Hepatitis B vaccination coverage among Iranian children aged 15-26 months in 2006

This study in 2006 estimated the hepatitis B virus (HBV) vaccination coverage in the Islamic Republic of Iran at the national and district levels in urban, rural and remote populations of 41 university health service areas. Of 21 905 children recruited to the study, vaccination coverage based on vaccination card records was 100% in 14, 15 and 10 of the 41 university areas for the 1st, 2nd and 3rd doses of HBV respectively. National levels of HBV1, HBV2 and HBV3 coverage were 98.9%, 98.8% and 98.4% respectively. The lowest HBV vaccination coverage rate was 90.7% (in a remote district). HBV vaccination coverage was at an acceptable level in Iranian children

Relationship between occurrence of Guillain-Barre syndrome and mass campaign of measles and rubella immunization in Iranian 5-14 years old children

Background: Case reports and epidemiologic studies have reported a relation between different vaccines including measles, rubella, mumps and Guillain-Barre syndrome (GBS). In this study we investigated relation between receiving measles and/or rubella vaccines and occurrence of GBS after national immunization campaign in 2003 in Iran. Materials and methods: We used the national surveillance system for acute flaccid paralysis from the beginning of 2002 to the end of 2004 and studied the incidence of GBS disease among 5-14-year-old children. The 3-year time span of the study was divided into fifteen 10 weeks intervals and the number of reported and confirmed GBS case reports in each time period was analyzed supposing their distribution was according to Poisson distribution. Results: From 2002 through 2004 there were 370 patients confirmed GBS case reports among persons 5-14 years of age. The annual incidence in this age group remained relatively constant over the 3-year period and ranged from 0.65 per 100,000 population in 2004 to 0.76 in 2003. The estimated average annual incidence of GBS in persons <15 years of age was 1/100,000 (CI 95%: 0.88-1.13), and 0.7/100,000 in persons 5-14 years of age (CI 95%: 0.58-0.83). No obvious seasonal pattern in GBS occurrence was observed. The mean number of GBS patients during each 10 week study interval was 23.8. Twenty-five patients with GBS were reported in the time period which coincided with national immunization campaign. The probability of occurring ≥25 cases of GBS in that time period according to Poison distribution with expected case numbers of 23-8 is equal to 0.43 (p = 0.43). Conclusion: The yearly incidence rate of GBS in this study was similar to other studies. According to our results, there was no increase in GBS Incidence in the 4 weeks national Immunization campaign and 6 weeks after it in comparison to other 10 weeks periods before or after this time period. © 2008 Elsevier Ltd. All rights reserved

Cost-effectiveness of rotavirus vaccination for under-five children in Iran

Background: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. Objectives: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. Patients and Methods: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran�s ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98 coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. Results: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. Conclusions: Assuming that the illness episodes are 100 and 300 for Rotarix and 300 for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested. © 2015, Growth & Development Research Center

The Pooled Cut-off Point of Waist Circumference as Core Component of Metabolic Syndrome Diagnosis among the Iranian Population; a Systematic Review and Meta-Analysis

Introduction: According to a nationwide study, one-third of the Iranian population suffer from metabolic syndrome (MetS). The most controversial criteria for the diagnosis of MetS is central obesity which would be defined by waist circumference (WC) and needed to be gender and ethnic-specific. There are several national studies that reported different cut-offs for WC so the present study aimed to do a systematic review and meta-analysis to achieve an overall statistical estimate of WC for the Iranian population. Method: A comprehensive search was conducted in international databases from inception to June 2020. The search keywords were waist circumference AND metabolic syndrome AND cut AND Iran. We used the QUADAS-2 tool for quality assessment and the HSROC model for estimating pooled specificity, sensitivity, and the cut-off point from included studies in R software. Results: A total of 3571 studies were evaluated and 24 studies fulfilled the inclusion criteria. Finally, 8 studies were included. All the studies were cross-sectional. Studies with missing MetS prevalence were excluded. Most of the studies had an unclear risk of bias in patient selection. There was a wide variation among reported cut-offs for WC from national and original studies. The Pooled cut-off points of WC for the diagnosis of MetS was 90.55 cm (95%CI: 90.51-90.60) in men and 89.24 cm (95%CI: 89.13-89.36) in women. The pooled sensitivity and specificity in men were 0.67 and 0.68, respectively and the pooled sensitivity and specificity in women were 0.61 and 0.57, respectively. Conclusion:&nbsp; Our results were highly consistent with the only national study and the only consensus about WC cut-off. Further nationwide studies are suggested to be involved in a Mata-analysis for calculating more precise WC cut-off

