An approach to the milestones of spine surgery in Persian traditional medicine.

BACKGROUND: The diagnosis and treatment of spine disorders have been challenging for thousands of years in different nations and medical schools. Despite this long history, there are many information gaps in this regard. The current research deals with the milestones and progress of spine surgery from ancient times until now, emphasizing the innovations of sages in the Persian traditional medicine era. METHODS: The present study is based on searching original and library documents, data from databases such as PubMed, Scopus, and Science Direct, and search engines such as Google Scholar. RESULTS: In Persian traditional medicine, Rhazes (865-925 AD) was the first sage who applied spine surgery based on the innovative knowledge of Galen (second century AD) and Paulus Aegineta (seventh century AD). Hally Abbas (tenth century AD), by suturing two separated bones during spine surgery, and Albucasis (936-1013 AD), by inventing, describing, and drawing the surgical instruments involved in surgeries in this area, and also using cauterization in the treatment of children's hunchback, were the innovators of new methods. CONCLUSION: The modern knowledge of spine surgery is based on intelligent experiences and prominent thoughts from thousands of years worldwide. However, sometimes, these key points have remained hidden. This issue necessitates investigating this science in different schools and territories for comparative studies, identifying the firsts in the prominent points of this field, preserving the identity of sages and nations, and preventing scientific plagiarism.

Immune endotyping and gene expression profile of patients with chronic rhinosinusitis with nasal polyps in the aspirin-exacerbated respiratory disease (AERD) and the non-AERD subgroups.

BACKGROUND: Chronic Rhinosinusitis (CRS) is a paranasal sinus inflammatory disease and is divided into two subgroups defined as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays a T helper (Th)2 biased phenotype, and based on sensitivity or tolerance to aspirin or non-steroidal anti-inflammatory drugs (NSAID), is further subdivided into Aspirin-exacerbated respiratory disease (AERD) and non-AERD groups. Considering the challenge of diagnosis and treatment in patients with CRSwNP, particularly the AERD subtype, and the significance of endotyping in these patients, we examined the immune profile and endotyping based on gene expression analysis in the AERD and the non-AERD groups of patients with CRSwNP. MATERIAL AND METHOD: In this study, 21 patients were enrolled and were categorized into AERD (N = 10) and non-AERD (N = 11) groups based on their sensitivity to aspirin. After the special washing period, nasal polyps were biopsied in both groups, and the infiltration of eosinophils, neutrophils, plasma cells, and lymphocytes was compared between the AERD and the non-AERD groups. Also, gene expression levels of transcription factors including Tbet, GATA3, RoRγt, and FoxP3 and inflammatory cytokines including interleukin (IL)1ß, IL1RAP (IL1 receptor accessory protein), IL2, IL4, IL5, IL10, IL13, IL17, TNFα, and IFNγ were investigated by quantitative Real-time PCR (qRT-PCR). Statistical analyses were performed using analytical tests including Kolmogorov-Smirnov, Mann-Whitney, and T-test. A P value less than 0.05 was considered statistically significant. RESULTS: The mean ± SD age of the studied groups was 37 ± 8.7 years old (21-50) for the AERD, and 40.4 ± 7.7 years old (31-52) for the non-AERD. LMS/EPOS/SNOT scores and pulmonary function tests showed no difference between the two groups. Serum immunoglobulin E (IgE) levels were found to be higher in patients with AERD (p = 0.04), however, the peripheral blood counts of eosinophils were comparable in the two groups. In the histopathologic analysis, the AERD group showed higher percentages of eosinophils (p = 0.04), neutrophils (p = 0.04), and plasma cells (p = 0.04) than the non-AERD group. Additionally, the gene expression levels of GATA3 (p = 0.001), IL4 (p = 0.04), IL5 (p = 0.007), and IL17 (p = 0.03) were significantly higher in the AERD than the non-AERD groups. CONCLUSION: Higher gene expression levels of GATA3, IL4, IL5, and IL17 were observed in the AERD group compared with the non-AERD group. These findings point to distinct patterns of inflammation in patients with AERD, with a predominance of Th2 inflammation.

Evidences for reaction mechanism of 9DB1 DNA catalyst.

