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Sajadi HS, Safikhani H, Olyaeemanesh A, Majdzadeh R. Challenges in institutionalizing evidence-informed priority setting for health service packages: a qualitative document and interview analysis from Iran. Health Res Policy Syst 2024; 22:110. [PMID: 39160569 DOI: 10.1186/s12961-024-01207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Setting and implementing evidence-informed health service packages (HSPs) is crucial for improving health and demonstrating the effective use of evidence in real-world settings. Despite extensive training for large groups on evidence generation and utilization and establishing structures such as evidence-generation entities in many countries, the institutionalization of setting and implementing evidence-informed HSPs remains unachieved. This study aims to review the actions taken to set the HSP in Iran and to identify the challenges of institutionalizing the evidence-informed priority-setting process. METHODS Relevant documents were obtained through website search, Google queries, expert consultations and library manual search. Subsequently, we conducted nine qualitative semi-structured interviews with stakeholders. The participants were purposively sampled to represent diverse backgrounds relevant to health policymaking and financing. These interviews were meticulously audio-recorded, transcribed and reviewed. We employed the framework analysis approach, guided by the Kuchenmüller et al. framework, to interpret data. RESULTS Efforts to incorporate evidence-informed process in setting HSP in Iran began in the 1970s in the pilot project of primary health care. These initiatives continued through the Health Transformation Plan in 2015 and targeted disease-specific efforts in 2019 in recent years. However, full institutionalization remains a challenge. The principal challenges encompass legal gaps, methodological diversity, fragile partnerships, leadership changeovers, inadequate financial backing of HSP and the dearth of an accountability culture. These factors impede the seamless integration and enduring sustainability of evidence-informed practices, hindering collaborative decision-making and optimal resource allocation. CONCLUSIONS Technical aspects of using evidence for policymaking alone will not ensure sustainability unless it achieves the necessary requirements for institutionalization. While addressing all challenges is crucial, the primary focus should be on required transparency and accountability, public participation with an intersectionality lens and making this process resilience to shocks. It is imperative to establish a robust legal framework and a strong and sustainable political commitment to embrace and drive change, ensuring sustainable progress.
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Affiliation(s)
- Haniye Sadat Sajadi
- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Olyaeemanesh
- National Institute of Health Research and Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- School of Health and Social Care, University of Essex, Colchester, United Kingdom.
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Liu Q, Jiang L, Ho KY, Lam KKW, Lam W, Yang F, Mao T, Sun M, Shen B, Ho JM, Liu PK, Chiu SY, Wong FKY. Spiritual Interventions Among Pediatric Patients With Cancer: A Systematic Review And Meta-Analysis. J Pain Symptom Manage 2024; 68:e8-e20. [PMID: 38518833 DOI: 10.1016/j.jpainsymman.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
CONTEXT Although spiritual intervention is crucial in the care of childhood cancer patients (CCPs), its effectiveness has not yet been systematically evaluated. OBJECTIVES To determine the effectiveness of existing spiritual interventions on psychological, spiritual outcomes, and quality of life (QoL) in CCPs. METHODS We searched eight databases to identify relevant randomized controlled trials and quasi-experimental studies. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Results were either synthesized in a systematic narrative synthesis or a meta-analysis using a random effects model, where appropriate. The pooled treatment effect was estimated using the standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS Twelve studies with 576 CCPs were included. Eight studies showed a high risk of bias. The overall effect of existing spiritual interventions on QoL (Z = 1.05, SMD = 0.64, 95%CI = -0.15 to 1.83, P = 0.29), anxiety (Z = 1.11, SMD = -0.83, 95%CI = -2.30 to 0.64, P = 0.28) and depressive symptoms (Z = 1.06, SMD = -0.49, 95%CI = -1.40 to 0.42, P = 0.12) were statistically nonsignificant. The nonsignificant findings could be attributed to the high heterogeneity among the included studies (QoL: I2 = 85%; anxiety: I2 = 90%; depressive symptoms: I2 = 58%). CONCLUSION Evidence to support the positive effects of existing spiritual interventions on psychological and spiritual outcomes and QoL in CCPs is insufficient. Future studies should adopt a more rigorous design and unify the outcome measures to reduce the risk of bias and heterogeneity, respectively.
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Affiliation(s)
- Qi Liu
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
| | - Ling Jiang
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
| | - Ka Yan Ho
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR.
| | - Katherine K W Lam
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
| | - Winsome Lam
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
| | - Funa Yang
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
| | - Ting Mao
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
| | - Mei Sun
- Xiangya School of Nursing (M.S.), Central South University, China
| | - Biyu Shen
- Department of Nursing (B.S.), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, China
| | - Jacqueline Mc Ho
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
| | - P K Liu
- Hong Kong Children's Hospital (P.K.L.), Shing Cheong Road, Kowloon Bay, HKSAR
| | - S Y Chiu
- Department of Adolescent Medicine (S.Y.C.), Queen Mary Hospital, 102 Pokfulam Road, HKSAR
| | - Frances-Kam-Yuet Wong
- School of Nursing (Q.L., L.J., K.Y.H., K.K.W.L., W.L., F.Y., T.M., J.M.C.H., F.K.Y.W.), Hong Kong Polytechnic University, Hung Hom, Kowloon, HKSAR
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Rezaei N, Sharafkhah M, Farahmand Y, Sepanlou SG, Dalvand S, Poustchi H, Sajadi A, Masoudi S, Roshandel G, Khoshnia M, Eslami L, Akhlaghi M, Delavari A. Population attributable fractions of cancer mortality related to indoor air pollution, animal contact, and water source as environmental risk factors: Findings from the Golestan Cohort Study. PLoS One 2024; 19:e0304828. [PMID: 38857263 PMCID: PMC11164345 DOI: 10.1371/journal.pone.0304828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/15/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Environmental risk factors are significant contributors to cancer mortality, which are neglected. PURPOSE This study aimed to estimate the population attributable fraction of cancer mortality due to the environmental risk factors. METHODS Golestan cohort study is a population-base cohort on 50045 participants between 40-75 with about 18 years of follow up. We detected 2,196 cancer mortality and applied a multiple Cox model to compute the hazard ratio of environmental risk factor on all cancer and cancer-specific mortality. The population attributable fraction was calculated, accordingly. RESULTS Biomass fuels for cooking, as an indoor air pollution, increased the risk of colorectal, esophageal, gastric cancer, and all-cancer mortality by 84%, 66%, 37%, and 17% respectively. Using gas for cooking, particularly in rural areas, could save 6% [Population Attributable Fraction: 6.36(95%CI: 1.82, 10.70)] of esophageal cancer, 3% [Population Attributable Fraction: 3.43 (0, 7.33)] of gastric cancer, and 6% [Population Attributable Fraction: 6.25 (1.76, 13.63)] of colorectal cancer mortality. Using a healthy tap water source could save 5% [Population Attributable Fraction:5.50(0, 10.93)] of esophageal cancer mortality, particularly in rural areas. There was no significant association between indoor air pollution for heating purposes and animal contact with cancer mortality. CONCLUSION Considering the results of this study, eliminating solid fuel for most daily usage, among the population with specific cancer types, is required to successfully reduce cancer related mortality. Adopting appropriate strategies and interventions by policymakers such as educating the population, allocating resources for improving the healthy environment of the community, and cancer screening policies among susceptible populations could reduce cancer related mortalities.
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Affiliation(s)
- Negar Rezaei
- Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Sharafkhah
- Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yalda Farahmand
- School of Medicine, Terhan University of Medical Sciences, Tehran, Iran
| | - Sadaf G. Sepanlou
- Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Dalvand
- Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreatobiliary Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sajadi
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Masoudi
- Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoud Khoshnia
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Layli Eslami
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboube Akhlaghi
- Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Delavari
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Harooni J, Joukar F, Goujani R, Sikaroudi MK, Hatami A, Zolghadrpour MA, Hejazi M, Karimi Z, Rahmanpour F, Askari Shahid S, Jowshan MR. Cohort profile: the PERSIAN Dena Cohort Study (PDCS) of non-communicable diseases in Southwest Iran. BMJ Open 2024; 14:e079697. [PMID: 38604628 PMCID: PMC11015286 DOI: 10.1136/bmjopen-2023-079697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
PURPOSE This study conducted in Dena County is a population-based cohort study as part of the Prospective Epidemiological Research Studies in Iran (PERSIAN). The specific objectives of this study were to estimate the prevalence of region-specific modifiable risk factors and their associations with the incidence of major non-communicable diseases (NCDs). PARTICIPANTS This PERSIAN Dena Cohort Study (PDCS) was conducted on 1561 men and 2069 women aged 35-70 years from October 2016 in Dena County, Kohgiluyeh and Boyer-Ahmad Province, Southwest Iran. The overall participation rate was 82.7%. FINDINGS TO DATE Out of 3630 participants, the mean age was 50.16 years, 2069 (56.9%) were women and 2092 (57.6%) were rural residents. Females exhibited higher prevalence rates of diabetes, hypertension, fatty liver, psychiatric disorders, thyroiditis, kidney stones, gallstones, rheumatic disease, chronic lung disease, depression and osteoporosis compared with males (p<0.05). Furthermore, the urban population showed elevated rates of diabetes, thyroiditis, kidney stones and epilepsy, whereas psychiatric disorders and lupus were more prevalent in rural areas (p<0.05). According to laboratory findings, 418 (13.0%), 1536 (48.1%) and 626 (19.3%) of the participants had fasting blood sugar >126 mg/dL, low-density lipoprotein >100 mg/dL and haematuria, respectively; most of them were female and urban people (p<0.05). FUTURE PLANS PDCS will be planned to re-evaluate NCD-related incidence, all-cause and cause-specific mortality every 5 years, along with annual follow-up for 15 years. Some examples of additional planned studies are evaluation of genetic, environmental risk, spirometry and ECG tests.
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Affiliation(s)
- Javad Harooni
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Goujani
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Masoumeh Khalighi Sikaroudi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Hatami
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Amin Zolghadrpour
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Hejazi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Karimi
- Students Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Fatemeh Rahmanpour
- Students Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sakineh Askari Shahid
- Department of Public Health, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammad-Reza Jowshan
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Nutrition, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran
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Nakhaee S, Zadeh AA, Madadjoo Y, Azadi NA, Mansouri B. Evaluation of urinary trace element levels in patients with opioid use disorder undergoing methadone treatment in western Iran. Sci Rep 2024; 14:5662. [PMID: 38454098 PMCID: PMC10920885 DOI: 10.1038/s41598-024-56241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
The monitoring of essential and toxic elements in patients with Opioid Use Disorder (OUD) undergoing methadone treatment (MT) is important, and there is limited previous research on the urinary levels of these elements in MT patients. Therefore, the present study aimed to analyze certain elements in the context of methadone treatment compared to a healthy group. In this study, patients with opioid use disorder undergoing MT (n = 67) were compared with a healthy group of companions (n = 62) in terms of urinary concentrations of some essential elements (selenium (Se), zinc (Zn), copper (Cu), iron (Fe), manganese (Mn), calcium (Ca)) and toxic elements (lead (Pb), cadmium (Cd), arsenic (As), and chromium (Cr)). Urine samples were prepared using the acid digestion method with a mixture of nitric acid and perchloric acid and assessed using the ICP-MS method. Our results showed that the two groups had no significant differences in terms of gender, education level, occupation, and smoking status. Urinary concentrations of Se, Cu, and Fe levels were significantly lower in the MT group compared to the healthy subjects. However, the concentrations of Pb, Cd, As, Mn, Cr, and Ca in the MT group were higher than in the healthy group (p < 0.05). No significant difference was established between the levels of Zn in the two groups (p = 0.232). The results of regression analysis revealed that the differences between the concentration levels of all metals (except Zn) between two groups were still remained significant after adjusting for all variables (p < 0.05). The data obtained in the current study showed lower urinary concentrations of some essential elements and higher levels of some toxic elements in the MT group compared to the healthy subjects. These findings should be incorporated into harm-reduction interventions.
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Affiliation(s)
- Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadi Zadeh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 9717113163, Iran
| | | | - Nammam Ali Azadi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Borhan Mansouri
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Mahdi S, Marzieh L, Habib R, Elahe P, Sanaz D. The role of healthcare professionals to improve organ donation and transplantation outcome: a national study. Cell Tissue Bank 2024; 25:159-165. [PMID: 36707455 PMCID: PMC9883121 DOI: 10.1007/s10561-023-10071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Improve the quality of donor coordination activities caused by an increased organ donation rate. The aim of this study was to assess the influence of organ donation coordinators' characteristics on rate of donation and family consent rate in Recognition Centers (RCs) and Organ Procurement Units (OPUs) in Iran by analyzing the organ procurement and transplantation data. MATERIALS AND METHODS Based on a questionnaire, this retrospective study evaluated the number of confirmed brain deaths, family consent rate, organ recoveries, rate of expired brain death cases before and after family consent in Iran. RESULTS According to results, the overall family consent rate in the entire country is equal to 60.63%. The work experience had a significant effect on the number of procured organs (P < 0.004), death rate after family consent (P < 0.04), and eligible donor death before family consent (P < 0.03). The type of unit (RCs or OPUs) had significant difference on death after family consent (P < 0.023), the death before family consent (P < 0.014), the sum of procured organ (P < 0.04). CONCLUSION The consent rate and donor management in the cases of brain death are unacceptable. The coordinators need training to increase their efficiency in terms of family approach and maintenance of brain death. Only by improving the level of family consent and increasing the coordinators' maintenance skills for brain death cases can the amount of organ donation in Iran be doubled to the current amount.
