The Iranian government does not fund HIV pre-exposure prophylaxis (PrEP), and PrEP is infrequently used in Iran, in part due to uncertainties about its cost-effectiveness, stigma, and lack of education. In this study, we assessed the cost-effectiveness of PrEP among Iranian people who inject drugs (PWID). The cost-effectiveness analysis compared PrEP-alone, a combination of PrEP with harm reduction (HR), and an HR-alone strategy among PWID over a 10-year time horizon. For the cost analysis, we considered the healthcare program development perspective. The primary outcome was disability-adjusted life years (DALYs) averted. Analyses included costs and health outcomes, as well as the incremental cost-effectiveness ratio (ICER), which was reported as the cost per DALYs averted. The PrEP-alone strategy, found to be dominated with an ICER of USD − 572.65 per DALY averted, was not cost-effective at a willingness-to-pay threshold of USD 4669.60 per DALY averted in Iran. In contrast, combining PrEP with HR was cost-effective at the same willingness-to-pay threshold. The ICER was USD 1,153.86 per DALYs averted for combining PrEP with HR compared to HR alone. The combination of PrEP with HR was a cost-effective strategy 76.3% of the time. Compared to HR, combining PrEP with HR is a cost-effective intervention among Iranian PWID for reducing the economic burden and improving health outcomes associated with HIV over a 10-year time horizon. Iran should add PrEP to its current HR programs for PWID.

Background and Aims:HIV pre-exposure prophylaxis (PrEP) has a crucial role in HIV prevention globally. Our study aimed to explore the approaches to address and overcome barriers to PrEP implementation among key populations in Iran. Methods:In this multi-stage qualitative study, first, we employed in-depth interviews to identify possible barriers to PrEP implementation in Iran. Second, we conducted three focus group discussions with HIV experts to categorize barriers to PrEP implementation among key populations using the Causal layered analysis. Last, we collected HIV expert's opinions on possible solutions to overcome the barriers. Results:We found four layers of barriers (including potential solutions) in PrEP implementation: litany, systemic causes, and discourse/myth. In the litany layer, increasing HIV knowledge among key populations and healthcare providers was identified as a solution. In the systemic layer, cooperation and coordination among all societal organizations and providers were reported as a solution. In the discourse/myth layer, gaining the trust of the key populations, providing PrEP in private sectors, using telemedicine, and religious beliefs were identified as solutions. Conclusion:Our deep multi-step qualitative analysis showed that barriers to implementing PrEP in Iran are several, complex, and cross-cutting. Addressing them requires interventions among key populations at risk for HIV, such as PrEP users, health providers, and the community in general, to build a supportive environment for PrEP as one of the HIV prevention strategies in Iran.

The Iranian government does not fund pre-exposure prophylaxis (PrEP), and it is not used in Iran due to uncertainties in its cost-effectiveness. In this study, we examined the cost-effectiveness of PrEP among female sex workers (FSWs) in Iran. The cost-effectiveness analysis compared only PrEP, a combination of PrEP with harm reduction (HR) with only HR scenario among FSWs over a 10-year time horizon. The perspective of the healthcare provider was used in the analysis. The primary outcome was disability-adjusted life year (DALY) averted. Analyses included health and cost outcomes, as well as the incremental cost-effectiveness ratio (ICER), which was reported as the cost per DALY averted. Only PrEP was not cost-effective at a willingness to pay threshold of 4669.6 USD per DALY averted in Iran. In contrast, PrEP and HR strategies were cost-effective at the same willingness to pay threshold. The ICER was 868.47 USD per DALY averted for PrEP and HR compared to HR alone. Compared to HR, combining PrEP with HR is a cost-effective intervention among Iranian FSWs for reducing the clinical and economic burden associated with HIV over a 10-year time horizon. Iran should add PrEP to current HR programs for FSWs.

