Health challenges and facilitators of arbaeen pilgrimage: a scoping review.

BACKGROUND: The Arbaeen Pilgrimage, a momentous religious journey drawing millions of participants annually, presents a profound spiritual experience. However, amidst its significance lie various health challenges that pilgrims encounter along the way. Addressing these challenges is vital to ensure the well-being of participants and the success of this extraordinary event. In light of this, the aim of this study is to examine the health challenges of the Arbaeen Pilgrimage, identify facilitators for solving these challenges, and propose effective solutions to enhance the overall pilgrimage experience for all involved. METHODS: The scoping review was performed by searching databases such as Web of Science, PubMed, Scopus, and Google Scholar search engine with a focus on the keywords "Arbaeen", "Arbaeen walk" and "Arbaeen pilgrimage". The search was not constrained by a specific time limitation in the databases. Data from studies were extracted using a data extraction form consisting of 9 fields. The selection of articles and data extraction were carried out by two researchers, adhering to predefined inclusion and exclusion criteria. Any disagreements were resolved through consultation with a third researcher. The study was reported following the PRISMA checklist. RESULTS: Out of 1619 retrieved articles, 9 were finally included in this study. All these studies were published since 2017 and conducted in Iraq and Iran. In total, 101 health challenges and facilitators were identified, comprising 61 challenges and 40 facilitators. The challenges with the highest frequency included "infectious disease outbreaks" (n = 7), "Poor management of Iraq's health system in waste collection and disposal" (n = 4), "Rising incidence of walking injuries among pilgrims (e.g., burns, fractures, lacerations, wounds, and blisters)" (n = 4), and "Insufficient knowledge about personal and public health"(n = 4). The most important facilitators to solving the challenges were: "Customized pilgrim training and addressing their issues, with a focus on vital practices" (n = 6), "Coordinating mass gathering stakeholders, including health ministries and organizations" (n = 4), and "Implementing an agile syndromic system for rapid surveillance and identification of contagious illnesses" (n = 4). CONCLUSION: The article discusses health challenges faced during the Arbaeen Pilgrimage and proposes facilitative measures for participants' well-being. It emphasizes the significance of addressing health risks in large gatherings and suggests incorporating measures for a safer and enjoyable pilgrimage experience. Overall, understanding and managing these health factors can lead to a successful execution of the Arbaeen Pilgrimage, benefiting the physical and spiritual well-being of all involved.

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults.

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Incidence, accuracy, and barriers of diagnosing healthcare-associated infections: a case study in southeast Iran.

BACKGROUND: Healthcare-associated infections (HAIs) are a threat to patients. Accurate surveillance is required to identify and prevent HAIs. To estimate the incidence rate, report the accuracy and identify the barriers of reporting HAIs using a mixed-method study. METHODS: In this quantitative study, we externally evaluated the incidence rate and accuracy of the routine surveillance system in one of the main hospitals by an active follow-up of patients from September to December 2021. We used in-depth interviews with 18 experts to identify the barriers of the routine surveillance system. RESULTS: Among 404 hospitalized patients, 88 HAIs were detected. The estimated rate of HAIs was 17.1 (95% Confidence Intervals 95: 14.1, 21.1) per 1000 patient-days follow-up. However, in the same period, 116 HAIs were reported by the routine surveillance system, but the agreement between the two approaches was low (sensitivity = 61.4%, specificity = 82.6%, negative predictive value = 89.7%, and positive predictive validity = 46.5%). The minimum and maximum positive predictive values were observed in urinary tract infection (32.3%) and surgical site infection (60.9%). The main barrier of reporting HAIs was lack of cooperation in reporting HAIs by infection control link nurses and laboratory supervisors. CONCLUSIONS: The discrepancy between the longitudinal study findings and the routine surveillance might be related to the inaccessibility of the surveillance system to clinical information of patients. In this regard, decreasing the barriers, increasing the knowledge of infection control nurses and other nurses, as well as the development of hospital information systems are necessary.

Agenda-setting in policies related to high-risk sexual behaviours, stimulants, and alcohol abuse in Iranian adolescents.

