Peritoneal dialysis vs. hemodialysis among patients with end-stage renal disease in Iran: which is more cost-effective?

BACKGROUND: There is little economic evidence on different modalities among patients with end-stage renal disease (ESRD) in Iran. This study aimed to assess the cost-utility of peritoneal dialysis (PD) and hemodialysis (HD) among ESRD patients in Iran. METHODS: From the health system perspective and with a 10-year time horizon, we conducted a cost-utility analysis based on a Markov model to compare three strategies of PD and HD [the second scenario (30% PD, 70% HD), the third scenario (50% PD, 50% HD) and the fourth scenario (70% PD, 30% HD)] among ESRD patients with the current situation (PD, 3% vs. HD, 97%) as the basic scenario (the first scenario) in Iran. Cost data for PD, HD and kidney transplantation were extracted from the medical records of 720 patients in the Health Insurance Organization (HIO) database. The Iranian version of the EQ-5D-5 L questionnaire was filled out through direct interview with 518 patients with ESRD to obtain health utility values. Other variables such as transition probabilities and survival rates were extracted from the literature. To examine the uncertainty in all variables included in the study, a probabilistic sensitivity analysis (PSA) was performed. TreeAge Pro 2020 software was used for data analysis. FINDINGS: Our analysis indicated that the average 10-year costs associated with the first scenario (S1), the second scenario (S2), the third scenario (S3) and the fourth scenario (S4) were 4750.5, 4846.8, 4918.2, and 4989.6 million Iranian Rial (IRR), respectively. The corresponding average quality-adjusted life years (QALYs) per patient were 2.68, 2.72, 2.75 and 2.78, respectively. The ICER for S2, S3 and S4 scenarios was estimated at 2268.2, 2266.7 and 2266.7 per a QALY gained, respectively. The analysis showed that at a willingness-to-pay (WTP) threshold of 3,000,000,000 IRR (2.5 times the GDP per capita), the fourth scenario had a 63% probability of being cost-effective compared to the other scenarios. CONCLUSION: Our study demonstrated that the fourth scenario (70% PD vs. 30% HD) compared to the current situation (3% PD vs. 97% HD) among patients with ESKD is cost-effective at a threshold of 2.5 times the GDP per capita (US$4100 in 2022). Despite the high cost of PD, due to its greater effectiveness, it is recommended that policymakers pursue a strategy to increase the use of PD among ESRD patients.

Adsorption of diazinon from aqueous solution using metal organic framework and functionalized graphene: Comparison of BBD, ANN models.

In the present study, metal organic frameworks (MOFs) and aminated graphitic carbonaceous structure (ACS-RGO) through chemical synthesis prepared by a simple precipitation method and used for diazinon removal. Several techniques such as XRD , FESEM and FTIR were applied for identification of MOF-5 and ACS-RGO. Also, response surface methodology (RSM) was employed in this work to look at the effectiveness of diazinon adsorption. To forecast pesticide removal, we applied artificial neural network (ANN) and Box-Behnken Design (BBD) models. For the ANN model, a sensitivity analysis was also performed. The effect of independent variables like solution pH, various concentrations of diazinon, MOFs and ACS-RGO adsorbent dose and contact time were assessed to find out the optimum conditions. Based on the model prediction, the optimal condition for adsorption ACS-RGO and MOF-5 were determined to be pH 6.6 and 6.6, adsorbent dose of 0.59 and 0.906 g/L, and mixing time of 52.15 and 36.96 min respectively. These conditions resulted in 96.69% and 80.62% diazinon removal using ACS-RGO and MOF-5, respectively. Isotherm studies proved the adsorption of ACS-RGO and MOF-5 following the Langmuir isotherm model for diazinon removal. Diazinon removal followed by the pseudo-second and Pseudo-first order kinetics model provides a better fit for analyzing the kinetic data associated with pesticide adsorption for ACS-RGO and MOF-5, respectively. Based on the obtained results, the predicted values for the efficiency of diazinon removal with the ANN and BBD were similar (R2=0.98). Therefore, two models were able to predict diazinon removal by ACS-RGO and MOF-5.

