RESUMO
Leishmaniasis has a long history in the Islamic Republic of Iran. This study aimed to show the trend in leishmaniasis incidence from 1983 to 2012 and to describe the epidemiological characteristics in 2012. In a retrospective cross-sectional study, data were extracted from th%e national leishmaniasis surveillance system for the 3 clinical types-cutaneous (zoonotic and anthroponotic) and visceral (zoonotic). The average annual number of cutaneous leishmaniasis cases was 18 884 (average annual incidence 32 cases per 100 000 inhabitants). In 2012 the highest incidences were in age groups 1-4 and 5-9-years (43 and 40 per 100 000), and more males (57%) than females (43%) were infected. The annual average number of zoonotic visceral leishmaniasis cases was 175 (average annual incidence 0.18 per 100 000). The incidences of cutaneous and zoonotic visceral leishmaniasis have decreased in recent years, which coincides with national leishmaniasis control efforts.
Assuntos
Leishmaniose/epidemiologia , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , MasculinoRESUMO
BACKGROUND & OBJECTIVES: ZCL is a growing threat in many rural areas of Iran which involves 17 out of 31 provinces. This study was conducted from April to November 2011 for evaluation of the efficacy of phostoxin and zinc phosphide against rodents. METHODS: Rodent control operations were carried out using phostoxin and zinc phosphide. To evaluate the effect of rodent control operation on the main vector density, an entomological survey was carried out. The effects of the operation on the disease incidence were also evaluated. RESULTS: After intervention, the reduction rate of rodent burrows was 32.68% in the village treated with phostoxin and 58.14% in the village treated with zinc phosphide. The number of rodent holes in the control area showed 6.66-fold increase at the end of the study. The incidence of the disease decreased to 19.23 and 11.40 in areas treated with phostoxin and zinc phosphide, respectively. A total of 4243 adult sandflies were collected and identified. The most common and dominant species was Phlebotomus papatasi. In the village treated with phostoxin, the density of P. papatasi in outdoors was lower than indoors. Nevertheless, the density of P. papatasi in the village treated with zinc phosphide was higher in outdoors. INTERPRETATION & CONCLUSION: It is concluded that phostoxin is less effective and has low safety in comparison with zinc phosphide, so that this rodenticide can be used only in special situations such as lack or ineffective rodenticides and only in the colonies far from human and animal dwelling places in small scales.
Assuntos
Compostos de Alumínio/administração & dosagem , Leishmaniose Cutânea/prevenção & controle , Controle de Pragas/métodos , Praguicidas , Fosfinas/administração & dosagem , Compostos de Zinco/administração & dosagem , Animais , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Leishmaniose Cutânea/epidemiologia , Phlebotomus/crescimento & desenvolvimentoRESUMO
AIMS: Most evidence on psychosocial factors in recent-onset psychosis comes from high-income countries in Europe, Australia, Canada and the USA, while these factors are likely to differ under varying sociocultural and economic circumstances. In this study, we aimed to investigate associations of self-stigma, religiosity and perceived social support with symptom severity and psychosocial functioning in an Iranian cohort of people with recent-onset psychosis (i.e. illness duration of <2 years). METHODS: We used baseline data of 361 participants (N = 286 [74%] male, mean age = 34 years [Standard Deviation = 10.0]) from the Iranian Azeri Recent-onset Acute Phase Psychosis Survey (ARAS). We included assessments of self-stigma (Internalized Stigma of Mental Illness, ISMI), religiosity (based on Stark & Glock), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS), symptom severity (Positive And Negative Syndrome Scale, PANSS) and psychosocial functioning (clinician-rated Global Assessment of Functioning Scale, GAF, and self-reported World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0). Descriptive analyses were employed to characterize the study sample. Covariate-adjusted ordinal and multivariable linear regression analyses were performed to investigate cross-sectional associations of baseline ISMI, religiosity and MSPSS with concurrent PANSS, GAF and WHODAS 2.0. RESULTS: Higher self-stigma was associated with poorer self-reported functioning (B = 0.375 [95% Confidence Interval (CI): 0.186, 0.564]) and more severe concurrent symptoms (B = 0.436 [95% CI: 0.275, 0.597]). Being more religious was associated with poorer clinician-rated functioning (OR = 0.967 [95% CI: 0.944, 0.991]), but with less severe symptoms (B = -0.258 [95% CI: -0.427, -0.088]). Stronger social support was associated with poorer clinician-rated (OR = 0.956 [95% CI: 0.935, 0.978]) and self-reported functioning (B = 0.337 [95% CI: 0.168, 0.507]). CONCLUSION: This study shows that self-stigma, religiosity and perceived social support were associated with symptom severity and clinician-rated as well as self-reported psychosocial functioning in an Iranian cohort of people with recent-onset psychosis. The findings extend previous evidence on these psychosocial factors to one of the largest countries in the Middle East, and suggest that it may be worthwhile to develop strategies aimed at tackling stigma around psychosis and integrate the role of religiosity and social support in mental ill-health prevention and therapy.
