Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program.

BACKGROUND AND OBJECTIVES: Multimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran. RESEARCH DESIGN AND METHODS: In a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy. RESULTS: In 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52-2.54) and class 3 (OR 4.52, 95% CI 3.22-6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65-4.68) and class 3 (OR 1.84, 95% CI 1.28-2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01-2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28-0.62) and to class 2 (OR 0.61; 95% CI: 0.38-0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95). DISCUSSION AND IMPLICATIONS: A large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development.

Text mining of hypertension researches in the west Asia region: a 12-year trend analysis.

More than half of the world population lives in Asia and hypertension (HTN) is the most prevalent risk factor found in Asia. There are numerous articles published about HTN in Eastern Mediterranean Region (EMRO) and artificial intelligence (AI) methods can analyze articles and extract top trends in each country. Present analysis uses Latent Dirichlet allocation (LDA) as an algorithm of topic modeling (TM) in text mining, to obtain subjective topic-word distribution from the 2790 studies over the EMRO. The period of checked studied is last 12 years and results of LDA analyses show that HTN researches published in EMRO discuss on changes in BP and the factors affecting it. Among the countries in the region, most of these articles are related to I.R Iran and Egypt, which have an increasing trend from 2017 to 2018 and reached the highest level in 2021. Meanwhile, Iraq and Lebanon have been conducting research since 2010. The EMRO word cloud illustrates 'BMI', 'mortality', 'age', and 'meal', which represent important indicators, dangerous outcomes of high BP, and gender of HTN patients in EMRO, respectively.

Mortality and disability-adjusted life years for smoking-attributed cancers from 1990 to 2019 in the north Africa and middle east countries: a systematic analysis for the global burden of disease study 2019.

AIM AND BACKGROUND: Smoking is a modifiable risk factor for cancers. The aim of the study is to estimate the trend of mortality and DALYs of smoking-attributed cancers in the North Africa and Middle East (NAME) countries. METHODS: In this study, estimates from the Global Burden of Disease 2019 (GBD-2019) study were used to report the mortality and DALYs for 16 smoking-attributed cancers. The mortality and DALYs rates from smoking-attributed cancers were evaluated by age, sex, and the 21 countries of the NAME countries from 1990 to 2019. RESULTS: Age standardized mortality rates (ASMR) for the 29 smoking-attributed cancers in the NAME countries in 1990 and 2019 were estimated to be 24.7 (95% Uncertainty Interval: 21.5, 27.8) and 22.4 (95%UI: 19.8, 25.4) respectively, which shows a 9.2% decrease in the three decades. DALYs/100,000 for smoking-attributed cancers was, also, estimated to be 600.3 (95%UI: 521.6, 682.6) and 515.6 (95%UI: 454.9, 585.4) respectively, which indicates a 14.1% decreased in these three decades. In the last three decades, the percentage changes in DALYs/100,000 for smoking-attributed cancers in males and females were - 0.16 and - 0.03, respectively. Plus, The percentage changes in ASMR in males and females were - 12% and 8%, respectively. Furthermore, The highest ASMR and DALYs were observed in Lebanon, Turkey, and Palestine in 2019. CONCLUSION: The mortality rates of cancers from smoking have increased substantially among females, in most countries of the NAME region, in recent years. The burden caused by smoking can be reduced through modifying lifestyle and applying strict laws on smoking by governments and policymakers.

A registration trend in eyelid skin cancers and associated risk factors in Iran, 2005-2016.

BACKGROUND: Eyelid skin cancers are the most prevalent ophthalmic malignancies. This study aimed to evaluate the association of the Human Development Index (HDI) and lifestyle risk factors with eyelid skin cancers in Iran. METHODS: This ecological study analyzed the data collected from the Iranian National Population-based Cancer Registry (2005-2016). The data on provincial-level eyelid skin cancer risk factors were obtained from national sources. The association between provincial HDI and lifestyle risk factors with the prevalence of eyelid skin cancers was assessed. RESULTS: The mean 12-year age-standardized incidence rate (ASIR) of eyelid skin cancers was 16.22 per 100,000 (9,104 cases). The overall ASIR showed an upward trend with an estimated annual average increase of 0.006 per year. There were positive correlations between the prevalence of overall eyelid skin cancers and provincial HDI, smoking, and obesity (r = 0.32, 0.42, and 0.37, respectively). In multivariate analysis, obesity/overweight remained a positive predictor for high prevalence of total eyelid skin cancers (OR = 1.97, 95%CI = 1.08-3.58, P = 0.026), carcinoma (2.10, 1.15-3.83, P = 0.015), and basal cell carcinoma (1.48, 0.99-2.20, P = 0.054). CONCLUSIONS: An increasing trend in ASIR of eyelid skin cancers was observed in more than a decade in Iran which was positively associated with provincial HDI and prevalence of obesity. The findings of the study highlight the importance of promotional programs for preventing obesity/overweight and appropriate allocation of screening facilities based on the HDI level.