The first reported reaction mechanism of a DNAzyme, i.e. 9DB1, by using molecular dynamics (MD) simulations includes some ambiguities. We try to overcome some of these ambiguous aspects such as the role of mono and divalent metal ions and observed metal rescue effects by surveying the role of functional groups of original 9DB1 and a variety of its rate conserving and rate decreasing mutations via MD simulations. Conformational differences of these two distinct groups are responsible for their opposite rate trends. Blocking of the OH3' of acceptor nucleotide from effective attack by its hydrogen bond to O4' of donor nucleotide is observed in rate decreasing mutations. Our simulations manifest the role of Na+ and Mg2+ ions in bringing close to each other the ligated atoms. These findings along with observed conformational changes explain carefully the reported metal rescue effects for some phosphate groups.

The historical course of varicose vein surgery in the Persian medicine.

INTRODUCTION: Dawali (varicose veins) is the disease of chronic dilation of veins. The veins of the legs become dilated and blue due to excessive accumulation of blood. This disease and the effort to identify and treat it has a very long history. The condition may have first been described in the Ebers Papyrus more than 3500 years ago. The present study deals with the turning points and progress of varicose vein surgery since ancient times, emphasizing the innovations of the scholars of the Islamic period. METHODS: The present study is based on searching library documents and database data such as PubMed, Scopus, Science Direct, and search engines such as Google Scholar. In the end, the Prisma flow chart was drawn. RESULTS: Besides diagnosing different varicose veins (legs, thighs, abdomen, uterus, and testes), the scholars of the Islamic period were well-versed in their prevention, etiology, and treatment. In treating varicose veins, these physicians used methods such as cleansing, phlebotomy, compression, leech therapy, and surgery, and some of them were the founders of new treatments. CONCLUSION: The surgical treatment of varicose veins in the past was similar to modern surgical therapies. What distinguishes yesterday's varicose vein surgery from today's surgery is a more advanced tool. There is no denying the remarkable progress in using health principles, treatment techniques, and surgical instruments to facilitate surgery and reduce the disease's complications and recurrence. However, the treatment framework and foundation, such as phlebectomy and compression, were all invented and introduced in the distant past.

Cauterization's history in the Persian medicine school.

BACKGROUND: Cauterization has been used in various medical schools to prevent and treat diseases. Its application dates back to shortly after the invention of fire. Despite its long history, different aspects and the importance of cauterization in various medical schools have remained elusive. The present study addressed the milestones and progress of cauterization from ancient times to the present, emphasizing the innovations of the Persian medicine school. METHODS: The present study is based on searching in the library documents of famous Persian medicine scholars and data from databases such as Ovid, PubMed, Science Direct, Scopus, ProQuest, and Google Scholar search engines. RESULTS: Persian Medicine scholars used various cauterization methods such as hot metals and corrosive drugs to stop bleeding, prevent the development and spread of infection, and treat hydrocephalus and rabies. Cauterization has been associated with considerations to prevent irreversible tissue damage and whether or not it is internal or external. CONCLUSION: Cauterization has been associated with different practical purposes. With evolutionary progress and the use of different techniques and tools throughout history, the tools such as Electrocautery or Galvanocautery are some manifestations of new applications of cauterization. Numerous studies have indicated the continuation of newer applications, indicating the inexhaustible human interest in this ancient technique.

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018.

BACKGROUND: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA. METHODS: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. RESULTS: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. CONCLUSIONS: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Efficiency of Iranian Hospitals Before and After Health Sector Evolution Plan: A Systematic Review and Meta-Analysis Study.

Purpose: Aging, chronic diseases, and development of expensive and advanced technologies has increased hospitals costs which have necessitated their efficiency in utilization of resources. This systematic review and meta-analysis study has assessed the efficiency of Iranian hospitals before and after the 2011 Health Sector Evolution Plan (HSEP). Methods: Internal and external databases were searched using specified keywords without considering time limitations. The retrieved articles were entered into EndNote considering inclusion and exclusion criteria, and the final analysis was performed after removing duplicates. Heterogeneity between the studies was assessed using Q and I2 tests. A forest plot with 95% confidence intervals (CI) was used to calculate different types of efficiency. The data were analyzed using STATA 14. Results: Random pooled estimation of hospitals technical, managerial, and scale efficiencies were 0.84 (95%CI = 0.78, 0.52), 0.9 (95%CI = 0.85, 0.94), and 0.88 (95%CI = 0.84, 0.91), respectively. Sub-group analysis on the basis of study year (before and after HSEP in 2011) indicated that random pool estimation of technical (0.86), managerial (0.91), and scale (0.90) efficiencies of Iranian hospitals for 2011 and before were better than technical (0.78), managerial (0.86), and scale (0.74) efficiencies after 2011. Conclusion: Type of hospital ownership was effective on hospital efficiency. However, HSEP has not improved hospital efficiency, so it is necessary for future national plans to consider all aspects.