Background:eHealth has proven effective in changing health-related behaviors and overcoming barriers to HIV care. This systematic review and meta-analysis aimed to review the effect of eHealth on HIV Pre-Exposure Prophylaxis (PrEP). Methods:A systematic review and meta-analysis was conducted in international databases without a time limit until August 2024 to identify studies evaluating the effectiveness of eHealth interventions for PrEP among key populations. This search strategy used a combination of keywords related to "eHealth", "HIV", and "pre-exposure prophylaxis". A random effects model was used to compute the pooled measure of association (relative risk). The results were combined using a random-effects model for meta-analysis. The I2 index was also used to measure heterogeneity between the studies. Results:Twelve articles involving 3,578 participants were included in the meta-analysis. The findings showed that using websites had a positive effect on PrEP (RR=1.90, 95% CI: 1.30-2.79). Moreover, e-health interventions had the greatest effect on PrEP uptake among female sex workers (FSWs) (RR=2.27, 95% CI: 1.62-3.17). Furthermore, e-health demonstrated a notable effect on PrEP uptake (RR=1.90, 95% CI: 1.30-2.79), particularly in studies with follow-up less than six months (RR=1.85, 95% CI: 1.19-2.09). Additionally, studies conducted in the United States reported the most significant effect of e-health on PrEP (RR= 1.71, 95% CI: 1.38-2.11; I2 = 0.41%). Conclusion:eHealth interventions have the potential to improve the effectiveness of PrEP among key populations. Integrating e-health interventions with comprehensive healthcare services and providing continuous support can improve PrEP uptake, adherence, and retention in the future.

ABSTRACT Background and Objective Cardiovascular diseases (CVDs) are the top cause of death and disability globally. Estimating the years of life lost (YLL) can inform policy and intervention programs. The present study was designed and implemented to estimate the number of deaths and YLL, estimate their trend, and examine demographic characteristics due to cardiovascular diseases. Material and Methods This retrospective population‐based study analyzed mortality trends and YLL associated with 4314 deaths caused by CVDs. Data recorded in the Kazerun Forensic Medicine Organization were used to calculate the YLL due to cardiovascular diseases. For the descriptive analysis, we utilized the χ2 test, considering a p value of less than 0.05 as statistically significant. Results Men died from CVDs at an average age of 63.4 (±16 years), while women died at an average age of 61.5 (±17 years). CVDs caused over half (52.3%) of mortality in both sexes. Mortality from heart disease was significantly higher among individuals with lower education levels and self‐employed individuals throughout all years. The total number of YLLs due to CVDs was 43,107, which equals 14 years lost per 1000 individuals. While more men died from CVDs throughout most of the study, the difference between the number of male and female mortality narrowed in 2018 and from 2021 to 2023. According to the generalized additive model (GAM), years of life lost from heart disease mortality were increasing until almost 2019, but after 2019, this trend has been decreasing. Conclusion The calculation of total YLL reveals a significant social burden of premature mortality from CVDs in the southwest of Fars province. This issue should be prioritized as a public health concern, necessitating preventive measures such as education, evaluation, and reduction of modifiable risk factors, increased physical activity, and blood pressure management to decrease mortality rates.

Introduction: Amputations from trauma can lead to disability and pose a challenge for health care services. This study hopes to shed light on the trend, the changes, outcomes, and factors associated with trauma leading to amputations in Shiraz, Iran. Method: A cross-sectional study was conducted to assess patients who experience amputations due to trauma in Shiraz from 2017 to 2023. The sampling method consisted of patients hospitalized at Shahid Rajaee Hospital in Shiraz. We included participants who were hospitalized for traumatic amputations. Outpatients, follow-up cases, and non-trauma-related amputations were excluded from the analysis. Data collection included variables such as admission year, gender, age, and level of amputation. Result: 435 patients were included, and 92.2% were males. The average age of patients was 36.1 years, and the majority of patients (88.8%) underwent minor amputations. Amputation was most common among motorcycle riders (47.5%), while traffic accidents and lower limb injuries significantly contributed to major amputations, accounting for 21.9% and 51.3% of cases, respectively. The average hospital stay was 5 days. The majority of patients stayed over two days. Upper limb injuries and amputations had a significant association (p < 0.001), as well as contact with a blunt object and amputation (p = 0.002). The presence of many injuries was associated with shorter stays in a hospital (p = 0.045). We found a statistically significant increase in amputations by gender (p <0.001) and type (p=0.006) during the study period. The overall trend peaked in 2022. Conclusion: The pattern of limb loss rates among participants, mostly men, was worrisome. Motorbike drivers are clearly at greater danger, and road accidents play a big part in severe amputations. The association between arm injuries and amputations shows the need for focused ways to stop this.