Association of cigarette smoking, obesity, and underlying medical conditions with COVID-19 hospitalization and mortality in Iran: A nationwide retrospective ecological study.

Background: Coronavirus Disease 2019 (COVID-19) has resulted in a considerable number of deaths worldwide. This ecological study aimed to explore the relationship between COVID-19 hospitalization and mortality with smoking, obesity, and underlying conditions in Iran. Methods: Provincial-level COVID-19 data were obtained from the official reports. Two outcomes were assessed: the total number of hospitalizations and deaths. Data on underlying health conditions, cigarette smoking, and obesity were obtained from national surveys. Negative binomial regression was used to report incident rate (IRR) ratios. Results: As of April 22, 2020, a total number of 43 950 lab-confirmed COVID-19 hospitalizations and 5391confirmed COVID-19 deaths were officially reported. Adjusting for underdetection to cover the number of clinically-confirmed COVID-19 cases, a total of 76 962 additional hospitalizations (ie, total lab- and clinically-confirmed hospitalizations = 120 912; 175% increase) and 7558 additional deaths (ie, total lab- and clinically-confirmed deaths = 12 949; 140% increase) were estimated during the same period. Provinces with a higher prevalence of obesity (IRR: 2.75, 95% CI: 1.49, 5.10), cigarette smoking (1.81; 95% CI: 1.01, 3.27), hypertension (1.88; 95% CI: 1.03, 3.44), and diabetes mellitus (1.74; 95% CI: 0.96, 3.16) had a higher likelihood of COVID-19 death rates. Conclusion: Inequality in COVID-19 hospitalization and mortality was observed in provinces whose populations had underlying diseases, in particular, obesity, cigarette smoking, hypertension, and diabetes.

Urbanization and noncommunicable disease (NCD) risk factors: WHO STEPwise Iranian NCD risk factors surveillance in 2011.

This study was conducted to examine the relationship between urbanization and risk factors of noncommunicable diseases (NCDs) according to the World Health Organization stepwise approach to surveillance of NCDs. This study is part of a NCD risk factor surveillance of 10 069 individuals in all provinces of the Islamic Republic of Iran, aged over 20 years, during 2011. By utilizing 2011 census data, urbanization levels were determined in all provinces and logistics regression was used to examine the relationship between urbanization and risk factors. Among males, urbanization had a positive correlation with low physical activity (OR=1.7; 95% CI: 1.42-2.09), low fruit and vegetable consumption (OR=1.8; 95% CI: 1.09-2.96), and high BMI (OR=1.4; 95% CI: 1.20-1.70). Among females there was a positive and significant correlation with low physical activity (OR=1.2; 95% CI: 1.08-1.49), low fruit and vegetable consumption (OR=1.22; 95% CI: 0.78-1.91) and high BMI (OR=1.3; 95% CI: 1.14-1.53). Thus, urbanization has a significant correlation with increases in NCD factors in the Islamic Republic of Iran.

Urban-Rural Differences in the Prevalence of Self-Reported Diabetes and its Risk Factors: The WHO STEPS Iranian Noncommunicable Disease Risk Factor Surveillance in 2011.

The high prevalence of diabetes in Iran and other developing countries is chiefly attributed to urbanization. The objectives of the present study were to assess the prevalence of self-reported diabetes and to determine its associated risk factors. This study is a part of the national noncommunicable disease risk factor surveillance, conducted in 31 provinces of Iran in 2011. First, 10069 individuals, between 20 and 70 years old (3036 individuals from rural and 7033 from urban areas), were recruited. The major risk factors were studied using a modified WHO STEPS approach. Diabetes was considered based on self-reported diabetes. The prevalence of self-reported diabetes was 10% overall. The prevalence in the rural and urban settings was 7.4% and 11.1%, respectively. Moderate physical activity (OR=0.45, 95% CI=0.29-0.71) and family history of diabetes)OR=6.53, 95% CI=4.29-9.93) were the most important risk factors among the rural residents and systolic blood pressure (OR=1.01, 95% CI=1-1.02), waist circumference (OR=1.02, 95% CI=1.01-1.03), and overweight (OR=1.36, 95% CI= 1-1.84) were significantly associated with self-reported diabetes in the urban residents. The prevalence of self-reported diabetes in the urban setting was higher than that in the rural setting. Physical inactivity, abdominal obesity, and high blood pressure were the most important risk factors associated with self-reported diabetes in Iran.

