mohammad fararouei

Exposure to air pollution is a major health problem worldwide. This study aimed to investigate the effect of the level of air pollutants and meteorological parameters with their related lag time on the transmission and severity of coronavirus disease 19 (COVID-19) using machine learning (ML) techniques in Shiraz, Iran.

Study Design:

 An ecological study.

In this ecological research, three main ML techniques, including decision trees, random forest, and extreme gradient boosting (XGBoost), have been applied to correlate meteorological parameters and air pollutants with infection transmission, hospitalization, and death due to COVID-19 from 1 October 2020 to 1 March 2022. These parameters and pollutants included particulate matter (PM2), sulfur dioxide (SO2 ), nitrogen dioxide (NO2 ), nitric oxide (NO), ozone (O3 ), carbon monoxide (CO), temperature (T), relative humidity (RH), dew point (DP), air pressure (AP), and wind speed (WS).

Based on the three ML techniques, NO2 (lag 5 day), CO (lag 4), and T (lag 25) were the most important environmental features affecting the spread of COVID-19 infection. In addition, the most important features contributing to hospitalization due to COVID-19 included RH (lag 28), T (lag 11), and O3 (lag 10). After adjusting for the number of infections, the most important features affecting the number of deaths caused by COVID-19 were NO2 (lag 20), O3 (lag 22), and NO (lag 23).

Our findings suggested that epidemics caused by COVID-19 and (possibly) similarly viral transmitted infections, including flu, air pollutants, and meteorological parameters, can be used to predict their burden on the community and health system. In addition, meteorological and air quality data should be included in preventive measures.

Several health, environmental, and lifestyle-related factors have been separately linked to multiple sclerosis (MS) by different studies. However, these studies did not adequately account for the temporal association of these factors with MS while considering the influence of other variables in the analysis. A comprehensive investigation of these factors remains scarce.

A hospital-based case-control study was carried out between Jun 2020 to Mar 2021 on 525 cases and 1050 controls frequently matched by age and sex. Cases and controls were selected at the same time and from the same centers (Motahari and Imam Reza referral centers) in Shiraz (the capital of Fars Province). Health, socio-demographic, and lifestyle status during adolescence were studied in this case-control study.

The likelihood of having a history of autoimmune disease(s) (ORyes/no=15.67, P<0.001) and family history of MS (ORyes/no=11.57, P<0.001) were higher in cases. In addition, the likelihoods of reporting a history of head/neck traumas (ORhaving a history/no history=9.16, P<0.001), smoking (ORregular/other =2.24, P=0.008), and stressful events (ORyes/no=1.47, P=0.007) were higher among the case group. On the other hand, the odds of sun exposure (ORmost the time/seldom =0.14, P<0.001), physical activity (ORactive/inactive=0.45, P<0.001), and good quality sleep (OR=0.93, P<0.001) were significantly lower in the case group.

This study provided a broad picture of the factors associated with MS, most of which were modifiable. Positive alterations to these factors through social and health educational programs are likely to reduce the burden of MS in Iran.

Multiple sclerosis (MS) is associated with many healthrelated problems and changes in diet were shown to help the patients reduce some symptoms. This cross sectional study investigated the relationship between dietary acid load with fatigue, quality of life, and nutrient adequacy ratio in MS patients. Totally, 283 MS patients were enrolled in Shiraz, Iran between June 2018 and February 2019. Dietary acid load indices including potential renal acid load (PRAL) and net endogenous acid production (NEAP) were determined for the patients. The level of fatigue and quality of life of the individuals were evaluated by the modified fatigue impact scale (MFIS) and the multiple sclerosis quality of life-54 questionnaires (MSQoL-54), respectively. Nutrient intake was determined to calculate the mean adequacy ratio (MAR) using a food frequency questionnaire (FFQ). The mean score of MAR, NEAP, and PRAL was 0.9±0.18, 87.71±44.86, and 36.27±33.81, respectively. After adjusting for confounders, a significant, negative and very weak association was observed between physical health composite (PHC) of the quality of life and NEAP (p=0.003) and PRAL (p=0.007). Also, a significant, negative, and very weak correlation was found between MAR and NEAP (p=0.006) and PRAL (p=0.028) in a crude model. Furthermore, after adjusting for confounders, the association between MAR and NEAP remained significant (p=0.003). Our findings revealed that there might be an association between dietary acid load indices, physical dimension of MSQoL-54 and MAR.

