The effect of smoking on latent hazard classes of metabolic syndrome using latent class causal analysis method in the Iranian population.

BACKGROUND: The prevalence of metabolic syndrome is increasing worldwide. Clinical guidelines consider metabolic syndrome as an all or none medical condition. One proposed method for classifying metabolic syndrome is latent class analysis (LCA). One approach to causal inference in LCA is using propensity score (PS) methods. The aim of this study was to investigate the causal effect of smoking on latent hazard classes of metabolic syndrome using the method of latent class causal analysis. METHODS: In this study, we used data from the Tehran Lipid and Glucose Cohort Study (TLGS). 4857 participants aged over 20 years with complete information on exposure (smoking) and confounders in the third phase (2005-2008) were included. Metabolic syndrome was evaluated as outcome and latent variable in LCA in the data of the fifth phase (2014-2015). The step-by-step procedure for conducting causal inference in LCA included: (1) PS estimation and evaluation of overlap, (2) calculation of inverse probability-of-treatment weighting (IPTW), (3) PS matching, (4) evaluating balance of confounding variables between exposure groups, and (5) conducting LCA using the weighted or matched data set. RESULTS: Based on the results of IPTW which compared the low, medium and high risk classes of metabolic syndrome (compared to a class without metabolic syndrome), no association was found between smoking and the metabolic syndrome latent classes. PS matching which compared low and moderate risk classes compared to class without metabolic syndrome, showed that smoking increases the probability of being in the low-risk class of metabolic syndrome (OR: 2.19; 95% CI: 1.32, 3.63). In the unadjusted analysis, smoking increased the chances of being in the low-risk (OR: 1.45; 95% CI: 1.01, 2.08) and moderate-risk (OR: 1.68; 95% CI: 1.18, 2.40) classes of metabolic syndrome compared to the class without metabolic syndrome. CONCLUSIONS: Based on the results, the causal effect of smoking on latent hazard classes of metabolic syndrome can be different based on the type of PS method. In adjusted analysis, no relationship was observed between smoking and moderate-risk and high-risk classes of metabolic syndrome.

Biophysical and ultrasonographic changes in early patch/plaque stage of mycosis fungoides, compared with uninvolved skin.

BACKGROUND: The goal of this study was evaluation of the skin biophysical properties in early patch/plaque stage of mycosis fungoides (MF) and its comparison with uninvolved skin in order to gain a better understanding of the pathogenesis of diseases. MATERIALS AND METHODS: The stratum corneum hydration, transepidermal water loss (TEWL), surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, R5), thickness, and echo density of epidermis and dermis were measured on lesions of 21 patients and compared with controls (average measures of uninvolved perilesional and symmetrical skins) by paired sample t test. RESULTS: Stratum corneum hydration (P < 0.001) and echo density of dermis (P = 0.044) were significantly lower, whereas pH (P-value = 0.007), erythema (P < 0.001), and melanin content (P = 0.007) were significantly higher in lesions. There was not any significant difference in TEWL, friction index, sebum, temperature, R0, R2, R5, thickness of epidermis and dermis, and echo density of epidermis between lesions and normal skin. CONCLUSION: Parapsoriasis/MF lesions are specified by a set of certain changes in biophysical properties which are mainly correlated with histological changes. These sets of alterations may help in noninvasive, early diagnosis of parapsoriasis/MF.

Using multiple self-regulated learning measures to understand medical students' biomedical science learning.

