Trends in Animal Bites and Rabies-related Deaths in Northern Iran: Implications for Public Health Interventions.

BACKGROUND: Rabies remains a public health problem in middle-income countries like Iran, despite being preventable. This study aimed to evaluate the six-year incidence of animal bites in the southern Caspian Sea region from 2016 to 2022, and focus on estimating the direct costs of animal bite cases using the incidence-based method. METHODS: A multicenter, registry-based study was conducted using surveillance data of animal bites. RESULTS: Of the 40922 cases reported during the study period, 65.9% were male and 34.1% were female. Animal bites were most frequent among individuals over 50 years of age (23.5%), while children under 10 years of age had the lowest frequency of animal bites (2.3%). Animal bites were most common in June. Dogs were responsible for 33277 (81%) cases, cats for 5,624 (13.7%) cases, cows for 1054 (2.5%) cases, and other animals for the remaining cases. During the six-year study period, four deaths due to rabies were reported in the study area. The annual bite incidence rate was 386.3 per 100000 people in northern Iran. The males-to-female ratio was highest in 2019 (M/F ratio=2.4, 95% CI=1.2‒3.4). CONCLUSION: The elderly are at higher risk of animal bites, especially in rural areas. It is important to emphasize the use of protective clothing, washing wounds with soap water and rabies vaccination as initial treatment. Targeted vaccination efforts for eligible animals should be prioritized to minimize unnecessary financial burden. Educating farmers about rabies prevention programs, especially in cases of cow bites, is also important.

The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran.

The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran is necessary. We dealt with drownings on three levels of prevention including before, during, and after the injury in northern Iran (Guilan province). This study aimed to investigate the use of Haddon's matrix in preventing three-level drowning cases before, during, and after the accident in the north of Iran. This qualitative study consisted of 9 focus groups with a sample size of 78 people including 48 nursing staff, 21 emergency medicine specialists, and 30 people from non-medical personnel (local community leaders, executive officials of relevant organizations, lifeguards, staff working in health centers, and families of victims). All group discussions were recorded and the questions were based on the focus group table. According to Haddon's table of results, the major risk group was the young and adolescent boys and more in the area of neglect in culture-building and education. In this study, the role of factors was investigated separately and the necessary solutions were presented that can be used as a scientific and practical basis to achieve the main goal of drowning prevention. These strategies require cross-sectoral collaboration, which seems to be a strong interaction with a greater focus on major risk groups to address deficiencies and prevent the recurrence of potential accidents. The study aimed to investigate the use of Haddon's matrix in the prevention of three-level drowning cases before the event, during the event, and after the event in northern Iran.

Suitability of existing definitions for drowning to meet the new definition: a scoping review.

BACKGROUND: Past studies have shown a lack of consensus on the definition and terminology of drowning among experts in the field and relevant organizations. There is a need for a new look at the definition of drowning to improve the understanding of drowning events. METHODS: A literature search of seven electronic databases, including PubMed, EMBASE, CINHAL, MEDLINE, Sport Discus, and Social Sciences from 1960 to 2020 was conducted using the MESH search terms "drowning", "near-drowning", "submersion", and "immersion". Cochrane databases were also searched for systematic reviews The items were searched in all fields of publication, including title, abstract, and keyword. RESULTS: The search identified approximately 2500 articles, 230 of which were reviewed. The inclusion criteria were applied to the full text of 230 articles, and 25 articles addressing the different definitions of drowning were assessed. They were reviewed critically by authors using a standard review form. The search identified that there were at least 20 different outcome measures for drowning incidents reported. Definitions of drowning in the literature were found for the following terms: dry versus wet drowning, secondary drowning, drowned and near-drowned, drowning without aspiration and drowning with aspiration, near drowning without aspiration or with aspiration, active drowning, passive drowning, silent drowning, witnessed and unwitnessed, immersion, submersion, death certificate records drowning, unintentional submersion, road traffic injury leading to passenger vehicle drowning, drowning, near drowning, salt or freshwater drowning, and cold water drowning. CONCLUSIONS: In the literature, a lack of consensus was observed but the following terms should not be abandoned; "Non-fatal drowning" which is used to describe death following rescue and life with at least 24 hours of in-hospital survival and the development of one or more complications and "Fatal drowning" which implies death occurring at the scene or 24 h of a submersion incident.

