The increasing trend of blood donation in Iran

BACKGROUND: This is the first study on the blood donation trend in Iran at a national level. We report different characteristics of blood donation such as demographic status, donor type, donation trend, and geographical distribution of blood donation in Iran between 2003 and 2017.METHODS: This study used data registered in the donor vigilance part of the Iranian Blood Transfusion Organization. Statistical analysis was conducted using SPSS (SPSS Inc., Chicago, IL, USA) and ArcMap GIS version 10.2 software. A P-value <0.05 was considered statistically significant.RESULTS: Based on the study results, blood donation in Iran reached >2 million units in 2017; moreover, it is predicted that Iran will achieve >29 donations per 1,000 population in 2022. The proportion of regular and repeated donors increased from 77% in 2013 to 87% in 2017. The average blood donation rate in seven provinces was higher than the national average, and the average growth rate of their blood donation per population was positive.CONCLUSION: The results of the current study showed that there is a recent increasing trend toward blood donation in Iran. Furthermore, the largest share of donations is related to regular donors. The increasing proportion of regular and repeated donors has led to the improvement in the quality and consequently health level of donated blood.

Estimation of the rate and number of underreported deliberate self-poisoning attempts in western Iran in 2015 / 한국역학회지

OBJECTIVES: Rates of attempted deliberate self-poisoning (DSP) are subject to undercounting, underreporting, and denial of the suicide attempt. In this study, we estimated the rate of underreported DSP, which is the most common method of attempted suicide in Iran.METHODS: We estimated the rate and number of unaccounted individuals who attempted DSP in western Iran in 2015 using a truncated count model. In this method, the number of people who attempted DSP but were not referred to any health care centers, n0, was calculated through integrating hospital and forensic data. The crude and age-adjusted rates of attempted DSP were estimated directly using the average population size of the city of Kermanshah and the World Health Organization (WHO) world standard population with and without accounting for underreporting. The Monte Carlo method was used to determine the confidence level.RESULTS: The recorded number of people who attempted DSP was estimated by different methods to be in the range of 46.6 to 53.2% of the actual number of individuals who attempted DSP. The rate of underreported cases was higher among women than men and decreased as age increased. The rate of underreported cases decreased as the potency and intensity of toxic factors increased. The highest underreporting rates of 69.9, 51.2, and 21.5% were observed when oil and detergents (International Classification of Diseases, 10th revision [ICD-10] code: X66), medications (ICD-10 code: X60-X64), and agricultural toxins (ICD-10 codes: X68, X69) were used for poisoning, respectively. Crude rates, with and without accounting for underreporting, were estimated by the mixture method as 167.5 per 100,000 persons and 331.7 per 100,000 persons, respectively, which decreased to 129.8 per 100,000 persons and 253.1 per 100,000 persons after adjusting for age on the basis of the WHO world standard population.CONCLUSIONS: Nearly half of individuals who attempted DSP were not referred to a hospital for treatment or denied the suicide attempt for political or sociocultural reasons. Individuals with no access to counseling services are at a higher risk for repeated suicide attempts and fatal suicides.

Estimation of the rate and number of underreported deliberate self-poisoning attempts in western Iran in 2015 / 한국역학회지

