Patients� experience of tuberculosis treatment using directly observed treatment, short-course (DOTS): A qualitative study

Background: Despite effective diagnosis and treatment, prevalence of tuberculosis (TB) is still growing. The directly observed treatment, short-course (DOTS) strategy to treat TB was introduced by the World Health Organization more than a decade ago. Little is known about patients� experience of TB treatment, according to DOTS, in Iran. Objectives: This study aimed to understand the patients� experience of tuberculosis treatment according to DOTS in Iran. Patients and Methods: This study is a qualitative study, using content analysis to examine patients� experience of TB treatment and to understand their compliance during DOTS. In this study, a semi-structured interview with open questions was answered by 40 patients, who had a diagnosis of pulmonary and extrapulmonary tuberculosis, and improved during the course of their treatment. The method of sampling was purposive sample and the interview process lasted until data saturation. Results: Data analysis resulted in the extraction of six themes, which reflect the experiences of the study participants. The themes are: 1) individual factors; 2) change of the attitudes and beliefs of patients on TB treatment; 3) support terms of patients with tuberculosis; 4) the role of health care professionals; 5) social factors and 6) the financial burden. Conclusions: Successful completion of TB treatment requires an effective partnership between the patient and health care professionals, and a harmony between the cultural context, attitude of the patient, family support and health literacy. Future health policies should address these issues to improve patients� adherence to DOTS. © 2015, Iranian Red Crescent Medical Journal

Patients� experience of tuberculosis treatment using directly observed treatment, short-course (DOTS): A qualitative study

Background: Despite effective diagnosis and treatment, prevalence of tuberculosis (TB) is still growing. The directly observed treatment, short-course (DOTS) strategy to treat TB was introduced by the World Health Organization more than a decade ago. Little is known about patients� experience of TB treatment, according to DOTS, in Iran. Objectives: This study aimed to understand the patients� experience of tuberculosis treatment according to DOTS in Iran. Patients and Methods: This study is a qualitative study, using content analysis to examine patients� experience of TB treatment and to understand their compliance during DOTS. In this study, a semi-structured interview with open questions was answered by 40 patients, who had a diagnosis of pulmonary and extrapulmonary tuberculosis, and improved during the course of their treatment. The method of sampling was purposive sample and the interview process lasted until data saturation. Results: Data analysis resulted in the extraction of six themes, which reflect the experiences of the study participants. The themes are: 1) individual factors; 2) change of the attitudes and beliefs of patients on TB treatment; 3) support terms of patients with tuberculosis; 4) the role of health care professionals; 5) social factors and 6) the financial burden. Conclusions: Successful completion of TB treatment requires an effective partnership between the patient and health care professionals, and a harmony between the cultural context, attitude of the patient, family support and health literacy. Future health policies should address these issues to improve patients� adherence to DOTS. © 2015, Iranian Red Crescent Medical Journal

A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran

Background: Hepatitis C virus (HCV) infection is one of the major public health challenges generating a relevant burden. High-risk groups, including people who inject drugs (PWID), are at serious risk for developing HCV. In recent years, several investigations have been conducted in Iran to assess the prevalence e of HCV among PWID. The aim of the present study was to synthesize the literature performing a comprehensive search and meta-analysis. Methods: A comprehensive literature search was carried out from January 2000 to September 2019. Several international databases, namely Scopus, PubMed/MEDLINE, Embase, ISI/Web of Science, PsycINFO, CINAHL, the Cochrane Library and the Directory of Open Access Journals (DOAJ), as well as Iranian databases (Barakathns, SID and MagIran), were consulted. Eligible studies were identified according to the following PECOS (population, exposure, comparison/comparator, outcome and study type) criteria: i) population: Iranian population; ii) exposure: injection drug users; iii) comparison/comparator: type of substance injected and level of substance use, iv) outcome: HCV prevalence; and v) study type: cross-sectional study. After finding potentially related studies, authors extracted relevant data and information based on an ad hoc Excel spreadsheet. Extracted data included the surname of the first author, the study journal, the year of publication, the number of participants examined, the type of diagnostic test performed, the number of positive HCV patients, the number of participants stratified by gender, the reported prevalence, the duration of drug injection practice and the history of using a shared syringe. Results: Forty-two studies were included. 15,072 PWID were assessed for determining the prevalence of HCV. The overall prevalence of HCV among PWID in Iran was computed to be 47 (CI 95: 39-56). The prevalence ranged between 7 and 96. Men and subjects using a common/shared syringe were 1.46 and 3.95 times more likely to be at risk, respectively. Conclusion: The findings of the present study showed that the prevalence of HCV among PWIDs in Iran is high. The support and implementation of ad hoc health-related policies and programs that reduce this should be put into action. © 2020 The Author(s)

