Background:Updating hypertension-related healthcare services requires understanding of the utilization status and its associated factors. This study aimed to assess patterns of healthcare utilization related to hypertension and its associated factors in Tehran. Methods:This population-based cross-sectional study was conducted on adult residents over 30 years of age using a multistage stratified random sampling from December 2024 to May 2025. The data were collected using telephone interviews via a researcher-made questionnaire that included demographic information and information on the utilization patterns of health services related to hypertension. Multiple logistic regression was used to evaluate factors associated with health service utilization at the 95% confidence level using STATA-Command Survey software version 18. Results:Among the 4,500 participants, 14.6% (95% CI= 13.4-15.8) reported the utilization of healthcare services in healthcare facilities in Tehran during the past two years, with 22.3% (95% CI= 19.5-25.3) utilization observed among individuals with hypertension. In total, the largest proportion of reasons for receiving related health services were related to having worrying about symptoms (75.5%), good response and behavior from service providers (61.3%), and a high level of centers-doctors/healthcare providers (42.4%). Among the 3843 people who did not receive health services, the greatest proportion were related to financial problems and a lack of favorable insurance status (81.2%) and inadequate health service to meet needs (63.2%). Utilization was significantly related to increasing age (OR =3.94, 95% CI= 2.01--5.09), higher education level (OR =3.74, 95% CI= 1.85--5.02), better socioeconomic status (OR =3.21, 95% CI= 1.61--4.96), having armed forces health insurance good (OR =4.03, 95% CI= 1.27--6.98), and supplementary insurance good (OR =6.13, 95% CI= 2.41--8.14). Conclusion:Utilization of hypertension-related services in Tehran is suboptimal and is not only due to individual inattention but also the result of the interaction of various individual, economic, and social factors, which must be viewed as a package of intervenable issues to improve it.

Iran has an extensive governmental network of primary health care facilities and hospitals. In 2019, the integration of asthma-related services into this network was designed and pilot-tested. Primary health care providers (PHCPs) and family physicians (FPs) are the main members of the care provision team and are responsible for case identification and management. The pilot was conducted from November 2019 through April 2020 in seven areas-Kerman, Maragheh, Ahvaz, Kashan, Urmia, Karun, and Qazvin-covering both urban and rural locations and a population of approximately one million people. Our objective was to report indicators related to the integration of asthma identification, referral, and management within the existing primary health care system. In total, 350,894 individuals were screened for asthma by PHCPs. The observed proportion of positive (probable) cases among those screened was 2.48%. Key process indicators included screening uptake (34%), attendance of referred cases at physician visits (83%), and follow-up adherence (49% of confirmed cases). We conclude that improving screening uptake and the accuracy of asthma case detection by PHCPs are the most effective strategies for enhancing care provision efficiency. The findings of the pilot project have significant implications for understanding efficient integration of asthma-related services. The results indicate that integrating asthma care into primary health services is feasible and can improve early detection and care coordination, informing policy decisions for broader implementation and resource planning.

Iran has an extensive governmental network of primary health care facilities and hospitals. In 2019, the integration of asthma-related services into this network was designed and pilot-tested. Primary health care providers (PHCPs) and family physicians (FPs) are the main members of the care provision team and are responsible for case identification and management. The pilot was conducted from November 2019 through April 2020 in seven areas-Kerman, Maragheh, Ahvaz, Kashan, Urmia, Karun, and Qazvin-covering both urban and rural locations and a population of approximately one million people. Our objective was to report indicators related to the integration of asthma identification, referral, and management within the existing primary health care system. In total, 350,894 individuals were screened for asthma by PHCPs. The observed proportion of positive (probable) cases among those screened was 2.48%. Key process indicators included screening uptake (34%), attendance of referred cases at physician visits (83%), and follow-up adherence (49% of confirmed cases). We conclude that improving screening uptake and the accuracy of asthma case detection by PHCPs are the most effective strategies for enhancing care provision efficiency. The findings of the pilot project have significant implications for understanding efficient integration of asthma-related services. The results indicate that integrating asthma care into primary health services is feasible and can improve early detection and care coordination, informing policy decisions for broader implementation and resource planning.

