Cost of Illness of COVID-19 and Its Consequences on Health and Economic System.

The outbreak of COVID-19 has had destructive influences on social and economic systems as well as many aspects of human life. In this study, we aimed to estimate the economic effects of COVID-19 at the individual and societal levels during a fiscal year. This cost of illness analysis was used to estimate the economic burden of COVID-19 in Iran. Data of the COVID-19 patients referred to the hospitals affiliated to Bushehr University of Medical Sciences in 2021 were collected through the Hospital Information System (HIS). The study methodology was based upon the human capital approach and bottom-up technique. The COVID-19 pandemic has resulted in 9711 confirmed hospital cases and 717 deaths in Bushehr province during the study period. The direct and indirect costs were estimated to be $1446.06 and $3081.44 per patient. The economic burden for the province and country was estimated to be $43.97 and $2680.88 million. The results showed that the economic burden of this disease particularly premature death costs is remarkably high. Therefore, in order to increase the resiliency of the health system and the stability in service delivery, preventive-oriented strategies have to be more seriously considered by policymakers.

Prevalence of vitamin D deficiency and its associated risk factors among rural population of the northern part of the Persian Gulf.

BACKGROUND: Accumulating evidence indicates that vitamin D deficiency has been increased globally over the last two decades. However, the majority of these studies are concerned with cities and there is scant information regarding the prevalence of vitamin D in rural areas. The main aim of this study was to investigate the prevalence of vitamin D deficiency and its associated risk factors among the rural population in Bushehr province which shares the longest border with the Persian Gulf. METHODS: The rural inhabitants of more than 25 years old from three mountainous, plain, and seashore areas of Bushehr province were selected through a stratified multi-cluster random sampling method. After obtaining the participants' demographic and anthropometric data and their past medical history, serum 25-hydroxyvitamin D [25(OH)D] was measured using ELISA. RESULTS: A total of 1806 (means ±SD, 46± 14years old) rural subjects (35 % males and 65 % females) participated in this study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 28 %, 50 %, and 22 %, respectively. The deficiency of vitamin D in women was higher than in men (OR=1.27, 95 % CI: 1.05 to 1.54, P=0.04). There was a positive significant correlation between age and serum vitamin D levels. Men with vitamin D deficiency had higher BMI (P=0.008); this association was not observed among women (P=0.7). There was no significant difference between the food item's consumption frequencies, and vitamin D status (P>0.05). The mountainous, and plain areas had the highest and lowest vitamin D levels, respectively. CONCLUSIONS: Although, Bushehr province is located in a sunny part of Iran, the prevalence of vitamin D deficiency was high among its rural population. The shift of their lifestyle patterns and rapid industrialization in these rural areas may be responsible. Therefore, the enrichment of dietary sources with vitamin D and the use of vitamin D supplements are recommended to tackle the high prevalence of vitamin D deficiency in the rural population of the northern part of the Persian Gulf.

Childhood exposure to metal(loid)s in industrial and urban areas along the Persian Gulf using toenail tissue as a biomarker.

Metal(loid)s (MLs) with natural or anthropogenic sources may cause adverse health effects in children. This study aimed to compare the childhood exposure to ΣMLs (essential, non-essential and toxic) in an industrial and an urban area in Southwest Iran using toenail tissue as a biomarker. The present study was carried out with school children in the age range of 7-12 years, who were living in an industrial area in the petrochemical and gas area (PGA) of the Central District of Asaluyeh County and in an urban area (UA) located in the Kaki District. A total of 270 boys and girls were recruited in January to April 2019. The ICP-MS was used for determination of the studied MLs. A multi-linear regression model was constructed to assess the effect of residence area on toenail ML levels. A significantly higher level of ΣMLs in toenail from the PGA was observed compared to the level in the UA (8.839 vs. 7.081 µg/g, ß = -0.169 and p < 0.05). However, all of the 15 MLs studied were detected in the toenail samples from both study sites. Significant differences for the mean Cr (ß = -0.563), Fe (ß = -0.968), Mn (ß = -0.501), Ni (ß = -0.306), and Pb (ß = -0.377) levels were found between toenail samples from the study areas (p < 0.05), with higher levels in the PGA. The results of this study suggest that children in industrial area are prone to a greater risk for ML exposures compared with those living in a non-industrial urban area.

Diet, exposure to polycyclic aromatic hydrocarbons during pregnancy, and fetal growth: A comparative study of mothers and their fetuses in industrial and urban areas in Southwest Iran.