Current and former smokers among adolescents aged 12-17 years in Iran: A systematic review and meta-analysis

Background: Smoking, especially among adolescents, is considered a serious public health concern worldwide being associated with increased mortality. The present study was designed as the first systematic review and meta-analysis of the prevalence of current and former smoking behavior among adolescents in Iran. Methods: Seven international scholarly databases, namely Scopus, Embase, Pubmed/Medline, ISI/Web of Science (WOS), the Cochrane Library, Psyc Info and Cinahl, were extensively searched from January 2000 to September 18, 2019. Google Scholar was also mined. Iranian databases were searched as well (namely, MagIran, Scientific Information Database (SID), and Barakatkns). The DerSimonian-Laird's approach, via the Freeman-Tukey double arcsine method, was used to synthesize the prevalence estimates. Results: The prevalence of current smokers among Iranian adolescents was estimated to be 9 (95 CI: 7 to 10). Stratifying based on gender, the prevalence was 12 among boys (95 CI: 10 to 14) and 6 among girls (95 CI: 5 to 8). The prevalence of former smokers among Iranian adolescents using the random-effect model was computed to be 24 (95 CI: 21 to 27). Conclusion: The findings of this study showed that the prevalence of current and former smoking behavior among Iranian adolescents is a relevant public health concern. The country's young population should be given more attention by health policy- A nd decision-makers and implementation of ad hoc prevention and control policies should be on their agenda. © 2020 The Author(s)

Prevalence of Hepatitis C Virus in Tuberculosis Patients: A Systematic Review and Meta-Analysis

Background: Infection with Hepatitis C Virus (HCV) increases the hepatotoxicity of anti-tuberculosis drugs. The purpose of this systematic review and meta-analysis is to determine the prevalence of HCV infection in patients with tuberculosis (TB). Methods: PubMed/MEDLINE, ISI/Web of Sciences, CINAHL, EMBASE, the Cochrane Library and Scopus were searched from January 2000 to March 2018. The overall prevalence of HCV in patients with TB was calculated using the random-effect model with 95 confidence interval (CI). To evaluate heterogeneity, I2 test was used. Egger's regression test was utilized to check publication bias. Results: Twenty-one articles were selected for the final analysis based on the inclusion/exclusion criteria. A total of 15,542 patients with TB participated in the studies. The overall prevalence of HCV infection in patients with TB was 7 95%CI: 6-9. Subgroup analysis revealed that diagnostic test (P=0.0039), geographical background (P=0.0076) and gender distribution (P=0.0672) were statistically significant moderators. Men had a higher risk for HCV than women (Odds Ratio, OR=2.02; 95%CI: 1.28-3.18). Conclusion: The results of this study highlighted the importance of screening HCV in TB patients. Knowing whether HCV is present or not in these patients can be helpful in effectively treating them

Patient safety culture assessment in Iran using the �Hospital survey on patient safety culture� tool: A systematic review and meta-analysis

Background: Paying attention to patient safety is a crucial aspect of the healthcare provision delivery. Integrating and coordinating the different parts of the health system can ensure a safe, high-quality and efficient care. Patient safety culture (PSC) is a broad, complex and multi-dimensional conceptual framework. In recent years, several studies have been conducted to evaluate PSC using the �Hospital Survey on Patient Safety Culture� (HSOPSC) tool. The aim of this study was to examine the level of PSC in Iranian hospitals. Methods: ISI/Web of Sciences (WoS), PubMed/MEDLINE, Embase, CINAHL, PsychINFO and Scopus as well as Iranian databases including MagIran and SID were searched from January 2000 to July 2018. The Newcastle-Ottawa Scale checklist was used to assess the quality of the studies. The mean score of the participants� responses for each dimension of the questionnaire was calculated using the DerSimonian-Laird's random model with a 95 confidence interval. Results: In the current systematic review and meta-analysis, 27 studies conducted between 2012 and 2017 were included. The participants were 9264. Low scores (in the range 37.79�65.43) were found, especially when compared to other countries such as Lebanon, Turkey and the USA. Conclusion: Our results showed that in Iran the level of PSC is low and requires special attention from healthcare managers and providers. PSC should be a very important priority in Iran's health sector. Health decision- and policy-makers should pay particular attention to offering training programs to promote and develop PSC. © 2019 INDIACLE

Tuberculosis in Iran: a historical overview from al-Tabari, Rhazes, Avicenna and Jorjani to Abolhassan Ziy�-Zarifi. Old and new pioneers in the fight against tuberculosis: challenges, pitfalls and hopes