Hepatitis B virus (HBV) remains a significant public health challenge in Iraq, necessitating a comprehensive evaluation of the national hepatitis B control plan. This study aimed to assess the epidemiological trends of HBV in Iraq from 2015 to 2022 and evaluate the implementation and effectiveness of the national control plan. A descriptive cross-sectional study was conducted using national HBV surveillance data from all available Iraqi governorates between 2015 and 2022. The program evaluation component was performed in Wasit Governorate and included 24 randomly selected primary health care centers (PHCCs). Descriptive statistics, Mann–Whitney U, Kruskal–Wallis, and chi-square tests were performed using SPSS version 25 and Microsoft Excel. The annual HBV incidence rate declined from 8.3 to 3.5 per 100,000 population between 2015 and 2022, with consistently higher incidence rates among males and marked geographic variation across governorates. The highest incidence rates were observed among individuals aged 15–45 years and those aged > 45 years. Childhood hepatitis B vaccination coverage exceeded the national target by 2022; however, prevention of mother-to-child transmission and HBV diagnosis coverage remained below target levels. Evaluation of PHCC performance showed that 88

We evaluated the IraPEN program, a localized adaptation of the WHO PEN initiative in Iran, with respect to cardiovascular disease and hypertension screening and management. A cross-sectional ecological study utilizing the Input-Process-Output-Outcome framework was conducted during 2020–2021. Aggregated data from non-communicable disease (NCD) facilities were collected and analyzed by urban/rural primary healthcare settings. The study evaluated 610 NCD facilities, serving 1.8 million adults aged ≥ 30, of whom 515,488 underwent 10-year WHO/ISH CVD risk scoring and hypertension assessment, indicating coverage of 30

BACKGROUND:To assess the effectiveness of the IraPEN program in decreasing the risk of cardiovascular disease (CVD) and associated risk factors in selected areas of Iran. METHODS:A secondary data analysis of longitudinal data collected between 2016 and 2017 from health centers in four pilot areas. The target population consisted of people aged 40 years and above, as well as individuals aged 30-40 years who had at least one CVD risk factor. We compared mean CVD risk and risk factor levels before and one year after the intervention and utilized Generalized Estimating Equations to analyze the trends during subsequent visits. RESULTS:A total of 160,223 eligible individuals (93,081 female) were screened at baseline, of which 25,764 individuals (17,386 female) were followed up for at least one year. The proportion of men with a CVD risk score above 10%, according to the WHO/ISH risk charts, decreased from 7.5 to 5.3%, while the proportion of women decreased from 6.1 to 4.7%. Based on the revised WHO risk score, the mean CVD risk for those with a risk score above 10% at baseline and one year later was 0.198 and 0.177 in men and 0.119 and 0.109 in women, respectively. There was a significant decrease in all risk factors, except for waist circumference in both sexes and BMI in women. The trend analysis of risk factors over time confirmed these findings. CONCLUSION:The program was modestly effective in reducing CVD risk in the pilot areas. However, further modifications may be needed to enhance its effectiveness.

The effectiveness of prophylactic systemic antibiotics in preventing ventilator-associated pneumonia (VAP) in patients receiving invasive mechanical ventilation (IMV) in intensive care units (ICUs) remains uncertain. This meta-analysis aims to evaluate the efficacy of antibiotic prophylaxis in reducing the incidence of VAP among the IMV population. We conducted an extensive search of databases, including PubMed, Web of Science, Embase, and the Cochrane Library, from their inception to December 2023. We aimed to identify studies evaluating the effects of prophylactic systemic antibiotics on VAP, early- and late-onset VAP, mortality rates, median ventilation days, and lengths of ICU and hospital stays, facilitating a comprehensive meta-analysis. Seven studies involving 939 patients indicated that the use of preventive antibiotics reduced VAP compared to control groups (risk ratio [RR] of 0.61). The early-onset VAP rate was also lower in the treatment group compared to the control groups (RR of 0.40). Prophylactic systemic antibiotics may effectively reduce VAP incidence in ICU patients on IMV but do not significantly impact other clinical outcomes. These findings may stem from the fact that VAP accounts for a small fraction of ICU deaths, and most studies focused on early-onset VAP, which has lower mortality. However, definitive recommendations cannot be established without the necessity of well-designed randomized controlled trials.

