Markers of community outbreak and facility type for mitigation of COVID-19 in long-term care homes in Ontario, Canada: Insights and implications from a time-series analysis.

PURPOSE: The resident deaths among Long Term Care Home (LTCH) accounted for more than 65% of total deaths in the province of Ontario, Canada, during March 29 to June 3, 2020, yet not all LTCHs were severely affected. METHODS: We carried out a retrospective cohort study, with case control for questions for which data allowed, with LTCH COVID-19 databases obtained from Ontario's Ministry of Long Term Care. We performed a combined temporal and spatial data analysis of COVID-19 cases and deaths among LTCH residents, identified trends, contributing factors, and early markers of LTCH outbreak severity. RESULTS: Our analysis shows that for-profit LTCHs had higher death-to-bed ratio, also with an average rate of increase of death-to-bed ratio higher for for-profit homes than other types of management. We find from uni- and multi-variable analyses (linear and nonlinear) that staff infection has the strongest association with death-to-bed ratio from among the descriptor variables considered, reflecting the risk of the disease in the health region/community. We also identify a delay of up to 8 days between the trends in fatalities among individuals outside LTCHs and that of LTCH residents. We did find an association between policy change to single LTCH/staff and reduction in weekly LTCH resident death, albeit with an expected time delay of about 7-10 days. CONCLUSIONS: The association between the risk of COVID-19 in the health region and the deaths among LTCH residents, and the delay between fatality among individuals residing outside and inside LTCHs suggests that fatality in a health region could be a predictor of outbreak in LTCHs within the same health region.

Prevalence of Non-alcoholic Fatty Liver Disease in Iran: A Systematic Review and Meta-analysis.

Background: Non-alcoholic fatty liver disease (NAFLD) has a benign course in several patients; however, a serious form of this disease can turn into liver failure, liver cirrhosis, and hepatocellular carcinoma. Aim: This study aims to estimate the prevalence of NAFLD in Iran. Method: We searched the following databases from January 2000 to December 2022: Scopus, Pubmed/Medline, Embase, Web of Sciences, the Cochrane Library, and Google Scholar also a number of Iranian databases, namely MagIran, SID, and Elmnet. Additionally, the quality of the included studies was evaluated through the Newcastle-Ottawa Scale. We estimated heterogeneity between studies using the I2 statistic. Furthermore, we performed a synthesis of prevalence estimates through the random-effects DerSimonian and Laird model across the included studies with a 95% confidence interval. To assess the publication bias, we also used Egger's test. Results: Thirty-one studies were eligible for inclusion. The overall number of participants in the present study was 41,971. The overall prevalence of NAFLD in Iran was 33% [CI: 27-37%], with I2 = 99.7% (P < 0.01). The prevalence was 35% [CI: 27-43%] and 37% [CI: 27-47%] in males and females, respectively. We used Egger's test, and no significant publication bias was identified in the overall prevalence (P = 0.45). Conclusion: According to the results of this study, the prevalence of NAFLD in Iran is not only high but alsoa growing trend. Effective strategies for changing lifestyles, changing eating habits, and encouraging physical activities among Iranians are recommended. Also, providing screening tests, especially among high-risk groups, has a significant effect on early diagnosis and NAFLD control.

Off-label drug use during the COVID-19 pandemic in Africa: topic modelling and sentiment analysis of ivermectin in South Africa and Nigeria as a case study.

Although rejected by the World Health Organization, the human and even veterinary formulation of ivermectin has widely been used for prevention and treatment of COVID-19. In this work we leverage Twitter to understand the reasons for the drug use from ivermectin supporters, their source of information, their emotions, their gender demographics, and location information, in Nigeria and South Africa. Topic modelling is performed on a Twitter dataset gathered using keywords 'ivermectin' and 'ivm'. A model is fine-tuned on RoBERTa to find the stance of the tweets. Statistical analysis is performed to compare the stance and emotions. Most ivermectin supporters either redistribute conspiracy theories posted by influencers, or refer to flawed studies confirming ivermectin efficacy in vitro. Three emotions have the highest intensity, optimism, joy and disgust. The number of anti-ivermectin tweets has a significant positive correlation with vaccination rate. All the provinces in South Africa and most of the provinces of Nigeria are pro-ivermectin and have higher disgust polarity. This work makes the effort to understand public discussions regarding ivermectin during the COVID-19 pandemic to help policy-makers understand the rationale behind its popularity, and inform more targeted policies to discourage self-administration of ivermectin. Moreover, it is a lesson to future outbreaks.