OBJECTIVES: Rates of attempted deliberate self-poisoning (DSP) are subject to undercounting, underreporting, and denial of the suicide attempt. In this study, we estimated the rate of underreported DSP, which is the most common method of attempted suicide in Iran. METHODS: We estimated the rate and number of unaccounted individuals who attempted DSP in western Iran in 2015 using a truncated count model. In this method, the number of people who attempted DSP but were not referred to any health care centers, n0, was calculated through integrating hospital and forensic data. The crude and age-adjusted rates of attempted DSP were estimated directly using the average population size of the city of Kermanshah and the World Health Organization (WHO) world standard population with and without accounting for underreporting. The Monte Carlo method was used to determine the confidence level. RESULTS: The recorded number of people who attempted DSP was estimated by different methods to be in the range of 46.6 to 53.2% of the actual number of individuals who attempted DSP. The rate of underreported cases was higher among women than men and decreased as age increased. The rate of underreported cases decreased as the potency and intensity of toxic factors increased. The highest underreporting rates of 69.9, 51.2, and 21.5% were observed when oil and detergents (International Classification of Diseases, 10th revision [ICD-10] code: X66), medications (ICD-10 code: X60-X64), and agricultural toxins (ICD-10 codes: X68, X69) were used for poisoning, respectively. Crude rates, with and without accounting for underreporting, were estimated by the mixture method as 167.5 per 100,000 persons and 331.7 per 100,000 persons, respectively, which decreased to 129.8 per 100,000 persons and 253.1 per 100,000 persons after adjusting for age on the basis of the WHO world standard population. CONCLUSIONS: Nearly half of individuals who attempted DSP were not referred to a hospital for treatment or denied the suicide attempt for political or sociocultural reasons. Individuals with no access to counseling services are at a higher risk for repeated suicide attempts and fatal suicides.

Review of clinical spectrum of gastroesophageal reflux disease in a general population; a study from South-East Iran

Background: Gastroesophageal reflux disease [GERD] is one of the most common gastrointestinal problems worldwide

The aim of this study was to evaluate the clinical spectrum, prevalence, and some of the variables that are supposed to be the risk factors of this chronic disorder

Methods: This population- based cross-sectional study was conducted in a one-stage randomized clustered sample of adult inhabitants in Kerman city in 2011-2012. A total of 2265 subjects with age range of 15-85 years were enrolled

Face to face interview was performed for all the subjects. GERD was defined as at least weekly heart burn and/or acid regurgitation during the past year. Association of GERD with factors like demographic variables, medical condition, diet and life habits were analyzed

Results: A total of 2265 subjects including 988 [43.8%] male and 1275 [56.3%] female patients were evaluated. The prevalence of GERD was 28%. The prevalence was higher in female patients and with aging. There was also a significant association between GERD and the following risk factors: lower educational level [p 0.000l], higher body mass index [p =003], presence of depression [p<0.000 1], and anxiety [p <0=0001]

Conclusion: GERD as a common disorder in our region was seen more in elderly and female patients and was associated with some anthropometric, metabolic, medical conditions, and behavioral habits

Estimation of prevalence and incidence of sexually transmitted infections in Iran; a model-based approach

Background: Routine reporting of sexually transmitted infections [STIs] in Iran is one of the main information sources on STIs, endures some diminution under influence of several factors. We aimed to adjust registered STI data with a model-based approach and estimate the incidence and prevalence of STIs in Iran

Methods: In this cross-sectional study, we developed a stochastic compartmental model considering effects of influential factors on STI reporting process to adjust registered STI data. We reviewed literature and used Delphi method to collect data and estimate model parameters. We calibrated the model using Monte Carol simulation with 95% confidence interval [CI]. Finally, we validated the models by comparing their output with investigational data

Results: The estimated prevalence of male urethral discharge was 0.40% [95% CI: 0.26%, 0.65%]; the prevalence of genital ulcers was 3.68% [95% CI: 2.31%, 6.43%] in women and 0.16% [95% CI: 0.10%, 0.27%] in men. The estimated incidence for Neisseria gonorrhoeae, Chlamydia trachoma and syphilis per 1000 women was 2.44 [95% CI: 1.17, 6.65], 5.02 [95% CI: 2.78, 10.16] and 0.04 [95% CI: 0.02, 0.05] respectively; the corresponding figures per 1000 men were 0.43 [95% CI: 0.26, 0.80], 0.82 [95% CI: 0.42, 1.92] and 0.005 [95% CI: 0.003, 0.008]

Conclusions: Various factors are responsible for the obvious underestimation in the number of STIs registered in Iran. Notwithstanding this underestimation, our models offer an indirect method of estimating the prevalence of STIs in the country. Providing policymakers and STI experts with more realistic estimates might prompt policymakers and STI experts to recognize the importance of STIs in Iran and help them to develop appropriate prevention and control programs

