Correlation between socioeconomic indices and epidemiological indices of thyroid cancer from 1990 to 2019 year: a global ecologic study.

BACKGROUND: The incidence of thyroid cancer as the most common type of endocrine gland malignancy has risen more significantly than any malignancies in recent years. Estimated new cases of thyroid cancer in the United States in 2024 were 12,500 and 31,520 for men and women, respectively, and estimated deaths were 1,180 for women and 990 for men. Indices of socio-economic have been commonly used to measure the development of countries. Therefore, this study aimed to examine the correlation between indices of socioeconomic status and epidemiological indices of thyroid cancer throughout the world. In addition, this study has compared two indices of human development and a socio-demographic index. METHOD: This worldwide ecological study used data on thyroid cancer incidence, mortality, human development index (HDI), and sociodemographic index (SDI) between 1990 and 2019 from the Global Burden of Disease (GBD). We evaluated the correlation between incidence and mortality rates with socioeconomic indices by using Pearson's correlation coefficient. Furthermore, for the first time, the generalized additive model (GAM) was employed for modeling. The statistical software R, version 4.2.2, was used to conduct all statistical analyses. RESULTS: The correlation between the incidence of thyroid cancer and the HDI was significant and positive (r = 0.47, p-value < 0.001). While the correlation between thyroid cancer mortality and HDI was not statistically significant (r = 0.01, p-value = 0.076). Besides, the incidence of thyroid cancer was significantly positively correlated with SDI (r = 0.48, p-value < 0.001). The multiple GAM showed that for one unit increase in HDI, the risk of thyroid cancer was increased by 2.1 times (RR = 2.1, 95%CI = 2.04 to 2.19), and for one unit increase in SDI, the risk of thyroid cancer was shown to increase by 2.2 times. (RR = 2.2, 95%CI = 2.19 to 2.35). CONCLUSION: It has been evident that countries with higher incidence of thyroid cancer display higher socioeconomic indices. While, countries with higher socioeconomic indices, report lower mortality rates. However, based on the modeling results, it can be concluded that the SDI is slightly more useful in this regard. Therefore, examining the epidemiological indices of thyroid cancer by socio-economic indices can be useful to reflect a clear image of the distribution of this cancer in each country, and can be used for planning cancer prevention strategies.

The effect of COVID-19 pandemic on diabetes care indices in Southern Iran: an interrupted time series analysis.

BACKGROUND: Type 2 diabetes mellitus (T2DM) requires a continues bulk of cares. It is very probable COVID-19 pandemic is affected its healthcare coverage. METHODS: The interrupted time series analysis is used to model the trend of diabetes healthcare indices, such as the health worker visits, physician visits, body mass index (MBI), fasting blood sugar (FBS), and hemoglobin A1c (HbA1c), before and after the start of COVID-19 pandemic. The reference of data was the totals of all T2DM patients living in Fars Province, Southern Iran, areas covered by Shiraz University of Medical Science (SUMS), from 2019 to 2020. RESULTS: A significant decrease for visits by the health workers, and physicians was observed by starting COVID-19 pandemic (ß2 = -0.808, P < 0.001, ß2 = -0.560, P < 0.001); Nevertheless, the coverage of these services statistically increased by next months (ß3 = 0.112, P < 0.001, ß3 = 0.053, P < 0.001). A same pattern was observed for the number of BMI, FBS and HbA1c assessments, and number of refer to hospital emergency wards (ß3 = 0.105, P < 0.001; ß3 = 0.076, P < 0.001; ß3 = 0.022, P < 0.001; ß3 = 0.106, P < 0.001). The proportion of T2DM patients with HbA1C < 7%, and controlled hypertension during study period was statistically unchanged. CONCLUSIONS: When the COVID-19 pandemic was announced, T2DM healthcare coverage drastically decreased, but it quickly began to rebound. The health monitoring system could not have any noticeable effects on diabetes outcomes.

Effects of a theory-based training program with follow-up home visits on self-management behavior, glycemic index, and quality of life among Iranian patients with type 2 diabetes mellitus.

