Iranian Journal of Public Health
Volume:49 Issue: 9, Sep 2020

The main objective of this study was to review the goals and programs of rehabilitative care in different countries to achieve a framework for a national operational plan for expanding rehabilitation services in Iran.

In this qualitative study (scoping review), national rehabilitation documents were reviewed in a selected list of countries. We searched several databases including Web of Science, PubMed, Scopus, and Google Scholar and main website such as WHO. Then, the review results were presented to a panel of experts to receive their feedback and opinion for a framework of national rehabilitation policy and strategies in Iran.

In the preliminary phase, 1775 documents were found and 17 documents were selected from Asia, Europe, three islands near Australia, America, and Australia continents. National policies and programs regarding rehabilitation could be categorized in three fields: 1) Removing the barriers to access rehabilitative health services, 2) strengthening and improving rehabilitation, relevant appropriate technologies, Supportive Services, and Community Based Rehabilitation, and 3) Collecting international data on social support and improving the quality of research and services related to rehabilitation.

To achieve a successful national rehabilitation framework in any country, it is required to strengthen information and research database, implement annual monitoring of policymaking, assess the next year rehabilitation needs of society, finding causes of disabilities for effective planning.

Given   the   importance   of   proper   management   of   Health   Care   Waste   Management (HCWM), comprehensive information on interventions in this field is necessary. Therefore, we aimed to systematically review and meta-analysis of characteristics and results of interventions in the field of HCWM.

The required data were gathered through searching the keywords such as waste management, biomedical waste, hospitals waste, health care waste, infectious waste, medical waste, Waste Disposal Facilities, Garbage, Waste Disposal Facilities, Hazardous Waste Sites in PubMed, Scopus, EMBASE, Google scholar, Cochrane library, Science Direct, web of knowledge, SID and MagIran and hand searching in journals, reference by reference, and search in Gray literatures between 2000 and 2019. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis.

Twenty-seven interventions were evaluated. Most of the studies were conducted after 2010, in the form of pre and post study, without control group, and in hospital. Interventions were divided into two categories: educational interventions (19 studies) and multifaceted managerial interventions (8 studies). The most studied outcome (in 11 studies) was KAP (knowledge, attitude and practice). The mean standard difference of interventions on KAP was estimated 3.04 (2.54–3.54) which was significant statistically (P<0.05). Also, interventions were considerably effective in improving the indicators of waste production amount, waste management costs and overall waste management performance.

Despite positive effect of interventions, due to the methodological deficiencies of published studies and high heterogeneity in results of studies, caution should be exercised in interpreting and using the results of the studies.

We aimed to determine the accuracy of self-reported diabetes, hypertension, and hyperlipidemia in Chinese adults and examine factors that affect the accuracy of self-reports.

This representative cross-sectional survey was conducted in Liwan District, Guangzhou City, Southeast China. Self-reported data were collected using a structured questionnaire. Biometrical data were recorded, including blood lipid, blood glucose and arterial blood pressure levels. Sensitivity, specificity, and κ values of self-reports were used as measurements of accuracy or agreements. The Robust Poisson-GEE was applied to determine the association of participants’ characteristics with the accuracy of self-reports.

Self-reported and biometrical data of 1278 residents aged 18 yr and older (693 women and 585 men) were used to calculate three measures of agreement. The agreement between self-reports and biomedical measurements was substantial for both hypertension and diabetes (κ=0.77 and 0.76), but only slight for hyperlipidemia (κ=0.06). Similarly, the sensitivity was higher for hypertension and diabetes (72.3% and 71.2%) than for hyperlipidemia (6.8%), while the specificity was high overall (≥98%). The factors associated with an accurate self-reported diagnosis in respondents with disease included having undergone blood pressure measurement (for hypertension) or blood glucose measurement (for diabetes) in the past 6 month, having attended health knowledge lectures in the past year and having social health insurances (for hypertension), and having undergone physical discomfort in the past 2 weeks (for hypertension and diabetes).

The accuracy of self-reported hypertension and diabetes was high, whereas that of self-reported hyperlipidemia was lower among the population.