Nanocellulose: A comprehensive review investigating its potential as an innovative material for water remediation.

Rapid growth in industrialization sectors, the wastewater treatment plants become exhausted and potentially not able to give desirable discharge standards. Many industries discharge the untreated effluent into the water bodies which affects the aquatic diversity and human health. The effective disposal of industrial effluents thus has been an imperative requirement. For decades nanocellulose based materials gained immense attraction towards application in wastewater remediation and emerged out as a new biobased nanomaterial. It is light weighted, cost effective, mechanically strong and easily available. Large surface area, versatile surface functionality, biodegradability, high aspect ratio etc., make them suitable candidate in this field. Majorly cellulose based nanomaterials are used in the form of cellulose nanocrystals (CNCs), cellulose nanofibers (CNFs), or bacterial nanocellulose (BNC). This review specifically describes about a variety of extraction methods to produced nanocellulose and also discusses the modification of nanocellulose by adding functionalities in its surface chemistry. We majorly focus on the utilization of nanocellulose based materials in water remediation for the removal of different contaminants such as dyes, heavy metals, oil, microbial colony etc. This review mainly emphasizes in ray of hope towards nanocellulose materials to achieve more advancement in the water remediation fields.

Photocatalytic degradation of ciprofloxacin using a novel carbohydrate-based nanocomposite from aqueous solutions.

Pharmaceutical substances in the ecosystem pose a notable hazard to human and aquatic organism well-being. The occurrence of ciprofloxacin (CIP) within water sources or the food chain can perturb plant biochemical processes and induce drug resistance in both humans and animals. Therefore, effective removal is imperative prior to environmental discharge. This study introduces a Novel Carbohydrate-Based Nanocomposite (Fe3O4/MOF/AmCs-Alg) as a proficient photocatalytic agent for degrading CIP in aqueous solutions. The fabricated nanocomposite underwent characterization using FTIR, XRD, FESEM, DRS, and VSM techniques. The analyses conducted verified the successful synthesis of the Fe3O4/MOF/AmCs-Alg nanocomposite. Utilizing the optimized parameters (pH = 5, nanocomposite dose = 0.4 g/L, CIP concentration = 10 mg/L, light intensity = 75 mW/cm2, and a duration of 45min), the Fe3O4/MOF/AmCs-Alg/Vis nanocomposite demonstrated an impressive CIP degradation efficiency of 95.85%. Under optimal experiment conditions, CIP removal efficiency in tap water and treated wastewater samples was 91.27% and 76.78%, respectively. Furthermore, the total organic carbon (TOC) analysis indicated a mineralization rate of 51.21% for CIP. Trapping studies demonstrated that the superoxide radical (O2°-) had a notable contribution to the breakdown of CIP. In summary, the Fe3O4/MOF/AmCs-Alg/Vis system offers numerous benefits, encompassing effective degradation capabilities, effortless catalyst retrieval, and remarkable nanocomposite reusability.

Heart failure: a prevalence-based and model-based cost analysis.

Introduction: Heart failure (HF) imposes a heavy economic burden on patients, their families, and society as a whole. Therefore, it is crucial to quantify the impact and dimensions of the disease in order to prioritize and allocate resources effectively. Methods: This study utilized a prevalence-based, bottom-up, and incidence-based Markov model to assess the cost of illness. A total of 502 HF patients (classes I-IV) were recruited from Madani Hospital in Tabriz between May and October 2022. Patients were followed up every two months for a minimum of two and a maximum of six months using a person-month measurement approach. The perspective of the study was societal, and both direct and indirect costs were estimated. Indirect costs were calculated using the Human Capital (HC) method. A two-part regression model, consisting of the Generalized Linear Model (GLM) and Probit model, was used to analyze the relationship between HF costs and clinical and demographic variables. Results: The total cost per patient in one year was 261,409,854.9 Tomans (21,967.21 PPP). Of this amount, 207,147,805.8 Tomans (17,407.38 PPP) (79%) were indirect costs, while 54,262,049.09 Tomans (4,559.84 PPP) (21%) were direct costs. The mean lifetime cost was 2,173,961,178 Tomans. Premature death accounted for the highest share of lifetime costs (48%), while class III HF had the lowest share (2%). Gender, having basic insurance, and disease class significantly influenced the costs of HF, while comorbidity and age did not have a significant impact. The predicted amount closely matched the observed amount, indicating good predictive power. Conclusion: This study revealed that HF places a significant economic burden on patients in terms of both direct and indirect costs. The substantial contribution of indirect costs, which reflect the impact of the disease on other sectors of the economy, highlights the importance of unpaid work. Given the significant variation in HF costs among assessed variables, social and financial support systems should consider these variations to provide efficient and fair support to HF patients.