Compared to oxcarbazepine and carbamazepine, botulinum toxin type A is a useful therapeutic option for trigeminal neuralgia symptoms: A systematic review.

OBJECTIVES: This review aimed to compare the effectiveness of three treatments: BTX A, CBZ, and OXB, in managing trigeminal neuralgia (TN). MATERIAL AND METHODS: We conducted a thorough search for research articles related to our issue using specific keywords on several databases, including Cochrane Central Register of Controlled Trials, Science Direct, Scopus, PubMed, Elsevier, Springer Journals, Ovid Medline, EBSCO, and Web of Science. Our focus was on publications from 1965 to 2023. RESULTS: We retrieved 46 articles from the search and reviewed them carefully. Out of these, we selected 29 articles that met the inclusion criteria. Among the selected articles, 11 investigated the effects of CBZ and OXB, while 18 explored the impact of BTX A on the improvement of TN symptoms. The response rate ranged between 56% and 90.5% for CBZ and between 90.9% and 94% for OXB. The response rate for BTX A ranged between 51.4% and 100%. All these three treatments had a remarkable effect on the improvement of TN. Importantly, findings highlighted that side effects of CBZ and OXB could lead to treatment discontinuation in some cases, whereas BTX A's side effects have been minimal and less frequent. CONCLUSIONS: Consequently, BTX A emerges as a promising alternative for TN treatment. However, additional clinical trials are necessary to validate this finding, and further research is required to establish a standardized protocol for administering BTX A in TN.

Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030.

This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be - 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were - 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of - 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001-2016 were - 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be - 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.

Ambient air pollutants and breast cancer stage in Tehran, Iran.

This study aimed to examine the impacts of single and multiple air pollutants (AP) on the severity of breast cancer (BC). Data of 1148 diagnosed BC cases (2008-2016) were obtained from the Cancer Research Center and private oncologist offices in Tehran, Iran. Ambient PM10, SO2, NO, NO2, NOX, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene, and BTEX data were obtained from previously developed land use regression models. Associations between pollutants and stage of BC were assessed by multinomial logistic regression models. An increase of 10 µg/m3 in ethylbenzene, o-xylene, m-xylene, and 10 ppb of NO corresponded to 10.41 (95% CI 1.32-82.41), 4.07 (1.46-11.33), 2.89 (1.08-7.73) and 1.08 (1.00-1.15) increase in the odds of stage I versus non-invasive BC, respectively. Benzene (OR, odds ratio = 1.16, 95% CI 1.01-1.33) and o-xylene (OR = 1.18, 1.02-1.38) were associated with increased odds of incidence of BC stages III & IV versus non-invasive stages. BC stage I and stage III&IV in women living in low SES areas was associated with significantly higher levels of benzene, ethylbenzene, o-xylene, and m-xylene. The highest multiple-air-pollutants quartile was associated with a higher odds of stage I BC (OR = 3.16) in patients under 50 years old. This study provides evidence that exposure to AP is associated with increased BC stage at diagnosis, especially under premenopause age.

Artificial intelligence in screening, diagnosis, and classification of diabetic macular edema: A systematic review.

We review the application of artificial intelligence (AI) techniques in the screening, diagnosis, and classification of diabetic macular edema (DME) by searching six databases- PubMed, Scopus, Web of Science, Science Direct, IEEE, and ACM- from January 1, 2005 to July 4, 2021. A total of 879 articles were extracted, and by applying inclusion and exclusion criteria, 38 articles were selected for more evaluation. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2). We provide an overview of the current state of various AI techniques for DME screening, diagnosis, and classification using retinal imaging modalities such as optical coherence tomography (OCT) and color fundus photography (CFP). Based on our findings, deep learning models have an extraordinary capacity to provide an accurate and efficient system for DME screening and diagnosis. Using these in the processing of modalities leads to a significant increase in sensitivity and specificity values. The use of decision support systems and applications based on AI in processing retinal images provided by OCT and CFP increases the sensitivity and specificity in DME screening and detection.