[Evaluation of Salivary Secretory Immunoglobulin A Levels in Diabetic patients and association with Oral and Dental Manifestations]

Objectives: Oral and dental manifestations in diabetic patients can arise due to numerous factors, including elevated salivary secretory immunoglobulin A [s-IgA] levels. This study aimed to evaluate s-IgA concentrations in patients with type 2 diabetes mellitus [T2DM] and to investigate the association between s-IgA levels and oral and dental manifestations of T2DM

Methods: This cross-sectional descriptive study was carried out between October 2011 and September 2012 in Kerman, Iran, and included 260 subjects [128 patients with T2DM and 132 healthy controls]. Unstimulated salivary samples were collected from all subjects and s-IgA levels were determined using the immunoturbidimetric method. The oral cavities and teeth of T2DM patients were evaluated for oral and dental manifestations

Results: Both diabetic and control subjects with higher concentrations of s-IgA had significantly higher numbers of decayed, missing or filled teeth [DMFT] and periodontal index [PDI] scores [P <0.050]. s-IgA levels were significantly higher in subjects with oral candidiasis [P <0.050]. Among diabetic patients, significantly higher s-IgA levels were concomitant with xerostomia and denture stomatitis [P

Conclusion: Individuals with a greater number of DMFT, a higher PDI score and oral candidiasis had significantly higher s-IgA levels. s-IgA levels were not significantly higher among diabetic patients in comparison to the control group. However, significantly higher s-IgA levels occurred with xerostomia and denture stomatitis in diabetic patients. In addition, s-IgA was significantly higher in patients with uncontrolled diabetes compared to those with controlled diabetes

Social network size estimation and determinants in Tehran province residents

Network scale-up is an indirect method for estimating the size of hidden, hard-to-count or high risk populations. Social network size estimation is the first step in this method. The present study was conducted with the purpose of estimating the social network size of the Tehran Province residents and its determinants. Maximum Likelihood Estimation was applied to estimate people's network sizes by using populations of known sizes and the scale-up method. Respondents were selected from Tehran province through convenience sampling in 2012. Out of thirteen selected subpopulations with known size, ten had minimum accuracy which used in our analysis. Of the 1029 respondents in this study, 46.7% were male. The social network size of Tehran Province residents was estimated to be 259.1 [CI[95%]: 242.2, 276] based on the ten known populations remained in this study. This size was 291.8 in men and 230.4 in women. Younger people [18-25 years old] had larger network sizes compared to the other age groups [P<0.001]. Our estimation for social network size of Tehran inhabitants was smaller than that previously estimated size for the whole country [c=380]. In addition, we found that the social network of subpopulations was different. This difference means that we need local estimations for sub-populations to improve the accuracy of population size estimation using network scale up method

application of network scale up method on estimating the prevalence of some disabilities in the southeast of Iran

More than a billion people have some form of disabilities worldwide. Persons living with a disability have many needs [including physically, mentally, and socially needs]. Estimating the size of disabled population is a challenge in health systems. An innovative indirect method to estimate the size of populations is network scale up [NSU] having widely used for hidden populations. The method is based-on the social network of individuals. We assessed the capability of NSU to estimate persons living with a disability being a middle population [neither non-hidden nor hidden populations] in the Southeast of Iran [Kerman City, southeast Iran]. A total of 3052 of Kermanian people over 20 year old were interviewed by simple random sampling. We asked them whether they knew acquaintances with complete blindness, severe visual impairment, deafness, severe hearing impairment, limb defects, and mental retardation, if yes; we wanted them to count them. Based on the network scale up method, the prevalence of the populations was estimated at 5.21/1000 in Kerman City where severe visual impairment was 1.35, mental retardation was 1.039, severe hearing impairment was 1.005, limb defects was 0.78, deafness was 0.59, and complete blindness was 0.56 [per 1000 inhabitants]. The results were not exactly comparable to previous studies using different methods such as surveys. Although the method has some limitations, considering its easiness and cost-effectiveness, modified NSU could be used when direct methods are not practicable

