COVID-19 infection mortality risk in Iranian patients with type 2 diabetes, hypertension and obesity.

Background: Diabetes mellitus and hypertension are highly prevalent among patients with severe COVID-19. Aims: To study the mortality risk of COVID-19 infection in patients with type 2 diabetes and additive effect of hypertension and obesity in the Iranian population. Methods: This was a cross-sectional survey of the national COVID-19 registry from the Iranian Ministry of Health. The medical status of 22 002 patients with COVID-19 between 1 March and 30 April 2020 was analysed. Results: Patients with type 2 diabetes had a higher risk of mortality with an odds ratio (OR) of 1.67 [95% confidence interval (CI): 1.53-1.82, P < 0.001]. The risk of mortality was also high in patients with diabetes and hypertension, with an odds ratio of 1.76 (95% CI: 1.56-1.99, P < 0.001). The odds ratio of the risk of mortality in patients with diabetes, hypertension and obesity was 1.87 (95% CI: 1.35-2.58, P < 0.001). Conclusion: Type 2 diabetes, hypertension and obesity each predict mortality in Iranian patients with COVID-19, and when they are present together, patients have a greater risk of mortality.

IRAN National Cancer Control Program (IrNCCP): Goals, Strategies, and Programs.

Background: Annually, over 131000 new cases of cancer have been identified in Iran, with an increasing trend that is predicted to grow by 40% by 2025. The most important contributing factors to this increase are the improvement of the health service delivery system, increased life expectancy, and the aging of the population. The aim of this study was to develop Iran's "National Cancer Control Program" (IrNCCP). Methods: The present study is a cross-sectional study that was conducted in 2013 using the method of reviewing studies and documents and focused group discussions and a panel of experts. In this study, the available evidence related to cancer status and its care in Iran and other countries, as well as national and international upstream documents, were reviewed and analyzed. Then, by analyzing the current situation in Iran and other countries and conducting stakeholder analysis with the strategic planning approach, the IrNCCP was developed with a 12-year horizon consisting of goals, strategies, programs, and performance indicators. Results: This program has 4 main components, including Prevention, Early Detection, Diagnosis and Treatment, and Supportive and Palliative care, as well as 7 supporting components including Governance and policy-making, Cancer Research, Developing facilities, equipment, and service delivery network, Providing and managing human resources, Providing and managing financial resources, Cancer information system management and registry, and Participation of NGOs, charities, and the private sector. Conclusion: Iran's National Cancer Control Program has been developed comprehensively with cross-sectoral cooperation and stakeholder participation. However, like any long-term health intervention, strengthening its governance structure both in terms of implementation and achievement of expected goals and evaluation and modification during the implementation of the program is essential.

A spatio-temporal analysis of influenza-like illness in Iran from 2011 to 2016.

Background: Investigating the spatial aspects of the disease can help decision-makers and researchers better understand the pattern of the disease, and is also very important in the implementation of the disease control programs. Given the vast area of Iran, as well as the diverse geographical and climate conditions of the country, using the geographical information system (GIS) is a suitable method for the study of influenza. In this study, we provide a clear picture of the distribution of the influenza-like illness (ILI) in Iranian provinces through the years from 2011 to 2016 by applying a spatio-temporal analysis, using geographic information system (GIS). Disease rates by location and year are estimated, and then hot spots and cold spots are distinguished. Methods: This study was conducted using the ILI incidence rate data recorded in the Iranian Influenza Surveillance System from August 2011 to August 2016. The Choropleth map method and the various equal interval and natural break classifications were used. The local Getis-Ord Gi* method was then used to identify the hot spots and regions where, for some reason, the distribution of the disease had significantly clustered spatially. Statistical analyses were done using the ArcGIS 10.2 software. Results: This study indicates that the highest ILI rate belongs to the period from August 2014 to August 2015 with a rate of 180.26 (95%CI: 177.65 to 182.9) per 100,000 people. The results show that the highest 5-year mean of ILI rate belongs to Zanjan, Markazi, Lorestan, Ilam, North Khorasan, and South Khorasan provinces. Also, results from the local Getis-Ord Gi* method show that ILI has formed a hot spot between the years 2011 and 2013 on the eastern borders of Iran and afterward during the years 2014 to 2016 in the western regions of the country. Conclusion: Given the importance of influenza and its huge economic burden on the society, identifying the hot spot regions can help better manage the disease. This study indicates the distribution of the disease has formed a hot spot in the western regions of the country.