BACKGROUND: This research article retrospectively analyses the agenda-setting approach of policies concerning high-risk sexual behaviours, stimulant and alcohol abuse among Iranian adolescents. METHODS: This qualitative case study policy analysis involved analysing 51 national documents and conducting interviews with 49 policy-makers and executives. Purposive sampling with a snowball strategy and semi-structured interviews were used. The data was analysed using the framework analysis method, with Kingdon's multiple streams framework serving as the analytical framework. RESULTS: The study has identified the confluence of several factors, including the problem stream, the policy stream and the political stream. Within the problem stream, several factors contributed, such as the prevalence of high-risk behaviours, strong scientific evidence on these behaviours, changes in human immunodeficiency virus (HIV) transmission patterns, increased statistics of poisoning and deaths related to alcohol abuse, and the visit of Iran's supreme leader to the slums of Mashhad city. The policy stream has two periods of denial and acceptance. The denial period includes considering these high-risk behaviours to be the consequences of western culture, emphasis on the religious aspects and sinfulness of these behaviours, resisting the prevalence of anomalous behavioural patterns, abstinence and religious obligation of chastity, and avoiding ethical corruption. The acceptance period includes adolescents training, fear messages, promotional and cultural activities, parent training, school staff training, providing psychiatric services for withdrawal, counselling and reference to receive specialized services. The political stream involves global attention towards non-communicable diseases and high-risk behaviours, and the significant impact of preventing these behaviours during adolescence on the health status of society. Also, the supreme leader's attention to social harms, and the establishment of the National Committee for Prevention and Control of Alcohol, have played significant roles. CONCLUSIONS: While the problem stream helped to highlight the problem and increase policy-makers' attention, the politics stream played a significant role. Despite international evidence on the effectiveness of training in sexual issues in reducing high-risk behaviours, it did not succeed in being added to the agenda. The policy stream was heavily influenced by ideology and the political parties in power, affecting evidence-based policy-making. In countries with an ideological approach, the political stream plays a vital role in setting problems on the agenda.

Barriers and Problems in Implementing Health-Associated Infections Surveillance Systems in Iran: A Qualitative Study.

Background: Healthcare-associated infections (HAIs) are among the most critical challenges for patients and healthcare providers. To achieve the goals of the surveillance system, it is necessary to identify its barriers and problems. This study aimed to identify the barriers and problems of the surveillance system for HAIs. Methods: This qualitative study was conducted using the content analysis method to investigate the challenges of this surveillance system from the perspective of 18 infection control nurses from hospitals in different cities of Iran with work experience of 1 to 15 years. Data were collected through semi-structured interviews and analyzed using the Lundman and Graneheim qualitative content analysis method. Results: In this study, we found 2 categories and 7 subcategories. Two categories were barriers related to human resources and organizational barriers to infection control. The 7 subcategories included weakness of medical staff in adherence to health principles, obstacles related to patients, high workload and insufficient motivation, lack of staff knowledge, lack of human resources, functional and logistical weaknesses, and weaknesses in the surveillance system. Conclusion: To reduce problems and improve HAIs reporting, the HAIs surveillance system needs the support of health system officials and managers. This administrative and support focus can establish the framework for removing and lowering other barriers, such as the number of reported cases, physician and staff noncooperation, and the prevalence of HAIs. It can also bring HAIs cases closer to reality.

What Do Future Trends in Medical Education Mean to the Scientific Development of Iran's Health System?

Background: Medical education system in Iran has an essential role in responding to scientific development targets from both education and research perspectives. Investigating future trends and analyzing how they interact with the medical education system helps increase awareness and give insight into the preferred future. Methods: The present qualitative study consists of Systematic reviews and interviews that have been analyzed using content analysis. Afterward, the themes and codes were visualized in the form of maps and presented in a focus group discussion of experts to define how medical education trends will impact scientific development. Results: The future trends of Iran's medical education system were classified into six groups: workplace changes, demographic changes, changes in concepts, the emergence of new players, structural changes in universities, and technology development. The next point is how they will influence science development. Their impact on science development is classified into five main groups or main streams of change of new financial models, open science, redesigning the research management, the role of universities, and capacity building. Conclusion: Our findings showed that redesigning the structure of medical education is the most important priority to make the system as agile as needed to capture the signs and act. New meanings and concepts should also be considered in restructuring, like power balance, competency-based and personalized education, cost-effectiveness, and openness.