CONTEXT: Understanding self-regulated learning (SRL) is complicated due to the different measures used to identify the key SRL processes. There is a growing trend in applying event measures of SRL (microanalysis and trace) but aptitude measures (questionnaires) continue to be widely used in medical education. A major concern is whether aptitude measures are a valid approach to capture the dimensions of SRL processes. This study examined correlations between SRL microanalysis, SRL trace and the Motivated Strategies for Learning Questionnaire (MSLQ) and how these measures were associated with biomedical science performance. METHODS: An SRL microanalysis assessment interview was administered to 76 first-year medical students individually when performing a biomedical science learning task. All written materials by students were collected for further trace analysis. Students completed an MSLQ 2 weeks before completing their biomedical science course. Correlation analyses were used to determine the correlations between the three SRL assessment measures. Bivariate and multiple analyses were conducted to compare students on different course or task performance using the three SRL assessment measures. RESULTS: Microanalytic metacognitive monitoring (κ = 0.30, P < .001) and causal attributions (κ = 0.17, P = .009) had statistically significant correlations with use of the SRL trace strategy. MSLQ self-efficacy correlated with microanalytic self-efficacy (r = .39, P = .001). Bivariate tests showed that microanalytic metacognitive monitoring, causal attributions and adaptive inferences, and SRL trace strategy use had significant associations with task performance (P < .05). Microanalytic self-efficacy, metacognitive monitoring and causal attributions, SRL trace strategy use and MSLQ self-efficacy had significant associations with course performance (P < .05). Measures of use of the SRL trace strategy and MSLQ subscales did not show significant associations with task and course outcomes in multiple analyses (P > .05). CONCLUSIONS: Event measures, specifically SRL microanalysis, had greater associations with both task and course outcomes compared with the MSLQ measure. The SRL microanalysis is recommended for the assessment of SRL in biomedical science learning. However, to fully understand medical students' SRL a multidimensional assessment approach that combines event and aptitude measures should be used.

Forecasting zoonotic cutaneous leishmaniasis using meteorological factors in eastern Fars province, Iran: a SARIMA analysis.

OBJECTIVES: To predict the occurrence of zoonotic cutaneous leishmaniasis (ZCL) and evaluate the effect of climatic variables on disease incidence in the east of Fars province, Iran using the Seasonal Autoregressive Integrated Moving Average (SARIMA) model. METHODS: The Box-Jenkins approach was applied to fit the SARIMA model for ZCL incidence from 2004 to 2015. Then the model was used to predict the number of ZCL cases for the year 2016. Finally, we assessed the relation of meteorological variables (rainfall, rainy days, temperature, hours of sunshine and relative humidity) with ZCL incidence. RESULTS: SARIMA(2,0,0) (2,1,0)12 was the preferred model for predicting ZCL incidence in the east of Fars province (validation Root Mean Square Error, RMSE = 0.27). It showed that ZCL incidence in a given month can be estimated by the number of cases occurring 1 and 2 months, as well as 12 and 24 months earlier. The predictive power of SARIMA models was improved by the inclusion of rainfall at a lag of 2 months (ß = -0.02), rainy days at a lag of 2 months (ß = -0.09) and relative humidity at a lag of 8 months (ß = 0.13) as external regressors (P-values < 0.05). The latter was the best climatic variable for predicting ZCL cases (validation RMSE = 0.26). CONCLUSIONS: Time series models can be useful tools to predict the trend of ZCL in Fars province, Iran; thus, they can be used in the planning of public health programmes. Introducing meteorological variables into the models may improve their precision.

Comparison of biophysical, biomechanical and ultrasonographic properties of skin in chronic dermatitis, psoriasis and lichen planus.