BACKGROUND: Uncontrolled diabetes is an important public health problem that endangers the quality of life of patients. Promoting self-management through well-planned training is an essential strategy to control diabetes effectively. This study aimed to examine the effects of a training program based on social cognitive theory (SCT) on self-management behavior, glycemic index, and quality of life among patients with type 2 diabetes mellitus. METHODS: This is a quasi-experimental study with a pretest-posttest design. The statistical population included 106 adults with type 2 diabetes mellitus assigned to the intervention and control groups [n1 = n2 = 53], who received services from two urban health centers. A multi-method, SCT-based training program consisting of six 60-80-min sessions was run, followed by 2-3 follow-up home visits [once a month for each participant] for the intervention group. The data were collected before and three months after the intervention and were analyzed in SPSS 19. RESULTS: Before the intervention, there was no significant difference between the two groups regarding the main variables. After the intervention, there was a significant increase in the intervention group's mean scores of knowledge, self-efficacy, social support, outcome expectations, self-regulation, self-management behavior, glycemic index, and quality of life. There were no significant changes in these constructs in the control group after the intervention. The regression analysis results indicated that social cognitive theory and self-management could explain the variance in quality of life [adjusted R-squared = 0.476]. CONCLUSIONS: The findings support the effectiveness of the multi-method, SCT-based educational intervention in improving self-management behaviors, glycemic index, and quality of life among patients with type 2 diabetes mellitus. It is suggested that the quality of type 2 diabetes care programs should be promoted. However, further research is needed to evaluate the long-term outcomes.

Hookah Smoking: A Potentially Risk Factor for First-Ever Ischemic Stroke.

OBJECTIVE: Hookah consumption, as a common non-cigarette tobacco product, is wrongly considered as less harmful. Moreover, little is known about hookah consumption and risk of ischemic stroke. The current study aimed to assess the association between hookah consumption and first-ever ischemic stroke (FEIS). METHODS: This case-control study was performed on individuals admitted at a tertiary referral center in Shiraz, Southern Iran between October 1, 2018 and September 20, 2019. We compared FEIS patients with randomly selected stroke-free individuals as a control group. Using a multiple logistic regression analysis, we assessed the association between hookah consumption and FEIS. RESULTS: A total of 208 FEIS patients (mean age 65.2 ± 15.9 years) and 212 age and sex-matched controls (mean age 63.2 ± 14.4) were recruited. The prevalence of vascular risk factors and comorbidities including ischemic heart disease, hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, cigarette smoking, and sleep apnea was higher in patients with FEIS than their control counterparts. After adjusting for a wide range of confounders, including socioeconomic factors, hookah consumption was still an independent risk factor for FEIS (odds ratio: 3.2, 95% CI: 1.7-6.1). CONCLUSION: Hookah consumption is associated strongly with FEIS. Public awareness about risk of hookah consumption should be raised.

Seasonality and time patterns in attempted suicide in Ilam province of Iran: An appraisal of current data of 2010 -2014.

Background: Seasonality in suicide has been investigated from the early 19th century to explore the productive environmental variables. Seasonality studies can provide information on prevention and interventions in suicide. In this study, we examined seasonality in suicide and aimed to explore the differences in seasonality between rural and urban areas, mental disorders, and genders. Methods: In this cross-sectional study, overall identified suicide cases in Ilam province from 21 March 2010 and 11 December 2014 were identified, using systematic registration suicide data (SRSD). Two methods were used separately to analyze seasonality (Chisquare, Edwards' T). Seasonal effect (peak/ trough seasons) and (deaths/ attempts suicide) was explored by ratio statistics. The null hypothesis was that the completed suicides in each method group were evenly distributed over a year. Results: Significant seasonality was observed in suicide during the study period, with one peak in the spring and one in the winter. Our results showed that suicide seasonality following mental disorders was statistically significant with a peak in the spring, regardless of other factors such as gender and age. When all non- mental suicides are taken into account, the seasonality remains statistically significant, but the peak season is shifted to autumn. Conclusion: Investigating suicide in Ilam revealed a significant seasonality for both rural and urban areas, which was greater in the urban part. A significant seasonality in suicide was observed in attempters with mental disorders. In suicide attempters with mental disorders, findings showed two peaks in the spring and the autumn.