Gait mechanism due to overloaded weight of the obese may be altered, but yet uncertain whether an added loaded weight on body weight can alter or not gait characteristics.

We applied with 0 kg (no load), 5 kg, 10 kg, and 15 kg of the load carriage respectively on the obese (n=11) to grasp a mechanism on the control of impact types and dynamic stability during gait. Gait characteristics was analyzed with three-dimensional cinematography and ground reaction force system consisted of a length of 1 stride, mean velocity of center of gravity during supporting phase, breaking force, propulsive force, dynamic posture stability index (DPSI), and extrapolated centre of mass (XCoM) respectively. We performed repeated measures one-way analysis of variance (0 kg, 5 kg, 10 kg, and 15 kg) and performed the post hoc test (Duncan) at (P<0.05) in case of significant level respectively.

Onestride length and mean velocity were decreased according to gradual increase of a load carriage, but breaking and propulsive force were somewhat increased. Particularly a decrease of gait velocity and stride length kept the range for DPSI and XCoM theta of a level of no-load carriage.

Usually load carriage during prolonged time of the obese is few case, but rather a load carriage of 5 kg may alter a gait posture potentially with prolonged time of load carriage.

To explore the effect of the "Yilian Family Medical Health Service Platform" used by cardiology nurses on the health education of cardiovascular patients.

Overall 380 patients with coronary heart disease were selected from the Second Hospital of Dalian Medical University, Dalian China in 2019. They were divided into control group (190 cases) and observation group (190 cases) according to the method of digital random allocation. The traditional discharge health education model was used in control group, that is, oral education before discharge. On the basis of traditional health education, the "Yilian Family Medical Health Service Platform" was recommended in the observation group. Patients could use the platform to communicate and consult with the family doctor team. The awareness of disease and medication, compliance, incidence of rehospitalization, and satisfaction with nursing work were compared in the two groups after discharge from the hospital.

The experimental group was significantly better than the control group in terms of disease awareness, medication adherence, return visits, and rehospitalization (P <0.05).

The "Medical Federation Family Medical Health Service Platform" could be used by nurses as a continuation of health education for patients with cardiovascular disease after discharge from the hospital. It can promote patient recovery, improve medication compliance, reduce the rate of rehospitalization, and obviously improve patients’ satisfaction to the nursing staff.

Identifying risk factors associated with mortality is important in providing better prognosis to patients. Consistent with that, Bayesian approach offers a great advantage where it rests on the assumption that all model parameters are random quantities and hence can incorporate prior knowledge. Therefore, we aimed to develop a reliable model to identify risk factors associated with mortality among ST-Elevation Myocardial Infarction (STEMI) male patients using Bayesian approach.

A total of 7180 STEMI male patients from the National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry for the years 2006-2013 were enrolled. In the development of univariate and multivariate logistic regression model for the STEMI patients, Bayesian Markov Chain Monte Carlo (MCMC) simulation approach was applied. The performance of the model was assessed through convergence diagnostics, overall model fit, model calibration and discrimination.

A set of six risk factors for cardiovascular death among STEMI male patients were identified from the Bayesian multivariate logistic model namely age, diabetes mellitus, family history of CVD, Killip class, chronic lung disease and renal disease respectively. Overall model fit, model calibration and discrimination were considered good for the proposed model.

Bayesian risk prediction model for CVD male patients identified six risk factors associated with mortality. Among the highest risks were Killip class (OR=18.0), renal disease (2.46) and age group (OR=2.43) respectively.

We aimed to determine the socio-economic factors associated with unmet healthcare needs of the population aged 20 and over in Serbia.

We used data from the 2013 National Health Survey (NHS) of the population of Serbia. We focused only on the data concerning the population aged 20 and over. The final sample thus included 13,765 participants. The logistic regression was used to examine the socio-economic factors associated with unmet health care needs.

According to the data obtained in this study, 26.2% of the population aged 20 and over reported unmet health care needs during the previous 12 months. The multivariate analysis shows that significant indicators of unmet healthcare needs include: gender, age, marital status, level of education, financial and employment status.