We aimed to investigate the patterns of incidence and prevalence of bone sarcoma (BS) and soft tissue sarcoma (STS), morphology as well as geographical distribution in the elderly in Iran.

By the primary site of the tumor and the morphological types, whole cases of cancer were classified. Then, the WHO classification (2018) and the third revision of the standard International Classification of Diseases for Oncology (ICD-O-3) were used to assign a code to them. The estimated incidence rates were obtained as the frequency of the newly-diagnosed cases within one year divided by the calculated population of the mid-year Iranian residents as estimated by the Iranian Bureau of Statistics. The age-standardized incidence rates were also estimated for both bone and soft tissue sarcoma.

The annual crude incidence rates of sarcomas in males (0.80 per 100,000) were more than in females (0.55 per 100,000) in all years. The total combined crude incidence in 2014 years was obtained at 0.67 per 100,000 people. In terms of disease grade majority of the patients were of grade 3 (11.5 %). In terms of tumor location, the Lower extremity was 16.8%, the Visceral (including gastrointestinal & uterus) 15.8%, the Thoracic 12.8%, and the Pelvic & abdominal wall 9.7%.

Even though such sarcoma is more prevalent in elderly men, its incidence was also observed in lower-aged female groups. In addition, the incidence rate of BS was lower in comparison with that of STS, and the patients often exhibited an unknown degree of sarcoma.

Correctly estimating the prevalence of sexually transmitted infections (STIs) is crucial for monitoring and managing these diseases effectively.

This study aimed to estimate the prevalence of STI syndromes and evaluate the surveillance systems for STIs in Marvdasht.

We conducted a cross-sectional study in 2018 involving a population-basedrandomsampleof 3 879 participants aged 18-50 in Marvdasht city. Genital ulcers and secretions in both genders were used as the primary outcomes to assess the completeness of the system and calculate the correction factor. A mathematical model was developed to estimate the correction factor for the prevalence of selected syndromes in each gender. The correction factor was determined by dividing the cases estimated through the mathematical model by the cases reported by the surveillance systems.

The estimated prevalence (with 95% confidence intervals [CI]) of urethral discharge in men and women, based on the model, was 25.32% (23.08 - 27.56) and 47.03% (39.93 - 54.13), respectively, and for genital ulcers, it was 5.16% (4.06 - 6.86) for men and 15.50% (9.5 - 21.5) for women. In both genders and for both syndromes, the reported prevalence by the care system (men: discharge 0.09% [0.07 - 0.11], ulcer 0.04% [0.03 - 0.06]; women: discharge 0.12% [0.1 - 0.15], ulcer 0.19% [0.16 - 0.22]) was severely underestimated. The highestandlowest underreporting correction ratios in the national STI monitoring system were observed for urethral discharge in men (124.5) and genital ulcers in women (7.26), respectively.

The study revealed that the reported prevalence of STI syndromes in Iran is significantly underestimated compared to the actual prevalence in the population. Fundamental revisions are necessary to enhance the system’s validity and completeness in detecting and reporting STIs.