Financial burden of prostate cancer in the Iranian population: a cost of illness and financial risk protection analysis.

BACKGROUND: Prostate cancer is the second most common cancer in males worldwide and the third most common among Iran's male population. However, there is a lack of evidence regarding its direct and indirect costs in low and middle-income countries. This study intends to bridge the gap using a cost of illness approach, assessing the costs of prostate cancer from the perspectives of patients, society, and the insurance system. METHODS: Two hundred ninety seven patients were included in the study. Data for a 2-month period were obtained from patients registered at two hospitals (Tabriz, Tehran) in Iran in 2017. We applied a prevalence-based, bottom-up approach to assess the costs of the illness. We used the World Health Organization methods to measure the prevalence and investigate the determinants of catastrophic and impoverishing health expenditures. RESULTS: We determined the total costs of the disease for the patients to be IRR 68 million (PPP $ 5,244.44). Total costs of the disease from the perspective of the society amounted to IRR 700,000 million (PPP $ 54 million). Insurance companies expended IRR 20 million (PPP $ 1,558.80) per patient. Our findings show that 31% of the patients incurred catastrophic health expenditure due to the disease. Five point forty-four percent (5.44%) of the patients were impoverished due to the costs of this cancer. CONCLUSION: We found an alarmingly high prevalence of catastrophic health expenditures among prostate cancer patients. In addition, prostate cancer puts a substantial burden on both the patients and society.

Cost-effectiveness analysis of different screening strategies for helicobacter pylori infection in Iran: A model-based evaluation.

BACKGROUND: The World Health Organization recommends assessing screening for helicobacter pylori infection to lower gastric cancer (GC) rates. Therefore, we carried out a study to evaluate the cost-effectiveness of different H. pylori screening approaches in Iran. MATERIALS AND METHODS: We used a Markov model with a 50-year time horizon and health system perspective to compare four H. pylori screening strategies (endoscopy, serology, urea breath test [UBT], stool antigen test [SAT]) to no screening in the population aged 20 years and older in Iran. Model parameters were extracted from primary data and published studies. Cost data also came from medical records of 120 patients at different stages of GC. We calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each strategy. Probabilistic sensitivity analysis (PSA) using Monte Carlo simulation tested the model's robustness. All analyses were done in TreeAge Pro 2020. RESULTS: All screening strategies provided more QALYs compared to no screening. Base-case analysis found the UBT strategy was the most cost-effective, with an ICER of 101,106,261.5 Iranian rial (IRR) per QALY gained, despite being more costly. No screening and endoscopy were dominated strategies, meaning they had higher costs but provided fewer effectiveness compared to other options. PSA showed at a willingness-to-pay (WTP) threshold of 316,112,349 IRR (Iran's GDP per capita) per QALY, UBT was the optimal strategy in 57.1% of iterations. CONCLUSION: This cost-effectiveness analysis found that screening for H. pylori may be cost-effective in Iran. Among the 4 screening strategies examined, UBT was the most cost-effective approach. Further studies should do cost-effectiveness analyses for specific age groups to optimize the benefits achieved with limited resources.

Statistical modeling and optimization of dexamethasone adsorption from aqueous solution by Fe3O4@NH2-MIL88B nanorods: Isotherm, Kinetics, and Thermodynamic.

