Iranian Journal of Public Health
Volume:49 Issue: 11, Nov 2020

COVID-19 is a public health emergency of international concern. Its incidence rates and mortality are very high; however, so far, an effective drug treatment remains unknown. Based on the role of convalescent plasma therapy in previously identified viral pneumonias, patients with severe COVID-19 have been given this therapy. This systematic review and meta-analysis aimed to summarize the clinical evidence regarding the efficacy and safety of convalescent plasma therapy in the treatment of severe COVID-19.

PubMed, Embase, Ovid, China Knowledge Network, China Biomedical, VIP Chinese Sci-tech Journal, Wanfang Database, and the International Clinical Trials Registry Platform were searched up to 21 June 2020, to identify clinical studies and registered trials on the use of convalescent plasma in the treatment of critically ill patients with COVID-19. Stata 13.0 was used to perform Meta-analysis. All records were screened as per the protocol eligibility criteria.

Nineteen clinical reports regarding convalescent plasma in the treatment of severe COVID-19 were included. Through systematic analysis, convalescent plasma was found to yield some efficacy on severe COVID-19 and had almost no obvious adverse reactions.

Convalescent plasma therapy seems to yield some efficacy among patients with severe COVID-19 and almost no obvious adverse reactions were found. However, at present, the clinical evidence is insufficient, and there is an urgent need for support from high-quality clinical trial data.

The coronavirus disease-19 (COVID-19) negatively affects immune system. It is linked with adverse pregnancy outcomes. These complications may be linked with the infections mediated deficiency of micronutrients in pregnant women. COVID-19 cause’s malabsorption of micronutrients thereby increases the risk of their deficiency. Both micronutrients deficiencies and poor micronutrients intake can compromise immune function and may increase the risk of pregnancy complications associated with COVID-19 infection. Vitamin A, C, D, E, and selected minerals iron (Fe), selenium (Se), and zinc (Zn) are the micronutrients essential for immuno-competency and play a significant role in the prevention of adverse pregnancy outcomes. Immune function and pregnancy outcomes can be improved by adequate intake of micronutrients in diet or in supplements form. Based on regulatory links between viral infection, micronutrients, immunity, and pregnancy outcomes, this review highlights the role of micronutrients in boosting immunity to reduce or prevent pregnancy complications in COVID-19 infected women.

Glucose transporter-1 (GLUT-1) has been differentially expressed in various malignancies including gastric cancer (GC). Several previous meta-analyses of GLUT-1 have some significant limitations, such as researching the association between GLUT-1 and various cancer types with no specificity, not studying clinicopathological parameters with GLUT-1, existing conspicuous heterogeneity and so forth. Therefore, we performed a meta-analysis to evaluate the association between GLUT-1 expression and survival of gastric cancer patients, as well as clinicopathological characteristics.

We systematically searched PubMed, Embase, Web of Science and China National Knowledge Infrastructure for relevant studies in accordance with the applicable criteria up to Aug 2017. Hazard ratios (HRs) and odds ratios (ORs) with their 95% confidence intervals (CIs) were used as the effective measures.

A total of 13 studies involving 1972 patients were included in this meta-analysis. The results demonstrated that there was a significant association between GLUT-1 expression and overall survival (OS) (HR=1.45, 95% CI=1.13-1.87) or disease-free survival (DFS) (HR=2.18, 95% CI=1.46-3.25). Moreover, GLUT-1 expression was significantly correlated with worse tumor nodes metastases (TNM) stage (OR=0.34, 95% CI=0.28-0.43), presence of lymph node metastasis (OR=2.88, 95% CI=1.34-6.19), intestinal type of Lauren classification (OR=3.84, 95% CI=2.57-5.74) and invasion of serosa (OR=0.25, 95% CI=0.18-0.35).

Our meta-analysis showed that GLUT-1 was significantly correlated with poor OS and DFS in gastric cancer. Additionally, GLUT-1 was also a potential prognostic indicator of aggressive clinicopathological parameters in gastric cancer.