Effect of Consumption of Whole-Wheat Breads on FBS, HbA1c, and Blood Lipids in Patients with Type 2 Diabetes.

Whole-wheat can have positive effect on blood parameters, such as blood sugar and fat profiles, in patients with diabetic. The aim of this study was to assess the effect of whole-wheat breads on hemoglobin A1c (HbA1c) and blood lipids in patients with type 2 diabetes (T2D). The study population included men and women with T2D aged 30 years old and over in Arak, Iran. Using random sampling method, 60 patients with T2D were selected and randomly divided into control and intervention groups. After taking blood samples from the patients, the intervention group was administered 180 g of wholegrain wheat for 12 weeks. The participants were asked not to change their diets and amounts of physical activity during the study period. After 12 weeks, blood samples were taken and insulin resistance indexes, blood glucose levels, and lipid profiles were examined. The results indicated that consumption of whole-wheat bread for 12 weeks can significantly reduce body weight, and HbA1c, triglyceride, total cholesterol, and low density lipoprotein cholesterol (LDL-c) levels, and increase high density lipoprotein cholesterol (HDL-c) levels (P<0.05). However, in the control group, changes in body weight, body mass index, HbA1c, total cholesterol, HDL-c, and LDL-c levels did not significantly differ before and after the intervention period (P>0.05). As consumption of whole-wheat bread has positive effects on control of various physical and biochemical indictors in patients with diabetes, its consumption should be included in educational programs at health centers across the country.

Physical and mental growth and development in children with congenital hypothyroidism: a case-control study.

INTRODUCTION: The clinical complications of congenital hypothyroidism such as brain disorders are very subtle and are not recognizable in infancy period. They are recognizable when it is too late for treatment or prevention. General screening of newborns is effective in diagnosing congenital hypothyroidism and initiating initial treatment. The aim of this study is to compare the physical and mental growth pattern of children with congenital hypothyroidism with healthy ones. METHODS: This case-control study was performed on 34 patients and 68 healthy children who were matched in terms of inclusion and exclusion criteria. Children development screening test (ASQ), children development assessment test (Bayley), preschool Wechsler intelligence scale (WPPSI) and age and steps questionnaire of emotional social development (ASQ-SE) were completed by trained questioners. Data were analyzed using STATA software. RESULTS: The results indicated that there was no significant difference between the mean of verbal (P = 0.77), non-verbal (P = 0.81) and general (P = 0.66) IQ in permanent and transient patients and healthy individuals. Also, there was no significant difference between the mean of different ranges of ASQ test (including communication, delicate and large movements, problem solving and social) at 12 months and 42 months (P < 0.05). According to Bayley test, there was no significant difference between the cases (permanent and transient) and controls in the cognitive (P = 0.42) and expressive (P = 0.38) categories. The difference was significant in the perceptual (P = 0.011), large (P = 0.03) and delicate (P = 0.04) movements categories. CONCLUSION: This study emphasized on the high effectiveness of neonate hypothyroidism screening program, so that the difference between 3.5 years old children with and without this disease has decreased significantly. Early diagnosis of the patients, while creating beneficial effects for patients and increasing quality of life, cause reduction in the long-term costs of the health system.

Effect of cold stress on polyamine metabolism and antioxidant responses in chickpea.