Inequality in households' access to primary health care (PHC): a case study in Kerman, southeast Iran.

BACKGROUND: Fair access to health services is a vital issue in low-and middle-income countries. Therefore, the present study was conducted to evaluate the equity in access to primary health care (PHC) services in southeastern Iran. METHODS: This household-based survey was conducted on 1128 households in Kerman, southeastern Iran in 2019-20. A multistage probability method was used to select the samples. The online questionnaire was designed and its link was provided to the questioners. After receiving the training, the questioners went to the door according to the sampling guide. The collected data were analyzed at a significance level of 0.05, using the STATA software. The concentration index (CI) was also used to measure inequality in access to PHC services. RESULTS: The results showed that there was a significant difference between gender and location in access to PHC services (P < 0.05). However, no significant difference was found between the access rates to PHC services and the variables of age, marital, education, health insurance, and Supplementary insurance (P > 0.05). The mean rate of access to PHC services was 3.51 ± 0.53. Cultural access (3.76 ± 0.54) and timely receipt of PHC services (2.51 ± 0.72) accounted for the highest and the lowest access rates, respectively. The concentration index for the distribution of PHC services among the income-adjusted population was 0.014 (CI 95%: -0.022 to 0.051), indicating pro-rich inequalities in access to PHC services. CONCLUSION: The results indicated that pro-rich inequality, but it was close to the equality line. Also, the access level was assessed as moderate to high. Therefore, planning and policy-making seems essential for reduce inequality, and development and promotion of access to PHC services, especially timely provision of services and organizational access.

Distinct genetic variation and heterogeneity of the Iranian population.

Iran, despite its size, geographic location and past cultural influence, has largely been a blind spot for human population genetic studies. With only sparse genetic information on the Iranian population available, we pursued its genome-wide and geographic characterization based on 1021 samples from eleven ethnic groups. We show that Iranians, while close to neighboring populations, present distinct genetic variation consistent with long-standing genetic continuity, harbor high heterogeneity and different levels of consanguinity, fall apart into a cluster of similar groups and several admixed ones and have experienced numerous language adoption events in the past. Our findings render Iran an important source for human genetic variation in Western and Central Asia, will guide adequate study sampling and assist the interpretation of putative disease-implicated genetic variation. Given Iran's internal genetic heterogeneity, future studies will have to consider ethnic affiliations and possible admixture.

What the policy and stewardship landscape of a national health research system looks like in a developing country like Iran: a qualitative study.

BACKGROUND: The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points. METHODS: This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro. RESULTS: Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base. CONCLUSIONS: Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework.

HIV prevalence and continuum of care among incarcerated people in Iran from 2010 to 2017.

BACKGROUND: Incarcerated people are at an increased risk of contracting HIV and transmitting it to the community post-release. In Iran, HIV epidemics inside prisons were first detected in the early 1990s. We assessed the HIV prevalence and its correlates, as well as the continuum of care among incarcerated people in Iran from 2010 to 2017. METHODS: We used data collected in three national bio-behavioral surveillance surveys among incarcerated individuals in 2010 (n = 4,536), 2013 (n = 5,490), and 2017 (n = 5,785) through a multistage cluster sampling approach. HIV was tested by the ELISA method in 2010 and 2013 surveys and rapid tests in 2017. Data on demographic characteristics, risky behaviors, HIV testing, and treatment were collected via face-to-face interviews. HIV prevalence estimates along with 95% confidence intervals (CI) were reported. Using data from the 2017 round, multivariable logistic regression models were built to assess the correlates of HIV sero-positivity and conduct HIV cascade of care analysis. RESULTS: The HIV prevalence was 2.1% (95% CI: 1.2%, 3.6%) in 2010, 1.7% (95% CI: 1.3%, 2.1%) in 2013, and 0.8% (95% CI: 0.6%, 1.1%) in 2017 (trend P value < 0.001). Among people with a history of injection drug use, HIV prevalence was 8.1% (95% CI: 4.6%, 13.8%) in 2010, 6.3% (95% CI: 4.8%, 8.3%) in 2013, and 3.9% (95% CI: 2.7%, 5.7%) in 2017. In 2017, 64% (32 out of 50) of incarcerated people living with HIV were aware of their HIV status, of whom 45% (9 out of 20) were on antiretroviral therapy, and of whom 44% (4 out of 9) were virally suppressed (< 1000 copies/ml). CONCLUSIONS: While HIV prevalence has decreased among incarcerated people in Iran, their engagement in the HIV continuum of care is suboptimal. Further investments in programs to link incarcerated people to HIV care and retain them in treatment are warranted.