Tuberculosis is a serious respiratory infectious disease, caused by Mycobacterium tuberculosis bacteria. It has always represented a permanent, serious public health challenge over the course of human history, because of its severe epidemiological, clinical and societal implications. The present review aims at over-viewing the contributions of the Iranian medicine to the control, management and treatment of tuberculosis, from the glorious past of the eighth-ninth centuries to the present, from Ali Abu al-Hasan Ahmad ibn Sahl-e Rabban al-Tabari to Rhazes, Avicenna, Jorjani and Abolhassan Ziy�-Zarifi. However, despite the efforts, tuberculosis and, in particular, multidrug-resistant tuberculosis still represent a great public health concern in Iran. On the other hand, this country can capitalize on its millennial, incredibly rich story of major achievements in the battle against tuberculosis to develop and implement ad hoc public health programs for the control of the disorder, including targeted and specialized interventions. ©2020 Pacini Editore SRL, Pisa, Italy

Ensuring adequate health financing to prevent and control the COVID-19 in Iran

On February 19th 2020, the Iranian Ministry of Health and Medical Education (MoHME) has announced the first 2 cases of SARS-CoV-2, a novel emerging coronavirus which causes an infection termed as COVID-19, in Qom city. As such, the Iranian government, through the establishment of the "National Headquarters for the management and control of the novel Coronavirus", has started implementing policies and programs for the prevention and control of the virus. These measures include schools and universities closure, reduced working hours, and increased production and delivery of equipment such as masks, gloves and hygienic materials for sterile environments. The government has also made efforts to divulge high-quality information concerning the COVID-19 and to provide laboratories and hospitals with diagnostic kits and adequate resources to treat patients. However, despite such efforts, the number of cases and deaths has progressively increased with rising trends in total confirmed cases and deaths, as well as in new daily cases and deaths associated with the COVID-19. Iran is a developing country and its economic infrastructure has been hit hardly by embargo and sanctions. While developed countries have allocated appropriate funding and are responding adequately to the COVID-19 pandemics, Iran has experienced a serious surge of cases and deaths and should strive to provide additional resources to the health system to make healthcare services more accessible and to increase the fairness of that access. All relevant actors and stakeholders should work together to fight this disease. © 2020 The Author(s)

Evaluation of effective indexes on quality of life related to health in western Iran in 2013

Background: Today, indexes regarding longevity and life expectancy have increased; the most important issue now is how to spend time loving or in other words quality of life. Objectives: This study was aimed to evaluate effective indexes on quality of life related to health in western Iran in 2013. Materials and Methods: In this cross-sectional research, 918 families were selected among different counties of Ilam Province by multi-stage clustering sampling. The data collection instrument was a questionnaire used to measure the general economic and quality of life: the SF-36 health status questionnaire. Data were analyzed using multivariate regression models. Results: The mean age of the study participants was 32.97±9.5 years, and the mean score for their quality of life was 61.74±12.31. There was a significant statistical relationship between people�s quality of life and their marital status, province of residency, income, economic situation, and life satisfaction (P < 0.05). Also, there was a significant and inverse correlation between people�s age and quality of life (r = 0.21), physical health summary (r = 0.21) and mental health summary (r = 0.08). Conclusions: The mean quality of life among the individuals studied was in the middle level, however, it is important to consider the different dimensions of their living situations, such as economic protections, social cooperation, ability to present suitable behaviors to solve problems, and living situation, especially among deprived people. © 2016, Iranian Red Crescent Medical Journal

The role of insurance providers in supporting treatment and management of hepatitis C patients

Today, one of the most important global public health challenges is represented by hepatitis C virus (HCV), which imposes relevant costs. Globally speaking, the median cost of HCV-related complications ranges from 280 for an uncomplicated hepatitis to 139,070 for a liver transplantation. There are effective therapies for HCV patients worldwide, which has increased the hope of improving the process of managing and curing these patients. The adherence of patients to the pharmacological treatment and the use of effective drugs in the management of HCV disease are of crucial importance for health policy- and decision-makers. Studies show that, globally, insurance coverage for patients with HCV is not adequate in that still many patients are not covered by insurance programs. This issue as well as the economic conditions of countries are very serious challenges for ensuring an effective treatment. The most important and greatest help currently available to ensure HCV treatment is to implement plans to reduce costs and support patients. Some studies have shown that the expansion of coverage by private payers seems able to generate positive spillover benefits to public insures. Insurers, in addition to maintaining and increasing their own interests, are trying to increase their social status as a sponsor of patients. In conclusion, HCV disease requires serious policies and affordable insurance coverage. © 2019 The Author(s)