Epidemiology and Health

Original Articles

The probability of diagnostic delays for tuberculosis and its associated risk factors in northwest Iran from 2005 to 2016: a survival analysis using tuberculosis surveillance data: Reza Ebrahimoghli, Hassan Ghobadi, Davoud Adham, Parviz Jangi, Abbas Abbasi-Ghahramanloo, Eslam Moradi-Asl; Epidemiol Health. 2022;44:e2022060. Published online July 18, 2022; DOI: https://doi.org/10.4178/epih.e2022060

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OBJECTIVES
Early diagnosis is essential for effective tuberculosis (TB) control programs. Therefore, this study examined the risk of delays in TB diagnosis and associated factors in Ardabil Province in northwest Iran from 2005 to 2016.
METHODS
This longitudinal retrospective cohort study was conducted using data obtained from the Iranian National Tuberculosis Control Program at the provincial level between 2005 and 2016. The total delay in diagnosis was defined as the time interval (days) between the onset of symptoms and TB diagnosis. Survival analysis was conducted to analyze the delay in diagnosis. Associated factors were identified using a Cox proportional hazards model.
RESULTS
A total of 1,367 new TB cases were identified. The 12-year median diagnostic delay was 45 days (interquartile range [IQR], 30-87). The annual median diagnostic delay decreased from 68 days (IQR, 33-131) in 2005 to 31 days (IQR, 30-62) in 2016. The probability of a delay in TB diagnosis decreased by 5.0% each year (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.04 to 1.07). Residence in a non-capital county (HR, 0.83; 95% CI, 0.74 to 0.92) and referral from the private health system (HR, 0.74%; 95% CI, 0.65 to 0.84) were significantly associated with an increased risk of delay in TB diagnosis over the 12-year study period.
CONCLUSIONS
The median delay decreased during the study period. We identified factors associated with a longer delay in TB diagnosis. These findings may be useful for further TB control plans and policies in Iran.; Summary

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Key Message
A longitudinal analysis of tuberculosis surveillance data from northwest Iran showed that during the 12-year period from 2005 to 2016, a total of 1,367 tuberculosis cases were registered, of whom 942 patients had a prolonged diagnostic delay (>30 days) and the probability of a delay in tuberculosis diagnosis decreased by 5.0% each year.

Unemployment and COVID-19-related mortality: a historical cohort study of 50,000 COVID-19 patients in Fars, Iran: Alireza Mirahmadizadeh, Mohammad Taghi Badeleh Shamooshaki, Amineh Dadvar, Mohammad Javad Moradian, Mohammad Aryaie; Epidemiol Health. 2022;44:e2022032. Published online March 12, 2022; DOI: https://doi.org/10.4178/epih.e2022032

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Abstract

OBJECTIVES
Previous studies have estimated the risk of death associated with unemployment in the coronavirus disease 2019 (COVID-19) pandemic, but no studies have examined unemployment before COVID-19 infection as a risk factor for COVID-19-related mortality. Thus, this study aimed to investigate COVID-19 mortality among this population.

METHODS

Data on 50,038 people aged 25-59 years were collected from 38 agencies in Fars Province, Iran, from February 2020 to July 2021. Follow-up lasted from participants’ diagnosis with COVID-19 based on the results of a reverse transcription-polymerase chain reaction test to participants’ death or the end of the study period. The association between unemployment and COVID-19-related mortality was estimated using the Poisson regression method, and a sensitivity analysis was conducted to calculate the E-value.

RESULTS

Unemployment was associated with a 2.41-fold (95% confidence interval [CI], 2.01 to 2.90) higher age-adjusted and sex-adjusted risk of COVID-19-related mortality. The adjusted Poisson regression analysis showed 8.82 (95% CI, 6.42 to 12.11), 2.84 (95% CI, 1.90 to 4.24), and 1.58 (95% CI, 1.24 to 2.01) times higher risks of COVID-19-related mortality among unemployed people aged 25-39 years, 40-49 years, and 50-59 years, respectively, than among their employed counterparts. Unemployment increased the risk of COVID-19 mortality by 3.31 (95% CI, 2.31 to 4.74) and 2.30 (95% CI, 1.86 to 2.84) times in female and male, respectively. The E-value was 3.43, reflecting the minimum strength of confounding required to shift the association between unemployment and COVID-19-related mortality toward the null.

CONCLUSIONS

Unemployment prior to COVID-19 infection increased the risk of COVID-19-related mortality. COVID-19-related mortality disproportionately impacted unemployed women and younger unemployed people.

Summary

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Key Message
This study adds new insights to the existing body of work on the topic of unemployment and COVID-19-related mortality. Unemployment prior to COVID-19 infection was found to increase the risk of COVID-19-related mortality, which disproportionately burdened unemployed female and younger unemployed people. It seems older unemployed people and unemployed males may tend to have more financial resources and savings when they lose a job, making younger unemployed people and unemployed female more vulnerable to financial stress, which can lead to deferred care and increase their risk of COVID-19-related mortality.