The presence of pharmaceutical compounds in the environment poses a significant threat to human and aquatic animal health. Dexamethasone (DEX), a synthetic steroid hormone with endocrine-disrupting effects, is one such compound that needs to be effectively removed before discharging into the environment. This research presents a novel approach utilizing magnetically recyclable Fe3O4@NH2-MIL88B NRs as an efficient adsorbent for the treatment of DEX from aqueous solutions. The synthesized adsorbent was characterized by X-ray diffraction (XRD), scanning microscopy (SEM), transmission electron microscopy (TEM), vibrating sample magnetometer (VSM), diffuse reflectance spectra (DRS), and Fourier transform infrared spectroscopy (FTIR). Response surface methodology based on central composite design (RSM-CCD) was employed to optimize DEX removal efficiency by determining the optimal conditions, including pH, adsorbent dose, time, and DEX concentration. Under the optimized conditions (pH: 5.53, adsorbent dose: 0.185 g/L, time: 16.068 min, and DEX concentration: 33.491 mg/L), Fe3O4@NH2-MIL88B NRs revealed remarkable DEX adsorption efficiency of 91 ± 1.34% and adsorption capacity of 180.01 mg/g. The Langmuir isotherm and pseudo-second-order kinetic model were found to fit well with the experimental data, indicating a monolayer and chemical adsorption process. Thermodynamic analysis revealed that the adsorption process was spontaneous and endothermic. The study also investigated the inhibitory effect of background ions on DEX removal by Fe3O4@NH2-MIL88B NRs. Magnesium exhibited superior competitive ability with dexamethasone to occupy the active sites of the adsorbent compared to other background ions. The reuse of the adsorbent over ten consecutive cycles resulted in a 39.46% decrease in removal efficiency. The Fe3O4@NH2-MIL88B NRs are surrounded by abundant amounts of functional groups and π-electrons bands that can play a key role in the adsorption and separation of DEX from aqueous environments. The promising results obtained under real conditions highlight the potential of Fe3O4@NH2-MIL88B NRs as a practical and efficient adsorbent for the removal of DEX and other similar corticosteroids from aqueous solutions.

Viability of two adaptive fuzzy systems based on fuzzy c means and subtractive clustering methods for modeling Cadmium in groundwater resources.

The Adaptive Neuro-Fuzzy Inference System (ANFIS) combines the strengths of both Artificial Neural Networks (ANNs) and Fuzzy Logic (FL) into a single framework. By doing so, it allows for quicker learning and adaptable interpretation capabilities, which are useful for modeling complex patterns and identifying nonlinear relationships. One significant challenge in assessing water quality is the difficulty and time-consuming nature of determining the various factors that impact it. Given this situation, predicting heavy metal levels in groundwater resources, both urban and rural, is essential. This paper investigates two methods, ANFIS-FCM and ANFIS-SUB, to determine their effectiveness in modeling Cadmium (Cd) in groundwater resources. The parameters to be considered are: dissolved solids (TDS), electroconductivity (EC), turbidity (TU), and pH were assumed to be the independent variables. A total of 51 sampling location were used with in the groundwater resource were used to develop the fuzzy models. For evaluating the performance of ANFIS-FCM and ANFIS-SUB models, three different performance criteria including the correlation coefficient, root mean square error, and sum square error were used for comparing the model outputs with actual outputs . Based on the obtained results from scatter plots of actual and predicted value by ANFIS-SUB and ANFIS- FCM models, the determination coefficient (R2) value for total data, test and train sets is equal to 0.978, 0.982, 0.993 and to 0.983, 0.999 and 0.998 respectively. This result proved the Cd predictions of the implemented ANFIS-FCM model was significantly close to the measured all experimental data with R2 of 0.983. The performance of the implemented ANFIS-FCM model was compared with the ANFIS-SUB model and it is found that the ANFIS-FCM provided slightly higher accuracy than the ANFIS-SUB model. Also, the results obtained from the comparison between the predicted and the actual data indicated that the ANFIS-FCM and ANFIS-SUB have a strong potential in estimating the heavy metals in the groundwater with a high degree of accuracy.

