The effect of climate change on malaria transmission in the southeast of Iran.

Malaria is a vector-borne disease, likely to be affected by climate change. In this study, general circulation model (GCM)-based scenarios were used for projecting future climate patterns and malaria incidence by artificial neural networks (ANN) in Zahedan district, Iran. Daily malaria incidence data of Zahedan district from 2000 to 2019 were inquired. The gamma test was used to select the appropriate combination of parameters for nonlinear modeling. The future climate pattern projections were obtained from HadGEM2-ES. The output was downscaled using LARS-WG stochastic weather generator under two Representative Concentration Pathway (RCP2.6 and RCP8.5) scenarios. The effect of climate change on malaria transmission for 2021-2060 was simulated by ANN. The designed model indicated that the future climate in Zahedan district will be warmer, more humid, and with more precipitation. Assessment of the potential impact of climate change on the incidence of malaria by ANN showed the number of malaria cases in Zahedan under both scenarios (RCP2.6 and RCP 8.5). It should be noted that due to the lack of daily malaria data before 2013, monthly data from 2000 were used only for initial analysis; and in preprocessing and simulation analyses, the daily malaria data from 2013 to 2019 were used. Therefore, if proper interventions are not implemented, malaria will continue to be a health issue in this region.

The effect of climate variables on the incidence of cutaneous leishmaniasis in Isfahan, Central Iran.

In recent years, there have been considerable changes in the distribution of diseases that are potentially tied to ongoing climate variability. The aim of this study was to investigate the association between the incidence of cutaneous leishmaniasis (CL) and climatic factors in an Iranian city (Isfahan), which had the highest incidence of CL in the country. CL incidence and meteorological data were acquired from April 2010 to March 2017 (108 months) for Isfahan City. Univariate and multivariate seasonal autoregressive integrated moving average (SARIMA), generalized additive models (GAM), and generalized additive mixed models (GAMM) were used to identify the association between CL cases and meteorological variables, and forecast CL incidence. AIC, BIC, and residual tests were used to test the goodness of fit of SARIMA models; and R2 was used for GAM/GAMM. 6798 CL cases were recorded during this time. The incidence had a seasonal pattern and the highest number of cases was recorded from August to October. In univariate SARIMA, (1,0,1) (0,1,1)12 was the best fit for predicting CL incidence (AIC=8.09, BIC=8.32). Time series regression (1,0,1) (0,1,1)12 showed that monthly mean humidity after 4-month lag was inversely related to CL incidence (AIC=8.53, BIC=8.66). GAMM results showed that average temperature with 2-month lag, average relative humidity with 3-month lag, monthly cumulative rainfall with 1-month lag, and monthly sunshine hours with 1-month lag were related to CL incidence (R2=0.94). The impact of meteorological variables on the incidence of CL is not linear and GAM models that include non-linear structures are a better fit for prediction. In Isfahan, Iran, meteorological variables can greatly predict the incidence of CL, and these variables can be used for predicting outbreaks.

The impact of heat waves on mortality and years of life lost in a dry region of Iran (Kerman) during 2005-2017.

The present study was conducted to compare the impact of heat waves on mortality and years of life lost (YLL) in Kerman, Iran during the years 2005-2017. Daily mean temperature in a combination of intensity and duration were used in order to define heat waves (90, 95, and 98th percentile and ≥ 2, 3, and 4 consecutive days). YLL was calculated according to Iran's life table and by considering the discount rate. In order to investigate the impact of heat waves in different lags and its cumulative effect on mortality and YLL, Poisson and linear models within distributed lag nonlinear models were used respectively. A maximum lag of 14 days was considered. The best model was selected based on AIC (Akaike Information Criteria). The model was adjusted for air pollutants, public holidays, days of the week, and humidity. The average daily mortality and YLL were 10.54 ± 4.31 deaths and 175.58 ± 91.39 years respectively. They were higher in men and in heat waves matching a definition of above the 98th temperature percentile and ≥ 3 days, than others. Except heat waves defined as the 98th percentile and ≥ 4 days, the impact of heat waves on mortality and YLL were the highest at lag 0. The cumulative relative risk of total mortality was significantly higher in heat waves above the 95 and 98th percentiles. The cumulative effect of heat waves on total YLL was significantly higher only above the 98th percentile. Men over 65 years old were the most vulnerable and had the highest mortality and YLL. Heat waves with temperatures above the 98th percentile that lasted at least 2 or 3 consecutive days had a significant effect in increasing both total YLL and mortality in Kerman, Iran.

