Patterns of Health-related Quality of Life in Men Who Inject Drugs: A Survey in Southeast Iran.

OBJECTIVES: Understanding patterns of quality of life in people who inject drugs (PWID) can help healthcare providers plan and manage their health problems in a more focused manner. Therefore, the current study aimed to identify patterns of health-related quality of life in PWID in southeast Iran. METHODS: This cross-sectional study was conducted in southeast Iran on men who had injected drugs at least once during the last year. We used convenience sampling in 2 drop-in centers and venue-based sampling at 85 venues. Demographic characteristics, high-risk behaviors, and health-related quality of life were evaluated using the 5-level EQ-5D version (EQ-5D-5L) questionnaire. Latent profile analysis was used to identify patterns of quality of life. RESULTS: This study enrolled 398 PWID, who had a mean age of 34.1±11.4 years. About 47.9% reported a prison history in the last 10 years, 59.2% had injected drugs in the last month, and 31.6% had a history of sharing syringes. About 46.3% reported having 2 or more sexual partners in the last 6 months, and 14.7% had a history of sex with men. Out of the 5 EQ-5D-5L profiles, the fifth profile had the most people (36.6%). Most variations in quality of life were related to pain and discomfort. CONCLUSIONS: We showed that the pain and discomfort dimension of EQ-5D-5L had more variation in PWID. This finding will be useful for allocating appropriate interventions and resources to promote health-related quality of life in this population.

Non-communicable Diseases Surveillance: Challenged by COVID-19.

Non-communicable diseases as a leading cause of death have a surveillance system in most countries. This is disturbed by the emergence of coronavirus disease-2019 (COVID-19) in December 2019. In this regard, health system managers at decision-making levels tried to overcome this problem. Therefore, strategies to deal with this issue and bring the surveillance system to an ideal state were proposed and considered.

Motivating non-physician health workers to reduce the behavioral risk factors of non-communicable diseases in the community: a field trial study.

BACKGROUND: Non-communicable diseases behavioral risk factors can be improved if effective interventions are designed considering the health system's capabilities and local resources. This study evaluated the effectiveness of interventions that aimed at increasing non-physician community health workers' motivation in reducing non-communicable diseases behavioral risk factors in the community. METHODS: A randomized field trial study was conducted in 32 community health centers in 4 Iranian districts after a baseline population survey on the status of NCDs of 30-70-year-old individuals (n = 1225). The interventions were performed to improve insufficient physical activity, insufficient fruit consumption, insufficient vegetable consumption, high salt intake, and tobacco use. Four intervention packages were implemented in 24 community health centers; the other 8 centers were used as control groups. The non-physician community health workers performed the interventions. The packages additively included goal-setting, evidence-based education, operational planning, and incentive payments. A second survey was conducted 1 year after the start of the interventions to identify the effects on an independent random sample of 30-70-year-old individuals (n = 1221). Difference-in-difference method was used to quantify the interventions' effects. RESULTS: The average age of participants in both surveys was about 49 years. Also, about half of the participants were female, and about 43% were illiterate or had a primary school education. The interventions had statistically significant effects only on decreasing the prevalence of insufficient physical activity. The package with all the intervention components decreased the odds of insufficient physical activity to 0.24 (95% CI, 0.08, 0.72). The package with operational planning but no performance-based financing did not change the odds of insufficient physical activity. CONCLUSIONS: This study highlighted the importance of components, design, and implementation details of interventions intended to reduce NCDs behavioral risk factors. Some risk factors, such as insufficient physical activity, seem more easily modifiable with limited low-cost interventions in a one-year horizon. However, risk factors related to healthy food consumption and tobacco use need more extensive interventions. TRIAL REGISTRATION: This trial was registered on the Iranian Registry of Clinical Trials (IRCT20081205001488N2) on 3 June 2018 ( https://en.irct.ir/trial/774 ).

Adverse effects following COVID-19 vaccination in Iran.

