Mental health status and psychosocial issues during Nationwide COVID-19 quarantine in Iran in 2020: A cross-sectional study in Mazandaran Province.

The coronavirus disease 2019 (COVID-19) pandemic is spreading rapidly, and its psychosocial impact remains a big challenge. In this respect, quarantine has been recommended, as a significant practice, to prevent the given condition. Therefore, the present study was to determine the prevalence rates of depression, anxiety, and stress and to reflect on the impact of COVID-19, as a traumatic stressor event, on individuals. This web-based survey was fulfilled via an online questionnaire, completed by respondents selected through the cluster sampling technique, from March 24 to April 10, 2020, living in Mazandaran Province, Northern Iran. Accordingly, the data regarding demographic characteristics, physical health status, quarantine compliance, contact with COVID-19, and additional information were collected. The psychosocial impact of the pandemic was then assessed by the Impact of Event Scale-Revised (IES-R), and the respondents' mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Data analysis was further performed by linear regression. The study findings, from 1075 respondents, revealed that 22.5% of the cases had moderate-to-severe depression, 38.5% of the individuals were suffering from moderate-to-severe anxiety, and 47.2% of the participants were experiencing moderate-to-severe stress. In 14.5% of the respondents, the psychosocial impact of COVID-19 also varied from the possibility of post-traumatic stress disorder (PTSD) to immunosuppression (p < 0.01). With the high prevalence rates of depression, anxiety, and stress, mental health professionals are suggested to develop psychosocial interventions and support plans for the general population to reduce the impact of the COVID-19 pandemic on public mental health status.

Measles and rubella serosusceptibity among population vaccinated with different schedules: the potential impact on measles-rubella elimination in Iran.

BACKGROUND: Iranian children were vaccinated with the scheduled two doses of monovalent measles vaccine (mMV) from 1984. In December 2003, a nationwide campaign of measles-rubella (MR) immunization was established to vaccinate 5-25 year- old individuals. In 2004, the mMV was replaced with measles- mumps- rubella (MMR) vaccine. Despite the high vaccination coverage, the outbreaks of measles still occur in the country. In this Study, the MR immunity status of various age groups, vaccinated with different schedules was investigated, and the immunologic response of seronegative subjects to revaccination was examined. METHODS: This cross-sectional study was conducted among 7-33-year-old healthy individuals with a documented history of measles vaccination from November 2017 to June 2018. The subjects were categorized as follows: group A, including 20-33 year-old individuals; vaccinated with 1-2 doses of mMV at ages 9 and 15 months, and revaccinated with MR, group B, including 15-19-year-old individuals, vaccinated with two doses of mMV at 9 and 15 months of age, and received additional dose of MMR upon school entrance, group C, including 11-14 year-old individuals, vaccinated with two-doses of MMR at the ages of 15 months and 6 years, and group D, including 7-10 year-old individuals vaccinated with two-doses of MMR vaccine at the ages 12 and 18 months, respectively. Levels of antimeasles- antirubella IgG antibodies in the collected sera were measured. Also antimeasles- antirubella IgM and IgG of seronegative individuals were reexamined at 4-6 weeks after MMR revaccination. The collected data were analyzed using descriptive statistical methods. RESULTS: A total of 635 individuals were investigated in this study. Group A, 98; group B, 295; group C, 139; and group D, 103 persons. Overall, 12.3 and 18.4% of the population were seronegative for measles and rubella antibodies. This rate varied greatly between the 4 groups: group A, 0/0-2%; group B,15.2-25.0%; group C,11.5-17.2%; and groupD,14.6-18.4%. After revaccination, 92 and 94.9% of seronegative individuals showed IgG response to measles and rubella vaccines, respectively. CONCLUSION: Despite the high coverage rate of M-R containing vaccines, a significant number of vaccinated subjects were seronegative for measles and rubella, possibly because of secondary vaccine failure; this may negatively affect measles-rubella elimination targets in the country. If these findings are confirmed in similar future studies, a more robust regional/national supplementary immunization activity will be considered.

Lack of association between vitamin D insufficiency and clinical outcomes of patients with COVID-19 infection.

