Manoochehr Karami

Background Aerial entry points are critical in the international spread of infectious diseases, underscoring the need for effective management of acute respiratory viral infections (ARVIs). Recent global outbreaks, including COVID‑19, have highlighted the importance of strengthened public health measures at air borders. However, evidence on ARVI management strategies at these points remains fragmented. This scoping review mapped and synthesized existing approaches to quarantine protocols, contact‑tracing methods, and advanced or innovative technologies used at aerial entry points. Methods We conducted a scoping review following the Arksey and O’Malley framework, refined by Levac et al., and reported in accordance with PRISMA ScR guidelines. Scientific databases were systematically searched for English language studies published between 2003 and 2024 that described the management of ARVIs at air borders. Data from eligible studies were charted and analyzed using thematic analysis to identify and categorize quarantine approaches, contact tracing strategies, and advanced or innovative technologies applied in these settings. Results A total of 80 studies were included in the review, addressing diseases such as COVID 19, influenza, SARS, and Ebola. Most studies were conducted in high income countries and in regions of Southeast Asia and the Western Pacific. Various quarantine approaches were identified, including mandatory quarantine, risk based quarantine, and home based isolation strategies. Contact tracing methods ranged from traditional manual approaches using passenger information to technology supported systems that improved the speed of identifying exposed individuals. Several studies reported the use of advanced digital technologies such as digital health passports, geofencing monitoring systems, and electronic reporting platforms to support monitoring, compliance, and data management during public health responses at air borders. Conclusion The findings highlight the diverse range of quarantine protocols, contact tracing approaches, and emerging technological tools used to manage ARVIs at air borders. Despite these developments, evidence regarding the effectiveness and long term implementation of these strategies remains limited. Further research is needed to strengthen the evidence base and support evidence informed policies for managing respiratory infectious diseases at international points of entry.

International air border crossings are crucial for controlling the spread of respiratory pandemics like COVID-19. Effective screening at these points is vi

Primary health care (PHC) is the first point of contact for people to receive healthcare services in developing countries' health systems. In defining primary health care as a community-oriented approach, a wide range of essential health services, including health promotion, prevention and rehabilitation, are mentioned. Furthermore, in its basic principles, comprehensiveness, fair access, and appropriateness to the necessities and preferences of the individual, family, and society have been addressed. Importantly, PHC emphasizes well-being, people-centered care as opposed to disease-centered care, by providing services within the community. However, in low-and middle-income countries (LMICs), access to the formal health system is often limited to emergency situations, fostering an episodic model of care (1) . This episodic care presents significant challenges in LMICs, primarily due to systemic issues such as inadequate infrastructure, workforce shortages, and the delivery of poor-quality services. These challenges contribute to fragmented health systems that often marginalize disadvantaged populations (2) . PHC offers a strategic pathway to close these gaps and accelerate progress toward universal health coverage (UHC). According to the World Health Organization (2018), scaling up PHC in LMICs could prevent up to 60 million deaths and extend the average life expectancy by 3.7 years by 2030. Furthermore, it is estimated that 75% of the health gains required to meet the "Sustainable Development Goals" (SDGs) are achievable through strengthened PHC systems (3) . However, persistent barriers remain-limited funding for preventive services, under-resourced and inadequately trained community health workers, high out-of-pocket expenditures, and fragmented insurance systems-all disproportionately affect PHC implementation in LMICs (4) . This situation highlights the significant gap between the current state of LMIC health systems and the ideals of the PHC paradigm.Since 1978, PHC has been used as the most vital way to attain the goals of "health for all", UHC and SDGs (2,5) . The adoption of appropriate and innovative solutions to support the health of communities is an essential part of PHC-based health systems. Considering the evolution of digital health and novel technologies, health systems need to adopt such innovative tools to provide high-quality services appropriately. The vision of many countries and the recommendation of the World Health Organization are to use new technologies and innovative approaches to achieve the health system's goals and provide quality services (6) . Accordingly, this article presents an overview of the current landscape of digital health and the adoption of emerging technologies-particularly artificial intelligence (AI) within primary health care systems in developing countries. Drawing on experiences and strategic guidance from the WHO, this work highlights real-world applications and policy-level insights. The article subsequently delves into the critical challenges hindering the effective integration of AI in LMICs, with particular attention given to systemic barriers, infrastructural deficits, and sociopolitical obstacles that complicate implementation efforts.In simple language, artificial intelligence (AI) is a process in which a computer rather than human intelligence performs the tasks of health workers, such as providing screening services, training, follow-up and similar health care. Today, AI tools play a substantial role in communities' daily lives and in more specialized fields. Automated machine learning and deep learning are new fields of artificial intelligence. In the developed models in machine learning, on the basis of the written algorithm, the machine is asked to provide training in the form of a video or written media according to the question of the recipient of the service or care received.One of the most well-known new technologies used to provide health promotion services (education) is the S.A.R.A.H. system, introduced as an artificial intelligence-based system with a generative approach by the World Health Organization. This technology can be available to users 24 hours a day in eight languages to provide educational and health promotion services related to various topics (7) . Another example is the use of AI based on the BrewAI platform, which, by providing a simple user interface, allows non-specialists in machine learning models to enter data to predict disease outbreaks (5) . In the field of preparedness and response to biological threats, the EPIWATCH platform is another example for generating epidemic warnings before identifying them with the usual health care system (8) .Recent studies have shown a growing trend in AI-driven interventions for public health, with significant improvements in diagnostics, disease prediction, and telemedicine applications. For instance, a scoping review by Abbasgholizadeh Rahimi, et al. (2021) underscores the role of AI in community-based PHC, emphasizing machine learning models for risk assessment and risk treatment adherence (9) . Despite the practical use of artificial intelligence tools in the clinical field, the use of new technologies in the field of health, specifically in primary health care, has been limited. A review of the available evidence indicates that the use of machine learning models and other artificial intelligence tools in the early identification of cancers can predict the risk of high blood pressure, the health of elderly persons, and other respiratory diseases. The findings of a systematic review revealed that the most commonly used methods for accessing new technologies for health service providers were machine learning models (9) .Although the integration of digital health technologies in low-and middle-income countries (LMICs) is widely viewed as a promising advancement, significant challenges remain. Despite the possibility of enhanced access and quality of care,...