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Affiliation(s)
- Shadnoush Mahdi
- Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Latifi Marzieh
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahban Habib
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA USA
- Southern California Medical Education Consortium, Universal Health System, Temecula, CA USA
| | - Pourhosein Elahe
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Dehghani Sanaz
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Sina University Hospital, Hassan-abad Sq. Emam Khomeini St, Tehran, Iran
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Ghareghozloo M, Moridi M, Alimardi M, Safari K, Moghadam ZB. Development and psychometric evaluation of the sexual and reproductive health needs of incarcerated women scale: a methodological study. J Public Health (Oxf) 2024; 46:e65-e77. [PMID: 38102950 DOI: 10.1093/pubmed/fdad257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study aimed to develop and validate a comprehensive tool designed to assess the sexual and reproductive health (SRH) needs of incarcerated women. METHODS A methodological study was conducted from January to March 2023 in two female prisons in Tehran and Hamedan, Iran. The participant pool consisted of women who had been incarcerated for a minimum of 6 months and were aged between 15 and 49 years. The instrument development involved two phases. Phase I involved a literature review and interviews with incarcerated women to understand their SRH needs. Phase II assessed psychometric properties to establish the scale's validity and reliability. RESULTS The SRH Needs of Incarcerated Women (SRH-NIW) scale was refined, comprising 37 items across six domains: pregnancy and childbirth services, parenting services, family planning and sexual health services, personal and medical care services, screening services and infection control services. Exploratory factor analysis explained 66.15% of variance. The Content Validity Ratio and Content Validity Index were 0.8 and 0.94, respectively, indicating high content validity. Average Variance Extracted values ranged from 0.592 to 0.698. The whole scale showed a Cronbach's alpha of 0.823, and the Intra-class Correlation Coefficient was 0.879. CONCLUSION The SRH-NIW scale is a valid and reliable tool for assessing the SRH needs of incarcerated women. It can enhance healthcare services and interventions for incarcerated women, potentially leading to policy improvements within the prison system.
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Affiliation(s)
- Mohadeseh Ghareghozloo
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 141973317, Iran
| | - Maryam Moridi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 141973317, Iran
| | - Masoud Alimardi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Kolsoom Safari
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Zahra Behboodi Moghadam
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran 141973317, Iran
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Mansouri B, Azadi N, Drebadami AH, Nakhaee S. Trace element levels: How Substance Use Disorder (SUD) contributes to the alteration of urinary essential and toxic element levels. PLoS One 2024; 19:e0294740. [PMID: 38315674 PMCID: PMC10843129 DOI: 10.1371/journal.pone.0294740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024] Open
Abstract
Increasing illicit drug use is one of the main problems in most countries or societies. Monitoring heavy metals and trace elements in this vulnerable group seems to be necessary. Therefore, we assessed the urinary trace element and toxic metals/metalloids concentrations (Zinc (Zn), Iron (Fe), Copper (Cu), Chromium (Cr), Lead (Pb), Cadmium (Cd), Arsenic (As), Nickel (Ni), and Mercury (Hg)) in opium, tramadol, and cannabis users compared to healthy subjects. In this cross-sectional study, patients with substance use disorder (SUD) (n = 74) were divided into four groups: cannabis, tramadol, opium, and mixed (simultaneous use of more than one of the three studied substances), along with a healthy group (n = 60). Urine samples were prepared by dispersive liquid-liquid microextraction method so that heavy metals/metalloids could be measured by ICP-MS. The mean urinary concentration of Cu (48.15 vs. 25.45; 89.2%, p<0.001), Hg (1.3 vs. 0.10; 1200%, p < 0.001), and Zn (301.95 vs. 210; 43.8%, p < 0.001) was markedly lower among patients with SUD. The mean urinary concentration of other elements including As (1.9 vs. 4.1; 115.8%), Cd (0.1 vs. 1.10; 1000%), Cr (6.80 vs. 11.65; 71.3%), Ni (2.95 vs. 4.95; 67.8%), and Pb (1.5 vs. 7.9; 426.6%) were significantly higher among patients with SUD compared to healthy subjects. When sub-groups were compared, no significant differences were observed between their trace element levels (Kruskal-Wallis test, p > 0.05). This can be an indication that regardless of the type of drug, the levels of trace elements are changed with respect to healthy individuals. Our results showed that illicit drug use causes changes in urinary trace element/heavy metal/metalloid levels and highlights the need for monitoring heavy metals and trace elements in individuals with substance use disorder. Assessment of different elements in biological samples of drug dependents may be useful for implementing new prevention and treatment protocols. In case of changes in their levels, complementary recommendations, attention to diet, and periodic assessment of toxic metal levels within treatment programs will be needed.
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Affiliation(s)
- Borhan Mansouri
- Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nammamali Azadi
- Biostatistics Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Arezo Hashemi Drebadami
- State Welfare Organization of Kermanshah, Substance Abuse Prevention Research Center, Research Institute for Health, Kermanshah, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Southern Khorasan, Iran
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9
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Kabir MJ, Moeini S, Heidari A. Strategies for improving the financing of family medicine program: Evidence from Iran. Health Sci Rep 2024; 7:e1813. [PMID: 38204751 PMCID: PMC10776829 DOI: 10.1002/hsr2.1813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/26/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
Background and Aims The impact of health financing on the performance of the entire health system, including access, quality, and efficiency of healthcare, has been emphasized in the Astana Declaration, and the need to strengthen primary healthcare (PHC) and policy integration has been emphasized. After about two decades, the family medicine (FM) program in Iran is still facing great challenges. The aim of this study is to explore strategies for strengthening financing of the FM program in Iran, a vital component of PHC. Methods A qualitative study was conducted in 2021. Purposeful sampling was used to select 34 policymakers, managers, and experts from various levels of the Ministry of Health, Iran universities of medical sciences, plan and budget organization of Iran, and health insurance organization in Iran. Thirty-four semistructured interviews were conducted to collect data, which were analyzed by content analysis. Results Through the analysis of interviews, our study has identified five strategies (identification and management of sustainable resources, pooling of sustainable resources, modeling of service provision, payment system model and its implementation process, and FM management structure), and 13 actions for strengthening financing of the FM program in Iran. Conclusion Our study has identified five strategies and 13 actions for strengthening the financing of the FM program in Iran. These strategies and actions should be considered by policymakers during the review of the FM program in Iran. Without implementation of the suggested strategies and action, allocated resources may be wasted.
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Affiliation(s)
- Mohammad Javad Kabir
- Health Management and Social Development Research CenterGolestan University of Medical SciencesGorganIran
| | - Sajad Moeini
- Department of Health Services Management, School of Health Management & Information SciencesIran University of Medical SciencesTehranIran
| | - Alireza Heidari
- Health Management and Social Development Research CenterGolestan University of Medical SciencesGorganIran
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10
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Zare MG, Okati-Aliabad H, Ansari-Moghaddam A, Mohammadi M, Shahraki-Sanavi F. Prevalence and risk factors of pre-hypertension and hypertension among adults in Southeastern Iran: Findings from the baseline survey of the Zahedan adult cohort study. PLoS One 2023; 18:e0295270. [PMID: 38060532 PMCID: PMC10703255 DOI: 10.1371/journal.pone.0295270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Hypertension (HTN) stands as the leading modifiable risk factor for cardiovascular disease(CVD) and premature death globally. Understanding its prevalence and risk factors is essential for effective prevention and management of HTN. This study aimed to investigate the prevalence of Pre-hypertension (pre-HTN), HTN, and its risk factors in adults participating in the Zahedan adult cohort study (ZACS). This cross-sectional study used the baseline data of the ZACS. Ordinal logistic regression analysis was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for potential risk factors. Among the 10,016 participants in this study, 60.89% were women, with an average age of 50.44 ± 9.18 years. The prevalence of pre-HTN and HTN was 42.03% (men 45.44%, women 39.84%) and 18.47% (men 21.09%, women 16.79%), respectively. Being male, older age, having higher socioeconomic status (SES), being overweight and obese, having a family history of HTN, comorbidities such as diabetes and CVD, as well as abnormal blood lipid levels (triglycerides and HDL cholesterol) were the most significant predictors of pre-HTN and HTN. These findings highlight that more than half of the participants in this study exhibit pre-HTN or HTN, placing them at risk for CVD and stroke. Implementing comprehensive preventive strategies tailored to these identified risk factors is imperative to alleviate the disease burden, enhance disease management, and improve HTN treatment and control.
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Affiliation(s)
- Mojtaba Gholami Zare
- Department of Epidemiology, MSc Candidate of Epidemiology, School of Public Health, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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11
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Khatami K, Estedlal A, Vali M, Kamalipour A, Mahmoudinezhad G, Nejabat M, Nowroozzadeh MH, Vardanjani HM. Prevalence and secular trends of four causes of blindness and visual impairment in Iran (1990-2019): a comparative study based on the Global Burden of Disease project's data. Int Ophthalmol 2023; 43:4719-4728. [PMID: 37713146 DOI: 10.1007/s10792-023-02872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE The purpose of this study was to investigate the prevalence of cataracts, refractive disorders, age-related macular disease (AMD), and glaucoma, as well as their trends from 1990 to 2019 in Iran, in comparison with high-middle socio-demographic index (HMSDI) countries and the world, using the Global Burden of Disease (GBD) 2019 study. METHODS The GBD study provided data on the prevalence of blindness and visual impairment (VI), as well as four of their causes including cataracts, refractive disorders, age-related macular disease (AMD), and glaucoma. Using Joinpoint analysis, the annual percent change (APC) was calculated to assess the trend of change in prevalence in each category of diseases from 1990 to 2019, stratified by sex and age, for Iran, HMSDI countries, and the world. RESULTS In 2019, refractive errors and cataracts were the most common causes of blindness and VI for both genders in Iran, HMSDI countries and the world. Iran had a higher age-standardized prevalence in all four categories of ophthalmologic disorders compared to HMSDI countries and the world for both genders in 2019. Additionally, the age-specific prevalence of all four disorders in 2019 was higher in Iran compared to HMSDI countries. However, in terms of trends of prevalence from 1990 to 2019, the rate of reduction for the four ophthalmologic disorders in Iran was higher than in HMSDI and the world for both males and females. Furthermore, Iran had a greater percentage of reduction in prevalence for all age groups in all four disorders compared to HMSDI countries. CONCLUSION The prevalence of cataracts, refractive errors, AMD, and glaucoma in Iran was higher compared to HMSDI countries in 2019 for both sexes and all age groups, but the trends of prevalence for all four disorders from 1990 to 2019 in Iran had a higher slope of reduction compared to HMSDI countries for all ages and sexes.
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Affiliation(s)
- Kiana Khatami
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - AliReza Estedlal
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - AliReza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA
| | - Mahmood Nejabat
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hossein Molavi Vardanjani
- MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- MD-MPH Department, School of Medicine, Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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12
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Khashayar P, Sharifnejad Tehrani Y, Tabatabaei-Malazy O, Khashayar P, Saeedi Moghaddam S, Shobeiri P, Golestani A, Esfahani Z, Shokri Varniab Z, Nasserinejad M, Pourabhari Langroudi A, Dilmaghani-Marand A, Kazemi A, Rezaei N, Larijani B. The national trend of the burden of Chronic Kidney Disease (CKD) in Iran from 1990 to 2019. J Diabetes Metab Disord 2023; 22:1657-1671. [PMID: 37975103 PMCID: PMC10638225 DOI: 10.1007/s40200-023-01298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/03/2023] [Indexed: 11/19/2023]
Abstract
Purpose Chronic Kidney Disease (CKD) has become the 8th leading cause of death in Iran in 2017, 5 steps up from 1990. This is important as hypertension, diabetes, and chronic glomerulonephritis along with exposure to toxins or heavy metals are the main risk factors for the disease. Despite its heavy burden, there are limited studies on the incidence and prevalence of the disease in the Iranian adult population. The present article studies the burden of CKD at the national level in 2019, and its trend over the past three decades. Methods In 2019, the Global Burden of Disease (GBD) study provided an annual estimation of the burden of 369 diseases and injuries in 204 countries from 1990 until 2019. The data estimating CKD and related mortality in Iran were collected from the disease registry, survey, and scientific literature. All-ages and age-standardised indices of incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) were extracted for both sexes. Results Since 1990, the age-standardized incidence (34.7% (95% uncertainty interval 30.8 - 38.8)) and prevalence (19.6% (17.7 - 21.8)) of CKD have risen, while a 21.5% (-28.8 - -15.4) and 18.0% (-35.4 - -10.8) decrease were noted in age-standardized DALYs and deaths rates, respectively. The lowest prevalence was reported in the eastern and western provinces. Conclusion Current study provides comprehensive knowledge about the CKD burden, suggesting the Iranian healthcare system has been more effective in averting deaths rather than managing morbidities. Multi-sectoral action plans are needed to strengthen preventive and early detection programs in high-risk areas. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01298-y.