Background: Skin biometrology is a useful method for evaluation of inflammatory skin disorders such as dermatitis, psoriasis, and lichen planus. The current study tries to compare the biophysical features of skin in dermatitis, psoriasis, and lichen planus. Methods: By a convenient sampling method, 22 mild to moderate chronic dermatitis, 26 psoriasis, and 21 lichen planus patients were recruited in the study. Stratum corneum (S.C.) hydration, Transepidermal water loss (TEWL), pH, erythema, melanin, sebum, friction, elasticity parameters (R0, R2, and R5), skin temperature, skin thickness, and echo-density of epidermis and dermis were measured on the lesional (selected active lesion), uninvolved perilesional, and uninvolved symmetrical skin. The average of perilesional and symmetrical uninvolved parameters was used as control, while the percentage change of each parameter [(lesion - control / control) ×100] was calculated, and compared among three diseases by ANOVA test using SPSS software version 18. The significance level was set at α=0.05. Results: Comparison of percentage changes showed that the changes in TEWL, friction index, sebum content, R2 (gross elasticity), R5 (net elasticity), skin temperature, dermal thickness, and epidermal density are not significantly different among three skin diseases. But there were significant differences in three diseases considering the decrease in S.C. hydration (p<0.001), R0 (opposed to firmness) (p<0.001), and dermal density (p<0.001) compared to control skin. Moreover, the increase in skin pH (p<0.001), melanin content (p=0.048), erythema (p=0.023), and epidermal thickness (p <0.001) significantly differed among these diseases. Conclusion: Dermatitis, psoriasis and lichen planus lesions had specific biophysical changes. It may be helpful in their differential diagnosis.

Self-regulated learning processes of medical students during an academic learning task.

OBJECTIVES: This study was designed to identify the self-regulated learning (SRL) processes of medical students during a biomedical science learning task and to examine the associations of the SRL processes with previous performance in biomedical science examinations and subsequent performance on a learning task. METHODS: A sample of 76 Year 1 medical students were recruited based on their performance in biomedical science examinations and stratified into previous high and low performers. Participants were asked to complete a biomedical science learning task. Participants' SRL processes were assessed before (self-efficacy, goal setting and strategic planning), during (metacognitive monitoring) and after (causal attributions and adaptive inferences) their completion of the task using an SRL microanalytic interview. Descriptive statistics were used to analyse the means and frequencies of SRL processes. Univariate and multiple logistic regression analyses were conducted to examine the associations of SRL processes with previous examination performance and the learning task performance. RESULTS: Most participants (from 88.2% to 43.4%) reported task-specific processes for SRL measures. Students who exhibited higher self-efficacy (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.09-1.90) and reported task-specific processes for metacognitive monitoring (OR 6.61, 95% CI 1.68-25.93) and causal attributions (OR 6.75, 95% CI 2.05-22.25) measures were more likely to be high previous performers. Multiple analysis revealed that similar SRL measures were associated with previous performance. The use of task-specific processes for causal attributions (OR 23.00, 95% CI 4.57-115.76) and adaptive inferences (OR 27.00, 95% CI 3.39-214.95) measures were associated with being a high learning task performer. In multiple analysis, only the causal attributions measure was associated with high learning task performance. CONCLUSIONS: Self-efficacy, metacognitive monitoring and causal attributions measures were associated positively with previous performance. Causal attributions and adaptive inferences measures were associated positively with learning task performance. These findings may inform remediation interventions in the early years of medical school training.

Introducing a model for optimal design of sequential objective structured clinical examinations.

In a sequential OSCE which has been suggested to reduce testing costs, candidates take a short screening test and who fail the test, are asked to take the full OSCE. In order to introduce an effective and accurate sequential design, we developed a model for designing and evaluating screening OSCEs. Based on two datasets from a 10-station pre-internship OSCE and considering three factors, namely, the number of stations, the criteria for selecting the stations, and the cut-off score, several hypothetical tests were proposed. To investigate their accuracy, the positive predictive value (PPV), the pass rate, and the negative predictive value (NPV) were calculated. Also, a "desirable" composite outcome was defined as PPV = 100 %, pass rate ≥50 %, and NPV ≥25 %. Univariate and multiple logistic regression analyses were conducted to estimate the effects of independent factors on the occurrence of the desirable outcome. In half of the screening tests no false positive result was detected. Most of the screening OSCEs had acceptable levels of pass rate and NPV. Considering the desirable composite outcome 20 screening OSCEs could have successfully predicted the results of the corresponding full OSCE. The multiple regression analysis indicated significant contributions for the selection criteria (p values = 0.019) and the cut-off score (p values = 0.017). In order to have efficient screening OSCEs with the lowest probability of the error rate, careful selection of stations with high values of discrimination or item total correlation, and use of a relatively stringent cut-off score should be considered.