Hidradenitis suppurativa in Black and White patients - a clinical study.

OBJECTIVE: It is suggested that hidradenitis suppurativa (HS) is more prevalent and causes greater morbidity in Black patients than in White. Clinical data are however lacking. PATIENTS AND METHODS: We therefore describe HS risk factors, disease severity and clinical phenotypes in the Blacks and Whites. Patients referred for HS between 1984 and 2019 at the Johns Hopkins Hospital were identified using the Pathology Data System (PDS). Clinical and sociodemographic characteristics were extracted and the van der Zee & Jemec HS clinical phenotypes were recovered. RESULTS: A total of 278 patients were identified. Ethnically, 108 (38.8%) were White, and 170 (61.2%) Black. The following HS phenotypes were found: Regular (n=193, 69.4%), scarring folliculitis (n=40, 1.4%) frictional furuncle (11.2%), conglobata (n=9, 3.2%), syndromic (n=3, 1.1%) and ectopic (n=2, 0.7%). No statistically significant ethnic differences in clinical presentation were found. Blacks however had more severe diseases than Whites (p= 0.024 for trend). With multivariate logistic regression analysis, we found that male sex, disease duration, and smoking were independent predictors of regular HS phenotype. Major limitations are the limited number of cases studied and the lack of data regarding response to therapies. CONCLUSIONS: Demographics and phenotypical presentation of HS patients do not seem to be associated with Black ethnicity. However, there is a significant trend for Blacks to present with more Hurley stage 2 and 3 disease compared to White patients. It is speculated that ethnic differences are epiphenomena to social factors, highlighting the broader importance of ethnicity.

Responses of some matrix metalloproteinases activities to an acute session of endurance exercise and electrical stimulation in induced myocardial infarction in Wistar rats.

OBJECTIVE: Myocardial infarction is the irreversible cell death of cardiac muscle that takes place after the blood flow is cut off to a specific region of the heart muscle. The molecular angiogenesis process that may follow after the incidence, due to any activity or its intensity, is unknown. The purpose of this research was to examine some of the matrix metalloproteinase (MMP) responses to an acute course of endurance exercise and electrical stimulation in induced myocardial infarcted Wistar rats. MATERIALS AND METHODS: In this experimental case-control study, 40 induced myocardial infarcted Wistar rats (8-week-old, mean weight 130±30 g) were randomly assigned into 4 conditions: endurance exercise, exercise + electrical stimulation, only electrical stimulation, and control group. The infarction was induced 24 hours after the subcutaneous injection of 150 mg/kg of Isoproterenol. The exercise and exercise plus electrical stimulation groups performed a session of endurance exercise on an animal treadmill, at 20 m/min for one hour. The electrical stimulation was delivered by foot shock, set with the intensities of 0.5 mA for 20 minutes. Immediately after the cessation of the treatment protocol, MMP1, MMP2, and MMP9 were measured by the ELISA method. Data analysis was performed by using Two-way ANOVA and significance was set at α = 0.05. RESULTS: One session of endurance exercise or electric stimulation, or their combination, had no significant effect on the level of MMPs. CONCLUSIONS: One session of acute endurance exercise, stimulation, or their combination, elicited no significant effect on the level of MMPs of artificially induced myocardial infarcted Wistar rats.

IL-4/13 Blockade and sleep-related adverse drug reactions in over 37,000 Dupilumab reports from the World Health Organization Individual Case Safety reporting pharmacovigilance database (VigiBase™): a big data and machine learning analysis.