Benzo (a) pyrene in infant foods: a systematic review, meta-analysis, and health risk assessment.

Exposure of infants to chemicals during their development will have major effects on their health. One of the major exposures of infants to chemicals is through their food. The main structure of infant food is milk, which is high in fat. There is a possibility of accumulation of environmental pollution, including benzo (a) pyrene (BaP). In this systematic review, the amount of BaP in infant milk was surveyed for this purpose. The chosen keywords were: benzo (a) pyrene, BaP, Infant formula, dried milk, powdered milk, and baby food. A total of 46 manuscripts were found in the scientific database. After initial screening and quality assessment, 12 articles were selected for extraction of data. By meta-analysis, the total estimate of BaP in baby food was calculated to be 0.078 ± 0.006 µg/kg. Estimation of daily intake (EDI) and Hazard Quotient (HQ) for noncarcinogenic risk and Margin of exposure (MOE) for carcinogenic risk were also calculated for three age groups 0-6 months, 6-12 months, and 1-3 years. HQ was lower than 1 and MOE was more than 10,000 for three age groups. Therefore, there is no potential carcinogenic and non-carcinogenic risk for infant health.

Economic Burden of Asthma in Northwest Iran.

Background: The economic burden of asthma is a major public health concern. This study estimates the economic burden of asthma in Northwest of Iran. Methods: A longitudinal study was conducted between 2017 and 2018 in Tabriz (Iran) using the Persian version of the Work Productivity and Activity Impairment (WPAI) questionnaire. Direct and indirect costs associated with asthma were estimated based on the societal perspective, prevalence-based approach, and bottom-up method. Annual indirect costs were estimated using the human capital (HC) method. The structural equation model was used to evaluate the relationship between costs, sex, and asthma severity. Results: A total of 621 patients with asthma were enrolled in the study. Significant differences were found between female and male patients for the mean cost of radiology (P=0.006), laboratory (P=0.028), and diagnostic (P=0.017) tests at baseline, and for laboratory (P=0.012), and diagnostic (P=0.027) tests at one-year follow-up. The more severe asthma, the more significant the costs for annual physician office visits (P=0.040) and medications (P=0.013). As asthma severity increased, significantly higher expenditures were observed in women for days lost from work at baseline (P=0.009) and one-year follow-up (P=0.001), and in men for productivity loss at work due to impairment at baseline (P=0.045). A significant association between indirect costs and the cost of impairment-related lost productivity at work (ß=3.29, P<0.001), and between severe asthma and indirect costs (ß=32.36, P<0.001) was observed. Conclusion: High costs are incurred by Iranian asthma patients, especially because of impairment-related productivity loss at work associated with asthma exacerbation.

Association Between Non-alcoholic Fatty Liver Disease and Heavy Metal Exposure: a Systematic Review.

Non-alcoholic fatty liver disease (NAFLD) is a debilitating disease with adverse effects including cirrhosis and hepatocellular carcinoma. Heavy metals can cause severe dysfunction in different body organs including the liver. This review offers the study regarding the positive or negative association between heavy metals exposure and non-alcoholic fatty liver disease. The method used in this study is a systematic review based on searching in the PubMed, Scopus, and Science direct databases with the keywords of fatty liver, non-alcohol fatty liver, heavy metal, mercury, cadmium, arsenic, chromium, thallium, lead, iron, zinc, and nickel. There were 2200 articles searched in databases, and after assessment, 28 articles were selected. Positive association is established between arsenic, cadmium, iron, lead, mercury, and fatty liver disease. A negative relationship is found between zinc, copper, and progressive fatty liver disease. Furthermore, laboratory methods for NAFLD diagnosis were examined according to the obtained manuscripts. Among the different diagnostic methods, magnetic resonance imaging (MRI) is a sensitive method.

Persistence and remote sensing of agri-food wastes in the environment: Current state and perspectives.