To the ultimate overall goal to train sufficient numbers of highly qualified general practitioners. We analyzed the recent study on the necessity of medical humanities education for general practitioners and the status of the humanities education of general practitioners. Meanwhile, the model of medical humanities education for general practitioners in China in the future is prospected, with the support of the general practice departments in comprehensive tertiary hospitals. Improving the training mode of general practitioners is performed by a combination of enhancing their clinical skills and medical humanity education, cultivating high-quality general practice faculty by the use of innovative teaching methods. General practitioners need to have a comprehensive understanding of patients and their needs, integrate the whole process of "seeing patients" and "seeing people", consider the best interests of patients, and adopt the most effective treatment plan, which involves human value care and reflects medical humanistic quality. Therefore, general practitioners should have medical humanistic education. The general practice education system in the developed countries in Europe and America is relatively mature, and the medical humanistic quality education of general practitioners is explored early. On the other hand, in mainland China, general practice starts late and develops slowly, and the medical humanistic quality of general practitioners is not sufficiently paid attention to. Currently, there are still many problems to be further addressed and resolved.

The Coronavirus disease 2019 (COVID-19) pandemic outbreak has led to travel bans and restricted social contact. Sudden decrease of social activities can easily trigger social anxiety, especially for community youths. Existing studies have inconclusive results regarding whether the development of youths’ social anxiety can be predicted by psychological capital. This study aims to clarify the influence mechanisms of psychological capital and coping style on social anxiety during the COVID-19 pandemic outbreak.

 Overall 600 community youths with ages of 18–22 yr in Northeast China were randomly selected and voluntarily answered the online questionnaire survey in Mar 2020. General information questionnaire form, positive psychological capital questionnaire, social interaction anxiety scale, and simple coping style questionnaire were used to obtain the participants’ information.

Psychological capital has a medium negative correlation with social anxiety, low positive correlation with positive coping (r = −0.42, 0.38), and low negative correlation with negative coping (r = −0.19). Social anxiety is negatively correlated with positive coping to a small degree and positively correlated with negative coping at a medium level (r = −0.16, 0.43). Positive coping has a low positive correlation with negative coping (r = 0.13). Positive coping and negative coping play partial mediating roles between psychological capital and social anxiety, with mediating effect values of −0.03 and 0.01, respectively.

Youth’s psychological capital is closely associated with coping style and social anxiety. In addition to its direct bearing on social anxiety, psychological capital influences social anxiety through the mediating effect of coping style.

Internet addiction and poor mental health are two pervasive problems during adolescence. This study aimed to determine whether Internet addiction and poor mental health status exhibited a bidirectional relationship in which either variable could become a risk factor for the onset of the other.

Longitudinal school-based survey with a baseline sample of 1547 students among 8 schools (10th graders) in Japan surveyed in 2015 and followed up 1 year later. The schools are located in the middle city. We assessed internet addiction using the Japanese version of the Diagnostic Questionnaire developed by Young and mental health status using the 12-item General Health Questionnaire. Regression analyses including the covariates tested whether Internet addiction was related to the onset of poor mental health among youth who had never internet addiction, and poor mental health was related to the onset of internet addiction.

The incidence for Internet addiction and poor mental health during one year were 22.0% and 8.8%, respectively. Multiple regression analyses showed that poor mental health (adjusted odds ratio: 2.17 [95%CI: 1.45–3.25]) promoted new onset of Internet addiction and Internet addiction (adjusted odds ratio: 2.39 [95%CI: 1.36–4.20]) also promoted new onset of poor mental health.

Internet addiction and poor mental health status each increased the risk of onset of the other. Adolescents, their parents and schools need to take policies to use properly Internet.

We investigate the effects of NFκB inhibitor pyrrolidinedithiocarbamic acid ammonium salt (PDTC) on the viability, apoptosis and cell phenotype of HK-2 cells in the co-culture system of myeloma cells in renal tubular epithelial cells.

This study was performed in Qiqihar Medical University, Qiqihar, China from Jun 2018 to Jan 2019. RPMI-8226 cells and HK-2 cells were inoculated in the co-culture chamber and cultured to establish the co-culture system. An immunoturbidimetric assay was performed to detect κ light chain and λ light chain in RPMI-8226 cells. The effect of PDTC on the secretion of κ light chain and λ light chain of RPMI-8226 cells was detected by immunoturbidimetry and the ratio was calculated.