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Affiliation(s)
- Patricia Khashayar
- Osteoporosis Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Center for Microsystem Technology, Imec and Ghent, University Ghent Belgium, Ghent, Belgium
| | - Yeganeh Sharifnejad Tehrani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ozra Tabatabaei-Malazy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouria Khashayar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Shokri Varniab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasserinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ashkan Pourabhari Langroudi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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13
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Mouseli A, Sharafi M, Mastaneh Z, Shiri MS. Contrasting socioeconomic inequality with noncommunicable diseases: Insights from a population-based survey using the concentration index in Kong cohort study. Health Sci Rep 2023; 6:e1682. [PMID: 37936619 PMCID: PMC10625898 DOI: 10.1002/hsr2.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Background Noncommunicable diseases (NCDs) are the major causes of mortality across the globe, which impose a substantial burden on health care systems, particularly in low- and middle-income countries. The present study aimed to determine socioeconomic inequality in the prevalence of NCDs using the concentration index (CI). Methods This cross-sectional study was conducted on the baseline data of the Bandar Kong cohort. The principal component analysis was used to determine people's socioeconomic status (SES). The CI and Lorenz Curve were used for the assessment of socioeconomic inequality. Multivariate logistic regression was used to assess the relationship between SES and the prevalence of NCDs. A p Value less than 0.05 is considered significant. Results Frequency and prevalence of diabetes was 653 (16.22%), hypertension 848 (21.06%), chronic lung diseases 161 (4%), epilepsy 70 (1.74%), mental disorders 191 (4.74%), stillbirth 299 (13.94%), thyroid disorders 391 (9.71%) and depression 146 (3.63%). CI for the prevalence of diabetes was [-0.107, %95 CI: -0.146 to -0.068], hypertension [-0.122, %95 CI: -0.155 to -0.088], chronic lung disease [-0.116, %95 CI: -0.202 to -0.03], psychiatric disorders [-0.230, %95 CI: -0.304 to -0.155], depression [-0.132, %95 CI: -0.220 to-0.043] and stillbirth [-0.162, %95 CI: -0.220 to -0.105]. The Gini index was negative for all these diseases, indicating that these are significantly concentrated in people of poor SES. Conclusions The findings suggest that selected NCDs were concentrated among the poor and the low-income. Particular attention may be necessary to address the problem of NCDs among these groups.
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Affiliation(s)
- Ali Mouseli
- Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
- Department of Health Services Management, School of HealthHormozgan University of Medical SciencesBandar AbbasIran
| | - Mehdi Sharafi
- Social Determinants in Health Promotion Research Center, Hormozgan Health InstituteHormozgan University of Medical SciencesBandar AbbasIran
| | - Zahra Mastaneh
- Department of Health Information Management and Technology, School of Allied Medical SciencesHormozgan University of Medical SciencesBandar AbbasIran
| | - Maryam Shiravani Shiri
- Department of Health Services Management, School of HealthHormozgan University of Medical SciencesBandar AbbasIran
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14
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Malekpour MR, Ghamari SH, Ghasemi E, Hejaziyeganeh S, Abbasi-Kangevari M, Bhalla K, Rezaei N, Shahraz S, Dilmaghani-Marand A, Taghi Heydari S, Rezaei N, Lankarani KB, Farzadfar F. The effect of Real-Time feedback and incentives on speeding behaviors using Telematics: A randomized controlled trial. ACCIDENT; ANALYSIS AND PREVENTION 2023; 191:107216. [PMID: 37429155 DOI: 10.1016/j.aap.2023.107216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/16/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
Speeding behaviour of drivers is highly correlated to their tangible consequence. Therefore, this study aimed to evaluate the effectiveness of telematics-based feedback and financial incentives in reducing speeding behaviors through a randomized controlled field trial. This randomized controlled trial included four groups of (1) control, (2) information-only, (3) gain-of-reward, and (4) loss-of-reward. While drivers of the control group were unobtrusively monitored using telematics devices, drivers of the information-only group received real-time, weekly, and monthly feedback via text message. In both groups with financial incentives, in addition to receiving feedback, drivers could receive payments at the end of each month based on observed speeding. The primary outcome was the distance traveled at speeds more than 10% (S10 + ) above the posted speed limit as a proportion of the total traveled distance. A total of 397 male taxi drivers consented to participate in the study. After the stratified randomization, the mean age of the participant was 46.0 (95% Confidence Interval: 43.8 to 48.2), 47.0 (44.7 to 49.3), 46.1 (43.7 to 48.5), and 48.8 (46.5 to 51.1) years for the control, the information-only, the gain-of-reward, and the loss-of-reward groups, respectively. The mean S10 + rate per 100 km was 0.9 (0.5 to 1.2) for the control, 0.8 (0.4 to 1.1) for the information-only, 0.7 (0.3 to 1.1) for the gain-of-reward, and 1.3 (0.4 to 2.2) for the loss-of-reward group at the start of intervention. During the intervention phase, the loss-of-reward group with 0.6 (0.5 to 0.7) had the lowest mean of S10 + rate, followed by the gain-of-reward group with 0.8 (0.7 to 0.8). The loss-of-reward and gain-of-reward groups were the most influenced groups by the intervention, with 38.0% (13.2 to 55.7; p-value < 0.01) and 29.4% (2.0 to 49.2; p-value = 0.04) less S10 + rate than the control group, respectively. It was figured out that providing information regarding drivers' behavior without appropriating motives or penalties would have a minuscule impact.In addition, the group of drivers who were treated with instant punishment was the most influenced group by the intervention.
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Affiliation(s)
- Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedamirhossein Hejaziyeganeh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavi Bhalla
- Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Shahraz
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Kamran B Lankarani
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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15
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Safi S, Ahmadzade M, Karimi S, Akbari ME, Rouientan H, Abolhosseini M, Rezaei Kanavi M, Khorrami Z. A registration trend in eyelid skin cancers and associated risk factors in Iran, 2005-2016. BMC Cancer 2023; 23:924. [PMID: 37777736 PMCID: PMC10543867 DOI: 10.1186/s12885-023-11414-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Eyelid skin cancers are the most prevalent ophthalmic malignancies. This study aimed to evaluate the association of the Human Development Index (HDI) and lifestyle risk factors with eyelid skin cancers in Iran. METHODS This ecological study analyzed the data collected from the Iranian National Population-based Cancer Registry (2005-2016). The data on provincial-level eyelid skin cancer risk factors were obtained from national sources. The association between provincial HDI and lifestyle risk factors with the prevalence of eyelid skin cancers was assessed. RESULTS The mean 12-year age-standardized incidence rate (ASIR) of eyelid skin cancers was 16.22 per 100,000 (9,104 cases). The overall ASIR showed an upward trend with an estimated annual average increase of 0.006 per year. There were positive correlations between the prevalence of overall eyelid skin cancers and provincial HDI, smoking, and obesity (r = 0.32, 0.42, and 0.37, respectively). In multivariate analysis, obesity/overweight remained a positive predictor for high prevalence of total eyelid skin cancers (OR = 1.97, 95%CI = 1.08-3.58, P = 0.026), carcinoma (2.10, 1.15-3.83, P = 0.015), and basal cell carcinoma (1.48, 0.99-2.20, P = 0.054). CONCLUSIONS An increasing trend in ASIR of eyelid skin cancers was observed in more than a decade in Iran which was positively associated with provincial HDI and prevalence of obesity. The findings of the study highlight the importance of promotional programs for preventing obesity/overweight and appropriate allocation of screening facilities based on the HDI level.
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Affiliation(s)
- Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Rouientan
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abolhosseini
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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16
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Khanali J, Ghasemi E, Rashidi MM, Ahmadi N, Ghamari SH, Azangou-Khyavy M, Malekpour MR, Abbasi-Kangevari M, Hashemi SM, Naderian M, Rezaei N, Dilmaghani-Marand A, Farzi Y, Kazemi A, Yoosefi M, Hajebi A, Rezaei S, Azadnajafabad S, Fattahi N, Nasserinejad M, Abdolhamidi E, Haghshenas R, Rezaei N, Djalalinia S, Larijani B, Farzadfar F. Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021. Sci Rep 2023; 13:15499. [PMID: 37726324 PMCID: PMC10509214 DOI: 10.1038/s41598-023-42341-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
The study aimed to estimate the prevalence of lipid abnormalities in Iranian adults by demographic characterization, geographical distribution, and associated risk factors using national and sub-national representative samples of the STEPs 2021 survey in Iran. In this population-based household survey, a total of 18,119 individuals aged over 25 years provided blood samples for biochemical analysis. Dyslipidemia was defined by the presence of at least one of the lipid abnormalities of hypertriglyceridemia (≥ 150 mg/dL), hypercholesterolemia (≥ 200 mg/dL), high LDL-C (≥ 130 mg/dL), and low HDL-C (< 50 mg/dL in women, < 40 mg/dL in men), or self-reported use of lipid-lowering medications. Mixed dyslipidemia was characterized as the coexistence of high LDL-C with at least one of the hypertriglyceridemia and low HDL-C. The prevalence of each lipid abnormality was determined by each population strata, and the determinants of abnormal lipid levels were identified using a multiple logistic regression model. The prevalence was 39.7% for hypertriglyceridemia, 21.2% for hypercholesterolemia, 16.4% for high LDL-C, 68.4% for low HDL-C, and 81.0% for dyslipidemia. Hypercholesterolemia and low HDL-C were more prevalent in women, and hypertriglyceridemia was more prevalent in men. The prevalence of dyslipidemia was higher in women (OR = 1.8), obese (OR = 2.8) and overweight (OR = 2.3) persons, those residents in urban areas (OR = 1.1), those with inappropriate physical activity (OR = 1.2), patients with diabetes (OR = 2.7) and hypertension (OR = 1.9), and participants with a history (OR = 1.6) or familial history of CVDs (OR = 1.2). Mixed dyslipidemia prevalence was 13.6% in women and 11.4% in men (P < 0.05). The prevalence of lipid abnormalities was highly heterogeneous among provinces, and East Azarbaijan with 85.3% (81.5-89.1) and Golestan with 68.5% (64.8-72.2) had the highest and lowest prevalence of dyslipidemia, respectively. Although the prevalence of high cholesterol and LDL-C had a descending trend in the 2016-2021 period, the prevalence of dyslipidemia remained unchanged. There are modifiable risk factors associated with dyslipidemia that can be targeted by the primary healthcare system. To modify these risk factors and promote metabolic health in the country, action plans should come to action through a multi-sectoral and collaborative approach.
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Affiliation(s)
- Javad Khanali
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Seyedeh Melika Hashemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Amirali Hajebi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Shahabeddin Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Maryam Nasserinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
- Center for Life Course Health ResearchFaculty of Medicine, University of Oulu, Oulu, Finland
| | - Elham Abdolhamidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, 1411713137, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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17
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Ghasemi J, Safizadeh M, Khajeh Z, Nakhaee N. Immediate Antecedents of Intentions for Having Children in Southeast Iranian Women. Korean J Fam Med 2023; 44:289-294. [PMID: 37599004 PMCID: PMC10522470 DOI: 10.4082/kjfm.23.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Over the last decade, Iran has experienced a declining birth trend. Identifying the proximate determinants of fertility intentions among married women is informative for population studies. This study aimed to examine the importance of three immediate antecedents of fertility intention. METHODS We invited 1,100 married women to complete a well-validated questionnaire based on the theory of planned behavior (TPB). The sampling framework consisted of visitors attending hospitals in two cities in southeastern Iran. Intention for having children was measured using the item "Do you intend to have a/another child during the next 3 years?" Attitude, subjective norms, and perceived behavioral control were measured using eight, three, and three items, respectively. Structural equation modeling was used to specify the model and to test the predictive ability of the TPB constructs. RESULTS The response rate was 90.7% (N=998), and the mean±standard deviation age of the respondents was 34.8±7.4 years. More than 50% of the respondents reported intending to have a child in the next 3 years. All three TPB model constructs showed significant associations with fertility intentions. The standardized beta coefficients for attitudes, subjective norms, and perceived behavioral control were 0.74, 0.41, and 0.55, respectively. CONCLUSION The TPB model showed that psychological mechanisms play an important role in predicting the childbearing intentions of married women in Iran. Of the three TPB constructs, attitude was the strongest predictor of the intention to have a child.
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Affiliation(s)
- Javad Ghasemi
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansoureh Safizadeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Khajeh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nouzar Nakhaee
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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18
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Ebrahimi H, Masinaei M, Aminorroaya A, Aryan Z, Mehdipour P, Rostam-Abadi Y, Ahmadi N, Saeedi Moghaddam S, Pishgar F, Ghanbari A, Rezaei N, Takian A, Farzadfar F. Risk of incident cardiovascular diseases at national and subnational levels in Iran from 2000 to 2016 and projection through 2030: Insights from Iran STEPS surveys. PLoS One 2023; 18:e0290006. [PMID: 37611004 PMCID: PMC10446220 DOI: 10.1371/journal.pone.0290006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Cardiovascular Disease (CVD) is the leading cause of death in developing countries. CVD risk stratification guides the health policy to make evidence-based decisions. AIM To provide current picture and future trend of CVD risk in the adult Iranian population. METHODS Nationally representative datasets of 2005, 2006, 2007, 2008, 2009, 2011, and 2016 STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) studies were used to generate the 10-year and 30-year risks of CVD based on Framingham, Globorisk, and World Health Organization (WHO) risk estimation models. Trend of CVD risk was calculated from 2000 until 2016 and projected to 2030. RESULTS In 2016, based on Framingham model, 14.0% of the Iranian, aged 30 to 74, were at great risk (≥20%) of CVD in the next 10 years (8.0% among females, 20.7% among males). Among those aged 25 to 59, 12.7% had ≥45% risk of CVD in the coming 30 years (9.2% among females, 16.6 among males). In 2016, CVD risk was higher among urban area inhabitants. Age-standardized Framingham 10-year CVD risk will increase 32.2% and 19%, from 2000 to 2030, in females and males, respectively. Eastern provinces had the lowest and northern provinces had the greatest risk. CONCLUSIONS This study projected that CVD risk has increased from 2000 to 2016 in Iran. Without further risk factor modification, this trend will continue until 2030. We have identified populations at higher risks of CVD to guide future intervention.