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Is there a relationship between internet access and COVID-19 mortality? Evidence from Nigeria based on a spatial analysis
Richard Adeleke
Dialogues in Health.2023; 2: 100102. CrossRef

Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran: a closer look at risk factors: Leila Mirzaei, Keyhan Ashrafi, Zahra Atrkar Roushan, Mohammad Reza Mahmoudi, Irandokht Shenavar Masooleh, Behnaz Rahmati, Farshid Saadat, Hamed Mirjalali, Meysam Sharifdini; Epidemiol Health. 2021;43:e2021009. Published online January 20, 2021; DOI: https://doi.org/10.4178/epih.e2021009

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Abstract

OBJECTIVES
The objective of this study was to evaluate the prevalence of Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran and to investigate related risk factors.

METHODS

This cross-sectional study was conducted among 494 patients receiving immunosuppressive drugs, including cancer patients undergoing chemotherapy (n=188) and those treated with prolonged corticosteroid administration (n=306). All fresh fecal samples were examined using the direct wet-mount, formalin ethyl acetate concentration, and agar plate culture techniques.

RESULTS

In total, 16.8% of patients were positive for at least 1 intestinal parasite; the helminthic and protozoan infection rates were 5.1% and 12.3%, respectively. The infection rate was significantly higher in corticosteroid-treated individuals (19.6%) than cancer patients (12.2%) (p<0.05). The prevalence rate of S. stercoralis among patients receiving chemotherapy and those treated with corticosteroids were 4.3% and 5.2%, respectively. The prevalence rate of S. stercoralis infection was significantly higher in older patients (p<0.05).

CONCLUSIONS

Strongyloidiasis is one of the most common parasites among patients receiving immunosuppressive drugs in northern Iran. Early diagnosis and proper treatment of these patients are necessary to minimize the complications of severe strongyloidiasis.

Summary

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Key Message
This study showed strongyloidiasis is one of the most common parasitic diseases among patients receiving immunosuppressive drugs in northern Iran and early diagnosis before chemotherapy or steroid therapy is necessary.

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Seropositivity Rates of Strongyloides stercoralis Antibody in the Southeastern Region of Republic of Korea: A Single-Center Retrospective Study
Taehwa Kim, Seungjin Lim
The Korean Journal of Parasitology.2022; 60(3): 181. CrossRef
The Coexistence of Blastocystis spp. in Humans, Animals and Environmental Sources from 2010–2021 in Asia
Adedolapo Aminat Rauff-Adedotun, Farah Haziqah Meor Termizi, Nurshafarina Shaari, Ii Li Lee
Biology.2021; 10(10): 990. CrossRef
Comparison of Molecular and Parasitological Methods for Diagnosis of Human Trichostrongylosis
Mehdi Pandi, Meysam Sharifdini, Keyhan Ashrafi, Zahra Atrkar Roushan, Behnaz Rahmati, Nayereh Hajipour
Frontiers in Cellular and Infection Microbiology.2021;[Epub] CrossRef

Copro-molecular diagnosis of the Toxoplasmatinae subfamily in dog and cat populations in northern Iran: Leila Izadi, Shahabeddin Sarvi, Seyed Abdollah Hosseini, Afsaneh Amouei, Mehdi Sharif, Mohammad Taghi Rahimi, Tooran Nayeri, Ahmad Daryani; Epidemiol Health. 2020;42:e2020074. Published online December 4, 2020; DOI: https://doi.org/10.4178/epih.e2020074

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Abstract

OBJECTIVES
The oocysts of the Toxoplasmatinae subfamily (Neospora caninum, Hammondia hammondi and H. heydorni, and Besnoitia besnoiti) are morphologically similar to Toxoplasma gondii, and indistinguishable from each other. This study investigated the prevalence of the Toxoplasmatinae subfamily in dog and cat fecal samples using a nested polymerase chain reaction method.

METHODS

Overall, 200 fecal samples from domestic dogs (n=120) and cats (n=80) were collected from 15 farms in northern Iran. The samples were homogenized in 2.5% potassium dichromate solution and subsequently concentrated with sucrose solution. DNA was extracted from samples using a genomic DNA kit. Specific primers and the 18S rDNA gene were used to screen and detect all Toxoplasmatinae oocysts.

RESULTS

Overall, 2.5% (3 of 120) and 22.5% (18 of 80) of the fecal samples collected from dogs and cats were infected with Toxoplasmatinae. In dogs, 2 samples were positive for N. caninum and 1 sample was positive for T. gondii. In cats, all 18 positive samples belonged to T. gondii. No contamination with H. heydorni was observed in dog fecal samples or H. hammondi and B. besnoiti in cat fecal samples. A phylogenetic analysis revealed that the T. gondii (cat) and N. caninum (dog) found had similarities with parasites reported from other regions of the world.