Social hidden groups size analyzing: application of count regression models for excess zeros

In the case of sensitive questions such as number of alcoholics known, majority of respondents might give an answer of zero. Poisson regression model [P] is the standard tool to analyze count data. However, P provides poor fit in the case of zero inflated counts, when over-dispersion exists. Therefore, the questions to be addressed are to compare performance of alternative count regression models; and to investigate whether characteristics of respondents affect their responses. A total of 700 participants were asked about number of people they know in hidden groups; alcoholics, methadone users, and Female Sex Workers [FSW]. Five regression models were fitted to these outcomes: Logistic, P, Negative Binomial [NB], Zero Inflated Poisson [ZIP], and Zero Inflated Negative Binomial [ZINB]. Models were compared in terms of Likelihood Ratio Test [LRT], Vuong, AIC and Sum Square of Error [SSE]. Percentages of zero were 35% for number of alcoholics, 50% for methadone users, and 65% for FSWs. ZINB provided the best fit for alcoholics, and NB provided the best fit for other outcomes. In addition, we noticed that young respondents, male and those with low education were more likely to know or reveal sensitive information. Although P is the first choice for modeling of count data in many cases, it seems because of over-dispersion of zero inflated counts in the case of sensitive questions, other models, specifying NB and ZINB, might have better goodness of fit

Trends of obesity in Iranian adults from 1990s to late 2000s; a systematic review and meta-analysis

Obesity is currently emerging as a global epidemic, affecting 10% of adult population worldwide. The primary objective of the current systematic review is to describe the trend of overall prevalence of obesity in Iranian women and men through a meta-analysis. We searched the medical literature published from 1990 to 2007 in Medline [PubMed], EMBASE database, and the Iranian digital library. All published reports of research projects, papers in relevant congresses, unpublished crude data analysis, proceedings, books and dissertations were reviewed. Data from eligible papers that fulfilled the qualification criteria entered meta-analysis [Random Model]. Data from 209,166 individuals were analyzed. The overall prevalence of obesity in adults was 18.5% [95%CI: 15.1-21.8], respectively. The prevalence of obesity in men and women was 12.9% [95%CI: 10.9-14.9] and 26.2% [95%CI: 21.3-30.5], respectively. The trend of obesity was similar in both genders; women had almost a constantly higher risk of obesity than men during the recent two decades. Data from 209,166 individuals were analyzed. The overall prevalence of obesity in adults was 18.5% [95%CI: 15.1-21.8], respectively. The prevalence of obesity in men and women was 12.9% [95%CI: 10.9-14.9] and 26.2% [95%CI: 21.3-30.5], respectively. The trend of obesity was similar in both genders; women had almost a constantly higher risk of obesity than men during the recent two decades

Modeling of human immunodeficiency virus modes of transmission in Iran

Main technique to control acquired immunodeficiency syndrome [HIV] infection is the effective preventive programs among high-risk groups. Modeling is one of the effective methods where there is inadequate data. We used the modes of transmission [MOT] model to predict the transmission of HIV infection in Iran. We systematically searched published and grey literature to find values for the input parameters of MOT in 2010. The data were discussed by experts before being fed into the model. Using the Monte Carlo simulation, we computed the 95% confidence interval [CI] for the outputs of the MOT. The MOT estimates that 9136 new HIV infections would have occurred in Iran in 2010 [95% CI: 6831, 11757]. About 56% [95% CI: 47.7%, 61.6%] of new infections were among intravenous drug users [IDUs] and 12% [95% CI: 9.5%, 15%] among their sexual partners. The major routes of direct and indirect HIV transmission in Iran are unsafe injection [68%] and unprotected sexual contact [34% unprotected heterosexual and 10% homosexual] respectively. If current coverage for safe injection among IDUs increases from 80% to 95%, new HIV infections in this group would decrease around 75%. IDUs remain at highest risk of HIV infection in Iran, so the preventive program coverage for IDUs and their spouses needs to be increased. As the sexual transmission of HIV contributes increasingly to the pool of new infections, serious measures such as harm reduction program are required to reduce sexual transmission of HIV among the relevant key populations.