Assuntos
Transtornos Psicóticos , Estigma Social , Apoio Social , Humanos , Masculino , Feminino , Adulto , Transtornos Psicóticos/psicologia , Irã (Geográfico) , Adulto Jovem , Funcionamento Psicossocial , Índice de Gravidade de Doença , Estudos Transversais , Escalas de Graduação Psiquiátrica , AutoimagemRESUMO
OBJECTIVES: Studies on the comorbidity of multiple sclerosis (MS) and allergic disorders have shown conflicting results. Carbamazepine (CBZ) is widely used in MS to control pain. We have compared the incidence of rash from CBZ use in MS and epilepsy. MATERIALS AND METHODS: Consecutive adult patients with MS and epilepsy were studied retrospectively. A detailed survey of medical records concerning CBZ treatment was performed. RESULTS: A total of 495 patients with epilepsy and 442 patients with MS were included. Sixty-five per cent of patients with epilepsy and 20% of patients with MS had used CBZ. In CBZ-exposed patients, rash occurred in 15/89 (17%) in MS and in 43/323 (13%) in epilepsy, a difference which was not significant. Women below 50 years experienced more skin reactions than older women and men. The unadjusted odds ratio (OR) for rash in the MS vs epilepsy group was 1.32 (CI 0.70-2.51, P = 0.40). Adjusting groups for gender and age reduced the OR to 1.11 (CI 0.56-2.19, P = 0.76). CONCLUSION: Compared with epilepsy, which is only rarely caused by immunological mechanisms, the autoimmune disorder MS was not associated with a different occurrence of CBZ skin reactions. The trend towards an increased occurrence of rashes in MS can partly be explained by a higher predisposition to CBZ rash in women of fertile age.
Assuntos
Anticonvulsivantes/efeitos adversos , Carbamazepina/efeitos adversos , Epilepsia/tratamento farmacológico , Exantema/induzido quimicamente , Esclerose Múltipla/tratamento farmacológico , Dor/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Dor/etiologia , Estudos Retrospectivos , Fatores SexuaisRESUMO
Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus is transmitted to humans through the bite of Ixodid ticks or contact with blood or tissues of CCHF patients or infected livestock. In December 2008, a re-emerging outbreak of CCHF occurred in the southern part of Iran. Five people were hospitalised with sudden fever and haemorrhaging, and CCHF was confirmed by RT-PCR and serological assays. One of the cases had a fulminant course and died. Livestock was identified as the source of infection; all animals in the incriminated herd were serologically analysed and more than half of them were positive for CCHFV. We demonstrated that two routes of transmission played a role in this outbreak: contact with tissue and blood of infected livestock, and nosocomial transmission. Phylogenetic analyses helped to identify the origin of this transmission. This outbreak should be considered as a warning for the national CCHF surveillance system to avoid further outbreaks through robust prevention and control programmes.
Assuntos
Vírus da Febre Hemorrágica da Crimeia-Congo/genética , Vírus da Febre Hemorrágica da Crimeia-Congo/isolamento & purificação , Febre Hemorrágica da Crimeia/diagnóstico , Febre Hemorrágica da Crimeia/transmissão , Gado/virologia , Animais , Anticorpos Antivirais/sangue , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Surtos de Doenças , Vírus da Febre Hemorrágica da Crimeia-Congo/classificação , Vírus da Febre Hemorrágica da Crimeia-Congo/imunologia , Febre Hemorrágica da Crimeia/mortalidade , Febre Hemorrágica da Crimeia/virologia , Humanos , Irã (Geográfico)/epidemiologia , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Testes Sorológicos , Carrapatos/virologia , ZoonosesRESUMO
Visceral leishmaniasis (VL) is endemic in parts of Islamic Republic of Iran. A cross-sectional seroprevalence study was carried out in children in Booyerahmad district in the south-west of the country. Serum samples were taken from 1628 children up to 10 years old from different areas in Booyerahmad in 2005-06. AntiLeishmania antibody was detected in 50 out of 1628 children (3.1%) by direct agglutination test (antibody titre > or = 1:3200). There was no significant difference in seropositivity between the sexes (2.8% males and 3.3% females). The highest rate of infection (5.2%) was in the age group 10 years. Further studies are needed to explore the reservoirs and vectors of the disease in this region.