CONCLUSIONS

This is the first study to provide data on the epidemiology of Toxoplasmatinae oocysts in Iran. The findings suggest that public-health monitoring for the effective control of feces from cats and dogs and improved pet hygiene habits are needed.

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Endoparasites of European Wildcats (Felis silvestris) in Greece
Anastasia Diakou, Despina Migli, Dimitris Dimzas, Simone Morelli, Angela Di Cesare, Dionisios Youlatos, Petros Lymberakis, Donato Traversa
Pathogens.2021; 10(5): 594. CrossRef

Epidemiologic Investigation

How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time: Meysam Olfatifar, Seyed Mehdi Hosseini, Payam Shokri, Soheila Khodakarim, Naghmeh Khadembashi, Sajjad Rahimi Pordanjani; Epidemiol Health. 2020;42:e2020058. Published online August 10, 2020; DOI: https://doi.org/10.4178/epih.e2020058

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Abstract

OBJECTIVES
Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis.

METHODS

An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas.

RESULTS

The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables.

CONCLUSIONS

The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.

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Spatio-temporal Analysis of COVID-19: A Global Study
Sajjad Rahimi Pordanjani, Maryam Mohammadian, Somayeh Derakhshan, Fatemeh Hadavandsiri, Seyed Saeed Hashemi Nazari, Mohammad Hossein Panahi
Middle East Journal of Rehabilitation and Health Studies.2023;[Epub] CrossRef
Factors Associated With Diagnostic Delays in Human Brucellosis in Tongliao City, Inner Mongolia Autonomous Region, China
Jingbo Zhai, Ruihao Peng, Ying Wang, Yuying Lu, Huaimin Yi, Jinling Liu, Jiahai Lu, Zeliang Chen
Frontiers in Public Health.2021;[Epub] CrossRef
Clinical Effect of Doxycycline Combined with Compound Sulfamethoxazole and Rifampicin in the Treatment of Brucellosis Spondylitis
Xin-Ming Yang, Yong-Li Jia, Ying Zhang, Pei-Nan Zhang, Yao Yao, Yan-Lin Yin, Ye Tian
Drug Design, Development and Therapy.2021; Volume 15: 4733. CrossRef

Original Articles

Temporal trend and spatial distribution of acute lymphoblastic leukemia in Iranian children during 2006-2014: a mixed ecological study: Sajjad Rahimi Pordanjani, Amir Kavousi, Babak Mirbagheri, Abbas Shahsavani, Koorosh Etemad; Epidemiol Health. 2020;42:e2020057. Published online July 29, 2020; DOI: https://doi.org/10.4178/epih.e2020057

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Abstract

OBJECTIVES
The present study investigated the spatiotemporal epidemiological status of acute lymphoblastic leukemia (ALL), the most common childhood cancer, in Iran.

METHODS

Using an exploratory mixed design, this ecological study examined 3,769 under-15 children with ALL recorded in the National Cancer Registry of Iran during 2006-2014. Data were analyzed using the Mann-Whitney U test, the Getis-Ord general G (GOGG) index, optimized hot spot analysis, and Pearson correlation coefficients (PCC) at a significance level of 0.05.

RESULTS

The average annual incidence of the disease was 2.25 per 100,000 under-15 children, and the cumulative incidence rate (CIR) was 21.31 per 100,000 under-15 children. Patients’ mean age was 5.90 years (standard deviation, 3.68), and the peak incidence was observed among 2-year to 5-year-olds. No significant difference was found in mean age between boys and girls (p=0.261). The incidence of ALL was more common during spring and summer than in other seasons. The GOGG index was 0.039 and significant (p<0.001). Hot spots were identified in south, central, and eastern Iran and cold spots in the north and west of Iran. The PCC between the CIR and latitude was negative (r=-0.507; p=0.003) but that between the CIR and longitude was positive (r=0.347; p=0.055).

CONCLUSIONS

The incidence of ALL in Iranian children was lower than that observed in developed countries, but showed an increasing trend. It can be argued that the incidence of ALL is due to synergistic interactions between environmental, infectious, geographical, and genetic risk factors.

