Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021

BACKGROUND

Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050.

METHODS

Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.

FINDINGS

In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8-63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0-45·0] in 2050) and south Asia (31·7% [29·2-34·1] to 15·5% [13·7-17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4-40·3) to 41·1% (33·9-48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6-25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5-43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5-17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7-11·3) in the high-income super-region to 23·9% (20·7-27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5-6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2-26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [-0·6 to 3·6]).

INTERPRETATION

Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.

FUNDING

Bill & Melinda Gates Foundation.

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021.

METHODS

The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk-outcome pairs. Pairs were included on the basis of data-driven determination of a risk-outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk-outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk-outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws.

FINDINGS

Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7-9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4-9·2]), smoking (5·7% [4·7-6·8]), low birthweight and short gestation (5·6% [4·8-6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8-6·0]). For younger demographics (ie, those aged 0-4 years and 5-14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9-27·7]) and environmental and occupational risks (decrease of 22·0% [15·5-28·8]), coupled with a 49·4% (42·3-56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9-21·7] for high BMI and 7·9% [3·3-12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6-1·9) for high BMI and 1·3% (1·1-1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4-78·8) for child growth failure and 66·3% (60·2-72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP).

INTERPRETATION

Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Background

The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.

Methods

We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends.

Findings

In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of -0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = -0.41), inflammatory bowel disease (AAPC = -0.72), multiple sclerosis (AAPC = -0.26), psoriasis (AAPC = -0.77), and atopic dermatitis (AAPC = -0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR.

Interpretation

The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively.

Funding

The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

Dietary Fiber Intake and Related Factors in Community-Based Iranian's Elderly

Background

There are considerable documents suggesting that inadequate fiber intake (FI) is a key risk factor for various chronic diseases. The aim of this study was to investigate Dietary FI in the Persian elderly.

Methods

This descriptive-analytic study was performed to investigate FI in a sample of the elderly who received free services from healthcare centers in Karaj, Iran. For sampling method: at first, the names of 36 centers were written on small pieces of paper and poured into a container, then another person was asked to randomly select the names of 10 centers, then referring to each of the centers and preparing a list of elderly people, the study subjects were selected, The study was conducted between September 2018, and April 2019Several questionnaires were used to collect data regarding DF: characteristics, daily FI , knowledge, SE (self-efficacy), perceived benefits, and barriers towards FI as well as stage of readiness of FI. t-test and ANOVA were used to compare independent mean values. Data were checked for normality before analysis by using Kolmogorov-Smirnov (K-S) test to check data normality.

Results

Totally of 400 elderly individuals entered the study with the average amount of fiber per day. The data analysis indicated they did not know the recommended intake of at least 25 gr each day. feeling less hungry and fiber's price was the most frequent perceived benefits and barriers towards FI , respectively. Gastrointestinal diseases ( P < 0.001), smoking (P < 0.001), and perceived barriers (P < 0.001), were statistically significant independent positive predictors of FI.

Conclusion

The findings of the current study indicated that FI among elderly people in Iran was very low and varied a great by gender, education, marital status, income level, employment status, smoking, stage of change, and gastrointestinal disease.

Social networks and internet emotional relationships on mental health and quality of life in students: structural equation modelling

BACKGROUND

Social networks and relationships create a sense of belonging and social identity; hence, can affect mental health and the quality of life, especially in young people. The present study was conducted to determine the predicting role of social networks and internet emotional relationships on students' mental health and quality of life.

METHODS

The present cross-sectional study was conducted in 2021 on 350 students at Alborz University of Medical Sciences selected by convenience sampling. Data were collected using five questionnaires: socioeconomic status, social networks, internet emotional relationships, stress, anxiety, depression scale (DASS-21), quality of life, and a checklist of demographic details. Data were analyzed in SPSS-25, PLS-3, and Lisrel-8.8.

RESULTS

According to the path analysis, the DASS-21 score had the most significant positive causal association with internet emotional relationships in the direct path (B = 0.22) and the most negative association with socioeconomic status (B = - 0.09). Quality of life had the highest negative causal association with the DASS-21 score in the direct path (B = - 0.26) and the highest positive association with socioeconomic status in the indirect path (B = 0.02). The mean duration of using social networks (B ≈ - 0.07) and internet emotional relationships (B ≈ - 0.09) had the highest negative association with quality of life.

CONCLUSION

The use of the internet and virtual networks, internet emotional relationships, and unfavorable socioeconomic status were associated with higher DASS-21 scores and reduced quality of life in the students. Since students are the future of countries, it is necessary for policymakers to further address this group and their concerns.

