Iranian Journal of Public Health

Defining the Role of Fungi in Respiratory Infections: Clinical Features, Underlying Conditions, and Imaging Findings

Ehsan Esmaeili — 2026-10-04

Abstract
Background: Pulmonary fungal infections are increasingly recognized as significant contributors to respiratory disease, particularly among immunocompromised patients. Despite their clinical importance, differentiating colonization from true invasive infection remains a major diagnostic challenge.

Methods: In this multicenter cross-sectional study (June 2024–May 2025), 568 adults with suspected lower respiratory tract infections from three tertiary hospitals in Tehran were evaluated. Respiratory specimens underwent microscopy, culture, and galactomannan (GM) testing. Yeast isolates were identified using multiplex PCR (YEAST PLEX). Clinical characteristics, comorbidities, and radiological findings were analyzed.

Results: Fungi were detected in 342 patients (60.2%). Fungal-positive patients were older than negatives (52.4 ± 15.7 vs. 49.1 ± 17.3 years, p = 0.038). Candida species (56.4%) predominated, followed by Trichosporon (24.9%), Aspergillus (12.9%), Pneumocystis (3.2%), and other molds. Hemoptysis was significantly more common in fungal-positive patients (21.1% vs. 12.4%, p = 0.019), whereas cough, fever, and pleuritic chest pain showed no differences. Cavitary or nodular infiltrates were associated with fungal positivity (31.6% vs. 14.6%, p < 0.001), while ground-glass opacities and consolidations were not. GM testing was positive in 73.8% of Aspergillus-positive patients and 9.3% of controls (p < 0.001), with higher mean optical density indices in infected cases.

Conclusion: Pulmonary fungal infections are common and underrecognized in respiratory disease. BAL sampling, GM testing, and radiologic correlation provide valuable tools for distinguishing true infection from colonization, particularly in older and immunocompromised patients.

A cross-sectional analysis of the association between hypertension and kidney stone in population aged 35–70 years old in Hoveyzeh cohort study in southwest Iran

Shahla Ahmadi Halili — 2026-10-04

Introduction: Nephrolithiasis, or kidney stones, mentions to crystal calculi in the upper urinary tract, which can causes several problems, including hypertension. The aim of the present study was to investigate the relationship between hypertension and kidney stones and its associated risk factors.

Material and Methods: This Population-based cross-sectional study conducted on 10,009 individuals, aged 35–70 years in using the baseline data of Hoveyzeh cohort study in southwest Iran. For data collection, a checklist containing demographic information and the history of underlying diseases was used. Kidney stone history was self-reported and verified with the doctor by medical records. The analysis of variances, chi-square test, Kruskal–Wallis, and logistic regression were used to analyze the data. Statistical significance was defined as P-values less than 0.05. STATA version 14 was used for all analyses.

Results: the result from current study confirmed a significant association between hypertension and kidney stone disease (P <0.001(. This relationship is independent of some confounding factors such as age, ethnicity, education, occupation, smoke, diabetes, metabolic syndrome, creatinine and BUN. However, a significant association was observed between kidney stone with gender (P <0.001(, and obesity (P = 0.001).

Conclusion: In this study, a significant association exists between the occurrence of kidney stone and hypertension as well as gender and obesity. Despite some previous studies which reported age, diabetes, metabolic syndrome, smoking and high social economic status are a risk factors for development of kidney stone; however, in our study, we did not find those to be associated with kidney stone.

Evaluation of Efficacy of plasma air purifier for elimination of microorganisms

Elham Khosravi — 2026-10-04

Background: Many infections spread through airborne microorganisms from patients or environmental sources. Air purifiers with plasma technology may help reduce these pollutants, including viruses, bacteria, and fungi. Testing the effectiveness of in room plasma air purifiers is essential to prevent hospital airborne diseases.

Objective: The aim of this study was to investigate the effectiveness of plasma technology air purifiers in removing some bacterial and fungal pathogens in a simulated hospital room.

Methods: This study investigated the effectiveness of a plasma air purifier (HANIS, model CR100) in reducing airborne pathogens in a simulated hospital room. Air samples were taken before and after the purifier was operated to measure bacterial and fungal concentration. Results were analyzed with SPSS 23.