PDTC significantly increased the viability of HK-2 cells. PDTC reduced the apoptosis of renal tubular epithelial cells. After PDTC treatment, the expression of cell surface marker E-cadherin decreased, and the expression of α-SMA increased, which induced the renal interstitial fibrosis. The secretion of κ light chain and λ light chain of RPMI-8226 cells was significantly decreased after the addition of PDTC, but the ratio was not changed.

PDTC can inhibit the cell activity, promote apoptosis, and reduce the secretion of secretion of κ light chain and λ light chain through inhibiting the NF-κB pathway activation of myeloma cell RPMI-8226.

This study investigated the effect of sodium bicarbonate (HCO3-) intake on maximum muscle strength variables during eight weeks of high-intensity exercise of a sprinter.

The study was conducted on 30 elite sprint athletes in Seoul, Republic of Korea as in 2016 with ≥3 yr of an athletic career by assigning 10 each to three groups (the control, training, and sodium bicarbonate-training combination groups [HCO3- and training group]). The training group and the HCO3- and training group participated in a high-intensity exercise program for 90 min per session, five days a week for eight weeks in total, and it involved 80%-90% heart rate max intensity increase every 2-3 weeks, and allocation of internal exercise, aquatic exercise, and hill exercise. HCO3- was provided to the HCO3- and training group, and involved an intake of 300 g of HCO3- per 1 kg body weight, once a day, 90 min prior to the high-intensity exercise program for eight weeks.

HCO3- intake during high-intensity training had a positive effect on maximum muscle strength. A positive effect was observed in the HCO3- and training groups; however, the effect on maximum muscle strength was stronger in the HCO3- and training groups. In particular, the effect on maximum muscle strength was observed during extension than during flexing starting from the fourth week of the exercise program with HCO3- intake.

HCO3- intake during 8 weeks of high-intensity training began to have a positive effect on maximum muscle strength. Therefore, HCO3- intake during high-intensity exercise is effective in improving exercise capacity.

We aimed to explain health symptoms and health literacy on the use of pesticides, investigate predicting factors and to formulate the health literacy model for the appropriate use of pesticides by cornfield farmers in the northern of Thailand.

The reliability and validity from 246 samples were selected by proportional stratified random sampling. Data were collected through a questionnaire in 2016 in Phayao province and were analysed by descriptive statistics and logistic regression.

 All of samples exposed from paraquat, the mean years of farm experience were 14.1 yr and five groups of health symptoms from pesticides were muscle and skeleton, epithelial/ mucosal, neurobehavioral, gastrointestinal and endocrine group. The predicting factors had influenced the health literacy of cornfield farmers regarding the use of pesticides were as following: 1) attitude on pesticides exposure (OR= 1.43, CI=1.26-1.64), 2) prevention of the practice of pesticides exposure(OR= 1.03, CI=1.01-1.05) 3) outcome of the expectation on the prevention of pesticides exposure (OR= 0.584, CI=0.41-0.82), 4) the number of secondary occupation(OR= 0.58, CI=0.38-0.89). These affecting factors were considered for the construction of a health literacy model on the use of pesticides. It could predict the model at 42.5%. The health literacy model could be equal to constant (6.85) + attitude on pesticides exposure (0.36) + behavior on the prevention of pesticides exposure (0.03) – outcome expectation on the prevention of pesticides exposure (0.54)- frequency of secondary occupation (0.53).

We recommend intervention of attitude, practice, outcome expectation and occupation to set up policy for health services among cornfield farmers.

To study the anti-cancer effect of isoalantolactone, a sesquiterpene    lactoneisolated from the roots of Inula heleniumon human gynecologic cancer cells.

A structure-activity relationship experiment was designed to identify the functional moiety of isoalantolactone for its significant anti-cancer activity. Five gynecologic cancer cell lines were treated with isoalantolactone. Cell proliferation was determined by MTT assay in vitro and cell apoptosis by flow cytometry.