Association between social capital, health-related quality of life, and mental health: a structural-equation modeling approach.

AIM: To explore the association(s) between demographic factors, socioeconomic status (SES), social capital, health-related quality of life (HRQoL), and mental health among residents of Tehran, Iran. METHODS: The pooled data (n=31519) were extracted from a population-based survey Urban Health Equity Assessment and Response Tool-2 (Urban HEART-2) conducted in Tehran in 2011. Mental health, social capital, and HRQoL were assessed using the 28-item General Health Questionnaire (GHQ-28), social capital questionnaire, and Short-Form Health Survey (SF-12), respectively. The study used a multistage sampling method. Social capital, HRQoL, and SES were considered as latent variables. The association between these latent variables, demographic factors, and mental health was determined by structural-equation modeling (SEM). RESULTS: The mean age and mental health score were 44.48±15.87 years and 23.33±11.10 (range, 0-84), respectively. The prevalence of mental disorders was 41.76% (95% confidence interval 41.21-42.30). The SEM model showed that age was directly associated with social capital (P=0.016) and mental health (P=0.001). Sex was indirectly related to mental health through social capital (P=0.018). SES, HRQoL, and social capital were associated both directly and indirectly with mental health status. CONCLUSION: This study suggests that changes in social capital and SES can lead to positive changes in mental health status and that individual and contextual determinants influence HRQoL and mental health.

Identifying associated factors with social capital using path analysis: A population-based survey in Tehran, Iran (Urban HEART-2).

Background: Social capital has been defined as norms, networks, and social links that facilitate collective actions. Social capital is related to a number of main social and public health variables. Therefore, the present study aimed to determine the factors associated with social capital among the residents of Tehran, Iran. Methods: In this large cross-sectional population-based study, 31531 residents aged 20 years and above were selected through multi-stage sampling method from 22 districts of Tehran in 2011. The social capital questionnaire, 28-item General Health Questionnaire (GHQ-28), and Short-Form Health Survey (SF-12) were used. Hypothetical causal models were designed to identify the pathways through which different variables influenced the components of social capital. Then, path analysis was conducted for identifying the determinants of social capital. Results: The most influential variables in 'individual trust' were job status (ß=0.37, p=0.02), marital status (ß=0.32, p=0.01), Physical Component Summary (PCS) (ß=0.37, p=0.02), and age (ß=0.34, p=0.03). On the other hand, education level (ß=0.34, p=0.01), age (ß=0.33, p=0.02), marital status (ß=0.33, p=0.01), and job status (ß=0.32, p=0.01) were effective in 'cohesion and social support'. Additionally, age (ß=0.18, p=0.02), PCS (ß=0.36, p=0.01), house ownership (ß=0.23, p=0.03), and mental health (ß=0.26, p=0.01) were influential in 'social trust/collective relations'. Conclusion: Social capital can be improved in communities by planning to improve education and occupation status, paying more attention to strengthening family bonds, and provision of local facilities and neighborhood bonds to reduce migration within the city.

Pattern of in-hospital pediatric mortality over a 3-year period at University teaching hospitals in Iran.

INTRODUCTION: Causes of death are different and very important for policy makers in different regions. This study was designed to analyze the data for our in-patient children mortality. MATERIALS AND METHODS: In this cross-sectional study from March 2011 to March 2013, all patients from 2 months to 18 years who died in pediatric intensive care unit, emergency room or medical pediatric wards in the teaching hospitals were studied. RESULTS: From a total of 18,915 admissions during a 2-year-period, 256 deaths occurred with a mean age of 4.3 ± 5 years and mortality 1.35%. An underlying disease was present in 70.7% of the patients and in 88.5% of them the leading causes of death were related to the underlying diseases. The most common underlying diseases were congenital heart disease and cardiomyopathy in 50 (27.6%). The four main causes of deaths were sepsis (14.8%), pneumonia (14.5%), congestive heart failure (9.8%), and hepatic encephalopathy (9.8%). CONCLUSION: We may conclude that after sepsis and pneumonia, congestive heart failure, and hepatic encephalopathy are the leading causes of death. Most patients who died had underlying diseases including malignancies, heart and liver diseases as the most common causes.