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Affiliation(s)
- Hedyeh Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Aryan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Parinaz Mehdipour
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Farhad Pishgar
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States of America
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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19
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Azadnajafabad S, Ahmadi N, Rezaei N, Rashidi MM, Saeedi Moghaddam S, Mohammadi E, Abbasi-Kangevari M, Naderian M, Ghasemi E, Farzi Y, Kazemi A, Dilmaghani-Marand A, Yoosefi M, Rezaei S, Nasserinejad M, Fattahi N, Rezaei N, Haghshenas R, Foroutan Mehr E, Koolaji S, Razi F, Djalalinia S, Larijani B, Farzadfar F. Evaluation of the diabetes care cascade and compliance with WHO global coverage targets in Iran based on STEPS survey 2021. Sci Rep 2023; 13:13528. [PMID: 37598214 PMCID: PMC10439917 DOI: 10.1038/s41598-023-39433-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023] Open
Abstract
This study aimed to investigate the diabetes mellitus (DM) and prediabetes epidemiology, care cascade, and compliance with global coverage targets. We recruited the results of the nationally representative Iran STEPS Survey 2021. Diabetes and prediabetes were two main outcomes. Diabetes awareness, treatment coverage, and glycemic control were calculated for all population with diabetes to investigate the care cascade. Four global coverage targets for diabetes developed by the World Health Organization were adopted to assess the DM diagnosis and control status. Among 18,119 participants, the national prevalence of DM and prediabetes were 14.2% (95% confidence interval 13.4-14.9) and 24.8% (23.9-25.7), respectively. The prevalence of DM treatment coverage was 65.0% (62.4-67.7), while the prevalence of good (HbA1C < 7%) glycemic control was 28.0% (25.0-31.0) among all individuals with diabetes. DM diagnosis and statin use statics were close to global targets (73.3% vs 80%, and 50.1% vs 60%); however, good glycemic control and strict blood pressure control statistics, were much way behind the goals (36.7% vs 80%, and 28.5% vs 80%). A major proportion of the Iranian population are affected by DM and prediabetes, and glycemic control is poorly achieved, indicating a sub-optimal care for diabetes and comorbidities like hypertension.
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Affiliation(s)
- Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shahabeddin Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Human Nutrition Program, Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Maryam Nasserinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Foroutan Mehr
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Koolaji
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Razi
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran.
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20
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Rezaei Z, Lotfi F, Bayati M, Kavosi Z. The effect of Covid-19 pandemic on healthcare utilization in public vs private centers in Iran: a multiple group interrupted time-series analysis. BMC Health Serv Res 2023; 23:822. [PMID: 37528374 PMCID: PMC10394764 DOI: 10.1186/s12913-023-09846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The outbreak of Coronavirus in late 2019 and its continuation in the following years has affected all human societies, government organizations, and health systems. Access to health services is an important issue during crises. The present study aimed to investigate the effect of the Covid-19 pandemic on the consumption of health services in the public sector compared to the private sector in Iran. METHODS The research population consisted of all insured individuals covered by Iran Health Insurance Organization in Fars province, which amounts to approximately 2,700,000 people. The required information including the utilization of laboratory, radiology, medicine, and hospitalization services was extracted on a monthly basis from February 2019 to February 2021. The Multiple Group Interrupted Time Series Analysis (MGITSA) was used for data analysis along with STATA.15 software. RESULTS According to the findings of MGITSA, in the short-term, the utilization of private laboratory, radiology, medication, and hospital admissions had decreased by approximately 18,066, 8210, 135,445, and 1086 times, respectively (P < 0.05). In the long-run, the use of laboratory and radiology services had increased by about 2312 and 514 times (P < 0.05), respectively. The comparison between the public and private sectors showed that in the short-term, the use of radiology services decreased by about 12,525, while the use of medication increased by about 91,471 times (P < 0.05). In the long-run, the use of laboratory services decreased by about 1514 times (P = 0.076) and no change was observed in the other services utilization (in public relative to private centers). CONCLUSIONS Utilization of health services in the public versus private centers, except for medication and hospitalization, significantly decreased in the short-term. However the utilization of most services returned to the usual trend in the long-term. The reduction in access to health services could impose a significant burden of various diseases, at least in the short-term, and increase health costs in the coming years.
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Affiliation(s)
- Zohreh Rezaei
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farhad Lotfi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Ave, Shiraz, 71336-54361, Iran
| | - Mohsen Bayati
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Ave, Shiraz, 71336-54361, Iran.
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Almas Building, Alley 29, Qasrodasht Ave, Shiraz, 71336-54361, Iran
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21
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Rafiemanesh H, Shadloo B, Amin-Esmaeili M, Rahimi Y, Gholami J, Rahimi-Movaghar A. Prevalence of Tuberculosis among People Who Use Drugs in Iran: A Systematic Review and Meta-analysis. ADDICTION & HEALTH 2023; 15:219-227. [PMID: 38026719 PMCID: PMC10658100 DOI: 10.34172/ahj.2023.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/28/2023] [Indexed: 12/01/2023]
Abstract
Background Drug use, especially injecting drug use, is associated with a higher risk of tuberculosis (TB). This study aimed to systematically review the prevalence of TB among people who use drugs (PWUD) in Iran. Methods A systematic search was conducted in international and national databases. All studies that provided data on the prevalence of TB among PWUD based on screening tests and diagnosis from 1990 up to August 2019 were assessed. Meta-analysis was performed on the prevalence of active TB among people who inject drugs (PWID). Findings Overall, nine studies were included. The studies were carried out from 1994 to 2012 in seven out of the 31 provinces of Iran. Seven studies provided data on the prevalence of TB diagnosis among 1087 PWID. The pooled prevalence of TB diagnosis was 10.1% (95% CI: 4.5, 15.8) in studies carried out in hospitals and 0.54% (95% CI: 0.04, 1.04) in other settings. Conclusion The present review suggests an approximately 40 times higher prevalence of TB among PWID compared to the general population. However, most of the included studies were conducted on a subpopulation of drug users, and caution should be exercised when generalizing the findings.
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Affiliation(s)
- Hosein Rafiemanesh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran
| | - Behrang Shadloo
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Yekta Rahimi
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
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22
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Ghamari SH, Mohebi F, Abbasi-Kangevari M, Peiman S, Rahimi B, Ahmadi N, Farzi Y, Seyfi S, Shahbal N, Modirian M, Azmin M, Zokaei H, Khezrian M, Sherafat R, Malekpour MR, Roshani S, Rezaei N, Fallahi MJ, Shoushtari MH, Akbaripour Z, Khatibzadeh S, Shahraz S. Patient experience with chronic obstructive pulmonary disease: a nationally representative demonstration study on quality and cost of healthcare services. Front Public Health 2023; 11:1112072. [PMID: 37397720 PMCID: PMC10308222 DOI: 10.3389/fpubh.2023.1112072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Due to insufficient data on patient experience with healthcare system among patients with chronic obstructive pulmonary disease (COPD), particularly in developing countries, this study attempted to investigate the journey of patients with COPD in the healthcare system using nationally representative data in Iran. Methods This nationally representative demonstration study was conducted from 2016 to 2018 using a novel machine-learning based sampling method based on different districts' healthcare structures and outcome data. Pulmonologists confirmed eligible participants and nurses recruited and followed them up for 3 months/in 4 visits. Utilization of various healthcare services, direct and indirect costs (including non-health, absenteeism, loss of productivity, and time waste), and quality of healthcare services (using quality indicators) were assessed. Results This study constituted of a final sample of 235 patients with COPD, among whom 154 (65.5%) were male. Pharmacy and outpatient services were mostly utilized healthcare services, however, participants utilized outpatient services less than four times a year. The annual average direct cost of a patient with COPD was 1,605.5 USDs. Some 855, 359, 2,680, and 933 USDs were imposed annually on patients with COPD due to non-medical costs, absenteeism, loss of productivity, and time waste, respectively. Based on the quality indicators assessed during the study, the focus of healthcare providers has been the management of the acute phases of COPD as the blood oxygen levels of more than 80% of participants were documented by pulse oximetry devices. However, chronic phase management was mainly missed as less than a third of participants were referred to smoking and tobacco quit centers and got vaccinated. In addition, less than 10% of participants were considered for rehabilitation services, and only 2% completed four-session rehabilitation services. Conclusion COPD services have focused on inpatient care, where patients experience exacerbation of the condition. Upon discharge, patients do not receive appropriate follow-up services targeting on preventive care for optimal controlling of pulmonary function and preventing exacerbation.
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Affiliation(s)
- Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnam Mohebi
- Haas School of Business, University of California, Berkeley, CA, United States
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Peiman
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Besharat Rahimi
- Department of Internal Medicine, AdventHealth Orlando Hospital, Orlando, FL, United States
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahedeh Seyfi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Shahbal
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modirian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Azmin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Zokaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khezrian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sherafat
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Fallahi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Haddadzadeh Shoushtari
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Akbaripour
- Razi University Hospital, Guilan University of Medical Sciences, Guilan, Iran
| | - Shahab Khatibzadeh
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Saeid Shahraz
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, MA, United States
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23
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Izadi R, Bahrami MA, Sarikhani Y, Bastani P. Qualitative document analysis on Iranian contents and trends of population policies: Lessons learned and avenues for future. Heliyon 2023; 9:e17377. [PMID: 37408904 PMCID: PMC10319230 DOI: 10.1016/j.heliyon.2023.e17377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
Population-related policies are among macro-strategic policies considered by all governments in the world. To achieve the desired population structure, it is first necessary to identify the general policy approach over time. This article aims to identify the main requirements of population policies during the last 70 years in Iran. This is a qualitative content analysis study conducted via the analysis of all relevant national policy documents from 1951 to 2022. To retrieve the relevant documents, we searched the official website of eight policymaking bodies in Iran. After identifying the documents, their eligibility was evaluated using Scott's method, and as a result, 40 documents were selected for analysis. Finally, we used a qualitative content analysis to synthesize the data using MAXQDA version 10. The findings showed that the political requirements for population reduction can be classified into four main themes of "Religious, scientific, and legal infrastructure", "Changes in the rules", "Institution building, programming and division of tasks", and "Information and service provision", with 11 sub-themes. Furthermore, the political requirements for an increasing population can be divided into six main themes of "Education & acculturation", "Legal dos, and don'ts", "Financial and non-financial support for families", "Structural and information infrastructure", "Health services", and "Stewardship", with 30 sub-themes. In this study, by an all-round look, and the analysis of policies of the last 70 years of Iran, it was determined how the population policies originate from the political-cultural background of society, and provide the ground for the changes in the cultural-social, political, and economic structures and as a result demographic change. In other words, the main requirements to formulate the population increase and decrease policies in Iran as a country with golden experiences to implement the population policies were shown; which can be helpful as a guide to formulate the population policies in Iran and provide a model for successful policy making in the countries with a similar background to Iran.
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Affiliation(s)
- Reyhane Izadi
- Department of Health Care Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Amin Bahrami
- Health Human Resources Research Center, Department of Health Service Management and Health Economics, School of Health Management and Information Sciences, India
| | - Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Peivand Bastani
- College of Health and Human Sciences, Charles Darwin University, Alice Springs, NT 0870, Australia
- Faculty of Health and Behavioral Sciences, School of Dentistry, University of Queensland, Brisbane, QLD, 4072, Australia
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Nikpour S, Atlasi R, Sanjari M, Aalaa M, Heshmat R, Mafinejad MK, Larijani B, Mehrdad N. Extracting virtual modules of diabetes courses for training primary health care professionals: a scoping review. J Diabetes Metab Disord 2023; 22:73-81. [PMID: 37255842 PMCID: PMC10225411 DOI: 10.1007/s40200-023-01184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/05/2023] [Indexed: 06/01/2023]
Abstract
Purpose There is plenty of evidence on the interventions that can improve outcomes of diabetes. Thus, there is an urgent need to innovate and provide cost-effective ways to optimize the best care for diabetes. The aim was to examine the components of diabetes courses to extract training virtual modules for training primary health care professionals (PHCPs) (i.e. general practitioners, nurses and nutritionists). Methods In this scoping review, a systematic approach based on the Arksey and O'Malley method was used. In order to develop the modules for diabetes courses, search strategy was developed using main keywords. Also, databases including PubMed, Web of Science, Scopus, CINAHL, ERIC and Embase, and Google search engine were searched up to April 10th 2021. Two researchers independently screened the retrieved courses. After removing duplicates, and according to the eligibility criteria, the components of each retrieved course were extracted. Results Diabetes training courses have been selected to examine their components to extract training modules. Initially, we found 120 courses related to the training of PHCPs. All information about 44 courses were available online. The researchers reviewed the courses according to tool approved by panel of experts, inclusion criteria, and purpose of the study. Thus, we first extracted 23 eligible programs and 15 final programs were considered for extracting the modules. According to the tool developed by the panel of experts, we extracted 9 virtual modules for diabetes courses including principles, prevention or delay, management, complications, education, special conditions, information technology, referral system of diabetes for training PHCPs. Conclusion Education is an important part of diabetes and needs of PHCPs should be addressed in educational programs in the future. The design of the diabetes training course based on extracted modules in this research for the training of PHCPs can help in this field.