The incidence of traffic accidents in Iran is significantly higher than the global average (more than 17000 deaths a year, mostly young adults). The aim of this study was to determine the risk factors of high-risk drivers based on their observable driving behaviors, police records, and car condition in Fars province (Iran). In this case-control study, an interviewer interviewed a random sample (about 1 in 5 of the drivers) of all drivers who were referred to Shiraz traffic accident court from March 21, 2021, to June 21, 2021, due to being involved in a traffic accident. Based on the police report, we interviewed at-fault drivers who caused injurious or fatal traffic accidents as the case group (200 at-fault drivers) and those not-at-fault drivers as the control group (200 not-at-fault drivers). No matching was done. Data were collected using a researcher-made questionnaire filled out through face-to-face interviews with the drivers. Using univariate and multivariate logistic regression, the statistical analyses were conducted in R 4.0.2 software. In this study, a total of 400 drivers were interviewed, of whom 367 (91.8%) were male. The mean ages of the case and control groups were 32.35 years (SD=9.84) and 31.75 (SD=10.33) years, respectively (P>0.05). In addition, 102 (51.0%) and 95 (47.5%) drivers were married in the case and control groups, respectively. Based on the results of a multiple logistic regression model, statistically significant associations were observed between the risk of being the at-fault driver in an injurious or fatal traffic accident and receiving a traffic ticket due to speedingovertaking (ORspeeding overtaking/no ticket=3.38, 95%CI: 1.75, 6.49, P<0.001), self-reported high-speed driving (ORyes/no=2.41, 95%CI: 1.25, 4.63, P=0.008), and having a history of car accident within the recent two years (ORyes/no=1.87, 95%CI: 1.11, 3.14, P=0.017). Our study suggested that among several potential factors, recently receiving traffic tickets due to speeding or overtaking, self-reported speed driving, and recent car accidents may effectively be used to screen out high-risk drivers who will probably cause injurious or fatal car accidents in the future. Intervention measures for the defined high-risk drivers including closer supervision and training programs may reduce the risk of fatal accidents in Iran.

the present study aimed to investigate gender difference in the perceived cause (intrinsic or extrinsic) of falls leading to fracture (FLF) and its association with selected social, health, and environmental factors.

All patients aged 60 years or older who were admitted to two referral hospitals due to FLF from August 1, 2018, to the end of May 2019, were included in the study. An interview-administered questionnaire was used to collect the required data from 300 participants (136 men and 164 women).

When compared to men, women were less physical active, were less smoker, had lower education, had more vision problems, used more sedatives, and were more satisfied with their life (P less than 0.05 for all). No statistical difference was observed between men and women about the perceived cause of Fall.

Although women and men were the same in the perceived cause of fall, they had considerably riskier lifestyles and lower health status. These factors include education, vision condition, physical activity, occupation, and taking sleeping pills. On the other hand, men were more smoker and alcohol user.

In 2020, shortly after recognizing the COVID-19 virus in China on March 11, the World Health Organization (WHO) declared the Covid-19 outbreak a pandemic. It is estimated that COVID-19 is responsible for millions of morbidities and deaths globally, causing devastating health, social and economic crises. This ecologic study aimed to define the correlation between a few key elements of a national health system (i.e., quality of health care services, rate of provided COVID-19 diagnostic tests, and coverage of flu vaccine in the preceding years of the COVID-19 pandemic) and the fatality rate of COVID-19 in countries that were affected by the Covid-19 epidemic in the early phase of the pandemic. In this ecological study, data regarding the total population, number of active cases, total cases, mortality, and time to peak of the COVID-19 epidemic for the countries with defined criteria and the required data available were collected from the Worldmeter database. Thehealth system quality of the selected countries was obtained using a report by WHO (Measuring Overall Health System Performance for 191 Countries). The Flu vaccine coverage of the selected populations was ordered and ranked using graphs provided by a joint VENICE–ECDC–WHO survey. The analysis was done by fitting meta-regression using rates and confidence intervals. A forest graph was used to show the summary of the results. R version 6.3 (package meta) was used to do the analysis. The average Case fatality rate (CFR) of the 26 selected countries was 115 per 1000 for COVID-19. Testing for heterogeneity suggested that CFR was highly heterogeneous among the countries. The regression analysis results suggested that CFR for COVID-19 was inversely related to the rate of COVID-19 diagnostic tests and was directly related to the rate of flu vaccine coverage). The direct correlation between flu vaccine coverage and CFR of COVID-19 may suggest a positive effect of the natural circulation of flu infection on the effectiveness of the individuals’ immune response. Also, the natural flu infection may protect those who could not tolerate the respiratory complications of COVID-19 infection. The results may help NHSs to cope better with future pandemics. In addition, to provide a faster and more effective response to any future infectious pandemic, better access to diagnosis tests seems to be an effective approach in reducing morbidity and mortality.

It has been found that the new coronavirus can affect various parts of the cardiovascular system. Cardiovascular complications caused by coronavirus disease 2019 (COVID-19) are often serious and can increase the mortality rate among infected patients. This study aimed to investigate the prevalence of cardiovascular complications in COVID-19 adult patients. 