Factors associated with late initiation of antiretroviral therapy in Iran's HIV/AIDS surveillance data.

Early initiation of Antiretroviral Treatment (ART) in HIV patients is essential for effectively suppressing the viral load and prognosis. This study utilized National HIV/AIDS Surveillance Data in Iran to identify factors associated factors with the duration to initiate ART. This hybrid cross-sectional historical cohort study was conducted on Iran's National HIV/AIDS Surveillance Data from 2001 to 2019. Sociodemographic characteristics, route of transmission, HIV diagnosis date, and ART initiation date were collected. Multivariable linear and quantile regression models were employed to analyze the duration to initiate ART by considering predictor variables. This study included 17,062 patients (mean age 34.14 ± 10.77 years, 69.49% males). Multivariate quantile regression coefficients varied across different distributions of the dependent variable (i.e., duration to initiate ART) for several independent variables. Generally, male gender, injecting drug use (IDU), and having an HIV-positive spouse were significantly associated with an increased duration to initiate ART (p < 0.05). However, a significant decrease was observed in older patients, those with a university level education, men who had sex with men (MSM), and patients diagnosed after 2016 (p < 0.05). Despite improvements in the duration to initiate ART after implementing the WHO's 2016 program in Iran, various sociodemographic groups were still vulnerable to delayed ART initiation in the region. Therefore, programs including early testing, early ART initiation, active care, educational and cultural interventions, and appropriate incentives are required for these groups.

The Trend of Years of Life Lost due to Gastrointestinal Cancers in Fars (Iran) 2004-2019.

Background: Gastrointestinal cancers can cause major health problems globally since their burden is increasing in many countries. We aimed to investigate the trend of years of life lost due to gastrointestinal cancers in Fars Province, southern Iran during the 2004-2019. Methods: In this cross-sectional survey study, we obtained the information regarding all deaths due to gastrointestinal cancers in Fars Province from the electronic population-based death registration system (EDRS). Years of Life Lost (YLL) was calculated using the YLL template of 2015 by the WHO. To examine the trend for different years, join point regression based on the log-linear model was used. Joinpoint regression analysis describes changing trends over successive periods of time and the increasing or decreasing rate within each period. Results: During the years of 2004-2019, 9742 deaths due to gastrointestinal cancers occurred in Fars Province. 6013 (61.72%) cases were male and 3729 (38.28%) cases were female (Male / Female Sex Ratio: 1.61). Overall, 4152 cases (42.63%) were due to gastric cancer and 2112 cases (21.68%) were due to liver cancer. Total years of life lost due to premature death from gastrointestinal cancers during the 16-year study period was 73565 yr (2.33 per 1000 persons) in men, 52766 yr (1.71 per 1000 persons) in women, and 126331 yr (2.02 per 1000 persons) in both sexes. Conclusion: Among all cancers, the highest mortality rates in both sexes belong to gastric cancer. This study showed the trend of YLL rate of malignant neoplasms of liver and intrahepatic bile ducts, esophagus, oral cavity, and colon cancer were increasing in both sexes, however, the trend of YLL rate for malignant neoplasms of the small intestine was decreasing in both sexes. Variation of GI cancers patterns and trends around the Fars Province indicated that a more comprehensive control plan is needed to control these variations.

Trend Analysis of Lung Cancer Mortality and Years of Life Lost (YLL) in South of Iran, 2004-2019.

