Prevalence of Domestic Violence against Women and Its Visibility in Southeast Iran.

Background: We aimed to estimate the prevalence of domestic violence against women at Reproductive Age (WARA) and its visibility in southeast of Iran. Methods: Adopting a modified time-location sampling, we recruited 933 WARA in the city of Kerman, Iran from Aug to Dec 2019. Domestic violence (DV) was divided into three main categories: Physical, psychological, and sexual. Data were obtained by direct and Network Scale-Up (NSU) methods through self-administered questionnaires. Generalized Estimating Equations (GEE) was used to determine the association between socioeconomic variables and the violence experience. Visibility was defined as the ratio of NSU over direct estimates. Results: Using the direct method, the annual prevalence of psychological violence was estimated at 60.9%. Corresponding figures for physical and sexual violence were 34.7% and 37.7%, respectively. NSU estimates were about one-third of the direct estimates. Divorced and widowed, self-employed, and less educated women were more likely to experience DV. Conclusion: While the average DV was as high as 44%, its visibility was as low as 33%. Nearly two-thirds of domestic violence against women remains undisclosed. This indicates a high level of stigma perceived around this type of violence.

Quality of Life and Its Association With HIV-Related Stigma Among People Living With HIV in Kerman, Iran: A Cross-Sectional Study.

ABSTRACT: This study aimed to evaluate the quality of life (QoL) and its association with HIV-related stigma among people living with HIV (PLHIV) in Kerman province, southeast Iran. A convenience sample of 104 PLHIV was recruited. Data on QoL were collected using the HIV/AIDS-Targeted QoL instrument. Internal and external stigma were measured using an instrument developed by UNAIDS. The average QoL score was 52.5 ( SD =13.9). In multivariable model, PLHIV who experienced higher external stigma score (B = -1.9; 95% confidence interval [CI]: -2.6 to -1.1) and higher internal stigma score (B = -1.1; 95% CI: -1.5 to -0.6) had lower level of QoL. The low level of QoL among PLHIV in Iran indicates the need for initiatives to increase QoL among this population. Our data suggest that QoL in PLHIV could be improved by interventions aimed at reducing stigma in both community and health care settings.

Prevalence of Posttraumatic Stress Disorder Following the Earthquake in Iran and Pakistan: A Systematic Review and Meta-Analysis.

Posttraumatic stress disorder (PTSD) is a common mental disorder following traumatic events. The present study was conducted to understand the prevalence of PTSD after the earthquake in Iran and Pakistan. The review includes all articles published from inception to March 2019. The pooled prevalence for overall PTSD was 55.6% (95% CI: 49.9-61.3). It was 60.2% (95% CI: 54.1-66.3) and 49.2% (95% CI: 39.4-59) for Iranian and Pakistani survivors, respectively. Women experienced higher incidence of PTSD than men. The variation of PTSD based on the clinical interview was lower than the self-report approach. The interval time between the earthquakes and the assessment showed that the prevalence of PTSD decreased over time. The prevalence of PTSD in Iran and Pakistan was higher than the global average, and the rate of the disorder in Iran was higher than in Pakistan. Sex, method of assessment, and time lag between the occurrence of disaster and assessment of PTSD affect the prevalence.

Estimating the Size of Hidden Groups.

NSU studies have been applied in different countries. For example, this technique has been used in the United States to estimate the number of women who had been raped in the last year.

Public Stigma Toward Female and Male Opium and Heroin Users. An Experimental Test of Attribution Theory and the Familiarity Hypothesis.

