The Global Burden of Metabolic Risk in Cardiovascular Disease: Trends in Disability-Adjusted Life Years from the Global Burden of Disease Study, 2019.

Introduction: Metabolic risk factors significantly elevate the risk of cardiovascular diseases (CVDs) and are recognized as one of the primary contributors to these conditions. This study explored the trends and percentage changes in disability-adjusted life years (DALYs) attributable to metabolic risk factors for CVD from 1990 to 2019. Methods: Data from the Global Burden of Disease study was utilized to depict changes across metabolic risk factors by sociodemographic indices and sex groups. The Mann-Kendall test was employed to ascertain the significance of these trends. Results: The findings indicate that the DALY percentage change over these years was more pronounced in low-middle and middle Socio-demographic Index (SDI) countries than in others. The most substantial percentage increase, approximately 60%, was observed in regions with low SDI, attributed to high body mass index (BMI). On average, the greatest DALYs were associated with high systolic blood pressure (SBP). Moreover, the trend for high low-density lipoprotein cholesterol and high SBP declined in countries with high SDI. Conclusions: It can be concluded that to mitigate the global mortality and morbidity from heart diseases, there needs to be a focused emphasis on managing metabolic risk factors, particularly in low-Middle and middle SDI countries.

Metabolic Syndrome and Ischemic Stroke in Iran: Incidence and Disability-Adjusted Life Years 1990 to 2019.

Introduction: Metabolic syndrome (MS) is one of the conditions that may increase the risk of ischemic stroke (IS). This study focuses on factors of MS related to the incidence, years of life lost (YLL), and years of life disability (YLD) caused by IS. Materials and Methods: The age-adjusted data (incidence, YLL, and YLD) related to four factors of MS [fasting plasma glucose, body mass index (BMI), low-density lipoprotein, and systolic blood pressure, SBP] were extracted as risk factors for IS during the years 1990 to 2019 from global burden of disease study. ARC GIS V.10 software was used to investigate the geographical distribution and the Cochran-Armitage test was used to investigate the trend of these indices. Results: The highest incidence of IS was reported in Golestan provinces in 2019 [women: 180 (95% UI 153-213), men: 163 (95% UI 141-191), and both genders: 172 (95% UI 149-201)]. High SBP has the highest impact on YLD (96-102 per 100,000 population in some provinces) and YLL (688-824 per 100,000 population in some provinces) in men and women (YLD: 126-156, YLL: 586-785 per 100,000 population in some provinces). High BMI has increased YLD caused by IS from 1990 (35 per 100,000 population) to 2019 (53 per 100,000 population). Conclusion: Considering the importance of IS and the impact that MS has on this disease, it seems that one of the most effective possible measures is to eliminate MS. The factors of MS are mostly related to lifestyle, and MS can be controlled with a suitable plan, which can be considered as primary prevention for IS.

Spatial and temporal analysis of thyroid cancer incidence in Guilan Province, Northern Iran, 2009-2018.

BACKGROUND: Thyroid cancer is one of the most common malignancies of the endocrine system, the fifth most common malignancy in women worldwide, and the second most common cancer in women over 50 in 2019. It is the sixth most common cancer in both sexes and the third most common cancer in women in Guilan province. This study was conducted to describe the geographic variation and investigate any changes in the trend of the thyroid cancer incidence rate. METHODS: This study was conducted on the data of the Guilan University of Medical Sciences cancer registration system. The crude and age-standardized incidence rate was calculated per 100,000 person-years. Joinpoint regression analysis evaluated the time trends and annual percent changes (APC). The incidence rate was estimated separately for each city and high-risk areas were shown on the province map using GIS software. RESULTS: 1742 cases of thyroid cancer (83.7 % in women and 16.3 % in men) were registered in Guilan province from 2009 to 18. The incidence of thyroid cancer was 5.1-fold higher in women than men. The results of the joinpoint regression analysis showed that the age-standardized incidence rate of thyroid cancer in both sexes has increased significantly over ten years (APC: 26.4; 95 %CI: 22.5-30.4), (P-value < 0.001). In our study, Astaneh-ye Ashrafiyeh, Lahijan, and Langarud cities were identified as high-risk areas of the province for both sexes. CONCLUSION: The trend of incidence of thyroid cancer in Guilan province is increasing. Also, a wide geographical variation was found in the incidence of thyroid cancer.