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Affiliation(s)
- Soghra Nikpour
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasha Atlasi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of medical Sciences, Tehran, Iran
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ramin Heshmat
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Khabaz Mafinejad
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, NO 10, Jalal-AL-Ahmad St., Chamran HWY, P.O. Box:14117-13137, Tehran, Iran
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Djalalinia S, Azadnajafabad S, Rezaei N, Malekpour MR, Ghasemi E, Yoosefi M, Naderimagham S, Ghamari A, Haghshenas R, Farzi Y, Moghaddam SS, Rezaei N, Farzadfar F. The first nationally and sub-nationally representative non-communicable diseases cohort study in Iran: Iran Cohort Study (ICS) protocol. J Diabetes Metab Disord 2023; 22:913-920. [PMID: 37255781 PMCID: PMC10225386 DOI: 10.1007/s40200-022-01143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 09/09/2022] [Indexed: 06/01/2023]
Abstract
Purpose Non-communicable diseases (NCDs) have become a global health priority with a great need for prompt evidence-based preventing and managing interventions. Here, we describe the development of a comprehensive cohort study that provides the most accurate results for NCDs' risk factors, named the Iran Cohort Study (ICS) to estimate the effect size of the risk factors associated with major NCDs. Methods This cohort is an observational prospective study, which its baseline data was gathered through the Iran STEPwise Approach to NCD Risk Factor Surveillance (STEPs) survey in 2016. Following the STROBE criteria, the protocols for investigation of several areas were developed. The follow-up phase began through telephone calls to estimate the effect size of socio-demographic, behavioral, and metabolic risk factors on the incidence of or death due to major NCDs during the three years of study period. Delinerables The main deliverables of ICS are planned to be as following; a comprehensive bank of primary data and follow-up data, national and subnational reports on estimation of the effect size of various risk factors, and a policy brief on the policy options and recommendations for promotion of ongoing programs and designing new interventions. Also, the collected data on the individuals' health status will be sent to the participants as an electronic health record. Conclusion The present study is the first comprehensive national and sub-national representative cohort study on NCDs' risk factors in Iranian adults. The results could be used for promotion of health planning and also future complementary studies and programs.
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Affiliation(s)
- Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Shohreh Naderimagham
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713136 Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Moradi S, Parsaei A, Saeedi Moghaddam S, Aryannejad A, Azadnajafabad S, Rezaei N, Mashinchi B, Esfahani Z, Shobeiri P, Rezaei N, Naghavi M, Larijani B, Farzadfar F. Metabolic risk factors attributed burden in Iran at national and subnational levels, 1990 to 2019. Front Public Health 2023; 11:1149719. [PMID: 37325329 PMCID: PMC10268245 DOI: 10.3389/fpubh.2023.1149719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/28/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Metabolic risk factors (MRFs) predispose populations to a variety of chronic diseases with a huge burden globally. With the increasing burden of these risk factors in Iran, in this study, we aimed to report the estimated burden attributed to MRFs at national and subnational scales in Iran, from 1990 to 2019. Methods Based on the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, data of deaths and disability-adjusted life years (DALYs) attributable to four top MRFs in Iran including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body mass index (BMI), and high low-density lipoprotein (LDL) for the 1990-2019 period, were extracted. The socio-demographic index (SDI) was used to report the data based on the corresponding socio-economic stratifications. The results were reported in national and subnational 31 provinces of Iran to discover disparities regarding the attributable burden to MRFs. Furthermore, we reported the causes of diseases to which the attributable burden to MRFs was related. Results Overall, the age-standardized high LDL, high SBP, high BMI, and high FPG-attributed death rate changed by -45.1, -35.6, +2.8, and +19.9% from 1990 to 2019, respectively. High SBP was the leading risk factor regarding attributed age-standardized death rates reaching 157.8 (95% uncertainty interval: 135.3-179.1) and DALY rates reaching 2973.4 (2652.2-3280.2) per 100,000 person-years, in 2019. All rates increased with aging, and men had higher rates except for the +70 years age group. At the subnational level, provinces in the middle SDI quintile had the highest death and DALY rates regarding all four MRFs. Total deaths, DALYs, YLLs and YLDs number by the causes of diseases linked to MRFs increased over the study period. Cardiovascular diseases, diabetes mellitus, and kidney diseases were the main causes of burden of disease attributable to MRFs. Conclusion Herein, we found divergent patterns regarding the burden of MRFs as well as disparities in different regions, sex, and age groups for each risk factor and related causes. This could provide policymakers with a clearer vision toward more appropriate decision-making and resource allocation to prevent the burden of MRFs in Iran.
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Affiliation(s)
- Soroush Moradi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Parsaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Armin Aryannejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Baharnaz Mashinchi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Hosseini Nami A, Kabiri M, Zafarghandi Motlagh F, Shirzadeh T, Fakhari N, Karimi A, Bagherian H, Jamali M, Younesikhah S, Shadman S, Zeinali R, Zeinali S. Genetic attributes of Iranian cystic fibrosis patients: the diagnostic efficiency of CFTR mutations in over a decade. Front Genet 2023; 14:1140034. [PMID: 37274793 PMCID: PMC10234504 DOI: 10.3389/fgene.2023.1140034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/10/2023] [Indexed: 06/07/2023] Open
Abstract
Objectives: Cystic fibrosis (CF) is the most prevalent autosomal recessive disorder among Caucasians. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause this pathology. We, therefore, aimed to describe the CFTR mutations and their geographical distribution in Iran. Method: The mutation spectrum for 87 families from all Iranian ethnicities was collected using ARMS PCR, Sanger sequencing, and MLPA. Results: Mutations were identified in 95.8% of cases. This dataset revealed that the most frequent mutations in the Iranian population were F508del, c.1000C>T, c.1397C>G, c.1911delG, and c.1393-1G>A. In addition, we found weak evidence for Turkey being the possible geographical pathway for introducing CFTR mutations into Iran by mapping the frequency of CFTR mutations. Conclusion: Our descriptive results will facilitate the genetic detection and prenatal diagnosis of cystic fibrosis within the Iranian population.
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Affiliation(s)
- Amin Hosseini Nami
- Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
| | - Mahboubeh Kabiri
- Department of Biotechnology, College of Science, University of Tehran, Tehran, Iran
| | | | - Tina Shirzadeh
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
| | - Negar Fakhari
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
| | - Ali Karimi
- Max Planck Institute for Brain Research, Frankfurt am Main, Germany
| | - Hamideh Bagherian
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
| | - Mojdeh Jamali
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
| | - Shahrzad Younesikhah
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
| | - Sara Shadman
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
| | - Razie Zeinali
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
- Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Sirous Zeinali
- Dr. Zeinali’s Medical Genetics Laboratory, Kawsar Human Genetics Research Center, Tehran, Iran
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Aryannejad A, Saeedi Moghaddam S, Mashinchi B, Tabary M, Rezaei N, Shahin S, Rezaei N, Naghavi M, Larijani B, Farzadfar F. National and subnational burden of female and male breast cancer and risk factors in Iran from 1990 to 2019: results from the Global Burden of Disease study 2019. Breast Cancer Res 2023; 25:47. [PMID: 37101247 PMCID: PMC10131337 DOI: 10.1186/s13058-023-01633-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 03/06/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is one of the most burdensome cancers worldwide. Despite advancements in diagnostic and treatment modalities, developing countries are still dealing with increasing burdens and existing disparities. This study provides estimates of BC burden and associated risk factors in Iran at the national and subnational levels over 30 years (1990-2019). METHODS Data on BC burden for Iran were retrieved from the Global Burden of Disease (GBD) study from 1990 to 2019. GBD estimation methods were applied to explore BC incidence, prevalence, deaths, disability-adjusted life years (DALYs), and attributable burden to risk factors based on the GBD risk factors hierarchy. Moreover, decomposition analysis was performed to find the contribution of population growth, aging, and cause-specific incidence in the total incidence change. Age-standardized rates (per 100,000 population) and 95% uncertainty intervals (UI) were reported based on sex, age, and socio-demographic index (SDI). RESULTS Age-standardized incidence rate (ASIR) increased from 18.8 (95% UI 15.3-24.1)/100,000 in 2019 to 34.0 (30.7-37.9)/100,000 in 2019 among females and from 0.2/100,000 (0.2-0.3) to 0.3/100,000 (0.3-0.4) among males. Age-standardized deaths rate (ASDR) increased slightly among females from 10.3 (8.2-13.6)/100,000 in 1990 to 11.9 (10.8-13.1)/100,000 in 2019 and remained almost the same among males-0.2/100,000 (0.1-0.2). Age-standardized DALYs rate also increased from 320.2 (265.4-405.4) to 368.7 (336.7-404.3) among females but decreased slightly in males from 4.5 (3.5-5.8) to 4.0 (3.5-4.5). Of the 417.6% increase in total incident cases from 1990-2019, 240.7% was related to cause-specific incidence. In both genders, the BC burden increased by age, including age groups under 50 before routine screening programs, and by SDI levels; the high and high-middle SDI regions had the highest BC burden in Iran. Based on the GBD risk factors hierarchy, high fasting plasma glucose (FPG) and alcohol were estimated to have the most and the least attributed DALYs for BC among females, respectively. CONCLUSIONS BC burden increased from 1990 to 2019 in both genders, and considerable discrepancies were found among different provinces and SDI quintiles in Iran. These increasing trends appeared to be associated with social and economic developments and changes in demographic factors. Improvements in registry systems and diagnostic capacities were also probably responsible for these growing trends. Raising general awareness and improving screening programs, early detection measures, and equitable access to healthcare systems might be the initial steps to tackle the increasing trends.
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Affiliation(s)
- Armin Aryannejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran
| | - Baharnaz Mashinchi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran
| | - Mohammadreza Tabary
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Shahin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Second Floor, No.10, Jalal Al-E-Ahmad Highway, Tehran, 1411713137, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Behzadifar M, Behzadifar M, Saran M, Shahabi S, Bakhtiari A, Azari S, Bragazzi NL. The role of Iran's context for the development of health technology assessment: challenges and solutions. HEALTH ECONOMICS REVIEW 2023; 13:23. [PMID: 37079131 PMCID: PMC10116738 DOI: 10.1186/s13561-023-00438-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
Health technology assessment (HTA) is a comprehensive and structured evaluation that aims to analyze the potential impacts of health technologies, including medical devices, diagnostic tools, pharmaceuticals, and public health interventions. Its purpose is to provide policymakers with evidence-based information to inform decisions related to the utilization and implementation of these technologies. HTA allows for the comparison of various scenarios related to a technology across a wide range of factors. This can aid in the creation of an essential drug list and health benefits package that is tailored to the actual needs of the community within a given healthcare system. In the present paper, we review the role of Iran's context for the development of HTA, in terms of challenges and solutions.
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Affiliation(s)
- Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Saran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahad Bakhtiari
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Samad Azari
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Human Nutrition Unit Department of Food and Drugs, University of Parma Medical School, Building C, Via Volturno, 39, 43125 Parma, Italy
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30
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Bahrami M, Jalali A, Ayati A, Shafiee A, Alaedini F, Saadat S, Masoudkabir F, Shahmansouri N, Noorbala A. Epidemiology of mental health disorders in the citizens of Tehran: a report from Tehran Cohort Study. BMC Psychiatry 2023; 23:267. [PMID: 37072723 PMCID: PMC10114335 DOI: 10.1186/s12888-023-04773-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Mental health disorders (MHD) impose a considerable burden on public health systems. With an increasing worldwide trend in urbanization, urban mental health stressors are affecting a larger population. In this study, we evaluated the epidemiology of mental health disorders in the citizens of Tehran using the Tehran Cohort Study (TeCS) data. METHODS We utilized data from the TeCS recruitment phase. A total of 10,247 permanent residents of Tehran metropolitan (aged 15 years and older) were enrolled in the study from March 2016 to 2019 via systematic random sampling from all 22 districts of Tehran. The participant's demographic, socioeconomic, and medical characteristics were evaluated by conducting comprehensive interviews. The standardized Persian version of the General Health Questionnaire version 28 was utilized to assess the mental status of the patients according to four central mental health disorders. RESULTS Almost 37.1% of Tehran residents suffered mental health problems (45.0% of women and 28.0% of men). The greatest incidence of MHDs was seen in the 25-34 and over 75 age groups. The most common mental health disorders were depression (43%) and anxiety (40%), followed by somatization (30%) and social dysfunction (8.1%). Mental health disorders were more frequent in the southeast regions of the city. CONCLUSIONS Tehran residents have a significantly higher rate of mental health disorders compared to nationwide studies, with an estimated 2.7 million citizens requiring mental health care services. Awareness of mental health disorders and identifying vulnerable groups are crucial in developing mental health care programs by public health authorities.