[Sampling in qualitative research: a guide for beginning]

Sampling in qualitative and quantitative research are very different, because it aims, gaining a deep understanding of the phenomenon is being investigated, rather than generalizing the results. Participants Selection in the qualitative study is done with aim of achieve the maximum information about the phenomenon under study. In quantitative research there is too much emphasis on a random selection, an equal chance for selection of all members of the research community, but in the qualitative study samples or participants are selected or invited. Purposive sampling that also is called purposeful or qualitative sampling that means purposeful selection of samples for acquiring knowledge or information. This type of sampling does not focus on developing the fixed and immutable rules or generalizing the results but try to better understand the phenomenon in special field. Purposive sampling consists of three main types including "Sampling to Achieve Representativeness or Comparability", "Sampling Special or Unique Cases" and "Sequential Sampling". Saturation in qualitative research as a method of sampling is considered the gold standard. In this paper, we tried to introduce the participant's selection methods and the differences between quantitative and qualitative method and the strategy for decision making about data saturation will be offered

Estimation of basic reproductive number of flu-like syndrome in a primary school in Iran

Iran, similar to other countries, had faced H1N1 flu outbreak in 2009. In order to assess its transmission dynamic, we estimated its force of infection [beta] and basic reproductive number [R[0]]. Within a middle size primary school in Iran, we actively followed students and detected flu-like syndrome among students and their families in the first three months of academic year; October through December 2009. We estimated the probability of disease transmission within families [beta] fitting random effects Poisson regression model. Moreover, R[0] within the school was computed based on the number of detected cases. In 452 students, 204 influenza-like syndromes were detected. The estimated beta within families was 0.10; increasing one infectious member within each family was associated with 30% increase in this number. The estimated R[0] for the first month was 1.21 [95% C.I.: 0.99, 1.47]; corresponding numbers for the first two and first three months were 1.28 [95% C.I.: 1.05, 1.54] and 1.32 [95% C.I.: 1.11, 1.59], respectively. It seems that the dynamic transmission of H1N1 virus was more or less comparable with that in other seasonal species. Our findings showed that the virus mainly circulated among students within schools. In addition, it seems that the transmission rate within families was relatively high

Size estimation of groups at high risk of HIV/AIDS using network scale up in Kerman, Iran

To estimate the size of groups at high risk of HIV, Network Scale UP [NSU], an indirect method, was used. 500 Kermanian male aged 18 to 45 were recruited. 8 groups at high risk of HIV were defined: Users of opium, unknown drug, ecstasy, and alcohol; intra?venous drug users [IDUs; males who have extra?marital sex with females [MSF]; male who have sex with female sex workers [MFSW]; and male who have sex with other male [MSMs]. We asked respondents whether they know anybody [probability method], and if yes, how many people [frequency method] in our target groups. Estimates derived in the probability method were higher than the frequency method. Based on the probability method, 13.7% [95% CI: 11.3%, 16.1%] of males used alcohol at least once in last year; the corresponding percent for opium was 13.1% [95% CI: 10.9%, 15.3%]. In addition, 12% has extra-marital sex in last year [95% CI: 10%, 14%]; while 7% [95% CI: 5.8%, 8.2%] had sex with a female sex worker. We showed that drug use is more common among young and mid-age males; although their sexual contacts were also considerable. These percentages show that special preventive program is needed to control an HIV transmission. Estimates derived from probability method were comparable with data from external sources. The underestimation in frequency method might be due to the fact that respondents are not aware of sensitive characteristics of all those in their network and underreporting is likely to occur

Xerostomia after radiotherapy and its effect on quality of life in head and neck cancer patients