OBJECTIVE: Atopic dermatitis displays a relevant sleep burden sustained by clinical (i.e., itch), psychological (i.e., inadequate coping strategies) and therapeutic (i.e., frequent loss of drug response) triggers. Dupilumab, the first biologic approved for atopic dermatitis, showed excellent effects on improving pruritus and sleep after only two weeks of treatment but, in some cases, may have paradoxical effects. The rate of sleep-related side-effects remains unknown. More specifically, adverse-drug reactions (ADRs) related to dupilumab have been investigated during the safety phase of randomized clinical trials or in small retrospective epidemiological surveys, but little is known about sleep-related ADRs in real-life settings. Therefore, we took advantage of a global large-scale pharmacovigilance database, carrying out a comprehensive data mining analysis to look at different sleep-related ADRs reported among patients under anti IL-4/13 therapy. MATERIALS AND METHODS: We analyzed individual case study reports (ICSRs) in VigiBaseTM, the World Health Organization (WHO) global pharmacovigilance database of ADRs collected by national drug authorities in > 140 countries (> 90% of the world population). We looked for patterns of potentially sleep-related ADRs and we applied a disproportionality analysis based on Bayesian Confidence Propagation Neural Network (BCPNN). A meta-analytical approach was used to synthesize the overall effect size of sleep-related ADRs potentially associated to Dupilumab administration. RESULTS: From inception up to March 9, 2021, 94,065 ADRs from 37,848 unique reports were included and analyzed in the present paper: 1,294 of them (1.4%) concerned sleep disturbances (n=27). Most of sleep-related complaints were generic sleep disorders (n=630), followed by insomnia (n=312), somnolence (n=81), lethargy (n=60), night sweats (n=30), middle insomnia (n=39), hypersomnia (n=25), poor-quality sleep (n=21), initial insomnia (n=17), sleep apnea syndrome (n=13), nightmares (n=11) and sleep deficit (n=11). Interestingly, restlessness and restless leg syndrome, nocturnal dyspnea, narcolepsy and bruxism were reported in 7, 6, 5, 4 and 3 cases, respectively. Only sleep deficit [OR 15.67 (95% CrI 8.61-28.51); IC 3.24 (95% CrI 2.26-3.97)], generic sleep disorder [OR 6.22 (95% CrI 5.74-6.73); IC 2.60 (95% CrI 2.48-2.71)], nocturnal dyspnea [OR 3.68 (95% CrI 1.53-8.87); IC 1.56 (95% CrI 0.03-2.56)] and middle insomnia [OR 1.87 (95% CrI 1.36-2.56); IC 0.88 (95% CrI 0.39-1.30)] achieved the statistical significance threshold. CONCLUSIONS: In this work, we identified over 37,000 unique case-reports of Dupilumab side-effects reported on the WHO pharmacovigilance database. We specifically categorized those related to sleep issues, which were 1,294. Our findings from large numbers of cases provide data supporting the clinical observations that Dupilumab is usually effective in improving sleep quality and sleep disturbances/impairments, given the lack of statistical significance of several sleep-related ADRs. Further work is needed to closely scrutinize the impact of Dupilumab on sleep, in terms of underlying mechanisms, and to better understand residual sleep disorders in patients with atopic dermatitis and other allergic diseases treated with Dupilumab. Thus, sleep monitoring may be helpful for dermatologists in managing atopic dermatitis patients treated with dupilumab. The limitations of spontaneous reporting systems including underreporting and reporting bias, heterogeneity of sources and impossibility to infer any causal relationship merit consideration and further research is needed.

Physical activity reduces oxidative stress and improves lipid profile made by smoking - Effectiveness of irregular and continuous training programs.