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Affiliation(s)
- Mahboobe Bahrami
- Department of Psychiatry, Behavioral Sciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Alaedini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Saadat
- Department of Emergency Medicine, University of California, Irvine, CA, USA
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Shahmansouri
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, 1419733141, Iran.
| | - Ahmadali Noorbala
- Psychosomatic Medicine Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, 1419733141, Iran
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Sadeghian Tafti MR, Ostovar A, Saeedi Moghaddam S, Shobeiri P, Ehrampoush MH, Salmani I, Khajeaminian MR, Fallahzadeh H, Dehghani Tafti A. Burden of road traffic injuries in Iran: a national and subnational perspective, 1990-2019. Inj Prev 2023; 29:101-110. [PMID: 36564169 PMCID: PMC10086501 DOI: 10.1136/ip-2022-044677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/10/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Reliable and valid information on burden of road traffic injuries (RTIs) is essential for short-term and long-term planning. We designed the present study to describe the levels and trends of burden of RTIs in Iran from 1990 to 2019. METHODS This is an observational epidemiological study. We used the Global Burden of Disease (GBD) 2019 estimates to report RTIs incidence, prevalence, mortality and disability-adjusted life-years (DALYs) by sex, age group and road user category in Iran and each of the 31 provinces from 1990 to 2019. RESULTS Age-standardised incidence, prevalence, death and DALY rates of RTIs decreased by 31.7% (95% uncertainty interval (UI): 29.4 to 33.9), 34.9% (33.8 to 36.0), 57.7% (48.1 to 62.3) and 60.1% (51.7 to 65.2), respectively between 1990 and 2019. The 2019 age-standardised DALY rates varied from smallest value in Tehran 303.8 (216.9 to 667.2) per 100 000 to largest value in Sistan-Baluchistan 2286.8 (1978.1 to 2627.9) per 100 000. The burden of RTIs was mainly related to injuries sustained by drivers or passengers of motorised vehicles with three or more wheels and pedestrians' injuries, mostly affected males aged 15-29 years and individuals aged ≥70 years. CONCLUSION The reducing trend in the burden of RTIs in Iran possibly reflects the effectiveness of the intervention programmes. However, with regard to the Sustainable Development Goals the burden is still at an alarming level. Further reductions are necessary for specific road user groups such as adolescent and adult male drivers or passengers of motorised vehicles, also pedestrians aged ≥70 years.
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Affiliation(s)
- Mohammad Reza Sadeghian Tafti
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Ehrampoush
- Department of Environmental Health, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Ibrahim Salmani
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mohammad Reza Khajeaminian
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Hossein Fallahzadeh
- Center for Healthcare Data Modeling, Departments of biostatistics and Epidemiology, School of public health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abbasali Dehghani Tafti
- Department of Health in Disaster and Emergencies, School of public health, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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A 30-year trend of ischemic heart disease burden in a developing country; a systematic analysis of the global burden of disease study 2019 in Iran. Int J Cardiol 2023; 379:127-133. [PMID: 36898585 DOI: 10.1016/j.ijcard.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/01/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Evaluating the burden of ischemic heart disease (IHD) as the first cause of mortality worldwide is necessary to develop healthcare policies. This study aimed to report the national and subnational IHD burden and risk factors in Iran according to the Global Burden of Disease (GBD) study 2019. METHODS We extracted, processed, and presented the results of the GBD 2019 study regarding incidence, prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and attributable burden to risk factors of IHD in Iran during 1990-2019. RESULTS Age-standardized death and DALY rates decreased by 42.7% (95% uncertainty interval, 38.1-47.9) and 47.7% (43.6-52.9) during 1990-2019, slower since 2011 and reached 163.6 deaths (149.0-176.2), 2842.7 DALYs (2657.0-3103.1) per 100,000 persons in 2019. Meanwhile, with a lower reduction of 7.7% (6.0-9.5), the incidence rate reached 829.1 new cases (719.9-945.2) per 100,000 persons in 2019. High systolic blood pressure and elevated low-density lipoprotein cholesterol (LDL-C) contributed to the highest deaths, and DALYs age-standardized rates in 1990 and 2019. They followed by high fasting plasma glucose (FPG), and high body-mass index (BMI) with an upward trend of contribution from 1990 to 2019. A convergence pattern in the provincial death age-standardized rate was observed, with the lowest rate in Iran's capital city; 84.7 deaths per 100,000 (70.6-99.4) in 2019. CONCLUSION The incidence rate reduced remarkably lower than the mortality rate, which necessitates promoting primary prevention strategies. Also, interventions should be adopted to control growing risk factors like high FPG, and high BMI.
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33
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Malekzadeh R. Iran Quality of Care in Medicine Program, a Gateway to Collecting Healthcare Data in the Absence of Nationwide Digitized Health Information. ARCHIVES OF IRANIAN MEDICINE 2023; 26:124-125. [PMID: 37543934 PMCID: PMC10685725 DOI: 10.34172/aim.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Reza Malekzadeh
- Professor of Medicine Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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34
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Shadnoush M, Latifi M, Rahban H, Pourhosein E, Shadnoush A, Jafarian A, Dehghani S. Trends in organ donation and transplantation over the past eighteen years in Iran. Clin Transplant 2023; 37:e14889. [PMID: 36545788 DOI: 10.1111/ctr.14889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND This article will review the trends in organ donation over the past 18 years in Iran. MATERIAL AND METHODS All donation and transplantation statistics were extracted by reviewing the Organ Procurement and Transplantation database of the Ministry of Health of Iran from 2002 to 2019. RESULTS Iran's national deceased donation rate from 2002 to 2019 increased 19.06-fold from .75 to 14.3 per million population (PMP). After the beginning of the COVID-19 pandemic, the rate of organ donation in Iran decreased significantly. Although 1 year after the onset of the pandemic, due to the widespread adoption of COVID19 vaccination, the rate of organ donation began to increase again, this system is still under performing. During the years under examination, the rate of deceased kidney donation increased significantly compared to living kidney donation and reached up to 2001 kidney transplantations in 2021. From 2002 to 2019, the rate of liver transplants increased to 12.8. Likewise, the rate of heart transplants increased 8.4-fold, from 15 to 126 cases during the same time. CONCLUSSION Although a personal choice, the process of organ donation involves medical, legal, ethical, organizational, and social aspects. The trend in increasing donation rates over the past years can be attributed to multiple influences, which include rigorous team efforts in the organ donation and transplantation systems, in addition to creating a donation culture and promoting donation through media platforms. Moreover, we can say that the rising rates of deceased donor transplantation also can drive down rates of commercial living donor transplantation.
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Affiliation(s)
- Mahdi Shadnoush
- Faculty of Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Latifi
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Beverly Hills, California, USA.,Southern California Medical Education Consortium, Temecula Valley Hospital, Universal Health System, Temecula, California, USA
| | - Elahe Pourhosein
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shadnoush
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arefeh Jafarian
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Dehghani
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Tehran, Iran
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35
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Karbassi Yazdi A, Muneeb FM, Wanke PF, Hanne T, Ali A. How, When, & Where temporary hospitals fit in turbulent times: A hybrid MADM optimization in the middle east. COMPUTERS & INDUSTRIAL ENGINEERING 2023; 175:108761. [PMID: 36466770 PMCID: PMC9707025 DOI: 10.1016/j.cie.2022.108761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Governments have been challenged to provide temporary hospitals and other types of facilities to face the COVID-19 pandemic. This research proposes a novel multi-attribute decision-making (MADM) model to help determine how, when, and where these temporary facilities should be installed based on a set of critical success factors (CSFs) mapped in an uncertain environment. We portray the available facilities for temporary hospitals based on the CSFs that must be considered to make critical decisions regarding the optimal position based on the government's strategic decision-making process, thus indirectly providing better services and maximizing resources. In relation to earlier work, this research builds upon hybrid Pythagorean fuzzy numbers to find weights in Best-Worst Methods and rank temporary facilities based on evaluation by an area-based method for ranking. Policy implications and future directions are derived.
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Affiliation(s)
- Amir Karbassi Yazdi
- School of Engineering, Universidad Católica del Norte, Larrondo 1281, 1781421, Coquimbo, Chile
| | | | - Peter Fernandes Wanke
- Center for Logistics Studies, COPPEAD - The Graduate School of Business Administration Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thomas Hanne
- Institute for Information Systems, University of Applied Sciences and Arts Northwestern Switzerland, Switzerland
| | - Adnan Ali
- School of Management, Xi'an Jiaotong University, Shaanxi, Xi'an, PR China
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36
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Faridi S, Krzyzanowski M, Cohen AJ, Malkawi M, Moh'd Safi HA, Yousefian F, Azimi F, Naddafi K, Momeniha F, Niazi S, Amini H, Künzli N, Shamsipour M, Mokammel A, Roostaei V, Hassanvand MS. Ambient Air Quality Standards and Policies in Eastern Mediterranean Countries: A Review. Int J Public Health 2023; 68:1605352. [PMID: 36891223 PMCID: PMC9986936 DOI: 10.3389/ijph.2023.1605352] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023] Open
Abstract
Objectives: National ambient air quality standards (NAAQS) are critical tools for controlling air pollution and protecting public health. We designed this study to 1) gather the NAAQS for six classical air pollutants: PM2.5, PM10, O3, NO2, SO2, and CO in the Eastern Mediterranean Region (EMR) countries, 2) compare those with the updated World Health Organizations Air Quality Guidelines (WHO AQGs 2021), 3) estimate the potential health benefits of achieving annual PM2.5 NAAQS and WHO AQGs per country, and 4) gather the information on air quality policies and action plans in the EMR countries. Methods: To gather information on the NAAQS, we searched several bibliographic databases, hand-searched the relevant papers and reports, and analysed unpublished data on NAAQS in the EMR countries reported from these countries to the WHO/Regional office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE). To estimate the potential health benefits of reaching the NAAQS and AQG levels for PM2.5, we used the average of ambient PM2.5 exposures in the 22 EMR countries in 2019 from the Global Burden of Disease (GBD) dataset and AirQ+ software. Results: Almost all of the EMR countries have national ambient air quality standards for the critical air pollutants except Djibouti, Somalia, and Yemen. However, the current standards for PM2.5 are up to 10 times higher than the current health-based WHO AQGs. The standards for other considered pollutants exceed AQGs as well. We estimated that the reduction of annual mean PM2.5 exposure level to the AQG level (5 μg m-3) would be associated with a decrease of all natural-cause mortality in adults (age 30+) by 16.9%-42.1% in various EMR countries. All countries would even benefit from the achievement of the Interim Target-2 (25 μg m-3) for annual mean PM2.5: it would reduce all-cause mortality by 3%-37.5%. Less than half of the countries in the Region reported having policies relevant to air quality management, in particular addressing pollution related to sand and desert storms (SDS) such as enhancing the implementation of sustainable land management practices, taking measures to prevent and control the main factors of SDS, and developing early warning systems as tools to combat SDS. Few countries conduct studies on the health effects of air pollution or on a contribution of SDS to pollution levels. Information from air quality monitoring is available for 13 out of the 22 EMR countries. Conclusion: Improvement of air quality management, including international collaboration and prioritization of SDS, supported by an update (or establishment) of NAAQSs and enhanced air quality monitoring are essential elements for reduction of air pollution and its health effects in the EMR.
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Affiliation(s)
- Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Michal Krzyzanowski
- Environmental Research Group, School of Public Health, Imperial College London, London, United Kingdom
| | - Aaron J Cohen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States.,Boston University School of Public Health, Boston, MA, United States.,Health Effects Institute, Boston, MA, United States
| | - Mazen Malkawi
- World Health Organization/Regional Office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE), Amman, Jordan
| | - Heba Adel Moh'd Safi
- World Health Organization/Regional Office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE), Amman, Jordan
| | - Fatemeh Yousefian
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Faramarz Azimi
- Environmental Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Momeniha
- Center for Solid Waste Research, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Sadegh Niazi
- International Laboratory for Air Quality and Health, Faculty of Science, School of Earth and Atmospheric Sciences, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Heresh Amini
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Adel Mokammel
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Roostaei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Shahraki-Sanavi F, Woodward M, Ansari-Moghaddam A, Okati-Aliabad H, Mohammadi M, Khorram A, Shabestari S, Poustchi H, Malekzadeh R. Cohort Profile: The Zahedan Adult Cohort Study (ZACS)-a prospective study of non-communicable diseases in Sistani and Baluch populations. Int J Epidemiol 2022; 51:e350-e357. [PMID: 35138365 DOI: 10.1093/ije/dyac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/25/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Department of Epidemiology and Biostatistics, George Institute for Global Health, Imperial College London, London, UK
| | | | - Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahdi Mohammadi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Khorram
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sahar Shabestari
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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38
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Chan DWM, Abdul Hadi Sadeq D, Mohammed Fadhil A, Cristofaro M, Sarvari H. Barriers and solutions in adopting public–private partnerships in road transportation infrastructure projects for developing countries: results of a Delphi survey in Iran. JOURNAL OF FACILITIES MANAGEMENT 2022. [DOI: 10.1108/jfm-01-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Purpose
Sustainable economic growth in both developed and developing countries requires the restructuring and expansion of road transportation infrastructures (RTIs). However, RTIs are always subject to high costs and delays, especially in developing countries with fewer resources than developed ones. Cost overruns and inaccurate forecasts usually lead to project failures. In this regard, some governments in developing countries have adopted public–private partnerships (PPPs) to deliver RTI projects with very positive outcomes. However, academic research has not yet studied the most recurring barriers and associated solutions to adopting PPPs in RTIs particularly for developing countries. This paper aims to fill up this knowledge gap in the existing literature.
Design/methodology/approach
A Delphi survey method involving 103 experts in RTIs based in Iran was implemented. Results indicated that the most perceived barriers to applying PPPs in RTIs in developing countries are linked to political, legal and economic factors. Ten other experts also participated in semistructured interviews, which were thematically analyzed to provide practical effective solutions for overcoming those identified barriers.
