فهرست مطالب haidar nadrian

 Current evidence suggests that health literacy (HL) impacts self-care behaviors and quality of life (QOL) in patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate the impact of a short-time health literacy promotion program (HeLPP) on self-care behaviors and QOL in rural patients with type 2 diabetes.

 Conducted from 2018 to 2019 in Chaldoran county, Iran, this randomized controlled trial followed the Solomon four-group design. Participants included 160 rural individuals with T2DM, who were divided into two intervention (A and C) and two control (B and D) groups. Pre-tests were conducted for intervention group A and control group B, with post-tests administered to all groups at three and six months. Interventions, consisting of five training sessions lasting 45 to 55 minutes, were planned and executed based on pre-test analyses. Primary outcomes were QOL and self-care behaviors, and secondary outcomes were glycated hemoglobin (HbA1c), HL and patients’ awareness of the disease.

 Prior to the intervention, there was no significant difference in awareness, HL, self-care behaviors, HbA1c, and QOL between intervention group A and control group B (P>0.05). However, at three and six months after the educational program, intervention group A exhibited significantly increased average scores in awareness, HL, self-care behaviors, and QOL, along with reduced HbA1c levels (P<0.05) compared to control group B. No interaction was detected between the pre-test and the primary and secondary outcome scores after intervention.

 Implementing intervention programs like HeLPP focusing on enhancing practical HL and empowering T2DM patients seems to be promising in improving patients’ self-care behaviors and QOL, while reducing their HbA1c levels.

In recent decades, epidemics of various infectious diseases have occurred. Despite the health authorities' educational efforts to provide people with adequate information, there is not enough evidence regarding the evaluation and effectiveness of educational methods. Therefore, the present study aimed to evaluate the effectiveness of educational methods provided for the public during epidemics of infectious diseases from people's perspective.

  This cross-sectional study was conducted in Iran in 2023. The participants included individuals who were older than 15 years and were living in Iran during the recent epidemics. We used a tailored questionnaire consisting of 14 questions to gather information. The validity of the questionnaire was ensured by calculating the content validity index and ratio. Furthermore, its reliability was confirmed through a pilot study. The participants were selected using convenience sampling. In order to collect data, the questionnaire was distributed to the target group both electronically and in person. The collected data were analyzed using SPSS software (version 24) with normality tests conducted, and any P-value below 0.05 was considered significant.

A total of 278 individuals participated in the study, with the majority being women (61.9%). The average age of the participants was 33.9 years old. Most of the participants had a bachelor's degree (43.2%). According to the results of the study, social networks were identified as the most commonly used source for receiving educational materials during infectious disease epidemics (76.8%), and they were also considered to be the most effective source (87.6%). Additionally, based on the participants' opinions, social networks outperformed other information sources (78%). Face-to-face education provided by healthcare workers was identified as the most trusted educational source (81.6%), and the participants recommended this method to others more than any other method (82.4%). Interviews with healthcare experts and in-person education provided by healthcare workers were perceived as the most effective educational methods by the people surveyed (60.4%). Furthermore, the results indicated that as individuals age, their reliance on sources of information like the Internet, social networks, and newspapers tends to decrease.

  The results of the current study can provide valuable information for policymakers on educating the public during epidemics of communicable diseases, as well as help them make quick, effective, and evidence-based decisions.

We developed a protocol for a health literacy promotion program (HeLPP) to promote self-care behaviors and quality of life (QOL) among T2DM patients in Chaldoran County, Iran. To develop the educational program, we primarily conducted a behavioral and educational assessment on the pre-test data collected from the participants. In this paper, we report a summary of the protocol and the primary results of the pre-test findings.  The HeLPP protocol is naturally developed for a randomized controlled trial with Solomon four-group design. Developing the HeLPP, we will conduct it for both test groups. To plan the HeLPP and to find the main predictors of self-care behaviors and QOL, we firstly conducted a cross-sectional study (as a needs assessment phase). So, applying simple random sampling, data on 160 patients were collected and analyzed. The validated scales (Health Literacy Questionnaire (HLQ), Self-care activities scale, and Diabetes QOL Brief Clinical Inventory) were used to collect data. The mean age of participants was 61.08 ± 11.35. The most significant determinants of self-care behaviors were understanding (β: 0.26), reading skills (β: 0.23), and knowledge (β: -0.19). Self-care behaviors (β: 0.29) and decision-making (β: 0.28) were significant predictors of QOL.  Considering the predicting role of understanding, reading skills, and decision-making for self-care behaviors and QOL of the rural T2DM patients, the focus of HeLPP should be on clear communication, goal-setting, and teach back strategies. The developed protocol seems to be helpful in promoting the outcome variables of the study.

