were used to assess the relation of MS diagnosis (n = 12,270) to vaccination. A cohort of patients with MS was compared to control cohorts with Crohn's disease, psoriasis, and without these autoimmune diseases (total n = 198,126) in the 5 years after and before diagnosis. RESULTS: Patients with MS were less likely to be vaccinated compared to persons without the autoimmune diseases 5 years after diagnosis (odds ratio = 0.91, p < 0.001). Exceptions were vaccinations against influenza (1.29, p < 0.001) and pneumococci (1.41, p < 0.001). Differences were strong but less pronounced after than before diagnosis (p < 0.001). The likelihood of vaccination was also lower compared to patients with Crohn's disease or psoriasis. CONCLUSIONS: Patients with MS were not adequately vaccinated despite guideline recommendations. Increasing awareness about the importance of vaccination is warranted to reduce the risk of infection, in particular, in patients with MS receiving immunotherapies.

Prediction of Multiple sclerosis disease using machine learning classifiers: a comparative study.

INTRODUCTION: Hamedan Province is one of Iran's high-risk regions for Multiple Sclerosis (MS). Early diagnosis of MS based on an accurate system can control the disease. The aim of this study was to compare the performance of four machine learning techniques with traditional methods for predicting MS patients. METHODS: The study used information regarding 200 patients through a case-control study conducted in Hamadan, Western Iran, from 2013 to 2015. The performance of six classifiers was used to compare their performance in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-) and total accuracy. RESULTS: Random Forest (RF) model illustrated better performance among other models in both scenarios. It had greater specificity (0.67), PPV (0.68) and total accuracy (0.68). The most influential diagnostic factors for MS were age, birth season and gender. CONCLUSIONS: Our findings showed that despite all the six methods performed almost similarly, the RF model performed slightly better in terms of different criteria in prediction accuracy. Accordingly, this approach is an effective classifier for predicting MS in the early stage and control the disease.

Patterns of Drug Use and Related Factors Among Prisoners in Iran: Results from the National Survey in 2015.

Drug use by prisoners is one of the world's most important problems. We sought to determine the pattern of drug use behavior and related factors among prisoners of Iran in 2015. This cross-sectional study was part of the bio-behavioral surveillance survey conducted among 6200 prisoners in 26 prison sites in Iran who were selected through multi-stage sampling. Data were collected through questionnaires and interviews which inquired about participants' demographics and drug use behaviors. We analyzed study data using descriptive statistics, and crude and adjusted logistic regressions, in STATA-12. Of all prisoners, 74.0% had a history of lifetime drug use, and 16.6% of drug users had a history of lifetime injection drug use (IDU). According to the results of a multivariate logistic regression, male sex, being between the ages of 24 and 45, having a history of imprisonment, and having a history of lifetime high-risk sexual behavior were significant risk factors for lifetime drug use. Also, male sex, single status, and a history of previous imprisonment were significant risk factors for lifetime IDU. The prevalence of drug use in Iran's prison population is high and alarming. There is a continuing need for harm reduction programs, including the methadone maintenance treatment, among imprisoned drug users and IDUs.

Drug use and risk behaviour profile, and the prevalence of HIV, hepatitis C and hepatitis B among people with methamphetamine use in Iran.

BACKGROUND: Stimulants substances use, particularly methamphetamine use, is increasing globally, including in Iran. This study assessed the drug use and risk behaviour profile, and prevalence of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) among a large population using methamphetamine as their primary drug in Iran. METHODS: This cross-sectional study was conducted in eight provinces of Iran. Individuals using methamphetamine for ≥3 months during the past three years, with no life-time history of injecting opioid drugs were enrolled. Drug use and risk behaviour data were collected through interviews. Blood samples were tested for HIV antibodies (HIV Ab), HCV antibodies (HCV Ab), and HBV surface antigen (HBs Ag). RESULT: Among 567 participated, 84% were men and mean age was 36 years. Smoking with pipe was the most common method of methamphetamine use (53%), while 13% had a history of injecting methamphetamine, among whom 30% shared needles or syringes. Among those having sex during intoxication phase (n = 270), 48% never used condom. The prevalence of HIV Ab, HCV Ab and HBs Ag was 6.7% (95%CI: 4.7-9.1), 19.4% (95%CI: 16.2-22.9) and 1.4% (95%CI: 0.6-2.7), respectively. Age ≥ 30 years (adjusted OR [aOR]: 2.10, 95%CI: 1.18-3.76), lower education (high school vs. tertiary education, aOR: 13.95, 95%CI: 1.90-102.60), and injecting methamphetamine (aOR: 1.92, 95%CI 1.10-3.35) were significantly associated with HCV exposure. No factor was found associated with HIV infection. Among those reporting no potential injecting or sexual risk factors, 19.8% and 6.8% have HCV Ab positive and HIV Ab positive, respectively. CONCLUSION: High prevalence of injecting and sexual risk behaviours, HIV infection and HCV exposure were found among individuals using methamphetamine as their primary drug, demonstrating them as an emerging population at risk of HIV and HCV in Iran. Targeted screening and harm reduction programs for this population are required.