We found isoalantolactone strongly inhibited the cell proliferationofHEC-1, HAC-2, HOC-21, and HeLa cells. Its inhibitory effect was comparable to that of well-known chemotherapeutic agents, cisplatin and taxol. Furthermore, isoalantolactone induced apoptosis in HeLa cells via caspase. On the contrary, its 11, 13-dihydro derivatives had much weaker anti-proliferative activities than the parent compound.

Isoalantolactone exhibited strong anti-proliferative activities and apoptosis-inducing effects on gynecologic cancer cells. The 11, 13-dehydro lactone moiety was critical for its anti-proliferative activity.

In recent years, Facebook has increasingly become an essential part of the lives of people, particularly youths, thus many research efforts have been focused on investigating the potential connection between social networking and mental health issues. This study aimed to examine the relationship between Facebook use, emotional state of depression, and family satisfaction.

This study used the online survey created in Google Docs on the Facebook ‘wall’, as research method. The survey was available during Jun-Jul 2015 in Romania. In our cross-sectional study on a sample of 708 young Facebook users (aged 13-35), we divided the sample into 3 groups: ordinary, middle, and intense Facebook users. Materials and instruments: the survey comprised a series of basic demographic as well as some measures of Facebook addiction, depression, and family satisfaction. We used two methods connected with extensive Facebook usage, the first one measuring only the intensity of use, and the second one measuring not only the intensity but also the consequences of this use.

Facebook engagement is negatively related to family satisfaction. Moreover, Facebook engagement is positively related to depression symptoms. The Pearson correlations showed that higher Facebook intensity is positively associated with Facebook addiction.

The study confirm previously published findings of other authors in the fields of social networking psychology. The study examined the relationship between Facebook use, depression, and life satisfaction and the hypotheses were supported.

COVID-19 is a new disease, so we don’t know what comes next. Since information on delayed symptoms is limited, this study was conducted to assess the frequency of delayed symptoms in patients with COVID-19.

This follow-up cross-sectional study was conducted in a referral general hospital in Tehran, Iran from Feb to Apr 2020. Two hundred patients hospitalized for COVID-19 and were discharged were assessed for delayed symptoms 6 wk after discharge.

The mean age of the participants was 55.58±13.52, and 160 (80%) Of them were male. On admission to hospital, patients reported a mean of 5.63±2.88 symptoms per patient, range from 1 to 14 symptoms. Dyspnea was seen in 119 (59.5%) 0f them as the most frequent symptom. Then weakness, myalgia, and shivering were reported with a frequency of 111 (55.5%), 107 (53.5%), and 103 (51.5%), respectively. Six weeks after discharge reassessment was done. None of the patients was readmitted to the hospital. Ninety-four (42%) of them were symptom-free. Fatigue was the most frequent delayed symptom with a frequency of 39 (19.5%), and then dyspnea, weakness, and activity intolerance with a frequency of 37 (18.5%), 36 (18%), and 29 (14.5%) were reported, respectively.

Fatigue, dyspnea, weakness, anxiety, and activity intolerance were most frequent delayed symptoms, respectively. Majority of patient was symptoms free and those with symptom, had mild to moderate symptoms. The importance of symptoms is not fully recognized. Follow up clinics and in some cases rehabilitation programs may be helpful.

Hearing loss (HL) is one of the most common heterogeneous congenital disabilities worldwide. Gap junction protein β-3 (GJB3) gene encodes Connexin31 protein (Cx31). The hereditary type of hearing impairment in this gene are known to cause both autosomal recessive and autosomal dominant form. In addition, GJB3 mutations have been involved in sensorineural deafness, erythrokeratodermia variabilis (EKV), and neuropathy diseases. We aimed to investigate GJB3 mutations in people suffering from HL among three different ethnicities of Iranian population (Baloch, Kurd, and Turkmen).

In this descriptive study, 50 GJB2-negative non-syndromic hearing loss (NSHL) Iranian individuals from 3 ethnic groups of Baloch (n=17), Kurd (n =15) and Turkmen (n=18) were enrolled.  DNA extractions, PCR, and mutation detection was carried out for the two large deletions of the GJB6, del (GJB6 -D13S1830,) and del (GJB6 -D13S1854) followed by direct DNA sequencing method for the GJB3.