BACKGROUND: A protective effect of vitamin D against COVID-19 infection is under investigation. We aimed to analyze the effect of vitamin D sufficiency on the clinical outcomes of patients infected with COVID-19. METHODS: In this cross-sectional study we analyzed the vitamin D levels of COVID-19 patients who were admitted to Razi Hospital (an infectious disease referral center in Mazandaran province in northern Iran) from February to March 2020. Overall, a cutoff point of 30 ng/mL was used for the definition of vitamin D sufficiency. RESULTS: One hundred fifty-three patients were analyzed in this study who had laboratory documentation of a 25(OH) D level at the time of hospitalization. The vitamin D levels of the patients were 27.19 ± 20.17 ng/mL. In total, 62.7% (n = 96) of the patients had a 25(OH) D level of less than 30 ng/mL and 37.25% (n = 57) had a 25(OH) D level of more than 30 ng/mL. In total, 49% (n = 75) of the patients suffered from at least one underlying disease. The univariate and multivariable regression showed that vitamin D sufficiency was not associated with a statistically significant lower risk of adverse clinical outcomes of COVID-19 such as duration of hospitalization and severity of infection (P > 0.05). CONCLUSIONS: Sufficient vitamin D levels were not found to be protective against adverse clinical outcomes in patients infected with COVID-19. Chronic disorders in COVID-19 patients were found to have greater relevance than vitamin D levels in determining the adverse outcomes of the infection. Further studies are needed to determine the role of vitamin D level in predicting the outcomes of COVID-19 infection.

Opium use during pregnancy and infant size at birth: a cohort study.

BACKGROUND: The reported positive association between opiatic drug use during pregnancy and adverse pregnancy outcomes might be confounded by other factors related to high-risk behaviors, including the use of other harmful substances. In rural areas of Iran, opium use during pregnancy is relatively common among women who otherwise do not have a hazardous lifestyle, which reduces the risk of residual confounding and increasing the possibility to identify its effects. We aimed to examine the association of antenatal exposure to opium with risks of small for gestational age, short birth length, and small head circumference at birth. METHOD: In this cohort study in the rural area of the Golestan province, Iran, we randomly selected 920 women who were exposed to opium during pregnancy and 920 unexposed women during 2008-2010. Log-binomial regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI) for the associations between prenatal exposure to opium and risks of small for gestational age, short birth length, and small head circumference at birth. RESULTS: Compared with non-use of opium and tobacco during pregnancy, using opium only and dual use of opium and tobacco were associated with increased risks of small for gestational age at births (RR = 1.71; 95% CI 1.34-2.18 and RR = 1.62; 95% CI 1.13-2.30, respectively). Compared with non-use of opium and tobacco, exposure to only opium or dual use of opium and tobacco were also associated with more than doubled increased risks of short birth length, and small head circumference in term infants. CONCLUSION: Maternal opium use during pregnancy is associated with increased risks of giving birth to a small for gestational age infant, as well as a term infant with short birth length or small head circumference.

The Role of Doppler Imaging in the Assessment of Right Ventricular Function: a Case-control Study of Acute Inferior Wall Infarction.

BACKGROUND: Right ventricular infarction (RVI) develops in 30-50% of patients with inferior wall infarction (IWI). The rates of mortality, morbidity, and complications in these patients are greater than in the patients without RVI. We compared the tissue Doppler imaging (TDI) indices between a group of patients with IWI and RVI, with a similar group of patients who had IWI alone to investigate the application of TDI indices in the evaluation and detection of right ventricular function. MATERIAL AND METHODS: We studied 49 patients with first acute IWI in two groups. Group 1 (N=24) were patients with IWI and RVI while group 2 consisted of patients with IWI alone (N=25), based on standard electrocardiogram criteria. The peak systolic (Sm), peak early (Em) and late (Am) diastolic velocities, and Em/Am ratio were obtained from the apical four chamber view, at the lateral side of the tricuspid annulus. We measured trans-tricuspid early (ET) and peak (AT) filling velocity, ET/AT ratio, right ventricular end diastolic diameter (RVEDD), and tricuspid annular plane systolic excursion (TAPSE) by M-mode TDI projected at the long axis of parasternal view. RESULTS: The RVEDD and E/Em ratio were increased, while the TAPSE was significantly decreased in the patients with RVI as compared to those without RVI (4.7± 0.6 vs. 3.1±0.2 cm; p < 0.005, 5.6±2.21 Vs 4.5±1.2; p<0.006 and 1.7±0.4 vs. 2.3±0.5 cm; p <0.0001, respectively). However, the other statistically measured parameters were not significantly different between these groups. CONCLUSION: The measurement of RVEDD, E/Em ratio, and TAPSE, as right ventricular myocardial systolic and diastolic parameters by pulse wave TDI could be used to objectively assess the status of RV condition in patients with first acute IWI.