Assuntos
Proteção da Criança/estatística & dados numéricos , Doenças Endêmicas/estatística & dados numéricos , Leishmaniose Visceral/epidemiologia , Distribuição por Idade , Animais , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Análise por Conglomerados , Estudos Transversais , Reservatórios de Doenças , Vetores de Doenças , Cães , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Leishmaniose Visceral/sangue , Leishmaniose Visceral/etiologia , Leishmaniose Visceral/veterinária , Masculino , Vigilância da População , Estudos Soroepidemiológicos , Distribuição por SexoRESUMO
In 2001 a visceral leishmaniasis (VL) surveillance system was set up for children aged < or = 12 years in the primary health system in Meshkin-Shahr district of Ardebil province, north-western Islamic Republic of Iran. All cases with clinical signs and symptoms of VL and positive by the direct agglutination test were referred for physical examination and treatment. The mean annual incidence of VL decreased significantly from 1.88 before (1985-2000) to 0.77 per 1000 child population after the intervention (2001-07). In a control area with no surveillance, it increased from 0.11 to 0.23 per 1000. Early detection of VL using practical serological tests and timely treatment of cases could decrease the mortality and morbidity rates of VL in endemic areas.
Assuntos
Serviços de Saúde da Criança/organização & administração , Leishmaniose Visceral , Vigilância da População/métodos , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , Testes de Aglutinação , Distribuição de Qui-Quadrado , Criança , Notificação de Doenças/métodos , Doenças Endêmicas/prevenção & controle , Doenças Endêmicas/estatística & dados numéricos , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/epidemiologia , Estudos Longitudinais , Programas de Rastreamento/organização & administração , Avaliação de Programas e Projetos de SaúdeRESUMO
Zoonotic cutaneous leishmaniasis (ZCL), a vector-borne disease, poses serious psychological as well as social and economic burden to many rural areas of Iran. The main objectives of this study were to analyse yearly spatial distribution and the possible spatial and spatio-temporal clusters of the disease to better understand spatio-temporal epidemiological aspects of ZCL in rural areas of an endemic province, located in north-east of Iran. Cross-sectional survey was performed on 2983 recorded cases during the period of 2010-2012 at village level throughout the study area. Global clustering methods including the average nearest-neighbour distance, Moran's I, general G indices and Ripley's K-function were applied to investigate the annual spatial distribution of the existing point patterns. Presence of spatial and spatio-temporal clusters was investigated using the spatial and space-time scan statistics. For each year, semivariogram analysis and all global clustering methods indicated meaningful persistent spatial autocorrelation and highly clustered distribution of ZCL, respectively. Eight significant spatial clusters, mainly located in north and northeast of the province, and one space-time cluster, observed in northern part of the province and during the period of September 2010-November 2010, were detected. Comparison of the location of ZCL clusters with environmental conditions of the study area showed that 97.8% of cases in clusters were located at low altitudes below 725 m above sea level with predominantly arid and semi-arid climates and poor socio-economic conditions. The identified clusters highlight high-risk areas requiring special plans and resources for more close monitoring and control of the disease.
Assuntos
Leishmaniose Cutânea/epidemiologia , Adolescente , Adulto , Idoso , Animais , Criança , Pré-Escolar , Clima , Análise por Conglomerados , Estudos Transversais , Feminino , Sistemas de Informação Geográfica , Humanos , Lactente , Recém-Nascido , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , População Rural , Distribuição por Sexo , Fatores Socioeconômicos , Análise Espaço-Temporal , Adulto Jovem , Zoonoses/epidemiologiaRESUMO
We determined the knowledge and practice of private sector physicians in three cites regarding management of pulmonary tuberculosis (TB) and their determinants. A random sample questionnaire survey was conducted of 732 private physicians. Stratified analysis and logistic regression were used to identify the adjusted determinants of the two outcomes. A high proportion of the doctors had correct knowledge about the major diagnostic criteria but there was a low level of knowledge and practice of TB management. Significant risk factors for poor knowledge were age > or = 36 years, being a GP rather than a specialist and no attendance in TB training courses or attendance in courses held by institutions other than the public health system. Age > or = 36 years was the only significant risk factor for poor practice.
