The risk environments of people who use drugs accessing two harm reduction centers in Tehran,Iran: A qualitative study

BackgroundIran has developed the most robust harm reduction infrastructure in the Middle East, marked by availability of low threshold methadone maintenance treatment (MMT), needle and syringe program (NSPs), and condom distribution services. However, little is known about the socially situated risk factors that make harm reduction clients—specifically those enrolled in MMT—vulnerable to relapse or continued illicit drug use. In this study, we sought to understand the “risk environment” of clients enrolled in harm reduction services in Tehran, Iran.MethodsThrough observation and in-depth interviews with 22 drop-in-center clients and 8 staff members from July to August 2017, we explored the risk environments of clients of two drop in centers (DICs) in Tehran. All interviews were transcribed, coded and analyzed using a qualitative thematic analysis.ResultsWe found that compulsory drug treatment programs, social stigma, police encounters, and difficulties in obtaining governmental identification documents, among other factors, contribute to social marginalization of DIC clients.ConclusionMany interviewed DIC clients continued to use illicit substances (particularly methamphetamine) despite having access to methadone treatment. This study underscores the panoply of social and structural barriers that DIC clients face while attempting to engage in treatment and harm reduction services. Following the “risk environment” framework, it is essential to identify the structural factors shaping individual behaviors that perpetuate experiences of social marginalization and poor health outcomes in this population.     

Validity of SMART-COP score in prognosis and severity of community acquired pneumonia in the emergency department

BackgroundDetermining prognosis in community acquired pneumonia (CAP), is very important. Many scores are introduced up to now for prediction of pneumonia prognosis like SMART-COP.ObjectiveTo evaluate validity of SMART-COP score in prognosis and severity of CAP in emergency department (ED).MethodsAll patients older than 18 years old with clinical suspicion of CAP (meeting the inclusion criteria), were enrolled in our study. In this prospective study, patients were admitted to the ED of a tertiary referral center. Hospital length of stay, rate of intensive care unit (ICU) admission, mortality rate, number of intensive respiratory or vasopressor support (IRVS) use, patients' SMART-COP scores and all demographic data were recorded. Validity of SMART-COP in the prediction of IRVS rate and its correlation with other variables were determined.ResultsIn this study, 47.6% and 52.4% of patients were females and males respectively. The mean age of patients was 68.13 ± 16.60 years old. The mean hospital length of stay was 13.49 ± 5.62 days. Of all patients entered in our study, 55 cases (38.5%) needed ICU admission, 29 cases (20.3%) were expired within 1 month and 44 cases (30.8%) needed IRVS during their treatment. SMART-COP ≥5 (high risk CAP) accurately predicted the rate of ICU admission, one-month mortality and IRVS need (p-value = 0.001).ConclusionsSMART-COP≥5 had a high sensitivity and specificity in the prediction of patients' prognosis with severe CAP in the ED.     

Cigarette smoking and associated risk of multiple sclerosis in the Iranian population

Exposure to cigarette smoke is emerging as an environmental risk factor for multiple sclerosis (MS). We investigated the possible association between environmental tobacco smoke, its cumulative exposure, and MS risk. We used data from the Iranian Multiple Sclerosis Registry to identify a case-control of 662 patients who had MS and a comparison group of 394 patients. Information regarding current smoking status, including the number of cigarettes smoked per day, duration, and smoking pack-years indicative of cumulative dose of tobacco smoked was obtained. We analyzed the incidence of MS among ever–smokers who had been smokers during their disease course and prior to disease onset in comparison with never–smokers who had never been exposed by calculating the odds ratio (OR) with a 95% confidence interval (CI) employing logistic regression. Of the 662 MS patients, there were 523 women (79.0%) and 139 men (21.0%), with a mean age of 31 ± 10.0 years at disease onset. The risk for MS was increased among ever–smokers (OR = 1.78, 95% CI = 1.22–2.59, p = 0.03) compared to never–smokers. As compared with never smokers, the OR for patients with 6–10 pack years was 2.91 for men (95% CI = 1.11–9.47, p = 0.03) and 1.69 for women (95% CI = 1.02–6.45, p = 0.04). Our results demonstrate that cigarette smoking is significantly associated with an increased risk for MS. The risk effects of smoking were more noticeable in male patients and at higher tobacco doses.