Results: A total of 32 air samples were collected. In the first experiment, the bacterial concentration decreased to 76.66% after 2 hours and 80% after 3 hours. In the second experiment, the bacterial concentration decreased to 79.12% after 2 hours and 82.15% after 3 hours. The fungal concentration decreased by 100% in the first and second experiments after 2 and 3 hours. The plasma air purifier effectively reduced the microbial concentration without mechanical ventilation and showed statistically significant results.

Conclusion: Air purifiers effectively remove airborne pathogens to improve workers' health.

Determinants and Dynamics of Reproductive Behavior Among Single-Child Mothers: An Analysis Using the Multi-Theory Model (MTM)

Tayebeh Mokhtari Sorkhani — 2026-10-04

Background
Childbearing decisions are influenced by psychological, social, and environmental factors. This study examined the predictive role of Multi-Theory Model (MTM) constructs in initiating and sustaining childbearing behavior among women with a single child.

Methods
A descriptive study was conducted in 2025 with 400 women who had one child. Demographic data and MTM constructs were collected via a structured questionnaire. Data were analyzed using SPSS version 21. Analyses included descriptive statistics, normality tests (Kolmogorov–Smirnov and Shapiro–Wilk), Spearman correlations, and multiple regression with bootstrapping, with significance set at p < 0.05.

Results
Participants showed moderate to moderately high levels across MTM constructs. Behavioral confidence was the only significant predictor of initiation of childbearing (β = 0.34, p < 0.001, R² = 0.145), whereas transformational emotions significantly predicted the sustenance of behavior (β = 0.26, p < 0.001, R² = 0.168). Other constructs, including social environment and practice for change, contributed positively but were not significant. Correlation analyses confirmed that behavioral confidence and transformational emotions had the strongest associations with both initiation and continuation of childbearing behavior.

Conclusion
Behavioral confidence and emotional transformation play central roles in initiating and sustaining reproductive and childbearing behavior, while environmental and social factors have secondary influence. These findings support the applicability of MTM in reproductive health research and inform theory-based interventions to promote childbearing among women of reproductive age.

Global Burden of Leukemia Attributable to Smoking from 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

Qian Liu — 2026-10-04

Background:
Leukemia is a major hematologic malignancy worldwide. Cigarette smoking is a modifiable risk factor, yet its global contribution to leukemia burden remains underexplored.

Methods:
We analyzed data from the Global Burden of Disease (GBD) 2021 study for 204 countries and territories, 1990–2021. Outcomes included deaths, death rates, disability-adjusted life years (DALYs), DALY rates, and population attributable fraction (PAF). Analyses were stratified by sex, age, subtype, and socio-demographic index (SDI). Temporal trends were evaluated using estimated annual percentage change (EAPC).

Results:
Globally, smoking-attributable leukemia deaths increased from 23,738 (95% UI: 8,438–40,223) in 1990 to 34,151 (12,152–57,975) in 2021 (+43.9%), while DALYs rose from 565,148 (204,203–961,259) to 719,825 (263,395–1,207,483) (+27.4%). Age-standardized death rate (ASDR) declined slightly from 0.445 to 0.433 per 100,000 (EAPC –0.11%, 95% CI –0.13 to –0.08), and DALY rate from 10.596 to 9.122 per 100,000 (EAPC –0.52%, 95% CI –0.55 to –0.49). PAFs increased modestly for deaths (9.60% to 10.66%) and DALYs (4.84% to 6.56%). In 2021, men had over fivefold higher ASDR than women (0.723 vs 0.140 per 100,000), and accounted for most DALYs (606,412 vs 113,413). The burden rose sharply with age, peaking in ≥75 years. AML contributed nearly half of smoking-attributable deaths, followed by CLL, ALL, and CML. The highest ASDR was observed in high-SDI regions (>0.6 per 100,000).

Conclusions:
Smoking remains a substantial, preventable contributor to leukemia burden, particularly AML, disproportionately affecting men and older populations. Despite declining rates, the rising absolute burden highlights the urgency of strengthening tobacco control and integrating smoking cessation into leukemia prevention.

Association between air pollution exposure and lung cancer mortality in Tehran: A generalized additive model analysis

Kazem Naddafi — 2026-10-04

Background: Ambient air pollution has been recognized as a major environmental risk factor for lung cancer mortality. However, the nature of these associations, particularly their potential nonlinearity and spatial variation, remains insufficiently understood in highly polluted urban settings.