Assuntos
Fidelidade a Diretrizes/normas , Medicina , Médicos de Família , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Setor Privado/normas , Especialização , Tuberculose Pulmonar , Adulto , Fatores Etários , Antituberculosos/uso terapêutico , Atitude do Pessoal de Saúde , Competência Clínica/normas , Estudos Transversais , Terapia Diretamente Observada/normas , Educação Médica , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Irã (Geográfico) , Modelos Logísticos , Medicina/organização & administração , Avaliação das Necessidades , Avaliação de Processos e Resultados em Cuidados de Saúde , Médicos de Família/educação , Médicos de Família/organização & administração , Médicos de Família/psicologia , Indicadores de Qualidade em Assistência à Saúde/normas , Inquéritos e Questionários , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus (CCHFV) is transmitted to humans through the bite of Ixodid ticks or by contact with blood or tissues of infected livestock. In addition to zoonotic transmission, CCHFV can be spread from person to person and is one of the rare haemorrhagic fever viruses able to cause nosocomial outbreaks in hospitals. Crimean-Congo haemorrhagic fever is a public health problem in many regions of the world such as Eastern Europe, Asia, the Middle East and Africa. In addition to clinical symptoms, the diagnosis of CCHF is based on the use of serological tests for the detection of immunoglobulin M and immunoglobulin G antibodies and on the use of molecular tools such as RT-PCR. From 1970 to 1978, serological and epidemiological studies were performed in humans and in livestock of Iran. After two decades and observations of CCHF in some provinces of Iran, a CCHF surveillance and detection system was established in 1999, leading to a dramatically decreased mortality rate from 20% (year 2000) to 2% (year 2007).
Assuntos
Vetores Aracnídeos/virologia , Vírus da Febre Hemorrágica da Crimeia-Congo/isolamento & purificação , Febre Hemorrágica da Crimeia/diagnóstico , Febre Hemorrágica da Crimeia/epidemiologia , Carrapatos/virologia , Animais , Febre Hemorrágica da Crimeia/mortalidade , Febre Hemorrágica da Crimeia/transmissão , Humanos , Irã (Geográfico)/epidemiologia , Reação em Cadeia da Polimerase , Vigilância de Evento Sentinela , Testes SorológicosRESUMO
Visceral leishmaniasis [VL] is endemic in parts of Islamic Republic of Iran. A cross-sectional seroprevalence study was carried out in children in Booyerahmad district in the south-west of the country. Serum samples were taken from 1628 children up to 10 years old from different areas in Booyerahmad in 2005-06. Anti-Leishmania antibody was detected in 50 out of 1628 children [3.1%] by direct agglutination test [antibody titre > 1:3200]. There was no significant difference in seropositivity between the sexes [2.8% males and 3.3% females]. The highest rate of infection [5.2%] was in the age group 10 years. Further studies are needed to explore the reservoirs and vectors of the disease in this region
Assuntos
Prevalência , Estudos Soroepidemiológicos , Estudos Transversais , Leishmaniose VisceralRESUMO
In 2001 a visceral leishmaniasis (VL) surveillance system was set up for children aged ≤ 12 years inthe primary health system in Meshkin-Shahr district of Ardebil province, north-western Islamic Republic ofIran. All cases with clinical signs and symptoms of VL and positive by the direct agglutination test were referredfor physical examination and treatment. The mean annual incidence of VL decreased significantly from 1.88before (1985–2000) to 0.77 per 1000 child population after the intervention (2001–07). In a control area with nosurveillance, it increased from 0.11 to 0.23 per 1000. Early detection of VL using practical serological tests andtimely treatment of cases could decrease the mortality and morbidity rates of VL in endemic areas
En 2001, un système de surveillance de la leishmaniose viscérale a été mis en place pour les enfants âgésde 0 à 12 ans dans le système de santé primaire du district de Meshkin-Shahr, province d’Ardebil, nord-ouest dela République islamique d’Iran. Tous les cas présentant des signes cliniques et des symptômes de leishmanioseviscérale ainsi qu’une réaction positive au test d’agglutination directe étaient orientés en vue d’un examen physiqueet d’un traitement. L’incidence annuelle moyenne de la leishmaniose viscérale a nettement diminué, passant de1,88 avant l’intervention (1985-2000) à 0,77 pour 1 000 enfants après l’intervention (2001-2006). Elle a augmentédans une zone témoin sans surveillance, passant de 0,11 à 0,23 pour 1 000 enfants. Un dépistage précoce dela leishmaniose viscérale à l’aide de tests sérologiques pratiques et une prise en charge rapide des cas permettraientde réduire les taux de mortalité et de morbidité de la leishmaniose viscérale dans les zones endémiques
Assuntos
Vigilância da População , Incidência , Leishmaniose Visceral , Atenção Primária à SaúdeRESUMO
We determined the knowledge and practice of private sector physicians in three cites regarding management of pulmonary tuberculosis [TB] and their determinants. A random sample questionnaire survey was conducted of 732 private physicians. Stratified analysis and logistic regression were used to identify the adjusted determinants of the two outcomes. A high proportion of the doctors had correct knowledge about the major diagnostic criteria but there was a low level of knowledge and practice of TB management. Significant risk factors for poor knowledge were age > / = 36 years, being a GP rather than a specialist and no attendance in TB training courses or attendance in courses held by institutions other than the public health system. Age > / = 36 years was the only significant risk factor for poor practice