Pyrethroid resistance in Iranian field populations of Rhipicephalus (Boophilus) annulatus.

Resistance to acaricides in ticks is becoming increasingly widespread throughout the world; therefore, tick control requires resistance monitoring for each tick species. The aims of this study were to monitor the susceptibility status of the cattle tick, Rhipicephalus (Boophilus) annulatus (Acari: Ixodidae), against pyrethroid acaricides from Mazandaran Province, northern Iran, and where resistance was evident, and establish the possible underlying mechanisms. Fully engorged adult R. (B.) annulatus females collected on cattle from Mazandaran Province. Twenty-nine tick populations produced 10-18days old larvae and bioassayed with cypermethrin and λ-cyhalothrin by larval packet test and the levels of detoxification enzymes were measured. Population AM-29 had a maximum resistance ratio (RR99) of 20.21 to cypermethrin and 53.57% of the tick populations were resistant at LC99 level. With λ-cyhalothrin, 17.86% of the tick populations were resistant and AM-29 was the most resistant population with RR99=4.54. AM-29 also showed significant elevation of cytochrome P450 monooxygenase (P450) and glutathione S-transferase (GST) (2.76- and 2.39-fold, respectively) (P<0.001). Rhipicephalus (Boophilus) annulatus showed resistance to pyrethroid insecticides with elevated levels of P450, GST and para-nitrophenyl acetate (p-NPA) in resistant populations. Operational failure was noted in controlling R. (B.) annulatus by pyrethroid insecticides, therefore alternative pest management measures should be adopted in Iran. For the first time, a new estimate of insecticide resistance based on effective dose recommended by the pesticide manufacturer termed Operational Dose Ratio (ODR) is defined and discussed.

Maternal haemoglobin concentrations before and during pregnancy and stillbirth risk: a population-based case-control study.

BACKGROUND: Results of previous studies on the association between maternal haemoglobin concentration during pregnancy and stillbirth risk are inconclusive. It is not clear if haemoglobin concentration before pregnancy has a role. Using prospectively collected information from pre-pregnancy and antenatal visits, we investigated associations of maternal haemoglobin concentrations before and during pregnancy and haemoglobin dilution with stillbirth risk. METHODS: In a population-based case-control study from rural Golestan, a province in northern Iran, we identified 495 stillbirths (cases) and randomly selected 2,888 control live births among antenatal health-care visits between 2007 and 2009. Using logistic regression, we estimated associations of maternal haemoglobin concentrations, haemoglobin dilution at different stages of pregnancy, with stillbirth risk. RESULTS: Compared with normal maternal haemoglobin concentration (110-120 g/l) at the end of the second trimester, high maternal haemoglobin concentration (≥140 g/l) was associated with a more than two-fold increased stillbirth risk (OR = 2.31, 95 % CI [1.30-4.10]), while low maternal haemoglobin concentration (<110 g/l) was associated with a 37 % reduction in stillbirth risk. Haemoglobin concentration before pregnancy was not associated with stillbirth risk. Decreased haemoglobin concentration, as measured during pregnancy (OR = 0.61, 95 % CI [0.46, 0.80]), or only during the second trimester (OR = 0.75, 95 % CI [0.62, 0.90]), were associated with reduced stillbirth risk. The associations were essentially similar for preterm and term stillbirths. CONCLUSIONS: Haemoglobin concentration before pregnancy is not associated with stillbirth risk. High haemoglobin level and absence of haemoglobin dilution during pregnancy could be considered as indicators of a high-risk pregnancy.

Consanguineous marriage, prepregnancy maternal characteristics and stillbirth risk: a population-based case-control study.