Drug abuse and addiction exist around the world. People addicted to drugs such as opium or heroin often encounter dehumanizing discriminatory behaviors and health-care systems that are reluctant to provide services. Experiencing discrimination often serves as a barrier to receiving help or finding a home or work. Therefore, it is important to better understand the mechanisms that lead to the stigmatization of drug addiction and who is more prone to stigmatizing behaviors. There is also a dearth of research on whether different patterns of stigma exist in men and women. Therefore, this study investigated factors affecting gender-specific stigmatization in the context of drug addiction. In our vignette study (NMensample = 320 and NWomensample = 320) in Iran, we experimentally varied signals and signaling events regarding a person with drug addiction (i.e., NVignettes = 32 per sample), based on Attribution Theory, before assessing stigmatizing cognitions (e.g., blameworthiness), affective responses (e.g., anger), and discriminatory inclinations (e.g., segregation) with the Attribution Questionnaire. We also tested assumptions from the Familiarity Hypothesis by assessing indicators of respondents' familiarity with drug addiction (e.g., knowledge about addiction). Results, for example, show higher stigma if the person used "harder" drugs, displayed aggressive behavior, or had a less controllable drug urge. Self-attributed knowledge about addiction or prior drug use increased some forms of stigma, but diminished others. These findings only partially converged between men and women. We suggest that anti-stigma initiatives should consider information about the stigmatized person, conditions of the addiction, and characteristics of stigmatizers.

Health Pandemic and Social Media: A Content Analysis of COVID-Related Posts on a Telegram Channel With More Than One Million Subscribers.

BACKGROUND: Mobile-based social media play an important role in the dissemination of information during public health emergencies. OBJECTIVES: This study aimed to analyze the contents and trends of public messages posted on Telegram during Coronavirus Disease 2019 (COVID-19) pandemic. METHODS: A content analysis of the 1781 messages, posted in a public Telegram channel with more than one million subscribers performed over 9-weeks. The messages were categorized into seven categories. RESULTS: In total, 39% (n=703) of all messages were related to COVID-19. With the official confirmation of the case of COVID-19 in Iran, the number of COVID-related massages started to rise. Overall, the most frequent messages were of joke and humor (n=292, 41.5%), followed by educational messages (n=140, 19.9%). CONCLUSION: Our study showed that the most popular messages during first weeks of COVID pandemic were satirical, indicating that people may not had taken the risks of this pandemic seriously. It is crucial for health organizations to develop strategies for dissemination of reliable health information through social media.

Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients.

OBJECTIVES: Out-of-pocket (OOP) costs are a major part of the expenditures for healthcare services. In most cases, patient financial protection plans cover only direct medical costs and not other expenses by patients. METHODS: This cross-sectional study was conducted on 800 patients referring medical centers of Kerman to analyse all aspects of OOP, especially after the Health Transformation Plan in Iran. Using the probability proportional to the size of the medical center, samples from each ward in each medical center were determined in accordance with the previous year's patient number. Randomly selected medical records of the last 2 weeks of patients discharged were collected, information was extracted, and telephone interviews were conducted. RESULTS: The mean total OOP costs of a one-time hospitalization in all medical centers in Kerman was equal to 7 561 977 Iranian rials. Assuming a 5% threshold, 37% of patients in public centers were faced with catastrophic health expenditures for a one-time hospitalization. Based on the results of the regression model, reduction of length of stay, elimination of the need for the presence of next of kin, and provision of healthcare services out of hospitals can greatly reduce OOP expenditures. CONCLUSION: Although direct medical costs are of special importance, and it is very necessary to protect patients against such costs, patients usually incur a variety of costs when receiving inpatient services. Inattention to direct nonmedical costs and indirect costs due to patients' and their next of kin's absenteeism may cause households to face catastrophic expenditures.

Incidence of adverse reaction in blood donation: a systematic review.