Females, the elderly and those with the lowest levels of education and household income, as well as those who are divorced and unemployed are at highest risk of unmet healthcare needs. Different policies and approaches should be taken into consideration when it comes to vulnerable population groups in order to reduce the currently existing gaps to a minimum and provide more equal opportunities for health care to all citizens.

To explore the effect of nursing quality management on the nosocomial infection rate and Psychology State of patients with burn and plastic surgery.

Overall, 92 patients with burn and plastic surgery admitted to Qilu Hospital, Jinan, China from Apr 2017 to Jul 2018 were selected, in which 46 cases were randomly selected as a control group for routine nursing management, and another 46 cases as a research group to strengthen nursing quality management. The incidence of nosocomial infection, nursing satisfaction and nurse-patient disputes were compared. MMAS-8 scale was used to compare the compliance of the two groups. SAS and SDS score were used to compare the psychological status. The recovery and discharge were compared.

The incidence of nosocomial infection in the study group was significantly lower than that in the control group (P<0.05). The total satisfaction rate of the study group was significantly higher than that of the control group (P<0.05). The incidence of nurses-patients disputes was significantly lower than that of the control group. The SAS and SDS score of the study group were significantly better than the control group (P<0.05). The healing time, blood circulation recovery time of skin wounds and discharge time in the study group were significantly better than those in the control group.

Strengthening nursing quality management can effectively reduce the nosocomial infection rate of burn and plastic surgery. It helps to further accelerate the recovery of patients and make patients’ psychological state better.

Despite the awareness that regular exercise has a positive impact on maintaining health, patients with rheumatoid arthritis (RA) engage in markedly less exercise than do the general population. Weaimed to construct and test a structural equation model of exercise behavior in patients with RA based on self-determination theory and self-efficacy theory.

Participants were 214 outpatients with RA at Chonnam National University Hospital located in the Gwangju City, South Korea from Mar to Apr 2018. A structured self-report questionnaire was used to assess autonomy support, autonomy, competence, relatedness, autonomous motivation, self-efficacy, and exercise behavior. Collected data were analyzed using SPSS 22.0 and AMOS 22.0 program.

The structural model showed a good fitness with the data (χ2= 727.27, df = 392, P<0.001, TLI = 0.92, CFI = 0.93, RMSEA = 0.07, SRMR = 0.07). Autonomous motivation and self-efficacy had a significant effect on exercise behavior in patients with RA. This model explained 21.2% of the variance of exercise behavior in patients with RA.

Self-efficiency and autonomous motivation should be promoted in order to strengthen the exercise behavior of patients with RA.

Drowsiness condition is one of the significant factors often encountered when an accident occurs. We aimed to detect a method to prevent accidents caused by drowsiness and lost a focused driver.

The image processing technique has been capable of detecting the characteristic of drowsiness and lost focus driver in real-time using Raspberry Pi. Video samples were processed using the Haar Cascade Classifier method to identify areas of the face, eyes, and mouth so that drowsy conditions. The methods can be determined based on the bject detected.

Two parameters were determined, the lost focused and drowsiness driver. The highest accuracy value for driver lost focused detection was 88.00%, while the highest accuracy value for drowsiness driver detection was 90.40%.

In general, a system developed with image processing methods has been able to monitor the drowsiness and lost focused drivers with high accuracy. This system still needs improvements to increase performance.

To investigate the expression levels of miRNA-29a (miR-29a), tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) in peripheral blood of pulmonary tuberculosis patients and their correlation with clinical and pathological features.

A prospective analysis was performed on 192 pulmonary tuberculosis patients (pulmonary tuberculosis group) and 186 healthy patients (control group) who were admitted to Beijing Chest Hospital, Capital Medical University, Beijing, China from Jun 2015 to Jun 2019. Real-time quantitative PCR was used to detect the expression levels of miR-29a, and ELISA to detect the concentrations of TNF-α and VEGF in serum. The diagnostic value of miR-29a, TNF-α and VEGF in tuberculosis was analyzed using receiver operating characteristic curve (ROC). The correlation of the expression levels of miR-29a, TNF-α and VEGF with gender, age, low-grade fever, expectoration, hemoptysis and pulmonary tuberculosis classification was analyzed.