The family physician program plays a crucial role in promoting the quality of community‐based primary healthcare. This study aimed to explore the challenges and obstacles of implementing the family physician program in an Iranian urban community context.

A qualitative study design employing a conventional content analysis approach was conducted. The participants were nineteen healthcare recipients and healthcare providers from urban health centers in Bonab, Iran. Data were collected through semi-structured individual interviews until data saturation, and simultaneous data analysis was conducted. MAXQDA 10 software was used to manage the data. The study was conducted between February and July 2019 at the urban health centers in Bonab, Iran.

The analysis of the collected data yielded three main categories, namely, ‘socio-cultural and economic challenges’, ‘interpersonal communication difficulties’, and ‘inefficient management’. These categories emerged as the challenges faced in implementing the urban family physician program in the community.

The implementation of the family physician program is a long process that is influenced by various factors and the elimination of barriers requires developing infrastructures and culture growth and improving the professional settings and interpersonal relationships.

A short, valid, and reliable instrument is required for the easy assessment of health literacy in online surveys.

In this study, we investigated the validity and reliability of the Persian version of the 8-item Health Literacy Questionnaire as a brief online survey tool in 18-65-year-old Iranians.

This was a cross-sectional study undertaken in thirty-one provinces of Iran. A total of 2374 Iranian people with age 18 - 65 years participated in this study. To ensure the quality of English-to-Persian translation, the process of forward-backward translation was conducted. The scale’s factor structure was assessed using a series of exploratory factor analyses (EFA) and confirmatory factor analyses (CFA). In order to assess reliability, Cronbach’s alpha estimation, test-retest reliability, and Spearman correlation coefficients were applied.

Most of the participants were male (1610, 67.8%), married (1610, 67.8%), and 31 - 59 years old (1672, 70.4%). Cronbach’s alpha coefficients for the factors of finding & evaluating, understanding, decision making, interaction, and the questionnaire as a whole were 0.76, 0.46, 0.75, 0.82, and 0.59, respectively. Test-retest correlation coefficients for these factors and the questionnaire as a whole were 0.85, 0.94, 0.75, 0.82, and 0.86, respectively. Based on CFA, the four-factor structure of the 8-item health literacy (HL) fitted the data well.

The validity and reliability of the online version of the Persian 8-item Health Literacy Questionnaire to measure the HL of the public were approved. This short online tool can be helpful for future online survey studies on the health literacy of Persianlanguage populations at a large scale.

Usually non-daily smokers do not consider themselves smokers, and they are at a higher level of health risks due to smoking compared to non-smokers. This study aimed to identify the prevalence of non-daily smoking (NDS) and its associated factors among university students.

This cross-sectional web-based study was performed in Tabriz, Iran. A proportional random sample of 3666 students from all universities of Tabriz were recruited from July to August, 2019, and an online questionnaire was used to collect data. Predictors of NDS were investigated using a multiple logistic regression model.

A total of 15.7% and 7.8% of the students were daily and NDSs, respectively. Compared to the non-smokers, the NDSs were more likely to exhibit high-risk behaviors such as substance abuse (odd ratio [OR]=2.96; 95% CI: 2.12-4.13), alcohol drinking (OR=2.54; 95% CI: 1.78-3.62), hookah smoking experience (OR=9.30; 95% CI: 6.06-14.25), and regular hookah use (OR=24.22; 95% CI: 14.86-39.46). Compared to daily smokers, NDSs were more likely to be female gender (OR=0.16; 95% CI: 0.10-0.24), denial of being a smoker (OR=11.69; 95% CI: 6.86-19.91), not addicted to nicotine (OR=10.02; 95% CI: 4.21-23.85), and less likely to have an intention for quitting in recent months (OR=2.27; 95% CI: 1.28-4.04).