INTRODUCTION: Consanguineous marriage is associated with increased risks for congenital anomalies, low birthweight, and other adverse perinatal outcomes. In this population-based, case-control study we investigated the association between consanguineous marriage (first-cousin marriage) and stillbirth risk, using prospectively collected information from prepregnancy visits. MATERIAL AND METHODS: From 2007 to 2009, we identified 283 stillbirths (cases) and 2088 randomly selected live control births through prepregnancy visits in rural Golestan, Iran. The associations between consanguinity and prepregnancy maternal characteristics and stillbirth risk were examined using multivariate logistic regression. RESULTS: The rate of consanguineous marriage was 19.4% among cases and 13.6% among controls. Consanguinity was associated with increased stillbirth risk [odds ratio (OR) 1.53; 95% CI 1.10-2.14]. The association was significantly increased for preterm stillbirth (< 37 gestational weeks) (OR 2.43; 95% CI 1.46-4.04) but not for term stillbirth (≥ 37 weeks) (OR 1.14; 95% CI 0.75-1.74). Low and high maternal age, underweight, obesity, nulliparity, a history of infertility or miscarriage, previous obstetric complications (preeclampsia, preterm delivery, and stillbirth in previous pregnancies) were also associated with increased stillbirth risks. CONCLUSIONS: Consanguineous marriage is associated with increased risk of stillbirth, particularly preterm stillbirth. Findings for other maternal risk factors for stillbirth in rural Iran are consistent with previously reported findings from high-income countries.

Tubularized incised plate urethroplasty for hypospadias reoperation: a review and meta-analysis.

PURPOSE: Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. MATERIAL AND METHODS: Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. RESULTS: 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass's method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8% (95% CI: 18.3 to 25.5). CONCLUSION: Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias.

Incidence of side effects of antituberculosis drugs and their related factors in northern Iran: a retrospective cohort study.

Background: Antituberculosis drugs may cause mild, moderate or severe adverse drug reactions (ADR) leading to poor compliance. Description of the pattern of ADR and their related factors can help tuberculosis (TB) control program as part of the WHO programs. This study aims to investigate the incidence of ADR and associated factors among TB patients in northern Iran. Methods: This is a retrospective cohort study. The required information, including year of diagnosis, age, gender, residence area, nationality, HIV co-morbidity, history of anti TB treatment and ADR, was obtained from the Deputy of Health, Mazandaran University of Medical Sciences, Iran. All data were analyzed using SPSS version 21 software. Results: Out of 3903 TB patients, 136 (3.5%) experienced major ADR. The incidence of ADR for men and women as well as for those with and without previous treatment history were 3.9% vs. 3.3% and 5.3% vs. 3.4%, respectively (p>0.05). Multiple logistic regression models showed a higher chance of ADR among those aged over 59 compared with those aged under 29 (OR=2.63, 95% confidence interval: 1.54-4.49). Conclusions: Age over 59 can be considered a risk factor for ADR with anti-TB drug administration.

Multisectoral actions of mental health during the COVID-19 pandemic in Mazandaran province of Iran.

AIM: A widespread outbreak of COVID-19 is followed by adverse effects on the mental health of the general population. Therefore, this study is an audit to investigate the activities of various organizations during the COVID-19 pandemic in Mazandaran Province, Iran. METHODS: The aim of the study was to collect the data, the relevant officials in various organizations and units were contacted to collect the statistics of actions taken in psychology and psychiatry wards. Moreover, databases such as Google Scholar and Iranian resources were searched. RESULTS: According to the results, different healthcare systems worked in parallel during the peak of the COVID-19 pandemic. For example, Mazandaran University of Medical Science [MAZUMS] Health Vice-Chancellor performed the following activities during this crisis: establishing a virtual crisis management working group, holding a provincial educational committee to train the crisis management teams, organizing virtual psychological intervention teams in the healthcare systems, and so forth. In addition, the mental health activities by Mazandaran Welfare Organization during the COVID-19 outbreak included providing hostelry free psychological counseling, quarantine boarding and rehabilitation centers, and providing harm prevention protocols of COVID-19, especially for marginalized regions. In the third level of medical centers, including hospitals, consultation-liaison psychiatry or psychiatrists and clinical psychologists, therapeutic interventions for comorbid psychiatric disorders with COVID-19 disease, and online workshops for mental health were conducted to reduce burnout of medical staff and nurses. CONCLUSION: This study can provide a good guideline for different service providers by using the experiences of other centers to achieve better results.

The Effect of Preoperative Oral Melatonin on Postoperative Pain after Lumbar Disc Surgery: A Double-Blinded Randomized Clinical Trial.