DNA sequencing of GJB3 was shown a missense heterozygous mutation rs199689484 (NM_024009.3) GJB3: c.340G>A (p.Ala114Thr) in a Baloch patient, and a polymorphism rs35983826 (NM_024009.3) GJB3: c.798C>T (p.Asn266=) in a Turkman patient, in coding region of the GJB3. We did not detect del (GJB6 -D13S1830) and del (GJB6 -D13S1854) among these three ethnicities in Iran.

Deafness is a heterogeneous disorder. Specific genes and mutations contribute to hearing loss that varies from locus to locus as well as from population to population.

Hemodialysis (HD) patients and kidney transplant (KT) recipients are exposed to be infected by blood-borne viruses (BBVs). Current study was conducted to evaluate the prevalence of BBVs in HD and KT patients in the whole Iranian population.

From Jan 2016 to Dec 2017, 174 hemodialysis and 139 kidney transplant recipients enrolled in this survey. After blood sampling, serum samples were detected for HBV, HCV, HCMV, HIV and HTLV antibodies. Seropositive samples confirmed by Polymerase chain reaction (PCR) method.

Overall, 6 (3.44%) and 3 (2.15%) of hemodialysis-dependent and transplantation patients had evidence of HCV infection, whereas no patients were HIV and HBV positive, two cases (1.14%) of hemodialysis and one case (0.71%) of transplantation patients demonstrated the HTLV-1 infection. 52 (37.4%) of patients received graft were positive for HCMV antibody. In addition, our study showed a co-infection of HCMV with HCV (3 patients, 2.15%) in transplantation patients.

Prevalence of BBVs infection was lower in comparison to the previous studies. The current strict infection control practices in Iran appear to be effective in limiting dialysis and related infections after transplantation. Because BBVs infections constantly occur especially in dialysis and after transplantation units, our data will be useful to build a new strategic plan for the elimination of BBVs infection in kidney therapycenters.

The purpose of this research was to identify the main dimensions of management of referral systems in family physician program and then introduce them to policymakers of the country primary health care.

This descriptive-correlation study was designed in Mazandaran Province, northern Iran (2017). The participants were employees of health centers of Mazandaran and Fars Provinces, Iran. The dimensions influencing on the referral system were identified systematically in the selected countries by using researcher-made questionnaire according to a statistical method called Factor Analysis. The data sufficiency was evaluated by the Bartlett's and Kaiser-Meyer-Olkin’s tests. Reliability of test was calculated and confirmed according to Cronbach's Alpha and Combined Reliability tests. Validity of the test was calculated and confirmed based on the average variance extracted (AVE).

In confirmatory factor analysis, coefficient of effect of Electronic Health Record on referral system (as the most important dimension), coefficient of Family Physician, coefficient of structure of insurance, coefficient of policymaking in health care system, coefficient of proper stewardship of health system, and basic health care services, were 0.887, 0.877, 0.860, 0.804, 0.568, and 0.522, respectively.

Six effective dimensions including Electronic Health Record (as the most important dimension), family physician, structure of insurance, policymaking in health care system, proper stewardship of health system, and basic health care services were identified. According to six effective dimensions on management model of the referral system in the Iranian urban family physician program, the health system authorities pay serious attention to the six identified dimensions of the current study to improve the health of the urban community.

Hepatitis B is a major global health problem. It can cause chronic infections and put people at high risk of death from cirrhosis and hepatocellular carcinoma. The aim of this study was to report the epidemiological features of hepatitis B virus (HBV) infection and risk factors based on the data from Azar Cohort.

The population of this study comprised the people in the age range of 35-70 yr from Azar cohort, East Azerbaijan Province, Iran between 2015 and 2016. Based on cluster sampling, 4,949 people were selected and invited to complete the questionnaire and perform the tests. Blood samples were analyzed for serum HBV markers (HBsAg, HBsAb and HBcAb) by ELFA method. The data were analyzed using SPSS statistical software.