People living with HIV (PLHIV) are at an increased risk of type 2 diabetes mellitus (T2DM) due to aging, lifestyle, and antiretroviral therapy-related factors. This systematic review and meta-analysis estimated the pooled incidence, prevalence, and risk factors for T2DM among PLHIV globally, focusing on older populations. This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a comprehensive literature search in PubMed, Embase, Web of Science, and Scopus for English-language articles published by December 25, 2024. The I² index and Cochrane’s Q statistic were also used to assess study heterogeneity. A random effects model was used to compute the pooled measure of association with 95

The world is changing rapidly, mainly due to the impact of megatrends that have an impact on the entire human life, particularly in medical sciences. Medical research methodologies such as cohort studies provide very critical information, but it is not clear what would be its destination in the future. In this short article, we have tried to offer a somewhat different perspective on the future of cohort studies by analyzing the texts and their conclusions from the author's viewpoint. According to our assessment, cohorts will play a key role in medical research, but their methodology will significantly change in terms of designing, implementing, analysing, and applying the findings. The new generation of cohort study extracts most of their information from electronic health records, and it is not just restricted to a particular geographic area. With the changes in the levels of occupational exposure, risk factors, and the introduction of Omics, likely, occupational and birth cohorts as well as human diseases will likely undergo fundamental changes in the future. Big data will provide researchers with new opportunities, but information extraction and analysis require a team of specialists from several scientific fields. Furthermore, participants are likely to play a more active role in setting priorities and implementing research findings.

BackgroundPre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran.MethodsWe conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants' experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs.ResultsWe interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator's theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier's theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers).ConclusionsWe identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.

Background Abdominal surgery is considered a high-risk surgery for the development of surgical site infection. Few studies have evaluated the relative importance of its risk factors. Therefore, in this paper we mapped and summarized the evidence aimed to determine the relative importance of the risk factors and incidence of surgical site infections in abdominal surgery. Methods We searched SCOPUS, PubMed, and Web of Science databases up to March 16, 2023. Using the methodology of the Joanna Briggs Institute, we used both univariate and multivariate analysis results to evaluate the relative importance of the risk factors. Results Of 14,237 identified records, 107 articles were included in the review. The National Nosocomial Infection Surveillance (NNIS) risk index, operative time, and higher wound class were strong risk factors for surgical site infection incidence. Patients' educational status, malnutrition, functional status, and history of neurological/psychiatric disorders were also the risk factors, but there is a need for more evidence to reach a conclusion. The pooled incidence of surgical site infections was 10.6% (95% CI 9.02–12.55) in abdominal surgery, and the type of surgical procedures accounted for 31.5% of the heterogeneity. Conclusion Our findings show that surgical site infection in abdominal surgery is a multifactorial phenomenon with a considerable risk and has different risk factors with various relative importance. Determining the relative importance of the risk factors for prevention and control of surgical site infection is strongly recommended. We provide some recommendations for future research.

Background There is a dearth of robust evidence regarding the correlation between psoriasis with maternal and neonatal outcomes, making it challenging to establish definitive recommendations for the management of these patients. This systematic review and meta-analysis aimed to review the evidence with regard to the impact of maternal psoriasis on maternal and neonatal outcomes. Methods Following the PRISMA guideline, a systematic search of English articles using PubMed, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Library was conducted. The search was performed from inception to 22 nd of May 2022. Result A significant association was observed between psoriasis and maternal outcomes, including cesarean delivery [OR = 1.25 (95% CI: 1.13–1.30, p -value = 0.001)], (pre)eclampsia [OR = 1.29 (95% CI: 1.15–1.44, p -value = 0.0001)], gestational diabetes [Odds Ratio (OR) = 1.23 (95% Confidence Intervals (CI): 1.15–1.30, p -value = 0.001)], gestational hypertension [OR = 1.31 (95% CI: 1.18–1.45, p -value = 0.001)] and preterm birth [OR = 1.22 (95% CI: 1.10–1.35, p -value = 0.001)]. Also, there was a significant association between psoriasis and neonatal outcomes, including small for gestational age [OR = 1.07 (95% CI: 1.02–1.11, p -value = 0.053)], low birth weight [OR = 1.19 (95% CI: 1.02–1.38, p -value = 0.001)] and stillbirth [OR = 1.27 (95% CI: 1.04–1.55, p -value = 0.023)]. Conclusion Maternal psoriasis could negatively impact maternal and neonatal outcomes. Our results strengthen the importance of close monitoring of the mothers’ psoriasis status before and during pregnancy.