Early insulin glargine initiation in iranian people with uncontrolled type 2 diabetes: Glycemic control, and adverse events

To explore glycemic control, and adverse events of Iranian people with uncontrolled type 2 diabetes after initiation of long-acting basal insulin, glargine. People with uncontrolled type 2 diabetes that was on at least two oral anti-diabetic drugs (OAD) were enrolled in this observational prospective study. Insulin glargine was prescribed by physicians in the course of routine clinical practice. Patients were followed for 24 weeks. Insulin doses were titrated to reach fasting blood sugar (FBS) target between 90 mg/dl and 130 mg/dl. HbA1c and adverse events were recorded at baseline, week 12, and week 24. Form a total of 292 participants, 243 patients completed the study. HbA1c, FBS, postprandial glucose, total cholesterol, triglycerides, and low-density lipoprotein cholesterol, but not body mass index decreased during the study. The proportion of poorly controlled patients (HbA1C>9) decreased from 172 (58.9) to 39(13.4), and 21(7.2) during follow up. Controlled glycemia (HbA1C<7) was detected in 7(2.4), 48 (16.4) and 56 (19.2) of patients at baseline, week 12 and week 24. Hypoglycemia was reported in 5.1 and 3.4 of the participants in the week at 12 and 24, respectively. Patients felt more satisfied with their blood glucose control, timing and choices of meals, and hypo/hyperglycemic experiences. Insulin glargine initiation in people with uncontrolled type 2 diabetes on 2 OADs is associated with significant improvement in metabolic control. Insulin glargine has good safety profile and well tolerated by the patients. © 2018 Tehran University of Medical Sciences. All rights reserved

Prevalence of diabetes and other cardiovascular risk factors in an Iranian population with acute coronary syndrome

BACKGROUND: Coronary artery disease is the leading cause of death in industrialized countries and most patients with diabetes die from complications of atherosclerosis. The objective of this study was to determine the presence of diabetes mellitus and other conventional coronary heart disease risk factors (cigarette smoking, hypertension and hyperlipidemia) in patients with acute coronary events in an Iranian population. METHODS: The study included 514 patients with unstable angina or myocardial infarction (MI) out of 720 patients admitted to CCU ward of a general hospital from March 2003 to March 2005. History of diabetes, hypertension and cigarette smoking, demographic indices, coronary heart disease and diabetes mellitus treatment, myocardial enzymes, serum triglycerides (TG) and cholesterol and fasting and non fasting blood glucose levels and HbA1C of diabetics were recorded of admission sheets. The data were structured to appropriate one way ANOVA, T tests, and chi square test with SPSS 13 product for windows. RESULTS: Out of all patients 35.8% were female, 30% were diabetics (Duration 13.4 ± 8.7 years), 42% were smoker and 91% were hypertensive. Twenty four percent had MI and 76% had unstable angina. MI was significantly higher in diabetic patients (36.4% vs. 19.2%, P < 0.001). Location and extension of MI and myocardial enzymes did not differ between diabetics and non-diabetic patients. Diabetic patients were older than non diabetics (65 ± 11.6 vs. 59.7 ± 12.5 years, p < 0.05). Five (66.7%) out of 9 patients with fatal MI were diabetics (Odds Ratio = 2.98). Age, duration of diabetes and HbA1c levels, did not differ between diabetic patients with or without MI. Hypertension and current smoking was significantly higher in patients with MI compared to patients with unstable angina (p < 0.05). Serum TG, HDL-C, LDL-C and total cholesterol level did not differ between patients with MI and unstable angina. Diabetic patients compare to non diabetic patients were more hypertensive (96% vs. 88.7%, p < 0.005) and had higher serum triglyceride (TG over 200 mg/dl, 35.1% vs. 26.4, p <0.05). Diabetes was more frequent among women than men (36.4% vs. 26.4%, p < 0.05). Women were older than men (65 ± 11.6 vs. 59.2 ± 13 years, p < 0.005) and had higher total serum cholesterol (200 ± 41.8 vs. 192 ± 42.5 mg/dl, p < 0.05) and HDL-C levels (49.7 ± 22 vs. 40 ± 13 mg/dl, p < 0.005). Ninety seven percent of all patients had at least one of cardiovascular risk factors (hypertension, smoking, diabetes, high cholesterol and low HDL-cholesterol levels). CONCLUSION: In this study 19 out of 20 patients with acute coronary event have at least one of conventional cardiac risk factors. Diabetes and hypertension are leading risk factors, which may directly or indirectly interfere and predict more serious complications of coronary heart disease