Comparison of the capture-recapture method and seroprevalence survey for estimation of COVID-19 prevalence in the Islamic Republic of Iran.

Background: Reliable estimation of prevalence is important for monitoring and evaluation of COVID-19 prevention programmes among at-risk populations. Aims: We compared the capture-recapture method with a seroprevalence survey for accurate estimation of the prevalence of COVID-19 during a 1-year period in Guilan Province, northern Islamic Republic of Iran. Methods: We used the capture-recapture method to estimate the prevalence of COVID-19. Records from the primary care registry system and the Medical Care Monitoring Center were compared, using 4 matching approaches based on combinations of the following variables: name, age, gender, date of death, positive or negative cases, and alive or dead cases. Results: The estimated prevalence of COVID-19 in the study population from the beginning of the pandemic in February 2020 until the end of January 2021 was 16.2-19.8%, depending on the matching approach used, which was lower than in previous studies. Conclusion: The capture-recapture method may provide better accuracy than seroprevalence surveys in measuring the prevalence of COVID-19. This method may also reduce the bias in the estimation of prevalence and correct the misconception of policymakers about seroprevalence survey results.

Patterns of the Social Approach to Health in Selected Countries and Iran: A Comparative Study.

Background : The complexity of health and the role of its relevant socioeconomic factors have led countries to adopt new approaches to promote health, including the socialization of health. This comparative study aimed at examining the patterns of the social approach to health in 9 selected countries. Methods: Using the scoping review method, we collected the data by searching published articles in databases and the websites of the World Health Organization, the United Nations, and the World Bank. A total of 66 articles were included in the study based on the PRISMA protocol. Results : The thematic analysis showed that the most efficient model among middle-income countries was the one that consisted of good governance, effective social participation, and empowerment of mothers and children. The study findings also revealed that considering social welfare, governance, social participation, empowerment, and health literacy, Ecuador, Bulgaria, Egypt, and Cuba had the highest scores among the selected countries, respectively. We define socialization of health as public engagement in maintaining and promoting individual and social and psychological health in the society, a part of which is achieved through community-based medical education. Conclusion : In Iran, the centralized structure of the health system and inadequate transparency and accountability of the government have led to restricted public participation and poor intersectoral collaboration. We propose empowering civil society, setting up free political parties, and implementing the family medicine project as an effective policy for improving the socialization of health to achieve sustainable development goals in Iran.

The relationship between weight indices and injuries and mortalities caused by the motor vehicle accidents: a systematic review and meta-analysis.

BACKGROUND: The relationship between weight indices and injuries and mortality in motor vehicle accidents is unknown. Systematic review studies addressing the collection and analysis of the relationship in investigations are very limited. The purpose of this systematic review is to determine the relationship between BMI, obesity and overweight with mortality and injuries and their severity and vulnerable organs after the motor vehicle accident. METHODS: The databases (MEDLINE/PUBMED, EMBASE, Web of Science, etc) were searched for relevant abstracts using certain keywords. Of all the articles, similar ones were removed considering different filters. The collected data were entered into the STATA SE v 13.1. The heterogeneity of the data was analyzed using i2 statistics. In addition, the estimates of the study were done based on the age group (children and adults) and the impact of obesity on different regions of the body. RESULTS: A direct relationship was observed between the overall BMI and the degrees of injuries (CI=0.503-1.139), and mortality due to motor vehicle accident (CI=1.267-1.471). A positive relationship was found between obesity and AIS+2 (CI=0.653-1.426), and AIS+3 (CI=1.184-1.741), and ISS (CI=1.086-1.589). Also, a negative relationship between overweight and injuries rates, and a direct relationship between overweight and mortality (CI=0.979-1.167), and injuries with index of AIS+2 (CI=1.178-0.768) and AIS+3 (CI=0.48-2.186) were found. CONCLUSIONS: The prediction of injury, mortality and severity of injuries in the motor vehicle accident by the variable of obesity and overweight determines the need to design prevention programs for this vulnerable group at all levels.