COVID19 Prevention & Care; A Cancer Specific Guideline.

On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.

Environmental risk factors for the incidence of cutaneous leishmaniasis in an endemic area of Iran: A GIS-based approach.

OBJECTIVES: This study was designed to determine the environmental factors associated with cutaneous leishmaniasis (CL) in Isfahan Province, using spatial analysis. METHODS: Data of monthly CL incidence from 2010 to 2013, climate and environmental factors including: temperature, humidity, rainfall, wind speed, normalized difference vegetation index (NDVI), altitude and population density across the Isfahan's cities was used to perform spatial analysis by ordinary least square (OLS) regression and geographically weighted regression (GWR). RESULTS: OLS revealed a significant correlation between CL incidence and five predictors including temperature, population density, wind speed, humidity and NDVI; which explained 28.6% of variation in CL incidence in the province. Considering AICc and adjusted R2, GWR provided a better fit to the data compared with OLS. CONCLUSION: There was a positive correlation between temperature and population density with CL incidence in both local (city) and global (province) level.

Developing a WebGIS for Geo-Visualization of Cancer.

BACKGROUND: Considering the hygiene facilities and sharing the data of diseases, considerable attempts to promote the public awareness have been made by various media; however, most of the provided information is based on numerical and verbal statistics, and may not provide suitable understanding for people in regard with the situation of diseases. OBJECTIVES: The main aim of this study is to design an interactive WebGIS system in which people could simply produce and observe their favorite maps of different cancers and environmental parameters. They can use this tools to produce their personalized maps and explore various aspects of the cancer. MATERIALS AND METHODS: A system has been developed by using WebGIS for convenience of ordinary users without any knowledge about geospatial information system (GIS) to observe the situation of the diseases and environmental conditions in terms of static and user-produced interactive maps. It has also provided the possibility of spatial comparison of the arbitrary parameters in the framework of bar and pie diagrams. This system has been designed and launched on cancer database of Iran where information of meteorological stations has been embedded as environmental parameters. RESULTS: The innovative idea in this study has received less attention in previous works including possibility of producing web-based Choropleth map so that users could easily select the parameters and algorithms for classification and interactive coloring in the system to produce their personalized maps. CONCLUSIONS: Development of WebGIS tools and increased cooperation of people in terms of inserting the spatial labels on the map to report a disease or using their views about reasons of occurring a specific cancer in a specific region may cause turning the process of mono-direction flow of information to users to a bi-directional flow of information. As a result, cancer specialists could use the knowledge of local people and residents of different regions of the country to better analyze the situation of various kinds of cancers.

Spatial and spatio-temporal analysis of human brucellosis in Iran.

BACKGROUND: Brucellosis is an important public and veterinary health problem in Iran and poses enormous economic burdens and significant human morbidity. In order to better understand the epidemiology of the disease in Iran, yearly spatial distribution and possible hotspots of the disease have been investigated in this study. METHODS: A cross-sectional survey was performed on 39 359 recorded cases during April 2009 to March 2012 throughout the country. Moran's I was applied to investigate the yearly patterns of the spatial distribution. Presence of possible hotspots was investigated using both local Moran's I and spatial and space-time scan statistics. RESULTS: Moran's I at county and province level showed that distribution of human brucellosis was regularly clustered. Both local Moran's I and spatial and space-time scan statistics detected significant hotspots of human brucellosis cases with high incidence rates. Hotspots were predominantly located in the west, northwest and northeast. Comparison of the population-based frequencies of human brucellosis in different elevation classes indicated the highest possibility of human brucellosis occurred in counties with high average altitudes (>2000 m). CONCLUSIONS: Human brucellosis continues to be a widespread challenge, especially in western and northwestern parts of Iran. The hotspots highlight the potential high risk areas requiring special plans and resources for monitoring and control of the disease.