A 5-year scientometric analysis of research centers affiliated to Tehran University of Medical Sciences.

BACKGROUND: Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced. METHODS: This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers. RESULTS: The medians of the numbers of papers and books during a 5-year period were 150.5 and 2.5 respectively. The median of the "articles per researcher" was 19.1. Based on multiple linear regression, younger age centers (p=0.001), having a separate budget line (p=0.016), and number of research personnel (p<0.001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0.004). CONCLUSION: The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers.

Pharmacologic prevention of recurrent vasovagal syncope: A systematic review and network meta-analysis of randomized controlled trials.

Vasovagal syncope (VVS) is a transient loss of consciousness that currently imposes a high burden on health care systems with limited evidence of the comparative efficacy of available pharmacologic interventions. This study aims to compare all pharmacologic therapies suggested in randomized controlled trials (RCTs) through systematic review and network meta-analysis. A systematic search in PubMed, Embase, Web of Science, and Cochrane Library was conducted to identify RCTs evaluating pharmacologic therapies for patients with VVS. The primary outcome was spontaneous VVS recurrence. The secondary outcome was a positive head-up tilt test (HUTT) after receiving intervention, regarded as a lower level of evidence. Pooled risk ratio (RR) with 95% confidence interval (CI) was calculated using random-effect network meta-analysis. Pairwise meta-analysis for comparison with placebo was also performed when applicable. The surface under the cumulative ranking curve analysis was conducted to rank the treatments for each outcome. Twenty-eight studies with 1744 patients allocated to different medications or placebo were included. Network meta-analysis of the reduction in the primary outcome showed efficacy for midodrine (RR 0.55; 95% CI 0.35-0.85) and fluoxetine (especially in patients with concomitant anxiety) (RR 0.36; 95% CI 0.16-0.84). In addition, midodrine and atomoxetine were superior to other treatment options, considering positive HUTT (RR 0.37; 95% CI 0.23-0.59; and RR 0.49; 95% CI 0.28-0.86, respectively). Overall, midodrine was the only agent shown to reduce spontaneous syncopal events. Fluoxetine also seems to be beneficial but should be studied further in RCTs. Our network meta-analysis did not find evidence of the efficacy of any other medication.

Ambient temperature and air pollution, and the risk of preterm birth in Tehran, Iran: a time series study.

OBJECTIVE: The aim of the present study was to determine the relationship between temperature and air pollution, and preterm birth in Tehran, Iran. METHODS: In this time series study, the daily data of preterm births, air pollution, and maximum, minimum and mean temperature from March 2015 to March 2018 were used. To evaluate the effect of air pollution and temperature with and without adjustment of their mutual effects on preterm birth in lags (days) 0-21, the Distributed Lag Non-linear Models (DLNM) was used. The relative risk (RR) was estimated for extreme, moderate and mild heat (99th, 95th, 75th percentile) and cold (1st, 5th, 25th percentile) compared with the median, and for each 10-unit increase in PM2.5, NO2, and O3, 5-unit increase in SO2, and 1-unit increase in CO. RESULTS: The highest RR was seen in extreme (26.9 °C) and moderate (24.8 °C) heat of minimum temperature on lag 0 (RR = 1.17; 1.05-1.31, Adjusted RR = 1.16; 1.04-1.29, RR = 1.15; 1.05-1.26, Adjusted RR = 1.14; 1.03-1.25, respectively). In regard of cold, the only significant effect was for maximum temperature on lags 7-9 (RR = 1.02; 1.00-1.04). Each 10-unit increase in PM2.5 in Lag 0 (RR = 1.008; 1.001-1.014) and lag 1 (RR = 1.004; 1.001-1.007) and in NO2 in lag 0 (RR = 1.006; 1.000-1.012) had significant effects. CONCLUSION: Maternal exposure to a minimum daily temperature of 26.9 and 24.8 °C compared to 13.2 °C increased the risk of preterm birth by 17 and 15% on the same day, respectively. This risk increased by 0.8 and 0.6%, on the same day for each 10-unit increase in PM2.5 and NO2, respectively.

