Objectives Establishing mental health first aid (MHFA) programs is a strategy employed by developed countries worldwide to empower students in terms of mental health literacy; these programs have not received the support for implementation in Iranian schools. The present study aimed to explore the challenges in the implementation of teen MHFA (tMHFA) programs in Iranian schools and provide solutions. Methods This is a qualitative study, conducted in 2021. The participants were purposively selected from adolescents, their parents, and the experts in the field of mental health aid for adolescents (n=34) in Tehran. Data collection was conducted using semi-structured, in-depth individual interviews. The collected data were analyzed using thematic analysis based on an inductive approach in MAXQDA software, version 2020. Results Three main themes as challenges were extracted, including characteristics/tendencies of students (independence in decision-making, influence from media and virtual social networks, willingness to attend the classes, and personality and behavioral characteristics), infrastructure/resources (readiness and competence of teaching and specialized staff, financial resources, physical resources, relevant educational content and related guides, and service delivery network), and the course implementation process (governance and stewardship, managers' willingness and perspective, planning, practicality and skill-based, and effectiveness evaluation). Conclusion The tMHFA program's successful implementation in Iranian schools requires the involvement of students and their families, empowering the school staff, localizing educational content based on needs assessment, providing resources from multiple sources; using media and distance education, integrating the program into the routine school activities and including in school textbooks, using incentives such as a certificate of course completion, informing by influencers, governmental support via appropriate legislation, employing qualified and trusted teachers, coordination with the health network, and designing and establishing a robust monitoring framework.

Objective(s): With the spread of COVID-19 pandemic, different countries have implemented various intervention to control the disease. Providing information on how the disease spreads and local risk factors can help policymakers and managers to control the disease. The aim of this study was to analyze the spatial factors of Covid-19 disease in Hamadan province, Iran. Methods: All cases of Covid-19 in Hamadan province from the beginning of the epidemic (Jan 2020) to the end of March 2021 with a confirmed diagnosis of Covid-19 disease based on PCR test were included in the study. The required information was collected through the Covid-19 case registration system in Hamadan University of medical science, other provincial institutions and the Statistics Center of Iran. Statistical analyzes were performed in two parts: descriptive and analytical. Zoning maps were used to show the distribution of disease cases. Getis-Ord G statistic was used in the analytical analysis to analyze the hot spots. Results: A total of 25197 patients suspected of Covid-19 were studied. Of these 10366 were positive based on PCR test. There were 1510 confirmed positive cases of the disease who died during the period of investigation. Population density, employment rate, development index, illiteracy rate, distance from the provincial center, air temperature, number of frosty days, average air humidity showed a significant relationship with the incidence of positive cases of Covid-19 in Hamadan province. Conclusion: Based on the findings, the most important variables related to the increase in the death of covid-19 included the increase in population density and the level of development. The preparation of risk maps using GIS can help to plan a rapid response to the COVID-19 epidemic, focus on prevention programs in high-risk areas, and plan the necessary strategies appropriate to the epidemic trend to control COVID-19 and similar epidemics in the future.

1. Dept. of Pediatrics, Hamadan University of Medical Sciences, Hamadan, Iran 2. Occupational Health and Safety Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 3. Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran 4. Clinical Research Development Unit of Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran

Background and Objective: Parent health literacy plays a critical role in the health of the pediatric patients. Awareness about the level of health literacy of parents is essential. This study is aimed to investigate the health literacy among parents of referral children to Besat hospital, Hamadan, Iran. Materials and Methods: This cross-sectional study was conducted on 100 parents (87 mothers and 13 fathers), who their children were referred to Besat Hospital, in fall 2021. Samples were randomly selected. Demographic and TOFHLA questionnaire were used to collect data. SPSS 21 was used to analyze data by independent t-test, chi-square test, ANOVA at a significance level of 0.05. Results: The average leve of fathers' and mothers' health literacy was 32.64 +/- 10.23 and 64.96 +/- 22.75, respectively. A total of 85 (85%) of the participants were married and lived with spouses. The education level of 51.72% of mothers and 53.84% of fathers were under diploma. Parents' health literacy was significantly changed based on the parent's education level (p = 0.05), the parent's job (p= <0.001), and the place of residency (p=0.001). Effect of marital status (p=0.486) and parents' gender (p = 0.984) on parents' health literacy were not significant Conclusion: Half of the parents' health literacy was inadequate, and the level of health literacy was higher in parents that lived in urban and especial work with higher academic education