A systematic review and meta-analysis of observational studies published in English were conducted between December 2019 and February 2021. A complete search was performed in PubMed (PubMed Central and MEDLINE), Google Scholar, Cochrane Library, Science Direct, Ovid, Embase, Scopus, CINAHL, Web of Science, and WILEY, as well as BioRXiv, MedRXiv, and gray literature. A random effect model was used to examine the prevalence of cardiovascular complications among COVID-19 patients. The I2 test was used to measure heterogeneity across the included studies.

A total of 74 studies involving 34,379 COVID-19 patients were included for meta-analysis. The mean age of the participants was 61.30±14.75 years. The overall pooled prevalence of cardiovascular complications was 23.45%. The most prevalent complications were acute myocardial injury (AMI) (19.38%, 95% CI=13.62-26.81, test for heterogeneity I2=97.5%, P<0.001), arrhythmia (11.16%, 95% CI=8.23-14.96, test for heterogeneity I2=91.5%, P<0.001), heart failure (HF) (7.56%, 95% CI=4.50-12.45, test for heterogeneity I2=96.3%, P<0.001), and cardiomyopathy (2.78%, 95% CI=0.34-9.68). The highest pooled prevalence of cardiac enzymes was lactate dehydrogenase (61.45%), troponin (23.10%), and creatine kinase-myocardial band or creatine kinase (14.52%).

The high prevalence of serious cardiovascular complications in COVID-19 patients (AMI, arrhythmia, and HF) necessitates increased awareness by healthcare administrators.

Sexually transmitted infections (STIs) have a high prevalence in developing and least developed countries. Delays in seeking health care are among the main obstacles to the prevention and control of STIs. This study aimed to investigate the care-seeking pattern in the general Iranian population with sexually transmitted infection syndromes.

This population-based survey was conducted in 2016 among the population of Marvdasht County, who aged 18-50. The random cluster sampling method was used to select the sample. A checklist was used to collect information, and SPSS V.16.0 was used for data analysis. In addition, linear and logistic regressions were used to model the association between contributing factors and the behavioral pattern.

A total of 3,879 people with the mean age of 33.85 ± 8.85 participated in this study. The results showed that 31.83 and 3.3% of the males and females, respectively, took no action when experiencing common symptoms of STIs. In addition, the time interval between the onset of symptoms and visiting a medical center was 10.26±2.74 and 7.10±1.45 days in males and females, respectively (P ≤ 0.05).

The care-seeking frequency in males with sexually transmitted infection syndromes was low. Furthermore, the time interval between the onset of the syndrome and visiting a medical center was longer in males than in females.

Life satisfaction is a comprehensive concept reflecting the general feeling of people about the society in which they live. Previous research has found that health status is associated with life satisfaction. Sexual intercourse is of physiological and psychological needs, which is closely associated with the wellbeing of any individual. In this study, we examined life satisfaction in Marvdasht, Fars province. This population-based survey was conducted in 2016 among Marvdasht urban and rural population aged 18-50 years. The participants were selected via cluster random sampling. A telephone survey was conducted to complete an interviewadministered questionnaire. Significance level in this study was considered 0.05. All stages of data analysis was done in SPSS22 software. A total of 3879 participants from urban and rural areas of Marvdasht were interviewed. There was a difference between urban and rural men in terms of sexual satisfaction (P=0.01) (7.90±2.01 vs. 8.15±1.89) and life satisfaction (P=0.011) (5.64±3.54 vs. 5.14±3.71). Satisfaction in both cases in men in urban areas was better than men in rural areas. Also, the average score of sexual satisfaction was higher in rural men compared with that in urban male residents (P=0.01). Regarding women, at error level of 0.05, there was a difference between urban and rural women in terms of sexual satisfaction (P<0.0001) (8.62±1.502 vs. 9.12±0.789) and life satisfaction (P<0.0001) (8.37±1.641vs. 9.13±0.669), so that satisfaction in both cases in women in rural areas was higher than men in urban areas. Life satisfaction had a close relationship to geographical areas of residence. However, this was for women living in rural areas than women living in urban areas in both cases.

Sexually transmitted infections (STIs) are among the most common infectious diseases and a globally concerning public health issue, especially in developing countries.