The Relationship between Pregnancy Intention, Pregnancy Outcomes, Postpartum Depression, and Maternal Role Adaptation

Introduction: Unplanned pregnancy and its complications are a global problem that affects women, families, and the community. Objective: This study aimed to assess the relationship between pregnancy intention, pregnancy outcomes, postpartum depression, and maternal role adaptation in pregnant women referred to healthcare centers of Robat Karim City, Iran. Materials and Methods: This cohort study was conducted on 240 pregnant women referred to the healthcare centers of Robat Karim in 2019. They were selected by the convenience sampling method. After completing the London questionnaire in the 26th week of gestation, the participants were equally divided into planned and unplanned pregnancy groups. Edinburgh postnatal depression scale and parenting sense of competency scale were completed 10 days and 30 days after delivery. The obtained data were presented by descriptive statistics and analyzed by the Chi-square and t test for comparison between two groups and structural equation model for assessing the relationship between variables. Results: The mean ± SD values of age, marital duration time, and gravidity number of participants were 30±7.1, 1.5±0.02, and 5, respectively. The results revealed a significant difference between the two groups concerning the mean score of postpartum depression and maternal competency, 10 and 30 days after delivery (P=0.001). The results of path analysis showed that pregnancy intention had a negative and significant effect on postpartum depression (B = -0.58, t value=-2.5), but a positive and significant impact on maternal competency (B = 0.39, t value=-2). According to the determined amount of variance, the variable of intention to pregnancy predicts 33% of postpartum depression (R2=0.33). Also, two variables of pregnancy intention and postpartum depression predict 55% of maternal competency (R2=0.55). Conclusion: Pregnancy intention had a significant effect on maternal depression and competency. It is recommended that pregnancy intention be screened during pregnancy, and also appropriate training and social support be provided for mothers with unplanned pregnancies.

Investigating preventive health behaviors against COVID-19 in elementary school students' parents: A cross-sectional study from Tehran - Capital of Iran

BACKGROUND

Parents act as a role model for children in showing health behaviors. This study investigated factors affecting the preventive behavior in elementary school students' parents based on protection motivation theory (PMT).

MATERIALS AND METHODS

This cross-sectional study was conducted in Tehran (Iran) in 2020. Multistage sampling was used to choose 660 elementary school students' parents. The data collection instrument was a multi-sectional questionnaire, including sections on demographic characteristics, PMT constructs, self-reported health, and information sources related to COVID-19. In this study, descriptive statistics (mean and standard deviation) and analytical statistical methods (Pearson correlation and path analysis) were used to analyze the data. The range of Cronbach's alpha of the study instrument varied from 0.71 to 0.97.

RESULTS

The results of the current study revealed significant association between all PMT constructs and preventive behaviors. Knowledge from both direct and indirect paths was related to preventive behaviors (B = 0.76). Preventive behaviors had the strongest, direct relationship with age (B = 0.76). Based on the final fitted model, knowledge had the greatest impact on preventive behaviors through indirect and direct routes.

CONCLUSION

Knowledge was the most important variable which influenced preventive behavior, and it should be noticed in prevention programs.

Psychometric Adequacy of the Persian Version of the Performance Management Behavior Questionnaire in Universities

Introduction: Despite interest in improving performance management in universities, few studies have examined this topic. Because of the absence of validated tools in Iran for assessing behavior performance management, this study was conducted to validate the behavior performance management scale. Objective: This study aimed to assess the psychometric adequacy of the Performance Management Behavior Questionnaire (PMBQ) for the heads of university departments in Iran. Materials and Methods: This cross-sectional study was conducted in four phases. The first and second phases included PMBQ translation and its modification in accordance with the educational setting. The third phase consisted of the content and face validation, and the fourth phase aimed to evaluate the construct validity and reliability of this scale. All 400 faculty members (200 for exploratory factor analysis and 200 for confirmatory factor analysis) were studied. After translation, the 27-item PMBQ was evaluated for validity and reliability. Content Validity Ratio (CVR) and Content Validity Index (CVI) were computed for content validity. For construct validation, the exploratory factor analysis and confirmatory factor analysis were used. The PMBQ reliability was assessed by the Cronbach α coefficient. Results: Considering eigenvalues above one, five factors were identified that jointly explained 58.22% of the variance observed. Based on the arrangement of the factors, they labeled as monitoring performance management (9 items), coaching (6 items), goal setting (6 items), communication (3 items), and providing consequence (2 items). Results showed that the Average Variance Extracted (AVE) varied between 0.51 and 0.60; composite reliability was between 0.7 and 0.81, and the Cronbach α coefficient was between 0.70 and 0.82. Conclusion: PMBQ as a valid and reliable tool can be used for assessing the behavior of the heads of departments from the viewpoints of faculty members.

An asthmatic pregnant woman with COVID-19: A case report study

Background

COVID-19 represents with various clinical symptoms and infects the respiratory tract, throat, nose, and lung involvement can lead to severe lung disease and death., among asthmatic patients, infections can lead to deterioration. The severity, and prognosis of this disease are likely to be devasted in pregnant women with underlying diseases such as asthma.