Metabolic and genomic characteristics of polyamines (PAs) may be associated with the induction of cold tolerance (CT) responses in plants. Characteristics of PAs encoding genes in chickpea (Cicer arietinum L.) and their function under cold stress (CS) are currently unknown. In this study, the potential role of PAs along with the antioxidative defense systems were assessed in two chickpea genotypes (Sel96th11439, cold-tolerant and ILC533, cold-sensitive) under CS conditions. Six days after exposure to CS, the leaf H2O2 content and electrolyte leakage index increased in the sensitive genotype by 47.7 and 59 %, respectively, while these values decreased or remained unchanged, respectively, in the tolerant genotype. In tolerant genotype, the enhanced activity of superoxide dismutase (SOD) (by 50 %) was accompanied by unchanged activities of ascorbate peroxidase (APX), guaiacol peroxidase (GPX) and catalase (CAT) as well as the accumulation of glutathione (GSH) (by 43 %) on the sixth day of CS. Higher levels of putrescine (Put) (322 %), spermidine (Spd) (45 %), spermine (Spm) (69 %) and the highest ratio of Put/(Spd + Spm) were observed in tolerant genotype compared to the sensitive one on the sixth day of CS. Gamma-aminobutyric acid (GABA) accumulation was 74 % higher in tolerant genotype compared to the sensitive one on the sixth day of CS. During CS, the activity of diamine oxidase (DAO) and polyamine oxidase (PAO) increased in tolerant (by 3.02- and 2.46-fold) and sensitive (by 2.51- and 2.8-fold) genotypes, respectively, in comparison with the respective non-stressed plants (normal conditions). The highest activity of DAO and PAO in the tolerant genotype was accompanied by PAs decomposition and a peak in GABA content on the sixth day of CS. The analysis of chickpea genome revealed the presence of five PAs biosynthetic genes, their chromosomal locations, and cis-regulatory elements. A significant increase in transcript levels of arginine decarboxylase (ADC) (24.26- and 7.96-fold), spermidine synthase 1 (SPDS1) (3.03- and 1.53-fold), SPDS2 (5.5- and 1.62-fold) and spermine synthase (SPMS) (3.92- and 1.65-fold) genes was detected in tolerant and sensitive genotypes, respectively, whereas the expression of ornithine decarboxylase (ODC) genes decreased significantly under CS conditions in both genotypes. Leaf chlorophyll and carotenoid contents exhibited declining trends in the sensitive genotype, while these photosynthetic pigments were stable in the tolerant genotype due to the superior performance of defensive processes under CS conditions. Overall, these results suggested the specific roles of putative PAs genes and PAs metabolism in development of effective CT responses in chickpea.

The effect of Iran's health transformation plan on hospital performance: Kerman province.

Iran has performed Health Transformation Plan (HTP) from 2014 to obtain its defined goals. This study assesses and compares university and non-university hospitals' efficiency and productivity in Kerman provinces, Iran. The data of 19 selected hospitals, two years before and two years after Health Transformation Plan, was collected in this cross-sectional study. These data included the variables of physician and nurse number, and active beds as inputs and bed occupancy rate and inpatient admission adjusted with the length of stay as outputs. Data Envelopment Analysis method used to measure hospital efficiency. Malmquist Productivity Index is used to measure the efficiency change model before and after the plan. The efficiency and effect of the plan on hospitals' efficiency and productivity were assessed using R software. The results indicated that all hospitals' average efficiency before the HTP was 0.843 and after the HTP was increased to 0.874. However, it was not significant (P>0.05). Productivity also had a decreasing trend. Based on the DEA method results, it was found that university and non-university hospitals' efficiency and productivity did not increase significantly after the HTP. Therefore, it is recommended that attention be paid to hospitals' performance indicators regarding how resources are allocated and decisions made.

Clinical Characteristics and Reproduction Number of Coronavirus Disease (COVID-19) Cases in Markazi Province in Iran.

BACKGROUND: The first case of Coronavirus Disease (COVID-19) was reported in Iran on February 19, 2020. This study aimed to assess the characteristics and reproduction number (R) of COVID-19 in Markazi province in Iran. METHODS: This is a cross-sectional study. Confirmed cases (N=2430) in the regions covered by Arak University of Medical Sciences from Feb 20 to Aug 26, 2020 were enrolled in the study. The included variables were clinical and demographic characteristics of COVID-19 patients. The case fatality rate (CFR), incidence rates, and R were estimated based on the daily reported data. For estimating R, generation time was assumed on multi scenarios. R was estimated by R0-package. Moreover, Chi square test was applied. All the analyses were performed in STATA, Excel, ArcMap and R. A p-value less than 0.05 was considered as statistically significant. CONCLUSION: As R is slightly high, the risk of epidemic has reduced gradually. However, observing social distance and related guidelines are still recommended.

Abu Al Qasim Al Zahrawi (Albucasis) and types of his used surgical knives.