This study aimed to evaluate the syndrome-based point and lifetime prevalence of sexually transmitted infections in a big Iranian city.

This cross-sectional study was conducted in 2019 on a hospital-based random sample of 2107 people (men and women aged 15 - 50) at Marvdasht Central Hospital (Iran).

The lifetime prevalence of Sexually Transmitted Diseases (STDs) was significantly higher in women than in men (81.56% vs. 33.60%, P-value < 0.0001). Also, about 20.7% of men and 48.26% of women had at least one of the STIs-associated syndromes at the time of the interview (instantaneous prevalence) (P-value = 0.001).

The estimated prevalence of syndromes associated with sexually transmitted infections is alarmingly high. The results emphasize the need for further studies on effective health care and health promotion services to reduce STIs (including early detection and treatment of infections and public education).

Liver transplantation is one of the most effective treatments for acute liver failure, chronic liver cirrhosis, and hepatocellular carcinoma. This study was implemented to evaluate the survival rate of liver transplant in Asia.

Studies that investigated the survival rate of liver transplant were selected using a systematic search strategy in the following databases: Medline, Embase, Scopus, ProQuest, ISI Web of Science, and Cochrane to November 30th, 2020. The extracted data were entered into the Excel software. Then, stata 16.0 was used for analysis. The search identified 3046 articles of which, 713 were duplicates and 2156 deemed as irrelevant after reading titles and abstracts. Also, 51 articles were excluded as they were not original (i.e. letter, commentary, review) or did not meet the inclusion criteria. As such, 117 studies, involving 406,646 participants, were included in this meta-analysis.

In this study one, 2, 3, 5, and 10-year survival rates of liver transplant were estimated to be 85%, 80%, 75%, 73%, and 71%, respectively.

This study suggests that the survival rate of liver transplant in Asia is comparable with the corresponding rate reported in the United States and Europe. This study provides a better and more clear view of the efficiency of medical cares, regarding liver transplantation.

Phone interview is a safe way for collecting sensitive data due to no need for direct contact with the interviewees and their privacy.

The purpose of this study was to investigate the feasibility and validity of phone interviewing using mobile phones to collect sensitive information related to the participants’ sexual behavior.

This cross-sectional study was conducted on the sexually active population of Marvdasht, Iran, from 2017 - 2018.

A total of 5,894 individuals (2,991 from urban and 2,903 from rural areas) from both genders (n = 3,202 males vs. n = 2,692 females) with an age range of 18 - 50 years were included in this study. The participation rate was convincing (92.18%), and the response rate to all questions was also very high (99.1%). According to the results, gender and place of residency had statistically significant associations with the rates of participation and response.

The results suggested that a phone interview is a potentially useful method for gathering sensitive information in Iranian population, a community with a religious background.

Increased proportion of the retired population and the occurrence of retirement syndrome may significantly affect the Quality of life (QoL) and the well-being of older people. Therefore, the present study was conducted to examine the effect of training intervention on retirement syndrome and QoL among retired older men in Safashahr, Iran, in 2019.

 Using a randomized block design, the quasi-experimental study was conducted on 140 retired men with retirement syndrome. The subjects’ average age was 61.24±1.36 years. The older people were selected by purposive sampling and then randomly assigned to an experimental group (n=70) and a control group (n=70). The intervention comprised five 90-minute sessions of the practical training course of exercises for over 45 days in the experimental group. The study outcomes, such as retirement syndrome and QoL, were measured before, immediately after, and two months after the intervention. The study data were analyzed using SPSS Statistics 25, independent sample t-tests, Chi-square tests, and repeated measure ANOVA. The significance level was set at 0.05.

Based on the average score of retirement syndrome (< 0.001) and its subscales, such as helplessness and failure (HF) (p< 0.001), feeling of old and idle (FOI) (<0.001), feeling of confusion and conflict (FCC) (p<0.001), and feeling of effort and a new direction (FED) (p=0.025); an average score of QoL (p<0.001) and all its subscales, including physical activities (p<0.001), physical health (p<0.001), emotional problems (p<0.001), vitality (p< 0.001), mental health (p<0.001), general health perceptions (<0.001), except for physical pain (0.347) and social performance (0.41), there is a significant difference between the two experimental and control groups, before and after the intervention.