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Spatio-temporal Analysis of COVID-19: A Global Study
Sajjad Rahimi Pordanjani, Maryam Mohammadian, Somayeh Derakhshan, Fatemeh Hadavandsiri, Seyed Saeed Hashemi Nazari, Mohammad Hossein Panahi
Middle East Journal of Rehabilitation and Health Studies.2023;[Epub] CrossRef
Persistently high incidence rates of childhood acute leukemias from 2010 to 2017 in Mexico City: A population study from the MIGICCL
Janet Flores-Lujano, David Aldebarán Duarte-Rodríguez, Elva Jiménez-Hernández, Jorge Alfonso Martín-Trejo, Aldo Allende-López, José Gabriel Peñaloza-González, María Luisa Pérez-Saldivar, Aurora Medina-Sanson, José Refugio Torres-Nava, Karina Anastacia Sol
Frontiers in Public Health.2022;[Epub] CrossRef
Epidemiological characteristics and temporal-spatial analysis of overseas imported dengue fever cases in outbreak provinces of China, 2005–2019
Xinchang Lun, Yiguan Wang, Chunchun Zhao, Haixia Wu, Caiying Zhu, Delong Ma, Mingfang Xu, Jun Wang, Qiyong Liu, Lei Xu, Fengxia Meng
Infectious Diseases of Poverty.2022;[Epub] CrossRef
Temporal Trend and Spatial Distribution of Drug Poisoning in Semnan Province: A Retrospective Longitudinal Study
Masoudeh Babakhanian, Khadijeh Mamashli, Faezeh Ansariniya, Somayeh Rezaie, Hamed Azadi, Masumeh Ghazanfarpour, Sajjad Rahimi Pordanjani
Middle East Journal of Rehabilitation and Health Studies.2022;[Epub] CrossRef
Crude incidence, age-specific incidence, and standardized incidence rates of leukemia in children under 14 years of age in Iran: an updated meta-analysis

Przeglad Epidemiologiczny.2022; : 546. CrossRef

Impact of simulated cigarette excise tax increase on its consumption in Iran: Behzad Raei, Sara Emamgholipour, Amirhossein Takian, Mehdi Yaseri, Ghahreman Abdoli; Epidemiol Health. 2020;42:e2020054. Published online July 23, 2020; DOI: https://doi.org/10.4178/epih.e2020054

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Abstract

OBJECTIVES
To assess the impact of a simulated tax-induced cigarette price increase on its consumption by different expenditure clusters in Iran.

METHODS

Employing consecutive cross sections for cigarette consumption, a two-part model was applied for different expenditure groups.

RESULTS

A 75% price increase in cigarettes noticeably— as is common in some countries with strong tobacco control policies—reduces current consumption in all five social classes, causing nearly 8% of current male smokers to quit or not to start.

CONCLUSIONS

Findings of the current study suggest that Iranian policy makers go through to implement tobacco taxation policies to control smoking prevalence, which in turn might lead to a reduction in national healthcare expenditures as well as enhance the global community’s capacity to meet Sustainable Development Goals.

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The effect of price on cigarette consumption, distribution, and sale in Tehran: a qualitative study
Younes Panahi Golestan, Mohammad Ebrahimi Kalan, Ziyad Ben Taleb, Kenneth D. Ward, Mehdi Fazlzadeh, Raed Bahelah, Mohammad Reza Masjedi, Abdurrahman Charkazi, Nasir Dehghan, Shirin Shahbazi Sighaldeh
BMC Public Health.2021;[Epub] CrossRef

Changes in spirometric parameters after protective interventions among workers at a chlorine production plant in Iran: Daryoush Pahlevan, Amir Shomali, Sara Pooryahya, Kamyar Mansori, Majid Mirmohammadkhani, Farhad Malek; Epidemiol Health. 2020;42:e2020041. Published online June 6, 2020; DOI: https://doi.org/10.4178/epih.e2020041

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Abstract PDF: Abstract
OBJECTIVES
This study was conducted to assess changes in spirometric parameters after protective interventions among workers at a chlorine production plant in Semnan, Iran during 2012-2016.
METHODS
This quasi-experimental study included 100 workers at a chlorine production plant in Semnan during 2012-2016. Spirometric parameters (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], FEV1/FVC, peak expiratory flow [PEF], and PEF occurring in the middle 50% of the patient’s exhaled volume [PEF 25-75%]) were measured in all workers before the initial intervention in 2012. Protective interventions were then implemented for 4 consecutive years and the parameters were measured annually. A multivariable linear regression model was used to assess the factors affecting spirometric parameters before and after the protective interventions in SPSS version 24.
RESULTS
The mean values of all spirometric parameters significantly increased after the protective interventions (p<0.05). Multivariable linear regression showed that age (β=-0.40), body mass index (BMI) (β=0.71; 95% confidence interval [CI], 0.11 to 1.31), and type of mask (β=-7.88; 95% CI, -15.96 to -0.46) had significant effects on the mean difference in FVC. Similarly, age (β=-0.35; 95% CI, -0.70 to -0.01), BMI (β=0.80; 95% CI, 0.20 to 1.41) and type of mask (β=-8.88; 95% CI, -16.98 to -0.79) had significant associations with the mean difference in FEV1. The type of mask (β=-12.81; 95% CI, -25.01 to -0.60) had a significant effect on the mean difference in PEF.
CONCLUSIONS
All spirometric parameters significantly increased in workers after protective interventions were implemented. Therefore, protective interventions to prevent respiratory disorders in workers exposed to chlorine gas are suggested.; Summary

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Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran: Salman Khazaei, Erfan Ayubi, Ensiyeh Jenabi, Saeid Bashirian, Masud Shojaeian, Leili Tapak; Epidemiol Health. 2020;42:e2020037. Published online June 1, 2020; DOI: https://doi.org/10.4178/epih.e2020037

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Abstract PDF Supplementary Material

Abstract

Objectives
Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections.