There are a lot of reports related to adverse reactions post blood donation. The present study is designed to investigate the incidence of adverse reactions in blood donation around the world. This research was conducted through searching databases such as PubMed, Web of Science, Scopus, EmBase, Ovid, as well as the specialized journal of TRANSFUSION without any time limit by using the keywords including "Adverse Event", "Adverse Effect", "Adverse Reaction", "Complication", "Side Effect", "Vasovagal Reaction", "Local Reaction", "General Reaction", "Allergic Reaction", "Blood Donor", and "Blood Donation". In the initial search, 7054 documents were found, of which 2517 duplicates were excluded. After screening the remaining 4,537 documents, 97 one were reviewed for quality assessment, of which 30 with the appropriate quality were selected for the review process. The results of the study showed that the reactions caused by blood donation are very different. Most reactions were systemic, and ranged from 0.08 to 13 percent in different countries. The incidence of adverse reactions in blood donation differ across the countries which might be related to the donors' characteristics. The difference did even existed in studies conducted in the same country and the same year. This suggests that many factors can cause adverse reactions in blood donation, and that a wide range of them investigated in one study, most of which were systemic.

Estimating the Visibility Rate of Alcohol Consumption: A Case Study in Shiraz, Iran.

BACKGROUND: Network Scale Up (NSU) is applied in many settings to estimate the size of hidden populations. The visibility of alcohol consumption - as a hidden behavior - in Iran has not been yet set. Our aim is to estimate the visibility factor (VF) of alcohol consumption in Iran which is an Islamic country in the Middle East. METHODS: Ninety persons who had a history of alcohol consumption were recruited. Relationships in network were aligned in three main subgroups: immediate family, extended family, and non-family. According to the game of contact methodology, participants answered questions about total and aware number of persons they know in each relationship category. VF was calculated by dividing total number of people aware about the respondent's alcohol consumption by total number of respondent's social network. The 95% confidence intervals (CIs) were computed through bootstrapping. FINDINGS: The mean and standard deviation (SD) of participants' age was 32.9 ± 10.2, the sex ratio was 3. Overall VF (95% CI) was 40% (33% to 47%). VF was estimated at 44% and 23% among men and women's network, respectively. The immediate family was the highest informed group, followed by non-family and extended family members. CONCLUSION: The visibility of alcohol consumption in Iran was not high. This is due to religious and legal prohibitions around it.

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.

Incidence trend of breast Cancer in women of eastern Mediterranean region countries from 1998 to 2019: A systematic review and meta-analysis.

BACKGROUND: This study was conducted to provide evidence on the current status of breast cancer and its incidence trend in Eastern Mediterranean Region during 1998-2019. Also, this study aimed to investigate the association between the incidence of breast cancer and Human Development Index and some factors related to this index, including total fertility rate, and obesity, using a meta-analysis. METHOD: Data on incidence of breast cancer were collected from various sources, including PubMed, Embase, Web of Science, and WHO, from 1998 to 2019 using systematic review and meta-analysis. Pooled age standardized rate was calculated based on study duration and quality of data using a subgroup analysis and random effect meta-analysis. RESULTS: A total of 80 studies (545 data points) were analyzed. Pooled age standardized rate of breast cancer for Eastern Mediterranean Region was 37.1 per 100,000 person-year (95% confidence interval [CI], 34.5, 39.8) during 2011-2019. age standardized rate of breast cancer had an upward trend in Eastern Mediterranean Region from 2005 to 2019. However, the increasing trend was found to be slightly different in various regions based on quality of data. Moreover, pooled age standardized rate had a significant association with Human Development Index [- 89.2 (95% CI, - 119.8, - 58.7)] and obesity [1.2 (95% CI, 0.9, 1.5)]. CONCLUSION: Pooled age standardized rate of breast cancer in Eastern Mediterranean Region was lower than the global average. Also, the age standardized rate value and its incremental trend have been higher in countries with high-quality data than in other countries of this region in recent years. Data quality or physiological factors, such as increase in obesity rates, could be the reasons for this incremental trend.

Global prevalence of classic phenylketonuria based on Neonatal Screening Program Data: systematic review and meta-analysis.