Background: We aimed to determine the mortality rate and Years of Life Lost (YLL) due to lung cancer in Fars, Iran, during the period from 2004 to 2019. Methods: All deaths due to lung cancer in Fars Province, Iran from the electronic population-based death registration system (EDRS) were obtained. Crude mortality rate, age-standardized mortality rate, YLL and YLL rate data were calculated and trends examined. Results: During 2004-2019, 3346 deaths occurred due to lung cancer in Fars Province, which was 10.8% (3346/30936) of the total cancer deaths in this period. Crude mortality rate of lung cancer had increased 70% and 53% in male and female respectively from 2004 to 2019. The total YLL of lung cancer during the 16-year study period was 28,094 (0.9 per 1000) in men, 14,174 (0.5 per 1000) in women, and 42,268 (0.8 per 1000) in both sexes (sex ratio male/female=2). According to the join point regression, the 16- year trend of YLL rate due to premature mortality was increasing: APC was 2.5% (95% CI 0.9 to 4.2, P=0.005) for males, 1.4% (95% CI 0.3 to 2.6, P=0.017) for females. Conclusion: The mortality rate and YLL due to lung cancer in Fars Province is increasing, although the standardized mortality has a constant trend. Tobacco control is the most effective and least expensive way to reduce the number of lung cancer patients worldwide. National and local media can also play an important role in informing people about the risk factors.

The effects of powdered drinks enriched with curcumin and probiotics on lipid profile and atherogenic indices in patients with metabolic syndrome: A randomized, double-blinded, placebo-controlled clinical trial.

Cardiovascular disease is prevalent globally and is the most common complication of metabolic syndrome (MetS). Previous studies have suggested that curcumin and probiotics may improve the lipid profile, so we aimed to investigate the effects of the edible powder enriched with these substances on lipid profile level and atherogenic indices such as Atherogenic Coefficient (AC), Castelli Risk Index-I (CRI-I), Castelli Risk Index-II (CRI-II), and Atherogenic Index of Plasma (AIP). In the present parallel randomized double-blinded placebo-controlled clinical trial, 124 people with MetS with overweight or obesity were randomly allocated to 4 groups and were followed up for 8 weeks. The participants received a low-calorie diet and a daily sachet of enriched powder drink. The sachets contained either 109 CFU of probiotics or 1 g of curcumin, or probiotic + curcumin (pro + cur), or placebo, respectively. The fasting lipid profile and atherogenic indices were measured at the beginning and end of the study. One hundred and fourteen participants completed the study. At the end of the study, the within- and between-group comparisons showed no significant differences in lipid profile and atherogenic indices (p > .05). Based on the results of the current study, taking an oral powder containing 1 g curcumin and 109 CFU probiotics for 8 weeks had no effect on the lipid profile level and atherogenic indices; however, more studies are recommended.

Selenium supplementation improves the nutritional status of hemodialysis patients: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Malnutrition is highly prevalent in hemodialysis (HD) patients. These patients have high levels of oxidative stress and inflammation which can subsequently induce malnutrition. Selenium levels have been found to be decreased in HD patients. As selenium deficiency leads to oxidative stress and inflammatory response, the aim of this study was to evaluate the effects of selenium supplementation on oxidative and inflammatory markers and the nutritional status of HD patients. METHODS: In this randomized double-blind placebo-controlled trial, 80 patients on stable HD for at least 3 months without any acute illness or active infections were randomly allocated to two equal groups to receive one selenium (200 µg) or placebo capsule daily for 12 weeks. Serum levels of lipoproteins, malondialdehyde (MDA), interleukin-6 (IL-6), high-sensitivity C-reactive protein (HSCRP), homocysteine, ferritin and transferrin as well as the subjective global assessment (SGA) score, malnutrition-inflammation score (MIS) and hemoglobin (Hb) levels were measured at the baseline and at the end of the treatment phase. The primary outcome was a change in the nutritional status measured by the SGA score from the baseline towards the end of the treatment phase of the study. RESULTS: The SGA score and MIS decreased significantly in the selenium group compared to the placebo group (P < 0.001 for both). Moreover, serum levels of MDA decreased significantly in the selenium group compared with increasing levels in the placebo group (P < 0.001). Selenium supplementation also hindered an increase in IL-6 levels compared with the placebo group (P = 0.016). There were no significant differences between the selenium and placebo groups in terms of changes in serum levels of lipoproteins, HSCRP, homocysteine, ferritin and transferrin or Hb levels. CONCLUSIONS: This study shows that selenium may be an effective complementary supplement for reducing the severity of malnutrition in HD patients through alleviating oxidative stress and inflammation.