Five Common Cancers in Iran in 2019: Secondary Analysis to Discovering Cluster of Cancers.

INTRODUCTION: This study reports the prevalence of the 5 most common cancers and their geographical distribution based on the last update of cancer statistics in Iran (2019). MATERIALS AND METHODS: The data used in this study were extracted from the Global Burden of Disease (GBD) studies. It was prepared regarding sex in different provinces. Moran's I test was used to check geographical correlation and identify hot spots and cold spots. A significance level of 5% was considered in all tests. RESULTS: The most prevalent cancers among Iranian women reported Breast (312 per 100 000; 95% UI: 281-345), Thyroid (43 per 100 000; 95% UI: 26-51), Colon and Rectum (43 per 100 000; 95% UI: 39-47), Leukemia (33 per 100 000; 95% UI: 21 -41), and Uterine (29 per 100 000; 95% UI: 14-35) respectively; further, the most prevalent cancers among Iranian men reported Prostate (219 per 100 000; 95% UI: 158-258), Colon and Rectum (80; 72-88), Bladder (65 per 100 000; 95% UI: 58-71), Leukemia (40 per 100 000; 95% UI: 20-51), and Testicular (33 per 100 000; 95% UI: 20-48) respectively. CONCLUSION: exclusive of any type of skin cancer, Breast, prostate, colon and rectum, bladder, thyroid, testicular, uterine, and leukemia are most prevalent cancers in Iranian population.

The trend of marriage, childbearing, and divorce and its determinants of socio-economic factors on divorce in Yazd province 2016-2021: A cross-sectional study.

Background: In recent decades, families and their stability as an important social institution have changed significantly. Objective: This study aimed to investigate the marriage trends, childbearing, and divorce changes in Yazd province from 2016 to 2021 to estimate the effect of socioeconomic factors on divorce. Materials and Methods: A cross-sectional study was done in 2 phases. In the first phase, an ecological (time trend) was conducted to investigate the 5 yr trend in the occurrence of marriage, childbearing, and divorce, as well as the factors affecting the occurrence of divorce in the second phase. For the second phase of the study, 600 participants were selected. 300 divorced and 300 married applicants were chosen between 2016 and 2021. A binary logistic regression model was used to find the related factors affecting the occurrence of divorce. Results: The results showed a declining marriage (p = 0.05) and childbearing trend (p = 0.84), as well as an increasing trend in divorces (p = 0.02) in Yazd. Logistic regression analysis showed that college education (OR = 0.22, CI: 0.116-0.430, p < 0.001) and being self-employed (OR = 0.48, CI: 0.255-0.934, p = 0.03) could reduce the odds of divorce. In addition, nonresidents (OR = 2.1, CI: 1.314-3.562, p < 0.001), with > 10-yr age differences (OR = 3.8, CI: 1.803-8.213, p < 0.001) or the woman being older than her husband (OR = 3.4, CI: 1.981-5.848, p < 0.001) could increase the odds of divorce. Conclusion: Our results confirmed that a combination of socioeconomic characteristics affects the stability of family institutions.

COVID-19 vaccine in pregnant women and pregnancy outcomes: A historical cohort in center of Iran.