Phenylketonuria is a disease caused by congenital defects in phenylalanine metabolism that leads to irreversible nerve cell damage. However, its detection in the early days of life can reduce its severity. Thus, many countries have started disease screening programs for neonates. The present study aimed to determine the worldwide prevalence of classic phenylketonuria using the data of neonatal screening studies. The PubMed, Web of Sciences, Sciences Direct, ProQuest, and Scopus databases were searched for related articles. Article quality was evaluated using the Joanna Briggs Institute Critical Appraisal Evaluation Checklist. A random effect was used to calculate the pooled prevalence, and a phenylketonuria prevalence per 100,000 neonates was reported. A total of 53 studies with 119,152,905 participants conducted in 1964-2017 were included in this systematic review. The highest prevalence (38.13) was reported in Turkey, while the lowest (0.3) in Thailand. A total of 46 studies were entered into the meta-analysis for pooled prevalence estimation. The overall worldwide prevalence of the disease is 6.002 per 100,000 neonates (95% confidence interval, 5.07-6.93). The metaregression test showed high heterogeneity in the worldwide disease prevalence (I2=99%). Heterogeneity in the worldwide prevalence of phenylketonuria is high, possibly due to differences in factors affecting the disease, such as consanguineous marriages and genetic reserves in different countries, study performance, diagnostic tests, cutoff points, and sample size.

Sequential ambiguity and uncertainty in the early stage of a disaster relief: A case study of the Bam earthquake.

This study aimed to identify issues that arose during the early response stage of the Bam earthquake as perceived by the aid workers. Eleven people who had been involved in the Bam earthquake response, and who were working for the Red Crescent in Iran or the Kerman University of Medical Science teams, were interviewed. These groups were two of the main organizations providing assistance to victims of the Bam earthquake. The authors used two nonrandom sampling methods, namely, purposive and snowball sampling. The interviewees identified two main barriers for achieving an effective response at the early stage aftermath of the earthquake, as follows: first, the lack of accurate information on the location and extent of the earthquake due to shortage in communication tools and, second, inadequate training on different challenges posed in relation to the disaster, before the earthquake occurred.

Evaluation of the treatment failure ratio in individuals receiving methadone maintenance therapy via the network scale up method.

BACKGROUND: The network scale up (NSU) method is an indirect size estimation method that has received remarkable attention in estimating the sensitive behaviors. Using methadone maintenance therapy (MMT), which is a treatment for opioid use disorder, is a sensitive topic in many societies. The aim of this manuscript was to estimate the number of MMT users and its failure ratio using the NSU method in the city of Kerman, Iran, in 2016. METHODS: In this cross-sectional study, 1275 men and 1275 women which were aged >18 years and who had lived in the city of Kerman for at least 5 years were recruited via multistage sampling. Data was collected via face-to-face interviews using a questionnaire that was included questions for estimating the network size of the residents of Kerman as well as the number of MMT users and the existing failure among them. RESULTS: In total, the average network size of the citizens of Kerman was 235; among them, 97 were men and 138 were women. Overall, the numbers of MMT users and failures were estimated at about 5289 and 2731, respectively, leading to a failure ratio about 52%. The treatment failure ratio in the women and men was equal to 55% and 51%, respectively. Among the men, the failure ratio in all age groups was equal to ˜50%. Among the women, the failure ratio in those who were aged <18 years was equal to 76%. CONCLUSION: The considerable failure ratio indicates the need for conducting studies on MMT services in order to understand the reasons which exist regarding this failure. This is of particular importance in specific groups, such as in young women. Further, the comparable results with other direct methods indicate that the NSU method could be used in the size estimation of MMT failure ratios.

Estimating The Annual Abortion Rate in Kerman, Iran: Comparison of Direct, Network Scale-Up, and Single Sample Count Methods.