BACKGROUND: Vaccination is a key intervention to prevent COVID-19. Many vaccines are administered globally, yet there is not much evidence regarding their safety and adverse effects. Iran also faces this challenge, especially as data regarding the Sputnik V vaccine is sparse. Therefore, the aim of this study is to determine the adverse effects of the most commonly used vaccines in Iran. METHODS: Using a retrospective cohort study design, 6600 subjects aged 18 years or older who had received two doses of any of the three COVID-19 vaccines (Sinopharm, AstraZeneca, and Sputnik V) were selected using a random sampling method between March and August 2021. Subjects were asked about any adverse effects of the vaccines by trained interviewers via telephone interview. Vaccine-related adverse effects in individuals during the first 72 h and subsequently following both doses of the vaccines were determined. The demographic variables, type of administered vaccine, adverse effects, and history of the previous infection with COVID-19 were collected. Descriptive statistics (mean, standard deviation) and analytical statistics (Chi-squared and Wilcoxon tests) were performed at a 95% significance level using STATA software version 15 (STATA Corp, College Station, TX, USA). RESULTS: From 6600 participants, 4775 responded (response rate = 72.3%). Of the participants, 1460 (30.6%) received the AstraZeneca vaccine, 1564 (32.8%) received the Sinopharm vaccine and 1751 (36.7%) received the Sputnik V vaccine. 2653 participants (55.56%) reported adverse effects after the first dose and 1704 (35.7%) after the second dose. Sputnik V caused the most adverse effects with 1449 (82.7%) vaccine recipients reporting symptoms after the first or second dose, compared with 1030 (70.5%) for AstraZeneca and only 585 (37.4%) for the Sinopharm vaccine. The most common adverse effects after the first dose were fatigue (28.37%), chill/fever (26.86%), and skeletal pain (22.38%). These three adverse effects were the same for the second dose, although their prevalence was lower. CONCLUSIONS: In this study, we demonstrate that the Sputnik V vaccine has the highest rate of adverse effects, followed by the AstraZeneca and Sinopharm vaccines. COVID-19 vaccines used in Iran are safe and there were no reports of serious adverse effects.

Evaluating the impact of results-based motivating system on noncommunicable diseases risk factors in Iran: Study protocol for a field trial.

Background: Risk factors of noncommunicable diseases (NCD) are increasingly contributing to morbidity and mortality in Iran. Health care providers' competencies and motivation are essential factors for the success and efficiency of primary health care. This field trial aims to evaluate the impact of a results-based motivating system on population level of the NCD risk factors field trial (IRPONT) in Iran. Methods: Population groups of 24 rural or urban catchment areas from 3 provinces were randomized to 1 of the 4 types of study groups. The groups were defined based on a set of 4 intervention packages. Extra 8 rural or urban catchment areas in a separate city were considered as independent nonintervention (control) group. Population levels of major NCD risk factors in all 32 population groups were measured at the beginning of the trial, at the end of the first year, and will be measured in the second year through standardized population surveys. As the outcome measure, the difference in population levels of the risk factors will be compared among the study groups. Study group IV will be compared with combined control groups (study groups I, II, and III). Also, we will conduct subgroup analysis to determine the effects of interventions 2, 3, and 4. Ethics: This trial has received ethical approval from National Institute for Medical Research Development in Iran (IR.NIMAD.REC.1396.084) in 2017. Trial Registration Number: This trial has been registered on the Iranian Registry of Clinical Trials (identifier: IRCT20081205001488N2). Registered on 3 June 2018 and updated on 12 April 2020.

Population-Based Approaches to Prevent Domestic Violence against Women Using a Systematic Review.