Scoping Review of 5 Common Occupational Cancers and Their Related Exposures.

Background: Occupational cancers can be avoided by removing dangerous chemicals from the workplace or limiting occupational exposure. Approximately, 10 major risk factors account for 85% of all occupational cancers. This scoping review study aimed to determine the most important chemical carcinogens related to 5 known occupational cancers. Methods: In this scoping review, we followed Arksey and O'Malley's 5-step framework. Four databases (PubMed, Web of Science, Google Scholar, Scopus) were systematically reviewed for relevant published papers from January 2000 to September 2021. Studies were included in this scoping review, which examined the effect of carcinogenic (definite and probable) chemical exposures on 5 known occupational cancers (lung, bladder, laryngeal, leukemia, and liver). We reported the types of occupational carcinogens, the geographical diversity of studies, extraction of relative risks (RRs), hazard ratios (HRs), or odds ratios (ORs), and identified gaps in the existing literature. Results: The highest number of studies was related to lung cancer (LC) (n = 26), bladder cancer (BC) (n = 11), laryngeal cancer (LaC) (n = 8), leukemia (LeC) (n = 3), and primary liver cancer (PLC) (n = 2), respectively. Most studies were performed in France and Canada (n = 8), Germany (n = 4), Finland (n = 3), Netherlands (n = 2), and Finland (n = 2), respectively. Furthermore, the most common occupational chemical carcinogens associated with the 5 known occupational cancers were asbestos, benzene, crystalline silica, polycyclic aromatic hydrocarbons (PAH), and diesel motor exhausts (DME). Conclusion: Although the attributable risk of occupational cancers in developing countries is much higher, a small proportion of studies were performed in these countries.

A multi-centre survey on hospital malnutrition: result of PNSI study.

BACKGROUND: Disease-related malnutrition is associated with adverse outcomes such as increased rates of morbidity and mortality, prolonged hospital stay, and extra costs of health care. This study was conducted to assess nutritional status among patients and to determine the risk factors for malnutrition in Iran university f. METHODS: Persian Nutritional Survey In Hospitals (PNSI) was a cross-sectional study that conducted in 20 university hospitals across Iran. All the patients with age range of 18 to 65 years, who were admitted or discharged, were assessed by subjective global assessment (SGA). RESULTS: In total, 2109 patients were evaluated for malnutrition. Mean values of age and body mass index were 44.68 ± 14.65 years and 25.44 ± 6.25 kg/m2, respectively. Malnutrition (SGA-B & C) was identified in 23.92% of the patients, 26.23 and 21% of whom were among the admitted and discharged patients, respectively. The highest prevalence of malnutrition was in burns (77.70%) and heart surgery (57.84%) patients. Multivariate analysis presented male gender (OR = 1.02, P < 0.00), malignant disease (OR = 1.40, P < 0.00), length of hospital stay (OR = 1.20, P < 0.00), and polypharmacy (OR = 1.06, P < 0.00) as independent risk factors for malnutrition. Malnutrition was not associated with age (P = 0.10). CONCLUSION: This study provides an overall and comprehensive illustration of hospital malnutrition in Iran university hospitals, finding that one out of four patients were malnourished; thus, appropriate consideration and measures should be taken to this issue.

Severity and mortality of COVID-19 infection in HIV-infected individuals: Preliminary findings from Iran.