The expression levels of miR-29a, TNF-α and VEGF in pulmonary tuberculosis group were significantly higher than those in control group (P<0.001). The area under curves of miR-29a, TNF-α, and VEGF were 0.818, 0.743, and 0.805, respectively. miR-29a was closely correlated with low-grade fever, expectoration, hemoptysis and pulmonary tuberculosis classification (P<0.050). TNF-α and VEGF were closely correlated with patient age, low-grade fever, expectoration, hemoptysis and pulmonary tuberculosis classification (P<0.050).

Highly expressed in pulmonary tuberculosis patients, TNF-α and VEGF are closely correlated with the disease progression of patients, expected to become targets for the diagnosis and treatment of pulmonary tuberculosis in the future.

The incidence rate of depression in youth demographic increases year by year. High-level psychological capital is conducive to relieving depression, and mindfulness training is an effective psychotherapy. We aimed to investigate the influences of mindfulness training on psychological capital, depression, and procrastination, thereby providing a direction for psychotherapy in the youth demographic.

A questionnaire survey on the youths in four resident communities in the cities of Wuhan and Tai’an in China was carried out in 2020 by sending a self-rating depression scale (SDS). A total of 240 youth with SDS standard scores >53 were filtered out, as the research objects to be assessed by using SDS, positive psychological capital questionnaire (PPQ), five-facet mindfulness questionnaire (FFMQ), and pure procrastination scale (PPS).

Two groups showed no statistically significant differences in SDS, PPQ, FFMQ, and PPS scores before intervention. Self-efficacy, toughness, hope, optimism, and PPQ scores of the experimental group were improved significantly after intervention compared with those before the intervention, and they were significantly higher than those of the control group (P<0.05). SDS, PPQ, FFMQ, and PPS scores showed statistically significant differences before and after intervention. SDS and PPS scores of the experimental group after intervention were far lower than those of the control group, while FFMQ score was significantly higher than that of the control group (P<0.05).

Mindfulness training can improve psychological capital of the youth demographic effectively and relieve their depression, thereby improving their procrastination.

We aimed to identify the association between sleep problems and sedentary behaviors during work among Korean workers.

We employed a cross-sectional survey, and analyzed data from the 5th Korean Working Conditions Survey, conducted in 2017. The participants were 50,205 workers aged 15 years and above. The data were analyzed using Pearson’s correlation, chi-square distribution, and logistic regression.

Sleep problems occurred more frequently among female participants with higher ages; those with low educational levels; skilled agricultural, forestry, and fishery workers; elementary workers; and service and sales workers. With general characteristics as control variables, it was found that the odds of sleep problems were 5.547 times higher if the duration of sedentary behavior was longer.

It is important to improving work environment and provide education on various physical activities for workers with a long duration of sedentary behaviors to reduce sleep problems among them.

We examined whether multidimensional poverty index (MPI) explained variations in life expectancy (LE) better than income poverty; and assessed the relative importance of MPI indicators in influencing LE.

Cross-sectional data from 62 developing countries were used to run several multivariate linear regressions. R2 was used to compare the powers of MPI with income-poverties (income poverty gaps [IPG] at 1.9 and 3.1 USD) in explaining LE.

Adjusting for controls, both MPI (β =-0.245, P<0.001) and IPG at 3.1 USD (β=-0.135, P=0.044) significantly correlates with LE, but not IPG at 1.9 USD (β=-0.147, P=0.135). MPI explains 12.1% of the variation in LE compared to only 3.2% explained by IPG at 3.1 USD. The effect of MPI on LE is higher on female (β=-0.210, P<0.001) than male (β=-0.177, P<0.001). The relative influence of the deprivation indictors on LE ranks as follows (most to least): Asset ownership, drinking water, cooking fuel, flooring, child school attendance, years of schooling, nutrition, mortality, improved sanitation, and electricity.

Interventions to reduce poverty and improve LE should be guided by MPI, not income poverty indices. Such policies should be female-oriented and prioritized based on the relative influence of the various poverty deprivation indicators on LE.

We aimed to identify incidence rates of disability and its associated factors among Korean community-dwelling older adults.