The findings may provide valuable implications for the development of exercises among the elderly and further studies to evaluate the long-term effects of such interventions among the elderly.

End-Stage Renal Disease (ESRD) is an irreversible impairment of kidney function that leads to permanently dependent on alternative therapies such as hemodialysis, peritoneal dialysis, and renal transplantation. This study aimed to systematically investigate the survival rate of patients with renal transplantation, graft, and its related factors in Iran.

This systematic review and meta-analysis drew on articles indexed in six international and one internal databases (Medline/PubMed, ProQuest, Scopus, Embase, SID, and Web of knowledge) until Nov 2020. The reporting of the present study was performed in terms of PRISMA statement. All analyzes were performed using the STATA software.

Overall, 367 titles from 6 databases were evaluated of which 86 articles met the inclusion criteria. According to the random model, the graft survival rate at one, three, five, and 10 years were 92.48%, 85.08%, 79.96% and 68.15% respectively. Additionally, the patient survival rates at one, three, five, and 10 years were 91.27%, 86.46%, 81.17% and 78.15% respectively. There was a significant relationship between the age recipient and three-year graft survival rate (P=0.021). Additionally, there was an inverse and significant relationship between the donor age and 10-year patient survival rate (P=0.011).

The patient and graft survival in transplanted kidney patients is comparable with most developed countries.

Young children are in the fundamentally important physical and cognitive growth phases of their life. Undermining the health issues of this critical segment of the population may seriously affect communities’ health and development. Linear growth among children is a fundamental health index, which is affected by so many different factors. This study was carried out to evaluate the growth status of school-age children to identify some demographic and clinical factors that can predict linear growth among schoolchildren in the fourth largest Iranian city.
The present retrospective cohort study was carried out on a large sample (n=2488)of female and male schoolchildren from the first (7-year-old) to the last year (12-year-old) of primary school in Shiraz, the capital of Fars province.
Adjusted for the other study variables, negative and significant associations were found between children’s height Z-score and family size (P<0.001); and the number of decayed teeth (P=0.03). However, a direct and significant association was found between father’s education and children’s height Z-score (P=0.01). Concerning their weight, paternal literacy was inversely associated with the children’s weight Z-score (P=0.002). A positive and significant association was also found between the birth order and children’s weight (P=0.04).
Oral health is an important parameter in children’s growth and possibly development. Oral health services should be provided to children before school age.

Helicobacter pylori (H pylori) is the most prevalent human infection in half of the world population. Few studies investigated the reasons of infection to H pylori in societies. The current study was designed i to examine the relationship of food insecurity and quality of life with H pylori infection.

In this case- control study, 200 candidates were selected among the people who referred to Shiraz Imam Reza Clinic. They were asked to complete the general questionnaire, food security, and quality of life questionnaires. The H pylori excremental diagnosis test was also taken from them.  

The prevalence of H pylori infection was 28%. No relationship was observed between H pylori and age, gender, household size, and body mass index. However, the prevalence of H pylori infection was significantly higher in married individuals and housewives and volunteers with lower educations and those who took digestive medications. In addition, food insecurity (P = 0.04) and low quality of life (P < 0.001) were significantly high in individuals with H pylori infection. However, the possibility of suffering from H pylori infection in individuals who consume digestive medicines was 3.97 times higher than other individuals (95% CI: 2.11-7.40). Furthermore, with reduction of quality of life, the possibility of suffering from H pylori infection increased 1.77 times (95% CI: 1.203-2.591).

The data indicated a statistically significant increased risk of H pylori in marital status, occupation, educational level, quality of life, and food insecurity in the affected individuals. The association of food insecurity and quality of life with H pylori infection should be examined in future studies in different populations.