Effectiveness of an educational program on decreasing burns and injuries in Persian festival of fire: A burden of diseases approach.

Chaharshanbeh souri is a historical Persian firework festival which has several health and financial damages for Iranians near celebration of New Year. In this study we tried to find effectiveness of Chaharshanbeh souri educational campaign on decreasing burden of injuries due to fireworks of this day. In this before-after study, an educational campaign was done for 2017 focusing on children and students. Data of a registry which was designed for gathering information of injuries and mortalities of this festival was used to show effectiveness of the program. Disability adjusted life years was calculated and compared before and after intervention. The results of this study showed that mean age of injuries was increased from 27.75 to 32.65 years and DALY decreased significantly after the intervention (P=0.0460) showing that the intervention was effective. Educational programs might be effective to decrease burden of injuries related to Chaharshanbeh souri festival.

Analysis of apolipoprotein E genetic variation in patients with Alzheimer disease referred to Imam Reza Clinic, Rasht, Iran, in 2015.

Background: Alzheimer disease (AD) is a progressive neurological degenerative disorder and the most common form of dementia. There are about 100 genes linked to AD including apolipoprotein E (ApoE). This gene exists in the form of three allele polymorphisms of ε2, ε3 and ε4 and six genotypes of ε2ε3, ε2ε2, ε3ε3, ε2ε4, ε3ε4, and ε4ε4. We aimed to study the association of ApoE polymorphism with AD in Guilan province, Iran. Methods: The study group consisted of 70 AD patients and 100 healthy individuals as a control group. All subjects were recruited from 21 March to 22 September 2015 at Imam Reza Clinic, Rasht, Iran. The genomic deoxyribonucleic acid (DNA) was extracted from peripheral blood leucocytes, and subsequently, subjects were genotyped for ApoE using tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). The association between the risk allele and AD was assessed using the MedCalc software. Results: The distributions of ε3ε3, ε3ε4, ε2ε2, ε2ε4, ε4ε4 and ε2ε3 Genotypes among patients were 55.7%, 30.0%, 1.4%, 2.9%, 8.6%, 1.4% and in the controls were 79.0%, 8.0%, 0%, 1.0%, 1.0%, 11.0%, respectively. The genotype frequencies were significantly different between cases and the controls (P < 0.001). The individuals with the ε4ε4 and ε3ε4 genotypes had a greater risk for AD as compared to others; odds ratio (OR) = 12.15, 95% confidence interval (CI): 1.41-104.50, P = 0.020; OR = 5.32, 95% CI: 2.16-13.08, P = 0.003. In addition, the ε4 allele is significantly associated with higher AD risk among the studied population (OR = 5.63, 95% CI: 2.74-11.58, P < 0.001). Conclusion: This case-control study suggests that the subjects with ε4ε4 and ε3ε4 genotypes had an increased risk for AD in Iranian population.

Alloimmunization in Thalassemia Patients: New Insight for Healthcare.