Background: Higher mortality due to coronavirus disease 2019 (COVID-19) is reported among some immunocompromised patients; however, the relation between immunosuppression due to HIV infection and severity of COVID-19 infection remains unclear. We aimed to investigate the severity and mortality of COVID-19 infection in HIV-infected patients. Methods: This was a retrospective cohort study on all COVID-19 suspected and confirmed cases hospitlized in Iran between Febuary 19 (epidemic onset date) and April 8, 2020, whose data were recorded in the national database for Medical Care Monitoring Center. Hospitalized patients were followed from admittion to death/discharge. Patients' HIV status was recorded based on their self report. Logistic and Cox regression models were used to evaluate the association between HIV infection and the severity (according to the Glascow-Coma Scale situation, need for intubation and hypoxemia) and mortality of COVID-19 infection, respectively. Analyses were performed separately for COVID-19 suspected and confirmed cases. Results: Out of 122 206 severe acute respiratory infection (SARI) cases, 90 were HIV-positive (0.07%), with a similar mean age (Pt-test= 0.750) and distrubtion of gender (PChi-square= 0.887) and nationality (PChi-square= 0.202) as HIV-negative patients. A comparable proportion of HIV-positive and HIV-negative cases were tested for COVID-19 (p= 0.170); however, the frequency of positive results was lower among HIV-positives (p= 0.038). The frequency of COVID-19 and HIV coinfection was lower than expected among confirmed cases (adjusted OR= 0.54; 95% CI: 0.29-1.02) and suspected cases (adjusted OR= 0.68; 95% CI: 0.45- 1.02), which means that the frequency of COVID-19 infection was lower among HIV-positive cases. HIV infection decreased the risk of death among confirmed (adjusted HR= 0.33; 95% CI: 0.05-2.32), suspected cases (adjusted HR= 0.81; 95% CI: 0.33-1.94), and among SARI cases (adjusted HR= 0.73; 95% CI: 0.35-1.54). Conclusion: Our findings support the concept that HIV infection was not a risk factor to increase the severity and risk of death among COVID-19 infected patients.

Declining trends in HIV and other sexually transmitted infections among female sex workers in Iran could be attributable to reduced drug injection: a cross-sectional study.

OBJECTIVE: The HIV trend among female sex workers (FSWs) is understudied. We assessed the prevalence and trend of HIV and five other STIs among FSWs in Iran. METHODS: We recruited FSWs (1337 in 2015, 1005 in 2010) from 21 sites in 13 cities in two cross-sectional biobehavioural surveys. Eligible FSWs were women aged ≥18 years who reported selling sex to more than one male client in the past 12 months. Consenting FSWs were interviewed using a behavioural questionnaire and tested for HIV and five other STIs. We considered study sites as clusters in the analysis and two-sided Fisher's exact test to compare the HIV prevalence between the two survey rounds. RESULTS: HIV prevalence was 2.1% in 2015 (vs 4.0% in 2010, p=0.007). Lifetime drug injection was reported by 6.1% of participants in 2015 (vs 14.6% in 2010, p=0.003). In 2015, among FSWs with history of lifetime drug injection, HIV prevalence was 8.6% (vs 9.8% in 2010, p=0.425). The prevalence of other STIs in 2015 was 0.4% (95% CI 0.2 to 1.0) for syphilis, 1.3% (95% CI 0.8 to 2.1) for gonorrhoea, 6.0% (95% CI 4.8 to 7.4) for chlamydia, 11.9% (95% CI 8.5 to 16.5) for trichomoniasis and 41.8% (95% CI 39.2 to 44.5) for human papillomavirus. CONCLUSIONS: HIV prevalence among FSWs in Iran decreased, but remains considerably high. The decrease in HIV prevalence compared with 2010 might be explained by a decrease in drug injection. Other STIs are also high in this population. Harm reduction programmes need to be continued and scaled up among this underserved population in Iran.

Premature mortality of gastrointestinal cancer in Iran: trends and projections 2001-2030.