Background: Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc surgeries. The aim of this study was to investigate the effect of preoperative oral melatonin on the severity of postoperative pain after lumbar laminectomy/discectomy. Methods: In this double blinded randomized controlled clinical trial 80 patients undergoing an elective mini-open microdiscectomy surgery at Imam Khomeini educational hospital in Sari, Iran, were selected and randomly assigned into one of four groups. Patients in group A, B, C, and D received 3, 5 and 10 mg melatonin or placebo tablets one hour before surgery, respectively. Using the visual analogue scale (VAS) the severity of pain, nausea and vomiting, pruritus, and use of narcotics were assessed immediately after surgery and before leaving the post-anesthesia care unit, 6, 12 and 24 hours postoperatively. Results: In all three groups receiving melatonin at all three different doses, postoperative pain was significantly less than the placebo group (P<0.01). There were no statistically significant differences in postoperative pain level between the three groups receiving melatonin (P>0.05). The amount of opioid received by the patients within 24 hours after surgery had statistically significant differences within the groups (P=0.043, F=2.58). The results of post hoc analysis in terms of postoperative pain intensity showed statistically significant differences between the two groups receiving melatonin at a dose of 5 mg and the placebo group (P=0.04). No serious side effects reported in four groups. Conclusion: The use of oral melatonin with a dose of 5 mg, 1 hour before the surgery as an inexpensive method can effectively reduce pain intensity as well as the amount opioid use after lumbar laminectomy and discectomy.

Establishing clinical governance model in primary health care: A systematic review.

Clinical governance is a systematic approach to enhancing the quality of primary health care and ensuring high clinical standards, responsiveness to performance, and continuous improvement in service quality. The objective of the current study was to investigate the global experiences of clinical governance in primary health care. In the present systematic review, relevant articles from different countries were searched in various databases such as MD PubMed from Medline portal, Emerald Springer link, ProQuest, Cochrane, Scopus, Web of Science, and Consult until April 2019. The searched articles were checked through CASP and PRISMA checklists, and their results were extracted. Of the 17 selected studies, 16 belonged to developed countries, including England (13), Australia, Italy, and New Zealand, and one was from Turkey. The findings were divided into three general categories: (1) principles of effectiveness and risk management, (2) deployment requirements such as structural and organizational needs, resource and communication, and information management, and (3) barriers of clinical governance toward providing primary health care. it is recommended that a suitable framework or model be developed and designed adapted to the local culture and taking into account all effective dimensions for a proper establishment and implementation of clinical governance in primary health care.

Assessing mental health status among Iranian healthcare workers in times of the COVID-19 pandemic: A web-based cross-sectional study.

OBJECTIVES: The present study was conducted to assess 3(HCWs) during the COVID-19 pandemic. METHODS: A total number of 7626 HCWs were included in this web-based cross-sectional study, via the convenience sampling technique. To collect the required data, the sociodemographic characteristics information form, the Depression Anxiety Stress Scale-21 (DASS-21), and the Corona Disease Anxiety Scale (CDAS) were also employed. In addition, data analysis was performed using the SPSS Statistics software (ver. 24), as well as descriptive statistics, Chi-square test (χ2 ), and univariate/multivariate logistic regression models. RESULTS: The CDAS results revealed that 47.9% and 70.5% of the HCWs had experienced moderate levels of physical and psychological anxiety, respectively. Based on the DASS results, 44.8%, 43%, and 34.8% of the HCWs had been subjected to depression, anxiety, and stress symptoms during the COVID-19 pandemic, respectively. The logistic regression models correspondingly showed that depression among the HCWs was significantly correlated with risk factors, such as the age groups of 20-30 years (p = .001), 31-40 years (p = .006), female HCWs (p> .001), history of physical illnesses (p = .004), and history of psychiatric disorders (p> .001). Moreover, factors including the age groups of 20-30 years (p < .001), 31-40 years (p < .001), 41-50 years (p < .001), female HCWs (p> .001), history of physical illnesses (p < .001), and history of psychiatric disorders (p>.001) were assumed as significant predictors of anxiety in these individuals. Besides, factors such as the age groups of 20-30 years (p = .002), 31-40 years (p = .004), female HCWs (p>.001), occupation (p = .016), history of physical illnesses (p < .001), and history of psychiatric disorders (p> .001) could significantly predict the prevalence rate of stress in the HCWs in times of this crisis. CONCLUSION: Given the importance of mental health status among HCWs during the COVID-19 pandemic, health administrators and policymakers of the Ministry of Health and Medical Education in Iran are suggested to provide psychological screening and supportive care programs for HCWs with the aim of enhancing their mental health and successful coping with critical circumstances.