Preparing a precise report of disease outbreak investigation is an important step to share the acquired experiences about causes of outbreaks and control measures for control and prevention of current and further outbreaks. Assessing the quality of published reports of measles outbreak investigation. Three databases including PubMed, Web of Science, and Scopus were systematically searched to retrieve studies published between 2005 and 2022 on measles outbreak investigation reports. Data were elicited using inclusion criteria and assessing the guidelines for outbreak investigation reports. The results for mentioning each item in studies were reported by percentage. Sixty-four studies were assessed for the quality of measles outbreak investigation reports. Studies encompass a broad span of geographic areas. Funding revealed that outbreak investigation details are reported in most studies but some of them like type of study(37.5%), control/ unexposed selection/definition(18.75%), investigation team(10.93%), statistical test(32.81%), and symptoms of disease in cases(18.75%), are poorly reported. On the other hand, variables like description of the problem(89.07%), laboratory methods(84.38%), and feasible recommendations(95.32%), are highly reported. Outbreak Investigation and appropriate reporting are a pilar of measles elimination program. This study highlights significant limitations in the reporting of measles outbreak investigations, including incomplete reporting of key variables. To improve the quality of outbreak reports, this study offers some suggestions, such as adopting standardized reporting guidelines and providing training courses for investigators.

Digital technologies have improved the performance of surveillance systems through early detection of outbreaks and epidemic control. The aim of this study is to introduce an outbreak detection web application called OBDETECTOR (Outbreak Detector), which as a professional web application has the ability to process weekly or daily reported data from disease surveillance systems and facilitates the early detection of disease outbreaks. OBDETECTOR generates a histogram that exhibits the trend of infection within a time range selected by the user. The output comprises red triangles and plus signs, where the former denotes outbreak days determined by the algorithm applied to the data, and the latter represents days identified as outbreaks by the researcher. The graph also displays threshold values and its symbols enable researchers to compute evaluation criteria for outbreak detection algorithms, including sensitivity and specificity. OBDETECTOR allows users to modify algorithm parameters based on their research objectives immediately after loading data. The implementation of automatic web applications results in immediate reporting, precise analysis, and prompt alert notification. Moreover, Public Health authorities and other stakeholders of surveillance can benefit from the widespread accessibility and user-friendliness of these tools, enhancing their knowledge and skills for better engagement in surveillance programs.

Objective: This study has been aimed to investigate factors associated with elevated blood lead levels (BLLs) across different percentiles in individuals employed in the petroleum industry and residents of Kirkuk City . In addition, to provide evidence-based approaches to mitigate exposure risks and safeguard vulnerable populations. Methods: The study involved 357 participants and utilized quantile regression to examine BLL in petroleum industry workers and Kirkuk residents. Results: Median BLLs were higher among workers (17.5 μg/dL) compared to residents in the city (9.9 μg/dL) and suburbs (7.4 μg/dL). Factors such as smoking, outdoor work, and lower education were associated with elevated BLLs, as confirmed by quantile regression. Conclusions: This study found higher BLLs in petroleum workers compared to Kirkuk residents, associated with smoking, outdoor work, and lower education. The results emphasize the need for targeted interventions and policies to mitigate lead exposure risks in this industrial region.