BACKGROUND: Starting vaccination in pregnant women; numerous theories have been proposed that the vaccine might affect the mother or the fetus. OBJECTIVE: The goal of this research was to see whether there was a link between the Sinopharm vaccination and certain pregnancy outcomes in COVID-19-vaccinated women. STUDY DESIGN: This is a retrospective cohort study. METHOD: This study was conducted on pregnant women who delivered from 1 August 2021 to 1 January 2022 in Yazd city. We have followed the STROBE Guidelines when preparing the manuscript. In this period time, all pregnant women were 5787 people in which 5666 were in the second and third trimester. Among these women, 1222 women were randomly selected. RESULTS: Among 1222 pregnant women, 558 (45.6%) women had received one dose vaccine, 162 (13.3%) people had received two doses, and 502 (41.1%) women had not been vaccinated. On crude analysis, there was no significant difference between vaccinated and non-vaccinated groups. After adjusting for maternal age, maternal body mass index, parity, stillbirth history, abortion history, and gestational diabetes in multivariate analysis, no differences were found between the groups in pregnancy as well. CONCLUSION: Vaccinations during pregnancy seem to have no negative effects on the mother or the baby. This finding may aid pregnant women in deciding whether or not to take the vaccination.

Adjustment for collider bias in the hospitalized Covid-19 setting.

Background: Causal directed acyclic graphs (cDAGs) are frequently used to identify confounding and collider bias. We demonstrate how to use causal directed acyclic graphs to adjust for collider bias in the hospitalized Covid-19 setting. Materials and methods: According to the cDAGs, three types of modeling have been performed. In model 1, only vaccination is entered as an independent variable. In model 2, in addition to vaccination, age is entered the model to adjust for collider bias due to the conditioning of hospitalization. In model 3, comorbidities are also included for adjustment of collider bias due to the conditioning of hospitalization in different biasing paths intercepting age and comorbidities. Results: There was no evidence of the effect of vaccination on preventing death due to Covid-19 in model 1. In the second model, where age was included as a covariate, a protective role for vaccination became evident. In model 3, after including chronic diseases as other covariates, the protective effect was slightly strengthened. Conclusion: Studying hospitalized patients is subject to collider-stratification bias. Like confounding, this type of selection bias can be adjusted for by inclusion of the risk factors of the outcome which also affect hospitalization in the regression model.

Fifty years of struggle to control cutaneous leishmaniasis in the highest endemic county in Iran: A longitudinal observation inferred with interrupted time series model.

Negligible data are available following major social activities and environmental changes on leishmaniasis. Therefore, how interactions between these events influence cutaneous leishmaniasis (CL) risk is not well-known. This longitudinal study was undertaken to explore the impact of interventions conducted between 1971 and 2020 in Bam county, which has had the highest disease burden in Iran. Only confirmed CL cases during this period were taken into account. Data were analyzed by SPSS 22 using the X2 test to assess the significance of the difference between proportions. Moreover, we used interrupted time series (ITS) to assess the impact of three environmental events during this period. Overall, 40,164 cases of CL occurred in the past five decades. Multiple complex factors were among the leading causes that synergistically induced the emergence/re-emergence of CL outbreaks in Bam. The main factors attributed negatively to CL control were cessation of malaria spraying activity, expansion of the city spaces, and a massive earthquake creating new breeding potentials for the vectors. The highest impact on CL incidence during these years was related to the earthquake [coefficient = 17.8 (95% CI: 11.3, 22.7); p-value < 0.001]. Many factors can contribute to CL outbreaks in endemic foci. They also can cause new foci in new areas. Since humans are the single reservoir for CL in this area, early detection and effective management significantly contribute to controlling CL to reduce the disease burden. However, essential evidence gaps remain, and new tools are crucial before the disease can ultimately be controlled. Nevertheless, sustained funding and more trained task forces are essential to strengthen surveillance and case management and monitor the interventions' impact.

Bayesian statistics versus classical statistics in survival analysis: an applicable example.