Methods

This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models.

Results

In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females).

Conclusion

We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

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Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis
Sima Rafiei, Zahra Nejatifar, Rana Soheylirad, Samira Raoofi, Fatemeh Pashazadeh Kan, Ahmad Ghashghaee
Journal of Health Reports and Technology.2022;[Epub] CrossRef
The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran
Maryam Jabarpour, Mahlagha Dehghan, Giti Afsharipour, Elham Hajipour Abaee, Parvin Mangolian Shahrbabaki, Mehdi Ahmadinejad, Mahboobeh Maazallahi, Aseer Manilal
Canadian Journal of Infectious Diseases and Medical Microbiology.2021; 2021: 1. CrossRef
Survival rate in patients with ICU-acquired infections and its related factors in Iran’s hospitals
MEDSKorosh Etemad, Yousef Khani, Seyed-Saeed Hashemi-Nazari, Neda Izadi, Babak Eshrati, Yadollah Mehrabi
BMC Public Health.2021;[Epub] CrossRef

Oral colonization by Candida species and associated factors in HIV-infected patients in Ahvaz, southwest Iran: Elham Aboualigalehdari, Maryam Tahmasebi Birgani, Mahnaz Fatahinia, Mehran Hosseinzadeh; Epidemiol Health. 2020;42:e2020033. Published online May 24, 2020; DOI: https://doi.org/10.4178/epih.e2020033

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Abstract

Objectives
Oropharyngeal candidiasis is one of the most common opportunistic fungal infections among human immunodeficiency virus (HIV)-infected individuals. The most common cause is Candida albicans, followed by non-albicans Candida. This study aimed to identify colonized Candida species in HIV-infected patients from Ahvaz, Iran. Additionally, the relationships between immunity-related factors, lifestyle, and colonization of Candida spp. were studied.

Methods

Oral swabs were taken from 201 HIV-positive patients referred for consultations at the Behavioral Modification Center. Oral Candida colonization was detected using culture-based and molecular assays. Data were assessed by descriptive statistics and analyzed to investigate the correlation between Candida colonization and various factors, including the CD4⁺ cell count and viral load.

Results

It was found that 43.8% of patients were positive for Candida. The most common species was C. albicans (48.0%), followed by non-albicans Candida isolates, including C. dubliniensis, C. glabrata, C. tropicalis, C. parapsilosis, C. guilliermondii, C. kefyr, and C. krusei. Colonization of Candida spp. in patients was associated with a CD4 count ≤200 cells/mm³ (odds ratio [OR], 4.62; p<0.05), history of shared injections (OR, 6.96; p<0.001), and sex (OR, 3.59; p<0.05).

Conclusions

The results of this study showed that C. albicans was the dominant pathogen. The risk factors for colonization of Candida spp. were a CD4 count ≤ 200/mm³ , a history of shared injections, and sex. Other factors with potential relationships include viral load, age, and opportunistic infections, but further investigations are needed.

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Epidemiology, prevalence, and associated factors of oral candidiasis in HIV patients from southwest Iran in post-highly active antiretroviral therapy era
Maryam Erfaninejad, Ali Zarei Mahmoudabadi, Elham Maraghi, Mohammad Hashemzadeh, Mahnaz Fatahinia
Frontiers in Microbiology.2022;[Epub] CrossRef
Meyerozyma guilliermondii species complex: review of current epidemiology, antifungal resistance, and mechanisms
Reza Ghasemi, Ensieh Lotfali, Kamran Rezaei, Seyed Ataollah Madinehzad, Mahdi Falah Tafti, Nikta Aliabadi, Ebrahim Kouhsari, Mahsa Fattahi
Brazilian Journal of Microbiology.2022; 53(4): 1761. CrossRef
HIV-infected patients rarely develop invasive fungal diseases under good immune reconstitution after ART regardless high prevalence of pathogenic filamentous fungi carriage in nasopharynx/oropharynx
Xiaoman Chen, Yi Cao, Meijun Chen, Haodi Wang, Peishan Du, Hong Li, Huolin Zhong, Quanmin Li, Santao Zhao, Zhenjiang Yao, Wanshan Chen, Weiping Cai, Xiaoping Tang, Linghua Li
Frontiers in Microbiology.2022;[Epub] CrossRef
Neglected mycobiome in HIV infection: Alterations, common fungal diseases and antifungal immunity
Shuang Li, Xiaodong Yang, Christiane Moog, Hao Wu, Bin Su, Tong Zhang
Frontiers in Immunology.2022;[Epub] CrossRef
Update of the list of QPS‐recommended biological agents intentionally added to food or feed as notified to EFSA 13: suitability of taxonomic units notified to EFSA until September 2020
Kostas Koutsoumanis, Ana Allende, Avelino Alvarez‐Ordóñez, Declan Bolton, Sara Bover‐Cid, Marianne Chemaly, Robert Davies, Alessandra De Cesare, Friederike Hilbert, Roland Lindqvist, Maarten Nauta, Luisa Peixe, Giuseppe Ru, Marion Simmons, Panagiotis Skan
EFSA Journal.2021;[Epub] CrossRef
Transcription Factors of CAT1, EFG1, and BCR1 Are Effective in Persister Cells of Candida albicans-Associated HIV-Positive and Chemotherapy Patients
Elham Aboualigalehdari, Maryam Tahmasebi Birgani, Mahnaz Fatahinia, Mehran Hosseinzadeh
Frontiers in Microbiology.2021;[Epub] CrossRef