The mean (SD) age of the participants was 49.15 ± 9.02 years. The frequency rates of HBsAg, HBsAb and HBcAb were estimated as 1.03%, 16.9% and 24.95%, respectively. There was statistically significant association between family history of hepatitis (P<0.001) and jaundice history (P<0.001) with the presence of HBsAg. There was also a positive correlation between marital status (P=0.002), history of hospitalization (P<0.001), smoking (P=0.001), dental procedures (P<0.001), foreign travels (P=0.005), occupation status (P=0.002) and the presence of HBcAb.

The frequency of hepatitis B in Azar Cohort was 1.03% which is a lower rate compared with other reports from Iran. The association of the population studied and the increase of public awareness in this area can probably prevent this disease.

Body Mass Index (BMI) and maternal age are related to various disorders of the female reproductive system. This study aimed to estimate the causal effects of BMI and maternal age on the rate of metaphase II oocytes (MII) using a new statistical method based on Bayesian LASSO and model averaging.

This investigation was a historical cohort study and data were collected from women who underwent assisted reproductive treatments in Tehran, Iran during 2015 to 2018. Exclusion criteria were gestational surrogacy and donor oocyte. We used a new method based on Bayesian LASSO and model average to capture important confounders.

Overall, 536 cycles of 398 women were evaluated. BMI and Age had inverse relationships with the number of MII based on univariate analysis, but after adjusting the effects of other variables, there was just a significant association between age and the number of MII (adjusted incidence rate ratio (aIRR) of age =0.989, 95% CI: [0.979, 0.998], P=0.02). The results of causal inference based on the new presented method showed that the overall effects of age and BMI of all patients were significantly and inversely associated with the number of MII (both P<0.001). Therefore the expected number of MII decreased by 0.99 for an increase of 1 year (95% CI: [-1.00,-0.97]) and decreased by 0.99 for each 1-unit increase in BMI (95% CI: [-1.01,-0.98]).

Maternal age and BMI have significant adverse casual effects on the rate of MII in patients undergoing ART when the effects of important confounders were adjusted.

Using dexmedetomidine (Dex) as a sedative agent may benefit the clinical outcomes of post-surgery patients. We reviewed randomized controlled trials (RCTs) to assess whether use of a Dex could improve the outcomes in post-surgery critically ill adults.

We searched Medline, Embase, PubMed, and the Cochrane databases for RCTs comparing Dex with propofol or a placebo in post-operative patients, all included RCTs should be published in English before Jul 2016. Citations meeting inclusion criteria were full screened, and trial available data were abstracted independently and the Cochrane risk of bias tool was used for quality assessment.

Sixteen RCTs involving 2568 patients were subjected to this meta-analysis. The use of a Dex sedative regimen was associated with a reduce delirium prevalence [odd ratio (OR):0.33, 95% confidence intervals (CI): 0.24–0.45, I2= 5%, P<0.001], a shorter the length of ICU stay [mean difference (MD): -0.60, 95%CI: -0.69 to -0.50, I2=40%, P<0.001] and the length of hospital stay [MD: -0.68, 95%CI: -1.21 to -0.16, I2=0%, P=0.01]. However, using of Dex could not shorter the duration of mechanical ventilation [MD: -10.18. 95%CI: -31.08–10.72, I2=99%, P=0.34], but could shorter the time to extubation in post-surgery patients [MD: -47.46, 95%CI: -84.63–10.67, I2=98%, P=0.01].

The use of a Dex sedative regimen was associated with a reduce delirium prevalence, a shorter the length of ICU and hospital stay, and a shorter time to extubation in post-surgery critical ill patients.

Molecular profiling techniques are the rapid detection of biomarkers in the human papillomavirus (HPV) infected cells. We aimed to measure the expression level of three cell factors including Snail1, ZEB-1, and E-cadherin in cervical cancer (CC), precancerous and healthy samples, simultaneously, to find potential biomarkers.

The expression level of the mentioned cell factors were investigated in 72 CC patients, precancerous patients, and healthy controls by using Real-Time PCR.

The results demonstrated a significant reduction in the expression level of E-cadherin in cancer and precancerous cases than that in healthy cases; whereas the expression level of ZEB-1 and Snail1 were upregulated in cancer and precancerous samples. The receiver operating characteristic (ROC) analyses shows the highest AUC value emerged for Snail1: 1(95% CI: 1-1) in comparing CC and healthy groups with a sensitivity of 100.0 % and specificity of 100.0%.