Background and objective: The design and improvement of healthcare services related to diabetes require assessing the utilization of these services. The aim of this study was to assess healthcare utilization for diabetes and its associated factors in Tehran. Methods The present study is a cross-sectional, descriptive-analytical study conducted among 4500 adult residents (≥ 30 years old) of Tehran, the capital city of Iran, via a stratified random sampling method. A telephone survey was conducted in 22 districts of Tehran, and individuals were asked about their utilization of diabetes-related health services. Individuals were also asked about their reasons for receiving or not receiving services and associated factors. Data analysis was performed via Stata software version 18, with a confidence level of 95%. Results Out of a total of 4,500 participants, 12.2% reported having used services related to diabetes at a healthcare facility within the past two years. The most common locations for receiving the last diabetes-related services were private specialist physicians’ offices (33.8%). The most frequently reported reasons for service utilization were ensuring the safety of the service (72.4%) and “High professional level of the physician/health care provider in terms of knowledge, education, and quality of medical advice” (62.7%). Among the reasons cited by participants who did not utilize services, the most frequently mentioned were financial problems and a lack of service fees (80.9). Age over sixty years, being female, having a higher education level, having better socioeconomic status and self-reported health, having armed forces insurance, being married, being retired, having supplementary insurance, and having diabetes were significantly associated with greater utilization of diabetes-related health services (p < 0.05). Conclusion Despite the alarming increase in the incidence of diabetes in the country, the utilization of health services in Tehran may not be desirable. Tehran, with a population of more than 9 million people, accounts for approximately 10% of the country's population, and access to services should not necessarily be considered the ultimate utilization of people from services. Adequate education and awareness of diabetes, increasing the financial capacity of people to refer for services, and reforming health service packages with the aim of improving the quality, attractiveness, and effectiveness of services can be created with proper health policy planning and decisions. With appropriate technology, accessible health services can be utilized by people.

Background: Optimal glycemic control in Type 2 diabetes remains a critical public health challenge. This study was aimed at elucidating the sociodemographic, lifestyle, and clinical factors associated with poor glycemic control among Iranian patients. Materials and Methods: A cross‐sectional study was conducted on 546 patients with Type 2 diabetes at Imam Hossein Hospital, Tehran, from July 2023 to December 2024. Participants were categorized into good (HbA1c < 7 % ) and poor (HbA1c ≥ 7 % ) glycemic control groups. Data were collected using structured checklists and validated tools. Missing data were handled with multiple imputation, and logistic regression identified predictors of glycemic control. Results: Rural residence significantly increased the odds of poor glycemic control (OR = 3.04, 95% CI: 1.98–4.65). Limited medication access was a major determinant; participants reporting “rarely” or “sometimes” having access to prescribed medications had markedly higher risks (OR = 5.16, 95% CI: 2.41–11.06, and OR = 3.75, 95% CI: 2.20–6.40, respectively). Engaging in moderate and high physical activity (based on metabolic equivalent) was protective (OR = 0.49 and OR = 0.40, respectively). Additionally, each extra day per week of fatty food consumption increased the odds of poor control by 26% (OR = 1.26, 95% CI: 1.09–1.46). A 10 mg/dL increase in HDL cholesterol reduced risk (OR = 0.86, 95% CI: 0.75–0.98, p = 0.04), while longer durations of oral medication use were associated with a modest risk increase (OR = 1.05, 95% CI: 1.01–1.10, p = 0.02). Conclusions: These findings underscore the significance of geographic disparities, medication access, lifestyle practices, and dietary behaviors in diabetes management. Targeted interventions tailored to these factors are essential to improve glycemic outcomes in Type 2 diabetes.

