Abstract Our understanding of the Coronavirus disease 2019 (COVID-19) continues to evolve and there are many unknowns about its epidemiology. This study aims to synthesise case fatality rate (CFR) among confirmed COVID-19 patients, incubation period and time from onset of COVID-19 symptoms to first medical visit, intensive care unit (ICU) admission, recovery, and death. We searched MEDLINE, Embase, Google Scholar, and bibliographies of relevant articles from 01 December 2019 to 11 March 2020 without any language restrictions. Quantitative studies that recruited people with confirmed COVID-19 diagnosis were included. Two independent reviewers extracted the data. Out of 1675 non-duplicate studies, 43 were included in the meta-analysis. The pooled mean incubation period was 5.68 (99% confidence interval [CI]: 4.78, 6.59) days. The pooled mean number of days from the onset of COVID-19 symptoms to first clinical visit was 4.92 (95% CI: 3.95, 5.90), ICU admission was 9.84 (95% CI: 8.78, 10.90), recovery was 18.55 (95% CI: 13.69, 23.41), and death was 15.93 (95% CI: 13.07, 18.79). Pooled CFR among confirmed COVID-19 patients was 0.02 (95% CI: 0.02, 0.03). We found that the incubation period and lag between the onset of symptoms and first clinical visit for COVID-19 are longer than other respiratory viral infections including Middle East respiratory syndrome and severe acute respiratory syndrome; however, the current policy of 14 days of mandatory quarantine for everyone potentially exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be too conservative. Longer quarantine periods might be more justified for extreme cases.

Purpose Underreporting is the major limitation of a voluntary adverse drug reaction (ADR) reporting system. Many studies have assessed the effectiveness of different interventions designed to improve ADR reporting. The aim of this study was to systematically map interventions and strategies to improve ADR reporting among health care professionals. Methods The six‐stage methodological framework of Arksey and O'Malley was used to conduct this scoping review. Ovid MEDLINE, EMBASE, All EBM, and Web of Science were systematically searched from 1999 to February 2019, and the reference lists of the included papers were also searched for gray literature to identify any interventions and strategies that aimed to increase ADR reporting. Two reviewers screened the papers for eligibility based on the inclusion criteria and extracted their key data and analyzed them descriptively. Results Ninety out of 14 501 papers met the selection criteria. Using computerized registration and active surveillance can increase ADR reporting significantly. Educational interventions performed individually or combined with sending reminders and/or feedback, awards, and providing easier reporting channels can improve ADR reporting over a short to medium term. Multiple interventions may have more impact than single‐component interventions. Conclusion Multiple interventions could cause a greater increase in ADR reporting rates than single interventions. Although educational interventions appear to be effective, few studies have reviewed their long‐term effects to ascertain whether the improvements are sustained over time. Studies with a better methodological quality are required on this subject.

29Background: Our understanding of the corona virus disease 2019 continues to 30 evolve. However, there are many unknowns about its epidemiology. 31Purpose: To synthesize the number of deaths from confirmed COVID-19 cases, incubation 32 period, as well as time from onset of COVID-19 symptoms to first medical visit, ICU admission, 33 recovery and death of COVID-19.Data Synthesis: Out of 1675 non-duplicate studies identified, 57 were included. Pooled mean 41 incubation period was 5.84 (99% CI: 4.83, 6.85) days. Pooled mean number of days from the 42 onset of COVID-19 symptoms to first clinical visit was 4.82 (95% CI: 3.48, 6.15), ICU admission 43 was 10.48 (95% CI: 9.80, 11.16), recovery was 17.76 (95% CI: 12.64, 22.87), and until death 44 was 15.93 (95% CI: 13.07, 18.79). Pooled probability of COVID-19-related death was 0.02 (95% 45 CI: 0.02, 0.03). 46Limitations: Studies are observational and findings are mainly based on studies that recruited 47 however, the current policy of 14 days of mandatory quarantine for everyone might be too 52 conservative. Longer quarantine periods might be more justified for extreme cases. 53 54

The level of knowledge regarding VAP prevention seems inadequate in the present study. Although having knowledge about the principles of evidence-based care cannot guarantee the implementation of these principles, lack of knowledge may be a potential barrier to adherence to evidence-based guidelines for the prevention of VAP. This article is protected by copyright. All rights reserved.

