Pattern of contributing behaviors and their determinants among people living with HIV in Iran: A 30-year nationwide study

Introduction: A major shift in the routes of HIV transmission seams to be taking place in Iran. Our study aimed to investigate the 30-year trend of major HIV related behaviors in Iran. Methods: The national HIV/AIDS registry database (from September 1986 to July 2016 with data on 32,168 people newly diagnosed with HIV) was used to study the 30 years trend and demographic determinants of major HIV related behaviors. Results: The highest rate of drug injection (DI) among people living with HIV (PLHIV) was reported during 1996 to 1999 (p-for trend < 0.001) while the highest rate of sexual activity by minorities or hard to reach groups was during 2004 to 2011 (p-for trend < 0.001). Among males, drug injection was directly associated with being single (ORsingle/married = 1.34), being unemployed (ORunemployed/employed = 1.94) and having lower level of education (OR<highschool/≥highschool = 2.21). Regarding females, drug injection was associated with being housewife (ORhousewife/employed = 1.35) and lower level of education (OR<highschool/≥highschool = 1.85). In females, condomless sexual contact was more common among those younger (OR20−29/<20 = 6.15), and married (ORmarried/single = 7.76). However, among males those being single (ORmarried/single = 0.82), being more educated (OR≥highschool/<highschool = 1.24), and being unemployed (ORunemployed/employed = 1.53) reported more sexual activity by minoritised or hard to reach groups. Discussion: The pattern of major HIV related behaviors among Iranian males and females have been rapidly changing and people living with HIV (PLHIV) are being diagnosed at a younger age. Health education to younger individuals is an essential HIV controlling strategy among Iranian population. Implementation of surveys in hidden and hard-to-reach populations is also recommended. Copyright © 2023 Gheibi, Fararouei, Afrashteh, Akbari, Afsar Kazerooni and Shokoohi

Bone mineral density status in patients with recent-onset rheumatoid arthritis

Background: Osteoporosis is a sizable comorbidity complication in Rheumatoid Arthritis (RA) sufferers. In the current study, the prevalence of osteopenia and osteoporosis in active RA sufferers and the association of disease-related factors of osteoporosis and reduced bone mineral density (BMD) have been examined. Methods: In this cross-sectional study, 300 new-onset symptoms (less than one year) RA patients without a history of glucocorticoids or DMARDs were selected. Biochemical blood measurements and BMD status were performed with dual-energy X-ray absorptiometry. According to the T-scores of the patients, they were divided into three groups: osteoporosis<-2.5, -2.5 < osteopenia <-1, and − 1 < normal. Also, the MDHAQ questionnaire, DAS-28, and FRAX criteria were calculated for all patients. Multivariate logistic regression was used to determine the associated factors of osteoporosis and osteopenia. Results: The Prevalence of osteoporosis and osteopenia was 27% (95%CI:22–32) and 45% (95%CI:39–51), respectively. The multivariate regression analysis showed that age could play a role as an associated factor for spine/hip Osteoporosis and Osteopenia. The female gender is also a predictor of Spine osteopenia Patients with Total hip Osteoporosis were more likely to have higher DAS-28 (OR 1.86, CI 1.16–3.14) and positive CRP (OR 11.42, CI 2.65–63.26). Conclusion: recent-onset RA patients are at risk for osteoporosis and its complications, regardless of using glucocorticoids or DMARDs. Demographic factors (e.g. age and female gender), patients’ MDHAQ scores, and disease-related factors(e.g., DAS-28, positive CRP were associated with reduced BMD levels. Therefore, it is recommended that clinicians investigate early BMD measurements to have a reasonable judgment for further interventions. © 2023, The Author(s), under exclusive licence to Tehran University of Medical Sciences

Estimation of the wastage rate of MMR and pentavalent vaccines in open and closed vials in three western provinces of Iran

Background: Vaccine wastage is one of quality indicators of immunization program and high vaccine wastage will increase overall costs and impede efforts towards a more efficient and sustainable program. We aimed at estimating of the wastage rates of Measles-Mumps-Rubella (MMR) and pentavalent (diphtheria-tetanus-pertussis-hepatitis B -Haemophilus influenza type b) vaccines in different vaccine vial sizes. Study design: Multicentre descriptive study using existing data. Methods: This study was in three provinces (Hamadan, Kermanshah and Kordestan) of Iran including 131,135 populations with 2,548 under-1years children. Twenty-seven health facilities were selected randomly from nine districts in three provinces of western part of Iran. Six-months data including vaccination and vaccine stock records collected from April to September 2017. Finally, number of opened vials and number of target population vaccinated were collected and data were analysed to estimate the wastage rates in both unopened and opened vials of both antigens. Results: The wastage rate for combined MMR 2-dose and 5-dose opened vials for three provinces was 29%(Hamadan 18%, Kermanshah 14% and Kordestan 52%). The wastage rate for combined pentavalent single-dose and 10-dose vials for three provinces was 17% (in Kordestan33%, 11% Kermanshah 11% and Hamedan 3%). The total average of pentavalent single-dose and 10-dose vials wastage rate was 5% and varied 13% for urban and 3% for rural areas. The average of discarded unopened vials wastage rate in all facilities for MMR was 3.9% (3.2% for MMR 2-dose vial and 10.2% for MMR 5-dose vial). This rate was 1.7% for pentavalent total (1.9% for single dose vial and 0.4% for 10 dose vial). Conclusion: The vaccine wastage rates in Iran are in line with other countries and lower than the suggested rate based on WHO policies for multi-dose vials. The wastage rates were different for in provinces, districts and health facilities. The MMR total wastage rate in rural is higher than those in urban areas. However, the pentavalent total wastage rate was higher in urban area

Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program

Background and objectives Multimorbidity, defined as the presence of two or more long-term health conditions in an individual, is one of the most significant challenges facing health systems worldwide. This study aimed to identify determinants of classes of multimorbidity among older adults in Iran. Research Design and methods In a cross-sectional sample of older adults (aged ≥ 60 years) from the second stage of the Bushehr Elderly Health (BEH) program in southern Iran, latent class analysis (LCA) was used to identify patterns of multimorbidity. Multinomial logistic regression was conducted to investigate factors associated with each multimorbidity class, including age, gender, education, household income, physical activity, smoking status, and polypharmacy. Results In 2,426 study participants (mean age 69 years, 52% female), the overall prevalence of multimorbidity was 80.2%. Among those with multimorbidity, 3 latent classes were identified. These comprised: class 1, individuals with a low burden of multisystem disease (56.9%); class 2, individuals with predominantly cardiovascular-metabolic disorders (25.8%) and class 3, individuals with predominantly cognitive and metabolic disorders (17.1%). Compared with men, women were more likely to belong to class 2 (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.52–2.54) and class 3 (OR 4.52, 95% CI 3.22–6.35). Polypharmacy was associated with membership class 2 (OR 3.52, 95% CI: 2.65–4.68) and class 3 (OR 1.84, 95% CI 1.28–2.63). Smoking was associated with membership in class 3 (OR 1.44, 95% CI 1.01–2.08). Individuals with higher education levels (59%) and higher levels of physical activity (39%) were less likely to belong to class 3 (OR 0.41; 95% CI: 0.28–0.62) and to class 2 (OR 0.61; 95% CI: 0.38–0.97), respectively. Those at older age were less likely to belong to class 2 (OR 0.95). Discussion and implications A large proportion of older adults in Iran have multimorbidity. Female sex, polypharmacy, sedentary lifestyle, and poor education levels were associated with cardiovascular-metabolic multimorbidity and cognitive and metabolic multimorbidity. A greater understanding of the determinants of multimorbidity may lead to strategies to prevent its development

Food insecurity status and its contributing factors in slums’ dwellers of southwest Iran, 2021: a cross-sectional study

Background: One major factor causing food insecurity is believed to be poverty. Approximately 20 million Iranians live in slums with a vulnerable socioeconomic context. The outbreak of COVID-19, on top of the economic sanctions against Iran, has increased this vulnerability and made its inhabitants prone to food insecurity. The current study investigates food insecurity and its associated socioeconomic factors among slum residents of Shiraz, southwest Iran. Methods: Random cluster sampling was used to select the participants in this cross-sectional study. The heads of the households completed the validated Household Food Insecurity Access Scale questionnaire to assess food insecurity. Univariate analysis was utilized to calculate the unadjusted associations between the study variables. Moreover, a multiple logistic regression model was employed to determine the adjusted association of each independent variable with the food insecurity risk. Results: Among the 1227 households, the prevalence of food insecurity was 87.20%, with 53.87% experiencing moderate and 33.33% experiencing severe food insecurity. A significant relationship was observed between socioeconomic status and food insecurity, indicating that people with low socioeconomic status are more prone to food insecurity (P < 0.001). Conclusions: The current study revealed that food insecurity is highly prevalent in slum areas of southwest Iran. The socioeconomic status of households was the most important determinant of food insecurity among them. Noticeably, the coincidence of the COVID-19 pandemic with the economic crisis in Iran has amplified the poverty and food insecurity cycle. Hence, the government should consider equity-based interventions to reduce poverty and its related outcomes on food security. Furthermore, NGOs, charities, and governmental organizations should focus on local community-oriented programs to make basic food baskets available for the most vulnerable households

Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study

One of the reasons for high mortality of breast cancer (BC) is long delay in seeking medical care and end stage at presentation. This study was designed to measure the association between a wide range of socio-demographic and clinical factors with diagnostic delay in BC and stage at presentation among Iranian patients. From June 2017 to December 2019, 725 patients with newly diagnosed BC in Shiraz and Kermanshah were selected and information on BC diagnosis delay was obtained from the patient's medical record. Data on socio-economic status was obtained via a structured interview. Our findings suggest that 45.8 of the patients were diagnosed at a late stage (stage 3 or higher). A total of 244 (34) patients had more than 3 months delay in diagnosis. We found a significant association between stage at diagnosis and place of residence (adjusted odds ratio (aOR rural vs. urban = 1.69, 95 CI 1.49-1.97), marital status (aOR 1.61, 95 CI 1.42-1.88), family history of BC (aOR 1.46, 95 CI 1.01-2.13), and history of benign breast disease (BBD) (aOR 1.94, 95 CI 1.39-2.72) or unaware of breast self-examination (BSE) (aOR 1.42, 95 CI 1.42-1.85), delay time (aOR 3.25, 95 CI 1.04-5.21), and left breast tumor (aOR right vs. left 2.64, 95 CI 1.88-3.71) and smoking (aOR no vs. yes 1.59, 95 CI 1.36-1.97). Also, delay in diagnosis was associated with age, family income, health insurance, place of residence, marital status, menopausal status, history of BBD, awareness of breast self-examination, type of first symptoms, tumor histology type, BMI and comorbidity (p < 0.05 for all). Factors including history of BBD, awareness of BSE, and suffering from chronic diseases were factors associated with both delay in diagnosis and end stage of disease. These mainly modifiable factors are associated with the progression of the disease

Identifying the Components of Effective Learning Environments Based on Health Students\' Perception

Aims: Effective learning environment can lead to establish and strengthen the appropriate conditions of learning in higher education. This study aimed to identify and define the factors associated with effective learning environment in the field of health education. Participants & Methods: This qualitative study with content analysis approach was conducted in 2013. Participants were 9 graduate and 7 undergraduate students of health majors that were selected using purposive sampling method. Data were recorded by interview and were analyzed using qualitative content analysis. Findings: Analysis of the data revealed 4 themes and 13 classes active and interactive teaching (participating viewpoints of students in educational planning, engaging students in class discussions, providing practical examples to understand the content, relaxing about expressed thoughts, the possibility of constructive criticism master plan of activities and according to the conditions and individual differences between students), Joyful atmosphere (academic motivation, the joy of learning and attendance, a sense of acceptance and respect from teachers and classroom dynamics and vitality and fatigue), relation of courses with professional needs (knowledge of the needs of the job in training course content and related training to the needs of job opportunities) and professors&rsquo; scientific and power and expert (expertise and scientific capabilities in the field of teaching). Conclusion: 4 major themes and their characteristics can help to organize the learning environment in medical education

Low birth weight incidence in newborn' neonate in Qom, Iran: Risk factors and complications

Background: Low birth weight (LBW) is related with high morbidity of neonatal consequences and death. This study aimed to determine the incidence of LBW, its risk factors, and complications in born neonates in Qom, Iran 2017. Methods: This retrospective chart review was conducted with 602 newborns participants who were one of Qom hospitals in Iran. Data were extracted from the patients' medical records and entered into data collection sheet and were analyzed by t-test, Chi-square, Fisher exact, and independent t-tests in SPSS v. 18 software. Results: The overall incidence of LBW in born neonates was 9.6%, and the mean of maternal age was 28.8 years. Based on results, twin's birth (Odds ratio [OR] = 1.47), receiving corticosteroid (OR = 4.55), and premature rupture of membrane (PROM) (OR = 1.08) were the most important related factors of LBW and respiratory distress syndrome (RDS) (OR = 6.47.8), sepsis (OR = 5.36), and icterus (OR = 5.8) consequences of LBW. Nevertheless, poor feeding, hypoplasia, premature, tachypnea, meconium, intraventricular hemorrhage, hypotonic, and other neonatal complications do not show the significant relationship with LBW (P > 0.05). Conclusions: According to results, twin's births, receiving corticosteroid, and PROM are the important risk factors for LBW and RDS, sepsis and icterus were the most common complication of LBW. As a result, preventive programs for control of LBW and infant complications are essential

Diabetic peripheral neuropathy screening and the related risk factors to its prevalence in people with type 2 diabetes

Background: Diabetes peripheral neuropathy commonly occurs among people with diabetes, accounting for a large portion of diabetes care cost. Early recognition and appropriate management of neuropathy in patients can help to improve symptoms, reduce sequelae, and increase the quality of life and preventive foot care. Due to the importance of timely detection of complications of diabetes, the present study was performed to screen patients and to identify neuropathy and factors affecting its development. Methods: The current study is a cross-sectional study conducted on 453 type 2 diabetes patients. To select participants, we used a multistage random sampling method. The participants were examined by physician in terms of signs of DPN and other complications. Results: The prevalence rate of DPN was 26.2%, of which 41.3% was in the high-risk group in terms of diabetic foot ulcer. Also, diabetic foot ulcers were diagnosed in 9.2% of them. On the other hand, in patients without DPN, 3.5% had diabetic foot ulcers. Of note, 79.8% of the patients with DPN were previously undiagnosed. In addition, age, duration of diabetes, HbA1c, hyperlipidemia, and hypertension were associated with prevalence of DPN. Conclusion: Despite the relatively low prevalence of neuropathy in this study, more than 79% of them were previously undiagnosed, indicating the importance of annual screening. On the other hand, delay in diagnosis of DPN can cause further harm to patients. Also, we can use changeable risk factors as treatment strategies for DPN