Non-daily smokers do not consider themselves smokers and have no intention to quit smoking. They are more prone to present high-risk health behaviors. Health policymakers should pay more attention to NDSs while planning smoking cessation programs.

Our objective was to determine the frequency of inadequate functional health literacy (FHL) among adult Kurd population, and infer the contribution index of sociodemographic factors for FHL across gender.  In this cross-sectional study, multistage cluster sampling was employed to recruit 1000 people older than 18 years from 38 urban and 14 rural healthcare centers in Sanandaj, Iran. Data on FHL was collected from May to July 2019, through face-to-face interviews by using the validated Persian version of the Test of functional health literacy in adults (TOFHLA). The concentration index method was used to measure inequality in FHL.  Overall, 869 respondents (response rate: 86.9%) with a mean age of 33.68 (±13.0) completed the TOFHLA questionnaire. The average TOFHLA score was 51.9, which was 52.2 (±0.46) among males and 50.7 (±0.40) among females, p<0.001. Among females, the place of residence, monthly income, age, education level, and being head of the household contributed to 43%, 32%, 13%, 11.5%,  and 11% of FHL inequality, respectively. While, among males, the place of residence (45.2%), household size (15.1%), and monthly income (13.5%) contributed most to inequality in FHL.  FHL has disparities by gender and location. Males and rural people are at particular risk for poor FHL. For ease and better resolution of poor FHL, each population, gender, and area type should be considered as a stand-alone, which may help in identifying tailored interventions for males and females with low levels of FHL.

 Social isolation of older adults is one of the major global concerns associated with widespread negative outcomes. The present study aims to investigate the psychometric properties of the Persian version of the social disconnectedness and perceived isolation scales in Iranian older adults.

 The translation/back-translation process was performed based on the standard protocol of world health organization. Face and content validities were assessed based on the opinions of a panel of experts. The content validity of the scales was evaluated by calculating the content validity ratio (CVR) and content validity index (CVI). Internal consistency, reliability, and construct validity were evaluated using Cronbach’s alpha, test-retest method, and factor analyses, respectively. Factorial structure of the scales was tested using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and structural equation modeling in a sample of 390 community-dwelling older adults aged ≥ 60 years residing in Tabriz, Iran. Data analysis was performed in SPSS software, version 26 and AMOS version 24.

For the social disconnectedness scale, CVR=‌0.98 and CVI=‌0.91; for the perceived isolation scale, CVR=‌0.91 and CVI=‌0.96. The EFA with the varimax rotation identified new factors in both scales. Cronbach’s alpha of 0.64 for the social disconnectedness scale and 0.76 for the perceived isolation scale showed that their internal consistency was acceptable. The number of factors in the social disconnectedness scale changed from two to three factors, and the number of factors in the perceived isolation scale changed from two to four factors in the Persian versions. The CFA and SEM confirmed the three-factor solution of the Persian version of the social disconnectedness scale (RMSEA=0.050, GFI=0.951, CFI=0.950, and TLI=0.955) and the four-factor solution of the Persian version of perceived isolation scale (RMSEA=0.045, GFI=0.955, CFI=0.955, and TLI=0.950).

Although the structures are different from those of the main versions, the Persian versions of the social disconnectedness and perceived isolation scales have acceptable reliability and validity to be used in Iranian older adults.

In this study, we aimed to assess the cognitive determinants of weight control behaviors by dietary patterns among postmenopausal women with osteoporosis.

This cross-sectional study, based on the theory of planned behavior (TPB) was conducted from July to December 2017 among 240 postmenopausal women with osteoporosis in Tabriz, Iran. A validated and reliable TPB-based instrument, namely Weight-CuRB, and the food frequency questionnaire (FFQ) were used.