Falls leading to fracture and nutrition among older adults: a case-control study.

OBJECTIVES: Injurious falls, especially those leading to bone fracture, are major causes of death and disability among older people. Our aim was to measure the association of nutritional factors and physical activity with falls leading to fracture among Iranian older adults. METHODS: This is the second phase of a previously published case-control study on 300 patients and 590 controls. RESULTS: In addition to the socio-economic factors that were reported before, our results revealed that consumption of fish, vegetables, fruits, and nuts reduced the risk of falling, whereas consumption of cheese, red meat, and sweets raised the risk of falls among the participants. CONCLUSION: The results of our study suggested that diets rich in fish meat fruits and vegetables should be encouraged in the everyday life of older adults. We suggest health officials to take these important results into consideration when planning protective measures.

Gender difference in the perceived cause of fall leading to fracture and its potentially contributing factors among older adults.

BACKGROUND: the present study aimed to investigate gender difference in the perceived cause (intrinsic or extrinsic) of falls leading to fracture (FLF) and its association with selected social, health, and environmental factors. METHODS: All patients aged 60 years or older who were admitted to two referral hospitals due to FLF from August 1, 2018, to the end of May 2019, were included in the study. An interview-administered questionnaire was used to collect the required data from 300 participants (136 men and 164 women). RESULTS: When compared to men, women were less physical active, were less smoker, had lower education, had more vision problems, used more sedatives, and were more satisfied with their life (P less than 0.05 for all). No statistical difference was observed between men and women about the perceived cause of Fall. CONCLUSIONS: Although women and men were the same in the perceived cause of fall, they had considerably riskier lifestyles and lower health status. These factors include education, vision condition, physical activity, occupation, and taking sleeping pills. On the other hand, men were more smoker and alcohol user.

The Burden of Premature Mortality in Southern Iran during 2004-2019 Using Standard Expected Years of Life Lost: A Population-Based Study.

Background: Traditionally, mortality rates are used to estimate public health problems and determine the relative significance of different causes of mortality, but they cannot necessarily determine the burden of premature death. We aimed to investigate the 16-year trend of burden of premature mortality in Southern Iran. Methods: In this cross-sectional study, all deaths due to various causes of death in Fars Province from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, Years of Life Lost (YLL) and YLL rate data were calculated and to examine the trend, joinpoint regression was used. Results: During the study period, 281,903 deaths occurred, of which, 59.85% (n=168,735) occurred in men. Also, 42.18% of these deaths (n=118,610) occurred due to cardiovascular diseases (CVDs). The total number of YLLs due to premature death was 4,154,828 years. Of these, 2,591,564 years (62.37%) were in men. The highest number of YLL was due to CVDs, external causes of death and cancer. Trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -2.1% (95% CI -2.6 to -1.6, P<0.001) for males, -0.9% (95% CI -1.4 to -0.4, P=0.002) (P=0.002) for females. Conclusion: Although the trend of premature death has been decreasing during the years of study, but the seven major causes of premature death in 2004 to 2019 were non-communicable diseases, especially ischemic heart diseases, stroke, external cause of morbidity, and cancer. Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.

Environmental factors and incidence of thyroid cancer in the world (1990-2019): an ecological study.