The incidence of accidents, its types and leading causes are largely varied in different communities and within different ages. This survey investigated the incidence and types of injury after accidents in adolescent girls with regard to the parents' socio-economic status, schooling and health-related behaviors.
This cross-sectional study was conducted among 8159 high school girl aged 11-19 years, using a self-administered questionnaire. Demographic information, parents' socio-economic status, schooling and health-related behaviors, any accident causing the student to seek medical care during the year before the time of completing the questionnaire, the place, the cause and the body area injured in the accident were asked by single item scales.
The annual incidence of injury was about 4.4%. Of the total accidents, the most common type was car accident (45%). The most common affected body sites were legs (25.7%) and hands (%18.7); the most common place besides streets (31%) where the accidents happened was home (%19). Multivariate logistic regression revealed higher chances of injury among urban residences, those with lower school grades, those exposed to second-hand tobacco smoke, and those who spend more time with friends (P<0.05 for all).
The findings suggested that accidents among adolescent girls are affected by different aspects of life, most of which being modifiable. Most accidents can be prevented if appropriate strategies and intervention programs are applied. For example, providing safer streets, homes and environment and public education are possibly the most effective measures.

Family habits and the lifestyle of parents play an important role in the mental and social health of children. Given the high prevalence of psychiatric disorders in Iran and the lack of information on the factors associated with these disorders, it is necessary to study the relationship between the lifestyle of parents with common psychiatric disorders in children and adolescents. The present analytical cross-sectional study was undertaken from 2016 to 2017. A total of 1,022 children and adolescents aged 6 - 18 in Ilam, Iran, were enrolled in the study. The participants were selected through multi-stage cluster sampling from urban and rural areas of the city. Data on children were collected by using a semi-structured interview with the Kiddie-SADS-Present and Lifetime Version (K-SADS-PL) Questionnaire, and the Life Style Questionnaire (LSQ). Using IBM-SPSS software V. 24, the chi-squared test, Student’s t-test, and multivariable logistic regression model were used to analyze the data. There was a significant association between the mental health of parents with separation anxiety disorder (SAD) (adjusted odds ratio [aOR] = 0.86, P value [P] = 0.01). In addition, significant association was found between physical health (aOR = 1.17, P = 0.04), disease prevention (aOR = 1.22, P = 0.04), spiritual health (aOR = 0.83, P = 0.04), and avoidance of drugs, alcohol, and opiates (aOR = 0.87, P = 0.004) with obsessive-compulsive disorder. Attention deficit hyperactivity disorder with sports and fitness (aOR = 0.82, P = 0.01), social health (aOR = 1.33, P = 0.007), and social phobia with spiritual health (aOR = 0.76, P = 0.04) showed a statistically significant association. This study supports the hypothesis that the lifestyle of parents is an important determinant in the mental health of children.

The survival in Iranian HIV/AIDS patients based on data from Iran National HIV/AIDS Case Registry System has
not been evaluated. This study assessed the survival rates and associated factors among people living with HIV/AIDS in Iran. The population in this observational study included 32168 patients diagnosed with HIV/AIDS registered in Iran disease registry system between 1986 and 31 December 2015. Data until June 2016 (the cutoff date of our last data linkage) were investigated to estimate survival and related factors following HIV diagnosis. Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively. Cumulative proportion surviving was significantly lower in males than in females (P = 0.0001). A higher rate of survival was seen in female patients, who diagnosed after 2010, infected in sexual route, and had CD4 cell count more than 500, nonconfected patients with tuberculosis (TB), and those who received antiretroviral therapy (ART). Based on multivariate model, the mortality risk in female patients, those with CD4 cell count more than 500, patients who received ART, and those with TB and injection drug uses (IDUs) was higher. The survival in studied patients increased in recent time periods, and ART reduced AIDS‑related mortality in these patients. The survival can be increased by focus on improvements in patient care among male patients, IDUs, and patients with TB coinfection.

The survival in Iranian HIV/AIDS patients based on data from Iran National HIV/AIDS Case Registry System has not been evaluated. This study assessed the survival rates and associated factors among people living with HIV/AIDS in Iran. The population in this observational study included 32168 patients diagnosed with HIV/AIDS registered in Iran disease registry system between 1986 and 31 December 2015. Data until June 2016 (the cutoff date of our last data linkage) were investigated to estimate survival and related factors following HIV diagnosis. Of registered patients, 17.7% were diagnosed at AIDS stage. By June 2016, 27.2% of study population progressed to AIDS, and 8081 (25.1%) of patients died. The survival rate was 88%, 85%, 77%, and 67% for 1, 2, 5, and 10 years, respectively. Cumulative proportion surviving was significantly lower in males than in females (P = 0.0001). A higher rate of survival was seen in female patients, who diagnosed after 2010, infected in sexual route, and had CD4 cell count more than 500, nonconfected patients with tuberculosis (TB), and those who received antiretroviral therapy (ART). Based on multivariate model, the mortality risk in female patients, those with CD4 cell count more than 500, patients who received ART, and those with TB and injection drug uses (IDUs) was higher. The survival in studied patients increased in recent time periods, and ART reduced AIDS‑related mortality in these patients. The survival can be increased by focus on improvements in patient care among male patients, IDUs, and patients with TB coinfection.