BACKGROUND: Heart disease is the leading cause of death in the world and 17 million people die from cardiovascular diseases around the world each year, so finding factors that affect the survival of these patients is of particular importance. Therefore, finding the best model to analyze patient survival can help to find more accurate results. METHODS: There are different methods to survival analysis that assess one or more risk factors; the classic Kaplan-Meier method, Cox regression, parametric survival models, and newer models such as Bayesian survival. Cox regression is most common and is generally used for time-dependent data, and the main difference between cox regression and Bayesian models is that the prior distribution in Bayesian models can affect the values of the parameters. Some survival analysis models have certain conditions that need to be considered before analyzing the data. In this paper, we use a dataset from Kaggle and discuss these conditions. This dataset contains medical records of 299 patients with heart failure collected at the Faisalabad Institute of Cardiology and the Allied Hospital in Faisalabad (Punjab, Pakistan) from April to December 2015. RESULTS: This paper discusses that if the effective sample size is not sufficient, Bayesian survival models can be used to achieve more accurate results because this model is not affected by the sample size. The results of both methods are shown on a sample of cardiac data and based on the results of Bayesian Cox regression model, it was observed that Age, Anemia, Ejection fraction, High blood pressure and Serum creatinine were effective on patient survival. CONCLUSION: The Bayesian models are much more accurate to determine survival and determine risk factors when dealing with data on rare diseases or diseases with low mortality, including heart patients whose survival probability is higher than that of cancer patients.

Measles, mumps, and rubella (MMR) vaccine and COVID-19: a systematic review.

This study was performed to investigate published literature about the association between measles, mumps, and rubella (MMR) vaccine and COVID-19. This is a systematic review in which the databases of Chocrane, Pubmed, Scopus, Web of Science as well as reliable journals including Lancet, New England Journal of Medicine, Jama and also Centers for Disease Control and Prevention (CDC) publications were searched.Out of 169 documents discovered during the literature review, 56 ones were somehow related to the association between MMR vaccine and COVID-19, of which 11 ones mentioned the association between these two, and 8 of them contained a hypothesis about this relationship. A quasi-trial study reported the positive effect of the MMR vaccine on reducing the severity of COVID-19 symptoms among those who received it. Also, a cross-sectional study showed an association between the level of Immunoglobulin G (IgG) mumps and COVID-19. Moreover, a genomic data analysis study also reported the effect of Rubella Immunoglobulin G (IgG) level on COVID-19. It seems that due to the similarity of respiratory diseases including measles, rubella, and mumps to COVID-19, MMR vaccine should be investigated more deeply to see if it is effective in order to deal with this novel disease.

Bacteriospermia and its association with seminal fluid parameters and infertility in infertile men, Kerman, Iran: A cross-sectional study.

Background: The role of genital Ureaplasma species, genital Mycoplasma (M) species, and Chlamydia (C.) trachomatis, the most prevalent sexually transmitted bacteria, in male infertility are still not clear. Different reports about the impact of these bacteria on semen quality are controversial. Objective: This study was proposed to determine the frequency of bacteriospermia in men and investigate the relationship between the presence of these bacteria and semen quality using molecular assay. Materials and Methods: In this cross-sectional study, 200 semen samples obtained from men attending the research and clinical centers for fertility in Kerman, Iran, between July and December 2019 were analyzed for semen volume, progressive motility, non-progressive motility, total progressive motility, and viability according to the World Health Organization guidelines. The polymerase chain reaction was used for the detection of related bacteria. Results: The mean values of volume, progressive motility, non-progressive motility, total progressive motility, and viability were significantly lower in infertile men (p < 0.001). Statistically significant correlations were observed between the presence of M. genitalium and progressive sperm motility, M. hominis and semen volume, Ureaplasma parvum and the sperm normal form, and C. trachomatis and the sperm progressive motility and viability. Logistic regression analysis showed that M. genitalium (OR = 8.06, p < 0.001) and C. trachomatis (OR = 16, p = 0.01) were significantly associated with male infertility. Conclusion: During the infertility assessment, clinicians should consider of role C. trachomatis and M. genitalium in male infertility. Screening test particularly for asymptomatic individuals is recommended.

Burden of severe COVID-19 in center of Iran: results of disability-adjusted life years (DALYs).