Methods: This ecological time-series study examined the association between ambient air pollution and lung cancer mortality across the 22 municipal districts of Tehran city, Iran, from 2017 to 2022. Annual district-level data on air pollutants, meteorological variables, and economic indicators were analyzed. Generalized additive models (GAMs) were applied to capture potential nonlinear associations, while quasi-Poisson regression was used as a comparative approach. Temporal trends were assessed using Joinpoint regression, and both concurrent (Lag 0) and one-year lagged (Lag 1) exposures were evaluated.

Results: A total of 4,682 lung cancer–related deaths were analyzed during the study period. GAM analysis identified PM₂.₅ as the only environmental variable significantly associated with mortality, with evidence of a nonlinear exposure–response relationship. Other pollutants and meteorological factors did not retain independent associations after adjustment. Quasi-Poisson regression suggested additional associations; however, these were not supported in the nonlinear framework. Temporal analysis indicated a general decline in mortality, although statistically significant reductions were observed only in a limited number of districts. A strong regional effect was observed, indicating substantial intra-urban heterogeneity. In lagged models, most associations were attenuated, and PM₂.₅ was no longer statistically significant.

Conclusion: PM₂.₅ emerged as the most robust environmental predictor of lung cancer mortality in Tehran, with effects that vary across exposure levels and regions. The findings highlight the importance of accounting for nonlinear relationships and spatial heterogeneity in environmental epidemiology. Targeted strategies to reduce PM₂.₅ exposure may play a key role in lowering lung cancer mortality and addressing health inequalities in urban populations.

Illicit Tobacco Trade in Iran: Policy Implications for a Reform Roadmap

Alireza Shoghli — 2026-10-04

Introduction

Illicit trade in tobacco products (ITT) undermines tobacco control, public health, and government revenues. In the Islamic Republic of Iran, illicit tobacco trade remains widespread despite accession to the World Health Organization (WHO) Protocol to Eliminate Illicit Trade in Tobacco Products (ITP), indicating persistent implementation gaps.

Methods

A mixed-methods policy and systems analysis was conducted, including a review of national legislation, policy documents, and WHO reports; two national technical consultative meetings; twelve semi-structured expert interviews; and a comparative review of international experiences in countries that have successfully reduced illicit tobacco trade. Qualitative data were analyzed thematically and mapped against WHO-ITP obligations.

Results

Illicit tobacco trade in Iran is large-scale and structurally embedded, accounting for an estimated 20–30% of cigarette consumption, more than 50% of flavored waterpipe tobacco, and nearly all emerging nicotine products. Key drivers include fragmented governance, absence of a fully government-controlled and industry-independent track-and-trace system, incomplete supply-chain licensing, weak deterrence against organized smuggling networks, and limited protection from tobacco industry interference. Evidence from other countries indicates that enforcement-only approaches are insufficient without integrated governance and supply-chain transparency.

Conclusion

Illicit tobacco trade in Iran reflects systemic governance and policy failures rather than border weaknesses. Comprehensive, WHO-ITP compliant reforms integrating governance restructuring, independent track-and-trace systems, and targeted enforcement are essential. The proposed policies offer a realistic pathway to reduce illicit tobacco trade while strengthening public health and fiscal integrity.

Trends and projections of the burden of Alzheimer's disease and other dementias in Iran: A comparative study based on the Global Burden of Disease database 2023

Zou Yue xiao — 2026-10-04

Objective: This study aimed to analyze the burden of Alzheimer's disease and other dementias (ADOD) in Iran.

Methods: Utilizing data from the Global Burden of Disease Study 2023, we estimated the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for ADOD in Iran. The Joinpoint regression model was employed to calculate the average annual percentage change (AAPC) and describe trends over time. Furthermore, an autoregressive integrated moving average (ARIMA) model was used to forecast the incidence, prevalence, mortality, and DALYs for ADOD in Iran from 2024 to 2050.