The sample included 1,739 Koreans aged over 65 yr from the Korean Longitudinal Study of Aging (2006-2016) who reported no limitations in activities of daily living (ADL) or instrumental activities of daily living (IADL) at baseline (2006) and had complete data for other covariates. ADL, IADL, socio-demographic, lifestyle, and health-condition data were collected and analyzed using multiple logistic regression models.

The 10-yr incidence rates of ADL and IADL disability in subjects with no disability at baseline were 11.6% and 21.6%, respectively. After adjusting for socio-demographic, lifestyle, and health-condition factors, the incidence of ADL disability was higher in women (odds ratio [OR] =1.418, 95% confidence interval [CI]=1.102-2.613) and increased with age (OR=1.170, 95% CI=1.133-1.208), multi-morbidity (OR=1.194, 95% CI=1.015-1.406), and obesity (OR=1.563, 95% CI=1.057-2.311). It decreased in subjects living alone (OR=0.531, 95% CI=0.328-0.856). The incidence of IADL disability increased with age (OR=1.131, 95% CI=1.102-1.161), multi-morbidity (OR=1.199, 95% CI=1.054-1.365), and cognitive disability (OR=1.422, 95% CI=1.083-1.866) and decreased for subjects living alone (OR=0.484, 95% CI=0.328-0.715) and with overweight (OR=0.725, 95% CI=0.532-0.988).

Incidence rates of disability differed considerably based on socio-demographic, lifestyle, and health-condition factors. These results suggest the importance of identifying factors that can decrease the risk of disability in this group and of prevention efforts in populations with a higher disability risk.

Advanced maternal age (AMA) is considered a risk factor associated with preeclampsia and adverse pregnancy outcomes. We aimed to assess the mediating role of preeclampsia between AMA and adverse pregnancy outcomes.

A sample of 14646 pregnant women from the tertiary hospital of Hubei Province, China, during the years 2011-2017 were included in this study. Pregnant women were divided into 4 groups according to their age at delivery. Mediated effect of preeclampsia with relation to AMA and adverse pregnancy outcomes was measured using structural equation modeling.

Women in the highest age group were significantly associated with preterm delivery [RR 1.37 (95% CI 1.24 - 1.49)] and low birth weight [RR 1.28 (95% CI 1.11 - 1.45)] compared with women in the lowest age group. The indirect effect (mediated effect) of AMA on preterm delivery and low birth weight mediated by preeclampsia was [β 0.053 (95% CI: 0.047, 0.060)], and [β 0.045 (95% CI: 0.038, 0.052)], respectively. The estimated mediation proportion of the effect of AMA due to mediated effect of preeclampsia was (35.5%) for preterm delivery and (23.5%) for low birth weight.

Preeclampsia partially mediates the association between AMA and adverse pregnancy outcomes.

Human papillomavirus (HPV) has been found as the most considerable causes of cervical cancer. Recently, several molecular methods have been introduced to increase the accuracy of the screening programs and decrease the mortality rate. Among these methods, mRNA-based methods have more advantages as they assess the expression level of HPV E6 and E7 oncogenic mRNAs. This study aimed to evaluate the results of HPV RNA- and DNA-based methods among Iranian women population with normal cytology results.

Overall, 4640 women were enrolled referred to the Gynecology Oncology Ward of Vali-e-Asr Hospital, private and academic clinics, Tehran, Iran from Jan 2016 to Apr 2018. To assess the HPV-DNA infection INNO-LiPA® HPV Genotyping Extra-II kit was used. For HPV-RNA assessment, Aptima HPV Assay and in house HPV-RNA genotyping methods were applied.

The positivity rates of HPV infection according to DNA- and RNA-based methods were 18.0% and 11.2%, respectively (P<0.001). The positive predictive value, negative predictive value, specificity and sensitivity of DNA-based method in contrast with RNA-based method were 59.2% (56.6-61.6), 99.4% (99.0-99.6), 91.7% (90.8-92.6) and 95.2% (93.0-96.9) respectively.

At the present study for prognosis of cervical cancer, RNA-based method seemed to be more specific in contrast to DNA-based method. Patient follow up and further studies will be conducted in order to clarify the clinical sensitivity and specificity of the two methods.