Background: Rotavirus is the most common cause of gastroenteritis among children. Currently, four oral live-attenuated vaccines are available to prevent rotavirus infection. The World Health Organization (WHO) has recommended including rotavirus vaccination in national immunization programs; however, it has not been introduced to the Iranian national immunization program. The study aimed to assess the frequency of rotavirus gastroenteritis in the west of Iran and investigate the necessity of rotavirus vaccination. Study Design: A case series study. Methods: In this case series study, 284 cases under six years of age who presented with acute gastroenteritis from March 2021 to 2022 to a referral hospital in the west of Iran were evaluated. Data on baseline characteristics, clinical manifestations, results of stool test, ELISA for rotavirus detection, and polymerase chain reaction (PCR) test for genotyping of rotavirus-positive samples were recorded. Results: Results showed that the prevalence of rotavirus infection was 36.6%. The highest frequency was observed among children aged 6-12 months and during the autumn. According to the PCR results, G1P[8], G9P[8], G9P[4], and G1P [4] were the dominant genotypes, and 33.75% of samples were infected with multiple rotavirus genotypes. Conclusion: The study highlights the considerable prevalence of rotavirus infection among cases of acute gastroenteritis in children under six years of age who were referred to a referral hospital in the west of Iran and the high diversity of rotavirus genotypes in the targeted community. Consequently, physicians and health policymakers should prioritize strategies for the prevention and control of this infection, particularly by considering the rotavirus vaccine as a priority for the Iranian national immunization program.

Background: Occupational lead exposure poses a significant risk to workers in industrial settings, especially in petroleum refineries. The study aimed to examine the prevalence and determinants of high blood lead concentrations among refinery workers in Kirkuk, Iraq. It has also been aimed to provide evidence-based approaches to identify associated risk factors. Methods: A cross-sectional study was conducted among 187 workers from three departments (transportation, storage, and production) in a petroleum refinery from August 2023 to April 2024. Blood lead levels (BLLs) were measured using graphite furnace atomic absorption spectroscopy (GFAAS) (Agilent, Santa Clara, CA). The elevated BLLs were defined as lead levels in blood samples greater than 10 µg/dL. Data on demographic characteristics, such as occupations, smoking habits, and drinking milk, were collected using a researcher-developed information sheet. Statistical analyses included the Kruskal-Wallis test and Pearson Chi-Square test, and logistic regression was used to address the determinants of elevated BLLs. The corresponding associations were reported using odds ratios (OR) and adjusted OR (AOR) along with 95% confidence intervals (CIs). Results: Eighty-five percent of the workers had high BLLs, with a median BLL of 17.11 µg/dL. The findings revealed that workers employed in outdoor settings had 4.25 times higher AOR (95% CI: 1.24-14.48) of experiencing high BLLs compared to those working indoors, after adjusting for other factors. This was especially true for workers who spent nine to 16 hours outdoors. Additionally, age and smoking were also found to be associated with an increased risk of high BLLs. On the other hand, the analysis indicated that drinking milk had a protective effect against high BLLs. Conclusion: The high prevalence of elevated BLLs among refinery workers in Kirkuk underscores the urgency for immediate interventions. Regular monitoring of BLLs, improved training, dietary adjustments (e.g., consuming calcium and phosphate-rich milk, which can help lower BLLs), and smoking cessation programs are recommended to reduce lead exposure and safeguard workers' health. Furthermore, the results suggest that drinking milk could potentially reduce BLLs among petroleum refinery workers. Additional research is necessary to evaluate the effectiveness of these interventions and to continue monitoring exposure levels.

Background: Community health assessment (CHA) is a well-known method for identifying and analyzing community health needs. This CHA survey aimed to identify and analyze community health needs and assets to prioritize these needs and to plan and act upon significant unmet community health needs. Methods: The CHA was planned based on the suggested standard of the North Carolina Guide including eight phases from July to December 2023. The CHA survey was performed among Al-Marashda region residents in the Al-Manathera district. The sample size of our study was 184 interviews of 12536 population. The primary data, which included demographic information, quality of life statements, and community improvement, were collected from the community using a questionnaire through opinion surveys and focus groups, while the secondary data which included the social, health, and economic status of Al-Marashda region residents were obtained from district and governorate sources. Analysis of whole data sources allowed 10 areas of community concern to be identified. Results: Findings from the CHA survey showed that diabetes and high blood pressure, poverty and unemployment, and air pollution were the most common public health problems as priorities. Conclusions: The high-priority problems of Al-Marashda are in common with the noncommunicable diseases (NCDs) priority in Al Najaf. However, poverty and air pollution are specific to the Al-Marashda region. Public health authorities and the city governorate are advised to consider, support, and develop community diagnosis documents to implement appropriate interventions.