Case presentation

We present an Asthmatic pregnant woman who infected with SARS-CoV-2 admitted to two hospitals in Iran. The patient's symptoms were dry coughs, dyspnea, and inability to speak, numbness, and fatigue. The initial examination indicated a body temperature of 37.9 °C, oxygen saturation (SPO2) 91%, partial pressure of oxygen (Pao2) was 25 mm Hg, respiratory rate (RR) of 20 breaths/minute (b/m), blood pressure of 100/60 mmHg, and pulse of 80 bpm (beat/minute) and fetal heart rate (FHR) = 167/min. The pregnancy terminated by Caesarean Section (C/S) due to fetal tachycardia, a healthy baby with normal range. Anthropometric characteristics were born. Our case had leukopenia and also revealed, elevated C-reactive protein and erythrocyte sedimentation rate. Our case received supportive care and antibiotic & antiviral therapy and was discharged within 8 days with a good general condition.

Conclusions

The patient's condition improved after 8 days of hospitalization and the patient underwent appropriate clinical outcome in spite of underlying disease and infection with SARS-CoV-2

The relationship among fear and anxiety of COVID-19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model

INTRODUCTION

Coronavirus pandemic causes stress and anxiety for pregnant women worldwide. The present study was conducted for the path analysis of the relationship among fear and anxiety caused by coronavirus, pregnancy experience, and the mental health of pregnant women.

METHODS

This cross-sectional study was conducted on 222 pregnant women who were referred to Kamali Hospital in Alborz province in 2020. The eligible individuals entered the study through convenience sampling, and data were collected using five questionnaires including the Fear of COVID-19 Scale, the Anxiety of COVID-19 Scale, the pregnancy experiences Scales, Depression Anxiety Stress scale, and demographic checklist. The obtained data were then analyzed using SPSS-16 and Amos software.

RESULTS

According to results of the path analysis, the anxiety of COVID-19 and concerns during pregnancy were variables that were positively and significantly correlated with mental health only through one path, which was direct, and anxiety of COVID-19 had also the highest positive direct correlation among them (B = 0.32). The next variable was the happiness during pregnancy experiencing, which had a significantly negative and direct correlation with mental health disorder (B = 0.29). Moreover, fear of COVID-19 through the mediating concerns of pregnancy experiences was shown to have a significant positive relationship with mental health through an indirect path (B = 0.05).

CONCLUSION

Based on the result of this study, it is necessary to pay more attention to the mental health of pregnant women during a pandemic. In addition, it is recommended to provide a virtual training group to reduce anxiety caused by coronavirus and pregnancy concerns, as well as emphasizing the feeling of enjoying happiness caused by pregnancy experience during a pandemic.

A predictive model of the sunscreen use in the paddy workers based on the health action process approach model: a path analysis

BACKGROUND

Skin cancer is considered as one of the most common cancers in the world. There is little information about identifying factors affecting sunscreen use among paddy workers and their protective behavior. The present study aimed to determine a predictive model of the sunscreen use in the paddy workers based on the health action process approach model (HAPA).

METHODS

This cross-sectional study was conducted on 177 paddy workers who engaged in agricultural work in the north of Iran in 2018. Convenience sampling methods was used. Inclusion criteria were being a farmer for 5 years, working under the sunshine more than 2 h per day, and above the age of 30 years. A multi-sectional questionnaire (intention, risk perception (RP), outcome expectation (OE), action self-efficacy (ASE), action planning (AP), coping planning (CP), coping SE (CSE), self-monitoring (SM), and sunscreen use) was used for data collection. Data were analyzed with SPSS-21 and Lisrel-8.8 software.

RESULTS

The mean age of participants was 47.78 ± 12.66 years. The final path model fitted well (comparative fit index (CFI) = 0.98, RMSEA = 0.000), only coping self-efficacy (CSE) from both direct and indirect paths had an impact on sunscreen use (B = 0.73). Among the variables which are influenced only in one direction, coping planning (CP) had the most direct influence (B = 0.30) on behavior, and action planning had the lowest influence (B = 0.24).

CONCLUSION

Coping self-efficacy was the most important factor which had influence on the use of sunscreen, and it should be considered when designing interventional programs related to sunscreen use among paddy workers.

How to increase community participation capacity in food environment policymaking: Results of a scoping review

Background: Food environment plays a major role in health outcomes. A growing interest in community-based participatory research (CBPR) has led to its application in the improvement of the food environment. This scoping review aims to compile and map the literature and identify key strategies used for increasing community participation capacity in the food environment policymaking process.

Methods: The scoping review of peer-reviewed articles on community participation and food environment policymaking followed the framework suggested by Arksey and O'Malley (2005). Scopus, PubMed, and Web of Science were searched. A charting table was developed to extract the key information of each identified study. A directed content analysis approach was used to assign retrieved codes into categories proposed by Foster-Fishman.