The results of exploratory factor analysis (EFA) indicated three dietary patterns (total variance explained= 24.44%); healthy (n= 71), mixed (n= 78), and western (n= 91). In addition, food items consumed by participants were classified into twenty-two food groups for dietary pattern analysis. In the healthy and western dietary patterns, attitude ( β: 0.140, P < 0.001) and subjective norms (SNs) (β: 0.498, P < 0.01) were the only predictors of weight control behavior, respectively. In the women with healthy and western patterns, the TPB-based variables altogether explained 11% and 16% of variations in the behavior, respectively. Among all patients, the TPB- based variables explained 12.2% of variations in weight control behavior, within which SNs were the only significant predictor of the behavior (β = -0.199, P < 0.01).

Our findings highlighted the remarkable role of dietary patterns in the associations between weight control and its cognitive determinants. Dietary patterns should be considered while designing weight control educational interventions among women with osteoporosis. In such interventions, promoting SNs and perceived behavioral control (PBC) should be considered as the core strategies to promote the behaviors among the patients who follow an unhealthy diet.

Despite the intention to perform physical activity (PA), a number of individuals cannot manage to have PA program on a regular basis. In this study we explored the barriers of regular PA behavior among healthy adults in Tabriz, Iran.

This qualitative study with a conventional content analysis approach, was carried out from June to September 2020. Nineteen 30-59 years old individuals, were purposefully (purposive sampling) selected to participate in the study. The participants were formerly registered as “physically inactive” in the health records of Tabriz Health System. Individual semi-structured interviews were conducted until data saturation. Data were managed using MAXQDA-10 software.

The barriers of regular PA that emerged from our data were being listless and lethargic, non-supportive environment, disintegration in PA education chain, and restrictive social norms.

Our findings uncover several PA barriers that are less discussed in the literature. Poor level of regular PA among adults in Iran, as a developing context, is rooted in perceptions with social and economic origins, which should be taken into account by public health policy makers while planning PA promotion programs in such communities. To promote regular PA among healthy adults in developing countries, regular PA programs should be tailored to bridge the gap between their recognition of PA barriers and subsequent behavior change through creating group dynamics highlighting the measures to diminish the behavior.

The level of physical activity (PA) among middle-aged Iranians is less than optimal. This study will be carried out to analyze and recommend policy options to promote PA among urban middle-aged adults in Tabriz, one of the metropolitan cities in Iran.

This multi-method policy analysis study will include the following four phases: First, a qualitative content analysis to explore the reasons for lack of PA. Second, a comparative study of successful PA programs and policies in Iran and other similar developing countries. Third, a qualitative thematic analysis based on the policy triangle to analyses PA promotion policies using the key informants’ views. Fourth, analysis and prioritizing the policy options suggested by a panel of experts using the analytical hierarchy process (AHP) techniques.

Prospective policy analysis promises the systematic process of selecting potentially effective policy options to promote PA in metropolitan settings of developing countries. The results of this study will provide a comprehensive vision of the most appropriate policy options based on the criteria of acceptability, effectiveness, and feasibility for addressing PA at the local and national levels. Considerations on the challenges of PA policymaking cycle and the barriers to the implementation of current policies in the Iranian context will also be identified.

 Although the number of pedestrian traffic accidents is decreasing worldwide, more than one-third of traffic fatalities in Iran are related to pedestrians. High-risk behaviors of pedestrians increase their vulnerability to road traffic injuries.

 This study aimed to investigate gender differences in adopting safe pedestrian behaviors in Tabriz, Iran.

 This cross-sectional study was carried out among pedestrians aged 18 years and over (n = 508) living in the second municipal district of Tabriz, Iran. The stratified random sampling method was used to recruit a representative sample of adults from 23 July to 21 November 2019. A standardized, structured questionnaire was used for evaluating traffic behaviors in five domains (i.e., adhering to traffic rules, pedestrians’ traffic violations, positive pedestrian behaviors, pedestrians’ distraction, and pedestrians’ aggressive behaviors). The data was analyzed by SPSS version 22 using independent t-test, regression, chi-square, and ANOVA tests.

 Overall, 58.5% of the participants were female. Women had significantly higher scores in three domains of pedestrian traffic behaviors (i.e., no traffic violations, not being distracted, and not having aggressive behavior) than men (P < 0.001). Additionally, married women and women with higher education levels earned significantly higher scores than others in total pedestrian traffic behaviors. There were significant differences between men and women regarding the use of a personal car and walking daily more than an hour (P < 0.05).