Attributable risk of mortality associated with heat and heat waves: A time-series study in Kerman, Iran during 2005-2017.

The association between heat or heat waves and mortality should often be reported in a way that makes it sensible by health policymakers. In this study we aimed to assess the effect of heat and heat waves on mortality using attributable risks during 2005-2017. Nine heat waves were defined using a combination of severity and duration of mean daily temperature. Heat wave effects were assessed using added and main effects. Added effects were assessed as a binary variable and main effects were assessed by comparing the median temperature (in heat wave days) to Minimum Mortality Temperature (MMT). The effects of heat, mild heat and extreme heat on mortality were also assessed. Distributed Lag Non-linear Models were used to assess the relations in a bi-dimensional perspective in which the quadratic b-spline was chosen as the basis function for the dimension of the exposure and the natural cubic b-spline was chosen for lag dimension. The backward perspective was used to estimate the attributable risks. The total mortality attributed to non-optimal temperatures for all days was 1.91% (CI 95%: -6.36, 8.47). The attributable risks (AR) were 2.23%, 2.02% and 0.25% for heat, mild heat and extreme heat days, respectively. AR was more for females and the above 65 years old groups than other groups in heat, mild heat and extreme heat days. While the stronger heat waves defined based on temperature above the 95 and 98th percentile had a significant attributable risk for total mortality in the added effects; the weaker heat waves (defined based on temperature above of the 90th percentile (HW1, HW2, HW3) had higher attributable risks, significant for HW1 and HW2, in the main effects. Apparently weaker heat waves show more immediate effects, while stronger heat waves increase mortality over several days.

Evaluating health service quality: using importance performance analysis.

Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item's importance from the patients' perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients' viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

Flexural Performance and End Debonding Prediction of NSM Carbon FRP-Strengthened Reinforced Concrete Beams under Different Service Temperatures.

This paper aims to evaluate the influence of relatively high service temperatures (near or beyond the glass transition temperature (Tg) of epoxy adhesive) on the flexural performance and end debonding phenomenon in near-surface mounted (NSM) carbon fiber-reinforced polymer (CFRP)-strengthened, reinforced concrete (RC) beams. To this end, an experimental program consisting of 24 beams (divided into four groups) was performed, where different parameters was combined (i.e., service temperature, steel reinforcement ratio, CFRP ratio, and concrete compressive strength). In addition, the effect of the testing temperature on the end debonding phenomenon was investigated with an analytical procedure according to fib Bulletin 90, and the predictions were compared to experimental results. Taking specimens tested at 20 °C as a reference, no considerable change was observed in the ultimate load of the specimens tested below 60 °C (being in the range of epoxy Tg), and all specimens failed by FRP rupture. On the other hand, the increase in testing temperature up to 70 and 85 °C was followed by a decrease in the capacity of the strengthened beams and a change in failure mode, moving from FRP rupture to end debonding and concrete crushing. The analytical procedure successfully predicted the occurrence of premature end debonding failure and demonstrated that the effect of temperature on the mechanical properties of materials can be a key factor when predicting the premature end debonding in a NSM joint.

Assessment of fib Bulletin 90 Design Provisions for Intermediate Crack Debonding in Flexural Concrete Elements Strengthened with Externally Bonded FRP.