BACKGROUND: Abortion is a sensitive issue surrounded by social, cultural and religious stigmata. Therefore, estimation of its prevalence involves methodological challenges. The aim of this manuscript is to estimate the abortion prevalence, stratified by type, using a direct and two indirect methods. MATERIALS AND METHODS: This cross-sectional study was done in 2016, we recruited 1020 women aging 18-49 years. Three methods were applied to estimate the abortion prevalence: direct question, network scale-up (NSU), and single sample count (SSC). In the direct method, to guarantee anonymity, data were collected by means of a self-administered questionnaire. In other methods, data were collected through gender-matched street-based interviews. RESULTS: The annual rate of abortion estimated by direct and NSU methods were 2 respectively 9 (10 intentional, 4 therapeutic and 15 spontaneous) and 23 (9 intentional, 3 therapeutic, and 11 spontaneous) per 1000 women aging 18- 49 years. The annual rate of intentional abortion estimated based on SSC method was higher (15 per 1000) women than other methods. CONCLUSION: The present estimates are higher than previously reported ones. The results of three methods more or less supported each other confirming the internal validity of our estimates.

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.

Methodological considerations in using the Network Scale Up (NSU) for the estimation of risky behaviors of particular age-gender groups: An example in the case of intentional abortion.

BACKGROUND: Network Scale Up (NSU) is a promising tool for size estimation of sensitive issues. In this study we investigated the important methodological considerations to employ this method for estimating behaviors, such as abortion, which happens in a particular age-gender group. METHODS: We recruited 1250 males and 1250 females aged 18 to 50. Abortion rate was calculated through direct question and NSU methodology. The NSU was applied on three sub-samples (male, female and aggregate). Integrating replies to 25 reference groups, we estimated the network size (C) of respondents and its age-gender structure. To calculate the part of network that is subject to abortion, we compared two approaches: proportional and data based. The Visibility Factor (VF) was calculated through 222 females who had abortion. Direct estimate was considered as gold standard. RESULTS: Using C's derived from proportional method, the Relative Bias (RB) in the male and female samples was 33% and 84%. Applying the data-based C's, the RB in the gender-specific and aggregate samples was 5% and 2%. CONCLUSION: The proportional method overestimates the prevalence. The data-based method to calculate the C is superior. The determination of the age-sex distribution of the network and the specific VF is essential.

The Trends of Viral Hepatitis B and C and HIV Infections in Donated Bloods in Iran Between 2003 and 2017.

BACKGROUND: The rate of viral infections in donated bloods is one of the main indicators of blood safety which has to be monitored precisely. This paper provides a thorough study of blood safety indicators in the last 15 years in Iran. METHODS: The data of the transfusion organization in Iran from years 2003 to 2017 were used. The study focuses on the analysis of the frequency of viral hepatitis B and C (HBV and HCV) as well as human immunodeficiency virus (HIV) in blood donations. RESULTS: Of 27,442,124 donated bloods, the relative frequencies were 4, 302, and 81 for HIV, HBV and HCV, respectively. This study also shows that the corresponding frequencies were significantly lower in recent years (2.5, 53, and 26 per 100,000 samples in 2017). CONCLUSION: The presented study indicates an overall low infection rate and provides evidence for the effectiveness of modern safety measures in improving the level of blood safety in Iran.

The increasing trend of blood donation in Iran.

BACKGROUND: This is the first study on the blood donation trend in Iran at a national level. We report different characteristics of blood donation such as demographic status, donor type, donation trend, and geographical distribution of blood donation in Iran between 2003 and 2017. METHODS: This study used data registered in the donor vigilance part of the Iranian Blood Transfusion Organization. Statistical analysis was conducted using SPSS (SPSS Inc., Chicago, IL, USA) and ArcMap GIS version 10.2 software. A P-value <0.05 was considered statistically significant. RESULTS: Based on the study results, blood donation in Iran reached >2 million units in 2017; moreover, it is predicted that Iran will achieve >29 donations per 1,000 population in 2022. The proportion of regular and repeated donors increased from 77% in 2013 to 87% in 2017. The average blood donation rate in seven provinces was higher than the national average, and the average growth rate of their blood donation per population was positive. CONCLUSION: The results of the current study showed that there is a recent increasing trend toward blood donation in Iran. Furthermore, the largest share of donations is related to regular donors. The increasing proportion of regular and repeated donors has led to the improvement in the quality and consequently health level of donated blood.