The Effects of Smoking on Metabolic Syndrome and Its Components Using Causal Methods in the Iranian Population.

BACKGROUND: The aim of this study was to estimate the effect of smoking on metabolic syndrome (MS) and its components applying inverse probability-of-treatment weighting (IPTW) and propensity score (PS) matching. METHODS: Using data from Tehran Lipid and Glucose Study, 4857 participants aged over 20 years with information on smoking and confounders in the third phase (2005-2008) were included, and the MS was assessed in the fifth phase (2011-2014). IPTW and PS matching were used to adjust for confounders. RESULTS: Based on average treatment effect (ATE) estimates, smoking decreased the risk of hypertension (RR: 0.62; 95% CI: 0.43, 0.88), but increased the risk of low HDL cholesterol (1.20; 0.98, 1.48). Similarly, the average treatment effect in the treated (ATT) estimates using IPTW and PS matching suggested that smoking decreased the risk of hypertension (0.63; 0.52, 0.76, and 0.68; 0.54, 0.85), and increased the risk of low HDL cholesterol (1.24; 1.07, 1.43, and 1.28; 1.06, 1.54), respectively. CONCLUSIONS: Smoking seems to increase the risk of low HDL cholesterol but decreases the risk of hypertension.

Biophysical and ultrasonographic changes in pityriasis rosea compared with uninvolved skin.

BACKGROUND: Pityriasis rosea (PR) is a common, self-limited, inflammatory papulosquamous skin disease with a possible viral etiology. OBJECTIVE: The goal of this study was to evaluate skin biophysical properties in patients with PR compared with uninvolved skin to better understand the pathogenesis of PR. METHODS: Stratum corneum hydration, transepidermal water loss, surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, R5), thickness, and echodensity of the epidermis and dermis were measured on lesions of classic PR in 21 patients and compared with control sites (average of uninvolved perilesional and symmetrical skin) with a paired t test. RESULTS: Stratum corneum hydration (p < .001), R0 (p = .003), R2 (p = .001), R5 (p = .003), and echodensity of the dermis (p = .006) were significantly lower, whereas transepidermal water loss (p = .001), pH (p < .001), and erythema (p < .001) were significantly higher in PR lesions. There was no significant difference in friction index, sebum, melanin content, temperature, thickness of the epidermis and dermis, and echodensity of the epidermis between PR and normal skin. CONCLUSION: PR skin is characterized by certain alterations in biophysical properties, which are mostly correlated with histologic changes. These changes may be helpful in early, noninvasive diagnosis of PR.

Distribution of angle kappa measurements with Orbscan II in a population-based survey.

PURPOSE: To determine the mean angle kappa and its determinants in the population of Tehran, Iran. METHODS: In a cross-sectional survey with random cluster sampling, a total of 442 participants aged >14 years were selected from 4 municipality districts of Tehran for Orbscan acquisitions. Exclusion criteria were history of eye surgery for refractive errors, cataract or glaucoma, and use of topical medication or any type of contact lens at the time of the study. Mean angle kappa in different age and gender groups and its association with other factors was assessed. Considering the high correlation between the right and left eyes, only results of the right eyes are presented. RESULTS: After applying exclusion criteria, 800 eyes (399 right eyes and 401 left eyes) were examined. Mean participant age was 40.6±16.8 years (range: 14 to 81 years), and 38.8% of eyes were from men. Mean angle kappa was 5.46±1.33° in total; 5.41±1.32° in men and 5.49±1.34° in women (P=.558). It decreased significantly with age; 0.015°/year (P<.001). In individuals with myopia, emmetropia, and hypermetropia, the mean value was 5.13±1.50°, 5.72±1.10°, and 5.52±1.19°, respectively (P=.025); the post-hoc test indicated this was due to the difference between emmetropes and myopes. CONCLUSIONS: According to our results, angle kappa reduces with age, and the inter-gender difference is not significant. Largest angle kappas were seen among individuals with emmetropia. Angle kappas were larger in the hypermetropic population compared to the myopic population.