With the assessment of intermediate crack debonding (ICD) being a subject of main importance in the design of reinforced concrete (RC) beams strengthened in flexure with externally bonded fibre-reinforced polymer (FRP), several approaches to predict the debonding loads have been developed in recent decades considering different models and strategies. This study presents an analysis of formulations with different levels of approximation collected in the fib Bulletin 90 regarding this failure mode, comparing the theoretical predictions with experimental results. The carried-out experiments consisted of three RC beams strengthened with carbon FRP (CFRP) tested under a four-point bending configuration with different concrete strengths and internal steel reinforcement ratios. With failure after steel yielding, higher concrete strength, as well as a higher reinforcement ratio, lead to a higher bending capacity. In addition, the performance of the models is assessed through the experimental-to-predicted failure load ratios from an experimental database of 65 RC beams strengthened with CFRP gathered from the literature. The results of the comparative study show that the intermediate crack debonding failure mode is well predicted by all models with a mean experimental-to-predicted failure load ratio between 0.96 and 1.10 in beams tested under three- or four-point bending configurations.

External Validation of Finnish Diabetes Risk Score and Australian Diabetes Risk Assessment Tool Prediction Models to Identify People with Undiagnosed Type 2 Diabetes: A Cross-sectional Study in Iran.

Background: Noninvasive risk prediction models have been widely used in various settings to identify individuals with undiagnosed diabetes. Objectives: We aimed to evaluate the discrimination, calibration, and clinical usefulness of the Finnish Diabetes Risk Score (FINDRISC) and Australian Diabetes Risk Assessment (AUSDRISK) to screen undiagnosed diabetes in Kerman, Iran. Methods: We analyzed data from 2014 to 2018 in the second round of the Kerman Coronary Artery Disease Risk Factors Study (KERCADRS), Iran. Participants aged 35 - 65 with no history of confirmed diabetes were eligible. The area under the receiver operating characteristic curve (AUROC) and decision curve analysis were applied to evaluate the discrimination power and clinical usefulness of the models, respectively. The calibration was assessed by the Hosmer-Lemeshow test and the calibration plots. Results: Out of 3262 participants, 145 (4.44%) had undiagnosed diabetes. The estimated AUROCs were 0.67 and 0.62 for the AUSDRISK and FINDRISC models, respectively (P < 0.001). The chi-square test results for FINDRISC and AUSDRISC were 7.90 and 16.47 for the original model and 3.69 and 14.61 for the recalibrated model, respectively. Based on the decision curves, useful threshold ranges for the original models of FINDRIS and AUSDRISK were 4% to 10% and 3% to 13%, respectively. Useful thresholds for the recalibrated models of FINDRISC and AUSDRISK were 4% to 8% and 4% to 9%, respectively. Conclusions: The original AUSDRISK model performs better than FINDRISC in identifying patients with undiagnosed diabetes and could be used as a simple and noninvasive tool where access to laboratory facilities is costly or limited.

Experimental Study of the Effect of High Service Temperature on the Flexural Performance of Near-Surface Mounted (NSM) Carbon Fiber-Reinforced Polymer (CFRP)-Strengthened Concrete Beams.

This paper presents a study of the effect of high service temperature (near or beyond glass transition temperature (Tg) of structural epoxy adhesive) on the behavior of near-surface mounted (NSM) carbon fiber-reinforced polymer (CFRP)-strengthened reinforced concrete (RC) beams. The study includes experimental work as well as analytical and numerical analysis. To this end, fourteen beams have been tested up to failure in two different series. In series 1, specimens with three different CFRP areas have been tested at two different temperatures (i.e., 20 and 40 °C). In series 2, and with the aim of evaluating the effect of higher temperatures, only one CFRP area was tested under four different temperatures (i.e., 20, 60, 70, and 85 °C). Experimental results are evaluated in terms of load-deflections, failure modes, and bond performance. Furthermore, the experimental load-deflection curves are satisfactorily compared to both analytical predictions and finite element (FE) numerical simulations. In both cases, shrinkage and temperature effects on the short-term response of flexural elements have been accounted for. No significant reduction in stiffness and ultimate load was observed for specimens being tested up to 60 °C (in the range of epoxy Tg), showing FRP rupture failure in all of them. For specimens under 70 and 85 °C, the failure mode changed from FRP rupture to FRP end debonding and concrete crushing, respectively.