BACKGROUND: Development of alloantibodies against the foreign red blood cell (RBC) (alloimmunization) is a well-known complication in thalassemia patients when performing multiple transfusions. The study was conducted to know the prevalence of alloimmunization in thalassemia patients, in the Caspian Sea coastline. METHODS: This study is a descriptive, retrospective analysis of transfusion records of 190 patients with ß-thalassemia major who received regular transfusions. To detect the type of alloantibodies, two cells panel tests (kits; Iranian Blood Transfusion Organization [IBTO], 3 RBC cells and IBTO, 11 RBC cells) were used. RESULTS: Forty-seven patients were positive for alloantibodies (24.7%). Of them, 18.4% (35 cases) had only one alloantibody, and 6.3% (12 cases) had at least two or more of alloantibodies. The vast majority of alloantibodies were anti-Kell followed by anti-E, and anti-D, respectively. CONCLUSIONS: Blood matching for Rh and K antigens in patients with transfusion-dependent thalassemia could reduce the rate of RBC alloinununization.

Trend in Prevalence of Hepatitis C Virus Infection among ß-thalassemia Major Patients: 10 Years of Experience in Iran.

BACKGROUND: Hepatitis C virus (HCV) is the leading cause of transfusion transmitted infections (TTIs) among patients with ß-thalassemia major. A high prevalence of HCV was reported among these patients. The aim of this study is seeking the trend of the prevalence of HCV infection among the patients with b-thalassemia major in Guilan province, Northern Iran over a 10-year period. METHODS: A retrospective study was conducted on 1113 patients with b-thalassemia major in the Guilan province, northern Iran from 2002 to 2012, using multiple data sources. A blood sample was taken from each patient, and a questionnaire regarding demographic data and risk factors was completed for them. Enzyme-linked immunosorbent assay and recombinant immunoblot assay for HCV were performed in all cases. A stepwise forward logistic regression analysis was done. RESULTS: The prevalence of hepatitis C infection among ß-thalassemia major patients was 13.6%. The risk of hepatitis C among ß-thalassemia major patients was greater before screening program for HCV (odds ratio = 9.6, 95% confidence interval: 2.3-40.5). In addition, the prevalence of anti-HCV seropositivity was decreased dramatically among patients who have received transfusions after implementation of blood donor screening for HCV. There were no positive HCV cases in the patients younger than 10 years. CONCLUSIONS: The risk of TTIs including HCV can be reduced by implementing screening program for healthy blood.

Road traffic crashes in rural setting: an experience of a middle-income country.

OBJECTIVE: To date, there has been little information published on the death of rural road accident deaths. This study uses burden of injury method to explore a more accurate estimate of years of life lost due to road traffic crashes occurring over a four-year period in Guilan province, northern Iran. METHODS: Rural road accident deaths from 2009 to 2013 were extracted from Iran's Forensic Medicine System, Death Registry System and Road Trauma Research center database. RESULTS: During the study period, the average years of life lost due to motor vehicle crashes was 13.8 per 1 000 persons, ranging from 11.9 during March 2011-2012 to 15.8 per 1 000 persons during March 2012-2013. CONCLUSION: Road accident deaths in 2013 remained at the same high level as in 2009. The information obtained from this study provides a new perspective on fatal road traffic crash victims in rural settings and show us that more attention is needed in this area.

Traffic accidents in Iran, a decade of progress but still challenges ahead.

Iran has had incremental incidence of traffic accident mortality since introduction of mechanization about a century ago. But the newest data from Iran show decrease in the absolute number of deaths, death per 10,000 vehicles and death per 100, 000 populations. Despite its huge impact on health and economy, research in the field of traffic crashes is still scant and there are still deficiencies in problem oriented research on traffic accidents. Actual cooperation of policy makers, executive bodies and academician could build platform for intersectoral discussion of different aspects of traffic accidents and could reduce burden of traffic accidents.

Maternal Beliefs and Socioeconomic Correlated Factors on Child Mortality from Drowning in Caspian Sea Coastline.