Keratometry measurements, corneal astigmatism and irregularity in a normal population: the Tehran Eye Study.

PURPOSE: To determine the mean corneal power, astigmatism, and irregularity in a sample from the population of Tehran. MATERIALS AND METHODS: Four hundred and forty-two people residing in the first four municipality districts of Tehran were selected through a random stratified cluster sampling approach, 410 of which met the inclusion criteria and were enrolled in the study to have Orbscan II acquisitions between 9:00 am and 7:00 pm. The values obtained for keratometry, corneal astigmatism, and corneal irregularity were studied. RESULTS: The mean keratometry reading was 44.39 diopter (D) [95% confidence interval (CI): 44.22-44.57]. Age, spherical equivalent and corneal diameter were significantly correlated with mean keratometry reading in the multivariate model. Mean corneal astigmatism was 0.98 D (95% CI: 0.89-1.06), also significantly correlated with spherical equivalent in the multivariate model. Mean corneal irregularity in the central 3 mm zone was 1.25 D (95% CI: 1.20-1.29); this was significantly correlated with age. CONCLUSIONS: In a sample of the Tehran population, we found higher values of mean corneal power, astigmatism, and irregularity compared to other reports. Considering the high prevalence of cases of suspect keratoconus in the studied population, it is important to pay more attention to corneal indices in keratorefractive surgery.

Estimation of Generalized Impact Fraction and Population Attributable Fraction of Hypertension Based on JNC-IV and 2017 ACC/AHA Guidelines for Cardiovascular Diseases Using Parametric G-Formula: Tehran Lipid and Glucose Study (TLGS).

PURPOSE: An area of interest to health policymakers is the effect of interventions aimed at risk factors on decreasing the number of new cardiovascular disease (CVD) cases. The aim of this study was to estimate the generalized impact fraction (GIF) and population attributable fraction (PAF) of hypertension (HTN) for CVD in Tehran. PATIENTS AND METHODS: In this population-based cohort study, 8071 participants aged ≥30 years were followed for a median of 16 years. A survival model was used to estimate the 10- and 18-year risk of CVD. JNC-IV and 2017 ACC/AHA guidelines were used to categorize blood pressure (BP). PAF and GIF were estimated in different scenarios using the parametric G-formula. RESULTS: Of 7378 participants included in analyses, 22.7% and 52.3% were classified as hypertensive according to the JNC-IV and 2017 ACC/AHA guidelines, respectively. According to the 2017 ACC/AHA, the 10-year risk of CVD was 5.1% (4.3-6.0%), 8.9% (6.7-12.0%), and 7.1% (6.1-8.4%) for normal BP, elevated BP, and stage 1 HTN, respectively, and 20.8% (18.8-23.0%) for stage 2 of the 2017 ACC/AHA and JNC-IV. The PAF of stage 2 vs stage 1 and vs normal BP for CVD was 17.4% (11.5-21.8%) and 20.4% (14.6-26.4%), respectively. The GIF of 30% reduction in the prevalence of stage 2 HTN to stage 1 and to normal BP for CVD was 5.1% (3.4-6.6%) and 6.1% (4.4-8.0%), respectively. Based on JNC-IV, the PAF and GIF of 30% for CVD were 17.8% (12.7-22.9%) and 5.4% (4.0-6.9%), respectively. CONCLUSION: By reducing the prevalence of HTN by 30%, a remarkable number of new CVD cases would be prevented. In an Iranian population, the comparison of HTN cases with normal BP showed no association between stage 1 HTN and CVD, whereas elevated BP was a significant risk factor for the incidence of CVD.

Understanding the Reasons for Sharing Syringes or Needles to Inject Drugs: Conventional Content Analysis.