Results: A total of 28 studies were included in this review. Most studies used the CBPR approach to involve the community at least in the problem identification step of the policymaking process (n=12) and 7 studies reported their involvement in all the steps of policymaking. In 15 out of 28 studies, the level of community participation was at "involvement" and in 8 studies it was at "empowerment". Strategies for increasing relational capacity, member capacity, programmatic capacity, and organizational capacity of community participation were reviewed.

Conclusion: To improve food environment using the community-participation approach, identifying different strategies and adjusting them based on the social and political context of each society is of high importance.

Investigation E-health literacy and correlates factors among Alborz medical sciences students: a cross sectional study

Background Health literacy is one of the goals of public health and the key challenge of health education in the 21st century. This study aimed to determine E-health literacy and correlates among medical sciences students in Karaj, Iran 2017. Methods This cross-sectional study was performed on a thousand students of Alborz University of Medical Sciences. A multi-sectional questionnaire was used to collect data. The first section included age, major, marital status; educational grade, mother and father education, socioeconomic status, health status, membrane in social network and the second compromised a validated Persian version of the E-health literacy. We used t-test and analysis of variance (ANOVA) to compare the mean of variables and for categorical variables x2 was used with SPSS version 19. Results The mean age of the subjects was 25.5 ± 5.6 years, of which 65.3% were male. The medical students constituted the most number of participants (28.6%). Mean eHEALS score was 26.11 ± 6.6 years. There was a significant difference between female and male regarding E-health literacy (P = 0.04). Internet was the most commonly used sources for health information (67%), the majority of the students were members of one of the social networks (77.7%) that telegram and Instagram were among the most popular networks. Conclusion Improving search skills and assessing of health resources in students, especially in medical and Para-medical sciences, is recommended. Social networks can be used as channels for the transmission of the health messages due to high usage among students.

Popular water pipe smoking, medical sciences students' awareness, perceptions, and motivations

Objectives This study was done to investigate popularity, awareness, perceptions, and motivations regarding water pipe smoking (WPS) among medical sciences students in 2017. Methods This cross sectional study was done among 385 medical sciences student in 2017.The systematic random sampling was used to recruit subjects. Multidimensional questionnaire (demographic characteristics, awareness, perceptions, action, and water pipe motivators) was used. t-test, ANOVA, X2, and logistic regression was used to analyze the data by SPSS. Results The mean ages of participants were 22 ± 2.64 and 89% were male. The majority of the study sample was from health school. Most participants reported having smoked before. Family entertainment was found to be the most common motivator for WPS. The second one was to be fun. WPS use was significantly associated with age (odds ratio [OR], 0.17; 95% Confidence Interval [CI], 0.04-0.61); awareness (OR, 1.55; 95% CI, 1.35-1.78); and perception (OR, 0.71; 95% CI, 0.65-0.78). Conclusions Results show that WPS is very popular among Iranian youth. In designing public health programs, policy makers should consider the motivators for inclination to WPS. Intervention should focus on addressing students' perception and awareness regarding WPS.

Perspectives of adolescents regarding the sexual and reproductive health self-care: a theory-based qualitative research

Objectives It is widely accepted that sexual and reproductive health in adolescents are among the health priorities in the world that affects health aspects and the formation of beliefs and socioeconomic development in the community. However, achieving goals related to sexual and reproductive health is not possible without awareness and participation of the adolescents. On the other hand, proper knowledge about such issues can prevent many problems in this regard. Methods This qualitative study was carried out for one month in schools of Alborz University of Medical Sciences using content analysis. Data were collected from semi-structured, individual and in-depth interviews with female students. In addition, data analysis was performed using guided qualitative content analysis (theory-based). Results Analysis of the data led to the extraction of 11 primary codes classified in six categories of protection motivation constructs (perceived sensitivity, perceived severity, response efficiency, response cost, self-efficacy, and internal rewards) and two additional categories (communications and social contexts). Conclusion All interviewees found themselves exposed to sexually transmitted diseases and emphasized sexual self-care even though the majority of these individuals had inadequate self-efficacy.

Factors affecting the quality of life in women with gestational diabetes mellitus: a path analysis model

Background

Quality of life (QoL) is the most important indicator for assessing the status of health care in chronic diseases. The present study aimed to determine the pathway determinants model of QoL in patients with gestational diabetes mellitus (GDM).

Methods

This cross-sectional study was conducted on 329 women with GM referred to health care centers in Qom, Iran during 2018. Convenience sampling methods was used. Inclusion criteria were: afflicted by GM and received pregnancy care services from health center. Several questionnaires (Knowledge, attitude, self-efficacy (SE), social support (SS), pregnancy distress, self-management(SM) and QoL) were used for data collection. Data were analyzed with SPSS-21 and Lisrel-8.8 software using statistical path analysis.