Systematic Reviews

Medication errors among Iranian emergency nurses: A systematic review: Zohreh Hosseini Marznaki, Somaye Pouy, Waliu Jawula Salisu, Amir Emami Zeydi; Epidemiol Health. 2020;42:e2020030. Published online May 13, 2020; DOI: https://doi.org/10.4178/epih.e2020030

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Abstract

OBJECTIVES
Medication errors (MEs) made by nurses are the most common errors in emergency departments (EDs). Identifying the factors responsible for MEs is crucial in designing optimal strategies for reducing such occurrences. The present study aimed to review the literature describing the prevalence and factors affecting MEs among emergency ward nurses in Iran.

METHODS

We searched electronic databases, including the Scientific Information Database, PubMed, Cochrane Library, Web of Science, Scopus, and Google Scholar, for scientific studies conducted among emergency ward nurses in Iran. The studies were restricted to full-text, peer-reviewed studies published from inception to December 2019, in the Persian and English languages, that evaluated MEs among emergency ward nurses in Iran.

RESULTS

Eight studies met the inclusion criteria. Most of the nurses (58.9%) had committed MEs only once. The overall mean rate of MEs was 46.2%, and errors made during drug administration accounted for 41.7% of MEs. The most common type of administration error was drug omission (17.8%), followed by administering drugs at the wrong time (17.5%) and at an incorrect dosage (10.6%). The lack of an adequate nursing workforce during shifts and improper nurse-patient ratios were the most critical factors affecting the occurrence of MEs by nurses.

CONCLUSIONS

Despite the increased attention on patient safety in Iran, MEs by nurses remain a significant concern in EDs. Therefore, nurse managers and policy-makers must take adequate measures to reduce the incidence of MEs and their potential negative consequences.

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Predictors of patient safety competency among emergency nurses in Iran: a cross-sectional correlational study
Aghil Habibi Soola, Mehdi Ajri-Khameslou, Alireza Mirzaei, Zahra Bahari
BMC Health Services Research.2022;[Epub] CrossRef
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Food frequency questionnaires developed and validated in Iran: a systematic review: Arezoo Rezazadeh, Nasrrin Omidvar, Katherine L. Tucker; Epidemiol Health. 2020;42:e2020015. Published online March 30, 2020; DOI: https://doi.org/10.4178/epih.e2020015

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Abstract PDF

Abstract

OBJECTIVES
To systematically review and identify food frequency questionnaires (FFQs) developed for the Iranian population and their validation and reproducibility in order to determine possible research gaps and needs.

METHODS

Studies were selected by searching for relevant keywords in the PubMed, Scopus, Science Direct, Google Scholar, SID, and Iranmedex databases, unpublished data, and theses in November 2016 (updated in September 2019). All English-language and Persian-language papers were included. Duplicates, articles with unrelated content, and articles only containing a protocol were excluded. The FFQs were categorized based on: (1) number of food items in to short (≤80 items) and long (>80 items) and; (2) the aim of the FFQ to explore total consumption pattern/nutrients (general) or to detect specific nutrient(s)/food group(s) (specialized).

RESULTS

Sixteen reasonably validated questionnaires were identified. However, only 13 presented a reproducibility assessment. Ten FFQs were categorized as general (7 long, 3 short) and 6 as specialized (3 long, 3 short). The correlation coefficients for nutrient intake between dietary records or recalls and FFQs were 0.07-0.82 for long (general: 0.07-0.82 and specialized: 0.26-0.67) and 0.20-0.67 for short (general: 0.24-0.54 and specialized: 0.20-0.42) FFQs. Long FFQs showed higher validity and reproducibility than short FFQs. Reproducibility of FFQs was acceptable (0.32-0.89). The strongest correlations were reported by studies with shorter intervals between FFQs.

CONCLUSIONS

FFQs designed for the Iranian population appear to be appropriate tools for dietary assessment. Despite their acceptable reproducibility, their validity for assessing specific nutrients and their applicability for populations other than those they were developed for may be questionable.