Background and Objective: Due to the prevalence of myocardial dysfunction and Patent Ductus Arteriosus (PDA) in a large number of preterm neonates, the prognosis of these infants is highly related to their early diagnosis and treatment. In this regard, the present study aimed to determine the relationship between troponin T level and the prognosis of premature neonates admitted to the Neonatal Intensive Care Unit (NICU) of Fatemieh Hospital in Hamadan. Materials and Methods: In this cross-sectional study, a certain number of infants who underwent serum levels of troponin T from 72 hours to one week after birth were assessed for demographic information, length of hospital stay, complications during hospitalization, acidosis, inotropic agents, recovery, and mortality, as well as their relationship with troponin level. Results: Out of 61 neonates, 22 patients had large PDA with a troponin level of 436±50.2 pg/ml, 14 patients had a small PDA with a troponin level of 260.5±89.8 pg/ml, and 25 patients were without PDA with a troponin level of 277.1±229.7 pg /ml (P = 0.203). There was no statistically significant difference between the three groups. The mean levels of troponin were 423±521 and 274±154 pg/ml in deceased and surviving neonates, respectively (P=0.194). Inotropic was significantly higher in deceased patients (P=0.003), and troponin T level was statistically significant (P=0.008). The relationship between troponin level and severe acidosis (P=0.051) was not significant, with a small difference that could be clinically valuable. Conclusion: Serum troponin T level was higher in preterm neonates with large PDA and deceased ones who received inotropic agents due to hemodynamic disorders and severe acidosis.

Background and Objectives: Motorcyclists are one of the most vulnerable groups compared to other road users. Motorcycle road safety can be assured by identifying risk factors, using safety equipment, and improving roads for traveling. This study sought to identify and prioritize the risk factors involved in motorcyclists' traffic accidents in Tehran. Methods: In this descriptive-analytic study, the fuzzy TOPSIS method was used to develop a systematic process to achieve an optimal model through the selected criteria. To find significant risk factors in the model, the interviewed experts first selected the target criteria from an available long list of functional criteria. Then, using the SMART method, the key criteria in motorcyclists' traffic accidents were determined, and they were ranked according to their weights and weighting ratios. Results: Fifty people, including 42 (84%) males and 8 (16%) females, participated in the study. The mean and standard deviation scores of participants' age were 44.18 and 7.03 years, respectively. Based on the fuzzy analysis, alcohol intake, cell phone use, breaching the speed limit, failure to use safety equipment, and driver's age, among other criteria, were ranked first to fifth. Conclusion: This study showed that the most important risk factors associated with motorcyclists' traffic accidents were the human ones. Given that various studies in Iran have shown that human factors are the leading causes of traffic accidents, policymakers and administrators need to take the necessary measures to manage and control them.