 Our findings suggest gender differences in the five dimensions of pedestrian traffic behaviors in Iran. Gender-specific risk reduction strategies in the Iranian pedestrians’ safety intervention programs may promote safe traffic behaviors of pedestrians.
 

The aim of the present study was to investigate the relationships between cognitive factors, weight control behavior, bone mineral density (BMD), and the risk of bone fracture by the dietary pattern among Iranian postmenopausal women with osteoporosis.

In this cross-sectional study (2017), 240 postmenopausal women with osteoporosis referring to two densitometry clinics in Tabriz (Iran) were recruited to participate in the study using a convenience sampling technique. Then, nutrition survey, BMD, the risk of bone fracture, weight control behavior, and a framework-based weight control behavior questionnaire (Weight-CuRB) were applied to collect data.

Using factor analysis, three distinct dietary patterns were identified, including healthy, mixed, and western patterns, which accounted for 24.24% of the total variance in food intake. After adjustment for cognitive and socio-demographic variables, patients with a western dietary pattern and no control on weight showed the increased risk of major osteoporotic (odds ratio [OR]: 4.82, CI: 2.02-11.45, P = 0.000) and hip (OR: 3.13, CI: 1.36-7.19, P = 0.007) fractures (P<0.001). In addition, in the subjects with western dietary pattern and no control over their weight, results showed an increased risk of low BMD (OR: 0.451, CI: 0.199- 1.042, P = 0.044).

In general, the increased intake of fruits, nuts, the vegetable oil in a healthy dietary pattern, and adoption of appropriate weight control behaviors may reduce the risk of bone fracture in postmenopausal women with osteoporosis. Accordingly, health practitioners and healthcare providers should consider weight control in their risk assessment of bone fracture in postmenopausal women with osteoporosis

The worldwide trend of hookah use among adolescents is increasing, and literature shows a relationship between obscenity and adolescents’ tendency toward hookah smoking. As there is a lack of appropriate instruments to measure the obscenity of hookah smoking, in the present study, we aimed to develop an instrument to measure hookah smoking obscenity among adolescents.

In this methodological study, a sequential exploratory design was used to conduct the study from February 2017 to July 2018 on adolescents in Tabriz, Iran. In the qualitative phase, we conducted semi-structured individual interviews (with 18 students) and a focus group discussion (FGD) (with 13 students) to explain the concept of obscenity and develop the items of hookah smoking obscenity scale (HSOS). We then examined the psychometric properties of the HSOS based on face, content, construct and predictive validities as well as internal consistency and repeatability.

The HSOS was developed with 21 items based on the results of qualitative data analysis. Applying confirmatory factor analysis (CFA), the χ2/degree of freedom (df) ratio was found to be 3.792 for the four-factor structure of the questionnaire and the fit indices of this structural model were satisfactory. The values of Cronbach’s alpha and the intraclass correlation coefficient (ICC) for the constructs in the HSOS ranged 0.81-0.93 and 0.79-0.92, respectively.

We found the HSOS with a good level of fit indices, validity, and reliability. The HSOS may be applied by school healthcare providers and health practitioners to find valid and reliable data on the obscenity of hookah smoking when developing hookah smoking

Considering the increasing prevalence rate of smoking among Iranian adolescents, and recent evidence on the relationship between obscenity of smoking and tendency of adolescents towards the behavior, there is a need for an appropriate measurement tool to measure the level of obscenity on cigarette smoking among adolescents. This study was conducted to develop a valid and reliable questionnaire for measuring the obscenity of cigarette smoking in adolescents.

This study was conducted in Tabriz, Iran, using an exploratory sequential mixed methods design. To explain the concept of obscenity and develop the questionnaire’s items, 18 students attended semi-structured individual interviews and 13 others took part in focus group discussions (FGDs) in three groups of 4-5. Extracting and summarizing the codes derived from the interviews, an item pool was developed, from which the initial draft of the scale was provided. Next, the psychometric properties of the scale were assessed using face, content, construct, and predictive validity, as well as internal consistency, and reliability in a sample of 1013 high school students.