BACKGROUND: Surgical incisions require surgical knives. Different surgical knives have been used for surgical practice since its first appearance in surgical science, and evolved according to its progress. Albucasis, Spanish physician (936-1013 AD), is one of the surgical science pioneers whose initiatives in therapeutic and surgical methods are appreciable, as are his surgical instruments including numerous surgical knives. This study aims at thoroughly investigating the appearance, specifications, innovations, and applications of knives in specific surgical techniques. METHODS: Volume 30 of the Al-Tasrif li-man ajaza'an al-ta'lif (Al-Tasrif) of Albucasis was complemented with findings in Google Scholar, Ovid, PubMed, Science Direct, and Scopus databases to assess the types of surgical knives used by Albucasis and individualized for different diseases. RESULTS: The majority of the knives in Al-Tasrif have special names such as Mesbar, Maghdah, and Meshel. He chose a special knife dependent on the type of surgery and the incision needed, and adapted the shape of each knife to its use. CONCLUSIONS: Albucasis, more than previous physicians, such as Paulus Aegineta (625-690 AD), has invented surgical knives on basis of his own experiences and observations. His accurate knowledge of surgical techniques has resulted in appropriate designing and making functional knives.

Potential effective inhibitory compounds against Prostate Specific Membrane Antigen (PSMA): A molecular docking and molecular dynamics study.

One of the most prevalent cancers in men is prostate cancer and could be managed with immunotoxins or antibody treatment. Because of the substantial rise of the Prostate-Specific Antigen and the Prostate-Specific Membrane Antigen (PSMA), cancer vaccination should be rendered with these antigens. Through pharmacodynamic experiments in a library of natural compounds from ZINC database, the current research sought to identify compounds that could suppress PSMA protein. To test the most productive compounds for further research, the Library has been scanned with Pharmacophore and ADMET analysis followed by molecular docking methods in the first phase. After selecting 15 ligands with the best pose related to docking results, to evaluate the stability of the ligand-protein bounds of the compounds, a molecular dynamics simulation considering the effect of the presence of zinc ions on the protein structure was performed. The measurement of ligand binding modes and free energy has shown that four compounds, including Z10, Z06, Z01, and Z03, have formed critical interactions with the active site's residues. Besides, multiple approaches were employed to determine their inhibition rating and describe the variables that facilitate the attachment of ligands to the protein active site. The results are obtained from the MMPBSA/GBSA analysis of four selected small molecules (Z10, Z06, Z01, and Z03), which are very close to the IC50 value of reference ligand (DCIBzl); they are -13.85 kcal/mol, -12.58 kcal/mol, -10.71 kcal/mol and -9.39 kcal/mol respectively. Finally, we evaluate the results obtained from selected ligands using hydrogen bond and decomposition analyzes. We have examined the effective interactions between ligands and S1/S1'pockets in protein. Our computational results illustrate the design of more efficient inhibitors of PSMA.

Epidemiological status of suicide in the Middle East and North Africa countries (MENA) from 1990 to 2017.

BACKGROUND: Suicide is proposed as an important and growing issue in public health. The aim of this study is to compare suicide load in the Middle East and North Africa (MENA) countries in order to pave the way for correct health policy making. METHODS: The population included 21 MENA countries. The data of Global Burden of Diseases in 2017 that estimate death rate for 264 causes was used. The GBD considers suicide according to definition of the ninth and tenth editions of the international classification of diseases as death due to poisoning or intentional self-injury. All suicide-related analyzes were evaluated using these indicators in excel 2016. RESULTS: The highest percentage of total suicide DALY attributable to risk factors of Alcohol and drug use are related to United Arab Emirates and Afghanistan countries, respectively. Iran is the sole country without suicide DALY attributable to alcohol consumption risk factor. Moroccan women and Libya, Afghanistan and Yemen men have the highest DALY rates in terms of ASR in the region, respectively. Suicide incidence have an increasing trend until the age group of 20-24 and then a decreasing trend. This trend is on the rise again since the age of 65. DISCUSSION: The necessity to improve social, cultural and economic factors along with effective measures on suicide prevention especially among low and middle income countries, performing more studies and precise registration of the cases especially in the areas that suicide is considered social stigma and crime should be considered as high agenda in national and regional strategies.

Knowledge, Attitudes, and Practices Toward Coronavirus Disease 2019 in the Central Area of Iran: A Population-Based Study.