High School Students' Depression Literacy about Interventions and Prevention: A Survey in Tehran.

Background: Given the high prevalence of depressive disorders in the present world and the lack of adequate awareness about prevention and appropriate interventions, increasing mental health literacy is vital for promoting mental health to reduce depression and its consequences. Methods: In this descriptive cross-sectional study, participants were recruited among the second high school students in the 2018-2019 academic year. The sample size was 2038, and samples were selected by multistage cluster sampling from different areas of Tehran. Demographic variables like age, gender, level of education, and parents' characteristics and mental health literacy questions in treatment and prevention areas were evaluated. Results: Analyses showed that of high school students, 83% considered getting help from psychiatrists and 80% considered learning stress management as the best preventive measures, while as the best treatment measures, 79.5% considered counseling the best place to refer for visiting a professional and 45% selected general counseling centers. Conclusion: The study results showed that high school students have a positive attitude toward preventing and treating depressive disorders, getting help from specialists, and useful measures for depressed people. But they did not know enough about preventive measures, including learning effective coping skills, reading self-help books, and continuing to take psychiatric medications. Planning and providing the necessary training are important, especially for high school students.

Trends and projection of incidence, mortality, and disability-adjusted life years of HIV in the Middle East and North Africa (1990-2030).

Evidence shows a growing trend of the HIV epidemic in the Middle East and North Africa (MENA). We aimed to project the incidence, mortality, and disability-adjusted life years (DALY) in the region from 1990 to 2019 and assess its trend by 2025, and 2030. We extracted the HIV incidence, mortality, and DALY data from the Global Burden of Disease (GBD) and UNAIDS databases. The joinpoint regression model was used to examine changes in HIV trends. The trend changes were estimated by average annual percent change (AAPC). In most countries, an increasing trend was observed in HIV incidence, mortality, and DALY. Specifically, the highest growth in the annual incidence rate was related to Egypt (AAPC = 14.4, GBD) and Iran (AAPC = 9.6, UNAIDS). Notably, Qatar (AAPC = - 5.6, GBD), Bahrain (AAPC = - 3.3, GBD), and Somalia (AAPC = - 4.2, UNAIDS) demonstrated a significant reduction in incidence. Regarding mortality rates, Djibouti (AAPC = 24.2, GBD) and Iran (AAPC = 16.2, UNAIDS) exhibited a significant increasing pattern. Furthermore, the estimated increase in incidence by 2030 was most marked in Djibouti (985%) and Iran (174%). Iran (422%) and Egypt (339%) showed a prominent rise in mortality rates. GBD data showed 16 countries had an increasing pattern in DALY in both genders. According to age and period effects, there was a significant upward trend in incidence, mortality rates, and DALY. Findings highlighted the urgent need for improved prevention and treatment services, including expanding access to HIV testing, promoting safe practices, increasing antiretroviral therapy coverage, and supporting targeted interventions for high-risk populations.

Donor Risk Factors and Environmental Conditions Associated With Poor-Quality Corneas: An Analysis of the Central Eye Bank of Iran (2018-2021).

PURPOSE: The purpose of this study was to investigate the donor risk factors and environmental conditions associated with poor-quality corneas using the database of the Central Eye Bank of Iran over 4 years. METHODS: This cohort study was conducted on the recorded data of all donated corneas at the Central Eye Bank of Iran database from March 2018 to March 2022. Donors' characteristics and tissue variables were extracted from the database. The final corneal quality was determined based on slitlamp biomicroscopic observations and the results of specular microscopy. Environmental variables were also obtained from reliable resources. Risk factors for poor-quality corneas were calculated using logistic mixed-effect regression analysis. All analyses were performed with STATA 17.0. The significance level of 0.05 was considered for all the analyses. RESULTS: The data of 20,625 eyes of 10,601 donors were evaluated. We found that donor age had an inverse correlation with endothelial cell density (r = -0.28, P < 0.001). The trend of donated corneal poor quality decreased between 2018 and 2021. Several factors, including intoxication (odds ratio [OR] = 1.29), obesity (OR = 1.34), diabetes mellitus (OR = 1.63), hypertension (OR = 1.52), and pseudophakic eyes (OR = 1.56), were associated with the poor quality of donated corneal tissues. The outdoor temperature over 26°C was associated with higher odds of poor corneal quality (OR = 1.31), whereas high relative humidity decreased the odds of poor corneal quality (OR = 0.82). CONCLUSIONS: This study revealed that the cause of donor death, obesity, donor comorbidities, pseudophakia, and environmental factors could affect the corneal quality and make the donated corneas less suitable for transplantation.