Escherichia coli as one of the most predominant pathogens is the major cause of ‎urinary tract infections (UTI) worldwide. E. coli strains could be classified into distinct phylo-groups based on PCR method. Additionally, studying the antimicrobial resistance profiles of these strains is essential for finding the effective selection of treatment and evaluating the differences among resistance patterns of particular phylogenetic groups. This study aimed to determine the phylogroups of E. coli isolated from patients with UTI in Tehran, Iran.

The urine samples were collected from patients suspected to UTI from four hospitals in Tehran, Iran; Mofid, Vali-Asr, Bu-Ali and Tehran Heart Center (THC) Hospitals during 2014-2016. Assessing the ‎antimicrobial resistance profile of the identified strains was accomplished using ampicillin, ‎ceftriaxone, cefotaxime, and ceftazidime among β-lactam group; gentamicin, and ‎streptomycin among aminoglycosides; nalidixic acid and norfloxacin from quinolones; and ‎chloramphenicol disks. The phylogenetic characterization of 60 E. ‎coli isolates obtained from patients with UTI was done by triplex PCR method.

E. coli strains showed high resistance toward streptomycin (93.33%), ampicillin (86.6%) and nalidixic acid (73.33%) while resistance against chloramphenicol showed the lowest (10%). The prevalent groups were B2 (n=50/60, 83%), followed by D (n=6/60, 10%), B1 (n=3/60‎‏‎, 5%), and A (n=1, 1.6%).

The most predominant phylogenetic group was B2 with the major frequent detected with ‎the major drug resistant (48%) compared to other Phylogenetic groups.

The study aimed to assess affecting structural factors on the entrepreneurship behavior of the academic members of healthcare in Qazvin University of Medical Sciences, Central Iran.

This was a descriptive, cross-sectional study conducted among faculty members working in five faculties of Qazvin University of Medical Sciences, Iran in 2018. Data were collected using a three-part standard questionnaire including demographic characteristics, entrepreneurial behavior and structural factors questions. ANOVA and linear regression modeling were used in STATA software version 14.

Of 270 academic staff who participated in the study, 204 (73%) completed the questionnaire. The mean score reported for entrepreneurial behavior was 3.76±0.55 considered high tendency toward entrepreneurship. Moreover, the average conditions of the structural elements have been 2.51±0.89 considered average. Linear regression analysis showed that along with increasing age, entrepreneurship behavior increased (P=0.018, β=0.52), while an increase in educational level led to a decrease in entrepreneurship behaviour (P=0.001, β=-0.74). In a final model, organizational structure revealed a significant effect on entrepreneurship behavior (P<0.001, β=0.25). Only physical facilities didn't show a statistical significant effect on entrepreneurship score (P>0.05).

Universities must also pay attention to acquiring and developing the science and technology gained from academic research and transferring them through entrepreneurship channels. Considering the effect of structural elements on entrepreneurial behavior of the academic members, the need for such substructure in the universities and the country’s higher education organizations to assist development of entrepreneurial behavior among the academicians is greatly felt.

Human Echinococcosisis a cyclo-zoonotic infection caused by tapeworms of the Echinococcus granulosus sensu stricto complex. The detection of mitochondrial genome data of genus Echinococcus can reflect the taxonomic status, genetic diversity, and population structure genetics.

Totally, 52 formalin-fixed paraffin-embedded (FFPE) tissue samples from patients with histologically confirmed CE were collected from Mazandaran province, Iran in the period of Mar 1995 to May 2018. All extracted DNAs from (FFPE) tissue samples were subjected to amplify by polymerase chain reactions method targeting cytochrome c oxidase subunit 1 (cox1) gene. All PCR amplicons were sequenced to phylogenetic analysis and genetic diversity.

Molecular analysis showed that 50(96.1%) and 2 (3.84%) isolates were identified as G1 andG3 E. granulosus genotypes, respectively. DNA sequence analyses indicated a high gene diversity for G1 (Haplotype diversity: 0.830) and G3 genotypes (Hd: 1.00). Based on multiple sequence alignment analyses, 7 (13.46%; G1 genotype) and 2 (3.84%; G3 genotype) new haplotypes were unequivocally identified.