Thyroid cancer (TC) is the most common endocrine malignancy. Environmental risk factors such as presence of pollutants in air as well as the combustion of fossil fuels or carbon as a cooking habit in closed environments inside houses affect thyroid hormonal homeostasis and diseases. This study aimed to estimate the association between environmental risk factors and the incidence of thyroid cancer worldwide from 1990 to 2019 including particulate pollutants coming from fossil fuels employed in closed environments. Data on the incidence of thyroid cancer and some environmental risk factors were extracted from the Global Cancer Observatory (GLOBOCAN) for 204 countries and territories from 1990 to 2019. Pearson's correlation coefficient was used to determine the correlation between the thyroid cancer incidence and environmental risk factors. Finally, a generalized additive model was fitted for modeling. R 3.5.0 was used for analysis of the data. The most relevant results showed that the age-standardized incidence rate (ASIR) of thyroid cancer has a positive and significant correlation with environmental air pollution by O3 (r=0.63, P value<0.001), by particulate matter pollution (r=0.23, P value<0.001), and by household PM2.5 air pollution (r=0.52, P value≤0.001). In contrast, the correlation between ASIR and high temperature (T>25.6°C) (r=-0.27, P value<0.001) is negative and significant. The modeling results showed that particulate matter pollution and O3 pollution and household PM2.5 air pollution which originated from solid fuels are risk factors for thyroid cancer. Therefore, more research in this field is necessary in areas with high levels of air pollution at the national and international levels.

Prevalence and risk factors associated with tuberculosis and HIV coinfection in Iran: A multivariate firth logistic regression for rare events.

INTRODUCTION: Among the complications caused by HIV infection, tuberculosis (TB) is the most important challenge. The study aimed to determine the predictors of TB and HIV coinfection by using Firth logistic regression analysis. METHODOLOGY: This cross-sectional study was conducted on 32,168 HIV-positive patients diagnosed in Iran. The required information was obtained from the national HIV/AIDS surveillance data. RESULTS: The prevalence of TB in HIV patients was 3.2%; the prevalence of TB in males and females was 944 (91.83%) and 84 (8.17%), respectively. Based on results of multivariate Firth logistic regression, male gender OR male/female = 1.91; injecting drug use (IDU) OR YES/NO = 1.46; illiterate or primary groups OR illiterate or primary /university = 2.23; high school group OR high school/ university = 2.24 all increased the risk of TB and HIV coinfection (p < 0.05). Also, having CD4 > 500 [OR CD4 > 500 / < 200 = 0.39], CD4 351-500 [OR351 / < 200 = 0.65], and CD4 200-350 [OR200-350 / < 200 = 0.64] decreased the risk of TB and HIV coinfection (p < 0.001). CONCLUSIONS: According to the results of this study, male gender, low education, injecting drug users, and low CD4 count at the time of diagnosis, were significant predictors of TB and HIV coinfection. Therefore, regular and periodic screening programs and linkage to the care and treatment of HIV patients need special attention.

Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis.

Objective: Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran. Methods: This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group. Results: The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients. Conclusion: A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.

Unintentional injuries in children in the south of Iran, 2004-2019: a trend analysis of mortality rates.

INTRODUCTION: Injury is one of the main causes of death and disability in the world. This study was designed to determine the trend of mortality rate and years of life lost (YLLs) due to unintentional injuries in children in southern Iran. METHOD: In this cross-sectional study, we extracted all death reports due to unintentional injuries based on age, gender and the year of death based on International Classification of Diseases (ICD-10)from the Electronic Death Registration System. The YLL analysis due to premature death related to unintentional injuries was executed by the 2015 YLL template from the WHO using the Excel V.2016 software. To examine the trend of crude mortality rate and YLL rates for different years, joinpoint regression was used based on the log-linear model. RESULTS: During the 16-year study period (2004-2019), 6590 deaths due to unintentional injuries in children aged 0-19 years have occurred. The total YLLs due to unintentional injuries were 138 482 in males and 53 168 in females. The three main causes of YLLs in our study were transportation injuries (67.37%), drowning (7.19%) and burns (6.70%). According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing; the annual per cent change was -5.2% (95% CI -6.5% to -3.9%, p<0.001) for males and -4.3% (95% CI -5.7% to -3.0%, p<0.001) for females. CONCLUSION: Based on the findings of this study, the trend of mortality and YLL rate has been decreasing. Road traffic injuries were the most frequent injuries and the most common cause of death. Mortality rates fell by half. To improve child survival, injuries must now be recognised as a major child health problem, and to prevent deaths from injuries in children, early and preventive measures should be taken into account.