Objective: In this systematic review, we aimed to evaluate the existing strategies and interventions in domestic violence prevention to assess their effectiveness. Method : To select studies, Pubmed, ISI, CINAHL, PsycINFO, Cochrane, Scopus, Embase, Ovid, Science Direct, ProQuest, and Elsevier databases were searched. Two authors reviewed all papers using established inclusion/ exclusion criteria. Finally, 18 articles were selected and met the inclusion criteria for assessment. Following the Cochrane quality assessment tool and AHRQ Standards, the studies were classified for quality rating based on design and performance quality. Two authors separately reviewed the studies and categorized them as good, fair, and poor quality. Results: Most of the selected papers had fair- or poor-quality rating in terms of methodology quality. Different intervention methods had been used in these studies. Four studies focused on empowering women; 3, 4, and 2 studies were internet-based interventions, financial interventions, and relatively social interventions, respectively. Four interventions were also implemented in specific groups. All authors stated that interventions were effective. Conclusion: Intervention methods should be fully in line with the characteristics of the participants. Environmental and cultural conditions and the role of the cause of violence are important elements in choosing the type of intervention. Interventions are not superior to each other because of their different applications.

Stigma in COVID-19: A barrier to seek medical care and family support.

The new coronavirus pandemic at the end of 2019 raised fear around the world. The rapid spread and relatively higher observed case fatality of this disease compared to other viral respiratory infections, have caused social reactions such as xenophobia and stigma. These negative social attitudes and acts will affect different segments of the society, such as patients and their families and health care providers. Also, this could disrupt the identification and surveillance of patients and could lead to considerable negative impacts on its control and management.

Early Cessation of Breastfeeding and Determinants: Time to Event Analysis.

BACKGROUND: The onset of breastfeeding has a high success rate in most countries, but the time for termination of breastfeeding varies between countries. OBJECTIVE: This survey was aimed to determine the effective factors on the early termination of breastfeeding. METHODS: This study was conducted in 2018, in Iran. About 410 mothers were enrolled in the study. All considered factors were evaluated as factors influencing the continuity of breastfeeding. Survival analysis was used to analyze data. RESULTS: The mean age of the mothers was equal to 29.48 ± 5.8 years. The frequency of termination of breastfeeding before the first 2 years was equal to 34%. The mean of breastfeeding duration was equal to 21.49 ± 5.3 months. The percentage of infants who had been breastfed for 24 months was equal to 65.8%. An infant's birth weight (2500-4000 gr) (hazard ratio: 0.54), neonatal birth order (hazard ratio: 0.69), neonatal pathologic jaundice (hazard ratio: 1.52), starting time of using complementary food (hazard ratio: 2.45), using pacifier (hazard ratio: 2.82), and the status of using artificial milk (hazard ratio: 3.29) were significantly associated with cessation of breastfeeding before 24 months of age. The probability of termination of breastfeeding at 6, 12, 18, and 24 months of age was reported by 6%, 8%, 15%, and 34%, respectively. CONCLUSIONS: There were notifiable variations in breastfeeding rates both in national and international levels. Nevertheless, in this study, the mean of breastfeeding duration was longer compared to a number of countries and previous national studies.

Barriers to Health Service Utilization Among Iranian Female Sex Workers: A Qualitative Study.

OBJECTIVES: In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. METHODS: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. RESULTS: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. CONCLUSIONS: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS.

Trend Analysis and Affecting Components of Human Brucellosis Incidence During 2006 to 2016.

INTRODUCTION: Brucellosis is communicable between humans and animals. In spite of having an active health care system. Iran is considered as an endemic area and it stands in the fourth place in world ranking. One of the common methods for identifying the disease incidence is a regression analysis. Therefore, the aim of the study was to investigate the trend of brucellosis incidence during 2006 to 2016 and the components affecting such disease. MATERIALS AND METHODS: This was a trend study which was conducted on the total of 144 brucellosis cases were recorded in the registration software in CDC of Iranian, Ministry of Health. We analyzed the changes in brucellosis incidence during 2006 to 2016 in Juybar province by the join point regression. Moreover, comparing the changes of incidence in one year intervals was also taken into account. RESULTS: The average age of patients was 18±29 years. About 60% of the patients were men, and 85.4% had used non-pasteurized dairy and meat products. The contact with animals had a significant difference between the two genders (P= 0.006). During 2006 to 2016, brucellosis incidence had a decreased trend about 15%. This trend had a breakpoint in a way that during 2006 to 2008, 66.2% decrease and during 2008 to 2016, 7% increase was observed that none of these annual percentage changes (APC) were statistically significant at p= 0.05. Also, APC of brucellosis incidence in groups below 20 and between 20 to 50 years old had a decrease in a way that in groups under 20, it had 26.7% decrease and it was statistically significant. CONCLUSION: It is necessary to provide appropriate education training, information on the Human Brucellosis for the young and individuals with high risk professions. Moreover, some health behaviors such as not using non-pasteurized dairy, animals' vaccinations, and awareness of the disease symptoms are needed.

