Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors.Purpose: This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews. Methods: We conducted a systematic search of interna- tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist. Results: A total of 207,221 children with ASD and22,993,128 neurotypical children were included. Six meta- analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17–1.52),macrosomia (OR, 1.11; 95% CI, 1.05–1.18), low birth weight (OR, 1.63; 95% CI, 1.48–1.81), very low birth weight (OR, 2.25; 95% CI, 1.79–2.83), small for gestational age (OR,1.17; 95% CI, 1.09–1.24), jaundice (OR, 1.74; 95% CI, 1.42–2.12), male sex (OR, 1.47; 95% CI, 1.39–1.55) and 1-minuteApgar score <7 (OR, 1.40; 95% CI, 1.26–1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta- analyses, low in 2, and moderate in 1. Conclusion Based on these results, clinicians should consider the risk factors for ASD and screen children in clinics.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors.Purpose: This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews. Methods: We conducted a systematic search of interna- tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist. Results: A total of 207,221 children with ASD and22,993,128 neurotypical children were included. Six meta- analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17–1.52),macrosomia (OR, 1.11; 95% CI, 1.05–1.18), low birth weight (OR, 1.63; 95% CI, 1.48–1.81), very low birth weight (OR, 2.25; 95% CI, 1.79–2.83), small for gestational age (OR,1.17; 95% CI, 1.09–1.24), jaundice (OR, 1.74; 95% CI, 1.42–2.12), male sex (OR, 1.47; 95% CI, 1.39–1.55) and 1-minuteApgar score <7 (OR, 1.40; 95% CI, 1.26–1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta- analyses, low in 2, and moderate in 1. Conclusion Based on these results, clinicians should consider the risk factors for ASD and screen children in clinics.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors.Purpose: This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews. Methods: We conducted a systematic search of interna- tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist. Results: A total of 207,221 children with ASD and22,993,128 neurotypical children were included. Six meta- analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17–1.52),macrosomia (OR, 1.11; 95% CI, 1.05–1.18), low birth weight (OR, 1.63; 95% CI, 1.48–1.81), very low birth weight (OR, 2.25; 95% CI, 1.79–2.83), small for gestational age (OR,1.17; 95% CI, 1.09–1.24), jaundice (OR, 1.74; 95% CI, 1.42–2.12), male sex (OR, 1.47; 95% CI, 1.39–1.55) and 1-minuteApgar score <7 (OR, 1.40; 95% CI, 1.26–1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta- analyses, low in 2, and moderate in 1. Conclusion Based on these results, clinicians should consider the risk factors for ASD and screen children in clinics.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors.Purpose: This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews. Methods: We conducted a systematic search of interna- tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist. Results: A total of 207,221 children with ASD and22,993,128 neurotypical children were included. Six meta- analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17–1.52),macrosomia (OR, 1.11; 95% CI, 1.05–1.18), low birth weight (OR, 1.63; 95% CI, 1.48–1.81), very low birth weight (OR, 2.25; 95% CI, 1.79–2.83), small for gestational age (OR,1.17; 95% CI, 1.09–1.24), jaundice (OR, 1.74; 95% CI, 1.42–2.12), male sex (OR, 1.47; 95% CI, 1.39–1.55) and 1-minuteApgar score <7 (OR, 1.40; 95% CI, 1.26–1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta- analyses, low in 2, and moderate in 1. Conclusion Based on these results, clinicians should consider the risk factors for ASD and screen children in clinics.

Current studies have controversial reports about the effect of maternal smoking during pregnancy (MSDP) on the risk of psychiatric disorders among offspring. The purpose of this systematic review and meta-analysis was to assess the effect of MSDP on the risk of Tourette syndrome (TS) and chronic tic disorders (CTD) among offspring. A systematic search using PubMed, Scopus, and Web of Science was conducted up to July 2019 to retrieve potential studies in English. Fixed and random-effects meta-analyses was performed to estimate pooled relative risk (RR) with 95% confidence interval (CI) according to heterogeneity. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Heterogeneity among studies was explored using the I2 statistic. Of the 641 studies from the initial search, 7 were included in the quantitative synthesis (3 cohort and 4 case control studies). Overall, MSDP increased the risk of TS and CTD among the offspring by 35% (pooled RR, 1.35; 95% CI, 1.17–1.56; I2 =45.8%; P-value=0.08). The results of this meta-analysis revealed that there is a significant association between MSDP and the risk of TS and CTD in offspring, and MSDP may be considered a potential risk factor for TS and CTD.