Physico-chemical properties and reactive oxygen species generation by respirable coal dust: Implication for human health risk assessment.

This study investigates the mineralogy, micro-morphology, chemical characteristics and oxidation toxicity of respirable dusts generated in underground coal mines. The active sampling was applied to collect airborne particulates with aerodynamic diameter <4 µm (PM4) at depth greater than 500 m from earth surface. The average mass concentration of PM4 was extremely higher than recommended values. QXRD and FESEM-EDS analyses were applied to study the micro-mineralogy and micro-morphology of respirable dusts. The chemical analysis by ICP-MS revealed an enrichment of V, Cr, Cu, Zn, As, Ag, Cd and Sb in respirable dust compared with the background environment and world coals. The EPA's health risk model showed that the health risk posed by Cr and Co in all workplaces exceeded the acceptable risk value for human health. The synthetic respiratory tract lining fluid (RTLF) model was utilized to achieve a novel insight into the toxicity of respirable coal dust. The result showed an overall depletion of lung surface antioxidants with the decreasing trend of ascorbic acid > reduced glutathione >> urate, implying low- to medium level of oxidative stress. The result of this study can be applied globally by decision-makers to decrease hazardous exposure of mine workers to respirable dust.

Prevalence of autoantibodies in type 1 diabetes mellitus pediatrics in Mazandaran, North of Iran.

Objectives Type 1 diabetes is an autoimmune disease. Its most important immunologic markers are pancreatic beta-cell autoantibodies. This study aimed to determine diabetes mellitus antibodies frequency among children and adolescents with type 1 diabetes. Methods This descriptive study evaluated the frequency of four diabetes autoantibodies (glutamic acid decarboxylase 65 autoantibodies [GADA], islet cell autoantibodies [ICA], insulin autoantibodies [IAA], tyrosine phosphatase-like insulinoma antigen-2 antibodies [IA-2A]) and their serum level in children and adolescents diagnosed with type 1 diabetes mellitus at the diabetes department of Bou-Ali-Sina Hospital and Baghban Clinic, Sari, Iran, from March 2012 to March 2018. The relationship between the level of different antibodies and age, gender, and diabetes duration were determined. A two-sided p value less than 0.05 indicated statistical significance. Results One hundred forty-two eligible patient records were screened. The average age at diabetes diagnosis was 4.2 ± 4.4 years. The median duration of diabetes was 34.0 (12.7-69.7) months. 53.5% of patients were female, and 81.7% of them had at least one positive autoantibody, and ICA in 66.2%, GADA in 56.3%, IA-2A in 40.1%, and IAA in 21.8% were positive. The type of the autoantibodies and their serum level was similar between females and males but there was a higher rate of positive autoantibodies in females. The level of IA-2A and ICA were in positive and weak correlation with age at diagnosis. Conclusions More than 80% of pediatric and adolescent patients with type 1 diabetes were autoantibody-positive. ICA and GADA were the most frequently detected autoantibodies. The presence of antibodies was significantly higher in females.

Treatment default and its related factors among tuberculosis patients, a case-control study in Iran.

Introduction: Treatment default is one of the main challenges in tuberculosis (TB) control and is considered a major barrier to achieving the sustainable development goals (SDG). Identifying the factors associated with this outcome can help us provide appropriate strategies for decision making. This study investigates the determining factors of treatment default among TB patients. Methodology: In this case-control study, all 88 TB patients experiencing treatment default during an11-year-period in Mazandaran province, Iran, were compared with 176 randomly selected TB patients without a history of default. Cases and controls were matched based on the year of incidence as well as the treatment center. Related factors of treatment default were determined using multivariate logistic regression models. Results: For men, the odds ratio of experiencing treatment default was 1.67 (p=0.165). In addition, considering ages >64 years as the reference group, the odds ratios for 15- to 24- and 55- to 64-year-olds were 0.95 (p=0.940) and 0.37 (p=0.123), respectively. The corresponding odds ratios for patients 25-34, 35-44 and 45-54 years of age were 1.29 (p=0.547), 1.40 (p=0.472), and 1.39 (p=0.512) respectively. Moreover, the odds ratios for urban residents, patients with a history of imprisonment, a history of previous treatment, adverse treatment effects, previous exposure, non-Iranians and patients with smear-positive TB were 1.72 (p=0.070), 1.24 (p=0.657), 1.47 (p=0.756), 0.99 (p=0.998), 0.98 (p=0.960), 9.29 (p=0.010), and 2.27 (p=0.049) respectively. Conclusion: Non-Iranian nationality and smear-positive TB were detected as predictors of treatment default among patients with tuberculosis.