Xerostomia is one of the one complications following radiotherapy that can affect quality of life [QoL] This study aims to assess the severity of xerostomia in patients with head and neck cancers after radiotherapy and its effect on QoL. In this longitudinal prospective study, the severity of xerostomia and related QoL was assessed in 63 head and neck cancer patients who referred to the Radiotherapy Ward. Patients completed a xerostomia questionnaire [XQ] at the beginning, and 2, 4, and 6 weeks after treatment over a period of 6 months. Additionally, unstimulated saliva was collected using the spitting method at all 4 visits. QoL significantly worsened with increased time [P = 0.0001]; meanwhile, the severity of xerostomia increased significantly [P = 0.0001]. However, there was no significant change in the amount of saliva at these 4 time points [P = 0.23]. Regression analysis showed that with each milliliter decrease in saliva secretion, the QoL score decreased 2.25%. With one score increase in xerostomia, from the QoL mean score there was a 1.65% decrease. The decrease in saliva and xerostomia that resulted from radiotherapy plays an important role in worsening QoL among patients who undergo radiotherapy for head and neck cancers. Although the amount of saliva has a significant association with QoL, the xerostomia score which shows subjects' general feeling also independently impacts QoL. In future studies, we recommend patient assessments for periods longer than 6 months

Evaluation of current guthrie TSH cut-off point in Iran congenital hypothyroidism screening program: a cost-effectiveness analysis

The threshold of thyroid-stimulating hormone [TSH] in current screening for congenital hypothyroidism [CH] from the heel prick test is 5 mU/l. This study uses cost-effective analysis to evaluate increasing the threshold to minimize false-positive results and recall rates. Cost of screening, diagnosis and treatment, education, and care of mentally retarded patients were gathered from the Ministry of Health State Welfare Organization and Department of Education in Tehran. Screening data were obtained from 34,007 neonates in the Central Health Laboratory of Tehran University of Medical Sciences in 2009. Sensitivity analysis and calculation of confidence interval for incremental costs and effects [gained disability adjusted life years - DALYs] and incremental cost-effectiveness ratios [ICER] were performed by Monte Carlo simulation with Ersatz software. ICER for screening programs with different TSH cut-off points versus no screening was similar, and approximately -4.5 +/- 0.2 thousand US dollars per gained DALY. In the proposed cohort [10,000 neonates], gained DALYs were 316 +/- 50 for a cut off point of 5 mU/l, 251 +/- 40 for 10 mU/l, 146 _ 23 for 15 mU/l, and 113 +/- 18 for a cut-off point of 20 mU/l. Sensitivity analysis showed that the model remained the same when the input parameters were changed. This study demonstrates that the current threshold of TSH in the national CH screening program in terms of cost-effectiveness is the most appropriate threshold. However, more studies are needed to examine new strategies and methods to reduce recall rates and related consequences such as repeated thyroid testing in neonates

Exploring maternal mortality in relation to socioeconomic factors in Iran

<p><b>INTRODUCTION</b>Maternal mortality is a tragic death, and is perceived as a sensitive indicator of the socioeconomic status and healthcare services in a given country. In this study, the relationship between maternal deaths and factors such as socioeconomic development and the proportion of medical professionals in Iran was examined.</p><p><b>METHODS</b>This was an ecological study, where three main groups of data based on different provinces were applied. Data included maternal mortality ratio, the proportion of medical professionals and socioeconomic variables, such as urban residency, unemployment and literacy. Data were obtained from various sources, including census returns, the Family Unit at the Ministry of Health and Medical Education, Tehran and the Iran Medical Council. Data were analysed using univariate and multivariate methodologies.</p><p><b>RESULTS</b>Multivariate analysis showed a significant inverse relationship between maternal deaths and variables of male literacy (p < 0.001) and unemployment (p = 0.04). A marginally significant association was also found between maternal deaths and the proportion of midwives (p = 0.09).</p><p><b>CONCLUSION</b>Our findings underscore the role of literacy, particularly male literacy, in the prevention of maternal deaths. Iran, as a male-dominated society, could benefit from targeting men for training programmes to enhance the health of their families, and ultimately, that of the society. As economic status does play a role in maternal deaths, there is a need to strengthen the financial situation of families. The number of skilled medical personnel available in a population also plays a key role in reducing maternal deaths.</p>