OBJECTIVE: The aim of the study was to identify the possible benefits of physical activity program in improving the antioxidant enzymes activity and lipid profile among smokers. PATIENTS AND METHODS: Fifteen cigarette smokers (CS), 14 hookah smokers (HS), and 14 non-smokers (NS) participated in the low-intensity continuous training (LCT). Eleven CS, 12 HS, and 12 NS participated in the moderate-intensity intermittent training (MIT). The LCT groups performed a 20 to 30-minute continuous exercise at 40% of the VO2max. The MIT groups performed 6 to 10 sets of 2-minute sprint at 70% of the VO2max interspersed by a 1-min recovery period. At baseline and after 12 weeks of intervention, the antioxidant defense activity and lipid profile were assessed. RESULTS: The improvement in antioxidant capacity under the effect of MIT program is statistically more significant than after LCT. The increase of glutathione peroxidase (GPx), superoxide dismutase (SOD), glutathione reductase (GR), malondialdehyde (MDA) and α-tocopherol was higher in smoker subjects participating in the MIT program compared to those participating in the LCT. In contrast, the LCT program has favorably altered lipid and lipoprotein profile of smokers and thus reduced their cardiovascular risk. CONCLUSIONS: The combination of the two training methods may have major implications in both defense and prevention programs.

Chilblain-like lesions (COVID-19 toes) have the same impact on family members than psoriasis systemically treated: insights from a case-control study targeting the pediatric population.

OBJECTIVE: COVID-19 toes represent the main dermatological COVID-19 cutaneous manifestation in pediatric patients. Its diagnosis exposes the whole family to social stigma and this aspect was not previously evaluated. PATIENTS AND METHODS: This was a multicenter, case-control, observational study that compared the family impact of COVID-19 toes vs. psoriasis (PsO). We enrolled 46 pediatric patients (23 with psoriasis and 23 with COVID-19 toes, age and gender matched) and their parents/caregivers that had to fill the Dermatitis Family Impact (DFI) questionnaire. RESULTS: DFI index did not differ significantly between both subgroups (p=0.48), and in psoriatic patients did not correlate with both Psoriasis Area Severity Index (PASI) (p=0.59) and itch-VAS (p=0.16). CONCLUSIONS: COVID-19 toes, a transitory dermatosis, exerted a similar impact/perturbation on family dynamics than PsO, a well-known stigmatizing, chronic inflammatory dermatosis.

Effects of high-intensity interval training and plyometric exercise on the physical fitness of junior male handball players.

OBJECTIVE: This study analyzed the effects of high intensity interval training (HIIT) combined with plyometric exercise on the physical fitness of junior male handball players. PATIENTS AND METHODS: Subjects (age ~17 years) were randomly divided between experimental (n=17) and control (n=15) groups. During the 8-week intervention, the experimental group replaced a part of their regular regimen by HIIT, combined with plyometric exercise. Assessments in both groups before and after the intervention included: squat jump (SJ), countermovement jump (CMJ), sprint performance (5 m, 10 m, 20 m and 30 m), change of direction tests (Illinois modified test [Illinois-MT] and T-half test), 20-m shuttle run, and repeated sprint T-test. RESULTS: The two-way analyses of variance revealed significant group-time interactions (all p<0.05), favoring the intervention group in 5 m, 10 m, 20 m and 30 m sprint (d=0.33, 8.3%; d=0.52, 7.6%; d=0.57, 6.8%; and d=0.58, 8.8%, respectively), T-half (d=0.25, 5.1%), Illinois-MT (d=0.47, 4.2%), SJ and CMJ (d=0.34-0.39, 34-4-34.9%), repeated sprint T-test best time, mean time and total time (d=0.83, 6.9%; d=0.62, 7.4%; and d=0.61, 7.2%, respectively), 20 meter shuttle run test aerobic maximum speed and predicted maximal oxygen intake (d=0.36, 7.5%; d=0.19, 9.4%, respectively). CONCLUSIONS: HIIT combined with plyometrics can aid in the development of physical fitness abilities, which are extremely important to junior male handball players.

Higher rates of COVID-19 but less severe infections reported for patients on Dupilumab: a Big Data analysis of the World Health Organization VigiBase.