Background: This report provided the effect of 15 preventable factors on the risk of breast cancer incidence. Study design: A systematic review and meta-analysis. Methods: A detailed research was conducted on PubMed, Web of Science, and Scopus databases in January 2020. Reference lists were also screened. Prospective cohort studies addressing the associations between breast cancer and 15 factors were analyzed. Between-study heterogeneity was investigated using the χ2, τ2, and I2 statistics. The probability of publication bias was explored using the Begg and Egger tests and trim-and-fill analysis. Effect sizes were expressed as risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. Results: Based on the results, out of 147,083 identified studies, 197 were eligible, including 19,413,702 participants. The RRs (95% CI) of factors associated with breast cancer were as follows: cigarette smoking 1.07 (1.05, 1.09); alcohol drinking 1.10 (1.07, 1.12); sufficient physical activity 0.90 (0.86, 0.95); overweight/obesity in premenopausal 0.92 (0.82, 1.03) and postmenopausal 1.18 (1.13, 1.24); nulliparity 1.16 (1.03, 1.31); late pregnancy 1.37 (1.25, 1.50); breastfeeding 0.87 (0.81, 0.93); ever using oral contraceptive 1.00 (0.96, 1.05); ever using estrogen 1.13 (1.04, 1.23); ever using progesterone 1.02 (0.84, 1.24); ever using estrogen/progesterone 1.60 (1.42, 1.80); ever taking hormone replacement therapy 1.26 (1.20, 1.32); red meat consumption 1.05 (1.00, 1.11); fruit/vegetable consumption 0.87 (0.83, 0.90); and history of radiation therapy, based on single study 1.31 (0.87, 1.98). Conclusions: This meta-analysis provided a clear picture of several factors associated with the development of breast cancer. Moreover, the useful information in this study may be utilized for ranking and prioritizing preventable risk factors to implement effective prevention programs.

OBJECTIVES: According to Traffic Police, about 35% of deaths and more than 50% of injuries caused by traffic collision in the roads of Tehran are among drivers and car occupants. This study was conducted to determine areas with the highest number of traffic collisions and perform spatial analysis of traffic collisions involving drivers in Tehran during April 2014 to March 2017.METHODS: The present study was a cross-sectional and descriptive-analytic research. In this study, all traffic collision that driver was accounted (100 percent or less) for crash occurrence which resulted in the death of at least one person (driver, pedestrian or passenger) were included in the analyses. Geographic information system software was used to show spatial distribution of events from zoning maps. Moran index was used in the mathematical analysis in order to determine the distribution pattern of the events from and Getis-Ord G statistics was applied to analyze the hot spots (high risk points).RESULTS: A total number of 519 traffic collisions were investigated in this study. Moreover, 283 cases (54.5%) of the incidents took place in direct routes and 236 cases (45.5%) occurred at intersections. The most frequent events were in the region 4 (57 cases) and the least frequent events were reported in the region 10 (6 cases). Moran statistics show that the distribution of the studied events significantly follows the cluster pattern (p<0.001).CONCLUSIONS: The northeastern and northwest margins of Tehran are the most prone areas for drivers involved with traffic collisions leading to death. Most traffic collisions leading to death take place at highways located at the entrance and exit points of Tehran and highways in regions 2 and 5.

Background: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) is a major public health problem in Iran. It imposes heavy costs on governments and affected people. Determining the survival duration of patients and recognizing the related factors can help the disease surveillance system. Objectives: The current study aimed at determining the survival rate and the related factors concerning patients with HIV/AIDS identified in Tehran, Iran. Methods: The study population of the current retrospective cohort consisted of patients with HIV/AIDS covered by the Health Center of Southern Tehran. The data were obtained by referring to the HIV/AIDS care centers and reviewing the patients’ records. Survival rates of the study subjects during 10 years follow-up were calculated. The Cox proportional-hazards model was used to determine the relationship between independent variables and survival of patients with HIV/AIDS. Results: A total of 487 patients were investigated in the current study. Four-hundred thirty-three subjects (88.9%) were male, and 54 (11.1%) female. The mean ± standard deviation of the participants’ age was 44.08 ± 9.00 years. According to univariate analyses, the variables of gender, marital status, education level, occupational status, transmission way, infection with hepatitis C or tuberculosis, and history of antiretroviral treatment were significantly associated with the survival time of patients with AIDS. In the final model, a significant relationship was found between the variables of treatment, coinfection with tuberculosis, occupational status, education level, marital status, and mortality. Conclusions: The current study was one of the few research that examined the survival rate of HIV-infected patients in Iran. Considering the expansion of AIDS epidemic in Iran, it is necessary to take appropriate measures to prevent the spread of the epidemic and decrease the mortality rate of infected patients through early detection and timely treatment of HIV-positive people coinfected with tuberculosis, creation of employment opportunities for patients and addicted individuals, controlling substance abuse, and paying more attention to harm reduction programs in individuals that have unsafe sex as one of the most important high-risk groups to increase their survival time.