Findings
The findings indicated that all the presented barriers achieved above-average scores and could be considered severe obstacles of applying PPPs in RTIs for developing countries. In terms of barriers and solutions reported, these seem to converge on three profound elements: political stability, legal framework and conjoint management.
Originality/value
To the best of the authors’ knowledge, this is the first-ever research study regarding the barriers to adopting PPPs in delivering RTI projects for developing countries. Practical recommendations for overcoming these perceived barriers and achieving better implementation of PPPs in RTIs for developing countries were advocated. This work has contributed to the extant PPP theory as the management of coproduction in delivering RTI projects.
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Behling R, Roessner S, Foerster S, Saemian P, Tourian MJ, Portele TC, Lorenz C. Interrelations of vegetation growth and water scarcity in Iran revealed by satellite time series. Sci Rep 2022; 12:20784. [PMID: 36456635 PMCID: PMC9715656 DOI: 10.1038/s41598-022-24712-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Iran has experienced a drastic increase in water scarcity in the last decades. The main driver has been the substantial unsustainable water consumption of the agricultural sector. This study quantifies the spatiotemporal dynamics of Iran's hydrometeorological water availability, land cover, and vegetation growth and evaluates their interrelations with a special focus on agricultural vegetation developments. It analyzes globally available reanalysis climate data and satellite time series data and products, allowing a country-wide investigation of recent 20+ years at detailed spatial and temporal scales. The results reveal a wide-spread agricultural expansion (27,000 km[Formula: see text]) and a significant cultivation intensification (48,000 km[Formula: see text]). At the same time, we observe a substantial decline in total water storage that is not represented by a decrease of meteorological water input, confirming an unsustainable use of groundwater mainly for agricultural irrigation. As consequence of water scarcity, we identify agricultural areas with a loss or reduction of vegetation growth (10,000 km[Formula: see text]), especially in irrigated agricultural areas under (hyper-)arid conditions. In Iran's natural biomes, the results show declining trends in vegetation growth and land cover degradation from sparse vegetation to barren land in 40,000 km[Formula: see text], mainly along the western plains and foothills of the Zagros Mountains, and at the same time wide-spread greening trends, particularly in regions of higher altitudes. Overall, the findings provide detailed insights in vegetation-related causes and consequences of Iran's anthropogenic drought and can support sustainable management plans for Iran or other semi-arid regions worldwide, often facing similar conditions.
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Affiliation(s)
- Robert Behling
- grid.23731.340000 0000 9195 2461Remote Sensing and Geoinformatics Section, Helmholtz Centre Potsdam GFZ German Research Centre for Geosciences, Potsdam, Germany
| | - Sigrid Roessner
- grid.23731.340000 0000 9195 2461Remote Sensing and Geoinformatics Section, Helmholtz Centre Potsdam GFZ German Research Centre for Geosciences, Potsdam, Germany
| | - Saskia Foerster
- grid.23731.340000 0000 9195 2461Remote Sensing and Geoinformatics Section, Helmholtz Centre Potsdam GFZ German Research Centre for Geosciences, Potsdam, Germany
| | - Peyman Saemian
- grid.5719.a0000 0004 1936 9713Institute of Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Mohammad J. Tourian
- grid.5719.a0000 0004 1936 9713Institute of Geodesy, University of Stuttgart, Stuttgart, Germany
| | - Tanja C. Portele
- grid.7892.40000 0001 0075 5874Karlsruhe Institute of Technology (KIT), Campus Alpin, Institute of Meteorology and Climate Research - Atmospheric Environmental Research (IMK-IFU), Garmisch-Partenkirchen, Germany
| | - Christof Lorenz
- grid.7892.40000 0001 0075 5874Karlsruhe Institute of Technology (KIT), Campus Alpin, Institute of Meteorology and Climate Research - Atmospheric Environmental Research (IMK-IFU), Garmisch-Partenkirchen, Germany
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Baheshmat S, Gholami J, Amin-Esmaeili M, Shadloo B, Rahimi-Movaghar A. Spouse and Child Abuse Associated With Illicit Drug Use in Iran: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2022; 23:1494-1509. [PMID: 33706634 DOI: 10.1177/1524838021998655] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is a high prevalence of substance use disorders, especially among men, in Iran and is associated with a high burden on families. We aimed to systematically review the association between illicit drug use and spouse and child abuse in Iran. METHOD Comprehensive terms were used to search three international databases (ISI, Medline, and Scopus) and a national database of Scientific Information Database up to September 2019. The retrieved citations were screened based on the eligibility criteria and then data were extracted, and the risk of bias was assessed by two independent investigators. Data were analyzed using random-effects model to estimate pooled odds ratios (ORs) and the heterogeneity of studies. RESULTS The search yielded 18 articles that met the inclusion criteria. Illicit substance use in husbands was associated with increased odds of current violence (OR = 3.50; 95% CI [2.09, 5.86]), current physical violence (OR = 5.41; 95% CI [3.50, 8.35]), current psychological violence (OR = 6.20; 95% CI [3.74, 10.30]), and current sexual violence (OR = 7.23; 95% CI [4.06, 12.87]) against spouse. In studies on child abuse, the odds of current physical child abuse by parents who used an illicit substance was 3.88 times (95% CI [1.50, 10.01]) higher than parents who did not use any illicit substance. CONCLUSION The results of the current study showed that illicit substance use is associated with an increased risk of spouse and child abuse. This is an important social and health consequence of drug use and should be addressed in all drug control plans.
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Affiliation(s)
- Shahab Baheshmat
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Amin-Esmaeili
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Behrang Shadloo
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
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Shahabi S, Kiekens C, Etemadi M, Mojgani P, Teymourlouei AA, Lankarani KB. Integrating rehabilitation services into primary health care: policy options for Iran. BMC Health Serv Res 2022; 22:1317. [PMCID: PMC9635163 DOI: 10.1186/s12913-022-08695-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background Providing rehabilitation services in primary health care (PHC) is associated with numerous health, social, and economic benefits. Therefore, low and middle-income countries, such as Iran, should benefit from the advantages of integrating rehabilitation services into PHC. We conducted a qualitative study to determine policy solutions that could facilitate the integration of rehabilitation services into Iran’s PHC network. Methods Semi-structured interviews were conducted with 38 participants, including health policymakers, rehabilitation managers, faculty members, and rehabilitation practitioners. Purposive and snowball sampling strategies were adopted to recruit participants. The WHO Health System building blocks framework analysis was applied to analyze the collected data. Results Participants’ perspectives and experiences outlined potential policy options including: (1) stewardship: increasing political support, strengthening the leadership of the rehabilitation sector, and promoting inter-sectoral collaborations; (2) service delivery: increasing the knowledge of healthcare professionals, using local volunteers, deploying mobile rehabilitation teams, using telerehabilitation, and improving referral pathways; (3) financing: increasing government funding, preparing a package of rehabilitation services, and using appropriate payment mechanisms; (4) human resources: expanding rehabilitation workforce, training rehabilitation assistants, and enhancing employment and social opportunities; (5) information systems: establishing a comprehensive information system and an effective surveillance system; and (6) technologies: facilitating access to a range of rehabilitation equipment and raw materials, especially for prosthetics and orthotics services. Conclusion Based on the WHO six building blocks framework, this study identified several policy options for integrating rehabilitation services into the Iranian PHC Network. Some of the policy options include increasing political support, promoting inter-sectoral collaborations, increasing the skills and knowledge of healthcare workers, establishing effective referral pathways, strengthening team-working, and increasing government funding.
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Affiliation(s)
- Saeed Shahabi
- grid.412571.40000 0000 8819 4698Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Manal Etemadi
- National Center for Health Insurance Research, Tehran, Iran
| | - Parviz Mojgani
- grid.444911.d0000 0004 0619 1231Iran-Helal Institute of Applied Science and Technology, Tehran, Iran ,Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouei
- grid.411746.10000 0004 4911 7066Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- grid.412571.40000 0000 8819 4698Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Pormasoumi H, Rostami D, Jamebozorgi K, Mirshekarpour H, Heshmatnia J. COVID-19 management in Iran and international sanctions. Eur J Transl Myol 2022; 32:10777. [PMID: 36200579 PMCID: PMC9830411 DOI: 10.4081/ejtm.2022.10777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 01/13/2023] Open
Abstract
Iran has one of the highest death rates from COVID-19 among Middle Eastern countries. In addition to having a better disease registration system compared to neighboring countries, many factors including economic conditions, have played an important role in increasing the number of mortality rate. This is while that during the Corona pandemic, Iran has been undergo severe sanctions by the United States, that has faced this country with a severe economic crisis. Considering the role of sanction on the country's health management in our study, we examined Iran's management plans against the Corona pandemic and the effect of sanctions on it. Quarantine and corona restrictions, on the one hand, and international sanctions, on the other hand, have put double pressure on the Iranian government. Although drugs and basic medical equipment are exempted from economic sanctions, direct and indirect effects of the sanctions have limited Iran's banking system and created widespread restrictions in the fields of trade, production, and investment. Fortunately, despite the sanctions, many hospitals had an appropriate performance in line with the health promotion program. It is obvious that economic sanctions have severe and harmful effects on public health and have led to poor health consequences in Iran, but attention to planning, standards and improving the quality of the hospital is an important issue in Corona management. Despite multiple mutations, this virus is likely to face with a more dangerous virus in the world future. Now, it is time to take appropriate management measures to remove these sanctions by relying on international solutions and interactions.
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Affiliation(s)
- Hosien Pormasoumi
- Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Daryoush Rostami
- School of Allied Medical Sciences, Zabol University of Medical Sciences, Zabol, Iran
| | | | - Hosein Mirshekarpour
- Department of Radiology, School of Medicine, Afzalipour Hospital, Kerman University of Medical Sciences Kerman, Iran
| | - Jalal Heshmatnia
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Science, Tehran, Iran. ORCID iD: 0000-0003-2966-4380
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Faridi S, Yousefian F, Roostaei V, Harrison RM, Azimi F, Niazi S, Naddafi K, Momeniha F, Malkawi M, Moh'd Safi HA, Rad MK, Hassanvand MS. Source apportionment, identification and characterization, and emission inventory of ambient particulate matter in 22 Eastern Mediterranean Region countries: A systematic review and recommendations for good practice. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 310:119889. [PMID: 35932896 DOI: 10.1016/j.envpol.2022.119889] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/16/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
Little is known about the main sources of ambient particulate matter (PM) in the 22 Eastern Mediterranean Region (EMR) countries. We designed this study to systematically review all published and unpublished source apportionment (SA), identification and characterization studies as well as emission inventories in the EMR. Of 440 articles identified, 82 (11 emission inventory ones) met our inclusion criteria for final analyses. Of 22 EMR countries, Iran with 30 articles had the highest number of studies on source specific PM followed by Pakistan (n = 15 articles) and Saudi Arabia (n = 8 papers). By contrast, there were no studies in Afghanistan, Bahrain, Djibouti, Libya, Somalia, Sudan, Syria, Tunisia, United Arab Emirates and Yemen. Approximately 72% of studies (51) were published within a span of 2015-2021.48 studies identified the sources of PM2.5 and its constituents. Positive matrix factorization (PMF), principal component analysis (PCA) and chemical mass balance (CMB) were the most common approaches to identify the source contributions of ambient PM. Both secondary aerosols and dust, with 12-51% and 8-80% (33% and 30% for all EMR countries, on average) had the greatest contributions in ambient PM2.5. The remaining sources for ambient PM2.5, including mixed sources (traffic, industry and residential (TIR)), traffic, industries, biomass burning, and sea salt were in the range of approximately 4-69%, 4-49%, 1-53%, 7-25% and 3-29%, respectively. For PM10, the most dominant source was dust with 7-95% (49% for all EMR countries, on average). The limited number of SA studies in the EMR countries (one study per approximately 9.6 million people) in comparison to Europe and North America (1 study per 4.3 and 2.1 million people respectively) can be augmented by future studies that will provide a better understanding of emission sources in the urban environment.
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Affiliation(s)
- Sasan Faridi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Yousefian
- Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Vahid Roostaei
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roy M Harrison
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham, UK; Department of Environmental Sciences, Faculty of Meteorology, Environment and Arid Land Agriculture, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faramarz Azimi
- Environmental Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Sadegh Niazi
- International Laboratory for Air Quality and Health, School of Earth and Atmospheric Sciences, Science and Engineering Faculty, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kazem Naddafi
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Momeniha
- Center for Solid Waste Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mazen Malkawi
- Environmental Health Exposures Centre for Environmental Health Action (CEHA), World Health Organization (WHO), Jordan
| | - Heba Adel Moh'd Safi
- Environmental Health Exposures Centre for Environmental Health Action (CEHA), World Health Organization (WHO), Jordan
| | - Mona Khaleghy Rad
- Environmental Health Exposures Centre for Environmental Health Action (CEHA), World Health Organization (WHO), Jordan
| | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Dietary habits are associated with the prevalence of type 2 diabetes: a study among a middle eastern population. J Nutr Sci 2022; 11:e78. [PMID: 36304825 PMCID: PMC9554423 DOI: 10.1017/jns.2022.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Worldwide type 2 diabetes (T2D) prevalence is increasing dramatically. The present study aimed to evaluate the association between dietary habits and T2D in an Iranian adult population using a cross-sectional analysis of the Shahedieh cohort study. Participants were adults aged 35-70 years (n 9261) from Zarch and Shahedieh, Yazd, Iran, who attended the baseline phase of the Shahedieh cohort study. Dietary habits including meal frequency, fried-food consumption, adding salt to prepared meals and grilled-food consumption were assessed by a standard questionnaire. T2D was defined as fasting plasma glucose (FPG) ≥126 mg/dl according to the American Diabetes Association. Multiple logistic regression assessed the association between dietary habits and T2D. Individuals who consumed a meal more than six times per day compared to three times per day had greater odds for T2D (OR 2⋅503, 95 % CI 1⋅651, 3⋅793). These associations remained significant in a fully adjusted model. There was a significant association between greater intakes of fried foods and prevalence of T2D (OR 1⋅294, 95 % CI 1⋅004, 1⋅668) in the adjusted model. No significant associations were observed between other dietary habits (adding salt to prepared meals and grilled-food consumption) and odds of T2D in all crude and adjusted models. In conclusion, we have highlighted the association between meal and fried-food consumption frequencies with risk of T2D. Large longitudinal studies in different ethnicities are needed to confirm these associations.