The outbreak of COVID-19 disease is an international public health concern. Therefore, the analysis of information related to mortality and disability due to COVID-19 is considered important, so the present study was designed and conducted with the aim of assessing COVID-19 Disability-Adjusted Life Years (DALYs) in Yazd. In Yazd province, all suspected cases of COVID-19 that would be referred to central hospitals in order to get confirmed through PCR or CT scan test, were recruited to our study. The fatality data of COVID-19 was gathered from the forensic medicine organization. The Disability-Adjusted Life Years (DALYs) combines in one measure years of life lost (YLL), the loss of healthy life due to premature mortality and years of life lived with disability (YLD), the loss of healthy life because of disease and disability. The total burden of COVID-19 was 23,472 years. The number of years lost due to premature death was 23385 and the number of years of life with disability due to COVID-19 was estimated to be 87 years. The disease burden was 12992 years for men and 10480 years for women. The overall incidence of COVID-19 was 1411 per 100,000, of which 1419 in men and 1402 in women per 100,000. The outbreak of COVID-19 pandemic affected a large population and the residents of Yazd Province lost many years of their lives due to this disease.

Prevalence of Leishmania major Yakimoff and Schokhor (Kinetoplastida: Trypanosomatidae) in Sandflies in Iran: A Systematic Review and Meta-Analysis.

Cutaneous leishmaniasis is an important parasitic and vector-borne disease in Iran and can be transmitted to humans and animals through bites of infected female sand flies. The present study aimed to determine the pooled prevalence of Leishmania major in sand flies in Iran. A systematic review and meta-analysis was performed in the present study, so that databases, namely PubMed, Web of Sciences, Science Direct, ProQuest, Embase, Cochrane Reviews, and Scopus as well as IranDoc, SID, Elmnet, and Magiran were searched for finding Persian articles. Inclusion criteria of study contained the study in Iran and investigation of L. major parasite in sand flies. The quality of studies was examined by Joanna Briggs Institute Critical Appraisal Checklist for studies that reported prevalence data; and the data were analyzed by Stata 14 software. In total, 42 studies were evaluated, all of which had investigated the infection of Phlebotomus papatasi Scopoli (Diptera: Psychodidae). The infection of Phlebotomus caucasicus group was investigated in 13 studies, Phlebotomus ansarii Lewis in four studies, Phlebotomus salehi Mesghali and Rashti in five studies, and the infection of other species of sandflies in seven studies. According to the meta-analysis, the pooled prevalence of Ph. papatasi, Ph. caucasicus group, Ph. salehi, and Ph. ansarii were equal to 2.4, 6.2, 1.6, and 9.2%, respectively, with 95% confidence interval. According to reports of different rates of sand fly infection in different regions, all studies should have certain and standard forms and formats to determine the pooled prevalence of sand fly infection.

Trend of Congenital Hypothyroidism Incidence and Its Affecting Factors in Shahr-e-Kord, Western Iran.

BACKGROUND: Congenital hypothyroidism is one of the most common endocrine disrupters and metabolism, and is one of the most important preventable causes of physical and mental disabilities. METHODS: This was a case-control study, in which 54468 infants were screened from 2006 to 2014 in Shahre-Kord, western Iran. To describe the data, central and dispersion indices such as mean and standard deviation was used. For modeling, logistic regression was used. All the tests were performed at the significant level of 5%. RESULTS: Overall, 111 cases were diagnosed with hypothyroidism, which made the prevalence value equal to 2 cases per 1000 births. The prevalence in females and males was 1.9 and 2.2 per 1,000 birth, respectively. The odds ratio for this disorder was 4.47(2.42-9.28) for the neonates with a family history of hypothyroidism and 1.72(1.05-2.82) for those born through cesarean. CONCLUSION: The incidence of this disorder is similar in males and females, and the incidence of this disease in people with a family history is far more than others.

Impact of Mass Screening on the Number of Confirmed Cases, Recovered Cases, and Deaths Due to COVID-19 in Iran: An Interrupted Time Series Analysis.