Projection of mortality attributed to heat and cold; the impact of climate change in a dry region of Iran, Kerman.

BACKGROUND: Estimating the effects of climate change on human health can help health policy makers plan for the future. In Iran, there are few studies, about investigating the effects of climate change on mortality. This study aimed to project the effect of low (cold) and high (heat) temperature on mortality in a dry region of Iran, Kerman. METHODS: Mortality attributed to temperature was projected by estimating the temperature-mortality relation for the observed data, projection of future temperatures by the statistical downscaling model (SDSM), and quantifying the attributable fraction by applying the observed temperature-mortality relation on the projected temperature. Climate change projection was done by three climate scenarios base on Representative Concentration Pathways (RCP2.6, RCP4.5 and RCP8.5). Adaptation was considered by using different minimum mortality temperatures (MMT) and risk reduction approaches. The current decade (2010-19) was considered as the reference period. RESULTS: All three climate change scenarios, showed that the mean of temperature will rise about 1 °C, by 2050 in Kerman. The number of deaths attributed to heat were obviously higher than cold in all periods. Assuming no adaptation, over 3700 deaths attributed to temperature will happen in each decade (2020s, 2030s and 2040s) in the future, in which over 3000 deaths will be due to heat and over 450 due to cold. In the predictions, as Minimum Mortality Temperature (MMT) went up, the contribution of heat to mortality slightly decreased, and cold temperature played a more important role. By considering the risk reduction due to adaptation, the contribution of heat in mortality slightly and insignificantly decreased. CONCLUSION: The results showed that although low temperatures will contribute to temperature-related mortality in the future, but heat will be a stronger risk factor for mortality, especially if adaptation is low.

The Effect of Relaxation Techniques on Anxiety, Fatigue and Sleep Quality of Parents of Children with Leukemia under Chemotherapy in South East Iran.

INTRODUCTION: Cancer can cause emotional stress in parents, which has a negative impact on the quality of their life. Also, anxiety and psychological stress have a negative effect on the health of parents, and fatigue causes a sense of weakness and reduces the capacity for mental and physical activity, and insomnia, as well as stress and inability to perform their occupational and social functions. This study aimed to determine the effect of relaxation techniques on anxiety, fatigue, and sleep quality of parents of children with leukemia under chemotherapy in South East Iran in 2015. METHODS: This is a randomized controlled trial study. The study population included parents of children with leukemia undergoing chemotherapy who were admitted to a teaching hospital in South East Iran. One hundred twenty parents were randomly assigned to control and intervention groups, and the experimental group was provided with Benson relaxation technique. Data collection tool included a demographic questionnaire, state-trait anxiety inventory, Brief Fatigue Inventory, and sleep quality inventory. Data analysis was done by SPSS 16 and paired t-test, Wilcoxon, Mann- Whitney, regression, One - Way ANOVA and Pearson tests were performed, and p ≤ 0.05 was statistically significant. RESULTS: The mean score of state anxiety in the intervention group was 60.86 ± 8.95 and 35.95 ± 4.61 before and after the intervention, respectively. The mean score of trait anxiety was 56.56 ± 4.75 and 34.45 ± 4.95. The mean score of the fatigue was 73.83 ± 14.63 and 43.71 ± 11. 06, and the mean score of the quality of sleep was 13.5 ± 6.05 and 5.7 ± 3.43 before and after the intervention respectively. There was a statistically significant difference among state-trait anxiety, fatigue, and sleep quality in intervention and control groups after the intervention. There was a statistically significant negative correlation between fatigue and age, but there was no statistically significant relationship among the mean fatigue, weight, the number of sons and daughters, education, occupation, gender, place of residence and income (p> 0.05). There was no statistically significant relationship among the quality of sleep of parents, education, gender, and place of residence, but there was a statistically significant relationship between state anxiety and education (p≤0.05). CONCLUSION: The results can predispose family-centered nursing care to support more the parents of children with cancer in the face of the stress of illness. Developing programs for training muscle relaxation techniques will improve family functioning and mental health.