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The association between healthy beverage index and sarcopenic obesity among women with overweight and obesity: a cross-sectional study
Niloufar Rasaei, Rasool Ghaffarian-Ensaf, Fatemeh Gholami, Farideh Shiraseb, Alireza Khadem, Seyedeh Fatemeh Fatemi, Khadijeh Mirzaei
BMC Endocrine Disorders.2023;[Epub] CrossRef
The association between Healthy Beverage Index and psychological disorders among overweight and obese women: a cross-sectional study
Niloufar Rasaei, Rasool Ghaffarian-Ensaf, Farideh Shiraseb, Faezeh Abaj, Fatemeh Gholami, Cain C. T. Clark, Khadijeh Mirzaei
BMC Women's Health.2022;[Epub] CrossRef
Evaluating macro‐ and micronutrients and food groups intake with the risk of developing inflammatory bowel disease: Is there any association?
Farnaz Farsi, Negin Tahvilian, Azadeh Heydarian, Sara Karimi, Sara Ebrahimi, Nasser Ebrahimi‐Daryani, Sanam Tabataba‐Vakili, Javad Heshmati, Marjan Mokhtare
Food Science & Nutrition.2022; 10(11): 3920. CrossRef
The interaction between rs 3,807,992 genotypes with the dietary inflammatory index on Leptin, Leptin resistance, and Galectin 3 in obese and overweight women
Farideh Shiraseb, Mena Farazi, Niloufar Rasaei, Cain C. T. Clark, Shahin Jamili, Khadijeh Mirzaei
BMC Endocrine Disorders.2022;[Epub] CrossRef
Interaction between CETP polymorphism and dietary insulin index and load in relation to cardiovascular risk factors in diabetic adults
Faezeh Abaj, Masoumeh Rafiee, Fariba Koohdani
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Dietary Antioxidants and Risk of Parkinson's Disease in the Singapore Chinese Health Study
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Movement Disorders.2020; 35(10): 1765. CrossRef

Original Articles

Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran’s position?: Elham Khatooni, Isa Akbarzadeh, Elham Abdalmaleki, Zhaleh Abdi, Elham Ahmadnezhad; Epidemiol Health. 2019;41:e2019045. Published online October 11, 2019; DOI: https://doi.org/10.4178/epih.e2019045

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Abstract

OBJECTIVES
Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.

METHODS

This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.

RESULTS

Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.

CONCLUSIONS

Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.

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Iranian women's birth experiences: a cross-sectional study
Mona Ghobadi, Farzaneh Pazandeh, Barbara Potrata, Ehsan Kazemnejad Lili
British Journal of Midwifery.2022; 30(12): 685. CrossRef
Sanctions on Iran and their impact on child health*
Yasmin Madani-Lavassani
Medicine, Conflict and Survival.2020; 36(4): 359. CrossRef

The relationship between maternal mental health and communication skills in children in Shiraz, Iran: Najmeh Maharlouei, Hossein Alibeigi, Abbas Rezaianzadeh, Pedram Keshavarz, Hadi Raeisi Shahraki, Hamid Nemati, Kamran B. lankarani; Epidemiol Health. 2019;41:e2019035. Published online July 19, 2019; DOI: https://doi.org/10.4178/epih.e2019035

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3 Citations

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Abstract

OBJECTIVES
Child development is a significant issue in global public health, and maternal mental health (MMH) can have a remarkable effect on children’s development of communication skills. We aimed to investigate the association between MMH and communication skills in a sample of Iranian children.

METHODS

This study was conducted in Shiraz, Iran during 2016. In total, 640 mothers who lived in Shiraz and were registered in the Fars Birth Cohort (FBC) study were invited to attend the FBC clinic with their children. A trained physician evaluated MMH using the General Health Questionnaire (GHQ). Additionally, a trained nurse assessed the children’s communication development status using the Ages and Stages Questionnaire for 60-month old children.

RESULTS

The majority of the mothers were homemakers (82.8%) and had high school diplomas (38.9%). The mothers’ mean age was 33.7±4.6 years. Seventy-nine (12.3%) children had delayed communication skills, but no significant association was found between children’s communication skills and the mothers’ total GHQ score (p=0.43). In total, 493 mothers (77.0%) had abnormal somatic symptoms, 497 (77.7%) had abnormal anxiety/insomnia, 337 (52.7%) had social dysfunction, and 232 (36.3%) suffered from depression. Logistic regression indicated that after adjusting for confounders, the odds of delayed communication skills were 3-fold higher among the children of mothers with abnormal somatic symptoms than among other children (p=0.01).

CONCLUSIONS

The study results confirmed that MMH had a significant impact on children’s communication skills. Moreover, maternal abnormal somatic symptoms exerted the strongest impact on the development of communication skills in 5-yearold children.