Results: In 2023, the age-standardized incidence rate (ASIR) of ADOD in Iran was 117 per 100,000 population (95% UI: 101.2–132.9; Table 1). The ASIR was 104 per 100,000 (95% UI: 88.3–119) for males and 129.1 per 100,000 (95% UI: 112–146.5) for females. From 1990 to 2023, the AAPC for ASIR was -0.1123 (95% CI: -0.1208 to -0.1038), indicating a slight declining trend in the incidence of ADOD in Iran. The number of incident cases in 2023 was 77,337.7 (95% UI: 66,610.3–87,407.1; Table S1). The age-standardized prevalence rate (ASPR) in 2023 was 673.7 per 100,000 (95% UI: 570.2–775.7), with rates of 591.8 per 100,000 (95% UI: 496.7–685.8) for males and 748.1 per 100,000 (95% UI: 636–859.3) for females. The AAPC for ASPR from 1990 to 2023 was -0.1206 (95% CI: -0.1269 to -0.1144), reflecting an overall decreasing trend in ADOD prevalence. The number of prevalent cases in 2023 was 438,730.3 (95% UI: 372,153.3–504,153.8; Table S1). The age-standardized mortality rate (ASMR) showed an average annual increase of 0.7%, while the total DALYs remained relatively stable, with a 0.5% increase observed in males. Projections from the ARIMA model suggest that from 2024 to 2050, both the ASIR and ASPR of ADOD in Iran will continue their declining trajectories. By 2050, the ASIR is projected to be 111.8 per 100,000 (95% UI: 98.1–125.6), and the ASPR is projected to be 651.0 per 100,000 (95% UI: 591.8–710.2).

Low Albumin, High CRP, and Glasgow Prognostic Score as Predictors of Mortality and Malnutrition in Patients with Cancer: Results from nutritionDay 2021-2024 in Iran

Mahdi Mirfendereski — 2026-08-22

Background: Malnutrition and systemic inflammation are key determinants of cancer outcomes. Hypoalbuminemia, elevated C-reactive protein (CRP), and the Glasgow Prognostic Score (GPS) are well-established prognostic indicators. However, their predictive value for mortality and malnutrition among hospitalized cancer patients remains unclear. This study investigated their prevalence and clinical associations using data from the Iran oncology nutritionDay survey (2021–2024).

Methods: A cross-sectional study with a 30-day follow-up was performed on 167 cancer patients admitted to the teaching hospitals of Mashhad University of Medical Sciences. Data were collected using standardized nutritionDay questionnaires. Serum albumin, CRP, and GPS were assessed in 124, 123, and 80 patients, respectively. Associations with 30-day mortality and malnutrition were analyzed.

Results: Hypoalbuminemia (<3.5 g/dL) was observed in 61.3% of patients, elevated CRP (≥10 mg/L) in 79.7%, and GPS score of 2 in 61.3%. Malnutrition prevalence was 63.4% to 66.1% in albumin-tested, CRP-tested, and both-tested patients. Hypoalbuminemia increased 30-day mortality (adjusted OR = 5.067, P = 0.015) and malnutrition (OR = 3.452, P = 0.004). High CRP increased mortality (OR = 8.158, P = 0.047) but not malnutrition (P = 0.082). A high GPS result (scores 2) increased mortality (OR = 4.332, P = 0.035) and malnutrition (OR = 3.834, P = 0.011).

Conclusion: Hypoalbuminemia, high CRP levels, and high GPS values were frequent among hospitalized cancer patients and were predictors of poor outcomes. GPS could potentially act as a combined prognostic and nutrition-related biomarker and needs further validation.

Keywords: Glasgow Prognostic Score, cancer, malnutrition, mortality.

Factors influencing depression in adults with obstructive sleep apnea according to sleep duration

Myoungjin Kwon — 2026-10-04

Background: Obstructive sleep apnea (OSA) is a sleep disorder that significantly affects mental health and often leads to depression. Despite the growing body of research, a significant gap remains in understanding the factors influencing depression in adults with OSA, particularly regarding the role of sleep duration. Therefore, this study aimed to investigate the factors affecting depression in adults with OSA, focusing on sleep duration.

Methods: This descriptive study was a secondary analysis of data from the Korea National Health and Nutrition Examination Survey conducted in 2022. It included 3,048 participants, categorized based on their risk of OSA and sleep duration. The STOP-Bang tool was used to assess OSA risk, and depression was measured using the Patient Health Questionnaire-9. Statistical analyses were conducted using SPSS version 27, with significance set at p < 0.05.

Results: We found significant differences in factors such as snoring, fatigue, observed apnea, hypertension, age, and sex based on the degree of OSA and sleep duration. Participants with inappropriate sleep duration exhibited severe depressive symptoms, highlighting the critical role of sleep duration in managing depression among patients with OSA.

Conclusion: These findings highlight the critical role of sleep duration in depression management among OSA patients and provide a basis for developing targeted and individualized interventions.

Social Media Influencers and Vaping: Assessing the Need for Digital Public Health Policies for School-Aged Children

reza abdollahi — 2026-10-04