Results

The mean age of participants was 30.93 ± 5.42 years. The final path model fitted well (CFI =1, RMSEA = 0.0003) and showed that, only age variable from both direct and indirect path had an impact on QoL (B = 0.51). Among variables that directly affected the QoL, SS had the highest effect (B = 1.02) and SE (B = 0.01) had the lowest effect. In the indirect path, only the knowledge variable by affecting the SE had an impact on the QoL (B = 0.0045).

Conclusion

SS had the greatest impact on the QoL. Obviously, providing all the requirements to support patients can help them overcome problems and improve their QoL. Distress negatively affects the QoL through SM and it should be noticed in interventional studies.

Cultural adaptation and psychometric adequacy of the Persian version of the physical activity scale for the elderly (P-PASE)

OBJECTIVE

This cross sectional study was conducted to investigate cultural adaption and validation of the Persian version of the PASE among the elderly community dwellers in Iran. Out of 278 elderly people, 65% of them were female. After translation and cultural adaption, the PASE was evaluated with respect to the validity and reliability. Regarding the construct validity, the concurrent validity was assessed between the PASE and ADL, IADL, self-rated health, and TUG test.

RESULTS

The mean score of P-PASE was equal to 153.73 ± 48.47. P-PASE scores were significantly and negatively correlated with TUG (r = - 0.691, P < 0.001) and age (r = - 791, P > 0.001), and were also significantly correlated with ADL (r = 0.775, P < 0.001), and IADL (r = 0.161, P < 0.001). The ICC was obtained as 0.92 (95% CI 0.90-0.94), 0.86 (95% CI 0.82-0.87), and 0.91 (95% CI 0.90-0.94) for the leisure time activity, household activity, and work-related activity scores, respectively. The Cronbachs̓ alpha coefficient was equal to 0.74, 0.74, and 0.79, respectively for leisure time activity, household activity, and work-related activity domains.

Perspectives of paddy workers regarding the use of sunscreen: a theory-based qualitative research

Background

Skin cancer is one of the most frequent types of cancer. This study aims to clarify farmers’ perspectives regarding the use of sunscreen according to Health Action Process Approach.

Method

Twenty-seven farmers were recruited an interviewed. The samples were classified according to their age, sex, and education. The data were collected through a deep and semi-structure interview during one-month period. Questions were asked based on Health Action Process Approach (HAPA) and were continued until the saturation stage.

Results

The data were classified into six categories (intention, risk perception, outcome expectation, self-efficacy, perceived barriers and action planning). Most of the interviewees did not use sunscreen and did not intend to use it either. They indicated some threats of sunlight, such as burn and rash, redness, itching, soreness and darkness of skin. The participants pointed to some physical outcome expectation of the sunscreen and mentioned some perceived barriers such as time limitation, low income, non-familiarity with sunscreen, the notion that sunscreen is only for women and the farmers prioritize farming and believed that sunscreen is not required in all seasons.

Conclusions

Risk perception, outcome expectation and perceived barriers should be considered designing appropriate interventions. The education of protection behaviors should be considering during interventional strategies.

Effect of education based on protection motivation theory on adolescents' reproductive health self-care: a randomized controlled trial

BACKGROUND

Adolescents should be empowered to improve their reproductive and sexual health needs. The present study aimed to investigate effects of protection motivation theory-based education on student girls' reproductive and sexual health self-care.

METHODS

This randomized controlled trial was conducted in parallel on 90 female students living in dormitories of the Alborz University of Medical Sciences in Iran. The data collection lasted from January 2017 to May 2018. Convenience sampling was performed, and samples were put into intervention and control groups by block randomization. The intervention group received six educational sessions based on the protection motivation theory(PMT). The data collection tool of this research consisted of the protection motivation theory and reproductive health self-care questionnaires.

RESULTS

There was no significant difference between control and intervention groups in demographic characteristics. The results of the repeated measures test indicated that the reproductive health self-care variable had a significant change (p = 0.000), and there was a significant difference between groups (p = 0.000). The total score of the Protection Motivation Theory Questionnaire was not changed over time (p = 0.54) and there was no significant difference between groups (p = 0.51) according to results of the repeated measures test.

CONCLUSION

According to effects of an educational intervention based on the protection motivation theory, it is suggested to utilize this model as an educational framework for adolescents' reproductive and sexual health by healthcare providers, schools and universities as well as holding periodic courses educating adolescents within short-term intervals in order to achieve the higher sustainability of the educational results.