An efficient stratified-based ground motion selection for cloud analysis

In the quantitative seismic risk assessment of structures, cloud analysis has been widely used due to its simplicity to obtain the conditional probability of structural response exceeding a certain level, conditioned on the ground motion intensity. The accuracy of this analysis relies on the selected ground motion records in terms of seismic hazard levels and the number of records. This paper presents an adaptive ground motion selection approach with a stratified sampling scheme to reduce the number of required analysis and to accurately capture structural response with a desired level of confidence. The stratified sampling scheme is used to obtain enough data points from each hazard level in an iteration fashion, while the formulation of the seismic demand model of interest is determined using a Gaussian mixed model clustering algorithm at each iteration. The proposed ground motion selection approach is applied to obtain seismic demand hazards of a non-linear single-degree-of-freedom system and the results are compared to a site-consistent model. The results show that the proposed selection method is efficient, particularly at near collapse limit states

Physical Inactivity Is Correlated with Levels of Quantitative C-reactive Protein in Serum, Independent of Obesity: Results of the National Surveillance of Risk Factors of Non-communicable Diseases in Iran

Increased C-reactive protein (CRP) levels are associated with coronary heart disease, stroke, and mortality. Physical activity prevents cardiovascular disorders, which can be partly mediated through reducing inflammation, including serum CRP levels. The association of different intensities of physical activity, sedentary behaviours, and C-reactive protein (CRP) levels in serum was examined after adjustment for markers of adiposity, including waist-circumference and body mass index (BMI), in a large population-based study. Using data of the SuRFNCD-2007 study, a large national representative population-based study in Iran, the relationship between quantitative CRP concentrations in serum and physical activity was examined in a sample of 3,001 Iranian adults. The global physical activity questionnaire (GPAQ) was used for evaluating the duration and intensity of physical activity. Total physical activity (TPA) was calculated using metabolic equivalents for the intensity of physical activity. Quantitative CRP concentrations in serum were measured with high-sensitivity enzyme immunoassay. The CRP levels in serum significantly correlated with TPA (r=-0.103, p=0.021 in men and r=-0.114, p=0.017 in women), duration of vigorous-intensity activity (r=-0.122, p=0.019 in men and r=-0.109, p=0.026 in women), duration of moderate-intensity activity (r=-0.107, p=0.031 in men and r=-0.118, p=0.020 in women), and duration of sedentary behaviours (r=0.092, p=0.029 in men and r=0.101, p=0.022 in women) after multiple adjustments for age, area of residence, BMI, waist-circumference, smoking, and diabetes mellitus. Physical activity (of both moderate and vigorous intensity) is inversely associated with the quantitative CRP levels in serum, independent of diabetes and body adiposity

Temporal analysis of the incidence of meningitis in the Tehran metropolitan area, 1999-2005

<p>Abstract</p> <p>Objectives</p> <p>The aim of this study was to describe the temporal determinants of meningitis incidence in the population living in the Tehran metropolis.</p> <p>Methods</p> <p>All cases of meningitis reported to health districts throughout the Tehran metropolis from 1999 to 2005 were abstracted from patient files. Referral cases (patients who did not reside in the Tehran metropolis) were excluded. For each year, sex- and age-specific incidences were estimated. Temporality and its determinants were analyzed using Poisson regression.</p> <p>Results</p> <p>Age-specific incidence is highest among males younger than 5 years of age at 10.2 cases per 100,000 population per year. The lowest incidence was among females aged 30 to 40 years at 0.72 cases per 100,000 population per year, with an overall male-to-female incidence ratio of 2.1. The temporal analysis showed seasonality, with a higher risk of meningitis in spring at a rate ratio of 1.31 with a 95% confidence interval (CI) of 1.20 to 1.41 and in autumn (rate ratio = 1.16, 95% CI 1.06, 1.27). For periodicity, we found a peak of occurrence around the years 2000 and 2003.</p> <p>Conclusion</p> <p>The epidemiology of meningitis in Iran follows similar patterns of age, sex, and seasonality distribution as found in other countries and populations.</p