OBJECTIVE: To investigate maternal beliefs, practices about causes and determinant factors on drowning and maternal socioeconomic correlated factors on child mortality from drowning. METHODS: From March 2005 to March 2009, in a register-based cohort study and household survey, individual records utilizing drowning registry data of northern Iran were enrolled.   Mothers (n=276) who responded to multiple questions in a household survey were included. The patterns, interrelationships and effects of socioeconomic correlated factors on child mortality were analyzed. RESULTS: A significant difference in relation to mother's educational level and age and family income distribution was noticed. Participants in household survey also reported that establishment of a multi-sectorial collaboration, integration of public health messages into local television, additional rescue stations and lifeguard, hazard environment fencing, increasing adult supervision, more support on increasing swimming ability among the children were all effective on reducing of drowning death. CONCLUSION: Due to the high rate of drowning in children and lack of attention among olders, a greater emphasis should be placed on educating mothers to assist a better supervision on their children.

Evaluation of chest and abdominal injuries in trauma patients hospitalized in the surgery ward of poursina teaching hospital, guilan, iran.

BACKGROUND: Trauma, especially chest and abdominal trauma are increasing due to the growing number of vehicles on the roads, which leads to an increased incidence of road accidents. Urbanization, industrialization and additional problems are the other associated factors which accelerate this phenomenon. A better understanding of the etiology and pattern of such injuries can help to improve the management and ultimate the outcomes of these patients. OBJECTIVES: This study aimed to evaluate the patients with chest and abdominal trauma hospitalized in the surgery ward of Poursina teaching hospital, Guilan, Iran. PATIENTS AND METHODS: In this cross-sectional study, the data of all chest and abdominal trauma patients hospitalized in the surgery ward of Poursina teaching hospital were collected from March 2011 to March 2012. Information about age, gender, injured areas, type of injury (penetrating or blunt), etiology of the injury, accident location (urban or rural) and patients' discharge outcomes were collected by a questionnaire. RESULTS: In total, 211 patients with a mean age of 34.1 ± 1.68 years was entered into the study. The most common cause of trauma was traffic accidents (51.7%). Among patients with chest trauma, 45 cases (35.4%) had penetrating injuries and 82 cases (64.6%) blunt lesions. The prevalence of chest injuries was 35.5% and rib fractures 26.5%. In chest injuries, the prevalence of hemothorax was 65.3%, pneumothorax 2.7%, lung contusion 4% and emphysema 1.3%, respectively. There were 24 cases (27.9%) with abdominal trauma which had penetrating lesions and 62 cases (72.1%) with blunt lesions. The most common lesions in patients with penetrating abdominal injuries were spleen (24.2%) and liver (12.1%) lesions. The outcomes of the patients were as follow: 95.7% recovery and 4.3% death. The majority of deaths were observed among road traffic victims (77.7%). CONCLUSIONS: Considering the fact that road-related accidents are quite predictable and controllable; therefore, the quality promotion of traumatic patients' care, and the road safety should be noted as problems associated with public health.

Prevention of drowning by community-based intervention: implications for low- and middle- income countries.

BACKGROUND: Drowning is a serious but neglected health problem in low-and middle-income countries. OBJECTIVES: To describe the effectiveness of drowning prevention program on the reduction of drowning mortality rates in rural settings at the north of Iran, and guide its replication elsewhere. PATIENTS AND METHODS: This interventional design included pre- and post-intervention observations in the rural area of the Caspian Sea coastline without a comparison community. Cross-sectional data were collected at pre- and post-intervention phases. Outcome evaluation was based on a four-year period (March 2005-March 2009) utilizing drowning registry data for the north of Iran. RESULTS: The implementation program increased the rate of membership in an organization responsible for promoting safety in high risk areas near the Caspian Sea. Compared to a WHO standardized population, drowning incidence in rural areas of the study demonstrated a continuous decrease in age-specific drowning rate among the oldest victims with a gradual decline during the implementation. In the study area, the epidemiological aspects of the study population were exposed and contributing factors were highlighted. CONCLUSIONS: This study showed that the promotion of passive interventions had a greater effect on drowning rate than that of active interventions.