Background: The spread of the coronavirus disease 2019 (COVID-19) pandemic has imposed high threats on global health, life and work style, and social and economic development. The current study aimed to extract knowledge, attitudes, and practices related to COVID-19 among the general population in the central area of Iran. Method: A cross-sectional study was conducted in Arak City between April and May 2020. Stratified random sampling was applied to select the study participants. Phone interview was applied to collect the data. Data were collected using a questionnaire that was constructed and validated in this study. The questionnaire included demographic variables and items about knowledge, attitudes, and practices toward COVID-19. Descriptive and inferential analyses were conducted in STATA software. Results: In total, 544 participants completed the questionnaire; 76% of the participants accounted COVID-19 as a high threat 1 month from the onset of COVID-19. From the maximum attainable scores of 1, 6, and 6, for COVID-19-related knowledge, attitudes, and practices, means of 0.77 (0.13), 4.97 (0.63), and 5.35 (0.70) were obtained, respectively. Females had a higher practice score (5.4 ± 0.6). The participants with a family history of heart and respiratory diseases had significantly higher attitude and practice scores. SMS from the Ministry of Health had a significant impact on knowledge, attitude, and practice scores (p < 0.05). Conclusion: Higher attention should be given to increase the knowledge, attitudes, and practices of men and the housewife group. COVID-19 preventive messaging from the Ministry of Health was among the most influential methods of increasing knowledge that attracted public attention.

World one-hundred days after COVID-19 outbreak: Incidence, case fatality rate, and trend.

BACKGROUND: The prevalence of viral diseases is on the rise and has caused many problems for public health. COVID-19 is a new viral outbreak in the world. This study aimed to investigate the trends of incidence and case fatality rate (CFR) of COVID-19 in the world by April 30, 2020. METHODS: This was a descriptive-analytical study. We investigated the number of cases and deaths in 35 selected countries and regions of the WHO that had at least 10,000 cases by the time of the study. In addition, the incidence and CFR of COVID-19 were investigated. Finally, time trends of the number of cases, deaths, and CFR were investigated using ordinary least squares regression models. RESULTS: The total number of confirmed cases of COVID-19 was 3,090,184. The European region had the highest number of COVID-19 patients (1,434,649 [46.43%]). Ukraine with 10,406 and the USA with 1,003,974 cases have reported the lowest and highest confirmed cases, respectively. In addition, the European region and the African region with 157.13 and 2.50 patients per 100,000 population had the highest and the lowest incidence rate, respectively. India (2.44) and Spain (455.69) had the lowest and the highest incidence rate per 100,000 population, respectively. In the world, 217,759 deaths have happened, of which 135,961 (62.44%) were reported in the European region. Furthermore, the USA had the highest number of deaths (52,428) due to COVID-19. CFR was 7.05% in the world, which ranged from 3.74% in the African region and 9.48% in the European region. The number of patients and deaths due to COVID-19 had increasing trends in all countries, and the trend of CFR just for Iran and Ukraine was negative. CONCLUSION: The countries had different trends in the morbidity and mortality of COVID-19. However, regarding the increasing trend of the disease in the world, it will be more important to rely on public prevention strategies. It is necessary to apply and continue public health policies at national and global levels till the control of the disease.

Preferences of Medical Sciences Students for Work Contracts in Deprived Areas of Iran: A Discrete Choice Experiment Analysis.

BACKGROUND: An unequal distribution of human resources affects access to health-care services. This study aimed to elicit the preferences of medical, dentistry, and pharmacy students about attributes of work contracts in deprived areas of Iran; this is a primary important step to decrease inequity. METHODS: Two-hundred and one students were entered into the study through proportional sample size estimation from Kermanshah University of Medical Sciences in the west of Iran in 2018. The attributes of work contracts were determined using the discrete choice experiment (DCE) method, then possible dual scenarios of work contracts were designed through the D-efficiency method of SAS software and the data were collected using a questionnaire designed by the researchers. The conditional logistic model was used to analyze the data. RESULTS: Salary, workplace, side facilities, scholarship, and workload were considered as important factors for working in the deprived areas (p<0.001). There were differences between the students' preferences regarding their residential areas, majors, and state or tuition-paying education (p<0.001). Higher payments, side facilities, and availability of quota after working in the deprived areas were considered as creators of higher utility, and working in deprived areas and high workload were considered as creators of lower utility (p<0.001). CONCLUSION: This study provides new evidence about the preferences of medical sciences students for work contracts in deprived areas of Iran. According to the findings, money is not the only factor that affects the decisions of medical sciences students related to working contracts in deprived areas of Iran. Designing work contracts that are matched with preferences of the workforce can lead to an improvement in equity, access, and utilization of health-care services.