OBJECTIVE: Dupilumab (Dupixent®) is a monoclonal antibody that inhibits IL-4 and IL-13 signaling used for the treatment of allergic diseases. Whilst biologic therapy is traditionally regarded as immunosuppressive and capable to increase the infectious risk, Dupilumab does not display these characteristics and may be even protective in certain cases. We investigated the link between Dupilumab therapy and SARS-CoV-2 infection. MATERIALS AND METHODS: We carried out a comprehensive data mining and disproportionality analysis of the WHO global pharmacovigilance database. One asymptomatic COVID-19 case, 106 cases of symptomatic COVID-19, and 2 cases of severe COVID-19 pneumonia were found. RESULTS: Dupilumab treated patients were at higher risk of COVID-19 (with an IC0.25 of 3.05), even though infections were less severe (IC0.25 of -1.71). The risk of developing COVID-19 was significant both among males and females (with an IC0.25 of 0.24 and 0.58, respectively). The risk of developing COVID-19 was significant in the age-group of 45-64 years (with an IC0.25 of 0.17). CONCLUSIONS: Dupilumab use seems to reduce COVID-19 related severity. Further studies are needed to better understand the immunological mechanisms and clinical implications of these findings. Remarkably, the heterogenous nature of the reports and the database structure did not allow to establish a cause-effect link, but only an epidemiologically decreased risk in the patients subset treated with dupilumab.

Safety profile of Dupilumab during pregnancy: a data mining and disproportionality analysis of over 37,000 reports from the WHO individual case safety reporting database (VigiBase™).

Atopic dermatitis, known also as atopic eczema, represents a commonly diagnosed, chronic or recurrent/relapsing inflammatory disorder. From a clinical point of view, it is characterized by acute flare-ups of intense itching, eczematous pruritic lesions involving dry skin. Dupilumab is the only biologic agent approved to treat moderate to severe course of atopic dermatitis, which can be particularly severe during pregnancy causing distress and impacting on maternal and fetal health. However, there is a dearth of data concerning the safety profile of Dupilumab during gestation. Therefore, we took advantage of a large global pharmacovigilance database. From inception up to March 9, 2021, 94,065 adverse drug reactions (ADRs) from 37,848 unique reports were retrieved. Of these, 36 reports related to pregnancy, puerperium and perinatal ADR could be extracted from the pharmacovigilance database. More than half of reports (n = 21; 58.3%) were spontaneous abortion, followed by other events, including exposure to the drug during the pregnancy (n = 8; 22.2%). Two cases of abortion were reported. No studied pregnancy, puerperium and perinatal ADR was found to be associated with the use of Dupilumab. The only OR significantly greater than 1 was the OR associated with the risk of developing heterotopic pregnancy (21.66 [95% CrI 2.95-159.02]) even if the IC was highly imprecise (1.45 [95% CrI from -2.34 to 3.09]), probably because of the single case of heterotopic pregnancy reported. In conclusion, Dupilumab use appears safe during gestation. Further studies are needed, especially to better understand the mechanisms underlying the pharmacological actions and ADR of Dupilumab.

Geographic tongue clinical response in moderate-to-severe psoriatic patients undergoing secukinumab: a real-life, multicenter retrospective observational study.

Geographic tongue (GT), a form of inverse psoriasis, is frequently linked to plaque psoriasis. The objective of the study is to evaluate IL-17 blocker (secukinumab) effect on GT severity. This reallife, multicenter, retrospective observational pilot study evaluated patients with plaque psoriasis and concomitant GT that started in label treatment with secukinumab. Patients were evaluated twice (T0=baseline and T1=after 16 weeks) by a dentist and a dermatologist collecting data on cutaneous Psoriasis Area Severity Index (PASI) and oral statuses using Hume's classification of the Geographic Tongue Severity Index (GTASI). Twenty-nine psoriatic patients with GT treated with secukinumab were enrolled for the study. Seventeen patients display type I GT, 6 type II and 6 type III with an overall GTASI of 25.52±9.57 at the baseline (T0). No correlation was found between delta GTASI and delta PASI (r=-0.27, p=0.1551). GTASI decrement from T0 to T1 was statistically significant ([95%CI -26.64 to -19.56], t=-13.36, p<0.0001). Secukinumab may enter in GT therapeutic armamentarium as the first biologic IL-17 blocker in patients with concomitant moderate-to-severe plaque psoriasis.