The presence of polycyclic aromatic hydrocarbons (PAHs) in the fetal environment is a high-priority concern due to the fetus being more sensitive than adults to these ubiquitous xenobiotics. The aim of the present study was to compare the maternal and fetal serum levels of ΣPAHs and their effects on fetal growth in an industrial and an urban area in Southwest Iran. The industrial area was the petrochemical and gas area (PGA) of the Central District of Asaluyeh County and the urban area (UA) was the Central District of Bushehr County, Ninety-nine maternal serum (MS) and 99 cord serum (CS) samples from the PGA and 100 MS and 100 CS samples from the UA were collected during May 2018 to February 2019. The mean concentrations of ΣPAHs were significantly (p < 0.05) higher in the PGA than the UA in both MS (157.71 vs. 93.56 µg/L) and CS (155.28 vs. 93.19 µg/L) samples. Naphthalene (NAP) was the predominant PAH detected in all the studied samples. Significant negative associations were found between birth weight and anthracene (ANT) level in MS (ß = -22.917, p = 0.032; weight decrement = 22.917 g for a 1 µg/L increase in ANT); head circumference and chrysene (CHR) level in MS (ß = -0.206, p = 0.023; head circumference decrement = 0.206 cm for a 1 µg/L increase in CHR); and birth height and NAP level in CS (ß = -0.20, p = 0.005; height decrement = 0.20 cm for a 1 µg/L increase in NAP). Maternal diet had a significant effect on the serum levels of PAHs. The results of this study showed that transmission of PAHs from mother to fetus through the cord blood is an important issue and mothers who live in industrial areas and consume PAH-containing foodstuffs, and their fetuses, are more at risk than those living in a non-industrial urban area.

Use of toenail-bounded heavy metals to characterize occupational exposure and oxidative stress in workers of waterpipe/cigarette cafés.

Tobacco smoke is known for releasing metals in indoor air of waterpipe/cigarette cafés. However, the worker exposure to metals, and its association with oxidative stress in these cafés are still unclear. To this end, 54 workers and 38 customers from waterpipe/cigarette cafés (the exposed group), 30 workers from non-smoking cafés (the control group 1 (CG_1)) and 32 individuals from the general population (the control group 2 (CG_2)) were selected and toenails samples were then taken from them. Our findings revealed a significant difference in terms of toenail-bounded metal levels between the exposure and control groups (CG_1 and CG_2) (Mann-Whitney U test, Pvalue < 0.05). This study has also indicated that "type of tobacco" could be considered as a predictor for toenail-bounded heavy metals. Furthermore, our research's results suggest that toenail-bounded heavy metals are positively and significantly correlated with urinary levels of 8- hydroxy-2'-deoxyguanosine (8-OHdG, as a biomarker for the degradation of deoxyribonucleic acid (DNA) oxidative stress). Therefore, it can be concluded that workers of waterpipe/cigarette cafés are at high risks of adverse health of DNA oxidative degradation.

Human, Forest and vegetation health metrics of ground-level ozone (SOMO35, AOT40f and AOT40v) in Tehran.

PURPOSE: We aimed to investigate the spatial O3 indices (SOMO35: annual sum of maximum daily 8-h ozone means over 35 ppb, AOT40: the accumulated exposure over an hourly threshold of 40 ppb during daylight hours between 8:00 and 20:00 in the growing seasons of plants) in Tehran (2019-2020). METHODS: The data of ambient O3 concentrations, measured at twenty-three regulatory ambient air quality monitoring stations (AQMSs) in Tehran, were obtained. RESULTS: The annual mean O3 concentrations were found to be 15.8-25.7 ppb; the highest and lowest annual mean concentration of ambient O3 were observed in Shahrdari 22 and Shahr-e-Rey stations, respectively. Spatial distribution of exposure to O3 across Tehran was in the range of 1.36-1.64; the highest O3 concentrations were observed in the northern, west and south-western parts of Tehran, while the central and south areas of Tehran city experienced low to moderate concentrations. The indices of SOMO35, AOT40f and AOT40v across AQMSs in Tehran was in the range of 1830-6437 ppb. Days, 10,613-39,505 ppb.h and 4979-16,804 ppb.h, respectively. For Tehran city, the indices of SOMO35 and AOT40f were 4138 ppb. days and 27,556 ppb.h respectively. Our results revealed that the value of SOMO35 across AQMSs of Tehran was higher than the recommended target value of 3000 ppb. days. CONCLUSIONS: To reduce O3 pollution and its effects on both human and plants health, the governmental organizations should take appropriate sustainable control policies.

Age-sex specific and sequela-specific disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation: An assessment at the national and subnational levels in Iran, 2016.