OBJECTIVE: To determine the maternal risk factors associated with preterm delivery in Iran.METHODS: A population-based case-control study was conducted including 48 women having preterm delivery (case group) and 100 women having term delivery (control group) between March 2007 and March 2012 in the maternity hospitals of the Selseleh County, Lorestan province, Iran. Information regarding maternal risk factors was collected by structured interview and reviewing the medical records. The maternal risk factors associated with preterm delivery were identified using univariate and multivariable logistic regression analysis after adjusting the sparse data bias. The area under the receiver operating characteristic (ROC) curves was estimated to evaluate the discrimination power of the statistical models.RESULTS: Multivariable analysis demonstrated that multiparty (odds ratio [OR], 14.23; 95% confidence interval [CI], 1.60–127.05), history of gestational diabetes (OR, 0.10; 95% CI, 0.01–0.99), thyroid dysfunction (OR, 97.32; 95% CI, 5.78–1,637.80), urinary tract infection (OR, 16.60; 95% CI, 3.20–85.92), and taking care during pregnancy (OR, 0.12; 95% CI, 0.03–0.50) had significant impact on preterm delivery after adjusting the potential confounders. The area under the ROC curve for the aforementioned maternal risk factors was 0.86 (95% CI, 0.80–0.92).CONCLUSION: Our study provides evidence for the associations between multiparty, history of gestational diabetes, thyroid dysfunction, urinary tract infection, as well as taking care during pregnancy, and preterm delivery.

Objectives: Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections. Methods: This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models. Results: In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females). Conclusion We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

Objectives: Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections. Methods: This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models. Results: In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females). Conclusion We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

Co-infection with hepatitis B and C among HIV infected patients are prevalent among high-risk populations. This meta-analysis aimed to estimate the prevalence of HIV, HCV and HBV co-infections among high-risk populations in Iran. We systematically searched the national and international electronic databases until 2016. The primary outcome was the prevalence of HIV, HBV, HCV and HIV co-infections in different high-risk populations in Iran. All English and Persian studies conducted on Iranian high-risk groups were included in the study. The review was reported based on PRISMA guidelines and data were analysed at 95% confidence level using random effect models.Overall, 916 relevant papers were recognised and 14 articles were included in the metaanalysis. The pooled estimates of HBV/HCV, HCV/HIV, HBV/HIV and HBV/HCV/HIV were 1.3% (95%CI: 0.5–2.1), 16.3% (95%CI: 1.1–31.6), 0.5% (95%CI: 0–1.4) and 0.5% (95%CI: 0.2–0.8), respectively. Based on subgroup analysis, there was a higher proportion of all co-infections from the years 2010–2016 as compared to that of the years 2003–2009. Our results highlighted that HCV/HIV co-infection in Iranian high-risk groups including injection drug users (IDUs) and prisoners is common. In addition, the increasing trend of coinfections should be considered alarming for policymakers.

OBJECTIVES: This study aimed to map the incidence of cutaneous leishmaniasis (CL) in Iranian army units (IAUs) and to identify possible spatial clusters. METHODS: This ecological study investigated incident cases of CL between 2014 and 2017. CL data were extracted from the CL registry maintained by the deputy of health of AJA University of Medical Sciences. The standardized incidence ratio (SIR) of CL was computed with a Besag, York, and Mollié model. The purely spatial scan statistic was employed to detect the most likely high- and low-rate clusters and to obtain the observed-to-expected (O/E) ratio for each detected cluster. The statistical significance of the clusters was assessed using the log likelihood ratio (LLR) test and Monte Carlo hypothesis testing. RESULTS: A total of 1,144 new CL cases occurred in IAUs from 2014 to 2017, with an incidence rate of 260 per 100,000. Isfahan and Khuzestan Provinces were found to have more CL cases than expected in all studied years (SIR>1), while Kermanshah, Kerman, and Fars Provinces were observed to have been high-risk areas in only some years of the study period. The most significant CL cluster was in Kermanshah Province (O/E, 67.88; LLR, 1,200.62; p < 0.001), followed by clusters in Isfahan Province (O/E, 6.02; LLR, 513.24; p < 0.001) and Khuzestan Province (O/E, 2.35; LLR, 73.71; p < 0.001), while low-rate clusters were located in the northeast areas, including Razavi Khorasan, North Khorasan, Semnan, and Golestan Provinces (O/E, 0.03; LLR, 95.11; p < 0.001). CONCLUSIONS: This study identified high-risk areas for CL. These findings have public health implications and should be considered when planning control interventions among IAUs.
Bayes Theorem* ; Humans ; Incidence ; Iran ; Leishmaniasis, Cutaneous* ; Military Personnel ; Public Health ; Spatial Analysis