How physical activity behavior affected well-being, anxiety and sleep quality during COVID-19 restrictions in Iran.

OBJECTIVE: The Islamic Republic of Iran has displayed one of the highest rates of COVID-19 infection in the world and the highest rate of mortality in the Middle East. Iran has used a stringent package of preventive health measures to mitigate the spread of infection, which however has negatively affected individuals' physical and psychological health. This study aimed at examining whether physical-activity (PA) behavior, anxiety, well-being, and sleep-quality changed in response to the COVID-19-related public health restrictions enforced in Iran. PATIENTS AND METHODS: An online questionnaire was disseminated to adults residing in Iran from November 17, 2020, to February 13, 2021 (~88 days), during Iran's strictest public health restrictions. Main outcome measures included Godin-Shephard Leisure-Time Exercise Questionnaire, General Anxiety Disorder-7, Mental Health Continuum-Short Form, and Pittsburgh Sleep Quality Index. RESULTS: A total of 3,323 adults (mean age 30±11 years, 54.3% female) participated in the survey. Firstly, the restrictions generally reduced PA behavior: (a) among inactive participants (IPs), 60.6% became less active vs. 5.1% who became more active; and (b) among active participants (APs), 49.9% became less active vs. 22.8% who became more active. Secondly, PA behavior was associated with higher well-being and sleep quality during the restrictions: (a) APs reported higher (or lower) levels of well-being and sleep quality (or anxiety) than did IPs; and (b) among IPs as well as among APs, the more active the participants, the greater (or lower) the levels of well-being and sleep quality (or anxiety). CONCLUSIONS: This study showed the beneficial role of PA behavior for well-being, anxiety, and sleep quality during the COVID-19 restrictions, whereas such restrictions appeared to decrease PA participation. Active lifestyle should be then encouraged during the COVID-19 outbreak while taking precautions.

Cardiometabolic index: a new tool for screening the metabolically obese normal weight phenotype.

PURPOSE: People with the metabolically obese normal weight (MONW) phenotype are considered as an extremely high-risk group for unfavorable health consequences, but they are frequently undetected due to deceptive body mass index (BMI) and complex assessment. This study aimed to explore the clinical usefulness of cardiometabolic index (CMI) in identifying MONW individuals. METHODS: This cross-sectional study involved a total of 47,683 normal-weight subjects aged ≥ 18 years. Participants underwent anthropometrics, routine biochemical tests, and questionnaires for a full evaluation of the metabolic profile. The odds ratio (OR) of CMI and MONW phenotype was determined by the Logistic regression models and the diagnostic accuracy of CMI was evaluated by the receiver operating characteristic (ROC) curve analysis. RESULTS: The prevalence of MONW phenotype was 11.0%. After multivariate adjustment, the ORs for MONW in the highest compared with the lowest quartile of CMI was 71.20 (95% CI 55.19-91.86), and 1-SD increment of CMI brought a 54% additional risk. In ROC analysis, compared with BMI and waist circumference, CMI showed superior performance for identifying MONW individuals with an AUC of 0.853 (95% CI 0.847-0.860) in men and 0.912 (95% CI 0.906-0.918) in women, respectively. Moreover, CMI exhibited the highest diagnostic accuracy in younger age groups (aged 18-34 for men; aged 18-34 and 35-44 for women), in which AUCs surpassed 0.9 in both sexes. CONCLUSIONS: CMI could be served as a valuable indicator to identify MONW phenotype of Chinese adults, particularly for young people.

A cross-sectional survey among physicians on internet use for epilepsy-related information.