We assessed disability-adjusted life years (DALYs) due to dental caries preventable through water fluoridation apportioned by sex, age group, sequela, province, and community type in Iran, 2016. The burden of disease due to dental caries was extracted from the Global Burden of Disease Study 2016 (GBD 2016) and the caries preventive effect of water fluoridation was calculated using a database of fluoride levels in drinking water. All the preventable DALYs were caused by years lived with disability (YLDs) because of the non-fatal character of dental caries. DALYs and DALY rate (per 100,000 people) preventable through water fluoridation at the national level in 2016 were 14,971 (95% uncertainty interval 7348- 24,725) and 18.73 (9.19-30.93), respectively. The national population preventable fraction (PPF) of dental caries by water fluoridation was determined to be as high as 0.176 (0.141-0.189). The share of sequelae in the preventable DALYs at the national level were estimated to be 76.8% for edentulism and severe tooth loss, 21.4% for caries of permanent teeth, and 1.8% for caries of deciduous teeth. The national DALYs and DALY rate preventable through water fluoridation exhibited no difference by sex, but considerably increased by age from 110 (37-223) and 1.5 (0.5-3.1) for the age group 0-4 y to 4331 (2334-6579) and 88.9 (47.9-135.1) for the age group 65 y and older, respectively. Over 80% of the national preventable DALYs occurred in urban areas due to higher population and lower coverage of fluoridated drinking water. The highest provincial DALYs and DALY rate preventable by water fluoridation were observed in Tehran and Gilan to be 3776 (1866-6206) and 37.2 (18.6-60.8), respectively. The results indicated that water fluoridation can play a profound role in the promotion of dental public health and compensate the spatial inequality and increasing temporal trend of health losses from dental caries at the national level.

National and subnational mortality and disability-adjusted life years (DALYs) attributable to 17 occupational risk factors in Iran, 1990-2015.

We estimated age-sex specific and cause-specific mortality, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) attributable to 17 individual occupational risks in Iran at the national and subnational levels in 1990-2015 based on the Global Burden of Disease Study 2015 (GBD 2015). The burden of disease attributable to occupational risk factors was calculated using the comparative risk assessment methodology based on 10 outcomes and 21 risk-outcome pairs. The temporal changes in the attributable burden of disease were decomposed into the contribution of population growth, population ageing, risk-deleted DALY rate, and risk exposure. National DALYs attributable to occupational risks at the national level in 1990, 2005, and 2015 were 138,210 (95% uncertainty interval 64,429-223,028), 193,243 (91,645-310,281), and 228,310 (106,782-371,709), respectively indicating a total increase of 65% (65-67) during the study period. Between 1990 and 2015, the share of the attributable DALYs for women rose by 55% (51-58) from 13% (12-14) to 20% (19-21). The proportion of YLLs in national DALYs attributable to occupational risks during the study period slightly decreased from 24% in 1990 to 23% in 2015. The five occupational risks with the highest contributions in the national attributable DALYs in 2015 were ergonomic factors (107,490), noise (52,122), exposure to particulate matter, gases, and fumes (26,847), asthmagens (19,347), and exposure to asbestos (7842). From 1990 to 2015, the increase in total DALYs attributable to occupational carcinogens (112%) was higher than that for other occupational risks. During the study period, changes in risk deleted DALY rate and risk exposure led to decreases in total DALYs attributable to occupational risks by 14% and 30%, respectively. Based on the Gini coefficient, spatial inequality in DALY rate attributable to occupational risks at the provincial level decreased during 1990-2015. A comprehensive plan for management of exposure to occupational risks, especially occupational carcinogens can cause an important effect for control of the increasing trend of occupational health losses.

Prevalence and risk factors of asthma and allergic diseases in primary schoolchildren living in Bushehr, Iran: phase I, III ISAAC protocol.

Asthma and allergic diseases present a major health burden. Information on the prevalence of these diseases indicates that these diseases are increasing in various parts of the world. It was hoped that this study would be helpful to health system policy-makers in planning allergy prevention programs in the region.The prevalence of asthma and allergic diseases and relation between the various risk factors involved were assessed among schoolchildren in the city of Bushehr, Iran. The ISAAC Phase I and III questionnaires were completed by parents of 1280 children aged 6-7 years and self-completed by 1115 students aged 13-14 years.The prevalence of atopic eczema, allergic rhinitis and asthma among 6-7 year-old students were 12.1%, 11.8% and 6.7%, respectively. While, the prevalence of these diseases among 13-14 year-old students were found to be 19%, 30% and 7.6%, respectively. There was an association between asthma and allergic rhinitis as well as eczema (p<0.05). Consumption of fast food as a risk factor was significantly associated with asthma (p=0.03).The prevalence of asthma and allergic diseases was high among schoolchildren in the city of Bushehr, Iran. Also an association was observed between the fast food consumption and asthma.