Abstract Objectives Insulin resistance is the most common metabolic change associated with obesity. The present study aimed to investigate the relationship between insulin resistance and body composition especially adipose tissue in a randomized Tehrani population. Methods This study used data of 2,160 individuals registered in a cross-sectional study on were randomly selected from among subjects who were referred to nutrition counseling clinic in Tehran, from April 2016 to September 2017. Insulin resistance was calculated by homeostasis model assessment formula. The odds ratio (95% CI) was calculated using logistic regression models. Results The mean age of the men was 39 (±10) and women were 41 (±11) (the age ranged from 20 to 50 years). The risk of increased HOMA-IR was 1.03 (95% CI: 1.01–1.04) for an increase in one percent of Body fat, and 1.03 (95% CI: 1.00–1.05) for an increase in one percent of Trunk fat. Moreover, the odds ratio of FBS for an increase in one unit of Body fat percent and Trunk fat percent increased by 1.05 (adjusted odds ratio [95% CI: 1.03, 1.06]) and 1.05 (95% CI: 1.02, 1.08). Also, the risk of increased Fasting Insulin was 1.05 (95% CI: 1.03–1.07) for an increase in one unit of Body fat percent, and 1.05 (95% CI: 1.02–1.08) for an increase in one unit of Trunk fat percent. Conclusions The findings of the present study showed that there was a significant relationship between HOMA-IR, Fasting blood sugar, Fasting Insulin, and 2 h Insulin with percent of Body fat, percent of Trunk fat.

Background. A strong link between morbidity and mortality from COVID-19 and diabetes mellitus is reported by many studies. The present study estimated the pooled prevalence of diabetes in patients with COVID-19. Material and methods. International scientific databases were searched until 15 April 2020. There was no limitation in time and language of the published papers. Quality assessment of studies was performed using the Newcastle-Ottawa Scale (NOS) checklist. The random effects model was used to report the pooled prevalence with 95% confidence interval (CI). Results. The pooled prevalence of diabetes in patients with COVID-19 was 14% (95% CI: 11.17). Due to high heterogeneity (I-2 of 93.4%, P < 0.001), three subgroups were analyzed based on study location, age and sex. The prevalence of diabetes (P) was higher among male patients (P = 16%, 95% CI: 0.12, 0.20), patients aged >= 65 years (P = 19%, 95% CI: 0.08, 0.31). The prevalence of diabetes was 15% (95% CI: 0.10, 0.20) among patients in Wuhan, China and 10% in patients in other cities in China (95% CI: 0.06, 0.15), and 39% in patients from other countries (95% CI: 0.04, 0.74). Conclusion. According to the results of this systematic review, the prevalence of diabetes in patients with COVID-19 is higher in other countries compared to China. The prevalence of diabetes among COVID-19 patients was also significantly higher in men and elderlies. This evidence may be useful for health policymakers to design suitable preventive and therapeutic interventions in patients with diabetes and COVID-19.

Background & Objectives: Cesarean section rates have increased significantly over the past decade. This increase has not been clinically justified. The objective of this study was to investigate the effect of medical factors on the type of delivery. Materials & Methods: This prospective cohort study was done on 200 pregnant mothers. The main exposure in this study was the medical reasons for cesarean section and the main outcome of cesarean delivery. The relative risk index was calculated using the Cox regression model. Results: Of the 196 pregnant women remained in the study, 40.31% had Cesarean section. Compared to non-medical factors, the risk of Cesarean section was higher (Relative Risk = 4.64) in mothers with medical factors. Also, the risk of elective Cesarean section was higher in mothers with medical factors (Relative Risk = 2.34). On the other hand, the risk of Cesarean section and elective Cesarean section was and higher in mothers with previous abortion (Relative Risk = 2.11) and hard labor (Relative Risk = 3.25), respectively. However, there was a significant relationship between maternal mental disorder during pregnancy and Cesarean section delivery (Relative Risk = 1.49). Conclusion: Based on these results, there is an association between medical factors and type of delivery. Therefore, maternal preventable or controllable medical problems during pregnancy requires more attention.