BACKGROUND: This qualitative study was undertaken with the aim to identify the reasons for sharing syringes or needles among people who inject drugs (PWID) in Iran. METHODS: We used purposive sampling to recruit 4 groups of participants, male PWID (n = 14), female PWID (n = 6), service providers (n = 8), and human immunodeficiency virus (HIV)/addiction experts (n = 9). Data were collected through 2 focus group discussions (FGDs) among male PWID, and semi-structured interviews with female PWID, service providers, and HIV/addiction experts. Using conventional content analysis, themes were extracted for reasons for sharing needles to inject drugs. FINDINGS: We found 13 themes for barriers such as low perceived risk of HIV, high stigma around drug injection and use, low access to harm reduction education and prevention services due to their limited working hours as a well as uneven geographical distribution of services, some structural barriers like incarceration, poverty, and homelessness, and several competing survival needs beyond the injection-related safe behaviors. CONCLUSION: Our study was able to provide the perspectives of both PWID and health care authorities and providers towards several barriers to accessing HIV prevention services that lead to needle sharing among PWID in Iran. These barriers need to be addressed to achieve the target of HIV epidemic control.

Effect of ambient air pollution and temperature on the risk of stillbirth: a distributed lag nonlinear time series analysis.

OBJECTIVES: This study aimed to determine the effect of ambient air pollution and temperature on stillbirth in Tehran. METHODS: In this time-series study, the effect of O3 (ppb), CO (ppm), NO2 (ppb), SO2 (ppb), PM2.5 (µg/m3), and minimum, maximum, and mean daily temperature (°C) on stillbirth was evaluated in Tehran, Iran between March 2015 and March 2018. Using a quasi-Poisson regression model in combination with a Distributed Lag Non-linear Models (DLNM), the Relative Risk (RR) was estimated through comparing the high temperature (99th, 95th, and 75th percentiles) and low temperature (1st, 5th, and 25th percentiles) with the median. The effect of air pollution was estimated for each 1-, 5-, or 10-unit increase in the concentration during lags (days) 0-21. RESULTS: Among air pollutants, only a 5-ppm increase in the SO2 concentration in lag 0 increased the risk of stillbirth significantly (RR = 1.062; 1.002-1.125). The largest effect of heat was observed while comparing the 99th percentile of minimum daily temperature (26.9 °C) with the median temperature (13.2 °C), which was not statistically significant (RR = 1.25; 0.95-1.65). As for cold, a non-significant protective effect was observed while comparing the 1st percentile of maximum daily temperature (3.1 °C) with the median temperature (23.2 °C) (RR = 0.92; 0.72-1.19). CONCLUSION: Each 5-ppm increase in the mean daily SO2 in lag 0 increased the risk of stillbirth by 6% while other air pollutants had no significant effects on stillbirth. In lags 0 and 1, the heat increased the risk of stillbirth while the cold had protective effects, which were not statistically significant.

Differentiation of inflammatory papulosquamous skin diseases based on skin biophysical and ultrasonographic properties: A decision tree model.

BACKGROUND: The biophysical and ultrasonographic properties of the skin change in papulosquamous diseases. AIMS: : To identify biophysical and ultrasonographic properties for the differentiation of five main groups of papulosquamous skin diseases. METHODS: Fifteen biophysical and ultrasonographic parameters were measured by multiprobe adapter system and high-frequency ultrasonography in active lesions and normal control skin in patients with chronic eczema, psoriasis, lichen planus, pityriasis rosea and parapsoriasis/mycosis fungoides. Using histological diagnosis as a gold standard, a decision tree analysis was performed based on the mean percentage changes of these parameters [(lesion-control/control) ×100] for differentiation of the diseases. RESULTS: The accuracy of the decision tree model for differentiation of five diseases was 67% which developed based on changes in stratum corneum hydration, epidermal thickness, skin pH, melanin index, R0 (reciprocal of firmness) and erythema. Among the flowcharts for pairs of diseases, three models for differentiation had high accuracy (> 95%): those of psoriasis from lichen planus, pityriasis rosea, and parapsoriasis/mycosis fungoides. LIMITATIONS: Validation studies on a larger sample size in situations where the diagnosis is unclear are needed to confirm the accuracy and applicability of decision trees. CONCLUSION: Skin biophysical and ultrasonographic properties may help in the differentiation of papulosquamous diseases as simple and non-invasive tools.