G3 genotype (Buffalo strain) was identified from two human hydatidosis isolates in the region. Present study strengthens our knowledge about taxonomic status, transmission patterns of Echinococcus parasite to human and heterogeneity aspects of this parasite in clinical CE isolates of Northern Iran.

The purpose of this study was to investigate the role of eotaxin family members including C-C motif chemokine 11 (CCL11), C-C motif chemokine 24 (CCL24), and C-C motif chemokine 26 (CCL26) as the subgroups of CC-chemokine in patients affected with osteoporosis and osteopenia.

Overall, 19 osteoporotic patients, 18 osteopenic individuals, and 20 healthy subjects were recruited in this study. The bone mineral density (BMD) was then measured at the lumbar spine (L1-L4) and the hip (femoral neck and total hip) using dual-energy X-ray absorptiometry for diagnosis of bone density and related disorders. Additionally, enzyme-linked immunosorbent assay (ELISA) technique was employed to measure the serum levels of CCL11, CCL24, and CCL26.

The circulating levels of CCL11, CCL24, and CCL26 had been increased in both groups of patients with osteopenia and osteoporosis compared to those in healthy subjects (P<0.05); while no significant difference was observed between serum levels of these chemokines in such patients.

Eotaxins can play a role in the pathogenesis of osteoporosis and osteopenia; however, further studies are needed to clarify various roles of eotaxins in the pathophysiology of osteoporosis and osteopenia.

The prevalence of HIV/AIDS has been increasing in Iran, especially amongst the young population, recently. The joint model (JM) is a statistical method that represents an effective strategy to incorporate all information of repeated measurements and survival outcomes simultaneously. In many theoretical studies, the population under the study were heterogeneous. This study aimed at comparing three approaches by considering heterogeneity in the patients.

This study was conducted on 750 archived files of patients infected with HIV in Fars Province, southern Iran, from 1994 to 2017. Proposed Approach (PA), Joint Latent Class Models (JLCM), and Separated Approach (SA) were compared to evaluate the influence covariates on the longitudinal and time-to-event outcomes in the heterogeneous HIV/AIDS patients.

Gender (P<0.001) and HCV (P<0.01) were two significant covariates in the classification of HIV/AIDS patients. Time had a significant effect on CD4 (P<0.001) in both classes in the three approaches. In PA and SA, females had higher CD4 than males (P<0.001) in the first class. In JLCM, females had higher CD4 than males (P<0.01) in both classes. The patients with higher Hgb had also higher CD4 (P<0.001) in both classes in the three approaches. HCV reduced the CD4 significantly in both classes in PA (P<0.05) and SA (P<0.001). Within the survival sub-model, HCV reduced survival rate significantly in the second class in PA (P<0.05), JLCM (P<0.01) and SA (P<0.001).

PA was an appropriate approach for joint modeling longitudinal and survival outcomes for this heterogeneous population.

We aimed to explore the correlation between the time and risk preferences and the smoking behavior of adult population in western Iran.

Overall, 792 individuals with the age of 35 to 65 yr participating in an ongoing national cohort study (Persian Cohort) were approached to complete a pre-structured questionnaire in 2017. Time preferences were measured using a standard choice-based method. The individuals' discount rates were identified by questions that offered binary monetary choices on immediate future and distant future, by making trade-offs between them. Probit regression model was used to investigate the relationship between time preferences and smoking when controlling for demographic and socioeconomic variables.

Time and risk preferences had statistically significant direct correlations with smoking. A unit increase in discount rate was associated with a 4.4% percentage point increase in the likelihood of being smoker. A present-biased individual had 5.7% percentage points lower likelihood of being smoker. Moreover, a unit increase in willingness to take the risk increased the likelihood of being a smoker by 1.5% percentage points.

Time and risk preferences are important determinants of smoking behavior. These factors should be considered in designing effective prevention and control programs. Policies that increase the immediate costs of cigarette smoking or the immediate benefits of smoking cessation are likely to have a greater impact on reducing the prevalence of cigarette smoking.