Silent changes of tuberculosis in Iran (2005-2015): A joinpoint regression analysis.

INTRODUCTION AND AIM: Tuberculosis (TB) poses a severe risk to public health through the world but excessively distresses low-income nations. The aim of this study is to analyze silent changes of TB in Iran (2005-2015): A joinpoint regression analysis. MATERIALS AND METHODS: This is a trend study conducted on all patients (n = 70) that register in control disease center of Joibar (one of coastal cities and tourism destination in Northern Iran which was recognized as an independent town since 1998) during 2005-2015. The characteristics of patients imported to the SPSS 19 and variation in incidence rate of different forms of pulmonary TB (PTB) (PTB+ or PTB-) and extra-PTB (EPTB)/year was analyzed. Variation in incidence rate of TB for male and female groups and different age groups (0-14, 15-24, 25-34, 35-44, 45-54, 55-64, and above 65 years) was analyzed, variation in trend of this diseases for different groups was compared in intended years, and also, variation in incidence rate of TB was analyzed by Joinpoint Regression Software. RESULTS: The total number of TB was 70 cases during 2005-2015. The mean age of patients was 42.31 ± 21.26 years and median age was 40 years. About 71.4% of patients were PTB (55.7% for with PTB+ and 15.7% with PTB-) and rest of them (28.4%) were EPTB. In regard to classification of cases, 97.1% of them were new cases, 1.45% of them were relapsed cases, and 1.45% of them imported cases. In addition, history of hospitalization due to TB was observed in 44.3%. CONCLUSION: Despite recent developments of governmental health-care system in Iran and proper access to it and considering this fact that identification of TB cases with passive surveillance is possible. Hence, developing certain programs for sensitization of the covered population is essential.

Epidemiologic Investigation of Dysentery in North of Iran: Use of Geographic Information System (GIS).

INTRODUCTION: Dysentery is an intestinal inflammation which is created by the microorganisms attacking intestine mucus. Knowing the prevalence of this disease in different societies paves the way for programming and providing treatment and preventive measures. The main purpose of this study is to investigate the epidemiologic pattern and geographical distribution of dysentery based on GIS. METHOD: This was a cross-sectional and analytical study. The dysentery cases were gathered from the section of contagious diseases in health chancellery of Mazandaran University of medical sciences through a checklist during the years 2008 to 2013. In order to analyze the data, we made use of chi-square test. Then, the GIS software was used to recognize the geographical distribution of the disease. FINDINGS: There was reported about 653 cases affected by dysentery and the disease proportion was equal for both men and women. Most of the persons with dysentery was city dwellers. The highest rate of incidents was reported to be in Fereidunkenar in 2011, and the disease was mostly found among farmers, students, and college students. CONCLUSION: Since dysentery is a disease transmitted from water and food, and in this study, it was found out that the disease sources included using polluted water, vegetables, and lack of appropriate personal hygiene. Therefore, it is essential to take into consideration the health issues. Moreover, the suitable conditions of the geographical area which has the highest rate of incident have paved the way for dysentery occurrence. In addition, using geographic information system (GIS) as a visual instrument can help the stakeholders and officials to elaborate on the death trend and recognize the areas for optimal use of the available resources.