COVID-19 Pandemic and Comparative Health Policy Learning in Iran.

BACKGROUND: On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a global pandemic. Starting in December 2019 from China, the first cases were officially announced on February 19 in Qom city, Iran. As of April 3, 2020, 206 countries have reported a total of 932166 cases with 46764 deaths. Along with China, USA, Italy, Spain, and Germany, Iran has been suffering the hardest burden of COVID-19 outbreak. Worse still, countries like Iran are struggling with the double burden of political sanctions to provide lifesaving medical equipment and medicines to combat the emergency. METHODS: Using systematic document content analysis and through the lenses of health policy triangle, this article aims to compare the policies and strategies that Iran is adopting, with the experience and recommendations of China and WHO to combat COVID-19. RESULTS: Iran has formulated contextual-based policies to combat COVID-19 outbreak before and after virus entrance. Insufficient whole-government, whole-society approach in managing the outbreak, inadequate lifesaving and protective equipment, and delayed decisive governance are the biggest challenges in policy making to combat COVID-19. COVID-19 policies are a public health concern and require professional advocacy attempts through appropriate inter-sectoral collaboration and whole-government coalitions. CONCLUSION: COVID-19 is an unfolding outbreak; hence, policy learning is crucial to formulate appropriate policies and implement them accordingly. Iran has made many efforts to defeat the outbreak, but more coherent, timely and efficient action is required, now, more than ever, to save lives and slow the spread of this pandemic.

Burden of Obstructive Lung Disease in Iran: Prevalence and Risk Factors for COPD in North of Iran.

BACKGROUND: Globally chronic obstructive pulmonary disease (COPD) was reported as the fourth leading cause of death (5.1%) in 2004 and is projected to occupy the third position (8.6%) in 2030. The goal of the present project is to describe the prevalence and risk factors of COPD in a province in the north of Iran. METHODS: This study followed a stratified cluster sampling strategy with proportional allocation within strata. The stratification of the sample according to the 31 provinces of Iran is incorporated in the sampling process. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (2 puffs) of salbutamol. The descriptive statistics for categorical variables included the number and percent and for continues variables included the mean ± SD. RESULTS: A total of 1007 subjects were included in the study. Among all participants, 46 (5%) subjects had COPD on the basis of symptoms and 43 (8.3%) subjects had COPD on the basis of spirometry criteria. In univariate analysis, urban inhabitants in comparison with rural inhabitants had lower COPD risk (OR: 0.48; 95% CI: 0.24-0.95), smoker had higher risk compared with nonsmokers (OR: 1.97; 95% CI: 1.01-3.82), and subjects with exposure to dust (OR: 2.07; 95% CI: 1.09-3.94) had higher risk compared with contrary status. CONCLUSIONS: This study showed that occupational and environmental smoke exposure was associated with COPD. A new design of preventive measures must be taken to control cooking energy and cooking stoves, particularly in rural areas.

Evaluation of Urban and Rural Family Physician Program in Iran: A Systematic Review.

BACKGROUND: Global experience as well as expert views weight the Family Physician program (FPP) as a primary solution for various problems of healthcare system in Iran. In spite of the valuable information has been collected during conducting FPP, few studies have been done to evaluate the actual performance of this program. This study reviewed the studies related to the evaluation of the FPP systematically. METHODS: The authors systematically searched PubMed, Web of Science, Scopus, Embase, Irandoc and SID for articles published in English and Persian until Nov 2017 without limitation for starting time. Selection stages of the articles were done based on PRISMA flow diagram guidelines. RESULTS: Of all articles evaluated, 19 were selected. Four articles were removed due to inadequate quality of the study. Only one article evaluates urban and the rest are about rural. Eight articles were categorized as the process evaluations and 12 outcome assessments (one of them was common). CONCLUSION: We achieved three main findings. First, the rural FPP has improved access to the healthcare services, but improvement in patient finding and quality of cares remains questionable. Second, there are considerable concerns in the referral system between levels I and II in both urban and rural programs. Third, there was no efficient planning to implement the FP as the gatekeepers of health care system effectively. These issues deprived the efficiency aim of FPP and need serious consideration.