Food demand is expected to increase globally by 60-110% from 2005 to 2050 due to diet shifts and population growth. This growth in food demand leads to the generation of enormous agri-food wastes (AFWs), which could be classified into pre-consumption and post-consumption. The AFW represents economic losses for all stakeholders along food supply chains, including consumers. It is reported that the direct financial, social, and environmental costs of food waste are 1, 0.9, and 0.7 trillion USD/year, respectively. Diverse conventional AFW management approaches are employed at the different life cycle levels (entre supply chain). The review indicates that inadequate transportation, erroneous packaging, improper storage, losses during processing, contamination, issues with handling, and expiry dates are the main reason for the generation of AFWs in the supply chain. Further, various variables such as cultural, societal, personal, and behavioral factors contribute to the AFW generation. The selection of a specific valorization technology is based on multiple physicochemical and biological parameters. Furthermore, other factors like heterogeneity of the AFWs, preferable energy carriers, by-products management, cost, end-usage applications, and environmental legislative and disposal processes also play a crucial role in adopting suitable technology. Valorization of AFW could significantly impact both economy and the environment. AFWs have been widely investigated for the development of engineered added-value biomaterials and renewable energy production. Considering this, this study has been carried out to highlight the significance of AFW cost, aggregation, quantification, and membrane-based strategies for its management. The study also explored the satellite remote sensing data for Spatio-temporal monitoring, mapping, optimization, and management of AFW management. Along with this, the study also explained the most recent strategies for AFW valorization and outlined the detailed policy recommendation along with opportunities and challenges. The review suggested that AFW should be managed using a triple-bottom-line strategy (economic, social, and environmental sustainability).

Cost of Lung Cancer: A Systematic Review.

OBJECTIVES: We performed a systematic review of studies estimating the cost of illness of lung cancer to compare costs between studies and examine cost drivers, emphasizing generalizability and methodological choices. METHODS: A systematic search on studies published in English on cost of illness of lung cancer was performed in MEDLINE (PubMed), Embase, Web of Science, and Scopus. Databases were searched in January 2017, and records were screened based on eligibility criteria. The systematic search was updated on May 7, 2020. The quality of included studies was appraised using a modified Drummond checklist. RESULTS: Of the 4891 records screened, 19 records were included. Most of the studies were cross-sectional and retrospective and used a prevalence-based approach and a bottom-up approach. Direct medical costs ranged from 4484.13 US dollars purchasing power parity to 45 364.48 US dollars purchasing power parity. Total medical costs as a percentage of total gross domestic product (GDP) ranged from 0.00248 to 0.1326 (median 0.0217), and total medical costs as a percentage of total health expenditure ranged from 0.038 to 0.836 (median 0.209). CONCLUSIONS: There was considerable methodological heterogeneity that made it difficult to compare results between studies. The costs of lung cancer are substantial and impose a substantial economic burden on patients, healthcare systems, and societies. By comparing cancer costs with total health expenditures and GDP per capita, it can be concluded that lung cancer imposes a considerable economic burden on patients and healthcare systems in countries with lower GDP per capita and higher incidence rate.

Preparation of a cellulose acetate membrane using cigarette butt recycling and investigation of its efficiency in removing heavy metals from aqueous solution.

This study investigated the recycling of freshly-smoked cigarette butts (FCBs) and unsmoked cigarette filters (UCFs) into a cellulose acetate (CA) membrane. The both samples were prepared by means of a combination of seven cigarette brands, and the phase inversion method was used to recycle each sample into a membrane using N-methyl-2-pyrrolidone. The efficiency of the prepared membranes for the removal of chromium, cadmium, and lead from an aqueous solution in a forward osmosis reactor was investigated. The results showed that the both membranes had a smooth surface and macrovoids. The flux of the prepared membranes from the UCFs and FCBs recycling were 14.8 and 13.2 LMH, respectively. The porosity and reverse salt of the UCFs membrane were 61% and 3.5 gMH, while those for FCBs membrane were 58% and 3.9 gMH. The observed metal removal efficiency of the both membranes was in the range of 85 to 90%. However, increasing the concentration of metals up to five times caused a slight decrease in the removal efficiency (less than 5%).