OBJECTIVE: We investigated views towards the Internet in a sample of Italian healthcare specialists involved in epilepsy field, to identify factors associated with the attitude of being influenced by information found on the Internet. METHODS: This study was a self-administered survey conducted in a group of members of the Italian Chapter of the International League Against Epilepsy (ILAE) in January 2018. RESULTS: 184 questionnaires were analyzed. 97.8 % of responders reported to seek online information on epilepsy. The Internet was most frequently searched to obtain new information (69.9 %) or to confirm a diagnostic or therapeutic decision (37.3 %). The influence of consulting the Internet on clinical practice was associated with registration to social network(s) (OR: 2.94; 95 %CI: 1.28-6.76; p = 0.011), higher frequency of Internet use (OR: 3.66; 95 %CI: 1.56-9.21; p = 0.006) and higher confidence in reliability of online information (OR: 2.61; 95 %CI: 1.09-6.26; p = 0.031). No association was found with age, sex, years in epilepsy practice or easiness to find online information. CONCLUSION: Internet is frequently used among healthcare professionals involved in the epilepsy to obtain information about this disease. The attitude of being influenced by the Internet for diagnostic and/or therapeutic decisions in epilepsy is independent on age and years of experience in epilepsy, and probably reflects an individual approach towards the Web.

Pertussis immunization in healthcare workers working in pediatric settings: Knowledge, Attitudes and Practices (KAP) of Occupational Physicians. Preliminary results from a web-based survey (2017).

INTRODUCTION: The present study aims to characterize knowledge, attitudes and practices in a sample of occupational physicians (OPh) towards pertussis immunization in healthcare workers (HCWs) from pediatric settings. MATERIAL AND METHODS: A total of 148 OPh (45.9% males, mean age of 40.3 ± 13.2 years) compiled a web questionnaire including a knowledge test on Italian recommendations for HCWs, epidemiology and pathology of pertussis infection, being then investigated about risk perceptions and vaccination practices. A General Knowledge Score (GKS) and a Risk Perception Score (RPS) were calculated. Multivariate odds ratios (OR) for predictors of vaccine propensity were calculated through regression analysis. RESULTS: 78 participants regularly recalled pertussis vaccination status and/or performed pertussis vaccination in HCWs (52.7%). Proactive status was correlated with the aim to avoid pertussis infection in HCWs and its diffusion to other adults (p < 0.001, both statements). GKS was satisfying (72.4% ± 14.9), but participants underestimated the clinical issues of pertussis infection (RPS 60.8% ± 9.5) when confronted with influenza (73.9% ± 10.9) and HBV infection (68.1% ± 10.1). GKS and RPS were well correlated (r = 0.244, p = 0.003). Eventually, a better GKS and the aim to avoid pertussis infection in HCWs were predictive of a proactive status for pertussis vaccination (OR 4.186 95%CI 1.809-9.685 and OR 11.459, 95%CI 3.312-39.651, respectively). CONCLUSIONS: Adherence of OPh to HCWs pertussis vaccination was unsatisfying. As knowledge status was predictive for vaccine propensity, information programs for OPh should be more appropriately designed, stressing that HCWs may represent a significant reservoir for pertussis infection in high risk groups (e.g. children/newborns, frail elderly).

The hepatitis C virus in Iran: health policy, historical, ethical issues and future challenges.

BACKGROUND: Hepatitis C infection (HCV) can have a harmful effect on the health of people and can impose relevant healthcare costs. The World Health Organization has identified the elimination of Hepatitis C by 2030 as an important goal for all countries. This study aimed to identify the HCV-related policies in Iran. METHODS: A qualitative approach was used for this study. Data was collected through a comprehensive search of documents and interviews with different stakeholders related to the HCV program. Data was analyzed and validated using content analysis based on the policy triangle framework. RESULTS: Our findings highlighted that certain social and cultural issues related to stigma can impact on awareness-raising processes. It is also necessary to consider HCV directly in the context of government policies. All relevant stakeholders should be included. Continued talks and interactions need to be made between them for the active participation of all actors. CONCLUSION: The findings of this study can provide useful information for improving, supporting and developing policy processes. Healthcare providers should address all aspects of the disease by 2030 in order to achieve the goal of HCV elimination. Evidence-based planning, support for up-to-date policies and resource mobilization are needed to achieve this ambitious goal.