Background: Insulin resistance can be a predictor of adverse fatty liver disease and health problems. Objectives: The present study aimed to investigate the effect of insulin resistance on fatty liver disease. Methods: This study used the data of 2,160 individuals registered in a cross-sectional study who were randomly selected from among clients of a nutrition clinic in Tehran from April to December 2019. Insulin resistance and beta-cell activity were calculated by the homeostasis model assessment formula. The study outcome was defined as having fatty liver disease. The odds ratio (95% CI) was calculated using logistic regression models. Results: The mean age was 35 (± 9) in healthy subjects and 49 (± 8) in fatty liver disease patients (age range: 16 to 42 years). Nearly 34.5% of the individuals had fatty liver disease. According to the adjusted results of the logistic regression model, the risk of NAFLD was 1.05 (P < 0.001) for one unit increase in fasting insulin and 1.01 (P < 0.001) for one unit increase in 2-h insulin, which indicated the statistically significant relationship of NAFLD with fasting insulin and 2-h insulin. Also, the risk of NAFLD was 1.01 P < 0.001) for one unit increase in FPG, which was statistically significant. Moreover, the adjusted risk of NAFLD was 1.00 (P < 0.001) for one unit increase in 2-h glucose, which was not statistically significant. Finally, the adjusted risk of NAFLD was 1.29 (P < 0.001) for one unit increase in HOMA-IR, which was statistically significant. Conclusions: The findings of the present study demonstrated that insulin resistance could increase the risk of fatty liver disease. Also, each one-unit increase in fasting blood sugar, fasting insulin, and 2-h insulin increased the risk of fatty liver disease. Therefore, the results of this study may be useful for health policymakers to design suitable preventive and therapeutic interventions for those with NAFLD to prevent and control this disease.

Background: Due to the controversial effects of mental health disorders during pregnancy on infant health, the present study aimed to evaluate the effect of gestational depression, stress, and anxiety on the growth of offspring at six months of age in disadvantaged communities in South of Iran. Methods: The sample comprised of 470 pregnant women (response rate=98%) who are participated in the Bandar Abbas Pregnancy Cohort study. Maternal mental health was measured by the DASS-21 questionnaire during pregnancy. Data on infant growth was collected based on infant`s growth chart at six months of age. The relative risk of suboptimal infant growth was calculated by Modified Poisson regression models at 5% significant level. Results: The prevalence of depression, anxiety, and stress was 19.0%, 26.1% and 6.5%, respectively. At six months of age, the mean (SD) of infant`s weight (gram), height (cm) and head circumference (cm) were 7287.30 (1019.85), 63.23 (5.62) and 41.39 (2.70), respectively. Compared to normal mothers, the risk of suboptimal weight at six months of age significantly increased by 71% in mothers who were classified as having depression (Adjusted RR: 1.71, 95% CI: 1.07, 2.09). The presence of anxiety significantly increased the risk of suboptimal height at six months of age by 43% (ARR: 1.43, 95% CI: 1.07, 1.92). There were no statistically significant effects of either depression anxiety or stress on the suboptimal head circumference at six months of age. Conclusion: Our results showed that mental health disorders of pregnant women might adversely influence the weight and height growth of offspring within the first six months of age. Screening protocols to early diagnose of mental health disorders during pregnancy, and to strict follow up of diagnosed cases postpartum are proposed.

Objectives Postpartum depression (PPD) is a major depressive disorder. Its symptoms begin 4 weeks after delivery. Several studies have evaluated the association of the type of delivery with PPD; however, there are controversies regarding this association. Therefore, the aim of this systematic review was to estimate the overall association between cesarean section (CS) and PPD. Methods The international databases of Medline, Scopus, Web of Science, Science Direct, EMBASE and Ovid were searched until May 2017. Quality assessment was done using the Newcastle-Ottawa Scale. The pooled odds ratio in case-control and relative risk in cohort studies were used as the measures of association. A random-effects model was applied for the report of the results with 95% confidence intervals. Results Of 989 studies, 32 articles met the eligibility criteria and were included in the review. The adjusted OR of the association between CS and PPD was 1.15 (95% CI: 1.00, 1.34) and the crude odds ratio of this association was 1.36 (1.20, 1.55). The odds ratio of the association of elective and emergency CS and PPD was 1.29 (1.12, 1.49) and 1.36 (1.20, 1.55), respectively. In addition, the pooled relative risk of the association between CS and PPD was 1.22 (0.94, 1.58) in cohort studies. Conclusions Based on the results of this meta-analysis, it seems CS, regardless of the type of cesarean, is a risk factor for PPD.