BACKGROUND: The present study was conducted to determine the trend and projection of premature mortality from gastrointestinal cancers (GI cancers) at national and subnational levels in Iran. METHODS: Employing the data obtained from Iranian Death Registry System (DRS) and population data from census, the mortality rates of GI cancers was calculated among 30-70 age groups. The trends of esophageal, colon and rectum, gallbladder, pancreases, stomach, and liver cancer premature mortalities were estimated and projected at the national and subnational levels from 2001 to 2030. Then, Spatio-temporal model was used to project spatial and temporal correlations. RESULTS: The overall mortality rate of GI cancers was higher in males than in females, indicating 6.1, 3.9 and 3.9% per 100,000 individuals among males in 2001, 2015 and 2030 respectively and 3.8, 3.1 and 3.7 per 100,000 individuals among females in the same time-frame. The overall mortality rate of GI cancers in males was decreasing until 2015 and will remain stationary into 2030; however, the rate will be increasing among females in both time-frames. Also, there was a considerable variation in the mortality trends of different cancers. Pancreatic, gallbladder, and liver cancers were shown to have an increasing trend while a drop was observed in the mortality rates of stomach, colon and rectum, and esophageal cancers. CONCLUSION: Variation of GI cancers patterns and trends around the country indicated that a more comprehensive control plan is needed to include the predicted variations.

The concept of virginity from the perspective of Iranian adolescents: a qualitative study.

BACKGROUND: Premarital sex can increase the risk of sexually transmitted diseases (STDs) in adolescents, and lack of premarital sex can be considered as a reliable policy for STD prevention, which is used by some countries such as Iran. Since the success of this policy is related to the concept of virginity, the present study was conducted to determine the concept of virginity from the perspective of Iranian adolescents. METHODS: In this qualitative study with phenomenological approach, the research team visited public places, including parks and coffee shops, and interviewed a number of 15-19-year-old adolescents. The data were collected using in-depth interviews with semi-structured questions and analysed using thematic analysis method. RESULTS: Several themes, including virginity as the lack of emotional relationship with the opposite sex, lack of physical contact, nonpenetrative relationship, virginity as a myth, virginity as a commitment, having an intact hymen, and not knowing the meaning of virginity, were extracted from the data. CONCLUSION: The most reliable policy on STD prevention is the lack of premarital sex. The success of this policy is related to the concept of virginity. The findings of this study showed that the participants did not consider physical contact as the breach of virginity. This may indicate that the policy of not having sex before marriage or lack of premarital sex is not enough and Iranian adolescents are at risk of STDs. Therefore, policymakers must take steps towards modifying the concept of virginity in the adolescents' value system and provide and implement educational programs on sexual health for adolescents.

Iranome: A catalog of genomic variations in the Iranian population.

Considering the application of human genome variation databases in precision medicine, population-specific genome projects are continuously being developed. However, the Middle Eastern population is underrepresented in current databases. Accordingly, we established Iranome database (www.iranome.com) by performing whole exome sequencing on 800 individuals from eight major Iranian ethnic groups representing the second largest population of Middle East. We identified 1,575,702 variants of which 308,311 were novel (19.6%). Also, by presenting higher frequency for 37,384 novel or known rare variants, Iranome database can improve the power of molecular diagnosis. Moreover, attainable clinical information makes this database a good resource for classifying pathogenicity of rare variants. Principal components analysis indicated that, apart from Iranian-Baluchs, Iranian-Turkmen, and Iranian-Persian Gulf Islanders, who form their own clusters, rest of the population were genetically linked, forming a super-population. Furthermore, only 0.6% of novel variants showed counterparts in "Greater Middle East Variome Project", emphasizing the value of Iranome at national level by releasing a comprehensive catalog of Iranian genomic variations and also filling another gap in the catalog of human genome variations at international level. We introduce Iranome as a resource which may also be applicable in other countries located in neighboring regions historically called Greater Iran (Persia).

Dual Unsafe Injection and Sexual Behaviors for HIV Infection Among People Who Inject Drugs in Iran.