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Sepanlou SG, Rezaei Aliabadi H, Malekzadeh R, Naghavi M. Maternal Mortality and Morbidity by Cause in Provinces of Iran, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019. ARCHIVES OF IRANIAN MEDICINE 2022; 25:578-590. [PMID: 37543883 PMCID: PMC10685769 DOI: 10.34172/aim.2022.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 08/07/2023]
Abstract
BACKGROUND Since 1990, maternal mortality ratio (MMR) has significantly decreased in Iran. However, estimates for mortality and morbidity by cause at subnational scale are not available. METHODS This study is part of the Global Burden of Diseases study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 31 provinces of Iran from 1990 to 2019. RESULTS Since 1990, MMR declined from 44.5 (95% UI: 38.6-50.1) to 15.9 (14.7-17.3) per 100000 live births in Iran. In 1990 MMR ranged from 18.5 (11.2-26.4) to 76.9 (38.4-114.7) per 100000 live births across provinces. Respective figures for 2019 were 7.1 (5.2-9.3) to 34.0 (25.1-44.7) per 100000 live births. In 2019, MMR was higher in young women (aged 10 to 14) and older women (aged 45 or more). Percentages of deaths under 25 years was 24.8% in 1990 and 16.0% in 2019. There was remarkable decline in years lost due to premature death (YLL) rates from 1990 to 2019. While the decline was modest for years lived with disability (YLD) rates. Indirect maternal deaths and other maternal deaths ranked first or second in almost all provinces. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic Index (SDI) from 1990 to 2019 in all provinces and an evident convergence across provinces. CONCLUSION MMR has declined to levels much lower than Sustainable Development Goals in all provinces. Although there was a convergence in trends, there are still disparities across provinces. The decline in disabilities caused by maternal disorders is not as significant as mortality, which needs further actions.
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Affiliation(s)
- Sadaf G. Sepanlou
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, USA
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Djalalinia S, Azadnajafabad S, Ghasemi E, Yoosefi M, Rezaei N, Farzi Y, Kazemi A, Ahmadi N, Nasserinejad M, Fattahi N, Rezaei S, Abdolhamidi E, Foroutan Mehr E, Haghshenas R, Rezaei N, Abdi J, Moghisi A, Mahdavihezaveh A, Akbari Sari A, Raeisi A, Jamshidi H, Larijani B, Farzadfar F. Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021. ARCHIVES OF IRANIAN MEDICINE 2022; 25:634-646. [PMID: 37543889 PMCID: PMC10685773 DOI: 10.34172/aim.2022.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/08/2022] [Indexed: 08/07/2023]
Abstract
BACKGROUND Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present. METHODS In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey. RESULTS By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants. CONCLUSION The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.
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Affiliation(s)
- Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasserinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Fattahi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahabeddin Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Ohio State University, Columbus, OH, USA
| | - Elham Abdolhamidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Foroutan Mehr
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Abdi
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Moghisi
- Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Ali Akbari Sari
- National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Raeisi
- Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Jamshidi
- Research Institute for Endocrine Sciences, School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Health burden and economic loss attributable to ambient PM 2.5 in Iran based on the ground and satellite data. Sci Rep 2022; 12:14386. [PMID: 35999246 PMCID: PMC9399101 DOI: 10.1038/s41598-022-18613-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/16/2022] [Indexed: 01/02/2023] Open
Abstract
We estimated mortality and economic loss attributable to PM2·5 air pollution exposure in 429 counties of Iran in 2018. Ambient PM2.5-related deaths were estimated using the Global Exposure Mortality Model (GEMM). According to the ground-monitored and satellite-based PM2.5 data, the annual mean population-weighted PM2·5 concentrations for Iran were 30.1 and 38.6 μg m-3, respectively. We estimated that long-term exposure to ambient PM2.5 contributed to 49,303 (95% confidence interval (CI) 40,914-57,379) deaths in adults ≥ 25 yr. from all-natural causes based on ground monitored data and 58,873 (95% CI 49,024-68,287) deaths using satellite-based models for PM2.5. The crude death rate and the age-standardized death rate per 100,000 population for age group ≥ 25 year due to ground-monitored PM2.5 data versus satellite-based exposure estimates was 97 (95% CI 81-113) versus 116 (95% CI 97-135) and 125 (95% CI 104-145) versus 149 (95% CI 124-173), respectively. For ground-monitored and satellite-based PM2.5 data, the economic loss attributable to ambient PM2.5-total mortality was approximately 10,713 (95% CI 8890-12,467) and 12,792.1 (95% CI 10,652.0-14,837.6) million USD, equivalent to nearly 3.7% (95% CI 3.06-4.29) and 4.3% (95% CI 3.6-4.5.0) of the total gross domestic product in Iran in 2018.
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Rezaie L, Nazari A, Safari-Faramani R, Shohaimi S, Khazaie H. Iranian psychiatrists' attitude towards clozapine use for patients with treatment-resistant schizophrenia: a nationwide survey. BMC Psychiatry 2022; 22:534. [PMID: 35933353 PMCID: PMC9357336 DOI: 10.1186/s12888-022-04179-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clozapine has the greatest efficacy for treatment-resistant schizophrenia (TRS), even though its underutilization is not uncommon across different countries. This study aimed to investigate the knowledge and attitude of Iranian psychiatrists toward clozapine use. METHOD In this cross-sectional study, a questionnaire was distributed among psychiatrists registered with the Iranian Psychiatrists Association (including its provincial branches) to assess their knowledge and attitude towards clozapine use. A total of 282 psychiatrists completed the questionnaire. Descriptive analysis was used to describe demographic information, and Chi-square tests were conducted to determine if there is an association between academic position and work experience. All statistical analyses were performed using SPSS® version 25.0 for Windows, and a significance level of 0.05 was used. RESULTS Most respondents (93%) acknowledged that they prescribed clozapine for their patients, and 74% believed that clozapine was more effective than other antipsychotic drugs. However, 43.3% of the respondents said they did not believe in the safety of clozapine. Difficulty initiating and having no firsthand experience in the superiority of clozapine were reported by 81.2 and 80% of the respondents, respectively. Our results also showed an association between having an academic position and access to appropriate facilities for the control and management of patients treated with clozapine and believing in the safety of clozapine (p < 0.05). Longer work experience (more than 15 years) was associated with a higher prescription of clozapine, belief in greater effectiveness of clozapine, and its safety (p < 0.0001). CONCLUSION Iranian psychiatrists had a good self-perception of knowledge about the efficacy of clozapine for patients with TRS, but concerns about serious side effects are common. Psychiatrists with longer work experience and academic positions were more optimistic towards clozapine use than the younger ones with no academic position. Considering the results in planning the strategies to decrease concerns about clozapine use is recommended.
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Affiliation(s)
- Leeba Rezaie
- grid.412112.50000 0001 2012 5829Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Azadeh Nazari
- grid.412112.50000 0001 2012 5829Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- grid.412112.50000 0001 2012 5829Department of Epidemiology, School of Health Social Development and Health Promotion Research Center Research Institute for Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- grid.11142.370000 0001 2231 800XDepartment of Biology, Faculty of Science, Universiti Putra Malaysia, Serdang, Selangor Malaysia
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Ghamari SH, Abbasi-Kangevari M, Saeedi Moghaddam S, Aminorroaya A, Rezaei N, Shobeiri P, Esfahani Z, Malekpour MR, Rezaei N, Ghanbari A, Keykhaei M, Naderian M, Larijani B, Majnoon MT, Farzadfar F, Mokdad AH. Rheumatic Heart Disease Is a Neglected Disease Relative to Its Burden Worldwide: Findings From Global Burden of Disease 2019. J Am Heart Assoc 2022; 11:e025284. [PMID: 35730651 PMCID: PMC9333364 DOI: 10.1161/jaha.122.025284] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Rheumatic heart disease (RHD) takes a heavy toll in low‐ and middle‐income countries. We aimed to present worldwide estimates for the burden of the RHD during 1990 to 2019 using the GBD (Global Burden of Disease) study. Methods and Results Sociodemographic index (SDI) and age‐period‐cohort analysis were used to assess inequity. The age‐standardized death, disability‐adjusted life years, incidence, and prevalence rates of RHD were 3.9 (95% uncertainty interval, 3.3–4.3), 132.9 (95% uncertainty interval, 115.0–150.3), 37.4 (28.6–46.7), and 513.7 (405.0–636.3) per 100 000 in 2019, respectively. The age‐standardized incidence and prevalence rates increased by 14.4% and 13.8%, respectively. However, disability‐adjusted life years and death rates decreased by 53.1% and 56.9%, respectively. South Asia superregion had the highest age‐standardized disability‐adjusted life years and deaths. Sub‐Saharan Africa had the highest age‐standardized incidence and prevalence rates. There was a steep decline in RHD burden among higher‐SDI countries. However, only age‐standardized deaths and disability‐adjusted life years rates decreased in lower‐SDI countries. The age‐standardized years of life lost and years lived with disability rates for RHD significantly declined as countries' SDI increased. The coefficients of birth cohort effect on the incidence of RHD showed an increasing trend from 1960 to 1964 to 2015 to 2019; however, the birth cohort effect on deaths attributable to RHD showed unfailingly decreasing trends from 1910 to 1914 to 2015 to 2019. Conclusions There was a divergence in the burden of RHD among countries based on SDI levels, which calls for including RHD in global assistance and funding. Indeed, many countries are still dealing with an unfinished infectious disease agenda, and there is an urgency to act now to prevent an increase in future RHD burden.
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Affiliation(s)
- Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran.,Tehran Heart CenterTehran University of Medical Sciences Tehran Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran.,Endocrinology and Metabolism Research Center Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran.,Department of Biostatistics University of Social Welfare and Rehabilitation Sciences Tehran Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Mohammad Keykhaei
- Feinberg Cardiovascular and Renal Research Institute Northwestern University, School of Medicine Chicago IL
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Mohamad Taghi Majnoon
- Pediatric Group Children Medical Center Faculty of Medicine Tehran University of Medical Sciences Tehran Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center Endocrinology and Metabolism Population Sciences Institute Tehran University of Medical Sciences Tehran Iran.,Endocrinology and Metabolism Research Center Endocrinology and Metabolism Clinical Sciences Institute Tehran University of Medical Sciences Tehran Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation University of Washington Seattle WA.,Department of Health Metrics Sciences University of Washington Seattle WA
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Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 399:1625-1645. [PMID: 35397236 PMCID: PMC9023870 DOI: 10.1016/s0140-6736(21)02751-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Better evaluation of existing health programmes, appropriate policy making against emerging health threats, and reducing inequalities in Iran rely on a comprehensive national and subnational breakdown of the burden of diseases, injuries, and risk factors. METHODS In this systematic analysis, we present the national and subnational estimates of the burden of disease in Iran using the Global Burden of Disease Study 2019. We report trends in demographics, all-cause and cause-specific mortality, as well as years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by major diseases and risk factors. A multi-intervention segmented-regression model was used to explore the overall impact of health sector changes and sanctions. For this analysis, we used a variety of sources and reports, including vital registration, census, and survey data to provide estimates of mortality and morbidity at the national and subnational level in Iran. FINDINGS Iran, which had 84·3 million inhabitants in 2019, had a life expectancy of 79·6 years (95% uncertainty interval 79·2-79·9) in female individuals and 76·1 (75·6-76·5) in male individuals, an increase compared with 1990. The number of DALYs remained stable and reached 19·8 million (17·3-22·6) in 2019, of which 78·1% were caused by non-communicable diseases (NCDs) compared with 43·0% in 1990. During the study period, age-standardised DALY rates and YLL rates decreased considerably; however, YLDs remained nearly constant. The share of age-standardised YLDs contributing to the DALY rate steadily increased to 44·5% by 2019. With regard to the DALY rates of different provinces, inequalities were decreasing. From 1990 to 2019, although the number of DALYs attributed to all risk factors decreased by 16·8%, deaths attributable to all risk factors substantially grew by 43·8%. The regression results revealed a significant negative association between sanctions and health status. INTERPRETATION The Iranian health-care system is encountering NCDs as its new challenge, which necessitates a coordinated multisectoral approach. Although the Iranian health-care system has been successful to some extent in controlling mortality, it has overlooked the burden of morbidity and need for rehabilitation. We did not capture alleviation of the burden of diseases in Iran following the 2004 and 2014 health sector reforms; however, the sanctions were associated with deaths of Iranians caused by NCDs. FUNDING Bill & Melinda Gates Foundation.
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