The 22-item Cigarette Smoking Obscenity Scale (CSOS) was developed based on the codes derived from qualitative data. Explanatory factor analysis revealed five-factor structure (Negative Attitude; Negative Consequence; Negative Valuation; Inappropriate Relationship; A gateway to addiction). In confirmatory factor analysis, the χ2 /df ratio was 3.911 for the CSOS five-factor structure. Suitable values were obtained for the goodness of fit indices (GFI=0.88, AGFI=0.85, NFI=0.87, IFI=0.90, CFI=0.90, RFI=0.85, and RMSEA=0.072). The Cronbach’s alpha and intraclass correlation (ICC) coefficients for the constructs ranged between 0.77 to 0.90 and 0.80 to 0.91, respectively.

The validity and reliability of the CSOS was appropriate; therefore, it can be used in future studies as a suitable tool for measuring the obscenity of cigarette smoking in adolescents.

There are no studies on the trend of gastric cancer (GC) incidence in Kurdistan, a province in the west of Iran. We aimed to estimate the trend, age‑standardized incidence rate (ASR), and annual percentage change (APC) of GC in this province during 2001–2014.

The data of newly diagnosed GC patients were obtained from the regional Cancer Registering Database. The ASRs were calculated per 100,000 population during 2001–2014. Direct standardization and 95% confidence intervals (CI) were calculated by an efficient method. The temporary changes in ASRs were determined based on the APC by the joinpoint regression model.

Overall, 2225 newly diagnosed GC patients were identified. The ASRs ranged from 13.5 (95% CI: 10.4–17.3) to 29.0 (95% CI: 24.5–34.0). The highest ASRs were related to the men and women lived in Divandareh as 32.26 and 13.66, respectively. The respective APC value of GC incidence in women demonstrated a nonsignificant increase during 2001–2008 and a nonsignificant decrease during 2008–2014 (P = 0.1). Accordingly, the incidence of GC in men increased during 2001–2004 (P = 0.1) and decreased during 2004–2014 (P = 0.001).

The incidence of GC showed nonsignificant and significant decreasing trends in women and men in Kurdistan province, respectively. Despite such decreasing trends, the Kurdistan province is still considered as one of the regions with high incidence of GC in Iran. Therefore, it is necessary to implement screening programs in the province to early diagnose GC.

Disposal and release of plastic bags in the environment can cause environmental, economic, and social problems. The aim of this study was to explore the determinants of the behavior of plastic bag use (BPBU) among residents using socioecological approach (SEA).

In this cross‑sectional study, multistage random sampling was employed to enroll 400 residents in Hadishahr County, North West of Iran. A valid and reliable instrument based on SEA variables was used.

Hierarchical multiple linear regressions were performed with SEA and BPBU as outcome variables. Predictors of outcome variables were classified into four different blocks. Demographic characteristics and SEA constructs explained 50% of the observed variance in BPBU. In the first block, age (P = 0.03) and purchase frequency (P = 0.902) were significant predictors of BPBU (R2 = 0.34), and in the third block, access to alternatives in environment (P = 0.01) wassignificant predictor for BPBU (R2 = 0.49). The majority of residents (47%) were taking home 6 to 10 plastic bags and more than 10 freezer bags after their shopping per week.

Health‑care providers may consider purchase frequency and SEA as a framework for developing educational, environmental, and social interventions aiming at reducing the consumption of plastic bags.

Optimism is known to be associated with many health behaviors. However, the associations between optimism, tobacco smoking and substance abuse in adolescents are not well documented. This study aimed to address this research gap in a large school-based population.

Participants (N = 1104) were selected based on multi-stage cluster sampling method. Cigarette and hookah smoking behaviors, illicit drug use, optimism, and relevant covariates were measured using a validated questionnaire. Data were analyzed using ordinal logistic regression.

After adjustment, higher optimism score was a protective factor against being situated in advanced stages of cigarette smoking (odds ratio [OR] = 0.88, 95% CI: 0.84-0.91), hookah smoking (OR = 0.91, 95% CI: 0.88-0.94), and illicit drugs usage (OR = 0.90, 95% CI: 0.85-0.95). Moreover, the results showed that negative-stability and negative-globality domains of optimism were significantly higher among advanced-stage smokers and illicit drug users.