Parkinson's disease (PD) is the second most common neurological disease. This study explores the determinant factors influencing medication adherence and disease stage among PD patients. This study was conducted on 161 PD patients at the Neurology Clinic. The eight-item Morisky Medication Adherence Scale (MMAS-8) and the International Parkinson and Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) were used. Medication adherence and disease stage were analyzed using the chi-square test to measure the association of qualitative variables, and the Kruskal-Wallis test to test the association of quantitative data. Ordinal logistic regression was used to relate study variables with study outcomes. Medication adherence has a significant association with PD duration, number of times of taking PD drugs daily, comorbidity, total number of medications used, side effects, and history of medication discontinuation. The mean score of MDS-UPDRS subscales significantly differs. Medication adherence levels are suboptimal among PD patients, with significant correlations between medication adherence and disease stage, motor symptoms, and motor side effect. These insights underscore the critical need for targeted interventions to improve medication adherence and mitigate disease burden in PD patients.

This study evaluated the effectiveness of the IraPEN program, an adapted version of the WHO Package of Essential Non-communicable Disease (PEN) intervention, in managing diabetes from September 2020 to September 2021 using the Input-Process-Output-Outcome framework. In this Cross-sectional/Ecological study, aggregated data was collected from IraPEN facilities by medical universities using the electronic health system. The data was presented as numbers and proportions, for urban and rural healthcare facilities separately. The study surveyed 610 NCD facilities from184 comprehensive health centers under the supervision of 56 medical universities, which provided services to 1,785,226 individuals aged > = 30 years. In terms of input/process, 78

Background:Hepatitis B virus infection is a major health concern globally, with regional and national variations that require context-specific analyses. Aim:To assess trends, including age- and gender-specific variations, of hepatitis B virus incidence in Iraq from 2012 to 2022. Methods:We analysed national surveillance data from 2012 to 2022 on confirmed hepatitis B virus cases among all age groups in Iraq. Joinpoint regression was used to estimate the annual percentage change and average annual percentage change in incidence. Results:Annual incidence decreased from 9.7 per 100 000 population in 2012 to 3.5 in 2022. Incidence was consistently higher among males, however, joinpoint regression showed a significant decrease in incidence among males (-13.8%) and females (-14.9%). The lowest decrease (-41.1%) occurred after 2017 among those aged 0-4 years. Incidence among the 5-14 years age group peaked in 2014 and decreased thereafter (-10.8%). Among individuals aged 15-44 years, incidence increased until 2016 and then decreased significantly (-18.9%). Among those aged >45, incidence increased until 2015 and then stabilised. Conclusion:Age- and gender-specific interventions are needed to strengthen hepatitis B prevention and control in Iraq.

Background Hepatitis B virus (HBV) infection remains a significant public health concern in Iraq, necessitating a comprehensive study to understand the temporal and demographic patterns of incidence rates. This study explored gender disparities, regional variations across governorates, and age-related incidence rates from 2015 to 2022. Additionally, this study evaluated the effectiveness of the national HBV control plan, focusing on vaccination coverage, prevention of mother-to-child transmission, blood safety, diagnosis, and treatment. Methods This study employed a descriptive cross-sectional study design to analyze the descriptive epidemiology profile of HBV in Iraq. National-level data from 2015 to 2022 for different governorates are examined. The evaluation phase specifically focused on the Wasit governorate, which includes 24 primary health care centers (PHCCs) representing 50% of the total centers. Statistical tests, including t tests, ANOVA, and chi-square tests, were conducted using SPSS and Excel to identify significant patterns in the data. Results The incidence of HBV decreased from 8.3 per 100,000 people in 2015 to 3.5 per 100,000 people in 2022. Gender disparities consistently indicated higher rates among males, while significant variations were observed among the governorates. Age-related analysis revealed the highest incidence rates in individuals aged 15–45 and over 45 years. The national plan successfully achieved high vaccination coverage but faced challenges in preventing mother-to-child transmission and diagnosing viral hepatitis B. The evaluation scores for PHCCs varied, with 88% falling within the acceptable range. Conclusion This study provides a comprehensive overview of the epidemiology of HBV in Iraq, highlighting declining incidence rates and significant demographic variations. Although there has been success in vaccination coverage, challenges persist in preventing mother-to-child transmission and achieving viral hepatitis B diagnosis targets. The evaluation of PHCCs indicates areas for improvement in healthcare service delivery. These findings offer valuable insights for targeted interventions and policy adjustments, ultimately aiding in effectively controlling and preventing hepatitis B in Iraq.