To improve health equity, many countries have undergone consistent health sector reforms during the two past decades although most of them still have some challenges ahead.
This systematic review aimed to determine the impact of health system reforms on inequities and social determinants of health (SDOH) since the year 2000.
PubMed, Scopus, and Google Scholar databases were utilized to conduct a literature search of related records from January 2000 to August 2014. Out of 1,559 published articles, 29 were selected according to specified inclusion and exclusion criteria.
Almost all investigated countries have considered financial interventions to address increases in governmental health expenditures and implement universal health coverage. While most countries stressed in-patient or outpatient care, primary care is often disregarded in many health system reforms. Although the aforementioned reforms have been somewhat successful, several socioeconomic groups continue to experience health inequities.
These results illustrate the vital role that socioeconomic and political determinants play in the success of studied reforms. Furthermore, emphasizing primary health care, implementing reforms in a stepwise and well-monitored manner, and utilizing quality control mechanisms can mitigate health inequity.

Vitamin D has been linked to health conditions and many serious diseases including cardiovascular, diabetes, and cancer. This study was conducted to determine the correlation between vitamin Dwith diet quality, sun exposure, physical activity, sociodemographic, and anthropometrics indices. In a cross-sectional study, 180 subjects (90 males and 90 females) aged from 14 to 57 years were enrolled. A questionnaire was used to collect sociodemographic and anthropometric data, physical activity and food intake information. The correlation between serum vitamin D with these variables was analyzed. Significant difference was noted between two genders regarding age, weight, body mass index, waist circumference, job, income, physical activity, LDL, HDL, TG, and cholesterol. Low quality diets denoted to a mean global score of 47±6.3 and 46±6.4 in male and females, respectively. No significant difference was found between diet quality, calcium intake (1310±734 mg), and vitamin D intake (1.8±1.5 mg) with serum vitamin D level. Further analysis revealed that there was a significant positive correlation between cholesterol and saturated fat intake and serum vitamin D. Between two genders, the correlation between physical activity (p<0.005), sitting time(p<0.04), and income(p<0.04) with serum vitamin D level was significant. Based on significant correlation between serum vitamin D level, with cholesterol, saturated fat intake, physical activity and income, we can conclude that physical activity has correlation with a favorable vitamin D status.

Firefighters for difficult activities and rescue of damaged people must be in appropriate physical ability. Maximal oxygen capacity is an indicator for diagnosis of physical ability of workers. This study aimed to assess the cardiorespiratory system and its related factors in firefighters.
This study was conducted on 110 firefighters from various stations. An self-administered questionnaire (respiratory disorders questionnaire, Tuxworth‑Shahnavaz step test, and pulmonary function test) was used to collection of required data. Average of humidity and temperature was 52% and 17°C, respectively. Background average noise levels were between 55 and 65 dB. Data were analyzed using SPSS software (version 19).
The mean age of the study participants was 32 ± 6.2 years. The means of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC were 92% ±9.4%, 87% ±9.2%, and 80% ±6.1%, respectively. The participants’ mean VO2‑max was 2.79 ± 0.29 L/min or 37.34 ± 4.27 ml/kg body weight per minute. The results revealed that weight has a direct association with vital capacity (VC), FVC, and peak expiratory flow. In addition, height was directly associated with VC, FVC, and VO2‑max (P The findings of this study showed that the amount of maximum oxygen consumption is close with the proposed range of this parameter among firefighters in other studies. Furthermore, the results of the study revealed that individuals had normal amounts of lung volume index. This issue can be attributed to the appropriate usage of respiratory masks.