Aims: Addiction science has made great progress in the past decades. We conducted a scientometric study in order to quantify the number of publications and the growth rate globally, regionally, and at country levels. Methods: In October 2015, we searched the Scopus database using the general keywords of addiction or drug-use disorders combined with specific terms regarding 4 groups of illicit drugs – cannabis, opioids, cocaine, and other stimulants or hallucinogens. All documents published during the 20-year period from 1995 to 2014 were included. Results: A total of 95,398 documents were retrieved. The highest number of documents were on opioids, both globally (60.1%) and in each of 5 continents. However, studies on cannabis showed a higher growth rate in the last 5-year period of the study (2010–2014). The United States, the United Kingdom, Germany, Canada, Australia, France, Spain, Italy, China, and Japan – almost all studies were from high-income countries – occupied the top 10 positions and produced 81.4% of the global science on drug addiction. Conclusion: As there are important socio-cultural differences in the epidemiology and optimal clinical care of addictive disorders, it is suggested that low- and more affected middle-income countries increase their capacity to conduct research and disseminate the knowledge in this field.

IssuesAlcohol production, marketing and consumption are illegal in Iran. This systematic review examines the lifetime and last 12‐month prevalence of alcohol consumption among the general and young population in Iran.ApproachWe searched Web of Science, PubMed, Embase, Scopus and Iranian scientific databases (i.e. Scientific Information Database and Magiran) for relevant publications in English and Persian from inception to 12 May 2019. Following a random‐effects meta‐analysis, we estimated the pooled prevalence of alcohol consumption among the general population and young people (<30 years old). Meta‐regression was used to identify potential sources of heterogeneity.Key FindingsOf the 2400 identified records, 62 met the inclusion criteria. The overall pooled prevalence of lifetime alcohol consumption among the general population and young people was 13.0% [95% confidence intervals (CI) 10.0, 16.0]. The overall pooled prevalence of last 12‐month alcohol consumption was 12.0% (95% CI 7.0, 18.0) for the general population and 15.0% (95% CI 9.0, 22.0) for young people. The prevalence of alcohol consumption varied from 0.03% to 68.0% in different regions, 0.3% to 66.6% among males and 0.2% to 21.0% among females.ImplicationsOur findings highlight the need for public health surveillance of alcohol use in Iran.ConclusionThese estimates show that, on average, one in eight people in the general population have ever consumed alcohol in Iran, indicating that alcohol consumption is not an uncommon practice in the country.

The relationship between Parkinson's disease (PD) and risk of hip fracture yielded inconsistent results. Therefore, we conducted the present systematic review and meta-analysis of published observational studies to assess the association between PD and risk of hip fracture. PubMed, ISI, EMBASE, and Cochrane databases were searched systematically to identify studies assessing the relationship between PD and the risk of hip fracture up to July 01, 2017. In addition, to find related articles, the reference section of retrieved articles was checked. Random-effects model was used for calculation of pooled hazard ratio (HR) and 95% confidence intervals (CI). Thirteen independent studies containing 564,947 participants were included in the meta-analysis. The overall results of included studies showed PD to be associated with the risk of hip fracture (HR = 3.13, 95% CI 2.53-3.87) in women 3.11 (2.51-3.86) and men 2.60 (2.19-3.09). Our meta-analysis showed the direct association between PD and the risk of hip fracture in both men and women. However, due to the limitations of this study, further well-designed studies are required to confirm our findings.

Background: The growing trend of breast cancer in Iran and the adverse consequences arising from the delay in diagnosis and treatment in females has been a challenge. Objectives: This study was conducted to identify the predictors for diagnosis and treatment delay in females with breast cancer in the north of Iran. Methods: This cross-sectional study was performed on 232 patients with a definite diagnosis of breast cancer at Razi Hospital, which is the main referral centre in Guilan Province, Iran, using sequential sampling methods. Data were collected using a six-section questionnaire through interviews and medical records of the patients. Data were analyzed using descriptive statistics, logistic regression and chi square test. Results: Delays of more than one month was observed in 53% of patients and more than three months delay was observed in 31%. Of the patients with a definite diagnosis of breast cancer, 87% returned within seven days for treatment interventions. Three variables of: stage of disease (stage II: P = 0.002, OR = 7.19 and stage III: P = 0.034, OR = 1.95), lack of complementary insurance (P = 0.007, OR = 2.26) and primary insurance (P = 0.067, OR = 3.52) were important risk factors for patient delay. Knowledge and attitude regarding the symptoms of breast cancer (P = 0.007), the most important method for breast cancer diagnosis (P = 0.004), and the importance of self-examination was significantly different between patients with and without delay in the onset of treatment. Conclusions: This study showed that about one-third of patients with breast cancer had a patient delay of more than three months. In addition, 16.8% and 13% of patients experienced system delay in diagnosis and treatment, respectively. The government is responsible to not only teach people on the signs of breast cancer, but also to establish a powerful screening system for breast cancer.