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Prevalence and Risk Factors Associated With Self-reported Psychological Distress Among Children and Adolescents During the COVID-19 Pandemic in China
Zuguo Qin, Lei Shi, Yaqing Xue, Huang Lin, Jinchan Zhang, Pengyan Liang, Zhiwei Lu, Mengxiong Wu, Yaguang Chen, Xiao Zheng, Yi Qian, Ping Ouyang, Ruibin Zhang, Xuefeng Yi, Chichen Zhang
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Antenatal Depression Symptoms Among Pregnant Women Seeking Health Services in Erbil, Iraq
Kathryn Mishkin, Shaymaa Samir Maqsood, Hamdia Mirkhan Ahmed
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Comparing Growth and Development of Low and Normal Birth Weight Children at Age of 60 Months
Najmeh Maharlouei, Sogand Farhangian, Hadi Raeisi Shahraki, Abbas Rezaianzadeh, Kamran Bagheri Lankarani
Shiraz E-Medical Journal.2020;[Epub] CrossRef

Severe complications of tramadol overdose in Iran: Paria Habibollahi, Alireza Garjani, Samad Shams Vahdati, Seyyed-Reza Sadat-Ebrahimi, Neda Parnianfard; Epidemiol Health. 2019;41:e2019026. Published online June 16, 2019; DOI: https://doi.org/10.4178/epih.e2019026

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8 Citations

Abstract PDF

Abstract

OBJECTIVES
Severe complications of tramadol overdose have been reported; however, few large-scale studies have investigated this issue. Therefore, this study aimed to explore the presentation and complications of tramadol overdose in patients admitted to an intoxication referral center in northwestern Iran.

METHODS

Patients with tramadol overdose admitted to Sina Teaching Hospital in Tabriz, Iran during 2013-2017 were included. For each patient, the following data were collected: demographics, previous drug or medication overdose, whether the patient was in the process of quitting drug use, ingested dose of tramadol and co-ingestants, Glasgow Coma Scale (GCS) score, clinical symptoms at the time of admission, and admission characteristics. Serotonin toxicity was diagnosed in patients who fit the Hunter criteria. Multiple logistic regression was performed to identify variables associated with the incidence of severe complications of tramadol overdose.

RESULTS

In total, 512 cases of tramadol overdose were evaluated, of which 359 patients were included, with a median age of 41 years (range, 16-69) and a median tramadol dose of 1,500 mg (range, 500-4,000). The most frequent complications associated with tramadol overdose were hypertension (38.4%), tachycardia (24.8%), and seizure (14.5%). No serotonin toxicity was detected in patients. Having a GCS score <15, having taken a tramadol dose of >1,000 mg, being in the process of quitting drug use, being 30-49 years old, and male sex were significantly related to the incidence of severe complications of tramadol overdose.

CONCLUSIONS

Although seizure was prevalent among Iranian patients with tramadol poisoning, serotonin toxicity and cardiogenic shock were rare findings.

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Tramadol Abuse-associated Seizure: An Epidemiological and Electroencephalographic Study
Farhad Iranmanesh, Hamide Arvan, Habibeh Ahmadipour, Faranak Gadari, Hussien Barzegar, Mahdiyeh Khazaneha
International Journal of High Risk Behaviors and Addiction.2023;[Epub] CrossRef
Increase of high‐risk tramadol use and harmful consequences in France from 2013 to 2018: Evidence from the triangulation of addictovigilance data
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British Journal of Clinical Pharmacology.2022; 88(8): 3789. CrossRef
Determination of Tramadol and Fluoxetine in Biological and Water Samples by Magnetic Dispersive Solid-Phase Microextraction (MDSPME) with Gas Chromatography – Mass Spectrometry (GC-MS)
Banafsheh Sefaty, Mahboubeh Masrournia, Zarrin Es’haghi, Mohammad Reza Bozorgmehr
Analytical Letters.2021; 54(5): 884. CrossRef
Machine learning algorithms to predict seizure due to acute tramadol poisoning
B Behnoush, E Bazmi, SH Nazari, S Khodakarim, MA Looha, H Soori
Human & Experimental Toxicology.2021; 40(8): 1225. CrossRef
Factors Associated with Tramadol Abuse: A Cross-Sectional Study Among Commercial Drivers and Assistants in the Accra Metropolitan Area of Ghana
Mavis Danso, Francis Anto
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Evaluation of mitochondrial dysfunction due to oxidative stress in therapeutic, toxic and lethal concentrations of tramadol
Leila Mohammadnejad, Kambiz Soltaninejad, Mohammad Seyedabadi, Seyed Khosro Ghasem Pouri, Mohammad Shokrzadeh, Hamidreza Mohammadi
Toxicology Research.2021; 10(6): 1162. CrossRef
Rapport de cas d’un choc cardiogénique et syndrome sérotoninergique sur une synergie entre tramadol et venlafaxine
G. Barthélemy, D. Gusu, D. Glorieux
Journal Européen des Urgences et de Réanimation.2021; 33(4): 201. CrossRef
Drug utilization review of tramadol hydrochloride in a regional hospital in South Africa; findings and implications
Akhona Fynn, Elvera Helberg, Brian Godman, Johanna C Meyer
Hospital Practice.2020; 48(2): 92. CrossRef

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