We used two national surveys (2010: N = 1597; 2013: N = 1057) of people who inject drugs (PWID) in past-month to assess the prevalence and population size of PWID with either safe or unsafe injection and sex behaviors, overall and by HIV status. In 2013, only 27.0% (vs. 32.3% in 2010) had safe injection and sex, 24.6% (vs. 23.3% in 2010) had unsafe injection and sex, 26.4% (vs. 26.5% in 2010) had only unsafe injection, and 22.0% (vs. 18.0% in 2010) had unsafe sex only. Among HIV-positive PWID in 2013, only 22.1% (~ 2200 persons) had safe injection and sex, 14.2% (~ 1400 persons) had unsafe injection and sex, 53.1% (~ 5200 persons) had unsafe injection, and 10.6% had unsafe sex (~ 1100 persons). Among HIV-negative PWID in 2013, only 27.5% (~ 22,200 persons) had safe injection and sex, 25.9% (~ 20,900 PWID) had unsafe injection and sex, 23.2% (~ 18,700 persons) had unsafe injection, and 23.3% (~ 18,800 persons) had unsafe sex. HIV-positive and -negative PWID in Iran continue to be at risk of HIV acquisition or transmission which calls for targeted preventions services.

Determinants of risky sexual practice, drug abuse and alcohol consumption in adolescents in Iran: a systematic literature review.

BACKGROUND: Evidence shows that the prevalence of risky sexual practice, drug abuse, and alcohol consumption behaviors in low and middle income countries such as Iran is not in a favorable condition. Preventive programs against these behaviors in Iran are very rare, and the results are unclear, which may be due to the lack of deeply and systematically understanding of the determinants of these behaviors. Evidence suggests that these behaviors are coincidence. So all of these behaviors were examined together. The present study was conducted aiming at determining the reasons for the occurrence of these behaviors among 15-19-year-old adolescents in Iran. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed to review published and unpublished studies in Iran. The databases used were Scopus, PubMed, Web of Science, and Cochrane Library. The query terms were "Synthetic Drug" OR "Designer Drug", AND Adolescents OR Teenagers OR Juvenile, AND Iran. The Joanna Briggs Institute Critical Appraisal Checklist was employed for critical appraisal. The quantitative studies using the regression model to analyze the factors affecting these behaviors were studied as the form of the theme. For analyzing the data, narrative synthesis and thematic analysis were used. RESULTS: Twelve studies were meticulously reviewed. The findings were classified into five main themes (including individual, family, friends, school, and community) and 26 sub-themes. The most frequent main theme and sub-themes were respectively Family, Higher age, Male gender, Weak religious beliefs, Low self-esteem, Anti-social behaviors in family, Mother's employment, Parenting style, Poor intimacy of parents, Absence of parents, Peer pressure, and Lack of appropriate recreation. No primary study has referred to the political, economic, or policy factors affecting such behaviors. CONCLUSIONS: The most identified sub-themes belong to family factors. Iran is a country with ideology of Islam; however, being Muslim does not guarantee adherence to all Islamic guidelines. So being Muslim is not a good reason to prevent these behaviors. Iran needs precise policy making in this area through considering family structure. It is also suggested that primary studies referring to the political, economic, or policy factors affecting such behaviors should be carried out.

Call for new stories: Exploring the etiology of suicide in Iran (Causal layered analysis).

Background: Despite many studies on suicide, the causation remains ambiguous, and there is a necessity for new all-inclusive methodology. Causal layer analysis (CLA) is a relatively new technique to deeply explore the etiologies of suicide in Iran. Methods: Causal layered analysis (CLA) combines empirical, interpretative, critical, and action research methods in comprehensive hierarchical layers of causality, like an iceberg. Layers begin from the first observable layer called litany to the deeper underneath layers, including systemic, worldview, and metaphor. In the litany layer, the general appearance of suicide in Iran was extracted through published evidence. In the systemic layer, observed quantitative results of litany was interpreted based on the short-term historical facts by conducting 30 semi-structured interviews with experts. In the worldview layer, 40 deep interviews with suicide attempt cases, 10 focus-groups among adolescents, and 20 semi-structured interviews with nurses and experts were conducted. In the myth and metaphor layer, the Persian poetry of the last century was studied and suicide notes and stories were reviewed. Results: Three causal models of CLA 1 (self-burning of women as an objection to the closed society), CLA 2 (duality of parent's addiction- divorce), CLA 3 (suicide as a reaction to the identity crisis) were extracted. Conclusion: Macrohistorical changes such as war, urbanization, and modernity have confronted the new the new generation with distinctive and unexpected realities in life, which are not similar to their dreams and old stories. Suicide is a reaction to this silent inner battle between old metaphors and new realities.