Background: Considering the importance of pedestrian traffic crashes and the role of environmental and demographic factors in the severity of these crashes, this article aimed to review the published evidence and synthesize the results of related studies to determine any associations between demographic and environmental factors and the severity of pedestrian-vehicle crashes. Methods: All epidemiological studies published from 1970 to 2019 were searched in international electronic databases (PubMed [Medline], Scopus, Web of Science, Embase, ScienceDirect, and Ovid) and reference lists of the identified articles were also searched. Studies were included if they investigated the severity of pedestrian-vehicle crashes as outcome, measured any environmental and demographic factors for pedestrian-vehicular crashes as exposure, designed observational, and if they were written in all languages. Quality of included studies was evaluated using the strengthening the reporting of observational studies in epidemiology checklist for observational studies. Results: We found 3126 references among which 24 studies were included in this review. All retrieved studies were conducted between 1990 and 2019 and had a cross-sectional design. In most of these studies, the associations between environmental and demographic variables such as vehicle speed or speed limits, pedestrian age, lighting, type of road, type of vehicle, and alcohol intake with the severity of pedestrian traffic crashes were examined. Conclusion: This study showed that few studies were conducted in this area; in fact, most of the studies were carried out in metropolises of developed countries. As a result, studies which provide strong causal inferences by focusing on high-risk groups and a higher level of evidence such as cohort and case-control ones are needed in developing countries.

Background: The most important factors that affect the incidence of vaccine-related complications are the constituent biological components of the vaccine, injection site reactions, age and sex. The aim of this study is to determine the incidence rate of adverse events following immunization with pentavalent vaccine (DTPw-Hep B-Hib (PRP-T) vaccine (pentavac) (adsorbed) is manufactured by Serum Institute of India ltd), which was introduced in Iran in November 2014. It is important to monitor vaccine-related adverse events because of the role of vaccine safety in immunization program success.Methods: This study was a mixed cohort study that included 1119 children less than 1 year of age. In 2015, the children were referred to Hamadan health centers to receive pentavalent vaccine at 2, 4 and 6 months of age. The data were collected from the parents of the children using a questionnaire that was administered either face-to-face or by telephone. The cumulative incidence of side effects and risk ratio was reported with 95% confidence intervals (CI). Chi-squared tests and logistic regressions were used to investigate the association between the variables.Results: The cumulative incidence rate of pentavalent-related adverse events during 48 h following immunization was estimated to be 15.8% for swelling, 10.9% for redness, 44.2% for pain, 12.6% for mild fever, 0.1% for high fever, 20.0% for drowsiness, 15.0% for loss of appetite, 32.9% for irritability, 4.6% for vomiting and 5.5% for persistent crying. There is no evidence for the occurrence of convulsion and encephalopathy among children who receive pentavalent vaccines.Conclusion: Further large studies with long time follow up are required to address rare events include convulsions, encephalopathy or persistent crying. However, Findings urge immunization programs to use pentavalent vaccinations and to continue implementing the current immunization program in children under 1 year of age.

