Background Rabies is one of the oldest zoonosis viral diseases, which still remains as one of the most important threats to public health in the 21st century. Methods This cross-sectional study examined epidemiologic features of all 33,996 cases of persons bitten by animals and referred to the rabies prophylaxis centers in Golestan province between March 2017 and March 2020. Factors included demographic information of the victim (age, gender, and occupation), type of invasive animals (dog, cat, and other types), time of bite (year, month, and hour), place of residence (urban or rural), and injury and treatment statuses. We also obtained national and provincial animal bite incidence data for all of Iran and for Golestan province for the longer interval 2013–2020 to examine broader time trends. We used SPSS version 19, QGIS version 3.1, and Excel 2013 to generate frequency distributions and descriptive statistics. Results The incidence rates of animal bites in Golestan province and Iran as a whole both increased smoothly. The latest incidence rate of animal bites in Golestan was 652 per 100,000 people, almost three times the overall national figure for 2020. Most cases of animal bites (67.6%) occurred in rural areas, and 36% of the victims aged under 19 years old. Dog and cat bites accounted for the great majority of cases (89% and 8%, respectively). The highest rate of animal bites was reported in the spring (30.8%). The lower limb was the most commonly bitten area in these individuals (64.6%). Of note, 87% of the cases received incomplete prophylactic post-exposure treatment, and 18% received immunoglobulin. Conclusion The increasing rates of animal bites in the study area as well as the higher rate compared to the national average indicates the need for further review of animal bite control programs.

ObjectivesThis study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran.MethodsIn this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district’s health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider’s perspective using an activity-based costing (ABC) method.ResultsThe cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%).ConclusionUsing disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.

Backround. Diabetes is an important public health problem, one of four priority noncommunicable diseases targeted for action by world leaders. The aim of this study was to investigate the factors affecting diabetes control in patients with type 2 diabetes in the rural areas of northern Iran. Methods. This study was conducted following a descriptive-analytical cross-sectional study design based on the data of 308 patients with type 2 diabetes in the rural areas of golestan province. The samples were selected through two-stage stratified random sampling. Data were collected using a questionnaire (completed by the interviewer) and by measuring the blood glucose, blood pressure, and lipid profile of patients and also using data from patients' records. Data were analyzed using descriptive and analytical statistics and SPSS version 19. results. The mean age of patients was 57 ± 15 years and 220 patients (71%) were female. Fifty-five percent of patients had a family history of diabetes and 69% had comorbidity. The mean vegetable intake in patients was 3 days a week with 1.5 servings per day and only 20% had exercise at least three times a week. The proportion of patients with adequately controlled glycated hemoglobin (hBA 1c), blood pressure (BP), triglyceride (Tg), low-density lipoprotein (lDl), and high-density lipoprotein (hDl) were 27, 91, 31, 41 and 55.5%, respectively. There was also a significant relationship between the controlled blood glucose with increasing age, absence of comorbidity, the number of nutrition counseling, and lowering blood triglycerides. Conclusion. The results of this study showed poor blood glucose control in the studied geography. Therefore, considering these data, it seems necessary to review the national plan for the prevention and control of diabetes.

Objective: To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province, north part of Iran. Methods: This cross-sectional study was performed based on the data of 12 181 animal-bite patients from Golestan province who were referred to the rabies prophylaxis centers between March 2019 and March 2020. The study was a societal perspective, and all patients were investigated by census method. The micro-costing method with a bottom-up approach as well as the human capital approach were used to estimate the economic burden. Results: In our study, the economic burden caused by animal bites was estimated at $1 383 639 (275 354 672 060 Rials). The largest share of costs was related to direct healthcare costs, direct non-healthcare costs, and indirect costs accouting for 91%, 5%, and 4%, respectively. In addition, the average cost of a animal-bite patient was estimated at $113.5 (22 605 260 Rials) (The average cost of a case in type 2 and 3 exposures was $45 and $412.8, respectively). The largest share of direct healthcare costs was related to immunoglobulin, vaccine, and personnel expenses accounting for 61.3%, 19.8%, and 11.65%, respectively. Conclusions: Our study shows that animal bites in Golestan province, north of Iran impose a high economic burden on the communities, especially the healthcare system, which indicates the need to review management and control programs of animal bites and rabies based on animal-bite patterns of the area.

background. Diabetes is an important public health problem. this study aimed to investigate the quality of care in patients with diabetes type 2 and its consequences in rural areas at Golestan province, North of Iran, in comparison to standards of the Ministry of Health and Education of Iran and the American Diabetes Association. Methods. this was a cross-sectional study based on data from 308 patients with diabetes type 2 in rural areas at Golestan province, which was conducted through a two-stage classified sampling method and random selection. Data of this research was gathered through a questionnaire (fulfilled by the interviewer), assessment blood sugar, and information obtained from patients' files. Data were analyzed by descriptive statistics and sPss version19. results. the mean age of patients was 57 years and 88 patients (29%) were male. Only 35% of patients were visited seasonally by a family physician. In addition, only 24% of patients were visited at least once a year by an ophthalmologist, and 31% of patients underwent a glycated hemoglobin test at least twice a year. Influenza and hepatitis vaccines were given to 1.6% and 9.4% of patients, respectively. 85% of pa-tients were evaluated once a year for lipid profile and 61% for creatine and albumin. Only 31% of patients received nutrition counseling at least once a year. controlled glycated hemoglobin (HbA 1c ) was 27% and most patients were in the range of overweight and obesity (> 75%). Conclusion. The findings of this study showed that the quality of diabetes care and its consequences in patients is not desirable and is far from the standards provided by the Iran's Ministry of Health and the American Diabetes Association and requires revision in the current program of diabetes control. (clin Diabetol