BACKGROUND: Mass screening for the coronavirus disease 2019 (COVID-19) began in Iran on March 23, 2020, with the purpose of improving early detection of patients for their own health and to prevent onward transmission to others. In this study, we evaluated the impact of the change towards mass screening on new cases reported, cases recovered, and deaths due to COVID-19. METHODS: This study analyzed the daily reports on the number of new cases confirmed by polymerase chain reaction (PCR) testing, cases recovered, and deaths due to COVID-19 provided to the Ministry of Health and Medical Education of Iran. Changes in trends on these outcomes were evaluated using interrupted time series analysis. RESULTS: From February 19 to May 6, 2020, a total of 519544 COVID-19 tests were done and 101650 diagnoses were made (case/ test ratio 19.6%). For the same period, 6418 deaths due to COVID-19 were reported (case fatality ratio 6.3%). The number of cases detected increased significantly over the period of scale-up of mass screening (P=0.003), as did the number of recovered cases (P=0.001). The number of deaths due to COVID-19 did not change before versus after mass screening. CONCLUSION: Following the scale-up of mass screening for COVID-19 in Iran, the rate of new cases detected and reported recovered accelerated significantly. Mass screening is likely to have detected many mild and asymptomatic cases that were infectious. Our data support the role that mass screening, coupled with isolation and contract tracing, can have in slowing the COVID-19 epidemic.

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

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

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

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

The increasing trend of blood donation in Iran.

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

Population Size Estimation of Tramadol Misusers in Urban Population in Iran: Synthesis of Methods and Results.

BACKGROUND: Estimating the population who use drugs is essential for planning, monitoring, and evaluation of substance use prevention and treatment. This study aims to estimate the population who misuse tramadol in urban population in Iran. METHODS: We used the wisdom of the experts (WOTE) and network scale-up (NSU) methods to calculate the population of tramadol misusers in 10 provincial capitals of Iran, in 2016. The WOTE was conducted among pharmacists in drugstores and the personnel of traditional medicinal herbs stores. They guessed the best estimation of tramadol misusers population in their cities. The NSU method was conducted among the general population and participants were questioned about ever and daily, non-medical use of tramadol during last 12 months in their network. The median of the methods was used to calculate the proportion of the adult population (15-49 years old). FINDINGS: The population size of tramadol misusers in studied cities was 83300 [95% uncertainty limits (UL): 47960-256220]. This corresponded to 6.6 per 1000 (95% UL: 3.88-20.30) of the 15-49-year-old population. The projected number of tramadol misusers for all 31 provincial capitals was 118290 (95% UL: 68100-363130840) and 212440 (95% UL: 122310-653410) for all urban areas. NSU also estimated the number of people who misuse tramadol on daily basis. These numbers were 52000 (95% UL: 19940-176570) for studied cities, 73840 (95% UL: 28320-250740) for all 31 provincial capital cities, and 132610 (95% UL: 50860-450310) for all urban areas in Iran. CONCLUSION: This study presents information on high prevalence of tramadol misuse in urban population. We need national control measures and demand reduction programs to control tramadol misuse.

The Association between Adverse Events in the Last 5 Years and the Rate of Breast Cancer.

BACKGROUND: This study was conducted in Yazd Province, Central Iran aimed to investigate the relationship between adverse events and breast cancer during 2012-2014. METHODS: Hospital-based case-control study of 150 women with breast cancer and 150 healthy women (did not have breast cancer) was conducted. Sampling was performed in the form of accessibility. Data collection was conducted using questionnaire through interview. The collected data were entered into SPSS for statistical analysis. RESULTS: The mean age of participants was 51.58 yr. Eight percent of cases and 1.3% of the controls had experienced the sister's death over the past 5 yr, this difference was statistically significant (P=0.03). Factors such as disability due to illness, divorce, unemployment, the second marriage, addiction, ill spouse, child's problems (such as conflict, unemployment, addiction, legal troubles, illness), taking care of their own parents or their husband's parents, migration, change of habitat, loss of home, communication problems, job-relevant factors were not significantly different between the two groups (P>0.05). Mean of severity of adverse events in both groups was significantly different (8.92±8.29 in the case group, 5.72±5.6 in the control group) (P=0.000). CONCLUSION: There was no significant relationship between adverse events in the last 5 yr and the risk of breast cancer. Factors such as personality and ability to cope with problems may positively influence this relationship.