Effect of the Theory of Planned Behavior Education on Nutritional Behaviors of Overweight and Obese Women Before Pregnancy

Objectives: Maternal nutritional behavior before and during pregnancy contributes significantly to improving the outcomes of pregnancy and the health of the newborns after birth. In addition, the theory of planned behavior (TPB) is a proper model for use during pre-pregnancy and pregnancy. Therefore, the present study evaluated the effect of TPB education on nutritional behaviors of overweight and obese women before pregnancy. Materials and Methods: This randomized controlled trial was conducted on 100 overweight and obese women who attended a nutrition unit in Khansar during April-August 2017. A convenient sampling method was used and the samples were randomly divided into intervention and control groups. The intervention group participated in five nutritional training sessions based on the TPB in addition to routine care. Data were collected with TPB and nutritional behaviors questionnaires before, after, and 2 months after education. Finally, the Student’s t test, Fisher exact test, as well as Mann-Whitney U test, chi-square and repeated-measure tests were utilized for data analysis. Results: Based on the result of the repeated measure test, the overall score of the TPB changed (P=0.002) over time and a significant difference was observed between the 2 groups (P=0.002). In addition, the result of the repeated measure test indicated that the length of time affects the nutritional behavior score (P=0.000) and there was a significant difference between the 2 groups in this regard (P=0.000). Conclusions: Considering the effect of training, based on the TPB, on nutritional behavior, the content of this training is suggested to be included in the pre-pregnancy program.

Is Routine Iron Supplementation Necessary in Pregnant Women With High Hemoglobin?

Background:

Iron supplementation is a chief component in prenatal care, with the aim of preventing anemia; however, extreme maternal iron status may adversely affect the birth outcome. Given the negative consequences of high maternal iron concentrations on pregnancy outcomes, it seems that iron supplementation in women with high hemoglobin (Hb) should be limited.

Objectives:

The aim of this study was to examine the effect of iron supplementation on iron status markers in pregnant women with high Hb.

Patients and Methods:

In a randomized, double-blind, placebo-controlled trial, 86 pregnant women with Hb > 13.2 g/dL and ferritin > 15 μg/l in the 16th - 20th week of pregnancy were randomized into experimental and control groups. From the 20th week until the end of pregnancy, the experimental group received one ferrous sulfate tablet containing 50 mg of elemental iron daily, while the control group received a placebo. Hb and ferritin levels at 37 - 39 weeks of pregnancy were evaluated and compared. In addition, after delivery the birth weight was measured in two groups and compared.

Results:

There were statistically significant differences between the two groups in Hb (p = 0/03) and ferritin (p = 0/04) levels at the end of pregnancy, but the incidence of anemia exhibited no difference in either group (p < 0/001). In addition, the mean of birth weight in experimental group and control group were 3391/56 ± 422, 3314/06 ± 341, respectively and it was not significant difference (p = 0.2).

Conclusions:

Not using iron supplementation did not cause of anemia in women with Hb concentrations greater than 13.2 g/dL during pregnancy; thus, the systematic care and control of iron status markers without iron supplementation is recommended for these women.

The Impact of Demographic Factors and Blood Sugar Control on the Incidence of Urinary Tract Infections in Khorramabad in 2013

Background:

Diabetes is one of the most serious metabolic disorders to affect different organs in the body. Patients with diabetes are hence at risk of developing other problems. Urinary tract infections (UTI) are one of the problems that occur more commonly in diabetic patients than in others. There are several risk factors that lead to the incidence of UTI in diabetic patients.

Objectives:

We conducted this study to determine the effect of different factors on the incidence of UTI in diabetic patients in order to decrease the incidence of this problem.

Patients and Methods:

In this cross-sectional study, data concerning 233 patients who were referred to the largest diabetes center in Khorramabad, Lorestan province, Iran, were recorded. The relationships between various factors and the incidence of UTI in these patients were evaluated using SPSS version 16. We used chi-square and logistic regression to analyze the data. A P < 0.05 was considered to be statistically significant.

Results:

The incidence of UTI increased significantly with increasing age (P = 0.009). The incidence of UTI was higher among females than among males, and it was higher among unemployed people than among those in other occupations. The prevalence of UTI among patients who control their diabetes through diet and exercise was lower than that among those undergoing other types of treatment; however, no significant relationship was found between the different types of oral medication and the incidence of UTI. We did not find any relationship between the incidence of UTI in diabetic patients and other factors such as literacy, marital status, BMI, addiction, history of hospitalization, and level of HbA1c.

Conclusions:

We found that age, gender, occupation, and the type of medication used are all risk factors for the incidence of UTI in diabetic patients. Other factors such as literacy, marital status, addiction, and history of hospitalization did not have any significant association with the incidence of UTI in diabetic patients.

Older People's Perspectives on Health, Physical Activity and Nutritional Behaviors

Background: Approaches for investigating health-promoting lifestyle generally focus on physical activity and regular diet. To explore the perspectives of Iranian elders regarding health, healthy eating and physical activity (PA) this study was conducted in 2012.