Optimism was found to be a protective factor against tobacco smoking and substance abuse; whereas pessimism (negative-stability and negative-globality) was found to be a determinant factor. Further research is needed to investigate the effects of optimism on the transition in cigarette and hookah smoking stages.

Some treatment reported for cutaneous leishmaniasis. The studies examined the impact of the paromomycin has different characteristics and results. The aim of the present study was to conduct a systematic review and meta-analysis of all randomized clinical trials evaluating the effectiveness of paromomycin in the treatment of cutaneous leishmaniasis in Iran. Literature search was conducted using MEDLINE, Web of Science, Scopus, Scientific Information Database, IranMedex, Magiran, Iranian Registry of Clinical Trials (from February 2000 to May 2016), and references cited in the text of selected studies. Search terms used were “paromomycin”, “cutaneous leishmaniasis”, “randomized”,” aminosidine”, “controlled trial”, and “clinical trial”. Random effects models were used to calculate the measure of association, with 95% confidence intervals, to analyze the efficacy of paromomycin in the treatment of cutaneous leishmaniasis. Initial search yielded 76 citations. Of these original results, 9 met our specific selection criteria. Four of the randomized controlled trials compared the efficacy of paromomycin in the treatment of cutaneous leishmaniasis with that of a placebo; they were included in the meta-analysis. The success rate of treatment with paromomycin was higher than that with the placebo (pooled RR=4.50, 95% CI: 2.54 to 8.02; P=0.001 and I2=26.7%), whereas the difference with the non-placebo treatments was nonsignificant (pooled RR=0.79, 95% CI: 0.58 to 1.073; P=0.131 and I2=83.3%). No significant difference was observed between paromomycin and the other treatments in their effectiveness in the treatment of cutaneous leishmaniasis. Because no single drug is effective against all the forms of leishmaniasis, we suggest multidrug therapy.

Our aim was to determine the association between age at menarche (AAM) and breast cancer adjusted for recall bias (misclassification) in AAM. We have used data provided from a case-control study conducted in Iran from 2005 to 2009. The cases and controls were frequency matched based on 5-year age groups and region of residence. First, logistic regression was conducted to estimate the odds ratio (OR) and second, Bayesian analysis was applied to estimate the ORs adjusted for misclassification. The study was conducted on 880 cases and 998 controls. In the assumption of no correction for recall bias on self-reported AAM, the OR was 1.36 (95% Credible Interval (0.98, 1.90). Based on a sensitivity value = 71% and a specificity value = 81% (the indices about the ratio of true recall of AAM) for the case and control groups (as the first scenario), the AAM ≤ 12 years of age was associated with a lower OR for breast cancer by 1.23 (95% Credible Interval: 0.50, 3.13). In the other scenario, with consideration of 100% sensitivity and specificity of self- reported AAM in the case group, and 71% and 81% sensitivity and specificity of the item in the control group, the related OR between breast cancer and AAM was found increased to 2.96 (95% Credible Interval: 0.75, 7.66). After adjustment for misclassification related to recall bias, this study provides evidence that the self-reported mode of AAM has a moderate impact on calculation of the OR.

Excessive use of plastic bags has become a major problem in the worldwide causing irreparable damages to the environment and humans. The purpose of this study was to identify the individual and environmental factors associated with the use of plastic bags among the vendors of Hadishahr city, Iran. This is a cross-sectional study conducted on 400 vendors working in Hadishahr city. The data were gathered using a researcher-made questionnaire, which measured knowledge and attitudes of vendors regarding the use of plastic bags at the individual level.  At the environmental level, access to alternatives plastic bags and social support to use of alternative was measured. Plastic bags in kilograms per week was measured as the consumer behavior Data were analyzed using SPSS software via Chi-square, t-test and hierarchical regression tests. The average usage of plastic bags by the vendors was 4.5 kg per week. 97.8% of vendors gave plastic bags for the customers to carry away their purchased items. The individual-level factors (knowledge and attitude), along with social support for the use of alternatives taken from environmental factors were the most important predictors for the use of plastic bags; they were able to predict consumption behavior (15%) along with other variables. In order to reduce the plastic bags consumption while training, it is necessary to provide social support for the usage of alternatives and environmental access to these alternatives.