The molecular biomarker Snail1 may be helpful to early diagnosis and prognosis of CC in the HPV-infected human populations. Considering the increased expression level of Snail1 in cancer and precancerous tissue compared to healthy tissue as well as the area under the ROC curve, Snail1 can be used for early detection of CC.

Human capital is an effective variable on the health condition of a society and its changing changes health expenditure as the proxy of health. This study aimed to investigate the relationship between human capital determinants and health expenditure.

An empirical model was used with 7 variables included gender parity (GPI) index, literacy rate, life expectancy at birth, GDP per capita, physician per capita, and hospital’s bed as the independent variable and health expenditure as depended variable. After unit root test of data by using Zivot-Andrews method, the model was estimated by ordinary least square (OLS) method.

GPI had the negative and significant impact on health expenditure. Literacy had the positive and significant impact on depended variable. In addition, GDP per capita and life expectancy had positive and significant on health expenditure. Hospital bed and physician per capita did not have the significant relationship with health expenditure.  The value of R-squared and Durbin-Watson statistic were 0.99 and 1.95 respectively, which showed good model fit.

literacy rate and GPI index as the proxy of human capital had the different impact on health expenditure. The first had positive and the latter had negative. GDP per capita had the positive impact that showed health was a normal good.

To model, the predictors of injuries caused the hospitalization of motorcyclists using a hybrid structural equation modeling-artificial neural network (SEM-ANN) considering a conceptual model.

In this case-control study, 300 cases and 156 controls were enrolled using a cluster random sampling. The cases were selected among injured motorcyclists in refereed to Imam Reza Hospital and Tabriz Shohada Hospital, Tabriz, Iran since Mar 2013. The predictability of injury by motorcycle-riding behavior questionnaire (MRBQ), Attention-deficit/hyperactivity disorder (ADHD) along with its subscales and motorcycle related variables was modeled using SEM-ANN. By SEM, linear direct and indirect relationships were assessed. To improve the SEM, the ANN was utilized sequentially to account for the nonlinear and interaction effects that is not supported by SEM.

The predictors of injury were: MRBQ, ADHD, and its subscales, marital status, education level, riding for fun, engine volume, hyper active child, dark hour riding, cell phone answering, driving license (All P less than 0.05). In addition, the findings reveal the Mediating role of MRBQ for the relationship between underlying predictors and injury. Furthermore, ANN showed higher specificity (95.45 vs.77.88) and accuracy (90.76 vs.79.94) than usual SEM which lead us to introduce the second and third order effect of MRBQ into the modified SEM.

The hybrid model provided results that are more accurate; considering the results of the modeling, having intervention programs on ADHD motorcyclists, those have the hyperactive child, and those who answer their cell phones while driving, and improving the motorcyclists’ goal is highly recommended.

The Gail model is the most well-known tool for breast cancer risk assessment worldwide. Although it was validated in various Western populations, inconsistent results were reported from Asian populations. We used data from a large case-control study and evaluated the discriminatory accuracy of the Gail model for breast cancer risk assessment among the Iranian female population.

We used data from 942 breast cancer patients and 975 healthy controls at the Cancer Institute of Iran, Tehran, Iran, in 2016. We refitted the Gail model to our case-control data (the IR-Gail model). We compared the discriminatory power of the IR-Gail with the original Gail model, using ROC curve analyses and estimation of the area under the ROC curve (AUC).

Except for the history of biopsies that showed an extremely high relative risk (OR=9.1), the observed ORs were similar to the estimates observed in Gail's study. Incidence rates of breast cancer were extremely lower in Iran than in the USA, leading to a lower average absolute risk among the Iranian population (2.78, ±SD 2.45). The AUC was significantly improved after refitting the model, but it remained modest (0.636 vs. 0.627, ΔAUC = 0.009, bootstrapped P=0.008). We reported that the cut-point of 1.67 suggested in the Gail study did not discriminate between breast cancer patients and controls among the Iranian female population.

Although the coefficients from the local study improved the discriminatory accuracy of the model, it remained modest. Cohort studies are warranted to evaluate the validity of the model for Iranian women.