The Effectiveness of Fluoride Varnish and Fissure Sealant in Elementary School Children: A Systematic Review and Meta-Analysis.

Background: Highly necessary to evaluate the effectiveness of preventive interventions to prioritize them at the community level. We aimed to systematically investigate the related studies on the effects of fluoride varnish and fissure sealant on dental caries in 6-12 children. Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library and Scopus databases using Fluoride Varnish, Fissure Sealant, Caries, and Oral Health keywords. The timeframe selected to search for articles is from 2000 to Dec 2020. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. The intervention groups in this study were fluoride varnish and fissure sealants, each of them compared to the control groups. Results: We included nine studies. In the intervention group 84,380 and control group 11,254 individuals were studied. Eight of the studies were Randomized Clinical Trial (RCT) and Field RCT, and two was non-RCT. In the overall Fluoride Varnish efficacy study, 4 were fully effective, 1 was ineffective, and all 4 were completely effective for Fissure Sealant. There was a significant difference between decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices in both interventions and comparison groups. Moreover, the mean difference of DMFT for Fluoride Varnish and Fissure Sealant in the intervention and control groups were -0.55 and -0.29, respectively (P=0.00). Conclusion: Due to the efficacy of fissure sealant and fluoride varnish in preventing dental caries in children aged 6-12 yr, these interventions can be considered as health priorities of societies and health systems interventions in countries.

Prevention and control of non-communicable diseases in iran: the case for Investment.

BACKGROUND: Non-communicable diseases are imposing a considerable burden on Iran. This study aims to assess the Return on Investment (ROI) for implementation of Non-communicable diseases (NCDs) prevention program in Iran. METHODS: Four disease groups including cardiovascular diseases, diabetes, cancer, and respiratory diseases were included in our ROI analysis. The study followed four steps: 1) Estimating the total economic burden of NCDs using the Cost-of-Illness approach. 2) Estimating the total costs of implementing clinical and preventive interventions using an ingredient based costing at delivering level and a program costing method at central level.3) Calculating health impacts and economic benefits of interventions using the impact measures of avoided incidence, avoided mortality, healthy life years (HLYs) gained, and avoided direct treatment costs. 4) Calculating the ROI for each intervention in 5- and 15- year time horizons. RESULTS: The total economic burden of NCDs to the Iranian economy was IRR 838.49 trillion per year (2018), which was equivalent to 5% of the country's annual Gross Domestic Product (GDP). The package of NCD will lead to 549 000 deaths averted and 2 370 000 healthy life years gained over 15 years, and, financially, Iranian economy will gain IRR 542.22 trillion over 15 years. The highest ROI was observed for the package of physical activity interventions, followed by the interventions addressing salt, tobacco package and clinical interventions. Conclusions NCDs in Iran are causing a surge in health care costs and are contributing to reduced productivity. Those actions to prevent NCDs in Iran, as well as yielding to a notable health impact, are giving a good economic return to the society. This study underscores an essential need for establishment of a national multi-sectorial NCD coordination mechanism to bring together and strengthen existing cross-agency initiatives on NCDs.

Risk assessment of heavy metals consumption through onion on human health in Iran.