A joinpoint and age-period-cohort analysis of ocular cancer secular trends in Iran from 2004 to 2016.

Investigating secular trends of ocular cancer registration in Iran. After acquiring Iranian national population-based cancer registry data, trends of age-standardised incidence rates (ASIR) of ocular cancers and annual percent changes (APC) between 2004 and 2016 were analysed in age groups, gender, topography and morphology types with joinpoint regression analysis. Age, period, and cohort effects on incidence rates were estimated by age-period-cohort model. Geographic distribution of ASIR was assessed using GIS. Overall ASIR of ocular cancers was 16.04/100,000 (95% CI 15.77-16.32). Joinpoint regression analysis showed a significant increase of ASIR between 2004 and 2009 for males (APC = 5.5, 95% CI 0.9-10.2), ages over 50 years (APC = 5.2, 1.2-9.4), skin/canthus/adnexal cancers (APC = 4.2, 0.8-7.7), and carcinomas/adenocarcinomas (APC = 4.3, 0.6-8.1); however, between 2009 and 2016 a declining trend was observed in all investigated variables. ASIR of retinoblastoma was significantly increased (averaged APC = 20.7, 9-33.7) between 2004 and 2016. age-period-cohort analyses showed that incidence rates of ocular cancers significantly increased with aging, time periods, and birth cohort effects (p < 0.001). ASIR varied from 6.7/100,000 to 21.7/100,000 in Iran. Excepting retinoblastoma, all ocular cancer incidence trends were downward over a 13-year period; however, it was increasing between 2004 and 2009 cancer. ASIR was significant aging in Iran.

Multiple air pollutants exposure and leukaemia incidence in Tehran, Iran from 2010 to 2016: a retrospective cohort study.

OBJECTIVE: Leukaemia is one of the most common cancers and may be associated with exposure to environmental carcinogens, especially outdoor air pollutants. The objective of this study was to investigate the association of ambient air pollution and leukaemia in Tehran, Iran. DESIGN: In this retrospective cohort study, data about the residential district of leukaemia cases diagnosed from 2010 to 2016 were inquired from the Ministry of Health cancer database. Data from a previous study were used to determine long-term average exposure to different air pollutants in 22 districts of Tehran. Latent profile analysis (LPA) was used to classify pollutants in two exposure profiles. The association between air pollutants and leukaemia incidence was analysed by negative binomial regression. SETTING: Twenty-two districts of Tehran megacity. PARTICIPANTS: Patients with leukaemia. OUTCOME MEASURES: The outcome variables were incidence rate ratios (IRR) of acute myeloid and lymphoid leukaemia across the districts of Tehran. RESULTS: The districts with higher concentrations for all pollutants were near the city centre. The IRR was positive but non-significant for most of the air pollutants. However, annual mean NOx was directly and significantly associated with total leukaemia incidence in the fully adjusted model (IRR (95% CI): 1.03 (1.003 to 1.06) per 10 ppb increase). Based on LPA, districts with a higher multiple air-pollutants profile were also associated with higher leukaemia incidence (IRR (95% CI): 1.003 (0.99 to 1.007) per 1 ppb increase). CONCLUSIONS: Our study shows that districts with higher air pollution (nitrogen oxides and multipollutants) have higher incidence rates of leukaemia in Tehran, Iran. This study warrants conducting further research with individual human data and better control of confounding.

Severity of Disease and COVID-19 Complications During Hospital Stay: A Prospective Cohort Study.