Background & Objectives: inappropriate diet and the lack of necessary nutrition receiving during pregnancy, effects on maternal and neonatal health. This study carried out to investigate the effect of maternal supplements during pregnancy on growth indices at birth. Material & Methods: This cohort study was carried out on part of Bandar Abbas Cohort study data. The main exposure in this study was the consumption of dietary supplements during pregnancy and the dependent variable was the growth indices of newborns. The adjusted relative risk index using a Modified Poisson Regression model was applied. All analysis were performed using the STATA software. Results: 196 of participants remained in the study. The age range of mothers was from 16 to 42 years old and the mean of that was 27.28 (± 5.62). 81, 84 and 149 of mothers had taken an iron supplement, multivitamins, and vitamin D irregularly respectively. 12.76%, 8.68%,18.88% of the newborns, had abnormal weight, height, and head circumference at birth respectively. The relative risk of low birth weight and consumption of multivitamin 2.65 was achieved. Also, the relative risks between low birth height and iron and multivitamin supplements were 3.54 and 4.56 respectively. Conclusion: There was a relationship between irregular consumption of iron and multivitamins during pregnancy with weight and height at birth, but there was no relationship between the consumption of nutritional supplements during pregnancy and the head circumference. Mothers' nutritional supplementation during pregnancy requires more attention.

Background: The effect of maternal mental health during pregnancy on Cesarean section through implications of pre- and postnatal birth have narrowly been investigated. The aim of the present study was to investigate the effect of maternal mental health during pregnancy on the type of delivery in the suburbs of Bandar Abbas. Methods: This study used data of 200 mothers registered in a prospective cohort study on pregnant women in the suburbs of Bandar Abbas, South of Iran, during 2016-18. The presence of depression, anxiety, or stress in expecting mothers were measured by DASS-21 questionnaire and the outcome defined as having Cesarean section (Cesarean section) was measured at postpartum. The relative risk (95% CI) was calculated using Cox regression models. All analyses were performed using STATA statistical package, with a significance level of 5%. Results: Information of 196 mothers were collected (98% response rate); the mean age of the participants was 27.28 (±5.62) years. The prevalence of depression, anxiety, and stress was 13.8% (27), 40.4% (40), and 7.6% (15), respectively. Nearly 40% of mothers went through Cesarean section. Compared to mothers with good mental health, the risk of Cesarean section was 96% higher in depressed mothers (RR=2, 95% CI: 1.43-2.74) (p=0.001), 81% higher in anxious mothers (RR=1.81, 95% CI: 1.29-2.53) (p=0.003), and 75% higher in stressed mothers (RR=1.75, 95% CI: 0.86-3.56) (p=0.121). Conclusion: The findings of this study showed that poor mental health, especially anxiety and depression, during pregnancy could increase the risk of Cesarean section. Accordingly, screening protocols for mental health status and prenatal counseling sessions are suggested for pregnant mothers to increase their informed decision on types of delivery.

OBJECTIVES:Depression, which is the most common comorbidity in breast cancer (BC) patients, has adverse effects on patients' quality of life, disease progress, and survival.METHODS:The protocol of this study was registered in PROSPERO (registration No. CRD42019121494). We electronically searched published studies through January 2019 with the aim of finding articles that investigated the prevalence of depression among BC survivors. Web of Science, Scopus, PubMed/MEDLINE, Science Direct, and Google Scholar were searched to obtain relevant published studies. This review included 14 cross-sectional and 4 cohort studies published from 2000 to 2018. We used a random-effects model to conduct the meta-analysis and generated a summary estimate for the pooled prevalence with 95% confidence intervals (CIs). A subgroup analysis was also conducted based on the depression assessment tool used and the study design.RESULTS:The total sample size of the studies contained 2,799 women with BC, including 1,228 women who were diagnosed with depression. The pooled prevalence of depression among Iranian women with BC was 46.83% (95% CI, 33.77 to 59.88) with significant heterogeneity (I2 =98.5%; p<0.001). The prevalence of depression ranged from 14.00% (95% CI, 4.91 to 23.09) to 95.90% (95% CI, 91.97 to 99.83). The results of the subgroup analyses suggested that the depression assessment tool, year of publication, and study design were sources of heterogeneity.CONCLUSIONS:Our findings indicate a high prevalence of depression among BC patients, underscoring the urgent need for clinicians and health authorities to provide well-defined social and psychological supportive care programs for these patients.