Considering the importance of onions consumption in the household diet, controlling of heavy elements' concentration in foodstuffs is important to ensure the safety of an individual's health. This study aimed to evaluate the risk of heavy metals through onion consumption on human health. In this cross-sectional experimental study, 22 onion samples with varieties red, yellow, and white in the two autumn and winter seasons in 2020 were randomly collected from the different provinces of Kurdistan, Hamedan, and Kermanshah. The concentrations of heavy metals were evaluated with an atomic absorption spectrometer. The risks of human health were evaluated by the hazard quotient (HQ) and the obtained results were analyzed with one-way ANOVA and one sample t-test. The obtained findings demonstrated that all collected samples contained heavy metals. For example, the cadmium (Cd) concentration in onion samples in the province of West Azerbaijan, Kurdistan, Hormozgan, Isfahan, and Zanjan was 526.49, 274.49, 69.77, 67.39, 65.69 µg kg-1, respectively. While the standard specified in Iran for the concentration of Cd in onions is 50 µg kg-1. However, the rate of lead (Pb) contamination in samples collected from Isfahan, Hormozgan, Zanjan Khuzestan, Tehran (Varamin) was 296.50, 266.71, 261.49, 215.64, 106.19 µg kg-1, respectively, which less than maximum allowable limit recommended by WHO-FAO (300 µg kg-1). The HQ for non-cancerous diseases for Cd and Pb were 8.6 × 10-2 and 1.6 × 10-1, respectively, and the probability of carcinogenic risk for Pb (8.1 × 10-4) was at the level of acceptable. There is no concern about the non-carcinogenic diseases and carcinogenic risk of consuming heavy metals in onion. Therefore, for optimal management and prevention of further pollution, it is recommended to study the origin and determine the amounts of heavy metals for their potential contamination of foodstuffs from the region's soil, water, and dust.

Cost-Effectiveness of Screening Helicobacter pylori for Gastric Cancer Prevention: a Systematic Review.

Globally, prevalence of Helicobacter pylori is around 50%, and it has a directly proportional relationship with gastric cancer. Screening and treatment of Helicobacter pylori could reduce gastric cancer by 35%. Drawing on the scarce resources, it is reasonable to use the most cost-effectiveness Helicobacter pylori screening procedure. The purpose of this study was to evaluate Helicobacter pylori screening techniques and to specify the efficient technique from a cost-effectiveness perspective. This systematic review was conducted via searching electronic databases including Scopus, Embase, PubMed, Web of Science, and Cochrane Reviews. Our search retrieved 904 articles, of which, 606 full-text studies have been selected after duplicate removal. Next, the 25 articles were sorted based on eligibility criteria and quality appraisal; eventually, only eight studies have been included for analysis. We reported the incremental cost-effectiveness ratio (ICER) screening compared to non-screening and different screening strategies. Eight studies were identified and retained for the final analysis. In this study, when screening techniques were compared to no-screening, serology screening techniques showed to be cost-effective. The lowest ICER calculated was US$$1230 cost per life-year gained (LYG) and US$1500 cost per quality-adjusted life-year (QALY). However, determining the optimal strategy compared to other strategies was depended on parameters such as context-specific, type of cost, threshold, and perspective, and also, it influenced by the framework of the cost-effectiveness analysis.

The economic burden of road traffic injuries until one-year after hospitalization: A survey study.

OBJECTIVE: Road Traffic Injuries (RTIs) are one of the most crucial and challenging public health problems in low and middle income countries. Despite continuous efforts to estimate both personal and societal costs of RTIs however, their long-term effects have remained marginal. The current study aimed to explore the economic burden of RTIs until one year after the victim's hospitalization. METHODS: The study included a total of 1150 RTI victims, who were admitted to two trauma-referral hospitals during 2016. Data on direct medical costs, direct non-medical costs and indirect costs were gathered for each study sample via hospital records and phone surveys. Direct and indirect costs from a social perspective were estimated based on Micro Costing Approach followed by the Human Capital Approach. Also, the explanatory variables affecting the costs of RTIs were identified using the liner regression model. RESULTS: The average amounts of direct (medical, non-medical), indirect, and total costs of RTI were estimated as 2,908 US$ (1,591 US$, 1,316 US$), 5,790 US$, and 8,701 US$ respectively. Also, several variables were significantly affecting the costs of RTIs including age, marital status, employment status, severity of injury, receiving physiotherapy care, victim's vehicle type in crash, crash time and location. CONCLUSIONS: Findings suggest that RTIs are considered as an enormous burden on Iranian GDP per capita and health expenditure per capita occupying 167% and 347% respectively. This enormous economic burden caused by RTIs requires more policy regulations and prevention programs to decrease RTIs.