The barriers to the full implementation of strategic purchasing and the role of health policy and decision-makers: past, current status, ethical aspects and future challenges.

Healthcare systems are complex, multi-level, highly integrated organizations, comprising of different professional figures, institutions, and resources. Such breadth and complexity reflect the multi-dimensionality of the concept of health, which implies the adoption of a holistic approach. Health, rather than merely being the absence of disorders or infirmity, is a highly dynamic state, which represents the abilities of an individual to cope with adverse social, physical and emotional/psychological events and conditions, continuously adapting to them. Ensuring an adequate health state is one of the most important concerns, and the healthcare systems are called to renew themselves in order to meet with the new challenges and health needs. Throughout the last decades, due to demographic shifts and transitions, epidemiological and societal changes, technological achievements and scientific advancements, healthcare systems have undergone an extensive series of reform plans. Therefore, health policy- and decision-makers have made efforts to develop and implement initiatives for preserving the quality of the healthcare provisions. Strategic purchasing is an approach of purchasing that takes into account several health-related issues such as a proper, comprehensive planning of service delivery, the design and selection of the best packages of services and provisions, the appropriate selection of providers and the allocation of economical and financial incentives to provide better services and to motivate managers to adopt appropriate policies to implement strategic purchasing. Here, we intend to consider the various dimensions and aspects that can be effective in strategic purchasing, as well as the main barriers and obstacles that hinder its full implementation.

The evolution of a neglected disease: tuberculosis discoveries in the centuries.

Tuberculosis (TB) and humans have coexisted for more than 40,000 years. The word "tuberculosis" derives from "tubercle", the histological lesion which appears in the organs, described by Pott in the late Eighteenth century and found, by molecular biology, in human skeletons dating back to 5000 BC. Early description of TB can be found in the writings of ancient India and China and in the Bible. In ancient Greece tuberculosis was not considered contagious, but Aristotle recognized the contagious nature of the pig's and ox's scrofula. The suspicion that phthisis is a contagious disease and that isolation can reduce the risk of transmission was expressed for the first time by the Arabian Avicenna, in his work "The canon of medicine". In 1699, the Health Council of the Republic of Lucca founded the "sanatorium" concept as place of care and isolation. In 1865 Villemain inoculated tubercular material from a human lymph node into a rabbit, obtaining for the first time the typical tubercular lesions. Some years later, on March 24, 1882, Robert Koch announced to the Berlin Society of Physiology the discovery of Mycobacterium tuberculosis. In the same period Virchow improved awareness of risk factors and correct behaviours among the general population. In 1952 Waksman won the Nobel Prize for the discovery of the first active drug against TB: streptomycin. Nevertheless, drug resistance appeared rapidly some years later and it is still a great challenge in TB fight nowadays.

Tuberculosis in Iran: a historical overview from al-Tabari, Rhazes, Avicenna and Jorjani to Abolhassan Ziya-Zarifi. Old and new pioneers in the fight against tuberculosis: challenges, pitfalls and hopes.

Tuberculosis is a serious respiratory infectious disease, caused by Mycobacterium tuberculosis bacteria. It has always represented a permanent, serious public health challenge over the course of human history, because of its severe epidemiological, clinical and societal implications. The present review aims at over-viewing the contributions of the Iranian medicine to the control, management and treatment of tuberculosis, from the glorious past of the eighth-ninth centuries to the present, from Ali Abu al-Hasan Ahmad ibn Sahl-e Rabban al-Tabari to Rhazes, Avicenna, Jorjani and Abolhassan Ziya-Zarifi. However, despite the efforts, tuberculosis and, in particular, multidrug-resistant tuberculosis still represent a great public health concern in Iran. On the other hand, this country can capitalize on its millennial, incredibly rich story of major achievements in the battle against tuberculosis to develop and implement ad hoc public health programs for the control of the disorder, including targeted and specialized interventions.