HIV prevention cascades for injection and sexual risk behaviors among HIV-negative people who inject drug in Iran.

BACKGROUND: The HIV prevention cascade complements the HIV treatment cascade and helps evaluate the access to and use of harm reduction programs among HIV-negative individuals at risk for HIV, including people who inject drugs (PWID). This study aimed to estimate the HIV prevention cascades among PWID in Iran. METHODS: Using data from the 2014 national bio-behavioral surveillance survey, 2,391 PWID were recruited from 31 harm reduction facilities and through outreach efforts across 10 major cities. PWID aged ≥18 years who reported drug injection in the past year were interviewed, and information regarding their demographic characteristics, sexual and drug injection practices, and access to services were gathered. PWID were also tested for HIV infection. We examined the prevention cascade framework among HIV-negative PWID. RESULTS: The majority of PWID were male (97.6%) and more than half aged ≥ 35 years old (55.5%). Overall, 2,092 (92.5% [95% CI: 90.8, 93.9]) were HIV-negative; 93% of whom knew illicit drug injection could increase the risk of HIV transmission, 54% had access to free-of-charge sterile needles and syringes, 51% used sterile needles and syringes in their last injection practice, and 33% used sterile needles and syringes in all injection practices in the past month. Also, 87.8% (95% CI: 85.1, 90.0) of HIV-negative PWID had sex with any partner in the past year; 88% of whom knew using condoms could reduce the risk of HIV transmission, 35% had access to free-of-charge condoms, 32% used condoms in their last sexual practice, and 18% used condoms in all of their sexual practices in the past month. CONCLUSION: The majority of HIV-negative PWID in Iran were at risk for HIV acquisition through unsafe drug injection or sexual practices. Harm reduction programs should improve access to free sterile needles, syringes, and condoms for PWID.

Alcohol Use Disorders Identification Test (AUDIT): Validation of the Persian version in an Iranian population.

BACKGROUND AND AIMS: It is important to incorporate a screening test for unhealthy alcohol use into primary and other health care settings. The Alcohol Use Disorders Identification Test (AUDIT) is one of the most commonly used of such tests. The objectives of this study were to evaluate the psychometric properties of the Persian version of AUDIT, and to determine the best cut-off points for detection of hazardous drinking and alcohol use disorders. METHODS: We translated the AUDIT to Persian and assessed its face and content validity, reliability, and criterion validity against the diagnosis of alcohol use disorders according to the International Classification of Diseases, 10th Revision (ICD-10) diagnostic guidelines, as assessed using the Composite International Diagnostic Interview (CIDI). We determined the best cut-off points for detection of hazardous use, harmful use, and dependence using receiver operating characteristic (ROC) curve analysis. Psychometric properties were assessed in a sample of 400 participants attending medium-term residential drug treatment centers located in Tehran, Iran. RESULTS: The Persian AUDIT had high internal consistency (Cronbach's alpha = 0.88) and test-retest reliability (intraclass correlation coefficient = 0.84). The questionnaire also had excellent face and content validity as well as criterion validity when compared with CIDI. The best cut-off points for alcohol dependence, harmful use, and hazardous use were 11 (sensitivity = 95.6, specificity = 80.4), 7 (sensitivity = 85.5, specificity = 84.2), and 5 (sensitivity = 87.6, specificity = 92.9), respectively. CONCLUSIONS: The Persian version of the AUDIT has excellent psychometric properties as a screening tool for alcohol use disorders and hazardous alcohol use in settings in which alcohol use is common. Further research on the AUDIT in the general population and in primary health care settings is warranted.