BACKGROUND Consanguinity (when couples share at least one common ancestor) is a public health issue with a variety of distributions and incidence rates worldwide. Several epidemiological studies have explored the association between consanguinity and low birth weight (LBW). However, the results are inconsistent. This meta-analysis aimed to explore the overall association between consanguineous marriage and LBW. METHODS We searched PubMed, Web of Science, Scopus, ScienceDirect, and reference lists of articles up to May 2015. We included cohort, case-control, and cross-sectional studies addressing the association between consanguinity and LBW. We assessed heterogeneity using Q-test and I2 statistic. We explored publication bias using the Egger's and Begg's tests and the funnel plot. We meta-analyzed the data and reported the overall odds ratio (OR) and mean difference with 95% confidence intervals (CI) using the random-effects model. RESULTS We included 24 out of 3941 retrieved studies, with 44,131 participants. We indicated that LBW was associated significantly with first-cousin marriages (OR = 1.36; 95% CI: 1.03, 1.69) and non-significantly with second-cousin marriages (OR = 1.20; 95% CI: 0.49, 1.91). Furthermore, first-cousin marriages can reduce the birth weight of siblings of consanguineous couples 144 g more compared to non-consanguineous marriages. CONCLUSIONS This meta-analysis measured the association between consanguinity and LBW. Based on the current evidence, consanguineous marriage can increase the risk for LBW. However, further evidence based on large cohort studies conducted in different settings is required to make a robust conclusion regarding the effect of consanguinity on LBW.

Background A 25% relative reduction in the prevalence of hypertension is a global target. This meta-analysis estimated the effect of excess weight loss on hypertension.Methods We searched PubMed, Web of Science and Scopus until January 2016. We included prospective cohort studies addressing the association between overweight/obesity and hypertension. We expressed the strength of association using risk ratio and the excess risk using attributable risk fraction with 95% CI based on the random-effects model.Results We found 7617 references and included 10 studies with 173 828 participants. Compared with normal weight, the risk ratio of hypertension was 1.52 (1.37, 1.67; 9 studies, I-2 = 82.4%) for overweight and 2.17 (1.84, 2.50; 9 studies, I-2 = 88.9%) for obesity. The excess risk of hypertension attributable to overweight was 32% (24%, 40%; 8 studies, I-2 = 85.5%) and that attributable to obesity was 47% (40%, 54%; 8 studies, I-2 = 88.2%). That means, excess weight loss may reduce the risk of hypertension by between 24% and 40% in people who are overweight and by between 40% and 54% in people who are obese.Conclusions Excess weight loss is a vital strategy for controlling hypertension and is sufficient for achieving the global target, particularly if it is accompanied with other preventive measures.

fruits and vegetable consumption ( = +1, p=.006), sugar foods (=-0.4,p=.2) and good general health ( = +2%, p=.2). Conclusions SG was significantly and linearly distributed in adolescents regarding weight status and its determinants.A socially adapted intervention can help tackling or at least not worsening inequalities.

BACKGROUND Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide. Several studies have explored the nasopharyngeal carriage of S. pneumonia in Iran. This meta-analysis is aimed at exploring the overall prevalence of nasopharyngeal carriage of S. pneumoniae among healthy children and its resistance to antibiotics. METHODS We have systematically reviewed published studies from international databases (PubMed, Web of Science, and Scopus) and national databases (Iranmedex, Magiran, Medlib, SID and Irandoc) and reference lists of articles published up to May 2015. Only cross-sectional studies supported with sensitivity test on samples collected from nasopharyngeal area were included and heterogeneity was assessed using Q-test and I2 test statistic. Publication bias was explored using the Egger's and Begg's tests and the funnel plot. The overall prevalence of analyzed data were reported with 95% confidence intervals (CI) using the random-effects model. RESULTS A total of 16 studies were included in the final analysis. The pooled prevalence of S. pneumoniae nasopharyngeal carriage was 18% (95% CI: 14% - 23%). Antibiotic resistance rates were 26% (95% CI: 15% - 37%) to penicillin, 30% (95% CI: 10% - 49%) to erythromycin and 34% (95% CI: 10% - 57%) to tetracycline respectively. CONCLUSION This study could be able effectively estimate the overall prevalence of nasopharyngeal carriage of S. pneumoniae and its antibiotics resistance rate among healthy children in Iran. In addition, the findings evidenced the role of pneumococcal vaccination in reducing the prevalence of S. pneumoniae carriage among healthy children in Iran.