INTRODUCTION:Cancer is projected to become the primary cause of death in the 21st century. Although childhood cancer is relatively rare, it remains a significant contributor to mortality among children. This study examines the geographical distribution of childhood cancer incidence in Iranian provinces using data from the National Cancer Registry between 2014 and 2018. MATERIALS AND METHODS:This registry-based study analyzed data from 14,711 children under 20 diagnosed with common childhood cancers, sourced from the Iranian National Population-based Cancer Registry for the period 2014-2018. The age-standardized incidence rates (ASR) were calculated using direct standardization methods and reported per 1 million person-years. Spatial autocorrelation measures, including global and local indices such as Moran's I and Getis-Ord's G, were employed to identify high-risk and low-risk areas, assess overall spatial dependence, and pinpoint specific clusters and hotspots of incidence rates. RESULTS:ASR for childhood cancer in Iran was 119.56 per 1 million individuals aged 0-19 years. Boys had a higher ASR (129.98) than girls (107.68). Childhood cancer cases increased from 2765 in 2014 to 3354 in 2018, with leukemia as the most common type, followed by brain and nervous system, lymphoma, bone, and connective and soft tissue cancers. Spatial analysis identified high-risk clusters in central Iran (Isfahan, Yazd, Tehran) and low-risk clusters in the northeast (Kermanshah, West and East Azerbaijan, Kurdistan). CONCLUSION:This study highlights high childhood cancer incidence in Iran, particularly among boys and in central regions, with elevated leukemia rates. These findings call for targeted prevention strategies and further research to address geographic and gender disparities and to improve care programs.

Background and Objectives: Understanding the KAP of the community regarding common diseases during religious tourism and pilgrimage has not been extensively explored. The current study aimed to investigate the knowledge, attitudes, and practices of Arbaeen pilgrims concerning the common diseases and therapeutic measures in the year 2023. Methods: The present study was a descriptive-analytical cross-sectional conducted in Arbaeen pilgrims in the year 2023. The sampling method was convenience sampling. The data collection process involved faceto-face interviews conducted by a researcher who approached the pilgrims. Knowledge, attitude and performance were measured using a researcher-made questionnaire, which was validated and tested for reliability during the study. Results: Among the 840 participants, the highest frequency was the age groups of 21-30 years (41.67%) and 31-40 years (31.07%), respectively. The mean knowledge, attitude, and performance score was 58.48 (SD= 6.94), 42.97 (SD=5.59), and 40.37 (SD= 6.18), respectively. Older age, female gender, higher education level, employment status, emergence of disease symptoms before travel, self-reported socioeconomic status, and self-reported health status had a significant relationship with at least one of the areas of knowledge, attitude, and performance (P<0.05). Conclusion: The results of this study indicated that the awareness, performance, and attitudes of Arbaeen pilgrims are not satisfactory and require improvement in certain areas. Consequently, it is recommended to implement targeted educational interventions based on the specific needs of the Arbaeen pilgrims.