BACKGROUND: COVID-19, with its high transmission and mortality rates and unknown outcomes, has become a major concern in the world. Among people with COVID-19, severe cases can quickly progress to serious complications, and even death. So, the present study aimed to examine the relationship between the severity of the disease and the outcome in patients afflicted by COVID-19 during hospitalization. METHODS: A total of 653 patients with COVID-19 aged 18 years or older were included from Khorshid hospital in Isfahan, Iran and followed for a mean of 22.72 days (median 23.50; range 1-47). Severe COVID-19 was defined by respiration rate≥30 times/min, oxygen saturation level≤88% in the resting position, and pulse rate≥130/min. The primary outcome was mortality. The secondary outcomes included need for mechanical ventilation and intensive care unit (ICU) admission. RESULTS: During 4233 person-days of follow-up, 49 (7.5%) deaths, 27 (4.1%) invasive ventilation and 89 (13.6%) ICU admissions in hospital were reported. After adjustment for potential confounders, severity of the disease was positively associated with risk of mortality, invasive ventilation and ICU admissions (hazard ratio [HR]: 5.99; 95% CI: 2.85, 12.59; P<0.001, HR: 7.09; 95% CI: 3.24, 15.52; P<0.001 and HR: 4.88; 95% CI: 2.98, 7.98; P<0.001, respectively). In addition, greater age (HR=1.04; 95% CI=1.02-1.07; P=0.002), chronic kidney disease (HR=3.05; 95% CI=1.35, 6.90; P=0.008), blood urea nitrogen (BUN) (HR=1.04; 95% CI=1.03-1.05; P<0.001) and creatinine (HR=1.44; 95% CI=1.26-1.65; P<0.001) were probably significant risk factors for mortality in severe COVID-19 patients. CONCLUSION: More intensive therapy and special monitoring should be implemented for patients with older age, hypertension and kidney disease who are infected with COVID-19 to prevent rapid worsening.

Depression Literacy of Women and Girls in Terms of Prevention and Interventions.

Objective: Recognizing the status of mental health literacy among women and girls as effective and key individuals in family and society seem to be essential. Therefore, the present study was conducted to evaluate depression literacy among women and girls in Tehran on prevention and effective interventions for improving depression. Method : This study was part of a large mental health literacy project on residents of Tehran in 2017, with a sample size of 1023 girls and women aged 16-68 years. Random Digit Dialing (RDD) sampling was done using the Australian questionnaire, whose Persian version's validity and reliability was tested in our previous study. Data were analyzed by SPSS 21 software. In order to determine the effect of demographic variables on predicting depression literacy among participants, multiple regression analysis was performed. Results: Receiving counseling, relaxation training, having physical activity, and studying self-help books were the most helpful items, respectively, from the participations' point of view. More than 70% of participants agreed with avoiding stressful situations and close relationship with family and friends, while only 49.8% agreed with coping skills learning. Based on the regression analysis, only higher education and the history of exposure to a person with similar Vignette problem were able to predict mental health literacy in the area of intervention and prevention. Conclusion: Considering the effects of women's and girls' depression on individual, family, and even social life, more attention should be paid to improve depression literacy in this group.

The indicators and methods used for measuring urban liveability: a scoping review.

OBJECTIVES: Liveability is a multi-dimensional and hierarchical concept which consists of various criteria and sub-criteria and may be evaluated in different ways. The aim of this study was to systematically review indicators and methods used for the evaluation of urban liveability in literature. CONTENT: The five-stage methodological framework of Arksey and O'Malley was used to conduct this scoping review. A systematic search of electronic databases, including Scopus, Medline (via PubMed), Embase, Web of Science and EBSCO was done until May 29, 2019. Web searching, searching reference lists and hand searching was also conducted to retrieve more relevant articles. Two reviewers screened the papers for eligibility based on the inclusion criteria and extracted their key data and reported them descriptively. SUMMARY: Sixty seven (67) out of 3,599 papers met the selection criteria. This review showed five distinct domains considered to be important components of liveability. These were Economical, Environmental, Institutional, Social, and Governance (Political) domains. The most important subdomains (indices) which were frequently applied in various studies were Environmental friendliness and Sustainability, Socio-Cultural Conditions and Economic Vibrancy and Competitiveness. We also identified seven different methodologies and six ranking tools used for assessing urban liveability. Among the quantitative methods, three methods accounted for 89.6% of the articles. These methods were the Analytical hierarchy process and entropy (AHP; n=24; 50%), Factor analysis & Principle Component Analysis (FA & PCA; n=12; 25%) and Spatial Multi-criteria Decision-making Method (Spatial; n=7; 14.6%). Among the ranking tools used, three ranking tools accounted for 65.4% of the articles. These tools were the Livable City Scientific Evaluation Standards (LCSES; n=9; 34.6%), The Global Liveable Cities Index (GLCI; n=4; 15.4%) and the Economist Intelligence Unit (EIU; n=4; 15.4%). OUTLOOK: This paper discusses and summarizes the latest indicators and methods used for determining urban liveability. The information offered in the review can help future investigators to decide which method suits their purpose and situation better and measure urban liveability more systematically than before.