Patterns of sexual behaviors and related factors among prisoners in Iran: results from a national survey in 2015.

PURPOSE: The purpose of this paper is to determine patterns of sexual behaviors and related factors among prisoners in Iran, 2015. DESIGN/METHODOLOGY/APPROACH: This cross-sectional study was a part of a bio-behavioral surveillance survey conducted on 6,200 prisoners in 26 prisons in Iran. The subjects were selected through multi-stage sampling. Questionnaires and interviews were used to collect data on participant's demographics and history of sexual behaviors. Using STATA-12 software, the collected data were analyzed through descriptive statistics, and crude and adjusted logistic regression. FINDINGS: A total of 5,508 prisoners with a response rate of 88.8 percent participated in this study. Of all prisoners, 55 percent (n=3,027) had a history of "unsafe sex in the lifetime" of whom 53.4 percent (n=1,549) never used condoms during unsafe sex in the lifetime. Based on the results of multivariate analysis, risk factors for "unsafe sex in lifetime" were the following: higher level of education (AOR=1.79, CI: 1.41-2.28), being single (AOR=1.32, CI: 1.18-1.47), unemployed before imprisonment (AOR=1.45, CI: 1.06-1.97), having history of previous imprisonment (AOR=1.31, CI: 1.17-1.47) and history of drug use in the lifetime (AOR=1.53, CI: 1.35-1.75). ORIGINALITY/VALUE: Prisoners are high-risk groups that are prone to practice unsafe sex. Prisoners who are single, unemployed before imprisonment, a drug user, with a higher level of education and with a history of imprisonment are likely to be sexually active in their lifetime. Thus, they are a priority for receiving suitable interventions.

Prevalence and risk factors for HBV and HCV in prisoners in Iran: a national bio-behavioural surveillance survey in 2015.

OBJECTIVES: To provide more accurate estimates of the prevalence of Hepatitis B (HBV) and Hepatitis C (HCV) and their contributing factors among prisoners in Iran. METHODS: Cross-sectional study of 6200 Iranian prisoners in 2015. Data were collected through questionnaires and interviews. HBV infection and HCV exposure status of the participants was determined by HBsAg and HCV antibodies blood tests using enzyme-linked immunosorbent assay (ELISA). Data were analysed in STATA-12. RESULT: Prevalence of HCV exposure was 9.48% (95% CI: 8.73-10.27), and prevalence of HBV was 2.48% (95% CI: 2.07-2.89) in the general prison population. In multivariate analysis, the most important risk factor for HBV was a history of drug use in lifetime (adjusted odds ratio, AOR: 1.8, 95% CI: 1.17-3.02). The main risk factors for HCV exposure were a history of drug use in lifetime (AOR: 4.08, CI: 2.56-6.27), age over 30 (AOR: 2.68, CI: 2.01-3.56), and having tattoos (AOR = 1.67, CI: 1.35-2.07). CONCLUSION: Although vaccination is used to control HBV among prisoners, prevalence of HCV exposure is alarming in the prison population of Iran, especially among people who inject drugs. Eliminating viral hepatitis in Iran by 2030 requires a national commitment and rapid measures for targeting this high-risk group. Given the increased efficiency of HCV treatment in recent years, prisons provide an opportunity to access patients for treatment.