Background: Kidney and ureter cancers are two of the most prevalent urological cancers among Iranians. However, studies on the epidemiology and incidence of these cancers are primarily regional and focus on a specific period. Objectives: The present study investigated the trend of the incidence rate of kidney and ureter cancer in Iran from 2004 to 2016. Methods: In this study, information on kidney and ureter cancer cases in Iran from 2004 to 2016 was extracted from the Iranian National Cancer Registry (INCR). Crude and age-specific incidence rates (ASIR) were calculated, and the age-standardized rate (ASR) was measured, using the World Health Organization (WHO) standard population. The Joinpoint software program 4.9.0.1 was used to calculate the annual percent changes (APC) in the trend of the incidence rate of kidney and ureter cancers by age group, regional centers, and tumor grades across a 13-year period. Results: During the study period, 19 659 incidences of ureter and kidney cancer occurred in Iran. The crude and ASR of kidney cancer increased from 0.98 and 1.33 per 100 000 population in 2004 to 3.1 and 3.5 per 100 000 population in 2016, respectively. In addition, the crude and ASR of ureter cancer increased from 0.04 and 0.05 per 100 000 population in 2004 to 0.9 and 1.1 per 100 000 population in 2016, respectively. The national ASR of kidney cancer APC was 22.2% (P > 0.05) from 2004 to 2006 and 4.8% (P < 0.05) from 2006 to 2016, respectively. The national ASR of ureter cancer APC was 290.8% (P < 0.05) from 2004 to 2006 and 7.5% (P < 0.05) from 2006 to 2016. Conclusions: According to the results of this study, the incidence rate of kidney and ureter cancer increased over 13 years in Iran. Hence, the implementation of epidemiological studies in various regions and provinces is crucial for gaining a comprehensive and precise understanding of the underlying causes of kidney and ureter cancer incidence.

This study aimed to examine the impacts of single and multiple air pollutants (AP) on the severity of breast cancer (BC). Data of 1148 diagnosed BC cases (2008–2016) were obtained from the Cancer Research Center and private oncologist offices in Tehran, Iran. Ambient PM10, SO2, NO, NO2, NOX, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene, and BTEX data were obtained from previously developed land use regression models. Associations between pollutants and stage of BC were assessed by multinomial logistic regression models. An increase of 10 μg/m3 in ethylbenzene, o-xylene, m-xylene, and 10 ppb of NO corresponded to 10.41 (95% CI 1.32–82.41), 4.07 (1.46–11.33), 2.89 (1.08–7.73) and 1.08 (1.00–1.15) increase in the odds of stage I versus non-invasive BC, respectively. Benzene (OR, odds ratio = 1.16, 95% CI 1.01–1.33) and o-xylene (OR = 1.18, 1.02–1.38) were associated with increased odds of incidence of BC stages III & IV versus non-invasive stages. BC stage I and stage III&IV in women living in low SES areas was associated with significantly higher levels of benzene, ethylbenzene, o-xylene, and m-xylene. The highest multiple-air-pollutants quartile was associated with a higher odds of stage I BC (OR = 3.16) in patients under 50 years old. This study provides evidence that exposure to AP is associated with increased BC stage at diagnosis, especially under premenopause age.

Introduction: This study assessed the incidence and severity of side effects associated with coronavirus disease 2019 (COVID-19) vaccination among healthcare workers registered with the Medical Council of the Islamic Republic of Iran. Methodology: A retrospective cohort study was conducted on the healthcare workers focusing on the side-effects of COVID-19 vaccines from March to June 2021. Data were collected using online questionnaires. Multivariable logistic regression was used to assess the association between side effects of the vaccines and demographic variables, comorbidities, vaccine type, and history of COVID-19. Results: Out of 42,018 people who were included, 55.85% reported at least one side effect after receiving the first vaccine dose. 4.59% of those with side effects sought diagnostic intervention or were referred to treatment centers. Multivariable logistic regression indicated that being a woman, higher education, having a history of COVID-19 infection, and having comorbidities increased the risk of side effects. The AstraZeneca vaccine significantly increased the risk of side effects compared to the Sputnik vaccine, while the Sinopharm vaccine decreased this risk. The risk of developing a side effect decreased with age. The risk of moderate and severe side effects was significantly associated with gender, younger age, comorbidities, and a history of COVID-19 infection. Moderate and severe side effects were less reported by those who received the Sinopharm vaccine. Conclusions: Clinical complications after COVID-19 vaccination, directly or indirectly caused by the vaccines, are common. However, the benefits of COVID-19 vaccines greatly outweigh the risk of reversible side effects, especially among the high-risk population.