Methods: Participants in this qualitative study were selected through purposeful sampling. Ten focus groups were conducted with 60 older adults in 3 elderly centers in Tehran. A moderator’s guideline that consisted of general and specific questions was used. Focus groups were audio recorded, transcribed verbatim and analysis was performed using conventional content analysis.

Results: Participants explained their perspectives regarding health, healthy eating and PA in the following 5 categories: meaning of health was represented based on issues such as absence of pain and disorder, complete body wellbeing, staying away from hazards, complete individual satisfaction, experiencing positive events, effective communication, faithfulness and trust in God. The healthy eating category was featured by adequate eating, age balanced diet, refraining from under or over nutrition and sensible consumption of fruits and vegetables. The PA was described - according to the level of performing outdoor activities or household tasks. Expressions about the perceived benefits and barriers of healthy eating and PA were aligned the two remaining categories.

Conclusions: Participants have referred to the association between both PA and dietary practices and health. Understanding how older people define physical activity and nutritional behavior and recognition of the most important perceived benefits and barriers that might contribute to have a healthy eating or adequate PA profile could procure insight into the type of interventions that are required to promote healthy lifestyle among Iranian older adults.

Physical activity in Iranian older adults who experienced fall during the past 12 months

Background

Physical activity may have several benefits for elderly people. However, the risk of falling might prevent this population from showing interest in physical activity. This research was aimed to explore facilitators and barriers to physical activity in older persons who have experienced at least one fall in the past 12 months.

Methods

This cross sectional study was conducted in 2010-2011, in Tehran, Iran. Using a multistage sampling method a group of elderly people entered into the study. A multi-section questionnaire was used to collect data on demographic information, physical activity level, and different determinants that might influence physical activity. Several statistical tests including linear regression were used to analyze the data.

Results

In all, 180 old people from 40 elderly centers (49 men and 131 women) took part in the study. The mean age of participants was 65.9 ± 6.1 years. The result indicated that most participants experienced two or more falls during the last year (54.5%). Those who had more falls significantly scored lower on the Physical Activity Scale for Elderly (p < 0.0001). ‘Keeping in touch with friends’ was the most important advantage cited by participants for performing physical activity. The results obtained from linear regression analysis showed that ‘perceived benefits’ was the only significant factor that associated with physical activity (β = 1.03, p < 0.001).

Conclusion

The findings suggest that perceived benefits could facilitate physical activity among elderly regardless of number of falls, self-reported health and daily living activities. However, we observed inverse association between number of falls and physical activity. Indeed the findings suggest that we should reinforce benefits exist when designing programs to increase physical activity among elderly population.

Impact of maternal hemoglobin concentration on fetal outcomes in adolescent pregnant women

Background:

Studies on the association between maternal hemoglobin (Hb) concentration and adverse pregnancy outcome have been inconsistent. Many studies have shown the impact of Hb concentration on pregnancy outcomes in adult women; however, it is not revealed in adolescent pregnant women.

Objectives:

The aim of this study was to examine the effect of Hb concentration on birth outcomes in pregnant adolescents as a high-risk group.

Patients and Methods:

In this cross-sectional study, 312 healthy and nonsmoker adolescent pregnant women with gestational age (GA) of 37-40 weeks were chosen by random sampling, and were followed until delivery. A complete history was obtained from women. In addition, clinical examination and Hb test were performed. After birth, the associations between Hb concentration during pregnancy and birth outcomes were investigated. Statistical analyses were performed using SPSS software by t-test, chi-square and ANOVA.

Results:

In total, about 23.2 % were anemic, 58% had normal level of Hb (11-13.2 g/dL) and 18.8% had Hb > 13.2 g/dL. The mean birth weight was 3197.8 ± 398.25 grams and it was more in mothers with Hb = 10.5-12.5 g/dL than others (Hb < 10.5 or Hb > 12.5 g/dL) (P < 0.001). The lowest mean birth weight was found in mothers with Hb < 10.5 (3033.33 ± 422). Moreover, the mean birth weight of male newborns was more than females (P = 0.001). Eight percent of neonates had Apgar score less than eight. Low Apgar score in anemic group and mothers with high Hb concentration (Hb > 12.5 g/dL) was more than others.

Conclusions:

Abnormal Hb concentrations increase the risk of adverse birth outcomes such as low birth weight (LBW) and low Apgar scores in pregnant adolescents, so intensive care is recommended for this group of pregnant women.

Fruit and vegetables intake among elderly Iranians: a theory-based interventional study using the five-a-day program

Background

The benefit of FV intake in old age is well documented. However, there is evidence that old people do not consume enough FV. The purpose of this study was to evaluate the effectiveness of a tailored nutrition intervention that aimed to increase the FV intake among elderly Iranians aged 60 and over.

Methods

This quasi-experimental study was performed among a community-based sample of elderly in Tehran, Iran in year 2008 to 2009. Data were collected at baseline and 4 weeks follow-up. At baseline face-to-face interviews were conducted using a structured questionnaire including items on demographic information, stages of change, self-efficacy, decisional balance, daily servings of FV intake. Follow-up data were collected after implementing the intervention.

Results

In all 400 elderly were entered into the study (200 individuals in intervention group and 200 in control group). The mean age of participants was 64.06 ± 4.48 years and overall two-third of participants were female. At baseline total FV intake was not differed between two groups but it was significantly increased in the intervention group at posttest assessment (mean serving/day in intervention group 3.08 ± 1.35 vs. 1.79 ± 1.08 in control group; P = 0.001). Further analysis also indicated that elderly in intervention group had higher FV intake, perceived benefits and self-efficacy, and lower perceived barriers. Compared with control group, greater proportions of elderly in intervention group moved from pre-contemplation to contemplation/preparation and action/maintenance stages (P < 0.0001), and from contemplation/preparation to action/maintenance stages (P = 0.004) from pretest to posttest assessments.

Conclusion

This study suggests that the Transtheoretical Model is a useful model that can be applied to dietary behavior change, more specifically FV consumption among elderly population in Iran and perhaps elsewhere with similar conditions.

Physical activity among a sample of Iranians aged over 60 years: an application of the transtheoretical model

BACKGROUND

Physical inactivity is one of the leading causes of major chronic disease, which contributes substantially to the global burden of disease, death and disability. This study examined physical activity in a randomly selected sample of elderly people in Tehran, Iran.

METHODS

A random sample of 400 elderly people aged 60 years and over was selected through multistage sampling. A multi-sectional questionnaire that contained demographic characteristics, physical activity knowledge, benefits, barriers, self-efficacy, and readiness stage was used. Physical activity was measured by questions retrieved from the Physical Activity Scale for the Elderly.

RESULTS

This study showed knowledge, perceived benefits, and self-efficacy could predict physical activity stage of change (P<0.001). Sixty-two percent of participants reported laziness as the most important barrier for not engaging in physical activity. Meeting new people (74%), having fun (71.8%), and contacting friends (67.73%) were the most prevalent reasons for participating in physical activity.

CONCLUSION

According to this study, individuals with higher knowledge, perceived benefits and self-efficacy were more likely to engage in physical activity. Furthermore, those who perceived lower barriers towards this behavior were more physically active.

Extracting the small vibrations of a vessel wall

Cardiac and vascular diseases are among the main causes of mortality. Diagnosis of these diseases in the early stages can be very helpful for their treatments. One of the effects of atherosclerosis is the reduction of vessel wall vibrations. Echocardiography images cannot show these vibrations, due to their lack of resolution. In this study a new model for vessel simulation in an ultrasonic system is proposed that can be used for RF signal generation for imaging vessel wall layers. To extract the high frequency vibrations, at the first stage large motion of the vessel wall due to heartbeat is removed from RF signals using continuous wavelet transform and then these simulated vibrations are estimated by calculating the phase difference between Hilbert transforms of signals. This method may be used to detect the areas with atherosclerotic plaque non-invasively and with a respectable spatial resolution. The proposed method has been used for real data from the inferior wall of the aorta and the anterior wall of the hepatic vein to evaluate the efficiency of this method for real ultrasound data.

Italian guidelines for molecular analysis in myotonic dystrophies

Myotonic dystrophies, the most common form of adult muscular dystrophy, comprise at least two forms, clinically and genetically heterogeneous. Myotonic dystrophy type 1 and type 2 are both caused by unstable repetitions in untranslated gene regions: a [CTG]n expansion in the 3' region of the DMPK gene on chromosome 19q13 (DM1) and [CCTG]n tetranucleotide repeat located in the first intron of the ZNF9 gene on chromosome 3q21 (DM2). DM clinical features are caused by a gain of functions RNA mechanism in which the CUG and CCUG repeats alter nuclear functions, including alternative splicing of shared genes. Southern blot and/or polymerase chain reaction PCR-based approaches allow the detection of DM mutations in almost 100% of cases, however, the expansion size and the elevated grade of somatic instability make molecular testing for DM a diagnostic challenge. The increased use of DNA testing for DM generates many questions regarding the indications and interpretations of the test which require standardized methods, routinely available in molecular genetic laboratories. Here, we propose Guidelines for the molecular diagnosis of DM1 and DM2 approved by the Italian Ministry of Health in 2005 (Piano Nazionale Linee Guida, PNLG). Best practice for DM molecular analysis in diagnostic application, presymptomatic and prenatal testing, using direct and indirect approaches are described, with particular attention focused on ethical, legal and social issues. Overviews of materials used in the molecular diagnosis, as well as internet resources, are also included.